President Donald Trump, staring down a double-digit polling deficit with less than three weeks before Election Day, has resorted to trying to make one of his vintage conspiracy theories a hit in syndication: the idea that former Vice President Joe Biden is in a steep stage of cognitive decline and is only kept lucid by a mysterious cocktail of prescription drugs.
“We can’t have a leader that’s just about half-shot. Can we believe we’re even fighting against this guy?” Trump told supporters at a rally in North Carolina on Thursday. “This is crazy. This is the craziest race. You know what? I’m running against the worst candidate in the history of presidential politics… I wish he was good, I wish he was good.”
Even Trump’s former doctor is adding fuel to the unproven bonfire.
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“As a citizen of this country, I watch Joe Biden on the campaign trail and I am… convinced that he does not have the mental capacity, the cognitive ability to serve as our commander-in-chief and head of state,” former White House physician turned Republican congressional candidate Dr. Ronny Jackson told reporters in a call organized by the Trump campaign on Tuesday. “I really think that he needs some type of cognitive testing before he takes over the reins as our commander in chief, if that is in the cards.”
Trump and those close to him have baselessly trafficked in those claims about Biden for more than a month, with the president telling reporters during a White House press briefing at the end of September that reporters looking for proof that “people say he was on performance-enhancing drugs” should “check out the internet.” Following Trump’s hospitalization to treat his infection with the coronavirus, however, some are raising questions about whether the president’s own current pharmaceutical cocktail is intended to keep him artificially amped.
“He’s hopped up full of steroids and other performance enhancers,” one former White House official told New York magazine last week, adding that the president is “on more drugs than a Belgian racing pigeon.”
But physicians told The Daily Beast that while dexamethasone, the corticosteroid Trump was prescribed during his hospitalization, can occasionally give patients increased energy and a sense of invincibility, it’s the opposite of a performance-enhancing drug.
“It wouldn’t be advantageous—it would be disadvantageous,” said Dr. Edward Shorter, a professor of psychiatry and the history of medicine at the University of Toronto. While dexamethasone and other corticosteroids do have psychiatric effects, Shorter said, “they’re sort of negative effects—they induce illness, rather than increasing performance.”
“With a short course, it is unlikely that psychiatric side effects of the drug would afterwards long persist,” said John Sotos, a transplantation cardiologist, flight surgeon in the Air National Guard, and presidential health enthusiast. “For some illnesses it can be very hard to tease out whether a person's mental state is due to the underlying disease or due to the steroid treatment for the disease, and for this patient there is the additional consideration that his baseline mental state is, in the view of many physicians, pathological.”
While the White House declined to say what medications the president may still be taking following his treatment for COVID-19, Sotos said that it’s unlikely that Trump would still be taking dexamethasone.
“I do not think it likely that he would be kept on a steroid for more than two weeks, because A) we are told he is doing well, and B) two weeks is the point at which secondary effects occur in the adrenal glands that greatly complicate the continued use of a steroid,” Sotos said. “The ‘likely’ estimation is far from a certainty, however: physicians will continue the drug as long as they think the benefit outweighs the risks.”
Shorter and other physicians told The Daily Beast that public conflation of dexamethasone with some sort of generic “uppers” has been a media failing, particularly in light of the manifest falseness of the allegations Trump has leveled at Biden.
“I have no faith in President Trump’s claims about Mr. Biden, given the documentation of his 20,000 or so lies told while in his present position,” said Lorrin M. Koran, professor emeritus of psychiatry and psychopharmacology at Stanford Medical School. “The press has not done a good job of fact-checking the president and quickly making known the falsehood of many of his statements.”
Suppositions about both candidates’ health, physicians and medical experts said, are clearly filling a vacuum left by the White House medical team’s refusal to share information about the president’s condition, and the increased speculation about Biden’s health coming from the Trump campaign and its allies.
“The Trump/Jackson claims about Biden’s cognition are so obviously false and baseless, even using those claims as a take-off to discuss politicizing health strikes me as a disservice to the public because it can’t help but lend some credence,” said Sotos.
As for conspiracy-laden statements from Jackson—who later clarified that although he was making serious claims about Biden’s health, he “literally had nothing to do with his medical care at the White House”—doctors expressed serious frustrations.
“I would simply note that he has always been excessive in his praise of Trump’s physical and mental prowess, saying for example early on in Trump’s presidency that he is ‘fit’ to serve two complete terms, and has ‘great genes’ that could help him live to be 200 years old,” said George Annas, who chairs department of health law, bioethics and human rights at the Boston University School of Public Health.
“They’ve got a couple of physicians on board who are deeply politicized and have bought into their line completely,” said Shorter, who called Jackson’s comments about Biden’s cognition “ridiculous.”
“Previous White House physicians have been… distinguished figures, very very circumspect,” Shorter added. “But we have these physicians who’ve just been spouting off all the time because they’ve been co-opted by the president.”
As for Biden being on some sort of debating steroids for the first debate, Shorter archly suggested that if anybody was using medicinal assistance that night, it was Trump—using “some kind of performance-diminishing drug.”
