queuebit · April 15, 2016 19:27
diff --git a/.block b/.block
 license: mit
diff --git a/README.md b/README.md
diff --git a/hctriage_abrev_metadata.json b/hctriage_abrev_metadata.json
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diff --git a/hctriage_metadata.json b/hctriage_metadata.json
 [{"c_name":"healthcare triage","v_id":"wBr3fniyb4w","title":"Obamacare and October 1st: Healthcare Triage #1","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nhttp:\/\/www.healthcare.gov\n\nHealthcare Triage is a new series from Dr. Aaron Carroll and the team behind Crash Course and Mental Floss Videos. In this episode, Aaron gets a visit from noted hypochondriac John Green, and allays some of his fears about Obamacare. He provides an overview of what is going to happen on October 1st, when the Affordable Care Act, AKA Obamacare, goes into effect. Aaron will talk stuff like individual mandates, subsidies, and the three-legged stool of Obamacare, which is not a real stool. You'll learn who exactly is affected by the changes on October 1st, get a brief tour of healthcare.gov, and learn a little about alien alternative medicine, which also isn't even real. The rest of the video is totally real. All this, plus the aforementioned metaphorical furniture should make this pretty hard to resist.\n\nRead more on Aaron's blog: http:\/\/theincidentaleconomist.com\/\n\nWritten by Aaron Carroll\nProduced by Stan Muller\nGraphics by Mark Olsen\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1380492565","likes":"9232","duration":"417","transcripttext":"Aaron Carroll: Hi, I'm Dr. Aaron Carroll, and on this new YouTube show, we're going to try to help you understand how medical research and health policy work, we're gonna make sense of a lot of the confusing information out in the world, and we're gonna have a lot of fun doing it.  We're officially launching in a few weeks, but today, we're gonna give you a little preview and talk to you about Obamacare.  \n\nSo I have this friend who's a little bit of a hypochondriac. His name is John Green, and he's been asking me a lot of panicked questions about Obamacare.  \n\nJohn Green: Wait, Aaron, I heard that the cost of my family's insurance is gonna triple in the next year.\n\nAaron: No.\n\nJohn: Well, but my uncle told me his Medicare is being taken away, that's true, right?\n\nAaron: That's not gonna happen.\n\nJohn: All right, Aaron, what about this?  I heard that, under Obamacare, medications are now going to have side effects.\n\nAaron: That was already the case.\n\nJohn: Also, I just got this e-mail from a friend that said, under Obamacare, anyone over the age of 45 will be euthanized.\n\nAaron: Wow. Absolutely not.  \n\nJohn: Also, that reminds me, I just got an e-mail about someone whose lupus was cured by aliens. Why don't we just get our healthcare from aliens?\n\nAaron: Well, I suppose w--NO!  That's not how we get healthcare!  \nOkay, clearly we need to start with the basics.  Let's talk about what Obamacare is and what it isn't and what changes are in store for you.\n\n(Healthcare Triage intro plays)\n\nAlthough Obamacare was passed in 2010, the big pieces of the law are scheduled to go into effect on October 1st, just days from now.  But what does that mean to you?  Will your insurance change?  Will you still be able to get medical care?  If you don't have insurance right now, how will you get it?  No matter what you think of the law politically, it's in your best interest to get as much out of it as you can.  So today, we're going to explain how Obamacare works and how it will affect you.  \n\nFor decades, the most glaring problem in the United States healthcare system has been that millions of people are uninsured. We're one of the few industrialized countries in the world that doesn't provide universal coverage to its citizens. Here's a list of some of them that do.  For the past few years, the number of people who lack any coverage for a year in the United States has hovered at around 50 million people.  Is that list still scrolling? We'll wait.  By the way, all of those countries are democracies; they all voted to get that universal coverage.  \n\nLots of people don't have insurance because they have some form of chronic illness.  That's not a surprise, because I mean, come on! If you're already sick, what insurance company would want to cover you?  And if they do, the policy that they'll give you will likely cost a fortune, and that's a whole other problem.  Health insurance is really, really expensive.  Last year, the average employer-sponsored health insurance policy cost almost $6,000 for an individual.  The average plan for a family cost more than $16,000.  The average two-bedroom apartment rents for about $12,500.  I'm just sayin', that's too much money for many Americans to afford.  \n\nThe architects of Obamacare had a number of very straightforward goals.  The first was to make sure that no one could be denied insurance if they wanted to buy it.  This idea is called guaranteed issue.  The second was that people should all be charged a similar amount, even if they have a chronic condition.  They shouldn't be punished for being sick.  This idea is called community ratings. That's not to be confused with the TV show Community's low ratings, which are infuriating, 'cause that show is awesome.  These are the major thrusts of Obamacare's regulations.  \n\nBut there's a problem here.  If you make it so that no one can be denied a plan if they want it, and no one can be forced to pay more if they're sick, there's no reason for healthy people to buy insurance.  They can just wait until they get sick, and then they can go buy a plan for the same amount they could have before they got sick.  But if only sick people buy insurance, then the price of premiums goes way up.  This leads even more healthy people to skip buying a plan, only sick people are left, price goes up even more, more healthy people opt out, and we get what we call a death spiral for the private insurance industry, which, while it sounds really cool, we really don't want that to happen.\n\nTo avoid this, we need to come up with a way to convince healthy people to buy insurance.  One way is to charge people a penalty if they don't.  Obamacare handles this by charging people a fine of $95 or 1% of their income if they don't buy insurance.  That's the individual mandate, but that creates one more problem.  \n\nHow do you make people pay for something if they can't afford it? One way would be to subsidize it, and people who make less than 400% of the poverty line would get a tax credit from the federal government to help them pay for the insurance.  These are the subsidies of Obamacare.  These three factors: the regulations, the individual mandate, and the subsidies, form the three-legged stool of Obamacare.  The reason we call it that is because it only works if it's balanced.  Remove any one of the legs and the stool's gonna fall over.  Remove any one of these three things from Obamacare and the law would just fall apart.\n\nSo that's how Obamacare works. It also happens to be pretty much how Massachusetts's health care system works, and Switzerland's, for that matter.  And those systems are working pretty well.  I mean, have you seen the healthy glow of those Swiss people and Bostonians?  \n\nBut what will all of this mean to you?  You, like John, may have heard some pretty scary things about Obamacare.  But here are the facts: If you're 65 or older, and you have Medicare, nothing will change for you --  by which I mean, you keep your Medicare. Nothing changes. You need to sign up for nothing on October 1st. If you have insurance from your job, or from someone in your family, then it's very, very likely that nothing will change for you either. Most people in the United States get their insurance this way, and you will continue to do so next year, too.  You also need to do nothing on October 1st.  If you get your insurance from Medicaid, or from the Veterans Administration, or from some other government source, then nothing will change for you either. You'll still get your insurance from the government and you, too, need to do nothing on October 1st.  \n\nThat leaves the group of people who really need to pay attention to what's coming up on October 1st, and those are legal citizens who are uninsured right now or think they might be uninsured next year.  That's who Obamacare is really going to affect, and there are just over 30 million of you.  You should go to www.healthcare.gov.  That's been set up to help you get the insurance that you're gonna be required to have in 2014. The site will ask you a few simple questions and use that information to make some recommendations for you for insurance.\n\nIf you make less than 133% of the poverty line, you'll qualify for Medicaid, which is free.  Some states, unfortunately, aren't participating in the Medicaid expansion, which'll be a problem for very poor people in those states, but that's still in flux.  Everyone else will go to the insurance exchanges, where companies will offer plans at bronze, silver, gold and platinum levels.  The more you're willing to pay, the more robust your coverage will be.  But it's your choice!\n\nIf you make less than 400% of the poverty line, you'll get a subsidy to help with the premiums, and the vast, vast majority of people who are uninsured in the United States right now are going to get those subsidies.  And for many of them, the bronze-level plans will be pretty affordable. \n\nAnd that's it!  There are other bells and whistles to Obamacare, and we'll be covering them in future episodes, but this is what you need to know right now to get ready for 2014.  So whether you like the idea of Obamacare or you hate it, it's coming on October 1st. You owe it to yourself to at least take a look and consider your options.  Go to healthcare.gov and see how much insurance is going to cost you.  It's not gonna be as scary as you've been told, even if it's not as awesome as getting healthcare from aliens.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/wBr3fniyb4w"},{"c_name":"healthcare triage","v_id":"dF3Dcol5XLg","title":"What is Health Insurance, and Why Do You Need It?: Health Care Triage #2","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nIn this episode of Healthcare Triage, Dr. Aaron Carroll gets some surprised questions from \"friend of Obama\" John Green who is still waiting for his big government giveaway . Unfortunately, insurance still costs money, and it's still really complicated. Aaron explains how the insurance system we have today came to be, and why most of us get coverage through our jobs. He talks about why we need insurance, which basically boils down to the fact that health care is really, really, really expansive. More importantly, he explains why you need to know what premiums, networks, deductibles, co-pays, and co-insurance are, and how they have to be considered in the true cost of insurance. Also, ground unicorn horn.\n \nMake sure you subscribe above so you don't miss any upcoming episodes!\n \nRead more on Aaron's blog: http:\/\/theincidentaleconomist.com\/\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1383514163","likes":"2260","duration":"498","transcripttext":"Aaron: Hi, I\u2019m Doctor Aaron Carroll and welcome back to Healthcare Triage. We\u2019re gonna be doing this show every week now so make sure you subscribe right down there.\n\nIn the first episode we talked a lot about ObamaCare and how people without insurance were going to try to start getting it. But that led to a lot of questions about insurance in general.\n\nJohn: Yeah, exactly. When am I going to stop having to pay for my insurance?\n\nAaron: You\u2019re still gonna have to pay for your insurance. ObamaCare is about access....\n\nJohn: Now Aaron, this was supposed to be about big government giveaway to friends of Obama. I am friends with Obama. I don\u2019t understand what went wrong.\n\nAaron: Nothing went wrong. Let\u2019s start this week with the basics of health insurance. How does it work? How much is it gonna cost? We\u2019re gonna answer that and more in this episode of Healthcare Triage.\n\n(Intro)\n\nAaron: Comprehensive health insurance isn\u2019t as old as you think. The first real plans appeared in the US around the time of the civil war. And really, those were just types of accident insurance in case you got injured while traveling on a train or a steamboat. This wasn\u2019t nothing since trains and steamboats exploded pretty regularly in those days but it didn\u2019t do much to help with what we would all consider routine healthcare. Well into the 20th century, there just wasn\u2019t that much need for health insurance. After all, what would you do with it? There wasn\u2019t much healthcare to buy. If you got sick it wasn\u2019t like there was an MRI scanner or artificial heart that you were gonna get. You went to the doctor for leeches and laudanum but if you got really sick, well you sort of died.\n\nBut as doctors and hospitals learned how to do more than amputate legs and shake their heads wistfully, they realized there was real money in this gig. So in 1929 a bunch of them joined up and formed an insurance plan called \u2018Blue Cross\u2019. They helped people buy their services. Doctors didn\u2019t like the idea of hospitals being in charge so they created their own plan in 1939 which they called \u2018Blue Shield\u2019. So you had your \u2018Blue Cross\u2019 for hospital services and your \u2018Blue Shield\u2019 for physician services until they merged to form \u2018Blue Cross and Blue Shield\u2019 in 1982.\n\nFor the most part, people bought health insurance on their own if they wanted it. Some jobs offered it, but employer sponsored insurance wasn\u2019t really a thing until World War Two. War time emergency plans put wage controls in place and so by law companies couldn\u2019t compete for workers by paying them more. With so many men fighting overseas, employees were relatively scarce. So employers started competing for workers by offering them benefits like health insurance. Those weren\u2019t restricted by wage controls and soon lots of jobs were paying for more and more comprehensive coverage. After World War Two, President Harry Truman proposed scrapping this system for one of universal public health insurance. People loved this idea, but doctors, hospitals and many businesses hated it. They\u2019d already invested quite a bit in the current system. Labor unions also realized that they had a lot to gain by keeping insurance tied to jobs. They'd fought hard to get benefits for their members and changing to a national insurance system would have made these gains moot. Truman lost. Employee based health insurance won.\n\nOver the next twenty years private insurance increased in popularity but remained mostly unavailable to the elderly, the poor and the unemployed. No-one wanted to cover seniors \u2018cause they get sick a lot and cost a ton of money. But this meant that more and more people were faced with the difficult decision of going broke or letting their parents die. This was intolerable to many Americans because all of them expected to be old one day and they had no interest being stick in this dilemma. After years of fighting, President Johnson signed Medicare and Medicaid into law to cover the elderly and the poor and today government programs cover about one third of Americans. The rest of the insured are covered by private insurance.\n\nBut why do we even need insurance? To put it simply, healthcare is very, very expensive. My oldest son had to go the emergency department about a month ago. He received just an ultrasound and a doctor read it. Turns out he was fine and he just needed an antibiotic. The cost of that visit: $6,000. And that\u2019s cheap compared to really big things like a hospital stay. Last year we spent something like 2.7 trillion dollars on health care. That\u2019s upwards of 18% of our GDP. Most people don\u2019t have the kind of money to pay for care if they get sick. That\u2019s where insurance come in. Everyone individually pays less, but sick people get the money. We pool risk and the money goes to whoever needs it. By the way, anyone that complains that they don\u2019t like paying for someone else\u2019s healthcare is completely missing the point. Insurance is always about paying for someone else\u2019s healthcare, it transfers money from the healthy to the sick.\n\nHow does insurance work? Well the first thing you do is pick a plan. Plans differ on the amount of actuarial value they have. That\u2019s a fancy term for describing the approximate percentage of the cost of care that insurance will cover. If a plan has 60% actuarial value then it covers 60% of the cost and you cover 40%. Plans with higher actuarial value cost more. You pay more upfront and pay less later. And the insurance exchanges which we talked about on our last video, bronze plans have a 60% actuarial value, silver plans are 70% and gold plans are 80%. Insurance also has networks of physicians. These are doctors or hospitals with whom the companies have negotiated lower rates. You get better coverage if you stay in network and pay more if you go out of network. So if there are certain doctors you really want to see, you need to make sure they\u2019re part of your plan.\n\nThe money you pay up front is called a premium that\u2019s often charged monthly. That\u2019s what you see when you find out how much a plan costs. That is not all the spending you\u2019ll do. Pretty much every plan comes with a deductible. This is an amount of money that you\u2019re responsible for paying even after the premiums before insurance coverage kicks in. The reason plans use this is that they think correctly that you\u2019re less likely to spend your money than their money. It prevents you from going out and getting a ton of care that you might not need. More expensive plans, which have more upfront money, usually have lower deductibles. Less expensive plans have higher deductibles. Not all care is subject to the deductible. For instance, most preventive care is fully paid for by your insurance right away.\n\nEven after you spend the deductible you\u2019re not done. Most plans come with co-pays. These are set fees that you have to pay each time you access the healthcare system. They may be $20 for a doctor\u2019s visit or $100 for an emergency department visit. And it gets better. There\u2019s also co-insurance. It\u2019s the amount that you yourself have to pay for care above what your insurance pays. And then you have to give them a first born child, two wishes and an ounce of ground unicorn horn. Just kidding, it\u2019s actually only one wish. OK, I\u2019m kidding about the whole thing. It\u2019s just the co-insurance is real. It\u2019s not all bad. Plans now come with an annual out of pocket maximum. For a family, it\u2019s at most $12,700 and for an individual it\u2019s $6,350. So after you\u2019ve paid that amount of deductibles, co-pays and co-insurance, you\u2019re done. It\u2019s all on the insurance after that. Even better, there are no longer any annual or lifetime limits, you insurance can never run out.\n\nSo if you bought a silver plan, say, with an actuarial value of 70% for yourself from the exchange in Indiana, the premium might be around $4,000 a year or just over $350 a month. Let\u2019s say it has a $1,500 deductible, $20 in co-pays for doctor visits and 15% co-insurance. When the year starts, even with the insurance, you\u2019ll be paying for almost everything until you spent the $1,500. Then you\u2019ll be paying $20 for each visit plus 15% of other charges until you hit $6,350.\n\nIn a bad year you could be on the hook for a total of about ten grand or the cost of the premium plus the maximum out of pocket expenses. This is going to come as a shock to most people who assume that health insurance would now be cheap or even free. But you have to look at what might\u2019ve happened without it. What if it had been you had to go the emergency department a month ago? Instead of costing you $6,000 under this plan you would\u2019ve been responsible for a $350 copay and $900 co-insurance payment. That $1,250 is much less than $6,000 and this could happen a couple times a year. Or you could get really sick or you could have a kid. The average price of having a baby in the United States is $30,000. If you have a Cesarean section it\u2019s $50,000. People with insurance are way, way, way better off than those without it.\n\nSo do your research. Figure out what you\u2019re willing to pay upfront in premiums but don\u2019t forget that networks, deductibles, co-pays and co-insurance matter too. Figure out if you\u2019d rather pay more upfront or gamble that you won\u2019t need to and pay more later, but make an informed decision. Now you know and knowing is half the battle. I always wanted to say that. Go Joe!","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/dF3Dcol5XLg"},{"c_name":"healthcare triage","v_id":"mkr9YsmrPAI","title":"Sugar Doesn't Make Kids Hyper: Healthcare Triage #3","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nDo you think that sugar makes kids hyper? Well, you're wrong. Yes, WRONG. How do we know? Randomized controlled trials.\n \nRCTs are pretty much the most robust study design there is, and also the only way to prove causality. This week's episode of Healthcare Triage explains how randomized controlled trials work, and why they are superior to other types of studies. It also explains how they've been used to prove, without a doubt, that sugar doesn't make kids hyper. Don't believe it? Watch the video and argue with us in the comments below if you're still not convinced.\n \nMake sure you subscribe above so you don't miss any upcoming episodes!\n \nRead more on Aaron's blog: http:\/\/theincidentaleconomist.com\/\n\nLink to a meta-analysis of many of the studies discussed here: http:\/\/jama.jamanetwork.com\/article.aspx?articleid=391812\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1384191085","likes":"5155","duration":"375","transcripttext":"You can't turn on the news these days without finding out that something else is bad for you. Cell phones will give you cancer. Artificial sweeteners will kill you. Eating at night will make you fat. Video games will make you violent. Reading in the dark will make you blind. It's a wonder the species hasn't died out already.\n\nBut in almost none of these cases, has anyone ever proven that something causes something else. To do that, you need a specific and certain type of study. You need a Randomized Control Trial or RCT. But RCTs are the hardest and often most expensive kind of studies to do. Nonetheless, they are necessary to prove a causal link between one thing and another. And they're the topic of this week's Healthcare Triage.\n\n[Intro]\n\nI've written a number of books about medical myths. And the one that still causes me the most heartache and gets me the most hate tweets is the myth that sugar makes kids hyper. I can already hear some of you screaming. You now think I'm crazy or that I'm in pocket of Big Sugar. You've seen it for yourself, you or your kid gets hyper when you, he, or she eats sugar. But what you're describing isn't a study, it's an anecdote. I don't care that you've seen it lots of times. The plural of anecdote is not data. So what do we need to do to prove that sugar makes kids hyper?\n\nFirst, we might get a bunch of kids together and give them candy. We'd see if they acted hyper after they ate it. Let's say they did, would that prove anything? NO! They might've been hyper already or maybe they all got more and more tired over the hours and hours we forced them to eat candy and that's what made them hyper. You can't tell if it was the sugar or if it was something else unrelated to that, that led to their hyper behavior.\n\nSo another thing we could do is take a different set of kids and not give them candy. Then we could compare their behavior to the kids who got candy. And as long as we kept everything else the same, like the time of day, we can be more sure that it's the candy that had an effect. The kids that didn't get the candy comprise what is called a Control Group. And this study design would be a Controlled Trial.\n\nBut these's another potential problem. Maybe the kids in the first group were all boys. Maybe the second group was all girls and that might mean that the differences we see might not be because of the candy, but because girls are made of sugar and spice and boys are made of snails and puppy dog's tails. To overcome this type of bias, we can't let the parents make the decision of which kids go in each group. We have to make it random. If we take all the kids and randomly assign them to candy or no candy, then we can be even more sure that whatever effect we saw was because of the sugar. This is a Randomized Control Trial.\n\nIt's still not perfect though. Maybe the kids who got the candy loved the sweet, sweet taste of sugar so much that they acted differently just out of happiness. Maybe the kids who got no candy were so pissed that they just sat and sulked. Then the difference wouldn't be because of the sugar, it would just be because of the taste.  Or maybe the parents who saw their kids get sugar just believed that their kids were more hyper. They may want to prove me wrong so badly that they convinced themselves that they saw hyperactivity even when it wasn't there.\n\nTo overcome these biases, we have to prevent the kids, who are the subjects, from knowing whether they are in the sugar or no sugar group. We also have to prevent the parents, or the observers, from knowing that too. So first, we have to come up with a placebo, or fake treatment. Say, sugar-free candy.  Bleh! But if the kids can't tell which is which, then we've blinded them  to which group they're in. If the observers also don't know which group the kids are in, this would be a Double-Blinded Randomized Placebo Controlled Trial. That's a mouthful, but it's  pretty much the most robust study design you can have.\n\nThis is a subtle, but incredibly important thing.  Other study designs can prove an association, or a correlation, but as Hank and John and anyone who thinks scientifically like to say: \"Correlation is not causation\".  We may know that television viewing is correlated with Attention Deficit Hyperactivity Disorder, but is that because TV causes ADHD, or is it because kids with ADHD like to watch more TV?  Or is something else to blame?  Could it be the parents of kids with ADHD are more permissive of TV watching?  We just don't know!  Only a randomized controlled trial can prove causality.  \n\nNow, you can't have a randomized controlled trial for everything.  We're never gonna have one that proves that breastfeeding is superior to bottle feeding, because it wouldn't be ethical to force women to do one or the other.  We'll never have a randomized controlled trial of smoking and cancer, because it wouldn't be right to force people to smoke.  We're too sure it's probably really bad for you.  That, by the way, is how the tobacco companies get away with saying that it's never been proven that smoking causes cancer.  'Cause there's never been a randomized controlled trial.  And there never will be.  Back to sugar and kids!\n\nThere have been 12, count them, 12 randomized controlled trials of sugar and hyper-active behavior in kids.  They've been published in places like the New England Journal of Medicine.  That is likely more studies than for any drug you've ever taken.  These studies looked at sugar differences and overall diet and found no difference.  They looked at kids getting sugar in a huge bolus, say from gorging candy bars, and found no difference.  They've even studied kids whose parents swear that they are sensitive to sugar and found no difference.  And in the best study of them all, they gave a whole bunch of kids a sugar free beverage, and then lied to a random half of the parents and told them that their kids got sugar.  Those parents rated their children as more hyperactive.  It is not the sugar.  Parents just believe it is.  This myth is entirely in their heads.  \n\nSo there are plenty of good reasons kids might act hyper when they get sugar.  Often it's at a birthday party or on a holiday or on Halloween.  Moreover, some parents are so crazy about sugar that their kids never get it, so when they do, those kids are really, really excited and hyper, but that's not because of the sugar, it's because of the parenting.  Sugar doesn't make kids hyper.  We know that because we have randomized controlled trials to prove it.  Case closed.  And next time someone tells you that they read something causes some other bad outcome, make sure you ask them if the study was a randomized controlled trial.  I can almost guarantee you it wasn't.  \n\nBefore we go, please note that there are plenty of other reasons not to give kids too much sugar, the pediatrician in me feels compelled to say that.\n\n(Endscreen)","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/mkr9YsmrPAI"},{"c_name":"healthcare triage","v_id":"nJqderdey_I","title":"The HPV Vaccine, and Why Your Kids Should Get It: Healthcare Triage #4","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nHuman Papillomaviruses (HPV) are the cause of genital warts, and believed to lead to a number of cancers. But there's a vaccine for HPV that can prevent you from getting infected. This week, Rosianna sends in some questions about the safety and efficacy of the vaccine, based on some emails she's received. Aaron takes the opportunity to talk about HPV, how the vaccine works, how safe it is, and how misinformation is preventing us from saving lives.\n \nMake sure you subscribe above so you don't miss any upcoming episodes!\n \nRead more on Aaron's blog: http:\/\/theincidentaleconomist.com\/\n\nHere are some links to stuff Aaron has written on this with references:\nhttp:\/\/theincidentaleconomist.com\/wordpress\/this-is-why-we-vaccinate-hpv-edition\/\nhttp:\/\/theincidentaleconomist.com\/wordpress\/hpv-and-sexual-activity\/\nhttp:\/\/www.cnn.com\/2013\/06\/04\/opinion\/carroll-douglas-hpv-vaccine\/index.html?hpt=op_t1\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1384726932","likes":"2777","duration":"412","transcripttext":"Rosianna: Hey Aaron. So I received the HPV vaccine a couple of years ago. I just got this really scary email from my friends that basically says that the HPV vaccine is killing people, that the lead researcher has spoken out against it and also that it basically does nothing to prevent cervical cancer whatsoever. Can you help because I\u2019m really freaking out about this right now.\n\nAaron: The HPV vaccine is the subject of this week\u2019s Healthcare Triage.\n\n(Intro)\n\nWhen I was a medical student interested in becoming a pediatrician, we were warned again and again about a disease called Epiglottitis. It\u2019s just what it sounds like, an infection of the epiglottis, most often by a bacteria known as Haemophilus influenzae type B. It was always an emergency requiring rapid intubation. Kids died from it. But by the early 90\u2019s, the Haemophilus influenzae type B or HIB vaccine was being commonly used. And by the time I was a resident, the incidents of HIB disease had declined by more than 99%. I\u2019ve never seen a case of epiglottitis \u2013 ever. Know why? \u2018Cause vaccines work and when people attack them I start to get a bit upset. As Rosianna said, there\u2019s an email going around that claims that one of the researchers who was involved in the discovery of the HPV vaccine has now renounced it. That\u2019s not entirely true.