yo doc

zed

kirk, you’re gonna LOVE this story

mccain actually prepped the blackwater!

shoot, my strike tag missed

that was supposed to say;

“mccain actually prepped the brownshirts blackwater for the congressional hearings

anyway, here is the link

Zed2?? at 4pm??

But do you really want a brain like McCain running our country??? NOT

This is a great topic. I’ve wondered about the effects of heart bypass surgery on some other politicians, like Cheney, but I really hadn’t thought about the various insults to the brain that McCain has suffered.

McCain’s brain forgets that once upon a time he was in a wee bit of trouble with the law and lobbyists… remember Charlie Keating, senator? Never gotten “into bed” with a lobbyist? Ahem.. some of St Ronnies alzheimers rub off on you too?

it was posted too early and pulled

I think it’s safe to say that John McCain if he should become our next president will be the first president to be sedated on his first day to protect the nation. It took a few years for George Bush. See?

I knew that… just a time warp thingy!!

wow Kirk, this is a post to read and reread. thanks!

Hi, Kirk, all.

I gotta admit, I am a little troubled by this kind of “diagnosis at a distance” game.

I’m not saying I don’t think McCain is an angry militaristic nut whose anger at his captors and torturers probably plays an important animating role that is relevant to his performance as President. But it seems a little much for a physician to attempt a medical diagnosis of a public figure he has never met, let alone examined.

Yes great post Kirk! Nothing like a clinical view of things as they really are with McCain’s brain….

I remember a family story of a friend of the grandparents, a physician, listening to FDR on the radio in the waning days of WW2 and saying, “That man’s had a stroke.” That, in the days when the press did not report on the health or extracurricular activities of politicians.

So when I heard a McCain soundbite on the car radio tonight while driving home, and heard the wheeze in his voice, at the beginning of each major phrase, I wondered: Does he have respiratory problems? Incipient cancer? A failing heart?

Dunno. But I do think the nation needs to know his medical condition sooner rather than later.

Thanks, Margot.

For a shrink (well,this shrink) this is a challenging topic to write about. I so honor the experience (and suffering) of all torture survivors; as a trauma psychiatrist, I never want to pathologize trauma survivors.

Yet as a physician, I don’t want any more trauma/torture victims on our sorry planet. Eight years of Bush have shown me that the Chief Executive’s mental health has profound implications for all of us.

I’m hoping my post is respectful of Sen McCain as an individul while provoking serious discussion about his intellectual/emotional funciton and his capacity for self-control. I’d only presume to ask such questions of someone running for high elected office.

(as best as I can tell, neither of the other Senators running for PRez have revealed any life or medical history to suggest their brains are remarkable in the meidcial sense.

and believe me, in the medical world a “remarkable” brain biology is nothing to be desired.)

Actually, I had the opposite reaction. I thought kirk did a good job of avoiding the Fristian “I diagnose via video” traps. For instance:

Am I saying that Sen McCain meets diagnostic criteris for PTSD? I’m not, because I honestly don’t know – some of the diagnostic criteris require direct knowledge of the Senator’s direct inner experience.

What I am saying in this post is that Sen McCain’s life history indicates that his brain is at greater than average risk of dysfunction and impairment in the following areas . . .

This isn’t a diagnosis — it’s a statement of general medical information, laid next to the generally available information on McCain and his background.

But, Physio, it’s not a misdiagnosis to say he’s an *sshole…! Would it…? ;-)

Halfway through this post (so far). Thanks for the laughs, Kirk.

If having a brain was a requirement for being President, we would never have had George Bush.

Great informative post, Kirk! Might strike a bit too close to home for comfort, though…

It must be grand not to have to deal with the VA like regular veterans, if McCain had to interface with the system that we in the rank & file used, he would undoubtedly be in no condition to run for any office.

I think you’re confusing the presence of an organ with its efficient functioning! (Even Mrs Schaivo had a brain all those years).

FunnyD

Every politician – even Dan Quayle – has a brain.

Speculation beyond the evidence.

;>)

If having a brain was a requirement for being President, we would never have had George Bush.

so true, and it was obvious he didn’t have a brain in 2000 (and before)

Brain injury would explain McCain’s curious choice to turn his back on his own military service in order to become a Bush toady.

But it seems a little much for a physician to attempt a medical diagnosis of a public figure he has never met, let alone examined.

Physio Prof, the post is long, and I don’t expect that everyone has had the time to read all 2000+ words.

In most of the post, I discuss known biological risk factors for McCain’s brain.

In the close of the post, I explicitly state I don’t know whether McCain’s brain meets PTSD criteria.

While I do make observations about behaviors and symptoms consistent with known causes of CNS dysfunction, I don’t make any diagnosis in the post.

I do raise questions about the effect of known risk factors for cerebral dysfunction (like boxing) – those questions do not (and should not) require a direct doctor paitinet relationship for public discussion.

