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SANJAY GUPTA MD
Tough Medicine; In Pursuit of Pleasure; Gregg Allman: Hepatitis C is No Picnic
Aired June 25, 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: Good morning. I'm Dr. Sanjay Gupta. Welcome to the program.
Today, we're going to be talking about the science of pleasure and why good judgment might sometimes be bad for you.
And this woman and others say a well-known medicine saved them from breast cancer, but it may now no longer be available. We'll tell you why that is.
And a rock 'n' roll legend gets a liver transplant and finds himself back on tour.
And, finally, this man robbed a bank, not for the money he says, but so he could land himself in jail where he could finally find a quality medical care he'd been seeking for so long. But that doesn't make any sense. I did a little digging.
But, first, from coast-to-coast, families who depend in full or in part on Medicaid are bracing for a major cut in federal dollars. Now, states want more control over the shrinking budget. And if this doesn't affect you directly, it sure affects more people than you might think.
You see, Medicaid isn't just for those who need it financially, it also helps supplemental care for those who need it, including one special little boy named Justin Frye (ph).
UNIDENTIFIED FEMALE: Mom, can you be the reader?
UNIDENTIFIED FEMALE: Sure.
GUPTA (voice-over): Justin Frye is undergoing physical therapy at his home in Summit, New Jersey. This is following his 10th major operation in just as many years. You see, Justin suffers from a rare genetic disease affecting one in 125,000 people.
GENEVIEVE SPIELBERG, JUSTIN'S MOM: When I gave birth, I noticed that his thumbs were angulated. And I'm like, what with his thumbs? What with his thumbs? And, well, in the first hour, life changed forever.
GUPTA: Justin was born with Rubinstein-Taybi Syndrome, RTS. It's characterized by physical deformities and varying degrees of mental retardation. Justin, who's about to turn 11 next month, functions at the cognitive level of someone half his age.
Justin is covered under his father's insurance, but that money doesn't come close to covering all the family's expenses. Supplemental Medicaid coverage from the state of New Jersey helps to cover payments and medical equipment and therapy sessions.
SPIELBERG: I just received a letter indicating that we need to select an HMO for Justin. And sadly, I learned that none of our doctors are in any of these plans.
Well, my fear is again that we not get coverage for him by doctors that have the type of background necessary to work with a child like him because he is a unique situation. And, of course, the bigger fear is when Medicaid is his primary insurance and my husband and I are no longer here and it is not a program that can cover all of his needs, what's going to happen? Because he doesn't have a voice.
GUPTA: I'll tell you, that's really the most vulnerable who are in trouble and at risk.
I want to bring in NYU Langone Medical Center's Andrew Rubin to talk about this. He is the host of "Health Care Connect" on Sirius XM Dr. Radio.
Andrew, thanks for joining us.
You just saw the story on Justin. Under the Stimulus Act from February 2009 and also health care reform 2010, the sense is that states are going to be required to maintain eligibility levels for adults when this all rolls in in 2014.
But until then, what is happening right now? What is happening to someone like Justin?
ANDREW RUBIN, VICE PRESIDENT, NYU LANGONE MEDICAL CENTER: So, under the Stimulus Act, there was $900 million pumped into state budgets to maintain the programs that they had in place. But to take this money, they agreed that they wouldn't cut services.
So, what you're seeing now is this money starts to run out. And it runs out at the end of this month. States are, you know, scrambling to find ways to maintain what they have, but cover the cost of these programs.
In the case of this story we just saw, New Jersey is moving many of its beneficiaries into a Medicaid health plan which, as you know, limits doctor, you know, access.
GUPTA: Yes. That was the big problem. None of the doctors taking care of Justin are actually on this plan.
Is this a case of robbing Peter to pay Paul? I mean, what sort of options are the states looking at?
RUBIN: So, there are not a lot of options because when they agreed to take this money, they sort of -- the government tied their hands in terms of reducing eligibility for others who they might want to actually drop off the program. So, remember, each state in the Medicaid program gets to establish their own beneficiary levels.
So, for example, in the state like New York, it tends to be a little bit more generous to apply for Medicaid as opposed to another state where they are more restrictive programs. New Jersey is one of those more generous states. So, they are trying to -- they have to maintain the eligibility. So, they're going to look to cut other things.
