Presidential Race Raises Medical Records Dilemma

The gesture hardly quieted detractors when the White House, succumbing to Republican and news media pressure, issued a four-page summary of President Clinton’s medical records over the weekend, saying the president had no signs of heart disease, cancer, tuberculosis or other major killers.

The Dole campaign, noting that the 73-year-old former senator released complete results of his last two physical exams, continues to insist that Clinton do the same. A Wall Street Journal editorial decried the “Medical Records Stonewall,” charging that Clinton’s “resistance to scrutiny suggests that something embarrassing lurks in his medical history.”

Ironically, it is the oldest first-term presidential candidate ever--a senior citizen with a disabled arm and a history of surgery to remove his prostate gland and a kidney--who has taunted the baby boomer president to come clean, he of the morning jog and robust appetite.

But beyond the politicking and role reversals is a dilemma expected to grow more urgent and confusing as genetic testing gains new crystal-ball powers to peer into a person’s medical future: How much do we need to know about a president’s or candidate’s health?

Historians, political scientists and physicians are divided over the question. Some call for full disclosure of all medical records, perhaps going as far as to commission outside physicians to thoroughly examine candidates or review their records.

Others insist that presidential candidates are entitled to privacy and need reveal only those conditions likely to incapacitate them physically or mentally while in office. They argue that a full-disclosure policy could backfire, discouraging a sick candidate or president from seeking help for fear of his or her condition becoming public.

At the moment, predictions about a candidate’s future health are based on such measures as blood pressure. But on the horizon, researchers say, are genetic tests that might read in one’s DNA the potential predisposition to mental, physical or even emotional disorders.

“I hope we can agree now that that possibility is so fraught with mischief that that information should be off-limits,” said George Annas, a professor of health law at Boston University. Annas said he could imagine a scenario in which one candidate had his DNA profile done and then challenged his opponent to do the same. “That’s political blackmail and one-upmanship,” he said.

Among the advocates for full medical disclosure and independent physician review is Dr. Herbert Abrams, a Stanford University radiologist and author of “ ‘The President Has Been Shot,’ ” a 1992 book on the Reagan assassination attempt. “It’s like an airline pilot who goes through an annual physical,” he said. “It’s to protect the public.”

As an example of one “cover-up,” he said FDR’s doctors never let on that he was gravely ill with malignant hypertension while running for his fourth term in 1944--a disease that killed him months after being elected, leaving Vice President Harry Truman to take over.

Disagreeing with many ethicists, Abrams said that even HIV test results should be public. “It has to do with a 208-week contract [the president] makes with the American people” and with “the business of living out that contract,” said Abrams, who had not seen the latest Clinton medical summary and could not comment on it.

“‘In order to run for the highest office on Earth, one must necessarily give up a certain degree of privacy,” said Dr. Jerrold Post, a George Washington University psychiatrist and coauthor of “When Illness Strikes the Leader.” He added: “The public does have a right to know that the president does not suffer from an illness that could interfere with his functioning.”

Clinton, 50, who once discussed his underwear preference on MTV, had to be hounded to divulge that he sometimes has a sore back, heartburn and occasional hoarseness, among other maladies itemized in the most recent summary by Clinton’s principal physician, Dr. E. Connie Mariano.

Robert Gilbert, a political scientist at Northeastern University and author of “The Mortal Presidency,” argues that presidents are entitled to much the same privacy as other citizens. He criticizes the idea of an independent physician review of candidates’ health as being undemocratic. “I don’t think any group of fallible human beings”--i.e. doctors--”should have the power to decide whether someone can run for president,” he said. “It would diminish the political dimension of the election and make it a medical judgment.”

Medical pronouncements might cloud political choices, Gilbert said, citing John F. Kennedy’s undisclosed Addison’s disease during his 1960 campaign against Richard Nixon. If Kennedy’s ailment had been made known, the close election might easily have gone the other way, depriving America of a remarkable leader, he said.

Some note that Dole chairs a group whose mission is to ensure that people with disabilities are not discriminated against, even if they run for president. Paul Hearne, president of the Dole Foundation for Employment of People With Disabilities, said: “We strongly believe that people with a disability can do anything that anyone else can do, and it’s only relevant to the extent that there may be a particular task that the individual cannot do.” In that case, he said, “reasonable accommodation can make up for that.”

“My very strong feeling is that a person with a disability has as much right to be president as anyone else,” he added.

The disclosure issue promises to become even more charged in the future. One can imagine, researchers agree, that mere decades from now a zealous reporter or opponent could run a DNA profile on a candidate or president simply by snatching a fork he’s used and analyzing the saliva.

And what if such an analysis reveals, say, a 1-in-3 chance of developing Alzheimer’s disease over the next several years? “Predictive testing should never be a part of the state’s evaluation of individuals, whether they’re running for office or applying for licenses,” said Dr. Paul Billings, a medical geneticist and deputy chief of staff at the Veterans Affairs Palo Alto Health Care System.

“No matter how bad you think it is now,” he said of the medical records dilemma, “it’s only going to get worse” with DNA testing.

The so-called Working Group on Presidential Disability--a private, nonpartisan panel of physicians, officials and scholars--is expected to offer recommendations on the issue after its final meeting, at the White House, in early December.