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SANJAY GUPTA MD
Hundreds of Drugs in Short Supply; Your Brain on Drugs
Aired February 25, 2012 - 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: Americans are addicted to drugs, booze or prescription medication more than ever before in our history. It's an epidemic we can no longer ignore. I'm not going to ignore it.
If you're not the one in trouble, you could be sure that it's a parent. A brother or a sister, a friend, a coworker. You may have seen the signs and you are unsure of what to do.
Well, today, we are going to help you. This morning, an in-depth look at addiction, how to get help before it's too late.
And also, the very latest on medicine and science has to offer us. We're going to have all that in a second.
But, first, news I want to share about the shortage of critically important cancer medicines. As a doctor, you never want to deny your patients any sort of treatment. But last year alone, doctors here in the United States had to tell more than half a million cancer patients that the drugs they needed simply weren't available. We're not talking about the developing world. We are talking right here at home.
One of those medicines was Doxil. It's primarily used to treat women with ovarian cancer like Renee Mosier. I met her last November.
(BEGIN VIDEO CLIP)
RENEE MOSIER, OVARIAN CANCER PATIENT: You feel like you are in a fight with one hand tied behind your back, where you just said let's go with what we have and see what happens. And the cancer pretty rapidly recurred.
(END VIDEO CLIP)
GUPTA: Now, this week, there's a temporary fix. The FDA announced that they it will allow a replacement drug. They say it's virtually identical to Doxil and it's going to be imported from India.
Now, Renee will likely be put on this medication. But you know what? It still doesn't solve the larger problem of the shortages.
Case in point: another drug in critical short supply is methotrexate. Now, this is used for many childhood cancers. The FDA said this week it has found an additional supplier and various companies have agreed to increase production. But joining me now is a family who said that this may not solve their problems. Twelve-year-old, Owen McMasters, you see him there. He's been taking methotrexate to help fight a form of leukemia. He joins us along with his parents, Beth and Kelly. Kelly is a surgeon who also treats cancer patients.
Thanks to all of for joining us.
Owen, let me just start with you. How are you feeling? How are you doing?
OWEN MCMASTERS, ACUTE LYMPHOBLASIC LEUKEMIA PATIENT: I'm doing fine.
GUPTA: You are feeling OK? You were diagnosed with leukemia, my understanding is, in November 2011. And your parents told me that the nurses at the hospital asked you to start thinking about your one wish for the Make a Wish foundation.
What did you wish for?
O. MCMASTERS: I -- for my Make a Wish, I decided to make my wish that all the children with ALL could get the methotrexate that they need.
GUPTA: That's powerful. ALL is the form of leukemia that you have as well, right"
O. MCMASTERS: Yes.
GUPTA: And obviously, you are making this wish because not enough kids have the medication, have access to it.
Kelly, I mean, you are a doctor, a cancer doctor. I mean, Owen just started an intense three and a half year chemo therapy regime. His next methotrexate treatment is this Friday, my understanding is.
Is it going to happen for him?
KELLY MCMASTERS, OWEN'S FATHER: As far as we understand right now, there will be methotrexate for him this Friday. And it looks as if actions recently taken by the FDA, along with the pharmaceutical companies, will temporarily relieve the shortage and allow him to start his high dose treatment on March 9th.
GUPTA: I want to pick up on that. I mean, so after this Friday, after, you know, the next few weeks, what about the guarantee of methotrexate for Owen, what about other kids that Owen is wishing for? Kelly?
K. MCMASTERS: Well, there's a band aid that's been put on this problem. Victory has been declared. But this problem is far from over. There are over 250 drugs in critical short supply. Many of them cancer drugs for which there are no alternatives. Methotrexate is a drug that's really effective for kids with leukemia and there's no substitute.
This shortage could come up again and again and again. Six months ago, it was Ara-C, a different drug that's essential for leukemia patients. So, we need to fix this problem.
GUPTA: So, what -- the problem, I mean, and we have been beating the drum on this, as you may know. But what is the alternative? I mean, I'm curious.
Let's say, you know, this Friday, it wasn't available, or the next time it's not available. Are there alternatives also being given, Kelly?
K. MCMASTERS: Well, there are no alternatives really for methotrexate, except to wait and delay the treatment until such time as the drug became available.
GUPTA: But that's not -- I mean, you're a cancer doctor. That's not the right answer, I mean, because if you delay treatment, that's a problem.
I mean, Beth, my wife, would go crazy if she heard that sort of response. And what did you think when you heard that response?
BETH MCMASTERS, OWEN'S MOTHER: Well, Owen and I were at the clinic when he was getting a full day of a different chemotherapy drug when his oncologist told me that we may or may not to be able to start his high dose methotrexate and may not even get his (INAUDIBLE) that he's getting last week and this week, and explained that there was a critical shortage and there would be none.
