If Woodrow Wilson hadn't suffered a devastating stroke in 1919, might he have been able to drag the United States, kicking and screaming, into the League of Nations, and would her participation have made it effective in preventing the Second World War? If Mountbatten and Nehru and Gandhi had realized that Jinnah was dying of tuberculosis, could they have withstood his demands for a separate Muslim nation and prevented Partition of the Indian subcontinent? If the Western powers had known of the Shah of Iran's leukemia, would they have earlier forced him to create a regency and a managed succession, and avoided the Islamic revolution; and might this have forestalled the USSR's invasion of Afghanistan in 1979, the Iran-Iraq war of 1980-88, the Iraqi invasion of Kuwait, the consequent presence of U.S. troops in Saudi Arabia which so enraged Osama Bin Laden and, who knows, the present debacle in Iraq? The game of What If...? is irresistible, and this is the grown-up version of it.

David Owen was first a medical doctor, specializing in neurology. He became a Labour MP and, in due course, the youngest Foreign Secretary since Anthony Eden. He was later ennobled by Margaret Thatcher for his services to Conservatism via his part in splitting the Labour Party, or it may have been to impress foreigners so that he could sort out former Yugoslavia. (Opinions differ.) At any rate, he's a proper doctor and a proper politician, and he performs brilliantly in explicating both worlds. I was never once lost in the medicine or the history. And there's lots of both: Lord Owen is pitch perfect in filling in the medical background to the conditions he discusses, and equally deft in adumbrating the history and political circumstances.

He offers four case studies in detail, each of which is fascinating. Prime Minister Anthony Eden and the Suez Crisis; President Kennedy; The Shah of Iran; and President Mitterand's prostate cancer. Of these, the Kennedy chapter is unexpectedly the least interesting, only because the details are the most familiar to us—though Owen's account is infinitely more digestible than Robert Dallek's tedious 2003 doorstop (when anybody tells me they actually finished Dallek's book, I call them a liar). Owen comes to the conclusion that Kennedy's appalling back pain and the terrifying regime of drugs he took for that and for his Addison's Disease—not to mention his reckless recreational drug-taking—seriously compromised his decision-making during the Bay Of Pigs fiasco and his later summit with Khruschev. It's fair to suppose that Kennedy's uncertain performance emboldened Khruschev in his approach to America. But by the Cuban Missile Crisis, Kennedy's health had radically improved and he performed brilliantly, correcting the damage.

With all the case studies, the web of secrecy which the principles spun is breathtaking. And the complicity of their physicians worrying. This is one of Owen's big themes: a physician's duty is to his patient, but how far do the interests of the state crowd in and compromise him? Lord Owen concludes that the Hippocratic Oath has its limits. Sometimes, the public interest demands that a head of state's health must be public. Owen thinks that the public would, these days, be more understanding of ill health than they used to be. I doubt it. I think it's still inevitable that politicians fear their ailments will be viewed as weaknesses, and will continue to conceal them. Winston Churchill's physician, Lord Moran, concealed Churchill's heart attack in a White House bedroom at the moment the United States entered the war. More recently, Tony Blair went to considerable lengths to conceal his heart problems from the public. So, no change there, then.

Lord Owen also considers many illnesses which heads of state have suffered: he notes depression (Lyndon Johnson, Willy Brandt, Teddy Roosevelt, Winston Churchill, Calvin Coolidge); cancer (the Shah of Iran, Andrew Bonar-Law, Georges Pompidou); heart disease of various kinds (Dwight Eisenhower, Henry Campbell-Bannerman, Woodrow Wilson); alcoholism (Richard Nixon, George W. Bush, Boris Yeltsin); bi-polar disorder (Teddy Roosevelt again, Mao Zedong); and rank insanity. Owen cites a study which has concluded that 29% of American Presidents suffered some form of mental illness while in office (and 49% at some time in their life). Of course, this includes such illnesses as the senility which afflicted Ronald Reagan, and alcoholism.

Interestingly, fewer of our leaders are judged barking than you would expect. Of elected premiers, only Paul Deschanel, appointed president of France in 1920, is deemed to have been clinically insane (if the name is new to you, do look him up; he's excellent value for money). Owen has a stern physician's rigor about using the word  'mad', and mental illness doesn't necessarily mean nuts.  So, Hitler, Stalin, Mao, Pol Pot, Hussein, Amin, Mugabe and the many other despots and monsters, while undoubtedly atrocious, were all medically sane. The layman will object that they all, in some ways, lost their grip on reality, but then they all suffered from what Owen calls 'hubris syndrome'. (At risk of teaching my yiddische grandmother to suck kosher eggs, let me remind you that 'hubris' is an overweening self-confidence which, in Greek tragedy, invariably leads to ruin.)

This is something of a hobby horse for Owen. Although hubris syndrome is not, strictly, a form of madness or a medical condition, he'd like it to be adopted as a, let us say, diagnosis, and studied to discover whether its sufferers bring some predisposition to the table, or whether the offices they come to hold induce the condition. As a precedent, Owen cites shell-shock or post-traumatic disorder as a syndrome which wasn't recognized as a medical condition until fairly recently. Among the signs of hubris syndrome are: a tendency to view the world as an arena for personal glory; a disproportionate concern with image; a messianic self-aggrandization; excessive confidence in one's own judgement and contempt for advice or criticism; a belief that they will be vindicated by God or History; and so on. One reason for not considering hubris an illness is that while the individual can be said to suffer from the syndrome, his constituents typically do most of the suffering. Actually, Lord Owen's iterative description of hubris syndrome is a suspiciously exact description of Tony Blair and George W. Bush, and the good doctor has overtly political axes to grind, especially with regard to the present Iraq debacle, which he fairly characterizes as the most ill-considered foreign policy adventure of modern times.

By now, Owen has somewhat drifted off his point, but interestingly enough to take me with him. Whether this book is a historical overview or a polemic, it is full of fascinating detail and a page-turner from beginning to end. Given Lord Owen's magisterial tone, however, one can't help wondering what kind of a Prime Minister he would have made.