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Duration:33:34
Uploaded:2015-04-29
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Leave any questions you have in next week's video: https://www.youtube.com/watch?v=y4pZYtXwZdA

00:35 - Start!

2:05 - Is there an ethical way to harness the placebo effect? What are your thoughts on placebo surgeries or sugar pills that actually increase the patients sense of well being?

3:30 - JoneseyBanana I often chew a lot of sugar free gum when studying to prevent myself grazing on junk food. Are there any potential downsides to this, especially dentally or to the jaw itself? (Our video on artificial sweeteners: https://www.youtube.com/watch?v=Mf82FfX-wuU)

4:36 - In the Guns and Physicians vid (https://www.youtube.com/watch?v=nXJmdMoNuY4), you said you get a physical every year. I remember you told John Green elsewhere that annual physicals (for men) are probably not necessary. Can you elaborate?

6:27 - How are you able to keep up with all the new research on such a wide range of topics? And how do you make any judgements on areas of conflicting research?

8:36 - What are your thoughts on accutane (isotretinoin) and its continued use on people as an acne medication?

10:09 - Do we know anything about brain freezes? What causes them, how to prevent them, and how to stop them once they've happened?

11:19 - Can you talk about ozone therapy and Aloe Vera products (such as forever living products)! Both are promoted as miracle treatments! Any research? Any results? Your opinion?

12:55 - What's the actual research on best hand washing practices? Length of time? Best type of cleanser? Water temperature? (Link to antibacterial soap video: https://www.youtube.com/watch?v=FS3LcIURelY)

15:00 Can you talk about what adults who had their vaccinations as kids should do in areas where there are measles outbreaks?

15:55 - How can a hypochondriac, like myself, do from having anxiety attacks and annoying his/her doctor? How can we separate real pain from psychosomatic pain?

17:20 - My wife and daughter have celiac disease, and we're planning another child. Should we introduce our new child to gluten early?

18:16 - What is your stance on moderate alcohol consumption by pregnant and breast feeding mothers? Is there any available research?

21:06 - How do you Feel about the CHIP program? It seems to me like it insures a lot of kids for a very low price. Can we expand it?

22:58 - Codeine is available over the counter in most other countries. Why is that not the case in the US?

24:19 - How do you feel the field of mental illness (specifically depression, anxiety disorders and so on) has changed since you became a pediatrician?

25:03 - Does long-term use of prescription amphetamines affect cardiac or mental health in later life?

26:07 - Why is eating mostly processed food bad for your health? (Aaron's NYT piece: http://www.nytimes.com/2015/04/21/upshot/simple-rules-for-healthy-eating.html?abt=0002&abg=1)

27:36 - Which SPF Factor should I use if I live in the UK and how often should I apply it if it is 20 degrees C and sunny? I have been told buying SPF 50 sun cream is pointless. Thank you! (Our episode on sunscreen: https://www.youtube.com/watch?v=bvG4sy_YfXM)

29:03 What does the research show for long-term risks associated with secondhand smoke exposure? For someone who was heavily exposed during childhood, is there any way to mitigate those risks as an adult?

29:53 - What is being done to address publication bias by the pharmaceutical industry? Just how effective are some of the most commonly used drugs, relative to their original FDA trial data? (Our video on conflict of interest: https://www.youtube.com/watch?v=UJtLUaeEkbk)

30:19 - Regarding Diet soda, is there any danger to drinking it in larger amounts (NOT the aspartame)?

31:18 How healthy is Honey in reality? Is it actually as good for you as it is made out to be?

Oh, also, we've got merch :) http://dft.ba/-HCTMerch

Next Wednesday we'll be live at 11:30a ET: https://www.youtube.com/watch?v=y4pZYtXwZdA

We're live - hey! Welcome to Healthcare Triage Live! I think we're live. Um, we try to do this every once, we're trying to do this now once a week, we're trying to get a regular time, and we appreciate the many, many, many questions that people put in the comments ahead of time for today's show, which let us sort of queue them up so you'll be able to see them ahead of time.

