The Health of US Presidents: Fitness to Lead
By James Brewer
A call for rigorous monitoring of the health of American presidents and other leading statesmen and stateswomen has been made by an eminent medical expert, in an intriguingly documented presentation at a meeting in London.
John H Mather, a medical biographer who has studied in depth the effects of illness on many of the world’s great leaders, asserted that the history of presidential health crises had been marked by cover-ups, poor medical care or both. Acute illnesses of statesmen had often been down-played, and some presidents had hidden their medical problems.
Despite the active and sometimes aggressive role of television and the press, it was still possible to cover up a presidential disability, he said.
Dr Mather is widely published on matters of medical policy and is an acknowledged expert on the medical history of Sir Winston Churchill.
He was giving the Grace Filby Memorial Lecture, at a meeting of the Women in War Group. The event, on September 15, 2017, attracted a considerable audience to the venue, the Polish Hearth Club in South Kensington. His talk provided worrying glimpses into the way the ailments of presidents FD Roosevelt, Kennedy and Reagan were down-played at the time. He referred in passing to studies of many presidents including those of Lincoln’s melancholia, Harding’s final illness, and Johnson’s difficulties.
Dr Mather, who is based in Tennessee where he practises, declared: “For obvious reasons, hiding a serious presidential illness is politically and morally unacceptable. The health of the president is of more than personal interest to the individual holding office: his actions and judgment, each of which are influenced by his physical and mental illness, can critically affect us all.
“It becomes our business when an impairment prevents him from reacting skilfully and sensibly to a national security crisis or when chronic fatigue keeps him from taking steps to resolve serious domestic problems.
“We now have a richly detailed history of the ‘illnesses’ in the White House. Today, a vigorous press corps and our own ability to see a president in action on TV seems to make it less likely that we could have a disabled president and not know about it. Nonetheless the issue remains: what constitutes a permanent disability in a president and what needs to be done to prove it?”
He said that sometimes the doctors who provided unsatisfactory treatment also promoted the cover-up. “Cover-ups prevent us from knowing that a person is incapacitated and when he needs to be replaced, either temporarily or permanently. How can we distinguish, whether a surprise political action is a symptom of psychological turmoil or a bold masterstroke of strategy that went awry?”
He said that the 25th Amendment to the Constitution, ratified in 1967, defined the procedures for replacing a disabled president, temporarily or permanently. This provision has been used in about a dozen circumstances for temporary reasons. The commonest reasons have been when the president has been anesthetised for a diagnostic procedure or surgery.
Permanent replacement had not been invoked but it would be difficult, both medically and politically. The provision did not define what was an incapacitating disability, and this would be a problem if a president resisted efforts to remove him.
“What constitutes a permanent disability in a president, and what needs to be done to prove it?” he asked.
It might ultimately be advisable, Dr Mather said later in answer to a question from the audience, to set up a standing medical commission that went beyond the requirements of the constitution. This could monitor the presidential physical and mental health and in the total context. “It is really a serious issue, and I do not know how to resolve it,” admitted the speaker.
He said many presidents have been afflicted with illnesses that compromised their ability to govern. Their physicians had often exerted a lot of influence but their political colleagues usually had the upper hand in determining how the illness or disability was presented to the public.
In March 1981, Ronald Reagan was shot in the chest and needed hospital treatment. The constitutional transfer of power to the vice president never took place. In 1984, a diagnosis of a probable cancer of Reagan’s right colon was identified. He had a colectomy and recovered well.
In December 1986, the White House made a brief announcement that Reagan was to have prostate surgery. Little information was provided to the press except that it was for a benign condition. Apparently, it was the First Lady, Nancy Reagan, who directed a low-key release of information as she was unhappy with graphic accounts during the colon cancer episode. During these two elective surgeries, Reagan’s powers were formally and briefly transferred to his vice president in accordance with the 25th Amendment.
Six years out of office, Reagan announced in 1994 that he was suffering from Alzheimer’s disease. This unleashed an examination of his second term and whether early signs of dementia could have been detected then. It has been speculated that his inability to remember details of the Iran-Contra scandal is prime evidence. A comparison of the televised debates of 1980 and 1984 show that his later answers were more muddled with more pauses. A psychologist concluded that Reagan had early senile dementia, based on the cadence of the responses.