Moreover, given the absolute and sacred requirement for patient confidentiality, I’m not persuaded that pshysicans with a direct patient relationship can (or should) be asked to convety such questions about their patients to the public at large.

Havig said that – heck – I’m from L! I was (and am) gorssed out by mD”s especially shrinks who run to proffer diiagnoses of cleebrities. In that respect, I share the concenrs you set forth.

er – I’m from LA, not “L”.

Jebus – can’t type for beans.

Brain injury would explain McCain’s curious choice to turn his back on his own military service in order to become a Bush toady.

that or blackmail

McCain´s brain forgets to tell him he is married.

Yeah, well…
Guess nobody’s brain is perfect!
;-)

But it seems a little much for a physician to attempt a medical diagnosis of a public figure he has never met, let alone examined.

Perhaps we should call in the world’s leading expert on remote brain diagnostics, Dr. Bill Frist, to give an opinion on McCain’s brain.

This line of inquiry, while well-intended, is likely to backfire. It’s too easy to distort the message to sound like Karl Rove’s infamous 2000 whispering campaign: they said he’d gone insane from the torture (along with the part about the illegitimate black child).

It suffices to beat him up for “100 years of war” and “bomb bomb bomb, bomb bomb Iran”.

With Renzi indicted how’s your delegation doing?

John McCain could very well be another Ronnie Reagan. Scary. I can see McCain one day playing around with The Phone calling in the nuclear codes thinking he’s ordering cheeseburgers!

At least McCain has a brain. Bush’s brain is now a political pundit on Fox news.

with VP Jeb Bush whispering “just die, old man” from a room just off the oval office.

but then I read on, and it’s sad.

I’m with PhysioProf on this. I distinctly remember some outrage about someone else’s (Frist?) tendency to commit long-distance diagnosis.

I would have more sympathy for your thoughts about non-specialists prescribing psychotropic medication if there were enough specialists to go around and if more people could afford them. But there aren’t and they can’t.

McCain is one helluva soldier.

David Schuster is on Hardball!!!

(part way through your fantastic article, Kirk)

I don’t see this as an attempt to diagnose. More like a state of the brain general address. The premise is, we cannot escape our biology.

I think Renzi´s seat might go Dem but I am not in his district. If other seats stay the same it would be a 5 to 3 Dem advantage.

with VP Jeb Bush whispering “just die, old man” from a room just off the oval office.

bite your tongue

I gotta admit, I am a little troubled by this kind of “diagnosis at a distance” game.

I would agree although speculation can be fun. The only medical facts we have on McCain are that he is a 71 year old white male with a history of recurrent melanoma and chronic pain secondary to wartime trauma and torture. His current psych history is a blank because we don’t know it. He has a past history of intrusive ideation consistent with PTSD but there was probably never a diagnosis. He also has a past history of alcohol abuse.

I am sure you could include anger and being a serial adulterer on a social axis if they are still using those but I don’t know what that is indicative of medically. Politically it means his judgment is suspect and has trust issues.

My diagnosis: Senex iratus, amator belli, and certainly anus ingentis.

It’s odd that a thorough medical and psychological exam is not a prerequisitge for running for President. They do physical exams for ball players, why not presidents? As for the post, I thought it informative, fair and balanced, by no means diagnosing from a distance. The point we don’t get swifter as we age is a good one.

Kirk, do we know anything about John McCain’s alcohol history? That can have profound effects later in life.

I would have more sympathy for your thoughts about non-specialists prescribing psychotropic medication if there were enough specialists to go around and if more people could afford them. But there aren’t and they can’t.

My son has to go to the ER to be prescribed Neurotonin, his Psychiatrist refuses to prescribe it, and we have no pediatric neurologists on Island…

My sense is that Mc is over the hill. He is not capable of 100% of normal brain functioning simply because of his age.

He doesn’t seem to be playing with a full deck and the strategy may be to get him on the top spot and let him die in office to be replaced by the next manchurian candidate.

A war veteran who survived torture? Sounds good doesn’t it? Trouble is that this does not qualify anyone for that tough job. He’s dumb too. Never seen any evidence of a sharp mind in him.

Cool, AZ will turn bluer! 8-)

Kirk – This is terrific. Thank you. I’ve been concerned about his history affecting his mind.

Did McCain have chemotherapy? I’ve dealt with this in our family and there is such a thing as “chemo brain”. Kaiser is doing a research on this now – or at least some of their med team are part of a research.

He speaks too slow of loses his temper. He’s unbalanced. Pack it Johnnie boy.

I am curious about those concerned about discussions of national leaders’ brain function (by physicians not treating the patient) believe such discussions would ideally be conducted.

The treating physicians – even when supposedly released by the White House or the candidate – have been found to systematically skew and minimize medical info putting their patient the candidate (or the President) in a less than favorable light.

This occured with Reagan’s GSW, Pres Wilson’s (IIRC) stroke. This is clearly occuring now with Shrub’s apparent (and widely noted) psych/substance use symptoms.

