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HOUSE CALL WITH DR. SANJAY GUPTA

HHS Sec. Sebelius Says Health Care Reform Important; Government Prepares for Flu Season; Hospital Infections Kill Thousands Every Year; Organization Optimistic About Fight Against HIV/AIDS

Aired July 11, 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, HOST: Good morning. Welcome to HOUSE CALL: The show that helps you live stronger and longer. I'm Dr. Sanjay Gupta. Thanks so much for watching.

First up: Health care reform. What it means to your wallet and your health. I'm going to go straight to the source. Health Secretary Kathleen Sebelius -- she's going to join us here on HOUSE CALL.

And, hospital infections kill thousands every year. We'll introduce you to doctors who have surprising strategies aimed at changing all of that.

Also, it's considered an epidemic, HIV/AIDS in the African-American community. Discover why one man said he's optimistic about an end to the epidemic.

Some good news -- you're watching HOUSE CALL.

(MUSIC)

GUPTA: In the spotlight this week: Congress and the White House are struggling to agree about how to revamp health care, about how to transform it. One of the big hurdles as you might imagine is money, and specifically where to get it. The White House did get a boost from hospitals earlier this week.

(BEGIN VIDEO CLIP)

JOSEPH BIDEN, VICE PRESIDENT OF THE UNITED STATES: The status quo is simply unacceptable. Rising costs are crushing us. They're crushing families, crushing businesses, crushing state budgets -- and they are crushing the health care industry itself. As part of this agreement, hospitals are committing to contributing $155 billion -- $155 billion in Medicare and Medicaid savings over the 10 years to cover health care cost reform, over the next 10 years.

(END VIDEO CLIP)

GUPTA: Now, the vice president went open to say he believes legislation will be enacted by August. So, what could that mean for you? Well, it could mean a government-sponsored insurance plan on the table, a plan managed by the government like Medicare or Medicaid. The goal is to increase competition and to drive down all insurance costs. Critics say it would do more than that and they say it would drive down costs, it would drive down some of the insurers out of business, possibly cost too much money overall and possibly ration care.

Other components to this: a requirement that everyone have health insurance, if you don't, you'll be penalized. Businesses that don't offer insurance to employees would pay a penalty for each employee. And insurance companies couldn't deny anyone because of preexisting conditions.

There is a lot to talk about here. For more on all these plans and how they affect you and your health, we're joined -- delighted to have her around the show -- the White House Secretary of Health and Human Services Kathleen Sebelius.

Thanks so much for joining us.

KATHLEEN SEBELIUS, HEALTH & HUMAN SERVICES SECRETARY: Glad to be with you, Sanjay.

GUPTA: You heard a little bit of that overview there. But before we talk about...

SEBELIUS: I did.

GUPTA: ... health care transformation and reform, I just quickly want to ask a couple of questions about the flu. You had a summit on the flu this week.

SEBELIUS: That's right.

GUPTA: You've talked a lot about this. Let me ask you -- what was the biggest surprise from your summit for you?

SEBELIUS: The biggest surprise is most people thought it was an April-early May story and it's gone. And we have about 1 million cases of H1N1 virus right now. We've had 170 deaths. And what we're really watching is what may transpire when the flu mixes with seasonal flu in the fall and winter. And we need to be prepared for that.

GUPTA: Based on what you're seeing in South America and the southern hemisphere, how worried are you about this? How much of your time this has taken?

SEBELIUS: We're preparing for a vaccination program this fall if we can have a safe, effective vaccine ready. If we know it works against H1N1, we're prepared to launch a voluntary vaccination program and have some vaccine ready by mid-October. But we need to take steps to prepare for that.

GUPTA: You mentioned this in one of your answers, a sort of voluntary vaccine program.

SEBELIUS: That's right.

GUPTA: Is there anything that would ever possibly change your mind and sort of suggest that maybe this become a mandatory vaccine program?

SEBELIUS: Well, at this point, the scientists tell me that they think a voluntary program aimed at the target populations is really what we want to have available. This flu is presenting itself with younger population. We're talking about school-aged kids, kids in day care centers.

Those are the ones who are the most likely ones to be receiving the vaccine. Health care workers, of course, who come in contact with the disease, but different from seasonal flu which usually is targeted at older Americans. We're looking at a much of younger population who has gotten this disease and transmits it very, very quickly.

