Dr. Jon LaPook

"No One Wants a Crazy Person"

2013-02-01T08:47:49-05:00

Only about five percent of violence is committed by people with serious mental illness. Those with schizophrenia are about two to four times more likely to commit violence than the average person but proper treatment significantly lowers that risk. Tragically, the severe stigma attached to mental illness delays early diagnosis and treatment.

I recently interviewed Zac Pogliano, a 21-year-old man with schizophrenia. His diagnosis was delayed for one year because he was ashamed of telling anybody he was hearing voices. He told his mother, Laura, "No one wants a crazy person." Untreated, Zac had severe paranoia and delusions. Treated, his symptoms appear under control as he attends an outpatient psychiatric program and works towards independence.

I want you to meet Zac Pogliano and his loving mother and introduce them to everyone you know. They are perfect ambassadors for the fight against the stigma of mental illness. Zac, who has never been violent, told me, "People will judge you, especially after someone gets assaulted by a crazy guy. I could be that crazy guy." Yes, people with schizophrenia can have insight - and all sorts of other wonderful qualities, just like people without serious mental illness.

One way to dispel myths about people with mental illness is to shine a light on them. Here is a link to a segment about Zac and Laura Pogliano that appeared last night on the CBS Evening News with Scott Pelley.

Dr. LaPook Goes to Washington

2012-05-10T16:19:23-04:00

How long does it take for Congress to pass potentially life-saving legislation that has widespread support and no obvious opposition? We are now at fifteen months and counting.

Since 2005, the number of medications in short supply -- including cancer drugs -- has more than tripled. The reasons are complex and include manufacturing problems and reduced production due to lower profits with generic drugs. There is no simple answer. However, one solution lies with giving the FDA more power to help solve the problem. Given enough warning, the FDA has been able to prevent shortages by helping companies increase production. What the FDA wants is a law requiring companies to warn the agency when drugs are running out. That very law -- that would help fix the problem -- was introduced in Congress fifteen months ago with bipartisan support, the backing of the President, and no obvious opposition from any special interest group. But it has still not reached the floor for a vote. I went to Washington and asked six members of Congress -- three Democrats and Three republicans -- why it's taking so long. The segment aired earlier this week on the CBS Evening News with Scott Pelley.

Finally, the finish line appears close. Two weeks ago, drug shortage legislation finally cleared a Senate committee. And just this morning I got some good news from Michael Mahaffey, the Communications Director for Representative Tom Rooney, a Republican from Florida. He told me that the Energy and Commerce Committee approved a larger bill today that includes the legislation. That means language supporting the new law has now passed out of committee in each chamber of Congress. The next step is for the full House and Senate to finally vote on the issue. Senate Majority Leader Harry Reid's office told CBS earlier this week that the vote may occur in the Senate before Memorial Day.

Finally, a Spectacular Example of Progress In Haiti

2012-01-26T08:31:49-05:00

On April 8th, 2010, I watched helplessly as the only oxygen machine in a poorly equipped Haitian clinic was taken from a premature baby and given to a woman struggling in labor. The woman gave birth to a healthy girl named Rodsandy. The premature baby died; he had no name.

Now, almost two years later, a stunning, modern teaching hospital with oxygen outlets in the walls is about to open in the town of Mirebalais thanks to a joint effort between Partners In Health, the government of Haiti, and donors from all over the world. Earlier this month, Dr. Paul Farmer (co-founder of Partners In Health) and Dr. David Walton (director of the hospital) took me on a tour of the 320-bed facility. At the very end of this video, Paul pours out his heart in the most succinct, passionate vision of health care equity I have ever heard.

Is Technological Multitasking Ruining Our Communication?

2011-07-11T13:27:43-04:00

When I was a boy, my sisters and I tried stringing two paper cups together to see if we could talk to each other through the vibrating, taut string. We were only about 10 feet apart and it was hard to tell if we were hearing each other through the cups or through the air. The main point wasn't the conversation; it was the cool technology. After all, who in his or her right mind uses a communicating device when somebody is in earshot?

Do I even need to answer that? Apparently, the answer is "yes."

A little more than a year ago, I was having dinner with my dear friend, Deborah Berke, a world-renowned architect. She was fed up even before we had taken a single bite. That morning, she had caught two of her young architects furiously texting each other -- about 6 feet from each other. She and her partners decided to limit texting, e-mail, Internet use and multitasking. The rules? You can check e-mail each morning, again at lunch and once more before you leave for the day. Internet use is only for research. And no multitasking! Easier said than done.

