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SANJAY GUPTA MD
Problems with Obamacare Signup; The Heart of Dick Cheney; Good Medicine or TMI?; How Sweet It Is
Aired October 20, 2013 - 16:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN HOST: Hey there and thanks for joining us.
Good medicine or TMI? The genetic test that some parents should really do before they have kids.
Also, how sweet it is. A new study concludes Oreos are actually addictive. Really? We'll explain that.
Plus, Dick Cheney opens up in his new book called "Heart: An American Medical Odyssey."
But, first --
GUPTA: Obamacare. You know, even the president has been frustrated by this. He says some of the problems on the sign-up Web site are just unacceptable. The federal government says techs are working around the clock to try to fix all this, and they say it's getting better.
But my friend Elizabeth Cohen who is on the story says it's not good enough.
ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: I put in my user name and password, it didn't recognize it.
(voice-over): Error messages, page not found, system down. It's been a tough nearly two weeks for Obamacare.
(on camera): There were error messages, or that little annoying kind of like twirly thing. I hate it, right?
(voice-over): I have been trying since day one to get an account and log in on healthcare.gov. I failed again.
(on camera): You couldn't make this page work.
(voice-over): And again.
(on camera): It wouldn't log me in. (voice-over): And again.
(on camera): It's not working.
(voice-over): When I called the 1-800 number, the reps tell me volume is high and to try again during off-peak hours. So, I tried at 10:30 at night, 7:00 in the morning. And still, it didn't work.
So, finally, I set my alarm clock for 3:00 a.m. Sunday morning. Guess what? The system was down for maintenance.
GUPTA: And here with me now is my friend and senior medical correspondent Elizabeth Cohen, it's amazing, everyone is talking about how challenging this has been. Did you ever get through?
COHEN: I did eventually get through, so day 14 --
GUPTA: Day 14.
COHEN: Day 14, I managed to -- my login and password never worked that I tried to get originally, but I created a new account and I managed to get in. But it took me -- I had to try to create a new account many, many types before I succeed at that.
GUPTA: And you were doing this to see how long it would take. I'm sure there people that gave up.
COHEN: Right. I kind of had to game the game. I had to create one login and username and tried to do that at various hours. And I tried to create a new account, that didn't work. I mean, it was really persistence and sort of figuring things out.
GUPTA: This is the federal site. Is that right?
GUPTA: That's a lot of what we've been talking about is the federal site, which is healthcare.gov. But 14 other states plus the District of Columbia have their own sites and they seem to be working better. We have our latest count that says more than 242,000 people have signed up for new insurance, about half of those in New York state alone. If people are watching and still having problems with this, I mean, what would you tell them?
COHEN: I would tell them if they're trying to log in and it's not working, they need to call the 800 number and specifically say, look, I've been trying and trying and trying, do I need to reset my password? Do I need to create a new account? You know, ask those questions and I think that can really help.
You know, they told me on the site, try at odd hours. So I tried at 10:00 at night. I even tried at 3:00 in the morning.
GUPTA: Did you ever try calling that number ever? COHEN: I did many times, yes.
GUPTA: Was it hard to get through?
COHEN: Easy to get through.
GUPTA: It's interesting.
COHEN: I've got to tell you, a shout-out to the call reps. I mean, they're terrific. They're very helpful and they answer almost instantly.
GUPTA: Go figure. You would figure that would be the backlog the number of humans answering the phone. But they've actually got that part, at least.
COHEN: It's the technology that seems to be the problem, not the people.
GUPTA: There's a message here about technology, I'm not sure what it is.
COHEN: I think so.
GUPTA: I'm not sure what it is. Elizabeth, thanks so much. Appreciate it.
You know, most people have a pretty strong opinion about Dick Cheney, but whatever you think of him, you may be surprised to know over the past 35 years, he's had five heart attacks, open heart surgery, a heart pump and even a heart transplant at age 71. All this is revealed in his new book called "Heart". He's written with his cardiologist Jonathan Reiner.
I'll tell you, he was so concerned at times about his health that just two months after taking the oath as vice president, he took a very unprecedented action.
(BEGIN VIDEO CLIP)
DICK CHENEY, FORMER VICE PRESIDENT: Basically what I did was I resigned the vice presidency effective March 28th of 2001.
GUPTA: So, nearly for your entire time as vice president there was a letter of resignation sitting there.
