If you don't know what all of the kerfuffle is about, read the
Pulmcrit Post (including the comments)
Listen to the interview with Paul Marik
I sent Paul the questions below and he was kind enough to answer them:
As I imagined, the interview and post were galvanizing. We've had thousands of hits. Listeners sent in a bunch of ?s. They were all on the same general theme. I think the best formed constellations would be:
“You've made your career as a critical care myth-buster. You look at the best-available evidence and cut down unsupported care. If you were not the author of the current study, would you be endorsing it or lambasting it as preliminary and unproven?”
Unlike egdt and other debunked therapies, there is an enormous amount of basic science, preclinical data and clinical data to support this approach. A critical review of the literature would lead one to ask why this has not been tried before; the science is compelling. Furthermore, multiple studies have demonstrated that in critically ill patients, Vit C levels are extremely low or undetectable. This is a universal finding not unique to our patients (see question below). Same goes for thiamine. Donnino showed that about 1/3 of patients with sepsis are thiamine deficient; our patients are not unique.
“Was there a lack of internal validity in the study design – unblinded, before-and-after, etc. Potential confounding with Vit C / thiamine deficiency vs sepsis?”
Dr. Rumbak at Tampa General has been doing this [the protocol] for about 6 months with similar results. There are at least 20 centers that are now doing this.
“Does Paul think there is any possibility his result could be false due to chance or systemic bias?”
No. Why don't the skeptics speak to the patients who have left our ICU alive and without residual organ failure. Linus Pauling was a two time Nobel Laurate; he had kinda figured this out. The NIH has awarded Dr. Fowler millions of dollars to do a RCT with Vit. C (alone). They would not have done this is they thought this was b/s.
A listener sent this tweet, a quote from a lecture in Virginia
For more on this go on over to
- EMCrit 281 – Why Can't Emergency Medicine and Trauma Surgery Just Get Along? - September 4, 2020
- EMCrit 280 – Who Should Get Angiotensin II with Rinaldo Bellomo - August 19, 2020
- EMCrit Wee – Is it Tamponade with Jacob Avila - August 17, 2020