[Vision2020] Health of Presidential and Vice Presidential Candidates

Tom Hansen thansen at moscow.com
Mon Oct 20 06:00:41 PDT 2008


Greetings Visionaires -

Copied and pasted below from today's (October 20, 2008) issue of the New 
York Times (http://tinyurl.com/5nq38k) is an article concerning hkealth 
reports of four presidential and vice presidential candidates.

My primary purpose for posting this article is to reflect on the 
candidates' physical abilities to complete their initial four-year 
obligation to the American people once elected.

---------------------------------------------------------------

Many Holes in Disclosure of Nominees’ Health 
By LAWRENCE K. ALTMAN, M.D.
October 20, 2008

Fifteen days before the election, serious gaps remain in the public’s 
knowledge about the health of the presidential and vice-presidential 
nominees. The limited information provided by the candidates is a striking 
departure from recent campaigns, in which many candidates and their 
doctors were more forthcoming.

In past elections, the decisions of some candidates for the nation’s top 
elected offices to withhold health information turned out to have a 
significant impact after the information came to light. This year, the 
health issue carries extraordinary significance because two of the four 
nominees have survived potentially fatal medical problems that could recur.

If elected, Senator John McCain of Arizona, 72, the Republican nominee, 
would be the oldest man to be sworn in to a first term as president and 
the first cancer survivor to win the office. The scars on his puffy left 
cheek are cosmetic reminders of the extensive surgery he underwent in 2000 
to remove a malignant melanoma. 

Last May, his campaign and his doctors released nearly 1,200 pages of 
medical information, far more than the three other nominees. But the 
documents were released in a restricted way that leaves questions, even 
confusion, about his cancer. 

A critical question concerns inconsistencies in medical opinions about the 
severity of his melanoma; if the classification of his melanoma is more 
severe, it would increase the statistical likelihood of death from a 
recurrence of the cancer. 

Senator Joseph R. Biden Jr. of Delaware, 65, the Democratic vice-
presidential nominee, had emergency surgery in 1988 for an aneurysm in an 
artery in his brain and elective surgery for a second one. His campaign 
released 49 pages of medical records to The New York Times late last week 
showing that he was healthy, but the documents did not indicate whether he 
had had a test in recent years to detect any new aneurysm.

The two other nominees are younger and apparently in good health, but less 
is known about their medical history. Senator Barack Obama of Illinois, 
47, the Democratic presidential nominee, released a one-page, undated 
letter from his personal physician in May stating that he was 
in “excellent” health. Late last week, his campaign released the results 
of standard laboratory tests and electrocardiograms from his checkups in 
June 2001, November 2004 and January 2007. The findings were normal. 

Gov. Sarah Palin of Alaska, 44, Mr. McCain’s running mate, has released no 
medical information. 

There may be no serious problems with the health of any of the nominees. 
But absent fuller disclosure, there is no way for the electorate to know. 

The health of the four nominees is a matter of concern because in the past 
a number of candidates, and in some cases their doctors and aides, have 
distorted, kept secret or spoken about the facts only at the last minute 
when medical events forced the issue. Examples include Senator Thomas F. 
Eagleton (depression), Senator Paul E. Tsongas (cancer), Senator Bill 
Bradley (heart rhythm abnormality) and, as a vice-presidential nominee, 
Dick Cheney (heart disease).

I am a physician who has covered the health of presidential candidates for 
36 years. Since 1980, The Times has made it a practice to question 
nominees for president and other high political offices and, with their 
permission, their doctors about their health.

The Times has requested such interviews with Mr. Obama since last spring 
and with Mr. McCain and his doctors since March 2007. None were granted. 
More recently, The Times sent letters to all four nominees requesting 
interviews about their health with them and their doctors. None agreed. 

The candidates’ health has drawn little attention for most of this long 
campaign season despite the importance of the issue. But since Mr. McCain 
selected Ms. Palin as his running mate in August, questions about his 
health have intensified. In recent weeks, more than 2,700 physicians have 
signed a petition that ran as an advertisement demanding that Mr. McCain 
fully release his health records; the petition is sponsored by Brave New 
Films, the company led by Robert Greenwald, a Hollywood filmmaker who has 
contributed $2,250 to Democratic candidates and has made a number of anti-
McCain videos. Beyond the advertisement, Mr. McCain’s health has become 
the subject of both speculation and distortion on the Internet and other 
media. 

