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Sanjay Gupta MD

Investigators Trying to Figure Out Salmonella Outbreaks; Stroke Caused By Chiropractic Adjustment; Caffeine and Your Health; Medical Trials: What You Should Know Before You Turn Your Body Over to Science

Aired June 28, 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: Good morning, welcome to HOUSE CALL. So many important things to share this morning.
We've been hearing a lot about salmonella over the last several days. We're going to take a look at how investigators are trying to figure it all out. And I'll tell you what you need to know, what you're thinking about the next time at the grocery store.

And get this. A stroke caused by chiropractic adjustment. This is a story you're going to have to hear.

And moms trying to keep up any way they can. Caffeine can help. Sometimes caffeine can be a problem for your health. But do you really know what it's doing to your body?

And finally, a topic I quickly wanted to talk about for some time, medical trials. They can be the best hope for desperate patients, but what should you know before you turn your body over to science? The questions you need to ask, those are coming up.

But first, we start with another outbreak. This one was big. More than 700 people in 34 states becoming sick of salmonella in tomatoes. Here's what we know. Right now, investigators are in Mexico and Florida trying to track down the cause and origin of the outbreak. At this point, they still don't know. And officials at the Food and Drug Administration acknowledge they may never know the exact cause. That's because if you look at it, tomatoes actually move through a pretty complicated supply chain.

We sat down and talked to a food safety expert, who points to what he thinks the problem is.

(BEGIN VIDEO CLIP)

MICHAEL DOYLE, UNIVERSITY OF GEORGIA: There is not a system in place that will enable trace back of tomatoes. What happens is tomatoes may be repackaged from one country or one source and in another source and repackaged in containers that are not necessarily labeled as the to the location in which these tomatoes have been grown and further processed.

That's the reason it's been so difficult for our Food and Drug Administration, but hopefully, it will be a lesson learned that will enable the FDA to develop criteria for the produce industry. (END VIDEO CLIP)

GUPTA: Now in case you're worried, tomatoes will be back in restaurants and in produce departments. If you're really concerned about it, you can check the FDA Web site and find out which tomato growing regions are still deemed safe.

An estimated 20 percent of American adults have received chiropractic care at some point during their lives. Does that surprise you? It surprised me a little bit. A lot of times, it brings significant relief of lower back and neck pain. Well, like most things, there can be risks, significant risks.

Take a look.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Britt Harwe hasn't always been this way. A stroke left her weak on one side, unable to eat or swallow and blind in one eye. She blames it on a simple visit to her chiropractor.

BRITT HARWE, STROKE VICTIM: You can do the manipulation. Immediately, I felt a rushing in my head, the sound. I couldn't speak.

GUPTA: Doctors say Britt suffered from a partebo basular (ph) stroke, caused by excessive neck manipulation to the spinal column.

MICHAEL BATIPPS, DR., NEUROLOGIST: Manipulation of the neck should be done by someone who's very expert in it and someone who knows how to take the proper precautions.

GUPTA: Many chiropractors successfully use this form of therapy to ease neck pain. Sometimes when the neck is improperly twisted, the bones that protect the parteo arteries that go up the back of the neck can pinch or snap, causing a kink in those arteries. They can produce blood clots. Once they become loose, they travel to the brain, causing a stroke.

BATIPPS: Because not only is there the theoretical possibility of kinking of the (INAUDIBLE) artery, which is somewhat rare, there's also the possibility of kinking the spinal cord.

GUPTA: Advocacy groups say stroke caused by neck manipulation, though still rare, is on the rise because the use of chiropractic treatment is also on the rise.

The American Chiropratic Association is aware of the problem and has updated its Web site with consumer information on what to look for in a licensed chiropractor.

KEVIN CORCORAN, AMERICAN CHIROPRACTIC ASSN.: This is part of an ongoing campaign that we've had to make sure that a patient understand all the risks and the opportunities of chiropractic care.

GUPTA: Britt sued her doctor and settled out of court. She's now involved with the chiropractic stroke awareness group. That's an organization that alerts people of the risks of stroke and chiropractic care.

Licensed chiropractors are required to attend an accredited chiropractic school for two to four years and take state approved exams. The group reminds that chiropractors are not medical doctors, don't have to pass the same tests as physicians in order to hang up a shingle.

HARWE: People need to know that when you're using the type of actor, is it a medical degree? That's why it's so important that they need to specify that their doctor's a chiropractic.

GUPTA: A fact that Britt believes could have changed her life had she known that more than a decade ago.

(END VIDEOTAPE)

GUPTA: So could it happen to you? That's what you're probably wondering. We're going to have some answers. We're going to give the chiropractor their chance to respond. That's in 60 seconds.

