by moral rejection of the act than by pro- fessional objectivity ... suicide as a choice," throughout history .... lifespan.1-3 Some of this reduced life span may be ...
Leters to the Editor
Suicide by the Elderly Dr. Susan Sorenson's editorial' on suicide by the elderly seems driven more by moral rejection of the act than by professional objectivity (e.g., her use in the introductory sentence of such prejudicial terms for suicide as "self-slaughter" and "self-murder"). Although she speaks of "the recent introduction ... of the idea of suicide as a choice," throughout history and in almost all civilized societies deliberate suicide has been seen as the expected, proper, even heroic thing to do under certain conditions. In our and many other Western countries there have been for quite some time increasingly intensive public debates of the issue; growing numbers of Americans (seemingly approaching a majority) approve of self-deliverance under certain conditions. It is entirely possible that, in the foreseeable future, several states may even legalize doctor-assisted suicides with proper safeguards. (Last year's Washington State petition drive was defeated only narrowly, something that would have been unthinkable only a few years ago.) Sorenson sees suicides by the elderly as mainly due to passing episodes of clinical depression or "extreme stress" caused by health, financial, and other problems that could be presumably remedied by medical, social-service, and other interventions. This view is not shared by many who are professionally in touch with the issue. Most planned suicides by the elderly seem to occur after prolonged rational deliberations (often involving family and friends, even doctors) by persons who no longer see anything to live for and face only a slow descent through unmitigated mental and physical suffering to inescapable death-a descent that no medical, public-health, or other intervention can change. Their choice is "self-deliverance" in the true sense of the word. Legitimate disagreements on moral and religious grounds do exist as to + firefighter and, 9if so, Thetheaverage act is ever years. justifiedwas whether of Risks limitof(120o) ofthe upper judgmenexcessconditions. 11under % in what also of firepercentmust deliberate misuse weight.2 andFifty-three ideal tal errors have health and may mass index (weight/ be considered, also had bodypublic fighters dealing a role to play in preventing of excessiveandweight.3 indicative height2) out impulsive one rules mid-arm But ifthickness, cirwith such. skinfold Tnceps suicides triggered suicides andand circum-by muscle solely mid-arm cumference, one90th, how argue conditions, remediable 80th, thecan were above values ference conis apublic health self-deliverance of perthat60th percentile, respectively, and Sorenson's by Dr.males.4 I am cern? by The for Canadian centiles agepuzzled views health(Table "publiclevels statement cholesterol totalhere mean serumthat sharply rights individual than the greaterintersect," were age group 1)and for each remark by her I am completelybaffled and above is recomwhich intervention level mended and the national average value.5 Mean HDL concentrations were lower than the average concentration; similarly, LDL and triglyceride concentrations were
that a "useful comparison can be drawn between abortion and suicide among the elderly." On moral and professional grounds, public health should be concerned with preventing or remedying conditions that drive elderly to suicide but not with preventing their suicides. Dr. Sorenson need not ask "Whose choice is it?" The choice is the individual's. [] Godfrey M. Hochblnu, PhD Requests for reprints should be sent to Godfrey M. Hochbaum, PhD, School of Public Health, University of North Carolina, Chapel Hill, NC 27599-7400.
Reference 1. Sorenson SB. Suicide among the elderly: issues facing public health. Am J Public Health. 1991;81:1109-1110. Editorial.
Firefighters and Heart Disease Firefighting is a stressful occupation that exposes workers to risk of ischemic heart disease due to carbon monoxide inhalation and elevated epine-pherine levels. Indeed, of 101 firefighters reported as having died on the job, 45 died from heart attacks.1 We report the results of our study examining nutritional factors affecting risk for heart disease in this group. All subjects were selected from an urban center in eastern Canada from May 1987 to February 1988. Of 200 firefighters in five stations, 174 were interviewed on shift. Weight, height, triceps skinfold thickness, and left mid-arm circumference were measured using standard techniques. Each subject's weight was compared to the upper limit of the largest frame size for ideal weight according to height.2 A venous blood sample was analyzed for high density lipoprotein (HDL), low density lipoprotein (LDL), total cholesterol, and triglycerides. The mean age of the firefighters was 37 + 6 (SD) years, with a range of 22 to 55
t
to the Edit
3. Burton BT, Foster WR. Health implications ofobesity: an NIH Consensus Development Conference. JAm Diet Assoc. 1985;85: 1117-1121. 4. Jette M. Guide for anthropometnc measurements of Canadian adults. Ottawa, Ontario,
Canada: Health and Welfare Canada; 1981.
5. National Swy: A Report to the Department of Natonal Health and We4fare. Ottawa, Ontario, Canada: Nutrition Canada; 1973. 6. Rifkind BM. lipid research clinics program reference values for hyperlipidemia and hypolipidemia. JAMA 1983;350:1869-1872.
