What Do We Actually Know About Our Aging POTUS Candidates’ Health?

The Daily Beast/Getty
The Daily Beast/Getty

Why, on a sunny Saturday last November, did President Donald Trump make an unplanned, unannounced visit to Walter Reed National Military Medical Center, leaving the White House in such apparent haste that his button-down shirt was open and tieless?

Because doctors wanted to be able to see his “gorgeous chest,” of course.

“[The media] said, ‘he wasn’t wearing a tie—this is a sign of a massive heart attack,’” Trump later groaned at a rally in Sunrise, Florida, nine days after his surprise hospital visit and thin subsequent explanation sparked fears that he had suffered some sort of medical emergency. “Why would I wear a tie if the first thing they do is say, ‘take off your shirt, sir, and show us that gorgeous chest?’ It’s true. ‘We want to see, sir. We’ve never seen a chest quite like it.’”

Nearly 250 days later, Trump’s “sir”-laden pantomime of his visit to Walter Reed is the closest that the American public have received to an official explanation for the incident—and, medical doctors fear, it’s the latest sign that presidents and presidential hopefuls are feeling increasingly empowered to hold back potentially critical information about their health from voters.

“The release of health information by candidates, and the interest of news organizations in it, plateaued for a while and has declined to the point where the news media seem to be satisfied with simple summaries, and have not put them under the scrutiny that was done in the past,” said Dr. Larry Altman, a physician and journalist who has covered the health of world leaders for decades. “One of the major tasks of journalism is to hold candidates for elected office to full disclosure of their health, and be transparent in doing so. And in recent times, that just hasn’t been done to the degree it once was done.”

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Both President Trump and former Vice President Joe Biden and their supporters have increasingly traded pointed barbs about the other’s mental acuity and physical stamina, giving age and health an outsized role ahead of the election.

But increased attention on the physical and mental fitness of the president and his would-be successor has coincided with a moment where both candidates feel little pressure to release additional information about their health—a trend that experts in presidential health told The Daily Beast could have the effect of withholding critical information from voters choosing between two septuagenarians this November.

“The medical reports are getting shorter,” said George J. Annas, director of the Center for Health Law, Ethics and Human Rights at Boston University’s School of Public Health, who said that “the public has a right to know” of any serious medical condition that could seriously hamper a president’s ability to serve.

If Trump and Biden’s most recent medical releases are any indication, however, that information is not coming anytime soon.

At first, he thought it was just a pinched nerve.

Sure, Sen. Joe Biden of Delaware had been combatting increasingly bothersome headaches for months, but the stress of a failed presidential campaign and steering the Judiciary Committee during the Robert Bork confirmation hearings had been understandably taxing. The senator was under intense pressure to restore his reputation in Washington after his abortive run for the White House—pressure that came largely from himself—and he wasn’t going to let the humiliation, or anything else, force him back from public service. “The mistakes that had forced me from the presidential race did not, would not, define me,” he later wrote in his memoir.

But the large bottle of Tylenol he kept on standby wasn’t strong enough in early 1988, when Biden felt a pain shoot through his neck while working on a shoulder press machine in the Senate gym. On the post-workout train back to Wilmington, Biden’s right side went numb, and his legs felt heavy. He briefly wondered if, at 45, he was having a heart attack.

“I didn’t want to worry Jill, but I gingerly told her that maybe I’d pulled a muscle or something,” Biden wrote in his 2007 memoir Promises to Keep: On Life and Politics. “So she made arrangements for me to see a doctor, who concluded I had probably pinched a nerve.”

Weeks later, after a stint in a neck brace had seemed to fix the problem, Biden passed out on the floor of a Rochester hotel room after “lightning flashing inside my head, a powerful electrical surge—and then a rip of pain like I’d never felt before.” He was flown home to Delaware, barely conscious, so gray that when he got home, his wife “didn’t even stop to ask me what I wanted to do.” 

