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SANJAY GUPTA MD
Task Force: PSA Screening Does More Harm than Good; Toxic Atmosphere in Aging Schools
Aired May 26, 2012 - 16:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, HOST: A lot of people are asking questions and today I'm going to try to answer some of the bigger ones. What you need to know about the flesh-eating bacteria.
Also, why one in two schools have air quality so bad it can make children sick. What to do about it?
And what is the filthiest spot with the most germs in your work place. We're going to get to those.
But, first, let's take a look under the microscope.
You know, we're looking at this controversial new position from the U.S. Preventative Services Task Force which said men should not be screened routinely with a PSA test. Now, as you probably know by now, it's a simple blood test and it's the only screening test for prostate cancer which is the second-leading cause of cancer deaths in men.
Now, the American Cancer Society supports this new guidelines, but many groups do not.
So, I'm here today with Dr. Otis Brawley. You know, him from the American Cancer Society. Also, Dr. Scott Miller, a neurologist who says not screening can cost lives.
We're going to get to that in just a minute. But, first, I want to explain some of the reasoning behind these new recommendations. Basically, they say that more people could be harmed by unneeded treatment after a worrisome PSA result than are saved by early detection.
Now, we talk about these numbers a lot, but it's not an abstract problem. I want to bring in Dr. Jeffrey Stark. He's a pediatrician in Houston who last year became a prostate cancer patient himself.
Welcome back, Dr. Starke. Thanks for joining us.
You know, as I said, there's real stories behind a lot of these numbers.
You were concerned as many men are about prostate cancer. You had a family history. You wanted to get it checked out. So, what happened after that?
DR. JEFFREY STARKE, HAD COMPLICATIONS AFTER PROSTATE BIOPSY: Well, several years ago, I had a slight rise in my PSA from screening, and then I had a biopsy done which showed everything was OK. I had more testing done after than and had again a very slight rise in my PSA, and the urologist wanted to do another biopsy, which I done a year ago, February.
And I got extremely sick. Even though I had antibiotics, I got a septic, a severe bacterial infection, with high fever, shaking, chills. My blood pressure went dangerous low, my circulation shutdown and I was hospitalized for four days here in Houston.
GUPTA: And you're OK now, obviously. That's all resolved?
STARKE: Yes. I'm fine. Actually, I had a heart rhythm problem afterwards as well, but now everything is fine. I don't have prostate cancer.
GUPTA: I'm going to get back to you in a second in a second, Dr. Starke.
But, Dr. Miller, you hear a story like that, and, obviously, this is one case. There are lots of different cases, but what do you think as a urologist when you hear something like this? He got harmed, you know, potentially by this, by going to the biopsy, getting the infection, his heart problem, did not have prostate cancer. How big a concern is that to you?
DR. SCOTT MILLER, UROLOGIST: I'm very concerned. I sympathize with Dr. Starke's position, his perspective on it, and I'm happy that he's fully recovered and happy that he doesn't have prostate cancer, but that is a complication of the biopsy, with the test scores put forward, is that that would be a result -- these types of complications are result of the PSA blood testing which is clearly a complication of the biopsy.
GUPTA: What do you tell your patients in terms of -- at the beginning of the whole process? Somebody comes in and they say, I want to get a PSA test. How do you talk them through how that whole scenario could go for them?
MILLER: Well, the first thing I tell them is what the PSA test is for, to screen for prostate cancer. It's not to diagnose prostate cancer, we need other test to diagnose prostate cancer. The PSA blood test can vary depending on the patient's situation, depending on whether they're old, young, what their risk factors are for prostate cancer, will be one factor in terms of my recommending a biopsy subsequently.
GUPTA: Dr. Brawley, obviously, your position, you have written about this and talked about it quite a bit, and the American Cancer Society supports these new guidelines -- what do you think the role of PSA tests? I mean, it sounds like people want to abolish it nearly completely.
DR. OTIS BRAWLEY, CHIEF MEDICAL OFFICER, AMERICAN CANCER SOCIETY: We need to move screening into the patient/physician relationship, where physicians look at a particular patient and say, these are the known harms, these are the possible benefits, there are a lot of harms associated with it, but there are maybe some benefits. Do you want to get screened? And let the patient decide.
GUPTA: But, look, I'm a doctor, and I would have a hard time answering that question. I've read all these studies. How is a patient supposed to make that decision?
BRAWLEY: Well, I think the most important thing is, there's been so much, you should get a prostate screen without actually explaining to people that there are harms out there.
GUPTA: What would you say to them? I asked Dr. Miller the same question. So, let's say I'm getting a test in your office. I know you're not an urologist. But let's say I am, what would you tell me?
