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SANJAY GUPTA MD

"May Be Hazardous To Your Health"; New Year's Resolution

Aired January 4, 2014 - 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. Welcome to SGMD.

New Year's time is a great time to hit the reset button, with your health and a lot of other things as well. Whether you need a fresh start or just a tune-up, today is an important show because we're going to talk about checklists, things that you need to bring to your doctor before you see them.

And also, the biggest myths around losing weight. A lot of people thinking about this time of year. So, I decided to give you a roadmap to a smart and healthy year.

But, first, 50 years ago this week, a bombshell landed that did more to change American health habits than anything else ever did. It was a surgeon general's report that made a firm connection between smoking and cancer and it told people bluntly that smoking is dangerous.

(BEGIN VIDEOTAPE)

UNIDENTIFIED MALE: Make your own 30-day Camel mildness test in your T-zone.

GUPTA (voice-over): During smoking's heyday back in the 1940s and '50s, ads like this were commonplace.

UNIDENTIIFED MALE: What cigarette do you smoke, Doctor? In this nationwide survey of general practitioners, surgeons, throat specialists, diagnosticians and so on, the brand named most was Camel.

GUPTA: By 1950, American adults were smoking 4,000 cigarettes for every person, every year. But in 1952, "Readers Digest", then the country's most popular magazine, published a two-page article, cancer by the carton. It was the first time a mainstream publication like this connected smoking to cancer.

STAN GLANTZ, CENTER FOR TOBACCO CONTROL: The tobacco industry's public relations strategy to defuse public concern was just brilliant. They set up their own scientific organization and said to the public, we're doing research on this. Don't worry about it. We'll find out if there's anything bad in cigarettes, and if there are, we'll get rid of them.

GUPTA: But in 1955, the Federal Trade Commission forbade companies from making positive health claims about cigarettes. Blocking ads like this one from Philip Morris, "Scientifically proved, less irritating to the smoker's nose and throat." Big tobacco adapted. GLANTZ: They started making implied health claims by doing things like putting filters on cigarettes. Claiming they were making light cigarettes, mild cigarettes, implying that those were somehow healthier.

UNIDENTIFIED MALE: The Federal Trade Commission and "Readers Digest" have done you a favor.

GLANTZ: It's a moment that helps launch fictional ad whiz Don Draper on AMC's "Mad Men."

(BEGIN VIDEO CLIP, "MAD MEN"/AMC)

DON DRAPER: We can say whatever we want. How do you make your cigarette?

LEE GARNER, SR.: We breed insect repellant tobacco seeds, plant them in the North Carolina sunshine, grow it, cut it, cure it, toast it --

DRAPER: There you go. There you go.

LEE GARNER, JR.: But everybody else's tobacco is toasted.

DRAPER: No, everybody else's tobacco is poisonous. Lucky Strikes is toasted.

(END VIDEO CLIP)

GUPTA: In fact, that was an actual Lucky Strike slogan, in real life.

But evidence of harm became overwhelming. On January 11th, 1964, Dr. Luther Terry issued the very first surgeon general's report.

LUTHER TERRY, THEN-U.S. SURGEON GENERAL: The strongest relationship between smoking -- cigarette smoking and health in the field of lung cancer. There is a very strong relationship and probably a causal relationship between heart disease and cigarette smoking.

GUPTA: A strong relationship. Just how strong? He reported a 70 percent increase in mortality for smokers, heavy smokers at least 20 times more likely to develop lung cancer than nonsmokers.

GLANTZ: The surgeon general's report was the beginning of changes in public attitudes in smoking, which began to lay the foundation for a lot of the progress that we've seen today.

GUPTA: That surgeon general's report launched one of the biggest public health campaigns in American history.

That first warning on the pack in 1966 was a milestone. But it was also a major understatement. Cigarette smoking may be hazardous to your health. Over the years, it got more pointed, "dangerous to your health." And today, even more blunt, "causes lung cancer, heart disease, and more."

(END VIDEOTAPE) GUPTA: I told you those labels, they do have an effect. In fact, in the last half century, the number of adults who smoke has gone down from 42 percent you see there in 1965 to about 19 percent today.

