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Transcripts

September 22, 2004

Host: Michael Grant
Topics:
· Proposition 101;
· Proposition 104
In-Studio Guests:
· Mike Gardner, former state lawmaker and political consultant;
· Chad Campbell, program director, Arizona Advocacy Network Foundation;
· Dr. Nabil Dib, Chief of Cardiovascular Surgery, Arizona Heart Institute and Hospital

>> Michael Grant:
Tonight on "Horizon," growing new heart muscle in patients who have suffered a heart attack. It's a promising new treatment and now the procedure makes progress. Plus, proposition 101 would require voter passed initiatives to have a revenue source other than the general fund for new spending. Prop 104 would change the time to file an initiative with the state from four to seven months before the election. That's next on "Horizon." "Horizon" is made possible by...

>> Michael Grant:
Good evening. I'm Michael Grant. Those stories in a moment. First, access to affordable healthcare and prescription drugs certainly a large campaign issue in the presidential election. The wife of democratic presidential candidate John Kerry in town to talk about that issue and attend a fund-raiser. Organizers say nearly 4,000 turned out to see Teresa Heinz-Kerry at the Sundome. She talked about the rising costs of healthcare and prescription drugs and a patient's bill of rights.

>> Teresa Heinz Kerry:
John believes that John Edwards and other patient's bill of rights is absolutely accurate, no doctor or nurse should be told by an official or -- an official -- a person on the telephone that the doctor cannot have an MRI done for something or this particular drug. It's wrong! Wrong! [ APPLAUSE ] Just because there may be doctors who abuse or just because there are people who abuse, and there are in every walk of life, there are people who skirt and abuse, but you don't penalize the good people and the smart things because of a few people who abuse, ever. [ APPLAUSE ] And so John not only allows an HMO patient to choose their doctor, to not have to leave their doctors, but the doctors should be able to practice medicine, period, on day one, every child in America will have healthcare if he's elected president. Day one. No parent hard up, sometimes often lonely, should be at bed at night worried sick because their child cannot go get seen about the asthma or about their attention deficit or about diabetes.

>> Michael Grant:
Is the Arizona initiative and referendum process a broken system? Some say yes, feel it's time to put certain restrictions on voter approved proposals. Two propositions on the ballot in November seek to do just that but opponents say the proposition will make it more difficult for citizen groups to put reform measures on the ballot. More on that in a moment. First, proposition 101, the state must currently pay for the cost of voter passed initiatives.

>>> Michael Grant:
Proposition 101 would change that. Producer Merry Lucero has details.

>> Merry Lucero:
Proposition 101 would amend the Arizona constitution to require all ballot measures that propose mandatory expenditures of state revenues, establishes a fund for any specific purpose, or allocates funding for any specific purpose have a funding source in place to cover all present and future costs of the initiative or referendum. Prop 101 also mandates that the funding source cannot be the state's general fund. In addition, if the revenue source does not cover the mandatory spending in the proposition, state lawmakers would be able to reduce the amount of funding for that purpose to the amount that is supplied by the revenue source.

>> Michael Grant:
Joining me now former state lawmaker and political consultant Mike Gardner who supports the proposition, in opposition, Chad Campbell, program director of the Arizona Advocacy Network Foundation, a coalition of social, environmental and economic advocacy groups and individuals. Gentlemen, good to see you.

>> Michael Gardner:
Thank you for having us.

>> Michael Grant:
Mike, why is this a good idea?

>> Michael Gardner:
You know, the initiative process is an excellent tool to spur public debate on the important public policies at the moment. However, it's a flawed debate if you're only looking at one side of the equation. What proposition 101 does is help bring that balance to that public policy debate. If it's talked about any new program you have in mind but let's also talk about the funding to go along with the program otherwise it's just a one-sided debate. The funding priorities of the state shouldn't be -- right now a lot of money goes to healthcare and education, public safety. If a new initiative comes along, the legislature must fund it, period. What will happen is other funding priorities of the state now become less priorities because of the single debate that happens on that one single initiative.

>> Michael Grant:
Chad, why is it a bad idea?