The early signs of Alzheimer’s disease are very subtle, said Dr Mather, and Reagan may have had some of them late into his presidency, with minor episodes of forgetfulness, not simply attributable to old age.
Franklin D Roosevelt, at the inauguration In January 1945 for his fourth term, decided on a modest ceremony on the south portico of the White House. Was this really to save money at that juncture of the war or did the president know that his health was rapidly deteriorating and that he needed to limit physical activity, asked Dr Mather.
At the ceremony, the 32nd president refused to wear a hat or his Navy cape, trying to appear vigorous and fit, but really, he was dying of hypertension and arteriosclerosis. At the end of his short inaugural speech he complained of chest pain, an angina attack. At the following reception Woodrow Wilson’s widow commented that “he looks exactly as my husband did when he went into his decline.” While his personal physician, Rear Admiral Ross McIntire (surgeon general of the Navy) knew of these chest pains he had described them as indigestion.
Until the Tehran conference in November 1943 FDR coped well with his complications from polio, but from that time his health dramatically deteriorated. He tended to let his mouth sag, his hand shook and he was losing weight.
We now know that Roosevelt’s blood pressure had been rising every year and by 1941 it had reached 188/105. In early 1944, he saw a cardiologist who found the president had hypertensive heart disease and cardiac failure. The president was given digitalis, with a spectacular recovery.
Shortly after the inauguration in 1945 he left for the Yalta summit to meet Stalin and Churchill. It became apparent to Churchill’s physician, Lord Moran, that Roosevelt “appears a very sick man. He has all the symptoms of hardening of the arteries in an advanced stage, so I gave him only a few months to live.” Lord Moran was right.
Some commentators have surmised that had Roosevelt not been so “disabled” the Yalta discussions would have taken a different direction, especially on Poland. Dr Mather said that while it seems likely that some results from the conference might have been different, the geopolitical situation with the Russians occupying vast territories in Eastern Europe would have required serious confrontations and a connivance with Churchill. Roosevelt was not medically capable in mind or body so to engage, contended Dr Mather.
FDR’s primary physician from 1933, Dr McIntire, was an ear, nose and throat surgeon recommended by President Wilson’s former physician. McIntire was assured that “the president is as strong as a horse (notwithstanding his infantile paralysis) with the exception of a chronic sinus infection that makes him susceptible to colds, that’s where you [McIntire] come in.”
At Christmas 1943 the family was shocked at Roosevelt’s gasping for breath. McIntire assured them that the president was coming down with the flu. FDR’s daughter Anna pressed for an internist or cardiologist, not just an ENT surgeon, to see her father. Now we know how important that consultation proved to be.
McIntire “was inventive in the tactics of his misinformation,” said Dr Mather. In late 1944, he told reporters that the president was suffering from “a moderate degree of arteriosclerosis although no more than normal in a man of his age; some changes on the EKG, cloudiness in the sinuses and bronchial irritation.” McIntire soon afterwards denied accusations that he had misled the public.
Dr Mather spoke of John F Kennedy who began his term at the age of 43 with seeming boundless energy and vigour. “In fact, Kennedy’s health was not good with a long series of childhood illnesses, a struggle with back pain and Addison’s disease, and insufficiency of the adrenal glands. This was little known to the public during his presidency and the full story has only recently been revealed. He became dependent on cortisone for his Addison’s disease, heavy doses of pain medications and an injected cocktail that included amphetamines.”
Kennedy was first diagnosed with Addison’s disease in 1947 and he was soon taking cortisone which steadily had to be increased in dosage. “This information was withheld as his office reported that he was having recurrent bouts of malaria contracted when he was in the Navy.”
By artful statements from physicians the concern that Kennedy had Addison’s disease was obfuscated and that was politically effective. Kennedy regularly received intravenous injections of various “cocktails” each of them including amphetamines.
During the Bay of Pigs incursion into Cuba, Kennedy had a severe urethritis as a complication of his Addison’s disease. “Did his ill health affect his ability to make prudent and sensible decisions? We really can’t be certain.”
