Letters to the Editor

(Aust Prescr 1997;20:31-2)

Letters, which may not necessarily be published in full, should be restricted to not more than 250 words. When relevant, comment on the letter is sought from the author. Due to production schedules, it is normally not possible to publish letters received in response to material appearing in a particular issue earlier than the second or third subsequent issue.

Consumer product information affects us all

Editor, - One of the repeated criticisms of consumer product information (CPI) (Aust Prescr 1996;19:30-4) from groups other than consumers has been the length of these documents. But what do consumers think?

Merck Sharp & Dohme (MSD) and Astra Pharmaceuticals have been testing CPI leaflets with consumers since their introduction in January 1993. On average, the CPIs tested by MSD have been 3-4 A4 pages in length, while those of Astra average 3 A4 pages, when set out in a 3 column format. MSD and Astra are focusing their testing on the elderly, as these consumers are considered more `at risk' in their use of medicines.

CPIs have been tested with over 500 consumers and, of these, about 10% have commented, without prompting, that the documents were too long. Upon further discussion, few of these consumers could suggest what information could be omitted. Some felt that the list of ingredients could be left out. However, when the reason for including this was explained (i.e. in the case where the patient has an allergy to one of the ingredients), they fully appreciated the need for the list. Men who felt CPIs were too long usually thought that the pregnancy and breast-feeding sections could be deleted. Several commented that the CPI would be too long `for most people', but considered it an appropriate length for themselves.

Upon reviewing the testing results, the comments obtained from consumers are overwhelmingly positive, with comments like:

• there should be one for every medicine

• it makes it easier to work out what to ask your doctor

• it is very clear and easy to understand

• very informative

• to be congratulated on covering everything

• in language I can understand

• so helpful, can't find a fault with it

• very clear, straightforward

• couldn't be clearer

• understandable, easy to follow

• easy to find what you want to know

Several consumers also commented that they would use the CPI as a reference and that they would take it with them when visiting their doctor.

The consumer testing undertaken to date does not suggest any need for CPIs to be reduced in length or changed from their present form.

Until consumers tell us that they do not want CPIs as comprehensive as the existing documents, we should continue our current approach.

Deborah Monk
Chair
CPI Content/Quality Assurance Reference Group
C/- APMA
North Sydney, N.S.W.

Drugs for the doctor's bag

Editor, - I refer to the article `Drugs for the doctor's bag' by Professor J. Murtagh (Aust Prescr 1996;19:89-92). I wonder if you could clarify for me the basis for the use of intravenous hydrocortisone in asthma rather than a parenteral form of a synthetic glucocorticoid. The former can produce very significant plasma and extracellular fluid volume expansion, whereas the latter does not. In older patients where there may be an element of cardiac compromise, it would seem prudent not to expand volume.

Judith A. Whitworth
Professor and Head
Department of Medicine
St George Hospital
University of New South Wales
Sydney, N.S.W.

Professor J. Murtagh, the author of the article, comments:
I am aware that there is a tendency for increased plasma volume expansion with intravenous hydrocortisone compared with synthetic glucocorticoid. However, it seems to be more theoretical than practical. It must be remembered that almost all the patients presenting with severe acute bronchial asthma are young people and, in practice, the use of hydrocortisone has never been a problem for me or my colleagues.

This has been standardised teaching for many years and is recommended in the `Respiratory Drug Guidelines'.¹ Furthermore, it was and still is readily available on the Emergency Drug (Doctor's Bag) Supplies.

However, I have no problem with the advantage of using a synthetic glucocorticoid for the very severe asthmatic attack and would certainly use it for the older patient especially those with an associated cardiac decompensation problem. Dexamethasone injection has been available on the Doctor's Bag Supplies for many years.

R E F E R E N C E
1. Victorian Drug Usage Advisory Committee. Respiratory drug guidelines. 1st ed. Melbourne: Victorian Medical Postgraduate Foundation, 1994:52-3.

Lindane

Editor, - Can you please explain why benzene hexachloride (lindane) lotion is still available for the treatment of scabies and other ectoparasites. The class of chemicals to which lindane belongs has been adjudged to be so toxic that it cannot be used to protect buildings against termites. How is it therefore that this organochlorine insecticide is still in use medically?

F. Winter
General Practitioner
Vaucluse, N.S.W.

The Editor comments:
Advice from the Therapeutic Goods Administration and the Medicines Evaluation Committee of Victoria suggests that lindane is unlikely to cause problems if used correctly. Although lindane is more extensively absorbed through the skin than permethrin¹, it is important to have a drug to treat Norwegian scabies or to be used where there is resistance to other treatments. Lindane is probably only going to be used once in a patient's life, so the risk of chronic adverse effects is unlikely to be a problem as any absorbed drug is rapidly eliminated. Ecotoxicity does not always equate to human toxicity.

Although lindane has been used for many years, its use is now discouraged because safer drugs are available for the treatment of scabies. Currently recommended treatments are permethrin and benzyl benzoate.²

R E F E R E N C E S
1. Franz TJ, Lehman PA, Franz SF, Guin JD. Comparative percutaneous absorption of lindane and permethrin. Arch Dermatol 1996;132:901-5.

2. Victorian Drug Usage Advisory Committee. Antibiotic guidelines. 9th ed. Melbourne: Victorian Medical Postgraduate Foundation, 1996.