Secrets, lies and TMI: A history of White House health disclosures

On Sept. 26, 1955, the president of the United States did what many of us do upon waking up. It just happened to be national news. “He had a good bowel movement,” Dwight D. Eisenhower’s press secretary told reporters.

One of Eisenhower’s physicians added, “The country will be very pleased — the country is so bowel-minded anyway — to know that the president had a good movement this morning, and it is important. It is good for the morale of people.”

This intimate detail, revealed two days after Eisenhower suffered a major heart attack, represents one extreme when it comes to medical transparency from the nation’s top brass. On the opposite end is Defense Secretary Lloyd Austin, who kept the nation and even President Biden in the dark about his prostate cancer diagnosis, surgery and subsequent hospitalization following complications.

How much information do national leaders owe the public about their personal health? And when do we reach the point of too much information, intestinal or otherwise?

[Defense secretary’s undisclosed hospitalization draws new internal investigation]

“Some (medical) things are so obviously not the public’s business, and some are,” but figuring out where to draw the line is tough, said journalist Matthew Algeo, author of the 2012 book “The President Is a Sick Man,” about Grover Cleveland’s top-secret surgery for cancer.

U.S. history provides several cautionary tales that support transparency — at least to a point.

Several times, White House physicians failed to disclose major presidential health crises. The public didn’t learn that Franklin D. Roosevelt was on death’s door during his fourth term or that Woodrow Wilson was severely debilitated by a massive stroke, facts that had major consequences on the world stage.

In total, four presidents (including Roosevelt) and seven vice presidents have died in office of natural causes.

More recently, President Donald Trump and his staff were cagey about his health. In 2016, the year he became the oldest person elected president to that point, his physician claimed without providing any real evidence that he would “be the healthiest individual ever elected to the presidency,” and skepticism about his reported weight in 2018 spawned a “girther” movement. Later, the White House and the president’s physicians failed to tell the public how seriously ill he was with COVID-19 during the 2020 campaign.

He wasn’t the first presidential candidate to conceal health problems. Physicians treating Sen. Paul Tsongas of Massachusetts, a leading candidate for the Democratic nomination in 1992, didn’t level with the press about a recurrence of the cancer that led to his death five years later at the age of 55. And Vice President Hubert H. Humphrey’s 1968 campaign for president failed to disclose suspicions that he had bladder cancer, which would kill him in 1978.

In 1972, health matters tripped up the presidential candidacy of Sen. George McGovern (D-S.D.) when he — and the press — learned that his running mate, Sen. Thomas Eagleton of Missouri, had been hospitalized for depression and treated with electroshock therapy. While McGovern publicly declared “1,000 percent support” for Eagleton, he and others ultimately forced the vice presidential hopeful to withdraw from the ticket.

White House news has a way of slipping past the most diligent of gatekeepers. In 1893, a Philadelphia newspaper reporter learned that President Cleveland had undergone a cancer operation aboard a friend’s yacht off Long Island.

The administration denied the report. The nation was in the midst of a financial crisis, and Cleveland didn’t want to make things worse by turning his health into a news story, Algeo said. And Cleveland had been appalled by the intense public attention to the drawn-out agonies of former president Ulysses S. Grant, who died in 1885 of throat cancer.

“Grant’s death was a horrible, ghoulish, constantly updated spectacle,” Algeo said. “Every single twist and turn of his health was reported, and not always reliably.”

Finally, there was another reason for Cleveland to stay mum about his health. “He didn’t think it was anybody’s business,” Algeo said. It wasn’t until 1917 that one of the physicians who removed a tumor in Cleveland’s mouth confirmed that the operation had taken place.

Decades later, the Eisenhower White House made strides on the transparency front, at least initially. When Eisenhower suffered a heart attack in 1955 at the age of 64, he reportedly ordered his press secretary to “tell them everything.”

“It was a serious crisis and a teachable opportunity. They got very good surgeons who held regular briefings about what heart disease actually is,” said University of Virginia historian William Hitchcock, author of the 2018 book “The Age of Eisenhower: America and the World in the 1950s.”

But when Eisenhower later suffered a stroke, Hitchcock said, his staff brushed it off. “I think they felt ‘there’s nothing to see here.’ Which of course isn’t true.”

Eisenhower’s medical crises helped spur the passage of the 25th Amendment, which governs voluntary and involuntary transfers of power when the president is incapacitated.

Since then, the public has learned in real time about a variety of sensitive presidential ills, from Ronald Reagan’s prostate and colon operations to Jimmy Carter’s hemorrhoids. Barbara A. Perry, a presidential historian at the University of Virginia, remembers watching late-night host Johnny Carson joke about how Carter was being treated by a physician who happened to be a “rear admiral.”

Jokes or no jokes, “you can’t go wrong with transparency,” Perry said. Presidents should release information about any medical problem other than minor matters that can be addressed in the White House physician’s office, she said. This kind of openness should extend to the Cabinet, Perry added. If she were president, she’d tell Cabinet members that “if medical privacy is important to you, and you’re entitled to that as an American citizen, then I can’t appoint you.”

John G. Sotos, a retired San Francisco flight surgeon and cardiologist who manages a website devoted to presidential medical history, wrote in the Journal of the American Medical Association in 2021 that the law should require clinicians to disclose to the vice president and Cabinet whenever the president has a “medically disqualifying condition.” He proposed using the “well-established” list of conditions that the Air Force relies upon to determine whether air traffic controllers are fit to serve.

In an interview, he said Cabinet members should have to tell the president about serious medical problems. But Sotos said he doesn’t think anyone needs to know about minor matters, such as an uncomplicated urinary tract infection or hemorrhoids. He cautioned that a focus on trivial health details could “game the system” by giving the appearance of openness without actually being transparent. John F. Kennedy’s staff, for example, used deception and distraction to keep the public’s focus away from his true health problems, he said.

Meanwhile, members of Congress have floated proposals about the medical evaluation of presidents and presidential candidates, but none has become law. Republican presidential candidate Nikki Haley says she wants candidates older than 75 to take mental competency tests — a poll suggests Americans like the idea — and Carter, the oldest ex-president, has suggested that there should be an age limit for the presidency.

Whether or not new policies are adopted, it’s not likely that the media will ever get the level of access it had following the 1881 assassination attempt on President James Garfield (even if the White House was giving the press an overly rosy assessment of his condition). Physicians provided daily bulletins to reporters about details ranging from his pulse and temperature to his rectal feeding.

And before Garfield died later that year, an Associated Press reporter was allowed to sit outside the president’s sick room and tell other journalists what he heard. “I listen for every sound,” he wrote his wife. “A dog barking in the distance is heard. A fountain splashes on the lawn. Not a step is heard in the mansion. The president sleeps.”