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The Wednesday Letter
March 7, 2001
A Vast Conspiracy
Write to Karl Loren -- he will answer
Things are NOT what them seem to be!
In this expose I, Karl Loren, reveal one of the most basic attacks on civilization that exists today -- I demonstrate the truth of the fact that whether it was Bush or Gore who won, THIS conspiracy was ready to move ahead with the drugging of America.
When The New York Times leads the battle in the Drugging Of America, and I copy their material, the laws on copyright are loud and clear. You may, indeed, copy material that is copyrighted for the purpose of "Fair Comment." The New York Times article is below.
The Secrets Are Being Told!
So, I accuse the New York Times, and most of the rest of the media, for telling a story that got huge headlines for one day, but for NOT telling you the truth below that story. That story, not told, is the story that needs to be told!
This expose should rock the world -- and with your help it can. The only reason these drug pushers continue to get away with their filth is because NOT ENOUGH of you are spreading the word, and speaking out. Help me and help yourself. Tell people about this article and help save society.
Let people know about this data -- the data alone can save a person's life -- if more people know about this, there is a chance that society can be saved -- that's how important this is!
Health care costs have been one of the fastest growing of any type of cost in society!
Health care costs have actually risen to more than 14% of the entire GDP
For some years the smart doctors, and smart hospitals, saw that bypass surgery was the place to go if you wanted to earn millions of dollars.
But, these heart specialists didn't have the long vision. They never had a chance. Those who want to earn more money, within health care, realize that total health care costs cannot continue on the rapid increase -- else there would be price controls or some intervention by the government -- or revolt by the people. They secretly planned for the drugging of America!
Here and there some thoughtful doctor talks about the whole mess.
For these reasons a vast conspiratorial plan was hatched, decades ago. I wrote about this in 1994!
This plan involved deliberately building up total health costs as rapidly as possible -- yes!
But, making the part of that increased cost something that could be deliberately sacrificed, some time in the future, in favor of the real master planners -- the drug companies. I exposed the entire Master Plan in one whole Chapter of my Book, several years ago.
That plan, then, selected heart disease as the primary health problem, and bypass surgery as the temporary solution.
The idea was to greatly increase the popularity of bypass surgery, even though it was known to be a bad solution to heart disease -- but it was dramatic and the very high cost could be justified by the high tech requirements for delivering it. It was always a fraud, but it was certainly not recognized as a fraud.
The fraud was covered increasingly by leading newspapers.
When bypass got up to many billions of dollars per year, and the total of ALL health care had risen to the maximum percent of the GDP, then a concerted effort would be made to demolish bypass surgery in favor of drugs.
That plan started many years ago. It continues today. Health care costs will stay relatively stable while the internal mix of costs shift drastically AWAY from bypass surgery TOWARD drugs.
Drug costs are now rising even more rapidly than heart surgery costs. Click here.
Some of the final nails are being hammered into the bypass coffin, with the headlines in newspapers around the world -- February 8, 2001, reporting the publication of a carefully planned attack on bypass -- showing that bypass patients, more than 40% of them, suffer at least a 20% reduction in mental ability by the time of five years after surgery.
Let's set the stage:
This Most Prestigious Of Medical Journals Leads The Attack On America -- With An Attack On Bypass Surgery!
In The New England Journal Of Medicine, issue dated February 8, 2001, a study on bypass surgery was reported.
I didn't Used To Be So Dumb!
This study contained the stunning information that more than half of the people who have bypass surgery suffer a decline by at least 20% in mental ability, and that 42% of the people who have had bypass still have this drastic decrease in mental ability even five years later.
Needless to say, this is NOT good news for the thousands of doctors who make their living by diagnosing the "need" for bypass and performing the surgery.
This single study will probably decrease the use of bypass surgery in the US by a very significant percentage -- and will undoubtedly be the direct cause of some large number of doctors who retire early, or change their careers to leave this sinking ship.
As astounding as this story is, the underlying facts are far more astounding.
For years the politically correct viewpoint has been that heart disease was primarily caused by poor diet -- including eating eggs and butter. The fact that this is completely false does not phase those who make this claim.
Why? Because they know that the recommended diet is not only harmful, but is so difficult for most people to follow that they will never blame the doctor, but will only blame themselves for their failure to be able to stay on the diet.
Just ask around you! Ask every other person (about the number who are overweight in America) as to whether they have tried to use a diet to lose weight and reduce their risk of heart disease. Many of them will answer, "Yes, but it didn't work!" Many will say "No!" They are the ones who would rather eat, get fat, and then take a drug. Everyone is a loser when it comes to the government-recommended diet -- but not a weight loser!
