Trump’s visit to Dr. Oz was a disaster.

We Didn’t Learn Much About Trump’s Health From Dr. Oz, but We Learned Plenty About American Health Care

We Didn’t Learn Much About Trump’s Health From Dr. Oz, but We Learned Plenty About American Health Care

Health and medicine explained.
Sept. 15 2016 10:16 PM

Patient Trump in the Land of Oz

We didn’t learn much about Trump’s health Thursday, but we learned plenty about what’s wrong with America’s medical system.

dr oz donald trump.
Donald Trump and Dr. Mehmet Oz on Dr. Oz.

CNN

Dr. Mehmet Oz views himself as “America’s Doctor.” He’s so taken with the idea that he’s trademarked the phrase. As many have pointed out, it’s probably a very good thing Oz is not actually the doctor for all Americans, especially for those who want their care to be based on reliable scientific evidence. So when he invited presidential nominee Donald J. Trump on his daily television program, it seemed to be a match made in charlatan heaven—two men with no use for facts, endorsing each other’s flimflammery in an infomercial. And that’s precisely what it was. But unwittingly, behind its own back, the show also wound up doing something useful, even educational: It demonstrated a number of fundamental problems with how medicine is practiced in America.

There are a couple of important points to hit before we dive into Trump’s made-for-TV health assessment. First, medical records are private, and there is absolutely no reason that Trump has to reveal his full medical history, on television or otherwise. In fact, Oz even agreed that Trump would not be asked about certain topics, although we don’t know which. In a real doctor-patient interaction, this would of course be dangerous. But this wasn’t a real doctor-patient interaction, despite Trump’s best efforts to pass it off as such. (“I view this as, in a way, going to my doctor,” he said. “It’s just a little bit public, that’s all.”) It was a TV show and a political ad, with a little jargon thrown in for the sake of verisimilitude, and on its own terms it was a stupid and useless exercise.

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Medical conversations with a high-profile individuals can actually serve the public good. But Oz whiffed on the opportunity. Trump offered up a sparse letter, labeled as a medical record, though it was really just a summary of other medical records (remember, medical records do not boil down to one document). It contained the results of a number of tests. Unfortunately, many of these tests are unnecessary and relatively meaningless. For example, Trump’s prostate specific antigen levels were reported as within normal parameters. Trump himself said that the PSA is a number he is concerned with: “Give me that number. I want to know,” he said he always tells his doctors. But the United States Preventive Services Task Force—whose entire function is to help us all prevent illness from both under- and overtesting—recommends against PSA testing because it appears to cause as many problems as it solves. It seems that Trump’s doctors, like Oz, know that their patient is the one in charge here. Oz then reported that Trump’s score on his computed tomographic angiogram of the coronary arteries was good. That’s great, but what he didn’t mention is that this test is simply not an appropriate screening for people without heart disease, cardiovascular symptoms, or other worrisome risks. Either Trump is getting plenty of unwarranted medical testing or there’s something he’s not telling us. It’s probably the former, but again, without any of the actual records, there’s no way to know. We’re weighing evidence blind here.

Oz nodded his way through these numbers. He failed to point this out, but what the tests really revealed is that Trump’s medical regime seems to be a classic example of the overuse of resources and testing by the wealthy. Such tests don’t save lives in patients when testing is not recommended, and Trump gave no reason to explain why they would have been. But many celebrities and politicians get them anyway, passing the cost on to the insurance pool (which in part answers the question of why health care costs keep rising but our outcomes stay the same). If others follow Trump’s example—and indeed those of Presidents Barack Obama and George W. Bush, who both also had CT coronary angiograms done—it would increase costs to both individuals and the health care system at large. It could also lead to a good deal more misdiagnoses and unnecessary and often dangerous treatments. Oz’s response to the results? Healthy results! Meanwhile, Trump thinks our spending is out of control. He may be right, but his treatment is not setting a particularly good example.

