YouTube: https://youtube.com/watch?v=aGEXIcUAWdw
Previous: Ticks! They Can Really Make you Sick
Next: Coffee! It's Not Bad for You, and It might Even be Good!

Categories

Statistics

View count:11,486
Likes:262
Comments:13
Duration:31:33
Uploaded:2015-07-02
Last sync:2024-02-13 16:00
When does a baby's eye color stop changing? Are plastics bad for you? These questions and more answered this week on Health Care Triage LIVE!

Master question list: https://docs.google.com/document/d/1dk-KPVNfkzC1R4YDDF69Fn1Z4KcPxTl5Whis_VtNnDU/

Visit our subreddit: http://www.reddit.com/r/HCTriage

Support HCT at Patreon! http://www.patreon.com/healthcaretriage

TIMESTAMPS

00:04 - WE'RE LIVE!

01:52 - 1.You said in your nutrition video that it better to eat 2 apples than to drink the same 27g (or whatever it was) of sugar in apple juice. Why? 27g of sugar is 27g of sugar.

03:40 - 2. Listerine. Wikipedia says 3/10 meta analyses found link to oral cancer. I'm a lazy brusher but doesn't mind using Listerine. Thoughts?

06:15 - 3. Is there any evidence that the body absorption rate for caffeine is higher when taken from a liquid like coffee or tea as compared to taken from a capsule or pill?

08:00 - 4. Is Rh factor and blood type linked at all? Or are these 2 completely different things?

09:05 - 5. Are devices that help babies to sit/stand before they are able to unassisted (bumbo, jumparoo, exersaucer) bad for development?

11:25 - 6. A French doctor told me that food allergies are very rare in France. He adds that it's possibly due to the very low amounts of GMO they eat there. Any research on that?

14:10 - 7. Would it be bad for non-smokers to use NRTs as psychostimulants? What are the risks? It seems like it can have some cognitive benefits, but I can't find any research on their use in non-smokers.

15:40 - 8. I have chronic yeast infections. I get one every month. Is it unsafe to take the over the
counter anti-fungal medication for them every month? Home remedies have not worked.

16:42 - 9. What does the research show regarding the link between mood/mental health and gut bacteria?

18:43 - 10. With the Supreme Court's decision on allow same-sex couples to marry, lots of people have been posting misinfo of the effects of same-sex couples on kids. What does the science actually say about this?

21:03 - 11. At what age does a baby's eye color stay what it is? (ours is blue and I'm curious if they'll shift at 1 year or something as I've heard all kinds of stories).

21:48 - 12. Are sugar free gummy bears actually laxatives or is that just an internet joke?

23:18 - 13. What are your thoughts on statins and their use? Do you think they are overprescribed or as necessary as the health community purports them to be?

24:43 - 14. Are plastics bad for you? A lot of people refuse to eat out of plastic containers, especially after food has been reheated in the microwave.

25:38 - 15. Is hitting Snooze bad for my sleep habits? I struggle with waking up & want to be a morning person, but it's so nice to ignore the alarm for 5 minutes. Is this counterproductive to waking up early?

26:08 - 16. If teaching people about vaccinations makes them less likely to vaccinate, isn't the best thing for society to require everyone to be vaccinated?

27:18 - 17. Prisons are the biggest mental health providers in the US. Why do you think medical care, including psychotropic medication, doesn't usually play a bigger part in rehabilitation?

27:48 - 18. Does soy sauce affect hormones in any significant way? I love soy sauce

29:03 - 19. What's your method for selecting studies to cite in HCT? Do you ever feel like you'd like to do systematic reviews rather than narrative ones for the show?

30:30 - Byyyyyyye
Aaron: We are live! Look at that, and like almost exactly on time. Kudos to the Healthcare Triage staff and all the wonderful people who work here because that usually takes us much longer. Given that we're so on-time, I'm going to try to get through our housekeeping stuff reasonably quickly today, but we still should always talk about it.

