Welcome to Healthcare Triage Live! We got on the air, everything seems to be going well.

A couple of housekeeping notes before I get started. First of all, we want to remind everyone we now have a Facebook page, Facebook/healthcaretriage. I think over a thousand of you have liked it so far, which is great. Please keep going, join up, spread the word. It's a great way to share all the videos and make sure that everybody is getting all the great Healthcare Triage content that they want.

Even more important, and even more exciting -- well, at least it is for us -- we want to announce that we have joined Patreo... Patreon, Patreon, Patreon. We now have a Patreon page and I want to make sure I pronounce everything correctly. So, and there you can hear it on repeat! We are now on Patreon, a subscription-based service that allows you, the viewers, to support all of the good work that we're trying to do here at Healthcare Triage. Many of your other favorite YouTube programs are also getting help from Patreon. It's a way for the community and all the people that love the shows that they're watching to help make it better.

We want to stress all the time that Healthcare Triage is always going to be free. All the content that you watch, everything you like about it will always be free to share, free to watch, readily available. None of that is gonna change. But if you can help, if you can help subscribe, if you can help us with some resources, there's so many exciting things that we would like to do with the show to make it better.

We've already gone from one show a week most weeks to about three shows a week when we can pull off Live as well. We're happy to keep doing that, but there are just some things we'd like to do, including making the set a little bit better, improving some of the equipment that we use, and trying to get a lot of other things done. We'd even like to go travel and go on location and make the shows even more exciting.

There are also lots of great rewards that you can get if you go and subscribe. You know, for even just a small amount of money, you can get access to special Healthcare Triage information and feeds, and if you're willing to do more, you can even get a, you know, a signed pill. Healthcare Triage pill, the most exciting part of our Healthcare Triage set. For the right amount of money, we will get one, sign it, and ship it off directly to you.

So, enough of my shilling for the moment. Please go to Patreon. Is it... patreon.com/healthcaretriage, check it out, please consider subscribing. We really appreciate the support so we can continue to grow and big and better.

All right, we had some technical difficulties last week at the beginning of the show, and so I'm going to start today by actually repeating the first three questions from last week, in case some people didn't get to see them, and also so those three people who submitted them get the thrill of my saying their name live on the internet. 

(2:36) First question, Jenna Galland Peterson, "I've been frequenting several pregnancy and parenting forums lately and there seems to be a lot of women swearing by the 'soft cup method,' by which they trap ejaculate against the cervix using a menstrual cup, typically overnight. Is there any merit to this?"

Jenna, that is certainly better than doing nothing. You know, people have been using the cervical cap for a long period of time. Basically, all it is, is it's like a cup that goes over the cervix and blocks the sperm or the semen from actually getting through and trying to work their way up to the egg. It is better than nothing. So it will work a decent percent of the time. It is, however, nowhere near as effective as many other easy birth control methods, including condoms, birth control pills, IUDs, which would work much, much better than a cervical cap. So better than nothing? Merit? Sure. Could you be using other birth control which would work better? Absolutely, and probably those would be better for most people.

Second question, from twdude. "Can you talk or explain about febrile seizures? As a 911 dispatcher, parents often call extremely freaked out about them and have often never heard of them before."

Ok, the way I usually explain this to patients is that if I took a bat and I hit you in the head hard enough, you would have a seizure. That would be enough of an insult to your brain that you would have a seizure. Doesn't mean you have epilepsy, doesn't mean that you would have a seizure disorder for the rest of your life. It's a one-time insult, likely, and you would then move on with your life.

Babies have very undeveloped brains, and they're just not as well-protected, so even less of an insult can make a baby over-taxed and cause them to have a seizure. And a fever can do that in a small baby, where it's not often even the height of the fever, some people think it's how quickly that the temperature is rising, and that can be enough of an insult that a baby will have a seizure. They're, they are generalized, so it wouldn't be in one part of the body, it would have to be the whole body. They would be what we call tonic-clonic, where they're shaking, and they can't last for too long. But if they're short, they're limited, and they're generalized, and they don't seem to have any negative right afterwards, the vast majority of babies that have them will be absolutely fine the rest of their lives.

