Soon after, a close friend and sympathizer (also a PhD in pharmacology) synthesized an antilycanthropogen, which he has named lycanthrostop. He will be marketing it under the brand name Halt-o-Wolf. Two forms of the drug are available: an oral prophylactic form (5 mg taken three times daily for 3 days prior to the full moon) and an intramuscular form to use when an acute attack has begun. Clinical trials are under way, and I am being mentioned as the first subject to have been treated successfully. My ever-grateful appreciation is expressed to Davis and his team for alerting me to my condition. Lupo Velasques Alias Dr. F.N. Sanders, BDS, Dip Data Editor CME (South Africa's Continuing Medical Education Monthly) Pinelands, South Africa
My cat thinks your article on lycanthropy was some doggone cock-and-bull tale, but I think it was a shaggy dog story. Maybe someone in Labrador will know for sure. Dr. Hairry Wolf Rover's Return Kennel Lane Isle of ')ogs, England
The article on lycanthropy caused me to reflect on a recent diagnostic triumph of mine. I discussed my findings with an associate, Dr. Grimm, who concurred with my
conclusions. I practise dermatology in Scarborough. One Monday morning a young girl brought her mute grandmother to see me. The girl introduced herself as "Red" and explained that she had come to see me because of her concern about certain transformations she had recently noticed in her grandmother. The elderly woman lives alone in a condominium in the woods, and Red had gone to visit AUGUST 15,1992
her one Sunday morning, as was her habit. The doorman greeted Red and commented how strange it was that the moon was still visible at 10 am. She gave him one of the herrings that her mother had packed and went up to visit her grandmother. Immediately on entering the den, where her grandmother was watching Canadian sport fishing ("Real Life, Real People"), Red noticed that her grandmother had substantial hair on her ears. (I suspected the Ychromosome syndrome but waited for the history.) Red removed her hood, and her grandmother tried to bite her ear off with her snout. Red feinted - first left and then right - and was soon being chased by an animal that looked like a wolf but was wearing her grandmother's nightie. Red's life was saved by a passing taxidermist in sheep's clothing. The events are now clear in my mind. Red's grandmother was not replaced by the wolf who tried to eat her; rather, she suffered from lycanthropy and had transformed at the thought of Sunday morning lox and bagels. For years, thousands of parents like me have told their children the story of Little Red Riding Hood and how the big bad wolf tried to eat her. It was not a wolf but, rather, the transformed grandmother. -All these story books are now known to be inaccurate and will have to be corrected. This tale is probably one of the most widely known documented cases of lycanthropy.
long, dark hair over her left distal forearm and hand on Apr. 1, hours after removal of a plaster cast that had immobilized the limb for 6 weeks. She was assured by various health care professionals that the furriness, although of unknown mechanism, would regress, but not before the next new moon. In the meantime she has trimmed her claws and is fiercely exercising the stiffened, painful and somewhat deformed limb while pawing through manuscripts with the unaffected one. Hefting the completed spring 1992 issues of CMAJ still elicits howls, however. - Ed.] I thought it fitting that Mr. Andrew House's letter "Alleged link between hepatitis B vaccine and chronic fatigue syndrome" saw the light of day in your Apr. 1 issue (page 1145), sharing space with "Psychopharmacology of lycanthropy." It was an appropriate debut for a letter that unblushingly ridiculed sick human beings. The disparaging tone and point of view reminded me of the way psychiatric patients used to be discussed in the bad old days. House, a confessed fourthyear medical student at the University of Ottawa, finds it amusing that the Nightingale Foundation should perform a public duty in informing colleagues of an observation that led them to suspect a link between the administration of hepatitis B vaccine and chronic
fatigue syndrome. House presumably feels that this broadside at colleagues and patients is safe because a study Howard Bargman, MD, FRCPC performed by the Laboratory CenAssistant professor of dermatology tre for Disease Control, Ottawa University of Toronto (Can Med Assoc J 1992; 146: 37Toronto, Ont. 38), found no such link. Had he [Perhaps it was a side effect of paused at the literature in his having worked so doggedly on the tumultuous rush into print, howmassive Mar. 15, 1992, issue, but ever, he might have discovered one CMAJ editor noted with inter- that the criteria used to establish a est, though not total surprise (hav- diagnosis of chronic fatigue syning read again an earlier letter to drome were those set out by the the editor [128: 368]), a growth of US Centers for Disease Control in CAN MED ASSOC J 1992; 147 (4)
399
1987. Most researchers and people working in the field are dissatisfied with this definition, and several are labouring to find a better one. Far more disturbing than the lack of knowledge is the lack of compassion in House's voice. The fact that House, not yet qualified, feels comfortable in holding sick people up to ridicule in a public forum reflects poorly on his teachers at a major Canadian medical school and equally poorly on the voice of the representative of Canadian medicine that chose to publish such a piece. House may claim the defence of youthful folly; no such excuse is available to the venerable CMAJ.
