Health, vigor, sickness and age: transparency & the presidency
Posted October 9, 2016
With two candidates of highly advanced age — Trump would be the oldest president elected, and Clinton would be the second oldest after Reagan — mainstream observers, including the New York Times, have pushed both candidates to be more forthcoming about their medical records. Clinton’s history of falls, including two that caused serious injuries, in 2009 and 2013, have drawn particular concern.
Hillary Clinton’s health scare at the New York 9/11 Memorial heightened concerns over her health that had percolated till then. She was forced to leave that event early, and appeared to freeze outside the waiting limousine as security personnel lifted her bodily into the vehicle. Her campaign later announced that she had, two days earlier, been diagnosed with pneumonia. Three days later her doctor released a letter detailing her condition and her ongoing medical treatments.
Neither candidate has been especially forthcoming on their health. In August, Trump's doctor released a hyperbolic letter short on specifics that claimed he “will be the healthiest individual ever elected to the presidency.” In September, Trump went on the Dr. Oz television show to release details, including, CNN noted, "a litany of commonly ordered preventative medicine labs" and all of them "with a normal number." The only abnormality was his weight, an obese 236 pounds on his 6-foot 2-inch frame.
There is of course, nothing new about presidents and presidential candidates being cagey about their health. Below is a quick overview of noteworthy presidential health crises. One consistent thread is that the more vulnerable a president is, the more attention the voters and the president should pay to choosing and preparing the vice president, something that is, in fact, rarely done.
Date: Operation on July 1, 1893
What: Mouth cancer
In the midst of the Panic of 1893, which would plunge the nation into deep economic depression for the next five years, Cleveland, 57 at the time, discovered he had mouth cancer. This was particularly frightening at the time because former President Ulysses S. Grant had died of the same malady just eight years earlier. To avoid further unsettling the markets, he kept the operation tightly secret. The surgeons operated through the mouth, leaving his moustache intact. A newspaper account based on leaks from one of the doctors was fiercely denied and the reporter discredited. Twenty-three years later, one of the surgeons published an account validating the story.
The President is a Sick Man, by Matthew Algeo
“A Yacht, A Mustache: How A President Hid His Tumor,” NPR Morning Edition, July 6, 2011.
Date: October 2, 1919
Prior to his election in 1912, Wilson had suffered a series of minor strokes. But the most infamous occurred on October 2, 1919, just after his strenuous coast-to-coast campaign to pressure the Senate to ratify the Treaty of Versailles and join the League of Nations. Wilson promptly disappeared from the scene. In March, the Senate rejected the treaty and the League. For the last 18 months of his tenure, Wilson was hidden from public view and his wife ran the Presidency. His stroke would remain a secret until after his death. Constitutional questions about his wife’s role would linger until 1967, when the 25th Amendment would finally provide a means to remove a disabled president. Wilson’s closest advisors and his wife both loathed Vice President Thomas Marshall, and took active steps to isolate him during the crises and its long aftermath.
What: Congestive heart failure
A heavy smoker, sedentary for most of his adult life due to polio paralysis, and suffering from severe hypertension, FDR entered the critical final months of WWII a virtual invalid due to rapidly declining health. In March of 1944, he was diagnosed with congestive heart failure. Any concerns over his health during the campaign had been dismissed with humor and red herrings. "Fatigue, chronic bronchitis, episodes of influenza, colitis, and intentional weight loss were all invoked as explanations for his deterioration," Dr. Hugh Evan, a professor at the New Jersey Medical School writes. His actual condition was carefully hidden from the public and, often, even from the patient. FDR's inner circle remained in denial to such an extent that his new vice president, Harry Truman, was given no warning and was not brought in to key government briefings. Truman became president after 83 days as VP, and was only then briefed on the Manhattan Project and asked to decide whether to use the atomic bomb on Japan.
1944: FDR and the Year that Changed History, by Jay Winik
The Hidden Campaign: FDR's Health and the 1944 Election, by Dr. Hugh Evan
Truman is Briefed on the Manhattan Project, History.com, April 24 On This Day in History
Date: Summer 1955
What: Heart attack
In the summer of 1955, as the country geared up for the 1956 election, President Dwight Eisenhower had a heart attack while golfing in Colorado. For 12 hours, the White House rebuffed inquiries by pointing to indigestion caused by a hamburger with onions. The White House went into overdrive, offering information in detail down to the president’s daily bowel movements. Nine months later, with the 1956 campaign underway, he went under the knife to remove a bowel obstruction related to his newly diagnosed Crohn’s disease. Less than a year into his second term, he suffered a mild stroke, which resulted in temporary speech problems. Not long after, he sent a private letter to Vice President Richard Nixon asking him to be prepared to assume the powers of president if Eisenhower were incapacitated. In fact, Nixon had already been filling that role during intermittent absences, in close consultation with the Cabinet and the National Security Council.
