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 ete 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.

Senator Keon examines his scars T| a his recent article (Can Med Assoc J 1990; 143: 13621364), by Charlotte Gray, deeply moved me; Dr. Wilbert Keon's altruism and selflessness in accepting his appointment to the Senate clearly show. Too bad Keon was one of the pawns who allowed the federal government to pass a tax that is clearly discriminatory to physicians in general and to clinical medical groups in

particular. How can a doctor assume a leadership role in politics when he sells out his own profession? May I suggest that Keon honestly examine his motives for accepting a seat in the Senate, and if indeed the motive is leadership perhaps -

For prescribing information see page 1 172

he should represent the views of ties I thought I could make a his profession. useful contribution in the Senate to health and science policy as our Ronald W. Witzke, MD country restructures itself. 51 6th St. SE In any event, it is an extremeMedicine Hat, Alta. ly interesting time in Canadian history, and it is my privilege to be significantly involved as our [Dr. Keon responds:] future unfolds. Dr. Witzke's letter expresses the Wilbert J. Keon, MD opinion that I was disloyal to our Senate of Canada profession with my position on the goods and services tax (GST). Although the GST discriminates against physicians in some respects, virtually every other group Accouchement vaginal that testified before the Senate apres cesarienne committee also felt the tax was unfair to its area or discipline. I I I faut feliciter Gail Goldman hope that some of these discrepet ses collegues pour l'originaancies will be adjusted within the lite de leur travail qui etudie near future. la clientee et les caracteristiques Canada and consequently our des medecins qui pratiquent des national institutions may undergo accouchements vaginaux apres major change in the next few cesarienne (AVAC) au Quebec years. The Senate itself is facing (> [Can Med Assoc J 1990; 143: considerably. Our profession has 1017-1024]). made tremendous contributions Cependant, il est important to society over the years. Unfortu- de rappeler que l'etude porte sur nately, in the last quarter-century la periode de 1985 a 1987 et on most of the public attention that doit s'interroger pour savoir si les we have attracted has focused on conclusions des auteurs seraient our own self-interest, and I be- les m&mes s'ils refaisaient l'enlieve that we must make an all-out qu&te actuellement. effort to involve ourselves in the R&emment, a l'occasion de broader issues of society as a visites d'inspection professionnelwhole. le, les membres du Service d'insOver the past 20 years or so I pection professionnelle de la Corhave volunteered with other col- poration professionnelle des leagues an enormous amount of medecins du Quebec ont constate time on medical societies and sci- que I'AVAC se pratique de plus en entific bodies to help our profes- plus par les omnipraticiens dans sion grow and develop in direc- les milieux ou ceux-ci font un tions that were felt to be impor- pourcentage important de l'obst& tant. Because of the vast experi- trique. La Corporation croit etre ence I have gained in these activi- en mesure de fournir des donnees %

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CAN MED ASSOC J 1991; 144 (9)

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precises sur ce sujet avant la fin de 1991. Dans leur article Goldman et ses collegues affirment que certains medecins peuvent pratiquer un taux eeve de cesariennes a cause d'une clientele plus a risque. Une etude de la Corporation en 1987 et en 1989 sur des gestes obstetricaux, dont la cesarienne, n'a pas permis de tirer cette conclusion. ' Enfin, ltude de Goldman et de ses collegues a permis de situer le groupe d'age des femmes qui ont un AVAC. La majorite sont des femmes de plus de 30 ans. Les auteurs deplorent ne pas connaitre le niveau de scolarite de celles-ci. Nous sommes d'accord avec eux, car a notre avis le mouvement de 1'AVAC est venu d'une clientele feminine scolarisee. Gilles Bernier, MD, FRCSC Service d'inspection professionnelle Corporation professionnelle des medecins du Quebec Montreal (Que.)

Reference 1. Profil de l'utilisation des interventions obstetricales au Quebec. Bull Corp Prof Med Que 1990; 30 (4): 9-13

Looming manpower shortage has Canada's obstetricians worried his article (Can Med Assoc J 1991; 144: 478-479, 482), by Lynne Cohen, briefly addresses reasons for this development but focuses largely on the reasons family physicians are opting out of intrapartum care.

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they might encounter, as newly qualified specialists, to share a portion of the abortion workload. Forgoing a career in obstetrics would be an understandable response to this dilemma. It would be most unfortunate if this reasoning played a muted role in the recruitment shortage. Perhaps this possibility should be researched.

John Biehn, MD, CCFP St. Joseph's Family Medical Centre 346 Platt's Lane London, Ont.

Preventing smoking among young people I t is surprising that US cigarette companies are spending $9 million daily in tobacco advertising, as noted in Patrick Sullivan's article "Tobacco companies have sights on teens, US activist warns Nova Scotia MDs" (Can Med Assoc J 1990; 143: SMOKING thru Sthe ceONE 19th

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CAN MED ASSOC J 1991; 144 (9)

Hiroshi Kawane, MD, DMS Department of Medicine Kawasaki Medical School Kurashiki City, Okayama, Japan

References

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I have wondered what role abortion may play in the obstet- ("pctre ofth flotin world"),; a rician-gynecologist recruitment shortage. For a variety of reasons increasing numbers of obstet- style of painting and wood-block prints rician-gynecologists are opting developed in Japan from the 17th out of performing therapeutic through the 19th centuries. The subabortions. Potential recruits could jects depict the world of pleasure plus not be oblivious to the pressure landscape. 1108

1351-1352). They are also advertising cigarettes aggressively in Japan, promoting them on television every night as a glamorous product. ' Another problem in Japan is the sale of tobacco through vending machines. It is estimated that there are 500 000 tobacco vending machines throughout the country.2 Children can get cigarettes as easily as they buy soft drinks. According to calculations by the Japan Tobacco Problem Information Center, underaged smokers smoked approximately 60 billion cigarettes last year, nearly twice as many as 6 years ago. Youngsters, especially teenage girls, tend to think that smoking is glamorous and fashionable. I have launched an antismoking campaign with the theme "Smoking is old-fashioned" (Fig. 1). The theme for last year's World No-Tobacco Day was "Growing up without tobacco." I hope that the government will take immediate action to prohibit tobacco advertising on television and restrict sales of cigarettes in vending machines.

1. Kawane H: Tobacco advertising in

Japan [C]. Can Med Assoc J 1988: 1 39: 193-194 2. Idem: A smoke-free hospital [C]. A4rcli InternAMed 1990: 150: 1350

Informed consent to HIV antibody testing I n response to the letter from Dr. D.P. Hill (Can Med Assoc J 1991; 144: 403) about the legal status of informed consent to HIV antibody testing, Dr. EikeHenner W. Kluge (ibid: 403-404) states that testing in the absence of consent should "Xbe approached LE I e

MAI 1991

[Vaginal delivery after cesarean section].

LETTERS * CORRESPONDANCE We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spa...
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