tors have not yet taken to censoring my personal opinions, no matter how misguided they may be.
this right, and it was expected that they would submit their written comments after the meeting. (For whatever reason the three dissentAndrew House, MD ers eventually elected not to offer Department of Internal Medicine their minority opinions for publiOttawa General Hospital in spite of encouragement cation, Ottawa, Ont. to do so from the editorial committee.) Finally, we did not attempt to offer a consensus statement diStandards, guidelines rectly after the meeting (a practice and clinical policies followed by the US National Institutes of Health [NIH]). We feared I very much enjoyed the recent that this practice would, as the review by the Health Services night wore on, encourage memResearch Group (Can Med bers to agree to a lowest common Assoc J 1992; 146: 833-837). denominator in order to arrive at However, I take issue with the closure. There is evidence that statement concerning consensus this has occurred at some consenconferences: "few formal mecha- sus conferences3 (Dr. Joseph FoSean J. O'Sullivan, MD nisms exist for dealing with dis- ley, chairman of the NIH ConsenTillsonburg, Ont. sus Conference on Assessment of agreement." The organizers of the Can- Dementia: personal communica[The author responds.] adian Consensus Conference on tion, 1992). The problem can be I wrote a tongue-in-cheek re- the Assessment of Demential"2 avoided by our practice of taking sponse to an article that described (CCCAD) carefully considered several months to complete the the alleged link between hepatitis this problem of discordance and written reports. B vaccine and chronic fatigue syn- dealt with it (with some success) Our experience suggests that one can effectively deal with the drome. The aim of my letter was by means of three separate techdiscordance expected when any twofold. First, I wished to point niques. out the difficulty in ascribing to a First, a clear voting system group of highly intelligent and particular drug the side effects of was used, and all substantive is- opinionated experts are brought chronic fatigue and lassitude in a sues were decided by a hand together and asked to come to a population such as health care count after full discussion. The meaningful agreement. "Nonsenworkers who are prone to over- level of consensus reached was sus consensus"4 is not inevitable. I do hope that many (if not work and stress. Second, I wished judged according to predeterto poke fun at a system (of which mined criteria as clear agreement all) members of the Health SerI am a willing member) that seems (80% or more of the members vices Research Group will, after to demand such trying conditions. agreed), intermediate agreement some consideration, agree comIt appears that my descrip- (56% to 79% agreed) or no agree- pletely with us. tion of myself and my colleagues, ment (less than 56% agreed). Our who often walk around in a state published reports reflected both A. Mark Clarfield, MD, CCFP, FRCPC of subwakefulness after a sleepless these votes and the level of agree- Chair Consensus Conference night on call, was grossly misinter- ment reached. As a result, readers Canadian on the Assessment of Dementia preted by Dr. O'Sullivan as "hold- could determine not only exactly Professor of medicine ing sick people up to ridicule in a what the members had agreed on McGill University public forum." Is O'Sullivan so but also what degree of concor- Montreal, Que. far removed from his training as dance was achieved. to forget the demands placed on Second, any member was al- References house staff, or has the Epstein- lowed the opportunity of append- 1. Organizing Committee, Canadian ConBarr virus simply robbed him of ing a dissenting opinion to the sensus Conference on the Assessment of his sense of humour? final report. We felt that this pracDementia, Clarfield AM (chmn): Assessing dementia: the Canadian consenAlthough I may continue to tice would allow us to agree to sus [E]. Can Med Assoc J 1991; 144: hide behind the defence of youth- disagree over a particularly ran85 1-853 ful folly I am proud to belong to corous point. During the confer- 2. Canadian Consensus Conference on the an association whose journal edi- ence three participants requested Assessment of Dementia, 5-6 October 402
CAN MED ASSOC J 1992; 147 (4)
LE 15
AOUJT
1992
My cat thinks your article on lycanthropy was some doggone cock-and-bull tale, but I think it was a shaggy dog story. Maybe someone in Labrador will know for sure. Dr. Hairry Wolf Rover's Return Kennel Lane Isle of ')ogs, England
