By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

Last night, Attorney General Michael Mukasey collapsed while giving a speech. CNN had a camera rolling during the event, giving us an unusual look at what happened. I got a call in the middle of the night to come take a look. (Watch Video)  Even doctors, while we read about diseases and see patients after they end up in the ER, we hardly ever witness things like this. I decided to blog about it this morning, hoping we might all learn something from seeing what happened to Mukasey.

During his speech, he seemed to have word-finding difficulties. He started to say a word, paused and repeated it. He then began to slur his words, and had a slight drooping of the right side of his face. After that, he slumped forward and passed out, requiring assistance to the ground. All of these events serve as clues as to what may have caused the problem in the first place.

Word-finding difficulties are sometimes an indication there is a problem with the speech center of the brain, typically located on the left side of the brain. It could be because of inadequate blood flow to the brain or sometimes bleeding within the brain itself, as was the case in late 2006 with Sen. Tim Johnson. (Read more) The fact that the right side of his body began to droop and he slurred words was also important signs. After all, the right side of the body is controlled by the left brain. Another clue:  He seemed to pass out, probably because of overall decreased blood flow to the brain. And, finally, he reportedly is now doing well able to talk and in good spirits. Clearly, whatever caused this seems to be temporary.  It could have been a fainting spell.

In the emergency room, doctors probably checked his blood pressure to see whether he was dehydrated, drew his blood to look for a blood sugar that was too low or other abnormalities. They may have obtained a CAT scan of his brain and taken a look at his carotid arteries, the vessels that lead to his brain, to see if there is any blockage, and his heart to see if any clots were present that may have traveled from his heart to his brain.

One of the questions his doctor will most likely want to answer: Was this a TIA, a transient ischemic attack, also known as a mini-stroke? That is a temporary interruption of blood flow to the brain. The person may experience a sudden weakness or numbness of the arms, legs and/or face, difficulty with speech and loss of balance.

If you have ever experienced those things, you should definitely tell your doctor about it – even if the symptoms lasted just a few minutes. That’s because about a third of people who have a TIA go on to have a full stroke sometime in the future.

Here’s the good news: Preventing that stroke may be as simple as starting an aspirin a day or another blood thinner. That may be all that is needed for the attorney general as well. We wish him a speedy recovery.

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

When I am in the operating room, I am a very good decision maker. I make the right decision, and I make it quickly. Place a burr hole here instead of there. Extend the fusion to T1 instead of C7, or use a fenestrated clip instead of a straight one. I am good at those decisions. Ask me to pick out a tie in the morning, and I am seemingly paralyzed until my sleepy wife comes over and yanks one out and hands it to me. It is always the perfect tie and no surprise; she thinks I am a terrible decision maker. She thinks I can be wishy washy.

When it comes to decision making, I am apparently not alone. And, thanks to Sam Wang, a neuroscientist from Princeton, (read study) I may have a pretty good defense. There is no question there are still a lot of people who are undecided when it comes to picking a president, and Sam has a pretty good idea why. He, along with his colleagues think peering into the brain may offer a few clues.

Generally speaking, decision-making can be broken down into two distinctive pieces. The first part is when you gather evidence, and then second part is when you commit. That can be like a switch going off. In the brain of an undecided voter, it may be that “evidence gathering” part that is simply taking longer. It’s not that these undecided are indifferent, according to Wang, but they are more willing to take their time, essentially trading off speed for accuracy. At some point though, they typically hit a tipping point and the decision is activated.

Other undecided voters may have an even more interesting process happening. They have already made up their minds, but they haven’t committed yet. They will tell you they are undecided, even though their brain has gathered the necessary evidence and a decision has been activated. Often times, people around them already know the individual’s decision, before the individual does. When my wife picks out that tie for me, she may already know that tie is my preference, even though I haven’t decided yet. There is a third group as well. This is a group that thinks they have decided, but when it comes to actually voting, they switch their minds at the last second. They thought they were committed emotionally, but the brain had gathered evidence and pointed them in a different direction.

It gets a little confusing.

Wang thinks you can tease out the true intentions of an undecided voter by asking more open-ended questions in polls. So, instead of asking, “Whom would you vote for if the election were held today, Sen. Obama or Sen. McCain?” Instead, you ask, “Who do you think understands your problems better?” or “Are you more concerned about the economy or terrorism?” or even “Which candidate has the better temperament?”

