Wednesday, February 13, 2008
The First Patient
By Dr. Sanjay Gupta
Chief Medical Correspondent

All week long, we will be talking about the health of the president. This weekend, we will present "The First Patient" a special about this topic.

I am curious to know how important you think it is for the health of the patient to be divulged. It has always seemed amazing to me that we aren't given more information about the physical and mental health of our candidates. It is arguably one of the toughest and most important jobs in the world.

No question, the information we get today is better than in elections past. John F. Kennedy denied he had Addison's disease throughout his campaign, even though he was officially diagnosed and treated for it. Franklin D. Roosevelt was essentially a dying man when he ran for his fourth term, even though most voters didn't realize it at the time. Roosevelt's doctors didn't even tell him he was suffering from congestive heart failure.

In 1992, you may remember that Paul Tsongas was the first cancer survivor to run for office. What was not known at the time was that Tsongas had a recurrence a year before the campaign. His cancer was back again before he would've been inaugurated. So, what do we deserve to know and when should we know it?

Tsongas for his part actually asked then-president Bill Clinton to create a commission that would require all candidates to release all of their medical records. That never happened.

Last month, Sen. John McCain's campaign released a summary of his records. His staff has promised to release his full medical records should he receive the Republican nomination.

That's important because the 71 year old McCain was diagnosed more than once with malignant skin cancer and would be the oldest president in our history.

As governor of Arkansas, Mike Huckabee weighed more than 280 pounds when he was diagnosed with Type 2 diabetes five years ago. Through diet and exercise, the 52-year-old Huckabee is now 110 pounds lighter and symptom free.

Sen. Hillary Clinton is 60. So far, she hasn't reported any health problems.

Sen. Barack Obama, 46, was a smoker, a habit that cuts an average of 11 years off life expectancy. Obama has told us he has quit smoking and he can often be seen chewing Nicorette gum.

Does the health of the candidate matter to you and would you vote differently based on that information?

Programming Note: Watch "The First Patient" Saturday and Sunday at 8 p.m. and 11 p.m. ET **update: due to coverage of the shootings at Northern Illinois University, "The First Patient" was pre-empted and has not yet been rescheduled. We'll keep you posted.**

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Thank you for someone finally bringing this issue up. I think we absolutely have a right to know about the health of our candidates and I am shocked that we do not know more. John McCain is the oldest and has serious health conditions. It would absolutely affect my vote.
As long as the candidate can think and communicate, I don't want to know their heatlh issues. They have the same rights as any other American, privacy of health care information. They do have the responsibility to assess whether they can carry out the duties of office if elected.
Wednesday, March 07, 2007
Mental Illness in U.S. Presidents--"Call Me Incompetent But Don't Call Me Crazy"

This is very serious subject for several reasons-

- We obviously need mentally competent Presidents of the United States

- We need better laws to ensure such mental competency both prior to and while holding such an important office

- We need to ensure that psychiatric evaluation,diagnosis,and treatment of Presidents are as free as possible from any influence whatsoever from partisan politics.

I had planned to write on this topic in the future but was stimulated by a remark that Sen. Dick Durbin (D-Ill and new Senate Majority Whip) made in January of this year that our current Vice-President was "delusional" about Iraq and the daily vitriol that spews forth on a number of mostly progressive liberal blogs about the sanity of our current president and vice-president. Reflecting upon Mr. Reagan's Alzheimers disease while still in office was another stimulus to this piece.

As a physician I go out of my way NOT to tele-longdistance-diagnose anyone as was done by former Sen (Dr.) Bill Frist in now landmark Terri Schiavo case where Frist insisted she was not in a persistant vegitative state.(He then tried to recant saying he was speaking as a Senator not a Doctor?)

But back to the more to the general issue of presidential mental health

About a year ago (Jan 2006) an excellent article which studied biographical source material in 37 presidents from 1776 to 1974 was published in The Journal of Nervous and Mental Diseases on the topic of Mental Illness in U.S. Presidents... and concluded that 18 presidents (49%) met criteria suggesting psychiatric diagnoses and in 10 instances (27%)"a disorder was evident during presidential office, which in most cases probably impaired job performance". Thankfully the authors concluded that no national calamities appeared to have occurred due to presidential mental illness. Here is the abstract for the article. (Sorry folks you must cough up some bucks for a full reprint)

Presidents with mental illness provide opportunities to discuss the stigma of mental illness,the treatment of mental illnes, the possible abuse of psychiatry (see Citizens Commission on Human Rights) and issues surrounding privacy in a public figure whose privacy rights in my opinion need to be subjugated by the public's right to know the health and competency of their President who is also their Commander-in-Chief.

In 1967 the 25th Amendment to the U.S. Constitution was ratified which addresses transfer of power in cases of presidential illness or death precipitated by the tragic assasination of President John Kennedy in 1963.

