Sunday, October 12, 2008
McCain and Sarah Palin: Till Death Do Them Part? There Are Indications That John McCain Is A Lot Sicker Than We Know?
Posted by ed. dickau at 7:19 PM
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By ALEXANDER COCKBURN
In the crucial final weeks of the campaign John McCain is mostly doing only one event a day. This is the man of whom his primary care physician at the Mayo Clinic in Arizona, said to journalists in a conference call last May 23: “At the present time, Sen. McCain enjoys excellent health and displays extraordinary energy.” He looked tired and sick in the second debate in Nashville. As Sarah Palin rabble-rouses the crowds with calls for Obama to be forthright, she may be wondering, “how forthright has John McCain been with me? If he wins on November 4, will I be president in six months or a year?”
But if McCain’s battle with melanoma has suddenly turned critical, wouldn’t his doctors feel compelled to divulge their knowledge about the candidate? The answer is No. The legal penalties under HIPAA (the medical privacy act) for disclosure of protected health information, without that patient’s consent, are extremely serious.
No one is more under day-to-day scrutiny than the President. When Reagan ran for re-election he already knew he had colon cancer and that was kept quiet until after he won. In health matters, secrecy often wins out in the political crunch. What follows are the essentials of a story by Fred Gardner and myself in the latest issue of our CounterPunch newsletter.
In the past fifteen years, John McCain has had four melanomas removed. The most dangerous was the one taken from his temple in 2000, classified by his doctors as an invasive melanoma, stage IIA, on a standard scale that makes stage IV the most serious.
The 2000 surgery left McCain not only with a puffy jaw but also with a scar down his neck. Dr Eckstein’s public statement, released May 24 of this year, stated:
“Regarding his past skin issues, the Senator has received skin care at Mayo Clinic in Arizona since August, 2000. Four malignant melanomas were surgically removed in the past. Three of these were ‘in situ’ melanomas, meaning they were limited to the top layers of the skin and were not invasive. These three early melanomas on his left shoulder, left arm and left nasal sidewall, were removed in 1993, 2000 and 2002, respectively. A fourth melanoma that was invasive was removed from his left lower temple in 2000.
“Each melanoma was a new primary melanoma and did not represent a recurrence of any previous melanoma. There was and is no evidence of recurrence or metastasis, meaning spread of the invasive melanoma nearly eight years after surgery. Other less serious skin cancers have been removed over the years without complication. These have been non-melanoma basal cell and squamous cell cancers.
“Many questions have been asked about the removal of the invasive melanoma from Senator McCain’s left lower temple in August 2000… To summarize, we continue to find no evidence of metastasis or recurrence of the invasive melanoma as we approach the eighth anniversary of that operation. This was most recently confirmed with his comprehensive examination and tests in March 2008 and with Dr. Connolly’s skin examination on May 12, 2008. The prognosis for Senator McCain is good because the time of greatest risk for recurrence of invasive melanoma is within the first few years after the surgery.”
A press conference at the same time received relatively upbeat treatment. The New York Times’ medical correspondent, Dr. Lawrence Altman, sharing a byline with Elisabeth Bumiller, informed readers the next day, May 24, 2008: “Sen. John McCain, 71, is in excellent health and shows no evidence of the recurrence of the melanoma skin cancer that led to extensive head and neck surgery in 2000, McCain’s doctors said Friday.”
The McCain campaign had just allowed three-hour access by a group of reporters to 1,173 pages of medical records. They were not allowed to make any copies or take any of the materials out of the room. Reporters did note that two pathologists at the Armed Forces Institute of Pathology who examined the melanoma specimen from McCain’s left temple in 2000 suggested there were two melanomas on his temple, not one, as his doctors had said publicly at the time.
"Two experts in the field, who reviewed the report,” wrote Altman and Bumiller “said it was unclear whether the melanoma on McCain’s temple had metastasized from another, or whether there was one new primary melanoma. If the spread was through the nearby melanoma, then there is greater risk to McCain than the public has been led to believe, said Dr. Lynn Schuchter, a melanoma expert at the University of Pennsylvania, and Dr. Mohammed Kashani-Sabet, director of the Melanoma Center at UC San Francisco.”
For stage IIA melanoma, the survival rate 10 years after diagnosis is about 65 per cent. But the outlook is much better, as McCain’s doctors noted, for patients who have already survived more than seven years.
Dr. Suzanne Connolly, McCain’s dermatologist at the Mayo Clinic, told reporters that there was “no crystal ball to predict with certainty” if McCain’s cancer would return, but she put the chance at less than 10 per cent at this stage in his life.”
On September 20, 2008, CounterPunch was contacted by a reader in Washington, D.C., reporting conversations pointing to a dramatic, recent worsening in McCan’s medical condition and prognosis.
Though pressed by CounterPunch the reader insists on remaining anonymous. Over the course of several exchanges with our reader, we can report the following. An official in the National Institutes of Health, well known to our reader, has confided to her that in an informal conversation with a doctor in a California hospital the NIH official had learned that there had been a metastasis of McCain’s melanoma, and that this had come to light in a checkup in the past few weeks.
Urged to reconfirm this news and to provide further details, our reader pressed the NIH official for more details and reported back to us on September 26 that after she had asked the NIH official to verify the details, the official:
“decided this was important, and contacted her doctor friend to get what info she could. So here it is. John McCain recently was diagnosed with a melanoma recurrence, with a metastasis to the lymph node, in his latest, most recent cancer checkup, which took place at John Wayne Cancer Institute in California.”
Attempting to confirm this intelligence, CounterPunch contacted four physicians, none of whom want to be identified. Two remarked the subsidence of swelling in McCain’s left jaw in recent months. A UC San Francisco cancer specialist said, “It looked to me like he had something going on in his left jaw for a long time, and then it appeared much less puffy in the last few months. My theory was that he had gotten some radiation therapy. It was way pooched out compared to what it is now. He used to not show his left side on camera. And then he appeared to be going head-on. So my guess was that he had had some radiation.”
An East Coast oncologist said of John Wayne Cancer Institute in Santa Monica, California, “That would be the place he’d go because the world’s expert surgeon for melanoma, Donald Morton, is there.” Dr. Morton, while head of surgical oncology at UCLA, developed a technique that minimizes the number of lymph nodes that must be removed during biopsies.
A Los Angeles radiologist put the question of McCain being treated directly to two colleagues at John Wayne. “They said ‘no,’ but I had the strong impression they weren’t being forthright. I’ve known these guys 30 years and I sensed from their tone that they weren’t leveling with me.”
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