Dr. Sanjay Gupta: A Real Life Superhero

From Mild-Mannered Reporter to Lifesaving Neurosurgeon

TJ: What is the current situation with Ebola?
GUPTA: There are a couple of different ways to answer that question. There is the center of where this all started in West Africa. You still have an ongoing situation there with intermittent spikes in the number of cases in some of the locations in West Africa. You have some areas where you had cases that are now declaring themselves disease-free, so there has been some real progress in those areas. I think, as has happened in the past, you can essentially declare countries Ebola-free, and that some of the public health practices that have been known to work in the past have started to show some impact in this present outbreak as well. But there is still a concern for being able to account for all of the cases and being able to do effective contact tracings. So it’s ongoing and it’s quite possible that we will still see more cases travel around the world.

TJ: In Japan, people often wear surgical masks during the flu and cold season. Would masks help prevent the spread of Ebola?
GUPTA: As far as Ebola goes, wearing a mask is not really going to help with that. It’s not an airborne disease. Masks for certain types of airborne viruses can be effective, but I think sometimes, more than anything else, they can serve as a reminder not for Ebola but for many pathogens that are essentially transmitted because someone touches a surface and then touches their mouth, nose or eyes. Even though a mask doesn’t cover your eyes, it is just a reminder not to do that. So I think there may be some virtue, but I don’t think masks help with Ebola.

TJ: What’s the situation in the United States now? Do we have Ebola completely under control?
GUPTA: There’s been no evidence of secondary transmission beyond what we’ve seen in the past. There were the two nurses in Dallas. There have been other patients who were exposed in West Africa and then came here during the incubation period and have been monitored. Except for Mr. [Thomas] Duncan and subsequently the patients who came to Washington state quite ill and then passed away, all the other patients have survived. So you have a situation where you have shown that basic treatment like replacing fluids, treating bleeding disorders if there is one–those types of things really do seem to work. But I think it’s quite possible that we will have other patients with Ebola that are diagnosed in the United States. Every place in the world essentially could have cases until the situation is controlled in West Africa.

TJ: What can we do to get a grip on the situation in West Africa?
GUPTA: Well, to be fair, you’ve had Ebola outbreaks in Central and West Africa since 1976. This is the biggest by far. It’s the biggest even if you add all of the other ones together. Having said that, the same things that have worked in the past can work this time as well. You have basic contact tracing, so when someone is sick you find out the people they have been in contact with. You monitor those people and make sure if they develop a fever or anything they are cared for immediately and isolated. That is how you control an outbreak–basic public health practices. For people who are sick with Ebola, fluid loss appears to be the biggest problem that is most likely associated with death, so being able to replace fluids quickly is a very important part of the care. I was there in West Africa early on and I saw some of this. Until you have a situation where people feel the medical establishment, whatever shape or form that is, is actually helping patients, people weren’t going to seek care because every time the doctors and nurses showed up wearing those bio-contamination suits–these hazmat-type suits, all it represented to people was death. Those people show up; that means people are going to die. It wasn’t: those people show up with a magic potion that can help people, because there is no specific treatment, but now I think you’re starting to see the tide turn there as well. You're starting to see that with aggressive and early care in West Africa, patients are surviving when they otherwise would have died. You also have the possibility of free clinical trials going on with experimental medication. They are small trials in the scheme of things, but if they work and get good data back those medications may become more widely available and you may have a vaccine at some point in the next year. It may not be soon enough for this particular outbreak. There’s good news and bad news in there. The bad news is it wouldn’t be available soon enough but the good news is it means the outbreak would have ended. I also think that from a travel perspective, when you open these large, several-hundred-bed Ebola wards in Liberia, for example, it’s sending a signal that you might have come in contact with Ebola. You want to leave the country before you get sick because if you get sick here things don’t look so good. The odds are not in your favor, so you leave. But when you get these big isolation wards open and people are saying, “You don’t need to leave. We can give you the care here,” I think it gives you a better chance at really containing this. Simply putting good medical presence on the ground in West Africa sends not only a practical message of care but also a psychological one.

TJ: When you travel to these areas how do you protect yourself ? Do you find yourself in dangerous situations?
GUPTA: I was in Ebola wards. This is a virus that is not particularly contagious, but it is particularly infectious and what that means is it doesn’t spread easily from person to person, but just a small amount of the pathogen that gets on you could potentially cause an infection. It’s not airborne but there is so much virus in even a small amount of bodily fluid. That’s what makes it infectious, so you’ve got to cover your skin. You’ve got to cover any possible port of entry and you have to be very careful in how you take off your gear because once you’ve been through an isolation ward you’ve got to assume that your gear is now contaminated. There’s a very particular systematic way in which you remove gear. That may sound so simplistic compared to all of the other things we are talking about with vaccine trials and new medications and monoclonal antibodies, but if you don’t take your gear off properly you can become infected. So how do I stay safe? First of all, I do a lot of homework ahead of time. I think being a doc helps in these situations because I have been practicing infectious disease protection for about 20 years and I also am very vigilant for myself and for my entire team. I’ve got an entire team that I feel in part responsible for.

