Paul E. Marik

Paul Ellis Marik (born March 26, 1958)[1] is a medical doctor and former professor of medicine who until his resignation in January 2022 served as chair of the Division of Pulmonary and Critical Care Medicine at Eastern Virginia Medical School in Norfolk, Virginia, and was also a critical care doctor at Sentara Norfolk General Hospital. His research interests include sepsis and tissue oxygenation.[2][3] In August 2023 the American Board of Internal Medicine informed Marik his certification was to be revoked for spreading misinformation.[4]

Paul Ellis Marik
Born (1958-03-26) March 26, 1958
Johannesburg, South Africa
Occupation(s)Medical practitioner and educator
Years active1989–2021
TitleProfessor of Medicine, with Tenure
EVMS Foundation Distinguished Professorship in Internal Medicine
Academic background
EducationUniversity of the Witwatersrand (MBBCh, M.Med, BSc Hons, Diplom)
College of Medicine of South Africa (Diplom)
Alma materUniversity of the Witwatersrand
ThesisPrognostic profiles in acute myocardial infarction (1989)
Academic work
DisciplineInternal Medicine
Sub-disciplinePulmonary and Critical Care Medicine
InstitutionsBaragwanath Hospital, Johannesburg
Department of Internal Medicine, Wayne State University
Department of Medicine, University of Massachusetts
Department of Medicine University of Massachusetts, Washington Hospital Center
Department of Critical Care, University of Pittsburgh Medical School
Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University
Main interestsSepsis, tissue oxygenation

Marik developed the "Marik protocol" (also called the "HAT" protocol), a now discredited treatment for preventing sepsis.[5] He is a co-leader of the Front Line COVID-19 Critical Care Alliance (FLCCC), which has misleadingly advocated for the anti-parasitic drug ivermectin to treat COVID-19 against the advice of leading health agencies.[5][6][7] Marik has called himself a "status quo destabilizer".[8]

Early life and education

Marik was born in Johannesburg, South Africa.[9] He earned a Master of Medicine in the Specialty of Internal Medicine in 1987 at the University of the Witwatersrand in Johannesburg.[10][11]

Marik was an ICU attending at Baragwanath Hospital, in Soweto, South Africa.[12]

Career

Marik did a critical care fellowship in London, Ontario, Canada, and subsequently has worked in the United States in teaching hospitals since 1992.[12]

In 2001, Marik was author of the Handbook of Evidence Based Critical Care.[13] Reviewing its second edition for the journal Anaesthesia and Intensive Care, K. M. Ho wrote in 2011 that the book was "useful for junior doctors or intensive care trainees" but had "some limitations" such as "obvious drug dosage error" and "omissions of hypotensive effects".[14] Another review, by Peter J. Papadakos in 2003 for the journal Respiratory Care, called it "an excellent introduction to the concept of evidence-based medicine".[15]

From 2002 to 2006, Marik was part of the Editorial Board of Chest journal.[16]

In 2005, Marik was named Director at the Division Pulmonary and Critical Care at Jefferson Medical College (JMC) and Thomas Jefferson University Hospital in Philadelphia.[2]

In 2009, Marik became a professor and Chief of Pulmonary and Critical Care Medicine at Eastern Virginia Medical School.[17]

In 2011, an international committee assembled by the main thoracic and respiratory national societies published guidelines for the diagnosis and management of idiopathic pulmonary fibrosis. The guidelines' section on the treatment of complications relied in part on the results of Marik's 2001 research on the association of gastric reflux and aspiration.[18]

In 2012, an international committee updated guidelines for the management of severe sepsis and septic shock. In its section of supportive therapy recommendations, the committee based its concept on blood product administrations partly on research performed by Marik and W. Sibbald in 1993.[19]

In 2017, Marik won the American College of Physicians award for outstanding educator of residents and fellows.[20] He has written over 450 peer-reviewed journal articles.[21]

