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CNN: Special Investigations Unit
The First Patient: Health and the Presidency
Aired May 25, 2008 - 20:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Hello, I'm Dr. Sanjay Gupta in Washington. Welcome to "The First Patient." The president of the United States has the most powerful job in the world. Over the next hour, we're going to show you the physical and mental toll it takes, as well as all that goes into keeping the president healthy.
First, though, everybody knows the Secret Service protects the president. But did you also know that there's a White House doctor just steps away from the commander in chief at all times?
GUPTA (voice-over): No matter where the president is, a White House doctor is close by.
DR. CONNIE MARIANO, FORMER WHITE HOUSE PHYISICAN: The doctor is always within a few feet away, so you essentially shadow the president.
UNIDENTIFIED MALE: Kind of meld in with the Secret Service.
DR. JOHN HUTTON, FORMER WHITE HOUSE PHYSICIAN: We were always on call.
UNIDENTIFIED MALE: At any time, anywhere in the world.
GUPTA: Dr. Connie Mariano ran the White House medical unit under President Clinton. Five military doctors, five nurses, five physician assistants, three corpsmen or medics and three administrations. The mission? Executive medicine. Keep the president healthy day-to-day and protective medicine. Treat the commander in chief in a worse case scenario like an assassination attempt.
The nerve center for White House medical care since President Hoover is an office next to the map room, across from the elevator the president takes to get to the West Wing from his residence upstairs.
HUTTON: We would just greet him as he got off the elevator.
UNIDENTIFIED MALE: It's beautifully situated because it's right opposite the elevator so the president and first family can just walk across.
GUPTA: President Bush's doctor is Air Force Colonel Richard Tubb, a family physician. He's in charge of the White House medical unit. The White House communications office declined to let us speak with Dr. Tubb. DR. RICHARD TUBB, WHITE HOUSE PHYSICIAN: The president continues to be in outstanding health.
MARIANO: This is one of those moments you pinch yourself. The president says come walk with me. You just make sure you don't want to trip as you're walking in front of the world.
GUPTA: But Dr. Connie Mariano, now at the Center for Executive Medicine in Scottsdale, Arizona agreed to give us a president's few of health care.
How would you rate the medical facilities of the White House?
MARIANO: At the White House itself, it's very much your typical doctor's offices. It's got a private exam room on the ground floor, which has a crash cart.
GUPTA: A crash cart is used for emergency resuscitation. The goal -- stabilize the president and get him to a hospital. Air Force One also comes quipped with tremendous medical capability.
MARIANO: In this compartment, we have an operating room table that can be brought out and placed in the center of the room. There's an operating light that can be brought forward around to the front of the table. All of this is all contingency planning in case we ever are in a worse case scenario.
UNIDENTIFIED MALE: How do you feel?
BILL CLINTON, FORMER PRESIDENT OF THE UNITED STATES: Great.
MARIANO: This is a patient like no other. Their decisions impact millions of lives.
GUPTA: An ailing president potentially affects world diplomacy, president policy and the economy. Consider this. Use President Eisenhower's heart attack on Saturday, September 24th, 1955 caused the Dow Jones Index to drop 6.5 percent the following Monday.
DR. JERROLD M. POST, GEORGE WASHINGTON UNIVERSITY: An illness to the president is not just a personal matter. It is a devastating public crisis.
ROBERT GILBERT, AUTHOR: And so this puts a tremendous burden on presidents, because obviously, they're human beings. They're not -- they're not gods. They're human beings. They do become ill, the way the rest of us become ill. They do get the colds. They do get the flu. And many presidents have had much more serious ailments. And they really have to continue to exude the fact that they are optimistic, that they are well, that they're able to meet any challenge that possibly comes their way.
GUPTA: When we come back, we will take you inside the hospital and the White House situation room in the tense hours after President Reagan was shot. And the grueling life on the campaign trail. Is the primary schedule unhealthy? Plus, the biggest medical cover-ups in White House history.
UNIDENTIFIED MALE: He gave President Kennedy shots in the throats, which is almost horrible to think of because you don't know what he was putting in there.
GUPTA: Less than three months after taking office on this very spot, President Reagan came face to face with a deranged young man with a 22-caliber handgun. The lessons from that tense and tragic afternoon have prompted presidents and their doctors to prepare for their worst.
GUPTA (voice-over): March 30th, 1981, 2:25 p.m. Six shots ring out as President Reagan leaves a Washington hotel. A Secret Service agent pushes President Reagan into his limousine as would-be assassin John Hinkley is wrestled to the ground. The limousine races down Connecticut Avenue, first toward the White House, until the president coughs up blood. And then toward George Washington University Hospital, six blocks away.
