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SANJAY GUPTA MD
Healthcare on Trial; Stem Cell Breakthrough; Critical Drugs in Short Supply; Fat Joe "Drops a Body"
Aired November 19, 2011 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, HOST: Hi, there. I'm Dr. Sanjay Gupta.
This morning, they very important yet complicated stories that we're going to make sure you understand at the end of this half hour.
GUPTA (voice-over): America's health system is changing. That means your insurance coverage is changing as well. Why the Supreme Court is now getting involved.
Then, using stem cells to fix the damage from a heart attack. The surprising new evidence.
And what's behind a critical shortage of cancer drugs?
Plus, rapper Fat Joe drops a body. Why he's not so fat anymore.
GUPTA: We begin, though, big news out of Washington. The Supreme Court says they will decide a challenge to the sweeping healthcare law that President Obama signed last year.
A lot of people have been paying attention to this. The main issue is that controversial requirement that everyone be required by insurance. It's called the mandate. Starting in 2014, if you don't have insurance through a job or Medicare or Medicaid, you have to buy it yourself.
Now, while there are subsidies for those who can't afford it, this specific part of the law requiring the mandate has been unpopular. But according to a new CNN/ORC poll, a majority of Americans are now be in favor of it overall.
Joining me from New York is NYU Langone Medical Center's Andrew Rubin. He's been on the show before. He's the host of "Health Care Connect" on Sirius XM Doctor Radio.
Andrew, you and I have been talking about this for some time now. First of all, let me start off just simply -- did this surprise you at all, that the Supreme Court is taking this on?
ANDREW RUBIN, NYU LANGONE MEDICAL CENTER: No, we knew this would happen. It's the best way to get to the finish line on whether health care reform is going to survive because it's been going back and forth in the courts far too long.
GUPTA: Well, give it to me straight here. Patients ask me this all the time as a doctor. If the Supreme Court overturns health care reform what does that mean for health care? What does it mean for this whole plan, this whole bill overall?
RUBIN: OK. Well, you have to remember, health care reform has two parts. One is health insurance reform. And that's really what this individual mandate is all about.
Now, if the individual mandate is overturned by the Supreme Court, then it really throws into question the entire health care reform bill and law at this point, which is really restructuring the entire health care system.
GUPTA: Andrew, don't know if you have done this recently. I did open enrollment. A lot of companies have these to figure out their health insurance. There are some big changes for next year. And I think one message is clear, you shouldn't assume your coverage for next year is going to be the same as it was for this year.
Do you have any advice? I mean, based on everything you know, what you're seeing, for people filling out their open enrollment in terms of changes coming down?
RUBIN: Yes. Sanjay, big changes this year. In fact, insurance premiums for employers went up 10 percent last year. For the average employee, it's $10,000 across the United States. It's a really big number.
So, last year about 20 percent of employees offered these high deductible, consumer-directed plans. This year the number is 32 percent. And the problem is, with the high deductible, consumer- directed plan, they look similar to older plans. And if you're not reading the fine print, you could be surprised to see that you now have a $2,000 or $2,500 deductible, last year the same insurance came with a $1,000 deductible.
So, the message is make sure you read your benefit plan and you understand what you are buying before you actually enroll in it.
GUPTA: Do you -- when you are giving advice, and you manage in a big provider network, is there some basic advice to make sure people get the best coverage and best insurance overall, and they protect themselves from big bills?
RUBIN: I do. I've been saying this a lot lately and I really believe it. But it's a hard concept for a lot of Americans to understand. An HMO or an EPO, which is like an HMO but doesn't require a referral to see a specialist, can be a very cost-effective insurance plan for a lot of people to choose. You don't typically have deductibles and there are no co-insurance amounts.
The problem is, you have to stay in network. So, you're essentially turning the management of your health care over to a very controlled network of doctors. If you are willing to make that compromise, you can save yourself a lot of money. Heretofore, a lot of Americans didn't like that restrictive behavior on the part of employers or insurance companies. So, they went to these PPO plans where they had out of network benefits.
Those out of network benefits are becoming increasingly expensive for employees because the more you go out of network, the more the employers are making you pick up a bigger percent of those costs.
GUPTA: You know, you're so good, Andrew, at giving us the big picture and obviously, the details of the picture as well. You know, I have a feeling you and I are going to be talking quite a bit over the next few years.
RUBIN: Absolutely, many years.
GUPTA: Thanks for joining us, as always, Andrew Rubin.
You know, prevention is key -- as Andrew was talking -- to keeping people healthy and controlling medical costs. But we also need new treatments.
This week, we saw some pretty exciting results, some things that really, I thought, were fascinating from two studies that were treating patients with stem cells taken from their own hearts. Now, think about that for a second.
