An independent panel should evaluate the health of presidential candidates

President Joe Biden’s 2024 re-election campaign ended on the afternoon of 21 July 2024, not with a bang but a whimper: he posted a brief letter on X (formerly Twitter) announcing he would stand down.1 Even before his disastrous performance in the debate against Donald Trump on 27 June 2024, during which he sometimes seemed confused and forgetful, public polling showed that voters were concerned about his age—he is 81 years old—and his fitness. In a September 2023 poll, 57% of respondents said Biden’s age would “severely limit his ability to do the job” if he were re-elected in 2024.2

With Biden out of the race, attention has turned to Trump, who, at 78, is by far the oldest presidential nominee in US history, a record previously held by Ronald Reagan, who took office at the age of 69. While his own debate stumbles were less scrutinized, Trump often rambled incoherently and a post debate poll found that 60% of voters think he is too old to serve as president.3

Never has the fitness of US presidential candidates been on the ballot in such a stark fashion. And never has there been such a drumbeat of calls for candidates to undergo a standardized, transparent assessment of their physical, mental, and cognitive health.456

There’s a long history of American presidents hiding their illnesses or being protected by the media—from John F Kennedy concealing his Addison’s disease during his 1960 election campaign to Woodrow Wilson’s denial that he had experienced multiple strokes.7 The public is left almost entirely in the dark about a presidential candidate’s medical history and fitness to serve. Without mandatory independent assessments of a candidate’s fitness, all we have is the voluntary release of letters from the candidate’s personal physician. These letters tend to read like campaign propaganda: selective in which facts are left out and typically written to show the candidate in the best possible light.

Trump’s go-to physician for this purpose is Ronny Jackson, a US physician, a Texas Republican, Fox News contributor, and Trump supporter whose medical license expired in 2020 (although he still holds a “military active” medical licence).8 Since the attempted assassination of Trump at a rally in Butler, Pennsylvania on 13 July 2024, Trump’s campaign team has released remarkably little medical information on his possible injuries—except for a letter from Jackson. The physician is well known for praising Trump’s “incredible genes.” In 2016, a letter was released apparently written by Trump’s previous personal physician, Harold Borstein, a gastroenterologist. The letter was reportedly scribbled in five minutes while waiting for a limousine—saying that Trump’s laboratory results were “astonishingly excellent.”9 Borstein has since been reported as saying that Trump dictated the letter himself.10

In the face of this information blackout on the health of presidential candidates, armchair diagnosticians unfortunately fill the void. While there is an important role for health professionals in explaining medical topics in the popular media, professional medical associations advise clinicians that it is unethical and unacceptable to offer medical opinions in the media about individuals they have not personally evaluated.11 Such advice is roundly ignored. On both sides of the political aisle, plenty of health professionals take to the media to share their medical guesswork

Such speculation is unhelpful. It gives the public the false impression that complex diseases can be diagnosed from afar. Weaponizing armchair diagnoses for political gain stigmatizes those suffering from the illness and suggests that illness or disability by itself disqualifies someone from holding political office—in fact, a 2019 Rutgers University study found that one in 10 elected officials in federal, state, and local government had a disability (in the survey, 1.6% of officials had mental or cognitive impairment).12 As the US population ages, age-related cognitive conditions are likely to become more common, and we need a discourse about these conditions that is not sullied by turning them into political barbs.

The best way to move beyond sycophantic letters from personal physicians and the gossipy musings of cable news medical contributors is to have a standardized, independent, transparent, multi-disciplinary assessment of the presidential candidates by a non-partisan body that commits to publishing the results. It would need to be a body that is highly respected for its independence—such as the US. Preventive Services Taskforce or the National Academy of Medicine.

Arthur Caplan, bioethicist at New York University, argues that medical diagnoses would not, of course, disqualify a candidate: “Certainly, you could run for president, have health issues, and still be elected. People may say they don’t care. People may say, ‘As long as you’re functioning, we don’t care about health problems that might be identified in an annual physical.’”13 But he notes that Fortune 500 companies require independent medical examinations of potential CEOs, not just letters from a personal physician, a standard that should also apply to presidents.

The idea of forming a standing medical commission to conduct this kind of assessment has been around for three decades. It should be revisited. In the journal JAMA in 1994, former president Jimmy Carter announced the formation of a working group on presidential disability, whose members later went on to propose a non-partisan standing medical commission to periodically assess and report on the president’s fitness.14 Carter, who is 99 years old, already has an extraordinary legacy in global health; launching a standing medical commission to evaluate and report on the health of presidential candidates would burnish that legacy even further.15