opinions without comparisons with similar well-known products. Disk diagnostic utility programs are able to detect weak sectors of the disk surface, can move data to more reliable sectors and can refresh the low-level format on sectors. The products available vary in their ability to perform these functions. To claim that any of these products "repairs the spot" is misleading. Although there are compelling reasons for recommending disk diagnostic utility programs it is dangerous to imply that these products replace the need for back-up systems. Hard disks are prone to wear and tear and ultimate demise. Replacing the hard disk before the ultimate demise will certainly save aggravation but still requires a means of moving the data and programs from the original to the new drive. In addition, properly executed back-up systems with offsite storage are the only means of assisting a practitioner faced with other catastrophes such as stolen computer equipment or a major fire. Reviews of disk diagnostic utility programs that compare several products have been published. One of these reviews' rated the program Disk Technician highly but not as the best. Furthermore, the review described the report produced by this program in normal operation as a confounding array that makes comparison with other programs difficult. The program was tested four times: the results were inconsistent, and the reviewer concluded that the product was somewhat unpredictable and limited to partitions of 32 megabytes. Articles and reviews with a narrow focus and strong bias do not serve the interests of the medical community but only promote the individual product. Since many physicians do not consider themselves experts in understanding the impact of computers on the practice of medicine it may be 368
CAN MED ASSOC J 1990; 143 (5)
necessary to subject such articles views, I refer Essak to the and reviews to appropriate peer thoughts of CMAJ's news and review before publication. features editor, below. Should software reviews published in Zafar Essak, MD medical journals be permitted to Clidex Systems Inc. contain bias? Should software reBox 2275 views be treated differently from New Westminster, BC book reviews? I invite readers to comment. Reference 1. Rosch WL, Dang LJ, Frentzen J: Diskdiagnostic utilities find trouble spots. PC Week 1990; Mar 12: 76-79
[Dr. Goldman responds.] I agree totally with Dr. Essak's view that disk diagnostic utility programs were never intended to replace back-up storage devices for hard disks. That kind of value judgement was neither written nor implied in my article. As I noted, "the wise physician will also use a back-up system that permits periodic storage of the hard disk's contents on tape". The rest of the paragraph details the reasons why back-up systems are necessary. Essak correctly points out that Disk Technician Advanced is only one of several available products and is not necessarily the best. He refers to a detailed review published in PC Week Mar. 12, 1990. My review of the product was written more than a year ago, and I cannot claim responsibility for the delay or for the sporadic appearance of my column. Does that mean that I don't take responsibility for keeping up
with developments? Hardly. Faithful readers of my column will note that I write updates on software reviewed previously if circumstances warrant it. 1,2 Finally, Essak raises an important point when he criticizes the lack of comparison of Disk Technician Advanced with other products on the market. I have
written reviews comparing competitive products in the past3 and will try to do so more often. Regarding the question of bias in computer software re-
Brian Goldman, MD Assistant professor Department of Family and Community Medicine University of Toronto Toronto, Ont. Contributing editor, CMAJ
References 1. Goldman B: Mastering environmental emergencies with your computer. Can Med Assoc J 1988; 138: 67-68 2. Idem: Treating inflammatory arthritis: A software review. Can Med Assoc J 1988; 139: 992 3. Idem: How do you spell relief? Two software reviews. Can Med Assoc J 1989; 140: 541
[CMAJ responds.] Dr. Essak's point about peer re-
view is well taken, but CMAJ's news and features section does not have the resources to implement such a procedure. As for bias in our computer reviews, a review is automatically a subjective experience. Bias in our computer reviews will be eliminated the day it disappears from our book reviews. Patrick Sullivan News and features editor, CMAJ
The Medical Reform Group has a purpose A lthough the Medical Reform Group (MRG) of Ontario has experienced the dilemma of finding an issue as rivetting as Bill 94 (which banned extra-billing in that province) we are not without a purpose, as sug-
gested in Lynne Cohen's article "The Medical Reform Group searches for a purpose" (Can Med AssocJ 1990; 142: 1311-1312). Our principles are as much a beacon to us today as when they were set to paper in 1979. * Access of every person to high-quality, appropriate health care must be guaranteed. The health care system must be administered in a manner that precludes any monetary or other deterrent to equal care. * Health care workers, including physicians, should seek out and recognize the social, economic, occupational and environmental causes of disease and be directly involved in their eradication. * The health care system should be structured in a manner in which the equally valuable contribution of all health care workers is recognized. Both the public and health care workers should have a direct say in resource allocation and in determining the setting in which health care is provided. Since 1986, when the fight over Bill 94 was won, we have presented briefs on a number of issues consistent with our founding principles. For example, we were influential in our support of midwifery before the Ontario task force, opposed the Patent Act at the Senate committee hearings, have had continuous involvement in the Health Professions Legislation Review in Ontario and have supported freestanding, publicly funded abortion clinics. Our concerns brought out at the Lowy Commission about pharmaceutical advertising are reflected in the College of Physicians and Surgeons of Ontario's investigation into the relations between doctors and the drug industry. Currently cutbacks in federal transfer payments, the potential of the free trade agreement to open the Canadian market to US forprofit health care companies and
