Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of about 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting them on Wednesdays to coincide with the schedule of his old BMJ column. We hope you enjoy them.

The only important politician whom I have ever treated was the vice-president of a small country who complained of having difficulty in reading state papers after lunch. I advised him not to take three or four beers with his repast, as was his habit, and the problem was solved. Whether the country benefited from this radical cure, I cannot say. Superficially, at any rate, things went on much as they had before.

The diseases of the powerful are a perpetually interesting subject, combining as they do the pleasures of historical understanding with those of prurience. In 1969 and 1980, Dr Hugh L’Etang, editor of The Practitioner, published two books on the subject, titled The Pathology of Leadership and Fit to Lead? respectively. The point at which the search for power itself becomes pathological is inherently uncertain; but no doubt every senior hospital doctor will have his own opinion or experience of the matter.

In 2008, David Owen, a doctor and practising politician, published a book, In Sickness and in Power, in which he proposed a new syndrome, the Hubris Syndrome. No doubt he had seen it close up: a man or woman in power for so long that he or she loses contact with reality and any sense of personal fallibility. A medical case is graphically described in The Dismissal: The Last Days of Ferdinand Sauerbruch, Surgeon by Jűrgen Thorwald. Sauerbruch, a brilliant but arrogant surgeon, began to dement and did not realise his own powers were declining; persisted in operating, though he started to kill patients. He did this with the complaisance of the authorities because, after the war, the East Germans were pleased, for reasons of propaganda, that he continued to work in Berlin; Thorwald’s book contains one of the most chilling epigraphs imaginable, quoting Dr Josef Naas, the Administrative Director of the East German Academy of Sciences:

In the coming struggle of the proletariat, in the clash between socialism and capitalism, millions will lose their lives. In the face of this fact it is a trivial matter whether Sauerbruch kills a few dozen people on his operating table. We need the name of Sauerbruch.

Recently I read a book about the illnesses of the Presidents of the Fifth Republic of France, The Last Taboo: Revelations about the Health of the Presidents by two journalists, Denis Demonpion and Laurent Léger. It seems that being president is not very good for the health, and perhaps not even very good for the health care the presidents receive. For example, when Sarkozy fainted while jogging, an argument broke out about how to transport him to hospital. Someone was of the opinion that, as he was President, the least they could do was take him by helicopter, even if ambulance was quicker. Importance has its drawbacks as well as its prerogatives.

Mitterand, who survived practically his entire presidency of 14 years with secondaries from prostate cancer (latterly unable to fulfil many of his duties) resorted to quacks, though he never abjured orthodox medicine. As usual, alternative medicine was additional rather than truly alternative.

In de Gaulle’s day, the medical establishment surrounding the president was much more modest: a couple of inexperienced housemen constantly on call for him. At one point, however, de Gaulle travelled everywhere with a portable ventilator. Some curare had gone missing from a hospital, and the security service feared an assassination attempt with curare-tipped arrows. How glad I am not to be powerful!