And later, caffeine and your health. How much is too much? Stay tuned.

(COMMERCIAL BREAK)

GUPTA: We are back with HOUSE CALL. Before the break, we brought the story of Britt Harwe. She suffered a stroke after an adjustment at her chiropractor's office. She settled her lawsuit, but as we investigated, we found there are hundreds more like it in litigation as things stand right now.

Millions turn to chiropractors for the treatment, the successful treatment of pain. But just how safe are they? We want to get to the bottom of this. So helping us is Bill Lauretti of the New York Chiropractic College. Thanks for joining us.

BILL LAURETTI, NY CHIROPRACTIC COLLEGE: Thank you for having me this morning, Sanjay. Nice to be here.

GUPTA: Yes, you're welcome. You heard that story about Britt Harwe. As a chiropractor, what did you think?

LAURETTI: Well, I'll say that any time that a patient gets injured by any medical treatment, it's a tragedy. It's a tragedy for all involved, a tragedy for the patient, a tragedy for the loved ones of the patient, and a tragedy for the doctors involved also. Certainly all of us who have chosen to pursue a career in healthcare have done so because we want to help people.

GUPTA: Right.

LAURETTI: And any time a patient is injured, it's a terrible thing. And it's something to be taken seriously. GUPTA: You know, we've got a lot of response, that piece that first aired. To be fair, there are good doctors, bad doctors, good chiropractors, bad chiropractors, like anything. But how do you know? How do you know someone's actually going to be qualified as a doctor of chiropractic care? How strict are the regulations?

LAURETTI: They're actually quite strict. Our educational requirements are quite vigorous. All of the applicants to chiropractic school have to have a minimum of three years of undergraduate, including many of the basic sciences: chemistry, biology and so forth.

Then our professional education is five very vigorous academic years, full time education, including both the clinical sciences, diagnosis, x-ray, technique and so forth, as well as the basic sciences, physiology, human dissection, biochemistry, and so forth.

GUPTA: Does this sort of thing happen? I mean, you know, with Britt Harwe, obviously it happened to her, but I mean it seems to me that this is potentially something that could happen to other patients? How do you -- how does a patient know that this is not going to happen? How do they protect themselves?

LAURETTI: Well, you know, certainly we can look at these individual anecdotal cases and say they're tragic, but I think we have to look at maybe a little bit more scientific data to get a better idea of what's going on.

Certainly all of the studies that have been done on this topic, all show that this is an extremely rare phenomenon. Somewhere in the range of between one and one million to one in five million chiropractic neck treatments.

With that said, there's also some real questions coming with some of the more recent research whether or not there's really a cause and effect here, or whether it's a coincidence.

GUPTA: Right.

LAURETTI: Some of the more recent studies have shown that maybe these patients are going to the chiropractor with neck pain and headache, which by the way, is one of the only early symptoms of this type of stroke. And the chiropractor gets blamed for causing the stroke, whereas the patient may have gone to their medical doctor as well...

GUPTA: Right.

LAURETTI: ...and just as easily had this stroke if nothing was done to their neck.

GUPTA: OK, so you know, we have found as we investigated this, there are hundreds of lawsuits pending out there. You probably know about a lot of these yourself, but people who watch a segment like this, they think OK, I like chiropractors. I get relief from them, but I want to know what the red flags are. Quickly, what are some of the red flags?

LAURETTI: I'd say a red flag that suggests that something's unusual from neck pain or headache, if that's what you have, would be any sort of nerve conditions, whether it's tingling, radiation into the arms or legs, that's something you should be concerned about.

Also, the biggest red flag that I teach my students is any time a patient walks in saying they've had the worst headache ever, or they've had an unusual type of headache, or an unusual type of neck pain, that could be an early warning sign that something else is going on.

GUPTA: All right. Bill Lauretti, I appreciate your coming on the show. This is something we got a lot of response to. And I'm a neurosurgeon, you're a chiropractor trying to relieve people of their pain. I really appreciate it. Thank you very much.

LAURETTI: Thank you very much.

GUPTA: Now coming up next, we have some shocking new estimates about the number of people living with one chronic and incurable disease. I was actually stunned by these numbers. You have to hear that.

And also...

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: The jitteriness, the nervousness of feeling that the heart may be racing a little bit or even skipping a heart beat every now and again.

(END VIDEO CLIP)

GUPTA: Find out what that daily dose of caffeine is really doing to your body. We're making a HOUSE CALL. Stay with us.

