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HOUSE CALL WITH DR. SANJAY GUPTA
New Guidelines About Mammograms; New Hope for Migraine Sufferers; Jailed for Being Sick?; Surprising Science Behind Faith
Aired April 7, 2007 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
UNIDENTIFIED MALE: ...as breaking the world record for the oldest person to hit a hole-in-one. The record-setting shot happened here, the fourth hole of the Bidwell Park golf course, a 96-yard par 3 Elsie pulled out the driver. Because of the slope of the green, Elsie and her playing partners didn't realize she had hit an ace until they reached the green.
CATHY CROWDER, MCLEAN'S GOLF PARTNER: We looked. And we thought, well, where did Elsie end up? And we were looking all around. And Elizabeth walked by the cup, and she said "Here she is, right here in the cup!"
UNIDENTIFIED FEMALE: I said, oh my Lord, it can't be true, it can't be true. I was so excited. And the girls were just absolutely overcome. So was I.
UNIDENTIFIED MALE: Fame is nothing new for Elsie. She's been featured in national golf magazines and was invited to appear on "The Tonight Show with Jay Leno," an offer she declined.
UNIDENTIFIED FEMALE: I didn't want to go there and be on there. I don't like a lot of publicity.
UNIDENTIFIED MALE: But with her record-setting shot, Elsie may have to get used to it.
NGUYEN: Congratulations, Elsie. Not too bad at all.
Well, we have a look at some cold, extreme cold along the East Coast. That is coming up.
REYNOLDS: But first, we've got "HOUSECALL" with Dr. Sanjay Gupta. He's taking a look at the body and soul. That starts right now.
GUPTA: Thanks, guys. This is HOUSECALL. We're making the rounds this morning for some of the week's most intriguing medical stories.
First up, new guidelines challenging what women have been told for years about mammograms. We're taking your e-mails. We're going to get you some answers.
Plus, new hope for migraine suffers. Could two drugs be better than one?
Then, jailed for being sick? A man in prison for months because he's ill. We have that story.
Finally, this Easter weekend, a look at whether our brains are somehow hard-wired for faith. The surprising science behind faith, coming up on HOUSECALL.
We're starting, though, with a change in what's been standard medical advice for a long time. For years, women over 40 have been told they need routine mammograms. Now the American College of Physicians says women with no risk factors for breast cancer should talk to their doctors first, that perhaps they could postpone their mammogram until they turn 50.
The American Cancer Society says annual mammograms starting at age 40 are still the way to go. You know what? It's leaving a lot of women wondering who they should believe.
So here to clear things up is Dr. Larry Norton. He's director of Breast Cancer Programs at Memorial Sloan-Kettering Cancer Center.
Doctor, first of all, thanks for being with us.
LARRY NORTON, DR., MEMORIAL SLOAN-KETTERING: Hey, my pleasure.
GUPTA: We've - you've talked a lot about this. You have mothers out there, you have sisters out there, you have wives out there.
GUPTA: What should they do? When should they get that first mammogram?
NORTON: They should start their mammograms annually at age 40. There's absolutely no question about it. Actually, it's inexplicable to the rest of us in the cancer community why these guidelines have changed. There's no new information, there's no new analysis. We still need to figure out why they made this recommendation.
GUPTA: Well, I mean, any thoughts on that? I mean, this is the American College of Physicians who came out with this. So this is obviously a well-organized physician group.
NORTON: Well, yes. This is an organization of internists and physicians, most people think that means all doctors. It doesn't. It doesn't refer to cancer specialists, surgeons, lots of other people.
The controversy, if there is one, relates not do mammograms, find cancers, we know for sure that they do. And indeed, mammograms do reduce the death rate from cancer from age 40 to 49 as well as over 50, that everybody agrees on.
The issue is that they also find things that turn out on biopsy not to be cancer. And so what the American College of Physicians is saying is talk to your doctor, because if you're afraid that you might go through unnecessary biopsies, then you should express that fear so you can discuss it.
