Medical Disclosure In Presidential Elections
In a May 2014 conference, Republican strategist Karl Rove suggested that Hillary Clinton may have brain damage. The current Democratic nominee was diagnosed with a blood clot on her brain after a preceding fall in December 2012. The events — including an alleged thirty days in the hospital and the wearing of glasses specialized for those with brain trauma — were all factors in Rove’s call for further disclosure of Clinton’s health. The Democratic response was swift and unequivocal. “There are no responses for this level of lying,” said Clinton spokesman Nick Merrill at the time. “She is 100 percent. Period.” Huffington Post editorialist Howard Fineman charged Rove with sexism for bringing up the issue. Even the Colbert Report satirized Rove’s malapropism and the media fire storm that ensued.
However, Rove is hardly the first person in the press to call for a more complete release of a presidential candidate’s medical records. In an October 2008 editorial, the New York Times commented that it was “disturbing” the lack of availability of health records from both the McCain and Obama campaigns. The same critique by the New York Times was directed towards both the Bush and Kerry campaigns of 2004. These calls in the press for the release of confidential medical information has been a long time coming. The presidency and the election process are inundated with instances of omission and commission of medical ailments.
A Long History Of Non-Disclosure
The health of a president is crucial to a functioning executive branch. A 2004 Gallup poll showed 96 percent of respondents agreeing, that the president’s health is essential for good job performance. The discussion of medical disclosure and its implications is not just a theoretical act; past presidents and prospective candidates have indeed engaged in withholding or even deceiving the press and public about medical ailments.
Cleveland: In 1892, Grover Cleveland was campaigning to return to the White House after being voted out by Benjamin Harrison four years earlier. During the campaign, it was discovered that Cleveland had cancer in the jaw. Its presence and severity were hidden from the public. Cleveland won the election and subsequently had a secret surgery to remove the cancerous lump. The cancer and the surgery were not disclosed until 1917.
Wilson: In Woodrow Wilson’s campaign for the presidency, he failed to disclose that he had three strokes, stemming from a circulatory disease and hypertension. Wilson won the presidency and the following reelection. In 1919, Wilson suffered a massive stroke, causing significant cognitive impairments. This event and its severity were hidden from the public. Only Wilson’s wife, chief of staff and personal physician were allowed to see him. Wilson continued in his post, with many postulating that his wife, Edith, took over her husband’s presidential duties.
Harding: The following election after Wilson, Republican Warren Harding failed to disclose a heart condition. He suffered a fatal heart attack in 1923, only two years into his first term in office.
FDR: Franklin Roosevelt’s polio was well-known in the press. However, in his third term, Roosevelt was diagnosed with congestive heart failure, pulmonary disease and hypertension. His White House doctor did not explicitly inform him, however, the physical effects would have been clearly felt. Nevertheless, he opted to run for a fourth term while the public was unaware of his rapidly declining health. He died shortly after the start of his fourth term in office from a massive cerebral hemorrhage. The public did not find out about his preexisting conditions until more than 25 years after his death.
Eisenhower: Dwight Eisenhower was able to complete his two terms in office. This was not what was expected by his doctors. Eisenhower suffered from a heart attack in 1955, shortly before declaring his candidacy for reelection. It was reported to be mild in nature to the public. His cardiologist predicted that Eisenhower had five to ten years remaining. This statement by the doctor was a deliberate falsehood. In reality, the heart attack was much more serious than reported with many of his doctors believing he would not survive a second term in office. Eisenhower was able to endure a second term, but not without incurring abdominal obstruction and a mild stroke.
JFK: In the 1960 election for president, John Kennedy knew he suffered from a severe adrenal gland illness — Addison’s disease. He was hospitalized nine times in the 1950s, many of which were related to physical ailments of the disease. However, in being asked about the disease, Kennedy said, “No one who has the real Addison’s disease should run for the presidency, but I do not have it.” He attributed his issues to a case of malaria contracted during his service in WWII. This obfuscation of the truth was echoed by his physician who indicated Kennedy did not have Addison’s disease. It was not until 2002, when the truth was learned about the extent of Kennedy’s ailments.
All of the aforementioned cases lead up to the 1972 election. Until this point, the public was ignorant and the press was passive in acknowledging the health difficulties and non-disclosure of presidential candidates. This would change with Thomas Eagleton — the first and only vice presidential nominee ever to be dropped from the ticket.
