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New Mammogram Guidelines; Skyrocketing Drug Costs; Holiday Travel and H1N1

Aired November 21, 2009 - 07:30   ET


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

You know, we've been talking about it all week now -- new cancer screening guidelines for women. Now, the task force that issued that advice is a little bit on the defensive. We're going to hear what one member has to say.

And prescription drug prices -- well, they're on the rise. Question on a lot of people's minds is, why? Some experts say one possible reason could surprise you.

Plus, Thanksgiving travel -- it's beginning. What you need to know about H1N1 before you head to the airport.

You're watching HOUSE CALL.


GUPTA: You know, new mammogram recommendations are causing on uproar. We've got some details on that in a moment.

But, first, another new set of screening guidelines out for girls and women. This concerns cervical cancer. Now, the American College of Obstetricians and Gynecologists is now telling women they don't get cervical cancer screenings or Pap tests nearly as often.

In fact, they're saying women in their 20s should now get tested every two years and women in their 30s who had three consecutive clear tests can go every three years. As for the younger girls, the American College of Obstetricians and Gynecologists now set age 21 as the time for a first Pap test.

Now, the American Cancer Society points out that Pap testing finds pre-cancers, not cancers. So, it says these new guidelines are a good move and reduce unnecessary biopsies.

Meanwhile, the U.S. Preventive Services Task Force announced new mammogram recommendations -- you'd probably heard about this. They're saying that women between the ages of 40 and 49 no longer need to get routine mammograms, unless they are at risk for breast cancer. Women 50 and older need only go every other year.

Now, I spoke with one of the task force members who helped make this controversial recommendation happen and asked questions a lot of women and doctors are asking as well.

Take a look.


GUPTA: About 75 percent to 90 percent of breast cancers are found in women who have absolutely no family history and no identifiable risk factors. If you are a woman hearing that at age 40, right now, watching, 75 percent and 90 percent of breast cancer found with people with no risk factors, no family history, what should they do?

LUCY MARION, PHD. RN, U.S. PREVENTIVE SERVICES TASK FORCE: I would -- I would not recommend it. I would not make a recommendation. We are saying that the benefits are small.

GUPTA: What do you mean by that? When you say the benefits are small, let's not beat around the bush here, what exactly are you trying to say?

MARION: We look at it in various ways. For example, we look at life years gained by the actual screening every year or every other year. And the life years gained for that group is not very large. There are some life years gained, but it's not very large. And I know...

GUPTA: You're a nurse and I just -- I don't want to, you know...


GUPTA: ... dig ourselves into a hole here. You are a nurse. You're in a profession that's dealing with compassion.

Are you comfortable with what you are saying right now? Because what you're saying, what I'm hearing you say is that you're saying some lives just aren't worth it. We -- that's why we're changing the screening recommendations. And that is an incredibly frightening thing to hear from someone like yourself.

Is that what you are saying?

MARION: No, I'm not saying that some lives are worth it. I do not say that. But, look, as you know, as a physician, there are many screening tests that could save lives, or could create many other issues that we've made decisions about.

GUPTA: So, really, the harm that you're saying to women, the harm that you cite is that it could cause unnecessary anxiety and worry in women who get these mammograms, for example, if they have a false positive. Do you think it would cause anxiety in women if they're told that, look, 90 percent of the 90 percent of women who develop breast cancer never had a risk factor? And now, you're not sure if you have that breast cancer because it's the test. Don't you think that causes anxiety as well?

MARION: Yes. We do know that the biggest risk factor is age. That's clear. And so, the other -- and we know other risk factors. And we know that many do not have known risk factors if you don't include age.

GUPTA: To be fair, you didn't look at the population data. You looked at computer modeling of what you assumed the population would behave like.

So, to be clear, about 15 percent of breast cancers out there were found on routine mammograms. What the task force conceded is that there are a lot of breast cancers that are found between the ages 40 and 49 on routine mammogram. The task force also conceded -- a lot of those women's lives were saved as a result of those mammograms.

Yet, the task force concluded that it was not necessarily -- any no longer recommend these routine mammograms, it saves lives. It targets women in this particular age group, that the task force is not recommending it anymore. It's just confusing to me as a doctor and as just a member of society.

MARION: Many cancers do not progress. And that, with the -- with the screening that we have, we cannot determine which of those cancers would progress. And so, that's another issue for us to be facing.


