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HOUSE CALL WITH DR. SANJAY GUPTA
Cleveland Clinic Maybe Hospital of the Future; Doctor Claims Effective Stem Cell Treatment; African-Americans More Prone to Depression
Aired July 18, 2009 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN HOST: Good morning. Welcome to HOUSE CALL: The show that helps you live longer and stronger. Thanks so much for joining us. I'm Dr. Sanjay Gupta.
First up: Could the answers to the nation's health care issues be found in Cleveland? Many experts say yes. We're going to go there and look at some solutions for HOUSE CALL.
And, a doctor claims he can save lives with a new stem cell treatment. Is he peddling hope or maybe a cure?
Plus, home from Iraq, injured and now facing divorce. How one man battled depression and he won. What other men need to hear from him.
You're watching HOUSE CALL.
GUPTA: You know, as Congress continues to haggle over which health care bill is best, everyone agrees the goal is to reduce skyrocketing costs and get more people insured. That's one thing people do agree on.
But just how do you go about getting people great care at an affordable price? We think we found a good example, one which many experts say the nation should be following.
CNN's chief national correspondent John King took a look.
JOHN KING, CNN CHIEF NATIONAL CORRESPONDENT (voice-over): Cardiac intensive care unit at the Cleveland Clinic -- world renowned for both its high-quality care and its comparatively low costs. Those who work here, like Dr. Steven Nissen, an important example as Washington debates a radical restructuring of American health care.
DR. STEVEN NISSEN, CHMN., CARDIOVASCULAR MEDICINE: Everything that we do is done with the patient at the center of the picture, not the doctor at the center.
KING: At many hospitals, cardiologists and cardiac surgeons work in different departments. Here, all under one roof. The business model that translates into more collaboration and less competition for patients and for health care dollars.
NISSEN: The Cleveland Clinic is not a fee-for-service model. I get paid a salary. We all get the same check. It doesn't matter whether we do an operation or do an angioplasty. And so, we have taken that issue of income out of the equation.
Now, unfortunately, that's not the case across the country. And that does lead to excess costs. Everybody wants to do their procedure.
DR. TOBY COSGROVE, CEO, CLEVELAND CLINIC: What are we talking about today?
KING: CEO Dr. Toby Cosgrove is an outspoken advocate of reform but also sounds several cautionary notes as Washington debates just what to do and how to pay for it.
COSGROVE: Fifty percent of the hospitals in the United States are running in the red. So, if you begin to look at reducing the amount of money that's coming to hospitals to look after patients, I think you're beginning to look at failure of a group of hospitals.
KING: Cleveland Clinic holds itself out an example of how to lower costs, yet also improve results.
UNIDENTIFIED FEMALE: It's time for you to go home.
KING: The emphasis on preventive care is designed to reduce the need for expensive surgeries and procedures.
COSGROVE: Begin to reimburse for wellness. Right now, if I do a heart operation, I get paid for doing a heart operation. If I prevent somebody from needing a heart operation by helping them understand their diet and their exercise, I don't get paid anything.
KING: Wellness is a Cleveland Clinic obsession. It won't hire smokers. Healthier foods dominate the cafeteria options; a farmer's market on campus; yoga classes for employees and patients.
COSGROVE: Seventy percent of the cost of health care is from chronic diseases. And chronic diseases come from really three big things -- from obesity, from lack of exercise, and from smoking.
So, we have got to go after the prevention in wellness aspect. And that will bring us down the level of disease across the entire country. We live longer. We live healthier. And we live cheaper.
GUPTA: It's amazing to hear the head of a cardio-thoracic surgery program talking about prevention and wellness. That was John King.
And continuing his push forward to health care reform, President Obama named Dr. Regina Benjamin as his nominee for U.S. surgeon general. Dr. Benjamin runs a nonprofit clinic in a coastal fishing community in Alabama, and says her goal as surgeon general would be to make sure no one falls through the cracks. Take a listen.
(BEGIN VIDEO CLIP)
DR. REGINA BENJAMIN, U.S. SURGEON GENERAL NOMINEE: My father died with diabetes and hypertension. My older brother and only sibling died at age 44 of HIV-related illness. My mother died of lung cancer, because as a young girl she wanted to smoke just like her twin brother could.
