Cancer Medicine Politics

The most intentionally obtuse response ever?

You may recall that on Friday afternoon, I posted a bit of a rant about how a certain liberal blogger named Matt Stoller had disparagingly and contemptuously referred to Presidential Candidate John McCain as a “crazy, cancer-ridden dishonest madman.” It turns out that Mr. Stoller was displeased by my much-justified rebuke. His response is an example of the most studiously, intentionally obtuse avoidance of answering what my real criticism was, including an elaborately constructed straw man, some quote mining, and one really dumb additional statement that reveals Mr. Stoller to be far more concerned with scoring political points than with scientific accuracy or even decency.

Truth be told, I knew about Mr. Stoller’s response on Saturday afternoon and debated over whether it was worth bothering to craft a response then. I ultimately decided that mowing my lawn was more important. Later on Saturday night, I thought about crafting a response again, but decided that, with my wife gone to visit her folks for the night, downing a couple of tasty brews, kicking back and watching some entertainingly over-the-top horror movies, including Grindhouse (just the trailers and the first part, Planet Terror, not the second part, Death Proof, which, let’s face it, was not very good) and Beyond Reanimator was preferable. At least that way torturing my brain with illogic would be entertaining. (In retrospect, though, maybe I should have used the time I wasted watching Beyond Reanimator to do something productive.)

However, sitting around Sunday afternoon, I got to thinking. First, I was still annoyed at his despicable language, and his response, if anything, had annoyed me more because it made it quite clear that he just didn’t get it. On the other hand, if Mr. Stoller was so nice as to respond to me, surely he deserved at least one more reaction from me. I certainly don’t want to change this into a prolonged exchange, à la Steve Novella and Michael Egnor, but one more rejoinder struck me as being worthwhile Maybe I could even show Mr. Stoller why his response was so inadequate, although I doubt I could show him why his response shows him to be so full of crap that he burps farts.

Or maybe not, but trying will probably be more fun than watching Beyond Reanimator was. Even if it’s on the same level as that movie, at the very least it will give me one more chance to try to explain why his dragging cancer into his anti-McCain rhetoric was uncalled for.

Mr. Stoller first tries to construct a straw man by implying that I was arguing that the health of Presidential candidates is not important or relevant. He did this by first trying to imply that McCain is hiding something about his health, citing a New York Times article that I linked to. First he quotes me:

“Crazy cancer-ridden dishonest madman”? Nice. I wonder if Matt spit out the term “cancer-ridden” with the same amount of contempt and venom while typing as he did when he spit out the terms “crazy,” “dishonest,” and “madman.” I wonder if he thinks “cancer-ridden” is just as bad an insult as the other terms.

As a cancer surgeon, I found that bit about “cancer-ridden madman” to be a truly despicable rhetorical gambit, not to mention irrelevant. John McCain had melanoma. He was successfully treated for it, and has been cancer-free for seven years, making the likelihood of a recurrence very small.

Seeming peeved that I didn’t address his entire post when the intent of my criticism was not to critique his analysis, such at was, but to criticize his use of cancer survivors as punching bags in his quest to tear McCain down, Mr. Stoller cites a passage from the NYT article, as well as from a CNN article, about McCain’s not having given full access to his medical records, going on to say:

It is very likely that McCain has cancer or some other serious illness. There’s no reason McCain wouldn’t let reporters look at his records otherwise. McCain is 72 years old and he was a POW, a member of a group with high rates of illness due to ill-treatment on the part of their captors.

Cancer is relevant to the Presidency. Misleading the press about one’s health is relevant to the Presidency. This is not just a dude looking for a job, he’s going to have his hand on the nuclear trigger. Imminent death from a terminal disease kind of skews your perspective on this, you know what I’m saying?

