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US2016: Donald Trump, Hillary Clinton and modern medici...

World

World, Politics

US2016: Donald Trump, Hillary Clinton and modern medicine

After a week in which the American nation’s – and perhaps the world’s – attention was focused on Hillary Clinton’s physical condition, J. BROOKS SPECTOR takes a longer, larger look at the medical issues of presidential candidates and presidents.

There was a time when a president or presidential candidate’s medical circumstances pretty much fell under a veil of secrecy – and personal privacy. Their illnesses were just nobody else’s business. But some presidents might well never have been elected in the first place under today’s insistence for great, pervasive public disclosure and transparency. Others might well have been besieged for information in ways that were anathema to their respective times. Such circumstances deserve fuller consideration as we follow the public uproar, largely among the alt.right and the media, over Hillary Clinton’s current illness and the mysteries of Donald Trump’s state of health.

In 1860 when Abraham Lincoln first ran for the presidency, and then again in 1864 when he ran for re-election, just how different would things have turned out if it had become known he was given to periods of serious depression, called “melancholy” back then? Joshua Shrenk, writing in The Atlantic magazine some years ago, had observed:

When Abraham Lincoln came to the stage of the 1860 state Republican convention in Decatur, Illinois, the crowd roared in approval. Men threw hats and canes into the air, shaking the hall so much that the awning over the stage collapsed; according to an early account, ‘the roof was literally cheered off the building’. Fifty-one years old, Lincoln was at the peak of his political career, with momentum that would soon sweep him to the nomination of the national party and then to the White House. Yet to the convention audience Lincoln didn’t seem euphoric, or triumphant, or even pleased. On the contrary, said a man named Johnson, observing from the convention floor, ‘I then thought him one of the most diffident and worst plagued men I ever saw.’

The next day the convention closed. The crowds dispersed, leaving behind cigar stubs and handbills and the smells of sweat and whiskey. Later the lieutenant-governor of Illinois, William J. Bross, walked the floor. He saw Lincoln sitting alone at the end of the hall, his head bowed, his gangly arms bent at the elbows, his hands pressed to his face. As Bross approached, Lincoln noticed him and said, ‘I’m not very well.’

Lincoln’s look at that moment – the classic image of gloom – was familiar to everyone who knew him well. Such spells were just one thread in a curious fabric of behaviour and thought that his friends called his ‘melancholy.’ He often wept in public and recited maudlin poetry…. ‘No element of Mr. Lincoln’s character,’ declared his colleague Henry Whitney, ‘was so marked, obvious and ingrained as his mysterious and profound melancholy.’ His law partner William Herndon said, ‘His melancholy dripped from him as he walked.’”

Still, that was in a sentimental age, and an emotional state of intense melancholy might well have made real sense given the imminent collapse of the national project and the beginnings of a four-year-long civil war.

Move forward over a hundred years more recently. If one thinks of how Missouri Democratic Senator Tom Eagleton had been virtually hounded off the ticket as George McGovern’s running mate in 1972 when it became public he had undergone shock therapy treatments for depression years before, it is easy to envision how Lincoln’s candidacy might have fared if medicine (and the public) had had a real understanding of conditions like depression – but had had no ability to treat it. Even after he had to drop out, Eagleton had famously joked that unlike most other candidates for high office, at least at the end of his treatments he had received a certificate declaring his sanity – although a lot of good it did him when the Democrats quickly replaced him with Sargent Shriver for the election, to avoid criticism.

Of course, the McGovern-Shriver ticket ended up being crushed by President Richard Nixon and Vice President Spiro Agnew in that election. But we now know (and certainly should have understood much better) about Nixon’s mood swings and his proclivity for constitutional and legal treacheries as well as Agnew’s duplicity and corruption. So, maybe Eagleton was on to something about requiring certificates of mental health for candidates….

Turning to other medical issues, when John F. Kennedy was running for the presidency in 1960, it turned out several physicians were treating him for a range of conditions, including Addison’s disease, and with a variety of pharmaceuticals, including substances that can have mood altering properties. Among those treating him was Dr Max Jacobson – the original “Dr Feelgood” – who began injecting Kennedy with a blend of steroids and amphetamines for his chronic back pain and fatigue. At the time, none of this was declared publicly, and the man’s public image was one of great, good health with all those competitive touch football games, the sailing around Cape Cod, and other physical pursuits with his friends and a large, roistering family. Once Kennedy was elected, Jacobson continued his treatments, although, given their mood altering character, they were suspended by the White House’s medical office, at least during the Cuban Missile Crisis – thankfully.