So, what can you do? You can cut doctor payments. You can increase co-payments on many classes of people who are currently eligible for Medicaid.
But they are really limited in what they can do. So, they're going to go after whatever limited things they can do. And in this case, it's going to be putting people in Medicaid-managed care plans.
GUPTA: And how partisan has it seemed to be? I mean, Republican governors want the rules changed to lower eligibility levels? Is that what are you finding, too, Republican governor states?
RUBIN: Well, basically, you know, this debate is not just Medicaid, it's Medicare as well. You know, how to pay for all these programs.
The Republicans want these maintenance effort requirements -- that's what they're called -- to be reduced, to give the states more ability to control their budgets. Remember, Medicaid is paid for by the federal government and the states.
RUBIN: And the states have to balance their budgets with their Medicaid dollars. And this is something they'd like to reduce. But, again, their hands are tied in what they can reduce.
So, there's been some legislation submitted by Senator Hatch to give the states more flexibility. I just think that's going to happen. So, the states have to sit tight until 2014 when health care -- the broader health care reforms kick in. And until then, they're just going to tweak at the things they can tweak at which put more burden on the most vulnerable.
GUPTA: Lots of discussion on this, Andrew. It's fascinating. And you're right, Justin is an extreme case. But, hopefully, we don't see more and more stories over the next two or three years.
Andrew, hope to talk to you again on this. Appreciate it.
RUBIN: Sure. GUPTA: And, you know, a lot of people are desperate for health care. This man walked into a bank in Gastonia, North Carolina, handed the teller a note and by the time the local station TV tracked down, he was in jail.
Here's what he told them.
(BEGIN VIDEO CLIP)
JAMES VERONE, ROBBERY SUSPECT: The note said this is a bank robbery. Please only give me $1. Because I want to make it known to whoever would know that, you know, it wasn't done for monetary value. It was done for medical reasons.
(END VIDEO CLIP)
GUPTA: The man's name is James Richard Verone. He said he has had problems with his foot and back and he's got a strange lump on his chest. He's 59, unemployed.
And all of it got me thinking, is it really possible, in this day and age, Mr. Verone couldn't get access to the care he needed except in jail?
We called around on this and we learned in North Carolina, if you are an adult under 65, you can't get Medicaid unless the state board certifies you're disabled. The local law office said Mr. Verone never applied for Medicaid because they couldn't say for sure if he would have made it, he would have qualified.
The director of a local non-profit Health Net told the paper, "There are other programs available. You don't have to rob a bank to get health care in Gaston County."
Dramatic story for sure. But at this point, it looks like it was probably a bad decision for Mr. Verone.
And up next, we're asking this question: why does pleasure feel so good? Does it even matter? Either way, we're going to examine the biological basis for human pleasure and why some of us just can't seem to get enough.
GUPTA: You know, some of us, it seems, just can't help ourselves. Lots of high profile men recently have been in the news airing their dirty laundry for all the world to see.
It kind of makes you wonder -- don't they know any better? Well, maybe not. Earlier, I spoke with David Linden. He's author of "The Compass of Pleasure."
GUPTA: I'm really interested in this, this whole idea of a biological basis for behavior. And, you know, the question I've been getting a lot lately, maybe you have as well, is when you look at people like Weiner, like Congressman Weiner, you look at DSK, Strauss- Kahn, or even Schwarzenegger, what springs to you mind? I mean, is there a biological basis for this sort of indulgent -- seemingly indulgent behavior?
DAVID LINDEN, THE COMPASS OF PLEASURE: Well, absolutely. I think the thing we have to realize is that it's not an accident that these people got where they are because of the set of personality traits. So, these are people who are novelty-seeking and risk-taking and compulsive. And those traits can serve you very well in government or entertainment or the arts or sports. But those same traits can also get you in trouble.
GUPTA: Is it that everyone else that's not doing this is better at controlling it and these traits are more prevalent than we think?
LINDEN: Well, so what we now know is that there's an evolutionary ancient pleasure circuit in our brain that is dependent upon the neurotransmitter dopamine. And so, this circuit exists so that we find eating food to be rewarding and find sex to be pleasurable, all the things to get our genes to the next generation.
