Biden’s doctor calls him ‘fit for duty.’ But are exams reliable? What historians say

President Joe Biden recently underwent his annual physical exam, continuing a decades-long practice that sheds light into the health of the commander-in-chief.

After undergoing the exam Feb. 28, Biden’s doctor released a summary of the results, identifying “no new concerns” and concluding that the president remains “fit for duty.”

The summary stated that Biden, 81, is currently being treated for sleep apnea, gastroesophageal reflux and peripheral neuropathy in his feet, among other minor conditions. It also noted that the president still abstains from alcohol and tobacco and exercises five days per week.

For the past half-century, every president has undergone regular and publicized physical exams, which include routine testing and occasionally reveal previously unknown conditions.

However, the results — which are released at the discretion of the president — should not necessarily be taken at face value since presidents have a history of deceiving the American public about their health, historians told McClatchy News.

History of the annual physical

For most of the country’s history, the health of the president has been treated with an extreme degree of secrecy, Thomas Balcerski, a presidential historian at Eastern Connecticut State University, told McClatchy News.

“There are so many examples of concealment that are almost incredible to believe,” Balcerski said.

Perhaps most notably, Grover Cleveland underwent a partial jaw replacement surgery aboard a covertly camouflaged yacht in 1893 in the hopes that word would not get out.

Similarly, Franklin Roosevelt — who famously kept his wheelchair usage from the American public — was diagnosed with a congenital heart condition in 1944, which he also kept under wraps, Balcerski said.

However, a turning point came during the presidency of Dwight Eisenhower, who suffered multiple heart attacks, Balcerski said.

“He seems to be the first one who tried to cut off concerns about his fitness to run again in 1956 by appearing before the public in a wheelchair and in his hospital bed in his recovery stages,” he said.

But it was not until the Nixon Administration that presidents began regularly undergoing standardized physical exams, of which some of the results were released to the public, Jacob M. Appel, a professor at the Icahn School of Medicine and presidential health historian, told McClatchy News.

“Since Nixon each president has done these, not necessarily every year, but on a fairly regular basis,” Appel, who is currently writing a book on presidential health, said.

What do the exams include?

“Just like anyone else going to the doctor, these are pretty routine, basic physicals,” Appel said.

The exams, which can vary by president, typically include blood and urine panels, which test for things like cholesterol and glucose. Hearing, dental and skin exams are also routine.

Some presidents’ public results, like George H.W. Bush’s in 1989, revealed more extensive testing, including a chest X-ray and an electrocardiogram.

The results also often include a president’s social history, such as their smoking and drinking habits as well as their exercise routines.

What about cognitive exams?

Biden, who has faced criticism that he suffers from a poor memory, did not take a cognitive test as part of his physical, a White House spokesperson recently told reporters.

However, cognitive testing is not typically administered during these physicals, though Trump said he took one and “aced” it in 2020, Appel said.

“Whether or not standard cognitive testing should be part of this process is an interesting question because most Americans — if they’re 80 or 90 — and go to their general practitioner, probably you get a cognitive test,” Appel said.

However, passing a mental fitness test — which typically includes simple questions like correctly naming the day of the week or identifying animals — would not necessarily indicate fitness to be president.

“It’s a great accomplishment if you’re a nursing home patient with advanced Alzheimer’s disease,” Appel said. “It’s not a great accomplishment for the average human being.”

Do the results matter?

The president is under no legal obligation to undertake a physical examination, much less release the results to the American public, Balcerski said.

“The analogy I’ll give is that it’s like releasing tax returns,” Balcerski said. “They’re not legally bound to do it.”

Because of this, the president is within his rights to withhold any test results that he sees fit, Balcerski said.

“It is definitely a political exercise,” Appel said. “The American people should put absolutely no trust in this … We have learned over and over again — including in recent times — that politicians have deceived the public about their health in very high stakes ways.”

For example, Appel said, Lyndon Johnson withheld his skin cancer diagnosis from the public, and Paul Tsongas, a candidate for president in 1992, stated he was cancer free, which, at the time, was “patently false.”

The public can only presume that some results are similarly being withheld now, Appel said, adding, “We will learn in a generation or two what we don’t know.”

Pushing back against this, Balcerski said that Biden’s physical results appear detailed and thorough, adding “I would expect a physician’s integrity to be on the line here.”

Regardless of whether not the president’s full health status is revealed, some “interesting tidbits” can often be gleaned from the exams, Appel said.

During one of Clinton’s physicals, for example, it was revealed that he was developing hearing loss and required a hearing aid late in his presidency.

Similarly, he said, “I think the average person would have been stunned at what good shape George W. Bush was in. Even well into his presidency, he had the body and vital signs of a trained professional athlete.”

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