Paul Marik: Life and Career

Editorial Note — Freedom of Research and the Right to Be Heard. This page documents the research, writings, and claims of Dr. Paul E. Marik, the critical-care physician and former chief of pulmonary and critical care medicine at Eastern Virginia Medical School, known for his work on vitamin C in sepsis and on repurposed drugs, in the spirit of open scientific inquiry. The First Amendment’s protection of speech, and the long American tradition of medical dissent that runs from Semmelweis to Barry Marshall to Linus Pauling, exists precisely so that minority and unpopular research can be examined on its merits rather than silenced by institutional consensus. We present his facts and claims as he stated them, attributed to him, drawn from his papers and books. Readers are presumed to be intelligent adults capable of weighing evidence, consulting their own physicians, and making informed decisions about their own bodies. This page is provided for educational and historical-record purposes; it is not medical advice and does not endorse self-treatment. Censorship of a researcher is not refutation of the research. — MyHealthcare.com

Paul Ellis Marik is a critical-care physician — a doctor who looks after the sickest patients in hospital intensive care units — who trained in South Africa and then worked in Canada and the United States. Over three decades he published several hundred research papers, wrote three editions of a textbook of evidence-based critical care, devised a vitamin C treatment for sepsis that became known as the hydrocortisone, ascorbic acid and thiamine (HAT) protocol, co-founded a group of doctors that wrote COVID-19 hospital treatment protocols, and later turned to writing about repurposed drugs and metabolic approaches to cancer.

This page follows his working life in plain language, in the order the record shows it: his medical training and first studies in Johannesburg, the intensive care unit at Baragwanath Hospital in Soweto, his research in London, Ontario, his years in Pittsburgh, his post as head of a division at Thomas Jefferson University in Philadelphia, his long period as chief of pulmonary and critical care medicine at Eastern Virginia Medical School in Norfolk, the alliance he co-founded in 2020, and the writing on cancer and metabolism that has occupied him since. The dates come from the affiliations printed on his own papers in PubMed, from Thomas Jefferson University’s published history of its pulmonary and critical care division, and from the publisher records of his books.

Medical Training in Johannesburg
The Baragwanath Intensive Care Unit
London, Ontario: Blood Transfusion in Sepsis
The Pittsburgh Years and the First Textbook
Division Director at Thomas Jefferson University
Chief of Pulmonary and Critical Care Medicine in Norfolk
Vitamin C, Thiamine and Hydrocortisone in Sepsis
The Front Line COVID-19 Critical Care Alliance
Writing on Cancer and Metabolism
Timeline
Key Research Papers
Connections
Featured Videos

1. Medical Training in Johannesburg

Marik trained in medicine at the University of the Witwatersrand in Johannesburg, South Africa. His early training was in internal medicine — the branch of medicine that cares for adults with diseases of the heart, lungs, kidneys and other internal organs — and his first documented research came from that field.

In 1990, working in the Department of Medicine at J.G. Strijdom Hospital in Johannesburg, he and three colleagues published a prospective study of 233 patients admitted with a heart attack (acute myocardial infarction). The study looked for the clinical signs, present when a patient first arrived, that predicted who would die early. It appeared in the South African Medical Journal and is the earliest paper in PubMed that carries his name. Predicting which patients are most at risk, and how to act early for them, became a thread that ran through much of his later work.

One of his co-authors on that paper, J. Lipman, also appears on his next intensive-care studies, which places him in critical care in Johannesburg’s public hospitals at the start of the 1990s.

