DR MARC SIEGEL: Presidential fitness and what we deserve to know
Everyone knows an elderly relative or friend with a failing memory. It is one of the least pleasant experiences in life, and as dementia progresses, and the person reaches for memories that are no longer there, feelings of frustration and uncertainty increase. Relatives and caretakers worry and may feel helpless, even as the patient themselves denies a problem and may also vary in mental acuity from one day to the next or even from one moment to the next. Gait may be affected depending on the specific diagnosis, and falls become more frequent.
Most people would agree that there is a difference in seeing the symptoms of dementia or cognitive slipping occur in someone's relative versus the president of the United States. The concern with the president of course is demonstrating a continuing ability to execute the duties of the office at the highest level. The president's yearly physical has become a yardstick to gauge that ability. This is why Dr. Kevin O'Connor, White House physician during President Joe Biden's term is under scrutiny for his reports that reassured the American public that Biden was in excellent health and fit to serve. In February 2024, he wrote, "An extremely detailed neurologic exam was again reassuring in that there were no findings which would be consistent with any cerebellar or other neurological disorder, such as stroke, multiple sclerosis, Parkinson's or ascending lateral sclerosis, nor were there any signs of cervical myelopathy. This exam did again support a finding of peripheral neuropathy in both feet."
But missing from this letter, as from previous letters on President Biden's health, was any mention of an MRI of the brain or or neuro-cognitive testing. Peripheral neuropathy or sensory loss in his extremities would hardly be a cause for concern about fitness. Further, even if there was a discussion about possible use of a wheelchair among White House insiders, as a new book, "Original Sin," by CNN's Jake Tapper and Axios' Alex Thompson suggests, this would also not be a reason to question fitness. FDR famously served from a wheelchair during World War II, even if he tried to hide it so as not to show weakness to the Nazis.
Biden's gait or feebleness would only have mattered when he was president if it were tied to a progressive neurodegenerative disorder, which Dr. O'Connor was claiming it wasn't. But was this assessment entirely accurate or comprehensive? We don't know. But what we do know, now that Special Counsel Robert Hur's audiotapes have finally been released, is that Biden was clearly suffering from periods of profound disorientation and memory loss while president involving very important events such as when his son died or when he left office as vice president. Hearing these moments on tape, as opposed to reading them on a transcript, are very sobering and are enough to question his fitness in and of themselves. Yet nothing was done except for apparent obfuscation and coverup.
There has been a long history of obscuring presidential health, from Woodrow Wilson to FDR to Eisenhower, even to Ronald Reagan, where there is still some debate about whether he began to show mild signs of cognitive impairment in his second term.
But this tawdry history of lack of disclosure doesn't make it right.
We still don't know what former President Biden suffers from. He had brain aneurysms and a bleed back in 1988 which were repaired by an open method (craniotomy) which could lead to long term cognitive problems, and he suffers from atrial fibrillation (irregularly irregular heart beat), which recent studies have shown increased risk of cognitive decline. There is a risk of vascular dementia.
Whatever the underlying cause of his periods of disorientation and memory lapses we wish him well. But we also wish the country an era of greater disclosure and transparency especially when it involves our highest office.
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