None of these open-ended questions would help me pick out a tie, but they might help you decide on electing a president. Are you still undecided? If so, why do you think you are still uncommitted?

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

As the presidential election draws near, one issue people have been talking about a lot is health care. The candidates talked about it for a good chunk of the recent debate, and most people are pretty interested in what it all means. The problem is, hardly anyone understands it. I wanted to use this blog to share some of what we uncovered.

First of all, Senators McCain and Obama throw out wildly different numbers. McCain says the average cost of health insurance in this country is around $5,800 for the average family, while Obama cites the figure as closer to $12,000 (listen to the candidates in their own words).

Well, according to AHIP (America’s Health Insurance Plans), the results of a study about health care costs put the national average cost of a family health care plan at $5,799. That seems to be the number McCain is using. There are a couple important caveats. Your cost of health care is very dependent on where you live. For example, the cost of a family plan in Massachusetts is over $16,000. In Wisconsin, the cost is closer to $3,000 (read study results).  McCain does say that under his plan, consumers will be able to buy health care from different programs so, even if you live in Massachusetts, you would be able to buy a Wisconsin plan. The other caveat is health care costs are incredibly dependent on something known as pre-existing conditions. If you have an already diagnosed illness, it can make getting health care much more expensive, if not impossible.

According to our digging, Obama’s number of $12,000 seems to come from a Kaiser Family foundation survey (read survey). That survey looked specifically at the cost of employer-based coverage, not individual family plans. The reason the number is so much higher is because employers “pool” their employees together. People who have existing conditions are pooled with those who are healthy, and that drives up health care premiums overall.

In a way, they are both right – but they are talking about very different things. In case you are curious, as things stand now – 62 percent of people have employer based coverage, 15 percent are insured through the government, 5 percent have individual plans and 18 percent are uninsured.

Obama wants to create a plan that allows all consumers to have access to the same sort of plans he has as a U.S. senator. With so many people joining such a national plan, the Obama campaign is banking on health care costs coming down overall. He also wants to mandate that every child have health care insurance.

With McCain’s plan, there is a $5,000 tax credit for families, which would cover all but $800 of the average health care plan. And, they tell us if you currently have employer-based coverage, you could still use the credit to pay for the taxes you begin paying on your health care benefit or to offset co-pays and out-of-network costs.

Have you considered all this and if so, which plan do you like more? Why?

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

Lately, there has been a lot of talk about double standards when it comes to the health of the presidential candidates. An ad from the group Brave New Films that ran in the New York Times called for Sen. John McCain to release all his medical records to the public, not just journalists. McCain campaign officials told us this was a double standard, reminding us that Sen. Barack Obama released only a one-page summary, basically stating he was in excellent health.

But, when it comes to double standards, there is something else worth considering. We have retirement ages for many different professions in this country. CEOs at many large companies including American Airlines, Boeing and Exxon are required to step down at 65. Airline pilots, for example, must retire at 65, a limit set by Congress. Generals and admirals in the U.S. military face a mandatory retirement age of 64, even though their commander-in-chief does not. As we all know, there is no mandatory retirement age for president.

Over the last several months, we have been looking into what it takes to be “Fit to Lead.” No doubt, we have seen McCain for the last 18 months tirelessly campaigning and certainly being more active than most people half his age. I have gone to sleep watching him on television and there he is again, when I wake up. Some say that should be evidence enough his stamina to lead the country. As we have blogged about in the past, cancer is the foremost issue for him, but his own doctors have given him an unequivocal thumbs up.

Ronald Reagan was our oldest president: He was 77, at the end of his second term. At 72, McCain would be the oldest ever sworn in as a first term president. But, Golda Meir was prime minister of Israel until she was 76. French President Charles de Gaulle was 78. And, South Africa’s Nelson Mandela was 80.

So, does age matter? Should there be an age limit for our leaders?

Programming note: Don’t miss CNN Special Investigations Unit “Fit to Lead” with Dr. Sanjay Gupta
Saturday and Sunday, October 11-12 at 8 p.m. and 11 p.m. ET

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

This week, I did a series of pieces about how astronauts stay fit in space. Sure, it was fascinating to be strapped into a system of pulleys and harnesses that effectively simulate weightlessness. It was interesting to be pulled up to a vertical treadmill or eZLS - the enhanced zero gravity locomotion system. And, yes, I got to be an astronaut for a day, experiencing firsthand what it may feel like to exercise in space. (watch video)
 
I learned that exercise in space, especially for those long missions, is essential for astronauts, not something you might do occasionally. It has to be comfortable to do and it cannot interfere with the function of the spacecraft. (read more)  More than that, though, I learned how beneficial gravity is for us on Earth. Doctors call it axial load. You can think of it as a slight tension on our bodies, more importantly our ligaments, tendons and bones. Turns out, this slight pulling of gravity slows down the loss of bone mass, which in space accelerates 10 times faster than a post-menopausal woman.

