Health and the 2016 US Presidential Candidates

The 2016 Presidential Campaign is nearing its end; in only two weeks American voters will decide who, most likely Hillary Clinton or Donald Trump, will sit in the Oval Office. The US presidency is a hard job, with grueling hours and the need to make critical decisions at any time, day or night. Campaigning for president is itself a tough physical endeavor, one that speaks loudly of the health of the candidates. This year has been especially bitter, with accusations and recriminations more appropriate to a college dorm than to the highest office in the land.

My primary work is as a family, preventive, and sports medicine physician. During this season, many people have asked me what I think of the health of the candidates. On one hand, I am not the personal physician of either candidate. I have never met either of them, much less taken a medical history or performed a physical. Any opinion that I render is dependent on publicly available medical information and observations that I have made from afar. On the other hand, the coverage does provide a great deal of data. For the sake of my friends and readers, who have asked me repeatedly, I will give an opinion.

Donald Trump

An article on CNN dated 15 Sept 2016 states that Trump is 70 years old, stands 6’3” and weighs 236 lbs, giving him a body mass index of 29.5.[1] By medical standards, he is overweight and therefore is at higher risk for diabetes, heart disease, and various types of cancer than Americans with a BMI between 21 and 25. A recent blood pressure was 116/70, remarkably good for a 70-year-old unless he is on medication, and is fasting blood sugar is 99 (normal is around 100). Trump takes Rosuvastatin for high cholesterol and triglycerides (the fat in his blood), and recent triglyceride results were 61, which is normal.[2] He also takes a low dose aspirin for cardioprotection. Trump’s latest liver function tests, thyroid tests, electrocardiogram (ECG), and chest xray were normal. His colonoscopy (2013) and transthoracic echocardiogram (2014) were also normal. These results suggest that Donald Trump is in good health for a man his age, although I have not seen independent confirmation.

Observations are also important. The human gait changes over time, with stride length diminishing and pace slowing. Medical students are often taught that “gait is the signature of the nervous system.” Trump’s gait is essentially normal, comparable to those of other older presidential candidates such as Ronald Reagan and Bob Dole. His facial expressions and muscle movements are equal and fluid, suggesting a normal nervous system.

His posture is fair, but he rolls his shoulders in, as most people do. Thus Trump is at higher risk for shoulder weakness and chronic pain, although I was not able to find a picture of him without shirts or shoes on the internet.  Given his age and weight, Trump is at high risk for arthritis of his weight bearing joints, especially his knees, hips, and spine.

Trump’s mental health has been the source of speculation and scorn for thousands of talking heads. His statements certainly come across as arrogant, but the same can be said for most billionaires, politicians, and otherwise prominent people. Some have suggested that arrogance is a prerequisite to run for president. Though a character flaw, arrogance is not a diagnosis. Narcissism, the excessive admiration of one’s own attributes, is a diagnosis that has been applied to Trump, but could equally well be applied to most rich, famous, and powerful people.

Hillary Clinton

On 14 Sep 2016 Dr. Lisa Bardak, Hillary Clinton’s attending physician, states that the 68-year-old Clinton is “healthy and fit to serve as President of the United States.”[3] It mentions her having sinusitis and a left ear infection in Jan 2016, for which she received a CT scan of the sinuses and brain as well as antibiotics and a myringotomy tube (ear tube). Clinton received antibiotics again for a “right middle lobe pneumonia” in Sep 2016. Bardak notes that she “felt dizzy” at a 9/11 commemoration event, and gradually improved. Clinton has hypothyroidism (treated with Armor Thyroid), Coumadin (which Bardak did not explain), and vitamin B12. Her other results are as follows:

“Of note, she has remained stable for many years on Armor thyroid to treat her hypothyroidism (a low T3 level).  Her laboratory testing (vitamin D, CBC, fasting blood glucose, comprehensive metabolic panel, hemoglobin A1-C, vitamin B12) was normal, including cholesterol of 189, LDL of 103, HDL of 56 and triglycerides of 159. Her vital signs showed a blood pressure of 100/70, heart rate of 70, respiratory rate of 18, temperature of 97.8, and pulse-oximetry (oxygen dissolved in the blood) of 99%.[4]