\n\nBut before we get into that, let\u2019 start with some facts that no-one disputes. Human Papillomaviruses are a group of viruses that are known to cause warts. About forty types of them are transmitted by sexual contact. Any type of sexual contact. About six million new infections occur each year in the United States. That\u2019s a huge number, in fact HPV is so common that almost all women will have an HPV infection at some time in their life. For the vast majority of them this isn\u2019t much more than an inconvenience. Their immune system fights the infection off and they\u2019re fine. But in some women, especially those infected with certain strains of viruses, the infection sticks around. Some of those cases lead to cervical cancer. About 4000 women die of cervical cancer in the United States each year. About 250,000 of them die from it worldwide. The HPV vaccine was originally developed to prevent women from being infected and thus prevent them from getting cervical cancer later. And that\u2019s where we can re-join Rosianna\u2019s story.\n\nDoctor Diane Harper, one of the researchers of the vaccine itself has claimed that the manufacturers of the immunization are overselling its cancer protection properties. She\u2019s not totally wrong. One of her complaints is that you need immunity for a long period of time to make sure the protection lasts. The vaccine hasn\u2019t been around long enough to prove that\u2019s the case. But that\u2019s not a reason not to use it. It\u2019s a reason to monitor its long term potency and give a booster if necessary and we\u2019re doing that.\n\nHer other claim is that since regular pap smears can detect early problems and help with diagnosis leading to significantly reduced cervical cancer mortality, we don\u2019t need a vaccine. She says that pap smears prevent cancer. That\u2019s not true. They help detect it earlier, but cancer still occurs. Moreover, many women don\u2019t get pap smears regularly. They cost money and time and we have pap smears today and like I said thousands of women die of cervical cancer every year.\n\nAnd cervical cancer isn\u2019t the only cancer that HPV causes. The incidence of rectal cancer has been increasing for decades and most experts believe that HPV is partially the reason for it. The same goes for oral cancers. A recent study found that more than half of such cancers were associated with HPV infections. There are no pap smears for those types of cancer, there\u2019s only the vaccine. And these cancers occur in boys as well as girls. That\u2019s why we\u2019re now recommending that everyone get the vaccine. The only way never to get HPV is never to touch another humans genitals \u2013 ever. For most people that\u2019s not gonna happen. Even condoms aren\u2019t totally protective here since you can get HPV from an area of skin that\u2019s not covered. It\u2019s either never ever ever touch or get the vaccine \u2018cause the vaccine works. Studies show that.\n\nThe vaccine was introduced in late 2006. In the three years before that the prevalence of HPV infection in girls aged 14-19 years was 11.5%. In the three years after it was introduced the prevalence was only 5.1% and that\u2019s with only a third of girls in that age group even getting the vaccine. Know what would have happened if we\u2019d done better? Another 50,000 girls alive today would not get cervical cancer in their lifetimes if we got that number to 80%.\n\nThe vaccines are safe too. By last summer, more than 46 million doses of the vaccine had been given in the United States. Initial studies conducted before FDA approval found no serious side effects. A recent safety review by the FDA and the CDC found reports to the vaccine adverse event reporting system had been consistent with those preapproval safety studies. In fact, the CDC has investigated many of the deaths allegedly attributed to the vaccine and found that there\u2019s no consistent pattern and nothing that links them to getting the immunization. The Institute of Medicine did their own review and found, again, no reason for concern.\n\nSome people are opposed to the HPV vaccine because they believe that it sends an implicit signal to girls that the sexual activity through which they might acquire HPV is permissible. In other words, they think that if you give the vaccine to girls it makes them more likely to have sex. Someone should do a study to see if that actually happens. And of course someone has. Researchers looked at 1398 girls of whom 493 got the HPV vaccine and 905 didn\u2019t. Then they looked at the pregnancy rates in those two groups as well as pregnancy testing rates. They even looked at reported contraceptive counselling. You know what they found? There were no significant differences in any of these things between girls who received an HPV vaccine and those who did not.\n\nAnd why do we need to start the vaccine when girls are young? Because it only works if you\u2019ve never been exposed to HPV before.  The only way to guarantee that is to catch kids before they ever have sex. Research shows that the average age of first intercourse in the US is seventeen for boys and seventeen and a half for girls. But more than 6% of kids in the United States have had sex before the age of thirteen. Look, I think that\u2019s too young too but those are the facts. Moreover, vaginal intercourse isn\u2019t the only type of sex that can give you an HPV infection. An additional 7% of girls and 9% of boys have engaged in oral sex without ever having vaginal intercourse. Bottom line, about half of the almost 19 million new sexually transmitted infections diagnosed each year are in teens and young adults. We need to catch these kids early.\n\nI have one more bit of research for you. The most common reasons that parents refuse the HPV vaccine for their kids are safety concerns and because they think it\u2019s not needed. In other words, they\u2019re getting misinformation from emails and articles like the one that showed up in Rosianna\u2019s inbox. That\u2019s a tragedy and a preventable one. Vaccinate your kids.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/nJqderdey_I"},{"c_name":"healthcare triage","v_id":"vIK8PR6tzBU","title":"Turkey Doesn't Make You Sleepy: Healthcare Triage #5","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nWe have Healthcare Triage mugs and posters available at DFTBA.com! http:\/\/dft.ba\/-HCTmerch\n\nWhile Thanksgiving is a time focused mainly on family, friends, and giving thanks, it's also the cause of a pervasive medical myth: that turkey makes you sleepy. Don't start with us about the tryptophan. Gah! We know about the tryptophan, and you're not helping your case.\n \nIt's your Thanksgiving duty to watch this video and share it with everyone you know. Help us beat down this lie! You owe it to the turkeys.\n\nMake sure you subscribe above so you don't miss any upcoming episodes!\n\nRead more on Aaron's blog: http:\/\/theincidentaleconomist.com\/\n\nThis was part of a paper on medical myths that Aaron published in the BMJ: http:\/\/www.bmj.com\/content\/335\/7633\/1288?view=long&pmid=18156231\nThe key references are #40-53 here: http:\/\/www.bmj.com\/content\/suppl\/2007\/12\/21\/335.7633.1288.DC1\/vrer501965.www.pdf. Knock yourself out. \n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1385326802","likes":"2024","duration":"136","transcripttext":"It\u2019s Thanksgiving. And while it\u2019s a time when many of you will gather with family and appreciate the good things in life, it\u2019s nothing but frustration for me. That\u2019s not because I don\u2019t like gathering with my family or because I don\u2019t have a lot to be thankful for, I do. It\u2019s because Thanksgiving is the time when I\u2019m forced to hear over and over and over again the pernicious myth that turkey makes you sleepy. It doesn\u2019t. That\u2019s wrong and this is Healthcare Triage.\n\n(Intro)\n\nThe myth that turkey makes you sleepy is so pervasive that I bet you even think you have a scientific explanation for it, it\u2019s the tryptophan. And it\u2019s true that L-Tryptophan is sold as a dietary supplement to help you sleep, but it\u2019s there that the facts stop supporting this lie.\n\nLet\u2019s start with the fact that turkey doesn\u2019t have that much tryptophan in it. In fact, chicken and ground beef have the same amount of tryptophan in them, about 350 milligrams per 4 ounce serving. It turns out that cheese and pork actually have more tryptophan in them than turkey does, but no one ever claims that the ham and cheese sandwich made them sleepy, no, it\u2019s always the turkey.\n\nThen let\u2019s move on to the fact that the amount of tryptophan in turkey is much less than the amount that\u2019s recommended to help you sleep. Some sources say you need a thousand milligrams or more, which means you\u2019d have to eat more than three quarters of a pound of turkey just to get that much tryptophan. Most people don\u2019t eat that much in a sitting, even at a Thanksgiving dinner.\n\nIt gets worse. If you buy tryptophan as a sleep aid and look at the side of the box, it\u2019s likely you\u2019ll see instructions telling you to take it on an empty stomach. Why? Cos tryptophan is poorly absorbed with food, especially with a big meal. In other words, if you wanted to use turkey as a delivery system for tryptophan, getting it from a big Thanksgiving meal is gonna be really ineffective. There\u2019s nothing about this myth that makes sense.\n\nOf course there are plenty of other reasons that you might get sleepy on Thanksgiving. Big meals can cause drowsiness. So can alcohol. So can a case of not wanting to do the dishes. Also the Thanksgiving Day parade is extremely boring. So blame your sleepiness on any of these things, just don\u2019t blame it on the turkey. Admit to yourself that the turkey was delicious, make yourself a Myles Standish, loosen your belt and take a nap. Maybe you\u2019ll luck out and miss the parade.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/vIK8PR6tzBU"},{"c_name":"healthcare triage","v_id":"CdcNLBfeTis","title":"How We Pay for Obamacare: Healthcare Triage #6","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nAfter we posted our video on \"How Obamacare works\" tons of commenters asked how Obamacare is paid for. Often, the question was NSFW. But you ask, we answer.\n \nIn this episode, we will explain how much Obamacare costs, and what spending cuts and revenue increases (ie taxes) were passed to pay for it. You'll get to see why it really is \"deficit reducing\".\n\nMake sure you subscribe above so you don't miss any upcoming episodes!\n\nRead more on Aaron's blog: http:\/\/theincidentaleconomist.com\/\n\nHere are two great sources for this data. The first is The Tax Foundation: http:\/\/taxfoundation.org\/article\/how-938-billion-health-care-bill-financed. The second is the CBO: http:\/\/www.cbo.gov\/publication\/21351.\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1386550024","likes":"2537","duration":"408","transcripttext":"So after our first video we got lots of comments which asked us how ObamaCare could possibly be paid for. Lots of them weren\u2019t very polite about it. But because of the new YouTube-Google+ commenting system we can\u2019t go back and answer the comments on the old video so we thought we\u2019d make a new one right now. Welcome to Healthcare Triage.\n\n(Intro)\n\nLet\u2019s start with the fact that the cost of ObamaCare and its effects on the budget change from year to year. Also anything in the future is just a projection, it\u2019s a best guess. Also, the more years you look at the more it\u2019s gonna cost. For the purposes of this video we\u2019re going back to the beginning. When the law was first passed, all the calculations looked at its first decade. In other words, the numbers were valid from 2010 to 2019. They were calculated by the Congressional Budget Office or CBO, a non-partisan organization which works for congress. All of congress not one party or the other.\n\nAs many of you noticed, there are a lot of goodies in ObamaCare. The Medicaid expansion, for example, was projected to give free health insurance to about sixteen million people. That wouldn\u2019t come cheap. In fact, the CBO projected that the Medicaid expansion would cost about 434 billion dollars over a decade. The subsidies and the exchanges cost money too. Sixteen or so million people receiving subsidies would cost the federal government another 464 billion dollars. There were also some small business tax credits in the law for the first few years. Those cost 40 billion dollars. Add them up and the projected ten year cost to the ACA was 938 billion dollars and 938 billion dollars is a lot of money but that doesn\u2019t mean there wasn\u2019t a plan to pay for it, there was. We were going to get the money from grandma. Probably with some advice about not diving into the shallow end of the pool.\n\nIn all seriousness, the first big source of money is Medicare, specifically it was in the Medicare Advantage program. You see, back in the Bush administration a lot of people thought the private insurance companies could do a better job at providing Medicare insurance to elderly Americans than the government could. In fact this had been an ongoing debate for a long time. President Bush signed into law a new program to have the private insurance companies give it a try. Qualifying companies could receive the same amount of money that we would spend on government Medicare. If they could provide the benefits for less money they could keep the extra in profit. Sounds fair right? Well it quickly became apparent that they couldn\u2019t do it. After all, there are lots of expenses in private insurance that aren\u2019t needed for government insurance. The government doesn\u2019t have to advertise or pay executives and the government doesn\u2019t care about profit. So the private insurance companies got the government to start paying them extra. Eventually it was costing us 14 cents on the dollar more for Medicare Advantage than for Medicare itself. ObamaCare ended that practice. Private companies could continue to provide Medicare to elderly citizens but we went back to the original deal. They got the cost of government Medicare and not one dime more. After all, that was the original intent of President Bush\u2019s program. The savings for this change, 136 billion dollars.\n\nAlterations were also made to the way that Medicare would update the fee for service payment rates for care. Fees for services has always been a problem because it incentivizes you to do more even if that more is unnecessary. That\u2019s a bad model. Savings, 196 billion dollars. Medicare also used to pay what's called a disproportionate hospital share payment to providers who take care of the uninsured. But ObamaCare is going to reduce the number of uninsured. Those DSH payments are no longer needed. Savings, 22 billion dollars. There\u2019s some changes to how Medicare reimburses home health care for 40 billion dollars. Some changes in how they pay for senior\u2019s drugs which actually cost 43 billion dollars more. A revision to the Medical Improvement Fund for 21 billion dollars. Some reductions in subsidies to rich people who get the Medicare prescription drug program for 11 billion dollars. And finally some changes were made in how some Medicare programs relate to each other for a 29 billion dollar savings. Add all that up and we save 417 billion dollars alone from changes to Medicare over a decade.\n\nBut grandma can\u2019t foot all the bill. Remember the individual mandate and employer penalty, people in companies are gonna pay them. That\u2019ll net the government 69 billion dollars. There are also some new taxes and fees on health insurance companies, medical device companies, indoor tanning and other providers. Those will bring in 107 billion dollars. There are some cuts to Medicaid including cuts to its disproportionate hospital share payments. Those are worth 45 billion dollars. And taxes. A new Medicare tax of 0.9% was passed on individuals making over $200,000 and couples making more than $250,000. Regular old Medicare tax was also added to unearned income over those amounts. That\u2019ll bring in 210 billion dollars. Starting in \u201917, there\u2019s also a 40% excise tax, or the Cadillac tax, on insurance on the amount paid above $10,200 for individual coverage and $27,500 for family coverage. Granted, not many plans are that expensive but even so, this\u2019ll brings in 32 billion dollars.\n\nWhat\u2019s left? First some miscellaneous health care provisions. These included increased tax revenue from coverage provisions, 46 billion dollars, ending the cellulosic biofuel producer credit, is that really a thing? Oh, OK. Anyway, 24 billion dollars. Changes in how payments to corporations are reported, 17 billion dollars, a change to medical expense reductions, 15 billion dollars and some changes to health savings accounts and flex spending accounts, 19 billion dollars. Total for these, 149 billion dollars. Finally there are some changes to other programs whose savings were applied to ObamaCare. These included education reforms including the student loan program and Pell grants, community living assistance services and supports and public health programs and community health centers. Add those up for a final 52 billion dollars in savings. I\u2019m still not convinced about that cellulosic biofuel thing, are you sure it\u2019s real? Add that up together and you get 1.08 trillion dollars in revenue and savings. In other words, that\u2019s an increase in funds available in the federal budget of more than a trillion dollars to pay for ObamaCare. Since it was projected to cost only 938 billion dollars. That means that ObamaCare reduces the deficit.\n\nI know, it\u2019s hard to believe, but you have to remember that the law is more than just the good stuff. It\u2019s so long and complicated because it also includes all these taxes and savings. That\u2019s how we pay for ObamaCare. What\u2019s even better is that as we move forward, the taxes and savings get larger faster than the expenses so it reduces the deficit even more in the future. You will hear people say that this isn\u2019t true. Most of them say so because they believe the government will repeal the taxes or stop the savings. Maybe, but that'll take an act of congress and congress isn\u2019t doing much lately. But if you don\u2019t want ObamaCare to cost more, don\u2019t let them make the changes. Tell them to keep the medical device tax, don\u2019t repeal the excise tax, keep the tax on tanning. If we do, and we pretty much have so far, ObamaCare will be paid for. But not cellulosic biofuel evidently. Thanks Obama.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/CdcNLBfeTis"},{"c_name":"healthcare triage","v_id":"gNiORew3uRY","title":"Survival vs Mortality Rates: Healthcare Triage #7","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nAlmost every time someone wants to proclaim the US to be the \"best in the world\" in health care, they point to survival rates. Those refer to the percent of people who live a certain amount of time after they've been diagnosed with a disease. But there are real problems in using survival rates to compare the quality of care across systems. The metric people should be using is mortality rates. And when we compare mortality rates, we don't look nearly as good. Why is this important? Glad you asked. We answer in this week's episode.  \n\nMake sure you subscribe above so you don't miss any upcoming episodes!\n\nThis happens to be one of Aaron's pet peeves. He's written on it many, many times at his blog. Many posts, all of which are chock full of links and references, can be found here: http:\/\/theincidentaleconomist.com\/wordpress\/tag\/survival-rate\/\n\nJohn Green -- Executive Producer \nStan Muller -- Director, Producer \nAaron Carroll -- Writer \nMark Olsen -- Graphics \n\nhttp:\/\/twitter.com\/aaronecarroll\nhttp:\/\/twitter.com\/realjohngreen\nhttp:\/\/twitter.com\/crashcoursestan\nhttp:\/\/twitter.com\/olsenvideo","uploaded-unix":"1387146116","likes":"2440","duration":"338","transcripttext":"Aaron: How do we measure our ability to prevent death?  What's the difference between survival and mortality rates?  That's the topic of this week's Healthcare Triage.\n\n(Healthcare Triage Intro plays)\n\nAlmost every time someone goes on some \"best in the world\" rant about the US healthcare system, they inevitably turn to cancer care.  They claim that people in the United States do so much better than those in other countries.  When Rudy Giuliani was running for president, he proclaimed that his chances of surviving his prostate cancer were 82% in the United States, versus only 44% in England under socialized medicine.  Of course, those numbers are completely unsupported by any evidence, if we go by actual data, then the 5-year survival rate of prostate cancer is 98% in the United States versus 74% in England.  Still scary, but pretty irrelevant nonetheless.  I know, I know, some of you are already screaming, how can I dismiss such differences?  I can because they're comparing survival rates, what we really should care about when we compare systems is mortality rates.  I can't stress how important this difference is.  \n\nMortality rates are defined by the number of people who die of a certain cause in a year divided by the total number of people. For instance, the mortality rate for people with lung cancer in the United States is 53.4 per 100,000 people.  Survival rates are something else entirely, they calculate the percentage of people with a disease who are still alive a set amount of time after diagnosis.  The 5-year survival rate for people with lung cancer in the United States is 15.6%. 53 deaths per 100,000 people and 16%, those aren't measuring the same thing.  \n\nYou can only decrease the mortality rate, or the number of people who die each year, by preventing death or curing the disease.  That's really it.  That's a cure or a life extension and both are unequivocally good.  On the other hand, survival rate, or how long you live with a disease, can be increased by preventing death, curing the disease, or by making the diagnosis earlier.  And there's the rub.  \n\nLet's say there's a new cancer of the thumb killing people.  From the time the first cancer cell appears, you have 9 years to live, with or without treatment.  From the time you can feel a lump, you have four years to live, with or without treatment.  Let's say we have no way to detect the disease until you feel the lump.  The five year survival rate for this cancer is about zero, because within five years of detection, everyone dies, even on therapy.  Now I invent a new scanner that can detect thumb cancer at the cellular level.  Because it's the United States, we invest heavily in the technology.  Early detection is everything, right?  We have protests and lawsuits and an awareness campaign with ribbons and everything and now everyone is getting scanned like crazy.  Not only that, but people are getting chemo earlier and earlier for the cancer.  Sure, the side effects are terrible, but we want to live.  We made no improvements to treatment, patients are still dying four years after they feel the lump, but since we're now making the diagnosis five year earliers, our five year survival rate is now approaching 100%.  Everyone's living nine years with the disease.  Meanwhile, in England, they say that the scanner doesn't extend life and they won't pay for it.  Rationing.  That's why their five year survival rate is still 0%.\n \nJohn: USA!  USA!  Yes!  \n\nAaron: The mortality rate is unchanged, the same number of people are dying every year, we've just moved the time of diagnosis up and subjected people to five more years of side effects and reduced quality of life.  We haven't done any good at all.  We haven't extended life, we've just lengthened the time you have a diagnosis.  We've also spent a crapload of money, but that's almost beside the point.  \n\nYou think this thumb cancer scenario is far fetched?  In England, women are screened by mammography every three years starting at age 50, yet in the United States, the American Cancer Society recommends women be screened by mammography every year starting at age 40.  The five year survival rate for a woman diagnosed with breast cancer in 2001 in the US was 89%.  In the UK, it was 80%.  The mortality rates?  In 2010, they were 22 per 100,000 women in the US versus 24 per 100,000 women in the United Kingdom.  That's not as dramatic a difference.  And it's not just women.  We screen way more for prostate cancer, too.  In the US, the ten year survival rate for men with prostate cancer is 98%, for men in the UK, it's 69%.  Huge difference.   But the mortality rate per 100,000 men in the US is 23 versus 23.7 in the UK.  Barely any difference at all.  Hard to believe we're spending almost two and a half times per person for healthcare what they do over there.\n\nNow, that's not to say that survival rates don't have their place.  They do.  Individual doctors need them every day for patient care.  When a patient is sitting in a room with her physician, and she's just learned that she has cancer, the only thing she cares about is \"What can I expect?'  She doesn't care about the population or the mortality rate, she wants to know, \"What's gonna happen to me?\"  And that's where survival rates are necessary.  Doctors want to be able to say to patients with confidence that you have a certain chance of living five years or ten years or more.  We want to know that here in the US based on the way we screen if you're this age and have this cancer and it's at this stage, this is the probability you'll live for five years.  That's what patients want to know, and it's totally reasonable, and that's what survival rates can tell us.  What they can't tell us is if that time is based on earlier diagnosis or better outcomes or both.  They can't tell us if we're necessarily improving outcomes.  That's what I care about as a health services researcher.  That's what you should care about when we discuss the quality in the United States healthcare system, and that's why you should use mortality rates to compare our system to others.\n\n(Endscreen)","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/gNiORew3uRY"},{"c_name":"healthcare triage","v_id":"BncyJxsI1yg","title":"Poinsettias Aren't Poisonous, and Other Holiday Myths: Healthcare Triage #8","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nOn Thanksgiving, we destroyed the myth that turkey makes you sleepy. But there are lots of holiday myths, and in this episode of Healthcare Triage, we take apart some more. These all come from a paper Aaron co-wrote in the BMJ. All the references for the studies he talks about are there: http:\/\/www.bmj.com\/content\/337\/bmj.a2769\n\nHappy holidays!\n\nJohn Green -- Executive Producer \nStan Muller -- Director, Producer \nAaron Carroll -- Writer \nMark Olsen -- Graphics \n\nhttp:\/\/twitter.com\/aaronecarroll\nhttp:\/\/twitter.com\/realjohngreen\nhttp:\/\/twitter.com\/crashcoursestan\nhttp:\/\/twitter.com\/olsenvideo","uploaded-unix":"1387749602","likes":"1878","duration":"405","transcripttext":"At Thanksgiving I spent some time railing against the myth that turkey makes you sleepy but that\u2019s far from the only myth plaguing our holiday landscape so let\u2019s kill some more. Welcome to Healthcare Triage.\n\n(Intro)\n\nHoliday Myth #1: Poinsettias are poisonous. I\u2019ve never bought a poinsettia before, including this one, but evidently they\u2019re pretty popular at this time of year. People seem to think though that they need to be concerned about kids, pets or even drunk adults around them because they\u2019re toxic. Nope. In a study of 849,575 plant exposures reported to US poison control centers none, not one, of the 22,793 cases of poinsettia ingestion resulted in any significant issues. No-one died and the vast, vast majority of them didn\u2019t need medical attention of any kind. In 92 of the cases children ingested substantial quantities of the plant but none needed medical treatment. Toxicologists all over the world have concluded that poinsettia exposures and ingestions can be treated without referral to a healthcare facility. But I know you\u2019re not so easily convinced. You, and some rather sadistic researchers, are determined to find out how much of the plant you\u2019d have to consume to make it dangerous. Those researchers, likely with your support, forced rats to eat the stuff until they died. Unfortunately they couldn\u2019t find a toxic amount of poinsettia even after making the rats eat the equivalent of 600 leaves, that\u2019s like a kilogram of the sap. I\u2019m not telling you to go out and eat poinsettias, but stop worrying, they\u2019re not poisonous.\n\nHoliday Myth #2: You can cure a hangover with anything. It\u2019s the holidays. If you\u2019re not drinking already, more power to you. But there\u2019s no way to cure a hangover. They\u2019ve studied everything from aspirin and bananas to drugs and water. I know that you can do an internet search and find endless options for preventing or treating hangovers. You can even find \u201cmedical experts\u201d touting magical cures. But here at Healthcare Triage we rely on science and no scientific evidence, none, supports any cure or effective prevention for alcoholic hangovers. There\u2019s a great systematic review of randomized controlled trials, remember those, evaluating medical interventions for preventing or treating hangovers. They found no effective interventions in either traditional or complementary medicine. Yes, you can find a few small studies using unvalidated symptom scores that show minor improvements but these studies are flawed and without a good randomized controlled trial you can\u2019t prove causality. The conclusion of the exhaustive review was that propranolol, tropisetron, tolfenamic acid, fructose or glucose and dietary supplements including borage, artichoke, prickly pear and Vegemite even all failed to cure hangovers effectively. There are some studies in rats that claim that a new hangover cure is on the horizon. But how the heck can you tell if a rat is hungover? Until they prove that these things work in humans you should beware, they\u2019re not without risks. A study out of Australia found that a kudzu root containing \u201changover cure\u201d, and yes that\u2019s in quotes, maybe linked to an increased risk of cancer. A hangover is caused by drinking too much.  Thus, the most effective way to avoid a hangover is to consume alcohol only in moderation or not at all. If you\u2019re not gonna do that, just suck it up.