Um, however, many of these questions are just pumping in right this second, so a lot of these will be, ah, we'll see if I know the answers, and you will hear me say, "I don't know," if I don't, um, but this is our weekly show where we try to answer many of your questions live. You can try tweeting them to the Healthcare Triage account, but even better, you can put them in the comments section of this video.

Afterwards, this video will still remain up and you can watch it, but don't continue to put questions in the comments section for this video. Put them in next week's Healthcare Triage Live. Once we shut down today, we're not going to pull any more questions from the comments below. But for the moment, you know, feel free to keep going.

Um, I've been asked by our technical expert and now lawyer, Mark, to remind you that we're not giving medical advice on this show, that you should not take anything I say and go out and do it. If there's any actual medical questions, you should talk to your doctor! And you should - oh, look at this - you should get, ah sorry, I was just distracted by a picture right here, ah, you should get medical advice from your doctor. But let's stop with all this and begin.

First question from datapirate, "Is there an ethical way to harness the placebo effect? What are your thoughts on placebo surgeries or sugar pills that actually increase the patient's sense of well being?"

Of course it's ethical to use the placebo effect. We do it every day. Um, any time you give your kid a hug and a kiss on the boo-boo and tell them that it's going to be better, you're of course using the placebo effect. All the time! You know, when my kids have rashes, we will put, like, moisturizer on it and tell them it's "cream" that's gonna help it make better. Even if they have pain, you put a Band-aid on it to make it feel better. That's placebo effect.

If you're asking if we can medicalize it and charge people for it, that's another story. And charging people for it, especially, is where it gets squirrely. But there are many things that even doctors do every day that it's placebo, you know, whether it's consoling someone if they're in pain, or you're sympathizing or empathizing.

 A lot of those things help, even if they're not... and every therapy that we give out, as we talked about in our episode on the placebo effect, has both a biologic and a placebo effect. The question as always is, is the biologic effect greater than the placebo effect, or how much is the relative contribution.

Surgeries? Well now you're actually potentially giving people harm, and so a placebo surgery is a little more complicated. But we should not be under the illusion that we're not using the placebo effect in everyday medicine all of the time. Because we are.

Next question, from jonesybanana. "I often chew a lot of sugar free gum when studying to prevent myself grazing on junk food. Are there any potential downsides of this, especially dental or to the jaw itself?"

You will see lots of sites will try to tell you that the artificial sweeteners are dangerous, and they're not! Watch our episode on artificial sweeteners. But, um, and you'll actually even see the groups like the ADA, the American Dental Association, promote the use of sugar-free gum because it increases saliva and it actually can pull some of the bad bacteria off of teeth. It shouldn't replace brushing, but it actually can reduce the chance of getting a cavity in some ways.

And so there are not many downsides. I don't know of any long-term downside effects specifically to the jaw. Of course if your jaw gets tired, stop. You know, as with anything, if your body's giving you a signal that something is bothering you, don't keep doing it. But no, sugar-free gum is actually, might be on the side of things where it helps, not harms. And so there really is no good reason to keep avoiding it.

Next question comes from benjaminalexander. He said, "In the Guns and Physicians vid, you said you get a physical every year. I remember you told John Green elsewhere that annual physicals (for men) are probably not necessary. Can you elaborate?"

Yes I can! Most of what I was talking about in that video is about kids, 'cause I'm a pediatrician, and we talked specifically about anticipatory guidance and protecting kids, with suicide and things like that. And with respect to children [audio glitches out briefly] that they should be having at least annual physicals, and especially when they're babies and younger, even more often. We have to do vaccines, we have to do a lot of parenting advice, we have to do a lot of behavioral talk, you know, where do parents learn to be good parents? Where do they ask their questions? Pediatricians' offices, mostly, most often the best thing. Tons of anticipatory guidance, but injury prevention is performed in a physician's office. A lot of this stuff, you've got to talk through with parents developmentally and check if kids are developing normally and screen them for developmental delays and for autism and for ADHD and for everything else you want to do. A lot of this happens in the yearly visit for pediatrics. Could we do a better job at being more effective and efficient in the pediatric well care visit? Absolutely! I, for one, would like to see less of a focus on the physical exam and more of a focus on parenting. Um, that's me. I was just talking about that this weekend at the Pediatric Academic Society meeting with a lot of my colleagues.