Producer Sally Rosen and I shot "before" and "after" footage for the CBS Evening News. Initially, the employees were skeptical. How can you let e-mail sit unanswered for hours? How can you not text? But they all agreed to give it a shot.

When I returned almost a year later, every employee without exception called the experiment a success. The new rules made it easier for them to get into "the zone." Deborah explained to me that, for an architect, getting into the zone means being able to close your eyes and be inside a building, walking down the hallways, imagining every detail. "How long does it take to really get into the zone?" I asked. The reply was surprisingly uniform from the architects I interviewed: about two hours -- time they now had since they weren't consumed by digital juggling.

The youngest architects rediscovered this thing called "the telephone." It turns out, they explained, it's like 50 emails back and forth -- all at once. And you can tell by people's tone whether they're being sarcastic or serious, or what kind of day they're having. The nuance of conversation returned as they found themselves talking more on the phone to clients and more in person to each other.

The biggest surprise was that mentoring improved. Young architects could now overhear the phone conversations of their older colleagues, learn how they spoke to their clients, how they handled difficult situations. It beat reading a CC'ed e-mail, hands down.

For perspective, I interviewed Nicholas Carr, author of The Shallows: What the Internet Is Doing to Our Brains. He told me some companies have tried to limit the use of e-mail but he hadn't heard of an experiment such as the one Deborah Berke had pulled off. He explained, "I think that finally there is a bit of a backlash happening. People are beginning to realize you sacrifice something, you lose something when you are always connected, when you are always multitasking when you are always shifting your focus. I hope that a countermovement, a counterculture, gains strength and begins to influence the way people act."

As I use my computer to finish typing the last few sentences of this blog and prepare to beam it into cyberspace, I understand that technology is now deeply woven into the fabric of my life. I love it as much as the next guy -- probably more. In the 1980s, I completed a fellowship in medical computing, helped create one of the world's first electronic textbooks of medicine and wrote the software that runs my medical practice. I have more gizmos than I can wave a stick at. But bit by bit -- and byte by byte -- I'm learning that when we become enthralled with technology, we can let it dictate how we behave. Deborah Berke recognized that, recoiled, and is grabbing back control.

Harnessing technology means just that -- putting a harness on it, not letting it run wild.

WATCH the segment about Deborah Berke's experiment that aired on CBS Evening News:

Laura Ziskin: Remembering A Pioneer In Fighting Cancer

2011-06-15T09:11:48-04:00

This post originally appeared on CBSnews.com.

CBS News medical correspondent Dr. Jon LaPook remembers Laura Ziskin, producer of the "Spider-Man" film franchise and co-founder of Stand Up To Cancer, who died on Sunday evening after a seven-year battle with breast cancer. She was 61.

Laura Ziskin's fierce, brave fight with breast cancer is over but she battles on through the organization she co-founded, Stand Up To Cancer (SU2C.)

I was lucky enough to work with her -- though way too briefly. She blended a Hollywood producer's understanding of how to get things done with a patient's frustration that not enough was getting done to help create today's new model for cancer research: collaboration among researchers, drug companies and government.

The hundreds of millions of dollars Laura helped raise are awarded to researchers on a big condition: cooperate with each other. This may sound obvious but academics are used to competing for scarce NIH funding.

Stand Up To Cancer, building on a concept championed by people like Multiple Myeloma Research Foundation founder Kathy Giusti, told grant applicants they had to play in the same sandbox. Not only could they no longer eat each other's lunch, they had to prepare lunch together.

The result has been a dramatic acceleration of research. An example is the rapid development of a new type of lung cancer treatment by scientists in California and Maryland. Last September, we profiled that stunning teamwork in a segment that aired on the "CBS Evening News" the night of the 2010 Stand Up To Cancer broadcast:

During rehearsal just before that broadcast last fall, Laura was in full producer mode, attending to every detail while warming us all with her delicious personality. That is how I will remember her: in the thick of it, a class act trying to help others.

Alzheimer's Disease: Avoiding the Biggest Mistake

2011-04-04T12:06:07-04:00

An estimated 5.4 million Americans have Alzheimer's disease. For every one of them, there are three unpaid caregivers: about 15 million people providing 17 billion hours of unpaid care each year. William Thies, Ph.D. -- the Chief Medical and Scientific Officer of the Alzheimer's Assocation -- told me that way too often those caregivers fail to seek appropriate help and are unaware of free or low-cost resources.

