Doctors Playing in Political Arena: The Wrong Prescription?

Should doctors speak publicly about their political affiliations?

Oct. 24, 2008 — -- For physicians, does the Hippocratic Oath's injunction to "first, do no harm" also extend to the realm of politics?

The question is being debated in medical circles after several prominent doctors have spoken out on medical issues related to Sen. John McCain, the Republican presidential nominee.

One of them, Dr. John Alam, a licensed physician who is the former executive vice president of Vertex Pharmaceuticals, used his medical expertise to comment on McCain's health in a most public way.

In a letter published in this week's issue of the medical journal The Lancet, Alam wrote that the 72-year-old Republican's death risk is 12 percent for the next two years, after his battle with melanoma in 2000.

Basing his analysis on the health summaries released by the McCain campaign in May as well as a 1996 study of the rate of survival for patients with melanoma in the Annals of Internal Medicine, Alam told that he believes the American people should be informed about the candidates' health and that his research has nothing to do with his own political affiliation.

A registered Democrat, Alam has contributed the maximum amount of financial support to both the Obama campaign and the Democratic National Committee – all of which he disclosed in the footnotes of his letter.

But Alam argues that his vote on Election Day has nothing to do with his examination of McCain's medical records and that there is no political motivation behind his research.

"My intention was not to imply not to vote for McCain but was to put the facts [about his health] on the table," said Alam.

"Am I an Obama supporter? Absolutely," said Alam. "But I went about this analysis in an objective way without knowing what the answer would be before I began."

Alam said that he did not begin his research until September – four months after McCain's health summary was released – in hopes that someone else would delve deeper into the senator's death risk before he felt obligated to.

He added that while many people were criticizing the McCain campaign for not releasing enough information about the senator's medical history, he found that they had given the public enough to determine exactly what his risk would be of death should he be elected.

But Alam's method of research – as well as his outspoken political beliefs – has rankled some medical professionals, who say they believe medicine and politics don't mix.

Medical Profession Should Be Nonpartisan, Docs Say

Dr. Darrell Rigel, a clinical professor of dermatology at New York University Medical Center, says that not only is Alam's research faulty, but the pharmaceuticals executive was also wrong to publicly endorse one candidate over another rather than simply speaking more generally about melanoma risks.

According to Rigel, Alam did his research as if McCain were diagnosed with melanoma today, rather than eight-and-a-half years ago.

"The issue is that when he was first diagnosed with melanoma, he had about a 30 percent chance of dying in five years," said Rigel, who has done his own research at NYU on the risks of death associated with melanoma. "But he is eight-plus years out, and most of his risk [over 98 percent] is gone."

Rigel said that 95 percent of the risk of dying of melanoma cases like McCain's disappears after five years, and 99 percent is gone after ten.

"The point [Alam] is missing is that most of McCain's risk is gone after eight-and-a-half years," said Rigel, who says he has not given money to either candidate or political party.

Rigel estimates that McCain's chance of dying of melanoma in the next four years is less than 1 percent.

Rigel also criticizes Alam for talking so specifically about McCain despite never having treated him, a detail he believes points out the political motivations behind the letter.

"Doctors should keep their [political affiliations] to themselves," said Rigel. "You're there to educate the public but not to say you're a Democrat or a Republican."

John Spangler, a professor of family medicine at the Wake Forest University School of Medicine, said that because of Alam's outward support for Obama his research will almost certainly be seen as biased.

"It doesn't past the sniff test when you have a Democratic supporter write an article that's unfavorable [toward a Republican]," said Spangler.

Publicly supporting one candidate over another can harm the medical profession as a whole, said Spangler.

"The first rule you agree to as a doctor is 'do no harm,'" said Spangler. "Being partisan can do harm to the profession."

"We want [to be viewed] as advocates for the patients – no matter what their political leanings," he said.

Health, Not Doctors, Has Been in Forefront of Elections

Presidential historians, asked whether they can ever remember a time when doctors were as outspoken as they have been in this election – from Alam to the group of doctors who published an advertisement in the New York Times on Oct. 3 demanding McCain release his full medical records – struggled to recall a precedent.

Thomas Whalen, a presidential historian at Boston University, said that while health has always been at the forefront of presidential elections – from JFK's cover-up of his Addison's Disease to Ronald Reagan's struggle with Alzheimer's -- never before has he seen so many doctors speaking out for a particular candidate.

"In the past doctors have raised questions, but this has gotten a bit more aggressive," said Whalen. "That is groundbreaking."

Larry Sabato, the director of the Center for Politics at the University of Virginia, says there are more politically-minded doctors because of their vested interests in the upcoming election.

"Doctors have become much more aware that their future careers and income are going to be determined in large part by what the government does with health care," said Sabato. "They've started paying more attention and becoming more active in politics."

But by becoming too outspoken, doctors can put a strain on the doctor-patient relationship, Spangler believes.

"I don't want politics to get in the middle of me and my patients," said Spangler. "They may strongly disagree with me and they may question my judgment if I were to tell them which way I was voting.

"It's best to try to leave politics outside of the examination room."