Up-to-date drug information
C
auchon and Leduc’s ar ticle,1“Finding the right information at the right time. Par t 1: Drugs, refer- ence books, clinical practice guide- lines,” notes that a new medication cannot be found in the Compendium of Pharmaceuticals and Specialties(CPS).
The Canadian Phar macists Association (CPhA) is a major pub- lisher of drug and therapeutic infor- mation in Canada, including the CPS, the Compendium of Nonprescription Products(CNP), Therapeutic Choices, the Nonprescription Drug Reference for Health Professionals, and Herbs:
E v e r y d a y R e f e r e n c e f o r H e a l t h Professionals. We have addressed the problem of lack of information on new Canadian products before they are included in the CPS by publish- ing an update on our website (www.cdnpharm.ca).
S e l e c t “ C P S / C N P U p d a t e s , ” which brings users to a table listing new products, newly approved indi- cations for drugs, and other informa- t i o n o f i n t e r e s t t o h e a l t h c a r e practitioners.
We also publish the product mono- graphs as soon as they are available.
This ser vice continues CPhA’s tradi- tion of providing timely, high-quality drug information and is available free at www.cdnpharm.ca simply by select- ing the appropriate product from the
“CPS/CNP Updates” table.
—Carol Repchinsky, BSP Editor-in-Chief, Publications Canadian Pharmacists Association Ottawa, Ont by e-mail
Reference
1. Cauchon M, Leduc Y. Finding the right information at the right time. Part 1: Drugs, reference books, clinical practice guidelines. Can Fam Physician 2001;47:337-8.
Using terminology correctly
I
respectfully object to many of the statements and the rationale used in the editorial,1 “Emergency contracep- tion and family physicians,” by Dr Sheila Dunn in the June 2001 issue of Canadian Family Physician. By stating that postcoital birth control methods are … “ more accurately referred to as the ‘emergency contraceptive pill,’”Dr Dunn er roneously defines a method of birth control that is postu- lated to act by preventing implantation of a human embryo.1It is inappropri- ate to define a product as a contracep- tive when it likely acts after conception
has occurred. In the interests of being scientifically accurate, we should use terms that accurately reflect what is being described. The use of factual ter- minology also contributes to better patient understanding and informed consent.
Dr Dunn states that patients must be informed in order to appropriately use means to prevent human embryos from implanting or remaining viable.
For patients to be truly informed about their health, they must be informed of all possible treatment options and alternatives (in addition to potential risks, benefits, and side effects).
Contrar y to the implication in Dr Dunn’s editorial, it is entirely possi- ble for physicians who have reser va- tions about postcoital birth control to provide nonjudgmental and supportive care while making patients aware of all of the options and alternatives (which might or might not include amniocen- tesis, chorionic villus sampling, adop- tion, and induced abortion).
I agree with the National Advisor y Committee on Emergency Contra- ception’s statement that …“ the num- ber of unwanted pregnancies is a serious public health concer n for which there is underused preventive treatment.”1I assert that a truly com- pr ehensive pr evention strategy, which informs patients of available options in addition to means that pre- vent a human embr yo from continu- ing its natural progression toward a full-term pregnancy, enhances the likelihood that individual patients will employ preventive strategies.
It is ironic that, according to the arti- cles cited by Dr Dunn,1such contracep- tive means “should not be used if a woman knows she is pregnant.”2-4 Because it is possible to detect preg- nancy within 10 days of conception using human serum β-human chorionic
VOL 47: AUGUST • AOÛT 2001❖Canadian Family Physician•Le Médecin de famille canadien 1545
Letters ❖ Correspondance Letters ❖ Correspondance
Make your views known!
