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Trump’s second presidential physical exam, explained

Trump’s second annual physical revealed he’s in “very good health” without many details.

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Last year, the White House physician said Trump had to lose a few pounds. That’s about all we learned from the press event about his physical exam.
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President Donald Trump had his second full physical exam last Friday. By that evening, the 72-year-old’s personal physician — Dr. Sean Conley — released a statement saying a team of 11 doctors had examined Trump, and that Trump is in “very good health.” In an unusual move, he also predicted the future over the next two years by stating that he expects the commander-in-chief to remain healthy “for the remainder of his presidency and beyond.”

A week later, a few more details have now emerged in a final medical statement — most notably, that Trump gained four pounds, which means he’s now technically obese. But altogether, the report appears to be a nothingburger. It didn’t really reveal anything new about the president’s health.

And we shouldn’t expect anything more: The presidential physical exam is best understood as political theater — a show of the president’s vigor and fitness — not an opportunity to reveal new medical information. Here’s what to know about the second exam.

What a presidential physical exam involves

Trump’s physical this year was conducted by Dr. Sean Conley, a Navy officer who took over the job from Ronny Jackson last year. It lasted four hours and took place at the Walter Reed National Military Medical Center outside Washington. Conley determined Trump is in “very good health overall.”

Conley’s predecessor, Jackson, had served in three administrations — that of George W. Bush, Obama, and Trump — then left the post in 2018 when the president nominated him for secretary of veterans affairs. He later withdrew his nomination after getting embroiled in a number of scandals, including allegations of excessive drinking on the job and improper prescribing of medications to White House staff. (The New York Times reports he has returned to the White House medical unit in the capacity of assistant to the president and chief White House medical adviser.)

Scandals aside, the physicals White House doctors perform look a lot like any physical a man Trump’s age would get: basic lab tests (cholesterol, hormone, and vitamin level tests), screening tests for age-related disease (such as cancer or heart disease), and the standard slew of other health assessments like checking blood pressure and the eyes, ears, and throat.

Last year, Jackson determined that Trump was in “excellent” physical and cognitive condition. That physical attracted an unusual degree of scrutiny amid questions about Trump’s mental health and fitness for office. In a first, Trump had requested a cognitive exam — apparently a response to Democratic members of Congress who had reignited the discussion about the 25th Amendment, a process that could remove a president who is unfit to govern.

The presidential physical doesn’t typically include an evaluation of mental fitness, and Conley did not report that he did another cognitive assessment this year.

What we know about Trump’s physical health and habits

As with his tax records, candidate Trump never released his medical records. So what we knew about his health, until last year’s physical results were announced, was mostly gleaned from media reports and dubious notes penned by his colorful longtime doctor, Harold Bornstein.

Last year, Jackson reported that Trump’s blood pressure was 122/74, which is in the normal range. Trump’s PSA was very low, meaning he has no prostate troubles. His total cholesterol was 223, and his LDL (or “bad”) cholesterol was 143, which is borderline high. Trump’s 20/30 vision was very good for his age. At 6-foot-3, he weighed in at 239 pounds — one pound shy of obesity, according to the body mass index.

This year, Conley reported that not much had changed. Trump is 6’3 and weighs 243 pounds, which means he’s gained a few pounds and is now technically obese. His total cholesterol is 196 (with an HDL of 58 and an LDL of 122) and is still on the high side. His blood pressure — at 118/80— is still in the normal range. There were no major changes in his health from last year, except for an increase in his statin dose, and the addition of shingles and pneumonia vaccines.

We also know Trump doesn’t drink alcohol or smoke, and he sleeps about four to five hours per night. The president takes a pretty standard range of medications for his age, including Ambien to help him sleep when he travels overseas; Crestor, a statin that lowers cholesterol; a low dose of aspirin to prevent cardiovascular disease; antibiotics to control rosacea; and Propecia for baldness.

