didates who have applied several times are given credit for their perseverance and for their well established strong motivation to study medicine. This year Queen's University offered positions to several applicants who had been rejected in previous years. The admissions committee of the faculty of medicine at Queen's University has included a representative from the lay public as well as two student representatives for the last several years. Choosing a medical class from a very large pool of highly desirable applicants is indeed a difficult task. However, I assure Mr. Meadows that, although the selection procedure is far from perfect, the committee does not operate like "a coldly ratiorrar computer". PAUL C.S. HOAKEN, MD Chairman Faculty of medicine admissions committee, 1975-76 Queen's University Kingston, Ont.
To the editor: Mr. Meadows repeats many erroneous charges that are often levelled at medical school admissions committees. While several of these charges may (and probably did at one time) have a factual basis, there have been radical changes in recent years. I doubt whether nowadays one could adduce any credible evidence that admissions committees in Canadian medical schools are driven by any motive other than that of conscientiously endeavouring to choose students with the potential for ultimately providing the best possible quality of medical care to the citizens of Canada. True, they don't always succeed in this endeavour, but Canada can and should be proud of what they have been able to achieve. University transcripts are not accepted at face value by most (perhaps all) admissions committees. While practices vary, most employ a type of weighing-on-value system with respect to both the courses that have been taken and to the institution at which they were taken. To equate an 80% average achieved in an introductory course where few students fail with an 80% average achieved in an advanced course where the achievement of honours standing is a rarity would reflect the kind of idiocy that I have never encountered in an admissions committee. The offspring of physicians do not enjoy any priority status in selection for medical school, though it is true that they are more likely to apply for entry to medical school and thus be over-represented in the applicant pool. If Mr. Meadows believes that judgements of admissions committees have never been questioned seriously, he has been living in a different milieu than most of us. The nickus a few years
ago over the admission of Chinese students to the University of Toronto was given national coverage and thus led to a great deal of public scrutiny of that university's admission practices. The public interest in the medical school admission process is well served through the presence on most admissions committees of lay members and, in many cases, of student members. Mr. Meadows' final paragraph seems to reflect his belief that computers have a major role in the admission process. This also is not so. Computers may be used at some of the larger schools for the handling of complex data but in most cases they are not used in admission procedures. Even where they are used for this purpose, admission decisions remain human decisions, made by serious, sympathetic and dedicated people. The central problem in medical school admissions at present is that there are many more capable and dedicated young people wanting to enter medicine than can be accommodated. All applicants are aware of this and the wiser ones plan their university careers in such a way as to provide rewarding alternative career pathways against the possibility that they may not be admitted to medical school. A surprising number, however, fail to do this or do it so late in their academic careers that alternatives are hard to find. Whether this problem could be alleviated by more vigorous and effective premedical counselling is clearly a subject that deserves serious consideration in our universities. DOUGLAS WAUGH, MD Executive director Association of Canadian Medical Colleges Ottawa, Ont.
Tardive dyskinesia treated with manganese To the editor: Dr. I. Ray (Can Med Assoc J 117: 129, 1977) reported a case of tardive dyskinesia treated successfully with deanol acetamidobenzoate. This, he suggested, reinforced the hypothesis that this condition is caused by dopaminergic overactivity. A recent report by Kunin1 throws light on another aspect of this serious side effect of long-term treatment with tranquillizers. Reasoning from published observations that phenothiazines are potent chelators of manganese and that manganese is present in high concentration in the extrapyramidal system, Kunin treated with chelated manganese 15 patients that had withdrawal symptoms and tardive dyskinesia. Ten were also treated with niacin or niacinamide. Four patients returned to normal in a few days, there was definite improvement in nine patients in 2 to 5
days, and one patient, although unresponsive to manganese, responded dramatically to niacin. Only one patient showed no response. Kunin suggested that manganese may be useful in the prevention as well as the treatment of tardive dyskinesia. I have seen similar responses in a smaller number of cases. A. HOFFER, MD, PH D 3A-2727 Quadra St. Victoria, BC
References 1. KUNIN RA: Manganese and niacin in tite treatment of drug-indUced dyskinesia. J Orthomol Psychiatry 5: 4, 1976
Is gynecology good for obstetrics? To the t.ditor: Although I thoroughly agree with the general message of Dr. H.B. Atlee's commentary on this subject (Can Med Assoc J 117: 287, 1977), I believe two points warrant some comment. I am disturbed by Dr. Atlee's question "Have we advised her about breastfeeding, or do we leave that to the neonatologist, who imagines he can make as good a milk as God and that there is no difference to a baby between a rubber nipple and its mother's breast?" Every neonatologist I have known, including those who have written recently on the subject, has been well aware of the superiority of breast milk and breastfeeding. I think this question perhaps reveals that Dr. Atlee has had an unhappy experience or is expressing a bias against the pediatricians who have a close interest in the welfare of the newborn. That Dr. Atlee has a tendency to overdraw his remarks is evidenced by his phrase "the callousness of professionalism". I do not accept that callousness is a characteristic of professionalism. Finally, I wish Dr. Atlee had not used the word "physiologize"; I criticize the editors of the Journal for permitting the publication of this unacceptable corruption. AF. HARDYMENT, MD, FRCP[C]
1217-75 W Broadway Vancouver, BC