(voice-over): Cheney discovered there was no provision in the Constitution to replace a vice president who was alive but incapacitated, so he drew up a letter of resignation to give to the president. CHENEY: It says, "In accordance with Section 20 of Title 3 of the United States Code, I, Richard B. Cheney, hereby resign the office of vice president of the United States."
GUPTA: How did President Bush react when you told him about this?
CHENEY: He was a little surprised. But he thought it was a good idea.
(END VIDEO CLIP)
GUPTA: And you could see my full, exclusive interview with Dick Cheney Sunday night in "60 Minutes", and also right here next weekend on SGMD.
Now, coming up for any potential parents out there -- genetic testing before you get pregnant. What's out there, who needs to worry, and what can put your mind to rest.
GUPTA: For prospective parents out there -- the fear of passing on a genetic disease can lead to a painful dilemma. But there are tests you can undergo before you even conceive to learn if your baby's at risk and now, some are pushing to make these standard practice.
UNIDENTIFIED FEMALE: Who wants pizza?
UNIDENTIFIED GIRL: Me.
GUPTA (voice-over): The Golds appear to be a typical American family.
But look at a little closer.
UNIDENTIFIED FEMALE: Should mommy talk about her day?
GUPTA: Five-year-old Eden cannot walk or even talk.
UNIDENTIFIED FEMALE: You want yogurt?
GUPTA: She has a progressive neurological disorder called Mucolipidosis Type 4, or ML4. It's a rare genetic disorder that's more common among Ashkenazi Jews, people of eastern or central European Jewish descent.
Eden's development stopped at 18 months. Doctors say she'll be blind by age 12 and she won't live beyond early adulthood.
There is no treatment or cure. But ML4 is preventable. So, how did this happen?
The Golds knew that one in four Ashkenazi Jews are carriers for genetic diseases like ML4 or Canavans or Tay-sachs, which is why they got screened before they got married or so they thought. RANDY GOLD, DAUGHTER HAS ML4: My doctor screened me for two diseases and Caroline's doctors screened her for those same two diseases, plus six others. But neither of us was screened for Mucolipidosis Type 4 and that's what we both carried and we gave it to our daughter.
GUPTA: When both parents are carriers of a disease, they have a 25 percent of passing it on to their child, but the problem is there's no standardized screening, so they turned their fate into a mission.
R. GOLD: So, instead of asking why us, we decided to make sure that the tragedy of Eden's story doesn't happen to another family.
GUPTA: Their work has grown into a new web-based education and screening program for 19 genetic diseases that are more common among Ashkenazi Jews. Established at Emory University, it is called JScreen and it allows visitors to request an at-home screening kit online. A genetic counselor delivers the results.
Last year, Eden became a big sister when the Golds added another daughter to their family. She is perfectly healthy.
CAROLINE GOLD, DAUGHTER HAS ML4: We believed in life again and that we had hope and we knew there would be joy and good times. I think she helped us see the world in a different way that we maybe had lost sight of once Eden was diagnosed.
GUPTA: And Eden will ultimately help many children she will never even meet.
R. GOLD: Eden is really here to save people's lives. And she does that every day. And if that's what she's here to do, there is no more noble a life than that.
I love you. Oh, my goodness, what was that?
GUPTA: Now, for these parents it seems to make sense but is more testing something everyone should be doing?
Well, joining me to talk about that is genetic expert Dr. Michael Gambello.
Thanks for joining us.
Most people think of genetic testing after the baby is born, they get that heel prick. I have three daughters, I've seen this. And they are testing for about 30 different diseases.
But what we're talking about here is actually before they ever get pregnant, right.
DR. MICHAEL GAMBELLO, GENETIC EXPERT: Correct.
GUPTA: And there's a certain -- they should be getting tested for certain diseases at that point you're saying?
GAMBELLO: I guess "should" is a word I'm not sure I would use. But I think they should be offered the possibility to do carrier testing to know their risks if that's what they opt for.
GUPTA: So, you are trying to figure out what their chances are of having a child who may have one of these diseases. How reliable are these tests?
GAMBELLO: The tests are quite reliable, usually greater than 98 percent reliable.
GUPTA: So, if somebody has the tests and they get the results back and it shows that they both carry a gene for this, what do you say to the parents?
GAMBELLO: Well, you inform them of what the risks are and what are some of the options they might have in order to have a healthy child.
GUPTA: We talked about people of Ashkenazi Jewish descent in this piece, but other groups that are also considered higher risks that may be more likely to be suggested testing?
GAMBELLO: Well, I think every ethnic group has certain genetic diseases that are more prevalent in that group. So I think every group should consider being informed about what they are at high risk for.
