Many U.S. presidents have concealed significant medical problems from the public, but the practice has come under heightened scrutiny after former President Joseph R. Biden’s cancer diagnosis and reports of debilitating cognitive decline that aides tried to cover up.
Newly released books say that Mr. Biden, 82, struggled to carry out the duties of the presidency as the oldest person to hold the office and that 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 public polls showed significant doubts about 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 “Original Sin,” which chronicles the cover-up of Mr. Biden’s cognitive decline.
In February 2024, White House physician Kevin C. O’Connor 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. That includes a blood test, which almost certainly would have revealed Mr. Biden’s advanced prostate cancer.
Privacy laws also shield the president and presidential candidates from disclosing any medical information. Thus, they can choose what information to disclose about their health.
Most of the public was unaware that four-term President Franklin D. 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 of late-stage prostate cancer, have raised new questions about a president’s medical privacy.
So far, nobody in Congress has proposed a legislative change that would require medical exams and disclosures for those seeking and holding the nation’s highest office.
However, Republicans are stepping up oversight.
A House panel this month subpoenaed three of Mr. Biden’s top White House aides and requested a transcribed interview with former presidential physician Kevin O’Connor to examine what Republican lawmakers suspect was a cover-up of Mr. Biden’s cognitive deterioration.
House Oversight and Government Reform Committee Chairman James Comer, Kentucky Republican, called it “one of the greatest scandals of our generation” and said he was examining whether Mr. Biden was even aware of the hundreds of laws, memoranda and thousands of pardons signed by autopen.
President Trump said he doubts Mr. Biden was even aware of major policy decisions, including those resulting in the massive influx of illegal immigrants who poured across the southern border during his term.
“We’re going to 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 that Mr. Biden’s mental acuity had deteriorated significantly during his four years in office.
Beginning in 2022, he forgot the names of close aides, struggled to speak coherently and became almost completely isolated from his presidential Cabinet.
In 2024, Mr. Biden was unable “to find words, to remember what he was saying, to stay on one train of thought,” aides revealed.
The president’s ability to do the job was almost certainly impacted.
Mr. Biden could not work in the evenings or early in the morning, and staff tried to limit his important tasks from 10 a.m. to 4 p.m. After public trips and falls, his mobility declined to the point that staffers discussed putting him in a wheelchair if he served a second term.
Perhaps most alarming is that aides fretted he was too mentally frail to lead in a 3 a.m. national or international emergency.
Earlier this month, Mr. Biden disclosed his diagnosis of stage four prostate cancer that had 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 spokesman said Mr. Biden hadn’t been tested for prostate cancer since 2014.
“This is either malpractice or a cover-up,” said Rep. Ronny Jackson, Texas Republican and former White House physician. “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 were 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 he had 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 Wilson sustained a major stroke in October 1919, but neither his vice president nor his 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.
Wilson never disclosed that he had at least three minor strokes before his first campaign for the presidency.
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 had been hospitalized nine times in the late 1950s to treat his back and stomach problems, and his spine had fractured because of 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 his COVID-19 diagnosis during the final year of his first term. Information later leaked to the media said the president was much sicker 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 his opponents have suggested that he has mental health problems such as dementia and narcissistic personality disorder.
Mr. 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. Capt. Sean P. Barbabella, the White House physician, said Mr. Trump “exhibits excellent cognitive and physical health.”
Mr. Biden and his wife denied that the former president suffered from cognitive decline and covered it up. They sat together for an interview on “The View” this month to declare that the sensational claims by his former aides 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.”
• Susan Ferrechio can be reached at sferrechio@washingtontimes.com.
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