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Who is Really in Charge of America's Health?

Aired August 5, 2004 - 20:00   ET


HEIDI COLLINS, CNN ANCHOR (voice-over): Tonight, the happy world of prescription drugs.


UNIDENTIFIED ACTOR: That's why I take Clarinex.


COLLINS: The drug companies spending billions to make you:


NARRATOR: Ask your doctor.



NARRATOR: Ask your doctor.



NARRATOR: Ask your doctor.



NARRATOR: Ask your doctor.


COLLINS: So, who is really in charge of your health?

UNIDENTIFIED MALE: They may believe the television more than they do me sometimes.

COLLINS: Tonight, the power of the pill, drug ads, doctors and you.


COLLINS: Good evening, everyone. Thanks for joining us tonight. I'm Heidi Collins. Paula is off.

We hope you're feeling great tonight. But if you're not, chances are pharmaceutical industry specialists have a drug that can help and they want to you ask for it by name. More than ever, billions of dollars of advertising are urging you to ask your doctor for specific prescription medications, and it's working. Studies show one third of us have asked our doctors about drugs we've seen advertised. And 70 percent of those who asked for a specific brand get it.

So is that a good thing?

CNN medical correspondent Elizabeth Cohen has been digging for answers. She is joining us now with more on this tonight.

So it really does seem like we've been inundated with these ads. It doesn't really seem to matter when you're watching television, day or night. They're everywhere.

ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: That's right. And that's where I got the idea to do this story, Heidi.

I woke up one morning, turned on the television. There was an ad for a prescription drug. I brought my daughter to the pediatrician. There was an ad right in the pediatrician's office. Read a magazine, another ad. Go home and watch sports, another ad right there. They're everywhere.

COLLINS: In fact, it is called direct-to-consumer advertising. Let's take a look.


COHEN: They call her Dot, and Dot has done great things for sales of the antidepressant drug Zoloft.

VAL DIFEBO, DEUTSCH INC. AD AGENCY: What we thought was important here was to have Dot communicate to people how Dot was feeling.

COHEN (on camera): And did Dot work?

DIFEBO: Dot works. Dot works.

COHEN: And the dancing Viagra men work and the come-hither woman works and the cute bellies work. One study from a health care policy think tank shows every one dollar the pharmaceutical drug industry spends on drug advertising to consumers yields about $4.20 in sales. These days, people know the names of what they see on TV.


UNIDENTIFIED MALE: There's one called Cialis.

UNIDENTIFIED MALE: A sleep one I see all the time, Ambien.

UNIDENTIFIED FEMALE: Zoloft. That's the cartoon bubble that smiles and frowns and bounces around.

UNIDENTIFIED FEMALE: Penile dysfunction, there are always couple cavorting romantically.


NARRATOR: Cialis is here.


COHEN: The aim, to saturate you with tried-and-true marketing techniques like sex and fear on TV, in magazines, even while you're watching car racing or the Poker World Series.

DIFEBO: You're going to see them when you wake up in the morning and when you go to bed at night, because we know that's where you are and we want you to see these ads.

COHEN: Val DiFebo's advertising agency developed the Dot campaign and several other pharmaceutical ads.

DIFEBO: I would say drugs have become part of the fabric of our lives. They're a part of maintaining a healthy lifestyle, the same way exercise is, the same way being with your family and being happy are.

COHEN: But all of this has some people worried that it's created a nation of hypochondriacs, where everyone who sneezes thinks they have allergies, where everyone who had a bad night's sleep asks their doctors for a prescription.


BILL MAHER, HOST: Tell your doctor. Tell your doctor? When you tell your doctor, isn't he just a dealer at that point?


UNIDENTIFIED MALE: It's creating illness where none previously existed.

JOSEPH CALIFANO, FORMER HEALTH, EDUCATION AND WELFARE SECRETARY: We're also making a lot of people think that there's a pill for anything that -- there's a pill for any problem they may have and if you just get your doctor to prescribe it for you -- if he won't prescribe you for you, he is the bad guy.

COHEN: Many doctors have a hard time saying no.

CALIFANO: Doctors don't like to lose patients any more than anyone likes to lose a customer.

COHEN: The pharmaceutical industry says it's helping people.

LORI REILLY, PHARMACEUTICAL RESEARCH & MANUFACTURERS: We know that about 24 million people since 1997 have gotten diagnosed with a condition for the first time as a result of seeing a direct consumer advertising.

COHEN: And those ads are for some of the most expensive drugs on the market. Dr. Bob Goodman says patients are disappointed when he tells them the drug they saw on TV isn't right for them or that's there's a less expensive generic drug that would work as well.

DR. ROBERT GOODMAN, COLUMBIA UNIVERSITY: You talk about disappointment is when patients sees a generic drug written on their prescription when they came asking for something else. That's disappointing.

COHEN (on camera): They don't want the generic.


COHEN: They want what they saw on TV.

GOODMAN: They want the name brand.

COHEN (voice-over): And what man wouldn't react to this?


UNIDENTIFIED FEMALE: My man takes Levitra.


