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HOUSE CALL WITH DR. SANJAY GUPTA
A Collision of Medicine, Law and Ethics; What Are Your Medical Rights?; Race Matters When It Comes to Certain Cancers
Aired May 30, 2009 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN HOST: Welcome to HOUSE CALL, the show that helps you live longer and stronger. I'm Dr. Sanjay Gupta. Thanks for watching.
A court ruling forces a 13-year-old boy to undergo chemotherapy. It's a remarkable collision of medicine, law and ethics. We're going to dig into it.
What treatment is Daniel Hauser undergoing? And the whole thing raises this question: what are your medical rights?
Plus, race matters when it comes to certain cancers.
We're going to protect you here on HOUSE CALL.
GUPTA: A boy on the run for nearly a week with his mother. It's remarkable. A judge ruled cancer-stricken Daniel Hauser must undergo chemotherapy treatment. His tumor is growing.
How will this treatment help him? We're going to have more on that in a moment.
But first, let's give you more background on Daniel Hauser's story. Here's CNN Susan Roesgen.
SUSAN ROESGEN, CNN CORRESPONDENT (voice-over): This is a big debate around a 13-year-old boy: should Daniel Hauser be forced to have chemotherapy to treat his cancer? His mother says the first round left him in terrible pain and she fled with him to California, saying if she hadn't taken him, he'd have gone on his own.
COLLEEN HAUSER, DANIEL HAUSER'S MOTHER: He was going to run away. Daniel was going to run away. Then what do I have? I mean, he was going to run. And that just broke my heart.
ROESGEN: This interview was done by an independent movie production company that also provided a private plane to bring Colleen and Daniel home. It turns out the two of them have intended to find an alternative to chemo in Mexico but never got that far.
DAN ZWAKMAN, HAUSER FAMILY SPOKESMAN: They got close to the border and then heard of reports they didn't like. Nobody has verified them to say whether it did or didn't happen but they understood at the time there was violence on the other side of the border. So they thought, for their own safety, it was best not to go.
ROESGEN: According to the judge in this case, Daniel Hauser and his parents now know that without chemotherapy he will die. They say he will start the treatment again.
Susan Roesgen, CNN, New Ulm, Minnesota.
GUPTA: All right. Thanks, Susan.
You know, Daniel's tumor had not only grown but was bigger than before his first round of chemo back in February.
Let's go over to our magic wall here and take a look. When you're talking about this type of cancer, one of the tests doctors that are going to get is this simple chest X-ray. What they would likely see is a mass in this area over here where one his lymph nodes got quite big and was pushing right over here on his trachea or his wind pipe. A lot of time, doctors and patients -- will describe their patients' sort of feeling like they're breathing through a straw.
Now, when you talk about Hodgkin's lymphoma overall, you're talking about a cancer of the lymphatic system. All this green in here is your normal lymph nodes. What happens to these cells called Reed-Sternberg cells will start to divide, as you there. Once they divide enough, they start to form this mass or tumor like you see there. And that is the problem.
When you talk about Hodgkin's lymphoma, lots of different things patients will start to experience, side effects from not only the disease but the treatment as well: Swollen lymph nodes, for example, unexplained weight loss, night sweats, lack of energy, unexpected fever -- these are some of the things that Daniel Hauser has been experiencing for months now.
Now, typically, people with Hodgkin's lymphoma respond very well to therapy. But, remember, Daniel got one dose and then stopped for a while. When you think about antibiotics, for example, it's sort of similar. Taking one dose and stopping is almost worse than not having taken it at all.
So, it's a little bit tough to say just how successful this second round of treatments are going to be. This week, he also started another medication which is very important, prednisone. It's a steroid which can shrink the tumor immediately and is likely to provide some relief to Daniel in the short run.
This first dose of chemotherapy was Thursday. Doctors say at least six doses are going to be necessary.
We're going to continue to follow this amazing story on HOUSE CALL. We'll certainly bring you any developing news.
GUPTA: You know, if you're a parent, the Daniel Hauser case might have you wondering what rights do you really have when it comes to your child's medical care. Now, CNN senior medical correspondent Elizabeth Cohen has answers in this week's "Empowered Patient."
It's been this amazing case, Elizabeth, as you know, the sort of confluence of medicine, ethics and law. The court sided with the doctors. Is that normally the case? And what do you found?
ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: Sanjay, that is normally the case. Normally, courts will say, "Look, this child's life is at stake. There is a medical treatment that will be probably, 90 percent save this child." The parents have to do it even if they don't want to.
But what is interesting, Sanjay, is that courts don't always decide that. And I think it's important for parents to know sort of the lay of the land. So, there have been some cases where courts have said, look -- said to the parents, "If you can find an M.D., a licensed physician who will oversee your child's care and give them alternative medicine and no chemotherapy, you can do that."
