Of Colons and Candidates

In 1985 the American public was treated to detailed information about President Reagan’s colon when he was diagnosed and successfully treated for cancer. I wondered in a Washington Post Health Section column at that time how much intimate knowledge about a president’s, or any elected official’s, physical condition the American public was entitled to have. Aren’t even presidents entitled to some privacy? Then came the 24-hour news cycle and Monica Lewinsky’s stained dress. At that point no presidential biological material, inside or outside the body, seemed off limits.

The sad news of Senator Kennedy’s brain cancer has made the general question of balancing politicians’ privacy and the public’s right relevant again, especially in a presidential election cycle. In 1992 Sen. Paul Tsongas, locked in a primary battle with Bill Clinton, claimed he had been cured of lymphoma, but he died a day before the end of what would have been his first term, had he accomplished his White House bid. Since then medicine’s ability to diagnose and prognosticate has only grown, but in general effective interventions lag behind.

Presidents and candidates for the office do release the results of their physical exams, but this is voluntary. The press and the public have no way of knowing what information is withheld, nor exactly when it is released. For example, some cancer patients may get checked for suspicious cells every three months, but politicians may not release medical records, and even if they do, they might hand them over to the press just months before election day.

Also challenging is the question of whether the explosion of new drugs now marketed for conditions like insomnia and erectile dysfunction should be part of a presidential medical report. I have often wondered how many highly stressed candidates used Ambien or some related sleep medication, which would likely disable them for that now-legendary “3 a.m. phone call.” Or, to stay awake on 4 hours of sleep amid half a dozen stump speeches, how many use Provigil? If Bob Dole had been elected, would we have been told that he used Viagra? Would we have needed to know?

The answer to the “need to know” question for many of these new drugs is obscure because we don’t know much about the long-term effects of their use. Not only is the system for our follow-up data poor (though perhaps improving with the FDA’s new “Sentinel” program), never before in human history have so many people been on so many drugs for so long. There is virtually no understanding about how these medications might affect an individual’s mood or judgment, especially over the long term.

The question will only become more pressing as genetic knowledge information explodes. The issue is not confined to risks for maladies like cancer, stroke, or heart disease. When more is known about what genes increase the risk of depression, for example, will that screening be reported? George Stephanopoulos revealed that he used an anti-depressant while working in the White House as the Communications Director for President Clinton. There has been much speculation about the effect of steroids on President Kennedy’s mood (though it was probably positive). It is not difficult to imagine that a future president would be prescribed a mood-lightener. What would this mean for his or her conduct in office?

Many will conclude that the imponderables implied by more medical information are so overwhelming that we should not even raise these questions, and that the practice of releasing presidential health records should remain voluntary and unregulated. But when there is one serious incident that could have been anticipated by the medicine of the day, whenever that day arrives, that judgment may change.

Tags: genetics, Media, medicine

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