But with respect to adults, it, you know it's not as clear how much of a benefit the annual physical exam is giving, especially for males who are young, in their twenties and thirties. Um, that's what we were talking about with John. 'Cause John is a, you know, a male in his twenties or thirties. And so for him, perhaps a physical exam wouldn't, but for children, which is what that video is about, yes, they are different. That's my elaboration.

Question four, from dash574. "How are you able to keep up with all the new research on such a wide range of topics? And how fo you make any judgments on areas of conflicting research?"

Well, we employ about 40 people whose job it is specifically to review the literature at all times and feed it to me - no, I'm joking.

I do a lot of reading. Part of it is that is my job. I am-, you know, I'm not as much-, I do a little bit of practice in pediatrics, but the vast majority of my job is I'm a health services researcher - this is what I do! And I actually consider it part of my service obligation to do a lot of the writing that I do, whether it'd be on the blog, in the New York Times, or other places - AcademyHealth, JAMA-. 

So, I read a lot of the medical literature, and I try to consume that, and the more that you do something, the better that you get at it. So, with practice, I've gotten better at reading and digesting papers and new research, and I get methods. Again, that's what I do, so this is my area of expertise.

"How do I make any judgements on areas of conflicting research?" I try to be Bayesian - that's a big word, but you should watch our video on Bayesian analysis where, in other words, I try to know "this is the body of literature that has come before, and therefore, it pushes us in one direction or another to believe something is true or not, and when a new piece of evidence comes along, it has to be weighed along with that.

So, if we have 52,000 studies showing us that autism and vaccines aren't related - even if there was one more tiny study that all of a sudden proved it was - it wouldn't counter all that previous research- you have to take it in line with it. This is why I often think continued study in that area is somewhat questionable, because at this point the OVERWHELMING evidence shows us what is truth, and each new study adds to it in a tiny way.

Of course, when we can have a systematic review or meta-analysis - more videos for you to watch - those are the ways of gathering all the research together and then weighing the sum total of it. And when those kinds of things are available, you'll notice I favor them because those are good ways of trying to look at what all the little studies together tell us in aggregate.

Next question: Johnathan Blackwell, "What are your thoughts on Accutane (isotretinoin) and its continued use on people as acne medication?"

So, "isotretinoin" - it's so hard to keep saying that, so we'll say "Accutane." Accutane is a phenomenally powerful and successful drug in curing some types of acne that are very hard to get rid of, and it works very well in certain populations. The problem was that it had been later links-, that it might be causing some bowel issues and some depression or suicide, all of which can be watched and managed. But, I think it was Roche, when the lost a big case about Accutane to some people who'd had bowel issues, they pulled it from the markets. So, Accutane's actually gone in the United States.

Other forms of isotretinoin are still around, and there are people that will argue it's incredibly powerful and useful, but you have to monitor the side effects - but all drugs have side effects. And so, this is not one of those where I'm like, "Ohmigod, that's terrible, nobody should ever use it." I understand when it is used by some doctors because it is a powerful drug for removing acne that's hard to get rid of.

But, of course, as I said at the beginning, that's a decision to be made with your doctor, and it has to be as carefully and under the close observation of a physician to make sure that none of the bad side effects or things that occur are happening.

Next question from "Arts Freak:" "Do we know anything about brain freezes: what causes them, how to prevent them, and how to stop them once they've happened?"

