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January 20, 2008
Dr. Elmer Huerta
President, American Cancer Society
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Info: Dr. Elmer Huerta discusses the American Cancer Society. He was elected president of the American Cancer Society in fall of 2007. He is the first Latino to hold this position.


Uncorrected transcript provided by Morningside Partners.
C-SPAN uses its best efforts to provide accurate transcripts of its programs, but it can not be held liable for mistakes such as omitted words, punctuation, spelling, mistakes that change meaning, etc.
BRIAN LAMB, HOST, C-SPAN’S ”Q&A”: Dr. Elmer Huerta, what does it mean to be president, CE – are you a CEO or COO of the American Cancer Society?

ELMER HUERTA, PRESIDENT, AMERICAN CANCER SOCIETY: No, I’m the national voluntary president.

LAMB: What does that mean?

HUERTA: It means, for me, it’s an extraordinary honor. The first time in 94 years of the American Cancer Society that a person of Hispanic origin is elected to be the president – national volunteer president. For me, it’s an extraordinary honor.

It means that a lot of my time is going to be dedicated to the fight against cancer. And on the personal side, it is the opportunity to fulfill the promise I made to my mother before she died of cancer, that I would dedicate all my time to make sure that every American has the same access to health care, cancer care, that she enjoyed during her journey.

LAMB: When did that happen, and what kind of cancer did she have?

HUERTA: My mother had bladder cancer. That happened exactly 13 years ago. And this is very important, because bladder cancer is usually a condition that is found late, because it’s one of those silent cancers.

Once the diagnosis came, usually patients die two or three years later – with the best treatments.

My mother, she had early detection. Her doctor with a very good eye said, ”(INAUDIBLE), what’s going on with this leg? And why is she having urinary tract infections, one after the other?”

He did what we call a cystoscopy. He looked inside the bladder, and he found a very early cancer, so my mother lived 12 years. So she benefited from early detection, which is an important issue for a lot of people, because they don’t have no access to early detection.

Then she enjoyed life, she was very well. The time came when the condition restarted again, recurred. And then she had the need of treatment – chemotherapy, surgery. And then she had access to the best doctors that would treat this condition.

Everything happened in Peru. I’m a Peruvian by birth. She had access to the best doctors, the best organizations, the institutions. And she enjoyed good treatment that extended her life.

The time came when the condition was really advanced, nothing to do. And my mother told me, ”My son, when the time comes that I feel that you should let me go, I will let you know.”

I said, ”OK, mother, that’s fine.”

The time came. I remember one day in February of the year 2006 she said, ”Elmer, that’s it. Please do something, because my pain is unbearable.”

She was with injections of morphine here and there, all the medications that needed to control the pain, but it wasn’t enough.

”Are you ready, mother,” I told her.

”Yes, I’m ready.”

By this time she had what we call very advanced disease. The tumor recurring in the bladder extended to the pelvis, so it was incurable at that time.

So, what we did, Brian, was to give her what we call a morphine pump – a morphine pump. We put – we placed the morphine pump at noon time on Wednesday, in February. She slept the afternoon. The next day on Thursday morning, I had to come back to the United States, because of everything happening in Peru.

I peeked in her room. I said, ”Mother,” and she was awake.

”Come in, son,” she said. ”I know that you’re leaving, because you have to go to your home.”

I said, ”How are you doing, mother?”

And she said, ”I’m doing great.” ”Oh, really.”

She said, ”I didn’t sleep this well since you were a baby.”

”Oh, really. And what about the pain, mother?”

”The pain is there, but who cares about the pain?”

Starting that day, for three months, there was never a complaint at home. She would get all her friends and have toasts for her health and the health of other people, and she had a wonderful and a very human end. That is access to palliative care, Brian.

That’s what I promised her. ”Mother, I’m going to do my best to make sure that every person that crosses my path,” – every American, because I’m in the United States of America now, I’m a U.S. citizen, proud to be an American citizen – I told her, ”I’m going to do my best to make sure that every person has access to the same level of care you have during your cancer journey.”

LAMB: How do you define ”palliative”?

HUERTA: Palliative care – ”pallium” in Greek means pain, ”pallium.”

So, palliative care has to do with pain control, but goes beyond pain control. It also goes towards giving you quality of life – or in this case, quality of death. If you have symptoms that are really bothering your daily life, your routines, then you should have medications or interventions to mitigate those kind of problems – nausea or vomiting or diarrhea or pain or fever.

Anything that is bothering you during the last days of your life need to be controlled. And that is what we call palliative care.

LAMB: Where do you spend most of your time?

HUERTA: I am the director and founder of a very special health facility here in Washington, D.C., at the Washington Hospital Center. This is called, Brian, the Cancer Preventorium. This name, Preventorium, some people say, ”What is that?”

I told them, ”Do you remember in the history of medicine the old sanitoriums?”

”Oh, yes, I do,” they say. ”Isn’t that for mental health and for tuberculosis?”

Exactly.

In the 1940s, Brian, we used to have in the United States of America like 800 sanatoriums, places all over the country, where very sick people would get into just to die, because there were no cures for many of the conditions that affected them at that time. So, tuberculosis, mental health were conditions that used those sanatoriums.

Well, the Preventorium is exactly the opposite. To my Preventorium only apply well (INAUDIBLE), or I only see patients without symptoms. People there go the same way you take your car for a tune-up before your car breaks down.

