CORRESPON DENCE
Lack of interest in nutrition? To the editor: In the January 1979 issue of The Annals of the Royal College of Physicians and Surgeons of Canada are 328 abstracts of papers in 27 categories, from allergy and immunology to vascular surgery (beginning on page 22). These papers were presented at the college's annual meeting in February 1979 in Montreal. Of the 328 papers only 10 were about nutrition and the use of vitamins: 1 each referred to orally administered postoperative nutrition, the control of chyle formation with diet in dogs, the protective effect of a high-fibre diet against the development of bowel cancer in rats, the use of bran in reducing the cholesterol content of bile in patients with gallstones, the increase in the cholesterol content of bile in women with a highly refined carbohydrate diet, nutritional management of gastrointestinal fistulas and protein requirements with total parenteral nutrition, and 3 discussed the use of a synthetic vitamin D3 metabolite in hyperparathyroidism, osteoporosis and renal osteodystrophy. These 10 papers represent 3% of the total. I think this percentage is representative of the interest the profession has in nutrition. Contributions to the Correspondence
section are welcomed and if considered suitable will be published as space permits. They should be typewritten double-spaced and, except for case reports, should be no longer than 1½ manuscript pages.
This lack of interest in nutrition (45.6%) had serum ferritin values may be equated with the near total diagnostic of iron deficiency (less rejection of the unwritten law of than 11 ng/ml in females and less nature - we are biochemical beings; than 23 ng/ml in males), while 49 what we are and therefore the ills (54.4%) had either normal or we endure are largely dependent on elevated serum ferritin values. Of the the biochemical substances we 49, 14 had inflammatory disorders, provide in our diet. With this rejec- 11 had hematologic malignant dition, nature's law has been supplanted seases, 8 had sickle cell disease, 6 by the pursuit of scicace, the syn- had liver disease, 3 had malignant thesized pill and the intricate bio- tumours, 3 were taking iron supplechemical test. ments, and 1 each had autoimmune I wonder if the medical profes- hemolytic anemia, folate deficiency, sion, like a moth that has been burned aortic incompetence and splenic vein in the lamplight that attracted it, has thrombosis. Even if hematologic not already been seriously betrayed malignant diseases and hemoglobinopathies are excluded because they are by science. disorders in which the serum ferritin CARL J. REICH, MD, FRCP[C] 205A Medical Centre value may not be an accurate guide Calgary, Alta. in the assessment of iron stores,1'2 measurement of the serum ferritin Serum ferritin concentration concentration failed to identify iron and bone marrow iron stores deficiency in 32% of the patients. Thus, while diagnostically low To the editor: We read with interest serum ferritin values accurately rethe article on this topic by Drs. flect iron deficiency, the reverse does M.A.M. Ali, A.W. Luxton and not appear to be true, particularly in W.H.C. Walker (Can Med Assoc J hospitalized patients with compli118: 945, 1978). Our data on the cating illnesses. evaluation of the serum ferritin concentration as an index of iron defiPATRICK L. MCGINNIS, MD ASHOK R, PATEL. MB, FACP ciency in hospitalized patients supK.R.P. RAO, MD port the view that, in the presence of PRABODH C. SHAH, MD Division of hematology certain associated conditions, the Cook County Hospital measurement of the serum ferritin Hektoen Institute Chicago, Illinois concentration may not be reliable in the diagnosis of iron deficiency. The serum ferritin concentration References 1. PETERSON CM, GRAZIANO JH, DE was measured in 90 patients whose Ciu'riis A, et al: Iron metabolism, bone marrow at that time contained sickle cell disease, and response to no stainable iron. Of the 90, 41 cyanate. Blood 46: 583, 1975
1204 CMA JOURNAL/MAY 19, 1979/VOL. 120
2. SHAH PC, PATEL AR, VOHRA RM, et
al: Ferritin levels in hematologic malignancies (abstr). Presented at XVIIth Congress of the International Society of Hematology, Paris, July 23-29, 1978
The logic of SI To the editor: Although I have no scruples about cramming drachms and grains down the drain, I wish to question the passive acceptance of Syst.me international d'unit6s, the SI unit system, by the medical profession. The Metric Commission of Canada - which no doubt pays good salaries and indexed pensions to a bunch of otherwise redundant civil servants - is charged with converting us to a system of measurement based on 1 650 763.37 wavelengths of krypton radiation, or the metre. The commission tells us that 95% of the rest of the world is already using this system. This is a blatant political lie. As far as the promotion of international trade is concerned, I am told that it is still impossible to screw a Japanese metric nut onto a European metric bolt. Irrespective of what the rest of the world may or may not be doing, it was my understanding that international medicine had already developed its own commonly understood units, and that medical professionals throughout the world were able to converse with and understand each other. We now have to change to SI units. Is this a professional decision that has been made by the Canadian Medical Association or by an international medical association, or are we just floating along in a gust of political hot air? Blood cell counts that hitherto were expressed as the number of cells per cubic millimetre are now to be expressed as the number of cells per litre. Why? Which member of the international medical community has used cells per litre all along? Transylvania perhaps? I can only conclude that either errors in sampling and counting are going to be multiplied by 106 or that it will take forever to get the blood work done
