So how am I doing?

I started this website when I retired, now in its seventh year and below are the stats for 2021, a fairly typical year. My mission has been to teach the basics of fluid physiology to clinical prescribers, and to provide impartial opinions on the various flavours of intravenous therapies available to confused customers. There has never been a day without someone somewhere in the world lands on one of my pages.

The Review Article that started it all is still being cited, sometimes appropriately but too often wrongly!

Our latest peer-reviewed Open Access communication has been cited a creditable 16 times in its short life, making it WILEY Top-Cited Paper of 2020-21! I hope many more young clinical scientists will read and refer to this summary of the more complicated stuff in coming years. is a labour of love, into which I have invested hundreds of hours of my time and over a thousand pounds in web publishing fees. When the Invoice comes through, I wonder if there aren’t deserving charities I should support instead. But it is the interactions with people around the world that brings pleasure, even through the pandemic of social media and teleconference calls.

And then there are efforts by the Pharmaceutical Industry to promote biophysical osmotic therapies in spite of the physiology and trial evidence that suggests they will have little if any clinical benefit. The most recent example from CSL Behring was “Ten Myths about Albumin”;

Myth #1. Albumin leaks from the intravascular space into the interstitial compartment and contributes to oedema.

No, it does not.

Albumin, a major plasma protein, is essential for maintaining intravascular oncotic pressure. Up to 5% of intravascular albumin leaks per hour into the extravascular space [transcapillary escape rate (TER)] …

Now I trust those who have followed me know that albumin DOES escape from plasma to tissue fluid and is a component of a vital circulation of extracellular fluid. Indeed, the Authors tell you the normal rate of Escape of albumin, but they and their Editorial Reviewers completely miss that they contradict their own myth-buster. They even claim it is a myth that albumin contributes to oedema even though basic science and clinical reports tell us otherwise.

ICM’s Senior editor Giuseppe Citerio invited me to criticise this publication in a Letter, but I offered instead a Paper of similar style with Open Access to counter the expressed opinion that “Albumin plays an important role in critical care as a prognostic marker and therapy.” I was advised that the Article Processing Charge (APC) of several thousands Euro could not be waived, making it impossible for me to respond. It is not disclosed who paid the APC for the promotional Opinion piece written by Clinicians who have accepted payments from the product manufacturer.

NEJM “is committed to publishing …. review articles that are free from commercial interest”, see below. The Journal ICM appears to fall short of such high standards.

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