Thanks for pointing out your context. I have a better perspective of the question.

As for the delusions of grandeur bit, you have a point I had not thought of. However, a hallmark or narcissism is in my understanding a delusion of grandeur. How else would you explain their behaviours then? I might be wrong here, but doesn't narcissism fall under the larger umbrella of personality disorders? I don't know for sure, but I have the idea that personality disorders are in fact treated with medications. Could it be then that all those narcissists you refer to are not in treatment because, well, they think themselves too high and mighty to have a problem? How many narcissists are self-aware enough to realise their behaviour is a problem. How many narcissists would accept the fact they have one and allow themselves then to be treated?