(Intro)

I'm told I'm on.  I'm just Tweeting it because nothing is real unless it's been Tweeted.  And now it has been Tweeted.  Yay!  We apologize for all the issues last week besides my being like, at death's door, I apparently also infected the equipment and it wouldn't work, so we'll try again and hopefully you're all watching this week.  Thank you so much for tuning in.  HCTMerch.com.  Right?  Yes, yes.  'Cause we'd love for you to buy a mug or poster.  Go support us on patreon.com/healthcaretriage.  We're already late, I'm just gonna start.

Amanda Treadwell asks, "Amber necklaces?  I have a few friends recommending these for a teething child.  I keep thinking choking and strangulation hazard.  Thoughts?"  

My thoughts are, you are correct.  Why?  Why?  So amber necklaces, evidently they're these, like, they make like, they put the beads on necklaces and kids are supposed to chew on it and evidently it's the chewing on it, it's supposed to release enzymes or compounds or something, oil, something that's supposed to soothe--why?  No!  No, no, no! 

No, first of all, it's like, would you--do you really want your kids gnawing on stuff and just getting whatever seeps out of it?  That doesn't seem like a good idea, plus this is a monster choking hazard.  You know, like, they get, they manage to chew off one of those beads or pull it off and they're gonna choke, or, you're right, they got a necklace on and they could strangle themselves.  It's like, we don't even want a blanket in bed with babies, 'cause we're worried, but you're gonna give them like a choker with little choking hazards on it?  That's insane and why amber? 

I mean, if your kid's in pain, talk to your doctor.  We have medications for that.  You know, I'm not suggesting children should be in pain, you know, and sometimes, we used to just have them gnaw on frozen things, 'cause the cold makes their teeth feel better.  I know I'm stealing this from a comedian, I can't remember which comedian, but we used to like, give them frozen waffles and the joke was like that the, that the indentations are like natural drool cups to catch the drool, but regardless, no on the amber necklaces.  No, no, no, no, no.  Do something else that's reasonable.  

Amanda- [coughs] -I apologize, I'm still getting over my flu, it's rough.  Amanda Cook asks, "In The Martian, Mark Watney survives for a long time on just potatoes, water, and vitamins.  Probably not a great idea, but is it possible?  How long until you'd run into major medical issues?" 

So, from what I gather, the author of that book did a lot of research to see, to make this as realistic and believable as possible and he, I know he actually like, talked to botanists and stuff, so I'm gonna guess that whatever Mark Watney did, it's possible to survive.  Of course, survival is not the same as, you know, happy living.  He prob--I'm gonna guess that the vitamins took care of, like, whatever like, you know, amino acids he certainly needed or whatever else was extra.  You know, the potatoes would work as a source based on everything else and maybe given enough carbs, you get through.  I don't doubt by the time you get off Mars, you know, he was suffering, but people starve all the time and at least he was being fed and had some vitamins and water and so I think it's possible. 

Hotrhetoric asks, "How do you know when to have a mole checked out?  Is it better to get a suspicious mole checked out sooner or can it wait?"  

If you're asking me, you should have it checked out.  It seems like a good rule of thumb.  If you're worried, then ask.  The, you know, best case scenario is that your doctor's gonna look at it and be like, no, don't worry about that.  On the other hand, it might be concerning, so I would not wait, you know, get it checked out.  Again, checked out is the baseline.  I'm not saying get it biopsied, I'm not saying get it scanned, I'm not saying run labs, but you should have at least a doctor look at it, or healthcare provider look at it. And especially I would never tell you to wait considering that I've never seen it and I don't know anything about your history or what it looks like, so you shouldn't be getting advice from YouTube anyway. You should be getting advice from real healthcare professionals we say every week. Do that!

Leah78 asks a book here, that I'm gonna summarize. "I see quite a few questions on healthcare triage live starting with some sort of diet drinks, supplement, activity and ending with a question 'is it better for me'" at which point I seem to always answer the questions with "no" cause there are no studies linking those things to positive differences in health outcomes.

Leah78's problem is that he thinks or she thinks people don't want to know always about health outcomes but mood, comfort, energy, you know softer outcomes and things like that. Then that, maybe you'd be less susceptible to all product that claim to make you feel better you want to see this addressed.

Look, most of the time I'm addressing the hard outcomes of health because that's the promises that are being made. And if that's the promises that are being made, I'm going to investigate them. For instance when I drink hot tea it's not because Lipton has put an ad out saying it's gonna cure my cancer, or it's gonna improve my diet. It's that I like hot tea and it makes my throat feel better and we don't need a study for that because there's no harm, it's just you're going to do it if you like it, and it costs like pennies, and that's awesome all the way around.

