Is there a doctor in the court? A bout 45 000 Breathalyzer tests are conducted each year on Ontario drivers suspected of being impaired. Penalties for a first conviction are a fine of up to $2000 and a minimum licence suspension of 1 year. As a result, there is a great demand by lawyers for "experts" to testify in court. A recent impaired driving case in provincial court (criminal division) illustrates the problems that may be encountered when medical practitioners testify in this area. The case involved a man charged with driving while having a blood alcohol (ethanol) concentration in excess of 80 mg/dL (17 mmol/L). A qualified medical practitioner testified that breath and blood alcohol tests measure only the "free" alcohol and not the alcohol bound to the blood proteins. Since the accused had been taking two medications (diltiazem and ketoprofen) that are highly protein bound, these drugs would displace the alcohol bound to the blood proteins and cause a falsely high blood alcohol reading. This testimony was clearly not supportable on the basis of any literature. Only one of the many hundreds of studies showing that alcohol is water soluble and not bound to protein in the blood need be cited.' In addition, other highly protein bound drugs have been shown to have no effect on blood alcohol concentrations and pharmacokinetics.2 As a result of this inaccurate and speculative testimony the case was remanded to a later date for rebuttal evidence from a forensic toxicologist from our laboratory, at considerable expense to the taxpayer. Not only are medical experts asked to testify in the highly specialized field of forensic toxicology but forensic toxicologists are often asked about medical evi544
CAN MED ASSOC J 1991; 144 (5)
dence that is beyond their expertise. During the training of expert witnesses at the Centre of Forensic Sciences, Toronto, one of the most important skills acquired is when to say "I don't know" or "It is beyond my expertise." Such skill is essential to the proper administration of justice and to the credibility of the witness. J.G. Wigmore, BSc S.P. Lintlop, MSc Toxicology Section Centre of Forensic Sciences Toronto, Ont.
References 1. Jones AW: Physiological aspects of
breath-alcohol measurement. Alcohol Drugs Driving 1990; 6 (2): 1-25 2. Dittmann V, Pribilla 0, Wagner T: Ethanol elimination in man under the influence of frequently prescribed beta receptor blockers. Blutalkohol 1985; 22: 364-370
Gender bias on the CMA Board of Directors? n page 200 of the Jan. 15, O X 1991, issue of CMAJ is a photograph of the physicians attending the December 1990 meeting of the CMA Board of Directors. It is surprising to see that in a collection of 29 people there are only 2 women. Is this how the CMA sees itself or wishes to be seen? It would seem reasonable that the board turn its attention to what appears to be quite serious gender bias.
A.M. Bienenstock, MB, BS Associate professor Department of Psychiatry McMaster University Hamilton, Ont.
[Dr. Bienenstock is certainly correct that the number of women on the CMA Board of Directors seems to be relatively small when, overall, women constitute about 18% of the medical profession. But most of that 18% are in the younger groups
and have not yet risen through the political ranks of the profession to the level of the board. Thus, the number of women now on the board is understandable. Nevertheless, a CMA committee is now looking at issues facing female doctors, one of which is how to enable and encourage them to become more active in the politics of the profession. We urge Bienenstock not to worry that the two female board members are unable to make themselves heard. Dr. Carole Guzman is president elect of the CMA, and Dr. Judith Kazimirski chairs the board. Their numbers may be small, but they pack a powerful political punch! - Ed.]
We could learn a lesson from Kenya's midwives F
aull marks to John Kinahan
for daring to oppose the establishment by advocating a role for professional midwives in this country (Can Med Assoc J 1990; 143: 1353-1355). Some of us who have had experience outside North America appreciate the value of an associate trained to conduct normal deliveries and to recognize and refer potential problems developing during pregnancy and labour. As in any other branch of clinical medicine the doctor should deal with the abnormal; the specialist should be available for consultation and transfer of care when appropriate. A midwife should be permitted to practise her art in a hospital setting as an independent practitioner with limited privileges. If the standard of care provided by midwives in this country is questionable, then we must seek to improve it. The importance of a team approach in the delivery of health care should be recognized in this area as in other areas of Our profession.
Shame on the editor for inserting an unqualified statistic with the statement "The perinatal death rate at [Pumwani Maternity Hospital] was 21.6/1000; in 1986 the Canadian rate was 7.9/1000." The demographics of Kenya render direct comparison between the perinatal mortality figures for this hospital and Canada unjustified. My Latin is a little rusty, but sometimes I think the word "obstetrician" must be derived from "ob" (in the way of; against) and "stare" (to stand).
ing that one does not want to receive offers through the mail: the Canadian Direct Marketing Association, 607-1 Concord Gate, Don Mills, ON M3C 3N6, and the Direct Marketing Association, Mail Preference Service, 6 E 43rd St., New York, NY 10017, USA. I have done this, and it works! Perhaps physicians as a group can save part of Canada from deforestation and subsequent soil erosion, flooding and loss of wildlife by each of us writing three simple letters. Let us do it for our children's sake as well as for our own.
into the garbage can contribute to the problem. Please instruct your circulation department to cease mailing to the individuals on the enclosed list.
