Every day, my inbox bursts with opinions about everything from poop transplants to climate change. When news in medicine happens, someone will inevitably email me offering an op-ed.
Except on one topic: the health of the major presidential candidates. Almost no one wants to touch it.
This first became clear to me last year, soon after I started my job as First Opinion editor. Even in spring and summer 2023, the discourse wondered whether President Joe Biden and former President Donald Trump were too old to occupy the White House for another term. Around the same time, Sen. Mitch McConnell had frozen while speaking, while then-Sen. Dianne Feinstein had died after several years of concerns about her ability to perform her duties.
I thought STAT readers would want to hear from an expert on health and aging, so I reached out to probably dozens of gerontologists and geriatricians. (It took me longer than it should have to realize the difference between those specialties: Gerontologists study aging, geriatricians treat older patients.)
I started with those who had written previous First Opinions, but they all demurred or simply did not respond. When someone declined, I would ask them to suggest someone else who might be willing or able to write. I would then daisy-chain my way through a university’s gerontology department until I was four or five degrees from the original person I had reached out to.
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Many who declined said they were too busy. But others were frank: They simply did not want to — or were not allowed to — weigh in on such a controversial issue. Of course, there are plenty of people offering opinions and even diagnoses on cable TV and online, but those generally aren’t the measured experts that STAT readers want and deserve to hear from.
Eventually, I found an author who was willing to write something: Anna Chodos, an associate professor of clinical medicine in the Division of Geriatrics at UCSF and a practicing geriatrician. Quite reasonably, she did not want to comment directly on the health of Biden or Trump. Instead, she wrote a thoughtful op-ed arguing that age limits for politicians are a terrible idea. “Aging is a heterogenous, unpredictable process mitigated by old-fashioned advantages in life and luck,” she wrote.
But as an opinion editor, I still wanted to find someone who would give a full-throated argument: The candidates were too old! They were not too old! Trump was clearly becoming senile but Biden was fine! Biden was clearly becoming senile but Trump was fine! Everyone is worried about the wrong parts of aging!
Since then, I’ve tried again over and over as recently as this month.
Luckily, First Opinion has published some other pieces about the health of the candidates, most notably from Lawrence K. Altman, a physician and reporter who has been covering the topic since the 1970s for the New York Times. In February, he wrote a measured essay, packed with anecdotes from his previous reporting, arguing that the candidates should share more information. Like Chodos, he urged that people not give in to stereotypes: “Studies have shown that 17% of Americans aged 75 to 84 years and 32% of those 85 or older have dementia. But that means more than two-thirds do not have dementia.”
Come July, he was more forceful, arguing that Biden needed to release records from a full medical evaluation. And this week he made an important point: As Vice President Kamala Harris and Trump have begun to fling insults about each other’s cognitive health, they have overlooked the suffering of millions of Americans with mental illness.
This past week, STAT also published ethicist George J. Annas making a surprising argument: that the president and candidates deserve doctor-patient confidentiality. He points out that the public needs the president to be able to freely discuss embarrassing conditions with their physician, rather than hide them. (He does say that the president has an ethical responsibility to share any conditions that might interfere with their ability to perform their duties.)
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But none of those essays, packed with information though they are, completely scratched the itch for me. It’s always hard to find experts — trained to prize nuance and to write 30-page academic articles — who are willing to make the kind of argument that fits into a Google-friendly headline. But I’ve found this, without a doubt, to be the hardest topic about which to assign op-eds on in my almost 20 years of working in opinion journalism.
The question is: Why?
The reasons that experts gave me seem to fall into three buckets.
First, it’s too complicated to judge whether someone has Parkinson’s or cognitive decline or mental illness from afar. Fair.
Second, they don’t want to anger colleagues. They worry that a simplistic argument will make their peers look down on them, perhaps damaging their professional reputation. Also fair. The stigma of engaging with a popular audience is real, though fading. Institutions increasingly encourage this kind of writing, with some serious caveats.
Third, and most worrisome: They are scared to anger readers.
This is, to put it mildly, a contentious election. As a voter living in the Philadelphia suburbs, one of those “swing communities,” I see it on the ground, quite literally. No matter how well supported, experts worry that sharing an aggressive opinion could open them up to harassment online or offline. It’s something that all medical experts have become more cautious about in the wake of Covid. What might have once felt like public service, even an ethical imperative, now feels physically dangerous.
That means knowledegable people are less inclined to offer informed opinions than ever before. Good opinion writing is about helping readers think through the world, to equip them to understand the strengths and limits of opposing arguments. When the climate has made sharing a good-faith argument feel dangerous, we all lose.
I would never want someone to make an argument they are uncomfortable with or, worse, one that could open them up to harm. But I hope that things will change and we can bring back both the joy and the utility of making a bold, exciting op-ed that makes people mad in a good way.
As always, if you have a sharp, surprising idea for an op-ed, email me: [email protected]. You can find our guidelines here.
