When I was a resident one of our radiologists had kidney failure and was on dialysis. He also never missed a day of work, travelled often (he was adept at finding dialysis centers in what seemed like exotic places to me at the time), and was responsible for life and death decisions. If you have a CT scan or a chest x-ray misread by the radiologist as benign when there is really a cancer it is very bad indeed.
This radiologist is not alone. There are many people with significant but well-controlled health conditions or a history of serious health problems, such as cancer, heart disease, diabetes or epilepsy, who do high-stress high stakes jobs admirably. Ruth Bader Ginsburg was treated for colon cancer, pancreatic cancer, and had heart surgery while a Supreme Court Justice. She didn’t miss a day of work during her chemotherapy or radiation. Sonia Sotomayor has lived with diabetes since age 7. Chief Justice Roberts had a seizure while Chief Justice (his second seizure). It was Anthony Scalia who had sleep apnea, chronic obstructive pulmonary disease, high blood pressure, obesity, and was a smoker – conditions that sound less dramatic to the non medical public – who died in the middle of the night.
Bob Dole suffered from a “shattered right shoulder, fractured vertebrae in his neck and spine, paralysis from the neck down, metal shrapnel throughout his body and a damaged kidney” from injuries sustained in World War II. He was left with paralyzed right arm and hand. Pretty serious health history, but it didn’t stop him running for President.
George W. Bush used to drink a lot and was arrested once for drunk driving, eventually giving up alcohol. He went on to serve two terms as President.
Nixon was admitted for a Staph infection (a serious bacterial infection) while he was campaigning for President.
John McCain had a history of malignant melanoma. When he was running for President his chance of his cancer recurring over the next five years (i.e. when he would have been in office) was 14 percent and his risk of death was 9 percent. He also took medication for high cholesterol. He was 71 years old and would have been older than any other President when he assumed office. His health was barely an issue when he campaigned for President.
What serious medical condition are people worried about?
Hillary Clinton almost fainted and then disclosed she had pneumonia. The attention on her health makes little sense medically especially given the information she has presented and the health history of previous Presidents, candidates, and the Supreme Court justices. We have accepted their health conditions with few, if any, questions asked.
These cries for information about Clinton’s health imply there is some kind of new health standard for President, like there is for a pilot’s license. However, the three constitutional requirements for the Presidency do not mention health at all and medically speaking there are very few conditions that could actually affect someone’s ability to be President.
What if someone is at “high risk” of death? Predicting risk of death is almost impossible. Studies tell us more likely or less likely, they don’t predict. It’s medicine, not divination. For example, Justice Ginsburg had colon cancer and pancreatic cancer and a cardiac stent placed, yet somewhat unbelievably here she is 81-years-old and quite possibly the sharpest woman in the country. In contrast seemingly healthy people sadly die in the middle of the night or after a work out. If risk of death were the issue then based on risk every man 70 years or older should be exempt from the Presidency because just being a 70-year-old man means a 6-9% risk of a heart attack or stroke in the next 10 years. A similarly aged woman has a 1% risk. The prevalence of an abdominal aortic aneurysm (potentially fatal) is six times greater for men versus women. Women have a longer life expectancy than men. At the age of 65 an American man has an average of 17.9 more years while a similarly aged woman has 20.5. If life expectancy and risk of death is the standard then the Presidency should be a woman’s job.
What about this talk of Mrs. Clinton’s secret seizures? There is no evidence of seizures on camera or in her doctor’s letter and frankly it is discrimination or ignorance to suggest someone with epilepsy couldn’t be president. Epilepsy wouldn’t cause someone to inappropriately launch a nuclear strike, that happens because of a combination of bad judgement and bad information and possibly bad character. Theodore Roosevelt had epilepsy and some experts think FDR may have had epilepsy (he took phenobarbital, an anti-seizure medication). Even if Clinton did have epilepsy (this is hypothetical, she does not), the precedent is set by men that epilepsy is compatible with the office of President. Also, if epilepsy disqualifies one from the Presidency it should also disqualify one from being Chief Justice.
In reality there are very few conditions that could potentially medically exclude someone from being President. What I would be worried about are conditions that impact judgement and might include the following:
- Active substance abuse (or substance abuse within the past two years).
- A progressive neurological illness
- Any implantable device that could be hacked
I’m not saying this should be the list or even that there should be a list, rather I’m just pointing out how far off base many armchair diagnosticians appear to be about what actually matters health wise for the job of President. A President doesn’t need to walk or throw a baseball. There are no feats of strength. Standing isn’t required. She or he needs to be able to think, lead, and command.
What about Clinton’s transverse sinus venous thrombosis (the blood clot after her concussion), could that have impacted her brain? It did not cause a stroke and her physician said it did not cause any neurological damage so it’s moot.
What about heart disease? Why isn’t that on my list? Unless there is end stage heart disease it’s hard to see how cardiac disease would prevent the President from doing her or his job. Dick Cheney managed to be Vice President after four heart attacks. What if surgery is needed for a heart condition? Well, many Presidents may need a colonoscopy while in office or their appendix out or any other procedure for that matter. There are protocols for when a President has an anesthetic and of course that is one reason we have Vice President. Anyway, Clinton’s risk of a heart attack or stroke in the next 10 years is 1%. As she is on a blood thinner her risk may even be lower.
Hillary Clinton is as healthy or healthier than many men who have run for President or who have been President.
Why must Mrs. Clinton tell the world when she has pneumonia, a short-lived illness from which she is expected to make a full recovery, when that diagnosis in no way affects her ability to be President? It’s not as if pneumonia is going to cause her to accidentally fall on a red button and launch a nuclear war. Pneumonia is also not a precursor to dementia or psychosis. Answering irrelevant questions about her health justifies their asking and perpetuates the continued inappropriate focus on her health. Mr. Trump didn’t answer much about his health and the Press stopped asking. As there is no “healthy enough” test and no “health standard” for the Presidency exactly how will releasing more records help? And who gets to interpret these records? Apparently it’s Dr. Oz who gets to interpret Mr. Trump’s.
Let me be very clear, if you can be like Trump, a 70-year-old man with a normal blood pressure on a statin who released no other valuable health information, or like McCain, a 71-year-old man on a statin with a history of melanoma, and run for the highest office, you can certainly be a 68-year-old woman on a blood thinner and thyroid medication who had a bought of pneumonia.
This focus on Clinton’s health is either a complete lack of understanding about medicine, health, and disability or an egregious double-standard where being a woman is considered a medical condition.