Yukon doctors are concerned about waste, and unsolicited mail is a growing problem. Each Yukon doctor an-
Screening for hypercholesterolemia among Canadians:
Thank you for your cooperation.
There was a lot of discussion about which journals to target, and certain publications were strongly defended: "I read this magazine cover to cover. It's always useful. It cannot be branded as junk mail." The point is that any journal is "junk" if it is not read. Our aim is not to criticize publications but to ensure that the people who receive them want David L. Belcher, MB, BCh, DObstRCOG them. Box 7708 Arnold Clairman, MD If I continue to receive unso5203 50 St. B4-5927 Bathurst St. licited Drayton Valley, Alta. journals I will package Willowdale, Ont. them up and send them, postage [Originally the perinatal death rate free, to the minister in charge of at the Pumwani hospital stood Last November the Yukon Medi- Canada Post along with a note alone. The Canadian statistic was cal Association (YMA) endorsed a pointing out that the rules pertainadded simply because we thought plan to combat unsolicited mail. ing to direct mailing should be it answered a question some read- Physicians were invited to sign changed. ers would naturally ask: What is petitions requesting that their names be removed from the mail- Wendy Boothroyd, MD the rate in Canada? - Ed.] ing lists of journals they do not 2-3089 3rd Ave. read. The following covering letter Whitehorse, YT was sent on YMA letterhead.
Junk mail M
any physicians are concerned about the volume of medical magazines and junk mail that reaches their offices and homes. I have found a simple way to receive only the mail that is important. Since most of the free medical publications are sent to physicians by Southam, publisher of the Canadian Medical Directory, one need only write to Southam
Business Information & Communications Group Inc., 1450 Don Mills Rd., Don Mills, ON M3B 2X7, specifying which publications one does or does not want to receive. One can also call Ms. Mila Marbida at Southam, at
nually receives 40 kg of unsolicited journals - that's 1000 kg of journals that our medical community doesn't even open.
How much will it cost?
[correction]
Loggers cut seventeen trees to pro- I n the last paragraph of the duce our 1000 kg of wasted paper. If Discussion section of this artievery small community such as ours cle (Can Med Assoc J 199 1; could save seventeen trees by refusing 144: 161-168), by Dr. Steven A. something they did not want, then Grover and colleagues, the second global warming would be less of a sentence should have read as folproblem.
lows, with the added phrase in italics: "In the United States estimates of the increased life expectancy among low-risk individuals after cholesterol levels have been reduced vary from 3 days to 3 months.25" Grover notes that ref(416) 442-2157. erence 25 also estimates an inTo eliminate unwanted ad- gases. creased life expectancy of 5 to 29 vertisements in the mail it is We want to improve the health of our months among high-risk individunecessary to write a letter to each environment. Mailing journals to sub- als after intensive reduction of the of the following companies, stat- scribers who will put them straight cholesterol levels. -Ed. The papermaking process produces effluent containing dioxins and other environmental toxins. It consumes energy. Glossy paper cannot be recytled in the Yukon, so it is dumped in the landfill. There it is burned, releasing airborne pollutants and greenhouse
CAN MED ASSOC J 1991; 144 (5)
'545
CAN MED ASSOC J 1991; 144 (5)
dence that is beyond their expertise. During the training of expert witnesses at the Centre of Forensic Sciences, Toronto, one of the most important skills acquired is when to say "I don't know" or "It is beyond my expertise." Such skill is essential to the proper administration of justice and to the credibility of the witness. J.G. Wigmore, BSc S.P. Lintlop, MSc Toxicology Section Centre of Forensic Sciences Toronto, Ont.
References 1. Jones AW: Physiological aspects of
breath-alcohol measurement. Alcohol Drugs Driving 1990; 6 (2): 1-25 2. Dittmann V, Pribilla 0, Wagner T: Ethanol elimination in man under the influence of frequently prescribed beta receptor blockers. Blutalkohol 1985; 22: 364-370
Gender bias on the CMA Board of Directors? n page 200 of the Jan. 15, O X 1991, issue of CMAJ is a photograph of the physicians attending the December 1990 meeting of the CMA Board of Directors. It is surprising to see that in a collection of 29 people there are only 2 women. Is this how the CMA sees itself or wishes to be seen? It would seem reasonable that the board turn its attention to what appears to be quite serious gender bias.
A.M. Bienenstock, MB, BS Associate professor Department of Psychiatry McMaster University Hamilton, Ont.
[Dr. Bienenstock is certainly correct that the number of women on the CMA Board of Directors seems to be relatively small when, overall, women constitute about 18% of the medical profession. But most of that 18% are in the younger groups
and have not yet risen through the political ranks of the profession to the level of the board. Thus, the number of women now on the board is understandable. Nevertheless, a CMA committee is now looking at issues facing female doctors, one of which is how to enable and encourage them to become more active in the politics of the profession. We urge Bienenstock not to worry that the two female board members are unable to make themselves heard. Dr. Carole Guzman is president elect of the CMA, and Dr. Judith Kazimirski chairs the board. Their numbers may be small, but they pack a powerful political punch! - Ed.]
