Why Is Susan Collins Shaking?

It’s not because of the major media coverage

Senator Susan Collins

With a single tweet last week, I forced virtually every major media outlet to finally report on 73-year-old Maine Senator Susan Collins’ visible and worsening tremor.

But they’re still not telling the truth.

After 78-year-old Gov. Janet Mills dropped out of Maine’s U.S. Senate race, I was curious who upstart Graham Platner would be facing. Watching Collins' video announcing her sixth-term bid, I noticed the senior senator visibly shaking despite some clever camera cuts. When I checked the coverage, I was amazed no one had ever reported on her tremor.

So I tweeted the video clip, saying she was vibrating like an electric toothbrush. I’d like to apologize for that. On reflection, she shakes more like a chihuahua in the snow.

My tweet went so viral that within days, Collins was compelled to respond.

Here’s what Collins told a local NBC affiliate she granted an exclusive interview: “What I have is an extremely common condition that is called a benign essential tremor.” The outlet, News Center Maine, used the same language in its headline: “Sen. Susan Collins reveals medical condition: benign essential tremor.”

There’s just one problem. The condition isn’t actually called that. It’s called “Essential Tremor.”

Movement-disorder neurologists dropped the word “benign” from the name over a decade ago — and for good reason. The condition coincides with a 300 percent increased risk of dementia and a 45 percent increased risk of death. For many people the condition is debilitating, with 85 percent of patients seeking treatment reporting “functional disability” in daily life tasks like eating and drinking. Even sleep often becomes difficult. As a result, about 80 percent of patients screen positive for signs of clinical depression — the same rate as found in Parkinson’s cases.

In other words, Collins isn’t being honest; but the local media amplified her framing anyway, too lazy (or cushy) to independently check. And then the New York Times and other national outlets did the same.

Here’s the real story.

In 2011, two prominent neurologists working on the disorder — Elan D. Louis of Columbia (now at UT Southwestern) and Michael S. Okun of the University of Florida — published a paper titled, “It is Time to Remove the ‘Benign’ from the Essential Tremor Label.”

The old picture of essential tremor as a mild, single-symptom nuisance is wrong, they argued. Newer evidence has recast it as a progressive disorder linked to cognitive decline, mood disturbance, gait problems, hearing deficits, and even increased mortality. Calling it benign, they wrote, “is a mischaracterization of the disease course, and could prove misleading.”

Quoting from the paper:

“Over recent years, the older view of ET as a simple, monosymptomatic condition has been challenged, as new data have emerged painting a picture of a progressive disorder associated with several co-morbidities, and possibly even an increased risk of mortality.”

Today, medical institutions use the term “Essential Tremor.”

So how did countless national news outlets end up parroting a retired medical term? Because the local outlet she chose to give the exclusive to didn’t question it. And this wasn’t the first time.

The reporter behind the story, News Center Maine’s Phil Hirschkorn, got another campaign exclusive from Collins in which he somehow forgot to do his homework.

“Sen. Susan Collins says if she wins in November, it’ll be her last term,” another Hirschkorn exclusive from earlier this year reads.

What the reporter neglected to mention anywhere in the story is that Collins made this pledge before. During a televised debate during her first campaign for Senate in 1996, candidate Collins looked into the camera and said:

“I do support term limits and I have pledged that if I’m elected, I will only serve two terms, regardless of whether a term limits law or constitutional amendment passes or not. Twelve years is long enough to be in public service — make a contribution and then come home and let someone else take your place.”

Now Collins is running for her sixth term, after 29 years in office.

In other words, Collins made and violated the exact same promise she’s making now — something Hirschkorn should have at least mentioned in his article (or better yet, pressed her on).

To back up Collins’ “benign” framing, Hirschkorn quoted Dr. Rees Cosgrove, Chief of the Division of Functional Neurosurgery at Mass General Brigham. He said essential tremor is “not at all” incapacitating, that it isn’t associated with “cognitive decline or memory decline,” and — when asked whether it’s a physical condition without a mental component — replied, “Absolutely.”

Cosgrove is a real expert. He performs focused ultrasound treatments that target the part of the brain causing the tremor and destroys it. But in his own publications going back decades, I cannot find a single instance where he calls it “Benign Essential Tremor.” He calls it “Essential Tremor.” Because that’s what it’s called.

On a Mass General Brigham page detailing the procedure, Cosgrove says of patients: “This is the operation that makes grown men cry. They’re so emotional and they can’t believe that their hand, which has been shaking for years, isn’t shaking anymore.”

In a video interview, Cosgrove describes a grown man crying with relief after the treatment.

