Friday, May 23, 2008

Desperation in the American election : political assassination



A sense of desperation is slipping into the American election campaign. Hillary Clinton plumbs new depths of cynicism and vulgarity. Why is she staying in the campaign? In case Barack Obama is assassinated.
Senator Hillary Clinton referred to the assassination of Robert Kennedy in 1968 as a reason she should continue her battle with Senator Barack Obama for the Democratic nomination. My husband did not wrap up the nomination in 1992 until he won the California primary somewhere in the middle of June, right? We all remember Bobby Kennedy was assassinated in June in California. I don’t understand it,” Mrs. Clinton said, dismissing the idea of dropping out. (New York Times)
Whilst Bill and Hillary consider hiring a hitman, John McCain is worrying that he may die of natural causes and so has decided to release his medical records to prove that he is immortal. Studying the records, the first thing we conclude is that the man is a heart-sink patient. What is the easiest test you can perform to check if a patient is a hypochondriac? Weigh the notes.
the details of McCain's health are contained in 1,173 pages of medical documents
1173 pages? Clearly a hypochonriac. But just a minute
The details of McCain's health are contained in 1,173 pages of medical documents spanning 2000 to 2008 (source)
That is only 8 years. What about the other 62? This man is not a hypochondriac. He is a galloping hypochondriac. And note that he has not really released his records. He has only allowed journalists a glimpse. A glimpse on the following terms:
The newer batch of records has strict security guidelines attached. Only certain news networks and newspapers will be permitted to enter the room, and they will have only three hours to examine the papers. No cell phones or Internet access will be allowed in the room, located in a resort outside Phoenix, Arizona. Copying the records is also prohibited. Anyone who leaves the room for any reason except the bathroom will not be allowed back. (source)
Why would a journalist want to take a bath whilst he is reading McCain's medical records? Odd.

For those interested in the details of McCain's medical history – fascinating to most doctors – the sanitised summary of his notes is available here.

The summary is written by:
  • Dr. John Eckstein is a physician in our Internal Medicine Division and has been caring for Senator McCain for the past 16 years.
  • Dr. Michael Hinni is a surgeon in our Otolaryngology/Head and Neck Surgery Department. Dr Hinni specializes in surgical oncology of the head and neck. He performed Senator McCain's left lower temple melanoma surgery in August 2000.
  • Dr. Suzanne Connolly is a specialist in our Dermatology department, with extensive clinical experience. She is Senator McCain's dermatologist.
That is some very special free publicity for those three learned physicians and will not do their private practice any harm. From them we learn that Senator McCain takes the following medication:
  • Simvastatin, which is a cholesterol lowering medicine
  • Hydrochlorothiazide, for kidney stone prevention and Amiloride to preserve potassium in the blood stream
  • Aspirin, for blood clot prevention
  • Zyrtec, an anti-histamine as necessary for nasal allergies
  • Ambien CR, as necessary for sleep when traveling
  • A multiple vitamin tablet. 
Ambien CR is one of the “Z” drugs (not as addictive as valium and mogadon and Librium, honest, the drug companies have told us that…). Some dishonesty here. It is not NECESSARY for sleep when traveling. Drugs like this make elderly people more prone to falling over when they go for a pee in the middle of the night. But John McCain is not old, is he? Let us look at the side effects:
When you first start taking AMBIEN, use caution in the morning when engaging in activities requiring complete alertness until you know how you will react to this medication. In most instances, memory problems can be avoided if you take AMBIEN only when you are able to get a full night's sleep (7 to 8 hours) before you need to be active again. As with any sleep medication, do not use alcohol while you are taking AMBIEN. Sleepwalking, and eating or driving while not fully awake, with amnesia for the event, have been reported. If you experience any of these behaviors contact your provider immediately. In rare cases, sleep medicines may cause allergic reactions such as swelling of your tongue or throat, shortness of breath or more severe results. If you have an allergic reaction while using AMBIEN, contact your doctor immediately. Prescription sleep aids are often taken for 7 to 10 days – or longer as advised by your provider. Like most sleep medicines, it has some risk of dependency.
Does the leader of the free world occasionally engage in activities requiring complete alertness? Probably not.

Hydroclorthiazide and amiloride to stop kidney stones and preserve potassium in the blood. Plausible. Good for high blood pressure too. No mention of his blood pressure – an extraordinary omission that makes it difficult to take the report seriously. I presume (hope) it is mentioned in the full report.

