In Sickness, Health: Must Voters Know? : Politics: What if Tsongas had won? How would public react? And should candidates release medical records?

It didn’t happen this way, but it could have: Only a few weeks before his inauguration, the President-elect experiences a recurrence of a potentially deadly form of cancer. He and his physicians are optimistic it can be controlled, but the outlook is far from certain. A nervous nation is transfixed by the heroic struggle that ensues.

On the eve of Bill Clinton’s inauguration, former Democratic presidential candidate Paul E. Tsongas is again battling lymphoma. But Tsongas insists that had he been elected instead of Clinton, he could have assumed the presidency unimpaired, save for the two weeks he was undergoing chemotherapy and being treated for a subsequent infection.

And Tsongas said he believes that the impact on the nation’s psyche of a new President confronting a potentially life-threatening illness would have been inspiring, not debilitating.

“Obviously, I thought about this when the diagnosis came: What if I’d won?” Tsongas said in an interview following his recent release from the hospital. “I was pretty sick for those two weeks. But despite what was happening to me, I think if I can demonstrate courage, that would give the country something to hold onto, to look forward to.”

While Tsongas has some support for that view among those who work with cancer patients, political experts are less than sanguine about the prospect of a President knowingly beginning a White House term while fighting a serious disease. Several predict his experience will rekindle the debate over the release of presidential candidates’ health records.

History shows that the nation has, indeed, survived the ill health of presidents: Ronald Reagan was diagnosed with colon cancer during his second term, and underwent surgery. Franklin D. Roosevelt, who had suffered an earlier bout with polio, was a President in a wheelchair. John F. Kennedy suffered from Addison’s disease--a condition resulting from failure of the adrenal glands--which was a well-guarded secret that was not revealed until many years after his assassination.

In perhaps the most serious case, Woodrow Wilson’s capacity to lead the nation was severely diminished by a massive stroke he suffered in 1919. The extent to which his wife and aides made critical decisions during the last year and a half of his second term was not known until decades later.

But however well the country may have dealt with a President’s illness once he was in office, many experts argue that the specter of an incoming President with a serious disease could have a demoralizing or frightening effect on the American people.

“The country has come to believe it has the right to optimism at the start of any new Administration,” said Arthur Caplan, director of the University of Minnesota’s center for biomedical ethics. “We’d be facing an example of mass depression on an unparalleled order.”

In addition, a serious illness could prevent a new chief executive from advancing his agenda during the critical early days of his presidency, Caplan said. “Sickness and disability would basically be destroying the opportune time for putting forward the vision of an entire Administration,” he said.

Stephen Hess, a senior fellow at the Brookings Institution who has served on several White House staffs, added: “We don’t want a President who is distracted by serious illness. We expect our presidents to be honest and well. Those should be minimum requirements for the job.”

Tsongas’ latest medical crisis--coming at the time of the presidential election, and so close to the inauguration--has given added drama to the debate over release of a candidate’s medical records. He was a viable candidate, after all, who could have been elected.

Many political experts believe that the situation has to change before the next presidential campaign--that some mechanism must be established to enable fuller disclosure of medical information--although there is little agreement on how best to do this.

“I don’t think any candidate will ever be able to run for President again with a medical history like Paul Tsongas’ without intensive scrutiny,” said Susan Estrich, professor of law and political science at USC and former campaign director for 1988 Democratic presidential nominee Michael S. Dukakis.

“The political process will demand more,” she added. “Everyone will be required to release medical records--in the beginning--just like tax records. And if we don’t see them, we’ll assume the worst.”

Some experts said they would go further, proposing that presidential candidates submit to a complete medical examination by an independent panel of physicians.

“I think the time has come to think about not only public financing of political campaigns, but publicly accountable medical experts on some type of committee who would both examine and report the health status of major candidates,” said medical ethicist Caplan.

Many candidates--including incoming President Clinton--traditionally have resisted the notion that they must sacrifice privacy when it comes to their health. Instead, they have selectively controlled the flow of information that is released to the public, as well as access to their physicians.

And doctors continue to be bound by a longstanding medical ethic--regarded as sacred by the medical profession--that a physician may never discuss a patient’s health without permission from the patient.

Tsongas has been fighting lymphoma since 1983. In 1986, he underwent a bone marrow transplant after earlier treatment failed.

During his run for the presidential nomination, Tsongas turned his experience with cancer into a campaign issue. He frequently talked about his victory over the disease, emphasizing that he had been cancer-free since the transplant, and often speaking about the lessons that come from a brush with death at an early age.

But it was learned after he withdrew from the race that he had suffered a localized recurrence in an armpit lymph node in 1987, a fact that had not been well-publicized. Tsongas has maintained that the information about the 1987 recurrence was not deliberately withheld. Numerous reporters knew of it, he said, and it had been mentioned in a Boston Magazine article several years ago.

“Part of the problem was that the doctors had never dealt with a presidential campaign before, and their instinct is that everything should be confidential,” he said.

Tsongas acknowledged that he handled the health issue badly, and he has since called for the establishment of a special commission to draft recommendations for disclosure of medical information for future presidential contenders.

“I feel very strongly, had I to do it over again, I would have released all the records,” he said. “It’s simply not worth it--just put it all out there. . . . Where I begin to get nervous about the idea, though, is with things that have no current relevance--like some kind of social disease or mental problems that have long since gone away.”

In November, a new lymphoma was diagnosed in Tsongas’ abdomen. His physicians have said they are unsure whether it is the same cancer as the one diagnosed in 1983, or a new tumor, although it is a different cell type. The latest tumor is a large cell variety--rather than his earlier small cell tumor--which can be more aggressive, but also can be more responsive to treatment.

Tsongas already has undergone chemotherapy, and said he now faces six weeks of radiation. But his physicians are optimistic about his prognosis, he said, and he is feeling much stronger.

“According to the scans, the tumor is gone,” Tsongas said. “That doesn’t mean, of course, that there can’t be minor cells in there, but the doctors are very encouraged because they can’t see it any more. I’ve been swimming, and I’m heading to the Y to work out. I’ve gained about 10 pounds. But I’m as bald as a billiard.”

Tsongas said he would be “open” to the idea of subjecting a candidate to a physical examination.

Tsongas speculated that his cancer history probably cost him votes in the beginning of his race, but not as the campaign progressed. Initially, he said, “people were afraid of it. They would say: ‘I can’t vote for anybody who had cancer.’ . . . At the end, I think it (the cancer) was considered to be a political plus--but it’s nothing I recommend to anybody.”

Some experts speculated that Tsongas had not been pressed into greater accountability because the American public wanted to believe that someone with cancer could recover and become President.