I can't -- or I cannot change my family's past. I can be a voice in the movement to improve our nation's health care.
(END VIDEO CLIP)
GUPTA: And we've got some more troubling news about hormone replacement therapy for women. Large study out this week shows using any kind of HRT increases a woman's risk of developing ovarian cancer by 38 percent compared to women who have never used hormones. Now, this risk was regardless of how long you're on the therapy and whether it's was estrogen alone or combined with progesterone.
I could tell you, it's the age-old question medicine, risks and benefits. Talk to your health care provider to weigh your own personal risks and your own personal benefits.
Now, we have a CNN exclusive. A Florida doctor says he is saving lives with a new stem cell therapy. The catch: He's doing this in the Dominican Republic because it's not approved in the United States, and, in fact, experts say it's not even possible.
CNN's Drew Griffin investigated.
DREW GRIFFIN, CNN INVESTIGATIVE CORRESPONDENT (voice-over): Barbara Mckean's workout, yoga, in front of a Wii may not seem like much...
BARBARA MCKEAN, COPD PATIENT: I'm going to show you how the Wii works.
GRIFFIN: ... until you consider where she was just one year ago.
MCKEAN: I was very limited as to the activities I could do.
GRIFFIN: She has COPD, an incurable lung disease that should be killing her. Instead of dying, she says she's getting better, using oxygen only at night now. Even her family physician is amazed.
She believes stem cells from her own body are helping her improve. Barbara McKean is a patient of an American doctor working through this hospital in the Dominican Republic. Dr. Zannos Grekos is a Florida cardiologist who also runs a company called Regenocyte Therapeutics.
What he is doing cannot be done in the U.S. DR. ZANNOS GREKOS, RENEGOCYTE THERAPEUTICS: These procedures work and it's substantiated by objective data that we're collecting.
GRIFFIN: The procedure? Draw a patient's own blood, send it off to a lab in Israel where it's transformed into what the company calls Regenocyte. According to the company, the Regenocyte cells are then reinjected into the body to rebuild damaged areas.
GREKOS: We end up with between 40 million to 80 million stem cells. And then they also activate them and educate them to want to become the end organ of whatever tissue that we're looking to regenerate.
GRIFFIN: If that sounds impossible, it's because those at the forefront of stem cell research say it is.
DR. IRVING WEISSMAN, INTL. SOCIETY OF STEM CELL RESEARCH: There is no such cell. There's no cell called a Regenocyte.
GRIFFIN: Stanford University's Dr. Irving Weissman is the president-elect of the International Society for Stem Cell Research.
WEISSMAN: I'm disappointed and shocked that somebody would prey on a family that has an untreatable disease with the promise of a therapy that has no scientific or medical basis.
GRIFFIN: Dr. Grekos says he's not conducting any FDA-approved clinical trials. "Such trials are usually conducted before treating patients, too expensive," he says. But he will seek FDA approval by the end of the year. He also shrugs off the criticism of nonbelievers.
(on camera): You think that the head of the International Stem Cell Society -- Research Society and the head of Stanford Medical Center's biology's stem cell Department is just behind the times?
GREKOS: I think that they just need to be more educated.
GRIFFIN (voice-over): Grekos, who conducts information seminars in Florida retirement communities, says over the past 18 months, he has treated more than 100 people with various illnesses. He claims 80 percent responded to treatment.
In his seminars, he talks about hopes and possibilities -- careful not to promise results.
(on camera): You're treating them. You're not scamming them.
GREKOS: No. No, we're treating them.
GRIFFIN (voice-over): The FDA has not sanctioned the treatment in the United States because it has yet to be proven safe or even effective in humans. But that is all science.
What's harder to explain is the experience of Barbara McKean, who says the moment she felt her own stem cells injected into her body she felt healing.
MCKEAN: I sit now in the humidity talking to you. I didn't even step out on this porch before I got my stem cells. I couldn't do it.
GRIFFIN: Drew Griffin, CNN, Naples, Florida.
GUPTA: Terrific report there, Drew. A lot to think about for sure.
Now, a pastor with a surprising personal story of depression. Why he says the black church is doing more to help parishioners struggle with mental health problems.
