Presidential Illness: Give the People What They Want

Even presidents get sick. This should come as no surprise, given the circumstances.

First of all, despite the energetic arm waving and sweet campaign jams (whether endorsed by the artists or not) US presidents are− by and large− old. The average age of a president at election is nearly 55. That may not sound old, but bear in mind that’s the average from 1789 to 2008; for most of that period, life expectancy was well below 55. As recently as 1900, the overall (male and female) life expectancy was about 49.8 The current life expectancy for American men is around 76.4 (When we finally elect a female president, she’ll have until 81.4) Add the long hours, extended travel and stress of being Commander-in-Chief, and you have the perfect recipe for ailment.

Acute (sudden and severe) illness has cut several presidencies short; four presidents have died from sickness while in office. Many more have suffered in silence, laboring with the burden of chronic (long-lasting, non-infectious) disease. With one exception (I’m looking at you, Woodrow), illness did not affect the president’s cognitive or leadership abilities, but was concealed nonetheless. At times, extreme measures were taken to minimize the appearance of illness, sometimes covering it up entirely.

Calling in sick to the (oval) office

At least two presidents have had major medical procedures to treat chronic illness while in office: Grover Cleveland and Dwight D. Eisenhower.

In what has to be one of the most amazing medical maneuvers of all time, Grover Cleveland underwent a clandestine surgery to treat mouth cancer near the beginning of his second term in 1893. To pull it off, he arranged for his surgery to take place on a friend’s yacht in Long Island Sound, using the cover story of a month-long fishing trip. The surgery took place in the refurbished saloon of the boat, where he had several teeth and part of his jaw removed. To ensure there was no noticeable difference in either his appearance or speech, he was fitted with a prosthesis and continued to cultivate his trademark mustache. He never relapsed and the surgery was not officially acknowledged until 1917, nine years after Cleveland’s death.1,5

Dwight D. “Ike” Eisenhower had a massive heart attack in 1955, about midway through his first term. It was likely the result of chronic heart disease; it may not have been his first, or even his first as president. The public was informed, but the severity of his condition was substantially downplayed. In fact, efforts to keep Ike’s condition secret may have actually endangered his life: his doctor waited a full day to seek outside medical assistance, for fear of political repercussions. Ike also suffered chronic gastrointestinal issues throughout his military and political career. Intense intestinal pain brought Eisenhower back for a second surgery in 1956. The public was told that the results were normal, but that was far from true. The surgery revealed adhesions suggestive of Crohn’s or inflammatory bowel disease.3

Two of the most beloved (and boldly initialed) American presidents, FDR and JFK, also suffered from serious chronic illness that they attempted to conceal. JFK had a slew of troublesome medical conditions that he publically denied, including Addison’s disease, colitis, ulcers, and a degenerative back issue.2 Roosevelt contracted polio in 1921, and the disease left him paraplegic. He initially tried to hide his condition, but it was eventually leaked to the press. In response, the president underwent a medical exam to dispel fears about his health. Despite the fact that his condition had become public knowledge, FDR never allowed media photographers to take his picture while he was in his wheelchair. Instead, photo ops and public events were carefully planned so that he used a seat that was not reminiscent of his condition, like his iconic convertible7.

fdr disease
What. A. Boss.

Patient-in-Chief

Everybody gets sick, so why all the secrecy and subterfuge?

Well, it’s politics. Image is everything, and any display of vulnerability is an invitation for an attack. Illness− even when it is chronic and does not affect job performance− can be seen as weakness and weakness is fatal in politics. No president has wanted to be viewed, either at home or abroad, as a Patient-in-Chief− a sick old man past his prime.

But the shows of vigorous good health were not just for fellow politicians. In all of these cases, it was thought that admitting the complex reality of the President’s health would not only minimize the effectiveness of the president, but also destabilize the country. It was taken as given that the admission of chronic disease would inspire uncertainty in the public, that the people would also see illness as weakness and reject it.

We, the People

It’s reasonable to be concerned about an ill president’s capacity to perform the duties of the office. However, in the history of the American presidency only one president has been incapacitated by illness, Woodrow Wilson. Wilson had a major stroke that left him bedridden and unable to sign his own name, but neither Congress nor the American people were informed of his condition. For the next 17 months, until Wilson left office, essentially no one was allowed to see the president, and nearly all communication was relayed through his wife, Edith.6 Disconcerting, to say the least. But, in an era with TV and Twitter, repeating this maneuver would never work. (I know, never say never, but seriously: never). Not only that, there are now procedures in place for passing presidential duties on to the Vice President in such circumstances, thanks to the 25th Amendment (passed by Eisenhower, BTW).6

Instead, the evidence actually shows the opposite: chronic disease and disability do not make a person incapable of meeting the demands of the presidency. Collectively, the presidents mentioned here successfully led America through some of its most trying times: financial crises, WWI, the Great Depression, WWII, and the Cuban Missile Crisis. They were taken seriously by their peers, both nationally and internationally, and they handled some seriously challenging situations with nothing short of grace. Three (FDR, Eisenhower, and JFK) routinely rank in the top ten greatest presidents.

While it is certainly not commendable that these men concealed their health issues, it is understandable. They were combatting their own fears of disgrace and disgust by attempting (albeit misguidedly) to give the people what they (might have) wanted. They were striving to fit an unrealistic ideal of youthful experience. However, I’d like to think that their concerns too were unfounded. We will never know if honesty would have damaged or ended their careers, but I hope not. Maybe Americans would have seen the bravery and endurance these men evinced. And, when a candidate finally runs for office openly admitting a chronic condition, maybe they will see strength in his or her suffering and admire it, knowing that there is− as FDR famously said− nothing to fear but fear itself.

