McCain Nears 72–or Really 83?

John S. McCain, III will turn 72 in August, 2008. McCain’s age, health, and mental acuity will inevitably be factors in the campaign.

Will American voters be paying attention? Will McCain release full and accurate information on his health?

And how can one distinguish whether McCain’s behavior and judgment are normal and acceptable, or are deteriorating and therefore potentially dangerous? When is a gaffe a symptom?

Several actuarial and medical data points suggest that McCain’s upcoming 72nd chronological birthday could well be the equivalent of a biological 83rd birthday.

Below the break are a few guidelines and links to help inform an assessment of McCain’s age, health, and fitness for the Presidency.

(Cross-posting at Daily Kos, Raising Kaine, and Bits of News.)

John McCain on the Stump (AFP, April 1, 2008)

Chronological Age Vs. Biological Age

McCain will turn 72 on August 29th, 2008. If he were to be elected in November, he would become the oldest-ever first term President in American history.

But what if McCain’s biological age is really greater than his chronological age? Below are a few data points extracted from actuarial tables.

A 72-year-old white male has a 3.5 percent chance of dying within the following year.

But remember that McCain suffered 5 1/2 years of torture, stress, and poor nutrition in a North Vietnamese prison camp. Researchers have found that prolonged stress actually ages human beings prematurely at the cellular, DNA level, as reported by CBS in 2005.  Stress results in a thinning out of telomeres, the DNA “ends” that control aging. Here is the money quote from that report on 60 Minutes:

It was as though there had been in excess of 10 years of extra aging in these individuals’ blood cells. … And that’s actually an underestimate. That’s a very conservative estimate.

if each year of the stress of detention added two years to McCain’s biological age, a biological 83 year old white male would have approximately a 10 percent chance of dying by the end of August, 2009.

If each year of such stress added three years to McCain’s biological age, a biological 89 year old white male would have slightly more than a 16 percent chance of dying by the end of August, 2009.

Of course, as the researchers cited in the CBS report pointed out, some individuals have a better than average ability to cope with stress. How much damage did McCain suffer to his DNA’s telomeres?

As old as old McCain undeniably looks in recent photographs and on TV, some who have recently seen him up close have remarked that he looks even older in the flesh. He moves stiffly, and his wartime injuries (two broken arms, a badly injured knee, multiple bouts with dysentery) must cause him some discomfort. Although there are no public reports that he takes painkillers, his sporadic flat, wooden performances in public make one wonder whether he may be on more medications than his acknowledged multivitamin, daily low-dose aspirin, occasional Claritin, and regular Vytorin to control high cholesterol.

Malignant Melanoma: a Dogged Opponent

The overall 10 year survival rates for an elderly white male with melanoma are typically high–in the high eighties percent range. McCain has already survived 15 years after his initial melanoma surgery in 1993.

However, McCain has had three recurrences of melanoma since the initial diagnosis and surgery: two instances in 2000 and one reported instance in 2002. Although McCain has not released his medical records since 1999, the New York Times recently reported in some detail on McCain’s melanoma. The article notes that the most serious of McCain’s melonomas was the one removed from his left temple in 2000. It was classified as a Stage IIa (on a scale of I to IV) tumor; the 10 year survival rate for patients with this kind of lesion is a very respectable 65 percent. After the recurrence in 2002, McCain has now gone six years without a reported recurrence. The prominent bulge and scar on the left side of his face reportedly resulted from the 5 1/2 hour operation in 2000 that involved the precautionary excision of non-malignant lymph nodes, part of the parotid gland (which produces saliva), and tissue surrounding the tumor.

McCain’s Scar from Surgery for Melanoma in 2000 (Doug Mills/NYT)

Yet as Dr. Richard L. Shapiro, a New York University melanoma surgeon, noted in the same New York Times article:

With melanoma, a patient is never completely clear….