And later, doctors are under pressure to give their patients what they want. I heard some of these allegations myself covering the death of Michael Jackson. We'll examine when doctors should be saying now.
Stay with HOUSE CALL.
GUPTA: We're back with HOUSE CALL.
You know, depression has the potential to cripple the lives of more than 14 million Americans every year. Among African-Americans, the suffering is often buried in a community where mental health carries a fearsome stigma.
Joining me to talk about this, the Reverend Leland Jones, pastor of Greater New Light Missionary Baptist Church right here in Atlanta; and psychologist Allen Carter. He's director for clinical services for the Morehouse College Counseling Center. He also runs a private practice when allowed.
Thanks to both of you for joining us. As I was mentioning, I really -- this is something I've wanted to talk about for some time. So, lots of questions.
Reverend, let me start with you. When you came home from Iraq, you told a story about how you were injured; you were with walking with a walker. And then you had a pretty terrible personal crisis at home as well.
REV. LELAND JONES, GREATER NEW LIGHT MISSIONARY BAPTIST CHURCH: Well, let's just say that a few days back home -- I guess, ultimately, put a short spin on it, I was faced with divorce. And so, therefore, my entire world was altered. I came back, didn't have a church to pastor -- came back, physically couldn't run, came back, no longer wanted in the same capacity as being husband.
So, it took me through those dark spaces that basically I couldn't find a way to get out of. And I found myself having to go through the process of finding out if the V.A. could probably assist me with trying to get some answers because my thought process wasn't the way it should be. Now, I'm putting that mildly.
And so, that's when I found out, well, what depression is all about. I was sinking lower and lower.
GUPTA: When does it go from being something that's an awful situation to being depression?
ALLEN CARTER, PSYCHOLOGIST, MOREHOUSE COUNSELING CTR.: Well, like he said, he had something called, "This is the way it was. Now I don't have it." An inability to function in a very effective manner is one of the major things because one of the hallmarks of depression, that you feel hopeless and you feel like your life is unmanageable.
You just -- I had a patient one time say, you know, it felt like a wet blanket that was on her, OK?
So, when you feel like your life is unmanageable and you're not doing anything effectively, that's when it slips over from just normal, you know, sadness to where it becomes more clinical, when with your life is just spinning out of control.
GUPTA: Reverend, who -- if I may ask -- who did you call? Like, who do you turn to in a situation like this, a man of faith who's had all this happened? And was it stigmatized for you to call somebody and talk about this?
JONES: Well, for me, the V.A. did help. I know the V.A. sometimes becomes the whipping board for this process, but it did help. They gave me some -- they gave some guidelines, helped me out from a medicinal perspective.
But being a man of faith, I needed something more. And I contacted a gentleman by the name of Reverend Cameron Alexander of Antioch North Baptist Church here in Atlanta. And I haven't talked to him in about 15 years
He not only answered my call, but he talked to me for about an hour. He told me to meet him in his office and I did. He allowed me to cry, just get it out. And he gave me that spiritual insight that got me back on track.
And even to this day, that day was the transformative moment that said, you know what -- he is watching and at the same time you are OK and it's going to get better. And honestly, it started to steer me in the right direction of knowing I couldn't work this out for myself. I need the connection of someone -- whether it be a professional in one field or a professional in another field.
And I think that's the basis, I was -- the church has to understand, from a black church perspective, too many times we want to be -- or church period -- we want to be the answer all. God will handle it.
JONES: But ultimately, sometimes, it's a matter of dialoguing with those others who are professionals.
GUPTA: And I want to talk more about the role of church specifically. But let me ask you something, Doctor. There was a recent government survey that found that African-Americans have higher rates of depression as compared to whites, non-Hispanics. But a report by the surgeon general found that the percentage of blacks who actually get mental health care is only half...
GUPTA: ... of non-Hispanic whites. What is going on here?
So, you heard -- again, the reverend got good assistance -- it sounds like -- from the V.A.
CARTER: Well, he got whatever he got from it, OK? Yes.
GUPTA: Well, he got something that helped him. But why such a shortfall in numbers between blacks and whites?
CARTER: Oh, man, we've got this thing in our community called, "I'm a man, all right? And, you know, I don't want anybody to know that I'm hurting, you know, because, you know, you've got to just man up about it."
