Miracle Cure for Sepsis

[VentMonkey]

This is actually gaining a lot of traction and is being covered by many reputable physicians....

Not to mention being produced by a seemingly respectable physician who's apparently published in journals also.

@zzyzx would you care to elaborate as to why it is you feel this guy is a hack, other than using the word "ginormous"?*

*At least he hasn't used the non-word word "irregardless" yet?

 

[MonkeyArrow]

So I actually read the full text of the paper. I mean, sure, the results were drastic but there are severe issues with this type of literature that limit any ability to draw conclusions from. First of all, this is a retrospective study, non-randomized. Second, the control group was for a 7 month block before the 7 month experimental period, which means that process changes could've happened between control and experimental. Also, this was non-blinded, which could mean that there was confirmation bias, although the primary endpoints don't lend themselves to bias much (mortality: they dead or not?). Additionally, having a non-blinded treatment could mean there was more nursing and physician attention given to those in treatment group. This begs for a double-blinded, multi-center RCT.

 

[zzyzx]

Not to mention being produced by a seemingly respectable physician who's apparently published in journals also.

@zzyzx would you care to elaborate as to why it is you feel this guy is a hack, other than using the word "ginormous"?*

*At least he hasn't used the non-word word "irregardless" yet?

Sure, but give a day or so to respond because i hate typing on my phone

 

[zzyzx]

Vent, you asked why I suspect this doctor is a hack.

1) First, consider the headline, “doctor claims to have found cure for sepsis.” Really?! And not only that but a “miracle cure?” Surely any medical professional would be have a hard time believing such an extraordinary claim. Again, consider that he is not just claiming a reduction in sepsis death, but almost a complete cure. How long have human beings been fighting infectious diseases, which have always been our number one cause of death? And now we are to believe that one person has stumbled on a miracle cure?

2) Vitamin C. Anytime that you hear somebody claim that Vitamin C or an anti-inflammatory provides a miracle cure, you should be rolling your eyes. If you ever walk into a Whole Foods “natural cures” isle, take a look at the many claims that the peddlers of vitamins and anti-inflammatories make.

By the way, I bet you know many people who believe that taking vitamin C supplements will help cure a cold, right? Sadly I even know many medical professionals (nurses and paramedics mostly) who believe this to be true. The idea that vitamin C cures colds was at one point promoted by a noble prize winning scientist. However, numerous studies have shown that vitamin C neither cures colds or nor palliates the symptoms of cold. Yet people continue to use it.


3) Anecdotal evidence. The article provides too much anecdotal evidence. It reads not like an article in a serious medical journal, but more like something you would find in a popular magazine.

4) “He wants there to be a comprehensive study…but he said it will be difficult to fund because it uses drugs that have been on the market for decades: ‘We are curing it for $60. No one will make any money off it.” Oh really. So he is saying that no one is interested in studying something that will cure sepsis?!

Consider the recent updates in sepsis care. The studies that these changes were based on did not promote any new antibiotics or other drugs.

5) “By the time it’s done, it could be three years and the number of people who will die of sepsis by that time will be ginormous.” Medical professionals don’t use words like this. And yes, this is important. Imagine if you had no medical knowledge at all and you read a paramedics run report which stated, “The patient looked crazy sick!” As someone with no medical knowledge, that might not strike you as odd. You might think that this is how all paramedics do their medical documentation. However, because you are a professional paramedic, you recognize that writing something like this in medical documentation is inappropriate, and you would likely question that paramedic’s competency.

6) ““People who have studied sepsis a long time don’t want to believe a simple solution can work.” Really?!! Doctors don’t want simple solution to save people’s lives?

 

[zzyzx]

Here is another example of extraordinary claims made by a doctor using language that a medical professional should not be using. I''ll leave it up to someone else to spot all the red flags..

 

[VentMonkey]

Vent, you asked why I suspect this doctor is a hack.

