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SANJAY GUPTA MD
Health Care Controversy; Orphaned by Prescription Drugs; Sour on Swaddling?; Seeing While Blind
Aired March 9, 2013 - 16:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN HOST: Hi there and thanks for watching.
I've got a story that parents and grandparents need to hear. Some daycare workers will be breaking the law if they use a very common technique to put babies to sleep. I've used this technique myself for all three of my kids.
Also, the epidemic of drug abuse with prescription pain meds. There's a voice we often don't get to hear, the voice of the children.
And you're going to meet an 89-year-old woman who is completely blind and she's got this amazing story about how she was able to travel the world still.
Let's get started.
GUPTA: First up, though, a new documentary that takes a hard look at my profession, medicine. It's called the "Escape Fire" and it makes a controversial case that says doctors focus too much on money, they do unnecessary procedures. They don't spend enough time on basic prevention.
Case in point, a patient named Yvonne (ph), diagnosed in her 30s with heart disease, who had bypass surgery, 27 cardiac catheterizations and more than seven stents planted to keep her blood vessels open. Only then that she ended up at the Cleveland Clinic where doctors got her cholesterol and blood pressure under control and where they say counseling and diet and exercise helped Yvonne lose 20 pounds all in an effort to try and avert more surgery.
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE: I can't tell you how shocked we were when we saw her the first time, because here was a young woman whose diabetes was not well-controlled, her cholesterol was never well- controlled and her high blood pressure was never well-controlled. If someone had talked to her, I think someone had really -- teased out her chest pain and shortness of breath, I think many of her cardiac catheterization and stents would not have been necessary.
(END VIDEO CLIP) GUPTA: Now, earlier I spoke with Dr. Steven Nissen, the chairman of cardiology at the Cleveland Clinic. He is featured in the film. And also with Dr. Jeffrey Marshall, a leading cardiologist whose specialty is implanting stents.
GUPTA: Dr. Nissen, let me start with you. You say there's a lot of Yvonnes out there, the patient we just met. A lot of unnecessary stents. You say they don't prevent heart attacks, they don't lengthen life.
DR. STEVEN NISSEN, CHAIRMAN, CARDIOVASCULAR MEDICINE-CLEVELAND CLINIC: The problem is, if you have stable chest pain, we have very good studies dating back a number of years that show that getting a stent will not prevent a heart attack and will not make you live longer. These are techniques that should be used to relieve symptoms. And some people even that are getting stents don't even have symptoms. They have a blockage that's not causing symptoms, and yet they're actually having a procedure.
GUPTA: Are a lot of these stents unnecessary?
DR. JEFFREY MARSHALL, INTERVENTIONAL CARDIOLOGIST, NORTHEAST GEORGIA HEART CENTER: I don't believe so. Actually, about 70 percent of all angioplasty and stent procedures in this country are done in people actively having heart attacks, OK? Large heart attacks or kind of smaller heart attacks or having what we call unstable angina, that chest pain that is currently damaging the heart in patients. So less than 30 percent are actually done in these people with stable ischemic heart disease.
NISSEN: We're 50 percent more likely to have a stent than we would in, say, countries in Western Europe where they have similar disease rates. We're more likely to have a knee replacement or have a CAT scan or have an MRI. And that's because our system reimburses people for doing tests and doing procedures. Not for necessarily making people healthier.
GUPTA: I think what Dr. Nissen is describing is a fee-for- service sort of model. You get paid for the service that you're doing as opposed for the overall care of the patient.
This is what you do for a living. Is that how you get paid? So if you've got a patient who comes in, you get paid a certain amount because you do a stent. Are you incentivized to do more stents?
MARSHALL: Well, me personally, I'm on a salary. So --
GUPTA: It doesn't matter.
MARSHALL: It doesn't matter if I do one stent or five stents or ten stents. My job oh is to provide the right care for the right patient at the right time.
GUPTA: So you're salaried. MARSHALL: Yes, sir.
GUPTA: I'm salaried too as a physician. And, Dr. Nissen, you're salaried, as well.
GUPTA: How big a problem is it, then, these perverse incentives that you described?
NISSEN: We're not saying people are doing these procedures for profit. We're saying that the system has created incentives that in subtle and maybe not-so-subtle ways drives more procedures.
If you get a bump on your head, as a friend of mine had, and you go into the emergency department in America, you get a CAT scan. If you have that happen in Germany or in England, they say here's a list of instructions. If you have problems, come back and see us. We just spent $1,000.
GUPTA: Sometimes the patients demand this stuff.
NISSEN: Yes. But we have to educate patients.