First of all, that to everyone that's turned in for Parasite Month. Thank god it's over; I'm sort of done with it. But, enjoy the videos that we've had, and this week's Healthcare Triage Live will be any topic at all. So, get your questions in now; we've got some going already, but you can put 'em in right into the comments of the video right now, and we will get to lots and lots of them.

Check out our Facebook page - facebook.com/healthcaretriage - more and more people joining every day. You get to see lots of other stuff you otherwise wouldn't get: Besides all the videos, you can download some of the neat graphic that Mark has made, everything on there is free.

Reddit is also gaining some popularity. I was just on there yesterday answering some questions - [reddit.com/r/hctriage] "reddit dot com slash healthcare Triage," I think it is, but if not, links will be down below.

Off Screen [OS]: There's, like, and R in there.

A: Yeah, there's an R where, that's great, I screwed up - links below [OS laughter] links below, ignore everything I say, links below for all of that.

Patreon.com - we're so happy all of you stuck around for Month Two and those all weren't one-time donations. We cannot express enough our appreciation that you all are all helping support the show; it's helping us do even more and to make the show better and better. There's lots of great rewards. We had a second named-patron added in this week, so starting on Monday, that person will also get their name mentioned at the end of every episode. We're just really grateful for all the contributions and all the help that you guys can give us.

What else... [asking OS] Am I missing anything on housekeeping, because I don't have my usual list here. Nothing else could be that important, so let's not even bother. Let's get started! Question number one... I'm looking at the wrong questions here.

[Transcriber's Note: The question-givers' monikers are approximate; while the questions themselves were outlined in the video's description, the names were not.]

Question number one: "Hold-made" says, "You said in your nutrition video that it better to eat 2 apples than to drink the same 27g (or whatever it was) of sugar in apple juice. Why? 27g of sugar is 27g of sugar."

Well, a couple reasons: One, is that... Actually, no. Let's just go with one big reason. One is just an empty calorie. You drink 27 grams of apple juice and sugar, it's almost too easy.

[sliding noise, picks up mug] That's what I forgot. [points] Mugs, posters - you should get 'em.

Anyway! It's too easy to drink those calories. You can down 27 grams on a glass of apple juice so easily that it doesn't satiate you, it doesn't do anything, your body almost doesn't notice. Many of the mechanisms your stomach would use to know that it's time to stop eating are gone. You don't have anything to fill your belly. You eat two apples - one, it takes time. So, while you're actually eating the apples, your body is starting to recognize that is HAS been getting calories, and it immediately starts to release some things that go, "You could think about stopping eating."

Second thing is it's full of fiber, which is good for you; it's going to fill your stomach, and as your stomach has stuff in it, that's another signal that you could slow down eating. And so, in general, you're going to have a less easy time overstuffing yourself than you would if you just pound sugar drinks. And juice is a sugar drink, that's what it is. So, it's what I would refer to as an "empty calorie" - you don't get any other of the benefits of all the foods you're eating, you don't get a lot of the other nutrients, and you're also making it too easy. And the last thing we need to do so often in our lives is make it easier to put extra calories into our bodies.

Now, of course, that doesn't apply to everybody, and that doesn't mean that you can NEVER have apple juice. It's just a general rule of thumb that in general - that's what the nutrition recommendations were about - you're better off with the unprocessed foods than the processed foods.

Question two, "Eric Lynn - Listerine." He says that declaratively. " Wikipedia says 3/10 meta analyses found link to oral can[cer]-" Oh, Wikipedia... [OS chuckles] "I'm a lazy brusher but don't mind using Listerine. Thoughts?" Well, we gotta unpack so many things here.

First of all, using Listerine does not excuse you from brushing. Brushing is very important for many other reasons. You need the brushing often to remove some of the foods; you just can't do that by soaking your teeth in Listerine. So, while Listerine - and this has been shown in meta-analyses - while Listerine and other rinses can, over the long term, reduce the amount of plaque and reduce the amount of gingivitis you might have in your mouth, they don't do the same thing as brushing.