Within weeks of the Bay of Pigs fiasco he was in Vienna, meeting Soviet leader Nikita Khrushchev. Kennedy was misinformed about the timing of the meeting and an injection of amphetamines wore off too quickly. “The meeting was a disaster for Kennedy as he just sat there taking [verbal] shot after shot, tongue-tied and totally unsure of himself. Wiser heads eventually prevailed and many of the mind-altering medications were virtually eliminated by the time of the Cuban [missile] crisis.”
Despite the strong political motivations presidents have for hiding their medical problems it has become more difficult in recent years for them successfully to hide their physical infirmities, said Dr Mather.
“Eisenhower and his press secretary James Hagerty set a precedent in providing the public with detailed information about Ike’s three major medical episodes. Succeeding presidents have been hard put to do this and some do less.
“A president who appears perfectly healthy may be masking a serious medical condition. Kennedy in the White House was the picture of youth, energy and sterling health, all the while suffering from Addison’s disease, malfunctioning adrenal glands, and a painful back for which he took strong mind-altering medications.”
Hardest to spot and evaluate were the early stages of psychological changes involving executive skills of comprehension and analysis, besides the effects of mental fatigue. “It difficult to render a judgment as there is too much ambiguity. How can we distinguish, whether a surprise political action is a symptom of psychological turmoil or a bold masterstroke of strategy that went awry?”
In the first 200 years of the republic, 43 men of middle age and older served as president. Eight died in office, and one was politically forced out. None stepped down because of illness or injury. “This is seen to be an oddity as in the general population those working in high pressure, senior executive jobs who become sufficiently disabled are expected to end their careers prematurely. Presidents of the USA have followed a different pattern, hanging on to their jobs until their terms ended.”
Of President Donald Trump, Dr Mather said that he had been made to look a figure of fun, but it should be remembered “he was a businessman, he was never in politics” until the campaign. “He is very bright, he has an IQ of 155. How bad is his narcissism? Twitter, Twitter, Twitter… but there are others in that game.”
In Mr Trump, he saw “shades of Churchill” in his stance of “I shall never, never give in.”
In a general comment on leaders, he added: “Too much power can mess up the mind.”
Dr Mather is certified in ENT surgery and as an independent medical disability examiner, has additional recognition as a geriatrician and gerontologist, and conducts evaluations of veterans applying for disability compensation and pension benefits.
He served in the US Army as a major, and retired after 30 years federal service in 2004 having held senior positions as a physician executive.
He is active in the International Churchill Society, has received its prestigious Blenheim Award, and is now president of the Churchill Society of Tennessee He was educated at Harrow Public School, trained at Middlesex Hospital, and has dual UK and US citizenship. Among other interests, he is an elected member of the International Bow Tie Society.
Of the late Grace Filby, who died in June 2016, Dr Mather said that she “left us too quickly and yet she made a significant contribution to our understanding of basteriophages, which are ultra-microscopic waterborne viruses that infect and only destroy bacteria. Upon retirement from science teaching through the benefit of a Churchill Fellowship in 2007, for which Grace was eternally grateful, she took up the study of phage therapy in many parts of Europe.
“At the anniversary of the Winston Churchill Memorial Trust, Grace was presented to the Queen at Buckingham palace, the patron of the Trust, and Grace became a lifelong Fellow.” She contributed to a review of antimicrobial resistance offering documents on how phage therapy can work, scientific information which has yet to be capitalised upon, said Dr Mather.
Dr Mather was introduced by Celia Lee – herself an eminent historian – who is joint chair of the Women in War Group.
Celia Lee cited the initial puzzlement over the shock resignation in March 1976 of Harold Wilson as British prime minister. Later it was clear that he was beginning to suffer early Alzheimer’s disease; and the timing of his announcement was designed to divert press attention from the formal notification that Princess Margaret was to separate from her husband, helping ease the embarrassment of the Queen, whom Wilson admired, over the marital split of her sister.
Dr Mather was accompanied on his visit to London by his wife Karen Rhea. Dr Rhea is a paediatrician and psychiatrist.