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SANJAY GUPTA MD
Who's Got Your Baby's DNA?/FDA Approves New Drug for Multiple Sclerosis/What Your Scale Isn't Telling You/How Will Health Care Reform Affect You?
Aired February 6, 2010 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, HOST: Good morning, and welcome to SGMD. I'm Dr. Sanjay Gupta. Thanks for watching the program. This is a place we hope we can teach you to live longer and stronger. I'm going to be your doctor, and I'm going to be your coach, as well.
We start with some interesting information. Just about any time a baby is born in the United States, a piece of genetic material is taken, screening for all sorts of different diseases. But did you know the government also hangs onto that information? Why? We'll tell you.
Health care overhaul -- what's happening with it, who's going to pay for it, and might it change the way that your doctor practices medicine? Important questions. We'll have some answers.
And also, we have a medical mystery, something that causes joint pains or swelling, muscles pains, and also a red rash. What is it? I'll tell you. Let's get started.
Now, doctors screen practically every baby born in the United States for dozens of different diseases. Did you also know that the government keeps a record of your baby's DNA? CNN's patient advocate, Elizabeth Cohen, joins us.
You know, I just heard about this today. What's this all about? What's going on?
ELIZABETH COHEN, CNN CORRESPONDENT: Yes. I have to say, despite the fact that I've had four children, I didn't know about this until I started reporting on it. What happens is that when a baby is born in the United States, they prick their heels, get a drop of blood, and then test the baby for different numbers of diseases, depending upon the states, but sometimes as many as 50 different diseases, genetic diseases. And they save that blood, sometimes indefinitely. Some hospitals say 50 (ph), others say for just a couple months. But some save it indefinitely.
And they have -- the baby's name is linked to it. So that DNA is in a repository, linked to your baby's name. And some people are wondering, Why do they save it that long? And are there any privacy concerns with having my baby's DNA in there for that amount of time. GUPTA: Yes, it seems like a reasonable question. It seems reasonable to test for these things, but do they ask for permission to test and for them to keep it?
COHEN: You know, it's interesting. They really don't because these are -- at least, many of the tests are state-mandated. You have to get them.
COHEN: I mean, you could write a letter and try to opt out, but that would be a difficult thing to do. So the state mandates them, so they don't ask permission. They may tell you, Oh, we're going to do this now, but they don't actually ask your permission. They're allowed to not ask. And they don't ask your permission to store, either, in most states. So it's just there.
GUPTA: So if you're a parent and you're hearing this and saying, you know, I -- I think it's OK to test, but I don't want it stored, I want that destroyed afterwards, is there anything you can do as a parent?
COHEN: There are a couple of states where they actually have forms that you can fill out, where you request that it be destroyed and not stored. And so you can go to the Web site for your state department of health and see if you live in one of those states.
But if you don't -- and you probably don't -- you actually have to write a letter and make it very clear and follow up. I mean, it's not an easy thing to do. But if you put it in writing that you don't want it stored, then I'm told by the people who run these programs that it will be destroyed.
GUPTA: Thank you very much. And by the way, welcome back from Haiti. Both of us were there for a while, and it's good to be home. And I'm sure it was really tough to leave. I know it was for me, for sure.
COHEN: Yes, it was tough to leave. It was tough to leave.
GUPTA: You look great. I'm glad you're back.
COHEN: Thank you. Thank you. Thank you.
GUPTA: And there's some news-making headlines this week. A prominent British medical journal is retracting a landmark study that linked the measles, mumps and rubella vaccine to autism. It's a big deal. Editors of "The Lancet" say, quote, "It has become clear that several elements of the 1998 paper are simply incorrect," so they're retracting the full study.
Last week, the study's lead author, Dr. Andrew Wakefield, was found to have acted unethically in conducting the research. The council which oversees doctors in Britain said that, quote, "There was a biased selection of patients in the `Lancet' paper" and that his "conduct in this regard was dishonest and irresponsible." Now, as fans celebrate the Super Bowl this weekend in Miami, Florida governor Charlie Crist is making a play to reduce concussions in sports across the country. Get this. Now, the governor is announcing a national initiative this week targeting concussions. It's a plan he's going to bring to the National Governors Association meeting when they meet later this month. And what he hopes is to get states to write laws requiring young athletes, parents and coaches to be educated about the risks of head injuries.
He says states should also mandate that athletes be removed from practice or games if they're suspected of having a concussion. And they would need clearance from a licensed medical professional before playing again. Washington, Oregon already have laws in place to protect players, but proponents are hoping that these laws go nationwide.
And also Haiti. The U.N. is describing the nation as "stable but potentially volatile." Humanitarian workers say an armed group attacked a food convoy in southern Haiti, but U.N. peacekeepers held them off with warning shots. Nobody was hurt.
