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SANJAY GUPTA MD
Smart Bomb: Vaccine for Brain Cancer; Interview with Dr. Peter Pronovost; "Medical Waste" Being Used to Save Lives
Aired March 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, CNN HOST: Good morning. Welcome to the program. I'm Dr. Sanjay Gupta.
This is a special place -- a place we're going to teach you how to live longer and stronger. I'm your doctor, but I'm also your coach.
We start with a potential medical breakthrough in the world of brain cancer. Now, we typically think of vaccines to treat infectious diseases, but what about cancer? Something remarkable is happening. We'll take you there.
And Peter Pronovost -- pay attention to this guy. He has some information for you. If you've ever been in a hospital or had a loved one in the hospital, you're going to want to stop down and listen in.
And, finally, our medical mystery. This is something that is normally thrown away, considered medical waste. But it could also potentially save lives, even treat cancer. Can you guess what it is? We'll tell you.
Let's get started.
GUPTA: Now, imagine going from athletic and healthy, and in two days, you're suffering seizures, severe headaches. That's exactly what happened to the woman you're about to meet. She was diagnosed with a fatal brain tumor and a year later, she's healthy again. How?
Well, it's a new vaccine and on the frontier of cutting edge so- called personalized medicine.
DR. JOHN SAMPSON, PRESTON ROBERT TISCH BRAIN TUMOR CTR.: I heard you also volunteered to do a spinal tap today.
KAREN VANEMAN, BRAIN CANCER PATIENT: Yes.
GUPTA (voice-over): This is Karen Vaneman. She's bracing for another painful procedure. You see, she's got cancer, brain cancer, a killer tumor called glioblastoma.
(on camera): Glioblastoma. Glioblastoma multiforme, GBM. This is -- this is typically thought of as the worst type of tumor. Why?
DR. ALLAN FRIEDMAN, PRESTON ROBERT TISCH BRAIN TUMOR CTR.: Oh, because left untreated, the patient succumbs to the disease very quickly.
GUPTA (voice-over): Even with aggressive treatment, average survival is barely a year. Chemotherapy, radiation -- all the usual treatments hardly slow it down.
VANEMAN: Oh, good to meet you.
GUPTA (on camera): How are you?
VANEMAN: I'm fine, thank you.
GUPTA: Feeling good today?
GUPTA (voice-over): But here at the Preston Robert Tisch Brain Tumor Center, Karen found hope in experimental vaccine.
(on camera): When people hear the word "vaccine," they think this is something to prevent disease.
GUPTA: But that's not what's happening here exactly.
SAMPSON: No, it's not.
GUPTA (voice-over): Dr. John Sampson helped develop the vaccine.
SAMPSON: Essentially, all the cells in our body have a fingerprint. The fingerprint on your cells are different than the fingerprint on my cells. But the immune system can recognize the differences in those fingerprints.
GUPTA: The vaccine has a futuristic name. It's called CDX-110. It uses the body's own immune system to attack tumor cells. It won't work on every GBM patient, just the 40 percent or so whose tumors make one particular protein. In those patients, it goes off like a smart bomb.
SAMPSON: So, unlike chemotherapy, which really hurts all dividing cells in the body or radiation, the immune system can be absolutely precise. And so, we get a very tumor-specific attack with very low toxicity.
GUPTA: Which means the patients don't get as sick.
Now, Karen gets a shot, a painful one every month. But look at the results. We were able to pay her another visit, a full year later. Remember, most patients don't even live that long.
VANEMAN: It's been about a year and a half. As long as the vaccine works, then I'll be getting the monthly shots. And when it doesn't work, then I'm in trouble.
GUPTA (on camera): What can we say about this vaccine now? In terms of educating a patient about it, what do you tell them in terms of what it promises?
SAMPSON: We're always careful not to overpromise what somebody can deliver. And this is still in an experimental stage. But patients are living two to three times longer with the vaccine than we would have expected.
GUPTA (voice-over): As much as six years in some cases with no signs of returning cancer.
VANEMAN: What's changed in the last year has been mostly being more mindful of my priorities, my family and the granddaughter, my husband, who has been like a rock through this whole thing.
GUPTA: The vaccine is now part of a multicenter study with patients at dozens of hospitals around the country. Results are expected to be announced later on this spring.
GUPTA: It's great to see Karen doing so well. Of course, again, this isn't for everybody. But she has certainly had a lot of benefit.
And here's a question we get all the time. Could dental coverage become a part of health care reform? I'll answer that next on "Ask the Doctor."
Plus, President Obama got an overall clean bill of health this week, but should we care if he's still smoking?