and there is going to .be an epidemic of iatrogenic anemia. Notwithstanding the superior virtues of teracells and gigacells, the litre is not an official SI unit, so why are we converting to it? For reasons of logic perhaps? Would it not therefore be logical to express all blood components per litre? Wrong - blood chemistry is still to be expressed as milligrams per decilitre, not milligrams per litre. Why not cells per decilitre then, or why not stay with the existing incongruity instead of substituting another incongruity? Why change for the sake of change? Torr became fashionable and is now passe. Centigrade is funky and Celsius is camp. Instead of aspiring to degrees absolute (incidentally, we now have negative degrees absolute in Scientific American) it is acceptable to express temperature in terms of the effect of heat upon water, or in degrees Celsius. Why, then, is it unacceptable to express pressure in terms of its effect on a column of water or mercury? Is an analogue or digital readout in kilopascals any more infallible (or relevant to hemodynamics) than the height of a column of mercury? Woul'd not millibaumans be more trendy than kilopascals? Gobbledygook and trendy buzzwords are not the exclusive prerogative of the government. While parts of the SI system are commendable, there are some aspects that, when applied to medicine, appear to be more akin to intellectual snobbery. At least we shall be able to maintain a proper sense of reverence and propriety when we socialize with astronomers and nuclear physicists. The billions of public dollars that are to be channelled into the instrument and tool industries by this upheaval would be better spent on research. J.M. CLARK, FRcP[c]
6 John St.
Oakville, Ont.
Overprescription To the editor: A recent issue of The Medical Post (Feb. 27, 1979, page 37) reported that the suicide rate
among young people aged between 10 and 24 years in Ontario has risen by 32% during the past 7 years. Being in general practice I am constantly amazed by the number of young people who are taking large quantities of psychotropic medications for conditions ranging from obesity to athlete's foot. I have witnessed and treated hundreds of cases of overdose involving these drugs. It does not surprise me that thee suicide rate is skyrocketing. The Medical Post went on to state that the prescribing habits of physicians need changing. Yet only a few months ago Dr. Heinz Lehman, former director of the Allen Memorial Institute, Montreal, was quoted as saying: "To survive you need Valium." At that time there was little, if any, opposition to this perverted point of view from the medical profession - this does surprise me. Recently the Canadian Psychiatric Association persuaded those in charge of Ontario's drug benefit scheme to delete certain vitamins from their list of free medications. The psychotropic drugs, however, remain on the list. The reason behind this not so brilliant decision was that vitamins are dangerous - I have yet to see or hear of one instance of suicide by means of a vitamin overdose. This restriction on vitamins will seriously interfere with drug rehabilitation programs as well as with the practices of some nutritionally oriented physicians. Certain vitamins are absolutely essential in the withdrawal of addicted individuals not only from alcohol but also from the much abused psychotropic agents. There is no such thing as a Valium® deficiency, yet drugs of this type are prescribed liberally for just about every human ailment imaginable. The result of this idiocy is not only a higher suicide rate but also a growing trend towards an anesthetized population. We can reverse this tragedy through a greater emphasis on communication and a sound nutritional program that includes vitamins and
CMA JOURNAL/MAY 19, 1979/VOL. 120 1207
Lack of interest in nutrition? To the editor: In the January 1979 issue of The Annals of the Royal College of Physicians and Surgeons of Canada are 328 abstracts of papers in 27 categories, from allergy and immunology to vascular surgery (beginning on page 22). These papers were presented at the college's annual meeting in February 1979 in Montreal. Of the 328 papers only 10 were about nutrition and the use of vitamins: 1 each referred to orally administered postoperative nutrition, the control of chyle formation with diet in dogs, the protective effect of a high-fibre diet against the development of bowel cancer in rats, the use of bran in reducing the cholesterol content of bile in patients with gallstones, the increase in the cholesterol content of bile in women with a highly refined carbohydrate diet, nutritional management of gastrointestinal fistulas and protein requirements with total parenteral nutrition, and 3 discussed the use of a synthetic vitamin D3 metabolite in hyperparathyroidism, osteoporosis and renal osteodystrophy. These 10 papers represent 3% of the total. I think this percentage is representative of the interest the profession has in nutrition. Contributions to the Correspondence
section are welcomed and if considered suitable will be published as space permits. They should be typewritten double-spaced and, except for case reports, should be no longer than 1½ manuscript pages.
