Thursday, October 23, 2008

I vote against John McCain because he is a risk to people with melanoma, not because of his risk of melanoma.

Before I go any farther, let me just say that this post is the one time I'll say anything sympathetic about John McCain who I desperately hope loses this election and loses big. But this isn't about him, really.

It seems like during most election seasons, the New York Times' Lawrence Altman MD seems to get worked up about whether he has had enough access to political candidates' health records. Altman was a medical resident about 40 years ago and has never been much of a clinician as far as I can tell besides that--he did preventive health, public health work, and journalism. But, he seems to feel that reporters--and especially, he, being a doctor/reporter--have a right to go over presidential candidates' health records.

This is an appalling idea if we take away John McCain and our hope to see him lose, and think about this in the abstract. And I'm frustrated that a bunch of doctors who support Obama have apparently signed some kind of letter asking that McCain release all his medical records, and that some of them are saying a bunch of stuff in public about his melanoma risk. First of all, I don't know anything more about John McCain's melanoma risk than Bill Frist knew about Terri Schiavo's neurological function, which is to say, I know better than to pronounce my opinion about it.

Second of all, if I was able to look at all of John McCain's medical records, do a physical exam and history, and then quickly become a melanoma expert, does risk for a serious health condition mean that you're supposed to bow out of public life? If you think so, how far down does this argument apply? Governor? Mayor? City Council? Why would it stop at any particular level of office? If the argument is reasonable at the top, why shouldn't the voters of any given town know whether their mayor had guaiac-positive stool? Is it relevant to know whether your congressional candidate might have a brain aneurysm? Is it your right--no, your duty as a citizen--to demand full body CT scans and head MRIs for every person entering any political race at all? As a doctor, shouldn't I reserve my vote only for the candidate who puts his colonoscopy report up on the web so I can look inside his ass and judge for myself whether his polyps are sufficiently presidential?

John McCain's health plans mean his risk to people with melanoma is much more significant than his own risk of melanoma.

Finally, epidemiologically, the melanoma argument opens the door to a truly terrible line of logic, because underneath the medical argument must always be an epidemiological argument. By far the most common cause of death among US presidents in office is assassination. And deaths from cholera or bacterial pneumonia are unlikely for current US presidents. For all of Lawrence Altman's piety about presidents concealing their medical conditions, JFK hiding his Addison's disease was obviously irrelevant in the larger scheme of things. If we're so concerned about a president's chances of death, should we ask Lawrence Altman to be joined by security experts who can analyze the candidates' risk for being assassinated before we vote, which in presidential epidemiology is more likely than death from cancer? Does the public have a right to read all the death threats sent to presidential candidates so we can judge for ourselves whether they are serious? Shouldn't the Secret Service be granting the public complete access to suspected or potential assassins-in-the-making to assess whether they are serious threats or just rifle-toting equivalents of negative lymph nodes? In this election, I don't even want to think about such a thing.

So presidential epidemiology be damned; I am casting my vote for a black man with a significant smoking history and a bunch of racists who want him dead. I'm voting for him because of who he is while he is alive, not because of my morbid guesses about when he might die.

(If you want to be a doctor for Obama, here's a more reasonable way to do it.)

15 comments:

Kyle said...

It applies to president/vice only ... We are talking about our country, or planet.

It would not be so bad, if Palin were competent.

But to say it doesn't matter at all is ridiculous. It matters very much what the president-elect's health is. It matters very much whether or not he will live through his first year in office.

he can be a senator, a mayor, a governor - but a president, no.

It's not just the melanoma either, it's that combined with his age. He is very truly at risk - and that puts us all at risk if he were to be elected.

I am sorry if it personally offends you, but in no way do I agree that his health is off limits. It is almost as important as what he plans to do as president. If he dies, he can't do that now can he.

Kyle said...

it's a balancing act. The chances of death vs. the good they can do vs. the bad that will come if they do die.


God forbid Obama were to be assassinated, Biden is at least capable of running this country. Add to that, the great things that Obama could accomplish if elected- and it's worth it.

Likewise, forbid Mccain were to die - Palin is not capable of being president. She would destroy this country - and possibly more. Add to that the fact that McCain really won't do anything of value for us - and it;s not worth the risk.

It is something every voter needs to consider, seriously. Not to say it should be a huge news story, but I do believe it is relevant.

Justin said...

"As a doctor, shouldn't I reserve my vote only for the candidate who puts his colonoscopy report up on the web so I can look inside his ass and judge for myself whether his polyps are sufficiently presidential?"

These should have been a debate question. I select Bob Schiffer to ask it.

gaby said...

I find Joe Wright's comment very thoughtful and accurate. If we were to elect presidents based on their risk to die, no one would be elected. we would have to develop a statistical analysis about what's more risky: the risk of developing melanoma AND actually dying from it, or the risk of being black and being ratially hated by one insane gun owner. Go do the math...
Why don't we focus on the abilities that each candidate has to get our country out of the hole. I find that a bit more important.

gaby said...

I find Joe Wright's comment very thoughtful and accurate. If we were to elect presidents based on their risk to die, no one would be elected. we would have to develop a statistical analysis about what's more risky: the risk of developing melanoma AND actually dying from it, or the risk of being black and being ratially hated by one insane gun owner. Go do the math...
Why don't we focus on the abilities that each candidate has to get our country out of the hole. I find that a bit more important.

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Joe Wright said...

I'm sorry that I deleted some reasonable comments to this story in the process of deleting some wayward links to nude celebrities that somehow got into the comments thread. My apologies for those who posted to this original post.