Joining me now from Washington is Denis Buxton, who oversees stem cell research for the National Heart, Lung and Blood Institute.
Thanks so much for joining us.
I'm fascinated by these studies. Just to clarify, so both these studies, and some other big ones as well announced this week, used adult stem cells, not embryonic stem cells which have been controversial.
The first one that I saw was the one that you helped sponsor lead by Cedar Sinai and giving stem cells to patients who are just recovering from heart attack. So, someone had a heart attack. Their art function went down.
What did they find when they injected the stem cells into those hearts?
DENIS BUXTON, NATIONAL HEART, LUNG & BLOOD INSTITUTE: So -- thank you, Sanjay.
What they found was the patient's scar tissue, so the part of the heart that was damaged was reduced in size and apparently, new muscle was formed to replace the scar tissue. And this should help the patient's heart to function better in the future.
GUPTA: So, the first point, about growing new tissue. So, the scar is what forms in response to damage, a heart attack in this case. Scar tissue went down and new tissue took its place. Is that -- is that a first? BUXTON: I think this is the first time that we've seen a significant decrease in scar volume and it's replacement by what appears to be functional pumping of heart tissue. So, I think this is potentially very exciting.
GUPTA: There was another study as well just published in the "Lancet," fascinating as well. It gave stem cells to patients with severe heart failure due to heart attacks a long time ago, for example. They didn't measure growth of heart tissue like that Cedar Sinai study did.
What did they find in this "Lancet" study?
BUXTON: Well, so they did also look at scar tissue, and they found a decrease in the scar tissue in the heart. But the most exciting thing that they found was an increase in the pumping capacity of the heart. And so after six months, they saw basically a six-point increase. And after 12 months, this was then a 12-point increase in heart function.
So, this is larger than has been seen in over studies using different types of cells. And so, while this is a small patient population, it's potentially very exciting.
GUPTA: If you can, you know, because you talk about taking stem cells and injecting them into the heart. Can you briefly describe exactly how does that work? What is the process? For someone watching this and saying maybe I will be a candidate for this someday.
BUXTON: So, they took tissue from the heart, either using a biopsy -- so either taking a little bite of the heart through a catheter, or during bypass surgery, and they grew this up in the -- in basically a dish to create millions of stem cells. And then they inject the cells into the heart. They thread a catheter, basically a tube into the heart, and inject the cells into the coronary artery while they stopped flow in the artery. And the cells then migrate to the heart tissue and provide this functional improvement.
GUPTA: And again, that can take some time to actually see the increase in performance. That's part of why I found this so fascinating.
So, appreciate you bringing this to us. We'll keep an eye on it as well. Thank you.
Coming up, what's behind a shortage of life-saving cancer drugs?
Stay with us. We'll explain.
GUPTA: You know, right now in hospitals all around the country, patients are being told the drugs they need to treat their illness simply aren't available. Shelves are empty and doctors are forced to use second-best alternatives to treat their patients or maybe even delay treatment altogether. This week, the American Medical Association weighed in and declared this a national public health emergency. Hundreds of drugs in short supply. In fact, three of the anti-seizure medications I regularly prescribe to patients are on the list of drugs in steep decline.
What's going on here?
A new report out this week says drugs to treat cancers, infections, and cardiovascular disease have taken the biggest hit. Some 550,000 cancer patients this year alone have been told the cancer drugs they need simply aren't available to them.
And one of these patients is Renee Mosier. She's a very resistant form of ovarian cancer, and a drug called Doxil is most effective to treat her type of tumor. But her doctor can't get that medication for her as things stand now.
So, Renee and her oncologist, Dr. Wendel Naumann, join me.
Thank you, first of all, for joining us.
First of all, how are you doing?
RENEE MOSIER, OVARIAN CANCER PATIENT: I just started a clinical trial. My cancer has recurred. It was in remission twice for two and a half years each time. And this time I was only able to get one chemo drug. I could not get the Doxil. My cancer recurred while I was taking chemotherapy.
GUPTA: Is it because you -- I mean, is the thinking it recurred because you couldn't get this other medication?
MOSIER: Well, I took two chemo drugs each time before, and went into remission. This time I was only able to take one, so just have to draw a conclusion about that.
GUPTA: Yu know, seems like we have a certain expectation, Dr. Naumann. I mean, you prescribe a medication, your patient is going to get it. Has that -- it's a faulty assumption now. What do you think is going on?
DR. WENDEL NAUMANN, GYNECOLOGIC ONCOLOGIST: This is a huge growing crisis in this country where we're actually having to ration drugs. And this is something that's unbelievable in this country.
GUPTA: Did you have to tell Renee this?