But then what happens if you carry genetic variance that make this pleasure circuit work less efficiently, if it's ratcheted down -- well, what seems to be the case is in the blunted pleasure situation, people need to seek more pleasure. They need to be more pleasure- seeking and more novelty-seeking to achieve the same pleasure set that, quote, "normals," could get with more moderate behavior.
GUPTA: Do they have a choice then? I mean, are we providing a defense for this sort of behavior with what you're saying?
LINDEN: Well, I don't think so. I mean, the fact that something has a genetic contribution and addiction and compulsive behavior have approximately a 40 percent genetic basis with the remainder contributed by life experience and stress, that is not an excuse. It is harder for them. They are feeling stronger subconscious urges, but it doesn't make them automatons where their bad behavior is excused.
GUPTA: What is -- when you talk about pleasure just sort of a general thing, what is the compulsion to control pleasure? I mean, where does that come from? How did that evolve, do you think?
LINDEN: Well, I think what you have to realize is that evolution is a very slow process. And cultures and technology change very quickly. So, what we are well-adapted to is not modern day life. It's life in small hunter bounds.
And in those bounds, there are a particular set of traits that served us well. Novelty-seeking and compulsion in moderation is good. If you are too timid, if you're not novelty-seeking, pleasure-seeking enough, you're not going to find that new food source.
If you are too novelty-seeking, and pleasure-seeking, well, you're going to go over the line and you're going to become food for the lion. The same thing plays out in our modern society with the media.
GUPTA: Are you calling us lions?
LINDEN: Of course. Absolutely.
GUPTA: There was one thing when were you writing this book that was surprising, non-intuitive. I'm sure you had some ideas going into the book what you're going to find. What surprised you?
LINDEN: Well, I think that the thing that surprised me the most is I imagined people who were addicts were addicts because they took greater pleasure in their alcohol or heroin or gambling than other people did. It felt particularly great and so they were compelled to do it a lot.
But what seems to be is exactly 180 degrees the opposite. They take less pleasure in it so they have to do it more to compensate. And this is -- we find it in laboratory animals and we find it across the spectrum of both substance and behavior addictions in people.
GUPTA: Your work has been increasingly relevant it seems in our society. So, I appreciate you coming on to talk about it. Thanks so much.
LINDEN: Thank you for having me.
GUPTA: Fascinating guy, for sure.
Coming up, though, a drug for breast cancer costs almost $90,000 a year. Now, there are some big questions. This one for example, does it even work?
GUPTA: The FDA unveiled new warning labels for cigarette packages and they are much graphic. Let me tell you, the hope is that pictures of a diseased lung or even a dead body will make people think twice before lighting up.
First of all, let me show you the old -- the existing warning. "Surgeon general's warning: smoking causes lung cancer and heart disease and emphysema." The problem with this is it's been there for a long time, first of all, about 25 years. And experts are saying it's simply too easy to miss.
Let me show you some of the other ones here. For example this one, just a simple thing, "warning: smoking can kill you." They are saying labels must appear by September of next year.
Take a look at this one here. The warnings are going to cover the top half of every package front and back panels.
They're also going to have things like this. They're going to have a phone number, what you can call if you're trying to quit smoking, getting some specific health with addiction. Again, some of the graphics are tough to see, in fact. But there are going to be nine of these types of graphic images in all.
Now, take a look at this final one, health risks of tobacco use, one in five adults, 443,000 deaths per year. That's from lung cancer and heart disease alike.
Again, this is something that's been in place in other countries for many years and start seeing it in the United States this fall.
A controversial cancer drug is also back in the spotlight. On Tuesday, the Food and Drug Administration is holding a hearing on Avastin. It's already approved for several types of cancer and until last fall it was approved for breast cancer for women whose tumors had come back after the first-round of treatment.
Marcia Gilbert is one of those women.
(BEGIN VIDEO CLIP)
MARCIA GILBERT, BREAST CANCER PATIENTS: When I had the recurrence, my daughter was a junior in high school and my son was a sophomore in college, and I did fear that I wouldn't even see her graduate from high school. I had been very blessed, and not only did I attend and see those, but also my son's college graduation and then her college graduation a little over a year ago.
I personally feel like Avastin has been a major contributor to me doing as well as I have, and I'm concerned that this committee is just looking at the statistics, and not the individuals. And we are all -- we are all individuals and respond individually to treatments and we're not just statistics.