\n\nHoliday Myth #3: Suicides increase over the holidays. Holidays aren\u2019t always fun, certainly not for everyone. They can sometimes bring out the worst in us. The combined stresses of family dysfunction and exacerbation's and loneliness and more depression over the cold, dark, winter months is commonly thought to increase the number of suicides. But while the holidays might be a difficult time for some, no good scientific evidence exists to suggest that there is a holiday peak in suicides. Let\u2019s start with a study from Japan that looked at suicides between 1979 and 1994 that showed that the rate of suicide was lowest in the days before a holiday and highest in the days after it. In the United States on the other hand, a study of suicides over a 35 year period found no increase before, during or after holidays. Indeed, research suggests that people might actually experience increased emotional and social support during holidays. In the US again, rates of psychiatric visits decrease before Christmas and increase again afterwards. A smaller study of adolescents showed a peak in suicide attempts at the end of the school year, possibly reflecting a decrease in social support, but not around the holidays. Data from Ireland going from 1990 to 1998 also failed to connect suicides with the holidays. Irish women were no more likely to commit suicide on holidays than any other days. Irish men were significantly less likely to do so. It\u2019s not the weather either. People aren\u2019t more likely to commit suicide during the dark winter months. Around the world, suicides peak in warmer months and are actually lowest in the winter. Studies in Finland and in Hungary and in all kinds of other countries find that suicides are highest in the summer and lowest in the winter. Studies of suicides even from India show peaks in April and May. Studies from the US reflect this pattern as well with lower rates in November and December than in typically warmer months. Of course none of this evidence suggests that suicides don\u2019t happen over the holidays, but they\u2019re just not more likely. People should stop thinking they are.\n\nHoliday Myth #4: You lose most of your body heat through your head. Yeah, that\u2019s total crap. I bet some experts even told you this. I don\u2019t care. Maybe you\u2019ve even heard that the US army field manual for survival recommends this because, and I quote \u201c40% to 45% of body heat is lost through the head\u201d. If this were true, humans would be just as cold if they went without pants as if they went without a hat. But does anyone actually do that? No! And that\u2019s not because of modesty, they could wear shorts. This myth probably began because of the military anyway. They did a study back in the day in which scientists put subjects in arctic survival suits, but no hat, and measured their heat loss in extremely low temperatures. Guess what, they got really, really cold. And because their heads were the only parts of the body that were exposed to the cold, they lost most of their heat through that part of the body. But that\u2019s a terrible study, there were no controls. A better study would be to take people and stick various parts of their bodies in really cold water with different parts covered and uncovered and then see how much heat they lose in each case. Well someone did that study. I have no idea who volunteers for such stuff but they did it and in that controlled trial scientists found that there was nothing special about the head and heat loss. Any uncovered part of the body loses heat and will reduce the core body temperature proportionally. You lose heat through your head in the exact proportion that you head is to the rest of your body. So I guess if you have a really, really big head in proportion to your body, and I\u2019m not pointing any fingers, you could try and make some argument about increased body surface area, but this myth would still be pretty much a lie.\n\nIt\u2019s also not true that eating at night makes you fat, it was really due to that crock pot of Velveeta and sausage at your grandma\u2019s house. Happy holidays.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/BncyJxsI1yg"},{"c_name":"healthcare triage","v_id":"4SfcGmEVuBY","title":"The Sky Isn't Falling: Healthcare Triage #9","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nPundits, media types, and curmudgeons like to claim that things were so much better in the \"good old days\". They bemoan how kids are all sexed up and ruining everything now. They especially like to make these kinds of claims around the new year. They're wrong. Things are pretty much better than they've ever been, and we've got data to prove it. The sky isn't falling.\n\nMake sure you subscribe above so you don't miss any upcoming episodes!\n\nHere are some sources:\nTeen \"sex\" rates: http:\/\/www.cdc.gov\/nchs\/data\/databriefs\/db136_tables.pdf#3\nCrime stats: http:\/\/www.ucrdatatool.gov\/Search\/Crime\/State\/TrendsInOneVar.cfm\nDivorce: http:\/\/content.time.com\/time\/magazine\/article\/0,9171,1989124,00.html\nMortality: http:\/\/205.207.175.93\/hdi\/ReportFolders\/reportFolders.aspx\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1388357615","likes":"3802","duration":"388","transcripttext":"Happy New Year! As we- as we ush-...\n\nAs we usher in 2014 I look forward to hearing from pundits, politicians and cranky old people in general that the 'good old days' were just so much better than now. That's especially because the kids these days just suck. What with their twerking and texting and internet sexting they're all just a bunch of lazy, sexed-up good-for-nothings. And everything is terrible; chemicals in food and water, vaccines giving us diseases and people wasting their lives away on technology. \n\nExcept none of that's right. The sky isn't falling. 2014 is awesome, and not just because of Healthcare Triage. It's easy to look around and complain. Some people in the media seem to have made a career out of it. But longing for the past is not only somewhat misguided, it's just plain silly.\n\nLet's start with kids. It's true that there's unprecedented access to all kinds of information. It's true that some of this stuff is, well, porn. But every story that labels today's youth as oversexed and promiscuous misses the most obvious evidence. The teen birth rate in 2012 was a record low - it's less than half of what it was in 1991. The teen abortion rate is at an all time low - it's at less than half of what it was in the 70s. And it's now 38% of its peak in 1988. Even the teen pregnancy rate is at an all time low it's only 56% of its peak in 1990. African American teens - all time low. Hispanic teens - all time low. Non-Hispanic white teens - all time low.\n\nThey're even having less sex! In 1988 about 50% of boys aged 15-17 had had sex, in 2010 it was about half that. The rates in girls dropped from 37% to 27%. Will that stop us from going on and on and on about the good old days, how sex is ruining everything and how today's kids are just the worst? I doubt it. \n\nFor 37 years the Monitoring the Future study has been comparing American kids to those in 36 other countries. Last year they found that about 27% of American students drank alcohol in the last month. That placed them at the second lowest, behind only Iceland. The average drinking rate in the other countries was 57%, more than twice that of kids in the US. The proportion of American students who smoked was only 12%, also the second lowest in the rankings. And again, the average smoking rate in the other countries was more than twice that what we see in the US. By the way, those smoking and drinking rates were at a 37 year low. That means that they're the lowest in all the time we've been studying this issue.\n\nDespite everything you hear about the knockout game in cities, youth violence is also at an all time low. Ah, the kids these days! \n\nIt's not just the kids either. Ever heard the statistic that half of marriages end in divorce? Turns out that was actually never even true. It got up to about 40% around 1980, i.e. the good old days, but divorce rates are now at their lowest since before then. Seriously. \n\nThings are better with health too! Infant mortality is at an all time low. You may remember the 60s fondly, but a baby was more than 4 times as likely to die then. Moms were about 3 times as likely to die in childbirth then too. Life expectancy at birth, at almost 79 years, is longer than at any time in our history. You're less likely to die of cancer, diabetes, respiratory disease, influenza, pneumonia, chronic obstructive pulmonary disease or asthma than ever. You're even less likely to die from assault than in 1960, when I could first find data.\n\n Everyone complains about how unsafe they feel, but that fear is irrational. The rate of violent crime is lower than at any time since 1970. Murder - lowest since the early 60s. Rape - lowest since the mid-70s. Robbery - lowest since the late 60s. Aggravated assault - lowest since the mid-70s. Property crime - lowest since the late 60s. Larceny-theft - lowest since the late-60s. Burglary - lowest since the late-60s. Car theft - lowest since the late 60s.\n\nStill nostalgic for your youth? You may complain about how farming is done today, but there is no evidence at all that it's hurting us. People long for a return to organic farming but there's no data which shows that food raised this way is more nutritious or safer. And lots of those practices that you hate are what make life so enjoyable for the vast majority of people. \n\nNot that long ago, everyone had to grow their own food. If we still had to do that there wouldn't be time for people to build computers, and invent the internet, and produce YouTube content. \n\nBy the way more water meets health-based standards today than at any time in human history. 2014 is awesome.\n\nLook, I know everything isn't perfect. Kids are more obese than before, but even that trend has been reversing. From 2008 to 2011, obesity rates in preschoolers declined in 19 of 43 studied states and territories and held steady in almost all the others. In various areas around the country, obesity in all kids dropped nearly 17% from 2005 to 2009. \n\nAnd we like to complain that we're watching too much TV, we're spending too much time on the internet, we're so plugged into Facebook and Twitter that we're missing real life. We're even wasting time watching YouTube videos. But part of the reason we're doing so is because we have much more leisure time than ever before. Is that so wrong? \n\nWe hate processed food, but it makes it much easier to make dinner for our families. It doesn't take as long to clean clothes, or dishes, or the house. It doesn't take as much time to mow the lawn or care for our yards. It doesn't take as long to do many jobs, even. So we have more free time, and we spend some of that using modern technology. \n\nDo our kids really have fewer friends than we did? Is there any evidence for that at all? And do you really think technology is all bad? When I was a kid if I wanted to know what the chief export of the United States was in 1977 I'd have to get my mom or dad to drive me to a public library so I could look it up. Now my kids can walk over to the computer and tell you in seconds. I used to be annoyed by games like cookie clicker, then a couple of days ago my 7 year old girl told me how many quadrillion cookies she needed to buy her 100 antimatter condenser. This is bad?\n\nIt may be fun, or even human nature to long for days of yore. But it's important to realize that we see things through the haze of nostalgia. We remember the good and forget the bad. We also ignore the amazing progress we've made and see only the negative. But this is likely how it's always been. I bet if we dug into the archives we'd find some amazing editorials complaining how radio would rot kids' minds, or how since color TV was invented, kids spent no time outside anymore. And yet here we are.\n\nBesides, before now, there was no Healthcare Triage. Would you really give that up? I think not. Happy New Year! It's a great time to be alive!","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/4SfcGmEVuBY"},{"c_name":"healthcare triage","v_id":"q0OtUbDYdxw","title":"RAND and the Moral Hazard: Healthcare Triage #10","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nAs we've explained in previous episodes, insurance is complicated. Even John gets confused (watch the video!). But there's a reason we have all these deductibles, co-pays, and co-insurance. It's because of the moral hazard, and a very important research study known as the RAND Health Insurance Experiment. Watch this episode and learn all about it.\n\nMake sure you subscribe above so you don't miss any upcoming episodes!\n\nHere's more info on the RAND HIE: http:\/\/theincidentaleconomist.com\/wordpress\/the-moral-hazard\/\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1389132469","likes":"1887","duration":"412","transcripttext":"\n\nIntroduction\n\n\n\nJohn Green: I'm trying to figure out my plan, I have to decide if I want a high deductible, a high co-pay, or a high monthly premium.  \n\nDr. Aaron Carroll: Would you rather pay the money up front or would you rather pay it later?\n\nJohn: I don't know, what's better?\n\nAaron: Totally depends on how you like it.\n\nJohn: Well, I don't--I mean, I guess, I guess I would like to pay--I guess I would like it to be future-me's problem rather than current-me's problem.  \n\nAaron: Then probably--\n\nJohn: --pay later \n\nAaron: Then probably, okay, then go with the low deductible. But you're gonna have a high co-pay, you might also have high co-insurance, you're certainly gonna have a high deductible.\n\nJohn: What is co-insurance?\n\nAaron: That's the stuff that doesn't fall under the co-pay but still is responsible for you.\n\nJohn (confused): What?\n\nAaron: Yeah, remember? Okay, fine, you got the premium which is the now money, and then you got the deductible, but on top of the deductible you either have to pay the co-pay or the co-insurance every time you see a doctor.\n\nJohn: This seems inefficient to me.\n\nAaron: This is what we get.\n\n[break]\n\nAaron: We didn't stumble onto this system by chance. The reason all of this exists is because of a very important research study done a couple of decades ago. It's probably the most ambitious, largest study of health insurance that has ever been done or ever will be done. It was called the RAND (abbreviation for Research and Development) Health Insurance Experiment, and I'm gonna tell you all about it in this week's Healthcare Triage.\n\n[Healthcare Triage theme plays]\n\n\n\nThe Moral Hazard in Healthcare (1:08)\n\n\n\nThe RAND Corporation is a think tank that was established in 1948. They perform research in all kinds of areas including health, and in 1972 they began an 11-year study of health insurance.\n\nYou see, there was an ongoing debate about how insurance affects spending on healthcare in the United States. A number of people thought that insurance caused us to spend more than we otherwise would have on health care. It's part of what we refer to as the \"moral hazard.\"\n\nBasically, the \"moral hazard\" is the idea that people who are insulated from risk behave differently than people who are exposed to it. For instance if you have good car insurance you might drive less carefully because you're more protected. In healthcare, some apply the moral hazard to say that once you have good insurance, you're more likely to use health care even if you don't need it.\n\nIn my favorite example of this --because I find it amusing, not because I agree --if we all had employer-paid grocery insurance, we might all demand filet mignon instead of hamburger. This would evidently lead to skyrocketing food costs, mass starvation, and huge piles of rotting ground beef.\n\nIt's important to understand that people who apply the moral hazard to healthcare believe that people are using too much of it and that's why our costs are so high. They believe that if we somehow changed how we pay for healthcare and exposed people to the true costs, they would become better consumers and the whole system would cost less.\n\nAs a theory, the Moral Hazard in Healthcare was first described only about forty years ago in a seminal paper by the economist Mark Pauli and it's still just a theory. Like many theories, it has good parts and bad. It's not an undisputed law. For instance, recent work by another economist named John Neiman (Nyman?) explains that the moral hazard may actually do good in healthcare, by encouraging people who otherwise wouldn't get care to do so. We want sick people to get care!\n\nAnd think about it: That supermarket example isn't even remotely comparable. If I made colonoscopies free tomorrow, no one would start picking them up by the dozen. If I declared that no one would ever have to pay for chemotherapy again, you wouldn't ask for extra. If surgeons refused to accept payment for appendectomies anymore, would anyone go and get one just for the hell of it?\n\nWe have a hard enough time getting people to do the things we want them to do to be healthy, without making it harder for them to do so. Anyone who loves meat, loves filet mignon; no one loves going to the doctor.\n\n\n\nThe Experiment (3:20)\n\n\n\nWhat really matters is whether people are getting unnecessary healthcare. What we'd really like to know is whether people would spend less if the moral hazard was removed but stay as healthy. If that's the case, it's a good argument for making people pay more of their own bills. But if they get sicker, then it's a good argument for insurance covering all the costs.\n\nIf you want to see if one thing causes another, though, you need a randomized controlled trial. You might think that a randomized controlled trial of health insurance would be incredibly difficult. You'd be right! There have been two that I know of in the history of the United States and the RAND Health Insurance Experiment is by far the biggest. It contained about twenty-seven hundred families made up of people all under the age of 65. They came from six places across the United States to give it a nice geographic spread and they were all randomly assigned to one of four levels of insurance coverage.\n\nThey ranged in how much one had to pay in co-insurance from none to 25 percent to 50 percent to 95 percent. In other words, they measured different levels of the moral hazard. The \"none\" plan would involve no cost at all to people. The 95 percent plan is much like a health savings account where almost all of the spending is out-of-pocket.\n\nThe researchers' interests were varied, but centered on spending and health outcomes. The purpose of the study was to see if increasing the amount of cost-sharing would change how people used health care and how their health was affected.\n\nThe results are complicated, and have been interpreted and misinterpreted too many times to count, but here's the gist of what they found.\n\n\n\nThe Results (4:45)\n\n\n\nPeople in the high deductible plans --those who are most exposed to healthcare costs -- did spend significantly less and they consumed less healthcare. And yes, much of that care was unnecessary as healthy people did not suffer negative consequences from forgoing care.\n\nRemoving the moral hazard did no harm in the majority of patients, which is often touted as the result of the study. Because they were healthy! And of course, getting less care when you're healthy leads to few short-term negative results.\n\nSo it quickly became accepted fact that increasing cost-sharing was a good thing. People would use less care. They'd spend less. Insurance expenses --and therefore premiums --would come down. Everyone wins, right? This is why we have deductibles, co-pays, and co-insurance.\n\nBUT --and this is important --there were other findings in the Rand Health Insurance Experiment. Poorer participants with hypertension saw their mortality rates rise significantly. They died more. This is because it turns out that people are pretty bad at telling the difference between necessary and unnecessary care. If you're not healthy and you aren't rich, then you're more likely to go without necessary care and you're more likely to die.\n\n\n\nThe Debate Continues (5:55)\n\n\n\nThis debate isn't over. You can still find lots and lots of arguments from people who think that we're still too shielded from healthcare spending. They want high-deductible healthcare plans or even the elimination of all comprehensive insurance where only catastrophic things are covered. People who push for this believe that removing the moral hazard will not hurt people and will lead to significantly reduced healthcare spending.\n\nThey're not totally wrong: Removing the moral hazard is fine for most people. Yes, if we make it more expensive for individuals, if we demand \"more skin in the game,\" if we remove the moral hazard, people will seek less care, and that's fine for healthy people. But it's terrible for those who are ill.\n\nSo as we continue to reform the system, keep this in mind: Higher deductibles, co-pays, and co-insurance may be good for overall healthcare spending, but they may be bad for people's health.\n ","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/q0OtUbDYdxw"},{"c_name":"healthcare triage","v_id":"6IBArwEOhFM","title":"Myths About Antibiotics: Healthcare Triage #11","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nAntibiotics are one of the greatest medical innovations ever, responsible for saving something like a gazillion lives. But today, we're worried about overusing them, and there are concerns that one day they won't really work anymore. There are lots of misconceptions about antibiotics, and in this week's episode we're going to tackle a lot of them.\n\nMake sure you subscribe above so you don't miss any upcoming episodes!\n\nThose of you who want to read more and see references can go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=52679\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1389636275","likes":"2045","duration":"329","transcripttext":"Antibiotics are one of the greatest medical inventions of all time. They\u2019re responsible for saving untold numbers of lives but today, as with many medical interventions, we\u2019re worried about using too much of them as opposed to too little. There are also many misunderstandings and myths about antibiotics. We\u2019re gonna hit on a lot of them speed round style in this episode of Healthcare Triage.\n\n(Intro)\n\nAntibiotic Myth #1: Antibiotics kill germs that cause colds or the flu.\n\nNo! Antibiotics kill bacteria. Different types of antibiotics kill different types of bacteria. But the flu and colds are caused by viruses. Antibiotics don\u2019t kill viruses. Don\u2019t tell me how you got better on antibiotics when you had a cold. Was it part of a randomized controlled trial? No! Cos if it was, you would have seen that people who didn\u2019t take the antibiotics got better too. That\u2019s the point.\n\nAntibiotic Myth #2: You need and antibiotic if your snot is green.\n\nNo! Let\u2019s start with some basic facts. What makes snot turn green? When you have an infection, the body sends neutrophils, which are a type of white blood cell, to fight the germs. So if you have an infection in your nose it\u2019s likely there are more neutrophils present in your nasal passages than usual. These cells work by eating the germs that make you sick. Once they\u2019ve swallowed them, they keep them in what serves as their stomachs and then they digest them. One of the enzymes that the white blood cells use most often to digest the invader germs is called myeloperoxidase and myeloperoxidase has a fair amount of iron in it. Stay with me, I promise this is important.\n\nOnce the neutrophils get full of digested germs they burst. Then the iron in the myeloperoxidase gets mixed into the surrounding stuff in your nose and when you mix iron into that stuff, guess what color it turns? Green. No, the color green. Notice I said nothing about bacteria. That\u2019s because this works exactly the same no matter what the germ is. So you may have green snot with a bacterial infection but you could also have it with a viral infection. The bottom line is that the green does not tell you if it\u2019s bacteria and only bacterial infections need antibiotics.\n\nAntibiotic Myth #3: Birth control doesn\u2019t work if you\u2019re on antibiotics.\n\nThe concern for those who believe this myth is that somehow antibiotics interfere with a woman\u2019s absorption of the hormones in the birth control pill. This has been studied extensively. For instance, one study looked at hundreds of women in three dermatology practices with a history of long term use of antibiotics and birth control pills together. There was no statistically significant difference between how many women got pregnant in the group on both antibiotics and birth control pills and the control groups where women were taking just birth control pills.\n\nRemember, birth control pills fail at least 1% of the time even under ideal conditions. That\u2019s why people think they fail when they\u2019re on antibiotics but it\u2019s not the antibiotics. Now there\u2019s a tiny amount of evidence that one antibiotic called rifampin, which is a drug usually used for tuberculosis, may make birth control pills less effective. A study looked at thirty women who were on both the antibiotic rifampin and birth control pills and found that while the level of the hormone in their blood was lower than we might have liked, still none of them got pregnant. There\u2019s no evidence for antibiotics in general making the pill less effective. Period. Oh, that, that was bad.\n\nAntibiotic Myth #4: Once you\u2019re on antibiotics, you\u2019re no longer contagious.\n\nI think school systems invented this myth. They send your kid home because he\u2019s a \u201cdanger\u201d to all other kids like Typhoid Mary or something but as soon as you\u2019ve got him on antibiotics then sure, let him come back. First of all, the time period when you\u2019re contagious varies according to what infection you have. For many viral infections, especially the viruses that cause most of our colds and the flu, antibiotics will never ever make you less contagious. Even more problematic is that sick people are often contagious before they show any symptoms. When you\u2019re infected with a virus you typically shed or spread it for at least a day or two before you have any idea that you\u2019re sick. The virus is in anything coming out of your mouth or your nose at that time even before you\u2019re coughing and sneezing. You shed virus when you\u2019re actually sneezing and you shed virus even when you're starting to feel better. You\u2019re a nightmare!\n\nBacteria on the other hand aren\u2019t usually as contagious. You know why doctors treat strep throat? It\u2019s not cos primarily they think it will make other people less likely to get infected. It\u2019s because back in the day they were trying to prevent rheumatic fever. Now it\u2019s not even clear we\u2019re doing that because the strains of strep have changed and I\u2019m, I\u2019m not even gonna start taking about that because it\u2019s another story and we\u2019re doing speed round. There are very few scientific studies that tell us how long you\u2019re gonna be contagious. The idea of 24 or 48 hours is roughly based on how fast we think antibiotics decrease the load of bacteria within the body. For some conditions though, you could still be contagious with only a small amount of bacteria around even after you\u2019ve been on antibiotics for a while. For other conditions, a person might never have been very contagious or the period of being contagious might have passed even before they started the antibiotics. Some infections are still contagious as long as you have a rash or have a cough where as others are not. But the idea that once you\u2019re on antibiotics you\u2019re safe for others is just crazy. Well, not literally crazy, figuratively ah, all right, next!\n\nAntibiotic Myth #5: It\u2019s OK to take someone else\u2019s antibiotics.\n\nNope! I just told you that certain antibiotics kill certain bacteria. If you don\u2019t have the same bacteria, the antibiotic won\u2019t work for you. It\u2019s very likely that you have no idea what bacteria you\u2019re infected with. Ask your doctor, don\u2019t assume.\n\nAntibiotic Myth #6: You can stop taking your antibiotic when you start to feel better.\n\nRemember when I said you could feel better and still be contagious. That\u2019s cos you can feel better and still be infected. Take all the antibiotics.\n\nWe\u2019re out of time, but we\u2019re not done with antibiotics. We still need to talk about resistance and MRSA and superbugs. We\u2019ll get to those other things soon.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/6IBArwEOhFM"},{"c_name":"healthcare triage","v_id":"o65l1YAVaYc","title":"Vaccines Don't Cause Autism: Healthcare Triage #12","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nThanks to Audible.com for supporting this episode of Healthcare Triage. You can get Nate Silver's The Signal and the Noise, or a book of your choice, free at Audible.com: http:\/\/www.audible.com\/triage\n\nThere is almost no topic in health and health policy that immediately polarizes people more than the idea that vaccines cause autism. Even though the original big paper on this topic came out at the end of the last century, the anger this causes is still raw and potent. But there is a very, very large amount of research showing that vaccines and autism are unrelated. Please, watch the video before you jump down my throat.\n \nMake sure you subscribe above so you don't miss any upcoming episodes!\n\nHere are references for all the studies I talk about: http:\/\/theincidentaleconomist.com\/wordpress\/?p=52677\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1390183187","likes":"7569","duration":"477","transcripttext":"\n\n1998: The Hypothesis\n\n\n\nIn 1998 an article was published in the Lancet that followed the cases of twelve children with developmental regression and gastrointestinal symptoms, such as diarrhea or stomach pain. Nine of these children had autism, and eight of the nine had parents who thought the symptoms of their autism had developed after the vaccine for measles, mumps, and rubella (or the MMR vaccine) was administered. \n\nThis was not a randomized controlled trial, nor even a scientific study, it was merely a description of a small group of children. To be honest, it's difficult to imagine that this study could get published in the Lancet today. But based on the beliefs of the parents of those eight children, a frenzy of fear about vaccines and autism has ensued for more than a decade. That's the topic of this week's Healthcare Triage.\n\n[Intro sequence]\n\nLet me start with some caveats: I'm a pediatrician and a health services researcher. I see kids with autism, I treat kids with autism, I've even been part of funded NIH research to improve the ways we screen for and diagnose autism in children.  It's a real condition that is increasing in prevalence and has a significant impact on children and families across the world. I do not deny in any way that we need to do more about autism, but it has nothing to do with vaccines. \n\nAnd every dollar that we waste on that topic is a dollar we can't spend on important research or treatment to help children with autism and their families.