Dr. Richard Bartlett promotes Budesonide (a common asthma medication) to treat Covid19. Is his new protocol worth trying? Let’s check the facts.
This is Part Two of a living document in response to Dr. Richard Bartlett’s interview on ThriveTime radio, his earlier interview on America Can We Talk, and his white paper. See my Notes and Disclaimers and Medical Review Update at the bottom of Could Budesonide Cure Covid? (Part One). All opinions are my own. This is not medical advice.
Overview – Parts One (1-9) and Two (10-18)
- Budesonide is a Safe, Common Asthma Medication (Fact Check: Appears to be true)
- Budesonide Delivered A 100% Clinical Success Rate (Fact Check: Insufficient data. But his at-risk patients call the procedure life-saving.)
- Budesonide Is A “Perfect Match” For Covid (Fact Check: Inconclusive. On the one hand Budesonide appears to be a good match for blocking the cytokines. On the other hand, some researchers don’t think cytokines are the issue.)
- Other Countries Are Using Similar Protocols (Fact Check: Sort of. Japan, Spain, Oxford, and China are testing similar protocols. But I couldn’t find any studies for inhaled steroids in Taiwan, South Korea, France, or NIH. France has studied anti-inflammatories, and South Korea’s Celltrion is working on a “therapeutic antibody treatment.”)
- Early Treatment With Inhaled Steroids Is Why Taiwan, South Korea, And Japan Have So Few Deaths (Fact Check: Empirical /clinical treatment data is hard to find; all three countries used strict isolation/quarantine/tracing measures to contain the virus.
- The Current Standard Of Care Globally Is Go Home And Tough It Out (Fact Check: True)
- Social Distancing, Protective Gear, And Masks Are Insufficient (Fact Check: True)
- Masks Increase Virus Exposure of Asymptomatic Wearers, Raising Risk of Illness (Fact Check: True)
- COVID Is A Rapidly Mutating Virus, Making Vaccine A Losing Strategy (Fact Check: Yes and No. True, Iceland reported 291 mutations in April. But vaccine researchers say they’re all very similar, meaning significant change is slow.) [PART TWO BEGINS WITH #10]
- Early Treatment with Budesonide via Nebulizer is the Current Best Strategy (Fact Check: Appears to be True.)
- The US Should Consider Making This Treatment Available Because It’s Already FDA-Approved For Asthma (Controversial, especially if the protocol is misrepresented. And it has been.)
- Naysayer: World Magazine Doctor Says Patients May Have Survived Without Treatment (Fact Check: Of the dozens of cases Dr. Bartlett has treated, he prepared only two case studies. But as noted above his at-risk patients call the procedure life-saving.)
- Naysayer: Dr. Larry Wilson Says No Proven Benefit (Fact Check: Ignores Dr. Bartlett’s success. Bias exposed by comments to the article.)
- Naysayer: Midland Reporter-Telegram (Fact Check: Misrepresents comments.)
- Other Naysayers: Cheap Steroid Treatment Naysayers (Example of how naysayers criticize incomplete information while people are dying for lack of an effective treatment.)
- Contact Dr. Richard Bartlett
- Conclusion (Safe enough to warrant further exploration.)
Dr. Bartlett points out, “early detection and early treatment” is the normal standard of care for other life-threatening illnesses in America. He says, “This idea of running out of hospital beds started in China. If you treat people early you don’t have to worry about running out of hospital beds. They never get that far.” He recommends early treatment with budesonide inhaled via nebulizer. He claims this is the safest and most effective delivery method for the medicine in an outpatient setting because:
- nebulization delivers higher targeted drug concentrations in the airways achieving rapid onset of action
- nebulized corticosteroids can be dosed at considerably lower doses than oral or intravenous alternatives
- there is minimal systemic absorption with nebulized corticosteroids hence, fewer adverse effects
(Source: pieced together from Dr. Richard Bartlett’s interview on ThriveTime radio and his white paper)
Fact Check: Appears to be True. Some experts recommend inhaled cortosteroids (ICS) for those with asthma or lung disease during the pandemic. The lead researcher on the Oxford study said, “Ideally, it may be that the corticosteroid therapy would be given to anyone with a new, dry cough, and while they are awaiting their COVID test results.”