GUPTA: I want to switch gears to something that you have been entrenched with, really, since almost the start of the job, talking about health care transformation. There are lots of questions swirling around this and you have talked a lot about this. I want to drill down details if we can right away.

SEBELIUS: Sure.

GUPTA: One of the questions -- one of the answers that always comes back when people say, "Why now," is we can't afford not to do this. We have to do this.

SEBELIUS: That's right.

GUPTA: What is that really based on, Madam Secretary? You know, Bill Clinton said the same thing in the early mid-'90s. And after that, we had the biggest growth in the economy in 25 years, actually a surplus at the end of his administration. Does this have to happen economically? Is that the argument?

SEBELIUS: Those who have insurance are paying higher and higher premiums, higher deductibles, higher out of pocket costs. Those don't have insurance are really locked out of the marketplace financially and lots of families right now have coverage that is for catastrophes but doesn't cover day-to-day expenses, which is why medical bankruptcies are on the rise throughout America. We know our businesses are not competitive in a global marketplace because the business owners can't afford to layer the health care costs on to each and every product.

So, I think everyone acknowledges -- business leaders, providers, labor leaders, teachers, nurses and doctors -- that what we have right now is simply unsustainable. Medicare will go broke. Medicaid is busting state budgets. So, we have to get a handle on costs for everyone.

GUPTA: Well, it does seem to be some consensus along those lines, from a lot of...

SEBELIUS: Right.

GUPTA: ... a lot of a -- you know, bedfellows that may not have been together in the past. SEBELIUS: That's right.

GUPTA: One thing that you have less consensus on though is the whole talk about this public option. And I want to drill down a little bit on that.

First of all, there's been some talk about whether the public option for sure going to be on the table. The president says yes. We've heard from the chief of staff, Rahm Emanuel, that not necessarily.

Let me ask you specifically, are there other things such a trigger, for example, saying, look, let's give the private sector three to five years to address all the problems you just outlined, lower cost, increase access -- if it doesn't work in three to five years, then the public option becomes reality? Could that happen some?

SEBELIUS: Well, I think it could happen, but the president has been pretty strongly in favor of a public option as one of the options in a new marketplace -- a health exchange as a new marketplace. So, those who don't have insurance at all or those who have insurance which is unaffordable can actually have a new place to shop, a health insurance exchange. And along with the private plans, there would be a side-by- side public option operating with the same rules, the same playing field.

GUPTA: Madam Secretary, one of the things that comes up often is a term called "comparative effectiveness." And we probably just lost a lot of viewer as they hear that term. You know, this is something that we talk about a lot within my medical community. As you know, I'm a neurosurgeon.

SEBELIUS: Right.

GUPTA: You know, you have these examples -- what if a 2-year-old girl, for example, came into my emergency room with a terrible injury from a car accident, say, the family, of course, wants everything done. I want to do everything but I know the chances are slim. We're ready to move it forward until one of this comparative effectiveness study says this is a no-go.

Do you worry about these sorts of studies dictating at all how doctors can be able to take care of patients -- in situations like that, where the chances are slim but your gut tells you should do everything?

SEBELIUS: Well, I don't think anybody wants to interfere with a doctor's judgment about what is best for his patient or her patient. So, that's not what the research is about. It really is about looking at what is the most effective drug or device, what is the most effective procedure, how do two different choices measure up side by side, if they're looked at in a clinical study, and then using that to inform providers, inform consumers about choices that might be available.

I think you as a doctor, Sanjay, would definitely want to know if you could administer a drug as opposed to performing surgery. That might be equally effective; you'd probably opt for the drug, a less harmful intervention possibly.

So, we think comparative effectiveness research can inform and empower providers and consumers to make the best possible use of the wonderful technology in medicine that we have.

GUPTA: All right. I know your time is short, Madam Secretary. We'd love to talk to you a lot more.

SEBELIUS: Nice to visit with you.

GUPTA: Hopefully, we can find some time in the future.

SEBELIUS: Great.

GUPTA: Take care of your own health, by the way. I know you've been very busy.

SEBELIUS: I will.

