That Steroid Euphoria

Before the sun came up here, in the far west, the doctor back east, a retired internist and occasional proofreader here, left this comment on what might be happening with President Trump:

When the president spoke of feeling incredibly well after receiving steroid therapy, saying “I feel better than I did 20 years ago!” I chalked that up to the dexamethasone talking, and his “steroid euphoria.” Many people get hyped-up on these meds, and some even become overtly manic and psychotic. Steroids can really mess up your mind.

I’m also concerned about his steroid treatment at this time, because I have a hunch that Trump hasn’t taken them before, unlike JFK, who had been on cortisone for years to treat his Addison’s. So who knows how Trump’s mind will function while on these drugs? I took a peek at his twitter feed this morning, and it freaked me out (more than usual). All caps, one after another and another. Nuts!

Internists are specialists in differential diagnoses. Their job is to figure out what’s going on, or more precisely, what’s gone wrong. Steroids can be a problem. Roid Rage has sidetracked the career of any number of professional athletes. They just wanted to bulk up. They ended up in jail. They became a little too overtly manic and psychotic. Coaches want that special player with that “killer instinct” – but not an actual killer.

Trump isn’t there yet, but he seems to be becoming overtly manic. The Washington Post’s Erica Werner and Jeff Stein report this:

Economic relief talks screeched to a halt Tuesday as President Trump ordered Treasury Secretary Steven Mnuchin to stop negotiating with House Speaker Nancy Pelosi until after the election.

In a series of tweets less than 24 hours after he was released from a hospital, Trump accused Pelosi (D-Calif.) of failing to negotiate in good faith, after she rejected an opening bid from Mnuchin in their latest round of talks.

“I have instructed my representatives to stop negotiating until after the election when, immediately after I win, we will pass a major Stimulus Bill that focuses on hardworking Americans and Small Business,” Trump wrote.

But no one gets any help anywhere with anything before the election – not one damned penny – which seems an odd way to try to win this election, particularly since Trump stands alone here:

Trump’s surprising announcement stood in stark contrast with recommendations from Federal Reserve Chair Jerome H. Powell, who had said in a speech hours earlier that more economic stimulus was needed to sustain the recovery.

Trump’s tweets sent the stock market lower, as many businesses, households and investors had been hoping for a jolt of fiscal stimulus amid signs the economy had lost momentum.

Powell was clear, do nothing and the economy crashes, perhaps for good. The Dow dropped six hundred points. The guys on Wall Street knew that too, but Trump was defiant, or this was the dexamethasone talking:

Trump’s pronouncement came after days of sustained if long-shot negotiations between Pelosi and Mnuchin. Pelosi later speculated to Democratic colleagues on a conference call that the president’s sudden change in position might be connected to the steroids he’s taking as he battles Covid-19.

“Believe me, there are people who thought, who think that steroids have an impact on your thinking,” she told Democrats, according to a person on the call, who spoke on the condition of anonymity to discuss the private comments. “So, I don’t know.”

But everyone knows that Donald Trump has a short attention span. The economy might collapse? He was thinking of judges:

The White House’s focus now appears to have shifted from the economic talks to solely pushing for the Supreme Court confirmation. Even though several Republican senators have tested positive for the novel coronavirus, McConnell is moving forward swiftly with Barrett’s nomination, trying to get her confirmed before the election.

Still, Trump’s move disappointed some members of his party who were hoping to be able to deliver new relief to their constituents.

Does he want them to lose their elections too? No one knows. This did seem to be manic euphoria:

The economy showed signs of a partial recovery in May and June, but businesses and households have struggled as the virus continues to infect thousands of Americans each day. Trump has sought to play up the economy’s recovery, often touting partial or incomplete information. That continued Tuesday, when he misstated the health of the U.S. economy during his string of tweets.

“Our Economy is doing very well,” he wrote. “The Stock Market is at record levels. JOBS and unemployment also coming back in record numbers.”

Even some of Trump’s top advisers have said that the economy is not doing well and that more assistance is needed. Further, the stock market is not at record levels, and it also doesn’t reflect the broader health of the economy. The unemployment rate has come down from its April peak of about 15 percent, but it is still at 7.9 percent, and millions are struggling to pay their bills, afford food and find jobs. The United States has recovered barely half of the jobs lost in March and April.

