A family member sent me this video interviewing Richard Bartlett, MD, a family practice doctor in Odessa, TX. In the video, Dr. Bartlett claims to have found the cure for COVID-19 – an inhaled steroid, Budesonide. Here is my response to my family member:
TL:DR version: This guy’s claims are not credible and his proposed treatment does not have sufficient evidence to support it.
Here’s the long version of my response:
In the sciences, responsible scholars are unwilling to make any claims, let alone really bold claims, until other scholars have verified their claims. You may recall the cold fusion debacle at the University of Utah in the 1980s in which Stanley Pons claimed (with Martin Fleischmann of the University of Southampton) that he had discovered cold fusion. He was forced to retract those claims when no other scientists could replicate his research. Basically, it is highly irresponsible (and, in a pandemic it is reckless, unethical, and dishonest) to make claims that have not been tested, verified, and validated by other experts. As I watched the video, a number of red flags popped up for me. I will detail them in turn. But, before I do, I will note one thing that makes this claim seem almost credible.
The current evidence we have suggests that two drugs may help people with COVID-19, dexamethasone and Remdesivir. Dexamethasone is a steroid and it has been shown to help but is absolutely not a cure for everyone who takes it. It cuts the risk of death by about a third for patients on ventilators (it cuts the risk of death by about a fifth for those on oxygen). Remdesivir is NOT a steroid. It is an antiviral that interferes with the production of viral RNA (as opposed to DNA). Thus, it could seem credible that inhaled steroids like Budesonide would be effective, especially since our early understanding of COVID-19 was that it was a respiratory virus. This also seems plausible because COVID-19 is often contracted by breathing in particles from infected individuals into the lungs where the virus is able to infect cells. However, more research has revealed that COVID-19 spreads to other parts of the body and causes damage in other locations (e.g., kidneys, cardiovascular system, etc.). Thus, the claim that inhaled steroids works seems plausible. But just because something “seems” plausible doesn’t mean it actually works.
UPDATE 7/20/2020: A new study suggests inhaling interferon beta may reduce the risk of developing severe disease from COVID-19 by as much as 79%. However, appropriate caution about the results is warranted as the study has not been peer-reviewed, has a small sample size, and needs replication. This study is a good illustration of how research should be done, in contrast to Dr. Bartlett’s claims.
Now, on to the red flags…
Red Flags
As I watched the interview, a number of very serious problems surfaced. Here they are in detail.
1) The most outlandish problem with Dr. Richard Bartlett’s interview was that he was claiming things that are demonstrably untrue. He suggested that the very low death rates in Taiwan, Japan, and Iceland (among other countries) are due to the medical experts in those countries using inhaled steroids. That is demonstrably false. Iceland, for instance, closed all of its borders, tracked down every single case of COVID-19, isolated them, and eventually, stopped the virus. They also force anyone coming into the country to quarantine for two weeks – everyone! You can read about their efforts here. Similar approaches were taken in Taiwan, New Zealand, Vietnam, and South Korea. None of these countries attribute their low death rates to the use of inhaled steroids to treat patients. They used contact tracing and quarantine to minimize the number of cases. Dr. Bartlett is being dishonest and misrepresenting the facts when he claims that these countries used inhaled steroids to treat these patients when there is no evidence to support his claims. This was a major red flag suggesting he is being dishonest.
2) When Dr. Bartlett was asked how many patients he had treated, he didn’t give a direct answer. A scientist with compelling evidence would know exactly what their sample size is. I have published dozens of research articles and I make it very clear in all of them what my sample size is. Sample sizes are a component of any research study because other researchers need to know the basics of the research design so they can replicate it. Instead, he just keeps saying that he’s treated lots of people and has had a 100% success rate. He provides no more information about the patients: How severe were these cases (we know COVID-19 cases vary in severity)? How old were they? What other comorbidities did they have? He provides no additional information in a credible format. These are serious red flags to me.
3) As noted above, responsible scientists submit their research for publication before they make claims, particularly bold claims. Dr. Bartlett’s evidence is entirely “anecdotal,” which is to say he has no real evidence at all. Unless he has kept detailed records for every single patient he has treated with clear information about their diagnosis with COVID-19, the length of time they had the disease before they were treated, other medical interventions involved, all underlying comorbidities, and can rule out all other possible medical interventions that would have helped, and can aggregate that information into a clear pattern of success, he would not be able to publish these claims. Stories are powerful. We like them. And we find them convincing. But scientists don’t find them compelling. We want evidence. Lots of it. And we need to have it verified, ideally by 2 or more experts. Dr. Bartlett’s claims are extraordinary. Extraordinary claims require extraordinary evidence. He provides none.
4) These claims have all the hallmarks of a conspiracy theory. The video was posted on July 3rd. If this was the cure, major news outlets around the world would have picked this up. So far, none of them are touching this. Conspiracy theorists will point to this and say that it is evidence that there is a conspiracy against Dr. Bartlett. But that is the problem with conspiracy theorists – when something does happen, it supports their conspiracy; and when nothing happens, it also supports their conspiracy. It’s virtually impossible to convince conspiracy theorists that they are wrong because all the evidence, including the absence of evidence, is seen to support their conspiracy. Yet, doesn’t it seem far more reasonable to conclude that, if someone had found a cure nearly two weeks ago that every major news source on the planet would have put this on the front page or made this the headline in their broadcasts? Only a conspiracy theorist would look at the lack of media coverage and see a conspiracy to hide a cure.
5) Dr. Richard Bartlett has not, to my knowledge, ever published a single research article in the scientific literature. There is one Richard Bartlett with a user profile on Google Scholar – a law professor at the University of Western Australia (who, no doubt, is going to be pissed that someone with his same name is going to get a lot of negative publicity). There are some other “R Bartletts” who have published research, but those individuals do not appear to be Dr. Richard Bartlett from Texas. So you can see the Google Scholar profile for an actual scholar, here is my Google Scholar profile. The nice thing about Google Scholar is that it is publicly accessible. There are other ways to find research by scholars, but they are behind paywalls and the public cannot see them. But Google Scholar makes it quite easy to see whether someone is a recognized scholar. Dr. Richard Bartlett is not. Our most basic criteria for determining whether someone is an expert in the sciences is to see if they have published research in their stated area of expertise. In this case, Dr. Bartlett should have published research in medicine related journals, particularly on the uses of inhaled steroids or on the treatment of viral respiratory infections. He has not. He is NOT an expert. Just because he is a medical doctor does not mean he is an expert on these topics. There are lots of MDs who push treatments that are completely ineffective and even harmful.
So, those are the red flags. I did some additional digging on this topic and here’s what I found:
a) I found two review articles by actual experts on the efficacy of inhaled steroids for treating COVID-19 (article 1 and article 2). Neither claim this is the cure for COVID-19. Here is the summary from one of those studies, “At present, there is no evidence as to whether pre-morbid use or continued administration of ICS [inhaled corticosteroids] is a factor for adverse or beneficial outcomes in acute respiratory infections due to coronavirus.”
b) Further digging by a local news channel called Dr. Bartlett’s claims into question as well.
So, the long answer to your question is: Dr. Bartlett is, at a minimum, not being honest (as detailed above). He is also being irresponsible in making claims that have not been verified with peer-review. He is not an expert on respiratory infections or inhaled steroids. He is dishonest about his claims and evasive with his answers. The scientific literature does not support his claims, though responsible scientists admit that more research is needed.
My verdict: There is no compelling evidence that Dr. Bartlett has found “THE CURE” for COVID-19. Maybe this will help; maybe not. The only way to know for certain is to conduct rigorous clinical trials.
