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John McCain's Cancer

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It's impolite to talk about cancer.

That's about the best reason I can think of to explain why John McCain's stage IIA (or is it IIIB?) melanoma isn't the subject of every political chatterbox show on cable news. It certainly isn't because McCain has ever come clean and settled the many unanswered questions on the subject. Or because the medical community has weighed in and found the chances of recurrence to be negligible.

Far from it. The fact is that John McCain's health is the most underreported, underdebated, and underappreciated risk factor in a potential McCain presidency. Sure, his age comes up all the time on TV and at the water cooler, usually in the context of a joke. If age alone were McCain's biggest health risk, I'd be the first in line to give him a pass and move on to more pressing issues. But his age is only an aggravating factor in a disturbing medical history whose records run 1,173 pages long. And because McCain has simply refused to divulge that history, we're not talking about it.

Of course, the McCain campaign would respond that they have indeed released the candidate's medical records, in full, back in May. To that, Frank Rich's New York Times column this Saturday provides a better response than I could ever hope to muster:

"The twin-pronged strategy of truculence and propaganda that sold Bush and his war could yet work for McCain....John McCain's full medical records, our sole index to the odds of an imminent Palin presidency, also remain locked away. The McCain campaign instead invited 20 chosen reporters to speed-read through 1,173 pages of medical history for a mere three hours on the Friday before Memorial Day weekend. No photocopying was permitted.....This is the same tactic of selective document release that the Bush White House used to bamboozle Congress and the press about Saddam's nonexistent W.M.D."

Simply put, there has been no release of John McCain's medical records, only a media stunt. Unfortunately, a number of news organizations (notably excepting The Times) took the bait hook, line and sinker, pretending that 20-odd crack reporters were able to sift through close to 400 pages per hour per person and issue a clean bill of health. As a consequence, we're no longer talking about an issue that trumps every one of the important questions about policy, judgment and experience that define the public discussion about John McCain.

The truth is more complicated than the facile conclusions reached by that handful of sanguine journalists locked in a room in Scottsdale, and far more portentous. The most straightforward reason why a full release of McCain's medical records is imperative to determining what the real risk is of his history of recurrent cancer is that there are in fact two conflicting reports from 2000 of the status of McCain's melanoma: one from the Mayo Clinic Scottsdale, and one from the Armed Forces Institute of Pathology (the "gold standard" of pathology, according to a melanoma specialist at UCLA). The Mayo Clinic doctors concluded eight years ago that the lesion on McCain's temple was a stage IIA melanoma. The Armed Forces Institute of Pathology determined that the same lesion was possibly two distinct melanomas, which would indicate an incidence of metastases, which implies a significantly more advanced stage of cancer.

To put that in terms of McCain's projected mortality during a McCain presidency, the respective 5- and 10-year survival rates for a stage IIA melanoma for a 72 year-old man are 79% and 64%. If the melanoma is in stage IIIB, which is what the possible satellite metastases suggest, the 5- and 10-year rates are 53% and 38%, respectively (McCain is now eight years into that projection). How likely is it that the melanoma is at stage IIIB rather than IIA? It's impossible to say without reviewing the medical records.

Over 2,300 doctors have signed an open letter entitled "John McCain's Health Records Must Be Released." That includes dozens of oncologists and melanoma specialists. If these medical professionals are sufficiently concerned about this issue to put their professional reputations behind this clear public statement, shouldn't the rest of us be at least a little bit worried?