The Common Cold

I was on my high school debating team back in 1964-65. My partner and I won a fair number of matches but never a UIL title. So it goes. Nonetheless, I think that we both benefited from the discipline and preparation for our matches.

Tonight, as I watched President Biden face off against challenger DJT, I wondered how much of Biden’s enfeebled performance was the result of drugs. No, not performance enhancing drugs (e.g. Modafinil, methylphenidate, or dextroamphetamine) but medications meant to alleviate the symptoms of an acute, upper respiratory illness (URI) – a cold. Such medicines typically include sympathomimetic agents as well as antihistamines.

Let me say that confusion and poor cognitive performance are common side-effects of common cold medicines available to all without a prescription – over the counter (OTC) drugs, as they are known. In older men, such medicines often cause urinary retention (inability to pee) and confusion up to and including frank delirium.

I can say that I have had delirium at least once in my life. I was the senior resident on call and was experiencing a URI that gave me a fever of 104F. I was out of my mind, and incapable of doing anything useful as a doctor. Fortunately, Susan was also on call, and she summoned my Chief Resident to take up my responsibilities. It turns out that my junior resident was the most competent and most accomplished second-year Family Practice resident in his peer group, and he could have easily dealt with the night’s medical demands by himself. This isn’t always the case, and my Chief Resident’s intervention to substitute for me was a welcome blessing.

This brings me back to tonight’s debate. Early in the debate, Biden’s answers to questions became muddled. His responses trailed into incoherence. He was having trouble finding words to complete his sentences. These were signs of confusion, if not delirium, I think.

As the debate wore on, his performance improved somewhat, but it never rose to the level of his State of the Union address performance. My best bet is that he took or was given some simple, OTC preparation for a cold, and it totally undermined his debate performance. Sigh, that sucks.

Biden needs to not make this mistake again – should Trump accept the challenge of a second debate.