This is a straw man. I never said that a history of cancer wasn’t relevant to the Presidency. Indeed, note that Mr. Stoller conveniently and clearly intentionally omitted from his citation of my post what I said next:

Whatever reasons one might have for not wanting him to be President, even if his having survived melanoma is one of them (an aspect of the overall package that, in McCain’s case, I rank pretty darned low on the list of reasons not to vote for him, given the low likelihood of his tumor recurring), using the term “cancer-ridden” as part of a string of disparaging adjectives gives the impression that the vile moron who wrote the above sentence views being a cancer survivor as something to be ashamed of, something on the same order of being dishonest, crazy, or a madman.

Note how nowhere did I say that the issue of McCain’s cancer was irrelevant. I simply said that in McCain’s particular case I ranked its importance low because of a relatively low risk of recurrence of his melanoma. A more detailed discussion of the issue would have taken a separate and longer post. Such was not my intent.I also pointed out what my real objection was, namely Stoller’s use of “cancer-ridden” as an insult on the order of “dishonest” or calling McCain a “madman. It was a vile thing to write, and, instead of simply apologizing for it, Mr. Stoller decided to dodge and weave and construct straw men arguments about what I said.

I also wonder on what basis he concludes that McCain “likely has cancer or some other serious illness.” The article he cites was from May. Despite the security requirements on reporters who saw McCain’s more recent records, does he really think that if there were evidence of serious disease or recurrence of his melanoma (or the development of another cancer) that it wouldn’t have come out? Moreover, Mr. Stoller all-too-conveniently neglected to mention that McCain did issue a report and let his physicians give a press conference on the state of his health, which is summarized in a report on McCain’s website about his health status. Here are key excerpts.

A report from John D. Eckstein, M.D.:

I will begin with a synopsis of the Senator’s general health, based on his most recent comprehensive evaluation in March 2008 and a subsequent follow up visit and tests earlier this month. At the present time, Senator McCain enjoys excellent health and displays extraordinary energy. While it is impossible to predict any person’s future health, today I can find no medical reason or problems that would preclude Senator McCain from fulfilling all the duties and obligations of President of the United States.

About McCain’s melanoma:

Regarding his past skin issues, the Senator has received skin care at Mayo Clinic in Arizona since August, 2000. Four malignant melanomas were surgically removed in the past. Three of these were in situ melanomas, meaning they were limited to the top layers of the skin and were not invasive. These three early melanomas on his left shoulder, left arm and left nasal sidewall, were removed in 1993, 2000 and 2002, respectively. A fourth melanoma that was invasive was removed from his left lower temple in 2000.

Each melanoma was a new primary melanoma and did not represent a recurrence of any previous melanoma. There was and is no evidence of recurrence or metastasis…of the invasive melanoma nearly eight years after surgery. Other less serious skin cancers have been removed over the years without complication. These have been non-melanoma basal cell and squamous cell cancers.

Many questions have been asked about the removal of the invasive melanoma from Senator McCain’s left lower temple in August 2000. Dr. Hinni, who performed the surgery, will explain in detail the surgical procedure. To summarize, we continue to find no evidence of metastasis or recurrence of the invasive melanoma as we approach the eighth anniversary of that operation. This was most recently confirmed with his comprehensive examination and tests in March 2008 and with Dr. Connolly’s skin examination on May 12, 2008. The prognosis for Senator McCain is good because the time of greatest risk for recurrence of invasive melanoma is within the first few years after the surgery.

There is a detailed description of the surgery in 2000 for McCain’s melanoma in which he also had part of his parotid gland removed, as well as a lymph node dissection. None of this indicates that he’s had a recurrence, and the fact that McCain is seven years out makes it unlikely that he will recur. Is it impossible? Of course not. But, as I said, I rank this issue low on the list of reasons not to vote for McCain. My little rant was not intended as a discourse on the exact role of a candidate’s health in assessing his or her fitness for office but rather an pointed rebuke at an insensitive and loutish disparagement of cancer patients in the service of a political attack. His insults were nasty and unnecessary. Mr. Stoller could very easily have raised these issues and made the point that a President’s medical history matters, as does a history of cancer, without using an insult that denigrates all cancer survivors by calling McCain a “crazy cancer-ridden dishonest madman.” He chose not to. When criticized for his nastiness, Mr. Stoller chose instead not to apologize, but rather to intentionally ignore the very point of the criticism in the first place.

