medicine is prescientific by definition, since its arrival predates the scientific age. Both my articles describe the theoretic framework of ayurvedic medicine in some detail. Although Dr. Chopra presents circumstantial evidence to support the viability of the concepts, even he would admit that, from the present state of scientific knowledge, the concepts are difficult to verify and therefore remain speculative. Nevertheless, it is possible to scientifically evaluate ayurvedic therapies. Bodeker states that the articles do not describe the full range of scientific studies either completed or in progress; he is undoubtedly correct. On the other hand, they more than adequately convey a sense of the depth and breadth of scientific study of ayurvedic treatments. For that reason the articles can hardly be described as "a substantial imbalance in reporting." Bodeker seems to have difficulty in grasping the difference between in-vitro and in-vivo studies. There have been numerous in-vitro studies on the effects of certain ayurvedic compounds but few double-blind placebo-controlled studies involving humans suffering from the diseases ayurvedic medicine purports to correct. As pointed out by Dr. Victor Herbert, professor of medicine at Mount Sinai Medical Center, New York, such in-vitro studies have "no relation to human disease. What happens in a test tube has nothing to do with what happens in a real, live person." Some of these problems will be ironed out as a result of clinical trials. Such studies have not been completed and the data not yet analysed; until then the jury of scientific opinion is out. To say otherwise would do a great disservice to CMAJ readers. Dr. Kubacki's comments are those of a true believer in ayurvedic medicine. At this time, 12
CAN MEDASSOCJ 1991; 145(1)
however, it would take a transcendental leap of faith to accept the points he raises as the unvarnished truth. Brian Goldman, MD Contributing editor, CMAJ
Letters of support needed W r e are appealing to the x members of the CMA to help in a campaign to remedy an apparent case of human rights abuse involving a
physician.
From several unofficial sources we understand that a young Cuban neurologist, Dr. Julian Aranta, has been imprisoned without charges being laid at the Combinado del Este prison in Havana since Oct. 26, 1990. We have not established what charge is to be laid in this case, but some unconfirmed reports state that it could be involvement in attempting to set up a human rights group among Cuban physicians; other reports state that the charge will be involvement in a plot to overthrow the government. The latter charge, especially, seems totally preposterous to those of us who knew Arana when he worked at the University of British Columbia in the laboratory of the Department of Pharmacology and Therapeutics. Between 1987 and 1988 Arania was on a Pan-American Health Organization Fellowship to learn new biochemical techniques that he could implement at the Institute of Neurology and Neurosurgery in Havana. Arafna was a diligent medical scientist and a caring, sensitive individual. He was proud of the educational and medical standards of his homeland and of the accessibility of these services to the people of Cuba as a whole. We never heard him criticize or com-
plain about conditions in Cuba. Indeed, he was anxious to return home to his family and to begin working with his newly acquired skills at the institute. We - his friends and colleagues in Canada - are dismayed that Arafna has been held for over 6 months without formal public charges being laid. We wish to be assured that he is allowed visits by his family and his lawyer, and we want to be certain that he will either have a fair and open trial in the near future or, if not charged, that he will soon be released. We hope that Canadian physicians will take a few moments to write a letter in support of Julian Arania. Such letters should be sent to Dr. Thomas L. Perry, Sr., Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Sciences Mall, Vancouver, BC V6T 1Z3. We will forward them to officials in Cuba by some means other than the postal service, which is exceedingly slow between Canada and Cuba. We thank those physicians who take the time to respond to our request for letters and CMAJ for the opportunity to publish our plea for help. James G. Foulks, MD, PhD Charles Krieger, MD, PhD Bernard A. MacLeod, MD Thomas L. Perry, Sr., MD Thomas L. Perry, Jr., MD David M.J. Quastel, MD, PhD Morley C. Sutter, MD, PhD James M. Wright, MD University of British Columbia Vancouver, BC
Caution urged in use of restraints I have recently received two mailings of a glossy flyer ..about the Olympic Papoose Board (Olympic Medical Corp., LE lerJUILLET 1991
Seattle) advertising it as a safe, fast restraint for frantic patients that saves time and improves patient care. In the introduction it is claimed that a struggling, frantic child can be immobilized in less than 60 seconds on a papoose board and, further on, that the extra-large papoose board is an extremely useful aid for the temporary restraint of patients with nervous disorders or involuntary muscle spasm and for the mentally retarded. Nowhere in the advertisement are the dangers or disadvantages of such restraints detailed. On the contrary, the safety and convenience of the product are stressed. Restraints are not without danger, particularly such new ones as the Olympic Papoose Board, in which hardly any movement is possible. They are terrifying to any child, particularly to those who are mentally or neurological-. ly handicapped. They may contribute to illness and death by preventing breathing or through the possibility of vomiting and
aspiration. I therefore urge that all restraints be used with caution in any medical situation - pediatric or otherwise - and that manufacturers of such restraints be required to detail the limitations and dangers of their products. Peter K. Lewin, MD, FRCPC 716-170 St. George St. Toronto, Ont.