The article on lycanthropy caused me to reflect on a recent diagnostic triumph of mine. I discussed my findings with an associate, Dr. Grimm, who concurred with my
conclusions. I practise dermatology in Scarborough. One Monday morning a young girl brought her mute grandmother to see me. The girl introduced herself as "Red" and explained that she had come to see me because of her concern about certain transformations she had recently noticed in her grandmother. The elderly woman lives alone in a condominium in the woods, and Red had gone to visit AUGUST 15,1992
her one Sunday morning, as was her habit. The doorman greeted Red and commented how strange it was that the moon was still visible at 10 am. She gave him one of the herrings that her mother had packed and went up to visit her grandmother. Immediately on entering the den, where her grandmother was watching Canadian sport fishing ("Real Life, Real People"), Red noticed that her grandmother had substantial hair on her ears. (I suspected the Ychromosome syndrome but waited for the history.) Red removed her hood, and her grandmother tried to bite her ear off with her snout. Red feinted - first left and then right - and was soon being chased by an animal that looked like a wolf but was wearing her grandmother's nightie. Red's life was saved by a passing taxidermist in sheep's clothing. The events are now clear in my mind. Red's grandmother was not replaced by the wolf who tried to eat her; rather, she suffered from lycanthropy and had transformed at the thought of Sunday morning lox and bagels. For years, thousands of parents like me have told their children the story of Little Red Riding Hood and how the big bad wolf tried to eat her. It was not a wolf but, rather, the transformed grandmother. -All these story books are now known to be inaccurate and will have to be corrected. This tale is probably one of the most widely known documented cases of lycanthropy.
long, dark hair over her left distal forearm and hand on Apr. 1, hours after removal of a plaster cast that had immobilized the limb for 6 weeks. She was assured by various health care professionals that the furriness, although of unknown mechanism, would regress, but not before the next new moon. In the meantime she has trimmed her claws and is fiercely exercising the stiffened, painful and somewhat deformed limb while pawing through manuscripts with the unaffected one. Hefting the completed spring 1992 issues of CMAJ still elicits howls, however. - Ed.] I thought it fitting that Mr. Andrew House's letter "Alleged link between hepatitis B vaccine and chronic fatigue syndrome" saw the light of day in your Apr. 1 issue (page 1145), sharing space with "Psychopharmacology of lycanthropy." It was an appropriate debut for a letter that unblushingly ridiculed sick human beings. The disparaging tone and point of view reminded me of the way psychiatric patients used to be discussed in the bad old days. House, a confessed fourthyear medical student at the University of Ottawa, finds it amusing that the Nightingale Foundation should perform a public duty in informing colleagues of an observation that led them to suspect a link between the administration of hepatitis B vaccine and chronic
fatigue syndrome. House presumably feels that this broadside at colleagues and patients is safe because a study Howard Bargman, MD, FRCPC performed by the Laboratory CenAssistant professor of dermatology tre for Disease Control, Ottawa University of Toronto (Can Med Assoc J 1992; 146: 37Toronto, Ont. 38), found no such link. Had he [Perhaps it was a side effect of paused at the literature in his having worked so doggedly on the tumultuous rush into print, howmassive Mar. 15, 1992, issue, but ever, he might have discovered one CMAJ editor noted with inter- that the criteria used to establish a est, though not total surprise (hav- diagnosis of chronic fatigue syning read again an earlier letter to drome were those set out by the the editor [128: 368]), a growth of US Centers for Disease Control in CAN MED ASSOC J 1992; 147 (4)
399
1987. Most researchers and people working in the field are dissatisfied with this definition, and several are labouring to find a better one. Far more disturbing than the lack of knowledge is the lack of compassion in House's voice. The fact that House, not yet qualified, feels comfortable in holding sick people up to ridicule in a public forum reflects poorly on his teachers at a major Canadian medical school and equally poorly on the voice of the representative of Canadian medicine that chose to publish such a piece. House may claim the defence of youthful folly; no such excuse is available to the venerable CMAJ.