But, the scientists already know two things:
Even if you stay on the recommended diet for preventing heart disease, that diet will not reduce your cholesterol levels, and, in fact,
The recommended diet is exactly the wrong diet needed to prevent heart disease.
So, the doctors know that their recommendations on the primary defense against heart disease will fail. (The American Heart Association published false statistics on the success of their recommended treatments, and got caught. I exposed those false claims!)
The master planners created a second line of defense -- another that they know would fail.
You may not have even heard of this second line of defense, because even the doctors don't believe it, but it IS the official government protocol.
If the patient is unable, or unwilling, to stay on the "proper" diet, then the patient may need some psychological counseling -- group therapy -- so that he can get on the proper diet. The doctors know that this psychological stuff just doesn't work. Prozac is even touted to help people diet!
Now, you, as a patient, have failed to follow the doctor's advice and stay on the "proper" diet, and you have failed as a participant in a counseling series, so you come back to the doctor, high cholesterol and worried.
The doctor looks at you, sadly, and says, reluctantly, "Well, the only other alternative is that you should start taking this cholesterol-lowering drug, and continue on it for the rest of your life!"
You can hardly complain!
It is YOUR fault that you failed on the diet and YOUR fault that you failed in therapy.
And, anyway, the insurance pays for the cholesterol-lowering drug.
So, you start the drug.
Now, it also well known, perhaps not by the public yet, that these cholesterol-lowering drugs don't reduce the rate of death from heart disease.
So, what is the fourth line of defense against death from heart disease?
Under The Knife:
Bypass surgery. One of the biggest frauds in medical history. A fraud that I have written many hundreds of pages about! Click on the picture above, or here, for one of those articles.
For instance, read this confession from a former heart surgeon:
"If the patient still couldnt make a decision to undergo open heart surgery I would go out and visit with his or her spouse," says Dr. Carrow, "and point to the same spot on the angiogram and say this problem is what we call a widow maker." The spouse would then run to their loved one and plead with them to consent to the operation.
"If all of this didnt work, then we would apply the icing on the cake. This consisted of sending a patient who had undergone successful heart bypass surgery to visit the prospective surgical candidate and tell them how successful the operation was." It wasnt easy to find a patient who had a successful operation, notes Dr. Carrow.
"The heart surgeon would then come in and say how easy the surgery was to perform. All members of the heart team were trained to circumvent the question: how effective is the outcome of the surgery? We would answer that question by saying that years ago there was only a six percent chance of success. Today there was a 96 percent chance. Every patient would interpret this as a cure. The nurses were told to tell the patient they would be holding their hand through the whole procedure. Then the pastor would come in and say a few words. It was well orchestrated."
"We call all of this patient education. It was really patient coercion. I was involved in over 2000 open heart procedures. Only about 200 were necessary. We had a 90% failure rate," says Dr. Carrow. These numbers were recently confirmed by a landmark Harvard study.
In another famous case, reported on the front page of the Wall Street Journal, drunk heart surgeons were still performing bypass surgery. This story was one of the opening salvos in the carefully planned campaign to invalidate bypass surgery -- this campaign started many years ago -- and continues today.
Here is that story.
In the Canton, Ohio case, Dr. Rice was accused of being drunk while performing surgery. He went into three different alcohol-treatment programs, but refused to have a urine test and was finally locked out of the operating room. One of the other doctors who was trying to cover up Dr. Rices drunkenness even said that "although Dr. Rice has a slight tremor in his hand, it seems that the tremor is always in the right direction!"
The death rate among bypass surgery patients was high, but hidden. At one hospital the death rate after bypass surgery was 25% -- an unbelievable statistic that was deliberately hidden from public view. Read that story here.
There is an extremely well-documented story about a physician from New Zealand named Ross Gardner. He moved into South Bend, Indiana in 1974. He convinced Memorial Hospital to open a bypass surgery service.
Dr. Ross, and a new partner, Dr. John Rubush, got rich doing 300 to 400 bypass surgeries per year, on into the 1980’s. They were grossing one to three million dollars per year.
Unfortunately, after some years of seeming success, the death rate began to rise and the Hospital’s NEW chief of surgery was forced to investigate. He actually did nothing. The Cardiologists in town decided that their patients would die if they sent them to Memorial. The Cardiologists simply quit sending patients to Memorial.
Only then did it come out that the death rate among the patients of Dr. Ross and Rubush was higher than ANY OTHER hospital in the United States doing bypass surgery! Finally the Chief of Surgery acted.