In March 2021, Marik was reprimanded by the Virginia Board of Medicine and ordered to complete additional education in prescribing practices after it was found he had prescribed drugs, including phenobarbital, oxycodone, tramadol, alprazolam, and diazepam, to people who were not his patients.[22][23] In November 2021, he sued his employer, Sentara Health, over its ban on prescribing ivermectin for COVID-19. His clinical privileges at Sentara Norfolk General Hospital were suspended shortly afterward.[24][25] He resigned from Eastern Virginia Medical School effective December 31, 2021.[26][27][28][29]

Advocacy for IV vitamin treatments

Marik is inventor of the "Marik protocol", also known as the "HAT" protocol, which proposes intravenous administration of hydrocortisone, ascorbic acid (vitamin C), and thiamine (vitamin B1) as a treatment for preventing sepsis for people in intensive care.[5] Marik's own initial research, published with four other authors in Chest in 2017, showed a dramatic evidence of benefit. The single-center, observational study compared outcomes of 47 consecutive sepsis patients who were treated with HAT during a 7-month period to 47 consecutive control patients during the preceding 7-month period. The study reported 19 deaths in the control group and 4 deaths in the treatment group.[30]

Marik's findings received attention on social media and National Public Radio, but drew criticism from the wider medical community for being science by press conference.[31][32][8] ER doctor Jeremy Faust was one of a number of skeptics of the results, noting the low reliability of the study design and potential for bias.[8] The controversy prompted other groups to conduct studies of the HAT protocol.[8] A systematic review of six randomized and five non-randomized controlled trials in 2021 found that the claimed benefits of the protocol could not be confirmed.[33]

In August 2023 Marik was informed by the American Board of Internal Medicine that his board certification was to be revoked for "spreading false or inaccurate medical information".[4][34]

COVID-19

Marik is a co-founder of the Front Line COVID-19 Critical Care Alliance (FLCCC), a group of physicians and former journalists formed in April 2020 that advocates for ineffective COVID-19 treatments, including hydroxychloroquine, the anti-parasitic drug ivermectin, and intravenous vitamin C.[5][6][7][35][36]

Marik was lead author of a journal article on the efficacy of ivermectin as a COVID-19 treatment, which had been provisionally accepted for publication by a Frontiers Media journal in early 2021, but which was subsequently rejected on account of what the publisher said were "a series of strong, unsupported claims based on studies with insufficient statistical significance" meaning that the article did "not offer an objective [or] balanced scientific contribution to the evaluation of ivermectin as a potential treatment for COVID-19".[37]

In November 2021, the Journal of Intensive Care Medicine retracted a paper written by Marik and others associated with the FLCCC, including Pierre Kory. The paper promoted a combination of vitamins and drugs as treatment for patients hospitalized for COVID-19. The combination was called MATH+ by the FLCCC and included methylprednisolone, ascorbic acid, thiamine, heparin, and other ingredients. The retraction was triggered when it was found the paper misreported the mortality figures of hospitalized patients treated with MATH+, falsely making it appear to be an effective treatment.[38][39][40]

By April 2022, Marik had become associated with a right-wing political group called Defeat the Mandates. Appearing at a rally in Maryland, Marik began promoting further COVID-19 misinformation, saying without evidence that vaccines, masks and social distancing "didn't work" and that information about "early treatment" had been suppressed – "They don't want you to know this because they want you to be scared".[41]

Selected publications

Marik, Paul E. (2012). "Pneumonia, Aspiration". In Vincent, Jean Louis., and Hall, Jesse B. eds. (2012). Encyclopedia of Intensive Care Medicine. Springer Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-00418-6

