Reviews | How much of our business is the health of Biden and Trump?

One of the trickiest questions surrounding this election concerns the health of the aging candidates themselves.

President Biden is 81 and former President Donald Trump is 78; the major presidential parties have never presented candidates this old. Both men have been seen as showing signs of cognitive decline, leading to calls for greater disclosure of the health status of our presidential candidates.

These arguments raise difficult questions that will not be addressed in this week's debate, but which remain increasingly relevant. How much information do our politicians owe us about their health? And more generally, as our society ages, who decides how old is too old? It is natural to assume that doctors might understand Mr. Trump's or Mr. Biden's health better than other voters. But it is not that simple.

The health of politicians has long been characterized by secrecy and political maneuvering (recall President Franklin Roosevelt, whose wheelchair was rarely visible in photographs). But these questions are even more pressing today, as social media amplifies questions about the health and fitness of public officials. Take, for example, Sen. John Fetterman of Pennsylvania, whose health was the subject of much debate when he ran for office while recovering from a near-fatal stroke. Or former President Trump's Covid diagnosis in office and the resulting, highly politicized speculation about its severity.

It is not a surprise. Much of politics is about perception, and good health is closely linked to the perception of strength. This is partly justified: the public should know whether a presidential candidate is likely to die while in office. And part of this comes from the stigma that accompanies illness and old age, in the same way that we have long confused illness or disability with weakness.

It is time for us to challenge these assumptions. People are increasingly living with diseases that were once fatal. Cancers that were once terminal can now become chronic. Illnesses like heart disease can be managed. When we examine the health of political candidates, we must consider these changing realities. It is also important to analyze the difference between a disability that requires accommodations but does not eliminate the ability to work, blindness or use of a wheelchair, for example, and a progressive and potentially fatal illness. . Age can be a life-limiting condition, but aging is a process we all go through.

However, it is almost impossible to thoughtfully assess the health of a political candidate when health information itself becomes politicized and the truth is unclear. For example, Mr. Trump was enthusiastic about his good results on the Montreal Cognitive Assessment in 2018 and recently said that Mr. Biden should take the test. But what is not clear about Mr. Trump's statements is that this is a test for dementia or other cognitive decline, not a test for aptitude. We expect any presidential candidate to succeed; it's not something to announce. Although a candidate can take stock of a physical exam performed by their own physician, it might be more helpful to receive objective data, such as laboratory results or, if the question is cognitive, more in-depth neuropsychiatric testing. If we want to demand that our politicians disclose health information, we must receive this information in a standardized way and not as an artillery weapon used by one party against another.

Age-related health information is particularly complicated. There is no test that can tell us how old is too old. And in many areas in which individuals wield considerable power, there is no official age limit or required testing to assess the impact of age. There is no official age for performing surgery, for example, nor are there mandatory cognitive or physical tests. It's up to surgeons and their colleagues to check themselves, to know when the scales are tipping and it's time to step aside.

This is inevitably a heartbreaking decision, one tied to how we all come to terms with mortality and how we define ourselves. Colleagues have told me that there are surgeons who make this decision only after not one but several bad outcomes for their patients or near misses. But it is a decision that each of us, if we are lucky enough to see old age, will one day have to make in our own way. There are countless other examples, like deciding when to stop driving or when it's time to stop living alone.

Whatever this threshold, it is different from one individual to another and changes over time. When I began practicing medicine, there were official age limits beyond which patients with organ failure were not considered for transplant. You could be a robust 75-year-old, but if you had catastrophic lung disease, you were simply too old to receive a transplant. This donated organ would serve a younger person better.

But today, many transplant programs don't have such hard and fast thresholds. Instead, we look at broader markers of health and resilience, like frailty, to determine whether patients on the fringes of what we once thought was an unacceptable age would benefit from a transplant. It's logic. But as we continue to push the boundaries, there will inevitably come a time when we go too far, for example by performing a transplant on someone too frail to benefit. Or allowing a surgeon to enter the operating room despite recognizable physical or cognitive deficits. Or even push back the age margins when it comes to our elected officials. These examples are of course all different, but they come from the same changing perception of age.

It's easy to say that 40 is the new 30, 50 is the new 40, etc. What that actually means depends on who we are. For some, that could mean decades of living between retirement and death, and for others, it could mean never reaching retirement.

Age is real. This is not to say that an octogenarian is not competent enough to become president. But presidential candidates are not required to reveal their health records, leaving the public uncertain about the impact of aging on our candidates.

This does not mean that all medical data must be disclosed, but we would benefit from relevant and consistent medical data between applicants. If we had this, we would be able to see age for what is not a political weapon, but an additional factor, alongside political opinions and experience, that we must take into account.

The history of our presidency is replete with examples of hidden illnesses, secrets, and stigma surrounding illness. But illness and aging don't have to mean weakness or hidden from public view. In intensive care, we must know the age and comorbidities of our patients to know how to best treat them, know what they are able to tolerate and when to take a step back.

As the American public, we deserve the same level of understanding about the health of our political candidates.

Daniela J. Lamas is an opinion editor and pulmonary and critical care physician at Brigham and Womens Hospital in Boston.

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