In January 2015, a 48-year-old woman was admitted into the intensive care unit at Sentara Norfolk General Hospital, US. Dr. Paul Marik, chief of pulmonary and critical care at Eastern Virginia Medical School, was in charge of the intensive care unit at that time.

"Her kidneys weren't working. Her lungs weren't working. She was going to die," Marik said. "In a situation like this, you start thinking out of the box."

Coincidentally, Marik recently read medical journal article by researchers at Virginia Commonwealth University in Richmond, involving Vitamin C and decided to order IV infusions of it, along with hydrocortisone, a steroid, to reduce inflammation, and thiamine.

"I was expecting the next morning when I came to work she would be dead," Marik said. "But when I walked in the next morning, I got the shock of my life."

The patient was recovering.

Astounding decrease in mortality rates

Marik then tried the treatment again on the next two sepsis patients who were admitted, and was similarly surprised due to the positive results.

After treating 50 patients, he decided to write up his results and submitted them to the journal Chest. Only four of the 47 patients died in hospital, an 8% mortality rate - and all the deaths were from their other underlying diseases, not sepsis.

Forming a retrospective study, Marik drew upon 47 septic patients with similar conditions that were admitted the previous year and reported that 19 had died, a 40% mortality rate.

Despite the unconventional method to evaluate a potential new treatment - usually tested in parallel with a placebo or standard treatment - the results were too stunning and Marik decided he would treat all his sepsis patients with his vitamin C concoction.

Marik has since then treated 150 patients, and reported that only one has died of sepsis. The claim is phenomenal and it is not hard for the scientific community to be excited about the news of a potentially effective treatment for sepsis as about one in three Americans died per year due to sepsis.

For starters, the sample size has been small and the comparison of mortality rates is unconventional.

Too much hype, too little evidence

However, there have been many false promises regarding the treatment of this condition over the years, reminding that the results should be viewed with caution.

"If it turns out in further studies that this is true, and we can validate it, then this will be an unbelievably huge deal," said Craig Coopersmith, a surgery professor at Emory University School of Medicine. "But right now we should treat it as a preliminary deal that needs to be validated."

Coopersmith is also a top sepsis researcher and warns that there have been hundreds of exciting results from sepsis studies that have failed in larger follow-up research.

But Marik also took the initiative of having another researcher to examine the idea in the lab. John Catravas, who studies and teaches bioelectrics at Old Dominion University has spent researching lung function and explained that endothelial cells which form linings of the blood vessels, separate during sepsis to allow fluid in the lungs.

When he looked at the effect of the vitamin C and steroid, separately and in combination on the cells, he found that the combination supported what was happening in the clinical setting.
"We can't both be completely insane," Marik said.

Vitamin C as main ingredient attracts skepticism

However, Dr David Carlbom, an associate professor of pulmonary critical care at the University of Washington also highlighted that the cases were all at one hospital. Carlbom said that carrying out the study at multiple sites would ensure that nothing particular to Norfolk would explain the significant difference.

The fact that the main ingredient is vitamin C, has attracted a great deal of skepticism.

But Dr Berry Fowler, the lead researcher of the previous vitamin C study at Virginia Commonwealth University explained that the once-trendy antioxidant had a different effect depending on the method of delivery. If injected, it can influence the immune system's response to inflammation, he said.

The NIH granted the team USD3.2 million to run a carefully controlled study of vitamin C to treat sepsis, with conventional methods, including placebos and multiple trial sites. The study will finish later in the year but meanwhile, Coopersmith insists that the results should be viewed with slight skepticism.

Marik on the other hand, will continue his "miracle cure" as his medical residents calls it, on his patients. MIMS

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