Transcript: Your Health Season 3 Episode 17 | Jan 29, 2002

A slate reads "The advice given in the following program is of a general nature only. Viewers should consult their own medical professional for medical advice specific to their circumstances."

(music plays)

Against a gray background, an animated blue, green and gray grid shows clips of doctors and patients as the white letters of the title of the show fly forward: "Your Health."

Maureen says THIS WEEK.

Melissa Santagato is in her late thirties, with short dark brown hair and bangs. She wears glasses and a green cardigan.

Melissa says WELL, HE MADE THE COMMENT
THAT SOMETIMES THOSE THINGS
CAN ADD UP TO A SYNDROME AND
I ASKED HIM WHAT EXACTLY DID
HE MEAN BY THAT.
HE SAID THERE IS A SYNDROME
CALLED WILLIAMS SYNDROME.

Maureen says TRACKING DOWN A
DOES ORDER.

Rob Meyers is in his mid-thirties, clean-shaven with brown hair. He wears glasses, a light brown suit, shirt and black and white tie.

Rob says IF YOU TAKE THIS, THE
CHANCES ARE YOU WILL BE
ALIVE IN TEN YEARS, THERE IS
A GREATER CHANCE YOU WILL BE
ALIVE.
JUST BECAUSE YOU DON'T FEEL
THE DISEASE DOESN'T MANY YOU
DON'T HAVE THE DISEASE.

Maureen says TAKING DRUGS
BEFORE YOU ARE SICK, IS IT
GOOD MEDICINE?

Paul Caldwell is in his late fifties, with a beard and receding white hair. He wears a blue shirt and dotted yellow tie.

Paul says I KNOW, I KNOW, YOU THINK
YAWNING IS JUST BORING,
TEDIOUS, HO-HUM, RIGHT?
WRONG.

Maureen says AND EXPLORING
THE BIG YAWN ON MEDICINE
101.

The animated grid appears showing clips of a woman holding a baby, pills, a surgery, a needle and a man doing exercise.

The title of the program reads "Your Health." The "R" in "Your" ends with an "X."

Maureen Taylor stands next to a TV screen in a studio. She is in her late thirties with shoulder-length light brown hair. She wears a brown jacket and patterned colourful blouse.

Maureen says IS THAT HELLO, I'M MAUREEN
TAYLOR, IT'S NOT OBVIOUS AT
BIRTH, AND ALTHOUGH AS
CHILDREN THEY HAVE HEALTH
PROBLEMS, AT FIRST THEY SEEM
UNRELATED.
FOR MELISSA AND BOB
SANTAGATTA IT WITH DOCTOR
WHO PUT IT ALL TOGETHER.

The TV screen shows a picture of boy.

Maureen continues THEIR SON JOHN REPORT HAS A
RARE DISORDER CAUSED BY A
MISSING OR INVERTED
CHROMOSOME T IS CALLED
WILLIAMS SYNDROME.

[monitor beeps]
A blue slate reads "Williams Syndrome. Produced by Janet Aronoff."

A clip plays.

Children sit on the floor. John rests his head on his hands bending forward constantly. He is a 9 year old boy with brown hair.

A blond teacher asks DOES ANYONE KNOW WHAT
THAT SHAPE IS CALLED.
A HEXAGON IS WHEN WE PUT
TWO OF THOSE TOGETHER.

Bob says HE WOULD CRY AT NIGHT FOR
HOURS ON END.
IT WOULD GO ON FOREVER.
HE HAD COLIC FOR TEN MONTHS.
AND HE WAS VERY EMOTIONAL,
VERY EASY TO UPSET.

Bob and Melissa sit in a living room. Bob is in his forties, clean-shaven with short gray hair. He wears glasses, a gray sweater and blue jeans.

Melissa says I WENT BACK TO WORK AFTER
SIX MONTHS AND BOB, HE
MINDED JOHN ROBERT IN THE
AFTERNOON.
AND HE WOULD SAY TO ME, YOU
KNOW, SOMETHING DOESN'T
QUITE SEEM RIGHT.
WE WENT TO THE PEDIATRICIAN
WITH OUR CONCERNS AND SHE
KEPT SAYING WELL, HE IS A
BOY, SOMETIMES IT TAKES
LONGER.

The teacher says JOHN REPORT, YOU CAN SIT
DOWN PLEASE.

Melissa says HE HAD DEVELOPED
EXTRABUSINESS MUSS, A
CROSSED EYE AT 18 MONTHS SO
WE HAD TO HAVE THAT TAKEN
CARE OF.

John leans forward covering his head with his hands.

Melissa continues WHENEVER WE WENT FOR THE
FIRST EYE EXAM, REGARDING
THE STRYBYSMUS, THE CHIEF
OPHTHALMOLOGIST AT
CHILDREN'S 4079, AFTER WE
TOLD HIM THE THINGS OF JOHN
REPORT AS FAR AS COLIC FOR
TEN MONTHS, HE MADE THE
COMMENT THAT SOMETIMES THOSE
THINGS CAN ADD UP TO A
SYNDROME.

A caption appears on screen. It reads "Melissa Santagato."

Melissa continues AND HAD THE PEDIATRICIAN
EVER SAID THERE WAS ANYTHING
ELSE WRONG WITH HIM.
AND BECAUSE WE HAD BEEN TO
THE PEDIATRICIAN WITH OUR
CONCERNS, WE SAID NO, AND
THEN AFTER HE LEFT I SAID TO
BOB, YOU KNOW THAT IS THE
SECOND TIME HE HAS SAID
THAT.
AND THEN JUST LEFT OR
FINISHED WITH US.
SO I WENT OUT AND I FOUND
HIM IN THE HALL AND I ASKED
HIM WHAT EXACTLY DID HE MEAN
BY THAT.
HE SAID THERE IS A SYNDROME
CALLED WILLIAMS SYNDROME.

John says I GOT IT FOR MY BIRTHDAY.

The teacher says I KNOW, WHAT ARE WE GOING
TO DO NOW, SQN ERT.
WE'RE GOING TO FINISH
CUTTING.

The caption changes to "Doctor Paul Dick. Pediatrician." Paul is in his mid-thirties, with a black beard and black hair. He wears glasses, gray suit, white shirt and dark patterned tie.

