美国国家公共电台 NPR Why The Newly Proposed Sepsis Treatment Needs More Study

 

ARI SHAPIRO, HOST:

The noted¹ astronomer² Carl Sagan had a saying. Extraordinary claims require extraordinary evidence. Last week, a physician made the extraordinary claim that he had an effective treatment for sepsis, sometimes known as blood poisoning. It kills around 300,000 Americans every year, so even a modest improvement in survival could save tens of thousands of lives. NPR's Richard Harris looks at how scientists are now planning to test this extraordinary claim.

RICHARD HARRIS, BYLINE³: Sepsis is the leading cause of death in the hospital. It's an overwhelming inflammation usually triggered by an infection. Because it's so often deadly, people took notice when a well-regarded critical care physician at Eastern Virginia Medical School announced he'd found an effective treatment. Paul Marik's protocol⁴ involves intravenous steroids and vitamins which he says saved many of his patients. Former Food and Drug Administration Commissioner⁵ Robert Califf says, prove it.

ROBERT CALIFF: I mean nothing has worked despite all the great ideas that people have had, often ballyhooed with observational data like this, claiming that it's a big effect. So I'd say the odds⁶ are still that it doesn't work, but every once in a while, something works in an unexpected way.

HARRIS: With 800 people a day dying of sepsis in the United States, it would be best to know as rapidly as possible whether Dr. Marik has found a significant improvement to sepsis treatment. The way to do that is to run a carefully conducted study, a randomized controlled trial where some people get the new treatment, others get standard treatment and neither patients nor doctors know which is which.

CALIFF: It would take a very small randomized trial done by people independent of him to prove it. And then the whole world would benefit.

HARRIS: Knowledge is power, but this won't be quick. Even under ideal circumstances, it could take two or three years to plan, fund and run a trial like that. Some doctors aren't waiting. David Carlbom, medical director of the sepsis program at Harborview Medical Center in Seattle, heard Marik give a talk about his protocol and decided⁷ to offer it to his patients.

DAVID CARLBOM: Because of the potential benefit and I think very few harms, I talk to families when I'm caring for a septic shock patient and discuss this with them and get their consent to trying this therapy.

HARRIS: His view after treating five patients is strictly⁸ impressionistic, not scientific. But at least some patients responded well.

CARLBOM: I don't know if it's the medicine. Maybe it's just us taking good care of them. Maybe it's just them and their disease. But I was a little surprised that they actually sort of did seem to heal faster from their septic shock.

HARRIS: Another early adopter is trying this method at the University of South Florida in Tampa. Dr. Mark Rumbak is an old friend of Marik's and heard about the treatment months ago. Rumbak says he's tried it on 30 or 40 patients, most of whom did well.

MARK RUMBAK: Not only are they doing better, but they do better quickly. Within 24, 48 hours, you already see the patients responding. It's actually quite nice. It's quite dramatic. They respond fairly quickly.

HARRIS: But again, these are anecdotes⁹, so both of these doctors would like to see the results of careful studies. Many others say they'll wait for that data before changing how they treat sepsis. Dr. Gordon Bernard at Vanderbilt has been studying sepsis for 30 years.

GORDON BERNARD: I'm in the camp that says, you know, I've seen things that looked interesting many, many times over the decades that I've been doing this, and none of them have panned out. And so this is just one more.

HARRIS: Bernard says wishful thinking could have led Dr. Marik to conclude that only 1 out of his 150 patients had died of sepsis. More people did die but reportedly of other causes.

BERNARD: You could spend all day long adjudicating some of these cases as to whether they died of sepsis or something else.

HARRIS: That question would be answered in a rigorous study. Califf, now at Duke University, says it doesn't always pay to be skeptical¹⁰. He remembers that it took more than a decade for doctors to believe Australian scientists who discovered that stomach ulcers¹¹ can be treated with antibiotics¹².

CALIFF: We always have to be aware that every once in a while, something works, and we don't want to miss that opportunity.

HARRIS: Dr. Marik says he's hoping to move forward quickly with a controlled clinical trial. Richard Harris, NPR News.

1 noted   

adj.著名的，知名的

参考例句：

• The local hotel is noted for its good table.当地的那家酒店以餐食精美而著称。
• Jim is noted for arriving late for work.吉姆上班迟到出了名。

2 astronomer   

n.天文学家

参考例句：

• A new star attracted the notice of the astronomer.新发现的一颗星引起了那位天文学家的注意。
• He is reputed to have been a good astronomer.他以一个优秀的天文学者闻名于世。

3 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

4 protocol   

n.议定书，草约，会谈记录，外交礼节

参考例句：

• We must observe the correct protocol.我们必须遵守应有的礼仪。
• The statesmen signed a protocol.那些政治家签了议定书。

5 commissioner   

n.（政府厅、局、处等部门）专员，长官，委员

参考例句：

• The commissioner has issued a warrant for her arrest.专员发出了对她的逮捕令。
• He was tapped for police commissioner.他被任命为警务处长。

6 odds   

n.让步，机率，可能性，比率；胜败优劣之别

参考例句：

• The odds are 5 to 1 that she will win.她获胜的机会是五比一。
• Do you know the odds of winning the lottery once?你知道赢得一次彩票的几率多大吗？

7 decided   

adj.决定了的，坚决的；明显的，明确的

参考例句：

• This gave them a decided advantage over their opponents.这使他们比对手具有明显的优势。
• There is a decided difference between British and Chinese way of greeting.英国人和中国人打招呼的方式有很明显的区别。

8 strictly   

adv.严厉地，严格地；严密地

参考例句：

• His doctor is dieting him strictly.他的医生严格规定他的饮食。
• The guests were seated strictly in order of precedence.客人严格按照地位高低就座。

9 anecdotes   

n.掌故，趣闻，轶事( anecdote的名词复数 )

参考例句：

• amusing anecdotes about his brief career as an actor 关于他短暂演员生涯的趣闻逸事
• He related several anecdotes about his first years as a congressman. 他讲述自己初任议员那几年的几则轶事。 来自《简明英汉词典》

10 skeptical   

adj.怀疑的，多疑的

参考例句：

• Others here are more skeptical about the chances for justice being done.这里的其他人更为怀疑正义能否得到伸张。
• Her look was skeptical and resigned.她的表情是将信将疑而又无可奈何。

11 ulcers   

n.溃疡( ulcer的名词复数 )；腐烂物；道德败坏；腐败

参考例句：

• Detachment of the dead cells produces erosions and ulcers. 死亡细胞的脱落，产生糜烂和溃疡。 来自辞典例句
• 75% of postbulbar ulcers occur proximal to the duodenal papilla. 75％的球后溃疡发生在十二指肠乳头近侧。 来自辞典例句

12 antibiotics   

n.（用作复数）抗生素；（用作单数）抗生物质的研究；抗生素，抗菌素( antibiotic的名词复数 )

参考例句：

• the discovery of antibiotics in the 20th century 20世纪抗生素的发现
• The doctor gave me a prescription for antibiotics. 医生给我开了抗生素。