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SANJAY GUPTA MD
Mass Killing in Arizona
Aired January 9, 2011 - 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, everyone. I'm Dr. Sanjay Gupta. Thanks for joining us for a very special edition of SGMD.
We begin this morning with the breaking news out of Tucson, Arizona where a mass shooting left six people dead, 12 wounded, including Congresswoman Gabrielle Giffords.
Carol Costello has the latest developments.
CAROL COSTELLO, CNN CORRESPONDENT: Yes, thanks and good morning, Sanjay.
Here's what we know: a man opened fire on a crowd gathered outside a supermarket in Tucson. The gathering was a meet-and-greet session being held by Congresswoman Gabrielle Giffords. Six people were killed. Giffords was wounded along with 11 others.
Police have identified the shooter as Jared Loughner, age 22. He is in federal custody this morning. Doctors say Congresswoman Giffords was shot once in the head and is in critical condition right now at the University Medical Center in Tucson.
Among the six people killed was this man, he was District Judge John Roll. A native of Pittsburgh, Judge Roll joined the court in 1991. He was named chief justice in 2006.
The bullet that hit Congresswoman Giffords entered one side of her head and came out the other. Doctors say the 40-year-old congresswoman was shot at close range. Former U.S. surgeon general, Dr. Richard Carmona, is on the staff at the medical center treating Giffords. He talked about her injury.
(BEGIN VIDEO CLIP)
DR. RICHARD CARMONA, FMR. U.S. SURGEON GENERAL: She has a severe wound but he's cautiously optimistic that it is a possible that she can survive. But make no mistake: this is going to take a little while to see how she does after her surgery. She could need more surgery. There are lots of complications that occur with problems like this.
And so, you know, she's in our thoughts and our prayers and we're all hoping the best of her. But I've been taking care a lot of people like this before. I know how difficult a path it is to recovery. I saw the CT scan and MRI, I saw what was done. I know the surgery that was done. With guarded optimism, I hope that she will survive. But this is a very devastating moment.
(END VIDEO CLIP)
COSTELLO: A very devastating wound.
And, Sanjay, I want to ask you about that. You heard Dr. Carmona, he's saying he's optimistic and yet, things sounded so much more hopeful last night. But when you say you're optimistic, it doesn't sound so hopeful.
GUPTA: Well, you know, I think that surgeons are typically pretty guarded especially in the immediate aftermath of something like this because it's a dynamic situation, so many things that are going on at that point. But you get -- you get an idea as details start to emerge exactly what was happening.
For example, Ted Rowlands reporting last night when the congresswoman got to the hospital, she was able to communicate with the doctors. That's a very good sign.
And, you know, one of the things that surgeons want to look for is just what is the neurological status at the time the patient gets to the hospital. She got there very quickly, obviously, because this was a public situation. And at that point, a CAT scan usually done to get an idea of exactly what's happened to the brain and then to sort of figure out, you know, should the patient be taken to surgery and if so, what's the operation to be performed.
COSTELLO: The Arizona newspaper is reporting that the bullet went in the front of her head and exited the back. Is -- there's no graceful way it put this, but is that -- is that a good thing, you know, as far as her recovery goes, that the bullet exited her brain?
GUPTA: Yes. I think, you know, they call that a through and through injury or in and out injury. Typically is. It may not be if it actually crosses from one side of the brain to the other, meaning: left to right or right to left. That typically is not a good thing, but if it's gone in sort of near the front and then closer somewhere over here, that -- what it means there's so much energy, so much velocity and momentum of a bullet that if it's all sort of absorbed by the brain, you think of the brain almost as a fluid medium, it just absorbs that energy, it starts to swell, there can be bleeding as a result of that.
If the bullet exits, then a lot of times that energy keeps going and is not all sort of within the skull cavity.
COSTELLO: So, there's not quite so much damage inside when the bullet exits that fast.
GUPTA: That's the hypothesis. Again, as long as it's not crossing from one side of the brain to the other, that typically is not a good thing. COSTELLO: The other thing that I've heard is that the point at which the bullet entered her head, like struck the part of the brain that you don't use very much, is that possible?
GUPTA: Well, you know, there are certainly -- there are certainly parts of the brain that would cause more concern than others as far as injury goes. So, for example, the left side of the brain over here is responsible in most people for speech. When we say that, we say the ability to understand communication, both spoken and written, the ability to express yourself in any way, you know, to follow a command, to write something down, to speak.