My problem with all these supplements and diets and drinks and activities is that they're promising the moon. They're not saying "hey, you know buy this acai berry because it tastes good" or "because you know what if you like it and you drink stuff you like you might have a happier life" that's not what the ad says.

The ad talks about your antioxidants, and your risk of cancer, and improves brain health, and you're gonna be smarter blah. None of that is true none of that is improving. So, low level stuff like "it's gonna improve your mood", "it's gonna, you know, give you some energy" Yeah, yeah, coffee, this [holds up cup] improves my energy. But it's not marketed as like a magic "whoo" kind of solution, it's caffeine. It works.

And I know exactly what I'm doing and I'm paying exactly the market value for what I think it should be, and I'm overpaying because I went to Starbucks. You know you could go and get this dirt cheap and still get your caffeine. So, that's the problem.

So... and there not going to be those studies because that's not what they are trying to market on nor is anyone disputing this. Always we should be weighing the harms, we should be weighing the benefits. And if the benefit... and the harms are negligible, like none. Like it's a beverage, it's not going to harm you. We know exactly what's in it, there's nothing wrong with it. And the cost is low, because even the economic cost can be a harm. If there's no harm, then any benefit you might get from it – even if it's a personal "I like the taste" benefit – is going to outweigh the harms. Go, do it.

I like somethings... I like Scotch, and it can even cost like 40, 50, 60, 70 dollars a bottle. I'm willing to pay that. But there's no ads out there telling me it's gonna make me healthier or promising any kind of things. I just like it and I'm willing to spend – which is the harm – money on it because that's what it's for me. And I'm not gonna sit here and preach that you should do it, cause I don't know if you'll like it. But you know if we're talking about just like local personal mood, comfort, energy things like that, we don't need a study.

You know what works for you, you know what you are willing to spent for it. That's where it starts and ends – if there's no harm. The problem is when they make this claims about gross benefit for everyone. That's where it gets into problems. And that's what we are trying to dispel here on... [screen freezes 7:40-7:55]

...these are different parts or pigskin because it most naturally mimics human skin. And then, they leave some empty, they use some Neosporin, they use some hydrogen peroxide, they use some other stuff. Neosporin actually results in quicker healing, and better scar, and everything sort of better overall than doing nothing. Because it's better to keep a would moist and covered, and Neosporin helps with that. It also has, you know, antibacterial properties cause it's got antibacterials in it, so it's gonna help you in that respect as well. So, yes, now like "so much so that you're gonna notice monster differences" and I said "every cut has to be covered in Neosporin," no.

But, you know, if you're gonna cover it, and if you're gonna, you know, cover it with Neosporin to keep it sort of moist and covered and then cover with a band-aid that is the way to sort of achieve optimal wound grow... optimal wound healing. You could do that with things other than Neosporin as well. Aloe seems to work with burns and some other things you can do as well, but Neosporin is good.

Derekzoo "Learning about healthcare and systems in the United Stated and now the creation of Medicare and Medicaid had an enormous impact and hospitalization rates in the U.S. which also increased reimbursement rates. Could you help me understand reimbursement rates and it's connection to health care costs or hospitals" and all this other stuff.

So, this is such a big question we could spend hours on it. So, yes, Medicare when it was first passed it was demonised by the AMA and many other groups because they thought it was a government  takeover of healthcare.

They even got Ronald Reagan to produce this like – I guess it's like a podcast that you would call these days – it was these ads that people would play you know on... there was a record and it talked about how it was the end of days (?~9:35) end in Doctor salaries in the 70s and 80s, and you know now that we are trying to slow that down it's still... we still do an enormous amount of spending in healthcare and Medicare... Medicare and Medicaid, some of that is on reimbursement rates, but it's not entirely on reimbursement rates and it is complicated.

And as they've tried to slow reimbursement rates in Medicare doctors are savvy as are most people when it comes to economics and they've increased their volume to replace what they were getting on a per item reimbursement, so it's all complicated and difficult, and I just possibly can't do it justice in a couple minute question on healthcare triage live. 

The (?~10:11) asks, I contacted chicken pox at the age of three weeks, consequently I've never received the vac-

[camera freezes, audio cuts out 10:16-10:27, audio returns]

- or this mixed with this percentage more likely, but it is likely with most cancers that there is some familial or genetic component, which is why, and some of these cancers are tied into each other. For instance, on Friday, healthcare triage news we're going to be covering is we did some stuff on breast cancer and actually high for two first degree relatives with either breast or ovarian cancer, actually leaves you at a higher risk for breast cancer, cuz some of these are even linked together. Not just by family, but also by different parts of the body systems.

So yes, if your family has a history of skin cancer, you should be at more- have a higher 

[audio cuts 11:00-11:02]

-asks, what is the research on saturated fat? Is it bad? What amount would be detrimental to health? Go watch our full episode on fats. That's a good start.

