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Sanjay Gupta MD

Saving Those in Cardiac Arrest: Have We Been Doing it Wrong?; Best Treatments for Depression; New Testing for Allergies; Does Birth Order Determine Success?

Aired March 15, 2008 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

SANJAY GUPTA, CNN HOST: Welcome to HOUSE CALL. We're making the rounds this morning to some of the most intriguing medical stories of the week.
First up, it's the mainstay of saving those in cardiac arrest, but have we been doing it wrong?

Then, they voted it number one. We're talking about the best treatments for depression.

Also, what you need to know about new testing for allergies and how it could help you.

Finally, could your birth order determine your success in life? Find out.

Now, if you've ever taken a CPR course, you remember the drill. Breaths first, then chest compressions. But it turns out there may be a better way to save a life. Paramedics in Arizona have been doing something different and reporting they're that they're tripling the survival rate.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Seven weeks ago, Mike Mertz collapsed at the wheel around the corner from his townhome in Glendale, Arizona.

MIKE MERTZ, CARDIAC ARREST SURVIVOR: And the fire department was here within about four or five minutes. And they performed on me here. That's how they got me stable enough to get -- to take me to the hospital.

GUPTA: The paramedics saved Mertz with a new kind of CPR. The standard way, clear the airway, insert a breathing tube, then alternate two breaths with 30 chest compressions.

But Glendale EMTs are doing it a new way. Start immediately with 200 chest compressions, strong and quick like this, 100 a minute. Then shock with an electrical defibrillator. Then another 200 compressions right away. No stopping to check for a pulse or another breath.

Then Bobrow, who oversees the state's paramedics says it works because for the first several minutes after cardiac arrest, there's enough oxygen in the body to keep you alive for several minutes, but only if you pump on the chest to circulate blood. Any delay even to check a pulse or clear the airway, it's critical time that's lost.

BEN BOBROW, DR., ARIZONA DEPT. OF HEALTH SERVICES: Interrupting the blood flow to the heart and brain for even ten seconds can be all it takes to actually decrease the chance of a successful resuscitation.

GUPTA: The American Heart Association says it needs to see more research before changing official CPR guidelines.

UNIDENTIFIED MALE: He truly was dead.

GUPTA: Mike Mertz says the chance to meet the men who saved him is living proof the new way works.

(END VIDEOTAPE)

GUPTA: To be clear, this new technique is controversial. The American Heart Association says it doesn't plan to change it's guidelines for now. But either way, I strongly encourage every one of you at home to take a CPR class. I guarantee, you could possibly save a life one day.

Now antidepressants are the most commonly prescribed drugs in the United States. So we recently reported that researchers in the United Kingdom found anti-depressants didn't work any better than placebos unless you're severely depressed. It's a finding that could have some people questioning the efficacy of these popular medications.

On CNN.com this week, you voted to learn more about depression medications. So we invited Dr. Boadie Dunlop from Emory University School Medicine to join us.

First of all, welcome to the show.

BOADIE DUNLOP, PSYCHIATRIST: Thanks for inviting me.

GUPTA: This was an interesting study. And I think, frankly, it scared a lot of people, saying maybe these medications weren't as effective as people thought. What do you think?

DUNLOP: Yes, it did get a lot of attention around the world, sugar pill same as effective as an anti-depressant.

The study that they did was a type of study where they grouped lots of trials together and look at the overall effect of the treatments. Those studies have been done before. And some of them have found anti-depressants to be better than placebos. Some have found no difference.

The trouble with those kinds of studies is that they combine good studies with bad studies or I should say well designed studies with poorly -- less well designed studies. And so, you can dilute out true findings with less well defined studies. So this certainly isn't the last answer to this question.

GUPTA: You know, it's interesting that you say this isn't the last answer. I mean, is there an answer? I mean, as a psychiatrist, can you say definitively that anti-depressants work?

DUNLOP: I feel I can say that definitively, yes. And the difficulty is that when you do studies for a short periods, you do induce a lot of placebo response. Where you can see anti-depressants separate from placebo is over the longer period. That's where you can really see the benefit of anti-depressants, preventing relapse of depression.

GUPTA: So you're saying, you know, if someone were to take a sugar pill or an antidepressant in the short-term, there may not be a huge difference. But longer term, the placebo or sugar pill is not going to last.

DUNLOP: Yes. And it varies by individual. Some people will not respond to placebo at all and some people do. And it's a very interesting question about what those factors are.

GUPTA: You know, everyone talks about the fact that we over- prescribe anti-depressants. I think every time we've talked about this topic, someone has written in and said that. What of it? Do we over-prescribe these medications? How do you know when you really need the medication?

DUNLOP: Well, that's a difficult decision, because it's not just the doctor's decision. The patient has to be willing to go along with what the doctor's recommending. The doctor may say, you know, psychotherapy would be the best option for you, talk therapy. But if the patient doesn't want to do it, what are you going to do? They're still suffering, they still want help.

