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The Situation Room

New Mammogram Advice Raises Concerns; Putting 9/11 Suspects on Trial; Prescription Drug Prices Up

Aired November 17, 2009 - 17:00   ET

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

BLITZER: Don't go far away, Jack.

Thank you.

To our viewers, you're in THE SITUATION ROOM.

Happening now, new breast cancer screening guidelines sparking huge controversy and concern. A government-appointed task force says most women should delay regular mammograms and forget about self-exams if they're in their 40s. We're going to hear from one of those experts and from a Congresswoman who says early screening literally saved her life.

Hunger is on the rise in America -- a shocking new government report says more than 49 million people -- let me repeat that -- 49 million people in the United States of America, including 17 million children, had trouble getting enough food last year. I'll speak about it with the Agriculture secretary, Tom Vilsack who prepared this new report.

And battered by a series of deadly bombings -- are Pakistanis right now in a state of denial?

Why some are blaming America instead of the Taliban.

I'm Wolf Blitzer.

You're in THE SITUATION ROOM. New guidelines on mammograms -- they're affecting tens of millions of women and creating huge confusion and concern among many of them. The recommendations issued by a government task force -- the recommendations say women in their 40s don't need an annual breast cancer screening.

So what prompted the task force to reverse its position on this critical health care issue?

And who exactly is on this panel to begin with?

Let's go to our senior medical correspondent, Elizabeth Cohen.

She's gone through the report and has all the details -- Elizabeth?

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: Wolf, a group of 16 experts, from doctors to nurses to epidemiologists, sat down to figure out who should get routine mammograms and who shouldn't. Well, the list has angered many breast cancer patients.

(BEGIN VIDEOTAPE)

COHEN (voice-over): The government might say routine mammograms are unnecessary for women in their 40s, but Sarah Fought would beg to differ. A routine mammogram caught her cancer when she was 42.

SARAH FOUGHT, BREAST CANCER SURVIVOR: I think it saved my life because my cancer was detected earlier.

COHEN: She says she's horrified by the new recommendations.

FOUGHT: It's foolhardy and I think you're playing with people's lives.

COHEN: Many experts agree with her -- the American Cancer Society, the American Society for Clinical Oncology, Susan G. Komen for the Cure and the Patient Advocate Foundation all disagree with the government and say women in their 40s should get mammograms.

The government task force agrees that mammograms do catch cancer in women in their 40s -- in fact, that 15 percent of cancers in women that age are detected thanks to mammograms.

But they also say there are down sides to mammograms. Women get exposed to small amounts of radiation year after year, plus there are lots of false positives that make women worry unnecessarily and prompt biopsies that aren't needed.

But Fought says a mammogram saved her life.

FOUGHT: Until a better method for detecting cancer is identified, to me, there is no reason to set aside mammograms.

(END VIDEO TAPE)

COHEN: Wolf, the task force says that for every 1,000 women who are scanned in their 40s, there are 98 false positives and they catch two cases of cancer -- Wolf.

BLITZER: Lots of -- lots of commotion as a result of this, Elizabeth. Give us some perspective, because it wasn't that long ago another study said maybe these tests for prostate cancer, men shouldn't necessarily rely on them.

What's going on here?

COHEN: What's going on here is that experts are trying to take a look at all these screenings that we all just assume are good for us.

And the question is how many cases of cancer do they actually catch? And then, on the other hand, how many false positives do they catch?

When you catch a false positive, that requires further testing. That testing itself and the treatment that could follow could cause harm. There's a lot of attention now to checking and seeing if these screenings really work.

But I'll tell you, people whose diseases were caught by this screening really find this horrific. They say I am a living example of how these screenings work.

BLITZER: And one of those people is here in THE SITUATION ROOM, Elizabeth.

Thanks very much.

A member of Congress who is also a breast cancer survive credits early detection with literally saving her life.

Florida Congresswoman Debbie Wasserman Schultz, a Democrat, strongly opposes these new recommendations.

She's here in THE SITUATION ROOM.

Congresswoman, thanks very much for coming in.

REP. DEBBIE WASSERMAN SCHULTZ (D), FLORIDA: You're welcome.

BLITZER: When you saw this report and read it, I assume you were shocked -- that women in their 40s no longer should routinely get an annual mammogram or even do these self-exams.

WASSERMAN SCHULTZ: These are very disturbing recommendations. As someone who found my own breast cancer through a breast self-exam and had a mammogram, and knowing that there are tens of thousands of women from 40 to 49 years old in this country that are diagnosed with breast cancer every year and that it's often diagnosed at a later stage and is more aggressive, to say that women in that 10 year age gap should not get mammograms is just totally inappropriate.

BLITZER: And you were how old when you...