So, patients, for example, they go to see me. I say, ”Hi. How are you doing?”

They say, ”I’m doing great.”

”Any symptom?”

”No.”

”So, what do you want from me?”

”Well, a checkup. And I would like to talk to you about how to eat better, because I’m not doing well in that regard.”

”OK.”

So, my consultation, Brian, is a consultation in which we talk about prevention – cancer prevention, diabetes prevention, heart disease prevention. Maybe we can talk about this a little bit later, how these three bigs – cancer, heart disease and diabetes – they share what we call risk factors.

Smoking affects the three of them. Overweight – being overweight affects the three of them.

So, I talk about prevention, and then I do screenings, following the guidelines of the American Cancer Society, trying to find out early conditions.

So, we see people with those symptoms, and we detect early cancer, hypertension, high blood pressure without symptoms, diabetes with symptoms, and many other conditions that are latent, but without symptoms yet.

LAMB: Are there any cancers that it doesn’t matter when you find them are fatal?

HUERTA: Not all cancers are fatal. Not all cancers are fatal. And that’s one of the big accomplishments I think we have made as a society – as, I would say, the American society – in controlling cancer.

Of course, we have to know that out of four cancers, three of them – 75 percent – they have means to be detected or prevented early. They are curable. You will find them early.

One – I am sorry. Twenty-five percent of these cancers are what we call ”occult,” hidden cancers, that may happen to anyone. For example, brain cancer. For example, leukemias, lymphomas, kidney cancer, pancreas cancer.

There is a list of cancers that are called occult, or hidden cancers, that unfortunately we have no ways to find them early. Therefore, when you find them – bladder cancer, my mother’s cancer – that when you find them, it is late, and usually they take the life of the person.

LAMB: There are three men running for president of the United States who have cancer, or depending on what you’d ask them, they might say they had cancer. Rudolph Giuliani, prostate cancer. John McCain has melanoma, and Fred Thompson has some kind of lymphoma.

HUERTA: Leukemia, lymphoma.

LAMB: Lymphoma.

HUERTA: He had a lymphoma.

LAMB: Thank you.

Should we worry about that, as these people are running for president and have cancer?

HUERTA: Well, we know now that cancer could be cured. Their conditions were found early, and probably they are safe to go for office and be president. That would be – I would say that they are safe. I mean, my personal impression is that they are cured for these conditions.

But what really worries me, Brian, is what’s going on with millions of Americans now that are not having to the same quality of access to cancer care that these three gentlemen probably have during their journey.

There are almost 50 million people now in America without health insurance. Cancer is one of the leading causes of bankruptcy in the United States as we speak.

LAMB: Personal bankruptcy?

HUERTA: Personal bankruptcy. Yes, bills from the hospital. If you get cancer and you have no health insurance, you are condemned to bankruptcy.

That’s why the American Cancer Society is now asking the American people to think about this issue, and when they go to vote in November they think about the candidate that better is going – suits their needs and change.

We don’t advocate right or left or up and down, no. We want change. Because at the American Cancer Society, we have a very clear mission – to decrease mortality by cancer by 50 percent, to decrease incidence of cancer by 25 percent by the year 2015.

And you know what? With the current state of affairs regarding health care, we will not get to those goals. At the opposite, we will go backwards.

LAMB: Didn’t Richard Nixon start a war on cancer?

HUERTA: It was a great thing. It was in 1971. It was before Christmas in 1971.

I think it ignited a movement, a wonderful thing, and we have good accomplishments. But what is going on in the last years regarding access to health care, Brian, is probably going to wipe out all the advancements that we have over the last 40 years in the history.

LAMB: How much money on a yearly basis does the taxpayer through the federal government spend on cancer prevention?

HUERTA: The budget of the National Cancer Institute, which is the leading organization in cancer research in the United States and in the world, the budget is around $5.2 billion for one year. Our viewers probably are remembering how much money we are spending now on other things – a week.

So, I think we need more money, definitely. We need to change the way we think in terms of cancer prevention and early detection, because that’s another issue.

We are great in treating conditions. Our health care system in the United States – and most of the world, I would say, Brian – is great in treating, because the center of this universal health care is disease and illness.

Once the illness comes, oh, my God, we’re great. We can operate, we can any part of your body give you treatments for this, for that. Why? Because the center of this health care universe is the illness, the disease.

Wouldn’t it be great if we kind of change that health care universe towards preventive and – to prevention, early detection, what we call health promotion? Can you imagine people going earlier without symptoms? Exactly the same way you take your car to the shop for the tune-up.

When people – what do you have? Nothing. OK. I do some tests on you, I ask you some questions, risk assessments. OK. You know what? You have the condition. It’s hidden still. Your blood pressure, look at this. My God, 160 over 100. You have any symptoms? No. OK.

By intervening, this person, I’m saving the government, everybody, a heart attack or maybe a stroke 20 years later. So, wouldn’t it be great to change the health care system toward the preventative side?

We’re not ready yet. We are not ready yet. I would love to see that happening.

LAMB: When a patient comes to you for the first time and they are asking all those questions and you’re giving them a checkup, what are the early indicators that there’s a problem?

HUERTA: For example, just by seeing them, I can see that person is overweight or obese. Big problem. Why? Because we know that being overweight or being obese is related to cancer, heart disease and diabetes?

