Horizon, Host: Ted Simons

April 22, 2008


Host: Ted Simons

Alzheimer's Author

  |   Video
  • Dr. Marwan Sabbagh, local physician and researcher on Alzheimer�s Disease, talks about risk factors associated with the disease and steps he recommends to prevent Alzheimer�s.
Guests:
  • Marwan Sabbagh - Neurologist and leading expert in Alzheimer�s research, author of "Alzheimer�s Answer"
Category: Medical/Health

View Transcript
Ted Simons:
What was once commonly referred to as senility or dementia is now known as Alzheimer's disease. It is a brain disorder characterized by cognitive and memory loss. But is it normal aging, or is it possible to prevent Alzheimer's disease? Are there avoidable risk factors and measures that can be taken to stop or slow the process? Dr. Marwan Sabbagh is a neurologist and leading expert in Alzheimer's research. He has authored a book called the "Alzheimer's Answer." joining me now is Dr. Sabbagh. And doctor, thank you for joining us on Horizon.

Marwan Sabbagh:
Thank you for having me.

Ted Simons:
Is there an answer for Alzheimer's disease?

Marwan Sabbagh:
A very complex topic and question. What we do know there are risks that we consider modifiable and the book says we can take it upon ourselves to reduce the risk. The is essentially what the answer would be, we do not want to wait for our unforgetfulness.

Ted Simons:
Let's start with basics. Can Alzheimer's be prevented?

Marwan Sabbagh:
That's the premise of the book. We know that you could make an argument that Alzheimer's is an inevitability. We know there's risks we can change. We might be able to delay it if not prevent it. They say you could reduce it by 75\% if you follow all recommendations. I can answer yes, time will tell.

Ted Simons:
Same question about Alzheimer's being slowed when it comes on?

Marwan Sabbagh:
Correct. Correct. The things we can't change are age and heredity. But clearly there might be other things that we can reduce.

Ted Simons:
Let's talk about the key factors. Obviously heredity has to play a very big part, age and what other factors?

Marwan Sabbagh:
Those are the two unmodifiable risk factors. But modifiable risk factors would include health factors like cholesterol, heart disease, diabetes, body weight. We know there's an association with obesity and Alzheimer's disease. Dietary changes. And other health habits as well.

Ted Simons:
Do any of those factors weigh more than the others?

Marwan Sabbagh: That's not clear. We know if you look at each of these individual opponents, they address for risk reduction. I don't think anybody, scientifically speaking if you control your diabetes more than blood pressure, you reduce the risk of Alzheimer's. I don't think we've extrapolated that far.

Ted Simons: How about a vaccine for Alzheimer's? I know there has been a lot of talk about this. Any progress at all?

Marwan Sabbagh:
Huge amount of progress. Chapter 20 of book I talk about Alzheimer's disease in the way it's not talked about. I talk about it as from a terminal disease to a chronic disease much like diabetes is. That evolution is happening now. There's over 60 drugs in development for the treatment of Alzheimer's among them are vaccines. Half a dozen companies are working on vaccine therapy now.

Ted Simons:
That's going back to the idea of slowing Alzheimer's once diagnosed?

Marwan Sabbagh:
Correct.

Ted Simons:
Do you see a time when diagnosed with Alzheimer's suffer some of the symptoms and live a long and otherwise healthy life?

Marwan Sabbagh:
Yes, that's the vision I see in the future. Harkin back to quarter of century with H.I.V. you had H.I.V. you were going to die. It was inevitability. Now you can slow it down and people live long periods of time. Same thing will happen with Alzheimer's. You will be identified early in the disease. We'll give you a cocktail what I consider to be chemo therapy type approach where you take five or six medications not just one and that will arrest your progression and live a productive life.

Ted Simons:
The concept of exercising your brain has been talked about a lot even for the folks not on the road to Alzheimer's, if you will, it's a good idea it's a muscle, use it or lose it type of things. Are there certain brain exercising that are better than others?

Marwan Sabbagh:
Once you have Alzheimer's disease, it has shown to reduce the risks of complications like behavioral changes. One of those things you want to understand like mentally stimulating is probably better for prevention than for treatment.

Ted Simons:
So, do a soduko puzzle, do a crossword puzzle, learn a new language.

Marwan Sabbagh:
Correct.

Ted Simons:
Count to 100 backwards by seven, all that stuff cannot hurt, right?

Marwan Sabbagh:
No, it cannot. My dad is 75 and learning a new language. One of things we know is engaging in stimulating activities does reduce the risk for developing Alzheimer's. We have used it to think it was strictly western society but they studied it in China and found those who played a Chinese game did better than those who didn't. We know crossword puzzles and do we know that one is better than the other, we don't know the answer. It's helpful and added to animal models. When looking at animal studies those less stimulated had more Alzheimer's in the brain.