I note with horror that he is taking a multi-vitamin tablet. Now we know he is a hypochondriac. It is inconceivable that a well nourished American multi-millionaire is vitamin deficient. This is wibble. I am amazed that Mayo Clinic physicians have let themselves be associated with that. They do not seem like purveyors of wibble.

The history of melanomas is of concern. I hope he is cured. He may be. But melanomas have a habit of recurring.

Finally, spare a thought for this:
He was a Navy pilot in Vietnam, and his plane was shot down in October of 1967. He broke both arms and a leg after ejecting from his plane. He was a prisoner of war in Hanoi for 5.5 years. As a POW, he was beaten and tortured repeatedly…
That reminds me of something:



Paranoid nonsense. Of course it is.

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19 Comments:

Blogger Marcin said...

The Manchurian Candidate? Blimey, Doc.

Friday, May 23, 2008 11:47:00 PM  
Blogger jayann said...

I think they mean 'for (sleep when) travelling, as (when) necessary'. So, he takes it, when travelling, when he needs it -- they're saying. If so he wouldn't become tolerant otoh it could have more of a hangover effect.

Friday, May 23, 2008 11:56:00 PM  
Anonymous Paul said...

And why do I, as a pediatrician, get paid FAR less for a 45 minute consult on a kid with ADHD, then my OWN cardiologist, who spends 10 minutes with me, listens to my chest, and LEAVES?

Saturday, May 24, 2008 12:19:00 AM  
Anonymous Susan said...

"Does the leader of the free world occasionally engage in activities requiring complete alertness?"

Oh come on. He probably takes it to help him sleep when constantly jetting between time zones (e.g. campaigning!) That sort of schedule means that you never have time to adjust your sleep patterns to the time zone you are in and the result is permanent jet lag and exhaustion. I'm sure that has an severe effect on alertness whatever your age.

I think he would be a terrible president but for many reasons other than him taking the occasional Ambien.

Saturday, May 24, 2008 1:46:00 AM  
Blogger L said...

"as needed" in American prescribing parlance does not mean "because it is necessary". It is usual way to write a layman-readable version of PRN (pro re nata).

1100 pages does not seem that strange to me for eight years worth of Senatorial medicine. I have seen perfectly ordinary charts accumulate at something like that rate. Then again, I have been working as a psychology extern in a mental hospital this year.

Saturday, May 24, 2008 1:47:00 AM  
Anonymous Anonymous said...

Why haven't Obama and The Hildebeest released their medical records? IIRC, Bill Clinton *never* released his.

Wonder what they're hiding.

Saturday, May 24, 2008 2:47:00 AM  
Blogger Dr John Crippen said...

Yes, as necessary may well mean "as required" or PRN as we say.

Even so, don't like these drugs. They do make old people fall over. And supposing he is woken in the middle of a drug induced sleep and has to make a serious decision?

John

Saturday, May 24, 2008 8:16:00 AM  
Anonymous Browned off said...

At least he isn't an alcoholic. OUR esteemed leader has all the hallmarks - putting on weight, doughy face, baggy eyes, bad tempered, ageing rapidly, indecisive, shaking hands. Rumour has it that the number 10 bin is weighed down with empty bottles of his favourite dram.

Saturday, May 24, 2008 9:47:00 AM  
Blogger Woffle said...

Bathroom being American for toilet, of course. But then we knew that...

Saturday, May 24, 2008 10:24:00 AM  
Anonymous Anonymous said...

So are patients with multiple chronic illnesses that require treatment in secondary care (and therefore lots of letter exchanges) considered to be heart sinks on the basis of the weight of their notes?

Weight of notes seems like a pretty crap way of judging levels of hypochondria. Can't you find a more valid indicator?

Saturday, May 24, 2008 12:41:00 PM  
Anonymous Anonymous said...

Is he really a hypochondriac, or is he one of those wealthy Americans who think if they take every pill they can live forever? e.g. does he have any plans to be crygogenically frozen?

Saturday, May 24, 2008 2:40:00 PM  
Anonymous Anonymous said...

1 in 78 americans get melanoma? in my practice of 6000 we have had 5 melanomas in the last 10 years. i think the dermatology doc is quoting from her own referred figures.
either that or there is a god/bin laden.
i think the truth is that every insured yank has every freckle removed, just to be on the safe side. no wander the notes are so voluminous.