One thing that I really paid attention to when Dr. Rhee was speaking yesterday was something he referred to in her neurological exam after she got out of the operating room, take a listen to this.
(BEGIN VIDEO CLIP)
UNIDENTIFIED REPORTER: What are some of the simple commands she responded to?
CARMONA: Again, I'm not going to get into the specifics of what she did or she didn't do. Suffice it to say, it is a very severe injury and her physicians took care of her to the best of their ability and they're monitoring her very closely now.
CARMONA: I'm sorry?
UNIDENTIFIED REPORTER: She would need more surgery, right?
CARMONA: I didn't say. She could. In these cases, sometimes, more surgery is needed and that will be determined as they observe her care over the next few days and weeks.
UNIDENTIFIED REPORTER: Why would she need more surgery?
CARMONA: There's a lot of reasons. There are a lot of complications. There are a lot of things that can happen. And, you know, rather than discuss conjecture, I certainly hope that nothing else happens and she recovers to her best ability with the injury she has.
UNIDENTIFIED REPORTER: Is there a risk for long-term brain damage?
CARMONA: Hard to say right now. That's going to be determined as she wakes up and her physicians are evaluating her every day and do neurologic testing and so on.
(END VIDEO CLIP)
GUPTA: So, one of the things specifically that Dr. Rhee said yesterday in addition what Dr. Carmona said, was that someone is following commands. So, it comes out of the operating room, still could be having a breathing tube in, unable to speak, but they come up and say, you know, can you -- can you raise two fingers with this hand.
And if they can, it says so many different things about the higher levels of brain. First of all, she could hear you. Second of all, she can process that information. And third of all, she can execute a command, you know, use motor strength to actually do what she said and they might test the other side of the body as well to sort of get an idea is everything working. Wiggle your toes, for example.
All these things so important not just because they demonstrate not just reflex activity, people may have reflex movements -- this demonstrates a very higher level of understanding and brain function.
COSTELLO: I thought it interesting that he didn't specifically say what commands she was responding to.
GUPTA: Right. There are some -- yes, there are some pretty standard commands that doctors will ask. One of them is to raise two fingers as opposed to saying just squeeze my fingers, because people may squeeze, you know, sort of in a reflex way if they feel somebody's hand in their palm.
This was, it was something that sort of at least gave them reason as you said to be optimistic in the immediate aftermath of the surgery, which again is a -- was a very -- I was a little surprised, frankly, because doctors typically do hold their cards close to the vest here.
COSTELLO: Also, I'm sure there's a problem with swelling of the brain in these instances and that's something they really have to watch.
GUPTA: That is probably the biggest issue after something like this. You have so much energy that's absorbed in the brain, even with the bullet that's passed in and out or through and through. You have to watch that. And that swelling can occur afterward, not just the time of the injury, but in the day or two after the injury has taken place. So, critical exams, continuing to do the exam where you ask them to follow commands, all of that being done, you know, maybe every hour for the next day or two.
COSTELLO: This is going to be a long process, whatever, right? It's going to be months and months for her to recover.
GUPTA: Yes. I mean, I think, you know, the sort of initial stuff, the acute stuff, may be several days, but she may need some -- she may obviously need some more time in the hospital and then maybe even rehab, depending on exactly what has happened to her. We'll get a pretty good idea about that.
We're going to have much more live with the latest from Arizona within minutes. But up next, the results of some huge news from the medical world that was the infamous study that linked vaccines and autism. Well, now, there's a major medical journal that says it wasn't just bad science, it was downright fraud -- as SGMD continues right after the break.
GUPTA: We begin this morning, though, with shocking allegations of deliberate fraud against the doctor who first reported a link between autism and a childhood vaccine. Now, in many ways, the 1998 study is credited for having started the anti-vaccine movement among concerned parents.
It isn't the first time the study has been called into question by medical experts though. Last year, "The Lancet" retracted the study, citing numerous problems with its methods as well ethical missteps and financial conflicts of interest.
But "The British Medical Journal" says it goes beyond just bad science. It accuses researcher Andrew Wakefield of intentionally publishing fabricated information to suit his theory that vaccines cause autism. It's being dubbed an elaborate hoax.