Dick says WILLIAM SYNDROME IS QUITE
RARE.
IT OCCURRED PROBABLY AROUND
ONE IN 20,000 BIRTHS, ONE IN
40,000 BIRTHS.
AND SO MOST PEOPLE DON'T
KNOW ANYONE WHO HAS WILLIAMS
SYNDROME OR HAVEN'T EVEN
HEARD OF IT.
AND THAT INCLUDES MANY
HEALTH PRACTITIONERS.

Melissa says FOR MYSELF IT WAS KIND OF
LIKE A WEIGHTLIFTED OFF MY
SHOULDERS BECAUSE NOW I KNEW
WHAT I WAS DEALING WITH.
AND NOW WE COULD RESEARCH
THE SYNDROME AND NOW WE
COULD GET JOHN ROBERT THE
HELP THAT HE REQUIRED IN THE
AREAS THAT HE REQUIRED AS
OPPOSED TO HIT-AND-MISS.

Dick says WILLIAMS SYNDROME HAS A
NUMBER OF CLASSIC FEATURES.
IT HAS BEEN DESCRIBED TO
HAVE A CLASSIC FACES THAT
INVOLVES CHANGES AROUND THE
MOUTH AND AROUND THE EYES,
THAT FOR A KNOWLEDGEABLE
PRAK ITNER YOU CAN EASILY
RECOGNIZE IT.

Dick sits in classroom cutting a piece of paper. He repeatedly moves his mouth and closes his eyes.

Dick continues THE PROBLEM IS THAT
CHARACTERISTIC LOOK REALLY
DOESN'T APPEAR THAT MUCH IN
THE FIRST YEAR OF LIFE.
SO FOR THE MOST PART
WILLIAMS SYNDROME IS NOT
DETECTED UNLESS THERE HAVE
BEEN TIME ENOUGH FOR SOME OF
THE PROBLEMS TO CROP UP.

Bob says HE HAS HAD EYE SURGERY,
EAR SURGERY, HE'S HAD DOUBLE
HERNIA, SO HE HAS BEEN UNDER
THE KNIFE A FEW TIMES,
TUBES.

Dick says SINCE 80 percent OF HEESE
CHILDREN HAVE A MURMUR, THEY
WILL OFTEN BE SENT TO A
CARDIOLOGIST FOR
INVESTIGATION OF THAT
MURMUR.
AND IF IN FACT THEY DETECT A
NARROWING OF THE GRADE
ARTERIES COMING OUT OF THE
HEART THAT WILL PLANT THAT
SEED IN THAT CARDIOLOGIST'S
MIND, ESPECIALLY A WELL
TRAINED PEDIATRIC
CARDIOLOGIST WILL
IMMEDIATELY RECALL THAT
CONNECTION.
AND SO OFTEN THAT IS ENOUGH
TO TRIGGER THE CARDIOLOGIST
TO REFER A CHILD TO A
GENETICIST.
WITH IS HERE ARE SOME DNA
SAEFERMS FROM FAMILIES WITH
WILLIAMS SYNDROME.

The caption changes to "Doctor Lucy Osborne." Lucy is in her thirties with brown hair tied-up. She wears earrings and a green sweater.

Lucy says ALMOST EVERYBODY WITH
WILLIAMS SYNDROME HAS A
DELETION.
THIS WALLS THOUGHT TO BE A
SPORADIC EVENT.
SO THAT THE CHANCE OF
ANYBODY HAVING A CHILD WITH
WILLIAMS SYNDROME WAS THE
SAME AS ANYBODY ELSE WALKING
AROUND ON THE PLANET.

Dick examines a girl’s throat.

Dick says OPEN UP AND SAY AW.

The girl says AHH.
Dick says LOUDER.

The girl says AHH.

Dick says LOUDER.

The girl says AHH.

Dick says GOOD FOR YOU.

The caption changes to "Hospital for Sick Children."

Dick says ABOUT 15 percent OF CHILDREN OF
INFANTS, IN FACT, WITH
WILLIAMS SYNDROME WILL
DEVELOP A HIGH BLOOD CALCIUM
TO THE POINT THAT IT CAN
CAUSE PROBLEMS.
IT CAN CAUSE THEM TO BE
IRRITABLE, TO HAVE REAL
TROUBLE GROWING.
OFTEN THEY WILL BE
DEHYDRATED AND CAN LOOK
QUITE SICK FROM IT.

The caption changes to "Melissa and Bob Santagato."

Melissa says IT CAN GIVE THEM STOMACH
PAINS, AND GAS AND PROBABLY
HE SHOULD HAVE BEEN TESTED
FOR THAT AFTER THEY SAY
COLIC IN CHILDREN SOMETIMES
WILL LEAVE AFTER 12 WEEKS,
BUT WE HAD IT FOR THE TEN
MONTS.
BUT BECAUSE OUR PEDIATRICIAN
HAD NEVER HEARD OF WILLIAMS
SYNDROME IN HER 25 YEARS OF
PRACTICE, THE CALCIUM LEVEL
WAS NEVER TESTED.

At the classroom, the teacher says SEE HOW MANY OF THESE YOU
NEED TO COVER UP THAT.
I WILL GIVE YOU SOME.
NOW REMEMBER IT HAS TO GO
EXACTLY ON TOP.

The teacher hands John colourful blocks.

Melissa says HE HAS SOME SPATIAL
DIFFICULTIES, IF YOU WOULD
ASK HIM TO DRAW A PICTURE IT
WOULD BE PROBABLY WAY OFF OF
WHAT HE IS ACTUALLY SEEING
JUST BECAUSE OF THE SPACING.
HE IS JUST NOW STARTING TO
TRACE LETTERS SO HE IS
BEHIND IN THAT WAY, BUT HE
IS COMING ALONG.

Dick says THESE CHILDREN HAVE AN
ABILITY TO LEARN, THEY LEARN
AT A SLOWER PACE BUT THEY DO
HAVE THE ABILITY.
IT TAKES TIME, IT TAKES
PATIENCE.

The caption changes to "Doctor Lucy Osborne. University of Toronto."

Lucy says THERE IS A RANGE OF
LEVELS OF INTEGRATION INTO
SOCIETY WITH PEOPLE'S WITH
WILLIAMS SYNDROME BECAUSE
THERE IS A RANGE IN THE
LEVEL OF ABILITIES.
ALTHOUGH AS A RULE THEY HAVE
AN IQ OF AROUND 55 WHICH IS
VERY SIMILAR TO DOWN
SYNDROME, THERE IS A HUGE
RANGE AND SOME PEOPLE ARE
HAVE IQs IN THE NORMAL
FUNCTIONING RANGE AND CAN
ACTUALLY INTEGRATE INTO
SOCIETY QUITE WELL AND HOLD
DOWN JOBS AND DO MANY OF THE
THINGS THAT WE DO.