1) First, consider the headline, “doctor claims to have found cure for sepsis.” Really?! And not only that but a “miracle cure?” Surely any medical professional would be have a hard time believing such an extraordinary claim. Again, consider that he is not just claiming a reduction in sepsis death, but almost a complete cure. How long have human beings been fighting infectious diseases, which have always been our number one cause of death? And now we are to believe that one person has stumbled on a miracle cure?

2) Vitamin C. Anytime that you hear somebody claim that Vitamin C or an anti-inflammatory provides a miracle cure, you should be rolling your eyes. If you ever walk into a Whole Foods “natural cures” isle, take a look at the many claims that the peddlers of vitamins and anti-inflammatories make.

By the way, I bet you know many people who believe that taking vitamin C supplements will help cure a cold, right? Sadly I even know many medical professionals (nurses and paramedics mostly) who believe this to be true. The idea that vitamin C cures colds was at one point promoted by a noble prize winning scientist. However, numerous studies have shown that vitamin C neither cures colds or nor palliates the symptoms of cold. Yet people continue to use it.


3) Anecdotal evidence. The article provides too much anecdotal evidence. It reads not like an article in a serious medical journal, but more like something you would find in a popular magazine.

4) “He wants there to be a comprehensive study…but he said it will be difficult to fund because it uses drugs that have been on the market for decades: ‘We are curing it for $60. No one will make any money off it.” Oh really. So he is saying that no one is interested in studying something that will cure sepsis?!

Consider the recent updates in sepsis care. The studies that these changes were based on did not promote any new antibiotics or other drugs.

5) “By the time it’s done, it could be three years and the number of people who will die of sepsis by that time will be ginormous.” Medical professionals don’t use words like this. And yes, this is important. Imagine if you had no medical knowledge at all and you read a paramedics run report which stated, “The patient looked crazy sick!” As someone with no medical knowledge, that might not strike you as odd. You might think that this is how all paramedics do their medical documentation. However, because you are a professional paramedic, you recognize that writing something like this in medical documentation is inappropriate, and you would likely question that paramedic’s competency.

6) ““People who have studied sepsis a long time don’t want to believe a simple solution can work.” Really?!! Doctors don’t want simple solution to save people’s lives?

I can respect your point of view, and you do indeed make a valid argument.

 

[FLdoc2011]

@E tank
Clearly his approach seems "too good to be true" to some as cited in the EMS 1 article, but to me it's sad that it's not yet being embraced, or adopted quite as rapidly in the CC world by intensivists.

Because right now it's a theory based on a single center and not a controlled trial. Certainly raises an interesting thought regarding this treatment and will hopefully spawn further trials but in general we don't adopt some treatment/modality based on such limited data without it being replicated and standing up to some degree of proper inquiry.

 

[FLdoc2011]

Vent, you asked why I suspect this doctor is a hack.

I think you're being a little black and white with certain things. First, Dr Marik is not hack and well known in the sepsis circle. I think it's fine to always be somewhat skeptical about certain claims, but at the same time just as much damage can be done about being stubbornly steadfast in whatever current beliefs you have and not willing to accept data that suggests something that goes against what you may think.

I don't think anyone, let alone the study authors, are saying this is the end-all-be-all in sepsis treatment or even that this one small study proves beyond a shadow of a doubt. It's another data point that can be added to previous data suggesting that there may be a signal here worth looking into.

https://emcrit.org/pulmcrit/metabolic-sepsis-resuscitation/

From that site:

Ready for prime time?

This is a controversial question, which will undoubtedly leave practitioners with divided opinions. When exactly do we reach a tipping point, beyond which we feel that there is enough evidence to implement a therapy? This is almost more of a philosophical question than a scientific one, making it impossible to reach consensus. Hardcore evidence-based medicine disciples may be aghast at using a therapy without a large multi-center RCT, whereas more integrative, theoretically-minded clinicians may be willing to consider it.