Also checking in on the USNS Comfort. Our John Vause reports more seriously wounded Haitians continue to make their way to that hospital ship. Doctors have performed more than 200 operations and they are still going around the clock. Now, the ship was starting to get too full, so they're starting to ship less serious cases to a children's hospital in Port-au-Prince. The military says this is all part of a long-term plan to take care of Haiti's wounded.
Now, when you hear "health care reform," you may tune out. I get it. We've been talking about this for a long time. But you do need to hear this. We're talking about your wallet here specifically, your care, and how your doctor could possibly treat you differently depending on what happens on Capitol Hill.
And listen to this new term we heard this week: "normal weight obesity." We're going to explain why the number on the scale may not be telling you the real truth about your health.
Stay with the program.
GUPTA: You know, every week at this time, I'm going to be answering your questions. Think of it as your own personal appointment -- no waiting, no insurance, incidentally, needed, either.
Here's a question from a CNN.com reader. "Can you please tell me if Ampyra works on patients who are in their secondary progressive phase of MS and cannot walk at all."
Well, thanks for writing the question. First of all, Ampyra -- there's a lot of excitement about this. This is a drug that was recently approved by the FDA to help those who have multiple sclerosis walk better. It's very encouraging for the MS community because of that, but unfortunately, Ampyra's not been tested on people who have lost their ability to walk.
Think of it like this. It's designed to help people with any type of MS improve their walking speed, but it's not going to work on people whose nerves may have already been destroyed. Ampyra sort of works on nerves that are still alive.
Now, the reason it's so exciting -- the drug is the first MS therapy that is taken orally, by mouth, and the first of its kind to receive FDA approval. It's expected to be available sometime in March.
If you want more information than that, you can log onto CNN.com/health. We've got an article on the site, give you a lot more details about the drug.
(INAUDIBLE) quickly, as well. You know, as much as we've talked about health care on this show, an important topic, it really does come down to you taking personal responsibility, and we're here to help you with that. We heard a new phrase this week we're going to tell you about. It's called "normal weight obesity."
A new study out by the Mayo Clinic shows that when you're at normal weight but you have too much fat versus lean muscle mass, you are what they call normally weight obese. Now, they say this condition can cause a fourfold increase in developing metabolic syndrome, something you should know about. That's a group of dangerous conditions -- high blood pressure, high cholesterol and diabetes. Again, you're at risk for that.
Mayo Clinic folks estimates that means as many as 30 million people who fall into this normal weight obese category. So the key to all of this is not simply losing weight but changing what that weight is comprised of. For me, it means keeping their body fat below 23 percent, women below 33 percent. You can get that tested at your local gym, your doctor's office, even some of those home scales do a pretty good job.
To increase muscle mass, try lifting weights or switching to interval training. I got my mom actually using dumbbells to try and do just that.
Coming up, we have our conversation of the week, breaking down health care, what it means to you and your wallet in plain English. That's straight ahead.
Now, also, can you guess which disease has this rash? Let's see who's right. I'll tell you later in the show. Stay with us.
GUPTA: Welcome back to SGMD. Every week, we're going to have this topic on the show called "Colorful Conversations." We're going to get the chance to talk to scientists, medical innovators, even celebrities, all of whom are right now having an impact on your life.
When it comes to health care, frankly, I think there's been a lot of noise on this topic and very little understanding. So we want to dig through that a little bit today, really get down to what's happening, how it's going to affect you and how it's going to affect your wallet.
I have two guests here who I think are some of the best in the business. These guys have been writing about this topic for some time and are really willing to sit down and help us dig.
Dr. Darshak Sanghavi is the chief of pediatric cardiology at the University of Massachusetts medical school. He's also the health columnist for "Slate" magazine. Jonathan Cohn is here, as well. He's senior editor at "The New Republic." He knows the ins and outs of health care better than just about anyone.
So as things stand now, you support the current bill.
DR. DARSHAK SANGHAVI, PEDIATRIC CARDIOLOGIST: I support the House version over the Senate version. I think both are better than nothing.
GUPTA: Jonathan, the same for you?
JONATHAN COHN, "THE NEW REPUBLIC": Absolutely the same.
GUPTA: Jonathan, how might this change the dynamic between the physician and the patient relationship? Most people who are paying attention to this really want to know how it's going to impact them. Will there be an impact on that dynamic?
COHN: Well, I mean, I think on a surface level -- I mean, in terms of you go to the doctor and how is your experience with a physician different -- you won't see a lot changing. You'll still be able to pick your doctor, as much as you could now. If the insurance expansion works, and I believe it would, you'll have an easier time getting to the doctor. You'll have an easier time paying your bills.
