Marik and Data Fraud

[BigRedBeta]

Evidence of Fabricated Data in a Vitamin C trial by Paul E Marik et al in CHEST

Blog on surgery, medicine, medical ethics, health policy and health politics.

kylesheldrick.blogspot.com

Obviously Marik's metabolic cocktail study has been a huge outlier

A reasonable argument is being made that his data could be fraudulent and might explain why

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[turkeyjerky]

english please?

 

[SurfingDoctor]

english please?

Not a statistician, but the argument made was that in a non-matching setting, a random effect would be a p value of 0.5 or there about. This makes sense because the chance of random error to void the null hypothesis should be less than 5% or 0.05. Of course, that p value threshold is made up but whatever. In a random event, like heads or tails of a coin, the chance of error in rejecting the hypothesis that the coin will be heads is 50% or 0.5. That's where that 0.5 in the argument comes from.

If the patients were consecutive as suggested in the paper, then the chance of random error in matching for each group would be 50% or a p value of 0.5, the random event being the age of the admission and their underlying co-morbidity (unless you only admitted males 60 to 70 with heart disease only or something like that). But instead, they are 1 or a 100% chance of randomness that the groups are perfectly matched. That person argues that is statistically impossible, therefore the patients weren't consecutive in a before and after study design (pre HAT implementation and post-HAT implementation). Instead it is postulated that the patients were picked to match (even though the paper doesn't say they were and in fact says they weren't) to generate the data... ie, possibly, the authors picked the patients by intention to generate the data of significant effect.

In the wet lab... we call this dry labbing.

 

[Radetzky]

Marik has been off the chains for a while, his main intention has been to be a contrarian. He just happened to be on the right track when he criticised the practice of drowning people in fluid. But now we are seeing clearly what he’s really about.

Sadly the allure of eminence is too much for some.

 

[BigRedBeta]

Marik has been off the chains for a while, his main intention has been to be a contrarian. He just happened to be on the right track when he criticised the practice of drowning people in fluid. But now we are seeing clearly what he’s really about.

Sadly the allure of eminence is too much for some.

Love that last line.

 

[Onefellswoop87]

Marik has been off the chains for a while, his main intention has been to be a contrarian. He just happened to be on the right track when he criticised the practice of drowning people in fluid. But now we are seeing clearly what he’s really about.

Sadly the allure of eminence is too much for some.

Couldn’t agree more. I worked with him as a resident. His ICU book is great. If he stopped after articles helping to debunk CVP / fluid responsiveness and then volume (over)resuscitation, I think he’d be held in quite high esteem in the crit care academia community.

Much of the unit rolled our collective eyes at the vitamin C protocol but as a resident, we ordered the protocol, especially for a low risk and potentially high reward med like vit C.

We would even have to order bmp more often to check glucose, cause he was convinced the ascorbic acid falsely elevated the finger stick glucometer reading. But no, it was the steroid that made it go high, not just the reading.

But you gotta hand it to him, he really drank his own kool-aid. He believes it and defends his protocols aggressively.

 

[SurfingDoctor]

Couldn’t agree more. I worked with him as a resident. His ICU book is great. If he stopped after articles helping to debunk CVP / fluid responsiveness and then volume (over)resuscitation, I think he’d be held in quite high esteem in the crit care academia community.

Much of the unit rolled our collective eyes at the vitamin C protocol but as a resident, we ordered the protocol, especially for a low risk and potentially high reward med like vit C.

We would even have to order bmp more often to check glucose, cause he was convinced the ascorbic acid falsely elevated the finger stick glucometer reading. But no, it was the steroid that made it go high, not just the reading.

But you gotta hand it to him, he really drank his own kool-aid. He believes it and defends his protocols aggressively.

Wait... WTAF?! He didn't think steroids caused hyperglycemia, it was Vit C?!

That's some of the stupidest sh-t I've ever heard.

 

[Onefellswoop87]

Wait... WTAF?! He didn't think steroids caused hyperglycemia, it was Vit C?!

That's some of the stupidest sh-t I've ever heard.