That brushing is really important; that's how you get rid of a lot of the food particles and the bacteria that might be stuck on there, and some of that stuff is sticky. That's why they work so well - they've evolved to learn how to stick around in your mouth even when you try to get rid of them. So just because you're a lazy brusher, using Listerine is not a solution - get over your laziness.

The second is that it's not the quantity of the meta-analyses, it's the quality of the meta-analyses. And without looking at the Wikipedia page, "given that three of 10 meta-analyses found a link to oral cancer," I'm going to guess that something was fundamentally different about those meta-analyses: perhaps they let in less high-quality papers, perhaps they were more permissive in some of the outcomes that they used.

But there are really good meta-analyses have been done. The last one that I saw was published in 2012, and the results of that, and I'm quoting here, "This quantitative analysis of mouthwash use and oral malignancy revealed no statistically significant associations between mouthwash use and the risk of oral cancer, nor any significant trend in risk increasing daily use, and no association between use of mouthwash containing alcohol and oral cancer risk."

So, they're even looking at dose-response, and they're looking at the components, and none of those find a risk to oral cancer. So, again, it's not the quantity. Like we talked about in our episode on meta-analyses itself, you have two competing meta-analyses: One that said organic food was more nutritious, one that said that organic food was NOT more nutritious, and I favor this one [the latter].

It doesn't matter that they're one of two - it's what they let in in the quality. Their definition of "nutritious" over here [the first analysis mentioned] was very strange, and they were much more permissive in the quality of the research, and THAT'S why I discount that one, and favor the ones that are better [i.e. the latter-mentioned analysis]. So, it's not the number; it's what actually in those.

Next question comes to us from "MentoriNigh - Is there any evidence that the body absorption rate for caffeine is higher when taken from a liquid like coffee or tea as compared to taken from a capsule or pill?"

Most people are not getting their caffeine from a capsule or pill; most people are getting it through food, so it's a small percentage of people that are getting it through capsules or pills. The second thing to know is that is, therefore, probably a supplement. And as we've detailed many, many times on Healthcare Triage in many, many episodes - supplements are not well regulated, and so you never know what you're getting. It's not even clear what you're taking in a supplement of caffeine is giving you in terms of actual dosage of caffeine. So, it's not the way I would go.

But there likely are differences in the way that the body absorbs caffeine based on the mechanism by which you get it. For instance, when we did the episode one - [looks OS] we haven't done the episode, the episode on coffee is upcoming.

When I wrote the upshot piece at the New York Times on coffee, one of the things I talked about was that there are some links between caffeine use and getting high blood pressure even though those don't translate into different outcomes in terms of cardiovascular disease. But those associations between caffeine and high blood pressure don't appear to be as strong when you're getting the dose from coffee.

Why? I don't know, nobody really knows. But it does point to the fact that the caffeine being absorbed through coffee is different than the caffeine being absorbed in other ways. So, likely something in the way that you take it - be it through a drink or through some other substance - there are likely differences in how you're getting them, and that there is some evidence that the caffeine has absorbed through coffee doesn't appear to impact blood pressure in the same ways as caffeine taken through other sources.

Next question comes from "Ivon Cornejo - Is Rh factor and blood type linked at all? Or are these 2 completely different things?"

They are sort of different things. So, Rh factor is sort of when you're the plus or the minus when we talk about blood types: When someone is O positive [O+] or O negative [O-], the "+" or "-" is the Rh factor. The O, the A, or the B have to refer to other antigens, and the problem is, of course, is that when we move your blood from one person to another - or even from mom to baby with births and whatnot - if you're -, if you don't have it and then you see it, you can try to attack it because your immune system doesn't know what it is. But the attacks from O to A or to B are different than the attacks of Rh - to +. So, they are similar in that you have to worry about them sort of in the same way with respect to the immune system, but they are different in that you can be O, A, or B; you can be Rh + or -; you can be almost any combination of all those. They're just two different things.

