The rich are different from you and me, including when it comes to health.
In the hoopla over the release of Hillary Clinton’s and Donald Trump’s medical information — OMG! She’s on a blood thinner and developed pneumonia; he’s clinically obese and on a cholesterol-lowering statin — the clearest message is that being privileged, white, and wealthy gives you such a big leg up on staying healthy and alive that you can (almost) get away with making your main exercise … gesticulating, as Trump told Dr. Oz in a show aired on Thursday.
“There’s no overt smoking gun here and no major reason for being critical,” Dr. Nortin Hadler of the University of North Carolina at Chapel Hill said about the medical data released by Clinton’s primary care physician. But “we could point out how frequently affluent people age 68 or 70 are well,” added Hadler, author of “Rethinking Aging: Growing Old and Living Well in an Overtreated Society.”
He and other physicians dragooned by reporters into reading the candidates’ medical tea leaves looked for anything that might be a red flag — and came up with, at most, a pale pink doily. Here are the five main takeaways from this week’s presidential health circus:
They’re not going anywhere for a while
We’ll have these two to kick around for a while. Having made it to age 70, Trump has a life expectancy of another 14.2 years, meaning he has a good statistical probability of easily surviving two terms (his or Clinton’s) unless his obesity triggers a fatal development. Clinton, at almost 69 (her birthday is next month), can expect to live another 17.18 years. But those are averages for the entire population. If the candidates were black or Hispanic, their life expectancy would be about two years less, according to the Centers for Disease Control and Prevention.
Stairmaster, meet Mr. Trump; Mr. Trump, meet Stairmaster
At 6 foot 3 inches and 236 pounds — the figures Trump’s doctor gave in a letter released Thursday — the Republican is just shy of clinical obesity, with a body mass index of 29.5. (Obesity is defined as 30 and above. Overweight is 25 to 29.9.) He’d likely benefit from more physical activity than mounting podiums. But socioeconomic status (the term scholars prefer to “being rich and educated”) again rides to the rescue. Although being so overweight raises his risk of cancer, heart attacks, stroke, and other serious diseases, easy access to medical care tempers that.
Trump is taking the cholesterol-lowering drug rosuvastatin and low-dose aspirin, which reduce his chances of at least cardiovascular disease and death. The drugs seem to be doing their job: His doctor disclosed that Trump’s total cholesterol level is a healthy 169 (good is 200 or lower), his high-density lipoprotein (“good cholesterol”) level is 63 (good is 40 or above), and his low-density lipoprotein (“bad cholesterol”) is 94 (good is 100 or lower).
Clinton can easily afford the medications she takes regularly: a blood thinner to guard against stroke, and thyroid pills to counter underactive thyroid.
And if Trump decides to work out, there are gyms in or near many Trump-branded properties, not to mention the pedestrian nirvana of New York’s Fifth Avenue. In contrast, poor neighborhoods are notoriously unwalkable. In high-income areas, 75 percent of streets have lighting, compared to 51 percent in poor neighborhoods, found a report by the Robert Wood Johnson Foundation; the former also have more streets with sidewalks (89 percent) than poor communities do (49 percent), as well as more safety measures such as marked crosswalks and pedestrian-friendly medians (13 percent vs. 7 percent).
Small hands?
Trump’s testosterone level of 441.6 inspired much Twitter guffawing, since it’s well short of the top of the range: normal is 240 to 950, with a 1 percent drop every year after 30. But “testosterone levels vary widely and decrease with age in men,” Hadler said. “This level is well within normal limits for a 70-year-old.” More noteworthy is that Trump got it tested at all: it’s not recommended unless a man has symptoms of androgen deficiency. Trump also got a PSA test for prostate cancer, which is not recommended either. “It’s always the first number I ask for,” he said during his Dr. Oz appearance.
“He’s overtested,” as well-off people tend to be, Hadler said.
Also not recommended is a screening test for coronary heart disease called a coronary calcium scan, which Clinton had. It’s not advised for routine screening of people with no risk factors for heart disease, though some physicians recommend it based on age alone — older than 50 for women and older than 40 for men.
Trump also received at least one echocardiogram, a heart-imaging test that is “ill-advised as a screen for low-risk people, which he claims to be,” said Al Lewis, founder of the wellness and preventive medicine consulting firm Quizzify. Medical experts recommend against them.
And as a never-smoker, Lewis said, “Trump should not have gotten a chest X-ray,” according to the US Preventive Services Task Force.
White privilege
Cancer is largely a disease of the elderly, with risk rising as you age. But race is somewhat protective, at least for men. In Trump’s age group, the risk of cancer is 21.5 per 1,000 people among whites but 23.6 among blacks.
Tell us more!
What else do voters deserve to know? The results of a personality test. A president’s cancer or stroke is unlikely to threaten the republic, let alone world peace or economic stability. His or her narcissism, impulsivity or other psychological Achilles’ heel? Yup. Here, too, wealth comes in handy: fewer psychiatrists accept insurance than do any other specialists, found a 2014 study, but paying out of pocket is probably not an issue for the two candidates.
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Excellent analysis and we’ll composed article. Thank you.
Without commenting on the candidates’ health but rather just looking at the doctoring, I’d say Mr. Trump is not attracting “the best people” to his medical team. Many of these tests — PSA, echo, EKG, chest xray — should simply not be done routinely. And he especially shouldn’t be getting what his doctor refers to as “an annual physical every year.”