I think he was so committed to vitamin C and steroids as the cure all. I’m putting some of my words into his actions. And there are some articles that ascorbic acid falsely elevated finger stick readings. But Even finger sticks elevated above the BMP, well, they were still hyperglycemic.

 

[chessknt]

I think he was so committed to vitamin C and steroids as the cure all. I’m putting some of my words into his actions. And there are some articles that ascorbic acid falsely elevated finger stick readings. But Even finger sticks elevated above the BMP, well, they were still hyperglycemic.

It is a point of care test it isn't supposed to be identical to the lab blood draw....

Marik deserves to go down in medical history as a snake oil quack ****ty clinician after his flccc nonsense and the pain he inflicted on so many people with that. That he is also a research hack who has to cheat to get his terrible idea published and is now getting sued for it is just extra gravy on his downfall. Couldn't have happened to a more deserving person.

 

[BicepsTriceps]

Marik has been off the chains for a while, his main intention has been to be a contrarian. He just happened to be on the right track when he criticised the practice of drowning people in fluid. But now we are seeing clearly what he’s really about.

Sadly the allure of eminence is too much for some.

Word.

 

[lymphocyte]

Heartbreaking if true.

Marik was a hero of mine all the way back in medical school. Iconoclastic, charismatic, and very enjoyable to read. I still have a copy of his "Evidence-Based Critical Care" on my desk at home.

As an aside -- early goal directed therapy, tight glycemic control, metabolic resuscitation, and lots of negative trials... critical care medicine is littered with awful research. I think this is what happens when most of the field is defined by consensus statements than actual pathophysiology.

 

[SurfingDoctor]

Heartbreaking if true.

Marik was a hero of mine all the way back in medical school. Iconoclastic, charismatic, and very enjoyable to read. I still have a copy of his "Evidence-Based Critical Care" on my desk at home.

As an aside -- early goal directed therapy, tight glycemic control, metabolic resuscitation, and lots of negative trials... critical care medicine is littered with awful research. I think this is what happens when most of the field is defined by consensus statements than actual pathophysiology.

Oof... did not age well.

 

[chessknt]

Heartbreaking if true.

Marik was a hero of mine all the way back in medical school. Iconoclastic, charismatic, and very enjoyable to read. I still have a copy of his "Evidence-Based Critical Care" on my desk at home.

As an aside -- early goal directed therapy, tight glycemic control, metabolic resuscitation, and lots of negative trials... critical care medicine is littered with awful research. I think this is what happens when most of the field is defined by consensus statements than actual pathophysiology.

He is a hero for the far/alt right in the USA too. I can't tell you how many times in the stepdown unit I saw one of his bull**** papers on the side table as we were wheeling them to the ICU to be intubated. Then the family would get hostile citing his 'science' and tell me I was a horrible doctor and would get sued for not giving ivermectin and iv vitamin c and inhaled budesonide and whatever nonsense was in vogue that month. I had to explain to them that the author had been fired and was being sued for falsifying his data and we wouldn't be doing any of that. Then they would go off about a conspiracy or fake news or whatever programming drives these people.

He did so much harm by providing a false validity to these people, it negates any good he ever did. By far.

 

[The Knife & Gun Club]

He is a hero for the far/alt right in the USA too. I can't tell you how many times in the stepdown unit I saw one of his bull**** papers on the side table as we were wheeling them to the ICU to be intubated. Then the family would get hostile citing his 'science' and tell me I was a horrible doctor and would get sued for not giving ivermectin and iv vitamin c and inhaled budesonide and whatever nonsense was in vogue that month. I had to explain to them that the author had been fired and was being sued for falsifying his data and we wouldn't be doing any of that. Then they would go off about a conspiracy or fake news or whatever programming drives these people.

He did so much harm by providing a false validity to these people, it negates any good he ever did. By far.

I distinctly recall a patients wife telling me she knew my name, was going to come to my home, and shoot me with the 0.45 she keeps in her trunk, because we wouldn’t give her husband ivermectin and Vit C.

