Because of the risks of speculation and uncertainty associated with any disclosure regarding the ill health of government leaders and candidates to high office, the public often receives misleading or even totally inaccurate information on this subject. Doctors, willingly or unwillingly, connive in issuing misleading medical bulletins. Families, aides, and colleagues are not informed, sworn to secrecy, or actively participate in the cover-up to protect their own positions. Because of the confidentiality of the doctor-patient relationship, it is difficult to confirm reports on a government leader's health. Despite many proposals, no formal mechanism exists to evaluate a leader's medical records.
This situation causes especial concern in relation to the responsibility for control of nuclear weaponry.
Many presidents of the USA have suffered serious illnesses while in office. For example, J F Kennedy suffered from adrenal insufficiency and was treated over a long period by hormonal replacement therapy, although the Kennedy family repeatedly denied any ill-health. In the USSR, the medical condition, and occasionally the death, of leaders was concealed as a matter of practice. In France, the death of former president François Mitterand was followed by a barrage of information—including a book by his former physician—about his long-standing illness and allegations as to his unfitness for office.