When Dr Miriam Adelson was awarded the US Presidential Medal of Freedom, the nation’s top civilian honor, by Donald Trump in November, the public response ranged from disdainful to “who?” Her husband, the casino billionaire Sheldon Adelson, is widely known for his record donations to Republican causes, as well as passionate support for conservative Israeli interests. Many news articles about the award described Miriam solely as his wife.

But Miriam’s influence has been deeper than many credit, although she appears to have been perfectly comfortable remaining in her 85-year-old husband’s shadow until recently.

Facebook Twitter Pinterest Donald Trump awards the Presidential Medal of Freedom to Miriam Adelson at the White House on 16 November 2018. Photograph: Saul Loeb/AFP/Getty Images

The 73-year-old has played a pivotal role in forming the couple’s interests and alliances in the US, where she is a naturalized citizen, and in her native Israel, according to public records and interviews with people who know her socially and professionally. Evidence suggests that she is the driver in the couple’s political and philanthropic activities, whether pushing for the relocation of the US embassy to Jerusalem from Tel Aviv or donating an unprecedented $113m to this year’s midterm elections

“Everybody says it’s Sheldon, but it’s Miriam,” says Michael Cherry, the associate chief justice of the Nevada supreme court, who sits on the board of the Las Vegas methadone clinic that the Adelsons founded.

“Sometimes I chuckle and sometimes I just shrug,” says Ron Reese, the senior vice-president of communications for the Las Vegas Sands Corp, the casino company that Sheldon created.

Case in point: a photo of Sheldon that accompanied some stories about their midterms donations cropped Miriam out, leaving only bits of her spiky blonde hair and one lens of her rimless glasses. Paul Krugman, the New York Times columnist, tweeted, “Some thoughts on giving Miriam Adelson, who has done nothing for her country besides being the wife of a Trump-friendly megadonor, the Presidential Medal of Freedom. Of course it’s ludicrous, and an insult to people who received the medal for genuine service.”

Paul Krugman (@paulkrugman) Some thoughts on giving Miriam Adelson, who has done nothing for her country besides being the wife of a Trump-friendly megadonor, the Presidential Medal of Freedom. Of course it's ludicrous, and an insult to people who received the medal for genuine service. But ... 1/

The Adelsons declined to be interviewed for this story, but Miriam told a Fortune writer in 2012 that “Sheldon is everything to me. He is my best friend, as I know I am to him, and he is a ‘mensch’. He claims that I’m an angel and I say he is the ‘wind beneath my wings’. In any case, we are on a magnificent flight together.”

One of the few outward hints of Miriam’s powerful role comes with the couple’s his-and-hers political contributions – made to the same candidates and causes, in identical amounts. When the couple gave $30m to the Congressional Leadership Fund, dedicated to electing Republicans to the US House of Representatives, last May, it was $15m from him and $15m from her.

Miriam turns out to be far wealthier than her husband, who was ranked #21 on the Forbes 2018 billionaire ranking. She appears nowhere on the Forbes list, but according to the corporate filings of the Las Vegas Sands Corp casino company, which accounts for the bulk of the couple’s wealth, she directly controls a 41.6% stake, compared to her husband’s 10%.

Worth $17.4bn at the current stock price, her holdings make Miriam wealthier than a number of the world’s richest men, including Rupert Murdoch and Charles Schwab.

Sheldon serves as Las Vegas Sands’ chairman. Miriam is director of community outreach. It isn’t an executive role, but her presence in the executive offices is commonplace. Nevada journalist Jon Ralston recalls Miriam walking unannounced into Sheldon’s sprawling office during an interview about online gambling. “Suddenly it was, ‘Sheldon, tell him that’s off the record’,” Ralston recalls. “He’s just so blunt and I think that worries Miriam.”

Facebook Twitter Pinterest Las Vegas Sands chairman Sheldon Adelson has suggested he listens closely to his wife. Photograph: Tara Todras-Whitehill/AP

Sheldon has suggested that he listens closely to his wife. In a court hearing over his early deal to build a casino in Macau, Sheldon quipped that he’d been told not to discuss the touchy subject of gambling when he met with China’s vice premier in 2001. “I was a good boy, like when my wife tells me to shut up, I shut up,” he said, according to the Las Vegas Sun.

The couple met on a blind date after Sheldon told a friend he’d like to date an Israeli woman. Sheldon grew up in Boston in a working-class family that voted Democratic. His mother immigrated to the US from England while his father was of Ukranian and Lithuanian-Jewish ancestry.

He had a reverence for Israel. On an early trip there, Reese says, Sheldon donned a pair of his late-father’s shoes so they could at last touch Israeli soil.

Sheldon was a serial entrepreneur from a young age, running businesses that ranged from windshield de-icing kits to Comdex, once the leading computer industry tradeshow. When he and his partners sold Comdex in 1995, it provided the wealth he used to demolish the one-time Rat Pack hangout Sands Casino and build the Venetian. His experience in the conference business led him to a less gambling-centric approach to casinos that was so successful it inspired rivals including Steve Wynn to establish their own conference centers.