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2. The Baragwanath Intensive Care Unit

From about 1991 to 1993 his papers list the intensive care unit of Baragwanath Hospital in Soweto, Johannesburg. Three papers from this period show the range of questions he was already asking:

Antibiotic dosing. In 1991 he led a prospective randomised study in critically ill adults and children that compared giving the antibiotic amikacin once a day with giving it twice a day. The question — whether a simpler schedule works as well for very sick patients — was a live one in intensive care at the time.
How an intensive care unit is used. In 1993 he, P. Kraus and Lipman described the patients admitted to the Baragwanath unit and how its beds were used, in a paper titled “Intensive care utilisation: the Baragwanath experience”.
Reading the pulse of a ventilated patient. Also in 1993, as sole author, he studied whether the rise and fall of the systolic blood pressure with each breath of a breathing machine could indicate the filling pressure of the heart. This question — how a doctor can tell from the bedside whether a patient needs more fluid — became one of the main subjects of his career.

The fluid question is followed in detail on the page about his critical-care research and textbooks.

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3. London, Ontario: Blood Transfusion in Sepsis

In the early 1990s Marik worked in Canada, at the A.C. Burton Vascular Biology Laboratory of the Victoria Hospital Research Institute in London, Ontario, with the Canadian critical-care researcher William J. Sibbald.

Their best-known paper from this period appeared in the Journal of the American Medical Association (JAMA) in 1993. It studied patients with sepsis — the life-threatening reaction of the whole body to an infection — and asked whether a transfusion of stored red blood cells actually increased the amount of oxygen the patients’ tissues received. The paper is cited by later sepsis guidelines and research on transfusion in critical illness.

Sepsis would remain the centre of his research for the next thirty years: the condition itself is described on the site’s Sepsis page.

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4. The Pittsburgh Years and the First Textbook

Marik then moved to the United States. Around 2001 his papers list the Section of Critical Care Medicine at Mercy Hospital of Pittsburgh, and in 2002 the Department of Critical Care Medicine at the University of Pittsburgh. Thomas Jefferson University’s division history later records that he was recruited to Philadelphia “from the University of Pittsburgh”.

The Pittsburgh years were among his most productive. Papers from this period include:

Aspiration. In 2001 the New England Journal of Medicine published his review “Aspiration pneumonitis and aspiration pneumonia”. It set out the difference between two conditions that are often confused: a chemical injury of the lungs caused by inhaled stomach contents, and a lung infection caused by inhaled bacteria from the mouth and throat. The review became widely cited.
Sepsis. In 2001 he and the critical-care physician J. Varon wrote “Sepsis: state of the art”, a long review in Disease-a-Month. Varon remained a frequent co-author in the years that followed.
Feeding the critically ill. With G.P. Zaloga he published a 2001 systematic review of early tube feeding into the gut (enteral nutrition) in acutely ill patients, and in 2004 a meta-analysis in the BMJ comparing feeding into a vein (parenteral nutrition) with enteral nutrition in acute pancreatitis.
The adrenal glands in critical illness. In 2002, again with Zaloga, he wrote “Adrenal insufficiency in the critically ill: a new look at an old problem” in the journal Chest, on how severe illness can leave the body short of the stress hormone cortisol. The condition is described on the site’s Adrenal Insufficiency page.

In 2001 the publisher Springer also brought out his first book, the Handbook of Evidence-Based Critical Care. Its aim, carried through two later editions, was to give intensive-care doctors a single reference that set out the research evidence for and against each common treatment.

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5. Division Director at Thomas Jefferson University

From 2005 to 2008 Marik was Director of the Division of Pulmonary and Critical Care Medicine at Thomas Jefferson University in Philadelphia. The university’s own history of the division lists him among its chiefs and says he was recruited mainly to build critical care medicine at Thomas Jefferson University Hospital.

Two papers from these years are among his most cited:

Corticosteroid insufficiency. In 2008 he was first author of the consensus statements of an international task force of the American College of Critical Care Medicine on how to diagnose and manage a shortage of corticosteroid hormones in critically ill adults.
Central venous pressure. Also in 2008, with M. Baram and B. Vahid, he published a systematic review in Chest asking whether the central venous pressure — the pressure measured in the large vein near the heart, then widely used to guide how much fluid to give — predicts whether a patient will respond to more fluid. Under the subtitle “the tale of seven mares”, it concluded that the central venous pressure did not predict fluid responsiveness. His university affiliation on that paper is Thomas Jefferson University.