>> Chad Campbell:
Well, the initiative process in the State of Arizona is a constitutional right for the voters. We've had that since the inception of statehood, and we've used it very wisely, as Mike mentioned, we've used the initiative process to actually fund two of the most important programs -- or important program areas in the state, education and healthcare. Voters have used it very responsibly and if this passes, it will basically complicate the tax code, first of all, making it extremely hard for a citizen-based group to get an initiative written in manner that can be put on the ballot legally and it will create the impression even if it's not new, it's going to be a new tax no matter what. As we all know, passing a new tax in the State of Arizona is not the easiest thing and I'm not advocating we should be passing taxes in Arizona but there are certain circumstances where the citizens feel that the legislature is not addressing the needs that we feel are important to us and we've used the initiative process to fund those programs.

>> Michael Grant:
But, Chad, with a about the core argument here, which is eventually this, initiatives sometimes turn into, who has the best bumper sticker campaign? And some of these are complicate issues. I don't know, you throw in a proposition that says everybody in the state gets a free car, which in concept might sound pretty good, but you don't have that -- the other side on, well, how do we pay for this?

>> Chad Campbell:
I think we actually tried everybody gets a free car measure when the legislature passed the alternative fuels measure a few years back.

>> Michael Grant:
Touché.

>> Chad Campbell:
I think that proves the exact point we're trying to make. If you pass this measure, it takes any direct control the citizens have over the general fund and sometimes the legislature doesn't make the best choices with that. Granted, it is complicated sometimes, the ballot measures are -- it's a lot of information to sort out, but so is a candidate campaign and I think we have to put the trust in the voters as we have for time in memorial since we've become a state and let them make the decision.

>> Michael Grant:
Mike, but the counter argument is this. Listen, the people of the state get called on to make a policy decision. They say to the legislature, "we feel this is a policy, a good policy, it's a priority," legislature implement it, it's up to you to figure out how to -- we've told you we like education and we like maybe healthcare. And if you've got to whack some other areas of the budget, that's your job, we just want to give you a general policy directive that that's the way you should go.

>> Michael Gardner:
Luckily the voters in this state, they get the luxury of voting on one subject at a time. The legislature, on the other hand, must develop a comprehensive budget, and it's a zero-sum game unless prop 101 passes. It's zero-sum in that if a new program gets funded, something else has to be defunded. Now, they can make those wise decisions and thoughtful debate does happen at the legislature on a daily basis on those kind of funding priorities but without prop 101, that doesn't happen. Now all of a sudden this new initiative automatically rises to the top of the priority list. Everything else must be less priority. For example, a new proposition comes along that says we're going to spend $50 million on program XP one of the few places for the legislature to go to cut has to be the universities, our public safety. Now, are those less of a priority because the voters just passed this new initiative? I don't think so. I think the voters still agree with those but they didn't have the luxury of having that sort of debate, all they had was a single subject debate. We need a comprehensive debate and legislature needs the flexibility to negotiate what the priorities of the state is.

>> Michael Grant:
Chad, do you see any merit at all in the argument that with voter protection so much of the budget is off limits to the legislature in terms of what it can do, that the passage of these new policy initiatives does start cutting into bone, it doesn't cut into fat.

>> Chad Campbell:
Actually in all respect to Mike, I don't see any merit to that argument. We have actually looked at the budge net this state, and according to numbers we've put together, less than 5% of the budge set actually tied up by citizen initiatives and for the main part that was healthy Arizona. Granted, that was an expensive proposition. Most of the mandated spending in the state is actually federally mandated programs or legislatively imposed education formulas or healthcare formulas and also lawsuit settlements. So we don't agree with the argument that the hands are tied, legislators' hands are tied currently. There are other states where that's true but in Arizona the numbers don't back that opinion.

>> Michael Gardner:
Actually that's not true. Prop 301, for example, passed by the voters mandates a certain spending level for K-12. That issue alone is 45% of the entire state budget. That may not be reduced. It's been tested in court. The legislature tried to freeze some spending in K-12 last year. Arizona education association took it to court. They verified that the legislature can't touch that. Prop 301 by itself takes off the books 45%. Then you mix in healthy Arizona, the AHCCCS funding, that gets you up to about 65% of the entire budget is off limits. It is not allowed to be touched. Now we're talking any new program must come out of that last third.

