The outrage was swift and resolute: Karl Rove had delivered a blow beyond
the pale when he suggested – insinuated, hinted, alluded to, without
actually saying it – that an aging Hillary Clinton might have brain damage.
“Thirty days in the hospital?” Rove said during a conference
in Los Angeles in May. “And when she reappears, she’s wearing
glasses that are only for people who have traumatic brain injury? We need
to know what’s up with that.”
Rove was referring to the concussion suffered by Clinton in December 2012,
when she was coming to the end of her tenure as secretary of state. Doctors
later discovered that she had a blood clot in the vein that runs between
her skull and brain behind her right ear. She spent three days at New
York Presbyterian Hospital, not 30, as Rove said.
That error, plus Rove’s reputation as a ruthless political operative,
brought widespread criticism. Clinton soon after her illness stepped down
from her post (President Barack Obama appointed Sen. John Kerry). But
at 66, she has been making the rounds at speaking engagements, and on
Tuesday her book “Hard Choices” will be published. This has
fueled speculation for months that she will run for president in 2016,
and if she does, she’ll be the front-runner for the Democratic nomination.
Republicans may be well-advised to raise questions about her fitness for
office, even at this early stage, when no major candidate has yet officially
declared him- or herself a candidate. And Americans seem to be of the
opinion that her health and age shouldn’t be an issue. A Washington
Post-ABC News poll last week showed that two-thirds of respondents disapproved
of the issues Rove raised.
Are those questions, which overnight went from whispers to screams echoing
in the 24-hour cable-news landscape, simply dirty politics? Or are they
part of a larger debate about the physical and mental abilities presidents
and candidates should exhibit?
This is not an academic exercise, since throughout American history, there
have been many examples of crucial health information about sitting presidents
that was deliberately kept from the public.
Dr. Michael Brant-Zawadzki, executive medical director at the Hoag Neurosciences
Institute in Newport Beach, says there have been raging debates in the
medical community about whether older doctors should be tested to see
whether their cognitive abilities have waned.
Many CEOs of big companies are scrutinized in such a way as well. So why
not the leader of the free world?
“The population has a stake in making sure that people responsible
for their lives are not impaired,” he said.
A certain amount of memory loss as we age is normal. But it would be important
to know the moment when a person begins a real cognitive decline that
might lead to dementia or Alzheimer’s disease. Obamacare now requires
Medicare to pay for a cognitive test for people 65 and older during their
annual wellness visit. The goal is to get dementia patients treatment
as soon after diagnosis as possible.
There’s no way to tell whether Clinton’s concussion –
caused by a fall – precipitated her blood clot, or the clot caused
her to lose consciousness and fall. She seems to have made a full recovery,
and the effects of the clot likely are not permanent. But Clinton, who
had a blood clot in her leg (called a deep vein thrombosis) as first lady
in 1998, might have a genetic predisposition to “sludgy” blood,
which could make clots more likely than among the general population.
“It didn’t seem to be a permanent event of any sort,”
Brant-Zawadzki said. “But we don’t know, and her doctors probably
don’t even know, because I doubt they tested her cognitive status
before and after, and for most normal functions, to you and me, to the
untrained eye, or to the untested individual, you wouldn’t be able
to tell. And so that may be good enough for any typical life activities,
or even leading the country.”
Every move Clinton, or Jeb Bush, or any other potential candidate for president
makes between now and 2016 will be closely scrutinized. “You can’t
hide,” said Lori Cox Han, a professor of political science at Chapman
University. “As president or a presidential candidate, you’re
on stage constantly.”
If Clinton were elected as the nation’s first female president,
she would be 69 and 86 days on Inauguration Day 2017, the second-oldest
president in the nation’s history at that point; Ronald Reagan was
69 and 348 days on Inauguration Day 1981.
Han dismisses speculation that Clinton’s gender has made her a more
available target than a man would be in a similar situation.
“There is absolutely no gender bias,” she said. “This
is a completely legitimate question we’ve asked of presidential
candidates for years.”
Brant-Zawadzki says one issue that gets overlooked is that older people
have an advantage over their juniors in at least one area: wisdom.
“Even though our processing speed and some memory wanes with age,
what has been found is that wisdom actually increases with age,”
he said. “So there’s a good reason to think about our leaders
as being preferable if they have some age under their belts, right? Neuroscience
points to, ‘Hey, it’s better to consider older folks for leadership
positions, because wisdom accrues with age.’”