Next question comes to us from "Lisa Jones - Are devices that help babies to sit/stand before they are able to unassisted (bumbo, jumparoo, exersaucer) bad for development?"

"Bad" is a pejorative word. "Bad" would imply that you're causing real damage. There is SOME evidence that they can lead to delay. And again, these aren't usually randomized controlled trials; these are usually associations. But there's some evidence that putting babies in these things may delay the times at which they stand on their own; so instead of doing it at nine months, maybe they do it at 10 or 11 months. And so, lots of pediatricians will then say, "Well, that's a bad thing," and it's hard to argue that it's a good thing, but it's a delay... they all walk.

There's aren't a whole legion of children out there who grew into adults who can't walk or sit up or crawl because they weren't in a bumparoo or a jumpo or an exersaucer - they all turn out okay in the end. But there's a delay! Because, of course, if they're not forced to develop the skills to try it on their own, they do it later. That doesn't mean that they won't become NBA stars or that they will have long-term deficits because you did that.

So, "bad" is pejorative. If it makes you feel any better my son -  [points OS] one of them is sitting over there - he was in an exersaucer A LOT because it was the only way we could get peace in our household. So, that was more important then the extra-, on the other hand, he walked very late - at 16 months - so maybe we screwed him. I don't know. [OS laughter] But he runs now, he's great, he's totally functional now, and so it all turns out okay in the end.

Having said that, there's an exception - those mobile walkers are BAD, and I'm using the pejorative word there. Those ones that can move and that allow them to walk are bad because there have been many injuries of kids that manage to get over to stairways or into places they shouldn't because they are able to walk at a time when they are [points to head] other developmentally not supposed to be walking. So, they don't know about the danger of stairs, and now we're providing them the means to get over to them and fall down.

So, the ones that move - walkers - those I would not recommend. Those are different. The ones that are stationary though and just allow them to stay upright or jump in the doorway and whatnot - I would hesitate to use the word "bad" there.

"OliverSaintAman" says, "A French doctor told me that food allergies are very rare in France. He adds that it's possibly due to the very low amounts of GMO they eat there. Any research on that?" SO much tied up in this question! Let's start without the GMO; we'll get to the GMO at the end there.

So, "Are food allergies very rare in France?" Part of the problem is how we define "food allergies." Not the "problem," part of the DIFFERENCE is likely how we define "food allergies." If we define them as what we can see in a person or how severe they are and say, "You have to have a certain level of reaction before we define it an 'allergy,'" - there are differences. If we define it as "seeing a blood-test difference," that's also very different.

There are also differences because of how we feed people and what they are. There are lots of systematic views; in fact, I published-, was an author on a systematic review that looked at early feeding - early solid-food feeding - and how this was related to kids later developing eczema and food allergies. In fact, I think we just did a recent Healthcare Triage News in this because we were talking about the fact that a recent study showed that exposing kids to peanut protein - even kids that were already known to have reactions to peanuts - wound up with them having less chance of a peanut allergy later in life after five years of age. So, over and all, exposing them again and again and again in a controlled way led to less allergies.

It may be that if people are more permissive in other countries and allow kids to be exposed to stuff, there could be less food allergy in later in life - that's very possible. THAT'S what I think would likely-, THOSE things account for differences in food allergies between us and other countries. How we define it, how we expose kids to it, how we actually diagnose it - those are all big differences.

GMOs are different because as, of course, we've talked about in our episode on GMOs, the overwhelming amounts of evidence doesn't show that GMOs are being linked to real differences in food allergies. In fact, people are allergic to lots of stuff that has no GMO in it, people are allergic to the stuff that does have GMO in it in the same amounts - it's not the GMO.