DR. JOSEPH GIORDANO, GWU HOSPITAL: As he collapsed, his blood pressure was 70 -- very, very low. And we put him on the gurney and the residents immediately started IVs and got fluid in him.
UNIDENTIFIED MALE: The president has been shot once in the left chest.
EDWIN MEESE III, COUNSELOR TO PRESIDENT REAGAN: As I got to the hospital with a couple of others there, the president saw us. And he looked up and he said, "Who's minding the store?"
GUPTA: Minding the store at the White House -- cabinet members and a number of top aides. They gather in the situation room, trying to determine if a larger attack is under way.
FRED FIRLEDING, FORMER WHITE HOUSE COUNSEL: But that was one of the major concerns we had was, you know, what was this? Who was it? Was it a lone gunman? Was it a conspiracy? Was it a start of something really significant?
GUPTA: Remember, this is the height of the Cold War.
RICHARD ALLEN, FORMER NATIONAL SECURITY ADVISER: There was double the number of Soviet submarines off our coast within a very short flying time, as we would say. If you had a missile, it was four to five minutes from the White House.
GUPTA: As a precaution, Secretary of Defense Caspar Weinberger orders an increased alert of strategic air command forces, putting B-52 pilots at the ready. Reagan's uncertain health triggers other responses. Directors of the New York Stock Exchange shut down trading, and the Treasury announces plans to buy back dollars to maintain the stability of U.S. currency overseas.
DAVID GERGEN, FORMER WHITE HOUSE COMMUNICATIONS DIRECOTR: There was a great deal of tension in the room that day, because the vice president was gone. The president was incapacitated. And basically, the president's top three advisers -- the so-called "troika" of Baker, Meese and Deaver -- were all at the hospital.
GUPTA: Outside the hospital, presidential aide Lyn Nofziger downplays the seriousness of Mr. Reagan's injuries.
LYN NOFZIGER, FORMER PRESIDENTIAL AIDE: And the president's condition is good, remains good and remains stable.
GUPTA: However, inside, President Reagan is suffering from serious internal bleeding.
GIORDANO: We were watching the blood come out of the chest tube, and a very significant amount came out. And there was no question in my mind that he had to go to surgery.
GUPTA: 3:24 p.m. President Reagan is wheeled into the operating room. At the White House, a desire to show the world there is no leadership vacuum that might be exploited by an enemy.
UNIDENTIFIED MALE: As of now, I am in control here, in the White House.
GUPTA: 6:45 p.m. President Reagan emerges from a successful operation to stop his internal bleeding and remove the bullet lodged near his heart.
DR. WILLIAM KNAUS, TREATED PRESIDENT REAGAN: He was very, very tired. He had pain in his chest from his incision and the surgery itself.
GUPTA: 7:00. Vice President Bush, having rushed back from Texas, meets in the situation room and decides no transfer of power is necessary. National security adviser Richard Allen is recording the meeting.
GEORGE H.W. BUSH, FORMER PRESIDENT OF THE UNITED STATES: My view is, the more normal everything is, the better it is.
GUPTA: 8:20 p.m. Bush and deputy press secretary Larry Speakes give a press briefing. The vice president paints a rosy picture of the president's postoperative health.
BUSH: But he's emerged from this experience with flying colors and with the most optimistic prospects for a complete recovery.
UNIDENTIFIED MALE: Has the president turned over control or authority to the vice president?
UNIDENTIFIED MALE: There has been no cause for that to take place.
GUPTA: But there was a need in the 48 hours following surgery, according to Dr. William Knaus, an intensive care physician who treated President Reagan.
KNAUS: He was disoriented. He had to be reminded periodically of where he was and what time it was. I mean, remember, any surgery patient loses concept of time and date and sort of place, because they really -- the effects of anesthesia. So, he had to be reminded what day it was, when he was shot, how long ago that was. And he had to be reminded frequently.
GUPTA: Even so, chief of staff James Baker, deputy chief of staff Michael Deaver and counselor to the president, Edwin Meese, arrive in the president's hospital room at 6:45 the next morning. They get President Reagan to sign a bill restricting federal price supports for dairy products.
UNIDENTIFIED MALE: I brought the bill over to him, as I remember, then. I think it was worthwhile and useful to let the public know that he was OK, that he was not serious -- not more seriously injured -- and that business was as usual, or as much as usual it could be, with the president in the hospital.
