john f. kennedyJohn F. Kennedy was probably the sickest U.S. President ever. He suffered from a disease called Autoimmune Polyendocrine Syndrome, which was not described genetically until 1981, 18 years after he was assassinated (Medicine, 1981;60(5):355-62). This disease made him miserable by knocking off his thyroid and adrenal glands, and probably his parathyroid glands also. Multiple defects in his immune system had caused him to suffer a strep infection called scarlet fever in childhood, colitis (bloody diarrhea), gastritis, a duodenal ulcer (burning in the stomach), chronic urinary infections, and chronic prostatitis. While he was president, he was treated by an allergist, an endocrinologist, a gastroenterologist, an orthopedist, a urologist and several other doctors.

His doctors treated his many symptoms with an unbelievable amount of drugs, including:
• lack of adrenal gland hormones, treated with excessive doses of corticosteroids that caused severe osteoporosis, which resulted in broken bones in his spine, multiple failed surgeries and chronic back pain. He was also given salt tablets to replace the salt lost from his lack of adrenal hormones.
• lack of thyroid hormones (diagnosed at age 38), treated with thyroid pills. Low thyroid function causes tiredness, mood changes, forgetfulness, and constipation.
• chronic, severe back pain, treated with narcotics and xylocaine injections into his back.
• depression, treated with tranquilizers such as Ritalin, Librium and other drugs.
• insomnia, treated with sleeping pills and barbiturates that are habit forming.
• decreased ability to fight infections, treated with gamma globulin injections
• day-time sleepiness, treated with amphetamines and other stimulants
• chronic urinary tract infections and prostatitis, treated with long-term antibiotics and gamma globulin injections
• reduced male hormones, treated with testosterone injections
• incorrectly diagnosed food allergies, treated with antihistamines. (His wife thought that the antihistamines were causing him to be depressed.)
• belly pain, treated with atropine that can cause tiredness, dry mouth, dizziness, and constipation.

Early Medical History
At age two, Kennedy developed scarlet fever caused by a streptococcal infection, which was the first sign that there was something defective in his ability to kill germs. He continued to have intermittent unexplained fevers and chills for the rest of his life. Recurrent fevers can be a sign of an autoimmune disease in which his own immunity attacks his own cells. In high school, he weighed 117 pounds and developed bloody diarrhea caused by colitis, which may have been caused by his own immune system attacking his intestines. Doctors wrongly thought that this might have been caused by allergies, so he saw an allergist who prescribed a ridiculous diet of peas, corn and prunes. That succeeded in causing even more weight loss, and it did not stop his diarrhea or cramping. In the late 1930s, doctors discovered another way to treat colitis: cortisone-type drugs. They placed time-release pellets of cortisone under his skin. Cortisone-type drugs make people hungry and feel good and they gain weight, and they help to relieve pain from colitis and arthritis, but they have horrible side effects. They weaken bones to cause osteoporosis, they knock off a person’s immunity to make him susceptible to all sorts of infections, and they shut down the adrenal glands so the person no longer makes his own cortisone that is necessary to stay alive.During his undergraduate days at Harvard, Kennedy was reported to have been treated at least three times for venereal diseases that started a lifetime of urinary tract problems. His immune system was probably compromised because of the cortisone he had taken for colitis.
It now appears that Kennedy had Autoimmune Polyendocrine Syndrome type 2 (APS-2), a disease in which his own immune system attacked his cells as it would attack germs, to destroy his thyroid, adrenal and perhaps his parathyroid glands (Annals of Internal Medicine, Sep 5, 2009). The syndrome was first described as genetic in 1981 (Medicine, 1981;60(5):355-62), and 28 years later a U.S. Navy physician, Dr. Lee Mandel, analyzed Kennedy’s symptoms and realized that they fit a diagnosis of APS-2. This syndrome is a rare recessive disease that runs in families. Kennedy’s younger sister had damaged adrenal glands, and his son had a damaged thyroid gland.

Incredible Courage
Kennedy volunteered to serve during World War II, but was rejected by both the Army and the Navy because of spine and back problems that he said were caused by playing football at Harvard. With perseverance (and his father’s connections), he was able to join the Naval Reserve and become an officer on a patrol torpedo (PT) boat. In the battle in the Solomon Islands on Aug. 1, 1943, at age 26, his ship was sunk by a Japanese destroyer, Amangiri. He swam several miles to an island with 11 of the 13 crew members, and carved a distress signal using coconut shells. He and the crew were eventually saved.