\n\nThe initial article I mentioned in the Lancet was not a study. It had no real statistics and proved no association or causation. But it caused so much concern that led to a whole bunch of real studies to combat it. \n\n\n\n1999-2004: No Supporting Evidence Found (1:31)\n\n\n\nJust one year later in 1999, a study was published in the same journal. No difference was seen in the age of diagnosis for those who did and did not receive vaccines. That meant either there was no association between MMR and autism or that it was too weak an association to be detected even in a larger sample of children.\n\nSome were unimpressed. They still were concerned. In 2001, a study was published in the Journal of the American Medical Association that looked at data on over ten thousand kindergartners born in California from 1980 through 1994.\n\nThe incidence of autism over that time increased from 44 per 100,000 births to 208 per 100,000 births. That's a 373% increase. MMR coverage, on the other hand, rose from 72% to 82%, a relative rise of only 14%. It was determined in this study that the relatively small increase in MMR could not possibly be responsible for the huge increase seen in autism.\n\nThe next year in 2002, a study was published in the New England Journal of Medicine that followed all children born in Denmark from 1991 through 1998. They obtained data on over 537,000 children born in those years. They could find no association between the development of autism and the age of vaccination, the time since vaccination or even the date of vaccination. That same year, a similar study was published in the journal Pediatrics. It followed over 535,000 children in Finland born between 1982 and 1986. It too could find no association between the MMR vaccine and autism. In 2004 the Lancet published another study, which matched 1294 children with autism against 4469 kids without it. They found no relationship between the MMR vaccine and autism.\n\n\n\n2004: Retraction (3:16)\n\n\n\nIn 2004, ten of the twelve authors of that first Lancet paper retracted the supposition that the MMR vaccine could cause autism. This kind of thing is unbelievably rare in the medical literature. An eleventh author could not be contacted before the retraction. Only one researcher --the main one, in fact --held firm. For the record, that researcher is no longer licensed to practice medicine in the United Kingdom.\n\nIn 2005 a systematic review or 'study of studies' examining the effectiveness and unintended effects of the MMR vaccine was published in the Cochrane Collaboration. They identified 31 studies which met the criteria for their review. After a thorough investigation, even though the MMR could be associated with a number of side effects or other issues, there was no evidence for an association between the vaccine and autism.\n\nAnd in 2012, they  updated their work. This time the research they found included 5 randomized controlled trials, 1 controlled trial, 27 cohort studies, 17 case control studies, 5 time series trials, 1 case cross-over trial, 2 ecological studies, and 6 self controlled case series studies. All of these together involved about 14,700,000 children. And in all that data, they could find no link between vaccines and autism - because there is no link!\n\nAnd another study, no matter how many times you ask for one, isn't going to overcome this massive amount of data.\n\nHumans try to make sense of the world by seeing patterns. When they see a disease or condition that tends to appear around the time a child is a year or so old --as autism does --and that is also the age that kids get particular shots, they want to put those things together. Parents watch their kids more carefully after they get shots; sometimes they pick up on symptoms then. But just because two things happen at the same time doesn't mean that one caused the other. This is why we need careful scientific studies. And as I've outlined here, there have been many, many such studies that have failed to find any real evidence to support the hypothesis that vaccines cause autism.\n\nDon't tell me it's the mercury in thimerosal that's to blame. There has been no thimerosal in infant vaccines since 2003, and autism hasn't disappeared in the last decade.\n\nThis was all because of one paper, a decade and a half ago, that described the beliefs of the parents of eight children with autism. And that's what makes the next part in this all the more tragic.\n\n\n\nThe Tragic Results (5:32)\n\n\n\nIn 2011, the British Medical Journal released an article which described, in detail, how that 1998 Lancet paper wasn't just junk science, it was a lie. It described how the main author --the only who still supports its findings --changed the records, changed the stories and changed the numbers to create the appearance of an association where none existed. The journalist who wrote the BMJ article tracked down the patients in the study, and showed how none of their stories or information matched up to what was published in the final paper. He found that there were discrepancies as to whether the children actually had regressive autism. He found that there were falsifications and other symptoms that were alleged to cause the autism. He even discovered the dates had been changed. \n\nAlthough the Lancet paper alleged that 8 of the 12 patients reported symptoms days after the MMR vaccine, the BMJ investigation confirmed that for almost all of these children, that wasn't the case. And if that wasn't bad enough, it turned out that all of the patients had been recruited by anti-MMR campaigners. The study was also commissioned and paid for by a group that planned litigation against the vaccine manufacturers.\n\n\n\n'A Fraud' (6:38)\n\n\n\nThe British Medical Journal called the original Lancet paper, 'A fraud'. \n\nIt's easy to become cynical about people's loss of trust and understanding in science, to the point that you think it's unlikely that we will ever be able to convince some people that the MMR vaccine is safe. That's a tragedy in and of itself. It's easy to believe that the perpetrator of this fraud will not suffer the repercussions he deserves. Many still continue to lionize him and believe him to be a victim of some powerful cabal.\n\nIt's hard for me to be dispassionate about those who abuse the trust people give physicians. I get even more riled up when someone violates the rules of ethical science. I think it's likely that children have not been given an MMR vaccine because of this fraud. I think it's likely children have gotten sick because of this fraud. I think it's likely some children have died.\n\nI hope we can find some way to change that in the future.\n\n\n\nClosing and Sponsor (7:20)\n\n\n\nThis episode of Healthcare Triage is supported by Audible.com, a leading provider of premium digital spoken audio information and entertainment on the internet. Audible.com allows its users to choose the audio versions of their favorite books with a library of over 150,000 titles. We recommend The Signal and the Noise by Nate Silver, which explains the analysis of data and statistics in an entertaining and informative manner.  It's great; you should go listen to it now.  You can download an audio version of The Signal and the Noise or another of your choice at www.audible.com\/triage \n\n\n \n ","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/o65l1YAVaYc"},{"c_name":"healthcare triage","v_id":"6XDV3IwnF8Q","title":"Trans Fats, Sugary Soda, and Effective Regulation","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nHealthcare Triage #13\n\nWe are seeing a lot of changes recently as to what we are \"allowed\" to eat. When the FDA decided to get rid of trans fats, I applauded. When New York City tried to ban sodas bigger than 16 ounces, though, I booed. Why is this not hypocritical? Watch and find out.\n                                                                                                                                                                 \nMake sure you subscribe above so you don't miss any upcoming episodes!\n\nData for all the things I talk about are here : http:\/\/theincidentaleconomist.com\/wordpress\/healthcare-triage-banning-trans-fats-versus-sodas\/\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1390779686","likes":"2294","duration":"271","transcripttext":"\n\nIntroduction\n\n\n\nRecently the FDA took steps that will eventually lead to the banning of trans fats in food in the United States. I think that's a great idea. Not long ago the city of New York tried to ban sodas of a certain size in restaurants. I think that's a terrible idea. How can both of these things be true? That's the topic of this week's Healthcare Triage.\n\n(Intro)\n\n\n\nGetting Rid of Trans Fats (0:24)\n\n\n\nGetting rid of all trans fats is not a trivial thing. For a long time they existed in many of our processed foods, both because they made foods last longer, and partially because they helped with the taste. Also, not too long ago we thought trans fats were actually healthier for us than more traditional animal fats. Now it turns out that they do make food last longer, and it turns out that they often taste and feel great in your mouth. But they're not healthy.\n\nIn fact, lots of studies have shown that trans fats are significantly more likely to lead to heart disease or even death than other kinds of fats. In 2006 the FDA mandated that all foods now had to print exactly how much trans fats were in each of them. This is because it turned out that the recommended daily amount of them was almost zero, or about two grams per day. Anything above that was considered unsafe, and in fact they got such a bad rap that most restaurants and foods started banning them voluntarily. Today about 75 percent of companies have already removed trans fats from the foods that they produce.\n\nWhat the FDA did recently is decide that companies now have to make a case for including trans fats in the foods that they produce. Given that they are so unhealthy and unnecessary and in fact must be produced in a lab, it's very unlikely that any companies are going to try to do so. \n\nThis will not come free. It's estimated that it will cost somewhere between 12 and 14 billion dollars over the next 20 years to remove trans fats from all the foods we eat. But there's no doubt that it'll make us much healthier. \n\n\n\nWhy Not Ban Sodas? (1:41)\n\n\n\nBut recently, the city of New York tried to ban sodas above 16 ounces in restaurants for the same reason: they think it'll make us healthier. Why isn't that a good idea?\n\nIt's not that they don't have a good case. Sodas can have a lot of sugar in them. A big soda today can have 275 calories or more. In the 1950s the average meal had about seven ounces of soda. Today that same meal might contain 42 ounces of soda.\n\nThis could be one of the reasons why Americans are, on average, about 25 pounds heavier than they were back then.\n\nThe reason I think banning sodas of a certain size is a bad idea is because it's cherry-picking: We've picked one source of sugar delivered one way and decided to restrict that in certain places. But without a holistic way to attack the entire obesity problem, this just doesn't seem to make much sense.\n\nFor instance, the ban applies to restaurants and movie theaters but not to vending machines or supermarkets or convenience stores. Why just that one place ? And why just a 16-ounce size? In other words, if you get a 12-ounce soda which is unlimited and can be refilled as much as you like, that's okay; but having one 16-ounce soda, that's a bad idea.\n\nResearch shows that people might be more likely just to buy two 12-ounce sodas than the one 16-ounce soda they might have gotten, just to make sure that they have 'enough.' In other words, this kind of thing could actually backfire.\n\n\n\nThe Real Problem: Calories (2:55)\n\n\n\nAnd why is it okay to go to the Cheesecake Factory and get a Farmhouse Cheeseburger at 1530 calories and follow it up with a piece of Ultimate Red Velvet Cheesecake for 1540 calories, but you're gonna ban the 250-calorie soda that might come along with it? I mean, in that case you've already consumed 3000 calories before you've touched a french fry, and it had nothing to do with the soda, but that's the only that we're gonna choose to ban.\n\nIt's not just cheap food, either. A Porterhouse at Morton's with mashed potatoes and half a side of creamed spinach has over 2500 calories with 85 grams of saturated fat and almost 3000 milligrams of sodium. That's the same as eight pieces of Original Recipe Kentucky Fried Chicken plus mashed potatoes with gravy, coleslaw, and four biscuits --with an extra one-and-a-half days of fat on the side.\n\n\n\nAlternatives? (3:44)\n\n\n\nNow if you want to come up with some holistic way to try to reduce peoples' calorie consumption overall, maybe I'd be in support of that. If you wanted to find a way to try to attack certain nutrients --say, sugar --by coming up with a tax on sugar, I'd be willing to look at economic analyses to see if that kind of thing would work. But cherry-picking one delivery source of calories while leaving everything else untouched just doesn't seem to make much sense and it isn't going to work.\n\n\n\nConclusion (4:05)\n\n\n\nTrans fats are artificial; they're made in a lab; and adding them to our food has been hurting us. It makes a lot of sense to stop doing that. Banning sodas of a certain size in a certain place is not a holistic solution to the obesity epidemic. It's totally rational to oppose the ban on sodas while supporting the FDA's ban on trans fats, and I'll continue to do so.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/6XDV3IwnF8Q"},{"c_name":"healthcare triage","v_id":"gl5GXArC134","title":"Is Organic Food Better for Your Health?","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nMany of my friends and family will only touch organic food. That's their right, and I don't try to fight with them. I sometimes get uncomfortable, though, when they make claims about organic food that just aren't supported by data and evidence. Moreover, I think arguing with anyone who is attempting to eat more fruits and vegetables that theirs are in some way \"not good enough\" is counter-productive. Watch the video and argue with me in the comments below.\n \nMake sure you subscribe above so you don't miss any upcoming episodes!\n\nHere are references for all the studies I talk about: http:\/\/theincidentaleconomist.com\/wordpress\/?p=53086\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1391383204","likes":"4963","duration":"421","transcripttext":"There's a joke I like to tell, that the difference in places I lived before in Indiana, is that seeing a goat or a chicken used to be a field trip and now it's my commute. Once you get over that, though, one of the perks of living closer to farmland, sometimes even just across the street, is that you have access to amazingly fresh food.\n\nTwo summers ago, we participated in a farm share, where each week we would get a box of organically-raised produce. It's not an understatement to say that this completely redefined the eating habits of my family. We went from a meat-heavy diet to a much more vegetable-oriented one. My wife became much more concerned with how our food was raised and processed, and before long she was near-obsessed with whether our food was organic.\n\nShould she be?\n\nThat's the topic of this week's Healthcare Triage.\n\n[INTRO MUSIC PLAYS]\n\nOrganic food is grown without synthetic pesticides, fertilizers, antibiotics, or hormones. Today it accounts for more than 31 billion dollars in sales a year in the United States. More than four percent of all food sold is organic, and whole industries and companies have grown up around its production and marketing.\n\nMany people have are organic food fans because they think it's healthier than non-organic food. Some think it's more nutritious. Others think that it's safer, as pesticides or other chemicals used in conventional farming are dangerous. They're willing to pay more for organic food. Look, I'm almost hesitant to get into this, because this always, and I mean ALWAYS, results in a flood of hate mail. But here on Healthcare Triage, we rely on research, and research says there's no difference.\n\nThe best and most recent study was published in September of 2012 in the Annals of Internal Medicine. It was a systematic review that collected and analyzed all the studied published in the medical literature published between 1996 and 2009 that compared organic to conventionally-grown food. As you can imagine, there were a lot of studies done over that time. Let's go over them in detail.\n\nThere were 223 studies that compared organic and conventionally grown food for nutrient content and contaminants. 153 looked at fruits, vegetables, and grains, and 71 looked at meats, poultry, and eggs. Seventy percent were from Europe, and twenty-one percent were from the US or Canada.\n\nThere were no significant differences in the vitamin content of organic and conventional plant or animal products. With that many studies, of course, you can cherry pick one or two that might make a food type look better, but overall? No difference.\n\nThey conducted further studies that looked at eleven other nutrients including ascorbic acid, potassium, calcium, phosphorus, magnesium, iron, protein, fiber, quercetin, kaempferol, flavonols, and phenols. They found statistically significant differences in only two.\n\nOne was phosphorous, and was due to one really outlying study, and when they got rid of that study, the significant differences went away. The other was phenols, and was mostly due to two studies that did not report sample size, which is really odd.\n\nSome studies reported that organic milk had more omega 3 fatty acids, but they were pretty much all looking at raw milk, which almost none of us drink. Besides, why are you drinking milk anyway? Is it because the milk industrial complex told you to? You obviously haven't read any of my rants on that, have you?\n\nStan, write it down. We're doing that in a future episode.\n\nAnyway, back to the researchers. They looked at pesticide levels in the two types of food, too. Organic food did have a significantly lower chance of being free of any pesticides at all, which isn't surprising given that they use no pesticides and conventionally raised food does, but when they looked at the studies examining whether the level surpassed maximum allowed safety limits, it turned out that differences were no longer significant.\n\nBacterial contamination with e. coli was found in seven percent of organic food and six percent of conventionally raised food. No significant difference. And when they looked at all the food types, and all the bacteria you can likely imagine, they found no significant differences. There were also no significant differences in contamination with fungal toxins or heavy metals.\n\nBut, look, what we really care about is what happens to actual humans who eat this stuff. Are they healthier? The analysis included seventeen studies examining over 13,800 participants. Two of them looked at pregnant women and children, to see if the type of food they ate changed whether they developed asthma, eczema, wheezing, or other symptoms or markers of atopic disease. It didn't.\n\nEleven more looked at adults who weren't pregnant, and most examined biomarker levels and serum, urine, breast milk, and semen among those who ate organic or conventionally grown food. Overall? Wait for it-! No significant differences.\n\nOnly one study looked at clinical outcomes, though. It found that eating organic meat in the winter actually increased the risk of illness due to campylobacter infection.\n\nThis enormous body of research shows that there just doesn't seem to be any real health benefits or protections from eating organic food. I know lots of you are going to refuse to believe that, but that's what the evidence says.\n\nBut don't take my word for it, listen to a real expert: Norman Borlaug, for those of you who aren't West Wing fans, and, really, what's wrong with you if you're not? He won the Nobel Peace Prize in 1970. Why? Because he arguably saved more lives than any other person in human history for developing disease-resistant, high-yielding plant varieties that saved, like, a billion people from starvation. Towards the end of his career, he argued that there's just no way to feed the world's population without chemical fertilizers and technological advancements. With no proven benefit from organic methods, we're only hurting ourselves and the chance for others to eat cheaply and easily by advocating for them. He called organic food, and I quote, \"Ridiculous.\"\n\nPlease note that I'm not making any arguments here about differences in organic and conventional farming with respect to how they effect the environment, how they treat workers, and how they treat animals. There may be differences there and if you want to make those arguments, fine. But when you talk about nutrition and safety, that's where you're on shaky ground.\n\nMy eating habits changed when we had the farm share because I was eating a wider variety of healthy foods and they tasted good. That's not because of how they were fertilized as much as it was that they were fresh and non-industrial. Once you've tasted a homegrown tomato, the ones you buy in the store are intolerable. They're grown to stay fresh longer and be pretty much indestructible. Tomatoes you grow for yourself are grown to taste awesome even if they're ugly. And better tasting food is more likely to be eaten. That's an argument for organic food that makes sense, but we need to be honest about what it costs.\n\nIt's much more expensive than conventionally grown food, and many people can't afford it. Additionally, as Norman Borlaug said, it's unlikely we could feed everyone using only organic techniques, certainly not without a whole lot more people being forced back into the agricultural sector.\n\nAnd we should not be making any type of fruit or vegetable the enemy, please. Talking anyone who's willing to eat healthy food out of doing so isn't helping the collective waistline, people! I'm for anything that helps us get people worldwide to eat more healthy food and less crappy food. I'm not sure that organic food is the most cost-effective way to do so, but one thing I do know is that it's often being sold as more nutritious and less likely to harm you than conventionally raised food. That's counterproductive, and it's just not true.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/gl5GXArC134"},{"c_name":"healthcare triage","v_id":"Mf82FfX-wuU","title":"Are Artificial Sweeteners Harmful?","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nOur episode on Organic food was a hit, but lots of you had questions in the comments asking about the safety of artificial sweeteners. We live to serve, so this week's episode is about the research in that area. These chemicals get a bad rap, but you might be surprised by what you learn by watching. Send your hate tweets to Aaron. He's used to them.\n \nMake sure you subscribe above so you don't miss any upcoming episodes!\n\nHere are references for all the stuff I talk about: http:\/\/theincidentaleconomist.com\/wordpress\/?p=53215\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1391987280","likes":"3963","duration":"351","transcripttext":"\n\n Introduction \n\n\n\nI've been getting a lot of comments and questions about artificial sweeteners. You wanna know if they're safe, we live to serve. Welcome to Healthcare Triage.\n\n(Intro music plays)\n\nPeople are justifiably suspicious of chemicals. I'm fine with that. But sometimes that suspicion goes to far. Sometimes chemicals, including drugs do some good. There's a definite benefit to artificial sweeteners. Have you seen our collective waistline recently? The important question is are there harms that outweigh the benefit?\n\n\n\n Saccharin (0:32) \n\n\n\nWe have a ton of data on whether artificial sweeteners are harmful. Not all artificial sweeteners are the same. Saccharin is one of the oldest, and made from coal tar according to Mental Floss. There have been more than 50 studies written about the effect of saccharin on rats. About 20 of them were done in rats consuming saccharin for at least one and a half years. 19 of these studies found nothing. One study found an increase rate of bladder cancer, but it was in a type of rat that gets easily infected with a bladder parasite that can leave it more susceptible to cancer.\n\n Scientists then moved on to see if giving saccharin to two generations of rats would do anything. They fed rats and then their rat children lots and lots of saccharin. They found that male rats in the second generation got more bladder cancer. Because of this some countries banned saccharin and others, like the United States, started labeling products with warnings. There was one problem. The link between saccharin and cancer couldn't be found in humans. Ironically, later work found that often, cancer induced in rats doesn't equal cancer in humans. For instance, if you give rats vitamin C in the same dose as saccharin in similar studies, that causes bladder cancer in rats too, yet no one attempts to ban vitamin C. There's no real evidence, even in the animal models, that saccharin is dangerous.  \n\n\n\n Cyclamate (1:48) \n\n                 \n\nCyclamate was approved by the FDA for use in the United States in 1950. Almost 20 years later, a landmark study found that cyclamate increased the rate of, wait for it, bladder cancer in rats. This led to it being banned in a number of countries. Later the ban was lifted pretty much everywhere except for the US. Always with the rats and their cancerous bladders. But in one of those studies you can't believe they actually did, some scientists fed thirty-seven monkeys either no cyclamate, 100mg per kilogram of cyclamate, or 500 mg of cyclamate everyday for twenty-four years.\n\nBy the way, 500 mg per kilogram is like drinking thirty cans of diet soda a day for twenty-four years.\n\nAt the end of the study they killed the remaining monkeys and autopsied them. Three animals in the cyclamate receiving group had cancers,  but they were different types of cancer in different parts of the body and they were common cancers in monkeys.\n\nTheir conclusion was that there was no apparent risk in consuming that much cyclamate. Did that change our policy? Of course not.\n\n\n\nAspartame (02:50)\n\n\nThis brings us to aspartame. Today, this seems to be the sweetener of choice when discussing harms. Approved for use in 1981, it took until 1996 for panic to set in. In that year a paper was published that got a lot of attention. It discussed the fact that there had been a recent increase in the incidents of brain tumors and questioned whether this could be linked to aspartame. As usually happens with these kinds of things, the media had a field day.\n\nBut here's the thing, further investigations with national cancer institute statistics showed that brain cancer began in 1973; eight years before aspartame was introduced. Also most of the increases in people with brain tumors were seen in people over seventy, who are not huge consumers of diet soda. As with vaccines and autism, once the myth is out there, it's really hard to beat it down.\n\nA double- blinded, randomized, controlled trial of self- reported \"aspartame sensitive people\" showed that aspartame didn't cause headaches. A similar study showed that it didn't affect memory, behavior, mood, or even EEG changes. Another study, published in 2006, followed more than 285,000 men and almost 190,000 women and couldn't detect any relationship between aspartame and brain or blood cancer.\n\nAnd don't bring up methanol and artificially sweetened beverages either. Analyses show that there is more methanol in a glass of tomato juice or in fruits and vegetables than there is in diet soda. Some people find diet beverages distasteful for other reasons.\n\n\n\nOther Reasons (4:13)\n\n\nA few studies have shown that drinking artificially sweetened beverages doesn't promote weight loss, or even promotes weight gain. More often than not, this is because people end up over-compensating for calorie savings they think they're getting for switching beverages. Think of the person who orders dessert as a reward for having diet soda. But in those cases, it's not the diet beverage that caused weight gain; it's the dieter's behavior. You can even find people who postulate that artificially sweetened beverages trick the brain into wanting more calories, but there's really no proof of that.\n\nFinally, some will claim that diet drinks will cause the brain to release insulin, which can change your metabolism and make you hungry. That's a bit hard to swallow. That's like saying if you eat sugared, dense food that tasted terrible, it would trick your brain into not releasing insulin. That doesn't happen, of course. It's the pancreas that releases insulin, anyway, not the brain.\n\n\n\nBottom Line (05:00)\n\n\nThe bottom line is that artificially sweetened beverages are safe. That doesn't mean you should tons of them. My wife and I limit our kids consumption's of soda to caffeine-free, diet types, but we don't let our children drink them everyday. We stress moderation in everything, including such drinks. A study published just a short while ago in JAMA Internal Medicine found that the added sugar from drinking just one extra 20 ounce Mountain Dew a day is associated with a significantly increased risk of cardiovascular disease.\n\nWe shouldn't make the perfect the enemy of the good. Given a choice between a sugared soda and a sugar free soda, I'd chose the latter every time. There's an abundance of evidence that an overconsumption of sugar is contributing to health problems. There's a lack of evidence that artificial sweeteners are doing the same thing.            \n ","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/Mf82FfX-wuU"},{"c_name":"healthcare triage","v_id":"yN-MkRcOJjY","title":"The Healthcare System of the United States","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nWe've been getting a lot of requests to talk about the health care systems of different countries. It's really hard to compress the complexities of each into an episode, but we're going to try. First up is the United States. Others will follow, including next week.  \n \nMake sure you subscribe above so you don't miss any upcoming episodes!\n\nHere are references for all the stuff I talk about:\nJohn's video on health care costs: http:\/\/www.youtube.com\/watch?v=qSjGouBmo0M\nAaron's series on costs: http:\/\/theincidentaleconomist.com\/wordpress\/what-makes-the-us-health-care-system-so-expensive-introduction\/\nAaron's series on quality: http:\/\/theincidentaleconomist.com\/wordpress\/how-do-we-rate-the-quality-of-the-us-health-care-system-introduction\/\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1392660489","likes":"2482","duration":"456","transcripttext":"\n\n Introduction \n\n\n\nWhenever I talk about health policy, especially as we try to reform it here in the United States, I get a lot of requests to talk about how exactly health care works in different countries. Lots of countries. It's not that I don't think these are great questions, I do! It's that summarizing a health care system in just a few minutes isn't easy. But we don't shirk from difficult tasks here so we're gonna start tackling countries one by one starting with the United States, here on Healthcare Triage.