SENATOR JOHN MCCAIN'S HEALTH STATUS AND THE ARROGANCE OF PREVENTIVE MEDICINE

Abstract

To the Editor: Health problems related to the 72-year-old U.S. Senator and presidential candidate John McCain were a great concern in the 2008 presidential race.1 Senator McCain had a high-risk cutaneous melanoma removed approximately 8 years ago, and it has been pointed out how great might be his mortality risk due to melanoma.2 In fact, a closer look at McCain's health records3 might call into question the wisdom of modern preventive medicine; although McCain has no evidence of heart or other cardiovascular disease, he has been taking the cholesterol-lowering drug simvastatin because of slightly abnormal lipids.3 Accumulating evidence suggests that, in the routine treatment of elderly subjects with statins, an increase in cancer incidence and mortality may exceed in magnitude any decrease in cardiovascular disease morbidity and mortality.4 This might be particularly striking in subjects who already have cancer. In fact, statin drugs have been shown to modulate the immune system through coordinated activity in various arms of the immune reaction. In particular, statins increase the peripheral numbers and functionality of regulatory T cells (Tregs) in vivo by increasing the activity of the transcription factor forkhead box P3.5 Even though this is thought to stabilize atherosclerotic plaque by reducing effector T-cell responses within the atheroma, it may impair the host antitumor response by suppressing tumor-specific effector T-cell functions, resulting in immune tolerance to cancer cells. Indeed, an early Tregs recruitment, which can induce tumor cell immune evasion after the initial phases of melanoma development, has been found at the tumor site in melanocytic lesions, suggesting that maintenance and prevalence of Tregs at the tumor site could contribute to an inadequate immune response, resulting in an uncontrolled melanoma growth.6 Therefore, although John McCain will not be the 44th U.S. president, he deserves to be defended from the arrogance of so-called preventive medicine. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this letter. Author Contributions: All authors contributed in the preparation of this letter Sponsor's Role: There was no sponsor.