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The politics of illness

When should a leader disclose a serious sickness? This question, as old as the nation, has gained new urgency and interest from an unlikely source - a series on TV.

By The New York Times

© St. Petersburg Times,
published October 15, 2001


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[Photo: NBC]
Martin Sheen portrays President Josiah Bartlet in the NBC series West Wing. Bartlet, who has multiple sclerosis, raises a question faced by real presidents and many other politicians: How much should the public know about leaders’ illnesses?
NEW YORK -- The television show West Wing picked up its story line Wednesday, extending a fictional plot based on a genuine problem -- the long history of hidden illness in the White House.

West Wing President Josiah Bartlet has multiple sclerosis, a chronic neurological ailment that the first lady, a physician, has treated secretly during Bartlet's first term. Multiple sclerosis is usually not fatal though it is often disabling, and it has not hampered Bartlet's work.

In last season's closing episodes, the physically fit, mentally alert Bartlet wrestled with how his chances for re-election might be affected by public knowledge of his ailment, which, until then, had been known to only a small number of aides. Preparing Bartlet for a news conference at which he was to disclose his illness, the White House press secretary told him to start by calling on a medical reporter in a certain seat who, strange to say, had my name.

This fictional Dr. Lawrence K. Altman was expected to ask the same kinds of medical questions that I have asked over many years in interviewing real presidents and presidential candidates about their health.

Instead, Bartlet passed over my Hollywood doppelganger for a political reporter, as the frame froze for a summer respite.

Sorkin has done for multiple sclerosis what millions of dollars of advertisements and celebrity endorsements could not. Some other disease groups are somewhat envious because their sponsors wish he had chosen their causes.
Though disappointed that my double was denied the opportunity to probe the veils around the president's condition, I was not surprised at the president's move.

Candidates usually affirm that they are in good health and pledge to be open about any illness they may develop while in office. But illness often strikes unexpectedly, and when it occurs in politically awkward times, leaders often ignore their pledges.

Weaving a presidential illness into the plot of a hit series illustrates the public's keen interest in leaders' health.

A major reason for such interest is that the public has learned, often long afterward, that a number of officials, their families, aides and doctors have lied or devised cleverly worded cover stories to conceal or put an unusually favorable spin on a leader's serious illness.

The nation was told little about President Woodrow Wilson's debilitating stroke, suffered in office. Aides to Franklin D. Roosevelt, paralyzed by polio, carefully avoided having him photographed in a wheelchair. When he ran for a fourth term, the White House doctor did not disclose Roosevelt's failing heart and severe hypertension.

President John F. Kennedy and his family denied that he had Addison's disease, a hormonal deficiency of the adrenal glands. Lyndon B. Johnson concealed treatment for a basal cell skin cancer, which had no serious medical significance.

In his 1992 presidential campaign, Sen. Paul E. Tsongas and his doctors said he was free of non-Hodgkins lymphoma when, in fact, he had had a recurrence.

Developments during and after the 2000 campaign have heightened the interest.

Sen. Bill Bradley did not disclose that he had bouts of atrial fibrillation, a heart rhythm abnormality that he regarded as a nuisance, until a new episode caused him to go to a hospital. A perceived lack of candor may have contributed to the fizzling of his campaign in the final days before the New Hampshire primary.

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[Photo: AP]
Vice President Dick Cheney and his wife, Lynne, leave Washington’s George Washington Hospital on June 30, after he had a defibrillator inserted.
Doctors for Dick Cheney, the vice presidential nominee who apparently had the most serious health problem in the campaign, wrote letters with sketchy details about his history of coronary artery heart disease and attesting to his good health. He refused to discuss his health in detail.

Then, last November, during the vote recount, Cheney was taken to a hospital with his fourth heart attack in 22 years, a milder one than his earlier ones. Cheney later returned to the hospital for treatment of complications affecting a stent, a device placed in one of his coronary arteries to help keep it open. Last summer, a defibrillator was implanted in his chest, because tests had revealed that he was prone to potentially dangerous, abnormal heart rhythms.

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[Photo: AP/FDR Librar]
President Franklin D. Roosevelt, who was left paralyzed by polio, was rarely photographed in a wheelchair because advisers feared the public would think him weak. He visits with Ruthie Bie, granddaughter of caretakers on his N.Y., estate.
At a news conference at George Washington University Hospital, where Cheney was treated for chest pain in November, officials at first failed to disclose his heart attack. They cut off the conference before sharper questioning could elicit the cause of the chest pain that had brought him to the hospital. Hours later, embarrassed hospital officials called a second news conference, to say what they had known -- that Cheney had indeed had a heart attack.

