could result in psychotic or severe depressive episodes. Tryptan is also prescribed as an alternative to benzodiazepine drugs for patients with mild to moderate sleep disorders. Many people who cannot tolerate benzodiazepines may have no alternative other than L-tryptophan. If readers have any further questions about Tryptan, they should feel free to contact me at 1-800-361-1448 or 1-800-3611552.
would argue that this time has arrived when fetal brain waves are recordable (about 6 weeks). Obviously, any point along the way, including the 23-week mark, is arbitrary and depends on each person's perspective. When the issue (whether to regard a fetus of a certain age as expendable) is such a momentous one, literally a life-or-death one, surely it is not just or scientific to choose some arbitrary time. Actually, if one insists on choosing an arbitrary age for fetiAnne Nickel, MD cide the study of intrauterine deDirector velopment seems to show that the Medical Department most rapid transition in this conand Regulatory Affairs tinuous process occurs at about 6 ICN Canada Limited Montreal, PQ to 8 weeks, when the embryo is changing into a fetus. Reference Aside from this theorizing about when an early human be1. Belongia EA, Hedberg CW, Gleich GJ comes a "person", the fact reet al: An investigation of the cause of the eosinophilia-myalgia syndrome as- mains that in this country, since sociated with tryptophan use. N Engl J the law on abortion changed in Med 1990; 323: 357- 365 1969, there is virtual abortion on request of the mother. Can we honestly say that this is "respect The fetus as a person for human life"? We tend to dismiss this little entity (the young fetus) as not T he CMA and its Committee on Ethics have worked deserving of any attention, but diligently and thoughtfully those that do look at this individin preparing the discussion paper ual of, say, 8 to 12 weeks find that she or he is amazingly well develon the status of the human fetus. It seems, on reading the arti- oped (for instance, starting to suck cle "CMA's discussion paper on the thumb at 11 to 12 weeks), is fetal rights may spark debate" lovable and a source of surprise (Can Med Assoc J 1990; 143: 404- and wonder, and is certainly not 405), by Patrick Sullivan, that the worthy of being violently elimiauthors of the discussion paper nated just because the mother are trying to establish the age of wishes it at that particular time. fetal viability (about 23 weeks) as the time before which feticide is Patrick G. Coffey, MD Sydel Ct. not of much consequence and 48 Box 13, Group 4, RR 5 after which it might be, when, for Bowmanville, Ont. instance, they state: "At that point the capacities of the fetus meet There are some problems with the the minimal requirements that are CMA's discussion paper on fetal otherwise considered necessary rights. The major one is the defifor someone to be considered a nition of "'person". According to person." the Oxford dictionary a person is Some people, however, would an individual human being and argue that an early human being that is all. If we want to include does not become a "person" till the qualities of reason, free will sometime after birth, and others and responsibility, then we are 1156
CAN MEDASSOCJ 1990; 143(11)
going to have to take personhood as starting sometime between the ages of 6 and 15. I see the hand of Dr. EikeHenner Kluge, the CMA's director of ethics and legal affairs, in the term "full-fledged". People don't have feathers. With regard to "the physician's private morality", morality must always in a sense be private. With even a little knowledge of history and literature one must gravely distrust the generally accepted values of society. They can go just as far astray as those of individuals. Michael Newman, MD Winnipeg Clinic 425 St. Mary Ave. Winnipeg, Man.
