recommended for all women be- States. It appears that poor lifeginning at age 50". This recom- style, increasing litigation and inmendation is very similar to ours. adequate renumeration are among the key factors affecting the selecE.A. Clarke, MB, BS, MSc tion of obstetrics and gynecology Vice-president as a specialty. Epidemiology and Statistics We face the very real possibilOntario Cancer Treatment the next decade of havwithin ity and Research Foundation A.B. Miller, MB, FRCPC ing a significant shortage of comProfessor petently trained specialists to proDepartment of Preventive Medicine medical care to Canadian vide and Biostatistics women. University of Toronto J.C. Laidlaw, MD, PhD, FRCPC Although I know that the Executive director CMA is to address this issue, neiMedical Affairs ther the federal nor the provincial Canadian Cancer Society governments are willing to do so Toronto, Ont. in a constructive way. Like the References radiation oncologists, we can look forward to a serious manpower 1. Andersson I, Aspegren K, Janzon L et shortfall.
2.
3.
4.
5.
al: Mammographic screening and mortality from breast cancer: the Malmo mammographic screening trial. Br Med J 1988; 297: 943-948 Tabar L, Fagerberg G, Duffy SW et al: The Swedish two county trial of mammographic screening for breast cancer: recent results and calculation of benefit. J Epidemiol Community Health 1989; 43: 107-114 Chu KC, Smart CR, Tarone RE: Analysis of breast cancer mortality and stage distribution by age for the Health Insurance Plan Clinical Trial. J Nati Cancer Inst 1988; 80: 1125-1132 Eddy DM, Hasselblad V, McGivney W et al: The value of mammography screening in women under age 50 years. JAMA 1988; 259: 1512-1519 US Preventive Services Task Force: Guide to Clinical Preventive Services, Dept of Health and Human Services, Washington, 1989: 26
Why are some specialties so unpopular? I read with interest the letters in the Dec. 1, 1989, issue of CMAJ (141: 1122-1123) related to how students come to choose various specialties. We in obstetrics and gynecology have noticed a significant decrease in Canada in the number of students who choose this specialty. By contrast, obstetrics and gynecology is the second most common specialty in the United
Arthur Leader, MD, FRCSC Associate professor of obstetrics and gynecology University of Ottawa Ottawa, Ont.
Familial dysautonomia (Riley -Day syndrome) D
r. Ruth C. Sky's letter briefly describing this syndrome (Can Med Assoc J 1989; 141: 514) is timely. Physicians are going to be treating more dysautonomic children and adults, as recent advances have increased patients' longevity. Sky advocates that physicians recommend to families that they contact the Toronto chapter of the Dysautonomia Foundation of Canada. My experience in Montreal has shown that affected families have no trouble contacting the Montreal chapter as soon as a diagnosis is made. A greater problem is that delays have occurred in diagnosis. Physicians should familiarize themselves with the constellation of signs and symptoms summarized in Sky's letter. Early diagnosis of dysautonomia definitely improves the quality of life for patients and their families. Now that
increasing physician awareness has increased the frequency of diagnosis, the estimated carrier rate in Ashkenazi Jews has been revised upward to approximately 1 in 30, identical to that of TaySachs disease (Dr. F.B. Axelrod: personal communication). It is imperative that we decrease the diagnostic delay in familial dysautonomia. Shirley Katz, MD, CM, CCFP Assistant professor of family medicine McGill University Montreal, PQ
Abbs. in Js It is apparently the policy (P) of some medical journals (Js) to allow the writer (W) to use in his or her article (A) any abbreviations (abbs.) desired, so long as each abb. is explained the first (1st) time it is used. Now if it were the P of the J to allow the W to use in his A abbs. that might be considered standard (Sabbs.) and that everyone understands, such as SNAFU and FO, I would have no objection. Even so, I would still have some difficulty (D), since LOA means left occiput anterior when I am reading CMAJ but "length over all" when the A is in my favourite yachting J. But allowing NSabbs. forces those of us who suffer from incipient Alzheimer's disease (IAD) or even established Alzheimer's disease (EAD) or just a short attention span (SAS) to go back through the pages (pp.) over and over again. I can understand that this P of the J allows a reduction in costs (C), since inevitably the # of pp. in an A will be reduced. But the D is that if I am not reading every p. of the A and some point catches my eye (I) I have to initiate a search (S) back through the pp. to discover what some esoteric abb. such as UYHOK means. So perhaps editors (Eds.) CAN MED ASSOC J 1990; 142 (4)
287
2.