The following is a summary of the publicly known medical information about 
all four nominees and the outstanding questions about each.

John McCain

Mr. McCain’s difficulty raising his arms and his sometimes awkward gait 
are remnants of severe, untreated injuries he suffered in Vietnam. Mr. 
McCain, a Navy pilot, broke both arms and his right knee when his jet was 
shot down over North Vietnam in 1967. He experienced additional wounds 
while being tortured during his five and a half years as a prisoner of 
war. Mr. McCain may eventually need joint replacements, according to his 
doctor at the Mayo Clinic in Scottsdale, Ariz.

Mr. McCain has released more details about his health than the other three 
nominees, though he has done so in a phased way and has apparently not 
agreed to any extensive interviews about his health. A handful of 
reporters were allowed to view his records during his bid for the 2000 
Republican presidential nomination. Another group of reporters were 
permitted to see newer records last May. By not allowing reporters to 
interview him or his doctors extensively about his entire medical history, 
he has made it impossible to get a complete picture of his diagnoses and 
treatment. 

In 1999, early in his first run for the presidency, Mr. McCain allowed a 
small number of reporters, including me, to review an estimated 1,500 
pages of his medical records without photocopying or recording the 
information. 

In doing so, Mr. McCain gave the public its broadest look at the 
psychological profile of a presidential candidate. He released 
psychological records about him that were amassed as part of a Navy 
project to gauge the health of former prisoners of war. Assessments were 
based on standard psychological tests and what Mr. McCain told his doctors 
after his release. The records mentioned that in 1968, about eight months 
after his capture and after some particularly brutal beatings from his 
North Vietnamese captors, Mr. McCain attempted suicide, trying to hang 
himself with his shirt. 

The records and his doctors, whom I interviewed with the senator’s 
permission in 1999, said he had never been given a diagnosis of a mental 
health disorder or treated at the project’s center for a mental health 
disorder. 

The records also showed that a surgeon removed a melanoma from Mr. 
McCain’s left shoulder in 1993. Melanomas can be a far more deadly form of 
skin cancer than the more common basal cell and other types.

In early August 2000, just as Mr. McCain’s rival George W. Bush was about 
to receive the Republican presidential nomination, Dr. John F. Eisold, the 
attending physician at the United States Capitol, detected two more 
melanomas, Mr. McCain’s second and third.

One on Mr. McCain’s left arm was determined to be the least risky type, in 
situ. But the one on his left temple was dangerous.

A few days after detection of the melanomas, Mr. McCain sought care for 
them at the Mayo Clinic in Scottsdale. Mr. McCain’s campaign said this 
year that the left-temple melanoma was 2.2 millimeters at its thickest 
part and graded as Stage IIA on a scale in which Stage IV is the worst. 
Stage II meant that the melanoma had not spread into the lymph nodes. The 
number of melanomas is less significant than the thickness measured in the 
pathology assessment of any one of them. 

Mr. McCain underwent extensive surgery on his face and neck for the 
melanoma on Aug. 19, 2000. Surgeons removed more than 30 lymph nodes, and 
pathologists then determined that all of them were cancer free. 

In March 2007, as Mr. McCain was making his second bid for the Republican 
nomination, The Times began asking his campaign for permission to speak 
with the senator and his doctors, citing the history of such interviews. 

On May 6, 2008, Jill Hazelbaker, a McCain spokeswoman, denied the 
requests, writing in an e-mail message that The Times was “not at the top 
of the list” and including a link to a Times editorial that had criticized 
Mr. McCain for not disclosing health information and Senator Hillary 
Rodham Clinton of New York for not disclosing financial records. 

On May 23, Mr. McCain allowed a small pool of journalists, including three 
doctor-reporters, though none from The Times, to spend three hours 
reviewing a newer set of his Mayo Clinic records. That set, 1,173 pages, 
included records from 2000 to 2008 but none of the records made available 
in 1999. Again, the campaign did not allow the journalists to photocopy 
any documents.

