Respectful Insolence

After all the recent blogging about John McCain’s health and whether his melanoma will recur or his left ptosis is anything other than from benign causes, probably relating to aging, you just know I couldn’t pass this story up:

WASHINGTON (AP) — If John McCain is elected and goes on to win a second term, there’s as much as a one-in-four chance America could see its first woman president — Sarah Palin.

It’s actuarial math.

The odds highly favor either McCain or Barack Obama completing a first term in good health. After that, McCain’s odds still are still fairly solid, but his chances of dying or being in poor health go up faster than Obama’s, mainly because of his age.

The personalized actuarial study shows:

An Atlanta actuarial company specializing in individualized estimates of life and health expectancy has run the numbers for McCain, 72, and Obama, 47. The firm, Bragg Associates, calculated the odds of the candidates dying in office, adjusted for their known health problems.

McCain would be the oldest president to begin a first term in office. By the end of a second term, Jan. 20, 2017, he would have a 24.44 percent chance of dying, compared with 5.76 percent for Obama, the firm estimates.

The “health expectancy” (i.e., the number of years left of good health that can be expected) was also calculated for both candidates:

The firm estimates that McCain has a health expectancy of 8.4 years, while Obama can expect another 21.9 years of good health. The calculations are from January, 2009, covering two terms in office for either candidate. McCain, if he’s like others in his age group, would have a cushion of just about five months.

I found these estimates a bit odd in one aspect: Barack Obama is only 47. Why would he be expected to have only another 22 years of good health? The reason: He’s a smoker. True, he said he was quitting in February, but even if he quit cold turkey, for purposes of actuarial estimates he’s not considered a nonsmoker until a year after his last cigarette. Moreover, risk of lung cancer, although it starts to fall immediately after one quits smoking, never quite falls back to baseline (i.e., to what it would have been if the person had never smoked).

Another thing I have to wonder about. John McCain’s mother is 95 years old. I have to wonder if the actuarial firm took family history into account, as clearly there’s some longevity in there, which makes me also wonder if the firm may have overestimated McCain’s chances of dying and underestimated his health expectancy. Still, these are the cold, hard numbers, and reality is that, although McCain has an excellent chance of surviving four more years, like any person in his 70s his chances of dying climb rapidly after that. It’s just biology. Of course, as was pointed out in the article, these estimates of the odds of dying are averages, and a 24% chance of dying within 8 years means a 76% chance of surviving. With Sarah Palin as the Vice President, though, these numbers are a lot scarier than they would be otherwise. After all, when similar speculation was being made about Ronald Reagan 28 years ago, George Bush, Sr. was the Vice Presidential running-mate, and a lot of people thought he was more qualified than the top of the ticket.

Comments

  1. #1 Ted H.
    September 30, 2008

    Didn’t McCain say that he would only serve one term? Was there a flip-flop on that?

  2. #2 Trin Tragula
    September 30, 2008

    Another thing I have to wonder about. John McCain’s mother is 95 years old.

    Yeah? And how many of those years did she spend in the Hanoi Hilton?

  3. #3 Adrienne
    September 30, 2008

    Do we know if Obama ever really quit smoking? I had heard that he did, but recently I’ve heard rumors that he hasn’t really quit. I wonder if he’s just been careful not to get photographed smoking by the press.

    Also, that’s scary to hear your risk of lung cancer never quite goes back to baseline after you quit smoking. Yes, OK, I’m a former smoker, and I also grew up in a heavily smoking household. I thought I read somewhere that after 15 years of nonsmoking, your risks did in fact fall back to baseline. But that was a long time ago, so I’m sure Orac’s claim is more recent.

  4. #4 Adrienne
    September 30, 2008

    TrinTragula wrote:

    Yeah? And how many of those years did she spend in the Hanoi Hilton?

    LOL! Good call. Also, how many melanomas has *she* had removed? Do we know?

  5. #5 Orac
    September 30, 2008

    Yes, OK, I’m a former smoker, and I also grew up in a heavily smoking household. I thought I read somewhere that after 15 years of nonsmoking, your risks did in fact fall back to baseline.

    Close to baseline, but not quite all the way back. Smokers’ risks remain at least slightly elevated forever. On the other hand, even after 50 years of smoking, quitting produces immediate benefits.

  6. #6 Ted H.
    September 30, 2008

    According to Snopes Obama quit smoking, but occasionally ‘falls off the wagon.’