What we know that is in mild depression, people on average do better with talk therapy than they do with medication. That's the average person. Now some people may need medicine in a mild depression. But in severe depression, people clearly need medication to get better nearly always, often in combination with psychotherapy.

GUPTA: There's so many antidepressants out there. If someone has severe depression, as a psychiatrist, how do you know which medication you're going to start with or which ones work best?

DUNLOP: Well, that's a real challenge. There is no indication that any one antidepressant is better than than any other. However, what we do know is that people have depression and anxiety combined, that serotonin drugs seem to be better treatments. So an SSRI like Sertalene (ph), which is Zoloft, or Fluxtene (ph), which is Prozac would be a better option than Vieproprion (ph), which is Wellbutrine (ph) in someone with mixed anxiety and depression.

GUPTA: Is there an option to try talk therapy always first? I mean do you say, look, let's always leave medication as a sort of a second resort. Let's try other things first. Or how quick are you to pull out the prescription pad?

DUNLOP: Well, it's a very challenging decision. And it really is something you work out with the patient. It matters with the level of distress they have, the level of thoughts of self harm they have. So generally, though, the greater the severity, the more I am likely to indicate we need to use anti-depressants from the beginning. And sometimes, that helps the talk therapy go better.

GUPTA: Not the last word, what do we need to do to get to that final word?

DUNLOP: Well, we need more research into the biology of placebo response, better design of clinical trials. And there are efforts underway at Emory and elsewhere to achieve that.

GUPTA: All right. Well, we will have you back to talk about, because we would like the final word one day hopefully on anti- depressants. Dr. Boadie Dunlop, thank you so much.

Now since the 1920s, 57 percent of presidents have been first- born children. Think about that. So does your birth order determine your success in life?

And pollen season, it's right around the corner. That's the bad news. The good news, your doctor may be better able to better diagnose your allergies. We'll tell you why.

Plus, what's in your drinking water? Probably not what you expect. Find out what's coming out of your tap. That's right after the break.

(COMMERCIAL BREAK)

GUPTA: Let's get to some medical quick hits now. The Senate plans to hold hearings next month. Get this, after the Associated Press found that tap water may contain drugs, such as antibiotics, estrogen, and painkillers. The AP investigation found trace amounts of medications had gotten into the water supply of at least 24 major metropolitan areas. And that potentially affects 41 million Americans.

And some shocking findings out this week. At least one in four teenaged girls has a sexually transmitted disease. That's more than 3 million teens. The study released by the Centers for Disease Control and Prevention found the most common virus in teen girls is HPV. That's the virus that causes cervical cancer. Health officials say they must do better in reaching at-risk teens. We'll continue to bring you the latest on both of these stories, as they develop.

Plus, relief is on the way for allergy suffers. New guidelines can mean better testing and better treatment. That story when HOUSE CALL returns.

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL. You know, spring is just around the corner and it marks the return of allergy season. For some people, that means stuffy nose, itchy, watery eyes, sneezing congestion. It can be awful.

Well, Judy Fortin tells us about different kinds of medications that do offer some relief.

(BEGIN VIDEOTAPE)

JUDY FORTIN, CNN MEDICAL CORRESPONDENT (voice-over): This tiny white pill, an antihistamine, may help allergy sufferers cope with their symptoms.

KATHLEEN SHEERIN, DR., ATLANTA ALLERGY AND ASTHMA CLINIC: It's like having a cold all the time. Your nose is stuffy, it's runny, it's itchy. And there's no reason to live that way.

FORTIN: Allergist Kathleen Sheerin says the expanded array of over the counter allergy medications offers relief for many of her patients.

SHEERIN: If you're an otherwise healthy young person, not with multiple medical problems and not taking multiple medication, then it's OK to try if you have the standard allergy symptoms.

FORTIN: She recommends patients with preexisting medical conditions such as high blood pressure or diabetes check with a doctor before self-medicating. Both over-the-counter medications and those available by prescription have potential side effects.

Antihistamines may cause drowsiness. Decongestants release stuffiness, but may raise blood pressure and cause insomnia. If all else fails, some patients rely on monthly allergy shots, which help increase their ability to tolerate an allergen.

Judy Fortin, CNN, reporting.

(END VIDEOTAPE)

GUPTA: All right, Judy, thanks. And new guidelines are out this week helping allergists determine just what you're allergic to. Well, we spoke to Dr. Martha White. She's director of research at the Institute for Asthma and Allergy and started by asking her about these new diagnosing guidelines.

(BEGIN VIDEOTAPE)

MARTHA WHITE, DR., ALLERGIST: The major value of the new guidelines is that they define for us within the realm of inhalant allergy testing, contact allergy testing, and then drug testing what works and what doesn't work. Many of the things mentioned are things that we've been doing for a long time, but they give relative value.