GUPTA: I want to point out something. I think this is important. Because I think when people watch the film, they're left with the impression that Yvonne finally came to the Cleveland Clinic, she got her cholesterol under control, her weight under control, and things were great for her after that.
But that's not the whole story. She ended up having another open heart operation, another bypass operation.
I think that's an important point. It doesn't always work. I mean, the impression I think was a little bit misleading there. Don't you think, Dr. Nissen?
NISSEN: I do. Look, we can't prevent disease in everybody. But we have to try. The problem with Yvonne's case is she had all of those stents before she had had the risk factors controlled.
That's not good medicine. We have to teach young physicians that prevention comes first.
GUPTA: In the spirit of educating people out there, I have cardiac disease in my family, who should actually get a stent?
MARSHALL: So, anybody that's having a heart attack should get a stent. It's the best treatment and saves lives, period. Everybody agrees on that.
The next group of people are people really that have tried medical therapy, that are on medical therapy and they're failing. There are lots of people like that.
(END VIDEOTAPE) GUPTA: And you can see "Escape Fire" in its entirety, followed immediately by the rest of my discussion on rescuing the American health care system. That's Sunday night, 8:00 p.m. Eastern right here on CNN.
Coming up on SGMD, though, orphaned by prescription drugs. I'm going to take you to this town where parents are scarce. A place the kids are calling a new normal.
GUPTA: You've probably heard me talk a lot about prescription drug overdoses. Reason being that it's an epidemic. It kills another person every 19 minutes. It can happen much more easily than you think. You know, what we don't hear enough is the story of people left behind. And far too often, it's the kids.
GUPTA (voice-over): If this town could talk it would describe a simple, idyllic life, proud people. It would also whisper a sobering story, about an epidemic that is tearing apart family --
AVERY BRADSHAW, FATHER OVERDOSED ON OXYCONTIN: I lost my dad and my uncle to drug abuse.
GUPTA: -- after family --
HANNAH EATON, LOST UNCLE AND COUSIN TO DRUG ABUSE: I've lost both my uncle and my cousin after two years of prescription drug abuse.
GUPTA: -- after family.
SEAN WATKINS, MOTHER OVERDOSED ON PRESCRIPTIN DRUGS: I lost both my mother and my grandmother to OxyContin.
GUPTA: It is not uncommon to hear stories like this echoing down the hallways every day at this high school in Rock Castle County, Kentucky.
EATON: And you're constantly hearing of someone else dying because of abusing prescription drugs.
GUPTA: Sixteen-year-old Avery Bradshaw knows this story all too well.
BRADSHAW: My grandpa he just sat me down and told me that he was gone.
GUPTA: When Avery was just 7, his father overdosed on OxyContin. He says his mother was in and out of his life.
BRADSHAW: The hardest part of growing up without a dad would be like not having that model family like that you always see.
GUPTA: He's lucky enough to live with his great grandparents. In this town, that model family is being redefined.
WATKINS: There's got to be plenty more in this school that's -- had the same thing happen to them. It's a terrible thing.
GUPTA: A terrible thing that 17-year-old Junior Sean Watkins saw firsthand.
WATKINS: We went in her room, and she was face-down on the bed.
GUPTA: When he was 10, Sean walked in on a terrifying scene in his mother's bedroom. She was dead, after overdosing on pain killers, OxyContin.
WATKINS: I thought it was -- it was awful. My mother died. But I couldn't understand the gravity of the situation. I didn't understand that my mom was gone forever. I was going to see her again.
GUPTA: Sean had known for years that his mom was in trouble.
WATKINS: My mother started off, you know, with back pain, started off just taking pills for that. And eventually it got worse, and developed into other drugs.
GUPTA: A prescription drug for back pain leads to dependence and eventually an overdose.
KAREN KELLY, EXECUTIVE DIRECTOR, OPERATION UNITE: This is happening in Rockcastle County every week but it's happening in eastern Kentucky every day. It's leaving our communities in shreds and we're left behind to pick up the pieces from that.
GUPTA: Karen Kelly is the executive director of Operation UNITE, a community coalition devoted to preventing overdosed deaths in Kentucky. In fact, Kentucky is the fourth most medicated state in the nation and it has the sixth highest rates of overdose deaths.
In one county alone --
KELLY: Half of the kids have no parent in the home whatsoever. So now we're seeing many raised by great grandparents because we've lost an entire generation of young people and, you know, the kids are really the ones paying the biggest price.
NANCY HALE, OPERATION UNITE VOLUNTEER: We were just sick and tired of going to funerals. We were sick and tired of having kids come in and not being able to sit through physics class because they were worried about mom who had overdosed or dad had been arrested.
GUPTA: Nancy Hale worked in the Rockcastle County School System for 34 years.
