JONATHAN REINER, M.D.2026年8月13日Dick Cheney’s heart problems were never a national secret.迪克·切尼的心脏问题从来都不是什么国家机密。I was Mr. Cheney’s cardiologist for 27 years, including his two terms as vice president. During his time in the White House, he needed stents, a defibrillator and medical treatment for an arrhythmia and a blood clot in his leg. After the defibrillator was implanted in his chest in 2001, he would frequently show visitors to his West Wing office a sample device provided to him by the manufacturer.我曾担任切尼的心脏科医生长达27年，包括他的两届副总统任期。任职期间，他曾需要安装支架、除颤器，并接受心律失常和腿部血栓的医治。2001年胸腔植入除颤器后，他经常向西翼办公室的访客展示制造商提供给他的样品设备。Mr. Cheney’s candor about his health was an anomaly for an American politician. Grover Cleveland underwent secret cancer surgery while he was president (on board a yacht for maximum privacy). Franklin Delano Roosevelt hid his use of a wheelchair from the public. Ahead of his campaign for a fourth term, he struggled with severe hypertension and congestive heart failure, but the public was told that the president’s health was “excellent in all respects.” Joe Biden’s disastrous debate performance raised concerns that the White House had attempted to conceal the president’s decline. For weeks after his hospitalization this summer, Senator Mitch McConnell shared almost no details about why he was absent from office.切尼对其健康状况的坦率在美国政治人物中实属异类。格罗弗·克利夫兰在担任总统期间曾秘密进行过癌症手术（并且是在游艇上进行，以求最大程度保密）。富兰克林·德拉诺·罗斯福向公众隐瞒了他使用轮椅的事实。在竞选第四任期之前，他饱受严重高血压和充血性心力衰竭的困扰，但公众被告知总统的健康状况“在所有方面都非常出色”。乔·拜登灾难性的辩论表现引发了人们的担忧，认为白宫试图掩盖总统的衰退。今年夏天，参议员米奇·麦康奈尔在数周住院治疗期间没有分享任何关于他为何无法履职的细节。In June, President Trump celebrated his 80th birthday, and at the end of this term he will be the oldest person ever to serve as this nation’s leader. After Mr. Trump’s medical evaluation in May, Dr. Sean Barbabella, the physician to the president, wrote that Mr. Trump “remains in excellent health” and that his “demanding daily schedule, including multiple high-level meetings, public engagements and regular physical activity, continues to support his overall well-being.”今年6月，特朗普总统庆祝了他的80岁生日，在本任期结束时，他将成为有史以来担任美国领导人最年长的人。在特朗普5月份接受体检后，总统医生肖恩·巴贝拉博士写道，特朗普“仍然非常健康”，并且他“繁重的每日日程——包括多次高层会议、公共活动和规律的体育锻炼——继续支持着他的整体健康”。Despite reassurances from the White House to the contrary, at times over the past year, the president has not looked well. I am not Mr. Trump’s doctor, and have only reviewed his records that have been made public. But Mr. Trump is probably the most photographed president in American history, and a variety of physical ailments are easy to see. He’s had large bruises on both hands, swelling in his legs and episodes when it appears that he is struggling to stay awake. He’s also had advanced imaging performed for unclear reasons. The public is again left to wonder whether the nation’s leader is OK.尽管白宫一再作出保证，但在过去一年中，总统有时看起来状态并不好。我不是特朗普的医生，只查阅过已公开的病历。但特朗普可能是美国历史上被拍照最多的总统，各种身体上的不适很容易被看到。他的双手都有大片瘀伤，腿部肿胀，并且曾出现过难以保持清醒的情况。他还因不明原因接受过高级影像检查。公众再次不得不想知道，国家领导人是否安好。Despite the unparalleled power afforded to the president of the United States, there is no formal requirement for the commander in chief to certify his fitness for duty. That’s a mistake. Members of the military, Secret Service agents, commercial pilots, school bus drivers and air traffic controllers all must periodically demonstrate that they are well enough to perform their work. The current practice of reporting the results of a yearly medical examination for the president began in the Nixon administration, but it’s only a custom, not a formal obligation. And, as history has shown, it can be unreliable.