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6. Chief of Pulmonary and Critical Care Medicine in Norfolk

In 2009 Marik moved to Eastern Virginia Medical School in Norfolk, Virginia, as Professor of Medicine and Chief of the Division of Pulmonary and Critical Care Medicine. Eastern Virginia Medical School is the affiliation printed on his papers from 2009 to 2021. His 2017 sepsis study lists both the medical school and the pharmacy department of the Norfolk teaching hospital.

His Norfolk years produced the later editions of his textbook and a steady stream of research:

Textbooks. The second edition of the Handbook of Evidence-Based Critical Care appeared from Springer New York in 2010, organised by organ system. A third edition, retitled Evidence-Based Critical Care, followed from Springer International Publishing in late 2014 (dated 2015), at about 835 pages.
Fluids. With R. Cavallazzi he updated the central venous pressure meta-analysis in 2013, subtitled “a plea for some common sense”; with X. Monnet and J.-L. Teboul he wrote reviews of the bedside tests that do predict fluid responsiveness; and in 2017 he led an analysis of fluid use in severe sepsis and septic shock in a large United States hospital database.
Guidelines and nutrition. In 2017 he was a co-author of the joint guideline of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine on corticosteroid insufficiency in critical illness, and of an international research agenda for nutrition and metabolism in intensive care. In 2016 he and M.H. Hooper published a meta-analysis comparing full-calorie with reduced-calorie feeding in intensive care patients.

At Eastern Virginia Medical School he also began the work for which he became widely known outside intensive care: the combination of vitamin C, thiamine and hydrocortisone in sepsis.

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7. Vitamin C, Thiamine and Hydrocortisone in Sepsis

In 2016 Marik wrote a commentary in Critical Care Medicine titled “‘Vitamin S’ (Steroids) and Vitamin C for the Treatment of Severe Sepsis and Septic Shock!”. The following year he and colleagues published the study that made his name more widely known.

In 2017 the journal Chest published a retrospective before-after study from his Norfolk intensive care unit. Forty-seven consecutive patients with severe sepsis or septic shock treated with intravenous vitamin C, hydrocortisone and thiamine over seven months were compared with 47 patients treated in the seven months before. The authors reported a hospital mortality of 8.5% (4 of 47) in the treated group against 40.4% (19 of 47) in the earlier group. They concluded that the combination might prevent progressive organ failure and reduce deaths, and called for further studies. Marik later named the combination “HAT therapy”.

Several randomised trials tested the combination in the years that followed. The first large one, VITAMINS, enrolled 216 patients with septic shock and reported time alive and free of blood-pressure-support drugs over seven days of 122.1 hours with the combination against 124.6 hours with hydrocortisone alone. Marik’s reasoning, his later papers and these trials are set out on the page The HAT Protocol: Vitamin C, Thiamine and Hydrocortisone in Sepsis; the vitamins themselves are described on the site’s Vitamin C and Vitamin B1 (Thiamine) pages.

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8. The Front Line COVID-19 Critical Care Alliance

In April 2020, in the first months of the COVID-19 pandemic, Marik co-founded a group of critical-care physicians called the Front Line COVID-19 Critical Care Alliance. His co-authors on the group’s papers included long-time colleagues such as Varon, G.U. Meduri, J. Iglesias and Pierre Kory.

In a review they published in 2022, he and his co-authors told the story of how the group began. Early reports of respiratory failure in COVID-19 showed “inexplicably high mortality rates”, they wrote, and this led them to form “a clinical expert panel called the Front-Line COVID-19 Critical Care Alliance”, working from shared impressions of “what was working and what wasn’t working”. They added that guidance early in the pandemic had called for “supportive care only”, with “a specific prohibition against the use of corticosteroids”.

