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Sanjay Gupta MD

Boutique Doctors: Do They Sometimes Go Too Far, Like With Michael Jackson?; Troubling Complications of Sleep Medications; Breaking Barriers

Aired July 04, 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: Welcome to HOUSE CALL: The show that helps you live longer and stronger. I'm Dr. Sanjay Gupta, reporting to you from Los Angeles.

A lot of discussion about Michael Jackson this week as you know. Couple of things caught my eye: boutique doctors -- these are these elite doctors. Do they sometimes go too far in taking care of the rich and famous, like Michael Jackson? I went along with one doctor to try and find out.

Also, fighting for sleep could sometimes leave you fighting for your life -- looking at some of the troubling complications of sleep medications.

And also, breaking barriers: one doctor's journey to help a community.

You're watching HOUSE CALL.

(MUSIC)

GUPTA: We are coming to you from Los Angeles.

A lot of investigation this week into the medical mystery surrounding Michael Jackson's death. One of the things that people have been focusing on is the doctor that was by his side in Michael Jackson's last few minutes -- a boutique doctor, one of these doctors for hire, a doctor to the stars, Dr. Conrad Murray. You've seen his picture certainly.

What exactly do these doctors do? I can tell you a couple of things that I learned. First of all, the practice of having these concierge doctors has been around for over a decade. But it's raised a lot of interesting questions: the costs, the duties, the ethics. Take a look.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Michael Jackson, medical mystery. Many believe this man, Dr. Conrad Murray, holds the answer. He's known in the medical community as a concierge doctor, boutique M.D., doctor to the stars.

(on camera): He had a $150,000 a month doctor at his beck and call. DR. CHERYL BRYANTBRUCE, ELITE PERSONAL PHYSICIAN: Yes.

GUPTA: That surprise you?

BRYANTBRUCE: No, not at all.

GUPTA (voice-over): Dr. Cheryl BryantBruce would know, she's also a concierge doctor and charges up to $150,000 a year for 24/7 service anywhere in the world. She has at least 20 patients.

I was curious to know what all of that money buys you.

(on camera): What's the craziest thing you've ever done for a patient?

BRYANTBRUCE: This young gentleman, he was in a panic because he decided that he might have an STD. And so, I get called out in the middle of the night for an STD check only to find myself (INAUDIBLE) a very interesting party.

GUPTA (voice-over): For another patient, she traveled to Cancun for a week. Why? The patient wanted her own doctor with her just in case.

And this. Just a few minutes into our interview, Dr. Bryant- Bruce gets a call, and we get a glimpse into her life.

BRYANTBRUCE: You know we can send the trainer with you. I mean, I understand you're going on location and all, but we can send a trainer with you.

GUPTA (on camera): Did I hear you just say that you're going to send a trainer and essentially a masseuse to New York with that patient?

BRYANTBRUCE: Yes.

GUPTA: Most of her patients are famous and wealthy. They expect discretion. And that is why Dr. Bryant-Bruce wouldn't divulge too many names. But did she say supermodel Marisa Miller is a client and she took us along in a visit with another patient.

(on camera): So, we're about to make a real life house call here. This is what Dr. Bryant-Bruce does several times a day, going to see her patients wherever they may be.

(voice-over): The patient is Jimmy Coco. You may have seen him on "E!." He's legendary for providing tans -- you know, those world- class spray-on tans. She checks him for strep throat and then gives him an injection. In this case, the anti-inflammatory Toradol. But it got me wondering.

(on camera): Have you given shots of Demerol or OxyContin to your patients before?

BRYANTBRUCE: I have, yes. GUPTA: You know Dr. Conrad Murray. You know his background. You know the story. Are you surprised that the King of Pop, Michael Jackson, had Dr. Conrad Murray as his doctor?

BRYANTBRUCE: To be honest, actually, I am. I am a bit surprised. Because he had access to anybody that he wanted, and, you know, the fact that he did choose a specialist, and that he didn't appear to do his homework.

(END VIDEOTAPE)

GUPTA: Now, I should point out a couple of things. Dr. BryantBruce there was referring to this idea that Dr. Murray was a specialist. She's under the belief that it should be family practice doctors or primary care doctors that should serve as these concierge doctors taking care of the patient as a whole and taking care of their family as well.

