Making tough calls on a president's health is tricky, says doc to former VP
In the spring of 2001, then-Vice President Dick Cheney, age 60, lay in a hospital bed, watching television news while recovering from a procedure to prevent another heart attack.
TV anchor Tim Russert suggested he should resign and maybe spend whatever time he had left time with his family, remembered Cheney's doctor, Jonathan Reiner, who was in the room.
"I looked at the vice president, maybe naively, and said: 'You need to understand that if I ever think you're not capable of fulfilling your job, you won't have to ask me, I'll just tell you,'" Reiner, still one of Cheney's doctors and a professor of medicine and surgery at George Washington University, told USA TODAY.
"I think that's the key thing for people caring for these kinds of unusual patients is to have the ability to be frank with them," he continued. "To provide usual care to an unusual patient."
That's the challenge right now, Reiner said, for President Joe Biden's physician, Kevin O'Connor.
Biden's health has come under increasing scrutiny since his stumbling performance in a televised debate two weeks ago. A lifelong stutterer, he has always made verbal gaffes, but those took on greater significance after the blank stares and trailing sentences of the debate.
In a statement released Monday, O'Connor responded to rumors about a neurologist who visited the White House a number of times, saying the doctor treated many patients there and had not seen the president outside of his annual physicals.
Biden's last neurological testing in February found no evidence of a stroke, Parkinson's disease or similar problem, but he has not taken or made public the results of any cognitive tests.
Reiner said if he were O'Connor, he would have had Biden, 81, checked out again for symptoms the President displayed at the debate and in other recent appearances. He would also be checking the presumptive Republican nominee, former President Donald Trump, 78, whose recent public appearances have also raised red flags, Reiner said.
"I think both candidates have exhibited behavior that would warrant a cognitive test. Period," he said.
Tension between patient privacy and public need
It may be that O'Connor hasn't given Biden cognitive tests because he doesn't want to know the results, said Reiner, adding that he knows O'Connor personally and has "enormous admiration" for him professionally.
"You have to be prepared to deal with whatever the test shows," Reiner said. "If you don't test for something, you don't have to disclose something."
That's the danger of having the President's doctor belong to the White House staff, Reiner said. The allegiance of someone on the White House staff is going to be divided between what is best for their patient and what is best for the president's team.
"Everything they say gets vetted through layers of West Wing administration before it's released ? not just in this time, but any time," Reiner said.
The president has the same legal right to medical privacy as any other patient and his care team can only release information with his permission.
When Reiner treated Cheney for the eight years of his vice presidency, Cheney, now 83, had a number of medical issues including multiple procedures, but "not a single time did the White House edit a word of what I said."
That, Reiner said, was the benefit of having him as a doctor outside the chain of White House command ? along with a patient who cared more about his own health than his political future, a willingness to be public about his health and a patient who was number two in line, not the president himself.
Most presidential physicians have been active members of the U.S. military, which gave them a measure of distance from White House politics. But that situation isn't foolproof, either, he said.
Dr. Sean Conley, who was Trump's physician from 2018 to 2021, including the start of the COVID-19 pandemic, holds the rank of Navy Commander. That's a relatively low rank, Reiner noted, for someone who might be in a position of telling the Commander in Chief he has a health problem that could prevent him from fulfilling his duties.
"Is he going to tell the president I think maybe you need to hand over the reins of power for a while because it doesn't appear that you're functioning very well?" Reiner said. "What is the possibility that that would happen? Zero."
Long history of hiding presidential health problems
Presidents and their doctors have a long track record of keeping quiet about their health problems.
In 1893, President Grover Cleveland had two secret surgeries aboard a yacht to remove a cancerous tumor in his mouth. An implant was fashioned to help replace the missing portion of his palate and enable him to speak somewhat normally.
In 1919, President Woodrow Wilson suffered a severe stroke that left him incapacitated for the remaining two years of his term. He apparently had a history of vascular disease going back 16 years before his election, which he never made public.
Franklin Delano Roosevelt's health was an issue when he ran for election to his fourth term in the fall of 1944, then age 63.
FDR quieted doubts by campaigning in an open-air car across New York City's five boroughs. Despite the pouring rain, 3 million New Yorkers came to see him and he delivered a policy address that night. He conducted similar tours and speeches in other major cities, including Chicago, Philadelphia and Boston.
But at the Yalta conference a few months later, in February 1945, both U.K. Prime Minister Winston Churchill and Soviet Premier Joseph Stalin expressed concern about Roosevelt's health. Some historians even say that he was having small brain bleeds that interfered with his ability to negotiate the treaty or remember what had been decided.
Roosevelt died on April 12, 1945 of a massive cerebral hemorrhage.
More recent leaders have had health issues, too.
President John F. Kennedy suffered from Addison's disease, a rare disorder in which the body doesn't make enough of certain key hormones. He was diagnosed at age 30, but never made that diagnosis public, though the disease remains potentially fatal.
President Ronald Reagan's Alzheimer's disease may have started before he left office in 1989. He announced his diagnosis in a letter penned in 1994, though the disease can start many years before a formal diagnosis.
And when former Massachusetts Senator Paul Tsongas ran for president in 1992, he said he had fully recovered from an earlier case of the blood cancer non-Hodgkins lymphoma and his health wasn't an issue. But after he dropped out of the race for the Democratic nomination it came to light that he was facing another bout of cancer. He died three years later.
Biden's medical record
Biden has had a physical every year of his presidency and made the results public. That has been the custom for presidents, though not required by any law, Reiner noted.
According to a Feb. 28 report on his annual physical, the President had "an extremely detailed neurologic exam," which was "again reassuring in that there were no findings which would be consistent with any cerebrellar or other neurological disorder, such as stroke, multiple sclerosis, Parkinson's or ascending lateral sclerosis, nor are there any signs of cervical myelopathy."
The report said he takes the following medications:
The statin Crestor to prevent heart disease, as do about a third of all eligible adults (far fewer than should, according to cardiologists);
The blood thinner Eliquis which also reduces the risk of heart attack and stroke;
Two acid reflux medications, Pepcid and Nexium;
Seasonal allergy medications Allegra and Dymista nasal spray.
He also has been "remarkably committed" to using a CPAP machine to treat his sleep apnea, a condition that leads to frequent waking during the night and, left untreated, has been associated with an increased risk of heart disease and early death.
The medical team also reviewed his stiff gait and determined that it "has not worsened since last year." X-rays confirmed previously diagnosed arthritis.
Trump, by contrast, has not released any medical information in years. "We don't even know how much he weighs or what medication he's taking," Reiner said.
"We don't even know what happened in November of 2019 when he was emergently taken to Walter Reed on a Saturday afternoon," he said.
The former president is visibly overweight and known to have an unhealthy diet and avoid exercise.
Neither man smokes or drinks much alcohol.
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It's reasonable, Reiner said, for anyone who is in charge of the U.S. government and military to have a full medical examination every year and for the results to be made public.
After all, he noted, pilots, truck drivers and school bus drivers have to meet certain regular physical standards, as do the Secret Service agents who protect the president.
"Why do we give a pass to the person that controls the most powerful military in the history of the planet?"
Karen Weintraub can be reached at [email protected].
This article originally appeared on USA TODAY: Presidential health is high stakes, especially for the doctors
