Many holes in disclosure of nominees’ health

THE DOCTOR’S WORLD

By Lawrence K. Altman, M.D.

updated 6:52 a.m. ET Oct. 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).

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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.

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