Should the public be privy to the intimate details of the health of the presidential candidates and their running mates? Is it any of our business? Physicians I've spoken with are split on the issue. But increasingly our culture seems interested in seeing the data for ourselves. This may seem more appropriate given recent history, remembering Ronald Reagan's Alzheimer's disease or Paul Tsongas' lymphoma.
The public often assumes that being denied total access implies that a candidate has something to hide. Senator John McCain has put out more details of his medical record than Senator Barack Obama or either of the vice presidential picks, but the circumstances of his 2008 release were unusual to say the least, fueling rumors. Senator McCain allowed a select group of reporters three hours to look over 1000 pages of records -- without the aid of photocopying. They then had 45 minutes to quiz his doctors.
If elected, Senator McCain would be the oldest first term President, raising questions about whether he is susceptible to mental decline over the next four to eight years. The insurance actuarial firm John M. Bragg & Associates crunched the numbers and concluded, by their calculations, Senator McCain had 8.4 years of expected "healthy life"—this includes factoring in his bouts with skin cancer. However, originally, each of his four skin cancer lesions were reported to be primary melanomas. But an Armed Forces pathologist report suggested that the melanoma on his left temple had spread or metastasized from another lesion, a potentially much more serious condition. Still, since it's been eight years since a recurrence, his risk at this point is low. But it should be noted that because melanoma can be such a nasty cancer, many doctors have stated that they don't ever consider survivors to be totally cured.
In contrast, there is less buzz surrounding the issue of Senator Barack Obama's health, although all he has released is a letter from his doctor stating that his health is excellent and the results of standard checkup tests were normal. The same insurance firm that released a forecast for Senator McCain, gave Senator Obama an expected 21.9 years of "good health." This was reportedly shortened by about 10 percent because of his history of smoking and difficulty quitting. Smoking accounts for about a third of heart attacks and deaths related to cardiovascular disease—not to mention its link to cancer.
Gov. Sarah Palin has released nothing and has not allowed interviews on the subject. Reports did circulate about the tanning bed she had installed in the Alaska Governor's mansion, though we don't know if she ever used it. Of course use of tanning beds is strongly linked to melanoma and other skin cancers.
Perhaps the thorniest ethical issues are raised by Senator Joseph Biden's health record. Senator Biden had two aneurysms 20 years ago and has released some of his medical records along with a letter from a physician stating that he has recovered fully. Neurosurgeons I spoke with indicated that if new aneurysms aren't picked up around the time of surgery, then a patient is at roughly the same risk for developing a new aneurysm as the rest of the population. Some institutions take a second follow-up scan five years post-aneurysm, but there is no universal guideline on this. We do not know whether Senator Biden had any follow-up scans. This raises the straightforward question asked by Dr. Timothy Johnson: "If Sen. Biden has had follow-up imaging, what were the results?" According to the campaign, an internal request has been made to release more information on Senator Biden's neurological health record, however no new information has come out yet. Many doctors have said, however, that at this point there is no strong medical reason to rescan him, since he's 20 years removed from his attacks.
The question for us is do we hold our candidates to a higher standard than ourselves -- even when it comes to medical matters? Crystal balls aside, no set of exams guarantees our future president and vice president a clean bill of health for the next four to eight years. But the lack of transparency will continue to lead many to speculate on what medical problems may have been downplayed or outright hidden. In the future candidates may find that full disclosure early on gives the public the information they desire, and grounds any further speculation in facts.