LAMB: Why is it?

HUERTA: Well, for cancer, we probably – it depends. Cancer of the breast, for example, we think that the excess of fat tissue in your body acts as a little sponge that kind of sucks in the hormones. And these hormones are released very slowly. And that stimulates your breast tissue and that’s how you develop breast cancer.

Same thing happens with prostate cancer. We don’t know how it happens with colorectal cancer, but what initial observations that we have is that obesity is related to many types of cancer.

Diabetes, because this extra weight that you are carrying is making your pancreas to really work so hard that it comes a time when the pancreas says, ”My God. I cannot keep working. I cannot produce more insulin.” Then you become diabetic.

Or heart disease, because usually that person who has obesity is also a person with high cholesterol, high triglycerides, all these lipids. And that deposits in your arteries, and that predisposes you to heart attacks and strokes.

So, just by seeing that little thing, like I said, this person needs some intervention, needs some help.

LAMB: You mentioned the cholesterol. Isn’t Lipitor the biggest selling drug in the United States?

HUERTA: One of the best selling drugs. That is true.

LAMB: What’s it do?

HUERTA: Well, all these medications, they belong to a family of medications called statins. What they do is, they shut down the production of cholesterol in your liver. By shutting down the production of cholesterol, then your cholesterol level goes below 200. And that prevents in the future that this excess of cholesterol kind of deposits in your arteries, preventing strokes and heart attacks.

LAMB: And why do you think so many people in the United States are on Lipitor?

HUERTA: Because high cholesterol is a very prevalent problem. Number one and number – why is that? Because we don’t have the best food in the world. Trash food is king in America, unfortunately.

People, they just – because it’s easy, it’s cheap, people just go and just buy trash food all over the place. And trash food is very high in calories, very high in fat. So, that’s our king (ph) in many homes, you know, these two and three little bottles.

And so, that’s, I think, and (ph) it (ph) becomes because of what you are eating.

And also, Brian, we are a very sedentary society. The basic exercise that a lot of people do during the day is to push their remote control with a finger. That’s it. That’s all.

So, lack of exercise and bad nutrition, that leads you to overweight.

LAMB: How much money, if you had it all, would you spend on cancer prevention in a year’s time? Say, take the $5 billion. Would you move it to the patient, or would you move it to more research?

HUERTA: Well, given a universe of money, a pot of money, I would say that at least half of that money would need to go to cancer prevention and control, at least.

Currently, probably less than 10 percent of the money, five percent of the money – five percent is going to prevention.

LAMB: Five percent of what money?

HUERTA: The whole money.

LAMB: Of the $5 billion.

HUERTA: Yes. Because we are so much into cure. There’s a war on cancer that you have to cure. And we don’t realize that cancer is a preventable condition.

Talk about smoking – 440,000 people die because of smoking in this country every single year. That means 1,200 a day. That means in the hour we are going to be talking here, 50 Americans are going to die because of cigarette smoking.

That is preventable.

LAMB: How do you know that they die because of cigarette smoking?

HUERTA: Well, we have many studies that have been done in many places in the United States and all over the world. And a direct link between smoking and death has been laid out. So we understand that, for example, out of 100 people who die because of smoking, 30 die because of cancer, 60 die because of heart attacks and strokes, and 10 percent because of emphysema.

LAMB: What is it that kills them from the smoke?

HUERTA: Well, smoking – the smoke has at least 4,000 chemicals – 4,000. Out of those 4,000 chemicals, a number that goes around 250 are carcinogenic, meaning causes cancer.

But in addition to that, it has carbon monoxide that decreases the amount of oxygen in your blood, and that causes damage in your heart.

And cigarette smoking also has tar. And tar is like a little painting that you are putting inside your respiratory tract, and that gives you cancer.

So, we know. We understand now that all these components of cigarette smoke really cause disease and death.

LAMB: Go to the tar. How does that directly cause cancer inside your system?

HUERTA: Well, tar – they have molecules that have been shown that can start what we call the differentiation process in your cells, in your epithelium. The epithelium is the surface liner in your bronchi. This very delicate epithelium, they are insulted every day because of this tar. So, the carcinogenic mechanism, which goes from what we call promotion of cancer to the starting of the cancer to the multiplication of the cells, is triggered by the chemicals in tar.

LAMB: Why is it that a country that has proven, according to you and others, that smoking causes cancer and heart disease, allows that process to continue. And then insurance companies pay for the result of that, and the federal government pays in Medicare for the result of that.

Why wouldn’t – and I know we’ve been through all these lawsuits and everything with the tobacco companies. Why do we keep doing this?

HUERTA: Well, it is a very difficult question to ask, Brian. But I would say is the power that the tobacco companies have here in the U.S. and all over the world. They are companies that are extremely powerful, very politically well connected. And they also run in one, I would say, kind of very simple thinking, which is freedom. You are free to smoke. So, for many years, that was their little (ph) (INAUDIBLE). And they would say freedom.

Once we demonstrated that it wasn’t really a freedom, but at the opposite, it was slavery to nicotine, which is a drug which is more addictive than cocaine and heroine, then when this course started to change.

But I would it’s the power, it’s the economic power that these companies have that in the name of freedom to do whatever you want with your body, they are just – they have a green light to keep selling their products all over the world.

LAMB: Why are they so powerful, and how do you see the power being used?