The data? Some 23% of all the Medicare patients there died after bypass surgery in 1984! This death rate was ten times higher than the best bypass surgery centers.
Was this unusual? Well no! What was unusual was that the statistics on death rates for bypass surgery had been kept hidden for many years and only in 1984, for the first time, did these figures finally get into the media.
But, at least it is a fourth line of defense -- even though an invalid defense.
Why do the hospitals like bypass surgery?
"The money in medicine is in cardiac surgery," says James Hinton, chief executive of Presbyterian Health Services, the hospital's parent. "Cardiology is unquestionably profitable. That's what they're going after."
The reason is right there -- money ---
here for that entire story in the Wall
Since the first three lines of defense have been such miserable failures, the fourth line, bypass surgery, has become one of the fastest growing types of medical procedures in history, and now accounts for many billions of dollars per year -- surgery that makes the doctors rich, and the patients worse off.
Can you believe it, then, when the "establishment" comes out to be critical of bypass surgery?
What can be the reason for that?
The reason is simple. The plan was laid in place many, many years ago. The Master Planners knew that people who have health insurance, and don't pay their own health costs, will always seek more and better (free) treatment. The Master Planners agreed that they would allow bypass surgery to take the "last chance position" at very high cost for each surgery.
They knew that bypass surgery would become a larger and larger part of the total bill for medical care -- and that when bypass surgery got high enough, it would then be safe to start attacking it as worthless.
That is the attack you have seen over the last few years.
Like The Grains Of Sand In An Hour Glass!
One drop of sand, then another! You don't think each grain of sand means much, but in a bit, the time has passed. In a few more years you will see that bypass surgery is in complete disgrace as a medical practice.
The individual attacks are rather infrequent, but they build up on you. You see a story here, and then there, now and then, and you gradually begin to realize that bypass is NOT a very good solution to heart disease.
In the mean time, the drug companies who had been producing worthless heart medications have come out with NEW (also worthless) drugs for heart treatment. The fact that they are "new" hides the fact that they are also worthless.
So, here is the bottom line.
As all of the money that has been spent for bypass surgery continues to increase, and then to start decreasing because of the bad publicity on bypass, there are new drugs coming on the scene to solve your problem.
And, you see, the total cost of medical care does NOT go up -- or not much!
The drug industry is deliberately taking money out of the pockets of the heart surgeons and putting into their own pockets.
It is hard for the government to deny the poor citizen his "right" of access to prescription drugs -- but it would be easy for the government to look for ways to avoid giving every citizen who wanted one, one of those $100,000 expensive bypass surgeries.
Can you see the difference, politically, between Congress passing a law for "Senior Prescription Drugs," compared with "Universal Bypass Surgery?" The country still believes in drugs. A large percentage of society is skeptical about bypass surgery.
So, this whole thing was planned many years ago -- to build up the total cost of medical care, with some very high priced treatments that could later be sacrificed so that the drugs could take their place.
Is it working?
WASHINGTON -- Retail spending on prescription drugs grew 84%, or $42.7 billion, between 1993 and 1998, a new study said.
The study, conducted for the National Institute for Health Care Management Research and Education Foundation by Barents Group LLC, said most of the increased cost is being borne by third parties such as employers and health plans.
But it warned that consumers eventually will be forced to pay for the increase in drug costs through higher premiums, reduced wages or reduced services.
According to the study, retail prescription drug expenditures grew from $50.6 billion in 1993 to $93.4 billion last year.
The study said more than 30% of the growth in spending on prescription drugs came from sales in "four therapeutic categories - oral antihistamines, antidepressants, cholesterol reducers, and anti-ulcerants - which tend to include heavily advertised drugs."
"Pharmaceuticals are consuming an ever bigger piece of the health care pie," said NIHCM Foundation President Nancy Chockley
"In 1998, for every dollar spent by the U.S. pharmaceutical industry on research and development, nearly 50 cents was spent on product promotion," she said.
It would be easy to criticize a single person getting $100,000 worth of bypass surgery, but that same amount of money would probably buy drugs for 100 different people each year. So, drugs seem cheaper than bypass, and it is easier to get government health insurance to pay for drugs.
It is even easier to increase the drug money within the government budget if the total cost of health care is NOT going higher.
So, how do you do that?
You plan on a series of attacks on bypass surgery while you plan some clever public relations campaign to promote the new drugs for heart health.
If that were the only story it would be bad enough, but now take a look at the other ways that the drug companies are starting to increase their grab at your money.
