Resources

Concise review of asthma management

BRONCHIAL ASTHMA. PRINCIPLES OF DIAGNOSIS AND TREATMENT, 4TH EDITION

Editors: M. Eric Gershwin, Timothy E. Albertson

The Humana Press Inc, 999 Riverview Dr, Suite 208, Totowa, NJ 07512 USA; telephone (973) 256-1699; fax (973) 256-8341; e-mail humana@humanapr.com 2001/400 pp/$125 (US)

OVERALL RATING Excellent STRENGTHS Concise and thorough WEAKNESSES None AUDIENCE Primary care providers

Overall, this book provides a concise and thorough review of asthma management, directed at primary care providers. Although many contributors are from the same institution, the various sections of the book are well referenced with recognized international authors. This book would be a useful resource for anyone involved in asthma management.

There is excellent discussion on risk factors for developing asthma and on managing asthma in children, adults, and pregnancy. The authors present an American perspective on asthma management. Therefore, the role of leukotriene receptor antagonists (LTRA) differs slightly from Canadian guidelines, which suggest first-line use of LTRA only when use of inhaled corticosteroids (ICS) is not possible and not as an alternative for ICS in mild persistent asthma as suggested by the American guidelines.

There are also excellent sections on infection and environment, exercise-induced asthma, occupational asthma, alternative therapies, and self-management programs (this list is not exhaustive). The section titled exercise-induced asthma could be changed to exercise-induced bronchospasm because we know that exercise does not induce airway inflammation.

Perhaps the weakest area of the book is the discussion of combination therapy and how this therapeutic strategy is used in practical terms. Compelling data show superior asthma control when long-acting bronchodilators (LABA), such as salmeterol and formoterol, are added to ICS as compared with simply increasing the dose of ICS. This section could have been much longer and included some discussion on the potential of masking inflammation when ICS are tapered during concomitant LABA therapy.

The thorough text and many useful tables and illustrations make this book an excellent resource for primary caregivers and anyone with an interest in asthma.

—Anthony D. D’Urzo, MD, MSC, CCFP

Dr D’Urzo is Director of the Primary Care Lung Clinic in Toronto, Ont, and is a lecturer in the Department of Family and Community Medicine at the University of Toronto.

Darker side of the pharmaceutical industry

PRESCRIPTION GAMES: MONEY, EGO, AND POWER INSIDE THE GLOBAL PHARMACEUTICAL INDUSTRY

Author: Jeffrey Robinson

McClelland & Stewart Ltd, 481 University Ave, Toronto, ON M5G 2E9; website www.mcclellan.com 2001/262 pp/$36.99

OVERALL RATING Good STRENGTHS Easy to read, interesting, provocative WEAKNESS An inflammatory one-sided view of the pharmaceutical industry AUDIENCE General readers

This is an interesting expose of the pharmaceutical industry written for lay readers. “Big Pharma” is on the front line of research that potentially saves many lives; it is also a very profitable business whose shareholders expect a return on their investment. Herein lie the dilemmas and ethical arguments surrounding its actions. How altruistic should “Big Pharma” be? How profitable should it be?

The industry is chided for investing in medications for lifestyle complaints, such as baldness, impotence, and obesity where potentially greater profits can be made, rather than investing in cures for some of the more deadly infectious diseases where profits are less. Many recent medical advances are priced out of the reach of developing countries and many of the poorer members of our own society.

The increasing privatization of pharmaceutical research is perceived to have negative consequences. Many therapeutic questions will remain unanswered because the answers are not profitable. Promising researchers are attracted to research opportunities in the pharmaceutical industry to the detriment of other health research. Confidentiality clauses signed by naive researchers and suppression of negative research results further hamper the free flow of research. The Nancy Olivieri case and the Synthroid case are reviewed for interested readers.

The various methods that industry has used to extend its patents and prevent generic drugs from coming to market are well detailed. This is an issue close to the hearts of many Canadians. There are also chapters on pharmaceutical espionage and the pitfalls of direct-to-consumer marketing.

There is a provocative chapter on the relations between physicians, continuing medical education programs, and the pharmaceutical industry. While many physicians deny that they are influenced by industry, many examples to the contrary are cited. Consumers who are given minimal choice in drug selection ironically pay for the cost of this influence. Physicians who read this book will be challenged to examine their own behaviour.

While the book uses an inflammatory and rhetorical style and highlights mainly the dark side of the industry, many of the issues it raises need to be more openly discussed by the medical profession.