John finishes building a figure and his classmates clap.

Melissa says HE MAKES MY HEART SMILE.
WILL SAY MOM, I LOVE YOU,
AND GIVE ME A BIG KISS AND A
HUG.

Bob says IF YOU WANT TO SEE A
CHILD THAT IS FULL OF LOVE,
JOHN ROBERT IS A MODEL
CHILD.
I MEAN HE WILL HUG YOU 20
TIMES A DAY OR JUST WALK
OVER TO YOU AND GIVE YOU A
KISS AND SAY I LOVE YOU.

Lucy says THEY DON'T DRAW THE
NORMAL DISTINCTS BETWEEN
PEOPLE THEY HAVE MET AND
PEOPLE THEY HAVE NOT MET.
SO EVERYBODY APPEARS TO BE A
FRIEND IT IS VERY DIFFICULT
TO STOP THEM JUST GOING OFF
WITH ANYBODY THAT THEY MIGHT
MEET IN THE STREET OR ANY
WITH.

Melissa says HIS SOCIABILITY IS PART
OF THE SYNDROME.
WHICH IS ALSO A CONCERN THAT
IF SOMEONE HEARS HIS NAME
WHEN WE ARE OUT IN PUBLIC
AND SAYS OH, JOHN ROBERT,
WHY DON'T YOU COME WITH ME,
WHILE IT IS A CONCERN FOR
ALL PARENTS WITH YOUNG
CHILDREN, IT IS ESPECIALLY A
CONCERN FOR US BECAUSE HE
WON'T HESITATE TO GO.

Bob and Jon walk into a music shop.

Lucy says I THINK IT IS THE
COMBINATION OF THINGS THAT
MAKES THEM UNIQUE IT IS NOT
JUST THE FACT THEY LIKE
MUSIC, IT IS THE FACT THAT
ALTHOUGH THEY ARE VERY POOR
AT SOME THINGS, MUSIC IS
SOMETHING THEY CAN ACTUALLY
REALLY ENJOY AND THEY FEEL
SOME SORT OF EMPATHY WITH
IT.

John plays the piano next to his father and a woman. The woman and John high-five.

Lucy continues BUT THERE ALSO DOES SEEM TO
BE PROBABLY MORE PEOPLE THAN
WOULD YOU EXPECT WITH
WILLIAMS SYNDROME THAT
ACTUALLY HAVE QUITE GOOD
MUSICAL ABILITIES.
IT HAS BEEN REPORTED THAT
MANY OF THEM HAVE PERFECT
PITCH WHICH IS EXTREMELY
RARE IN THE GENERAL
POPULATION.

Melissa and his family play a board game.

Melissa says ARE YOU GOING TO HELP
WITH BY TURE, JOHN ROBERT.

John says I WANT TO DO THE
HYPOFIRST.

Melissa says I HOPE FOR HIM TO
GRADUATE FROM HIGH SCHOOL,
GO TO A VOCATIONAL SCHOOL.

Bob says EVERY ONE OF US WANTS OUR
CHILDREN TO BE THE BEST THEY
CAN BE, INCLUDING CHILDREN
WITH SPECIAL NEEDS.
YOU HAVE TO GIVE THEM THE
OPPORTUNITY TO EXCEL AND TO
REACH THEIR POTENTIAL AT
WHATEVER POINT THAT MAY BE.

Dick says MOST OF THE CHILDREN GAIN
A DEGREE OF INDEPENDENCE.
BUT FULL INDEPENDENCE LIVING
WITH THEIR OWN JOB, ON THEIR
OWN, IS SOMETHING THAT IS
DIFFICULT TO ATTAIN FOR MOST
OF THEM.

Melissa says YOU KNOW, WHENEVER YOU
HAVE A BABY YOU HAVE DREAMS
AND HOPES AND DREAMS OF WHAT
WILL HAPPEN WITH THAT CHILD.
AND WE HAVEN'T STOPPED
DREAMING.
WE JUST MODIFIED THEM A
LITTLE BIT.
YOU KNOW, YOU CAN'T... YOU
CAN'T STOP DREAMING JUST
ABOUT IS A CHILD WITH
SPECIAL NEEDS.

John says I'M TIRED, AREN'T YOU?

The clip ends.

(music plays)

Maureen says TIME FOR THIS WEEK'S
HEALTH QUIZ, WE ALL KNOW
THAT CARDIOPULMONARY
RESUSCITATION SAVES LIVES.
WHEN WAS CPR INVENTED, IN
1940?
1950, OR 1960.
WE'LL HAVE THE ANSWER LATER
ON "YOUR HEALTH."

Maureen and two guests sit at a table.

Maureen says YOUR CHOLESTEROL
LEVELS ARE NORMAL.
YOU FORGET WHERE YOU PUT
YOUR CAR KEYS THE ODD TIME
BUT MOSTLY YOUR MEMORY IS
FINE.
STILL, YOU ARE A CANDIDATE
FOR DRUGS TO TREAT HEART
DISEASE AND ALZHEIMER.
ARE YOU PART OF THE
BOTTOMLESS POPULATION OF
PEOPLE WHO ARE NEARLY SICK.
RECENT STUDIES SUPPORT THE
IDEA OF GIVING MEDICATIONS
TO PEOPLE BEFORE THEY EVEN
HAVE SYMPTOMS OF DISEASE BUT
SOME WORRY THAT THIS IS MORE
ABOUT EXPANDING MARKETS FOR
DRUG CHANCE PREVENTIVE
MEDICINE.
Dr. ROB MEYERS IS A
CARDIOLOGIST AT SUNNYBROOK
AND WOMEN'S COLLEGE HEALTH
SCIENCES CENTRE IN TORONTO.
CAROL KUSHNER IS A HEALTH
POLICY CONSULTANT, WELCOME
BOTH OF YOU.
ROB, THE HEART DRUGS THAT
I'M TALKING ABOUT ARE
STATINS, TELL US ABOUT THESE
DRUGS.

The caption changes to "Rob Myers. Cardiologist."

