As the presidential election draws closer, controversy continues over how the two major presidential candidates have handled the release of their personal health information, as well as what experts are saying about the candidates' health.
Actual knowledge of the candidates' physical fitness has come so far from letters released by their personal physicians. The first letter to be released came in July 2015 from Lisa Bardack, MD, an internist in Mount Kisco, N.Y. and Hillary Clinton's personal physician.
Bardack's letter, which is eight paragraphs long, contains both specific and general information about Clinton -- for example, it says that Clinton's most recent physical, in March 2015, found that her blood pressure was 100/65 and that her total cholesterol was 195, with an HDL of 64 and triglycerides of 69. It also notes that she is taking vitamin B12, antihistamines, and Armour Thyroid for hypothyroidism.
More generally, the letter says that Clinton "does not smoke and drinks alcohol occasionally. ... She eats a diet rich in lean protein, vegetables, and fruits. She exercises regularly, including yoga, swimming, walking, and weight training."
The letter also makes note of two episodes of deep vein thrombosis in 1998 and 2009, and an incident in December 2012, in which Clinton "suffered a stomach virus after traveling, became dehydrated, fainted, and sustained a concussion." Clinton had follow-up evaluations that found a transverse sinus venous thrombosis, and she was given anticoagulation therapy as well as glasses with a Fresnel prism to treat double vision resulting from the concussion.
"She had follow-up testing in 2013, which revealed complete resolution of the effects of the concussion as well as total dissolution of the thrombosis," the letter continued. "As a precaution, however, it was decided to continue her on daily anticoagulation" in the form of warfarin (Coumadin). Bardack concluded by saying that Clinton "is in excellent physical condition and fit to serve as president of the United States."
Letter from Trump's Doctor
Donald Trump's physician, Harold Bornstein, MD, of New York City, released a letter in December 2015 that was much shorter and lighter on details. "Mr. Trump had a recent complete physical examination that showed only positive results," Bornstein wrote in a four-paragraph letter. "Actually, his blood pressure, 110/65, and laboratory results were astonishingly excellent."
Bornstein wrote that Trump had lost 15 pounds in the past year and that he takes 81 mg of aspirin daily along with a low dose of a statin. "His PSA test score is 0.15 ... His physical strength and stamina are extraordinary." Trump's cardiovascular status is "excellent," and he has no history of alcohol or tobacco use, Bornstein added.
After noting that Trump has no cancer and has never had any orthopedic surgery, Bornstein concluded, "If elected, Mr. Trump, I can state unequivocally, will be the healthiest individual ever elected to the presidency."
That last line raised concerns for Peter Whitehouse, MD, PhD, professor of neurology at Case Western Reserve University, in Cleveland. "The physician who wrote this letter undermined his credibility by saying that," he said in a phone interview. “The physician who wrote this letter undermined his credibility by saying that,†he said in a phone interview. “Based on reading the letter, I would have doubts about referring to that physician; he has limited knowledge of the [health of] the 40-odd presidents we have had.â€
These health disclosures should be seen in the same light as candidates' income tax disclosures, Whitehouse continued. "I'd do it on a voluntary basis" -- that is, candidates shouldn't be required to disclose their health records, "but if you don't ... you're subject to scrutiny as to why not."
How Much Information is Enough?
The other experts contacted by MedPage Today all agreed that some degree of medical disclosure for candidates was necessary -- the question is, how much information to disclose? "Candidates for very high office, like president, do have an obligation to disclose if they have a serious health problem, like if they have cancer or have had a stroke." said Doug Brugge, PhD, professor of public health and community medicine at Tufts University in Boston. "If they just have risk factors -- like high cholesterol -- most of us have risk factors, so that is not such a big deal."
"As a matter of public policy, public interest and what may remain of a 'right to know' for the electorate, the medical fitness of a prospective U.S. president is important," Jay Wolfson, DrPH, JD, professor of public health, medicine, and pharmacy at the University of South Florida, in Tampa, wrote in an email to MedPage Today. "Prospective and actual public officials lose some of the private prerogatives they may have enjoyed (or presumed) prior to their entrance on the stage of public service. And being a candidate is being on that stage."
Clinton's concussion and its aftermath have been the subject of much speculation, including from physicians. Drew Pinsky, MD, discussed Clinton's medical record on his TV show in January, saying that as a result of the concussion, "she had to wear these prism glasses. ... That is brain damage, and it's affecting her balance."
Trump Also Scrutinized
Some mental health specialists have weighed in on Trump as well. Trump has "textbook narcissistic personality disorder," Ben Michaelis, PhD, a clinical psychologist in New York City, told The Atlantic last November. Howard Gardner, PhD, a professor of cognition and education at Harvard, agreed, calling Trump "remarkably narcissistic."
So many such pronouncements have been made in the press that the American Psychiatric Association reminded its members earlier this month of the association's "Goldwater Rule" -- named for the late Republican presidential candidate Barry Goldwater -- which prohibits psychiatrists from offering opinions for someone they haven't personally evaluated.
Experts were generally in agreement that clinicians of any kind should not be diagnosing either candidate from afar. "I do think it is questionable for physicians to make comments about anyone as it pertains to their health without actually personally evaluating them," said Mohana Karlekar, MD, medical director for palliative care at Vanderbilt University, in Nashville, Tenn. "Physicians must be mindful that any statement they make that includes a medical assessment will be interpreted by the general public as a valid assessment."
Neil Wenger, MD, MPH, professor of medicine at the University of California Los Angeles, agreed. "A professional would not act as a physician in this way," he said in an email. "When doing so, a physician has become a media personality or entertainer or is fulfilling some role, as did Senator Frist in the Schiavo case." Wenger was referring to Terri Schiavo, a woman in a persistent vegetative state whose husband wanted her life support removed; former senator Bill Frist, MD (R-Tenn.) argued against doing so and suggested that Schiavo might not be in a vegetative state. Schiavo's life support was eventually removed following a lengthy court battle; she was found on autopsy to have had severe, irreversible brain damage.
Case's Whitehouse also said that although diagnosis from afar is never appropriate, there is a role for historical analysis: "Historians can take a look at people's behavior and comment on likely pathologies, whether it's Woodrow Wilson's stroke or Ronald Reagan's memory loss; it's not appropriate to preclude historians from examining how the health of leaders can affect their behavior. What I'm objecting to is clinicians who don't know the person putting on clinical labels with any degree of certitude."
The Clinton and Trump campaigns did not respond to requests for comment on this story.