But the fact is that every woman that I speak with would much rather have a needle biopsy, which is not such a big deal, to make sure that the thing that the mammogram finds is not cancer, than actually miss a cancer that could cost her her life, or cost her her breasts.
You know, if we find these cancers early, we also could do breast conservation, lumpectomy.
NORTON: So we don't have to do mastectomy. And that's also a very important reason why people should get their annual mammograms.
GUPTA: All right, let's dissect this a little bit, if you will. Our viewers had a lot of questions for you, doctor.
GUPTA: Let's get to one. Deanna asks this question. "I just turned 40 and understand this is the age recommended to have a mammogram."
GUPTA: "Is this just a pattern outlined at this age?" Why start screening people in their 40s? Why not their 30s, based on what you just said?
NORTON: Well, actually, we do recommend that you should start your annual mammogram 10 years before the earliest first degree relative with cancer. That is, if your mother or your sister or your daughter has had breast cancer at a young age, you should start your mammograms 10 years before that, but not below 25.
Below 25, the mammogram really is not interpretable. So we often do start earlier. And I have many cases where I've picked up small cancers, curable cancers, cancers where we can conserve the breasts in quite young women, women in their 30s. It's not uncommon.
GUPTA: You know, one of the difficult things, doctor, is sort of sorting out what's good for individuals versus what's good for the public as a whole. I'm somewhat surprised -- I'm a physician, as well, as you know -- that we don't have more individualized recommendations. It's sort of a one size fits all. Start mammograms at 40, start colonoscopy at 50. Why don't - why isn't it more individualized with all that we know about how to test for these things?
NORTON: Well, I agree with you, indeed that we have to move in that direction. That's why we do say to get your annual breast screening 10 years before the earliest first degree relatives, specifically for that reason.
But there are individuals that we know have high risk because they have a genetic susceptibility for cancer, BRC-1, BRC-2, other mutations that you can inherit from your mother or your father. And that puts you at increased risk. And these people should be screened even earlier.
So you're right. We need more information for the individual. And we are moving in that direction, but to say that women should automatically only start at 50 is actually moving in the opposite direction from where we should be going.
GUPTA: That's not as individualized. Let's get to another e- mail now to really get into this. This is a viewer who writes this. "I'm 64 years old who has had annual mammograms since the 80s. Although the x-ray is more warranted than ever before, I hesitate because I am terribly concerned about accumulated radiation." Doctor, a lot of people are concerned about the radiation. What about it?
NORTON: No, the radiation dose is really very, very, very small. I mean, to give you some example of what we're talking about, if you get a Cat scan, which is dramatically more radiation, if you have 100 cat scans, it only increases your risk of cancer by 1 percent. The amount of radiation you get from a mammogram is very tiny, equivalent to flying in an airplane at high altitude, for example, or living in Denver one mile off the ground. It's a very small amount of radiation. And compared with not finding a cancer when it's curable, the radiation concern is trivial compared to the proven, life-saving benefits of mammography.
NORTON: So again, just to reiterate. Women who are listening right now have no family history, no risk factors they know of. Your recommendation as a cancer specialist is what?
GUPTA: I -- absolutely, to start at age 40 to do your annual mammograms or 10 years younger than your youngest first-degree relative. That's a mother or a sister or a daughter with breast cancer. Those are our guidelines. American Cancer Society, Memorial Sloan Kettering Cancer Center. And we stand by them.
GUPTA: Dr. Larry Norton, thanks for clearing that up.
GUPTA: It is a bit confusing for a lot of people out there. I really appreciate your time.
NORTON: Well, thank you for giving me the opportunity to clear that up.
GUPTA: All right, sir, thank you. And you can blog your thoughts about these new guidelines by going to CNN.com/health. Click on the paging Dr. Gupta blog.
Now some encouraging news for people who suffer from migraines. And I'm one of them, incidentally. An experimental drug made up of two common migraine medications may actually offer more relief. The new drug is called Trexima. It combines a migraine drug Imatrex and the pain-killer Napercin. Researchers found the combo actually works better than each of those drugs in isolation.
