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;38:1; 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