Now, the article alleges that Wakefield was being paid by a litigation team in England who is suing vaccine managers. They say this enticed him to have sort of preconceived idea about what he might find, leading him to falsify evidence to fit in to what his notion was.
For example, Dr. Wakefield claimed that the children he studied would get the vaccine and develop symptoms within a few days. But according "The British Medical Journal," medical records show, in one of the cases, the child actually had symptoms before the vaccine was ever given, not after. In another case, the child didn't develop symptoms of autism until six months afterwards, which negates any sort of relationships between vaccines and autism.
Now, the study was also not randomized, meaning, Wakefield handpicked the 12 children -- again, a very small study. It also says that he paid these children.
Now, why would Andrew Wakefield fabricate the study? I decided to try and find out myself and I went straight to Wakefield for an answer.
(BEGIN VIDEO CLIP)
GUPTA: Since 1998, you've obviously been dealing with this. But these charges that are big deal in the world of medicine, that you paid patients, that you did not randomize them, meaning you selected patients that you thought would be better for your study. And now, the most -- the most -- the most damning evidence of all that perhaps these numbers, the dates were all fabricated to sort of make a case.
Did you have some sort of preconceived notion of a link between the vaccine MMR and autism before you conducted the study?
DR. DAVID WAKEFIELD, ACCUSED OF FALSIFYING STUDY DATA: Absolutely not. Dr. Gupta, please, I urge you, go and read my book. I'll send you my book. I'm not trying to promote my book. I'm not trying to make money.
Take the book and read it and understand the truth. You will understand it. Many people don't.
The parents understand it. They get it because they've lived it. OK? And the claims to whether the vaccine caused their children harm or not came from the parents. Not me. I didn't have a preconceived notion of it at all.
I hadn't heard of autism since medical school, and this was a clinical examination of children on the merits of their clinical problems by the best people in the world, best clinical experts and pediatric gastroenterology in the world. And they came to the diagnosis, not me.
(END VIDEO CLIP)
GUPTA: Now, I tell you, Wakefield stands behind the study, believes that vaccines may cause autism, although there have been any major studies that have replicated this theory. That's what a lot of people are talking about.
Lee Grossman is here. He's president of the Autism Society of America. He joins us now from Washington.
Thanks so much for joining us, Doc.
LEE GROSSMAN, PRES. & CEO, AUTISM SOCIETY: Well, thank you for having us on.
GUPTA: You -- I think your phones must have been quite busy, obviously, some pretty interesting claims being made.
GUPTA: What is -- what is the position of the Autism Society of America and what's happened with Dr. Wakefield?
GROSSMAN: We are hoping that we're going to be able to now use this spotlight that's now again shown on autism, to change the conversation on autism, to talk about what it is that we need to do moving forward to help people with autism and support the families that are the primary caregivers for these people.
GUPTA: How important is it to find a cause for autism and how much of your organization's attention is focused on that?
GROSSMAN: There's much being -- much time, much money, many resources being spent on the medical side and developing the research to find those answers. We support that. We support that greatly.
The issue, though, that we see is so important in autism is that there's -- it's not being carefully balanced to serve the needs of those that are living with autism now. This ongoing conversation and dialogue that's going on and finding the definitive cause and maybe even the cure really isn't delivering and improving the services that people are asking for now. That is what our families are continually asking for.
GUPTA: Lee Grossman, we are obviously going stay talking about this. We appreciate your perspective very much. Thank you for your time.
GROSSMAN: OK. Thank you.
GUPTA: It's an emotional and it's controversial issue, obviously, for many families simply looking for some answers, wanting to protect their children's health any they can.
So, joining me more to talk about this is Dr. Roy Sanders, pediatric psychiatrist, medical director for the Marcus Autism Center. And my colleague, patient advocate, Elizabeth Cohen.
Just like with Lee Grossman, I'm sure you've been very busy, given the sort of work that you do. Families come to you to ask about vaccinations.
DR. ROY SANDERS, MARCUS AUTISM CENTER: Right.
GUPTA: Should I get my child vaccinated?
SANDERS: Yes, a lot of times --
GUPTA: What do you tell them?
