asthma, which occurred when, while fighting a cold, I made a house call to a cat lover.) This suspicion of intimidation was born out by Hugh Keenleyside,l who recalled the saying that "dogs look up to their human masters, cats look down upon them, and only pigs treat them as equals." William D. Panton, MD Vancouver, BC
Reference 1. Keenleyside HL: Hammer the Golden Day: Memoirs of Hugh L. Keenleyside, vol 1, McLelland and Stewart, Toronto, 1981:53
The doctors of our house have followed the suggestion of Dr. Waugh and read to us his article. As officials of the International Association of Cats Owning a Doctor we were rather pleased that a human being wrote such an accurate article on us. However, Waugh forgot to mention the multiple functions a cat has in the house of a doctor: we use play therapy and impersonate babies to take the edge off their stressful lives, we patiently listen to their recriminations about the medical system, and we always try to show them how to enjoy the present moment.
Although we agree that one cannot train a cat to do tricks we would like to shed light on the reverse situation - humans can be trained by cats. As a matter of fact, the doctors in our house have been quite clever in learning a few tricks: to give us cat food or brush our hair or even type our letters when we give the paw, roll over, jump high in the air or put our ear next to their mouth to listen to one of their stupid secrets. You wouldn't believe the kick they get out of that! We take this opportunity to remind all cats owning a doctor that they can become members of 1314
CAN MED ASSOC J 1992; 147 (9)
For example, on balmy spring our association by sharing their and summer evenings I take Peter tricks with us. for a walk around the neighbourMistral, president hood on a leash. I will also ignore Blizzard, vice-president a treat held in the hand of The Zephyr, treasurer Lady who Shares My Typewriter c/o Carole MiIard Buteau, MD or placed on the floor in front of Jacques Buteau, MD Montreal, Que. me until she says I may have it. I resisted learning such strange behaviour until she read me an arti[The author responds:] cle claiming that cats were too I thank Dr. Panton for his kind impatient and stupid to learn this commentary on my piece on cats. kind of thing. The quotation from Hugh Keen- Simon Teakettle the Younger leyside's book is priceless - I Gatineau, Que. shall quote it often. Mistral, Blizzard and Zephyr are clearly a wise and talented trio. Their pets are fortunate in- India's physicians deed to be in the care of such an debate whether to go understanding and sympathetic, if abroad or go private somewhat disrespectful, trio. I hope they don't mind if I pass n reading the article by Carotheir comments on to another of T lyn in the June 15, my feline correspondents, Simon .L1992,Abraham of CMAJ (146: issue Teakettle, of Gatineau, Que. 2221, 2224-2226, 2229) concerning India's health care sysDouglas Waugh, MD I was disheartened to learn tem, Ottawa, Ont. of yet another obstacle that conI must take issue with both Dr. fronts this desperate system: the Waugh and his feline correspon- rapid flux of physicians to pridents on the matter of cats doing vate practice or to developed tricks. In fact, we are capable of nations. Having spent elective time as every trick that dogs do and of amazing feats that no canine a medical student in a governwould consider attempting. As ment hospital in India, I realize you probably know, Simon Tea- that no easy solutions are availkettle the Elder came when called able to correct the imbalance in (unless he was busy doing some- health care availability and delivthing else), sat when asked (unless ery between rich and poor. Behe wasn't in the mood) and gave cause the problems seem insurfirst one paw and then the other mountable (like many others that (if he thought the treat being of- confront India) it is rare for physicians faced with the choice of fered was worth the effort). I comforts and recognition personal I scene When entered the or service to their country selfless to the items perforadded several mance list. In addition to coming to choose the latter. In the overwhelming squalor when I'm called (particularly if I can smell a banana or nectarine), of the government hospital in sitting when asked politely, and India I developed great admiragiving one paw and then the other tion for those doctors who had (which is the method I use to forgone the opportunity of "sellencourage the opening of a pack- ing out" for personal gain, avoidage of Tender Vittles) I do several ing private practice or immigrathings formerly thought to be sole- tion to. the West. They embraced the hardships and chose to stay in ly in the province of dogs. LE Ier NOVEMBRE 1992