COHEN: Who wouldn't want to be this happy? So either these ads are helping sick people seek treatment...


UNIDENTIFIED MALE: Wouldn't you like to try it?

UNIDENTIFIED MALE: Why, yes. Yes, I would.


REILLY: It's getting people treated for conditions they weren't aware of in the past. That's a positive health step forward.

COHEN: Or the ads are convincing healthy people they should take drugs they don't really need.


NARRATOR: Think aspirins and heart medications alone are enough?


COHEN: You decide.


COLLINS: And we're back now with medical correspondent Elizabeth Cohen. It seems to me part of what Bill Maher said was actually dead on. Traditionally, we go to the doctor and he or she tells us what to do. Now we're going there and we're telling them. That really has changed the doctor/patient relationship, hasn't it?

COHEN: Well, absolutely.

These ads to a very large extent have changed the doctor-patient relationship. And doctors tell us, a patient comes in. They ask us for whatever they saw advertised the night before on television. And they said, we don't have much time with patients. We have five or 10 minutes. It's not always enough time to explain why that drug might not be right. A lot easier to just write that prescription and hand it to the patient. And it makes the patient happy.

COLLINS: So a little more time with the patient, maybe that's another story we can look into, too.

COHEN: Oh, yes. Oh, yes. Lack of time is a serious issue.

COLLINS: All right, CNN medical correspondent Elizabeth Cohen, thanks so much.

Two of the people you just heard from join us now. Lori Reilly is vice president of policy and research for the group Pharmaceutical Research and Manufacturers of America. Also with us tonight, Joseph Califano, once the secretary of Health, Education and Welfare under President Carter and now chairman and president of the National Center on Addiction and Substance Abuse at Columbia University.

Welcome to the both of you tonight. Thanks so much for being here.

Mr. Califano, I would like to begin with you, if I could. What's really the harm here? Before you go out and get one of the drugs, you do have to have a prescription, right?

CALIFANO: Of course you have to have a prescription. But the problem with advertising on television directly to people, the pharmaceutical company is trying to sell a brand. It's trying to sell its product. It wants to sell as much of it as it can at the highest price it can.

It is not really interested in anything else. And what happens is, patients then go to their doctor and say, gee, I'd like this. If I can get this wonderful arthritis drug, I can dance and swing around. And it's not real. It puts pressure on doctors.


CALIFANO: We know that from surveys of doctors. It's not the way medicine ought to be prescribed or sold in this country.


COLLINS: Ms. Reilly, let me ask you. This is big business, as you heard Mr. Califano allude to. We're talking about billions of dollars here. What about the welfare of the patient?

REILLY: Well, obviously, the welfare of the patient is what is important. Doctors and patients need to decide what medicine is appropriate for that person.

When you talk about survey data, we know that 88 percent of the time a patient walks into the doctor's office, they actually have the condition of the drug that they're asked about. And less than half of the time, the patient actually gets that drug that they're asking about. A lot of times, the doctor may give them other alternative medication, a generic medication, or tell them that a lifestyle change is more appropriate.

So just because a patient asks about a drug does not necessarily mean that they're going to get the drug that they ask for.

COLLINS: Mr. Califano, you heard those numbers, 88 percent. Are people really still taking drugs that they actually don't need at all?

CALIFANO: Oh, sure they are.

And it puts enormous pressure on individuals -- individual doctors, who should be -- you know, this is not health promotion. This is treatment promotion. This is drug promotion. This is drug selling. And there are many situations in which individuals would be better off by changing their diet, by changing their lifestyle than by getting a drug.

And doctors do say -- 65 percent of the doctors in another survey said they gave drugs out to patients because patients said to them that they wanted the drugs and put pressure on them to get them.

COLLINS: Mr. Califano, let's for a moment, if we could, get back to the actual ads that we're seeing on television as consumers. You saw them in the piece preceding this.

They're pretty sexy ads, pretty alluring, if you will. The way that that makes things look to the consumer, are the expectations for these drugs often too high?

CALIFANO: Of course they are. And side-effects aren't properly laid out. They can't be in 60 seconds.

Let me just take one example. The array of erectile dysfunction drugs, they financed the Super Bowl this year. And the investment in that


COLLINS: What do you mean by that, Mr. Califano?

CALIFANO: I mean they financed -- they were the most common ad run on the Super Bowl this year, were the erectile dysfunction drugs.

COLLINS: And were they just marketing to people who suffer from E.D.? CALIFANO: No. That's my point.

My point is, they were marketing to a bunch of macho man. And the implication and the subliminal and very effective message was, boy, if you think you have good sex now, you'll really have great sex if you try one of these drugs. Insurance costs go up because of the pressure to prescribe these brand name drugs, which are usually the highest priced, most profitable drugs for the pharmaceutical companies that are advertised.

REILLY: Heidi, if I can just respond to a few points really quick, we know in this country -- there was a recent study done by Rand Health that half of American adults are undertreated for different conditions, conditions like diabetes, asthma, high cholesterol. These are all conditions that have DTC advertising, and yet we still have undertreatment.

