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Sanjay Gupta MD

Deciding When to Die; Health Care Law in Federal Appeals Court; Why We Do What We Do; Dealing with Diabetes

Aired June 11, 2011 - 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: Our investigation of cell phone safety in a possible link to cancer. It's triggered a lot of questions. I'm going to answer as many as I can this morning.

Also, a neuroscientist who is literally peeling back your subconscious. Let's put it this way: you don't have as much control over yourself as you think you do. We'll explain.

And a top race car driver who's beating diabetes with the help of his dad and a little ingenuity.

But, first, picture this -- a family loses a beloved sister and then discovers it was suicide. And then they realize someone else helped her do it. We're going to hear from them in a moment and from the man who some people are calling the new Dr. Death.

The original Dr. Death, of course, was Dr. Jack Kevorkian, who died last week of natural illness at the age of 83. In his last TV interview ever, he revealed a pretty grim view of life in general.

(BEGIN VIDEO CLIP)

DR. JACK KEVORKIAN, "DR. DEATH": Schopenhauer said it nicely. What crime has this child committed that it should be born?

GUPTA: That's a profound -- it's a deeply pessimistic thing to hear.

KEVORKIAN: But it's very sensible.

(END VIDEO CLIP)

GUPTA: According to a recent Gallup poll, Americans are split pretty much right down the middle as to whether assisted suicide is morally OK.

Now, while the public is evenly divided only two states, Oregon and Washington, have laws allowing doctors or anyone else for that matter to assist in suicide -- and even then, only under some circumstances. More than 40 states explicitly forbid it, and yet it happens more than you might think.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Jana Van Voorhis had a long history of mental illness and when she was 58, she took her life.

According to the Final Exit Network, she is one of hundreds they have helped along to a peaceful death. Viki doesn't see it that way.

VIKI THOMAS, JANA VAN VOORHIS' SISTER: I think Jana would still be here if Final Exit had not been involved.

GUPTA: Jana submitted her application to Final Exit. At the time, Dr. Lawrence Egbert was the group's medical director and determined Jana was ready to die.

V. THOMAS: They had what she sent them which said odd things about her health. It said liver cancer and -- what else did it say?

TOM THOMAS, JANA VAN VOORHIS' BROTHER-IN-LAW: Rat poison.

V. THOMAS: Yes.

T. THOMAS: And all sorts of real strange things.

GUPTA: One day in March of 2007, Viki received a suspicious call asking them to check on Jana.

T. THOMAS: But a day or two later, we did go over to check on Jana because we weren't able to reach her by phone and that's when we found her dead.

GUPTA: Jana died by suffocating herself with a tank of helium. It's Final Exit's method of choice.

T. THOMAS: Their theory is that they don't want to be part of any physical activities with the person that's going to die. So, they explain how to do it, show them how to open the valves and they have them do the valves themselves.

GUPTA: Ultimately, Egbert, along with three Final Exit members, were tried for conspiracy to commit manslaughter. Two members entered plea agreements and because of a hung jury, the third will be retried.

As for Egbert, the jury found him not guilty.

V. THOMAS: Do you remember where this was?

GUPTA: For the Thomases, there are only pictures left.

T. THOMAS: Everybody's all dressed. Look at Jana, she looks great.

(END VIDEOTAPE)

GUPTA: And the doctor tried but acquitted in Jana's case, Dr. Lawrence Egbert, joins me now from Baltimore.

Thanks for joining us, Doctor.

You know, some folks have taken to calling you the new "Dr. Death." And I know that's not a term that sits well with you.

The starting point, how would you explain what you do?

DR. LAWRENCE EGBERT, FORMER MEDICAL DIRECTOR, FINAL EXIT NETWORK: I explain it very simply by saying it's something that somebody desperately wants to have happened. There are a lot of people who have -- who are suffering. There are a lot of people who have suffered, and have come to the point where they can't handle it anymore. So, they want out.

GUPTA: You don't like the term suicide, even, I understand. Why not?

EGBERT: Well, suicide has a lot of negative connotations, especially from a religious point of view. And so, basically, the reason we try and use the word like "hastening death," for example, the -- is because of the stigma associated with it.

You know, just a few years ago, this was illegal. A Supreme Court judge said it's immoral right now, so that the idea, there's a very powerful people who are very uncomfortable with the idea from a religious point of view.

GUPTA: You're referring to Justice Scalia, suicide -- referring to it as immoral.

I do want to ask you specifically about Jana's case. Now, that the trial is over, you can talk about this.

The family says they were never contacted or consulted. Is that right or fair? And they said that also she suffered from a history of mental illness. Was she of sound mind to even consider this idea of ending her own life?

EGBERT: Well, was she of sound mind? We thought so. She was sufficiently sound to get along in society.