Some See No Difference, Or Favor Inhalers Over Nebulizers
NIH (Feb 2018): “This study found no significant difference between the two groups with respect to the method of treatment. Therefore, Turbuhaler can be used at home by patients so, it leads to elimination of costs and hospital stays.” (Citation: Emami Ardestani M, Klantar E, Azimian M. Comparison of the Efficacy of Budesonide Nebulizer Suspension and Budesonide Inhalation Suspension in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Tanaffos. 2018;17(2):96-102.)
Also found this from Lancet:
Patients with pulmonary diseases are considered to have an increased risk of having COVID-19. However, the prevalence of COVID-19 is lower in this patient population than in populations of other chronic illnesses, and treatments used in pulmonary diseases might reduce the risk of infection and the development of disease symptoms.1
Guidelines from the Global Initiative for Chronic Obstructive Lung Disease and the Global Initiative for Asthma recommend the use of prescribed ICS in pulmonary diseases to prevent the worsening of pulmonary disease severity during the pandemic. I
If aerosolised medications must be used [for patients treated at home], clinicians should prefer inhalers over nebulisers, unless the patient cannot perform the specific breathing techniques the inhaler requires or the drug formulation is unavailable as an inhaler.6 Exhaled air dispersion and virus transmission with inhalers are less than with jet nebulisers because inhalers have lower emitted doses and generate less aerosol mass.Lancet (6/22/2020) Use of aerosolised medications at home for COVID-19
Dr. Bartlett says Nebulizer benefits outweigh concerns in Outpatient Settings
Nebulizers are very effective at treating breathing disorders like SARS-CoV-2, but concerns of spreading particles in size up to 5 um via aerosol cause concern for providers when considering what route to order for respiratory medications. This case study is focused on treatment in the outpatient setting, and therefore, there are different considerations when examining the efficacy of nebulized therapy. Small-Volume Nebulizers (SVNs) offer several advantages for drug delivery: nebulization delivers higher targeted drug concentrations in the airways achieving rapid onset of action, nebulized corticosteroids can be dosed at considerably lower doses than oral or intravenous alternatives, and there is minimal systemic absorption with nebulized corticosteroids hence, fewer adverse effects. 7 & 14Case Study Report, SARS-CoV-2 and The Case for Empirical Treatment, Authors – Richard P. Bartlett, MD and Alexandria Watkins, DNP
Oxford: Early Treatment Recommended
News Medical (07/07/2020): Asthma inhalers being trialed for treatment of COVID-19 in Oxford. (“Studies have shown that some corticosteroids, such as dexamethasone, could reduce the inflammation of the respiratory tract in these patients and benefit them by alleviating the symptoms of severe disease…Lead researcher on this team Dan Nicolau… said… “Ideally, it may be that the corticosteroid therapy would be given to anyone with a new, dry cough, and while they are awaiting their COVID test results.”
11. The US Should Make This Treatment Available Before FDA-Approval Because It’s Already Proven safe for Similar Uses
“I’ve had to care for two people that were hit by pick-up truck on the side of the road. Two times this has happened. If they’re bleeding I can make a makeshift tourniquet with my belt to stop the bleeding. My belt is not FDA-approved but I can save a life. The good news is Budesonide has been FDA approved for twenty years.” (Source: Dr. Richard Bartlett’s interview on ThriveTime radio)
Critics will point out FDA-approval for one ailment doesn’t make medicine safe for another. But as the comments on Dr. Wilson’s post reveal, proactive flu-season Nebulizer treatments with anti-inflammatory drugs is common among COPD and other pulmonary patients.
12. Naysayer: World Magazine Doctor
A doctor writing for World Magazine says the evidence is still out on this “Silver Bullet” for Covid19. His main argument seems to be, “Since most patients with COVID-19 do survive, it raises the question: Did his patients benefit from the steroids, or were they patients who would have survived anyway?”
