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SANJAY GUPTA MD

Supreme Court Tackles Obama's Health Care Law; Autism in America; Are We Pushing Our Soldiers Too Far?

Aired March 31, 2012 - 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: A medical mystery continues with new news about autism. Cases are still on the rise and not just by a little bit. And we're going to tell you what we think is going on and also what to look for.

Also, a just-retired top Army general has a focus on the increasingly important issue: post-traumatic stress disorder. I'm going to ask him about that soldier who's accused of mass murder in Afghanistan.

We're also digesting what just happened at the Supreme Court. For three days, that's unprecedented for a single case, the justices argued about President Obama's massive health care law. We've been getting lots of questions, which I'm going to try to answer in just a minute.

But, first, let's give you a recap. Now, remember, the most controversial part of the law is the so-called individual mandate. That's the requirement that everyone carry insurance. Is it constitutional? It's there to balance another part of law that insurance companies must cover people even if they're sick.

Now, without healthy people in the system, companies say they would have to make rates, premium rates, sky high for everyone. But critics say, look, you can't force individuals to buy a private product like health insurance. The government says that's not it. Everyone gets medical care sooner or later. Requiring insurance is just a way to make sure that other people don't foot the bill.

But Justice Scalia didn't seem to buy this.

(BEGIN AUDIO CLIP)

ANTONIN SCALIA, U.S. SUPREME COURT ASSOCIATE JUSTICE: Why do you define the market that broadly? Health care. It may well be that everybody needs health sooner or later, but not everybody needs a heart transplant, not everybody needs a liver transplant.

DONALD VERRILLI, SOCILITOR GENERAL: That's correct, Mr. Scalia, but you never know --

SCALIA: Could you define the market? Everybody has to buy food sooner or later. So you define the market as food. Therefore, everybody is in the market. Therefore, you can make people buy broccoli.

(END AUDIO CLIP)

GUPTA: And that's a little bit of how it went. In fact, just minutes after that court session indeed, CNN's Jeffrey Toobin came literally running down the steps with this.

(BEGIN VIDEO CLIP)

JEFFREY TOOBIN, CNN SENIOR LEGAL ANALYST: This was a train wreck for the Obama administration. This law looks like it's going to be struck down. I'm telling you, all of the predictions, including mine, that the justices would not have a problem with this law were wrong.

(END VIDEO CLIP)

GUPTA: You know, according to our latest CNN/ORC poll, the country is pretty much divided over mandatory health insurance. Forty-seven percent in favor, 51 percent oppose. One in three Americans want the Supreme Court to completely overturn the current health care law. And base on what we've heard, it's faith is very much in question.

I've been getting a lot of questions on how this could affect all of us, all of you -- or your family. So, I'm going to give it my best shot.

And joining me to help, my producer Danielle Dellorto, who's been filtering through all the questions.

DANIELLE DELLORTO, CNN PRODUCER: Yes.

GUPTA: Thanks for being on the show.

DELLORTO: Thanks. Thanks for having me.

GUPTA: Sure.

DELLORTO: We've literally received hundreds of questions from people all over the country and our blog and Facebook and Twitter.

GUPTA: It's hard to understand. I mean, there's a lot of this. Not surprising.

DELLORTO: And you're the best person since you've read the 2,700-page bill twice.

GUPTA: Right, I did.

DELLORTO: So --

GUPTA: Job requirement.

DELLORTO: Exactly. So, let's jump right and get started, so we can get to a lot of this.

The first one actually comes from Twitter. She says, "My daughter was diagnosed with a brain disorder. How will repealing health care law affect pre-existing condition status?"

GUPTA: Well, this is somewhat tough question to answer -- the way things stand is that people are not discriminated against based on preexisting condition if they are a child. That's going to be true for all people by the year 2014. So, that's in play for her now, and that's really important. If she didn't have that getting health insurance plan with the pre-existing condition could be prohibitively expensive.