\n\n(Intro music plays)    \n\n\n\n\n How the system is paid for (0:30) \n\n\n\n(Star Spangled Banner plays)\n\nThe United States health care system is similar to that of many other countries in that it's a mixture of both private and public components. Lets start with the easy stuff. Almost all care is provided for by the private sector, although some hospitals are run by the government, most are run by private organizations. About 70 percent of hospitals are non-profit, leaving the rest in for-profit hands. Most physicians therefore also work for private organizations and are not employed by the public sector.\n\nOther components of the health care system are also in the private sector, including pharmaceutical and medical device companies. Research is paid for by both private and public sources, with a little bit more coming from the private side. Added together however, US spending on medical research counts for the vast majority of R&D spending in the world.   \n\n\n\n How the system works (1:16) \n\n   \n\nBut where countries differ the most is in how they give citizens access to their systems. In this area, the United States is somewhat of an anachronism. Until recently, about 15 percent of people in the United States were uninsured. This meant that if they needed care, they'd have to pay for it out of their own pocket, and unless you've been living under a rock, you should know that health care in the United States is really, really expensive.\n\nSo that's a problem - it means that a lot of people don't get the care they need, and it means that we're failing a large number of people who live in the United States. About 60 percent of US citizens get health insurance from their employer. These plans usually don't charge people different amounts based upon factors such as age, gender or past medical history. They range in benefits, but for the most part they cover preventive care, care if you get sick, and prescription drugs.\n\nPlans vary in terms of how much people have to pay out of pocket for them... but we already did a video on how private insurance works, and you really should have watched that already.\n\n\n\n Medicare (2:07) \n\n   \n\nAbout 15 percent of Americans are covered by Medicare, and most of them are elderly people. Medicare is a national social insurance program, run and administered by the federal government. It's the closest thing we have to what most people refer to as a single-payer system, where all people are covered by one type of insurance.\n\nBut Medicare's pretty complicated:\n\nFirst, there's Medicare Part A, which covers you if you're hospitalized. It's pretty much free to most people over the age of 65, and almost no one doesn't get it.\n\nMedicare Part B covers outpatient services, and is sometimes deferred by people who are still getting insurance from their jobs. It has a pretty low deductible, and then has co-insurance of 20%. It covers tons of stuff, including pretty much all tests and procedures you might get outside the hospital, as well as lots of medical equipment that you might use.\n\nThere are private, supplemental Medigap policies that are offered by private companies, that often cover the co-pays or co-insurance, or add in extra benefits. Almost everyone buys one of these, too, so that elderly individuals wind up paying much less for their health care than you'd expect.\n\nMedicare Part C, or Medicare Advantage, is an opportunity for private companies to offer Medicare-like benefits better than the government can. If they do, and they do it for less money, they keep to keep the extra in profit. Medicare beneficiaries can opt into Medicare Advantage plans instead of traditional Medicare. They sometimes have different benefit that appeal to them, and about a quarter of them choose such a plan now.\n\nAnd Medicare Part D contains the prescription drug plans. They're actually designed and run by private insurance companies, but they're approved and paid for by the federal government. Individual Medicare beneficiaries pick the Part D plan they like, depending on what drugs they think they might need.\n\nThat's Medicare. Costs us about $536 billion last year.\n\n\n\n Medicaid and other government programs (3:46) \n\n   \n\nThe other big government program is Medicaid. Unlike Medicare, Medicaid is a state-based program. Basically, it's supposed to provide health care coverage for the poorest among us. There are some minimal federal guidelines that are set for Medicaid, and then each state gets to implement it as it sees fit.\n\nSome states are more generous, and some, less so. Generally, Medicaid is meant to cover those at the low end of the socioeconomic spectrum. The government defines \"poor\" this way. While you look at that, remember this amazing fact: A single parent with a child who makes minimum wage earns more than the poverty level. That's how low the line is.\n\nRegardless, traditional Medicaid must cover:Kids under 6 years of age to 133% of the poverty line, and kids 6 to 18, to 100% of the poverty line.The States Children's Health Insurance Plan, or SCHIP, ups this to about 300% of the poverty line in most states.Medicaid also covers pregnant women, up to 133% of the poverty line,and parents fo 1996 welfare levels.Finally, it covers the elderly and those with disabilities, who receive supplemental security income.The first important thing to note is that adults without children aren't mentioned at all! And in most states, they can't get Medicaid. Let me say that again: in most states, even the poorest adults without children - even those who make nothing at all - don't get Medicaid!\n\nAnd it gets worse: those 1996 welfare levels can be super-low. So low that, for instance, in Arkansas, a couple with two children making $3,820 a year is too rich for Medicaid. Granted, some states are more generous, but in many of them, parents have to be very, very poor in order to get Medicaid.\n\nThe Medicaid expansion in the Affordable Care Act was supposed to fix this. It was supposed to give Medicaid to everyone who makes less than 138% of the poverty line, regardless of whether or not they have kids. It would have finally made Medicaid the universal program for the poor, that many already believe it to be.\n\nBut because of the Supreme Court decision that made the Medicaid expansion optional, lots of states are refusing it, leaving an addition 5 million people with low incomes with no insurance this year.\n\nIn 2009, Medicaid covered more than 60 million Americans, about 1 in 3 children are covered by Medicaid, and 1 in 3 births is covered by Medicaid. A lot of Americans are in poverty. In 2011, Medicaid cost us about $414 billion.\n\nThere's also the Veteran's Health Administration, which is totally a government-run system, that provides care to veterans, and Tri-Care the military health insurance program that applies to some veterans, military personnel and retirees, and dependents. Tri-Care works more like a private insurance.\n\nThink that sounds complicated? It is!\n\n\n\n Costs (6:17) \n\n   \n\nInterestingly, while about two-thirds or so of people get insurance from private companies, only about one-third of spending comes from the private sector. In other words, the government has to cover about one-third of people in the United States, but has to pay about two-thirds of the bill. Tell me again how the government isn't getting the short end of the stick.\n\nThe money involved in health care in the United States is simply unbelievable! You may remember this video of John's, which talks about how out-of-control our spending is. Go watch it again. It's based in part in a series I did on my blog, and the link for that is in the video info section below.\n\nI've also added a link to a series on quality in our system, which is, well, not what you'd hope for, given all that spending.\n\n\n\n Obamacare - Conclusion (6:57) \n\n   \n\nObamacare will change some of what I said, but not by much. Basically, we hope to get some people who didn't get insurance through their jobs, Medicaid, or community-rated, guaranteed-issue insurance like employed people get.\n\nWith respect to the Affordable Care Act, we're only talking about 30 million people or so, or about 10% of our population. And for more info on that, go watch our first episode.\n\nSo that's the U.S. health care system, as neatly packaged as I can make it in under 10 minutes. It's private insurance for most, Medicare and Medicaid for some, and VA or Tri-Care for a few.\n\nHow does this compare to other countries? Keep watching future episodes to find out.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/yN-MkRcOJjY"},{"c_name":"healthcare triage","v_id":"1TPr3h-UDA0","title":"Canada's Healthcare System Explained!","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nLast week we discussed the United States health care system. This week we discuss Canada's. We also take some time to bust some myths about their single payer health care system. Fight about it in the comments below.\n\nMake sure you subscribe above so you don't miss any upcoming episodes!\n\nReferences for a lot of the \"myths\" about Canada can be found here: http:\/\/theincidentaleconomist.com\/wordpress\/in-defense-of-canada\/\nAaron's series on quality is here: http:\/\/theincidentaleconomist.com\/wordpress\/how-do-we-rate-the-quality-of-the-us-health-care-system-introduction\/\nCanadian wait time data is here: http:\/\/www.hc-sc.gc.ca\/hcs-sss\/qual\/acces\/prov-eng.php\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1393195074","likes":"3829","duration":"445","transcripttext":"\n\nIntroduction\n\n\n\nIt's never been clear to me why so many people in the United States are so worried about the healthcare system in Canada. Sure, they have a single-payer system, but we sort of do too. Both their system and ours are called Medicare! The biggest difference is that theirs covers everyone, and ours only covers the elderly.\n\nHere in the United States, single-payer healthcare is as American as apple pie if you're over 65, but a communistic tyrannical end to freedom if you're 64. Canada, however, has no such problem. They're all in for Medicare. And their system is the topic of this week's Healthcare Triage.\n\n[intro plays]\n\n\n\nAbout the Canadian Healthcare system (0:41)\n\n\n\nPretty much all Canadians receive their healthcare coverage through public funding, with spending decisions made at the province level. Most healthcare is free to those who use it, with no money out of pocket. Medically necessary care is covered, including maternity care and infertility treatments. The government pays for about 70% of total healthcare spending. The other 30% is private spending. Most of that is for drugs, dentists, and optometry, which aren't covered by the government program. Most Canadians buy supplemental private insurance through their jobs to cover the cost of things not covered by their Medicare. \n\nMost hospitals are publicly funded, and they're required to operate under a fixed budget. This is one of the ways that Canada controls its healthcare spending. But most family physicians are private, and most actually operate on a fee-for-service basis. This is what makes them a single-payer system but not a socialized medicine system. Public spending but private delivery system. And doctors do pretty well there; in 2012, the average doctor's income before taxes was about 225,000 Canadian dollars. Generalists make a bit less. Specialists make a bit more. Canada negotiates at a federal level for its drugs; this is another way that it controls spending. \n\n\n\nWaiting Times (1:48)\n\n\n\nCanada has somewhat of a reputation for wait times. There are days when it feels like everyone I talk to knows someone who's just been screwed by the Canadian healthcare system. Data, however, don't support this assertion. Canada's quite good about being transparent about its wait times. You, and I mean any of you, can go to official websites and see the average wait times for all kinds of things, just by using the internet. Go ahead, give it a try! We put a link in the video info below. By the way, I challenge you to try to find out this kind of information in the United States. Most people just assume the US is better, when it's often not.\n\nMoreover, most of the wait times in Canada are for things that are elective. They may be longer than some would like, but they're not in any way life-threatening. \n\nBut why are there wait times at all? Because limiting supply is cost-effective. Canada spends remarkably little on healthcare, which leaves the country lots of money to spend on other things. They also focus more on outcomes that matter to health, and less on process measures, like \"how fast can you get an optional MRI\" than other countries do. And if Canadians really cared en masse about fixing these things, they would do so. I encourage you to go read my series on quality again; link in the video info section. See how Canada really compares to other countries. You might be surprised. \n\n\n\nMyth 1 about the Canadian Healthcare System (2:59)\n\n\n\nWhile I have your attention though, let's go over some myths about the Canadian healthcare system.\n\nOne: Doctors in Canada are flocking to the United States to practice. Every time I talk about healthcare policy with physicians, one inevitably tells me the doctor he or she knows who ran away from Canada to practice in the United States. Evidently there's a general perception that practicing in the United States is much more satisfying than countries such as Canada. \n\nSurvey after survey shows us that's not the case. Docs in Canada like working there much more than doctors like working here. There are data on immigration. The Canadian Institute for Health Information keeps track of doctors moving in and out of Canada. When emigration spiked, 400-500 doctors were leaving Canada for the United States in a year. There are more than 800,000 physicians in the US right now, so I'm skeptical that every doctor who claims to know one of these \u00e9migr\u00e9's actually does.\n\nBut it turns out that in 2003, net emigration became net immigration into Canada. Let me say that again. More doctors were moving into Canada than were moving out. \n\n\n\nMyth 2 (3:58)\n\nTwo: Canadians flock to the United States to get care. Many people in the United States believe that people in Canada, frustrated by wait times and rationing, come to the United States for care. These are almost always anecdotal stories and you should know by now how much stock I put in anecdotes. As always, when we can, we should turn to evidence and research.\n\nAnd on this topic, it does exist. The most comprehensive work I've seen on this topic was published in a manuscript in the peer reviewed journal \"Health Affairs\". That study looked at how Canadians crossed the border for care, and the authors used a number of different methods to try and answer the question.\n\nFirst, they surveyed United States border facilities, in Michigan, New York, and Washington. It makes sense that Canadians crossing the border for care would favor sites close by, right? It turns out that about 80% of such facilities saw fewer than one Canadian per month. About 40% saw none in the prior year. And when looking at the reasons for visits, more than 80% were emergencies or urgent visits. In other words, tourists who had to go to the emergency room for a broken leg or something. Only about 19% of those already few visits were for elective purposes.\n\nNext, they surveyed America's best hospitals, because if Canadians were gonna travel for care, they'd be more likely to go to the most well-known and highest quality facilities, right? Only one of the surveyed hospitals saw more than 60 Canadians in one year. And again, that included both emergencies and elective care.\n\nFinally, they examined data from the 1800 Canadians who participated in the national population health survey. In the previous year, only 90 of those 1800 Canadians had received care in the United States. Only 20 of them had done so electively. \n\nLook, I'm not denying that some people with means might come to the United States for care. If I needed a heart-lung transplant there's no place I'd rather be. But for the vast, vast majority of people, that's not happening. You shouldn't use the anecdote describing these things at a population level. This study showed three different methodologies, all with solid rationales behind them, all showing that this meme is mostly apocryphal. Maybe that's why the manuscript was titled \"Phantoms in the Snow\".\n\n\n\nMyth 3 (6:00)\n\n\n\nThree: Canada has longer wait times because they're a single payer system. When people wanna demonize single payer systems like Canada, they always wind up going after rationing, and more often than you'd think, they talk about things like hip replacements or cataract surgeries. Stories about rationing aren't true. Canadian doctors don't deny hip replacements to the elderly. But there's more.\n\nDo you know who gets most of the hip replacements in the United States? The elderly! Do you know who pays for care for the elderly in the United States? Medicare. Do you know what Medicare is? A single payer system.\n\nCanada isn't some dictatorship. They aren't oppressed. In 1966, the democratically elected government enacted their single payer system. Since then, as a country, they've made a conscious decision to hold down spending. One of the ways they do that is by limiting supply, mostly for elective things, which can create wait times. Their outcomes are otherwise comparable to ours. Please understand: the wait times can be overcome! They could spend more! They don't want to. We can choose to dislike wait times in principle, but they're a by-product of Canada's choice to be fiscally conservative. They chose this.\n\nThose in the United States who are concerned about healthcare spending and what it means to the economy might respect that course of action, but instead, we attack. That's our problem, not theirs.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/1TPr3h-UDA0"},{"c_name":"healthcare triage","v_id":"zoW8PSGPzAo","title":"What Kills Us? How We Understand Risk.","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nOne of the things that baffles me about people is how they completely misunderstand risk. Lots of my friends panic about things that have no real chance of killing them, but ignore the things that will. This can lead us to make irrational decisions, and sometimes irrational policy. What really will kill us? Watch and learn.\n \nMake sure you subscribe above so you don't miss any upcoming episodes!\n\nReferences can be found here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=53600\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1393799401","likes":"3195","duration":"376","transcripttext":"Quick, what\u2019s the number one killer of women in the United States? Did you say breast cancer? You\u2019re not even close. What\u2019s the number one killer of men? What about kids? The point here is that we as a people have no idea what\u2019s gonna kill us. We\u2019re afraid of things that have only a slim chance of hurting us and we ignore the real dangers. That\u2019s the topic of this week\u2019s Healthcare Triage.\n\n(Intro)\n\nIn 2001, The American Academy of Pediatrics issued a policy statement that recommended that all kids less than two years of age sit in safety seats on airplanes, like they do in cars. This was a real problem for a lot of parents. You see, for those of you who don\u2019t have kids, up until a child is two years old, they can ride in your lap on a plane. And you don\u2019t have to buy them their own seat. While this may sound uncomfortable, I know any number of people including yours truly, who have flown holding an infant in their laps. When our first child was born, I was a fellow and my wife wasn\u2019t working, so traveling to see family was a luxury. We couldn\u2019t easily afford that extra ticket.\n\nBut the AAP wanted the FAA to require children to be restrained on aircraft. They also wanted me, as a parent, to buy a seat for my child. Finally, they informed me as a pediatrician, that it was my duty to tell all of my patients\u2019 parents about this. Lots of people supported the AAP in this endeavor. They were scared to death of flying. They figured that if we were worried about protecting kids in cars, we damn well better protect them in airplanes.\n\nBut that fear of plane crashes is somewhat irrational. How much good would this policy actually do? Some enterprising researchers crunched the numbers and gave us more exact figures. They performed an econometric analysis to see what would happen if the FAA changed its rules. Here\u2019s the first bit of awesomeness. The recommended policy would likely prevent about 0.4 child air crash deaths per year in the United States. Got that? Less than one child\u2019s life might be saved in a whole year.\n\nNow you may be thinking that this is still worth it. After all that child might be someone you know. There\u2019s a problem though. If you make people buy seats for their children, they may not be able to afford to fly. Instead they might choose to drive. And driving is way more dangerous than flying. Driving is so unsafe that it turned out that this policy would increase the number of child deaths, if somewhere between five percent and ten percent of families decided to make a trip by car instead of by plane. Of course this calculation varied by the distance being driven, with longer trips incurring more car related danger. But if the average trip was 400 miles, and if just five percent of families chose to drive instead of fly, this policy would result in an increase in child deaths. Not so clear any more, is it?\n\nMoreover this doesn\u2019t take into account the cost of the policy. Lets say for the sake of argument that no families whatsoever would convert to a road trip. That\u2019s not realistic, but go with it for a second. This means that we\u2019d actually save lives under the mandatory restraint policy. Let\u2019s also stipulate that the average cost of the policy would be about $200 for a seat for each small child flying. Sound OK? Under these simple and reasonable assumptions, the cost per each child death prevented would be 1.3 billion dollars. If you want to be precise, it was calculated to be $1,283,594,063. For comparison that\u2019s about 33,000 times more per life year saved than the policies that mandate restraint in cars. It\u2019s also pretty much the most expensive injury prevention policy imaginable.\n\nAll this because people panic about flying in a plane. They have no fear of driving though. Car accidents killed 895 five to fourteen year olds in 2010. Accidents in general killed more than 1,600 kids, which is more than were killed by all cancer, congenital malformations, suicide and homicide combined. Want to save kids\u2019 lives? Prevent accidents, including car accidents.\n\nSo let\u2019s move on. What\u2019s the number two killer of kids and young adults aged 10 to 24? Ready? Suicide. You\u2019d never know it by the way we minimize the importance of mental health. Close behind suicide is homicide. Think we\u2019re doing a lot about that? Suicide and homicide each kill more than twice as many in this age group as cancer.\n\nBut most deaths occur in adults, so let\u2019s talk about them. The number one killer of people overall in the United States is heart disease. Heart disease kills more people than all cancers combined. It kills more than four times as many people as respiratory diseases, and almost five times as many people as strokes. It\u2019s heart disease, heart disease, heart disease. I know women are scared to death of breast cancer, but heart disease kills more women than all cancers combined. Breast cancer isn\u2019t even the biggest cancer killer in women. In 2014 it\u2019s expected that more than 72,000 women will die of lung cancer compared to only 40,000 from breast cancer. More than 300,000 women will die from heart disease.\n\nMen are no better. They\u2019re all panicked about prostrate cancer. And it\u2019s expected that less than 30,000 men will die of prostrate cancer this year. Almost that many will die of colon and rectal cancer. Compare that to the more than 86,000 men that will die from lung cancer, or the more than 300,000 that will die from heart disease.\n\nThe tragedy here is that a lot of heart disease is preventable. We know what to do. A great deal of lung disease is preventable too if people would stop smoking. Breast cancer and prostrate cancer, there\u2019s not nearly as much you can do. We obsess over organic food and artificial sweeteners and terrorist attacks and germs and whether cell phones will give us cancer. They won\u2019t. And I\u2019d wager tons of lives have been saved because they\u2019re available to quickly get help in emergencies.\n\nYou know what kills adults? Heart disease. Wanna make that better? Take care of yourself, exercise and eat better. If you have to focus on cancer, then recognize that lung cancer is still far and away the biggest problem we face. You know what kills kids? Accidents. Then suicides, then homicides. Want to really make a difference in kids\u2019 lives? Make those things more rare. We have the ability to act rationally. That will mean giving up our biases and refusing to fall prey to media campaigns and fads. We can do better.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/zoW8PSGPzAo"},{"c_name":"healthcare triage","v_id":"FS3LcIURelY","title":"How Much Good Is Antibacterial Soap Doing You?","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nThis episode of Healthcare Triage is brought to you by Audible.com, the leading provider of audio books and spoken word entertainment on the internet. You can download a free book of your choice at http:\/\/www.audible.com\/triage.\n\nIf something has a benefit, and no harms, then you should likely use it. But if something has no benefits, and potentially real harms, then you shouldn't. The latter is the case with antibacterial soap. Although the stuff is ubiquitous, there's tons of data showing it doesn't do what it's supposed to, while possibly damaging us and the environment. Watch this week's episode to learn about the difference between efficacy and effectiveness, why bacterial counts really don't matter here, and why the FDA made the right call. Then, as always, feel free to attack Aaron in comments or on Twitter.\n \nMake sure you subscribe above so you don't miss any upcoming episodes!\n\nReferences can be found here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=53849\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1394401798","likes":"2560","duration":"307","transcripttext":"Whenever anyone asks me about a health related decision, my answer\u2019s always the same.  Weigh the benefits against the harms.  If there are tons of benefits and almost no harms, you should likely do it.  If there are some benefits and some harms, then it\u2019s a harder choice.  If however, there are almost no benefits and harms, then it\u2019s a no-brainer.  Don\u2019t do it.  But more often than you'd think, we\u2019re doing stuff in that last category.  A recent example is the use of antibacterial soaps.  That\u2019s the topic of this week's Healthcare Triage.\n\n(intro)\n\nLet\u2019s start with the benefits.  People use antibacterial soaps because they think they\u2019ll prevent more disease and make them healthier.  Is this true?  To the research!\n\nIn 2007 a nice systematic review was published in the Journal of Clinical Infectious Diseases, that looked at all studies that were published in the medical literature published between 1980 and 2006.  Twenty seven of them met the criteria for this review.  Four of them were community based randomized control trials.  These studies included children, and they all had outcomes we should care about, like cough, fever, diarrhea and skin infections.  And, wait for it, the use of antibacterial soap did nothing to prevent anyone from getting these illnesses above the use of plain old soap.\n\nThis is what we call effectiveness, which is a term that describes how well things work in the real world.  Nine other studies looked at efficacy, which is a term that\u2019s used to describe how well things work in ideal conditions like the lab.\n\nThese studies measured how many bacteria were on people\u2019s hands, both before and after using antibacterial soap or plain old soap.  Some of them, not all, did find that bacterial counts were reduced with antibacterial soap.  All of them studied soaps with higher antibacterial content than is normally available.  Some of them required participants to wash their hands multiple times.  A couple required them to wash their hands for at least 30 seconds, and one found that the reduction of bacteria was only seen after getting people to wash their hands 18 times a day, for 30 seconds each, for five consecutive days.  No one does that.\n\nThe antibacterial industry will dispute this.  They sometimes point to a metanalysis published in the Journal of Food Protection in 2011.  They found 25 different studies which had a whopping 374 observations included in them.  Can you tell I\u2019m unimpressed?  Most of these studies  had fewer than 15 participants.  The outcome in them was again, the number of bacterial colonies on people\u2019s hands.\n\nYou have to remember that here in the real world most communicable diseases are due to viruses, not bacteria.  So all this laboratory focus on bacteria count seems beside the point.  And out here in the real world, it turns out that antibacterial soaps don\u2019t prevent you from getting disease or keep you healthy.  So overall, no real benefits.\n\nNow let\u2019s look at the harms.  That 2007 systematic review found 11 studies examining how antibacterial soaps affect an emerging resistance in bacteria.  In the lab, they found that the use of these soaps did appear to increase the number of antibiotic resistant bacteria found.  Unfortunately though these studies appear to be underpowered, the trends did look worrisome.  Even the possibility that we\u2019re creating resistance is a problem though.  We can\u2019t conclusively say that it\u2019s happening because of these studies but it\u2019s such an issue that you need a really, really good reason to risk it.\n\nThere are animal studies that show the risks of antibacterial ingredients interfering with the endocrine system.  None in humans though.  But there are studies in humans that have found an association between the use of  antibacterial ingredients and allergies and hay fever.  This stuff gets into our water, and horrifyingly into animals in the water too.  \n\nSo what we have here is almost no evidence that things do what they\u2019re supposed to, prevent communicable illnesses.  