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Mental Health

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Health video.

Nightly News

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Stronger marijuana linked to more psychosis in teens

Seven women sue Tennessee after being denied medical exemption under state's abortion ban

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Containers being moved from ship to access fallen Baltimore bridge’s roadway

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Pop Culture News

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Science News

The largest fresh egg producer in the u.s. has found bird flu in chickens at a texas plant.

Experts warn of Medicare premium hikes to cover Wegovy for heart risks

Bird flu confirmed in Texas worker who had contact with dairy cows

Senate investigating whether ER care has been harmed by growing role of private-equity firms

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Mental health care is hard to find, especially for people with Medicare or Medicaid

Rhitu Chatterjee

With rates of suicide and opioid deaths rising in the past decade and children's mental health declared a national emergency , the United States faces an unprecedented mental health crisis. But access to mental health care for a significant portion of Americans — including some of the most vulnerable populations — is extremely limited, according to a new government report released Wednesday.

The report, from the Department of Health and Human Services' Office of Inspector General, finds that Medicare and Medicaid have a dire shortage of mental health care providers.

The report looked at 20 counties with people on Medicaid, traditional Medicare and Medicare Advantage plans, which together serve more than 130 million enrollees — more than 40% of the U.S. population, says Meridith Seife , the deputy regional inspector general and the lead author of the report.

Medicaid serves people on low incomes, and Medicare is mainly for people 65 years or older and those who are younger with chronic disabilities.

The report found fewer than five active mental health care providers for every 1,000 enrollees. On average, Medicare Advantage has 4.7 providers per 1,000 enrollees, whereas traditional Medicare has 2.9 providers and Medicaid has 3.1 providers for the same number of enrollees. Some counties fare even worse, with not even a single provider for every 1,000 enrollees.

"When you have so few providers available to see this many enrollees, patients start running into significant problems finding care," says Seife.

The findings are especially troubling given the level of need for mental health care in this population, she says.

"On Medicare, you have 1 in 4 Medicare enrollees who are living with a mental illness," she says. "Yet less than half of those people are receiving treatment."

Among people on Medicaid, 1 in 3 have a mental illness, and 1 in 5 have a substance use disorder. "So the need is tremendous."

The results are "scary" but "not very surprising," says Deborah Steinberg , senior health policy attorney at the nonprofit Legal Action Center. "We know that people in Medicare and Medicaid are often underserved populations, and this is especially true for mental health and substance use disorder care."

Among those individuals able to find and connect with a provider, many see their provider several times a year, according to the report. And many have to drive a long way for their appointments.

"We have roughly 1 in 4 patients that had to travel more than an hour to their appointments, and 1 in 10 had to travel more than an hour and a half each way," notes Seife. Some patients traveled two hours each way for mental health care, she says.

Mental illnesses and substance use disorders are chronic conditions that people need ongoing care for, says Steinberg. "And when they have to travel an hour, more than an hour, for an appointment throughout the year, that becomes unreasonable. It becomes untenable."

"We know that behavioral health workforce shortages are widespread," says Heather Saunders , a senior research manager on the Medicaid team at KFF, the health policy research organization. "This is across all payers, all populations, with about half of the U.S. population living in a workforce shortage."

But as the report found, that's not the whole story for Medicare and Medicaid. Only about a third of mental health care providers in the counties studied see Medicare and Medicaid patients. That means a majority of the workforce doesn't participate in these programs.

This has been well documented in Medicaid, notes Saunders. "Only a fraction" of providers in provider directories see Medicaid patients, she says. "And when they do see Medicaid patients, they often only see a few."

Lower reimbursement rates and a high administrative burden prevent more providers from participating in Medicaid and Medicare, the report notes.

"In the Medicare program, they set a physician fee rate," explains Steinberg. "Then for certain providers, which includes clinical social workers, mental health counselors and marriage and family therapists, they get reimbursed at 75% of that rate."

Medicaid reimbursements for psychiatric services are even lower when compared with Medicare , says Ellen Weber , senior vice president for health initiatives at the Legal Action Center.

"They're baking in those discriminatory standards when they are setting those rates," says Steinberg.

The new report recommends that the Centers for Medicare & Medicaid Services (CMS) take steps to increase payments to providers and lower administrative requirements. In a statement, CMS said it has responded to those recommendations within the report.

According to research by Saunders and her colleagues at KFF, many states have already started to take action on these fronts to improve participation in Medicaid.

