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SANJAY GUPTA MD
Questions on Prostate Tests; Apple CEO Steve Jobs Dies at Age 56; Fear and Suspicion; Hip-Hop Star Speaks Out
Aired October 8, 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, and thanks for being with us.
One thing I'm going to keep reminding you today is: in medicine, what you see isn't always what you get.
For example, Catherine Graves thought her husband was having an affair. She hired a private investigator. But what she found is worse than she ever imagined. We'll explain.
And we're also going to talk with Tionne Watkins, T-Boz from the super group TLC. When she was a little girl, a doctor said she likely would not live to see 30. Talk about wrong.
And Steve Jobs, dead at age 56. Sad news, but he lived far longer than his doctors first expected. We'll tell you why. What we can all learn from this.
But, first, the federal agency that told millions of women to delay getting mammograms is starting another tough argument. The U.S. Preventative Services Task Force now says most men should not bother with screening for prostate cancer. They say the PSA test does more harm potentially than good, that it barely reduces deaths and leads to a lot of unnecessary treatment and complications.
Now, there's already some pushback. For example, the head of the Prostate Cancer Foundation -- that's a patient group -- calls the new recommendation, quote, "a terrible mistake." And we reach out to the American Neurological Association as well. They told us they were still working on their response.
To help me sort it out for you, I'm with Dr. Christopher Logothetis. He's an oncologist at MD Anderson Cancer Center and has these conversations with his patients all the time.
What will you tell your patients now if anything different based on what's just happened?
DR. CHRISTOPHER LOGOTHETIS, PROF. OF ONCOLOGY, MD ANDERSON CANCER CENTER: Well, I think first of all, I haven't received the official report or had the chance to review it in detail. But based on the availability information, the dilemma that we discussed in the clinic every day is actually reflected in this decision which suggests that there is harm and purely focused on the benefits of detecting cancer ignores the fact that many patients are exposed to the risk of overtreatment and its complications. I think the most accurate figure that exists on this is approximately 44 interventions need to be made in order for one patient to be saved.
GUPTA: Now, one thing -- and correct me if I'm wrong -- besides getting a static number, a one number PSA test, what also seems to matter is the trend. So, for example, if you have a number and then it goes up or jumps up significantly over a year or two, that's valuable information for doctors to know as well. I mean, should that continue?
LOGOTHETIS: Absolutely. And I think that's precisely where we're evolving to. So the two extremes of the argument -- screen nobody or widely screen indiscriminately to everybody are clearly wrong. And then the more nuanced argument and that is to use this screen as a smoke detector to justify further investigation and reflect rather than automatically go PSA, biopsy on one measurement and intervention is what's being -- what's evolving right now.
GUPTA: It may even evolve over the next few weeks. Maybe we'll have you back on to talk about it again. Thanks so much.
LOGOTHETIS: Wonderful. Thanks.
GUPTA: Thank you.
And less two months ago, Steve Jobs announced he was leaving Apple. This week, as you know, he died. He was very private about his medical conditions.
But in 2003, he was diagnosed with what he called a rare type of pancreatic cancer. Since then, he's been under the microscope. In 2004, he had surgery to remove the tumor.
After a leave of absence, he came back to Apple and he seemed healthy. But in 2009, his weight loss was striking and that year, he also had a liver transplant.
Joining me now is Dr. David Kooby from Emory University, a surgeon who treats patients with pancreatic cancer.
Welcome back to the show.
I didn't know that we would be talking again so soon. We talked early August about Steve Jobs. He didn't have classic pancreatic cancer. It was referred to as a variant.
To talk about it -- what specifically did he have?
DR. DAVID KOOBY, EMORY UNIVERSITY SCHOOL OF MEDICINE: Well, the pancreas has two major functions. One is an exocrine gland that helps with digestion. Makes a fluid that gets into the intestines and that is what -- that is the cell type that the typical pancreatic cancer rises from. And so, that's the disease that Patrick Swayze had.
The type that Steve Jobs had came from a different cell type, the endocrine portion of the gland. That's the one makes insulin and other hormones that get into the bloodstream. And it's a less common disease. In general, has a better prognosis but obviously, it still can be lethal.
GUPTA: Right. And they talk about pancreatic cancer, I think they said the one that Patrick Swayze had, one year survival, around 20 percent. Five-year survival in the single digits. Terrible prognosis.
What about for this neuro endocrine type tumor? What are the numbers?
KOOBY: This type of diseases, about -- unfortunately, about half of the people who are diagnosed will have metastatic disease or disease that has spread to a different site by the time they're diagnosed. On the flip side, people can still do well for quite a while as Mr. Jobs did even though did he have metastatic disease. And that's evident by the fact that he had a liver transplant.
