Covering Candidates’ Medical Records

Larry Altman talks about access and interest

Three weeks ago, John McCain, who would be the oldest president in history if elected, released 1,173 pages of his medical records to the press. He did so only after a series of delays, however, and then granted a pool of about a dozen news outlets access to them for three hours, with no photocopying allowed. One reporter whose employer was not invited to view the documents was The New York Times’s Lawrence K. Altman. His exclusion was a bit ironic, given that he is an M.D. and was part of the group that viewed the last batch of McCain’s medical records, which the senator released in 1999 during his first bid for the Oval Office. Those earlier records covered McCain’s well-being prior to 2000, including his experience as a prisoner of war during the Vietnam War and his treatment for melanoma, among other things. Lost month’s disclosure covered his life since and showed that the cancer has not recurred and that, despite a few effects of age, he is mostly healthy. There was quite a bit of media attention to the release of the records, but it hasn’t always been that way. Altman talked with CJR’s Curtis Brainard about how the press has come to be so interested in candidates’ health and protocols for covering their ailments.

Curtis Brainard: NPR had a report in 2003 about John Kerry’s and Bob Graham’s medical histories, which said that there’s been a “noticeable change in how forthcoming presidential candidates have been and should be about their health problems.” Do you agree?

Lawrence Altman: It depends where your starting point is. I would say, yes, if you’re looking at the history of say, presidential candidates or candidates for high office. In the past, White House physicians have been known to lie; candidates for president or nominees have been known to evade the truth, distort the facts, or lie. You’ve got Woodrow Wilson with a stroke and his wife allegedly running the affairs of the country; you’ve got Franklin Roosevelt who may or may not have been told how deathly ill he was in his last term, and certainly nothing was told to the country about it; you’ve got Kennedy every which way not acknowledging that he had Addison’s disease; you had [Thomas] Eagleton who had to leave the [Democratic] ticket in ‘72 because he didn’t tell [George] McGovern about his past history of electric-shock therapy and depression; and there was [Paul] Tsongas in the mid-1990s and the fact that he had a recurrence after they had maintained that he was cured of cancer.

I think all of those, collectively, led to the public to want to know more about the health of the people who were going to run their country. There has been a movement for candidates to disclose more information than they have in the past. Starting with [Ronald] Reagan in the 1980s, the Times and I started interviewing candidates; we did their medical histories, and we have done that for a number of presidents and candidates for other offices. And I guess over that period of time, it has been a custom or a standard for the presidents to disclose information about their health.

CB: According to an article in The Arizona Republic, “McCain’s Republican presidential campaign called the sweeping health disclosure unprecedented in the annals of American politics.” Is that accurate?

LA: It depends on how you want to define this. In terms of the information that [McCain’s campaign] released in 1999 — making the records available first to The Associated Press exclusively and then only reluctantly opening them to other reporters, including myself — there probably hadn’t been another candidate running for office who had been a prisoner of war and whose psychological constitution was being called into question. That may have been unprecedented.

It is not unprecedented, to my knowledge, for candidates to allow reporters to look at their records, because I have done that. Having done it this time, they certainly imposed limits, and those limits are not unprecedented, but they certainly don’t argue for the fact that they made a complete release of all the information. Both in 1999 and now, copies were not allowed to be made, and I can understand that, but to have a slew of reporters and give each individual reporter three hours to go through what was said to be approximately a thousand pages — that’s 333 pages per hour, and I don’t think speed readers can read that much that fast. I don’t know what was in the records and I don’t know how much there was to read on each page, but [the time limit] doesn’t allow anyone, in my mind, to make a thorough analysis and recording, which is what you’d want. And then not to allow news organization that weren’t allowed to participate in the pool in the first place to examine the records afterwards — they denied me that permission; and I don’t know, maybe they denied other news organizations. And then what was billed as a two-hour teleconference turned into an approximately a forty-five-minute one.

CB: So you weren’t in the pool?

LA: No, they chose to exclude us. They had made it clear that they did not want the Times as part of this. They did not like the editorial that ran in early May—which I had nothing to do with—pointing out that [McCain] had passed his April deadline for issuing his medical records; we’d been trying to get them for over a year. He also hadn’t released Mrs. McCain’s tax records. So they had an editorial about these records, and his campaign specifically cited that when we requested, yet again, to do an interview and were told we were “not at the top of the list.”

CB: The New Republic’s blog, The Plank, complained that you, specifically, were excluded, arguing that because you are an M.D. you would have been better suited to analyzing the records. Is it necessary to have a medical background for this type of reporting?

LA: I think it helps. Taking it away from McCain and answering your question generically, it would depend on the real medical problems of a particular candidate. For somebody who has been healthy and there’s not much to write about, then maybe a physician could look into what isn’t included and see if that’s significant. But it certainly would come into play in terms of a candidate or an officeholder who had a particular medical condition that posed chronic issues — because it may not be chronic in the sense that it’s present at the moment, but it raises questions for future care and what are the implications and so forth. It would be extremely helpful to know a lot about the medicine and the condition, which documents to look for.

CB: The Times’s editorial that you mentioned argued that, “No presidential candidate should get to the point that he has locked up his party’s nomination without public vetting of his health.” Given that some ailments can be concealed, do you agree, or should reporters only press a candidate when there’s an obvious issue, such as McCain’s melanoma?