So here's the thing, these days we actually do believe that it's like the saturated fat that is the- Well I say we, meaning I think still like the, you know, most of the nutritional commentariat, nutritional expertise group. The establishment, if you will, um, does actually believe it's saturated fats that's the bad thing.

We're not still sure. We just aren't positive. It seems like it's linked to high levels of cholesterol, and high levels of cholesterol are linked to increased levels of heart disease. And blah blah blah, and you get all the way down the line. But, you know, we don't have a ton of good randomized controlled data that says that this is still the case, and given how we've made so many mistakes on fat in the past, I hesitate to say we know anything for sure in this area at all. 

Trying to write a book, we're getting close. Might think about nutrition and the things that people say are bad for you and aren't Cuz I think this stuff is fascinating, um, and there's more and more data, the more I look into it that says we don't know what the hell we're talking about. So we'll see. 

(?~12:11) Gupta says brushing your teeth only once - lag/audio cuts out- 

I, on the other hand, you know, I brush my teeth, but I'm not nearly the zealot that she is. I have one filling in my mouth. One. And I got that cuz I got braces as an adult in my thirties, and the braces gave me a cavity, cuz I just couldn't get the- But it's like, I have no cavities. My teeth are amazing! It's just genetics. I hope my kids get my teeth, not Amy's teeth, cuz like that's what it is. There's actually studies that show as kids get cavities, it's often with bacteria that's in their mother's mouths, from like sharing spoons.

And so it's like that's where the majority of the danger comes from. Brushing teeth? We don't know. Having said that, mouths are gross, and they're dirty. And anything you can do to help clean that up a little bit will help with breath, will help with your social game, will help with, like you know, your overall hygiene. And from that respect, brushing teeth is great. 

Bad breath is terrible. So, you know, I'm going to air on the side of brushing teeth twice a day at least. I'm gonna do that. Just cuz, like, again what's the cost? Minimal. What's the harm? Negligable. What's the benefit? Good in social aspects, theoretical in terms of preventing cavities and mouth health, probably good for gingivitis too, and also for removal of plaque and tartar, both of which are bad. So, for all those reasons, you should brush your teeth.

Last question, (?~13:28) What is the true likelihood of me giving a baby whooping cough if I am not up to date on my TDAP vaccination? 

Higher than you'd think these days, cuz you know, pertussis is actually coming back. Um, and it's bad for babies. I've seen them hospitalized. I've, like, taken care of babies hospitalized with pertussis. It's bad! It's bad enough that's why, like, the new recommendations are that every pregnant woman, every pregnancy should get, like, re-immunized again.

Um, I would do it. What's the true likelihood? It's low. In the scheme, probably, of, you know, absolute percentages, but, you know, we're again weighing benefits and risks and the harms are real and when a baby gets pertussis, it's bad and it's hard to treat in kids - in adults it's really hard to treat. Um, and so, given that we do lots of stuff in the world to prevent rare occurrences, this is one that's- it's gonna work, it's gonna help and it's- it can happen, it does happen. I would do this, if you're asking me personally. Like, my family, we would do this. We're not gonna have any more babies. But if Amy was revaccinated and some day when my kids have babies and they say to me ''You, as a grandparent should also be vaccinated.'', I'm gonna get the shot. Cause I would- I don't want, you know, vaccines work. They're awesome. They work. And, like, we should do them. 

Alright. We're gonna make this a shorter one than usual, cause my voice is still somewhat (14:51) and we wanna get out on time. We will have no live next week we said? No liveshow next week! We're gonna catch up and watch- you should, you should catch up, watch some of the older episodes. Big, you know, um. This week's Healthcare Triage was on like ''Kids are actually awesome'' and you should watch it and it's been pretty popular. And you should watch all the episodes of Healthcare Triage. And you should tell other people to watch all the other episodes of Healthcare Triage, cause it's awesome. We've short of plateaued, we need to push! We need to do well! Yay! Go! Go watch them. Go watch them again. Tell everybody else to watch them. Share them with your friends. 

Um, check out facebook.com/healthcaretriage. Check out the Reddit site. I gotta get back on there. I've been sick and check out what's going on and answer lots of questions. Um, there will be a link in the description to the master question list document if you wanna know what we talked about in the episode and where, where you can go. You should use it. It'll be updated for March this afternoon, I'm told by Mark. Um, patreon.com/healthcaretriage. We soo appreciate your support. It's really important. We actually have some new episodes coming up that we were just talking about that we need to make investments and just some really good graphics and the money to do that kind of stuff comes from your support. We really do appreciate it.

Otherwise, thanks for tuning in. Watch the Healthcare Triage news on Friday, Healthcare Triage classic on Monday. No live next week, but we'll be back the week after that! You should tune in. Thanks a lot.