I spoke to doctors and people close to Trump this week. We're right to worry about his health

Dr James Merikangas, a board-certified neurologist and clinical professor of neuropsychiatry, said he immediately noticed problems with Trump’s movements when he saw the video of the president descending a ramp

Just before 11pm on Saturday, June 13, the President of the United States (or a staffer with access to his Twitter account) thought it necessary to explain to his 82,100,000 followers why he had appeared to have trouble descending a metal ramp earlier that day.

Over the course of that evening, a video clip of Donald Trump’s appearance at the US Military Academy’s commencement ceremony had been trending on Twitter with the hashtag #TrumpIsNotWell. It depicted him taking small, hesitant, unsteady-seeming steps as he walked down a ramp next to Lieutenant General Darryl Williams, the academy’s superintendent.

In Trump’s rendering of events, the halting, tentative gait captured on video was a reaction to a ramp that was “very long [and] steep” (it wasn’t), “had no handrail” (true), “and, most importantly, was very slippery” (the weather in West Point, New York was sunny and dry). He also claimed to have “ran down to level ground” over the “final ten feet” of the ramp, though the video shows him taking just several normal steps as he transitions to level ground.

But if the president thought his explanation of events would put an end to the matter, he thought wrong. Instead, the video — and the #TrumpIsNotWell hashtag — have continued to trend on social media, and the health of the oldest first-term president in American history continues to be an unresolved issue as he runs for reelection.

Trump’s physical condition has been a subject for speculation since he announced his quest for the GOP nomination in 2016, and that speculation has been fed by a series of hyperbolic, often nonsensical pronouncements by his own doctors.

While most presidential candidates release medical records or detailed statements from physicians, Trump’s only concession to this tradition was a one-page statement from his then-physician, New York-based gastroenterologist Dr Harold Bornstein, who later admitted that his note was dictated by Trump himself.

In it, he “state[d] unequivocally” that Trump would be “the healthiest individual ever elected to the presidency,” and claimed that Trump’s “medical examination showed only positive results” (which are generally not a good thing in medical parlance).

Trump was able to make the perception of his own stamina into an advantage for his campaign as he spread unfounded conspiracy theories about the condition of his then-opponent, ex-Secretary of State Hillary Clinton.

But it is his own health that has become an issue since he assumed the presidency. And the June 13 video is just the latest in a number of incidents that have raised questions about whether the president is doing OK.

Dr James Merikangas, a board-certified neurologist and clinical professor of neuropsychiatry at George Washington University School of Medicine, said he immediately noticed problems with Trump’s movements when he saw the video.

“My reaction to that was that he's got a problem with his balance and with his posture,” said Merikangas, who added that he has long noticed issues with how Trump carries himself during public appearances.

“You’ll notice that when the president sits in his chair, for instance, he doesn't lean back against the chair — he always is sort of crouching, leaning forward. With his legs spread apart, this abnormal posture is something you see in people who've got a neurologic problem, though I can't say specifically which,” Merikangas continued. “And his problem with balance with his gait is also something that happens with people who have some sort of degenerative brain problem usually in the frontal lobes of the brain… it certainly is suspicious, the way he was walking.”

While Merikangas declined to offer a specific diagnosis because doing so would require a physical examination and testing, he said that if Trump were a friend, family member or colleague, he would advise him to see a doctor and get an MRI or PET scan.

“Knowing a lot of neurologists and psychiatrists in my practice, I've had some of them who are perhaps a little older, come up to me and say, ‘Hey, Jim, if you start to notice, in me, signs of something, please let me know because I don't want to be out there treating patients if I'm impaired’,” he said.

The June 13 video was just the latest in a multitude of appearances during which Trump’s presentation has raised questions. On multiple occasions he has slurred his words, appeared sedated, or both, in addition to his frequent loud sniffing during public appearances, and occasions in which he has appeared to forget words or confuse one word for a similar-sounding one (e.g. “oranges” for “origins”). And to the extent the physicians who have been responsible for his care since he assumed the presidency have tried to put it to rest, their efforts have often done more harm than good to the president’s cause — and in some cases, their own reputations.

