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A “silver bullet” for COVID-19?

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Medicine

A “silver bullet” for COVID-19?

A Texas doctor claims he’s found a cure for COVID-19, but the evidence is still out

Several readers have written to inform us about Richard Bartlett, a Texas doctor and onetime congressional candidate who says he has discovered a “silver bullet” for COVID-19. His proposed cure? Inhaled steroids.

This would be world-changing news, probably deserving a Nobel Prize, if true. It would save thousands of lives, end the economic and social upheaval caused by preventive measures, and save billions of dollars on hospital treatments.

As the ancient Spartans famously said: “If.”

I can’t say with certainty Dr. Bartlett hasn’t discovered a cure, for the same reason he shouldn’t imply that he has: What he currently has is a hypothesis, one whose evidence is as yet too limited to conclude that the treatment works at all, much less that it works in most or all COVID-19 patients. We simply don’t know. So how could we find out whether it’s a blockbuster—or a bust?

Back in March, we discussed a statistic called the “number needed to treat” (NNT). The NNT is the number of patients we’d need to treat in order to expect a medicine to have the desired effect in one patient. For a perfect treatment that benefits every patient who receives it, the NNT is 1. For many common prescriptions, though—statins for prevention of a heart attack, for instance—the NNT is more in the range of 20 to 100. You’d need to treat 20 to 100 patients in order to benefit just one. 

Many medical conditions and illnesses go away by themselves. Given the relatively high NNT of many treatments, it’s often hard for researchers to tease out whether a new treatment is improving patient outcomes, or whether those patients would have fared equally well without the treatment.

This timeless source of job security for research statisticians brings us back to Dr. Bartlett and his series of patients. According to CBS7, Bartlett says he’s treated “dozens” of COVID-19 patients and all have survived. 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?

Answers are on the way: Oxford and the Queensland University of Technology are already investigating this idea with their STOIC (Steroids in COVID-19) clinical trial. Queensland University of Technology elaborates on its origins: Two researchers “had noticed early on in the pandemic that people with asthma and the chronic lung disease COPD were under-represented in the numbers of seriously ill COVID-19 patients.” This struck them as unusual, since you’d normally expect patients with sick lungs not to have an advantage against respiratory viruses. That made them wonder whether those patients’ inhaled steroid treatments might be what was helping them.

In light of the recent discovery that another corticosteroid can help in severe cases of COVID-19—but not in less severe disease—I’m very curious to learn what the STOIC trial will reveal. STOIC aims to reach a conclusion by September. 

In the meantime, let’s not—pardon the pun—jump the gun in our search for a silver bullet.

Comments

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  •  Xion's picture
    Xion
    Posted: Sat, 07/11/2020 05:26 pm

    This is good news.  Unfortunately, actual science is so often obscured by politics that we may never know.  It's final success or failure hinges on what Trump says about it.

  • Yokefellow
    Posted: Sun, 07/12/2020 11:28 am

    Thank you,World, for putting this information out there.  Especially, since Facebook has apparently already removed the video.  I went to another site (heavy.com) and found the video.  While I agree with Dr. Horton that the studies need to be done, it is quite clear from what Dr. Bartlett said and what was contained in the article at the website that this form of treatment has almost no risk.  Dr. Bartlett points out that often times studies are done using these forms of treatment on people who are far along in the illness, and then statistics come back that seem to be negative.  They improperly did that with hydroxychloroquine.  We later found out that the studies seemed to have been politicized because of the hatred for President Trump.  When a treatment such as this has such a minimal risk and low cost, it makes common sense to use it more widely.  Also, no mention was made in your article about the apparent use of this treatment inTaiwan, Japan, Singapore and other countries where Covid 19 deaths are very low.  It seems to me that Dr. Horton should have commented on that important information as he discussed this treatment.

  • HANNAH.
    Posted: Mon, 07/13/2020 08:44 pm

    Found two links to the video of Texas doctor Richard Bartlett. The second is better than the first.
    1. On heavy.com, the audio is at breakneck speed that can't be adjusted, but it's understandable if you "listen fast" (she wrote with humor). https://heavy.com/news/2020/07/budesonide-coronavirus-covid-19/
    2. I viewed the full interview (at normal speed) here: 
    https://www.bing.com/videos/search?q=america+can+we+talk+Richard+Bartlett&docid=13821167219277&mid=E7A8F1ABFC11E7EE0DAAE7A8F1ABFC11E7EE0DAA&view=detail&FORM=VIRE

  • DM
    Posted: Mon, 07/13/2020 11:26 am

    Also in the meantime, use Dr. Bartlett's possible cure , just in case.  

  • Sun shine
    Posted: Mon, 07/13/2020 11:56 am

    My question is, how many COVID patients have been prescribed inhaled steroids around the US since March?  They're pretty common in the general treatment of ARDS.  If they haven't been routinely used, why?  

  • MC
    Posted: Mon, 07/13/2020 02:32 pm

    My children used pulmicort for their asthma when they were little, and it helped them avoid bronchitis and pneumonia. It worked really well on croup too when they came down with that. Normally pulmicort is not a rescue medication like Albuterol, but for croup it actually is. Our pediatrician told us to use it for croup. TherewThere several occasions our children woke up with croup and we thought we would have to take them to the ER, but as soon as we gave them the pulmicort, they cleared up and stayed clear for the rest of the night. It makes sense because cold and flu are also corona viruses and have similar symptoms. Croup is often caused by corona viruses too. That is pretty exciting, and I hope more doctors can try the treatment.

  • TM
    Posted: Mon, 07/13/2020 03:15 pm

    Your picture is misleading. Dr. Bartlett said that this treatment for COVID19 is best done with inhaling the steroid through a nebulizer. 

  • Nanamiro
    Posted: Sat, 07/18/2020 11:22 pm

    I wish there were as much skepticism about universal cloth mask wearing! No scientific evidence it works, but if you don't wear one, you must hate your neighbor!

    If a medication looks hopeful, why not a little more enthusiasm? It will likely save way more lives and keep more people out of the hospital than all these silly cloth masks.