Also, the lawyer for Dr. Conrad Murray has also spoken out, saying unequivocally, really, that his client, Dr. Murray, did not give Michael Jackson any Demerol or OxyContin.

This whole practice of concierge medicine, I can tell you, does create some gray areas. A lot of money -- as you can tell, as you just heard -- exchanging hands. What exactly are you buying? Might a doctor somehow be coerced by their patients into prescribing these pain medications? You just don't know.

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(BEGIN VIDEO CLIP)

CHERILYN LEE, MICHAEL JACKSON'S FORMER NURSE: He asked me if I can find someone for him. He said, "I will pay them anything, if you can find me an anesthesiologist or another doctor, a nurse practitioner, physician assistant also."

But he asked me, he said, "Can you find me a doctor? I don't care how much of money they want, I don't care what it is they want. I want this drug. I want this medication." He didn't say drug. He said, "I want this medication to sleep."

(END VIDEO CLIP)

GUPTA: That was Cherilyn Lee. Now, CNN has confirmed that she is a registered nurse and a nurse practitioner in the state of California. She claims that Michael Jackson really begged to try to get his hands on some Diprivan or Propofol.

Now, this may be a medication you've never heard of. That's because it is typically used in hospitals. It has ever used, really used outside the hospital setting.

The claim is that he wanted to use it for sleep. And it really begs the question -- it begged the question to me: how far will people go to try and get a good night's sleep? (BEGIN VIDEOTAPE)

GUPTA (voice-over): Insomnia -- Michael Jackson allegedly complained of it all the time.

LEE: He was so adamant about -- I will pay any amount of money to someone to help me to sleep.

GUPTA: And with that, he joined the nearly one in three Americans who complain of insomnia sometimes -- pretty common. But the way he may have treated his sleeplessness -- stunning.

(on camera): Have you heard of such a thing?

DR. KEEV KAIN, UNIVERSITY OF CALIFORNIA, IRVINE: I've heard of abuse of Propofol within the health care settings. I've never heard about Propofol being used or Diprivan being used to -- as a sleep aid medication.

GUPTA: If you had to sort of put this together, how could something like this happen?

KAIN: Very interesting question. One of the possibilities is a mix-up in the public about what is sleep and what is general anesthesia. So, when you go to the operating room for surgery, you undergo general anesthesia, which is obviously a physician-induced com coma. When you sleep at night in your bed, that's going to sleep.

GUPTA (voice-over): To understand how it's different, you need to look inside the brain. With an over-the-counter sleep med, the medication typically floods histamine receptors. With the prescription sleeping pill, like Ambien, Restoril, Lunesta, they work by hitting even more areas of the brain -- the hypothalamus, the brain stem, the cortex.

But Propofol?

(on camera): So what is Propofol exactly?

KAIN: Propofol is a -- is a central nervous system depressant. It works on your brain. It basically puts the entire brain to sleep. It depends on the dose that you use, now. If you use a touch of Propofol, then you can actually get high from it. The more Propofol you use, the more you get into general anesthesia.

GUPTA: Take a look at it. This is what it looks like, almost looks kind of like milk. In fact, in hospitals they refer to as milk of amnesia.

(voice-over): Think of it as a turbo-charged sleeping agent. It works by putting the whole brain to rest. It's a medically induced coma.

(on camera): How dangerous is this?

KAIN: As dangerous as it comes. You will die if you will give yourself or if somebody will give you Propofol and you're not in the proper medical hands.

GUPTA: Can you write me a prescription for some Propofol and I can go get some?

KAIN: I don't think so.

GUPTA: Not possible?

KAIN: Not possible. Propofol is injected intravenously. It is not taking orally. So I don't think that the pharmacy will give you intravenous Propofol. You have to go to a hospital.

GUPTA: So, I really wanted to find out for myself, how easy it is to get this particular medication?

So we came to this pharmacy in North Hollywood to find out.

If I came in with a prescription for Propofol, is that -- I mean, could I get a prescription for Propofol filled here?

UNIDENTIFIED MALE: No.

GUPTA: Absolutely not?

(voice-over): Absolutely not because this drug is not a sleeping medicine. It is a powerful sedative that should never be used outside of a medical setting. And, if used improperly, it can kill.