Contact us by e-mail at [email protected] on the College’s website at www.cfpc.ca
by fax to the Scientific Editor at (905) 629-0893 or by mail to Canadian Family Physician College of Family Physicians of Canada
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Communiquez avec nous par courier électronique:
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1546 Canadian Family Physician•Le Médecin de famille canadien❖VOL 47: AUGUST • AOÛT 2001
Letters
❖Correspondance
gonadotropin testing, a 7-day window of time (assuming a 72- hour window postconception for emergency means to pre- vent a pregnancy from continuing) might determine the ultimate fate of any individual human embryo.
—Graham Mansell, MD, CCFP
Ottawa, Ont by e-mail
References
1. Dunn S. Emergency contraception and family physicians. An once of prevention when it real- ly counts [editorial]. Can Fam Physician 2001;47:1159-60 (Eng), 1166-8 (Fr).
2. Dunn S, Davis V. Emergency contraception. Summary of the Society of Obstetricians and Gynaecologists of Canada’s clinical practice guidelines. Can Fam Physician 2001;47:1261-3 (Eng), 1267-9 (Fr).
3. Glasier A. Emergency postcoital contraception. N Engl J Med 1997;337:1058-64.
4. Bracken MB. Oral contraception and congenital malformation in offspring: a review and meta-analysis of the prospective studies. Obstet Gynecol 1990;76:552-7.
...
I
would like to comment on Dr Dunn’s ar ticle,1“Emergency contraception and family physicians” in the June 2001 issue. Dr Dunn goes so far as saying that, “Some individuals and groups argue that it is an abortifacient. It is critical to explain that the therapies used in Canada will not interfere with an established pregnancy; they can only pre- vent one from happening.”1
The point is, a pregnancy has already happened; it is just that the endometrium is not responsive to the implantation of the pregnancy.
I quote Jim Hughes2in Campaign Life Coalition National Newsof June 2001.
The… government and medical community have failed to recog- nize a simple truth, a truth summed up perfectly by children’s author Dr. Seuss: “A person’s a person no matter how small.”
Or put in scientific terms, as the embryologist Dr. Dianne N.
Irving described it in the International Journal of Sociology and Social Policy, “After fertilization the single-cell human embryo doesn’t become another kind of thing. It simply divides and grows bigger and bigger, developing through several stages.”…
We are no longer in the scientific dark about the beginning of human life. As the late novelist and medical doctor Walker Percy put it, life begins “when chromosomes of the sperm fuse with the chromosomes of the ovum to form a new DNA com- plex that thenceforth directs the ontogenesis of the organism.”
This produces the “continuum that exists in the life of every individual from the moment of fertilization of a single cell.”
Therefore, Percy said, “The onset of individual life is not a dogma of the church but a fact of science. How much more con- venient if we lived in the thirteenth century, when no one knew anything about microbiology...”2
If we accept the destruction of this newly formed DNA, then we are debating the value of some class of human beings, in this case an unborn child, an embryo, a fetus, whatever you want to call the tiniest possible person.
—Gabriel Lemoine, md Sainte-Anne-des-Chênes, Man by mail
References
1. Dunn S. Emergency contraception and family physicians. An once of prevention when it real- ly counts [editorial]. Can Fam Physician 2001;47:1159-60 (Eng), 1166-8 (Fr).
2. Hughes J. When life begins. Campaign Life Coalition National News 2001; (June):3-4.
Response
I
thank Drs Mansell and Lemoine for expressing their thoughts on emergency contraception. The concerns they raise reflect the ethical and moral debate that often sur rounds the use of postcoital contraception. I am unlikely to be able to resolve their personal concerns about this therapy but would like to address some of the issues they raise.Drs Mansell and Lemoine have both implied that emer- gency contraception works after conception or pregnancy has occurred. This is not correct. Conception is defined1as the onset of pregnancy and is marked by implantation of the blastocyst in the endometrium. The “human embryo”
Dr Mansell discusses does not develop until the end of the second week after fertilization.2
The balance of evidence suggests that the most widely used emergency contraceptive pills work primarily by inhibiting or delaying ovulation.3 Therefore, in most cases where emergency contraception is effective, fertilization