Seagram Defends Ad "Talking About Alcohol" is an educational program developed by the Education Development Center, Inc, an independent nonprofit organization recognized worldwide as a leader in health and education programs for children, families, and schools. The program is written for parents of children 9 to 11 years of age and consists of a 24-page workbook and an audiocassette that is offered fiee of charge to anyone calling toll-free 800-SEAGRAM. Parents who received the tape were asked in an objective research study by Charles Atkin, PhD, Michigan State University, "Did the tape provide useful ideas for discussing why your child shouldn't drink?" Ninety-two percent of the parents responded that they found the tape "somewhat to very helpful." The National Association of School Nurses, Inc, has said this about the program: "NASN feels the tapes and handbook are an excellent tool for parents to use, both for initiating discussion and teaching about the dangers of alcohol." The United States Catholic Conference, Department of Education, wrote the following about the program: "The result is a handbook and an audiocassette designed to assist parents in being more responsive to their children on issues regarding alcohol and in being more persuasive in communicating their values and expectations." Yet your publication has been criticized for accepting advertising offering the same program free of charge to Public Health personnel throughout the countiy,1-3 and Seagram has been criticized for making it available. The interests of Seagram, the public health community, and theAmerican public in eliminating the problems associated with consumption of alcohol by underage drinkers coincide. We should all collaborate to convey that message. [1 Sepn E. Hebt
1176 American Joumal of Public Health
References 1. Freedman JE, Novey SR, Cowell C, Schiffer WKY Seagram fought California Proposition 134. Am J Publc Heakh 1991;81: 1347. Letter. 2. Godshall WT. "Talking about Alcohol" uses deceptive strategy. Am J Public Heakh 1991;81:1347-1348. Letter. 3. Mosher JF. The need for a responsible advertising policy. Am JPubic Heakh 1991; 81:1348. Letter.
Requests for reprints should be sent to Stephen E. Herbits, Joseph E. Seagram & Sons, Inc, Executive Offices, 375 Park Avenue, New York, NY 10152-0192.
Dissimilarities between Tuskegee Study and fflV/AIDS Programs Emphasized In a recent article Thomas and Quinn' claim that the strategies used to recruit and retain participants in the Tuskegee Syphilis Study were quite similar to those being advocated today for human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) prevention programs. It is my opinion that these similarities should be viewed only in light of the significant dissimilarities between the two cases. While the Tuskegee Syphilis Study had no protocol or any supervision by an independent review board, no ADDS study or any other medical study on human subjects in the United States can be conducted today under those conditions. At the present, medical research on human subjects should be approved and monitored by an institutional review board that includes members not affiliated with the
institution. In the Tuskegee study, no information was given to the subjects about the true nature of the study, and thus informed consent was not obtained. Such activities would be in clear violation of the National Research Act and the accompanying legislation on the protection of human subjects.2'3 Moreover, the subjects of the Tuskegee study were prevented from getting known effective treatment for syphilis. While no such treatment has been found yet for AIDS, the HIV/AIDS prevention programs aim to disseminate true and accurate information about the nature of this syndrome; their efforts are contray to what the researchers in the Tuskegee Study were doing. An emphasis on thie safeguards that have been put in place to prevent studies similar to the one conducted in Tuskegee
should accompany any "open and honest discussion" of the Tuskegee experiment. I suggest that such an approach will greatly enhance any effort to restore trust between the Black community and public health authorities. 0 Gerho B. GmnfeIl, PhD Requests for reprints should be sent to Gershon B. Grunfeld, PhD, Department of Medical Humanities, Southern Illinois University, School of Medicine, P.O. Box 19230, Springfield, IL 62794-9230.
References 1. Thomas SB, Quinn SC. The Tuskegee Syphilis Study, 1932 to 1972: implications for HIV education and AIDS risk education programs in the Black community. Am J
Publc Healh 1991;81:1498-1505.
2. National Research Act, Pub L No. 93-348, § 212, 474 (July 12, 1974). 3. 45, 46 CFR (July 12, 1974) and subsequent
revisions.
Handedness, Traffic Crashes, and Defensive Reflexes Recent data suggests that left-handedness is associated with shortened lifespan.1-3 Some of this reduced life span may be due to the sequelae of birth stressors that are purportedly related to the emergence of left-handedness,24,5 yet lefthanders also have higher rates of injury6 and are 5.3 times more likely to die as a result of injury.3 One puzzling finding is that lefthanded drivers are 1.9 times more likelyto have traffic crashes6 and are 3.8 times more likely to die of crash-related injuries.3 Casual obseivation suggested that a reflex pattern may place left-handers at riskwhen driving. The defensive reflexfor an unexpected event involves asymmetrically raising the hands in a protective posture. Right-handers appear to respond holding their left hand high and their right hand low, whereas left-handers reverse these movements. To relate this reflex to traffic crashes, imagine that the hands are holding a steering wheel and that there is a sudden incident that triggers the driver's defensive reflex. For the right-hander, with the left hand held high and right hand held low, the steering wheel rotates clockwise and the car swerves to the right, off the road or into slower moving traffic. For left-handers the reverse occurs, and the car veers to the left into oncoming traffic. This defense-startle reflexwas tested in 313 subjects (166 male, 147 female, mean age 20.2years). When subjectswere relaxed, the experimenter elicited the star-
August 1992, Vol. 82, No. 8