GUPTA: Some that are probably higher risk and I guess that would come out in a conversation with a genetic counselor.
GUPTA: If the couple comes back, they both carry the gene and they say I want to increase my chances of having a healthy baby, what can they do?
GAMBELLO: There are a lot of options and they can certainly discuss that with maternal fetal medicine specialists. Some of the options are they can use a sperm donor. They can use an egg donor. They could do in vitro fertilization with something called re-implantation diagnosis where we actually find out if the embryo is affected. They could adopt, so there are a lot of options open to people.
GUPTA: All right. Doctor, thank you so much for joining us.
GAMBELLO: You're welcome.
GUPTA: Good information. Appreciate it.
Now, from nature to nurture. Addicted to Oreos? You really could be. I'll explain. That's next.
(OREO COMMERCIAL AD PLAYS)
GUPTA: Do you remember that old Oreo commercial? Brings back some memories.
Well, believe it or not milk's favorite cookie turned 100 last year. But just this week researchers at Connecticut College said that Oreo is just as addictive as cocaine, at least in lab rats. I want to point out that these pictures of these lab rats with Oreos are pretty darn cute but the researchers could have used any high-fat or high- sugar food and obviously a lot of people, it caught their attention.
And, Eric Stice is our go-to guy with food and eating addiction.
I spent time with you, Dr. Stice, in your lab actually going through your scanner myself. What did you think of the study?
ERIC STICE, SENIOR RESEARCH SCIENTIST, OREGON RESEARCH INSTITUTE: Well, I thought it was -- provided very good evidence that the palatable foods, high-fat, high-sugar foods activate brain reward circuitry in a very parallel that drugs of abuse do. GUPTA: That's amazing and I want to talk specifically about that. But, first of all, these were rats, what about in humans? You've done research in that particular area.
STICE: Yes. No, and a lot of other people have actually administered food in the brain scanners and it's clear that palatable foods activate our reward centers exactly the same way as drugs of abuse, and rats -- you know, there's a very parallel set of findings coming out of the rat literature that looks exactly like what we see with humans as well.
GUPTA: People think of -- when they think of drug of abuse, cocaine was the example they gave in the study and people said that's really addictive. Cocaine is very addictive and now we're drawing this comparison between that and sugar, high-fat, high-sugar foods.
Let me start by asking this, how do you define addiction? What does that mean from your perspective?
STICE: Addiction really is composed of two concepts. One is the idea of abuse, that you have problems from use. So, people who use cocaine lose their jobs or become, you know, rejected from their family because of the problems. Those are negative consequences from use. Parallels with overeating would be that you develop medical problems from overheating.
But there's also dependence when you get your body physiologically used to having cocaine or palatable food on board, and it creates a sense of tolerance so you have to escalate the amount of cocaine to get the same effect and there's evidence the same thing happens, the more you eat Oreos, the more you'll escalate your intake of Oreos to experience the same degree of pleasure.
GUPTA: So you start craving them more -- if you eat some, you start craving more and therefore eating more than ever. It sounds very cyclical.
STICE: Yes, there's two changes that happen in our brains as, you know, we eat a whole bunch of palatable foods on a we get a blunted response of our reward circuitry which is akin to drug abuse. So, escalating the amount of cocaine you have to do to get high, you would similarly have to escalate the amount of Oreos you eat to feel the same degree of pleasure.
But the other aspect of it is, a little bit more insidious, and that is you become hyper vigilant to cues that have been associated with the reward from food or drugs, and when you see those cues, you start craving the food or the drugs and that's what really maintains the behavior.
GUPTA: But this idea of equating in some way sugar and cocaine, I mean, the brain only has pleasure center, one sort of pleasure area. Does it discriminate between different types of pleasure? Can we really put these on the same sort of ground, sugar and cocaine?
STICE: So, they're not exactly the same thing and slightly different areas of the reward circuitries involved in each. But, you know, this does really extend some work by a surgeon out of France very nicely that found that rats would liver press for sweet taste just as much as they liver press for cocaine, and the whole field was very incredulous about it when he initially published the findings but the new data line right up with that.
GUPTA: Yes, I saw the study where the rats would be pushing on the liver just as vigorously for the sugar as the cocaine.
Let me ask you something that was a little bit more philosophical almost. But people have heard the numbers regarding the obesity epidemic, 35 percent of Americans are not just overweight but obese. When we release these kinds of studies, I mean, is it saying addiction is in some way an excuse? I mean, are the people who are obese, is this -- is this more because of this addiction? How much of this is willpower versus what's happening in the brain?
