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Sanjay Gupta MD
Life-Saving Contest; "Psych Bible" Overhaul
Aired May 12, 2012 - 16:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
SANJAY GUPTA, M.D. is next. CNN NEWSROOM continues at the top of the hour with Don Lemon.
DR. SANJAY GUPTA, HOST: The race is on. If you saw somebody collapse in front of you today, no heartbeat, would you know what to do? Would you be able to do it? We'll explain.
Plus, the name game. This could be a pivotal time in the world of mental health. The DSM, the so called Psych Bible, gets an overhaul. It could mean big changes for patients and doctors alike.
But, first, a look "Under the Microscope".
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE: I don't want to be fat for the rest of my life. I've got diabetes.
UNIDENTIFIED MALE: Sleep apnea.
UNIDENTIFIED FEMALE: High blood pressure.
UNIDENTIFIED MALE: I get dizzy when I get up.
UNIDENTIFIED FEMALE: Everything is hurting now.
(END VIDEO CLIP)
GUPTA: You saw a clip there from "The Weight of the Nation". It's a four-part film from our sister network, HBO.
And I'll tell you, all of us are under the microscope this morning -- our habits, our behavior, our country.
This film was part of an unprecedented push by doctors and government health officials. In part what's driving this, this week, we've got some new numbers, a projection that by the year 2030, 42 percent of the U.S. population will be obese. Not just overweight, but obese.
Now, in some sort of twisted way, this could count as good news. The last prediction four years ago was that 51 percent of us would be obese.
Of course, none of this is so remotely good enough. So, here with me to talk about it from HBO, John Hoffman, the director and executive producer of "The Weight of the Nation". You've covered a lot of ground. It's four hours, as we mentioned. At the end of the day, a lot of people say look, it's calories in and calories out.
First of all, is that true? Do you believe that? Or is it possible that some calories treat our bodies differently than others?
JOHN HOFFMAN, DIRECTOR & EXECUTIVE PRODUCER, "THE WEIGHT OF THE UNION": I'm not going to speculate about whether carbohydrates in refined form or complex form ultimately are more fattening than others. But we are eating way too much. Maybe 300 calories more per person than we were eating 30 years go.
And so, the inexorable weight gain that's happening across this country really has to be recognized that a large part is being driven by overconsumption. We are not moving enough.
But I'm convinced that the experts who say that we can't exercise our way out of this problem have a point. That the overconsumption going on is really what is driving the largest part of this epidemic.
GUPTA: Yes, I mean, you know, the context is pretty simple. You can go out and run a few miles and maybe burn a couple of hundred calories. It's not enough to counterbalance what people eat.
I asked the previous question because I think there is a lot of this -- the science emerging that's saying, look, you know, we thought we were doing the right thing. We were eating low-fat, low triglycerides. We started calling sugary foods health foods and look what happened.
But I want to play something here and this may be difficult, I warn viewers ahead of time, to watch. But I think it makes a point. Take a look.
(BEGIN VIDEO CLILP)
JON LOMASNEY, MD: This is a heart from a 26-year-old woman of normal size, height, and weight, who died of a non-cardiac cause. Her cardiovascular system is entirely normal.
Now, in contrast, we have a heart from another individual, in this case, a male who is in his 50s. He was weighed 500 pounds and he was 5'9" in height. His BMI was calculated to be 70. Over 30 is obese.
UNIDENTIFIED MALE: This is really dramatically different from a normal heart.
(END VIDEO CLIP)
GUPTA: You know, John, in medical school, it was always the images that stuck with me as a student at that time.
What did you think the first time you saw that?
HOFFMAN: I was there. And it was shocking to see that. And even more shocking were the aortas of these people, and to see in the 26- year-old healthy woman, there were the beginning signs of fatty deposits, and what we learned from the heart study is those fatty deposits can start at the age of 5. So, it's a grim look at what is happening inside of us that we're just not aware of when we're eating the wrong foods. And sugary foods are driving a lot of this.
GUPTA: It's mystifying to people, and there's a lot of blame. Like you said, you exercise more, eat less, and that is part of it, for sure. But it's more complicated with that simple explanation as well.
I wish you the best of luck with this. A lot of people will be watching. I already had a chance to watch it. Thanks to you.
But parts one and two are going to premiere Monday night, 8:00 p.m. in HBO, followed by parts three and four Tuesday night at 8:00. For more information about this, you can logon to the weightofthenation.hbo.com.
John Hoffman, I appreciate your time.
GUPTA: Still ahead, I'm going to share one proven piece of advice on controlling your weight.
John, you might want to stick around for this.
You can do this while actually eating more. We want to hear this and you want to start doing it today.