After a spinal tap, a CT scan, and a bedside administration of the Catholic last rites, doctors at Saint Francis Hospital told the senator that he faced something much more complicated than a pinched nerve: two aneurysms, one on either side of his brain. They explained the condition in terms of a bicycle tire: when a spot on the inner tube thinned, it started to bulge, and air—blood, in the analogy—could leak out, or it could burst. One of Biden’s had already leaked, and could burst at any moment.

“I was lucky to be alive,” Biden recalled. “But if the aneurysm bled again, I probably wouldn’t survive.” 

Biden, after grimly telling his teenage sons young Beau and Hunter what he wanted on his tombstone just in case, underwent two microsurgical craniotomies at Walter Reed National Military Medical Center to fix the aneurysms, unsure if he would awake from the procedures, or retain his mental faculties if he did.

“Maybe I should have been frightened at this point, but I felt calm,” Biden wrote in Promises to Keep. “It surprised me, but I had no real fear of dying. I’d long since accepted the fact that life’s guarantees don’t include a fair shake.”

More than three decades later, Biden’s description of the episode in his memoir, and of his seven-month road to recovery before returning to the U.S. Senate, is the most vivid—and most thorough—accounting of his health that has ever been ma
de accessible to the general public. While the presumptive Democratic presidential nominee has generally outpaced the medical disclosures of his rivals, he has still followed the recent trend of releasing increasingly brief summaries of health records.

In 2008, as the Democratic vice presidential nominee, Biden gave reporters access to 49 pages of his health records, far outpacing his opponent, Sarah Palin, who refused to release any medical records, and his next would-be successor, Paul Ryan, who released a short, one-page letter from a physician in 2012.

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In December 2019, however, Biden released a three-page letter from his osteopath, Dr. Kevin O’Connor, a followup to a two-sentence statement earlier that year that called him “more than capable of handling the rigors of the campaign.”

In the letter, O’Connor, who has been Biden’s primary care physician since 2009, highlighted four conditions: an irregular heartbeat discovered after he had his gallbladder removed in 2003, elevated cholesterol for which he takes Crestor, occasional acid reflux, and seasonal allergies. A 2014 CT scan revealed no recurrence of aneurysms, and while O’Connor noted that “a good deal of time in his youth” spent in the sun meant that several localized non-melanomas had been removed, the letter states that the former vice president does not smoke or drink, and works out “at least” five times a week.

“Vice President Biden is a health, vigorous, 77-year-old male, who is fit to successfully execute the duties of the presidency,” O’Connor concluded.

The public information upon which that conclusion was based is far from comprehensive from a journalistic perspective, Altman said—even though the three-page disclosure could potentially contain just as much useful information as the 49-page release in 2008.

“It’s perfectly conceivable to me that the three pages that he released… contain the information that you’d want that would have been in the 49 pages,” Altman said. “You’re just summarizing information at a later date.”

The main point of contention, Altman said, is “an area of medical controversy”: whether medical doctors should treat a president the same as any other patient, or as, well, the president.

“There is certainly a school of thought that somebody of the age of Biden, and that means, Trump as well, should undergo neurological tests, just because of their age and the high incidence of dementia that occurs in the late seventies and eighties, and therefore the public should be entitled to that information,” Altman said. “But the White House doctors I dealt with felt that they should not treat the president medically in any different manner than they would treat the patient if the president were a private citizen.”

Historically, several major-party nominees have worked to obscure relevant medical issues from the public, with potentially calamitous results. When former Massachusetts Sen. Paul Tsongas sought the Democratic nomination in 1992, he claimed that he had been “cured” of non-Hodgkin’s lymphoma, despite medical experts cautioning that he had been in remission too short a time. Nine months after dropping out of the race, Tsongas confirmed that the cancer had returned. In late November 2000, as George W. Bush and Al Gore were engaged in a prolonged battle over the results of the presidential election, Bush cautioned that running mate Dick Cheney’s hospitalization following chest pains was not a heart attack, only for it to be confirmed hours later that Cheney had suffered his fourth heart attack.

As the coronavirus pandemic—which the CDC has warned poses a particular risk to older Americans—continues, forcing both candidates to stay inside and swear off the large rallies Trump loves and the close contact with voters at which Biden excels, the shortchange of medical information about the man who would be the oldest person ever to serve is conspicuous.