Several have upped their payments to mental health providers. "But the scale of those increases ranged widely across states," says Saunders, "with some states limiting the increase to one provider type or one type of service, but other states having rate increases that were more across the board."

Some states have also tried to simplify and streamline paperwork, she adds. "Making it less complex, making it easier to understand," says Saunders.

But it's too soon to know whether those efforts have made a significant impact on improving access to providers.

CMS has also taken steps to address provider shortages, says Steinberg.

"CMS has tried to increase some of the reimbursement rates without actually fixing that structural problem," says Steinberg. "Trying to add a little bit here and there, but it's not enough, especially when they're only adding a percent to the total rate. It's a really small increase."

The agency has also started covering treatments and providers it didn't use to cover before.

"In 2020, Medicare started covering opioid treatment programs, which is where a lot of folks can go to get medications for their substance use disorder," says Steinberg.

And starting this year, Medicare also covers "mental health counselors, which includes addiction counselors, as well as marriage and family therapists," she adds.

While noteworthy and important, a lot more needs to be done, says Steinberg. "For example, in the substance use disorder space, a lot of addiction counselors do not have a master's degree. And that's one of their requirements to be a counselor in the Medicare program right now."

Removing those stringent requirements and adding other kinds of providers, like peer support specialists, is key to improving access. And the cost of not accessing care is high, she adds.

"Over the past two decades, [in] the older adult population, the number of overdose deaths has increased fourfold — quadrupled," says Steinberg. "So this is affecting people. It is causing deaths. It is causing people to go to the hospital. It increases [health care] costs."

• Centers for Medicare & Medicaid Services
• mental health

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Good Sleep for Good Health

Get the Rest You Need

Sometimes, the pace of modern life barely gives you time to stop and rest. It can make getting a good night’s sleep on a regular basis seem like a dream.

But sleep is as important for good health as diet and exercise. Good sleep improves your brain performance, mood, and health.

Not getting enough quality sleep regularly raises the risk of many diseases and disorders. These range from heart disease and stroke to obesity and dementia.

There’s more to good sleep than just the hours spent in bed, says Dr. Marishka Brown, a sleep expert at NIH. “Healthy sleep encompasses three major things,” she explains. “One is how much sleep you get. Another is sleep quality—that you get uninterrupted and refreshing sleep. The last is a consistent sleep schedule.”

People who work the night shift or irregular schedules may find getting quality sleep extra challenging. And times of great stress—like the current pandemic—can disrupt our normal sleep routines. But there are many things you can do to improve your sleep.

Sleep for Repair

Why do we need to sleep? People often think that sleep is just “down time,” when a tired brain gets to rest, says Dr. Maiken Nedergaard, who studies sleep at the University of Rochester.

“But that’s wrong,” she says. While you sleep, your brain is working. For example, sleep helps prepare your brain to learn, remember, and create.

Nedergaard and her colleagues discovered that the brain has a drainage system that removes toxins during sleep.

“When we sleep, the brain totally changes function,” she explains. “It becomes almost like a kidney, removing waste from the system.”

Her team found in mice that the drainage system removes some of the proteins linked with Alzheimer’s disease. These toxins were removed twice as fast from the brain during sleep.

Everything from blood vessels to the immune system The system that protects your body from invading viruses, bacteria, and other microscopic threats. uses sleep as a time for repair, says Dr. Kenneth Wright, Jr., a sleep researcher at the University of Colorado.

“There are certain repair processes that occur in the body mostly, or most effectively, during sleep,” he explains. “If you don’t get enough sleep, those processes are going to be disturbed.”

Sleep Myths and Truths

How much sleep you need changes with age. Experts recommend school-age children get at least nine hours a night and teens get between eight and 10. Most adults need at least seven hours or more of sleep each night.

There are many misunderstandings about sleep. One is that adults need less sleep as they get older. This isn’t true. Older adults still need the same amount. But sleep quality can get worse as you age. Older adults are also more likely to take medications that interfere with sleep.

Another sleep myth is that you can “catch up” on your days off. Researchers are finding that this largely isn’t the case.

“If you have one bad night’s sleep and take a nap, or sleep longer the next night, that can benefit you,” says Wright. “But if you have a week’s worth of getting too little sleep, the weekend isn’t sufficient for you to catch up. That’s not a healthy behavior.”

In a recent study, Wright and his team looked at people with consistently deficient sleep. They compared them to sleep-deprived people who got to sleep in on the weekend.