India at government hospitals to continue teaching their philosophies to impressionable medical students and to serve the less fortunate. The quality of care at government hospitals is impeded only by the lack of financial resources. Diagnostic tests are not available unless the patient can afford to part with a large portion of his or her yearly income. However, this is not encouraged, because even if a diagnosis were made the necessary care - surgery or drug treatment - could not be afforded. Many times the physicians pay out of their own pockets to help patients they believe have a good chance of recovery. Although they may not have received specialist training at Western universities they understand the lifestyles of the impoverished and cater to them. These physicians and others like them are the real jewels of India. It is a sad reality that public health and preventive medicine are the least desirable careers in a country such as India, which could benefit from them the most. The greatest improvements in the health of the population have been made when public-health and other reforms have been enacted; for example, the reduction in the death rate of infants correlates with the increased literacy of the population. I hope that as the attractiveness of public health careers grows within North America it will also do so - as with many of our less desirable advances in India and other developing countries. Until then, a few enlightened and dedicated practitioners continue fighting to achieve the ever-elusive goal of providing the greatest good for the greatest number.
ham to use examples from India, where millions of people go without any medical care and where city streets are littered with homeless families and their excrement, as a justification for either the introduction of user fees or the expansion of privatized medicine in Canada. The article represents not much more than a very superficial glance at a complex reality. Using this to make an international comparative analysis of health policy is as dangerous as making a diagnosis without ever examining the patient. It is neither accurate nor valid. The editors of CMAJ no doubt expect reports of biomedical research to meet certain standards, such as the test of peer review, before accepting them for publication. They should be equally vigilant with articles on health care policy.
more, while concentrating on the feelings of euphoria that in most cases accompany the NDE, Morley ignores (in a most unscientific fashion) the aspect that has impressed most researchers: the power of the NDE to change values and personal outlook. My research has convinced me that the core features of the NDE, though not constituting "proof' of an afterlife, nevertheless provide evidence that something transcendental occurs at death. Contrary to what Morley suggests, the NDE is not a phenomenon created by the technowizardry of modem medicine. It's as old as Plato or the Tibetan Book of the Dead. The design of the jacket of Life After Death was taken from a painting done in the year 1500 by Hieronymus Bosch.
Rosana Pellizzari, MD Davenport Perth Neighbourhood Centre Toronto, Ont.
Reference
Near-death experience denied
[The author responds:]
e~aders of CMAJ are not well served by Dr. Morley J. Tuttle's letter in the May 15, 1992, issue (146: 1700). The view that cerebral anoxia or other factors, such as anesthesia and various drugs, explain the phenomenon now referred to as near-death experience (NDE) is a simplistic, reductionist dodge. In my book Life After Death,1 to which Morley kindly refers and from which he quotes, I look at all the "scientific" attempts to explain NDEs and find them singularly wanting. There is no one Sonia Anand, MD physiologic or electrochemical exJunior resident in internal medicine planation that covers the extraorMcMaster University dinary range of variables in the Hamilton, Oat. experience reported by nearly 8 It is hardly fair for Carolyn Abra- million North Americans. What's
NOVEMBER 1, 1992
R
Tom Harpur Richmond Hill, Ont.
