Medical privacy versus enormous political power

An article in STAT today talks about the way Capitol hill lawmakers get prescriptions filled while here in DC. This segment has a lot of tongues wagging:

There have been rumors about some members of Congress for years, Thad Cochran in particular is known to have some issues with his memory (insider reports are more dire than that, pointing to sundowning), but having a pharmacist say he has or is providing Alzheimer’s medication goes beyond rumor or even personal experience and into actual clinical diagnosis.

So, what do you think? Is there a point at which this is simply not okay? Is a diagnosis with Alzheimer’s that point? Something more? Or should we just rely on a democratic process to protect us? Given that medical information is secret, is the democratic process enough?

Personally, I think there has to be a point at which the person does not have the capacity to serve. Dementia robs people of legal capacity, and voting in Congress should have at least those standards. But if you ask me where the line should be, I honestly do not know.

There’s no pbjective measure of capacity to hold office. The healthiest person can make the stupidest decisions, depending on who’s judging. In the end, it has to be their constituents’ decision.

As for whether or not there’s medical evidence that might affect that judgement, that’s not down to those who have access to it - and certainly not a pharmacist. It’s down to the prescribing doctor, if they think there’s an issue about someone’s capacity, to try to persuade the person concerned to consider their position. And that’s as far as it can go.

Firstly, that pharmacist should be fired and stripped of his/her license for divulging confidential medical information. I don’t care if he didn’t name names, you just don’t talk at all about this sort of thing in public.

Well, somebody damn well should. And who else was in a position to do so?

I’d give him a fucking medal.

I’d disagree.

There’s the legal concept of ‘testamentary capacity,’ IOW, whether a person has the mental capacity to know what s/he is doing when making a will.

If you don’t have that capacity, you shouldn’t be in Congress* either. Regardless of what your constituents think. And yes, there should be some sort of test for it.

*Or in the White House, or on the Supreme Court or the lesser Article III courts.

I liken RTFirefly’s view on this to the right-wingers who oppose common-sense things like needle exchanges, because they would rather have people die of preventable diseases to prove a political point.

Don’t like politicians taking prescription drugs? Great. Wait till you see them in office and not on medication.

Maybe there should be a process whereby the people they represent get together every so often and decide if the Congressman is still fit to represent them. The President is different - any time the VP or the cabinet or Congress decides he isn’t fit, they can remove him.

We can’t rely on doctors - what do they know?


I don’t actually see what confidential information has been divulged. What we know is that out of a population of 535 people, someone is getting diabetes medication, and someone is getting Alzheimer’s medication. At the firm I work for, we have been told about medical issues that the employee population has had that impact the firm’s insurance coverage. The information did not identify (directly or indirectly) the specific employees, and no one seemed troubled by it. I don’t see a problem posed by the pharmacist’s statement.

To the broader question, I suppose one could legislate that certain medical conditions disqualify a person from holding office. But it is obviously possible for someone to obtain medication covertly either through another person, through a cooperative doctor, or from online/overseas sources. So a member of Congress who really wanted to have or hold on to his or her position could still do so without the OAP being aware of the disqualifying condition. I don’t see any good way to catch someone already in office who is in a decline before it became so blindingly obvious that they might already be forced to resign, assuming they did not want to be caught.

Would such legislation survive a constitutional challenge?

I honestly don’t know, but I"m not sure that it matters since I don’t consider that a true solution even if it were successfully implemented. Also, good luck getting such a law passed to begin with.

I’d be for all candidates getting a physical by a neutral doctor, and the results of that physical being available to potential voters.

It should be up to the voters to decide whether a condition is disqualifying. But, if the voters do not know that their candidate has that condition, then they are being denied being able to make an informed choice.

If someone is running for senate, and their doctor says that they have a year or two of normal function, then a couple years of decline, and they will likely die before their term is up, isn’t that the sort of thing that the voters should be made aware of?

Voters may say they love this guy and his policies so much that they don’t care, and they trust that he will retire and be replaced without issue when that time comes, and so not find the condition disqualifying. Or voters may want stability, and choose someone healthier.

Not knowing is what causes speculation. It makes us study their every move, looking for signs of failing health or mental acuity.

Especially as many of our legislators and executives are bit on the older side, when health does tend to start getting difficult to maintain.

Nothing at all stops a candidate from getting such a physical and publishing his results, and then challenging his opponents to do likewise; the voters are welcome to infer that a demur from a candidate is based on his poor health.

True, but doesn’t really address the question of whether a candidate in “poor” health should have a right to keep that from the public.

I get that nothing stops them, I was saying that it would be useful to compel them. It would be useful as well, if there is a standard for the doctor and the physical.

Trump’s doc’s statement that he would be the healthiest president ever to hold the office was obviously a lie, and yet, for some reason, there were some people who took it at face value, and then started pointing to Clinton’s health, even though she had an actual doctor with an actual medical report on her health.

You think that trump supporters may have been a bit more reticent if they knew he was suffering from alzheimer’s, or had cancer and would die before his term was up?

Nothing stops the public from believing candidates have secret ailments. As in, Hillary Clinton and brain tumors, or whatever that nonsense was last year.

I just don’t think health concerns matter that much to most voters. Look at all the politicians who have been reelected in spite of very well known concerns about age and health: Thurmond, Byrd, McCain, Dingell, Inouye, Reagan, and many others. Though I have strong political differences with some on that list, I have to say that it is a pretty distinguished group, all things considered. (I thought about adding Trump because of his obvious mental health issues, but I decided not to include the most terrifying counter-example.)

I think the health of a candidate is a perfectly legitimate thing to raise during campaign. I do question whether it is a good idea to require disclosure of health issues. If you think someone isn’t up to the stresses of the job, but the candidate won’t give you the ammunition you want, feel free to vote for someone else based on your suspicions. It’s a free country.

This is a joke, right?

Certainly, I don’t think he gets to call himself “reserved” anymore.

FWIW, Open Secrets shows that he donated $100 to Trump last year.

Tax returns are nominally private too, but they’ve recently become information voters expect to see from candidates before giving them their vote. I could see something similar happen with medical records, where the cultural expectation is there, but I wouldn’t want it to be legally mandatory. If you think you can get elected without divulging, good for you. Look at Trump and his tax returns.

Just because you have Alzheimer’s doesn’t mean that your mental faculty is significantly impaired. At least to start with. Look at Terry Pratchett, for example.

I come down between you two. There is a definite tension here between professional ethics and the public’s right to know. I’m inclined to side with the pharmacist here as long as the pharmacist hasn’t violated HIPAA, which I am pretty sure is not the case. I know pharmacists and while they never talk about individuals using actual names, they do talk about their job pretty loosely. But naming names is the clear bright line and that wasn’t done here.

If trump had 18 months to live, then yeah, many trump voters would have not been so keen to be electing pence. Some may have even been turned off by severe degenerative mental diseases.

The president really needs to be at the top of his game. Any impairment, significant or not, compromises our country at its highest levels.