WASSERMAN SCHULTZ: I was 41.

BLITZER: You were 41.

So you would have fit in this category?

WASSERMAN SCHULTZ: Yes.

BLITZER: They do say that women who have a history of breast cancer in their family should get these mammograms.

Did you have a history of breast cancer in your family? WASSERMAN SCHULTZ: I didn't have a history of breast cancer in my family. I had two great aunts. It turned out that, ultimately, I was diagnosed as having the breast cancer gene mutation. But the bottom line is that instead of making things more clear for women, this task force's recommendations are making things clear as mud -- totally confusing women. The American Cancer Society, the Susan G. Komen Foundation and all the major cancer organizations continue to recommend and disagree with these findings, that women over than -- older than 40 should have a routine mammogram every year. And that will save lives.

BLITZER: The -- this -- what's, I guess, worrying to you and to a lot of folks out there, this study that was released has the stamp of the U.S. government on it. And it sounds very authoritative. They're basically saying all these mammograms -- all these exams, they're simply putting a lot of women needlessly through some mental anguish. If they -- if they feel something, if they see something, they have to go through mammograms or biopsies and could cause them all sorts of pain.

WASSERMAN SCHULTZ: That is so patronizing. I mean to assume that women, armed with more information about their own breast health, would simply get hysterical and have anxiety and not know what to do and not make a sound decision, in consultation with their health care professional, is patronizing. We need to make sure that women get more information, not less, and make sure that women are screened, because we know that early detection and screening saves lives. We've actually had a drop -- since women have gotten screenings and mammograms older than 40 -- a drop in the death rate of women. And we know that's directly because of the early detection.

BLITZER: Now there's some concern out there in connection with the current health care bill. It's a connection with health care insurance in general. If the U.S. government puts out a recommendation like this and says, you know what, women in their 40s don't need mammograms, which can be expensive, health insurance companies are going to say we're not paying for any more mammograms, so forget about it.

How worried are you about that?

WASSERMAN SCHULTZ: Well, it's important to know this is not the U.S. government's recommendation. The Department of Health and Human Services has not endorsed these recommendations. This is simply an independent task force that is providing these recommendations to the U.S. government. And they are, I know, contemplating them and reviewing those recommendations.

BLITZER: But even...

WASSERMAN SCHULTZ: But that is very troubling.

BLITZER: But having said that, even if there is a recommendation like this, that could convince a health insurance company, we're not paying for mammograms. WASSERMAN SCHULTZ: That's the most troubling part about this, is right when we're trying to reform our health care system, change it from a sick care system to one that's focused on prevention, this task force is recommending that women 40 to 49 years old don't have preventive screenings to potentially detect breast cancer early. And insurance companies could start to use that as standard practice in -- for coverage decisions, especially because health insurance companies are what's driving health care (INAUDIBLE)...

BLITZER: How is your legislation moving forward, because you have specific legislation that you hope can fix this?

WASSERMAN SCHULTZ: And The Early Act, which is my legislation that would help educate women young women focusing on their breast health, if these recommendations go forward, all the more reason why we are going to need to educate individual women, because then they are going to need to be armed as individuals with all the information they need to know whether they're going to need to get a mammogram or not.

But I'm hopeful that these recommendations will just be put aside, where they belong.

BLITZER: We'll see if they will or won't.

Debbie Wasserman Schultz.

WASSERMAN SCHULTZ: Thank you.

BLITZER: Thanks for coming in.

WASSERMAN SCHULTZ: Thanks, Wolf.

BLITZER: And just ahead, a dramatically different perspective -- we're going to speak to a member of that government task force that changed these breast screening recommendations. You're going to hear why she says it was absolutely the right decision. We'll get the other side. That's coming up.

In the meantime, let's check in with Jack Cafferty.

He's got The Cafferty File -- Jack.

CAFFERTY: Wolf, more and more Americans are saying now that health care is not the government's responsibility. There's a new Gallup Poll that shows 50 percent of those surveyed say the federal government should not have to make sure that all Americans have health care coverage. Forty-seven percent say it is the government's job.

This marks a big change in attitudes from the past decade. And it's the first time since Gallup started tracking this question that more people are against the idea of the government being responsible. The reason for the shift isn't known, although it's possible the current debate has increased Americans' skepticism about the role government could play in health care. A poll by the Associated Press seems to back this up, as well. It shows that Americans are worried about the hidden costs in reforming health care. Although most people agree major changes are needed in the current system, the Democratic bills pending in Congress are not getting strong support. The polls suggests the public is now onto the fact that when it comes to these pieces of legislation -- in the House case all 2,000 pages of it -- the devil is in the details.

