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VIP patients don’t always get the best medical treatment

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The rich and famous enjoy endless advantages in healthcare, but medical professionals’ extreme attentions can come with a price. Some doctors puzzling over US president Donald Trump’s plethora of coronavirus drug treatments suggest he was subject to “VIP syndrome”: when doctors pile on unnecessary and potentially harmful treatments in a bid to follow orders and show they’re taking every possible step.

While being treated for coronavirus, Trump took an experimental antibody treatment from Regeneron, which has only been tested on 275 people and has not yet been authorized for general use, and the steroid dexamethasone, which is used for patients with severe symptoms but carries risks for those with milder cases. Trump also received the antiviral remdesivir; though this drug is authorized as coronavirus treatment, there’s no study on all three drugs used in combination.

“The most likely explanation is that his medical team felt that they should throw the ‘kitchen sink’ at him,” says Joshua Barocas, professor of medicine at Boston University School of Medicine and infectious diseases physician at Boston Medical Center. “We have a tendency to use this approach with VIP patients because it gives the perception that we’re doing everything.”

The drugs Trump took have a relatively low risk profile, says Barocas, but this medical approach can lead to unintended negative consequences. “[Trump’s] VIP status unquestionably got him rapid access to experimental drugs,” says Arthur Caplan, director of NYU Langone’s division of medical ethics. While such exclusive access is undeniably a privilege, the full effects of these drugs are still unknown. “There are risks with unapproved drugs in combination but his doctors seemed willing to push the envelope to save him,” says Caplan.

The term “VIP syndrome” has been used in medical literature since 1964 to describe the poor decisions that doctors can make when treating celebrities. A fear of upsetting star patients can lead deferential doctors to provide too many treatments, or fail to insist on appropriate interventions. Michael Jackson, whose doctor gave him a surgical anesthetic to help him sleep and failed to notice when he stopped breathing, is one prominent example.

Overall, though, the risks of VIP syndrome rarely outweigh the benefits that come from being a patient with status and wealth. Both president Trump and former governor Chris Christie were able to check into hospital as a precaution, whereas most patients in the US have to wait until their symptoms are severe.

Getting treatment early can be a significant advantage in treating coronavirus in particular. “The president and other high-profile politicians likely have access to remdesivir earlier than most patients,” says Barocas. “Earlier intervention with remdesivir is beneficial since it helps to decrease viral replication. Once patients are really sick, remdesivir’s capacity to help is limited.”

And the ability to simply check into hospital as a precaution, and know that you’re being treated by a diligent healthcare team, is a huge benefit afforded to few in the US. “The president has access to a helicopter and can mobilize the military to get him care if he needs it,” says Barocas. “He does not have to wait for treatment. He doesn’t have to wait for oxygen.”

When a reporter asked on Oct. 3 why the decision was made to check the president into Walter Reed Medical Center, his doctor Sean Conley answered, “Because he’s the president of the United States.”

In a country where millions don’t have basic health insurance, Trump’s medical care, paid for by taxpayers, is an overwhelming privilege. “Our healthcare system remains fundamentally unjust and unethical,” says Caplan.

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