(END VIDEOTAPE)

GUPTA: As we talk about insomnia, Propofol, sedative drugs and Michael Jackson, there was a name that kept popping up, Dr. Neil Ratner. A source told me that he saw Dr. Neil Ratner with Michael Jackson in a hotel room with lots of equipment, including I.V. poles, drips, and this rack with lights and monitors on it. It was unclear what exactly was going on. But the source told me that Ratner said he takes him down and then brings him back up in the morning, referring to Michael Jackson.

I wanted to talk to Dr. Ratner more about this so I tracked him down in Woodstock, New York.

(BEGIN VIDEO CLIP)

GUPTA: Your name was obviously associated with Michael Jackson and people said that there was a question of whether or not you gave anesthesia to him while he was tour. And we just wanted to come to the source, you, and -- and here, and find out if that had happened.

DR. NEIL RATHER, TREATED MICHAEL JACKSON: I'm very upset. I'm distraught. Michael was a good person. I can't talk about it right now.

(END VIDEO CLIP)

GUPTA: Dr. Ratner is a board-certified doctor. He was one of Michael Jackson's doctors on the "HiStory" tour back in '96-'97. He did have his license suspended for three years back in 2002 because of insurance fraud.

Tune in tonight at 8:00 Eastern. CNN's Don Lemon takes an in- depth look at Michael Jackson's life and legacy. Don't miss "CNN PRESENTS," "Michael Jackson: Man in the Mirror." That's tonight at 8:00 Eastern, only on CNN.

Now, performing CPR can be tricky -- a lot of discussion about that this week. But we have a unique way that you probably aren't going to forget could possibly save a life.

Also, a young black doctor's first day on the job -- some nervous moments for sure and a little patient that she'll never forget.

Finally, the FDA is taking a closer look at the side effects of over-the-counter medications. How could this change what you're now taking for those aches and pains?

Stay with HOUSE CALL.

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GUPTA: We're back with HOUSE CALL.

Lots of news coming out of the FDA this week. First of all, two warnings -- important ones -- especially for popular smoking cessation drugs: Chantix and Zyban are the names of the drugs. They're going to now contain these strongest safety warnings the FDA puts out there about the concern of serious mental health concerns.

Here's what the FDA says specifically. It said, the new warning is based on reports of changes in behavior, depression, hostility, suicidal thoughts -- all of that while taking the medication.

The FDA is taking a look at some prescription painkillers -- specifically the painkillers Vicodin and Percocet. A panel now is recommending those two medications be pulled from the market.

The interesting thing about this -- they're focused on high doses of acetaminophen. Now, you may know that as the generic name for Tylenol. They think that the top daily dose of Tylenol should be reduced.

They're concerned that the acetaminophen in all these medications could possibly lead to liver damage. This is something that's been known for sometime. Percocet and Vicodin have acetaminophen in them, combined with a narcotic, and that's how they offer the pain relief.

And I should point out, this is a panel. The panel makes recommendations to the FDA. The FDA doesn't necessarily have to abide by those recommendations, but I can tell you that they typically do.

HOUSE CALL is back in 60 seconds.

(COMMERCIAL BREAK) GUPTA: We're back with HOUSE CALL.

With Congress off this week, President Obama is still trying to push forward his health care reform plan. This time, he used it in an interesting way -- with an interactive town hall meeting, as you can see here. He urged the audience not to listen to the critics but to just try and keep -- still fighting for reform. In fact, he said, "Give better care, not just more care."

(BEGIN VIDEO CLIP)

BARACK OBAMA, PRESIDENT OF THE UNITED STATES: The biggest thing we can do to hold down costs is to change the incentives of the health care system that automatically equates expensive care with good care. And this is an important concept, so I want everybody to really focus on this. We are -- we've been under the illusion that the more health care we get, the healthier we become. And it turns out that every study shows that the question is, are you getting the right care?

(END VIDEO CLIP)

GUPTA: In case you're wondering, there's a new CNN/Opinion Research poll out there that shows how you might be feeling about this at home and shows just how much work President Obama still has left to do. Take a look here. When asked if the Obama health plan passed, would your family be better off -- only 20 percent said yes; 35 percent said they'd be worse off; and 44 percent say they would stay the same.

Meanwhile, Congress is back on Monday and sure to pick up where they left off.

Remember, we are dedicated to this issue. HOUSE CALL is going to be the place that you can count on to get all the latest news about health care reform.

Now, health care does need reform, but it also needs more diversity. That's something that people have talked about for some time. African-Americans are far underrepresented in the field of medicine overall. The next generation of black doctors is looking to smash some of the barriers.