Rob says STATINS ARE ACTUALLY THEY
COME FROM PROBABLY 30 YEARS
BACK IN TERMS OF HOW LONG
AGO THEY WERE FIRST
PRODUCED.
THEY ARE DRUGS THAT ARE VERY
POPULAR TO LOWER YOUR BLOOD
CHOLESTEROL LEVELS.
THEY ACT ON YOUR LIVER, YOUR
LIVER MAKES CHOLESTEROL,
WHETHER YOU FEET OR NOT IT
MAKES IT.
AND THEY INTERFERE IN ONE OF
THE STEPS OF THE LIVER
PRODUCTION PROCESS SO IT
STOPS IT OR REDUCES IT FROM
BEING MADE.

Maureen says NOW YOU MOSTLY
PRESCRIBE THOSE TO PEOPLE
WHO TEST HIGH FOR THE BAD
CHOLESTEROL.
BUT RECENT STUDIES HAVE SAID
THAT PERHAPS WE SHOULD BE
GIVING THEM TO PEOPLE WHO
HAVE NORMAL CHOLESTEROL
LEVELS, WHY IS THAT?

Rob says THE BAR, IT IS NEVER
REALLY CLEAR WHERE THE BAR
SHOULD BE.
A THE LEVEL OF YOUR
CHOLESTEROL SHOULD BE
LOWERED T DEPENDS HOW MANY
RISK FACTORS YOU HAVE, FIRST
OF ALL.
IF YOU HAVE HEART DISEASE
YOUR CHOLESTEROL LEVEL NEEDS
TO BE, WE TALK ABOUT THE LDL
WHICH IS THE BAD STUFF.
LDL NEEDS TO BE LESS THAN
TWO AND A HALF.
IF YOU DON'T HAVE HEART
DISEASE AND ONLY ONE RISK
FACTOR, LET'S SAY HIGH BLOOD
PRESSURE THAN YOUR LDL MAY
BE ESSENTIAL AT 3.... SO THE
BAR VARIES DEPENDING ON THE
NUMBER OF RISKS YOU HAVE.

Maureen says HOW IMPRESSED
ARE YOU AT SOME OF THESE
STUDIES.

The caption changes to "Carol Kushner. Health Policy Consultant." Carol is in her early forties with short red hair and bangs. She wears glasses, black jacket and orange shirt.

Carol says WELL, MY CONCERN IS THAT
WE ARE ALWAYS VERY
ENTHUSIASTIC WHEN WE GET NEW
INFORMATION FROM STUDY
RESULTS LIKE THIS.
AND MAY TEND TO WANT TO
EXTRAPOLATE THE FINDINGS TO
THE TOTALLY HEALTHY
POPULATION.
MAYBE INAPPROPRIATELY.
AND MAYBE AGAIN, TO THE
DETRIMENT OF PATIENT HEALTH
BECAUSE SO FAR EVEN WITH THE
VERY LARGE TRIALS, THE
SIDE-EFFECT PROFILE LOOKS
PRETTY GOOD WITH THESE DRUGS
SO FAR BUT WE REALLY DID IN
WHAT IS GOING TO HAPPEN IF
WE EXPAND THIS TO THE
GENERAL POPULATION.
OR WHETHER THAT'S A WISE
MOVE AND THAT'S WHERE MY
CONCERN COMES IN, WE NEED TO
STUDY THESE THINGS VERY
CAREFULLY TO MAKE SURE THAT
THE BENEFIT IS COMMENSURATE
WITH THE RISK.

Maureen says SO FAR STATINS, YOU SAY
THEY HAVE BEEN AROUND ABOUT
30 YEARS, ROB.
WHAT ABOUT ADVERSE REACTS TO
THEM.

Rob says THEY RUN COMMON.
THERE ARE NOT A LOT OF
ADVERSE REACTIONS.
IT ALWAYS MAKES ME THINK
WHEN YOU GET A DRUG AT A
PHARMACY THEY GIVE YOU THIS
FULL PAGE, IF YOUR TOE NAIL
TURNS YELLOW IT WILL SAY TOE
NAILS MAY TURN YELLOW.
I DON'T KNOW WHY ANYONE
TAKES A DRUG WHEN YOU SEE
THE SIDE EFFECTS.
THE MAIN ONE IS IT CAUSE A
NONINFECTIOUS HEPATITIS, IN
OTHER WORDS YOUR LIVER GETS
INFLAMED, VERY RAFERMENT AND
THE OTHER RARE THING IS
MUSCLE INFLAMMATION.
SO WHEN YOU CONSIDER HOW
MANY PEOPLE BENEFIT VERSUS
HOW MANY PEOPLE DO POORLY IS
A NO-BRAINER.

Carol says AS LONG AS THE DRUG IS
RESTRICTED TO A RELATIVELY
SMALL NUMBER OF PATIENTS AT
HIGHER RISK BECAUSE THIS ARE
COMING IN AT A HEISER...
HIGHER RISK TO BEGIN WITH.
BUT WHEN YOU BEGIN TO EXPAND
TO THE POPULATION AT LARGE,
THEN A VERY SMALLER, RARE
EVENT CAN BECOME
CONSIDERABLY MORE
SIGNIFICANT.

Maureen says AND WE ARE TALKING
MILLIONS OF PEOPLE IN THIS
LATEST STUDY.

Carol says POTENTIALLY.

Maureen continues IF YOU TAKE IN ALL THE
DIABETICS AND ANYBODY WHO
MAY BE HAS A MOTHER FATHER
WITH HEART DISEASE AND THEY
ARE AT HIGHER RISK, YOU KNOW,
ROB, IT COULD BE MILLIONS.

Rob says THAT IS THE ARGUMENT
BEING MADE, AN INTERESTING
ARGUMENT.
IS YOU CAN TAKE A DRUG, AND
THE QUESTION IS HOW MANY
PEOPLE DOES IT HELP.
SO IF IT HELPS ONE OUT OF A
MILLION PEOPLE ARE YOU GOING
TO GO AHEAD AND PRESCRIBE
THIS DRUG TO A MILLION
PEOPLE.
THE ANSWER IS PROBABLY NOT.
IF IT HELPS ONE OUT OF
10,000, YOU HAVE TO DECIDE
AT WHAT LEVEL ARE YOU GOING
TO START PRESCRIBING IT TO
EVERYBODY.
THE THING IS CARDIAC DISEASE
IS SO COMMON THAT EVEN
SOMETHING AS MARCHLY
BENEFICIAL, WELL, EVEN A
MARGINAL BENEFIT MAY
TRANSLATE INTO 50,000 PEOPLE
ACROSS THE WORLD.