—Laurie Pereles, MD, MSC, CCFP, FCFP

Dr Pereles practises family medicine in Calgary, Alta, and is a teacher and researcher at the University of Calgary.

Help for migraine sufferers

MIGRAINE, REVISED EDITION

author: Valerie South

Key Porter Books Limited, 70 The Esplanade, Third Floor, Toronto, ON M5E 1R2; telephone (416) 862-7777; fax (416) 862-2304 2001/229 pp/$19.95

OVERALL RATING Very good STRENGTHS Clarity, thoroughness, applicability, organization for easy reference WEAKNESSES None AUDIENCE Educated public and family physicians

Migraine is an extremely debilitating condition, which, until recently, has been poorly recognized in family practice. Consultation to determine kind of headache, severity, lifestyle factors, and prophylactic or acute treatments, and to sort through the many choices available for people, is very time-consuming. Therefore, a book such as this is ideal for patients and physicians. It is written in very accessible but not condescending language.

A particularly strong section in the second chapter on diagnosing migraine presents tips for patients on how to prepare to see their doctors. A chapter on women and migraine is particularly helpful because female outnumber male sufferers by at least 3:1. A little-recognized population that experiences migraines is infants and children, and lifestyle and medical treatments for them are well outlined. The author suggests ways of dealing with the emotional and management factors involved when a child has chronic or severe pain.

Strong emphasis is placed on self-management with regard to food and environmental triggers. The author also talks about guilt and family relationships that are affected by migraine.

A brief but helpful outline of various medical treatments is given in a chapter by Dr Marek Gawel on tryptans. An interesting chapter with a fair and descriptive approach to complementary therapies provides some cautions as to their efficacy and safety and recommends consulting a physician.

This book was produced in association with the Migraine Association of Canada, the American Council on Headache Education, and the Canadian Medical Association. I highly recommend this book to all patients who suffer from migraines and to family physicians, because it would help them work as a team to treat migraines successfully.

—Evelyn Jain, MD, CCFP

Dr Jain practises family medicine, with a special interest in migraine headaches. She is a Clinical Assistant Professor in the Faculty of Medicine at the University of Calgary in Alberta.

THE MIGRAINE COOKBOOK

Editor: Michele Sharp

Key Porter Books Limited, 70 The Esplanade, Third Floor, Toronto, ON M5E 1R2; telephone (416) 862-7777; fax (416) 862-2304 2001/160 pp/$24.95

OVERALL RATING Very good STRENGTHS Well organized, attractive, easy to use WEAKNESSES None AUDIENCE Migraine sufferers and their families

Migraine is one of the most undertreated, misunderstood and misdiagnosed disorders of the last century. And yet it is a serious medical disorder that significantly affects millions of North Americans; … 15 to 18 percent of women, 5 to 6 percent of men, 4 to 5 percent of children under twelve, and 10 percent of adolescents.… As Rosemary Dudley, the founder of The Migraine Association of Canada, stated “Perhaps no other condition so disrupts the lives of its victims and yet evokes so little sympathy and compassion for the afflicted.”

—Michele Sharp from The Migraine Cookbook

Migraine is more than just a headache and can be completely disabling. It is often very difficult to determine all the triggers, but it is clear to most migraine sufferers and their doctors that diet is an important factor. Foods that initiate migraine attacks contain vasoactive amines that affect the body’s blood vessels, especially those that supply blood to the brain. The book provides an excellent introduction to migraine and an excellent overview of not only dietary factors but also other triggers (the main one being food).

The usual culprits that trigger migraines are caffeine or caffeine withdrawal, chocolate, fruit, alcohol, dairy products, monosodium glutamate, artificial sweeteners, nuts, seeds, certain beans, and vegetables. Patients are strongly encouraged to keep a food-trigger diary to pinpoint the exact foods affecting them.

This cookbook focuses on a variety of foods. There is an attractive selection of appetizers and snacks, fruits and salads, main courses, and desserts, and a short but very good vegetarian section. An excellent feature of this book is that each category has been divided into a fast section and a “when you have more time” section for more complicated dishes. Each recipe is accompanied by a table outlining the 10 most common triggers with a check mark indicating that the recipe is free of certain triggers. Most of them have eliminated at least eight or nine of these triggers. Most migraine sufferers will particularly appreciate the dessert section because chocolate, the national obsession, is out of bounds for most of them.

I highly recommend this book to migraine sufferers.

—Evelyn Jain, MD, CCFP

Dr Jain practises family medicine, with a special interest in migraine headaches. She is a Clinical Assistant Professor in the Faculty of Medicine at the University of Calgary in Alberta.