LETTERS * CORRESPONDANCE

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Setting the record straight J am writing to correct an inaccuracy in Patrick Sullivan's

otherwise informative account of the June 1990 Ontario Medical Association (OMA) council meeting (Can Med Assoc J 1990; 143: 47-48). I did, indeed, decide not to seek re-election to the OMA Board of Directors because of personal attacks by self-styled "medical militants" in Toronto. However, this campaign against me began not, as Sullivan wrote, after the board had adopted its position paper but when it became clear that I intended to work within the OMA and not to use my seat on the board to disrupt the organiza-

For prescribing information see page 564

tion's functioning, as the "militants" had hoped. Many colleagues around the province have taken issue with aspects of OMA policy and action from time to time and have, quite rightly, made vigorous protest verbally, in writing and at OMA district elections. The attacks that led me to decline re-election were not legitimate protests but efforts by the "militants", rather than my constituency, to punish me for perceived "ideological impurity". Since 1985 David Peterson's Liberals have unremittingly attacked and humiliated the doctors of Ontario. This strategy has created an atmosphere in which sincere activism in medical politics is increasingly irrelevant, while the malicious and misguided among us, mongering fear and calling names, have thrived. Not the least benefit of any "new partnership" between the OMA and the Government of Ontario will be the reversal of this unfortunate and destructive situation. Irvin I. Wolkoff, MD 1-1 1 Elvina Gdns. Toronto, Ont.

Long-term management of asthma T | ahe paper "Acute asthma: emergency department management and prospective evaluation of outcome", by Drs. J. Mark Fitzgerald and Frederick E. Hargreave (Can Med Assoc J 1990; 142: 591-595), demonstrates what many family practitioners have known for a long time, namely that hospitals treat asthma as an acute condi-

tion, yet it is a chronic disease. Unless Canadian respirologists are less busy than their colleagues in Britain, where I was until recently, I cannot see them being able to take on the preventive management of asthma, as the authors recommend. In my opinion this should be the responsibility of the

family practitioner. Much of the work in a family practice concerns the management of chronic disease. A practitioner who is knowledgeable about and interested in asthma can do much to correct the situation found by Fitzgerald and Hargreave at follow-up, provided that the patient attends the office soon after the acute attack has been dealt with in the emergency department. Preventive management requires regular, sometimes frequent, office visits for patient education and supervision. Does a respirologist have the necessary time for so many visits from so many patients? Although busy too, the family physician will be dealing with many fewer asthmatic patients than a specialist. Furthermore, not many patients want the frequently long journey to the specialist's office, in the case of my patients a 230-km round trip. When there is not an interest in asthma, follow-up results will continue to be as Fitzgerald and Hargreave found them. A couple of years ago in Britain a group of family practitioners with an interest in asthma formed the General Practitioners in Asthma Group (GPIAG) in order to improve the quality of asthma diagnosis and management by all family practitioners. We are now over 300 strong and totally community based. Respirologists, of course, have an important role in asthma CAN MED ASSOC J 1990; 143 (6)

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control, but we believe that asthma's long-term management has to be undertaken by the family doctor. Should there be a similar group in Canada? Mervyn M. Dean, MB, ChB, MRCGP PO Box 10 Hampden, Nfld.

References 1. Fitzgerald JM, Sears MR, Roberts R et al: Underdiagnosis and undertreatment of asthma in a population of Canadian school children. Presented at the European Congress of Chest Diseases, Dublin, July 4, 1988 2. Mayo PH, Richman J, Harris HW: Results of a program to reduce admissions for adult asthma. Ann Intern Med 1990; 112: 864-871

[The authors reply.] We agree with Dr. Dean's comments on the chronic nature of asthma and the important role of the family physician in its control. The patients who come to the emergency department represent only a minority of all patients with asthma. By presenting with an acute, life-threatening event they warrant, when geography and physician availability permit, review by a specialist at least once. This visit should allow a comprehensive evaluation, including skin testing, pulmonary function evaluation and asthma education. Following this a significant proportion of such patients and most of the asthma patients who never need to attend the emergency department are best managed by

Hypertension and eating habits

I was astounded that CMAJ would publish the advertisement for Sectral (acebutolol hydrochloride), which I noticed in the May 1, 1990, issue (142: 976 A, B). The ad is very explicit. After listing all the food that we eat in this country it states: "In Canada it can be difficult to control peoples' eating habits." (Presumably this is not true in other countries.) It then goes on to state: "In hypertension controlling treatment can be easier than diet." Although the ad does not say so we can presume that this approach is more family physicians, particularly profitable for May & Baker Pharthose interested in asthma or ma, the division of Rh6nethose who are part of the kind of Poulenc Pharma Inc., Montreal, group suggested by Dean. that manufactures Sectral. Such a group could help imNote that the message does prove the diagnosis and treatment not urge physicians to use this of asthma.' A recent report on a antihypertensive while they are hospital-based outpatient program trying to get patients to deal with showed a significant reduction in their food addiction. If it did this asthma morbidity and the need I would have no objection and for hospitalization.2 Family physi- would be prepared to commend cians are in an ideal position, May & Baker for its ethical apparticularly in group practices, to proach to advertising. No, the ad develop such programs, and we urges physicians not even to try encourage them to do so. but, rather, to give up before they start and rely on the medication J. Mark Fitzgerald, MB, FRCPC Department of Medicine University of British Columbia Vancouver, BC Frederick E. Hargreave, MD, FRCPC

Department of Medicine McMaster University Hamilton, Ont. 460

CAN MED ASSOC J 1990; 143 (6)

only. We know that food can be addictive, just like tobacco and alcohol. CMAJ does not accept ads for tobacco or alcohol, yet it blithely accepts an ad from a drug company that clearly condones

food addiction. Even distillers show a greater sense of ethics in their advertising when they urge people to drink moderately and not to drink and drive. I had been taking antihypertensives for 22 years and was about 15 kg overweight. I knew excess weight was not good for people with hypertension, but I was not prepared for what happened when I took off that excess weight: I was able to stop taking antihypertensives altogether. Since that experience I have talked to a number of people who have been able to do the same thing. If this ad represents the thinking of the drug companies, who have more influence on doctors than doctors are prepared to admit, I can see why no physician ever told me that losing weight might enable me to stop taking antihypertensives altogether. It saddens me to think that CMAJ, by publishing this ad, is promoting the notion that physicians should avoid lifestyle issues affecting their patients. Wendell W. Watters, MD

Professor emeritus of psychiatry McMaster University Hamilton, Ont.

[Sectral's manufacturer responds.] It is not and never has been our intention at Rh6ne-Poulenc to recommend that physicians prescribe medication only. The treatment of many conditions requires both lifestyle adjustments and drug regimens. We are strong believers in this type of treatment. Dr. Watters' suggestion that we condone food addiction is, we believe, a misinterpretation. In the ad we are not talking about food addicts: the ad clearly states that "the average Canadian will consume . . . ". Therefore, the figures it presents concern the general population and not individuals suffering from obesity. The statement about foods consumed in a lifetime in Canada