Now the majority of those studied were pain-free within two hours of taking the drug and they stayed pain-free for about 24 hours. A lot of people - a lot of benefit for that. So how do you know if you have a bad headache or a migraine? Judy Fortin got us some clues.
ANNA LOSCALZO, MIGRAINE SUFFERER: I always get them on the left side. So it's kind of right here. And then I feel the pain somehow in my ear, and it's never on the other side, ever. It's always on the left side.
JUDY FORTIN, CNN CORRESPONDENT: Anna Loscalzo is one of an estimated 28 million Americans who suffer with migraines. The pain can be excruciating, and often accompanied by symptoms such as nausea, vomiting, and extreme sensitivity to light and sound.
GREGORY ESPER, DR., NEUROLOGIST: People with migraine often can't function. They can't go to work. Kids can't go to school.
FORTIN: Migraines are three times more common in women than men. Researchers are exploring whether there is a hormonal connection, but there are other triggers. Sometimes a change in the weather might bring on a migraine, or certain foods can be the problem. Sufferers blame Aspartame and diet sodas, caffeine, nuts, alcohol, smoked meats, aged cheeses, and chocolate.
ESPER: It depends on the person. Some people can eat chocolate without any problem at all. Other people, one bar of chocolate will trigger the migraine.
FORTIN: There is no cure, but there are medications to treat migraines. Over the counter products, such as Ibuprofen, Naproxen and aspirin help some sufferers, while others rely on prescription drugs. But doctors warn, taken too often, pain medications can sometimes cause more headaches.
Judy Fortin, CNN, Atlanta.
GUPTA: All right, thanks, Judy.
Now, imagine being locked up because you're sick. Meet a man in jail for that very reason. He's been there for eight months so far.
Plus, news on women and hormone therapy, something that flies in the face of earlier recommendations.
And is your brain hard-wired for faith? Some interesting science behind spirituality.
And then, portion sizes and America's expanding waistline. Should restaurants be blamed? UNIDENTIFIED FEMALE: HOUSECALL viewers have a chance to win a copy of Dr. Sanjay Gupta's new book on aging. Just log onto the CNN Web site at CNN.com/chasinglife.
GUPTA: Welcome back to HOUSECALL. Many Americans don't even think it exists here, but a dreaded disease common a century ago is popping up again in modern America. In fact, get this -- a man is locked up, locked up right now in Arizona, with an extremely rare but very lymph form of tuberculosis. We hear from him now.
CNN's Thelma Gutierrez has the story.
THELMA GUTIERREZ, CNN CORRESPONDENT (voice-over): In Phoenix, Arizona, Robert Daniels is in custody, in solitary confinement in a hospital prison ward, not because he's committed a crime, but because he's sick, very sick.
ROBERT DANIELS: I never thought that this could happen. I'm telling you, I'm sometimes sitting on the bed and I'm just crying because of all the quietness.
GUTIERREZ: We can't see Robert Daniels. We can't meet him. Daniels has tuberculosis, a deadly drug-resistant strain. He's been quarantined by the state.
DANIELS: I'm not being isolated, I'm being incarcerated.
GUTIERREZ: For the past eight months, the 27-year-old has been confined to his room, equipped with a special ventilation system. His only contact with the outside world is the medical staff, who feed and treat him and a telephone.
DANIELS: I don't have nobody to talk to. I have my mental health is going down. I'm just slowly dying.
GUTIERREZ: Daniels says he contracted TB while living with his wife and children in Moscow. He returned to the United States for medical treatment. Arizona health officials told Daniels that he was infectious and repeatedly warned him to wear a mask in public. He didn't.
BOB ENGLAND, MARICOPA COUNTY HEALTH DIR.: I hate locking people up.
GUTIERREZ: Maricopa County health director says when the public is at risk, he has no choice.
ENGLAND: It is a very rare individual for whom we need to pursue legal remedies and legally isolate somebody so that they don't expose others.
GUTIERREZ: But some say Daniels' civil rights are being violated because he has not been charged with any crime.