We could learn a lesson from Kenya's midwives F
aull marks to John Kinahan
for daring to oppose the establishment by advocating a role for professional midwives in this country (Can Med Assoc J 1990; 143: 1353-1355). Some of us who have had experience outside North America appreciate the value of an associate trained to conduct normal deliveries and to recognize and refer potential problems developing during pregnancy and labour. As in any other branch of clinical medicine the doctor should deal with the abnormal; the specialist should be available for consultation and transfer of care when appropriate. A midwife should be permitted to practise her art in a hospital setting as an independent practitioner with limited privileges. If the standard of care provided by midwives in this country is questionable, then we must seek to improve it. The importance of a team approach in the delivery of health care should be recognized in this area as in other areas of Our profession.
Shame on the editor for inserting an unqualified statistic with the statement "The perinatal death rate at [Pumwani Maternity Hospital] was 21.6/1000; in 1986 the Canadian rate was 7.9/1000." The demographics of Kenya render direct comparison between the perinatal mortality figures for this hospital and Canada unjustified. My Latin is a little rusty, but sometimes I think the word "obstetrician" must be derived from "ob" (in the way of; against) and "stare" (to stand).
ing that one does not want to receive offers through the mail: the Canadian Direct Marketing Association, 607-1 Concord Gate, Don Mills, ON M3C 3N6, and the Direct Marketing Association, Mail Preference Service, 6 E 43rd St., New York, NY 10017, USA. I have done this, and it works! Perhaps physicians as a group can save part of Canada from deforestation and subsequent soil erosion, flooding and loss of wildlife by each of us writing three simple letters. Let us do it for our children's sake as well as for our own.
into the garbage can contribute to the problem. Please instruct your circulation department to cease mailing to the individuals on the enclosed list.
Yukon doctors are concerned about waste, and unsolicited mail is a growing problem. Each Yukon doctor an-
Screening for hypercholesterolemia among Canadians:
Thank you for your cooperation.
There was a lot of discussion about which journals to target, and certain publications were strongly defended: "I read this magazine cover to cover. It's always useful. It cannot be branded as junk mail." The point is that any journal is "junk" if it is not read. Our aim is not to criticize publications but to ensure that the people who receive them want David L. Belcher, MB, BCh, DObstRCOG them. Box 7708 Arnold Clairman, MD If I continue to receive unso5203 50 St. B4-5927 Bathurst St. licited Drayton Valley, Alta. journals I will package Willowdale, Ont. them up and send them, postage [Originally the perinatal death rate free, to the minister in charge of at the Pumwani hospital stood Last November the Yukon Medi- Canada Post along with a note alone. The Canadian statistic was cal Association (YMA) endorsed a pointing out that the rules pertainadded simply because we thought plan to combat unsolicited mail. ing to direct mailing should be it answered a question some read- Physicians were invited to sign changed. ers would naturally ask: What is petitions requesting that their names be removed from the mail- Wendy Boothroyd, MD the rate in Canada? - Ed.] ing lists of journals they do not 2-3089 3rd Ave. read. The following covering letter Whitehorse, YT was sent on YMA letterhead.
Junk mail M
any physicians are concerned about the volume of medical magazines and junk mail that reaches their offices and homes. I have found a simple way to receive only the mail that is important. Since most of the free medical publications are sent to physicians by Southam, publisher of the Canadian Medical Directory, one need only write to Southam
Business Information & Communications Group Inc., 1450 Don Mills Rd., Don Mills, ON M3B 2X7, specifying which publications one does or does not want to receive. One can also call Ms. Mila Marbida at Southam, at
nually receives 40 kg of unsolicited journals - that's 1000 kg of journals that our medical community doesn't even open.
How much will it cost?
[correction]
Loggers cut seventeen trees to pro- I n the last paragraph of the duce our 1000 kg of wasted paper. If Discussion section of this artievery small community such as ours cle (Can Med Assoc J 199 1; could save seventeen trees by refusing 144: 161-168), by Dr. Steven A. something they did not want, then Grover and colleagues, the second global warming would be less of a sentence should have read as folproblem.
lows, with the added phrase in italics: "In the United States estimates of the increased life expectancy among low-risk individuals after cholesterol levels have been reduced vary from 3 days to 3 months.25" Grover notes that ref(416) 442-2157. erence 25 also estimates an inTo eliminate unwanted ad- gases. creased life expectancy of 5 to 29 vertisements in the mail it is We want to improve the health of our months among high-risk individunecessary to write a letter to each environment. Mailing journals to sub- als after intensive reduction of the of the following companies, stat- scribers who will put them straight cholesterol levels. -Ed. The papermaking process produces effluent containing dioxins and other environmental toxins. It consumes energy. Glossy paper cannot be recytled in the Yukon, so it is dumped in the landfill. There it is burned, releasing airborne pollutants and greenhouse
CAN MED ASSOC J 1991; 144 (5)
'545
