Presidential Candidates Should Undergo Standardized Cognitive and Physical Testing

Health professionals often perform the “eyeball test” when they first meet a patient. Through the power of observation, pixels of information are gathered quickly and often unconsciously to determine whether a patient is unwell.

We listen to the cadence of their speech; we watch their mannerisms, posture, and gait; we scan their faces, skin turgor, and complexion — we make an immediate evaluation as to whether the patient is ill or not. It is a crude tool, but it works. It may not provide a complete diagnosis, but it can signal to clinicians that the patient is in need of help.

It appears that the nation performed this “eyeball test” during a presidential debate in June and an assassination attempt in July — and we determined that more information was needed. Following the debate, there was intense examination by party leaders, the public (especially from donors), and the media on President Biden’s cognitive fitness. Without clear information on his health status, calls for him to step down rung out. Meanwhile, the Trump campaign left the public in the dark for days after the assassination attempt on former President Donald Trump, refusing to discuss his condition or release a medical report.

Ultimately, President Biden decided not to seek a second term, but this does not diminish the need for the public to know about the health of their presidential candidates. For the moment, the attention is on Trump and Vice President Kamala Harris as well as their running mates, Sen. JD Vance (R-Ohio) and Minnesota Gov. Tim Walz (D). This knowledge should not be used to discriminate but to ask fair questions about each of their ability to lead a nation.

This is not the first time that the public has had questions about its leaders.

In the past, the public was not told about ongoing health issues with their elected officials. For example, President Franklin Delano Roosevelt was paralyzed by polio, but this was covered up by images of Roosevelt standing or sitting down with others around tables and in cars. His condition was largely invisible in the media, and the ongoing narrative was that he had overcome this affliction.

President John F. Kennedy had Addison’s disease, a serious disease requiring corticosteroids. In the early 20th century it could be considered a death sentence for those afflicted. Yet, during an interview in 1959, as Kennedy was starting his presidential campaign, he denied having the disease. He reportedly said, “No one who has the real Addison’s disease should run for the presidency, but I do not have it.” Notably, patients with this disease may have skin color that looks tan due to the increase in melanin production; his administration cleverly used his dark skin as a sign of vigor and athleticism rather than illness.

President Ronald Reagan may have begun to develop signs consistent with Alzheimer’s disease during his second term. As an actor, his ability to read scripts with emotion may have helped him communicate with the public without appearing to have cognitive impairment.

But in this day and age, the public is primed to be on the lookout for anything suspicious regarding their candidates’ health and ability to perform. This could have positive implications, leading to a more open discussion about what level of health is required to serve as president.

This discourse should not be punitive, but based on realistic ideas of what the public expects from their elected officials — especially presidents and vice presidents. Physical challenges can often be managed through assistive devices and other technologies. However, high executive functioning and emotional intelligence are critical to succeeding in the job and ensuring the public’s confidence in its leaders. It’s not unreasonable to expect that a president can analyze complicated scenarios, make cogent decisions, and communicate clearly and with empathy.

It is imperative that we include mental status checks and thorough cognitive testing in physical exams for all candidates. This is especially important for senior officials making decisions that can impact public safety and well-being. Mandating that all candidates undergo standardized evaluations would help to avoid ageism and political party influence.

We cannot forget, however, that patient privacy is sacred. There are laws in place to protect our health information such as the Health Insurance Portability and Accountability Act (HIPAA). Healthcare professionals must follow strict guidelines. Health systems are built to support these restrictions, including access to electronic medical records.

So, where does that leave us with the reporting of presidential health evaluations and records? Here’s an analogy to support my proposal:

In medicine, physicians have the legal, moral, and ethical responsibility to report to their state health and regulatory boards if they notice that their colleagues show physical and/or psychological impairment.

The Federation of State Medical Boards released a formal position statement on what is to be reported and how it can be done confidentially. Yet, research findings published in 2010 showed that 17% of physicians surveyed had direct personal knowledge of a physician colleague who was incompetent to practice medicine in their hospital, group, or practice, and of those with this knowledge, only 67% reported their impaired colleagues to authorities. It can be emotionally challenging to report colleagues, but it has to be done to not only help the colleague, but also for the safety of their patients.

Imagine that the president is the physician, and the public is the patient. If the physician is impaired, the patient’s life is at risk. Decisions made by the physician can harm the patient.

My proposal is to establish an independent, apolitical commission that requires that all presidential and vice presidential candidates submit their comprehensive medical information, which would be shared with the public when situations arise that raise alarm. There would need to be an impartial discussion on the level of information that needs to be released and by whom.

The Hippocratic Oath, “do no harm” should apply to everyone, including our leaders.

Saralyn Mark, MD, is the former senior medical advisor to the White House, HHS, and the National Aeronautics and Space Administration (NASA). She is the American Medical Women’s Association COVID-19 and Health Innovation lead. Mark is founder/president of iGIANT (impact of Gender/Sex on Innovation and Novel Technologies) and SolaMed Solutions. She is the author of Stellar Medicine: A Journey Through the Universe of Women’s Health and host of the “Always Searching” podcast.

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