BRAWLEY: I do practice general internal medicine. I think there is a point in time where the patient can legitimately say, doc, I can't make a decision. Can you help me or can you make a decision for me? And I think the doc should weigh the patient's concerns, weigh the patient's risk factors, also inform the patient that we don't really have good studies to show that this saves lives.
MILLER: I disagree. I think there is evidence in several studies that it does save (ph) I'm not going to quote the statistic, but there has been a 40 percent reduction in prostate cancer deaths, since the advent of PSA.
GUPTA: I've heard you say that, look, if you have symptoms, you should get tested. What are symptoms?
BRAWLEY: Yes. Any man who has urinary problems like benign prostatic hyperplasia. I think it's very reasonable to do the test there.
GUPTA: But most people develop that.
BRAWLEY: So, it may be reasonable to do the tests.
GUPTA: I don't mean to keep interrupting you. If you say the symptoms are similar to these urinary symptoms, and most men would develop, aren't you just testing them now late?
BRAWLEY: Not necessarily. Indeed, there are some studies that suggest that is not the case, that we can still have early detection when using the test. I bring it up because again, the conversations men have, they say, look, I'm going to develop the symptoms which would lead to PSA testing. So, you're saying wait until I'm more advanced in age to get the testing and that could potentially be also letting cancer run amuck.
But let me let Dr. Miller weigh in, what are you going to do now? How does it effect your practice?
MILLER: May I respond to the symptom question? I actually disagree. I do think patients that have symptoms need to be evaluated for many reasons, including a PSA blood test, but number one, prostate cancer often is not curable once you have symptoms from the prostate cancer. BRAWLEY: Keep in mind, all of us agree, I think you'll agree with this, men who are over the age of 50 especially should know the known harms associated with PSA screening and treatment. It's really not the screen. It's the treatment associated with the screen that causes the harms, along with the potential benefits.
GUPTA: Dr. Starke, you've been listening to this conversation. Look, I mean, would you do it again? Given all that you know now and all that you've just heard?
STARKE: I teach residents and students, and it reinforced the principle that I teach them, and that is, when a person without significant risk factors is screened with any kind of test, a positive result is much more likely to be a false positive, and if that false positive leads to an invasive treatment or procedure being done, it can lead to consequences. And unfortunately in my case, those consequences occurred.
Well, I'm glad you're doing well, Dr. Starke. I hope we tried to make this a little clearer for people. It's confusing. But it's as I was saying to Dr. Brawley and Dr. Miller ahead of time, it's fun to dive into these issues every now and then -- thanks for joining us.
UNIDENTIFIED MALE: Thanks for the opportunity.
GUPTA: We'll keep talking about it, I think.
But coming up, what to do when a child's school is making him or her sick. We'll explain.
GUPTA: You know, I keep an eye out for stories about health dangers in the environment around us. Then just recently, I was dismayed to learn that schools can potentially be a danger spot. In fact, get this -- one school in three has air quality that is so bad by EPA standards that it can literally make children sick.
So, some fed up parents didn't wait for summer vacation. They said their kids are staying home until things get better.
(voice-over): In picturesque Winsted, Connecticut, a 250-year-old New England town, a typical school day at Hinsdale Elementary. But one fourth grader, Matthew Asselin wouldn't be there this morning or any morning.
MELISSA ASSELIN, MATTHEW ASSELIN'S MOTHER: Now, if you look at him, what do you think? Do you think he's going to be friendly?
GUPTA: Matthew's mother, Melissa, an elementary school teacher, is home schooling her son this year.
ASSELIN: When he was out of school he was well. And when he was in school, he became ill. Last year was by far his worst year. He missed more than 50 days of school.
GUPTA: Mold at Hinsdale, she says was making her son sick.
ASSELIN: This bag represents most of the medications that Matthew was on last year. This is Xopenex, Veramyst. He was given erythromycin. This was right before he went in the hospital for pansinusitis.
When he left school, he left all this behind, too. He needs none of it. So this is garbage.
UNIDENTIFIED FEMALE: So this is actually a zero, Alexandria (ph).
GUPTA: Alexandria O'Meara's parents pulled her from Hinsdale this fall after a persistent cough wouldn't go away. That was a tough decision because her father, Paul, was on the school board at the time.
PAUL O'MEARA, ALEXANDRIA O'MEARA FATHER: She's been on the nebulizer, steroids and another medication. Since she's been at parochial school, she hasn't been on any of it.
GUPTA: The school district spent $16,000 this fall to get rid of the mold at Hinsdale and the board is now trying to decide whether to close the school temporarily to replace the leaky roof and make other repairs.
