Many holes in disclosure of nominees’ health

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.

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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.

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