Canad. Med. ASS. J. COPoNDENcE 83Jan. 11, 1969, vol. 100

question. The same viewpoint is expressed in theauthor's statement justifying the performance ofchromosomal studies on the peripheral blood of thetwo patients described: "Because of the uncertaintyin regard to the congenital defects of myositisossificans progressiva, their possible origin at thechromosomal level was considered worth investiga-tion." Once again the author clearly implies that heconsiders the congenital anomaly aspect of thedisease to be separable from that component of thedisease which usually has a clinical onset in thefirst two decades of life. He is entitled to hisopinion, but I would wager that he is wrong onfirst principles. Moreover, McKusick1 states that

the onset of the process in the fasciae andtendons may be in fetal life."

Finally, the results of the chromosome studies arereported as follows: "the chromosomes were normalin number and karyotype and showed no defects inmorphology or chromosomal pattern." I would beunwilling to argue with anyone who claimed thatthese were the most uniquely normal set of normalchromosomes ever observed! But I would like topoint out that since the word karyotype defines bothchromosome number and morphology, its use in thesentence is utterly redundant. Furthermore, what isa "chromosomal pattern"? Can a set of chromosomesnormal in number and morphology (and karyotype!)still have an abnormal "chromosomal pattern"?My criticisms are not directed at the author of

this otherwise informative paper, but at the qualityof editorial review which permits the defects in thearticle to reach publication.

LEONARD PINSEY, M.D., F.R.C.P.[C]Director,

Cell Genetics LaboratoryLady Davis Institute forMedical Research of theJewish General Hospital,3755 C6te St. Catherine Road,Montreal 249.

REFERENCE

1. McKusIcK, V. A.: Heritable disorders of connectivetissue, 3rd ed., The 0. V. Mosby Co., St. Louis,1966, p. 401.

AIR-BORNE FUNGI ANDRESPIRATORY ALLERGY

To the Editor:With reference to the article written by Dr. B.

Rose and myself, entitled "Air-Borne Fungi andRespiratory Allergy: A Montreal Survey" (Canad.Med. Ass. 1., 99: 827, 1968), I wish to report thatI carried out a comparative survey using mouldextracts produced by Purex Laboratories with thoseused in the initial study. The comparison was madeon a group of 20 patients, each of whom was simul-taneously tested with the original antigens and thePurex antigens. In all cases the results were identi-cal.

Prior to this small comparative study, and sincein my own practice, I have found that Purex is the

only company able to supply from stock in Canadaall the moulds which were necessary to carry outsuch a survey.

Although the original survey was done on themoulds found in the atmosphere of Montreal, withsuch a wide selection of mould extracts being avail-able it seems quite reasonable to employ extractsof the moulds found in the various areas acrossCanada for similar procedures in the various cities.Currently a similar study is in progress in Toronto,using 23 different moulds found in this area. Thiscurrent study will attempt to go one step furtherand assess clinically the results of hyposensitizationwith mixtures of the appropriate mould extracts.

W.-P. WARREN, M.D., F.R.C.P.[C]3329 Bloor Street West,Toronto 18.

FRAUD IN SCIENCE

To the Editor:In the December 7 issue (Canad. Med. Ass. I.,

99: 1103, 1968), I read with interest that sectionof The London Letter dealing with "Fraud inScience".

Dr. Gilder refers to Rosen's article in the NewScientist in which the author, among other ex-amples, points out that the chance of producingsuch convincing results as Mendel obtained was lessthan one in 10,000 and that the suspicion remainsthat he did not gather his figures with completeobjectivity. Dr. Gilder and Rosen are in agreementthat the editorial system must try to filter thedubious material out.

For the sake of the record, it should be notedthat Mendel's laws of heredity, as indicated in hisnote, were based mainly not on experiments withpeas but on crossings of Mirabilis jalapa. It shouldalso be added that a discovery may not be success-ful in the hands of other than the discoverer himself.

Dr. Gilder did not suggest how "dubious material"should be defined, but I can well agree with Rosen'sstatement that 90% of published papers havenegligible merit or signfficance and I suggest thatthese are the only papers in which the editorialsystem, however efficient, could find "doctored" re-sults that should be eliminated. Dr. Gilder's ob-servations on fraud in science prompted me to re-call some of the past dubiosa: Ignaz Semmelweis,who was persecuted until he was driven insane forproclaiming what he believed he had proved wasthe cause of puerperal fever; and Louis Pasteur,whose hypothesis and proofs of bacterial infectionwere described by no less a man than the greatRudolph Virchow as "nonsensical".

