LETTERS * CORRESPONDANCE
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors of accepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement.
Seules peuvent etre retenues pour publication les lettres recues en double dont la longueur n'excede pas 450 mots. Elles doivent etre mecanographi&es en qualite (> sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession des droits d'auteur. Les lettres ne doivent rien contenir qui ait ete presente ailleurs pour publication ou dej& paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont detruites. Les lettres retenues peuvent etre abregees ou faire l'objet de modifications d'ordre redactionnel.
Protection against ultraviolet radiation T n he effects of the sun on the skin are quite rightly given "headline billing" on the cover of the Apr. 15, 1992, issue
of CMAJ. Unfortunately, although the epidemiologic importance of excessive sun exposure is forcefully and accurately outlined in "MDs and ozone depletion: Be careful not to turn patients into 'cancerphobes'," by Dr. Peter P. Morgan (146: 1397-1399), the important details of sunscreen use are presented vaguely. There is widespread confusion among the public and even among physicians about which sunscreen to recommend, and certainly CMAJ should not compound this confusion. SEPTEMBER 15, 1992
I really don't know what an "industrial-strength sun blocker" is. The sun protection factor (SPF), and not the "blocking factor" mentioned in the article, is the measure of protection against short-wave ultraviolet radiation (UVB). The number implies relative protection; for example, with an SPF of 15 approximately 1/15th of the UVB penetrates the skin. However, there may not be much greater protection with higher SPFs, and the accuracy of the higher numbers is questionable. I recommend that my patients use something with an SPF of at least 15, but I don't insist on higher numbers. It is extremely difficult to quantify penetration of the skin by long-wave ultraviolet radiation (UVA), and the claims of many sunscreens to protect against UVA are not supported by clinical data. Avobenzone (Parsol 1789), currently in only two of the sunscreens in Canada (which are somewhat more expensive than most of the competition), has shown the best available protection against UVA apart from that provided by opaque true "sunblocks." Although UVA has long-term damaging effects on the skin, the prime culprit, as far as is known, is UVB. Thus, if cost is a significant impediment the use of a reputable UVB sunscreen is appropriate. Ignored in the article is substantivity - that is, how well the sunscreen stays on the skin. A greasy sunscreen is best for someone engaging in water sports or likely to sweat profusely but is unacceptable on the face, where it may stimulate the development of acne or come into contact with the eyes and cause stinging.
It should be emphasized to patients that sunscreens are only an adjunct in protection and should not be used as a means to achieve lengthy exposure to sunlight. Finally, Dr. Donald Rosenthal, whom Dr. Morgan quotes, is a Hamilton, not Ottawa, dermatologist. John Goodall, MD, FRCPC Ottawa, Ont.
The frequent reports in the news media about the dangers of excessive exposure to sunlight continually remind and frighten people about the possibility of getting skin cancer. However, these reports do not discuss the connection between people's nutritional health and their susceptibility to cancer of the skin. Since ultraviolet radiation increases the formation of free radicals it would not be surprising if an increase in the availability of antioxidants prevented some of the toxic reactions to ultraviolet radiation. Selenium is such a preventive nutrient. Burke and colleagues' reported that a lotion containing 0.02% L-selenomethionine or water containing 1.2 parts per million of this substance when given to hairless, pigmented mice protected them against damage from ultraviolet radiation. These doses did not cause any toxic reactions. The authors concluded that "L-selenomethionine is effective in protecting against skin cancer . . . both by retarding the onset and reducing the number of lesions and . . . in reducing the acute damage induced by UV ir-
radiation-inflammation (sunburn), blistering, and pigmentation (tanning)." No blisters develCAN MED ASSOC J 1992; 147 (6)
839
