• Aucun résultat trouvé

Continued lack of abortion training is disheartening

N/A
N/A
Protected

Academic year: 2022

Partager "Continued lack of abortion training is disheartening"

Copied!
2
0
0

Texte intégral

(1)

792

Canadian Family Physician | Le Médecin de famille canadien}Vol 64: NOVEMBER | NOVEMBRE 2018

L E T T E R S

}

C O R R E S P O N D A N C E

Top 5 recent articles read online at cfp.ca

1. Prevention in Practice: Overdiagnosis: causes and consequences in primary health care (September 2018)

2. Clinical Review: Optimizing medications in older adults with cognitive impairment. Considerations for primary care clinicians (September 2018)

3. Child Health Update: Second-generation antipsychotics in children. Risks and monitoring needs (September 2018) 4. Clinical Review: Approach to tinnitus management (July 2018)

5. RxFiles: Tapering opioids using motivational interviewing (August 2018)

The term cognition-enhancing medications is misleading

T

he subheading “Cognition-enhancing medications”

in the article by Lee and colleagues is misleading.1 Drugs for treating dementia do not enhance cognition;

at best, they have minimal effects on cognition or mar- ginally slow the decline in cognitive function.

A Cochrane review of memantine looked at the evi- dence in 3 different groups of patients with dementia.

In those with moderate to severe Alzheimer disease there was a small beneficial effect on cognition at 6 months (2.97 points on the 100-point Severe Impairment Battery). In mild to moderate Alzheimer disease, the effect on cognition was barely clinically detectable, and for mild to moderate vascular demen- tia the effect on cognition was not supported by clinical global measures.2 After 26 weeks of treatment, rivastig- mine only slowed the rate of cognitive decline; it did not enhance cognition.3 Donepezil versus placebo led to a 2- to 3-point mean difference in score on the Alzheimer’s Disease Assessment Scale 70-point cognitive subscale.

Galantamine at a dose of 16 to 24 mg/d improved the score by about 3.4 points but led to more withdrawals due to adverse effects and caused cholinergic adverse effects in up to 20% of patients.4

The independent French drug bulletin Prescrire International concluded that, “at best, drugs for Alzheimer’s disease can only stabilize or slightly improve cognitive function, in only a minority of patients,”5 reflecting the change in rating of medical ben- efit for these drugs by the French Pharmacoeconomic Committee from “major” to “low.”6

In support of their recommendations for the use of “cognition-enhancing medications” the authors cite an article in the Canadian Geriatrics Society Journal of CME.7 The lead author of that paper was Dr Lee, who was also the lead author of the paper in Canadian Family Physician.1 In her earlier article, Dr Lee acknowl- edged receiving educational grants or honoraria from Pfizer, Janssen-Ortho, Novartis, AstraZeneca, and Solvay. The other 3 authors of that article also listed conflicts with various companies that make drugs to treat dementia.7 In the recent article, Dr Lee did not list any conflicts of interest.1

Ahn et al looked at the association between the pres- ence of individual principal investigators’ financial ties to the manufacturer of the study drug in randomized controlled trials and the trial’s outcomes after account- ing for the source of research funding.8 They concluded that the financial ties of principal investigators were independently associated with positive clinical trial results. Whether the same conclusion applies to authors of narrative review articles was not investigated.

Misleading titles and subheadings might influence the way readers interpret the material that follows and should be avoided.

—Joel R. Lexchin MD CCFP(EM) FCFP Toronto, Ont

Competing interests

In 2015 to 2018, Dr Lexchin was a paid consultant on 3 projects: the first looking at indication-based prescribing (United States Agency for Healthcare Research and Quality), a second developing principles for conservative diagnosis (Gordon and Betty Moore Foundation), and a third deciding what drugs should be provided free of charge by general practitioners (Government of Canada, Ontario Strategy for Patient-Oriented Research Support Unit, and the St Michael’s Hospital Foundation). He also received pay- ment for being on a panel that discussed a pharmacare plan for Canada (The Canadian Institute, a for-profit organization), for being on a panel at the American Diabetes Association, for a talk at the Toronto Reference Library, and for writing a brief for a law firm. He is currently a member of research groups that are receiving money from the Canadian Institutes of Health Research and the Australian National Health and Medical Research Council. He is member of the Foundation Board of Health Action International and a board member of Canadian Doctors for Medicare.

References

1. Lee L, Patel T, Molnar F, Seitz D. Optimizing medications in older adults with cogni- tive impairment. Considerations for primary care clinicians. Can Fam Physician 2018;64:646-52 (Eng), e366-72 (Fr).

