Short Wave - Sepsis Is A Global Killer. Can Vitamin C Be The Cure?

Episode Date: February 4, 2020

Every day, approximately 30,000 people die globally of sepsis. The condition comes about when your immune system overreacts to an infection, leading potentially to organ failure and death. There is no cure. But then in 2017, a doctor proposed a novel treatment for sepsis, a mixture that included Vitamin C, arguing it saved the lives of most of his patients. NPR's Richard Harris has been reporting on this treatment and how it's divided scientists from around the world. Follow host Maddie Sofia on Twitter @maddie_sofia. Email the show at [e-mail] pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Maddie Safai in the house with Richard Harris, yet another one of my favorite science correspondence. We must be all your favorites. I mean, you're all special. That's what my mother always said, you're all my favorite. Richard, you have some serious business to discuss today. Indeed, I do. Yes. I'm going to talk to about sepsis. Right. So for anybody who might not know,

sepsis is actually caused by the body's reaction to an infection. Basically, the immune system overreacts, causing this huge inflammatory response. Blood vessels get all leaky, which messes up how blood flows throughout the body. In severe cases, septic shock can set in, and that's when your blood pressure drops to dangerously low levels, sometimes leading to multiple organ failure and death. Doctors treat that initial infection, and they can try to manage the dangerous symptoms of sepsis, but there's no cure for it. That's right. And as a result, it is the single most expensive condition in U.S. hospitals. Best estimate is that it strikes 1.7 million people a year in the United States and kills more than a quarter of a million.

Wow. So it's a huge toll. Right. And one of the reasons it's so common is because a lot of different types of infections can result in sepsis. Many roads lead to sepsis. But even though it's a huge deal, we don't really talk about it that much. And that's kind of weird, isn't it? It's such a common condition. But it is an even bigger problem globally.

30,000 people die of it every single day. That's wild. That's a huge number. Yeah. It's truly an underappreciated disease. And why I'm telling you the story today is because results have been published from an important new study on the treatment of sepsis with a transfusion of a simple mixture, really, of vitamin C and thiamine. Thyman, which is vitamin B1.

That's right. And also some corticosteroids. These are all cheap and readily available drugs. So today on the show, the journey to find a cure for sepsis. We hear the latest on this wild claim about a potential cure of a vitamin C drug cocktail. Okay, Richard, when you were first telling me about this, you said you actually got to talk to somebody a few years ago who received this newfangled treatment. Right. I was interested in really following how this evolved, this audacious idea and seeing where it would go. And actually, a number of doctors immediately started picking it up and started using it, at least on their most desperately ill.

patients, and I talked to one of them, this guy with an incredible story named Christopher Kelly, who had this horrible logging accident. This is out in Seattle. I was cutting for a logging outfit up on these rock cliffs, and I fell about 150-foot fur tree into these maple trees. They had a bunch of dead tops, we call them widow makers. And when that fir tree came down, the butt of it bounced toward him, crushing him. I heard the bones crunch when it got me.

It was pretty crazy. I'd yell for a minute and then I'd pass out and I guess my ribs were ripping my lungs is the reason I was only, you know, in and out of consciousness. And amazingly, he was there for a couple of hours before a couple of other men working in the area found him and got him on a Medevac helicopter to Harborview Medical Center in Seattle. In the end, he says he wound up with a shattered pelvis, all of his ribs broken, 22 bones and all. The day I met him, he developed a very high fever along with shock. That's one of Kelly's doctors, David Carlebaum, who realized that sepsis was beginning to set in. So sepsis is one of the big risks in injuries like this because infections sometimes start on the wounds on the skin or from inside the lungs or internal injuries or whatever. And the infection, of course, can turn into septic shock, which is the nastiest form of this condition when organs start to fail.

And that often leads to death. And as we mentioned earlier, there's no known cure for sepsis. That's right. Carl Baum could treat the underlying infection with antibiotics, but he was also one of a set of doctors who had actually started experimenting with this new treatment of vitamin C and thiamine and steroids. I discussed it with his son, and his son was very amenable. We talked about the fact that it's a new therapy that there really wasn't very strong evidence, but I felt there was not a ton of risk and that this could be beneficial. Did it work, Richard? Well, hold on.

How quickly did he respond? Usually patients are very sick for a few days before responding to antibiotics. And him, it took about a day. His fever had cleared, and he was off the medicines to support his blood pressure and looked remarkably better. But this is not actually a totally new idea at all. I mean, vitamin C's curative properties have been batted around for decades and decades. A lot of it's kind of kooky, so that actually works against this argument. People are initially and understandably skeptical about it.

But that said, it is true that people who have sepsis have. surprisingly low levels of vitamin C in their blood, so there is some biological plausibility to doing this. Right. And Carlebaum himself was still on the fence about whether this was really the real deal. But other doctors had also had similar stories to tell, and in fact, Carlbaum decided to try the treatment after reading about it in a report by this well-known critical care doctor named Paul Merrick, who's at Eastern Virginia Medical School in Norfolk, Virginia. Good morning.

