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HOUSE CALL WITH DR. SANJAY GUPTA

How Much is Health Care Reform Going to Cost?; A Possible Natural Way to Lower Bad Cholesterol; A Doctor's Note Could Get You Marijuana

Aired June 27, 2009 - 07:30   ET

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


DR. SANJAY GUPTA, CNN HOST: Good morning. Welcome to HOUSE CALL: The show that helps you live longer and stronger. I'm Dr. Sanjay Gupta. Thanks so much for watching.

First up: show me the money. How much is health reform going to cost? Who's going to pay for you? Most importantly, how's it going to affect you?

Plus -- is there an alternative to statins? There is a possible natural way to lower bad cholesterol. This is something that caught my eye.

And a doctor's note used to get you out of school, now it could get you marijuana. But does everyone who has the note really need the pot?

You're watching HOUSE CALL.

(MUSIC)

GUPTA: We start, though, with the serious debate proposals and deal-making that are going on right now in the halls and the committees of Capitol Hill. All of it aimed at reforming health care. It is that time.

CNN's congressional correspondent Brianna Keilar is here with the latest -- Brianna?

BRIANNA KEILAR, CNN CONGRESSIONAL CORRESPONDENT: Sanjay, a key breakthrough this week with the Senate Finance Committee -- this is the committee seen as the best chance for getting an overhaul, a health care overhaul plan that has bipartisan support.

An announcement came from Senator Max Baucus -- chairman of this committee -- that they have pared down the price tag of their plan to about $1 trillion. They trimmed off about $600 billion from the previous week. This is a big development and a step towards finding a bipartisan deal on exactly what will go into their health care plan.

So, how exactly are they going to pay for this $1 trillion? Well, CNN has learned from senior Senate sources familiar with these negotiations that half of it, about $500 billion of it, will come by cutting government spending -- perhaps through cutting payments to hospitals that treat uninsured patients, the idea being, more people will be insured so that will be less of a burden for them. And also, cutting Medicare advantage programs, trims to the supplemental -- the supplemental Medicare coverage provided through private insurers.

These sources also say the other $500 billion will come through raising taxes. For instance, by charging penalties to people who decline to get insurance, by charging penalties to employers who decide not to contribute to their employees' health insurance -- and most significantly, by taxing employer-provided health benefits.

So, this announcement this week of this trimmed-down price tag, $1 trillion, really a key development. But it is not a deal. We understand that these key Democrats and Republicans are looking at the idea of a "health co-op" instead of the government-run insurance plan that many Democrats favor as the middle ground that they can find for some bipartisan support for their health care plan. But we don't have the details of that. And we're expecting not to get those details until after Congress' week-long July 4th recess, Sanjay.

GUPTA: All right, thanks.

You know, we've been hearing a lot from Congress and the president. But we also wanted to hear from you, our viewers. After all, your health could be affected by whatever is decided in Washington. So, we asked you what you were with looking for in health care reform.

Suepreziatti twitted this, "Health decisions made by doctors, not insurance companies; government plan offered for those who can't afford coverage.

Tdan67 writes, "A discussion about getting serious about prevention and not treating disease, treating disease is not working." I got to agree with that one. Obviously, it makes a lot of sense to keep people from getting sick in the first place.

From the blogs, Larry writes, "There's a solution here. It's probably right in front of our faces, as usual. Insurance companies need to start giving people the coverage they pay for, and hospitals need to get real about their charges. You don't charge $56,000 for a procedure that should only cost $5,600."

Also, reacting to this week's ideas for how to pay for health care reform, Ambersmith twitted this, "Don't want to be taxed for my health benefits." And another, a terminology choice in doctor's choice and plans, "Affordability but no tax increases," was another tweet.

And if you want to become part of the conversation, you can follow me at Twitter.com/SanjayGuptaCNN. Also, e-mail us HouseCall@CNN.com.

Now, if all the talk about health reform leaves you with more questions than answers, you're in the majority. It is a complicated issue -- one of the most complicated of all issues. And we've been doing a lot of reporting on this.