We have some evidence or at least concerns, that they do harm.  When something has no benefit and even potential harm, you don\u2019t do it.  That\u2019s what\u2019s going on here.  That\u2019s why the FDA recently moved to change its policy to require manufacturers to prove that antibacterial components work and are safe, if they want to keep using them.  That\u2019s not likely to occur.  As a side note, the FDA first proposed removing antibacterial components in 1978.  It only took them this long to act on it.  \n\nThis isn\u2019t to say that good hand hygiene isn\u2019t important.  A systematic review published in the American Journal of Public Health found that teaching people about hand hygiene and getting them to wash their hands, significantly reduced the risks of getting a gastrointestinal or respiratory illness.  Hand washing works.  They also found that using antibacterial soap didn\u2019t do much at all above plain old soap.  Antibacterial soaps, no benefit, potential or real harm.  No-brainer. Stop using them.\n\nThis episode of Healthcare Triage  is supported by Audible.com, a leading provider of premium digital spoken audio information and entertainment on the internet.  Audible.com allows the users to choose the audio versions of their favorite books, with a library of over 150,000 titles.  We recommend, \u201cEverything Bad is Good for You\u201d by Steven Johnson.  It fits very well with our episode on how the sky isn\u2019t falling.  You can download a free audio version of \u201cEverything Bad is Good for You\u201d or another of your choice at audible.com\/triage.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/FS3LcIURelY"},{"c_name":"healthcare triage","v_id":"1haLoJpUNdw","title":"Five Second Rule Debunked!","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nDoes anyone really think there's something magical about five seconds when it comes to food and the floor? There's a press release out this week (I still can't find the study) that claims that the five second rule is \"real\". It isn't. If bacteria are going to transfer, they do it fast. Plus, there is no evidence at all that actual health is affected by the time food sits on the floor. Watch Aaron recoil at both bologna and the mangling of science in this week's episode.\n \nMake sure you subscribe above so you don't miss any upcoming episodes!\n\nReferences can be found here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=54051\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1394996460","likes":"1669","duration":"299","transcripttext":"(Aaron drops piece of food)\n\nAaron Carroll: One, two, three, four, five.  Some people would have you believe that this food is safe, but that food is not, all because of some arbitrary five second rule.  Now I'm not gonna eat this, because that floor is gross and bologna is gross and because of science, because the five second rule isn't real.  This is Healthcare Triage.\n\n(Healthcare Triage intro plays)\n\nSo evidently there's a new study out of Aston University in the United Kingdom claiming that the five second rule is true.  They claim that students examined how e.coli and staph aureus move from carpet, laminate, and tiled surfaces to toast, pasta, biscuits, and sticky sweets.  When they were in contact from three to 30 seconds.  They claim that time is a significant factor and how much bacteria transfer when food is in contact with the floor and that how long it's in contact is related to how much bacteria move.  \n\nWhere to start with this?  First of all, I've scoured the internet, and I can't find the actual study results.  I can find a press release from Aston University's School of Life and Health Sciences, but I can't find the actual study.  I can't examine the methods, I can't see what statistical tests they performed, I can't tell if the results are clinically significant.  To be honest, I'm somewhat appalled that without this, the media ran it so heavily.  Almost every single major media outlet reported on this breathlessly.  I'm especially skeptical because good research already exists on this subject.\n\nJillian Clark won the public health Ignoble Award in 2004 at Harvard University for her work showing that many foods were significantly contaminated with e.coli after brief contact with tile.  She also found that floors were, in general, rarely contaminated with bacteria, but the main take-home point here is that there's no magic about five seconds--food either got contaminated or it didn't.  But there's an actual peer reviewed study on the subject, published in The Journal of Applied Microbiology in 2007.  Food scientists conducted three experiments to find out what happens when the five second rule comes up against salmonella, a fairly common but nasty bacterium that can cause vomiting and diarrhea.  First, they tested how well salmonella survived on various surfaces.  They found the bacteria were still alive after four weeks on dry wood, tile, or carpet, and enough of the bacteria survived to be able to transfer it to food.  Next, they tested how much time it took for the bacteria to transfer from these different floor surfaces to bologna or bread.  Over 99% of the bacterial cells transferred from the tile to the bologna after just five seconds of the bologna hitting the floor.  Transfer from wood was a bit slower, up to 68% of the bacteria were transferred, and transfer from carpet was actually pretty rare, with less than half of a percent of bacteria transferring to bologna.  When bacteria did transfer, they moved to the food almost immediately upon contact.  By five seconds, it was way too late.  Of course, in all these cases, the bologna was unfit to eat before it hit the floor, because bologna is gross.  \n\nOther bacteria, like campylobacter and salmonella, can survive well on formica, tile, stainless steel, wood, and cotton cloths.  If you listen to microbiologists, you can never be too careful about cleaning things up in the kitchen, and you also can't trust the five second rule.  Bacteria that can make you sick can survive on the floor or other surfaces for a long time, and they can contaminate other foods that touch them for only just a few seconds.  \n\nBut bacteria aren't the only thing that can make you sick when food hits the floor.  Another peer reviewed study of pesticides was published in the Journal of Exposure Analysis and Environmental Epidemiology in 2003.  They found that toxic chemicals can transfer to foods like apples, cheese, and of course, bologna.  Pesticides do seem to take a little longer to transfer than bacteria though.  The average pesticide was only one percent efficient in transferring over to the food at the one minute mark, but up to 83% transferred if it was left on the floor for 60 minutes.  Don't try to invoke the one hour rule.  \n\nApplying more force to the food, like throwing it against the floor, also resulted in more pesticide getting on the food--up to 70% at ten minutes on hardwood flooring when bologna was squished with a 1500 gram force.  But again, no magic with five seconds--either stuff transfers or it doesn't.  \n\nLet me say that I'm not suggesting that you should panic about food that hits the floor, to be honest, I'm not terribly squeamish about eating food that's fallen, the human body is pretty good at fighting off a lot of germs, but what I hope you'll stop doing is believing that there's some protective effect of time.  No one is studying the clinical effectiveness of this--they're only studying efficacy, bacteria counts (as we discussed in our episode on antibacterial soap), there's no proof, none, that you're less likely to get sick if you get to the food in any amount of time.  If you don't think the floor is safe, then don't eat any food that hits it, no matter how fast you get to it.  If you don't care about the floor, then don't rush, 10 seconds is really no worse than five.  ","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/1haLoJpUNdw"},{"c_name":"healthcare triage","v_id":"hzyFZcuHmeI","title":"The Milk-Industrial Complex: Why You Don't Need to Drink Milk","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nReaders of Aaron's blog know of his beef with the milk industrial complex. Why does milk, of all beverages, get a pass in our efforts to reduce everyone's caloric intake? Why is it encouraged, when all others are shunned? Is it because you need the calcium? Is it because it makes your bones stronger? Watch, and learn why the milk emperor has no clothes.\n \nMake sure you subscribe above so you don't miss any upcoming episodes!\n\nReferences can be found here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=54205\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1395605666","likes":"6460","duration":"315","transcripttext":"I know those milk moustache commercials are a hit. I know you\u2019ve been told that milk does a body good. But at some point someone has to point out that the milk emperor has no clothes. In fact, we\u2019re doing it today here on Healthcare Triage.\n\n(Intro)\n\nSeriously people, has it occurred to none of you that we\u2019re the only mammals on the planet who consume milk after the early childhood period. We\u2019re so obsessed with it that we steal the milk from other species in order to keep drinking it. Look, I\u2019m all for breastfeeding. It\u2019s what all the other mammals do and I believe that evidence shows that breastfeeding is good for infants. I also understand that we likely breastfeed for a shorter duration than nature intended and in those cases giving kids milk based formula and cow\u2019s milk are fine. But after age two or so, or whenever the brain no longer needs the extra fat for development, there\u2019s really no good reason for us to keep drinking the stuff.\n\nThink about human history. Before we domesticated animals, we were getting along without any other animals milk. Lots of humans can\u2019t even drink milk because they\u2019re lactose intolerant. They do just fine. Here in the United States, there are recommendations all over the place trying to get kids and adults to limit their intake of calorie containing beverages \u2013 except milk! Milk gets a pass. In fact, lots of recommendations say that we should be drinking up to three cups of the stuff per day. Those three cups contain more than 240 calories and more than 36 grams of sugar. Ironically, non-fat milk contains more sugar than whole milk. What\u2019s with these recommendations? Ostensibly, it\u2019s because we need the calcium for bone strength, \u2018cause more milk and the calcium it contains will make your bones stronger. You know where this is going, right? To the research!\n\nIn 2007, a meta-analysis was published in the American Journal of Clinical Nutrition looking at calcium intake and the risk of fractures. It included seven prospective cohort studies of more than 170,000 women and almost 3000 hip fractures. They found no association between total calcium intake and the risk of hip fracture. For men, they found five prospective cohort studies of more than 68,000 men and more than 200 hip fractures. No association there either. They also found five clinical trials seeking to prove that improving calcium intake would prevent fractures. More than 5600 women and 1000 men took part in these studies where they randomly got calcium supplementation or placebo. They looked at all kinds of fractures and the calcium did nothing significant. There were four trials that looked specifically at hip fractures and there they found that calcium supplementation increased the risk of hip fracture. Increased it!\n\nBut maybe milk is different. In 2011 a meta-analysis was published in the journal of bone and mineral research. Researchers tried to gather all prospective studies looking for an association between milk intake and the risk of developing a hip fracture. There were six studies that included data on more than 195,000 women who sustained more than 3500 hip fractures. Guess what? There was no association between milk intake and the risk of fracture. There were three studies of more than 75,000 men with 195 hip fractures. Analyses again could not establish a statistically significant relationship. No proof in protective affective milk. To repeat, milk isn\u2019t going to stop you from breaking your hip. But there\u2019s a more recent study published in JAMA Pediatrics just earlier this year. It was a prospective cohort study of 96,000 men and women in the long-standing Nurses\u2019 Health Study and Health Professionals Follow-up study. They asked participants to rate their milk consumption as teenagers and then followed them to see if they got hip fractures over the next 25 years or so. Turns out that males who drank more milk as teens had a 9% higher risk of having a hip fracture later in life. When height was added to the analytic model the relationship wasn\u2019t significant anymore.\n\nSo the good news is that the milk isn\u2019t going to hurt you, but it\u2019s not going to help you either. Drinking too much milk can be awful for your gut. It makes it bleed. Every single year of residency, I admitted at least one child who was drinking a ton of milk and then slowly bled from his or her G.I. tract to a level of anemia that would kill an adult. It was always shocking and the parents were always horrified to hear that it was excessive milk consumption that had put their child in the hospital for an extended stay. Here\u2019s a news story. We\u2019ll take the word of Duke University health system. \u2018Cow\u2019s milk is low in iron and can actually prevent iron from being absorbed from the diet. In addition, some children develop small amounts of bleeding from their intestines when they have too much cow\u2019s milk.\u2019\n\nAm I saying milk is evil? No! It\u2019s an important part of a small child\u2019s diet and you should listen to your doctor about your toddler\u2019s consumption. Moreover, like most things in moderation, it\u2019s totally awesome. What else are you going to drink with hot apple pie? How else are you going to turn your bowl of Life cereal into a delicious paste? And Oreo without milk is close to a sin. But at some point, in older children and adults we should own that milk is a calorie laden beverage like many others. It holds no special place and you don\u2019t need it. Phenomenal marketing and a lot of wisdom have convinced you otherwise. Get over it.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/hzyFZcuHmeI"},{"c_name":"healthcare triage","v_id":"kLLXkYQkPqI","title":"Healthcare Triage Questions #1","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nThis week, Healthcare Triage presents its first questions video! Many of you submitted questions over Twitter, and John and Aaron sat down to answer them. Hilarity sometimes ensues. Make sure you get your question in next time if you want to see it answered. Or, if you want your Twitter handle prominently displayed in a video. Or both.\n\nAND SORRY I SCREWED UP HDL\/LDL!!!\n\nMake sure you subscribe above so you don't miss any upcoming episodes!\n \n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1396217193","likes":"3008","duration":"901","transcripttext":"Aaron: Hi, I'm Aaron Carroll.\n\nJohn: I'm John Green.\n\nAaron: And this is Healthcare Triage.\n\nJohn: And today we're going to answer some of your questions.\n\n(Intro Music)\n\nJohn: Alright Aaron, this question comes from Roseperson; What policy change could have the biggest benefit for US health?\n\nAaron: Well we're starting off easy, aren't we?  Um, I guess if I had to pick one thing to do it would be is if we could somehow transition the way that we reimburse care from sort of doing anything and how much volume it is, to sort of trying to pay for things perhaps that work versus not work.  Though I think the likelihood of that happening anytime soon is pretty small, but that would do a lot.\n\nJohn: What kind of daily exercise is best long-term, walking, running, short versus long distance, cycling, etc.?\n\nAaron: You know, people ask that kind of question all the time, and the simple answer is whatever you will do for a long period of time, meaning whatever you will do consistently.  The same thing has been shown with diet.  You know, people will wonder what's the best kind of diet.  The truth of the matter is whatever will work for you and whatever will stick so that you keep doing it over a period of time.\n\nJohn: And how long should I - how, how much exercise should I be getting a day?\n\nAaron: Uh, people are act- I think most people would say thirty secon- oh God, thirty minutes of activity a day.  Thirty seconds is too short, too short.\n\nJohn: He said thirty seconds\n\nAaron: Nope\n\nJohn: I'm in\n\nAaron: Nope, too short, thirty minutes\n\nJohn: Go, go, go, go, go, I'm almost there, I'm almost there\n\nAaron: You want your - heart elevated, thirty minutes.\n\nJohn: Alright, thirty minutes a day.  What if I want to do, like, two hours a day, is that a problem?\n\nAaron: No, as long as you can handle it; but the problem that most people do is they push too hard and then they get sore, or they get tired, or they can't sustain it over a period of time, and then they stop, and stopping is what we want to avoid.\n\nJohn: Like that day that I ran eight miles, and then the next day... I couldn't walk.\n\nAaron: Exactly.  When I tried P90X for a while, and it's like, it took me half an hour to get out of my car.\n\nJohn: [laughs]\n\nJohn: Ben asks, \"Hey, you're a doctor.  Can you take a look at my rash?\"\n\nAaron: Sure!  Yeah, looks fine.\n\nJohn: Yeah. Yeah, I think you're alright. Yeah. I'm not a doctor, but, that's, that's no big deal\n\nAaron: That looks fine.\n\nJohn: njnerdymom asks, \"Why are some hospitals more prestigious, like the Mayo Clinic?  And, are they better?\"\n\nAaron: Well, some are prestigious cause they have very good PR departments and very good advertising; some are prestigious cause they make a lot of money and some are prestigious just because they have high quality people that work there.  Uh, but,  uh it's not like every hospital is prestigious in everything, so some may be good in some things and not as good as other things, some may be good at everything.  Uh, but, there's no great evidence that necessarily the prestige translates into quality or better care.\n\nJohn: onceuponA asks, \"Will you please use Healthcare Triage to tell my dad that soda isn't leaching calcium from my bones?\"\n\nAaron: Yeah this is a myth. Um, it's actually related to the fact that in early evidence they showed that carbonated beverages slightly increased how much calcium will be in your urine. Uh, but what they didn't tell you is that on the back side is that your body quickly readjusts to retain more calcium so that you don't lose any of the aggregate. And studies that have been done over long periods of time with different kinds of carbonated beverages have shown that people don't have problems with relationship to their bones or breaking them.\n\nI happen to know onceuponA and I know that this is a question from her dad, so I'm telling Adriana's dad \"Don't worry about this.\"\n\nJohn:  Emily asks, \"What are the actual risks and benefits of home birth vs birth center vs hospital?\"\n\nAaron: That's a great question and unfortunately it's not terribly easy.  I mean of course you go to the hospital for sort of insurance purposes.  Not insurance of health insurance but just of in case something goes wrong, you're there.  Uh, But the truth of the matter is that the vast majority of births are gonna do just fine and probably would be great at home.  And don't really need that.  But I think most people go to the hospital for the \"what if?\"\n\nJohn: This is helpful to me because as you know I am a massive hypochondriac.  Um, so I would be asking all of that. \n\nAaron: Well that's good.\n\nJohn: What you don't know is that I ask Aaron of these questions what the camera isn't on.\n\nAaron: But I give you the same answers.\n\nJohn: I know, you do.  Consistently the same answers.\n\nAaron: Very consistent.\n\nJohn: psionedge asks, \"Does privatizing Medicare\/Medicaid have any evidence of saving money while actually working?\"\n\nAaron: Yes.  Uh, in the sense that when they look at sort of Medicare Advantage programs, which are private companies which are administering Medicare across the country, if you look at it in a county-to-county basis, there are places in the country where Medicare Advantage is actually providing the Medicare benefits for less money.  Those are much rarer however than the times when Medicare Advantage is costing much more money.\n\nSo if you're asking me is there any evidence that in some markets, private insurance can provide Medicare benefits more cheaply than Medicare can, yes. But holistically overall, the government is probably more efficient at providing those benefits.\n\nJohn: Does improving patient satisfaction scores affect other outcomes?\n\nAaron: Oh wow.  See questions like this sound simple but are just not.  Because the question is what is satisfaction and what are the outcomes? And there are studies that show that patients who are more satisfied and have a better relationship with their doctor actually might adhere to recommended therapy more closely and therefore get a better benefit.\n\nJohn: That's definitely true for me.\n\nAaron: But there are also studies that show that trying to please patients in an effort just to get better satisfaction often can lead to increased costs and less good outcomes.  And that was actually shown in a study published a couple years ago that got a lot of press because they were showing that satisfaction actually cost more and even lead to higher mortality.  But that's cause sometimes doctors go overboard in an effort to please patients do the wrong thing. That's not good.  But building a good relationship in order to improve satisfaction, that's a good thing. \n\nJohn: So this is one of those places where actually sometimes satisfied customers are not, um, healthy, the healthiest possible customers.\n\nAaron: No. Correct, and often what people want is not what is best for them. And sometimes you have to explain and do things that might make them more upset in the short term.  But you try to do it in a manner that builds a bond that hopefully increases that quality of the relationship in the long term.\n\nJohn: I have been asking my doctor, who you recommended to me, to give me Botox, uh, for months because I'm becoming an older gentleman and I'm on YouTube, and there's no room on YouTube for wrinkles. \n\nAaron: Right.\n\nJohn: He just is completely unsympathetic to my position.\n\nAaron: As would I be.\n\nJohn: And so I give him very low patient satisfaction scores.\n\nAaron: That may be.  But see, I think he's probably doing you a service in the long run.\n\nJohn: [laughs] Okay this question is from James. What's the #1 thing you can do to help you live longer?\n\nAaron: I would need to know James to answer that question. \n\nJohn: I can show you a picture of him; he looks like that. \n\nAaron: It depends, you know, if you smoke the #1 thing to do is stop smoking.  If you are eating unhealthily, the #1 thing you can do is eat better.  If you don't exercise, the #1 thing you can probably do is exercise.  \n\nJohn: Let me ask you this: Is, this is a totally personal hypochondriac question, um, if I'm choosing between changing my diet so that it's heavy in fruits and vegetables, lower in fat OR exercising which of those is more important to me living a longer healthier life?\n\nAaron: I, looking at you and knowing you I would say probably exercising.  Cause I would imagine, you're not obese, your diet is probably decent to begin with and any changes... \n\nJohn: (whispers)  It's not great.\n\nAaron: Well any changes you're making are at the edges.  You're not talking about probably eating multiple servings of meat a day or eating so much that you're really unhealthy.  So in that case, probably getting good exercise you'd be better off.  \n\nJohn: That's helpful.  Alright I've got a few more questions for you.  How effective is stretching for preventing sports-related injury?\n\nAaron: Not at all.\n\nJohn: In fact isn't it bad?\n\nAaron: Not at all.  This is one of those that blows people minds but there have been systematic reviews, there was one in like I think 2004 and they looked at hundreds of trials.  There were six good studies and none of them showed that stretching prevented injury.  There have been other studies to show that you know warming up and everything else, it doesn't actually make you perform better and in fact, some studies show that when they randomize people to stretch or not they don't run as fast, jump as high.  In other words they don't even perform as well.  So you're not preventing injury and you're potentially making yourself not play as well.  So I don't know why we still do this.\n\nJohn: Um, is it true that you should stretch after you exercise to minimize, you know, soreness the next day or whatever?\n\nAaron: I've seen no good evidence about the stretching.  What I have seen people push is that you should just, you know, walk perhaps.  Or just try to work your muscles through and the idea is that you're trying to get the lactic acid out.  I've not seen any good studies to say whether that's true or not but that at least makes a little bit of sense.\n\nJohn: Have there been studies that conclude that food dye does or does not negatively affect children's behavior?\n\nAaron: This is, I wish this one as clean as like sugar is where it's, like, so clear that there have been huge randomized controlled trials that show that it doesn't.  But there are some randomized controlled trials of kids who already have hyperactive behavior, like who have ADHD, pretty severe ADHD, where eating a lot of foods with some dyes could lead to slightly worse behavior in parent's eyes.\n\nJohn: Wow. \n\nAaron: So, having said that, if you have a child with severe ADHD and you're concerned about this and you want to try no dyes, okay.  But the problem is that people extrapolate this to say \"Oh if my normal child gets dye then somehow he's gonna be a bad kid\". That there's no evidence for.  So the idea that we need to avoid these like the plague holistically, there's not much evidence for that. \n\nJohn: There's no evidence for it, but like I mean it's possible, it sounds like.\n\nAaron: Well everything's possible!\n\nJohn: Now I'm freaking out about food dye.\n\nAaron: No, no. And you need...\n\nJohn: Nope, too late. I'm on the - I'm on the - I'm on the crazy train. I've already left the station. I'm removing all the dye from my child's life. He's already- he's already got a lot of energy. \n\nAaron: Yeah but if you - But see if you go to those lengths then you could probably make him hate you and you're probably gonna you know not, you want to have a better relationship with your child that's more important.\n\nJohn: Don't worry. He already hates me. \n\nAaron: Oh.\n\nJohn: We're covered on that front.\n\nJohn: Dietary cholesterol is not strongly linked to LDL blood levels.  True, false or in between? Also, what are LDL blood levels?\n\nAaron: LDL is the low density lipoproteins. See I knew that one.\n\nJohn: Good or bad?\n\nAaron: Uh, that is the. . . \n\nJohn: Oh boy\n\nAaron: Oh my god, see this is the danger.  \n\nJohn: HDL is bad, right? \n\nAaron: HDL is bad, LDL is good.  So this is a great question because it's a \n\nJohn: Who's the doctor now?\n\nAaron: Right, well this is where it gets . . I rarely get asked this question with respect to LDL levels.  It's always HDL levels, but they're, they're sort of linked. The truth of the matter's that the vast majority of people actually are what we call hyporesponders, meaning that they don't actually respond with respect to their blood cholesterol levels to what they're eating in their diet.  So you could actually change what you eat - eat tons of eggs, don't [eat] eggs.\n\nThey did a study where they gave regular people three eggs a day every day for a long time - no change in their dietary cholesterol.  I mean, in their actual blood cholesterol.  About 30% of people are what we call hyperresponders, meaning their levels do change with respect to food, but it's much less than you'd think.  Changing your diet by something like 100 milligrams of cholesterol a day might bump it by 2, which is almost inconsequential.\n\nJohn: Two points out of like?\n\nAaron: Two points out of, when we talk about like 200 or more.  \nJohn: We're talking about hundreds, yeah.\n\nAaron: Right.  So you would actually have to change your, the amount of cholesterol you take massively to truly change how much cholesterol, to get yourself from an unsafe to a safe level.  Which is why medications are recommended for people who truly are at unsafe levels.\n\nJohn: Is sitting as harmful as smoking? Please say no, please say no, please say no, please say no.\n\nAaron: No! \n\nJohn: Thank you.\n\nAaron: This is one of those, this is one of those, they, this was in the news a lot and - the study basically said that people who sit for eight hours a day or more are more likely to have cardiovascular disease than people who sit for less than eight hours a day.  But what they really meant was that people who don't exercise are going to have a higher cardiovascular risk than people that do exercise.  \n\nBut there is no question that smoking is just bad.  And if I had to say which of these would I be more concerned about, if you're a smoker stop smoking.  I mean that is by far the worst thing that you can do in respect to all of this stuff.  Having said that, if you're not smoking, yeah, be less sedentary. It's only going to improve your life.\n\nJohn: But in that study didn't they say that like, even people who exercise 30 minutes a day, if they have a very sedentary lifestyle, there's still an increased risk?\n\nAaron: It is increased risk, but it's like \"increased risk.\" You know, how much more so? Smoking is going to be so much worse for you over the long term, in the risk that you could die, uh, than, than, than the sitting.  Uh, having said that, if you have a choice do both.  If you have, you know if you're not smoking I would absolutely encourage you to be more active.  But if, but if, if somebody was presenting to me with both and said, \"I sit for eight hours a day and I smoke.\" Unequivocally I would say stop smoking.  That would be number one.  \n\nJohn: Is sugar as addictive as cocaine?\n\nAaron: No, but you know, the reason this was in the news so much - there was this crazy study, and I don't remember whether it was by high school students or college students, but what they did was they basically got all these rats to run through a maze. And for like some of the rats at the end of the race - at the end of the maze - they gave them a cookie, an Oreo. And in other rats when they got to the end of the maze, they gave them cocaine.  \n\nAnd so they found that the rats were just as eager to get through the maze whether they got cocaine or a cookie.  That does not mean that Oreos are as addictive as cocaine.  And I don't know why anyone would think that that's the case. It means that rats like both?\n\nJohn: Okay, discuss the evidence for nutritional supplements.