HALE: So we were like, what can we do, how can we help these families?
GUPTA: So Hale and other teachers decided to start a club at the school. Where kids could learn and teach others about drug prevention.
BRADSHAW: It really helps a lot of kids that are going through those problems to know that they're not alone.
GUPTA: But Sean says the pain of growing up alone never goes away.
WATKINS: It's tough, you know. You've got somebody else's house and they've got a loving mom and dad and yours are -- yours are gone.
GUPTA: And this terrible new normal isn't just in Kentucky. In fact, nationwide, more than 4 percent of all children don't live with their parents. That number has more than doubled in the past 20 years. Addiction like you just saw there is a big reason.
A legal fight over the best way to help babies stop crying and go to sleep. Everybody wants to learn more about this. So Dr. Harvey Karp is going to stop by to show us.
GUPTA: We are back with SGMD.
Got milk. Here's a question: which kind?
You've probably noticed a lot more variety in the dairy section lately and a lot isn't dairy at all. You need to know this, because just because it looks like cow milk doesn't mean it necessarily has the same nutrients.
Let me go through this a little bit. Rice milk, for example, that's a good option in baked goods but not to replace dairy milk, that's because it contains virtually no calcium or protein.
There's coconut milk, as well. That contains some of the good, quote-unquote, "coconut fat", low in carbs, but it's also low in protein and calcium. The unsweetened kind is an OK option for people lactose intolerant for example, or have dairy allergies.
My favorite, though, as far as milk alternatives go is almond milk. That's over here. That's a good swap because it contains the same amount of calcium as cow's milk, actually has more vitamin E. Plus, get this, it's lower in calories and in fat. Almond milk tastes pretty good, as well. It has a creamy taste. It's great with oatmeal, smoothies or in cereal.
OK. Time to talk about a trick that I learned pretty quickly when I first became a dad -- swaddling. I don't know if we could have gotten by without it. It can help your baby from crying, encourage better sleep. But some people now say it's also dangerous. And in a handful of places it's actually been banned.
So we decided to call the authority on all things baby and sleep related, Dr. Harvey Karp. He's the author of "The Happiest Baby Guide to Great Sleep." He's a big proponent of swaddling. You got a DVD that shows these techniques, specifically.
Thanks for joining us again.
DR. HARVEY KARP, AUTHOR, "THE HAPPIEST BABY GUIDE TO GREAT SLEEP: Yes, thank you, Sanjay. Appreciate it.
GUPTA: We got a lot of comments when you joined the show and I think it's because so many people deal with the issues you talk about -- swaddling.
GUPTA: You learned it in the hospital. I did. I was actually champion swaddler for a while in our family.
KARP: Oh, you were.
GUPTA: I don't know how my wife feels about that comment.
But just talk about swaddling, first. Why is it effective?
KARP: Well, you know, the baby is in the womb for nine months. This is how much room they have. They're not expecting to be in a world where they can have, you know, full use of their arms. As a matter of fact, the world is too big for them.
So babies don't need freedom. They need security. Swaddling is the key to keeping a baby happy and calm, because it promotes sleep -- lots of studies show that. And it reduces crying.
GUPTA: The concern -- I read some of the same stories that you did, I'm sure, about people being concerned about it now, even banning it, s. Saying it may be more likely to be associated with SIDS, maybe more likely to be associated with problems of the hips.
What was your reaction when you first heard that?
KARP: It's just totally wrong-headed. I mean, I don't want to be dismissive of my colleagues, of course. But if you look at the studies on the hips, for example, all the swaddle studies that show it's a hip problem were done in primitive cultures, with a totally different type of swaddling.
As long as the babies can move their legs a little bit, it's perfectly fine for the hips, and even the biggest center here, the International Hip Dysplasia Institute of the United States, recommends swaddling.
And for SIDS, it probably reduces the risk of SIDS and suffocation, because if you don't swaddle your baby, they tend to flail and wake up. And that's what items parents to bring the baby in bed with them or put the baby to sleep on the stomach. And a study was just done last year that shows if you swaddle your baby, you're twice as likely to put your baby in the safe position.
So swaddling actually increases safety. It doesn't decrease it. GUPTA: Well, we're going -- you have a DVD out. Let's look at this ourselves here a little bit, and I'll tell you flat out. My youngest is 3 now so it's been a little bit of time.
How long for you since you swaddle one of your --
KARP: Mine is 29. But I swaddled a baby yesterday. So I'm a lot more on key with that.
GUPTA: OK. I'll point out, we have a couple dolls here and blankets. These are fancy blankets.
GUPTA: We didn't have these when I had my youngest. But just take a look here.