SANDERS: -- yes, what the families are coming is because I've already taken care of kids that where they have one child who's been diagnosed with autism, ask me about a second child being immunized and what we need to do about a second child being immunized or we diagnose the child early because we are able to diagnose some kids relative early, whether they continue with the vaccination process.
And what I tell them right now is the risk associated with not vaccinating is greater than the risk of vaccinating. And I tell them that in our own case, because I have an older son with autism and a younger son who is typical, that we had both sons vaccinated.
GUPTA: On schedule, on time?
SANDERS: On schedule, on time. Yes.
GUPTA: Elizabeth, you've been talking to a lot of parents as well -- you know, and who are struggling with this. They hear something like this and I think -- as Lee Grossman was saying -- it just added more confusion rather than clarification. What are you hearing from moms and dads both about this?
ELIZABETH COHEN, CNN SR. MEDICAL CORRESPONDENT: You know, Sanjay, I think there's two camps of parents here. There are some parents who are what I called true believers. They really believe that vaccines are the devil, that they give kids autism, and this latest news this week doesn't really matter to them. They still are against vaccines and they still defend Dr. Wakefield. But then there's other camp of parents and I know both of us know parents in these camps, who are kind of on the fence and who aren't sure and who are anxious when they hear news about this link, at this alleged linking. And they are sort of feeling better today because they feel, wow, that was all a hoax. I didn't need to worry about this. I can vaccinate with, you know -- and feel calm about it.
GUPTA: We don't know what causes autism.
GUPTA: But there have been a lot of papers suggesting that vaccines don't.
GUPTA: And speaking of middle of the road, one thing that parents will try to do is split up vaccines. Is that something that you've heard from parents as well? Is that sort of their "let's play it safe" sort of route?
COHEN: You probably remember those visits with your daughters where you go in and the pediatrician goes out with a tray of like six shots, right? And each of those, they have more than one, you know, vaccine in them. That's a lot to get at one time and pediatricians will tell you that it's safe. And I have some friends who are very anxious about that.
GUPTA: And a lot of people will say, look, that is crazy. Not only crazy but it's dangerous because even in the interim period, they say, don't bring the child back or even in the interim period, before you do bring the child back -- they're at risk when they didn't need to be.
SANDERS: They are at risk and they're also putting other children at risk. And that's one of the things that I talked to parents about is that you're not just being a good parent to your child by getting your child immunized, you're also being a good parent to all the other children that your child comes in contact with by getting them immunized.
COHEN: I'm not saying they're skipping immunizations.
COHEN: I'm talking about if you want to delay by a week or two.
GUPTA: It is amazing to think that the vaccines that we give nowadays, even though they maybe greater in number, still aren't as -- don't generate the same sort of immune response that vaccines of the past did and the autism rates were presumably lower.
GUPTA: You have a child with autism.
GUPTA: A teenager now.
GUPTA: Lee Grossman was just about this a little bit. But what are the challenges of raising now a teenager with autism?
SANDERS: Well, it's been a challenge, you know, all along. It was a struggle getting diagnosed. I was seen as being a crazy dad who thought that something was wrong with their child when there really wasn't anything wrong. We talked about the fact that one of us essentially had to go to work to make at least $100,000 a year, you know, before the taxes, in order to pay the $60,000 a year it costs to do the applied behavioral interventions and integrated therapy and to have somebody there to take care of him all the time to work with it.
Now, that being said, he was classically autistic at 4 and 5, completely withdrawn stereotypic, fixated, rigid, tantrums all the time, rarely talked. And now, you know, he is getting ready. He's really pushing us. He's wanting to go into high school at this point.
He's much more involved with other people. He still has a lot of problems but he is definitely on his way to being a functioning adult.
GUPTA: Well, I'm glad we had a chance to talk about this. I know we could talk about it all the day. But we ran out of time.
Dr. Sanders, thanks so much.
Elizabeth, this is something that we're going to be talking about it. Appreciate it.
COHEN: Thanks. Thanks a lot.
GUPTA: Welcome back to SGMD.
By now, you probably know, on this show, we like to introduce you to ordinary people doing some extraordinary things. Well, today, a famous neurologist, Dr. Oliver Sacks, who knows from personal experience that sometimes, an otherwise normal brain can just go haywire.
GUPTA (voice-over): Oliver Sacks maybe a world famous neurologist. But there's one simple thing, something important, something most of us take for granted that he can barely do at all -- that's to recognize a face, even a famous one.
