Off screen: Almost going. Let's see.

Aaron: No, I don't like that face!

Off screen: OK, that looks good. Waiting for the live stream preview to comes on board. There we go. Are we ready?

Aaron: Yes, go. I'm hitting the button.

Off screen: Yeah.

Aaron: And we've confirmed? We're live?

Off screen: Yeah.

Aaron: Are we live?

Off screen: Yes, we're going.

Aaron: We're live! Yes! We pulled it off. Um, we're still one man short this week so it's been a, you know, it's always difficult trying to keep things going when we don't have a full load. But Healthcare Triage is live. I'm going to trust it, I've tweeted it and we will assume it is true. Thank you for tuning in. As always, we appreciate it.

As we wait for people to arrive I will do the traditional housekeeping notes. First of all, as I mentioned before, Mark is still away so no cool graphics this week. Um, and we miss him but we carry on none the less. And since he's also not here he won't be waving at me to remind you, as always, that none of this should constitute medical advice. Do not, you know, start any kind of therapy or take any drugs or do anything that you hear on the show, because of stuff you hear on the show without talking to your doctor first.

You should go check out our Facebook page, facebook.com/healthcaretriage. See all the videos, you know, comment, meet lots of other people, you can download the cool posters we put up, it's a good way to stay in touch with anything. Plus we put a lot of the links and stuff that you might want to find from other things that I mention there on the Facebook page as well.

Father's Day is coming up. It's, you know, just a week and a half away. Um, I'm a father, I hope many of you are too. You can get cool mugs, you can get posters, lots of merch. It's all Healthcare Triage all the time and we love it.

Aaron: We finally have a podcast of the show.  That was one of the first milestones on the Patreon page, and--Patreon page, I keep saying that wrong--Patreon page, and we made it, which is awesome.  So there's now a podcast of the live show, since it's the least graphics intensive show that we do, you can listen to it on the go, wherever you like.  It's on iTunes, SoundCloud, and if you use something else, we've got an RSS feed available.  All the links are in the description, and on the Facebook page, and in closing, you know, of course Patreon, Patreon, Patreon, Patreon, it's a great way for you guys to help support the show.  The perks are now out in the world.  Everyone who's signed up before June is now getting the perks, they include like, getting to vote on future episodes, which many people have already done.  There's see Healthcare Triage a week early.  You've--the people who are Patrons have already seen Monday's episode, it's like looking into the future, it's amazing, they get to see it early.  And there's lots of other good perks.  Peoples' names in the credits, getting their ment--names mentioned out loud, I think it's Cameron Alexander who's our research associate, I just said his name again.  If you--if you--if you do it now, a lot of the perks won't kick in until July, so we should say that out loud, 'cause on the first of the month is when everything starts, but if you wanna get access to the calendar, the feed, the polls, and all the other great perks, you can sign up now, you will be, you know, the first billing will be on July 1 and that's when the magic starts to happen, so thank you to everyone who supported us in the past, we appreciate it, and we look forward to having more support in the future. 

On with the show.  First question comes from M. Avery.  What can we do to make medical research more accessible for laypeople, people trying to make health decisions who aren't medically trained?  So those are two separate things.  One is how do we make it more accessible, and two is how do we make it more understandable, which I think you're asking for both those things.  Accessibility's a problem, although there's a lot of changes that have happened in the last few years, which are good.  Part of it is that in the past, the only way that you could actually access medical research was to subscribe to the journal, and journals are incredibly expensive, unless you work for like, an educational institution, which has institutional access. 

Very few people could get access, and then only really you would hear about a medical study if the press covered it, which was rare.  There's like, hundreds of thousands if not more of like, studies published every year, and you're going to see very few of them in the media, so how would you know?  So, a lot of journals are going to what we call open access, meaning that anybody can see them.  The federal government is taking steps with any research which is federally funded, which is a lot of it, that even if journals push it out under like, a paywall or a firewall to begin with, eventually it has to be open access that anyone can see, say after a year or so.  And so there's a lot of push to make research more accessible in those ways. 