HUERTA: Well, every time a bill is introduced in Congress to, for example, now regulate nicotine as a drug for the FDA, you see the power of the tobacco industry fighting with the power of the health organizations. You see their lobbyists are extremely powerful, and they are introducing all the time amendments to your bill trying to weaken it.

And so, they work very hard. They are very smart people, that they know how to do their job well done. And if you are in that fight, you can see their power, because they are there. And they invest a lot of money, because it’s their economical interest.

LAMB: Would you say they buy their access? Do they buy their power?

HUERTA: Well, the word ”buy” can be interpreted in many ways. But if somehow – and this has been in the press, the popular press, you know, all these big trips that many politicians they take to many places in the world, are financed by the tobacco companies.

And if you have a client like that, that is helping you somehow in doing something for you, you may want to reciprocate in the future, being nice to their views. And if you have some legal ways to justify what you are going to do, then you do it.

LAMB: When did you leave Peru and come to the United States, and why?

HUERTA: I left Peru almost 20 years ago. Brian, I’m a medical oncologist by training, meaning that I used to give chemotherapy to patients with cancer.

Being in Peru 20 years ago, I realized – and I was already practicing medical oncology – I realized that most of the patients that were sent to me for chemotherapy have very advanced cancer.

But you know what really, really broke my heart is that most of these conditions, Brian, were either preventable or detectable.

So for me to give chemotherapy to a woman with cervical cancer, which is a condition that can be found 10 years earlier just by doing a simple PAP smear, was heartbreaking.

A woman would come with a huge tumor in her breast. And when I would ask these people, ”Do you know what a PAP smear is,” these women would say, ”Isn’t that things that doctor do in your throat, Dr. Huerta?” She didn’t know.

But at the same time, it was amazing, the same woman, when asked, ”Did you watch last night’s episode of ’Simplemente Maria,’” – a very popular soap opera – the woman, she was in pain because of the cancer, she would say, ”Oh, yes, Dr. Huerta. I saw, I watched that episode. And you know what? Jose is going to marry Maria. She’s so nice.”

And she would know the whole soap opera by heart, the plot.

See, how is this possible? How is it possible that these people, they don’t know simple health facts that are leading them to these terrible health conditions, but they are so knowledgeable on soap operas and entertainment, on Madonna, Michael Jackson?

Why is that? Because of the media. Because the media bombards relentlessly these communities with entertainment messages (INAUDIBLE).

So, it was 20 years ago. And I took a very tough decision, which is to leave medical oncology. I left medical oncology as a specialty to dedicate my life to cancer prevention and control, because after those observations, for me the solution was to confront cancer, fight cancer by early detection and prevention, number one.

And number two is that I, because of the influence of the media that I saw, I said, ”I’m going to approach the media to see if the media can help me to spread the message to empower people to act.

And that’s what I started to do. In Peru I started to have radio shows and television shows. And I came to the United States, because at that time 20 years ago, the only place in the world that would provide formal training in cancer prevention and control was the United States, right here in Bethesda and the National Cancer Institute.

LAMB: You got your basic undergraduate degree where?

HUERTA: My basic undergraduate degree was in Peru, my specialty in internal medicine in Peru, my medical oncology training in Peru. So, when I came here to the United States in 1989, I had to repeat all over again all that stuff, in order to get my credentials, and in order to get my new specialty.

LAMB: Where did you get that?

HUERTA: I went to Baltimore, to the hospital by the name St. Agnes Hospital – a wonderful hospital which is affiliated to the Johns Hopkins system. At least it was at that time.

And then, after finishing my internal medicine training – again, here in the United States, I had to repeat it – I went to the National Cancer Institute to do a three-year fellowship on cancer prevention and control.

And the start of this three-year program, I was very fortunate, because they sent me to Johns Hopkins to do my master’s in public health, which is the place I saw the light. This is public health is what I was always needing. I didn’t know about it.

LAMB: When did you first get involved in the American Cancer Society?

HUERTA: Oh, this is very funny, Brian. It was sometime in the ’70s. I was in Peru, a medical student. A brochure came in my hands. I looked at this brochure – a beautiful brochure. It was for cancer education.

”Oh, my God,” I said. And then I saw the logo of the American Cancer Society, the little sword. ”My god,” I said. ”Who is this people who put a lot of time in putting this thing for patient education?” I never saw that before.

That was my first contact with the American Cancer Society, in the ’70s in Peru.

Then, here in the United States in 1989, as soon as I started my residency program in Baltimore, I was approached by the Maryland division, at that time. And they asked me to be a volunteer. For me, it was like they were inviting me to go to heaven, because I had such an admiration for this organization, that when they told me, ”Dr. Huerta, would you like to volunteer for us,” I said, ”Immediately.”

And that’s how I started my volunteer work with the American Cancer Society, in 1989.

LAMB: So, what kind of responsibility do you have as president, volunteer president?

HUERTA: Well, the volunteer president is the person who is kind of the medical face of the American Cancer Society, for the American people during one year. In addition, we run some committees that has to do with the working of the organization.

And also, we try to come up with some ideas that you may have during – in other words, what kind of things can you contribute for the American Cancer Society. And in that regard I have two ideas that are in the works to make it possible during my year.

The first one, Brian, is that I want to see the American Cancer Society be much more proactive in reaching out to the American people. We have, for example, a 1-800 number, which is wonderful, 24 hours a day, seven days a week. You call there and you get advice on cancer.

