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Next week's Healthcare Triage livestream: https://www.youtube.com/watch?v=I-auXByvGvI

00:00 - We're LIVE!

02:56 - 1. M. Avery - What can we do to make medical research more accessible for lay people (people trying to make health decisions who aren't medically trained)?

05:32 - 2. Jessica Benson - what are your thoughts on coconut oil and all of its supposed benefits and uses?

06:53 - 3. Ivana Sunjic - What are some of the diagnostic tests used for IBD,aside from colonoscopy? Are certain tests (eg CRP) better than others?

09:38 - 4. Jessica Benson - what are your thoughts on teenagers starting school so early and how that affects them and their performance ? is there research on this topic

12:18 - 5. Adam C. - A friend who works @ Epic tells me different EHR software can easily interface, but providers often don't have incentive to set up a connection bc they want to provide more services. Could you comment?

15:07 - 6. Sam Cook - Does cooking food make it less or more nutritious to eat? Does the heat break down nutrients, or does making it easier to digest make the nutrients more accessible to the human body?

17:13 - 7. Greg Pinn - I know how you feel about milk, but are there any positive or negative differences in drinking organic or hormone free milk over traditional milk?

19:17 - 8. synopsysbane - what are your thoughts on Polyphasic sleep?

20:21 - 9. MrEganator - Can you tell me how much of an impact emotions have on the prognosis of a disease?

22:21 - 10. TerryTown What does the medical research say about chia seeds and ground flaxseed? Am I wasting my money?

23:57 - 11. smoothmasterz - Is there any research on children (specifically 8-16 years old) and weightlifting? There are lots of anecdotal advice saying "no," but these are the people who say it's bad generally.

26:17 - 12. Sher - I had a couple of major knee surgeries (ACL and lateral and medial meniscus) when I was 16. I'm now 22 and run and bike regularly. I still hear the crunching of scar tissue but don't feel anything at all. Will this scar tissue cause a problem later in life?

28:30 13. Yousef Fouad - Okay med student here, wanted to know your own take on EBM teaching, is it adequate?

30:33 - 14. Sam Murray - Hey, I have a question actually, What's an appropriate way to ask a doctor for a second opinion of you think he's not responding appropriately to your issue?

32:43 - 15. MrEganator - Does the weather contribute to any cold-like symptoms?

 (00:00) to (02:00)


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.


 (02:00) to (04:00)


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 liveshow, 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. 


 (04:00) to (06:00)


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. 


 (06:00) to (08:00)


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. 


 (08:00) to (10:00)


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 biospies, 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.


 (10:00) to (12:00)


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 somtimes 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. 


 (12:00) to (14:00)


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. It's why they're very expensive and difficult to do. The idea that the only reason we don't have better communication between EHRs across the country is because providers aren't incentivized to do that, there is no truth to that. And how would we incentivize them? Would we pay them? Who's going to pay them? It's not their job. It's not the job of the provider to figure out how to set up their EHR. That's just not a skillset they bring to the table, it's not something they're going to do. So you know, do I think that providers and hospitals and offices probably dont do as much as they can to do communication? Sure. 


 (14:00) to (16:00)


But that's not why EHR.. EHR softwares, they don't talk to each other. And often it's the company's fault that they don't talk to each other. Because it is in all of those companies' best interests that the data can't be shared between EHRs as cleanly as we'd like. It incentivizes the providers to keep buying their own company's 
software. So if you buy one thing from Epic, you buy everything from Epic. If it was easy to hook it up, then we could just throw the Epic in the trash and get a new system. That's not how these things work. Epic may have ways that they say that you could set up new connections, but I'm really into this field, and I'm telling you that none of the vendors make it totally easy to get data in and out them in ways that people could do tons and tons of innovation. That's just not the case. I've often said if there's one thing I wish the high-tech act would do, it would be to force providers -- or force the vendors-- to actually do that, to make it so the data could come in and out totally cleanly, whenever we want it. That would improve communcation, would improve care. That's what we all want. 

Next question, Sam Cook. Does cooking food make it less or more nutritional to eat -- less or more nutritious to eat? Does the heat break down nutrients, or does making it easier to digest make the nutrients more accessible to the human body? 

There's not an easy answer to this question. And it is probably true that cooking food in some ways does remove some of the proteins or perhaps some of the things that we care about. But it is a relative change, not an absolute change. People are not vitamin-deficient because we cook our food; people are not getting too little protein because we cook our food; people are not getting too little carbs or fat or anything else we care about because we cook our food. And the fact that most people are not viamin-deficient.