Maureen says AND PROVIDED IT HAS BEEN
TESTED AGAINST OTHER THINGS
THAT WE KNOW ALREADY WORK,
AND I'M THINKING HERE OF
ASPIRIN OR DID ET AND
EXERCISE, BUT I'M NOT
SURE...

Rob says THOSE ARE IN ADDITION TO.
I THINK IT IS PRETTY WELL
SHOWN, THESE THINGS ARE KIND
OF LAY ERRED SO BY THE TIME
YOU GET TO THE CHOLESEROL
TRIALS THAT CLEARLY SHOW
BENEFIT, THESE PEOPLE ARE
ALREADY ON ASPIRIN, THEY ARE
ALREADY SUPPOSED TO BE
FOLLOWING THEIR DIET BUT
NOBODY FOLLOWS THEIR DIET
ANYWAY IN MY EXPERIENCE.
IT IS A VERY HARD THING TO
MAKE PEOPLE DO.
I MEAN THERE ARE SO MANY
THINGS THAT A PERSON CAN DO
TO LOWER THEIR RISK OF HEART
DISEASE, SO MANY THINGS.

Maureen says THAT WE DON'T DO
ANYWAY.

Carol says BUT INDEED, EVEN TAKING
DRUGS, THE COMPLIANCE IN
TERMS OF TAKING DRUGS FOR
YOUR ENTIRE LIFETIME IS NOT
NECESSARILY A REGIMEN THAT
PEOPLE CAN ADHERE TO.
SO THE PURPOSES OF A TRIAL
WHERE YOU ARE BEING VERY
CLOSELY MONITORED, BUT I
THINK IN THE REAL WORLD, WE
ARE DEALING WITH PEOPLE
WHOSE LIVES MAY NOT BE THAT
WELL CONTROLLED AND SO
COMPLIANCE IS ALSO AN ISSUE.

Rob says AND I THINK COMPLIANCE
SAY BIG DEAL BECAUSE ARE YOU
TALKING TO PEOPLE WHO YOU
DON'T FEET DISEASE, LIKE
BLOOD PRESSURE.
SO YOU HAVE HIGH
CHOLESTEROL.
HI A PATIENT TODAY, SHE HAS
HIGH CHOLESTEROL, HIGH BLOOD
PRESSURE, AND SAYS I FEEL
FINE, WHY AM I TAKING THESE
DRUGS.

Maureen says WHAT DID YOU
TELL HER.

Rob says WELL, WHAT I TOLD HER WAS
WHAT I TELL EVERYBODY, EVERY
DAY WHICH IS IF YOU TAKE
THIS DRUG, THE CHANCES ARE
YOU WILL BE ALIVE IN TEN
YEARS, THERE IS A GREATER
CHANCE YOU ARE GOING TO AN
LIVE.
JUST BECAUSE YOU DON'T FEEL
THE DISEASE DOESN'T MEAN YOU
DON'T HAVE THE DISEASE, SO
IT IS KIND OF LIKE PENCILIN
AND AMMONIA, SO ARE YOU NOT
GOING TO TAKE PENCILIN FOR
YOUR PNEUMONIA, ARE YOU
BECAUSE YOU FEEL THE
PNEUMONIA, THERE IS NO
DIFFERENCE, YOU JUST DON'T
FEEL THE HIGH BLOOD PRESSURE.
STILL GOING TO CAUSE A
STROKE.

Carol says I THINK THERE IS A
DIFFERENCE IN THE SENSE THAT
ESTABLISHED DISEASE IS
DIFFERENT FROM AN
ESTABLISHED RISK FACTOR.
AND THAT WHEN YOU GO AS A
PATIENT WITH AN ESTABLISHED
DI CEASE, SEEKING TREATMENT
TO SOME DEGREE YOU ARE
ASSUMING ON YOURSELF THAT IF
YOU ARE GOING TO BE TREATED
THERE MAY BE SOME RISKS, IF
IT IS SURGERY, DRUGS, WHAT
TESTIFY IS, BUT THAT YOU ARE
SEEKING A BENEFIT TO DEAL
WITH THAT DISEASE.
THE STATUS OF RISKS, LIKE
HYPERTENSION OR HIGH BLOOD
PRESSURE OTHER KINDS OF
CONDITIONS WHICH MAY BE
BELOW THE THRESHOLD AT WHICH
WE THINK OF AS A PROBLEM, IT
IS A LITTLE DIFFERENT.
YOU FEED A VERY GOOD BURDEN
OF PROOF TO SAY THIS WILL BE
A NET BENEFIT.

Rob says I THINK THE POINT IS YOU
ARE TALKING ABOUT WHERE THE
THRESHOLD IS.

Carol says YES, AND WE DON'T KNOW...

Rob continues IT IS DIFFERENT THAN
SAYING... IT IS VERY WELL
PROCHB, NOBODY FEELS THEIR
CHOLESTEROL T AN A SYMPTOM
ATTIC DISEASE BUT CLEARLY
SOME PEOPLE WITH HIGH
CHOLESTEROL NEEDS TO BE
TREATED.
HOW DO YOU IDENTIFY THE
GROUPS.

Carol says NO ARGUMENT THERE.

Rob continues YOU HAVE TO DO A STUDY TO
LOOK AT THE GROUPS.

Maureen says WELL, WOULD YOU PUT YOUR
PATIENT ON THE CHEAPEST ONE
AVAILABLE OR DOES IT HAVE TO
BE THE ONE THAT WAS JUST
STUDIED WHOSE NAME I GUESS
WE DON'T WANT TO MENTION BUT
IT IS STILL VERY EXPENSIVE.
I MEAN WHAT DO YOU DO THERE.

Carol says IT IS A GOOD QUESTION.
I MEAN THE FRUT IS THAT
THERE ARE A LOT OF DIFFERENT
DRUG PRODUCTS IN THAT CLASS,
CORRECT.

Rob says YUP.

Carol continues AND PICKING ONE BECAUSE
THERE WAS A STUDY, A
WELL-FUNDED STUDY TO
ESTABLISH ITS EFFICACY DOES
NOT NECESSARY HAD AM THAT
THE OTHERS ARE...