  7. #7 D. C. Sessions
    September 30, 2008

    Well, do keep in mind that McCain was also a heavy smoker, although he did without for a while in Vietnam. It was pretty much SOP for his generation and especially in the Navy. I’d have to check to see when he quit the second time.

  8. #8 wfjag
    September 30, 2008

    And, Sen. Obama’s mother died at 53 of ovarian cancer. I looked for anything on whether there are any established or suspected genetic links between ovarian cancer in mothers and lung cancer (small cell or non-small cell) developing in their children. The closest I found was the statement:

    “Some women inherit genes from their parents that are more resistant to damage and cancer than others. Those whose genes do not provide as much protection against cancer are said to be genetically susceptible to the disease. Scientists have shown that some cancers (i.e., breast cancer) involve genes that are passed down from parents to their children, and the link between such genetic mutations and lung cancer is also becoming more probable. But the link to heredity has not been absolutely confirmed in lung cancer.”

    http://www.healthywomen.org/healthtopics/lungcancer

    So, any idea what the chances are of ending up with a President Biden?

  9. #9 Orac
    September 30, 2008

    President Biden wouldn’t be nearly as scary as President Palin.

  10. #10 TsuDhoNimh
    September 30, 2008

    McCain’s grandfather died at 61, his father at 70 … he’s notdoing well on that front.

  11. #11 Rjaye
    September 30, 2008

    Yeah, President Biden is much less frightening than Pres…I can’t even type it.

    I think the age of the candidates is among the lesser reasons for voting for or not voting for a person for president. I’d rather vote for the not so healthy or aged better candidate than the fully fit and politically lacking person.

    That said, that’s not an issue for me here.

  12. #12 randy
    September 30, 2008

    I am with TsuDhoNimh. Why doesn’t anyone ever mention McCain paternal lineage life spans (the 61 and 70)

  13. #13 tim gueguen
    September 30, 2008

    I don’t think you have to worry about McCain’s as yet hypothetical second term in regards to Palin. I still doubt she’ll even make a year as VP, let alone a second term.

  14. #14 C.A.
    September 30, 2008

    How do they define “good health”? My parents will turn 74 and 75 next month. They both currently lead very busy and active lives, but they’ve each been hospitalized during the past four years.

    What if McCain gets pneumonia and spends a week in the hospital all drugged up? I had what was called a mild case a year ago, no hospitalization, and it still took me a full month to get my normal stamina back — and I’m 30 years younger than he is.

    Or what if he has a mild heart attack? He could still be considered in good health after spending a couple of months recovering from such an episode, but who’s going to run the country while he’s incapacitated? And what is the probability that he’ll be incapacitated for more than 24 hours at some point during the next four years? Just looking around at people I know in my parents’ age group, I’ve got to believe it’s a whole lot higher than 24%, even if most of them do return to “good” health after most of these illnesses.

  15. #15 Blake Stacey
    September 30, 2008

    What if McCain gets pneumonia and spends a week in the hospital all drugged up?

    Then according to the Twenty-Fifth Amendment, full executive authority would come to rest upon Acting President Sarah “In the event of Rapture, this wolf-hunting chopper will be unmanned” Palin.

  16. #16 D. C. Sessions
    September 30, 2008

    One factor not mentioned in these discussions is that the Presidency is hard on a body. It prematurely ages the young; have a look at JFK during three short years in his 40s.

    The popular wisdom is that Ronald Reagan was the only President in recent times who didn’t visibly fall apart in office. Attribute it to afternoon naps or being more of a delegator than most, if you will; on the other hand his Alzheimer’s went from unnoticed to jokes about his memory while he was in office.

  17. #17 Caligirl
    September 30, 2008

    The results of this are flawed since John McCain has suffered (4) bouts of cancer. This is a VERY SERIOUS matter that should NOT be easily dismissed, especially in light of the obvious deficiencies in his running mate. This subject is being picked up newspapers around the country. For more information see the following:

    http://www.youtube.com/watch?v=DHvJPGnkQxE

    http://www.youtube.com/watch?v=lvesa49zSIM&feature=related

    http://www.huffingtonpost.com/2008/09/30/new-urgency-over-mccain-m_n_130298.html?page=28&show_comment_id=16262422#comment_16262422

  18. #18 Orac
    September 30, 2008

    The results of this are flawed since John McCain has suffered (4) bouts of cancer.