Miriam Ochshorn Adelson – “Miri” to friends and “Dr Miriam” to some colleagues – was born in Tel Aviv in what was then the British Mandate of Palestine to parents who had escaped Poland in the 1930s. Her grandparents and extended family were killed in the Holocaust. “They raised me to foster and fight for liberty – for myself, for my people, for wider humankind, and at all times,” Miriam once wrote in a column. She described serving as a medical research officer in the Israel Defense Forces and developed an interest in treating drug dependency partly after helping prostitutes who took to the streets to feed their addictions. The Israeli Ministry of Health recommended Miriam to study at Rockefeller University in 1986 under Dr Mary Jeanne Kreek, a leading researcher in the discovery of methadone as a heroin addiction treatment. Kreek became Miriam’s mentor and friend. Two years after her arrival in New York, Miriam asked Kreek and her husband to come to dinner with a man she was dating. It was Sheldon.

Kreek describes Miriam as “driven by science, medicine helping people suffering from addictive diseases”.

“I will tell you that Miriam didn’t feed off of Sheldon,” says Kreek. “Miriam helped shape Sheldon and make him who he is today.”

The Adelsons married in Jerusalem in 1991, honeymooning in Venice, where Sheldon has credited Miriam with having the idea to theme his first Las Vegas casino as the Venetian, building a canal with gondoliers and replicating details of many of the city’s famous palazzos.

Federal election records reflect that Sheldon’s first political donation, in 1984, was $1,000 to the Democratic candidate from Massachusetts for US Senate, John Kerry. Miriam’s US political contributions began in 1991 – also to Democrats. Yet by the late 1990s, the majority of the Adelsons’ support went to Republicans.

Facebook Twitter Pinterest Former New York City mayor Rudy Giuliani kisses the hand of Miriam Adelson before the first presidential debate in September 2016. Photograph: Win McNamee/Getty Images

Former Nevada senator Harry Reid says labor disagreements triggered Sheldon’s shift to the right. “He had a beef he couldn’t settle with the unions,” Reid says. “That was what did it.”

The Adelsons’ ambitions in politics were unleashed by a 2010 US supreme court ruling, Citizens United v FEC, which removed limits on political spending by corporations. Two years later, Sheldon told Reese he planned to give several million dollars to support Newt Gingrich’s unlikely presidential campaign, and subsequently forked over a total of $20m. Reese recalls that he told Sheldon, “it’s going to change everything. You guys are testing a new law.”

In this year’s midterms, their donations went largely to Republican candidates, and political action committees supporting them, across the country.

Politics are by no means the Adelsons’ main preoccupation. Miriam founded an addiction treatment clinic in Tel Aviv in 1993 and a second in Las Vegas in 2000, where she is said to don a white lab coat and treat patients. “She runs the meetings. She’s got time for everybody. I just think she walks on water,” says Cherry. He adds, “I can’t stand Sheldon’s political views. I’m a Democrat.”

Mark Parrino, the president of the American Association for the Treatment of Opioid Dependence, describes the Las Vegas clinic as “a very good clinic”. Reid, for his part, calls Miriam a “visionary”.

Raising their two sons in Las Vegas, the Adelsons have also given an estimated $100m to turn the region’s Hebrew day school into a preschool-through-12th-grade institution.

The school philosophy promotes “Adelson values” – described on its website as associated “with the Hebrew word ruach, which translates as spirit or soul”. Each morning, students recite the US pledge of allegiance, then sing the “Hatikvah,” Israel’s national anthem, says Matt Boland, the school’s director of marketing and communications.

The most radical thing about the school may be its enforcement of a stringent no-drugs policy. Every student and employee is required to be randomly drug tested three to four times per year. Miriam does some of the testing herself, Boland says. Those who fail a test are privately counseled, with education about the physical and mental effect of drugs.

Facebook Twitter Pinterest Miriam Adelson took over as the publisher of the daily newspaper Israel Hayom this summer. Photograph: Baz Ratner/Reuters

The Adelsons jet frequently from Las Vegas to Tel Aviv, and they pushed for the controversial transfer of the US embassy to Jerusalem, offering to pay for its cost in the face of vociferous international condemnation. “He was able to get Trump to move the embassy,” says liberal political commentator Noam Sheizaf. “He is one of the most important players around Israeli politics and very controversial. … Everything Adelson says or does is news in Israel right now.”

The question is which Adelson is in the driver’s seat. Miriam, who appears to many around her to be the unrecognized ideological force behind many of the couple’s causes, may be seeking a more public role. She took over this summer as publisher of the Israel Hayom, the free Hebrew language daily newspaper that the Adelsons founded and she owns.

Sometimes called Israel’s Fox News for its conservative stances, the paper is Israel’s most-read daily and is sometimes called the “Bibiton” – a combination of conservative Prime Minister Benjamin Netanyahu’s nickname and the Hebrew word for newspaper. The Adelsons have a long friendship with the embattled Netanyahu, who has referred to Sheldon as “the gingy” for his reddish hair.

To Miriam and many around her, Trump’s medal caps a lifetime of strident effort. At the ceremony, Kreek sat in the fourth row. Miriam wore a bright red dress she had made for the occasion. She described the experience in a column for Israel Hayom:

“When (Trump) clasped America’s highest civilian honor around my neck, I was euphoric with wonderment and gratitude,” she wrote. She thanked the president for his support in what appeared to be a reference to the US embassy move to Jerusalem. “He knows that one has to stand for what is right, even if that means standing alone.”