GUPTA: After suffering a stroke in 1957, President Eisenhower thought there should be a way under the Constitution to transfer power to the vice president temporarily. In 1967 -- 10 years later -- the 25th amendment was ratified, authorizing the vice president to assume command when the president is incapacitated.
GUPTA (voice-over): When President Reagan was shot in 1981, then Vice President Bush chose not to invoke the 25th amendment, a position endorsed by Reagan's top advisers.
GERGEN: In retrospect, I think it was the right decision not to invoke. The tendency was, why do we want to rock the boat this way? As I say, there is a -- there is, I think, a natural, built-in tendency to want to present the country with a -- put things in the best light and to reassure people that things are in good hands. But I do think Vice President Bush would have been prepared to step up to it, had the recommendation come from the group.
KNAUS: I think if, that day after surgery, you know, Vice President Bush had walked in and said, you know, I'm taking over now, I think it would have been absolutely appropriate. I don't think any medical person -- I certainly would not have questioned it. I would think that is was absolutely the logical thing to do. There would have been no question at all in our minds.
GUPTA: Presidential historians have criticized the Reagan White House for not invoking the 25th amendment when President Reagan was shot.
ROBERT E. GILBERT, PRESIDENTIAL HISTORIAN: I think the 25th amendment certainly should have been invoked. There was a period of hours -- 10 to 15 hours -- when Ronald Reagan could not respond to a crisis. KNAUS: The consideration of transferring presidential authority or invoking the 25th amendment were never raised with any of the medical staff, as far as I was concerned. They certainly were never raised with me.
GUPTA: Four years later, when President Reagan needed cancer surgery that required general anesthesia, he signed a letter transferring power temporarily to Vice President Bush. But some historians, and even members of the Reagan White House disagree over whether he ever actually invoked the 25th amendment.
BUSH: I, George Herbert Walker Bush --
GUPTA: When he took over the Oval Office, President Bush established elaborate and classified contingency plans covering medical emergencies. He never needed them. President Clinton also drew up contingency plans when he took office.
MARIANO: One of the earliest meetings is with a physician, chief of staff, legal counsel present -- actually first lady -- regarding the 25th amendment. And goes into effect, this is what we would do if something like this happened.
GUPTA: President Clinton was planning to invoke the 25th amendment after tearing a quadriceps tendon, if his operation required general anesthesia. It didn't.
GEORGE W. BUSH, PRESIDENT OF THE UNITED STATES: Good morning, everybody.
GUPTA: President George W. Bush made history on June 29, 2002, when he had a colonoscopy.
ARI FLEISCHER, WHITE HOUSE SPOKESMAN: At 7:09 a.m., article 25 of the constitution was invoked, temporarily transferring the power of the presidency to Vice President Dick Cheney. At that time, anesthesia was administered to the president.
BUSH: I did so because we're at war. And I just want to, you know, be super, you know, super cautious.
TUBB: The procedure lasted for 20 minutes and was completely uncomplicated. No polyps were found. No abnormalities were found.
GUPTA: The White House released this picture of President Bush later that day at Camp David. Mr. Bush resumed his presidency two hours and 15 minutes after invoking the 25th amendment.
GUPTA: Connie Mariano gave us this laminated copy of the 25th amendment. If you look inside the medical bag of any white house doctor, you'll find a copy just like it.
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: Would you children like to be president of the united states?
GUPTA: Next, be careful what you wish for.
UNIDENTIFIED MALE: over the last 150 years, about two-thirds of presidents have failed to reach their life expectancy.
GUPTA: When we return, we'll look at the toll the presidency takes on the person.
(END VIDEO CLIP)
GUPTA: Welcome back. I'm at the Carter Presidential Library in Atlanta, in a replica of President Carter's Oval Office. Now, the person in the Oval Office probably has the toughest job in the world. With all that power, all that responsibility comes intense stress -- a proven risk factor for death and serious illness.
UNIDENTIFIED MALE: Tell me, would you children like to be president of the United States? We'll start with you, Frankie. Would you?
UNIDENTIFIED MALE: Well, I think I would like to be president, because I think it's a great honor to be president. And I could help the poor people and maybe try to stop all the wars. And my -- I think my mommy and daddy and my brother would be very proud.
GUPTA: It's great to believe anyone could grow up to be president. But the job itself is probably the toughest in the world.
CAPRICIA MARSHALL, FORMER WHITE HOUSE SOCIAL SECRETARY: The demands are on you all day, all night, every single day of the calendar year.
GUPTA: It's not only a tough job, it can be a real killer.