TJ: I was surprised to learn you began medical school at the University of Michigan at the age of 16. Can you tell me about how that happened and how you became a CNN correspondent?
GUPTA: Yes, I graduated from high school when I was 16 and started college at that time. There are a few of these programs around the country in the United States. I was accepted into a program that will accept you into medical school out of high school. It was six years and I finished medical school when I was 22. Besides neuroscience, throughout medical school and my neuroscience training I was interested in the overall policy of health care, looking at how policies were created and the evolution of them in the United States and other countries. So I was writing a lot about that issue for various magazines. Ultimately, I worked for the White House with the Clinton administration on these types of issues and when I was there I came into contact with people who were in the world of journalism. In fact, one of the guys I spent time with was a person who was in charge of CNN. This was in the late nineties and he really wanted to build a medical unit, so he was talking to me about that. It wasn’t something that I ever really considered. I was living in a small town in Michigan after I left the White House, but ultimately, one of my mentors became the chairman of the big university in Atlanta. I moved down to Atlanta to take a faculty position at the university. I literally ran into the CNN people I had met four or five years earlier and that was sort of it. I was going to come in and comment on health policy issues for CNN. This was the summer of 2001. That was going to just sort of be a side thing that I did, but about two- and-a-half weeks after I started, the attacks of 9/11 occurred and all of a sudden I was a doctor working at an international news network during this incredibly painful but historic time. I tried reporting on all sorts of different kinds of stories and that was the beginning of my career.

“ You’ve had Ebola outbreaks in Central and West Africa since 1976. is is the biggest by far... even if you add all of the other ones together.”

TJ: I don’t think most people realize you are a practicing surgeon.
GUPTA: They jokingly still refer to that as my day job and the other stuff is my other job, but neurosurgery isn’t something you leave, really. I’ve spent most of my life in the world of neuroscience and training in neurosurgery and really enjoy it. I work for a great department and my life is about 50/50 now: 50% medicine and 50% media. I operate every Monday. Monday is our OR day and then every other Friday I pretty much operate as well. I see patients in the office on Thursdays, so it’s two days or three days a week depending on the week.

TJ: I must ask you: Did you really turn down the position of Surgeon General (laughs)?
GUPTA: I did ... (laughs). Well, it was a tough thing. I worked in public service before at the White House but it just wasn’t the right time and I didn’t realize I wouldn’t be able to practice surgery as Surgeon General, which I always found kind of ironic in retrospect. Most of the other Surgeons General either weren’t surgeons or they were already retired from the practice of surgery. If you walk away from neurosurgery for four years it would be very hard to go back to the profession, so that was certainly part of the thinking. I could definitely consider getting back into public service. I don’t know what sort of job it would be. That was just a few years ago when I had the conversations with President Obama, but I very much loved my things like that. Even in Chernobyl, I don’t have the numbers in front of me, but I believe there probably was a slight increase in thyroid cancer as compared to the population outside of that area that was not affected. Obviously, this was a terrible disaster... the worst nuclear disaster in 25 years. Tens of thousands of people were displaced. We have this radioactive material that was getting into the air but also getting into the water, the ocean, and it was getting into the soil. This was an agricultural area, so you have some radioactive particles that are going to have a much longer half-life and they are going to affect that area of Fukushima for a much longer time as well. But if the question was, “How much impact did it have in the area as compared to areas that were similar to Fukushima but not directly exposed?” It’s hard to predict. It could have a slightly higher risk of cancer and I think it surprises people sometimes to know that it’s probably not as big an impact as they would think. The greater impact is often the perception. Even today people aren’t likely to buy agriculture from Chernobyl and Fukushima may experience that same reaction. I think you should look at the numbers and figure out what is the projected increase in risk. There is a projected increase in risk for Fukushima for thyroid cancer because the thyroid is one of the areas of the body that is going to take up these radioactive particles. There will probably be an increase in cancer risk, but I think it will probably be lower than a lot of people think.

TJ: What are your thoughts on universal health care and the health care system in Japan?
GUPTA: I had written an entire book about the transplant system in Japan a few years ago. I got really interested in what is known as presumed consent, this idea of how you can increase organ donation and the idea of flipping the model of it in the United States. This is the idea of having a system where people can certainly opt out of organ donation. But if they don’t opt out or if they don’t make a specific request to opt out even at the time of a loved one’s death, then consensus can be presumed. I don’t think it’s something that could work everywhere, but I just found it interesting from a psychological perspective because I think 80% of people say they would donate their organs or a loved one’s organs at the time of death if they thought it could help somebody, but only about 20% of people do and it’s often because it’s that decision at the moment that weighs so heavily on people. If it’s reversed and the decision you make is to withhold the organs, that’s a different decision matrix rather than saying you won’t give them. I think if you look at the health care system in Japan and you say that the government will pay for most things that revolve around prevention in terms of decreasing health care costs and creating a healthier population overall, that’s a pretty effective way to do things. It’s where we are starting to head in the United States as well. You see more preventive strategies including screening, exams and all these things covered. I think it will take time, but I think it will lead to a healthier population overall. I am not familiar enough with the Japanese system. I don’t think the Japanese government covers everything in Japan, but they cover a fair amount and as a result the access to care is probably greatly improved. They talk about health care reform in Japan as well. There was an article I believe in The Wall Street Journal just last week talking about the revamping of the health care system and I’m not exactly sure what’s on the table, but for 50 years or so they’ve had universal coverage that is 70% covered in terms of costs for preventive care. My guess is it would lead to a healthier population overall and I believe people are required to have health care insurance in Japan. That’s similar to what the individual mandate is now in the United States, which as you know came under Supreme Court challenge but was subsequently upheld so the individual mandate in some ways is more reflective of what Japan has been doing for a long time.

