A February 8 letter written by U.S. Representative Ronny Jackson (R-Amarillo) that urges President Biden to undergo a cognitive exam was signed by 37 other House Republicans.

“We again write to you to express concern with your current cognitive state,” the letter reads. “We believe that, regardless of gender, age, or political party, all Presidents should follow the example set by former President Trump to document and demonstrate sound mental abilities.”

Jackson cites President Biden’s response to a Fox News reporter as an alleged example of mental decline. The reporter asked if rising inflation was a political liability.

“No, it’s a great asset,” Biden muttered in response. “More inflation. What a stupid son of a b—h.”

Jackson writes that “the Alzheimer’s Association lists’ changes in mood and personality,’ including being more ‘easily upset’ as one of ten signs of mental decline.”

Jackson also authored a letter of the same nature to the White House in June 2021, which fourteen House Republicans signed on.

“As you may remember, several Members of Congress sent you a letter on this issue in June of last year, to which you have not replied,” wrote Jackson.

Jackson was the White House Physician from 2013 to 2018, serving Former Presidents Barack Obama and Donald Trump. He was elected to the U.S. House of Representatives in 2020 for Texas House District 13, which covers the Texas panhandle, including Amarillo, Gainesville, and Wichita Falls.

Of the ten House Republicans in total who are physicians, two signed the letter: Jackson, who specializes in emergency medicine, and Representative Greg Murphy from North Carolina, a urologist.

Other Republican members of the Texas delegation who signed onto both letters include Representatives Brian Babin (Woodville), Beth Van Duyne (Irving), and Pat Fallon (Sherman).

Two more Texans signed only onto the second letter; Representatives Randy Weber (Friendswood) and Troy Nehls (Richmond).

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The White House also refused to reply to the most recent letter, dated February 8, 2022.

Former President Barack Obama’s official photographer, Pete Souza, did offer a scathing response to Jackson on Twitter.

“Hey Ronny, I didn’t know you were a liar when you sat next to me in the spare limousine,” Souza tweeted. “But I could tell you were often hung over on foreign trips. I have photos in the archive to prove it.”

A report released by the Pentagon in March 2021 found that Jackson violated rules against consuming alcohol while on duty as Obama’s physician during two official trips to Argentina and the Philippines.

As the physician to Former President Trump, he announced in a January 2018 press conference that Trump aced a cognitive exam, scoring “30 out of 30,” and declared he had “absolutely no cognitive or mental issues whatsoever.”

In that same press conference, Jackson claimed Trump was in “excellent shape,” had “incredibly good genes,” and stated that “if he had a healthier diet over the last 20 years, he might live to be 200 years old.”

Just two months later, Trump nominated Jackson to be U.S. Secretary of Veterans Affairs. However, Trump rescinded his nomination after the allegations of drinking on the job and allegations of poor treatment towards subordinates surfaced.

In the February 8 letter, Jackson points to how when political opponents and mental health advocates called for Trump to be cognitively tested in 2018, he obliged and “excelled” in the exam.

In September 2020, doctors reviewed Trump and Biden’s medical history and current state before the election and provided a report of the results.

The report found that both Donald Trump and Joe Biden “come from family histories of exceptional longevity (e.g., familial longevity). As such, there is suggestive evidence that both candidates are likely to be “super agers”—a subgroup of people that maintain their mental and physical functioning into late life and tend to live longer than the average person their age.”

Amongst the group of doctors was professor of public health at the University of Illinois at Chicago Stuart Jay Olshansky, who analyzes the longevity of presidents. “With Biden, not only are there not warning signs, the signs that you see show he’s in exceptional health.” Olshansky said.

In contrast, Jackson cites a November 2021 poll by Politico that showed voters’ increasing doubts about Biden’s mental fitness.

The poll found that 48% of voters disagreed with the statement that President Biden is mentally fit, compared to 46% that said they did agree. That reflected a big swing from an October 2020 poll by Politico, where voters who agreed Biden was mentally fit outnumbered those who did not agree by a 21-point margin.

Jackson additionally mentions Biden’s December 16, 2021 press conference with the COVID-19 response team, where he struggled to announce the total number of the population that had received a booster shot.

“You appeared to be unable to read the numbers in front of you,” wrote Jackson. “You said, ’57… excuse me… 570… I don’t want to read it, I’m not sure I got the right number…’ before being corrected by Dr. Anthony Fauci with the right statistic of 57 million.”

“This is not just a recent trend,” added Jackson. “Your mental decline and forgetfulness have become more apparent over the past two years.”

Olshanksy previously disagreed with this line of thinking.

“There’s a tendency for some to interpret his stuttering as some cognitive defect,” Olshansky told The Washington Post last May. “It’s not. There’s no evidence they are related. And usually there’s a political motive … It’s just nonsense.”

Richard M. Dupee, chief of geriatrics at Tufts Medical Center, similarly told The Washington Post in a May interview, “Sometimes where he hesitates with his speeches, he’s had that for a long time,” he added. “He was never a great speech person.”

“With time, our reflexes get a little bit slower and our ability to sort of recall [things] is a little bit less. That’s normal aging,” Dupee said. “Honestly, I don’t see anything that concerns me.”