Both groups of people gained weight with lack of sleep. Their bodies’ ability to control blood sugar levels also got worse. The weekend catch-up sleep didn’t help.

On the flip side, more sleep isn’t always better, says Brown. For adults, “if you’re sleeping more than nine hours a night and you still don’t feel refreshed, there may be some underlying medical issue,” she explains.

Sleep Disorders

Some people have conditions that prevent them from getting enough quality sleep, no matter how hard they try. These problems are called sleep disorders.

The most common sleep disorder is insomnia. “Insomnia is when you have repeated difficulty getting to sleep and/or staying asleep,” says Brown. This happens despite having the time to sleep and a proper sleep environment. It can make you feel tired or unrested during the day.

Insomnia can be short-term, where people struggle to sleep for a few weeks or months. “Quite a few more people have been experiencing this during the pandemic,” Brown says. Long-term insomnia lasts for three months or longer.

Sleep apnea is another common sleep disorder. In sleep apnea, the upper airway becomes blocked during sleep. This reduces or stops airflow, which wakes people up during the night. The condition can be dangerous. If untreated, it may lead to other health problems.

If you regularly have problems sleeping, talk with your health care provider. They may have you keep a sleep diary to track your sleep for several weeks. They can also run tests, including sleep studies. These look for sleep disorders.

Getting Better Sleep

If you’re having trouble sleeping, hearing how important it is may be frustrating. But simple things can improve your odds of a good night’s sleep. See the Wise Choices box for tips to sleep better every day.

Treatments are available for many common sleep disorders. Cognitive behavioral therapy can help many people with insomnia get better sleep. Medications can also help some people.

Many people with sleep apnea benefit from using a device called a CPAP machine. These machines keep the airway open so that you can breathe. Other treatments can include special mouthguards and lifestyle changes.

For everyone, “as best you can, try to make sleep a priority,” Brown says. “Sleep is not a throwaway thing—it’s a biological necessity.”

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5 dead and over 100 hospitalized from recalled Japanese health supplements

Akihiro Kobayashi, president of Kobayashi Pharmaceutical Co., arrives at a news conference in Osaka, western Japan, Friday, March 29, 2024. In the week since a line of Japanese health supplements began being recalled, several people have died and more than 100 people were hospitalized as of Friday. The Osaka-based pharmaceutical company came under fire for not going public quickly with problems known internally as early as January. The first public announcement came March 22. (Yohei Fukuyama/Kyodo News via AP)

Akihiro Kobayashi, president of Kobayashi Pharmaceutical Co., bows in apology at a news conference in Osaka, western Japan, Friday, March 29, 2024. In the week since a line of Japanese health supplements began being recalled, several people have died and more than 100 people were hospitalized as of Friday. The Osaka-based pharmaceutical company came under fire for not going public quickly with problems known internally as early as January. The first public announcement came March 22. (Kyodo News via AP)

A factory of Kobayashi Pharmaceutical Co., is seen in Osaka, Japan on March 26, 2024. Health supplement products believed to have caused a few deaths and sickened more than a hundred people have been ordered taken off store shelves in Japan. The products from Kobayashi Pharmaceutical, billed as helping lower cholesterol, contained an ingredient called “benikoji,” a red species of mold.(Keiji Uesho/Kyodo News via AP)

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TOKYO (AP) — Five people who took a Japanese health supplement have died and more than 100 have been hospitalized as of Friday, a week after a pharmaceutical company issued a recall of the products, officials said.

Osaka-based Kobayashi Pharmaceutical Co. came under fire for not going public quickly with problems known internally as early as January. The first public announcement came March 22.

Earlier in the week , the number of deaths stood at two people. Company officials updated the number of dead to five Friday, and said 114 people were being treated in hospitals after taking products — including Benikoji Choleste Help meant to lower cholesterol — that contain an ingredient called benikoji, a red species of mold.

Some people developed kidney problems after taking the supplements, but the exact cause was still under investigation in cooperation with government laboratories, according to the manufacturer.

“We apologize deeply,” President Akihiro Kobayashi told reporters Friday, bowing for a long time to emphasize the apology alongside three other top company officials.

He expressed remorse to those who have died and have been sickened, and to their families. He also apologized for the troubles caused to the entire health food industry and the medical profession, adding that the company was working to prevent further damage and improve crisis management.