The message for the rest of us is to embrace gravity. In addition to your aerobic exercise, which you should do most days of the week, add some axial load to your routine. And, this is a message for everyone, especially women in their 40s and 50s who will have to deal with menopause. Pick up some dumbbells, park yourself under a bench press or learn how to use a cable system. It’s good for your health and for your bones.

Are you doing something to make gravity benefit your body?  

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

A few weeks ago, my producer Chris Gajilan and I got on the phone to talk about a series of stories we wanted to do on space medicine. I was really excited because since I was a kid, I have always been interested in space and had dreams one day of going there. Life, though, does sometimes take you in different directions, and I opted for the brain surgery job, instead of the rocket scientist…ba dum. I’ll be here all week…

Seriously, though, when I heard NASA scientists had come up with a model of weightlessness here on Earth, I jumped at the chance to investigate. It wasn’t exactly what I expected. In order to re-create the fluid shifts that are seen with prolonged space travel, scientists decided to put a group of patients at bed rest… for 3 months. Head down about 6 degrees, feet up, and absolutely no getting out of bed. As I learned, while extremely cumbersome, it is a pretty good model.

Over time, lots of things start to happen to your body, things that can be devastating. Turns out, as human beings, we like a little gravity. It keeps just enough pressure on our joints and bones to keep them strong. Without the usual gravitational force, our bones start to wither away. And, the calcium that starts seeping out of the bones finds its way into our bloodstream and can cause painful and sometimes dangerous kidney stones. Astronauts can develop advanced bone loss. As astronauts push farther into space on longer missions, the concern is that they will face debilitating osteoporosis so severe they can spontaneously break bones.

So, NASA scientists now had two challenges. One was to create the model. Two: figure out a way to prevent some of these serious health problems when astronauts are in space for prolonged periods. Tomorrow, I will tell you what the smartest minds in the world came up with; but today, I wanted to see what you thought. What do you think are some of the biggest health problems for astronauts in space and what do you think could be done about them?

If you want to cheat… take a look at this preview (watch video).

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

Look, it’s not easy. As people get older, they tend to get more sedentary. It could be that exercise becomes less a priority or that aching joints become a hindrance. Heart disease and strokes can weaken the body. So, it’s no surprise then one of the fastest growing business sectors is focused on ways to help seniors stave off physical decline. That is why a You Tube video about “Cane Fu Fighting” caught our eye.

Take a look at this! (watch video)

Instead of becoming more sedentary after being told they need a cane, these seniors are getting more fit. Instead of being resigned to a life of becoming increasingly immobile, these seniors are pledging to be more active than ever before. Yes, it is violent. For sure. But, it is both a good form of exercise and a form of self defense. Over the next few years, you can expect to see these courses offered in retirement communities, nursing homes and even on cruise ships.

But, it got me thinking. This is not really about “Cane Fu Fighting”; this is about how our bodies change as they age. Getting most seniors to go to the gym every day may be more of an exercise in futility. So, what else out there works? How do you plan to stay active and healthy as you get older? What do your parents or grandparents do?

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

A few years ago, a woman called me in the middle of the night to tell me her son-in-law had been taken to jail. This was a woman I knew pretty well, and I was stunned to hear the story she proceeded to tell me. Her grandchild (his daughter) had been found unconscious at the house and taken to the hospital. Doctors there quickly figured out the child had been shaken. Just a few months old, her little neck muscles had not been strong enough to stabilize her head, which in young children is relatively bigger with respect to their bodies. She developed a blood collection on her brain and shearing of small blood vessels deep inside. Ultimately, she never recovered; she died in her mother’s arms. The little girl’s dad had been the only one in the home and subsequently admitted to handling the child in a rough manner when she was persistently crying.

In a moment of anger, he had killed his child and essentially sentenced himself to imprisonment. As a dad, I can’t imagine the incredible grief he is still suffering today, so many years later. As a neurosurgeon, I have seen this story play out more times than I care to remember.

