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SANJAY GUPTA MD
Dangers of Food Poisoning; Diabetes Drug Linked to Heart Risks; Interview with Harry Markopolos, Fraud Investigator
Aired July 3, 2010 - 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. I'm Dr. Sanjay Gupta.
Welcome to a place where you can learn how to live longer and stronger. I'm your doctor. I'm also your coach.
First up, an exclusive story: Imagine a woman who almost died -- why -- because she ate raw cookie dough. Foodborne illnesses that becoming increasingly more common -- just how dangerous are they? We'll tell you.
Plus, it was once the most popular diabetes drug anywhere in the world. The safety concerns about Avandia. You're just going to have to hear this.
And finally, our medical mystery this week. It's hidden in the painting in the Sistine Chapel. Michelangelo hid very ancient aspects of anatomy inside art. I love this stuff.
Let's get started.
GUPTA: Your food -- you're expected to be safe and the United States House has passed a food safety bill. The Senate is still in limbo on this. But I can tell you, it's become an urgent matter, which is why we're talking about it today.
In fact, just in the past two weeks, the CDC has been investigating a multi-state salmonella outbreak from frozen dinners. It sickened 37 people in 18 states.
Also, the USDA has reported a recall of 35,000 pounds of ground beef. Why? Due to possible E. coli contamination.
You know, these aren't just statistics. Foodborne illnesses like this can kill you and possibly make you very sick.
Linda Rivera did something that perhaps we have all done at one point or another. She took a little bite of raw cookie dough. But what happened to her after that is something that really no one could have predicted.
Here's our exclusive interview.
(BEGIN VIDEOTAPE) GUPTA (voice-over): Linda Rivera was living the good life -- a mother, wife, a special ed assistant. Linda was happy and healthy. But all of that changed in May of 2009.
LINDA RIVERA, FOOD POISONING VICTIM: I felt like I had that cold, the flu, something like that.
GUPTA: In fact, Linda got so sick her husband took her to the emergency room. There she was diagnosed with irritable bowel syndrome and sent home.
But the thing is: she didn't get any better.
RICHARD RIVERA, LINDA'S HUSBAND: And I asked her if she's OK. And she said, "No, if I have to go through this one more day, I'll die." So, we took her in.
GUPTA: The doctors told her she had contracted E. coli OH-157. That's a dangerous foodborne illness that can attack organs. The E. coli had settled into her colon and doctors now had to remove it. A few days later, Linda was told what gave her E. coli.
L. RIVERA: Our attorney called us and said that it was cookie dough. I usually use a big tub, make lots of cookies at one time. Just a couple of bites, that's all it took.
BILL MALER, RIVERA'S ATTORNEY: The reality is, about 60 percent, 65 percent of everybody who buys these products admits that they eat it raw. Seventy-six thousand people get E. coli O1587 every year, between 50 and 100 deaths every year. So in the scheme of bugs, it's -- it's a relatively low number, but it's a really nasty, nasty bug.
GUPTA: For a whole year, Linda had lots of problems. Her kidneys shut down. She couldn't walk or talk. She went into cardiac arrest.
Three times, she was almost given her last rights. But she never gave up.
L. RIVERA: OK. For 15 minutes ...
GUPTA: Now in a rehab hospital in San Francisco, Linda is learning to live again.
DR. PHILLIP O'KEEFE, CALIFORNIA PACIFIC MEDICAL CTR.: Her ability to deal with the pain and problems that she still has really been heroic.
GUPTA: Her husband Richard is right there with her, says he wouldn't wish this on anyone.
R. RIVERA: Probably, any family to have to go through this. I mean, just -- it does tear your life away. Linda's probably the most giving and cheerful and optimistic woman you'll ever meet. And she gave and gave and gave. And to see what this has done to her just tore me apart. GUPTA: Linda is not going to give up. She says she has a lot to live for.
L. RIVERA: I don't want this horrible disease to win. So I want the rest of the world to know about it. They need to know.