(END VIDEO CLIP)
GUPTA: You know, you hear a story like that and it's extremely powerful. But let me lay out the controversy. Approval to treat breast cancer was based on some preliminary studies. We found that women getting Avastin went longer without symptoms of getting worse.
But when the full results came out, it was disappointing. For the group as a whole there was only a slight slowdown in symptoms and no improvement in survival.
So, even with success stories like Marcia, the FDA withdrew their approval. And you might be surprised to hear this, but many breast cancer groups say it was the right move.
(BEGIN VIDEO CLIP)
KARUNA JAGGAR, EXECUTIVE DIRECTOR, BREAST CANCER ACTION: I think that at the core, we cannot settle for hope. We need to rally demand treatments which perform, which actually improve overall survival, and which improve the quality of life for women.
(END VIDEO CLIP)
GUPTA: It is extremely unusual for a drug maker, in this case Genentech, get a new hearing to appeal an FDA decision. It happens Tuesday. We'll keep you posted on that.
Meanwhile, Avastin is still approved for other cancers so doctors can prescribe it, but without approval as a breast cancer therapy, insurance companies are less likely to pay.
You can't ignore, Avastin is expensive. Nearly $90,000 a year for treatment. The FDA says it doesn't consider cost but this is an issue.
Herceptin, another breast cancer drug is about $50,000. Erbitux for head and neck cancer, up to about $80,000, again per year. Yervoy, a drug that shows promise against melanoma, $120,000 a year.
The companies all have programs offering at least some help to people who can't afford it. Still, with numbers like these, there's a lot of pressure to make sure these miracle drugs really do help.
Recognize that guy? What about his music? You know the Allman Brothers, right? But do you know what Gregg Allman has been going through the past couple of years? We're going to tell you his story. That's next.
GUPTA: You know, last month, federal health officials approved a new drug to treat Hepatitis C. They say it's a big improvement over previous medications. Hep C is insidious. It lurks in the body for years. By the time it's often found, it's usually done some pretty serious damage.
And Gregg Allman knows that all too well. You know him. He became a legend with the Allman Brothers.
His brother Duane died at 24 in a motorcycle crash but Gregg lived the rock and roll lifestyle for more than four decades, as he puts it, before learning that he had hepatitis. It led to liver cancer. It led to a liver transplant.
We caught up with him at the Allman Brothers' old stomping ground, in Macon, Georgia.
GREGG ALLMAN, ROCK LEGEND: Three rules of the day: don't mess with my wife, don't sit on my Harley, and do not mess with my Hammond B-3.
GUPTA (voice-over): The rock legend Gregg Allman, the good old days were filled with good times and great music, a lot of it here at the big house in Macon, Georgia.
ALLMAN: We thought, we should go find us a big huge house, you know, big what we call a big huge hippie crash pad.
GUPTA: Today, that big house is a museum -- a testament to the Allman Brothers band.
ALLMAN: I mean, every time I look somewhere, it brings back a different memory.
GUPTA: But Allman is here for more than just a stroll down memory lane. He's taping a public service announcement for drug company Merck about hepatitis C, a disease he said he got after years of heavy partying and risky behavior.
ALLMAN: They think I got it from an early tattoo.
GUPTA: Allman wasn't diagnosed until more than a decade later.
ALLMAN: I just started to get real tired, you know? Energy just ain't there.
GUPTA: For years, the virus lived undetected in his system, all the while doing irreversible damage to his liver.
And after 10 years of failed treatments, Allman developed cancer and he needed a new liver.
ALLMAN: They put me on the liver list and in five months and five days, they found me a 29-year-old liver.
GUPTA: Now, just a year after the transplant, Allman is back to touring, full time.
ALLMAN: Your energy comes back a little bit at a time. It's so much better than it was.
GUPTA: He still has hepatitis C but he's living with it. And while a liver transplant is no picnic, it's much better than the alternative, and he wants to get that message out.
ALLMAN: It doesn't really matter how you get the Hep C, you got it. And you need to treat it.
GUPTA: Mr. Hot Lanta himself back in 1971. He looks good after that liver transplant as well.
Good luck, Gregg.
Thanks for being with us as well at home, everybody. I'm Dr. Sanjay Gupta.
Time to get you back to the CNN NEWSROOM for a quick check of your top stories making news right now.