What Candidates Can Learn From McCain About Health Records Disclosure

With Hillary Clinton releasing new medical records in the wake of her bout with pneumonia and Donald Trump taking to Dr. Oz’s TV show to discuss his doctor’s report, the issue of presidential candidate health is back in the spotlight — where it has been many times before.

Donald Trump, Hillary Clinton reveal health details; Clinton resumes campaigning 2:47

I’m not a doctor but I read the medical records of two presidential candidates and covered them for television. Standards and expectations about what candidates are willing to share or feel compelled to disclose today have changed in the direction of less, not more.

Related: Clinton Releases Health Stats to Public, Trump to Dr. Oz

It’s not always a simple equation.

The known health issues surrounding a candidate, and how those play out politically, makes the difference in decisions about disclosure. Political pressures outweigh simple transparency for the benefit of voters. If there is a political upside to providing an in-depth medical review, it is more likely to happen. Without such an imperative, campaigns lean on the candidate’s right to privacy.

A doctor’s note or a medical summary has not always been enough to satisfy demands in campaigns past.

John McCain, 2008

In 2008, Senator John McCain was a candidate with a history of melanoma, the most serious form of skin cancer, and traumatic injuries from his military service and prisoner of war captivity. Age was also a political factor. McCain was 72 on election day and could have become the oldest person elected president. He was running against a much younger rival, 47 year-old Barack Obama who had been a long-time smoker, something that carried its own health risks.

McCain’s campaign tried to prove his fitness to be president by opening up his records – but that openness did have limitations.

The campaign chose to provide information on the Friday of Memorial Day weekend when fewer Americans were expected to be following the news. They also set time and access limits.

McCain’s team invited reporters who had regularly traveled with the campaign to review the records. We were given three hours in a room with each of us getting a set of hospital and doctors ‘ documents that could not be copied or removed. I was also able to bring a colleague with medical expertise. Dr. Nancy Snyderman and I worked together to review the package of personal medical data.

The point of such a review was to look for any red flags about medical issues, diagnoses or medications that might affect a candidate’s ability to do the job.

Related: Cancer, Combat, Coughs: A History of Presidential Health Concerns

Evidence that McCain was cancer free was critical. Notations that reflected normal signs of aging or common issues like medicine for cholesterol were noted with some interest. Conditions such as arthritis with a reduced range of motion read like a slice of his biography because they reflected McCain’s severe injuries from the Vietnam War. Any lingering effects, both physical and psychological, from his imprisonment could have been noteworthy.

The trove of records also contained many everyday medical topics that are of a normal but intensely personal nature. While the campaign set out to create boundaries that day to balance privacy and public record, I also felt a responsibility to be respectful as I sifted through such intimate details.

This was about searching under tight time constraints for what could have been relevant to his candidacy and not just intrusively wandering through his history. The campaign provided about 12-hundred pages for our review. As a tactical campaign matter, they also released the much-anticipated tax returns of McCain’s affluent wife Cindy the very same day. It was a summer blizzard of documents in Arizona. Overwhelming us with information served the campaign’s interest to minimize the potential impact of specific details.

John Kerry, 2004

In 2004, the pressures were different. Senator John Kerry was running against a sitting wartime president who was known to be in fit physical condition. Part of Kerry’s candidacy was a distinction that he volunteered to serve in the US Navy and earned medals while deployed to Vietnam.

During the campaign season, Kerry, then 60, had dealt with some medical issues. He had surgery for prostate cancer and another to repair an old shoulder injury that left the candidate unable to shake voters’ hands for a short time.

Kerry’s campaign arranged for reporters to speak to his personal physician to provide more detailed information on his health. The political environment of 2004 also stirred intense pressure on Kerry to authorize the release of his military service and medical records but Kerry had refused to waive his privacy rights for years.

Related: Who's Right in the Clinton-Trump Tussle Over Transparency?

Political adversaries seized on his reluctance and challenged the validity of Kerry’s claims about his actions in combat and extent of injuries that resulted in three Purple Heart citations.

Kerry’s campaign decided to make more information available but harnessed the tactic of surprise. In April 2004, without advance notice, a group of regular “travelers,” reporters who covered the campaign, not medical journalists, were given thirty minutes to review dozens of pages of Kerry’s military medical files.

Kerry’s doctor was also made available for questions. No copies could be made. Given the scope of the material, lack of time to prepare and such a short deadline, reporters in the room divided the task and we reviewed the records in sections to be sure every page was read. Kerry’s files revealed that shrapnel from a combat injury remained lodged in his thigh. There were also mundane findings like his treatment for allergies, respiratory ailments and a urinary tract infection.

The limited time to review and assess such newsworthy records gave the Kerry campaign the ability to declare its transparency while also reducing the chances that reporters would find some fact or detail that the campaign would have preferred remain private.

For both of those campaigns, there was a political high ground to claim for providing this access to medical records and doctors’ interviews. But both were also able to game out the impact of their disclosures by testing the reviewing reporters with strict time limits and a cascade of documents. Both men were ultimately deemed healthy and fit to serve as president but neither were elected and the rest is history.