Ted Simons:
Food and drink. How much does it factor into this?

Marwan Sabbagh:
A lot. Our dietary can influence it. We know diets high in saturated fats increase risks for Alzheimer's. There's been some studies which suggest that the Mediterranean diet, fish, whole grains, and a little bit of red wine does reduce the risk of developing Alzheimer's disease. We know that certain types of fish, not all fish are going to be good. If you have to eat one fruit, I would say it's blueberries for sure not muffins but berries.

Ted Simons:
Supplements?

Marwan Sabbagh:
Supplements are a little controversial. I spend a chapter on the supplements. Folic acid as the best evidence of protection. There's some controversy and evidence with vitamin e. If I had to bet, I would bet on folic acid for risk reduction. Two studies have been very good evidence for that. In terms of supplements you can take a whole cornucopia of memory improving. If I have to pick the supplements it would be huperzine, turmeric, resverotrol, curcumin, phosophotulseurum, and others.

Ted Simons:
I know turmeric is in the food.

Marwan Sabbagh:
India has the lowest Alzheimer's in the world. India is a genetically diverse country. It has one of the most potent free radicals scavengers, antioxidents, and anti inflammatories. It's a natural food preservative.

Ted Simons:
We keep hearing about especially red wine helping a variety of things. Does it play a factor here?

Marwan Sabbagh:
Very cautious about alcohol, two, four ounces glasses of wine, or two shots of spirits not and or less, might reduce the risk. Any alcohol consumption anything above the amount of 230 grams ethanol you increase the risk for developing Alzheimer's disease. What's not clear is it any alcohol consumption or red wine? It has the way to show to preserve the longevity of brain cells.

Ted Simons:
Are you optimistic?

Marwan Sabbagh:
I am optimistic. My goal as I tell people in life is to work myself out of a job. For right now I have job security in foreseeable future. The way we see Alzheimer's will change. Like said we will change it to chronic disease and identify people at-risk through a blood test or scan you're at-risk 10\% or 80\%. I believe prevention is a major step forward in the future.

Ted Simons:
Thank you for joining us.

Environmental Bill

  |   Video
  • We discuss an important environmental issue on Earth Day. HB2017 restricts implementation of programs to reduce greenhouse gas emissions in Arizona unless they are expressly authorized by federal law and consistent with federal law. We hear support and opposition to the measure.
Guests:
  • Sandy Bahr - Conservation Outreach Director, Sierra Club's Grand Canyon Chapter
  • Jake Flake - State Senator
Category: Sustainability

View Transcript
Ted Simons:
Good evening and welcome to "Horizon." I'm Ted Simons. Today is Earth Day, a time to focus our attention on environmental issues. A bill dealing with greenhouse gasses got preliminary approval today in the state legislature. The measure restricts implementation of regional programs to reduce greenhouse gas emissions in Arizona unless they are specifically authorized by, and consistent with, federal law. Here with two differing views on the measure sponsor of the bill, Senator Jake Flake and Sandy Bahr, Conservation Outreach Director Sierra Club's Grand Canyon Chapter. Thank you for joining us.

Jake Flake:
Thank you.

Ted Simons:
Senator, why is this bill necessary?

Jake Flake:
I think it's necessary because I think the legislature needs a public discussion on this and the legislature needs to set this public policy. This is a huge public issue, a huge issue. And something that should be debated in public and debated by the legislature which sets policy and then signed by the governor and let the governor and agencies carryout this policy after it's instituted by the legislature. That's what this bill does.

Ted Simons:
Is there enough legislative input on this initiative and the things the governor wants to do?

Sandy Bahr:
Absolutely. First of all, the best thing you can say about this bill it's premature. Obviously it does over things. It undercuts the clean car standards that's be in the works for couple of years. The governor set up a climate change advisory group. All of the large utilities, salt river project, Arizona Public Service Company and Tucson Electric Power all had seats at that table. Many recommendations came out including ones to participate and look at regional programs and recommendation to implement the clean car standard. The clean car standard passed out of that committee unanimously. None of the businesses objected to it. Now at the last minute, right before it goes to the governor's regulatory review council, the legislature is looking to pull back and undercut that measure.

Jake Flake:
However in this climate change advisory group, there were no legislators present, none invited to the table. There were no automobile manufacturers. There's 25 people to the group, and yes, some of the utilities were invited, no legislators, no auto manufacturers and out of 49--there was 49 recommendations given there, none of which the legislature is even aware of yet, hasn't come out to as yet. And yet this is a policy change where government the legislature sets policy. This is clearly a separation of powers.