So the docs with direct patient access don’t. If docs like myself – without direct patient access – don’t raise and discuss these question, could someone please help me undestand which docs are left to carry out the task?

We know that Sen McCain drank to the point of excess as a naval cadet and young officer.

We also know that – as a competitive boxer lacking skill and a reverse gear – he was at rsik of multiple CNS injuries from these activites.

BTW I just saw Shields and Brooks on the NewsHour weekly roundup. Not to worry everything is fine with McCain. Brooks who breathes talking points and Shields who gets so giddy over McCain that he practically pees in his pants at the mention of his name just said so. The myth of saint McCain lives on.

Reading your list on what happens when one has been tortured, I can’t help but think of the upcoming trials of “the worst of the worst”. Hope they can get this kind of info out to the jury. Oh wait? No jury???

Great post, Kirk.

What are we doing with another thread up so soon? This is a critical subject.

with VP Jeb Bush whispering “just die, old man” from a room just off the oval office.

All the Republicans are pretending that George Bush doesn’t exist. There’s no way they put the name “Bush” on the ticket.

I have no trouble discussing behaviours/actions/characteristics that may affect an individual’s ability to function in office. I have no problem tracking the severity of the symptoms. Are they getting worse? better?

I do have problems attaching a diagnosis to it.

Are we right to be concerned about McCain’s fitness for office? You bet.

ekunin, I share your mystification: we get to see the Prez’ gallbladder scars and hear what’s happening on their gut walls, but we aren’t given any meaningful assessment of their CNS function or capacity.

Even Shrub doens’t think with his intestines or gall bladder (though it often may seem so)

True. Is there ever a repost? This needs to be digested.

JFK had Addison’s which supposedly incapacitated him for long periods. We can’t depend on the President’s doctors or the VA. Appellate Courts when they need judges choose from District Court judges on a revolving basis. Perhaps we can use Medical School professors on a revolving basis.

Great article, Kirk, and plenty of food for thought. I don’t see it as a Fristian VideoDiagnosis™, but as questions raised that need to be considered about someone who is, as you say, asking us to vote him the ‘Leader of the Free World’. When you put yourself in that position, the people have a right to know, becuase you will be responsible for events that affect all of their lives. You are no longer a ‘private citizen’ in that sense.

The new post was pulled…good!

Just because someone is 71, it is not a disqualifier imo. My dad is 79, and golfs three times a week, follows the news in detail, and remembers far more than anyone I know.

Bush has always shown instability and ineptness. There is no way he could handle the position of president. I would here people say he is an ordinary person. Ordinary? How? I need some smart clear thinker in that position who has integrity and character.

The treating physicians – even when supposedly released by the White House or the candidate – have been found to systematically skew and minimize medical info

Medical coverage in the media generally sucks. It is usually absent, inconsistent, or just wrong.

Just because someone is 71, it is not a disqualifier imo.

Not a disqualifier but a concern. The stress of the Presidency tends to age even healthy individuals prematurely.

I do not believe that those questionning Kirk’s outstanding essay have actually read the complete post. With humor, metaphor and keen understanding he instructs us all about ourselves and then McCain given his life/medical history. Read it!

LMAO! I could see that happening too. ;-)

Agreed.

Not a disqualifier but a concern. The stress of the Presidency tends to age even healthy individuals prematurely.

which we can see in the photographic record, of this president and the ones before him

I agree. It isn’t just the chronological years it’s what happened to the brain along the way. If an alcoholic or snorted the person has brain damage. Medications can have terrible side effects that are long lasting. There is disease that can impair the brain.

I figure someone in that age range of experience and still young enough to handle stress has the best odds, especially if they managed to avoid trauma to the brain.

Fern, as pointed out above, this post doesn’t attach a diagnosis (or diagnoses). This post does riase questions about whether a diagnosis (or diagnoses) may be present.

In medicine – especially in discussions of CNS function – merely considering a set of symptoms without reference to any diagnoses would be a bizzare undertaking.

Considerations of neuropathology/disrupted neurological function imply a diagnosis (or diagnoses) as soon as mechanisms come into discussion. The fancy medical name for senility from boxing, for instance, is dementia puglisitca. This is merely a fancy way of saying “brain don’t work good from fighting.”

To reiterate: this post raises questions about the effect of known biological history upon John McCain’s brain.

The stated desire to have such discussions without reference to diagnoses fascinates me, yet wholly fails to persuade me.

Could those who are asking for g for such limits on raising questions about the executive function of the very public figures who choose the public scrutiny inherent in campaiging to be Chief Executive enlighten the rest of us about the basis for this desire -a s well as describing how the discussions of medical questions could be conducted without refence to known diagnoses?

Inquiring clinicans (this one, at any rate) would love to know.

untreated high blood pressure’s another

My parents did not start to lose it until they were 83 years old. Unnoticeable at first, it started to get bad after three years.

Still, I think McCain is not all there.

You dad is the exception, McVain is over the hill for many reasons. And he strikes me as not intelligent on top of it all.

