Reliable, verifiable medical records from presidential candidates – what’s so hard about that?

n May 2008, presidential candidate Barack Obama released a summary letter of his general health signed by Dr. David Scheiner, who had been Obama’s primary care physician for 21 years. Providing limited detail, the doctor found Obama to be in “excellent health” and “in overall good physical and mental health needed to maintain the resiliency required in the Office of the President.” The Obama campaign indicated at the time that it was not planning to release any further medical records, and it didn’t.

As president, Obama has periodically released health summaries publicly. The most recent report available on the White House website, appears to be from June 12, 2014, in which Dr. Ronny Jackson, physician to the president, provides two pages of detail and concludes: “The President’s overall health is excellent. All clinical data indicates that the President is currently healthy and that he will remain so for the duration of his Presidency.”

This is not a high standard of disclosure for a candidate or a president to meet, assuming that a candidate or a president is in good health. This relatively low standard is also hard, if not impossible, to enforce. John McCain, a cancer survivor in 2008, chose to give selected reporters just a three-hour opportunity to look at some of his health records, but his health did not become a significant issue in the campaign. On his campaign website, McCain posted a health summary more detailed than Obama’s. Hillary Clinton in 2008 apparently did not make any health records public (she has released tax returns for the years 2007-2014, with 2015 promised to be forthcoming).

2016 Candidates vary in providing detailed medical records

Green Party candidate Jill Stein is a doctor married to a doctor, and they have two sons who are doctors. She has not released her medical records this year, nor did she when she ran for president in 2012. She has publicly posted the first two pages of her 2015 tax return filed jointly with her husband, Dr. Richard Rohrer.

Libertarian candidate Gary Johnson, president and CEO of a medical marijuana company, appears not to have released any medical records. Of all the presidential candidates, Johnson has had perhaps the most serious physical mishap:

On October 12, 2005, Johnson was involved in a near-fatal paragliding accident when his wing caught in a tree and he fell approximately 50 feet to the ground. Johnson suffered multiple bone fractures, including a burst fracture to his twelfth thoracic vertebra, a broken rib, and a broken knee; this accident left him 1.5 inches (3.8 cm) shorter. He used medicinal marijuana for pain control from 2005 to 2008.

Former Democratic candidate Bernie Sanders released a letter from his doctor in January 2016 summarizing his “general health history and current medical evaluation.” The letter said that the Senator takes daily levothyroxine to maintain thyroid function and intermittent indomethacin, a non-steroidal anti-inflammatory medication to relieve pain. Dr. Brian P. Monahan, the Attending Physician for the Congress of the United States, concluded: “You are in overall very good health and active in your professional work, and recreational lifestyle without limitation.”

Before Republican candidate Donald Trump released any medical report, he promised that “it will be perfection.” He also wrote on twitter: “I consider my health, stamina and strength one of my greatest assets. The world has watched me for many years and can so testify – great genes!” On December 4, 2015, Trump’s doctor of 36 years issued a brief, four-paragraph letter, the highlight of which was that Trump had lost 15 pounds in the past year. Dr. Harold N. Bornstein of Lenox Hill Hospital, New York, concluded: “If elected, Mr. Trump, I can state unequivocally, will be the healthiest individual ever elected to the presidency.”

The Democratic candidate, Hillary Clinton, released her own medical records letter months ahead of the others. A two-page letter dated July 28, 2015, noted that Clinton had “a deep vein thrombosis in 1998 and in 2009, an elbow fracture in 2009 and a concussion in 2012.” (Deep vein thrombosis involves the formation of blood clots, usually in the legs, and is not life-threatening with timely treatment.) Dr. Lisa Bardack of the Mount Kisco Medical Group (near Chappaqua, New York) has been Clinton’s personal physician since 2001. She described Clinton’s recovery from the noted conditions, adding that as a precaution against further blood clots, Clinton takes an anticoagulant daily. Dr. Bardack concluded: “In summary, Mrs. Clinton is a healthy female with hypothyroidism and seasonal allergies, on long-term anticoagulation…. She is in excellent physical condition and fit to serve as President of the United States.”

Drudge dredges old news and Fox News gets sweaty

A year after Clinton’s doctor specifically addressed Clinton’s already well-publicized falls, the Drudge Report reprised the incidents as if there were something new to them. Drudge was pushing the same Hillary health narrative back in February when it failed to get traction. That was after he pushed the same theory in October, based on Clinton’s coughing during the Benghazi hearings. All the same, The Hill of August 8 passed on the re-recycled Drudge story, while noting that a “new” picture of Clinton, apparently needing help up the stairs, was taken in February. Elements of the Drudge story reprise have gone viral, and are still going viral, despite detailed debunking by sites like Mediaite.com and wonderfully extreme rants from Wonkette.com.