Well, it's not your brain "freezing." It's not. And "what causes them?" Isn't it eating cold stuff? I don't even know what else would cause them, but-. So, if you're eating cold stuff really fast and all of a sudden you get that really intense headache - that is... I think it's about the speed of the cold. In other words, if you introduce something cold very quickly, it's just such a difference in temperature that maybe it affects the blood flow or the nerves or something like that.

"How do you avoid it?" Don't eat super cold things really super fast. "How do you stop it once it's happened?" I think just wait. It'll get better, it always does for me. I don't think this is anything that's been studied... closely.

Now, that as I'm saying it, maybe I'm wrong. Maybe it has! I will have to go look it up. It's possible someone's done good research on brain freezes. I just don't think it's been one of those things that - no one's worried about the long-term, chronic brain freezes or that the pain sticks around. I'm pretty sure it always goes away. I don't know how much research has been done. But I'll look it up.

Next question: "Junior Ooval - Can you talk about ozone therapy and aloe vera products, such as Forever Living products. Both are promoted as miracle treatments: any research, any results, your opinion?"

"Forever Living products?" Anything that's promoted as a "forever living" product, I'm skeptical, right there. Ozone therapy - there's nothing, there's no science or anyone knowing anything behind that working at all. It just doesn't exist as far as I know.

With respect to aloe vera - aloe vera DOES work; aloe vera is one of those things that actually, in one of our myth books, it's one of the few things that actually works well. It was one of the rare times where, you know, we were actually able to say, "That myth works."

They've done randomized controlled trials looking at burns and to see whether they heal faster with the use of aloe vera versus other things, and it turns out aloe vera actually performs better than many other things we use as medications. And so for burns and for healing - MILD burns, mind you - aloe vera actually does work.

Now, if you're talking about-, are they using it for anything different, like ingesting it? That's crazy. And is aloe vera a "miracle?" No. I mean, it's a reasonably good therapy for treating burns, but it's not miraculous, like the burn doesn't disappear. So, there is research in aloe vera.

There is... I think I'm not sure if there's much research on ozone, but what does exists shows that there's no association or really that it's doing much good at all. So, I don't understand why people are doing the ozone therapy. I do understand why people user aloe vera for what it's intended. If you're using it for other purposes or if they're promoting it, then no, probably not much evidence at all.

Daniel Hawksin - "What's the actual research on best hand-washing practices? Length of time? Best type of cleanser? Water temperature?"

Okay! So, they've done some stud-, well, first of all, we shouldn't deem it-, if you're going to wash your hands - that's great. Let's start with that. I'm not gonna demonize you because you're not washing it "right." Washing your hands is great; you know, it's a good way to prevent infectious diseases from spreading around and things like that.

So, if you go to the CDC, they have this poster - which I've seen before - which talks about it. It's pretty intense, because it's the whole thing, you're supposed to do this [demonstrates different hand-positions], then you're supposed to do this [x3], then you're supposed do-, it's like, it's crazy. And it's supposed to take a minute, and that's basically supposed to make sure you get around, and then all the way at the end where you're supposed to dry your hands, then use the paper towel to turn off [lag pause] - it's intense.

I don't know that there's-, you know, probably half a minute to a minute is great, more is longer, there's probably diminishing returns at some point. The washing and the scrubbing is more important than the soap? So don't think it's like, "Oh, soap," - the washing, the scrubbing, the trying to physically get the stuff off - important. That's what you really want to focus on. And you don't want to do it for five seconds; you want to make sure that you have enough time to really get every inch of your hand. That probably takes about 30, 40, 50, maybe 60 seconds.

The temperature? Whatever feels good on your hands. I don't think that the cold or the hot actually makes that much of a difference? And for the types of cleanser - you know, soap. Anti-bacterial, of course - if you've watched that episode - not. They're taking that stuff off the market; that doesn't really work that well. Remember the tons of germs are not, you know-. First of all, need bacteria; either they're not bacteria and need an antibiotic. Lots of them are not. You don't need that antibacterial or that, you know (?~14:50) antibacteriacidal component, it's being removed from lots of products right now. Soap and water. Soap and water works great.