Don't take a chance with it. It's not worth it. You give up your life, you lose everything.
GUPTA: I tell you, we did speak to Linda's husband this week and he says Linda is improving little by little. He figures at best, she's going to be in rehab for another six to eight months and then she'll go home and do outpatient rehab. She's also going to require a nurse's care for some time to come as well.
Foodborne contamination, cookie dough, that's what this is all from. Linda, we wish you well.
Now, the drug Avandia is under fire again. It's used to lower blood sugar levels, but they finally could be doing some significant harm as well. Two new studies raise more concerns about popular diabetes drug increasing the risks of some pretty serious side effect.
Here's what they found. After analyzing records of nearly 230,000 elderly patients, those taking Avandia were 27 percent more likely to have a stroke, 25 percent more likely to develop heart failure, and 14 percent more likely to die.
There's another study as well that updated research that was first published in 2007. Researchers there looked at a total of 56 studies and found that taking Avandia raised the risk of heart attacks by 28 percent.
Now, keep in mind something important. Diabetes alone does increase your risk for all those things. But the important thing is when patients were switched to another diabetes drug, roughly 500 heart attacks and roughly 300 case of heart failure were avoided every month. That's according to a recent Senate Finance Committee report.
I can tell you, this is confusing and a fight is brewing over this very issue. In fact, there was another study -- a third separate study -- that found that there wasn't an increased risk of serious side effects.
The FDA first approved Avandia in 1999. Here's what we know: Then, it required black box safety warnings. You're going to look at one right here. That's -- they're put on the medication after concerns were first raised three years ago.
Avandia's manufacture GlaxoSmithKline complied but continues to insist the drug is safe. The FDA advisory committee is going to meet in two weeks to see if there is enough evidence to keep the drug on the market or not. GlaxoSmithKline, GSK, the company, said in a statement, "We look forward to participating in a rigorous scientific discussion about the new studies at this FDA meeting."
Now, keep in mind, this is a drug for diabetes. So you shouldn't simply stop taking it. That would be dangerous. But you should know that there are many other options out there.
In fact, if you want to know what some of those onyxes are we're going to have it for you. "Ask the Doctor," that's next.
And, also, a guy who is credited for taking down Bernie Madoff -- he has his sights set on something that affects every one of us -- it's fraud. It's fraud in health care. And the numbers are just staggering.
Stay with us.
GUPTA: And we are back with SGMD.
Every week at this time, we're going to be answering your questions. Think of this as your appointment -- no waiting, no insurance necessary.
I got a question from Twitter. It reads, "Is there an alternative medicine for Avandia?" Something that we were just talking about -- the answer is yes. In fact, the American Diabetes Association tells us patients do have option if they have concerns about Avandia -- the story of the week.
First of all, it's important to have a good discussion with your doctor about this. And there are some questions you may want to ask specifically.
First of all, will this new drug lower my blood sugar?
Will it cause hypoglycemia? Which means it will lower my blood sugar too much.
Will it cause weight gain?
Can I afford the drug? Ask about cost.
What are the side effects? Keeping in mind that all drugs do have some side effects.
Let me a list of some of the other alternative drug. Most people with Type II diabetes start on a true and tried group called Metformin. This is a generic drug. It's pretty affordable, especially if you don't have insurance.
If you want to stick to the same type of drug as Avandia, your doctor may suggest something know as Actos.
And there's newer class of drugs called DPP-4 inhibitors.
And now, there are daily and weekly injections. Many patients with diabetes do require insulin as well.
Also, keep in mind, there's simple proper diet and exercise. That can work for a lot of people.
GUPTA: That, of course, brings us to our "Fit Nation Challenge." We're just two weeks away from the New York City triathlon. I'm doing it.
I'm a little nervous, so I invited six CNN viewers to join me. Now, they're from all over the country. Take a look at their locations. In fact, we're going to zero in today on Linda Fisher- Lewis. She's been training in Oregon. We're going to be checking in with her.