Only about 20 to 30 percent of the population is susceptible to indoor air problems like mold or dust. But for those who are, the symptoms get increasingly severe.
In Fairfield, Connecticut, so many of the students and teachers were getting sick with respiratory problems that officials decided to tear down McKinley Elementary and start from scratch. The school was riddled with mold.
JOELLEN LAWSON, SPECIAL EDUCATION TEACHER, FAIRFIELD PUBLIC SCHOOL: I started to get sick the second year when they put me in the basement classroom.
GUPTA: McKinley's the special ed teacher Joellen Lawson taught for 23 years before she became permanently disabled with a serious lung condition called chronic obstructive pulmonary disease.
LAWSON: There are three levels, mild, moderate and severe. Because I've lost 50 percent of my lung capacity, I'm considered a moderate COPD person. Yes, I've also never had a pain-free day since then because have I chronic pain, I have muscle spasms.
GUPTA: You can see another source of pain for Joellen, if you ask her if she misses teaching.
LAWSON: I'm sorry, that's a really loaded question for someone who has been forced to leave the profession when they didn't want to. I'm sorry.
GUPTA: If you think Connecticut is somehow unique, consider this -- a 2010 survey of school nurses nationally found 40 percent knew of children and staff sickened by their school environment. And not all school districts have the money to fix the problem.
Here at Southern Middle School in Reading, Pennsylvania, concerns about air quality closed the basement gym. And mold is visible in the computer lab.
UNIDENTIFIED MALE: And we see some colonies, there's probably two or three different kinds of mold here.
GUPTA: And take a look upstairs.
UNIDENTIFIED MALE: When it rains heavily, the water actually rains into the room. What we do is we take these buckets, these trash cans and we collect the water.
UNIDENTIFIED MALE: It's raining outside and inside.
GUPTA: A teacher shot this video.
(on camera): What about mold?
DREW MILES, INTERIM-SUPERINTENDENT, READING SCHOOL DISTRICT: One of the residual effects to the water would be mold certainly.
GUPTA (voice-over): Drew Miles is acting superintendent of Reading schools. He's seen the video and he says there's no money to replace that roof.
MILES: The buildings continue to deteriorate and we only have a small amount of dollars to spread to do just some minimal things like new roofing.
LILY ESKELSEN, VICE PRESIDENT, NATIONAL EDUCATION ASSOCIATION: There are some people who would say this would never happen in my school.
GUPTA: Lily Eskelsen of the National Education Association, which is the largest teachers union, agreed to meet me in Reading, Pennsylvania.
(on camera): How big a problem would you say air quality -- indoor air quality in schools is to a student's health?
ESKELSEN: Right now, the last estimates said about a third of our schools -- about a third of our schools have some kind of problem that causes respiratory problems in children.
GUPTA: That's remarkable. A third --
ESKELSEN: It's horrific. It is horrific.
GUPTA: Would you send your kid to this school?
MILES: To this school, would I send my child to this school? For the quality of education that I believe that these teachers can provide and the principal will demand? Yes. From a facilities standpoint, if I had another option, I would exercise it.
GUPTA: You're the superintendent. People are going to be surprised because, I mean, you're the guy who they're going to say, look, I mean, make it the school that you want to send your own kid to, but you can't do that.
MILES: I can't with the financial means that I have now.
GUPTA: I will tell you, the acting superintendent you saw -- he was fired this spring after that story first aired on CNN. And just this month, the school board said they're laying off more than 10 percent of the teachers in Reading. No mention, though, of repairs to the school.
You know, if you as a parent want to look for signs of trouble in your child's school, poor air quality in particular, one red flag is mold as you saw there. You might see it specifically staining the ceiling. Also look for thick dust on the lockers and on the floor, and one that you might not think of -- cars and buses that are idling inside. Well, the exhaust fumes can get inside the school through vents and doors. If you see these types of things, sound the alarm.
Also, stay right there, after the break, we're going to take on flesh- eating bacteria. Stay with us.
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE: The swab actually measures the amount of ATP on the surface, it's adenosine triphosphate.
(END VIDEO CLIP)
GUPTA: What they're doing is looking for the spot in our office that's most contaminated with unwanted bacteria. You're going to see what they found in just a few minutes.
But first, something more serious -- something that has a horror movie-sounding name, flesh-eating bacteria. I'm going to tell you what you need to know. First of all, there's no evidence there are more cases than usual this year. But there's a lot more attention.