GUPTA: Right. Right.
Let me ask you -- obviously, you were not his treating physician. You didn't speak to doctors. But patients -- what are they experiencing? I mean, do you have any idea what his life might have been like, especially over the last couple of years?
KOOBY: It's not one cancer. Not everybody has the same course. It can be found very early. It can have no symptoms. Or it can be very symptomatic.
So, in his case, it's, like you said, I wasn't one of his treating physicians, it's hard to know exactly what he was experiencing. Some people will have symptoms by chemical set produced by the tumor that can be controlled with medication. And other people are symptom free.
So he, obviously, was doing well.
GUPTA: Do you use any Apple devices in the hospital, at your work?
KOOBY: I am a Mac guy. I have an iMac at home. I use an iPhone, which I depend on tremendously.
GUPTA: It's amazing the consumer electronics and what he did. One time I got to speak to him, he talked about how excited he was about the medical applications of iPads and all the other devices. So, iSad as a lot of people said.
GUPTA: Yes. Thanks a lot, Dr. Kooby. I appreciate you coming back to talk about it.
KOOBY: Thank you.
GUPTA: A good chance to educate people about this disease as well.
Cancer also figured in the announcement of the Nobel Prize for Medicine this weekend. It went to three scientists whose research led to experimental treatments that stimulate the immune system. Now, one is called Provenge. That's a vaccine against prostate cancer.
Interestingly, one of the scientists, Ralph Steinman, had pancreatic cancer. We were just talking about that with Dr. Kooby -- a different type though than Steve Jobs had. And he used his own therapy. In a twist, he died three days before the prize announcement.
Now, the Nobel is only supposed to go to living recipients. But in his case, they bent the rules.
Now, coming up, find out what this woman is doing, what she is experiencing for the very first time. Something most of us take for granted. That's next.
GUPTA: I want you to imagine what it might be like if you couldn't hear the sounds around you, things we take for granted. You couldn't hear music. You couldn't hear the birds outside. You couldn't hear the voices of your parents or even your children.
Now take a look at this. This video on YouTube has been seen by more than 6 million people.
The woman here, her name is Sarah Churman. She was born almost completely deaf. But she just got this new device, a new hearing aid that's implanted just inside her head. It's remarkable. You're watching her turn it on and hear for the first time.
(BEGIN VIDEO CLIP)
SARAH CHURMAN: I want to hear myself cry.
(END VIDEO CLIP)
GUPTA: To understand just how this works, it's a remarkable video.
I want to show you an animation that shows how the ear is supposed to work. You see the sound waves going in from the external ear to the middle ear. That's the eardrum there.
You see the eardrum sort of vibrating back and forth. It's taking those vibrations and sort of amplifying the sound through those bones and that snail-like structure basically then transmitting all of these vibrations, trying to make sense of it in some way and then transmitting it via that yellow structure which is the nerve going to the brain. That's how things are supposed to work.
Now, in Sarah's ear, the sound wave vibrations don't prompt the nerve cells to translate those vibrations for the brain. So the new implant has a sound processor. It's about an inch and a half long and it basically uses the natural eardrum as a microphone. So, it's still using your own ear.
The processor inside the ear basically cleans out all that background noise and sends Sarah's brain a clear signal so she can really hear. Again, amazing to watch someone regain a sense really for the first time. Now, I should point out as well that most insurance companies won't cover this. The device, the procedure, it's expensive, about $30,000.
Medical technology is one factor driving up the cost of seeing a doctor. And last year's health care law is supposed to push these costs down.
It's very controversial. But there are states that want to do even more, like Vermont and Montana. This week, Montana's governor said he wants Montana to set up its own health system like the one they have in Canada, a sort of government-run health care. Vermont is already building a system where the state will cover medical care for every citizen.
Now, the inspiration they say for this is a flood of stories from patients who just can't pay their bills.
HEATHER LOUGHLIN, STRUGGLING WITH MEDICAL BILLS: Their bills, like here was the latest, a couple days ago to the mail box -- hospital bill, hospital bill, already gone to collections, medical bill.
GUPTA (voice-over): For 42-year-old Heather Loughlin, this is almost a daily ritual.
LOUGHLIN: They're unopened because I now just put them if piles unopened because just talking about it I get emotional. If I open them and get reminded every time how much money I owe, it sets me back and then I don't do what I need to do to take care of myself for that day.
GUPTA: In February of 2008, Heather was diagnosed with M.S., and ran up more than $80,000 in medical bills. Bills her insurance company wouldn't cover.
LOUGHLIN: I'm less and less capable of taking care of myself physically, let alone fighting phone calls, letters, appeals, lawyers. I'm not taking it laying down even though all I want to do is lay down. All I want is the luxury to just be sick.