The Eagleton Affair
Senator George McGovern was riding an insurgent campaign to the 1972 Democratic nomination for president to the dismay of party stalwarts. Even though the nomination was nearly wrapped up, McGovern came to the Democratic convention on July 10th needing to fight off last stands from establishment favorites Former Vice President Hubert Humphrey and Senator Edmund Muskie. McGovern also needed a running mate — the deadline for filing was July 13th. McGovern’s top choice for a running mate was Senator Ted Kennedy. Even with the Chappaquidick incident, Kennedy remained a respected and popular figure in Democratic politics. To McGovern’s chagrin, Kennedy unexpectedly turned down the offer. Going to the backup choice, Senator Abe Ribicoff also said no. This left the McGovern team scrambling to find a suitable replacement before the 4 PM deadline on July 13th. After a few more names were crossed off the list, Thomas Eagleton’s name came up. The 42-year old senator from Missouri, Eagleton was well-respected among his senate colleagues who drew support from organized labor and Catholics. At 3:45 PM, fifteen minutes before the filing deadline, the McGovern team called Eagleton about the running mate position. The conversation lasted all of 35 seconds. The only question ever asked towards Eagleton was if there were any skeletons in his closet. Eagleton’s response was no. With that, he was offered and promptly accepted the number two position on the ticket. There were as of yet no standard procedures to performing personal background checks on potential running mates.
Even before Eagleton was officially announced as the running mate, there were rumors swirling around Washington and Missouri that Eagleton had a drinking problem and mental health issues. While the drinking problem was not true, Eagleton was hospitalized three times in the 1960s to treat depression (later diagnosed as bipolar II disorder), which included the use of electroconvulsive therapy.
Immediately after the convention, the McGovern team was informed about Time looking into Eagleton’s health issues. Furthermore, the Detroit Free Press received an anonymous tip about Eagleton’s hospitalizations. A reporter from the Free Press went to St. Louis to follow up on the leads. Eagleton’s initial response to his hospitalizations was that he was being treated for “melancholy” and “exhaustion” due to his campaigning. As more press inquiries built up, Eagleton confided to the McGovern team about his shock therapy. Gary Hart, McGovern’s chief of staff, upon hearing this new revelation was adamant that Eagleton release his medical records to him — something that was never before expected of a vice president. After speaking directly with McGovern about his past, the two immediately held a press conference where Eagleton revealed the shock therapy. In that same briefing, McGovern announced his unequivocal one-thousand percent support for Eagleton.
Instead of quashing the story, Eagleton’s revelations and McGovern’s support became national headline news. A few days after the press conference, a Pulitzer-Prize winning journalist, Jack Anderson, came out with a story alleging that Eagleton was arrested for eleven driving violations — six relating to drunk driving. The allegations turned out to be completely false, leading to a full retraction. However, this was not until after Anderson went on Face the Nation to discuss his report. The day before, the Washington Post called for Eagleton’s withdrawal from the ticket; the New York Times did the same the next day. With the press editorials came fellow Democrats calling for Eagleton’s withdrawal. One notable exception was Ted Kennedy, who urged Eagleton to remain on the ticket. Eagleton was still unwilling to release his medical records to the McGovern people for fear of something too damning would come out. However, he did facilitate a meeting between some of the doctors who treated him while he was hospitalized and McGovern. In an era of atomic weapons and political assassinations, the idea of someone with mental illness having his finger on the nuclear button, created a lot of unease, even among psychiatric professionals. On July 31st, Eagleton resigned from the ticket.
In just eighteen days, the playbook on medical disclosure and on vetting candidates had irrevocably changed. Private medical records and health history were now for the first time fair game for the press. Given the enormity of the office of the presidency, the public had a right to truly know who these candidates were. It became a matter of ethics. The public good outweighed any concerns for the privacy of a candidate. Four years later in the 1976 election, every candidate, except for Senator Eugene McCarthy, disclosed some form of his medical record. Beginning in 1980, the New York Times, led by Lawrence Altman, MD, started a tradition of interviewing candidates on their medical histories.
Non-Disclosure Still Continued
In the new era of medical disclosure, there were still instances of presidential candidates withholding and deceiving the public.
Reagan: Ronald Reagan, only in his 70th day in office, was the victim of an attempted assassination. At George Washington Hospital, it was discovered that a bullet had punctured a lung and was lodged only one inch from his heart. Reagan was quickly treated for the gunshot wound. While in the hospital, Reagan would wave in his window to indicate his recovery progress. The press would echo these sentiments, showing instances of Reagan doing better. However, Reagan was only alert for about one hour each day at first. His six month recovery often left him exhausted and incoherent. In his 1984 reelection, Reagan never outwardly exhibited frailty from the gunshot wound. Though the official medical records were never fully disclosed, Reagan biographer Edmund Morris believed the wounds were never fully healed. His health would seriously affect his functioning of the executive in the last two years of his presidency.
Tsongas: Another major incident of the health of a presidential candidate occurred in 1992. Former Senator Paul Tsongas was a candidate for the 1992 Democratic nomination. In his candidacy, Tsongas was the first cancer survivor to run for president. He was the recipient of a bone marrow transplant in 1986 to treat his non-Hodgkin’s lymphoma. During the campaign, Tsongas made his cancer story an issue, talking openly about his experience. He and his physician also reiterated that he was cancer-free since 1986. While Tsongas won the New Hampshire primary, Bill Clinton gained momentum from coming in second. After suspending his campaign, Tsongas declared that, in fact, the lymphoma reemerged in 1987 and then again during the campaign. Tsongas and his physician had flat out lied to the press and the public. He would undergo treatment around the inauguration of Bill Clinton and eventually died right before the beginning of Clinton’s second term. In an about-face of how he withheld from the public the knowledge of his health, Tsongas later advocated for full medical disclosure for all future presidential candidates.