GILBERT: Just looking at presidents who have died of natural causes, they have tended to do badly. Over the last 150 years, about two- thirds of presidents have failed to reach their life expectancy, despite the fact that they have the best medical care that you can imagine.
GUPTA: Professor Robert Gilbert is a leading scholar on presidential health.
GILBERT: People who run for president tend to have type A personalities. And type A personalities tend to be more prone to illness.
GUPTA: While our last few presidents seem to have defied the odds and live long lives, historians have determined that many of our leaders were seriously ill while in office. Dwight Eisenhower suffered from both a heart attack and a stroke. Lyndon Johnson had gall bladder surgery and also had heart problems. Kennedy's health -- well, we'll get to that later.
Besides cardiovascular illness and stroke, just in the last century, U.S. presidents have suffered from high blood pressure, cancer, diabetes, respiratory illness, gall bladder disease, kidney disease, prostate disease, Addison's disease, Graves disease, pneumonia, ileitus and obesity.
UNIDENTIFIED MALE: Brenda, would you like to be president? And don't you think it's time we --
UNIDENTIFIED FEMALE: Well, I haven't quite figured up my mind yet, but I think it is a great honor to be a president.
POST: The job of the president is immensely difficult because he is under the constant glare of the public spotlight.
GUPTA: Dr. Jerrold Post, an expert in political psychology, says the toll of the job can be seen in their faces.
POST: The pictures of the president and how he ages from the day of inauguration, show a really disproportionate amount of aging in response to that stress.
GUPTA: Hardest job in the world, they say. It's because of what, specifically?
MARSHALL: The constant demand and from everyone and everywhere. It's -- it's not just the issues that we're dealing with in our country, or within the White House walls.
GUPTA: A day in the life of the president can be grueling. Well, these are some of President Bush's daily schedules -- meetings, receptions, briefings, gaggles. Day in, day out, the pace can be unforgiving. Still, as with anyone, it's the stress of personal sadness that often causes the greatest burden.
Capricia Marshall spent eight years in the White House as social secretary during the Clinton administration. A close adviser to the first family, she was often there during the trying times.
MARSHALL: I was awoken in the middle of the night at my home by the White House operator, to be informed that Mrs. Kelley, his mother, had just passed away. And so, I went to the White House then. And -- which was very hard on him, even though he knew that his mother was very, very ill. But he was also going through so many other things -- issues, larger issues -- that the country was facing. It's something that not many of us can ever comprehend.
POST: When President Clinton's mother died, I think the public really would have understood, had he taken a few days off to privately grieve.
GUPTA: But he didn't. He went from the funeral to a NATO summit in Brussels. For most people under stress, a vacation is often the best medicine.
GERGEN: The presidency, in particular, requires someone who is -- who's got internal reserves that are replenished on a regular basis.
GUPTA: Gergen was an adviser to Presidents Nixon, Ford, Reagan and Clinton.
GERGEN: I happen to believe that we're better served by someone who is willing to take some vacation time, and not be there 24/7.
GUPTA: But even when the president gets away, the presidency follows.
MARSHALL: A vacation never was truly ever a vacation. And even Christmas with them was also work. I mean, you know, being the president and first lady, you never get to go home and turn it off. It's on 24/7.
GUPTA: And that may be the biggest risk to the leader's health.
DR. MICHAEL IRWIN, UCLA NEUROPSYCHIATRIC INSTITUTE: Stress is just as serious as these other factors, such as smoking, alcohol use, lack of physical activity.
GUPTA: Dr. Michael Irwin studies the effects of stress on the body's immune system.
IRWIN: We know that stress accumulates and affects one's body and one's mental health over time. And it's the accumulation of this chronic stress that is important.
GUPTA: Every president has to find his own way of coping with stress. In the early 1900s, Theodore Roosevelt took to rugged hikes and outdoor adventure to keep his mind and body healthy. Herbert Hoover became known for his 10-pound medicine ball. Presidents have done pretty much everything to stay fit to lead, whether to prevent illness, or in spite of it.
GERGEN: Roosevelt was someone who knew how important it was to not be there at the desk every hour of the day. Every afternoon, punctually, there would be a cocktail hour in which people were invited into the White House. His friends and family would be there. And it was against the rules to talk about politics.
DR. LAWRENCE MOHR, FORMER WHITE HOUSE PHYSICIAN: During my time at the White House, it was very clear that each of the presidents had the ability to deal with the stress remarkably well.
HUTTON: He said, there comes a time in the day when you're not on the newsreel any more, and you can turn it off. He says, because there's nothing I can do about this overnight.