GUPTA: After hearing stories like Heathers, the state of Vermont took a radical step. In May, Governor Peter Shumlin signed a law setting up a fully government-run health care system, for everyone. It's called single-payer.
Dr. Deb Richter was one of the doctors who pushed it.
DR. DEB RICHTER, VERMONT HEALTHCARE FOR ALL: If we have one-payer with one set of rules, one set of regulations and one reimbursement, their administrative cost will go down significantly. I think most primary care physicians are onboard with the single-payer because of that.
GUPTA: But some doctors, like Orthopedic Surgeon Adam Shafritz, are worried that the government will cut costs by simply not paying them a decent fee.
DR. ADAM SHAFRITZ, ORTHOPEDIC SURGEON: There are a number of physicians, specifically specialty physicians, whose practices might already be in financial jeopardy right now and they're looking to the future and saying, well, gee, can I even afford to stay in business and should I be looking elsewhere? Looking, perhaps, to leave the state?
GUPTA: If his fears come true and doctors do leave Vermont, Heather could be left in bigger trouble -- hard to believe considering her situation now.
LOUGHLIN: Having to have my retired parents go back to work part time to make ends meet because of my situation is really difficult.
GUPTA: As much as we talk about the policy changes in Washington, there are real stories, obviously, behind all those numbers. We'll keep bringing them you to.
Now, coming up, a woman hires a private investigator to check on her husband and turns her world upside down in a way she never expected.
GUPTA: Catherine Graves hired a private investigator because she thought her husband was having an affair. Now, talk about misconceptions. There was no affair. In fact, he had a fatal brain tumor.
You know, recently, we heard about the struggle of Steve Jobs. But, you know, sometimes the fight is just as hard, even harder on the family. Here's Catherine Graves who writes about it in "Checking Out." It's an in-depth look at what goes on in your mind.
GUPTA: You've been together for a decade. And something just seemed to be different. It wasn't anything real specific. What were you seeing?
CATHERINE GRAVES, HUSBAND DIED FROM BRAIN TUMOR: His behavior had become pretty apathetic, and less motivated to do things. And definitely less interested in me and spending time with me.
GUPTA: As his wife, what was -- what came to your mind? What were you thinking?
GRAVES: I was thinking that he was having an affair. And at that point we had been to marriage counseling. And the counselor, I think, kind of concurred with the idea that maybe he was having an affair or other engagements. You know, maybe not just one.
GUPTA: Did you ever, at this point, suspect health problems?
GRAVES: No way.
GUPTA: It wasn't something that came to mind.
GRAVES: Wasn't even on the radar.
GUPTA: It got worse, despite the counsel, right? To the point that you were very suspicious of him?
GUPTA: What did you do?
GRAVES: I hired a private investigator which was probably a month before he got diagnosed. And I was convinced. And our accountant also was convinced that there was something financially going on because money was unaccounted for. It was missing from the business.
And we thought maybe gambling, maybe drugs, you know, maybe drugs were the reason for the huge change in his personality.
So I hired someone to follow him around to figure out what was going on. So we had never been so disconnected before.
GUPTA: Did that person ever give you a report?
GRAVES: She phoned me the day I was leaving the hospital from his surgery. And she started to go into detail about how, you know, the car hasn't really moved much, and I just told her what had happened. And she just was, you know -- obviously had never heard that one before. A reason for someone hiring a private investigator.
Yes, she's like, well, that's a first. So -- hopefully the last, too. But, yes. So -- so we went to the emergency room and got the CAT scan. And I do remember walking into the emergency room, and he looked at me as if he knew that he should know who I am. But I don't think he was sure how.
GRAVES: And so that was pretty heartbreaking. And then I was, you know, really scared. And then we went into a little room and 10 minutes later, Dr. Sander came in, the emergency room doctor, and said you have a giant tumor in your brain. And John started laughing. And I, of course, fell apart.
GUPTA: It must have been so -- such a time of conflicted feelings for you. It's terrible news. But it was also an explanation.
GRAVES: Exactly. Exactly. And there was definitely a sense of at least this wasn't about me. And, you know -- because for over a year, I just -- it was a horrible feeling, thinking that my husband wasn't in love with me anymore. And at least I knew it had nothing to do with me.
But, you know, flash forward 10 seconds later to -- but he has a giant tumor in his brain and what does that mean? So -- GUPTA: You said this, but this happened so fast.
GRAVES: And this sounds terrible to say, but I'll be the one to say it. You know, when someone is suffering like that and you've been taking care of them and you're not taking care of yourself, it takes a toll. And you finally just want it to end.
And so, when it finally ended, it was almost euphoric in that I had some freedom. I mean, I hadn't left the house for almost six months. So, I think that was part of the reason I kind of went a little off the deep end.