Premenstrual Syndrome is the term used to describe a woman who seems irritable during the menstrual cycle every month.
That condition has not become a new mental disease.
|Eli Lilly has one of the most evil, and most profitable drugs ever invented -- Prozac.|
Their patent monopoly on that drug expires in just a very short time. Then many others will be able to make it, even though by a different name, and the price for Prozac will drop tremendously.
So, Lilly found a way to take the same drug, Prozac, repackage with NEW health claims -- a claim that it would "cure" this new mental disease -- PMS. Since the patent laws allow a new monopoly on this "new" drug (because of the new types of claims) the Lilly company has been able to extend for many years to sale of their evil stuff. Click here for details. More details here.
But at what cost?
The cost is the invention of a new mental disease and the drugging of women who have a hard time for some days during the month. The fact that a change in diet would make these symptoms disappear is NOT of interest to either doctors or the drug companies. In fact, the official government recommended diet will increase the problems of PMS.
Now, let's consider another extremely common health problem -- arthritis.
The drug companies have a drug for arthritis. It certainly doesn't cure arthritis, but it is a pain killer and it "works." The fact that MSM works as well or better, at a fraction of the cost? Well, let's suppress that information while the government health insurance pays for the drug.
But, there is always fighting WITHIN the drug industry, and Tylenol wants to get its increased share of the health budget.
So, they come out with a non-prescription, but special form, of Tylenol just for arthritis. They are selling millions of bottles.
Then, cleverly, and maliciously, they know that if a person will be more active, exercise, their arthritis pain will decrease. So, they give millions of dollars to your local YMCA and YWCA to sponsor "Seniors' Swim Exercise Classes."
I've seen them.
They don't really help much, but they, again, make the person feel guilty for NOT getting enough exercise so as to defeat the pain of arthritis.
The doctor says to you, "Take this arthritis drug AND get more exercise."
Even though more exercise might be beneficial for you, the doctors know you won't do it, or that only a very few will do it.
So, you fail to do the swim class at your local YMCA (widely advertised with grants to the YMCA, from the drug companies, through the front men of the non-profit foundation for Arthritis, etc.
Now that you have failed, you feel guilty and don't complain that your only solution, now, is a drug.
And the government-paid health insurance pays!
After all, you deserve the best drugs that money can buy!
There are more and more instances of drugs being promoted as the solution to all medical problems -- whereas the government recommendation on diet is exactly the one that will increase the amount of disease.
Where does this all lead?
To the drugging of America.
So, when you hear that bypass surgery causes damage to mental abilities, recognize that as what it is -- a blatant to move money out of the high-priced surgical part of health care into the lower cost drug part of health care.
And, both Republicans and Democrats are falling all over themselves to give you FREE drug prescriptions -- after all, you deserve the best health care in the world -- at least the best that drugs can provide.
What do you think is the purpose of drugging America?
I'll reveal that dirty secret another day -- or write me personally and I'll answer that question for you.
Here are the stories that appeared in the nation's media -- taken from one study deliberately planted in the prestigious New England Journal Of Medicine.
Reprint From The New York Times
Mental Decline Is Linked to Heart Bypass Surgery
February 8, 2001
Mental Decline Is Linked to Heart Bypass Surgery
By DENISE GRADY
• Saving the Heart Can Sometimes Mean Losing the Memory (Sep. 19, 2000)
• Anatomy Home
• Health Home
• After the Bypass
Five years after heart bypass surgery, 42 percent of patients show a significant decline on tests of mental ability, probably from brain damage caused by the surgery, doctors from Duke University say in a new study.
Older patients and those with a drop in test scores soon after surgery were most likely to show declines five years later. The report, being published today in The New England Journal of Medicine, has evoked mixed reactions among experts.
On the one hand, they say that a lowered test score does not necessarily mean a person is mentally impaired and that the 42 percent figure might needlessly frighten patients away from surgery that could save their lives. On the other hand, researchers concede that the study was done well and that it highlights an ugly truth that surgeons know but are not eager to discuss with patients: some patients do wind up mentally impaired after bypass surgery. And doctors are not sure why, though they suspect various factors that interfere with blood flow to the brain during surgery.
The findings also seem likely to fuel the debate about whether all of the approximately 500,000 bypass operations done each year in the United States are necessary, or whether more patients with blocked arteries, particularly older people, should be treated with medication or less invasive procedures to open clogged blood vessels.
The researchers are not the first to link mental decline to bypass operations. But earlier studies were shorter term, and many doctors hoped that the cognitive losses would be temporary. The new study is the first to show lasting changes in so many patients so long after the surgery.
