According to the WHO definition of health, which is “a state of complete physical, mental, and social well-being, and not merely the absence of disease and infirmity,” several million Americans became unhealthy on Tuesday November 8th, 2016 as Florida folded to Trump. As Hillary’s prospects became bleaker many more millions, particularly those on Twitter, lost their health. The WHO sets a high bar for health. It is easier for a camel to pass through the eye of a needle than for a person on social media to be in “complete mental and social well-being.”
Whilst WHO has set a high bar for health, modern medicine casts a wide net for disease, and the duo have led to mass over medicalization, overdiagnosis and overtreatment. Yet despite the wide net, Trump has thus far managed to evade the psychiatrists, medicine’s version of the FBI, who have tried imposing upon him a range of psychiatric disorders including “extreme present hedonism”, which sounds like “hyperbolic discounting,” which basically means someone who doesn’t give a rat’s tail about the future. Base jumpers suffer from this condition. I once suffered a milder version – and then I became a father and grew up.
Trump doesn’t look like a base jumper. And you’re going to need more than hyperbolic discounting to nail him on the 25th Amendment. Some tried diagnosing Trump with “mild cognitive impairment” (MCI) – a condition which heralds the more persuasive cognitive decline of dementia. MCI reminds me of an old medical school friend who went around administering the mini mental test to elderly patients on medical wards. One of the questions was: what are the dates of the 2nd World War (WW2)? No patient got that question right because my friend thought WW2 started in 1940. It started in 1939.
Another question in that test was the name of the prime minister. One patient told my friend – “it’s not that evil milk snatcher” (alluding to Mrs. Thatcher). He lost a point – not for civil disobedience, Tony Blair was the prime minister back then, but for his cheek. The mini mental test did not give bonus points for cheekiness, which arguably draws more mental resources than trying to recall the date of WW2.
Trump isn’t cheeky, certainly not in the conventional sense. But he’s not short of ripostes. His response to the North Korean dictator, with unsubtly flavored biometric one-upmanship, is the stuff of immediate post-pubertal boys in school playgrounds.
Don: “Mine is longer than yours.”
Bill: “Well so what, mine gets put to work, yours doesn’t.”
This is not normal. And here is the key point. When someone says Trump isn’t “normal”, you have to specify the context of “normal.” There are various types of “normal.” There’s “normal for Norfolk” (a euphemism in Britain for “slightly dim”), “normal for France” (a euphemism for “arrogant cheese-eating surrender monkey,” or just a self-conceited public intellectual) and there’s “not normal for Punjab” (I’ll leave that for another day). There’s also “normal for Brooklyn”, which Trump seems to be. But Trump isn’t “normal for the White House.” It is not normal for the President of the most powerful country the world has ever seen to be responding to every little jibe on Twitter, and every little snide in the New York Times.
To be fair, these are not normal times, and the Republic, which comprises an unprecedented number of snowflakes, might have met its match in the White House – Trump may be the first snowflake POTUS, with dermis papyracea, a consummate troll, who must respond in kind to every taunt, who loves pig wrestling, mud fighting with the press, a Youtube commentator who must have the last word in an internet argument at 2 a.m. He is modern media’s president – a populist with an ego of Henry the 8th.
I once asked a Punjabi cab driver in Manhattan what he thought of Trump. After spending the first minute laughing uncontrollably, he started the sentence with “MC” and ended the sentence with “BC.” (1)
“MC. Oye, Trumpa – theda Punjabi, BC.” (2)
Meaning, Trump is normal for rural, like really rural, Punjab.
Trump had an annual physical examination recently – a ritual which lacks good evidence – meaning there’s no good data that it improves outcomes. Presidents have long been known to ignore evidence-based medicine. Obama had a virtual colonoscopy – which CMS declined for screening for colorectal cancer. Obama thus received lower value care than the proletariat, which means either we don’t value our president or we don’t think “high value” is really high value. And Bush got a coronary stent despite being asymptomatic – poor lad didn’t even get to enjoy the placebo.