Hillary’s publicly available health history includes the following:

Coughing fits

Coughing fits can be due to many conditions, ranging from allergies to acid reflux to serious respiratory disease. Hillary has had several episodes of these fits. She also suffers from hoarseness, which can be related. Dr. Bardak states that Clinton has had allergies for many years and that they are controlled on Clarinex, an antihistamine.[5]

Right elbow fracture

While serving as Secretary of State in 2009, Clinton fell and fractured her elbow in the basement of the State Department. The fracture had to be significant because she underwent surgery to fix it. A small, non-displaced fracture would likely have been treated non-operatively. White women are at high risk for osteopenia and osteoporosis (thin bones). Epidemiologically speaking she probably has both, and this may have contributed to the severity of the fracture. By contrast, in the 1996 campaign, for example, a 73-year-old Bob Dole leaned on a fake railing at a campaign event, which gave way. He fell three feet to the floor and hit his right side and arm but was not seriously injured.

Secretary Clinton is not thin, which lowers her risk for osteoporosis, but raises her risk for high blood pressure, diabetes, heart disease, and various types of cancer. Fortunately for her, the blood pressure and HgbA1C are normal.

A bigger question is why she fell. It could have been something as simple as tripping over a rug. Standing equilibrium decreases with age, as does vision, muscle strength, and many other factors that protect against falls. Past falls are a significant predictor of future falls.

Fainting and Traumatic Brain Injury

In late 2012, Clinton fainted and hit her head, sustaining what was then announced as a concussion. The State Department suggested that a stomach virus and subsequent dehydration caused the fall. She had chronic headaches after the fall and in December a follow up brain scan revealed the presence of a subdural hematoma, a collection of blood between the brain and the skull. This reveals that the blow to the brain was far more significant than originally thought. Her history is significant for a blood clot in her right leg in 1998, which means that she may have a genetic tendency to get blood clots easily. Clinton began taking Coumadin, a blood thinner which she continues today. Clinton’s head CT in January was probably a follow up on her brain injury in 2012.

In January 2013, observers noted that Clinton was wearing glasses with a Fresnel Prism, used to treat double vision.[6] This was likely related to the fall in the previous December.

Pneumonia and Near Collapse

While getting into a black van after a 9/11 commemoration ceremony in Manhattan, Hillary nearly fell to the ground several times. Had she not been physically held up by supporters and Secret Service agents, she would have fallen.[7] The video begins with Clinton leaning against a metal bollard with a woman holding Clinton. As Hillary moves she slumps, is caught by the Secret Service, and slumps twice more. Her head bobs several times. She lost a shoe while being whisked away. Common causes of such symptoms include dehydration, as in the earlier episode, heart conditions, and seizures. Dehydration is the most likely culprit, although Clinton’s history of brain injury elevates her risk of seizures, and her family history of heart disease is also concerning.

Sometimes Clinton’s upper body movement seems normal, and other times she seems to be supporting herself with a podium. Sometimes her step length seems normal, and other times it seems short and halting. Even at her best, such as during the second presidential debate, she looked repeatedly at her feet while walking. Each step was carefully placed. This suggests that her balance is poor and she needs visual cues to stay upright. She sat every time that she could while Trump stood without support during many intervals.

Other notes

Some may argue that the president’s health is less important because a president has access to the best medical care in the world. Having worked with the White House Medical Unit on more than one occasion, I appreciate their dedication and professionalism; working long hours and traveling anywhere with little notice. The volume and variety of patients that they see is low compared to many primary care clinics, but their training is excellent.

Whether or not presidents have access to the best medical care in the world, they certainly have access to the most medical care in the world. Powerful people tend to want to stay powerful, and since their power is related to their work, they are impatient with the healing process. They want short cuts, usually in the form of more interventions, more drugs, and more procedures. To some extent this is true of everyone, but powerful people are able to get what they want. Often this is harmful.