DANIEL POCHODA, ARIZONA ACLU: He gets no TV, no phone. He has a light on in his cell 24 hours a day, 7 days a week. His phone calls are monitored.
GUTIERREZ: The Maricopa Sheriff's Department says Daniels created his own problem.
JOHN MACINTYRE, MARICOPA COUNTY SHERIFF'S DEPT.: I personally would have been perfectly happy if Mr. Daniels had shown the sense that God gave a goat and kept his mask on.
GUTIERREZ: For Robert Daniels, there's no end in sight. Doctors say treatment for the type of TB he has could take years
Thelma Gutierrez, CNN, Phoenix, Arizona.
GUPTA: You know, and as Thelma pointed out, Mr. Daniels' type of tuberculosis is very rare. It's called drug-resistant. That makes it virtually untreatable with current medicine.
Now the good news is that it is rare in America. According to the Centers for Disease Control and prevention, just 49 cases of XDR- TB, that's extremely drug-resistant TB, have been reported in the United States in almost 15 years.
Now that's in contrast to nearly 14,000 cases of regular TB reported in just 2006. Now TB is spread through coughing, sneezing, and speaking. And the germs can remain airborne for hours, which is how you get infected. The symptoms -- chest pain, coughing up blood, weight loss, fever, and night sweats. One thing to remember, the most common form of TB is very treatable.
Let's get more now of this week's medical headlines in "The Pulse."
UNIDENTIFIED FEMALE (voice-over): A vaccine to help prevent childhood pneumonia has some added benefits. Besides taking care of bacterial infections, Prevnar also reduces the rate of repeat ear infections and the need to insert ear tubes.
For women in their 50s, hormone therapy may not be as bad as we once thought. A recent study finds hormone therapy does not elevate heart disease risk when taken early on in menopause, usually between the ages of 51 and 59.
However, the study confirmed that stroke risk is still elevated. Experts say this new information should be considered when looking at short-term use of hormone therapy.
And finally, a new resource for parents of children with autism. The Kennedy Krieger Institute launched the Interactive Autism Network, the first national online autism registry. Parents can log on, register their child and find local centers to participate in autism research. Visit www.ianproject.org for more information.
GUPTA: Great. And hopefully, that will turn out to be a great resource.
Now stay where you are. It's a weekend that many are celebrating their faith. So next, we take a look inside the brains of the faithful. Are we in some way hard-wired to spirituality?
And later in the show, millions suffer from asthma, but new research gives one more possible cause. And get this, it's something you can control. Stay tuned.
GUPTA: We're back with HOUSECALL. As millions celebrate Easter this weekend, we're taking a scientific view of faith. A new field of medicine is seeking to discover whether human brains are wired to believe.
GUPTA (voice-over): Generations of people believing in God, generations of skeptics trying to figure out why. Now hard science is taking a hard look, exploring the brain to see whether human beings are hard-wired for faith. And astoundingly, the answer may be yes.
ANDREW NEWBERG, DR., HOSPITAL OF UNIV. OF PA: The brain is set up in such a way that it's very easy for us to have religious and spiritual beliefs and experiences and make religion and spirituality a part of our lives.
GUPTA: Dr. Andrew Newberg is a pioneer in a new field called Neurotheology, conducting ground-breaking studies of brain activity during prayer.
NEWBERG: It's become a wonderful window, so to speak, into understanding how religion and spirituality affect human beings.
GUPTA: Using spec imaging, a brain-scanning technology, Newberg has examined nuns deep in prayer, Tibetan Buddhists meditating, Pentecostal Christians speaking in tongues. No matter what the religion, no matter what the form of worship, prayer makes certain regions of the brain light up in a special and unique way, like this, the frontal lobe, right behind the forehead, focuses concentration. The limbic system deep in the center triggers feelings of awe and joy. The parietal lobe at the back of the brain brings on that feeling of being something greater than one self. Dr. Newberg says the faithful see this as confirmation that God has designed us to believe.
NEWBERG: The nuns took a look at those scans and said this is great, it makes sense to them. If God's up there and we're down here, obviously, there has to be some kind of conduit through which we understand God.
