It’s become common to see news articles insisting that Donald Trump is getting “the best care in the world,” or as Dr. Sean Conley said during the first press event at Walter Reed Medical Center, “beyond state of the art care.” That Trump might be getting treatments unavailable to most people may be frustrating, but it also seems … obvious. After all, the whole reason that wealthy people constantly insist that America has the “best healthcare system in the world” is that America has a healthcare system that gives the wealthy what they want. The New York Times has estimated that the treatment Trump has received so far would cost the average American over $100,000, and much of it is simply unavailable to them.
But that doesn’t mean that wealthy and famous people get the best health care. It means they get what they want in health care, even if what they want is entirely not what they need. After all, the number of celebrities who have died from prescription drugs provided by their personal physicians is absolutely legion. Personal physicians stay personal physicians by pleasing the boss, not by being the best doctors on the planet—and that may be just as true inside the Trump White House as it is in any celebrity compound.
Because it looks a whole lot like Conley is a “Doctor Feelgood” who has provided Trump with a kitchen-sink approach that may be covering up his symptoms at the cost of his health.
Conley became Trump’s physician after being at the White House for only a year on the recommendation of previous White House physician Ronny Jackson. Jackson was famously the doctor who inflated Trump’s height and underreported Trump’s weight so that he could avoid being technically obese in medical records. More recently, Jackson took on CNN for reporting about events on a trip that happened a year after Jackson left the White House. Jackson repeatedly made the same kind of claims that Conley has taken up since—proclaiming Trump the healthiest man alive. Just so, so good … he also happens to have lost his position at the White House amid an ongoing investigation by the Navy.
Among the accusations against Jackson is that he was known as “Candyman” because he was willing to freely hand out prescription drugs to White House staff. And it was on Jackson’s recommendation that Conley got the nod to be Trump’s new physician.
Which makes it worth looking closely at the treatment Trump is receiving. And … Warning: I’m not a doctor. I’m not a health specialist. So do not treat this as more than just an interested amateur who reads a lot of journals. Please do not override the recommendations of your own doctor based on any statement I make. Thanks.
Trump got antibody treatment far too early
Regeneron monoclonal antibody “cocktail”—Regeneron’s treatment is a mixture of two different monoclonal antibodies that are designed to increase the body’s own response against COVID-19. At the Saturday conference at Walter Reed, Dr. Brian Garibaldi said that Trump had been treated with the Regeneron therapy "about 48 hours ago.” Which means that Trump was given his first treatment of the cocktail well before his diagnosis was admitted to the public. But there’s an issue with this right off the bat. Regeneron’s own statements indicate that the results of phase 1/2a trials show that the "greatest treatment benefit was in patients who had not mounted their own effective immune response.” All patients in the study entered their trials already being confirmed as being COVID-19 positive and already several days into treatment.
But Donald Trump was given a “compassionate use” authorization for his COVID-19 at what we’ve been told was the very outset of his disease course, well before his body could have mounted a response on its own. Those other patients who have received this authorization were given the treatment well into the course of their infection when it became obvious that their bodies were not mounting a significant defense.
Considering that one of the largest issues with patients dying or suffering severe effects from COVID-19 has been an overly strong response by the immune system resulting in a “cytokine storm,” it’s difficult to see how treating Trump with these antibodies at the beginning of his illness could be considered either safe or effective, especially since this was not a situation examined in Regeneron’s trials.
Trump should not be taking Remdesivir outside of a hospital
Trump was immediately placed on a five-day course of the antiviral drug Remdesivir. There are at least two reasons to be concerned about this: First, this therapy is generally reserved for patients who are exhibiting a more severe reaction to COVID-19. News that Trump’s oxygen levels twice dropped into the 80s, and that he was given oxygen, might have justified this. However, Remdesivir is available under an emergency use authorization from the FDA that specifies in-hospital treatment.
Trump should have been hospitalized at least through Tuesday evening just to finish the course of Remdesivir … if, of course, that treatment began when the public was told.
Trump should not be getting the steroid dexamethasone
Both Remdesivir and the anti-inflammatory steroid dexamethasone have contributed to the decreasing rate of death among patients hospitalized with COVID-19. But both of them are suitable only for specific cases. The commonly available steroid became part of the COVID-19 standard of care following a study in The New England Journal of Medicine. That study did show an increase in survival rate, but only “among those who were receiving either invasive mechanical ventilation or oxygen alone.” Dexamethasone provided no improvement for patients who were not receiving respiratory care.
In short: If Trump is not getting oxygen, he should not be getting dexamethasone. There is not only no benefit from the drug, there are a huge number of potential side effects. Even leaving aside the normal threat that steroids can represent, a study in the Journal of Hospital Medicine specifically found that use of steroids with patients who did not need oxygen or intubation had negative effects.
There may have been reason to administer a dose of dexamethasone to Trump in association with the oxygen treatment that he received, especially if doctors thought that he would require continuing oxygen or intubation. But there appears to be no reason this treatment should have continued when oxygen treatment was suspended. As The Washington Post points out, dexamethasone can cause blood clots, blurred vision, insomnia, mood swings, and “frank psychotic manifestations.” The side effects of steroids like dexamethasone can also be feelings of empowerment and invulnerability, even though the patient’s actual condition is declining.
All of this makes it seem that Conley is not giving Trump “the best” treatment, he’s just giving him all the treatments. Though the mix, very noticeably, does not include hydroxychloroquine, even though Conley approved of Trump taking this drug earlier. It’s worth revisiting what Trump said about his interaction with Conley at the time:
Trump: “I asked him ‘what do you think?’ He said ‘Well, if you’d like it.’ I said ‘Yeah, I’d like it. I’d like to take it.’”
That appears to be exactly the kind of medical advice Conley is giving Trump now. Trump is getting what he wants, not what he needs.
One other note: The extraordinary spate of even more disturbing than usual tweets from Trump have been widely connected to the administration of steroids and their well-known side effects. Which raises a question: When did Trump start getting steroids?
Conley danced around the issue of Trump’s oxygen use when speaking with the press, deliberately misleading the public over Trump’s condition. He later admitted that he was trying to be “upbeat” rather than providing a truthful response. He has continued to refuse to give a date on which Trump had his last negative test for COVID-19, suggesting—strongly—that Conley is collaborating in an effort to cover up when Trump was first diagnosed.
Consider this evidence that Trump knew he had been exposed by Monday, Sept. 28: First, here’s a picture of Donald Trump and Mike Pence on Sept. 25, one day before the Rose Garden event at which Amy Coney Barrett was officially introduced to a largely mask-free crowd of Republican supporters.
The following tweet shows Pence and Trump just three days later on Monday, Sept. 28. Rather than being side by side, Pence is at a separate podium, well away from Trump. This kind of arrangement had been used in some previous COVID-19 announcements, but had not been employed for several weeks before making a reappearance on that day. And it was not just Pence. Everyone spoke at a separate podium from Trump.
It seems clear that by that day, Trump knew he had been exposed. He may have even tested positive. The following day, Trump went to the debate against Joe Biden, where he notably did not take a COVID-19 test because he “arrived too late.”
Considering Trump’s behavior on the debate stage, had Conley already provided him with steroids to cover up his COVID-19 symptoms at the time of the debate? White House staff talking about Trump’s illness repeatedly mentioned “lethargy.” Trump also made a point of making noises about a “drug test” before the debate, but definitely did not actually take such a test himself.
All of which makes it entirely possible that Trump was given dexamethasone, or some other steroid, before the debate—which would go some ways toward explaining his train wreck of a performance.