And this week's Empowered Patient column, Elizabeth Cohen has compiled the list of top 10 questions or top questions viewers are asking.

You know, you and I talk about this a lot. It is complicated. And there's not a lot of details yet. So, maybe more questions than answers right now. What are some of the top questions?

ELIZABETH COHEN, CNN SR. MEDICAL CORRESPONDENT: Well, obviously. In all the terms that you hear thrown around ...

GUPTA: That's right.

COHEN: ... there's so much confusion.

GUPTA: Yes.

COHEN: One of the questions that I get a lot is about people -- is from people with preexisting conditions. People with preexisting conditions, if they don't get insurance through their employer, they have a terrible time getting insurance, in fact, most of them can't. So, I've been getting a lot of questions, "What does health care reform mean to me if I have a preexisting condition?"

And it's interesting. President Obama addressed that at a town hall meeting in Wisconsin last week, and he says that under his plan, no insurance plan would be able to deny coverage on the basis of preexisting conditions.

So, it's interesting. If he gets what he wants, that would be great, right, for these people. But he hasn't included any details. How is he going to do this?

GUPTA: Right.

COHEN: How is going to wave his magic wand and tell insurance companies, "You've got to take all comers, even people with preexisting conditions"? That's going to be tough.

GUPTA: It's a pure financial decision for the insurance company.

COHEN: That's right. Absolutely.

(CROSSTALK)

GUPTA: Yes. But it is hard to get those questions because you know that they're really struggling. They need to get insurance somehow.

What about people with insurance? Are you getting questions from them as well?

COHEN: Right. I think it's important to remember that most Americans do have health insurance and that most of those people get it from their employers. So, that's a good thing. So, if you're happy with the insurance you get from your employer, what does health care reform mean to you?

Now, President Obama would say that under his plan, it wouldn't mean anything to you. You would stick with the coverage you have. However, some Republicans and other folks say, wait a minute. President Obama's plan to have a government-sponsored health insurance program will crowd out all of the private options.

It will be so cheap that employers will go for it in this page (ph) and that they won't -- the employers won't select private insurance companies anymore; and the fear is that the government- sponsored insurance won't be as high quality as the private insurers. So, there -- you know, there's an excellent chance that all of us will have pretty different insurance in a couple of years than we do now.

GUPTA: A lot of people are trying to predict the future here. Who knows what's going to happen?

COHEN: It's hard to do.

GUPTA: We've been down this road for several decades. And who knows if we're going to see health care reform or not. A lot of people are optimistic about it, though.

COHEN: I think so. I think it's different than in '93. I think in '93, there wasn't the kind of consensus that we have now. In '93, there was sort of a feeling of everyone was off in their own direction.

And now, there's sort of a consensus. We've got to do something because the situation is so bad. We don't agree on what should be done, but I think everybody agrees something has to be done.

GUPTA: That's right. And the president speaking to the AMA, insurance companies, trade unions -- a lot of people coming together.

COHEN: Right. Trying to bring people together.

GUPTA: We'll follow it. Thanks a lot.

COHEN: Thank you.

GUPTA: And you can also follow Elizabeth's column. It's going to break down more of the most frequently asked questions about health care reform, really good stuff. Visit the Web site: CNN.com/EmpoweredPatient.

What does it take to get marijuana? In a few states, it's doctor's notes. How tough is it really? We're going inside a so- called pot doc's clinic.

Stay with HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: And we are back with HOUSE CALL.

The death of pop icon Michael Jackson at the age of 50 left all of us stunned at HOUSE CALL. And an autopsy performed on Friday left us asking a lot of questions -- more questions than answers. And that's really not unexpected. In fact, you could take it a step further and say, there's a good chance we may never know what caused the death of Michael Jackson. Here's what we do know: Paramedics and doctors at UCLA say Michael Jackson suffered from sudden cardiac arrest.

