What Records Should Bernie Release?

And are we entitled to candidates' health info?

This is Oliver. He is fit as a fiddle.

The View From Here

The latest dust-up in the Democratic primary is Bernie Sanders’s medical records. He said he would release them in full; instead, he released several physicians’ letters attesting to his above-average health for his age, and said last night at CNN’s Town Hall that he won’t be releasing anything else. His press secretary then ratcheted things up to crazy level by going on CNN and bizarrely claiming that demands for Sanders to release his comprehensive medical records as promised were akin to birtherism. She also (falsely) claimed that Bloomberg had had a heart attack too, just a day after (falsely) claiming Bloomberg was accused of sexually assaulting 64 women (Bloomberg’s company has been sued by 64 women for sexual harassment and discrimination, which is damning enough, but pretty significantly different from the man himself being accused of sexual assault 64 times over). Both of these statements were walked back afterwards, but it’s not good.

I can see why Team Sanders thinks the medical records demands are unfair and moving the goalposts. After all, he’s done the same thing all of the candidates have: Offered a letter from his physician detailing his basic health metrics, his history of any serious conditions, and current medications. While some candidates in the past have released far more, that’s not the standard. But releasing more comprehensive reports has been how older candidates with checkered health have sought to soothe voters’ fears. John McCain, for example, released the totality of eight years of medical records that included cancer history to demonstrate that he was healthy enough at 71 to run for president — that, though, was an unusual move. Now, there are several candidates who will be nearly a decade older when they take office. At least two of them have had heart issues.

I don’t think the standard should be higher for older candidates than for younger ones. But perhaps when candidates have had serious and potentially life-threatening health crises, we should think about what we want our standards to be. And in an age of Donald Trump, who had his quack personal doctor write a letter attesting that he was “the healthiest individual ever elected to the presidency” — despite obvious evidence to the contrary — I do wonder if it’s time to standardize presidential health disclosures across the board.

It does not make sense to demand every candidate release the totality of their health records. For one, there is no centralized Health Records Database from which this information can be pulled. Think of your own health records — have you gone to the same doctor for your entire life? Are all of your records in one place? Do you even know where they all are? I certainly don’t.

And for another, there’s a lot of health information that is just not relevant. Do we care when candidates were vaccinated for measles or if someone broke her arm when she was 12? Of course not. Does it matter if a candidate has had a vasectomy or an abortion or a history of yeast infections or hemorrhoids or contracted pubic lice in their 20s? No. Should those things be kept private from the public? Yes. For female candidates in particular, this is dangerous territory, given that reproductive health is so politicized.

Mental health is complicated, too. There is the question of stigma: If folks know that their mental health histories will be laid out in public should they seek public office, it stands to reason that they’ll be less likely to seek care — a worse outcome all around. And would it be disqualifying if, say, Joe Biden sought treatment for depression after his wife or son died? Of course not. But you can imagine how his theoretical use of anti-depressants would be weaponized to unfairly tar him as “crazy” or unfit for office. You can see how that stigmatization would have broad consequences for the rest of the country, and send the message that seeking mental health care is professionally dangerous. You can see how that would discourage people from seeking the care that would improve their lives.

At the same time, some aspects of mental health history strike me as just as relevant as aspects of one’s physical health. As a person who has watched family members and loved ones struggle with serious mental health issues, I can’t help but think it’s relevant if a person who is seeking to run the United States and be the Commander in Chief of the U.S. armed forces has a history of serious mental health crises and non-compliance with medication that make it difficult or impossible to do their job. I’m not sure that’s ableist any more than saying someone with a history of untreated or under-treated but largely invisible physical health problems that compromise one’s ability to physically perform certain kinds of labor are relevant to certain types of employment. Where that line is drawn — what is relevant and what is not — is exceptionally tricky. How to balance it with genuine concerns about stigma around mental health makes it all the more challenging. I do not have the answers here, but it seems worth discussing.

And then there is the question of cognitive fitness to be president. Brains deteriorate, especially with age. We also know that wealthy people who have cognitively demanding jobs may see that deterioration slow and tend to live longer (see, e.g., Supreme Court justices, who live forever). All of the older candidates in the race have the kind of jobs that tend to keep a person sharp; they are all wealthy enough to have the healthcare resources they need to thrive physically and mentally into old age. And unlike, say, measuring a person’s cholesterol, there is no clear numerical test that determines if a person has mild cognitive impairment; it’s largely the judgment call of a doctor, based on a series of tests and evaluations. But it certainly seems relevant, doesn’t it? Especially when you look at our current president? And even when you look at this very old field — Bernie seems as mentally sharp as ever, while Biden, for example, strikes me as not quite as quick on the draw as he used to be. That’s concerning. But lay observation seems insufficient here.

This is all to say: I can see why Bernie is backing away from the promise to release the entirety of his health records. I can see why he and his supporters say what he has released is more than enough. And maybe it is.

We have a lot of information already. We know that Bernie Sanders is nearing 80 years old and recently had a heart attack. We know Donald Trump cannot string a sentence together and has impulse control issues. Isn’t that enough information for voters to assess and decide if electing either of them is worth the risk?