tors have not yet taken to censoring my personal opinions, no matter how misguided they may be.
this right, and it was expected that they would submit their written comments after the meeting. (For whatever reason the three dissentAndrew House, MD ers eventually elected not to offer Department of Internal Medicine their minority opinions for publiOttawa General Hospital in spite of encouragement cation, Ottawa, Ont. to do so from the editorial committee.) Finally, we did not attempt to offer a consensus statement diStandards, guidelines rectly after the meeting (a practice and clinical policies followed by the US National Institutes of Health [NIH]). We feared I very much enjoyed the recent that this practice would, as the review by the Health Services night wore on, encourage memResearch Group (Can Med bers to agree to a lowest common Assoc J 1992; 146: 833-837). denominator in order to arrive at However, I take issue with the closure. There is evidence that statement concerning consensus this has occurred at some consenconferences: "few formal mecha- sus conferences3 (Dr. Joseph FoSean J. O'Sullivan, MD nisms exist for dealing with dis- ley, chairman of the NIH ConsenTillsonburg, Ont. sus Conference on Assessment of agreement." The organizers of the Can- Dementia: personal communica[The author responds.] adian Consensus Conference on tion, 1992). The problem can be I wrote a tongue-in-cheek re- the Assessment of Demential"2 avoided by our practice of taking sponse to an article that described (CCCAD) carefully considered several months to complete the the alleged link between hepatitis this problem of discordance and written reports. B vaccine and chronic fatigue syn- dealt with it (with some success) Our experience suggests that one can effectively deal with the drome. The aim of my letter was by means of three separate techdiscordance expected when any twofold. First, I wished to point niques. out the difficulty in ascribing to a First, a clear voting system group of highly intelligent and particular drug the side effects of was used, and all substantive is- opinionated experts are brought chronic fatigue and lassitude in a sues were decided by a hand together and asked to come to a population such as health care count after full discussion. The meaningful agreement. "Nonsenworkers who are prone to over- level of consensus reached was sus consensus"4 is not inevitable. I do hope that many (if not work and stress. Second, I wished judged according to predeterto poke fun at a system (of which mined criteria as clear agreement all) members of the Health SerI am a willing member) that seems (80% or more of the members vices Research Group will, after to demand such trying conditions. agreed), intermediate agreement some consideration, agree comIt appears that my descrip- (56% to 79% agreed) or no agree- pletely with us. tion of myself and my colleagues, ment (less than 56% agreed). Our who often walk around in a state published reports reflected both A. Mark Clarfield, MD, CCFP, FRCPC of subwakefulness after a sleepless these votes and the level of agree- Chair Consensus Conference night on call, was grossly misinter- ment reached. As a result, readers Canadian on the Assessment of Dementia preted by Dr. O'Sullivan as "hold- could determine not only exactly Professor of medicine ing sick people up to ridicule in a what the members had agreed on McGill University public forum." Is O'Sullivan so but also what degree of concor- Montreal, Que. far removed from his training as dance was achieved. to forget the demands placed on Second, any member was al- References house staff, or has the Epstein- lowed the opportunity of append- 1. Organizing Committee, Canadian ConBarr virus simply robbed him of ing a dissenting opinion to the sensus Conference on the Assessment of his sense of humour? final report. We felt that this pracDementia, Clarfield AM (chmn): Assessing dementia: the Canadian consenAlthough I may continue to tice would allow us to agree to sus [E]. Can Med Assoc J 1991; 144: hide behind the defence of youth- disagree over a particularly ran85 1-853 ful folly I am proud to belong to corous point. During the confer- 2. Canadian Consensus Conference on the an association whose journal edi- ence three participants requested Assessment of Dementia, 5-6 October 402
CAN MED ASSOC J 1992; 147 (4)
LE 15
AOUJT
1992