And doctors, parents, even the president, turn to the man that I'm about to talk to. The topic? How to save lives and prevent medical errors.
Stay with us.
GUPTA: And we are back with SGMD. 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 necessary.
Let's get right to it. A question from M.C. Mitchell says, "Why is dental insurance not considered part of health insurance?"
You know, I said earlier on the show, it's something that we get asked about all the time. For a lot of insurance plans out there, dental insurance is not considered part of your traditional health insurance. Let me break down what's happening like this. The Senate bill that passed in December has served as a template for the president's most recent proposal and it does call for increasing dental coverage for every kid 21 and younger. And that's sort of the caveat there. The discussion on expanding who qualifies for Medicaid could also lead to more people, including kids, getting basic dental coverage. But as things stand now, about one in five children don't have dental coverage at all.
And that really is an issue, a medical one. There is a relationship between your teeth and the rest of your body. And it's a very clear one. People who tend to have poor teeth can have more serious problems later in life like gum disease, heart disease, even cancer.
So, of course, being able to address these problems early makes a huge difference, probably saves a lot of money, as well down the road. So you can see, M.C., why dental coverage is being considered as a part of reform.
GUPTA: Now, you know, there was some news this week about President Obama, about not being able to kick the smoking habit. He had a physical exam. This was something that came out.
We decided to talk about it because his struggle could be a lesson to millions still going through the same thing. You know, he falls off the wagon occasionally. And his doctor has urged him to quit and you probably know that.
But there's been a lot made about how much he smokes and continues to smoke. It's a difficult addiction to break for lots of different reasons. One is in a way that a lot of these substances work.
What happens is that nicotine, along with other substances, bind to the pleasure centers in the brain. The things that you crave, the things that you don't -- you get a certain sense of euphoria when the nicotine hits those pleasure centers, and just having something to put in your mouth, an oral fixation, so to speak, back and forth. That's why people gain weight often after quitting because instead of smoking, they eat instead.
A couple pieces of advice, not necessarily that we're giving the president advice, for people out there who want to quit, surround yourself with supportive people that help counsel you through all of this. And there's also nicotine replacement and prescription drug in some cases. It just takes time to do.
Now, there are a lot of incentives out there. This might help. And what is remarkable to me, I think in a lot of people, is the short span of time that it takes to really start getting the benefit from quitting smoking.
Look at this, even within 20 minutes of quitting, your blood pressure starts to drop. Within 10 years, your lung cancer risk starts to come back down, though, not quite to the level as someone who didn't smoke, but pretty good. So, just know that it's never too late to quit. Now, next, his father's death propelled him into medicine. But what he learned from that experience is now saving lives, lots of them. A great conversation just ahead.
And our medical mystery. It is something that is normally thrown away but can now be used to save lives when a certain substance, bone marrow, is just not available. Can you guess what it is?
Stay with us.
GUPTA: And we're back with SGMD.
As you know, if you've been tuning into the program, every week, we're going to be taking you into the lives of some very fascinating people -- people who are changing our world. This week, our guest has life-saving information for all of us.
Now, if you've ever been in a hospital or had a family member in one, you're going to want to stop what you're doing and listen in today. More than 40,000 people in the United States die every year from what are known as preventable infections. Those are ones that sometimes are caught in the hospital.
Dr. Peter Pronovost is working down to cut down those numbers. He's a critical care specialist at John Hopkins University School of Medicine and author of the book "Safe Patients, Smart Hospitals." He's named one of "TIME" magazine's most influential people on 2008.
Thanks for joining us.
DR. PETER PRONOVOST, AUTHOR, "SAFE PATIENTS, SMART HOSPITALS": Thanks for having me here, Sanjay.
GUPTA: This is a fascinating topic, and maybe never been more timely given all that's going on with health care.
GUPTA: The idea that we can prevent mistakes. And I want to talk about that.
But let me -- let me ask you, you know, we're doctors. We're both doctors. How did you get interested in medicine?
PRONOVOST: Well, early on, I always wanted to be a physician. I liked the intellectual part of it. I liked the interpersonal part. But I really got focused on safety and quality, quite frankly tragically, when my father was misdiagnosed with a cancer.
And by the time he got the right diagnosis, he was beyond getting the appropriate therapy, which would have been a bone marrow transplant. And he came home to die. I was a fourth-year medical student, and he died horribly in pain. And I know, as you know now, that no patient needs to die in pain. They should have had better care. And the system let him down. It let me down. And we have to do better.
GUPTA: That's a tough thing to sort of digest, I think, not only for physicians, but in particular, for patients or potential patients who will visit hospitals. I mean, are hospitals potentially dangerous places?
