Mar. 1, 2002
By Alice Y. Chang, M.D.
Brigham and Women's Hospital
Despite my addiction to television, I somehow resisted or missed "The West Wing" craze until this season. My interest was piqued when a friend asked me about the president’s diagnosis of multiple sclerosis (MS). I asked how the diagnosis interfered with his life. She couldn’t recall if he was having any symptoms but asked, “Isn’t it a serious disease?”
People who ask me about MS usually have a friend or relative with the condition. They understand that it can start with vague symptoms of numbness, tingling, dizziness or double vision, and that it can progress to permanent nerve damage with subsequent weakness, difficulty walking and other physical impairments. MS is an autoimmune disease in which our own immune system attacks the linings of nerves. In the beginning, these symptoms are usually temporary and complete recovery occurs between attacks. When permanent damage to the nerves develops, weakness and loss of function result.
MS starts with mild symptoms that may gradually worsen over several years, or they may occur in a pattern of recurring neurological symptoms with normal periods in between. Treatments during a flare-up can include intravenous corticosteroids that help shorten the duration of the attack. No treatment has been proven convincingly to stop the progression of the disease. Some studies have shown that interferon injections can slow the worsening of symptoms and reduce the likelihood of developing permanent disabilities, but the information is still preliminary. Not everyone gets or needs treatment between flare-ups. We do not know who is more likely to develop permanent or progressive damage and which 10 percent of people will have only mild symptoms throughout life.
In three successful seasons, the president on "The West Wing" has had only two possible relapses, one episode of dizziness prior to a debate, and one in the oval office. These episodes were referred to in the inquiry as “collapses,” but there were no signs that the president lost consciousness or fell in the one I witnessed. In real life, “collapse” has a more serious connotation. Otherwise, as I have witnessed in the past few episodes, this president is active and does not appear to have irreversible neurological damage from his condition. He has the relapsing/remitting pattern of symptoms and has shown very little progression during the seven years since his diagnosis. He probably falls into the 10 percent of people who have a mild case of the disease.
Given my assumptions about this fictional president's disease, I would say his prognosis for a benign course is good. So if anything more dramatic occurs with his health, I will raise a skeptical eyebrow. It may make for an exciting plot twist, but do not assume this is a true depiction of the disease. Right now, the president's MS is unfortunately more of a political problem for him, as his staff and his wife, who is a physician, are under investigation for hiding his medical condition. As the next election approaches, his adversaries are taking advantage of their physical or youthful appearance and threaten to perform push-ups as part of their campaign against the current president.
On a political note, I think there are few cases where our “right” to know a president’s medical history is relevant. In the same way that your medical history is not important to your employer unless you cannot physically or mentally carry out your job, I don’t feel it would be anyone’s right to know if the president has MS. Moreover, it is the president’s mind, not his or her physical condition, that is most important. Think about President Kennedy, who had Addison’s disease, the absence of steroid hormones that are critical to dealing with stressful situations. Think about President Franklin D. Roosevelt who was confined to his wheelchair because of polio and subsequently had a stroke. Had they been running for office today, would they have been elected? How might history have been different otherwise?
The "The West Wing" writers have chosen well by selecting a medical condition that is often misunderstood. The president shows us that MS is not always the debilitating condition that many people imagine. And, as has been pointed out in recent episodes, MS is not a life-threatening condition, nor does it affect mental capacity. This case also brings into debate why and when the public should be interested in the medical conditions of the real U.S. president.
Alice Chang, M.D., is an instructor in medicine at Harvard Medical School, and on the faculty of the Department of General Medicine at Brigham and Women's Hospital. Her clinical interests and experience are in the fields of primary care, women's health, hospital-based medicine, and patient education.
This interview is not intended to
provide advice on personal medical matters, nor is it intended to be a
substitute for consultation with a physician.
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