GUPTA: All right. Thanks, Madam Secretary.

SEBELIUS: Thanks.

GUPTA: Coming up: Refrigerated cookie dough heading back on to the shelves. We'll tell you the latest from the FDA and what it means for you.

Also -- reducing dangerous infections inside America's hospitals. We're on it. Elizabeth Cohen introduces us to hospital heroes who are protecting patients.

HOUSE CALL is back in 60 seconds.

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL.

We're checking out this week's "Medical Headlines" now. We start with an update on E. coli outbreak linked to cookie dough. Food and Drug Administration says they still haven't found that E. coli strain that has made so many people sick. But officials now believe that the dough contained two forms of bacteria. They don't expect to find the matching strain.

They do believe the contamination most likely was in the wrong ingredients used to make the cookie dough. Meanwhile, the Nestle plant making the dough is back in production. No timeline on when the dough will bee back in stores.

Also, a new study has a clear warning for summer travelers. The longer the journey, the higher the risk of developing a dangerous blood clots. Now, researchers found you have a nearly threefold higher risk for blood clots when traveling versus staying at home. And for every two hours of traveling, the risk of getting a clot increases by about 18 percent -- for plane travel, 26 percent. It's important to point out that your overall risk for getting a blood clot is still very low. Whenever you travel, you can try some simple things: take breaks from sitting, move around, stretch your legs, drink plenty of water.

HOUSE CALL is back in 60 seconds with some uncommon heroes trying to keep you infection-free.

Stay with us.

(COMMERCIAL BREAK)

GUPTA: Welcome back.

Hospital-acquired infections are preventable but they still kill tens of thousands of people every year. And some say the reason is because many hospitals don't make some sort of concerted efforts to change the trend.

In this week's "Empowered Patient," senior medical correspondent Elizabeth Cohen found some people who are trying to make the infections rare, not inevitable.

In, I think, just about every hospital talks about this, as our own hospital, infections a big problem. So, what's happening? What are they trying to do?

ELIZABETH COHEN, CNN SR. MEDICAL CORRESPONDENT: Right. It is indeed a big problem. And here's the trend that they're trying to stop, Sanjay. Right now, as we speak, there are 1.7 million hospital- acquired infections each year.

GUPTA: Amazing.

COHEN: And I think, sometimes, people don't understand this. What happens is, you walk into the hospital without an infection. You get an infection in the hospital and 99,000 people a year die from these infections according to the Centers for Disease Control. And there has been some criticism of hospitals. They haven't moved quite as quickly as they should have to try to stop this.

GUPTA: Sort of two questions. Why would that be? I mean, you'd think that everyone would want to stop this, if it's a preventable death. And what are experts sort of recommending? I mean, you've been talking to people on this particular topic.

COHEN: Right. I'll take the second question first, which is -- what you can do as an empowered patient to not get an infection in the hospital. There's not a lot you can do. I'll be honest. I mean, sometimes you're just a victim of an infection and there's nothing you can do.

But there are a couple of things you can do. You can ask your doctors and nurses to wash their hands in front of you and you can -- you can be polite about it, but you can say, I'd like to see you wash your hands. You can also ask to be clipped instead of shaved for an operation because razors can leave nicks where bacteria kind of fester. Also, you can ask, "Do I need preoperative antibiotics?" Because sometimes patients need them but doctors and nurses forget to give them.

Now, why hasn't there be more progress? Well, you know, some critics have said hospitals don't like to talk about this so much. I mean, it's the hospital getting someone sick. So, they don't necessarily want to be terribly public about the fact that they're actually getting people sick.

GUPTA: You're right. And we have a lot of infection control committees where doctors sort of share that information within the hospital, coming up. And it's interesting, about the preoperative antibiotics as well, because there was a study that said, you have to give it at least an hour beforehand. But, so many times, the patient is given the antibiotic, right, as they're wheeled into the operating room.

COHEN: Right, which should not (ph).

GUPTA: It doesn't make the difference that it should.

COHEN: Right.

GUPTA: Yet, there are people who are making a difference, health care professionals.

COHEN: That's right. And we profiled -- in fact, David Martin, who I know you know well.

GUPTA: Yes.