PRONOVOST: Hospitals clearly do a lot of good. But, unfortunately, they also sometimes harm. The way we summarize evidence in medicine is often lengthy guidelines, that might be 100 to 300 pages long that might tell me to do 80 or 100 things. You know, I'm practical guy, I can't do 80 or 100 things.
PRONOVOST: So, one of the novel things we did and really innovative, though, simple, was we made a checklist. Now, checklists aren't new, my son Ethan uses them to keep track of his homework, my mom uses them when she goes to the grocery store. But we haven't applied them in medicine.
And the checklist was simple. It was wash your hands, clean your skin with a soap called chlorhexidine, avoid placing these catheters in the groin, cover yourself and the patient when you're placing these catheters.
Now, what we found was our docs were doing those things 30 percent of the time -- 30 percent. It was remarkable.
GUPTA: If a doctor goes in to do one of these things that you're talking about and doesn't wash their hands, or doesn't put on a gown, and the patient gets an infection -- is that a mistake? Is that a lack of judgment? What exactly happens? How do you classify that?
PRONOVOST: There's also times when the doctor just says, oh, you know, I'm busy, I forgot, I'm human, I'm fallible, I forget to wash my hands.
But, Sanjay, sometimes, it's -- the nurse corrects the doctor and the doctor says, essentially, screw you, I'm not going back to do this. And that is arrogance and it's dangerous, and I think it can't be tolerated in medicine anymore.
GUPTA: Should there be some sort of oversight committee of some sort to implement what Peter Pronovost is saying and saying, look, if it doesn't happen, there's going to be some repercussions here?
PRONOVOST: Right. Well, Sanjay, you hit on something really important, because the federal government has supported us to put this program in every hospital in every state. We're going state by state by state.
But in some states, Sanjay, only 20 percent of the hospitals have signed up. And when I asked them, I said, OK, well, are you signing up? And they'll say, "Well, I'm using your checklist, Peter." And I'll say, OK, that's great, but I don't really care. What are your infection rates? That's what the public cares about.
And routinely, they either don't know or they're still high, and they say, but I'm using the checklist, Peter. And I'll say, well, let me ask you a simple question. In your hospital, if a brand new nurse were to see your senior physician not comply with the checklist when he's placing a catheter, would she speak up? And would he go back and fix the mistake?
And Sanjay, I get laughed at. They literally say, are you nuts? Of course, that wouldn't happen. You know, and -- but think about that for a second. In what other industry is there an agreed-upon standard?
I mean, nobody's debating the evidence if we should do this that one worker is not allowed to ensure that another worker complies. And the mistake is potentially deadly. I mean, we know that these infections kill around 31,000 a year alone. And we've shown they're needless deaths.
GUPTA: That's fascinating stuff. We do need to take a quick break, but we're going to have much more with Dr. Peter Pronovost after the break. You know, a couple things I want to talk about specifically, how do you get that culture to change?
Stay with us.
GUPTA: And we're back with SGMD and Dr. Peter Pronovost. He's a critical care specialist at Johns Hopkins School of Medicine, also author of the book "Safe Patients, Smart Hospitals." He developed this checklist to help stop medical infections and it's working.
PRONOVOST: When I testified before Congress about these checklists, there was a lot of enthusiasm to, quote, "regulate the checklist." And I strongly opposed it because you would stifle innovation. Regulation is too slow and too blunt of an instrument to keep up with science. I mean, a new paper could be published tomorrow that says there's a new item on the checklist and regulation can't keep up.
What I favor is making outcomes transparent. That if infection rates were public and the consumers had access to them, then we wouldn't have to micromanage medicine. We would encourage all the science and new breakthroughs to try to get them as low as we could.
GUPTA: As a medical reporter, we talk about all kind of issues -- gene therapy, brain cancer vaccine, new treatments for asthma on any given day, cord blood stem cells.
GUPTA: Checklist -- it sounds so simple yet it could potentially have as much, if not more, impact than any of those things.
PRONOVOST: You're absolutely right, Sanjay. I estimated that if we put this simple bloodstream program in all countries, it would likely -- I mean, in all of the United States, these 32,000 deaths a year, it would likely save more lives than virtually any other medical therapy over the last quarter century.
GUPTA: That's a remarkable thing you just said.
PRONOVOST: It's profound and the public doesn't know it. I mean, these risks -- it's not like -- I mean, you know, around the same number of people die each year from breast cancer, maybe a few thousand more. But we don't have yet a cure for breast cancer. I wish we did.
