always indicated. We refer Massey to the original document.'
Smoking and health
T he message emphasized by those addressing the issue Michel Chateauvert, MD, CCFP of smoking and health in Department of Family Medicine Anne Duffie, LLB, MD the Jan. 15, 1991, issue of CMAJ Norbert Gilmore, PhD, MD is that although much has been McGill Centre for Medicine, Ethics accomplished in the battle to and Law and Department of Medicine eliminate smoking by Canadians, McGill University Montreal, Que. there is still a long road to travel. 1-I Reference The CMA continues to give smoking and health issues highest 1. Chateauvert M, Duffie A, Gilmore N: Human Immunodeficiency Virus Anti- priority in its lobbying efforts and body Testing: Counselling Guidelines in its policy development efforts. from the Canadian Medical Association, As noted by the cited authors, CMA, Ottawa, 1990 perhaps the single most effective action we can take is to promote an increased sales tax on all tobacco products. As it did in 1989, the CMA, along with other members Informed consent of the National Campaign for Acto HIV antibody testing tion on Tobacco (Canadian CanI would like to correct an im- cer Society, Canadian Council on and Health, Heart and pression that I may have inad- Smoking of Canada, Foundation Stroke vertently given in the second-
last paragraph of my response (Can Med Assoc J 1991; 144: 403404) to the letter from Dr. D.P. Hill (ibid: 403). AIDS is a reportable commmunicable disease in most Canadian provinces. There is some variation in whether this reporting should include nominal reporting of HIV seropositivity. For instance, I believe that Alberta and British Columbia do not require such reporting, whereas Ontario and Nova Scotia apparently do. ' The point I was trying to make is that, to the best of my understanding, in none of these provinces have the greater-interests-of-society considerations of the Canadian Charter of Rights and Freedoms triggered a mandatory testing provision. Eike-Henner W. Kluge, PhD Director of ethics and legal affairs Canadian Medical Association
Reference 1. Responding to HI V/AIDS in Canada, release 1, AIDS Research Program, McGill Centre for Medicine, Ethics and L aw, Montreal, 1990 630
CAN MED ASSOC J 1991; 144 (6)
Non-Smokers' Rights Association and Physicians for a Smoke-Free Canada), is urging the Minister of Finance to impose significant tax increases on all tobacco products. Several provincial medical associations, including those of Prince Edward Island and Ontario, have participated in comparable lobbying for increases in provincial taxes. With 35 000 Canadians dying annually from smoking-related diseases the CMA will continue with others to press for further taxation reform. As noted by the cited authors, physicians must step up their efforts to increase the rates of smoking cessation among their patients. One positive observation, though: physicians have been leading by example. The latest survey carried out by the CMA,4 in 1989, showed that at that time 7.9% of physicians smoked, compared with 32.7% of all Canadians. The survey also indicated that most physicians do not allow smoking in their offices or clinics and that 80% support the CMA policy recommending that pharmacies not sell tobacco products.
There is without doubt much more that can be done in the war against tobacco, and the CMA will continue to give this issue its highest priority and urges its physician members to do likewise. Douglas A. Geekie, BPHE, CPH Director of communications and government relations Canadian Medical Association
References 1. Walters DJ: The gathering momentum against tobacco: Action by physicians is needed on all fronts. Can Med Assoc J 1991; 144: 134-136 2. Pipe A, Walker J, Esdaile D: Canadian physicians and tobacco. Ibid: 137-139 3. CMA Policy Summary: Smoking and health: 1991 update. Ibid: 232A-232B 4. Shariatmadar A: The Smoking Habits of Canadian Physicians, Dept of Health Policy and Economics, CMA, Ottawa, 1989
I concur with the editorials by Walters' and Pipe, Walker and Esdaile.2 It was the action by physicians in the United States that made the impact in reducing cigarette smoking in this country during the last two decades. I thought CMAJ readers might be interested in knowing how serious a problem smoking is in China and how the physicians in China are combatting the problem. According to Dr. M.Z. Chen,3 minister of public health of the People's Republic of China, China ranks as the first in the world in both population and output of tobacco products. A sampling survey of 500 000 people in 1984 showed that the smoking rate among people over the age of 15 years was very high: as high as 61% among the men and lower among the women (7%), for an average of 34%. The rate was lower among doctors (30%) than among factory workers (40%) and government or business people (44%). However, when compared with their US counterparts male Chinese doctors fared poorly, with a rate of 57% as compared with 18%. Therefore, the Chinese Minis-