Some babies may have them more than once. A baby that has had one febrile seizure is a little more likely than the general population to have a second, but it keeps going down over time. They don't really have epilepsy in the long term in higher amounts, so it's not a concern for the long-term prognosis of that child, and there really are no tests or anything else to do. Parents get freaked out by that, because they see "seizure" and they think that the whole medical system should kick into gear and lots of tests and concern should happen. That doesn't. Because we know that febrile seizures for the most part, unfortunately, are a normal thing that happens to some babies and doesn't have long term implications. And so you will absolutely freak out if you see one in your child, but I'm telling you for the most part, not a reason for concern in the long run. Still call your doctor, always, as Mark the lawyer would tell me, I'm not giving out medical advice over the internet, but you should... and you should call your doctor, but in general, you shouldn't be too concerned.

And the third question from last week, lisapindoc, "We already know about the potential (honking sound in background) side effects of advanced maternal age. There are recent studies on the potential side effects of advanced paternal age. What have the results been?"

It's so hard, you know, I'm gonna break the wall here. Right behind this thing right here, there's, like, outside, and a very, very busy street in Indianapolis, and even when we're filming once in a while, the trucks are so loud! You don't get to see that because we cut that, but watching live, the magic of honking, right here for you.

Anyway, potential side effects of advanced paternal age. Um, first of all, when we talk about the bad parts of advanced maternal age, it's always important to remember that they still are small. The vast, vast, vast majority of women who have babies, even what we would call advanced maternal age, have totally normal, healthy children. Um, some things are more common when women get into advanced maternal age, like Down Syndrome is more common, but still not totally common, you know it's still only a couple of percent or even less, and so, it's still most people are having healthy babies.

With advanced paternal age, the data is even more scarce. There are some studies that show that there's an association perhaps with autism, but a lot of other studies show there's not. And some other studies show that there might be a problem with advanced paternal age and some issues, but it doesn't appear that the same associations are there with respect to women.

Having said that, again, talk to your doctor and they will give you the specifics about what the potential risks are. But again, usually they are small, and for people that want to have children, that's why you have children. And so, you know, talk to your doctor, but always weigh the benefits versus the harms and in the vast majority of times the potential benefits of wanting and having a child vastly outweigh the risks that you might be facing.

Now to new questions! Spencer Bernard: "I found your Healthcare Triage episode on e-cigs interesting." Which I appreciate. "As a follow-up, is there any evidence that nicotine by itself is a carcinogen? Should we be concerned for people who use nicotine gum or patches?" As a carcinogen, I don't think so. Certainly not in what we're seeing with respect to, you know, to smoking. It is the smoke. And it is sometimes the tobacco, because remember, of course, that people that use chewing tobacco can still have a significantly increased risk of having cancer in certain areas of the body. But I don't know if that's the nicotine. That really usually is other things that are in the tobacco. I'm not sure that we have great studies, unfortunately, because people haven't been using pure nicotine for a very long period of time and with follow-up, so it should be watched closely.

It certainly cannot be anywhere near [siren sound in background] the dangers that you're going to see from smoking, because if we saw those kinds of -- and the cops obviously don't like this answer -- but if we, it's not going to be the same dangers, because if the same relative risk were there from smoking, huge numbers of people would be getting cancer from nicotine patches and nicotine gum, and that's not occurring. We may find out that there's an increase over zero in the future, as we continue to monitor this, but it's going to be much, much, much less than the risk of smoking. So in terms of harm reduction, absolutely people should go those routes to help them quit smoking.

[8:36]
Next question comes from Stu Maher. "With the creation of more user-based health products, is healthcare and health monitoring switching to a more user-controlled environment? What products will have the most impact on consumers?"

So, you know, there's all kinds of products, and I don't know what you're referring to. If you're talking about things like supplements, there's going to be no change in the fut... there's no evidence at all of any of the supplements working, and as you've seen from our many Healthcare Triage videos, especially Healthcare Triage News, the supplements often don't even contain what you think you're getting, they're not regulated, they often are harmful. I'm not pro-supplement. I don't have a lot of faith in that.

There's a lot of technology going around. For instance, my, like Nike Fuelband here. And the Apple Watch, which just won't ship. I'm looking at you, Apple, I'm looking at you. Where's my Apple Watch? I ordered it -- I ordered it on April 10th! Where's my Apple Watch?