This lack of interest in nutrition (45.6%) had serum ferritin values may be equated with the near total diagnostic of iron deficiency (less rejection of the unwritten law of than 11 ng/ml in females and less nature - we are biochemical beings; than 23 ng/ml in males), while 49 what we are and therefore the ills (54.4%) had either normal or we endure are largely dependent on elevated serum ferritin values. Of the the biochemical substances we 49, 14 had inflammatory disorders, provide in our diet. With this rejec- 11 had hematologic malignant dition, nature's law has been supplanted seases, 8 had sickle cell disease, 6 by the pursuit of scicace, the syn- had liver disease, 3 had malignant thesized pill and the intricate bio- tumours, 3 were taking iron supplechemical test. ments, and 1 each had autoimmune I wonder if the medical profes- hemolytic anemia, folate deficiency, sion, like a moth that has been burned aortic incompetence and splenic vein in the lamplight that attracted it, has thrombosis. Even if hematologic not already been seriously betrayed malignant diseases and hemoglobinopathies are excluded because they are by science. disorders in which the serum ferritin CARL J. REICH, MD, FRCP[C] 205A Medical Centre value may not be an accurate guide Calgary, Alta. in the assessment of iron stores,1'2 measurement of the serum ferritin Serum ferritin concentration concentration failed to identify iron and bone marrow iron stores deficiency in 32% of the patients. Thus, while diagnostically low To the editor: We read with interest serum ferritin values accurately rethe article on this topic by Drs. flect iron deficiency, the reverse does M.A.M. Ali, A.W. Luxton and not appear to be true, particularly in W.H.C. Walker (Can Med Assoc J hospitalized patients with compli118: 945, 1978). Our data on the cating illnesses. evaluation of the serum ferritin concentration as an index of iron defiPATRICK L. MCGINNIS, MD ASHOK R, PATEL. MB, FACP ciency in hospitalized patients supK.R.P. RAO, MD port the view that, in the presence of PRABODH C. SHAH, MD Division of hematology certain associated conditions, the Cook County Hospital measurement of the serum ferritin Hektoen Institute Chicago, Illinois concentration may not be reliable in the diagnosis of iron deficiency. The serum ferritin concentration References 1. PETERSON CM, GRAZIANO JH, DE was measured in 90 patients whose Ciu'riis A, et al: Iron metabolism, bone marrow at that time contained sickle cell disease, and response to no stainable iron. Of the 90, 41 cyanate. Blood 46: 583, 1975
1204 CMA JOURNAL/MAY 19, 1979/VOL. 120
2. SHAH PC, PATEL AR, VOHRA RM, et
al: Ferritin levels in hematologic malignancies (abstr). Presented at XVIIth Congress of the International Society of Hematology, Paris, July 23-29, 1978
The logic of SI To the editor: Although I have no scruples about cramming drachms and grains down the drain, I wish to question the passive acceptance of Syst.me international d'unit6s, the SI unit system, by the medical profession. The Metric Commission of Canada - which no doubt pays good salaries and indexed pensions to a bunch of otherwise redundant civil servants - is charged with converting us to a system of measurement based on 1 650 763.37 wavelengths of krypton radiation, or the metre. The commission tells us that 95% of the rest of the world is already using this system. This is a blatant political lie. As far as the promotion of international trade is concerned, I am told that it is still impossible to screw a Japanese metric nut onto a European metric bolt. Irrespective of what the rest of the world may or may not be doing, it was my understanding that international medicine had already developed its own commonly understood units, and that medical professionals throughout the world were able to converse with and understand each other. We now have to change to SI units. Is this a professional decision that has been made by the Canadian Medical Association or by an international medical association, or are we just floating along in a gust of political hot air? Blood cell counts that hitherto were expressed as the number of cells per cubic millimetre are now to be expressed as the number of cells per litre. Why? Which member of the international medical community has used cells per litre all along? Transylvania perhaps? I can only conclude that either errors in sampling and counting are going to be multiplied by 106 or that it will take forever to get the blood work done