So, the idea that we have a problem with health and nutrition in America or in the developed world because we cook our food is just not true. You will probably find people who can do a study that'll show, -

 (16:00) to (18:00)


- study that'll show, "Ohmigod, we reduced the level of a certain vitamin by making this food canned or making this food cooked, and it is probably statistically significant." Maybe. But clinically significant? No.

We have been cooking our food for a long, long, long time, and the history of the world is not that we are getting less and less nutritious. Food is very nutritious. People who have nutritional deficiencies are usually not getting enough food. It is not that they are cooking their food too much.

So, this is a distraction. It's like the argument about organic versus regular vegetables; I'm thrilled you're eating vegetables. Really. It's not where I care how organic or how natural your vegetable are. If you like the taste of organic food better, awesome. If it makes you happier to buy it, great.

But people who are arguing about the relative quantities of conventionally-grown versus organically grown fruits and vegetables - or so, again, it's a distraction. I'd rather people just eat more of those things. So, getting into arguments about the nutritional value of these kinds of things, it's almost getting us off the subject.

Next question comes from "synopsysbane - what are your thoughts on polyphasic sleep?" [asks Off-Screen] I'm not even sure what "polyphasic sleep" is, any ideas?

OS: [unintelligible]

A: We're gonna Google it! And while we're Googling it, I'm going to go to the next question, and then I'm going to come back to that one.

"Greg Pinn - I know how you feel about milk, but are there any positive or negative differences in drinking organic or hormone-free milk over traditional milk?"

It's like you're teeing 'em up for me. Yes, you may like the taste better. Otherwise, really, there's not much of a difference at all. Again, why are you worrying about how mu-, you know, it's milk! You should be drinking it as an add-on toy our diet anyway, so.

What are you getting out of the organic versus the non-organic? People will talk about the vitamin D levels - we're not vitamin D deficient. And even then, in regular people, supplementing with more vitamin D or milk -

 (18:00) to (20:00)


-supplementing with more vitamin D or milk doesn't make them healthier. So, you're worried about the wrong thing; worry about things that matter or things that can make a big difference in your life. 

You know, substituting organic milk for regular milk is an infinitesimal change in most people's diet; it's just not going to make that much of a difference. So, go ahead, drink it if you want hormone-free milk the same way.

You know, everybody's worried that the hormones in milk are what are driving changes in people's health and everything else. Well, first of all, why are you making so much milk that this makes a difference? Secondly, everybody's treating hormones like hormones like hormones; hormones are very specific molecules that make a difference in very specific pathways in your body, and the hormone that they might use in cows for various reasons are not the same hormones that cause girls to develop early. It's just not always the same.

So, trying to say hormones are what matter, you know, hormones and soy and all this stuff - it's not all the same. Plus, there aren't enough usually in the milk to make a difference. Do I think we need to give cow hormones? No, so I'd rather not. But it's not how I would choose to focus my time on choosing one over the other. Drink what makes you happy, and drink it in the amounts that make you happy.

Did we find "polyphasic sleep?"

OS: Oh yeah, "sleeping more than once a day." So, naps!

A: Oh! All right. "Synopsysbane" is asking me about polyphasic sleep; evidently, it's napping. I love naps. I wish I could nap, I just can't figure that in my day.

There are a lot of studies, actually, that can show the benefits of napping and that short naps even can actually overcome quite a bit of the issues and make things better when people are sleep-deprived. It'd be nice if everybody got enough sleep; it'd be nice if we had a world where everybody would nap whenever they want. I'm not going to suggest that we reorient society to allow people to nap when they want, but if you can nap and you find that it's beneficial to you - and that's what you mean by "polyphasic sleep" - why not! Go ahead, it's great!

What are, you know, the benfits and harms? Lots of benefits, very few harms. Absolutely you should do it if it's making you happy, -

 (20:00) to (22:00)


- do it if it's making you happy, and you feel like it's going to make you better.

But again, do I think that the body of evidence that's available tells us we should reorient the way that the world works that everybody can nap? That's not gonna happen, and I would think people would have a hard time making the argument that the benefits would outweigh the potential harms we'd have to overcome to get society to change in that way.

Next question from "MrEganator - Can you tell me how much of an impact emotions have on the prognosis of a disease?"

