Health of John McCain (2008)

Introduction

Laws

Sources

Sources of Information

Contents of This Page

2000 Presidential Campaign

In 1999, Mr. McCain released about 1,500 pages of his medical and psychiatric records, which were amassed as part of a Navy project to gauge the health of former prisoners of war (1).

Editorial: This disclosure has been called "an extraordinary look at his medical history" (2). Indeed, it was remarkable.

2008 Presidential Campaign: Papers

The McCain campaign allowed inspection of 1,173 pages of medical records, spanning 2000 to 2008, on May 23, 2008 (1).

The campaign chose this date -- the Friday before Memorial Day weekend -- "in what his campaign advisers said was an effort to play down reporting about his cancer surgery. Despite Mr. McCain's favorable report, the advisers have said they do not consider articles about his melanoma as politically helpful and are hopeful that they will attract less notice over the long holiday" (1).

Editorial: Although a candidate's medical information may be "politically unhelpful," it can certainly be helpful to voters as they choose a new President. Attempts to minimize the spread of information that helps the voter should be condemned. Many occupations, from bus driver to camp counselor to food service worker, have medical requirements, and no one in those fields likes it very much, just as the McCain campaign doesn't much like the informal medical-disclosure requirement that has arisen over the past decades for presidential candidates. An informed electorate is important to the future of this country.

The medical information was not "released" in the tradtional sense of the word. Instead, "a tightly controlled pool of about 20 reporters was shown into a conference room at the CopperWynd Resort near the Mayo Clinic in Scottsdale. The reporters were permitted three hours to review and take notes on the 1,173 pages of Mr. McCain's medical documents... but they were not permitted to remove the documents from the room or photocopy them. Campaign officials said they imposed the restrictions to prevent the widespread dissemination of the actual records and to protect Mr. McCain's privacy" (1).

Editorial: If 1200 pages are reviewed in three hours, an average of 9 seconds may be devoted to each page. I have not seen news reports describing whether the documents were hand-written or typed. The bad reputation of physician hand-writing is not exaggerated: it can easily take 9 seconds to decipher a single sentence of a hand-written note. By comparison, War and Peace is about 1300 pages (3), and the King James Bible is about 1100 pages (4). Can they be read in three hours?

Editorial: Should a presidential candidate be allowed privacy with respect to his or her medical records? All of us want privacy for our own records, so it is easy to empathize with a statement that a candidate should have some privacy. The question is complicated, however. First, the candidate is volunteering for the job of President. He or she is not being compelled to run for the office. Second, every member of the US armed forces must disclose his or her complete medical record (if asked) to a person or persons empowered to determine the member's fitness for duty. In the military, the empowered person is usually a physician. For the Presidency, the electorate is the group empowered to determine the member's fitness for duty. Third, as William Safire has written, "The President's body is not wholly his own; that is why we go to such lengths to protect it" (5).

2008 Presidential Campaign: Physicians

After the three-hour review of medical documents on May 23, reporters conducted a 45-minute conference call with Senator McCain's doctors at the Mayo Clinic Scottsdale (1).

Senator McCain has been a patient at the Mayo Clinic since 1992 (6), under the care of Dr. John Eckstein (7). McCain had periodic comprehensive physical examinations during the 1990s (6) and annual examinations since 2000 (7). At the time of his melanoma surgery in August 2000, he had not been seen at the Mayo Clinic for 27 months (8).

Senator McCain has received annual examinations since August 2000, and has received skin care at the Mayo Clinic in Arizona since August 2000 (6). He underwent a "comprehensive evaluation" in March 2008 (6).

Assumption: "Skin care" probably means examinations from a dermatologist. All good internists can deliver some degree of skin care.

Question: The Mayo Clinic has three campuses (Minnesota, Florida, Arizona). The statements above are unclear whether McCain was seen at only the Arizona campus, or at more.

Nick Muzin, a Washington doctor, is serving as a medical adviser to the campaign (9).

2008 Presidential Campaign: Disclosure Extent

The campaign described the 1173 pages as "every single piece of paper" in McCain's medical records for the last eight years (9).

Editorial: This claim of "every single piece of paper" is important and reassuring. As noted elsewhere, physicians are obligated to disclose only the information a patient wants disclosed. If this is the entire medical record, then that concern vanishes... almost. It is always possible that the medical record from only one institution was presented, and that significant undisclosed records are elsewhere. In the McCain case, this seems unlikely, as so much of his care occurred at the Mayo Clinic Scottsdale. One wonders, however, how exact is the statement about "every single piece of paper." It takes only one piece of paper, out of thousands, to change a life.