COHEN: CNN's David Martin did a terrific job profiling four people -- four hospital workers who are making a difference in their hospitals. They said, all right, the buck stops here.

And they've come up with some really -- sometimes very simple ways to try to keep infections down; sometimes as simple as just being public about it. Just saying, "Hey, you know what? We're going to be public. We're going it put our infection right on our Web site so that we can sort of get everyone to do something about it."

GUPTA: You know, it's interesting, as you talk about this, because we talk about health care reform a lot. And sometimes, there are some low hanging fruit, not that it's easy but you could save so much money...

COHEN: Absolutely.

GUPTA: ... and lives obviously, as you point out as well.

COHEN: That's right.

GUPTA: Good stuff.

COHEN: Important stuff. GUPTA: Yes. Elizabeth, thanks, as always.

COHEN: Thanks.

GUPTA: And to learn more about the risk of hospital acquired infections, go to CNN.com/EmpoweredPatient. You can read this week's column. And we also have an interactive gallery about the hospital heroes Elizabeth introduced us to.

Well, here's a hero as well in his own right. My interview with Phill Wilson, the executive director of the Black AIDS Institute. He's been living with the disease for 30 years. Here's why he says he's optimistic for the first time in a long time -- that's coming up.

Stay with HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: Welcome back to HOUSE CALL.

There is an epidemic of AIDS in black American. African-Americans make up 12 percent of the U.S. population but account for almost half of people living with HIV/AIDS in this country.

Now, the executive director of the Black AIDS Institute, Phill Wilson, is on a mission to try and bring those numbers down. I had a chance to sit down with him to find out his plan.

(BEGIN VIDEOTAPE)

GUPTA: What is the Black AIDS Institute?

PHILL WILSON, EXECUTIVE DIRECTOR, BLACK AIDS INSTITUTE: Our job is to get black folks involved in fighting AIDS.

GUPTA: Is there a sense of optimism? Is there a sense of outrage?

WILSON: I think there is a sense of optimism. I think there's a great sadness, and I think that there is a sense of being overwhelmed.

GUPTA: When you look at the next few years, how do those emotions change?

WILSON: The AIDS epidemic in Washington, D.C., you know, the capital of the wealthiest country in the planet, is worse than the AIDS epidemic in Port-au-Prince, the capital of arguably, the poorest country in the planet. That's a reason to be outraged, you know?

And I'm hopeful that we can use that outrage to mobilize. Now, I'm optimistic because I think more so than ever before, black folks understand that the AIDS epidemic is impacting us and impacting us in desperate ways.

I go around the country and say AIDS in America is a black disease. People hate it when I say that. Black folks hate it when I say that. White folks hate it when I say that. But the truth of matter is, we bear the brunt of the AIDS epidemic in this country, and the only way that we're going to solve AIDS in America is for us to solve AIDS in black America.

GUPTA: Part of the mandate is to end the black AIDS epidemic?

WILSON: Absolutely.

GUPTA: How do you do it?

WILSON: We are not where we want to be. Obviously, it's not over. But we're not -- we're not where we were. Now, for the first time in a long time, I'm extremely optimistic. I think we'd laid a solid foundation and I think, quite frankly, Sanjay, we have the potential to actually (INAUDIBLE), not eradicate the virus but in terms of how you define an epidemic, I think we can do that and I certainly think we can reach that in the next five years.

GUPTA: How do you address the other part of this -- this whole idea of taking the knowledge that may be present and turning it into action?

WILSON: It's really about getting people to take ownership of the epidemic. We can set goals around increasing HIV testing, around increasing condom usage, and around getting people to change their sexual behavior.

That's about cultural norms. That's about engaging the traditional institutions in the community. That's about getting the churches involved. That's about getting media organizations and key opinion leaders to say, "OK, this is the way we behaved as a community at one point in time and we're going to change that."

(END VIDEOTAPE)

GUPTA: Just a terrific conversation with Phill Wilson there.

You know who's been working on a lot of stories like this? Our very own Soledad O'Brien. She's got a special documentary coming up. It's called "Black in America 2." You can catch it here, only on CNN, July 22nd and 23rd.

And, you know, you can meet just about anybody online nowadays, including your fitness trainer. Is an online workout coach a solution for you?

