On Monday evening, President Trump left Walter Reed National Military Medical Center, where he was being treated for the coronavirus, and returned to the White House, after tweeting that he was “feeling really good.” But, since Trump was hospitalized, on Friday, Americans have heard a steady stream of contradictory and confusing information. This weekend, the White House doctor, Sean Conley, was evasive about Trump’s condition but eventually admitted that the President had run a high fever and that his oxygen levels had dropped below the normal range. Trump received supplementary oxygen and was treated with REGN-COV2, an experimental antibody drug, and the steroid dexamethasone—all of which indicate that his disease is serious and potentially worsening. Trump will continue treatment at the White House, but Conley did not give a clear answer as to whether he will remain in his residence. When Trump returned to the White House, where numerous staffers, including two members of the housekeeping department, have been infected, he immediately removed his mask.
Earlier on Monday, I spoke by phone with Lawrence Altman, a physician who has been writing for the Times for more than fifty years, with a focus on the health of political leaders. His interview with Ronald Reagan in 1980 marked the first time a candidate had extensively discussed his health with a reporter. Altman is currently a global fellow at the Woodrow Wilson International Center for Scholars. During our conversation, which has been edited for length and clarity, we discussed the media’s coverage of Reagan’s dementia, the pressures faced by White House doctors, and how transparent a President is obligated to be about his own health records.
How did you get interested in political leaders and their health?
I think from reporting on it for the Times. In 1972, [Senator George McGovern’s Vice-Presidential running mate, Senator Thomas] Eagleton had to disclose that he had been hospitalized three times for depression, and had had electroshock therapy on two of those occasions. And Bob Boyd and Clark Hoyt, with the Knight chain, found out and were ready to report on it. The McGovern-Eagleton team just called a press conference, and denied them their scoop, but they disclosed Eagleton’s problems. And I got called in immediately to work on it.
I went out to St. Louis and reported that the Washington University main teaching hospital, Barnes Hospital, had moved Eagleton’s medical records. And I wrote a story about that for the Times, and raised the spectre that anybody [who was working at the hospital] could have examined his records—and it later was known that the Nixon White House had Eagleton’s records.
Could you talk a little bit about what the media environment was like for Presidents or politicians, but Presidents especially, with regard to their health, before 1972, and certainly before 1980?
I talked to [the political columnist] Russell Baker at one point, and other reporters who were there at the time. They were working before 1972, and were covering Eisenhower. And I think it was like how reporters didn’t cover Kennedy’s escapades. There was a feeling that Presidents and political leaders were entitled to their privacy, and reporters didn’t dig into them unless there was some major reason. And, therefore, they took at face value whatever was said and didn’t do what today we would call investigative journalism. I would call it doing their homework, just digging in and looking for the facts.
Why did Reagan agree to do an interview, and how did that come about?
That came about because, in 1980, during the campaign, Reagan was going to be the oldest person to become President, if elected. People questioned why he was saying one thing at one time of the day and another at another time of the day. And some people raised the question, more from political scuttlebutt rather than on the basis of any fact, that he might have senility. In those days, Alzheimer’s was not a household word. Senility was the predominant word. And Reagan had, during the campaign, said his doctors would attest to his health.
So I and the Times challenged him on it. And he agreed. And I had requested that I not only interview Reagan but do so after interviewing his doctors. I wanted to talk to them directly. And he agreed to that after some time. His staff, from what I gather, opposed it for a long time. But he finally agreed, and I went out to California and interviewed all the doctors he said he had seen, interviewed them as I would any doctor regarding a patient I had.
From that information, I learned that his mother had senility in the few years before her death. And then, with that information, I asked him about his mother. He told me that, and senility was his word. I told him about Alzheimer’s, and he didn’t know about Alzheimer’s. And, at one point in the interview, I asked him, “Well, if you had any question with your mental status, or became senile like your mother, or in any way”—and I probably used the word dementia—and I said, “What would you do?” He immediately said, “Step down. Resign.” I asked him how he would know, and he said his doctors would be following him, and he would listen to whatever his doctors told him. And that became a story that I wrote in 1980. It was the first interview that I know of, certainly in recent times, asking a political candidate or a Presidential candidate prospectively about his health. And he was quite open in the sense I’ve just described.
Did some people think that this was poor form, or impolite to ask such things? Was there any sort of backlash?