And according to this Harvard Medical School link, melanoma patients have a high risk of developing brain tumors:

More than fifty percent of patients with melanoma develop brain metastases; that type of cancer has the highest brain metastasis incidence rate…. The interval between initial diagnosis and central nervous system involvement may be long; people with melanoma should see their doctors regularly for follow-up exams. Metastatic brain tumors are most frequently multiple in number (about seventy-five percent of the time), and are associated with a high incidence of seizures (twenty-five to thirty-seven percent of people).

Besides battling melanoma, McCain may also have a significant risk of familial heart disease. While he is fond of pointing to his nonagenarian mother as an indicator of his likely longevity, voters should be aware that McCain’s father, Admiral John S. McCain, Jr., died of a heart attack at the age of 70. Admiral John S. McCain, Sr., died of a heart attack (likely brought on by war-related stress) at the age of 61. In treating his high cholesterol, McCain is probably not extending his life by taking Vytorin; note the recent reporting on Vytorin’s lack of effectiveness in reducing the incidence of heart attacks. In short, McCain has already lived longer than his father and his paternal grandfather, both of whom died of heart disease.

McCain certainly is having regular checkups and asserts that he is in good health. In early 2007 he was claiming to exercise regularly:

McCain told reporters that he exercises frequently, including sit-ups, push-ups and swimming when he can, and that he and his wife hike, camp and backpack often when they’re in Arizona.

McCain told reporters that he had hiked the Grand Canyon rim-to-rim in the summer of 2006, when he was nearing 70. Would he be up to a repeat performance today? Perhaps McCain is as healthy and vigorous as he claims, but where is the credible photographic or video evidence? Such assertions of physical vigor seem oddly reminiscent of another septuagenarian’s alleged physical feat back in 1966. Remember Mao Zedong’s famous staged swim in the Yangtze River in 1966 as he pushed China into the agony of the Great Proletarian Cultural Revolution?

Although Mao was in his early 70s, party propagandists claimed that the Chairman had swum nearly 15 km in 65 min. that day–a world-record pace, if true. The contention elicited guffaws from foreign observers, who took the claim as a sign that China was descending into political madness.

Mao Swimming the Yangtze at 72

McCain may also end up reminding us of what happened not long ago to another superpower with an aging, infirm, unimaginative, ideologically hidebound ruling caste. Recall the animatronic Soviet General Secretary Leonid Brezhnev (died in 1982 at the age of 76), succeeded by the equally frail Yuri Andropov (died in 1984 at the age of 69), and then by the debilitated Konstantin Chernenko (died in 1985 at the age of 73). By the time the energetic and intelligent Mikhail Gorbachev rose to power, the Soviet economy and political system had already reached the brink of implosion and was impervious to mere reform.

In any case, McCain’s odds of dying–or at least of experiencing a major problem with recurring melanoma or with familial heart disease–in the coming year may be relatively low, but they are more than trivial. McCain’s odds of suffering from diminishing physical and cognitive capacity within the next few years are significant and need to be entered into the nation’s political calculus for this year’s election.

Gaffes or Symptoms?

If McCain continues to make frequent mental “gaffes” (walking in full battle regalia through a staged event at a Baghdad market and proclaiming normalcy, falsely asserting that General Petraeus does not even use an armored vehicle when moving around Baghdad, singing “bomb, bomb Iran,” conflating Iran and al Qaeda multiple times; stumbling badly as he tries to read speeches from teleprompters; appearing physically listless and emotionally wooden at evening rallies or on Sunday morning Meet the Press, etc.), something more than than chronological age and “senior moments” may be at work. The gaffes could be resulting at least in part from his advanced biological age and medical conditions. Some observers in the blogosphere are already referring to such stumbles by McCain as “senior moments” or as “McCain moments.”

McCain’s mental performance and physical fitness unavoidably will be important factors in the campaign, as will his choice of vice president–and potential (and even likely) successor.