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL. It's time for a check of the medical headlines. First up, we got some unsettling new numbers about the number of Americans with diabetes. Get this, the Centers for Disease Control says 8 percent of Americans or 24 million people are currently living with the disease. That's actually up 15 percent from 2005. Now, most cases are Type 2 diabetes. That's the type that's related to obesity as opposed to Type 1. That's the type that you're born with.

You may know that diabetes can put you at risk for conditions like heart disease and stroke. And experts stress maintaining a healthy diet and talking with your provider about how to keep your blood sugar under control is key.

Also in the news, a recent study finds people with low levels of Vitamin D are increased risk of death from all sorts of different causes, especially heart disease. The study found that more than half older Americans actually have insufficient levels of Vitamin D.

Now besides heart disease, Vitamin D levels lower than 20 to 30 nanograms per milliliter, that's how they measure it, have been associated with immune dysfunction, high blood pressure, bone fractures and cancer, you name it. Remember, though, it's not hard to win this one. Foods like tuna, eggs, milk, which naturally contain Vitamin D, sun exposure, and of course, Vitamin D supplements as well, can all help boost your levels. Some good news there.

Now onto something that gives many of us a boost, caffeine. Sales of caffeinated drinks have skyrocketed. They've gone up a lot in recent years. The industry estimates 17 percent of adults consume at least one gourmet coffee every single day. That's not cheap. And with their demanding schedules, busy moms are no exception.

Here's the thing. Those daily energy boosts may trigger some unwanted health effects.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): How much caffeine is too much?

UNIDENTIFIED FEMALE: I have about 40 (INAUDIBLE) a day. So I'm drinking coffee every waking hour.

GUPTA: These moms, who are also CNN i-reporters are fairly typical caffeine consumers. A national seed foundation found more than 65 percent of mothers drink caffeinated beverages to get through their day.

STACY DEBROFF, MOMCENTRAL.COM: We are facing the busiest generation of moms ever. We dash from place to place. We find ourselves always on the go and usually with a cup of coffee in hand.

GUPTA: But here's the thing. Research shows caffeine can trigger migraines, heartburn, put women at increased risk for miscarriage.

ALLEN DOLLAR, DR., EMORY CARDIOLOGIST: The jitteriness, the nervousness, of feeling that the heart may be racing a little bit or even skipping a heartbeat every now and again, you know, those are very common short term side effects of caffeine. And again, the good news is there are no serious health consequences to that either in the short or the long term.

GUPTA: So there are no serious long term health effects, but relying on caffeine for energy drains the body, because it never gets a chance to properly recharge.

DEBROFF: Take advantage of small breaks in the action. Sometimes you only have 10 minutes as a mom. And you have to think of what can I do to restore my energy so I can then get ready to go forth on the next mom mission that awaits me.

GUPTA: The key of course is moderation. Experts agree 200 milligrams of caffeine a day is safe. That's between one and four drinks, depending on how you choose to caffeinate.

(END VIDEOTAPE)

GUPTA: Now keep in mind something as well. It takes about five hours to get rid of the caffeine you just had. So bottom line, go to bed at 11:00, no caffeine after 6:00. You sort of get the idea. You can do the math.

Up next, reaching new levels in clinical trials. We're going to give you the scoop on the right questions to ask before signing up. And later in the show, a woman's embarrassing moment that made her change her life forever. You'll want to hear the story. Stay with us.

(COMMERCIAL BREAK)

GUPTA: You know, we talk a lot about clinical trials on this show. And for good reason. It can sometimes be the best hope for struggling patients. Now researchers are going to new levels to find people to participate in their trials on everything from rare cancers to excessive sweating.

But before you sign up, what questions should you be thinking about? Get your pen and paper out, Elizabeth Cohen is here with this week's "Empowered Patient."

ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: Sanjay, I'm amazed. Maybe it's just me, but I've seen signs all over the place trying to recruit people...

GUPTA: Right.

COHEN: ...for clinical trials. In my doctor's office, there are little posters saying hey, can we use you for a study of radio stations like your ads when I am driving home? And so you have to wonder do I want to join this study? There are some pros.

One of them is you could make hundreds or even more than $1,000 for being a study subject. And you're helping mankind. And you may also get a treatment that could be good for you, but there are some cons. It's an experimental treatment. They don't necessarily know a whole lot about it.

So let's take a look at some questions you should ask before you join a clinical trial. One, ask what are the side effects of the experimental treatment that I could be receiving? And two, what happened to other study subjects who had the same treatment?

I mean, you know, Sanjay, chances are if you're joining a study, you're not the very first person...

GUPTA: Right.

COHEN: ...to get that. They're probably people proceeded you. And if people didn't proceed you, probably animals proceeded you...

GUPTA: Right, right, right.

COHEN: ...that you could ask, gee, what happened to them?

