June 15, 2008 (Vol. 28, No. 12)

Henry I. I. Miller, M.D. Physician and fellow Stanford University

Should Politicians Be Required to Take Periodic Intelligence and Mental Status Tests?

Most Americans are unhappy with the performance of the U.S. Congress, which has granted no favors recently to the pharmaceutical and biotech industries. Both regulation and its congressional oversight are broken with no repair in sight.

Recent polls have found congressional approval ratings in the range of 20–28%, but we continue to elect and re-elect scoundrels, liars, and the intellectually challenged. The elusive quality of electability seems not to correlate with truthfulness, integrity, courage, or intelligence but only with a certain affability—and with the ability to raise funds for campaigns.

It’s no coincidence that the intelligence level of members of Congress has so often been spoofed. “Suppose you were an idiot and suppose you were a member of Congress. But I repeat myself,” quipped Mark Twain. Milton Berle observed, “You can lead a man to Congress but you can’t make him think.” Will Rogers addressed the consequences of these deficiencies: “When Congress makes a joke it’s a law, and when they make a law, it’s a joke.”

There are numerous examples of the joke being on us. Not too long ago, a friend of mine was seated at a banquet table with the family of a former midwestern Representative. The relatives expressed relief at his having entered politics because none of them thought he was smart enough to enter the family scrap-metal business.

I was at a conference that a member of the powerful House Commerce Committee attended by teleconference. As he recited from a prepared statement, he included the stage instructions—such as “Pause for emphasis”—that had been inserted by his speechwriter. And where one line had been inadvertently duplicated, he read it a second time. Carelessness? Stupidity? Senility? Don’t voters have a right to know?

Senator Pete Domenici (R-New Mexico) was sufficiently forthright to reveal last year that he had been diagnosed with frontotemporal lobar degeneration—an inexorably progressive, incurable disease characterized by wasting away of the frontal and temporal lobes of the brain. Because of the behavioral changes and dementia that accompany this condition, Domenici announced that he would not seek reelection in 2008.

I have great sympathy for Domenici, who is in the twilight of both career and life. But should the people of New Mexico be represented for another year by a senator who admits to suffering from progressive dementia? I believe he should have resigned at the time his illness was diagnosed.

And then there is nonagenarian Sen. Robert Byrd (D-West Virginia), the longest serving senator in American history. In his 51st year in the Senate, the 90-year old’s public utterances speak for themselves.

As a voter and taxpayer but also as a physician, I worry about whether such people are fit to serve. Nor are these isolated examples. The two U.S. senators who are supposed to represent my own interests are dubious: Sen. Dianne Feinstein (D-Calif.), 74, and Sen. Barbara Boxer (D-Calif.), 67, give me cause for concern. Boxer usually seems befuddled, and flaws in knowledge and judgment make Feinstein a liability.

Other states have their own candidates for legislators who belong not in the House or Senate, but in assisted living. Too many are well past their use-by dates.

Perhaps we should treat dissatisfaction with our representation as a medical rather than a solely political issue. How? By asking candidates and incumbents to volunteer for periodic intelligence and mental status testing. After all, we often demand to know whether a candidate has recovered from open-heart surgery, cancer, or a stroke, and many states require elderly drivers to be relicensed.

A mental status exam by an expert offers an assessment of cognitive abilities, memory, and quality of thought processes. It includes assessments of alertness, speech, behavior, awareness of environment, mood, affect, rationality of thought processes, appropriateness of thought content (presence of delusions, hallucinations, or phobias), memory, ability to perform simple calculations, judgment (“If you found a letter on the ground in front of a mailbox, what would you do with it?”), and higher reasoning such as the ability to interpret proverbs abstractly: “A stitch in time saves nine.”

An intelligence test measures various parameters that are thought to correlate with academic or financial achievement. Every legislator need not be a genius, but I’d like mine to be smarter than the average person in the supermarket or laundromat. I’d like them to know the difference between DNA and the PTA.

The journalist and satirist H.L. Mencken observed, “Congress consists of one third, more or less, scoundrels; two thirds, more or less, idiots; and three thirds, more or less, poltroons.” Testing might help us to weed out a few idiots. Getting rid of the scoundrels and poltroons will have to wait.

Henry I. Miller, M.D., a physician and fellow at Stanford University’s Hoover Institution, was an official at the NIH and FDA from 1977 to 1994. Phone: (650) 725-0185. E-mail: miller@hoover.stanford.edu.

This site uses Akismet to reduce spam. Learn how your comment data is processed.