If the law is completely overturned, that's going to go away. So, she will have to get her insurance in the open market, just like everybody else, and probably pay a lot more money for it. If the plan is severed, so mandate goes away, but some parts of the bill stay. In effect, she could still have insurance but it would be a little tricky in terms of how it would get paid for and who would exactly pay for it.

DELLORTO: Here's another question. This one comes from Twitter. It writes, "Isn't preventative care supposed to be free? I received a bill last week after my yearly check-up."

GUPTA: Yes, that's a good point, because it is supposed to be free. It's supposed to have no co-pays. It's supposed to have no additional fees if it's a preventive screen. So, trying to prevent disease from happening.

Couple of things could have happened in this particular case. September of 2010 is when this new plan went into effect in terms of making preventive screenings free. So, if this person's insurance plan was before September of 2010, hasn't been modified since, they may still be grandfathered in without getting the preventative screenings for free.

Or, you know, it could be a little bit of a misunderstanding, which is doctor thinks, look, this is a sick visit. A person came in for a specific problem, patient thinks they are coming in for a preventative, you know, well visit and that might be something the patient or this person should talk to their doctor about, how was this classified? Because again they are right, if it's preventative, it should be totally free.

DELLORTO: All right. I think we have time for one more question.

GUPTA: OK. How am I doing? Am I doing all right?

DELLORTO: Yes. You're doing good. I love it.

This one said -- this one is actually from Facebook, "I'm a Medicare patient and I received a check to help pay for my prescription drugs. Will I get another one?"

GUPTA: It's interesting. This is the donut hole that a lot of people sort of, have heart about, maybe don't fully understand. But if you imagine a donut, you eat through one side of the donut, and then you're in the hole, and then you go through to the other side of the donut.

It's the hole part, the donut hole that people are focused on. So, you get -- once you make your way to the first part of the donut, you're getting reimbursed for some of those drug coverages. But in the middle of the donut hole, you're not.

So this past year, you would have gotten a check for $250. Going forward, he wouldn't expect to get another check to his question, but brand name drugs would be cheaper for him, about 50 percent cheaper, and generics would be about 7 percent cheaper while he's in the middle of this donut hole. So, after he spends a certain amount of money in drugs, he would get those benefits until he spend assert amount again.

DELLORTO: All right.

GUPTA: A lot there.

DELLORTO: It's a lot there. It's a confusing bill.

GUPTA: And I guess in June, right, that's when we'll get a decision from the Supreme Court on that.

DELLORTO: Exactly. And see which way it goes.

GUPTA: Thanks for being set with us.

DELLORTO: Thanks for having me.

GUPTA: We appreciate it. Thank you.

We got a lot more to get this morning as well. Just ahead, a highly anticipated report says cases of autism are on the rise. And it's happening fast.

(COMMERCIAL BREAK)

GUPTA: Going under the microscope this morning, we got an alarming new report about autism. You know, for the first 12 years, the CDC ha worked out regular estimates of how many 8-year-olds have autism. That's how they figure out these numbers. They looked at 8 year olds.

In 2000-2002, the number was one in 150. In 2004, the data showed an increase to one in 125, children having autism. In 2006, it was one in 110.

But this week, the latest CDC data as of 2008, shows one in 88 children has autism. Now, that's a 78 percent increase in just a decade.

Now, what this new report does not tell us is the question a lot of people have, that is why? Why are these numbers going up? And why are they going up so fast?

Researchers say part is better detection, noticing more cases, but that doesn't explain it all. A lot of you may have thought that as well.

Something is causing a real rise and while studies are underway right now, we still don't know what that something is. There are things we do. We know things about effective treatment. We know how important it is to spot the signs early, when treatment can help the most.

And here to talk more about that specifically is Dr. Gary Goldstein. He's an autism specialist at the Kennedy Krieger Institute.

Welcome to the show. Thanks so much for being here. Appreciate it.