You can find small studies that maybe say different things, but when we aggregate them in the [shrugs] aggregate, we put them all together and there's lots and lots of studies on GMOs, and lots and lots of them have not been done by industry, we cannot find really good evidence that shows that GMOs are any more unhealthy than conventionally grown food. And given that they do a lot of good in the world, it's hard to start arguing against them.

But I could spend the rest of the time talking about GMOs here; I encourage you - go watch our episode on GMOs. I'm sure we will flag this in here, and Mark will put up a link, or someone will, in the rundown later. Go watch that episode; I can talk about it in far more detail there.

Next question, "Ikuwongs - Would it be bad for non-smokers to use NRTs as psychostimulants? What are the risks? It seems like it can have some cognitive benefits, but I can't find any research on their use in non-smokers."

I'm gonna guess you can't find any research on this because no one is recommending it, as far as I know. If we're talking about NRTs, I assume we're talking about nicotine gum, nicotine patches. No one is recommending those for psychostimulants. When you say "it has cognitive benefits," I'd be like, "What benefits are you looking for?" because I don't know exactly what you mean.

It is going to make you smarter? I would doubt that. Is it gonna make you more attentive? I don't know if that's true either. No one has studied this because no one is recommending its use - that you buy nicotine gum or that you buy nicotine patches to get some sort of cognitive benefit. So, I'm gonna say don't probably do that.

We still won't make that medical advice because - that's another housekeeping thing I forgot - lawyer Mark would tell us: None of what you hear today is medical advice! You should never make any medical decisions or take or don't take any pills or do or don't get any procedures or anything else without talking to YOUR doctor - don't listen to me! I'm a guy on YouTube right now. I'm not your doctor; I'm not telling you how to take care of yourself or how to treat yourself. You should go to your doctor for that.

We're here to talk about sort of things in general, but for individual decisions like Ikuwongs about whether he or she should take NRTs as psychostimulants - talk to your doctor. I'm pretty sure your doctor will say "don't do it" anyway.

"CCTprod" says, "I have chronic yeast infections. I get one every month. Is it unsafe to take the over the counter anti-fungal medication for them every month? Home remedies have not worked."

No, I don't think it's unsafe. Again, you should talk to your doctor before making any individual medical decisions. But a lot of those are just topical, and you're gonna take them, and they're going to get rid of it, and that's going to be fine. There are some steps you can likely take to try to limit your yeast infections. Given that you're describing trying lots of things, it's very likely you've tried these already, but sitting around in a wet bathing suit is often not a good idea, lots of other things you can try as well.

I would encourage you to go talk to your doctor about that because there are probably some steps you could take. It's very possible that you may be one of the rare people that even need some sort of prophylactic measures or drugs. But again, talk to your doctor about that. But I don't think that there's any real concern about using the over-the-counter ones as needed because ,again, they're topical - you're not really taking a lot of systemic treatment or therapy for that.

Next question - "Julesthebunny - What does the research show regarding the link between mood/mental health and gut bacteria?" I swear to you I keep toying with the idea of tackling this in a regular episode of Healthcare Triage. The problem is that a lot of this is still really early. You know, talking about the microbiome and how all of this works - it's really early.

There was a great piece recently - I think it was the New York Times - that talked about what you're actually addressing. There's a couple researchers out there who are trying to make the argument that bacteria in the body are releasing a fair number of neurotransmitters, and that it makes sense that those neurotransmitters regulated by the bacteria in our gut somehow could be affecting our mood because that's how we stim-, that's how a lot of the drugs we use for mood therapy are - they are working on serotonin or norepinephrine or something else. So, a lot of them are releasing those.

But there are questions because, of course, if - and this is where I would agree with those questions - if the bacteria in your gut were hugely responsible for your mood, then every time somebody took an antibiotic, they should theoretically be seeing huge mood changes. Because if the bacteria are mega-affecting your mood, and we kill the bacteria - because antibiotics do that, and lots and lots of people take antibiotics - we'd expect mood to be drastically altered.

