Will Trump Live to 500?

Six days passed between the president’s physical exam and the release of the doctors’ findings on Thursday. Even then, the anticlimactic unveiling raised only more speculation about the true state of Donald Trump’s health.

On February 8, Trump underwent a physical exam, according to the White House, which afterward released a brief press memo that said it was from the president’s new physician, Sean Conley. But the authorship of this report is questionable for several reasons, one of which is the sentence “The president is very grateful for the outstanding care he received today, and he especially wants to thank the doctors, nurses, enlisted and civilian staff who participated.”

It would be unheard-of for a doctor to praise himself in such a statement. Odder still is the subsequent assertion that Trump is “in very good health and I anticipate he will remain so for the duration of his Presidency, and beyond.” This sort of long-term prediction is atypical for any physician, much less one whose only charge is to assess the president’s ability to execute the duties of the office.

Read: The problem with Trump dictating his own medical assessment

It would inspire more confidence in the objectivity of the process if just once a doctor would simply share Trump’s test results in a transparent way. This has not been the case at any point in Trump’s presidency, during which his health reports have been inconsistent and sprinkled with—if not entirely written in—sensational prose. As a result, the credibility of the presidential health-assessment process and the professionals involved have entered a free fall.

Trump’s first physical as a candidate was reportedly performed by his former doctor, Harold Bornstein. After a year of journalistic scrutiny and national ire over the odd assessment (in which Trump was declared “the healthiest individual ever elected to the presidency”), Bornstein accused the president last year of dictating the assessment—and of sending associates to “raid” his office and take possession of his medical records.

Earlier, during the 2016 presidential campaign, Trump underwent a mock evaluation on The Dr. Oz Show, in which Oz spent most of the hour letting Trump say that he was doing great. Oz was later appointed by Trump to his Council on Sports, Fitness, and Nutrition, despite being called before Congress and castigated for unethical behavior.

In 2018, Trump’s new physician, Ronny Jackson (before being embroiled in scandal), gave an audience-of-one-themed press conference peppered with the words excellent and incredible and suggested that Trump could live to 200 because he has such excellent genes. (“Hands down, there’s no question that he is in the excellent range … I put out in the statement that the president’s health is excellent, because his overall health is excellent … Overall, he has very, very good health. Excellent health … incredible cardiac fitness … He has incredible genes … He has incredibly good genes, and it’s just the way God made him.”)

Two months later, Jackson was nominated by Trump to lead the Department of Veterans Affairs’ health-care system, the nation’s largest, despite having no experience in health-care policy or administration.

As I’ve written with regard to evaluating Trump’s mental health, it is historically unprofessional for doctors to speculate from afar. But in the absence of a transparent process, even though it’s not possible to make a comprehensive assessment, it’s possible to say more than nothing.

Read: How much will we find out about Trump’s health?

What we do know: The president is 72 years old, and he is widely reported to sleep little. He avoids exercise because of his erroneous belief that it “depletes energy.” He has evidence of coronary artery disease, atherosclerosis, according to a coronary arterial calcium score done last year. He takes a cholesterol-lowering medication because of a history of high cholesterol. He is obese and eats a lot of junk (specifically the Filet-O-Fish). He is regularly described in palace-intrigue stories as “increasingly isolated,” and he is under as much professional stress as it’s possible for a person to be.

There is no suggestion here that he’s physically unfit to execute the duties of the office, but it’s also unclear on what basis any doctor could deem that “very good health.” As in the past, there’s little evidence that this assessment is not primarily about good publicity—about outcome, not process.