It is of little value to say that he didn’t mean it. He is a good man who made a terrible mistake. It did make me wonder, though, just how much are young parents equipped to be able to deal with babies and very young children. Most parents are shocked when I tell them the consequences of shaking a baby or handling the child in a rough manner. Add in a little immaturity, lack of necessary patience, and you literally have a prescription for disaster.

As you can read today (link to story), there are some relatively simple ways to prevent a fatal mistake. But, should we be doing more?

There are no instruction manuals when it comes to children, as there are with most other things in life.

Should there be a sort of “manual” and what sort of things should be in it? What would you put in a manual that goes home with new parents?

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Dr. Sanjay Gupta

Chief Medical Correspondent

When an athlete is tested for banned substances, most of us have a certain expectation the result will come back positive or negative. And, based on that result, an athlete will either be innocent or guilty. But, it’s not even close to being that easy, according to a new article in Nature, written by biostatistician Dr. Donald Berry (Read study). Dr. Berry calls the science so “weak,” it is often impossible to tell whether an athlete, who has tested positive for a banned substance, really doped or not. Even as a student of statistics, this was pretty amazing to me, so I decided to look further.  (Watch video)

Dr. Berry uses the example of Floyd Landis to make his point. Berry concurs Landis had an unusual test result, but argues that result is pretty meaningless. Here’s why:  because Landis provided 8 pairs of urine samples, and assuming an approximately 95 percent specificity, the probability of all 8 samples being labeled “negative” is the eighth power of .95 or just .66 (66 percent).

If that’s a little too much math and science for you at this hour, here is the final conclusion: Floyd Landis’ test had a 34 percent chance of being a false positive! Remember, this is a guy who was stripped of his title and banned from competition for 2 years. All of that was based on a test that had a very high false positive rate. By the way, Landis maintains his innocence and claims he has never used illicit substances. 

To be fair, testing authorities will say they err more on the side of false negative than false positive. Of course, that means there are probably some cheaters out there who will never get caught. It is by no means a perfect system, and is made ever more complicated by designer drugs made specifically with the idea of being undetectable. 

So, what to do about this system of checking for doping? Based on the science, it hardly seems accurate enough — the more you test, the more false positives and negatives you will see. Is the idea of testing for banned substances too imperfect to be meaningful?

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

I have logged hundreds of thousands of miles, looking at the burden of AIDS around the world. I have been with the Partners in Health teams in Rwanda and the Clinton Foundation in Kenya. I have seen the work being done in Haiti, to name a few. Today, I would like to draw some comparison with what is happening right here at home.

Yesterday the Black AIDS Institute reported that if African-Americans with HIV/AIDS were their own country, they would make up more HIV/AIDS cases than seven of the countries currently receiving emergency funding for… AIDS. Think about that. There are almost 600,000 African-Americans living with HIV, and there are still 30,000 newly infected cases every year. As things stand now, AIDS remains the leading cause of death among African-American women between the ages of 25 and 34, and the second-leading cause of death among African-American men between 35 and 44 years of age.

As Jesse Milan, board chair of the institute, said, “When the world wasn’t looking, the AIDS epidemic refused to go away.”  AIDS has always been a disparate African-American problem. Even at the beginning of this epidemic in the United States, when there were only a few thousand cases, more than a quarter of them were among African-Americans.

Today, 47% of the HIV cases in the United States are in African Americans, even though African Americans make up only 13% of the population. If you peer deeper into certain cities, you find of all the HIV cases in Washington DC, 80 percent are among African Americans. In Jackson, Mississippi – 84%.

Add to all of this: In New York City, African Americans living with HIV are 2 and half times more likely to die as compared to HIV infected Caucasians. So, African Americans living in the United States are more likely to have HIV and more likely to die from it. Staggering.

And, here is another thing — AIDS rates in this nation’s Latino community are increasing with little notice. Though Hispanics make up about 14 percent of the U.S. population, they represented 22 percent of new HIV and AIDS diagnoses tallied by federal officials in 2006.

No doubt, if you live in a resource rich country like Denmark or the United States, you have a better chance at living a longer life with HIV as compared to many other places around the world. But still, the stats you are reading this morning are worse in some ways than a few of the Sub Saharan countries we typically associate with the worst of the AIDS burden.

So, what to do? I think most would agree that global funding for AIDS needs to be a continued priority. Today the President will authorize 48 billion more dollars toward those efforts. But, how do you think we should better address the AIDS/HIV problems at home?

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.