Alcohol consumption and plasma lipoproteins T n he Atherosclerosis Update in the May 15, 1990, issue of CMAJ (142: 1089), by Drs. Sital Moorjani and Paul J. Lupien, describes the beneficial effects of moderate alcohol consumption on the risk of coronary heart disease (CHD) through increases in the level of high-density lipoprotein (HDL) cholesterol but concludes with the contradictory statement that "it would not be wise to recommend moderate consumption of alcohol to nonusers". I fail to see why we should not recommend a practice that reduces CHD-related illness and death. Surely the risk of alcoholism is negligible except for addiction-prone patients, who could easily be screened out on the basis of their history. Allen Gold, MD, FRCPC 360 Victoria Ave. Montreal, PQ
[The authors respond.] Although the moderate consumption of alcohol has beneficial ef-
would argue that this time has arrived when fetal brain waves are recordable (about 6 weeks). Obviously, any point along the way, including the 23-week mark, is arbitrary and depends on each person's perspective. When the issue (whether to regard a fetus of a certain age as expendable) is such a momentous one, literally a life-or-death one, surely it is not just or scientific to choose some arbitrary time. Actually, if one insists on choosing an arbitrary age for fetiAnne Nickel, MD cide the study of intrauterine deDirector velopment seems to show that the Medical Department most rapid transition in this conand Regulatory Affairs tinuous process occurs at about 6 ICN Canada Limited Montreal, PQ to 8 weeks, when the embryo is changing into a fetus. Reference Aside from this theorizing about when an early human be1. Belongia EA, Hedberg CW, Gleich GJ comes a "person", the fact reet al: An investigation of the cause of the eosinophilia-myalgia syndrome as- mains that in this country, since sociated with tryptophan use. N Engl J the law on abortion changed in Med 1990; 323: 357- 365 1969, there is virtual abortion on request of the mother. Can we honestly say that this is "respect The fetus as a person for human life"? We tend to dismiss this little entity (the young fetus) as not T he CMA and its Committee on Ethics have worked deserving of any attention, but diligently and thoughtfully those that do look at this individin preparing the discussion paper ual of, say, 8 to 12 weeks find that she or he is amazingly well develon the status of the human fetus. It seems, on reading the arti- oped (for instance, starting to suck cle "CMA's discussion paper on the thumb at 11 to 12 weeks), is fetal rights may spark debate" lovable and a source of surprise (Can Med Assoc J 1990; 143: 404- and wonder, and is certainly not 405), by Patrick Sullivan, that the worthy of being violently elimiauthors of the discussion paper nated just because the mother are trying to establish the age of wishes it at that particular time. fetal viability (about 23 weeks) as the time before which feticide is Patrick G. Coffey, MD Sydel Ct. not of much consequence and 48 Box 13, Group 4, RR 5 after which it might be, when, for Bowmanville, Ont. instance, they state: "At that point the capacities of the fetus meet There are some problems with the the minimal requirements that are CMA's discussion paper on fetal otherwise considered necessary rights. The major one is the defifor someone to be considered a nition of "'person". According to person." the Oxford dictionary a person is Some people, however, would an individual human being and argue that an early human being that is all. If we want to include does not become a "person" till the qualities of reason, free will sometime after birth, and others and responsibility, then we are 1156
CAN MEDASSOCJ 1990; 143(11)
going to have to take personhood as starting sometime between the ages of 6 and 15. I see the hand of Dr. EikeHenner Kluge, the CMA's director of ethics and legal affairs, in the term "full-fledged". People don't have feathers. With regard to "the physician's private morality", morality must always in a sense be private. With even a little knowledge of history and literature one must gravely distrust the generally accepted values of society. They can go just as far astray as those of individuals. Michael Newman, MD Winnipeg Clinic 425 St. Mary Ave. Winnipeg, Man.
Alcohol consumption and plasma lipoproteins T n he Atherosclerosis Update in the May 15, 1990, issue of CMAJ (142: 1089), by Drs. Sital Moorjani and Paul J. Lupien, describes the beneficial effects of moderate alcohol consumption on the risk of coronary heart disease (CHD) through increases in the level of high-density lipoprotein (HDL) cholesterol but concludes with the contradictory statement that "it would not be wise to recommend moderate consumption of alcohol to nonusers". I fail to see why we should not recommend a practice that reduces CHD-related illness and death. Surely the risk of alcoholism is negligible except for addiction-prone patients, who could easily be screened out on the basis of their history. Allen Gold, MD, FRCPC 360 Victoria Ave. Montreal, PQ
[The authors respond.] Although the moderate consumption of alcohol has beneficial ef-
