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The Latest on Autism; Popular Cancer Test for Men Under Scrutiny; Inside India's Medical Tourism: Price is Right, But What About Care?

Aired April 4, 2009 - 07:30   ET


DR. SANJAY GUPTA, CNN HOST: Good morning. Welcome to HOUSE CALL, the show that helps you live longer and stronger. I'm Dr. Sanjay Gupta. Thanks so much for joining us.

As you know, here at HOUSE CALL, we're committed to autism. There is a mystery here. The disorder is on the rise, we're not any closer to finding a cause or any better treatments. So, we got the latest.

Also, a popular cancer test for men has come under scrutiny. Was it worth the time? Is it worth the expense?

Now, I'm going to go to India to go inside the medical tourism peak (ph). It's fascinating stuff. The price seems to be right, but what about the care? That's the question.

You know, it's been one year since the first World Autism Awareness Day. The question on many minds is: has anything changed? Well, the answers we found out: yes and no. There's still no known cause or no known cure, that's the big no -- but for at least one time of autism, a bit of promise, the possibility that some of the symptoms could be reversed.

So, get this, new animal research shows that certain medications may help reverse what is known as Rett Syndrome. That's something that's on the autism spectrum. So, there is some possible hope of there.

Meanwhile, right now, researchers got their eyes on something else -- environmental factors that together with genetics might put children at risk, everything from pesticides to a mother's health during pregnancy.

But as we've been reporting on autism, something struck us here at HOUSE CALL. Everyday, 67 children are diagnosed with autism, and that leaves a lot of parents searching for help, picking doctors, treatments, and, of course, trying to pay the bills.

Now, one Harvard study finds that it can cost more than $3 million to care for a person with autism.


GUPTA (voice-over): When he was born, Darian Sepulveda had his mother's personality -- and his father's eyes. For 18 months, he laughed, he cried, he even spoke. At two, it all disappeared.

ADA SEPULVEDA, SON HAS AUTISM: I was losing my child, basically, in front of my eyes. He was just dying on me.

GUPTA: Darian was diagnosed with autism. While his family began waging a battle against his disease, another fight was brewing with Darian's health insurance company.

A. SEPULVEDA: I had absolutely no problem with coverage until Darian was diagnosed.

OK, open the ...


A. SEPULVEDA: Door -- very good.

GUPTA: Now, Darian is 10. His diagnose began a financial spiral for his family, years of denied claims, unpaid bills, mortgages, loans, debt that has become untenable.

A. SEPULVEDA: I call him the billion dollar baby or the billion dollar boy because it's very costly.

KEVIN WREGE, COUNCIL FOR AFFORDABLE HEALTH INSURANCE: Health insurance policies currently cover medical diagnosis and medical treatment for autism.

GUPTA: But many families say not all treatments are covered. For example, Darian's speech and neurological problems and some medications were not paid for. Insurance companies say most autism treatments are experimental, unproven, covering them would cause everyone's insurance rates to spike.

A. SEPULVEDA: You don't tell a person that has a diabetic child, "Oh, well, you know, there is no cure for this." You give him insulin, you treat them.

UNIDENTIFIED FEMALE: Good job, keep your fingers up.


GUPTA: Those insurance problems continue into the teenage years, into adulthood. Sixteen-year-old Tyler Bell is about to graduate high school.

PETER BELL, SON HAS AUTISM: Who is your favorite musician?

T. BELL: Tyler.

P. BELL: Tyler.

GUPTA: Peter Bell is Tyler's father. He's also a spokesperson for the advocacy group Autism Speaks. He's been fighting for insurance coverage for most of Tyler's life. And now, he's concerned about Tyler's transition to adulthood. P. BELL: The face of autism is changing. We're talking about kids that are now starting to shave and do all those things that teenagers do and will eventually become adults.

GUPTA: Adults with autism, with no insurance coverage and no other safety net to provide for them.

P. BELL: I've heard some people say, "I hope my child dies before me." And I don't know any other disease or disorder where that's the case. That's my biggest fear -- is that if we're not here to provide for him, who will?


GUPTA: You know, the laws are starting to change. In fact, that advocacy group Autism Speaks that you just heard from is lobbying to get legislation passed that would mandate private health insurance coverage for autism.

Now, eight states have already signed on so far and more legislation is in the pipeline. President Obama is pushing for the same thing at the federal level. That would -- that would make private insurers cover screening, diagnosis, testing and treatment of autism until the age of 21.

Now, we want to get back to something we were talking about at the top of the show, a popular prostate cancer screening has some medical experts divided. In this week's Empowered Patient, Elizabeth Cohen brings us both sides of the PSA debate to help us be more informed.

