I am reprinting this, from colleague Dr Henry Abraham, in its entirety. He thoughtfully articulates concerns I share.
Dear Dr. Barbabella:
I am concerned that you have examined President Donald J. Trump for the third time since last January, even as the White House called your assessment on May 26 an “annual dental and health checkup,” and despite the president’s claim that “everything checked out PERFECTLY. Three days after your evaluation you claimed that he “remains in excellent health, demonstrating strong cardiac, pulmonary, neurological, and overall physical function.”
The American people don’t seem to be buying that story. A recent poll showed that 59% of Americans feel he lacks the mental acuity for his position, hardly a vote of confidence in the president’s self-assessment.
In my experience as a physician, it’s uncommon for a healthy person to require a medical evaluation three times in a year. Certainly the ecchymoses in his hands are a tell. It may be a sign of aging. If it’s from handshaking, as you suggested, why in both hands? If it’s from prescribed aspirin, Harvard emergency physician Jeremy Faust wondered if a high dose was because you were trying to prevent a heart attack. What about his edematous ankles? Venous insufficiency is your diagnosis, but that’s relatively uncommon in men. Have you ruled out right sided heart failure, or is he taking a drug like amlodipine that also causes swollen ankles? Your credentials as a combat surgeon are exemplary, but there may be other medical specialists who might help in dealing with an especially challenging case.
As a psychiatrist I have concerns about his mental status which appears to have worsened in the last year. Why has he taken the MOCA test of cognitive abilities three times since 2018? Is the president slowly declining, or is his mental function dropping off a cliff? The danger posed by his apparent psychiatric decline is compounded by his unfettered access to our vast nuclear arsenal. Like any patient with advancing dementia, there’s a time when the car keys have to be taken away. I fear the president is at that point, and should be lawfully removed from office. I base this extraordinary request on my observations of his increasingly poor judgment, reduced impulse control, rage attacks, grandiosity, feelings of omnipotence, and his growing intoxication with nuclear weapons over which he alone has control.
As a specialist in substance use disorders I recommend, if you have not already done this, a urine tox screen on the president. He has an admittedly thinly sourced history of abusing psychostimulants since 1992. I have previously described a photo of the president with dilated pupils, a singularly abnormal finding in an elderly man under normal room illumination. Was this from a stimulant? In my clinical experience a tox screen would be indicated in any patient presenting this way, especially if he described nocturnal tweeting frenzies, grandiosity, paranoia, and daytime sleepiness consistent with stimulant withdrawal.
Other specialists who may be helpful in this complex case include hematologists, neurologists, and infectious disease experts. His black and blue hands bespeak a bleeding disorder. Aggressive use of aspirin may be the culprit, but have you ruled out blood dyscrasias such as the leukemias or platelet disorders?
While there are a number of red flags that appear to presage dementia, such as difficulties in speech, logic, calculations, and orientation in space, they are intermittent. You might argue that occasional mental lapses are part of being nearly 80. But a cluster of them even when intermittent is worrisome, especially when mixed with disinhibition, rage, and access to weapons of mass destruction. Missing from the public record are the actual scores of his three prior MOCA screens for cognitive decline. As you know the MOCA is a rapid screen taking ten or so minutes to complete. I strongly recommend a more thorough neuropsychological battery to assess the president’s ability to remember, pay attention, solve problems, and use language.
The patient’s father developed a dementia in later life which was diagnosed as “Alzheimer’s disease.” But his emotional disinhibition was more consistent with frontotemporal dementia, or FTD. The frontal lobes of the brain, shown below in dark blue, help you plan, organize, observe social graces, and exert good judgement. The temporal lobes, in light blue, deal with memory, language, and modulating anxiety and rage.
If his father’s dementia was the FTD type, the president has a 25 to 50% chance of developing the same illness. FTD patients exhibit apathy, poor judgement, and speech difficulties.
As you know, there are other causes of dementia. e.g. the vascular type from small blood clots in the brain. Brain imaging can put those concerns to rest, and so I was disappointed when last October you elected only to perform an MRI study of the president’s cardiovascular system. Brain MRI, PET, and/or SPECT scans are long overdue.
Last on my short list of rule-out diagnoses is neurosyphilis which in the U.S. from 2019 to 2023 increased 61%. It is not a stretch of one’s imagination to consider that the current president has a history of unprotected sex with infected partners. Neurosyphilis can linger for years without being detected. Undetected it can progress to a dementia with an expansive demeanor and grandiose delusions, symptoms we see in Donald Trump today. A simple blood and spinal fluid test can lay this possibility to rest.
Most importantly is that while you have a duty to protect the president’s privacy, you have a far greater duty to protect the common good. You have served your country on the battlefield. Now you are called upon to render Americans and the world a far greater service.
Sincerely,