NAUMANN: We did, yes. We had one course, then the Doxil was unavailable and we had to go with single agent. We had no other real good alternative.
GUPTA: I mean, what was your reaction when you hear this?
MOSIER: Well, you feel like you're in a fight with one hand tied behind your back. We, at the time, said let's go with what we have and see what happens. And the cancer pretty rapidly recurred. So -- GUPTA: There -- a lot of these drugs are made by a single company. So if the company has trouble with their manufacturing in any capacity, they may have to shut down production of their drugs altogether. I mean, that's just the reality.
So, what is one to do? What would you do? What am I to do?
NAUMANN: Well, our hospital system has been very proactive in stockpiling these drugs when we know that there's a looming crisis. That can't be done everywhere, obviously.
I think that we do need to have some sort of contingency plan. I think the AMA has addressed that in their statement.
I'm not sure that current pending legislation is going to necessarily fix all of the problems or will fix some of them.
GUPTA: President Obama specifically talked about asking drug companies to flag a problem prior to the problem occurring or trying to anticipate it.
NAUMANN: If they're going to discontinue production, they have to notify the FDA. But sometimes, in this case, it was a production problem that was noted on FDA inspection and the company voluntarily shut down. So, we don't have a contingency plan there. There's no other company in the world that makes this drug.
GUPTA: You are getting some very good care, Renee, obviously. You were talking about that and how effective it has been in the past. You said, we're just going to go with this one drug.
I mean, was there a part of you that say there is something else that we must be able do here? Do I have to look overseas? Do I need to go somewhere else?
Were there any other options at all for you?
MOSIER: Well, no. I just put my trust in Dr. Naumann, and, you know, hope that the single agent drug would work. But it didn't. And since then, we turned to other alternatives.
GUPTA: Other medications that are available.
MOSIER: Other medications -- not chemo medications. I'm in a clinical trial now, and trying some other drugs, hopefully, that will put me back into remission.
GUPTA: Is there something else going on here, Dr. Naumann? I'm sure you talk about it with your colleagues.
I mean, this is a -- it's not a novel problem. We've heard about this sort of thing before, but it does seem to be getting worse. And the AMA is calling it an emergency.
Is there a peek behind the curtain in terms of what you're seeing? NAUMANN: It's probably a perfect storm. You know, we have very few drug companies manufacturing these, these are outsourced to single manufacturers. Even very common drugs like methotrexate are now hard to find. Pacotaxol, another drug that's used in breast cancer and ovarian cancer in short supply.
This is a problem. We get a list of drugs on a monthly basis that will be on a short supply and we have to make alternatives and alternative plans. So, we have a committee in our hospital that actually does this, it has to decide which drugs will be substituted for short drugs.
GUPTA: It's hard for me to ask this almost, you are both here. But, I mean, you wanted to prescribe a different medication that was not available for Renee. It wasn't available. So you went to plan B.
That's our plan A. Plan A is what you wanted to do.
And, again, excuse me for asking, but is that inferior care or is it less than standard or optimal care for Renee?
NAUMANN: It's clearly not what I wanted to do. I think the response rate and the chances of remission would have clearly been better had we had those drugs, but there's no way to get the drug.
GUPTA: How long is this going to last? Have you heard?
NAUMANN: Well, I mean, that's the problem. We don't know. So, this inspection, the FDA inspected this plant. They voluntarily shut down in May. We were told by two months. So, we were hoping that by the third or fourth cycle, that Renee could go back on the combination. But that process has not been resolved. So, we're sort of in limbo. And there's no contingency plan for production right now. So
GUPTA: So many problems we talk about all the time that we really don't know how to solve. This one, while complicated, seems like something we can do something about for you, Renee.
MOSIER: I hope so.
GUPTA: And for lots of other people like you. I appreciate you both coming in. I hope a lot of people are listening to this.
Thank you both very much.
MOSIER: Thank you.
GUPTA: And still ahead, taking a turn here, rapper Fat Joe comes clean about the changes he's made to try to save and his own life.
(BEGIN VIDEO CLIP)
FAT JOE, RAPPER: I guess what happened with me is, like, they say a crackhead or drug addict just hits rock bottom. You know, I just hit rock bottom to where I knew that if I didn't make this a lifestyle change, I'm going to die.
(END VIDEO CLIP)
(VIDEO CLIP PLAYS)
GUPTA: Rapper Fat Joe there. You know, he's huge in the rap world. But he's not quite as big in person anymore. After losing half a dozen friends to heart attacks last year alone, he decided it was finally time to get his own weight under control.
JOSEPH ANTONIO CARTAGENA, RAPPER "FAT JOE": You know, I was talking my trainer yesterday, and I realized that he said when was the last time you were slim? I swear to God I think when I was a month or two months old. That was it. I was Fat Joe ever since.