If a doctor put you on antibiotics, do you ever wonder how long the medicine stays in your system? One of our viewers wants to know and I got an answer for it coming up, "Ask the Doctor."

Stay with HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: Used to be that if you wanted a personal fitness trainer to help you with your workouts, you had to spend hours with them in the gym -- but not necessarily anymore. Why not take your fitness training online? Some pretty cool tools.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): We live our lives online these days. We buy plane tickets, we pay bills -- so, why not fitness?

ROBERT DOTHARD, FITNESS EXPERT: When people want help, a lot of times, the Internet is the best way to search for it. And if you can get that help immediately online -- that's great.

GUPTA: So, we put some of our "Fit Nation" experts on the hunt to look at some of the latest and greatest online fitness tools. Check out the "Fit Orbit," a real life fitness trainer online.

DOTHARD: I love the fact that you can pick the type of activity level you're in, whether you have a desk job, whether you're a frequent traveler.

GUPTA: Your "Fit Orbit" trainer can adjust your fitness goals on a daily basis and keep track of your nutrition.

The biggest downside?

DOTHARD: Once it's online, that intensity can be removed a little bit.

GUPTA: Next, if you're in the mood to run, GMaps pedometer. It's a cool free tool from Google.

DOTHARD: For business travel, it's great. As you travel, you map out your course, you see the distance and, I guess, once you check the weather, good to go.

GUPTA: If nutrition is more of your focus, check out a new online meal plan tool called "Sensei."

CHERYL WILLIAMS, CLINICAL NUTRITINIST, EMORY UNIVERSITY: Users have the option of choosing from frozen dinners, fast food, home cooked meals. And each of those meal type options, there's an emphasis on healthy food choices.

GUPTA: The plan comes complete with recipes, shopping lists and a cost for meal calculator. But if all you need is a little inspiration, a free healthy tips e-mail service called "Healthy Mondays" may be your one-stop shop.

WILLIAMS: It really focuses on promoting small, sustainable changes. Overall, it's a good program, but I would recommend that consumers kind of try the seven-day trial to see if it works for them.

(END VIDEOTAPE)

GUPTA: Now, you know, we've been looking into this quite a bit. And these aren't the only online fitness tools out there, but it's a pretty good sampling. Also, you have all of our great resource of information yourself. So, be sure to check out my four-month forum, guide of getting people in terrific shape. I'm hoping we're going to be able to help each other get fit, for me, in it's time for a big birthday. I'm anxious to hear from you.

So, chime in. Join can join me on my blog, CNNHealth.com or on Twitter, that's SanjayGuptaCNN -- and almost 400,000 followers there. I'm keeping track of all the great tips and hope to share with them with you.

Now, itchy, painful poison ivy -- you may come in contact with outdoors this summer. But how do you treat the symptoms? Well, the sooner the better. That's a tease. I'll tell you why -- that's straight ahead.

(COMMERCIAL BREAK)

GUPTA: Welcome back to HOUSE CALL. Thanks for staying with us. It's time for my favorite segment of the show, "Ask the Doctor."

Let's get right to it. Celia from Waldorf, Maryland, e-mailed us this. "I want to know how to treat my symptoms from poison ivy."

Well, thanks for the question, Celia. You know, it's the oil sap in poison ivy called urushiol that causes those painful rashes.

Now, if you've come in contact with poison ivy, a couple rules of thumb: wash the area immediately. If more than 10 minutes has passed, a good washing is only going to remove about half the oil. There are some over-the-counter washes that are about 70 percent effective of getting rid of the oil hours after the exposure.

Rubbing alcohol also can help. Over-the-counter lotions are kind of the old standby treatments. Severe cases can be treated with steroids by a doctor.

Let's get to another question now from Twitter. Cinderella Lady -- she wants to know this. "How long does the antibiotic cipro or ciprofloxacin stay in your system?"

Well, this is an antibiotic commonly prescribed for urinary tract infections. It's generally prescribed for three to five days, depending on the infections. Various antibiotics can stay in your system for quite a while, but cipro -- we look this up -- stays in the body about 20 hours or so after the last dose.

Quick caveat: it's going to depend on someone's kidney function. For people with impaired kidneys, for example, the antibiotic will stick around a little bit longer.

Thanks for writing in.

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