FOR some inexplicable reason, Prime Minister Patrick Manning has been missing a series of appointments scheduled by his office.

Within recent times, he has missed two very important functions hosted by the Trinidad and Tobago Manufacturers’ Association (TTMA).

He has been also known to miss several other functions across the country. The same could have been said for the summer months of last year and now, not even the Post Cabinet Press Briefing is graced with his presence.

Is the Prime Minister sending a subtle signal to those organisations whose functions he does not attend that they are being slighted?

Is he reducing his activities in the public domain for the purpose of curtailing any faux pas in a lead-up to the general elections?

More importantly, is the Prime Minister’s health unable to sustain him within recent times?

It would not be the first time that Heads of Governments conceal serious concerns with their health.

The most recent example was that of Ariel Sharon, the former Prime Minister of Israel who suffered a massive stroke on January 4, 2006 and has been in a coma since.

Neither Cabinet Ministers nor the public knew of the seriousness of his condition -- this at a time when Sharon was leading his country through a period of uncertainty.

Prime Minister Manning may or may not be faulted for hiding any serious medical condition he may have.

If there were the slightest hint that the Prime Minister was seriously ill, there would be the eruption of political infighting within the ruling party that would make the problems of the United National Congress (UNC) look like child’s play.

To be exact, our Prime Minister will not be the first head of a government to deceive the population about his health condition.

In November 1981, Francois Mitterrand was diagnosed as having disseminated cancer of the prostate in circumstances of great secrecy.

He had been elected President of France for the first time in May of that year.

This diagnosis was kept secret for nearly 11 years.

From having had a lively interest in all aspects of the Yugoslav problem, Mitterrand progressively disengaged until he retired in 1995, clearly dying. His illness once again raised questions as to the secrecy surrounding the health of Heads of Government and the extent to which their illness affects the way governments make decisions.

Woodrow Wilson suffered a right middle cerebral artery stroke in 1919 while in his second term as President of the United States.

His consciousness became impaired on October 2 with a “complete” paralysis of the left side of his body.

In not facing up to his illness, President Wilson referred to himself as being “lame.”

His wife and his personal physician who told the Cabinet on October 6, 1919, that Wilson was only suffering from a “nervous breakdown, indigestion and a deplet-ed nervous system”, buttressed this denial.

As a result, his wife is often spoken of as America’s only woman President.

Cancer and arteriosclerosis can lead to depressive illnesses, reduced energy and motivation, all of which can seriously affect decision-making, particularly in making leaders more inclined to the status quo, indecisive, less open-minded and readier to let the situation drift.

These characteristics were all apparent in many of the elderly leaders of Europe between the two World Wars, particularly Prime Minister Ramsay Macdonald in Britain, the Polish President Marshal Pilsudski and the Reich President of Germany, Hindenberg, whose frailty paved the way for Hitler.

Neville Chamberlain suffered from cancer of the stomach while he was Prime Minister. He was operated on in late July 1940, having only stepped down as Prime Minister on May 10, 1940, and continued as a member of the War Cabinet.

He resigned on October 3 and died on November 9.

Interestingly, when Chamberlain took over from Stanley Baldwin in May 1937, Churchill did not see him as likely to be soft on Hitler.

Even after the ill-fated Munich meeting with Hitler in September, Churchill was surprisingly supportive of Chamberlain and careful to avoid blaming him.

Only some time after Anthony Eden’s resignation as Foreign Secretary in February 1938, when the policy of seeking peace by appeasement with Hitler and Mussolini was well established, did Churchill give up on Chamberlain and begin to turn his fire on him, attacking him publicly for the first time on September 9, 1938.

It is impossible to prove whether Chamberlain’s cancer had any effect on his decisions in government, but it seems likely.

Another problem arises from drugs taken by Heads of State or Government, particularly in relation to Prime Minister Anthony Eden and President John F. Kennedy.

Most of the descriptions of Anthony Eden’s illness at the time of Suez in 1956 focus on his well-known problems with inflammation of the bile duct or cholangitis.

We know now that in the midst of the Suez Crisis, Sir Horace Evans, Eden’s physician, packed the Prime Minister off to Jamaica to recuperate.

He allegedly warned Eden that he could no longer afford to rely on the benzedrine, an amphetamine brain stimulant that he had been consuming in large quantities in the crisis up until then. Eden also told an adviser when the Suez Crisis blew up that he was practically living on benzedrine.

Eden’s medical records have never been fully disclosed, but on October 5, 1956 he had a shivering fever just two days after a critical meeting, running a temperature of 106 degrees.

This has been put down to his cholangitis, but may have been heightened by high dosages of amphetamine

President John F. Kennedy is now known to have had adrenal insufficiency.

At the post mortem, his adrenals were found to be greatly reduced in size, the result of disease and suppression following replacement therapy.

Yet, Kennedy, his doctors and his family consistently presented an image of him as being fully fit, apart from a wartime back injury, both prior to and after his election.

His brother, Bobby Kennedy, went as far as to deny he had “classical Addison’s disease”, using the word classical as a cover in that he did not have Tuberculosis (TB)-induced disease, then the most prevalent cause.

There were rumours that Kennedy was on heavy doses of steroids, particularly on occasions when his face showed a degree of puffiness, but they were never followed through by the Press.

Most political commentators agree that if it had been known that Kennedy was suffering from Addison’s and was on steroids he would not have beaten Vice-President Richard Nixon in the very close Presidential election of 1960.

The overriding question raised by all these case histories is how in a democracy it is possible to construct a mechanism whereby a Head of State or Government can be legitimately eased out of office.

Doctors have to be very careful in formulating fixed structures for a political situation that will often be in considerable flux.

First, we have to be clear as to whether it is reasonable for the personal physicians of a Head of State or Government to be charged with a dual responsibility -- both to the good of their patient and to the best interests of their nation.

I think it is not: although doctors cannot divorce themselves from their duties as a citizen, their primary purpose is to serve their individual patient.

In that balancing act, they should not lie in public statements about their patients, but they have no mandate to disclose that which their patient refuses to sanction. They can, however, fall back on silence.

If these criteria are accepted, a personal physician for a Head of State or Government can never be a substitute for independent medical assessment.

On balance, I believe there should be provisions in place in a democracy to ensure that before voting any candidate for Head of State or Government into office, whether for the first or for subsequent elections, the general electorate should know the results of an up-to-date independent medical examination.

Relying on a politician, ambitious for office, to reveal their true health or on their own personal doctor, family or friends is not sufficient.

Nor can electors depend on probing journalists or fellow politicians to know the medical condition of a candidate, particularly those who have not already been subjected to the intrusive scrutiny surrounding a Head of State or Government.