Independent presidential health panel proposed

Recent media attention given to Senator John McCain's health evaluations and speculations about the potential health risks associated with Senator Barack Obama's smoking history underscore the deep interest U.S. citizens have in the health status of their chief executive. A better understanding of presidential candidates' health is important as voters evaluate potential fitness for executing the 'highest office in the land.'

In an invited commentary in the June 4 issue of the Journal of the American Medical Association, two University of Michigan medical historians assess the past record of presidential health and recommend a method for assuring impartial, candid health evaluations for future presidents and presidential candidates.

"Within the last seventy-five years, most of our presidents were less than precise in reporting health problems to the public," says Howard Markel, M.D., Ph.D., the George E. Wantz Distinguished Professor of the History of Medicine, and director of the U-M Center for the History of Medicine. "I believe the public would appreciate annual assessments of the sitting president and vice-president, as well as an impartial health report on leading presidential candidates."

In their commentary, Markel and Alexandra Minna Stern, Ph.D., propose establishment of a congressionally appointed, permanent, nonpartisan panel. After setting ethical standards for accessing existing health records, these multispecialty physicians, ethicists, lawyers and health care scholars would assess the records and prepare reports for the White House and Congress.

"Its non-partisan nature would free the panel of the conflict of interest that is inherent when a president's, or presidential candidate's advisors and personal physicians provide health information, sometimes quite selectively," says Stern, the Zina Pitcher Collegiate Professor in the History of Medicine and associate director at the Center for the History of Medicine.

Although strong advocates of patient privacy, the authors argue that the president is the most public of patients and the most powerful person on earth. Such individuals abnegate typical privacy privileges. In short, the public needs to know. Still, there should be privacy provisions: not all health information touches on presidential fitness for duty. The proposed panel would set consistent, ethical standards to protect non-relevant health information; these standards also would apply to any presidential candidates who volunteer to participate.

Such a panel would also augment application of the Twenty-fifth Amendment, which provides for transfer of power when a president dies or is disabled. Together with a president's physician and administration officials, the congressionally-appointed panel would work to assure smooth and consistent application of the amendment.

"In this digital age, the public expects to have timely, relevant health information about presidents and presidential candidates. Setting up a mechanism for ethical, unbiased heath report cards would deliver on this expectation and set the same standards for presidents and presidential contenders," concludes Markel.

Citation: JAMA, Presidential Health and the Public's Need to Know, June 4, 2008, 2558-2561, Vol. 299, No. 21.