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SANJAY GUPTA MD
Your Health, Your Vote; Costly Cancer Breakthroughs
Aired September 29, 2012 - 16:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, HOST: Hello, and thanks for being with us.
Today, amazing progress in the war on cancer. There are real cures being developed but they also come with a staggering cost.
Also, I hope you have a strong stomach for this. You're not going to believe what we found in these filthy restaurant play areas.
Plus, an issue we talk about a lot here on SGMD: cell phones. Now, the government is asking FCC to update their radiation safety limits. We'll explain.
But, first, election promises into our medical care.
GUPTA: You know, this week we're going to se the first debate between Mitt Romney and President Obama. Health care is a key issue, one of the biggest, in fact. And it's back in the spotlight after Romney said people without insurance can always just go to an emergency room.
Now, with barely a month ago before the election, I wanted to zero in on what's at stake here.
GUPTA (voice-over): Since President Obama's health care law was enacted, 3.1 million people under the age of 26 are now covered by their parents' plans, and preventive care is covered 100 percent by insurance companies. Seniors, in particular, have benefited on prescription drugs.
BARACK OBAMA, PRESIDENT OF THE UNITED STATES: Seniors who fall in the coverage gap known as the donut hole will start getting some help. They'll receive $250 to help pay for prescriptions, and that will, over time, fill in the doughnut hole.
GUPTA: Five-point-five million seniors have saved a total of nearly $4.5 billion on prescription drugs since the law was enacted -- according to the Health and Human Services Department.
He also plans to slow spending on Medicare.
OBAMA: I have strengthened Medicare. We've added years to the life of Medicare. We did it by getting rid of taxpayer subsidies to insurance companies that weren't making people healthier. GUPTA: By 2014, the law requires everyone to have health insurance, whether they purchase it themselves, or through their employers. And insurers can't deny you if you have a pre-existing condition, or increase your rates.
The law has become a cornerstone of the Obama campaign.
OBAMA: I refuse to eliminate health insurance for millions of Americans who are poor and elderly or disabled -- all so those with the most can pay less.
GUPTA: But Romney says the Affordable Care Act is unaffordable.
MITT ROMNEY (R), PRESIDENTIAL NOMINEE: We know that health care is too expensive. Obamacare doesn't make it less expensive.
GUPTA: He wants Obamacare gone, including the drug prescriptions for seniors. But he does want to keep pieces of the health care plan. Although he doesn't say exactly how his plan would work.
ROMNEY: We have to make sure that people who have pre-existing conditions are able to get insured and that folks that get sick don't get dropped by their insurance company.
GUPTA: Romney and his running mate Paul Ryan propose to cap malpractice insurance, cut Medicaid by $810 billion over the next 10 years, give states more control over their Medicaid funds, overhaul Medicare.
The overhaul? People now younger than 55, when they reach retirement, would have the option of getting a voucher to purchase private insurance. Or they could stick with traditional Medicare.
REP. PAUL RYAN (R-WI), VICE PRESIDENTIAL NOMINEE: This financial support system is designed to guarantee that seniors can always afford Medicare coverage, no exceptions.
GUPTA: Now, some major differences between the candidates, as you see there. But perhaps, one of the biggest split is over Medicaid. Currently, most people understand Medicaid to be this sort of safety net for the poor. But what it actually covers is poor families, pregnant women, people with disabilities, as well as senior citizens.
There is a lot there and joining me to talk about it from New York is Andrew Rubin. He's been on the program before. He also oversees the 1,400 doctors for New York University Langone Medical Center. I hope I got that right.
Andrew, thanks for being with us.
You know, you and I talked about this before. Medicaid covers one in five Americans, including more than one in three children. Why -- how do you explain this as being a big issue for seniors? ANDREW RUBIN, NYU LANGONE MEDICAL CENTER: OK, well, there are about -- you know, there are millions of Americans in the Medicare program. But there are 9 million Medicare beneficiaries, 9 million, who are also eligible for Medicaid. They're called duly eligible.
And these tend to be disabled Americans, so they could be under 65. But the bulk of these people are over 65 and poor, and they have no assets, no money. So they rely on Medicaid to pick up a lot of the cost and services that Medicare doesn't cover. Long-term care, as you said, being a big one.
GUPTA: So some of the changes that are being proposed, for example, with Obamacare, what does that mean for these seniors?