But that doesn't make it understandable.  First of all, it's very difficult to read a medical journal article, even if you do get through all the jargon.  Understanding it is difficult.  We've done many episodes trying to explain how you should go about better understanding medical research.  I'm toying with the idea of writing a book on the subject as well.  And even then, the media doesn't often do a good job, and there's been a lot of articles, especially in the last few weeks, interestingly enough, I've seen them on Vox, the New York Times, and many other sources, talking about how the media's not doing a very good job of describing research.  They oversell things which they shouldn't, they don't talk about things that they perhaps should, so if I had to give you a quick decision in trying to understand medical research in people that aren't health-trained, and it will sound self-serving, but it's watch Healthcare Triage.  That's what we do.  That's the show!  Trying to translate, you know, research and evidence and data into ways that will make sense to all of you, the general public, so that you can make better decisions about your health and health policy, that's--that is almost the definition of what Healthcare Triage is about.  It's also about what I'd say our blog is about, the Incidental Economist, it's also about what I try to do at the New York Times in writing, that's my job!  It's what I wanna do!  So, find people that want to do that.  Follow them.  Follow them on Twitter.  Follow them on YouTube. 

Follow them on, you know, their other media sources.  So do that.  That's what we do. 

Next question, Jessica Benson, "What are your thoughts on coconut oil and all of its supposed benefits and uses?"  So, if you watch our episode on nutrition recommendations, you know that I don't think that there's any magical nutrient.  I don't think there's any demon nutrient.  I don't think there's anything magic about coconut oil, um, it is--it is sort of the thing du jour, I'm pretty sure that's what they put in like, the Bullet Coffee and everybody's like, wow, it's the new big thing, and it will be until they've wrestled every dollar they can out of your pocket, and then they'll find the new next big thing.  There's nothing magical.  It's a--it's a liquid source of fats, it's coconut oil, um, it is probably no better or worse for you than, say, olive oil or something like that, and it's not magic.  It's not.  And again, if it was evolutionarily magic, animals would have adapted to find coconut oil to get the magic into themselves, and they don't, 'cause it's not magic. 

On the other hand, it's not the devil either.  It's not gonna kill you anymore than any other sort of source of liquid fats probably would.  So, uh, you know.  I think it's--I shrug my shoulders, it's coconut oil, it's another source of nutrients.  I wouldn't go crazy about it, I wouldn't go crazy in either a good or a bad way, but you know, I don't--I think many of the purported health benefits are being oversold, 'cause that's also sometimes what the media does.  See question one from M. Avery. 

Next question, from Ivana Sunjic, "What are some of the diagnostic tests used for IBD?" Inflammatory Bowel Disease, "aside from colonoscopy?  Are certain tests like CRP better than others?"  You guys ask a lot of questions about IBD.  I hope that's not because I have it.  And Hank has it, too, so maybe it is because we have it, I don't know.  Inflammatory Bowel Disease is a sort of autoimmuneish type disease where unfortunately, some of us, our bodies attack our bowels and they can lead to long-term effects as well as short term badness, and so there's two kinds, there's Crohn's Disease and Ulcerative Colitis, for the most part. 

I have Ulcerative Colitis, um, and so, there are tests that the--the main stage, you get a colonoscopy, which is when they stick a camera up you from behind, and take biopsies, and look, that's what they do, it's a colonoscopy, and I've had many of them, yay. 

But of course, if we could do it more easily, and, you know, without having to do the invasiveness of a colonoscopy, and the colonoscopy's not the bad part, it's the prep, and those of you that have had the prep for the colonoscopy know what I'm talking about. 

So the tests, CRP is C-Reactive Protein, it's a laboratory test which looks at the levels of C-Reactive Protein in your blood.  CRP is a marker of inflammation, so people who are having an active sense of inflammation, perhaps from like, IBD, will have a raised level of CRP and they can use that to sort of monitor therapy and sometimes even to try to help with the diagnosis.  The problem with CRP is that it is very nonspecific, so it is sensitive in the sense that like, if you have disease, the test is very likely to be true, but it is not specific in that if you don't have disease, it won't be low, 'cause many things will cause CPR to go up, any kind of inflammation can cause CRP to go up, an infection can make CRP go up, certain kinds of stress might--all kinds of things will make your CRP go up, so if you have a high CRP, it's not necessarily--it does not mean that you're going to have--it does not mean that you have IBD, it could mean that you have some sort of inflammation, nonspecific, and if you have low CRP, it doesn't necessarily rule you out either, so those other--that, as a blood test, not so good. 