Prior to this past week, Trump claimed that his medical records would reveal “perfection.” In fact, Oz discovered, he’s overweight (and likely obese, unless you believe that he has grown in height in the past few years). Trump also has elevated cholesterol that was apparently serious enough that it didn’t respond to both diet and exercise changes (which constitute the first line of intervention) and at least two other statins (a kind of lipid-lowering medication) before rosuvastatin (marketed as Crestor) reportedly finally worked for him. (Let’s leave aside the controversy over whether statins are being overprescribed because their benefits have been overplayed.)

Oz also failed to discuss any medication side effects. He did not ask Trump if he experienced any of the several side effects that rosuvastatin may carry. Perhaps this was one of the topics that was vetoed. After all, rosuvastatin has been reported to cause a fishy odor. (If something smells like last week’s mackerel, it might be Donald J. Trump himself.) Other side effects of rosuvastatin include the feminization of the breasts in men, known as gynecomastia, and—I can almost hear the internet’s reaction—a yellowing of the skin. There is even a case report implicating rosuvastatin in short-term memory loss. If true, this could explain reports that Trump can’t seem to remember things that he has said in the past. These are things a real doctor, in a real doctor’s visit, would’ve told his patient.

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One sign of a truly excellent physician is the ability to detect dangerous problems in a patient who otherwise seems healthy. Oz missed a major chance here, too. When Trump mentioned that he never seems to get colds (and that his friends and family have noticed this), Oz let this slip by, but some doctors might have been alarmed by this fact. Sometimes, a lack of immune response is actually a sign of a disease.

For example, before the appearance of powerful antiviral medications, many patients with AIDS lived healthily for swaths of time and then suddenly fell ill and died quickly. They seemed healthy at times, but that was only because their immune systems were not generating the small (but annoying) responses to infections that our body normally should, including cough, aches, and phlegm. In particular, the inability to mount an appropriate fever in a patient with a relatively benign flu-like viral infection could be an extremely ominous sign—of AIDS, of advanced cancers, of a rare autoimmune disease. While Trump is likely not suffering from such a malady, the comment should have raised a red flag for Oz.

There was also Trump’s assertion that sleeping less means, simply, that you love life more. Oz left this claim unrefuted, nodding along. So it was particularly amusing when, during the commercial break a few minutes later, Oz reminded his viewers of the importance of getting enough rest.

As usual, Oz paid special attention to Trump’s weight, as if a patient’s body mass index were somehow interchangeable with life expectancy (it’s usually not). In America, it seems that losing weight is always the default American answer whenever we discuss getting healthy, and there the conversation stops. In fact, not all weight loss is created equal. Trump says he recently lost 30 pounds (and confessed that he wants to lose a few more, something Oz encouraged). Sometimes weight loss is a sign of appropriate changes in exercise and diet. Sometimes it could mean cancer. So if we are to believe reports of Trump’s weight loss, it warrants a discussion as to why. This news might be good, or it might be terrible. Weight without the appropriate context, like many things in medicine, is just a number.

The one thing Oz did do correctly was to conduct a 10-part review of systems. This is the protocol that determines how much money a doctor is reimbursed for his or her work—if at least 10 systems are discussed, Medicaid and Medicare will provide reimbursement at the highest rate. In his interview Oz covered exactly 10 systems—head/neck, cardiovascular, lung, gastrointestinal, endocrine, neurologic, immune, genitourinary, hematologic, and skin—a true model of efficiency.

So although we learned very little about Trump’s health in this interview, at least one thing was confirmed: Oz is a wizard at making money in the medical business. Maybe he is America’s doctor, after all.

Disclaimer: The opinions expressed in this article are solely those of the author and do not reflect the views and opinions of Brigham and Women’s Hospital.

Jeremy Samuel Faust is an emergency medicine physician at Brigham and Women's Hospital in Boston and a clinical instructor at Harvard Medical School. He is the co-host of FOAMcast. Follow him on Twitter.