GUPTA: So why are the guidelines so important?

WHITE: It's an opportunity to take a look at the field of allergy and really define in one document what works, what doesn't, and how it works, and what's preferred.

GUPTA: What are some things patients need to know when they go to the allergist? WHITE: Be prepared for, usually a few hours. And if skin testing is done, it's usually done on the arm or the back. There's a few little pricks. It's not that terribly uncomfortable. And sometimes that will be followed up by injections under the skin to make sure that you don't have allergies that are being missed.

Alternatively, one can look at the blood and do RAS testing. That takes a little bit longer for the diagnosis to come back. Usually several days to a couple of weeks, but both methods work.

GUPTA: And here's a good question. Any new allergy breakthroughs or technologies on the horizon?

WHITE: There's a lot of work that's being done with what we call sublingual immunotherapy. You know, our traditional allergy shots are given by injections. And they work very well.

In Europe, they're using allergens that can be given under the tongue. It's called sublingual or split immunotherapy.

What the FDA is doing, actually, is they're working on standardizing the extracts themselves. So not only the concentration, but what's in the vial. And that's very important. That will allow people who are on allergy shots to be able to transfer to a different allergist and not have to start all over again, because of differences in the extracts that are being used.

So that is something that is an ongoing process that I think is very, very helpful for patients and for the allergy community in general.

(END VIDEOTAPE)

GUPTA: All right, Dr. White, thank you so much. Definitely some news we can use there. And in case you missed any part of today's show, not to worry. Check out my podcast for the HOUSE CALL highlights. It's free at i-Tunes or at CNN.com/podcast.

Now, stay where you are. Just ahead, new parents trying to do everything by the book. But how do you know the book is right? Just ahead, five reasons you might question those new baby rules.

And later...

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: I was 25 and I didn't think I was going to make it to my 30th birthday.

(END VIDEO CLIP)

GUPTA: She may have saved her life and in the process she became an ironman. Her story when HOUSE CALL continues.

(COMMERCIAL BREAK) GUPTA: We're back with HOUSE CALL. New parents want to do everything right. They often follow to a "T" what their pediatrician recommends. But there are times when your intuition can serve you just as well.

And Elizabeth Cohen is here with this week's "Empowered Patient." Aren't we supposed to listen to the pediatrician?

ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: You know what? You are. And so, I was actually surprised to hear pediatricians say sometimes you shouldn't listen to every single detail that we tell you. Or listen, but it's OK. And it's actually a good thing to question us. They said some of what we tell you you have to do. Your newborn has to go in a rear-facing car seat, no arguments.

But that there are other things that are a little more gray, but doctors sometimes say as if they're black and white. So let's take a look at two of them. We talk about five of them on our (INAUDIBLE) cnn.com. But let's talk about two of them now.

Sometimes a doctor will say after a certain age, don't pick your baby up if she cries at night, if she wants to eat or be comfortable. Don't do it. Teach her to sleep through the night. And really, that's one way to do it, but there are other ways that are just as good too. And different families use different approaches.

Also, even in this day and age, and I got to say, Sanjay, this sort of surprised me, is that there are pediatricians who will say a baby ought to be home with her mother or some other caretaker. Don't do daycare. And really, there's no science behind that. As a matter of fact, there's lots of science saying that daycare is OK. But some pediatricians, their opinion is that daycare is not OK. And you have to realize...

GUPTA: That's something to make parents feel guilty, too. I mean, you know, if they are leaving their kids with daycare. They need to be home with them.

Well, what about, you know, our kids had trouble with feeding. And you know, we asked our pediatrician, who's very good for advice. But what about feeding, absolutes there?

COHEN: You know what? There aren't a lot of absolutes with feedings. And that's an important thing for parents to remember. For example, doctors say that at around four to six months, babies should start taking solid foods. And that's a good suggestion. But some babies at six months, seven months, they're just not into it. They want the breast or the bottle. They don't want real food.

And so what pediatricians told me was if your baby's still not eating solid food at six, seven, eight months, bring them to me. I want to see them. But you know what? It's OK.

GUPTA: Right.

COHEN: The world's not going to end. We'll figure this out. GUPTA: But what about -- we get a lot of information, separating fact from fiction or fact from absolutes? How do you do that?

COHEN: Well, what you want to do is listen closely to what your pediatrician is saying. And don't be afraid to say, I hear what you're telling me, but can you tell me is this something I have to do? Or are there some other options, because I would prefer to do it this way. Toilet training is another area where that comes up. There are different ways to do it. And there's no one absolute.

GUPTA: And mom often knows best.

COHEN: That's right. That is true.

GUPTA: Knows the kids. Dad knows something, too.