She had friends. She had a car. She kept a lovely house. She was a person who officially is of sound enough mind to get along in society.

She's not incarcerated. She has had mental therapy. So, we were considering her of a sound mind.

GUPTA: During your tenure with the Final Exit Network, how many applications did you review and how many did you actually approve?

EGBERT: Well, in the four or five years roughly, I don't -- I didn't keep a tally of the numbers, so that the president of the organization, Dr. Dincin, would be a better source. I would guess around 300 patients, people that applied for this service.

GUPTA: And can you give a percentage? I mean, if someone applies, how likely are they to be approved?

EGBERT: Well into the 90 percent. GUPTA: So, most people?

EGBERT: Everybody -- pardon?

GUPTA: Most people get approved. What criteria are you considering when you look at one of these applications and does someone have to be terminal? Does someone have to be physically suffering? How do you -- how do you measure that?

EGBERT: People invariably are suffering. Mostly, it's physical -- a lot of it is psychological. A lot of it -- of the people that I talked with and the people that I met, and the people that I read about, all of them have been suffering not just a while, but for a long while.

GUPTA: And when you're actually seeing someone die, because of your decision, what is that like for you as a doctor?

EGBERT: Well, I never got used to it. I was telling someone one time, he's a psychologist, I said, I just don't seem to get used to this and she chuckled and laughed at me and said, "When you get used to it, that's the time you ought to quit."

GUPTA: Dr. Egbert, it's a fascinating discussion, a polarizing one, as you better than anyone knows. But I appreciate you spending time with us this morning.

EGBERT: Sure.

GUPTA: In some other news, my report on radiation from cell phones and a possible link to cancer. A lot of people are talking about this. And you have questions. I'm going to try to answer more of them. That's straight ahead.

(COMMERCIAL BREAK)

GUPTA: You know, in Atlanta this week, just a few blocks from CNN, a federal appeals court heard a challenge to the massive federal health care law. More than two dozen states brought the case and in January, they won.

A federal judge struck down a key requirement that everyone buy insurance coverage if they weren't already covered, through an employer, Medicaid or Medicare.

Now, that judge's ruling is on hold while the case is appealed. That requirement, like a lot of the law, doesn't go into effect until 2014.

But according to a new CNN/Opinion Research poll, it's already unpopular -- 44 percent for it, 54 percent against. In that same poll, after the economy, people said health care is the most important issue in their vote for president.

So, joining me now from New York to talk about this: CNN's senior legal analyst, Jeffrey Toobin. Thanks for joining us, Jeff.

JEFFREY TOOBIN, CNN SENIOR LEGAL ANALYST: Hi, Sanjay.

GUPTA: So, Jeff, we've talked about this before, but what happened in this hearing here? Did the judges sound like they would support the law or throw it out like the judge in the first trial?

TOOBIN: Well, you know, this one was a little hard to tell. Just to put this all in a little perspective, there have been a lot of these cases all over the country, kicking around the federal courts. So far, three district court judges have upheld the law, said it's constitutional, two district court judges have said it's unconstitutional, including the one in Florida.

GUPTA: Right.

TOOBIN: And these cases are starting to move through the appeals process.

This summer, there are four federal appeal courts that are hearing these appeals. One was heard about a month ago. The one was this week in Atlanta.

The first one that was heard sounded like the judges were pretty sympathetic to the constitutionality of the law. This one, I think, it was more ambiguous.

But it's always hard to read from judges' questions how they're ultimately going to vote in the case. So, I don't think we can say anything conclusive at this point.

GUPTA: Let's put a little bit of specifics on what we're talking about here. The law is sort of this grand bargain, a safety net, if you will. Insurance companies required to cover anyone, even if they have a serious or chronic illness. The tradeoff is you have to carry insurance. You can't just wait until you get sick.

So, if the judge throws out the insurance buying requirement, this mandate, so to speak -- what happens to the rest of the deal?

TOOBIN: That's very hard to say. And, in fact, that's one of the key arguments even in both sides, because the anti-health care law advocates say, look, this part of the law is so integral to the whole system that you have to throw out the whole thing. And one of the judges, in fact, did that. All the other judges have said you can separate this.

But as a political matter, if you get rid of the mandate, and don't wind up forcing all those millions of new people into the system, there is a sort of political question of how it's going to work because all other parts of the law, like the part that says kids can stay on their parents' insurance until they're 25, the part that says you can't be denied insurance because of a preexisting condition, those benefits are more or less contingent on getting all those new customers into the insurance system. GUPTA: Right.

TOOBIN: So, it's very hard to know how to work.

But, by the way, let's be clear: it's not at all clear that the Supreme Court, which almost certainly will get this case, will strike down any part of this law. The last word is a long way away.