The group’s hospital protocol was built around methylprednisolone, ascorbic acid, thiamine and heparin (MATH+). In a 2021 paper setting out its scientific rationale, Marik and his co-authors described the lung phase of COVID-19 as an organising pneumonia with immune dysregulation, clotting and injury to the small blood vessels. Alongside the protocol, Marik wrote or co-wrote papers in 2020 on quercetin with vitamin C, on a treatment algorithm for melatonin, and on vitamin D status and COVID-19 deaths. These protocols, the papers behind them, and the large randomised trials that later tested corticosteroids and other drugs in COVID-19 are described on the page MATH+ and Paul Marik’s COVID-19 Treatment Protocols.

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9. Writing on Cancer and Metabolism

From 2023 Marik’s writing turned to cancer. In that year the alliance published his book Cancer Care: The Role of Repurposed Drugs and Metabolic Interventions in Treating Cancer, with a second edition in 2024. The full text is free to download from the alliance’s website, and the second edition is also sold in print and as an electronic book. In its preface Marik writes that he “read more than 1800 peer-reviewed papers” for it.

The preface explains why he chose the subject of repurposed drugs — medicines already licensed for one illness and studied for another. “Around 30 percent of all prescriptions in the United States are written for off-label uses,” he writes, and he argues that repositioning licensed drugs can offer “safe, affordable, and effective treatments in a short period of time.” He also writes: “I want to be clear that I am not suggesting I have found a cure for cancer, nor am I the first to propose using repurposed drugs for cancer.”

His peer-reviewed papers from these years were written with the researchers M.T.J. Halma and J.A. Tuszynski. They include a 2023 review in Nutrients of cancer metabolism as a target for treatment, which states that “Cancer is amenable to low-cost treatments, given that it has a significant metabolic component, which can be affected through diet and lifestyle change at minimal cost”, as well as later reviews on the effects of the coronavirus spike protein and on muscle in ageing.

Since 2025 he has written a series of further guides on the alliance’s website, among them “Stopping the 10 Deadliest Cancers” (July 2025), “Dietary Interventions in Cancer” (September 2025), “Targeting Cancer Stem Cells” (August 2025) and “Cancer Resistance Mitigation” (March 2026). He also writes a newsletter, subtitled “Effective Treatments using Diet, Repurposed Drugs and Nutraceuticals”, where a March 2026 post set out plans for a “cancer and metabolic library”.

The book is described on Cancer Care: Paul Marik’s Book on Repurposed Drugs, and his view of cancer as a disease of metabolism on Paul Marik’s Metabolic Approach to Cancer.

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10. Timeline

1990 — Department of Medicine, J.G. Strijdom Hospital, Johannesburg; study of 233 patients with heart attack, his earliest paper in PubMed.
1991–1993 — Intensive care unit, Baragwanath Hospital, Soweto; studies of amikacin dosing, intensive care use and blood-pressure variation in ventilated patients.
1993 — Victoria Hospital Research Institute, London, Ontario; study of stored-blood transfusion in sepsis with William J. Sibbald, in JAMA.
2001 — Mercy Hospital of Pittsburgh; review of aspiration pneumonitis and aspiration pneumonia in the New England Journal of Medicine; first edition of the Handbook of Evidence-Based Critical Care.
2002 — Department of Critical Care Medicine, University of Pittsburgh; review of adrenal insufficiency in the critically ill.
2005–2008 — Director, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia.
2008 — First author of the American College of Critical Care Medicine consensus statements on corticosteroid insufficiency; “the tale of seven mares” review of central venous pressure.
2009 — Professor of Medicine and Chief, Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk.
2010 — Second edition of the Handbook of Evidence-Based Critical Care.
2014–2015 — Third edition, Evidence-Based Critical Care.
2017 — Before-after study of vitamin C, hydrocortisone and thiamine in sepsis, in Chest.
2020 — Co-founds the Front Line COVID-19 Critical Care Alliance (April); MATH+ hospital protocol.
2023 — First edition of Cancer Care; review of cancer metabolism with Halma and Tuszynski.
2024 — Second edition of Cancer Care.
2025–2026 — Further cancer guides and newsletter posts.

