Hauser WA, Annegers JF, Anderson VE: Epidemiology and the genetics of epilepsy. In Ward AA ... when Andre St-Maurice, of. Greenfield Park, Que., finally per-.
giving to both Americans and Canadians not only what they want but also what they need. A. Mark Clarfield, MD, CCFP, FRCPC Director, academic affairs Sarah Herzog Memorial Hospital Jerusalem, Israel and Sir Mortimer B. Davis-Jewish General Hospital McGill University Montreal, Que.
References 1. Kingman S: Cut price treatment for Americans. BMJ 1993; 306: 539 2. Redelmeier DA, Fuchs VR: Hospital expenditures in the United States and Canada. N Engl J Med 1993; 328: 772-778 3. Rouleau JL, Moye LA, Pfeffer MA et al: A comparison of management patterns after acute myocardial infarction in Canada and the United States. N Engl J Med 1993; 328: 779-784
Drowning deaths in people with epilepsy his article (Can Med Assoc J 1993; 148: 781-784), by Drs. C. Anthony Ryan and Graeme Dowling, highlights the risk of drowning for patients with epilepsy. The authors suggest that all people with epilepsy practise preventive measures "regardless of the degree of seizure control," apparently on the basis of one case in which a person who hadn't had seizures for 15 years drowned. It is unclear whether this person's death occurred in a bathtub or a shower and whether it could have been prevented if the authors' suggestions had been followed. According to age-specific cumulative incidence and prevalence rates' and 1991 Canadian census
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data by age2 an estimated 405 201 Canadians have a history of seizures, of whom 163 858 currently have seizures. Therefore 241 343 Canadians will not have had a seizure within the past 5 years. We agree that, regardless of their history of seizures, people should not swim without appropriate supervision or participate in boating activities without a personal flotation device. We also agree that people with epilepsy should use showers with built-in safety features. We question, however, the value of recommending that almost 250 000 Canadians with a remote history of seizures alter their bathrooms for what appears to be a very low risk of drowning. Joseph Dooley, MB, FRCPC Kevin Gordon, MD, MSc, FRCPC Peter Camfield, MD, FRCPC Neurology Division Izaak Walton Killam Children's Hospital and Dalhousie University Halifax, NS
References 1. Hauser WA, Annegers JF, Anderson VE: Epidemiology and the genetics of epilepsy. In Ward AA, Penry JK, Purpura D (eds): Epilepsy, Raven, New York,
1983: 267-269 2. Age, Sex and Marital Status (cat no 93310), Statistics Canada, Ottawa, 1992
[The authors respond:]
to us that the cost of a hand-held "telephone" showerhead (which cuts off the water supply upon the showerhead's release) is approximately $80 and that of a diverter valve attached to the faucet (which allows the use of either the standard showerhead or the "telephone" one) $30 (excluding the goods and services tax). The suppliers we spoke to offered free installation for uncomplicated faucet arrangements. C. Anthony Ryan, MB, FRCPC Department of Pediatrics University of Alberta Hospitals Graeme Dowling, MD, FRCPC Departments of Pathology and of Community Medicine and Health Sciences Administration University of Alberta Edmonton, Alta.
Medical "litter"-ature milestone in the annals of
A\ junk mail occurred recently when Andre St-Maurice, of Greenfield Park, Que., finally persuaded Canada Post that circulars needn't be delivered to people who do not wish to receive them (Le Devoir, Montreal, Apr. 20: 3). This development not only will save thousands of trees but also will help reduce water pollution, energy consumption and dioxin production. Meanwhile, current distribution practice dictates that Canadian physicians receive millions of unwanted publications annually. It is hoped that publishers and pharmaceutical companies will soon follow Canada Post's example and ensure that their material goes only to those who want it.
We agree with Dr. Dooley and his colleagues that the risk of drowning in a bathtub or shower is statistically likely to be low in patients with infrequent seizures. However, we believe that the individual patient should decide whether to take this risk, especially if the bathroom alterations are not costly. For example, a medical equip- Thomas J. DeMarco, MD ment supplier in Edmonton indicated Coaticook, Que.
LE I r AOIiT 1993