But here’s where we learn the true measure of the man:

Orac is not just wrong, he’s misplacing his professional norms onto a political process fraught with bad faith. He’s like all those scientists tut-tutting people to not jump to conclusions about whether this or that storm are directly related to climate change. He believes in his authority over the social context of medicine rather than recognizing that the public has a right to weigh in on the Presidential nominee. If the Presidential nominee has cancer I want to know about it. And if he’s at risk for getting cancer, as he probably is, it’s a problem.

Mr. Stoller is Exhibit A for a political process fraught with bad faith. Passionate and reasoned debate is possible without using demeaning language that disparages cancer patients, but that’s clearly not what he is interested in. (Come to think of it, I’m not so sure I like his use of “crazy” and “madman,” either, as they rather imply that he’s about as contemptuous of people with mental illness and as willing to disparage them as well as he is of cancer patients.) He’s once again full of crap when he constructs a straw man claiming that I believe in my authority over the right of the public to weigh in about a Presidential nominee or that I was arguing that a history of cancer isn’t a consideration when examining a candidate. How he got that from what I said required a willful misreading of my rebuke. As for my “authority” over the social context of medicine, I view it more as advocacy for my patients. Mr. Stoller’s remark was an insult to every cancer patient I’ve ever taken care of, and understandably I didn’t like it one bit. Apparently, this sort of behavior is a pattern for Mr. Stoller, who has been criticized for advocating the demonization of his opponents.

Regarding John McCain, mission accomplished, Mr. Stoller. Too bad cancer patients and the mentally ill were collaterally insulted. But, hey, what’s a little demonization in the name of politics? If the current administration can do it, why not Mr. Stoller?

Even more disturbingly dumb, though, is Mr. Stoller’s statement likening me to climate scientists “tut-tutting people not to jump to conclusions that specific storms or hurricanes are related to climate change. That remark is consistent his “crazy cancer man McCain” insult and really reveals his true agenda. Not only does Mr. Stoller apparently like to demonize his political opponents as an explicit political strategy, he clearly doesn’t give a rodent’s posterior about getting science or medicine right as long as he can score points that support his politics. Who cares about all those climate scientists who understandably become agitated when activists go beyond what the science actually shows by linking individual storms to anthropogenic global climate change? They’re just boring old farts “tut-tutting.” Who needs that boring old science, with its insistence on careful experimentation and hypothesis testing, after all? Ditto norms in medicine as well. Ditto, apparently, anyone who calls him to task for a lack of simple human decency and sensitivity in using cancer as a convenient insult and a means of demonizing John McCain.

As fellow ScienceBlogger Ed Brayton put it:

Decide that your opponents are purely evil rather than mistaken and all bets are off. You will do precisely what the STACLU crowd does, and what many on the far left do as well – you’ll either fall for any criticism anyone makes of your enemy, no matter how unsupported it is by the evidence, or you’ll reach the point where you don’t really care whether a criticism is accurate as long as it makes Them look bad.

I suspect that Mr. Stoller falls into the latter category. Fortunately, apparently many of his readers do not. Indeed, several of them have taken him to task in the comments for his insensitivity towards cancer patients in his quest to insult and demonize John McCain (for example, here, here, and here), and my fellow ScienceBlogger Mike the Mad Biologist concedes that he should have noticed Mr. Stoller’s slur. Not that I think any of this will register. I’ve probably wasted my time here.

But, hey, I wasted my time watching Beyond Reanimator. At least this makes the point that it’s not cool to piss on each and every cancer patient that I and any other surgeon, oncologist, or radiation oncologist have taken care of. There are lots of reasons not to like John McCain. That he survived melanoma is not one of them.


In case Mr. Stoller wants to paint me as some sort of Republican shill, he should read this recent post by me first.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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