Dr. Sanjay Gupta is a neurosurgeon, with positions on the neurosurgery service at Grady Memorial Hospital in Atlanta and on the faculty of Emory Medical School. He seems to be a reasonably well-respected neurosurgeon. Of course, Gupta is also a CNN medical correspondent, where in theory he’s there to provide knowledgeable medical commentary. He seems like a good choice to talk about Trump’s COVID-19 treatment.
So I was pretty surprised when I saw this Mediaite story: CNN’s Dr. Gupta Questions Trump Medications: ‘Steroids in Particular’ are ‘Typically Given to Severely or Critically Ill Patients’.
In the CNN appearance, Gupta said:
What we still don’t know is why these various medications were added, what triggered that. Again, the steroids in particular are a medication typically given to severely or critically ill patients. It has significant side effects. It can change people’s behavior, make them not able to sleep, restless, really hungry. It’s not a medication that you give lightly. Remdesivir is a medication that should only be given in hospitals.
Now, I’m not an MD, but I spent six years at the Duke medical school doing research while in graduate school, and I audited most of the classroom work so I could talk usefully with the principle investigators, who were MDs. Plus, I’ve had some experience with steroids myself, with cortisone injections in my knees, and my ex-wife getting prednisone for severe poison ivy. What Gupta said just didn’t sound right.
To be fair, Gupta is a neurosurgeon, and basically, neurosurgeons don’t see patients who aren’t severely or critically ill. No one calls him for a dermatology consult. So it could have been a slip.
In any case, I looked up dexamethasone in the Physician’s Desk Reference. Dexamethasone is described in the PDR as:
Synthetic long-acting glucocorticoid; used by oral, parenteral, ophthalmic, and topical routes
Used for many conditions in adult and pediatric patients, including cerebral edema, inflammatory systemic arthritis, prevention of transplant rejection, and many allergic, dermatologic, ophthalmic, and systemic inflammatory states
Little to no mineralocorticoid activity; roughly 20 to 30 times more potent than hydrocortisone and 5 to 7 times more potent than prednisone.
No big surprises here: basically all the corticosteroids are analogs of hormones naturally produced in the body, and all of them are used to treat some kind of inflammation.
(They are not similar to the steroids you hear about as performance-enhancing drugs. Those are anabolic steroids, related to testosterone. If you hear someone talking about “‘roid rage,” they’re talking about anabolic steroids.)
Many, many medical conditions include inflammation, so it’s no surprise that anti-inflammation drugs are widely used for everything from tissue rejection to severe hay fever and dandruff. (“Severe allergic rhinitis” and “seborrheic dermatitis.”) Look through the PDR for dexamethasone and see the conditions for which that particular formulation is prescribed. Go ahead, I’ll wait. I’ll get another cup of coffee, it’ll take a little while.
Back? Good. So I was a little surprised to see Gupta assert that it is “typically given to severely or critically ill patients.” How many critically ill cases of hay fever and dandruff does one see?
Then he doubled down in a tweet… or did he?
Lots of questions about dexamethasone (steroid). Yes, some steroids used for lots of things, even minor skin rashes. For Covid-19, however, dexamethasone only recommended for hospitalized patients on ventilators or requiring supplemental oxygen. Not for mild symptoms.
— Dr. Sanjay Gupta (@drsanjaygupta) October 7, 2020
It’s interesting because we’ve quietly gone from “severely or critically ill” to a much narrower statement about COVID-19, saying it’s “recommended for hospitalized patients on ventilators or requiring supplemental oxygen.”
Guess what? Trump got it in the hospital and had received supplemental oxygen. That looks to me to be a walk-back.
So, look, it is CNN. And Gupta’s “science” reporting has been questioned before. But I’ve often said the correct response to hair-on-fire reporting about Trump is to point and laugh.
This is one of those times.