A number of Trump White House veterans generally regard a January 2018 marathon briefing on the results of Trump’s annual physical by then-Physician to the President Dr Ronny Jackson as an unmitigated disaster. Jackson, then a Rear Admiral in the Navy, was a well-regarded doctor who had also treated former President Barack Obama and his family. He said during that briefing that Trump had “a very strong and a very probable possibility of making it completely through his presidency with no serious medical issues” on account of his “incredible genes,” despite at least one test result that, according to outside experts, showed Trump to have heart disease.

The president attempted to reward Jackson — who is now running for a Texas House seat as a Republican — with a nomination to be Secretary of Veterans Affairs, though the attempt failed amid questions about his prescribing practices and temperament. His successor, Dr Sean Conley, has gotten into hot water over the president’s alleged use of hydroxychloroquine as a prophylactic against Covid-19 infection (despite no evidence that the drug, which recently lost FDA Emergency Use Authorization as a coronavirus treatment, was effective as a preventative or treatment), and over his explanation for Trump’s unscheduled visit to Walter Reed National Military Medical Center in November 2019.

Conley, an officer in the Navy’s medical corps who holds the rank of commander, said at the time that Trump had traveled to the Bethesda, Maryland location on a lark in order to get a head start on his 2020 physical. While the White House has repeatedly denied that the trip was made for an emergency of any sort, administration officials have yet to explain why the trip was on such short notice with no notification to the local law enforcement agencies which would normally clear a safe path for the president; why the president traveled by motorcade rather than by helicopter; or why Conley traveled with the president instead of meeting him at Walter Reed.

Merikangas, a former naval officer himself, noted that Conley is comparatively low-ranked compared to his predecessors, who have usually held an O-6 (Navy captain, Army/Marine Corps/Air Force colonel) rank or higher (admiral or general). He posited that Conley’s low rank makes him more vulnerable to pressure from his patient, who as commander-in-chief, could, in theory, order Conley to lie about his health.

But Dr William Lang, a former White House Medical Unit director and ex-Deputy Physician to Presidents Clinton and George W Bush, said Conley was the most senior physician serving under Jackson, making him the person who was most qualified to take over when Jackson stepped aside during his brief stint as a cabinet nominee.

Lang said he was always told to tell the truth when speaking about the president’s health because “bad news doesn’t get better with age”: “The teaching that we had the from high levels, and the practice that we had was always that there's nothing to be gained [from lying] so you just tell the truth, because the truth is gonna come out anyway.”

He added that in his experience, “there is nothing that is going to compel a presidential physician to lie, and there’s nothing that a military officer is going to lie about … because … something is going to come out if there is more to it”.

But Anthony Scaramucci, the ex-White House communications director who has known Trump for years, said the only way Conley could remain his position would be by doing whatever the president and his staff want him to do and saying what they want him to say.

“There’s no question” that Conley would be fired if he pushed back on any such requests, he said, though he also posited that the White House communications staff would massage language to make a false statement true enough for him to not be lying outright.

Rick Wilson, the ex-GOP consultant who is one of the former Republicans behind The Lincoln Project anti-Trump Super PAC, also said the only way Conley has lasted in his role is by going along with things.

“They clearly look for somebody who is going to be compliant… The obvious centerpiece of what they want is somebody who's going to be on their team and not going to make waves or cause trouble,” said Wilson.

But University of Virginia Center for Politics director Larry Sabato suggested that it doesn’t matter whether Conley or others lie because no one will believe anyone associated with Trump anyway.

“The credibility gap existing with Donald Trump is as large as the one Lyndon Johnson suffered on Vietnam, which is saying something. After a while you just don't believe anything he says,” said Sabato, who added that one has a better chance of grasping the truth by rejecting everything Trump or his advisers say because so much of it is inaccurate.

But regardless of whether voters believe Trump or not, Wilson predicted that there would eventually be a full accounting of the 45^th president’s health issues.

“I predict when all this is over, we're going to find out that there have been some health scares and some medical issues that will pop our f**king eyes out,” he said.