You know, she spent 20 years in law enforcement, but a car accident took a lot of that away from her. She's using this challenge to help get her body back in shape, get back to helping people as well.
Take a look at how she's doing.
LINDA FISHER-LEWIS, FIT NATION PARTICIPANT: Hi, I'm Linda. I'm one of the six to the "Fit Nation Challenge" for the New York City triathlon. I just wanted to check in and let you know how things have been going.
It's been a challenge over the last five months. It's been a lot of good opportunities and some hard times as well. Just having the confidence and believing in yourself that you can do this, finding the time to workout and get in the training that you need to so that you're ready for a three-hour race.
Well, I think I'm ready. I've put in the time. I'm definitely scared to death. Swimming in the Hudson has been a fear for me. I know I can swim the distance, it's just the Hudson River.
Other than that, I think, you know, the biking has been good, the running has been good. There have been challenges with weather here in Oregon. The weather has just been horrible. We haven't had just only one day over 80 degrees, so I know the heat is going to be something for me to think about when I'm in New York.
But I want to thank everybody for their support, for the opportunity. And I'm looking forward to seeing everyone in New York City.
GUPTA: All right. Linda, good stuff. Thanks so much for putting in all the hard work. Keep it up. I'll see you in the Hudson River, hopefully the finish line as well.
Coming up: I'm going to introduce you to a bounty hunter of a different kind. His targets are crooks who were committing health care fraud. Stay with us.
GUPTA: And we are back with SGMD.
You know, last month, Congress heard a hearing about how to clean up the Medicare program. We heard a staggering estimate that fraud takes $1 in every $10 spent on health care, 10 percent, on all of that in this country, Medicare included.
But it comes as no surprise to one of the country's best fraud investigators, Harry Markopolos, the financial analyst who warned government regulators about Bernie Madoff. They ignored him until it was too late. And he wrote a book called "No One Would Listen."
I decided to pay him a visit to hear about his latest target: health care.
GUPTA: You know, when you talk about Madoff, $65 billion or whatever, in many ways, some of the data regarding Medicare suggests there's that much fraud going on every single year, $60 billion a year.
HARRY MARKOPOLOS, FRAUD INVESTIGATOR: Well, at least. And that's only against Medicare, which is about half of what's spent on medical care in this country. The other half is private individuals like me and you that have our own insurance through our employer. Those plans are also being cheated on. And so, the losses are actually a lot higher than that.
GUPTA: Medicare fraud, what does that mean exactly?
MARKOPOLOS: It means the government is paying money for goods and services that are not being delivered. Someone is spending a false bill and the government is paying it. And it's not resulting in any health care for the American population.
GUPTA: What percentage of health care practitioners do you think engage in fraud?
MARKOPOLOS: We really don't know. We can just guesstimate that about 10 cents of every health care dollar is stolen.
MARKOPOLOS: That's the minimum. It may be as high as 20 cents per dollar. We're not sure.
GUPTA: What -- what are some of the most egregious examples you've seen of Medicare fraud? MARKOPOLOS: Invasive surgery, heart surgery where heart surgery is not required. Putting in a stent where maybe a drug would do.
GUPTA: That is -- I mean, so, you're talking about someone literally battering some -- I mean, performing open heart surgery that wasn't necessary just to make money. I mean, you're not just talking about taking money. You're talking about potentially killing somebody if the operation didn't go well or some complication occurred.
MARKOPOLOS: That's correct. You get an infection, who knows what's going to happen. But they want to put in the device or the stent instead of treating it with drugs, which is a lower cost to the government, of course, and may be a better treatment for the patient. But they want to open them up because that's what they get paid to do. They get paid on a per procedure basis, not what's right for the client.
GUPTA: I've heard crazy examples of doctors literally -- not doctors but criminals -- literally billing on behalf of doctors who are no longer even alive. So, literally sending out bills on behalf of these doctors to patients, the doctors aren't even alive.
MARKOPOLOS: Dead doctors billing is a problem. That's been found certainly in New York State.