LAMB: From?

HUERTA: From specialists.

LAMB: Nurses? Doctors?

HUERTA: We have specialists, people who have been specially trained to go through these computer programs and answer your questions on cancer. They are specialists, health educators.

Well, but usually that phone call comes from a person with cancer in the middle of the night, during the day. ”I have cancer.” OK. We guide them, and we are wonderful in that. I am so proud of that.

LAMB: How many people are on staff doing that in the middle of the night?

HUERTA: Well, we have, I think on the night shifts, we have at least 25 people working overnight. And during the day it’s huge. It’s a football field sized, huge, immense place in Austin, in Texas. I’m very proud of that.

Then we have a Web page, cancer.org. Wonderful information. But also, again, mostly used by patients with cancer.

So, given what I have done with my life, given the result of what I have achieved using the media, being proactive, being on the face of people every single day with my radio programs, with my television programs every week, and seeing that people, they can really change knowledge, they can change attitudes, they can change behaviors by being bombarded with messages.

I would like the American Cancer Society to be more in the face of people with these new technologies.

LAMB: Where is the American Cancer Society headquartered?

HUERTA: Atlanta, Georgia.

LAMB: How much money a year does it cost to run it?

HUERTA: The budget, the annual budget of the American Cancer Society is around $1.1 billion now.

LAMB: Where does the money come from?

HUERTA: Eighty-five percent of our money comes from donations from the American public.

LAMB: From individuals, or from …

HUERTA: Individuals.

LAMB: … large corporations?

HUERTA: Individuals. And the single – this is important – the average donation is only $45.

LAMB: What’s it cost to belong to the society?

HUERTA: The cost?

LAMB: Yes. Is there a yearly cost, if you are a member?

HUERTA: No. Actually, you are a volunteer.

For example, I’m a volunteer 100 percent of my time.

LAMB: But I mean, if, for instance, if somebody wants to join the American Cancer Society and contribute?

HUERTA: Oh, they – ah, well, we don’t ask for membership, if that’s what you mean. No. This is not a membership organization. This is a voluntary organization.

So you want to, for example, be a volunteer and say, ”I would like to be at your office in downtown Silver Spring, Maryland, giving some food for some people. I would like to just donate to you. How can you use me?”

We can use these volunteers, but that may be the only thing they do during the year.

LAMB: How many people are on staff, and who runs it?

HUERTA: The CEO of the American Cancer Society is a man that is really admired by a lot of people in the United States. His name is John Seffrin, Dr. John Seffrin. He is our CEO.

And he’s really leading the organization to where it’s very, very high, high, high steps (ph). And we have a staff that is distributed all over the United States. We have divisions and all over the United States and the territories. And we have four million volunteers.

LAMB: How many local offices around the country?

HUERTA: We have offices at every single county in the United States. We have offices – big offices – in, for example, Atlanta, in Baltimore. But we also have little offices in counties all over the United States..

LAMB: So, you have more than 3,000 offices around the country.

HUERTA: … yes.

LAMB: The National Cancer Institute is operated by what group?

HUERTA: The government.

The structure is like this. The Department of Health and Human Services, right, this is the Cabinet position of the president. This DHHS, the Department of Health and Human Services, they have some big, big components. One of those, for example, is FDA. Another one is NIH, the National Institutes of Health. Another one, for example, is SAMHSA, alcohol and tobacco. Then we have the Medicare and Medicaid services.

Out of the NIH, the National Institutes of Health, are like 27 big institutes. One of those institutes – actually, the largest institute of the NIH – is the National Cancer Institute, which, as I explained to you, is a federal government organization.

LAMB: So, go back to your practice. How many days a week do you practice?

HUERTA: I see patients three days a week.

LAMB: How many patients?

HUERTA: Four (ph) days. And we see around 20 to 25 patients a day. We start early in the morning, around 8:30 in the morning, and we go until 5 p.m. in the afternoon. And we do these checkups, as I told you. That’s what I focus my practice, which is early detection and prevention.

LAMB: Who comes to you?

HUERTA: The person – 85 percent of my patients are people without symptoms at all. So, people who really have understood that they need to prevent and detect early, any condition. That’s number one.

Regarding demographics, because most of my radio programs and my television programs are in Spanish, my patients, 90 percent of my patients are Latinos.

LAMB: But let me just for instance. If I called you and said I want to come in for a checkup, can I come in?

HUERTA: Well, sure. I can give you an appointment, and you will have your appointment. And you pay your $120, because we don’t work with any insurance company. And paying (ph), I will give you the service …

LAMB: How long will it take …

HUERTA: (INAUDIBLE).

LAMB: … to get an appointment with you?

HUERTA: Now it is backed up. It’s at least two or three months’ waiting lists. And the reason is that, I tell people, you are fine. You are healthy. So, it’s like your car. Ready (ph) for your tune-up.

And people do that. They understand that, because this is not an acute service model. You see, it’s a preventative service, so you can wait.

LAMB: Where do you do – and we have some video of this – your television show?

HUERTA: Well, the television show is a program. It’s one hour. It’s live. And what we do there is try to talk to people.

My objective is to empower people to know how to talk to the doctor. People, they should know how to talk to the doctors, ask the right questions, provide the doctors with the right information, so doctors can take the right decisions.

