Presidential candidates shouldn’t have health secrets

By F D Flam

The presidential debate last week revealed an embarrassing fact about the American political system: We are all low-information voters. No matter how diligently any of us might keep up with the news, we don’t have access to basic data on the physical, cognitive and mental health of the people we’re electing to lead us.

That could change if all presidential candidates were required to undergo an exam by an independent panel of physicians and reveal the results to voters.

Biden’s confused, sometimes incoherent performance last week unleashed a flurry of speculation on social and mainstream media. Aides, associates and foreign leaders who’ve had close contact told reporters that alarming lapses had become more frequent over the last two years — and that on recent trips to Europe there were moments of “sharpness … mixed with occasional blank-stared confusion.”

Some doctors (and donors) speculated over whether an undisclosed medical condition could have caused Biden’s poor performance. Others attributed his performance to simple exhaustion or to his lifelong struggle with stuttering. Without any requirement for medical transparency, voters don’t know what to believe.

This is hardly the first time questions have arisen about an elected official’s physical or mental fitness. During and after Donald Trump’s first presidential run, experts raised doubts about his health, noting his obesity, bad diet and instances of slurred speech. Neurologists said his vocabulary was degenerating, and speculated about cognitive decline.

Going back further, experts have contended that Ronald Reagan’s Alzheimer’s disease had started affecting his speech and perhaps his judgment during his second term, long before the public was informed of his diagnosis in 1994. Franklin Delano Roosevelt carefully disguised his permanent disabilities from polio and Woodrow Wilson hid a major stroke. The public was in the dark about Lyndon B. Johnson’s episodes of severe depression, which were chronicled in the diaries of his wife, Lady Bird Johnson. John F. Kennedy didn’t disclose that he had an adrenal gland disorder known as Addison’s Disease.

For all presidential candidates, disclosing key health information should be mandatory. Health is more important than age — many people function just fine well into their 80s and beyond and relative youth is no guarantee of health. (FDR died in office at just 63.)

In 1994, former President Jimmy Carter assembled a working group on presidential disabilities, said Arthur Caplan, who is head of bioethics at New York University. Carter’s group proposed that a non-partisan panel could carry out medical evaluations.

“The key variable you’re looking for is an independent assessment,” said Caplan. The evaluations could be done by a panel appointed by the National Academy of Medicine and Science, he said, or perhaps some other group seen as non-partisan.

Personal physicians tend to hold back anything a president or candidate doesn’t want disclosed, Caplan said. Consider the unconventional note Trump shared in 2016, allegedly from a doctor, claiming he “will be the healthiest individual ever elected to the presidency,” with lab results that were “astonishingly excellent.”

Any private company would hold their chief executive to a higher standard. Caplan points out that Fortune 500 companies will demand health data on potential CEOs, usually requiring an independent executive physical rather than just a note from a personal physician.

We should have the same for presidential candidates. Nothing in these independent checkups would necessarily disqualify a candidate — voters would be free to decide what did and didn’t matter.

Because so many medical tests give probabilities rather than certainties, interpreting the results for voters would take some judgment and skill. New blood tests for a protein called p-Tau 217 can pick up early signs of the abnormal proteins that characterize Alzheimer’s Disease, but people can potentially test positive and stay healthy for 10 or more years — plenty of time to complete two terms. Genetic tests can predict who has a high probability of developing all kinds of diseases, from dementia to cancer, but again, a person with no existing symptoms might do fine for at least eight years. Voters would have to weigh this type of information the same way they balance a candidate’s financial disclosures, personal history and policy positions.

The flurry of post-debate medical speculation was followed by a flurry of objections to all the armchair diagnoses, reminding us that only a proper medical exam could reveal what’s wrong with the president. But speculation inevitably follows an information vacuum. Until our policies change, we have no power to make our leaders get the appropriate tests, or to make anyone tell us the results.