The study, based on 261 patients who had bypass surgery at Duke from 1989 to 1993, relied on mental tests done before surgery and then six weeks, six months and five years later. The patients' average age was 61, with a range of 50 to 71. Patients were considered to have declined mentally if their test performance at five years was at least 20 percent lower than their score before surgery. A 20 percent drop was similar to the difference in function between subjects at ages 40 and 60.
The drop in scores in the bypass patients could not be attributed to aging, the authors said, because it was more than two to three times the mental decline found in 5,888 Medicare patients who did not have bypass surgery and whose cognitive abilities were followed for five years in a separate study.
A doctor not associated with the study, William A. Baumgartner, chief of cardiac surgery at Johns Hopkins Hospital, said researchers at his hospital were also studying the problem but had found far fewer patients with significant long-term problems, perhaps 8 percent to 10 percent.
"I was shocked at the 42 percent," Dr. Baumgartner said. "We just haven't seen that in our five-year follow-up. People who read this thing are going to be scared out of their minds that they're going to be some kind of invalid. In our series, that is clearly not the case. They need further work to see how this affects the well-being of patients."
They Won't Even Notice It!
Dr. Mark F. Newman, an author of the study and chief of cardiothoracic anesthesiology at Duke University Medical Center, said researchers were not sure how many of the patients were troubled by their declines or even aware of them, since the changes might not cause problems in their daily lives.
But Dr. Newman said he hoped the findings would not lead patients to shun bypass surgery. "In a lot of patients, we prolong their life," he said. "We have to continue working on improving the quality of their life as well."
Several elements of bypass surgery can potentially cause brain damage, Dr. Newman said. One is the heart-lung machine, through which the patient's blood is circulated to pick up oxygen. Doctors suspect air bubbles produced by the machine may block blood flow through minute vessels in the skull, killing brain cells. The machine may also pump droplets of fat released from the surgical site to the brain, where they can cause the same problem as air bubbles. It is also possible that the machine does not provide enough oxygen for some patients.
The other possible source of trouble is fatty deposits in the patient's own aorta, the large vessel that carries blood out of the left side of the heart. Surgeons clamp the aorta and may sew blood vessels to it during bypass surgery; those procedures can break off deposits, which may then travel to the patient's head and block blood flow.
Dr. Newman said newer techniques in which the surgery was done without the machine, and with little or no manipulation of the aorta, might help to protect the brain. But not all patients are candidates for the new techniques. In the United States, about 20 percent of bypass operations are done without the heart-lung machine. The machine will always be needed for some types of cases, Dr. Newman said, and for that reason researchers are trying to develop drugs that patients can be given during surgery to help brain cells tolerate declines in blood pressure and oxygen level that cannot always be avoided during surgery.
But other researchers say it is not clear that the heart-lung machine should take all the blame. Dr. Ola A. Selnes, a neuropsychologist at Johns Hopkins, who wrote an editorial in the same issue, said other studies had shown cognitive declines in elderly patients who had operations not involving the heart; the stress of anesthesia and major surgery may have been too much for them.
Dr. Selnes noted that cognitive problems in bypass patients might be partly due to their underlying vascular disease, which affects blood vessels all over the body.
A weakness of the study, and of earlier ones, is the lack of a control group — a set of patients who do not have bypass surgery but who have vascular disease similar to that in the surgical patients and who match them in age, sex, race, education level, lifestyle and so on. Only by comparing two such groups over time could researchers find out how much mental decline is due to bypass surgery and how much to vascular disease. Dr. Selnes said such a study was under way.
When answers do become available, Dr. Selnes said, it might be possible to identify patients who are particularly at risk for cognitive problems, and to suggest alternative treatments to bypass surgery. "Not everyone has to have bypass," Dr. Selnes said. "There are choices. Of these 600,000 being done very year, only a subset really require what you might call emergency surgery."
Other patients, he said, could be offered medical treatment or less invasive procedures like balloon angioplasty to open clogged vessels.
"There has been a kind of blind faith that bypass is the ultimate answer to any kind of heart disease, and I think that has to be rethought," Dr. Selnes said.
Saving the Heart Can Sometimes Mean Losing the Memory
By SANDEEP JAUHAR
Dave Stueber for The New York Times A small number of coronary bypass patients, like James Haneman suffer cognitive impairment after the surgery. This has led to a debate about heart-lung machines.