You guys are very quantifiable or a lot of quantifiable answers on these questions. "How much of an impact?" Like a number? No.

There's also a two-way street on this. Emotions are effected by disease-, you're asking about disease affects-, how much emotions affect disease. But disease also effects emotions. It's not just like, "How is my emotional state going to affect my disease," but disease is also going to have an affect on my emotions. So, it's important to treat all of it.

You can't artificially improve your emotions in the sense that you're going to improve your disease. We can't do that randomized controlled trial; I can't take people with diesase and then, somehow, artificially try to make them happy or sad in such a way to see if it affects how well their outcomes are from a physical standpoint - that would be unethical and probably impossible.

However. There are a lot of studies that show associations that people with better emotional states might have better prognosis. You never know which way the arrow is. It could be the people with a better prognosis have a better emotional state. So, I can't untie this for you in the way that you would like.

But I would say that we SHOULD just treat all of it; we should be treating people's mental health at the same time that we are treating people's physical health. We should be trying to have people have the best emotional health that they can at the same time that we're trying to make them have the best physical health that they can. And trying to figure out how to separate them, and say that we should treat one in order to benefit the other -

 (22:00) to (24:00)


 - in order to benefit the other is doing it wrong.

But unfortunately, I agree that that is somehow the lens of which we look at this. We would be probably much, much better off by trying to incorporate it, and do it all at the same time, and treat everybody to make it good in the same way to try to benefit everybody as much as possible.

Next question is from "TerryTown: What does the medical research say about chia seeds and ground flaxseed? Am I wasting my money?"

...Yes? I don't know how to break it to you. Well, it depends on what you mean by "waste." Again, it's your money. Does it make you happy? Then, it's not a waste. Are you getting enough emotional and physical benefit from it that you think it's worth the dollars you're spending? Yes. Do I think that this is a cost-effective way for you to improve your health? No.

No, there's very little evidence that shows that ground flaxseed and chia seeds - which I bet you're paying a decent amount for - are improving your health above what a good cup of coffee or a good book or anything else would do for you. It is perfectly fine to use your disposable income to spend it on things that make you happy. And if taking those supplements makes you feel good, I'm all for it. If you do it and you think you're not getting a benefit and you're wasting your money, then, yes, I would say that you're not-, "Why are you doing it, why." 

There are no good studies that would say, "These are, like, you're providing a real benefit above what you would get from otherwise a real reasonably nutritious diet." That that is worth spending a decent amount of money for; there's just no evidence for that at all. So, you know, "Are you wasting your money," is a personal question. Would I consider it a waste of money for me? Yes. That's why I don't do it. But you? That's a value decision that only you can make. So, you should.

Next question is from "smoothmasterz - Is there any research on children -"

 (24:00) to (26:00)


"- on children (specifically 8-16 years old) and weightlifting? There are lots of anecdotal advice saying 'no,' but these are the people who say it's bad generally."

It depends on what you mean by "weightlifting." If you mean "being active" and working your muscles in like a tone way, then I would say no. There's probably no evidence that says that's a bad thing. If you're talking about "I want to do hard-core strength training, because I want my 8 year-old to be ripped?" ... Yeah, it's probably not a good idea.

One, because - and again, some of this is going to be anecdotal, but - they're not as good at letting you know when they've reached the point of knowing when it's dangerous. I think adults are probably better off knowing their bodies well enough to say, "This is hurting me," or "I'm not feeling good about this, and I want to stop." But kids don't do that as well.

I mean, I can tell you that my children - who are all in this age range - will tell me after they've been walking for a while that they're tired and they want to stop, and I know that their bodies can take more, but they don't want to do it anymore, so they tell me they want to stop.

How do you know when they're weightlifiting that they've hit the wall? Are you going to stop the second they're like, "Ohmigod, that's actually more wieght than I can easily lift, and I don't want to do it?" Are you going to stop them? Or are you gonna stop them when they get super, you know, when it's a ton of weight?  You just won't know, so that's one of the reasons that we don't really encourage super-strenuous activity in children to begin with.

Having said that, certainly there's activity which we think is good exercise, and some kids will complain immediately. And we know that being active is good for them, and sometimes kids just don't want to do it, and they will use lazy terms or say that they're tired or anything else to stop, even when we know that it's probably better that they get up and run around every once in a while.