There’s another internet meme that, if true, would be more troubling. In this case there’s a purported leak of medical reports written by the same Dr. Bardack who wrote Clinton’s July 2015 health letter. These reports first appeared on a twitter account that was apparently taken down by its owner soon after the post. The documents have a superficial credibility, but may be fake – Snopes.com analyzes the question and calls it “unproven.” And that is a problem, because the questions are serious and need to be answered despite the political lynch mob rushing to judgment.

The diagnoses listed in these reports are “Complex Partial Seizures, Subcortical Vascular Dementia.” “Dementia” is a scary word. Clinton’s opponents are running with it, while the Clinton campaign has yet to respond more effectively than to call the attacks “shameful,” without further elaboration.

Curiously, the Dr. Bardack “dementia” documents are both dated well before her July 2015 letter affirming Clinton’s “excellent physical condition.” The authenticity of the July letter is undisputed. The earliest Dr. Bardack “report” dated February 5, 2015, discusses complications continuing from Clinton’s December 2012 concussion – blacking out, twitching, memory loss “have become worse over the last few months.” The letter refers to a diagnosis of early-onset Subcortical Dementia in mid-2013. The plan included increasing anti-seizure medication and ordering another MRI (brain scan).

The second Dr. Bardack “report” dated March 20, 2015, repeats much of the first, noting that: “Patient is being treated with both an anticoagulant and anti-seizure medications…. Patient is starting to become more depressed about her medical condition and the way it’s affecting her life…. We elected to raise the dosage on her antidepressants and anxiety medications. She advised me of her future plans and I advised her to travel with a medical team.” Strikingly omitted from the second report was any mention of an MRI or its results.

Three weeks later, on April 12, 2015, Hillary Clinton announced that she was running for President.

Does the “dementia” meme have legs? And whose legs might it have?

Sean Hannity and other Fox News folks are running one-sidedly with the Hillary Health meme. One of the frequent Fox “experts” is Dr. Marc Siegel, who was chasing the Hillary health question back in April before it was a meme in the twittersphere (@ HilsMedRecords). Fox News seems prepared to pursue this as long as it can, with Hannity hammering away and Martin Shkreli making an on-air diagnosis of Clinton’s “Parkinson’s Disease.”

But there’s another question lying in wait for the honest inquisitor and it goes something like this: so if Clinton has dementia and sounds cogent all the time, what’s up with Donald Trump who always sounds demented?

Salon was making that case back in April, quoting Trumperies like this Q&A sample from a meeting with the Washington Post editorial board:

QUESTION: This is about ISIS. You would not use a tactical nuclear weapon against ISIS?

TRUMP: I’ll tell you one thing, this is a very good-looking group of people here. Could I just go around so I know who the hell I’m talking to?

The writer, Sophia McClennen, went on to wonder:

As we scratch our heads and wonder how someone who says and does such things can still be a frontrunner, I want to throw out a concern. What if Trump isn’t “crazy” but is actually not well instead? To put it differently: what if his campaign isn’t a sign of a savvy politician channeling Tea Party political rhetoric and reality TV sound bites? What if it’s an example of someone who doesn’t have full command of his faculties?... At times it can be very hard to distinguish between extreme right-wing politics and symptoms of dementia.

McClennen goes on to analyze Trump’s behavior as potentially early Alzheimer’s, which his father had for six years before he died. She suggests that Trump should take appropriate tests to demonstrate his mental fitness. And talking about all the ways comics have made fun of the way Trump speaks, she says: “It’s not funny if he really has lost the ability to speak like a healthy adult.”

Salon on August 10 had another McClennen piece again shredding the idea of Trump’s mental competence. One of her points is that when Trump announced his health letter, he got the name of his doctor wrong (naming the doctor’s father). The son is a gastroenterologist, whose website has since been taken down.

The Constitution (Article II, Section 1) requires only that a president be a natural born citizen, at least 35 years old, and a resident for at least 14 years. There is no challenge to Clinton or Trump on a constitutional basis. The Constitution is silent on a presidential candidate’s mental or physical health. Once in office, a president’s failing health is not an impeachable offense. The 25th Amendment (Section 3) allows the president to step aside upon “written declaration that he [sic] is unable to discharge the powers and duties” of the presidency. The vice president then becomes the acting president until the president self-declares in writing the ability to resume the office. The 25th Amendment (Section 4) also provides for the removal of a president who is unaware of an inability to perform, whenever “the Vice President and a majority of either the principal officers of the executive departments or such other body as Congress may by law provide” declare in writing the president’s inability and submit it to Congress. In the event that the president disputes the inability, Congress decides.

Everything about Section 4 looks like an opportunity for serious, perhaps long-lasting chaos. We need to know now how healthy Clinton and Trump actually are. Dr. Bardack could help by saying whether the reports with her name on them are genuine. Both candidates could help by taking such medical tests and making such disclosures as are needed to answer fundamental questions about their competence now and in the future (insofar as that’s knowable). That’s what a rational electorate would expect, that’s what responsible political parties would insist on, and that’s what honorable candidates would provide.