COHEN: I think so.

GUPTA: Elizabeth, thanks as always. And make sure to check out the rest of Elizabeth's top five tips at CNN.com/empoweredpatient. Every week, she writes about ways you can empower yourself to get the most out of your health care.

Now with the presidential election looming, a closer look at the candidates according to birth. Elizabeth will be back for that. Does being a first born ensure a smoother path to the presidency.

Up next, though, she used to work up a sweat tying her shoes. Overcoming the odds. How a woman weighing 348 pounds got her life back. Stay with us.

(COMMERCIAL BREAK)

GUPTA: Welcome back to HOUSE CALL. Every week, we bring you weight loss success stories, proving that whether you have 20 pounds or 120 pounds to lose, you can succeed.

Sherry Coulombe, a schoolteacher weighing in at 348 pounds, could barely walk down the hall. She says her obesity was killing her. But then she made the decision to take charge.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): The ironman triathelon. Swim 2.4 miles, bike 112, and run a full marathon. It's grueling for anyone. But at 348 pounds, 29-year-old Sherry Coulombe never dreamed she could even come close.

SHERRY COULOMBE: My life was miserable. I couldn't walk down the hallway without losing my breath.

UNIDENTIFIED MALE: You know, there's a risk of getting hernias.

GUPTA: Her weight also interfered with her ability to get pregnant.

COULOMBE: That was the turning point.

GUPTA: She underwent gastric bipass surgery at DeKalb Medical Center in Atlanta, where doctors shortened her digestive tract to limit her calorie intake.

COULOMBE: By the time when I had the surgery I was 25. And I didn't think I was going to make it to my 30th birthday.

GUPTA: She lost more than 150 pounds in nine months, but it wasn't easy.

COULOMBE: You know, it's hard to go from eating a big plate of food mentally to eating something that fits inside of a dixie cup.

GUPTA: And there can be major risks involved with the surgery, such as anemia, vitamin deficiencies, and dumping syndrome, where the body passes food too quickly, causing nausea and weakness. Rarely bothered by side effects, Sherry is now almost 170 pounds lighter and an accomplished tri-athlete, something she never imagined possible.

COULOMBE: I'm still the same person, just a more confident person, a more active person, and a more healthy person.

(END VIDEOTAPE)

GUPTA: And you can read more about Sherry's story online at CNN.com/fitnation. Also, share your own weight loss story by submitting an i-report on the "Fit Nation" Web site. It may just end up being profiled.

What do George W. Bush, Bill Clinton, Jimmy Carter, and Gerald Ford all have in common besides being president? Well, it has to do with their birth order. Can you guess? Learn who might have a leg up this political season just ahead.

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL. You know, with the presidential election looming, Elizabeth Cohen takes a closer look at candidates according to birth. Does being a first born ensure a smoother path to the presidency?

(BEGIN VIDEOTAPE)

COHEN (voice-over): What do Hillary Clinton, Barack Obama, George W. Bush and Gerald Ford have in common? They're all the eldest children in their families.

KEVIN LEMAN, PSYCHOLOGIST: The first born's rule.

COHEN: Literally, they do. In the past 70 years, more than half of U.S. presidents have been first borns.

LEMAN: They tend to dominate. They tend to control. They tend to be opinionated. COHEN: Psychologist Kevin Leman wrote the book on birth order. He points out that four of the past six presidents have been eldest children. George W. Bush, Bill Clinton, Jimmy Carter, and Gerald Ford. George H.W. Bush was second of five and Ronald Reagan was the baby of the family.

Even among people who try to become president, first borns rule at least this season. Eight of the 11 major candidates who started the 2008 race are eldest or only children. John McCain is not. He's a middle child.

Leman says leadership comes naturally to first borns. After all, they had to take care of younger siblings. And a new study from Brigham Young University says first borns with one sibling get more time with mom and dad. About 20 minutes more quality time per day with dad and 25 more minutes with mom. There are many who say this birth order stuff is squishy science, that the research is flawed and paints families with too broad a brush.

JOE RODGERS, PSYCHOLOGIST, UNIVERSITY OF OKLAHOMA: There are many first borns who are natural leaders, but there's nothing about being first born that automatically leads to leadership.

GUPTA: Others beg to differ. They point to studies showing first borns are more likely to be CEOs, surgeons, MBAs. While birth order certainly can't predict the presidential race, history shows it's a factor.

Elizabeth Cohen, CNN, Atlanta.

(END VIDEOTAPE)

GUPTA: Thanks, Elizabeth.

Stay with CNN for unparalleled political coverage and check out the most viewed political blog on the web. It's the political ticker at CNN.com/politics. Also, make sure to tune in next weekend for a very special HOUSE CALL. We're going to be providing weight loss inspiration and practical tips so you can be ready for spring for summer.

Remember, this is place for all your 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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