Care-related stress can cause poor health that strikes down caregivers just as surely as Alzheimer's devastates its victims. I recently visited Mike and Carol Daly, a wonderful couple in their late sixties. Seven years ago, Carol was diagnosed with Alzheimer's disease. Mike is a former New York City cop, married to Carol for 47 years and still deeply in love with and devoted to his wife. When I first met them almost three years ago, Carol knew she was 65 years old; now she doesn't have a clue. Mike has been pretty much going it alone. He doesn't want to bother other family members or anybody else for that matter. Since I last saw him, he's gained 15 pounds, no longer exercises, and takes medications for sleep and anxiety.

Mike is old school, salt of the earth. He doesn't complain, he doesn't ask "why me?" He also doesn't clearly appreciate the toll the past several years have taken on him. A few hours after my recent visit, he emailed, "Yes, caring for Carol is not easy but it does not stress me out. Yes, I know the day will come when I will not be able to care for Carol by myself. Yes, I will eventually have to seek out help."

Eventually.

Why wait? Getting caretakers to seek help sooner rather than later is a major goal of the Alzheimer's Association. Here is a link to specific advice from that organization: http://alz.org/we_can_help_we_can_help.asp

In the meantime, Mike Daly absolutely blows me away. In this two-minute segment that ran on the CBS Evening News with Katie Couric, watch the way he gently and lovingly applies her makeup. And -- at the very end -- check out the way he looks at her, all these years later, for better or for worse.

Radioactive Plume? The Coast Is Clear

2011-03-19T11:50:32-04:00

My wife and two sons are flying from New York to Los Angeles this morning but I'm not worried about the so-called "radioactive plume" coming from the crippled Japanese nuclear reactors. In fact, I hate the term "radioactive plume" -- now appearing widely in the media -- because it conjures up an image that is much scarier than the reality of the radiation danger to the West Coast.

Yesterday, as concerned residents in California and Washington awaited further news about the plume, the Associated Press reported that a diplomat with access to radiation tracking by the U.N.'s Comprehensive Test Ban Treaty Organization said tiny amounts of radiation had reached California. But as radiation expert Dr. Donald Bucklin told me, these instruments "can measure miniscule changes in radiation" that have "absolutely no effect on human beings." In fact, according to the diplomat, initial readings were not dangerous in any way -- "about a billion times beneath levels that would be health threatening."

Despite reassurances from many different experts and agencies, fear -- much more than radioactivity -- was in the air: tweeted, emailed, and broadcast. A physician friend in L.A. emailed me that there was widespread panic among his patients and asked me to go on CBS radio -- which I did -- to try to provide a reality check. The situation in Japan is still dangerous and fluid but after consulting with experts on radiation and nuclear accidents over the past several days, here's why I'm not worried about my family flying to California:

1) Chernobyl was a much worse accident yet no significant radiation reached the U.S.

CBS nuclear safety consultant Cham Dallas, PhD told me that the radiation released at Chernobyl was 100 times more than the combined radiation from Hiroshima and Nagasaki. But only an insignificant "blip" of radiation reached Savannah, Georgia about 5400 miles away -- about the same distance as Tokyo is to Los Angeles. And no health problems in the U.S. have been detected as a result of Chernobyl, which was a level 7 incident according to The International Atomic Energy Agency; the crisis in Japan is currently level 5.

2) Experts tell me the amount of radiation released from the Japanese nuclear reactors is not nearly enough to cause a problem in the U.S.

Radiation dose is measured in something called "millisieverts." Background dose due to natural radiation exposure varies from place to place but is about 3 millisieverts a year. Nuclear plant workers are limited to 20 millisieverts a year. One hundred millisieverts in one dose can increase the risk of cancer. One hundred to 500 millisieverts can cause bone marrow damage, leading to infection and death. A chest x-ray is 0.1 millisieverts.

The Tokyo Metropolitan Government announced yesterday that radiation levels in downtown Tokyo were at 0.000047 millisieverts an hour, barely higher than the 0.000035 millisieverts an hour that is typical.

Cham Dallas told me that -- as it stands now -- any cumulative radiation exposure to people on the West Coast as a result of the Japanese accident should be clinically insignificant, amounting to less than a tenth of a chest x-ray (0.01 millisieverts).

3) Direct measurements of radiation on the West Coast reveal no significant increase so far.

Yesterday, health officials in California and Washington said radiation is not higher than usual. Last night, the Environmental Protection Agency confirmed that no radiation levels of concern have reached the United States, saying: "The doses received by people per day from natural sources of radiation -- such as rocks, bricks, the sun and other background sources -- are 100,000 times the dose rates from the particles and gas detected in California or Washington State."

