Meet the Leading Expert on Political Leaders’ Health, and His ‘West Wing’ Doppelgänger

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Times Insider shares historic insights from The New York Times. In this piece, Lawrence K. Altman, M.D. — a physician journalist whose Times interview with Ronald Reagan in 1980 about the then-presidential candidate’s health is believed to be the first of its kind — ruminates on his experience chronicling would-be leaders’ fitness for office from the ’70s to the present.

“Did you watch ‘The West Wing’ tonight?” my sister Dottie asked over the phone in 2001 without offering any explanation.

“No, I’m working on a story.”

“‘The West Wing’s’ President Bartlet will call on you at a press conference after he discloses he has multiple sclerosis,” Dottie said. That scene about the fictional commander-in-chief was news to me. Because I was in a hotel room in San Francisco, I had to wait a couple of hours to view the episode locally. I often played pranks while working on The Harvard Lampoon and I wondered if she was reversing the role. So I went back to writing my story.

When the episode aired, I saw the president’s press secretary advise him to call on Lawrence K. Altman, who was sitting in The New York Times’s reserved seat. The doppelgänger bore my name but no resemblance to me. When President Bartlet reached the press room lectern, he scanned the audience. Choosing to ignore my doppelgänger, he settled on a political reporter as the camera frame froze in a cliff hanger to that season’s finale.

I was the first physician to work full time for a daily newspaper, in 1969. Aaron Sorkin, the creator of “The West Wing,” wrote me into the script because of my experience asking a number of real presidents and political leaders the kinds of questions other journalists did not: probing ones about their personal health. My coverage of the health of political leaders began in 1972 when the Democratic presidential nominee, Senator George S. McGovern of South Dakota, dropped his running mate, Senator Thomas F. Eagleton of Missouri, less than three weeks after choosing him at the last minute at the convention. Because of the stigma of mental illness, Mr. Eagleton deliberately withheld that he had endured three hospitalizations for depression and received electroshock therapy twice. In doing so, Mr. Eagleton created a political liability for his potential boss and president by raising an important question about trust: What else might the vice-presidential nominee have withheld?

In the early years of our nation’s history, Americans paid little attention to the health of presidential candidates for three main reasons. First, people lived from day to day not knowing when they might fall ill. Second, medical knowledge about most diseases was rudimentary; doctors had few tests to evaluate a patient’s health and little to offer patients. Third, even when journalists got wind of a political leader’s personal problems, they rarely wrote about them.

As medicine became more sophisticated, a number of candidates for the presidency and other offices, as well as their families and doctors, distorted information and were evasive when directly questioned regarding the documents they released about their health. Some even lied. Hiding their ailments was not new for politicians. For many, their nature was to convey an image of robust, if not perfect, health out of fear that voters might react negatively to disclosures about health problems.

In bits and pieces, the public first learned about the seriousness of hidden presidential illnesses long after the incumbents left office. Examples: President Grover Cleveland underwent secret cancer surgery on a ship off New York Harbor. President Woodrow Wilson’s wife and doctor controlled White House affairs while he remained paralyzed from a stroke during the last 17 months of his second term. President Franklin D. Roosevelt readily acknowledged his polio, but his White House doctor hid the severe high blood pressure that led to heart failure. President John F. Kennedy’s family denied he had adrenal insufficiency (Addison’s disease).

The McGovern-Eagleton fiasco pushed the issue of the health of political candidates to the forefront of public attention. Eight years later, in 1980, former California Gov. Ronald Reagan raised transparency about a candidate’s personal health to a new level. A few days short of his 70th birthday, and seeking to become the oldest man to be inaugurated president, Mr. Reagan responded to questions about his “old age” and his mental status by asserting that his doctors would attest to his excellent health.

After a discussion with A.M. Rosenthal, then the executive editor of The Times, I sought to interview Mr. Reagan and his doctors. It took months of constant calls, and persistence in reminding Mr. Reagan’s aides of his previous promise, before he agreed to the interviews. What would he do if his mental faculties declined as president, I asked in an interview that is believed to be the first in which a president discussed his health prospectively. He answered, in a story that became important in that election cycle, with a pledge to resign under such circumstances.