and there is going to .be an epidemic of iatrogenic anemia. Notwithstanding the superior virtues of teracells and gigacells, the litre is not an official SI unit, so why are we converting to it? For reasons of logic perhaps? Would it not therefore be logical to express all blood components per litre? Wrong - blood chemistry is still to be expressed as milligrams per decilitre, not milligrams per litre. Why not cells per decilitre then, or why not stay with the existing incongruity instead of substituting another incongruity? Why change for the sake of change? Torr became fashionable and is now passe. Centigrade is funky and Celsius is camp. Instead of aspiring to degrees absolute (incidentally, we now have negative degrees absolute in Scientific American) it is acceptable to express temperature in terms of the effect of heat upon water, or in degrees Celsius. Why, then, is it unacceptable to express pressure in terms of its effect on a column of water or mercury? Is an analogue or digital readout in kilopascals any more infallible (or relevant to hemodynamics) than the height of a column of mercury? Woul'd not millibaumans be more trendy than kilopascals? Gobbledygook and trendy buzzwords are not the exclusive prerogative of the government. While parts of the SI system are commendable, there are some aspects that, when applied to medicine, appear to be more akin to intellectual snobbery. At least we shall be able to maintain a proper sense of reverence and propriety when we socialize with astronomers and nuclear physicists. The billions of public dollars that are to be channelled into the instrument and tool industries by this upheaval would be better spent on research. J.M. CLARK, FRcP[c]
6 John St.
Oakville, Ont.
Overprescription To the editor: A recent issue of The Medical Post (Feb. 27, 1979, page 37) reported that the suicide rate
among young people aged between 10 and 24 years in Ontario has risen by 32% during the past 7 years. Being in general practice I am constantly amazed by the number of young people who are taking large quantities of psychotropic medications for conditions ranging from obesity to athlete's foot. I have witnessed and treated hundreds of cases of overdose involving these drugs. It does not surprise me that thee suicide rate is skyrocketing. The Medical Post went on to state that the prescribing habits of physicians need changing. Yet only a few months ago Dr. Heinz Lehman, former director of the Allen Memorial Institute, Montreal, was quoted as saying: "To survive you need Valium." At that time there was little, if any, opposition to this perverted point of view from the medical profession - this does surprise me. Recently the Canadian Psychiatric Association persuaded those in charge of Ontario's drug benefit scheme to delete certain vitamins from their list of free medications. The psychotropic drugs, however, remain on the list. The reason behind this not so brilliant decision was that vitamins are dangerous - I have yet to see or hear of one instance of suicide by means of a vitamin overdose. This restriction on vitamins will seriously interfere with drug rehabilitation programs as well as with the practices of some nutritionally oriented physicians. Certain vitamins are absolutely essential in the withdrawal of addicted individuals not only from alcohol but also from the much abused psychotropic agents. There is no such thing as a Valium® deficiency, yet drugs of this type are prescribed liberally for just about every human ailment imaginable. The result of this idiocy is not only a higher suicide rate but also a growing trend towards an anesthetized population. We can reverse this tragedy through a greater emphasis on communication and a sound nutritional program that includes vitamins and
CMA JOURNAL/MAY 19, 1979/VOL. 120 1207