On the West Coast, pharmacies are being cleaned out of potassium iodide pills by people wanting to protect themselves from thyroid cancer caused by radioactive I-131. The CDC has tweeted not to take potassium pills but either the word has not gotten out or people are not believing the word. Yesterday I received an email from a patient in Los Angeles asking me if she should stockpile potassium iodide. The answer is a definitive "absolutely not." And under no conditions should anybody take iodide pills or other forms of iodine without being told to do so by a health professional; the side effects can be very serious.

Obviously, in Japan the situation is quite different from here in the United States. The leak of radioactivity may well have health effects on those workers who have been directly exposed at the plants. Experts will need to monitor the residents in other areas of Japan for signs of radiation-associated illness. And officials in Japan will be looking for evidence of radioactivity entering the food chain. In the United States, imported food is routinely checked for radioactivity.

As for my family, I sent them off to Los Angeles with my usual reluctance. But I will not have a millisievert of fear about radioactivity.

HPV Affects Half Of U.S. Men

2011-03-01T07:02:11-05:00

A study out yesterday in The Lancet by Moffitt Cancer Center researcher Anna Giuliano, Ph.D., and her colleagues finds that 50 percent of men ages 18 to 70 in Brazil, Mexico, and the U.S. have genital infection with human papillomavirus, or HPV. HPV is the virus that causes cervical cancer in women. It also causes warts and cancer of the genitals and anus in both men and women. Over the past several years, researchers have realized that the virus can also cause cancer of the head and neck.

Aimee R. Kreimer, Ph.D., of the National Cancer Institute, estimates that about 65 percent of the approximately 8,000 cancers of the oropharynx (tonsils and base of the tongue) seen in the U.S. in 2010 were from HPV infection; 80 percent of these are in men. The rates for HPV-associated cancers like these are increasing; for sites like the mouth and larynx that are associated with tobacco and alcohol use, the rates are decreasing (though still too high since too many people still smoke and abuse alcohol).

An infection rate of 50 percent for a virus that can cause cancer sounds scary. But knowing a few more facts about HPV helps put the risk in perspective. About 90 percent of men and women infected with HPV virus get rid of it on their own within about two years. There are many different strains of HPV -- some that cause cancer and some that don't. Only about 6 percent of men have genital infection with HPV 16 -- the strain linked to more than 90 percent of cancers of the head and neck. And only about 0.6 percent of men have HPV 16 in specimens taken from their mouths; what percentage of those men go on to develop head and neck cancer is unknown.

Right now, there are many more questions than answers. How exactly does HPV get from the genitals to the mouth? Oral sex is one obvious answer but the virus may also be spread by the fingers, kissing, or some other unsuspected route. Why does the infection persist in 10 percent of people?

What's urgently needed is some way of detecting the virus early -- the oral equivalent of a Pap smear. Researchers are trying to develop such a test at centers like Johns Hopkins, where earlier this month I interviewed a 64-year-old man whose HPV-linked tongue cancer was picked up only incidentally because he happened to go to an ear, nose, and throat doctor to get ear wax removed. There's got to be a better way of picking up asymptomatic HPV infection of the head and neck - before it progresses to cancer.

Finally, today's study is sure to provoke discussion about whether an HPV vaccine like Gardasil should be routinely recommended by public health officials for males as it is for females. The vaccine covers four strains of HPV, including strain 16, the one most commonly linked to head and neck cancer. Right now, the CDC supports "permissive use" of the vaccine in males 9-26 but stops short of actually recommending its use.

WATCH:

A Game Changer In Prostate Cancer Screening

2011-02-25T15:56:29-05:00

An important new study out yesterday should lead to far fewer prostate biopsies.

First, some background. A lot more men will get prostate cancer than will die from it. On autopsy studies of men who die from OTHER causes at age 70, about 40 percent have microscopic evidence of prostate cancer. But only about 3 percent of men die from prostate cancer. Right now there's a huge focus on figuring out which men with prostate cancer should be treated -- and how aggressively.

In order to try to detect prostate cancer, doctors measure a protein in the blood called prostate-specific antigen -- or PSA. It tends to go up in prostate cancer (though not always) but can also be elevated in more innocent conditions such as inflammation of the prostate (prostatitis) or enlargement of the prostate with aging (benign prostatic hypertrophy). In recent years, doctors have been performing biopsies on men whose PSA level has been rising rapidly, even if it remains in the normal range -- thinking this might identify men with aggressive cancers that should be treated. But a large study out yesterday from Memorial Sloan-Kettering Cancer Center by Andrew Vickers, Ph.D. and colleagues found that rapidly rising PSA -- by itself -- is NOT a reason to do a biopsy.