Mr. McCain’s Mayo Clinic doctors answered selected reporters’ questions by 
telephone, but only for 45 minutes instead of the scheduled two hours. The 
McCain campaign did not allow New York Times reporters to ask questions in 
the teleconference.

The clinic doctors said that Mr. McCain was in good health and that no 
medical reason precluded him from fulfilling all the duties of president.

The doctors said that a fourth melanoma they detected on the left side of 
his nose in 2002 was also in situ, the least dangerous type. All four 
melanomas that Mr. McCain experienced were primary, or new, and there was 
no evidence that any of them had spread, the doctors said. 

However, the reporters’ summary cited a report dated Aug. 9, 2000, from 
two pathologists at the Armed Forces Institute of Pathology in Washington 
who examined a biopsy of the melanoma taken from Mr. McCain’s left temple 
a few days earlier.

The Armed Forces pathologists suggested that the left-temple melanoma had 
spread from another melanoma, known as a metastasis or satellite 
lesion. “The vertical orientation of this lesion,” the report said, “with 
only focal epidermal involvement above it is highly suggestive of a 
metastasis of malignant melanoma and may represent a satellite metastasis 
of S00-9572-A,” which is the “skin, left temple, lateral” biopsy.

The pool report was by nature unable to provide a complete portrait of Mr. 
McCain’s recent medical history. It left several questions, including 
about the number of biopsies and when they were done. On Aug. 18, 2000, 
Dr. John D. Eckstein, Mr. McCain’s personal physician at the Mayo Clinic 
in Scottsdale, noted in Mr. McCain’s records that there were two biopsies 
of the left temple. Dr. Eckstein’s note did not say where and when the 
biopsies were performed. The Armed Forces report cited one biopsy, so 
presumably a second was performed in Scottsdale. The Armed Forces 
pathologists said a melanoma had developed over a skin scar whose origin 
was unclear.

A skin lesion, not one of the four melanomas, had been removed from Mr. 
McCain’s left temple in 1996 and interpreted as being benign; some experts 
have speculated that it might have been misdiagnosed, and thus the origin 
of the 2000 melanoma.

The Armed Forces pathologists did not speak in the teleconference in May 
2008, and questions raised by their report have remained unanswered. The 
selected reporters did not ask about that report, and the Mayo Clinic 
doctors did not discuss it. A complete Mayo pathology report was 
apparently not included in the pool summary.

In interviews, several melanoma experts questioned why the Mayo Clinic 
doctors had performed such extensive surgery, because the operation was 
usually reserved for treatment of Stage III melanoma, not Stage IIA.

On Aug. 18, 2000, the day before Mr. McCain’s operation, his surgeon, Dr. 
Michael L. Hinni, wrote in the records that he planned to do the extensive 
operation because of the size and location of Mr. McCain’s melanoma. In 
the teleconference in May 2008, Dr. Hinni explained that because the 
melanoma was two centimeters across he had to make “a 6-by-6-centimeter 
island of skin, a fairly sizable wound” to remove it.

It is not known whether the Mayo Clinic in Scottsdale asked pathologists 
outside the Mayo system for an independent review.

If Mr. McCain’s 2000 left-temple melanoma was a metastasis, as the Armed 
Forces pathologists’ report suggested, it would be classified as Stage 
III. The reclassification would change his statistical odds for survival 
at 10 years from about 60 percent to 36 percent, according to a published 
study. 

The greatest risk of recurrence of melanoma is in the first few years 
after detection. His age, his sex and the presence of the melanoma on his 
face increase the risk.

The fact that Mr. McCain has had no recurrence for eight years is in his 
favor. But cancer experts see the 10th anniversary as an important 
statistical benchmark, and that would not occur until 2010. 

In May, his dermatologist at the Mayo Clinic, Dr. Suzanne M. Connolly, 
said in the teleconference that though there was no way to predict with 
certainty Mr. McCain’s chance of a recurrence, she judged it to be less 
than 10 percent. But melanoma is known to be quirkier than most cancers; 
doctors cite occasional cases in which melanomas come back after 15 or 20 
years.

Melanomas can spread to various areas in the body, including the skin and 
any internal organ. In general, such spreading means the melanoma would 
not be curable. Treatment would depend in part on what organ or tissues 
are involved and could include additional surgery, chemotherapy, 
biologics, vaccines and radiation.

