Andrew Harnik / AP

Hillary Clinton health conspiracy theories will never go away. Over the years, they have mutated into different forms, each with highly suspect amateur diagnoses. The rumors have even been contradictory and inconsistent. But through it all, unproven and debunked claims have served as a convenient shortcut for critics who want to delegitimize Clinton without bothering to engage on the merits of her actual record.  

Reckless speculation and insinuations that Clinton may be concealing a serious illness have been elevated to the mainstream by Donald Trump and conservative media during the 2016 election. On Tuesday, the Trump campaign released an ad featuring separate images of Clinton coughing, being helped up stairs, and stumbling as she left a September 11, 2001, memorial in New York City. “Hillary Clinton doesn’t have the fortitude, strength, or stamina to lead in our world,” a narrator warns ominously. By repurposing photos and video that Hillary haters rabidly circulate in misleading ways online, the ad feeds the Clinton conspiracy of the moment.

It’s worth noting, however, that claims that the Democratic nominee may be concealing a serious medical condition amount to the inverse of a conspiracy theory promoted by conservatives just a few years ago. In 2016, Clinton critics want you to believe she’s faking a clean bill of health, but as recently as 2012, they were spreading rumors that she was faking illness. When Clinton sustained a concussion that year that led to the postponement of her congressional testimony on the Benghazi attacks, conservative media outlets rushed to cast doubt on the diagnosis. The Daily Caller published a post dripping in skepticism that read: “If she has a concussion, let’s see the medical report. Let’s see some proof that she’s not just stonewalling.” The New York Post suggested Clinton’s story was too outlandish to be believed in an article headlined “Hillary Clinton’s head fake.”

The inversion illustrates why Clinton will never escape health conspiracy theories. Facts will be seized upon and twisted beyond recognition by her critics to support claims that she has something to hide, no matter what happens to her or what she does. That will continue even if the resulting narratives are inconsistent and contradictory. The disparity between reckless speculation a few years ago and what has unfolded during the current election highlights the cynicism that defines the effort to discredit Clinton by invoking her health.

It’s fundamentally irresponsible to promote potentially damaging accusations without proof. But there are plenty of reasons why Clinton conspiracy theories won’t go away and why their promoters won’t let up. It’s easier to speculate wildly than it is to construct a credible case against an opponent. Why take the time to research, analyze, and argue the merits of a candidate’s policy proposals when you can simply indulge in rumor and innuendo? Then there’s the fact that in this case the rumors and innuendo have an age-old target—women’s health. There’s a long tradition of dismissing women as weak and frail as a way to discredit them.

As insidious and untrue as they may be, the health conspiracy theories aren’t completely divorced from reality. Clinton’s concussion as well as her hospitalization for a blood clot made headlines during her tenure as secretary of state. And the Clinton camp is not entirely without blame for the extent to which the currently-in-vogue theory that she is hiding health problems has spread. By waiting several hours after Clinton abruptly departed the 9/11 memorial last month, the campaign created an information vacuum that paved the way for wild speculation over what had happened. Conspiratorial health rumors had already been swirling before the diagnosis, making the delay even more consequential.

The medical record of a presidential contender is not irrelevant, an idea that Clinton conspiracy theorists actively exploit. If a president suffers from a serious illness that could affect their ability to carry out the duties of commander in chief, voters deserve to know. The most important consideration when it comes to assessing Clinton’s health, however, should be medical information about the candidate provided by a physician, not the online rumor mill. After Clinton’s pneumonia diagnosis was publicly announced, the campaign released a letter from her doctor that concluded: “She continues to remain healthy and fit to serve as President of the United States.”

Despite this evidence, Trump and his allies frequently insinuate that Clinton is physically weak. Sean Hannity, an avowed Trump supporter, has used his platform on Fox News to raise questions over her health. In addition to releasing his new campaign ad, Trump has said Clinton “doesn’t have the stamina” to be president.  “Here’s a woman—she’s supposed to fight all of these different things—and she can’t make it 15 feet to her car, give me a break,” he said at a rally in October, before imitating the Democratic nominee stumbling as she left the 9/11 memorial. Trump surrogate Katrina Pierson, who is not a doctor and has a track record of making false statements, event went so far as to implausibly claim that Clinton has a medical condition known as dysphasia.

The Clinton campaign has framed Trump’s decision to question his opponent’s health as more evidence that he’s not a serious candidate. “Good to know Donald Trump’s meltdown has continued to his TV buys,” campaign spokeswoman Christina Reynolds said in response to a request for comment on Trump’s latest ad. “As a B-movie script, this would have been rejected for being so ridiculous. As a political ad, it’s just embarrassing and beneath the dignity of the office.”

But no matter how ridiculous, the way Trump promotes rumor and innuendo is sure to have consequences. It will likely embolden conspiracy theorists to spread ever-more-wild ideas. After Clinton’s pneumonia diagnosis, right-wing websites pushed a debunked conspiracy theory that Clinton had deployed a body double following her exit from the 9/11 memorial as a way of concealing a far more serious illness.

The idea that Clinton may be covering up a serious medical condition is not new. In 2014, Karl Rove reportedly suggested she might be concealing a traumatic brain injury, though he later insisted that he never explicitly said she had brain damage. Trump’s campaign frequently avoids making explicit assertions, too. But the campaign doesn’t need to: A wink, wink, nudge, nudge is more than enough to animate dark corners of the internet.

The exact form Clinton health conspiracies take in the future will depend on whatever narrative conspiracy theorists find easiest to construct or repurpose at the time. The extent to which they feature prominently in national political conversations will depend on how willing political leaders and other prominent voices are to legitimize them—by acting as if their flimsy premises are worthy of serious consideration.

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