Maureen says THAT THAT IS THE ONLY
ONE.

Carol continues YES, AND GIVE THAN THERE
ARE OFTEN VERY QUITE LARGE
PRICE DIFFERENTIALS THIS
COULD MEAN A GREAT DEAL, FOR
EXAMPLE, FOR A DRUG BENEFITS
PROGRAMME, FOR GOVERNMENT
EXPENDITURES ON DRUG
BENEFITS OR FOR INDIVIDUAL
EXPENDITURES OR
PHARMACEUTICAL INSURANCE
COSTS.

Maureen says OKAY, DOCTOR, HOW DO YOU
DECIDE WHICH TO PRESCRIBE.

Rob says THE DRUGS ARE MADE BY
DIFFERENT MANUFACTURERS.
LET'S SAY THERE ARE FIVE
STATINS, THEY IF... IF
SOMEBODY THEY DON'T GO
HEAD-TO-HEAD, YOU COMPARE
THE DRUG TO SOMEONE WHO IS
NOT ON THE DRUG AT ALLING WE
DON'T KNOW WHICH ONE IS
BETTER.

Carol says THAT IS A REAL PROBLEM
BECAUSE IT IS IN THE
PUBLIC'S INTEREST, I WOULD
ARGUE, TO KNOW WHICH OF
THESE DRUGS IS BETTER THAN
THE OTHER.

Rob says WHO IS GOING TO FUND IT.

Carol continues THAT IS WHY WE NEED TO
HAVE PUBLIC INTEREST FUNDING
FOR PHARMACEUTICAL RESEARCH.

Maureen says WHAT A POLLY
ANNA SHE S.

Rob laughs.

Rob says I DON'T CONSIDER PRICE
WHEN I PRESCRIBE THE DRUG, I
THINK IT IS NOT MY
RESPONSIBILITY ON AN
INDIVIDUAL BASIS WITH A
PATIENT.
I WILL PRESCRIBE THE DRUG
THAT I THINK IS BEST.
IF IT COSTS EXTRA MONEY, MY
ONLY CONCERN IS WHEN THEY
ARE NOT COVERED BY HEALTH
INSURANCE,.

Maureen says BUT IS IT YOUR
JOB TO REMAIN A LITTLE
SKEPTICAL WHEN THE DRUG REP
IS COMING TO SEE YOU, OR
WHEN ARE YOU INVITED OUT TO
AN EXPENSIVE DINNER AT A
CME.

Rob says NO, NOT ME, I DON'T DO
THAT BUT NO, FOR SURE.

Maureen laughs.

Rob continues THERE IS ALWAYS... IT IS
SUCH A BALANCE.
ON THE ONE HAND I THINK DRUG
MANUFACTURERS SHOULD BE
MAKING AS MUCH MONEY AS THEY
CAN.

Carol says THEY ARE, ROB.

Carol laughs.

Rob continues I THINK THEY SHOULD BE.
WHY, BECAUSE I'M NOT THERE
DOING RESEARCH ON MY OWN
DOLLAR TO FIND OUT WHICH
DRUG IS BETTER.
ALL THESE DRUGS ARE COMING
THROUGH, THEY ARE BETTER
DRUGS.
WE ARE ABLE TO TREAT PEOPLE
MORE AND MORE EFFECTIVELY IT
JUST SO HAPPENS IT IS A
PRIVATE ENTERPRISE SYSTEM
WHERE YOU HAVE TO PAY A LOT
OF MONEY FOR THAT, THE DRUGS
THAT IS I DON'T HAVE ANY
CRITICISM OF A DRUG COMPANY
SPENDING THE MONEY.
I MEAN THEY ARE CREATING A
PRODUCT.
THEY ARE IN IF IT FOR PROFIT,
IT JUST SO HAPPEN THIS ABOUT
FITTING PATIENTS, WELL
GREAT.

Carol says RIGHT, BUT WE HAVE A
RESPONSIBILITY AT A SOCIETAL
LEVEL, AT A GOVERNMENT LEVEL
TO MAKE SURE THAT THE
EXPENDITURES ON DRUGS, ON
MEDICAL DEVICES, ON MEDICAL
PROCEDURES ARE
COST-EFFECTIVE.
AND THAT REALLY REQUIRES, I
THINK, SOME KNOWLEDGE ABOUT
WHICH DRUGS WORK BETTER THAN
OTHER DRUGS, THAT'S THE
EFFICACY SIDE.

Rob says WHAT IF THE MOST
EFFECTIVE DRUG IS THE MOST
EXPENSIVE ONE.

Carol says THAN I GO FOR IT,
DEPENDING ON THE MARGINAL,
ADDITIONAL BENEFIT OF THAT
DRUG RELATIVE TO OTHERS.

Maureen says ALL RIGHT.

Carol continues YOU SAID YOURSELF IF IT ONLY
COSTS, IF IT IS ONLY 1
PERCENT MORE EFFECTIVE, IS
IT REALLY WORTH GIVING IT TO
A MILLION PEOPLE.

Maureen says LET'S GO BACK TO THE
STATINS.
ROB, WILL YOU BE
RECOMMENDING STATINS FOR SAY
DIABETIC PATIENT WHO DOESN'T
HAVE HIGH CHOLESTEROL, WILL
YOU BE CHANGING YOUR
PRACTICE.

Rob thinks and says I... THE REASON I'M BEING
TO HEDGE ON THAT IS BECAUSE
WE HAVE TO DEFINE WHAT IS
HIGH CHOLESTEROL, HIGH
CHOLESTEROL BY DEFINITION
MEANS IT SHOULD BE TREATED.
IF YOU HAVE HIGH COLE,
WHETHER DIET OR DRUGS, TO
SAY HIGH MEANS IT MEANS TO
BE TREATED.

Maureen says WHAT IF THEY
DON'T HAVE HIGH.

Rob says NO, I DON'T PUT PATIENTS
AT THIS POINT ON LIPID
LOWERING THERAPY, UNLESS
THEY NEED THE... THE
NATIONAL EDUCATION...
NATIONAL CHOLESTEROL
EDUCATION PROGRAMME
CRITERIA.
THAT MIGHT CHANGE T MIGHT
CHANGE NEXT YEAR BUT UNTIL
IT CHANGES I'M NOT THROWING
EVERYBODY ON A STATIN.

