Observations Yankee Doodling

What do we need to know about the presidential candidates’ health?

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5393 (Published 05 October 2016) Cite this as: BMJ 2016;355:i5393
  1. Douglas Kamerow, senior scholar, Robert Graham Center for policy studies in primary care, professor of family medicine at Georgetown University, and associate editor, The BMJ
  1. dkamerow{at}aafp.org

Standardized information may not really help

In the circus that is the 2016 US presidential election campaign, one of the newest sideshows has been the issue of the health of the candidates.

Hillary Clinton, now 68, began her campaign in 2015 by releasing a conventional report from her doctor describing recent examinations and her overall physical fitness to serve as president. This was updated in the past few weeks to include a discussion of Clinton’s widely publicized case of pneumonia and a recent sinus and ear infection.1 These became especially relevant because of Donald Trump’s continuing insistence that Clinton does not have the “stamina” to be president.

Trump, 70, at first refused to release his own medical records, instead publicizing a rather strange letter from his doctor stating that Trump would be “the healthiest individual ever elected to the presidency.”2 Then he selected the television doctor Mehmet Oz, hardly a bastion of medical accuracy,3 to perform a televised review of systems and an off the cuff evaluation of a set of laboratory test values that Trump supplied.4 Weird.

We can laugh at these shenanigans, but that obscures a serious question: how much should the public know about the health of candidates for president? Would it matter if we had standardized health information about all the candidates?

History supplies some cautionary tales of public lack of knowledge about presidential health. Woodrow Wilson was in poor health even before he had an incapacitating stroke in 1919, after which he went into seclusion for the rest of his last term. His deteriorating health was hidden from the public. John F Kennedy is now known to have had undisclosed adrenal insufficiency and was taking literally dozens of drugs, some appropriate medications, others stimulants and vitamins, during his presidency. Other recent presidents have had major medical events—myocardial infarctions, colon cancer surgery—while serving in office. Could any of these problems have been prevented by better disclosure while they were candidates?

I am not sure they could have. Certainly today’s constant glare of press attention would make hiding a sitting president’s diagnosis, treatment, or disability virtually impossible. Also, the 25th amendment to the Constitution, ratified in 1967, provides a clear path for removing a president who is incapacitated, even if he or she does not agree.

But what purpose, other than vague reassurance, would a “clean bill of health” in a candidate provide us? What level of blood pressure or cholesterol or blood urea nitrogen would be acceptable—or disqualifying—for a candidate? Some have suggested that a blue ribbon commission be named to define what health information the candidates should disclose and then perhaps also serve as interpreters of these data to the public.5

This sounds like a good idea at first, but I’m not sure it would accomplish anything. We’re not very good at predicting the future health of individuals. Most of our data are adequate for populations, but is there really an important difference between a 3% and a 5% risk of a heart attack in a person over the next five years? Can’t we just leave it to the candidates to supply whatever health details they consider appropriate to the public and judge them on that?

I think Trump’s unconventional, reality television method of revealing his health status was very much of a piece with the rest of his inappropriate candidacy: poorly prepared, offensively focused on him, insulting to the intelligence of viewers, and ultimately inadequate and unsatisfying.

What more do I need to know about his fitness for office?

Footnotes

References

View Abstract