Getting a candidate’s health information often requires enormous perseverance. When candidates dispense details sparsely and are reluctant to answer questions, and their aides actively discourage reporters’ probes into a subject about which the aides may know little, then speculation about hidden illnesses flourishes, with or without merit.

In the election cycles after Mr. Reagan, I interviewed many candidates for the presidency and, when questions arose about their health, candidates for other elected offices. Among them: President George H. W. Bush, Massachusetts Gov. Michael Dukakis, Kansas Senator Bob Dole, Massachusetts Senator John Kerry, New Jersey Senator Bill Bradley and former Massachusetts Senator Paul E. Tsongas, who was the first known cancer survivor to run for president. His doctor said he was cancer-free five years after he underwent a bone-marrow transplant for lymphoma. But then I reported that he did have a recurrence. Mr. Tsongas died a few days short of what would have been the end of his term if elected.

But other candidates refused my requests. Among them: President Barack Obama (whose doctor wrote a single-spaced, undated letter that omitted important information), Arizona Senator John McCain (who excluded all Times reporters from attending key news conferences) and Vice President Dick Cheney (who repeatedly refused interviews).

No law requires candidates to disclose their health information. However, my efforts at The New York Times have resulted in helping to make such disclosure as routine and standard as releasing financial records. Candidates now vet a potential running mate’s health information to avoid another McGovern-Eagleton fiasco. The Times has played a major role in these developments by creating a new area of journalism that has paid huge dividends. With rare exception, in recent years there haven’t been any surprises about significant ailments that candidates have tried to keep hidden from the public. In 1994, nearly six years after leaving the White House, Mr. Reagan told the world that he had recently received a diagnosis of Alzheimer’s disease. In 1997, I extensively interviewed his doctors, aides and others who knew him. Neither then nor in continuing interviews have I found evidence that he showed definitive signs of dementia as president.

Politicians are not forced to seek office. In running, they become public figures and yield much of their privacy. While there is no direct correlation between a politician’s health and performance in office, ill health can affect anyone’s ability to function. So it seems prudent for the public to insist on candidates’ transparency in disclosing their health information and providing medical assurance that they have a reasonable chance of serving a full term in good health. My experience has convinced me that no ailment should disqualify an individual from seeking office. But the candidate should inform the public beforehand about such an illness.

Serious gaps in disclosure of candidates’ health information have occurred in recent election cycles in part because news organizations relaxed their commitment to informing the public about what was and was not known about the health of a noncooperative candidate or one who delayed disclosure.

In this election, age is an important factor, because in eight days Hillary Clinton, 69, or Donald J. Trump, 70, will become one of the nation’s oldest presidents. (If Mr. Trump is elected, he will be the oldest.) Yet voters still have less than full accounts of their health. Until last month, the information Mrs. Clinton released was more than a year old. In December 2015, Mr. Trump released a bizarre letter from his doctor claiming that he would be the healthiest president ever — without any supporting medical evidence — inviting speculation and mockery. In August 2016, Mr. Trump’s doctor said he wrote the brief letter in five minutes.

As Mrs. Clinton discovered, secrecy about personal health problems involves the risk that medical events will force the issue and cause people to attach greater seriousness to the development of a new ailment. Her campaign was jolted when she nearly collapsed from dehydration while under treatment in September for a bacterial pneumonia that she hid not only from the public but also from her closest staff. That event forced Mrs. Clinton to authorize her doctor to update her medical history and include new information about an old episode.

Then, in a tit-for-tat move, Mr. Trump authorized his doctor to issue more somber — though still incomplete — information.

After the original “West Wing” episode ran, I was flooded with calls. Even The Times’s public relations team chided me for not having told them in advance about my role in the series, expressing skepticism that I knew nothing of it beforehand. Similar calls still come as new viewers discover the show. Perhaps a sign of our times is that people remember my appearance/nonappearance on “The West Wing” more than they do my stories about the health of political leaders that led to and followed it.