He does have the chops. He lakes critical thinking skills not to mention not knowing where he stands and has NO moral compass.

Senex iratus amator belli anus ingentis

i’m not sure even the google monkeys can help me with this one.

an old man who irrationally opposes young (romantic?) love but loves war and is a big asshole?

Hugh I cerainly agree that media coverage of biomedical and health issues sucks.

However, my point is that the candidates/Presidents’ physicians don’t fully reveal relevant biological info about their patients in real time. Although the media typically mangle the data after release, the docs fail to release complete info in the first place.

So – sucky as the media are – as the candidates’ docs don’t release this material…

We’re left with the universe of docs who aren’t treating any candidates.

If all us other docs collude in remaining silent about these questions (if docs like me don’t write posts that even our respected commentators find troubling)

I gotta admit, I am a little troubled by this kind of “diagnosis at a distance” game.

I would agree although speculation can be fun.

How then would you suggest these questions about the Prez candidates’ risks for medical questions which can affect judgement, memory and impuluse control be raised for the public?

I would prefer to see us discuss instances in which McCain has demonstrated poor judgment, poor memory, and poor impulse control–of which there are many–than to speculate about the organic condition of his nervous system.

From the post:

Sen McCain – like all victims of trauma and torture – is entitled to absolute privacy regardiing his personal medical history. We as American citizens, however, are entitled to all possible information about the men and women who choose to ask act us to select them as president.

OK; I guess I don’t get the distinction you’re making here. I think that I think that because of the power vested in POTUS to wage unholy hell and potentially wipe out life on earth, there is every need to know the biological makeup of every presidential candidate during the voting public’s decision-making process.

there is every need to know the biological makeup of every presidential candidate during the voting public’s decision-making process.

i’m pretty sure i disagree… although i haven’t given it much thought and might change my mind if i did.

there’s a difference between privacy and secrecy.

there is every need to know the biological makeup of every presidential candidate during the voting public’s decision-making process.

Should we force the candidates to allow their genomes to be sequenced, and the sequences published? This would allow the public to identify all sorts of genetic variants that would predispose a candidate for a variety of somatic, neurological, and psychiatric disorders.

If all us other docs collude in remaining silent about these questions (if docs like me don’t write posts that even our respected commentators find troubling)

I gotta admit, I am a little troubled by this kind of “diagnosis at a distance” game.

I would agree although speculation can be fun.

How then would you suggest these questions about the Prez candidates’ risks for medical questions which can affect judgement, memory and impuluse control be raised for the public?

BRAVO! Please keep this up, Kirk. We need to ask questions.

Possibly. Why not?

Just because someone is 71, it is not a disqualifier imo. My dad is 79, and golfs three times a week, follows the news in detail, and remembers far more than anyone I know.

LooHoo, I’m glad for you – the same is true of my dad (who is finally retiriing by selling his thriving business – in his early eighties) and my vibrant mom (in her late seventies).

When I sat on recipient selection committees for organ transplant teams, some of my colleagues were most frustrated when I’d continuall bring up the ADA and point out that we were legally forbidden from simply using age as a selection criteria: some 80 year olds have the bodies of the average 60 year old; some 60 year olds have the biology of 90 year old.

I completely agree that – in a specific individaul – their birth year may be far less useful assessment criteria than are cross-sectional measurmeents of biological capacity.

(BTW, I also thought using age as a cut-off criteria for any medical service was hideously immoral and hence unethical. However, the docs who creepy enough to speak those sentiments aloud clearly could not be deterred by ethical concerns.

ADA sure shut ‘em up.

ANd then we had to assess – case by case – which elder patients were (and which were not) likely to survive the surgery and the anti-rejection drugs.

Just as we should do for any patient.)

no. definitely not.

Senex iratus amator belli anus ingentis

Angry old man, war lover, giant asshole.

Although I’d give a lot more for a good psychiatric evaluation of the candidates. And the present occupant of the Oval Office and his backup man. How about you?

If you applied for a job manning the control panel of a nuclear power plant, would you be happy to provide your entire genome sequence to the employer as part of the job screening process?

Behind, that’s a good question – I’m sorry I failed to make the distinction. I recognize the absolute right to privacy right up to the point that person decides to seek Federal election (or Federal judicial nomination).

that’s better than the google monkeys. my curiosity is satisfied, thank you.

Since flawed performance of that job would pose a risk to a much smaller fraction of the earth, I might allow inspection of a much smaller portion of my being, say, a few psych tests, some eye tests, some personal history. If I were going to be elected to the position, I might think it fair that the people who had to decide on my fitness for the position actually had the information they needed to make an informed decision.

