When a former president receives a serious medical diagnosis, the traditional response has been to set aside political differences, offer warm praise and wish the individual a speedy recovery and complete return to health.
In many cases, that’s exactly what happened Sunday after former president Joe Biden disclosed that he has an aggressive form of prostate cancer. President Donald Trump, who has repeatedly attacked Biden since taking office, wished Biden “a fast and successful recovery.”
But in a reflection of today’s harsh political environment and reignited questions over Biden’s health during his reelection campaign and his inner circle’s handling of the situation, some Republicans and right-wing activists wasted little time asserting, without evidence, that Biden and his circle covered up the diagnosis.
Trump, speaking in the Oval Office on Monday, said the diagnosis was “very sad, actually” and that he felt “badly about it.” But he also questioned why it wasn’t caught earlier.
“That test is standard to pretty much anybody getting a physical, a good physical,” he said. “We had the doctors at the White House and over at Walter Reed, which is a fantastic hospital. I do it – I did a very complete physical, including cognitive tests.”
Trump inaccurately referred to Biden’s diagnosis as “stage 9,” an apparent reference to a pathology report giving his cancer a Gleason score of 9 on a scale that rises to 10 and indicates an aggressive cancer. Trump also questioned Biden’s cognitive ability.
“If you take a look, it’s the same doctor that said that Joe was cognitively fine, there was nothing wrong with him,” Trump said. “If it’s the same doctor who said there was nothing wrong there, that’s being proven to be a sad situation. … The doctor said he’s just fine. And it’s turned out that’s not so. It’s very dangerous.”
“Unbelievable this was missed, but the truth is, his physician was more concerned about assisting with the political cover up than providing world class medical care,” Rep. Ronny Jackson (R-Texas) posted on social media Sunday night.
Jackson was himself White House physician to President Barack Obama as well as Trump. He drew attention in 2018 for an effusive report on Trump’s condition, saying the president had done “exceedingly well” on a cognitive exam and had “incredible genes.”
The varying messages emerged as Biden thanked Americans on Monday for their “love and support.”
“Cancer touches us all,” Biden wrote on X in his first public comment about the diagnosis. “Like so many of you, Jill and I have learned that we are strongest in the broken places. Thank you for lifting us up with love and support.”
Biden shared a picture of himself seated with former first lady Jill Biden and their cat, Willow.
His cancer diagnosis renewed debate about who should receive annual screenings, and at what age, for signs of the disease. Prostate cancer specialists told The Washington Post that it is not unusual for someone Biden’s age to skip screening for prostate-specific antigen (PSA), which, when elevated, can indicate a higher risk of prostate cancer.
The U.S. Preventive Services Task Force, which makes medical recommendations about preventive services such as screenings, explicitly recommends against PSA screening in men 70 years and older. For men ages 55 to 69, the decision should be an individual one, it says. The guidelines note that “many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction.”
Biden’s prognosis depends on many factors that are not known publicly, said William Dahut, chief scientific officer of the American Cancer Society. That includes the degree to which the cancer has spread into the bones and whether it has reached organs such as the liver, Dahut said.
Ezekiel J. Emanuel, an oncologist and professor at the University of Pennsylvania who served on a covid-19 advisory board for Biden, said on MSNBC on Monday that Biden “probably” had the cancer “at the start of his presidency in 2021” because the former president “did not develop it in the last 100, 200 days.” Emanuel said later in an interview with The Post that the point he was trying to make is that the kind of cancer Biden had was “present” during his time in office “because this kind of cancer doesn’t develop overnight.”
“I didn’t say that there was a conspiracy,” Emanuel said. “I was very clear that he did have cancer, that’s a fact. That he knew or didn’t know, I don’t know and they don’t know.” Emanuel added that he “should have” clarified that his point “doesn’t mean the president knew” he had cancer.
Oncologists specializing in prostate cancer said even aggressive cancers can appear suddenly or without symptoms. “It’s certainly possible for more aggressive, advanced cancers to develop in a setting with low PSA, or develop and spread rather quickly, on the order of less than a year,” said Jason Efstathiou, a prostate radiation oncologist at Mass General Brigham.
Biden’s life and political career has been defined by both tragedy and triumph – his longtime aide and confidant Ted Kaufman has often described him as “the luckiest and the unluckiest person I’ve met” – and the news on Sunday reverberated around the universe of former Biden aides.