Anyway, um, do I think that these things are going to have a huge change in your life? No. And in fact, we did an episode on that. Because there are so many parts of what changes health, and everybody assumes it's the technology, but, you know, if you go back, and there's a paper in the Journal of the American Medical Informatics Association written by Chuck Friedman, who's one of, sort of, the grandfathers of medical informatics, and he posited what he called the theorem, the Essential Theorem of Bioinformatics. It basically said that an information source or a technology plus a person should be better than the person alone. But the second -- was it the second or third corollary? -- the First Corollary is that people are more important than the technology. The behavior change that has to occur is so muh more important than the technology, and we are too fixated on the technology itself and what the technology will allow us to do. We never focus on the important behavior change that has to occur along with the technology to make real change.

So is there potential? Sure. Do I think that we're actually focusing on the things that we need to do to get that change? I think that happens far too rarely. Um, and so I'm a little bit pessimistic. Go back 20, 30, 40 years, you will see articles in the medical literature and the lay press telling us that the advanced promise of healthcare technology is right around the corner. It always is right around the corner. We have to invest in the people side to make that change. Maybe that will happen now, but I don't see it happening quite yet.

[10:51]
Next question: San Diego Bay Realty, good luck, you just got an advertisement for yourself. Well done. "How do I find a minimalist doctor? I found that many doctors I visit offer most invasive solutions and get upset when I ask for less invasive alternatives." You can ask. You know, you ask. Say, "What's your practice philosophy?" Um, I say all the time, and I've said here on Healthcare Triage, like, I'm a minimalist, I try to do the bare minimum at all times. I hate tests, I hate drugs, I hate procedures. I just don't like them. Um, and my family will attest to this, where very often, I don't want to do things, and like when we talk about, you know, how we're going to make changes, we try very hard not to. So I think the best thing you can do is ask. Ask if people are minimalists, ask what their practice philosophy is. If they say that, keep seeing them. If not, then you should seek another doctor.

[11:40]
Our next question comes from Amanda Benke. "With my first pregnancy I was put on bed rest [audio glitches out] incompetent cervix. Can you tell me about the benefits and risks of bed rest during pregnancy?"

I think it was in our first book that I made a lot of OB-GYNs mad when I talked about the sort of systematic reviews and meta-analyses that have been done on bed rest because they show that there's really no good evidence that bed rest works.

[Off camera voice, incredulous] None?

Aaron Carroll: None!

Off camera voice: Oh, come on!

AC: No evidence. People shouting from off screen!

OCV: Disagree!

AC: There's no evidence that bed rest works.

OCV: I dis... Listen to your doctor, not to Aaron Carroll.

AC: So anyway, they put you on... now I'm moving over because someone is going to join us!  

OCV: Hello.

AC: How are you?

OCV: Good. [John Green sits down].

AC: I'm going to quickly answer the bed rest question.

JG: I'm a little disorganized. I've got a couple questions for you.

AC: Excellent. So, no, there's no evidence. When people have been put on bed rest or not put on bed rest, it actually doesn't decrease the chance of having a pre-term, or an early pregnancy, I mean an early delivery. So it's just not there, and there's a lot of negative consequences of bed rest: financial, emotional, even physical, if the women aren't moving around very well. So it definitely -- Mark would always point out, talk to your doctor...

JG: Talk to your doctor!

AC: Talk to your doctor...

JG: Talk to your doctor.

AC: But the evidence doesn't show that bed rest works.

JG: Talk to your doctor, though. I have to say, my best friend was on bed rest, and it was great.

AC: For her? Or...

JG: For everybody. It just organized all... the two couples, you know Chris and Reenie.

AC: Yeah.

JG: It organized the four of us around the needs of Marena and prepared for the baby. So I think it's great. Where's the camera? I think it's great!

AC: [laughs]

JG: Um, ah...

AC: This is why we need new...

JG: I have another question for you. Who is this person  who wanted a minimalist doctor? What about people who, what about someone like me, remember when I...

AC: Yeah...

JG: ...was asking you for a doctor? And I said, "I want a maximalist doctor!"

AC: Right! And so that's why we make recommendations based on what you would want.

JG: And I got, I have, I mean, he might even be too maximalist for me. Ah, he is a hard-core maximalist.

AC: Oh, my doctor is not.

JG: But he doesn't treat... your doctor is not?

AC: Minimalist! Like, he barely...

JG: If I have pain, I want it to be treated. If I have a cold, I want it to be treated. Like, you know how when you're always like, oh you can only kind...um, Tamiflu only cuts symptoms for like twelve hours, there's no use in it? What an amazing twelve hours!

AC: No, they still stink. It's just slightly less stinky than before. Yeah, my doctor doesn't even like to give eye contact much. Um...

JG: [laughs]. All right. So...