[The manufacturer responds.] Invented by a physician, the Olympic Papoose Board has been offered for sale in the United
JULY 1, 9991
States and Canada for more than 23 years. Tens of thousands of these restraints have been purchased by physicians and are in use in clinics and emergency departments. There has not been a single reported instance of physical injury or psychologic harm to a patient during their use. This history, we believe, amply supports our claims as to the safety and efficacy of the product. We agree with Dr. Lewin that any form of restraint - mechanical or manual - should be used with caution. Like any reputable manufacturer we do not hesitate to publish cautionary instructions for our products when applicable. Jay Jones President Olympic Medical Corp. Seattle, Wash.
Physicians and the ecologic crisis I n their letter (Can Med Assoc J 1989; 141: 1224) Dr. James M. Gall and associates object to the ecologically destructive use of plastic wrapping in the delivery of CMAJ. It would seem that no response in word or deed was felt necessary. I must add a second objection: Why is a 197 by 267 mm piece of paper required to house a 25 by 84 mm address label? To help reduce waste why not stick the address label to a bottom corner of the front cover of the journal and restrict the mailing of Strategy, Humane Medicine, posters and other supplements to every other issue of CMAJ? This would cut in half the number of
plastic wrappers necessary for distribution. Anyone who cringes at the thought of Canada Post employees bending the corner of an unprotected journal or of an address sticker sullying the cover should be reminded that this is an association journal, not a limited edition collector's item. Our planet deserves better treatment. Robert Barnes Clinical clerk McGill University Montreal, Que.
[The CMA responds.] At this time there is no practical alternative to plastic wrap. Representatives from the Division of Chemistry at the National Research Council have said that "such material [flexible plastic] is not a problem in sanitary landfill sites. . . . It is environmentally benign." We can only encourage our readers to recycle such materials if plastic recycling programs are available. The regulations of Canada Post Corporation require that certain information be printed on the journal itself, on the polybag or on a carrier card. At present the most cost-effective way of doing this is to use a separate carrier card. We use the blank side to print special announcements in order to save paper and keep down costs. Second-class mail regulations limit the number of polybag inserts to four per issue. For reasons of volume we are unable to limit our distribution of supplemental material to every other issue. Susan Stockwell Director of publications
CAN MED ASSOC J 199 1; 145 (1)
13
CAN MEDASSOCJ 1991; 145(1)
however, it would take a transcendental leap of faith to accept the points he raises as the unvarnished truth. Brian Goldman, MD Contributing editor, CMAJ
Letters of support needed W r e are appealing to the x members of the CMA to help in a campaign to remedy an apparent case of human rights abuse involving a
physician.
