The "Medical Center" Edition Of "Election '08"

Interesting stuff in the New York Times today from Lawrence K. Altman. M.D., concerning the medical records of the presidential and vice-presidential candidates (from here – this is kind of involved, but I think it’s important)…

In early August 2000, just as (John) Mr. McCain’s rival George W. Bush was about to receive the Republican presidential nomination, Dr. John F. Eisold, the attending physician at the United States Capitol, detected two more melanomas, Mr. McCain’s second and third.

One on Mr. McCain’s left arm was determined to be the least risky type, in situ. But the one on his left temple was dangerous.

A few days after detection of the melanomas, Mr. McCain sought care for them at the Mayo Clinic in Scottsdale. Mr. McCain’s campaign said this year that the left-temple melanoma was 2.2 millimeters at its thickest part and graded as Stage IIA on a scale in which Stage IV is the worst. Stage II meant that the melanoma had not spread into the lymph nodes. The number of melanomas is less significant than the thickness measured in the pathology assessment of any one of them.

Mr. McCain underwent extensive surgery on his face and neck for the melanoma on Aug. 19, 2000. Surgeons removed more than 30 lymph nodes, and pathologists then determined that all of them were cancer free.

OK, good for Senator McBush. Now, let’s jump forward seven years…

In March 2007, as Mr. McCain was making his second bid for the Republican nomination, The Times began asking his campaign for permission to speak with the senator and his doctors, citing the history of such interviews.

On May 6, 2008, Jill Hazelbaker, a McCain spokeswoman, denied the requests, writing in an e-mail message that The Times was “not at the top of the list” and including a link to a Times editorial that had criticized Mr. McCain for not disclosing health information and Senator Hillary Rodham Clinton of New York for not disclosing financial records.

Typical McBush campaign BS (it gets better with Hazelbaker later, though)….

On May 23 (this year), Mr. McCain allowed a small pool of journalists, including three doctor-reporters, though none from The Times, to spend three hours reviewing a newer set of his Mayo Clinic records. That set, 1,173 pages, included records from 2000 to 2008 but none of the records made available in 1999. Again, the campaign did not allow the journalists to photocopy any documents.

Mr. McCain’s Mayo Clinic doctors answered selected reporters’ questions by telephone, but only for 45 minutes instead of the scheduled two hours. The McCain campaign did not allow New York Times reporters to ask questions in the teleconference.

The clinic doctors said that Mr. McCain was in good health and that no medical reason precluded him from fulfilling all the duties of president.

The doctors said that a fourth melanoma they detected on the left side of his nose in 2002 was also in situ, the least dangerous type. All four melanomas that Mr. McCain experienced were primary, or new, and there was no evidence that any of them had spread, the doctors said.

However, the reporters’ summary cited a report dated Aug. 9, 2000, from two pathologists at the Armed Forces Institute of Pathology in Washington who examined a biopsy of the melanoma taken from Mr. McCain’s left temple a few days earlier.

The Armed Forces pathologists suggested that the left-temple melanoma had spread from another melanoma, known as a metastasis or satellite lesion. “The vertical orientation of this lesion,” the report said, “with only focal epidermal involvement above it is highly suggestive of a metastasis of malignant melanoma and may represent a satellite metastasis of S00-9572-A,” which is the “skin, left temple, lateral” biopsy.

The pool report was by nature unable to provide a complete portrait of Mr. McCain’s recent medical history. It left several questions, including about the number of biopsies and when they were done. On Aug. 18, 2000, Dr. John D. Eckstein, Mr. McCain’s personal physician at the Mayo Clinic in Scottsdale, noted in Mr. McCain’s records that there were two biopsies of the left temple. Dr. Eckstein’s note did not say where and when the biopsies were performed. The Armed Forces report cited one biopsy, so presumably a second was performed in Scottsdale. The Armed Forces pathologists said a melanoma had developed over a skin scar whose origin was unclear.

A skin lesion, not one of the four melanomas, had been removed from Mr. McCain’s left temple in 1996 and interpreted as being benign; some experts have speculated that it might have been misdiagnosed, and thus the origin of the 2000 melanoma.