AC: Oh my god, if you're watching, I apologize! I really do, you're my favorite doctor, you're the doctor I choose! So I apologize. But anyway...

JG: We have an announcement to make. Are we making our announcement?

AC: Yes! We're making another, we're repeating it because we made it already, but go ahead.

JG: Oh!! [holds confetti popper], Is this the right way, Stan?

Stan [off camera]: I don't know. There are arrows.

JG: Wait, which way do I hold it? "Warning...

AC: I don't know, but make sure you're holding it the right way. [laughing]

JG: "Grasp the safety tape with left hand."

A: Because otherwise you're shooting right into your groin, man. Don't do that.

J: Okay, let's do this - ready?

[popper pops, confetti flies, exclamations]

A: That was louder even than I expected, oh my -

J: Congratulations! I think there's some on the screen.

A: It's like, not congratulations to the people who have to clean this, but congratulations to us.

J: Yikes, well, that's us. That's us. That's everybody except for Aaron, he's got somewhere to go, but the rest of us will be cleaning this up. Congratulations on your Patreon.

A: Thank you, we're very excited.

J: I just wanted to say from my own experience, like Patreon for me - are you guys still laughing because of how great the explosion was?

OffScreen: Yeah.

J: I did a great job.

OS: You did.

J: This is the best $1.99 that Crash Course has ever spent.

A: What is in there? Wow.

J: Just energy, just potential energy that I turned into kinetic energy.

A: There you go.

J: Crash Course Physics coming soon. To me, what I love about Patreon is that basically it's saying-, only one or two percent of Healthcare Triage viewers need to support Healthcare Triage on patreon for it to become sort of a sustainable enterprise. And it's really a question of, "Who do you want Aaron and Stan and Mark working for? Do you want them working for advertisers, or do you want them working for you?" And if you want them to be answerable and accountable to you, then the best way to do that is to support Healthcare Triage on Patreon.

But anyway, I just wanted to say, obviously, for the many, many, many most of you who can't - it's all right, nobody's mad at you. Healthcare Triage is not gonna change. I just got a text message; could be about how something's wrong with my collar, so I'm going to look at it. [checks phone, A chuckles] Hold on, hold on, this is important.

[reads] "Hello. I will be about 30 minutes late because my cat had to go -" aw, "to the vet." Oh no! It's a babysitter thing. [to A] Your babysitter, who you turned us onto.

A: Oh! Very good!

J: She's cool. I like her.

A: Well, yes. But although now, she's late. So that's not [unintelligible].

J: Well, yeah. Typical. Typical of Aaron's babysitters. [A chuckles] All right. So, what are you - , should we answer more questions?

A: Sure!

J: Yeah! But go to the Patreon.

A: Yeah!

OS: Link's on the screen.

J: Link's on the screen, go to the link on the screen.

A: Lots of good rewards.

J: Lots of great rewards, but you don't really support-, do you? I think ultimately, you kind of support it not for the rewards, but because you want Healthcare Triage to be good, and you think that it's valuable, and you want to have its value reflected in -

A: I agree!

J: And that's why you support it, but the rewards are good.

A: But how cool would it be to be the Surgeon Admiral of Healthcare Triage?

J: It would be great.

A: Super.

J: How much do you have to give for that?

A: [asks OS] How much do you have to give to be the Surgeon Admiral?

OS: $500 a month.

J: $500 a month?

A: There's only gonna be one, though! Anyone can be Surgeon General; only you can be the Surgeon Admiral.

J: [chuckles] what does that even mean?

A: [chuckles] It's the Surgeon Admiral! Of Healthcare Triage!

J: $500 a month? What are we giving that person?

A: [laughing] You get to the be the Surgeon Admiral.

OS: [unintelligible]

A: Yes! They'll be the Surgeon Admiral of Healthcare Triage.

J: I mean, whoever-, if anybody-, well, the thing is you have a lot of wealthy physicians watching you, so you might actually get some.

A: That's right. One might want to be Surgeon Admiral. We should make them a card.

J: Wealthy physician, yeah, we'll make you a card. We'll totally do that, we'll make you business cards that say you're the "Surgeon Admiral of Healthcare Triage." We'd be happy to, that's not a big deal. For $500 a month -

A: You get it.

J: - if you make a six month pledge, we're in on the business cards.

A: "Surgeon Admiral."

J: I will say that-, yeah, I forget about that, that you have some-, we don't have any doctors watching SciShow.