The company’s products have been recalled — as have dozens of other products that contain benikoji, including miso paste, crackers and a vinegar dressing. Japan’s health ministry put up a list on its official site of all the recalled products, including some that use benikoji for food coloring.

The ministry warned the deaths could keep growing. The supplements could be bought at drug stores without a prescription from a doctor, and some may have been purchased or exported before the recall, including by tourists who may not be aware of the health risks.

Kobayashi Pharmaceutical had been selling benikoji products for years, with a million packages sold over the past three fiscal years, but a problem crept up with the supplements produced in 2023. Kobayashi Pharmaceutical said it produced 18.5 tons of benikoji last year.

Some analysts blame the recent deregulation initiatives, which simplified and sped up approval for health products to spur economic growth.

Yuri Kageyama is on X: https://twitter.com/yurikageyama

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Former president has declined to release details about his own condition beyond a short letter from his physician, contrasting with biden’s detailed report.

BEDMINSTER, N.J. — As former president Donald Trump escalated his attacks on President Biden’s health and mental fitness last fall, Trump released the first updated report on his own condition in more than three years.

This assessment, however, stood in stark contrast to the relatively detailed reports released by the White House during his term. Instead of specifics like blood pressure and medications, the letter had just three paragraphs without specific numbers proclaiming that Trump was in “excellent health” and had “exceptional” cognitive ability. It did not disclose Trump’s weight.

And after relying on a longtime personal doctor and then two White House physicians who had attested to his well-being in office, Trump turned to an unknown on the national stage to provide this report: Bruce A. Aronwald, a 64-year-old osteopathic physician from New Jersey — and a longtime member of Trump’s Bedminster golf club.

Trump’s and Biden’s cognition and general health have emerged as one of the primary issues for a majority of voters in the presidential race. There’s no rule that candidates must be more forthcoming about their health, but the lead author of an academic study of medical reports issued by Trump and Biden in the last campaign said the lack of detail in the letter makes it difficult for voters to truly understand whether the 77-year-old Trump is truly in better health than his 81-year-old opponent, as he regularly proclaims on the trail.

Trump, the presumptive GOP nominee, began his political career in 2015 by releasing a vague and hyperbolic medical report declaring that he’d be the healthiest president in history, which his physician at the time later said Trump had dictated to him. The new letter also provides none of the usual details for the public to examine, such as the precise extent to which Trump has continued to battle obesity and high cholesterol, as he did in office.

Aronwald declined to meet with a Washington Post reporter who visited his office about 19 miles from Trump’s golf club, and — through Trump’s campaign — said in a statement that he saw no reason to release further details about Trump’s health before the election.

“There is no need for President Trump to release another medical report in addition to the one he recently made public,” Aronwald said, referring to his November letter. “The President is strong physically and sharp cognitively, and he’s in excellent health overall.”

When The Post asked the campaign if Trump dictated the November letter to Aronwald, a person authorized to speak about the matter only on the condition of anonymity responded, “No.”

While it is Trump’s prerogative to keep the information private, S. Jay Olshansky, the lead author of a 2020 report in the journal Active Aging that compared the projected life span and health of Biden and Trump, said Aronwald’s letter lacks the specifics necessary to discern much information about Trump’s health.

Biden has released a six-page letter that details his blood tests, conditions and medications, which the White House said gives voters a clearer picture of health. “Joe Biden is proud to have been transparent with his health records as Vice President, as a presidential candidate, and as President,” White House spokesman Andrew Bates said in a statement. “He believes all leaders owe that level of honesty to the American people.”

A Post review of Aronwald found him to be a well-respected local doctor who had found notable success with a “concierge” medical service catering to well-off clientele like Trump; some patients say he has never been openly political. Federal campaign finance records show only a $1,000 donation in 2015 to the presidential campaign of former New Jersey governor Chris Christie (R).

Aronwald is also a well-known figure at Trump’s Bedminster club, with members saying they had noticed he spent time with Trump and his family when they were all at their villas near the pool.

“If you are sitting around the pool, you see him all the time,” a club member, who spoke on the condition of anonymity to describe what he saw at a private venue, said of Aronwald. “He is a fixture.”

In a statement to The Post for this story, Trump praised Aronwald, who has treated him since 2021.

“Dr. Aronwald is one of the best doctors in all of New Jersey and possibly the entire country,” Trump said. “He has a great reputation and I have many friends who have been patients of his for years. A great doctor.”

‘I just made it up’

Trump has long relied on personal physicians and White House doctors to respond to — and sometimes insulate him from — questions about his health.