Health care professionals wittingly or unwittingly collude to give presidents more health care than they need. Lincoln and Garfield might have survived had their physicians, in well-intentioned zeal, not probed to get the bullets that killed them. Even Bardak’s reassuring letter notes that Clinton got more care, not necessarily better care, than most people would for the same conditions. A single ear infection, even if it is persistent for a few weeks, is not an indication for a myringotomy tube. A sinus infection is not an indication for a brain CT scan, although it may have been done because of her prior subdural hematoma. Most people with pneumonia never get or need a CT scan, and a temperature of 99.4 is not indicative of a fever (100.4 is the generally accepted cut off for healthy patients). Clinton sustained the risks of relatively high medical doses of radiation and the risks of surgery, perhaps unnecessarily. More care does not equal better care.

This is not to blame Mrs. Clinton or her team; the pressures on a presidential candidate are extreme, especially in this era of inescapable public attention. High ranking generals, sports stars, and famous entertainers are also at high risk for getting more care, not necessarily better care. However well intended, this exposes them to risks that can be a detriment to good health.

Limitations

As I mentioned above, I am not the physician for either Donald Trump or Hillary Clinton. I have never examined or even spoken to either. The information that I have reviewed is a small sample of all of the information available about these people. I am writing at the request of friends and readers. The question about the health of the presidential candidates is important.

Conclusion

Does Trump’s health disqualify him from being president? No. Does Hillary’s health disqualify her from being president? No. President William Henry Harrison caught pneumonia and died within 40 days of taking office, and it is unlikely that either Trump or Clinton will do the same. Franklin Delano Roosevelt was crippled from polio his entire presidency, a fact concealed by the media of his day, but he was an effective president. Nonetheless, just like an employer needs to know if the applicant sitting in front of her is physically capable of doing the job, voters need to know if their two applicants, Donald Trump and Hillary Clinton, are physically capable of doing the job.

Donald Trump shows no evidence of being physically unable to be the President of the United States. Voters can choose against him for a variety of reasons, but his physical health probably should not be one of them. He seems to be as healthy as past candidates of similar age, including Ronald Reagan and Bob Dole.

Hillary Clinton’s health is more concerning. She has many medical problems both past and present. Some of these are very serious. She has current symptoms possibly consistent with ongoing neurological impairment. She does not appear to be as healthy as past candidates of similar age. Voters will decide if Clinton is healthy enough to receive their vote.

Whichever candidate wins, time will tell if they were healthy enough to serve as president.

 

[1] http://www.cnn.com/2016/09/15/health/donald-trump-health/index.html

[2] http://www.nytimes.com/2016/09/19/us/politics/donald-trump-health.html?_r=0

[3] https://m.hrc.onl/secretary/10-documents/05-physician-letter/HRC_physician_letter.pdf

[4] https://m.hrc.onl/secretary/10-documents/05-physician-letter/HRC_physician_letter.pdf

[5] https://m.hrc.onl/secretary/10-documents/05-physician-letter/HRC_physician_letter.pdf

[6] http://www.foxnews.com/health/2014/05/16/ophthalmologist-weighs-in-on-clinton-glasses-spectacle.html

[7] http://nypost.com/2016/09/11/hillary-clinton-has-medical-episode-at-911-ceremony/

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Do We Hate Our Bodies?

The other day I read an article written by a hospice chaplain from South Carolina entitled “What the dying really regret.” The author interviewed an elderly woman who was dying of cancer, who said:

“I know I’m supposed to hate my body…Everyone told me — my family, my school, my church. When I got older, magazines and salesgirls and boyfriends (told me), even if they didn’t say so out loud. The world’s been telling me for 75 years that my body is bad. First for being female, then for being fat and then for being sick…But the one thing I never did understand is, why does everyone else want me to hate my body? What does it matter to them?” Kerry Egan, CNN, 17 Oct 2014

The author concluded that the dying regret losing their bodies, and that makes the fact that society teaches us to hate our bodies all the sadder. Bodies decay over time; my grandmother memorably said that she felt like an 18 year old girl in an 80 year old body, but they are still the only thing that connects us to the material world.

Do people hate their bodies? Sometimes, yes. As a sports medicine physician I take care of anorexic athletes, thus far all female, in their teens and twenties, who perceive themselves as fat though they are wasting away. As a family medicine physician I have treated obesity in thousands of patients, including counseling them on how not to hate themselves for their weight. As a preventive medicine physician I have dealt with the larger problem of populations, whole groups of people, abusing their bodies and living unhealthy lifestyles in part to compensate for self-dissatisfaction. As a Christian minister I have counseled people who struggled with terrible feelings of inferiority, in part because of the look of their bodies.