I'm glad Mr. Califano brought up the issue of erectile dysfunction ads, because I think it's important to point out that after the first erectile dysfunction drugs started airing, for every million men that went in and asked their doctor about that condition, 30,000 of them had untreated diabetes, 140,000 had untreated high blood pressure, and 40,000 had untreated hypertension.

So to the extent that those ads caused people to go into their doctor and ask them about a condition that they clearly had, but maybe would not have known about had they not gone in, that is a positive health care development.

COLLINS: Unfortunately, we are going to have to leave it here.

To the both of you tonight, we certainly appreciate your time. Lori Reilly and Joseph Califano, thanks again to the both of you.


REILLY: Thank you.

CALIFANO: Thanks, Heidi.


COLLINS: It's one thing for a pharmaceutical companies to spend billions on advertising aimed at patients. But they spend even more money advertising to doctors. And sometimes there's more to it than that, tactics, for instance, that border on bribery.

Here's Drew Griffin now on one federal investigation into a pharmaceutical giant.


DREW GRIFFIN, CNN CORRESPONDENT (voice-over): When Schering- Plough wanted to increase sales of its hepatitis drug, Intron A, it set up clinical trials and pitched the drug physicians. Dr. Chris Pappas says Schering-Plough offered to pay him for every new patient he placed on the trial.

CHRIS PAPPAS, ST. LUKE'S EPISCOPAL HOSPITAL: It was somewhere around $1,500 to $2,500 per patient.

GRIFFIN: The problem, doctors say those clinical trials may not have been trials at all, but sales incentives. The company acknowledges the firm's sales practices are under investigation.

When Warner-Lambert wanted to boost sales of its epilepsy drug Neurontin, sales reps told doctors the drug could be prescribed for a lot more ailments than just seizures.

DAVID FRANKLIN, INDUSTRY WHISTLE-BLOWER: The company made a very conscious decision to expand what we would actually the drug to, to about 15 to 20 other indications, other syndromes, illnesses that we had absolutely no evidence that it was actually effective for.

GRIFFIN: Warner-Lambert's promotion of Neurontin for nonapproved use was, according to David Franklin, sales rep turned industry whistle-blower, strictly a decision to boost sales.

FRANKLIN: The company's own documents said that was about a $400 million a year market, which simply wasn't enough. It didn't justify the R&D, the sales and promotion for that particular product.

GRIFFIN: Far beyond free tickets to ball games, golf outings and expensive dinners, the investigations into some of the biggest drug companies have uncovered outright payoffs made directly to doctors to write prescriptions.

Mike Sullivan is the U.S. attorney in Boston.

MIKE SULLIVAN, U.S. ATTORNEY: I think most patients would be horrified to think that somehow their physician's judgment could be affected or was affected based on lavish gifts, lavish trips, stipends or based on some false information provided to the pharmaceutical industry.

GRIFFIN: False information? That is exactly what Sullivan's prosecutors exposed when it went after Warner-Lambert. Last may, Pfizer, which now owns Warner-Lambert, pleaded guilty to the off-label promotion of Neurontin and paid a $430 million fine.

In a statement, Pfizer says it is committed to compliance with all health care laws and FDA requirements and to high ethical standards in all aspects of its business practices. As a whistle- blower, David Franklin, the former Warner-Lambert sales rep, will receive $26 million of the fine for his help in the case, a financial victory, but Franklin was hoping for much more.

FRANKLIN: Real change, real congratulations would be in order when docs can start trusting the information that they're getting.

GRIFFIN: Dr. Chris Pappas is one of those doctors who no longer trusts the information drug companies bring to his office, and he says with good reason. PAPPAS: What this essentially was, was a marketing activity in the guise of a clinical trial.

GRIFFIN: Dr. Pappas heads the clinical trial unit at St. Luke's Texas Liver Institute in Houston. When a sales rep asking him to take part in a clinical trial for the drug Intron A, he said no. Doctors, he says, were to be paid for their time, time to fill out paperwork, report their findings and prove or disprove the effectiveness of the drug.

But Dr. Pappas says there was little paperwork, just the promise of a stream of checks for every new patient added to the so-called trial.

PAPPAS: You know, $25,000 to maybe $50,000.

GRIFFIN (on camera): To the doctor?

PAPPAS: To the doctor.

GRIFFIN (voice-over): Fifty thousand dollars for the doctor, hundreds of thousands of dollars to the company on a clinical trial that Dr. Pappas says, if conducted as pitched, was scientifically worthless.

PAPPAS: Well, nobody would admit that it was to prescribe the drug. That's essentially what happened.

GRIFFIN: Schering-Plough would not discuss the clinical trial, but told CNN it will implement new standards of business conduct for this fall.

"Our focus today," the company says, "is on the benefit to the patient, not to the benefit of the physician and that is how we're training our reps."

But Dr. Pappas says it is not just the drug companies that are to blame.

PAPPAS: I think the medical community has not been very responsible in accepting their part of the responsibility for all of this.

