yet to be resolved, surely there must be available to the patient enough integrity of choice in the management of the affairs connected to an illness that doubts and suspicions - for instance, of being manipulated - do not arise. Human nature is not logical, rational or noble, and scientific knowledge is relative, as much coming from insights as from experiments. However, the integrity of the physician's word to the patient - the foundation of medical ethics - should be ideal, not relative. Omelian Boris Y'arey, MD 961 Briarhill Ave. Toronto, Ont.
tions of the areas affected by the BSE epidemic in Britain to determine if the incidence of neurodegenerative diseases increases. If it does, then the scrapie and BSE agent(s) would be the most suspect. In the last decade there has been substantial progress in scrapie research by US and British teams but no comparable Canadian effort, mainly because of lack of funds. It is important that basic research into scrapie and allied diseases be encouraged in order that we may understand the cause and mechanisms of certain neurodegenerative diseases and possibly psychiatric syndromes that may be related to these infections. Peter K. Lewin, MD, MSc, FRCPC Hospital for Sick Children Toronto. O)nt.
Scrapie and human neurodegenerative diseases
References
crapie is a neurodegeneraS tive disease of sheep caused by a very unusual infective agent that seems to contain no nucleic acid. The agent has been designated as a "prion" by Prusiner' and a "protovirin" by me.' This agent is also responsible for the bovine form of spongiform encephalopathy (BSE)3 and possibly spongiform and other neurodegenerative diseases, such as Creutzfeldt-Jakob disease, in humans.45 Recently an epidemic of BSE related to the contamination of bovine feeds with offal containing scrapie-infected brains was reported from Britain.3 6 Although a working party in Britain has stated that it is "most unlikely that BSE will have any implications for human health" there is increasing indirect evidence that the infectious agents of scrapie, BSE and Creutzfeldt-Jakob disease are extremely similar, if not identical.4 It will therefore be most important to monitor for at least 5 years the human popula-
1. l'rusiner SB: Novel proteinaceous infectious particles cause scrapie. Scienice 1982:216: 136-144
2. Lewin PK: Infectious peptides: postulated mechanisms of protovirin replication in scrapie. Can ted Assoc J 1982: 127: 471-472 3. Morgan KL: Bovine spongiform encephalopathy: time to take scrapie seriously. let Rec 1988: 122: 445-446 4. Gajdusek DC: Unconventional viruses and the origin and disappearances of
kuru. Sicence 1977: 197: 943-960 5. Merz PA. Rohwer RG. Kascsak R et al: Infection specific particle from the unconventional slow virus diseases. Sci-
eneee 1984: 225: 437-440 6. BSE and scrapie: agents for change [E].
Lanticet 1988: 2: 607-608 7. Taylor DM: BSE and human health. let Rec 1989: 125: 413-415
8. Taylor C: New grants for BSE. Br Mled 1 1990: 300: 148
,
928
CAN MEDASSOCJ 1990: 142' (9)
Physician's view of the GST I t is pleasing to see CMAJ come out against the goods ,,and services tax (GST), but
the approach is a very narrow one. I would like to broaden the approach to this invidious tax, aptly referred to as the "gouge and screw tax". Sales taxes have always been in the provincial area in Canada and at the individual state level in the United States. Sales taxes are always regressive, in that those of low income pay the same amount of tax on a specific item as the wealthy, but this amount is a higher percentage of the former's income. The sales tax in Saskatchewan avoids this discrepancy: as a "health and education tax" it is specifically applied to hospitals and schools, thus reducing the costs of health care and education for those who can afford them least. Hence, the poor get their own money back in services. This will not necessarily be the same with the federal tax, which may go for defence or overseas aid. Income tax was introduced as a temporary measure in the First World War and not only has continued but has escalated enormously. In Britain the valueadded tax (VAT) was introduced at 8%; it is now 15%. In New Zealand it was 10%; now it is 12.5%. I predict that both will increase steadily. So will the GST. Gifts brought into Britain by tourists returning home now attract VAT on top of Customs duties. Eventually we will get the same treatment. The Economist reported Oct. 14, 1989 (page 19) that the consumption tax in Japan initially led to inflation and price gouging. Finance Minister Michael Wilson tells us that the GST will be fairer than the old manufacturers' sales tax that it will replace. Maybe. I remember when under a Liberal government the 12.5% sales tax on children's clothes was abolished. A spokesman for the Children's Clothing Manufacturers' Association interviewed on television was asked how long it would take for us to see cheaper
