Leading neurosurgeon calls on Biden to undergo testing and release results

Fallout from Joe Biden’s disastrous debate performance last week continues to draw calls for health exams and clinical testing for the US president, and speculation .

High-profile neurosurgeon Dr Sanjay Gupta called on Biden Friday to undergo neurological testing and release the results to the public, saying he and other brain specialists believe a detailed cognitive exam is warranted.

“From a neurological standpoint, we were concerned with his confused rambling; sudden loss of concentration in the middle of a sentence; halting speech and absence of facial animation, resulting at times in a flat, open-mouthed expression,” Gupta wrote for CNN .

Gupta qualified that his suggestion was based on “only observations, not in any way diagnostic of something deeper”. He continued that “the president should be encouraged to undergo detailed cognitive and movement disorder testing, and those results should be made available to the public”.

Gupta’s article followed a recent New York Times story, based largely on anonymous sources, that people in contact with Biden reportedly had recently noticed the president making more factual errors and losing concentration.

The same story raised the specter of Parkinson’s disease, although publicly available medical records show no evidence that the president has the disease. Parkinson’s is a neurodegenerative disease associated with a stiff gait, changes in motor skills and lack of facial expression. Some people also experience cognitive decline.

The president’s primary care physician, Dr Kevin C O’Connor, told the New York Times that he observed “no findings which would be consistent with” Parkinson’s disease in his most recent physical of the president.

The president’s most recent physician’s examination, from February , attributed his stiff gait to a healed foot fracture and peripheral neuropathy. Peripheral neuropathy is nerve damage that, in the president, resulted in a deficit in sensing hot and cold in his feet. O’Connor reported the president “continues to be fit for duty” with “no new concerns”.

Biden’s age, 81, has been a locus of concern for voters. Those concerns were piqued by a debate performance that was widely considered jumbled and disjointed. Trump is only three years Biden’s junior, at 78.

Notably, voters don’t particularly like either candidate. In a survey released by the Wall Street Journal two days after the debate, about half of voters said they were not enthusiastic about either candidate on the ticket and would like to replace them both.

Biden and his team have defended his debate performance and batted back calls to step aside by saying the president had a cold and was tired after international travel. Biden told Democratic governors that he needed to listen to his team’s warnings about his schedule, and get more sleep.

Gupta’s warning also draws on a tension in medicine that has been especially animated in the last two presidential administrations: between professionals’ “duty to warn” Americans about the fitness of their leaders and the potentially high degree of error inherent in “armchair” medicine.

During the Trump administration, a group of psychiatrists authored a book warning that the former president could be perhaps dangerously mad and a narcissist. The warning prompted the American Psychological Association to reiterate its commitment to the “ Goldwater rule ” against “armchair psychiatry”.

Cardiologists also questioned whether the former president was at risk of a heart attack because of high cholesterol levels reported by the White House physician, Dr Ronny L Jackson. At that time, Jackson reported the former president was in “excellent” cardiac health.

Amid pronounced concerns about Biden’s age, Trump’s rally speeches have been criticized as rambling, bizarre, incoherent and fascistic. For instance, Trump once described Israel’s Iron Dome missile defense system as: “Ding, ding, ding, ding, ding, ding. They’ve only got 17 seconds to figure this whole thing out. Boom. OK. Missile launch. Whoosh. Boom.” Trump, like Biden, has lapsed when trying to recall specific facts.