Fact check: Weak criticism. Of the dozens of cases Dr. Bartlett has treated, he prepared only two case studies. Both had multiple risk factors and tested positive for COVID-19. Case #1 was bedridden with a fever for five days and having trouble breathing before treatment. See details in Dr. Bartlett’s white paper (hosted at America Can We Talk). It appears that the second case study is of the man Dr. Bartlett mentions in his interview whose brother died of COVID-19.
Dr. Bartlett’s First Case Study
The first patient is a 63-year-old female, non-smoker, who is diagnosed with Waldenstrom’s Macroglobulinemia (2012) and Primary Cutaneous Marginal Zone Lymphoma (2020) and currently being treated with ibrutinib (Imbruvica). The patient also has a history of hypertension and hypothyroidism… [patient was symptomatic for five days before treatment, which began immediately based on likelihood of infection which was confirmed by test 10 days after initial symptoms]… the patient was empirically started on budesonide 0.5mg nebulizer twice daily, clarithromycin (Biaxin) 500mg tab twice daily for ten days, Zinc 50mg tab twice daily, and aspirin 81mg tab daily. The patient reported for the next two-days, symptoms improved once nebulized budesonide had been administered.Case Study Report, SARS-CoV-2 and The Case for Empirical Treatment, Authors – Richard P. Bartlett, MD and Alexandria Watkins, DNP
Dr. Bartlett’s Second Case Study
The second patient is a 38-year-old male, non-smoker, who has the following comorbidities: Type II Diabetes Mellitus (DM), hypertension, and gout. The patient takes Metformin 1,000mg tab, twice daily and Pioglitazone 15mg tab, daily for Type II DM, Lisinopril 2.5mg tab, daily for hypertension, and Probenecid 500mg tab, daily for gout. [March 29 symptoms began, flu test was negative, and was then] treated empirically and started on budesonide 0.5mg nebulizer twice daily, clarithromycin (Biaxin) 500mg tab twice daily for 10 days, Zinc 50mg tab twice daily, and aspirin 81mg tab daily… The patient completed a total of four rounds of Azithromycin 500mg tab on day one, then 250mg tab, daily for four-days, and stopped budesonide 0.5mg nebulizer twice daily, May 13th. He continued Zinc 50mg tab twice daily, and the aspirin 81mg tab daily, until a second consecutive negative was obtained.Case Study Report, SARS-CoV-2 and The Case for Empirical Treatment, Authors – Richard P. Bartlett, MD and Alexandria Watkins, DNP
13. Naysayer: Dr. Larry Wilson, chief medical officer at Midland Memorial Hospital
In Texas, Midland Memorial Hospital will not be testing budesonide – not because they think it’s a hoax, but because “legal and ethical issues with running any kind of drug trial and, because MMH is not a research facility.”
Midland Reporter Telegram (07/07/2020) – Wilson: No proven benefit using inhaled steroids for virus – excerpts:
After an Odessa doctor said in recent media interviews he believes he’s found the “silver bullet” for treating COVID-19, Midland Memorial’s chief medical officer [Dr. Larry Wilson] disputed that claim, saying there’s no evidence the treatment offers any benefit to coronavirus patients.
There is evidence that some steroids… may be effective in treating severe cases when given orally or intravenously… giving steroids to patients who are not severely ill may do more harm than good, he said.
He said weighing the benefits of steroid treatment with the possibility of suppressing the immune system is a judgment call that should be made only on hospitalized patients.
Odessa Regional Medical Center’s chief medical officer also addressed budesonide treatment in a report from KOSA-TV. Dr. Rohith Saravanan said blind, controlled studies, rather than anecdotal evidence, are needed to prove any effectiveness.