>> Chad Campbell:
And I make a point, though prop 301, that was not a citizen initiative, that was referred to the ballot by the legislature. That is an educational formula imposed by the legislature. If you look at citizen initiatives, citizen initiatives do not cost the state that much money, less than 5% like I said. So prop 301, granted, spends a lot of funding from the general revenue but it came from the legislature, not from the people's opinion.

>> Michael Grant:
Gentlemen, stay put, proposition 104 is another state constitutional amendment. Would it create an early initiative deadline by moving back the filing date for initiatives. That measure would give county recorders more time to verify the petition signatures before the election. Opponents say it will make it more difficult to put initiatives on the ballot and give lawmakers more time to respond with legislative counterproposals. Here's a look at what's proposed.

>> Merry Lucero:
Proposition 104 would amend the Arizona constitution to change the amount of time required to file an initiative with the state from four months before the election to seven months. And an initiative petition may be circulated for signatures for up to 27 months before the general election at which the measure is to be included on the ballot.

>> Michael Grant:
All right, Mike, give me your best pitch for proposition 104.

>> Michael Gardner:
After the passage of prop 105 by the voters, the voter protection act, it basically said the legislature can't touch any initiative approved by the voters. There's no greater responsibility than the citizens creating a law that is now a permanent law, a law that cannot be changed. If we're going to be empowering the voters to that extent and I don't have a problem with that, but we better make sure that there's enough public debate prior to that law becoming permanent. Currently what happens is, for example, the proposition 200 on the ballot in November, that got cleared to be on the ballot about three weeks ago. Early balloting starts next week. That's going to create about a month's worth of public debate on that topic before the first ballots are cast. Now, I submit that's not enough to have a full discussion on whether or not that proposition is a good initiative or a bad initiative. I'm not going to make a judgment call. We're barely starting to dig into it but balloting starts next week and it just barely got cleared to be on the ballot three weeks ago.

>> Michael Grant:
Chad, vote no on 104, why.

>> Chad Campbell:
Three simple reasons, effectively this will kill the initiative process in Arizona. There's never been a ballot that's had enough signatures in April to qualify. Secondly, this will move the initiative process away from the grass roots efforts that we've seen in the past into big money special interest groups and I say that because they will be able to pay for signature gatherers. That will be the only way you can get this on the ballot if this passes. Volunteer efforts will not be able to collect enough signatures by April. And lastly, and I think also just as importantly, though, is the fact that I've heard the argument as well that this was done to help the county recorder's offices and if that is the case, we submit if that you really want to help recorders' offices verify signature and give them enough time, instead of doing this, why don't we lower the number of signatures required or improve their technology to help them verify signatures a at a faster rate.

>> Michael Grant:
What about the argument that, hold it, this is not a good idea, to have something that you're sure something is on the ballot in late August and then you start voting on it in early October, that's not a big enough debate window?

>> Chad Campbell:
I would say to that actually I think the circumstance Mike just brought is up probably fairly unique and secondly, though, just because it was not officially on the ballot or we had some doubts about it, didn't mean the campaigns hadn't started. I've been hearing arguments about proposition 200 and also proposition 106, which was the clean elections bill that got removed by the courts, those campaigns were going on for a year. They were up and going in early January. So I don't think that's a valid argument. And actually if you talk about four months not being enough time for a voter to decide, I think if you ask the voter on the street, four months is probably too much time in terms of the campaign season for a lot of them. They get bombarded with messages a lot of the time.

>> Michael Grant:
Cynics are saying the legislature wants an early look at these things to be able actively to tinker in one way or another to, for example, throw up chaff on the election radar screen. What do you say to that?

>> Michael Gardner:
I think somebody's been worried about too many conspiracies, because if you actually look at when the last several initiatives have started, that made it on the ballot, and when they've actually completed, most of those take about a 12-month cycle. Most of those start in the summer of the year before they actually ended up on the ballot. That 12-month period of time, if the legislature wanted to mess with it, I guess they had that opportunity currently. This will not change that. All this does is allow the voters more opportunity to understand, more public debate, more time for the newspapers to dig deeper into who is supporting it and why, and to have that honest debate on a law that if passed will not become a permanent law.

>> Michael Grant:
Here's the difference, though, Mike, the legislature isn't sure that it's going to be on the ballot so they're rolling the dice when they pass the law. If you move it up well into the legislative term, they no longer have to gamble about whether or not you throw a counterproposal on the ballot.