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DR. XAVIERA ESTES, RESIDENT PHYSICIAN, MEMORIAL HOSPITAL: Well, I'm Dr. Estes.

GUPTA (voice-over): Dr. Xaviera Estes is one of America's young black doctors. It's her first day on the job at Memorial Hospital in Savannah. Already, she has a patient who is expecting a baby any hour now.

ESTES: She came in for contractions and we found that she's actually in pre-term labor.

GUPTA: As a little girl, Dr. Estes was fascinated with biology and the body.

ESTES: I decided in second grade I wanted to be a doctor.

GUPTA: Bight and passionate about medicine, she set her own path early. But growing up in predominantly black inner-city Houston, she was dreaming big.

ESTES: You can never be a doctor. Why won't you settle for being a nurse or a medical assistant? In doctor has ever come out of this community. That was my drive for pushing forward, to prove people wrong.

GUPTA: This past May, success. The proof now right in her hand -- a medical degree from Morehouse School of Medicine, a historically black medical college in Atlanta.

ESTES: I can't believe I'm here. This is such a surreal moment.

GUPTA: According to the Association of American Medical Colleges, less than 5 percent of U.S. physicians and surgeons are black. That's a shortage for sure.

These graduates are among some of the newest. But they're not nearly enough to close the gap, says Dr. John Maupin, president of Morehouse School of Medicine.

DR. JOHN MAUPIN, PRESIDENT, MOREHOUSE SCHOOL OF MEDICINE: It's going to take a long time to have the kind diversity that this country needs so that students can believe that that's what they can be. Biggest barrier right now is the graduation rate of African-American males and African-Americans from high school. We're having too many people drop out.

ESTES: I don't think we necessarily receive the type of support we needed to. Medical school is expensive. And so, not necessarily financial support, not the emotional support.

GUPTA: Morehouse School of Medicine says that the majority of its alumni go on to work in rural areas and inner cities. It's the core of the school's mission, ensuring diversity in underserved communities.

ESTES: OK, thank you so much.

GUPTA: Here at Memorial Hospital, it's an opportunity for Dr. Estes to work with minority patients. Eventually, she wants to open up a women's center. But on this day, the emphasis was all on her patient, and the new baby she helped deliver: Little Allison.

ESTES: They always say you'll never forget the first baby you delivered. I'll never forget that it's a baby girl and just new life into this world. And that's really exciting.

(END VIDEOTAPE)

GUPTA: Now, you know who's been working on a lot of stories like this is our very own Soledad O'Brien. She's got a special documentary that she's working on for some time. I see her in airports all over the country, flying all over the place. It's called "Black in America 2." Catch it here, only on CNN, July 22nd and 23rd.

(COMMERCIAL BREAK)

GUPTA: Welcome back to HOUSE CALL.

A cardiac arrest is what killed Michael Jackson. And a lot of people wondering this week, what would they do if someone suddenly collapsed in front of them? Would they know how to perform CPR? Would they be able to save a life?

We're about to introduce you to a woman who had a very clever tool, sort of reminding her exactly what to do. Elizabeth Cohen has her story.

Elizabeth, so, what did she do?

ELIZABETH COHEN, CNN SR. MEDICAL CORRESPONDENT: Sanjay, Deborah Bader indeed is an amazing woman.

Here's what happened. She was taking a walk in the woods with her husband Christopher -- he was 53 at that time -- and all of a sudden, he just fell to the ground. Deborah recognized the signs of cardiac arrest and she immediately began banging on his chest and she knew because of a one-minute radio PSA that she'd heard that she should beat to the tune of "Staying Alive," yes, that old Bee Gees song, because that song has about 100 beats per minute and that's about how many times per minute you're supposed to beat on someone's chest.

Christopher's doctor says that Deborah saved his life because it took 15 minutes for EMTs to come to the scene deep in the woods. Now, it's interesting, when Deborah got to the hospital, she -- you know, the doctors heard the story and they commended her and they said, "You know what we do, we do CPR to the beat of another song called 'Another One Bites the Dust.'" Another one's got, another one's got -- that's also 100 beats per minute.

Deborah said she prefers "Staying Alive" to "Another One Bites the Dust," but she said that ER doctors kind of have a dark sense of humor. But, Sanjay, the bottom line is that, even if you haven't had formal CPR training you still can save a life -- Sanjay?

