CONTACT How Mr. Cheney should've answered Dr. Gupta - Dr. Christian Thurstone

This week, Dr. Sanjay Gupta’s sometimes contentious interview with former United States Vice President Richard “Dick” Cheney appeared on CBS’ “60 Minutes.”

The doctor aggressively questioned — OK, it would be fair to say “hammered” — Mr. Cheney about whether his longstanding, serious heart condition compromised his ability to serve in public office. Consider this segment of the interview:

Dr. Gupta: “Did they (medical experts treating Mr. Cheney) talk at all about potential side effects — again, because of limited blood flow to the brain — on cognition, on judgment?”

(He continues in a cut-away segment): “When you talk about heart disease, obviously it affects all these different parts of your body — if not your cognition, then your state of mind, your mood.”

(The camera cuts back to the interview with Mr. Cheney.)

Dr. Gupta: “Was that something you had heard about in any way? (Mr. Cheney shakes his head.) “You didn’t know about it, and you weren’t worried about it?”

(The camera cuts away again to Dr. Gupta speaking with a CBS reporter)

“Look at how he reacts to things sometimes,” Dr. Gupta said — strongly implying that Mr. Cheney’s obvious frustration with his line of questioning was somehow related to the moodiness, cognition and “state of mind” he had just spoken about.

It is a shame Mr. Cheney — who clearly enjoys turning tables on reporters when he speaks with them — didn’t react to Dr. Gupta more like this:

“Well, if you’re really concerned about heart conditions and their association with cognitive impairment, let’s go there, shall we?

“The odds ratio for, or risk of, experiencing cognitive impairment related to a heart condition is approximately 1.62 — meaning a person who has a heart problem is 62 percent more likely to suffer cognitive impairment than someone who does not have a heart problem. (see source)

“Not good, eh? Something that should gravely concern American voters about their elected leaders? My physicians didn’t call me off the job — but OK, whatever you say, Dr. G.

“Now, let’s look at the odds ratio, or risk, of someone who used marijuana during adolescence experiencing cognitive impairment, memory difficulties, loss of executive function, psychosis and schizophrenia. And let’s take great care to note that the odds, or risk, worsen depending on the extent of use and the age of onset — which means the heavier the use and earlier it starts, the higher the risk.

“Why, golly. That risk is considerably higher than the risk of cognitive impairment faced by patients with heart trouble: science puts that odds ratio at 2.0-4.0 or more. In other words, the risk of cognitive loss and impairment for people who used marijuana heavily during adolescence is at least double the risk faced by people with heart trouble. Translated once again, we’re talking 100 percent to 300 percent greater risk — which, by my calculations, is greater than that 62 percent you find so troubling.

“So, in still other words, Dr. G., people who currently hold elected office with medical histories that include heavy marijuana use during adolescence are at a twofold to fourfold increased risk of experiencing these problems with cognition. Got that? Adolescent pot use doubles to quadruples the risk of experiencing the very problem you’re in here wanting to talk to me about.

“And let’s not get me started about how moody potheads are.”

Source: “Cognitive impairment in heart failure: a systematic review of the literature,” Vogels RL, Shelton P, Schroeder-Tanka JM, Weinstein HC.

UPDATE: Shortly after posting, we received this response from Bertha K. Madras, Ph.D., a professor of psychobiology in Harvard Medical School’s department of psychiatry. You can read more about her work here.

Sanjay Gupta can be held accountable for inconsistent attention to public health issues. Last night on ’60 Minutes’ (CBS), he was critical of Vice President Dick Cheney for holding office while having a serious heart condition.