He kept on despite of chronic back pain. In 1944, he went through unsuccessful back surgery with spinal fusions and metal plates in his spine, but he did not heal and developed deep infectious in his skin and bones. Things looked so bad that a Catholic priest administered last rites. While he was sick in bed, he wrote a Pulitzer Prize-winning book, Profiles in Courage.

After winning a seat in the House of Representatives in 1947 at age 30, he became very sick and was diagnosed with Addison’s disease, an inability of his adrenal glands to make cortisone. He took cortisone-type drugs daily for the rest of his life. Taking cortisone shut down his own adrenal glands to deprive his body of its own natural production of cortisone. Since suppressed adrenal glands are unable to produce cortisone, a person’s blood pressure can drop and he can go into shock and die. Cortisone is necessary to maintain blood pressure in times of physical crisis. All people who take cortisone for more than a week should be cautioned that in the next several months:
• if they are in an accident, they may need an immediate shot of cortisone, and
• if they need surgery, they should probably be given a cortisone injection prior to surgery.

From age 33 onward, his back hurt so much that he had several more surgeries. His X rays showed that he had severe osteoporosis, a side effect of the cortisone that he was taking. Because of this, he was worse off after each surgery. Back surgery on people with osteoporosis usually fails because the bones of the back are too weak to heal properly.

A Presidency on Multiple Medications
Kennedy was a master politician. When he was running for president at age 42 in July of 1959, Arthur Schlesinger, Jr., asked him whether he had Addison’s disease, and Kennedy emphatically denied it. In truth, he had been diagnosed with that disease at age 30 and had been taking cortisone drugs for much longer than that.

As president during the Cuban missile crisis, at age 45 (October 1962), he was making decisions with both sides aiming atomic missiles from submarines at each other. He took antispasmodics to control his colitis, antibiotics for a urinary infection, and increased amounts of hydrocortisone and testosterone along with salt tablets to control his adrenal insufficiency and boost his energy. He was also taking phenobarbital, paregoric and Metamucil.

How His Back Pain May Have Caused His Death
In Kennedy’s assassination on November 22, 1963, it was the second of the three shots that hit him in the head and killed him. He was wearing a stiff back brace that prevented him from falling forward as anyone else would have done. If he had not been wearing a back brace and had been thrown forward, he would have been immediately covered by secret service officers.

Should Presidents and Candidates Release Health Records?
Woodrow Wilson suffered a paralyzing stroke in October 1919, and his wife essentially ran the country for the rest of his term in office, with no release of this information to the public. When Dwight D. Eisenhower had a heart attack, his staff said that he was hospitalized because of an upset stomach. In 1992, two doctors for presidential candidate Senator Paul Tsongas said that he had had a successful 1986 bone marrow transplant for non-Hodgkin’s lymphoma, when they had actually found a cancerous lymph node that eventually killed him. Abraham Lincoln suffered from depression. Ronald Reagan slept through most of his cabinet meetings and the public was not told that he had Alzheimer’s disease until five years after he left office.

At least two of the leading candidates for the 2020 presidential election have medical issues. Senator Bernie Sanders had a heart attack at age 78. Dr. Harold Bornstein, President Donald Trump’s former physician, says that Trump dictated his own health letter claiming that he is in excellent health.  He is reported to weigh 243 pounds at 6′ 3”, which yields a BMI of 30.4 (30 or more is considered obese), but photos show that his height may be overstated and his weight may be understated. His LDL (bad) cholesterol is 122 even though he takes statins to lower it (anything over 100 increases risk for a heart attack). He also takes Ambien to help him fall asleep, low dose aspirin to help prevent a heart attack, antibiotics to control a rash on his face called rosacea, and Propecia for male-pattern baldness.

Does the voting public have a right to know the medical history and current conditions of its leaders and candidates for leadership? History tells us that this information has often been withheld or distorted. In the case of JFK, no one could have foreseen how his medical treatments might have affected the outcome of his assassination. At least the practice of allowing presidents to parade in open cars was stopped.

May 29, 1917 – November 22, 1963