residents and with family conflict. I encourage them to publish their findings on the use and effectiveness of the Care Management Form. Given the recent trends and proposed legislation in this area, detailed information on the use of directives would be welcomed by researchers, practitioners, administrators and elderly consumers of health care services. D. William Molloy, MB Director Memory Clinic Geriatric Research Group Hamilton Civic Hospitals Hamilton, Ont.
The "overpass syndrome" I read with interest "Newfoundland: For Canada's poor cousin, financial restraint is nothing new" (Can Med Assoc J 1991; 145: 340-341), by Charlotte Gray. I thought that Newfoundland was part of Canada and not just a cousin, poor or otherwise. Other provinces are referred to as sister provinces, but we are still a cousin? I also wonder where the information came from that specialists are only for the Avalon Peninsula and generalists for more remote areas. I spent 11 years in Gander as medical direetor recruiting for that area and more than 18 months at the Department of Health recruiting for the province. There are some very fine specialists in Clarenville, Burin, Gander, Grand Falls, Corner Brook and the Grenfell area. There is a general surgeon and anesthetist in Labrador City.
JANUARY 15,1992
The article may have meant to imply that subspecialists are for the Avalon Peninsula. The subspecialties we see outside the Avalon Peninsula include orthopedics,. spinal surgery, nuclear medicine, ophthalmology, otorhinolaryngology and urology. In addition there are the general specialties, which we classify as pediatrics, psychiatry, internal medicine, general surgery, and obstetrics and gynecology. The "overpass syndrome" was developed by Newfoundlanders in the St. John's area. The first overpass built in this province in 1959 was just outside St. John's, and it was stated that anything beyond that (especially from the medical point of view) was not considered in any planning. The planning is usually done in St. John's. It seems that this syndrome has led to erroneous information in an article that otherwise is an excellent summary of the situation.
I believe that the author must have been referring to the Canadian Coordinating Office for Health Technology Assessment (CCOHTA). CCOHTA is an initiative funded jointly by the federal, provincial and territorial governments. The office began operations in Ottawa in August 1990. CCOHTA has no mandate to regulate or control technology. Our mission is "to encourage the appropriate use of health technology by influencing decisionmakers through the collection, analysis, creation and dissemination of information concerning the effectiveness and cost of technology and its impact on health." Dev Menon, PhD, MHSA Executive director
Canadian Coordinating Office for Health Technology Assessment Ottawa, Ont.
[The author responds.] A. Edward Shapter, MD, FRCSC 80-82 Elizabeth Ave. St. John's, Nfld.
I am indebted to Dr. Menon for clarifying my comments. It was indeed the CCOHTA that I was referring to. I hope that encouraging the appropriate use of health techwill lead to a more rational Canadian Coordinating nology use of resources through controls Office for Health on the diffusion of unproven techTechnology Assessment nology. I take Menon's point that regulation and control are not J am writing to clarify a state- within CCOHTA's mandate. I had ment made by Dr. Perry Ken- not intended to suggest that, they dall in his article "Bill C-69: were. An obscure piece of legislation could spell doom for our health Perry RW. Kendall, MB, BS, MSc, FRCPC care system" (Can Med Assoc J Medical officer of health regard145: 527-528) 525, 1991; Department of Public Health ing the "Canadian Centre for City of Toronto Medical Technology Assessment." Toronto, Ont.
CAN MED ASSOC J
1992; 146 (2)
113
The "overpass syndrome" I read with interest "Newfoundland: For Canada's poor cousin, financial restraint is nothing new" (Can Med Assoc J 1991; 145: 340-341), by Charlotte Gray. I thought that Newfoundland was part of Canada and not just a cousin, poor or otherwise. Other provinces are referred to as sister provinces, but we are still a cousin? I also wonder where the information came from that specialists are only for the Avalon Peninsula and generalists for more remote areas. I spent 11 years in Gander as medical direetor recruiting for that area and more than 18 months at the Department of Health recruiting for the province. There are some very fine specialists in Clarenville, Burin, Gander, Grand Falls, Corner Brook and the Grenfell area. There is a general surgeon and anesthetist in Labrador City.
JANUARY 15,1992
The article may have meant to imply that subspecialists are for the Avalon Peninsula. The subspecialties we see outside the Avalon Peninsula include orthopedics,. spinal surgery, nuclear medicine, ophthalmology, otorhinolaryngology and urology. In addition there are the general specialties, which we classify as pediatrics, psychiatry, internal medicine, general surgery, and obstetrics and gynecology. The "overpass syndrome" was developed by Newfoundlanders in the St. John's area. The first overpass built in this province in 1959 was just outside St. John's, and it was stated that anything beyond that (especially from the medical point of view) was not considered in any planning. The planning is usually done in St. John's. It seems that this syndrome has led to erroneous information in an article that otherwise is an excellent summary of the situation.
I believe that the author must have been referring to the Canadian Coordinating Office for Health Technology Assessment (CCOHTA). CCOHTA is an initiative funded jointly by the federal, provincial and territorial governments. The office began operations in Ottawa in August 1990. CCOHTA has no mandate to regulate or control technology. Our mission is "to encourage the appropriate use of health technology by influencing decisionmakers through the collection, analysis, creation and dissemination of information concerning the effectiveness and cost of technology and its impact on health." Dev Menon, PhD, MHSA Executive director
Canadian Coordinating Office for Health Technology Assessment Ottawa, Ont.
[The author responds.] A. Edward Shapter, MD, FRCSC 80-82 Elizabeth Ave. St. John's, Nfld.
I am indebted to Dr. Menon for clarifying my comments. It was indeed the CCOHTA that I was referring to. I hope that encouraging the appropriate use of health techwill lead to a more rational Canadian Coordinating nology use of resources through controls Office for Health on the diffusion of unproven techTechnology Assessment nology. I take Menon's point that regulation and control are not J am writing to clarify a state- within CCOHTA's mandate. I had ment made by Dr. Perry Ken- not intended to suggest that, they dall in his article "Bill C-69: were. An obscure piece of legislation could spell doom for our health Perry RW. Kendall, MB, BS, MSc, FRCPC care system" (Can Med Assoc J Medical officer of health regard145: 527-528) 525, 1991; Department of Public Health ing the "Canadian Centre for City of Toronto Medical Technology Assessment." Toronto, Ont.
CAN MED ASSOC J
1992; 146 (2)
113
