(Bloomberg) -- Americans are naturally curious about the health of their president, and any sign of illness or frailty gets subjected to intense public scrutiny. That was not always the case. The US presidency has a checkered history with truth and disclosure when it comes to infirmity and maladies. Yet President Joe Biden’s poor debate performance on June 27 with former President Donald Trump — which has unleashed concerns among Democrats about his ability to win reelection, let alone serve another term — has renewed interest in just how much Americans are entitled to know about their leader’s health.
1. How much must presidents disclose about medical conditions?
There are no legal requirements imposed on the president to inform the public about his or her health. Modern-day presidents have traditionally been quite open, however. George W. Bush shared detailed medical reports. Barack Obama released full details of his health checks, including one in March 2016, shortly before he was due to leave office. Trump was not very forthcoming with details about his health when he was in office. Biden has released the results of his annual physical throughout his presidency, most recently on Feb. 28, 2024.
2. What do we know about Biden’s health?
White House physician Dr. Kevin O’Connor released a statement on July 8 that Biden, 81, sees a specialist for neurology, optometry, dentistry, orthopedics, radiology, cardiology, dermatology, physical therapy, and sleep medicine as part of his annual physical. The statement followed a heated press briefing where journalists interrogated Biden’s press secretary, Karine Jean-Pierre, about the president’s health after reports emerged that a Parkinson’s specialist had made frequent visits to the White House; according to O’Connor, those visits weren’t to treat Biden — who has not seen a neurologist outside of his annual physical — but rather military members who serve at the White House.
According to the Feb. 28 letter sent after Biden’s 2024 physical, there were “no findings which would be consistent with any cerebellar or other central neurological disorder, such as stroke, multiple sclerosis, Parkinson’s or ascending lateral sclerosis, nor are there any signs of cervical myelopathy.” The letter said the exam found peripheral neuropathy in both feet but no motor weakness. Biden has “excellent fine motor dexterity” but a subtle difference in “heat/cold sensation deficit” was elicited like in the previous year, the letter says.
Jean-Pierre said there are no plans for the president to receive a physical before the November election.
3. What do we know about Trump’s health?
Trump, who turned 78 in June, published a doctor’s note in November 2023 that stated his overall health is “excellent,” but did not share specifics such as his blood pressure or cholesterol levels. The note states his “physical exams were well within the normal range and his cognitive exams were exceptional” and that his cardiovascular studies were normal and cancer screening tests were negative. The note also says Trump reduced his weight through an improved diet and “continued daily physical activity.”
During his presidency, Trump mostly eschewed annual exams. But an unannounced, and still mostly unexplained, visit to a Washington-area hospital in November 2019 still prompts speculation that he had a health problem; Trump, perhaps inadvertently, fueled that speculation with a tweet that denied “having suffered a series of mini-strokes.”
In June 2020, Trump’s White House physician, Sean Conley, released a report saying that Trump “remains healthy.” The report also showed that Trump was obese, as measured by his body-mass index, and that he’d reduced his total cholesterol level to 167, within the normal range, by taking 40 milligrams daily of the statin rosuvastatin, more widely known under the brand name Crestor.
4. Which US presidents have had health scares?
Trump and Biden both contracted Covid-19 during their presidencies. Trump was diagnosed in October 2020, after which he was hospitalized in Walter Reed and treated with a therapy cocktail made by biotech company Regeneron. Biden tested positive twice in July 2022 and was given the antiviral drug Paxlovid, which sometimes causes “rebound positivity.”
A more dramatic health scare happened when Ronald Reagan survived an assassin’s bullet in 1981. There were divergent accounts of how badly he had been affected. Bob Woodward, in his 1987 book Veil: The Secret Wars of the CIA 1981-1987, wrote that after being released from the hospital, Reagan “could concentrate for only a few minutes at a time, then he faded mentally and physically,” and that his top aides “were intent on protecting this terrible secret and their own uncertainty” about whether his presidency could continue.
During his second term, Reagan had a cancerous tumor removed from his abdomen and four small polyps removed in a colonoscopy and also underwent prostate surgery, full details of which were given to the media. After his presidency ended in 1989, there was debate about whether he had been in the early stages of the Alzheimer’s disease that afflicted his later years.
More notorious instances of presidential ailments being kept quiet are from decades ago.
5. What are the more notorious cases?
When Woodrow Wilson suffered a paralyzing stroke in 1919 while campaigning on behalf of the League of Nations, the fact of his illness was announced but the severity of his condition was withheld by his wife, Edith, and the White House doctor. For the rest of Wilson’s term, Edith acted as a gatekeeper for all communication with him; some historians say she should be considered the first woman president.
Franklin D. Roosevelt was diagnosed with polio in 1921 and became paralyzed from the waist down. The fact of his illness was well known during his four terms as president, but he worked to project an image of a healthy and active person who had made more of a recovery than in fact he had. He used leg braces to stand while delivering speeches and asked news photographers not to take pictures of him in his wheelchair.
When Dwight Eisenhower suffered a heart attack in September 1955, his staff initially described the event as “a digestive upset during the night.”
And John F. Kennedy, while projecting an image of youthful vigor, suffered poor health during his short presidency from 1961 to 1963. It was known that he had a bad back — he’d had four spine surgeries before his election — but not that he had chronic digestive problems as well as Addison’s disease, an insufficiency of adrenal function, and that he took as many as eight medications a day.
6. How do other countries approach the issue of the leader’s health?
Most countries release details when needed, but few follow the US example in publishing so much detail. Full details of former UK Prime Minister Boris Johnson’s hospitalization with Covid-19 in April were released at the time, including during his three-day stay in intensive care, when he was given oxygen but not put on a ventilator. Former German Chancellor Angela Merkel’s health came under close scrutiny in 2019 when she suffered three bouts of trembling in just under a month and was evasive when questioned by the media. One of her predecessors, Helmut Schmidt, who was a heavy smoker, made news when he had a heart pacemaker fitted in 1981, toward the end of his eight-year term as Chancellor. And in France, Francois Mitterrand was diagnosed with prostate cancer soon after his election as president in 1981 but didn’t announce it until he underwent an operation in 1992 while still president, according to the New York Times.
--With assistance from Laurence Arnold and Guy Collins.
©2024 Bloomberg L.P.