In 2015, he tweeted that “as a presidential candidate, I have instructed my longtime doctor to issue, within two weeks, a full medical report — it will show perfection.”

A full medical report was not immediately forthcoming. Instead, the following day, Trump’s then-physician, Harold Bornstein, signed a four-paragraph letter that said Trump would be “the healthiest individual ever elected to the presidency.” It provided only a few metrics such as blood pressure and a PSA test for prostate screening.

Bornstein, a gastroenterologist who died in 2021, later told CNN that Trump “dictated that whole letter. I didn’t write that letter. I just made it up as I went along.”

As the 2016 campaign developed, Trump’s Democratic opponent, Hillary Clinton, released a detailed medical report and challenged Trump to do the same.

After pressure mounted on Trump to release more information, Bornstein conducted another examination and, in September 2016, Trump went on “The Dr. Oz Show” and, with a dramatic flourish, pulled out a new report for Oz to read. That letter included more information about blood tests and other metrics than the first letter, and said Trump was in “excellent physical health.”

In early 2017, Bornstein told the New York Times that Trump took drugs for hair loss, rosacea and high cholesterol. As a result of that revelation, he said he was told he was no longer under consideration to be White House physician. And two days after that article was published, Bornstein later told NBC News, a White House official and two others conducted a “raid” on his office to obtain the president’s medical records, which he said made him feel “raped, frightened and sad.” The White House responded at the time that it was “standard operating procedure” to obtain the documents and denied that it was a raid.

During his presidency, Trump’s first White House physician, Ronny Jackson, appeared in the White House briefing room in 2018 to announce that tests performed at Walter Reed National Military Medical Center found Trump to be in excellent health.

The results were detailed, showing that Trump’s weight had increased from 236 to 239 pounds, which qualified him as borderline obese for a man of 6-3. Jackson also said that Trump had scored a 30 out of 30 on a basic cognitive test designed to detect early signs of cognitive impairment. Jackson said nothing was being withheld from the tests, and he said that Trump’s release was more than any president before him had done. Jackson recommended that Trump try to lose 10 to 15 pounds.

But some physicians and analysts at the time said the report also showed Trump had an increased risk of heart problems — underscoring why releasing detailed results can provide important information beyond a general statement. CNN’s chief medical correspondent, Sanjay Gupta, noted that a CT scan showed that Trump’s coronary calcium score was 133, up from 98 in 2013 and 34 in 2009. Gupta wrote that a score over 100 “indicates plaque is present and that the patient has heart disease,” and also noted Trump had increased cholesterol levels. Jackson said in releasing the report that he had increased Trump’s cholesterol-lowering medication, in addition to his recommendations about diet. (No numbers about cholesterol or calcium were released in the latest report.)

Jackson, who is now a GOP congressman representing Texas, has been an outspoken supporter of Trump and critic of Biden’s health. The Navy in 2022 demoted him from retired rear admiral to retired captain after a Pentagon’s inspector general’s report that substantiated allegations about his inappropriate behavior as White House physician, The Post recently reported .

In November 2019, Trump went on an unannounced trip to the Walter Reed facility, which his spokeswoman said was a two-hour visit to give him a head start on his annual physical.

Trump released medical test results in 2019 and 2020 under the supervision of Sean Conley, who was then serving as his White House physician. They showed Trump had not lost weight in line with Jackson’s recommendation. Instead, his weight continued to increase, to 243 in 2019 and 244 in 2020, putting him in the obese range. He was being treated with a statin for high cholesterol levels.

Conley supported Trump’s usage of hydroxychloroquine, an anti-malaria drug, during the coronavirus pandemic. Conley wrote a May 18, 2020, memo in which he said he had discussed the evidence for and against the use of hydroxychloroquine and “concluded the potential benefit from treatment outweighed the relative risks.”

Then, after Trump contracted covid-19 in the fall of 2020, Conley made statements that played down the severity of Trump’s illness that were later contradicted by other White House officials and subsequent reporting. While Conley wrote in a memo that Trump was recovering and had “no symptoms,” then-White House chief of staff Mark Meadows told reporters that Trump was doing worse than Conley had let on. Conley later said that “it came off that we were trying to hide something, which wasn’t necessarily true. ... The fact of the matter is that he’s doing really well.”

After Trump lost his reelection bid, it was more than three years until he updated his medical status with the letter written by Aronwald.