Actually went down to visit him in his intensive care unit back in 2018. so I could see for myself and learn more about this. The beginning was really frustrating because, you know, I would round and see this and say, you know, this is really cool. And I would submit it for publication and people would poo me. So Merrick was the guy who came up with this idea of combining vitamin C and thymion and steroids along with a standard treatment for sepsis. Fortunately, I knew Richard Owen.

You know, he's a kind of an open-minded person. He's the editor of chest. And he said, yeah, I'll look at it. Chess is the journal where this was published. And the results he published are kind of unorthodox. He looked at 47 patients he treated one after another in this way. And then he compared it to 47 other patients who had been treated before he came up with this idea. And of the 47 patients were treated, only four had died and none of them had died of sepsis.

And of the previous 47 patients, 19 had died in the hospital. So he was thinking, wow, this is night and day. You know, so the naysayers, you know, they say this is, you know, snake oil and fairy dust and all kinds of things. But if you actually see it, I mean, it's just remarkable this. And the tragedy is that the people who should be interested in this, even if you're skeptical, just keep an open mind because people dive steps every single day. And, you know, we turn these people around. So he's pretty convinced at this point. Yeah, so it's working for him.

So he believes it. But he understands why. there's a lot of skepticism out there because this is an unconventional way of trying to test whether something works or not. Right. In theory, you'd want like a clinical trial with lots of control groups, placebo's, all that good stuff. Right. And there's another thing, right? People have said that they've come up with a cure for sepsis before. Or at least good treatment, supposedly, there was a drug that was actually approved to treat sepsis, but then on further examination, they decided it didn't work and they actually pulled it off the market. So this has been an area of huge frustration over the years.

Okay, so in order to know if it really could be a cure, we need clinical trials, right? So tell me where we are with those. So doctors around the world have actually launched dozens of studies to look at this. The designs vary a lot, but some of them are actually pretty careful studies where they randomly selected patients to either get the treatment or to get a placebo. You love to see it, Richard. The gold standard is here. Here we go. Keep going. That's it, that's it. And these studies have been done across multiple hospitals, too. Some tests were coordinated out of Harvard, some out of Emory University, Johns Hopkins. Hopkins. Anyway, a lot of these launched in 2018, and they're pretty much all still in progress,

or they finish collecting their data and they're still figuring it out and haven't published the results yet. Right. But there was that one study that has recently published its results, right? So what did they find? Right. So this was an Australian study. It was based on about 200 patients, and they were in hospitals in Australia and in New Zealand and also in Brazil. They announced their results a few weeks ago, and for them, vitamin C treatment was a total bust. No. Yes, alas, yes.

I talked to Dr. Ronaldo Balomo in Melbourne, Australia. He told me he understands why there's enthusiasm for the vitamin C treatment, given the dismal history of trying to find an effective treatment for sepsis. People latch on to promising interventions because of that frustration, and it's understandable. but, you know, the view from here is that we shouldn't substitute hope for evidence. He actually led the study, and a colleague of his presented the results in mid-January in Belfast, Northern Ireland, in a conference center called the Titanic. Honestly, Richard, Titanic is a weird thing to name a conference center, but fine.

Yeah, Paul Merrick thought it was a weird thing, too, and sort of an omen for him because he was actually at the conference when things turned south. for him. And that's the guy that came up with the original idea for the sepsis treatment. That's right. And his biggest complaint, actually, is that the study didn't treat people right away. It was an average of 12 hours after they checked into the ICU. And they don't even know how long before that people were sick and suffering from sepsis. So Merrick says, you know, as soon as my patient show up in the emergency room, I treat them right away. And he believes that if you wait more than even six hours, it's too late. So he thinks that's why this trial failed. And he says he

still uses it every day. He's treated 1,500 patients so far, and he still says he believes he's saving lives every day. So what does this mean for the future of sepsis treatment? Is it just still a big question mark, kind of? Unfortunately, still a big question mark. The ultimate lesson here, for one thing is that no single study is definitive. In this case, everyone agrees with a cliche that more research is needed. Science sure has a way of making us wait, huh, Richard? Unfortunately, it does. Yep. But fortunately, these studies are quite far along. and we should be getting results from them in the coming months or maybe by the end of the year, I hope at least by then. So we'll just need to wait and see.

For now, I can say this, vitamin C infusion is not an accepted treatment, but there are still some doctors who use it and say it's working for them. Today's episode was produced by Rebecca Ramirez, edited by Viet Le and fact-checked by Emily Vaughn. We had some engineering help from Josephine Nia Nia Nye. I'm Mani Safaya. Here with Richard Harris. I'm still here. This is Shortwave from NPR. See you next time. time.