But one expert in presidential lifespans told The Daily Beast that while Biden’s three-page release isn’t the most thorough, it contains enough for voters to feel relatively confident that he’s not hiding anything major.

“I feel very confident in the validity and reliability of the information contained within that letter,” said Dr. S. Jay Olshansky, a professor at the University of Illinois at Chicago’s School of Public Health and expert on presidential aging. In April, Olshansky produced “Longevity and Health of U.S. Presidential Candidates for the 2020 Election,” a white paper published by the American Federation for Aging Research that found that chronological age is a less important metric for judging presidential fitness than health and fitness. “Truth be told, you don’t actually need more than that… In order to generate an assessment of Biden, pretty much everything you need is in that three-page document.”

Trump, however, is another story.

“For Donald Trump, you and I have run into the same issue, which is, there just isn’t very much information that’s publicly available,” Olshansky said. As he works on an update to his article—hopefully set to publish in a peer-reviewed journal before the presidential debates this fall—Olshansky has struggled to obtain anything more than the cursory releases that Trump has provided the press, even trying to zoom in on the supposed medical records that Trump “released” on an appearance on The Dr. Oz Show in 2016, with no success.

“I can’t validate whether any of that information is self-reported, like height and weight,” Olshansky said. “At one point he was listed at 6’2”, and then he was relisted as 6’3”. Most people shrink as they get older—there isn’t anyone I know who gets taller.”

Trump has gone to outstanding lengths to av
oid sharing his medical history—and may be part of the reason that Biden feels no great pressure to release more information than he has already shared.

Trump said in September 2016—two months after former Secretary of State Hillary Clinton’s campaign released a two-page letter from her doctor that omitted her weight and after a sustained effort by the Trump campaign to paint her as at death’s door—that he would release “very, very specific” medical records. What was eventually released was a letter signed by longtime physician Dr. Harold Bornstein that he himself dictated, describing his health as “astonishingly excellent” and predicting that he would be “the healthiest individual ever elected to the presidency.”

“I think it’s a low point when the candidate-patient dictates his medical information and releases it as a summary from the doctor and the doctor signs it without the public’s knowledge that the patient had a heavy hand in releasing the information,” Altman said dryly.

Trump’s medical releases as president have, somehow, gotten even more brief. After initially allowing Dr. Ronny Jackson, the White House physician, to directly brief reporters about his annual exam, Trump has since cut those releases back to a single-page memo, in which Dr. Sean Conley simply reported Trump’s age, alleged height, weight, resting heart rate, blood pressure and temperature, adding that “there were no findings of significance or changes to report.”

“Dr. Jackson’s physical was several pages and then he stood in front of reporters for an extended period of time in the White House press room. And Dr. Conley releases a page of non-detailed statements and submits to no questions,” said Dr. John Sotos, a transplantation cardiologist, flight surgeon in the Air National Guard and presidential health enthusiast, who noted that Conley’s one-page letter states that its contents are what “the president has authorized me to release.”

“The way I read that is he’s saying to his colleagues, ‘Hey, don’t blame me if this level of release is not what you think it should be—I’m just following the orders of the boss.’”

Sotos told The Daily Beast that such scant disclosures could further erode American trust in their government. Sotos pointed to an incident in 2002 when President George W. Bush lost consciousness and hit his head after choking on a pretzel while watching football and White House physician Dr. Richard Tubb briefed the press on the exact procedures the president underwent immediately thereafter.

“We trusted that Dr. Tubb did a competent job and was not improperly constrained in what he released to the press,” Sotos said. “And of course, with President Trump, we can always be certain that there will be some constraints on what the doctors release.”

In 2018, Trump even ordered personal aides to raid Bornstein’s office and seize his medical records, in apparent violation of HIPAA, after the physician told Altman in an interview that the president takes finasteride, specifically Propecia, to prevent hair loss. Then-White House press secretary Sarah Huckabee Sanders described the incident “standard operating procedure for a new president.”

