Published 7 November 2008, doi:10.1136/bmj.a2486
Cite this as: BMJ 2008;337:a2486

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Let us see the medical records of future world leaders

Senator John McCain, when up against George W Bush to be the Republican nominee for the 2000 presidential election, revealed medical records that included details of the trauma resulting from his experiences in the Vietnam war. When it came to demonstrating a similar openness over the extensive surgery he underwent for a malignant melanoma on his face he was much less forthcoming. A press conference for medical journalists held in Arizona in May this year was in fact a video conference with his medical specialists elsewhere, and the distinguished medical journalist of the New York Times, Lawrence Altman, was not even able to ask a question.

Millions of voters, however, never even registered that he had had a melanoma. What concerned them was Senator McCain’s age. At 72 he would have been the oldest person to have been elected president for the first time.

Having just written In Sickness and In Power, a study of illness among prime ministers and presidents over the past century, I have come to three interrelated conclusions: many heads of government do not tell the public the truth about their illnesses, if they say anything at all; their personal doctors, when making public statements about their patient, also do not tell the truth; and, as a result of the secrecy concerning their medical treatment, these heads of government receive inferior treatment.

To take a few recent examples, François Mitterrand, as president of France, had for 11 years, in total secrecy, cancer of the prostate with secondary bone cancer. His personal doctor issued communiqués every six months giving no hint to the French public of Mitterrand’s true medical condition. Ariel Sharon, former prime minister of Israel, had a severe heart condition while in office and pretended to the press that he was fit and well. Prime Minister Blair denied that he had atrial flutter and pretended to the public that he had only recently had problems with his heart, while revealing to his Cabinet colleague David Blunkett that he had had the condition for years.

I do not believe it is in the public interest that this situation be allowed to continue. Everyone who wishes to put themselves forward to the electorate as a potential national leader ought to be compelled by party rules to submit to an independent health examination that doesn’t involve their personal doctors and that is assessed by people of proven independence. This would not run into conflict with any existing legislation protecting the rights of the individual. If potential candidates knew they faced independent assessment and that they had a health problem then either they would not stand or they would make it public of their own volition. For example, John Kennedy, in 1960, believed that he would never be elected president if he admitted he had severe Addison’s disease. Yet there is no reason why someone who has Addison’s disease should not be US president if it is well controlled with replacement therapy.

President Kennedy was a genuine war hero, and if he had been open about his illness for some years before he faced Richard Nixon there was arguably a chance that he could still have been elected. Now, however, nearly 50 years later, there is much greater public understanding of illness and less prejudice, and it would undoubtedly be much easier for candidates with Addison’s disease to convince their party and the public that they were fit for office.

Furthermore, when in office a president or prime minister should be obliged to have a yearly independent medical check up, and although this would not be made public the independent doctor would be obliged to inform the deputy prime minister or vice president if he or she had any concerns about the head of government’s capacity to handle the powers of office.

The medical profession should issue guidance to any doctor treating powerful leaders not to issue public communiqués or to comment on their patient’s medical condition—any such comments should be made by the public figure themselves or by independent doctors.

Finally, democratic countries should establish formal procedures for enabling a head of government to step down temporarily or permanently because of illness that affects their capacity to do the job. In August 1998 the prime minister of Norway, Kjell Magne Bondevik, had a severe depressive reaction. His initial decision was to resign, but he discussed the matter with his foreign minister, and together they announced publicly that he had depression. After four weeks of treatment and adapting his working practices he returned to work. His frankness was greatly respected by the Norwegian people and is widely regarded as contributing to the fight against the stigma that mental illness often carries.

No one has to stand for high public office, and it is not credible to argue that the medical condition of leaders is purely a matter for them. The decisions they take can have a major effect on the lives of millions of people, and it is not acceptable for the quality of their decision making to be impaired by physical or mental illness. They have an obligation to those electing them to be their head of government to ensure that their capacity to govern is maintained at the highest level.

Cite this as: BMJ 2008;337:a2486

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Lord Owen’s In Sickness and In Power: Illness in Heads of Government during the Last 100 Years is published by Methuen (2008).

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