the tremendous pressure put on provincial governments to contain health care costs under the free trade agreement contribute toward creating a political and economic climate in which support for user fees might wax again and private insurance could erode universal access to health care and result in a two-tier system. We applaud the Ontario Medical Association's decision to drop its legal challenges to Bill 94 and the Canada Health Act, as well as its efforts to secure binding arbitration. These new directions of the association are consistent with positions that could be found in our newsletter in the early 1 980s. Those who want to stay ahead in the 1990s might want to consider subscribing to our newsletter. Donald Woodside, MD Andy Oxman, MD Philip Berger, MD Haresh Kirpalani, MD For the Medical Reform Group of Ontario PO Box 366, Stn. J Toronto, Ont. M4J 4Y8
Medicine in South Africa D _
r. Frank J.W. Timmermans' response in the June 1, 1990, issue of CMAJ (142: 1176-1177) to the comments on his article "Medicine in South Africa (1)" (ibid: 477-478) does not refute a single correction made to his inaccurate statements. Instead Timmermans chooses to obfuscate by once again indulging in factually incorrect generalities. Predictably, he also chooses to challenge me, not on the basis of fact, but with malicious innuendo. The opening paragraph in my letter stated my position quite clearly and succinctly: to respond to factually incorrect and hypo-
critical statements. This does not constitute support for the apartheid system, nor does it qualify me as "typical of . . . most white South African physicians". As a white South African who attended a nonracial, outstanding liberal university I have consistently been opposed to the government of South Africa and its policies. I have always worked for a nonracial society and practised compassionate medicine on a nonracial basis. I chose to leave South Africa for one reason: refusal to serve in the military. My dilemma is eloquently described by Rian Malan in My Traitor's Heart: "I ran because I wouldn't carry a gun for apartheid and because I wouldn't carry a gun against it." I find it particularly odious to be identified by Timmermans as a South African who "defends apartheid", and far from being ignorant of both systems I consider myself well informed. The gist of my statement regarding health care in Canada and other countries is that disparities in health care are the result of political decisions made by generations of politicians and not a result of physician conspiracy. Any Ontario or British physician would confirm that. The recent announcement by the South African government that all state medical facilities are to be opened to all races and a single department of health established should be recognized as progress. In conclusion I would like to echo the comments of Dr. Kenneth M. Leighton (ibid: 1 1721173) by asking Canadian physicians to recognize that, despite the indefensible disparities in health care in South Africa, there are significant numbers of physicians working within the country to effect meaningful change. Ostracism of these physicians will not further their efforts. I welcome any discussion that encourages posiCAN MED ASSOC J 1990; 143 (5)
369
CAN MED ASSOC J 1990; 143 (5)
necessary to subject such articles views, I refer Essak to the and reviews to appropriate peer thoughts of CMAJ's news and review before publication. features editor, below. Should software reviews published in Zafar Essak, MD medical journals be permitted to Clidex Systems Inc. contain bias? Should software reBox 2275 views be treated differently from New Westminster, BC book reviews? I invite readers to comment. Reference 1. Rosch WL, Dang LJ, Frentzen J: Diskdiagnostic utilities find trouble spots. PC Week 1990; Mar 12: 76-79
[Dr. Goldman responds.] I agree totally with Dr. Essak's view that disk diagnostic utility programs were never intended to replace back-up storage devices for hard disks. That kind of value judgement was neither written nor implied in my article. As I noted, "the wise physician will also use a back-up system that permits periodic storage of the hard disk's contents on tape". The rest of the paragraph details the reasons why back-up systems are necessary. Essak correctly points out that Disk Technician Advanced is only one of several available products and is not necessarily the best. He refers to a detailed review published in PC Week Mar. 12, 1990. My review of the product was written more than a year ago, and I cannot claim responsibility for the delay or for the sporadic appearance of my column. Does that mean that I don't take responsibility for keeping up
with developments? Hardly. Faithful readers of my column will note that I write updates on software reviewed previously if circumstances warrant it. 1,2 Finally, Essak raises an important point when he criticizes the lack of comparison of Disk Technician Advanced with other products on the market. I have
written reviews comparing competitive products in the past3 and will try to do so more often. Regarding the question of bias in computer software re-
Brian Goldman, MD Assistant professor Department of Family and Community Medicine University of Toronto Toronto, Ont. Contributing editor, CMAJ