Ted Simons:
I was going to ask are you not so much against the idea of cap and tray and the concept of greenhouse gases and these things as opposed to the ideological fight that says get the legislature involved.

Jake Flake:
We know it has to be done. We area concerned about global warming. The President of the United States is accepting out his guidelines. I think the governor just jumped the gun in that she came out with an executive order in February of 2007 that we would join the Western Climate Initiative, the WCI. She jumped the gun without us giving her the authority to do this.

Sandy Bahr:
With all due respect, Senator Flake, the legislature has seen many of the recommendations from the climate change advisory group. They are contained in the various bills that's come to the legislature. The Western Climate Initiative hasn't made final recommendations. Anything that requires legislative implementation has to come to the legislature. They're jumping in to try to stop something before it's even developed. And it would be very silly for Arizona not to be part of all of the other western states who are looking at how can we as a region reduce our gas emissions? It would be silly for the governor to sit on her hands during that and it's unfortunate that that's what the legislature is doing. They are joining President Bush and saying we'll just wait. You know, president bush is saying let's wait until 2025 before we think about doing anything.

Ted Simons:
Senator, what would more legislative input do? What is missing so far that the legislature would bring to the discussion?

Jake Flake:
Public hearings. Public hearings on this put on by the legislature such was done in the short order. We didn't give the time that it deserved in my committee which passed my committee in which over 29 people signed on to speak for this bill. Two people signed on to speak against the bill. One of them being Sandy Bahr.

Sand Bahr:
There are a lot of hearings and clean car rules where a lot of people showed up. It was in the evening and at a time when the general public can participate. The legislature hearings a lot of times the general public can't participate.

Jeff Flake:
With due respect, the hearings with the climate change advisory group were done by teleconference were not in person a-good share of them.

Ted Simons:
Let me ask you something again, I know the argument is to get the legislature more involved. Behind all of this, do you think that greenhouse gases, that climate change, that global warming, do you think these are issues?

Jake Flake:
No matter what I think, as an old-time rural cowboy, I could give you my thoughts on this. It doesn't matter. They're coming whether I want them to or not. I can go back to old-timers older than me and say, well, we've had years like this such and such a time. Whatever we've had, they've seen another one like it. Is that true? Is there a cycle? Whether I think this or not, it did you want matter. This is coming and we have got to get ready for it. The issue is should this be done by the legislature or it should it be done by executive order? I think it should be done by the legislature.

Ted Simons:
Conversely business concerns if Arizona joins on, signs on and goes along with California and western states initiative that businesses might be hesitant to relocate here. That businesses here might hesitate to expand.

Sandy Bahr:
I--well that's not a valid argument in this case.

Jake Flake:
Sure it is.

Sandy Bahr:
The bottom line the western states are looking at it. If we're not part of the western climate initiative process, if we're not looking at cleanup our air through this clean car initiative, yeah, businesses won't want to come here. Who wants to come to a place with unhealthy air? If we don't look at it now, it will cost us more in the future. The clean car standard is one of easiest things we can do relative to transportation. The car companies say, oh, we want the legislature to be involved. Yet in states where legislature has to take specific action, they're opposing it there as well. They have opposed every kind of clean air program you can think of. They said the catalytic converter was going to put them out of business and destroy the economy. They are opposed to safety measures. It's time for the car companies to step up and be part of the solution. In this case the clean car standards is part of the solution. We need to look at all sectors. We need to look at transportation, at electricity production. The more we do now, the less we saddle our kids with the problems.

Ted Simons:
Senator, you said the issues are coming whether you want them here or not. They are heading in this direction?

Jake Flake:
Yes.

Ted Simons:
Why not take care of it now? Why not approach it now even by way of bypassing the legislature? They will get involved in one way, shape or form, won't it?

Jake Flake:
I think we should get involved. I don't think we should go with the California standards. I think we should wait another year for the national standards which the President has already proposed. He is waiting for congress to act. Our governor didn't wait for us to act. She went ahead and gave us executive order already and put us under California guidelines. I don't want to be under California guidelines. I would rather be under a national standard with us having some say about what that standard is.

Ted Simons:
If it means getting the legislature on board and a better relationship with the legislature, does it hurt to wait a little bit on this?

Sandy Bahr:
Is it absolutely does hurt. Scientists said we should reduce by 2\% per year. We need to start now to do that. The longer we wait, the more it will cost and the harder it will be to reduce those emissions. The bottom line there's legislative authority for implementing clean car rule. It gives the department of environmental authority to reduce emissions. The U.S. Supreme Court hardly a liberal body has said that carbon dioxide is considered a pollutant. With that in place and state law, the environmental has the authority and this is a last minute attempt to undercut it.