IRWIN: Social organization can also make you immune to stress. Good -- having a wide social support network to provide support for you.
GUPTA: But even so, the presidency carries a unique burden.
UNIDENTIFIED MALE: In the final analysis, the president is the only one that makes the decisions. I mean, he relies on his aides, but he has to decide what advice to take. UNIDENTIFIED FEMALE: I think it's probably one of the loneliest jobs there is. You have so many people around you all day long, and yet, everyone depends and looks to you. But you very -- you have very limited people that you can look to and depend upon. There are people around you all day long, and yet, you're really by yourself.
GUPTA: Coming up in the next half hour, secrets in the White House, medical cover-ups. And just ahead, what about the first patient's mental fitness?
Did President Reagan have Alzheimer's when he was president?
UNIDENTIFIED MALE: I think he did.
ROBERT E. GILBERT, PRESIDENTIAL HISTORIAN: In the summer of 1924, Calvin Coolidge underwent a devastating personal tragedy, the death of his favorite child, 16-year-old son, a boy who played tennis on the White House tennis courts and who developed a blister on one of his toes and it became infected, and he was dead within a week.
Calvin Coolidge's presidency changed after that. He was withdrawn. He slept 15 hours a day. He worked about four hours every day. He demonstrated all of the symptoms of clinical depression. From the time of the death of his son until Coolidge left office, he was an incapacitated president.
GUPTA: I'm here at the National Museum of American History in an exhibit called "The American Presidency: A Glorious Burden."
What happens when a friend or a colleague thinks the president is suffering severe depression or Alzheimer's? On those particularly touchy issues, there is no formal protocol, no special branch of the White House medical unit.
GUPTA (voice over): In the winter of 1974, as the Watergate investigations zeroed in on the White House, presidential aide David Gergen, who has worked for both Republicans and Democrats, says Nixon felt the pressure.
DAVID GERGEN, FORMER PRESIDENTIAL ADVISER: I don't think we'll ever know clinically what his condition was in the final throes of Watergate, but we have enough accounts and I was there to know that he had some very bad nights.
GUPTA: A group of senators led by New York's Jacob Javits worried that Nixon was wearing down under the stress. So they called Dr. Bert Brown, a psychiatrist and director of the National Institutes of Mental Health. He had treated many people in high level positions. DR. BERT BROWN, FMR. DIR. NATIONAL INSTITUTES OF MENTAL HEALTH: It was sort of a withdrawal from social contact. One of the senators mentioned that there wasn't a week that had gone by for four years where he didn't get a phone call on some point or other and had not received a phone call for several weeks.
GUPTA: And Dr. Brown had no official responsibility for President Nixon. But he told the senators: look for warning signs like increased drinking, mood swings or an uncontrolled temper.
GERGEN: This is a man who had wonderful lucid and far-reaching insight. And when he was under all that pressure, under all that stress, it's a close call whether the president is right there and should be there making decisions, say, on an international crisis.
GUPTA: At the time, no one suggested publicly that the stress was too much for Nixon, but political pressure was too much and he resigned, avoiding impeachment.
RICHARD NIXON, PRESIDENT OF THE UNITED STATES: We don't have a good word for it in English. The best is "au revoir." We'll see you again.
GUPTA: In 1964, "Fact" magazine quoted dozens of liberal psychiatrists analyzing Republican presidential candidate Barry Goldwater. Some examples: "a dangerous lunatic," "a result of rigid toilet training."
Goldwater sued for libel and won.
(On camera): Since then, the American Psychiatric Association tells its members not to analyze public figures from a distance. Of course, some psychiatrists still do, with varying degrees of scientific rigor.
(Voice over): In 1984, Dr. Louis Gottschalk, a prominent neurologist and psychiatrist, studied the debates between then President Ronald Reagan and his challenger, Walter Mondale.
Gottschalk is 88 years old now and he goes to work every day in a building that's named after him at the University of California in Irvine. He works with the Gottschalk-Gleser Scale, also named for him. It's a neurologic test of a person's ability to think clearly by looking at speech. Does that person repeat himself? Does he lose focus on what he's saying? You derive a score. A score between zero and one is considered normal.
RONALD REAGAN, PRESIDENT OF THE UNITED STATES: The system is still where it was with regard to the -- with regard to the progressivities I've said...
GUPTA: In the presidential debates that year, 1984, Mr. Reagan's score was 2.14, out of the normal range, signaling moderate impairment.
REAGAN: I have no hesitancy in saying so, and the prayers already answered. GUPTA (On camera): He looked a little lost there.