Joining me to talk all about this, Dr. Tom Frieden. He's the head of the Centers for Disease Control and Prevention.

Delighted to have you here on the studio. Happy New Year.

DR. TOM FRIEDEN, CDC DIRECTOR: Happy New Year. Great to be here.

GUPTA: This is a big -- I mean, this is a big milestone, 50 years now since some of those first labels came out, people just -- are hearing about this. But, you know, you still have a significant amount of people who are affected and even dying from cigarette-related diseases. Is there a best way for people to quit as they think about this more than ever on this day?

FRIEDEN: Well, it's kind of a glass half empty/glass half full story. On the one hand, half as high of a percentage of adults smoke, on the other hand it remains the leading preventable cause of death in this country and if you smoke, quitting is by far the single most important thing you can do to improve your health.

And there's ways you can quit more effectively, medication helps, quitting with a friend helps, getting help will help. Figuring out what triggers you to smoke and avoiding those triggers. All of those things are proven to work, but the bottom line is most Americans who have ever smoked have -- most Americans who have ever smoked have already quit and you can quit, too.

GUPTA: Is there one of those ways that you'd put at the top of the list?

FRIEDEN: I think basically every adult who's not pregnant who wants to quit should be on an FDA-approved medication to help them quit.

GUPTA: So, you would -- would that be an early on recommendation? I mean, if someone is -- presumably most people who go to their doctor have tried at least that's why they are talking to their doctor about it now, a medication would be the next step you think?

FRIEDEN: I think so. Now, on the one hand, most people who do quit do it cold turkey without medication. But medicine will double or triple the likelihood that you will succeed.

GUPTA: These particular graphic warnings, do you have an idea of how well they work? What the expectations are?

FRIEDEN: In terms of pack warnings, there's growing evidence that they are quite effective but in terms of the broader question about what works to help people quit smoking, it's pulling back the curtain and seeing you what and I see as doctors see, what other healthcare worker see, is the suffering, the disability, the disfigurement that smoking causes, and that's what we did with our tips from former smokers campaign which was very effective. GUPTA: Let's take a look at just part of one of these campaigns.

(BEGIN VIDEO CLIP)

TERRIE, 51, NORTH CAROLINA: I'm Terrie, and I used to be a smoker. I want to give you some tips about getting ready in the morning. First your teeth. Then your wig. Then your hands-free device. And now you're ready for the day.

(END VIDEO CLIP)

GUPTA: When you look at an ad like that, first of all, can you give us an idea how much it costs? What all goes in to creating something like that?

FRIEDEN: It's not a small job but we're outspent by the tobacco industry in just two or three days. But the fact is that there are millions of Americans who are disabled and disfigured and people like Terrie come forward and say, we want to help other people not have to go through what we went through and that specific type of ad that pulls back the curtain, the examination room curtain, and shows the disability and disfigurement of smoking, it works. It helps smokers quit.

GUPTA: I say this all the time as a doctor, I know you do as well, out of all the things we do in medicine and all these tremendous advancements that we make just reminding patients to quit smoking could be bigger than a lot of those other things put together.

FRIEDEN: Absolutely. You know, Terrie Hall (ph) passed away last year. But one of the things I told her was that her ads which were viewed over 2 million times on YouTube, her ads helped tens of thousands of people quit smoking. She might well have saved more lives than most doctors will in their career.

GUPTA: We'll stay tuned and see what happens. Great to have you here. Happy New Year.

FRIEDEN: Happy New Year.

GUPTA: Dr. Tom Frieden.

Coming up, we've got a big deadline we want to tell you about and the battle over this girl's fate. I'm sure you've heard the story. Her mother says she's moving. The hospital says she's brain dead. I'll explain how you can tell what's going on. We got that, next.

(COMMERCIAL BREAK)

GUPTA: We're back with SGMD.

