RAY SUAREZ: According to medical records released this week, former President John F. Kennedy was in far greater pain and taking many more medications during his presidency than previously known.
Washington physician Jeffrey Kelman examined the records with historian Robert Dallek, whose excerpts from an upcoming biography appear in this month's Atlantic Monthly. Dr. Kelman joins us now. Well, John F. Kennedy was famously the youngest man elected to the office. But it sounds like he had been sick for a really long time.
DR. JEFFREY KELMAN: John Kennedy was sick from age 13 on. In 1930, when he was 13, he developed abdominal pain. By 1934 he was sent to the Mayo Clinic where they diagnosed colitis or it was called colitis. By 1940 his back started hurting him, by 1944 he had his first back operation, by 1947 he was officially diagnosed as having Addison's Disease.
And he was basically sick from then on through the rest of his life. He had two back operations, in '54 and '55, which failed. And he needed chronic pain medication from '55 through his White House years, until he died in Dallas. He was never healthy. I mean, the image you get of vigor and progressive health wasn't true. He was playing through pain most of the presidency.
RAY SUAREZ: You reviewed his medical records.
DR. JEFFREY KELMAN: In aid of this new biography by Robert Dowling, we went to the Kennedy library where they opened the medical archives for the first time and we went back and interviewed all the records, starting from his time in the Mayo Clinic all the way up to his death.
RAY SUAREZ: And this was a guy who had to do what just to get through a day?
DR. JEFFREY KELMAN: By the time he was president, he was on ten, 12 medications a day. He was on antispasmodics for his bowel, paregoric, lamodal transatine [ph], he was on muscle relaxants, Phenobarbital, Librium, Meprobomate, he was on pain medications, Codeine, Demerol, Methadone, he was on oral cortisone; he was on injected cortisone, he was on testosterone, he was on Nembutal for sleep. And on top of that he was getting injected sometimes six times a day, six places on his back, by the White House physician, with Novocain, Procaine, just to enable him to face the day.
RAY SUAREZ: Now, in the late '40s he was diagnosed with Addison's Disease.
DR. JEFFREY KELMAN: Right.
RAY SUAREZ: Which is what exactly?
DR. JEFFREY KELMAN: Addison's Disease is adrenal insufficiency. The adrenal gland makes corticosteroids and other hormones that are used for salt metabolism, response to stress, response to inflammation. In '47 he was officially diagnosed in England, as being adrenally insufficient, and from that point on, at least that point on, he was being treated with daily corticosteroids of some form or another. There is some evidence he was actually being treated earlier, with a form of [inaudible] implanted under his skin. But at, from '47 he had to receive daily steroids to survive.
RAY SUAREZ: Now whether this was Addison's or simple adrenal insufficiency, this is still pretty dangerous?
DR. JEFFREY KELMAN: It's always dangerous; without being supported, patients die. And the steroids themselves have side effects, including susceptibility to infection. Kennedy needed multiple courses of antibiotics, he had urinary infections, skin infections, he had respiratory infections.
RAY SUAREZ: Can you, from the distance of 40 years, from what you were able to look at, his X-rays, his medical records, his prescriptions, talk about whether or how these illnesses affected his performance?
DR. JEFFREY KELMAN: We went to a lot of trouble, I mean, you can make a time line at the Kennedy Library looking at day by day, sometimes hour by hour, the history of the Kennedy presidency. And in correlating it as well as you could with the medical records, didn't seem to have affected his presidency at all. His judgment wasn't warped, in spite of the fact that he seemed to be in pain a great deal of the time, it didn't affect his performance as president. In certain ways I came out of it thinking he was a heroic character.
RAY SUAREZ: Was his appearance altered by the drugs that he was on?
DR. JEFFREY KELMAN: He gained and lost weight, both from the colitis and from the steroids, and from the appetite, that's why he was on testosterone, in order to stimulate muscle growth and stimulate his appetite. So his performance -- his appearance rather did change from time to time.
RAY SUAREZ: Now, in recent years there's been a lot of controversy over the use of steroids by athletes, by youngsters who are trying body building, people talk about "roid rage" and personality changes from using such medications. How do we know, or can we ever know whether they affected President Kennedy in what was still, I think, a pretty new drug regimen, wasn't it?
DR. JEFFREY KELMAN: Right. Steroids became available at all in 1937. And so this is reasonably new. The muscle building steroids are the testosterones, and he didn't appear to be getting doses high enough to cause psychological changes. The maintenance, corticosteroids he was receiving for the Addison's Disease, again, were probably not in high enough doses to cause psychiatric issues.
RAY SUAREZ: What can you tell from the X-rays?
DR. JEFFREY KELMAN: He had compression fractures in his low back, he had osteoporosis. He had a lot of surgery. In 1954, they put a plate in because the pain was so bad he needed, or they felt he needed to have his spine stabilized. It got infected in '55, they took the plate out. By the late '50s there were periods had he couldn't put his own shoes on because he couldn't bend forward.
RAY SUAREZ: And this is a man who also had to walk sideways down the stairs. You never saw this stuff in public apparently, but had trouble walking?
DR. JEFFREY KELMAN: He was on crutches. He couldn't bend down. There's one very nice picture of him being lifted up to Air Force One in a cherry picker box with a Secret Service man because he couldn't walk up the stairs.
RAY SUAREZ: If you had a patient, if someone been referred to you and you got this box of records, would you be expecting someone sort of tan and fit?
DR. JEFFREY KELMAN: No.
RAY SUAREZ: The way Kennedy that was presented to us?
DR. JEFFREY KELMAN: Never. It was the last thing I expected to find in the medical records. I saw him once, many years ago. And all I can remember is feeling this is a guy who couldn't have a care in the world. And that wasn't the case at all.
RAY SUAREZ: Has medicine changed in such a way that these conditions wouldn't be treated this way today?
DR. JEFFREY KELMAN: Clearly, but it's 40 years later. I mean there's more emphasis on non-steroidal anti-inflammatory agents, there's for emphasis on exercise programs to strengthen backs, less on braces, less on trigger point injection, although it's still used. He'd have been treated differently now, but that's 40 years of hindsight.
RAY SUAREZ: One of the reasons it's said that the records were released to you and Bob Dallek was that there was some feeling that this would demonstrate what a heroic thing this was, not that he had deceived the public by giving a false impression of health, but that it was just pretty hard to be John F. Kennedy day after day. After looking at everything that you looked at, which impression did you come away with?
DR. JEFFREY KELMAN: That was my impression. It's funny, I mean, the lesson that I got out of it was that this guy had a real disability, I mean, he was living with a disability which probably would get him federal disability or retirement if he was around today, and it was known. He was on enough pain medications to disable him. And he survived through it. He came out of it, and he performed at the highest level
RAY SUAREZ: Dr. Jeffrey Kelman, thanks a lot.
DR. JEFFREY KELMAN: Thank you.