So the objective of my show is really to empower people by giving them knowledge. Remember that by giving knowledge to any person, then you can change attitudes. And by changing attitudes, then you change behaviors.

LAMB: Where do you do this show?

HUERTA: For example, what we are watching there is that my computer has a presentation. So I do a PowerPoint presentation every week on different issues, for example, what is colonation (ph). For example, at the beginning of the year we talk about what are the 12 steps that you need to follow this year in order to have good health. And all the presentation would be cigarette smoking and cancer – things like that.

So, that presentation usually lasts for seven minutes, and then we talk to people, questions from the audience and responding to them.

LAMB: And where do you see this?

HUERTA: This show originates in Virginia, in the network called MHz Networks. And we are distributed in the satellite all over the United States.

LAMB: And who can see it, and how can they see it? Are you on other – is it Latino stations?

HUERTA: No, it’s – the network’s name is MHz and they are in the satellite and the dish network satellite system. So, this is an international channel. They have programs in many other languages.

LAMB: And if somebody wants to reach you to be able to see these programs, where do they go?

HUERTA: Well, we have a Web page. We have a Web page. The name of it is ”Prevention.” The word ”prevenciσn” in Spanish means prevention. So it’s prevencion.org. So, they can send me e-mails. I actually get a lot of e-mails asking me questions and things like that.

LAMB: Let’s go back to where we were before, and somebody comes to your office for this checkup, and you first look at their weight. What’s the second thing you look at?

HUERTA: The second thing is their attitude. For example, that’s important for men. Sometimes – most of the time, I would say – the man is kind of irritable, bad humor. I say, ”What’s going on with you, sir?”

And he says, ”Well, you know, Dr. Huerta, you do whatever you have to do, but do it quick.”

I say, ”If you’re in this bad mood, why are you coming here?”

And he says, ”Listen. If I don’t come here to have this checkup with you, that woman outside, my wife, she wouldn’t even feed me.”

That tells me that that man has not understood anything about prevention. He’s there, because the wife is bringing him to the clinic.

That is attitude, Brian. And that’s something that we all need to change towards prevention.

LAMB: Why men? And you know that this is – men often don’t want to go to doctors.

HUERTA: Exactly.

LAMB: Why do they not want to go to doctors? And why do women go?

HUERTA: We don’t know. But June is the month of men’s health, and they do shows on that month on this issue. What I found is that it doesn’t matter if you’re a black man, a white man or a Chinese man or a Latino man. All men, independently of their race, we don’t like to see the doctor.

We always wait until the very end. We neglect our own care.

Why? Some people think it’s because of this machismo thing that men have been brought up as very macho, and you don’t cry if you fall down. Nothing’s going to happen to you.

You see, men, I would say – I don’t know. I think it’s the way we were raised, that we believed that nothing is going to happen to us, because we are men. We are very strong.

LAMB: For this $120, $125, whatever, what else do you get? Do you get any kind of tests, any diagnostic tests, or just your attention?

HUERTA: Number one is the questions, all these questions about your risks, et cetera.

Then number two is the examination. I examine people from head to toe, as they say – complete physical examination. And a lot of people, they get very surprised by it, because, for example, for men, they – a doctor in their whole life, they had never touched their testicles. Never.

That tells you about the quality of care they received in the past.

After the examination, in which we teach women how to do the breast self-examination, we do the PAP smears, all that stuff, comes the counseling phase.

But what I want to stress – maybe it’s important for our audience – is that, Brian, there are only four tests that have been shown to be of any value in detecting cancer. Not even the fingers of my hand can count (ph) these tests.

Number one is the PAP smear. Every woman after the age of 40 – I’m sorry – every woman after their first sexual intercourse, they should have a PAP smear every year.

Number two is the mammogram. After 40 years of age, the woman should get a mammogram every single year.

Number three is the PSA for men. PSA and the direct examination among men. Even it’s some controversy right there – we can talk about that later – but that’s a test we do.

And number four, every person over the age of 50, we provide them the fecal occult blood examination and a colonoscopy, if necessary.

Only four tests. So, that is not expensive at all.

LAMB: So, how often should people have those four tests?

HUERTA: Well, regarding the PAP smear, the guidelines say, if you have three negative PAP smears, you can do the PAP smear every two or three years afterwards. The mammogram is every year after the age of 40 until the age of 75, approximately.

The PSA starting at the age of 50, every year. And the fecal occult blood every year, and the colonoscopy once every five to 10 years, if normal, if it has been normal the first time.

LAMB: What if you don’t have insurance?

HUERTA: Great question.

Most of my patients, they don’t have health insurance. So, what I told them through the media is, number one, you know what? You have to exercise your personal responsibility. You have to take care of yourself. Don’t wait anybody to help you. Don’t wait for any government program. Don’t wait for any charity. You do it yourself.

Maybe this year, you are not going to buy a dress or show you like, but you know what? Put your money towards your health as an investment.

Maybe with this money you buy your checkup. Because I told my listeners, in this country the worst thing that can happen to you is to get sick. If you get sick, you are on your way to bankruptcy. And what a shame, if that condition that is leading to you to bankruptcy is preventable or early detectable.

So, exercise your personal responsibility. Pay yourself your checkup.

Once they get a condition, we have a system. You have a navigator in my clinic, and we find hospitals, local doctors that they treat the conditions that we find. But because they’re early, Brian, they’re much more affordable than had we found these conditions late and advanced and incurable.

