As a political junkie and physician, the role of medical problems of ‘leaders’ and its effect on politics and history has interested me for many years. This all started when I saw the movie ‘The Madness of King George’. In this movie, King George III suffers from a ‘mysterious’ disease that produces periods of mental imbalance. The movie depicts the period of more than ten years after the rebellion of the American colonies, but even so, it made me wonder if the king was also afflicted by his ‘madness’ during that time and if he had been perfectly ‘normal’ could the course of American history might have been different.

The second impetus was reading a book about the history of Tuberculosis (TB). The author when describing ‘modern’ treatment for the disease discusses in some detail the discovery of the antibiotic ‘Streptomycin’. This drug was the first true treatment of TB and became available around 1947. The author says that the physician responsible for the development of the ‘new’ treatment mentions a letter he received from a physician taking care of a ‘leader’ in an ‘eastern’ country who enquired about the availability of this medicine. However, a few months later he received a letter saying that the medicine was no longer needed.

The timeline suggests that the patient in question was Mohammad Ali Jinnah. If Jinnah had survived even for a year, he could have been treated by this new medicine and lived longer. And that would clearly have changed the history of Pakistan. More importantly, Jinnah knowing the inevitability of his demise because of TB that was ‘incurable’ during the late forties made political decisions that he might not have made if he was healthy. So, for us in Pakistan, the fact that Jinnah knew he was dying from an ‘incurable’ disease perhaps made many things happen that might not have otherwise.

Another interesting situation is of Malik Ghulam Muhammad, the third governor general of Pakistan (1951-55). He was already sick when he assumed office and possibly suffered a serious neurological problem (stroke). Many contemporaneous observers mention Ghulam Muhammad’s ‘erratic’ behaviour during official meetings. Ghulam Muhammad was forced out of office because of his poor health.

The decision by Ghulam Muhammad to dismiss the ‘constituent’ assembly lead to the famous Tamizuddin Case (1954-55). This derailed democracy in Pakistan for many decades. Whether this decision had anything to do with Ghulam Muhammad’s unstable mental and physical condition after his stroke is debatable but the question still needs to be asked. Ghulam Muhammad died about a year after he left office.

Without dwelling on ‘ancient history’, even during the last fifty years the ‘health’ of political leaders has had a major impact on modern political politics. Lyndon Johnson (LBJ), the president of the United States, had suffered serious heart problems before he became president. However, at the height of the Vietnam War when confronted by opposition to his policies, he decided not to contest for re-election as president in 1968.

This, of course, brought in Richard Nixon as the next president. LBJ’s decision not to contest is often attributed to his medical problems. That he died only a few years later from a ‘massive’ heart attack proved his fears. If LBJ had run again he would have become president again. And that would have changed the ‘trajectory’ of the Vietnam War and modern history.

Around the same time, closer to home, President Ayub Khan in Pakistan, when confronted by popular opposition to his rule (1968-69), decided to leave his position and give over the reins of the country to General Yahya Khan. Ayub was also suffering from heart disease and like LBJ he died a few years after he relinquished his position as president. If Ayub was healthy, he might have decided to hang on, and the history of Pakistan would have been different.

Interestingly, the ‘mental health’ of leaders has always been an issue but was something that could never be brought up in any objective way. The two exceptions might have been ‘Emperor’ Bokassa of the Central African Republic and Idi Amin Dada, President of Uganda during the nineteen seventies. Both were accused of great personal cruelty and bizarre behaviour. Both ended up in exile.

Perhaps, democratic systems provide the best control against the emergence of leaders with serious mental problems, while dictatorships by their very nature promote megalomania and paranoia.

After the break-up of Pakistan, we had two successive rulers (1972-1988) that were physically healthy and both died prematurely of ‘unnatural’ causes. The nineteen nineties in Pakistani history was a time when two young politicians alternated as prime minister and clearly no health issues were of any importance.

Of course, the reason why this entire idea of health and leadership is suddenly of interest is the question about General (retd) Pervez Musharraf and his health and as such his ability to undergo trial on charges of treason and whether he should go abroad for treatment or stay in Pakistan.

First about former President Asif Ali Zardari. Even before he became president in 2008, questions were raised about his ‘mental health’. However, he went on to serve as president for five years during which time he did not demonstrate any psychological problems worthy of consideration.

Zardari is also known to suffer from diabetes and high blood pressure. While he was in the US before becoming president there were rumours that he had blockages requiring a ‘stent’ placement in one of his heart arteries. In 2011, while serving as president he reportedly had a mini stroke which happens in people with his medical background. Interestingly, he travelled abroad for treatment and recovered completely. Why he went abroad for treatment was discussed in great detail in the local media at that time.

In March of 2011, Mian Nawaz Sharif went to London for a ‘routine’ cardiac procedure. There, after the procedure he ended up with what we in the ‘business’ of cardiac medicine call an ‘adverse’ and nearly fatal outcome. Fortunately, he recovered completely. Yes, he went to London for a ‘routine’ procedure but if it was so routine then why London and not Pakistan? Also his younger brother, the chief minister of the Punjab, went off to see him. Fortuitously, neither of the two men that headed the party ruling the Punjab at that time were in Pakistan when Raymond Davis was let go by a court in Lahore.

As far as Mian Shahbaz Sharif is concerned, it is well known in medical circles that almost a decade ago he had surgery for a ‘Carcinoid tumour’ in the United States where some of his large intestine was removed. Since then he makes frequent visits to London for routine checkups to make sure that his tumour has not recurred. These checkups could well be done in Pakistan so, why London?

The bottom line is that ‘leaders’ like all citizens have the right to seek medical treatment wherever they feel most comfortable as long as they pay for such treatment themselves. Also they have a certain right of privacy if their medical problems do not interfere with their administrative functions.

Clearly Pervez Musharraf deserves the same right. And it is entirely preposterous that anybody besides qualified physicians and the family decide the need for medical treatment and where it should be sought.