THINK LIKE AN EPIDEMIOLOGIST: evaluating the President’s treatment regimen.

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I’ve had lots of requests to speak about the medical treatments Trump is receiving, what it means that he’s getting them, and what we should expect clinically.

These are the wrong questions to ask an epidemiologist. Why?

Because epidemiology is about POPULATION health not INDIVIDUAL health.

I can talk to you about probabilities—how frequently do these drugs work or not under experimental conditions, or how common it is for someone like the President to recover or die.

Importantly, epidemiologists rely on data about SIMILAR people to make predictions and inference. This is one reason we push for representation in randomized trials.

But who is similar enough to the President of the United States? Probably no one.

Epidemiological answers are population answers. They don’t tell you about Trump specifically. They tell you about OTHER people.

If you want to know about Trump, you need to talk to medical doctors.

That said, there are important things about Trump’s treatment regimen that I’ve been seeing medical doctors get wrong.

Trump’s medical team gave him Regeneron’s antibody cocktail.

This is prompting questions about whether the drug is a breakthrough, & how soon it can be rolled out to the public. Many doctors are calling it “promising”.

This misunderstands what happened here.

This drug is EXPERIMENTAL. We do NOT know if it works. We do not know if it has HARMFUL side effects. The randomized controlled trial is happening now, but Trump was given it as a special exception.

Many people are viewing this as a step forward for this drug, but actually it’s a step BACK, and will make it HARDER for us to learn if the drug works or not.

This makes it less likely you would be able to get it, even if it does work.

Having the president take this unproven drug brings it a ton of publicity.

If he recovers, the public will think the drug works; if he does not, they will think the drug does not work. WE CANNOT LEARN THIS FROM ONE PATIENT!

When people have strong beliefs about an experimental drug, they don’t want to join a randomized trial. Why would they risk being assigned to placebo if they believe the drug works? Why would they risk being assigned to the drug if they believe it is harmful?

Since the trial is currently on-going, this means that having a high-profile person taking an experimental drug will potentially lead to the trial failing to enroll enough participants. And if it doesn’t enroll enough participants, then we cannot find out if the drug works.

So, what’s my epidemiology take on Trump’s drug regimen?

His doctors are trying experimental treatments that have not been proven safe or effective. Doing so may or may not end up helping HIM, but it could very well hurt US.

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