From several unofficial sources we understand that a young Cuban neurologist, Dr. Julian Aranta, has been imprisoned without charges being laid at the Combinado del Este prison in Havana since Oct. 26, 1990. We have not established what charge is to be laid in this case, but some unconfirmed reports state that it could be involvement in attempting to set up a human rights group among Cuban physicians; other reports state that the charge will be involvement in a plot to overthrow the government. The latter charge, especially, seems totally preposterous to those of us who knew Arana when he worked at the University of British Columbia in the laboratory of the Department of Pharmacology and Therapeutics. Between 1987 and 1988 Arania was on a Pan-American Health Organization Fellowship to learn new biochemical techniques that he could implement at the Institute of Neurology and Neurosurgery in Havana. Arafna was a diligent medical scientist and a caring, sensitive individual. He was proud of the educational and medical standards of his homeland and of the accessibility of these services to the people of Cuba as a whole. We never heard him criticize or com-
plain about conditions in Cuba. Indeed, he was anxious to return home to his family and to begin working with his newly acquired skills at the institute. We - his friends and colleagues in Canada - are dismayed that Arafna has been held for over 6 months without formal public charges being laid. We wish to be assured that he is allowed visits by his family and his lawyer, and we want to be certain that he will either have a fair and open trial in the near future or, if not charged, that he will soon be released. We hope that Canadian physicians will take a few moments to write a letter in support of Julian Arania. Such letters should be sent to Dr. Thomas L. Perry, Sr., Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Sciences Mall, Vancouver, BC V6T 1Z3. We will forward them to officials in Cuba by some means other than the postal service, which is exceedingly slow between Canada and Cuba. We thank those physicians who take the time to respond to our request for letters and CMAJ for the opportunity to publish our plea for help. James G. Foulks, MD, PhD Charles Krieger, MD, PhD Bernard A. MacLeod, MD Thomas L. Perry, Sr., MD Thomas L. Perry, Jr., MD David M.J. Quastel, MD, PhD Morley C. Sutter, MD, PhD James M. Wright, MD University of British Columbia Vancouver, BC
Caution urged in use of restraints I have recently received two mailings of a glossy flyer ..about the Olympic Papoose Board (Olympic Medical Corp., LE lerJUILLET 1991
Seattle) advertising it as a safe, fast restraint for frantic patients that saves time and improves patient care. In the introduction it is claimed that a struggling, frantic child can be immobilized in less than 60 seconds on a papoose board and, further on, that the extra-large papoose board is an extremely useful aid for the temporary restraint of patients with nervous disorders or involuntary muscle spasm and for the mentally retarded. Nowhere in the advertisement are the dangers or disadvantages of such restraints detailed. On the contrary, the safety and convenience of the product are stressed. Restraints are not without danger, particularly such new ones as the Olympic Papoose Board, in which hardly any movement is possible. They are terrifying to any child, particularly to those who are mentally or neurological-. ly handicapped. They may contribute to illness and death by preventing breathing or through the possibility of vomiting and
aspiration. I therefore urge that all restraints be used with caution in any medical situation - pediatric or otherwise - and that manufacturers of such restraints be required to detail the limitations and dangers of their products. Peter K. Lewin, MD, FRCPC 716-170 St. George St. Toronto, Ont.
[The manufacturer responds.] Invented by a physician, the Olympic Papoose Board has been offered for sale in the United
JULY 1, 9991
States and Canada for more than 23 years. Tens of thousands of these restraints have been purchased by physicians and are in use in clinics and emergency departments. There has not been a single reported instance of physical injury or psychologic harm to a patient during their use. This history, we believe, amply supports our claims as to the safety and efficacy of the product. We agree with Dr. Lewin that any form of restraint - mechanical or manual - should be used with caution. Like any reputable manufacturer we do not hesitate to publish cautionary instructions for our products when applicable. Jay Jones President Olympic Medical Corp. Seattle, Wash.
Physicians and the ecologic crisis I n their letter (Can Med Assoc J 1989; 141: 1224) Dr. James M. Gall and associates object to the ecologically destructive use of plastic wrapping in the delivery of CMAJ. It would seem that no response in word or deed was felt necessary. I must add a second objection: Why is a 197 by 267 mm piece of paper required to house a 25 by 84 mm address label? To help reduce waste why not stick the address label to a bottom corner of the front cover of the journal and restrict the mailing of Strategy, Humane Medicine, posters and other supplements to every other issue of CMAJ? This would cut in half the number of
plastic wrappers necessary for distribution. Anyone who cringes at the thought of Canada Post employees bending the corner of an unprotected journal or of an address sticker sullying the cover should be reminded that this is an association journal, not a limited edition collector's item. Our planet deserves better treatment. Robert Barnes Clinical clerk McGill University Montreal, Que.
[The CMA responds.] At this time there is no practical alternative to plastic wrap. Representatives from the Division of Chemistry at the National Research Council have said that "such material [flexible plastic] is not a problem in sanitary landfill sites. . . . It is environmentally benign." We can only encourage our readers to recycle such materials if plastic recycling programs are available. The regulations of Canada Post Corporation require that certain information be printed on the journal itself, on the polybag or on a carrier card. At present the most cost-effective way of doing this is to use a separate carrier card. We use the blank side to print special announcements in order to save paper and keep down costs. Second-class mail regulations limit the number of polybag inserts to four per issue. For reasons of volume we are unable to limit our distribution of supplemental material to every other issue. Susan Stockwell Director of publications
CAN MED ASSOC J 199 1; 145 (1)
13