In a strange way, there was from his White House doctor, who was not his White House doctor at that time. He was his urologist in Santa Monica. He didn’t say anything to me at the time, but he wrote a book in which he took me to task because he said I went out there purposely to show that Reagan had dementia or Alzheimer’s. And he wrote that even though it turned out that Reagan had declared after he left office that he had Alzheimer’s. But he never mentioned that fact. And it was also that doctor, the urologist—his name was Burton Smith—who said he would never ask questions like “Who’s President of the United States?,” because he thought that was demeaning, but it was never clear what mental-status test Smith used on Reagan. Other doctors said they went through the usual routine.
How forthcoming were Reagan’s doctors after he was shot, in 1981, and what role did the media play in trying to get information?
I happened to be driving between Seattle and Vancouver for a story on the Shah of Iran and his medical care. I got to Vancouver, and then I had to come back to Seattle and fly back to Washington, D.C. And I picked up on the coverage the next morning. I went over to the hospital. I interviewed one of the doctors who had seen him in the emergency room, and wrote that. Certainly, no one stopped me from doing that, journalistically or medically. The hospital probably would have if they had found out that I had found the doctor to talk to.
But I think that in the hours to days that occurred thereafter, all the questions arose, and they had arisen in my mind. Why hadn’t they imposed the Twenty-fifth Amendment, or at least considered it? And it hadn’t been considered. And Dr. Dennis O’Leary, who was in a dual capacity of being a spokesman for George Washington University Hospital as well as for the White House, was painting a very rosy picture about Reagan, when he hadn’t seen Reagan and was only taking the word of doctors who had been treating him. But he didn’t say anything about the location of the bullet being near Reagan’s heart. It was in his lung, but it stopped short of his heart. That came out later. They were downplaying the state of his health, and apparently Nancy Reagan had done a lot to dampen what the White House spokespeople were saying. And they went through the usual public-relations episodes of pictures and visitors and so forth.
But, in those initial hours, he was seriously ill, much more than they told people. And that became more important when it was realized later. I spoke to Dan Ruge, who was the White House physician, and he said he had made a mistake. He carried the Constitution with him, and he knew the Twenty-fifth Amendment. And he knew that it should have been brought up, but it wasn’t. He took that upon himself as something that he should have done. And then Reagan recuperated.
In answer to your earlier question, I’m not sure that there was any further impediment. They held news conferences, but I don’t think there were any barriers that I can think of forty years later that stood in the way of trying to get the story. I do remember that it made no sense to me as to how many units of blood were transfused at a surgery and pre- and post-operation. And it didn’t fit with the picture.
And then I did my own homework overnight and found out that Reagan had received many more units of blood than O’Leary had said he got pre- and post-operatively. And he attributed that to not knowing that anesthesiologists could order blood during surgery, which to me was a heck of an admission of the dean in a medical school and a hematologist. But be that as it may. And I reported that.
How do you think, in hindsight, the press dealt with Reagan clearly aging toward the second half of his Presidency?
You have to go back in time and try to picture what things were like in 1984, when he was running for reëlection, and during the 1984-88 period, when he was there. One, his doctors said they saw no evidence of his mental deterioration. Two, I don’t think the medical profession at large, and the public, were as perceptive as they are now about the early stages of dementia, whether it’s Alzheimer’s or any other form of dementia, and they may not have been attuned to picking up some of the early signs.
But let’s say for the sake of discussion that there was a lot of support for the fact that he had early Alzheimer’s or early dementia, whatever kind. The question then is: what were you going to do about it? Would doctors then recommend that he not stay in office? What evidence did they have that his decisions were reflecting this mental-status decline in his everyday work? And the ones that I interviewed didn’t give such evidence.
What have you witnessed about the pressure on a doctor when that doctor is taking care of the President?
It goes through in steps. And I think you have to start with a basic point that the ancient tradition of medicine, which is reinforced by HIPAA, says doctors cannot disclose anything about their patients’ health without the permission of the patient. And, at the same time, the doctors are their patients’ advocates, and they’re not obligated to do so. They usually agree to do so. But they have to do it within the realm of permission.
And then it becomes thorny when the patient’s a President or a political leader. I’ve taken from early on the position that political leaders should be transparent in releasing their health information, because I believe the public has a right to know if its leader is able to carry out the duties to which they were elected and take an oath to carry out. The doctor should have an agreement with the President that the doctor has an additional obligation to be candid with the public. I don’t know what agreements Trump and his doctors made, or others.
