But the history of presidential health is marked by bigger lies, subterfuge, and what historians characterize as flat-out medical malpractice. The two most notorious, says Graff, involve the conspiracy between Woodrow Wilson's wife and his doctor to keep the president's strokes and in-office incapacitation a secret from Congress and the nation and a similar connivance to keep Franklin Roosevelt's life-threatening high blood pressure under wraps while he ran for his fourth term during what would be the final months of World War II. In both cases, Graff says, "the public was ill-served."
Wilson, elected president in 1912, had been suffering strokes since 1898—before he was governor of New Jersey, says Graff, 86. As a young code breaker during WWII, Graff says he witnessed firsthand the international concern over Roosevelt's failing health and attempts by his doctor, Ross McIntire, and aides to keep it hidden. (In an interview with U.S. News six years after Roosevelt's death in 1945, the now discredited McIntire insisted the president's health had been fine, that only a persistent cough and flu had depleted his reserves.) "We read the codes of many nations who thought Roosevelt was too ill for another term, and they were concerned he wouldn't live out his term," Graff says. The president died three months after his inauguration; the war ended four months later.
In 1999, during his first run for president, McCain released 1,500 pages of medical and psychiatric records that detailed his POW experiences and found him in good physical and mental health. But he now has a visible scar and puffiness on the left side of his face, evidence of surgery in 2000 to remove what doctors classified as a Stage IIA melanoma. Stage IV is the most serious. During the five-hour procedure, surgeons as a precaution removed lymph nodes near the cancer, and part of his saliva-producing parotid gland. It was McCain's fourth bout with skin cancer or lesions—the others, dating back to 1993, were successfully removed from his left shoulder, arm, and nose.
Meenhard Herlyn, a researcher at the Wistar Institute at the University of Pennsylvania and member of the Melanoma Research Foundation's scientific advisory committee, says that melanoma "continues to be a bad cancer—diagnosed in 60,000 new cases each year." The biggest factor in successful treatment is early diagnosis, before the cancer penetrates the deeper part of the skin where it could hit a lymph or blood vessel. The cancer mass McCain had removed in 2000 was 2 centimeters in diameter and 2.2 millimeters deep. "That's relatively thick," says Herlyn. In estimating risk, he says, any primary tumor in the skin thicker than 1 millimeter is considered at an increased risk for "having dissociated," or moved to other parts of the body. McCain's doctors reported that his cancer hadn't penetrated his lymph system. Though McCain is at greater risk for recurrence because of his age, gender, and multiple bouts with melanoma, he has been cancer free since 2002. There currently is no cure for melanoma once it spreads.
Age debate. The issue of McCain's age has been a touchy one—some who have raised it have been tagged as ageist. Democratic Party Chairman Howard Dean has pledged not to make an issue of it (insiders say they don't have to—it's already an issue), and Black, the campaign aide, has asserted that 70 just isn't what it used to be. So, is 70 the new 50? Karlene Ball says there's some truth to what Black says. "I've been studying cognitive aging for 30 years, and it is definitely the case that the 70-year-olds in our research now are cognitively younger than those we studied 20 years ago," says Ball, who directs the University of Alabama-Birmingham's Roybal Center for Research on Applied Gerontology. Improved healthcare and knowledge about the benefits of nutrition and physical activity have contributed to that trend, she says. But Bell adds this caution: There is a downward slope in memory as a function of age, though there are enormous individual differences. McCain likes to point to his 96-year-old mother as proof of his with-it genes. That may be stretching things a bit, says Ball. "Saying that your parents are free of dementia doesn't mean you won't get it," she adds, "but, still, it's good that they are because you don't have that risk factor." (McCain's father died of heart failure at 70.)