Management of cardiac arrest To the editor: We cannot be reminded too often of the essential primary steps to be taken in cases of cardiac arrest to maintain life in the first few minutes, otherwise the chance for survival may be lost before the services of experts with sophisticated equipment are available. As indicated by Dr. Alam S. Khan (Can Med Assoc J 117: 162, 1977), the diagnosis can be established quick-
CMA JOURNAL/OCTOBER 22, 1977/VOL. 117 859
To the editor: Mr. Meadows repeats many erroneous charges that are often levelled at medical school admissions committees. While several of these charges may (and probably did at one time) have a factual basis, there have been radical changes in recent years. I doubt whether nowadays one could adduce any credible evidence that admissions committees in Canadian medical schools are driven by any motive other than that of conscientiously endeavouring to choose students with the potential for ultimately providing the best possible quality of medical care to the citizens of Canada. True, they don't always succeed in this endeavour, but Canada can and should be proud of what they have been able to achieve. University transcripts are not accepted at face value by most (perhaps all) admissions committees. While practices vary, most employ a type of weighing-on-value system with respect to both the courses that have been taken and to the institution at which they were taken. To equate an 80% average achieved in an introductory course where few students fail with an 80% average achieved in an advanced course where the achievement of honours standing is a rarity would reflect the kind of idiocy that I have never encountered in an admissions committee. The offspring of physicians do not enjoy any priority status in selection for medical school, though it is true that they are more likely to apply for entry to medical school and thus be over-represented in the applicant pool. If Mr. Meadows believes that judgements of admissions committees have never been questioned seriously, he has been living in a different milieu than most of us. The nickus a few years
ago over the admission of Chinese students to the University of Toronto was given national coverage and thus led to a great deal of public scrutiny of that university's admission practices. The public interest in the medical school admission process is well served through the presence on most admissions committees of lay members and, in many cases, of student members. Mr. Meadows' final paragraph seems to reflect his belief that computers have a major role in the admission process. This also is not so. Computers may be used at some of the larger schools for the handling of complex data but in most cases they are not used in admission procedures. Even where they are used for this purpose, admission decisions remain human decisions, made by serious, sympathetic and dedicated people. The central problem in medical school admissions at present is that there are many more capable and dedicated young people wanting to enter medicine than can be accommodated. All applicants are aware of this and the wiser ones plan their university careers in such a way as to provide rewarding alternative career pathways against the possibility that they may not be admitted to medical school. A surprising number, however, fail to do this or do it so late in their academic careers that alternatives are hard to find. Whether this problem could be alleviated by more vigorous and effective premedical counselling is clearly a subject that deserves serious consideration in our universities. DOUGLAS WAUGH, MD Executive director Association of Canadian Medical Colleges Ottawa, Ont.
Tardive dyskinesia treated with manganese To the editor: Dr. I. Ray (Can Med Assoc J 117: 129, 1977) reported a case of tardive dyskinesia treated successfully with deanol acetamidobenzoate. This, he suggested, reinforced the hypothesis that this condition is caused by dopaminergic overactivity. A recent report by Kunin1 throws light on another aspect of this serious side effect of long-term treatment with tranquillizers. Reasoning from published observations that phenothiazines are potent chelators of manganese and that manganese is present in high concentration in the extrapyramidal system, Kunin treated with chelated manganese 15 patients that had withdrawal symptoms and tardive dyskinesia. Ten were also treated with niacin or niacinamide. Four patients returned to normal in a few days, there was definite improvement in nine patients in 2 to 5
days, and one patient, although unresponsive to manganese, responded dramatically to niacin. Only one patient showed no response. Kunin suggested that manganese may be useful in the prevention as well as the treatment of tardive dyskinesia. I have seen similar responses in a smaller number of cases. A. HOFFER, MD, PH D 3A-2727 Quadra St. Victoria, BC
References 1. KUNIN RA: Manganese and niacin in tite treatment of drug-indUced dyskinesia. J Orthomol Psychiatry 5: 4, 1976
Is gynecology good for obstetrics? To the t.ditor: Although I thoroughly agree with the general message of Dr. H.B. Atlee's commentary on this subject (Can Med Assoc J 117: 287, 1977), I believe two points warrant some comment. I am disturbed by Dr. Atlee's question "Have we advised her about breastfeeding, or do we leave that to the neonatologist, who imagines he can make as good a milk as God and that there is no difference to a baby between a rubber nipple and its mother's breast?" Every neonatologist I have known, including those who have written recently on the subject, has been well aware of the superiority of breast milk and breastfeeding. I think this question perhaps reveals that Dr. Atlee has had an unhappy experience or is expressing a bias against the pediatricians who have a close interest in the welfare of the newborn. That Dr. Atlee has a tendency to overdraw his remarks is evidenced by his phrase "the callousness of professionalism". I do not accept that callousness is a characteristic of professionalism. Finally, I wish Dr. Atlee had not used the word "physiologize"; I criticize the editors of the Journal for permitting the publication of this unacceptable corruption. AF. HARDYMENT, MD, FRCP[C]
1217-75 W Broadway Vancouver, BC
Management of cardiac arrest To the editor: We cannot be reminded too often of the essential primary steps to be taken in cases of cardiac arrest to maintain life in the first few minutes, otherwise the chance for survival may be lost before the services of experts with sophisticated equipment are available. As indicated by Dr. Alam S. Khan (Can Med Assoc J 117: 162, 1977), the diagnosis can be established quick-
CMA JOURNAL/OCTOBER 22, 1977/VOL. 117 859
