December 31, 2009

Sometimes it is interesting to play a game of what if. In our personal lives it is sometimes fun to speculate what would have happened to us if we had traveled down Robert Frost's road not taken.

In the case of FDR, who knows what may have transpired differently that would have effected not only we Americans, but the whole world.

But as the author Mr. Lerner says FDR was not the only president to keep quiet, but certainly his silence, or his doctors could have had disastrous repercussions. Water over the bridge so they say, but certainly interesting history.

Roosevelt's Last Days
Did cancer kill FDR?
By Barron H. Lerner
Posted Tuesday, Nov. 24, 2009, at 12:20 PM ET

President Franklin D. Roosevelt
Is it conceivable that Franklin D. Roosevelt's doctors knew he had widespread cancer in 1944 and still let him run for his fourth term as president? New research makes this astounding argument—and claims that the physician who supposedly told the truth about Roosevelt's death in 1970 was in fact continuing the deception he had helped create.

FDR may have died more than 60 years ago, but these questions still matter. Not only does presidential health—and the public's right to know about it—remain a controversial issue, but in Roosevelt's case, the lies in question, if true, changed history. As neurologist Steven Lomazow and journalist Eric Fettman point out in a book coming out this January, FDR's Deadly Secret, widespread knowledge of Roosevelt's cancer would have prevented him from running in 1944 and thus likely altered the shaping of postwar Europe.

Roosevelt was in the business of concealing his medical afflictions. After a bout with polio in 1921, he never regained the use of his legs and used braces and a wheelchair, but he asked not to be photographed in ways that would reveal his disabilities.

Beginning in early 1944, the fact that Roosevelt had severely elevated blood pressure and congestive heart failure was also kept secret. These diagnoses were made by Howard G. Bruenn, a Columbia University cardiologist and Navy physician who became Roosevelt's primary doctor. When Roosevelt died of a brain hemorrhage on April 12, 1945, early in his fourth term, Bruenn misleadingly analogized the bleed to a "bolt of lightning." Of course, he knew better: Very high blood pressure can cause bleeding in the brain.

It was not until 1970 that Bruenn came clean—or at least seemed to. In an article in the Annals of Internal Medicine, he described his heretofore secret efforts to treat Roosevelt's blood pressure and heart problems. The article became the definitive account of FDR's passing. However, according to Lomazow and Fettman, it was just another attempt to obscure the truth.

Over the years, other rumors about Roosevelt's health circulated, including the claim that he had suffered strokes. Most interesting was a 1979 paper in Surgery, Gynecology and Obstetrics by a surgeon and amateur historian, Harry Goldsmith, who noted that an enlarging skin lesion above Roosevelt's left eye disappeared in photographs after 1940. He theorized that the lesion was a melanoma, the deadliest of skin cancers, and that the disease had spread to Roosevelt's abdomen, causing him episodes of severe pain during the last months of his life.

Goldsmith's article received national attention, and he eventually self-published a book on Roosevelt's medical condition. But Lomazow and Fettman have greatly expanded Goldsmith's research. What they believe is that the melanoma spread not only to Roosevelt's abdomen but to his brain. The bleed that killed the president, they hypothesize, was due to the cancer, not the hypertension.

The most provocative evidence the authors present is that Roosevelt had a left-sided hemianopsia—a loss in vision—toward the end of his life. This indicated a mass in the right side of his brain. Lomazow and Fettman arrive at this conclusion based on an ingenious bit of research. On March 1, 1945, Roosevelt had given a speech to Congress, reporting on his recent trip to Yalta to meet with British Prime Minister Winston Churchill and Soviet leader Joseph Stalin. During the speech, Roosevelt appeared confused: He skipped words in his prepared remarks, ad-libbed, and repeated several points. Critics later seized on this speech as evidence that the president was deteriorating mentally.

Lomazow and Fettman obtained both a video of Roosevelt giving the speech and the text he used. Comparing the two, they concluded that the president could not see the left side of the page. His seeming mistakes and confusion reflected his attempts to compensate. The authors also found evidence of similar behavior by FDR when he had read another speech for newsreel cameras. There are also several other reasons to suspect that Roosevelt had cancer: He appears to have made secret visits to at least two cancer specialists for evaluation of melanoma, possible prostate cancer, or both. He also lost more than 30 pounds during his last year of life. Although Bruenn suggested that the weight loss stemmed from dieting, Lomazow and Fettman believe that cancer—leading to abdominal pain and loss of appetite—makes more sense.
How plausible is this research? If Roosevelt indeed had a hemianopsia, it suggests a brain mass, and melanoma would be as likely a cause as any. Brain metastases from melanoma are known to bleed. Melanoma could also explain the abdominal pains and weight loss.

But all of these symptoms have other possible explanations, and there was never an actual tissue diagnosis of melanoma (though Lomazow and Fettman would argue that such a finding would necessarily have been concealed). It is also possible that Bruenn, a cardiologist, really did not entertain the notion that the eye lesion—if a melanoma—was wreaking havoc elsewhere in the president's body. Bruenn would not have been the first specialist to focus exclusively on the parts of the body that he knew best. Perhaps most important, there is no smoking gun: In all of the documents Lomazow and Fettman unearthed, neither Bruenn nor FDR's other doctors ever used the word cancer.

Still, Lomazow and Fettman's research is of great importance. It is the latest to demonstrate the conflicts of interest that presidential physicians encounter as they serve both their patients and the public: Woodrow Wilson's physician concealed his patient's debilitating stroke, and John F. Kennedy's doctor did not disclose a diagnosis of adrenal failure. Although it is now much more difficult to cover up presidential illnesses, some critics claim that Ronald Reagan's physicians concealed mental deterioration at the end of his second term. Others say candidate John McCain was not forthcoming enough during the 2008 campaign about his own battle with melanoma.

If Lomazow and Fettman are right, Republican Thomas E. Dewey or a different Democrat should have been elected president in 1944. In that case, Harry S. Truman, FDR's vice president, would almost certainly not have been commander-in-chief from 1945 to 1952. The Cold War and subsequent American history might have taken a very different path.

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