It would certainly be nice to have a large, multicenter, placebo-controlled RCT. However, not every therapy requires one. The use of vitamin C to treat scurvy is based on a single-center open-label trial involving twelve sailors. There isn't any RCT proving that potassium should be repleted among patients with septic shock. Replacing an essential endogenous substance which is deficient doesn't necessarily mandate level-I evidence.

Although a single unassailable RCT is lacking, an extensive body of evidence does exist regarding vitamin C and thiamine. Over a half-century of experimentation attests to the safety of these vitamins. Several RCTs suggest that they are beneficial in critical illness, as reviewed above. Marik's results have similarities to prior RCTs, implying replicability. This clinical evidence is supported by robust basic science.

Clinical practice isn't scientifically perfect. Nearly all of our current therapies for sepsis lack level-I evidence. On the front lines of critical care, we are forced to treat dying patients based on the evidence that we have, not the evidence that we might wish for. In the context of this imperfect reality, treating septic patients with Vitamin C and thiamine may be a rational and evidence-based practice. Indeed, some authors recommended using IV vitamin C even beforeMarik's study was released (Honore 2016)

 

[VentMonkey]

@FLdoc2011 thanks for your posts, I absolutely believe, and am personally a fan of osteopathic therapies more often than not; everyone's different I suppose.

 

[Carlos Danger]

I had to check if it's April 1st yet after reading this article.
Is this dude a friend of Dr Oz?

Always remember that there are a large number of weirdos and hacks who are doctors

Paul Marik has been published hundreds of times. He's well-respected in the field of critical care and was heavily involved in developing the modern approach to treating sepsis. I'd go so far as to say that if you aren't familiar with his name at least - if not his work in sepsis - then you've never read any critical care related literature and thus are certainly not in a position to make such harsh judgements about the validity of his work.

But yeah, he's just a hack.....totally in the same vein as Dr. Oz.

 

[zzyzx]

"But yeah, he's just a hack.....totally in the same vein as Dr. Oz. "

Well, Dr Oz also has impeccable credentials. He's a cardiothoracic surgeon and lecturer at Columbia. But he's still a hack. Why? Because he peddles pseudoscience. He knows better, but he's made the decision to pursue wealth and fame.

Please refer to my post. I'm only quoting what Dr Marik has publicly said. I'm not making anything up. In the article he said that doctors are not interested in simple cures. He said that the reason other doctors have not funded his research is because they are only motivated by profit. He makes extraordinary claims without providing extraordinary evidence.

Do you guys really think this behavior is professional?

 

[zzyzx]

Here is an excellent podcast on how the popular media can be predicated to do a bad job on reporting medical news.

http://www.wnyc.org/story/on-the-media-2015-12-25

 

[Carlos Danger]

You still said he's a hack, which shows that you don't know the first thing about the guy, and is 100% untrue.

You were wrong, just own it.

 

[zzyzx]

Remi, is this a competition for you?

Moving on, the podcast I linked to is a really interesting discussion on how the media very often does a bad job of reporting on medical news. It's not media bashing, but rather a good exploration on why the media so often gets it wrong.

 

[Carlos Danger]

Remi, is this a competition for you?

Trust me, there is no competition here.

You made an irresponsible and patently false accusation about a well respected researcher, and several folks here called you out on it. Then you tried to backpedal, without admitting that you were wrong, and I called you out again. Now you are trying to change the subject.

And that's where we are.

 

[zzyzx]

I'll have no problem admitting I was wrong if in the near future we are told that vitamin C, steroids, and thiamine are as important for curing sepsis as antibiotics.

Reread the article, and consider that he is claiming a near 100% cure rate for sepsis.

Remi, I think you're missing the point. I don't care what this doctor's reputation is. I'm going by the public statements he has made. Consider that Andrew Wakefield was also a respected doctor, and that he even published his study (purporting a link between autism and vaccines) in The Lancet.

If you want to move past this argument, I think you'll find that podcast of interest.