Next question - "Kate D, "Can you talk about what adults who have had their vaccinations as kids should do in areas where there are measles outbreaks?"

I don't think much at all! You know, if you've had the full set of of MMRs all the way up through, you know, adolescence, you're pretty much considered, I think, good through adulthood. We're not at this point, as far as I know, recommending any kind of boosters for people that have had the full set of shots.

Of course, if you were born before 1957, you're pretty much assumed to have been exposed to measles and immune, because back then, of course, it was... it was much more rampant. As long as you've had the full set of shots, you're good! If you haven't, then you should talk to your doctor, because then, as adults, they do want you to get two or three... maybe one or two or three - I can't remember exactly what it is. But they do want you to get the shots to complete the immunization.

But if you have had the vaccinations as kids, as this "Kate D" asks, then you should be good. But as always, talk to your doctor, make sure what I'm saying is true.

Next question - "Terrytown, "How can a hypochondriac, like myself, -" ... I'm going to change the question because I don't understand - "- do from having a-, so what can you do about your anxiety attacks and annoying your doctor? How can we separate real pain from psychosomatic pain?"

Psychosomatic pain is real pain - first of all, let's own that. You know, when someone has butterflies in their stomach, they actually feel [lag] -t. It may be caused by nerves, but it feels real. When you feel nauseous because of being afraid, that is real nausea. And, so psychosoma-, it doesn't matter what the pain is caused by - that it's pain. We need to treat it.

Now, there's a question between treating it with drugs, whether it's attacking certain nerves and pathways and treating it with drugs that maybe help anxiety, and we have to treat the cause of the pain. So, what is my-, what-, the question is, "What can you do?"

Well, if you think you're having anxiety attacks and annoying your doctor, I'm less concerned about annoying your doctor than I am about the fact that you're having anxiety attacks, which are reducing your quality of life. You should talk to your doctor about the anxiety attacks. Perhaps you would benefit from therapy as well from working with a psychologist or a psychiatrist. It may be that medication is necessary.

The problem is that we treat pain as pain as pain, and therefore, everyone gets put on a pain med. And in this case, maybe a pain med wouldn't help you; you need to treat, again, the CAUSE of the pain. So, that's probably what you should do. But again, that's borderline medical advice; you should be talking to your DOCTOR about that.

Next question - "Jonathan Schroeder, 'My wife and daughter have celiac disease, and we're planning another child. Should we introduce our new child to gluten early?'"

No one knows on this one, I'm pretty sure; there were two really good trials in the New England Journal of Medicine that I can remember in recent years which actually looked at whether the early introduction of gluten for kids at high risk for celiac disease were more or less likely to develop celiac disease. And the answer was it didn't really make a difference at all one way or the other. I think one of them was even placebo-controlled.

Introducing kids early to gluten did not seem to make it more or less likely that they would get celiac disease - some of them got it, some of them did not. Breastfeeding also didn't seem to make much of a difference either, if I'm remembering it correctly.

So, I'm not telling you to do it, I'm not telling you to avoid it; I don't think anybody knows or anybody can really tell you that it's good or bad, but you should talk to your [sing-song] doctor. You should talk to your pediatrician and see how they feel about it as well. But that's what the research tells us.

"Noa Hak - 'What is your stance moderate alcohol by pregnant and breastfeeding mothers? Is there any available research?'"

Oh, Noa Hak, you really want to make my life hard. Okay, so, you know, if you open up the news, you're going to see articles going crazy one way or the other on this. They'll tell you, "Research shows that light drinking is NOT associated with difficulty," and this research shows you, "Moderate or light drinking IS associated with problems." This one will say "not behavioral problems," this one will say, "makes things better," this one will say, "it's worse," - NONE of them are randomized trials, of course, because it would be completely unethical to randomize mothers to get alcohol at this point to see if we could screw up their children. No one's going to do that study, at least, not in any reputable country.

