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Trump’s first full presidential physical exam, explained

(Source: www.vox.com)

Donald Trump will undergo his first full physical exam as president on Friday — an event that’s attracting an unusual degree of scrutiny amid questions about his mental health and fitness for office.

Concern about the president’s mental capacity has escalated in the past week with the publication of Michael Wolff’s book Fire and Fury: Inside the Trump White House. It paints a portrait of an individual who is not of sound mind, surrounded by people who believe he is not really fit to be president.

Coupled with Trump’s recent behavior — tweeting about the nuclear “button,” raging against Steve Bannon — Wolff’s insights have prompted some psychiatrists to renew their call for an emergency psychiatric evaluation. It’s also reinvigorated the discussion in Congress about the 25th Amendment, a process that could remove a president who is unfit to govern.

The White House has already made it clear that the biggest question about the 71-year-old president’s health — the state of his mind — will not be checked in Friday’s physical. The public is not likely to learn anything new about his physical health either. The presidential physical exam is best understood as political theater — a show of the president’s vigor and fitness — not an opportunity to reveal medical truths.

What will happen at Trump’s physical exam

Trump’s Friday physical is scheduled to take place at Walter Reed National Military Medical Center in Bethesda, Maryland, and will be conducted by Dr. Ronny Jackson, the White House physician.

A rear admiral in the US Navy, Jackson was deployed in Iraq until he was selected to be the White House physician in 2006. He’s since served in three administrations: that of George W. Bush, Obama, and now Trump. (Presidents can have their pick of White House physician, but as Stat reported, they tend to favor military doctors.)

The physical exam Jackson will give Trump will be a lot like any physical a man Trump’s age would get: basic lab tests (cholesterol, hormone, and vitamin level tests), screening tests for age-related disease (such as cancer or heart disease), and the standard slew of other health assessments like checking blood pressure, and the eyes, ears, and throat. (You can see the results of Obama’s last presidential physical here.)

The physical doesn’t include an evaluation of mental fitness — though, interestingly, if he were covered by Medicare, the government health insurance program for people over 65, the program would require that he “be checked on his cognitive functions and possible safety risks” during a routine physical, Politico reported.

What we know about Trump’s physical health and habits

As with his tax records, candidate Trump never released his medical records. And so what we know about Trump’s health has come mostly from media reports and suspicious notes from his colorful longtime doctor, Harold Bornstein.

Trump is 6-foot-3 and weighed 236 pounds the last time his weight was made public, in the fall of 2016 during a made-for-TV physical on The Dr. Oz Show. This means he’s overweight — though Politico got ahold of his New York driver’s license, and it says Trump is 6-foot-2. That would make the president obese, per his body mass index.

Trump doesn’t drink alcohol or smoke, and he sleeps about five hours per night. In interviews with the New York Times in early 2017, Bornstein revealed that Trump takes a statin to lower his cholesterol, as well as finasteride (a drug for male pattern baldness) a daily low-dose aspirin, and antibiotics to control rosacea.

On The Dr. Oz Show in 2016, Trump boasted, “I had my appendix out when I was 11, and that was the last time I was in a hospital.”

The questions Oz asked Trump about his health were based on a two-page medical note authored by Bornstein, who previously stated his patient would be “the healthiest individual ever elected to the presidency.” (The note was so bombastic, it drew widespread criticism. Even Bornstein backed away from the claim, later saying that he wrote it in five minutes while Trump waited outside his office in a limo.)

As for his eating and exercise habits, Trump reportedly doesn’t like to work out, and he favors fast food because he thinks it’s cleaner and safer than other food. According to a new book by his former campaign manager Corey Lewandowski and ex-top aide David Bossie, Let Trump Be Trump, Trump has a prodigious appetite and in one sitting ate “two Big Macs, two Fillet-O-Fish, and a chocolate malted,” the Washington Post reported.

“On Trump Force One there were four major food groups: McDonald’s, Kentucky Fried Chicken, pizza and Diet Coke,” Lewandowski and Bossie wrote. Indeed, Trump washes down his meals with a whopping 12 Diet Cokes a day, according to the New York Times.

Trump also has some extraordinary beliefs about exercise. In his New Yorker story about how Trump could realistically be removed from the presidency, Evan Osnos wrote: “Other than golf, he considers exercise misguided, arguing that a person, like a battery, is born with a finite amount of energy.”

On the campaign trail, we learned that Trump believes exercise is harmful. According to this 2015 New York Times profile, Trump said, ‘‘All my friends who work out all the time, they’re going for knee replacements, hip replacements — they’re a disaster.” Of standing and performing in front of an audience, he added, “That’s exercise.”