RUBIN: Well, for Obamacare, these duly eligible seniors, there should be no change. I mean, there are cost provisions for health care, but we're not going to talk about them now because they're already under way and I think everybody recognizes we have to take costs out of the current health care system, Medicare included. But what we're really talking about is the difference between what President Obama has in the health care reform law, and what the Ryan plan talks about, which is converting Medicaid dollars to state grant, block grant, which would essentially give the states control over their Medicaid dollars, and therefore, reduce federal expenditures and then potentially cut services.
There will be fewer dollars for Medicaid beneficiaries, so anyone who is getting Medicaid, there will be less services available.
GUPTA: You know, of course when you talk to the Romney/Ryan folks, they say, look, Medicaid is simply too expensive. And they consider this giving the states more flexibility in how they run the program. So -- I mean, is that a bad idea at that level?
RUBIN: You know, Sanjay, this is a really big issue. I mean, I don't think anybody doesn't want to help people the most in need. For the people who rely on the Medicaid system tend to be the most in need of access to health care, there's no question about that. And I don't think any Republican or Democrat would say we shouldn't help these people.
But the fundamental difference here is what can the country afford? President Obama and his health reform law believes that we can afford this, whatever he put into law and there's a lot of meat there. And the Republican platform, so far on health care reform is we have to make do with less. And there is no one right answer here. They're just two very different philosophical differences to solving the health care crisis in this country.
GUPTA: Andrew Rubin, thanks so much, as always.
And coming up, my exclusive look at one of the world's first treatments for melanoma, a type of skin cancer.
(COMMERCIAL BREAK) GUPTA: You know, just last week, the largest cancer center in the world, MD Anderson in Houston, announces plan to radically reduce deaths from cancer, all in the next few years. In fact, they call it their version of the "moonshot" program. And one of their big targets is melanoma, a malignant skin cancer. This is an extreme challenge treat. But I did see firsthand why there's so much excitement about this.
GUPTA (voice-over): At 32 years old, Brian Rose was chasing a dream, baseball coach for the Wichita Wingnuts, he was working his way up towards the big leagues. But in April 2010, he saw a troubling spot in the mirror.
BRIAN ROSE, MELANOMA PATIENT: I mean every morning you brush your teeth and see it. But I had the mindset, if I feel OK, nothing is wrong.
GUPTA: That was key, he felt fine, and he didn't think he needed to get checked out. But his girlfriend, Lupe, insisted. And she was right. It was skin cancer, melanoma.
They cut it out, but six months later, Brian's doctor said told him it had spread to his lung.
ROSE: But I remembered the specific question when he kind of pulled me aside, and said, "Now, are you -- do you understand what we're -- what we're dealing with, here?" And if you break it down even further, I think he was asking me do you understand that this could kill you?
GUPTA: Once it spreads, melanoma is almost always deadly, but the odds are better than they used to be. One reason is the drug that Brian received Zelboraf. Listen closely to the way Brian describes that medication.
ROSE: I have seen these things pop up while taking Zelboraf and you see them go away, and they come back up, and then they go away.
GUPTA (on camera): Eventually, you want the tumor to stop growing and regress. You see that on scans. Did you see evidence of that?
ROSE: Yes, I sure did.
GUPTA (voice-over): Zelboraf works on certain types of melanoma that carry a particular gene called BRAF. Think of BRAF like a target for the medicine.
The FDA made Zelboraf available just months after it approved another new medication, Yervoy.
You see, cancer cells can play a trick on the body, putting out a signal that slows down the immune system. Just like the brakes on a car.
(on camera): What does Yervoy do? How does it work?
DR. PATRICK HWU, MD ANDERSON CANCER CENTER: The antibody that is Yervoy takes the brakes off this thing so it can go after the cancer cell.
GUPTA (voice-over): It doesn't always work. But about 10 percent of the time, the tumor shrinks by more than 50 percent, sometimes it goes away entirely.
This new generation of drug is turning the tide against a variety of cancers.
(on camera): Now, all that's very exciting. But the problem is that many of these breakthroughs often come with a significant sticker shock. For example, Avastin, $88,000 a year for this medication. Zelboraf, this is $10,000 a month. And that can continue indefinitely as long as the patients taking it. And Yervoy, this medication is $120,000 for four doses, which makes up standard therapy.
Big sticker shock, and does not even taking into account the hundreds of thousands of hospital fees and physicians charges, all of it goes into taking care of a patient with cancer.
ROSE: And it adds up quick.
GUPTA (voice-over): As part of the clinical trial, Brian got Zelboraf free. Once it was approved by the FDA, he was only able to continue because the company that makes the drug agreed to keep providing it.