• After the Bypass
George M. Gutierrez for The New York Times Dr. Jeffrey Gold of Montefiore Medical Center in the Bronx, says the use of heart-lung machines is often the best option.
James Haneman believes his surgeons sacrificed his mind in saving his heart.
In 1989, Mr. Haneman had a law practice in New Orleans, earned a six-figure salary and sat on several important state and federal law committees. Then he had a heart attack and surgery to bypass blockages in his coronary arteries.
He came through the surgery fine — physically. But since then, Mr. Haneman says, he has had memory problems and even simple tasks, like writing letters, elude him. His doctors told him the problems would be only temporary. "They told me not to make any important decisions for a month," he recalled.
But when he returned to work, he recalled, "I could study something and not be ready to say it the next day, particularly in the order it had to be presented." The doctors told him to wait another month.
Frustrated, he turned to self-help tapes and books on memory enhancement. He tried computer exercises and reading nonfiction. But his problems persisted and after two years he quit practicing law. "When you can't remember anything, you can't practice law," he said. "I was doing my clients an injustice."
Though Mr. Haneman is an extreme example, heart surgeons say he is not alone. Doctors say evidence is mounting that a small but significant number of bypass patients suffer some degree of cognitive impairment, like memory and attention deficits and language problems, particularly if they spend time on heart-lung machines.
These patients are apart from the approximately 2 percent to 5 percent of patients who suffer strokes after bypass surgery, a procedure 600,000 Americans undergo each year.
It is unknown how many patients suffer the less catastrophic, but nevertheless debilitating, cognitive problems. Depending on how the problem is defined, studies suggest that anywhere from 10 percent to 50 percent or more of bypass patients do poorly on tests of memory, language and spatial orientation six months after surgery. These changes can persist years after surgery, and in many cases are probably irreversible.
A significant number of these patients will have recognizable problems in their day-to-day lives. It is estimated that the total cost of these problems exceeds $1 billion a year.
In part, experts say, the incidence of the problem is increasing because older, sicker patients are now being offered bypass operations. In the early 1980's, the average age of bypass patients was about 58, according to Dr. John Murkin, director of cardiac anesthesia at the University of Western Ontario in Canada. Now, it is 66.
"As we operate on older and older patients, because of the accumulated burden of disease in their blood vessels, we're seeing more neurological injury," Dr. Murkin said.
In part, experts say, the cognitive impairment itself is the result of stroke, particularly "ministrokes" that patients can suffer when fatty material is dislodged from the aorta, the body's largest blood vessel, when it is clamped in order to shunt blood into a heart-lung machine.
The acts of clamping and unclamping can break the hardened fat coating the wall of the aorta into tiny pieces, like pliers squeezing an eggshell, which can then lodge in the brain. "On video it looks like a snowstorm," said Denise Barbut, former director of stroke research at the Weill Medical College of Cornell University, who has used ultrasound to study the flow of these particles during bypass surgery.
Experts say there are probably several other contributing factors, including tiny blood clots or bubbles from the heart-lung machine, inadequate blood flow to the brain during surgery and brain inflammation.
Whatever the cause, the syndrome is so pervasive that heart surgeons and cardiologists have coined a term for it: pump head. Some even go so far as to encourage some patients to seek other remedies for their heart disease.
"A high-functioning 75-year-old who I might normally be very aggressive about bypassing, I might try to manage medically or with angioplasty," said Dr. Richard Fuchs, a cardiologist in private practice in Manhattan, referring to powerful heart drugs and balloon procedures that open up blocked arteries without surgery. Other experts say they save this advice for patients who already have some sort of cognitive impairment.
Some experts say some of the cognitive problems after bypass surgery may actually result from depression, which for reasons that are unclear develops in many patients after the surgery.
In any event, the cognitive impairment occurs in a minority of patients. "I have a fairly large cadre of patients who tell me they've never been better," said Dr. Jeffrey Gold, chairman of cardiothoracic surgery at the Albert Einstein College of Medicine and Montefiore Medical Center in the Bronx. "Many will tell you they're much more creative and prolific, that they haven't suffered any cognitive decline whatsoever."
Dr. Gold points out that some research shows that knee-replacement surgery can result in similar cognitive impairment and that bypass surgery done off a heart-lung pump results in stroke rates similar to those when conventional bypass surgery is done on pump. "I think pump head is a misnomer," he said. "The implication is that the cognitive decline is due to the pump, and that if you avoid it you're safe, but that doesn't appear to be the case."
When patients have cognitive changes after surgery, the effects are often subtle. They may think a little slower or feel "clouded." They may forget appointments or where they put things. They may become irritable or depressed.
