Many holes in disclosure of nominees’ health

Biden 'recovered fully'
Mr. Biden has “recovered fully without continued effects” from the aneurysm, Dr. Eisold, the Capitol physician, said in a letter released by the campaign. Dr. Eisold, a specialist in internal medicine, has a longstanding policy not to talk to reporters about his patients, even with their permission.

The Obama-Biden campaign referred me to Dr. Matthew A. Parker, an internist in Washington, who reviewed Mr. Biden’s records and also spoke with Dr. Eisold about them. Dr. Parker said that Dr. Eisold told him that brain imaging tests were not needed now because Mr. Biden had done well for the 20 years after the aneurysm. “It is a nonissue,” Dr. Parker said Dr. Eisold told him.

Dr. Parker, who is associated with George Washington University Hospital and Sibley Memorial Hospital, said he had not treated or met with Mr. Biden and did not have a direct connection to the campaign. Federal Election Commission records show that Dr. Parker contributed the maximum, $2,300, to Mr. Obama’s presidential campaign on March 13, 2008.

The medical records released by the campaign contain a summary of Mr. Biden’s operation and hospital stay in 1988 but no notes from a neurologist or neurosurgeon since then. So it is not known whether Mr. Biden has had recent brain imaging scans or has been evaluated by a neurologist or neurosurgeon recently. Dr. Parker said he did not ask Dr. Eisold when a neurologist or neurosurgeon last examined Mr. Biden.

Four leading neurosurgeons interviewed separately in this country and Europe said that as a vice-presidential nominee, Mr. Biden should have had recent brain imaging studies to detect any new aneurysm, because if one is found he might face more neurosurgery and be out of work for weeks or longer.

“What would I do in this situation?” said Dr. Eugene S. Flamm, the chairman of the department of neurological surgery at Montefiore Medical Center in the Bronx. “I would say, get an M.R.A. and check. You can’t just play the statistics.”

Doctors caring for political leaders and other prominent people often face difficulty in ordering tests that might clarify a situation for such patients but that are not recommended for all patients.

Dr. Parker said, “Some people will say, well, given the high-profile nature of the situation, we should do the test to be sure.” But, he added, “that is not necessarily wise.”

Among the reasons is a desire to avoid anxiety among patients and because doctors may not know what to do about an equivocal finding.

Dr. Parker said that even when he “pressed Dr. Eisold on the very same thing, given the circumstances” with Mr. Biden, Dr. Eisold “was very definitive about” not doing brain scan tests now.

The question of an aneurysm aside, the documents show Mr. Biden to have relatively minor health problems, including chronic sinusitis and allergies. He has an enlarged prostate, but a biopsy showed no evidence of cancer. With the help of a statin, he has normal cholesterol levels: 173 (HDL 47 and LDL 98) and triglycerides of 133.

In summary
All in all, the gaps and paucity of information leave the electorate with insufficient information to fully judge the health of the nominees. The information that has been released is a retreat from the approach that most campaigns took over the last 10 elections.

In an earlier time, there was a kind of gentlemen’s agreement between officials and the news media that permitted serious health conditions to be played down or kept secret.

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Franklin D. Roosevelt was crippled by polio more than a decade before he became president and, by his fourth term, he had developed serious heart disease, but the public was largely shielded from the profound effects. And while much was made of John F. Kennedy’s bad back and the rocking chair that gave him relief, it was only in the years after his assassination that his case of Addison’s disease, a hormonal disorder, became widely known.

What might be called the modern era of disclosure arguably began in 1972, when Mr. Eagleton had to step down as the Democratic vice-presidential nominee because he had not informed his running mate, Senator George McGovern, of his history of depression.

In 1992, Mr. Tsongas, who was seeking the Democratic nomination for president, spoke to me to assure the public that he was free of non-Hodgkins lymphoma, after a bone marrow transplant in 1986. In interviews, his doctors at the Dana-Farber Cancer Institute backed his assertion that he was cancer free. But in fact the cancer had recurred, and Mr. Tsongas eventually withdrew from the race. He died two days before his first term would have ended.

Other candidates who made themselves and their doctors available include the elder George Bush, Bob Dole, Al Gore and John Kerry. A leading example of openness was Ronald Reagan, whose age, 69, had become an issue in the 1980 election. Mr. Reagan authorized his doctors to be interviewed. He also agreed to an interview himself, against the wishes of his aides, answering all my questions, including what would he do if he became senile as president.

“Resign,” he said.

This story, Many Holes in Disclosure of Nominees’ Health, first appeared in The New York Times.

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