GRIFFIN: And now that may be changing. St. Luke's Hospital has begun seminars and instituted guidelines for doctors about gifts and payments from the drug companies. Other institutions like Duke University Medical Center in North Carolina have banned all drug company freebies, from coffee mugs to lunches, and limited when sales reps can see physicians.

But according to the chairman of Duke's Pharmacy Committee, doctors remain dependent on the drug companies and their sales staff.

DR. PETER KUSSIN, DUKE UNIVERSITY: That's absolutely true. And I think, unfortunately, when this has been looked at, the pharmaceutical industry is the major source of information about new medications and new treatments.

GRIFFIN: U.S. attorney Mike Sullivan says his prosecutions have netted $2.2 billion in fines, and that, he says, should be a wakeup call to the industry.

SULLIVAN: The message I think is clear to the pharmaceutical industry, that corrupt practices, illegal practices, practices that violate rules, regulations or laws is not tolerated by this administration and this department.

GRIFFIN (on camera): But David Franklin isn't so optimistic. The prosecutions and settlements here in Boston, even those costing $430 million, are to the huge pharmaceuticals just a drop in the bucket.

FRANKLIN: I'm sure there were lots of high fives and slap -- pats on the back at Pfizer when they settled this for $430 million. It was a stunning success.


COLLINS: Drew Griffin reporting from Boston.

Drew tells us the drug Neurontin could earn Pfizer $2 billion in sales this year alone. Since it first came on the market in 1994, almost 10 million prescriptions have been written for the drug.

We asked PhRMA, the pharmaceutical industry trade association, to respond to this story. A spokesman declined, citing antitrust issues.

Dr. Chris Pappas, who you just saw in our report, is one of the few mavericks inside the medical profession willing to talk about the money connection between doctors and drug companies. He joins us when we come back.


COLLINS: We're talking about the high-stakes marketing of prescription drugs to patients and to doctors. In the story before the break, we heard from Dr. Chris Pappas, who says one company offered him more than $1,000 for each patient he signed up for a clinical drug trial, the trial that may have been nothing more than a way to boost sales.

Dr. Pappas is director of clinical research for St. Luke's Texas Liver Institute in Houston. He is joining us from Madrid tonight.

Dr. Pappas, thanks so much for being here.

Let me just begin with this. As we've said, you've been a physician. It seems like you might have been in the middle of this. What's going on here?

PAPPAS: Well, I think most physicians have encountered throughout their career some type of interaction with the pharmaceutical industry. Most of it is through pharmaceutical representatives and then some of it is through clinical investigations that they're doing in association with the pharmaceutical industry.

And all of these relationships, I think, are relationships that, while very necessary and very important, also present problems of conflicts of interest. We have to remember that physicians have an obligation to their patients, first and foremost, but also have an obligation to try and improve our knowledge regarding the treatment of various diseases.

The pharmaceutical company has similar interests that are aligned with the physician, but they also have a business interest and responsibilities there.

COLLINS: Can you tell us if you could characterize a little bit about how widespread of a problem it really is?

PAPPAS: I wouldn't say that this problem is pervasive in everything the pharmaceutical industry does. That's certainly not the case. And our lives and our health are much better because of the pharmaceutical industry.

On the other hand, what I learned from being in the pharmaceutical industry is that the ability of the industry to influence physicians is probably a little more widespread.

COLLINS: And, obviously, I think one of the main issues here is, as a patient, I want to be able to walk into that doctor's office and trust my doctor. Should I be asking him some particular questions? Maybe I should be saying, hey, you know, that medication you're giving me, is the company telling you to do it? Are they paying you? Is that where we've gotten?

PAPPAS: Well, I think that's not an unreasonable approach to things.

While I think the pharmaceutical representatives have a very important role and they provide very important services to physicians and physicians' offices, a physician should not be obtaining their medical information on which they base clinical decisions from the pharmaceutical representative.

COLLINS: When this does happen -- and we're talking about a lot of money here -- are the companies really in this alone? It seems like the doctors should bear some sort of responsibility here.

PAPPAS: Oh, absolutely, absolutely.

I think the two things I learned when I was in the pharmaceutical industry, one was sort of the power of the industry, both good and maybe not so good. But then also, I was very surprised at the behavior of some of my colleagues. Some of my colleagues view the pharmaceutical industry as a source of free revenue and expect to be wined and dined. And I think it takes two to tango. That's for sure.

COLLINS: All right, Dr. Chris Pappas, thanks so much for your insight on this issue tonight. We sure do appreciate it. And, as we mentioned earlier, we asked PhRMA, the pharmaceutical industry trade association, to join us tonight, but the group declined. A representative said the group cannot comment on current litigation because of antitrust issues and cannot comment on the larger issue involved.

When we return, our focus shifts to terrorism and a surprise turn in homeland security, an American mosque, allegations of money laundering, and an FBI sting.

That's next.


COLLINS: There's a lot going on tonight on the terrorism front.

U.S. officials tell CNN one of the suspected al Qaeda operatives arrested this week in Britain is a senior figure, described as a major player.