clothes in the stores. He told us sorrowfully that we wouldn't; that, indeed, the manufacturers had already met and decided that the price of children's clothing would have to go up 15% in the coming season. With abolition of the tax, they would keep the clothes at the same price and nobly absorb the 2.5% loss involved. Oh, the crocodile tears! I predict the same will happen now. The GST will simply be piggybacked on top of the present manufacturers' sales tax, and every kind of excuse will be put forward to justify this. We are told this is the only way we can reduce the cost of our manufactured goods that are being exported. This is patently false. Most countries allow goods to be exported tax-free to keep their prices competitive with those of manufacturers in other countries. Many countries sell goods abroad at less than cost price. Ever heard of "dumping"? Has nobody in government ever seen a duty-free shop in the airport in Outer Mongolia where you can buy Canadian Club cheaper than in Canada? If whiskey can be exported free of duty and resold to returning travellers, then so can anything else. All you need to do is show your orders and bills of lading to a tax inspector and it is done - cumbersomely, perhaps, but done all over the world and all the time. To claim otherwise is sheer nonsense, whatever the tax structure. If the tax is revenue neutral, why go to all the trouble and expense of introducing it? I suspect that it will be revenue positive next year and even more so the year after that. The real objective is to transfer the burden of taxes from higher-income groups to lower-income groups. We, the well-heeled, pay income tax; the poor don't, but they will pay the GST. We are told the poor will get tax credits. Fine, but if they don't pay income tax now, the tax credit is not going
to help. Of what value is a tax credit anyway? My children are all away from home now, but when they were tax deductions they were worth about $200 each a year, and who can raise a child on $200? Prices went up, and taxes went up, but the child credit stayed the same. I bet that the GST will be added on top of the present manufacturers' sales tax and that it will rise steadily while the tax credit stays the same. Any takers? Lewis Draper, MB, ChB Box 390 Gravelbourg, Sask.
"Gender" versus "sex" I note with distress the use of the term "gender" as a synonym for "sex" in David Helwig's article "Gender insensitivity a major problem in medical research, MD says" (Can Med Assoc J 1990; 142: 240-241). In the interests of literacy and accuracy I would like to point out that "gender" is a word to be applied to grammar, not people. If a person is female, that is her sex, not her gender. This distinction may be confirmed by reference to any English dictionary. Philip M. Alderman, MD 940 Groveland Rd. West Vancouver, BC
Saline on the rocks
Winnipeg is enough at - 38°C to freeze solid an intravenous line. Fortunately, ice embolism did not occur. "Sangfroid" could have assumed an entirely new meaning! Patrick J. Taylor, MD Jeremy V. Kredentser, MD Division of Reproductive Endocrinology University of Manitoba Winnipeg, Man.
The creative mind and suicide avid Helwig, in his article D J entitled "Physician-poet intrigued by the psychopathology of creative minds" (Can Med Assoc J 1990; 142: 650651, 653), refers to the suicide of the US poet Sylvia Plath in Devon, England, in 1963. Although she did have a house in Devon, Plath gassed herself in a flat in London, England, as noted on the flyleaf of her novel The Bell Jar.' The event is noted poignantly in a recent memoir of the late Canadian author Margaret Laurence,2 who on reading in a London paper of Plath's death wrote that she and Plath lived in the same area of Hampstead, each separated from her husband, each with two young children. Laurence, however, despite her own depression, knew she would never take her life. She attributed this resistance to the strength given her during her upbringing by three mothers: her birth mother, her stepmother and her mother-in-law.
