Kennedy: Disease, History and Secrecy

The recent revelation that President John F. Kennedy concealed his severe illnesses appears quite shocking and appalling from our modern perspective. As reported by the historian Robert Dallek, Kennedy had severe chronic back pain that led him to take a series of strong, potentially sedating medications. Kennedy also used stimulants and drugs to lower his anxiety level. Finally, he concealed his Addison's Disease, or failure of the adrenal glands, that forced him to take chronic steroids.

Yet it is crucial to place Kennedy's story in its proper historical perspective. The secrecy that characterized his case was quite commonplace before 1970, both among politicians and "ordinary" patients. And the new openness that has subsequently emerged in medicine, while undoubtedly welcome, has nevertheless jeopardized certain positive components of the physician-patient interaction.

During the years when John Kennedy was sick, discussions about disease were usually limited to doctor and patient. Patients did not broadcast their diagnoses but rather kept the knowledge to themselves and close relatives. Nor did physicians discuss their patients in public, something that was explicitly forbidden by the teachings of the ancient Greek physician Hippocrates. Only if doctors maintained confidentiality, Hippocrates believed, could patients be entirely candid and thus receive the best care.

Indeed, in an era in which paternalism dominated medicine, physicians and family members at times conspired to keep the truth from patients. This secrecy occurred most frequently in the case of cancer. Patients with this diagnosis were generally told they had "tumors," "growths" or "inflammations." Mrs. B., wrote a New York physician in 1957, "does not know that she has carcinoma. She suspects that she does, but has been told before and again on this admission that she does not." Learning a diagnosis of cancer, it was believed, would cause patients to lose hope and perhaps commit suicide. When the medical condition was something less dire than cancer, secrecy was less of an issue. But doctors still routinely made treatment decisions without involving patients.

Sick political figures, like other patients, were diagnosed and treated in this atmosphere of reticence and secrecy. To be sure, when Eva Peron was diagnosed with advanced cervical cancer in 1951, it made political sense not to tell the Argentine people, who might then have been less inclined to reelect her husband, Juan Domingo Peron. But beyond this, Eva Peron's family truly did not want her to know her diagnosis. Her physicians were more than happy not to tell her.

By the early 1970s, however, patients were arguing that paternalism and secrecy were preventing them from participating in important treatment decisions. Among the most vocal critics were women with breast cancer, who publicly objected to surgeons' routine use of the disfiguring radical mastectomy.

A decade later, AIDS activists took up the mantle. While the confidentiality of an AIDS diagnosis was stressed, those willing to go public did so with a vengeance. Visibility became a way to push for both funding and entry into clinical trials. Today, the television and the Internet are replete with so-called illness narratives, which recount personal struggles with various diseases.

Openness also became an increasingly commonplace among sick politicians. As would Dallek, historians after 1970 used medical records and other sources to describe how past presidents and their staffs had deceived the public. Grover Cleveland, for example, had undergone a secret operation for cancer of the mouth in 1893. After Woodrow Wilson suffered a debilitating stroke in 1919, his wife Edith had basically run the country. Those close to Franklin Roosevelt correctly had assumed that he would die during his fourth term, but the voters were never told.

Although Edmund Morris has argued otherwise, many commentators believe that Ronald Reagan significantly departed from this legacy of secrecy among politicians. The 1981 assassination attempt on Reagan led to scrutiny of the "incapacitated" president and the passage of the 25th Amendment, which provides a framework for transferring power to the vice president. Reagan was also especially forthcoming during a later bout with colon cancer.

Today, immediate revelations of illness are the norm among politicians. Former New York City mayor Rudolph Giuliani's experiences with prostate cancer, including his treatment options, were scrutinized in great detail by the press. Vice President Dick Cheney's clogged coronary arteries and presidential candidate Bill Bradley's episodes of a heart arrhythmia generated similar attention.

There is, of course, no returning to the secrecy of the Kennedy era. The public demands information about health when choosing among candidates. Qualified historians, such as Dallek, should be given access to politicians' medical records after an appropriate waiting time.

Yet our modern openness has come at a cost. John F. Kennedy could candidly speak with his physicians about his medical problems without regard to how such information would play in the press. In this sense, sick politicians--and others who choose to go public with their illnesses--have lost an important benefit of being a patient.