We Need to Understand and Show Some Compassion One of the savviest politicians of our generation, known for his wit, charm, and calm under extreme pressure, Bill Clinton appears out of character in the speeches and interviews televised since his bypass surgery September 6, 2004—and his mental deterioration may be accelerating. Remember, this is the president who withstood public impeachment before the entire world for his relationship with Monica Lewinski without once losing control. Now, he is easily angered by hecklers, and makes factual mistakes and racial slurs while aggressively defending his wife’s campaign for presidency. Everyone sees his mental and emotional decline, yet to date, no medical professionals have spoken out about the cause or offered help. Not a single one—not one bypass surgeon, cardiologist or psychiatrist—has stepped forward in his defense; even though all of them are trained to recognize “post bypass surgery cognitive dysfunction.” One of the best-kept secrets in medicine is the brain damage caused during bypass surgery. During my 40 years of medical practice I have never heard a doctor warn a patient before bypass surgery that an expected complication is memory loss. After surgery when the family complains of dad’s fits of anger, I have never heard a doctor admit that personality change is a common consequence of surgery. Yet these well-recognized side effects have been reported in medical journals since 1969.1 Brain damage during bypass surgery is so common that hospital personnel refer to it as “pump head.” The primary cause is emboli produced during surgery from clamping the aorta and from the “heart-lung machine.” This machine pumps blood to keep the patient alive while the heart is stopped during the operation. Unfortunately, this pump also introduces toxic gases, fat globules, and bits of plastic debris into the bloodstream of the patient under anesthesia. Once they are in the bloodstream, these particles migrate to the brain where they can clog capillaries and prevent adequate amounts of blood and oxygen from flowing to the brain. Essentially, all patients experience brain emboli during surgery and for many the damage is permanent. In 2001, an article in the New England Journal of Medicine reported that 5-years after bypass surgery 42% of patients showed decline in mental function of approximately 20 percent or more.2 A study published this year (2008) in the Annals of Thoracic Surgery using MRI testing just after bypass surgery found brain damage in 51% of patients.3 Three years after their time on the bypass pump, significant permanent reduction in mental capacity was identified in 31% of patients. I am not talking major stroke here; but these patients can't remember names or numbers as they once did, experience sleep disturbances (including nightmares), suffer mood swings, and lose intellectual acuity. Approximately 30 percent of people suffer persistent depression and some even contemplate suicide. Our former president needs our understanding and support. A simple explanation by his doctors of the cause of his recent aberrant behaviors should bring peace of mind to Hillary and her campaign staff. If Mr. Clinton better understood his current limitations, he and his staff could take precautionary steps to avoid embarrassments. A long-overdue explanation would help his adoring public more easily accept his mistakes and readily forgive him. It is not your fault, Mr. Clinton. As importantly, public recognition of the harm done to Bill Clinton by the heart surgery business would help the patients who undergo bypass surgery, and their families, to better understand similar changes they have experienced. A little attention from the media could also shine some light on the lack of survival benefits from this $90,000 procedure performed nearly half-a-million times annually in the US, and the superior benefits coming from diet and lifestyle changes. I am saddened to see our former president suffer from public humiliation, but I am disgraced that my profession has thus far failed to come forward with a long over-due explanation and an apology to the Clintons and our nation for the harm they have done and the secrets they have kept. John McDougall, MD

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1) Hill JD, Aguilar MJ, Baranco A, de Lanerolle P, Gerbode F. Neuropathological manifestations of cardiac surgery. Ann Thorac Surg. 1969 May;7(5):409-19. 2) Newman MF, Kirchner JL, Phillips-Bute B, Gaver V, Grocott H, Jones RH, Mark DB, Reves JG, Blumenthal JA; Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001 Feb 8;344(6):395-402. 9Link: http://content.nejm.org/cgi/reprint/344/6/395.pdf) 3) Knipp SC, Matatko N, Wilhelm H, Schlamann M, Thielmann M, Lösch C, Diener HC, Jakob H. Cognitive outcomes three years after coronary artery bypass surgery: relation to diffusion-weighted magnetic resonance imaging. Ann Thorac Surg. 2008 Mar;85(3):872-9.