As before, the mainstream media covered this story. National Public Radio, which widely publicized the protocol in 2017, again took notice. Dr. Marik told NPR that “in his experience, the treatment is only effective if given within six hours after someone has suspected sepsis.” (The typical time-to-treatment with the cocktail was around 12 hours in the VITAMINS trial.) But this is simply another way of saying that early detection and treatment of severe sepsis and shock are important. The patients for whom Dr. Marik declares the protocol is effective are precisely the ones receiving timely treatments we know to be crucial, including antibiotics and, in some patients, fluids and vasopressors. It is safe to propose that for patients who do not receive these proven therapies promptly, nothing will work later. However, in the VITAMINS trial, that is not what occurred. Instead, all patients received antibiotics prior to randomization. Nor do we know how quickly patients received either antibiotics or the vitamin C cocktail in the Marik study, as these data were not reported. However, the authors of the VITAMINS trial have already indicated that a subgroup analysis that takes time-to-treatment into account may be forthcoming.
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ACEP Now: Vol 39 – No 02 – February 2020Eighteen other studies assessing this cocktail are under way. With that many trials, each with its own patient inclusion criteria and unique outcome measurements, one of them is bound to find some signal of benefit by chance alone. But based on the VITAMINS study, I believe we can conclude that this miracle cure is not to be. If benefit is uncovered by any of these subsequent trials, it is likely to be small and incremental at best. Knowing that, we must again widen our perspective in our continued search for therapies that can truly turn the tide against sepsis.
References
- Marik PE, Khangoora V, Rivera R, et al. Hydrocortisone, vitamin C, and thiamine for the treatment of severe sepsis and septic shock: a retrospective before-after study. Chest. 2017;151(6):1229-1238.
- Fujii T, Luethi N, Young PJ, et al. Effect of vitamin C, hydrocortisone, and thiamine vs hydrocortisone alone on time alive and free of vasopressor support among patients with septic shock: the VITAMINS randomized clinical trial [published online ahead of print Jan. 17, 2020]. JAMA. doi:10.1001/jama.2019.22176.
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5 Responses to “Vitamin C Not a Magical Cure for Severe Sepsis and Septic Shock”
February 5, 2020
Don SpragueHow convenient- no one to blame, yet somehow Dr Mariks’ protocol is not followed and lives are lost. Shame shame shame!
There is no question- Dr Marik and his team are saving many lives. If you can not follow his protocol exactly, you should not pretend that this is a valid trial. It is obvious that “big pharma” will try anything to discredit Dr Marik as he is a threat to their profit machine.
September 2, 2020
TroyYes – saving lots of Covid lives from Covid sepsis. Dr Faust is the Quack’s Quack.
April 9, 2020
Gary HubbardAs Dr.Maric emphasized the protocol must be started immediately not the close to 15 hrs. after emission. Designed to fail. That is really sad!
May 11, 2020
Lisa PoastAs stated on page 3 of this article…
Dr. Marik stated that “in his experience, the treatment is only effective if given within six hours after someone has suspected sepsis.”
And you state here that the “typical time-to-treatment with the cocktail was around 12 hours in the VITAMINS trial.”
My husband and I have read and listened to everything available online about the Marik protocol and VITAMINS study over the last couple of months, as well as Alpha A. Fowler, MD’s work that inspired the Marik protocol. We have agreed that if one of us becomes seriously ill and is at risk for septic shock, we will request the Marik protocol.
I concur with others who have commented here. The study was designed to fail.
September 2, 2020
TroyDr Faust is the Quack’s quack. The Marik Protocol is now the MATH+ protocol saving thousands of Covid patients