Saturday, May 24, 2008 8:09:00 PM  
Anonymous Anonymous said...

I'm no particular fan of Hillary, but I didn't get the feeling she was referring to anybody's asassination except to point out, correctly, that the day Robert Kennedy was shot, June 5, 1968, the Democratic candidate had not yet been decided.

People are acting as though it is not unusual NOT to have a decided candidate by now, but in fact, that most certainly does happen from time to time. She's correct in that regard.

Does she have an absolutely boneheaded tin ear? Absolutely. This is one example. The fake accents directed to certain crowds is another.

Nor is it surprising that McCain has generated voluminous medical records. A melanoma, with particular concern as to metastatic disease because of his political status. No, I'm not surprised at all.

None of this tells me McCain is, or is not, a hypochondriac.

What it does tell me is Dr. Crippen must think Ronald Reagan is the greatest statesman since Abraham Lincoln or Winston Churchill. He released his full medical records for his candidacy, his shooting, his colon cancer, etc.

I do remember the cancer records in particular, as it allowed the press to second-guess the hell out of his treating physicians over then-state-of-the-art doctrine for cancer screening, and whether more than recommended treatment should be done "because he's the President".

Which brings us back to McCain's voluminous medical records, which coincide with his Presidential ambitions.

.......arf

Sunday, May 25, 2008 8:17:00 PM  
Anonymous Anonymous said...

The Manchurian Candidate comment was as tasteful as Hillary's assassination idea.

How is your Toffophobia?

Monday, May 26, 2008 2:17:00 PM  
Anonymous Anonymous said...

Since we're on the subject of medical records, if there ever was a President with a scary medical record, it was Jack Kennedy. Even by contemporary medical standards his treatment was dangerous.....for him and for the country.

Secret Service agents assigned to him were of the opinion that he would have ended up in a wheelchair if he'd won a second term.

.......arf

Monday, May 26, 2008 6:27:00 PM  
Anonymous Anonymous said...

She's only voicing what a lot of people have thought - NOT necessarily hoped - there are some mighty wierd folks out there, especially in the Saowf, I'm hoping and presuming he already has presidential level security.
Mind you, the retraction in a liquor store made me laugh out loud - of all the joints...
j

Monday, May 26, 2008 7:41:00 PM  
Blogger Dr John Crippen said...

Arf

Yes, I know all about Kennedy and his medical problems. May I strongly recommend David Owen's book, In Sickness and in Power? Just published. He was the British Foreign Secretary and is also a doctor. He does a detailed analysis of Kennedy and all the problems; interestingly, he concludes that he was in a bad way round about the Bay of Pigs (that figures) but thereafter was getting his act together.

Fascinating stuff



John

Monday, May 26, 2008 10:09:00 PM  
Anonymous Anonymous said...

And also Richard Reeves book "JFK: Profile of Power" Reviewed here by William F. Buckley:

http://www.nationalreview.com/flashback/buckley200407011031.asp

Reeves reconstructed the Kennedy Presidency day by day, from original sources, eyewitnesses.

When he writes that on a certain day, at 3-PM, he left a meeting with some Ambassador to go up to his private residence for a dalliance with some starlet, it's because the starlet said so, AND the Secret Service record, now publicly available, had her entering on the day she said she did, and Kennedy's appointment record was.....open.....at that time.

Publication date of the book was 1994, so naturally he has to mention the date he had that meeting with some kids from Arkansas, including young William Jefferson Clinton.

So, yeah, he was seriously sick, and insiders knew it. Of interest, Janet Travell (of trigger point fame) treated him. She seemed to be treated as sort of the quack, when some of the Dr. Feelgood types were pumping him up with amphetamines, steroids, etc.

Go figure.....

Bobby was trying to get him off the stuff. I believe the quote was "I don't care if it's horse piss Bobby, it makes me feel better".

......arf

Tuesday, May 27, 2008 4:37:00 AM  
Anonymous Anonymous said...

Apparently he had numerours skin cancers, cancerous polyps and pre-cancerous lesions.

You didn't mention them.

Friday, May 30, 2008 5:32:00 AM  

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Dr John Crippen's weekly diary. The trials and tribulations, the pleasures and pitfalls of family medicine in the modern British National Health Service.

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