Sunday, October 19, 2008

Kennedy and Addison's Disease


kennedy The picture of health: Back pain forced President Kennedy to use an Air Force lift to board his plane. Voters never knew the extent of his ailments. (AP Photo/Harold Valentine)

A Hale Chief? Better Check Up on That.

By Robert Dallek
Sunday, October 19, 2008; B03

The American public seems pretty sure that it knows everything it needs to know about whether John McCain and Barack Obama are healthy enough to be president. I'm not. And whenever I think about whether both men are fit to serve, physically speaking, I think about the sinking feeling I had one lovely spring afternoon in 2002 when an archivist at the John F. Kennedy Presidential Library wheeled out the cartload of files showing how badly we had all been deceived about JFK's health.

The secret details of Kennedy's medical history were buried in 10 beat-up old cartons of records the library had held for 40 years. Past requests for access to these materials had all been refused by a committee of loyalists that included one of JFK's closest advisers, speechwriter Ted Sorensen. To my surprise, the committee had given me the chance to read the files; I had to agree not to photocopy them but was free to take notes or read passages into a tape recorder. Now I -- along with a physician friend, Jeffrey Kelman -- felt as if I were breaching a wall of secrecy. Here were not the usual neat boxes of presidential records, preserved in red-blue-and-silver-trimmed containers, but musty cardboard cartons that seemed to have sat untouched in some corner of the library since Janet Travell, one of Kennedy's physicians, had given them to the library after JFK's assassination in November 1963.

Between May 1955 and October 1957, Kennedy had been hospitalized nine times for a total of 44 days, including one 19-day period and two week-long stretches. Despite his public image of "vigah," as his accent rendered it, he suffered from bouts of colitis, accompanied by abdominal pain, diarrhea and dehydration; agony in his back triggered by osteoporosis of the lumbar spine; prostatitis, marked by severe pain and urinary infections; and Addison's disease, a form of adrenal insufficiency. Some of his difficulties, such as his back pain and Addison's, were open secrets among the press corps during his 1960 run for the White House, but the extent and severity of his problems -- to say nothing of the promiscuous variety of medications and doctors he relied upon to maintain his health -- had remained undisclosed. That's largely because the Kennedy campaign made every effort to hide his health problems -- obviously convinced that these disclosures, combined with his youth and Catholicism, would sink him.

Kennedy was following in a little-known but troubling tradition in American politics -- and one we should remember when we assume that McCain and Obama have told us everything we need to know. Since that day at the Kennedy library, I have been advocating the full disclosure of all presidential candidates' medical histories, physical and psychological, in no small measure because the Kennedy campaign's deceptions were in line with the deceits or shadings offered by Woodrow Wilson and Franklin D. Roosevelt during their own presidential bids.

Unbeknownst to the public, Wilson had suffered several small strokes before he ran in 1912 and continued to suffer them while in office; they proved to be preludes to a massive stroke in September 1919 that left him with a paralyzed left arm and leg and limited cognitive function. He could not stay alert for sustained periods of time or keep anything resembling a normal presidential work schedule. But the White House hid, as best it could, the extent of the president's incapacity from the public. Even though Wilson still had 18 months remaining in his term, which was being dominated by an economic recession and widespread fears of radicalism provoked by the Bolshevik revolution in Russia, the press, foolishly, deferred to the president's desire for privacy. White House subordinates declined to reveal the truth about the president's condition -- an amazing display of recklessness.

The public did not fully understand how badly Roosevelt's health was failing when he ran for a fourth term in 1944. He died the following April, during the waning months of World War II, of a cerebral hemorrhage brought on by arteriosclerosis. When Winston Churchill's physician saw FDR at Yalta in February 1945, the British doctor predicted that the president would be dead in a matter of months. After his death, shocked Americans wondered whether he should have run again in 1944 and whether he had performed as effectively as he might have at the Yalta conference with Stalin.

If Wilson, Roosevelt and Kennedy had fully disclosed their health problems, it might have cost them the Oval Office. Wilson would have been pressured to resign, something he considered doing in January 1920, and turn the presidency over to his vice president, former Indiana governor Thomas R. Marshall. Wilson's and his closest advisers' decision to keep the president's disability secret was an undemocratic abuse of presidential power.

If FDR and JFK had allowed the public to know about their own health problems in 1944 and 1960, respectively, they might well have lost. Then again, Roosevelt's hold over the electorate remained considerable, so he might have prevailed. And if JFK had leveled with the public about the pain he bore, he might have been seen as heroic for achieving so much despite his suffering.

But such calculations are beside the point, then and now. Politicians' political problems are their own. Their health problems belong to all of us, and if candidates don't like that, they need not run for president. It was and is the public's right to have the fullest possible information about a potential president's physical condition. If you want to be the most powerful person in the world, you will also have to be one of the least private. Voters deserve to know the full picture -- no ifs, ands or buts.

Those who squirm at this standard often point to the examples of Abraham Lincoln and Winston Churchill, both of whom suffered from depression, and argue that these titans might never have taken office if they had offered full disclosure of their emotional struggles. I do not take so dim a view of the electorate and believe that American and British voters would still have recognized their greatness. Democracy rests on informed decision-making, and I see no decent argument for secrecy -- especially if we may be passing the world's largest nuclear arsenal into ailing hands.

So on Oct. 3, when I read a full-page ad in the New York Times by 2,768 medical doctors calling on John McCain to release fully his health records to the public, I cheered. The voters' judgments should rest on the fullest possible information about the presidential candidates' potential performance in office. The fact that McCain could be our oldest elected president, a 72-year-old man with a history of skin cancer and a largely untested running mate, makes it all the more urgent that we know more about his health before voting. It's admirable that he shared 1,173 pages of his medical records with a small number of reporters during a three-hour period in May. But the limits the McCain campaign imposed on the review of those materials -- the eyebrow-raising time constraints, the exclusion of a New York Times reporter with an M.D. from the pool, the refusal to permit photocopying -- raise questions about what medical experts might find if given unrestricted access.

The requirement for full disclosure should apply to Barack Obama as well. His campaign has released only a single page of information about his health history. He is just 47 and seemingly in excellent health, but nobody is immune from illnesses that voters might want to take account of in November. And remember, we all thought JFK was the picture of youthful vigor, too.

Advances in modern medicine and in public understanding of diseases suggest that someone with a history of cancer or some other life-threatening illness need not be seen as barred from serving as president. But in an era when presidents shoulder such staggering responsibilities, voters in the United States -- and people around the world -- are entitled to know as much as possible about the person who will have so much to say about all our lives and futures.

Robert Dallek is the author of "An Unfinished Life: John F. Kennedy, 1917-1963." His latest book is "Harry S. Truman."