GUPTA (voice-over): Fat Joe, Joey Crack, Joseph Antonio Cartagena. He grew up in public housing and was taught that food equals love.
So when Joe hit the big time, he felt he deserved all the good food his lavish lifestyle could afford.
CARTAGENA: I'm rich now. I could go to Mr. Chow's and eat me all the lobster and steak I want.
GUPTA: And then in 2000, Joe's friend and fellow rap star Big Pond suffered a fatal heart attack.
CARTAGENA: I think I weighed about 450, 460 at my heaviest. And, you know, I always took pride in being fat. That's why my name was Fat Joe. And I always represented the big people. But I realized at a certain point, all my big people were dying.
GUPTA: Last year alone, six of Joe's friends died of heart attacks. Most were younger than him, but just about the same size.
CARTAGENA: I couldn't see a clearer picture of me being -- what's the difference between me and him, and me being in a casket and my daughter running around a funeral home and, you know, she doesn't have a dad no more.
GUPTA: So, Joe is eating healthier food in smaller portions, more frequently throughout the day, even when he's on the road. He's lost 100 pounds and counting.
CARTAGENA: This is breaking news, Sanjay. This is like my best, best, best friends on earth don't even know this. But, you know, I was diabetic for 16 years since I was 14, and being that I lost weight, no more diabetes. GUPTA: When he's not working nowadays, chances are, you'll find Fat Joe at the gym. But even though he's dropped the pounds, Fat Joe says he has no intention of dropping the name.
GUPTA: I got so much response to his story. One of the comments online on that new song, "Drop a Body," suggests that the leaner and meaner Fat Joe is actually rapping faster. He definitely said he's got more energy on stage. His rapping, though, might be just the same.
Now, if you're potentially trying to drop a body yourself, today could be your lucky day. We're kicking off our 2012 CNN Fit Nation Triathlon Challenge. Hopefully you've heard about this.
I've committed to racing in the 2012 Nautica Malibu Triathlon.
WILLIAM HUDSON, CNN PRODUCER: That's right, you have. Hey, buddy.
GUPTA: Are you going to join me too?
HUDSON: Yes, Michael Phelps -- I mean, Sanjay Gupta.
GUPTA: You'll see swim.
HUDSON: We'll see you soon.
GUPTA: See you later. Thanks.
He'll be joining us as well. One of my producers, William Hudson. He's going to train with me.
You can train with me. Make a two to three-minute video about why you should be picked to join next year's 6-pack. And if you're selected, we'll give you everything you need to compete in the race, including a bike, a wetsuit, six months of intense training, including three all expense paid training trips.
If you're still not convinced by all this, take a look at how much fun this year's 6-pack had on their journey.
(BEGIN VIDEO CLIP)
2011 6-PACK TEAM: We're the 2011 6-Pack. Whoo!
UNIDENTIFIED FEMALE: Ready to go?
UNIDENTIFIED FEMALE: Sixty is the new 40, we better be getting busy.
UNIDENTIFIED MALE: Definitely feels better than I did when I first started.
GUPTA: A year ago, could you have imagined yourself doing this? UNIDENTIFIED MALE: No way.
(END VIDEO CLIP)
GUPTA: If you want more information about the challenge, submit your own entry video that will change your life. Log on to CNN.com/Sanjay and you can share your story with us.
And last but not the least this morning, a sneak peek at my latest project. It's called "THE NEXT LIST." And it's up next. Stay with us.
GUPTA: "People who smell like everyone else disgust me," so says the man on profiling this weekend on "THE NEXT LIST." It's an exciting new program I'm working on where each week, we're going to spend time with innovators in all fields --forward looking thinkers like Christopher Brosius, who's a former New York City cab driver-turned- award-winning maker of perfumes.
(BEGIN VIDEO CLIP)
CHRISTOPHER BROSIUS, AWARD WINNING PERFUMER: All of the fragrances that I do here, you know, in the library, burning leaves, the tomato leaves, they mean very specific things to me. They are very -- you know, they're my memories. I mean to a degree, they are me.
But when another person smells them, they're having a very, very different experience.
(END VIDEO CLIP)
GUPTA: He wants to convey a feeling through these smells. It's remarkable stuff. You can see more with Christopher and his quest to perfect an invisible perfume. That's Sunday on "THE NEXT LIST," 2:00 p.m. Eastern, right here on CNN.
That's going to wrap things up for SGMD this morning. Thanks for being with us. You can stay connected with me throughout the week on my Lifestream, CNN.com/Sanjay. Also, join the conversation on Twitter @SanjayGuptaCNN.
Hopefully, we'll see you right back here next week.
And time now to get you a check of your top stories in the CNN "NEWSROOM."