Some medical experts have called for taking medical assessments out of the hands of the campaigns, moving instead to a system in which an independent panel subjects candidates to a battery of mental and physical tests. But there’s been little discussion of the idea this election cycle.

Candidates’ longstanding practice of releasing a doctor’s note was effectively reduced to a charade in the last presidential race, when Trump allegedly wrote his own medical note. Trump’s personal doctor at the time, Harold Bornstein, in a bombastic letter assured Americans that Trump, then 70, would be “the healthiest individual ever elected to the presidency.” Bornstein, who is no longer Trump’s doctor, later claimed the language came directly from Trump.

There’s no evidence this year’s candidates are similarly playing doctor. But voters could be fooled into thinking, without more corroborating details, that the oldest field of presidential candidates in modern history is also among the healthiest.

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Bloomberg, the 78-year-old former mayor of New York City, is in “outstanding health” and “in great physical shape,” Bloomberg's personal doctor wrote in December. The letter also acknowledges that Bloomberg needed a stent for a clogged artery, has had skin cancers removed and takes a medication known as a beta-blocker that regulates his heart rate.

Doctors notes released by Sanders, who is also 78, included a claim from one physician that he was “more than fit enough to pursue vigorous activities and an occupation that requires stamina and an ability to handle a great deal of stress.” The letters further noted that Sanders suffered heart damage after his October heart attack and received two stents to open a clogged artery.

Other candidates have disclosed significant medical events in their past. Joe Biden, the 77-year-old former vice president, needed brain surgery after suffering a hemorrhage in 1988. Doctors also caught another aneurysm at the time, though there’s been no recurrence. Biden's doctor in December released a note that called him “healthy, vigorous [and] fit to successfully execute the duties of the presidency."

Meanwhile, 70-year-old Sen. Elizabeth Warren is “in excellent health” and has "no medical conditions or health problems that would keep her from fulfilling the duties of the President of the United States,” her personal physician wrote in a letter released in December. Warren takes medication for just one medical problem, a common autoimmune condition known as hypothyroidism, according to the letter.

Trump’s own medical history has been the subject of persistent questions, most recently after an unplanned trip to Walter Reed Medical Center in November. The president also nominated his personal White House physician, Ronny Jackson, to run the Department of Veterans Affairs in 2018, just two months after Jackson praised Trump's "excellent" health and “great genes” in a televised briefing. Jackson later withdrew his nomination amid questions about his prescribing practices and damaging allegations about drunk driving, which Jackson denied.

In this year’s race, Sanders is facing new questions after previously promising to be fully transparent about his personal health. Sanders was slow to admit he had a heart attack in the fall.

“It’s the right thing to do,” Sanders said in November, when he promised a fuller accounting. “The American people have a right to know whether the person they’re going to be voting for, for president, is healthy.

But Sanders on Tuesday night said his campaign has released "quite as much as any other candidate has” on personal medical information and said he doesn’t think the campaign will release further details.

Asked on Wednesday about the senator’s apparent reversal, Sanders spokesperson Briahna Joy Gray charged that the persistent questions amounted to a “smear” campaign, while also falsely asserting Bloomberg had multiple heart attacks. Bloomberg adviser Tim O’Brien condemned Gray’s statement as a “Trumpy lie” before Gray said she had misspoken.

Sanders has also suggested it’s impossible to satisfy questions about a politician’s health. “You can start releasing medical records, it never ends,” he told NBC’s Chuck Todd earlier this month.

There’s evidence that Sanders has a point. Seeking to tamp down questions about his health, GOP candidate John McCain released thousands of pages of medical records to select reporters in May 2008 when he was 71. But McCain continued to be dogged by criticism — including ads in The New York Times — that he wasn’t sufficiently transparent and at risk of a medical event if elected president.

McCain died in August 2018, more than a year and a half after his second term as president would have concluded.