Do we know enough about presidential health?

In this Dec. 17, 2001 file photo, dark spots are visible on President Bush's cheeks and temple after it was disclose that the president had four lesions removed from his face, including two that are pre-cancerous but not a threat to the president's health. Woodrow Wilson's secret stroke. Grover Cleveland's secret cancer surgery. Franklin D. Roosevelt's secretly worsening heart disease at the world-changing Yalta Conference. Notice a lot of secrets?

19 May 2008

By LAURAN NEERGAARD

Woodrow Wilson's secret stroke. Grover Cleveland's secret cancer surgery. Franklin D. Roosevelt's secretly worsening heart disease at the world-changing Yalta Conference.

Notice a lot of secrets?

While the public knows far more today about the health of its presidents and presidential candidates than ever before, do we know enough? And does knowing about an illness even matter, by affecting how people vote?

They're questions that will gain more prominence Friday as one presidential candidate — Republican John McCain — performs the election-year ritual of releasing medical records to demonstrate he's healthy enough for office.

Last week at a meeting of the American College of Physicians, a high-profile panel of doctors suggested it's time to replace that ritual with a health exam for presidents and presidential hopefuls that mimics the regular fit-for-flight physicals required of pilots — one done by a team of independent physicians instead of the leader's own.

"Obviously this is a proposition that's a little bit contentious," acknowledged Dr. Leslie Pyenson, the CIA's one-time chief of medical and psychological analysis.

But one reason: The job of doctor to the president has an inherent conflict of interest, said Dr. E. Connie Mariano, who was President Clinton's White House physician.

"If you keep your patient in office, you can keep your job," she noted. "What happens when your patient can't do his job?"

There's a name for what sometimes happens when world leaders become ill: The captive-king syndrome, where aides deny a problem and run the country, said medical historian Dr. T. Jock Murray, a Canadian neurologist. Think Wilson's final stroke, which left his wife and a few others essentially in charge.

Perhaps more common today is what Mariano calls VIP syndrome. Whether they're politicians or celebrities or business bigwigs, VIPs feel entitled to expedited care; arrive with a "posse" of aides to be dealt with; and tend to disregard medical advice because "they think they know better," said Mariano, who cautions pushy patients at her VIP health clinic in Arizona.

Because they're "very intimidating patients," Mariano said only half jokingly, doctors can find themselves second-guessing if someone really needs, say, a rectal exam or other inconvenient test that every other patient would get because it could turn up important information.

As for noncompliant patients, Bill Clinton was among the healthiest presidents in recent history — yet needed open-heart surgery after leaving office to avoid a major heart attack, admitting he'd quit taking his cholesterol-lowering medicine.

The 25th Amendment — sparked by the Kennedy assassination and ratified in 1967 — spells out what happens if a president dies or is disabled and clearly unable to lead. There's a backup team, so pay attention to potential vice presidents' health, too, Mariano advised.

That amendment isn't just for worst-case scenarios but for temporary illness, too. Yet until recently it had been invoked only once: When President Reagan had colon surgery and briefly turned over power to his vice president. His staff hadn't brought up the option a few years earlier when Reagan was shot, shades of Murray's captive-king.

A Working Group on Presidential Disability in the late 1990s recommended making that temporary transfer of power routine instead of a big deal — and Murray praised President Bush for doing so twice, when he was sedated for a 2002 colonoscopy and again last year when he had colon polyps removed.

Conversely, Bush's doctors revealed his treatment for early-stage Lyme disease a year after he'd undergone it.

No one says a president's doctor has to volunteer information, Murray said, just that they're advised to tell the truth when they do talk.

But what most worried last week's physician panel are harder-to-prove impairments, such as problems with brain function or judgment. What if a leader shows subtle signs of Alzheimer's disease, psychiatric illness, or cognitive problems due to, say, heart disease? What if the doctors and politicians disagree — how should White House doctors balance the First Patient's right to privacy with their duty to the country?

"The president is a citizen like anyone else and therefore has a right to privacy," Murray stressed. "They're not interested in you knowing any chink in their armor."

Illness has changed history. Stalin rose to power due to Lenin's stroke, for example. Historians debate the impact of Winston Churchill's drinking and use of sedatives during World War II.

Indeed, when Pyenson led a CIA study of world leaders' health, he found that on average six a year suffer an assassination attempt, one successful — while two a year suffer a heart attack and one or two more are diagnosed with cancer.

As for presidents, it's hard to imagine one today having jaw surgery for cancer on a boat to keep it secret, as Cleveland did. But consider how doctors denied the extent of Roosevelt's illness even while recording whopping blood pressures of 260/150.

Similarly, Mariano pointed to Paul Tsongas, who in 1992 sought the Democratic presidential nomination as a cancer survivor. Although he campaigned saying he'd been cancer-free since a 1986 bone-marrow transplant — and had some doctors vouch for him — it was later disclosed that he'd actually had another tumor. Then shortly after the 1992 election, his lymphoma returned; he died five years later from treatment complications.

So when candidates release medical information, "they'll submit pieces of history to you," Mariano said. Not necessarily the whole story.