Let me give you two examples. There's the example of the Maxin family in Ohio. This family had a 7-year-old son with cancer.
And they said, you know what -- the court said, "You know what, you cannot give Noah chemotherapy if you can find a doctor who will oversee his alternative care." They did. They only had him off chemo though for five months, Sanjay, before the cancer came back and they put him back on chemotherapy and, sadly, Noah died several years later.
There's also another case that's very well-known called the Cherrix case.
COHEN: And this family, what happened was that, again, the son had cancer and the son said, "I don't want chemotherapy." The parents said the same thing. So, he went off his chemotherapy, had holistic treatments.
He is alive years later. He's 19 and Abraham Cherrix says he is in good health.
GUPTA: You know, it's interesting, because you hear about these sorts of cases and you hear about Daniel Hauser. They're all sort of life/death cases, cancer and several of them. What about if it's not life or death?
COHEN: Sanjay, if a child is sick but if it's not a life or death situation, the parents have quite a bit of leeway. For example, if your child has asthma and you want to treat your child with herbs and yoga, instead with medicine, that's your prerogative. You can do that. But if your child's asthma becomes so bad that it might actually kill him, that's a different situation, the courts might then move in on you.
GUPTA: All right, Elizabeth. Fascinating stuff. I know you've been following it. We've been following it as well. Thanks so much.
GUPTA: And if you missed any part of this segment or any part of this story, be sure to check out CNN.com/EmpoweredPatient. A lot more tips there.
We also learned this week that Supreme Court Justice-nominee, Sonia Sotomayor, has Type 1 diabetes. If she's confirmed, what impact might that disease have on her new job?
And also, does skin cancer discriminate? Who's at risk and the role race plays -- that's coming up.
And new guidelines about how much weight women should gain when they're pregnant.
HOUSE CALL is back in 60 seconds.
GUPTA: We're back with HOUSE CALL.
President Obama is challenging the Senate to move quickly to confirm his Supreme Court nominee, Sonia Sotomayor. Now, picking a nominee who could sit on the court for decades raises a lot of issues. One of them is a medical history.
So, here's CNN's Elaine Quijano.
ELAINE QUIJANO, CNN WHITE HOUSE CORRESPONDENT (voice-over): At eight-years-old, Sonia Sotomayor was diagnosed with Type 1 diabetes, a lifelong disease that, back in 1960s, meant she couldn't follow in the footsteps of her hero from the Nancy Drew mystery story.
BARACK OBAMA, PRESIDENT OF THE UNITED STATES: She was informed that people with diabetes can't grow up to be police officers or private investigators like Nancy Drew. In essence, she was told she'd have to scale back her dreams.
QUIJANO: According to the Juvenile Diabetes Research Foundation, Type 1 diabetes lowers life expectancy an average of seven to 10 years.
CNN senior legal analyst, Jeffrey Toobin, says health issues are fair game.
JEFFREY TOOBIN, CNN SR. LEGAL ANALYST: It's perfectly appropriate for a president to ask a judicial nominee about his or her health because the length of tenure is a big deal to a president in extending his own legacy through judicial appointments.
QUIJANO: Toobin notes the case of the late Judge Richard Arnold, whose cancer was a factor in being passed over for the high court.
TOOBIN: It came back that he was not cured. And almost for that reason alone, President Clinton did not nominate Richard Arnold. And sadly, Richard Arnold did in fact die of that cancer.
QUIJANO: But doctors say, if Type 1 diabetes patients monitor their blood sugar and take daily insulin shot, they can expect long, productive lives.
DR. FRAN COGEN, CHILDREN'S NATIONAL MEDICAL CENTER.: A person with Type 1 diabetes can do nearly everything. I think that she's already demonstrated to us by going through college, law school and becoming a judge that she has a capability to manage herself quite well.
QUIJANO (on camera): The American Diabetes Association applauded the nomination, saying people with diabetes should not be discriminated against. Nearly 24 million Americans have diabetes. It's estimated about 10 percent of them have Type 1 diabetes.
Elaine Quijano, CNN, Washington.
GUPTA: All right. Let's take look at some of other medical headlines this week.
The Institute of Medicine has issued new guidelines on how much weight women should gain during pregnancy. This is sure to get some attention. Women at a normal weight for their height should gain 25 to 35 pounds. Underweight women should gain more, 28 to 40 pounds. And overweight women should gain less, 15 to 25 pounds.
Now, the new recommendations reflect the surge in the number of Americans who are overweight or obese.
Also, a report out this week shows a marked decline in healthy living among middle age Americans. Come on, everyone. Obesity and moderate alcohol use both up. Exercising is down. Fewer people are eating fruits and vegetables. However, smoking rates have remained steady.