Also, I want to share this with you. My coworkers and I are trying to do our part, in our spare time, we picked up shovels, we got dirty, we planted a vegetable garden, right up the block from where we are. And our plan is to share it all with our local food bank, we'll explain.
Coming up, doctors changing the definition of illness. This is a pivotal time in medicine. Could you lose services, even insurance coverage? The evolution of mental health is next.
GUPTA: Big changes are coming to the psychiatrist's hand book that's known as the DSM. This manual essentially defines what is and what isn't a mental disorder. It has big implications for things like insurance; and also, who gets treated, medication, things liked that.
The final revised handbook comes out next year and that's 19 years after the last update. As I said, a pretty big thing in medicine, and the question a lot of people are asking is how does it impact us?
Joining me from Washington to talk about this is psychiatrist, Dr. Sally Satel. She lectures at Yale University. She's also a resident scholar at the American Enterprise Institute.
Welcome back to the show.
DR. SALLY SATEL, PSYCHIATRIST & LECTURER, YALE UNIVERSITY SCHOOL OF MEDICINE: Thank you very much.
GUPTA: You know, the one thing I hear more than ever nowadays is that there is a label for everything. And, you know, too many labels, too many treatments as the result.
Just from the 30,000 (AUDIO BREAK) changes that are happening with the guidebook, is that going to make that perceived problem even worse?
SATEL: Well, it is true that every year, it's been -- every time, it's been revised -- the DSM was first issued in 1952, we're now going into the fifth issue -- it does get bigger and bigger. But basically, when it does enlarge, when diagnosis proliferate, it's not as if we discovered new mental illnesses.
SATEL: We're just categorizing them differently.
GUPTA: Right. Because I mean, the perception is that -- especially I think for people outside of the world of medicine is that, look, something is driving this. More people who are, quote/unquote, "sick," taking medicines.
You're troubled by another changing fact, this would take kids at risk of developing mental illness, at risk of developing, and label them as pre-psychotic. These are children. The reason being from my understanding, we could get help for kids who need it sooner, which I guess would be a good thing.
But what do you think of that?
SATEL: Well, that was a very troubling recommendation. And again, the APA has recognized that the risks of prematurely labeling someone with what would be a prodromal kind of -- in other words, maybe a young -- a teenager or a younger person on their way to developing schizophrenia -- truthfully, that would be a constructive thing if we knew for a fact this was the early phases and we could intervene and that person would go on to develop a full-blown syndrome.
But there are no data to suggest the fact that that's the case. Only a small minority of children with a certain symptom profile where they're a little bizarre, they nay have a rich fantasy life, actually go on to have a psychotic illness in adulthood, only a small percentage. And so, it would be very, very risky to diagnose them this early, and the DSM has dropped that.
GUPTA: On the other hand, Asperger syndrome, for example, will no longer being a diagnosis, my understanding. Many of these children will now be diagnosed as being on the autism spectrum. You just brought this up.
But so, how will that affect insurance coverage? You have a child who has a diagnosis of Asperger's. What happens? And how do they qualify for some of these services you're talking about?
SATEL: Well, there's controversy over whether or not the new diagnostic category will actually exclude them. There's been several research teams working on this. One from Yale found that, in fact, under the new criteria, some high functioning children with Asperger's will be left out. There's another series of studies reported the other day in "The Times" that suggests that all of the people currently diagnosed with Asperger's would still remain under the umbrella of spectrum.
But if they're wrong and if the Yale folks are right, it's that some of them will be excluded, then their services are at risk.
Now, the solution, of course, is to try -- if we could -- is to separate, to uncouple the need for services from actually having a specific diagnosis, and just base the need for services on the function and the requirements of a specific child.
GUPTA: I mean, there's a lot here. And we're going to keep on top of it.
Dr. Sally Satel, thanks so much.
And next up, a scavenger hunt with a twist. Life and death this time is on the line.
GUPTA: And we are back with SGMD.
Do you know what this is? It's an automatic external defibrillator. A defibrillator or ED, it gives a shock to reset the patient's heart rhythm if the patient suddenly finds themselves in cardiac arrest. It literally can bring the heart back to life. And I've seen something like this work first hand.
There's a problem, that many people are afraid of using these devices and don't even know where to find them.
UNIDENTIFIED MALE: Defibrillator, that's right.
UNIDENTIFIED FEMALE: We're trying to locate and map out AEDs throughout the city of Philadelphia.
GUPTA (voice-over): Jen Yuan is a 46-year-old I.T. analyst. Bill Roper is a physician. He's in the campus with his son Alexander.
JEN YUAN, PHILADELPHIA MYHEARTMAP CHALLENGE PARTICIPANT: So, when people have heart attacks, they can take this out and help save their lives.
