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SANJAY GUPTA MD
Study: Alcohol Worse than Cocaine; Should Marijuana be Legalized?; Test May Predict Alzheimer's
Aired November 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. I'm Dr. Sanjay Gupta. Welcome to the show. Lots to talk about today.
First up, a question. What do you think? Could it be alcohol is worse than cocaine, heroin or LSD? A new study out there is getting lot of buzz. We're going to dive into it.
And speaking of drugs -- this week, California voted down recreational use of marijuana. And now, Colorado is going to hold a similar vote. You know, we are going to try to figure out what these types of drugs do to your brain.
And genetic testing, it may soon predict your chances of developing terrible diseases like Alzheimer's. The science is ongoing. But if there's no effective treatment, would you really want to know?
Some of that voice. It's amazing. She fell in love with opera at the age of 4 and went on to follow her dream of performing in them all over the world. But her lungs started to fail. And soon, she was in need of a double lung transplant.
It's a remarkable story. We've got it for you here on SGMD.
Let's get started.
GUPTA: First up this morning, though, it was a big election week as I'm sure you know. And health care continued to be a hot topic.
Take a look at some exit polls number that we thought were interesting. Fifty-three percent of senior citizens, specifically want health care repealed. Take a look. More than half. Twenty- three percent want expanded, 14 percent left as it is.
Also, take a look at how the vote changed between 94 and 16 years later, 2010. Senior citizens back in '94, 51 percent voted Republican, 48 percent Democrat. And now, 59 percent Republican, 38 percent Democrat.
So, the question for a lot of people: what does it mean? Who knows is probably the answer. But Republicans made a campaign issue about Democrats cutting spending. You saw it on a lot of campaign ads and seniors in this election appear to have listened, at least according to some of those numbers.
Another hot topic on the ballot: recreational marijuana. After a lot of speculation, a lot of debate, Californians, they decided to reject it this past week. Reject the recreational use of marijuana. But it hasn't stopped a new campaign already developing in Colorado to put legalization on the state ballot there in 2012.
And there is a new study in the "British Journal" that concludes that alcohol is more dangerous than heroin, LSD or even cocaine. So, we wanted to dig a little deeper on that specific issue on a second.
But, you know, my specialty is the brain. So, I found these stories together very interesting and wanted to talk about how these things might affect the brain. First of all, the human brain, you know, is the command center of your body. You know that. It controls everything you do and say.
And drugs and chemicals work in the brain by tapping, you know, the communication system, sort of interfering with the way that nerve cells normally send, receive and process information. We had various neurotransmitters, specifically in the brain. They are sort of the chemical messengers.
And drugs like nicotine, cocaine, marijuana -- well, they target these messengers. They also affect the brain's reward system and that reward system responds to pleasure by releasing the neurotransmitter such as dopamine and that those neurotransmitters regulate movement, emotion, the process of thought, motivation and pleasure.
So, you get an idea of what happens specifically. Drugs tend to hijack that system, causing large amounts of dopamine to overflow it. The large amounts of dopamine are what causes the sort of euphoria that you experience sometimes and also some of the crashes afterward.
Marijuana, for example, interferes with normal functions of the brain, like coordination, attention, altering time and space, and also reducing short term memory.
Today, we have Dr. Marvin Seppala, an addiction specialist from Hazelden Addiction Treatment Center to clarify some of these facts for us.
Good morning to you, sir. Thanks so much for joining us.
DR. MARVIN SEPPALA, CHIEF MEDICAL OFFICER, HAZELDEN: Good morning.
GUPTA: First of all, this study -- a lot of people have been talking about it, the British study talking about alcohol and comparing it to a lot of these other drugs -- cocaine, LSD, heroin. What do you make of that study?
SEPPALA: You know, it's an interesting and worthwhile study, and that it was primarily designed to inform the government about how to use their money to address the ills associated with drugs and abuse and with alcohol. And they really took an objective examination and defined the significant ills associated with alcohol use compared to other drugs. They looked at harm to self versus harm to others and kind of added this up. And the harm to others, social ills associated with drug abuse and alcohol abuse revealed a mayor problem associated with alcohol.
GUPTA: And what -- for the average person out there who hears this. I mean, is this -- is this -- what does it take away from them? And is this more reflection to the fact that just more people use alcohol versus these other drugs?
