Our top story today is that Healthcare Triage merchandise is finally available. You can get posters and mugs at dftba.com. Links down in the description.

But in real news, measles is back, the milk industrial complex takes another hit, and how does your favorite Halloween candy rank? This is Healthcare Triage News.

(Intro)

Measles! Did you know that in the United States, indigenous measles was declared eliminated in 2000? It was declared eliminated in all of the Americas in 2002, but this year, 2014, more measles cases have been reported in the United States than in any year in the last two decades. There were 592 cases through August. Why? Well, one reason we have to acknowledge is that more people are traveling to countries where measles isn't eliminated. When exposed, people are more likely to get infected and then bring it back to the United States. But the second reason, and the one we can't ignore, is that more and more people aren't vaccinating their children.

As we've discussed in prior episodes of Healthcare Triage News, measles is one of the most contagious viruses with an R₀ of eighteen. With something that infectious, we need about 92-94% of people to be vaccinated to achieve herd immunity. That's higher than for almost all other vaccine-preventable illnesses.

Complications from measles are common. Even in the United States, up to 0.3% of kids with measles can die. In the developing world, death is much more common, and in 2012, about 122,000 kids died of measles worldwide. Vaccinate your kids! Please!

Our second story is an old favorite of ours. You all know of my fascination with the milk industrial complex. Recently, a new paper was published in the BMJ that points another finger towards the fact that the milk emperor has no clothes. Seriously, how much do you love the Milk Emperor? Props to Mark on that one.

In this study, researchers took 2 huge groups of Swedes, one with more than 61,000 women, and the other one with more than 45,000 men, and then followed them for an average of 20 years. They wanted to see if milk intake was related to fractures or to death. 'Cause, you, know, milk is awesome for bones. Except there's pretty much no evidence for that. It also turns out that there's a growing concern that excessive milk intake could be related to bad cardiovascular outcomes. So what did these researchers find?

Women who had 3 or more glasses of milk a day had an increased risk of death compared to those who drank less than one glass a day, with a hazard ratio of 1.9. You heard that right. Increased risk of death. For every glass of milk drunk per day, the hazard ratio of death went up 1.15 in women and 1.03 in men.

But what about fractures? In men, no difference was seen anywhere. In women, it turns out that for each glass of milk drunk, the hazard ratio was 1.09 higher for hip fractures. It was 1.02 overall, but the 95% confidence interval was 1 to 1.04, so potentially non-significant, so the best we can say is that milk wasn't associated with any benefits in men with respect to fractures and a higher risk of hip fractures in women. Oh, and it's associated with an increased risk of mortality in everyone.

The paper also gets into some biomarkers that try to explain the mechanism for why milk might be harmful. I'll leave that to more basic science experts.

My point is this: The purported benefits of milk are unproven. There's a growing body of evidence that there's an association between more milk consumption and bad outcomes. Why does milk get a pass? Why do we push it so hard?

Finally, over to our friends at vox.com for an awesome article on how relatively unhealthy Halloween candy is. For each candy, they compared the amount of fat, sugar, and calories in a fun size, snack size, or single piece.

The least unhealthy: Sweet Tarts, followed by Hershey's Kisses, Tootsie Rolls, Laffy Taffy, and Jelly Belly Jelly Beans. Of course, "least unhealthy" is relative, but there you go. The most unhealthy: Number five was Butter Finger, four was Whoppers, three was Take Five, and if I'm being honest, that one really hurts cause I love the pretzel and chocolate thing. That just sucks. Number two unhealthy: Reese's Peanut Butter Cups, which is almost enough to make me despair, but the worst: Twizzlers, and my faith is restored cause I hate licorice.

Anyway, if you ate just one piece of each of the 29 candies ranked, you would have consumed almost 67 grams of fat, 255 grams of sugar, and 1936 calories, and we realize it's probably too late for this year, but hopefully you can use this information next Halloween.

This episode of Healthcare Triage is supported by audible.com, a leading provider of premium digital spoken audio information and entertainment on the Internet. audible.com allows users to choose the audio versions of their favorite books, with a library of over 150,000 titles. We recommend Candy Freak by Steve Almond. He goes around and talks to the last independent holdouts in the candy manufacturing industry. Stan tells me that it's funny and chock-full of good information. You can download a free audio version of Candy Freak or another of your choice at audible.com/triage.