There is no competency test for president. It looks to me that McVain is not suited to the job for many reasons, a rotting body and brain is just one that will not be discussed.

i think i’m with PhysioProf on this one.

do you think we also have the right to know personal information about the quality and stability of a candidate’s primary relationships? that can also have a bearing on their ability to focus on the job they have to do.

the fact of the matter, imo, is that we rightly depend on secondary clues for all of this – how well do they do the job their doing now (for example as senator), how well to they cope with the rigors of the campaign? that, imo, are not only the best, but also the appropriate ways for us to judge a candidate’s fitness.

How then would you suggest these questions about the Prez candidates’ risks for medical questions which can affect judgement, memory and impuluse control be raised for the public?

They can certainly be raised but usually not proved. Reagan confusing roles he played with real events was significant and indicative of dementia. Pope John Paul’s tremor and masked facies could not be disguised and was strongly suggestive of Parkinsonianism. But John McCain being an asshole is evidence of nothing other than that he is an asshole. Besides a severe mental condition isn’t even a bar to high office as the Alzeimerish Senator Bunning has shown.

From what you’ve bee able to glean from the ’secondary clues’ about Bush, do you think that you can write up an accurate capsule description on the man’s mental and physical state? Do you think that you know everything about the mental stability of Cheney that you would like to know?

yes. of course.

neither one is fit to hold office – or indeed power over anyone.

that was an easy one.

The people didn’t have a degreed Psychiatrist to know that Mad King George was crazy. They had a sense of normal behavior and down right lunacy. When that madness crossed over into the life of the citizenry, people drew the line. It would have been fine had King George gone to one of his palace estates but no, he had to go after the people.

Kirk,
Is there any way to compare, using the same set of variables, the functional state of McCain’s brain at this time with the functional state of Ronny Raygun at the same age? Of course, many people wonder about whether Reagan’s Alzheimer’s was beginning to affect his functional capacity while he was still president.

And then there’s possible comparisons to Woodrow Wilson’s last term, as well as FDR’s, to restrict ourselves to 20th century presidents.

Thanks for an interesting post. You sure do write well.

Bob in HI

In my more intemperate moods, I would likely call Senator McCain “bat shit crazy.” Dr. Kirk does us all a service by carefully explaining how McCain’s public history can provide for us evidence to assess – on the basis of physical and mental health – if we’re comfortable with John McCain as President. For me, the answer is “no”.

p.s. just to repeat my earlier disclaimer… i really haven’t given this much thought and might change my mind if i did.

but at the moment it seems to me that if someone is war mongering idiot, i don’t need to know why in order to conclude that they are not fit to be president.

Dear Dr. Kirk,
Thank you so much for this post! As a professor of piano and piano pedagogy, I have been reading for years a lot about brain research, and have colleagues that are doing research in this area. I won’t go into my own observations and experience plus research, I will just say that I very much appreciate what you are offering us! Thank you again!

Did everyone see this?

http://blog.seattlepi.nwsource…..blog_last3

Google wants our medical records so we can access them at anytime. Maybe this is another part to the New World Order? Could be.

Bush behaves like an alcoholic.

In what ways?

Glen Gould set of 160 CDs or something is being issued.

His speech is confused for one. I am not an expert, but he looks to me like someone who had too much booze and fried their brain.

Why are there no medical or psychiatric profiles available on candidates? I’d be happy just knowing their SAT score. Although my default assumption is that fighter pilots aren’t idiots, (carrier landings ar maybe the most difficult tasks ever invented by humans), I’ve never thought of them as particularly deep thinkers.
Doctor Kirk, can you enlighten us with some probabilities? With two return melanomas, is a third likely? With a boxing and alcoholic history, how does that advance the onset of…bad stuff? Not diasgnoses, but probabilities and actuarial statistics.

Mayb we can devise a suitable SAT-type test for presidential candidates. A mixture of knowledge, reasoning, attitude and philosophical questions. next PUAC?

great – make it easier for uncle sam to have our medical records.

i don’t think you measure those things with an SAT test.

Exactly Selise. Scary isn’t it? The Bush Family and their neocons would love nothing more than to be the Kings of the Planet and the CEO’s of one bank for the planet, one religion for the planet, one place for our medical records, one ideology…

*shuddering*

So creepy if you ask me.

Here’s a list of McCain names being tabulated over on Crooks & Liars:

http://www.crooksandliars.com/…..ent-504942

Hysterical.

Is that the palace estate in Crawford or the . . .

Oh, wait. You’re talking about Mad the Real King George. Had me confused there for a minute.

Okay, going to bed. I’m still trying to kick a virus. ;-)

Selise, there are quite a number of really interesting tests out there. Test of left/right, big gov/small/gov (puts me right next to the Dalai Lama) how about Jungian personality types? I’d love to see even one objective , non-spinnable datum. Even potential NFL draftees are more carefully scrutinzed and evaluated.
(following idea stolen from Jim Rome) I would really like to think that the next president is smarter than me. I haven’t had that feeling in a while.

Physioprof, the rhetorical tricks don’t seem viable.

I gotta admit, I am a little troubled by this kind of “diagnosis at a distance” game.

