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Uploaded:2015-01-26
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Once again, John Green joins Aaron Carroll on Healthcare Triage to answer questions submitted by you, the viewers.

John: Hi, I'm John Green.

Aaron: I'm Aaron Carroll.

John: And we are back today to answer your questions about healthcare, specifically I'm going to ask the questions and Aaron is going to answer them because he is the doctor. 

[Healthcare Triage Theme Plays]

John: Is there truly a medical benefit to circumcision?

Aaron: This one is going to raise anger. So, there is some good evidence that being circumcised reduces your chance of contracting HIV and some other sexually transmitted infections. There's some decent evidence that it might lower the risk of urinary tract infection or penile cancer. But all of those differences are pretty small. And-

John: Wait, you can get cancer of the penis?

Aaron: Yes you can. 

John: Oh my God.

Aaron: I'm not laughing at penile cancer, of course. 

John: What's the treatment, Aaron?

Aaron: I would imagine removing the penis if it's too big and perhaps chemotherapy and/or radiation. So again, there are some -

John: If the penis is too big or the tumor? That was a very ambiguous "it"?

Aaron: I would say the cancer.

John: Oh, okay.

Aaron: Having said that, yes, there is some statistically significant benefit but it's not high enough that we should make any kind of recommendation to say that universally we should circumcise or that it's - But it is enough of a benefit that we should make the argument that if people want to get circumcised, we should make it easy for that to happen. 

John: But a lot of time it's babies who don't have a want.

Aaron: Right, which is why -

John: And that's why the ethical - 

Aaron: Ethical and it comes in later because of course it is much more difficult and problematic to have a circumcision in life so there's a debate to be had. It is a very tricky question. 

John: I'm going to stay clear of it. 

Aaron: There you go. 

John: What is tunnel vision and why does it happen?

Aaron: Hm, well there's the short term and the long term. If you're talking about chronic, then it's just the idea that you start losing your peripheral vision and can only see a circle left. That's usually caused by damage to the optic nerve, or to some other area of the nervous system in such a way, from glaucoma or high blood pressure or something else with long term damage. The way you fix that is by reversing whatever the cause is. Short term, you can get that sometimes when you get that when you're going into shock, like I once in a while will go vagal and I'll pass out.

John: Really?

Aaron: It's happened to me a number of times.

John: You just faint?

Aaron: I can always tell when it's coming, but yes. 

John: One of the things I like about you is that you also have some weird health problems. 

Aaron: Oh yeah, and the anxiety and all that comes into play too. It's just not my number one. But when I know that that I'm going to faint or I know I'm going to pass out, the first thing that happens is that I can hear a ringing in my ears and I start getting tunnel vision. It starts to go like that.

John: I get tunnel vision when I work out too hard.

Aaron: Do you faint?

John: I do sometimes faint.

Aaron: That's happened to me more than once. I was with a friend who still makes fun of me for that.

John: I said to my personal trainer not too long ago that "I'm going to barf" and he said, "you're not going to barf. Just work through it." Then I was like *BLERGH*   

Aaron: See, I don't barf, I just say "I'm going down" and everybody says "what does that mean?" and then -

John: And then you're down.

Aaron: I once said it to Amy, my wife, "I'm going down" and handed her our baby then passed out on the table. I wake up and she's on the phone with 911. Well, I told you I was going down, you didn't need to do this.

John: How come we lose muscle mass over time?

Aaron: Well, it's funny. It's like we gain muscle mass until we're 30 then it starts to trickle off. Partially, that's hormonal changes, partially that's because people become more sedentary and they don't work out, sometimes it's dietary. It's just the way bodies are built, to develop for a while then it's a long, slow decline to death. Having said that, you can avoid that by exercise to help reduce that muscle mass loss. 

John: How's P90X3 going?

Aaron: It hurts. 

John: I'm very sore today.

Aaron: Only two days in and it hurts.

John: When are they going to make a better unemployment insurance than COBRA?

Aaron: We have one already, that's what the Affordable Care Act is. 

John: It's called Obamacare.

Aaron: You don't have to get COBRA anymore the second you lose your job, you can get regular old insurance which is way cheaper than COBRA. 

John: I started using a standing desk at work recently. Is sitting all day really killing us?

Aaron: It's not causal in the sense that we don't have good randomized control trials but there are a lot of good cohort studies that show that being sedentary is really really bad for you. The observational data is good enough to make us want to get up and move around more. I endorse your standing desk. It's a good idea. 

John: How regularly should I see the doctor for a "checkup"?

Aaron: Well, that depends on your age. Babies should be going multiple times a year - 

John: How often should I go?

Aaron: You -

John: 26 year old, healthy male. 

Aaron: Where's he? Anyways, a 26 year old arguably should, well there's nothing to do every year. At your age, you're getting closer to where there are recommended things to followed every year. Having said that, there was this great piece in the New York Times by the Zeke Emanuel, who was arguing that we don't even need annual check ups. There's no evidence for it at all. But there are things that we're supposed to do every year and screening tests that should occur every year. You should be getting certain vaccines every year and the way our system is built, we need a doctor visit to do a lot of those things. So still probably every year. And women are a whole different story because you often do need often gynecological care and screening tests that absolutely require every year. Absolutely every year for a woman and probably for men. 

