October 9, 2001
THE DOCTOR'S WORLD
By LAWRENCE K. ALTMAN, M.D.
The television show "West Wing" picks up its story line tomorrow, extending a fictional plot based on a genuine problem — the long history of hidden illness in the White House.
"West Wing" President Josiah Bartlet has multiple sclerosis, a chronic neurological ailment that the first lady, a physician, has treated secretly during Mr. Bartlet's first term. Multiple sclerosis is usually not fatal, though it is often disabling. But it has not hampered Mr. Bartlet's work.
In last season's closing episodes, the physically fit, mentally alert Mr. Bartlet wrestled with how his chances for re-election might be affected by public knowledge of his ailment, which, until then, had been known to only a small number of aides. Preparing Mr. Bartlet for a news conference at which he was to disclose his illness, the White House press secretary told him to start by calling on a medical reporter in a certain seat who, strange to say, had my name.
This fictional Dr. Lawrence K. Altman was expected to ask the same types of medical questions that I have asked over many years in interviewing real presidents and presidential candidates about their health.
Instead, Mr. Bartlet passed over my Hollywood doppelgänger for a political reporter, as the frame froze for a summer respite.
Though disappointed that my double was denied the opportunity to probe the veils around the president's condition, I was not surprised at the president's move.
Candidates usually affirm that they are in good health and pledge to be open about any illness that they develop while in office. But illness often strikes unexpectedly, and when it occurs in politically awkward times, leaders often ignore their pledges.
Weaving a presidential illness into the plot of a hit series illustrates the public's keen interest in leaders' health.
A major reason for such interest is that the public has learned, often long afterward, that a number of officials, their families, aides and doctors have lied or devised cleverly worded cover stories to conceal or put an unusually favorable spin on a leader's serious illness.
The nation was told little about President Woodrow Wilson's debilitating stroke, suffered in office. Aides to Franklin D. Roosevelt, paralyzed by polio, carefully avoided having him photographed in a wheelchair. And when he ran for a fourth term, the White House doctor did not disclose Roosevelt's failing heart and severe hypertension.
President John F. Kennedy and his family denied that he had Addison's disease, a hormonal deficiency of the adrenal glands. Lyndon B. Johnson concealed treatment for a basal cell skin cancer, which had no serious medical significance.
In his 1992 presidential campaign, Senator Paul E. Tsongas and his doctors said he was free of non-Hodgkins lymphoma when, in fact, he had had a recurrence.
Developments during and after the 2000 campaign have heightened the interest.
Senator Bill Bradley did not disclose that he had bouts of atrial fibrillation, a heart rhythm abnormality that he regarded as a nuisance, until a new episode caused him to go to a hospital. A perceived lack of candor may have contributed to the fizzling of his campaign in the final days before the New Hampshire primary.
Doctors for Dick Cheney, the vice-presidential nominee who apparently had the most serious health problem in the campaign, wrote letters with sketchy details about his history of coronary artery heart disease and attesting to his good health. He refused to discuss his health in detail.
Then, last November, during the recount, Mr. Cheney was taken to a hospital with his fourth heart attack in 22 years, a milder one than his earlier ones. Mr. Cheney later returned to the hospital for treatment of complications affecting a stent, a device placed in one of his coronary arteries to help keep it open. Last summer, a defibrillator was implanted in his chest, because tests had revealed that he was prone to potentially dangerous, abnormal heart rhythms.
At a news conference at George Washington University Hospital, where Mr. Cheney was treated for chest pain in November, officials at first failed to disclose his heart attack. They cut off the conference before sharper questioning could elicit the cause of the chest pain that had brought him to the hospital. Hours later, embarrassed hospital officials called a second news conference, to say what they had known — that Mr. Cheney had indeed had a heart attack.
Aaron Sorkin, the creator of "West Wing," said he was only vaguely aware of the history of presidential illness, had no specific political leader in mind when he wrote Mr. Bartlet's health problem into the plot, and did it only by happenstance.
The original story line called for the president to be in bed with just the flu. Then, Mr. Sorkin said, while dining with Stockard Channing, who at that time had played the first lady in one episode, he seized on the idea of her being a physician, "and so I searched for an interesting way to show that she was an M.D., rather than have her say, `as you know, I am a doctor.' "
His solution, Mr. Sorkin said in an interview, "was that while everybody thought that this would be a cold or the flu, she knew it could potentially be something much more serious than that."
Mr. Sorkin asked his research staff to find an affliction that did not put Mr. Bartlet in a wheelchair, could go undetected for years at a time, and that could be in remission and undetectable in checkups because there was no laboratory test for it. The search turned up multiple sclerosis, an ailment that Mr. Sorkin said he knew little about. Putting the spotlight on multiple sclerosis also tapped television's great potential to educate, even though Mr. Sorkin said that was not his intent. "As storytellers primarily, our only obligation is to captivate for however long we have asked for your attention," Mr. Sorkin said. He also said: "We try not to lie on the show, and I know that is a strange thing to say in the context of fiction."
Multiple sclerosis is an autoimmune ailment that affects an estimated 350,000 Americans, usually starting between the ages of 20 and 40. For unknown reasons, it strikes more women than men.
In its mild form, multiple sclerosis
can cause numbness in an arm or leg. Patients with more severe cases may
experience fatigue, emotional swings, blurred vision and hearing loss.
Some may have temporary difficulty walking; others may develop permanent
Copyright 2001 The New York Times
Copyright 2001 The New York Times Company