Consumer Directed Healthcare

Some argue an independent panel should gauge presidents and presidential candidates’ health
By Allison Van Dusen for Forbes.com

American presidents generally don’t like to talk about their health problems. Few people knew, for instance, that during their presidencies, Woodrow Wilson had suffered a massive stroke that left him partially paralyzed or that John F. Kennedy was taking as many as eight medications a day to deal with extensive back pain, digestive problems and the hormonal disorder known as Addison’s disease.

As the 2008 presidential race heats up, two University of Michigan medical historians argue in the June 4 issue of the Journal of the American Medical Association that given the poor track record of past presidents to share medical details and the already strong interest in the health histories of nominees Sens. John McCain and Barack Obama, Congress should appoint an impartial panel to evaluate presidents and presidential candidates’ health.

We asked one of the authors, Dr. Howard Markel, director of the Center for the History of Medicine at the University of Michigan, to explain the concept and who it will really help.

Howard Markel:  If you’re healthy, nothing. If there’s something slightly there, you don’t want to give your opponent or opponent’s spinner any kind of leeway to knock you down. With the era of the permanent campaign, instant communication and the 24-7 news cycle, no one wants to give out information that might hurt [his or her] chance to win an election. We have found out that anything can and will be used against them.

Should a president’s or presidential candidate’s health be of concern to the public?

Absolutely. The president is the most powerful person on the planet. Their mental, physical health and well-being, really does effect the global market, war, peace, political legislation–all sorts of things with the stroke of a pen. The caveat is that you really can’t predict based on a medical evaluation today what’s going to happen a year from now. You could be cleared as completely healthy and a year later have a debilitating heart attack. But it’s important for people to know. We make decisions based on where people go to worship, their income, where they went to college. From my perspective, as a physician and historian of medicine, this is a big piece of data we want to know.

Why do you think there currently isn’t a method to assure impartial, candid health evaluations for future presidents and presidential candidates?

It’s all about control. It’s only gotten worse with each successive campaign cycle. You have to control the information getting out that might hurt you, even information you don’t think would hurt you. Sen. [Barack] Obama smoked cigarettes. There’s no evidence he has lung cancer or heart disease. But in this era, smoking cigarettes is looked down upon much more negatively than when FDR was running for president and had a cigarette in his mouth.

Explain the method you propose.

Once somebody is president, he needs to be examined on a regular basis, annually or more frequently. We want nominees to be examined too. And it’s critical that they’re not examined by their own physicians. If I’m physician to the president I’m probably going to like that job. There’s a conflict of, do I do something that will get the president upset enough to fire me?

An independent panel would be appointed by Congress with all sorts of doctors, dermatologists, neurologists and cardiologists, so that [everything] is covered, but also other experts, such as lawyers and ethicists, to help in terms of publication of such a report. They would be independent umpires who don’t have a dog in the race.

It’s also critical that nominees and presidents are evaluated because the 25th amendment of the U.S. Constitution … is vague in how it defines disability. How it’s defined today compared to 1967, when the amendment was ratified, has changed markedly. We need clear definitions.

At the annual checkup, nominees could voluntarily say there are categories they want to opt out of disclosing. They may have a genetic screening and carry a trait … that they don’t want reported. They may say they want to talk about that with their children, but it has no bearing on their ability to govern.

What do you say to people who feel this is too big an invasion of the president’s or candidates’ privacy?

We offer patients confidentiality, and that’s critically important for regular patients. But let’s face it: The president of the United States and the nominees for president of the United States are the most public patients in the world. They have long since given up any elements of privacy. We know whether they like hot dogs or the Yankees. With health, it’s just too important.

What about those who might argue that disclosing information about the president’s health could affect global politics?

If the president has a serious illness, like let’s say a stroke, that’s serious. We need to know about that right away. The vice president needs to be put in place by the 25th amendment. If it’s a long-standing [health problem], you’ve got a little bit more leeway.

I would argue it’s a bigger threat to national security by hiding it than by disclosing it. Transparency is way better than opaque policies–that’s one thing history teaches us again and again.