About writing letters to medical journals

January 2012

A misleading statin report

In my November newsletter I told you about the misleading SATURN trial. Together with two of our members, Paul Rosch, Professor of Medicine and Psychiatry at New York Medical College and President of The American Institute of Stress, and Stephanie Seneff, Principal Research Scientist at MIT, I sent the following letter to New England Journal of Medicine:

Questionable conclusions from the SATURN trial

To define the relationship between the external and internal diameter of an artery as percent atheroma volume¹ is problematic, since dilation of the artery per se would be interpreted as a decrease of atheroma. This is hardly a trivial bias, because irrelevant factors may cause a significant dilation of the arteries without changing atheroma size. Brown et al. found that an isometric handgrip sustained for a few minutes during cardiac catheterization increased the luminal area by 35%,² and drugs as well as emotional factors that affect arterial tone may also be confounding factors. Furthermore, when arteries become sclerotic, they often widen. This widening can overcompensate for the increase of the atheroma until it occupies about 40 per cent of the wall area.³ Thus, an increase in vessel lumen could be due to diminished atheroma volume, compensatory widening in response to arteriosclerosis, vasodilating drugs, or the patient may be less stressed at the second investigation and therefore less prone to grip the nurse´s hand or something else.

1. Nicholls SJ, Ballantyne CM, Barter PJ et al. Effect of two intensive statin regimens on progression of coronary disease. N Engl J Med 2011 Nov 15.

2. Brown BG, Lee AB, Bolson EL, Dodge HT. Reflex constriction of significant coronary stenosis as a mechanism contributing to ischemic left ventricular dysfunction during isometric exercise. Circulation 1984;70:18-24.

3. Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med !987;316:1371-5.

A few days later I got the following letter from the journal:

Dear Dr. Ravnskov,

I am sorry that we will not be able to print your recent letter to the editor regarding the Nicholls article of 01-Dec-2011. The space available for correspondence is very limited, and we must use our judgment to present a representative selection of the material received. Many worthwhile communications must be declined for lack of space.

Thank you for your interest in the Journal.

Sincerely,

Gregory Curfman, M.D. Executive Editor

It is of course embarrassing that the editors accepted the SATURN report for publishing in one of the world´s most respected medical journals, but shouldn´t they have the guts to admit their mistake? Or has even this journal become dependent on the money from the drug companies?

How to meet criticism

A few months ago Jan Pedersen and coworkers, all of them strong supporters of the diet-heart idea, published an editorial in British Journal of Nutrition entitled The importance of reducing SFA to limit CHD.

I was astonished, because more and more researchers have realized that there is no scientific support for the claim that saturated fat is dangerous to health. On the contrary, many studies have shown the opposite.

Together with four members of THINCS I sent a letter to the journal explaining why the arguments presented by Pedersen and his coworkers are invalid.

Pedersen and his co-workers published a response to our letter without answering any of our objections (To read their response, click on the blue field in the upper right corner). Their answer is almost identical with a response I got a few years ago from Martijn Katan, one of Pedersen´s co-workers. You can read my letter and Katan´s response on Michael Eades blog together with Michaels comments.

A positive interpretation of our correspondence is of course that when supporters of a questioned paradigm start ridiculing their opponents instead of arguing in a scientific way, a paradigm shift is approaching.