(on camera): How about this one?
DR. OLIVER SACKS, NEUROLOGIST: Soft focus. The owner of this face is looking tough. But, I don't know who it is. Sometimes I fail to recognize myself.
GUPTA: Even yourself?
SACKS: Yes, I have occasionally started apologizing to a clumsy bearded man, only to realize that this is a mirror.
GUPTA (voice-over): He's face-blind. It's a rare and incurable condition that he's had since birth. Sacks suspects it's genetic, since his brother suffers from the same condition. He can see each facial feature just fine, but putting it all together, that's the problem.
(on camera): How about this picture?
SACKS: Well, that is very beautiful, immortal or an actress. Well, I'm sure one thinks of Marilyn Monroe.
GUPTA: I'm curious. You're looking at me right now -- can you describe what you're seeing?
SACKS: You have very beautiful white teeth. So, I would recognize you especially by your teeth.
GUPTA (voice-over): You see, he finds a way -- a way to adopt.
SACKS: I mean, now, I have outed myself about face blindness. It makes it easier.
GUPTA (on camera): Would you want to be cured of this if you could?
SACKS: I think so. I think if I was suddenly presented with thousands of familiar - potentially familiar faces, I think this might overwhelm me.
GUPTA (voice-over): A doctor of the mind, always looking to see the world with fresh eyes. He's still writing. He's still practicing as a physician. He even makes house calls.
SACKS: I want to get a whole picture, not only get a diagnosis of the matter but how the condition is affecting the person, how they are reacting to it, what I can do. But the whole person is very important for me.
GUPTA: I tell you, making the situation all the more challenging, Dr. Sacks recently found a tumor behind his right eye, a melanoma. And the treatment left him blind in that eye. So, he's adapting using just his left eye in addition to the face blindness. It's just unbelievable.
Dr. Sacks, good luck to you. We all wish you very, very well.
And we'll be right back. Stay with SGMD.
GUPTA: Thanks for watching a very special edition of SGMD this morning. We're going to continue following the breaking news out of Tucson now. Obviously, a very tragic story.
What we've been hearing most recently is that Congresswoman Giffords is still unconscious, they're saying, still in critical condition. One of the things we've been hearing a lot of questions is exactly what happens with a situation like this, how could someone survive an injury to the brain.
I have a model here. I just want to show you the right side of the brain over here. What doctors have described is what's known as a through and through injury. So, a bullet, for example, may be entering in this area and then exiting over here and possibly causing some damage, obviously to this part of the brain. Sometimes that can cause some bleeding, and the goal of the operation is to really alleviate some of that pressure in this area and take out any blood that has formed.
The next 4 hours, really couple of days so significant for her. One of the concerns is there can be swelling in that area of the brain, even, you know, a day or two later, sometimes even longer than that. So, doing some simple things to sort of test, make sure that the congresswoman is still able to follow commands, to be able to understand, process information, move her body in response to that so very important.
One of the ways that doctors do that sometimes is obviously she'll be in the intensive care unit and they keep conducting these neurological exams on her, even waking her up.
Now, you've been hearing congresswoman was following commands after the operation and then now they're saying she is obviously in critical condition, unconscious. This could also be a reflection of simply having sedation as well, sort of balancing pain medications and sedation with the need to have the congresswoman awake so they can examine her. So, that's sort of what's happening in the hospital -- now, obviously, checking for bleeding and things like that as well.
These are -- these types of injuries a lot of people have been e- mailing saying quite surprised that someone could survive a gunshot wound to the brain at close range. And, in fact, it can happen. It does happen -- if the type of injury is as described, sort of a through and through injury, an injury that did not pass from one side of the brain to the other, from left to or right to left.
Those types of injuries that the patient, as in the congresswoman's case, neurologically, she's able to communicate with her doctors even before she went into the operating room. These can be very good signs and sounds like doctors moved very, very quickly in her case as well.
So, we're going to have -- we're going to have a lot more as we get updates on the congresswoman and certainly any other patients in the hospital as well. Doctors are expected to hold a press conference around noon Eastern. We'll be monitoring that as well.
But thanks for joining us again for a very special edition of SGMD.
"NEWSROOM" with Carol Costello is going to continue right after the break. Stay with us.