"There's a common thread to all of these conditions," deduced Mandel. "All I did was pick up the clues that were out there anyway."
According to Mandel, the thread was APS 2, also known as Schmidt syndrome. APS 2 is an autoimmune disorder, sometimes running in families, in which the body is unable to produce several essential hormones. Many APS 2 patients have problems with their sex glands, pancreas and digestive system. The American Academy of Family Physicians estimates that APS 2 affects five out of every 100,000 people in the United States.
Mandel found another set of clues in two of Kennedy's relatives. According to Mandel, Kennedy's younger sister, Eunice Kennedy Shriver, who recently died at the age of 88, had Addison's disease. His son, John Jr., had Graves' disease, another autoimmune condition.
"Approximately one half of patients with APS 2 have relatives with autoimmune diseases," added Mandel.
Since APS 2 was not described until 1980, Kennedy's physicians may not have suspected a unifying disease connecting his endocrine problems. Furthermore, treatment for APS 2 is the same as for Addison's. So, the new diagnosis does not mean that Kennedy was necessarily sicker than his physicians knew or less able to carry out his presidential duties, said Mandel.
"It just means that now we may have a better understanding of his health problems," Mandel said. "Remarkably, John F. Kennedy managed to convey an image of health and vigor."
Dr. Paul Margulies, medical director of the National Adrenal Diseases Foundation and a practicing endocrinologist from Manhasset, N.Y., agreed with Mandel's findings and recalled how careful Kennedy's doctors were to keep the president's true condition from the public.
JFK enjoyed a level of privacy (many would say
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