AMA Journal of Ethics^®

Media stories this past August that used such terms as "unbelievable," "competitive," and "a good role model" in describing President Bush were reporting not on his handling of international affairs, running of the country, or even his approval rating among voters.¹ The superlatives referred to Mr. Bush's health and physical condition. The reports appeared following Mr. Bush's annual medical exam at the National Naval Medical Center in Bethesda, Md. Readers were informed of the President's height (6 ft), weight (189 lbs), blood pressure (106/70), heart rate when resting (44 beats per minute) and after running on the treadmill for 27:03 minutes (169 beats per minute), his body fat (14.4 percent), his high- and low-density lipoprotein, the latter, "near optimal."² On and on the report went, listing triglycerides, C-reactive protein, thyroid tests, and PSA level. It concluded by stating that Mr. Bush's TB skin test "showed no evidence that he has been infected by the bacterium."² Given the privacy of the patient-physician relationship, the presence of so much medical information in the news means that, first, the media figured the American public wanted to know, and, second, the patient—President Bush—consented to release of the information.

Such disclosure is a recent phenomenon. After a long tradition of silence about the health of our presidents, the public was told about Dwight Eisenhower's heart attack in the 1950s and Lyndon Johnson's gall bladder surgery in the '60s. The '70s brought presidential candidate George McGovern's replacement of his running mate Thomas Eagleton when it came to light that Eagleton had been hospitalized for depression. After that, disclosure of medical records became a sign that one had nothing to hide. Law professor George J Annas, who has written about the role of political candidates' medical records in their campaigns for office, points out that the releasing of medical information started to resemble a competitive sport after Senator Paul Tsongas's 1992 candidacy.^3,4 The first presidential candidate to announce that he had had cancer, Tsongas offered to submit to examination by an independent panel of physicians if the public wanted proof of his cancer-free state. Tsongas believed he was setting a precedent for the level of health information disclosure by candidates. "To the extent that Tsongas was right," Annas says, "presidential candidates wind up playing a public game of chicken with their medical records and thus their medical privacy."⁵

And "to the extent that Tsongas was right," President Bush has set the bar at a height not many presidents or candidates will be willing to challenge. The New York Times article that recounted all the levels and measurements noted above also informed readers of Mr. Bush's "high frequency hearing loss in both ears from 4,000 to 8,000 kilohertz" and told us that "the small harmless red blotches that appear on Mr. Bush's nose are due to widened capillaries resulting from sun exposure."² Imagine a president of 60-something years; how long would a thorough description of hearing and sight losses, and of "harmless" discolorations (A.K.A. liver spots) be? Who would consent to such disclosure? If the level of medical record disclosure were to discourage a qualified candidate from pursuing office, it would be acting against public interest.

There may be another motive for the disclosure of medical records. Writing about "the health of the president and presidential candidates" in 1995 (long before George W's stats were published) Annas says, ". . . to the extent that cholesterol levels and weight are used as measures of virtue, all this is nonsense and is likely to distract us from focusing on the substantive policy differences between the candidates."⁶ There is evidence that some people, at least, are making the equation between good health and virtue in President Bush's case. The "unbelievable physician condition" attributed to the president by one his examining doctors, is not an objective evaluation in the same way that "desirable/near optimal level" is.² The 7-page photo-essay on Mr. Bush entitled "Leader of the Pack" in the October 2002 Runner's World would suggest that the President's health, physical condition, and work-out schedule are being offered up as praiseworthy models.⁷ They are praiseworthy, no question. Moreover, by demonstrating his commitment to a regular work-out regime, the article bolsters the President's health and fitness initiative, a program that challenges teachers, principles, youth camp and club leaders to improve the physical fitness and reduce the obesity of young people in the US.⁸ On the other hand, the magazine article carries postage-stamp drawings or photos of 22 U.S. presidents and lists their body-mass indexes under the heading "Fit to Be President?" And White House officials admit that they "provided extraordinary access" to the President for the article because, "they believe it will burnish Bush's image with Americans who don't follow politics."⁹ These White House officials, then, must think (or believe that Runner's World readers will think) that George W. Bush's "unbelievable" physical condition and competitive running times improve his qualifications for leading the country.