And I think that's important to remember. When we talk about the doctor-patient relationship, for so many people in this country, financial barriers to care change the way they get medical care. You know, you go to the doctor and you get a prescription, and then you don't fill the prescription, right, or you don't get the follow-up visit because it costs too much. Well, that -- we won't see that happening as much anymore, so that will change.
GUPTA: With pediatric cardiology, my guess is there's a lot of art to what you do, as well as science. This idea of comparative effectiveness, trying to figure out what works and pay for those things -- that may sound great in principle, especially when we're talking about, like, economic principles, but when it comes to medicine, things that you may do that don't have definitive proof that they work, are you willing to say, You know what? Let's stop doing those things.
SANGHAVI: I think this is really the key for what actually scares a lot of Americans about health care reform. I think that in medicine, as both of us probably know, there's things that we know definitely work. You know, nobody argues about surgery for appendicitis. On the other hand, there are things we're not so sure about, you know, certain types of heart procedures for if you have chest pain -- we don't really think those really help people out, and there's a tremendous amount of variation in practice.
I think what comparative effectiveness research could do in a perfect world is at least make it very clear what we know for sure. Every American, when they go in with a heart attack, should be on a certain type of medication, aspirin and something called a beta blocker. We know that for everybody.
On the other hand, if you go in and you have depression, we don't really know what works best. Some people like psychotherapy. Some people may do better with medications. We need to make sure that we give people freedom in those kinds of situations.
I don't know for certain what the bill will do for those individuals, and I don't think that's really been clarified.
GUPTA: Jonathan, is there anything in that part of it that scares you at all, this idea that, Well, look, you know, Jonathan, we'd like to help you out, but what the doctor's recommended for you actually doesn't have evidence-based science behind it, so it can't be paid for. It's not going to be paid for. Is that part of it? Is that a justified fear?
COHN: Well, I think it's always scary when you hear that you might go to the doctor and someone is going to tell you, Your doctor recommends this, you can't have it. The two -- the two things I always try to remind people -- the first is that someone's already doing that for you. If you go to the doctor's office and the physician recommends a surgery and you have private health insurance, your private health insurance company will have the authority to say, No, we're not going to pay for that.
Now, the catch is, how is the insurance company making that choice? We don't really know.
GUPTA: I think your point about some of this already happening, whatever term you want to assign to it, rationing or whatever, I think Darshak and I both -- we spend a lot of Friday evenings calling insurance companies and lobbying on behalf of our patients. So I think you're absolutely right. It's a fair point.
And we'll have much more of our conversation about health care, and I think most importantly, why you should care about this if you haven't been paying attention so far. Stay with us.
GUPTA: We are back with the program. I'm here with Jonathan Cohn of "The New Republic" and also Dr. Darshak Sanghavi. He's a pediatric cardiologist and a columnist for "Slate."
As we continue the discussion, it's worth pointing out a few of the key points when it comes to these health care bills. There's a lot in here, so we'll just try and go through this quickly. First of all, insurers must cover sick people, or people with preexisting conditions. Individuals must have coverage, as well. We'll talk about mandates here. And subsidies for families with income less than $88,000.
The critics will say, Look, if you start mandating people to buy health care insurance, isn't, first of all, that just a kickback to the insurance companies? These people might be healthy. They may not have been buying health care insurance. Aren't you just forcing them to buy into an industry that some say needs regulating in the first place. Is that a fair criticism? Is that a fair concern?
COHN: I don't think it's a fair concern. For one thing, there's a lot of regulation of the insurance industry. To take one obvious example, we are going to limit the amount of money they can spend on administrative waste and profits. We're going to say that, You have to spend a certain percentage of your premium dollar on actual patient care. Now, they call that the medical loss ratio, which I think is kind of telling that as far as the insurance industry is concerned...
GUPTA: That's part of the bill you're talking about (INAUDIBLE)
COHN: Yes. Yes. But to get to the broader question here because I -- and people always say, Why do they have to require people to get health insurance? Well, it's because if you want to tell insurance companies they have to take anybody -- I mean, think about what would happen if you did that and you did nothing else, because you hear (INAUDIBLE) Why don't we just tell the insurance companies they have to take any customer, and leave it at that?
Well, what'll happen is only sick people will buy health insurance because why would you buy health insurance if you're healthy? You'd just wait until you get sick and then buy it. So now the only people with insurance are very sick. Premiums go through the roof and nobody can afford them. And that's why you get into this bill that will cost $100 million a year to provide subsidies for people, to make sure that people who are middle class and poor can actually fulfill this mandate and buy the insurance.
GUPTA: The best way to get people who are already sick or have some sort of previous condition coverage is a more comprehensive bill, but it's not going to do anything, Doctor, to cut costs, though, still. I mean, these people -- part of the problem is, and correct me if I'm wrong, is they simply cost more money. They're sick. And that's why insurance companies don't want to cover them.