Ah, but that’s what he said:

Three days ago, during his first day in the hospital, he tweeted, “OUR GREAT USA WANTS & NEEDS STIMULUS. WORK TOGETHER AND GET IT DONE. Thank you!”

And then after he announced Tuesday that the talks were off and that the economy was great, he wrote another Twitter post in the evening that suggested he actually supported the idea of more spending.

And then he didn’t support that at all:

The Trump tweets landed while House Democrats were in the middle of a conference call. Pelosi had been updating them on the status of her talks with Mnuchin. She had been telling them that they remained divided on issues including state and local funding and coronavirus testing.

A few minutes after Trump tweeted that the talks were over, Pelosi told lawmakers on the call what the president had said, made her comment about a potential link with steroids and then quickly got off the call, according to people listening in.

“Clearly, the White House is in complete disarray,” Pelosi said in a statement shortly afterward.

Because of the White House’s move, she said, “over time, household insolvencies and business bankruptcies will rise, harming the productive capacity of the economy and holding back wage growth.”

She was a bit exasperated, being one of those in the real world:

The airline industry last week began furloughing more than 30,000 employees because government aid expired, and some surveys have found that as many as 40 percent of restaurants will close within six months without additional aid. Tens of millions of Americans who have lost their jobs will receive no federal unemployment supplement absent an additional package from Congress, draining the U.S. consumer market and a key source of stimulus. Personal incomes already dropped in August as the spring relief expired.

Powell issued a dire warning Tuesday about the potential consequences of Congress and the White House failing to pass an additional stimulus deal. “Too little support would lead to a weak recovery, creating unnecessary hardship for households and businesses,” Powell said.

Pelosi last week urged airlines to hold off on layoffs, saying an airline payroll support program would be extended either as part of an overall deal or a stand-alone bill.

Now that won’t happen. Trump had turned to oddball outsiders:

Despite the push from some within the White House and lawmakers from both parties, conservatives had urged Trump to reject a new spending package.

Art Laffer, a supply-side economist generally regarded as outside the economic mainstream, said he visited the White House about a week ago and expressed the view that Trump should not approve a stimulus package. Stephen Moore, another outside economic adviser, has told White House officials that a stimulus package would do little to boost Trump’s political fortunes because it would not show results until after the election.

Do nothing now. That’s odd political advice, and Jonathan Chait sees this:

It is possible Trump – who just yesterday declared his desire to cut a deal – intends this as one of his “clever” negotiating ploys, enabling him to turn around and make a deal that he can paint as a capitulation by his panicked foes. But even if that happens, the window to boost the economy in time to help him (obviously the only consideration Trump cares about) is closing fast. Walking away from the extended hand of an opposition party willing to pump trillions of dollars into the economy may go down as the single greatest political blunder in the history of presidential elections.

But it won’t be a surprise:

Trump has frequently followed his party’s anti-government wing to politically disastrous outcomes. Trump spent most of his first year trying to pass a wildly unpopular partisan repeal of Obamacare, rather than attempting some kind of bipartisan patch-up bill he could rebrand as Trumpcare. He then passed an unpopular tax cut for wealthy heirs and business owners. He abandoned his populist promises to raise his own taxes, crack down on Wall Street, and rebuild infrastructure. All these failures forfeited his crucial 2016 appeal to economic populist swing voters who saw him as more moderate than typical Republicans.

Why did he allow himself to be led by the nose into self-defeating positions? Obviously, Trump knows very little about public policy. He does have some grasp of self-interest though, and has frequently expressed his correct view that it lies in casting aside anti-government dogma and borrowing as much money as he could.

But that’s not the case here. Captain Ahab had his white whale. Trump has Obama and now has all the Democrats:

Trump’s hatred and distrust of Democrats drove him to instinctive opposition. Trump thinks entirely in zero-sum terms, and habitually accuses anybody not working on his behalf of being motivated by a desire to defeat him. Once House Democrats passed an economic relief bill, just months after impeaching him, Trump probably assumed the bill could only hurt him. Or, at least, the fact Democrats passed it so willingly made it easier for right-wing ideologues to convince him that the bill would hurt him.

