By DANIEL STONE, MD (3)

President Trump’s wobbly walk down a ramp at his recent West Point visit along with his awkward  two-handed drink from a water glass have stirred recent speculation about a possible undisclosed neurologic issue such as early Parkinson’s Disease.  Although no specific conclusions can be drawn from these observations, they raise important questions regarding the President’s health.    

Trump would not be the first president to conceal health problems.  Toward the end of Franklin Roosevelt’s presidency, his blood pressure rose alarmingly.  As no drug treatments existed his doctors could recommend only that he stop smoking, lose weight and avoid dietary salt.  Less than six months after an un-knowing public re-elected him to a record fourth term, FDR predictably suffered a fatal stroke.  The public was similarly unaware of John Kennedy’s Addison’s Disease, a condition that required daily injections to replace the adrenal hormones his body could not make. 

The known facts about Trump’s health are concerning enough.   Despite taking a statin drug to reduce his cholesterol, Mr. Trump’s age and risk factors at his 2018 physical predicted a 16.7%  risk of a heart attack over ten years, as estimated by a standard American College of Cardiology risk calculator.  Trump was taking a statin at the time of that exam to lower his cholesterol.  As cholesterol levels on a statin may not reflect risk as accurately as un-treated levels, the calculator may under-estimate his true risk.     Although Trump’s doctors tout his health they seemed to be concerned about cardiovascular risk as they subsequently quadrupled his statin dosage, placing him highest dose of the most potent statin available.    In addition, the President’s annual exam revealed that his weight recently drifted up into the obese range, which means additional coronary disease risk along with an increased chance of stroke, chronic kidney disease, diabetes and several types of cancers.  

 Mr.  Trump’s judgment on health issues could be questioned given his use of finasteride, a medication used to prevent baldness.  The drug, which can cause loss of libido and breast growth in men, was the subject of an FDA warning in 2011 regarding high grade prostate cancer.  Although information published in 2019 was reassuring regarding prostate cancer risk, Trump has used the drug since at least 2016, well before this information was available.  His apparent willingness to take a vanity drug despite known serious health risks should cause concern regarding his awareness that presidential health issues are more than mere matters of personal preference.  

Although the “wobble-gait’ observations are non-specific they raised legitimate concerns about Parkinson’s Disease.  Caused by insufficient levels of brain neurotransmitters, the condition slows body movements, disrupts gait stability and produces tremor.  As the disease progresses 30% to 40% of Parkinson’s patients develop dementia.  2% of men the President’s age have Parkinson’s and the prevalence increases with time.  Even more concerning than the thought of a president with Parkinson’s Disease would be a President taking medication for Parkinson’s Disease .  Carbidopa/levodopa, the most commonly used drug, can be associated with mood changes.  Other commonly used Parkinson’s drugs are associated with impulsive behaviors, not something that we need to see more of in this President.  

The President’s awkward two-handed drink of water is less directly concerning.  Parkinson’s Disease produces a hand tremor during rest.   Tremors that occur during movement, like drinking from a glass, are  “action tremors” which are common and rarely debilitating.  But Trump’s use of his offhand to steady the other is the sort of maneuver one might use to suppress an action tremor.  This practice might be entirely innocent, but the possibility that the President might be trying to suppress a tremor, like his excessive attempts explain away the gait issue, might lead reasonable people to wonder whether he has something to hide.

The President’s record on health disclosures provides further reason for concern.  Dr. Harold Bornstein, Trump’s personal physician, released a statement in 2016 that Trump’s health was “astonishingly excellent” and that he would be the “healthiest individual ever elected to the presidency.”  The Trumpian sound of the bombast in the physician’s letter makes more sense after Bornstein’s revelation that the candidate dictated the statement.   Bornstein subsequently claimed that Trump’s White House had raided his office and taken all of Trump’s records without following standard procedures.  

Although the evidence that Trump harbors a significant neurologic diagnosis is less than convincing it still raises serious concerns.  In health matters, as with his personal  tax issues, the absence of transparency and the reliance on public relations strategies should concern the public.   Regardless of his current neurologic status, anyone with Trump’s risk factors and age would face substantial risk of debilitating  health problems over the course of a four-year term.  Given what we know, can the public have confidence that a medically disabled Trump would reveal serious health issues  and allow Vice-Presidential succession under the terms of the 25^th Amendment?   Ultimately, the presidential health issue for Americans to consider is not whether Trump can walk straight but whether he can talk straight.  

Dr. Daniel J. Stone is an internal medicine and geriatric specialist in Los Angeles. Dan is a regular contributor to the Deductible.