As you know, these lifestyle choices are associated with the risk of cardiovascular disease and diabetes. Researchers came to these conclusions after comparing the results of two large U.S. studies over 18 years.
Keep watching HOUSE CALL. We're going to get you healthy.
Next: Race and cancer.
HOUSE CALL is back in 60 seconds.
GUPTA: Skin cancer is the most common form of cancer in the United States. Think about it, the skin is the largest organ in the body. And the rates of skin cancer are increasing especially among people of color. This is a surprising trend that has dermatologists concerned.
Now, though African-Americans and Hispanic are less likely to develop melanomas, they're more likely to die from them. Think about that. Part of the problem: confusing messages about who's at risk.
Take a look at this, for example -- a recent "Consumer Report" survey found 73 percent of people with dark skin failed to wear sunscreen when in the sun for four plus hours, compared that to only 36 percent of people with fair skin.
Now, to help clear things up, we're joined by Dr. Charles Crutchfield. He's a dermatologist specializing in ethnic skin.
First of all, welcome, Doctor.
DR. CHARLES E. CRUTCHFIELD, DERMATOLOGIST: Hello. Thank you for having me.
GUPTA: You're in Minneapolis, I understand. There's a -- there's a lot of confusion, I would say, about this particular topic. First of all, why the huge disparity overall in death rates among people with dark skin and lighter skin?
CRUTCHFIELD: You know, I think one of the problems that we face is that people of color think that they have natural protection against the sun, and to a very small degree, they do. But essentially depending on the hue of the skin, the SPF protection factor is anywhere from eight to 12. And I recommend a minimum of SPF of 30 with UVA protection.
So, people think they're protected and they're not.
GUPTA: Are skin cancers, overall -- are they different in some way in people of color versus people who are fair-skinned?
CRUTCHFIELD: A little bit. The most common skin cancer in the world is basal cell and that's the most common skin in Caucasian skin. However, in skin of color, the most common skin cancer is squamous cells and there's a slight different there. Also location -- the incidents of melanoma in Caucasian skin and skin of color is about the same but it's more likely to occur on the palms and the soles and around the nails in persons of color.
GUPTA: You live in Minneapolis, Minnesota, which isn't a place, as far as I can tell, that's known for a lot of sun. But, you yourself, darker skin like me -- what do you do as far as sun protection goes? CRUTCHFIELD: You know, I think it's really important. I use a combination of two things. My favorite recommendation is sun protective clothing. When you put that on, it's always working for you. So, broad-brimmed hat and a special clothing that has a tight weave that will block off the sun.
But also, it's important to use a sunscreen with an SPF of 30 with UVA protection. The key to putting it on is, to making it work is to put it on 30 minutes before you go out in the sun, because it takes 15 minutes to set up appropriately and then reapply every hour. More frequently if you're either actively perspiring or if you are swimming.
GUPTA: Do you wear sun protection every day? And in the morning -- you just put it on every morning?
CRUTCHFIELD: It's in my facial moisturizer, yes.
GUPTA: When it comes to sunscreen overall, you hear about the SPF of 30. You mentioned it. It goes up to 85 I've seen as well. What do you -- I mean, is that worth the extra SPF? Is that really doing much more?
CRUTCHFIELD: No. Don't waste your money. What you really want to do is SPF of 30, but the more important component is the UVA protection. There are two parts of the spectrum. UVB, and just -- remember this is easier, B stands for burn, but UVA stands for things associated with aging such as wrinkles and skin cancer. So, even more important, you want to make sure that the sunscreen has UVA protection.
GUPTA: Look for it or a broad spectrum -- I think we talked about this last week as well on HOUSE CALL.
Thanks so much. This is a topic that comes up every year, especially about this time of year. And this is something we really wanted to dig into it. So, we appreciate it. Dr. Crutchfield, thanks.
CRUTCHFIELD: Thank you.
GUPTA: If you'd like to know a little bit more about all this topics, including places to find free screenings, if you see something on your screen, you're worried about it. We're going to tell you about it on CNNHealth.com. You can go to the Web site.
You've also been sending us your skin care questions all week long. I'm going to answer those. Our "Ask the Doctor" segment -- that's next.
GUPTA: It is time for my favorite segment of the show, "Ask the Doctor." Let's jump right in.
Nancy reads our blog and CNNHealth.com and wants to know this. "Does sunscreen interfere with vitamin D production in the skin?"
Well, Nancy, technically, the answer is yes. Sunscreen is going to reduce the amount of vitamin D produced in the skin. However, you still want to wear that sunblock.
If you're concerned you need more vitamin D, you can get it from drinking milk that is fortified with it, eating foods that naturally contain it, such as eggs and salmon. You can also consider taking vitamin D supplements.