These infections we have a cure. I mean, imagine if there was a cure for breast cancer and we were withholding it from patients. The public would go berserk. I mean, rightfully so.
To even put it in more context, Sanjay, you probably saw the news about the Toyota CEO apologizing. What the public may not know is he apologized because it's estimated there were about four deaths a year, 20 over five years that Toyota caused -- four deaths a year, right? We kill 31,000 just from these infections -- 100,000 from all infections.
GUPTA: Do you have your own checklist? I mean, this idea of checklists -- I mean, how much have you incorporated this into your own life? I mean, are you carrying around a checklist?
PRONOVOST: The way I organize my life is -- I think life is really governed by some key relationships that you have. And that, in my case, it's relationship with my God, my relationship with my wife and kids, my relationship with my co-workers and then kind of the community relationship. And for each of those, I literally have a -- and a relationship with myself -- a daily checklist.
Yes, I have a checklist to say, "Am I spending time with my kids?"
PRONOVOST: But most importantly, every week, I ask them to rate how good of a dad I was.
PRONOVOST: It's pretty humbling.
GUPTA: Wow. I'm not sure I'm ready for that.
PRONOVOST: That's going to be with my next book, because some of the insightful things when they said, you know, Dad, here's how I'm doing on a scale.
GUPTA: Actually, I want the data back on that quite yet. That's fascinating discussion. I really enjoyed it. And, you know, hopefully, a lot of people at home get something out this have as well. The simplest things sometimes, Peter ...
PRONOVOST: Yes, it's remarkable.
GUPTA: ... that make the huge difference. Thanks so much.
PRONOVOST: Well, thanks for having me, Sanjay.
GUPTA: I appreciate it.
GUPTA: And next week, we have a real treat for you. Check this out. This is a swim fin that you're looking at. It's actually built, designed for people who have lost limbs, literally using her whole body there to propel herself through the water.
That's Aimee Mullins. You're going to meet her next week. She's a double amputee, a remarkable woman and a remarkable story.
GUPTA: Now, take a listen to this staggering figure, something I found surprising. Foodborne illness, something we talk a lot about on this program, costs the United States more than $150 billion in total health costs every single year. That's according to a new study from the Produce Safety Project and the Pew Health Group.
Now, illnesses specifically from contaminated produce total roughly $39 billion. The group also ranks states in how much they spent on foodborne illnesses. I'll tell you what -- it's bad news for California. That particular state tops the list, spending $18.6 billion a year.
Now, these costs do reflect medical services like being treated by your doctor, staying overnight at the hospital, as well as how much money people lose from missing work if they're sick with a foodborne illness.
For more on this report, you can go to CNN.com/Health.
And our medical mystery this week is saving lives. I'll give you a clue: it's something that's considered medical waste but it can be used to treat cancers like leukemia, lymphoma, myeloma. I'll tell you what it is -- after the break.
Stay with us.
GUPTA: We are back with SGMD.
You know, we're staying on top of Haiti as promised. So many Haitians left homeless by the January earthquake are now bracing potentially for more misery. The rainy season is on its way. It usually begins around April or May, but rain is already starting to cause all sorts of problems. There were lots of heavy downpours over the weekend.
And, you know, I was in these tent cities that you're seeing right here. Can you imagine literally with a little bowl there trying to get all that water out of the area there? So many living in those tent cities and those streets are now flooded with debris.
You can see here there isn't a way to stay dry when you look at images like that. And in the southwest part of the country not impacted by the quake, the government says flooding killed at least eight people. So, it seems like it's misery upon misery.
Now, have you guessed it yet? It is something that is normally thrown away but it can also be used to save lives -- especially when bone marrow isn't available. That's a clue.
I'm talking about the umbilical cord and placenta. Now, they were considered medical waste until recently, but cord blood contains stem cells and those stem cells can be a lifesaver for people who cannot find a bone marrow match. In fact, stem cells are now being used to treat people with cancers like leukemia, lymphoma, myeloma.
You see, cord blood is easier to match than bone marrow because the immune cells are not yet developed. So, if you get a transplant with these stem cells, there's less of a chance of rejection. More than 200 hospitals participate in a program where women can register and they can donate anonymously.
This breakthrough is especially significant for minorities because the bone marrow registry is staggeringly short of matches for African-Americans, Latinos and Asians. And I can tell you, it's already making a difference. In 2001, cord blood transplants made up less than 1 percent of transplants of unrelated donors. As of last year, that number has risen to 24 percent.
Now, if you miss any part of today's show, be sure to check out my podcast: CNN.com/podcasting. And always 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.