So, there's a lot of stigma about it, too. You know, if you go to a doctor, like me a psychologist or psychiatrist, you know, you maybe crazy.
Although, you know, I tell you what, Dr. Gupta, I've been in private practice here for 28 years, OK? When I first started my practice, I didn't have -- I had had very few black males. Now, most of my practice is black males, OK?
CARTER: And so, there is some, you know, sliding away from that stigma, but it's still very much present.
GUPTA: Still very much present.
CARTER: Oh, yes.
GUPTA: The role of church specifically -- looking at mental health in terms of biblical terms. Good idea?
JONES: Biblical terms -- well, yes and no. Primarily in the New Testament, when we look at mental health, we biblically stated what we generally look at is that the outline of the narrative note that a person has a demon. There weren't the clinical diagnoses to go along with it. When we start looking at it from that perspective, well then, of course, it requires intervention to have to deal with those issues.
But I think what we're looking at from a practical perspective is, we're not looking at people's demons. We're looking at people who are going through a process that they need to break out of or to find some coping skills for those issues. And it's not a matter of saying, you've got it and you can't deal anything with it other than to suffer.
But it sometimes becomes a meat of simply saying, why don't we love you enough to listen to you first? Find out what's going on but then know we don't have the answers, and then to pivot to those professionals who just might.
GUPTA: And let me ask you really quickly, just a few seconds up, when do they come see you? What is sort of trigger point when they say, "OK, now, it is time" to seek the help of someone like yourself?
CARTER: Well, when you find that, you know, the resources that they have aren't coping -- helping them with coping that, the church can give them hope, but they have to have something called -- depression is much deeper than that. And they have to have some -- I still don't understand what's going on. I prayed, I prayed, I prayed, you know? I went to church. I did my part, you know, whatever. And it still ain't working.
Now, they have to go. And as the church teaches, there is always something else available for you. And this is where they can go into something called -- maybe there is something here I didn't see before that I can learn now.
GUPTA: Great dialogue. Reverend, you look well. I'm glad to see you. Thanks so much for being on show.
JONES: Much better now than before, sir.
GUPTA: Well, thank you, sir.
Good to see you smiling, Doctor.
GUPTA: Hope we can continue the dialogue. It's an important one.
GUPTA: Hopefully, we'll keep it going. Thanks so much for both of you.
CARTER: Thank you.
JONES: Thank you.
GUPTA: And for more stories of people creating solutions, tune in to CNN special documentary, "Black in America 2." You catch it here only CNN, July 22nd and 23rd.
Now, doctors feeling pressured, trying to answer the demands of patients. But what if what those patients want isn't necessarily good for them? We're taking you inside the new doctor dilemma and discover why having a beer tonight might just save your memory.
All of that is ahead on HOUSE CALL. Stay with us.
GUPTA: We're back with HOUSE CALL.
You know, on reporting the Michael Jackson story, I came across some troubling stories of Jackson asking for dangerous medication from doctors who allegedly did what he asked. Now, the behavior is not isolated to celebrities. And even when the medications or procedures may not be dangerous, doctors have a hard time sometimes saying no to patients.
CNN senior medical correspondent Elizabeth Cohen is here with more on this phenomenon.
And we've talked about this a lot, I guess, with Michael Jackson. Are there certain doctors who seem to be the most susceptible or at risk of this?
ELIZABETH COHEN, CNN SR. MEDICAL CORRESPONDENT: Yes. When I talked to doctors about this, Sanjay, cosmetic dermatologists, plastic surgeons, they say they get tons of pressure to keep doing more for their patients. And so, one cosmetic dermatologist I talked to said, that she actually trained medical students in the fine art of saying no. She says your work is going to be walking around. People will say this person's face and if they have had enough, you need to learn how to say no.
But it's not, of course, limited to plastic surgeons. Family doctors get requests for antibiotics.
COHEN: For the common cold.
COHEN: And in your practice, do you see that sort of patients asking for things they don't really need?
GUPTA: You know, mainly, it's pain medication. You know, we have a lot of patients. We have degenerative spine disease, for example, and they ask for pain medication. I'll tell you, it is difficult sometimes to sort out who legitimately needs it and who maybe abusing it.