A big and heartbreaking deadline coming up for a 13-year-old girl who was declared brain dead last month and whose family is fighting to keep the hospital from turning off the machine that is keeping her heart beating. She's been in the children's hospital of Oakland. And a judge has given the family of Jahi McMath until Tuesday to come up with another facility that wants to take her. In a minute, I'm going to explain how doctors look at a patient like this and how they make some of these tough decisions.

But, first, here's CNN's Dan Simon.

(BEGIN VIDEOTAPE)

NAILAH WINKFIELD, JAHI'S MOTHER: She's not a corpse up there. It is a pretty 13-year-old girl up there that I gave life to.

DAN SIMON, CNN CORRESPONDENT (voice-over): A mother holding out hope that her teenage daughter described as brain dead by doctors can somehow survive. Doctors at children's hospital in Oakland had the legal authorization Monday to remove the ventilator that is supporting Jahi McMath's body.

But a judge extended that window by a week. Her family meanwhile says they have video of the girl moving. Proof they say that she's fighting to stay alive.

WINKFIELD: She's responding. I go in there and I talk to her and I say, hey, Jahi, you need -- you need to start moving, girl, because you know what this hospital is trying to do to you.

UNIDENTIFIED FEMALE: Yes.

WINKFIELD: And she gets to, like, moving fast and it scared me the first time, but now that she do it more and more every day.

SIMON: The family has not produced the video. The hospital suggests it's muscle reflex, common they say in brain death victims.

(END VIDEOTAPE)

GUPTA: And joining me to talk about this from New York is Dr. Stephan Mayor. He runs the Neurocritical Care Unit in New York Presbyterian Columbia Hospital. And we've also spoken extensively, he and I, about this sort of thing when I wrote the book "Cheating Death" a few years ago.

Welcome to the program, sir.

I know you've probably been following this story about Jahi McMath. You know, three doctors have examined her now, as you may know, the outside expert is Dr. Paul Fisher who is head of pediatric neurology at Stanford.

And he found specifically some things I want to just relay. She has no reflexes. Her pupils are not responding to light. She cannot breathe on her own. And they did scans and found that there's no evidence of blood flow to her brain. There's also no electrical activity on EEG.

So, Doc, look, I'm a neurosurgeon. You're a neurologist. We hear these things.

Let me ask you first, do you think there's any room for misdiagnosis or error in diagnosis here?

DR. STEPHAN MAYER, NEUROLOGIST, NY PRESBYTERIAN HOSPITAL: Sanjay, in this setting, there's absolutely no chance of any kind of misdiagnosis. This is a black-and-white situation.

GUPTA: Any chance that she could have some sort of recovery which is, you know, obviously what her family is hoping and praying for?

MAYER: I understand what they're hoping and praying for, but there's absolutely no chance here for Jahi to ever survive the brain injury itself.

GUPTA: The intersection between just the human tragedy of this and obviously the clinical diagnosis is tough. I mean, you deal with this a fair amount, I imagine. What do you tell families who are in a situation like this?

MAYER: I've done it many, many times, Sanjay. And what you do is you tell them the truth. You explain the diagnosis. And it has to be presented in very black-and-white terms, which it is in this setting of brain death.

But one thing that I know that I would never do is try to force or enforce a withdrawal of support or something like that for family that doesn't want to do it, that can't bring themselves to do it or they're not ready for it, because really all you're going to do is cause a lot of pain for everyone involved.

GUPTA: Part of the confusion also seems to be, Dr. Mayer, because you hear these cases and we try to be very careful about this with respect to our positions in the media, but you hear about these cases where people did seemingly wake up after being in a coma, for example, for many years. And people get all these terms mixed up.

MAYER: Sure. Well, a coma is a severe brain injury. And the brain, though, is still getting blood flow, still getting oxygen, and still generating electrical activity, which is what the brain does. But most importantly, in a coma, even though that person is in a state of semi-responsiveness, looks like a deep sleep, there's a potential for recovery in a coma.

Brain death is different. As you said in the beginning, brain death, there's zero flow to the brain. There's no oxygen being -- coming to the brain or being consumed. There's no electrical activity.