3.
4.
5.
al: Mammographic screening and mortality from breast cancer: the Malmo mammographic screening trial. Br Med J 1988; 297: 943-948 Tabar L, Fagerberg G, Duffy SW et al: The Swedish two county trial of mammographic screening for breast cancer: recent results and calculation of benefit. J Epidemiol Community Health 1989; 43: 107-114 Chu KC, Smart CR, Tarone RE: Analysis of breast cancer mortality and stage distribution by age for the Health Insurance Plan Clinical Trial. J Nati Cancer Inst 1988; 80: 1125-1132 Eddy DM, Hasselblad V, McGivney W et al: The value of mammography screening in women under age 50 years. JAMA 1988; 259: 1512-1519 US Preventive Services Task Force: Guide to Clinical Preventive Services, Dept of Health and Human Services, Washington, 1989: 26
Why are some specialties so unpopular? I read with interest the letters in the Dec. 1, 1989, issue of CMAJ (141: 1122-1123) related to how students come to choose various specialties. We in obstetrics and gynecology have noticed a significant decrease in Canada in the number of students who choose this specialty. By contrast, obstetrics and gynecology is the second most common specialty in the United
Arthur Leader, MD, FRCSC Associate professor of obstetrics and gynecology University of Ottawa Ottawa, Ont.
Familial dysautonomia (Riley -Day syndrome) D
r. Ruth C. Sky's letter briefly describing this syndrome (Can Med Assoc J 1989; 141: 514) is timely. Physicians are going to be treating more dysautonomic children and adults, as recent advances have increased patients' longevity. Sky advocates that physicians recommend to families that they contact the Toronto chapter of the Dysautonomia Foundation of Canada. My experience in Montreal has shown that affected families have no trouble contacting the Montreal chapter as soon as a diagnosis is made. A greater problem is that delays have occurred in diagnosis. Physicians should familiarize themselves with the constellation of signs and symptoms summarized in Sky's letter. Early diagnosis of dysautonomia definitely improves the quality of life for patients and their families. Now that
increasing physician awareness has increased the frequency of diagnosis, the estimated carrier rate in Ashkenazi Jews has been revised upward to approximately 1 in 30, identical to that of TaySachs disease (Dr. F.B. Axelrod: personal communication). It is imperative that we decrease the diagnostic delay in familial dysautonomia. Shirley Katz, MD, CM, CCFP Assistant professor of family medicine McGill University Montreal, PQ
Abbs. in Js It is apparently the policy (P) of some medical journals (Js) to allow the writer (W) to use in his or her article (A) any abbreviations (abbs.) desired, so long as each abb. is explained the first (1st) time it is used. Now if it were the P of the J to allow the W to use in his A abbs. that might be considered standard (Sabbs.) and that everyone understands, such as SNAFU and FO, I would have no objection. Even so, I would still have some difficulty (D), since LOA means left occiput anterior when I am reading CMAJ but "length over all" when the A is in my favourite yachting J. But allowing NSabbs. forces those of us who suffer from incipient Alzheimer's disease (IAD) or even established Alzheimer's disease (EAD) or just a short attention span (SAS) to go back through the pages (pp.) over and over again. I can understand that this P of the J allows a reduction in costs (C), since inevitably the # of pp. in an A will be reduced. But the D is that if I am not reading every p. of the A and some point catches my eye (I) I have to initiate a search (S) back through the pp. to discover what some esoteric abb. such as UYHOK means. So perhaps editors (Eds.) CAN MED ASSOC J 1990; 142 (4)
287