Also, word tonight that British police arrested a man late today after receiving an extradition request from U.S. authorities. He's a British citizen accused of trying to use American-based Web sites to fund terrorism in Afghanistan and Chechnya.

And intelligence sources also tell CNN al Qaeda training camps along the rugged border between Pakistan and Afghanistan may be back in operation.

Meanwhile, early this morning, the U.S. government says two men connected with the mosque in Albany, New York, were arrested in an FBI sting. Thirty-four-year-old Yassin Aref, the imam of the mosque, and 49-year-old Mohammed Hossain, the mosque's founder, are charged with conspiracy and trying to launder money from the sale of a shoulder- fired missile.

The government says that missile was to be used in an act of terrorism.


JAMES COMEY, DEPUTY U.S. ATTORNEY GENERAL: This is not a case connected to the current terrorist threat. This is not a case where the defendants were discovered plotting terrorist violence.

The terrorist plot in this case is one that the government's agent, a cooperating witness, represented to be under way. It was not real. It was represented. This case is a sting.


COLLINS: Both suspects were arraigned late today and ordered held without bail.

Joining us now from Albany is Faisal Ahmad, who is a teacher at the Masjid as Salam mosque. And I want to begin by asking you, sir, the imam and the other founder of the mosque were arrested in the sting operation that we talked about here with the FBI basically agreeing to what they thought was a plan to buy a shoulder fired missile to assassinate a Pakistani diplomat.

These are pretty serious allegations. You know these men. Could they actually be helping terrorists?

FAISAL AHMAD, MASJID AS SALAM MOSQUE: The first reaction that I had was that we as a Muslim community, we realize that our members of the community, they are God-fearing people. We believe in one God. We believe in the God of Abraham, Moses and Jesus, and we believe in the hereafter.

And my first reaction was that in the hereafter, the justice will be had. And Muslims, our goal is to keep in mind that in the hereafter, the truth will be known. And Muslims, as -- in our religion and me as a member of this community, I definitely do not espouse any form of violence, and I don't know Imam Yassin or...

COLLINS: But if I may just stop you here. What about -- you're talking about the hereafter. What about right now? What about these men and possibly being connected to the funding of terrorists?

AHMAD: Well, you know, I think it's important that we reserve our conclusions. It's a civic duty to presume innocence until proven guilty.

I've listened to Imam -- Imam Yassin's Friday sermons for my -- for the time that he's been here, for 10 years, and he's always said good things. And I've never heard any word -- any word of violence or any anti-American sentiment from him.

Mr. Hossain, who is also a good friend of mine and the father of five beautiful children, he runs a pizza shop, and he is a very kind person. He's -- he gives pizza for free to -- to poor people in the neighborhood.

COLLINS: OK. But let me tell what you law enforcement officials are saying, in case you haven't heard. They're saying that these men actually have ties to a terrorist group that we've heard of before known as Ansar al Islam.

Is it possible that anyone at your mosque could be aligned with that group?

AHMAD: Well, I can speak for what I've heard. And I've never heard anybody speak of any forms of groups. Imam Yassin in his hupas (ph), in his talks, in his classes has never espoused any type of political ideology other than just the basic beliefs about Islam. And, again, Islam emphasizes belief in the hereafter. (AUDIO GAP) We want to convey to the community is that we...

COLLINS: Unfortunately, as you can see, we're having a little bit of difficulty with our satellite connection there to Faisal Ahmed. He is the Masjid as Salam Mosque that we've been talking to tonight, a member there and teacher there. We're going to try to get back to him as soon as we can to get more comment.

Meanwhile, joining us now from Washington is Akbar Ahmed. He's the chairman of the Islamic studies at American University.

Welcome to you, sir. Thanks very much.


COLLINS: Thank you for being here. The second time I think I've seen you today.

But you know, we do hear a lot about imams in other parts of the world preaching this anti-American sentiment, if you will. Should Americans be concerned that the same thing is happening right here, right now in the United States?

AHMED: Yes. We need to look at the sermons of the imams of the mosques as a barometer of what the community is feeling. And the imams could certainly lead the emotions of the community in a certain direction. It's a time of great sensitivity for the community here in the West and, indeed, in Muslim lands.

What is interesting in this particular case, Heidi, is the fact that the target was a Pakistani ambassador. Now, this is something quite new, because we have to put this in context.

There have been some very high profile Pakistanis targeted over the last few weeks. The prime minister designate, the chief minister of Baluchistan, a corps commander in Karachi, and a few months ago, President Musharraf.

So obviously we're seeing the continuation of that kind of strategy here in the United States.

COLLINS: So are you saying there could be a connection, then, as well?

AHMED: Certainly, I would say that there is a connection. I think we need to be looking at all these cases in a global context. We mustn't isolate them. We mustn't look at them through an ethnocentric lens and assume it's only to do with America. In fact, right now, the play is a global play and we need to be looking at it as such.

COLLINS: Let's talk about the mosques for just a moment. Is it possible that some mosques are being used as gathering places or connecting points, if you will, for people who are interested in devising terrorist plots?