Meanwhile, don't hold your breath for health care reform to happen any time soon. Republican Minority Leader Senator Mitch McConnell says the Senate will not rush this legislation. He says lawmakers can count on a lot of amendments. McConnell says the only way to guarantee that all of the senators and the American people can really understand the bill is to, "Delay the process."

So here's the question -- should health care be the government's responsibility?

Go to CNN.com/caffertyfile and lend us your thoughts -- Wolf.

BLITZER: And they will, Jack, no doubt about that.

CAFFERTY: You know, about that screening, I mean I -- I had prostate cancer about 10 years ago. It was picked up on a routine PSA test. You know, if they hadn't done the blood test, I -- nobody would have ever found it.

BLITZER: Yes. And there was a study that came out a few months ago saying forget about all these PSA tests, not necessarily all that important.

CAFFERTY: I'm -- I'm glad I got one.

BLITZER: Yes. I'm sure you are.

CAFFERTY: Yes.

BLITZER: All right, Jack.

We're -- all of our viewers are, as well, by the way.

Thank you.

Ninety-one -- think about it.

CAFFERTY: I didn't -- it's not going to happen, Wolf. It won't be happening. You might still be here. I'll be long gone.

BLITZER: Ninety-one years old at The Cafferty File.

All right, Jack.

Thank you.

Forty-nine million Americans had trouble finding enough to eat last year. A third of them -- get this -- children. This is the United States of America. A shocking new government report is just out. I'll speak with the secretary of Agriculture, Tim Vilsack. He prepared this report. Stand by.

And from shoe bomber Richard Reid to a blind sheikh who wanted to blow up New York landmarks, there are precedents for the upcoming civilian trial of the alleged 9/11 plotters.

(COMMERCIAL BREAK)

BLITZER: There's growing controversy over the Obama administration's decision to put the self-proclaimed 9/11 mastermind and four other alleged plotters on trial in New York City. The proceedings may be spectacular, but this case certainly won't be the first of its kind.

Let's bring in our homeland security correspondent, Jeanne Meserve.

She's working this story for us -- Jeanne, you've got some good comparisons here.

JEANNE MESERVE, HOMELAND SECURITY CORRESPONDENT: I think so. You know, the question is, will the trial of Khalid Sheikh Mohammed and the four other alleged 9/11 conspirators be unlike any other?

The answer we found is both yes and no.

(BEGIN VIDEOTAPE)

MESERVE: (voice-over): There has never been a terror attack in the U.S. with the scale and horror of 9/11. And there has never been a trial of an Al Qaeda member as important as Khalid Sheikh Mohammed.

But terror trials in civilian courts are nothing new. The people responsible for the first World Trade Center bombing and the bombings of U.S. embassies in Kenya and Tanzania; Sheikh Omar Abdel Rahman, the so-called blind Sheikh who wanted to blow up New York landmarks; shoe bomber Richard Reid, who attempted to bring down a transatlantic airliner; and 9/11 conspirator, Zacarias Moussaoui; have all been tried and convicted in federal courts -- some of them in New York.

ERIC HOLDER, ATTORNEY GENERAL: I'm quite confident that we can safely hold people there, that we can protect the people who surround the courthouse area and bring these cases successfully.

MESERVE: The 9/11 case will differ from others in one important respect -- Mohammed was waterboarded 183 times. And that will complicate the prosecution.

(BEGIN VIDEO CLIP FROM "AMERICAN MORNING")

DAVID KELLEY, FORMER U.S. ATTORNEY: Applications will be made by the defendants, for example, not to use any sort of statements or evidence that were the pro -- product of any sort of coercion or misconduct. MESERVE: A defense attorney in the Moussaoui case predicts there will be, as in his case, serious issues of language and culture to overcome and mountains of evidence to explore.

GERALD ZERKIN, MOUSSAOUI DEFENSE ATTORNEY: There were 180,000 FBI interviews. There were hundreds of videos that we had and there were thousands of CDs. And there were a couple thousand images on every CD

MESERVE: Classified evidence has played a part in all the terror cases. But only lawyers, not defendants, have access to it and it's discussed only behind closed doors.

The blind Sheikh and Moussaoui both used the courtroom as a platform to espouse their jihadi beliefs. No one would be surprised if Khalid Sheikh Mohammed does the same thing.

(END VIDEO TAPE)

MESERVE: Defense attorneys and prosecutors say this trial is likely to be similar to other terror trials in another respect -- because of its complexities, it will take years to get underway and more years to try it -- Wolf.

BLITZER: Wow! That's a long -- years and years...

MESERVE: That's what they're saying.

BLITZER: That's not just a six week trial or anything. This will go on for a long time.

MESERVE: That's right, because they expect there to be so many challenges from the defense to the evidence and the like.