So, we're not going to have a great answer. We're going to have lots of association studies, cohort studies, case-controlled studies - and they're all over the map. I think that, you know, the problem is that we don't know what the "okay"-dose is. It's VERY clear that lot of drinking is bad. It's very clear that drinking even moderate to high levels probably isn't good.

The question is - "What is the point at which it becomes okay?" Nobody knows. And so, the advice that doctors give out is, "Just don't do it," because the risk-benefit just seem too high. You know, the benefit to be gained by even mild drinking during pregnancy seems not high enough for most mothers - at least, almost every mother I know - to overwhelm the possible damage to a child.

Having said that, there are many, many, many mothers who probably engage in light drinking and have kids that turn out just fine, if not great. And so, what is my feeling? It's like I wish there was research, and I wish that we had great answers from research, and we don't. The available research is conflicting, and many people make choices based on their own preferences, and the vast majority of them do just fine. But your doctor will likely tell you, "Don't do it," as will probably most doctors I know.

Okay, but with breastfeeding, you know, there is no question that alcohol is getting into milk. That happens, so, you know, there are studies that try to tell people, "You know, even if you wait a while, the alcohol gets into the breast milk, so. There's less of a chance of causing developmental damage from that because we're really, you know, you're not going to get fetal alcohol syndrome from that. But if you wouldn't feed your kid alcohol, you wouldn't feed them alcohol in the breast milk. And so, most people will tell you while you're breastfeeding to be very conscious and not so much with the breastfeeding either.

Next question comes from "Anthrax Records" - "How do you feel about the CHIP program? It seems to me like it insures a lot of kids for a very low price. Can we expand it?"

I love the CHIP program! The CHIP-, I've written in the New York Times about it, I think we - ... Did we do a-? We did a Healcare Triage on this, did we do one on CHIP? Maybe not? Maybe not! Maybe that's a good topic!

But we've definitely done-, I've definitely written on it many times in the blog and the New York Times. So, the CHIP program is awesome, so much so that when we passed the Affordable Care Act, you know, that was really aimed at adults because we had already really reduced the problem of un-insurance in the United States for children.

UNDERinsurance is still a problem, but many, many children - many children - were improved-, had improved coverage because of changes in the CHIP program.

The CHIP program is the "Children's Health Insurance Program," and it was passed to expand Medicaid - or to expand what we would consider Medicaid - to many children in the United States. It was done a decade and a half or two decad;es ago, and it's been very successful; it has an incredibly high actuarial value such that, you know, kids who are on CHIP pay very little out-of-pocket.

There are many people that are concerned that ending CHIP would hurt a lot of kids, because it would result in their getting insurance products that actually would have a much lower actuarial value with a lot more cost-sharing, lead to a lot more underinsurance. But the recent doc-fix that we talked about in a Healthcare Triage News, like, a week or two ago, also included a two-year extension of the CHIP program, so. We're good for two more years.

We could expand it, I don't think expansion is gonna happen, because at this point, we believe that between CHIP and the Affordable Care Act, children are much better covered than they used to be. I think the concern over time is that are we going to allow for CHIP to go away and what that would mean for kids. But I don't see expansion happening anytime soon.

Next question - "Dan Falvo - 'Codeine is available over-the-counter in most countries. Why is that not the case in the U.S.?'"

That's not true! Codeine is not available in most other countries. It's available in SOME countries; I think you can get it in low doses -  if I remember when I last looked at this - in Denmark... maybe Canada, U.K., Sri Lanka-. But you know, we're not talking about every country. In fact, I think in most countries it might not, and if it isn't available, it's available with other things. Like, you know, like a "Tylenol with codeine" or for the British, "paracetamol and codeine." But it's not like you're going out and buying, you know, codeine by itself for the most part.

