thinkers

Do voters really care about the president’s health?

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The same people who will choose the next US president are part of a population with escalating obesity rates

By Arthur L. Caplan
18:38 September 18, 2016
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The first of three planned presidential debates in the United States will take place at Hofstra University in Hempstead, New York, on September 26. Maybe it’s good the debate is slated for a gym. If Democratic candidate Hillary Clinton and Republican candidate Donald Trump are really serious about proving their physical vigour and stamina, they can do laps in the arena while they answer questions.

Hillary, of course, had to leave a 9/11 commemoration in New York early on September 11, suffering from dehydration and a case of pneumonia. The infection had been diagnosed two days earlier, after she saw a doctor for a cough that had drawn intense interest from the ready-to-pounce conservative media. The only real health issue the illness raised is whether she had received the recommended vaccines to prevent pneumonia in people over 65 — something the 70-year-old Trump should be asked, as well.

The episode, and Trump’s appearance on Dr Oz and release of a letter from his own doctor summarising a recent physical on Thursday, made it feel like the presidential campaign had been replaced by a plenary session at an American Medical Association conference. Doctors and pundits spent the week analysing the candidates’ health, weight and stamina. One medical wag even suggested that Hillary had fallen ill because Russian President Vladimir Putin had managed to have her poisoned — an extremely difficult diagnosis to make based entirely on TV footage and news photos.

If the political furore over Hillary’s pneumonia lingers longer than the illness — which should clear up in a few weeks — that would be a sharp break with history. Voters pay little attention to their own health, and up to now, they haven’t paid much more to the health of the people who want to be president.

Neither Hillary nor Trump is interested in demonstrating their health in any meaningful way, beyond showing that they’re physically up to the demands of the job. Hillary sought to keep important medical information to herself; Trump chose to let Mehmet Oz tell us what he thinks we should know about how he is doing.

With little evidence of serious health issues, how did the physical condition of the candidates grab centre stage in this campaign?

The political weaponisation of medical diagnoses started with Trump as the target. A parade of Hillary allies this summer began offering, unsolicited, to pronounce Trump a pathological narcissist. This unsupportable assessment even made the cover of the Atlantic. Trump supporters in the conservative press, meanwhile, had been waiting for a chance to impugn Hillary’s health ever since she was treated for a blood clot in a vein in her head in 2013. The psychological mudslinging on the Left seemed to amplify the screwy diagnoses coming from the Right — some from people with licences in something or the other, some from campaign staffers and even some from physicians who had a relevant medical speciality. Without examining Hillary, talking to her or knowing her full medical history, conservative media outlets declared that she suffered from the effects of a stroke, many strokes, Parkinson’s, epilepsy and various other maladies.

To endorse Trump’s fitness for office, his gastroenterologist wrote a letter late last year that said Trump would be “the healthiest individual ever elected to the presidency” and that his lab results were “astonishingly excellent”. The doctor later admitted he had written the letter in five minutes while a limo waited outside his office to deliver it to Trump’s campaign. Until Trump’s release last Thursday of a later letter and his interview with Oz, a surgeon who does not perform physicals, offered his show as an examination room, that was all we knew about Trump’s physical condition. (He told Oz, “I feel as good today as I did when I was 30,” and that his hand motions during campaign speeches are “a form of exercise.”)

Hillary’s campaign put out its own health bulletin last Wednesday, releasing a letter from her physician, Lisa Bardack, that described her pneumonia as “mild” and “non-contagious”, and ran through her vital statistics, from blood pressure to cholesterol, essentially unchanged from a good review she released in July 2015.

If we really care about Trump’s or Hillary’s health, the way to find out about it is not to ask them, their staffers, their doctors, Dr Oz, Dr Phil or Dr Who. It is to have them supply their medical histories and submit to a thorough examination by an independent panel of doctors from areas such as internal medicine, oncology, geriatrics, psychiatry and neurology. The panel could be appointed by the National Academy of Sciences or the National Institutes of Health. It would tell presidential candidates to show up in August for a two-day physical, with the results to be reported before the end of the month. It is not too late to ask the candidates to take a day or two and do this now, if we really are keen to know whether they are fit enough to serve.

Is this sensible solution going to ever happen? No. Because while discussions of Hillary’s pneumonia and Trump’s weight make for employment for medical TV wanna-bes and help fill empty air on cable news channels, you don’t need to be all that healthy to be president, much less a politician.

For every muscular bodybuilder-turned-California governor Arnold Schwarzenegger, there are hundreds of paunchy, stressed-out, overweight and possibly mentally impaired occupants of legislatures at all levels of government and in Washington’s highest offices. American candidates run for office while smoking, drinking, frequenting tanning booths, skipping vaccinations, driving recklessly, avoiding exercise and abusing prescription drugs. Judging by election results, voters don’t seem to care. Americans have had people in or near the White House with bad hearts — president Dwight Eisenhower and vice-president Dick Cheney both had heart attacks while in office. America has had presidents who abused pain medications such as John F. Kennedy, Richard Nixon and, before he took office, George W. Bush. And at least one president surpassed any missteps exhibited by Hillary, frequently stumbling, tripping or banging his head: Gerald Ford.

Despite the sparring — among candidates, doctors and surrogates — over who has the better blood-pressure number and despite the media’s taste for solemn disquisitions on narcissism, coughing, obesity and pneumonia, the American people don’t seem to care. Polls show voters aren’t worried that either Trump or Hillary would be among the oldest presidents ever to take office (though a majority do want to see health records from the candidates, which most previous candidates have released). And while surveys show voters now think Hillary is less healthy than they used to, half of them say that won’t affect which candidate they vote for.

That’s no surprise. Since most of us do little to heal ourselves, it is fair to predict that this election won’t pivot on an arthritic hip. The same voters who will choose the next president are part of a population with escalating obesity rates, helmet-less motorcycle and bicycle operation, untouched treadmills, and billions of dollars in junk-food sales. Why would anyone expect the electorate to put vastly more importance on the president’s health than on their own?

The current obsession will pass. The election will be decided on other issues. Still, if we want to know more about the fitness of candidates for the presidency, the current approach to informing us clearly does not work. Independent, objective assessment by a panel of doctors is the right prescription — if only the voters and the politicians would follow it.

— Washington Post

Arthur L. Caplan is the director of the Division of Medical Ethics at NYU Langone Medical Center’s Department of Population Health.

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