management of pertussis. Although we may agree with Clarkson's comments about the diagnosis of pertussis, comments about this topic would have been inappropriate in the guidelines. The reasons for Dr. Clarkson's confusion about the recommendations for chemoprophylaxis are unclear. The guidelines state that unless there are contraindications all household, day-care and other contacts should receive erythromycin prophylaxis. Only if this is impractical should a more restricted approach be considered. Such a restriction would be less than ideal and should occur only in unusual circumstances, such as a very large outbreak or a shortage of chemoprophylactic agents. Local decision-making in unusual circumstances is preferable to rigid guidelines. There is no consensus about the management of pregnant contacts. An individual decision should be made in consultation with the woman's physician, account being taken of the nature of the exposure, the likelihood that small children will be exposed and the stage of the pregnancy, as well as other health conditions. Clarkson emphasizes updating and alerting physicians, other health care workers, schools and the public. This is considered to be an integral part of active surveillance, a term that also includes early detection so that preventive intervention is possible. The groups that prepared the report recommended a lower maximum daily dose and a shorter course of erythromycin than has previously been recommended, on the basis of unpublished data available to them. The new regimen should lead to better compliance because of fewer side effects, lower cost and shorter duration of therapy. They refrained from recommending a specific erythromycin product but felt that practitioners would benefit from knowin:g that some experts are Willi2 ng 640
CAN MED ASSOC J 1991; 144 (6)
to recommend erythromycin estolate, an approved product marketed in Canada, in preference to other erythromycins. ' Anne 0. Carter, MD, MHSc, FRCPC Secretary National Advisory Committee on Immunization and Advisory Committee on Epidemiology Noni E. MacDonald, MD, FRCPC Chairman Infectious Diseases and Immunization Committee Canadian Paediatric Society
Reference 1. Bass JW: Erythromycin for treatment
and prevention of pertussis. Pediatr Infect Dis 1986; 5: 154-157
Abortion and the law ccording to the Newsbrief "Most abortions would not conform to new law, MD warns" (Can Med Assoc J 1990; 143: 1099), Dr. William Hall, president of the College of Physicians and Surgeons of Alberta, in referring to Bill C-43, an Act Respecting Abortion, stated that most abortions "would not conform to the new law." He added that "the reality of the situation is that a number of abortions are done that do not [address] a physical, psychological or mental need." Forgive me for asking a silly question - after all, I am only a lay person - but does this not mean that physicians have been doing illegal abortions in Canada? We all know that the old abortion law was much more stringent, much more a "violation" of a woman's "right to choose." I am sure it all can be settled with a simple explanation dealing with one's "interpretation" of the old law. I prefer to call it a shell game, a game in which doctors want little responsibility and accountability for their actions. A
Strange how one's sense of logic vanishes when one is dealing
with the "strictly medical issue" of abortion. Ted Gerk
630-D Belgo Rd. Kelowna, BC
[Dr. Hall replies.]
The remarks that have caused Mr. Gerk some concern were made at the annual general meeting of the Alberta Medical Association (AMA) in late September 1990. As is often the case in such situations, the remarks were incorrectly quoted and taken out of context.
I had carefully prefaced my remarks by stating that I was speaking as a family physician and a member of the AMA. My term as president of the College of Physicians and Surgeons of Alberta has subsequently expired. My comments were directed at the proposed and now, thankfully, defeated Bill C-43, which put physicians in the thankless role of gatekeepers for the medical act of therapeutic abortion. As physicians we are increasingly being forced into this role, especially in regard to the newer and more expensive technologies aimed at extending life. In these situations we attempt to define explicit criteria that would either permit or exclude a medical procedure. In the case of abortion it would not be too difficult to articulate explicit physical and mental criteria that would clearly define situations in which therapeutic abortion would be of benefit to the health of a pregnant woman. The problem arises in formulating clear and explicit "psychologic" criteria. Some might consider the latter to be an oxymoron. It is for these psychologic reasons that most therapeutic abortions in Alberta are currently performed. I certainly take issue with Gerk's comment that physicians "want little responsibility and ac-
CAN MED ASSOC J 1991; 144 (6)
to recommend erythromycin estolate, an approved product marketed in Canada, in preference to other erythromycins. ' Anne 0. Carter, MD, MHSc, FRCPC Secretary National Advisory Committee on Immunization and Advisory Committee on Epidemiology Noni E. MacDonald, MD, FRCPC Chairman Infectious Diseases and Immunization Committee Canadian Paediatric Society
Reference 1. Bass JW: Erythromycin for treatment
and prevention of pertussis. Pediatr Infect Dis 1986; 5: 154-157
Abortion and the law ccording to the Newsbrief "Most abortions would not conform to new law, MD warns" (Can Med Assoc J 1990; 143: 1099), Dr. William Hall, president of the College of Physicians and Surgeons of Alberta, in referring to Bill C-43, an Act Respecting Abortion, stated that most abortions "would not conform to the new law." He added that "the reality of the situation is that a number of abortions are done that do not [address] a physical, psychological or mental need." Forgive me for asking a silly question - after all, I am only a lay person - but does this not mean that physicians have been doing illegal abortions in Canada? We all know that the old abortion law was much more stringent, much more a "violation" of a woman's "right to choose." I am sure it all can be settled with a simple explanation dealing with one's "interpretation" of the old law. I prefer to call it a shell game, a game in which doctors want little responsibility and accountability for their actions. A
Strange how one's sense of logic vanishes when one is dealing
with the "strictly medical issue" of abortion. Ted Gerk
630-D Belgo Rd. Kelowna, BC
[Dr. Hall replies.]
The remarks that have caused Mr. Gerk some concern were made at the annual general meeting of the Alberta Medical Association (AMA) in late September 1990. As is often the case in such situations, the remarks were incorrectly quoted and taken out of context.
I had carefully prefaced my remarks by stating that I was speaking as a family physician and a member of the AMA. My term as president of the College of Physicians and Surgeons of Alberta has subsequently expired. My comments were directed at the proposed and now, thankfully, defeated Bill C-43, which put physicians in the thankless role of gatekeepers for the medical act of therapeutic abortion. As physicians we are increasingly being forced into this role, especially in regard to the newer and more expensive technologies aimed at extending life. In these situations we attempt to define explicit criteria that would either permit or exclude a medical procedure. In the case of abortion it would not be too difficult to articulate explicit physical and mental criteria that would clearly define situations in which therapeutic abortion would be of benefit to the health of a pregnant woman. The problem arises in formulating clear and explicit "psychologic" criteria. Some might consider the latter to be an oxymoron. It is for these psychologic reasons that most therapeutic abortions in Alberta are currently performed. I certainly take issue with Gerk's comment that physicians "want little responsibility and ac-