This is interesting because people have been talking about this for sometime: PSA test -- useful or useless?

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: You know what, Sanjay, we found experts who said both of those things. And this is a really difficult decision for men to make. It's tough being a guy -- I really had sympathy after doing this story.

We, in fact, interviewed four experts on prostate cancer screening and said, "Well, what did you do? Have you been screened?" Two of them said you better believe I've been screened," and two of them said, "You'd better believe I'm not getting screened." And so, you can read what each of them had to say and that might help make the decision.

First, let me tell you about someone who was glad that he was screened. Andrew Traver is a patient who we wrote about in this week's column. He got screened at age 40 -- which is way earlier than is recommended. At age 44, they actually found a tumor in his prostate. He had it removed. His surgeon (INAUDIBLE) had told him he probably wouldn't have lived to be 50 if he hadn't gotten it removed.


COHEN: It was very, very aggressive. So, he's saying, "Of course, men should get screened, it saved my life."

GUPTA: No surprise that he thought it was a good idea and there are some pros here. Why are doctors hesitant to do the testing?

COHEN: Right. Some doctors are hesitant to do the test because they say, yes, there is a 1 percent or less chance that you're going to find a cancer like the one that they found in Andy Traver. They said there is a much larger chance that you're going -- that the doctor is going to find some small, relatively harmless cancer. I know that sounds crazy, harmless cancer. But in the prostate, there can be these tiny slow-growing cancers that are never really going to amount to anything.

So, this poor man, let's say, tested at age 40 or 50 could then spend the next several decades worrying about something that really is not worth worrying over. Also, if a doctor says, "You know what, let's treat this," that treatment could leave a man incontinent or impotent. That's certainly something that nobody wants. So, the treatment -- there's some problems with the treatment here and that's really what the issue comes down to.

GUPTA: And it's interesting, as people say, "Sometimes we'll die with prostate cancer, not because of it." But bottom line, after all the experts that you talk to, what's a dude to do? A guy to do?

COHEN: A dude is to talk to his doctor. That really what a dude is to do. And that sounds a little like passing the buck, but all the experts we talked to said that a man has to make this decision on his own with the advice of his doctor -- because there are certain risks to getting it, there are certain risks to not getting it. And you can only make that decision on your own.

GUPTA: And we have it on the record that you said that you felt pity for men.

COHEN: Yes, I did.

GUPTA: Well, if you just stay (ph), we're going to show it to you.



GUPTA: Elizabeth, thanks as always.

COHEN: Thanks.

GUPTA: You can read much more about Elizabeth's tips on her Web site, whether or not you should have PSA test, look at

Another potential salmonella outbreak in our food, this time it's pistachios. I love pistachios. It was a pretty scary warning -- a warning was to stop eating them altogether. And the low-cost treatments that are luring patients overseas for medical care. Never considered it, I decided to check it out myself. Stay with HOUSE CALL.


GUPTA: We're back with HOUSE CALL.

Voluntary testing -- authorities say that's how a potential problem with pistachios was found. Kraft has notified the FDA last week that it found Salmonella in roasted pistachios during routine testing. That prompted a government warning and a recall that took 2 million pounds of pistachio nuts off the market. And this nationwide scare has, once again, led to increased calls for more stringent food testing.

Also, the parents of a teenage organ donor have filed a lawsuit against the hospital and six doctors involved in their son's treatment. Now, before he died, Alex Koehne was treated for meningitis, but he also had cancer. And that wasn't caught.

And what happened was that his cancer ridden organs were transplanted into patients. Two patients who got those organs died, two others are now battling for their lives.

And take a look at this, researchers at Columbia University studied the brains of people who had a family history of depression and those who didn't. Now, the brain on the right here, look at the right side of the brain, this is an area in the purple that demonstrates a thinning of the surface of the brain.

That purple is much thinner than, for example, the left side of the brain, which is in green over here. This is about 28 percent thicker. Researchers believe this cortical thinning may set people up for depression even before symptoms appear. It could be a marker.

HOUSE CALL is back in 60 seconds.


GUPTA: We're back with HOUSE CALL.

This is a story I wanted to do for sometime. Consider this scenario: Your doctor tells you that you need an operation, maybe even a life-saving operation but it's simply too expensive. Some patients are being lured overseas by the promise of lower cost. I wanted to meet some of them, so I traveled to the place where many of them are headed -- India.


UNIDENTIFIED MALE: We're all dressed and pack and ready to go.

GUPTA (voice-over): People -- patients from all parts of the world, packing up and heading here -- all in search of the same thing. (on camera): We found ourselves in Delhi. What we really wanted to know is where are all these patients congregating. You know, there's question that medical tourism is very popular. If you Google it, you'll find more than 5 million results, $60 billion will be spent on medical tourism this year and in the next two years, $100 billion. I came here to Max Hospital and want to find the patients.