Aaron Sorkin, the creator of West Wing, said he was only vaguely aware of the history of presidential illness, had no specific political leader in mind when he wrote Bartlet's health problem into the plot and did it only by happenstance.

The original story line called for the president to be in bed with just the flu. Then, Sorkin said, while dining with Stockard Channing, who at that time had played the first lady in one episode, he seized on the idea of her being a physician, "and so I searched for an interesting way to show that she was an M.D., rather than have her say, "as you know, I am a doctor."'

His solution, Sorkin said in an interview, "was that while everybody thought that this would be a cold or the flu, she knew it could potentially be something much more serious than that."

Sorkin asked his research staff to find an affliction that did not put Bartlet in a wheelchair, could go undetected for years at a time and could be in remission and undetectable in checkups because there was no laboratory test for it. The search turned up multiple sclerosis, an ailment that Sorkin said he knew little about.

Putting the spotlight on multiple sclerosis also tapped television's great potential to educate, even though Sorkin said that was not his intent. "As storytellers primarily, our only obligation is to captivate for however long we have asked for your attention," Sorkin said. He also said: "We try not to lie on the show, and I know that is a strange thing to say in the context of fiction."

Multiple sclerosis is an autoimmune ailment that affects an estimated 350,000 Americans, usually starting between the ages of 20 and 40. For unknown reasons, it strikes more women than men.

In its mild form, multiple sclerosis can cause numbness in an arm or leg. Patients with more severe cases may experience fatigue, emotional swings, blurred vision and hearing loss. Some may have temporary difficulty walking; others may develop permanent paralysis.

Bartlet seems to have the relapsing variety -- an initial attack and then no problem for years. Other people may have frequent attacks and need a wheelchair after only a few years. Drugs like the Betaseron that Bartlet is taking can reduce the severity of the attacks and lengthen the amount of time between them. There is no cure.

The portrayal of multiple sclerosis on the series has been correct, said Arney Rosenblat, a spokeswoman for the National Multiple Sclerosis Society, and that accuracy reflects the close relationship that she and Sorkin said had developed between her group and the show's writers.

Many real-life political leaders have disclosed their ailments in the belief that openness would help thousands of other people prevent or cope with the same affliction.

For example, many Americans sought examinations of their bowels after President Ronald Reagan had surgery for colon cancer. In 1994, Reagan said he hoped to make more people aware of Alzheimer's disease when he wrote a letter to the public disclosing his case.

As a senator and presidential candidate, Bob Dole talked openly about his prostate cancer. More recently, Dole has appeared in advertisements discussing treatment for erectile dysfunction.

Sorkin has done for multiple sclerosis what millions of dollars of advertisements and celebrity endorsements could not. Some other disease groups are somewhat envious because their sponsors wish he had chosen their causes.

According to a Harris Poll cited by the National Multiple Sclerosis Society, 40 percent of patients with the disease have lied or hidden the diagnosis from family, friends and colleagues, fearing what it may do to their personal and professional lives.

Privacy about medical information is fundamental until people choose to yield it, and Americans have been doing that with increasing frequency. Still, a big gulf exists between informing family and friends and telling strangers.

Decades of reporting the issue have convinced me that no candidate should be disqualified from office for health reasons -- provided that the information is first disclosed to voters. Since no one is forced to run for office, candidates should expect to disclose personal health information as part of the privacy they yield.

Although White House physicians supervise the round-the-clock medical care available to presidents and vice presidents, elected officials can receive other medical care surreptitiously. Dr. Max Jacobson, a Manhattan doctor known for administering mood-altering drugs to many patients, probably injected Kennedy with amphetamines before the 1961 Vienna summit meeting with Soviet Premier Nikita S. Khrushchev.

President Bartlet's physician wife, Abigail, who is not the White House physician, has secretly injected him with Betaseron. But the plot hints that even she may not know everything about his medical history. For example, during Bartlet's many trips, other doctors could have prescribed medications without her knowledge. In one scene, the White House counsel suggests the possibility that her husband could have had a secret affair, acquired a sexually transmitted infection and been treated for it, all without her knowledge.

In discussing his multiple sclerosis, Bartlet will face a number of questions that Sorkin can be expected to explore:

Will Bartlet's multiple sclerosis progress?

If so, will he put his political life ahead of his health, in defiance of medical advice?

Would the public be culpable in electing someone with an ailment that can be aggravated, possibly fatally, by the stress?

What plans will Bartlet work out with his vice president to invoke the provisions of the 25th Amendment of the Constitution, which allows a president to transfer executive power to his vice president temporarily in the event of disability?

I wish my screen self could have interrogated President Bartlet about his health. But despite my fictional counterpart's nonspeaking role, I hope the dramatizations will encourage candidates to be more truthful about their health problems.

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