A: It seems some doctors are watching Healthcare Triage. I assume some scientists, I know -

J: Let me ask you -

A: Yeah -

J: Scientists are very well paid - just kidding. I wanna ask you about Diet Dr. Pepper.

A: Okay.

J: My second-favorite beverage. My favorite beverage, Wild Cherry Diet Pepsi, has been discontinued due to the pseudoscience at Pepsi.

A: [whispers] Aspartame.

J: Yeah, because of aspartame. How many Diet Dr. Peppers can I drink in a day without having any negative impact on my health?

A: I don't think there's actually an answer for that, but I would say, truly, there's no real reason you shouldn't.

J: I could have ten?

A: [inhales]

J: A day, everyday, for the rest of my life.

A: We covered where there was this study where they fed rats the equivalent of 30 - not rats, monkeys - the equivalent of 30 sodas a day, everyday, for 17 years -

J: Yeah?

A:  - and it didn't give them cancer in any higher amounts than they got.

J: Didn't give them anything else? Some strokes -

A: No, no. I'm saying they died of natural causes and monkey problems. There was, like, they couldn't really - 17 years! Of huge amounts of that much artificial sweetener.

J: What about the other stuff?

A: Well, that's where it's like, I'm [thinking vocals]. You know, I always say "moderation."

J: [reads can] What about "sodium--[lag]--ate?"

A: That's actually pretty common. That in a lot of stuff.

J: "Phosphoric acid."

A: That's probably in a lot of stuff, too.

J: All right. This says "phenylalanine."

A: Well, I don't know about that one.

J: All right. Do you want to answer some questions?

A: Sure.

OS: Number eight.

J: Oh, we're on number eight. "What are your thoughts on sex selection (IVF or PGD)? Do the benefits outweigh the risks, and why is it illegal in so many countries?"

A: Well, see - you say "benefits and risks," and what do you -

J: What's the benefits?

A: The benefit, I assume, is that you're getting a child of the sex that you like.

J: But that doesn't seem like a benefit.

A: Well, but see, this is where I -

J: It's not a social benefit.

A: It's not a social benefit, of course; we're only talking about personal benefits, and obviously, if these people are - if they think, "Is the benefit for you getting the child you want outweigh the risks?" [vocalization] It's societal risks, it's personal benefit.

Now, if you're saying that instead of having a natural pregnancy because you could absolutely conceive, but you want a certain sex so badly that you're going to go with IVF as opposed to then using natural pregnancy -

J: I don't like it.

A: That can't possibly-, it's hard to imagine all the benefits that outweigh the risks, because there are risks: It's very expensive, it's very difficult to do, and from a societal perspective, it's not so good.

If you're asking me my personal opinion, I'm not so keen on this. To be honest, personally, my wife and I didn't even find out the sex of our babies until they came out of the womb. So, even on the day that Amy was delivering, we had no idea what we were having right up until the last second. So, I much more in the "roll the dice, let's see what happens" camp.

J: We knew what we were having, and I definitely had a rooting interest.

A: Mm-hmm?

J: And I would've been, frankly, devastated if Alice had been a boy. But she wasn't. So, it's all good.

A: We were the same way with Syndey, I think. It's like, if the third one had been a boy again -

J: "Get it away from me," I think Mark [offscreen, referring to mic] is saying to get it further away from me.

A: We're tilting it.

J: We're both yellers. But yeah. [A laughs] Yeah, I would've been devastated, but that said, I - I don't know - to me, social-, the concerns of the larger social order, like, one thing that natural selection has proven pretty good at -

A: [nodding] Yup.

J: - is giving us the right number of boys and the right number of girls. [reads] "I have chronic UTIs and take Macrobid as a preventative, but is not as effective as it once was. Cranberry juice is known to be effective for UTIs, Are the cranberry supplements also effective?"

A: So, this is from "Adam Malle."

J: Yeah.

A: You know that the evidence on cranberry juice has actually been sort of waning, and so -

J: It works for me.

A: Well, again -

J: And the plural of "anecdote" is not "data" - I know.

A: Because you don't know if you didn't take the cranberry juice whether you'd be getting UTIs, so when they do trials, and they do all this stuff, so it's not sure that the cranberry juice works as well as everybody thinks. Cranberry extract, even less sure.