HOWEVER: men with increasing PSA levels should be still be followed with repeat PSA tests and with digital examinations -- and biopsy considered if a prostate irregularity (such as a nodule) is felt on exam or if the total PSA goes over a certain level. There's debate over what that level should be. A PSA of up to 4 is considered "normal" in most labs but some doctors consider doing a biopsy at a lower level; biopsying the prostate at a lower PSA level -- say 2.5 -- might pick up more cancers but would also lead to many more unnecessary biopsies (i.e., finding no cancer or finding a cancer that would never have caused any clinical problem).

The bottom line: screening for prostate cancer is a very tricky subject filled with nuance. What's clear is that men should carefully discuss the pros and cons with their doctor. But for men who do decide to have their PSA checked, the new data suggest they shouldn't worry about changes or spikes in their PSA, as long as their PSA is still in the normal range.

Dispatch From Haiti: "Controlled Chaos" of Cholera

2010-10-24T13:11:34-04:00

On Saturday afternoon we visited St. Nicolas Hospital in St. Marc, the current center of the cholera outbreak.

It was awful.

I spoke to a middle-aged man, Robert Raphael, whose family lives between St. Marc and Gonaives. Over the past week he has lost a brother, niece, nephew, and "five or six" cousins to cholera. Five or six -- he'd lost count.

The scene was controlled chaos. People of all ages were spread out in the front courtyard, inside an urgent care building, and in open air alcoves. I'd estimate we saw several hundred people, and there were those we couldn't see inside the hospital, where we weren't allowed. About half of the patients I saw had IVs.

There was loud, incongruously happy-sounding music blaring from a large loudspeaker just outside the front gate. I asked about it and was told it's a just-written Creole song promoting hand washing and teaching that kids are especially vulnerable to cholera.

While we were there, Robert Raphael's aunt who looked in her 70s arrived holding her stomach; I knelt down to talk to her and she was clearly distraught.

I met three wonderful doctors -- three women (two from Spain, one from Italy) who were rushing about treating patients. One told me they are no longer testing for cholera but making the diagnosis clinically (based on symptoms and physical exam) because, "It's an epidemic."

They clearly need more doctors and nurses, but seemed to have enough oral rehydration solution and IV fluids for now. They obviously need specialized supplies like "cholera beds" -- cots with holes cut in them for easier defecation.

I asked an 8-year-old named Ritchie if it was hard to "faire toilette" in public (it's all out in the open), and he looked embarrassed and said, "Yes." That got to me.

Clearly this hospital is max-ed out, but nevertheless making a huge difference. Ritchie and a 10-year-old girl I spoke to no longer needed the IVs they were getting initially.

Entrance to the city of St. Mark, the current epicenter of the cholera outbreak.

About 10 people came during the two hours we were there. A few kids were carried in by their parents. One four-year-old boy was able to drink oral rehydration solution as he sat in his father's lap.

But I saw an infant who was so dehydrated he needed an IV. Like any child, he cried in anticipation of the needle stick. But the dead giveaway that he was terribly sick was the absence of any tears -- he was too dry to have any.

So many of the kids were glassy-eyed and sad-looking. A few managed weak smiles. It was all absolutely gut-wrenching.

How much pain and suffering can one country stand?

Read my first report from Haiti here.

Cholera Death Toll Rising In Haiti: Inside Port-Au-Prince's Tent Camps

2010-10-24T01:30:43-04:00

We landed in Port-Au-Prince about three hours ago to reports of the first cases of cholera in Port-Au-Prince itself. We drove straight to Parc Jean Marie St. Vincent, the largest tent camp in Port-Au-Prince.

When I visited this camp last April, I spoke to Dr. Dubique Kobel, a Haitian-born, Cuban medical school-educated physian who is the medical director of the park, which is supported by Partners in Health. Back then there were about 48,000 people. Now Dr. Kobel says there are "over fifty thousand" -- exact numbers are hard to come by in Haiti. The camp is clearly bigger to my eye, with new small wooden housing structures on the road leading in.

More than 100 people were bathing outside and doing their laundry in very close quarters. The water came from a handmade well. Kids were splashing about in gutters of water. To my eye, this scene is a set-up for disaster should cholera strike.

Sebastian Petion, who has been our amazing "fixer" -- almost a producer -- in Haiti, told me that the greatest fear is an outbreak of cholera in the slum areas, where sanitation is much worse than in the tent cities like Parc Marie St. Vincent that are supplied by NGOs.

