spread of HIV. If anything, it will drive underground those who are in most need of being tested. There are good medical and public health reasons for being tested, but testing must be voluntary and with the full consent of the patient. Voluntary testing in the context of counselling before and after offers an excellent opportunity to help reduce the spread of HIV infection. Such an approach must be taken by caring, compassionate physicians and other care providers who are fully knowledgeable about the medical and social consequences of HIV infection. This epidemic can be contained by education but not by forced testing and legal threats. Who needs to be "protected from legal recrimination" when ordering an HIV antibody test? Not me. I have an easy and reliable way of avoiding legal hassles related to HIV antibody testing: carrying out the test with the knowledge and approval of my patient.
ple aged 35 years and over rather than for the entire population. Given that coronary artery bypass surgery is seldom performed on people under 35 the net effect was to divide the same number of procedures by a smaller population and generate an apparently higher rate. The figure of 131.8 was first reported by the Ottawa Citizen as applicable to the fiscal year 198687 and was subsequently "corrected" to 112.8/100 000. The figures were challenged by Dr. Wilbert Keon, director-general of the Ottawa Heart Institute, and defended by the Statistics Canada authors (Ottawa Citizen, Aug. 17, 1990: Cl). A follow-up story emphasized that the Statistics Canada group stood by their results, noted the true denominator only in passing and neither acknowledged that the original figures were misleading nor explained how the misunderstanding occurred (Ottawa Citizen, Aug. 18, 1990: A14). In fact, Statistics Canada data show that from 1983 the ageIain D. Mackie, MD adjusted rate of coronary artery Director bypass surgery in Ottawa has fallHIV Care Programme en and during 1986-87 was St. Joseph's Health Centre Associate professor of medicine 42.2/100 000, similar to that in University of Western Ontario Montreal, Regina and Quebec London, Ont. City (Rod Riley, Statistics Canada: personal communication, Oct. 2, 1990). The Statistics Canada authors Coronary artery will be publishing a clarification bypass surgery rates (Dr. Cyril Nair, Statistics Canada: in Ottawa personal communication, Sept. 25 and 26, 1990), but what concerns A Statistics Canada bulletin me is the misleading impression published in August 1990' Ottawa residents may have reported the rates of coro- formed from the media coverage. nary artery bypass surgery for resi- Moreover, any misapprehensions dents of various census metropoli- might well have been exacerbated tan areas. The rate for Ottawa was by the article "The Ottawa Heart prominently shown as averaging Institute: It's good, but can we 131.8/100 000 population be- afford it?" (Can Med Assoc J tween 1981 and 1987 - well 1990; 142: 616-620), by Dr. Peter above even the national rate in Morgan and Lynne Cohen, which the United States. Unfortunately, proved controversial among the authors did not explain that CMAJ readers (see the Letters secthe rates were calculated for peo- tion in the July 1 and Sept. 1,
1990, issues) and was reprinted by the Ottawa Citizen after the release of the Statistics Canada report. If we are to have an informed public debate about the direction of health care in Canada better strategies must be developed to communicate concepts and new data - not just from the bench and bedside but also from ongoing health services research. As matters stand, a glance at virtually any newspaper is enough to suggest that misinformation and misinterpretation remain the rule rather than the exception. C. David Naylor, MD Clinical Epidemiology Unit and Department of Medicine Sunnybrook Health Science Centre Toronto, Ont.