References 1. Goldman B: Mastering environmental emergencies with your computer. Can Med Assoc J 1988; 138: 67-68 2. Idem: Treating inflammatory arthritis: A software review. Can Med Assoc J 1988; 139: 992 3. Idem: How do you spell relief? Two software reviews. Can Med Assoc J 1989; 140: 541
[CMAJ responds.] Dr. Essak's point about peer re-
view is well taken, but CMAJ's news and features section does not have the resources to implement such a procedure. As for bias in our computer reviews, a review is automatically a subjective experience. Bias in our computer reviews will be eliminated the day it disappears from our book reviews. Patrick Sullivan News and features editor, CMAJ
The Medical Reform Group has a purpose A lthough the Medical Reform Group (MRG) of Ontario has experienced the dilemma of finding an issue as rivetting as Bill 94 (which banned extra-billing in that province) we are not without a purpose, as sug-
gested in Lynne Cohen's article "The Medical Reform Group searches for a purpose" (Can Med AssocJ 1990; 142: 1311-1312). Our principles are as much a beacon to us today as when they were set to paper in 1979. * Access of every person to high-quality, appropriate health care must be guaranteed. The health care system must be administered in a manner that precludes any monetary or other deterrent to equal care. * Health care workers, including physicians, should seek out and recognize the social, economic, occupational and environmental causes of disease and be directly involved in their eradication. * The health care system should be structured in a manner in which the equally valuable contribution of all health care workers is recognized. Both the public and health care workers should have a direct say in resource allocation and in determining the setting in which health care is provided. Since 1986, when the fight over Bill 94 was won, we have presented briefs on a number of issues consistent with our founding principles. For example, we were influential in our support of midwifery before the Ontario task force, opposed the Patent Act at the Senate committee hearings, have had continuous involvement in the Health Professions Legislation Review in Ontario and have supported freestanding, publicly funded abortion clinics. Our concerns brought out at the Lowy Commission about pharmaceutical advertising are reflected in the College of Physicians and Surgeons of Ontario's investigation into the relations between doctors and the drug industry. Currently cutbacks in federal transfer payments, the potential of the free trade agreement to open the Canadian market to US forprofit health care companies and
the tremendous pressure put on provincial governments to contain health care costs under the free trade agreement contribute toward creating a political and economic climate in which support for user fees might wax again and private insurance could erode universal access to health care and result in a two-tier system. We applaud the Ontario Medical Association's decision to drop its legal challenges to Bill 94 and the Canada Health Act, as well as its efforts to secure binding arbitration. These new directions of the association are consistent with positions that could be found in our newsletter in the early 1 980s. Those who want to stay ahead in the 1990s might want to consider subscribing to our newsletter. Donald Woodside, MD Andy Oxman, MD Philip Berger, MD Haresh Kirpalani, MD For the Medical Reform Group of Ontario PO Box 366, Stn. J Toronto, Ont. M4J 4Y8
Medicine in South Africa D _
r. Frank J.W. Timmermans' response in the June 1, 1990, issue of CMAJ (142: 1176-1177) to the comments on his article "Medicine in South Africa (1)" (ibid: 477-478) does not refute a single correction made to his inaccurate statements. Instead Timmermans chooses to obfuscate by once again indulging in factually incorrect generalities. Predictably, he also chooses to challenge me, not on the basis of fact, but with malicious innuendo. The opening paragraph in my letter stated my position quite clearly and succinctly: to respond to factually incorrect and hypo-
critical statements. This does not constitute support for the apartheid system, nor does it qualify me as "typical of . . . most white South African physicians". As a white South African who attended a nonracial, outstanding liberal university I have consistently been opposed to the government of South Africa and its policies. I have always worked for a nonracial society and practised compassionate medicine on a nonracial basis. I chose to leave South Africa for one reason: refusal to serve in the military. My dilemma is eloquently described by Rian Malan in My Traitor's Heart: "I ran because I wouldn't carry a gun for apartheid and because I wouldn't carry a gun against it." I find it particularly odious to be identified by Timmermans as a South African who "defends apartheid", and far from being ignorant of both systems I consider myself well informed. The gist of my statement regarding health care in Canada and other countries is that disparities in health care are the result of political decisions made by generations of politicians and not a result of physician conspiracy. Any Ontario or British physician would confirm that. The recent announcement by the South African government that all state medical facilities are to be opened to all races and a single department of health established should be recognized as progress. In conclusion I would like to echo the comments of Dr. Kenneth M. Leighton (ibid: 1 1721173) by asking Canadian physicians to recognize that, despite the indefensible disparities in health care in South Africa, there are significant numbers of physicians working within the country to effect meaningful change. Ostracism of these physicians will not further their efforts. I welcome any discussion that encourages posiCAN MED ASSOC J 1990; 143 (5)
369
