Medical experts: Biden needs to be evaluated for Parkinson’s

Sanjay Gupta just published a version of an article I’ve shopping around for the last 36 hours, except he doesn’t quote or cite any sources.

For reasons I elaborate on below, I think Gupta’s conclusion is pretty much unassailable, although if you think this is all just a giant conspiracy to drive Joe Biden out of the race you’ll no doubt disagree.

And if you think the only problem with Joe Biden is that he’s old, he isn’t “old” in the same sense that say Nancy Pelosi and Bernie Sanders and Chuck Schumer are old, unless you think stories like this, and this, and this are part of the media conspiracy to get rid of Joe Biden.

Another thing I don’t think is really contestable at this point is that if you want Joe Biden to stay in the race, he needs a genuine clean bill of neurological health, after being examined by appropriate medical experts. This is something that has not happened to this point, because the White House insists on clinging to the preposterous claim that Biden isn’t displaying any symptoms of potential parkinsonism.

As to why the same demands aren’t being made of Donald Trump, the answer is because the Republicans simply don’t care, and the Democrats do, because the Democrats aren’t in the grip of a cult of personality.

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One possible explanation for President Biden’s disastrous debate performance last week that many people are trying hard to ignore is that the president has a degenerative neurological disease.

Since then, I’ve spoken to several medical experts who believe the odds are high that Biden is suffering from some form of parkinsonism: the cluster of degenerative neurological conditions of which Parkinson’s disease is the best-known. None of these experts are, of course, purporting to make a formal diagnosis.  What they are insisting on is that it’s deeply irresponsible not to give Biden the sort of medical examination that would be given to any ordinary 81-year-old who had the evident symptoms he is displaying.

According to these experts, Biden has been exhibiting various classic symptoms of Parkinson’s, including a slowed walk, slight lurching inertia when starting a step or turn, flat face (hypomimia), a staring look with diminished blinking, and a low raspy voice (hypophonia), all occurring together.  “The pathologic elements seem fully aligned,” one doctor who has treated many Parkinson’s cases told me.

I spoke with two eminent medical academics, who are nationally-known experts on the subject of Parkinson’s and other movement disorders, and whose work on this subject has been cited thousands of times in the medical literature.

Both these doctors are chaired professors of Neurology at a top medical school.  In separate interviews, I asked each of them to comment on Biden’s White House physician Kevin C. O’Connor claim that Biden shows no signs of Parkinson’s, and therefore does not need to be tested for the disease.  O’Connor’s public report on Biden’s health back in February made this claim, and, according to the White House, nothing that has happened since, including Biden’s debate performance, has changed O’Connor’s view.  O’Connor is an osteopath, whose specialty is combat medicine.  He appears to have no specialized training in neurology, let alone movement disorders such as Parkinson’s.

Kelvin Chou, who holds a chair in Neurology at the University of Michigan Medical School, told me that he has concerns about the neurologic condition of both major candidates, and that “for President Biden, I think Parkinson’s disease would be the top concern given the clips I have seen. Based on chats with my neurologist and movement disorders colleagues, they all agree as well,” he added. (My emphasis).

As to the White House’s claim that there’s no need to evaluate President Biden for Parkinson’s, Dr. Chou explained that “the diagnosis of parkinsonism or Parkinson’s disease is made clinically, based on a detailed history and comprehensive neurological examination. Neurologists, who specialize in brain conditions, and movement disorders specialists, who specialize in Parkinson’s disease, are much more likely to be able to recognize signs and make a diagnosis than a general physician.”

In regard to O’Connor’s claim that Biden has exhibited no symptoms of Parkinson’s, another chaired professor of Neurology told me that “a full neurological exam by a neurologist, and ideally an expert in movement disorders, very well could reach a different conclusion.”