“If they say, ‘Oh, five cases, all solved. Magic pill. Silver bullet’ – well, that’s not how science works,” he said.Midland Reporter Telegram (07/07/2020) – Wilson: No proven benefit using inhaled steroids for virus
Drs. Wilson, Saravanan (Naysayers) Fact Check
Fact Check: Misleading. Summary of Issues:
- Nebulizer, inhaler, oral, IV are all different modes of medicine delivery
- Dr. Wilson comments on late treatment with oral or IV steroids for hospitalized patients
- Dr. Bartlett promotes early treatment with nebulized medicine. This avoids immune suppression and sends medicine directly to the lungs where it is needed
- Dr. Wilson says giving steroids to patients who are not severely ill may do more harm than good
- Pulmonary specialists routinely prescribe nebulizer treatments with anti-inflammatory drugs in flu season to patients with COPD to avoid severe illness
- Dr. Saravan contrasts “double-blind, controlled studies” with “anecdotal evidence” and “five cases”
- Dr. Bartlett and a network of physicians using his protocol have treated hundreds of patients since March with 100% success rate and zero deaths
See also these selected comments from Midland Reporter-Telegram post, two by the same caregiver, one by a nurse, one by a thinking adult. The main points are listed as bullets, followed by the full text of each comment.
Claudia Dickerman‘s Comment #1
- Dr. Bartlett: Recommends nebulizer treatment at first signs
- Dr. Wilson: Says only consider steroids for hospitalized patients (after virus gets a foothold)
- Claudia is an experienced caregiver of seniors with COPD and pulmonary problems
- Doctors routinely prescribe nebulizer treatments with anti-inflammatory drugs in flu season
- They often prescribe antibiotics preventively to avoid secondary complications of Pneumonia
Comment full text: Dr. Bartlett said VERY CLEARLY that the Nebulizer with anti-inflammatory drug treatment needs to be administered at the FIRST SIGNS, IE: chest pain, trouble breathing, fever, etc. NOT waiting until the virus gets a foothold which is what this guy is essentially saying, he says this treatment should only be administered if the person is sick enough to be hospitalized….
I am a caregiver and for years I have taken care of seniors with COPD and other pulmonary problems. FOR YEARS, their specialist has been prescribing Nebulizer treatments with anti-inflammatory drugs AND in the flu season, some even prescribed a course of antibiotics PREVENTIVELY to avoid the secondary complications of Pneumonia.
It is very clear to me that a CURE or a TREATMENT is the enemy of all who are using this COVID agenda for a variety of reasons, and if you are like me, you know what ALL those reasons are.
Jennifer Davis Trulock‘s Comments
- Jennifer is a nurse
- the multiple references to inhaled steroids are misleading
- inhaled and nebulized are not the same
- efficacy of drug depends on how it is administered and how it reaches its destination
- Wilson’s reference to oral and IV steroids suppressing the immune system is true but misleading
- Bartlett recommends nebulizing to avoid immune suppression and meds go directly to lungs
- Bartlett never said the drug decreased the number of infection rates in China, he stated that it decreased the death rates
Comment Full Text: As a nurse who grew up in Midland and currently lives in Houston, I see numerous things taken out of context from Dr. Bartlett’s original words, and just incorrect from a medical standpoint.
First of all, the benefit to seeing the drug work so effectively is to nebulize it, not inhale it. Yet the article, and MMH’s chief medical officer, used the incorrect term over and over. There is a difference in efficacy depending on how you administer the drug and how it reaches its destination.
Secondly, he mentions steroids decreasing the immune system’s ability to fight infections…which is true if you administer it through an IV, which is what most hospitals are doing. Bartlett specifically mentions that this is another reason to nebulize it…so that you don’t have that immune suppression and the meds go directly where they need to be. However, the medical officer seems to have missed that based on his statements.
Lastly, Bartlett never said the drug decreased the number of infection rates in China, he stated that it decreased the death rates. Again, there is a difference that this article has misrepresented.
Claudia Dickerman‘s Comments #2
- Dr. Bartlett’s information is misconstrued
- Claudia has been a caregiver for many years, including for 8-10 older clients, former smokers with COPD, over the span of 10 years
- Every flu season many clients got respiratory flu, were hospitalized, put on ventilators, some had pneumonia complications
- Soon pulmonary specialists PROACTIVELY prescribed Nebulizer machines and anti-inflammatory drugs (steroids)
- When the Pulmonologists took these PROACTIVE steps, clients no longer ended up in the hospital with dangerous illness or complications
Comment Full Text: One, two, three BINGO, just as I expected, it sure did not take very long for yet another Doctor to be “discredited” and the information he gave to be misconstrued. As a caregiver for many years, I had clients who were older, former smokers with COPD damage to their lungs. Every flu season, like clockwork many would get a respiratory flu, and end up hospitalized, some on ventilators, many with various strains of pneumonia complications.