Dr. Kobel said that yesterday a teenage girl from the camp was hospitalized with suspected cholera -- the first possible case in this tent camp -- but it is not yet confirmed.

William Lowry, the director of global development for Clean the World, has been down here since Tuesday, October 19, and has heard that there is a shortage of kits to diagnose the disease. Lack of rapid diagnosis can cause confusion because there are many other organisms such as E.coli, Shigella, and Salmonella, that can also cause severe diarrhea.

Dr. Kobel told me that people are very afraid they will get cholera. On Monday, public health officials will come armed with a loudspeaker on a truck to teach about prevention. A wooden structure is being erected to house suspected cases of cholera in an area where they will not contaminate others.

Of interest, Dr. Kobel told me he feels an outbreak like this may well have come much earlier without the work of the NGOs. They may have delayed the inevitable.

We're now on National Road 1 headed north to St. Marc, the current center of the cholera outbreak.

I fear this will become a major disaster. Haitians have no natural immunity to cholera. The incubation period of up to five days lets seemingly healthy but actually infected people travel and spread the disease. This could involve the entire country. I'm praying for a miracle.

WATCH:

Dr. Oz's Colonoscopy Finds Pre-Cancerous Polyp: What Can He Teach Us?

2010-09-03T11:28:33-04:00

Dr. Mehmet Oz just might be the last person on earth people would expect to get a colon polyp.

He's physically fit (he left me in the dust the last time we ran together), he eats a healthy diet, he doesn't smoke, and he has no family history of colorectal cancer or colon polyps.

But several weeks ago, when Mehmet had his first screening colonoscopy at age 50, I removed a small adenomatous polyp that had the potential to turn into cancer over time.

Statistically, most small polyps like his don't become cancer. But almost all colon cancers begin as benign polyps that gradually become malignant over about 10-15 years.

Since there's no way of knowing which polyps will turn bad, we take them all out. The good news is there's plenty of opportunity to prevent cancer by removing these polyps while they are still benign. But only about 63 percent of Americans between ages 50 and 75 get screened for colorectal cancer.

Patients who smoke, eat diets high in red and processed meats, drink too much alcohol, don't exercise, and are obese are at increased risk of colorectal cancer. So Mehmet's healthy lifestyle may actually have protected him from having a bigger polyp -- or even colorectal cancer by now.

But the bottom line is this: no matter what you do, you can't totally eliminate your risk of developing this disease, which is expected to strike 143,000 Americans and kill over 51,000 in 2010.

About the same number of women is affected as men. And about seventy percent of patients have no family history of colorectal cancer.

The take-away message is clear. Everybody should discuss with their doctor getting screened for colon cancer by age 50 - earlier if there's an increased risk because of factors like a family history of colon cancer, a family history of an adenomatous colon polyp before age 60, or inflammatory bowel disease.

African Americans tend to get colon cancer earlier than Caucasians and have a 50 percent greater death rate from it; so some experts recommend beginning screening at age 45 in this group.

Discuss with your doctor what test makes the most sense for you and when you should get it. Screening tests include colonoscopy, virtual colonoscopy using a CT scan, barium enema, flexible sigmoidoscopy, and various stool tests looking for invisible blood or other markers.

Ten years ago, Katie Couric's televised colonoscopy led to a 20 percent increase in screening colonoscopies across America -- a stunning rise called "The Katie Couric Effect."

Here's hoping for a "Dr. Oz Effect."

How to Survive the July 4th Barbecue

2010-07-02T13:03:35-04:00

My mother was very proud of the fact that none of her four children ever became sick from her cooking. While it's true she may have erred on the side of overcooking the turkey, being spared food poisoning is yet another in the long list of gifts from my mom.

Every year, about 76 million Americans develop illness from food, more than 325,000 are hospitalized, and about 5,000 die. The most common cause is contamination with bacteria such as Salmonella, Campylobacter, Shigella, and E. coli -- though other organisms such as viruses and protozoa can also be culprits. With the July 4th weekend about to begin, I thought it would be a good time to review some basic tips about food safety.

First, here's a short microbiology lesson to help answer a very common question: what actually causes the gastrointestinal upset caused by contaminated food? If you get sick within 12 hours of eating the contaminated food, it's probably from a bacterial-made toxin rather than directly from the bacteria themselves. That's because there are three basic ways that food contaminated with bacteria can make you sick:

1) The bugs (such as Staph aureus) make a toxin that is eaten with the food. This usually occurs when food is left at room temperature long enough for bacteria to produce the toxin. This causes relatively rapid onset (within 12 hours, though this can vary) of symptoms such as nausea, vomiting, and abdominal pain.

