between health advice given by travel agents and that given by public health agenciesin various parts of Canada. ... Halifax, NS. References. 1. White F, Sharma ...
government what to do? It is dangerous if the doctor resents the controls, and even more dangerous if he or she does not. John Kominek Chairman Citizens' Committee for Private Medicine Waterloo, Ont.
What happens to those who are incorrectly advised that no vaccination is necessary? There is also the issue of the potential liability of travel agents, and the question has been raised "as to whether an association publishing incorrect information would be held liable for injuries to individuals relying on it" .2
Health advice from travel agencies T- he study of major sources of published health advice for international travel' referred to by Dr. Robert Steffen (Can Med Assoc J 1986; 134: 213214) was stimulated by the frequently observed contradictions between health advice given by travel agents and that given by public health agencies in various parts of Canada. Mr. Sharma and I documented major discrepancies between the information published in the Travel Information Manual (TIM and that published by the World Health Organization and the US Centers for Disease Control. The former is used almost exclusively by travel agents and is an important source of other travel information (e.g., visa and currency requirements), while the latter is viewed - at least in North America - as reliable public health information. The observation that TIM publishes "exactly what is happening at the airports" raises an important question: Should airport officials or health authorities determine health policies? The idea that giving "vaccinations without reason" is "staying on the safe side" indicates a serious need to review any source of such health advice. All biologic products have an inherent risk and should not be given "without reason". To suggest that even unreliable information is justified because it leads to physician referrals is ethically contentious. 706
CMAJ, VOL. 134, APRIL 1, 1986
I would be encouraged to see the development of much closer cooperation between health and travel authorities, including the development of a common information base. Franklin M.M. White, MD, CM, MSc, FRCPC Professor and head Department of Community Health and Epidemiology Dalhousie University Halifax, NS
References 1. White F, Sharma M: Health advice to international travelers: an evaluation of sources [C]. N Engi J Med 1983; 309: 1587 2. Rozovsky LE, May E: Travel, illness, and the law. Travel Traffic Med Intern 1985; 3: 183-186
Is "20th-century disease" the right diagnosis? D_ rs. Donna Eileen Stewart and Joel Raskin's article on
psychiatric
assess-
ment of patients with 20th-century disease (Can Med Assoc J 1985; 133: 1001-1006) presents a more negative picture of alternative allergy practices than is warranted and relies too heavily on "blaming the victims". The article exemplifies this through three case summaries, in which the authors perceive the patients as lacking insight and judgement without saying how they came to this value-laden conclusion. Since 16 of the 18 patients in their sample refused psychologic
testing and 10 expressed reluctance to be interviewed by a psychiatrist, it appears that Stewart and Raskin are demonstrating their views without substantial evidence to support their conclusions. Furthermore, their article does not inspire conventional doctors to improve the services that they provide to patients who are hypersensitive to the environment. At worst, the authors' perspective may alienate these patients from receiving medical care by attaching negative attributes to them. There is evidence that some patients whose illnesses have been misdiagnosed and inappropriately treated by general practitioners and consultants do benefit from the help of clinical ecologists.' The failure of many traditional psychiatrists to provide helpful problem-solving devices to these patients makes psychiatric referral a questionable alternative for physicians frustrated by their own unfruitful efforts. With encouragement physicians might consider referring these patients to clinical ecologists, who prefer to consider physiologic mechanisms as being inherent in the complaints of patients who are sensitive to the environment. Variables such as nutritional, genetic and hormonal factors, psychosocial, physical, chemical and antigenic stressors, frequency of stress, and exercise conditioning factors are considered in the "total-load" concept of environmental illness.2 There is a need to go beyond oversimplification, the pitfall of looking for one cause to attach to a particular diagnosis, as Stewart and Raskin have done in outlining each patient's perceived precipitator of the disease. If conventional doctors can be encouraged to recognize that clinical ecologists operate systematically on effective principles and can help patients who are sensitive to the environment, then these patients will be less alienated from receiving medical treatment. Environmentally controlled clinics and hospital wards that limit patient exposure to chemicals in the air, water, food
