Every year, more than a million Americans get sepsis. About a third of them die, despite intensive medical care. Muhammad Ali died of sepsis. So did actress Patty Duke. Sepsis is a medical emergency that results from a bacterial infection of the bloodstream. Sepsis can lead to septic shock, which is a failure of circulation. Sepsis often leads to multiple organ failure. Even the survivors may be end up disabled. Fortunately, Dr. Paul E. Marik, who has long been an expert on sepsis, has found a treatment that seems to work. It is cheap and harmless and already available: intravenous vitamin C, along with steroids and some vitamin B1. After the staff at Marik's hospital started giving this treatment to all sepsis patients, patients at that hospital stopped dying of sepsis. Doctors at other hospitals should start using this treatment right now for all of their sepsis patients. There is no need to wait for more research.
Dr. Marik is a professor of internal medicine and chief of pulmonary and critical care medicine at the Eastern Virginia Medical School, in Norfolk, Virginia. Like every other doctor involved in critical care medicine, he has struggled to save the lives of septic patients. From reading the medical literature, Marik knew that scurvy (a severe deficiency of vitamin C) could cause the same symptoms as sepsis. He also knew that many patients with sepsis have low levels of vitamin C in their bloodstream. He also knew that steroids, which are commonly used for treating sepsis, might work well in concert with vitamin C.
Dr. Marik gave a combination of intravenous vitamin C and steroids to a 48-year-old woman who was about to die of septic shock. Within hours, she started to recover. Two days later, she was well enough to leave the intensive care unit. Dr. Marik and his colleagues were amazed by her recovery. They tried the treatment on two more patients who were about to die of sepsis. Those patients also recovered. At that point, Dr. Marik and his team started giving this treatment to all sepsis patients. They also added some thiamine (vitamin B1) to the protocol. Since then, none of their patients have died of sepsis. (However, a few died of the disease that caused their sepsis.)
In December of 2016, the journal Chest published a report on 47 patients who had been treated with Marik's protocol. None of them developed progressive organ failure, and only four of them died. In contrast, there were 19 deaths among 47 sepsis patients who had been treated at that hospital during the seven months before the protocol was introduced. The odds of an outcome this good happening by chance are less than one in a thousand.
These results are exciting, but many members of the medical profession have reacted with skepticism and even scorn. Since the 1970s, health faddists have made many false claims about vitamin C. Also, doctors have been trained to ignore any study that did not randomly assign patients to receive either an active treatment or a fake treatment (placebo). Marik did not do that. He gave all of his patients the best care that was available at the time. He then compared the results of his protocol with the results of the care that was standard in the seven months before the protocol was introduced.
Researchers should not use a placebo-controlled study to evaluate Marik's protocol. It would be unthinkable to let someone die, just to prove that a new treatment really would have saved his or her life. As Marik put it, you do not need to do a placebo-controlled trial of parachutes before you start using parachutes. Researchers may assign patients to receive a placebo only if there is genuine uncertainty about whether the real treatment would save their lives.
Vitamin C and thiamine are cheap, already available, and known to be harmless. Doctors have nothing to lose by trying Marik's protocol. In contrast, sepsis patients have everything to lose if the doctor fails to give them effective treatment on time. Hospitals should start using Marik's protocol now for all sepsis patients. If it does not work, they can stop using it. But if it does work, they will save lives that would otherwise have been lost.