[Article IV]
Cactina Pillets
This preparation may be considered briefly in view of the recent discussion in this series of articles of the pharmacology of the digitalis group and the principles of treatment in cardiovascular disease. The manufacturers maintain that cactina is wholly unlike digitalis, and that is the truth, as we shall show; but since they claim that it is useful in certain conditions of the heart in which digitalis is commonly employed by well informed clinicians, it is necessary to consider its cardiac actions—or its lack of them! It is difficult to determine just what action cactina is supposed to exert on the heart. For example, one advertisement contains the following:
“Cactina Pillets. A gentle cardiac tonic that supports and sustains the heart through its capacity to improve cardiac nutrition.”
Just how the cardiac nutrition is to be improved without an improved coronary circulation is not explained. It would be interesting to know in what other way this is to be accomplished, and how an improved coronary circulation can be induced without acting on the heart or vessels. But that is what digitalis does, and you should remember that cactina is so very different from digitalis! Then again:
“Cactina Pillets. A remedy that steadies and strengthens the heart by imparting tone to the heart muscle.”
That is a pretty direct statement, but digitalis imparts tone; and we must not forget that “cactina” is wholly unlike digitalis, and we are told that “cactina” is:
“Invaluable in all functional cardiac disorders such as tachycardia, palpitation, arrhythmia, and whenever the heart’s action needs regulating or support.”
If these are merely functional disorders of the heart, it is highly desirable to know what are the symptoms of really serious cardiac disease! Since the manufacturers give us no information concerning the mode of action of “cactina” we will turn to the literature of disinterested observers. If one attempts to discover the origin of “cactina,” he will probably meet with disappointment, for various bibliographies fail to mention the name of Sultan, who is said to have isolated “cactina” from Cactus grandiflorus. It seems that Sultan worked with Cactus, or some other plant, when a student of pharmacy, and it is to be remembered that Cactina Pillets are manufactured by the Sultan Drug Company.
It is doubtful whether Sultan actually worked with genuine Cactus grandiflorus; and, in fact, there is good reason for thinking that he did not, for all subsequent workers who have taken pains to secure genuine Cactus grandiflorus have failed to detect the presence of any active principle, except possible traces that are of no therapeutic importance whatever.
WHAT THE COUNCIL FOUND
The Council on Pharmacy and Chemistry examined the literature relating to cactus and certain proprietary preparations, including Cactina Pillets, alleged to be made from cactus, and has reported the results of its investigation (J. A. M. A. 54:888 [March 12] 1910) and we will quote from that report.
“The therapeutic value of this plant has been variously estimated by different observers. Experimental evidence as to its action is scanty and no complete chemical examination has ever been made.
“Reputable men have testified that some of the plants of the cactus family contain very active principles, but so far experiments seem to prove that Cactus grandiflorus has neither the action of digitalis nor that of strychnin. The principal contributions, clinical and experimental, for and against the drug are set out below.”
Typical advertisements of “Cactina Pillets” from the Medical Record and New York Medical Journal, respectively.
The report then proceeds to analyze the work of O. H. Myers, R. A. Hatcher, Boinet and Boy-Teissier, Sayre, Gordon Sharp, S. A. Matthews, P. W. Williams, Aulde and Ellingwood, and comes to conclusions that are set forth as follows, in brief:
1. It is uncertain what part of the plant contains the active principle, if any such principle exists.
2. Part of the experimental and clinical work has been published under proprietary auspices.
3. The value of clinical evidence when unsupported by animal experimentation is much diminished by the tendency of enthusiastic and untrained observers to attribute to the drug given the effect really due to general remedial measures, psychic suggestion and so forth.
In other words, the literature does not afford a report of a single piece of careful painstaking work the results of which lend support to the claims made for Cactina Pillets as stated above, for it is obvious that if Cactus grandiflorus contains no active principle, no active principle can be extracted from it. Some time after the report of the Council was published, Hatcher and Bailey secured genuine Cactus grandiflorus directly from a competent botanist, Dr. C. A. Purpus, of Vera Cruz, Mexico, and studied it experimentally. They reported (J. A. M. A. 56:26 [Jan. 7] 1911) in part as follows:
“We have been unable to obtain any evidence that the true Mexican Cactus grandiflorus possesses any pharmacologic action whatever; but, on the contrary, it appears to be a singularly inert substance when administered either by the mouth or by the vein.”
When colossal doses of Cactus grandiflorus are given by the vein, they sometimes—but not always—appear to exert an extremely feeble action on the heart; but this action is so slight that its nature could not be determined. Even the most colossal doses of Cactus grandiflorus administered by the mouth to cats, dogs and frogs exert no perceptible effect.
Sollmann thus satirizes the absurd claims made by the exploiters of proprietary forms of cactus: “Should the heart be too slow, cactus quickens it; if the heart is too fast, cactus slows it; should the heart be too weak, cactus strengthens it; if the heart is too strong, cactus weakens it; does the heart wobble, cactus steadies it; if the heart is normal, cactus does not meddle with it” (J. A. M. A. 51:52 [July 4] 1908).
Will physicians continue to accept the statements of an interested nostrum vender—who submits not a shred of evidence to support his claims, but who has a financial interest in convincing them—even when his statements are diametrically opposed to all the evidence that the Council on Pharmacy and Chemistry has been able to secure?—(From The Journal A. M. A., Jan. 19, 1918.)