"The defects can be subtle and patients can often compensate for them," said Dr. Mehmet Oz, a professor of cardiothoracic surgery at Columbia-Presbyterian Medical Center in Manhattan. "On the other hand, if their functioning is already low, the results can be debilitating."
Sometimes the changes can be a bit bizarre. "Suddenly the type of food or the type of restaurant they like changes," said Dr. Mani Subramanian, chief of cardiothoracic surgery at Lenox Hill Hospital in Manhattan. Dr. Gold of Montefiore said one of his patients recently had called after bypass surgery to say he was feeling well and was back at work. "But he told me, `I can't stand the taste of lettuce anymore.' He used to eat a lot of salad, but that changed after surgery."
For Paul Wechsler, a 60-year-old former architect who lives in New Jersey, the changes were not subtle or bizarre, just painful. "The bypass surgery knocked out a lot of my memory," he said from his home, where he spends most of his days. "It changed my whole life around mentally."
The memory problems started immediately after his bypass surgery in 1996. He told his doctor about them, and was assured they would be temporary. But in the following months he did not improve. He found himself asking his fiancée to calculate the tip at restaurants. "I couldn't understand jokes that she would tell me," he said. "Even now, she'll say something to me and I'll say, `What do you mean by that?' "
He had been running his own construction business and working as a salesman before the surgery, but he had to quit. "I used to enjoy the challenge of building things up from nothing," he said, but it gave him fits. Though he believes his mental functioning may now be starting to improve, he remains on permanent disability. "I still have to read a paragraph three times to get the meaning," he said.
To avoid the potentially deleterious effects of heart-lung machines, surgeons have developed off-pump, or beating-heart, bypass surgery. Here, surgeons insert a clamp through a small incision in the chest wall to immobilize a small section of the beating heart. A new vessel is then stitched, while the heart continues to pump blood to the brain and the rest of the body. Aortic clamping and a heart-lung machine can be avoided. The surgery is relatively new, however, and most bypass surgery is still done on pump.
But studies of whether off-pump surgery protects against pump head have not produced clear results. Dr. Oz of Columbia is now conducting a study, the largest to date, in which 600 bypass patients will be randomly treated with on- or off-pump surgery and studied for cognitive decline. "If we're going to make decisions affecting the lives of 600,000 people a year, we don't want to base that on the results of a small trial," he said.
Other treatments for pump head are being developed. Embolex, a Northern California company founded by Dr. Barbut, the neurologist, has designed a filter to catch debris from the aorta during surgery. Another company, Cardeon, has developed a balloon device that opens up inside the aorta during surgery, shutting off blood flow and obviating the need for a clamp.
Some experts believe that more attention is being paid to pump head today because more catastrophic results, like strokes and deaths, have sharply decreased as anesthesia and surgical techniques have improved. The mortality rate for bypass surgery is now less than 1 percent. "The nice thing is that today we can worry about the subtle changes," said Dr. Mark Newman, chairman of anesthesiology at Duke University Medical Center.
Dr. Gold of Montefiore said the decision about whether to perform bypass surgery on or off pump can be made in the operating room. He recently had a 52-year-old patient who expressed concern before surgery about intellectual decline. After opening up the patient's chest in the operating room and discovering by ultrasound that his aorta was lined with a large amount of plaque, Dr. Gold decided to do the bypass surgery off pump.
"The most important thing, in my humble opinion, is to be flexible," Dr. Gold said. "The goal is to fit to the patient's needs, not artificially choose a surgical modality." He added that for the majority of patients, on-pump surgery — the most studied — was their best option.
Los Angeles Times -- February 8, 2001
patients who undergo heart bypass surgery suffer a significant and, it turns
out, long-lasting loss of brain power, a study suggests.
Doctors have known that people often lose some of their mental sharpness immediately after a heart operation, but many seemed to recover fairly quickly. The new study, however, found that this recovery is short-lived.
The study looked at 261 patients who were on a heart-lung machine during bypass surgery. It found that five years after the operation, 40 percent showed a 20 percent drop in mental ability. That loss is similar to what a person normally goes through between the ages of 40 and 60.
Doctors do not know for sure why this mental loss happens, or even whether the operation causes it. For example, it might be that people whose arteries need to be replaced already have damaged blood vessels in their brains as well. The loss might also have something to do with being put on a heart-lung machine, which circulates blood through the patient's body during surgery.
An estimated 400,000 people a year are put on heart-lung machines for a bypass operation in the United States. The findings suggest that 160,000 of them risk losing some of their mental ability.