Now, one thing that's important to point out is that this is different than a heart attack. A heart attack, when you don't have enough blood flow to the heart, can cause a sudden cardiac arrest, but so can many other things, including a sudden electric abnormality with the heart, medications -- both prescription and nonprescription medications -- can cause this, as well as other things including an imbalance of electrolytes in the body.

Now, autopsy is performed, but it could still take six to eight weeks for toxicology reports to comeback, measuring the amount of medications in his blood, in his urine, in his tissues, both current and how much is built up over time as well.

But even with all of that information, again, it maybe very unlikely that they're going to develop a cause-and-effect relationship between what happened to Michael Jackson and what caused his death.

HOUSE CALL is back in 60 seconds.

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL.

You know, inspectors at Veterans Administration medical centers are finding some dangerous problems -- problems that expose patients to certain diseases, including HIV. Lawmakers are demanding answers.

And CNN senior medical correspondent Elizabeth Cohen is on the story.

(BEGIN VIDEOTAPE)

COHEN (voice-over): The V.A. conducted surprise inspections at 42 of their clinics and hospitals last month and found that fewer than half of them followed proper standards for colonoscopies and similar procedures.

At a Capitol Hill hearing, lawmakers questioned the competency levels of the Veterans Administration and those responsible for handling colonoscopy equipment.

REP. DAVID ROE (R), TENNESSEE: It's one, two, three, four. It isn't hard.

UNIDENTIFIED MALE: Right.

ROE: It's not rocket science.

COHEN: The V.A. inspections were part of a follow-up after revelations earlier this year that improperly handled equipment during routine colonoscopies possibly exposed thousands of vets to infectious diseases. Of the more than 10,000 vets called in for screenings, so far, six have tested positive for HIV, 34 for Hepatitis C and 13 for Hepatitis B.

Congress and the inspectors say these infections were not necessarily a result of the colonoscopy procedure. The vets might have become sick some other way. But when lawmakers questioned whether vets undergoing the same procedure today are safe, there were no guarantees.

DR. WILLIAM E. DUNCAN, DEPT. OF VETERANS AFFAIRS: I cannot guarantee to any veteran that they will not have an adverse event occur in our facility. I can guarantee that we are dedicated and committed to reducing those adverse events to the lowest possible level.

COHEN: And for Congress, that's just not enough.

REP. TIMOTHY WALZ (D), MINNESOTA: I know we talk about things like adverse events. Going in for a routine colonoscopy and being contacted later that you are HIV positive or Hepatitis C is not just an adverse event. That is absolutely catastrophic.

COHEN: Elizabeth Cohen, CNN, Atlanta.

(END VIDEOTAPE)

GUPTA: Now, you know, we should point out that the Veterans Administration is being commended in some quarters as well for being so open about all of these results.

(MUSIC)

GUPTA: Here's a story I really want to talk about. Some renewed hope for millions of Americans taking statins to reduce bad cholesterol, but who also suffer muscle pain and weakness as a result of the medications. New study out there says a dietary supplement red yeast rice could be a good alternative. Red yeast rice is derived for fungus grown on rice and is a dietary staple in some Asian with countries.

Now, this is a small study, just 62 patients, but found those who took three 600 milligram capsules red yeast rice capsules twice a day for 24 weeks were able to lower bad cholesterol by 27 percent. In fact, after only 12 weeks, and only two participants experienced the muscle pain and weakness that we talked about earlier.

Now, the National Institute of Health says there is strong scientific evidence for the use of red yeast rice, that's a supplement containing naturally occurring levels of reductase inhibitors. What it basically does, how it works -- it slows down the production of cholesterol in the body.

Of course, whether we're talking about statins or supplements, drugs can only do so much. All of the patients in this study were also enrolled in a diet and exercise program to help improve their cholesterol levels. If lowering cholesterol is on your to-do list, be sure to talk to your doctor about the best options for you.

Next: weight loss surgery through your mouth. We're going to show you how the procedure works.

Plus: using medication for pain versus just wanting to get high. Prescribing marijuana -- that's ahead on HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: Welcome back to HOUSE CALL.