I’m not saying I don’t think McCain is an angry militaristic nut whose anger at his captors and torturers probably plays an important animating role that is relevant to his performance as President. But it seems a little much for a physician to attempt a medical diagnosis of a public figure he has never met, let alone examined.

You start with a false premise.

In response, I’ve raised two questions:

Could those who are asking for such limits on raising questions about the executive function of the very public figures who choose the public scrutiny inherent in campaiging to be Chief Executive enlighten the rest of us about the basis for this desire – as well as describing how the discussions of medical questions could be conducted without refence to known diagnoses?

When asked to explain how to discuss biolgical issues without reference to diagnoses (and hence without reference to the causal mechanisms connected to most neuropsych diagnoses), the answer nods at the question, but never answers it:

I would prefer to see us discuss instances in which McCain has demonstrated poor judgment, poor memory, and poor impulse control–of which there are many–than to speculate about the organic condition of his nervous system.

OK – it’s an answer. It simply ignores the why question. It doesn’t really address the how question – but it does describe a way to have a discussion confined to phenomology. We disagree on this issue – and I’ll cheerfully stand alone (in our discussion) about the importance of at least raising questions regarding the..uh…physiological bases for the poor judgement, poor memory, and poor impulse control

Now the rhetorical trick. In answer to another commenter’s assertion

there is every need to know the biological makeup of every presidential candidate during the voting public’s decision-making process.

you reply:

Should we force the candidates to allow their genomes to be sequenced, and the sequences published? This would allow the public to identify all sorts of genetic variants that would predispose a candidate for a variety of somatic, neurological, and psychiatric disorders.

What a neat trick – it moves the topic from raising questions about possible diagnoses in a Prez candidate with apparent neuropsych symptoms to a general question about whether all cadidates should be forced to allow genomic sequencing.

This is about as persausive as answering a question about varibles affecting cardiac output with an impassioned discussion of retinal physiology.

A great effort – but it still deserves a failing grade.

On to the next exam.

Sigh – students – don’t they even bother to read the questions any more?

Great article, Kirk.

I guess you got me on the slippery slope fallacy!

I believe that a person’s history of statements, decisions, and actions is much more informative for predicting their future statements, decisions, and actions than armchair psychiatric/neurological diagnoses. I also believe that it is unseemly for a physician to engage in armchair medical analysis in public, even when it is a public figure being analyzed.

Did McCain have chemotherapy? I’ve dealt with this in our family and there is such a thing as “chemo brain”. Kaiser is doing a research on this now – or at least some of their med team are part of a research.

Great question, QuakerGirl. I’m sorry that anyone in yuor family has any experience of these matters.

I don’t know whether or not he did receive chemo. “Chemobrain” is certainly a possiblity with some forms of chemo.

A full assenssment of Senator McCain’s neuropsych history/function would encompass the dtails of his treatment (radiation/chemo/total time under general anesthesia) for melanoma.

In response to another commenter’s question about the risk of third recurrence of the melanoma, I don’t know the answer to this relevant question. Although McCain has been cancer free (apparently) for some years, I’m not certain what the prognostic significance may be of a five (or ten) year period without recurrence in a patient with prior melanoma recurrences.

physi prof, thanks for your answers. although we do not agree, i’m glad we havee this chance to exchange our views!

Same here. I do understand where you are coming from, and even for me this is a close case.

BTW, just to let you know, since this was such an interesting discussion, and led to some interesting asides, I will probably write about this topic at Drugmonkey (at ScienceBlogs). I will be sure to properly attribute any quotes to you or commenters here, as appropriate.

Is there any way to compare, using the same set of variables, the functional state of McCain’s brain at this time with the functional state of Ronny Raygun at the same age? Of course, many people wonder about whether Reagan’s Alzheimer’s was beginning to affect his functional capacity while he was still president.

Bob, I don’t believe any comparison is possible for the simple reason that I don’t know of any (available) assessments of Reagan’s neuropsych function conducted prior to the (announced) diagnosis of his Alzheimer’s (IIRC he was diagnosed at an age greater than McCain’s current age).

FWIW, I’m convinced that Reagan did exhibit sympoms consistent with DAT (dementia alzheimer’s type) during his second term.

wow physioprof – I’m genuinely honored. I’ll look forward to reading drugmonkey (and I love the name *g*)

I and the eponymous Drugmonkey himself blog there about biomedical issues including scientist career development, economics of the biomedical research enterprise (including NIH funding and grantsmanship), and selected substantive medical issues (most prominently, drug abuse).

http://scienceblogs.com/drugmonkey/

I’ll probably post tomorrow or Sunday.

Damn I wanted to be in on this one.

Thanks PhysioProf!

And FWIW – I think I understand where you’re coming rom on this, and I respect that place and you.

Though at over 2800 words the piece wasn’t the place for me to explore this, for most of my professional career I’ve been in conflict with systems/colleagues ’cause I’m fanatical about maintaining medical confidentiality. I think I’ve lost out on more than position due to that concern.