Using a scattering of scientific manuscripts as props, Gupta claimed that heart conditions are associated with cognitive impairment and depression. In a fractious tone, he repeatedly asked Vice President Cheney whether he made the right decision to hold office, given potential cognitive impairment or depression. Gupta omitted some relevant information:

  • Scientific evidence for increased risk does not predict a specific outcome on an individual basis. By claiming Vice President Cheney was at risk, he should have followed up by stating unequivocally that an increased risk does not imply de facto that he personally harbored depression or impairment. Would Gupta claim that because early marijuana use is associated with increased risk of developing schizophrenia, then all former early marijuana users holding government office should quit their jobs because they may be at higher risk? Should all government office-holders struggling with substance use issues, including smoking, resign because of higher risks for more rapid cognitive decline or stroke or cancer?
  • The odds ratio (risk) for cognitive impairment in persons with serious heart conditions, based on a recent meta-analysis, was reported to be ~1.62. This number should not be considered as final because this area of research has had challenges and conflicting interpretations. [A ratio of 1 means no added risk]
  • Should all current marijuana users in the U.S. government resign? Marijuana impairs cognitive function immediately after use, with effects on cognition reportedly persisting for as long as 20 days, or even longer.

Vice President Cheney could have asked Gupta why he is willing to ignore the risks of using marijuana — especially during adolescence — with subsequent association with cognitive impairment, IQ reduction, memory difficulties, executive function, psychosis and schizophrenia. Gupta’s challenge to Mr. Cheney could be equally applied to individuals currently holding government office who were heavy marijuana smokers during adolescence or who are current users.

Young, adolescent marijuana users, after they mature, are at increased risk for adverse consequences to brain function. For those early users with six years or duration of marijuana use, there reportedly is a significantly increased risk of:

  • nonaffective psychosis (adjusted odds ratio, 2.2)
  • being in the highest quartile of delusions Inventory score (adjusted odds ratio, 4.2)
  • hallucinations (adjusted odds ratio, 2.8) (McGrath et al, 2010).

Early onset of marijuana use, frequency and magnitude of marijuana use were all shown to impact cognitive performance. Findings suggest that earlier marijuana onset is related to poorer cognitive function and increased frequency and magnitude of marijuana use compared with later marijuana onset. Exposure to marijuana during a period of neurodevelopmental vulnerability, such as adolescence, may result in altered brain development and enduring neuropsychological changes. (Gruber et al, 2012)

In adults (average age 30 years), early-onset marijuana use, but not adult-onset marijuana users, adults performed poorly on selected executive tasks compared with controls. Findings indicate that early-onset, chronic cannabis users are cognitively impaired compared with controls, suggesting that early exposure to cannabis is associated with more adverse effects on the brain. These results are in line with previous studies examining cognitive effects associated with early cannabis exposure. (Fontes et al, 2011 and see also Ehrenreich et al, 1999, Wilson et al 2000, Pope et al, 2001)

Adolescent use is associated with an increased risk of developing schizophrenia (Evins et al 2013, 2012; Stefanis et al 2013, others).

Heavy marijuana adolescent users have increased risks for suicidal ideation (odds ratio 2.2); suicide attempt or severe attempt (univariate odds ratio 3.0; 4.8 respectively, (Shucheng et al 2013)

Marijuana-associated reduction of IQ does not disappear if early onset users stop using marijuana after they mature (Meier et al, 2012).

And there’s much more.

Gupta selected a target on the basis of politics, not science. Using his criteria, President Franklin D. Roosevelt should have resigned from office in the early 1940s because he was gravely ill with extremely high blood pressure, congestive heart failure (with no modern medicine to control either adequately) — and, possibly, harboring malignant melanoma. An outside opinion by a Boston physician, recruited to weigh in on President Roosevelt’s health, concluded he should not run for office because he was gravely ill and would not survive his term. Yet, President Roosevelt led the World War II victory with our allies.

About Christine Tatum

Christine Tatum is a veteran journalist whose communications and market intel firm, Media Salad, Inc., helps companies and nonprofit organizations win business and stay ahead of their competitors. Her professional stops include the Chicago Tribune, The Denver Post, the (Arlington Heights, Ill.) Daily Herald and the (Greensboro, N.C.) News & Record. Her work also has appeared in The Wall Street Journal, and New York Times.

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