Dear Colleagues and Friends,

John McCain is a 72 year old man with recurrent melanoma, hyperlipidemia, degenerative joint disease, and recurrent difficulty with certain efforts at recall.

These are the limited facts the American people have had access to. Over 1000 pages of medical records were shown to selected journalists for 3 hours with less than 48 hours of notice. The only medically trained journalist was Sanjey Gupta, MD from CNN.

This is the extent to which the American people have been informed. While I am certainly sensitive to the confidential nature of medical records, given the anxiety expressed by many of my patients regarding the risk of lost coverage or lost jobs in this current health economic climate, there are certain exceptions for disclosure regarding public safety.

As John McCain knows, a pilots records are comprehensively available for review by a certifying agency (the FAA, I believe) to insure the fitness of the pilot and the safety of passengers and the public at-large. In the election of the President of the United States of America, that certifying body is the American electorate.

A recurrence of metastatic malignant melanoma would essentially destroy John McCain's capacity as the Chief Executive and the American People have yet to receive a full accounting of the facts regarding his actuarial risk.

If he has had regional metastasis, his risk could be 30% or greater for distant metastasis to the brain, bone, and lung.

As you all know, melanoma is one of the most insidious, pernicious, and aggressive malignancies our patients must deal with and that we attempt somewhat pathetically to control with interferon, interleukins, and dismally active and terribly toxic chemotherapeutic regimens.

In addition, we lack the simple data to sensibly evaluate his cardiovascular risk as we would any septuagenerian in our exam rooms.

John McCain should [MUST] be held accountable by the American people and its agents, the free press, to release without restriction the entirety of his medical records.

Any hesitation to do so would clearly imply that there are significant medical concerns about his ability to fulfill the duties of the President.

Sincerely,

Michael D. Fratkin, MD Internal Medicine Hospice and Palliative Medicine Eureka, California

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