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The results of President Trump’s first full physical exam were released in a press conference Tuesday — and according to the top White House doctor, Trump is in “excellent” physical and cognitive health.
Not only did Trump reportedly get good scores on a battery of physical tests, he also earned a 30/30 on the Montreal Cognitive Assessment, a common dementia screening exam though not necessarily the best way to assess cognitive decline, according to the Alzheimer’s Association.
This year’s presidential physical attracted an unusual degree of scrutiny amid questions about Trump’s mental health and fitness for office.
Concern about the president’s mental capacity escalated with the publication of Michael Wolff’s book Fire and Fury: Inside the Trump White House. It paints a portrait of an individual who is not of sound mind, surrounded by people who believe he is not really fit to be president. Some Democratic members of Congress even reignited the discussion about the 25th Amendment, a process that could remove a president who is unfit to govern.
Aside from confirming the president’s mental fitness for office, Jackson’s report didn’t really reveal anything new about the president’s health.
That shouldn’t come as a surprise: The presidential physical exam is best understood as political theater — a show of the president’s vigor and fitness — not an opportunity to uncover medical truths.
What Trump’s physical exam involved
Trump’s Friday physical took place at Walter Reed National Military Medical Center in Bethesda, Maryland, and was conducted by Dr. Ronny Jackson, the White House physician.
A rear admiral in the US Navy, Jackson was deployed in Iraq until he was selected to be the White House physician in 2006. He’s since served in three administrations: that of George W. Bush, Obama, and now Trump. (Presidents can have their pick of White House physician, but as Stat reported, they tend to favor military doctors.)
The physical exam Jackson gave Trump was likely a lot like any physical a man Trump’s age would get: basic lab tests (cholesterol, hormone, and vitamin level tests), screening tests for age-related disease (such as cancer or heart disease), and the standard slew of other health assessments like checking blood pressure, and the eyes, ears, and throat.
The physical doesn’t typically include an evaluation of mental fitness — and the White House previously told reporters that the biggest question about the 71-year-old president’s health — the state of his mind — would not be checked in the physical.
But this year Trump asked for one, according to Jackson.
What we already knew about Trump’s physical health and habits
As with his tax records, candidate Trump never released his medical records. So what we knew about Trump’s health, until today’s physical results were announced, was mostly gleaned from media reports, and dubious notes from his colorful longtime doctor, Harold Bornstein.
Jackson reported that Trump is in “excellent” overall health. He has excellent cardiac health, according to a cardiac assessment he underwent, and his blood pressure is 122/74, which is in the normal range. Trump’s PSA is very low, meaning he has no prostate troubles. His total cholesterol is 223, and his LDL (or “bad”) cholesterol is 143, which is borderline high. Trump’s 20/30 vision is very good for his age.
His biggest health fault was his weight, Jackson said. Trump is 6 foot 3 and 239 pounds — one pound shy of obesity, according to the body mass index. (His weight is also three pounds higher than last reported in September 2016, according to a note from Trump’s colorful longtime doctor, Harold Bornstein.)
Jackson’s report that Trump gained only a few pounds since entering the White House raised eyebrows; some people close to him have speculated that Trump has put on more than that. Politico got a hold of his New York driver’s license; which says Trump is 6-foot-2. If correct, that would mean Trump is even more overweight.)
Trump also got a perfect score on the Montreal Cognitive Assessment.
“I can reliably say, and I think that the folks in the mental health would back me up on the fact that if he had some kind of mental, cognitive issue, that this test is sensitive enough, it would have picked up on it. He would not have got 30 out of 30,” Jackson reported. “And my personal experience is that he has absolutely no cognitive or mental issues whatsoever.” He added the president had requested that the cognitive test be included as part of the exam.
The physical results announcement also reiterated some details we already knew about Trump. For example, he doesn’t drink alcohol or smoke, and he sleeps about four to five hours per night.
The president takes a pretty standard range of medications for his age, Jackson again confirmed, including Ambien to help him sleep when he travels overseas; Crestor, a statin that lowers cholesterol; a low dose of aspirin to prevent cardiovascular disease; antibiotics to control rosacea; and Propecia for baldness.
As for his eating and exercise habits, Trump reportedly doesn’t like to work out, and he favors fast food because he thinks it’s cleaner and safer than other food. According to a new book by his former campaign manager Corey Lewandowski and ex-top aide David Bossie, Let Trump Be Trump, Trump has a prodigious appetite and in one sitting ate “two Big Macs, two Fillet-O-Fish, and a chocolate malted,” the Washington Post reported.
“On Trump Force One there were four major food groups: McDonald’s, Kentucky Fried Chicken, pizza and Diet Coke,” Lewandowski and Bossie wrote. Indeed, Trump washes down his meals with a whopping 12 Diet Cokes a day, according to the New York Times.
