Last month Sarah Constantin reported on a new potential treatment for sepsis (a life-threatening bacterial infection of the blood), developed by Dr. Paul Marik. The good news is that the ingredients are all pretty common off-patent vitamins and medications, so if approved it will be really cheap. I haven’t researched this treatment myself, but Sarah thinks it looks promising, and Sarah Constantin is the autodidact medical researcher I want to be when I grow up (she’s also a friend of mine). To quote her:
Sepsis is a really big deal. More people die from sepsis every year than from diabetes and COPD combined. Ten thousand people die of sepsis every day. A lot of these cases are from pneumonia in elderly people, or hospital-acquired infections. Curing sepsis would put a meaningful dent in the kind of hell that hospital-bound old people experience, that Scott described in Who By Very Slow Decay.
Sepsis is the destructive form of an immune response to infection. Normally the infection is managed with antibiotics, but the immune response still kills 30% of patients. Corticosteroids, which reduce the immune response, and vitamin C, which reduces blood vessel permeability so that organs are less susceptible to pro-inflammatory signals, can treat the immune response itself.
What evidence do we have for this treatment? It’s made up of individual ingredients known or suspected to fight sepsis, and in a retrospective study, 0% of Marik’s patients died of sepsis (although 8% died from their underlying illness), compared to half in the ~control group. But a retrospective study isn’t enough; we need the gold standard, a randomized control study.
The good news is this treatment is made from very common off patent medications, so if approved it will be very cheap. The bad news is that this treatment will be really cheap, so no there’s no monetary incentive to fund an RCT. To be clear: this is not the fault of pharmaceutical companies. No one is holding something back. They are merely responding to the incentives we have set up. But if you’d like to change the incentive system we live under, the principal investigator is now attempting to crowdfund an RCT of his treatment. Donations are handled through Eastern Virginia Medical School and are tax deductible.
My budget for substantial donations for the year is still exhausted by Tostan. But contributing to a better set of incentives for medical research is worth $20 out of my symbolism budget. Better incentives here means not just that treatments can be researched even if they aren’t monetizable, but that people like Sarah have an incentive to do this research and share it.* To that end, if you do decide to donate as a result of Sarah’s post, I’d really appreciate it if you also filled out her donation form so she can see how much she raised (for bonus points note acesounderglass.com as your immediate referrer so I can see how much I raised).
*”People like Sarah” technically includes me, since this is almost exactly the reasoning Ozy Brennan gave for donating to my favorite charity, Tostan.
Aceso Under Glass 
The last time I crowdfunded some research (kicked in $10 to a specific project my friend in grad school was working on), the university (Pennsylvania State, which I have never attended) spent the next few years sending me “have some school spirit – please donate!” junk mail. They probably wound up spending 30%-40% of the amount I’d given soliciting me for more.
I suppose it might be that the money I put in *did* mostly reach the project, and that the university then chose to irresponsibly blow money out of some other budget mailing me.
Nonetheless, this kind of soured me on the concept.
Cross-posting my comment from Sarah’s blog, to cast a wider net
Hey, this looks really promising to me, to the point where I’m considering a major donation here, but funding medical research is something I haven’t looked into very closely at all. Right now, my two biggest pieces of uncertainty are:
1) To what extent is donating here just funging against medical research in general/why couldn’t this be funded by the normal grant system?
2) If this study succeeds, and shows this does dramatically decrease sepsis mortality, how likely is it that medical institutions will change their practices, and how quickly?
Also, are there any particular deadlines for funding this, and will EVMS actually let us know when it’s fully funded? Also, let me know if there are any EA-type frameworks for evaluating this sort of thing that you know of, and thanks a ton for your research!
All my specifics come from Sarah, but i can answer 1in generalities: the system we have right now is the government funds basic research, and companies fund late stage. This is late stage research but there’s no money to be made, so no corporate funding. There are other sources of money but competition is much fiercer.
For 2, I’d look at the work of Atul Gawande as a good but achievable model. If proven i expect insurance to push this even harder than hand washing, since it’s much easier to control.
Depending on the amount of money you’re planning on, you may be able to arrange a conversation with the PI to get more specific answers. No promises but I’d potentially be willing to sit in in that.
First, thanks for the prompt and helpful response. I was a little unsure on “insurance pushing this” until I remembered that insurance != private insurance, and CMS already having pretty definite yet evolving guidelines for sepsis. In my experience (3 years supporting health insurance software) private insurance mostly just follows CMS’s lead.
Pending deciding this is a good idea, I could be donating up to 10% of the total funds required, so talking with the PI (presumably Dr. Marik himself?) would be plausible. You think that’s likely to be more productive conversation than with EVMS’s donor relations staff?
Also, Sarah said she wasn’t planning on reaching out to OPP due to not having a great relationship with them personally, but this seems somewhat up their alley (hard to quantify, high uncertainty, but potentially very high EV). Do you have any better relation with them than I do (eg. better than nothing?)
My recollection is that private insurance (especially HMOs running their own hospitals) were instrumental in the adoption of Gawande’s interventions. CMS saying they would stop paying hospitals to infect patients probably helped too, but they weren’t the only thing.
I would be really shocked if a generic EVMS donor staff knew anything about this project. It’s possible that there’s someone in the lab who would have more information than the PI, maybe a dedicated grant writer, but I would start by shooting for the PI.
I do in fact have some connection with OPP and have passed it on, no idea if it will go anywhere.