David Scheiner: Trump and Clinton are at that age when things start happening

COMMENT

Eight years ago, I wrote a medical report on the health of then-presidential candidate Barack Obama, whose personal physician I had been for 22 years.

That report was 276 words and described Obama's health as excellent. I was derided for issuing such a brief report, but there was nothing of significance in the medical history of this healthy, 47-year-old male.

Republican John McCain - a 71-year-old with a history of skin cancer - made nearly 1200 pages of records available for a group of reporters to review.

Today, the two major candidates for president are each almost as old as McCain was in 2008.

Having been in practice for 50 years serving a predominantly geriatric patient population, and now a septuagenarian myself, I can attest that the American people need much more medical information from these candidates.

If elected, 70-year-old Donald Trump would be the oldest person ever to enter the Oval Office, while Hillary Clinton, 68, would be a close second, behind Ronald Reagan. At these ages, stuff begins to happen.

What do we know about Clinton? Importantly, she deserves credit for issuing a useful two-page letter from her doctor in July 2015, but unfortunately that document raised as many questions as it answered.

We were told that Clinton has an underactive thyroid that is being treated with a replacement hormone and that she has a history of suffering thrombophlebitis (venous blood clots) in her legs.

This leads me to wonder if these clots were provoked by trauma or some other cause, since unprovoked clots have a more worrisome prognosis.

Around the time of her 2012 fall and concussion, Clinton suffered a venous thrombosis in her brain, and she is now on a blood thinner called Coumadin.

This is a difficult drug to control, and close monitoring of prothrombin times - a measure of how long it takes a person's blood to clot - is necessary.

We physicians should see a record of her prothrombin times to assess adequacy of control.

Being on Coumadin, she would have to avoid certain foods, such as green leafy vegetables, and avoid medications with problematic interactions. There are new anticoagulant medications that don't require such monitoring or diet and drug restrictions. Why isn't she on this more efficacious medication?

It took Clinton up to six months to make a full recovery, and for two months, she had double vision. This was not a simple concussion.

In 2013, her doctor's letter reported, her neurologic exam was normal. But that was three years ago. Concussions can cause cognitive decline. Would a current neuro-psychologic exam show any change?

This is all somewhat unfair to Clinton, however, who ends up being placed under greater scrutiny as a consequence of acting more responsibly than her opponent.

We can ask specific questions about her health because she has been willing to share some important information, even if it is inadequate. In contrast, we know nothing about Trump's health.


ABOUT CLINTON'S HEALTH

1 In 1998 Hillary Clinton suffered from deep vein thrombosis
2 The problem occurs again in 2009. She also fractures an elbow after falling
3 In 2012 Clinton suffered a stomach virus and faints. She is concussed, experiencing double vision, and it is discovered that Clinton was suffering from a blood clot.
4 Medical checks in 2013 find the effects of the concussion have been resolved. Clinton tests negative for blood-clotting disorders.
5 A medical report released in mid last year describes Clinton as a "healthy 67-year-old female". The report is by Clinton's doctor since 2001, Lisa Bardack
6 The statement says: "She has had a full medical evaluation, which reveals no evidence of additional medical issues or cardiovascular disease. Her cancer screening evaluations are all negative."


A one-page letter from his doctor - a gastroenterologist, not the type of physician who usually provides primary care - reported that Trump's "strength and stamina" were "extraordinary".

We were told "unequivocally" that he would be "the healthiest individual ever elected to the presidency". This stunningly unprofessional, hastily written letter contained only minimal medical information.

We essentially have no medical information on Trump.

It's impossible to know what questions to ask. We're told he has had "no significant medical problems". We are told that Trump plays golf regularly. We are told that his "cardiovascular status is excellent". I would very much like to see documentation of all this.

In particular, in view of his somewhat erratic behaviour during the campaign, I believe Trump also should undergo a neuro-psychologic evaluation; if normal, this would at least put an end to speculation that he has a personality disorder.

He is a septuagenarian asking voters to place him in one of the most demanding jobs on earth. We need to see his medical records.

Throughout this country's history, from Woodrow Wilson's stroke to Franklin D. Roosevelt's polio to John F. Kennedy's Addison's disease, Americans have repeatedly not been given important medical information about their leaders.

It's no wonder they are asking so many questions this year, but speculation and unanswered questions don't serve anyone very well - not the voters, not the candidates.

McCain set the standard. The medical reports from Clinton's and Trump's personal physicians do not suffice.

- David Scheiner is an assistant professor at the University of Illinois Medical School.

- Washington Post

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