ROSE: I think with Zelboraf, because I could see the pictures, you know, I could see scans. I could see that the disease was regressing, you know? And I knew that good things were happening. You kind of get a taste of what that was like before cancer, you know? And --
GUPTA: And what it takes. A year after his diagnosis, Brian and Lupe got married.
In some people, Zelboraf works miracles. The problem is, they don't last.
HWU: I've had patients that have been bedridden then, hadn't been able to get up and take their kids to Disney World. So it has had dramatic responses.
The issue is, they only last a few months, then the tumor comes back.
GUPTA: And this summer, Dr. Hwu told Brian it's time to try something else.
(on camera): This is TIL lab.
HWU: Yes, this is where we initiate all the cultures.
GUPTA: Brian is one of the first people in the world to receive this. It's called TIL with dendritic cells. Dr. Hwu takes immune cells called T-cells from Brian's tumor. T-cells can attack cancer. Dr. Hwu nurtures those cells, mixing them with the growth factor, then grows other immune cells, dendritic cells, which act as a vaccine. It helps T-cells multiply in Brian's body. He'll infuse the mixture of T-cells and dendritic cells into Brian. In effect, it's an anti-cancer smart bomb.
(on camera): You've had other patients who have had advanced melanoma, going through this therapy. There aren't many patients right now. It's brand-new.
How have some of the patients done?
HWU: Well, the response rate is between 40 percent to 50 percent, which is very high for metastatic events melanoma. Some of those patients have done very well, over two and three years now without any sign of disease.
GUPTA (voice-over): Again, remember, most of these patients would otherwise die in eight months. If it keeps going well, Dr. Hwu hopes to make it much more available. And he says the cancer field as a whole, is at a turning point.
HWU: You know, if we do this right, in 20 years, hopefully dying of cancer will be similar to patients dying of pneumonia. That it still can happen, but when somebody dies of pneumonia, you say, hey, that's a little unusual.
GUPTA: And to get there, somebody has to pave the way.
ROSE: And I'm ready for it, too. So, yes.
GUPTA: Now, they've been getting Brian ready for the past few days. He's going to get that actual infusion on Monday. It will be a couple of months before they do follow-up scans, and it starts to get any sense of whether this treatment is working. We'll keep an eye on Brian, let you know how he's doing.
Up next, as a parent you're not going to want to miss this.
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE: So here we go on a tour.
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GUPTA: Fast food restaurant play area, it can be a breeding ground for bacteria like you wouldn't believe.
(BEGIN VIDEO CLIP)
ERIN CARR-JORDAN, KIDS PLAY SAFE: Look in the cracks, filth. You can see there is trash.
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GUPTA: You're listening to Erin Carr-Jordan there. She's the bacteria-fighting mom. She has been busy documenting the filth that she finds in fast food restaurant play areas.
And I'll tell you, like me, she is concerned a lot about her child's safety. And we've talked about this before. She joins me now from her home in Phoenix.
Welcome back to the program, Erin.
CARR-JORDAN: Thanks so much. Good morning.
GUPTA: Good morning.
You know, one of the things you said, if this is happening in my town, it is likely happening in yours as well. That really -- that really caught my attention.
Tell us -- remind us how you got started in all of this.
CARR-JORDAN: This all got started by happenstance actually. I just happened to be with my one of my sons. We went into an establishment that have one of the play areas and I followed him in because he was still pretty little.
And right away, we noticed that there was a very big problem that needed correcting, including broken equipment, cracked in the equipment that could amputate, or second story windows that were broken. And it was just absolutely filthy and disgusting, smelled like urine. It was covered with graffiti. It clearly was just a marker that something was really wrong.
GUPTA: Yes, and, again, you know, the filth is one thing, but also these broken areas, potentially dangerous, you know, break a limb or something.
You know, just last week, Governor Jerry Brown vetoed a bill that would have established these standards for cleaning and for safety at these restaurant playgrounds. In the letter to the California state assembly, which passed the bill, he wrote his -- he wrote, "Until there is new evidence that the problem warrants more state law, let's let the locals enforce what can already be called a comprehensive mandate."
That was his quote, Erin. And he says look, let local folks basically handle this. Let's not do this at the state level. There's not enough evidence.
What do you say to him?
CARR-JORDAN: Well, I would say the data that supports it is the largest and most comprehensive ever collected in the United States. It was far larger than anyone else. I happened to be a very concerned mom. But more importantly, I'm also a researcher. And we looked at many locations and more than 70 locations.
Clearly, the local authorities don't have the authority. It's not within their bandwidth or jurisdiction at present to go in there. That was verified at every turn and then every county. In fact, somebody at the Environmental Health Department testified at the assembly health hearing and said, hey, listen, we don't go in there right now. Not only don't we include it in our inspections, but we can't require correction actions in the event that a problem exists.