GUPTA: All right. Thanks, Elizabeth.

We thought this was a really important topic. So, if you go to CNN.com/EmpoweredPatient, you can find a lot more information there, as well as a quiz to test your knowledge of CPR. You should go there now and take the quiz.

If you fail the quiz, we're going to provide you some resources, try and find a class near you. Take a CPR class, do it today. You could possibly save a life.

You've been tweeting, e-mailing, blogging us all your questions. I've got the answers. "Ask the Doctor" -- that's next.

(COMMERCIAL BREAK)

GUPTA: And we're back with HOUSE CALL.

It's time for my favorite segment of the show, we're not going to let it go, even from here in Los Angeles.

Let's jump right in. We got a question here from Twitter. "What can I do about Rosacea? Is there any treatments that are affordable out there?"

Well, first of all, Rosacea is a chronic skin condition and you know it if you've seen it. It sort of has these cardinal symptoms of redness, swelling, flushing sometimes, visible blood vessels on the face. You've probably seen people who have this.

But there are some treatments to choose from. Start off with sunscreen -- it could be as simple as that. It turns out that sun is a major irritant for Rosacea. So, this could be an inexpensive way to help. Just make sure that the sunscreen itself is not what's irritating your skin. Also, if you see a doctor, you might be prescribed a topical cream or oral antibiotic both aimed at reducing the redness.

Now, for severe Rosacea, there are treatments such as lasers, other light therapies, even surgical treatments. This is only for the very severe types. They kind of smooth out and re-sculpt the skin to some extent. But that is expensive, sort of the point of your question.

Keep in mind, these treatments may also take a couple months to work and you have to consult with your doctor obviously beforehand to find out the best option for you.

Now, tainted, raw, undercooked beef -- all common culprits that could keep you in the ER this holiday weekend. We have some safety tips for grilling.

Stay with HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: Now, the holiday weekend is upon us and we want to make sure that you're grilling error-free this weekend. Very important. Take a look.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): It's an American tradition: grilling out in the summer. But summer cookouts can also have an unwanted ending -- trips to the emergency room.

Every year, there are 76 million cases of food-born disease. And raw or undercooked meat is one of the most common culprits. But there are steps you can take to keep your celebration healthy. Start with separate cutting boards, to keep meat and vegetables separate. And watch how the food is handled.

CHRIS ROSENBLOOM, NUTRITIONIST, GEORGIA STATE UNIV.: Don't put your raw chicken on a plate, carry it out to the grill, cook your chicken, put it back on the plate because then you can cross contaminate the meat.

GUPTA: Georgia State University nutritionist Chris Rosenbloom suggests precooking the meat in the oven and then finishing it off on the grill.

ROSENBLOOM: That way, you're cooking the meat more rapidly and not having to have it on the grill quite as long.

GUPTA: Why is that important? Well, the American Dietetic Association says, when meat is grilled at high temperatures for long periods of time, compounds inside the food can react and can create cancer-causing compounds called hetero-cyclic amines. Grill with a meat thermometer to make sure you're cooking to the proper temperature and not using color as an indicator.

ROSENBLOOM: I think the kind of thermometer that's good to have is the one that gives you the temperature so you don't have to memorize them. But for chicken breast, you want it to be 170 degrees. For ground beef, 160 degrees.

For steaks, we're not as worried about those, but 145 is more for a rare steak, and 160 for a medium steak. But particularly for chicken and for ground beef, definitely want to use the meat thermometer.

GUPTA: And when it's time to consider whether or not to pack up the leftovers ...

ROSENBLOOM: There's a two-hour rule, but that rule changes to one-hour rule when it's greater than 90 degrees. When it's really hot and humid, get that to -- in the refrigerator, whether uncooked or cooked within one hour.

GUPTA: And finally, cleanup. Use a wire brush to eliminate food particles while the grill is still cooling down and use hot soapy water to kill any bacteria.

(END VIDEOTAPE)

GUPTA: Well, unfortunately, that's all the time we have for today. Here in Los Angeles, I'm Dr. Sanjay Gupta. If you miss any part of today's show, you can check out my podcast, CNN.com/podcasting.

Remember, this is the place for the answers to all of your medical questions. I'm Dr. Sanjay Gupta. Thanks for watching.

More news on CNN begins right now.