\n\nAaron: None. It's great for making really expensive urine, that's about it. They just don't work. I mean, the truth of the matter is most Americans have a totally well balanced diet are getting the vitamins they need. If you have to, take a multivitamin that's going to supplement you and probably put you over the edge. But the human body is just not meant to take in any excess vitamins or any kinds of supplements, your body doesn't process them, it just pees them out. And so you're really not doing much at all.\n\nIf there was some kind of nutritional benefit to eating more of this stuff, evolution. would have pushed us, and other animals, to eat more of the stuff. We basically are conditioned to eat about the right amount of the stuff, some people don't get enough, multivitamins fine. Some people get a bit too much, that's fine too, they're just gonna pee it out. But the idea that we're gonna massively supplement ourselves with any one vitamin or any one supplement and that's going to drastically change our health, there's really almost no evidence for that at all.\n\nJohn: Last question, from me. You just said that nutritional supplements only make for expensive urine. I have, as you may notice, medium-sized guns. Um, I was thinking of developing gigantic guns.\n\nAaron: Okay.\n\nJohn: Wouldn't nutritional supplements potentially help me with my gigantic guns development project?\n\nAaron: There's really not much evidence for that at all. Having said that... \n\nJohn: Devastating! \n\nAaron: I know. Well, the thing is if this stuff was easy and it actually worked, it would work for regular people. It only seems to work for really extreme bodybuilders who were working so hard anyway that they were gonna get massive muscle build up. For the vast majority of people it's just not going to make any difference at all. There is some evidence that recovery beverages like some of the protein shakes, or really there have been great studies that show that, you know, chocolate milk is just as good of a recovery beverage as the super expensive ones you buy in stores.\n\nJohn: Oh so now who likes milk?\n\nAaron: Well but [both laughs] Darn it! The milk is always on to me! But that would be a small... [bangs table repetitively] Anyway.\n\nJohn: Aaron Carroll, pro-milk. You heard it here first.\n\nAaron: Anyway, there's some evidence that that actually recovery but again you're talking about really intense high-performance athletes, not us, or at least not me, maybe you.\n\nJohn: Well probably also not me.\n\nAaron: Okay, but so then none of the supplements are really gonna make a difference at all.\n\nJohn: Alright, well thank you Aaron so much this has been tremendously educational as it always is and thanks for all your work on Healthcare Triage.\n\nAaron: Thank you. Oh, my pleasure, thank you.\n\nJohn: Alright, bye everybody!","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/kLLXkYQkPqI"},{"c_name":"healthcare triage","v_id":"UF1T7KzRnrs","title":"Test Characteristics: How Accurate was that Test?","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nDoes a positive test mean that you have a disease? Does a negative test mean you're healthy? Unfortunately, the answer to both these questions isn't a definitive \"yes\". How good a test is depends on it's sensitivity and specificity. Learn about both, and why understanding these test characteristics is so important. Next week we'll talk about what this all means in part II of this series, The Bayes Theorem. \n\nThe Vermont Study: http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3611728\/\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1396904437","likes":"1661","duration":"409","transcripttext":"People assume that when their doctor orders a test for them that the results are easy to interpret.  The reality is that this is far from true.  Every test \u2013 be it radiological or laboratory \u2013 is imperfect.  Sometimes the tests miss something that\u2019s concerning.  Sometimes they pick up stuff that isn\u2019t.  So, what makes a good test or a bad test?  That\u2019s the topic of this week\u2019s Healthcare Triage.\r\nLet\u2019s say there\u2019s a disease out there called Fakitis, but there\u2019s no test for it.  So, an enterprising researcher wants to figure one out.  He thinks that Fakitis will raise your white blood cell count, which is really just how many white blood cells you can see under a microscope set at a certain power.  So, he gathers a thousand people - with and without Fakitis - and he draws their blood. \r\nAs you can imagine, there are a range of white blood cell counts in this population.  So he has to set an amount that he will call a positive result \u2013 let\u2019s say it\u2019s fifteen.  Anyone with a white blood cell count of fifteen or higher is positive, and anyone less is negative. \r\nWhat this, or any researcher, would do is set up a table like so.  Every participant falls under one of these four boxes.  Patients in box A have Fakitis, and also have a positive test.  Patients in box B do not have Fakitis, but also have a positive test.  Patients in box C have Fakitis, but have a negative test, and patients in box D do not have Fakitis, and also have a negative test.\r\nBox A contains what we call the \u201ctrue positives.\u201d  Box D contains the \u201ctrue negatives.\u201d  These are both good results, and in an ideal world, all of the patients would fall under boxes A and D.  But that almost never happens.\r\nSome patients wind up in box B, which we call \u201cfalse positives.\u201d  They don\u2019t have the disease, but they do have a positive test.  And some patients wind up in box C, which we call \u201cfalse negatives.\u201d  They have the disease, but the test doesn\u2019t pick it up.\r\nWe use these ideas to calculate two test characteristics:  sensitivity and specificity.   \n\nSensitivity is the proportion of people who have a disease who have a positive test result.  It\u2019s the ratio of true positives to true positives plus false negatives.  If you follow our diagram, sensitivity equals A over A plus C.\r\nSpecificity is the proportion of patients who don\u2019t have the disease who have a negative test.  It\u2019s the ratio of true negatives to true negatives plus false positives.  If you refer to our diagram, specificity equals D over D plus B.\r\nLet\u2019s fill in the diagram with some real numbers.  The researchers gathered a thousand people.  It turns out that a hundred of them have Fakitis.  Of these people, 90 have a positive test and 10 have a negative test.  There are 900 people without the disease, and of them, 750 had a negative test, and 150 have a positive test.\r\nSensitivity, remember, is the proportion of people who have Fakitis who have a positive test.  A hundred people total have Fakitis.  90 of them have a positive test.  So the sensitivity is ninety over a hundred, or 90 percent.\r\nSpecificity, remember, is the proportion of people who don\u2019t have Fakitis who have a negative test.  Nine hundred people don\u2019t have Fakitis, seven hundred fifty of them have a negative test, so that the specificity is seven fifty over nine hundred, or 83 percent.\r\nIn an ideal world, both of these would be a hundred percent - the higher the better.  That almost never, ever happens. \r\nSo, setting the threshold for a positive result at a white blood cell count of fifteen led to a sensitivity of 90% and a specificity of 83%.  Is that good?  Well, it depends what you want to get out of the test.\r\nLet\u2019s say Fakitis is a really, really bad disease for which we have a treatment that\u2019s pretty easy to tolerate.  If that\u2019s the case, we\u2019d much rather make sure we don\u2019t miss any real cases of Fakitis.  Looking back at the diagram, we want to minimize the number of false negatives.  We want everyone who is disease-positive to be test-positive.  So, we could drop the threshold of the white blood cell count to, perhaps, twelve instead of fifteen.  That might change the results in this way.\r\nNow our sensitivity is ninety-nine over a hundred, or 99%.  Our specificity is five hundred over nine hundred, or 56%.  That\u2019s because as you increase sensitivity, you\u2019re going to decrease specificity.  Another way of putting it that as you make a test more sensitive, or more able to pick up disease if it\u2019s there, you make it less specific, or less able to prove that a positive result is really real.  But, if you have a disease you want to rule out because it\u2019s bad and you don\u2019t want to miss it, you want to maximize sensitivity.\r\nSometimes a positive diagnosis is a big deal and you really don\u2019t want to get a false one.  Think about a pregnancy test:  you\u2019re going to figure it out sooner or later anyway, and you really don\u2019t want to freak out tons of women.  Or men.  So, if Fakitis was like that, we\u2019d actually want to raise the threshold of the white blood cell count to lower the number of false positives.  Maybe we\u2019d set it at eighteen instead of fifteen.  How might that change things?\r\nNow our sensitivity is sixty over a hundred, or 60%.  But our specificity is eight hundred eighty over nine hundred, or 98%.  As we made the test more specific, or more able to prove a positive result is real, we made it less sensitive, or less able to detect disease if it\u2019s there.\r\nTests are rarely very sensitive and very specific.  Usually it\u2019s a trade-off, and we need to consider how much real disease we are missing and how many positive tests are over diagnosis.  Here\u2019s a real-world situation I pulled from the medical literature from a manuscript published in 2012:  The study involved 141,284 people.  Of them 728 were disease-positive.  The test had a sensitivity of 83.8% and a specificity of 90.6%.  Sounds decent, right?\r\nThis was a study of mammography in Vermont.  And mammography, remember, is considered really important by a lot of people.  But mammograms missed 118 of the 728 women with cancer.  Is that sensitive enough?\r\nBefore you say no, remember that increasing the sensitivity would make it less specific, and even with a specificity of almost 91%, more than 13,000 women had a positive mammogram that turned out not to be cancer.  These women likely had other procedures, tons of worry, and they had to spend lots of money.  And that\u2019s a lot of women.\r\nThe bottom line is that it\u2019s unlikely that most of us think about tests in this way.  We\u2019re likely not considering the trade-offs of sensitivity and specificity in judging whether the test is right for us.  But every time we get a test, we have to remember it doesn\u2019t give us a definitive answer.  It gives us a test result, and the interpretation of that result depends on whether those who designed the test decided to worry more about sensitivity or specificity.\n\nSo now that you know about sensitivity and specificity, how can you use them to make better decisions about healthcare?  Watch next week and find out.\r\n                                                                                                 \r\n ","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/UF1T7KzRnrs"},{"c_name":"healthcare triage","v_id":"Ql2jEJ-6e-Y","title":"The Bayes Theorem: What Are the Odds?","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nLast week we discussed test characteristics like sensitivity and specificity. This week, we'll talk about how those concepts get used in actual medical decision making. At least, we'll talk about how they're supposed to be used. You'll learn about Bayes' Theorem, too! Don't let the equations scare you. You're going to learn a ton. \n\nLikelihood Ratios: http:\/\/ktclearinghouse.ca\/cebm\/glossary\/lr\n\nFagan's Nomogram: http:\/\/mcmasterevidence.files.wordpress.com\/2013\/02\/fagan-nomogram.jpg\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1397522272","likes":"1625","duration":"521","transcripttext":"Last week, we talked about test characteristics like sensitivity and specificity. But while those things have meaning, it's not always clear how they translate into actual practice. To understand that, we have to talk about likelihood ratios and Bayes' Theorem. Stick with me--you're going to be glad you did. This is Healthcare Triage.\n\nThe problem with tests is that we think they're definitive. They're not. We think that positive means you have to have a problem, and that negative means you're safe. I showed you last week that lots of times you have false negatives and false positives, so it's a mistake to take a test and use that (and only that) to reach a conclusion. This kind of thinking completely ignores what we think about a patient when she walks through the door. You may remember \"fake-itis\" from last week. Maybe when we see our patient we're really sure she has \"fake-itis\". Then, a negative result should leave us concerned that it is a false negative. Maybe we thought there was almost no chance that she had the disease. In that case, a positive test may be more likely to be a false positive. Or maybe we weren't sure. Then either result might be important.\n\nBayes' Theorem, attributed to (get this) Thomas Bayes, takes this idea and turns it into a formula. Mathematically it says that the probability of A, given that B is true, is equal to the probability of B given A, times the probability of A, divided by the probability of B.\n\nHold on, hold on. Stay with me.\n\nIn this case, A is having \"fake-itis\", and B is a positive test result. So Bayes' Theorem says that the probability of having \"fake-itis\", given a positive test result is equal to the probability of having a positive test result if you have \"fake-itis\", times the probability of having \"fake-itis\", divided by the probability of having a positive test result. And I know that that's still complicated, but you don't really need to do the math here. You just need to understand the principle. You look at a patient. You determine based on her story and physical exam what the chance is that she has \"fake-itis\". You get a test. And then you do a calculation where you have a new chance that she has \"fake-itis\". And it involves sensitivity and specificity. You use them to calculate a likelihood ratio.\n\nA likelihood ratio is the probability that a test is correct, divided by the probability that it is incorrect. They come in two flavors: positive and negative, to assess the value of a positive and negative test result. A positive likelihood ratio is equal to sensitivity over one (1) minus specificity. A negative likelihood ratio is one (1) minus sensitivity over specificity. Bayes' Theorem works out that post-test odds equal pre-test odds times likelihood ratio. And I grant you that odds are not the same as probabilities--odds are the probability of something being true, over the probability of something being false.\n\nI know you're likely overwhelmed, so let's work through a real-world example. Last week, we found that mammograms had a sensitivity of eighty-three-point-eight (83.8) percent, and a specificity of ninety-point-six (90.6) percent. So first, we can calculate our likelihood ratios. Positive likelihood ratio equals sensitivity over one (1) minus specificity. That means it's zero-point-eight-three-eight (0.838) over one (1) minus zero-point-nine-zero-six (0.906), or eight-point-nine (8.9). A negative likelihood ratio is one (1) minus sensitivity over specificity. Or one (1) minus zero-point-eight-three-eight (0.838) over zero-point-nine-zero-six (0.906), or zero-point-one-eight (0.18).\n\nNow let's assume a woman comes into the office. She's really worried about breast cancer. We know, based on research and that paper, that about half a percent of women in this population had breast cancer. So the pre-test probability, based just on prevalence, is one-half (1\/2) of one (1) percent. That means there's a ninety-nine-and-a-half (99.5) percent chance that she doesn't have breast cancer. So her pre-test odds look like this. Odds are the probability something is true over the probability something is false. In this case, zero-point-zero-zero-five (0.005) over zero-point-nine-nine-five (0.995), or zero-point-zero-zero-five (0.005). \n\nAnd here we see one of the neat tricks about pre-test odds that makes life easier. For most pretty rare things, pre-test odds pretty much equal pre-test probability. Even for things like a pre-test probability of ten (10) percent, the pre-test odds are eleven (11) percent. So a lot of the time you can just estimate pre-test odds to be the pre-test probability.\n\nSo let's say the mammogram is positive. According to Bayes' Theorem, post-test odds equals pre-test odds times likelihood ratio. In this case, post-test odds equals zero-point-zero-zero-five (0.005) times eight-point-nine (8.9). The post-test odds therefore are zero-point-zero-four-five (0.045), or four-and-a-half (4.5) percent. You can convert this back to a probability by the equation probability equals odds over one (1) plus odds. Probability in this case equals zero-point-zero-four-five (0.045) over one (1) plus zero-point-zero-four-five (0.045) or four-point-three (4.3) percent.\n\nLet that sink in for a second. The average woman who has a positive mammogram has a four (4) percent chance of having breast cancer. There's a ninety-six (96) percent chance that she doesn't have breast cancer. And yet every woman I know who has a concerning mammogram immediately freaks out. That's because most people think that a positive mammogram means you have cancer. It doesn't it means that you have a four (4) percent chance of having cancer. I bet most of you thought you had a four (4) percent chance of having cancer before the mammogram was even done.\n\nNow this changes based on clinical suspicion. If you had a lump or a really concerning history, such that your doctor thought you had a pre-test probability of thirty (30) percent, instead of the background half of one (1) percent, then your equations change. Your pre-test odds would still be probability of something being true over probability of something being false. In this case, zero-point-three (0.3) over zero-point-seven (0.7), or zero-point-four-three (0.43). A positive mammogram would mean this--the post-test odds are still the pre-test odds times likelihood ratio, or zero-point-four-three (0.43) times eight-point-nine (8.9), or three-point-eight (3.8). And we still convert back to probability the same way. Probability equals odds over one (1) plus odds, or three-point-eight (3.8) over one (1) plus three-point-eight (3.8), or a final probability of seventy-nine (79) percent.\n\nThis woman with a positive mammogram would have almost an eighty (80) percent chance of having breast cancer. This is why mammograms can be a really powerful tool for women who are at high risk, but of debatable value for women who aren't.\n\nAs a thought experiment, I want you to see what a negative mammogram would have meant for this woman. Let's start at the beginning again, remembering her pre-test probability is thirty (30) percent. We remember that her pre-test odds were zero-point-four-three (0.43), and we use Bayes' Equation again, but with a negative likelihood ratio, since the test is negative. Post-test odds equals pre-test odds times likelihood ratio, or in this case zero-point-four-three (0.43) times zero-point-one-eight (0.18), for a final post-test odds of zero-point-zero-seven-seven (0.077). Going back to a probability, it's odds over one (1) plus odds, or zero-point-zero-seven-seven (0.077) over one (1) plus zero-point-zero-seven-seven (0.077), for a final probability of seven-point-one (7.1) percent.\n\nSo after a negative mammogram, this woman still has a seven (7) percent chance of having breast cancer. This woman probably feels reassured with her negative mammogram. But her chance of having breast cancer after the negative test, at more than seven (7) percent, is about twice as high as the first woman with the positive mammogram, at about four (4) percent. But that woman's probably freaking out, and she's at like half the risk.\n\nThis is because people don't think about tests appropriately. Unfortunately, too few doctors do as well. This is because this isn't the way we're trained to think. We think that positive means you've got disease and negative means you're safe. It's just too bad.\n\nNow, some of you may complain that although this makes a lot of sense, it's just too hard to calculate. So I'll show you a shortcut. This is a Fagan's nomogram. You start by finding your pre-test probability on the left. Then you draw a straight line through the likelihood ratio, and wind up at the post-test probability. Once you know the likelihood ratio of a test, it's easy to use.\n\nSo for the mammogram, the positive likelihood ratio was eight-point-nine (8.9). So let's try it for a few numbers. First is the one we did at zero-point-five percent. Drawing a line from there through eight-point-nine (8.9) gets us to about the four (4) percent we calculated. You can do this for any pre-test probability. You can also do this for a negative mammogram, with a likelihood ratio of zero-point-two (0.2). \n\nAnd there are studies which list the likelihood ratios of many, many tests. The Center for Evidence-Based Medicine in Toronto has tables of them at their website (link down below).\n\nGo knock yourself out, and see what a positive and negative test really means. And stop assuming that a positive test means disease, and a negative test means you're clear. That's not how it works. The vast majority of us are doing it wrong.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/Ql2jEJ-6e-Y"},{"c_name":"healthcare triage","v_id":"VFwYGFt5q90","title":"Is Marijuana Harmful to Health?","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nThere's just no way to talk about marijuana without someone completely misinterpreting what I say. Some of you are going to call me a fascist for saying anything bad about pot. Others are going to attack me for not coming down on it hard enough. But the truth of the matter is that many things that are far more dangerous than pot are totally legal in this country. That's not my opinion, it's what scientific studies show us. No one is saying marijuana is totally safe. But is it so bad for you that it should be illegal, even though it has benefits? Watch and decide. Happy weed day.\n \nThose of you who want to read more and see references can go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=54913\n\nAnd, yes, we do know about the new study on brain development, which came out long after we taped. But as with a lot of research, it's being totally misinterpreted by the media. Go check out the references to see a nice article where the author of the study says the same thing.\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1397944053","likes":"7728","duration":"348","transcripttext":"It's April twentieth! The twentieth of April. It's 4 20 or as some like to call it, weed day. I guess we're doing this. This is healthcare triage.\n\nTo be honest, this is an episode I thought about bailing on many times. There's just no way to talk about marijuana without someone completely misinterpreting what I say. Some of you are going to call me a fascist for saying anything bad about pot at all. Others are going to attack me for not coming down on it hard enough.\n\nSo I'm going to cloak myself, as I always do, in the power of data. Marijuana works by effecting the brain. It's a drug, like many others, with different effects on different people. It's active ingredient is tetrahydrocannabinol or THC. THC bonds to protein specific receptors in the brain to produce a number of results. \n\nIt can have a mild sedative effect and it can also lower your inhibitions. Marijuana can increase your pulse, lower your blood pressure, and increase your appetite. It can also interfere with short term memory, lower your reaction time, and make you unsteady on your feet. \n\nBut so can lots of other things that we like to eat. drink, or smoke. The real question is weather it is dangerous enough to be made illegal. And that's wear the screaming usually starts. \n\nThere's no evidence that marijuana causes a physical dependency like heroin does. Some argue though, that it can become psychologically addictive. Some will argue that the smoke is carcinogenic and causes lung cancer or respiratory disease. Others argue that regular use can effect the immune system. Still more argue that it increases the chance of developing a psychotic illness. But as I point out again and again in many of these videos, lots of things have both a benefit and a harm. \n\nNo one should be under the Illusion that marijuana has no harms. The question we should be concerned about is how much harm is there in marijuana and does that harm outweigh the benefit so much that it should be made illegal? \n\nAnd now the benefits. There's a growing body of evidence that marijuana has use in many medical conditions to improve quality of life. And you need only to talk to one of the gazillion marijuana users out there to hear about its other benefits as well. \n\nMoreover, there are lots of things in the world that can absolutely harm us that are totally legal. The two most obvious choices are tobacco and alcohol. Both of these substances are regulated but legal in most of the world. They can provide us with a useful benchmark against which we can compare marijuana. Don't blame the messenger, I'm just telling you what the science says. \n\nTo the research! Two years ago a study was published in the Journal of the American Medical Association investigating the effects of marijuana and tobacco on pulmonary function. Researchers followed a cohort of more than 5000 men and women for over 20 years, they wanted to see how smoking tobacco and marijuana affected lung health.\n\nWhat did they find? Not surprisingly tobacco use had significant negative effects on lung function. Marijuana use though had none. No lung effects at all. They couldn't even show that very high use of marijuana was bad for lung function, although the study wasn't powered for that specific analysis. Their conclusions and I quote from the Journal of the American Medical Association \"marijuana may have beneficial effects on pain control, appetite, mood, and management of other chronic symptoms. Our findings suggest that occasional use of marijuana for these or other purposes may not be associated with adverse consequences on pulmonary function.\" Tobacco totally does have adverse consequences on pulmonary function.\n\nAlmost in the same week the CDC published a report on binge drinking in adults in the United States. The results were sort of shocking. More than one in six adults in the United States is a binge drinker of alcohol. Those that do binge drink do more than 4 times a month, and when they do, they have about 8 drinks on average. More than 28% of binge drinkers were young adults, 18-24 years old, who had more than 9 drinks on average when binging. But elderly binge drinkers were those older than 65 drank the most often, about 5 and a half times per month. \n\nExcessive alcohol use accounted for an estimated 80 thousand deaths in every year of the study. The estimated economic cost of this damage's was more than two hundred and twenty three billion dollars in 2006 alone. \n\nAnother study was published in 1990, that described a cohort of more than 45,000 Swedes that were followed for 15 years, there was no increase in mortality in those marijuana after controlling for other factors. \n\nAnother study was published in 1997 in The American Journal of Public Health that followed more than 65,000 people in the US aged 15-49 years old. They found that marijuana use had no effect at on on mortality in women, and no effect on non-AIDS mortality in men either. \n\nSo let's review. Tobacco? Adversely impacts lung function and perfectly legal. Binge drinking of alcohol? Common, dangerous, costly to society, also totally legal. Marijuana? No impact on lung function, no impact on mortality, almost always illegal. \n\nI'm not arguing that marijuana should be sold in the aisles of drug stores or supermarkets. But here and in many other parts of the world, ya need a good reason to make something illegal. There are lots of things that are dangerous but regulated. We don't let kids buy tobacco or alcohol; totally makes sense. The same should apply to marijuana. \n\nWe don't let people drive under the influence of alcohol, totally makes sense, the same should apply to marijuana which has been shown to impair drivers significantly as well. There was even a meta-analysis published in the BMJ in 2011 confirming that, and I believe the results.\n\n But it's hard to continue to make the argument that the freedom that we enjoy should cover tobacco and alcohol yet not extend to marijuana. There is plenty of evidence that the former are unhealthy and are consumed at our own risk. The evidence against marijuana is thin.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/VFwYGFt5q90"},{"c_name":"healthcare triage","v_id":"_yF69KVbUaQ","title":"The Healthcare System of France","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nWe've covered the United States and Canada. today, we cross the Atlantic to discuss the healthcare System in France. Their system is a combination of universal social insurance with some optional private overlays. It's expensive (relative to most), but it's arguably the best in the world. Watch and learn why.\n \nThose of you who want to read more and see references can go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=55033\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1398641518","likes":"2715","duration":"343","transcripttext":"There's a saying I'm quite fond of, although I'm not sure who first penned it: \"The French love their healthcare system, and change it all the time. Here in America, we hate ours, but refuse to touch it.\" There's some truth to that, there's also a lot that much of the world could learn from France. Their healthcare system is the topic of this week's Healthcare Triage.\n\nToward the end of World War II, the French realized their country was in pretty bad shape. There was little chance that the shattered private sector was gonna be able to take care of all the people who might need healthcare in the next few years. So France established a system of national health insurance in 1945.\n\nThe system is, ironically for those of us in the United States, known as Social Security. Everyone in France must pay for mandatory health insurance. Insurance is obtained from non-profit funds. There really isn't any competition and there really aren't many choices. \n\nThere are 5, known as General, Independent, Agricultural, Student, and Public Service. One fund alone covers almost 85% of all people in France. I'll give you 3 guesses which one it is...\n\nThey all have pretty much the same benefits and the same reimbursement. The only people who don't fall into one of these 5 funds are people who have never worked or aren't covered by other sources. For those people, the government has its own plan, financed by taxes, that reimburses better than the other funds for people like the very poor who can't make out of pocket payments.