GUPTA: You say that very cavalier. I mean, this is just something that is known -- I mean, you know what, we know that doctor died a few years ago, we're just going to bill on his behalf and make money.
MARKOPOLOS: There's other frauds that are similarly bad, I think. Females coming in with prostate operations or certainly, male pregnancies. It's a no-brainer, yet the government pays those bills repeatedly.
Or dead patients receiving care. Bad enough that we have dead doctors billing, but what about dead patients billed for.
GUPTA: How can that -- 2010, I mean, literally -- I mean, someone is going to say, oh, yes, John Doe, his pregnancy, we'll take care of that. I mean, seriously?
MARKOPOLOS: That happens. That happens. There's other ones, psychiatrists that will bill 42 hours a day, 380 hours a week, until you catch them. They're easy to put away.
GUPTA: They're not delusional. They're doing this on purpose.
MARKOPOLOS: It's willful.
GUPTA: That -- some of that seems like it should be an offense.
MARKOPOLOS: That's the low-hanging fruit. The computers and these computer programs write, you will find the low-hanging fruit. To do the in-depth, the big massive frauds that are carefully hidden by master criminals, there you need a whistle-blower from the inside. That's the only way you're going to detect those big frauds.
GUPTA: We're going to have much more with Harry Markopolos straight ahead, and the fraud that could be hidden in your own medical bills.
We'll be right back.
(BEGIN VIDEO CLIP)
MARKOPOLOS: In Wall Street, they only steal your money, and that's bad and I thought Wall Street had the biggest crooks in the world until I got into the health care fraud.
In health care, not only do they steal your money, they can steal your life or they can take your loved one's life, and that's beyond evil. So, those are more important cases to me.
(END VIDEO CLIP)
GUPTA: And we are back with SGMD, and that Harry Markopolos. He's a fraud investigator who figured out the Bernie Madoff scam. He says thieves steal more money from Medicare every year than Madoff took in his whole criminal career.
GUPTA: We're not talking about inefficiencies here. We're not talking about mistakes. We're talking about people intentionally trying to make money off the government using Medicare?
MARKOPOLOS: Yes. They're up-coding. So a simple case of pneumonia comes in and it pays so much, but you can make several times that much if it's a complex case of pneumonia. So you just falsely code it as complex when it really was just simple.
Or you're billing for individual therapy but you're really providing the therapy in a group setting, which is much cheaper to deliver. So you're over-charging the government. And all of those little thousands and millions of dollars add up into tens of billions.
GUPTA: Patients come into the hospital. They have pneumonia. I get a chest x-ray. It shows simple pneumonia, but I say, ah, you know what, simple pneumonia only pays this much. A complicated pneumonia pays this much. I'm just going to check the box two boxes higher? Is that what we're talking about?
MARKOPOLOS: Yes. It's as simple as that and it costs you nothing to check that box two boxes higher. You're delivering those claim forms electronically. So, how much did that cost you? A fraction of a penny perhaps when you can make several thousand dollars more?
GUPTA: How do you make money? I mean, is there a percentage of what you bring back in terms of fraud?
MARKOPOLOS: Yes. The government basically will pay 50 cent per dollar of fraud located, but they'll fine the bad guys $3 for every $1 they steal and they give the whistleblower team which I usually lead 50 cents and keep $2.50 for the government. So, the bad guys end up paying the fines and penalties and they also pay the government's costs of investigation.
The problem is: we don't have enough government resources to take on enough cases.
GUPTA: What can they do? What can they be empowered to do?
MARKOPOLOS: The most important thing they can do is when they get their bill. It's called an "explanation of benefits." When you get it in the mail, they need to read it and say, was this treatment provided? Were these lab tests actually run?
And if you see things on there that you never received, pick up the phone. Call the number. Call the Medicare fraud hotlines. Call your local district attorney. Call someone in a position of authority so that they can be taken care of and investigated.
GUPTA: Will it be?