AHMED: Well, there are mosque and mosque -- I've been to many mosques where the imams are -- as we heard the previous interviewer say, peaceful people talking about piety, talking about remembering God and so on.

And there are other mosques where imams tend to be much more political and more fiery and sometimes tend to be very irresponsible, particularly considering the climate within which we are living all over the world, not just in the United States. It's a time of great sensitivity, particularly for Muslims who feel angry, uncertain, particularly the young.

COLLINS: This particular mosque that we've been talking about and just spoke with our guest about a moment ago had been under surveillance for two years. What do you think they were looking for?

AHMED: I think that the people who were watching the mosque would be looking for precisely this kind of action, this kind of rhetoric, this kind of whipping up of sentiments.

And the sting speaks for itself, that obviously it's connecting this particular action with a violent action, which may target a diplomat like the Pakistani ambassador.

Of course, at the same time, we need to make sure that the facts are correct, that there's a microscope looking at all these incidents, particularly from abroad, and, therefore, it's very important that we get the facts and the evidence absolutely correct.

COLLINS: Of course. I want to go one step further, though. How do you think the United States government can actually begin to start understanding and infiltrating these mosques that are, in fact, aligning themselves with terrorist groups?

AHMED: I think, Heidi, I'd look at it differently. I would want a strategy which doesn't so much want to infiltrate the mosque as much as want Muslim leaders within the mosque to begin to change their strategy, to begin to talk about the more compassionate nature of Islam, the more tolerant, the more inclusivist nature in Islam, which is very possible. It has been that historically. That is the challenge.

And I think Muslims -- Muslim leadership should be encouraged to move in that particular direction. That should be the energy that we should be directing this whole movement to. Not so much simply an infiltration, because that would be limited. It would only be security, law and order and in the end not very successful.

COLLINS: So you're talking much more about a direct relationship with that type of community?

AHMED: Exactly. And, again, I've just come from the United Kingdom. I watched how the British government has been dealing with the Muslim community.

And largely -- by and large, they've been quite successful, simply because they've had access to mosques, to Muslim leaders, to Muslim people and Muslim imams who have been very vocal about condemning this kind of action, any suggestions of violence, particularly Muslims living in Britain.

So here we have the United States' situation, where there are Muslims who are American, proud to be American, and that should be encouraged. They should be encouraged to step forward and, in fact, ensure that their community remains within the law and remains living in an harmonious environment.

COLLINS: All right. Akbar Ahmed, thank you so much tonight. We do appreciate your insight on this subject.

Next, another weapon in the war against terror, expecting the worst and preparing for it. Battlefield, Los Angeles, when we return.


COLLINS: When the terror alert level went to orange on Sunday in New York, Washington and Newark, New Jersey, it frightened a lot of people.

Images of the burning towers of the World Trade Center are seared into memory. And many Americans ask, can it happen again? The 9/11 Commission warns that an attack of an even greater magnitude is not only possible but probable.

In Los Angeles, emergency response teams are hoping for the best but getting ready for the worst. CNN's Thelma Gutierrez is there.


THELMA GUTIERREZ, CNN CORRESPONDENT (voice-over): 9:28 a.m., the port of Los Angeles, Long Beach. A dirty bomb detonates, ripping through a shipping container, releasing radioactive material into the air.

UNIDENTIFIED FEMALE: You need to come over here.

GUTIERREZ: 9:32 a.m., the first emergency crews arrive on the scene.

UNIDENTIFIED MALE: On a scale we have not seen in the United States since 9/11.

GUTIERREZ: 9:35, the command center in Sacramento is on full alert.

UNIDENTIFIED MALE: The U.S. is clearly under attack once again.

GUTIERREZ: It is a scenario no one wants to think about: a radioactive bomb detonated by terrorists, claiming dozens of casualties.

UNIDENTIFIED MALE: One, two, three.

GUTIERREZ: You're looking at a simulated attack, but the possibility is all too real, and emergency teams want to be ready.

ELLIS STANLEY, L.A. COUNTRY EMERGENCY SERVICES: This, as you indicated very appropriately, is a massive amount of people coming together, entities that may not have worked together in the past.

GUTIERREZ: Forty different local, state and federal agencies and 200 role players are taking part in the exercise here in Long Beach.

MICHAEL BOWMAN, LOS ANGELES CITY FIRE DEPARTMENT: We're really evaluating that coordination and communication and sharing and pooling of resources.

GUTIERREZ: NORAD, the North American Aerospace Defense Command, organized the massive effort.

Few people knew what to expect. The details were kept quiet.

UNIDENTIFIED MALE: Moderate to high levels of contamination on the (UNINTELLIGIBLE).

GUTIERREZ: They used capsules containing what NORAD describes as safe levels of live radioactive material in the drill.

BOWMAN: The purpose of those capsules is so that the first responders will have an actual device that they can search for, recover and secure.

GUTIERREZ: Homeland security expert Stephen Flynn once served as commander of the U.S. Coast Guard.

STEPHEN FLYNN, HOMELAND SECURITY EXPERT: If I were to rate on port security on a scale of one to 10, where one were a bull's eye and 10 were secure, on September 11, in our seaports, we were one. In a port like Los Angeles or Long Beach, we may be up to a three. That's not a passing grade.

