CORRESPONDENCE: LETTER TO THE EDITOR
Complementary Medicine Has No Place in Cardiovascular Medicine
Carl E. Bartecchi, MD*
* University of Colorado School of Medicine, 615 Dittmer Avenue, Pueblo, Colorado 81005 (Email: ckbartecchi{at}comcast.net).
The recent American College of Cardiology Foundation (ACCF) Complementary Medicine Expert Consensus Document—"Integrating Complementary Medicine Into Cardiovascular Medicine (1)"—presents problems for science-based physicians who demand evidence-based medicine. Complementary medicine implies that alternative medicine modalities are performed as an adjunct to Western medicine. There is, however, no place for unproven, unscientific (alternative) medicine in cardiovascular medicine. Alternative medicine practitioners attempt to skirt the unscientific nature of their unproven therapies by adding some therapies that have always been considered conventional—exercise, diets, physical therapy modalities, and relaxation prescriptions.
The Institute of Medicine (IOM) report (2) referred to in the ACCF Document argues that the true complementary and alternative medicine practices (chiropractic, acupuncture, naturopathy, homeopathy, and no doubt hundreds more) are rooted in forms of evidence and logic other than those used in biomedical sciences. I (3) and others have suggested that this constitutes the "free-ride" of alternative medicine.
The ACCF document points out the deficiencies and lack of evidence for most dietary supplements and herbs. I can think of little if any place for herbs and supplements in modern cardiovascular medicine. Today, we use digoxin, not the foxglove. Sampson (4), in his discussion of herbal remedies and basically all alternative remedies, suggests that they "are generally less effective or ineffective, and randomized clinical trials of these remedies measure mostly subjective symptoms. ... Inconsistent outcome from studies of alternative treatments seem to be the norm."
The ACCF document alludes to the problems related to chelation therapy, but it fails to criticize the launching of still another expensive trial of that repeatedly disproved therapy. Sampson suggests that, as scientists, we will not go astray by supporting a medicine based on evidence that has passed through the sieve of plausibility and that is consistent with basic sciences, other applied sciences, and history—all molded by wisdom and common sense.
The most glaring deficiency of the ACCF report is in the lengthy section on acupuncture, which suggests that there is evidence of value and potential indications for this alternative therapy. A recent review by Atwood (5) claims that "investigations of acupuncture to date have not demonstrated effects on the natural history of any disease." I know of no proven value for acupuncture in cardiovascular medicine. Acupuncture and especially "electro-acupuncture" has wonderful placebo capabilities. Positive effects from acupuncture can be attributed to psychosomatic mechanisms related to conditioning, expectation, suggestion, and distraction from the actual source of the pain or discomfort. Acupuncture, like much of Chinese medicine, is based on mysticism—belief in that which cannot be proven and unable to be understood.
In summary, there is no place for complementary medicine in cardiovascular medicine.
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1. Vogel JH, Bolling SF, Costello RB, et al. Integrating complementary medicine into cardiovascular medicine. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (Writing Committee to Develop an Expert Consensus Document on Complementary and Integrative Medicine) J Am Coll Cardiol 2005;46:185-210.2. Institute of Medicine Complementary and Alternative Medicine in the U.S.. Washington, DC: The National Academies Press; 2005. 3. Bartecchi CE. "Alternative" medicine’s free-ride Sci Rev Altern Med 2004;8:5-8. 4. Sampson W. Studying herbal remedies N Engl J Med 2005;353:337-339.[Free Full Text] 5. Atwood KC. The P6 acupuncture point and postoperative nausea and vomiting SRAM 2005;8:29-31.
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