Are people taught by society to hate their bodies? Often, yes. Advertisers use all of the formidable tools of psychology and manipulation to convince people that they are inadequate so that those people will buy their product in the (ultimately vain) hope of becoming adequate. The messages are compelling;

  1. You won’t find love in the world because you teeth aren’t white enough, so buy this product.
  2. You can’t be happy because your hair is too gray so buy this product
  3. Your will never be healthy and will die young because your body is too fat so buy this product.
  4. Look at the phenomenally beautiful woman (who is a genetic rarity, eats nearly nothing, works out constantly, and has an army of people to help with her hair, makeup and clothes) in this picture (which has been airbrushed and edited to eliminate any flaw)! Why can’t you look like her?

In the past this drum beat came to us through radio, television and print media but since we did not have these with us constantly, we had a respite from the message. Now with smart phones and other portable devices, we have no relief from hearing all that is wrong with us, physically and in every other way.

Other people, often trying to make themselves feel better about their bodies, denigrate ours. The interviewee referred to men and women alike telling her, with and without words, and even with and without meaning to, that her body was bad. From trade in jade and silk between Europe and China in 2000 BC to modern body shaping underwear, fortunes have been made selling people things to try to make them more beautiful.

Sometimes even the church teaches people to hate their bodies. In Romans 7, Paul anguished about the sin in his own life, discussing the fact that sin is present in his flesh. He concluded with the statement “Wretched man that I am! Who will set me free from the body of this death (V24)?” The obvious conclusion is that the physical body is wicked and the spirit is good. Since we should hate sin, we should hate our bodies.

However obvious, this conclusion is absolutely wrong, rooted more in Platonic dualism and in Gnostic hatred of the material world than in Christianity. Furthermore it is not at all what Paul meant. The Hebrews recognized that God created the universe, including our bodies, and that His creation was good. They had a healthy respect for the body and had no concept of a disembodied life after death as the later Greeks did. Beginning around the time of Daniel, Jewish thought included bodily resurrection from the dead, not ghosts floating around the universe forever.

As heir to this heritage, Paul had the highest regard for the human body. He called it the temple of the Holy Spirit and taught his students to honor it (1 Corinthians 6:18-20). Paul told his disciple Timothy that though not as valuable as godliness, physical exercise was profitable (1 Timothy 4:8). His statements in Romans 7 were not that the material body was wicked, because the body was as much a victim of sin as was all creation (Romans 8:19-23). Rather, Paul wanted to be delivered from sin. If the body was the source of sin, the most effective (and macabre) way to deal with sin in life was to eliminate the body. The Bible never teaches this.

Another common misconception is that Christianity teaches women to be ashamed of their bodies because sexuality is wicked and their body might cause someone else to sin. First, sexuality was created by God and nothing that He made is evil. Second, the entire Biblical book of Song of Solomon is devoted to romantic love, the courtship and married life of a young couple. The book glorifies human love in the context of a man and woman married for life. Only outside this context does Scripture discourage sexuality. Third, when a man looks at a woman and lusts after her, that sin is his, not hers. However if the woman dresses immodestly because she wants to provoke envious or lustful thoughts in others, that sin is hers. The key is for men and women to dress in a way that pleases themselves while being more concerned with others’ needs than with his/her own, and being more interested in personal character than in physical appearance.

The body is our connection to the natural world, the place where we laugh, love, and live. It enables us to feel cool breezes on hot days, embrace our families and friends, taste delicious foods, and smell fragrant flowers. The body allows us to think, to speak, to work, and to serve God and others in the world; doing His work so that others may know Him. God made creation for His glory, for our care and for our enjoyment, and He gave us bodies to be a part of it. Someday we will lose our earthly bodies, and then regain them, clothed in glory and incorruptible, in the new earth.

Though advertisers will continue to tell us that we are never good enough, and some other people will forever try to build themselves up at our expense, our Creator tells us that He loves us infinitely as we are, regardless of how we look and what we can or cannot do. The Church can never teach its members to hate the body, and each pastor, leader and teacher must have the right understanding. If we are to love the Lord and love our neighbor, we can do no less.