Sonnenfeld is a professor of leadership practice. Krumholz is a cardiologist and professor of medicine.
Earlier this week, Donald Trump suggested Joe Biden would use performance-enhancing drugs at the presidential debates and called for drug testing. The claim was widely laughed off as Trumpanda and spawned yet another mess of fact-free conspiracy theories. Still, Trump may have been on to something. The country is struggling to come to terms with Biden's cognitive impairment during the debate and his apparent recovery the night and into the next day.
The most likely reason for the temporary cognitive decline in older people who catch a cold is a side effect of cold medication. If so, we should stop worrying and use this debate not as an indication that the president is chronically debilitated, but as a reminder of how common such reactions are.
Biden has made several high-profile public appearances on the world stage in recent weeks, including commemorating the 80th anniversary of the Normandy landings in Normandy, France, and attending a press conference at the G7 summit in Italy, where he interacted with Americans and world leaders. Journalists who have been close to Biden in recent weeks have reported no such impairments, consistent with the bullish view of Biden's debate preparation team. If Biden had shown even a glimpse of the chutzpah he displayed in the debate, everyone would have noticed.
Throughout the debate, especially in the first half, Biden frequently wandered off on bizarre asides unrelated to the moderator's questions and engaged in barely audible mutterings — a performance that was not just worse than the minor gaffes we've come to expect from Biden, but seemed indicative of a clinical problem.
For example, when answering a question about inflation, he commented, “We finally beat Medicare.”
“I don't even know what he said in that last sentence, and I don't think he knows either,” Trump replied.
Biden stood stunned and open-mouthed during a break while answering a question about abortion, hesitantly delivering a stock line about immigration. This is not the president we've seen for the past three years, or even the past few weeks.
As time passed, the fog lifted. He recovered well during and after the debate, mingling with people well into the night. The next day, he delivered an impassioned speech in North Carolina without a moment's delay. Many of these drugs have short half-lives, which may explain Biden's post-debate resilience.
Biden's symptoms seem to be consistent with those of someone suffering from temporary drug-induced cognitive impairment. We know by now that he had a bad cold during the debate. Most people consider common over-the-counter cold medications like Dayquil, Tylenol, and Advil to be harmless. Though generally well tolerated, these medications have well-known side effects that can cause decreased alertness, impaired attention, poor memory, and slower reaction times, especially in older adults. These impairments are temporary, but can manifest as significant and alarming symptoms. Any experienced clinician has seen this symptom thousands of times. The risk may be even greater if cold medications are used in combination with other medications.
After hearing our thoughts, Marshall Mandelkarn, MD, professor of psychiatry at Yale University, agreed: “As a clinician, when someone presents with 'altered mental status,' I always consider the possibility of drug use as a cause. Not only is this common, it is often the most innocuous explanation for an altered mental status.”
Critics were quick to blame Biden's poor performance on a lay diagnosis of permanent mental decline. But if the performance was due to side effects from drugs, it would be premature to call for Biden's resignation. The remedy would be for the president to avoid using these drugs and for the nation's seniors to use this experience as a lesson. Age may be an issue, but perhaps it's just susceptibility to the effects of drugs that is the issue.
While Biden's post-debate Waffle House coffee was excellent, we think the reason his condition continues to improve is likely because the cold medicine he took is starting to wear off. Trump has misled the American public on many things, but he may have been inadvertently right about the role drugs played in Biden's debate performance.
We need to know if President Biden took cold medicine before the debate. His doctors need to evaluate what role it played. How the American public views the debate depends on the answer. It would be a tragedy if the implications of a poorly timed medication's side effects were exaggerated to the point that it could change the course of history.
Jeffrey Sonnenfeld, DBA, MBA, of the Yale School of Management, is the Lester Crown Professor of Leadership Practice and director of the Yale Institute for Chief Executive Leadership. Harlan Krumholz, MD, SM, of the Yale School of Medicine, is the Harold H. Hines, Jr. Professor of Medicine, a cardiologist, and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation. He is a member of the MedPage Today Editorial Board and Editor-in-Chief of the Journal of the American College of Cardiology.
This article originally appeared in Newsweek.