GUPTA: Although there is that first human, I guess...

COHEN: There always is, right exactly.

GUPTA: But hey, you know, is someone overseeing it, sort of generally to make sure that it's safe?

COHEN: Well, the folks who run the study definitely are supposed to have your safety in mind, but as a bioethicist put it to me, the doctors running the study, their first concern is to get data. Their second concern is you. Technically, you're not really their patient. So you should run any clinical trial by your own doctor, who does put you first. And you should remember the FDA does oversee clinical trials, but there certainly have been some concerns that they don't do that as well as...

GUPTA: Yes, you've reported on some of that.

COHEN: Yes.

GUPTA: And I have as well. Thanks, really good stuff, Elizabeth.

COHEN: Thanks.

GUPTA: Thanks as always. Check out her column as well for more tips about being a patient in a medical study. That's at cnn.com/empowered patient.

So got some sleep problems? I do. And so do most of the producers on this show actually. No surprise. Sleep problems are a big issue. So we've been doing some digging, found some natural solutions that may help you on answering your questions. My favorite segment, ask the doctor.

But first, how stopping to fill up her gas tank ended with an experience of change this woman's life. I'll tell you what I mean. Stay tuned.

(COMMERCIAL BREAK)

GUPTA: And we are back with HOUSE CALL. Sissy Lusk tried every fad diet you could possibly imagine. Sound familiar? And the story goes that one day, she was standing in line at a gas station when something happened there that changed her life forever.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Sissy Lusk's family always struggled with their weight. So when she started gaining as well, her mother was concerned.

SISSY LUSK: Mother was overweight. And a couple of my siblings were. And so constantly my mom was on diets. And she put me on diets right along with her.

GUPTA: Together, they tried everything from shakes to pills to the latest fad diet, but Sissy kept gaining.

LUSK: Somebody's asked me once before how in the world did you get that big? One pound at a time. But then one pound becomes two and two becomes 10 and 10 becomes 20.

GUPTA: At her heaviest, she weighed 345 pounds. But one hot summer day, Sissy found the inspiration she needed in the least likely place.

LUSK: I was in a gas station. I was paying for some gas. And a little boy behind me with his mom looked up at me and said why are you so fat? And I just thought I was going to die. That was the moment that I thought I can't live this way anymore.

GUPTA: So she joined Weight Watchers. And just as she had gained the weight pound by pound, she lost the weight. It's been six years since that day at the gas station.

LUSK: I owe my life to that little boy and his mom for humiliating me.

GUPTA: Sissy says she also owes quite a bit to Weight Watchers and has been trying to repay that debt teaching every day.

LUSK: I lead 14 meetings a week. And it gives me a real sense of purpose in life that I can help other people be who they want to be.

My name is Sissy Lusk and I've lost 215 pounds.

(END VIDEOTAPE)

GUPTA: And doesn't she look great. That's wonderful.

Here's a question for you. Does milk really help you sleep at night? My kids think so, but how about you? "Ask the Doctor," that's next.

(COMMERCIAL BREAK)

GUPTA: And it is time for our segment "Ask the Doctor," a chance for you to ask your own medical questions.

And here's one from Mollie in Hot Springs, South Dakota. She writes this. "Why are we so concerned about circulatory problems on airliners? How about people who sit confined to wheelchairs for years?"

It's actually a great question. And here's what a lot of people don't know. Experts used to think that it was something about the change in the cabin pressure on a plane that caused DVT or deep pain thrombosis. That's actually not the issue. It's really just sitting for a long period of time like your question states. You're absolutely right. People confined to a bed or those in wheelchairs for years can suffer DVT as well.

They can take a low dose of an anti coagulant or a blood thinner to try and prevent those clots from happening. But for people on airline flights, you can prevent DVT by keeping more hydrated, getting up walking around, just pumping your legs and feet when sitting for extended periods of time. It's a great question there.

Another question now, this one from our roving camera.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: Are there any natural medicines to help me sleep better at night?

(END VIDEO CLIP)

GUPTA: Great question, a question that we get a lot of. You could actually take a few different supplements. The herbal supplement chamomile, for example, the FDA considers safe. We did some homework on that. Some find it helps with insomnia.

Also, the hormone melatonin is thought to regulate your internal clock. It can be helpful for people doing shift work, however it can interact with some drugs, so make sure to tell your doctor before you take it.

Plus, certain foods. Just foods may help. For example, milk and turkey contain tryptophan. That's an amino acid with sedative like effects. That certainly helps some people go to sleep. You remember that from your holiday dinners for sure.

Well, unfortunately, that's all the time we have for today. Remember, this is the place for the answers to all of your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. More news now on CNN starting right now.