Also, there are different types. Some rare like the one that attacked Aimee Copeland right here in Georgia. Other flesh-eating infections are caused by common bacteria that get into a more susceptible person, and then they really do eat through fat and muscle tissue. You get extreme inflammation, you get swelling, you get pain, often fever.
But don't be paranoid, but I suggest if you have a cut and the pain seems greater than it should for the size of the cut or if the pain is growing rapidly or looks worse, don't ignore it, get it checked out. Any infection should be treated and some as we have seen now, are devastating. You know, anyone who has had an infection like that faces a long road back. You might find some inspiration here. A young man, a newly minted MBA in some ways, no different from most new graduates, he's worried about finding a job. If you think that's tough for him, consider his journey.
DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT (voice-over): In 2004, Manoj Rana's family couldn't have been more proud because he was coming to America to Purdue University to complete his degree in computer engineering. Just a month from graduation, however, his life changed forever. His neighbor two floors below intentionally set a fire with his wife and child still inside.
MANOJ RANA, SURVIVED APARTMENT FIRE: And by the time my roommate and I woke up, the whole apartment was on fire.
GUPTA: Rana and his roommate Trobat Single (ph) tried to escape but they couldn't.
RANA: My roommate collapsed in front of me and I started running down the stairs.
GUPTA: Rana only made it down a few steps before he collapsed. A fireman found him still alive but on the way to the hospital, he could hear paramedics talking about how badly he had been burned.
RANA: At that moment I was thinking about my family and what I had come here for to get a good education. And now this guy is saying that I don't have a chance to survive and I passed out, and then I woke up in University of Chicago Burn Unit after four months of induced coma.
GUPTA: Rana had burns over 95 percent of his body. So far he's had 54 operations. But he didn't give up. And he credits three people for his survival.
RANA: My father, my mother and my occupational therapist, Shannon Hendricks.
GUPTA: Rana says his father saved every hard earned penny so he could get an education.
RANA: My mother kept on telling me, have the faith and keep your eyes on the goal.
GUPTA: Then there's Shannon whom he calls his guardian angel. He said she's gone way beyond the duties as an optional therapist, making it her mission to help any way she could.
RANA: On top of my therapy, she would take me to church every Sunday. I think that was the only thing that kept me from going crazy because as a 22-year-old, I was living in a nursing home, and it was really, really depressing.
GUPTA: His biggest accomplishment so far, getting his MBA. He recently graduated with the highest honors.
RANA: I'm still happy that you know I can live an independent life and now I have gotten my MBA and hopefully you know I'll get a job soon and you know have a good life.
GUPTA: A lot of people rooting for him as well.
Well, news headlines are minutes away, but next, we're looking for the most germ-ridden spots in anybody's office. We'll show you.
(VIDEO CLIP PLAYS)
GUPTA: They're pretty pumped up there, the Lucky 7, for good reason. They just finished their practice triathlon. Something they never thought they would do. That's the last day before we left Hawaii, as you just watching there. What a week it was.
And now the "Chasing Life" tip for today.
So, so our "Chasing Life" today is avoiding a hidden hazard. The company Kimberly Clark, which makes household cleaning product by the way, just put out this report, the office kitchen and break room are filthy with bacteria. They tested 5,000 break rooms. They found the worst spots with refrigerator doors, microwave handles, and sink faucets.
So, naturally, you know, after hearing a report like this, I had to ask, what about ours?
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE: The swab actually measures the amount of ATP that's on the surface, it's adenosine triphosphate. It's bacteria, mold, yeast, animal and vegetable cells.
UNIDENTIFIED MALE: We got 296 on the refrigerator handle.
UNIDENTIFIED FEMALE: Four hundred and seventy-five for the microwave, which is what we kind of expect. And the reading on the meter will tell you how much contamination there is on the surface. Anything above 300 is considered pretty contaminated. We may want to clean it.
Goodness, my, 1,396.
UNIDENTIFIED MALE: Seventy-two.
UNIDENTIFIED FEMALE: Bathrooms are actually cleaner than common spaces like a break room because you know the bathroom is dirty and you're paying much more attention to getting it clean.
(END VIDEO CLIP) GUPTA: I'm definitely going to change some things for sure. Really opens your eyes when you hear a report like this. We talked to independent experts who said what they found there didn't surprise them. To stay healthy, as you might imagine, has more power now, the best thing you can do is wash your hands and do it a lot. If you don't have access to soap and water, use hand sanitizer. And also, try to clean up that break room.
That wraps things up for SGMD today. You can follow me at CNN.com/Sanjay or on Twitter @SanjayGuptaCNN. Time now though to get you a check of your top stories in the "CNN NEWSROOM."