GUTIERREZ: Achieving what Flynn would consider a passing grade will not be easy. The port of Los Angeles is one of the busiest in the world, with some 11 million containers coming in and out of here. Only 3 percent go through any kind of security inspection.


COLLINS: CNN's Thelma Gutierrez tonight.

Joining us now in Los Angeles is a high-ranking member of the Los Angeles Police Department, who oversaw today's drill. John Miller is the commanding officer of the LAPD's critical incident management bureau.

Mr. Miller, thanks so much for being with us. I want to ask you, this was a fairly large drill. I mean, we're talking about 4,000 people that were involved. But should there, God forbid, be a real bomb, will there be 4,000 people around?

JOHN MILLER, COMMANDING OFFICER, CRITICAL INCIDENT MANAGEMENT BUREAU, LAPD: I think there will be more than 4,000 people involved in the event of a real incident. But this is a nationwide drill. And the idea was to bring together the first responders who would -- who would come at this -- if this call actually came.

COLLINS: You know, obviously, there have been drills going on all over the country. And, actually, for years, I'm sure that law enforcement officials have been testing their skills, whether it be fire, ATF, police and so forth.

But what are we seeing now that's different about these drills? I mean, has there been an improvement?

MILLER: The things that were stressed in this exercise nationwide were the things that were taken for granted prior to September 11 and a lot of the lessons of September 11. Can we launch a unified command system between federal, state, local, police and fire, where they work together and stay on the same page?

Some of the problems on September 11. Can we communicate between each other effectively over different radio bands and frequencies that wouldn't necessarily work together? Can we make those adjustments?

And command and control, unified command, communication moving the intelligence, all of that was what was really tested here today, as well as the field exercises, what goes on behind the scenes.

COLLINS: So how do you think it went?

MILLER: I saw some things that were unexpected, that threw us for a loop. That's good. We can learn from those.

COLLINS: Like what, John?

MILLER: I saw some -- well, for instance, when we got to our staging area today, unbeknownst to us, someone had placed several tons of rebar right in the spot where we wanted to have our command post.

The easy thing to do would have said, well, we'll move the command post to somewhere convenient. We took the more difficult tack, which is to say this is the scene of the event. In real life, we'd face these problems. Let's work around this.

COLLINS: All right. I want to turn the corner for just a moment now if we could, John, and ask you a little bit about some of the activity that we've seen in other parts of the world as well -- and country, I should say.

Today, two arrests in Albany, New York, at a mosque on suspicion of terrorism. One arrest in Britain, a man wanted in the United States on suspicion of terrorism. And yesterday 12 people in Britain, also wanted for the same thing, suspicion of terrorism.

There's been an awful lot of arrests, an awful lot of activity. Can you put this into perspective for us? Is there a bigger picture here?

MILLER: Well, without commenting on any other agency's case, I think what you're seeing here is a distinct sign of the times. We're in a high threat period that runs between certainly -- pretty much the end of May all the way through the election.

All of the agencies have been tasked to take their cases, get them lined up and be ready to move forward with them. That's not just in the United States but many of our partners around the world. So I think what you're seeing here, especially in light of some of the revelations this week about distinct locations that al Qaeda has targeted, what you're seeing is an acceleration of those efforts, that FBI field offices, that local police agencies working with them are told, if you have a case that's ready to go, wrap it up now, go out and scoop those people up, because there is a real chance of an act of terrorism on U.S. soil.

I think there's a real desire to close out some of those long- term investigations and see what we can find out from them.

COLLINS: John Miller of the LAPD, thanks so much tonight.

MILLER: Thanks for having me.

COLLINS: Coming up next, Republicans make a long distance call for help.


ALAN KEYES (R), FORMER PRESIDENTIAL CANDIDATE: The state of Illinois has been and is now a leader in the United States of America.


COLLINS: But before he can move Illinois voters, he'll have to move to Illinois. When we come back.


COLLINS: The most closely watched race in the fall election is obviously the battle between President Bush and John Kerry. But the most interesting race could be the one developing in Illinois to fill a vacancy opening up in the U.S. Senate.

The Democrat, a candidate that burst into the headlines at the Democratic convention. The Republican candidate, well, that's still up in the air. The party is offering that role to a man who's no stranger to presidential politics. But he doesn't live in Illinois.

Here's CNN's Judy Woodruff.


JUDY WOODRUFF, CNN CORRESPONDENT (voice-over): He sounds like a proud new candidate.

KEYES: I'm deeply honored, of course, and also deeply challenged by the offer that they have made.

WOODRUFF: But he's not saying yes, at least not yet. Alan Keyes will announce his decision this weekend.

KEYES: I'll talk to y'all in a second.

WOODRUFF: And so Illinois Republicans are still without a Senate candidate with the election just three months away.

BARACK OBAMA (D), ILLINOIS SENATORIAL CANDIDATE: And out of this long political darkness, a brighter day will come.