Scrutinizing McCain’s performance on the campaign trail will not be a simple question of measuring his energy and calculating his judgment and experience. At what point do advancing years and physical debility begin to have an unacceptable impact on intellectual performance? Will voters feel confident that McCain’s judgments would be carefully considered and rational, and not the artifacts sparked–in the worst-case scenarios–by incipient dementia or an undiagnosed brain tumor metastasized from a wandering melanoma cell? Erratic behavior often has a direct organic cause.

McCain released his medical and psychiatric records in 1999 but has not done so since. Although he has promised to do so, he has not released them as of today, April 3rd, 2008. If and when he does release the records, will they be redacted and carefully censored?

The “keepers” surrounding national leaders have been quite adept at concealing their bosses’ frailties from the public. Consider, for example, the handling of Woodrow Wilson’s stroke, Franklin Roosevelt’s paraplegia, John F. Kennedy’s Addison’s disease, and Leonid Brezhnev’s practically comatose state. Even if McCain does not at this moment have a medical condition which would disqualify him from occupying the White House, voters need to be alert for any signs that he may be developing such a condition.

Spotting such an alarming development may not be easy, given McCain’s reputation for erratic behavior. As fellow Republican Senator Thad Cochran of Mississippi has said of McCain:

He is erratic. He is hotheaded. He loses his temper and he worries me.

If such behavior, normal for McCain, is regarded by the voting public to be acceptable, what would McCain have to do to render his behavior unacceptable to the public and to the generally fawning mainstream press?

While each individual ages mentally at his unique rate, studies by psychologists show:

Subjects between 65 and 75 started to show considerable slowing in response times and efficient processing.

Of course, one’s life experience can help compensate for such a decline in cognitive abilities. To what degree does the value of McCain’s experience counterbalance his obvious physical and apparent mental decline?

A key conundrum, as described by three Harvard researchers in an interesting study published in 2007, may turn out to be this one:

One of the challenges to studying the aging brain is that the early signs of Alzheimer’s disease are very subtle, and it is difficult to distinguish between the early stages of Alzheimer’s disease and normal aging.

Here are some behavioral symptoms typically found in patients with Alzheimer’s disease:

In early stages of the disease, people may experience personality changes such as irritability, anxiety or depression. In later stages, other symptoms may occur, including sleep disturbances; agitation (physical or verbal outbursts, general emotional distress, restlessness, pacing, shredding paper or tissues, yelling); delusions (firmly held belief in things that are not real); or hallucinations (seeing, hearing or feeling things that are not there).

Such symptoms are clearly not traits that any citizen would want to see in a potential President. So voters need to watch McCain’s words, manner, and behavior–very carefully. Will he display the judgment, mental agility, energy, and political skills required for the job that he seeks? Or will he prove himself to be physically and mentally unfit for such enormous responsibility?

And voters need to remember that McCain’s DNA is likely biologically more like that of a white male who is 83 years old than that of a white male who is approaching 72 years old.

Everyone makes mistakes, but at what point should McCain’s individual “gaffes” be considered a clear pattern of behavior? At what point would voters conclude that McCain should be regarded not as the unusually vigorous 72-year-old that he will surely claim to be on August 29th, but rather as an increasingly frail, cranky, and cognitively impaired biological 83-year-old who would be ill-suited for the pace and pressures of the Presidency?

Here, for example, is one recent photo that does not portray McCain in the most Presidential light:



John McCain Unhinged

And here is another:



John McCain Channeling Grandpa Simpson (AP)

Three Questions for Voters (and for the Media)

1. Will voters and the media give McCain the benefit of any doubts? Or will they pay careful attention to his missteps and misstatements on the campaign trail? Will the media report accurately on McCain’s alertness and stamina?

2. Will McCain’s gaffes eventually be generally regarded as a pattern of behavior demonstrating physical and mental decline? Will his energy level and quality of judgment be called into question?

3. If McCain were to suffer a medical crisis during the campaign, how would such an event affect the general election? Would voters even find out about such an emergency? Surely the public would need to start asking questions if McCain were to disappear for a stretch between now and November on an ostensible “vacation” with no photo or video coverage.