Many such treatments can be debilitating and impair an individual’s 
physical and mental stamina. If the patient was the president, the 
location of a recurrence and its treatment could raise the need to invoke 
the 25th Amendment, elevating the vice president to president, at least 
temporarily.

On the trail, Mr. McCain has played down concerns about his age by 
pointing to the vigor of his mother and her twin sister at age 96. Mr. 
McCain’s father died in 1981 at age 70 after a heart attack. 

In the May teleconference, Dr. Eckstein said that he had not detected any 
memory deficits in Mr. McCain and that the senator had not reported any. 
Dr. Eckstein did not report whether Mr. McCain had taken any baseline 
cognitive tests.

Mr. McCain has kidney stones and takes a statin for high cholesterol but 
has no evidence of significant heart disease, his doctors said.

In making his medical information public, Mr. McCain released his 
confidentiality in the traditional patient-doctor relationship.

For its part, the Mayo Clinic says it agreed to yield control over all of 
Mr. McCain’s medical information to his campaign and to refer all 
questions to the campaign. Pool reporters inspected the records at a hotel 
near the clinic, which sent the records there under security. In the 
teleconference, the doctors answered questions by telephone at the clinic 
with no reporters present.

Dr. Eckstein, Mr. McCain’s doctor, said he understood that the campaign 
had released all the McCain records to the pool reporters. But a 
spokeswoman at the Mayo Clinic in Scottsdale, asked if the institution 
could verify that the campaign had released all the records to the 
reporters, said she did not know whether the doctors had checked to be 
sure.

Last week, The Times contacted the McCain campaign to fill in gaps in the 
medical records. Ms. Hazelbaker, the McCain spokeswoman, wrote in an e-
mail message: “As you know, we disclosed over 1,200 pages of Senator 
McCain’s medical history to Dr. Altman’s colleagues in the press earlier 
this year. We also arranged a Mayo Clinic briefing with three of Senator 
McCain’s physicians that Dr. Altman listened to by phone. Additionally, we 
released a detailed document outlining his most recent physical and lab 
test results. It was an unprecedented level of disclosure, and Dr. Altman 
can look at the public document on our Web site if he wishes to do so. It 
was certainly more significant than the one-page doctor’s note Obama 
released, though I have little hope The Times will report it that way.” 

Barack Obama

On May 29, six days after the McCain campaign’s disclosures about his 
recent health, Mr. Obama’s campaign released an undated, single-page 
letter from his doctor in Chicago attesting to Mr. Obama’s “excellent 
health.”

The six-paragraph letter from Dr. David L. Scheiner said Mr. Obama had no 
known medical problems that would affect his ability to serve as 
president. Until the release of test results last week, the letter was the 
only information that Mr. Obama had made public about his health. 

Dr. Scheiner’s assessment was based on regularly examining Mr. Obama since 
March 23, 1987. Mr. Obama’s last checkup was on Jan. 15, 2007, a day 
before he created a presidential exploratory committee and more than a 
year before his campaign released the letter from Dr. Scheiner, a general 
internist who practices at the University of Chicago Hospitals and the 
Rush University Medical Center.

The letter was short, the Obama campaign said, because Mr. Obama had not 
had any serious health problems. The campaign declined to make Dr. 
Scheiner available for an interview.

Mr. Obama has had a notable medical problem: a difficulty in stopping 
smoking. It is not known how heavily he smoked. Dr. Scheiner wrote that 
Mr. Obama began smoking at least two decades ago and had made several 
efforts to stop. Mr. Obama has used Nicorette gum “with success,” Dr. 
Scheiner wrote, without defining success.

Nicorette, which contains smaller amounts of nicotine than cigarettes do, 
is a replacement therapy intended to ease the craving for nicotine and 
other withdrawal effects of cigarette smoking. 

Dr. Scheiner did not say when Mr. Obama had started using Nicorette, how 
much he had used or for how long he had used it. Reporters have often 
observed him chewing it.

Mr. Obama said he quit smoking in 2007 when he began his presidential 
campaign. But he has “bummed” cigarettes since then, he has said.