Tsongas would not be the only cancer survivor to run for president. Bob Dole, John McCain and John Kerry have each underwent treatment for some form of cancer before winning their respective parties’ nomination. Each candidate disclosed their medical records, but in a modified and sometimes constrictive fashion. Bob Dole released a nine-page summary of his medical records. In both 2000 and 2008, McCain released over one-thousand pages of medical records for the press. However, only a select few in the press were allowed to look at the records for a set amount of time. Before finally releasing his full military medical records, Kerry just used his physician’s word of his good health as enough disclosure. The same went with Vice President Cheney, who had suffered a series of heart attacks. Even President Obama’s medical disclosure had been thin. In 2008, his campaign released a single, undated page that just indicated by a physician that he was in good health.
While certain degrees of medical information have been released since 1976, there is no uniform standard, and what is shown, leaves much to the imagination.
Disclosure Is Not Clear Cut
History demonstrates that the health of presidents has impacted and perhaps played a consequential role in fulfilling the duties of one of the most powerful jobs in the world. Woodrow Wilson was in the midst of campaigning for the United States to join the League of Nations when his stroke beset him. FDR was noted to be deathly ill at the Yalta Conference. JFK was heavily medicated with a whole cocktail of drugs and painkillers during the Bay of Pigs and Cuban Missile Crisis. It is unclear to know how history would be different if these figures were healthy. Nevertheless, a healthy president is a clear priority for voters. The extent of disclosing medical history is less clear.
On the spectrum of disclosure, Paul Tsongas represents the most thoroughly transparent end. He believed everyone running for office should disclose their full medical records as well as submit to a physical exam by a panel of chosen medical experts. In this view, the national interest and public “right to know” carries absolute weight over any other concerns of privacy. While acknowledging that medical privacy is a right, presidential candidates waive their rights when they decide to run. The right to vote also includes the right to relevant information. Just like understanding a candidate’s positions on key policies is of importance to voters in determining what kind of president the candidate would be, so too do health records provide crucial insight.
It is also important to acknowledge that, so far, all medical disclosures by presidential candidates have been voluntary, although begrudgingly in many instances. The Health Insurance Portability and Accountability Act (HIPAA) extols the sanctity of patient confidentiality. No medical records may be publicized without the consent of a patient, unless there is an immediate threat to the public. This protection is extended to everyone, even presidential candidates. Releasing medical records is to let the public into the privacy of a candidate’s life. What information is pertinent for a voter is not clear cut, and candidates may be stigmatized for medical instances that have no bearing on the functioning in office. For instance, does a candidate need to release information if she had an abortion? This medical procedure seems unrelated to judging the competency of a candidate. Yet the releasing of this medical information may create a backlash among pro-life activists and create a feeding frenzy among the press. A similar situation extends to those who test positive for any sexually transmitted disease. What is medically important information can easily be confused with what is interesting or provoking, which does not trump the right to privacy of medical records.
Though not adopted, there have been proposed standards of medical disclosure among presidential candidates. In 1994, the Working Group on Presidential Disability was formed to debate the question, “does a physician’s promise of confidentiality to a patient trump the public’s right to know?” The majority opinion of this group of medical, public policy and bioethical experts concluded that the patient-doctor relationship is of crucial importance, yet the doctor of a president has an outsized role to play in determining the mental acuity and physical virility of a president. To build off of that, for presidential elections, a suggestion was the creation of a nonpartisan group in charge of creating standards for the releasing of medical information. Presidential candidates would voluntarily disclose their medical records to this group of experts who could then make an expert opinion on the fitness of the candidate to hold the office of the presidency. A focus could be placed on the core function of actually surviving the first term in office. If a candidate has an illness that would seriously jeopardized the completion of a first-term, like that of Tsongas, then this information needs to be disclosed to the voters.
Clinton And Trump And Beyond
As seen, the medical history of the president is not a black or white issue. Its rich history in American presidential politics has often instilled controversy, deception and coyness in candidates. It has also produced a growing hunger of the press to dig further into a candidate’s personal life.
On the 15th anniversary of September 11, the focus of the solemn day was turned back towards the issue of Clinton’s health. Politico’s homepage headline, “Clinton scare shakes up the race,” described a “wobbly” Clinton who had become “overheated and dehydrated.” A video showing the candidate hobble into a vehicle only sensationalized the media frenzy of what was later noted as an pneumonia episode. For his part, Donald Trump has only released a “hastily” written one-page statement from his personal doctor that received ridicule for its terseness and hyperbole.
Neither candidate has gone far enough in their disclosure. “The medical reports from Clinton’s and Trump’s personal physicians do not suffice,” said President Obama’s personal physician of more than 22 years.
Without a standardized approach to dealing with the medical history and disclosure of presidential candidates, the issue will continue to be filled with gossip and fear mongering for 2016 and beyond. For the sake of candidates, voters, and the press, this needs to change.