But there are also no good studies of this; we don't randomize children to get hardcore strength training and then see if it massively impacts their health - we just don't do it. And so, that's how it goes. I can't give you a definitive answer. I would just say that my experience -

 (26:00) to (28:00)


- would just say that my experience and common sense tells me that the reason we don't push kids to do things that adults - and again, it's a small percentage of adults - that adults do is because we just can't tell how aware they are of what's going on and when they should stop.

Next question comes from "Sher - I had a couple of major knee surgeries (ACL and lateral and medial meniscus) when I was 16. I'm now 22 and run and bike regularly. I still hear the crunching of scar tissue but don't feel anything at all. Will this scar tissue cause a problem later in life?"

I don't know. Maybe? Then again, I'm not saything this because I don't know, but because it's always a probabilty. So, the crunching you're hearing is probably-, it probably could be some - theoretically, scarred tissue, but - it's probably also tendons and things like that. When you hear the clicks and the stuff, and you know, when your joins pop, that's all weird, different things.

Joints popping is actually the fluid boiling, because you're reducing the pressure so much that air is escaping, which is technically boiling. Some of the pops you hear, like your neck and everything else, that's sometimes tendons, or sometimes you hear cartilage. You do hear weird stuff; if it's not hurting you, it's probably fine.

I think what you're really asking me, though - and what I wonder if you're asking me - is if the working it is gonna cause problems later in life, and then I would say, "I don't think so." I don't think that's going to be the cause. It's probably better that you remain active and that you continually work your body and not let it get sedentary. That is a better outcome than not.

But scar tissue in your body is often a problem later in life; the number one cause of obstructions in your gut later in life is scar tissue, like, previous surgery is almost the number one predictor about whether you have an obstruction later in life, because scar tissue is a bad thing anywhere. It's just you body doesn't know what or how to deal with it as well as other tissue.

So, could -

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- could scars cause problems later in life? Yes. Do I think this is necessarily scar tissue? No. And do I think working it is the problem? No. So, live your life. Do the things you should do, keep monitoring everything, keep talking to your doctor. I wouldn't spend time worrying about it because that's unproductive. But you should be aware of it and constantly talking about it to your doctors and make sure that you know how things are going - so yes, do that.

"Yousef Fouad" asks, "Okay med student here, wanted to know your own take on EBM teaching, is it adequate?" EBM is "Evidence-Based Medicine."

We did it specifically at Healthcare Triage News on David Sackett a couple weeks ago who just passed away, who's the father of evidence-based medicine. And a lot of what I talk to you about is evidence-based medicine even though I don't always explicitly say it.

So, sensitivity, specificity, base theorem, positive predictive value, negative predictive value, prevalence - trying to use statistics to make better decisions - that's all evidence-based medicine. So if you like Healthcare Triage, you like evidence-based medicine.

There's a whole world out there that doesn't like evidence-based medicine; they think we should do things based on experience and that medicine is more of an art and that you can't use numbers to define people, and of course, it's a combination always. It's like, a lot of the art is trying to figure out what people have so that then you can apply the evidence-based medicine to make better decisions; it's not "I should never talk or think about a person as a person," it is a combination. But. Evidence-based teaching I think it's not adequate. We give a few lectures on it, and we expect that students - especially medical students - will absorb it when that's just not the case.

Too few doctors understand still the underpinnings of evidence-based medicine, like too few doctors know what sensitivity and specificity are or positi-, you know, - "What is Bayes' theorum? How do we use these numbers to make decisions? What do positive and negative tests mean?" Too few doctors understand this, and I mean that. So, I think we could absolutely do more -


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- absolutely do more to teach evidence-based medicine.

Watch Healthcare Triage; it's a good start. Actually, I know lots of people that do use Healthcare Triage when teaching medical students or residents some of these concepts, so at least it makes us feel good that it's being used as an educational tool in this way to try to help doctors and students make better decisions and use evidence-based medicine more.

So, is it adequate? No. Could we do a better job? Yes. I think Healthcare Triage is trying to help.

"Sam Murray" asks, "Hey, I have a question actually, What's an appropriate way to ask a doctor for a second opinion if you think he's not responding appropriately to your issue?"

Do it! No doctor should be upset if you're asking for a second opinion. Now, if you're ALWAYS asking for second opinions at everything your doctor says, eventually, yes, they will not be happy about that anymore. So, if you second-guess everything your doctor does, your doctor may at some point say, "I don't think our bond of trust is good. I don't think we're getting somewhere. Maybe you'd rather see this other person as your primary doc, because you seem to trust their opinion more," that's reasonable, too.