GUPTA: All right. Thanks a lot. Appreciate your time.

We got another story back in the headlines this week as well: cell phones and cancer. We've been covering this for some time. We're continuing to ask the question: is your cell phone safe?

You know, in the past, the World Health Organization has said there's no way cell phones can be problematic. Problem is: they don't say that any more. They say cell phones are possibly carcinogenic, that is to say that they could cause cancer.

Now, earlier this week, I sat down with Ryan Seacrest on his radio show. He asked me to come on. And he asked me if parents should postpone getting their kids a cell phone?

(BEGIN AUDIO CLIP)

GUPTA: I'm delaying getting my kids cell phones, in part because of this, and in part because -- you know, I just think they spend more time on a device that has all sorts of games and other things on it, which I think is another issue. But I also think we -- you know, these types of problems that we're talking about, potential brain cancers, take 20 to 30 years to develop. You know, there's only been cell phones really in popularity in this country over the last 15 years. Our kids are going to use them their entire life.

(END AUDIO CLIP)

GUPTA: Now, the scale and the exposure is really what's going to be exponentially different here from our kids as compared to us. And, by the way, it's not just Ryan Seacrest asking these questions. My e- mail, my Twitter, we've been flooded with lots of messages from all of you viewers looking for advice.

So, I wanted to say -- it really all boils down to this: as silly as it sounds, try and keep your cell phone away from your body as much as possible. Use your speakerphone when you can, a corded earpiece or even text in an effort to keep your phone away from your head and out of your pocket. I hope that helps a little bit.

Now, protecting your brain from knowing what's going on inside of it. I'm fascinated by this. Just how much control do you have over your own mind?

New research suggests a lot less than you might think.

Stay with us.

(COMMERCIAL BREAK)

GUPTA: Most of us want to know why we do what we do. Sure, we know our decisions are made in the brain intensively. But some new research out there is shedding light on just how many of those decisions are made at the subconscious level, more so than you think.

Dr. David Eagleman is a neuroscientist at Baylor College of Medicine. He's also author of the new book "Incognito: The Secret Lives of the Brain."

Great title.

DR. DAVID EAGLEMAN, ASSISTANT PROFESSOR OF NEUROSCIENCE, BAYLOR COLLEGE OF MEDICINE: Thanks. I mean, essentially, that's what's going on. So, you have so much hidden machinery under the hood there, and it's starting to fascinate me to realize how much that goes on that we have no awareness of.

GUPTA: Is this something you can study? I mean, when you think about subconscious level decision-making, how do you -- how do you start even thinking about that?

EAGLEMAN: Well, here's the simplest example. When you move your arm or something, it feels like it's effortless, right? But you and I know there's a lightning storm of neural activity that underpins that. And if it weren't for the fact that we were a neuroscience, we wouldn't even suspect the existence of cells and muscles and electrical signals, right?

Well, it turns out everything in our lives is like that. There are lots of examples of this.

For example, I was -- I was impressed by a study I saw many years ago when I first got into neuroscience. Men were asked to rate the attractiveness of women's faces and photographs. In half the photos, the women's eyes had been dilated. Now, the men uniformly found these photographs were more attractive, but none of them were able to say, oh, I noticed her eyes were -- or her pupil was a millimeter wider here.

GUPTA: Right. Right.

EAGLEMAN: But their brains knew. Their brains were picking up on that, that dilated eyes is a sign of sexual readiness in women. Their brains knew, gave them the appropriate signals that were more attracted over here. Their behavior was steered appropriately, even though they had no idea why.

And it turns out that most of our attractions and our desires and so on is like that.

GUPTA: And you had another experiment, I think, as well where you have people actually do something and to give them an idea of how their subconscious mind is thinking, mimicking motions, was it --

EAGLEMAN: Oh, well -- OK, I was going to ask you to do this. So put your hands on the steering wheel.

GUPTA: OK.

EAGLEMAN: And I'd like you to make a lane change into your left lane. So, you're driving and you want to move over into the left lane.

GUPTA: OK. So, into the left lane. OK?

EAGLEMAN: OK. So, like almost everyone else, you got it wrong.

So, it turns out that the way you make a lane change in the left lane is you go to the left, then back to center, and all the way just as far to the right, and then you steer --

GUPTA: Yes.

EAGLEMAN: What you did just steered you off on to the sidewalk.

GUPTA: And then turn far enough to the right. Yes.

EAGLEMAN: Exactly. The point is, there are many things your brain takes care of, almost everything in your life your brain takes care of and we don't have conscious access to most of it. Most of what you can do, you don't even know how you're doing it.