GUPTA: Yes. I mean, I think a lot of people don't realize there isn't some sort of local either health authority or other authority who has some sort of defined jurisdiction.
But I should point out, as well, you also noted that the Maricopa County, Arizona Board of Supervisors unanimously voted in favor of the health care changes that you've been pushing for so long, and that's become law and that's where you live. So, that's something I know you have had a lot to do with it.
So where do you go next from here?
CARR-JORDAN: I'm working with other states around the country. I'm still very optimistic that this will be picked up on a federal level so that there is a consensus across the 50 states. I really do think there is a national health concern. That data indicates that there's no discrepancy between the states that I've been to.
So, I am very hopeful that the senators, representatives from across the country will say, hey, we recognize there is a problem and we want to keep the children in our states safe. And we'll pick it up. I intend to meet with people in Texas, and so on and so forth around the country in the upcoming weeks and months.
GUPTA: We have been telling people, you're on a crusade about this and you really are. And thank you for bringing this issue to light. I think a lot of people simply didn't know about it. It wasn't something that I have thought of either. So, Erin Carr-Jordan, thanks so much.
CARR-JORDAN: Thank you so much.
GUPTA: Still ahead -- I think about this all the time, is your cell phone safe? I'm going to tell you how you catch the risk of radiation. There's important stuff here. I'm going to tell you what to do and what I do.
But, first, motorcycles are dangerous enough. And when you add in a muddy dirt track and 40 other riders going at top speeds, the stakes get pretty high. Now, imagine being on that track and not being able to hear anything at all.
GUPTA (voice-over): For Ashley Fiolek, motocross racing is in her blood. ASHLEY FIOLEK, CHAMPION MOTOCROSS RIDER (through sign language translator): My dad used to race. And he brought me to watch one race, and I was 3-years-old and I fell in love.
GUPTA: But there was something different about Ashley -- she can't hear a thing. Ashley was born completely deaf. She speaks to us through a sign language translator, and her friend, Natalie.
FIOLEK: I don't know how would it be riding here. I grew up, and I was born deaf.
GUPTA: In a sport that prides itself on making noise, where hearing your opponents coming can be the difference between winning and losing, Ashley stands alone.
FIOLEK: She really has a hold of my lines when I'm riding, because it is really hard to see when somebody is coming up behind me.
GUPTA: She also uses the vibrations in the engine to make sure she is the right gear. At this race, Ashley is the only deaf rider to ever compete in motocross, was trying for her fourth championship title.
FIOLEK: I felt really good. You can every jump and in the big double, I hope you can win and hope to be the champion.
GUPTA: And she achieved just that, beating out her closest rival with a national championship.
But for Ashley, it is about more than just winning.
FIOLEK: I think it is really cool to be a role model to the deaf community. And it is a cool feeling to have people look up to you.
GUPTA: And for Natalie, her friend's impact is important, as well.
NATALIE SIMMONS, ASHLEY FIOLEK'S FRIEND: She is very important woman to motocross, and idol for all these young girls. Whether she is deaf or not, you know, she is like a smaller than I am and she can ride a dirt bike like that. It's crazy.
GUPTA: Proof that anything is possible.
(BEGIN VIDEO CLIP)
GUPTA: We've only been using cell phones regularly in this country since 1996, and that's important because research takes time. It can take decades to actually get answers. So when you hear that we know that they're 100 percent safe, we actually don't know.
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GUPTA: But here is what we do know, the longest international study called Interphone found that people who are studied with the most heavy cell phone use in 10 years, in fact, double their risk of brain glioma. That's a type of tumor.
Now, the World Health Organization now lists cell phone radiation in the same cancerous category as lead paint and diesel exhaust. Think about that. They consider cell phone a possible carcinogen.
Now, here's the good news. I think it's pretty simple to lower your exposure. For example, I always use a wired earpiece something that looks like this. Also, try not to talk with the phone directly against your head or keep it directly against body. Even the safety manual for this BlackBerry, for example, I don't think people read this, but it says to keep the phone at least an inch away from the body.
Also keep up the phone if you're in a place with a weak signal, because in that scenario, your phone is actually also working harder and as a result emitting more radiation.
I hope that helps.
It's going to wrap things up for SGMD. You can stay connected with me at CNN.com/Sanjay. Let's keep the conversation going on Twitter @SanjayGuptaCNN.
Time now though to get you a check of your top stories in "THE CNN NEWSROOM."