You know, certainly, it wouldn't work better than an antibiotic, and again, the antibiotic - nobody's really sure how good that is as well. Plus, to truly answer this question, I need to know your age and a lot more personal information. [gestures OS] And as Mark the lawyer tells us, I'm not giving you medical information -

J: Yeah, you gotta go to your doctor.

A: - go to your doctor, I'm not telling you not to take the medicine.

J: It sucks to have chronic UTIs though.

A: Yes.

J: My sympathies. It's not fun. You know what I had...I'm not going to talk about that. [A laughs] I like to talk about -

A: Please!

J: I'm not going to come on here and talk about my obscure health problems.

A: Well, okay!

J: Marina says, "Can you please talk about Patreon again?" I guess so, Marina, if you insist!

Patreon is a crowd-funding platform that allows you to monthly support Healthcare Triage, which will supplement the ad revenue and allow Aaron and Stan and Mark to focus more of their time and energies on making great Healthcare Triage videos. We're very excited about this; we've wanted to do it for a long time. What else?

A: I don't know if you can see it, but this microphone is resting on a piece of grey foam; we'd like to fix stuff like that. As well.

J: Yeah. I mean, one of the things that we'd really like to do is soundproof this room. Not just Healthcare Triage is filmed here, but also lots of other stuff: Crash Course Government, Mental Floss - and yeah, this room could use soundproofing, it's a little echoey in here.

A: And now, it needs some cleaning as well.

J: Yeah, well, that's-, again, something we're gonna do. But yeah, you know, I'm paying Stan and Mark -

A: That's right.

J:  - x number of dollars per hour to clean up.

A: That's right.

J: Marina also had another question: "I've heard there are studies showing that praying for sick people improves outcomes. Have you heard this?"

Yeah, "even if they don't know they're being prayed for." So, there is a little bit-, there was a large study, right?

A: Yes.

J: That indicated-, and it was sort of placebo -

A: It was absolutely placebo-controlled.

J: All right, so tell us about it.

A: It was on remote intercessory prayer. So, they basically prayed for people, it was a randomized controlled trial - people got randomized - that others would pray for them. They would never know if they were prayed for, and the doctors and the people doing the outcomes had no idea if they were prayed for, and then they wanted to see if they would do better. And in one or two studies, they did do better. Now, granted, it's not a monstrous better, but they did do relatively well.

J: Wow!

A: Having said that. There's lots of trials where they didn't do better, too.

J: That's pretty cool though, Aaron.

A: Yes. But of course, the one where they did do better gets - by far - the most press. The ones where they didn't do better get almost no press at all, no funding, no real source of everything else. So, is there potential there? Enough to make people excited about it? Yes. Is this something where I'd say it's been proven that it works in large doses and really makes a difference? The answer, unfortunately, is no.

J: It's pretty interesting though.

A: Yeah!

J: Michael Hafner says, "Thoughts on Brian Goldman's article titled It's time for doctors to admit that our lack of sleep is killing patients." 

A: Do they mean the doctor's lack? I'm assuming they mean the -

J: I believe they mean the -

Both: -doctor's lack of sleep.

A: Who's not admitting that at this point? Yes. Yes! It's all over the news, there's regulations, big court cases in New York, there's now all these rules about how long residents can work, doctors know this. It's not that we can't admit it; it's that it's very difficult for the medical system to change. Residents still provide very cheap labor, and changing that over into other people doing the work at night and doing long hours would cost us all a lot of money. And the healthcare system costs so much already that it'd be very hard to change this. We know! It's just that we're not willing to do anything about it.

J: I have to go because I have to get on a phone call, but you continue.

A: Thank you. Thank you for joining us!

J: Thank you, Aaron, always a pleasure.

A: Always fun when you're here.

J: I'm glad that I could set off those fireworks; [while exiting] that was very enjoyable, I'll see you guys soon!

A: Thank you! [moves center] All right! "Flying Beagles!" That was very exciting, was it not? For all the people that're joining us, and I'm sure all the people who can watch it later - thank you very much, John, for joining us.

"Flying Beagles" asks, "I remember when baby powder was extremely common to treat diaper rash. Have doctors concluded that baby powder actually does more damage to children's lungs? 

No. I don't think it's that they're-, I don't think the reason that baby powder has become less, it's just that we have things which work better. You know, the very thick ointments, which actually cover better, seem to do a better job then the "drying-agents idea" that was with baby powder. And so it just, you know, I think they get used less.

It does have problems with babies inhaling it as well, so there's no reason not to change, but I don't think that doctors-, I don't think that that was the major reason for the shift. If I'm wrong, I'll go look it up. But I don't think that was the major reason.

