Man Without Qualities

Saturday, October 02, 2004

The Candidate, The Doctors, The Times

Here is an interesting web site of obituaries of real people who, in the judgment of the site's author, might still be alive today if only they had an EBT heart scan. The list begins:

Jim F Fixx 1932 - 1984, (although Jim lived in the pre-EBT and pre-statin era, it seems appropriate to put his obituary first) 52-year-old Jim Fixx collapsed while out jogging July 20, 1984 and died of a massive heart attack. Autopsy revealed extensive heart disease with coronary artery blockages of 99%, 80%, and 70%. Jim took up running in the 1960's when he weighed 220 lbs. He is credited with helping start America's fitness revolution, popularizing the sport of running. His best-selling book, 'The Complete Book of Running' was published in 1977 and sold over 1 million copies. By that time he was jogging an average of 60 miles every week and his weight was down to 159lbs. In 1980 he published Jim Fixx's 'Second Book of Running: The Companion Volume to The Complete Book of Running'. Jim's father died of a heart attack at age 43 and Jim's cholesterol levels was above 250 mg/dl. He was survived by four children.
The end of Jim Fixx is not obscure. Moreover, the combination of high-performance in athletics and heart difficulties is not unprecedented - indeed, a disturbing number of even very young athletes die suddenly of heart attacks that could have been detected by various forms of heart scans, including ultrasound - as detailed here.

Yet, the New York Times today runs an article proclaiming Senator Kerry's vigorous health by a reporter who identifies himself as a physician, an article that includes this remarkable sentence about Dr. Gerald J. Doyle, John Kerry's personal physician in Boston:

Because of Mr. Kerry's excellent performance in vigorous activities, Dr. Doyle said he had not performed tests for heart disease, like an echocardiogram, exercise stress test or noninvasive CT scans.
That's it. No follow up question asking whether any other physician had conducted or recommended such tests. Nor does the reporter ask a single other doctor for a second opinion on this line of reasoning about the treatment of Senator Kerry.

The whole article is like that, from beginning to end. It is bent on reassuring the reader, and never comes down from its opening sentence: John Kerry, a lean athlete who is the picture of health as he skis, skates, cycles and windsurfs, is in robust condition, he and his doctors said in their first extended interviews discussing his medical history. But even if John Kerry is in sufficient health to become President, a 60 year old man who had cancer surgery just months ago is definitely not any reasonable person's idea of the picture of health.

The article is particularly notable in that it relates at length interviews with the Senator and three of his doctors. But there is no claim that these are the only doctors who have treated John Kerry, even recently - although the report in the article that Mr. Kerry gave three of his doctors permission to speak about his health with this reporter suggests that he does have other doctors. But the reporter seems not to have asked even for a list of all of John Kerry's doctors. Nor does the article even suggest that the Senator has released his medical records, or any of them. And although the reporter does state that the interviewed doctors were instructed by Senator Kerry that they could discuss any topic, there is no indication that the reporter had seen a written release to that effect (in practice, such a release must be in writing) or whether the doctors were even asked whether they had restricted themselves in their answers.

This article appears just days after Senator Kerry appeared with a glowing, unnatural orange tan. He has been ribbed by some for having a bad, fake tan administered in advance of his first debate with President Bush. That's probably right. But one might want to consider that orange skin is sometimes a symptom of much more than vanity:

Kennedy's Addisonism was diagnosed in 1947 by a physician in London. Kennedy had probably been suffering (literally) from the disease for years, if not decades. After the diagnosis, he was given less than a year to live. He was so ill during the sea voyage home from England, in October 1947, that he was given the last rights. Yet, during the 1960 presidential race, the JFK campaign flatly denied that JFK had Addison disease. The Kennedy campaign used a very narrow definition of Addision disease, namely, insufficiency of the adrenal glands caused by tuberculosis. This was deliberate, calculated, and grossly misleading. Bumgarner calls it "undoubtedly one of the most cleverly laid smoke screens ever put down around a politician". Adrenal insufficiency, no matter how caused, is a serious matter. .... It is sometimes mentioned that Kennedy had a tan year-round. In most of North America, this is unusual, and raises the question of disease. Addison disease, for example, causes bronzing of the sking that is often mistaken for a tan.
This New York Times story is far from reassuring. The Times has apparently failed to ask basic questions, especially follow-up questions, or to corroborate claims made by the candidate and his physicians through independent evaluation of medical records or otherwise. There is no legal or absolute obligation of a candidate to reveal his medical history. But the Times should not be reassuring its readers as to Senator Kerry's health unless the Times has done a reasonably thorough investigation to back up its reassurances. The Times reporter is well aware that it is more than treacherous to rely on such sources as the candidate and his physicians alone, as this passage from the article reveals:

Earlier, Mr. Kerry gave three of his doctors permission to speak about his health with this reporter. Each doctor, interviewed separately, said that Mr. Kerry had instructed him not to withhold any information about his medical history. .... In the past, White House and personal physicians have at times misrepresented or lied about a president's health. For example, Franklin D. Roosevelt's doctors did not disclose the heart and vascular disease that caused his death, and John F. Kennedy and his family denied reports that he had Addison's disease, or adrenal
insufficiency, and required hormone injections

Even this passage is odd. It wasn't just John F. Kennedy and his family who lied. John F. Kennedy's doctors also lied ... a lot. And much of the media went along with the lies then and at least recklessly - in many cases probably knowingly - facilitated the misrepresentations. Including the Times.

UPDATE: Concern over the propensity of politicians to misrepresent their health should be further intensified by this report from Drudge, although one should keep in mind that it has not been confirmed and may not be true:

DOWNING Street tonight is embroiled in sensational claims that Tony Blair risked his life by trying to hush up the true scale of his heart problems. An eminent cardiologist has told The Mail on Sunday that No 10 knew for almost a year that the Prime Minister had a potentially life-threatening atrial flutter but did not act quickly to correct it. .... Instead, for criminally irresponsible political reasons, Mr Blair s office refused to acknowledge the scale of the health problems, he said.
FURTHER UPDATE: Astute reader DC shares some professional skepticism about the Times coverage:

I am an internist. You are perceptive beyond what your medical expertise would allow. "Because of Mr. Kerry's excellent performance in vigorous activities, Dr. Doyle said he had not performed tests for heart disease, like an echocardiogram, exercise stress test or noninvasive CT scans." This quote shows that Dr. Doyle is perpetuating malpractice. Vigor of a human being does not always correlate to being risk-free. There have been many patients who have had an excellent evaluation that included stress testing who was later tragically found to have a terrible illness including heart disease. This has to do with all medical tests being limited by their sensitivity and specificity. I only need to remind you of President Clinton's recent experience.

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