If we're going to make a play and say, "The bacteria in your gut are super important," then killing the bacteria in your gut - as you would do with an antibiotic - would be super important. We don't see that. So, while I'm interesting in this as an ongoing theory, and I think that the fact that they're funding research in these areas and continuing to do work is great and makes sense, I'm not ready to buy onto this theory yet because the counterfactual - the fact that we can kill the bacteria and we're not seeing mega changes - would make me suspicious that the bacteria are hugely, hugely, hugely important to begin with.

Next question from "Chase Adams - With the Supreme Court's decision on allow same-sex couples to marry, lots of people have been posting misinfo of the effects of same-sex couples on kids. What does the science actually say about this?"

Well, there are a lot of studies that look at how kids do with respect to same-sex versus couples, and I think it's fair to say that the overwhelming evidence shows that kids raised in stable households with two parents do very, very, very, very well. And that doesn't matter whether they are same-sex or whether they are different sex or any combination I could imagine. The kids raised in stable households with more than one parent do very well.

That doesn't mean that kids raised in stable households with one parent don't do well. Lots and lots and lots of people do, and the problem is more often than not, this kind of research is used to try to discredit families - there are family structures that people don't approve of - than to say what's better. Because, again, it's important for people to remember that the OVERWHELMING number, the magnitude of the difference is very small. You can find things that are statistically significantly different but not necessarily clinically significantly different.

But in much of the evidence that people use is either flawed studies; or studies that don't make sense in general or that have real problems; or that find tiny, tiny, tiny little differences that are statistically significant, and then they preach this to the skies that this means that we shouldn't allow one or the other to occur. Which is, of course, never gonna happen anyway because it's the United States of America - and many other countries - people are free to do as they like. If single people want to have babies, they can. If other people want to have babies, they can. We're talking about legalizing structures to get benefits and do that, and when people are refusing that, they're often doing it to try to discredit some sort of family structure that they don't enjoy.

So, I would say that the overwhelming research shows that people raised in stable, happy, same-sex couple kids raised in stable, happy, same-sex couple families do very well - likely equally well - as those raised in stable, non-, you know, with different sex. But we should probably pull up those studies and review them one by one as opposed to just lumping them all together because they all have pluses and minuses.

"Evil King Gumby" says, "At what age does a baby's eye color stay what it is? (ours is blue and I'm curious if they'll shift at 1 year or something as I've heard all kinds of stories)."

They do shift. They do. I don't know that you can nail down the date. I would say if your child is one year old, it's pretty much a lock at that point. Also, if there's no chance - based upon your family history of them having-, if every person in your family tree has only ever had brown, the likelihood of it staying blue is low.

Having said that, my wife and I both have dark eyes, and one of my kids has blue eyes, and that's because you can find a grandmother on both sides of the family tree and somehow that recessive gene worked its way down. It's amazing, genetics are. But you watch over time, you'll see them shift in months; probably by a year it's pretty locked in.

"The Lion Pants" - I like that name - "Are sugar free gummy bears actually laxatives or is that just an internet joke?" Okay! [OS chuckles] Sorry, I just got a little note here. Here's the deal:

A lot of the artificial gummy bears and artificial sweeteners will use sugar alcohols like xylitol, and THOSE actually can wind up being laxatives. You've heard about this before; in fact, if you take a lot of xylitol gum or sorbitol gum or sorbitol gummy bears or things like that - those can actually be a laxative because they cause water shifts in your stool. And that actually can cause you to poop more. So, it's not necessarily that it's the gummy bears; it's the sweetener that they're using, and this will happen in lots of things that you can use sugar alcohols for.

In fact, it happens with some of the fat replacements as well; you may remember they had those potato chips for a while that used that artificial fat or whatever it was that wasn't going to get well absorbed, and it caused people to have diarrhea because these things don't get absorbed, they stay in the gut, they cause water shifts, people poop a lot.

