Monday 21 August 2017

Donald's your man - a look at Trump the patient

After his inaugural promise to free the Earth from the misery of disease, Maurice Gueret examines Trump the patient

US President Donald Trump . Photo: Stefan Rousseau/PA Wire
US President Donald Trump . Photo: Stefan Rousseau/PA Wire
Dr Maurice Gueret

The Trump era is up and running. Our American friends have a new sheriff, and he is going to take a bit of getting used to.

One line in The Donald's inauguration address stuck out for me. It wasn't the riot of American carnage. It was when he spoke about standing at the birth of a new millennium, getting ready to unlock the mysteries of space and free the Earth from the miseries of disease. It didn't ring true. Donald isn't the sort of man you'd want standing at the birth of anything. Any good midwife would spot this from a long distance, and have the tycoon President dispatched up the nearest golden elevator to wash his germophobe hands for a few hours.

Every doctor has a patient or two like Donald Trump. They are good payers, but less good at listening. Brash bulldogs in the waiting room. Thin-skinned pussycats on the couch. Not the sort of men you'd pick to unlock the mysteries of space. Even less to free the Earth from the miseries of disease. Unless it's male pattern baldness. Then, Donald's your man.

It was interesting that President Trump's personal physician waited until after the election to tell the world his healthiest patient was taking prostate medication to help his hair grow.

The medicine finasteride has a fascinating history. Back in the 1970s, a female endocrinologist from Cornell University visited a remote mountainside in the Dominican Republic to do research on a group of girls who were turning into boys at puberty. The children shared a genetic mutation that interfered with the way their bodies handled testosterone.

Though they grew into men, their prostate glands stayed small and their hairlines never receded.

Work began to develop a drug that mimicked these twin effects of this genetic mutation. Finasteride, also known as Propecia or Proscar, was the result. A quick look through the Trump family photo album will tell you that the men had little front cover.

The hairlines of Donald's grandfather, father and father's brother all went north quite early on. We don't know exactly how long Trump has been taking a low dose of this medicine, but it has been on the market for 20 years.

Professional coiffeurs suspect that the President may have had a bad cosmetic result from an early skin-flap operation to correct baldness. They believe that his current oddball hairstyle is an attempt to cover it up. Thankfully, hair restoration surgery has greatly improved since the 1980s when Trump may have had a bad job. Healthy follicles are now transplanted one by one rather than re-sewing huge flaps of hairy skin towards a receding hairline.

* I once knew an elderly man who ran small supermarkets. They weren't in very posh places, but he did well and put in very long hours. He worked long past an age when others might have retired. He was also an exceptionally kind man. If a lady in the neighbourhood became widowed, he would immediately drop in a large hamper of food. It was his quiet and unheralded way of helping out customers in hard times. He wasn't the sort to boast. It was only the widows and children who knew.

A big UK supermarket man died this month. Sir Ken Morrison took over his father's shop after the war and, from it, developed the biggest chain of stores in the north of England. Sir Ken was notoriously sceptical about modern business trends. When asked to hire management consultants, he wasn't impressed. He said plainly that if you don't know your own business, then it was time to give up.

We could do with a few old supermarket brains like this in the health service.

* Remember that phrase that was well worn by Fine Gael whenever an election was brewing. "Money will follow the patient," they said. Well, they have had their chance since 2011. They mightn't have had as much money as they hoped, considering that their predecessors frittered it all away, but three health ministers later, and money certainly does not follow patients.

It follows scandals, just as it always did. The bigger the mess, the more they pour in. Money follows the daily news. It follows Prime Time on RTE. We have a new theatre promised for Crumlin hospital one day after hideous scoliosis waiting times are revealed. After the maternity scandal in Louth, the number of obstetricians there was increased from two to nine.

But maternity units around the rest of the country were left as bereft and short on expertise as ever. Their scandals haven't made it to the telly. Ireland has the most poorly funded primary-care service in the civilised world. Its many scandals aren't as juicy or newsworthy as hospital ones. I despair at times of political promises. We deserve better in this age.

* Cartoons can form the basis of important research. There is one where a woman is asked by a doctor to identify her late husband by lifting the cover sheet in the mortuary. "That's him, all right," she says. "What washing powder do you use to get the sheet so white?"

If you laughed at that one, you are more likely to be intelligent. Researchers at a medical school in Vienna - a city not noted for comedy - have found that people who enjoy black humour or sick jokes tend to be cleverer, less grumpy and less aggressive.

I'd like to bring you more of the 12 cartoons from the study, but you'll have to do the research yourself. The samples used were those of the much celebrated Uli Stein. If you have schoolboy German vocabulary and an advanced sense of humour, you can google his work and conduct the research on yourself.

Dr Maurice Gueret is editor of the 'Irish Medical Directory'

drmauricegueret.com

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