GUPTA: Bill and Jen are on a mission: to find as many automatic defibrillators as possible, searching high and low for eight weeks across the city of Philadelphia.
BILL ROPER, PHILADELPHIA MYHEARTMAP CHALLENGE PARTICIPANT: We're on a scavenger hunt looking for AEDs. GUPTA: And we caught up with Bill and Jen, they were neck and neck for the lead with just two weeks left.
ROPER: We found another one.
GUPTA: The concept is a brain child of Dr. Raina Merchant, an emergency physician at the University of Pennsylvania Hospital.
UNIDENTIFIED FEMALE: My heart map.
UNIDENTIFIED FEMALE: My heart map.
DR. RAINA MERCHANT, UNIVERSITY OF PENNYSLVANIA HEALTH SYSTEM: Why not engage the public and use social networking to get people excited about helping to solve a public health challenge?
GUPTA: It's part race, part detective work, part scavenger hunt -- gyms, museums, train stations, anywhere to find portable life saving machines. It takes asking around, like when Jen went to the Philadelphia Museum of Work, she was told the devices were held by security.
YUAN: They have a number of security staff who are well trained in first aid, CPR, AED.
ROPER: Some of the harder ones are in smaller businesses where either the people didn't know that they had an AED, or they were locked in a place where they couldn't access them.
GUPTA: Dr. Merchant says the two biggest reasons that people don't use AEDs are lack of knowledge and fear of doing something wrong. In fact, the machine is quite simple. It literally talks you through every step.
AUTOMATED VOICE: Begin by exposing patient's bare chest and torso.
MERCHANT: You open the device, it starts talking to you. You put the pads on the chest, and you can't harm someone. It will tell whether or not you need a shock.
YUAN: Do you have one here?
GUPTA: It's a real competition, but there's teamwork, too. All of the AEDs that are found will be entered into a public database, so 911 centers and anyone with an app or a computer map can find them again.
GUPTA: I'll tell you -- more than 300 people took part in the contest, and I can tell you the winners as well. Jennifer Yuan who we just met is going to share the top prize, not with Bill Roper, who it turns out was very close, but with Jack Crichton. He's an athletic director at a local high school. He and Jennifer, just to give you context, found more than 400 of these AEDs.
As a prize, each can receive a little over $9,000. It's worth familiarizing yourself with these and learning how to use them.
Coming up: sharing life lessons.
(BEGIN VIDEO CLIP)
GUPTA: Lesson number six: graduates, do one thing every day that scares you. And in the process, become the action hero of your own life.
(END VIDEO CLIP)
GUPTA: That was me delivering the commencement address at my alma mater at the University of Michigan. Go blue.
Up next, though, more advice from a man who means a lot to me and a lot of other young doctors as well.
GUPTA: Graduation season as you probably know. About 18,000 new doctors are entering the real world this spring. In case you're curious about this, I was, new applications for medical school are actually on the rise. With all that's happening in medicine, many young people still want to be doctors. I applaud them.
You're soon going to learn what they don't know already, they need to read one book in particular. It's a look at young doctors learning tough lessons about their profession. I have my copy called "The House of God". It's like a cult classic in medicine. It's a satirical novel published in 1978 by a Harvard psychiatrist, Dr. Stephen Bergman, at the time he used the pen name Samuel Shem.
GUPTA: So, a doctor decides to write a novel. This is something I think about a lot. It's something close to my heart. For people who have not read "The House of God," and might not be in the medical profession, what can you describe the book in a sentence? What do you tell people what this book is about?
DR. STEPHEN BERGMAN, AUTHOR, "THE HOUSE OF GOD": This book is about a group of guys, young idealistic young doctors going through a year that disappoints them, and they're seeing ways that medicine should not be practiced and it's doing things to them that are not good.
And each of them through the course of this horror gets isolated from each other. And each of them gets isolated from their authentic experience of the system itself. It's like catch-22. You start to think I'm crazy for thinking this is crazy.
GUPTA: And it's so consuming. It's very hard for them to get a context. You brought a little bit.
BERGMAN: Well, this is a true story. This is one of the interns called Durant (ph). Durant was having a heart time. As he sat down to lunch, he took out a pill box, with a pill on his hamburger and munched it down. When I asked what it was. He said, "Valium, vitamin D. I've never been so nervous in my life."
"Does the valium help?" I asked. "It makes me feel kind of sleepy but I feel pretty unflappable. I'm writing orders for it for all of my patients."
"What, you're putting all of them on valium, too?" "Why not? They're all very nervous having me as their doctor."
After the others had left, Durant said he had a confession to make. He said, "It's my third admission last night. In the middle of all of this trouble with the yellow man, this guy comes into emergency, and I couldn't handle it. I offered him $5 if he'd go home. He took it and left."
