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CMAJ - November 3, 1998JAMC - le 3 novembre 1998

New guidelines nurture fear, not confidence

CMAJ 1998;159:1087

I agree with Dr. John Hoey's assertion in the editorial "When the physician is the vector" (CMAJ 1998;159[1]:45-6 [full text]) that Health Canada's new guidelines for preventing the transmission of bloodborne diseases amount to "an extraordinary step, an infringement of the basic human right to dignity and privacy." These guidelines will nurture rather than allay patients' fears and anxieties, and they sanction and abet public paranoia.

In an article by Barbara Sibbald in the same issue, "CMA says no to mandatory hepatitis B vaccination, screening for MDs" (CMAJ 1998;159[1]:64-5 [full text / en bref]), Dr. Ian Gemmill is quoted as saying "Where there is a small but real risk that can be avoided by [mandatory] immunization and testing, it's hard to argue against doing it." I disagree. This argument is refuted by statistics and, philosophically, by Drs. James Wright and Peter Singer, who posited that "[t]he same policies should apply in the case of all equivalent or greater risks to patients. . . ."1 They also pointed out that "anecdotal cases of disease transmission should not drive public health policy."

Political correctness should not be a substitute for rational, scientific, evidence-based policies and practices. Hepatitis B is topical today. Tomorrow will beget guidelines, regulations and "moral imperatives" for other subclinical seropositive states. For example, what should be done about physicians who have had malaria, a bloodborne disease at least as virulent as hepatitis B?

The real and significant hazards and risks can be properly addressed by experts in infection control, occupational health, public health, and hygiene and safety. Health Canada's unnecessary and regrettable new guidelines are contrary to scientific knowledge. Furthermore, they will be nearly impossible to implement. Unless the medical community takes a logical, united stand, all health care providers will soon face restrictions, and the public will be left with no one to attend to them.

Gabor Lantos, MD
Occupational Health Management Services
Toronto, Ont.

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  1. Wright JG, Singer PA. HIV-seropositive surgeons: informed consent and public health policy. CMAJ 1992;147[1]:29-31.