The prestgious College of Physicians of Philadelphia, of which I am a fellow, under then Executive Director Dr. Marc Micozzi launched several initiatives beginning in 1996 to better understand presidential health and disability with special emphasis on improving the 25th amendment by giving it,in Dr. Micozzi's words, "operational definition by statute or regulation"

Currently,for example, the 25th Amendment does not address who makes the final medical determination that the president is unable to hold office? (That's not good)

An educational exhibit took place at the College between 1996 and 1998 entitled "When the President is Patient" which traced George Washington's thigh carbuncle/abcess to George(Papa)Bush's thyroid condition.(see NY Times Coverage)

Sen. Arlen Specter (R-PA) delivered Opening Remarks (Nov 19, 1997) at a College Forum on Presidential Diability and the 25th Amendment where he closed by stating he was very interested in whether the College "will recommend legislative action to strengthen our current system for providing for the health of The President of the United states".(now that's a positive way of saying it) But Specter also raised the issue of the nation possibly being better served if White House Physician were required to consult with an independent panal of physicians for a mandatory second opinion. ("The panal will see you now-Mr. President")

In it's final report on the College's Presidential Health Task Force chaired by Dr. William Kissick the group concluded that "the current system of providing for the health of the president of the United States has in the past failed to serve effectively the president himself and the public, and has even been exploited as a means of deceiving the public about the state of the president's health.This committee went on to propose that an Act of Congress be passed into law to create a physician panal to provide a second opinion to the White House physician. A draft bill was even prepared by this committee. (Alas, I do not know the current status of this draft legislation?)

Needless to say the College of Physicians of Philadelphia deserves significant credit for these initiatives in the late 1990s. And special thanks to Dr. Marc Micozzi for spearheading these efforts and to Sen. Arlen Specter for assisting the College.

The College did not, to my knowledge, specifically focus on Presidential mental disability in any of its activities and deliberations?

Sufficed to say that psychiatric status is often ommitted from any or most of our own health evaluations. Yet for the President of the United States - past, present and future- I would focus on that first and foremost.

In our increasingly volatile world it seems like a pretty important priority to me?

Don't you agree? Let's hear from you!

Dr. Rick Lippin
What, exactly, are McCain's "serious health issues?" Other than the recurrent skin cancer, which is highly treatable, he's probably the healthiest of the bunch. There is no reason to think that at age 71, he couldn't make a run for the presidency of this country.

Of course, he's not my favorite candidate, so I'd say that his health isn't that big of an issue fith me, but seriously- what is is that you think you know about another person's health picture? And HOW do you know it?
There are five years unaccounted for in the life of John McCain while a prisoner of war. How can we be sure that he was not subjected to a brain washing technique which could render him a security threat in the future? I am not suggesting a Manchurian Candidate type of event but something less dramatic which could still inflict serious damage to our country.
A portion of the 25th amendment dealing with presidential disability needs to be modified.

The College of Physicians of Philadelphia worked with Sen. Arlen Specter R-PA) a while back to begin this process.

A key issue is having an independent panal of physicians instead of appointed White House Physicians decide on presidential disability.

Dr. Rick Lippin
Due to the fact that the it is unclear whether the term limiting 22nd Amendment applies to the 12th Amendment (essentially, no one shall be elected or appointed to the office of VP who is unfit to be president) it is possible that Hilary could be elected with Bill as her running mate. Then we find out that she has had... oh say severe liver disease, and cannot handle the stresses that come with the office and is "forced" to resign. Magically, her husband, is president again. Hmmm, maybe there was something to his campaign to modify the 22nd to allow multiple non-consecutive terms, but I digress.

Frankly, before electing anyone to an office that overseas not only the US, but in a way the entire world, we have a responsibility to find out all the probable scenarios that will make that person unfit to hold the office. Everyone is making a big deal about McCain's age. Is it any wonder why he is the ONLY one being completely forthright about his health and allowing his records to be released? Age does not equal bad health; bad health equals bad health. And McCain (by this I mean his advisors) realizes that the people are concerned about his health. The problem is not that we are concerned about his, it is that we are so focused on his "age" that no one seems to even consider the possibility that: Obama might have liver cancer because of his former smoking habit, Hilary might be going through severe depression as a result of her husbands infidelity, Huckabee might be "symptom-free" of diabetes on the outside then a ticking time bomb of insulin problems on the inside (Diabetes can cause blindness, have we considered the possibility of a blind president?), McCain's old age is... you get the idea. These are obviously all false examples but all REAL possibilities. We are electing someone for the next four years. No one expects the VP to end up in the office doing anything but watching over the Secret Service. Imagine the current VP as president... wow. So we should be confident, in every possible way, that the President we elect as a nation, will be the President to hand over the reins in 4 or 8 years.
I've noticed a prominent swelling in the area of Senator McCain's left parotid gland. It is worrisome, in light of Senator McCain's history of skin cancer, because he could have metastatic spread to his parotid gland, or to lymph nodes within that gland.
Will the media question him about that left facial swelling -- I'm sure I'm not the only one who has noticed it.

Randall E. Dalton, MD
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