So, if your sugar-free gummy bears have a sugar alcohol or one of those other types of artificial sweeteners in it, and you're eating a lot of them - as people often do with gummy bears - it is possible that that would give you a laxative. And that has been confirmed by one of the people in this room who I won't embarrass. But he did have this happen to him.

"Fake Idolatry - What are your thoughts on statins and their use? Do you think they are over-prescribed or as necessary as the health community purports them to be?" I think we've actually even discussed this, and this is one of those-, it's BROAD, so broad.

So, here's the thing: There are lots of people who benefit from statins, and that's awesome. There are people who aren't on statins that probably should be, and that's a mistake, in which we need to increase probably their use of statins. But there are probably people on statins who don't need to be. Given that statins can have significant side effects, and given that the actual differences among them, the actual benefit to many people is very small, we've had our guidelines increased to the point where I think it's to the point where if you're over 65 and you're African-American, a lot of the guidelines say you should be on a statin. I don't know if that's the case.

I've written about this multiple times at the New York Times; we did this in our (?~24:05)"number needed to treat," our (?~24:06) "number needed to harm;" I've talked about this in my piece on how when we call everyday processes "diseases" that people start to take more therapy, and that's a problem - we've done Healthcare Triage episodes on these as well. I encourage to go read or watch all of those because there'll be more detail.

In general, I think our guidelines have sometimes gotten a bit too permissive, but that doesn't mean that every person who's on a statin shouldn't be. So, we need to be better on both sides. I'm gonna start to speed up a little bit because we're running out of time.

So, "Alita Higginson - Are plastics bad for you? A lot of people refuse to eat out of plastic containers, especially after food has been reheated in the microwave."

Some plastics are bad for you. Those are usually-, they usually say on the packaging or some way "don't microwave these." Others are safe. Again, we're worried about the edges. These are people who are worried about incredibly tiny, if real, absolute increases in risk. Those are nowhere near what you would really be worried about; people do overthink this. However, on the other hand, you could make an argument that plastics are terrible for the environment - all of these things could be true.

I don't panic about this, if I'm being totally honest. Nor did I have my kids; my kids had baby bottles made out of plastic. We washed them, we put them in the dishwasher. We didn't heat our formula in the microwave because you shouldn't do that for other reasons that have nothing to do with cancer risk; it's because you can make the formula too hot and burn your baby. But I do put plastic in the microwave, I eat out of it, I'm putting my money where my mouth is. There ya go.

"TanUV90 - Is hitting Snooze bad for my sleep habits? I struggle with waking up & want to be a morning person, but it's so nice to ignore the alarm for 5 minutes. Is this counterproductive to waking up early?"

I don't think there are any randomized controlled trials in this; ya gotta do what works for you. I can't stand the snooze bar. I would rather sleep to the last second and get up - that's me. If hitting the snooze bar for two hours makes you feel better, awesome. I don't know. I don't know how that works for you. I'm baffled. But I don't think we have a randomized controlled trial - do what works best for you.

"David Davine - If teaching people about vaccinations makes them less likely to vaccinate, isn't the best thing for society to require everyone to be vaccinated?" That's a great question.

I think the best thing that society can probably do - there's a lot of research on this - is to make it as hard as possible for people to get out of vaccinating their kids, but allow them to do it, and not spend so much time talking about this in the media, because it turns out there's good research that talking about this in the media over and over and over and over and over and over and over again actually makes it even more mainstream for people to refuse to be vaccinated because they hear about it so much. They think, "Lots of other people are doing it, why don't I do it, too?"

Those same people who know this social science are arguing that the new California law may backfire; that making it harder and harder and by refusing to have any exemptions - again, we keep putting this back into the media and we're mainstreaming it. Vaccination refusal rates are pretty low in the United States; most people are getting vaccinated, and while we need to do everything that we can, we might not be doing this.

There will be an upcoming Healthcare Triage episode exactly on this topic in the next few weeks, maybe in the next week or two. So, watch for it.

