Christian Erickson

The prolific author and physician Richard Gordon once cracked that “the history of medicine is largely the substitution of ignorance by fallacies” [42]. The conflation of fallacy and ignorance in the case of digitalis plus calcium may be the acceptance of Bower’s shaky case reports at the expense of Lieberman’s stronger—and arguably more useful—finding that the most important determinant of calcium toxicity is the dose and rate of infusion,whether or not digitalis glycosides are present. While some of the timidity surrounding digitalis treatment is grounded in rational evidence, much of it still seems to reflect subjective interpretation insulated from empirical reality. As Blaustein notes, the ancient toxic taboos associated with cardiac glycosides “scared off many physicians and nearly relegated digitalis to oblivion before it was perspica-ciously resurrected by [William] Withering” [12]. Like the “pseudoaxioms” [43] that epinephrine should never be injected into toes or that opioids will mask the abdominal exam findings in a surgical patient, the old digitalis-calcium “stone heart” taboo withers under a careful review of the evidence.