So, for example, if I find an early cancer in the cervix, the woman says, ”OK, Dr. Huerta. We got together with my family. We have no health insurance. They told me that the price is this. We can afford that. I went to the hospital. I’m going to pay.” That’s it. So, they pay it.

Of course, ideally, it would be society who would take care of these charges. But because we are very far away from this kind of preventative model, that’s what I tell my patients and my listeners. Do it yourself – personal responsibility.

LAMB: I’ll bet you won’t want to answer this question, but maybe I can try it anyway.

What’s the worst kind of cancer that a doctor can tell you, you have?

HUERTA: Well, just the word cancer really is terrible. Yes, it’s devastating for a person just to know that he or she has cancer, in general.

LAMB: How many are there, by the way?

HUERTA: Oh, at least 200 types of cancer. That’s why when we say ”cure for cancer,” it’s kind of a misnomer, because there’s no cure for cancer, because there are cures for 200 different types of cancer.

But I would say, one of the most aggressive types of cancer is one cancer from the skin called melanoma, malignant melanoma. That is one of the most aggressive kinds of cancer.

But any cancer, Brian, could be extremely aggressive. And this is important. For example, breast cancer or prostate cancer, by this means (ph).

Even men, if we do autopsies in men in their 80s, who died because of diabetes or a car accident, whatever, 37 percent, they have prostate cancer that never gave them any sign. Whereas you find in men which is 52, 53, and he is found to have prostate cancer, but once they found it, this just disseminates all over the body, and he dies very soon.

So, there’s a difference between the aggressive kind of prostate cancer and the indolent form that can be with you forever. You die from many other conditions but prostate cancer.

LAMB: Go back to what you said earlier about women and breast cancer, or the whole idea that weight can be responsible for it.

There are people I’ve known who are slim and trim and in shape who have – they get breast cancer or ovarian cancer, and all that, and it has nothing to do with weight. Where does that come from?

HUERTA: It’s actually – well, that question goes towards saying for some of the smokers, and there are a lot of people, they smoke a lot, but they don’t get cancer. They don’t get heart disease. And there are many other people that they don’t smoke, and they get lung cancer, and they do get lung conditions.

So, in addition to obesity or what we call the risk factors – smoking, being obese, sedentary life, et cetera – there are genetic conditions, the genetic predispositions, as we call, that make you prone to develop a certain kind of cancer.

Now that I talk about genetics, a lot of people think that most cancers are hereditary, and that is not true. But only five to 10 percent of cancers that happen in the United States are hereditary, meaning that your mother, your father or somebody in your family had it.

LAMB: Which most often is hereditary?

HUERTA: Oh, for example, breast cancer, prostate cancer, lung cancer – now we’re seeing probably pancreatic cancer – that are related to heredity.

LAMB: It seems like – and I’ve had friends die of this – but when you hear the word pancreatic cancer, it’s trouble.

HUERTA: It is trouble. Unfortunately. And this is amazing, because it’s the fourth cause of cancer. I’m sorry. It is the fourth cause of death due to cancer – pancreatic cancer – both for men and women, after colorectal cancer.

But we have no means to detect it. And by nature, these cells are very aggressive, and they are unresponsive to chemotherapy and radiation therapy.

So, only the very few men or women who are ”lucky” to find it very localized, and they undergo a very extensive operation that lasts for six or seven hours of surgery, they save their lives.

Unfortunately, most of the patients with pancreatic cancer, like Pavarotti, for example, they die two years after the diagnosis, approximately.

LAMB: Back to your responsibilities with the American Cancer Society, you’re president. What’s the difference between your responsibility and your chairman’s responsibility?

HUERTA: Well, that’s a great question.

We, the board of directors of the American Cancer Society, are a very diverse group. So, there are what we call the medical volunteers, which I’m the president of, the medical side. And we have the lay side of volunteers, usually lawyers and accountants – all business people – and they elect a chairman of the board.

So, the chairman, which is the representative of the lay volunteer, and the president, which is the representative of the medical side – we both share the responsibility of directing the meetings and just in the operation of the organization. Of course, with the CEO – in this case, Dr. John Seffrin.

LAMB: How much of the $1.2 billion that you raise is spent on fund raising?

HUERTA: We are very into what we call the average spend that an organization of this size should need to spend in order to raise funds. I don’t have the exact number. But in the last report that we had, which is a report given by the organization that watches all these philanthropic organizations, our spending for fund raising is below average.

LAMB: But isn’t it somewhere around 20 percent?

HUERTA: I would say this – I think it’s less than 20 percent.

LAMB: Is that something you want to reduce?

HUERTA: Well, an organization should dedicate most of their money to the programs and the mission. And, of course, we need to raise some funds. But it is also important that the money be spent in programs and toward the mission of the organization.

LAMB: So, what is the money spent for?

HUERTA: For example, we do – we’re an organization that are the only organization in the world that has given initial support to scientists that in 43 occasions went to get the Nobel Prize in medicine. So, we do a lot of money to research, and we are committed to research.

But we also do programs for people with cancer. We have a variety of programs, for example, for people with cancer – the look good, feel better programs, programs for survivors. So, we have these call centers I told you. So, we have a lot of support for people with cancer.

And we also do advocacy. Advocacy is one very good way to really make things change in our country.