"Leo DeBroke - Prisons are the biggest mental health providers in the US. Why do you think medical care, including psychotropic medication, doesn't usually play a bigger part in rehabilitation?"

I wish it did, I don't know. We do mental health terribly-poorly in the United States, we do prisons terribly-poorly in the United States. Answering this question would be so much bigger; I think there's a gazillion reasons why we don't do this well. I think we're doing it better than we used to; mental health parity is so much better than it used to be, but you're right - there's still a long way to go.

"Alexander Lorenzen" says, "Does soy sauce affect hormones in any significant way? I love soy sauce."

I love soy sauce, too. Soy sauce has a crap-load of sodium, and so, I use the low-sodium soy sauce. Other than that, I never worry about this at all. You know, you will see a lot of people worried about soy and its effects with hormones and all these other things - as I like to say, "Hormones are not hormones!" There's many, many, many hormones in your body, and the idea that somehow the soy sauce hormone or the thing that soy sauce mimics is likely taking over your body is an incredibly small risk.

So, when people are getting their soy, and they're being vegetarians but getting a lot of their protein through soy, that's awesome - they need the protein. So, I'm not demonizing soy. I have not yet been convinced that this is something that the average person needs to be concerned about through any kind of systematic review or meta-analysis. It's something we can watch for, but you hear people talk about this all the time: They demonize this food or that food and say, "That's the cause of something bad in the environment." If that was the case, lots and lots and lots of people would have it.

There are cultures in the United States that use soy sauce even more than we do; they're not having huge hormone problems. All of this leads me to believe "too-long-didn't-read" answer is "I don't believe soy sauce is affecting your hormones in any significant way."

Last question! "Raphael Abacan - What's your method for selecting studies to cite in HCT? Do you ever feel like you'd like to do systematic reviews rather than narrative ones for the show?"

I try really strongly to pick systematic reviews and meta-analyses. In fact, if you go and read the stuff that I write at the New York Times - I wrote even a piece on my blog, "The Incidental Economies," about this - about the fact that I'm trying to pick systematic reviews and met-analyses almost exclusively for Healthcare Triage when they exist because all the research should be viewed in aggregate.

And part of the problem of a lot of the way we do studies is that we'll see some with the benefits, some with the detriment, and the news popularizes each one, and people take home the message that we just don't know what we're talking about. But these are all subtle, tiny changes, and we have to look at them all together. And so, if there's a great meta-analysis to systematic review, I'm picking that.

With Healthcare Triage NEWS, I like sometimes to focus on individual studies because they're new and they're topical. But we usually don't see those kinds of new or topical things in areas that have already been settled by meta-analysis or systematic review.

If you find that I'm picking individual studies, and you think I'm making a narrative out of them instead of citing the systematic review or meta-analysis, let me know. Because that's not what I'm trying to do. We are trying to use the big aggregated studies when we can and only go to the individual studies when we can't. That's our goal. So, I'm trying to do that already, let me know if I'm not.

All right! Another marathon completed, that should do it! Have a very safe Fourth of July! We will... I think not see you next week because we have to talk about scheduling. But unfortunately, I will be travelling to Seattle next Wednesday, and so I don't think that we will be doing Healthcare Triage Live. But the week after that, we should be back to normal.

We cannot do any of this without you; as always, thank you for watching, thank you for supporting the show. Facebook.com/healthcaretriage, the Reddit Healthcare Triage - go check those out, watch regular Healthcare Triage: news on Friday, show on Monday, live on Wednesday. We're pumping out so much Healthcare Triage these days; it's hard to keep up, but you should - you'll be much smarter with it.

Having said all of that, if you can - patreon.com/healthcaretriage  - we appreciate the support. We are blown away as we enter our second month how many of you have continued to support the show. It is absolutely going to make it bigger and better. We've got great plans, we've got other things that we're planning and doing, and we're excited to announce them as they come.

Regardless, thanks for watching. We appreciate your support. We'll see you soon.

[end]