It wasn’t long until the Pulmonary specialists figured out that AS A PREVENTATIVE measure patients experiencing this yearly illness were PROACTIVELY prescribed Nebulizer machines and anti inflammatory drugs (steroids) to use to stave off the possibility of hospitalization, complications of pneumonia and even possible death. I had the same 8-10 clients over a span of ten years, one of which was my own Father, and I know what I am talking about. When the Pulmonologists took these PROACTIVE steps, my clients no longer ended up in the hospital with dangerous illness or complications.
This Plandemic is in my opinion a bioweapon let loose by CHINA knowing it would collapse economies, most specifically the US economy and I believe it was the Communist Regimes way of battling the policies that President Trump was heaping on them, the tariffs and the trade war, etc. I also believe they manufactured this “designer” virus to target specific groups (the old, the sick, the vulnerable) and I believe that the Globalist Cabal worked with CHINA because it is their desire to DEPOPULATE and others things that this virus would bring to their door for them.
I also believe the Communist/Socialist/Progressive/Radical Left parties in the countries who are resisting the globalism agenda saw this as a great way to get things they wanted and we certainly see that with the Dem party in this country. AND if all that is not bad enough, this whole SOCIAL JUSTICE BS over the last month plus was just a “monster” waiting once gain to be released the next time a black man was “murdered” by cops, then we get not only BLM which is not a simple social justice organization but an organization that is funded by the very same Globalists that are involved in the virus agenda.
It is all so crystal clear to me and so many others. It is NOT conspiracy theory, it is WHAT is going on. I cannot understand for the life of me why President Trump has let himself be overridden in all of this…the Republicans are a bunch of lily-livered useless career establishment self aggrandizers and the Democrats are a bunch of Globalist Socialist Communists that are intent on collapsing this Republic. A large sector of voters are a bunch of uninformed apathetic easily terrified spineless people, and what we have left is people who understand all too well what is really happening and I just hope and pray to God Almighty that there are enough of us to vote against this in November. If we don’t win, it is game over. PERIOD
Steve Thomas‘ Comments
- Dr. Wilson claims no evidence inhaled steroid works
- Dr. Bartlett claims he has treated dozens of patients with 100% success since February
Comment Full Text: Dr. Wilson claims that there is no evidence that the inhaled steroid works? Seriously? Dr. Bartlett clearly claimed that he has treated dozens of patients with a 100% success rate since February. How much more evidence do you need?! Just because an official study hasn’t been done doesn’t always mean that there is no evidence. But you can bet that a study never will be done!
14. Naysayer: Midland Reporter-Telegram
More excerpts from the same article:
…Bartlett was interviewed Friday for the YouTube show “America, Can We Talk?”
Those who have shared the interview on Facebook are having it removed for violating the platform’s policies regarding misinformation on coronavirus, according to commenters on the YouTube video.
Bartlett made several claims in the video which are demonstrably false, including that 20 percent of the world’s population is at risk of dying from COVID-19 and that Japan and other countries have low numbers of coronavirus infections because they are using inhaled steroids.
A series of case reports from Japan found patients improved on ciclesonide – a different inhaled steroid – but the reports are considered “very low quality evidence,” according to an article in the European Respiratory Journal, because the treatment was given to only three patients and it’s unknown whether those patients would have improved without intervention.Midland Reporter Telegram (07/07/2020) – Wilson: No proven benefit using inhaled steroids for virus – excerpts:
In light of the EARN IT Act, it’s not surprising Facebook censored Dr. Bartlett’s video. It’s what happens when “Big Brother is watching you.” (As a Christian, this isn’t the end of the world. God is the One who sets up and takes down rulers. My hope is in Him.)
I did not take Dr. Bartlett’s statements to mean “20 percent of the world’s population is at risk of dying from COVID-19.” He said 20 percent of the world’s population are in the at-risk categories.