And most importantly for families to know, there's no potential for that brain function to ever come back. It's complete and total loss of all brain activity forever.

GUPTA: It is a -- it is a sad story to have to talk about. But I think, again, facts matter here, Dr. Mayer, sometimes those facts are difficult to hear, difficult to transmit. But we appreciate you being on the program and helping us out. MAYER: Thank you very much.

GUPTA: And coming up, we got a change of direction here, something to help you seize control of your own health this New Year. We got to create a checklist that you need to do before you see the doctor. We'll explain.

(COMMERCIAL BREAK)

GUPTA: It's the New Year, as you know, and a chance to make or reinforce good habits, that's what it's all about when it comes to our health. As the theme for 2014, we got this thing that we want you to think about, a theme of taking control.

Dr. David Agus, a friend of the show and top cancer doc and a big proponent of that approach as well, a good friend of mine. He's the author of a new book, it's called "A Short Guide To A Long Life."

Doctor, welcome back to the program.

DR. DAVID AGUS, AUTHOR, "A SHORT GUIDE TO A LONG LIFE": Thank you, Sanjay. It's a pleasure to be here.

GUPTA: Thank you.

You know, a lot of people start thinking about this time more than other times of the year. They make doctors appointments, for example, this time of year. You emphasize very important things in the book that the patient really does need to take control, take the reins and do some legwork before the appointment.

Some of the examples you give, take your own blood pressure, take your own pulse, chart these things.

When you tell people that, how specific should they be? Should they do it at a particular time of day? How often should they be measuring these things?

AGUS: Well, listen, in today's world, the time with your doctors, three, four, five, if you're lucky, 10 minutes. And the role of the doctor visit should not be to gather data but to analyze data. So, the notion that you go to your doctor at 1:00 and they check your blood pressure is kind of crazy. Whoever check your blood pressure in the morning when you get up, at night when you go to bed, when you are pissed off at a phone call.

There's an old adage, with enough data, error goes away.

So, I want people to take multiple measurements, the more the better, and go in with your data so you can discuss it when you get there.

GUPTA: You also talk about very simple things in this book which I found fascinating. For example, measuring your waist circumference and so people know how, this is important a technique as -- you want to take your measurement device, locate your hip bone, which is at the very top of your hips and place the tape measure around your stomach, right around your navel, above the hip bone. Make sure the tape is parallel with the floor.

You want to do this right so you get a proper measurement, as Dr. Agus is talking about. Don't suck in when you're doing this. Get a proper waist measurement.

What is the significance of that, Dr. Agus?

AGUS: Well, listen, be honest with yourself, right? Do the measurement correctly. You've got a metric to follow.

What we know is, especially in men, is at that circumference gets bigger, health problems start to happen. It correlates with inflammation, with diabetes, with multiple medical problems, including heart disease. And so, you really want to focus on it and work on it. This thing in the middle of our stomach here becomes its own organ and starts to make factors that can actually make disease accelerate.

So, a very simple measurement of a lot of things going on in the body is just measuring that circumference.

GUPTA: You know, I know you well enough to know sort of your personality and how you conduct your life. But one of the things you talk a lot about in the book is setting a schedule which doesn't surprise me knowing you, but you are talking about setting a schedule for virtually everything. Why is that so important?

AGUS: Listen, the data are dramatic. You know, first, they took 600 parents and they said, have your kids go to bed whenever they want and have them wake up 10 1/2 hours later. Here's a stop watch.

They said to another 600 parents, have your kids go to bed at the same time and get up the same time in the morning, sleep for 10 1/2 hours.

So, the same amount of sleep in both hours, the kids who went to bed and got up the same time almost a 25 percent increase in cognition. That's good to great right there.

And that holds true with your meals. When you have your left hand of at noon today and tomorrow at 2:00, stress hormones go up, so it lowers metabolism, you actually gain weight. You don't think as well and exercise as well.

We were designed for regularity and our kids demand it, right? When you're an hour late for your kids for lunch, they scream. We've squelched it as an adult and we need to go back to it.