BLITZER: OK. Jeanne Meserve, thanks very much.

A Russian cruise ship struggling to get out of an ice pack in Antarctica. The ship is filled with tourists, but they're keeping their cool, at least for now. You're going to find out why.

And Russian rappers -- yes, Russian rappers. Vladimir Putin is a big fan of their music, but will he like the message they're sending to Moscow?

Stick around.

You're in THE SITUATION ROOM.

(COMMERCIAL BREAK)

BLITZER: Betty Nguyen is monitoring some other important stories incoming into THE SITUATION ROOM -- Betty, what's going on?

NGUYEN: Hey there, Wolf.

Wanda Barzee -- she once helped her husband kidnap 14-year-old Elizabeth Smart. Well, today she pleaded guilty to the crime and agreed to testify against her husband. In exchange for her testimony, authorities have recommended a 15 year prison sentence. Her husband, Brian David Mitchell, will face trial for the kidnapping and daily rape of the teenaged girl during the nine months that she was held in captivity.

A Russian ice breaker now used as a cruise ship?

Well, it's caught in an ice pack near Antarctica. The Captain Khlebnikov is expected to be five miles from clear water with 100 tourists, journalists and scientists on board. The ship's captain reports that there is no danger to passengers and that their biggest worry -- sunburn.

All right, on to this story. On Saturday, Russian Prime Minister Vladimir Putin appeared on a music TV show and praised Russian rappers, graffiti artists and break dancers, saying that they could help fight drugs and other social problems. You see it right there.

Well today, other Russian politicians took up the challenge, staging a rap battle for justice and a rhyming message to President Medvedev to fight corruption and other Russian problems.

The power of rap -- Wolf.

BLITZER: Yes, Russian rappers.

Who knew?

NGUYEN: Yes.

BLITZER: They're looking pretty good out there.

NGUYEN: Pretty cool.

BLITZER: Very cool.

All right. Thanks, Betty.

Thanks very much.

We want to remind you, we have another way for you to follow what's going on right here in THE SITUATION ROOM. I'm now on Twitter. You can get my Tweets at Twitter.com/wolfblitzercnn -- wolfblitzercnn all one word. You can read my Tweets if you want to. You don't have to, only if you want.

The Taliban claiming responsibility for a series of deadly bombings.

So why are so many Pakistanis actually blaming America?

And 49 million Americans had trouble getting enough food to eat last year, including 17 million children. I'll speak about that with the Agriculture secretary, Tom Vilsack. His troubling new study is just out. (COMMERCIAL BREAK)

BLITZER: To our viewers, you're in THE SITUATION ROOM.

Happening now, detainees from Guantanamo Bay could soon be heading for a prison in Illinois. This has some people up in arms. But the Illinois senator, Dick Durbin, thinks it's a very good idea. We'll ask him why. That's coming up.

The Catholic Church is drawing a line over gay marriage here in the District of Columbia.

What will happen to their charitable work if they pull out of this troubled city?

Rick Baldwin will be here with the story.

And billions of tax dollars from ordinary Americans went to bail out the banks. Now, those same banks are slashing the loans they issue to small businesses -- small businesses that could be providing jobs for ordinary Americans. Jessica Yellin has been working the controversy.

I'm Wolf Blitzer.

You're in THE SITUATION ROOM. Health care reform may be looming, but business is apparently booming for companies that make brand name drugs.

CNN's Alina Cho looks into the big increase in prescription drug prices.

(BEGIN VIDEOTAPE)

ALINA CHO, CNN CORRESPONDENT (voice-over): At this pharmacy in New York City, the rising costs of prescription drugs is forcing some folks to make tough choices.

UNIDENTIFIED FEMALE: When you have the choice between paying your rent or getting your medications, the choice is obvious. You're going to pay for your shelter first.

UNIDENTIFIED MALE: I have to make choices. I have to pick and choose, you know, things that I have to do without to get this medication.

CHO: The nation is in the worst recession in decades. But as Americans have less money to spend, brand name drug prices are up -- way up.

DR. SIDNEY WOLFE, PUBLIC CITIZEN: There's no question that the public has been bamboozled, the White House has been bamboozled and the U.S. Congress has been bamboozled by this ever successful industry.

CHO: According to a new study for the AARP, the cost of brand him prescription drugs is up more than 9 percent, adding, on average, $200 a year to the price of a once daily pill. And the jump comes just as the drug industry is promising to shave $80 billion in drug costs over 10 years.

PROF. STEPHEN SCHONDELMEYER, UNIVERSITY OF MINNESOTA: Just a 10 percent increase this year may amount to a $20 billion to $25 billion increase in drug spend. That kind of overwhelms an $8 billion a year savings.

