© 2004 European Society of Cardiology
Response from authors to letter to the editor
Sir,There is a large and growing interest in complementary medical practices, both among patients and practitioners. The list of alternative remedies used in mild cardiac insufficiency includes Q10 (ubiquinone) and hawthorn (Crataegus) extract. The latter is sold as a prescription medication in Germany and also in Asia [1]. However, for no such therapy is there conclusive evidence of benefits from therapies, and too few studies seem to have addressed this topic.
The publication of our article comparing Cralonin therapy with usual therapies for mild cardiac insufficiency has obviously raised passions. Even if only Dr Anker accuses the authors of killing future HF patients, the main tenor of the correspondence appears to be that the article should not have been published, since the gullible readers of the Eur J Heart Fail will be misled into thinking that ACE inhibitors are no longer preferred treatment for heart failure.
We would rather hope that publication enables critical readers in the scientific community to make their own judgements. A study such as CAPPP was published in a renowned peer-reviewed journal, despite serious randomisation flaws, significant baseline differences between the treatment groups, and in some cases eccentric prescription patterns [2]. These deficiencies were acknowledged in the publication and could subsequently be debated. An example of a different kind is the use of digoxin in heart failure, which has a long history in Germany, despite a lack of conclusive evidence of benefits [3]. Recently, an analysis even indicated possible harmful effects on mortality in women [4]. Studies published in mainstream scientific journals highlight such issues and stimulate research and debate.
Our article does not attempt to hide differences and possible deficiencies in design and execution, but we as authors believed the study was of sufficient interest to submit to a specialised journal. As the benefits from ACE inhibitors in congestive heart failure, NYHA classes II–IV are incontestable, it would obviously be unethical to conduct placebo-controlled trials in patients so sick that ACE inhibitors are indicated. The participating practitioners would not have entered such patients into our study.
We are grateful to the Eur J Heart Fail for the decision to publish the study and let it be judged on its own merits by the journal's readers. As the correspondence shows, the article did not hide issues readers might criticise. We would be arrogant not to take such criticism to heart, as it serves to improve the design and conduct of future investigations in this field.
Complementary medicine should survive or fade because of its practices and results, which can and should be presented and discussed like those in any other medical practice.
Sincerely
M. Weiser, D. Schröder, P. Klein
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- Morelli V, Zoorob R.J. Alternative therapies: Part II. Congestive heart failure and hypercholesterolemia. Am Fam Physician (2000 Sep 15) 62(6):1325–1330.
- Hansson L, Lindholm L.H, Niskanen L, Lanke J, Hedner T, Niklason A, et al. Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet (1999) 353:611–616.[CrossRef][Web of Science][Medline]
- The Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med (1997) 336:525–533.
[Abstract/Free Full Text] - Rathore S.S, Wang Y, Krumholz H.M. Sex-based differences in the effect of digoxin for the treatment of heart failure. N Engl J Med (2002) 347:1403–1411.
[Abstract/Free Full Text]
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