2) The bugs (such as E. coli, a common cause of traveler's diarrhea) make a toxin after being eaten. It takes longer (usually at least 24 hours or so) for symptoms such as diarrhea to develop because it takes time for the bacteria to multiply and produce the toxin.

3) The bugs (such as Salmonella, Shigella, and Campylobacter) cause illness by damaging or invading the lining of the intestinal tract themselves. As with #2, it takes time for the bugs to multiply and make you sick. Because there is often severe damage and inflammation (colitis) in the lining of the colon, patients can develop bloody diarrhea. This is the form of illness that people commonly refer to as "dysentery."

Antibiotics kill bacteria but don't affect the toxin. That's why if you develop a bellyache and vomiting within a few hours of eating a sandwich that didn't taste right, your doctor will probably suggest supportive measures such as hydration and rest rather than an antibiotic. But if you develop severe diarrhea and fever a few days after that same sandwich, your symptoms may be directly from the bacteria or from toxin that the bacteria are still producing and so you may benefit from antibiotics.

How can you prevent foodborne illness? The most fundamental concept is that bacteria and other organisms want to eat the food at least as much as you do. They flourish at room temperature and die when heated up enough. The key word is "enough." You MUST know how to properly cook meat, fish, and poultry (for specifics, see the below link from United States Department of Agriculture). Bacteria linger on surfaces and can jump from the cutting board where you've just sliced chicken to the salad that you then chop up on that very same surface. They can grow when they're sitting in your shopping cart (buy meat just before checking out!). They can multiply when you leave food out -- whether it's leftovers or the potato salad that starts out in the back of your hot car and then sits outside all afternoon.

Very informative and helpful fact sheets about food safety are available from the USDA. I highly recommend you check this out.

For this week's CBS Doc Dot Com, soul food chef Charles Gabriel gives me a tour of his kitchen at New York City restaurant Rack and Soul and some tips on barbecue and food safety. His mother started him cooking in his North Carolina home at the age of nine and he's been cooking ever since. He's been making barbecue for almost half a century and is the only person alive to know his secret barbecue rub formula. I did succeed in getting him to reveal a few ingredients: paprika, salt and pepper.

Watch CBS News Videos Online

Umbilical Cord Blood: Save It and Save Lives

2010-06-17T13:52:57-04:00

Imagine throwing a lifesaving treatment in the garbage. That's exactly what happens in the United States over ten thousand times a day because we do not routinely offer to collect precious umbilical cord blood at the time of birth. Thousands of Americans --
many of them children -- needlessly die annually because they cannot find either a bone marrow or umbilical cord blood match to help treat conditions like lymphoma and leukemia. Yet umbilical blood is discarded as medical waste in the vast majority of the more than four million births occurring each year.

Bone marrow and umbilical cord blood both contain stem cells that can replace diseased bone marrow. Umbilical cord blood can be collected painlessly and with no risk in a few minutes at the time of birth. I witnessed its value first-hand in a segment I did for the CBS Evening News about a 4-year-old boy, Devan Tatlow, whose parents recently launched a desperate search for a bone marrow donor to treat his leukemia. There was no adequate genetic match for Devan among the 14 million potential bone marrow donors in registries around the world. But a near-match was found among only 175,000 cord blood units that reside in public blood banks in the United States. Though finding the match doesn't guarantee a cure for Devan, his doctors say he now has a good chance at a successful transplant later this summer.

Devan's situation perfectly illustrates the current state of the art. Before cord blood use began in the 1990's, taking bone marrow from a healthy donor was the only way to replace diseased blood cells. Over the years, registries such as the one run in the U.S. by the National Marrow Donor Program have helped save thousands of lives by matching donors willing to give their bone marrow cells to patients in need. But as Devan's parents discovered, finding a bone marrow match can be very difficult because the genetic match has to be very close. Fortunately for Devan and many others, umbilical cord blood matches don't have to be quite as close as bone marrow matches. But many patients are not lucky enough to find a match in either the bone marrow or umbilical cord blood registry.

According to Dr. Joanne Kurtzberg, Director of the Blood and Marrow Transplant Program at Duke University Medical Center, the public cord blood supply is way too small. She and other experts are looking to increase U.S. stores to 400-500,000 units -- about 2-3 times the current level. "It would be fantastic if hospitals were equipped and staffed to collect cord blood for public donations if mothers wanted to donate, but right now that's not the situation in the United States."