"Why is it not available in the United States?" Because we don't let anything almost be over-the-counter in the United States, our antibiotics aren't over-the-counter. At this point, you know, if you want to get... - oh, I'm blanking - ephedrine! You gotta talk to the pharmacist at this point.

So, um, you know, marijuana's not even legal in most of the United States even for medicinal purposes, so the idea that codeine is gonna become over-the-counter is not gonna happen anytime soon.

We also have a real problem with opiate addiction and everything else, so that trend just ain't happening. But I think it's a misrepresentation to say it's available over-the-counter in most other countries. SOME countries, but not-, so the United States, in this case, not a real outlier.

Next question - "Frabrizio Gonzales - 'How do you feel the field of mental illness - specifically depression, anxiety disorders and so on - has changed since you became a pediatrician?'"

It's gotten better! Because for no other reason that we gotten mental-, we gotten parity in the United States, or much closer to parity with respect to health insurance coverage. When I was starting, physical disease was covered very well; mental disease, you had to have super-awesome insurance, but these days, you know, insurance, by definition, is supposed to be doing both, covering both equally. So, it has gotten much better if for that reason and no other.

There's also a lot more medications than there used to be to help treat a lot of mental illnesses. So, I'd like to think that things have gotten better.

Next question - "Life Teen Two - 'Does long-term use of prescription amphetamines affect cardiac or mental health later in life?'"

Why are you... Okay, I see what you're asking. Yes, so-, I was going to ask, "Why are you doing that," but of course, yeah, now I'm gonna get it.

So, the question is, "Will long-term amphetamine use affect cardiac or mental health?" There's not a lot of evidence for that. Of course, it depends if you're abusing it or using it as prescribed. If you're using it as prescribed, the long-term affects should not-, are not being shown to be very bad, and it's always weighting the benefits and the harms.

The benefits definitely outweigh what tiny, minimal harms - theoretical as may be - are there. Lots of people need those amphetamines for a variety of reasons. And so, if you're getting them for something that you need, then by all means, you should be taking it. But again! Talk to your doctor. But this is not one we've stopped or been panicking about their use, because these-, or ignoring possible long-term use; it's studied very well.

Next question - "Santhothbodu - 'Why is eating mostly processed food bad for your health?'"

Well, you know, tons of processed foods are a way to cram tons of calories in, more than you think you're getting. The more processed it is, the more refined it is, the easier it is to get too much. With respect to processed meats, there's some epidemiologic evidence where people will say it's unhealthy. I've blogged about this, I've written about it in the New York Times, we even had Healthcare Triage on meat, and-...

Has that one one up yet, that gone up, right? The "meat" one? [unintelligible off-screen reply] Maybe we didn't. Crap. So many good episodes we need to do!

So, no! You know, it's like even the most heavily processed meats, there's not a ton of convincing evidence that they're terribly damaging. And then if it is, it's in huge quantities. And even then, it's a tiny relative increase in harms, not some massive, absolute increase.

And so, you know, mostly I would say the problem with processed food is it's an easy way to eat unhealthy in general. It's an easy way to eat too much. It's an easy way to get lots of things you don't necessarily need. And we're gonna have an upcoming episode, I think, on nutrition recommendations based on my recent New York Times piece on that. So, you can watch more in the future.

Next question - "Lenka Svoboda - 'Which SPF factor should I use if I live in the U.K., and how often should I apply it if it is 20 degrees Celcius and sunny? I have been told buying SPF sun cream is pointless. Thank you."

You've been told that by Healthcare Triage! We've done an episode on this; I'm absolutely positive of it. So, um - and you also screwed me up here because 20 degrees Celcius is, you KNOW I live in a place with Fahrenheit. So, I'm trying to do the math in my head and failing, and it doesn't matter.

[off-screen reply, "Seventy!"]