the morality of abortion" (Can Med Assoc J 1992; 146: 600, 601, 604-607) she was bold to tackle the topic of abortion and explained her ideas well. However, I believe that her arguments, well intended as they may be, are another quest for the elusive middle ground of the morality of abortion. It is not to be found. Exploring the question of a woman's responsibility in becoming pregnant in order to decide on the permissibility of terminating that pregnancy is flawed, because the woman does not answer the first question: Am I killing another human being? If the answer is No, then perhaps McEvoy's exercise of looking at specific examples of women seeking terminations may be useful. However, that will depend on the value the expectant mother gives to her unborn child as compared with the many other factors in her life. At best, all values are relative in this sort of world: nothing has any absolute value, including human life. No matter how well constructed and intricate the reasoning becomes for or against the decision to choose termination it will always Abram Hoffer, MD, PhD be fickle: the basis will be as Victoria, BC strong as the feelings about one's present job or career plan. This is Reference a rather disturbing way to decide the fate of an unborn child. 1. Burke KE, Combs GF Jr, Gross EG et If the answer is Yes, then all al: The effects of topical and oral Lselenomethionine on pigmentation and other considerations, compelling skin cancer induced by ultraviolet irra- as they may be, will not have any diation. Nutr Cancer 1992; 17: 123-137 greater value than that of the life of an unborn child. The woman's degree of responsibility in becoming pregnant should not decide the value or fate of human life, Responsibility and which remains inviolable.
oped in the treated mice during the early weeks of irradiation, but they did develop in two-thirds of the control mice. Burke and colleagues concluded with the practical suggestion that "protection might be provided by either topically or orally administered SeMet." Selenium is a good antioxidant. It is synergistic with vitamin E, the body's best-known fat-soluble antioxidant. The daily recommended dose is 200 ,ug. I have given 600 ,ug or more to certain patients for many years and have seen no toxic effects. I therefore suggest that the three best-known natural antioxidants - ascorbic acid, vitamin E and selenium be used to protect people against the toxic effects of excessive ultraviolet radiation, in daily doses of 3 g or more, 800 IU and 200 ,ug respectively. It should not take too much time to test these antioxidants in controlled studies. However, because the danger of skin cancer and melanoma is so great it appears prudent to take these simple nutrients as a precaution. They would, of course, have other advantages.
abortion P
atricia McEvoy is to be congratulated for winning the Dr. William Logie medical ethics essay contest, sponsored by the CMA. In "Is a woman responsible for being pregnant? Another discussion about 840
CAN MED ASSOC J 1992; 147 (6)
Donald G. Jansen, MD, CCFP
Campbell's Bay, Que.
Ms. McEvoy's article concludes that the morality of abortion is socially dependent. The author has not considered the impact of abortion on society.
First, feminist literature is replete with the desire to replace an androcentric, power-dominated approach to social organization and policy and thus stop the misuse of power by men. I agree that change is essential. Termination of pregnancy is the act of a powerful person (the pregnant woman) against a voiceless, innocent and powerless person. How does the misuse of power by women in this situation prove that their androgynous and gynocentric approaches to the use of power are different or better? Can the route to a more compassionate, nurturing and liberal society be through the destruction of any minority (in this case, fetuses)? Second, abortion may impede the goal of reproductive freedom for women. Making a woman responsible for the decision to terminate her pregnancy or not may absolve society of any responsibility to assist her and her child if she chooses to continue the pregnancy. The continuing poor treatment of single-parent families will result in more women being coerced, socially and financially, to choose abortion. This will ultimately shrink the size of the group in need and allow society to eventually ignore it altogether. In the long term, society can avoid the need to change the way it treats women and children by promoting abortion, among other programs. Therefore, if the approach to the morality of abortion is contingent on society's mistreatment of women, then abortion will become increasingly moral. Third, sex-specific abortion assists family planning. Female fetuses are preferentially aborted. As women become a minority in society will they be further oppressed by male-dominated power structures, or will there be greater value attached to the female sex (but as an object or commodity), and, if so, what happens to a woman's personhood and equality with men? LE 15 SEPTEMBRE 1992
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors of accepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement.