2. McShane R, Areosa Sastre A, Minakaran N. Memantine for dementia. Cochrane Database Syst Rev 2006;(2):CD003154.

3. Birks JS, Chong LY, Grimley Evans J. Rivastigmine for Alzheimer’s disease. Cochrane Database Syst Rev 2015;(9):CD001191.

4. Therapeutics Initiative. Drugs for Alzheimer’s disease. Ther Lett 2005;56:1-2. Avail- able from: https://www.ti.ubc.ca/wordpress/wp-content/uploads/2010/08/56.pdf.

Accessed 2018 Oct 9.

5. Drugs for Alzheimer’s disease: best avoided. No therapeutic advantage. Prescrire Int 2012;21(128):150.

6. Commission de la transparence, Haute autorité de santé. Réévaluation des médica- ments indiqués dans le traitement symptomatique de la maladie d’Alzheimer. Rap- port d’évaluation. Saint-Denis La Plaine, Fr: Haute autorité de santé; 2011.

7. Lee L, Rojas-Fernandez C, Heckman G, Gagnon M. Cognition-enhancing drugs in dementia: tips for the primary care physician. Can Geriatr Soc J CME 2011;1(1):5-9.

Available from: http://canadiangeriatrics.ca/2011/12/volume-1-issue-1-cognition- enhancing-drugs-in-dementia/. Accessed 2018 Oct 9.

8. Ahn R, Woodbridge A, Abraham A, Saba S, Korenstein D, Madden E, et al. Financial ties of principal investigators and randomized controlled trial outcomes: cross sectional study. BMJ 2017;356:i6770.

Continued lack of abortion training is disheartening

F

rom 1985 to 1987 I was a family medicine resident in Toronto, Ont. I wanted to do one of my electives

(2)

Vol 64: NOVEMBER | NOVEMBRE 2018 |Canadian Family Physician | Le Médecin de famille canadien

793 LETTERS

}

CORRESPONDANCE

in abortion care and was denied this by my program.

It disheartens me greatly to learn from Drs Myran and Bardsley1 that in 2018 abortion care is not a routine part of family medicine training, and that residents and gradu- ates have to find their own training after completing a family medicine residency, as I did. Abortion is an essen- tial medical service and it is legal in Canada. How can it be that family medicine training programs still do not pro- vide abortion training as part of the core competencies?

I hope that in 30 years residents will not be saying the same thing about training in medical assistance in

dying and end-of-life care. These are fundamental and essential parts of life, medical practice, and medical care.

Family doctors should be doing this work and should receive the appropriate education and training to sup- port them in doing it. Period.

—Chantal Perrot MD CCFP FCFP CGPP Toronto, Ont

Reference

1. Myran D, Bardsley J. Abortion remains absent from family medicine training in Canada. Can Fam Physician 2018;64:618-9 (Eng), e361-2 (Fr).

Competing interests None declared

Make your views known!

To comment on a particular article, open the article at www.cfp.ca and click on the eLetters tab. eLetters are usually published online within 1 to 3 days and might be selected for publication in the next print edition of the journal. To submit a letter not related to a specific article published in the journal, please e-mail letters.editor@cfpc.ca.

Faites-vous entendre!

Pour exprimer vos commentaires sur un article en particulier, accédez à cet article à www.cfp.ca et cliquez sur l’onglet eLetters. Les commentaires sous forme d’eLetters sont habituellement publiés en ligne dans un délai de 1 à 3 jours et pourraient être choisis pour apparaître dans le prochain numéro imprimé de la revue. Pour soumettre une lettre à la rédaction qui ne porte pas sur un article précis publié dans la revue, veuillez envoyer un courriel à letters.editor@cfpc.ca.

Références

Documents relatifs

One would understand them wanting to inform patients of any fees set by a family physician, as is currently done by the Régie de l’assurance maladie du Québec?. One would

Objective To assess the quality of point-of-care ultrasound (POCUS) training in family medicine residency programs and to obtain the opinions of current family medicine residents

Are Canadian family physicians opting out?” 5 the 2 licensing bodies in charge of undergraduate and postgraduate medical education for family physicians, the Medical Council

Advance care planning allows patients to assert their values and priorities for care throughout their disease course and throughout their lifespan, so that when unex-

As there is little known about the actual use of DRE in clinical practice and about family doctors’ training in this area, we wanted to survey the family medicine residents

Ask your preceptor for feedback after the clinical encounter Document the feedback immediately after a clinical encounter For on-service family medicine rotations, stack your

Our research showed that an estimated quarter of a million people in Glasgow (84 000 homes) and a very conservative estimate of 10 million people nation- wide, shared our

Studies (Centro Paraguayo de Estudios de Poblaci6n), to help mothers to space their pregnancies. The lack of adequate family planning services has clearly been a cause of