Two people running for president, ages 68 and 70. One has been acutely ill. The other is on anti-cholesterol medication. Both are out of shape.
As former Secretary of State Hillary Clinton and Donald Trump wage a divisive and stressful campaign in front of a highly polarized electorate, it's entirely possible that health may yet be a considerable factor in the outcome. Look at how Trump closed some of Clinton's lead in the polls in key swing states while Clinton was knocked out by pneumonia last month. Or the attention given to concerns about Trump's sniffs and Clinton's stamina in the first debate.
The latest is that the Trump campaign launched a new ad on Tuesday attacking Clinton over her health and stamina.
It's a regular theme of Trump's campaign; on a recent weekend he strayed from the teleprompter at an event in Pennsylvania, even staggering on stage to imitate how Clinton had wobbled to her car when she was sick back in September.
"She's supposed to fight all of these different things and she can't make it 15 feet to her car? Give me a break. Give me a break," Trump said to a crowd on Saturday evening. "Give me a break! She's home resting right now. She's getting ready for her next speech which is going to be about 2 or 3 minutes."
Trump's messaging has been somewhat contradictory. During the most recent debate he said that he admired that Clinton is "a fighter," who "doesn't give up."
Some probing into the health of our presidential candidates is not unusual. In fact, 69 percent of voters consider the release of "detailed personal health records" to be very or somewhat important, according to a recent survey; and understandably so. Their health is vital to the future of our country. Otherwise, we'd better really love these vice presidents.
So how do we determine if these candidates do have the stamina for the job?
Both candidates have disclosed some information about their health; and I'd like to believe both have solid, albeit conventional, physicians. But we are negligent to believe such generic, superficial metrics give us a real understanding of our presidential candidates' true health picture. Moreover, both Clinton and Trump are undermining themselves if they're not demanding more precise data and analysis to optimize their long-term health trajectories. After all, what is stamina if not the ability to perform optimally for the long haul?
And how ironic that these two candidates are only providing surface, snapshot data, given the $215 million pumped into the Precision Medicine Initiative under President Obama -- Washington's attempt to revolutionize and personalize health care by integrating and interpreting thousands of data points about individuals' genetic and phenotypic makeup. There is no indication that this revolutionary, forward-leaning health model is in place for either candidate in this high-stakes election cycle.
As the candidates provide detail for their plans for healthcare in America, we see that they are taking a similar, conventional tack to healthcare as a system. Trump's plan, updated this week, is to replace Obamacare with health savings accounts. Although Clinton's plan does try to tie mental health and community support with traditional medical care, neither candidate is seemingly moving us away from our current, disease-centric view of "healthcare."
And that is the lens through which we see the candidates as well.
Clinton's doctor was not very specific when she spoke about her pneumonia-challenged patient. She noted Clinton's medications, such as a blood thinner and medications for her low thyroid hormone levels. She disclosed allergy flare-ups, her basic vital signs, coronary calcium score and mammogram and breast ultrasound results. She referred to recent sinusitis and an ear infection.
Most of these are measures of already-expressed symptoms and reflect the minimal routine screening tests recommended for women, in general.
And while an acute disease like pneumonia is nothing to sneeze at - no pun intended -- we cannot look merely at flagrant, symptomatic disease to truly assess, at a deeply cellular level, the health trajectory of an individual.
Nor can we look at superficial metrics like a basic total cholesterol reading or an individual's weight. We learned via the Dr. Oz show, that Trump wants to lose 15 or 20 pounds, had a CT heart scan, and takes a statin to keep his cholesterol within "normal" ranges. Were lipid particle size and density assessed? Or inflammatory markers? What about genetic markers associated with cardiovascular risk? Perhaps specific genetic markers were not ordered (despite being broadly available). So what, then, about Trump's family history - which would help discern potential risk factors to monitor and even modify. It's not unusual for a deep-dive lipid panel analysis to reveal life-threatening metrics, despite otherwise "normal" surface readings.
And as for statins: They're no silver bullet. Pharmacogenomics research shows only one in 20 individuals benefits from a prescription top-grossing lipid-lowering medication.
Weight reports are also misleading. Body weight tells you little about an individual's body composition: The proportion of lean muscle mass to visceral fat -- metrics that can be life threatening if not optimized. Visceral fat wraps around the vital organs; while lean muscle is health protective, and we lose it with age.
The question of the moment is: Who is our healthier candidate, and who truly has stamina?
From the details we've gotten so far from either candidate, we really do not know.