he concept that hospitals should be smoke-free is Margaret Cox, MD praiseworthy. However, 144 Waterford Bridge Rd. committed smokers deprived of St. John's, Nfld. any inside smoking area cluster round hospital entrances, feeding References their habit. Two such victims, cyanosed 1. Plath S: The Bell Jar, Har-Row, New York, 1971 and trembling but with their nicotine levels restored, discovered 2. Laurence M: Dantce onl the Ear th, McClelland & Stewart, Toronto, 1989 that even a 10-minute puff in CAN MED ASSOCJ 1990; 142(9)
929
tions of the areas affected by the BSE epidemic in Britain to determine if the incidence of neurodegenerative diseases increases. If it does, then the scrapie and BSE agent(s) would be the most suspect. In the last decade there has been substantial progress in scrapie research by US and British teams but no comparable Canadian effort, mainly because of lack of funds. It is important that basic research into scrapie and allied diseases be encouraged in order that we may understand the cause and mechanisms of certain neurodegenerative diseases and possibly psychiatric syndromes that may be related to these infections. Peter K. Lewin, MD, MSc, FRCPC Hospital for Sick Children Toronto. O)nt.
Scrapie and human neurodegenerative diseases
References
crapie is a neurodegeneraS tive disease of sheep caused by a very unusual infective agent that seems to contain no nucleic acid. The agent has been designated as a "prion" by Prusiner' and a "protovirin" by me.' This agent is also responsible for the bovine form of spongiform encephalopathy (BSE)3 and possibly spongiform and other neurodegenerative diseases, such as Creutzfeldt-Jakob disease, in humans.45 Recently an epidemic of BSE related to the contamination of bovine feeds with offal containing scrapie-infected brains was reported from Britain.3 6 Although a working party in Britain has stated that it is "most unlikely that BSE will have any implications for human health" there is increasing indirect evidence that the infectious agents of scrapie, BSE and Creutzfeldt-Jakob disease are extremely similar, if not identical.4 It will therefore be most important to monitor for at least 5 years the human popula-
1. l'rusiner SB: Novel proteinaceous infectious particles cause scrapie. Scienice 1982:216: 136-144
2. Lewin PK: Infectious peptides: postulated mechanisms of protovirin replication in scrapie. Can ted Assoc J 1982: 127: 471-472 3. Morgan KL: Bovine spongiform encephalopathy: time to take scrapie seriously. let Rec 1988: 122: 445-446 4. Gajdusek DC: Unconventional viruses and the origin and disappearances of
kuru. Sicence 1977: 197: 943-960 5. Merz PA. Rohwer RG. Kascsak R et al: Infection specific particle from the unconventional slow virus diseases. Sci-
eneee 1984: 225: 437-440 6. BSE and scrapie: agents for change [E].
Lanticet 1988: 2: 607-608 7. Taylor DM: BSE and human health. let Rec 1989: 125: 413-415
8. Taylor C: New grants for BSE. Br Mled 1 1990: 300: 148
,
928
CAN MEDASSOCJ 1990: 142' (9)
Physician's view of the GST I t is pleasing to see CMAJ come out against the goods ,,and services tax (GST), but
the approach is a very narrow one. I would like to broaden the approach to this invidious tax, aptly referred to as the "gouge and screw tax". Sales taxes have always been in the provincial area in Canada and at the individual state level in the United States. Sales taxes are always regressive, in that those of low income pay the same amount of tax on a specific item as the wealthy, but this amount is a higher percentage of the former's income. The sales tax in Saskatchewan avoids this discrepancy: as a "health and education tax" it is specifically applied to hospitals and schools, thus reducing the costs of health care and education for those who can afford them least. Hence, the poor get their own money back in services. This will not necessarily be the same with the federal tax, which may go for defence or overseas aid. Income tax was introduced as a temporary measure in the First World War and not only has continued but has escalated enormously. In Britain the valueadded tax (VAT) was introduced at 8%; it is now 15%. In New Zealand it was 10%; now it is 12.5%. I predict that both will increase steadily. So will the GST. Gifts brought into Britain by tourists returning home now attract VAT on top of Customs duties. Eventually we will get the same treatment. The Economist reported Oct. 14, 1989 (page 19) that the consumption tax in Japan initially led to inflation and price gouging. Finance Minister Michael Wilson tells us that the GST will be fairer than the old manufacturers' sales tax that it will replace. Maybe. I remember when under a Liberal government the 12.5% sales tax on children's clothes was abolished. A spokesman for the Children's Clothing Manufacturers' Association interviewed on television was asked how long it would take for us to see cheaper