DR. GARY GOLDSTEIN, PRESIDENT, KENNEDY KRIEGER INSTITUTE: Thank you very much. Pleasure to be here.

GUPTA: I want to ask you about some of the things that work, because we try to be solutions-oriented on the program. But let me start off by asking, what do you make of these new numbers, these new prevalence numbers?

GOLDSTEIN: Well, I was surprised to see the plateau has not yet been achieved. We are still seeing an increase every two years.

GUPTA: Yes. And, you know, people have seen these numbers and we just ticked them off for people in terms of how the rates have gone up. I mean, when you look at these studies, does it give you any more insight into causes from an environment perspective or otherwise?

GOLDSTEIN: We know your genes do not change this quickly. Genes change over thousands of years, not over a decade or two. So, we know even though there's strong genetic influences on autism, that it cannot be responsible for the increase.

The other thing that's happened --

(CROSSTALK)

GOLDSTEIN: Yes. In the past decade, there's been enormous number of very large genetic studies, and we're identifying genes but the genes we identified, the changes in those genes puts you at risk, they don't actually cause you to have -- some of them, sometimes we find a gene that causes autism. More often, the gene changes that are seen in children with autism make you prone to it, but something else has to be pushing you over.

GUPTA: Yes. I mean, a lot of people are searching for what those environmental toxins are and looking what has changed in our environment over this last decade, which to your point a more likely explanation given this rapid increase.

But for parents who have young children or are thinking about this more acutely, what do they look for? Are there specific things that they can, after listening to this program they can be looking for?

GOLDSTEIN: Yes. And I like to emphasis, it is very important to make this diagnosis early. Even if you make a decision that you're at risk and may not have autism, it's important to know early that there should be intervention. We know early intervention works.

GUPTA: And I -- you know, I have a 2-year-old at home. And I have a 5-year-old and 6-year-old as well.

GOLDSTEIN: Right.

GUPTA: Two-year-olds -- I mean, you know, my 2-year-old is, you know, like a lot of other 2-year-olds I imagine. But what should, you know, parents be looking for?

GOLDSTEIN: OK, I think what you should be looking for is social engagement, response to you as a parent, that when your child, you reach out to them, they want to be picked up by you. They liked to be touched by you. They want you to be involved in what they are doing.

This is even pre-verbal. So that before a child can talk, you can sense or you should be looking for a social interaction, particularly with the care-giving, parent, usually the mother. Constantly interacting with you and looking for you.

GUPTA: You make the case for early intervention. But if you can for a second -- just tell me what does that look like? Like what does a 2-year-old under going in terms early intervention that could help, you know, with some of these symptoms of autism.

GOLDSTEIN: Right. So, if you come to our classrooms at Kennedy Krieger Institute, you would see something that looks like a small classroom for half a dozen 2-year-olds or 3-year-olds and they'd be going through various stages of interaction. Some one-on-one with the therapists, other in small groups with three or four, and the essence of it that as that child makes eye contact, has any indication of being social and interactive, you try to reward them, get excited, blow bubbles at them, find out what it is that they respond to and reinforce the social behavior.

GUPTA: Dr. Goldstein, you know, this is something that we've covered for a long time and we will continue to do so. We really appreciate your voice in all this. Thank you.

GOLDSTEIN: Thank you.

GUPTA: And coming up, shifting gears: a former top Army general is taking on a new challenge. He wants to find help for soldiers with brain injuries and PTSD. I'm going to get his take on whether this may have played a role in the apparent mass killings by a U.S. soldier in Afghanistan.

Stay with us.

(COMMERCIAL BREAK)

GUPTA: You know, we're learning more about the American soldier accused of killing 17 citizens in a shooting rampage in Afghanistan. Two senior U.S. officials said this week that Staff Sergeant Robert Bales snuck off his remote outpost twice during his alleged 90-minute rampage in two Afghan villages.

