In case you’ve just returned from a nearby planet, there’s been some mention in the news recently of the newly elected President Trump. Quite a bit in fact. But of all the millions of words printed following his inauguration, relatively few have looked at one of the most important things about him — just how healthy is he to be in one of the toughest jobs in the world? At the age of 70, he’s the oldest president ever elected, and all we know about his health comes from a short four-paragraph note from his physician — a Dr Harold Bornstein — published before his election.
In this, he states that Trump’s health is ‘astonishingly excellent’ and that, if elected, he would be ‘the healthiest individual ever elected to the presidency’. Some would say that, being somewhat short on detail but big on hype, the doctor rather sounds like the president himself. But we do now know that Trump takes a daily aspirin and a statin to control his cholesterol levels, which may reflect his self-confessed love of fast food.
The idea of taking a daily low-dose aspirin to reduce the risk of a heart attack really took off over two decades ago with the statistic that by taking one we reduced the risk of a second heart attack or stroke in people who had already suffered one by almost a quarter. This was then extrapolated further to people who had never had a heart attack but who might be at risk of one. Following this came studies showing that it might also reduce the risk of developing certain cancers such as bowel, stomach and gullet cancer.
However, as with all medication, there are two sides to this coin and any potential benefits have to be weighed against risks such as bleeding from the gut. We now have to take each individual patient on their own merit in advising about aspirin usage rather than using a blanket policy of aspirin being good for everyone.
To try to crystallise the latest best advice concerning aspirin use is not easy but there are three main points to take away here. The first is that you have to take it for at least five years to start to reap any benefits; second, we have very little evidence of significant benefit if you are under 50 years old. The third – and this is where Trump’s usage is interesting – is that the risks of continuing to take it rise sharply over the age of 70.
Taking a statin to lower cholesterol levels in someone who has never had a stroke or heart attack is equally muddy but most doctors would agree that if you have diabetes, have had — or are at risk of — a heart attack or stroke then statins are beneficial in the main.
If you are at moderate risk and not having side effects from a statin then carrying on taking them is usually sensible but, if you are taking them to simply try and negate the impact of an unhealthy lifestyle, then losing weight and doing more exercise, rather than munching pills, is the advice I would now be giving the president (probably just before being sacked as a result).
Dr Bornstein’s statement adds another interesting page to the list of medical statements from the physicians of American presidents, some of whom would have easily qualified as masters of the dark arts. Franklin D Roosevelt’s doctor stated that he was in remarkably good health when standing for a fourth term in office but conveniently forgot to mention he was suffering from the chronic lung disease and heart failure that killed him a few months after being re-elected.
John F Kennedy’s tanned and vital image was a key factor in him winning his television debate against Richard Nixon and helped elect him into the White House but few people were aware that his tan was not due to sunshine but to Addison’s disease — a potentially lethal condition requiring JFK to take daily doses of steroids to keep him alive.
Perhaps my favourite deception, however, was with President Woodrow Wilson, who suffered a number of strokes when in office, passed off at the time as a ‘mild illness’. His wife (who called him Woody) said some years later: ‘I don’t know what you men make such a fuss about. I had no trouble running the country when Woody was ill.’
It may be just me, but somehow I can’t ever see Melania Trump saying that.