And I was incredulous. I could not imagine that in the United States, a doctor could be telling me that the medication that my son must have, my son who is newly in remission and must have because of recurrences of the major risk, he may not have it. And that was when the nurses were talking to him about Make a Wish.
And on the way home, Owen said that need to be his wish. That he need to make sure that the drug companies, the government, whoever it was that was in control needed to make sure that all the children would have this medication because he knows how critical it is. As a mother, I was devastated.
GUPTA: I can't even imagine. I mean, I'm a little choked up.
Kelly, or Beth, let me ask you first. Do you have any confidence right now with the recent announcement by the FDA of more supplies coming in? I mean, are you satisfied? Do you think that this is going to solve the shortage problem?
B. MCMASTERS: I would like to think that it would solve the shortage problem. I think that Owen will get this week's medication. I think that he will probably get his first high dose on March 9th. But now we know, this is a risk each and every time that he needs a dose of this, and some of the other drugs that he gets.
And so far, the reason that they have obtained this is my understand is one of the companies has been able to release some drugs that they were actually holding, making me absolutely outraged that there was some drugs and the FDA had not responded to a request for authorization by that company to make and distribute the drug.
So, I'm not absolutely sure that we are going to be in the clear for this entire three and a half years. Now, it will be on my mind every month, every time we start something new, every time he needs methotrexate.
GUPTA: I mean, every moment, I imagine.
B. MCMASTERS: Yes.
GUPTA: And, really, Kelly, I don't mean to put you on the spot, but can you explain to our viewers like how is this even happening? Why are drugs being held? Why can't there be a guarantee that Owen can get what he needs? Why is this happening?
K. MCMASTERS: Well, this is a uniquely American problem. Other countries have solved this problem. I have friends in Argentina, Ecuador and India offered to get the drug for me. In the United States, the drug is so inexpensive. The drug companies don't make a profit on these cheap generic drugs. Methotrexate has been around for 50 years. And there's absolutely no excuse that this drug should not be available here in the United States.
GUPTA: I think you're right. But you know what? We are going to help you with your wish. We're going to beat the drum on this. We're going to continue to do it. Thank you for sharing your story.
I wish you the best. I wish -- I'll be thinking about you, OK?
O. MCMASTERS: OK.
GUPTA: All right. Guys, McMasters, thanks for joining us.
B. MCMASTERS: Thank you.
K. MCMASTERS: Thank you, Dr. Gupta.
GUPTA: I want to turn to something else as well that takes a heavy toll on families. It's drug abuse. Coming up, our new understanding of how addiction changes the brain. And also, the best new treatments out there. It's a little different from what we used to think back when those PSAs were aimed for shock value.
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE: This is your brain. This is heroin. This is what happens to your brain after starting heroin.
(END VIDEO CLIP)
(BEGIN VIDEO CLIP)
NANCY REAGAN, FORMER U.S. FIRST LADY: I want you to imagine just how loud it would sound if all the children in the world shouted, "Just say no," at the same time. That's how loud I want you to say it if someone offers you drugs.
(END VIDEO CLIP)
GUPTA: Of course, that was Nancy Reagan nearly 20 years ago. I'll tell you what doctors and researchers didn't know then is that it's not just a matter of will power.
Today, we have objective evidence that 23 million Americans who are fighting addiction right now, in fact, suffer from a chronic brain disease. This is important.
You see, drugs can actually change the brain, which lead to cravings. Those cravings can feel like thirst. They can feel like hunger.
So, let's take a second and look inside the brain. Keep in mind, everyone -- addict or not addict -- first of all, have a sort of anticipatory response. They crave something. And that involves the feeling of wanting something that feels good.
But take a look what happens specifically when some of these substances come into the brain, illicit drugs, prescription drugs, whatever they may be, and also of a sudden, that doping, those white particles, those are the feel-good chemicals. They make you feel good and that brain lights up. That's the reward system. That's why people take these medications or these substances.
But take a look now at what the brain looks like in someone who is an addict versus a non-addict, non-drug user over here. See those bright areas, they stay bright. That's very important because they got the reward and that reward persisted. But in someone who is a drug abuser, look at the changes here. The reward didn't very last long. And so, you imagine what the solution here.
What happens is that person keeps taking more and more of those substances to try and make feel better. And that's sort of the genesis of addiction. That's what it looks like inside the brain.
It's a little bit simplistic certainly in terms of how you look at addiction overall. But that's what occurs in the brain. And it also explains why it's not easy for an addict to just say no.
GUPTA: Something else I want to point out as well. That is young people are more resistant to many kinds of injury and illness, but not necessarily addiction. In fact, a substance abuser under the age of 25 is vulnerable in part because the areas of the brain that we just showed you that helps fight those urges, it isn't fully developed yet.