    Oh, please, give me a friggin’ break. The only bout of cancer that McCain has suffered that’s relevant to calculating his life expectancy is the melanoma for which he underwent a large operation, including a lymph node dissection. The other melanomas that were removed were all melanoma in situ. Melanoma in situ when completely resected portents close to a 100% survival rate.

    But I do thank you for pointing me to an article that clarifies that McCain really does appear to have had a stage IIa melanoma, not a stage IIIb. Per the Huffington Post article:

    “It was 2 centimeters across, 0.22 centimeters deep, and not ulcerated, which gives him a 66 percent survival rate over ten years. Melanoma is a particularly aggressive cancer. Mainly because skin is the largest organ in the body it can spread to the lungs, liver and the brain… Most of the occurrences will occur right away. I am reassured by the fact that it has been eight years now and there hasn’t been a reemergence of that melanoma.”

    It is mentioned that there was another report that listed the melanoma as stage IIIb, but it’s not clear where that came from. It’s also not uncommon to have a stage estimate that’s later changed as more clinical/pathology information is available. I’d want to know which was the later pathology report, if there are indeed two.

    Go back and read my previous posts:

    http://scienceblogs.com/insolence/2008/08/mccain_a_cancerridden_madman.php
    http://scienceblogs.com/insolence/2008/08/the_most_intentionally_obtuse_missing_of.php
    http://scienceblogs.com/insolence/2008/09/john_mccain_a_dead_man_walking_not_so_fast.php
    http://scienceblogs.com/insolence/2008/09/john_mccain_a_dead_man_walking_ptosis.php

    The bottom line is that because McCain has made it eight years, his chance of a recurrence of melanoma is much lower.

  19. #19 epador
    October 1, 2008

    Um, what are the medical explanations for the snarks against Palin and the lack of same against Obama?

  20. #20 Vonnie Gross
    October 1, 2008

    It may not be true…however I heard his last bout with melanoma was just two years ago or maybe three.The other thing is that howver deep the surgeries are when the cancer is removed it can lurk or can metastasis in the body elsewhere in any organ,ie liver, colon, anywhere with at least five years remission time. It is still a huge risk for the U.S considering his age and the damage to him during the Vietnam war.Then to have this ill equipt woman possibly in the oval office as President is really unthinkable.

  21. #21 Niobe
    October 1, 2008

    It will all be moot if some nut job decides to assassinate Obama.

  22. #22 Orac
    October 1, 2008

    Um, what are the medical explanations for the snarks against Palin and the lack of same against Obama?

    None at all. None are needed. Palin deserves all the snark she gets.

  23. #23 Tom T.
    October 1, 2008

    It perhaps bears reminding that this actuarial data is predictive over large populations, but essentially meaningless when applied to an individual.

  24. #24 Dawn
    October 1, 2008

    My ultra-conservative, “we NEVER vote Democrat” inlaws were over this weekend. Due to the fact I am a “g-d- liberal”, we don’t discuss politics, ever.

    However, I accidently commented that I thought Sarah Palin was Very Scary. (I blame the 2 glasses of wine I’d had….) To my shock and surprise, BOTH inlaws agreed with me and informed me that although they didn’t like Obama’s tax plan, they were voting for him because Palin scared the hell out of them too, and they could not vote for McCain and take the risk that she would end up as president.

    My teacher inlaws were appalled by her ignorance, her creationism, and her belief that since she can “see Russia from her back yard” that she is experience in foreign affairs!

  25. #25 SLC
    October 1, 2008

    Re wfjag

    1. But Senator Obamas’ maternal grandmother is 85 and still going strong.

    2. It is very dangerous to attempt to extrapolate someones chances of getting cancer from their family history. Former President Carters’ mother and father both died of cancer while his sister and brother also died of cancer, the latter two at a comparatively young age (I seem to recall that his sister was only in her 40s). However, Carter is in his late 70s and apparently has never had cancer.

    Re Orac

    1. Another concern is that it appears to me that Senator McCain is somewhat overweight, which, at his age is a significant risk factor for heart disease and stroke. He certainly does not appear to be in the same kind of external physical condition as Senator Obama or President Bush for that matter.