Maureen says CAROL WHAT
ADVICE DO YOU HAVE FOR
PATIENTS WHO ARE GETTING A
PRESCRIPTION FOR A DOCTOR,
WHAT QUESTION SHOULD THEY BE
READY TO ASK.

Carol says WELL, I THINK THEY SHOULD
BE ASKING WHAT IS... YOU
KNOW, WHAT KIND OF EVIDENCE
IS THERE OUT THERE THAT
PEOPLE LIKE ME, WHATEVER MY
PROFILE S THAT PEOPLE LIKE
ME, HOW WELL DO WE DO ON
THESE PRODUCTS.
AND IS THERE A LOWER COASTAL
ATTORNEY DIFFICULT, AND IS
THERE... ARE THERE OTHER
THINGS I COULD BE DOING IN
THE REALM OF DIET, EXERCISE
AND SO FORTH, LIFESTYLE
ISSUES THAT MIGHT HELP, IN
FACT, REDUCE MY RISK OF
HEART DISEASE.

Rob says THE PATIENTS ARE NOT
GOING TO, I DON'T THIS, IN
MY EXPERIENCE PATIENTS DON'T
LOOK AT LOWER COASTAL
ATTORNEY DIFFICULTS, THEY
DON'T CARE, HI DON'T THINK
THEY SHOULD CARE EITHER.

Maureen says MAYBE SHOWS SHOULD
MOTIVATE THEM.

Rob says SHOULD THEY CARE.

Carol says IF THEY ARE PAYING FOR IT,
YES.

Rob says IF THEY ARE PAYING THEY
WILL CARE BECAUSE I WILL BUY
THE CHEAPEST VCR WE CAN BUY.

Carol says WE HAVE AT LEAST 12
PERCENT OF CANADIAN WAS DRUG
COVERAGE, AT LEAST 12 percent.

Rob says ARE WE TALKING ABOUT
THOSE 12 percent, I AM THINKING
THERE 188 percent WITH DRUG
COVERAGE, THEY ARE SICK, NOT
WORRIED ABOUT THE LOWEST
COASTAL ATTORNEY DIFFICULT
THAT IS A GOVERNMENT
DECISION.

Maureen says I MIGHT BE
INTERESTED IN THAT AS A
TAXPAYER.

Maureen smiles.

Carol says IF I DON'T HAVE PRIVATE
HEALTH INSURANCE, IF I'M NOT
COVERED BY THE ONTARIO DRUG
BENEFIT PLAN OR ANOTHER
PROVINCIAL DRUG BENEFIT PLAN,
IT IS A BIG PROBLEM AND COST
DOES MAKE A DIFFERENCE.

Maureen says OKAY, WE ARE GOING TO
HAVE TO LEAVE IT THERE.
A GREAT DISCUSSION, THANK
YOU BOTH.

Carol and Rob smile.

Carol says THANK YOU.

Maureen says COMING UP.

In a clip, Paul says BELIEVE IT OR NOT, THE
STUDY OF YAWNING IS VERY
EXCITING.

The opening sequence rolls again.

Now, Maureen stands next to a screen that reads "Health Digest."

Maureen says YEAH RIGHT.
NOW A LOOK AT SOME STORIES
FROM THE HEALTH FILES.
MIDDLE-AGED MEN HAVE ANOTHER
GOOD REASON TO EXERCISE,
WORKING UP A SWEAT TWO OR
MORE TIMES A WEEK MAY REDUCE
YOUR RISK OF DEVELOPING
SEVERAL TYPES OF CANCER.

The TV screen shows a caption that reads "Anti-Cancer Exercise." A picture shows a man working out next to a glass of wine.

She continues BRITISH RESEARCHERS FOLLOWED
7500 MEN FOR ALMOST 19
YEARS.
AFTER ADD JUSTING FOR OTHER
RISK FACTORS INCLUDING
SMOKING AND ALCOHOL
CONSUMPTION, THEY FOUND THAT
THE RISK OF TOTAL CANCERS
WAS SIGNIFICANTLY REDUCED
ONLY IN MEN WHO SAID THEY
EXERCISED.
CANCERS OF THE PROSTATE,
UPPER DIGESTIVE TRACT AND
STOMACH WERE REDUCED
ALTHOUGH FOR SOME REASON THE
EXERCISERS DID SHOW AN
INCREASED RISK OF BLADDER
CANCER.

The caption on the screen changes to "Big Screen Smoking." A picture shows a man wearing a cowboy hat smoking and a film negative.

She continues AN AMERICAN STUDY PROVES
WHAT ANTI-SMOKING GROUPS
HAVE BEEN SAYING FOR YEARS,
CHILDREN AND TEENS ARE
INFLUENCED BY MOVIE STARS
THEY SEE LIGHTING UP ON
SCREEN.
RESEARCHERS IN NEW HAMPSHIRE
FOUND THAT THE ODDS OF A
CHILD SMOKING INCREASED IN
TANDEM WITH THE NUMBER OF
FILLS WITH SMOKING SCENES
WITNESSED BY THE CHILD.
THE PATTERN REMAINED
REGARDLESS OF OTHER SMOKING
RISK FACTORS SUCH AS HAVING
PARENTS OR PEERS WHO SMOKED.
AND FOR THOSE SMOKERS WHO
ARE TRYING TO QUIT, THERE IS
NEW SCIENTIFIC EVIDENCE THAT
ACUPUNCTURE HELPS.

The caption on the screen changes to "Pricking Addiction." A picture shows a woman smoking and a hand putting acupuncture needles.

She continues NORWEGIAN SCIENTISTS TREATED
A GROUP OF PACK A DAY
SMOKERS WITH ACUPUNCTURE AT
SPECIFIC POINTS IN THE BODY
ASSOCIATED WITH QUITTING
SMOKING.
A CONTROL GROUP HAD
ACUPUNCTURE ON POINTS NOT
ASSOCIATED WITH QUITTING.
CIGARETTE CONSUMPTION FELL
BY AN AVERAGE 14 CIGARETTES
A DAY IN THE ACUPUNCTURE
TREATMENT GROUP AND SEVEN
CIGARETTES A DAY IN THE
CONTROL GROUP.
FIVE YEARS AFTER THE LAST
TREATMENT, 18 percent OF THE
TREATED SMOKERS WERE STILL
NOT SMOKING WHILE ALL OF
THOSE IN THE CONTROL GROUP
WERE.
NOW THE ANSWER TO OUR QUIZ,
CARDIOPULMONARY
RESUSCITATION OR CPR
INVOLVES MOUTH-TO-MOUTH
RESPIRATION, AND CHEST
COMPRESSION.
AND IT WAS INVENTED IN 1960
BY AN ELECTRICAL ENGINEER
WORK AT MARYLAND JOHN
HOPKINS HOSPITAL..