GUPTA: Perhaps, but secular critics say the new research leaves many unanswered questions.
SCOTT ATRAN, UNIVERSITY OF MICHIGAN: In terms of understanding the fundamental nature of religious beliefs, why people have them, to what purpose they serve, I don't think it's going to give us very much insight.
GUPTA: So for scientists, the question of why we believe still remains a mystery. The answer perhaps an eternity away.
GUPTA: It's amazing stuff. And for more on the science behind faith, click on CNN.com/health, and read more on Dr. Newberg's research as well. While you're there, check out my weekly podcast. Wednesday evenings my newest podcast is downloadable. This week, I'm talking about living longer and healthier. Just a sample of what's in my up-coming book, called "Chasing Life." Before you go to the computer, though however, more HOUSECALL is coming up.
New information about weight and your asthma risk. And portion sizes out of control. We talk about this all the time, but who's to blame? The restaurants, or you, the consumer? You decide when HOUSECALL returns.
GUPTA: Welcome back to HOUSECALL. The nation's largest health philanthropy is making a huge investment in the battle against obesity. The Robert Wood Johnson Foundation says it's devoting $500 million over the next five years to fight the problem of dangerously overweight children. The group says it will focus on improving the access to affordable, healthy foods and safe physical activity.
And that physical activity is really necessary, considering the National Restaurant Association says Americans are eating out at least four times a week on average. And that may be contributing to the nation's obesity problem.
There's been a lot of talk lately about restaurants offering these monster portions with mega calories, but turns out that slimmer menu selections may be a hard sell.
UNIDENTIFIED MALE: One minute!
GUPTA (voice-over): When you eat out at a restaurant...
UNIDENTIFIED MALE: I've got a fish...
GUPTA: ...portions seem out of control.
MARISA MOORE, REGISTERED DIETICIAN: Studies have shown that the more food that we have in front of us, the more we tend to eat.
GUPTA: Most people only need between 1800 and 2800 calories a day, which can easily be achieved in one sitting, by eating a burger containing 1900 calories. So is it the restaurant's fault for offering giant portions or the customers for ordering them?
COLLEEN MCSHANE, ILLINOIS RESTAURANT ASSN.: Restaurants are on board to help fight obesity, but don't come in and tell them what to cook and what not to cook.
GUPTA: But some places are trying to make their menus leaner. The Seasons 52 chain doesn't have an entre over 500 calories, and uses all fresh ingredients.
CLIFFORD PLEAU, SEASONS 52: Feels like the right thing to do. I feel a responsibility as a chef to be putting the right types of ingredients in the dishes that I create.
GUPTA: Applebee's restaurant has partnered with Weight Watchers to provide meals with calories, fat, and fiber all listed on the menu. Even the Cheesecake Factory, known for its gut-busting desserts and portions, is trying to get skinnier. Still big portions, just less calories.
JIM ZAZZARO, CHEESECAKE FACTORY: Successful restaurants have a responsibility to really offer the guests what they're going to enjoy, what they're looking for.
GUPTA: And according to the restaurant managers we spoke with, customers are still looking for size.
GUPTA: And now there's another reason also to keep your weight under control. Obese and overweight people are 50 percent more likely to get asthma than people of normal weight. Researchers noted the connection but didn't say obesity specifically causes asthma. They do say the extra strain on the respiratory system can aggravate the condition.
Now when HOUSECALL returns, you have the chance to put yourself on the show, on HOUSECALL. Find out the details, just ahead.
GUPTA: Next week, we're going to talk about living a longer, healthier life, things you can start doing right now to extend your life. If you have questions about "Chasing Life" or want to tell me what you're doing to stay healthy, send me an i-report or an e-mail. Just e-mail me your thoughts. Go to CNN.com/housecall.
Make sure to tune in next weekend as well to see if your comment or your question makes the show. We'll be talking with a leading expert on aging, Dr. Thomas Pearls and taking all of your e-mails.
Remember, this is the place for the answers to your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.
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