SANGHAVI: There is no way around that. Taking care of people who are very sick costs a lot of money. And I still am having a lot of trouble understanding how the bill would really affect that. There's a very small percentage of people that consume the vast majority of health care resources, those who are very sick, people who have cancer, those who have heart attacks.
And I think that, also, when you start talking about "bending the cost curve," people hear "rationing" or they hear what you're interested in is not giving me the best health care, it's trying to make it cheaper. And I think that the fact is, is that the best health care is not always the cheapest. The best health care sometimes is fabulously expensive. And I think that we have to grapple with that.
GUPTA: Could we potentially be reducing the quality of health care in this country with a bill like this?
SANGHAVI: I think that this is also something we need to realize, is that many, many people who have private health insurance currently are actually very happy with their coverage. If you walk into a hospital and you've got good insurance, the type of care you get is truly the best in the world. And it's hard to imagine how we could leave that alone and then somehow bring everybody else up to that also and do it for less money. I just don't see how that happens.
COHN: I would -- I mean, I actually -- I'll try to make the case for that because I actually think this is possible. There is so much low-hanging fruit, so much obvious waste you can cut out, that with some very simple steps, you can at least get some money out of the system simply by looking at things like electronic medical records. That is an easy one, even if it was just for billing. I mean, anybody who's run a physician's office or been in a hospital billing operation knows the amount of administrative waste we have.
GUPTA: When you talk about this with your friends, or you know, people who aren't as into it maybe as you are, what is the argument that you -- are you making a moral argument? Are you making an economic argument? Are you making a, you know, This is just the right thing to do, argument? How do you -- how do you sort of tout this to your friends?
COHN: The case I like to make is the personal case. We're getting to the point where you say, Well, gee, even somebody making $50,000, $60,000, $70,000, $80,000 a year, and they have private insurance and they get cancer and suddenly they discover, you know, their policy doesn't cover a lot of the outpatient care they need, or the co-pays are very high, and now they're struggling, and these are middle class people, these are people who went to college, who had good jobs, who never thought they'd be in that situation -- and my argument to everybody is, Don't think it can't be you because I've met these people. They never -- no one ever thinks it can be them until it happens to them.
GUPTA: All right. Darshak, Jonathan, thanks so much. I hope this is a conversation that we can continue to have and cut through so much of the noise that we hear so much of. Thanks a lot.
And you just heard this broken down, I think, in plain English, clearly by two people who understand this bill and seem to support it, for the most part. Next week, we're going to take a little bit of a turn and hear some differing points of view on this, as well, and also specifically what it might mean for your care and your wallet.
Now, if you're heading out to the bar for the Super Bowl or maybe a nice meal, you may be getting more calories than you think. New research finds the average restaurant meal actually had 18 percent more calories than the menu stated. Eighteen percent may not seem like a lot, but it's 90 calories for a 500-calorie meal. And over time, that can add up, equal to about 10 pounds of weight gain in a single year.
Now, we should point out that the FDA allows up to a 20 percent discrepancy in menu calorie counts. Bottom line, harahachi (ph) bu (ph). Try and push the plate away before you've eaten too much.
Now, can you guess what disease has this rash? It also causes joint pain, swelling and a fever. Let's see if you got it right. I'll tell you next.
GUPTA: So have you guessed it yet, the medical mystery that can cause joint pain or swelling, muscle pain, a red rash? It's often called a "butterfly rash" because of the way that it looks on your face, like a little butterfly. The mystery is solved. We're talking about lupus. Lupus is a chronic autoimmune disease. Your immune system literally attacks your own health organs and your tissues, and the inflammatory disease seems to affect women more so than men. It seems more prevalent, incidentally, in African-American, Latino and Asian women, as well.
Now, there are three main types of the disease. Systemic lupus is the most common. It can affect multiple parts of your body, and experts tell us that no two cases of lupus are the same because of that. We gave some of the most common symptoms, but depending on the part of the body that's affected, your signs might be completely different than another person with the disease. That's why it's often mistaken for other diseases. It's called the "great imitator," in fact, in the medical community.
Now, if you're concerned you might have lupus, your best bet -- keep track of your symptoms. Write them down when they occur, and then go to your health care professional and talk about it. Make sure to also check out CNN.com/sanjayguptamd. We're going to be posting an image or a quiz like this one in the coming weeks. Send in your guesses. We can have this conversation. E-mail us, Sanjayguptamd@cnn.com.
Now, if you missed any part of today's show, be sure to check to the podcast, CNN.com/podcasting. And always remember, this is the place with the answers to all of your medical questions.
Thank so much for watching. I'm Dr. Sanjay Gupta. More news on CNN starts right now.