President John F. Kennedy had the most complex medical history of any resident of the White House, but managed to keep his multiple health problems largely secret, according to a surprising and comprehensive new analysis of his doctors' records.
The review, published in the Annals of Internal Medicine, takes a close look at Kennedy's White House medical records, as well as correspondence from his physicians. It reveals that the late president, unbeknownst to the public, had been diagnosed with Addison's disease, a rare endocrine disorder in which the adrenal glands do not produce enough of the hormone cortisol. He also suffered other health problems he kept out of the public spotlight.
At age 43, Kennedy was the youngest man ever elected president and media reports of the time, which were far less critical of political figures than today, depicted him as a picture of health, youth, and vigor. During his 1960 campaign for the presidency, Kennedy's personal physician even denied the Addison's diagnosis with a carefully-worded statement to the media.
But the new analysis of his medical records tells a different story. Lee R. Mandel, M.D. — a Navy Medical Corps endocrinologist in Chesapeake, Va., who conducted the new review — concluded Kennedy had a rare autoimmune endocrine disorder called polyendocrine syndrome type II, or APS II, which is characterized by the coexistence of hypothyroidism and Addison's disease, among other conditions.
He also notes that records indicate long before he became president, Kennedy was diagnosed with hypothyroidism, when he was a Massachusetts Senator.
Kennedy's White House medical records were first made available by the John F. Kennedy Presidential Library & Museum to historian Robert Dallek and his medical consultant, Dr. Jeffrey Kelman, in 2002, following years of requests. Since then, other researchers have analyzed Kennedy's medical records.
For the new review, Dr. Mandel examined additional long-hidden medical records, as well as correspondence between between various specialists at the Mayo Clinic and Lahey Clinic and Kennedy's father, Ambassador Joseph P. Kennedy. He also interviewed many of Kennedy's physicians.
"The library's medical records consist almost entirely of the medical files of White House physicians Janet Travell and George Burkley, as well as correspondence from various specialists, hospital discharge summaries, and radiography results," Dr. Mandel said.
"None of the medical files of any of the medical specialists involved in Kennedy's healthcare are at the John F. Kennedy Presidential Library & Museum. Review of the White House medical files revealed that Kennedy's major medical diagnoses can be explained on an endocrine autoimmune basis — namely [APS 2."
The possibility that Kennedy had Addison's was first tentatively suggested in the 1976 book, "The Search for JFK," by Joan and Clay Blair. They noted that in 1947, Kennedy, then a Massachusetts Congressman, collapsed during a visit to England. The attending physician reportedly told a Kennedy associate: "That young American friend of yours, he hasn't got a year to live."
Kennedy was later treated at the Lahey Clinic in Boston and reporters were told at the time — in a blatant fabrication — that he had suffered a serious recurrence of the malaria he had contracted in the Pacific during World War II.
After being discharged, records show he began taking asynthetic adrenal hormone, implanted in pellet form under the skin of his thigh, and by 1950 was taking daily cortisone pills as well, the newly released records indicate.
Even earlier, Kennedy had been suffering from other health problems, including gastrointestinal difficulties that were not publicly disclosed. In August 1940, Paul O'Leary, M.D., of the Mayo Clinic, gave the following assessment of Kennedy's health to his father, Joseph P. Kennedy, in a letter: "Jack's examination revealed a rather unique finding, which he perhaps discussed with you by this time. His blood pressure was exceedingly low, being in the neighborhood of 85, and for a boy of this age it should be approximately 120. This so-called static hypotension is a comparatively recently recognized entity and it might well be that some of Jack's gastrointestinal difficulties are attributable to this finding."
In 1954, Kennedy had surgery in New York for back problems that continued to plague him until his death. In 1955, he began treatment for hypothyroidism with liothyronine — medicine he would take twice daily for the rest of his life, the records show.
Dr. Mandel noted that other autoimmune conditions are associated with APS 2 and that Kennedy may have suffered from these as well, including chronic atrophic gastritis, hypergonadotropic hypogonadism, and celiac disease — "an interesting fact given that Kennedy had gastrointestinal symptoms [cramping, diarrhea, inability to gain weight] for most of his life."
He added that Dr. Janet Travell's listing of Kennedy's medications for Oct. 12, 1961, represented a typical day for the president. He was taking ascorbic acid twice daily, hydrocortisone, prednisone twice daily; methyltestosterone; liothyronine sodium twice daily; fludrocortisone; and diphenoxylate hydrochloride and atropine sulfate.
In addition, Kennedy also received testosterone daily during his entire presidency and was treated for anemia at various points in time, the record show.
"In summary, John F. Kennedy had many medical conditions during his lifetime," Dr. Mandel said. "Despite his many medical conditions as well as his recurrent back problems, John F. Kennedy managed to convey an image of health and vigor that masked the true state of his health to the U.S. public."
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