So it feels very odd for me to be advocating that anyone should have public questions raised about their neurobiology….

I blame the Supremes – if they hadn’t pulled their coup, I bet we wouldn’t have to think about Sen McCain.

VP Edwards would be so far ahead I could have just spent my time gardening this week….

but Raven, you were:

Raven February 22nd, 2008 at 3:09 pm

yo doc

can you enlighten us with some probabilities? With two return melanomas, is a third likely? With a boxing and alcoholic history, how does that advance the onset of…bad stuff? Not diagnoses, but probabilities and actuarial statistics.

Damn stratocruiser – good questions.

I looked for and could not find contingent actuarial data (in a pt with history of disease X – and treatment history Y – what is their risk for death/morbidity/etc according to their specific diagnoses).

I believe those resources are out there – and I’d like to find them for the next time we discuss this issue.

Yea but I have things I would have liked to discussed. Life in the big city.

Raven, if I am not mistaken, you are a veteran of Vietnam as well. I’m interested in your take on the idea of attempting to infer aspects of McCain psychological makeup that may have resulted from his experiences as a tortured prisoner of war.

Physio, I’m also interested in Raven’s observations.

But this post actaully describes biology. Assessing the presence/absence of symptoms consistent with those require to make or rule out PTSD does not require any attempt to infer “psychological makeup”.

That “intrapsychic” diagnostic perspective really left (US) psych diagnoses when DSM III replaced DSM II.

The explicit basis for DSM III/IV is to rely upon observable symptoms and/or patients’ direct report of the presence /absence of specific symptooms.

Because no one can observe “psychological makeup” or other intrapsychic mechanisms, current psych diagnoses go out of their way to neither rely upon nor posit such devices.

Just to take PTSD for an example:

After a traumatic envent (can’t recall if it was the schoolyard shootings a la “Don’t like Mondays” or the Chowhchilla kidnapping/bus “burial”, objective studies of brainstem evoked auditroy potentilas revealed that surviviors with PTSD show lack of the (usual) capacity of our brainstem to learn to “suppress” repeated stimuli.

This change in physiological function tells us nothing about the survivors’ psychological makeup – it does tell us about changes in their CNS function.

I hope that example helps clarify the difference between the current biologically based diagnoses and the former diagnostic systems that sought to rely upon (unverifiable) phenonomona such as “psychological makeup).

Kirk James Murphy, M.D. February 22nd, 2008 at 6:14 pm 118
physi prof, thanks for your answers. although we do not agree, i’m glad we havee this chance to exchange our views!

The point is somewhat missed I suspect… Kirk lays out some impacts that have accurred to McCain which he has in common with people that show pscho-trauma.

A mind body relation that exists that add additional influences to McCain’s mental state.
A personality inventory like The Minnesota Multiphasic Personality Inventory (MMPI) could reveal behavior tendencies and personality charateristics that would not enhance presidential behavior and judgement.
The observation that McCain has had past trauma is simply true. Seeing the two Bush and McCain in a hug is two people out of their league mentally. We do not need party animals making life and death decisions.
Thank you for the information. The post was interesting informative and a wake up call…is there someone more qualified to make rational decisions? Does Senator McCain’s manager’s need a leach to keep him out of trouble like his lobbyist handlers?
An evaluation would be welcome…like who’s driving and are they sober!
Excellent post.

Has anyone else noticed, how McCain’s left cheek sticks out compared to his right one ? It’s all I can see in any photo of his face any more, there is a distinct asymmetry between the two sides of his face … in my professional role in my second job as a health food salesman, it could be anything from generalized fat deposits to scar tissue to a nasty cyst or worse.

His skin tone leaves a lot to be desired in general, he needed much better consumption of B vitamins, vit. E, essential fatty acids … if he had just started as soon as he got back to America, given his life circumstances, it would have helped a lot

Kirk, This is fantastic information, splendidly presented.
I’m among those who believe that – in a globalized world where things happen quickly, it’s increasingly important to be better informed about what you call ‘our squishy divas‘. (I’ve never thought of my brain as a ’squishy diva’ before; I’m still chuckling. And reaching for more glucose-bearing chocolate…)

I read this post as a great primer for an important topic’; helping people recognize that we all have brains, and we all need to take care of them. Teachers, physical therapists, and school psychs deal with ‘brain stuff’ (brain research, brain anatomy, brain functions) all the time. So do people who design software.

I didn’t read this as a diagnosis, but rather as an appetizer to a long overdue topic of great significance. We all need to share this information and use it to make better decisions about how we teach, advise, guide, learn, and take care of ourselves.

——————
Errata for anyone interested — Kirk, have we been reading any of the same books…?

“The Paranoia Switch: How Terror Rewires Our Brains and Reshapes Our Behaviors“, Martha Stout (2007). Great information about how the brain reshapes itself in response to stress and trauma, and how to address these problems. It’s written for the general public. And in an age where it’s increasingly clear that extended trauma is implicated in some students’ learning disabilities, the research implications are very important for many areas of public policy.