GUPTA: And Lucy Marion is just one of the 16 members of this task force that makes recommendations on a range of health issues, not just cancer, incidentally. The rest of the panel, incidentally, is made up of other health care professionals. But there is not a cancer specialist on this particular panel. Instead, the group brings outside panels which gather evidence and then make recommendations based on that research.

Now, task force members come from all areas of medicine, from primary care doctors to nurses, and it includes two people with ties with the insurance industry as well. So, quite a diverse group.

Now, we should be clear that these new recommendations do not mean that a woman in her 40s cannot have a mammogram. This task force did not have the power to change health policies, so to speak. But, you know, the thing about is, insurance companies do use this task force to guide their coverage. And that, of course, has some women concerned.

So, we have Elizabeth Cohen investigating that, that particular angle -- Elizabeth.


ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: Sanjay, the first thing women in their 40s need to know is that 20 states have laws that say insurance companies have to cover their routine mammograms.

Here's a -- here's a map that shows those 20 states. Now, of course, this is legal stuff, so there's a caveat. In these 20 states, only some insurance companies have to cover women in their 40s. About half of all women work for companies that would not be covered by the state laws.

I know it's sort of confusing. The bottom line is that some women would be protected -- insurance companies would have to pay for their mammograms while in their 40s. Other women would not.

However, Sanjay, I've been talking to some observers who say, look, insurance companies in many cases could legitimately say, "We don't want to cover mammograms for women in their 40s now that the task force has changed their guidelines." However, it would be a P.R. nightmare -- that was their words -- a P.R. nightmare for an insurance company to say they're going to stop covering women in their 40s. And these observers I talked to said, they think insurance companies will keep on covering mammograms for women in their 40s.

Now, for any woman who is having trouble getting a mammogram covered, no matter her age or situation, there are some places that will give financial aid, so to speak, free or reduced cost mammograms. Women need to go to the Web sites for the National Breast and Cervical Cancer Early Detection Program. That's a part of the Centers for Disease Control and Prevention. Also, the American Cancer Society, and, also, the American Breast Cancer Foundation have help for women who cannot afford mammograms.

Now, to get these URLs and to get all sorts of information about what a woman in her 40s is supposed to do now, go to my column at -- Sanjay.


GUPTA: All right. Elizabeth, thanks. Some good information there.

Now, as you may know, Senate Democrats have unveiled their massive health care reform bill, the long awaited one. The price tag on this is about $848 billion over 10 years. It's actually longer than the House bill as well.

Senior congressional correspondent Dana Bash is on Capitol Hill looking through a lot of this.

There are differences, Dana, between the House and Senate bill. We'll start with some specifics. How are they going to pay for this? What about the taxes -- how is that going to work?

DANA BASH, CNN SENIOR CONGRESSIONAL CORRESPONDENT: There really is a big difference between the way Senate Democrats and House Democrats approach the whole issue of taxing in order to pay for health reform. In the House bill, what they passed a couple of weeks ago, it actually says that all wealthy Americans, individuals making $500,000 or more, they will all be taxed.

Well, that was a nonstarter in the Senate. And so, what they did, instead, is their plan taxes high-cost, high-end insurance plans, what's been known as Cadillac plans. Well, guess what, this is going to pose a big problem down the road because that's not going to go very far in the House because a lot of House Democrats -- even talking to them at the end of this week, they simply said that that's a nonstarter for them. Because, they say -- the reality is, it really affects working Americans, especially union members who have nice health plans in their contracts.

GUPTA: It's fascinating.

You know, one of the other things that sort of -- has come up -- is abortion. Will federal funds be used to pay for abortion in any way, shape or form? Are there differences here between the House and the Senate bills?

BASH: There are differences. Again, at the end of the day, this is one of those issues that threatened to derail this whole health care plan. In the House, you remember, there was -- there were very strict restrictions on abortion, saying basically that in a public plan, no abortion can be covered whatsoever. And in private plans, no abortion can be covered if any plans it takes, people would not get taxpayer money.

In the Senate, it's much less restrictive. Their bill allows the HHS secretary to determine whether the public option would offer abortion and also, allow abortion coverage in some private plans as long as the accounts would be separated.

Again, that is already -- we're being told by some anti-abortion Democrats in the House, a nonstarter.