And now he’ll lose the election:

Trump’s zero-sum mindset is one reason he is awful at making deals. If he has indeed walked away from the House’s offer, he has turned down what may have been his last, best chance to win reelection. Presidents have made worse policy choices before. But it is hard to think of a president who has ever made a purely political decision so predictably disastrous.

No, wait, he changed his mind again:

President Donald Trump reversed course Tuesday night and urged Congress to approve a series of coronavirus relief measures that he would sign, including a new round of $1,200 stimulus checks for Americans.

Earlier in the day, he had halted talks between top Democrats and Republicans until “after I win” the election, which appeared to have killed the chances of a new package. Both moves by the president, who was released Monday from the hospital where he was being treated for Covid-19, were made on Twitter.

“If I am sent a Stand Alone Bill for Stimulus Checks ($1,200), they will go out to our great people IMMEDIATELY. I am ready to sign right now. Are you listening Nancy?” Trump tweeted Tuesday night.

Why would she be listening? That might be the dexamethasone talking again:

He said in another tweet that he would approve funding for specific struggling industries, such as airlines and small businesses, which is short of what House Democrats proposed.

“The House & Senate should IMMEDIATELY Approve 25 Billion Dollars for Airline Payroll Support, & 135 Billion Dollars for Paycheck Protection Program for Small Business. Both of these will be fully paid for with unused funds from the Cares Act. Have this money. I will sign now!” Trump said.

Would he? He’s all over the place:

President Trump’s tweet Tuesday that he looks forward to next week’s presidential debate alarmed some medical and public health experts, who warned that his coronavirus infection might still be contagious then and could endanger others.

A day after the president was discharged from a three-night hospital stay, during which he was put on an aggressive mix of treatments usually reserved for the most severe cases of covid-19, the disease caused by the novel coronavirus, he continued to project an image of being fully in charge and able to conduct all of his regular activities.

Some outside health experts, however, said Trump’s determination to attend the Oct. 15 debate is part of a pattern of recklessness that has defined his response to the pandemic, with the president and his aides not wearing masks or observing social distancing. At least 19 people on his staff or his campaign, or who attended recent White House events, have tested positive for the virus in the past week.

These medical and public health experts are worried:

Several outside medical experts suggested that the president’s actions indicate he is unchastened by his own experience contracting a virus that has killed more than 210,000 Americans – or by the spreading infections among his own staff and supporters.

Trump’s removal of his mask moments after returning to the White House on Monday evening, and his subsequent assertion that he would appear at the debate “is irresponsible and reckless, and frankly that borders on malicious,” said Michael Mina, a physician and assistant professor of epidemiology at Harvard’s T. H. Chan School of Public Health.

It seems that our doctor back east was right:

President Trump’s team of physicians revealed Sunday that he was being treated with dexamethasone, and health experts immediately voiced concern. The powerful steroid has shown promise for treating patients with severe covid-19 who are getting supplemental oxygen, as Trump was, but may cause harm for those with minor infections.

The use of dexamethasone, experts say, contrasts with White House physician Sean Conley’s rosy assessments of Trump’s battle with the virus. Typically used to treat inflammation, dexamethasone was credited with improving the survival for critically ill coronavirus patients in a study published in the New England Journal of Medicine.

Here it may have been a bad choice:

Dexamethasone can have concerning side effects, ranging from blood clots, blurred vision, and headaches to “psychic derangements,” such as insomnia, mood swings and “frank psychotic manifestations,” according to the drug label.

Doctors know what to expect with dexamethasone because the drug itself is not new. The steroid, which is used to treat asthma, Crohn’s disease, IBS and some cancers, is 60 years old and ubiquitous.

And the side effects are well known:

Another well-known therapeutic effect of the drug is a sensation of euphoria. But the relief a patient may feel should not be confused with physical improvement, said Peter B. Bach, the director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center.

Before departing Walter Reed on Monday, Trump boasted on Twitter that he felt better than he did two decades ago.

