- Hi, I'm John Green
- I'm Aaron Carroll
- And today's the first of two videos where I'll be asking questions that you asked Aaron about healthcare and he'll be answering them.
- Looking forward to it

- The first question in very important, which is, do you guys have any merch?
- We do!
- Look at this.
- Posters and mugs.
- Yeah, so you can get your posters and mugs in the link in the doobly doo at dftba.com. To the research!
- Yes. 

- Next question from Alex: tell my mum whether or not she should keep spending her money on essential oils.
- That should only depend on whether you have stock in a company that sells essential oils. Otherwise, no.
- To be fair, I've enjoyed a good essential oil here or there. But not for health reasons. Just to improve the quality of my bath.
- Right. Ok, if you enjoy. Ok, fine, if like the smell then that is fine but you're not going to get any kind of health effect. Maybe mental health effect - maybe, maybe.
- I love my baths. I have. Aaron, I have the most magnificent, well-planned baths. Like, I have essential oils, I have these wonderful bath salts. Um, it's just, aggh.
- I like bath bombs.
- I like a good bath bomb occasionally. But I really, I almost. I have it down to such a science that I essentially build the bath bomb from scratch every time. Candles, low light.
- How often?
- Every day.
- Really?
- I take a bath every day. Like a 40 minute bath. The highlight of my day.
- That's a great life.

- Peter Beck asks: does the stupendous cost of becoming a doctor in the US versus the UK have a negative effect on healthcare quality?
- Oh, nationally? Hmm. There's no evidence for that. I would imagine that it probably does keep some people out of becoming a doctor because the price tag can seem so large that perhaps it discourages some people who are probably at the lower end of the socioeconomic spectrum from getting into it. But I don't think anybody's measured whether that's impacted downstream how healthy people are in the United States.
- Well you would think just from a macroeconomic perspective, that not having the best, most qualified people become doctors who could would negatively impact care - unless doctors are essentially just robots.
- Or, if there are still fewer doctors being produced than there are from the pool of qualified people. And I mean, medical school acceptance levels are so low that there're probably way more qualified people than we do produce doctors. So you'd imagine.
- But if you want the most. It's a question of whether, of whether there is such a thing as 'most qualified physician providing best care' versus like 'any qualified physician can provide vital care'.
- Right, ok, that is true as well. Yes, if medical school is cheaper you imagine we could theoretically have a better pool of people to derive doctors from, but I'm not sure that it makes much of a difference.

- Is homeopathy just an elaborate placebo?
- If people are using it colloquially to talk about alternative medicine in general, no. There are some things that people do which should be alternative medicine which have been proven even in randomised controlled trials to work. But if the question is specifically about homeopathy and they're just sort of adding the thing that's bad for you in tiny amounts to try to get better - that has not even really been proven to work in a large trial. So, if anyone is getting a benefit it could be placebo.

- Is there any evidence for using bicycle helmets?
- Sure! Uh, none of it is in randomised controlled trials. I mean we're not randomising kids to wear and not wear a bicycle helmet hit a, you know, letting them have an accident and seeing if they get hurt. But there are large cohort studies which show that wearing a bicycle helmet is significantly associated with a lower risk of head injury. Now whether that's because the actual helmet is protecting your head or because kids who wear bicycle helmets ride more safely or are more aware of cars, we don't know. But who cares? The act of wearing a bike helmet significantly reduces the risk of head injury.

- Is a detox necessary?
- No, I mean unless you're like a real heroin addict, then maybe, but yeah. Your body is full of organs - their only jobs are to detox you. Your liver, your kidneys. I mean, when you get a hangover that's because you've had a toxin in your body - alcohol. But the body knows how to break it down and get it out. You don't need to go on a special diet for that.
- You may recall that I did a juice fast a couple years ago.
- Yes I do.
- You were not terribly supportive of my juice fast.
- No, still not.
- And I will tell you it was a disaster. I've received no benefit. Um, I lost no weight. And all I did was feel terrible both during the juice fast and when I reintroduced solid food.
- There you go.
- Yeah.
- And never one study.

- Butter or margarine?
- Ooo. I think these days probably we'd lean towards butter, especially if the margarine's made with trans fat.
- Wow.

- Nina asks: are multivitamins really necessary, and do gummy vitamins work as well as regular ones?
- So, for the vast, vast majority of people, no. Multivitamins are not really necessary. They're getting plenty in their diet. That said, you know, as we've talked about before - they're cheap, there's almost no harms, sure. If you feel like your diet's not good enough you can eat a multivitamin. And there's no reason to believe that those gummy things are any less worthwhile than regular swallowed vitamins. So yeah, go ahead with the gummies.

- Bethany asks: what are the pros and cons of probiotics? Can they actually prevent infection or treat and cure disease?
- So, there haven't been terribly many studies of probiotics, but there's a decent amount of evidence that they're not, that they're good for you if you have acute diarrhoea or if you have some sort of GI infection and you're trying to get. Especially antibiotic-induced diarrhoea, probiotics can help. There's some evidence that they could be good for things like kids with eczema or other atopic disease. Um, but, for many, many other things including the treatment of coeliac it doesn't look like there's much evidence at all.
- I have a kid with eczema.
- There you go, so probiotics could be of some benefit.
- I will give him some of that kefir that my wife always makes me drink.
- Just some yogurt's fine. Yogurt with active culture should be fine.