GUPTA: A very important weekend with health care. Dana, we'll stay on top of it. I know you will as well. Thanks so much.

BASH: Thank you.

GUPTA: All right. Some sudden price hikes out there for popular prescription drugs. What's going on? We'll tell you.

Plus, holiday travel and H1N1 flu. We've got some tips on how to protect yourself and your family.

You're watching HOUSE CALL.


GUPTA: We're back with HOUSE CALL.'

You know, as Washington continues to work on health care reform and the economy, people across the country are still struggling to pay their bills. Maybe you're one of those people. Those bills, especially for medications, they continue to go up. And for a lot of people, the question is, why?

Alina Cho is going to join us with that particular report -- Alina.


ALINA CHO, CNN CORRESPONDENT: Hey, Sanjay. You may have heard that drug makers have struck a deal with the White House and Congress on health care reform. They've agreed to cut $80 billion over 10 years from the nation's drug bill. That's $8 billion a year.

Now, all of that sounds really good. But while everyone is talking about lowering costs, prescription drug prices are skyrocketing.

CHO (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 WOLFFE, 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 name 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 $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, would not go on camera but issued a statement, calling the argument 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." (on camera): Some patients are able to take generic drugs. And the price of generic has actually gone down almost 9 percent according to the study. But it's also important to note that 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. So, that means, Sanjay that most Americans who are buying prescription drugs these days are paying more for them -- Sanjay.


GUPTA: I'll tell you what, Alina, the story behind the story sometimes is really amazing stuff.

Now, on to another amazing story, though. A teenager loses his legs in an accident. But while he's still in the hospital, he decides to help others. We're going to tell you all about that and what you can do to help as well. We'll have that remarkable guy when HOUSE CALL returns.

Stay with us.


GUPTA: Over the past two years, CNN brought you some inspirational stories of ordinary people making an extraordinary impact by helping others. We call them CNN Heroes. These are individuals all over the world working to make life just a bit better for others.

Since January, viewers, like yourself, have nominated and voted for their heroes. And now, we're going to celebrate the work of our top 10 CNN Heroes of 2009.

Today, we are spotlighting Jordan Thomas. He's a teenager who lost both of his legs in a boating accident. And while still in the hospital, he decided to give back.

ANNOUNCER: This is CNN Heroes.


JORDAN THOMAS, CNN HERO: They say I'm a bilateral transtibial amputee. In layman's terms, I lost both legs from the mid-calf down. I'm just kind of normal kid that was turned into an abnormal situation.

It was a freak accident. I was 16 years old. My parents and I were going to go scuba diving. There were tons of waves that day and I jumped into the water.

I just got pushed behind the boat. I looked down and I just saw blood.

I had such great support. That's what helped me just kind of get through it. But when I saw the other kids that are in the hospital that didn't have great support, you recognize that something's got to be done.

My name is Jordan Thomas and I started my foundation there in the hospital, and I provide kids with limbs that they deserve.

There are a lot of insurance companies that will put a cap on prosthetics or they'll provide them with one pair of legs for their lifetime.

You never would know that you need new legs every year and a half. It's like shoes, you just outgrow them.

Noah is 6. His first leg, it didn't bend. They asked for a new knee, but he was denied. So, we provide him with a bendable knee that now he's proud to show off how his knee bends. It's great.

We've committed to these kids until they're 18, so we have a lot of work ahead of us, a lot. So we're excited about it.

We need to really work on this then.

We provide them with prosthetics, and that creates a whole gamut of opportunity for them to achieve whatever they want. I think they deserve that.


GUPTA: True CNN hero there, inspirational story.

And tune in Thanksgiving night as well to find out who the CNN hero winner is. It might be Jordan. My colleague, Anderson Cooper hosts the star-studded tribute to be seen around the world on Thursday, November 26th at 9:00 p.m.

Now, obesity is a major problem for America's teens. We talk about this a lot, and as a result of a new study that may surprise you, here's a hint: it's not just the lack of exercise.

Also, H1N1 flu advice that you need to know before getting on that plane. We'll explain, "Ask the Doctor."


GUPTA: We are back with HOUSE CALL.

You know, TV and video games get a lot of blame in the rise of obesity among us. But that blame may be a little misplaced as it turns out because a study from Johns Hopkins says that although teens keep gaining weight, their level of physical activity hasn't really gone down in the last 17 years.

