McCain war ordeal no health factor

WASHINGTON — Sen. John McCain's 5 ½ years as a prisoner of war in North Vietnam changed his life, but now that he is 71, that trauma seems unlikely to shorten his life span or cause mental illnesses or lead to physical conditions that are not already apparent.

That is the implication of a body of research on the lifetime effects of captivity and war trauma and the anecdotal experience of the small group of naval aviators imprisoned with McCain at the notorious "Hanoi Hilton."

The Republican presidential candidate's medical records dating to 2000 will be opened for view by the media today in Phoenix. The Arizona senator's multiple cases of melanoma, a potentially lethal skin cancer, are likely to dominate the documents.

Although some experts said sun exposure during his imprisonment may have led to his cancer, the records are unlikely to speak directly to the effects of his years as a prisoner of war. Despite his captivity, McCain has never received a diagnosis of post-traumatic stress disorder (PTSD), campaign spokeswoman Jill Hazelbaker said, and research suggests the syndrome has been rare in American aviator POWs who served in the Vietnam War.

McCain's years as a POW — he was released in early 1973 — constitute an unusual health variable among presidential aspirants.

There are no published studies of longevity among American POWs who served in Vietnam. Studies of Australian prisoners, however, found they had slightly increased mortality in the years and decades immediately after the war, particularly from accidents, suicide and substance abuse.

Studies of U.S. troops captured during World War II and the Korean War also found higher death rates in the early decades after their release, mostly from tuberculosis and cirrhosis of the liver. Once past that, however, their longevity was scarcely different from that of other veterans.

The most obvious effect of McCain's captivity is in his arms. He broke both and a leg after ejecting from his bomber in 1967. Inadequate treatment of the injuries and torture by his captors in Hanoi left him with a decreased range of motion in his arms, evident in the shrugging appearance of his shoulders.

At the prison, McCain was repeatedly beaten, bound and placed in prolonged solitary confinement.

Since his repatriation in 1973, he has occasionally been examined at the Robert E. Mitchell Center for Prisoner of War Studies, run by the Navy in Pensacola, Fla. However, Hazelbaker said the senator "has not for many years participated in any POW follow-up."

The center saw 470 of 666 POWs who served in Vietnam and has seen prisoners from World War II, Korea, the Iranian hostage crisis, the Persian Gulf War and the current wars in Iraq and Afghanistan.

A 1996 paper, one of the few to appear in a journal, reported that naval aviators imprisoned in Vietnam had eight times the amount of nerve and muscle damage as nonimprisoned fliers.

Over 14 years, 4 percent of the aviator POWs, all officers, experienced PTSD. Research on World War II prisoners found that officers as a group had far less psychological trauma than enlisted men.

More recently, the Pensacola center helped identify "late-onset stress symptomatology," or LOSS. The syndrome involves the return of troubling memories late in life, along with emotional anguish and guilt, often triggered by retirement and friends' deaths.

The idea that war trauma might return to haunt old age has been raised by other researchers. A 2001 study of 177 POWs in the Minneapolis area who served in World War II and Korea found that over four years, the number of men reporting PTSD symptoms rose from 27 to 34 percent, and symptoms worsened. Eleven percent said they had experienced symptoms, seen them disappear, and re-emerge with advancing years.

The naval aviators imprisoned in Vietnam are in their 60s and 70s. Now and in the years after their release, they seemed unusually resistant to psychological damage from the experience.

The lifetime prevalence of PTSD in all the Pensacola POW studies is 24 percent. In the naval aviators, it was 4 percent from 1979 to 1983.