The Quiz slate appears. The answer "3. 1960" appears highlighted in yellow.

Maureen says IT TAKES ABOUT SIX
SECONDS AND YOU HAVE BEEN
DOING SINCE BEFORE YOU WERE
BORN.
EVERYBODY YAWNS, BUT EXPERTS
ARE STILL TRYING TO FIGURE
OUT WHY.
HERE IS OUR MEDICAL
PROFESSOR Dr. PAUL CALDWELL.

Paul sits at a table with a stethoscope, a small skeleton model, a red microscope and other objects on it. Behind him, a human anatomy model and a TV monitor sit on a piece of furniture.

Paul says BELIEVE IT OR NOT, THE
STUDY OF YAWNING IS VERY
EXCITING.
I KNOW, I KNOW, YOU THINK
YAWNING IS JUST BORING,
TEDIOUS, HO-HUM, RIGHT?
WRONG.

He yawns and continues
EXCUSE ME.
YAWNING IS A VERY COMPLEX
PHYSIOLOGICAL ACTIVITY WHOSE
PURPOSE IS NOT COMPLETELY
UNDERSTOOD.

The caption changes to "Doctor Paul Caldwell. Family Physician."

He continues WE START YAWNING EVEN BEFORE
WE ARE BORN.
ON AN ULTRASOUND WE CAN SEE
INFANTS AS YOUNG AS 12 WEEKS
YAWNING IN THE UTERUS AND IT
IS ONE OF THE FIRST THINGS
WE DO AS NEW BONES.
ON AVERAGE WE ADULTS YAWN
ABOUT TEN TIMES A DAY, THE
MOST COMMON TIMES ARE WHEN
WE JUST WAKE UP AND JUST
BEFORE HITTING THE SACK.
YAWNING IS AN ALL OR NOTHING
EXPERIENCE, JUST TRY AND
STOP IN THE MIDDLE OF ONE.
A COMPLETE YAWN LASTS ABOUT
SIX SECONDS.

He points to the skeleton model and says YOU WOULD THINK THAT WITH
THAT WIDE OPENING OF THE
MOUTH AND THE SUCKING IN OF
AIR THAT YAWNING WOULD BE
SEEN MORE FREQUENTLY IN
SITUATIONS WHERE THERE IS
LOWER OXYGEN CONTENT IN THE
AIR WE ARE BREATHING BUT IT
IS NOT SO.
NOR DOES THE RATE OF YAWNING
INCREASE IF WE INCREASE THE
AMOUNT OF CARBON DIOXIDE IN
THE AIR AROUND US.
CONTRARY TO POPULAR BELIEF,
YAWNING DOES NOT IMPROVE
OXYGENATION OF THE BLOOD.
WATCHING SOMEONE ELSE YAWN
OFTEN TRIGGERS THE IMPULSE
IN YOU, READING ABOUT
YAWNING CAUSES YOU TO YAWN.
OF COURSE, IF YOU YAWN IN
SOMEONE'S FACE WHILE THEY
ARE TALKING, IT SENDS A
CLEAR SOCIAL MESSAGE, YOU
ARE BORED.
BUT O LISM PICK ATHLETES
YAWN BEFORE THEIR
COMPETITION.
AND A TROOPERS YAWN BEFORE
THEY JUMP.
AS THEY MOVE TOWARDS AN
INCREASED LEVEL OF ALERTNESS.
SO WHY DO WE YAWN?
SOME RESEARCHERS THINK
YAWNING IS LIKE STRETCHING,
BOTH INCREASED BLOOD
PRESSURE AND HEART RATE AND
FLEXED MUSCLES AND JOINTS,
STRETCHING THE JAW AND FACE
MUSCLES IS NECESSARY FOR A
GOOD YAWN, JUST TRY ONE WITH
YOUR MOUTH CLOSED.
DOESN'T REALLY WORK.
BUT THE MORE POPULAR BELIEF
IS THAT YAWNING IS A
PHYSICAL PHENOMENON THAT
REFLECTS A MENTAL STATE OF
DECREASED AROUSEAL OR
BOREDOM IN A SITUATION WHERE
YOU SHOULD BE ALERT, LIKE IN
CALCULUS CLASS.
THE PHYSICAL MOVEMENTS THAT
COME ABOUT AS A RESULT OF
YAWNING DON'T HAVE A
SPECIFIC PURPOSE.
JUST LIKE THE MOVEMENTS OF
SMILING, GRINNING, LAUGHING
OR CRYING.
ALL THEY ARE DOING IS
COMMUNICATING YOUR MENTAL
STATE TO THOSE AROUND YOU.
IF ARE YOU HAPPY, YOU LAUGH.
IF YOU ARE SAD, YOU CRY.
IF YOU ARE BOARD, WEARY OR
APATHETIC, YOU YAWN.
SENDING A CLEAR SIGNAL TO
THOSE AROUND YOU.
SO NEXT TIME I YAWN, PLEASE,
DON'T TAKE IT PERSONALLY.

Maureen says SEE HOW
CONTAGIOUS YAWNING IS.
YOU WILL FIND TRANSCRIPTS OF
Dr. CALDWELL'S MINIMEDICAL
LESSONS ON OUR WEB SITE AT
WWW.TVO.ORG/YOURHEALTH.
THAT'S ALL THE TIME WE HAVE
FOR THIS EDITION OF "YOUR
HEALTH."
I'M MAUREEN TAYLOR, AND
THANKS FOR WATCHING

(music plays)

A final slate reads "Your Health. Email: yourhealth@tvo.org. Fax: 416-484-4519. Mail: Box 200, Station Q, Toronto, ON, M4T 2T1."

The end credits roll.

Executive Producer, Patricia Ellingson.

Host and Producer, Maureen Taylor.

Producer, Cathy Perry.

Director, Michael Smith.

Logo: CEP Local 72m.

A production of TVOntario. Copyright 2002, The Ontario Educational Communications Authority.

Watch: Your Health Season 3 Episode 17