- © 2005 Canadian Medical Association or its licensors
As outlined in our commentary,1 we agree that every effort should be made to prevent fetal exposure to isotretinoin, a highly teratogenic drug.
Maria Valois and associates state that, unlike the situation in the United States, Health Canada has no evidence of a significant rate of pregnancy among Canadian women taking isotretinoin. Unfortunately, this impression is incorrect. The presentations to the FDA in February 2004, attended by Health Canada, included a study by the Organization of Teratology Information Services,2 which was funded by the US Centers for Disease Control and Prevention. More than half of the cases in that study came from Canada. The Canadian data were collected prospectively in 2002–2003 by The Motherisk Program (based in Toronto) and IMAGE (based in Montréal). On a proportional basis, Canada had substantially more cases than the United States.
This situation reflects the understandable ineffectiveness of reporting systems based on spontaneous reports. Moreover, in 2003 Health Canada stopped the development of MotherNet, a system that would have given the department such information continuously. The reason cited for the halt was lack of funding, although over $1 million had been spent on the project at that point.
Wouldn't it make sense for Health Canada to work with existing active surveillance programs in Toronto and Montréal and thus to receive the tremendous amount of data that are being collected on drugs in pregnancy in Canada? Presently, no arrangements exist for such collaboration.
Footnotes
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Competing interests: Neil Shear has received educational grants from Hoffmann-La Roche.