What STAT readers think about octogenarian presidents

STAT now publishes selected Letters to the Editor received in response to First Opinion essays to encourage robust, good-faith discussion about difficult issues. Submit a Letter to the Editor here, or find the submission form at the end of any First Opinion essay.

“I’ve reported on the health of every president since Reagan. Here’s what I think about Trump and Biden,” by Lawrence K. Altman

As a semi-retired physician, I appreciated the nuance in Dr. Altman’s essay. During my 40+ years in clinical practice I observed that people age in dramatically different ways. I had patients who were “old” in their 60s, both physically frail and mentally slow. I also had patients in their 80s and even 90s who were sharp as a tack and physically fit. With rare exceptions, all 40-year-olds are alike; after 60, the divergence was striking. When you have seen one 85-year-old, you have seen one 85-year-old. I worry less about whether President Biden mixes up a name than I do about former President Trump’s lack of restraint and judgment.
— Edward Hoffer, associate professor of medicine, part-time, Harvard

***

The issue, I think, is not the presence or absence of disease but rather the normal slowing of cognition and physical stamina that comes with age. I am 77 and very functional, but I do notice in myself, and others of my age, a certain decrement of function and, in many people, an unwillingness to learn. The world today is not the same world I grew up in or even the same world I retired from 15 years ago. Personally I think it now requires younger people with much more recent educational experiences. Do we need leaders who refuse to learn or unable to learn how to use a cellphone or do basic tasks on a computer? I don’t think so.
— Pam Kotler

***

I read this essay and found it enlightening. I am 86, and with the exception of forgetting people’s name, which has plagued me all my life, I feel quite certain that, unless I have a stroke, or fall down the stairs and land on my head, I may make it through my entire life without dementia. So, I would like very much to thank the author of this essay for mentioning that since 32% of those aged 85 and up have it, 68% do not. I live in an independent retirement home in Amherst, Massachusetts, where the mean age is 85. I find that most of the residents are not cognitively impaired. If they become so, and it’s rare, they are generally, with the consent of their families, moved to assisted living or a nursing home. I feel that, as hard as it is to get around (I have severe arthritis), it’s important to me to live independently. I think it diminishes people like me to be referred to as “too old,” but I know for sure I’d never want to take on the title of “leader of the free world.”
— Anne Stiles

“The health care system is ignoring world’s most promising approach to preventing cardiovascular disease,” by Arthur L. Kellermann

In his discussion of the evidence regarding the benefits of widespread administration of a polypill — which is, in his words, a radical departure from current practice — Dr. Kellerman makes the claim that, “It’s important to note that the dramatic decrease in heart attacks, strokes, and other serious outcomes the polypill achieved were in comparison to usual care, not a placebo.” One linked study, by Munoz et al., used usual care as a comparator. This study enrolled only 303 people and had narrow inclusion criteria. However, of the three much larger studies evaluated in the linked 2021 meta-analysis, two studies (TIPS-3 and HOPE-3) used a placebo comparator and one used “minimal care (blood pressure measurement and risk factor counseling).” I think it is important to clarify that only a subset of studies (and possibly only one) compared a polypill with usual care.
— Carrie Daymont, M.D., MSCE, Penn State College of Medicine

“How Medicare leaves Puerto Ricans behind,” by Mariela Torres Cintrón

The author fundamentally misunderstands the Inflation Reduction Act when she writes, “However, the program will include just 10 drugs to start with, leaving many others out of reach for financially strained populations like those in Puerto Rico. And frankly, the negotiated drug prices may still be prohibitively expensive given widespread poverty and lack of savings programs on the island.” The cap on out of pocket costs will apply regardless of the drug costs on the 10 or the other drugs. Puerto Ricans will spend the same $2,000 regardless of the cost of the drugs.
— Saira Sultan, Connect 4 Strategies