WOODRUFF: How do you pull a shooting star down to earth? A conundrum the state GOP grappled with even before the Democratic National Convention sent Barack Obama into the political stratosphere.

OBAMA: There is not a liberal America and a conservative America. There is the United States of America.

WOODRUFF: Even before the Republicans' first-string Senate candidate...

JACK RYAN (R), FORMER ILLINOIS SENATORIAL CANDIDATE: And there's no allegation of infidelity or breaking of any laws. Kept all civil and criminal laws. Kept my vows to my spouse.

WOODRUFF: ... was wiped out by a sex scandal. And their second- stringer pulled himself out of play before game time.

MIKE DITKA, FORMER CHICAGO BEARS COACH: I have a lot of commitments that I've made previous to this coming up.

WOODRUFF: It's been a bad news cycle for Illinois Republicans. Up against...

OBAMA: A skinny kid with a funny name.

WOODRUFF: In Keyes, the party might not have found a winner, but it's definitely found a lightning rod.

KEYES: Everybody knows. So, no, you don't give to a shameless, lying oath-breaking president any kind of credit...

WOODRUFF: There he was in 2000, thundering against Bill Clinton during Keyes' second maverick campaign for the White House. Add to that two Senate runs, and he has lived more political lives than most.

But Alan Keyes hasn't lived any of them in Illinois.

KEYES: That the state of Illinois has been and is now a leader in the United States of America.

WOODRUFF: if he runs, the Maryland resident will have to pull up stakes and move to the Midwest. A Keyes-Obama showdown would mark the first time ever both major parties have run black candidates in a marquee race.

Illinois Republican officials insist they are not intentionally pitting an African-American against Obama. It just worked out that way.

UNIDENTIFIED MALE: ... for doing this, from the bottom of my heart. WOODRUFF: One thing is clear. If Keyes enters the fray, the next senator from Illinois will be black. But most political experts are betting that the next senator from Illinois will be Barack Obama.

But if Keyes accepts the nomination, the former talk show host would certainly add fireworks. The outspoken conservative is a magnet for the media. He would spice up the contest, challenging Obama on issues and on race.

OBAMA: Thank you very much, everybody. God bless you.

WOODRUFF: Dimming, perhaps, one of the Democrats' brightest stars.


COLLINS: CNN's Judy Woodruff tonight. And we'll be right back.


COLLINS: Finally tonight, Cold War paranoia was alive and well in the early 1960s when a movie called "The Manchurian Candidate" was scaring audiences. A lot has changed since then, including "The Manchurian Candidate."

As Bill Schneider reports, there's new controversy over the new version.


BILL SCHNEIDER, CNN POLITICAL ANALYST (voice-over): Who is the real Manchurian candidate? That's become the big guessing game ever since a remake of the 1962 the movie was released last week.

The original portrayed a communist conspiracy bent on subverting the American political system.

UNIDENTIFIED FEMALE: I served them. I fought for them. I'm on the point of winning for them the greatest foothold they will ever have in this country.

SCHNEIDER: But with a twist. The communists were using her husband, a Joe McCarthy like politician as a front man.

UNIDENTIFIED MALE: I have here a list of the names of 207 persons who are known by the secretary of defense as being members of the Communist Party.

SCHNEIDER: Cut to 2004.

MERYL STREEP, ACTRESS: I think this is a very different kind of thing concerned with different fears, different kinds of paranoia.

SCHNEIDER: In the remake, the scheme to subvert the American political system is masterminded by a powerful, shadowy, multi- national corporation. JON VOIGHT, ACTOR: Among the shareholders in Manchurian Global, were they ever to publish a list, which they won't, you would find former presidents, deposed kings trust fund terrorists, fallen communist dictators, ayatollahs, African warlords and retired prime ministers.

SCHNEIDER: Modeled on Halliburton, the company Dick Cheney used to run? Ask the film's director.

JONATHAN DEMME, PRODUCER/DIRECTOR, "THE MANCHURIAN CANDIDATE": We are once again being terrified by our leaders into giving them carte blanche to conduct our affairs around the globe however they personally see fit, at great profit, by the way, to the multi-national corporations that they have so much involvement in.

SCHNEIDER: On the Web, some indignant conservatives say "The Manchurian Candidate" is John Kerry, a wholly owned and operated subsidiary of George Soros, one of his wealthy backers.

There's no end to the speculation about the villain played by Meryl Streep.

STREEP: Make no mistake, the American people are terrified. They know something is coming. They can feel it. And we can either shovel them the same old sugar, or we can arm them. We can arm them with a young, vibrant vice president.

SCHNEIDER: Notice the haircut. One conservative web site asks, "A cold diabolical, manipulative member of the U.S. Senate. Any thoughts on a real life middle aged blonde who might fit the description?"

Bill Schneider, CNN, Washington.


COLLINS: Thanks for being with us tonight, everybody. Tomorrow, will the wave of kidnappings and executions in Iraq weaken support for the United States? We'll look at that issue tomorrow. We hope to see you then.

For now, though, "LARRY KING LIVE" is next. Good night everybody.


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