Reference 1. Peters S, Chagani K, Paddon P, Nair C: Coronary artery bypasss surgery in Canada. Health Rep 1990; 2 (1): 9-26
The Medical Reform Group has a purpose T Nhe ideals of the Medical
Reform Group (Can Med Assoc J 1990; 143: 368369) appear to be lofty, although I have to pause at the idea of an uninformed/inexpert "public" having a direct say in health care resource allocations, as I have to pause at uninformed/inexpert politicians doing the same thing. I don't need a committee to tell me how to treat my patients; I have done my homework, and I know what I am doing. The same principles could surely be better applied in the same way to the distribution of health care resources but appear to be steadfastly refused by our bureaucratic bosses. Regarding Bill 94, certainly it banned extra-billing, but the net result to patients was just plain CAN MED ASSOC J 1990; 143 (12)
1287
ple aged 35 years and over rather than for the entire population. Given that coronary artery bypass surgery is seldom performed on people under 35 the net effect was to divide the same number of procedures by a smaller population and generate an apparently higher rate. The figure of 131.8 was first reported by the Ottawa Citizen as applicable to the fiscal year 198687 and was subsequently "corrected" to 112.8/100 000. The figures were challenged by Dr. Wilbert Keon, director-general of the Ottawa Heart Institute, and defended by the Statistics Canada authors (Ottawa Citizen, Aug. 17, 1990: Cl). A follow-up story emphasized that the Statistics Canada group stood by their results, noted the true denominator only in passing and neither acknowledged that the original figures were misleading nor explained how the misunderstanding occurred (Ottawa Citizen, Aug. 18, 1990: A14). In fact, Statistics Canada data show that from 1983 the ageIain D. Mackie, MD adjusted rate of coronary artery Director bypass surgery in Ottawa has fallHIV Care Programme en and during 1986-87 was St. Joseph's Health Centre Associate professor of medicine 42.2/100 000, similar to that in University of Western Ontario Montreal, Regina and Quebec London, Ont. City (Rod Riley, Statistics Canada: personal communication, Oct. 2, 1990). The Statistics Canada authors Coronary artery will be publishing a clarification bypass surgery rates (Dr. Cyril Nair, Statistics Canada: in Ottawa personal communication, Sept. 25 and 26, 1990), but what concerns A Statistics Canada bulletin me is the misleading impression published in August 1990' Ottawa residents may have reported the rates of coro- formed from the media coverage. nary artery bypass surgery for resi- Moreover, any misapprehensions dents of various census metropoli- might well have been exacerbated tan areas. The rate for Ottawa was by the article "The Ottawa Heart prominently shown as averaging Institute: It's good, but can we 131.8/100 000 population be- afford it?" (Can Med Assoc J tween 1981 and 1987 - well 1990; 142: 616-620), by Dr. Peter above even the national rate in Morgan and Lynne Cohen, which the United States. Unfortunately, proved controversial among the authors did not explain that CMAJ readers (see the Letters secthe rates were calculated for peo- tion in the July 1 and Sept. 1,
1990, issues) and was reprinted by the Ottawa Citizen after the release of the Statistics Canada report. If we are to have an informed public debate about the direction of health care in Canada better strategies must be developed to communicate concepts and new data - not just from the bench and bedside but also from ongoing health services research. As matters stand, a glance at virtually any newspaper is enough to suggest that misinformation and misinterpretation remain the rule rather than the exception. C. David Naylor, MD Clinical Epidemiology Unit and Department of Medicine Sunnybrook Health Science Centre Toronto, Ont.
Reference 1. Peters S, Chagani K, Paddon P, Nair C: Coronary artery bypasss surgery in Canada. Health Rep 1990; 2 (1): 9-26
The Medical Reform Group has a purpose T Nhe ideals of the Medical
Reform Group (Can Med Assoc J 1990; 143: 368369) appear to be lofty, although I have to pause at the idea of an uninformed/inexpert "public" having a direct say in health care resource allocations, as I have to pause at uninformed/inexpert politicians doing the same thing. I don't need a committee to tell me how to treat my patients; I have done my homework, and I know what I am doing. The same principles could surely be better applied in the same way to the distribution of health care resources but appear to be steadfastly refused by our bureaucratic bosses. Regarding Bill 94, certainly it banned extra-billing, but the net result to patients was just plain CAN MED ASSOC J 1990; 143 (12)
1287