Learn more: The Presidents: The Transformation of the American Presidency from Theodore Roosevelt to Barack Obama, by Stephen Graubard
What: Addison’s Disease and other serious chronic illnesses
Kennedy’s outward image was one of health and, in his favorite word, “vigor.” He was often pictured sailing, playing football and, sometimes, leaping out of a limousine. But all of his adult life, Kennedy suffered Addison's Disease, a potentially life threatening autoimmune failure of the adrenal gland that leads to insufficient production of key hormones, including those necessary for handling stress. Rudimentary hormone treatments became available in the 1940s. Kennedy also suffered from persistent colitis, which he treated with steroids. At that time, medical science was still ignorant of the deleterious effects of sustained steroid use. JFK's chronic back problems, which led to surgeries and pain killers, were probably caused by steroids. In addition to painkillers, one of Kennedy’s tools for managing his back was his ever-present rocking chair.
What: History of depression
Senator Thomas Eagleton (D-MO) was selected by George McGovern as his vice presidential nominee with very little vetting. A long shot to win, McGovern had already asked and been denied by his preferred options. Eagleton had a history of depression that had, in the medically primitive 1960s, at one point been treated with electroshock therapy. He and his wife decided to downplay this when talking to McGovern.
After the convention, rumors began swirling and Eagleton was forced to address them. "On three occasions in my life, I have voluntarily gone into hospitals as a result of nervous exhaustion and fatigue," Eagleton told reporters. "As a younger man, I must say that I drove myself too far, and I pushed myself terribly, terribly hard, long hours, day and night."
Learn more: “Thomas Eagleton Affair Haunts Candidates Today,” NPR, April 4, 2012.
What: Advanced age
As the oldest candidate to be elected president, at 69, Reagan had to reassure the public about his mental and physical strength, as well as his general temperament. He did the latter by moderating his tone and using disarming humor. He accomplished the former by dying his hair black and demonstrating youthfulness with horse riding and cutting brush with a chainsaw on his California ranch. In retrospect, the most interesting health moment in the campaign came when Dr. Lawrence Altman, the New York Times Medical writer, interviewed Reagan. Altman asked about his mother’s dementia, and Reagan reassured him that he would resign if doctor’s ever found him unfit for office. Reagan would later die of Alzheimer’s but it was not diagnosed until years after he left office. Based on his research at the time and extensive subsequent interviews, Altman has vigorously disputed any notion that dementia played a role in Reagan’s hands off White House management style, particularly in his second term.
Learn more: “When Alzheimer’s Waited Outside the Oval Office,” by Lawrence K. Altman, New York Times.
What: Rumors of mental health instability
The Story: Rumors that former Massachusetts Governor Michael Dukakis had been treated for mental illness began circulating on the fringe during the 1988 campaign, most notably in the writings of conspiracy theorist Lyndon Larouche. Outgoing President Ronald Reagan mainstreamed those rumors though: when asked about them he replied, “I’m not going to pick on an invalid.” Reagan quickly apologized, but Dukakis was now on defense. After more than a week of confusion and slippage in the polls, he released extensive medical records with a statement from his long-time physician. Those records showed a man in excellent health, but Dukakis to this day thinks his collapse in the polls came because he hesitated in confronting the rumors.
“Dukakis Releases Medical Details To Stop Rumors on Mental Health,” New York Times, August 3, 1988
Paul Tsongas ran for president in 1992 after having been treated for non-Hodgkin's lymphoma, a cancer that strikes the lymph nodes and can move very quickly. Tsongas had been treated five years earlier and had been clean for five years. That remission, he argued, was sufficient to prove he was cured. He wasn’t. By December of that year, the cancer had metastasized elsewhere in his body and within three years he was dead. The incident heightened widespread concerns that the health of presidential candidates should be an open book.
Picture of Paul Tsongas during 1992 presidential campaign.
Who: John McCain
What: Age & melanoma
John McCain was 72 while running for president in 2008, eliciting concerns about his age and health. McCain’s age and health elicited more intense concerns given serious questions about the capacity and temperament of his VP nominee, Sarah Palin.
Under pressure, McCain released 1,173 pages of his medical records, but he limited the pool of reporters viewing them, only allowed 3 hours, and did not allow any copies to be made. Before McCain's limited release, the New York Times slammed McCain in an editorial, noting his advanced age and his operation for melanoma. After the limited release, some 2,768 doctors, led by prominent physicians at major research institutions, bought a full-page ad in the New York Times citing his age and melanoma and calling on him to release his full medical records. The Times editorial board has remained consistent 8 years later. When Hillary Clinton was rushed from the 9/11 memorial service, going rigid on the curb before she was lifted awkwardly into the waiting vehicle by the Secret Service, the Times called for voluntary and thorough release of the health records of both candidates.