References
  1. "Paul Ellis Marik – Curriculum Vitae" (PDF). Eastern Virginia Medical School. Retrieved July 21, 2021.
  2. "Paul Marik, MD, Named Director, Division of Pulmonary and Critical Care" (PDF). JeffNews. Thomas Jefferson University. April 1, 2005. p. 2.
  3. "Los cinco de la ivermectina, el antiparasitario contra el Covid por el que hasta se censura". ELMUNDO (in Spanish). June 24, 2021.
  4. Gorski D (August 7, 2023). "The American Board of Internal Medicine finally acts against two misinformation-spreading doctors". Science-Based Medicine.
  5. Fiore, Kristina (January 6, 2021). "What's Behind the Ivermectin-for-COVID Buzz?". medpagetoday.com. Retrieved September 24, 2021.
  6. Hilary Brueck (September 17, 2021). "2 fringe doctors created the myth that ivermectin is a 'miracle cure' for COVID-19 — whipping up false hope that could have deadly consequences". Business Insider.
  7. Larche, Jessica (September 27, 2021). "Norfolk doctor leading charge for controversial COVID-19 treatment". WTKR. Retrieved October 9, 2021.
  8. Rubin R (July 2019). "Wide Interest in a Vitamin C Drug Cocktail for Sepsis Despite Lagging Evidence". JAMA. 322 (4): 291–293. doi:10.1001/jama.2019.7936. PMID 31268477. S2CID 195788169.
  9. Turner, Kelly Jane (January 28, 2021). "Doctor who discovered Ivermectin use for Covid-19 was born in SA, studied at Wits". Independent Online.
  10. "Biography – Dr. Paul E.Marik". benthamscience.com.
  11. Keene, Rochelle (2013). "Our Graduates, 1924–2012" (PDF). Faculty of Health Sciences, University of the Witwatersrand. Retrieved March 27, 2022.
  12. "Profiles – Eastern Virginia Medical School (EVMS), Norfolk, Hampton Roads". evms.edu. Retrieved September 24, 2021.
  13. "Handbook of Evidence-Based Critical Care" (PDF). Respiratory Care. 48 (6). June 2003.
  14. Ho, K. M. (March 2011). "Book Review: Handbook of Evidence-Based Critical Care. Second edition". Anaesthesia and Intensive Care. 39 (2): 320. doi:10.1177/0310057X1103900230. S2CID 86622425.
  15. Papadakos, Peter J. (June 1, 2003). "Book Review: Handbook of Evidence-Based Critical Care. Paul Ellis Marik MD MBBCh. New York: Springer-Verlag. 2001. Soft cover, illustrated, 535 pages". Respiratory Care. 48 (6): 625–626. Retrieved October 6, 2021.
  16. "New CHEST Editorial Board Members" (pdf). Chest. 122 (1): 13. July 2002. doi:10.1378/chest.122.1.13.
  17. "Skilled teacher wins national recognition". EVMS Magazine. Vol. 9, no. 3. Eastern Virginia Medical School. 2016–2017. Retrieved June 9, 2022.
  18. Raghu, Ganesh; Collard, Harold R.; Egan, Jim J.; Martinez, Fernando J.; Behr, Juergen; Brown, Kevin K.; Colby, Thomas V.; Cordier, Jean-François; Flaherty, Kevin R.; Lasky, Joseph A.; Lynch, David A.; Ryu, Jay H.; Swigris, Jeffrey J.; Wells, Athol U.; Ancochea, Julio; Bouros, Demosthenes; Carvalho, Carlos; Costabel, Ulrich; Ebina, Masahito; Hansell, David M.; Johkoh, Takeshi; Kim, Dong Soon; King, Talmadge E.; Kondoh, Yasuhiro; Myers, Jeffrey; Müller, Nestor L.; Nicholson, Andrew G.; Richeldi, Luca; Selman, Moisés; Dudden, Rosalind F.; Griss, Barbara S.; Protzko, Shandra L.; Schünemann, Holger J. (March 15, 2011). "An Official ATS/ERS/JRS/ALAT Statement: Idiopathic Pulmonary Fibrosis: Evidence-based Guidelines for Diagnosis and Management". American Journal of Respiratory and Critical Care Medicine. 183 (6): 788–824. doi:10.1164/rccm.2009-040GL. PMC 5450933. PMID 21471066.