SEPPALA: That's a major aspect of it. Tremendously more people use alcohol than other drugs, but also, people that use alcohol are more likely to engage in high-risk activities, driving while intoxicated, domestic violence and the like. Where people who use the other drugs in some respects, let's compare to heroin are often going to be tired and not very active.
GUPTA: Interesting. Interesting.
It's a good transition to what happened in California this week, Proposition 19, recreational marijuana use being legalized. That was on the ballot. It did not pass, as you know.
GUPTA: Does it surprise, first of all, that it did not pass?
SEPPALA: It does surprise me. I thought in California it might pass and certainly, people were preparing for that.
GUPTA: What -- so, this is something that comes up a lot. And we do a lot of reporting on this particular issue, but this is your field of expertise. So, marijuana, how bad is it -- I guess, for lack of a better way of putting that -- how much of a harm does this drug cause? And do you think maybe it should be legalized then?
SEPPALA: You know, the harms are relatively minimum. And some of it isn't fully studied, unlike alcohol. I mean, if you compare it to alcohol, alcohol is remarkably more harmful from a medical and a societal perspective.
But marijuana causes, an acute use, you know, while you're intoxicated, and shortly afterwards, a memory problems, concentration problems, slower reaction time, a little incoordination. Long term problems include some minor hormonal changers, primary sexual hormones for men and women. And -- but, there's no evidence of long-term problems with memory or concentration.
There are problems associated -- I'm sorry. There are problems associated with long-term use in adolescence, though. That's where the real difficulty lies. And one of the major tasks of adolescence is learning -- learning in school and the like and because of these short-term memory and concentration problems, it alters lives significantly.
GUPTA: Did you have a memory lapse right on all that answer? SEPPALA: I did.
GUPTA: Just kidding, don't answer that.
Real quick, though, just legal -- sorry about that -- legalization of marijuana. This is your world again. What are your thoughts? I mean, do you think it should be legalized ultimately for recreational use?
SEPPALA: You know, we're in the recovery business. However, if you look at legalization, you really have to say, it's the least problematic of the options that exist. And there's just so many difficulties with jailing our use because of, you know, use of marijuana because they have been caught with marijuana.
SEPPALA: And we get an opportunity to actually treat them medically, if we don't put them into the legal system.
GUPTA: Fascinating discussion. Dr. Seppala, thanks so much. Stay tuned, though. I have a feeling we'll be talking about this, again. Appreciate your time.
SEPPALA: Appreciate it as well. Thank you.
GUPTA: And next on SGMD: she returned to an opera career just a year after undergoing -- get this -- a double lung transplant. How did she do it?
(BEGIN VIDEO CLIP)
CHARITY TILLEMANN-DICK, RECEIVED DOUBLE LUNG TRANSPLANT: I remember trying to E and nothing would come out.
(END VIDEO CLIP)
GUPTA: Welcome back to the program. You know, opera singer Charity Tillemann-Dick. She's one of 11 children, the granddaughter of Holocaust survivors. She was raised to believe, in her own words, that fear is not an option. That was put to the test for her when she diagnosed with an illness that threatened to steal her voice, her career and really her life.
GUPTA (voice-over): That soaring voice belongs to Charity Tilleman-Dick, a voice that almost went silent. Six years ago, she was diagnosed with a rare lung disease. Without treatment, doctors said, she'd be dead within five years.
TILLEMANN-DICK: And it just -- it didn't seem real. GUPTA: For awhile, medication was enough. But by last summer, her only option was a double lung transplant at the Cleveland Clinic.
Her family, 10 brothers and sisters, have always been at her side. But when she rushed to surgery, she was alone. She pleaded with her doctor.
TILLEMANN-DICK: Please, please keep me alive so I can say good- bye to my mother. And I told him that if he could do anything to save my voice, to do it.
GUPTA: She was in a coma for a month. It was another month before she could speak a word.
TILLEMANN-DICK: They took me off of the trach. And they told me to say E and nothing would come out. And I could stop. And, finally, finally, you could hear E, E. It started coming out and tears streaming down my face. I remember thinking to myself, I am so deeply grateful. I can make sound.
When I got home, the first song that I sang, I had a real connection to was "Smile" by Charlie Chaplin. You know, smile when your heart is breaking, even though it's aching.
When I sing, I feel like I'm taken to another place and it's this place of pure sound and transcendent beauty.
GUPTA: Beauty saved by the grace of an organ donor.