I was the intern in the MICU at the time. Ma’am even if you did shoot me I’m not important enough to get his treatment plan changed anyway.

 

[MedicineZ0Z]

I distinctly recall a patients wife telling me she knew my name, was going to come to my home, and shoot me with the 0.45 she keeps in her trunk, because we wouldn’t give her husband ivermectin and Vit C.

I was the intern in the MICU at the time. Ma’am even if you did shoot me I’m not important enough to get his treatment plan changed anyway.

And you hopefully called the police and also happen to carry yourself within the laws of your jurisdiction (the latter being more important of course)?

 

[The Knife & Gun Club]

And you hopefully called the police and also happen to carry yourself (the latter being more important of course)?

Called the police as well as hospital security and risk management, and I do not carry a weapon, inside the hospital or otherwise.

 

[SurfingDoctor]

Healthcare... fu-k yeah!

I bet I could take out that appendix from 250 yards.... 300 with the right wind.

 

[chessknt]

Healthcare... fu-k yeah!

I bet I could take out that appendix from 250 yards.... 300 with the right wind.

So unbelievably important for your safety to conceal carry at least 3 lethal weapons at all times, especially while sleeping in the call room. New medical school curriculum is increasingly recognizing this and teaching ms1 classes on the indications and execution of lethal self defense utilizing tactical assault weapons that can fit in scrubs.

 

[Fart Daddy Smooth]

Heartbreaking if true.

Marik was a hero of mine all the way back in medical school. Iconoclastic, charismatic, and very enjoyable to read. I still have a copy of his "Evidence-Based Critical Care" on my desk at home.

As an aside -- early goal directed therapy, tight glycemic control, metabolic resuscitation, and lots of negative trials... critical care medicine is littered with awful research. I think this is what happens when most of the field is defined by consensus statements than actual pathophysiology.

Had never heard of "metabolic resuscitation". Looking it up, it seems to be based off administration of thiamine & a few othervitamins & minerals .. Do I have that correct?

I can sympathize w folks preferring natural remedies but it's always about taking some arcane combo of vitamins, rarely does it involve the types of lifestyle modifications that yield results. Low calories, aerobic exercise, stress reductions? No thanks, I'll take the ascorbic acid/hydrocortisone/thiamine infusion

 

[lymphocyte]

Had never heard of "metabolic resuscitation". Looking it up, it seems to be based off administration of thiamine & a few othervitamins & minerals .. Do I have that correct?

I can sympathize w folks preferring natural remedies but it's always about taking some arcane combo of vitamins, rarely does it involve the types of lifestyle modifications that yield results. Low calories, aerobic exercise, stress reductions? No thanks, I'll take the ascorbic acid/hydrocortisone/thiamine infusion

You sort of have that correct. It's not an arcane combination of vitamins, and most of my patients are beyond measures like stress reduction.

There's very good evidence to suggest hydrocortisone works (at least in terms of time to shock control and in combination with fludrocortisone, if you're an evidence-based purist). The VITAMINS trial even had hydrocortisone feature in both trial arms because they didn't think there was clinical equipoise with a pure placebo. I give it in septic shock, unequivocally if it's related to bacterial pneumonia. I'm curious if you practice differently.

Thiamine had some really interesting data to support its use that's not been borne out in randomized control trials. Oh well.

Vitamin C had signals of benefit that were pretty exciting (like in the CITRIS-ALI trial) but it's the same story as thiamine.

 

[chessknt]

Had never heard of "metabolic resuscitation". Looking it up, it seems to be based off administration of thiamine & a few othervitamins & minerals .. Do I have that correct?

I can sympathize w folks preferring natural remedies but it's always about taking some arcane combo of vitamins, rarely does it involve the types of lifestyle modifications that yield results. Low calories, aerobic exercise, stress reductions? No thanks, I'll take the ascorbic acid/hydrocortisone/thiamine infusion

Literally the only time I have used that phrase is for severely malnourished patients with refeeding syndrome where I justify ongoing ICU care due to need for ongoing metabolic resuscitation.