CHO: Consumer advocates say they've seen it all before -- higher prices every time the government is about to initiate major change.

WOLFE: We see how ghoulish this industry is. And it's almost taunting everyone -- as long as you're not going to control our prices, we're going to raise them as much as we want.

CHO: PhRMA, the leading drug industry lobby, will not go on camera, but issued a statement, calling tying drug price increases to health care reform "a flawed assumption" and adding, "price increases are the natural result of market forces. And, unfortunately, medicines are always looked at as a cost and never seen as a savings."

(END VIDEO TAPE)

CHO: Some patients are able to take generic drugs. And the price of generics has actually gone down almost 9 percent, according to the study. Also important to note, not every patient can take generics. In fact, brand name drugs account for nearly 80 percent of all prescription drug spending in the United States. That means most Americans who are buying prescription drugs are paying more for them.

Alina Cho, CNN, New York.

(END VIDEO TAPE)

BLITZER: There has been quite a lot of pushback to the new government recommendations on mammograms. Some doctors, breast cancer groups and cancer survivors say stopping self-exams and waiting until age 40 to routinely get annual screenings or mammograms could be a very deadly mistake.

A member of that government task force is defending the panel's decision.

Lucy Marion is the dean of the school of nursing at the medical college of Georgia.

She's now with us in THE SITUATION ROOM.

Dr. Marion, thanks very much for coming in.

LUCY MARION, TASK FORCE MEMBER: Thank you.

Glad to be here.

BLITZER: What do you say to those women out there who had a mammogram in their 40s and detected a problem they -- they -- of breast cancer and they are now alive?

If they wouldn't have had that mammogram, they say, in the 40s, they probably would be dead by right now.

MARION: Well, first of all, I'm really glad that they are alive, but our work has been to look at all the women and many studies over several years, and we have recommended that we don't routinely screen every woman just because they turn 40 years of age. Instead, we recommend that each woman at 40 talk with their clinician and make that decision together, but we're not saying not to screen. We're saying not to routinely screen.

BLITZER: What's the down side of routinely screening at age 40 and above because -- it would be to err on the side of caution, wouldn't it? Is there any negative risk of going to get a mammogram?

MARION: Yes, there are, and this is the work of the task force is to identify those harms and balance them with the benefits to get the net benefit, and the harms of screening is what we call the false positives. In other words, women will have unnecessary worry about cancer. They may have unnecessary biopsy. In some cases, they may have more radiation than healthy for them though in most cases that's a minor problem but there are those harms and we weigh those harms with the benefits of the few women that would benefit from that.

BLITZER: We just spoke to Congressman Debbie Wasserman Schultz, a Democrat of Florida diagnosed in her early 40s with breast cancer as a result of a mammogram, and I pointed out those concerns that you had. Here is her response. Listen to this.

(BEGIN VIDEO CLIP)

REP. DEBBIE WASSERMAN SCHULTZ (D), FLORIDA: To assume that women armed with more information about their own breast health would simply get hysterical and have anxiety and not know what to do and not make a sound decision in consultation with their health care professional is patronizing.

(END VIDEO CLIP)

BLITZER: All right. What do you want to say to the congresswoman?

MARION: I would -- I would like to reassure her that our work has been carefully done with many studies and we commissioned two studies, one to evaluate all of the literature available, all the studies, and the other is to use modeling to help us from network of cancer centers where we brought together all the data and the 16 of us who are prevention experts and primary care clinicians deliberated for a long time about the data and our recommendation were based on the data and we found that the evidence led to only moderate certainty that there were small benefits, not large benefits, during that age period at that time.

BLITZER: Some have raised some questions about the makeup of this task force. Were there oncologists as members of your team? MARION: No, there were no oncologists. However, we send out our recommendations before we finalized our decision for review from other experts in the area, but our team is made up of prevention experts again and primary clinicians. All of us have had extensive preparation in evaluating the data and are guided by evidence-based practice centers who systematically evaluate the literature so there is a very different rigor in all that we do and we make every effort to stay an independent body, not influenced by other recommendations but to look at the data study by study and the summaries that are given to us by the experts in the field.

BLITZER: Wouldn't it have been a good idea to include an oncologist or two on the task force?

MARION: Well, our task force is made up of primary care clinicians and prevention experts. An oncologist would not be the usual part of the primary makeup. They would be used as consultants but not part of the decision-making body.

BLITZER: Go ahead. Finish your thought. Sorry for interrupting.

MARION: Please ask the next question.

BLITZER: Well, are you saying that women should also stop self- examining themselves to see if there's a lump on their breast, is that what you're recommending as well?