When you recognize the way your father walks or the sound of somebody's voice or things like that, your conscious brain doesn't even have access to it. What happens is, your conscious mind is like a little stowaway on a transatlantic steam ship and is taking credit for the whole thing and it's not giving credit to the massive engineering that's under foot.

GUPTA: What does someone do with this? I mean, I guess if it's at the subconscious level, it's -- that's where it's relegated. But is there something -- is there a lesson here?

EAGLEMAN: Yes. It turns your brain is like a team of rivals that's always battling it out. And the important thing for us trying to understand ourselves is how do we negotiate with ourselves to manage this? So, we all have short-term temptations, whatever it is in our own lives, and what we have to think hard about is how do you set up these structures so that the long-term decision-making can win?

For example, alcoholics who are trying to quit need to get rid of all the alcohol in their house. Or, people who are trying to lose weight can go to these Web sites now where you give, let's say, $100 to these total strangers and you say, I promise that I'm going to lose 10 pounds by this date and if I don't, then you guys keep the money.

GUPTA: Wow.

EAGLEMAN: Otherwise I get the money back.

But what you're doing is your present self is giving away the money so that your future self has to work hard to get it back. That's the way we can tip the battle between the short and long-term parts of our brain.

GUPTA: You mentioned alcohol a couple times. And my sense is that you're talking about alcohol in the sense that it could make you less likely to exercise the conscious good judgment.

Are there things that can act in the opposite way, medications or anything else that you found that can enhance your ability to let the team of rivals on your side win?

EAGLEMAN: I mean, really it's just this issue of being part of the community fabric. I think having the right sort of community around you is what gives you that.

GUPTA: Surrounding yourself with peers whose values you emulate and --

EAGLEMAN: Quite right. Yes.

GUPTA: Fascinating guy. You're so young. I expected you to be older for all that you've done.

EAGLEMAN: Well, I eat my spinach and broccoli.

(CROSSTALK)

GUPTA: Well, good stuff.

And still ahead, a truly inspiring story about overcoming life's obstacles. You're going to meet the first Indy driver to race with diabetes. You want to see how he's managing his disease, both on and off the track. Stay with us.

(COMMERCIAL BREAK)

GUPTA: You know, we like to think professional athletes have it made. They're young, they're healthy, seemingly invulnerable.

But after this story you might think twice. This Saturday night, Indy car race at the Texas Motor Speedway, in car number 83, there's a driver who went through some serious twists and turns before he even made it to the starting line.

(BEGIN VIDEOTAPE)

UNIDENTIFIED MALE: The 83 of Charlie Kimball.

CHARLIE KIMBALL, RACE CAR DRIVER: Growing up, I wanted to race professionally. I wanted to race in the Indianapolis 500.

UNIDENTIFIED MALE: He is 10.9 seconds behind the race leader.

GUPTA (voice-over): This year, Charlie Kimball finally fulfilled his dream. In order to get here, though, he had to overcome a big hurdle.

You see, four years ago, he was told he had diabetes. So, Kimball took time to figure out how to cope with his diagnosis and figure out if he could race with diabetes -- something Indy car officials said was a first.

To qualify for these races, he not only had to be fast, he had to be healthy.

KIMBALL: If I go to high, my reaction time is slow and I'm not competitive. If I go too low, I get lightheaded. Go low enough, I could pass out and cause an accident.

GUPTA: His diabetes led him to a sponsor.

Kimball's pit crew consists of mechanics, engineers and his doctor. He has to make sure his body is ready along with his car, which now has special equipment.

KIMBALL: I wear a continuous glucose monitor, which is a sensor that I have on my body. And it reads blood glucose and wirelessly transmits to a pager-like display that I have Velcro to the steering wheel.

GUPTA: And he has a backup system designed by his father, just in case.

KIMBALL: I got a drink bottle mounted in the car, fill it with orange juice, which is full of sugar. The tube runs right into my helmet. And without having to take my hands off my steering wheel, I can drink that orange juice, bring my sugars up, and I don't have to stop.

GUPTA: Kimball is determined to get the message out that diabetes doesn't have to stand in the way of your dreams.

KIMBALL: I am living proof you can do almost anything you want in life with diabetes. You can even drive a race car a couple of hundred miles an hour.

(END VIDEOTAPE)

GUPTA: Great stories of people overcoming obstacles. Good luck there.

And next weekend, for Father's Day, we're going to bring the story of my friend Nick Charles. He's the father of a young girl now suddenly confronted with his mortality. What would you do? He's looking to make the most of the rest of his life. We're calling it, "Nick Charles: Lessons from the Fight," next weekend right here on SGMD.

That does it for today's program. Thanks for being with us this morning.

Time now to get you back inside the CNN NEWSROOM for a check of your top stories making news right now.