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COLUMNISTS
TODAY'S STORIES
23.05.2008
How Much Will We Learn About McCain's Health?

By the time you read this, a select group of reporters--apparently numbering about a dozen--may be inside a conference room at a Phoenix resort hotel, going over some 400 pages of Senator John McCain's medical records.

McCain has been promising to release those records for more than a year. And, given McCain's age and history of cancer, the issue of his health is more serious than it would be for most candidates.

But rather than make all the records public, the campaign has chosen to make them available to the pool reporters for a three-hour window. According to this account in the New York Times, the reporters can take notes but not make photocopies. The campaign is also making McCain's doctors, from the Mayo Clinic, available for interviews.

This is similar to the way McCain's advisors released his medical records in 1999, when he first ran for president, although this 400-page selection is smaller than the 1,500 pages they released last time. That original bundle amounted to the full McCain medical history, including psychiatric records the Navy collected as part of a project to assess the mental health of former prisoners of war. Via Time's Swampland, here's the campaign's explanation:

In 1999, the campaign also pooled the review of the physical documents--with a much smaller group. At the time, the review was hailed as both serious and thorough. Recognizing that this is a transparency issue, the campaign made the decision to put extensive and detailed summaries on our website, as well as host a ninety minute conference call with the physicians who have treated McCain over the past eight years. In 1999, reporters did not have direct access to his doctors, nor were summaries of his health made public. While we cannot satisfy all people all the time, we believe we are making Senator McCain's medical history public in a thoughtful and substantive manner.

I understand the desire to keep some control in this situation; for the sake of privacy, they don't want his original medical records bouncing all over the World Wide Web. Still, McCain is running for president and his health is an important, and legitimate, issue.

I'm out of the country, so I won't be on the conference call to follow the release. But here's one interesting question to keep in mind: The last time McCain released his medical records, one of the reporters who viewed them was the Times' Lawrence Altman. Not only is Altman the dean of science reporters, but he's also an M.D.--i.e., somebody who, even in the short span of three hours, would be able to assess the significance and full meaning of the records. And in an article earlier this year, Altman started raising questions about McCain's present health--and his campaign's curious delay in making the records public.

It sounds like the Times isn't in the pool this time around, which means no Altman. Will any other organizations have physicians as their representatives? ABC and CNN are on the list, so maybe Tim Johnson and/or Sanjay Gupta, both of whom are physicians?

Edit: I see Romenesko noticed the same thing. 

--Jonathan Cohn 

 

Posted: Friday, May 23, 2008 2:31 AM with 8 comment(s)

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WaltB said:

"But rather than make all the records public, the campaign has chosen to make them available to the pool reporters for a three-hour window. According to this account in the New York Times, the reporters can take notes but not make photocopies."  

What better way to encourage ongoing talk of hidden problems!  It certainly shows a weakness.

May 23, 2008 4:38 AM

mpatrickhendri said:

You guys are making too much of this health business. I mean, if McCain falls ill or dies, we'll have a President Romney or President Jindal (36 years old) or even President Crist.

I'm partial to Crist. His skin color isn't even found in nature. Crayola needs a new color: Cheese ball orange.

May 23, 2008 6:49 AM

aeromonas said:

I'm a doc and I've been posting here about McCain's melanoma for quite some time.

Lawrence Altman, writing for the NY Times, reported on what was known about the status of his cancer(s) prior to this latest release here

www.nytimes.com/.../09mccain.html

It would be helpful for some physician reporters like Altman to be able to review the latest records, and I find it mildly concerning that given the access he was granted back in 1999 and the objective, medically accurate way he's dealt with the story since, Altman wasn't let in this time around.  Nevertheless, I reckon that I or any halfway savvy physician could brief a lay reporter and tell him where  to look.

All I really care about are the pathology reports from each of his facial melanomas, the path reports from his neck dissection, the operative report from same, and a recent follow-up note that indicates whether or not McCain has experienced any recurrence of his cancer.

If all is has been indicated previously, then both McCain's melanomas were stage IIa or maybe IIb, each of which independently would have about a 20% chance of killing him over 10 years or about 36% combined risk.  But given that he's survived 8 years already, the chance of him dying now is much lower.  So all I really want to know is that the melanomas were indeed stage II and not more advanced at diagnosis and also that he hasn't had a local or regional recurrence since about which he neglected to inform us.

May 23, 2008 7:06 AM

JackR said:

aeromonas - Thanks for the medical detail on melanoma.  I have a question for you (or for Dr. Dan or other doctors reading this).  I am equally concerned about early onset dementia or Alzheimers a la Reagan--is there any way his medical records might alert us regarding this or any other way to make an informed inference?

May 23, 2008 9:33 AM

stgla said:

Wasn't Bill Frist available?  I understand Dr. Frist can make diagnoses with just one hour of videotape.

May 23, 2008 9:37 AM

Rhubarbs said:

About 14 percent of all people McCain's age today will be dead before the end of a first McCain term. About 32 percent will be dead before the end of a second McCain term. McCain is a man, though, which increases his annual chances of dying, and if there's one thing we can say generally about all presidential candidates (and most presidents) it's that they have higher stress, less sleep, and poorer nutritional diets than the norm. (The diet thing is mainly a function of campaigning; one presumes the president gets regular squares when in the White House.) These factors further increase McCain's already significant chances of dying in office.

To which I say, "So what?" That's really not a reason to vote against him. If he chooses a VP who would be a terrible president, then _that_ would be a reason to vote against him, as it would be for any presidential candidate. But if we had modern medicine and the modern fetish for opening candidates' personal records in 1864, it would have been pretty clear that Abe Lincoln was unlikely to survive his second term. In 1944, it was apparently obvious to everyone who met FDR that he would be dead soon. Should Americans have voted for McClellan and surrender in 1864 or Dewey and laissez fair in 1944 just because Lincoln and FDR were in poor health?

Thanks to James Madison, John Tyler, and the 25th Amendment, the health of a presidential candidate really shouldn't be an issue when choosing a president. When choosing a nominee? Absolutely. But our constitutional system has a process to remove a sick president and another to replace a dead one, so the republic will be fine even if McCain expires while taking the oath of office.

May 23, 2008 9:41 AM

liberal reformer said:

Rhubarbs: Excellent commentary. Political advantage rather than actual concern about John McCain's age and the status of his health is the primary motivation of the left.

May 23, 2008 10:18 AM

stgla said:

Rhubarbs is right, although keep in mind that risk tables, life expectancy, etc. are based on averages and do not take into account everything we know about this particular individual.  We could probably come up with a much better estimate of McCain's survival probabilities from his own medical records.  But the larger point rhubarbs makes is right.  As long as we have a clear line of succession, what matters is voters' perceptions of McCain's survival and their preferences for his replacement.

A better use of life tables, however, is to forecast the probability that McCain's elderly supporters will still be alive in November.

May 23, 2008 10:46 AM