DR. LOUIS GOTTSCHALK, UNIV. OF CALIFORNIA, IRVINE: I think so, too. He did repeat himself so much, and sometimes didn't finish sentences.
GUPTA: Did President Reagan have Alzheimer's when he was president?
GOTTSCHALK: I think he did. Some form of it.
GUPTA (voice over): Ridiculous, say those who were close to the president. They say symptoms never appeared while he was still in office. They point to major triumphs of his second term -- landmark arms control deals and the crumbling of the Soviet Union.
Alzheimer's creeps into a person's mind over a period of many years. In the president's case, the process likely started well before 1994, when he announced his condition publicly in a handwritten letter. But that doesn't mean he showed symptoms in office. And it may not have affected him at all for years.
DR. JOHN HUTTON, WHITE HOUSE PHYSICIAN 1984-1988: I never, absolutely never -- as the expression goes, he had forgotten more than I ever knew. You know, it was the type of thing that I never really noticed anything of any sort.
EDMUND MORRIS, REAGAN BIOGRAPHER: The unshakeable evidence is his diary entries. Every night this man wrote an account of his day as president. Every night for eight years. And the entries of his last days in office are as lucid and controlled and logical as they were when he became president.
GUPTA: But with Reagan in his mid-70s, there was speculation, even at the White House. In 1987, the deputy to new chief of staff Howard Baker said that several White House staffers came to him with concerns.
JAMES M. CANNON, WHITE HOUSE AIDE: They used, repeatedly, the words, "He's out of it," meanings with -- and suggesting that he was not really up to the job.
GUPTA: James Cannon now says the information was no good, but at the time he did warn Baker. Baker didn't consult the doctor, but instead had a conversation with Reagan and decided he was fine.
HOWARD BAKER, WHITE HOUSE CHIEF OF STAFF: I've never seen Ronald Reagan more energetic, fully engaged and more in command of difficult circumstances and questions that we were dealing with throughout this day. He's never been better.
DR. JERROLD M. POST, GEORGE WASHINGTON UNIVERSITY: This is clearly a decision where not only the White House physician should be involved, but some specialists should be involved as well, from neuropsychology and psychiatry and so forth.
GUPTA (on camera): Why should someone believe this, that President Reagan, while president, had Alzheimer's? GOTTSCHALK: Well, the clinch word is "should." I don't know that I would go that far. I don't believe that everybody will believe scientific findings.
GUPTA (voice over): Gottschalk, who didn't publish his study until Reagan's term was ending, denies any political motivation.
Democrats also faced questions about their mental state. The minds of presidents Woodrow Wilson and FDR were slowed by serious illness. Republican Dwight Eisenhower suffered a stroke and Lyndon Johnson's biographer, Michael Beschloss, said Johnson had struggled with depression and paranoia.
(On camera): Do you think top officials such as presidents or leaders at various states should be tested in some way for cognitive dementia?
GOTTSCHALK: I think so. But whether it can ever be done, I doubt.
BROWN: Well, as the former director of the NIMH and 40 years of psychiatry, I think it's a terrible idea. I don't think any set of psychiatric and psychological examination would tell us any more than a person of wisdom and maturity would say about the president's status.
GOTTSCHALK: It's all right to have a physical abnormality, but to have a mental problem is very touchy.
GUPTA (voice over): When we come back, we'll hit the campaign trail. Is it possible to stay healthy in such a grueling schedule?
SEN. BARACK OBAMA (D), PRESIDENTIAL CANDIDATE: How's it going Boston?
SEN. HILLARY CLINTON (D), PRESIDENTIAL CANDIDATE: Hello, New Mexico.
SEN. JOHN MCCAIN (R), PRESIDENTIAL CANDIDATE: I will win here in the state of Alabama with your help.
GUPTA (voice over): Running for president is a cross-country endurance race -- a marathon beginning early each morning and ending late at night.
CLINTON: Hey, we're on the road again.
GUPTA: It's a schedule that can leave candidates sick.
CLINTON: Can I get some lozenge or something? GUPTA: And tired.
DR. RICK KELLERMAN, AMERICAN ACADEMY OF FAMILY PHYSICIANS: Sleep deprivation is a very real problem for the candidate where it can lead to some foggy thinking. It can affect their memory. It can affect their concentration.
GUPTA: Fatigue appears to be one issue where the candidates agree.
OBAMA: You know what I got for Christmas? Eight hours sleep.
CLINTON: We tried to sleep whenever possible which is usually on planes or in the car. And some days, you know, there's not enough caffeine in the world to keep you going. We just have to follow through.