And, of course, historically, once candidates actually became presidents, as with Kennedy, their medical treatments usually remained closely guarded information. For example, in 1893, President Grover Cleveland had secretly undergone surgery for a large and growing cancer in his mouth, while sailing on a yacht from New York City to Cape Cod, then recuperating on the boat just as secretly for several more days. One of Cleveland’s requirements for agreeing to the surgery was that his prominent moustache would not be trimmed, lest people see him or his photograph in his shorn state and then begin wondering what had happened to him. This whole incident took place during a severe economic depression and Cleveland was clearly worried that any news of his surgery or his physical incapacity could have spooked the country even further than it already was in the economic crisis.

In an interview on National Public Radio five years ago, the radio network’s announcers spoke with author Matthew Algeo about his book on that surgery. As NPR’s write-up of the interview had noted:

Even back in 1893, Algeo says, it was pretty unusual for the president to disappear for four days, so it wasn’t long before people started talking. Two months after the president’s ‘fishing trip’, [the ostensible excuse for his absence] Philadelphia Press reporter E.J. Edwards published a story about the surgery which he had confirmed with one of Cleveland’s doctors. The president flatly denied Edwards’ story and even went so far as to launch a smear campaign to discredit the reporter. ‘So nobody believed E.J. Edwards,’ Algeo says. ‘He was dismissed as a disgrace to journalism.’

Edwards’ story may never have made its way into history books if one of Cleveland’s doctors, William Williams Keen, hadn’t eventually come forward. ‘Twenty-four years after the operation — when all the other principals were dead — there were only three witnesses left to the operation,’ Algeo says. ‘And [Keen] decided it would be the right thing to do to publish an article to explain what really happened and to vindicate E.J. Edwards.’ ”

In a rather ironic twist, this story first became widely known to a much larger public when it was dramatised as an episode in the NBC TV series, Profiles in Courage, itself inspired by John Kennedy’s book by the same name, written while he was still a senator. Just imagine nowadays what would have happened if a president ducked out of public life for nearly a week without a minute-by-minute schedule issued from the White House press office. The internet would be swamped by hordes of rumours propagating like mushrooms on a forest floor after a spring rainstorm. Ah, just like the fate of Hillary Clinton over her pneumonia.

More recently than Cleveland’s operation, in 1955, when President Dwight Eisenhower had suffered a major heart attack, his doctors and staffers worked hard to downplay the seriousness of his condition and to deflect discussion about the consequences of his attack that could have compromised his run for a second term of office in 1956. A review of a book by Clarence Lasby, Eisenhower’s Heart Attack: How Ike beat heart disease and held on to the presidency, published in The New England Journal of Medicine nearly 20 years ago, had observed:

Eisenhower was insistent that the public be informed of the medical aspects of his illness in order to avoid the deception about presidential health that had occurred with Cleveland, Wilson [and his breakdown following his fight with Congress over America’s joining of the League of Nations], and Franklin Roosevelt [and his many physical conditions].

However, neither Eisenhower nor his political aides wanted the public to know the opinions of the physicians about all aspects of his illness, such as the prognosis, particularly as it related to the feasibility of his running for another term. [Chief physician for Eisenhower, Dr Paul Dudley] White’s courting of the press and occasional comments that served as political fodder for the opposing party later caused him to lose favour with the politicians and ultimately with Eisenhower, who banned him from further press conferences a year after the acute attack.

And, of course, when President Ronald Reagan was shot in an assassination attempt, beyond the initial chaos in the White House over who was “in charge” in the hours after the shooting, and despite the fact that Reagan’s condition was sufficiently grave that he was unconscious during emergency surgery, the disability clause of the constitution were never invoked. Moreover, media advisories consistently downplayed the seriousness of the president’s condition in recovery; once again, presumably to avoid shocking or frightening the country at a particularly troublesome period in international affairs.

(This exercise of media spin ultimately presaged efforts to protect the Reagan image during his second term at a point when some believe Alzheimer’s was already coming into his life.)