I also suggest that the meaning of scientific ob-jectivity is different for the scientific genius thanfor the average man. Many of the great discoveriesin the natural sciences were beyond the scope oflaboratory experimentation and thus beyond "ob-jective" proof; many of them were propounded notonly against ordinary logic but against ostensiblyestablished scientffic experience. For example,Planck's constant, absolute zero temperature, wave

84 AE'.UANIM1TAS Canad. Med. Ass. J.Jan. 11. 1969, vol. 100

mechanics, the corpuscular theory of light, theeffect of gravity on light, and the theory of rela-tivity as a whole, were all regarded initially bycontemporaries as even less than "dubious". It isa historical fact that all of these great discoveriesfound their way at one time into the editorialwaste-basket. An editor must not hastily disposeof a contribution because the subject is unfamiliarto him or because the results appear to have beenobtained by unorthodox methods.

Dr. Gilder leaves hardly any room for scientific

ingenuity and intuition. One wonders if this atti-bide has gained momentum during the past decadeamong editors of scientific papers. Before givingshort shrift to a contribution that may be from oneof those in the 10% group, editors should rememberthat their predecessors helped to perpetuate someof the scientific falsehoods of one of the greatestinventors of scientific falsehoods-Aristotle.

J. W. MULLNER, M.D., Ph.D.375 King St. West,Brockville, Ont.

AEDUANIMITASTHE LANGUAGE OF MEDICARE

Much oratory and many printed words haveflowed in this country since the fateful day July19, 1965, when Prime Minister Pearson proclaimedthe four inflexible tenets of medicare. I have givenup the struggle to discard this imprecise euphemismfor universal, compulsory, government-controlled,tax-financed medical services. Perhaps it is just aswell that we should not constantly be reminded ofthe less agreeable aspects of the subject and thatthe word medicare should take its place withmotherhood, honour, bravery and other terms whichare close to sacrosanct.

However, it is clearly observable that the vocabu-lary of medicare relates mainly to money. You willlook in vain for terms like quality, progress, betterhealth and the like in current discussions. In theirplace. "costs,., "price,., . "open-ended contract" and "escalation" recur with de-pressing regularity. I have previously quoted EnochPowell, formerly Minister of Health in the U.K.,when he said that the only subject a Minister isdestined ever to discuss with the medical professionis money. Recent discussions of Federal and Pro-vincial Ministers of Health convince me that Mr.Powell was right and uncannily accurate.

Here is a selection of words gleaned from anofficial presentation made to provincial Ministers ofHealth. In my copy of the photostat an unknownhand has scribbled rude remarks opposite certainpassages which be found to be less than convincing."Hogwash", "B.S.", "Asinine reasoning", "Quality notconsidered" are representative examples and I can'tdisagree with this pungent assessment. However, itis the language of the presentation which interestsme, and I have gleaned 54 words and phraseswhich seem to me more appropriately applied to atreatise on economics than to a discussion of healthservices. I'll not burden you with them all but hereare a few: "law of the market place", "package of

benefits", "proportion of the G.N.P.", "rate of in-crease", "expense.., "short run , long run, govern-ments are contributing", "transfer of costs", "percapita expenditure", "cost control", "hold the line","steal a march on competitors" and "the take".These are the considerations which are belatedlyconcerning our political masters who actually seemsurprised that the cost of compulsory programs hasrisen uncontrollably in other nations.

You, doctor, are going to be held responsiblefor the cost of medicare because you are guilty ofexcessive use of diagnostic aids", "doctor-generated

services" and too prone to use "consultations andreferrals". If you are a specialist, particularly in thefield of obstetrics and pediatrics, you contribute tohigh-priced care because your practice covers normalchildbirth and well-baby supervision. We are"monopolists", we are all going to be subjected to"tight control" and "the answer lies primarily in thefee schedule" if not in the imposition of a salariedservice or payment by capitation fee.

What's your answer, doctor, to the problems oflongevity and to the phenomenon that the care ofsenior citizens costs twice as much as the average?Gould it be patient participation? I doubt it because"indemnity.., "co-insurance.., "utilization fee" and"deterrents" are mentioned but dismissed. Thewhole question of utilization is bothersome becauseit is astonishing to observe that people use a servicewhich they have paid for with their taxes, particu-larly when the goal of "a single public agency forpayment" has been attained. Our governmentplanners appear still to rely on the magic of theposition of the exclusive paymaster to control therunaway situation, but they are less confident thanformerly.When I had finished reading the extraordinary

document I reflected that our politicians and bureau-crats would be much happier if their medicareschemes could be run without utilizing the servicesof doctors. We are the culprits, the bad guys whooriginate all the bills. I can only conclude that wewill have to direct our attention more to thesemantics of economics, less to the jargon of clinicalmedicine and research, because medicare is with usand only money talks. A.D.K.