You know, obesity, in many ways, starts with your mouth. The more food you put in it, the more weight you can gain. Now, a new procedure is using the mouth to help people lose weight. It's called transoral gastroplasty, TOGA for short. And it could revolutionize the way gastric surgery is done.

I want to show you this animation to sort of explain what's happening here. There's a device that goes right into the esophagus into the stomach -- as you see here. It actually uses some suction to pull the stomach closed and this is actually a staple device. Staples are placed across the stomach creating a small pouch -- as you see there.

What happens as food comes in, it takes a long time to get to the stomach. You get a feeling of fullness much quicker. And that's how this procedure sort of works.

I want to give you a little bit of a -- just a sake of reference here in terms of a traditional bypass operation. When you look at that, you're looking at the esophagus here, the top of the stomach, what they do is take a small piece of the intestine, the small intestine and loop it up over here. Food comes through the esophagus, as you see there, and instead of passing into the stomach, it actually goes almost directly into the small intestine. That is called a gastric bypass operation.

Just one more, in the sake of completeness here, something known as a lap band procedure. That is the band. It causes a little bit of constriction there. So, again, you're creating a smaller pouch, tougher for the food to get through. And that is how most of these procedures work.

Now, the TOGA procedure is still in clinical trials, but the early results are very good. The study shows that after a year, the average amount of weight loss was right around 45 percent of excess weight, better than the numbers for the lap band operation.

Also, keep in mind -- no incisions here. This is all through the mouth. That's major benefit when you talk about recovery. But, it is still in trials. We probably are not going to know for a couple of more years how successful these patients will be at losing weight and, most importantly, keeping it off.

Now, doctors prescribing marijuana. Do patients need it or do they just want to get high? We're going to go inside a clinic. We're telling all the guys -- and those who love them as well -- what men need in order to live their healthiest lives ever. That's next on HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL.

You know, this week, Rhode Island joined California and New Mexico to became the third state to legalize the selling of marijuana for medical purposes.

But are patients who get marijuana prescriptions really sick? How do you know?

Dan Simon takes a look at the whole screening process.

(BEGIN VIDEOTAPE)

DR. ALLAN FRANKEL, GREENBRIDGE MEDICAL: So it's pain, anxiety, insomnia.

UNIDENTIFIED FEMALE: And depression.

DAN SIMON, CNN CORRESPONDENT (voice-over): Dr. Allan Frankel was a so-called pot doc. On a typical day, he says he'll see 13 patients at his Marina del Rey office and recommend they use marijuana to help them with their various aches and pains.

FRANKEL: I'm not trying to get patients stoned. I'm trying to get patients to feel normal.

SIMON: Instead of a prescription to obtain medical marijuana, a patient needs a doctor's formal recommendation, a letter. It's how you get inside one of the state's hundreds of dispensaries. You need to be at least 18, minors can get it if their guardian approves.

Dr. Frankel started his practice three years ago after nearly 25 years working as a regular is internist.

FRANKEL: I think it's the greatest medication I've ever worked with. I really do.

SIMON: For those who want it, getting access to medical marijuana in California is relatively easy.

CHRIS PEREZ, PATIENT: I'm here to sign up for a new patient.

SIMON: Chris Perez is a typical new patient, complaining of insomnia and depression.

(on camera): How does marijuana help you?

PEREZ: It calms me down. It eliminates the confusion and the congestion out there. SIMON (voice-over): After a 45-minute appointment which includes a thorough briefing on the types of marijuana, Dr. Frankel gives him the recommendation.

PEREZ: I'm legal. I can legally do this now in the state of California.

SIMON: Finding a pot doc in L.A. is like trying to find a plastic surgeon in Beverly Hills. They're everywhere, in the classifieds and on the Web.

Dr. Frankel charges his new patients $200. By law, the recommendation can only be good for up to a year. Patients then have to go back to the doctor to get a renewal. It's a system that is also being fueled by the explosive growth of dispensaries.