And I was struck by this, Elizabeth, when we're doing a reporting on Michael Jackson, how little there is in terms of a registry to track all that. I should only pick up the phone and say, how many Vicodin has such and such taken over this period of time. We just don't have that, which I think makes it so much more difficult.
COHEN: Where you want to know has another doctor prescribed Vicodin... GUPTA: Exactly.
COHEN: ... and there may be 10 other doctors prescribed Vicodin.
GUPTA: Right. And sometimes, they come and say they lost the prescriptions. It's impossible to even validate that sometimes. So, it's challenging stuff for sure.
GUPTA: And make sure you read the column as well. You should read the column as well to find out more about these common medications that are demanded by patients -- in her column: CNN.com/EmpoweredPatient.
All right. Getting non-meat protein in your diet, do you know your options and how much you really need? You got some questions, I got some answers. That's coming up in "Ask the Doctor."
First, test your medical knowledge though. What food or drink may reduce your risk of heart disease, stroke, and gallstones? We'll ask Elizabeth as well. She's still here.
The answer and another possible benefit -- coming up after the break.
GUPTA: Before the break, we asked what food or drink may reduce your risk of heart disease, stroke and gallstones. Well, the answer: moderate amounts of alcohol. And we'll get to just what moderate means in a moment.
But first, some news out this week you may be able to add dementia to the potential list of benefits. Researches follow people 75 years and older for about six years, tracking how much alcohol they drank and then testing them for dementia. What they found is that people who drink one to two drinks a day had some significant benefit when it came to dementia overall.
Take a look here -- 40 percent reduction in risk of dementia with moderate drinking alone. Now, keep in mind, if you start to drink more than that, you really started to erase a lot of those benefits and increase your risks.
Now, researchers aren't exactly sure what is going on here or why you get those benefits, it may have something to do with the fact that alcohol can actually reduce your risk of heart disease and stroke and that may overall increase your cognition in the long run.
A question that always comes up, how much is moderate and what exactly counts as a drink. Let's go over that real quick. What counts as a drink, first of all: 12 ounces of beer, 5 ounces of wine, 1 ounce of hard liquor. And typically, on average, about one drink a day for women, two drinks a day for men. So, potentially, a little bit of good news out there for you moderate drinkers. Now, from drinks for your mind to food for your body, "Ask the Doctor" is next with answers on everything from back pain to getting the protein you need.
You're watching HOUSE CALL.
GUPTA: And we are back with HOUSE CALL. It's time for my favorite segment, "Ask the Doctor."
Let's jump right in with the question from Jerold (ph). The question is this, "Can sciatica run down both legs at the same time?" Well, this is an area of my expertise. And I'll tell you, the short answer is yes.
Sciatica is caused when the sciatic nerve is pinched or pressed on by a disk or some bone in your spine. Now, the pain runs along your nerve and generally radiates from your lower back down the back of your legs. Oftentimes, the pain it intermittent but it could become worse with walking. It can also become constant.
A lot of times, just simple anti-inflammatories, stretches, physical therapy, sometimes, pain shots can help. But see your doctor if the pain is continuing, surgery might be an option for you, Jerold (ph).
Next, the question from my four months to fitness group, they get healthy initiative folks.
Deborah writes this: "What is the most effective way for women to get extra protein without meat, chicken or fish in their diet?"
Well, first of all, thanks for joining up, thanks writing. I would encourage women talking about building muscle mass, and that's probably where this question comes from. According to the American Dietetic Association, plant-based protein like nuts, tofu, beans and dairy products, they're all great ways to get the protein that you need. And look for that protein to make up about 10 percent to 35 percent of your daily calories every day, depending on your workout routine.
Now, the Institute of Medicine says, for women over the age of 18, they should be getting about 46 grams a day.
Here are a couple examples. I think you'll be happy about this: 8 ounces of yogurt will give you 11 grams; a cup of dried beans, 16 grams; and one cup of cottage cheese has a whopping 28 grams.
If you miss any part of today's show, be sure to check out my podcast: CNN.com/Podcasting.
Remember, this is the place for the answers to all of your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta.
More news on CNN starts right now.