Many U.S. presidents have concealed significant medical problems from the public, but the practice is now under heightened scrutiny in the wake of former President Joseph R. Biden’s cancer diagnosis and reports of debilitating cognitive decline that aides tried to cover up.
New books claim Mr. Biden, 82, was struggling to carry out the duties of the presidency as the oldest person to hold the office while those closest to him, including first lady Jill Biden, worked to keep it a secret as he prepared to run for a second term.
His inner circle rejected calls for a cognitive test that may have given the public a clearer picture of the president’s mental capabilities, even as the public polls showed significant doubts in his mental acuity and memory.
“If there’s no diagnosis, there’s nothing to disclose,” a dismayed doctor who worked in the White House Medical Unit told authors Jake Tapper and Alex Thompson in the new book “Original Sin,” which chronicles the cover-up of Mr. Biden’s cognitive decline.
Instead, White House physician Kevin C. O’Connor in February 2024 declared Mr. Biden “a healthy, active, robust 81-year-old male, who remains fit to successfully execute the duties of the Presidency.”
Mr. Biden would hardly be the first president to hide major health problems.
No laws require a president or presidential candidate to undergo a cognitive test or any other medical assessment, including a blood test that would have almost certainly revealed Mr. Biden’s advanced prostate cancer.
The president and presidential candidates are also shielded by privacy laws from having to disclose any medical information at all. It’s left up to them to pick and choose what voters and the public can know about their health.
Most of the public was unaware, for example, that four-term President Franklin Delano Roosevelt needed a wheelchair, or that President Kennedy was taking eight medications a day while in office, including codeine, methadone and Demerol, to control back pain, Addison’s Disease and other significant health problems.
Post-White House revelations about the seriousness of Mr. Biden’s cognitive problems, followed by his diagnosis with late-stage prostate cancer, raise new questions about a president’s medical privacy.
So far, nobody in Congress is proposing a change in the law that would force medical exams and disclosures for those seeking and holding the nation’s highest office.
But Republicans are stepping up oversight.
A House panel earlier this month subpoenaed three of Mr. Biden’s top White House aides and requested a transcribed interview with the ex-president’s physician, Dr. Kevin O’Connor, to examine what Republican lawmakers believe was a cover-up of Mr. Biden’s cognitive deterioration.
House Oversight and Government Reform Committee Chairman James Comer called it “one of the greatest scandals of our generation,” and said he’s examining whether Mr. Biden was even aware of the hundreds of laws, memoranda and thousands of pardons that were signed by autopen.
President Trump said he now thinks Mr. Biden wasn’t even aware of major policy decisions, including those resulting in the massive influx of illegal immigrants that poured across the southern border during his term.
“We’re gonna start looking into this whole thing with who signed this legislation. Who signed legislation opening our border? I don’t think he knew,” Mr. Trump said on Capitol Hill this month.
Aides reveal in “Original Sin” and other newly published books about Mr. Biden’s presidency that his mental acuity had deteriorated significantly during his four years in office.
He forgot the names of close aides beginning in 2022, struggled to speak coherently and became almost completely isolated from his presidential Cabinet.
Mr. Biden, in 2024, was unable “to find words, to remember what he was saying, to stay on one train of thought,” aides revealed.
His ability to do the job was almost certainly impacted.
Mr. Biden was unable to work in the evenings or early in the morning, and staff tried to limit his important tasks to the hours between 10 a.m. and 4 p.m. After public trips and falls, his mobility had declined to the point that staffers discussed putting him in a wheelchair if he served a second term.
Most alarmingly, aides fretted he was too mentally frail to be capable of leading in the event of a 3 a.m. national or international emergency.
Earlier this month, Mr. Biden disclosed he is suffering from Stage 4 prostate cancer that has spread to his bones, leading to more questions about whether his diagnosis was hidden from the public or ignored by the president’s doctor.
A Biden spokesman said the former president hadn’t been tested for prostate cancer since 2014.
“This is either malpractice or a coverup,” Rep. Ronny Jackson, Texas Republican and former White House physician, said. “The truth is, his physician was more concerned about assisting with the political cover-up than providing world-class medical care.”
Even if Mr. Biden’s cancer was known while he was president, medical confidentiality ethics rules and the preeminent federal health privacy law, HIPAA, would shield that information from public scrutiny. The same privacy rules would apply to the results of a cognitive test if the former president elected to take one.
Charles A. Stevenson, a professor at Johns Hopkins School of Advanced International Studies, said presidential candidates “should provide basic medical details on their health and ongoing treatments for specific conditions.” Once in office, he said, “the public deserves to be informed of any significant illnesses or situations such as medical procedures,” but not “ordinary fluctuations in the president’s health or behavior.”
Mr. Stevenson said members of the Cabinet and other senior officials “have an obligation among themselves to be alert to any condition that could prompt a 25th Amendment consideration of the president’s ability to discharge his duties.”
The 25th Amendment, however, has never been invoked even though at least one president was significantly incapacitated for part of his term. President Woodrow Wilson suffered a major stroke in October 1919, but neither his vice president nor other Cabinet members were willing to force him out of office. Instead, his wife secretly took over the duties of the presidency until his term expired more than a year later.
Mr. Wilson had at least three minor strokes before his first campaign for the presidency, but never disclosed them.
Mr. Kennedy’s significant medical problems also preceded his run for the White House. They were not known until his family agreed to release his records two decades ago. The information showed he’d been hospitalized nine times in the late 1950s to treat his back and stomach problems, and his spine had fractured due to osteoporosis, perhaps brought on by other drug interventions. He was unable to put on his shoes and socks without assistance.
Mr. Trump’s medical disclosures have also come under scrutiny and criticism.
His doctors declined to reveal the results of a lung scan after he was diagnosed with COVID-19 during the final year of his first term. More information was later leaked to the media, claiming the president was much sicker from the virus than he revealed at the time and that staff feared he would need to be put on a ventilator.
Mr. Trump’s weight and fast-food consumption have raised questions about his health, and he’s been accused by his foes of suffering from a variety of mental health problems, from dementia to narcissistic personality disorder.
Trump, 78, underwent his annual physical on April 11 and released the results two days later.
He underwent a test using the Montreal Cognitive Assessment, a screening tool for cognitive decline, and scored a 30 out of 30.
A blood test for prostate cancer showed normal results. White House Physician Capt. Sean P. Barbabella said Mr. Trump “exhibits excellent cognitive and physical health.”
Mr. Biden and his wife denied that he suffers from cognitive decline and covered it up. They sat together for an interview on The View this month to head off the sensational claims by his former aides and said they were unfounded.
“I did not create a cocoon around him,” Mrs. Biden said. “You saw him in the Oval Office. You saw him making speeches. He wasn’t hiding somewhere.”