MARION: We are recommending that cease that activity. This has been recommended -- in other countries and other agencies for some time because it has not been shown to decrease deaths, but it has shown to increase unnecessary biopsies and worry and, of course, the consistency of the breast changes from time to time and many times that would cause unnecessary treatments or diagnosis, and so, yes, we have made that recommendation. We recommend instead the screening mammogram from age 50 to 74. We feel that the benefits are clearly there. Every other year, biannually. Those are our recommendations.

BLITZER: Because Debbie Wasserman Schultz just here she felt a lump in her breast and she then went and got the mammogram and had the surgery and all the relevant treatment. She was what 40 or 41 years old and she makes the point she might not be here right now if she wouldn't have done that self-examination.

MARION: And -- and, of course, women will in routine care of their bodies will touch their breasts and will identify lumps but many of the lumps and most of the lumps that are found are not cancerous and not in need of diagnostic procedures and so we're looking at the larger body and we are recommending, as I've said, the screening mammogram starting at age 50 based on the data.

BLITZER: And I just want to be precise because we're almost all out of time, and I'm sorry for interrupting again but go ahead because I think you wanted to say something to Congresswoman Debbie Wasserman.

MARION: I am so glad that congressman did go to her physician and was treated and is alive today and that will continue to happen.

BLITZER: If a woman does feel a lump on her breast, are you saying ignore it, don't go to your doctor, don't follow up, is that what I'm hearing, Doctor?

MARION: No. We are recommending that the woman go immediately to her clinician and have the follow-up and the clinician can decide whether or not further diagnostics are needed and we do recommend that.

BLITZER: This is causing a huge uproar, as you know, and it's going to be widely, widely debated.

MARION: It is.

BLITZER: I'm sure you anticipated all of this because your recommendations are so diametrically different than everything we've heard about annual mammograms and self-examination. You appreciate the uproar.

MARION: Right, but recently now that -- now that we are aware of the importance of screening, we now are putting the effort in doing the studies to determine the harms also of screening so now we're balancing. We're balancing the harms and the benefits to determine the net benefit and now women can decide. If they are willing to go through procedures that may be -- most likely to be unnecessary and then talk with a clinician and they can have all of the screening that they would like based on their anxiety, their own health history so we're not saying not to screen. We're talking about turning 40 and being routinely screened simply because you turn 40.

BLITZER: Lucy Marion is the dean of the school of nursing at the Medical College of Georgia. Thanks very much, Doctor, for coming in.

MARION: Thank you, thank you.

BLITZER: Almost 17 American children at times had trouble finding enough to eat last year. I'll speak about that and more with the agriculture secretary, Tom Vilsack. He's walking into THE SITUATION ROOM. What's going on? We're going to ask the former governor of Iowa. Thanks for coming in.

TOM VILSACK, AGRICULTURE SECRETARY: You bet. Good to see you.

(COMMERCIAL BREAK)

BLITZER: Hunger is a grim reality for a growing number of Americans. Get this. 49 million people in the United States of America, including almost 17 million children, had trouble getting enough food last year. In an annual report the Department of Agriculture says more than a third of these had what the government calls, and I'm quoting now, very low food security. That means that at times they were forced to cut back on meals or skip them all together. Let's discuss what's going on with the agriculture secretary, Tom Vilsack, the former governor of Iowa. Mr. Secretary, thanks very much for coming in, and I read this report, and I said to myself how could be in the richest country in the world that so many millions of Americans, including so many million children, are at times hungry in our country?

VILSACK: Well, Wolf, it starts with poverty, and interestingly enough a substantial majority of those 49 million Americans, many of them are employed. They are working part-time jobs, two part-time jobs, low-paying jobs, and the result is that they have a hard time at end of the month being able to stretch that food dollar, even with the additional food assistance, so it starts with poverty. It starts with unemployment, starts with a difficult economy. Fortunately, those numbers would be substantially higher were it not for the snap program that the USDA program.

BLITZER: What's that?

VILSACK: It's the supplemental nutrition assistance program. People used to know it as food stamps. Part of the stimulus program was to increase financing for that, the WIC program which is woman and infant children, helps about nine million people and the snap program helps about 35 million and school lunch and school breakfast program, over 30 million children.

BLITZER: Clearly something is wrong, because you expect to here about hungry children and hunger in Congo or some place in Africa, but you don't expect to hear these kinds of numbers here in the United States.

VILSACK: Well, there's a difference. When we talk about hunger in those developing countries we're talking about a chronic situation, something that's occurring every single day. Here in America what we're talking about is during the month you may have one or two days where there may be difficulties, and fortunately most of the children in this country are sheltered from this. We still have a substantial number that we have to address, but adults are the ones who are making sacrifices so that their children can eat.

BLITZER: But there are children who are hungry.