“Feeling really good! Don’t be afraid of Covid. Don’t let it dominate your life,” he wrote after his brief hospitalization for the disease that has killed more than 210,000 Americans.

Patients who are prescribed a steroid like dexamethasone can over-exaggerate how well they feel, Bach told the Washington Post. But he advises patients who take the steroid not to be deceived by the reprieve and overexert themselves.

“Having taken this myself, for a herniated disc, I felt like a million bucks,” Bach said, “but actually I was barely able to move.”

He was barely able to move? That might describe the situation at the White House. The New York Times’ Maggie Haberman and Annie Karni report this:

The White House that President Trump woke up in on Tuesday morning was in full-blown chaos, even by the standards of the havoc of the Trump era.

Aides said the president’s voice was stronger after his return from the hospital Monday night, but at times he still sounded as if he was trying to catch air. The West Wing was mostly empty, cleared of advisers who were out sick with the coronavirus themselves or told to work from home rather than in the capital’s most famous virus hot spot. Staff members in the White House residence were in full personal protective equipment, including yellow gowns, surgical masks and disposable protective eye covers.

Yes, the worst had happened:

Four more White House officials tested positive, including Stephen Miller, a top adviser to Mr. Trump, bringing to 14 the number of people carrying the virus at the White House or in the president’s close circle.

Mr. Trump, diagnosed with Covid-19 last week, was still livid at his chief of staff, Mark Meadows, whose effort on Saturday to tamp down the rosy portrait of Mr. Trump’s condition given to reporters by his chief doctor was caught on camera. Other officials were angry with Mr. Meadows for not even trying to control the president.

This was chaos:

Some aides tried to project confidence – “We feel comfortable working here, those of us who are still here,” Alyssa Farah, the White House communications director, said in an interview on Fox News – but many saw the situation as spiraling out of control. The pandemic that Mr. Trump had treated cavalierly for months seemed to have locked its grip on the White House. West Wing aides, shaken by polls showing the president badly trailing Joseph R. Biden Jr., worried that they were living through the final days of the Trump administration.

The disarray was at the same time spreading across Washington. Almost the entire Joint Chiefs of Staff, including its chairman, Gen. Mark A. Milley, went into quarantine on Tuesday after coming in contact with Adm. Charles W. Ray, the vice commandant of the Coast Guard, who tested positive for the coronavirus. Late in the day, the stock market took a dive when Mr. Trump abruptly called off talks for a congressional coronavirus relief bill after the Fed chair, Jerome H. Powell, said such a stimulus was badly needed.

And now everyone was thinking the same thing:

Some White House staff members wondered whether Mr. Trump’s behavior was spurred by a cocktail of drugs he has been taking to treat the coronavirus, including dexamethasone, a steroid that can cause mood swings and can give a false level of energy and a sense of euphoria.

But it didn’t matter:

On Monday night, some of the staff members still at the White House had gathered to watch Mr. Trump’s return. When he defiantly took off his mask on the Truman Balcony for a made-for-television moment, aides said it was of course a statement. But they also wondered if the face covering was making it harder for the president to breathe.

Either way, some of them shrugged off the message it was sending to tens of millions of Americans about taking the coronavirus seriously.

The sentiment, according to one aide to Mr. Trump, was that “it’s his house.”

But that’s our house too. These are psychic derangements with mood swings and frank psychotic manifestations, as listed on the warning label. This guy may need some real time off, before he kills us all.

About Alan

The editor is a former systems manager for a large California-based HMO, and a former senior systems manager for Northrop, Hughes-Raytheon, Computer Sciences Corporation, Perot Systems and other such organizations. One position was managing the financial and payroll systems for a large hospital chain. And somewhere in there was a two-year stint in Canada running the systems shop at a General Motors locomotive factory - in London, Ontario. That explains Canadian matters scattered through these pages. Otherwise, think large-scale HR, payroll, financial and manufacturing systems. A résumé is available if you wish. The editor has a graduate degree in Eighteenth-Century British Literature from Duke University where he was a National Woodrow Wilson Fellow, and taught English and music in upstate New York in the seventies, and then in the early eighties moved to California and left teaching. The editor currently resides in Hollywood California, a block north of the Sunset Strip.
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