References

  1. Cashman, EC, & C. Timon. 2011. Otolaryngology and the American presidency: a medical legacy. ORL, 73:105-109.
  1. Dallack, R. The medical ordeals of JFK. The Atlantic, Special Issue. Web. 4 September 2015.
  1. Gilbert, RE. 2008. Eisenhower’s 1955 heart attack: medical treatment, political effects, and the “behind the scenes” leadership style. Politics and the Life Sciences, 27: 2-21.
  1. Life expectancy. Centers for Disease Control and Prevention. 20 January 2015. Web. 4 September 2015.
  1. Maloney, W. 2010. Surreptitious surgery on Long Island Sound: the oral cancer surgeries of President Grover Cleveland. New York State Dental Journal, 76:42-5.
  1. Menger, RP, CM Storey, B Guthikonda, S Missios, A Nanda, & JM Cooper. 2015. Woodrow Wilson’s hidden stroke of 1919: the impact of patient-physician confidentiality on United States foreign policy. Neurosurgical Focus, 39:E6.
  1. Meschia, J, BE Safirstein, & J Biller. 1997. Stroke and the American presidency. Journal of Stroke and Cerebrovascular Disease, 6: 141-143.
  1. Rosner, M. 2015. Life expectancy. OurWorldinData.org. Web. 4 September 2015.

Image source: Creative Commons, https://en.wikipedia.org/wiki/History_of_segregation_in_the_United_States_Armed_Forces

Ebola Epidemic: Fearbola

Aliases: Ebola hemorrhagic fever, Ebola virus disease, EVD, Ebola

Ebola virus disease (EVD) is one of the most virulent illnesses in the world, and the current outbreak is the largest ever recorded. As of July 30th, the Ebola epidemic had spread to include 4 countries in West Africa (Guinea, Liberia, Sierra Leone, and Nigeria), and there had been 1440 suspected and confirmed cases and 826 suspected case fatalities, amounting to a fatality rate of about 57%3 (for the latest update, here is the CDC outbreak site). In light of the seriousness of the situation, I thought it time for an exploration of the facts about this epidemic and the disease itself.

Where does Ebola come from?

Ebola outbreaks have occurred in waves since the disease was first identified in 1976 in the Democratic Republic of Congo, near the eponymous Ebola River1,3. While several animal species can carry the virus (see the Cause section below), they are thought to be accidental hosts, like humans. Although the natural host and disease reservoir remains unclear3, it currently considered to be fruit bats in the Pteropdidae family1. There are 5 species of Ebola virus, only 4 of which cause disease in humans1,3. The species vary widely in severity, with case fatality rates ranging from about 25% to 90%.

Why is this outbreak so bad?

The current Ebola epidemic is of the most lethal species, but that isn’t the only reason it has been so difficult to control. This is the first outbreak to occur in the affected region of West Africa, and medical professionals there were largely untrained for an Ebola epidemic. They were also short-staffed; there was a shortage of health workers on the ground. Most previous epidemics have happened in more rural areas, whereas this outbreak has struck fairly urbanized regions. With greater infrastructure comes greater travel, and people are better able to move the disease long distances, making potential cases harder to track2.

Fear has aided the disease. The belief that health workers are spreading the illness has made people unwilling to report cases. Relatives are also hesitant to report their loved ones for fear that they will be taken away to die alone. Compassion and cultural practices have also played a role; the care of sick relatives and funeral practices put the healthy at risk2.

Fear of the epidemic spreading to North America has ratcheted up with the return of Dr. Kent Brantly, an American aid worker, to the US for treatment after he contracted Ebola in Liberia. The CDC has been quick to nip these concerns in the bud, reiterating that 1. Ebola is not airborne, 2. Ebola is not waterborne, and 3. Ebola is controllable in US healthcare settings.

ebola epidemic
Mugshot.

Cause: EVD is (re)introduced into human populations through close contact with the bodily fluids of infected animals (this can include gorillas, chimpanzees, monkeys, fruit bats, forest antelope, and porcupines). It is then transmitted from person to person by direct contact (through broken skin or mucous membranes) with the bodily fluids, such as blood, secretions, or semen, of an infected person. It may also be transmitted indirectly, through contact with a contaminated environment. Recovered patients can remain infectious long after they return to good health; the virus has been found in the semen of male patients up to 61 days after recovery1.

Consequence: After an incubation period (the time from exposure to the onset of symptoms) of 2 to 21 days, patients will initially experience fever, extreme weakness, headache, muscle pain, and sore throat. As the disease progresses, the sick will develop a rash, diarrhea, vomiting, impaired kidney and liver function, reduced white blood cell and platelet counts, and, in the most extreme cases, internal and external bleeding1.

Cure: There is no vaccine or treatment for EVD. Outbreaks are controlled using quarantine and other transmission prevention measures1,3.

References

1. Ebola virus disease. World Health Organization. April 2014. Web. 3 August 2014. http://www.who.int/mediacentre/factsheets/fs103/en/

2. Osterholm, MT. “Why it’s harder to contain this Ebola epidemic”. Chicago Tribune. 4 August 2014. Chicagotribune.com. Web. 3 August 2014.

3. Outbreak of Ebola in Guinea, Liberia, Sierra Leone. Centers for Disease Control and Prevention. 3 August 2014. Web. 3 August 2014. http://www.cdc.gov/vhf/ebola/outbreaks/guinea/index.html

Image source: Creative Commons, http://ceb.wikipedia.org/wiki/Pteropodidae