美国总统被赋予无与伦比的权力，但并没有某种正式规定要求三军统帅必须证明其履职能力。这是一个错误。军人、特勤局特工、商业飞行员、校车司机和空中交通管制员都必须定期证明他们身体状况良好，能够胜任工作。目前向公众报告总统年度体检结果的做法始于尼克松政府，但这只是一种惯例，并非正式义务。而且，正如历史所表明的那样，这种做法可能并不可靠。This does not mean that every detail about a president’s health must be disclosed. It’s appropriate to withhold elements of a medical history that could be exploited by an adversary. In 2007, when we replaced Mr. Cheney’s defibrillator, we didn’t share information about a new wireless feature of the device that I considered a security threat to the vice president. (We ultimately were able to get the manufacturer to disable that capacity.)这并不意味着总统健康状况的每一个细节都必须被披露。保留病历中可能被对手利用的部分是恰当的。2007年更换切尼的除颤器时，我们没有分享该设备新增无线功能的信息，因为我认为这对副总统构成安全威胁。（我们最终成功让制造商禁用了该功能。）The 25th Amendment to the Constitution allows for the best solution to this problem: It permits Congress to establish a panel outside the executive branch to assess the health and fitness of the president. In April of this year, Representative Jamie Raskin introduced a bill to create a congressional commission that would do just that. Ideally, such a panel would be empowered to review data from routine presidential physical examinations, as well as assessments performed when medical concerns emerge.宪法第二十五条修正案为这个问题提供了最佳解决方案：它允许国会在行政部门之外设立一个小组来评估总统的健康和履职能力。今年4月，众议员杰米·拉斯金提出一项法案，旨在设立一个国会委员会来专门处理此事。理想情况下，这样一个小组应有权审查总统常规体检的数据，以及在出现医疗问题时进行的评估。If such a commission were in place today, these are some of the medical questions it could clarify concerning Mr. Trump’s health. The American public deserves answers to all of them.如果今天就有这样一个委员会，以下这些关于特朗普健康问题的医疗疑问或许就能得到澄清。美国公众理应得到所有这些问题的答案。1. Dr. Barbabella’s recent report states that the president was evaluated by 22 consultants, an extraordinary number of specialists for even the most extensive executive health evaluation. Why were so many physicians summoned, and what were their specialties?1. 巴贝拉博士近期的报告称，总统接受了22位会诊医生的评估，即便对于最全面的行政健康评估来说，这个专家数量也是非同寻常的。为什么要召集这么多医生？他们的专业领域是什么？2. Mr. Trump often shows prominent bruising on his hands, which the White House attributes to frequent handshaking and frequent use of aspirin. Trauma from handshaking has never seemed plausible, and it doesn’t explain why the president’s left hand is often similarly discolored. Also, why would the president take a dose of aspirin four times as high as the dose typically recommended by doctors?2. 特朗普的手上经常出现明显的瘀伤，白宫将其归因于频繁握手和经常使用阿司匹林。握手造成创伤似乎从来都说不通，也无法解释为什么总统的左手也经常有类似的变色。此外，总统为什么要服用医生通常推荐剂量四倍之多的阿司匹林？3. Swelling in the president’s legs last summer led to an unscheduled medical evaluation. The president’s physician described the problem as “chronic venous insufficiency,” a condition common in older people, that results from leaky valves in the veins of the legs. It usually develops gradually over a long period. But during Mr. Trump’s comprehensive physical examination just a few months earlier, Dr. Barbabella documented no swelling in the president’s legs. If that’s true, his swelling would be by definition acute, not chronic. Acute leg swelling is a potentially much more consequential finding that can be caused by issues such as heart and kidney disease. What’s the reason for this discrepancy?3. 去年夏天，总统腿部肿胀导致了计划外的医疗评估。总统医生将这一问题描述为“慢性静脉功能不全”，这是一种常见于老年人的疾病，由腿部静脉瓣膜泄漏引起。它通常是长期逐渐发展的。但在仅仅几个月前特朗普接受全面体检时，巴贝拉博士的记录中并没有显示总统腿部有肿胀。如果那是真的，那么他的肿胀根据定义就应该是急性的，而非慢性的。