LAMB: You hear from time to time that pharmaceutical companies spend as much as $1 billion to develop a drug. Is that true?

HUERTA: It is probably true.

LAMB: Is that?

HUERTA: Yes, it is true, I realize.

LAMB: Why? What in the world do they spend their money on?

HUERTA: Well, they need to really invest a lot of money in trying to do many experiments, trying to define many molecules, because there are so many chemicals around that they need to really define which one is the chemical that is going to act, what kind of action, the side effects. So, the money is spent in cancer, in developing drugs is enormous, definitely yes.

LAMB: What has the American Cancer Society done in the last 20 years, since you’ve been here, that has changed the cancer outcome, that’s helped people live longer? (INAUDIBLE) getting specifics?

HUERTA: Yes. Number one, tobacco, for example, tobacco control. We have been very big supporters over the last, I would say, 40 years of tobacco control.

Now, more than 20 states are tobacco-free, completely tobacco-free. And the American Cancer Society has really devoted a lot of time and energy to make sure that tobacco control is one of the pillars of our work.

LAMB: Does the American taxpayer still pay for tobacco price supports? Do we still help the tobacco farmer continue to grow it?

HUERTA: The last time I checked, that was going to be taken out, but probably there are some states that are still maintaining that.

LAMB: What else have you done as a society?

HUERTA: We have promoted early detection and cancer prevention. For example, we have done – we have really worked making sure that PAP smears, that mammograms are tests that are used for millions of people in the United States, millions of women.

We have a lot of educational programs. For example, we have these national nonsmoking days, the smoke-out day in November, which is a tradition that has gone for the last 20 years and is a wonderful program that makes people aware that smoking can be deadly to you. And millions of people haven’t smoked because of that.

LAMB: Just this week, if you picked up the ”New York Times” mid-week, it had a big front page story about a prostate test that you can have, a person, outside of the PSA test that might predict, based on your genes that you’re going to get it or not get it.

What do you think of that?

HUERTA: Yes, (INAUDIBLE) view, that is a single (ph) study done in Sweden, and they analyzed the genomes. They analyzed the genes of almost 3,000 men, and they compare – with prostate cancer – and they compare those genes with men without prostate cancer.

And they found that certain what we call ”snips,” certain characteristics in those genes make these men more prone to have prostate cancer – five times more prone compared to the men who do not have those changes in their genome.

And if those men have a family history of prostate cancer – a father or brother with prostate cancer – if they have also those changes in their genomes, they may have up to 10 times higher risk of developing the condition.

So, what I think is that this is the beginning of what we’re going to see in the next years, which is molecular biology, the personalization of detection and treatment. Maybe in the future, just by taking exams like this, they are going to examine your genome, and they may tell you that you have certain risk, but not only the risk, as we are learning in this case, but also the kind of cancer that you are going to get. Because remember when I told you prostate cancer can be a very indolent condition that you can live with for many years. But prostate cancer can be also a killer.

So, these tests may tell you, you need treatment right away, because this is a very aggressive form. We haven’t gotten to that point yet.

LAMB: How do you personally with – have you ever had cancer?

HUERTA: No, I don’t.

LAMB: So, what do you – what’s your lifestyle like? Do you smoke?

HUERTA: No, I don’t smoke. I exercise, and I …

LAMB: How much?

HUERTA: It goes on and off with my travel, and sometimes it is difficult, but I try to exercise at least three times a week, if not five days a week. I do the treadmill. That’s what we have at home.

Then I try to eat everything, Brian, but small portions. I try to be very conscious about the size of my plate. But I eat everything.

Then, of course, I don’t smoke. And I try to be in places where people don’t smoke.

And then, I see my doctor – of course at a hospital, we have to go every year, but my doctor – to have my checkups. So I had all the tests that are appropriate for my age. I have my own colonoscopy, which I filmed for my television show, and they show it to my viewers. So I have done all the tests that people need to have in order to find the detectable cancers.

LAMB: Do you eat fried foods? Do you drink?

HUERTA: I eat everything, but I try to be conscious with the size of the portion. So, for example, we have this delicious South American different kind of dishes. Some of them are fried. I eat them, but try to be very conscious with the amount.

Regarding alcohol, yes, I do drink. My favorite is port. I love port, but small portions. Less than two drinks a day is what I do.

LAMB: And so, what do you guess the next couple of years are going to mean for cancer?

HUERTA: Well, cancer – I think we are going to have some problem in the United States, Brian, with something that doesn’t have to do with the biology of the tumor. And that thing is called access to care.

We’re going back to the access to care issue.

If you have millions of people that are delaying their visit to the doctor because they have no health insurance, and once they see the doctor their condition is advanced, because cancer is silent, then you have early death, premature death.

Actually, we just published a paper, the American Cancer Society did. You know, we have problem for the very first time, Brian, that lack of access to health care causes premature death in America, the same way smoking causes premature death.

If you have a person without health insurance, that one person is 160 percent more prone to die of cancer during the first five years of diagnosis compared to a person who does have health insurance.

So, not having access can kill you.

So, if we don’t fix this problem of health care now, if you don’t fix this access to care problem, we are going to have a lot of problems in the next five to 10 years.

LAMB: Dr. Elmer Huerta, president of the American Cancer Society, thank you very much for joining us.

HUERTA: Thank you, Brian. I really appreciated your time. Thank you.

END




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