So, you want to talk us through this?
KARP: Yes. Here's a swaddle baby and here's where it's unswaddle. I personally just use a big square piece of fabric. I'm kind of old school. You fold -- hold like a diamond. But you have to be snug with the arms but allowing the legs to be able to flex and move. So --
GUPTA: That's that hip dysplasia thing. Don't want to cause that.
KARP: So, with this kind of a swaddle, it's super easy. Just put the feet in the bag and then bring over part of the wrap. But look what you do. You tuck it and snug it.
KARP: Those arms have to be snug. If they pop out, the kids smack themselves in the face and get more upset. And then you -- and then you close it with these little Velcro tabs.
But I've got to tell you one thing with swaddling. Most babies cry more when you swaddle them, which makes parents lose confidence. The key to successful baby calming is swaddling plus the next things that you do.
And the next things are to then roll the baby on the side or stomach. Do the shhh -- shhh-ing or the CD of white noise you can use all night long with the babies. And some babies even need a little bit of jiggly motion, because they're kind of like bouncing baby boys. They kind of need that kind of action.
GUPTA: I used to do that all of the time. My wife would literally say that's not how you do it and it's funny, because it worked. I called it the football pose.
KARP: There you go.
GUPTA: Kind of like a football. But it worked. Always enjoyable to have you here.
KARP: Thank you. Thank you very much.
GUPTA: On behalf of a lot of parents, thank you, as well.
KARP: Thanks for your time.
GUPTA: And still ahead, we'll see the world through the eyes of a woman who has been blind for half her life.
GUPTA: Time to introduce you to Arlene Gordon. She lost her vision half a lifetime ago, but it hasn't kept her from a lifelong dream of traveling the world.
GUPTA (voice-over): This is what the world looks like through Arlene Gordon's eyes -- 100 percent darkness, 100 percent of the time.
ARLENE GORDON: It started, yes, in my 30s, 40s. The vision became so bad that I decided to gamble. I said, you know, it's worse this way. I'm neither here nor there.
GUPTA: Gordon scheduled herself for an operation she was told could potentially make her vision even worse.
GORDON: For six weeks, I had the best vision I ever had in my life. It was fantastic. I was -- I could -- like a baby, walking around looking at everything.
GUPTA: But just as she had been warned, a few weeks later, Gordon's remaining vision vanished, rendering her completely blind.
But soon she learned to navigate her new world.
GORDON: As you tap, you're deliberately clearing the path in front of you.
GUPTA: The streets of New York industry were never enough, and Gordon refused to let her blindness stand in the way of her passion for travel -- Cuba, South Africa, countless cities in Europe, collecting souvenirs at every stop along the way.
And this is fascinating. Hand her a souvenir. And by feel alone, she can tell you exactly what it is and where she got it.
GORDON: Oh. It's a Buddha, isn't it? Yes. And that is from India.
GUPTA: Travel, she says, gave her a life, as any she had seen in the movies.
GORDON: When we were in Venice and the windows opened up and I remembered seeing the movie with Katherine Hepburn where she is looking out over the Piazza. There's so many things you can experience other than visually. As a matter of fact, one friend said to me, you know, I never saw as much as I did as when I traveled with you.
GUPTA: And I'm sure Arlene will get the experience even more of the world before she turns 90, which is this August. Happy birthday in advance.
You know, I spoke exclusively with Mayor Michael Bloomberg last September right after the New York City Board of Health Directors approved his ban or lid, so to speak, on the sale of all sugary drinks larger than 16 ounces.
(BEGIN VIDEO CLIP)
MAYOR MICHAEL BLOOMBERG (I), NEW YORK: If you want to take another portion, you can. Nobody is banning you from doing that. You can buy it -- as a matter of fact, you could buy two 16-ounce cups or four 16-ounce cups any time you want and take them all back to your seat or your table. But if the 16-ounce cup is there, you probably won't drink more than one of those. And that would make a big difference, because full-sugar drinks really are different than other kinds of things.
(END VIDEO CLIP)
GUPTA: I should point out, this Tuesday now, Bloomberg's ban, it goes into effect.
Now, we've talked about this a lot. But sugary drinks do pose a special challenge. While calories from food make you feel full, with soda or juice, you can take in hundreds of calories without your body noticing.
Plus, there's no fiber. And this is important. The fiber can slow down the rate that sugar is absorbed from your gut into your bloodstream. Without it, your liver can just start to be overwhelmed.
That's going to wrap things up for SGMD. Let us know what you think of the show, CNN.com/Sanjay. Follow me on twitter @DrSanjayGupta.
Up next, though, a check of your top stories in the CNN NEWSROOM.