GUPTA: You know, we did ask Charity as well if it feels different to sing with another person's lungs. And Charity said, look, I used to have a terrible lung disease, now I don't. So, it does feel different to sing, but it feels better, she said.
Incidentally, she and her sisters are on a company to increase awareness about organ donation.
Good luck, Charity. An amazing woman.
On to a sad story, though, that we learned about this week. Remember 11-year-old Shannon Tavarez? She was the young actress starring in the Broadway version of "The Lion King."
The beautiful voice, you really just can't forget it. She needed a bone morrow transplant to fight her battle with acute myelogenous leukemia. Well, we received the very sad news this week that, unfortunately, Shannon did not beat the odds.
You know, minorities have the hardest time finding a match. And we urge everyone who's watching to get on the list. I signed up myself a while back inspired in part by Shannon. And if you are interested in getting on the list yourself, you can find out how online by checking out BeTheMatch.org. Shannon inspired 10,000 people to register as potentially life-saving donors. To find out more, you can also logon to www.getswabbed.org. You can continue Shannon's mission there. It's really important to get this word out.
Condolences to her family.
We'll be right back with more SGMD.
GUPTA: You know, so much in medicine these days comes with a "but." There's a pill that can keep your cancer from growing, but insurance won't cover it. There's surgery to fix a rare disorder, but they come with serious side effects. And increasingly, there's this: genetic testing that can predict your chances of developing terrible diseases that don't yet have any effective treatments Huntington's disease, Alzheimer's.
So, the question is: just because you can know, would you want to know? Would you want to know how you might die? It's an important.
And with us now to discuss it, Dr. Maria Carrillo of the Alzheimer's Association, Susan Peterson-Hazan, who's a clinical social worker at Emory University, and CBS newsman, Barry Petersen. He's written a love story about his wife's struggle with Alzheimer's disease. The book is called "Jan's Story: Love Lost to the Long Goodbye of Alzheimer's."
And, Dr. Carrillo, let me start with you. There's been some news recently about Alzheimer's disease specifically regarding a test that can better predict your chances of developing it. What can you tell us about this?
MARIA CARRILLO, DIR., MED. & SCIENCE RELATIONS, ALZHEIMER'S ASSN.: That was called a cerebral spinal fluid test and it -- essentially, you get it by performing a lumbar puncture and taking some spinal fluid out. It has been thought to be able to predict Alzheimer's disease by measuring some proteins.
But we're a long way off from having that available in the clinic. It's really only an experimental form. It's going to be quite a few years before that test or any other is really ready.
GUPTA: What can we say about the test now?
CARRILLO: We are moving towards a future in which we should be able to predict who will go on to get Alzheimer's disease based on pathology, based on the biology of what's happening in the brain and being able to measure that in a person, a living person who hasn't yet developed Alzheimer's.
GUPTA: Barry, Jan was diagnosed when she was just 55 years old. And there are so many questions about how she's doing and how she was at the time. But you provided some footage of her playing the piano. Let's take a second and listen to that.
GUPTA: Barry, can you describe what was happening there in that particular footage?
BARRY PETERSEN, AUTHOR, "JAN'S STORY": I'm visiting her at the assisted living facility where she stays and, Jan, a once articulate foreign correspondent who actually worked at one point for CNN, now can no longer make a sentence. She's upbeat. She smiles. You know, she laughs a lot. And I think that's terrific.
She doesn't know who I am. But I, of course, know who she is. And when I go to see her, I have to confess, it's bittersweet. You know, there she is. There's the laughter. There's the girl. There's the smile.
But on the same token, you know, Jan is not there. Even though, on the outside, it just seems like it ought to be her.
GUPTA: I know you are listening to Dr. Carrillo and you probably heard about this test, what do you think about that test, Barry? I mean, if a test like that had been available, widely available, is this something that you would have wanted to know for Jan?
PETERSEN: No, I don't think so. And I'll tell you why for a couple of reasons. First, because I think if you have a test like this -- especially if there's any question about it or even let's say it's 100 percent accurate, how does that affect the ability for someone to get long-term care insurance, which can be critical for taking care of somebody in the latter stages of Alzheimer's? Once it's on your medical record, they're not going to touch you.
The second thing -- and I think you would understand this, Sanjay, because you're in a business where people would trust your skills and your knowledge. What happens if someone finds out that we might be prone to Alzheimer's?