Dr. Mark F. Newman, who led the study published in Thursday's New England Journal of Medicine, noted that many patients in the Duke University study might not have lived five years without the operation.
"Now it's a matter of fine-tuning" the operation "to improve the quality of life as well as the length of life," he said.
Moreover, the people who lost mental ground in this study might have lost brain power faster anyway, said Dr. Irving L. Kron, chief of cardiac and thoracic surgery at the University of Virginia School of Medicine.
"It may be that the stress of the operation brings things out or pushes things along that were there to start with," Kron said.
Newman said other research appears to indicate that there are fewer problems with the brain after bypass operations done without the heart-lung machine.
Participants in the latest study took tests in memory, attention, concentration and manual dexterity five times: before the operation, when they left the hospital, and six weeks, six months and five years later.
Fifty-six percent did significantly worse when they were released from the hospital than when they were admitted.
Nearly half of those people were back up to pre-operation levels when tested six months after the operation. But at the five-year mark, most were back down to the levels measured when they were leaving the hospital.
Older people and those with the least education were the most likely to have lower scores five years later.
People who did not show any losses just after the operation were in equally good shape five years later.
The bypass operations took place from 1989 through 1993, and the last five-year tests were given in 1998.
Doctors are more aware of problems which can cause brain damage than they were when those bypasses were done, and improved techniques "will reduce or have reduced neurocognitive dysfunction," Newman said.
"I think our technology is continuing to improve," he said.
- - -
On the Net:
Duke University Medical Center: http://www.mc.duke.edu
New England Journal of Medicine: http://www.nejm.org
American Heart Association: http://www.americanheart.org
University of Virginia Medical School: http://www.med.virginia.edu/schools/medschl.html
the archives of the Los Angeles Times for similar stories.
You will not be charged to look for stories, only to retrieve one.
By RON WINSLOW
Staff Reporter of THE WALL STREET JOURNAL
A new study suggests that a significant number of patients undergoing coronary-artery bypass surgery suffer sustained memory loss and other cognitive problems as a result of the operation.
The findings reflect growing awareness that the widely used procedure carries with it the risk of a variety of neurological problems, ranging from stroke to much less severe side effects such as confusion, difficulty concentrating or paying attention. The report is among the first to indicate that such cognitive deficits can recur as many as five years after surgery.
"We have thought of this problem as a transient or temporary injury that occurred but we were unsure of what the long-term consequences were," said Mark F. Newman, a cardiac anesthesiologist at Duke University Medical Center, Durham, N.C., and lead author of the study. The results, published in Thursday's New England Journal of Medicine, indicate people who suffer an immediate cognitive decline after the operation typically recover, but are at high risk of experiencing the deficit again.
More than 500,000 bypass operations are performed in the U.S. annually, and researchers have made important strides reducing death rates and the incidence of stroke, among other complications. But the more-subtle emotional and cognitive changes have gotten much less attention.
"My hope is that we can provide as much quality of life as we do quantity of life," Dr. Newman said. "The way to do that is to preserve cognitive function."
Investigators at Duke and elsewhere are studying the operation to determine possible causes and ways to avoid such deficits. Research by David Stump, a neuropsychiatrist and his colleagues at Wake Forest University Baptist Medical Center, for instance, indicates that debris that breaks off from a diseased aorta during the operation can end up in the brain, causing strokes or cognitive problems. The practice of returning to the patient any blood that collects in the chest cavity during the operation as well as how quickly body temperature, especially in the brain, is restored postoperatively also may play a role in cognitive deficits, he has found.
The new study, based on 261 patients who had bypass surgery at Duke from 1989 to 1993, found that 53% had at least a 20% decline in brain function, based on a battery of neurocognitive tests shortly after the operation. Scores, on average, returned to presurgery levels within six months, but among those with an initial decline, about two-thirds, in effect, had relapsed when they were tested again five years after the operation.
A weakness in the study is that the patients weren't compared with a control group who didn't have the surgery. Thus, it isn't possible to determine for sure how much of the effect resulted from the operation and how much might relate to such factors as a patient's condition prior to the surgery, or to declines associated with aging. Still, Dr. Newman believes the findings indicate bypass surgery can accelerate any cognitive decline linked to getting older.
Irving Kron, chief of thoracic and cardiovascular surgery at University of Virginia, Charlottesville, said he thinks the study suggests that if a patient already has a "tendency toward cognitive dysfunction," certain elements of bypass surgery could precipitate it.
Write to Ron Winslow at firstname.lastname@example.org
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