“The first thing he wanted to know when I was diagnosed was, ‘Was I happy with my doctors? Was I getting the advice I needed?’” said TJ Ducklo, a Biden aide who during the 2020 presidential campaign was treated for Stage 4 lung cancer. “He right away jumps at that.”
Many of the responses Sunday and Monday, from Republicans and Democrats alike, were in a supportive vein. “This is certainly sad news, and the Johnson family will be joining the countless others who are praying for the former president in the wake of his diagnosis,” House Speaker Mike Johnson (R-Louisiana) posted on Sunday night.
But some took a different tone.
Donald Trump Jr., the president’s son, posted an accusatory message just hours after Biden’s diagnosis became public suggesting the Biden family hid his condition. “What I want to know is how did Dr. Jill Biden miss stage five metastatic cancer or is this yet another coverup???” he wrote.
Former first lady Jill Biden has a doctorate in education but is not a medical doctor. Trump’s supporters often mocked her for using the honorific when the Bidens were in the White House.
Some of the criticism has focused on Biden’s last medical report as president, in February 2024, when his physician declared Biden in good health and cited no prostate issues. Some conservatives say that exam should have picked up Biden’s cancer, so either it wasn’t performed or the White House is covering it up.
“Is Team Biden accusing the WH physician of malpractice? Or just lying? Again,” conservative radio host Hugh Hewitt wrote on social media.
White House press secretary Karoline Leavitt on Monday reiterated Trump’s supportive comments about Biden from Sunday night. She said that the two men had not spoken, but that Trump “would be open to doing that.”
Asked whether Trump was concerned about the quality of the White House physicians and whether they should have caught the diagnosis sooner, she said, “Not as far as President Trump is concerned. The White House physician we have here is phenomenal.”
“To the best of my understanding,” Leavitt added, Trump, who is 78, is regularly screened for prostate cancer in his medical evaluations. His latest report, released in April, included a Prostate-Specific Antigen level of 0.10 ng/mL, well below any levels indicating a prostate cancer risk.
For years, Trump and some of his prominent allies have been quick to embrace and spread conspiracy theories about political opponents, giving them a particular resonance with his supporters, said Joseph Uscinski, a political scientist at the University of Miami.
“People who have a conspiratorial worldview or who don’t like Biden for whatever reason will not trust information about Biden, and they will come up with their own explanations,” said Uscinski, who studies conspiracy theories.
But the situation has been complicated by renewed accusations that Biden’s team covered up his cognitive decline as he pushed ahead with reelection. That charge is leveled in several new books, including “Original Sin: President Biden’s Decline, Its Cover-Up, and His Disastrous Choice to Run Again” by Jake Tapper and Alex Thompson.
“Original Sin” is scheduled to publish Tuesday – but now it will appear in a suddenly altered landscape.
The last few days have amounted to a striking sequence of events for the 82-year-old Biden, who is in the twilight of a long career after ceding the White House four months ago to a rival whose ouster was his stated reason for running for president.
Biden received the diagnosis of aggressive prostate cancer on Friday, his office said. That evening, Axios published an excerpt from Biden’s 2023 interview with special counsel Robert K. Hur, in which Biden speaks haltingly, including a digression about Beau’s death.
“In 2017, Beau had passed and … this is personal …” Biden can be heard saying. “I know you’re all close with your sons and daughters, but Beau was like my right arm, and Hunter was my left.” Hunter is Biden’s younger son.
Biden’s office announced his diagnosis on Sunday night, saying it “represents a more aggressive form” of cancer but that it appears to be sensitive to hormone therapy, allowing “for effective management.”
Some Republicans on Monday were trying to find a balance between wishing Biden well and continuing their attacks on his party. Vice President JD Vance said he wished Biden “the best” of health, but argued it was still fair to question whether his advisers hid his condition.
“Whether the right time to have this conversation is now or at some point in the future, we really do need to be honest about whether the former president was capable of doing the job,” Vance told reporters aboard Air Force Two.
“You can separate the desire for him to have the right health outcome with a recognition that whether it was doctors or whether there were staffers … I don’t think he was able to do a good job for the American people,” he added.
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Dan Merica and Ariana Eunjung Cha contributed to this report.
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