But taking individuals in this particular race out of it, we should think through what we believe candidates for the presidency should disclose (and it’s frankly unfortunate that Bernie is the catalyst for this — it should have been Trump but, like so much else with his presidency, the scope of his corruption and wrongdoing was so broad that the medical records scheme was just a drop in the bucket). People who serve in the military have to demonstrate a high level of physical and cognitive fitness according to a scale that slides according to their duties. The Commander-in-Chief doesn’t need to be able to haul a body across a field or scale a 20-foot fence. But surely his or her cognitive abilities matter as much as anyone else charged with firing a missile or planning a complex mission.

James Hamblin wrote about this for the Atlantic in the context of Trump’s cognitive function. He notes that “after age 40, the brain decreases in volume by about 5 percent every decade.” And continues:

Everyone experiences at least some degree of cognitive and motor decline over time, and some 8.8 percent of Americans over 65 now have dementia. An annual presidential physical exam at Walter Reed National Military Medical Center is customary, and Trump’s is set for January 12. But the utility of a standard physical exam—knowing a president’s blood pressure and weight and the like—is meager compared with the value of comprehensive neurological, psychological, and psychiatric evaluations. These are not part of a standard physical.

What would a better system look like? Perhaps a panel of agreed-upon expert physicians, none with personal relationships to the candidates, selected to review the previous ten years of the candidates’ health records and write individual summaries. Perhaps part of that process is an individual work-up, including a cognitive evaluation, by an agreed-upon physician who is not the personal doctor to any candidate. Hamblin suggests this in the context of a sitting president, but one can see how it could easily be applied to candidates, too:

A presidential-fitness committee—of the sort that Carter and others propose, consisting of nonpartisan medical and psychological experts—could exist in a capacity similar to the Congressional Budget Office. It could regularly assess the president’s neurological status and give a battery of cognitive tests to assess judgment, recall, decision making, attention—the sorts of tests that might help a school system assess whether a child is suited to a particular grade level or classroom—and make the results available.

Such a panel need not have the power to unseat a president, to undo a democratic election, no matter the severity of illness. Even if every member deemed a president so impaired as to be unfit to execute the duties of the office, the role of the committee would end with the issuing of that statement. Acting on that information—or ignoring or disparaging it—would be up to the people and their elected officials.

And then there is this truth: We are all human, living in soft, fallible, breakable human bodies. Yes of course we should consult the actuarial tables, check out doctors’ work-ups, and take candidates’ health into account when deciding whether they should occupy the most powerful position on earth for the next four to eight years. There are probabilities. But there are no guarantees. Part of our desire for fuller medical data is perhaps grounded in the superstition that “good health” is a promise and that the political leaders we admire are superhuman. It is not; they are not. We want more clarity because it gives us more surety. Maybe there is no surety to be had.


What I’m Writing

CNN: Town Hall proved that Trump should be worried


What I’m Cooking

I just returned from the most glorious weekend in Mexico City — what a place! But I sadly got food poisoning, which seems to be my MO at least once a year these days, so I’m in bed sipping on tea, Sprite and chicken broth and very very very much missing leafy greens. If my stomach could handle it, this is what I would be eating with my dinner: A super easy, bright and tasty kale salad, courtesy of Julia Moskin at the NYTimes.

Notes: I alternate between making this with almonds and making it with pine nuts - I use whatever is on hand, and I actually prefer it with pine nuts. It can also be quite nice with pieces of apple or even citrus, like orange slices with the film removed, or pieces of good cheddar. And this method of slicing kale is the best for any sturdy green you’re trying to prepare quickly, like chard or collards.

INGREDIENTS

  • 2cups sliced almonds

  • ⅓cup freshly squeezed lemon juice (from 2 to 4 lemons)

  • Kosher salt

  • 1 ½cups extra-virgin olive oil

  • 4cloves garlic, crushed with the flat side of a knife, peeled and left whole

  • 10 to 12ounces washed and dried kale leaves, thick stems removed (weight after trimming)

  • 1 ½cups freshly grated Parmesan (optional)

PREPARATION

  1. In a toaster oven or skillet, toast almonds until golden brown and fragrant. Set aside to cool.

  2. In a bowl, combine lemon juice and 1 heaping teaspoon salt. Slowly whisk in olive oil. Add garlic cloves and set aside to steep.

  3. Working in batches, cut the kale into thin ribbons: gather a large handful of leaves, bunch together tightly, and use the other hand to slice into 1/4-inch-thick pieces. This need not be done very precisely or neatly; the idea is to end up with a kind of slaw. (Recipe can be made up to this point 1 day ahead. Keep kale and dressing refrigerated separately.)

  4. Place chopped kale in a very large bowl. Sprinkle surface with almonds and then with cheese, if using. Remove and discard garlic cloves from dressing. Pour half the dressing over the salad and toss. Taste for dressing and salt and add more as needed, tossing to coat thoroughly. Serve within 1 hour.


Eat your greens and you’ll be fit for the presidency until you’re 105.

xx Jill