Certain jurisdictions in Canada legally require that physicians report unfit drivers. Physician attitudes and patterns of practice have yet to be evaluated in Canada for patients with brain tumours. We conducted a survey of 97 radiation oncologists, eliciting demographics, knowledge of reporting laws, and attitudes on reporting guidelines for unfit drivers. Eight scenarios with varying disability levels were presented to determine the likelihood of a patient being reported as unfit to drive. Statistical comparisons were made using the Fisher exact test. Of physicians approached, 99% responded, and 97 physicians participated. Most respondents (87%) felt that laws in their province governing the reporting of medically unfit drivers were unclear. Of the responding physicians, 23 (24%) were unable to correctly identify whether their province had mandatory reporting legislation. Physicians from provinces without mandatory reporting legislation were significantly less likely to consider reporting patients to provincial authorities (p = 0.001), and for all clinical scenarios, the likelihood of reporting significantly depended on the physician’s provincial legal obligations. The presence of provincial legislation is of primary importance in determining whether physicians will report brain tumour patients to drivers’ licensing authorities. In Canada, clear guidelines have to be developed to help in the assessment of whether brain tumour patients should drive.

Treatment of antisocial personality disorder Although Professor Maden's article was only 100 words long, 1 it contained some profound and, I think, unfair and unsubstantiated, statements. Where is the evidence that patients with severe antisocial personality disorders who do not want to be treated, like many of those detained in the dangerous and severe personality disorder (DSPD) unit at Broadmoor Hospital, where Professor Maden is the clinical director, can be effectively treated? Professor Maden criticises lawyers and independent experts but both he and others researching in the field have not produced independently verified evidence of efficacy. Professors Coid 2 and Duggan, 3,4 with others, have carried out meta-analyses and concluded that there was no evidence or that the evidence was very weak. Professor Duggan went as far as to suggest that this situation was ultimately unsustainable and would inevitably lead to legal challenges by those detained on the basis of their 'treatability'. The Canadians and Americans are concerned that psychological therapy with individuals with high scores on the Hare Psychopathy Checklist-Revised is making the situation worse and leading to increases in recidivism. 5 They appear to have moved on and are investigating biological treatments such as hormone treatment for sex offenders or even addressing the putative causes with gene mapping. 6 Is it really justifiable to blame lawyers and independent experts for pointing out this lack of evidence and that the DSPD project might not only be an expensive waste of time but it could be making the situation worse? Declaration of interest M.P.L. provides independent psychiatric reports to solicitors of patients in DSPD units. He is also a member of the Mental Health Review Tribunal and sometimes sits on DSPD units.

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Both these patients reported using neuroleptics intravenously for their sedative properties. Despite this potentially hazardous activity no complications occurred other than mild local phlebitis at the site of injection.