What to do when president is a patient Health: A group of physicians is evaluting how much the nation should know about the illnesses of a chief executive or a candidate.

February 23, 1997|By ROBERT A. ERLANDSON

PHILADELPHIA - If President John F. Kennedy's Addison's disease and addiction to painkillers had been known, he probably wouldn't have been elected in 1960. If former Sen. Paul E. Tsongas had been elected president in 1992, he would have died two days before the end of his term.

JFK's ailments were hidden from the electorate, however, and he was depicted as a vigorous athletic man with only a sore back.

Tsongas, who died Jan. 18, announced during the campaign that he had had non-Hodgkins lymphoma but he and his doctors said he had beaten it. The cancer is incurable, however, and Tsongas admitted later that he had concealed its recurrence.

They are the most recent cases that emphasize the need to formulate requirements for disclosure of the health of presidents and presidential candidates, a problem that has dogged the country since its beginning.

George Washington nearly died twice during his first two years in office, from a carbuncle on his left thigh in 1789 and from pneumonia a year later.

How different would United States history have been if Vice President John Adams had become president in the country's infancy instead of after Washington's two terms blazed the trail still followed today?

After Kennedy's assassination, the 25th Amendment to the Constitution on the transfer of power at presidential death or disability was ratified, but a high-powered ad hoc commission of physicians and historians concluded in December, after two years of study, that it is inadequate, particularly in such events as the shooting of President Reagan in 1981.

Determined to stimulate discussion of the issues, the College of Physicians of Philadelphia, a nonprofit organization that examines doctors' role in society and contemporary medical issues, has mounted an exhibition called "When the President is the Patient," using the history of presidential illness to focus on the need to define the amendment's terms.

The nagging problem is that while post-mortem transfer of power is obvious, the 25th Amendment does not define "disability" in cases where a president is alive but unable to serve. What does it mean? Who decides?

"The 25th Amendment is not adequate, it requires more interpretation," said Dr. Marc S. Micozzi, the college's executive director.

Candidate health arose in last year's campaign because of Bob Dole's age and his 1991 treatment for prostate cancer and President Clinton's refusal to discuss his health until pressure for disclosure mounted.

Clinton finally conceded the public's right to know about presidential health, and before he died, Tsongas urged creation of a commission to recommend what medical information candidates should make public.

Although no study group on candidate health has been formed yet, the Working Group on Presidential Disability, an ad hoc 50-member panel of historians and medical experts, spent two years examining the 25th Amendment.

It concluded that the private contingency plans between presidents and their vice presidents since Eisenhower and Nixon in 1957 are inadequate.

The panel, which will make formal recommendations later this year, said a formal contingency procedure must be adopted, citing the chaos after the Reagan shooting in 1981 as an example of the 25th Amendment's inadequacy.

Presidential illnesses have been concealed and lied about for most of the republic's existence but some cases have been more blatant than others.

Among them are Chester A. Arthur's Bright's disease; Grover Cleveland's cancer operation, which was reported as a "tooth extraction"; Woodrow Wilson's stroke; Franklin D. Roosevelt's polio and heart failure; and Kennedy's Addison's disease and painkiller addiction.

Presidential health has always had an impact on the country but today the effect is international, on stock markets and in other capitals.

It is a delicate public relations issue as much as a medical challenge, said Thomas A. Horrocks, the college's historian, who set up the exhibition with the help of 32 institutions across the country.

As the debate over the issue of disclosure of presidential and presidential-candidate health continues in many quarters, a continuing survey of visitors to the exhibition - about 1,800 so far - suggests that what the public needs to know and what it wants to know are different.

After seeing the displays, visitors are asked to answer six questions about presidential medical care and what the public should know about presidential health and illnesses.

Horrocks admits to great surprise at the results, that by very wide margins visitors say presidents should select their own physicians, control their own medical treatment and should not be required to release full information about their annual checkups.

People may be relating to the president as an individual and whether they would want all such information about themselves made public, Horrocks said.

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