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Key Research Papers

Marik PE, Lipman J, Eidelman IJ, Erskine PJ. Clinical predictors of early death in acute myocardial infarction. A prospective study of 233 patients. S Afr Med J. 1990;77(4):179-82. — PubMed PMID: 2300852
Marik PE, Lipman J, Kobilski S, Scribante J. A prospective randomized study comparing once- versus twice-daily amikacin dosing in critically ill adult and paediatric patients. J Antimicrob Chemother. 1991;28(5):753-64. — PubMed PMID: 1778878
Marik PE, Kraus P, Lipman J. Intensive care utilisation: the Baragwanath experience. Anaesth Intensive Care. 1993;21(4):396-9. — PubMed PMID: 8214542
Marik PE. The systolic blood pressure variation as an indicator of pulmonary capillary wedge pressure in ventilated patients. Anaesth Intensive Care. 1993;21(4):405-8. — PubMed PMID: 8214544
Marik PE, Sibbald WJ. Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA. 1993;269(23):3024-9. — PubMed PMID: 8501845
Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344(9):665-71. — PubMed PMID: 11228282
Marik PE, Varon J. Sepsis: state of the art. Dis Mon. 2001;47(10):465-532. — PubMed PMID: 11641650
Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: a systematic review. Crit Care Med. 2001;29(12):2264-70. — PubMed PMID: 11801821
Marik PE, Zaloga GP. Adrenal insufficiency in the critically ill: a new look at an old problem. Chest. 2002;122(5):1784-96. — PubMed PMID: 12426284
Marik PE, Zaloga GP. Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis. BMJ. 2004;328(7453):1407. — PubMed PMID: 15175229
Marik PE, Pastores SM, Annane D, Meduri GU, Sprung CL, Arlt W, et al. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 2008;36(6):1937-49. — PubMed PMID: 18496365
Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134(1):172-8. — PubMed PMID: 18628220
Annane D, Pastores SM, Rochwerg B, Arlt W, Balk RA, Beishuizen A, et al. Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intensive Care Med. 2017;43(12):1751-1763. — PubMed PMID: 28940011
Marik PE, Khangoora V, Rivera R, Hooper MH, Catravas J. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study. Chest. 2017;151(6):1229-1238. — PubMed PMID: 27940189
Fujii T, Luethi N, Young PJ, Frei DR, Eastwood GM, French CJ, et al. Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock: The VITAMINS Randomized Clinical Trial. JAMA. 2020;323(5):423-431. — PubMed PMID: 31950979
Marik PE, Kory P, Varon J, Iglesias J, Meduri GU. MATH+ protocol for the treatment of SARS-CoV-2 infection: the scientific rationale. Expert Rev Anti Infect Ther. 2021;19(2):129-135. — PubMed PMID: 32809870
Kory P, Meduri GU, Iglesias J, Varon J, Cadegiani FA, Marik PE. “MATH+” Multi-Modal Hospital Treatment Protocol for COVID-19 Infection: Clinical and Scientific Rationale. J Clin Med Res. 2022;14(2):53-79. — PubMed PMID: 35317360
Halma MTJ, Tuszynski JA, Marik PE. Cancer Metabolism as a Therapeutic Target and Review of Interventions. Nutrients. 2023;15(19):4245. — PubMed PMID: 37836529

Paul Marik: Life and Career

Table of Contents

1. Medical Training in Johannesburg

2. The Baragwanath Intensive Care Unit

3. London, Ontario: Blood Transfusion in Sepsis

4. The Pittsburgh Years and the First Textbook

5. Division Director at Thomas Jefferson University

6. Chief of Pulmonary and Critical Care Medicine in Norfolk

7. Vitamin C, Thiamine and Hydrocortisone in Sepsis

8. The Front Line COVID-19 Critical Care Alliance

9. Writing on Cancer and Metabolism

10. Timeline

Key Research Papers

PubMed Topic Searches

Further Reading

Connections

Featured Videos