Mercenary physicians. To the editor: Whilst discussing recent- ly with colleagues the poor attendance at a weekly lunch-time teaching session aimed primarily at ...
Impotence during antihypertensive treatment To the editor: Hydralazine hydrochloride and hydrochiorothiazide have many well documented side effects. I would like to report a suspected adverse reaction to one of these drugs that has not, to my knowledge, been reported previously. A 33-year-old, previously healthy highschool teacher was seen approximately 1 year ago after the school nurse had told him his blood pressure was high. There was a strong family history of hypertension. His blood pressure was 150/100 mm Hg; this elevation seemed borderline and the results of the rest of his physical examination were normal, but in view of his anxiety it was felt advisable to perform further investigations. An electrocardiogram, an intravenous pyelogram and a chest radiograph were normal. When he was seen 1 month later his blood pressure was 155/100 mm Hg. In view of the persistent elevation in diastolic pressure, antihypertensive treatment was begun with hydrochlorothiazide, 25 mg daily. When, 1 month later, his blood pressure was still 150/100 mm Hg the dosage was increased to 50 mg daily. A month later the reading was still 150/100 mm Hg and at that time hydralazine HCI was added to the regimen, at a dosage of 25 mg daily for 7 days, then 25 mg twice daily. On this visit he stated that he occasionally had difficulty sustaining an erection. At subsequent visits the hydralazine dosage was increased to 25 mg tid and eventually 50 mg bid. Some 9 months after his original visit his standing blood pressure was 125/95 mm Hg. However, at this time he stated that the difficulty in sustaining an erection was becoming worse, and it was decided to c.scontinue all medications and review the situation 1 month later. One month later he stated that he had not been impotent since the medication was discontinued. contributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double spaced and should not exceed 1½ pages in length.
It is not clear whether this patient's impotence was due to either medication, although the history suggests that hydrochiorothiazide was more likely to have been responsible, but in view of the widespread use of this drug one would have thought that such an adverse reaction would have been well recognized long before this. Similarly, hydralazine HCI, which has been in use for a long time, has not, to my knowledge, been reported as a cause of impotence. Therefore, I am puzzled as to whether either drug was the causative factor or whether the impotence was an unrelated problem; the latter seems unlikely, however, because the symptom cleared up immediately on cessation of treatment. It seems unlikely that emotional factors could have played a significant part in the causation of the impotence, as he appeared to be a well adjusted man with no similar symptoms previously or subsequently. He suffered only mild anxiety due to the knowledge of his high blood pressure. I suggested to him, after his symptoms cleared up, that it might be interesting to challenge him with each drug separately in an attempt to reproduce his symptoms and pinpoint, if possible, the responsible agent, but for some reason he vehemently rejected this suggestion. This suspected adverse reaction has been reported to the drug adverse reaction program of the health protection branch of Health and Welfare Canada. H. KEIDAN, MB, CH B
306 Boler Rd, Ste. 20 London, ON
Listing of investigational and emergency drugs To the editor: During the fall of last year the drug information centre of Toronto General Hospital compiled a list of drugs considered "investigational and/or emergency" being used in the
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major medical teaching centres across Canada. The list was made available at a nominal charge to all members of the Canadian Society of Hospital Pharmacists. The response has been gratifying, and it came to mind that members of the medical profession might wish to obtain such a compilation. The available listing, "A List of Investigational Drugs and/or Emergency Drugs for Canada", does not include all the drugs under investigation in Canada, but it does include any and all that are known to the pharmacy departments of 10 major Canadian teaching hospitals. Copies are available for $1.50 each from the Canadian Society of Hospital Pharmacists, 175 College St., Toronto, ON M5T 1P8. MJ.V. NAYLOR, a sc PHM, M Sc
Supervisor of drug information service Department of pharmaceutical services Toronto General Hospital Toronto, ON
Mercenary physicians To the editor: Whilst discussing recently with colleagues the poor attendance at a weekly lunch-time teaching session aimed primarily at general practitioners - and the only regular postgraduate teaching available in the area - I heard the view expressed that GPs could not afford to take the time off to attend or they would lose money. This reprehensible view reflects the mercenary attitude prevalent in our highly paid segment of society. Our members are being increasingly viewed with suspicion, as Matthews and Feather (Can Med Assoc J 114: 309, 1976) learned recently: roughly 17 to 20% of the people they questioned were sceptical about medical science, but 47 to 50% were sceptical about physicians. Furthermore, this view is an indictment of the fee-for-service system, which encourages such an attitude. T. HANCOUK, MB, BS
Chlpman, NB