"Blue Maroon Sara Gran." ... Is that two people or one, I'm not sure. "Is there any real evidence showing a benefit to taking Omega-3 pills, flaxseed and/or fish oils?"

There have been some real recent randomized controlled trials and reviews of the evidence which say less than we thought. And so a lot of the recommendations to do this aren't panning out. I know I've covered that on my blog, and this, of course, is everything we do in nutrition these days. I can't tell you how many articles I've written recently where we talk about the fact that what we thought we knew wasn't right. Which is why I try very hard not to preach too hard about specifically what things you should be eating. But again! Talk to your doctor. They should tell you the best.

The next person is in, I believe, Russian? And I can't read the name. "Are there any studies on the side-effects of taking melatonin as a sleeping aid regularly? Any of them regarding kids and teenagers specifically?"

So, yes, there's studies of melatonin; it has risks and it has benefits: The risks are relatively minimal, that's why it's sold as a supplement and why not as a drug. However, melatonin is a supplement, and as I've covered on Healthcare Triage before, supplements are often not regulated. You have no idea how much you're getting, and therefore, you don't know what your'e doing, so I don't tend to favor supplements. So, I don't usually say melatonin.

There are other drugs - even over-the-counter drugs - that people often use for sleep aids. They work great. You should talk to a doctor or pharmacist before you take them, but at least then you know exactly what you're getting and what they are. And I'm not saying that they're safer or more dangerous, but you know - you know. Knowing is more than half the battle in this case.

"Mitch Hayden - Are mercury fillings bad for you? It seems that all data points to no, but for some reason I can't find a dentist that will do them, and my insurance doesn't cover composite." This has been a hobby-horse of mine; I've been yelling about this since residency.

So, the older fillings have been a problem, because they fold, they can fall out. And there are some studies, although they're not randomized controlled trials, which point to slightly - and I mean, SLIGHTLY - higher levels of issues-, health issues with the mercury fillings than the non-mercury fillings. But we are talking slightly. And I've argued that forcing everyone to go composite, may mean that a certain number of people will not get fillings, which is way worse for you than getting a mercury filling, and I think this is a real problem.

There are a lot of dentists that are even trying to switch people over from the mercury fillings in their mouth to composite fillings. I have one filling in my mouth and it is mercury, and when my dentist and I talk about it, and every single time that I go to the dentist, he - to his credit - says, "It's not causing any trouble, we'll continue to watch it, at some point you might need to change it out for composite." And I always say in my head, "Never gonna happen, the mercury is gonna be fine, and you know it." [shrugs]

So. You know. That's that. So, I would not avoid a mercury filling, but their composite fillings have a slightly smaller association with problems, but they cost a lot more, and they have problems sometimes with the insurance, and that's a real issue that people need to consider moving forward.

"Amanda Banky - Any book recommendations for the lay person on diet, health, exercise, disease, etc.?" I'm gonna say no. No, because I think that people don't know -. Oh, here's the thing: I think that there are a lot of good books out there that tell you what's wrong with the science behind diet and exercise. I read The Big Fat Surprise last summer by Nina Tiecholz, I've read all of Gary Tom's books, and I've been fascinated by them.

Full disclosure - I know Gary Toms, I would say "reasonably well," at this point; I've spoken to him on the phone a number of times, so you know. Not that he needs my recommendation, but you should know that I know some of these people. So when I'm saying their books, take that with a grain of salt.

But I think that they're taking the evidence behind what's wrong with our nutrition pretty solid. However - and I would say this both to Gary and to Nina, and I have - when they transition into telling you what to do, I back off, because the science just isn't there. We don't have the large randomized controlled trials that tell us what is best. And so, I think there's a lot of good books to point out the problems with the nutrition recommendations; there are very few - if any - books that are good at telling you what to do.

I wrote an article on my nutrition recommendations that was in the New York Times a couple weeks ago and it was a pretty big hit; we're gonna cover that in an upcoming Healthcare Triage episode. But as you will see when I do it, they're pretty broad and non-specific, because I don't think there's a lot of science to tell you what to eat.

Next question comes to us from "Brett Labe - another vitamin question. My mother suffers from multiple sclerosis and is concerned about me developing it. Her neurologist suggests that I take vitamin D. Does the literature support this?"