UNIDENTIFIED MALE: My name is McCloud (ph).

GUPTA (voice-over): Behind these faces are very different stories.



GUPTA: Home for them is Nigeria, Jordan, United States, Afghanistan, the United Kingdom. But this is the common ground -- a hospital in India. All of them here on the very same day for surgery.

But why leave home? Some people don't have access to medical facilities in their own country. Others say they're tired of waiting, sometimes years for treatment. For most, it is simply cheaper.

(on camera): The patients come here for all sorts of different reasons, but what we know about Sandra is that she absolutely needed to have this operation, it is going to save her life. She came all the way from Las Vegas. Let's go meet her.



GUPTA: Hi, how are you?


GUPTA: Sandra, nice to meet you.


GUPTA (voice-over): Sandra Giustina has been waiting more than three years for surgery to treat her atrial fibrillation. Until now, she couldn't afford it. She was told she would get a bill for $175,000 in the United States.

How much is it going to cost here?

GIUSTINA: It will be under $10,000.

GUPTA: So, $175,000 versus $10,000?


GUPTA: Have you ever left the United States before this trip?

GIUSTINA: Not too much.

GUPTA: Her story is typical. On average, the cost of some operations can be 10 percent of what they would cost in the West. So, no surprise, some of them are venturing beyond their borders for the first time to get medical care.

What they often find is a new culture, a new language, but, also, a new kind of patient experience -- a balance of western medicine and eastern hospitality. At this hospital, they're catering to the familiar tastes of home.

(on camera): So, what do we have here? We have a -- Chinese food?

RITIKA SAMMADAR, HEAD DIETITIAN, MAX HOSPITAL: We have Chinese. We have, you know, the Indian. And then we have the Continental and, of course, the Arabic.

GUPTA: Arabic food as well. But why is this important to have food specific to the different cultures?

SAMMADAR: We have patients coming in from around the world and, you know, when patients that are away from home and sick and, you know, away from their friends and families, food is something which is really (INAUDIBLE). But they'd actually look forward to their authentic food.

GUPTA (voice-over): OK. So, the food is good, but, of course, it's the quality of medical care that really matters.

I scrubbed in on a few operations while in New Delhi to get an inside look. First up, ablation surgery for Sandra's heart.

(on camera): So, Sandra, how are you feeling?

GIUSTINA: Good. I'll be glad when it's over (ph).

UNIDENTIFIED MALE: She's been a little nervous.

GUPTA: Now, she's been a little nervous, but she said one of the things that helped her is that her doctor back home has been communicating with her doctor here in India. It gives her a real sense of comfort.

You ready to see the inside of your heart? Take a look at here at these images. What you're looking at is her beating heart and the catheters are going in. They're about to do the critical part of the procedure.



GUPTA: Before the break, you heard the stories, people going to India for major operations. The cost is low, it's affordable. Sandra was one of those patients and we're going to check in with her again. But, first, we got curious while we were over there. How does a hospital like this take care of patients from so many different countries?


GUPTA (voice-over): Most tourists book their operations online with the help of a medical travel planner. Companies like Planet Hospitals, facilitate the whole trip from booking the world's top docs to the promise of upscale accommodations -- Wi-Fi in your room, access to food chains and restaurants, coffee shops, even a book cafe -- all in the hospital lobby. They also have a 24-hour patient concierge.

VIPUL JAIN, PATIENT CONCIERGE, PLANET HOSPITAL: We don't say no to anything, from giving you a cell phone, helping you in the hospital, taking you out, go shopping, go sightseeing, (INAUDIBLE), anything and everything.

GUPTA: Patients say it's like tacking on a mini-vacation to their major medical operation. With all this personal attention, high-tech machines, highly-trained doctors, how can the price be so much cheaper?

DR. AJAYA JHA, NEUROSURGEON, MAX HOSPITAL: I think we keep the administration costs very low. We negotiate our machines very, very hard. I get paid less than 1/10 of what a neurosurgeon in the United States would make. Our personal costs are much lower.

GUPTA: Critics of medical tourism say what appears cheap for westerners is often not even affordable for locals. Most Indian natives rely on the public health sector which some say lacks basic medical supplies and resources.

(on camera): What do you say to the critics who say, look, you know, in a country of a billion, you have -- you have problems that can cause a lot of loss of life -- infectious disease problems, lack of clean water? You're still dealing with some of the issues that are dealt with in developing countries. How do you justify all this?

JHA: I don't think that I'm in any way doing a disservice to this country. In a country of a billion, we have to progress on both sides -- on the social side as well as in the professional side.