A Bedminster regular

A native of Bridgewater, N.J., Aronwald attended Syracuse University and received his osteopathic degree from an institution formerly known as the University of Medicine and Dentistry of New Jersey in 1986. (The school was later dissolved and its osteopathic department was taken over by Rowan University.) He served on the staff of a hospital and then joined a small family practice specializing in sports medicine.

By 2002, Aronwald entered the newly emerging field of concierge medicine, which caters to wealthy patients by charging an annual fee that gives them more access to doctors. A story from that time in a local publication, the Daily Record, said Aronwald had typically seen 30 to 40 patients a day, often receiving payment from “decreasing Medicare and HMO reimbursements.” Under the concierge system, Aronwald told the paper, he saw 10 to 12 patients daily who could afford to pay an $1,800 annual fee while also maintaining health insurance. The model proved lucrative and he helped other practices adopt it.

At some point he became a member of the Trump National Golf Club in Bedminster, which Trump opened in 2004. Trump has a house next to the club’s swimming pool, and he used the clubhouse during his presidency to entertain dignitaries and friends.

Aronwald in 2022 played in the Senior Interclub Championship at the Trump club. An individual familiar with the matter, who spoke on the condition of anonymity because they are not authorized to comment on the club, confirmed Aronwald is still a member.

Ira Monka, the president of the American Osteopathic Association, said Aronwald, with whom he once practiced, is one of New Jersey’s “top concierge doctors. You get to that point, you could not get there if you were not a solid fundamentally strong primary care doctor.” Monka noted that Aronwald and Biden’s doctor, Kevin C. O’Connor, are both osteopathic physicians, a profession that the association says is designed to bring harmony to a body’s structure and function and focuses on “the whole person: body, mind and spirit.”

Jack Kripsak, a physician who has known Aronwald for 50 years, said in an interview that Aronwald “has a lot of patients from that area, from that club — being a concierge doctor, he’s going to get that clientele.”

Kripsak said that Aronwald may have initially provided services to Trump’s daughter and son-in-law, Ivanka Trump and Jared Kushner, who also have a villa at Bedminster. Kushner could not be reached for comment. (A person with knowledge of the matter said that some members of the Trump family had previously known Aronwald but would not be more specific.) Kripsak said the former president reached out to Aronwald and asked whether he would become his primary care physician.

“It came as a surprise to Bruce. He called me and said, ‘President Trump gave me a call’” about being interviewed to be his personal physician, Kripsak said. After the interview, Aronwald told Kripsak that Trump “asked me to be his personal physician.”

Sandeep Tungare, a software developer who is a Democrat and contributor to Biden’s presidential campaign, said he has been a patient of Aronwald for three decades and has never heard him express political views. “I just think he is a good doctor,” Tungare said.

In his Nov. 23 letter about Trump’s health, Aronwald said he had conducted the most recent examination of Trump on Sept. 13, 2023. While not providing any specific numbers or names of prescription medication, Aronwald wrote that Trump’s “overall health is excellent,” that his physical exams were “well within the normal range and his cognitive exams were exceptional.” The letter also said that Trump’s cardiovascular studies were normal and cancer tests were negative.

The letter added that his laboratory analysis was well within the normal range and “even more favorable than prior testing in some of the most significant parameters, most likely secondary to weight reduction.”

The letter did not provide Trump’s blood test numbers or his weight, leaving it unclear if he would still be considered obese. Nonetheless, Aronwald wrote that Trump had “reduced his weight through an improved diet and continued daily activity, while maintaining a rigorous schedule.”

Olshansky, the researcher on aging, said Aronwald’s brief letter is not sufficient for his team of researchers to make an updated assessment later this year on Trump’s projected life span. Instead, the full “medical records are extraordinarily valuable,” he said. “They tell a story about health prospects for survival going forward. You can’t really do a thorough assessment of life span and health span without the medical records.”

Biden’s doctor, in his letter , gave a more detailed analysis, including metrics for cholesterol, blood pressure, weight and an electrocardiogram, providing more transparency but also information that might be cited by a political opponent.

O’Connor wrote that the president is being treated with a variety of medications, has a “stiff” gait, and is being treated for conditions including obstructive sleep apnea, gastroesophageal reflux and sensory peripheral neuropathy of his feet. Nonetheless, these conditions were not considered impediments, and O’Connor concluded that Biden is “a healthy, active, robust 81-year-old” who is fit to be president.

Alice Crites in Washington contributed to this report.