Despite this, Trump has targeted Biden’s mental acuity in recent months, releasing campaign ads on Facebook asking if he is “too old” and declaring that “geriatric mental health is no laughing matter.”

“Biden can’t put two sentences together,” Trump claimed in an interview with Fox News’ Chris Wallace that aired on Sunday, responding to polls showing that voters are more concerned with his mental sharpness than Biden’s by daring the former vice president to take the same test of cognitive functioning that he claims to have taken. “They wheel him out. He goes up, he repeats, they ask him questions. He reads a teleprompter and then he goes back into his basement.”

Wallace pointed out that the test in question, the Montreal Cognitive Assessment, is far from rigorous.

“They have a picture and it says ‘what’s that’ and it’s an elephant,” Wallace responded.

The Biden campaign told The Daily Beast that Trump’s comments were more reflective of the president’s desperation than of the vice president’s mental fitness for office.

“If the Trump campaign believes the answer to their precipitously dropping support is to triple down on yet another smear that’s backfired on them for over a year, then frankly, maybe it’s not just Donald Trump who’s missing something,” said Andrew Bates, the Biden campaign’s director of rapid response, “but also his campaign’s ‘strategists] who somehow still haven’t grasped that the ‘project, commit a self-own, then repeat’ model is accelerating their freefall.”

While declaring that Biden “doesn’t even know he’s alive,” Trump has also bristled at the implication that he is not in, well, astonishingly excellent shape. After video of his apparent difficulty walking down a ramp at West Point went viral in June, Trump spent weeks ranting about the episode in subsequent speeches, tweets and interviews.

“The general said, ‘Sir, Are you ready?’ I said, ‘I’m ready.’ And he led me to a ramp that was long and steep and slippery,” Trump said in an interview with the Wall Street Journal, part of a 500-word digression in response to a question about his handling of protests against police violence. “And I said, ‘I got a problem because I wear, you know, the leather bottom shoes.’ I can show them to you if you like. Same pair. And you know what I mean, they’re slippery. I like them better than the rubber because they don’t catch. So they’re better for this. But they’re not good for ramps. I said, ‘General, I got a problem here. That ramp is slippery… so I’m going to go real easy.’ So I did. And then the last ten feet I ran down.”

The Trump campaign referred questions about future medical disclosures to the White House, which declined to comment on the record.

Trump is not alone in getting hot under the collar about concerns that he’s too old to serve as president. In December 2019, right around when his campaign released the three-page health summary, Bide
n challenged an Iowa voter to a pushup contest when he questioned his age. 

“I’m not sedentary,” Biden fired back. “And you want to check my shape, man? Let’s do push-ups together here, man. Let’s run. Let’s do whatever you want to do. Let’s take an IQ test, okay?”

But that defensiveness—combined with the bipartisan reticence for releasing detailed medical histories—has some experts in presidential health worried that Trump and Biden are presaging a regression to the days when President John F. Kennedy kept his diagnosis of Addison’s disease secret, and when President Woodrow Wilson was so severely incapacitated by a stroke to the point that some historians consider his wife the “first female president of the United States.”

Increasing public pressure—particularly in light of the coronavirus pandemic—could force Trump and Biden to be more forthcoming about their medical histories, Sotos said, but added that voters have yet to make that desire felt.

“If this had been Ronald Reagan speaking in sentence fragments that were occasionally incoherent, I think the reaction to that would have been quite loud and strong,” Sotos said. “For whatever reason, that’s not happening with this president. The information is already out there, and it just doesn’t seem to be making a mark.”

Public pressure leading to public disclosure has happened before. In October 1992, after months of media questions about his medical history, Bill Clinton released his medical records and gave his doctors permission to speak with reporters. The disclosures revealed some embarrassing items (hemorrhoids) and some areas of mild concern (yo-yo dieting), but nothing that would lead voters to question whether he was ready to serve as commander in chief.

In the meantime, however, voters can only rely on what little Trump and Biden are willing to share.

“One has to remember that all information that’s released to the public is with the permission of the patient, whether it’s president or a dog catcher or whatever,” Altman said. “What’s released is up to the president.”

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