Seules peuvent etre retenues pour publication les lettres recues en double dont la longueur n'excede pas 450 mots. Elles doivent etre mecanographi&es en qualite (> sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession des droits d'auteur. Les lettres ne doivent rien contenir qui ait ete presente ailleurs pour publication ou dej& paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont detruites. Les lettres retenues peuvent etre abregees ou faire l'objet de modifications d'ordre redactionnel.
Protection against ultraviolet radiation T n he effects of the sun on the skin are quite rightly given "headline billing" on the cover of the Apr. 15, 1992, issue
of CMAJ. Unfortunately, although the epidemiologic importance of excessive sun exposure is forcefully and accurately outlined in "MDs and ozone depletion: Be careful not to turn patients into 'cancerphobes'," by Dr. Peter P. Morgan (146: 1397-1399), the important details of sunscreen use are presented vaguely. There is widespread confusion among the public and even among physicians about which sunscreen to recommend, and certainly CMAJ should not compound this confusion. SEPTEMBER 15, 1992
I really don't know what an "industrial-strength sun blocker" is. The sun protection factor (SPF), and not the "blocking factor" mentioned in the article, is the measure of protection against short-wave ultraviolet radiation (UVB). The number implies relative protection; for example, with an SPF of 15 approximately 1/15th of the UVB penetrates the skin. However, there may not be much greater protection with higher SPFs, and the accuracy of the higher numbers is questionable. I recommend that my patients use something with an SPF of at least 15, but I don't insist on higher numbers. It is extremely difficult to quantify penetration of the skin by long-wave ultraviolet radiation (UVA), and the claims of many sunscreens to protect against UVA are not supported by clinical data. Avobenzone (Parsol 1789), currently in only two of the sunscreens in Canada (which are somewhat more expensive than most of the competition), has shown the best available protection against UVA apart from that provided by opaque true "sunblocks." Although UVA has long-term damaging effects on the skin, the prime culprit, as far as is known, is UVB. Thus, if cost is a significant impediment the use of a reputable UVB sunscreen is appropriate. Ignored in the article is substantivity - that is, how well the sunscreen stays on the skin. A greasy sunscreen is best for someone engaging in water sports or likely to sweat profusely but is unacceptable on the face, where it may stimulate the development of acne or come into contact with the eyes and cause stinging.
It should be emphasized to patients that sunscreens are only an adjunct in protection and should not be used as a means to achieve lengthy exposure to sunlight. Finally, Dr. Donald Rosenthal, whom Dr. Morgan quotes, is a Hamilton, not Ottawa, dermatologist. John Goodall, MD, FRCPC Ottawa, Ont.
The frequent reports in the news media about the dangers of excessive exposure to sunlight continually remind and frighten people about the possibility of getting skin cancer. However, these reports do not discuss the connection between people's nutritional health and their susceptibility to cancer of the skin. Since ultraviolet radiation increases the formation of free radicals it would not be surprising if an increase in the availability of antioxidants prevented some of the toxic reactions to ultraviolet radiation. Selenium is such a preventive nutrient. Burke and colleagues' reported that a lotion containing 0.02% L-selenomethionine or water containing 1.2 parts per million of this substance when given to hairless, pigmented mice protected them against damage from ultraviolet radiation. These doses did not cause any toxic reactions. The authors concluded that "L-selenomethionine is effective in protecting against skin cancer . . . both by retarding the onset and reducing the number of lesions and . . . in reducing the acute damage induced by UV ir-
radiation-inflammation (sunburn), blistering, and pigmentation (tanning)." No blisters develCAN MED ASSOC J 1992; 147 (6)
839
