Antioxidants and ischaemic heart disease

SIR—In an era in which the slogan “evidence-based medicine” has replaced “medicine” and only fools claim to practise plain medicine it was refreshing to read in the June 14 issue of The Lancet the article1 and commentary2 on antioxidant therapy for ischaemic heart disease. Evidence in this instance, as so often, turned out to be a subjective concept. What was interpreted by the ATBC investigators1 as no favourable effect and, possibly, harmful is viewed by Nigel Stephens2 as confirming “what is already understood about vitamin E and b-carotene” (and he does not mean no effect or possibly harmful effect of vitamin E on coronary heart disease). The ATBC investigators “do not recommend the use of atocopherol . . . in this group of patients” whereas the commentator concludes that “there continues to be good reason to believe that a high dose of vitamin E may prevent myocardial infarction in patients with coronary atherosclerosis”. While trying to reconcile this contradiction I was left wondering who would be practising “evidence-based medicine”, rather than “medicine”, after reading that issue of The Lancet—a doctor who prescribes a high dose of vitamin E or a doctor who does not? Perhaps both, or, as I would suggest, neither.