1. Harpur T: Life After Death, McClelland and Stewart, Toronto, 1991
That my explanation of the NDE is a "simplistic, reductionist dodge" is all to the good. Scientific explanations are necessarily reductionist. Only when we are able to reduce the complex symptoms of a disease to a single cause can we undertake cure and prevention. Simplicity also conforms to the principle of parsimony that governs scientific explanations. The enormously complex psychologic consequences that attend the use of hallucinogens belie the need for a complex reductionist explanation of the "extraordinary range of variables" in NDEs. The effects of the use of lysergic acid diethylamide (LSD) sometimes mimic NDEs so effectively that a well-known theologian, Alan W. Watts,' took them seriously as a source of religious insight: CAN MED ASSOC J 1992; 147 (9)
1315
Reference 1. Keenleyside HL: Hammer the Golden Day: Memoirs of Hugh L. Keenleyside, vol 1, McLelland and Stewart, Toronto, 1981:53
The doctors of our house have followed the suggestion of Dr. Waugh and read to us his article. As officials of the International Association of Cats Owning a Doctor we were rather pleased that a human being wrote such an accurate article on us. However, Waugh forgot to mention the multiple functions a cat has in the house of a doctor: we use play therapy and impersonate babies to take the edge off their stressful lives, we patiently listen to their recriminations about the medical system, and we always try to show them how to enjoy the present moment.
Although we agree that one cannot train a cat to do tricks we would like to shed light on the reverse situation - humans can be trained by cats. As a matter of fact, the doctors in our house have been quite clever in learning a few tricks: to give us cat food or brush our hair or even type our letters when we give the paw, roll over, jump high in the air or put our ear next to their mouth to listen to one of their stupid secrets. You wouldn't believe the kick they get out of that! We take this opportunity to remind all cats owning a doctor that they can become members of 1314
CAN MED ASSOC J 1992; 147 (9)
For example, on balmy spring our association by sharing their and summer evenings I take Peter tricks with us. for a walk around the neighbourMistral, president hood on a leash. I will also ignore Blizzard, vice-president a treat held in the hand of The Zephyr, treasurer Lady who Shares My Typewriter c/o Carole MiIard Buteau, MD or placed on the floor in front of Jacques Buteau, MD Montreal, Que. me until she says I may have it. I resisted learning such strange behaviour until she read me an arti[The author responds:] cle claiming that cats were too I thank Dr. Panton for his kind impatient and stupid to learn this commentary on my piece on cats. kind of thing. The quotation from Hugh Keen- Simon Teakettle the Younger leyside's book is priceless - I Gatineau, Que. shall quote it often. Mistral, Blizzard and Zephyr are clearly a wise and talented trio. Their pets are fortunate in- India's physicians deed to be in the care of such an debate whether to go understanding and sympathetic, if abroad or go private somewhat disrespectful, trio. I hope they don't mind if I pass n reading the article by Carotheir comments on to another of T lyn in the June 15, my feline correspondents, Simon .L1992,Abraham of CMAJ (146: issue Teakettle, of Gatineau, Que. 2221, 2224-2226, 2229) concerning India's health care sysDouglas Waugh, MD I was disheartened to learn tem, Ottawa, Ont. of yet another obstacle that conI must take issue with both Dr. fronts this desperate system: the Waugh and his feline correspon- rapid flux of physicians to pridents on the matter of cats doing vate practice or to developed tricks. In fact, we are capable of nations. Having spent elective time as every trick that dogs do and of amazing feats that no canine a medical student in a governwould consider attempting. As ment hospital in India, I realize you probably know, Simon Tea- that no easy solutions are availkettle the Elder came when called able to correct the imbalance in (unless he was busy doing some- health care availability and delivthing else), sat when asked (unless ery between rich and poor. Behe wasn't in the mood) and gave cause the problems seem insurfirst one paw and then the other mountable (like many others that (if he thought the treat being of- confront India) it is rare for physicians faced with the choice of fered was worth the effort). I comforts and recognition personal I scene When entered the or service to their country selfless to the items perforadded several mance list. In addition to coming to choose the latter. In the overwhelming squalor when I'm called (particularly if I can smell a banana or nectarine), of the government hospital in sitting when asked politely, and India I developed great admiragiving one paw and then the other tion for those doctors who had (which is the method I use to forgone the opportunity of "sellencourage the opening of a pack- ing out" for personal gain, avoidage of Tender Vittles) I do several ing private practice or immigrathings formerly thought to be sole- tion to. the West. They embraced the hardships and chose to stay in ly in the province of dogs. LE Ier NOVEMBRE 1992
India at government hospitals to continue teaching their philosophies to impressionable medical students and to serve the less fortunate. The quality of care at government hospitals is impeded only by the lack of financial resources. Diagnostic tests are not available unless the patient can afford to part with a large portion of his or her yearly income. However, this is not encouraged, because even if a diagnosis were made the necessary care - surgery or drug treatment - could not be afforded. Many times the physicians pay out of their own pockets to help patients they believe have a good chance of recovery. Although they may not have received specialist training at Western universities they understand the lifestyles of the impoverished and cater to them. These physicians and others like them are the real jewels of India. It is a sad reality that public health and preventive medicine are the least desirable careers in a country such as India, which could benefit from them the most. The greatest improvements in the health of the population have been made when public-health and other reforms have been enacted; for example, the reduction in the death rate of infants correlates with the increased literacy of the population. I hope that as the attractiveness of public health careers grows within North America it will also do so - as with many of our less desirable advances in India and other developing countries. Until then, a few enlightened and dedicated practitioners continue fighting to achieve the ever-elusive goal of providing the greatest good for the greatest number.