VILSACK: There are indeed. There are indeed. Roughly a million children are very low food security which means that at some point in time during the month they are skipping a meal, they are cutting back on what they eat or they are going hungry.

BLITZER: These are little kids.

VILSACK: These are kids anywhere from 1-year-old to 18.

BLITZER: It's just shocking, a million kids at times every month are hungry.

VILSACK: It is -- that's the reason why we were talking to the senators today about the need for additional resources in the school lunch and school breakfast program because that is one place where we actually do get youngsters meals and we're going try to improve the access to those programs as well as nutritional value of those programs.

BLITZER: What do you need as secretary of agriculture to make sure that there is no hunger in the United States?

VILSACK: We need -- we need a growing economy. We need a comprehensive effort involving not just my department but lots of departments of government and state governments. We need states to aggressively promote the snap program, the ones who administer this program through the human services department. We need simplification in terms of application process for involvement in these programs. Sometimes our school lunch and school breakfast program have applications which can discourage people from participating, so we need simplification, additional access and we need to frankly increase the nutritional value of these programs.

BLITZER: Because the other side of this is obesity, so many poor families out there they can't afford to buy healthy food and they buy unhealthy food and as a result there's a huge obesity problem for young kids.

VILSACK: There is, and it's a twin problem. Part of it has to do with the fact we don't have much physical activity as we used to for kids.

BLITZER: In schools.

VILSACK: In schools today you would be shocked to know that just about half of the youngsters in this country actually have physical education opportunities in school. In high schools only about a third of high schools meet the physical education requirements and recommendations so we've got to get more active. We've got to get more engaged and frankly this is a wake-up call for the United States. It's a wake-up call for all of us to understand that there are food shortages in families, that this is an issue that needs to be addressed as is the nutrition issue.

BLITZER: We're counting on you, Mr. Secretary, to fix it.

VILSACK: I appreciate you giving me the opportunity to talk about this, because I think the more people are aware of it the more the food banks will receive assistance and the more non-profit organizations will kick in as they have and the more focus we put on this and I think the greater the chances are that we'll reduce those numbers over time.

BLITZER: Good luck.

VILSACK: Thank you.

BLITZER: The secretary of agriculture, Tom Vilsack with a tough job ahead of him. Thank you.

VILSACK: You bet.

BLITZER: Consumers blow the whistle on internet scams. UNIDENTIFIED FEMALE: I have seen many scams and offers on the internet and have only lured in by one, this one due to the fact that the scam was associated with a reputable website and required just one click.

BLITZER: A senate hearing highlights a real consumer threat, online companies signing you up for services you never wanted, and they are charging you a bundle.

And a U.S. soldier misses her deployment to Afghanistan because her child care plans fell through. Now this single mom could face serious charges. We'll explain right here in THE SITUATION ROOM.

(COMMERCIAL BREAK)

BLITZER: Day in and day out, devastating attacks are taking a heavy toll in Pakistan. Battered by these deadly bombings, some Pakistanis seem to be right now in a state of denial when it comes to casting blame. CNN's Ivan Watson is in Islamabad.

(BEGIN VIDEOTAPE)

IVAN WATSON, CNN CORRESPONDENT: October 28th, a car bomb in a Peshawar market more than 100 people killed and November 2nd, a suicide bomb at a bank, 35 dead, November 16th a suicide bomb at a Peshawar police station, six dead. These just a few grim examples of the worst violence to hit Pakistan in decades.

UNIDENTIFIED MALE: Peshawar --

WATSON: In this internet statement released last weekend, Pakistani Taliban spokesman claimed responsibility for suicide attacks targeting Pakistani police and soldiers. But ask survivors who they think is behind the bombings, and you often get surprising answers. According to a recent Gallup poll, only 25 percent of Pakistanis surveyed blamed the current crisis on the Taliban. Instead, the belief that foreign governments are somehow responsible for the deadliest wave of suicide attacks in Pakistani history is something you hear again and again across Pakistan. From the campus of an Islamabad university hit by two suicide bombers --

MARRIAM TAHIR, UNIVERSITY STUDENT: Who don't want Islam to be over the world, they are doing it.

WATSON: To the cat walks of fashion shows in Karachi.

NADIA HUSSAIN, FASHION MODEL: But the truth about the militants is they are not Pakistani.

WATSON: Some analysts say it's easier for Pakistanis to blame foreigners than it is to blame their own home-grown militants.

ISHTIAQ AHMAD, TERRORISM EXPERT: People are confused. People have been fed one kind of information which only says that the rope you are suffering is not because there is something wrong inside the country, it is because Pakistan's enemies are held back to you. WATSON: This confusion about the identity of the bombers on display at a shopping plaza still recovering from a recent suicide attack.