Seventy! Awesome! The temperature doesn't matter. The temperature is irrelevant; it's how sun there is, that's the first thing. So, it doesn't even matter that I couldn't immediately tell you what 20 degrees Celcius is. Are you out in the sun? You're getting UV rays. In fact, the most burned I've ever been was skiing, because all the light was reflecting off the snow, too, and I was getting huge doses of it.

In fact, two of my kids recently got terribly burned while skiing because we were not vigilant enough about it in the snow and the cold weather. It's the sun - that's the first thing.

The second thing is yes, anything above SPF 30 starts to get ridiculous, as we said in the Healthcare Triage episode. SPF 30 is, like, 94% effective. SPF 50 or 60 is probably like ninety-five or six percent effective - it's all minutia. What matters is how much, and I don't want to spend the next ten minute redoing that Healthcare Triage video, so links will be down below, find it, search it, learn how to put on sunscreen effectively, but yes - you absolutely need sunscreen if you're out in the sun, and SPF 50 is probably more than you need.

Next question, and we're probably running outta time here , but - "Camille-on-hound - 'What does the research show for long-term risks associated with secondhand smoke exposure? For someone who was heavily exposed during childhood, is there any way to mitigate those risks as an adult?'"

We don't have randomized controlled trials for this, again, because of course it would be completely unethical to expose kids to secondhand smoke and then see how different amounts and when we stopped had effected their lungs - it's not gonna happen. Most of the effects are short-term, that have been looked at, with respect to affecting breathing issues, like asthma. And of course, the second you stop exposing kids, they get better. So stopping at ANY TIME is better than not.

But are there long-term effects? Maybe? I wish we had better data, but that's unfortunately where we are. We're probably out of time, so I'm gonna go speed-round for these last three questions I have.

Question 20 - "Jack Cooper - 'What is being done to address publication bias by the pharmaceutical industry?'"

Not enough! Not enough. We require people to establish their-, or at least most reputable journals require people to state their financial conflicts of interest - that's a start. But still too many get left out. More importantly, we ignore all the other kinds of conflicts-of-interest: academic and professional and ideological conflicts-of-interest. So, not enough.

Next-, last two questions from "Mackenzie-ack - 'Regarding diet soda, is there any danger in drinking it in larger amounts, not the aspartame?"

You know, I think there are some-, you always get those school - what are they called - science fairs where they put the soda on the teeth and it decays the teeth or decays something. Yeah! You know, soaking anything in an acid for too long is bad. Brush your teeth after you drink. You know, I don't think that they're doing other-, you know, even the studies of, like, bone issues? They all pan out, they don't show any real problems.

However, I think in general, don't drink anything in crazy amounts. Everything in moderation, so I don't know, it probably leads to a bad diet. But it's not like-, there are no studies showing that it's gonna give you cancer or anything else, so that's my quick answer.

I've also got a note here to say I was wrong before - Mark is not impersonating a lawyer, so. Stan, the lawyer, is telling me that Mark was not impersonating a lawyer, and we don't want Mark to sue us, so, that mark is not.

Last question - "Maras Elin-, wow, Maras Ionut Maijita - 'How healthy is honey in reality? Is it actually good for you as it is made out to be?'"

[laughing] Who's making it out to be-, honey is like, it, I don't know. Honey is like anything else as a sweetener. Use it in moderation. Honey for babies is TERRIBLE; they get botulism, not kidding - infantile botulism. Saw a case of it almost every year that I was a resident, leads to kids being in the intensive care unit - they should not get honey.

For the rest of the world, once you're outside of that period, I don't think it's any better for you or worse for you. The idea that local honey cures your allergies is a MYTH - read my books. But is it better for you or worse for you than sugar or anything else? No.

There are no miracle things. If something was a miraculous, awesome gonna-cure-you-of-everything, I swear to you, we would have an episode on it. You would be-, pure people screaming it from the rooftops, and everybody would know it. They'd also find a way to charge you a billion dollars for it, because they would make it a drug. Having said that, it's not BAD for you, so there's no reason to truly avoid it either.

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