So, the question is, what is responsible for our growing problem with obesity? Well, the study's researchers say diet has a lot more to do with it than we previously thought. Part of it, as you might guess, has to do with portion sizes.

Take a look at this. For example, when it comes to spaghetti -- a pretty common dinner dish-- back in 1990, 500 calories., one cup of pasta, three meat balls. Fast-forward 20 years, 2010, more than double the number of calories, two cups of pasta, three meat balls, a lot more calories. That's one of the problems.

Also, breakfast food, for example, look at that. That is now considered a mini bagel, but that's the size of bagel used to be, about three inches in size, 140 calories. Again, go fast forward 20 years, six inches, 360 calories, more than double again.

It's part of the problem here and it's worth noting the study does not say that teens are getting enough exercise. They're not. In fact, only about 35 percent of high schoolers are getting the recommended amount of physical activity per week.

Bottom line here: watch those portion sizes. It makes a big difference.

Speaking of food, though, we've got some brain food we want to talk about as well, specifically a quiz. Take a look at this. Some of you may have seen. This a cool, new site that challenges the knowledge of news.

If you play now, I could be the one guiding you through. But if you really, other CNN headline news anchors can quiz as well.

And we're joined here by several members of our medical unit. We got Caitlin, Tia (ph)., Marian (ph), Caleb, Jorgen (ph) and Leslie to help with the quiz.

Are you guys ready?


GUPTA: All right. Little brain food for you guys. I want to pick me just because I actually haven't seen this yet and see what I have to say. You just tap.

(via computer): Thanks for picking me. I'm CNN's Dr. Sanjay Gupta and your host for this round of the CNN challenge.

So, once do you that...

(via computer): It's time to test that news knowledge of yours.

All right. Go ahead and try one of these questions. So, you get all sorts of questions here and if you hit begin, pretty simple, you get your first question. We're going to go to you.


GUPTA: During a recent interview who asked Headline News' Robin Meade to join his band? Kevin Bacon, Russell Crowe, Stephen King, or (INAUDIBLE).



UNIDENTIFIED MALE: I'm getting -- I admit that I'm cheating ahead of time but Stephen King.

GUPTA: All right. Let's try it out. You guys agree with that?


GUPTA: All right.

All right. You guys are right.

UNIDENTIFIED MALE: That's a good cheating.

GUPTA: One more question. All right. Let's do this. And who wants to take this one? Any volunteers?

UNIDENTIFIED FEMALE: I'll take this one.

GUPTA: OK. All right. Here we go. What is the occupation of a British erotic blogger? It's perfect, Marian -- whose double life as a prostitute became a hit TV series? Elementary school teacher, law clerk, cancer specialist, TV producer. Remember, you're watching a medical...

UNIDENTIFIED FEMALE: Cancer specialist.

GUPTA: All right. Let's try that.


GUPTA: You got it right, two out of two -- expect nothing less from the medical unit for sure.

Well, planning to fly for the holidays, we're going to have H1N1 travel picks you're not going to want to miss, "Ask the Doctor" -- that's next, my favorite segment with my favorite producers right over here.


GUPTA: And we are back with HOUSE CALL.

It's time for my favorite segment of the show, "Ask the Doctor." Let's get right to it.

Connie in Southern California asks this: "My family is going to be flying for the holidays. Should we be concerned about being in an enclosed space for five hours? I was able to get the H1N1 vaccine for my teenage son but my daughter and I have not been able to be vaccinated."

Well, Connie, it's important to think about how the H1N1 flu could affect your travel plans this holiday season. But keep in mind, the real key thing is protecting yourself and your family ahead of time. I know we talk about this all the time, but wash your hands frequently with soap and water. If soap and water aren't available, you can carry those alcohol-based hand sanitizers. I do the same thing.

Cover your nose and mouth with a tissue when sneezing, encourage people around to you do the same thing and avoid touching your eyes, nose and mouth. Studies show we touch our hands to our faces a lot -- a lot more than we might think.

In addition, some people might consider carrying a disposable mask especially if you're feeling sick yourself.

Finally, the CDC recommends that you can get vaccinated -- try to get vaccinated if you can, sometimes harder than it sounds.

For more information, check out to get some more information about vaccines as well.

Have a safe trip, Connie.

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,

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.