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‘The President Is Ill’: How Health Has Impacted the U.S. Presidency

For Ann Romney, it started as it has for millions of Americans. Numbness. Dizziness. “Foggy brain.” Simple things that, when combined, added up to a startling diagnosis: Multiple sclerosis.

After a year of aggressive intravenous steroid treatment in 1998, Romney’s M.S. went into remission, where it has since largely remained. But the symptoms still sometimes “come and go,” she recently told NBC News. In fact, she suffered a recent relapse during her husband’s presidential campaign.

To many of the 400,000 Americans living with M.S. — 200 are diagnosed with the disease every week — Ann Romney is a voice of power who fully understands their daily struggles. If Mitt Romney wins Tuesday’s election, what would it mean to have a first lady with M.S.?

To explore some of the possibilities — and for a thorough medical overview of the disease — we turn to Dr. Howard Markel, a physician in Ann Arbor who also directs the Center for the History of Medicine at the University of Michigan. In a separate post, Markel helped us examine how other health issues have impacted the U.S. presidency.

NewsHour: What would it mean to have a first lady with multiple sclerosis?

Markel: In terms of presidential politics and leadership, I don’t think it means much of anything. To be sure, multiple sclerosis is a serious neurological illness and has the potential to wreak havoc with health and daily functioning, but the unpredictablity of its progression, spread and course makes it impossible to predict what would happen over the next four or even eight years of a possible Romney presidency.

Moreover, we live in an era where many people live full and fulfilling lives despite a number of chronic illnesses or disabilities. Mrs. Romney is, undoubtedly, one of those people, and even in the event of a flare-up or worsening of her disease, the access she has to health care because of her husband’s wealth and position goes a long way in ameliorating those problems as does the advance of modern medicine which is making great progress in its understanding and treatment of M.S.

More broadly, her M.S. provides a superb opportunity to educate the American people about multiple sclerosis, the need for more research on the malady and the importance of us all working with and helping all Americans who face chronic illness to live productive and healthy lives.

NewsHour: Let’s talk more broadly for a moment. What’s happening in the body of someone who has M.S.?

Markel: Each case of M.S. is different, but in general, M.S. is an autoimmune disease afflicting the central nervous system. Basically, one’s immune system damages the protective insulation surrounding nerves in the brain, spinal cord and even the nerves responsible for sight, (optic nerves) — the myelin sheath — which leads to a disruption of how the brain communicates with the rest of the body.

It can range from mild to severe in its symptoms. In the latter situation, a patient can become blind or paralyzed depending upon where in the central nervous system the disease attacks. Moreover, the disease in an individual can be unpredictable in progression and manifestation. Symptoms may suddenly appear and persist or may quickly resolve. It can go dormant for months or years without so much as a flare-up.

Other patients have symptoms that last indefinitely and progress, with serious debilitation in terms of the paralysis or dysfunction of a specific part of the body where the nerve tissue was attacked. In the worst cases, it can affect one’s movement, muscle control, thought processes, balance, speech and vision.

NewsHour: What are treatments?

Markel: Up until the early 1990s, there were no real effective treatments for M.S. There exist a number of promising drugs such as Campath, a drug also used for treating leukemia that appears to kill immune cells circulating in the body of M.S. patients that are thought to be responsible for attacking the brain and spinal cord. Specific physical activities, exercise and even horseback riding (as in the case of Mrs. Romney) have been touted as helpful but there exists less data on the efficacy of those modalities. They certainly do not worsen a person’s M.S.

NewsHour: What does Ann Romney’s version of the disease look like?

Markel: At present, it appears that Mrs. Romney is in fairly good health without major disability from her M.S. She did have a flare-up last spring, but described it as mild and minor — a tingling sensation that caused her to feel dizzy and fall “flat on my behind” and affected her ability to speak for a short period. Without examining her or access to her medical records, it is difficult to make an accurate assessment, but it appears that at present her M.S. is what is called relapsing-remitting multiple sclerosis, where there are occasional flare-ups followed by long periods of remission in an unpredictable manner. At present, she appears to be in remission.

NewsHour: Is it common for M.S. to go into remission? What does that look like?

Markel: Yes, many cases of M.S. do go into remission and for all extents and purposes, those individuals look and function normally.

Ann Romney has said her flare-up this year might be related to stress. Does the scientific evidence support that link?

Markel: While stress can certainly exacerbate many health problems, there is no clear linkage between stress and worsening symptoms of M.S. The M.S. patient should live their life as normally as possible and engage in life’s challenges and pleasures as fully as anyone else. That said, it is always a good idea to remove stress from anyone’s life. Some researchers have noted in a study of a small group of patients that when stress management is introduced to an M.S. patient’s life for six or more months, some patients may experience fewer brain lesions and a slower progression of their disease based on MRI evidence.

NewsHour: Have we seen this disease in other U.S. first families?

Markel: Michelle Obama’s father suffered from M.S. and lived with the disease for 30 years before dying at the age of 66.

NewsHour: Could it have an impact on her husband’s term in office, if he were elected — from a policy or personal standpoint?

Markel: First of all, every human being either has or will have a serious illness sometime during their lives. It is a sad fact of life. And, of course, illness in a family member affects their loved ones, both at home and at work in many different and unpredictable ways.

But most people do rise to this challenge and manage both their work and their family member’s illness rather well. I suspect Mr. Romney will be among those people. The best part of this issue is an opportunity for all Americans to learn about M.S., its challenges and the many medical advances that are being made everyday. Today, people live full and happy lives despite a number of illnesses that once forced their predecessors to remove themselves from the mainstream of life. M.S. is one of those diseases. People live with it, confront it head-on, and often win the battle, no matter what the ultimate outcome may be.

Photo by Photo by Win McNamee/Getty Images.

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