John: Is the BMI (Body Mass Index) really a good marker of health and weight proximity? It's an 160 year old test... really.

Aaron: Well, we shouldn't ding it because it's old. Having said that, BMI isn't perfect just like any one metric isn't perfect. It is very possible to be very muscular and still have a high BMI and be very healthy. But generally it still is a decent metric for obesity and that has been correlated with a lot of bad outcomes. It's one of the better ones that we have, but I totally agree that it's not perfect.

John: Height to waist ratio is something that I hear a lot about.

Aaron: That is one of the ways of calculating BMI. The perfect way to calculate BMI is to put you in one of those body pod chambers where they figure out how much fat you have and how much your body mass is, but having said that, the number of height to weight or there are all these different ones, but it's all different ways of calculating BMI.

John: You know what I've noticed is that people with abdominal fat have much higher risks of everything.

Aaron: Yup.

John: I have that and it's not my fault. 

Aaron: Well, a little - 

John: Well, I like to eat fatty foods but it's not my fault in the sense that, it just doesn't seem fair.

Aaron: Well, fair, I didn't say fair but I mean, yes if you exercised more and ate a healthier diet, it is likely you'd have less abdominal fat. But it's not about blame. It's not.

John: Hella Della asks, "are there benefits to cutting red meat out of my diet?"

Aaron: If you eat a ton of red meat, yes. If you eat very little red meat, probably not much to be gained.

John: But you shouldn't eat a lot of red meat.

Aaron: You shouldn't eat a ton. All the studies that show that red meat is terrible for you are all talking about reducing the number of servings with an "s" of a day of red meat. Most of us aren't eating multiple servings of red meat a day. If you're eating that much red meat a day, you could probably stand to cut some out. But a little bit of red meat is probably fine.

John: Am I more at risk if my relatives have cancer?

Aaron: I would say depends on the cancer but the general answer would be yes. Yes, there are genetic components to many many cancers so certainly if many relatives have a certain type of cancer, it raises our index of suspicion for you. But it's also not a lock. Just because a relative has cancer doesn't mean you're going to get it.

John: Rona asks, "are scientists and doctors any closer to determining why nut allergies are growing so fast?

Aaron: No, there's a lot of theories out there. Some people think that it's the food that we eat, that somehow it's been processed in a way that's making more people have allergies. Some people believe that it has something to do with pollution and the general environment. But there are also people that not exposing kids in utero and as small babies to these things make them more likely to develop these allergies. So maybe our paranoia about it is unfortunately causing the rise in the numbers.  No one knows, it could be any or all of those things.

John: Three more questions. Rachel asks, "what is a hiccup exactly?"

Aaron: So it's a spasm of your diaphragm, the muscle at the bottom of your lungs which helps move everything up and down, and when that happens, it results in a secondary snapping of your vocal cords that produces that "hic" sound.

John: You know the people who have hiccups regularly for their entire lives?

Aaron: Yeah, they lose a ton of weight and are always so thin and scary.

John: Yeah, that's one of my big anxieties, that I'm going to be a hiccup person.

Aaron: Or have a horrible degenerative mental illness. 

John: Or both. Besides medication, what can I do to deal with the allergy I have to my pets? [whispers] I have an idea.

Aaron: So there's a number of - yes, yours is going to be worse than mine. So what you could do, first of all, is to never let your pet in the bedroom. You spend a significant amount of time in the bedroom and you don't want to let them in there. The second is trying to eliminate carpets in your house, that is where the dander - it's not the hair, everyone thinks its the hair, it's not. - it's the shed skin, its the dander and it can collect in rugs. When you vacuum, you can wear a mask or you can get someone else to do your vacuuming because that's when it gets spread up into the air. Have someone else wash your pets regularly and brush them to get all that dander out. But of course, getting rid of the pet would also help your allergy. 

John: Find a great home for that pet. And our last question, from Savannah, "how do you feel about abstinence only being taught in schools?"

Aaron: So I have not seen a lot of good evidence that says that abstinence only is better than teaching kids about sex and how to do it safely. The problem is that we make it an either/or and so we're saying when we're going to do abstinence only or we're going to do a comprehensive sex education, comprehensive sex education is better. However, adding abstinence in as an option to comprehensive sex education, I don't think many people have a problem with that at all. Just saying that you could just not, okay, but it probably needs to be part of it. The problem is when we say, let's only talk about that, that can be problematic. 

John: Aaron, thanks for answering all of our questions. I have one last question for you, when am I going to die and how?

Aaron: 2056 and by nuts. 

John: I'll take it. I'd take that in a second if there was a deal I could sign right now for 2056 by nuts, I would take it. 

Aaron: How old will you be in 2056?

John: Old enough.

Aaron: I'm just going to say, did I give you enough years of life?

John: Wait, no... 42 years from now...

Aaron: No, I've almost robbed you. You should get more than - 

John: Oh yeah, 80, I would take 80.  

Aaron: We've talked about 80. You're gonna get 80. 

John: I'd be delighted to get 80. 

Aaron: You'll get 80. I'm very confident you'll get 80. 

John: And I've always wanted to die by nuts. 

[Healthcare Triage Outro Music]