STICE: Well, there's two components of that. Certainly our ability to operate executive control and make choices of pursuing goals like employment and the long-term relationship over drugs of abuse or overeating is very essential. But very new research is finding that there's individual differences in how quickly we learn to associate cues with reward from food or drugs, and the people who rapidly learn these cues for reward, they're the ones that get sucked into the habit much more than other people.
So, there are genetic differences that have an influence on this. So, willpower, putting it very concisely, some people don't have to bring much willpower to the table whereas other people have to bring a great deal.
GUPTA: Eric Stice, thank you. You shed some interesting insights on that. Appreciate it. A check of your top stories just minutes away.
But still ahead, "Doogie Howser M.D." versus SANJAY GUPTA, M.D.?
(BEGIN VIDEO CLIP)
ANDY COHEN: He wrote a poem and proposed to her in the last line.
SOLEIIL MOON FRYE: Doogie. No?
COHEN: Oh, my God!
FRYE: I'm losing all of them!
(END VIDEO CLIP)
GUPTA: And more than a few laughs with Andy Cohen and Soleil Moon Frye. That's next.
GUPTA: We want to take a moment now and congratulate a few of our fit nation alumni. You may remember Nancy Klinger. She was in last year's bunch. When we first met her, she was reeling from a recent divorce, finding it hard to really do anything to keep healthy for herself. She recently completed a half Ironman race in Augusta, Georgia. Unbelievable.
Three of our other alumni, (INAUDIBLE), Douglas Mogle and Annette Miller, they did a relay in that race. I remember two of them did their first triathlon just a few weeks ago in Malibu. The key here is that all of them started small, one step at a time, and they transformed themselves from couch potatoes into triathletes, and you can do this as well.
So, I'm excited to announce we're now accepting submissions for our 2014 Fit Nation Challenge Team. And logon to CNN.com/FitNation and learn much more and join us.
Let's stay on topic here, you know, one of the things I've really come to love about these triathlons is the sport of cycling. This is a lot of fun, and for a lot of people it can be intimidating when you start but it doesn't have to be.
GUPTA: For somebody who may be, you know, in their late 40s, late 50s, who wants to get back into cycling again --
PETER MOLEY, PHYSIATRIST: Yes.
GUPTA: -- Doctor, what would be the thing that you sort of tell them to be mindful of?
MOLEY: I think the first thing is to be mindful of your current injuries. Make sure those are addressed and make sure you have some basic core stability, good range of motion, and then go to a proper bike shop. Get fitted for a bike.
GUPTA: You know, there's cars passing by us as we're talking. The interaction of bikes and traffic -- first of all, we're going with traffic which is how you should ride, right?
GUPTA: What else?
MOLEY: Bikers need to be alert. We're totally unprotected. Running red lights is not a good idea. Stop at a stop sign. Stop at red lights.
As you're riding, you want to be watching the cars. You want to try to get a feeling, are they going to turn, are they indicating, watch for doors opening.
It's a great sport. You see some beautiful things you'd never notice in your car and you get some exercise while you're doing it.
GUPTA: You notice the hills more.
MOLEY: You definitely notice the hills more.
GUPTA: Do you stretch after every ride?
MOLEY: I do like to stretch after I ride.
Tilt your pelvis and you can feel a stretch. Put your leg up and do a hamstring stretch. Do the other side.
GUPTA: Got it.
You are spending just a few minutes afterwards.
MOLEY: A few minutes afterwards. Stretch your gluts out and stretch your back.
GUPTA: It's nice for the back. I definitely feel that, awesome.
GUPTA: And you do feel the hills for a long times afterwards, but it's really good exercise.
Before we go I got to have late night fun with Bravo's Andy Cohen and also Soleil Moon Frye.
(BEGIN VIDEO CLIP)
COHEN: Guess what? It's game time.
Like fictional TV character Doogie Howser, M.D., Sanjay Gupta also got into medical school when he was still a kid, just 16. Wow. In honor of that we're going to play Doogie or Gupta.
Soleil, I'm going to give you a fact.
COHEN: You tell me if it's Doogie Howser or Sanjay Gupta.
He once used the carpenter's drill to operate on a man with a gun shot wound to his head. FREY: Doogie.
FRYE: No. Wow!
GUPTA: We had some fun that night. That's going to wrap things up for SGMD today.
Time now to get you back into the "CNN NEWSROOM" with Don Lemon.