Though I have never examined President Joe Biden nor read through his full health records, nevertheless, as a practicing internist who treats many elderly patients, I have reason to be concerned. What exactly is his level of cognitive function?
Most worrying is the area of executive function, which includes the ability to plan, pay careful attention to detail, perform tasks, concentrate on detailed information and most of all make decisions. It goes without saying that the president as this country’s chief executive must have a very high level of executive function.
The best way to approach Biden’s apparent multiple memory lapses and periods of disorientation is not to speculate based on video clips alone but to demand full disclosure and transparency, especially of a president almost 80 years old with a significant medical history. If he decides to run again, I’m on record demanding full health transparency of all candidates for higher office, tracing back to when John McCain was 71 and running for president in 2008. I called it “the McCain Protocol” in 2016 when both Donald Trump and Hillary Clinton were over 70 and running for president.
I would prefer Biden have a cognitive neuropsychiatric test right now, much as Trump underwent the Montreal Cognitive Assessment when he was in office and released the results.
Of course, there’s substantial precedent for ill presidents hiding their ailments from the public, from Woodrow Wilson’s severe case of Spanish flu (which arguably affected the Treaty of Versailles) and subsequent stroke to Franklin Roosevelt’s heart failure to the extent of Dwight Eisenhower’s heart disease to John Kennedy’s Addison’s disease, all while still in office.
There’s reason to pause before demanding full disclosure by a sitting president for fear of sending a message of weakness — more than Biden is already doing with his erratic behavior — to our enemies. Still, annual presidential physicals are now routine, and there comes a point where impairment is substantial enough that the impact of the illness is more dangerous than the need to present a strong face.
Has this president reached that point? We don’t know.