Now, they're trying to work on other tests to try to pick up, you know, Inflammatory Bowel Disease, whether in the blood or some other kinds of things, but the truth of the matter is that none of them are as sensitive and specific as colonoscopy are, and until one starts to approach that, we're gonna have to keep doing the colonoscopies, there's just sort of no way around it, but Inflammatory Bowel Disease is serious enough and it affects people so much that you'll get the colonoscopy.

You have to, it's just the way to go, so, short answer for this is there are some other tests they're using, but none of them are nearly as good, so we will keep using colonoscopy for that. 

Jessica Benson asks, "What are your thoughts on teenagers starting school so early and how that affects them in their performance?  Is there research on this topic?"  We did a two-parter on sleep, Jessica, you should go watch it, it's awesome.  It was two of the Monday episodes, they were back to back, and one of them specifically addressed this issue, which I will now recount for you now, but you should go watch Healthcare Triage.  It's a great show on YouTube.  It's a whole channel, you're watching it right now.  Go do a search for sleep, you'll find two great episodes. 

So, the problem is that we, in society, and especially in the United States, we've decided that teenagers need to get up at the crack of dawn to go to high school.  I--when I go to the gym sometimes at 6:45 in the morning, the kids in my neighborhood who are in high school are already out for the bus, it's insane.  And since kids don't go to bed at 6pm, it's very, very hard, especially for teenagers, to get the 8, 9, 10 hours of sleep we'd like them to get, because unless they go to bed really, really early, it's impossible.  And yet, that's what we require from them, so we're almost by definition, forcing them to be sleep deprived, and don't tell me they can go to bed early, sports activities, lots of activities that are even school-related can go to 8 or 9:00, then you expect them to do their homework, God forbid they should eat or have a social life, so they can't go to bed earlier.  We could, however, start school later.  There's nothing cra--you know, nothing magic about 7am that they have to start that early, especially when they're often getting out at like, 2.  So we could start it later.  There have been many, many studies that look at how sleep deprivation affects people.  Very few of them are on kids in a prospective manner, 'cause it's hard ethically to deprive kids of sleep and see how they do in school.  It's hard to do.  We could do it in college, and they have, but we can't really do it on teenagers. 

But what we do know is that a number of states or districts have made policy changes and started school later and what they do show, you should watch the episode, 'cause I might get some of the numbers wrong now, but I will stand by the ones in the episode, is that when they start the schools later, there's an association with better academic performance and better, you know, sort of quality of life and everything else. So we have a lot of ecologic evidence, and it's not--it's not like the RCT's that we'd like, but there's a decent amount of evidence that shows that letting kids get more sleep and starting school later is associated with better outcomes. The AAP has recently made a push--the American Academy of Pediatrics--to try to get schools to consider starting school later. It seems like a smart idea and something we should do, and there seems to be a decent amount of, you know, evidence saying at least those things are associated with each other so that's a good thing, we should probably consider it more.

Adam C. writes: "A friend who works at Epic" - who makes electronic health records - "tells me that different EHR" - Electronic Health Record - "software can easily interface, but providers often don't have incentive to set up a connection because they want to provide more services. Can you comment?" Providers are not setting up the connections because they want to provide more service... OK. So let's back up here. You know, no matter what any of these companies say, and it's all of them, it's not just Epic, it is not easy to set up interfaces with other electronic health records all over the country, that's ridiculous. That is not the case, it is not easy, and even then easy is a relative term. So what might be easy for someone that works at Epic and that's their job is not easy for a clinician who has no training with technological information at all. These are not iPods, they're like easy to use outside the box. Electronic health records are difficult to use and setting them up with networks and trying to make them secure with all the requirements of HIPAA is very difficult.