their official association and de- gin than conventional medical treatment or physiotherapy. The nouncing such nonsense? study was so convincing on effecPaul C.S. Hoaken, MD tiveness and cost-effectiveness Hotel Dieu Hospital that the authors and other mediKingston, Ont. cal authorities in England advocated inclusion of chiropractic [Dr. McWhirter responds:] services in the National Health It is not clear to me that the Service. Spinal Health Week proclamation (the origin of which I know noth- Brian McWhirter, DC ing about) contains anything to Thompson, Man. support Dr. Hoaken's comment about pseudoscientific dogma. In References saying that anything about spinal 1. Lewit K: Manipulative Therapy in Rehealth is "clearly established" in a habilitation of the Locomotor System, 2nd ed, Butterworth, Oxford, 1991: 273 scientific sense the proclamation S (ed): Principles and Pracobviously goes too far. However, I 2. Haldeman Chiropractic, Appleton and tice of agree with it that preventive spiLange, Norwalk, Conn, 1992: ch 8-10 nal examinations and chiropractic 3. Lewit K: Manipulative Therapy in Rehabilitation of the Locomotor System, care for faulty biomechanics and 2nd ed, Butterworth, Oxford, 1991: 258 posture are valuable to general Meade TW, Dyer S, Browne W et al: health and well-being, as do lead- 4. Low back pain of mechanical origin: ing medical authorities (such as randomised comparison of chiropractic and hospital outpatient treatment. BMJ the neurologist Lewit,l) who rec1990; 300: 1431-1437 ognize the roles of spinal dysfunction and manipulation. The doctrine that misaligned vertebrae result in pinched nerves, thereby obstructing life force and Hospital administration producing disease, is indeed historic. You do not hear this from lthough extremely imthe modem chiropractic profesA pressed with and supportsion, whether individuals or proive of Dr. Derek Gellfessional organizations, such as man's excellent book The CMA the Ontario Chiropractic Associa- Guide to Medical Administration tion. in Canadian Hospitals, I take This does not mean, however, issue with Dr. Bruce P. Squires' that spinal manipulation cannot suggestion that in 1978 there was have an unexpectedly wide range no single source of information on of effects on visceral function, hospital administration in Canada which is linked to spinal function (Can Med Assoc J 1992; 147: by spinal reflex physiology. For 387). intelligent discussions of the basic Textbooks on administration and clinical science in this area may indeed have been scarce, but see Haldeman2 and Lewit.3 the Canadian Hospital AssociaI do take issue with Dr. Bed- tion's distance education pronar's assertions that chiropractic grams (i.e., Departmental Mancare has no lasting benefit for agement, Health Services Manpatients with chronic low-back agement and Long Term Care pain and that public money spent Management) filled the gap in on chiropractic care is a waste. practical management education Meade and colleagues4 reported for administrators who wanted to that chiropractic care was signifi- study while maintaining full-time cantly more effective in the treat- jobs. More than 21 000 health ment of both acute and chronic care professionals have completed low-back pain of mechanical ori- these courses since they began, in NOVEMBER 1, 1992

1951. There was also a course in hospital administration at the University of Toronto, headed by Dr. Harvey Agnew, which began in 1947, and another at the University of Montreal, headed by Dr. Gerald Lasalle, which began in 1956. Carol Clemenhagen President Canadian Hospital Association Ottawa, Ont.

CT scanners vie for title I must protest the Newsbriefs item "Winnipeg hospital has busiest CT scanners in world, doctor reports" (Can Med Assoc J 1992; 146: 2207). Dr. Edward Lyons, head of radiology at the Health Sciences Centre, Winnipeg, indicates that the 8000 scans performed annually per computed tomography (CT) unit make the centre's two units the busiest scanners in the world. In our fiscal year ending Mar. 31, 1992, the single GE 9800 CT scanner in the Imaging Department at St. Joseph's Hospital, Hamilton, completed scans on 8420 patients. Assuming that the research behind Lyons' announcement is otherwise correct it therefore appears that our scanner is the busiest in the world. Furthermore, I state categorically that our machine receives no steroid injections whatsoever to maintain this performance level. This throughput is achieved during an equivalent of about one and a half shifts per day for 5 days a week only. At this time of crisis for Canadian unity our department would be more than pleased to share the secrets of our operation across provincial borders with Lyons or with physicians from any other scanning centres in the country. Our department is preparing to formally request updated CT equipment, and I would ask Lyons CAN MED ASSOC J

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