GUPTA: You're right. It is hard for people to say. But I think probably more people share that sentiment than they would ever admit to.
GRAVES: I think so.
GUPTA: What should people take away from your experience? Who may find themselves in that situation, maybe not even -- again, just a spouse. I have a lot of friends of mine who are caring for their parents now. And it is -- their entire lives, it's what they do. What do you tell them?
GRAVES: I tell people that they need to take time for themselves, no matter what, because John did not want me to leave the house. And he did not want anyone to come in and take care of him.
So I wish I would have found a way, you know, and been a little selfish. And left the house and done some things with friends -- stayed connected to people. You know, instead of just becoming a hermit. That's one thing I would highly recommend.
GUPTA: To have some attachments to your own life.
GRAVES: Yes. You have to maintain that for sanity, I think.
GUPTA: What about now? Do you still think about him a lot? I mean -- your emotional state?
GRAVES: Just in the last six months, nine months, maybe, I've started to remember some really good, happy times, which I think for some reason I had just -- those weren't coming to me. You know, all I would think about is kind of the negative, the end -- you know, the end of his life. But now, I just remember how happy we were, and that we had some great times. And he was just a super funny guy. And I was always laughing. And so, it's really nice.
GUPTA: A lot of important lessons in there for people who are caring for their loved ones and trying to care for themselves at the same time. So --
GRAVES: Yes, that's the key. Right.
GUPTA: Yes. Appreciate it. Thank you.
GRAVES: Thank you.
GUPTA: And coming up, a superstar singer who fooled her doctors and beat the odds not once, but twice -- T-Boz of TLC. The story is next.
GUPTA: You know, it's amazing, but it's been almost 20 years since Atlanta and then the world first heard about TLC. They were crazy. They were sexy. They were cool. All of that.
Lisa Lopes, as you may know, died in a car crash in 2002. But Rozanda Thomas and Tionne Watkins, T-Boz, well, they still make music. In fact, they sang in "American Idol" this year. And now, Watkins has something to share.
We have been talking about medical misimpressions all morning. Well, here's another. When she was a child, a doctor said she might not live to see 30.
GUPTA (voice-over): Long before she became famous as T-Boz, lead singer of the best-selling female hip-hop group TLC, Tionne Watkins knew she wanted to be a performer.
TIONNE "T-BOZ" WATKINS, MEMBER MUSIC GROUP TLC: I always had the same dream and always saw myself in baggy pants running from the left side of the stage bending to the right, shaking someone's hands, and a whole bunch of people were screaming for me.
GUPTA: Now, success didn't come easily, because T-Boz has a chronic illness. She suffers from sickle cell anemia. It's an incurable blood disorder that leaves people exhausted and in pain.
WATKINS: Doctors, they didn't give me a very happy ending. You won't live past 30. You know, you'll be disabled your whole life, you'll never have kids.
And I was looking around the room, like, well, I don't know who he is talking to, because that's not my story.
GUPTA (on camera): That's a lot for anybody to go through. But you were dealing with this as a young child.
GUPTA: And at the same time, you were having these grand dreams.
GUPTA: Sounds like you turned it around in some way.
WATKINS: Yes, I think it had to do a lot with my mother, too, because she never made me feel different.
GUPTA (voice-over): Then, just five years ago, after having achieved so much success, her life was turned upside down.
WATKINS: I started having headaches. But they were so frequent, something was wrong.
My doctor called, but his voice sounded funny. And I said, "You're going to say something like I have a brain tumor or something, right?" And he got quiet.
GUPTA: Now, while the tumor was noncancerous, her doctor said surgery was not an option because of her sickle cell disease. He suggested radiation therapy, but that could have put her career and quality of life at risk.
So, T-Boz found a surgeon who successfully took the tumor out.
(on camera): It sounds like you're one of these people who thinks of something, visualizes it, and makes it happen.
WATKINS: I go for it.
GUPTA: T-Boz is back in the studio these days working on a solo album. She is also using her celebrity to encourage people to become bone marrow donors.
WATKINS: What I'm trying to do is get more African-Americans to step up.
GUPTA: Now, African-Americans are especially vulnerable to sickle cell, like T-Boz. There is a fascinating reason behind this. The gene developed in people living in Central Africa, because it makes it harder for malaria parasites to infect the body, and malaria has always been a huge killer that part of the this world, so it's this evolutionary adaptation.
But that same mutation as you learn there can lead to this debilitating disease. It was really great to talk to Tionne.
Well, does it for this SGMD. Thanks for being with us.
Time to get you back in the CNN "NEWSROOM" and T.J. Holmes for a check of your top stories making news right now.