GUPTA: Yes. And about the screaming -- my kids screaming is something that I can't get out of my head. But you're absolutely right, this idea that the schedule can help and can decrease inflammation, which is something I want to talk to you about in just a second.

But we can't avoid talking about resolutions. It's that time of the year. And at the top of many lists as you know losing weight. So, we're going to ask Dr. Agus to stick with us, give you some of his best tips, and also debunk some weight loss myths. (COMMERCIAL BREAK)

GUPTA: And we are back with SGMD.

The New Year is a great time to mentally hit the restart button. That's what I call it.

Hopefully make some healthy changes to your life and maybe your loved ones as well. And for many of you losing weight is at the top of your resolution list. We want to talk about that and a little bit and I want to welcome back Dr. David Agus. He's author of this new book. You should read. It's called "The Short Guide To A Long Life."

Let's start with some myths, Dr. Agus. You say it's a myth that a little bit goes a long way when it comes to exercise and weight loss. How so?

AGUS: Well, listen, I mean, the data with exercise and weight loss are very simple, it's movement over time. And so, our bodies were designed to move. We were designed to walk all day.

And yet, we've built a society the opposite, right? The more important you are at a company, the closer your parking space is to your office. The richer you are, the more bathrooms in your house.

Well, that needs to change. It's movement over time. You know, in my office I have a treadmill desk, two hours a day when I do e-mails I'm actually walking at a slow pace. It takes a little while to get used to.

I wear a headset I can walk around the office when talking on conference calls and it makes a big difference. I dramatically reduce it and I follow it and I wear one of the bracelets so I look at my movement over time and I've got a metric.

GUPTA: Yes, you know, we weren't designed to lie or sit for 23 hours and go to the gym for 45 minutes to an hour. It is makes perfect sense just in terms of human evolution.

You also write that it's a myth that have to be mentally ready to change your diet. It's funny, a lot of people say, this is the New Year, I'm mentally prepared to do this. But you say it's not necessary to be that mental readiness. What do you mean by that?

AGUS: Well, listen, I mean, you know, diet is rather simple. We have data from randomized studies showing the best and healthiest way to lose weight is eat your meals on a regular schedule with a Mediterranean diet. So, it's not drinking this shake or this powder or these radical diets. Radical diets work many times because they make you concentrate on what you eat.

But the key is just very simple, eat real food, eat on a regular schedule, and eat nothing in between meals. When you eat in between meals, your body says I don't know when the next meal's going to come so it lowers metabolism. Remember those kids at high school that could never lose weight because they're all eating -- but they're eating celery all day? Well, the reason is their body didn't know what to do, so it lowered its metabolism because there was always something there to metabolize.

So, the key is just that regular schedule. Be in charge of it. Even when you were writing this book, I'm sure you were a diligent schedule, making sure you stayed nice and healthy. And we appreciate that.

Dr. David Agus, thanks for being on the program as well.

AGUS: Sanjay, thank you always. And thanks for what you do. I appreciate it.

GUPTA: Thank you. Happy New Year, sir.

And I've got a final bit of advice for you as well, especially for those looking to keep weight off and make sure it stays off. I do this. You simply write everything you eat or drink in a food journal. You don't have to do this forever, but still for the next few weeks. I tried this trick a few years ago when I decided to get in the best shape of my life, right around my 40th birthday. I kept a piece of paper in my pocket and I literally just wrote down everything, even a handful of M&M's from my colleagues desk, whatever it was, I wrote it down.

And after just about a week of food journaling, I realized that I was doing something that a lot of us do -- mindlessly eating and oftentimes it was sweets and foods that weren't that good to me and doing it at the office.

The truth is what you're going to find is that most of us grossly underestimate just how much food we consume at any given day.

Write everything down. It's going to help keep you more accountable. So, good luck.

That's going to wrap things up for SGMD. But I want you to stay connected with me at CNN.com/Sanjay. Send me a tweet from time to time @DrSanjayGupta. I like to read those. Let me know how your weight loss efforts are going and how your health is overall.

Time now though to get you back into the "CNN NEWSROOM" with Fredricka Whitfield.