ham to use examples from India, where millions of people go without any medical care and where city streets are littered with homeless families and their excrement, as a justification for either the introduction of user fees or the expansion of privatized medicine in Canada. The article represents not much more than a very superficial glance at a complex reality. Using this to make an international comparative analysis of health policy is as dangerous as making a diagnosis without ever examining the patient. It is neither accurate nor valid. The editors of CMAJ no doubt expect reports of biomedical research to meet certain standards, such as the test of peer review, before accepting them for publication. They should be equally vigilant with articles on health care policy.
more, while concentrating on the feelings of euphoria that in most cases accompany the NDE, Morley ignores (in a most unscientific fashion) the aspect that has impressed most researchers: the power of the NDE to change values and personal outlook. My research has convinced me that the core features of the NDE, though not constituting "proof' of an afterlife, nevertheless provide evidence that something transcendental occurs at death. Contrary to what Morley suggests, the NDE is not a phenomenon created by the technowizardry of modem medicine. It's as old as Plato or the Tibetan Book of the Dead. The design of the jacket of Life After Death was taken from a painting done in the year 1500 by Hieronymus Bosch.
Rosana Pellizzari, MD Davenport Perth Neighbourhood Centre Toronto, Ont.
Reference
Near-death experience denied
[The author responds:]
e~aders of CMAJ are not well served by Dr. Morley J. Tuttle's letter in the May 15, 1992, issue (146: 1700). The view that cerebral anoxia or other factors, such as anesthesia and various drugs, explain the phenomenon now referred to as near-death experience (NDE) is a simplistic, reductionist dodge. In my book Life After Death,1 to which Morley kindly refers and from which he quotes, I look at all the "scientific" attempts to explain NDEs and find them singularly wanting. There is no one Sonia Anand, MD physiologic or electrochemical exJunior resident in internal medicine planation that covers the extraorMcMaster University dinary range of variables in the Hamilton, Oat. experience reported by nearly 8 It is hardly fair for Carolyn Abra- million North Americans. What's
NOVEMBER 1, 1992
R
Tom Harpur Richmond Hill, Ont.
1. Harpur T: Life After Death, McClelland and Stewart, Toronto, 1991
That my explanation of the NDE is a "simplistic, reductionist dodge" is all to the good. Scientific explanations are necessarily reductionist. Only when we are able to reduce the complex symptoms of a disease to a single cause can we undertake cure and prevention. Simplicity also conforms to the principle of parsimony that governs scientific explanations. The enormously complex psychologic consequences that attend the use of hallucinogens belie the need for a complex reductionist explanation of the "extraordinary range of variables" in NDEs. The effects of the use of lysergic acid diethylamide (LSD) sometimes mimic NDEs so effectively that a well-known theologian, Alan W. Watts,' took them seriously as a source of religious insight: CAN MED ASSOC J 1992; 147 (9)
1315
