Just days before his expected nomination at the Republican National Convention, John McCain will celebrate his birthday. But don't bet on seeing a prime-time bash during the GOP's September get-together in Minneapolis: a presidential nominee blowing out 72 candles is not an image party bosses want to see on YouTube going into the fall battle.
Especially when that nominee visibly wears the toll of a long and, at times, extraordinarily difficult life. One that has included surviving a bone-crushing ejection from his Navy jet, torture during 5½ years as a prisoner of war in Vietnam, major surgery to remove a dangerous skin cancer from his face, and the stiff and sometimes pained bearing shared by many of his contemporaries. If elected, McCain would steal Ronald Reagan's record as the oldest first-term president in the nation's history.
While questions of age and health have shadowed McCain, they have largely remained under the radar. His staffers respond to queries about his condition by pointing to the demanding campaign schedule he has maintained for many months. But with his doctors at the Mayo Clinic in Scottsdale, Ariz., poised to release his current medical records before Memorial Day, and polls showing that a significant number of voters (32 percent in one survey) say that McCain is too old to be president, those back-burner issues are about to move front and center.
Top McCain aide Charlie Black says that the candidate's records will prove that he is in "good health." But their release is bound to reignite the debate over how much a candidate's age and health history should or could factor into the November contest, including how they may influence McCain's choice for vice president. And it will very likely renew discussion about the public's desire to know versus its right to know the full scope of nominees' medical conditions. The genie of disclosure will never be put back in the bottle, says Brian Balogh of the University of Virginia's Miller Center. When Thomas Eagleton's history of depression and electroshock therapy forced him to step down as Democrat George McGovern's running mate in 1972, "everyone became pretty self-conscious about candidates' past medical history," Balogh says. And post-Watergate, disclosure became de rigueur. "This was what the press demanded and what the American public expected and wanted to know about their presidential candidates," he says.
Presidential health. It wasn't always so. In the pantheon of presidents beset by maladies, deadly conditions, and some truly off-the-wall medical histories (Grover Cleveland had a cancerous lesion secretly removed from his jaw while in a chair lashed to the mast of a yacht plying the East River in New York),McCain's health trials don't look all that exceptional. Take Andrew Jackson, who suffered a head wound at age 13 during the Revolutionary War, was shot at least twice in gun battles, and carried in him at least three bullet fragments—one near his heart. It's most likely that Jackson suffered from malaria, lead poisoning, parasites, chronic diarrhea, depression, and was "swimming in heavy metals," notes H. W. Brands, a University of Texas historian, from the "cures" of mercury and a brew called "sugar of lead." (Family members, rather indiscreetly, also reported that as a youngster he "slobbered.") "In the early 19th to the early 20th century, people had a lot of things wrong with them, doctors didn't know how to fix them, and so they lived with them," Brands says. But Jackson lived to 78—at the time, a "good long life."
John Kennedy hid his diagnosis of debilitating Addison's disease—while in Congress, he had once been given last rites—and Chester Arthur kept secret his struggle with an incurable kidney disease. Dwight Eisenhower suffered a heart attack and stroke while in office—"the public was told about all of this," presidential historian Henry Graff says—and Lyndon Johnson survived a massive heart attack before he became president and another while in the Oval Office. He died of a third after leaving office.
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.)
Voters may need to be reminded, says Brands, that presidential candidates are human, a package of both good and bad—health histories included. McCain can take inspiration from Jackson, he says, who though beset by illness and considered old for his time, "was clearheaded and forceful until the last day of his presidency." But there's little doubt that what McCain's new medical records reveal and whether youth will be a quality he seeks in a vice president will both prove crucial to the case he'll make to the demanding American people about his own health and ability to serve. A case that becomes even more critical with 46-year-old Barack Obama as the Democratic front-runner.
With Stephanie Salmon