What we know about Trump’s mental health

When asked by reporters if Trump would be getting a psychiatric evaluation this week, White House spokesperson Hogan Gidley responded on Monday: “He’s sharp as a tack. He is a workhorse, and he demands his staff to be the same way.”

Yet even when Trump was still just a candidate, mental health professionals were speculating about his psychology and mental health — in Atlantic cover stories, in Vanity Fair, and on Twitter. There was talk about him exhibiting the personality trait of narcissism and signs of mental disorders.

Once he became president and his behavior became a matter of national security, the discussion got considerably more heated.

John Gartner, a clinical psychologist and former Johns Hopkins professor, started a Change.org petition — that now has nearly 70,000 signatures — calling for Trump’s removal based on the claim that he has “serious mental illness.”

A group of 27 mental health professionals put together a book called The Dangerous Case of Donald Trump, which offered the view that “Trump’s mental state presents a clear and present danger to our nation and individual well-being.” And the Yale psychiatrist who edited that book, Bandy Lee, recently told Vox she has advised Congress on the need for an emergency psychiatric evaluation because of the threat the president poses to public health.

Related

The psychiatrist who wrote the guide to personality disorders says diagnosing Trump is “bullshit”

Journalists have also attempted to analyze the president’s behavior for evidence of cognitive decline.

In May, Sharon Begley at Stat looked at changes in Trump’s speech patterns over decades in an effort to explain his “his tortured syntax, mid-thought changes of subject, and apparent trouble formulating complete sentences, let alone a coherent paragraph, in unscripted speech.”

She did this by asking experts in neurolinguistics, cognitive assessment, psychologists, and psychiatrists to compare Trump’s speech from decades ago to that in 2017. Their conclusion: “They all agreed there had been a deterioration, and some said it could reflect changes in the health of Trump’s brain.” CNN’s Sanjay Gupta has also zeroed in on abnormalities in his movements and speech.

Given that Trump has not undergone a cognitive, neurological, or psychiatric exam, we really have no idea whether there’s a medical explanation for his behavior. There’s also been a lot of pushback — from medical, legal, and political experts alike — on all the speculation about mental disorders and illness. As James Hamblin at the Atlantic noted, “To attribute Trump’s behavior to mental illness risks devaluing mental illness.”

Richard Friedman, a professor of clinical psychiatry and director of psychopharmacology clinic at Weill Cornell Medical College, argued Thursday in the Washington Post that we don’t even need to test Trump’s mental health because we already have ample evidence he is unfit: “Testing wouldn’t be conclusive, shouldn’t be the basis for disqualifying someone for the presidency and wouldn’t tell us anything we don’t already know. … The most accurate measure of a person’s fitness, whether mental or physical, is observable function in the real world — not the results of a fancy test or expert opinion. The fact is that Americans already have all the data they need to judge Trump’s fitness.”

We probably won’t learn the truth about Trump’s health anytime soon

When Dr. Jackson reports on his findings from the presidential physical, we might learn a few innocuous details about Trump, like whether he’s put on a few pounds since he entered the White House.

But Friday’s physical isn’t likely to reveal anything new about Trump’s health. That’s because Trump is entitled to the same patient privacy rights as other Americans, and it’s up to him what gets reported to the public. Neither the president nor his doctor is under any obligation to share complete or detailed medical records.

Presidents and presidential candidates have had a notoriously flimsy relationship with the truth when it comes to their health. Hiding a president’s medical history is pretty much the norm.

Jacob Appel, an assistant professor at Mount Sinai School of Medicine who studies the health histories of candidates, told Vox he’s convinced the public would not know if a president or presidential candidate is truly sick “until history renders its verdict years from now.”

Even if Trump did have a cognitive function test, we probably wouldn’t find out the results.

“I don’t think they would say the president is depressed or has had a stroke and has memory issues and part of the reason they wouldn’t do that is that it could imperil national security,” said Arthur Caplan, head of the division of medical ethics at NYU School of Medicine.

Looking back, we now know a number of past presidents and presidential candidates who were actually much sicker in office than the public knew. FDR’s paralysis was kept from public view, as was Woodrow Wilson’s 1919 stroke, which left him incapacitated. “His wife and his senior advisers ran the country while he was indisposed for many months,” Appel said. “The public was entirely unaware.”

That’s why Appel thinks it’s unfair that many members of the media are questioning Trump’s health while implying past presidents were perfectly healthy. “The reality is many presidents have been extraordinarily unhealthy — even at death’s door.”

More Info: www.vox.com

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