(on camera): There are more than 600 in Los Angeles alone. To put that number in perspective, there are more dispensaries here that Starbucks, 7-Elevens and even McDonald's.

(voice-over): That's not what architects of the medical marijuana law, like Revered Scott Imler, envisioned when California voters passed it in 1996. He says the dispensaries today are a little more than dope dealers with storefronts.

REV. SCOTT IMLER, CO-AUTHOR OF PROP. 215: That just wasn't the intention of Prop. 215. It was to get people off the black market, not to institutionalize the black market.

SIMON (on camera): Even Dr. Frankel estimates that about half of those buying medical marijuana are doing so just to get stoned. He says those users harm the industry and make it difficult for marijuana to be viewed as legitimate medication. At the same time, though, he says there's little doctors can do to combat misuse.

FRANKEL: It's true. Will people lie? Yes. They'll lie to get anything. I am not that concerned about that, because what they're just getting is cannabis.

SIMON: Getting cannabis. At its worst, California has created a system with plain-old drug abusers hiding under the cover of state laws; at its best, medication to help people manage their pain.

Dan Simon, CNN, Los Angeles.

(END VIDEOTAPE)

GUPTA: All right. Dan, thanks.

And, you know, you've been tweeting us your men's health questions. And we got some answers as well. Ask the Doctor is next.

(COMMERCIAL BREAK)

GUPTA: You know, it's no secret that men don't pay as much attention to their health as women. They're less likely to see the doctor and they're more likely to ignore health problems.

We decided to come up with a checklist to try and keep you healthy. It's by no means complete but it is a start. Men's health check in their 20s and 30s -- one thing, checking for testicular cancer. It is a very treatable cancer but it can be fatal if not caught early.

Checking blood pressure and, also, knowing your cholesterol numbers. Very important, if they're normal, you could start to put that off for a couple of years. As you get older, one of the things that men need to start thinking about is their cardiac health and, also, the overall health of their prostate gland.

As you get into your 50s, there is a test known as a prostate- specific antigen test. You want to talk to your doctor before getting this test completed. Rectal exam, colonoscopy -- those exams usually start around age 50. Of course, check with your doctor on your own history for all these things.

You know, the key to our motto here on HOUSE CALL -- living longer and stronger. All of it is about prevention. Now, I'll tell you, more tests isn't always the answer. But some can help potentially find diseases early on when they are easier to treat.

(MUSIC)

GUPTA: Let's jump right into the men's health edition of "Ask the Doctor" this week.

Here's a question from Tigressreow on Twitter: "What's an appropriate age for annual check-ups? And is an annual check-up covered by insurance?"

Well, first of all, congratulations for even thinking about this. I wish more men would. As a general rule, start thinking about annual exams in your 20s.

The caveat is this: you're going to talk to your doctor if you have a family history or some other risk factor. All of that could change. Again, as I said earlier, more tests or more expensive therapy even is not always the answer. Your annual physical should be covered by your insurance, and Medicare is also covering many of the tests done during your annual checkup as well.

We got another question from Twitter. Putmygamefaceon writes this, "How do you feel about older men taking testosterone supplements like DHEA?"

Let me tell you something. I did an entire documentary about this. You know, your body produces the hormone DHEA naturally. It also produces the male and female hormones testosterone and estrogen, in men and women, they both produce this. But as we age, these hormones start to decline.

Now, it's long been promoted DHEA is the sort of anti-aging therapy used to ward off chronic illness, maintain your energy and vitality. Clinical trials which have been done have found little evidence to backup these claims. There's just not a lot of research on the long-term effects as well of DHEA.

Now, it could potentially increase the risk of prostate, breast, ovarian and some other hormone sensitive cancers. It's not recommended for regular or long-term use. That's the bottom line.

Unfortunately, that's all the time we for have for today. If you missed any part of today's show, be sure to check out my podcast: CNN.com/podcasting.

And also join us at CNN.com/Twitter at SanjayGuptaCNN. We got more than 200,000 followers. Thank you very much.

Remember, this is the place for the answers to all of your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. More news on CNN starts right now.

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