A gentlemanly dispute

Upgrade Ambulatory Extra-Aortic Counterpulsation to Full-Support LVAD
Mohamed Zeriouh, MD; Anton Sabashnikov, MD; Nicholas R. Banner, BM, MD; André R. Simon, MD, PhD; Aron-Frederik Popov, MD, PhD
JCHF. 2015;3(4):342-343. doi:10.1016/j.jchf.2014.12.012
http://heartfailure.onlinejacc.org/article.aspx?articleid=2234659

Letter To The Editor | April 2015
Reply
Upgrade Ambulatory Extra-Aortic Counterpulsation to Full-Support LVAD
William T. Abraham, MD; Sanjeev Aggarwal, MD; Sumanth D. Prabhu, MD; Renzo Cecere, MD; Salpy V. Pamboukian, MD, MSPH; Alan J. Bank, MD; Benjamin Sun, MD; Walter E. Pae, MD; Christopher S. Hayward, MD; Patrick M. McCarthy, MD; William S. Peters, MBChB, MD; Patrick Verta, MS Stat, MD; Mark S. Slaughter, MD
JCHF. 2015;3(4):343-344. doi:10.1016/j.jchf.2014.12.011
http://heartfailure.onlinejacc.org/article.aspx?articleid=2234658
Great exposure for C-Pulse, a gentlemanly argument in a prestigious journal, not as to whether C-Pulse in general works, but how to frame the "theology" of who to target.(Quite a bit different to arguing what MyDicar's? results really are)
My take is that the Germans are "floating" the proposition (i.e.. there after a discussion from which they hope to refine a position), "look your overstating the disadvantages of LVADs compared to C-Pulse and this extremism on C-Pulse is blinding you to targeting it better" .  The Yanks are saying toughen up, C-Pulse DOES NO HARM (you're overstating your concerns about skin growing round the cuff), C-Pulse has the potential to do a great deal of good therefore it must always be the first option. Then the Yanks go on to give a little ground but not much, we can see your point about arrhythmia  but you'd have to be dam sure it was intractable arrhythmia.