  19. Dellinger, R. P.; Levy, Mitchell M.; Rhodes, Andrew; Annane, Djillali; Gerlach, Herwig; Opal, Steven M.; Sevransky, Jonathan E.; Sprung, Charles L.; Douglas, Ivor S.; Jaeschke, Roman; Osborn, Tiffany M.; Nunnally, Mark E.; Townsend, Sean R.; Reinhart, Konrad; Kleinpell, Ruth M.; Angus, Derek C.; Deutschman, Clifford S.; Machado, Flavia R.; Rubenfeld, Gordon D.; Webb, Steven; Beale, Richard J.; Vincent, Jean-Louis; Moreno, Rui (February 2013). "Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012". Intensive Care Medicine. 39 (2): 165–228. doi:10.1007/s00134-012-2769-8. PMC 7095153. PMID 23361625.
  20. "Awards" (PDF). ACP. Archived from the original (PDF) on January 30, 2019. Retrieved March 27, 2022.
  21. "Paul Ellis Marik – Editorial Board – Pharmacology & Therapeutics – Journal – Elsevier". journals.elsevier.com. Elsevier. Retrieved August 13, 2021.
  22. Adrienne Mayfield (May 19, 2021). "EVMS professor reprimanded by Virginia Board of Medicine". WAVY-TV.
  23. "Case Number 203034" (PDF). Virginia Board of Medicine. March 16, 2021.
  24. "Doctor gets letter of suspension just after suing Sentara Healthcare for chance to use ivermectin on COVID-19 patients". 13newsnow.com. November 23, 2021. Retrieved January 9, 2022.
  25. Ponton, Brendan (November 23, 2021). "Attorney, Sentara quiet over Dr. Marik's hospital suspension". WTKR. Retrieved March 27, 2022.
  26. "Dr. Marik resigns from position at EVMS in midst of legal battle with Sentara over use of ivermectin". WTKR. January 5, 2022. Retrieved March 27, 2022.
  27. Fiore, Kristina (January 5, 2022). "Controversial Doc Resigns From Medical School". medpagetoday.com. Retrieved January 9, 2022.
  28. "Norfolk doctor seeking to use ivermectin to treat COVID-19 resigns from EVMS". WVEC. January 6, 2022. Retrieved January 9, 2022.
  29. Jackson, Jon (January 6, 2022). "Doctor in Middle of Battle to Prescribe Ivermectin for COVID Patients Resigns as Professor". Newsweek.
  30. Marik, Paul E.; Khangoora, Vikramjit; Rivera, Racquel; Hooper, Michael H.; Catravas, John (2017). "Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock". Chest. Elsevier BV. 151 (6): 1229–1238. doi:10.1016/j.Chest.2016.11.036. ISSN 0012-3692. PMID 27940189. S2CID 3509326.
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  34. "FLCCC Doctors Plan to Fight Board Decision". FLCCC Alliance. August 8, 2023.
  35. Rawat, D; Roy, A; Maitra, S; Gulati, A; Khanna, P; Baidya, DK (November 2021). "Vitamin C and COVID-19 treatment: A systematic review and meta-analysis of randomized controlled trials". Diabetes & Metabolic Syndrome. 15 (6): 102324. doi:10.1016/j.dsx.2021.102324. PMC 8552785. PMID 34739908.
  36. Hesman Saey, Tina (August 2, 2020). "Hydroxychloroquine can't stop COVID-19. It's time to move on, scientists say". Science News. ScienceNews. Retrieved March 27, 2022.
  37. Offord C (March 2, 2021). "Frontiers Removes Controversial Ivermectin Paper Pre-Publication". The Scientist.
  38. Marcus A (November 10, 2021). "Bad MATH+? Covid treatment paper by Pierre Kory retracted for flawed results". Retraction Watch.
  39. "Retraction Notice". Journal of Intensive Care Medicine. November 9, 2021. doi:10.1177/08850666211049062. PMID 34749558. S2CID 243863375.
  40. "The FLCCC Physicians". FLCCC. Archived from the original on November 1, 2020. Retrieved November 12, 2021.
  41. Fiore K (May 19, 2022). "Misinformation Docs See Their Political Stars Rise". MedPage Today.
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