Editorial: It is unclear who assembled the papers for disclosure. Was it the Mayo Clinic, or was it personnel from the McCain campaign? Without a physician standing behind the statement that this was the Senator's entire post-1999 medical record, it is not possible to accept that this was the case.

Editorial: The McCain campaign's less-than-straightforward handling the Senator's medical records undermines the campaign's credibility in all matters of the Senator's health.

For example, they stated that the 2008 documents constitute every piece of paper in the records. What about records that were never printed on paper, e.g. electronic medical records? It would take a presumption of bad faith to believe the campaign would be so underhanded, but given their machinations, bad faith is hard to dismiss.

Consider, too, a scenario in which the documents disclosed to each reporter may have been different. It would be possible to hide information from one reporter, while disclosing it to another, such that (a) no one reporter would have enough information to draw certain [unfavorable] conclusions, yet (b) all information about the Senator would be disclosed, in a technical sense.

The campaign's unusual disclosure methods can easily lead to public mistrust of the entire process.

In the introduction to an important statement about Senator McCain's health, the CEO of Mayo Clinic Scottsdale said: "I would like to reiterate that patient privacy is integral to Mayo's core value that the needs of the patient come first, and we are releasing this information at the request of Senator McCain" (10).

Editorial: This is as disconcerting as the statement about "every piece of paper" was reassuring. By putting the patient first, instead of the country first, the Mayo Clinic gives itself permission to conceal important infomation, i.e. information that could influence the electorate's choice and/or bear on the candidate's ability to perform as President for four years. This concern is compounded by the absence of statements saying (a) The candidate had given his physicians permission to disclose any and all information, (b) The candidate had given his physicians permission to disclose any and all significant information. There is no statement that the physicians exercised any professional judgment in choosing what to say (and not say) in their prepared written statements. These omissions, which I hope only seem to be omissions because of incomplete reporting, give the impression that Mayo Clinic Scottsdale is operating at the behest of the McCain campaign. The fact that Mayo Clinic Scottsdale is in Senator McCain's state and, therefore, is in a position to benefit from his political influence, further taints any presumption of impartiality (especially when the CEO gets involved).

Reactions

As of Oct. 6, 2008, more than 2800 physicians have signed a petition asking McCain for "full, public disclosure of all of his medical records." It is not at all clear (and not at all likely) that this request is non-partisan.

Question: Both of the major disclosures (2000, 2008) occurred as part of campaigns for the presidency. McCain has, however, been elected to the Senate four times (1986, 1992, 1998, 2004). Was he as open about his health during these campaigns? Does a Senate candidate have the same ethical obligation to disclose health information as a presidential candidate?

Footnotes

1.	Altman, Lawrence K.; Bumiller E. "McCain's Health Is Called Robust by His Doctors." New York Times. 2008 May 24.
2.	Altman, Lawrence K. "On the Campaign Trail, Few Mentions of McCain's Bout With Melanoma." New York Times. 2008 March 9.
3.	Tolstoy, Leo. War and Peace. New York: Knopf, 2007. (ISBN 0307266931 @ Amazon.com).
4.	Holy Bible: The New King James Version. Nashville, TN: Thomas Nelson; Pew Library edition, 1994. (ISBN 0840704534 @ Amazon.com).
5.	Safire, William. "The Operating Room." New York Times. 1987 January 5, page 17. As quoted in: Abrams, Herbert L. "The President Has Been Shot": Confusion, Disability, and the 25th Amendment in the Aftermath of the Assassination of President Ronald Reagan. New York: WW Norton, 1992. Page 231. (ISBN 0-393-03042-3 @ Amazon.com)
6.	Eckstein, John D. Statement in Trastek.
7.	CNN.com. "McCain in 'excellent health,' doctor says." 2008 May 23.
8.	Hinni, Michael L. Statement in Trastek.
9.	Shear, Michael D.; Brown, David. "McCain's Medical Records Indicate He Is Cancer-Free, Generally Healthy." Washington Post. 2008 May 24, page A03.
10.	Trastek VF; Eckstein JD; Hinni ML; Connolly SM. Statement Of Health Status, Prepared By Mayo Clinic At The Request Of Senator John McCain. 2008 May 23.