Something tells me Trump did not negotiate that with his doctors, telling them that they had to be honest with the public, but go on.
Yeah. But I’m speaking in answer to your question in a generic way, because I think that’s the way you have to look at it. And then you can look for the breaches. I think, if there’s disagreement, the doctor has to negotiate with the patient to try to level with the public. And, if that doesn’t work, the doctor can say, “O.K., I can’t speak for you, because I would be withholding information that I believe that they should have. And therefore I’m not willing to speak publicly.” Or, if it got worse, then resign. I used to ask the White House doctors I dealt with, what would they do in this type of situation? They all told me that they pledged to resign. It never came to a case where that happened.
So you’re saying that when you interviewed doctors during past Presidencies, and asked them what they would do if they were asked to lie by the White House, or to be dishonest to the public, they said they would resign?
Correct. The White House doctors I interviewed. If it came to the point where the President wouldn’t let the doctor tell the story.
What have you made of the way that both the White House and Trump’s doctors have tried or not tried to communicate with the public? And how does it differ from what you’re used to seeing with the President and his health?
I think it’s far more confusing, because you’ve got the White House saying one thing, and you’ve got the doctors not being that articulate, saying something else, and then having to backtrack on their words. It’s been confusing to me why a White House doctor, knowing he’s going to step forward and talk to the public, wouldn’t have a written statement that that doctor could get up and talk from and have a set of laboratory and other test results that would be there as a basis, and discuss the case from that point.
Trump’s doctor has just spoken—I wouldn’t call it extemporaneously, I’m not sure what you would call it, but at least without any written information, and has had to sort of backtrack on what’s been said. Dr. Conley said, “I didn’t want to give any information that might steer the course of illness in another direction, and, in doing so, it came off that we were trying to hide something, which wasn’t necessarily true.” Well, aside from the fact that the statement is confusing, it just confuses everybody as to what really was the situation.
Well, that makes it sound like he’s trying to psychologically boost Trump, right?
Yeah. And that’s fair when you’re talking about the fact that any doctor is the patient’s advocate. But that doesn’t mean you’d go so far as to, particularly for a President, distort the information and mislead the public. I think the doctor for a political leader has an additional obligation—this is my opinion—not to mislead the public. I realize that’s not part of the Hippocratic oath, but that’s how history has evolved.
It seems like we have two different reporting issues going on. One is reporters asking Trump’s doctors and medical professionals about his illness. And the other is political reporters trying to piece together timelines about when the White House knew things about his condition, and so on. What questions are you most interested in reporters asking and answering?
Well, I think both are important. They’re coming at it differently. The political reporters are asking the questions that are important. When was the last negative test? When was the first positive test for Trump? The same thing for others in the White House. And getting at the process of how the White House was protecting the President and the visitors and everyone working there. That, to me, is a most important and fair story for political reporters.
In terms of the medical questions, which political reporters could ask, or medical reporters like myself could ask, I’d want to know a lot more detail about the tests that have been done. Blood tests, pulmonary tests, X-rays, what are the results? What is their thinking as a result of that combination of information? How did that affect their decision to treat with the experimental, in the sense that it’s not licensed, drug remdesivir, and the steroids? They’re fair questions to ask, because they would elicit information the public is entitled to have, and it would make it easier for the doctors and for the White House, because you’d have an accepted, official transcript of what the information was, and then people could argue it from there.
And I think there’s one other thing that both political reporters and medical reporters can ask about and push for. And that is the contact tracing of the people who were in contact with the President and other White House staff who were positive. You would protect the health of those individuals who came in contact, and might be positive, and might therefore spread it on to others.
It’s reported that the C.D.C. has a team ready to go do this, but hasn’t been asked to do it, or hasn’t the authority to do it. [After Altman and I spoke on Monday, the Times reported that the White House has decided not to do contact tracing for the Rose Garden event where Trump and others may have been infected.] And an additional part of such an investigation in my mind would be doing molecular testing, because you could be able to trace this outbreak in a way you have done others. That could also be useful for everybody else who’s involved in the protection of whoever is President.
Owing to a transcription error, a previous version of this post misstated the President whom journalists covered before 1972.