In today’s media feeding frenzy climate, it is almost certain none of these instances would stand uncontested by the media – or by internet sites, social media and the alt.right crowd.

And so, it should not be particularly surprising that in this year’s presidential race, Democratic candidate Hillary Clinton’s medical condition has become such an all-consuming issue. It is clear, now, that her doctor had diagnosed her with bacterial pneumonia some two days before Clinton had been forced to make an unscheduled exit from the 9/11 remembrance service at Ground Zero.

Eventually, but crucially, it was days after television viewers could see her stumbling and being helped into a waiting van, before a fuller picture of her illness emerged, when a substantial memorandum from her primary care doctor, Dr Lisa Bardack, was finally released – including results of tests conducted and a list of medicines currently being prescribed. On the face of it, running for president nowadays is obviously a stressful marathon lasting several months, and it is unsurprising that an older but basically healthy candidate could come down with a thoroughly treatable yet temporarily debilitating illness. And being forthright about it might well have elicited some sympathy from potential voters for Clinton – given that so many Americans are similarly overstressed in their own daily lives.

The problem for the Clinton campaign, however, was that a simple message of saying their candidate had become unwell with “x”, was being treated comprehensively, and would take a few days’ rest to recover, became yet another seeming example of foot-dragging on transparency. Instead, the information has had to be dragged from an apparently unwilling candidate and her staff who had wanted, instead, to stonewall as much as possible to protect Clinton’s privacy.

But we are now in an era when everyone can and does take video clips on their smartphone, and where the internet and social media can deliver facts, rumours, disinformation, and morbid speculations (like the Trump campaign spokesperson’s click-bait that Hillary Clinton had a serious brain disease) in a “New York minute” to the entire world. As a result, such efforts at holding back just don’t seem to work any more. Instead, they provoke the intense blowback the Clinton campaign has now suffered this past week.

Meanwhile, the Trump campaign managed to carry out a kind of partial striptease of their candidate’s health, tantalising and captivating their audience. After an initial scribbled letter from a Trump doctor – complete with misspelled words and some very odd phrasing – was deemed by all who read it to be totally unsatisfactory, the candidate then announced he would release his full medical record and hinted that he would do it on the Dr Oz television show. Ultimately he offered a few choice bits on the show, and then his campaign released rather more details to the media.

This “now you see it, now you don’t, but stay tuned, there will be more, much more” song-and-dance act largely captured the candidates’ duelling medical histories news cycle, even as Trump then positioned himself to roll out the newest iteration of his economic plan. In truth, economic analysts remain unconvinced by his rosy scenarios of economic growth and the government’s ability to pay for those promises, but Trump has yet again captured yet another news cycle, unless Clinton can deliver a sustained, crisp and telling critique of this plan in her remaining public appearances this week. Still, say what you will about Trump’s actual ideas, the man is one crafty strategist at playing the media, and it now seems to be having an actual effect in the ongoing polling – most especially in crucial battleground states such as Ohio and Florida.

(It is just possible that Clinton has managed to use this sudden, unexpected hiatus in campaigning for some important prep for the first presidential debate on 26 September, and that all of this medical stuff will be long forgotten, old news – if she blows Trump away that evening. If not, however, these developments may end up being seen as the hinge moment of her whole campaign and the event where things unravelled.)

One thing this whole dance has shown, however, is it is well past the time when there should be a mutually agreed-upon, perhaps even mandatory, release of medical records by the respective candidates – in a standard format – so that voters have something to work with as they weigh their votes. And while we’re at that, it is similarly well past time for the required release of a candidate’s tax returns, his or her assets register (including major debts), and any business ventures they are currently engaged in, as they enter the campaign for the presidency.

Voters really need to know as much as they can about a candidate’s background and public experience. Surely they need to know at least as much about a presidential candidate as the government routinely learns about a new entrant into the civil or diplomatic service. The voters are, after all, doing the hiring of a president via the ballot box. And that matters a lot. DM

Photo: A view of a new electronic billboard supporting US Republican presidential candidate Donald Trump, which depicts him as ‘Super Trump’, in Times Square in New York, New York, US, 14 September 2016. The ad was purchased by the Committee to Restore America’s Greatness and is being displayed until 16 September. EPA/JUSTIN LANE

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