TJ: What’s your take on medical marijuana? I believe Japan is decades away from considering it.
GUPTA: I’ve done two big documentaries on this issue and the most recent one was just a few months ago. First of all, politically I think you have 23 states now plus the District of Colombia which had medical marijuana laws on the ballot or have actually passed, so that is a huge change from five years ago. I think that when you look at the data on medical marijuana it’s pretty compelling, especially when you look at the data that is outside the United States. When I looked over a few decades of data that was some of the most recent data, the vast majority of U.S. studies were really designed to try to find out what the harm is to the lungs, what the harm is in terms of addiction, what the harm is with all sorts of different things, and a very small percentage, about 6%, were actually designed to find benefit. So overall, I think you had a very distorted picture of medical marijuana in the United States for a long time. At one point in this country, it was in the pharmacopoeia as a prescribed medication up until 1944 and then in the seventies it became a Schedule 1 substance and you had a lot of very negative portrayals of marijuana for a long time. I think it was confusing because there are a lot of prescribed substances that are FDA approved that cause a lot of harm in this country. While you don’t want to get into moral ambiguity when talking about these things, if I said to you that there are studies that show not only can marijuana but cannabis work as a medicine and that there are situations where it can work where nothing else has, then I think you begin to change your mind. If I add to that that you can create a medicine out of it that is non- psychoactive, is non-smoked, people’s image of what this is starts to change dramatically. So it’s a long answer to a short question, but it’s something I’ve given a great deal of thought to and in the past, as a writer for TIME Magazine, I had written articles that were not particularly in favor of medicinal marijuana, but I think any scientist should continue to look at the data and look in places that may not be the most obvious places. For me, it meant finding data from other countries, finding data from labs that were not financially dependent on funding from the government and getting at this issue a little more deeply. When I did that that changed my mind. I realized that I think there is some real value here. We told heartbreaking stories of children, for example, that had these refractory epilepsy diseases. They were having seizures 300 times a week! It was just so tough to hear and they went through the whole ladder of medications and did not get any benefit. Then they tried this non-psychoactive oil–edible oil that is cannabis-based–and suddenly they are better. You’d think this is apocryphal and it’s clearly anecdotal and obviously it’s one patient. How can you read into that? And then you say there are hundreds of kids like this and in fact there are well-designed studies that have been done already on these exact types of diseases, so it’s out there. The science is there if people want to dig. When I did that, I realized there could be some real utility to medical marijuana.

TJ: That should turn some heads in Tokyo. Is there any last tip you want to give us for staying healthy and disease-free?
GUPTA: I wrote this book called Chasing Life several years ago and I spent a lot of time living in Japan and Okinawa when I was writing my book. I learned a couple of things from the Japanese that I put into the book and I always talk about during my lectures here in the States. One of them was hara hachi bu, which is this notion of pushing the plate away when you are about 80% full, and I love that. I just thought it was so good because it’s kind of neuroscience-based. It takes about 15 minutes for your brain to catch up with your stomach and realize you had enough to eat. The problem is we could eat another three-course meal in 15 minutes, right? Nobody knows when they are 80% full but you’re not stuffed. You say, “Yeah, I could eat more, but I’m not going to,” and you push the plate away. Wait 15 minutes. You’re going to feel full and you’re probably going to have a much better diet. You’ll get all the benefits from not eating excess calories. The other thing was this concept of ikigai. I was interviewing centenarians, and I interviewed this 103-year-old woman. I asked her about her lifestyle and the same questions I am sure they get asked all the time, and she kept coming back to this ikigai word and it was “sense of purpose in life” and how that was so fundamentally important to being a centenarian. Once you lost your sense of purpose, even if you were healthy, you lost any reason to live anymore, and I thought that was so powerful. In the United States, you get to 65 and feel like you may be discarded from your professional life, and if you don’t have close relationships with your family you may get discarded from your personal life and feel you’re not valued as much, but I think having ikigai and continuing to value people as they get older is really important for long-term health. I learned this from your readers in Japan! tj

The complete article can be found in Issue #276 of the Tokyo Journal. Click here to order from Amazon.