Ted Simons:
We have to stop it right there. Thank you for both for joining us.

Jake Flake:
You're welcome.

Healthcare and the State Budget

  |   Video
  • How will balancing the state budget affect agencies such as AHCCCS and payments to hospitals and healthcare programs? John Rivers, president and CEO of the Arizona Hospital and Healthcare Association, joins us to talk about the cost of providing healthcare in a lean economy.
Guests:
  • John Rivers - President and CEO,Arizona Hospital and Healthcare Association
Category: Medical/Health

View Transcript
Ted Simons:
Many state agencies and programs are facing funding cuts in order to balance the state's budget. Some say those cuts could have a wide-ranging impact in the area of healthcare. State lawmakers have reduced payments from Access to hospitals as well as made cuts to the state's graduate medical education program. Joining me now to talk about the effects of some of those budget cuts is John Rivers, President and C.E.O. of the Arizona Hospital And Healthcare Association. Good having you here.

John Rivers:
Thank you.

Ted Simons:
The '08 budget, how much does it affect healthcare?

John Rivers:
To the tune of $4.5 million totally. About 1.5 million of that is state funding for graduate medical education as you referred to it or GME. State dollars for state Medicaid programs Access is matched with federal dollars. There's a compounding affect when you increase spending on Access. One additional dollar spent is two additional federal dollars that come into state. But budget cuts in state funding means two dollar reduction in federal fund. So total it's a $4.5 million reduction for GME.

Ted Simons:
How much does access cover in terms of hospital costs?

John Rivers:
About 88\% of total costs. Under plans underway for the 2009 budget that number could drop further. Which means in today's dollars if it cost $1,000 to take care of patient in one of the hospitals, we will be paid $888 from Access. We're being paid below cost on just about every patient.

Ted Simons:
It's worst in rural areas?

John Rivers:
It was worst until the legislature adopted a save pool which is a special pool to help our small rural hospitals. That's the money they appropriated every year for three or four years now. That has brought up rural hospital up to parity pretty much up with our urban hospitals in terms of payment.

Ted Simons:
Is SAVE saved?

John Rivers:
We don't know yet. SAVE was not touched in the 08 budget. It's on the chopping block in 2009 and several other programs in aggregate total $86 trillion.

Ted Simons:
What are the consequences of these cuts?

John Rivers:
Depends on the program. For example the GME cuts that were just approved by the state legislature, again 1.5 million in state money, 4.5 million total. Next year we'll produce--we'll have 48 fewer residency slots available in our Arizona hospitals. Remember, residency programs are where physicians go after they completed their formal medical education, after they have completed their internship program and going in areas of specialty whether it's surgery or cardiology or whatever it happens to be. With fewer GME slots, we'll have fewer doctors in Arizona. That's what it means over the years ahead. We're the state right now that ranks near the bottom of the list among all of the states for the number of doctors that we have per 100,000 population. That problem will now get worst.

Ted Simons:
How will hospitals react to this? I am a reaction is necessary. The '08 budget is in and the '09 budget is working on. Something is going to happen here. How will they react.

John Rivers:
I think the they will react is we will simply not be funding or picking up the slack for the residency positions that the state was paying for that now they're not going to be paying for. Those residency position also disappear. That means fewer doctors in the future. Now what happens, how we'll react to the 2009 budget depends on what decisions they make. If they make decision that is reduce payments further to hospitals, it means that we'll get further behind to answer your question directly. What are we going to do? Our ability to recruit doctors and nurses will be less than what it was before. It means our ability to reduce emergency room wait times will be severely impaired. It means our ability to expand our capacity to meet the needs of growing community will also be impaired. Fewer resources mean less capacity on our part to do the things that we need to do.

Ted Simons:
I know there's a talk of a hidden tax in this as well.

John Rivers:
It is a hidden tax. Somehow the costs have to be paid for by somebody. Unfortunately, our healthcare system involves robbing Peter to pay Paul. Much of the burden will be shifted over to commercial insurance companies who will increase premiums on people like yourselves who have to pay more.

Ted Simons:
Last question, critics say it's wrong but it's a done deal. Time for new plan, new idea. Any plans for new ideas in works?

John Rivers:
I don't know any other way to fund graduate education than the way it's done right now. It's a fair question that should there be a new model for funding? But the model we have is what we have got. It's fair to rethink that. I think for the time being we have to live with the decision which means fewer doctors in Arizona in the future.

Ted Simons:
Thank you for joining us.

John Rivers:
You're welcome.

Content Partner: