How To Analyze Presidential Medical Reports

This page explains how Dr. Zebra analyzes presidential-level medical reports and the beliefs that underlie his methods.

Contents:

Ground Rules ↑

"Presidential-level" refers to those who seek, hold, or, to a lesser extent, once held the presidency or vice presidency.

Anyone may issue what purports to be a presidential-level medical report, but the highest highest standards apply when a physician writes it.

Axioms ↑

(1)

Although physicians are professional men and women, when operating in the presidential sphere their integrity and sagacity can never be assumed.

Recent example: During the 2016 presidential campaign, Donald Trump's long-time private physician issued a medical report to the entire American electorate that was unprofessional in the exteme. The report purported to come from the physician, but it later emerged that he had merely signed statements that his patient had made. Why would a professional do this? It later emerged that he aspired to be the White House physician.

This was an unusual case because the attempt to dupe the public was so inept that it was immediately suspect.

(2)

If physicians want to deceive the public, they are likely to succeed.

Physician deceivers have several systematic advantages:

They have access to information the public does not.
They have technical knowledge the public does not.
They are considered personally trustworthy.
Society legally places enormous trust in them.
Unlike attorneys and politicians, who always operate in an adversarial environment where each side paints its own truth, physicians have no adversary. Physician truths are rarely disputed.
They are generally unsupervised in professional matters.
They have a shamanistic aura, a professional characteristic since time immemorial.
They are smart.
They are well-practiced at advocating for their patients in ways that take advantage of all the above.

This is weaponization of the white coat against the public. It need not be consciously corrupt.

(3)

To detect physician deceit requires deep technical acumen, deep scrutiny of the physician's precise words and actions, and deep skepticism that regards the physician as an adversary devoid of good intentions.

For those who would diagnose physician deceits, this is unfortunate, not to mention distasteful. Unlike the law, people don't go into medicine foretasting adversarial contests or duels in the English language. But when it comes to wringing honesty from people who may be hiding something important, there is no practical alternative.

Deceit Syndromes ↑

Any diagnostic challenge is aided when patterns ("syndromes") can be recognized. Thus, diagnosing deceits is aided when syndromes of deceit are known.

American history demonstrates several ways that presidential-level campaigns and physicians have deceived the public.

(1) Telling Falsehoods

No one will ever be surprised if a president or a presidential aspirant lies, whether the lie is about health or some other matter.

Example: Grover Cleveland insisted that his cancer-removal operation, as president, be kept secret. Afterwards, direct questions about his health were answered falsely.

Example: Senator Paul Tsongas had a bone marrow transplant in 1986 to treat cancer. While seeking the Democratic presidential nomination in 1992 he falsely stated the transplant had cured him, keeping secret a 1987 treatment for a recurrence. Tsongas had a reputation for honesty.

Beyond corrupt reasons to lie, physicians who believe in something greater than the truth may rationalize lying.

Civilian physicians may incorrectly believe their duty to the patient surpasses all others. (Imagine certifying Typhoid Mary, desperate for a job, as a food-handler!)
Military physicians may incorrectly believe their pre-eminent duty is to "the mission" and falsely equate that to the President's personal agenda, forgetting that their pre-eminent duty is to the Constitution.

Example: Franklin Roosevelt's death in April 1945 was a shock to the world because his physician had repeatedly and falsely proclaimed the president's health as excellent when, in fact, Roosevelt had been in terrible physical and mental shape for a year beforehand.

(2) Withholding Information

For physicians unable to lie, telling less than the full story can often achieve the same ends while troubling the conscience far less.

Example: Woodrow Wilson suffered a catastrophic, disabling stroke while President. His physician and wife kept it secret from the Cabinet, the Vice President, and the public by keeping Wilson physically isolated and out of view in his bedroom. Official papers passed to Wilson came back with his wife's handwriting.

Example: Senator Tsongas had his oncologists speak publicly about his medical history during his 1992 presidential campaign. They said he was cancer-free at the current time, not mentioning that Tsongas had been treated for a cancer recurrence after his supposedly-curative 1987 bone marrow transplant. By the end of 1992 Tsongas was being treated for cancer again.

Consultant physicians who know facts disaffirming the public report face an ethical knot. Should they say the public record is incorrect?

Example: Shot in the chest, the trauma team at George Washington University Hospital saved Ronald Reagan's life ... narrowly. Nor was his post-operative course smooth. Yet, throughout the episode the President's staff was anxious to portray him as being well, even arranging a charade in which, 13 hours after surgery, he signed legislation while in the intensive care unit, where he was disoriented. The true details emerge only months and years later.

Example: Crippled by his fifth stroke, Woodrow Wilson cannot urinate. A urologist from Johns Hopkins, seeing him in consulation, afterwards kept the stroke secret for four months, then disclosed it during a newspaper interview.

Simply not engaging with medical matters is another sub-type of this syndrome.

Example: William Taft's vice president, James Sherman was sick in 1912 and for that reason did not want to run for re-election. Taft ignored this and successfully pressed Sherman to run with him anyway. Sherman died before the election occurred, and Taft ran with a dead running mate.

(3) Technical Obfuscation

This technique relies on confusing voters by relying on technical terms or warping the definition of medical terms, ideally in a way that voters cannot comprehend. The goal is to allow strong denials -- but the electorate does not realize they are denials of a meaningless statement.

Example: John Kennedy had Addison disease, a serious illness. During the 1960 presidential contest, his campaign denied he had it by re-defining the term "Addison disease" to mean one particular, uncommon sub-type of the disease -- a sub-type that Kennedy did not have. Of note, this technical obfuscation did not for a moment fool the physicians at Parkland Memorial Hospital in Dallas, who knew enough from press reports to give Kennedy the extra steroids that an Addisonian shooting victim would require.

(4) Diverting Attention

A common cause of aircraft crashes is "channelized attention:" the pilot may be so focused on rectifying a minor problem #1 that s/he doesn't notice major problem #2 which ultimately crashes the plane. Voters and the press may be similarly distracted.

Example: The discussion of whether Senator Tsongas was cancer-free when he ran for President in 1992 displaced any discussion of side effects persisting from his earlier cancer treatments. Memorable videos of Tsongas swimming athletically helped quench such suspicions. Treated again for cancer later in 1992, Tsongas died in 1997 from cancer-treatment side effects two days before he would have finished his term, had he been elected.

Example: At press conferences reporters asked many questions about Dwight Eisenhower's heart attack. One of his cardiologists stated: "We quickly discovered that if we could distract the reporters for five to ten minutes at the beginning of these conferences we would have fewer difficult questions to answer."

(5) Deliberate Misinterpretation

Anyone who has received different medical opinions from different physicians knows that all facts in medicine can be interpreted in different ways, and that interpretations of those facts can be enormously confusing, and that interpretations can be cherry-picked to give either comfort or doubt. So, too, for presidential-level patients.

Example: Dr. Zebra remembers hearing, in 1984, a caller to a radio show gravely intoning that presidential candidate Walter Mondale had an incurable disease and should not be elected. Pressed, the caller disclosed the disease was hypertension. Though technically a correct statement, the show host rightly and abruptly cut off the caller.

(6) Not Looking

Some people do not investigate obvious issues because they fear what they may find. Others do not investigate so they can preserve plausible deniability.

Example: Six years after leaving office, Ronald Reagan withdrew from public life because of Alzheimer disease, a disease that invariably afflicts the brain long before being formally diagnosed. Reagan's frequent mental lapses, especially in his later presidential years, combined with his age and family history, had often spurred talk of Alzheimer disease while he was president, but no formal evaluation was ever done. Subsequently, retrospective analysis of Reagan's word choice and sentence structure over time has shown that the disease was present and manifesting itself while he was in office.

Example: During all his many clinical visits from a cardiologist, Franklin Roosevelt never asked a single question about his cardiac illness, which was life-threatening and highly symptomatic. This indifference markedly contrasted with his aggressive involvement in his polio care earlier in life.

(7) Not Seeing Due to Lack of Understanding

Physicians can't diagnose what they don't know.

Example: William Howard Taft had severe, obvious obstructive sleep apnea throughout his entire presidency, but in that era the disease was unknown to most physicians, including his. No one around him had any idea what was going on.

Example: It is not clear that Donald Trump's physicians understand sleep disorders.

(8) Medical Error

Though not strictly a deceit syndrome, it must always be remembered that no physician is infallible and no physician knows all of medicine.

Example: Dwight Eisenhower's heart attack was initially diagnosed, by a surgeon, as indigestion.

Doing it Right ↑

The litany of deception, above, should not suggest that honest transparency is impossible. Some presidents and their physicians have done it right.

Example: Struck by a heart attack during his first term as president, Dwight Eisenhower later described how he had decided what medical information to release: "I had been one of those who during President Wilson's long illness had wondered why the public was kept so much in the dark about his real condition, and thought that the nation had a right to know exactly the state of the president's heath. So now I had a quick reply: `Tell the truth, the whole truth; don't try to conceal anything.'" Eisenhower was re-elected for a second term the next year.

Example: One of Warren Harding's physicians, during the president's final illness, stated: "In the Harding illness we had to face constantly the attitude that we should not disclose the exact condition surrounding the illness. We determined, though, to present the actual findings as to temperature, heart rate, respiration rate, and leukocyte count, describing symptoms about which there could be no dispute, and let the physicians of the country draw their own conclusions. That was particularly important, since an incomplete diagnosis had already been passed out to the press."

Summary ↑

Readers of this website should understand that a hyper-critical eye must be applied to all presidential-level medical reports to ensure that no deceit syndrome is being perpetrated.

Physicians must understand there is nothing special about their patient, physiologically or ethically. Their professional obligation -- to always fairly represent the truth, both in private or public -- should not waver.