Smoking and health
T he message emphasized by those addressing the issue Michel Chateauvert, MD, CCFP of smoking and health in Department of Family Medicine Anne Duffie, LLB, MD the Jan. 15, 1991, issue of CMAJ Norbert Gilmore, PhD, MD is that although much has been McGill Centre for Medicine, Ethics accomplished in the battle to and Law and Department of Medicine eliminate smoking by Canadians, McGill University Montreal, Que. there is still a long road to travel. 1-I Reference The CMA continues to give smoking and health issues highest 1. Chateauvert M, Duffie A, Gilmore N: Human Immunodeficiency Virus Anti- priority in its lobbying efforts and body Testing: Counselling Guidelines in its policy development efforts. from the Canadian Medical Association, As noted by the cited authors, CMA, Ottawa, 1990 perhaps the single most effective action we can take is to promote an increased sales tax on all tobacco products. As it did in 1989, the CMA, along with other members Informed consent of the National Campaign for Acto HIV antibody testing tion on Tobacco (Canadian CanI would like to correct an im- cer Society, Canadian Council on and Health, Heart and pression that I may have inad- Smoking of Canada, Foundation Stroke vertently given in the second-
last paragraph of my response (Can Med Assoc J 1991; 144: 403404) to the letter from Dr. D.P. Hill (ibid: 403). AIDS is a reportable commmunicable disease in most Canadian provinces. There is some variation in whether this reporting should include nominal reporting of HIV seropositivity. For instance, I believe that Alberta and British Columbia do not require such reporting, whereas Ontario and Nova Scotia apparently do. ' The point I was trying to make is that, to the best of my understanding, in none of these provinces have the greater-interests-of-society considerations of the Canadian Charter of Rights and Freedoms triggered a mandatory testing provision. Eike-Henner W. Kluge, PhD Director of ethics and legal affairs Canadian Medical Association
Reference 1. Responding to HI V/AIDS in Canada, release 1, AIDS Research Program, McGill Centre for Medicine, Ethics and L aw, Montreal, 1990 630
CAN MED ASSOC J 1991; 144 (6)
Non-Smokers' Rights Association and Physicians for a Smoke-Free Canada), is urging the Minister of Finance to impose significant tax increases on all tobacco products. Several provincial medical associations, including those of Prince Edward Island and Ontario, have participated in comparable lobbying for increases in provincial taxes. With 35 000 Canadians dying annually from smoking-related diseases the CMA will continue with others to press for further taxation reform. As noted by the cited authors, physicians must step up their efforts to increase the rates of smoking cessation among their patients. One positive observation, though: physicians have been leading by example. The latest survey carried out by the CMA,4 in 1989, showed that at that time 7.9% of physicians smoked, compared with 32.7% of all Canadians. The survey also indicated that most physicians do not allow smoking in their offices or clinics and that 80% support the CMA policy recommending that pharmacies not sell tobacco products.
There is without doubt much more that can be done in the war against tobacco, and the CMA will continue to give this issue its highest priority and urges its physician members to do likewise. Douglas A. Geekie, BPHE, CPH Director of communications and government relations Canadian Medical Association
References 1. Walters DJ: The gathering momentum against tobacco: Action by physicians is needed on all fronts. Can Med Assoc J 1991; 144: 134-136 2. Pipe A, Walker J, Esdaile D: Canadian physicians and tobacco. Ibid: 137-139 3. CMA Policy Summary: Smoking and health: 1991 update. Ibid: 232A-232B 4. Shariatmadar A: The Smoking Habits of Canadian Physicians, Dept of Health Policy and Economics, CMA, Ottawa, 1989
I concur with the editorials by Walters' and Pipe, Walker and Esdaile.2 It was the action by physicians in the United States that made the impact in reducing cigarette smoking in this country during the last two decades. I thought CMAJ readers might be interested in knowing how serious a problem smoking is in China and how the physicians in China are combatting the problem. According to Dr. M.Z. Chen,3 minister of public health of the People's Republic of China, China ranks as the first in the world in both population and output of tobacco products. A sampling survey of 500 000 people in 1984 showed that the smoking rate among people over the age of 15 years was very high: as high as 61% among the men and lower among the women (7%), for an average of 34%. The rate was lower among doctors (30%) than among factory workers (40%) and government or business people (44%). However, when compared with their US counterparts male Chinese doctors fared poorly, with a rate of 57% as compared with 18%. Therefore, the Chinese Minis-