Now, Bales' attorney is suggesting that post traumatic stress disorder may be a factor. But that he's not going to go for the insanity defense. It is all pretty perplexing and very tragic as well.

I wanted to talk to someone who is not only a four-star general, but someone who has dedicated his life to better understanding the stresses on the fighting men and women, and what also happens to their brains.

And joining me now from Los Angeles is General Peter Chiarelli. He retired from the military in January, ending a four-decade career of service.

General, thanks for joining us this morning.

You know, I followed your work and comments over the years on PTSD and also the Army's efforts to detect it and reduce the number of suicides as well in the armed services. You're retired now for a couple of months.

Is there another voice like yours at your level within the military?

GEN. PETER CHIARELLI, FORMER VICE CHIEF OF STAFF, U.S. ARMY: Well, I think there is. I think everybody in the military is seized with the responsibility they have given 10 years of war to look hard at post-traumatic and brain injury.

And as I've said before, the problem we have is we just don't have reliable diagnostic tools in every instance tell us whether or not a soldier is suffering from either one of those diseases of the brain.

GUPTA: So, where does that leave us, then? I mean, because, obviously, we are sending soldiers in these combat zones. If we don't have the diagnostic tools, what do you do? How does one decide in who can go in, who should come out, those medical decisions?

CHIARELLI: Well, there are diagnostic tools, I know you know that. But the problem is they don't provide the certainty of walking into a room with a blood pressure cuff and asking a group of people who has high blood pressure.

Now, we know there's stigma associated with behavior health issues. And if you walked in the room and asked 100 people whether they'd had high blood pressure and nobody raised their hand, you could find out pretty quickly who, in fact, has high blood pressure and who doesn't, with some certainty with that blood pressure cuff. But we don't have those same kind of tools when it comes to determining whether or not someone has post-traumatic stress or traumatic brain injury.

GUPTA: With all that you do know and seen over the years, what was your initial reaction when you heard about a U.S. soldier allegedly killing these Afghan civilians?

CHIARELLI: Well, I mean, anyone who heard that, who was commanded, who is -- understands the effect, the expected effect, of multiple deployments was concerned, as was I. But I've got to say, we've got thousands and thousands of soldiers, sailors, airman and Marines who have gone on multiple deployments and not had issues like occurred in Afghanistan. So I think we really, really have to be careful of determining a cause and effect. Again, because we just don't know enough.

GUPTA: You know, with regard to Bales, Sergeant Bales, his lawyer said he had no interest in going back for another tour, he was told he wouldn't be going, and then almost overnight received new orders. I mean, you know, is that common situation? And if so, I mean, do you think it's a defense or played any role here?

CHIARELLI: Again, I don't know anybody who wants to go back for multiple deployments to Iraq or Afghanistan. I know every single one of us who went on a multiple deployment was, in fact, concerned at a certain point in time. But that's why we serve.

GUPTA: From a pragmatic standpoint, there's something about enough mental health professionals, to do what we can do right now, to sort of push the knowledge that we do have right now. I mean, how -- should we be doing more with what we know? And if we're not doing that, are we simply pushing our soldiers too far, expecting too much from them without the support tools to give them?

CHIARELLI: You know, the military services are the only people that I know that provide some kind of screening before a person deploys, while they're deployed, and when they come back. Now, given all that, if the tools were more accurate, I would think we would have a better handle on this. But the tools just aren't that accurate and that's the issue we have today.

GUPTA: I applaud your work. You know, obviously, this is a great interest's mine and also being able to screen people to have a comparison of the individual to that same individual as apposed to a shotgun approach for this criteria I think is going to be really important. I know you know that as well.

Again, General Chiarelli, thanks for getting up with is this morning. I really appreciate your time.

CHIARELLI: Hey, thank you.

GUPTA: Now, of course, brain trauma isn't confined just to the battlefield. So, up next, we're going to introduce to you a woman whose life changed in an instant when she was whacked by a car while riding her bike. She's expressing herself these days through some pretty incredible art. Stick around for this.

