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Ginsberg: This is Seth Ginsberg, America's patient advocate here filling in for my good friend Lisa Wexler who I hope is tuning in from "Down Under." I want to talk all about JFK but we are going to talk about it in a way that I think a lot of us can relate to which is that he had suffered health problems since childhood and used an arsenal of drugs including painkillers and stimulants to treat vario
us medical conditions during and leading up to his presidency. And you know the fact is, JFK suffered from colitis, prostatitis, and a disorder called Addison's Disease, which affects the body's ability to regulate blood sugar and sodium. He also had osteoporosis of the lower back causing pain so severe that he was unable to perform simple tasks, such as reaching across his desk to pull papers forward or pulling up his shoes and socks onto his left foot. Wonder if you knew that?  You know, we think about JFK, we think about vigor, we think about good-looking guy out there in Hyannis but we don't necessarily think about his health issues that many of us can relate to. Here to talk a lot more about those health issues and answers more questions is Dr. Alan Gibofsky, Professor of Medicine and Public Health at the Weill Cornell Medical College and attending rheumatologist at the Hospital for Special Surgery. Dr. Gibofsky, welcome to our show.


Gibofsky Thank you, Seth. Good to be with you.


Ginsberg: Chronic pain I think is the one that we can most all relate to at some level but Addison's Disease, could talk a little bit about that? This autoimmune condition?


Gibofsky: Sure, Addison's Disease is basically an insufficiency of the adrenal gland, the glands that sit above the kidney and in President Kennedy's case, they basically stopped working. Now why that should be is itself a mystery. Classical Addison's Disease was described in patients who had tuberculosis and tuberculous involvement in their adrenal glands and there's no evidence of tuberculosis in Senator Kennedy- or then- President Kennedy so we really don't know why he had Addison's Disease. Some speculate that it may have been from the prolonged stress of his immersion in the cold waters of the Pacific during his days on P.T. 109 but that part is still a mystery.


Ginsberg: Amazing. Now is Addison's something that you see often. Is that a common condition?


Gibofsky: No, it's a relatively rare condition. We will occasionally see partial shutdown of the adrenal gland, particularly in people who have been taking supplemental steroids for a long period of time but Addison's itself is quite rare.


Ginsberg: I mean is it painful? Is it something that hurts?


Gibofsky: It can be in the extreme cases painful. More often, it just leads to fatigue and a general sense of malaise.


Ginsberg: So we have a lot of insights now and I know that being an armchair physician is never a good idea, let alone an armchair historian physician to think back and all the complexities of these chronic conditions that resulted in the need to take all of these different medications. Is it as bad as one would think and how does that compare to those images of sterling, strong, vigorous-looking president and how do we reconcile those two?


Gibofsky: It's quite striking. We know that President Kennedy was hospitalized for back and intestinal illnesses. We know that he took, among other drugs, codeine, Demerol, methadone, Ritalin, Librium, barbiturates, thyroid hormone, so what you have is the portrayal of someone with vigor but really a chronically ill individual in constant pain.


Ginsberg: If we were to take these conditions and apply them to a patient today, would the treatment be any different?


Gibofsky: There may be some modifications. We now have ways of treating some of the causes of osteoporosis with various medications to prevent bone breakdown from steroids or augment bone breakdown and strengthen bone .We now use a lot more in the way of adjunctive non-pharmacologic therapies like nerve stimulation electrically, hypnosis, acupuncture and so on, but candidly, the medications that President Kennedy were taking are among the more common pain medications used even today.


Ginsberg: Dr. Gibofsky, I'm interested in your perspective on what it's like to treat patients with chronic pain, a totally invisible illness.


Gibofsky: I think you put your finger on it, Seth. I think because it's invisible, these patients often undergo an added layer of suspicion and concern; there's nothing that is visible about their disability and they suffer from that as well. They suffer from having to adapt their activities of daily living, they suffer from having to restrict their activities of daily living, and they also suffer from having to deal with the unpleasant side effects of many of the medications that we prescribe.


Ginsberg: Dr. Gibofsky is a Professor of Medicine and Public Health of the Weill Cornell Medical College and attending rheumatologist at the Hospital for Special Surgery joining us today to talk about the tragic chronic conditions that our 35th President, JFK had to live with and we appreciate the time, Dr. Gibofsky.