“One man who had had tremor since university days, and, uh, he was never really able to be fully employed at the level because he was socially so, uh, cognizant and reticent about being in public because he had such severe shaking… as he wrote his name, he started crying because he said, ‘You know, I haven’t been able to do that in 20 years.’”

But not at all incapacitating! What?

Essential Tremor also gets worse with age. Cosgrove’s clinical page lists “at least 70 years old” among the criteria for surgical intervention. Collins is 73. He also lists current medication use as a criterion. Collins has confirmed she takes medication for the condition.

In Collins’ statement to the AP, picked up by the Times and everyone else, she took a swipe at me.

“The tremor is occasionally inconvenient, and sometimes the subject of cruel comments online, but it does not hinder my ability to work,” she said.

You know what I call cruel? A sitting U.S. senator, facing a tough reelection, throwing millions Americans living with Essential Tremor under the bus to control a news cycle. Many of those people cannot work. Some sit in Dr. Cosgrove’s surgical suite and weep when their hands stop shaking for the first time in decades.

But that’s not how decorum works. “Cruel” is what little people get called; for the powerful like Collins who make decisions that result in layoffs, in cuts to public services, and in wars, she’s just being clear-eyed, hard-nosed, unsentimental.

It’s possible that Collins is one of the lucky ones who has a good prognosis. But how could she know for sure? And isn’t it the job of journalism to question and give the voters the opportunity to decide what they make of it? Instead, virtually every major outlet picked up News Center Maine’s “benign” framing — which is to say, they picked up Collins’ framing.

The New York Times’ headline reads, “Susan Collins Says She Has Long Had a Benign Tremor.”

NBC News at least put scare quotes around it: “Sen. Susan Collins reveals ‘benign’ tremor, says it hasn’t affected her job or how she feels.”

The Associated Press wire moved with “benign essential tremor” in the lede, and outlets from Fortune to ABC and even People Magazine ran with it.

All of these headlines are a subtle way of telling the public to stay in its lane, that you’re not authorized or credentialed enough to care about this issue.

Now some of you wince at the language I used to describe Collins’ tremor. Fine. But can you argue with the results? The announcement video had been on YouTube for three months — about as glaring a tableau of the gerontocracy as you could find anywhere — and not one major outlet had touched it. Until I posted the word “toothbrush.”

On the Breaking Points show, conservative commentator Emily Jashinsky noted that questions about Collins’ health had been circulating among Republicans for years before I broke the silence. Years. That’s the kind of logjam the media could break if it just spoke plainly about things.

The Times, hilariously, acknowledges this in its prim and proper way, linking to my post but refusing to quote it. The Times says:

“Her remarks came amid mounting online scrutiny — pushed in particular on the left — of the shakiness that is often detectable when Ms. Collins speaks, and questions about whether it has worsened with time.”

Questions about whether it has worsened with time? Anyone with access to YouTube can pull up Collins from ten years ago and Collins from last month and answer that question in about 30 seconds. The condition is well-documented as progressive. But the Times can’t just say what it plainly sees. In old school journalism, what I call Journalism 1.0, stating the obvious is considered “editorializing.”

Then there’s “pushed in particular on the left.” That little label reduces the scrutiny to partisan sniping. It suggests this is just “left” criticism, a tribal food fight. I’ve been writing about gerontocracy for years, and I’ve been just as blunt about Joe Biden’s decline and plenty of other Democrats. I don’t need to launder that through quotes from operatives or experts. I just say it.

That’s the core problem. The straitjacket of Journalism 1.0 is that reporters are not allowed to describe reality in their own words. They must route everything through someone else’s mouth. So they go hunting for the most “authoritative” voice they can find — which, in this case, turns out to be the politician with the strongest incentive to minimize the story. And so we get “benign.”

Here is how that works in practice:

1. A senator hands a friendly local outlet her preferred language.

2. The local outlet prints it.

3. The networks pick it up from the local.

4. The wires pick it up from the networks.

5. The national papers pick it up from the wires.

At no point does anyone in this chain stop and ask whether the word is medically accurate, or even consistent with the facts in front of them.

That is Journalism 1.0 in a nutshell. And clearly, newsrooms have learned nothing from the Biden episode.

The stakes here are not small. Collins is in one of the most closely watched Senate races in the country. She’s up against 41‑year‑old Democrat Graham Platner, a combat veteran who has been open about his own health — chronic pain, PTSD, a 100 percent VA disability rating — while continuing to work as an oyster farmer. Collins, by contrast, said nothing about a condition she now admits she has had for her entire 29 years in the Senate.

That is an actual story. And the only reason it is being told at all is because some punk outside the DC cocktail circuit had the audacity to type the word “toothbrush.”

— Edited by William M. Arkin