And so, there's is a fine line between second opinion - which is reasonable - and questioning everything. And I-, that is fine. But when you're making a big, momentous decision, when you're talking about a therapy that has both significant harms and benefits, then your doctor comes down on one side of it, but you want to know would other doctors answer that differently - it is very reasonable to get a second opinion. A good doctor will often promote that as a viable option and say - I say all the time; when I'm talking to people, even friends, "I'm giving you my opinion, you should go get a couple more, and then you should weigh them all."

Because a lot of this stuff is weighing benefits and harms, and I have an opinion about it, but it's an opinion, and so, that's fine. If not, you should be comfortable asking your doctor and saying to them, "I'd like to get a secon opinion about this, it seems like a big -"

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"- about this, it seems like a big decision, and I'm concerned about the benefits and the harms and the trade-offs there, and I want to talk to other people." 

And if your doctor - the first time you say that - has a problem? That's a problem often with the doctor; doctors should be okay with this, your ego should not be tied up in it. But you should also be comfortable talking to your physician about it. 

Of course, I think it's good to talk about these things in general with your physicians anyway, like, "How do you feel about second opinions in general," before it even comes up so you have a sense of what kind of doctor do you have, do you have a good relationship, and do you mesh well. Because having a good primary care physician or having a physician you have a good relationship with and can talk to honestly is very, very important. So, do that.

Last question because we gotta wrap this up - "MrEganator - Does the weather contribute to any cold-like symptoms?"

Oh, teeing me up, Mr. Eganator. I'm positive we have a Healthcare Triage about this, too, about colds being caused by the cold. I even know we did a Healthcare Triage News on this, I think because someone published a study where the media took it and said, "Oh, look! They proved that cold weather causes a cold," and that was utter crap. And we explained why, I believe in Healthcare Triage, where we took that study apart and explained why that just wasn't the case.

But, no. Cold weather does not cause the cold. Going out with wet hair does not cause a cold. If you don't believe me-, not being properly dressed doesn't cause a cold - I've included the-, read my books, read the blog, watch Healthcare Triage, there are lots of studies.

And it's amazing, because - you wonder who volunteers for these studies, but - they've done studies where they took people, I think prisoners, and they made them super-cold and wet, and then they injected viruses into their noses and saw if they got infected differently than the people who were kept warm and dry - the answer, of course, is no. They can look at people with wet hair - the answer, of course, is no.

There's a seasonal aspect to viruses - so, some of the viruses are more common in the winter - but that's the viruses are more common, -

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- common, not that you're more likely to get sick. Plus, there's a lot of people that think it works in different ways with the weather where when it's cold we're more likely to stay inside where we're in close contact to many other people, which leaves us more likely to get infected - so it's the staying inside and not going out under the cold and wet weather - which actually makes us more likely to catch an illness. We're doing it wrong. Shocker.

So, all of these things could lead to the idea that you're more likely to catch or get a cold or be exposed to something in the winter, but it does not mean that cold or wet weather is causing the cold - it is our behavior, it is the viruses, it's lots of other stuff that happens at different times of the year. So, this idea of, "make sure you're bundled up," or "don't go out with wet hair" or somehow be panicked about being outside or in the cold weather, or "it's the cold weather's fault" - no, that's just not the case. Watch the episodes; you'll learn a lot.

I'm gonna wrap things up now; thanks for watching Healthcare Triage Live! We appreciate you sticking all the way through if you did. Consider going to Patreon.com and becoming a patron; lots of cool rewards that you can get, we got milestones which we can meet, we appreciate everyone's support, we could appreciate even more. Go to the Facebook page - facebook.com/healthcaretriage - you'll see all these videos, lots of other links and resources and things you can download, and posters and all kinds of cool stuff. It's a great way to stay connected with everything Healthcare Triage. Check out our merch at dftba.com, and that is mostly it.

I hope next week Mark will be back? We will be operating at full capacity; we'll get back to doing Healthcare Triage News, there won't be any Healthcare Triage News this Friday. Continue to watch Healthcare Triage, we're in the midst of Parasite Month. It's gross, but you'll love it, you'll love to hate it.

Thanks for watching, we'll see you next week.

OS: Okay...[unintelligible]

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OS: -here...

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