Would President McCain survive a full-term?

Among the many travails of John McCain's faltering bid for the presidency is the semi-stifled suspicion that his chances of lasting through a four-year term are not rosy. Officially, the Obama campaign has distanced itself from allegations that McCain might be a lot sicker than he lets on. Supporters have been less restrained in suggesting that the Reaper is but a step behind the 72-year-old senator from Arizona.

In the past 15 years, McCain has had four melanomas removed. The most dangerous was the one taken from his temple in 2000, classified by his doctors as an invasive melanoma, stage IIA, on a standard scale that makes stage IV the most serious. The 2000 surgery left McCain not only with a puffy jaw but also with a scar down his neck.

Back in May, the McCain campaign sought to dispel concerns about McCain's health by permitting severely limited inspection of his medical records, plus a carefully controlled press conference with his doctors at the Mayo clinic in Arizona.

"Many questions," declared Dr John Eckstein, "have been asked about the removal of the invasive melanoma from Senator McCain's left lower temple in August 2000. To summarise, there is no evidence of metastasis or recurrence of the invasive melanoma as we approach the eighth anniversary of that operation."

The press conference received relatively upbeat treatment. For stage IIA melanoma, the survival rate 10 years after diagnosis is about 65 per cent. But the outlook is much better, as McCain's doctors noted, for patients who have already survived more than seven years.

Reporters did note that two pathologists at the Armed Forces Institute of Pathology, who examined the melanoma specimen from McCain's left temple in 2000, suggested there were two melanomas on his temple, not one, as his doctors had said publicly at the time.

The pathologists said it was unclear whether the melanoma on McCain's temple had metastasised from another, or whether there was one new primary melanoma. Metastasis would mean a Stage III reclassification, which would nearly halve McCain's statistical odds for survival.

"What people don't seem to get about this cancer," Lori Klaidman, a medical researcher into melanoma, tells me, "is that at stage IIa, his chances of surviving to 10 years were 64 per cent. But nearly 10 years have past since that diagnosis in 2000. It is much lower now.

"It might be more like 50 per cent survival to the end of his first potential term. Further, the minute those melanoma cells migrate to a lymph node, his chances for survival are anywhere from 15 to 63 per cent."

There has been an unconfirmed allegation of just such a metastasis. It is claimed that in a recent cancer check-up, which allegedly took place at the John Wayne Cancer Institute in Santa Monica, California, McCain was diagnosed with a melanoma recurrence, with a metastasis to the lymph node.

An East Coast oncologist says of the John Wayne Cancer Institute: "That would be the place he'd go because the world’s expert surgeon for melanoma, Donald Morton, is there." Dr. Morton, while head of surgical oncology at UCLA, developed a technique that minimises the number of lymph nodes that must be removed during biopsies.

A Los Angeles radiologist claims he put the question of McCain being treated directly to two colleagues at John Wayne. "They said 'no', but I had the strong impression they weren't being forthright," he told me. "I've known these guys 30 years and I sensed from their tone that they weren't levelling with me."

In his last debate McCain did not look good. Commended last May by Dr Eckstein for his "extraordinary energy", McCain has mostly limited himself in recent weeks to one event a day. So, in the increasingly unlikely event of a McCain-Palin victory, the inexperienced governor of Alaska could face a 50-50 chance of succeeding McCain within four years. This prospect may be playing a role in some voters' decisions.

Though she has declined to release her health records, Governor Palin appears to be in exuberant health. In May Barack Obama released a one-page, undated statement by his doctor that he's in "excellent" health. On the Democratic ticket it's the 65-year-old vice-presidential candidate, Joe Biden. whose health may be precarious.

Twenty years ago, Biden collapsed in a hotel room. He was rushed to hospital, and a priest gave the last rites to the Roman Catholic senator. He had emergency surgery for an aneurysm in an artery that was leaking blood into his brain. A day later he had elective surgery for a second aneurism. It's not known whether Biden has had any neuroscans in recent years.

The actual health of a presidential candidate, let alone a sitting president, usually remains secluded from journalistic inquiry. Often the press is complicit in such cover-ups. President Wilson's status as a stroke victim remained secret, with his wife dispensing his supposed orders. Other examples are the rapid decline of FDR in his final months, and Jack Kennedy's severely compromised physical condition, held secret till after his death.

In July 1985, President Ronald Reagan underwent an operation to remove a cancerous tissue from his colon. The existence of this condition was known but concealed during the 1984 election. We know now that Ronald Reagan was well into the foothills of senile dementia in his second term, and his aides were secretly debating whether to activate the stipulations of the 25th Amendment and lead him away.

At the time, members of the White House press corps were coy about alerting the public to the fact that the commander-in-chief was not firing evenly on all cylinders. To be fair, Reagan evinced confusion for many years, so it may have been hard to judge when he had conclusively retreated from the real world. ·