Letter to the Editor: Dr. Marik's Views Should Not be Taken Seriously : Emergency Medicine News

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Letter to the Editor

Letter to the Editor

Dr. Marik's Views Should Not be Taken Seriously

doi: 10.1097/01.EEM.0000511960.32079.05

    Editor:

    I am a senior staff member at Henry Ford Hospital in Detroit, MI. Not surprisingly, we take sepsis very seriously. I recently read Dr. Paul Marik's article, “Humans Are Not Yeast,” and I was stunned by the overtly contrary perspectives presented in this article which likely hit the inboxes and mailboxes of many a devoted EMN reader and induced a thorough head-scratching. (EMN 2016;38[9]:1; http://bit.ly/2bO6vWL.)

    This is especially true for those who are, like I was, not entirely familiar with the author and his reputation as an outspoken skeptic. This article flies in the face of our current mainstream understanding of pathophysiology with respect to acidosis, lactate physiology, and oxygen utilization dynamics, and delivers harsh criticism of sepsis treatment strategies.

    It states, “Lactic acidosis doesn't exist.” Really? Are we to drop MUDPILES and start feeding medical students MUDPIES? It goes on to suggest that, “‘Surviving Sepsis’ should really be relabeled ‘How Not to Survive Sepsis.’” I assume that is said because “this whole idea of trying to get rid of lactate by revving up oxygen delivery is bogus,” and that “titrating treatment to lactate clearance is another bogus myth.” Should the Centers for Medicare and Medicaid Services not be adopting measures ratified by the National Quality Forum?

    The currently accepted theories on these topics are not mere exercises in faith or mass superstition the way the article implies. On the contrary, the article contends with well-rooted fundamental concepts in some instances and it tangles with thoroughly investigated principles supported by current evidence in the mainstream literature in others. I applaud the efforts here to think outside the box and share new insights. Anyone with an open mind should be willing to entertain these arguments.

    But let's not get carried away presenting this in an authoritative fashion to such a wide audience as some sort of paradigm shift or dogma-busting development that will dismantle how we resuscitate the critically ill. Granted, the publication referenced its arguments and was not entirely devoid of scholar, but the proof was lacking to say that it “showed” what it set out to show.

    The piece is driven by strong opinion, and it is heavily biased. I'm sure my reaction to this comes as no surprise. The author himself acknowledges that he is going against the grain, and I believe his purpose is to antagonize the status quo. In fact, the only reason an article like this would not raise controversy is because it is too far-flung to be taken seriously by anyone that “still believes” in this stuff. That implication also fails, as if the tide has now turned or consensus opinion has finally reached the threshold to overturn conventional wisdom. It's not even close.

    Anthony O. Cruz, MD

    Detroit

    Wolters Kluwer Health, Inc. All rights reserved.
    • russell.mark1:11:54 PMI make no comment on the effectiveness of reducing lactate by oxygenation in sepsis, however ambient pressure oxygenation - or hyperbaric oxygen treatment - is a valuable method of clearing peripheral DIC (disseminated intravascular coagulation) in limbs following vasopressor administration during septic shock and preventing unnecessary limb loss and salvage surgery. HBOT is the gold standard in the prevention of gangrene following frostbite in the Antarctic and Arctic scientific missions and high-altitude climbing regions (there is a HBOT chamber in Kathmandu near Everest), which is also used for pulmonary edema and coagulation in climbers. The primary cause of limb loss following prolonged vasopressor administration in sepsis management is peripheral DIC. Ambient pressure oxygenation (HBOT) is also used increasingly for micro coagulation in long covid patients with remarkably good outcomes. Link to one of my own cases: http://mark-russell.net/Blog/index.php/2019/06/05/1257/
    • shieldsshauna16:28:56 AM"This piece is driven by strong opinion, and is heavily biased." And yours isn't? The proof of the pudding, my dear sir. I thought science was always evolving and the ability to look at new (or rediscovered) information is surely the sign of an open mind and high intelligence. Medical knowledge should be constantly evolving. Hanging on to your old sacred cows might lead to you ignoring developments that might help your patients. I know that is something that you wouldn't want.
    • rocketsurgeons11:01:38 AMThe only species that cannot make vitamin C are humans and guinea pigs; they have lost the gene to make vitamin C. So when other species get stressed, they can produce vitamin C and reduce the effects of stress from sepsis. Why not mimic nature and intravenously introduce vitamin C into humans suffering sepsis? Give HAT (hydrocortisone, vitamin C, and thiamine), and see what happens. It’s either going to work or it isn’t, much like a parachute: it either works or it doesn’t. Have you any firsthand results?