But don't go unprotected for long hours in the sun. The whole "Time" magazine column about this, you can find that at CNNHealth.com.
Got another question now from one of our Twitter followers writes this, "Dear Sanjay, how can I reduce my growing belly? I'd like to get my waistline to 34 from almost 37."
Well, first of all -- good for you for wanting to do this. Getting that under control is important, because the fat held around the belly is the worst sort of fat of all. It causes calcium buildup in your arteries, it raises your risk for heart disease and diabetes. It's even linked to some types of cancers -- recent studies have shown this.
Now, if you're at normal weight but still have trouble losing that pouch, make sure you're doing the right types of exercises. Sit- ups only tighten abdominal muscles. Studies show that full body strength training can help reduce belly fat.
But the best way is to lower your total body fat through exercise and diet. No surprise there. Rev up your metabolism, eat small meals every four to five hours, don't skip breakfast. Many studies show people who eat breakfast lose more weight and burn more calories than those who don't. You can also eat about 25 percent less just by eating breakfast everyday.
Now, do you ever feel like you just don't have the energy to get through the day? I feel like this every single day, it seems. It could be that you're not eating well enough. So, what foods really give you the most energy?
We got them when HOUSE CALL returns.
GUPTA: Million of Americans suffer from fatigue and exhaustion. It's usually from working long hours, lack of sleep, not exercising enough and, yes, not eating right. Sound familiar?
Well, one can fight fatigue with simple diet changes. I want to break it down for you today.
First off: beans, rice, peas, corn, pasta -- these are all known as complex carbohydrates. Your body's first preference for fuel is from these sorts of carbohydrates. What happens is they metabolize almost immediately by the body into blood glucose or sugar, and all cells of the body utilize this glucose as the main source of energy. So, for some quick, immediate energy, load up on these carbs.
Now the power of protein -- we hear about this a lot. You have complete proteins -- those come from meat, poultry and fish. You have incomplete proteins -- those come from veggies, nuts, beans, grains, fruits. The body breaks down proteins into what are called amino acids. Now, you get energy from amino acid breakdown process, but that's going to take a little bit longer.
And finally, water. It's essential for your overall health. You already know that. Our body is made up of two-thirds water. Water helps control body temperature, moves foods to the intestines and greases our joints, so to speak. It's also crucial for energy production.
If we don't drink enough we get dehydrated and that causes a lack of energy. Sometimes as well, your body mistakes hunger for thirst. You end up eating instead of simply drinking.
Here's a question for you: can you pray away the pounds? That answer may surprise you. I'll explain when HOUSE CALL returns.
GUPTA: We're back with HOUSE CALL.
You know, fighting the battle of the bulge. If turning to a fad diet hasn't helped you lose weight, maybe turning to a higher power will.
GUPTA (voice-over): It's Wednesday afternoon at Gospel Water Branch Baptist Church near Augusta, Georgia. But some parishioners aren't here just for the gospel, they're here to lose weight.
UNIDENTIFIED FEMALE: I didn't drink any sodas.
UNIDENTIFIED FEMALE: I hate more salads. Even I ate raw vegetables.
UNIDENTIFIED MALE: I really made a big effort to walk.
GUPTA: It's called the "Fit Body and Soul" program, initially part of a study by the Medical College of Georgia and now an indispensable program for churchgoers and community members alike.
UNIDENTIFIED FEMALE: And we do not want our health, our weight to hinder us from doing what you have willed for us to do in this world.
VYONNE DENT, PROGRAM INSTRUCTOR: We're trying to educate folks on the point of, you know, the high incidence of diabetes, hypertension, cardiac disease, cancer and stuff amongst African- Americans.
GUPTA: The tenets are simple: diet, exercise, food-journaling and community support. All of it resting on the backbone of faith.
DENT: In everything that we do, we always pray, you know? We're here to support each other with praying and scripture.
GUPTA: And the results -- they've been promising.
RODNEY EDMOND, ASSOCIATE PASTOR: I lost 30 (ph). My wife lost about 25 pounds doing the whole thing. Blood pressure went down. Cholesterol level went down. So we were very pleased.
JOYCE RAMSAY, PASTOR'S WIFE: My goal was like seven or eight pounds, but I've reached 10 pounds and I kept it off like a year and a half.
GUPTA: But Pastor Robert Ramsay says there's no secret to their success.
ROBERT RAMSAY, PASTOR: Food can be a part of temptation and you need that inner strength to overcome that temptation. So, I think every congregation can do it and they should endeavor to do it.
GUPTA: 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, CNN.com/podcasting. And join us at CNNhealth.com, and on Twitter: SanjayGuptaCNN -- over 100,000 followers there. Join us for a lot more.
Remember, this is the place for the answers to all of your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta.
More news on CNN starts right now.