A few years ago while reading a book about the history of tuberculosis (TB), I came across an interesting reference. The author quoted the person who discovered Streptomycin, the drug that finally brought TB under control, that he received a letter from the personal physician of a ‘leader of a country’ enquiring about the availability of this drug. Another letter followed a few months later saying that the drug was no longer needed. Since these communications occurred in the late 1940s, the leader in question could very well be Mohammad Ali Jinnah, the first governor-general of Pakistan. The fact that Jinnah was dying from TB is of great relevance to the history of Pakistan. First of course if the Indian Congress leaders and Lord Mountbatten had known about this, they might have delayed partition until Jinnah’s death, thereby preventing the partition of India. But then the fact that Jinnah was sick and died soon after the creation of Pakistan presented an entire set of challenges to the new country. Many of our present problems might have been avoided if he had lived longer. We in Pakistan might have gotten a constitution within a few years of the creation of the country and the ‘Objectives Resolution’ would never have happened. Besides Jinnah, Ghulam Mohammad — our third governor-general — had suffered a serious stroke while in office. Arguably his sickness might have been an important factor in some of the ‘bad things’ that happened to Pakistan during his time in power. There are rumours that towards the end of his tenure it was essentially his nurse that ran the country and he was not even capable of understandable communication. He was finally removed from office due to his medical condition and replaced by Iskander Mirza. Then again, Ayub Khan — the first military dictator of Pakistan — towards the end of his decade in power was seriously sick with heart trouble. This might well have been the reason why the agitation against his rule was so successful, making him leave and hand over the government to General Yahya Khan. Perhaps if Ayub Khan was in better health, he might have moved to a more democratic system instead of just giving up. In Pakistani history the health of our leaders has played an important role. In the US, the health of the president is a major concern. First because of a serious ‘stroke’ that left President Woodrow Wilson (1913-1921) incapacitated and for a while his wife essentially functioned as an ‘acting president’, not unlike what happened to Ghulam Mohammad as governor-general of Pakistan. President Feodor Delano Roosevelt (FDR) became president even though he was afflicted by polio. By the time he won his last presidential campaign, he was very sick and died soon after. President Kennedy also had various medical problems for which he received multiple medications. The American public was not aware of the medical problems of either of these presidents. However, with nuclear weapons an intact and reliable chain of command is vital. To make sure that there was some sort of legal recourse when a president became incapacitated for any reason, the 25th Amendment to the US constitution was passed in 1967. This amendment created a mechanism where if a president felt that he was not able to govern for any reason he could give over his powers to the vice-president and then reclaim them when he was able to govern again. Also, it allowed the vice-president and the cabinet to declare that the president, because of illness or other reasons, could not perform his duties and the vice-president took over until the president declared that he was able to resume the duties of his office. Obviously no such mechanism is available in Pakistan. If the prime minister or a president becomes too sick to function, they stay in ‘office’ unless they get better, resign or else are removed through existing constitutional means of impeachment for the president or a vote of no-confidence for a prime minister. The recent illness of President Asif Ali Zardari has made these issues extremely relevant. President Zardari evidently had a mini-stroke or what in medical lingo is called a Transient Ischemic Attack (TIA), and thankfully it seems that he is recovering well from it. If, for the sake of argument, we presume that President Zardari was temporarily disabled and if he was still in Pakistan, he would still be the president with all the powers of that office. That he is out of the country allows the chairman of the Senate to take over. President Zardari is not the only Pakistani ‘leader’ with health problems. Mian Nawaz Sharif, the head of his own faction of the Pakistan Muslim League, developed life-threatening complications earlier this year while having a ‘routine medical procedure’. My basic contention here is that the public has a right to know about the serious health problems of its political leaders and this right of the public takes precedence over the right to privacy in most circumstances. This is much more important in the present environment of a free media and the internet with a perpetual news cycle where even the most insignificant rumour gets spread around almost immediately. If factual information had been made available early with regular updates about President Zardari’s medical condition, then the entire media circus and bizarre rumours that surrounded his departure to Dubai could have been avoided. Also, when either the president or the prime minister become incapable of performing their duties due to any reason, there should be a mechanism available by which a temporary transfer of power takes place. In a dictatorship this would not be possible for obvious reasons but in a democratic system some mechanism must be available to maintain the chain of command. After all, if the US president has a finger on the ‘nuclear button’, then at least constitutionally so does the president of Pakistan. The writer has practised and taught medicine in the US. He can be reached at smhmbbs70@yahoo.com