I'd have to go look at the studies, but I'm going to say I don't know of any good evidence that vitamin D supplementation in a person who is vitamin D sufficient - in other words, "has enough" - that the supplementation will prevent multiple sclerosis. However, that is obscure enough that I would need to look into it.

And you should be talking to your doctor about that. Ask them what the evidence is. People need to ask their doctors tough questions. "What the evidence behind that, how sure are they, what are the risks and benefits, what about the cost, is it worth it?" And those questions are good, and the doctor should be able to answer them. And if they can't, then they should stop.

So. I'm going to do lightning-round for these last few questions, because we are just about out of time:

"ZZYZX" which I don't think... that's not from... that's not the thing from Archer, is it? Nah, forget it. "Are there any measurable physical benefits to post-exercise recovery methods such as deep tissue massage, ice baths, and electrical muscle stimulation?"

Deep tissue massage feels good. Everyone likes a good massage, so that's a benefit. The other things about making you get better faster? I don't, unfortunately, think so. There's a lot of anecdotal evidence, I don't think a lot of randomized controlled trials, but that's something we should look into.

"Brian Spitz - Eye doctors always say you should wear glasses to prevent eye strain, but glasses wearers say that wearing them caused their eyes to get worse. What does the research say?"

It doesn't make it get worse. That is poppycock. That is absolutely not true. Correcting your vision does not make your vision worse. In fact, people are worried sometimes that not correcting things like amblyopia is a problem. Having said that, eye strain is just strain. If you run a lot, you will get leg strain - your legs will hurt and get tired. What that means is that you should take a rest; it doesn't mean that you should never run or walk.

If you rest, your muscles will get better, you can keep running again. If you're finding that you're doing a lot of reading and you get eye strain, take a rest! Doesn't mean that you're ruining your vision. Your eye muscles will fix themselves. You cannot permanently damage your eyes by causing them a little bit of strain, that is ridiculous.

"Elius X - What is your take on the 'Healthy At Every Size Movement?'" What is the "Healthy At Every Size Movement?" I don't know, is that like an advertising campaign saying that people who - no matter how big or small they are are...I don't - ...?

OS: [unintelligible]

A: Oh! "Overweight but still in shape." You know, everyone thinks it's relative, and it depends on what you're talking about. It's important to recognize, by the way, that we talk about being overweight as a risk factor for things like diabetes and whatnot, but there are plenty of people who are overweight and live long lives.

It's a risk factor; it does not mean you will die or get disease. And we should be cognizant of that, and we should recognize it. It does mean that you're at higher RISK, which is reasonable to say that people should know that, but we shouldn't be demonizing or causing people-, there are healthy people in all kinds of walks of life. That's fine. But being overweight or morbidly overweight or obese definitely carries, it seems, higher risks for certain disease processes. We should also be cognizant of that.

"Curtis Chow - one more: Is there any evidence that dietary changes -

[lag, transcript insert: "- can have a positive effect on children-"]

- with autism spectrum disorders? If yes, which diets are supported by the best evidence, which are most effective?"

I don't know of any that have been done in randomized controlled trials. I know plenty of people who try them and report success. Of course, we don't know how much of that is placebo effect. I wouldn't tell those people not to, because placebo effect is just as important sometimes as regular effect, and if they're seeing benefit, that is awesome. But should we be telling other people to do it? Probably not without good evidence.

Anyway! Thank you for tuning in. Next week's Healthcare Triage will be Wednesday, 11:30 a.m.; we're going to continue to do this again, even though Stan [lag/cut] - so, it's gonna be awesome; we're gonna be doing it with one half of our support staff. We'll be flying by the seat of our pants. Anyway, tune in 11:30 next week Wednesday.

Secondly, link will be in the description momentarily, and you can ask your questions there, and ask the questions again on next week's video - not this week's video, we will not see those anymore, ask your questions on next week's video. 

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Healthcare Triage will always be free to watch, to share, to enjoy. But if we can get support from many of the research that we need, we can invest in the show, both technically, both the way that it looks, we could do a lot of interesting things - better graphics, better special effects, we could go on location, we could all kinds of fun stuff with Healthcare Triage. We've already gone from one show to three shows a week; it could be even more.

We really could do so much more if we had some support and resources. There are great rewards, as John said, I'm sure that everyone is doing it not for the rewards, but hey - it's great to get them anyway. There are some great ones, you'll go enjoy it, please go check out the page, anything you can do, even just a dollar a month would be appreciated and will help us make Healthcare Triage even better.

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