LA: I think ideally the statement that was in the editorial should apply, that the voters should have this as early as possible. To do the in-depth, thorough ones on every single candidate like you’ve had in this last campaign would require a monumental amount of time for one individual.

CB: Your 1999 article about the release of the first round of McCain’s records had some very intimate details about his mental constitution. Should all candidates’ be expected to provide such details, or only those with exceptional medical histories?

LA: Well, I think in his case, as I remember the political climate at time, he had to respond to the charges of his temper, to the charges that he had psychological problems as a result of being a prisoner of war for five years, or whatever the time was, and how that would affect him. And that, I guess, he had to do politically, as a reality.

But it’s only what can be determined by what the public sees of an officeholder or a candidate. I mean, we’ve certainly had a long period of time in this [primary] campaign, so there’s been a fair amount of exposure of these candidates to reporters and the public and if there was something really unusual, I think we would’ve picked it up in terms of mood or behavior or something along those lines. They may not be able to detect a more serious underlying medical condition, but everybody needs a full medical exam and that has to be made available, or should be made available.

CB: What about the case of Paul Tsongas, who would have died in office had he been elected? Was there anything that reporters could’ve picked up on at the time that would indicated that his condition was more serious than he let on?

LA: He brought it up as a campaign issue. He made himself a cancer survivor, he talked openly about his treatment, and therefore it became a campaign issue that he himself addressed. I remember talking to a number of political reporters at the time, and they hadn’t looked into it during the New Hampshire campaigning, which I think that year was the first major campaign. I believe he talked about it, but nobody went into the issue of what was the history of somebody with a cancer of that type, what were the chances that it would recur, and so forth. I believe we covered it around the time that he was campaigning in Maryland. It ordinarily takes a long time for the candidates to agree to do this. It seems to be something that, although they say they’ll talk about it, they’re very reluctant to actually turn over information and invite an independent check.

CB: I imagine that part of the reluctance has to do with the fear that disclosing certain aspects about a candidate’s health could hurt the campaign. In fact, at least one blog called an article you wrote in March about the lack of attention McCain’s health a “hit piece.” What is your reaction?

LA: Not having seen the particular blog and the comment I can’t directly comment on that, but you know, from the mail I get, people do not like anything said negatively about a candidate that they support. So part of it comes under that category, and I would ask them what their criticism was of reporting on the available information, interpreting it as best as possible, pointing out the number of people who are raising questions — and, my gosh, how many people were asking what was wrong with McCain’s cheek? Trying to answer a question when the campaign wouldn’t adequately answer it, and then putting together the information that was available, to me was responsible reporting.

So I don’t know what their particular criticism could be for doing that. I do remember in 2000 when [Bill] Bradley was running for president, we had been trying to get him to talk about his atrial fibrillation for some time and he didn’t do it until about a week before the New Hampshire primary, at which time we did a piece about it. People were complaining that we held the piece and ran it deliberately before the primary, but that was the choice of the candidate who wouldn’t give an interview until then. So you have to go by what the facts in the case are. We had no choice because we couldn’t responsibly report the information without his permission and his doctor’s permission and so forth. The candidate determined the timing of the piece, not the news organization.

CB: What about Barack Obama and Hillary Clinton? That article from March didn’t mention them. Have reporters given them the same rigorous treatment they’ve given McCain?

LA: Well, the request was made to those campaigns and, so far as I know, Mrs. Clinton did not issue anything about her health. Senator Obama released a statement from his doctor the week following McCain and we reported that. But until we had that statement from his doctor there was nothing to report on his health specifically that had medical bearing. And if you look at the Obama piece I did, I pointed out what information was not included in his doctor’s statement and the fact that the letter was undated and so forth.

CB: Some medical conditions, including McCain’s, can be a little ambiguous. On the one hand, he has a history of cancer; on the other hand, he successfully battled it and it hasn’t recurred. To what extent can reporters fall into the glass-half-full/glass-half-empty trap?

LA: If you’re talking about the cancer specifically, it depends on the state of understanding and knowledge about how melanomas behave. You have to point out as much of the facts and information as you can in that particular situation on deadline, and that’s why [in the Times article] I pointed out the Armed Forces Institute of Pathology report questioning whether [McCain’s melanoma from 2000] was a metastasis and not a primary [tumor growth], which would change the classification. And the McCain people, when I asked for clarification of this and asked to talk to the doctors afterward—which they’d told us they would allow and then didn’t—they just issued some statement from the Mayo Clinic [which operated on melanoma] saying they stood by their diagnosis. So there’s no way to keep checking; that closes off an avenue of communication. In our case, we had no way of specifically communicating with his doctors to clarify any point that they wanted to clarify or to clarify any of the points that we wanted to clarify. So we had to go by what was disclosed by the pool of reporters and the limited questioning that occurred in the teleconference. But there’s another aspect of this, too—why don’t candidates themselves raise the question about their opponents health? When that comes up, it should be covered. In 1996, Bob Dole brought up the fact that Clinton hadn’t disclosed his medical information and then there was whole issue about Clinton’s health.

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Curtis Brainard writes on science and environment reporting. Follow him on Twitter @cbrainard.