>> Michael Gardner:
If you move the date to April, most legislative sessions end in about 100 days, 120 days, by the time the signatures are counted, verified, court cases challenged, that's most likely be May or June, the legislative session will be long gone by then.

>> Michael Grant:
Mike is resisting my cynic's hypothetical here but let me throw it to you. What's wrong with that? To a certain extent a lot of the proposals you want to motivate action. If the legislature says, jeesh, I'm worried about this lets pass the thing and have enough time to do it, what's wrong with that result?

>> Chad Campbell:
I'm not going to say there is actually anything wrong with that. But to an extent that happens with the time frame we have. Usually the legislature has responded to efforts they see that they expect and are going to make the ballot. Even if the session ended, they've gone into a special session to address a need. I will throw out my own conspiracy theory. If you look at every session for the past four years there has been at least eight bills dropped aimed at significantly reducing the power of the initiative in this state, and really this is another attempt along with prop 101 to effectively kill the initiative process, and if you believe in direct voter participation in the law making process in Arizona, which is again a constitutional right, then it is a fundamental concept and a fund mental tenet of that is the ability to get your signatures on without a lot of money.

>> Michael Grant:
As you know, sometimes people are actually out to get you. How do you respond to that?

>> Michael Gardner:
Absolutely. Unfortunately we can only debate the topic at hand and not who is hiding behind tree number 1. The topic at hand, do the voters deserve more time to understand these initiatives before they vote? Absolutely. This is voter friendly. This is initiative neutral. It says you must turn in your initiatives three months earlier than normal, but also gives you three months longer on the other end. It's not out to get anybody. In fact you could even make an argument it's easier to get on the ballot if prop 104 passes because it allows I don't to collect signatures at the previous generally recollection.

>> Chad Campbell:
I want to respond to that. It gives you more time on the front end, however, that can be confusing to voters because they're collecting signatures prior to the --

>> Michael Gardner:
There's four elections a year anyway. If there's voter confusion, it will happen under the current system.

>> Michael Grant:
Mike Gardner, thank you for being here. Chad Campbell, good debate. Every 26 seconds in this country someone suffers a heart attack or coronary event. About every minute someone will die from one. There is no cure for congestive heart failure but there are treatments to prolong a person's life. One of those treatments has gained FDA approval. The announcement came today and we'll talk about that in a moment. First Merry Lucero tells us more about the procedure, a note to viewers, the story does contain some graphic video of surgery.

>> 911 Caller:
He has a real bad pain in his chest.

>> Stanley Thomure:
My father died of a heart attack, same disease in -- he was 48 years old. My whole family has a history of bad heart. And I had my first heart attack in 1973, and between '73 and '91 I had four more. I retired because of that.

>> Merry Lucero:
Stanley of lake Montezuma eventually suffered a sixth heart attack.

>> Stanley Thomure:
You can only have so many stints and so many angioplasties and then you got to go the whole route.

>> Thomure's doctor:
The lateral wall of your heart, there is dead tissue. That's where the cell will be injected.

>> Merry Lucero:
But there is hope for heart attack and congestive heart failure patients in a new procedure at the Arizona heart institute and hospital in Phoenix called myoblast cell transplantation. The experimental treatment could one day eliminate the need for heart transplants and has now been approved by the food and drug administration.

>> Doctor:
We have the muscle right there, good muscle right in view.

>> Merry Lucero:
Myoblast cell transplantation starts with a biopsy. A small section of muscle is removed from the patient's thigh. The cells are then cultured in a lab to make millions of new ones. Skeletal muscle cells are used because they can regenerate as opposed to damaged heart muscle. Dr. Ted Dietrich of the Arizona heart institute...

>> Dr. Ted Diethrich:
The myoblast procedure is where we take some cells from the, in this case, the thigh, we culture those cells over three-week period or longer, we get maybe 10, 20, 30 million cells and then we implant them directly into the heart muscle.

>> Merry Lucero:
Previously these newly grown cells were put into a hypodermic needle for injection into the heart during bypass surgery. But now the myoblast cells can be injected into the exact location of the damage in the heart using a 3-D guidance system attached to a catheter through the groin.

