Health of John McCain (2008)

What went wrong in 2008

As medical science advances, and people survive diseases that were once fatal, it is inevitable that candidates' medical histories will be an increasing part of future Presidential elections. The 2008 campaign will be recorded as the first with truly contentious medical issues (1).

It is, therefore, worth tabulating the mistakes that were made by the various parties in 2008, in the hopes that a plan for more rational approaches may be devised for campaigns to come. At the very least, physicians should perhaps contemplate the ethics of being clinically involved in political campaigns.

Errors by the McCain campaign

• The campaign should have allowed unhurried inspection of the Senator's medical records, by a wider range of professionals.
• The campaign should have published the medical surveillance plan that would be applied to a President McCain.
• The campaign should have published advanced directives that would have defined the medical circumstances under which a President McCain would have transferred the Presidency to the Vice President.
• Because of the great uncertainty about, and great importance of, the invasive melanoma of 2000, the campaign should have allowed independent melanoma pathologists to review the surgical speciments. (2)

Errors by the Mayo Clinic

• The Mayo Clinic should have disclosed the ground rules under which it was disclosing information about Senator McCain. That is, it should have disclosed the agreement(s) reached between it and the McCain campaign before the disclosures were made.
• The Mayo Clinic should have refused to say anything about Senator McCain's health unless it were allowed to speak freely. Anything less is collusion.

Errors by Senator McCain's physicians

• Senator McCain's physicians should have published the ground rules under which they disclosed information about Senator McCain. That is, they should have disclosed the agreement(s) reached with the McCain campaign before the disclosures were made.
• Senator McCain's physicians should have refused to say anything about his health unless allowed to speak freely. Anything less is collusion.

Errors by the press

• They should have grown some balls.

Errors by the author of this website

• He should have published this review of the Senator's health earlier. (He kept waiting for the press to grow balls.)
• He should have included more rigorous quantitative data on the predicted course of Senator McCain.

What Congress Can Do

The United States needs laws to govern the disclosure of medical information about candidates for President and Vice President. Such laws should balance a candidate's legitimate concerns for personal privacy with the electorate's need to know.

There is a straightforward approach that Congress should pass into law: The medical disclosure requirements of the Commander-in-Chief (and the Vice President) should be brought into line with the medical disclosure requirements of the hundreds of thousands of selfless men and women who serve today in America's armed forces.

The electorate has a legitimate need to know this information, since they are the final (and only) aribiters of any candidate's fitness to become President (3).

Specifics of the proposal

All branches of the US military has medical standards for its members. These standards should be applied to candidates for the Presidency and Vice Presidency, but in a unique way. Military standards should define requirements for disclosure, not fitness-for-duty requirements.

An example will show how such a law would operate.

Assume Congress has mandated the U.S. Air Force's medical standard for pilots as the disclosure standard. This standard, freely available in Air Force Instruction 48-123, contains a long list of medical conditions that disqualify a person from becoming an Air Force pilot, e.g. a history of seizures, a history of heart attack, and so on. Under the proposal outlined, a candidate would simply be required to disclose any and all of his or her medical conditions that would disqualify a pilot according to AFI 48-123.

For example, a candidate would have to disclose a past history of stroke, but would not have to disclose a simple episode of syphilis that was eradicated with antibiotics last summer. The candidate would have to disclose the use of Prozac, but not the broken arm sustained in a drunken brawl two years ago.

These Air Force standards are almost immune to political interference. They have largely been stable for years and are the fruits of decades of experience seeking to identify medical conditions that might jeopardize the safe and successful accomplishment of Air Force missions.

How much information should be disclosed about each diagnosis? This is harder to codify. For many conditions, the Air Force stipulates the information it needs to determine whether to grant a waiver for the condition. For example, after a heart attack, the Air Force wants to know how well the heart muscle is pumping now, what medications are being taken, and so on. Ideally, candidates should disclose enough information to get a "waiver" under the military system.

Disclosure requirements would apply after election, just as military medical requirements apply after enlistment.

Because these disclosure would be required by law, failure to disclose would have consequences. Intentional non-disclosure of medical information is a serious matter in the military, and so it should be for those aspiring to run the military. To protect candidates, who generally know little medicine, the disclosure requirement (and penalties for non-disclosure) should also fall on any physician who ever treated the candidate.

Deciding precisely which set of physical standards to apply is a detail that need not be decided now (4). The main point is to have some standard, any standard. It is folly that we have been more careful with the Army Private whose fingers clean a toilet, than with the commander-in-chief whose fingers are on the nuclear button.

Footnotes