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HThere is one statement that is taken for granted: Donald Trump will have the best care available for his Covid-19 diagnosis. In a literal sense, that’s true – you’ll have an attentive medical team 24 hours a day. This is essential for any sick president.
But in medicine there are many caveats about “VIP syndrome” – the special treatment doctors give to the rich, famous, powerful, or politically connected, and how that doesn’t always lead to the best medical outcomes.
“In the case of President Trump … you can see the countertransference,” said Dr. Andrés Martin, a professor of psychiatry at the Yale School of Medicine Center for Child Studies, referring to the feelings a doctor might have. towards a patient. “If I screw up, or if I piss him off, will he treat me like Biden?”
Trump’s medical team will face a veritable minefield as they attempt to form an alliance with the commander-in-chief, a notoriously demanding and publicity-conscious patient who sees the disease as a personal weakness, and diet and exercise con suspicion.
“All doctors are human too,” said Dr. Shoa Clarke, a preventive cardiologist at Stanford University who has written about VIP patients, called “red blanket” patients in some hospitals. “We are influenced by our own prejudices, conscious or subconscious, and we can be influenced by the people we see when we try to take care of them.”
“That certainly applies when it comes to patients who are political,” Clarke added.
Trump announced that he was positive for Covid-19 early Friday morning. He was transferred to Walter Reed National Military Medical Center on the same day, a move that White House physician Dr. Sean Conley later said was “very cautious.”
Sowing confusion, the president’s condition was later described in more serious terms, even as he recorded video and rode in a highly criticized caravan to greet his supporters. The president has already left the hospital to be treated in the White House medical unit, compared to a “mini-emergency care”.
In a video shot moments after his return, Trump addressed the American people as if he had already conquered the disease. “Don’t let it get the better of you,” he said, not wearing a mask, even though it’s almost certainly still contagious. “Don’t be afraid of him, you’re going to get over it, we have the best medical team, we have the best medicine.”
Trump has certainly had the most advanced medicine. He was treated with at least three drugs: an experimental monoclonal antibody to Regeneron, antiviral remdesivir and steroid dexamethasone, which are generally reserved for patients with “severe” Covid-19 or a “life-threatening” condition.
Average Americans will not have access to Regeneron’s antibody cocktail, and certainly not at the dose that Trump took, which was three times greater than what is being studied. Regeneron’s chief science officer, George Yancopoulos, recognized this special treatment.
“If I had to treat a patient, I would give him the high dose,” Yancopoulos said, according to the journal Science. “From a social point of view and the need to treat as many people as possible, I would give the lowest dose.”
Remdesivir has been in short supply for months. It was only available for hospitals to buy from the distributor, rather than the US government, on the same day that Trump is believed to have received his first positive test for Covid-19. Dexamethasone is normally reserved only for seriously ill patients.
All of this special treatment underscores the inequality in America’s medical system: ordinary people have to navigate bureaucratic hurdles and pay exorbitant prices for health care. But the special treatment is not necessarily healthy for the patient to whom it is given either.
“You treat too much or too little, but you rarely treat him like a regular patient,” who is a VIP, Martin said. “Why are you leaving now? Well, they are treating him badly. Why did you get [monoclonal antibody] plasma and steroids? Because they are treating it excessively. It’s certainly not the usual treatment. “
This paradox, that treating privilege can leave the privileged worse off or lead to medical errors, dates back to our history, according to Dr. Walter Weintraub, the revered University of Maryland professor of psychiatry who coined the term. “VIP syndrome” in 1964.
“The well-known cases of King George III of England and King Louis II of Bavaria can clearly demonstrate that the treatment of an influential man can be extremely dangerous for both patient and physician,” he wrote in that seminal article referring to two famous mentally unbalanced European monarchs.
The term has also been referenced after the deaths of many celebrities, from Michael Jackson to Prince to the legendary comedian Joan Rivers. VIP syndrome can cause doctors to be amazed, try to be too thorough or too calm, or hope to please the prominent person.
In an academic article, Martin gave an example of the treatment of the 14-year-old daughter of a prominent person. A thorough joint psychiatric appointment with her parents led to a diagnosis of depression and “psychogenic vomiting.” But before her third appointment with psychiatry, she went to the emergency room. Once there, staff discovered she was positive for cocaine and was pregnant, requiring stabilization.
Research has also supported these anecdotal cases. A 2012 study published in the Journal of the American Medical Association Internal Medicine found, by contrast, higher patient satisfaction was associated with higher drug spending and higher mortality.
Among the American political class, there are also stories of treatments gone wrong. Former first lady Eleanor Roosevelt lost her life to a rare form of tuberculosis, which some argue could have been detected if a more aggressive (and painful) bone marrow biopsy had been performed.
Doctors at the Cleveland Clinic, where the institution’s academic esteem attracts royal and political personalities from around the world, established principles for caring for VIPs. The first is “don’t break the rules” of clinical practice.
“In other words, discontinuing routine practice when caring for a VIP patient can endanger the patient,” the group of doctors wrote. Doctors at the Cleveland Clinic continued: “Usually the VIP is relieved if the doctor explicitly says, ‘I’m going to treat you like any other patient.”
