Everyone jumped to hate VITAMINS. I feel it is not fare. Did he use hyperbole to bring attention to the matter? Yes he did. Do vitamins at the proposed doses cause harm? No, they don't. Are they imprtantant for endogenous production of cathecholomins and immune system ( two most important systems which get desregulated in septic shock). They are.
He, in fact, almost single handedly dismantled sepsis one compain. Educated the whole generation of doctors about the role of thiamine and vitamin c in critical illness. Educated about the role of glycocalix. Educated about mitochondrial health.
But everyone, from a first year resident to blog attendings ( except Josh Farkas) hated on vitamins...
Here is two from the same edition :
DOI: 10.1097/CCM.0000000000005263
DOI: 10.1097/CCM.0000000000005262
Yes, no mortality improvement. But if I can get anything out of vit c, I will take it. As I write daily progress notes, I do celebrate weaning from pressors. It appears that vit c can accelerate it. So maybe we can be more inquisitive and make mental adjustments to what effects are we are asking from simple vitamins?
I was very optimistic and hopeful about VITAMINS, based mainly on my respect for the lead author. I adopted the therapy and started administering it close to 100% of the time for septic shock. I think many thousands of other clinicians did, too.
I do think he destroyed his credibility with many people, and certainly with me, for a variety of reasons, of which the hyperbole and promotion of the study were just one piece.
That doesn't mean that vitamin C is not an effective therapy for sepsis. They are two completely separate issues and need to be thought of and addressed separately. A broken clock is right twice a day. As of now I am agnostic. I do not prescribe vitamin C for sepsis anymore but I would change that if clear benefit could be expected. A reduction in organ failure or need for vasopressors would count as a benefit for me.
I will check out those meta-analyses. Thanks for sharing the DOIs and your perspective.
Why to use such a derragotory comments about one researcher.... How about bringing two metanalysis from sccm which actually show a difference for vit c, thiamine and hydrocortisone.
I thought it was a fair comment. I said he was prominent, which he was, and that the study was dodgy, which it most definitely was. And then that opens the door to many other people who attempt to refute (or replicate) the dodgy study. Isn't that how all this works?
I am open to all evidence of "truth," but that study was problematic and caused problems. Do you disagree?
I will certainly look at those meta-analyses. Please share the links if you have them. Thanks for commenting.
Everyone jumped to hate VITAMINS. I feel it is not fare. Did he use hyperbole to bring attention to the matter? Yes he did. Do vitamins at the proposed doses cause harm? No, they don't. Are they imprtantant for endogenous production of cathecholomins and immune system ( two most important systems which get desregulated in septic shock). They are.
He, in fact, almost single handedly dismantled sepsis one compain. Educated the whole generation of doctors about the role of thiamine and vitamin c in critical illness. Educated about the role of glycocalix. Educated about mitochondrial health.
But everyone, from a first year resident to blog attendings ( except Josh Farkas) hated on vitamins...
Here is two from the same edition :
DOI: 10.1097/CCM.0000000000005263
DOI: 10.1097/CCM.0000000000005262
Yes, no mortality improvement. But if I can get anything out of vit c, I will take it. As I write daily progress notes, I do celebrate weaning from pressors. It appears that vit c can accelerate it. So maybe we can be more inquisitive and make mental adjustments to what effects are we are asking from simple vitamins?
I was very optimistic and hopeful about VITAMINS, based mainly on my respect for the lead author. I adopted the therapy and started administering it close to 100% of the time for septic shock. I think many thousands of other clinicians did, too.
I do think he destroyed his credibility with many people, and certainly with me, for a variety of reasons, of which the hyperbole and promotion of the study were just one piece.
That doesn't mean that vitamin C is not an effective therapy for sepsis. They are two completely separate issues and need to be thought of and addressed separately. A broken clock is right twice a day. As of now I am agnostic. I do not prescribe vitamin C for sepsis anymore but I would change that if clear benefit could be expected. A reduction in organ failure or need for vasopressors would count as a benefit for me.
I will check out those meta-analyses. Thanks for sharing the DOIs and your perspective.
Thank you for your reply and for what you do. I grew up as doctor on your teachings and posts from Farkas, Spiegel and Kenny.
Thank you for continuous engagement and life learning.
And thank you for taking my point as a tribute to a great master who was there before us. And maybe who can see a little bit further than us.
"The truth will always win".
Why to use such a derragotory comments about one researcher.... How about bringing two metanalysis from sccm which actually show a difference for vit c, thiamine and hydrocortisone.
I thought it was a fair comment. I said he was prominent, which he was, and that the study was dodgy, which it most definitely was. And then that opens the door to many other people who attempt to refute (or replicate) the dodgy study. Isn't that how all this works?
I am open to all evidence of "truth," but that study was problematic and caused problems. Do you disagree?
I will certainly look at those meta-analyses. Please share the links if you have them. Thanks for commenting.