GUPTA: Wherever they go, candidates are tempted with food, often fast-food.
CLINTON: I like hot food.
GUPTA: Here's one thing you probably don't know about Hillary Clinton. She likes her food spicy.
CLINTON: I like hot food and I am convinced that there is an ingredient in hot peppers that has kept me healthy since 1992.
GUPTA: Tight schedules leave candidates little time for any real exercise. This may surprise you.
For most of us depresses immune function, making us more likely to get sick. But Dr. Rick Kellerman at the American Academy of Family Physicians does not think stress is a big problem for the candidates.
KELLERMAN: These are people that have learned how to cope at that stress. In fact, they may even thrive on the stress.
GUPTA: National campaigns also place the bright lights of the media squarely on the candidates -- scrutiny that has uncovered health problems in the past.
In 1972, Thomas Eagleton, George McGovern's running mate, dropped out after acknowledging to reporters he had undergone electroshock therapy for, quote, "nervous exhaustion."
In 2000, Democratic candidate Bill Bradley disclosed he'd been suffering from atrial fibrillation. That's an irregular heartbeat affecting two million Americans.
BILL BRADLEY, FMR. U.S. SENATOR AND DEMOCRATIC CANDIDATE: I confirm that I've had four episodes since then.
PAUL TSONGAS, FMR. U.S. SENATOR AND DEMOCRATIC CANDIDATE: I declare my candidacy...
GUPTA: No all candidates have been candid about their health. In 1992, would-be Democratic nominee Paul Tsongas said he had been cancer-free since a bone marrow transplant. But he didn't lead on that he had a recurrence of his lymphoma just a year earlier. His cancer was back again only days after the November general election and Tsongas died five years later.
So just how healthy are the men and woman running for president?
Ronald Reagan was our oldest elected president at 69,
MCCAIN: Thank you for coming out today.
GUPTA: John McCain is two years older.
McCain is a cancer survivor. He was diagnosed in 2000 with the most serious form of skin cancer, invasive melanoma, on his left temple. He had the cancerous tissue and lymph nodes in his neck removed.
MCCAIN: Thank you for serving, sir.
UNIDENTIFIED MALE: You bet.
MCCAIN: My health is excellent. I see my dermatologist every three months.
GUPTA: Not surprisingly McCain is known to be extremely careful in the sun.
MCCAIN: We just get in the shade.
GUPTA: Teddy Roosevelt at 42 was the youngest president ever. John F. Kennedy was the youngest elected president at 43. Barack Obama, at age 46, is the youngest of the current candidates.
OBAMA: Thank you, Delaware.
GUPTA: Obama was a smoker, a habit that cuts an average of 11 years off life expectancy. But the candidate told Larry King his wife Michelle pressured him to quit.
OBAMA: I'm doing all right. That shows you how scared I am of my wife.
UNIDENTIFIED REPORTER: How did you quit? Does that quitting down on...
OBAMA: Nicorettes. You want one?
UNIDENTIFIED REPORTER: Yes.
OBAMA: Try one out.
UNIDENTIFIED MALE: Senator.
GUPTA: Hillary Clinton is 60. She has not reported any health problems. Of course, there are no guarantees when it comes to health.
KELLERMAN: There are things that happen to people that we cannot predict, that we cannot prognosticate. So we can develop a risk profile. But in the end, we can't tell exactly who's going to have what and when.
GUPTA: Just ahead...
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ROBERT FERRELL, "ILL-ADVISED: PRESIDENTIAL HEALTH AND PUBLIC TRUST": There's only one word for it is weird.
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GUPTA: Some of the strangest, most dramatic medical cover-ups in presidential history.
GUPTA: As the columnist William Sapphire once wrote, the president's body is not wholly his own. Of course, that hasn't stopped many presidents from zealously guarding their medical privacy. And in several situations, it has crossed the line and become a genuine cover-up.
JOHN F. KENNEDY, PRESIDENT OF THE UNITED STATES: I, John Fitzgerald Kennedy...
GUPTA (voice over): America's youngest elected president, 43-year- old, John F. Kennedy.
A veil of secrecy has often shrouded the oval office, and when it comes to Kennedy's medical history, there was something lurking beneath the surface.
FERRELL: There's only one word for it is weird.
GUPTA: Presidential historian Robert Ferrell says Dr. Max Jacobson, known for his work with high society, was never officially the president's doctor, but treated him nonetheless.
Ferrell says his research found that Jacobson, known as Dr. Feelgood, gave what he called, quote, "vitamin injections," to the president.