GUPTA: How much of this was autobiographical?
BERGMAN: Well, as you know, fiction is weird. People ask me who the greatest character in the book is, the fat man. And I say, well, there really wasn't a fat man. It was, you know, it was mostly actually me. I started to act like that.
But on the other hand, the narrator, the narrator in the book is also me.
GUPTA: You spent a significant amount of time since then obviously writing a lot of other books. I read another one recently called "The Spirit of the Place."
BERGMAN: Good for you.
GUPTA: It was about a primary care doctor who was in some ways is coerced into coming back to the town where he grew up.
BERGMAN: A novelist is in a great position, because if you can't do it in real life, you can do it in fiction.
GUPTA: Yu can play out your life.
BERGMAN: You can play out your worst and your best fantasies.
So, I grew up in a small town in New York state, Hudson, New York. And it wasn't too pleasant an experience in some ways. There was one guy in the town who was absolutely essential to my development, all the way up until I left for college. He was one of these old roly- poly, cigarette-smoking general practitioner doctors.
So, I always wanted to go back to that town and join him in practice. I thought, what a wonderful thing that would be.
I didn't get to do it because I turned out to be a writer and a doctor. But I thought, I'll do it in my imagination. So, this is imagined autobiography. And a lot of the characters in the book, and he's a central book that the book is based on.
GUPTA: Dr. Stephen Bergman there, Sam Shem.
Coming up, something you really want to hear. A lot of people are interested in this -- a proven way to eat more and also weigh less. But, first, let me give you a story this weekend about healing after a teenager's unthinkable accident.
GUPTA (voice-over): Riding horses has been her passion since she was 4 years old. First came lessons, then shows. She even worked at a barn.
But two years ago, all that came to a screeching halt for 16- year-old Krystal Greco.
KRYSTAL GRECO, 16-YEAR-OLD PARAPLEGIC: I was getting a shower. I felt some muscle cramps in my mid-back.
GUPTA: She got out, got dressed.
GRECO: I felt a sharp explosion of pain.
GUPTA: By the time she arrived at the hospital, she couldn't walk. The cause, a ruptured disc in her spine.
GRECO: They told me that I had a bruised spinal cord and that I was a paraplegic from the waist down.
GUPTA: Krystal had congenital stenosis. It's a narrowing of the spinal canal that encases the spinal cord.
After surgery, she was transferred to the International Center for Spinal Cord Injury at Kennedy Krieger Institute in Baltimore.
GRECO: It is very, very, very intensive therapy for at least two hours, twice a day, every day.
GUPTA: She pushed herself, hard, determined to walk again and get back on a horse.
GRECO: I wanted to get back to my normal life. I didn't want to sit and mope.
GUPTA: Seven months after leaving Kennedy Krieger, she was competing in horse shows again.
Horseback riding mimics the natural movement of the limbs and helps with flexibility, balance, muscle strength. It enhances the exercises she was already doing at the hospital and at home.
Doctors call her recovery remarkable. She's regained movement in her hips and her knees and sensation has returned to her legs.
For now, Krystal can walk, up to 300 feet with the help of leg braces and a walker.
GRECO: Eventually, I do want to walk again and I can see that mentally as a realistic goal.
GUPTA: We've got a good one for chasing life today. It's all about choosing foods with higher water content. I want you to remember this, by changing just that one thing, you're going to increase the volume of what you eat by lowering the calories you consume.
Who doesn't want that? And why is it important?
What people trying to lose weight often tell me, they feel deprived because they're cutting their portions short. And I can you promise you this, you won't feel deprived if you simply practice this. It is known as volume metrics. It's going to help you feel full in fewer calories.
So for example, this normal sized hamburger over her, take a look there, about 600 calories. If you don't get the fries or chips, you're obviously saving calories. But may nut be as satisfied by simply eating that.
Or you could do something like this. This sort of makes the point over there. Cut the hamburger in half and slowly add all this food in here, a big salad with lots of vegetables, a big portion of watermelon as well. The total of this, 400 calories, and a guaranteed full stomach as well.
Now, if the only thing you change in your life right now, you're thinking about making a change. The only thing you do is this, to reduce each meal by about 200 calories which you did, pretty simply, you would lose about a pound a week, and you would still feel full. That's for about chasing life.
Got a busy week coming up. Next weekend, we're going to be coming to you from the big island of Hawaii. We're training with our Lucky 7 triathletes. Remember them? We're going to bring you advice on great, safe workouts and everything else you need to get yourself in shape.
Follow along with us at CNN.com/Sanjay or on Twitter@SanjayGuptaCNN. Make an appointment, come see us back next week right here on SGMD.
Time now, though, to get a check of your top stories in the "CNN NEWSROOM."