>> Dr. Ted Diethrich:
This is a minimally invasive procedure, just like a catheterization. So it can apply to a lot greater number of patients, and we should be able to treat patients who otherwise we could not with the open technique.

>> Michael Grant:
Joining me now is Dr. Nabil Dib, Chief of Cardiovascular Surgery at the Arizona Heart Institute and Hospital. Dr. Dib is also the principal investigator of the myoblast transplantation study. Dr. Dib, thanks for joining us. You know, we did a segment on this about a year ago. I think Dr. Dietrich was on. It is really an amazing procedure.

>> Dr. Nabil Dib.
Actually, we completed a 28-patient study so far with the open chest in the United States with the cell transplantation combined with a bypass surgery. The results so far is very encouraging. What we have seen that we were able to convert a scar tissue to a new muscle with this cell transplantation.

>> Michael Grant:
Absolutely remarkable. Now, there really are two component parts, I think, to the FDA approval that has just been received. There's the catheter procedure, which allows you to do this without open young up the chest, but as importantly, and I think this is unique to the heart institute, is this 3-D technology that allows you very precisely to identify where you're going to place those cells, correct?

>> Dr. Nabil Dib:
That's correct. That's very important technology. We have the ability by the catheter to reconstruct the heart in a three-dimensional imaging and identify the area of the heart attack, and we can transplant the cell in a very high accuracy to the scar zone with a resolution less than .2 millimeters of accuracy.

>> Michael Grant:
That's remarkable. Obviously I assume any time you can avoid an open heart, open chest kind of procedure that that's clearly the way to go?

>> Dr. Nabil Dib:
That's exactly correct. This is very important because with the catheter technology, we can apply this kind of therapy on the majority of patients.

>> Michael Grant:
You know, I've got to ask you the same question I asked Dr. Dietrich several months ago, and that is, why does my heart not know that, hold it, these are cells from my leg; they're supposed to be running and jumping and stuff like that, and I'm a heart muscle? Why don't we get a rejection phenomena going on here?

>> Dr. Nabil Dib:
Well, first, we are taking the cell from the same patient's thigh. So we remove usually a 2-gram of biopsy from the skeletal muscle. We isolate those cells, cells called myoblast, one step farther down from stem cells, and then we expand them in the lab to obtain hundreds of millions of them and then we transplant them to the scar zone. It is very important to know that our heart and our skeletal muscle were originated from the same cell, the same cell form both the cardiac muscle as well as the skeletal muscle. But after birth those cells disappear from the heart and they continue to survive in the skeletal muscles.

>> Michael Grant:
So you can reach into the leg muscle and that sort of genesis material is still there that was common to the heart muscle.

>> Dr. Nabil Dib:
That's what's common and is known to the heart muscle.

>> Michael Grant:
How does this help treat more patients? Give us some examples of how this improves things.

>> Dr. Nabil Dib:
Yes. Well, so far in spite of our best medical therapy, we still have 2 million patients with heart failure admitted to the hospitals per year. We think if we can improve the heart function even by 5 points we will see a tremendous difference in the quality and survival of patients.

>> Michael Grant:
And obviously repairing the scar tissue is critical to that?

>> Dr. Nabil Dib:
That's correct. And in the preclinical model we have seen improvement ranging from 10 to up to 15 points in the heart function.

>> Michael Grant:
Outstanding. Dr. Dib, it is excellent news, and it is fascinating research and a fascinating procedure, and we appreciate you joining us and talking about it.

>> Dr. Nabil Dib:
Thank you.

>> Michael Grant:
To see transcripts of "Horizon," perhaps find out about upcoming topics, please visit the website. The address is new. It is www.azpbs.org. Click on "Horizon" and you can follow the links.

>> Michael Sauceda:
President Bush and challenger John Kerry have finally settled on a debate schedule and Gammage auditorium at Arizona State University will play host to the last of the three presidential debates. Learn more about what it takes to prepare for a presidential debate and about other functions preceding the main event. That's Thursday at 7:00 on Channel 8's "Horizon" program.

>> Michael Grant:
Tomorrow following "Horizon" stay tuned for "Horizonte". That's the program that covers Arizona issues through a Hispanic lens and on Friday reporters will join me on "Horizon" to talk about the week's news events. We're happy you join us on a Wednesday evening. I'm Michael Grant. Hope you have a great one. Good night.

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