Many Holes in Disclosure of Nominees’ Health

In 1999, early in his first run for the presidency, Mr. McCain allowed a small number of reporters, including me, to review an estimated 1,500 pages of his medical records without photocopying or recording the information.

Nothing is known publicly about Sarah Palin’s medical history, aside from the birth of her child last April

In doing so, Mr. McCain gave the public its broadest look at the psychological profile of a presidential candidate. He released psychological records about him that were amassed as part of a Navy project to gauge the health of former prisoners of war. Assessments were based on standard psychological tests and what Mr. McCain told his doctors after his release. The records mentioned that in 1968, about eight months after his capture and after some particularly brutal beatings from his North Vietnamese captors, Mr. McCain attempted suicide, trying to hang himself with his shirt.

The records and his doctors, whom I interviewed with the senator’s permission in 1999, said he had never been given a diagnosis of a mental health disorder or treated at the project’s center for a mental health disorder.

The records also showed that a surgeon removed a melanoma from Mr. McCain’s left shoulder in 1993. Melanomas can be a far more deadly form of skin cancer than the more common basal cell and other types.

In early August 2000, just as 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.

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.

On May 23, 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.

 

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