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This week's questions:
1:23 The infant formula milk industry is a multi-billion dollar industry. You cannot turn on the television without at least watching an advertisement hailing the mental and physical benefits of X baby formula. Since then, there is a prevailing belief that parents MUST purchase this or that brand of baby formula otherwise their child will be at a disadvantage. Your opinion on this?
3:17 The Food and Drug Administration said there are serious and sometimes disabling side effects from the commonly used class of antibiotics called fluoroquinolones. Is this just another FDA overreaction or do the risks outweigh the benefits?
4:30 Folate during Pregnancies causes autism? Are we being trolled?
8:30 Is there a difference in regulation between herbalsupplements and vitamin supplements? I take magnesium oxide (which comes from behind the pharmacy counter) to prevent migraines.
8:50 Why don't we use male birth control?
10:27 IGG food intolerances and Leaky Gut?
11:40 Is there a way to lessen tolerance to dexamphetamines. I've been prescribed them for the last 7 years (I'm 19 now).
12:22 What diseases often produce false positive tests?
13:47 What causes visual snow and why do some people see it all the time? Is there reason to be concerned about it?

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I feel like I should like, start all these episodes looking surprised, like you just showed up, like, like Mr. Rogers--although now I'm dating myself.  Does anyone even know Mr. Rogers?  Okay, good, good, good.  I thought I would be like, you know.  Anyway, he'd always come home and he'd be like, surprised to see you were there and he put the sweater on and anyway.  Welcome to Healthcare Triage Live!  

We are late.  Late, late, late.  Not my fault.  So we're just gonna jump right in.  First, oh, by the way, it seems that all the questions people put in the comments last week somehow miraculously disappeared.  I don't know why, neither does anybody else.  We're not ignoring you, please just put the question back.  If you have a question and I didn't answer it, put it back.  We will re-add it to the list.  I don't know, we lost it, sorry.  

Anyway, "The infant formula milk industry,"--ahh, the milk industrial complex, "the milk industry is a multibillion dollar industry.  You can't turn on the TV without at least watching an advertisement hailing the mental and physical benefits of X baby formula.  Since then, there's a prevailing belief that parents must purchase this or that brand of baby formula or their child will be at a disadvantage.  You're a pediatrician,"  Yes, I am.  

You would honestly like to hear my opinion on these alleged medical claims.  Okay.  First of all, you know, first of all, you could breastfeed and not have to do the formula thing at all, so feel free.  Secondly, formula is like, you know, only up until one year, so at that point, you're turning to milk and when you're in the formula, it's like, you know, the vast majority of formulas are just fine.  

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They're just fine.  They're normal formulas.  It's like, once you read sort of the basic components, they're all the same.  Now, you can--if you go, there's a million on the shelf 'cause there's the soy based one, there'll be the, like, you know, super fat one, there'll be the low-iron one, there will be the one that's like, more easily digestible, there'll be the hypoallergenic one.  The vast, vast, vast majority of children need the basic formula and then everything above that is sort of like, uh, bonus or whatever.  Useless, I could say, for many, many people, useless.

Now, the idea that now we need the, like, super formula, 'cause that's gonna lead to a better brain--no.  No.  That's like, something in a lab or cooked up.  There's no randomized controlled trials or any trials that say that kids that get this or that formula are smarter, do better, develop better, you know, physically better, mentally--none, none, none.  That's all like, maybe.  It's almost the supplement industry.  It is just not based on actual research, so my kids were breastfed.  When Aimee was done with that, they were formula-fed.  It was the basic whatever (?~3:10) formula was available.  I can't even remember which company it was, 'cause I didn't care and for the most, most, most, most people, neither should you.  You just shouldn't.  

Next question from ak11234, "The Food and Drug Administration said there are serious and sometimes disabling side effects from the commonly used class of antibiotics called fluoroquinolones.  Is this just another FDA overreaction or do the risks outweigh the benefits?"  

Is this an--okay, what, now I'm like questioning, is this a new thing? 'Cause I mean, fluoroquinolones for all, for a while, like, you know, they were sort, we don't like to give them to young kids.  It can stain their teeth.  It can have some other issues.  We use them very commonly--I have not heard of any new serious or disabling side effect.  If it is a new thing, I don't know about it yet, which disturbs me because I should.  To be honest with you, I rarely prescribe fluoroquinolones.  I'm a primary care pediatrician.  Almost all the prescriptions that I give for antibiotics are amoxicillin.  

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Once in a while, augmented.

I really just don't get that deep into the weeds about the resistance because I just don't see it, so it is possible that something new has come down the path about fluoroquinolones and I don't know about it, but I'm going to look into it because you've made me nervous.  Until that moment, if there is anything new, then there weren't any crazy, disabling side effects that I've known in the past that would have prevented us from using them. Unless it was some kind of drug-drug interaction which is of course would be a concern. Bottom line, I'm going to look into this for you.

 Folate during Pregnancies causes autism? Are we being trolled? (4:33)

Folate during Pregnancies causes autism? Are we being trolled?

Aww, you're not being trolled, but here's where we went off the rails on this one. Alright, first of all, this was not a published, peer-reviewed study. Even though it was covered more than almost any other news story in the last two weeks that I know of in health and kids.

Except for the swaddling thing.

This was a presentation of an abstract at a meeting which means that truly all I know about is like this much (4:58) because that's all you can see. There is no peer-reviewed publication.

There's no vetted science. I don't know what the results were. It was a presentation at a meeting that a limited number of people heard, and yet it was covered as if it was the leading story in Science or Nature or the New England Journal of Medicine.  It's not the case.

In fact, one of the good studies that's been done on what should we think about abstracts was done by me.  When I was a fellow, back in the long ago, this is probably like 2001-ish or 2002-ish, I had a randomized controlled trial rejected from our pediatric meeting and it irked me so badly, because so much crap is often presented at those meetings, that we did a study to see what happens to abstracts that are presented at meeting. And the first thing we found is that this meeting, that I went to, something like 87% of abstracts that are submitted are accepted for presentation. So own up right off the bat. The litmus test for getting your stuff presented at a meeting, I'm sorry, the bar for getting your stuff presented at a meeting is low.

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