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Rapid response to:


Should oxygen be given in myocardial infarction?

BMJ 2010; 340 doi: (Published 17 June 2010) Cite this as: BMJ 2010;340:c3287

Rapid Response:

Medical Myths Die Hard

So "sliding scale insulin coverage", which came from the era of
treating the results of urine glucose testing,and was long
extrapolated,without study,to current finger-stick blood glucose testing
has finallybeen put to rest [1].The long interval between Holler's[2] case
report documenting life threatening hypokalemia during treatment of
diabetic ketoacidosis( DKA)with insulin without potassium supplements and
potassiums ultimate inclusion in current treatment protocols is an
historic fact.Metformin was tarred with the same brush that eliminated
Phenformin from the American market, again without study, resulting in
more than 3 decades of unavailability in the U.S.

We still use "normal" or 0.9% saline for everything intravenous
despite its dubious history and excellent reasons to replace it with more
physiologic electrolyte solutions[3].And industrial dose insulin therapy
of DKA based solely on "expert opinion" persisted long after studies
demonstrated the adequacy of low-dose insulin regimens[4].

The current suggestion that supplemental oxygen in myocardial
infarction may be harmful[5] and,at a minimum, has never been shown to be
beneficial has engendered the "expert opinion" argument and defense of
the status quo[6].As Tatsioni,[7] note ,it can be "difficult to
discern whether perpetuated beliefs are based on careful consideration of
all evidence and differential interpretation,inappropriate entrenchment of
old information,lack of dissemination of newer data, or purposeful
silencing of their existence".


1. Shagan BP.Does anyone here know how to make insulin work backward;
Why sliding scale insulin coverage doesn't work.Practical Diabetes

2.Holler JW.Potassium deficiency occuring during the treatment of
diabetic acidosis.JAMA 1946;132:1186-1189.

3.Awad S,Allison SP,Lobo DN.The history of 0.9% saline. Clinical
Nutrition.2008; 27:179-188.

4.Carroll P,Matz R.Uncontrolled diabetes mellitus in adults:
experience with low-dose insulin and a uniform treatment regimen(1976-
1982). Diabetes Care 1983; 6: 579-585.

5.Cabello JB, Burls A, Emparanza JI, Bayliss S,Quinn T.Oxygen therapy
for acute myocardial infarction.Cochrane Database Syst Rev 2010;

6.Atar D. Editorial: Should oxygen be given in acute myocardial
infarction? BMJ 2010;340:C3287.

&.Tatsioni A, Bonitsis NG, Ioannidis JPA.Persistance of contradicted
claims in the literature.JAMA 2007;298:2517-2526

Competing interests:
None declared

Competing interests: No competing interests

28 June 2010
Robert Matz
Professor of Medicine
Mount sinai school of Medicine NYC, NY 10029-6574