GUPTA (voice-over): Of course, no matter how far you travel for medical treatment, there are concerns -- like post-op care, and also, what your legal rights are. And there's no guarantee it's going to work out as planned.

Nigeria native, (INAUDIBLE), didn't need spinal surgery after all. That was a long trip, but the doctors in India determined pain injections alone would do the trick.

But good news for the patient from Jordan. He says rehab here in India has helped him gain back sensation in his legs after a traffic accident left him paralyzed last year. As for Sandra? Her surgery was a success. I had a look at her heart scan's post-op and the fibrillation is gone -- for now.

After spending time in India, it's clear to me that the surge in medical tourism has only just begun. India is now among a growing list of countries competing for your business, competing to save your life.

JHA: The machines which are used in the U.S. and here are just the same. Most of the people that work with us have been at least at a physician level, have either been trained or have had exposure or had communication with doctors in the United States. We can compete with anybody else in the world.

GUPTA: And the rest of the world is taking notice.


GUPTA: You know, that was an incredible journey for me. And if you still got questions, check out

Now, they say it's just baby fat, right? But could it mean something more? Could it be setting up infants for obesity? And did you actually read the dates on your food? Do you know what they mean? I answer your question -- just ahead.


GUPTA: We're back with HOUSE CALL.

Say it isn't so. Could that lovable baby fat be dangerous? Well, a new Harvard study says that infants who gain weight quickly are prone to childhood obesity. We're talking about infants here.

They said they looked at 600 babies and calculated what they call a weight-to-length ratio. Think of that as sort of a body mass index for babies. That's a measure of obesity that's more accurate than just weight.

Now, they calculated the score at birth, six months, and again at three years. Here's what they found: Overweight babies at six months were about 40 percent more likely to be obese by age three. And one of the things the study did not look at is why these children grow so quickly. When we dug into that a little ourselves we found previous studies that show a mother's weight before getting pregnant, excess weight gained during the pregnancy and complications like pregnancy related diabetes can increase the child's birth weight.

Obviously, the question here, what is going on? Overfeeding could be a factor and there's a tendency to make a baby finish the bottle. And in fact, babies are pretty good at knowing when they've had enough to eat.

Most pediatricians warn to control food overall, keep solids separate from liquids and exercise your baby. Yes, they can actually exercise as well. Place them on their bellies, get them to roll around, even move around a little bit more.

Now, babies don't typically have to worry about kidney stones. But I can tell you, they can be painful, they can be annoying -- and from personal experience, I can tell you they can be a real problem. A viewer wants to know what causes them. We'll have the answer in Ask the Doctor.


GUPTA: Time now to "Ask the Doctor." Let's jump right in.

Here's an e-mail from Mary in North Carolina. She asks this, "What are the 'rules of thumb' regarding safety the food items past their 'purchase by' dates and canned foods that are bent?"

Well, Mary, this generated a lot of interesting discussion in the newsroom. There are several different kinds of food labeling. But sell-by date seems like what you're asking about. Now, this tells a store how long to hold the food for sale.

You shouldn't buy a product after this date. A food sold on a sell-by date can still be eaten later. Let me tell you what I'm talking about here. A good example might be milk. If stored properly, it's generally safe five to seven days after the date on the label. This is a sell-by date for the grocery store, not a use-by date or expiration date for you. So, it's a big difference there.

Now, the other question -- should you eat food from a dented or bent can? Now, products can be consumed as long as there are no leaks and it appears in good shape. Never eat food though in severely dented, leaking or swollen cans or jars. It might make you sick. That bending or swelling could be a result of bacteria inside the can.

We've got another question now from our Twitter account. "What are the primary causes of kidney stones and how can you prevent them?"

Well, thanks for your question. You know, kidney stones are hard deposits that grow in the kidneys. Full disclosure, I had one. They are most commonly caused by an excess of calcium or uric acid in the kidney.

Now, small stones may pass through the body without problem although they can be painful. I can tell you. But large ones can sometimes need surgery.

There are some things you can do to avoid them. First of all, drink at least eight glasses of water a day. Also, limit your caffeine intake. Caffeine can be sort of a diuretic, can dehydrate you.

And depending on the type of kidney stone you tend to develop, you may need to alter your diet. For example, if you form uric acid stones, try eating less meat as meat breaks down to make uric acid. And if you form the most common type, calcium stones, try to avoid foods high in oxalates, like beets, almonds, sweet potatoes, spinach, chocolate or soy products. Well, unfortunately, that's all the time we have for today. If you missed any part of today's show, be sure to check out my podcast,

And remember, this is the place for the answers to all your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. More news on CNN starts right now.