Trump also has some extraordinary beliefs about exercise. In his New Yorker story about how Trump could realistically be removed from the presidency, Evan Osnos wrote: “Other than golf, he considers exercise misguided, arguing that a person, like a battery, is born with a finite amount of energy.”
On the campaign trail, we learned that Trump believes exercise is harmful. According to this 2015 New York Times profile, Trump said, ‘‘All my friends who work out all the time, they’re going for knee replacements, hip replacements — they’re a disaster.” Of standing and performing in front of an audience, he added, “That’s exercise.”
The long-simmering questions about Trump’s mental health
The Montreal assessment is a standard test of cognitive fitness and should rule out obvious neurological impairment.
Yet even when Trump was still just a candidate, mental health professionals were speculating about his psychology and mental health — in Atlantic cover stories, in Vanity Fair, and on Twitter. There was talk about him exhibiting the personality trait of narcissism and signs of mental disorders.
Once he became president and his behavior became a matter of national security, the discussion got considerably more heated.
John Gartner, a clinical psychologist and former Johns Hopkins professor, started a Change.org petition — that now has nearly 70,000 signatures — calling for Trump’s removal based on the claim that he has “serious mental illness.”
A group of 27 mental health professionals put together a book called The Dangerous Case of Donald Trump, which offered the view that “Trump’s mental state presents a clear and present danger to our nation and individual well-being.” The Yale psychiatrist who edited that book, Bandy Lee, recently told Vox she has advised Congress on the need for an emergency psychiatric evaluation because of the threat the president poses to public health.
Journalists have also attempted to analyze the president’s behavior for evidence of cognitive decline.
In May, Sharon Begley at Stat looked at changes in Trump’s speech patterns over decades in an effort to explain his “his tortured syntax, mid-thought changes of subject, and apparent trouble formulating complete sentences, let alone a coherent paragraph, in unscripted speech.”
She did this by asking experts in neurolinguistics and cognitive assessment, psychologists, and psychiatrists to compare Trump’s speech from decades ago to that in 2017. Their conclusion: “They all agreed there had been a deterioration, and some said it could reflect changes in the health of Trump’s brain.” CNN’s Sanjay Gupta has also zeroed in on abnormalities in his movements and speech.
There’s also been a lot of pushback — from Columbia psychiatrist Jeffrey Lieberman and other medical, legal, and political experts — on all the speculation about mental disorders and illness. As James Hamblin at the Atlantic noted, “To attribute Trump’s behavior to mental illness risks devaluing mental illness.”
Richard Friedman, a professor of clinical psychiatry and director of psychopharmacology clinic at Weill Cornell Medical College, argued in the Washington Post that we don’t even need to test Trump’s mental health because we already have ample evidence he is unfit.
“Testing wouldn’t be conclusive, shouldn’t be the basis for disqualifying someone for the presidency and wouldn’t tell us anything we don’t already know,” he wrote, adding that “the most accurate measure of a person’s fitness, whether mental or physical, is observable function in the real world — not the results of a fancy test or expert opinion. The fact is that Americans already have all the data they need to judge Trump’s fitness.”
We probably won’t learn the truth about Trump’s health anytime soon
As expected, Dr. Jackson’s report from the presidential physical on Tuesday only revealed a few innocuous details about Trump, like the fact that he has put on a few pounds since he entered the White House.
But even if Friday’s physical revealed something major about Trump’s health, we aren’t likely to hear about it. That’s because Trump is entitled to the same patient privacy rights as other Americans, and it’s up to him what gets reported to the public. Neither the president nor his doctor is under any obligation to share complete or detailed medical records.
Presidents and presidential candidates have also had a historically flimsy relationship with the truth when it comes to their health. Hiding a president’s medical history is pretty much the norm.
Jacob Appel, an assistant professor at Mount Sinai School of Medicine who studies the health histories of candidates, told Vox he’s convinced the public would not know if a president or presidential candidate is truly sick “until history renders its verdict years from now.”
If Trump did have a more involved cognitive function test, we probably wouldn’t find out the results.
“I don’t think they would say the president is depressed or has had a stroke and has memory issues and part of the reason they wouldn’t do that is that it could imperil national security,” said Arthur Caplan, head of the division of medical ethics at NYU School of Medicine.
Looking back, we now know a number of past presidents and presidential candidates who were actually much sicker in office than the public knew. FDR’s paralysis was kept from public view, as was Woodrow Wilson’s 1919 stroke, which left him incapacitated. “His wife and his senior advisers ran the country while he was indisposed for many months,” Appel said. “The public was entirely unaware.”
That’s why Appel thinks it’s unfair that many members of the media are questioning Trump’s health while implying past presidents were perfectly healthy. “The reality is many presidents have been extraordinarily unhealthy — even at death’s door.”