- Kari asks: can sun exposure on one part of the body cause melanoma on another part of the body?
- Well it can if it's a disease which metastasizes, so in other words if you get sort of melanoma from an area that has been exposed, theoretically it can move to another part of your body where it hasn't been exposed. But the primary incidence is likely to be where you get the sun exposure.
- Ah, that's interesting. Then how do people get, like, melanoma on their like, on the inside of the toenail or something?
- Well because it's not all related to sun exposure.
- Ah, ok.
- I mean some people get. But if you look, people are more likely to get melanoma on the limbs, where sun is exposed, than they are other places. But it can develop anywhere.
- Mmm. I'm very afraid of melanoma. Also everything else.

- This is a great question: what do you think needs to be done to ensure greater price transparency in US healthcare?
- Like a million things. Um, so, god, I mean they're trying to do a better job with it now but it's just never gonna happen in the US healthcare system as it's built this way. Because part of the way that private insurance can actually bring down spending is by making negotiated deals with providers for lower rates for their customers. So everyone's getting a different rate. So the idea that we'll have just one universal, published rate system is very, very unlikely in the United States as it stands today.
- But they have it in many countries in Europe?
- Sure. And there are some states like Maryland which have all payer, where they do make those kinds of judgements and make sure that everybody pays the same rate. But the United States at large doesn't do that at all. It doesn't mean it's impossible, but we're just not building that system.
- Do we have higher prices as a result of our lack of price transparency than countries with price transparency.
- We have higher prices absolutely than almost any other country, and I'm sure transparency has something to do with that. Also it's just that everything just costs more in this country. We just, it's a terrible price system - bad, bad, bad, bad.
- But, on the upside, we get way better health outcomes than those countries in Europe.
- Ok.
- Don't we?
- No! No-o.
- Dang it!
- You know with some things in some areas, we absolutely do very well. Like if I need a heart-lung transplant, yeah, I'd like to be in the United States. But, you know, if you need regular run-of-the-mill healthcare, sometimes the big outcomes that we care about at a population level are better in many, many, many other countries than the United States.
- Alright.
- We do have a lot of MRIs and CAT scanners. If that's your metric of quality, go USA. We're like number 2.
- You know who doesn't have a single MRI machine? The 90 million people in Ethiopia.
- That is true.
- It's amazing.
- It is.
- It's just astonishing.
- Yep.
- Uhh. We have like 50 within the city of Indianapolis.
- There are probably some in our sightline.
- Right, it's like they're like Starbucks.
- Yes, exactly.
- There's one on every corner.
- There's probably like a roving MRI machine in a van around here somewhere.
- I don't understand. I don't understand why we don't just fly one over.
- We don't need to- oh, to Ethiopia.
- To Ethiopia.
- Well because we can't bill very much for it probably.
- That's the problem.
- The price would be lower.

- Ok, this is from Troy, I think this is for both of us. What is your biggest health-related challenge and what are you doing to address it?
- Mine is probably ulcer colitis. I, you know, I just have a chronic illness and so I take medication, and I take care of my health, and I go to the doctor, and I have my regular colonoscopy, and I do everything I'm supposed to do.
- I also have to have regular colonoscopies because of, uh, um, polyps. But my, probably my biggest health problem is my anxiety disorder. Same thing, I'd rather have my anxiety disorder than UC. But like, uh, yeah, you just, you know, you treat it like a chronic illness.

- What do you think is the worst disease that you could have, Kiki asks. That's something I spend a tremendous amount of time thinking about, Kiki, so thank you for your question.
- See, well you're helping his anxiety now too, so good job. Um, that's a personal thing too, it's like, 'cause we, it dep-, worldwide or personal? I would hate any disease which removed my mental faculties, um, and left me perhaps on a slow, degenerative loss in that area. I mean, that would be really bad for me.
- Like Alzheimer's, or?
- Yeah, I think even worse. It's like, I just, the idea that I could, yes that would be bad. And especially if, if you were aware of it.
- Yeah. Well thanks for the uh, thanks for the downer, Kiki.
- We have to stop now for anxiety purposes.
- Now we're in a dark place. There's a lot of diseases I wouldn't like to have. Thanks for mentioning how many there are. Um, dystonia. Like, one of those really weird neurological, dystonius.
- But yeah, I think I, I would be more concerned I think about losing my mental than my physical.
- But if you lose your physical in such a way that you lose the ability to communicate. Then, I mean it does affect. Then you're sort of stuck inside of yourself. That, that's scary to me.
- Except that I. In again, wha- see we're debating, like, badness here. But there are some, so many great ways to help people communicate these days.
- That's true.
- And even people with incredibly bad dystonia still can often communicate in very effective ways in the world, so.
- Yeah.
- I don't know. I think I'm more afraid of the, losing the mental side than the physical side. But they're both bad, they're both bad.

- What can I as an individual do to improve health outcomes and impact health legislation?
- Vote. Vote for people who have, are supporting legislation or policy changes that you endorse.

- Aaron, thank you for answering all of our questions.
- Thank you for asking them.
- I am terrified but also informed.
- As am I.