急性腿部肿胀是一个潜在严重得多的发现，可能由心脏和肾脏疾病等问题引起。这一差异的原因是什么？4. The president often appears to struggle to stay awake, signs of a condition doctors refer to as excessive daytime somnolence. This problem, which is sometimes evident during Oval Office events, was not addressed in the report after Mr. Trump’s comprehensive physical exam in May. Although the president is a renowned night owl, his sleepiness seems relatively new. There are several possible causes for the president’s symptoms, some of which could have serious complications if left untreated. Has the president’s medical team identified the source of this issue? And how are they addressing it?4. 总统经常看起来在努力保持清醒，这是医生称之为日间过度嗜睡的迹象。这个问题在椭圆形办公室的活动中有时也很明显，但在特朗普5月份全面体检后的报告中并未提及。尽管总统是出了名的夜猫子，但他的嗜睡似乎是相对较新的情况。总统的症状可能有多种原因，其中一些如果不加以治疗，可能会导致严重并发症。总统的医疗团队是否已确定此问题的根源？他们又是如何处理的？5. In October 2025, Mr. Trump underwent advanced imaging of his heart and abdomen at Walter Reed National Military Medical Center. The president’s physician offered a vague description of the reason for the tests: “to identify issues early, confirm overall health and ensure he maintains long-term vitality and function.” He said the tests did not reveal any abnormalities. Was there a specific symptom or clinical event that prompted this testing?5. 2025年10月，特朗普在沃尔特·里德国家军事医疗中心接受了心脏和腹部的高级影像检查。总统医生对检查原因给出了模糊的描述：“及早发现问题，确认整体健康状况，并确保他维持长期的活力和机能。”他说检查未发现任何异常。是否有特定的症状或临床事件促使了这项检查？6. Past Trump medical reports have disclosed the president’s use of the drug finasteride, which prevents hair loss. The drug was not mentioned in the report after Mr. Trump’s most recent medical examination. In response to a query from The Washington Post about its absence, the White House responded, “The current report reflects all medications deemed clinically relevant to disclose at this time.” It does not matter, in any material way, if the president is or isn’t taking a hair-loss drug. The more important question is, what medications prescribed for Mr. Trump, if any, has the White House decided to withhold from the public?6. 以往的特朗普医疗报告曾披露总统使用非那雄胺，这是一种防脱发药物。在特朗普最近一次体检后的报告中并未提及该药。针对《华盛顿邮报》就此提出的询问，白宫回应称：“当前报告反映了此时被认为临床相关且应予披露的所有药物。”总统是否服用脱发药物在任何实质性方面都不重要。更重要的问题是，白宫决定对公众隐瞒哪些为特朗普开的处方药（如果有的话）？7. The president has spoken about how well he performs on cognitive testing. However, the exam that Mr. Trump describes, the Montreal Cognitive Assessment, is a brief and basic screening tool, with simple questions (draw a clock, identify a camel), often performed in response to a concern from the patient or a member of the family. Why has the president undergone this test numerous times, and have there been more sophisticated neurocognitive assessments performed?7. 总统曾谈到他在认知测试中表现如何出色。然而，特朗普所描述的蒙特利尔认知评估是一种简短而基础的筛查工具，包含简单问题（画一个钟、识别骆驼等等），通常是在患者或家属有担忧时进行。为什么总统多次接受这项测试？是否进行过更复杂的神经认知评估？Some people would argue that these personal medical details are more than the public deserves to know: After all, Buckingham Palace has not revealed many details about King Charles’s cancer or his treatment.有些人会认为，这些个人医疗细节超出了公众理应知晓的范围：毕竟，白金汉宫并未透露查尔斯国王癌症病情或其治疗的许多细节。But the United States does not have a king. In a representative democracy, the people must have confidence in the health of their leader, and in the leader’s capacity to guide the nation. We have been kept in the dark too long.但美国没有国王。在代议制民主国家，人民必须对他们的领导人的健康以及领导人领导国家的能力有信心。我们被蒙在鼓里太久了。Jonathan Reiner与切尼和莉兹·切尼合著了《心脏：一部美国医学史》(Heart: An American Medical Odyssey)一书。该书详细记述了这位美国前副总统与心脏病抗争的历程。翻译：经雷点击查看本文英文版。