clothes in the stores. He told us sorrowfully that we wouldn't; that, indeed, the manufacturers had already met and decided that the price of children's clothing would have to go up 15% in the coming season. With abolition of the tax, they would keep the clothes at the same price and nobly absorb the 2.5% loss involved. Oh, the crocodile tears! I predict the same will happen now. The GST will simply be piggybacked on top of the present manufacturers' sales tax, and every kind of excuse will be put forward to justify this. We are told this is the only way we can reduce the cost of our manufactured goods that are being exported. This is patently false. Most countries allow goods to be exported tax-free to keep their prices competitive with those of manufacturers in other countries. Many countries sell goods abroad at less than cost price. Ever heard of "dumping"? Has nobody in government ever seen a duty-free shop in the airport in Outer Mongolia where you can buy Canadian Club cheaper than in Canada? If whiskey can be exported free of duty and resold to returning travellers, then so can anything else. All you need to do is show your orders and bills of lading to a tax inspector and it is done - cumbersomely, perhaps, but done all over the world and all the time. To claim otherwise is sheer nonsense, whatever the tax structure. If the tax is revenue neutral, why go to all the trouble and expense of introducing it? I suspect that it will be revenue positive next year and even more so the year after that. The real objective is to transfer the burden of taxes from higher-income groups to lower-income groups. We, the well-heeled, pay income tax; the poor don't, but they will pay the GST. We are told the poor will get tax credits. Fine, but if they don't pay income tax now, the tax credit is not going
to help. Of what value is a tax credit anyway? My children are all away from home now, but when they were tax deductions they were worth about $200 each a year, and who can raise a child on $200? Prices went up, and taxes went up, but the child credit stayed the same. I bet that the GST will be added on top of the present manufacturers' sales tax and that it will rise steadily while the tax credit stays the same. Any takers? Lewis Draper, MB, ChB Box 390 Gravelbourg, Sask.
"Gender" versus "sex" I note with distress the use of the term "gender" as a synonym for "sex" in David Helwig's article "Gender insensitivity a major problem in medical research, MD says" (Can Med Assoc J 1990; 142: 240-241). In the interests of literacy and accuracy I would like to point out that "gender" is a word to be applied to grammar, not people. If a person is female, that is her sex, not her gender. This distinction may be confirmed by reference to any English dictionary. Philip M. Alderman, MD 940 Groveland Rd. West Vancouver, BC
Saline on the rocks
Winnipeg is enough at - 38°C to freeze solid an intravenous line. Fortunately, ice embolism did not occur. "Sangfroid" could have assumed an entirely new meaning! Patrick J. Taylor, MD Jeremy V. Kredentser, MD Division of Reproductive Endocrinology University of Manitoba Winnipeg, Man.
The creative mind and suicide avid Helwig, in his article D J entitled "Physician-poet intrigued by the psychopathology of creative minds" (Can Med Assoc J 1990; 142: 650651, 653), refers to the suicide of the US poet Sylvia Plath in Devon, England, in 1963. Although she did have a house in Devon, Plath gassed herself in a flat in London, England, as noted on the flyleaf of her novel The Bell Jar.' The event is noted poignantly in a recent memoir of the late Canadian author Margaret Laurence,2 who on reading in a London paper of Plath's death wrote that she and Plath lived in the same area of Hampstead, each separated from her husband, each with two young children. Laurence, however, despite her own depression, knew she would never take her life. She attributed this resistance to the strength given her during her upbringing by three mothers: her birth mother, her stepmother and her mother-in-law.
he concept that hospitals should be smoke-free is Margaret Cox, MD praiseworthy. However, 144 Waterford Bridge Rd. committed smokers deprived of St. John's, Nfld. any inside smoking area cluster round hospital entrances, feeding References their habit. Two such victims, cyanosed 1. Plath S: The Bell Jar, Har-Row, New York, 1971 and trembling but with their nicotine levels restored, discovered 2. Laurence M: Dantce onl the Ear th, McClelland & Stewart, Toronto, 1989 that even a 10-minute puff in CAN MED ASSOCJ 1990; 142(9)
929