    2. The issue as to the effect of Senator Obamas’ smoking habit on his health and potential longevity depends significantly on how many cigarettes per day he smoked, when he started smoking, and how close to the filter he smoked each cigarette. For instance, if he smoked 1/2 a pack per day, that would cause considerably less damage then smoking 2 packs per day (I don’t know what his intake was). Also, if he smoked each cigarette 1/2 way to the filter, this would be less serious then if he smoked all the way down to the filter. I don’t think we can make a determination of the risk factor in the absence of information on these issues.

  26. #26 SLC
    October 1, 2008

    Re D. C. Sessions

    One factor not mentioned in these discussions is that the Presidency is hard on a body. It prematurely ages the young; have a look at JFK during three short years in his 40s.

    Not a good example. Kennedy had serious medical problems before he even became president, which were covered up by his physicians. He was afflicted with Addisons’ disease and had back problems serious enough to require large doses of pain killers, administered by a Dr. feelgood physician. What affect these medications had on his judgment ability (recall that the late Chief Justice Rehnquist was also taking large doses of pain killers) we will never know. It is doubtful that, if he had not been assassinated, he would have survived to complete a second term in office.

  27. #27 Natalie
    October 1, 2008

    Then again, look at before and after pictures of both Clinton and GW Bush. Obviously eight years have passed between photos, but they both appear to have aged a remarkable amount during their presidency, considering how relatively young they were at the beginning of their presidency.

    Clinton seems to be recovering well, though. Or perhaps he’s had some work done.

  28. #28 SLC
    October 1, 2008

    Re Natalie

    Former President Clinton got a significant health scare several years ago and had to undergo a cardiac procedure. Since then, he has lost weight and changed his dietary habits to more healthy foods (no more Big Macs!).

    Although President Bush appears to have aged more then just being 8 years older, he in fact is in excellent physical condition for a man of his age. I occasionally have occasion to drop into the bike shop where he purchased his off-road bicycles and the employees there inform me that Bush is an excellent physical specimen who has no trouble keeping up with his younger Secret Service protectors when pedaling over at the Agriculture Departments’ facility in Beltsville, Md.

  29. #29 Tulse
    October 1, 2008

    Not to be alarmist, but these actuarial analyses don’t also include risk of assassination. In Obama’s case, I would suggest that such a risk is not negligible.

  30. #30 Tom T.
    October 1, 2008

    Note that Republican Presidents and other conservatives can be the victim of assassination attempts as well.

  31. #31 Natalie
    October 1, 2008

    SLC, fair point. I suppose two-termers really just look tired and stressed when they’re done being president, not necessarily “unhealthy”. Not that I can blame them for being tired.

  32. #32 RAJ
    October 1, 2008

    The swearing in of Sarah Palin as President of the US is analagous to appointing Jenny McCarthy the next head of the NIH.

  33. #33 Oldfart
    October 1, 2008

    Um, what are the medical explanations for the snarks against Palin and the lack of same against Obama?

    Posted by: epador | October 1, 2008 1:01 AM

    Uh – Palin is just being judged by the same Republican standard that they applied to Obama. All the Obama snarking has already taken place. It has been replaced by Palin snarking because people have become aware that a Harvard lawyer, top of his class, President of the Harvard Law Review, father to two young ladies and devoted husband is considerably more qualified than a woman whose main claim to fame is fecundity and an ability to field dress a moose.

  34. #34 pluky
    October 1, 2008

    As an actuary, I get a little nuts when I see stuff like this. Complete expectation of life calculations on a single life are all but worthless for anything other than assessing damages in a civil suit. The standard deviation of such estimates is huge.

  35. #35 oregontrailer
    October 2, 2008

    Old fart, et, al;
    The class-warfare insult about Harvard being more suitable to lead than someone with rural skills stinks of elitist tripe. Along that line of reasoning, who got the country into the current financial mess, moose hunters? And since when does having children disqualify someone for leadership? A big family is the first practical proving ground for diplomacy skills. :)

  36. #36 NM
    October 6, 2008

    Pluky

    I’m an epidemiologist and I’d have to agree. Mortality estimation in samples of 1 is serious misuse of mortality equations.

    The other point is that they are probably using the wrong data anyway. Whitehall has clearly demonstrated that higher social standing aids longevity.

    Congresscritters and Senators tend to live rather long lives. I wonder if they managed to adjust for that as well in their advertorial?

  37. #37 Prantha
    October 15, 2008

    No one ever asks how old John McCain’s FATHER is. I understand that his father died in his mid-50’s, but I dunno. Should this information be included in the actuarial analysis, or is just the mother’s health relevant?

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