Scott Strode, for example, he started drinking when he was just 10 years old. By 15, he was using cocaine. Then it got worse after college. In fact, it got so bad, and one night, after a bender, he woke up on the bathroom floor and eventually made the choice to fight back.
And Scott joins us now from Denver. Scott, thank you, first of all, for sharing your story.
You know, I'm a dad now. So, I think I approach these stories maybe from a slightly different perspective. You are clean now. You are running a non-profit in Colorado. You are helping other addicts. I want to talk about that in a second.
But, first, help parents out there understand, parents like me, how kids like you when you were just 10 years even got access and started using these drugs.
SCOTT STRODE, RECOVERING ALCOHOLIC & COCAINE ADDICT: Yes, I did start my use very young, Sanjay. And I was first introduced to alcohol just from seeing it in my own family. There was alcoholism in my family. So, I think witnessing it at a very young age kind of drew me towards alcohol probably earlier than some other kids.
And then once I was already out drinking at a very young age, I just started to get into a circle of people that led me to, you know, to marijuana and eventually cocaine.
GUPTA: I have been talking a fair amount this weekend on how addiction is, it's truly a brain disease. I'm preaching to the choir. I mean, you work in this area now. And like you are describing, you wanted to quit at times. You tried times in the past. You had relapses.
What was -- how -- what was the stage for you when you realized maybe it was starting to turn around, it was getting better for you?
STRODE: I think it took me about a year or so to actually get clean. For a year, I was consciously trying to quit drinking. I did what a lot of what they call sort of bargaining that recovering addicts do. It's like, OK, no more liquor. I'm only going to drink beer from now on.
And what I realized, when I added alcohol to the equation, I ended up using harder drugs. And it wasn't like I started the night out smoking cocaine. It was -- once I was intoxicated, I couldn't control that bad decision making and I ended up using.
GUPTA: I want to pick up with that pivotal moments, Scott, because, you know, we are trying in this show to really help people. I've been shocked by some of the numbers. And I'm glad you're talking to us.
We are going to take a quick break. But I want you to stick with us.
When we come back, Scott is going to explain how he got through this. How something as simple as exercise helped him with his addictions.
Also, addiction recovery expert, Dr. Petros Levounis, he's been on the show before. He's going to join in the conversation and also share some of the latest treatments of what's happening in medicine right now try to help people like Scott, the past Scott, and a lot of other people with addiction.
Stay with us.
GUPTA: And we're back with SGMD.
We are continuing the conversation with Scott Strode.
As you heard before the break, Scott started drinking at age 10. He was addicted to cocaine at 15. But he's fought like hell really against addiction. And he not only won, but he's also helping other addicts to stay clean.
Also joining to talk about solutions, we're having him back on the show, one of the country's top addiction and recovery experts, Dr. Petros Levounis.
First of all, Dr. Levounis, I don't know how much you could hear of Scott's story, you know, before the break. But, you know, for an addict, resisting the urge to use drugs is significant. I mean, it's like you or I needing food or water. It's hard, but manageable.
Let's talk about some of the newest treatments out there in the forms of medications that can help people quit.
DR. PETROS LEVOUNIS, DIRECTOR, THE ADDICTION INSTITUTE OF NEW YORK: Medications have done quite well in two areas of addiction, have done well for nicotine addiction and done well for opiate addiction.
We've have things like the nicotine replacement therapies and bupropion and varenicline. We do have methadone. We have buprenorphine, the newest medication in our fight against prescription pills and heroine.
And these medications have done quite well.
On the other hand, we haven't done quite as well for cocaine. We've tried several different medications. Nothing has come out to be truly successful.
GUPTA: What about alcohol?
LEVOUNIS: Alcohol is somewhere in between. We do have some medications for alcohol. They're safe, they're effective. They do have, of course, few side effects, but they're not quite as strong as we would have hoped originally.
I do prescribe them quite often for the treatment of alcohol dependence, but they have to be in combination with psychotherapy, in combination with some kind of psycho social intervention, meaning that they should go to Alcoholics Anonymous or doing something more than just taking the medications.
Medications are simply not strong enough to carry the entire burden of illness on their shoulders.
GUPTA: When people talk about disassociating their environment from their behavior. If you say in the same environment, the behavior is just going to continue. How big a deal was that for you, Scott?
STRODE: It was probably the biggest part of my recovery finally sticking. I mean, as I said, I tried to drink less and go to the bar less often, but if I kept myself surrounded with this group of people who were still actively using, then it made it very difficult to get sober.
Finally, I had to kind of cut ties with all of those friends. Overnight, I felt very alone and isolated. But it really was the only way I thought I could maintain my sobriety.