PETERSEN: Would they still trust us?
GUPTA: You counsel patients who are confronting this, Susan. I mean, first of all, what do you think about what Barry just said?
SUSAN PETERSON-HAZAN, CLIN. SOCIAL WORKER, EMORY UNIVERSITY: Well, I think he has the views of many of the people that we have talked to that they say they don't want to know.
Last Friday, I have an early memory loss group of people who have mild cognitive impairment and early Alzheimer's disease. And I posed the question, if you could have known, would you have wanted to? And two said "yes," they would like to know. But the others said "no," unless there was something we could do to alter the course.
(END VIDEOTAPE) GUPTA: Up next, I asked Barry if he would've changed anything if he would've known. His answer when we get back.
And later in the show, why is San Francisco cracking down on fast food Happy Meals? We'll tell you.
Stay with SGMD.
GUPTA: Is there any virtue, Barry, given all that you said and all that you've heard now, any virtue in knowing? Would you have changed anything if you would have known? And could that have been a virtue?
PETERSEN: I'm embarrassed to say that I would have. And when I talk to people I say it's the biggest mistake I ever made with Jan was we didn't sit down. We didn't do an advance directive. We didn't have this conversation.
I didn't want to sit down with her and have this conversation after she'd been diagnosed because I felt it would zap her own will to fight the disease, even though there are no medications that are effective. But if I had known in advance, that is definitely something I would have done. But, you know, this is a great conversation to say to people you really ought to be talking to the person you love --
PETERSEN: -- about how the life that we live is going to end by our choice and not let it just fritter away and lose the chance to have that control.
GUPTA: And I think it's difficult. Even among my own family with my parents, it's a difficult topic. Families need to have these conversations, but very few do. When we reported on these tests, it was amazing the number of responses we got on the blogs and literally hundreds of thousands of responses.
And I want to read an e-mail to you quickly if I can. A concern raised by one of our viewers, wrote this: "Once more of these tests become available and reliable, insurers will try and require them, arguing they qualify as pre-existing conditions, and employers could use them to screen out employees. This is very dangerous territory."
And there are supposed to be laws to protect individuals against that. Are those laws good laws? Are they enforceable? Do they work?
CARRILLO: They absolutely do exist. The GINA Act was passed about two years ago now and protects us from genetic information up to I think six generations removed. That is important.
However, it's not been tested yet and certainly not been tested in Alzheimer's disease in terms of genetic information. I would not recommend that the Alzheimer's Association does not recommend genetic testing be in our medical record because that law does not protect you against some types of insurance. So, we need to be very cautious.
GUPTA: Susan, have you ever had anyone regret knowing? Finding out some information like this and then regret that they had learned it?
PETERSON-HAZAN: Many times, they do dread the diagnosis, but they also many times are relieved, because they've known something was wrong. And so, actually having the diagnosis, learning that something -- they have a disease in some cases actually relieve people. It wasn't their marriage that was going bad. It wasn't all of these other things.
PETERSON-HAZAN: So, in a sense, having the diagnosis helped them.
GUPTA: Dr. Maria Carrillo, Susan Peterson-Hazan, and, Barry Petersen, thanks so much -- Barry as well, for sharing your story and Jan's story. Appreciate it.
CARRILLO: Thank you.
GUPTA: And we are back with SGMD.
You know, being a dad, my ears really perked up when I heard about the story this week -- San Francisco is trying to stop the distribution of toys with unhealthy meals. What does that mean for the average person?
Well, this week, there's a board of supervisors that voted by a large margin specifically to not have toys in any meals with high levels of calories, sodium, or fat. And they also said the food must contain a serving of fruits and vegetables.
We dug a little deeper specifically into this and what they said is there's going to be a 600-calorie cap on each meal and the meals must have less than 35 percent of the calories coming from fat.
Also, one more thing: no item -- no specific item within the meal can have more than 200 calories.
Now, you know, this is a big topic. We talk about it a lot. And supporters of this particular bill say they are trying to improve the nutritional value of kids' meals and also try to attack childhood obesity.
The final vote on this is next week. If it passes, it's going to go into effect next year. Parents say, hey, it may make it a little easier to say no. I think agree with that, as well, as a father of three.
Now, if you missed any part of today's show, be sure to check out my podcast, CNN.com/podcasting.
Thanks for watching, everybody. I'm Dr. Sanjay Gupta.
More news right now on CNN.