UNIDENTIFIED MALE: This might be blackwater.

UNIDENTIFIED MALE: Blackwater?

UNIDENTIFIED MALE: Blackwater.

UNIDENTIFIED MALE: Foreign currency.

WATSON: In a country traumatized by violence, there's only one thing that is certain. People are getting killed.

Ivan Watson, CNN, Islamabad.

(END VIDEOTAPE)

BLITZER: Almost every day that happens in Pakistan right now.

Let's go to Jack Cafferty. He has the Cafferty File. Jack?

JACK CAFFERTY, CNN CORRESPONDENT: The question this hour, Wolf, is should health care be the government's responsibility? A growing number of Americans don't think it is according to some of the latest polls.

Nick says, "Yes, the role of government is to protect its citizens. This isn't just limited to military force. We have Medicare, Medicaid food stamps. The nations around the world that have heavy involvement in the health care system have the best results with few exceptions. If you can find money to kill people, you can find money to protect people."

Jim in Canada says, "The mammogram decision says it all, cost before care. The government can control doctors' decisions simply by not covering procedures that can save lives. We see it in our care in Canada. Americans should be absolutely sure about the public option limitations and control before you let your representative vote yes rather than blindly agreeing just because it sounds good."

Ricardo in Cypress, Texas, says, "Hell no, the government's responsibility is to provide opportunity and the tools needed to its people so they are able to achieve high quality education, well paid jobs, support their family and be successful by their own means and determination but I guess we're expecting too much from our politicians in Washington."

Michael says, "It's one of the few things for which the government should definitely be responsible right up there with infrastructure and national defense. Every other civilized country in the world correctly believes it is in everyone's best interest to have a healthy population but here you take a backseat to a green god named dollar." And Denise in San Jose, California, "This is why the Democrats are in such a hurry to pass this very bad bill. The longer we have to find out what is really in it, the less support they have for it. We all want reform, but not this. They need to take their time, pass a bill that's good for everyone. There's no rush to pass it. Coverage wouldn't even begin for another five to seven years."

IF you didn't see your email here, you can go to my blog at CNN.com/CaffertyFile. Wolf?

BLITZER: And lots of people do as they should Jack. Thank you.

Reforming health care, we have more on the story coming up. Will the senate push the process into 2010? We're going to ask an insider. The number two Democrat in the senate, the Illinois senator Dick Durbin.

And online shoppers beware. You may be buying much more than you realize. You'll find out how you to avoid being charged for something you never even wanted. We'll explain right here THE SITUATION ROOM.

(COMMERCIAL BREAK)

BLITZER: For many Americans, shopping online is the norm, but check your credit card for any mysterious charges. The Senate Commerce Committee today is going after companies using aggressive and misleading tactics to trick customers to sign up for programs they never even wanted to join. Let's go to our internet reporter Abbi Tatton.

Abbi, these companies that are doing this, what's going on?

ABBI TATTON, CNN INTERNET REPORTER: Wolf, the names of these companies, Virtue, Web Loyalty, you probably never heard of any of them, but if you've ever bought an airline ticket, flowers or even ordered a pizza online, they might be charging your credit card right now. These companies partner with well-known online retailers so that after you've made your purchase, a screen like this comes up offering you $10 cash back or money off your next pizza purchase. And thousands of consumers are complaining that after they've clicked through a screen like this, they found out later that they were being charged $10 or $20 a month for mysterious membership programs without even submitting their credit card details. Take a listen.

UNIDENTIFIED MALE: This is nothing short of theft. It took me close it a year to recover my money, money that I did not give them permission to take.

UNIDENTIFIED FEMALE: I have seen many scams and offers on the internet and have only been lured in one this, one, due to the fact that the scam was associated with a reputable website and required just one click.

TATTON: Senate Commerce Committee Chairman Jay Rockefeller today slammed not just the companies that market this way, but online merchants that make millions from partners with them. BLITZER: Did these companies respond?

TATTON: Wolf, they weren't at the hearing today, but all three have defended their programs and said they have made recent changes to require some credit card information to make this process clearer. But some online merchants are now looking at their relationships with these companies. US Airways is one that says that they are now dropping this from their website. Wolf?

BLITZER: Thanks very much, Abbi Tatton for that.

To our viewers, you're in THE SITUATION ROOM.

Happening now, the best political team on television on these stories, an eye popping new tally of Americans dead. Republicans accusing the president of fiscal recklessness and irresponsibility. The president in China thanking communist leaders for helping keep the U.S. economy afloat. This hour, the bottom line on a big summit in Beijing and how much he's accomplished.

And she's a soldier and a mother and she failed to show up to fight a war.