Trump’s doctor who, incidentally was Obama’s doctor, did a thorough physical, including, at Trump’s insistence, a full cognitive assessment. I don’t know if one of the questions was “who is the current president”, which Trump might have answered “not crooked Hillary,” but Trump passed the test. That is, Trump is not cognitively impaired. Whether he is a stable genius or simply a genius who has bolted the stable, is a matter of opinion. What should be put to rest is the armchair diagnosing of Trump’s mental health which does disservice not only to psychiatry and psychiatrists, but to the genuinely mentally ill, because it implies that mental illness makes someone a tosser which, as Allen Frances the author of Saving Normal has pointed out, is untrue.
It was Trump’s heart at the heart of the controversy, specifically his calcium scan which, confirming that Trump’s heart is in the right place, anatomically, reported a calcium score of 133, prompting Dr. Sanjay Gupta, the peripatetic celebrity neurosurgeon with a cardiologist complex, to state that Trump has heart disease. Gupta’s comments created disquiet amongst cardiologists – neurosurgeons usually don’t diagnose heart disease without a cardiac consult, even from their armchair. Nevertheless, cardiologists remained divided whether a calcium score of 133 means Trump has heart disease.
The issue gets to the crux of what exactly is disease. Can someone be diseased without symptoms? If symptoms are no longer required for disease, does it mean harboring any pathology makes a person diseased? A study from Finland found that everyone has papillary carcinoma of the thyroid. It is normal to be diseased, at least in Finland.
Much has been made of the rise of Trump’s calcium score, from 34 in 2009 to 133 in 2018. Is the president getting more hard-hearted? What lies beneath Trump’s porcellaneous interior?
The likelihood that a 71-year-old white male has no coronary calcium is 15 %. Trump’s calcium score falls between the 40th and 50th percentile – which means it is normal for his age and race. Trump’s body mass index (BMI) is 30, which puts him in the obese category, though hardly obese for the White House. William Taft’s BMI was 42.3 – god only knows what his calcium score was – perhaps he had a heart which looked like it was stared at by Medusa. Even the younger, more playful, Bill Clinton, whose nuclear button was generally kept for events in the White House rather than across the Pacific, skirted obesity with a BMI of 28.3.
Trump’s calcium score portends a certain risk of cardiovascular death. But there are caveats. Though calcifications confer risk of future events, such as death, myocardial infarction, and stroke, they also protect – calcium is like the police arriving at a crime scene – their presence indicates that the situation was once dicey and could be dicey again, but their presence also reassures that there’s stability. Indeed, both statins and intense exercise increase coronary calcification – it’s like the surge in Iraq – numbers don’t tell the whole story about the degree of badness.
Nevertheless, Trump could be assassinated by a metabolic rebel, a non-calcified plaque with a fatty vest, an arterial suicide bomber which may suddenly rupture, particularly if he obsesses too much about the wall, or trash talks with Kim Jong Un, again. The WHO was onto something with that “complete mental well-being,” part. Trump may not have a psychiatric disorder but he does need a chill pill and get over himself.
Trump has been advised to up his statins and start running, though not from Mueller. I’d advise the president to take a Twitter sabbatical, meditate every morning, perhaps he can try Yoga like the Indian prime minister does, and get cracking with all those job-creating infrastructure promises he made – the economy isn’t going to get any better. Time to act your age, sir, not your shoe size, no matter how big you want us to believe it is.
For the rest of us, our own mental well-being might be better served obsessing less about the mental and physical health of the 45th President. 2020 will be here anon. Vote him out if you don’t like him.
- MC and BC are abbreviations for some unpleasant words in Punjabi. Please don’t google them. If you do discover what they mean, please don’t use them in polite company. Please don’t say these words to Punjabi cab drivers in Manhattan.
- It must be emphasized that the cab driver wasn’t paying Trump a compliment
Saurabh Jha is a radiologist who has read nearly a thousand calcium scans. He routinely makes armchair diagnoses. He can be reached on Twitter @RogueRad
Does Trump have heart disease – I don’t care, but he’s got brain disease, far worse.
Nicely done. There is way too much of this. Remember all of the diagnoses tossed out when Clinton fell down? I suppose it serves some purpose as it gets hits on blogs, and lets the loyal opposition have something to complain about, but people really shouldn’t take this seriously.