the morality of abortion" (Can Med Assoc J 1992; 146: 600, 601, 604-607) she was bold to tackle the topic of abortion and explained her ideas well. However, I believe that her arguments, well intended as they may be, are another quest for the elusive middle ground of the morality of abortion. It is not to be found. Exploring the question of a woman's responsibility in becoming pregnant in order to decide on the permissibility of terminating that pregnancy is flawed, because the woman does not answer the first question: Am I killing another human being? If the answer is No, then perhaps McEvoy's exercise of looking at specific examples of women seeking terminations may be useful. However, that will depend on the value the expectant mother gives to her unborn child as compared with the many other factors in her life. At best, all values are relative in this sort of world: nothing has any absolute value, including human life. No matter how well constructed and intricate the reasoning becomes for or against the decision to choose termination it will always Abram Hoffer, MD, PhD be fickle: the basis will be as Victoria, BC strong as the feelings about one's present job or career plan. This is Reference a rather disturbing way to decide the fate of an unborn child. 1. Burke KE, Combs GF Jr, Gross EG et If the answer is Yes, then all al: The effects of topical and oral Lselenomethionine on pigmentation and other considerations, compelling skin cancer induced by ultraviolet irra- as they may be, will not have any diation. Nutr Cancer 1992; 17: 123-137 greater value than that of the life of an unborn child. The woman's degree of responsibility in becoming pregnant should not decide the value or fate of human life, Responsibility and which remains inviolable.
oped in the treated mice during the early weeks of irradiation, but they did develop in two-thirds of the control mice. Burke and colleagues concluded with the practical suggestion that "protection might be provided by either topically or orally administered SeMet." Selenium is a good antioxidant. It is synergistic with vitamin E, the body's best-known fat-soluble antioxidant. The daily recommended dose is 200 ,ug. I have given 600 ,ug or more to certain patients for many years and have seen no toxic effects. I therefore suggest that the three best-known natural antioxidants - ascorbic acid, vitamin E and selenium be used to protect people against the toxic effects of excessive ultraviolet radiation, in daily doses of 3 g or more, 800 IU and 200 ,ug respectively. It should not take too much time to test these antioxidants in controlled studies. However, because the danger of skin cancer and melanoma is so great it appears prudent to take these simple nutrients as a precaution. They would, of course, have other advantages.
abortion P
atricia McEvoy is to be congratulated for winning the Dr. William Logie medical ethics essay contest, sponsored by the CMA. In "Is a woman responsible for being pregnant? Another discussion about 840
CAN MED ASSOC J 1992; 147 (6)
Donald G. Jansen, MD, CCFP
Campbell's Bay, Que.
Ms. McEvoy's article concludes that the morality of abortion is socially dependent. The author has not considered the impact of abortion on society.
First, feminist literature is replete with the desire to replace an androcentric, power-dominated approach to social organization and policy and thus stop the misuse of power by men. I agree that change is essential. Termination of pregnancy is the act of a powerful person (the pregnant woman) against a voiceless, innocent and powerless person. How does the misuse of power by women in this situation prove that their androgynous and gynocentric approaches to the use of power are different or better? Can the route to a more compassionate, nurturing and liberal society be through the destruction of any minority (in this case, fetuses)? Second, abortion may impede the goal of reproductive freedom for women. Making a woman responsible for the decision to terminate her pregnancy or not may absolve society of any responsibility to assist her and her child if she chooses to continue the pregnancy. The continuing poor treatment of single-parent families will result in more women being coerced, socially and financially, to choose abortion. This will ultimately shrink the size of the group in need and allow society to eventually ignore it altogether. In the long term, society can avoid the need to change the way it treats women and children by promoting abortion, among other programs. Therefore, if the approach to the morality of abortion is contingent on society's mistreatment of women, then abortion will become increasingly moral. Third, sex-specific abortion assists family planning. Female fetuses are preferentially aborted. As women become a minority in society will they be further oppressed by male-dominated power structures, or will there be greater value attached to the female sex (but as an object or commodity), and, if so, what happens to a woman's personhood and equality with men? LE 15 SEPTEMBRE 1992