“This is Your Brain on Music“, (2007) by Daniel Levitin gives a great rundown of brain structures, particularly those involved in listening to, enjoying, and analyzing music. (My takeaway: more kids would do better in math if they were given more music lessons and provided with instruments and instruction. This would make an **awesome** Book Salon subject sometime!)
Extra bonus: Howie Klein gives a recommendation on the back cover of the paperback version!
http://www.yourbrainonmusic.com/

“Proust and the Squid: And Science of the Reading Brain” (2008)by Maryanne Wolf. Explains the brain and its functions, as they relate to reading. (And she also covers different types of writing systems, including Chinese and Japanese, which many people in the software industry might find useful.) She does a great job of explaining how reading is ‘generative’ — a creative process that expands in leaps and bounds.
—————

Software involves designing stuff in hopes of helping more people ‘think better’. So it’s not a big surprise that some of the more visionary minds out of the software industry would fund more brain research.

For instance, Microsoft co-founder Paul Allen has put significant resources into moving forward better understandings of brain anatomy and neurology. More at:http://www.alleninstitute.org/

Also, the mind behind Palm Computing wrote a fascinating book on brain anatomy and the biology of learning. More at: http://www.onintelligence.org/index.php

To me, your post on ‘the squishy diva’ is a sign of the times, and also underscores that we need to be mindful about how we take care of ourselves, others, and how we use our knowledge to make better decisions (about elections, as well as about our daily lives and finances.)

making dinner here – rotl, i am so looking forward to reading your comment in detail.

your errata are fascinating: can’t waiit to read more

and now to eat….

Kirk MD @134 — Cool ;-)
I’ll check back tomorrow… I listed my fave ‘top 3 best titles for general readers’ of this post and the conversation on this thread.

Enjoy that dinner!
My ’squishy diva’ is desperately seeking some good REM cycles; off to bed…

Thank’s.
Kirk Murphy-Can’t top others in wit but in everyday colloquial terms that was sick.
g

Using this criteria you could certainly cut back on the number of people considered “fit” to be president. Now what about people like George Bush who have had little if no trauma, never been tortured, were partying types but has, to our knowledge not had cancer? Stupid from birth might be a relevant diagnosis, even from a distance, but if that was the criteria we would have considerably fewer Senators, Congresspeople, Governors, and elected officials as well as many high ranking military personnel. Who by the way gets to decide who is fit and who isn’t?

I missed some of the earlier comments yesterday, but it’s never too late…

perris: love that link about McCain fronting for Blackwater. thanks.

Mnemosyne: thanks for sharing that evocative memory of your family’s friend hearing FDR – that summons up a whole diffferent era. thank you.

nonplussed: loved your wry observation on VA care.

CaroylnU: I’m glad the humor came through – and glad you like the piece

darkblack: guilty as charged! ;>

FunnyDiva2002 @ 30:

Yeah, well…
Guess nobody’s brain is perfect!
;-)

….mine sure isn’t!

CT@47: that sounds like a real burden for you and your son – hope a pediatric neurologist starts up practice on your island.

ekunin@61 – what an intiguing idea…I really like that (and I’m so glad i’d never be asked to do it!)

kathieinmn@101 – your work sounds so interesting – I wish you would go into your own observations and experience plus research; I think we’d all learn a lot from you.

thanks also to the many commenters who let me know they liked the piece – I appreciate your taking the time to read it.

rotl – i’ve never had the opportunity to read any of those works (I was ignorant of them) – thank you for sharing them. I look forward to reading them. hope your squishy diva got all the REM cycles it needed.

Maddy – thanks for that. I’ll take that as high praise ;)

and kenoshaMarge:

Who by the way gets to decide who is fit and who isn’t?

that’s an easy one – the voters.

off to breakfast, folks….have a good weekend….

Well Kirk, I hope you find at least one of those books interesting.
I try to fit those REM cycles in at every convenient opportunity *g*

Great topic — agree with you that ‘the voters’ decide who’s fit and who isn’t. Although it’s worrisome to consider that this information could be misused, we can’t afford another GWBush (nor Cheney), IMHO. We all make mistakes; the farther up in any organization we go, the more our mistakes are magnified, and the less chance we have to correct them in a timely fashion (at least, as a general rule).

Political leadership needs to be held to some better kind of ‘vetting’ process. Someone can be a good elected without a lot of technical background as long as they’re fair minded, a good listener, and can make a decision (and stick to it). But in an age of complex technologies and complex organizations, we need a far better process than ‘who’s ahead in the polls’ or ‘who has raised the most money’.

To me, the voters need to decide.
But their decisions have to be based on information that is more informative, and better grounded, than polls and fundraising.

If polls and fundraising were the keys to presidential success, GWB would be a fine prez. I think we all agree that’s just not cutting it as methods to ensure that someone is qualified to make decisions that impact all of us

Happy reading!