Ill Wind

In Politics, Image Trumps Medical Reality

The mayor's prognosis looks good—medically, anyway. Ninety-three percent of men diagnosed with prostate cancer live at least five years, and since Giuliani is relatively young and his condition was caught early, his prospects are better than most. Doctors say that whatever course of treatment he opts for would disrupt the Senate campaign only briefly; surgery to remove the prostate gland might keep him from work for about three weeks, while some forms of radiation could allow him to continue on as if nothing's happened.

image A probing look at the walnut-sized gland
(detail graphic by Jim Willis & JR from Daily News)

Politically, the danger of diagnosis in public office has more to do with irrational expectations about our leaders' health than with such medical realities. While illness is a fact of life—and often a manageable one—the idea of illness doesn't seem to jibe with the fanciful expectations we heap on our politicians. Today's voters like a strong, inviolable type. Thus, the taller guy always seems to end up president, despite the fact that he's as destined for the grave as the rest of us.

Typically, this seemingly unassailable leader—who makes much of his hearty appetites and takes a few jogs with the press corps—doesn't have his groin area mapped out in the Daily News and the Post, which both ran diagrams of the prostate gland after news of the big C broke last week. Granted, they were impersonal, Any Man drawings, the kind you might find in a biology textbook or a doctor's office. But it was hard to see them without envisioning the mayor's walnut-sized gland and surrounding parts, and no pol—well, no one—wants that. (The News even ran a drawing of a rectal probe used in some radiation treatments, with one bare, bent leg of a presumably nonsenatorial "patient" sketched in the background.)

A public servant does need a certain vitality to function, of course, and a candidate's ailments can sometimes be worthy of consideration. It wasn't entirely inappropriate to worry over Paul Tsongas's health in the 1992 Democratic presidential primary, for instance (though it's worth noting that he died of pneumonia rather than the lymphoma that ignited the public concern in the first place). And maybe more voters should have been paying attention to Reagan's fading brainpower, which some say was on display well before he was reelected.

But the fixation on politicians' medical specs goes beyond making sure they'll live—or think straight—through their terms. While disabilities come by valiantly can enhance some leaders' manly charm (think Bob Dole's withered arm or Senator Bob Kerrey's wooden leg, war injuries both), watching sickness seize control of a public figure can remind constituents of their powerlessness over their own delicate innards. How else to explain the enduring horror of the Bush vomit episode, which, after all, was the result of a relatively harmless stomach flu? Watching the president throw up in the prime minister of Japan's lap brought out the bodily fear and shame in even the least squeamish of us.

Politicians past have gone to great lengths to spare the public such discomfort—and avoid the dreaded appearance of weakness. In an effort to keep his cancer under wraps, surgeons removed a tumor from President Cleveland's jaw on a boat. Franklin Roosevelt did his best to conceal the effects of having had polio (a cause later picked up by the FDR memorial commission, which wanted to depict the president standing unaided, though the man had spent his entire 13 years in office—and the majority of his adult life—in a wheelchair.) And John F. Kennedy took care to make sure people didn't find out about his having Addison's disease, a hormonal disorder that causes fatigue and muscle weakness.

Keeping such things private is virtually impossible these days. Even if a reporter doesn't spot a public figure on his way into the hospital, as happened with Giuliani, few in the vote-seeking business want to risk being perceived as hiding physical problems. This is exactly what happened to poor Thomas Eagleton, the Missouri senator who was George McGovern's running mate in 1972 until it came out that he had concealed a past treatment for depression, one of the few afflictions more damaging to the image than public vomiting.

The pressure to appear both healthy and forthright may explain the regular updates on his heart that Bill Bradley felt obligated to issue during the recent Democratic presidential primary. The whole thing left the former Knick seeming defensive, never mind that the irregular heartbeat he suffers from is a relatively common and benign condition.

Illness doesn't have to stand in the way of good leadership, of course. Whatever you might think of the Elián matter, the attorney general has proven extremely skillful in not letting her Parkinson's disease—or public fear of it—interfere with her job. Even while shaking throughout press conferences, Janet Reno has stifled unnecessary hype, telling reporters at the time of her diagnosis simply, "It doesn't bother me. And if you all will just get used to it, it won't bother you."

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