LETTERS * CORRESPONDANCE
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors of accepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement.
Seules peuvent etre retenues pour publications les lettres recues en double dont la longueur n'excede pas 450 mots. Elles doivent etre mecanographiees en qualite "correspondance" sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession du copyright. Les lettres ne doivent rien contenir qui ait eteO presente ailleurs pour publication ou deja~paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont detruites. Les lettres retenues peuvent etre abregees ou faire l'objet de modifications d'ordre redactionnel.
Chemical and biologic warfare T n he Canadian Chapter of the Israel Medical Association has 500 members in many cities and small communities across Canada. Like the other chapters in 38 countries around the world its main aims are to foster professional ties with our Israeli colleagues and to assist with the continued development and maintenance of the highest standards of medicine in Israel. Recently, however, the focus of the medical profession in Israel has suddenly been diverted to a terrifying problem: how to treat large numbers of casualties after chemical attack. As Canadians we are deeply troubled by the outbreak of hostil538
CAN MED ASSOC J 1991; 144 (5)
ities in the Middle East and are gravely concerned about the resultant human suffering and loss of life. As physicians we are witnessing with horror and revulsion the threat of chemical and "biologic" warfare against military and civilian targets alike. It is terrifying to imagine what might happen if Canadian cities were thus attacked and helpless casualties began streaming into our hospitals. Our colleagues in Israel are doing their best to somehow prepare themselves for the catastrophe that may result from a largescale chemical attack against their people. For our part we in the Canadian Chapter of the Israel Medical Association can do little more than categorically condemn the use of chemical and biologic weapons by anyone, under any circumstances. We call upon all members of our profession to join us in condemning this barbaric and reckless method of destruction and in seeking its ultimate ban. Ziv Gamliel, MD Executive member
Canadian Chapter Israel Medical Association
The national AIDS strategy is a start, nothing more I n his response (Can Med Assoc J 1990; 143: 12861287) to my letter (ibid: 1286) Dr. lain D. Mackie states: "There is no proof that harsh, restrictive public health measures such as those advocated by Parker will have any impact on the spread of HIV." In the next paragraph
Mackie implies that my philosophy is not compatible with that of a caring, compassionate physician fully knowledgeable about the medical and social consequences of HIV infection. Finally, Mackie wonders who needs protection from legal recrimination - not him, because he always has the knowledge and approval of his patients. The incidence figures confirm tha,t HIV infection is mismanaged. One in 1300 pregnant women were estimated to be HIV positive from an anonymous seroprevalence survey in British Columbia in 1989.' In 1987 we were asked "Can we afford the false positive rate?" because the reported rate of HIV seropositivity was 0.01% in US female blood donors.2 The rate in British Columbia is 7.69 times that quoted as a reason not to test! Medical philosophy has been set on its ear by this disease. Those of us in general patient care cannot entertain the possibility of this condition without broaching pretest counselling specifically for this disease. Because of the highly charged emotional connotation such counselling is not infrequently refused. To suggest it for such other conditions as leukemia, brain cancer and incipient mental or physical disability is, in my opinion, cruel until all available evidence is at hand. Yet we have no such concerns for the unfortunate people who might (or might not) be HIV positive. By a sleight-of-hand legal manoeuvre we have been persuaded that it is not in the patient's best interests to have early knowledge of his or her HIV status. "The right not to know" about serious disease has been given legitimacy,
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors of accepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement.
Seules peuvent etre retenues pour publications les lettres recues en double dont la longueur n'excede pas 450 mots. Elles doivent etre mecanographiees en qualite "correspondance" sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession du copyright. Les lettres ne doivent rien contenir qui ait eteO presente ailleurs pour publication ou deja~paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont detruites. Les lettres retenues peuvent etre abregees ou faire l'objet de modifications d'ordre redactionnel.
Chemical and biologic warfare T n he Canadian Chapter of the Israel Medical Association has 500 members in many cities and small communities across Canada. Like the other chapters in 38 countries around the world its main aims are to foster professional ties with our Israeli colleagues and to assist with the continued development and maintenance of the highest standards of medicine in Israel. Recently, however, the focus of the medical profession in Israel has suddenly been diverted to a terrifying problem: how to treat large numbers of casualties after chemical attack. As Canadians we are deeply troubled by the outbreak of hostil538
CAN MED ASSOC J 1991; 144 (5)
ities in the Middle East and are gravely concerned about the resultant human suffering and loss of life. As physicians we are witnessing with horror and revulsion the threat of chemical and "biologic" warfare against military and civilian targets alike. It is terrifying to imagine what might happen if Canadian cities were thus attacked and helpless casualties began streaming into our hospitals. Our colleagues in Israel are doing their best to somehow prepare themselves for the catastrophe that may result from a largescale chemical attack against their people. For our part we in the Canadian Chapter of the Israel Medical Association can do little more than categorically condemn the use of chemical and biologic weapons by anyone, under any circumstances. We call upon all members of our profession to join us in condemning this barbaric and reckless method of destruction and in seeking its ultimate ban. Ziv Gamliel, MD Executive member
Canadian Chapter Israel Medical Association
The national AIDS strategy is a start, nothing more I n his response (Can Med Assoc J 1990; 143: 12861287) to my letter (ibid: 1286) Dr. lain D. Mackie states: "There is no proof that harsh, restrictive public health measures such as those advocated by Parker will have any impact on the spread of HIV." In the next paragraph
Mackie implies that my philosophy is not compatible with that of a caring, compassionate physician fully knowledgeable about the medical and social consequences of HIV infection. Finally, Mackie wonders who needs protection from legal recrimination - not him, because he always has the knowledge and approval of his patients. The incidence figures confirm tha,t HIV infection is mismanaged. One in 1300 pregnant women were estimated to be HIV positive from an anonymous seroprevalence survey in British Columbia in 1989.' In 1987 we were asked "Can we afford the false positive rate?" because the reported rate of HIV seropositivity was 0.01% in US female blood donors.2 The rate in British Columbia is 7.69 times that quoted as a reason not to test! Medical philosophy has been set on its ear by this disease. Those of us in general patient care cannot entertain the possibility of this condition without broaching pretest counselling specifically for this disease. Because of the highly charged emotional connotation such counselling is not infrequently refused. To suggest it for such other conditions as leukemia, brain cancer and incipient mental or physical disability is, in my opinion, cruel until all available evidence is at hand. Yet we have no such concerns for the unfortunate people who might (or might not) be HIV positive. By a sleight-of-hand legal manoeuvre we have been persuaded that it is not in the patient's best interests to have early knowledge of his or her HIV status. "The right not to know" about serious disease has been given legitimacy,