(COMMERCIAL BREAK)

GUPTA: In this morning's installment of "The Human Factor," whacked and then everything was different. It's an art exhibition with an usual title mentally wrote what it's like to sufferer a traumatic brain injury, recover and then ultimately triumph.

(BEGIN VIDEOTAPE)

ELIETTE MARKHBEIN, ACCIDENT SURVIVOR: I was on my bike, and I heard this roaring car coming behind me. And I realized at that point the car was going to hit me.

GUPTA: Eight years ago, Eliette Markhbein was hit by a car and flung into the air.

MARKHBEIN: While I was in the air, I was seeing Central Park on my left and I was seeing people on the sidewalk going, "My God, my God."

And I really thought those were the last thoughts and the last sights of my life.

GUPTA: At the moment she slammed into the ground, Markhbein's successful career as a journalist was over. She had a traumatic brain injury.

MARKHBEIN: My helmet, it was cracked in two like a ripe melon.

GUPTA: Words that once came easily were now garbled and the pain radiating throughout her body became a daily sensation. Markhbein needed an outlet.

MARKHBEIN: I just naturally started to, you know, take paper and pencils and color things and draw things. And I didn't have a TBI. My mind functioned seamlessly when I was doing art.

GUPTA: Eventually, art was not just a respite from pain, but a new vocation.

MARKHBEIN: This is (INAUDIBLE). She's a Central Park jogger.

GUPTA: Eight years after her accident, Markhbein is still coping with her injuries, still feeling cathartic when she paints. Her latest work now hanging in a New York gallery depicts people who also had a TBI.

MARKHBEIN: This is Alexis Versailles (ph). She once shaken as a baby.

GUPTA: Her process mirrors traumatic brain injury. First, a charcoal rendering of her subject. The then, Markhbein cuts the work into pieces.

MARKHBEIN: Here, I have something that is beautiful and whole, and by putting it and taking scissors to it, I feel like I'm re- inflicting the traumatic injury to that person.

GUPTA: The next of the process, reassembling the image.

MARKHBEIN: So, it's a parallel between the three phases of traumatic brain injury, which is fractured, reassembled and whole.

You know, it shows all the scars that we have as a -- you know, survivors of traumatic brain injury. Whether they're emotional, whether they're physical, whether they're cognitive -- they're all part of that reassembled portrait.

GUPTA: The result is larger than life portraits of people who, like Markhbein, intensively rehabilitated both body and spirit and overcame.

MARKHBEIN: They're all like on hope that there is hope that, you know -- do not ever lose hope. You will recover. You will do something with yourself. It's long, it's painful, but there is hope.

(END VIDEOTAPE)

GUPTA: And it's worth pointing out as well, Eliette Markhbein's exhibition will be displayed at art galleries across the country in the coming months. Her hope in these paintings is what she calls "icons of hope", inspiring people living with TBI to be active participants in their own recovery.

Now, before we go, it's a news when it comes to chasing life this week. You're going to like this one. Regular chocolate consumption linked to lower BMI, which is body mass index, according to a new study. The results confirm the researcher's hypothesis that the metabolic benefits of chocolate may -- just may offset the amount of calories consumed.

Now, researchers think it may be the caffeine and other ingredients that in fact increase your metabolic rate. Now, dark chocolate in particular is high in anti-oxidants. We've talked about that. Also has anti-inflammatory properties. Cocoa may lowers blood pressure, increase HDL -- that's the good cholesterol -- and lower LDD, the bad cholesterol.

You know what? Don't go crazy. I mean, that goes without saying. Remember, a chocolate bar contains hundreds of calories and most of those are from saturated fats and sugars. It's called moderation.

Going to wrap things up for SGMD this weekend. Make it a point to come back and see us right here next weekend.

Time now to get you a check of your top stories with Randi Kaye in the "CNN NEWSROOM."