Also, Dr. Scheiner did not provide a standard measure of smoking risk. It 
is known as pack years — the number of packs smoked a day multiplied by 
the number of years a person has smoked. The pack-year number is used to 
help determine a patient’s risk of developing lung cancer, heart disease 
and other tobacco-related ailments. 

Information about Mr. Obama’s smoking is relevant because studies show 
that the risk of cancer and other tobacco-related serious diseases 
declines after an individual stops smoking, but not until then.

According to the newly released documents, in January 2007 Mr. Obama had a 
total cholesterol level of 173 (HDL 68 and LDL 96) and triglycerides of 
44. Those levels were normal.

Sarah Palin

Nothing is known publicly about Ms. Palin’s medical history, aside from 
the much-discussed circumstances surrounding the birth of her fifth child 
last April. Ms. Palin has said that her water broke while she was at a 
conference in Dallas and that she flew to Anchorage, where she gave birth 
to her son Trig hours after landing. 

Last week Maria Comella, a spokeswoman for Ms. Palin, said the governor 
declined to be interviewed or provide any health records. 

Joseph R. Biden Jr.

In 1988, Mr. Biden was working out on a shoulder press weight machine in 
the Senate gym when a pain shot through his neck. On the train home to 
Wilmington, Del., the neck pain returned more severely. His head ached. 
The right side of his body went numb. A doctor later diagnosed a pinched 
nerve, and a pain clinic prescribed a neck brace.

Shortly thereafter, on a trip to Rochester, Mr. Biden was alone in his 
hotel room when he felt a sharp stab in the back of his neck and a 
lightning flash in his head. The rip of pain was like none he had ever 
experienced. Nothing Mr. Biden did, including curling up in the fetal 
position, relieved the pain. He lay unconscious on the floor for five 
hours, he wrote in his autobiography, “Promises to Keep” (Random House, 
2007).

The next morning, he felt somewhat better and flew home. His wife, Jill, 
summoned from the school where she taught, immediately took him to a 
hospital. Doctors determined he had a berry-shaped bulge in an artery that 
was leaking blood into his brain. Such bulges, or aneurysms, can tear at 
any time. Ruptured aneurysms are fatal in about 50 percent of cases. Up to 
20 percent of survivors remain severely disabled. A Roman Catholic priest 
gave Mr. Biden last rites.

After a harrowing ambulance trip to Walter Reed Army Medical Center in 
Washington, a team of neurosurgeons put a clip on the artery to stop the 
bleeding. While recuperating, he suffered a major complication: a blood 
clot lodged in his lung.

A few weeks later, surgeons operated on a second aneurysm on the opposite 
side of his brain. Though it had caused no symptoms, it still could have 
burst as the first one did.

Mr. Biden returned to the Senate after a seven-month absence.

Now, a question arises: Has Mr. Biden developed a new aneurysm over the 
last two decades that could burst?

Doctors, who long thought that berry aneurysms were a once-in-a-lifetime 
event, now generally believe that they can recur. About 5 percent or less 
of patients who have had a berry aneurysm develop new ones at the original 
site or elsewhere in the brain.

“Over the last two decades,” said Dr. Robert F. Spetzler of the Barrow 
Neurological Institute in Phoenix, “we have learned much more about 
aneurysms, and the fact is that when you have had one aneurysm, you are 
more likely to develop another one. Although the likelihood is very low, 
it does exist.”

Doctors’ views vary widely on what types of brain imaging tests to 
recommend to patients who have had a berry aneurysm and when to do them. 
Some conduct no tests. Others periodically conduct tests like magnetic 
resonance angiograms. 

Mr. Biden has “recovered fully without continued effects” from the 
aneurysm, Dr. Eisold, the Capitol physician, said in a letter released by 
the campaign. Dr. Eisold, a specialist in internal medicine, has a 
longstanding policy not to talk to reporters about his patients, even with 
their permission.

The Obama-Biden campaign referred me to Dr. Matthew A. Parker, an 
internist in Washington, who reviewed Mr. Biden’s records and also spoke 
with Dr. Eisold about them. Dr. Parker said that Dr. Eisold told him that 
brain imaging tests were not needed now because Mr. Biden had done well 
for the 20 years after the aneurysm. “It is a nonissue,” Dr. Parker said 
Dr. Eisold told him.