The Census number of people age 65 and older in the United States on July 1, 2015 revealed “This group accounted for 14.9 percent of the total population.” Plus Nearly 3% of U.S. Adults Have Weakened Immunity (WebMD, 2016). If the at-risk groups totalled around 18% in 2016, 20% total in 2020 sounds reasonable.
It was irresponsible of Dr. Bartlett to credit inhaled steroids with the low numbers of deaths in Taiwan, Japan, and South Korea. But he’s on the front lines, researching possible therapies for efficacy and safety while actually treating patients and referring to other doctors. Does this mistake discredit all the success he’s had with a safe, cheap and apparently effective protocol?
15. Other Naysayers: Cheap Steroid Treatment Naysayers
Science Mag (6/16/2020): A cheap steroid is the first drug shown to reduce death in COVID-19 patients
Researchers announced that dexamethasone, a cheap, widely available corticosteroid, significantly reduced deaths of severely sick COVID-19 patients in a major clinical trial.
Even while acknowledging the breakthrough, naysayers criticized incomplete information. (“More detailed data would help us identify which subset of COVID-19 patients would benefit from steroids,” Bhadelia says). The Recovery team’s response was very similar to what Dr. Bartlett has been saying:
Landray acknowledges the criticism. “I fully understand why scientists want to see the details. I’m a scientist, I want to see the details.” But with thousands of people dying of COVID-19 every day, it was important to get the basic message out first, he says. “There is this tension between having the final details and the final decimal points nailed down, and having what is actually a clear-cut and practical message in the public domain.”
Sen. Bob Hall (R-Edgewood): The Texan reports Republican Senator Asks Abbott to Shift From ‘Repressive’ Coronavirus Strategy, Focus on Medically Vulnerable
17. Contact Dr. Richard Bartlett
How to reach Dr. Bartlett? His sister is a professional publicist: [email protected]
Host Comments (Clay Clark):
- Yesterday the Judicial Watch reported that dozens of scientists of the National Institutes of Health, the US government’s handsomely-funded medical research agency, have been fired over their secret financial ties to Communist China
- Science magazine says Fifty-four scientists have lost their jobs as a result of NIH probe
- Judicial Watch has received 165 pages of records showing that the FDA between 2012 and 2018 entered into eight contracts worth $96,370 to acquire “fresh and never frozen tissue” from aborted fetuses for use in the creation of humanized mice.
This treatment sounds to me like it’s worth discussing with your doctor, and may offer great hope for at-risk individuals.
If I or my loved ones were part of the at-risk population, I’d study this post and Dr. Bartlett’s white paper. Then draft a 1-2 minute pitch for why I’d like my doctor to consider it. I’d probably also mention my personal conviction that I am ultimately responsible for the outcome. I do not expect my doctor to be infallible. Hindsight is always 20/20, and we are crossing unchartered territory.
One of the biggest challenges to getting your doctor’s approval will be overcoming their natural and reasonable fear of lawsuit or disciplinary action if the treatment fails, or causes harm to others due to your carelessness. (Not saying this is the main concern, only that it is a concern because of our blame-obsessed culture).
Better medical care starts with giving your doctor the freedom to practice medicine.
When I was negotiating with my OB for the chance to try a VBAC (after three prior C-sections), I told him this: “I don’t want to be foolhardy. I’d just like the chance to try for a VBAC. I look at this as a team effort, relying on your expertise to redirect if things aren’t going well. But I’m not going to come back and sue you later because something went wonky too fast. There’s no such thing as risk-free childbirth, and I prefer taking on the risks of a trial of labor over the risks of a scheduled C-section.”
Same thing goes here. If it were me, I’d want a chance to try this breathing treatment. (The treatment involves more than only the nebulizer and medicine, so review the white paper!) One of the concerns raised about steroids is that long-term use of them during a previous epidemic (SARS? I don’t remember) caused bad side effects. This treatment is different in 2 ways: it uses a nebulizer (see the comments in response to Dr. Wilson for why this matters), and it’s not for such a long time.
I’m not a doctor, nurse, or pharmacist. Do your own research, and talk to your health advisor about your unique situation.
God bless you! 🙂