President Biden, this professor explained, “has displayed bradykinesia for a while.”  Bradykinesia is a slowness of movement which is one of the cardinal symptoms of Parkinson’s.  “Last week’s debate,” he added, “indicated a few other features of parkinsonism.”  Then this doctor – one of the world’s leading experts on movement disorders such as Parkinson’s – made a startling statement.  “With the caveat that I only would do so after performing a neurological examination, I would offer [President Biden] a trial of standard dopamine replenishment therapy (levodopa/carbidopa), and likely perform a DAT scan to assess if the dopamine innervation of the brain has been reduced.”  (A DAT scan is an imaging technique that uses a radioactive drug to evaluate the brain’s dopamine system, which is what Parkinson’s disrupts).

This Parkinson’s expert, in other words, seemed so certain that Biden suffers from parkinsonism of some type that he would, after a neurological examination, prescribe a course of drugs designed to treat the disease, to see if this would ameliorate those symptoms.

To emphasize how confident he was in his judgment, he added that he “would imagine every movement disorders doctor would [after evaluating Biden] conclude parkinsonism [was the correct diagnosis] very quickly.”  (My emphasis.  He did caution that “it is not possible to make a fully accurate diagnosis over the tv/computer screen.”)

I discussed the White House’s claims with another physician, who has treated hundreds of Parkinson’s cases, and who is also a medical malpractice attorney.  She told me that, if a general practitioner encountered a patient with Biden’s symptoms, and then failed to refer that patient to a neurologist for evaluation of possible Parkinson’s, that doctor would be guilty of malpractice.  The White House has admitted that Biden has not been evaluated by a doctor subsequent to the February checkup: this physician points out that, at Biden’s age, and in the presence of active symptoms,  “four months is an eternity, medically speaking.”

All this raises a disturbing possibility: if, as these Parkinson’s specialists aver, any 81-year-old patient who presented with Biden’s symptoms ought to be evaluated for Parkinson’s, the White House’s flat-out refusal to do so would seem to be a product of pure political calculation, rather than providing the standard of care that would be expected of a competent medical practitioner.

A further complication is that unmedicated Parkinson’s advances very quickly at Biden’s age.  If he were on the appropriate drugs, as he probably would have been months ago if he weren’t running for president, the course of the disease could have been slowed drastically or even stabilized, and his symptoms could have been seriously ameliorated. 

As things stand, Biden is at serious risk for worsening between now and November, as the stress and exhaustion of campaigning themselves increase the frequency of “bad days,” that will not be able to be explained away as the election nears.

The grim fact is that the politics of the situation may be literally killing the president.

And ironically, the White House’s calculations may well be as misguided politically as failing to have President Biden examined for parkinsonism is misguided medically.   At this point, it would be a tragic mistake for the Democratic party to nominate Joe Biden, without at least first determining whether the president does or does not suffer from a degenerative neurological disease.

If Joe Biden has Parkinson’s, then early intervention will be critical to extending both the length and the quality of his life.  And, if he is suffering from a disease that currently afflicts approximately one million Americans, Democratic party delegates need to know that before they choose the party’s presidential nominee next month.

At this point, failing to have President Biden evaluated by experts who can determine whether he has Parkinson’s would be both medical and political malpractice.

The thesis of this article is extremely modest.  It is that, under the circumstances, it’s imperative that Joe Biden be evaluated by experts in parkinsonism.  I have to this point encountered remarkable resistance to this idea among journalists.  One editor said that he would consider publishing this piece if I could produce a letter signed by hundreds of prominent neurologists, demanding that President Biden be tested.  This is a truly perverse framing of the evidentiary question.

I would, by contrast, challenge those who resist the article’s thesis to produce one prominent neurologist who, having observed President Biden’s public appearances in the last few months, including last week’s debate, will go on the record with a statement to the effect that he or she doesn’t believe any expert evaluation of the president’s condition is warranted.  And I would ask them as well: if this were your husband, or your father, or your friend, would you want him to be evaluated properly, so that he could get the treatment he might so desperately need?