Last year, Jackson had suggested Trump try to lose a few pounds and exercise more. But, as CNN reported, Trump hasn’t followed doctor’s orders. “The President received a diet and exercise plan last year after his annual physical, but the President admits he has not followed it religiously,” Hogan Gidley, the principal deputy White House press secretary, told CNN.

The news agency also reported that Trump likely hasn’t made any use of the White House gym, and instead gets his exercise by walking between White House buildings and golfing. This failure to workout might be explained by Trump’s extraordinary beliefs about exercise. In a New Yorker story about how Trump could realistically be removed from the presidency, Evan Osnos wrote: “Other than golf, he considers exercise misguided, arguing that a person, like a battery, is born with a finite amount of energy.”

Finally, we know Trump favors fast food because he thinks it’s cleaner and safer than other food. According to a new book by his former campaign manager Corey Lewandowski and ex-top aide David Bossie, Let Trump Be Trump, Trump has a prodigious appetite and in one sitting ate “two Big Macs, two Fillet-O-Fish, and a chocolate malted,” the Washington Post reported.

The long-simmering questions about Trump’s mental health

As for Trump’s mental health, he got a perfect 30/30 score on the Montreal Cognitive Assessment last year. The Montreal assessment is a standard test of cognitive fitness and should rule out obvious neurological impairment.

Yet even when Trump was still just a candidate, mental health professionals were speculating about his psychology and mental health — in Atlantic cover stories, in Vanity Fair, and on Twitter. There was talk about him exhibiting the personality trait of narcissism and signs of mental disorders.

Once he was elected president and his behavior became a matter of national security, the discussion got considerably more heated.

A group of 27 mental health professionals put together a book called The Dangerous Case of Donald Trump, which offered the view that Trump’s mental state presents a clear and present danger to our nation and individual well-being.” The Yale psychiatrist who edited that book, Bandy Lee, recently told Vox she has advised Congress on the need for an emergency psychiatric evaluation because of the threat the president poses to public health.

Richard Friedman, a professor of clinical psychiatry and director of the psychopharmacology clinic at Weill Cornell Medical College, argued in the Washington Post in 2018 that we don’t even need to test Trump’s mental health because we already have ample evidence he is unfit.

“Testing wouldn’t be conclusive, shouldn’t be the basis for disqualifying someone for the presidency and wouldn’t tell us anything we don’t already know,” he wrote, adding that “the most accurate measure of a person’s fitness, whether mental or physical, is observable function in the real world — not the results of a fancy test or expert opinion. The fact is that Americans already have all the data they need to judge Trump’s fitness.”

We may not ever learn the truth about Trump’s health

As expected, Conley’s report from the presidential physical only revealed a few innocuous details about Trump.

But even if he uncovered a major health problem, we aren’t likely to hear about it. That’s because Trump is entitled to the same patient privacy rights as other Americans, and it’s up to him what gets reported to the public. Neither the president nor his doctor is under any obligation to share complete or detailed medical records.

Presidents and presidential candidates have also had a historically flimsy relationship with the truth when it comes to their health. Hiding a president’s medical history is pretty much the norm.

Jacob Appel, an assistant professor at Mount Sinai School of Medicine who studies the health histories of candidates, told Vox in 2018 he’s convinced the public would not know if a president or presidential candidate is truly sick “until history renders its verdict years from now.”

If Trump did have a more involved cognitive function test, we probably wouldn’t find out the results.

“I don’t think they would say the president is depressed or has had a stroke and has memory issues, and part of the reason they wouldn’t do that is that it could imperil national security,” said Arthur Caplan, head of the division of medical ethics at NYU School of Medicine.

Looking back, we now know a number of past presidents and presidential candidates who were actually much sicker in office than the public knew. FDR’s paralysis was kept from public view, as was Woodrow Wilson’s 1919 stroke, which left him incapacitated. “His wife and his senior advisers ran the country while he was indisposed for many months,” Appel said. “The public was entirely unaware.”

That’s why Appel thinks it’s unfair that many members of the media have questioned Trump’s health while implying past presidents were perfectly healthy. “The reality is many presidents have been extraordinarily unhealthy — even at death’s door.”