Since news came out late last month that President Biden employs a continuous positive airway pressure (CPAP) machine to treat his sleep apnea — a condition that afflicts approximately 25 million other Americans — the media has been rife with arguments over how his illness might affect his abilities as commander in chief. This debate mirrors a range of others related to presidential health over recent years — a few serious, many speculative or farfetched, and some, like the supposed controversies surrounding whether Biden uses Botox or Donald Trump wears a toupee, outright trivial. What is lost in many of these discussions is that information about our political leaders’ health is generally of minimal use to the public.
One concern about relying on the known health information of presidents and presidential candidates is that it is often misleading or incomplete. Politicians and their doctors play a gatekeeping role in deciding what information is publicly shared. For example, former Massachusetts Sen. Paul Tsongas and his physicians assured the public that he was cancer-free during his 1992 presidential bid, failing to reveal that his non-Hodgkin’s lymphoma had returned five years earlier. Tsongas died of the illness before his hypothetical first term would have ended.
More recently, Dr. Harold Bornstein acknowledged in 2018 that candidate Trump had dictated verbatim Bornstein’s 2015 letter stating that his patient would be “the healthiest individual ever elected to the presidency.” Confidentiality laws, such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA), further constrain physicians who might wish to alert the public to concerns.
The level of impairment suffered by presidents during medical crises is usually only discovered in hindsight — whether Woodrow Wilson’s limitations after successive strokes, Franklin D. Roosevelt’s incapacitating cardiac disease, John F. Kennedy’s adrenal deficiency, Richard Nixon’s excess alcohol consumption or Ronald Reagan’s incipient Alzheimer’s dementia. It is a mistake to believe that similar health secrets could not be withheld from today’s press. A generation may pass before we learn with confidence whether Biden, Trump or any other contemporary president or candidate has suffered from a severe debility.
A second problem with such health information is that the lay person is often unable to assess it in any meaningful way. What was an average voter supposed to do with the knowledge that Nixon suffered from labile hypertension or that Republican nominees Gerald Ford, Mitt Romney and Bob Dole were united by histories of elevated cholesterol? Should longshot candidate Buddy Roemer’s diabetes have been disqualifying? Bernie Sanders’s hypothyroidism? What about Ross Perot’s resistance to providing any personal medical information at all?
Even a medical expert with an actuarial table will have a challenging time evaluating the significance of some diagnoses. For example, during the 2008 presidential campaign, New York Times medical correspondent Lawrence Altman analyzed the staging of John McCain’s melanoma, noting that whether it had been a stage IIA or stage III tumor — a matter not then clarified by his campaign — meant the difference between an estimated ten-year life expectancy of 36% vs. 60%. At that time, McCain had already survived eight years, further complicating the data’s significance.
As a medical historian, I was once asked how a prospective voter should compare the knowledge that McCain attempted suicide by hanging while a prisoner of war in 1968 with the fact that Barack Obama had a history of cigarette smoking. Candidly, I have no idea.
Yet the most important caveat regarding the health of presidents and presidential candidates is rarely if ever acknowledged: Even if every candidate’s complete medical history were disclosed in entirety, and voters based their decisions solely upon the health of these, that approach would not necessarily lead to the election of healthier or longer-lived presidents.
Often, in fact, history reveals the opposite. The most well-known example is that of Wendell Willkie, Franklin Roosevelt’s Republican challenger in 1940, a hale forty-eight-year-old who appeared far fitter than the older, wheelchair-bound incumbent. However, FDR’s ailments did not prevent him from reelection to another term four years later or from leading the nation during World War II, while Willkie was dead of a massive heart attack before the 1944 election.
According to physician-columnist Robert Steinbrook in 1992, candidates George H.W. Bush (age 68) and Ross Perot (age 62), had life expectancies of 13 years and 17 years, respectively. Bush lived another 26 years and Perot another 27. In 1996, a 72-year old male could have been expected to live to about 84; Bob Dole passed away at 98 in 2021.
The nature of the American presidency is like that of no other job, so both the competencies and health requirements to excel are unique. Some of our most revered presidents, from Lincoln to FDR to Reagan, have been our sickest, while several of our healthiest presidents are regarded as failures. Skills that might prove crucial in many occupations — such as physical agility, stamina, and even strong declarative memory — may prove less critical when someone is guided by armies of deputies and advisors. In contrast, sound judgment, which often comes with age or adversity, is essential for the job.
There are many reasons for voters to choose one presidential candidate over another. No evidence exists to suggest that underlying health issues have any significant bearing on how effectively they will run the country. By focusing on candidates’ medical records, rather than ideas, we do ourselves and the nation a disservice.
As a human being, I wish our presidents good health. As a physician, medical historian and citizen, I am far more concerned that they possess the wisdom to lead.
Dr. Jacob Appel is on the psychiatry faculty at the Icahn School of Medicine, where he teaches in the bioethics and history of medicine curriculum. He is the author of twenty books, including “Who Says You’re Dead?” (Algonquin, 2019).