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You can support Healthcare Triage on Patreon!
Next week:

Re: Mic pounding...SORRY! We used this mic because we knew John was coming at some point. Didn't anticipate the desk noise though (we tried to fix it during the show). We'll be back to our normal mic for next week. If you find it totally unbearable, skip to 21:14...most of it goes away after that.

:13 - We've got a Facebook page:
:35 - We're announcing our Patreon page! It's finally happening :)
2:39 - I've been frequenting several pregnancy & parenting forums lately and there seem to be a lot of women swearing by the "soft cup method" (trapping ejaculate against the cervix using a menstrual cup, typically overnight). Is there any merit to this?
3:37 - Can you talk about/explain Febrile Seizures? As a 911 dispatcher, parents often call extremely freaked out about them and have often never heard of them before.
5:36 - We already know about the potential side effects of advanced maternal age, there are recent studies on the potential side effects of advanced paternal age. What have the results been?
7:14 - I found your HCT episode on e-cigs interesting. 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?
8:38 - 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?
10:49 - How do I find a minimalist doctor? I found that many doctors I visit offer most invasive solution and get upset when I ask for less invasive alternatives.
11:48 - With my first pregnancy, I was put on bed rest for 11 weeks due to an incompetent cervix. Can you tell me about the benefits and risks of bed rest during pregnancy?
14:25 - CONFETTI!!!
15:03 - John talking about Patreon
18:16 - How many Diet Doctor Peppers can John drink in a day without impacting his health?
19:16 - 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?
21:14 - 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?
22:21 - Can you please talk about Patreon again?
23:19 - I've heard there are studies showing that praying for sick people improves outcomes, and it works even if they don't know they're being prayed for (no placebo effect). Have you heard this? Thoughts?
24:26 - Thoughts on Brian Goldman's article titled "It's time for doctors to admit that our lack of sleep is killing patients"
25:31 - 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?
26:11 - Is there any real evidence showing a benefit to taking Omega-3 pills, flaxseed and/or fish oils?
26:54 - Are there any studies on the sideeffects of taking melatonin as a sleeping aid regularly? Any of them regarding kids and teenagers specifically?
27:47 - 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.
29:16 - Any book recommendations for the lay person on diet, health, exercise, disease, etc.?
30:38 -Yet another vitamin question. My mother stuffers from multiple sclerosis and is concerned about me developing it. Her neurologist suggests that I take vitamin D. Does the literature support this?
31:30 - Are there any measurable physical benefits to post-exercise recovery methods such as deep tissue massage, ice baths, and electrical muscle stimulation?
32:04 - 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?
32:55 - What is your take on the Healthy At Every Size Movement?
33:55 - Is there any evidence that dietary changes 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?
34:44 - Tune in next Wednesday at 11:30a for the next HCT LIVE!
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..., 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.

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.

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.

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, 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!! 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.

JG: Grasp safety tape with left hand.