MARKOPOLOS: Probably not. There's probably not enough people on the other end of the phone to take those calls and follow up on those calls. But if you don't, you've given a green light to the bad guys. If you've at least picked up the phone, you know you did your job as a citizen. That's all we can ask of you.
GUPTA: Do you read your bill carefully?
MARKOPOLOS: I do. And you know what? I made a conscious decision because of the business I'm in and I have a family. I have three small kids. I have a wife. I make a conscious decision to ignore what I'm seeing, because I'm over-billed.
If I want my family to get health care, to continue to receive health care, I can't look at those bills. So, I don't practice what I preach and I'm ashamed to say that.
GUPTA: Now, for many Americans, cooking out is a vital part of celebrating the 4th of July. It's probably what we're going to do as well. Before you fire up the grill, there are a few things you should think about.
Some studies suggest people who eat a lot of charred meat may be at higher risk for cancers, including stomach cancer, pancreatic cancer, colorectal cancer, even breast cancer. It turns out when you cook certain to really temperatures, compounds called heterocyclic amines, they can form. Researchers suggest these chemicals could pose an increased cancer risk.
So, what should you do to limit your exposure.
First of all, clean your grill, I do, with soapy water. Get rid of the burned meat residue. Also, don't burn your meat. If you do burn part of the meat, cut that part off. You can precook your meats a little ahead of time on the microwave or stove and they aren't going to sit on the grill too long.
Also another potential risk that comes from the fat dripping on the charcoal -- the smoke that contains chemicals known as polycyclic aromatic hydrocarbons, which have caused tumors in animal experiments. Now, these compounds can be soaked up by the meat. So, to reduce the amount of carcinogens coming from the smoke, select leaner cuts of meat. Trim visible fat.
Consider grilling with foil poked with holes so the fat drips off but not with a lot of smoke. And don't pierce the meat while grilling. That way less fat is going to drip.
Hope you enjoy your Fourth.
Up next, have you ever been to the Sistine Chapel and looked up at the ceiling and seen a hidden part of the human anatomy? That's our medical mystery this week. You'll feel so smart after you watch this.
We'll have it right after the break.
GUPTA: And we are back with SGMD.
Our medical mystery this week is where anatomy meets art. I really do love this stuff. If you've ever been to the Sistine Chapel and seen the magnificent painting, did you notice that there's a part of anatomy hidden in the art work?
Researchers believe they have solved this mystery. In fact, it is the brain stem. You can see it right there.
Scientists say Michelangelo's best known works may have hidden messages to suggest the human brain is among God's greatest creations.
I want to show you something here. Look at the neck specifically. If you take a look at that image over there and take a look at the image here, it really does look like the brain stem. It's Michelangelo's painting called the "Separation of Light from Darkness." It's on the ceiling of the Sistine Chapel. It depicts the beginning of the universe.
A neurosurgeon from John Hopkins University studied the painting and found that the neck of God appears to contain the human brain stem. And you may not know this, but Michelangelo actually dissected cadavers to understand how the human body works and to help create so many of the paintings that have become famous today. Researchers say he put a hidden message in the ceiling of the Sistine Chapel to show people that he knew anatomy very, very well.
The brain stem incidentally controls breathing. It controls your heart beat and your blood pressure. All that information that goes to and from our body passes through the brain stem on the way to our brain.
Researchers say Michelangelo probably didn't know the functions of the various components of the brain but he understood it was a very important structure.
So, next time you visit the Sistine Chapel, see if you can find that brain stem.
Now, we have been reporting about Haiti on SGMD ever since the devastating earthquake struck this very small country. It's been six months since more than 220,000 people died and over 300,000 were injured in and around the entire Haitian capital. The country has made little progress in rebuilding and millions are displaced from their homes. Rubble and collapsed buildings, they still very much remain throughout the country.
So, I'm going to be returning to Haiti in the coming weeks to bring you the latest on what's being done to help and how your money is being spent as well. So, stay tuned to SGMD for much more on that.
And if you missed any part of today's show, be sure to check out my podcast at 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.