Donating cord blood to a public cord blood bank costs a family nothing. But because of lack of funding, only 170 of the nation's 5,815 hospitals -- just three percent -- are set up to collect it. In 2005, government legislation created support for National Cord Blood Inventory (NCBI) cord blood banks.

However, Dr. Kurtzberg says the effort has been underfunded. She was in Washington last month lobbying members of Congress to appropriate authorize the appropriation of $30 million annually for the next five years to support public cord banking. From hospital bed to bank, it costs about $2,400 to collect, transport, freeze, and store each cord blood unit. Private cord blood banking is available (and costly) but is only for use within a family and therefore doesn't help the vast majority of people in need. Because of collection standards, cord blood collected for private use cannot subsequently be donated for public use. So it can't help patients like Devan.

The bottom line is that we need to increase the supply both of potential bone marrow donors and of umbilical cord blood stored in public banks. Becoming a potential bone marrow donor could not be easier. You simply swab the inside of your cheek or lip for 20-30 seconds with a small, padded stick to collect cells for genetic analysis, send the specimen off to a lab, and you're done. If a match is subsequently found, you can always change your mind and decide not to be a donor. But giving bone marrow cells involves only minimal discomfort -- whether by having a small amount of bone marrow withdrawn from your hip bone under general anesthesia or by having blood taken from veins in your arms after you take 3-4 days of injections to bring cells from your bone marrow into your blood.

Because it's not routinely offered at the time of birth, donating umbilical cord blood to a public bank requires some initiative. But if umbilical cord blood were donated in only five percent of all births, the goal of 500,000 units would be reached within two years. And since the blood can be frozen and stored for at least twenty years, we would soon have a plentiful and growing supply that would provide a match for nearly everybody.

Adults wanting to volunteer as bone marrow donors can go to their local Red Cross or blood center, or can enroll on line at the Be The Match Registry of the National Marrow Donor Program. Just go to www.marrow.org and click "Join the Registry."

Mothers who would like to donate their baby's cord blood click here: Donate Cord Blood. Dr. Kurtzberg told me "they can also talk with their obstetrician or midwife about whether their local hospital is a collection site for a public bank. Finally, if their hospital is not a collection site (the case in most instances), they can contact Duke, MD Anderson or South Texas Blood & Tissue Center and donate through a kit program public cord blood donation that is being piloted through the National Marrow Donor Program."

This week's CBS Doc Dot Com is a profile of Devan Tatlow, who now has a shot at survival because of the kindness of a stranger.

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Dancing at 93 Years Old (VIDEO)

2010-06-10T13:15:55-04:00

Twenty-five years ago, Jennifer Dunning wrote in the New York Times, "DANCE doesn't seem to take much stock of its wise elders. Among those veterans is Mary Anthony, one of the city's most highly respected modern dance teachers." I'm a big fan of wise elders. It's how I learned medicine. So when I got the chance to meet the now 93-year-old Ms. Anthony earlier this week, off I went to her beautifully-lit, peaceful but active studio in the East Village of New York City. My goal as a doctor: try to gain some insight into her longevity. Yes, genes are important and she certainly chose the right parents. Exercise and diet are important (she still dances and is a vegetarian). But -- more interesting to me -- what have been the emotional and philosophical foundations of her life?

Mary Anthony came to New York City from Kentucky at seventeen with twenty-five bucks in her pocket, a dream of becoming a dancer, and a lot of spunk. As Mary Richards harshly found out from Lou Grant, not everybody likes spunk. But Ms. Anthony somehow made her way into the company of modern dance pioneer Hanya Holm, opened her own studio, introduced modern dance to television in the 1950's, founded the Mary Anthony Dance Theatre in 1956, and went on to a luminous career that's still glowing.

Great teachers knock me out and Ms. Anthony floored me. There she was, at 93, sitting on a chair in front of the barre, gently and rhythmically striking a drum, giving instructions to her dancers as they improvised their way across the dance floor. It was wonderful to see young students treating her with such respect, locked in on her every softly-spoken word.

Of course, I asked her to dance and tell me the secrets of her vibrant longevity. She showed me a few moves (her hand movements reminded me of Bob Fosse, who she said she loved), shared some stories (the music failed to play in one of her first New York auditions so she improvised and blew everybody away), spilled some philosophy (hint: don't even think about not believing in yourself), and left me wondering how anybody could fail to take stock of a wise elder.

Watch this week's CBS Doc Dot Com and my interview with Mary Anthony below:

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