Speculating on world leaders’ health is highly questionable

Attempts to diagnose Putin and other world leaders from a distance are of doubtful accuracy and value 

The despicable actions by Vladimir Putin in invading Ukraine have shocked the world. The systematic destruction of cities like Mariupol and the targeting of civilians is truly reprehensible. 

There is no doubt in the mind of this writer that Putin’s actions are those of a truly bad rather than a mad or sick person. 

To my surprise, there has been some speculation in the media that Putin’s actions are the result of health issues. A US ex-military intelligence officer has been quoted as saying that facial changes seen in recent photographs – “a puffy face” – are a sign the Russian President has been taking steroids or chemotherapy drugs. And Fiona Hill, a senior Fellow in the Centre on the United States and Europe in the Foreign Policy programme at Brookings, was quoted by Politico: “Putin’s not looking so great, he’s been rather puffy-faced. We know that he has complained about having back issues. Even if it’s not something worse than that, it could be that he’s taking high doses of steroids, or there may be something else. There seems to be an urgency for this (invasion) that may be also driven by personal factors.” 

A striking behavioural change by the Russian leader has led to suggestions that his immune system is compromised. TV images of his meetings show an almost comically long table, with Putin at one end and French President Emmanuel Macron at hailing distance many feet away. Putin’s own foreign minister Sergei Lavrov was also seated at the other end. 

The speculation is that Putin engages in such extreme social distancing because he sees himself as being especially prone to coronavirus infection. For the armchair medics, it was an easy extrapolation to say that this is because he is taking a high dose of immunosuppressant drugs. 

Speculation about the health of world leaders is nothing new, of course. Many have hidden serious maladies while in power. Which may explain, but not excuse, the rush to diagnose Putin at a distance. There has been speculation about his health over the years, with researchers in 2015 claiming they identified signs in Putin’s gait, which could point to Parkinson’s disease. In a British Medical Journal paper, they pointed out how the Russian leader had a tendency to keep one arm pinned to his side. 

“Our observations raised a debate among us whether President Putin might possibly be in an early stage of Parkinson’s disease, even in the absence of other obviously suggestive features”, the movement disorders experts said. 

Perhaps the biggest surprise as I researched this column was to discover (via an article in Medscape) that, for decades, US military and intelligence agencies have recruited physicians in psychiatry, internal medicine, cardiology, neurology, epidemiology, and other specialties to evaluate foreign leaders. Their role is to help policy-makers understand them and predict what they’re likely to do. The highly classified work is carried out by the CIA’s Medical, Psychological, and Health Security Centre (MPHSC). 

For physicians working in the MPHSC, much of their job is about understanding the human factor in foreign policy. US leaders want to know if a foreign leader is impaired physically or mentally, perhaps leaving others to make major decisions. 

The daily briefing for the US President often includes intelligence assessments about the health of foreign leaders, according to Nicholas Dujmovic, director of intelligence studies at the Catholic University of America in Washington, who edited President Bill Clinton’s daily brief. 

But even if a doctor has the opportunity to do an in-person observation, the lack of a personal exam and medical records means these medical and psychiatric assessments are of questionable accuracy and value. There are also ethical issues. The American Psychiatric Association (APA) considers it unethical for psychiatrists to diagnose people without personally examining them and obtaining their consent, though it makes an exception for psychiatrists working with US intelligence agencies. 

Thankfully, the piece on the bizarre CIA centre concluded by saying: “A lot of physicians consider it bad medicine to make inferences or diagnoses about people without seeing the patient.” 

According to Machiavelli, it is “a very wise thing to simulate madness”. Simulating madness may be part of Putin’s KGB playbook. But for any of us to claim that he is clinically mad (or indeed have any illness) is a step well beyond the boundaries of medical practice. 

On an absolutely separate note, I would like to record the passing of one of Ireland’s most engaging GPs. Dr Henry Jack was an ‘old school’ doctor. I loved meeting him at the ICGP and RCGP gatherings, which he attended into his 90s. A few years back, after I had written a column on the importance of patient stories, he sent me a nice note, with the following postscript: “I tended to listen to patients!” What a lovely man.