FERRELL: With dirty hands, he would spilt pills out on a desk and he would whatever suited his fancy. When Kennedy went to meet with Khrushchev, Jacobson was along and he gave Kennedy shots in the throat, which is almost horrible to think of because you don't know what he was putting in there.
GUPTA: What was in there, Ferrell says, were amphetamines. Dr. James Young was on the White House medical teams with Kennedy. He showed us the medical briefcase he used to carry. He's kept it in a closet for nearly four decades.
Darvon Compound, morphine, equinel(ph) -- controversial today but ready if the president or anyone in his entourage should need them.
But Young says the president was fit and says the only drug he ever gave the president was a daily dose of steroids for his Addison's disease.
A second briefcase was kept under the White House in a secret bunker in case of nuclear attack. The combination -- 529.
DR. JAMES YOUNG, FORMER WHITE HOUSE MEDICAL TEAM: JFK's birth date.
GUPTA: Some 40 years after the president's assassination, the JFK library granted historian Robert Dallek access to Kennedy's medical records.
Dalleck says the records paint a very different image from what many Americans thought of the young president, revealing a man in almost constant pain from a bad back.
ROBERT DALLEK, "AN UNFINISHED LIFE: JOHN F. KENNEDY, 1917-1963":They were shooting him up with the procaine. He couldn't go up the staircase like a normal person might, couldn't roll over in bed at night, couldn't pull the shoe and sock on his left foot.
GUPTA: Kennedy flatly denied his Addison's Disease, a hormonal deficiency that can cause fatigue, low blood pressure and weight loss. But he had it.
DALLEK: He was on so many medications to deal with the Addison's Disease, to deal with the back pain, and to deal with the continuing colitis, diarrhea he suffered from. He would take antispasmodics to deal with prostititis, urethritis, sinusitis, and lots of antibiotics that he had to take.
The country never knew about this.
GUPTA: Yet Dallek believes President Kennedy showed sound judgment in the face of great suffering.
DALLEK: I sent his medical records alongside of the two missile crises, and other crises, but principally (INAUDIBLE) missile crises. And what I found was that he was as cogent, as on top of things as you would ever want a president to be. The man had an iron will. There really was something heroic about him.
KENNEDY: Ask what you can do for your country.
FRANKLIN ROOSEVELT, PRESIDENT OF THE UNITED STATES: The only thing we have to fear is fear itself.
GERGEN: Fascinating question of history is whether the country would have elected Franklin Roosevelt in 1932 had people known that he couldn't walk.
GUPTA: Franklin Roosevelt served from a wheelchair. While he couldn't raise himself to his own two feet, he made every effort to raise the country out of the Great Depression. He coerced reporters into helping him shield his disability.
FERRELL: The reporters were a little careful with him. There's no question about that. But had they not been careful, the secret servicemen would have taken their cameras and removed the film.
GUPTA: But when he ran for a fourth term, the doctors didn't even tell him that he was dying of heart failure. And the public certainly didn't know.
President Roosevelt died a month after his inauguration.
GUPTA: Our next cover-up began here in New York harbor in the summer of 1893. President Grover Cleveland had secret surgery on a friend's yacht while the country was embroiled in a financial crisis. Sounds more like a Hollywood script. But it happened here, just months after Grover Cleveland won his second term as president.
FERRELL: He was on the yacht for two or three days. It went up to Massachusetts. And what happened there was that he was secluded from the public for perhaps six weeks.
GUPTA (voice over): The president had an operation to remove cancer in his jaw. The operation was covered up from the public for 24 years. A plaster mold was made of Cleveland's jaw after the surgery. You can see a hole even bigger than a golf ball. A portion of that tumor is in the Mutter Museum in Philadelphia.
Historians say another classic cover-up came in 1919, when Woodrow Wilson had a massive stroke.
FERRELL: He was just a shell of a man. It was impossible for him to show any large decisiveness. He could concentrate on a problem and not very well at that for perhaps 10 minutes, and for the rest of it, just simply shuffle around the White House. Servants had to remove rugs when he went from room to room. And you could hear the tapping of his cane.
GUPTA: Only his wife and a few associates knew how ill the president really was. They told the public their leader was suffering from exhaustion. Many say Edith Wilson effectively ran the country during that time.
GUPTA: History has taught us to ask tough questions about the president's health. We leave you to decide whether the public knows enough. Over the last hour, we hope we've given you a sense of what it takes and how challenging it is to ensure that the president is fit to lead.
Thanks for watching.