Dr. Parker, who is associated with George Washington University Hospital 
and Sibley Memorial Hospital, said he had not treated or met with Mr. 
Biden and did not have a direct connection to the campaign. Federal 
Election Commission records show that Dr. Parker contributed the maximum, 
$2,300, to Mr. Obama’s presidential campaign on March 13, 2008.

The medical records released by the campaign contain a summary of Mr. 
Biden’s operation and hospital stay in 1988 but no notes from a 
neurologist or neurosurgeon since then. So it is not known whether Mr. 
Biden has had recent brain imaging scans or has been evaluated by a 
neurologist or neurosurgeon recently. Dr. Parker said he did not ask Dr. 
Eisold when a neurologist or neurosurgeon last examined Mr. Biden.

Four leading neurosurgeons interviewed separately in this country and 
Europe said that as a vice-presidential nominee, Mr. Biden should have had 
recent brain imaging studies to detect any new aneurysm, because if one is 
found he might face more neurosurgery and be out of work for weeks or 
longer.

“What would I do in this situation?” said Dr. Eugene S. Flamm, the 
chairman of the department of neurological surgery at Montefiore Medical 
Center in the Bronx. “I would say, get an M.R.A. and check. You can’t just 
play the statistics.” 

Doctors caring for political leaders and other prominent people often face 
difficulty in ordering tests that might clarify a situation for such 
patients but that are not recommended for all patients.

Dr. Parker said, “Some people will say, well, given the high-profile 
nature of the situation, we should do the test to be sure.” But, he 
added, “that is not necessarily wise.”

Among the reasons is a desire to avoid anxiety among patients and because 
doctors may not know what to do about an equivocal finding.

Dr. Parker said that even when he “pressed Dr. Eisold on the very same 
thing, given the circumstances” with Mr. Biden, Dr. Eisold “was very 
definitive about” not doing brain scan tests now.

The question of an aneurysm aside, the documents show Mr. Biden to have 
relatively minor health problems, including chronic sinusitis and 
allergies. He has an enlarged prostate, but a biopsy showed no evidence of 
cancer. With the help of a statin, he has normal cholesterol levels: 173 
(HDL 47 and LDL 98) and triglycerides of 133.

In Summary

All in all, the gaps and paucity of information leave the electorate with 
insufficient information to fully judge the health of the nominees. The 
information that has been released is a retreat from the approach that 
most campaigns took over the last 10 elections. 

In an earlier time, there was a kind of gentlemen’s agreement between 
officials and the news media that permitted serious health conditions to 
be played down or kept secret.

Franklin D. Roosevelt was crippled by polio more than a decade before he 
became president and, by his fourth term, he had developed serious heart 
disease, but the public was largely shielded from the profound effects. 
And while much was made of John F. Kennedy’s bad back and the rocking 
chair that gave him relief, it was only in the years after his 
assassination that his case of Addison’s disease, a hormonal disorder, 
became widely known. 

What might be called the modern era of disclosure arguably began in 1972, 
when Mr. Eagleton had to step down as the Democratic vice-presidential 
nominee because he had not informed his running mate, Senator George 
McGovern, of his history of depression. 

In 1992, Mr. Tsongas, who was seeking the Democratic nomination for 
president, spoke to me to assure the public that he was free of non-
Hodgkins lymphoma, after a bone marrow transplant in 1986. In interviews, 
his doctors at the Dana-Farber Cancer Institute backed his assertion that 
he was cancer free. But in fact the cancer had recurred, and Mr. Tsongas 
eventually withdrew from the race. He died two days before his first term 
would have ended. 

Other candidates who made themselves and their doctors available include 
the elder George Bush, Bob Dole, Al Gore and John Kerry. A leading example 
of openness was Ronald Reagan, whose age, 69, had become an issue in the 
1980 election. Mr. Reagan authorized his doctors to be interviewed. He 
also agreed to an interview himself, against the wishes of his aides, 
answering all my questions, including what would he do if he became senile 
as president.

“Resign,” he said. 

---------------------------------------------------------------

Seeya round town, Moscow.

Tom Hansen
Moscow, Idaho
 
"We're a town of about 23,000 with 10,000 college students. The college 
students are not very active in local elections (thank goodness!)."

- Dale Courtney (March 28, 2007)


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