The Armed Forces pathologists did not speak in the teleconference in May 2008, and questions raised by their report have remained unanswered. The selected reporters did not ask about that report, and the Mayo Clinic doctors did not discuss it. A complete Mayo pathology report was apparently not included in the pool summary.

In interviews, several melanoma experts questioned why the Mayo Clinic doctors had performed such extensive surgery, because the operation was usually reserved for treatment of Stage III melanoma, not Stage IIA.

On Aug. 18, 2000, the day before Mr. McCain’s operation, his surgeon, Dr. Michael L. Hinni, wrote in the records that he planned to do the extensive operation because of the size and location of Mr. McCain’s melanoma. In the teleconference in May 2008, Dr. Hinni explained that because the melanoma was two centimeters across he had to make “a 6-by-6-centimeter island of skin, a fairly sizable wound” to remove it.

It is not known whether the Mayo Clinic in Scottsdale asked pathologists outside the Mayo system for an independent review.

If Mr. McCain’s 2000 left-temple melanoma was a metastasis, as the Armed Forces pathologists’ report suggested, it would be classified as Stage III. The reclassification would change his statistical odds for survival at 10 years from about 60 percent to 36 percent, according to a published study.

So one of the matters raised by Dr. Altman in his article today is the question raised by the Armed Forces pathologists about one of the melanomas removed from Senator McBush at his left temple by the Mayo Clinic doctors; the Armed Forces doctors apparently believe that that melanoma metastasized from the first, and their questions have remained unanswered, as Dr. Altman tells us. I would consider that to be significant, affecting his survival odds as noted in the prior paragraph.

Oh, and don’t expect any help from the McBush campaign, by the way…

Last week, The Times contacted the McCain campaign to fill in gaps in the medical records. Ms. Hazelbaker, the McCain spokeswoman, wrote in an e-mail message: “As you know, we disclosed over 1,200 pages of Senator McCain’s medical history to Dr. Altman’s colleagues in the press earlier this year. We also arranged a Mayo Clinic briefing with three of Senator McCain’s physicians that Dr. Altman listened to by phone. Additionally, we released a detailed document outlining his most recent physical and lab test results. It was an unprecedented level of disclosure, and Dr. Altman can look at the public document on our Web site if he wishes to do so. It was certainly more significant than the one-page doctor’s note Obama released, though I have little hope The Times will report it that way.”

WAAAAAHHHHH!!!!!! JOHN W. McBUSH IS LOSING BECAUSE OF THAT LIBURULL MEDIA AND THE NEW YORK TIMES!! WAAAAAAAAHH!!! BARACK OBAMA IS RAISING MORE MONEY THAN WE ARE!!! WAAAAHHHHH!!!!!!

What a bunch of freaking babies!

Oh, and as long as Ms. Hazelbaker referred to the release from Obama’s doctor, I should note that, yes, it probably isn’t complete, but at least it goes on record as saying that the senator from Illinois has no major ailments, which is good, aside from the fact that he’s a smoker. And the Times tells us that “Governor Hottie” didn’t release anything (yeah, I guess anyone who actually cares about the health of a prospective vice-president is nothing but a “socialist” – God, is this election over yet?).

I have to admit, though, that Dr. Altman’s article does raise some questions in my mind about Joe Biden, who was treated for two brain aneurysms 20 years ago.

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.

I, as a layman, have no grounds whatsoever to question Dr. Eisold, though I cannot help but wonder why it isn’t a good idea to do periodic tests to monitor whether or not an aneurysm would have returned (and I assume both of the aneurysms are being treated here as one “instance,” if you will).

And though Dr. Parker’s contribution may be completely legal, I feel a bit uncomfortable with the fact that a candidate’s physician can make that kind of contribution to the candidate (I mean, Dr. Parker could have done something like funnel it into the DNC somehow and let them disburse it – maybe making too much of a point out of that, I’ll admit).

So it looks like we’ll have to deal with a president who may have to “step outside” from time to time to take a drag (kidding – somehow I’m sure accommodations would be made for him; with the kind of stress he’ll be dealing with, breaking the cigarette habit will be almost a superhuman feat) and a vice-president who, literally, should have his head examined. I’ll take that, however, over someone who, unfortunately, is a ticking cancer time bomb and another nominee who won’t release any of her medical records at all.