A vitamin C ‘cure’ for sepsis? Don’t hold your breath … – HealthNewsReview.org

Chest is a prestigious medical journal. NPR is a prestigious news organization.

So when both publish findings (or, a story) suggesting vitamin C may be a possible treatment for sepsis, it gets attention. But is it the right kind of attention?

Some news outlets definitely pumped up the story with headlines like these:

Virginia doctor’s possible cure could save millions from sepsis

Sepsis is the number 1 killer of patients in hospitals. A doctor might have just stumbled on the cure.

“Sepsis: Deadly condition can now be treated through intravenous vitamin C”

The problem is that these glowing headlines are based on nothing more than an observational study of about 50 patients in a single intensive care unit in eastern Virginia. In other words, the kind of finding that’s very likely to get reversed when subjected to more rigorous study. It happens all the time.

It’s a fair question to ask if this really deserved air time during Morning Edition, NPR’s flagship morning news program that reaches millions each day. After all, finding an effective treatment for sepsis has eluded doctors for centuries. Wouldn’t it be prudent to wait a little longer to see if this very preliminary case series holds up?

Experts I spoke with questioned the decision to cover the study but said NPR’s piece, headlined “Doctor Turns Up Possible Treatment For Deadly Sepsis,” was appropriately cautious. They said it was a balanced look at the issue and did a good job of pointing out the following:

  • There have “been many false promises about this condition over the years” so NPR advises approaching the results “with caution”
  • This is “not the standard way to evaluate a potential new treatment” (no controlled study)
  • “There have been hundreds of exciting results from sepsis studies that failed in follow-up research”

So, how did all this fuss start?

Dr. Paul Marik is a critical care doctor with Eastern Virginia Medical School. In January of 2016 he was treating a 48-year-old woman with severe sepsis in the intensive care unit at Sentara Norfolk General Hospital. Sepsis occurs when an infection enters the bloodstream, spreads systemically, and triggers a cascading inflammatory response that can lead to widespread, multi-organ failure.

Dr. Marik

When sepsis is severe, anywhere from 15 to 30 percent of patients will die despite the traditional treatment approach of hitting the patients hard with intravenous antibiotics (for the infection) and intravenous fluids (to keep their blood pressure up). This is what Marik’s patient was facing.

Marik had recently read a study out of Virginia Commonwealth University that had shown some promise in using intravenous vitamin C for sepsis. So he improvised a triple cocktail of vitamin C, corticosteroids, and another vitamin, thiamine. The patient improved.

So did others he tried it on. When he found that only 4 out of 47 people (8%) treated this way died in the hospital — compared with 19 out of 47 (40%) who had died before he improvised the triple cocktail — he felt the results were just too promising not to share. That’s when the journal, Chest, decided to publish the results as original research. But is it research?

Dr. O’Brien

“It is research, but it is a very small study,” says Dr. Jim O’Brien, an ICU physician who is also the chairman of the board of directors for the Sepsis Alliance. “It’s an observational study, not a blinded and randomized clinical trial. So we need more rigorous, larger, and well-designed studies to see if the results hold up.”

Why is this story susceptible to hyperbole?

First, sepsis is the number one cause of death among hospitalized patients in this country. It kills nearly a quarter of a million Americans each year, and nearly 8 million people — mostly children — globally. According to to the Agency for Healthcare Research and Quality, sepsis is the most expensive condition treated in U.S. hospitals, costing more than $20 billion in 2011. It also has some of the highest readmission rates of any disease. Add to these numbers the fact that the pharmaceutical industry has invested billions trying to find treatments for sepsis, and you are looking at big numbers all around. Big numbers equals big eyes, and big eyes can mean big click rates and big ratings.

Second, vitamin C may be in your medicine cabinet right now. This realization might tempt some — like this NBC affiliate in Denver —  to erroneously conclude that Dr. Marik has “found a simple, inexpensive cure for sepsis.”

Dr. Ross

“There’s this belief that because it is a vitamin there can’t be toxicity,” says Dr. O’Brien. “But it’s still a drug. Still a chemical. We don’t know if there are toxicities or not.”

Dr. Joseph Ross, an internist at Yale University who specializes in health care delivery and quality, says there is another aspect of the vitamin angle to consider:

But so far the most egregious hype has come from the Eastern Virginia Medical School itself — the school where Dr. Marik is on the staff. It’s alarming when a medical school news release runs a headline like this: “A Cure for Sepsis?” Not only do they go on to describe Dr. Marik’s findings as a “breakthrough ..[it] promises to revolutionize sepsis care worldwide and produce results that are nothing short of astonishing,” but Dr. Marik himself is quoted as saying:

“We haven’t seen a patient die of sepsis since we began using the combination therapy a year ago. We have completely changed the natural history of sepsis.”

What’s really astonishing — disturbing actually — are health care organizations and news outlets that continue to do this: when given the choice between seducing readers with pablum or actually providing them with information in context, many opt for the former. And that is another widespread infection that needs treatment as soon as possible.

Correction 3/28/17: This post initially stated that 4 people treated with the vitamin C protocol died of sepsis. It has been corrected to note that these patients died in the hospital. According to the published study, they did not die of complications of sepsis.

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