GUPTA: We're in three different cities right now. But, Dr. Levounis, as you listen to Scott and you hear his story, is his a common story? I mean, you heard about how down deep he was and how he got out of it, as well.
LEVOUNIS: I think it is a common story and I think Scott did the right thing by cutting off his friends and by going to the gym, by finding his own way of combating the addiction.
But for the majority of people, getting the help of a 12-step program, getting the help of psychotherapy, of a counselor, of a doctor is often what is needed.
GUPTA: Well, with I think there's messages in here for so many people and just, you know, from an addiction standpoint, from a behavioral standpoint.
Scott Strode, thanks so much for sharing your story.
Dr. Levounis, you're the guy that we've been turning to. I really appreciate your insights. Thank you.
LEVOUNIS: Thank you.
GUPTA: And coming up, what happens when Medicare pays for meditation class? Do you ever think about this? Or they pay for yoga? We'll tell you. That's next.
GUPTA: Health issues don't come any bigger than heart disease. It's the number one killer, by far, in this country and in the developed world. You know this if you watch the show.
And you know something else as well. I have a family history of heart disease and I realize that the old ways of fighting it are just not enough.
So we decided to look at new tests and new diets. And you know what? Doctors all over the country are doing the same thing. So, we want to show you something this morning that we found in West Virginia, an experiment that seems to be working.
(BEGIN VIDEOTAPE) GUPTA (voice-over): The grave stones on this hill live like a tragic roll call. One family's losing battle with heart disease. Bob Korona, 1992, heart attack. Frank Stossel, another family member, heart disease. Another Korona, heart disease.
Here are Kathy and Frank Korona.
KATHY KORONA, SUFFERED HEART ATTACKS: By that large tree, my father and his father are buried. My father died at age 67. He had aortic stenosis that was so calcified at the autopsy. They couldn't even get a surgical probe through.
GUPTA: Frank and Cathy Korona have both suffered their own heart attacks as well. Cathy has two stents holding her arteries open. Frank has three.
West Virginia's rate of heart disease is right up there with the worst in the country. So maybe there wasn't much to lose when the hospitals treating the Koronas offered a new approach based on a program offered by physician Dean Ornish.
DR. DEAN ORNISH, PREVENTIVE MEDICINE RESEARCH INSTITUTE: You know, heart and blood vessel diseases kill more Americans, and in fact, in most parts of the world than virtually everything else combined.
What most people don't realize is that it doesn't have to be that way. We don't need to wait for a new breakthrough, a new laser, or something really high tech and expensive. We simply need to put into practice what we already know.
GUPTA: It teaches a brand of prevention that might seem a foreign here -- a plant-based diet without meat.
Stress management through yoga, meditation and regular exercise.
And that's not all.
Ornish says, to reverse heart disease, you have to break down emotional barriers that cause isolation and loneliness. Study after study has shown that stronger social ties mean healthier lives. So, when small groups, these heart patients open up with each and share their feelings.
UNIDENTIFIED FEMALE: It was really just energizing this morning for me.
GUPTA: Insurance pays for all of this.
FRANK KORONA, SUFFERED HEART ATTACKS: I've been taken off of four medications. That's good deal for everybody.
What about this heart rate here?
GUPTA: Even Medicare pays for 12 weeks of the Ornish program now, along with regular rehab for heart attack patients. That's right. Medicare is paying not just for tests and pills but for the same yoga and discussion groups that the Koronas say changed their lives and also gave them precious years with their new grandchild.
Here in these Appalachian hills, the grave stones of the future might tell a different story about heart disease in America.
GUPTA: It's worth pointing out not everyone agrees with this approach, but the thing is, for Frank and Kathy, it works.
Now, before we go, I bet you didn't know this about skinny jeans. If you love them, let me give you some reason to hate them. Now, if you know me, you know I'm not the fashion police. But jeans that are too tight can actually do a few things. They can compress nerves for example, even interfere with your digestion. Some doctors blame too tight jeans for back pain. Maybe next time, reach for your cookie pants.
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE: I'm going to go to change. I brought my cookie pants.
Notice the loose waste to accommodate the expanding stomach.
(END VIDEO CLIP)
GUPTA: "Scrubs" -- I love that show.
Unfortunately, that's going to wrap things up for SGMD this morning. You can follow me at CNN.com/Sanjay or Twitter @SanjayGuptaCNN. Get a sneak peek there at next week's show, as well. We're going to take a fascinating look at infertility and also new age baby making. If I got your attention, it got mine.
Make an appointment. Come back and see us next Saturday and Sunday, 7:30 a.m. Eastern.
Time now to get you a check of your top stories in the CNN NEWSROOM.