\n\nThese funds funds are financed largely by the public. More than 40% of healthcare spending is financed by payroll taxes and about a third from income taxes. The rest comes from tobacco and alcohol taxes, some transfers from other branches of Social Security, and a small amount from state subsidies. All together, this covers more then three quarters of all healthcare spending. \n\nThis insurance covers a lot: inpatient and outpatient care, specialists, dentists, midwives, diagnostic tests and services, prescription drugs, medical devices, mental health, even health related transportation. Stuff we'd never consider covering in the United States is included. Things like homeopathy, house calls, amazing maternity benefits, and even child care. Social Security covers somewhere between 70 and 80 percent of costs, leaving the remaining amount in individual's hands. But there's also voluntary health insurance, provided by private insurance companies or by the government for those who are poor. This insurance covers many of the costs that Social Security doesn't. More than 90% of the French have voluntary health insurance plans, mostly through their jobs. \n\nAlmost 70% of primary care physicians, and more than half of specialists are self-employed. Again, France is not socialized medicine. About two thirds of hospital beds are owned by public or non-profit groups. The other third are owned by individuals or corporations, and are totally for profit businesses. Doctors make much less than those in some countries, maybe a third of what doctors do in the United States. But they get medical school for free, and they pay nothing for malpractice insurance. And if they agree to charge government approved rates, they get some of their Social Security taxes waived too. So it's not as much of a difference as it first appears.\n\nFunds and budgets are set by the Ministry of Health, which also regulates the number of hospital bed, what equipment is purchased, and how many medical students are trained. The ministry also sets the prices for procedures and drugs, and defines priority areas for future focus and spending. It oversees agreements between Social Security and unions, which represent physicians. Doctors can choose to work outside of these agreements though, and charge more.\n\nPatients have total choice of where they go for care and who they see. Because prices and reimbursement are set at a high level, they can go pretty much anywhere. There is some level of gate-keeping, where patients pay less if they get referrals to specialists before they go there. But those referrals aren't to specific facilities or physicians, they're just permission to choose what they want.\n\nMost people in France pay very little themselves for their healthcare. After insurance kicks in, doctor visits cost one euro or less. A hospital stay can run as little as 18 euros a day, mostly for the room and board. Prescription drugs are like half a euro. All of these together are capped at 50 euros a year. An interesting of the system is that co-pays are regulated by sickness. People who have chronic conditions have all their co-pays waived. In other words, people who use the most care, in general, pay the least.\n\nFrance also allows pretty impressive access. For instance, it guarantees that cancer patients can get any drug they want, even expensive or experimental ones. As I said in the beginning of this episode, the French love their system. In international surveys, it always kicks butt in terms of satisfaction. It also crushes the competition in terms of quality. In almost every international comparison, not matter what methodology you use, France comes out near the top, if not in first place. I've never met, and rarely read anyone who has a bad story to tell about their care there. \n\nThe knock against the French system is that it's expensive. And it is, compared to lots of other countries. Its four thousand one hundred and eighteen dollars per person is well above the OECD average of three thousand three hundred and twenty two dollars in 2011. But it's nothing compared to the eight thousand five hundred and eight dollars we spend in the United States. With respect to spending as a percentage of GDP, France is near the highest in the world at 11.6%. That's beaten only by the Netherlands at 11.9%, and of course the United States at 17.7%.\nSo everyone else in the world may have a genuine case when they claim that France is too expensive, but I laugh at anyone in the United States who says so. \n\nGenuinely universal coverage, comprehensive benefits, complete freedom of choice of providers, top in the world outcomes. There's a good case to by made that the French have the best healthcare system in the world.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/_yF69KVbUaQ"},{"c_name":"healthcare triage","v_id":"m2Jq7vPxYGg","title":"Video Games Don't Cause Violent Behavior","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nEveryone just knows that violence is on the rise, especially among kids. Everyone just knows that violent video games have something to do with it. Except violence isn't on the rise, as we showed in our \"Sky isn't falling episode\". And there's really no evidence that video games are the cause of violence anyway. Step away from my video games!\n \nThose of you who want to read more and see references can go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=55217\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1399238804","likes":"5320","duration":"410","transcripttext":"Everybody knows that violence is on the rise in America. Everybody knows that video games are the cause of violence.\n\nBut violence isn't really on the rise, as we showed in our sky is falling episode and video games, well, there's really no evidence that they have anything to do with violence. That's the topic in this week's Healthcare Triage.\n\n(Intro)\n\nFull disclosure: I love video games, even the violent ones. When my kids came to me last fall to ask if they could work towards an Xbox One when it was released, I had to break the news that dad had already pre-ordered one months earlier. Take that into account when you watch this.\n\nPutting aside my personal feelings about video games, there's still no evidence that they cause violence. People who want to blame violent video games for IRL violence point to a literature that they believe supplies evidence for a link. But almost none of it does. \nMuch of it shows an association or a link between violent video games and aggressive thoughts or violent imagining in the short term. But I counter that reading a sad book would lead you to sad thoughts in the short term, but no one would say that causes depression.\n\nMoreover there's a problem here. Studies in controversial areas like this, are often subject to publication bias. In this case the term describes the fact that it's sometimes much easier to get a study with a positive result published than a negative one. If that's the case then a review of the literature is not really capturing the truth, it's only showing one biased side of the story.\n\nIt's not easy to prove this is occurring, after all it's possible that reality has bias and therefore studies leaning in one direction are showing you what is really true.\n\nThere are analytic techniques we can use though, to see if publication bias is occurring. In 2007 Christopher Ferguson published a meta-analysis of the studies of violence and video games, and found significant evidence of publication bias. In other words a study that shows a link between violence and video games was much more likely to be published than studies that didn't, and this can skew our view of the literature. \n\nBut let's go further into the literature he reviewed. The link between video games and aggressive behavior is really non-existent. The link between video games and aggressive thoughts is more robust, but again, that's not the same thing. Dr. Ferguson offered a number of suggestions in his paper to strengthen the future research in the area.\n\nThen he conducted such a study. He randomized 103 young adults to play no video game, a nonviolent video game, a violent video game where they played the \"good guy\" and a violent video game playing the \"bad guy\". Then they all had to do a frustration test. In other words they had to engage in some activity which would make it more likely that they would get frustrated and perhaps aggressive. And his study showed no link between playing the games and aggression.\nBut those kids who had a history of playing violent video games in real life had fewer hostile feelings and decreased depression during the frustration test. They had fewer hostile feelings and less depression.\n\nIt's not easy to do good research in this area. That's partially because so many people play video games, more over there's so many other things going on and unless you control for them, the associations shown are questionable.\nIn 2012 researchers conducted a study of more that 6500 8th graders and went the extra mile to control for other factors. When they did, they found that the association between video games and behavior became much, much smaller. \n\nPewDiePie will be happy to know that the country of Sweden published their own review of the literature in 2012. They found 161 manuscripts describing 106 unique empirical studies. They found 55 review articles of some sort. Of the 106 empirical studies, 71 were laboratory studies examining how playing video games affected aggression. But of course those studies couldn't measure actual aggression, just how people thought. And thoughts lasted from four to thirty minutes. They couldn't and didn't measure long term actual behavior.\n\n23 of the studies were cross-sectional surveys. Basically they're surveys asking about video game playing and aggressive thoughts. Any links between those things however were washed out when other factors, like mental state, family relationship and self-esteem were considered as well. \n\nThe remaining 12 studies were longitudinal in nature, or surveys collecting data repeatedly over time. 11 of them purportedly showed a connection between video games and aggression. But only three of the 12 had any data on family relationships and mental well being. And of those three, two of them found that those factors accounted for the relationship.\n\nIn other words the Swedes found that the research was flawed and that any connections were not to any actual violent behavior. No evidence at all.\n\nI'm not going to discount the fact that there is gun-related violence here in the United States way more than anywhere else in the world. I'm also not going to discount the fact that here in the US we spend billions of dollars on video games. But lots of countries spend more. \n\nHere's a chart of gun-related murders versus video game spending pr. person in developed countries. Can you see a relationship between video game spending and gun-related violence? 'Cause I can't.\n\nNow look, I'm not saying that violent video games are so devoid of negative ramifications that everyone should go play them whatever their age. Many are not appropriate for kids. They're rated and parents should use discretion and smarts in allowing their children to be exposed to them. I don't think that anyone is advocating that five-year-olds should be playing Call of Duty. And parents who allow that are making a questionable decision. \n\nWhat I often hear in public discussions is that some people believe that video games are so bad for kids that we need to think about going further. What will they do? Come up with sanctions? Ban them? Should we put them in a pile and burn them?\n\nI should come as no surprise that after playing hours of first person shooters people who play them think aggressive thoughts. What matters is if they act on them. When I watch the Walking Dead I admit it sometimes disturbs me. I don't let my kids watch it, but the line is different for everyone. My daughter watched Annie and she had nightmares about Miss Hannigan for a week. She got over it, it's part of growing up.\n\nWhen you get all fired up about video games and kids, what do you want?\n\nSeriously, answer the question. Do you want parents to think harder about how they parent? That's fine, but don't go to Congress to get that done. If you're looking for something from them, it's regulations and laws. What are those? Would you censor? I admit I'm incredibly uncomfortable with that. Many of my favorite books contain violence and the thought of people coming for them is absolutely chilling. Speaking as a pediatrician, as a father, as well as an American. Censorship is the nuclear option. You better have solid evidence to support you before you do it.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/m2Jq7vPxYGg"},{"c_name":"healthcare triage","v_id":"Zir-OXs8Rfo","title":"Pregnancy Myths","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nWe thought about doing myths about Moms, but that might get us in trouble. \"Mothers-to-be\" aren't as dangerous, at least not to any of us making these videos. So this week we present a whole bunch of pregnancy myths. It's amazing how many of those exist. If you learn one thing this week, let it be that if you have a sperm anywhere near an egg - YOU CAN GET PREGNANT. Enjoy.\n \nThose of you who want to read more and see references can go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=55348\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1399844226","likes":"2306","duration":"605","transcripttext":"It's Mother's Day! We talked about doing an episode on myths about moms, but then we thought that could get us in some trouble. So, we decided instead to focus on moms to be. They're not as scary, right? So get ready for some pregnancy myths. This is Healthcare Triage.\n\n(Intro)\n\nPregnancy Myth #1: You can't get pregnant using the \"pull out\" method. \n\nClose contact between a penis and a vagina can lead to pregnancy. Period. Even if you use the withdrawal method, it can still be too late. \n\nBefore the male actually ejaculates or climaxes, there are usually already drops of semen at the end of the penis. These drops of semen help to lubricate the head of the penis and may be present before a man feels close to ejaculating. Even one drop of semen can contain a million sperm, and it only takes one sperm.\n\nSure, there's a smaller chance sperm will fertilize the egg when you start with just one million of them, compared to when you have hundreds of millions as you would in full ejaculation. But it's still possible for one of the sperm out of that drop of semen to make it to the uterus.\n\nFurthermore, the seconds before climax aren't the best time to expect a guy to use good judgment and pull out. Studies show that when a hundred women used this method to prevent pregnancy, twenty three will end up getting pregnant within a year. Even if you pull out perfectly every time, sixteen in a hundred women will get pregnant. Those odds suck. \n\nOther studies confirmed that this is a terrible method of birth control. In a study of over nineteen hundred women in Turkey, 38% of the women using the pull out method experienced at least one unwanted pregnancy.\n\nIn another study from a family planning association, where about 30% of the population reported \"the pull out\" as their method of choice, about a third of people indicated that they or their partner had become pregnant when relying on withdrawal.\n\nPregnancy Myth #2: You can't get pregnant during your period. \n\nFor most women, the chance of getting pregnant during their period is slim, but it's not impossible.\n\nA normal period lasts three to five days, but can be as short as two days or as long as seven days. Most women have periods twenty one to forty five days apart, and the cycle tends to shorten and be more regular with age.\n\nIf your periods are on the shorter end of the spectrum, or if your periods do not occur in a regular cycle or a certain number of days, there's a greater chance that you will ovulate and thus that you could still get pregnant when your period is going on.\n\nUsually a woman ovulates about two weeks before her period, so that's the most likely time that she could get pregnant. But the egg can live for several days in the Fallopian tube or the uterus. And not all women ovulate exactly two weeks before their period. Some women ovulate much closer to the start of their period, and it's possible that a fertilized egg could survive the shedding of the uterus' lining that takes place during menstruation.\n\nPlus sperm can live for like a week inside a woman's body. Sperm that entered during a period might still be around when that period is done. so with both an egg and a sperm present, whether before, during, or after your period, pregnancy is possible.\n\nPregnancy Myth #3: You can't get pregnant if you have sex in the water. \n\nI'm just still amazed this one's a thing. You're just as likely to get pregnant from having unprotected sex in the water as you are from having unprotected sex out of the water. \n\nGranted, if a man ejaculates in the water, it's pretty unlikely that the sperm will find their way into the vagina and up into the egg, but it's not impossible either.\n\nAnd if there are living sperm in the vagina, and living eggs around and some way for them to get together, no matter how small or unlikely, you can get pregnant.\n\nPregnancy Myth #4: You can't get pregnant when you're on the pill. \n\n\nIn the course of a year, five to eight out of a hundred normal women using the pill will have an accidental pregnancy. Even if you use it perfectly, there's still a one in a hundred chance you could become pregnant.\n\n Those odds are better than other methods. Remember how crappy pulling out was? But the odds still aren't zero.\n\nBirth control pills work best when taken every day at the exact same time. If you take the pills absolutely perfectly, it's highly unlikely that you'll get pregnant. \n\nHowever, if you're forgetful about taking your pill at the same time every day, your chance of getting pregnant while using the pill may be slightly higher. And worse yet, missing even one day of the pill can significantly increase your chance of getting pregnant.\n\nBirth control pills are great in that they're much better than almost any other method at preventing pregnancy, but nothing is a hundred percent.\n\nPregnancy Myth #5: You can predict the sex of your baby without a doctor.\n\nWhen a woman gets pregnant, she is inundated with people who are sure they can predict the sex of her baby. They can't. They really, really can't. I've got research to prove it, here we go.\n\nLet's start with weight gain and shape of the belly. One study gathered 104 pregnant women, checked the shape of their belly during pregnancy, and found it had no relationship with the baby's sex. Another study of 500 births found that neither the mother's weight, nor her weight gain during pregnancy, helped determine whether her baby was a boy or a girl.\n\nLet's look at heart burn. There's a study that measured how much heartburn 64 pregnant women experienced during pregnancy. They found that the severity of heartburn symptoms had absolutely nothing to do with the sex of the baby. The study did have an interesting finding, though. The more severe a woman's heartburn, the fuller the head of hair on the newborn. Why? Your guess is as good as mine. But again, it had nothing to do with the sex of the baby.\n\nThere's \"mothers' intuition\". And sorry, pregnant women, you suck at predictions too. There was a study of 212 of you, 110 of whom had a \"strong feeling\" about whether the baby was a girl or a boy. You were all right about half of the time. In another study of 104 women, 55 percent of the women correctly guessed the sex of the baby. But if you calculate the success of the statistics, this was again not any better than they would have done by chance alone. Furthermore, mothers did not do any better whether they made the prediction early, late, or in the middle of the pregnancy.\n\nThere's babies' heart rate. Because some people claim that if the fetal heart rate is 140 beats-per-minute or faster, the baby is a girl. If the fetal heart rate has 139 beats-per-minute or lower, then it's a boy. Yeah....No. Scientific data shows that there is no significant difference in the baseline fetal heart rate of a male or female fetus at any recorded gestational age.\n\nSome people...use Drano? I don't know. This one's just insane, but okay. There are actually people that say that if you mix a pregnant woman's urine with Drano, and it turns green, this means she's having a boy. And if it turns brown, she's having a girl. However, other people seem to think that brown predicts a boy and green predicts a---whatever. Thank goodness two physicians from Vancouver evaluated the Drano test in a study, and they found that it doesn't work. Now matter what color the combination turns, it won't help you predict the baby's sex.\n\nAnd some people talk about morning sickness. And here's the thing. In cases of hyperemesis gravidarum, and I'm talking the very worst kind of morning sickness, which is defined as excessive, unrelenting nausea and\/or vomiting that prevents a pregnant woman from taking enough food or fluids in and sometimes requires hospitalization. Then you may have a slightly better chance of having a girl than a boy. Several studies support this finding. However, the difference isn't huge. We're talking a few percentage points, not a conclusive result. So even if you're puking your guts out all the time, the stork could very well be bringing you a boy.\n\nI've got a test for you that works about as well as any of these. Flip a coin. \n\nPregnancy Myth #6: Flying on a plane is dangerous for your unborn baby.\n\nUnless you've got specific medial problems, or problems with your pregnancy, the American College of Obstetricians and Gynecologists, the biggest group of OB-GYN doctors in the United States, says that pregnant women can fly safely up to 36 weeks of gestation. Now it's possible that the climate of the airplane, including things like low humidity and changes in the pressure of the cabin, do temporarily change an expecting mom's heart rate, blood pressure, and breathing. But not in any way that's been proven to have any detrimental effects on their baby.\n\nOne study followed 222 women, of whom 118 traveled by air at least once during their pregnancy. When the physicians compared the two groups, there were no differences in the length of pregnancy, the risk of having a premature baby, the baby's birth weight, the risk of vaginal bleeding, how often babies were admitted to neonatal intensive care units, or any combination of all of these possible things that could go wrong during pregnancy that I just mentioned.\n\nFinally, some pregnant women fear that exposure to noise vibrations, or even to cosmic radiation in the atmosphere, while traveling by airplane, could be harmful. There's not a lot of scientific evidence that has tested whether these are problems for an unborn baby. But the existing studies of the aircraft noise and galactic cosmic radiation exposure during air travel (much of it done on flight attendants who fly way more than you) indicates that any potential risk to a pregnant woman is so small that it shouldn't be cause for alarm.\n\nPregnancy Myth #7: Bed rest prevents preterm labor.\n\nThe very common practice of bed rest is based on common sense that strenuous work or play could trigger contractions and labor prematurely. However, the best answer to the question of whether bed rest actually prevents preterm labor, comes from four researchers who conducted a systematic review of the literature looking for studies investigating what happens to women at high risk of giving birth prematurely after they're put on bed rest.\n\nThe researchers could only find one study that really investigated the question. But it was a large study, with 1,266 women, and it showed that bed rest did not prevent preterm births. I know that this assertion is going to be met with a lot of angry responses. However, the authors of the systematic review concluded, as do I, that there's no evidence to support bed rest to prevent preterm birth. We have no evidence that it works, and we have one pretty large study that shows that it doesn't seem to work.\n\nAnd you need to remember that bed rest is not necessarily completely harmless. It can cause problems like deconditioning of the muscles. In addition, unnecessarily preventing mothers from working can create significant problems for a family's finances, and even for society as a whole. It can be incredibly hard on families and cause a lot of needless worry. There has to be a benefit, and that's far from certain.\n\nSo whether you got pregnant by accident, or on purpose, happy Mother's Day.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/Zir-OXs8Rfo"},{"c_name":"healthcare triage","v_id":"qMNuxPByEW0","title":"Healthcare in England","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nWe've done the US, Canada, and France. None of them are really socialized healthcare systems. To get at that, we need to go look at a system like that of the UK. More specifically, we're going to talk about England's National Health Service. See what a real \"government run\" system looks like, how it compares to yours, and what's good (and not so good) about it.\n\nFor those of you who want more information or references, go here: \nhttp:\/\/theincidentaleconomist.com\/wordpress\/?p=55536\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1400450229","likes":"2294","duration":"372","transcripttext":"(Music)\n We've done the United States, Canada, and France. None of them are really socialized healthcare systems. To get at that, we need to go look at a system like that of the UK. More specifically, the National Health Service of England is the topic of this week\u2019s Healthcare Triage.\n \n (Opening music)\n \n People like to throw around \"government run healthcare\" as a phrase. Most of the time it is a little hyperbolic. But, in the case of England it's actually pretty accurate. \n \n The National Health Service provides care to everyone. All kinds of care. The system covers everyone who is \"ordinarily resident\" in the country. Basically, that means everyone except visitors and illegal immigrants. But even those groups can receive free care in emergency departments and for certain infectious diseases.\n \n Coverage is pretty broad. Preventive services, inpatient care, outpatient care, physicians, drugs, dental care, mental health care, palliative care, rehabilitation, long term care, even some eye care- it's all covered.\n \n And it's pretty much free to citizens once they pay taxes. Almost everything I mentioned just a few seconds ago has no cost sharing what so ever with the exception of dentistry and outpatient drugs. The latter have a copay of just over seven and a half pounds. Inpatient drugs, on the other hand, are still free.\n \n And there are groups that are exempt, even from outpatient drug co-pays. Kids under sixteen, no co-pays. Kids sixteen to eighteen who are still in school, no co-pays. If you're sixty or over, poor, pregnant, have had a baby in the last year, or have a number of chronic diseases: no co-pays.\n \n It turns out that only six percent of prescriptions actually incur the full copay anyways. So, out of pocket cost are really, really low.\n \n Public expenditures cover more than 80% of all healthcare spending. About 3\/4 of that comes from general taxes, most of the rest from a payroll tax. Over-the-counter drugs and other medical products account for another 10% or so of spending. The rest is mostly private hospital care for elective procedures.\n \n A lot of this is covered by voluntary health insurance. Most of it, part of an employer based medical system. Basically, 10 to 11% of the population has private supplemental insurance. two private insurers cover about 2\/3 of all of those people. \n \n People are required to to register with general practitioners, who deliver the vast majority of primary care. Most GPs work under a national contract with the government and are paid through capitated services, a bit of fee for services, and bonuses for good performance. But unlike most other countries, GPs actually work for the government. \n \n As do specialists. Almost all of them are salaried at hospitals run by the NHS. Patients have more of an ability to choose not only which hospitals they'd like to go to but also which specialists they'd like to see in those hospitals than they had in the past.\n \n About half of specialists treat some private patients in private hospitals as well.\n \n Publicly owned hospitals are run by NHS trusts. They're paid-for-care, nationally negotiated, diagnosis related group rates, or DRG rates. Some carers purchase through the private sector, especially for mental health and elective care.\n \n Finally, the NHS pays for long-term care.  Although, less today than it used to.  Those who make less than 23, 250 pounds are entitled to free state-funded residential care.  Most residential care is paid for by the private sector, though. End-of-life palliative, however, is provided by the NHS in hospices, homes, or even hospitals. \n \n What's great about the NHS? It\u2019s cheap! In 2011, England spent about 9.4% of GDP on healthcare. Compared to the OECD average of 9.3% and the United States' 17.7%. They spent $3,405 on healthcare per person, which is just above the OECD average, but that $3,405 is only 40% of the more than $8,500 per person spent in the US. \n \n The number of physicians per 1,000 population at 2.8 is lower than OECD average of 3.2, but above the United States 2.5; which means they have more doctors than we do. They produce higher than average numbers of medical graduates as well.  \n \n Life expectancy at birth is 81.1 years: above the OECD average. Mortality of from cardiovascular disease is similarly better than average. Cancer mortality is below average, though it's worth acknowledging there have been better than average improvements in the last decade. Infant mortality rates are low as are suicide rates.  Diabetes prevalence is low in spite of the English diet. The percentage of adults who report being in good health is well above average. \n \n And they do this on a shoe-string!  Imagine if we in the United States spent 40% of what we do, right now, on healthcare. We'd have an extra like $1.6 trillion or more to play around with.  We could massive increase spending on tons of other programs and still have a surplus.\n \n There are downsides.  In order to keep spending so low the NHS makes certain decisions other countries might find unpalatable. Some drugs are unavailable.  Technology is nowhere near as prevalent as in other countries. Hospital beds are even scarcer than in the United States. Physicians and nurses work pretty hard.  Hospitals aren't geared towards personal comfort and can be over-crowded, under-staffed, and sometimes even dirty from what I hear. Waiting times can be longer than in other countries, and on many metrics of qualities the UK falls below where they would like to be.  They're working to try and fix some of this. They've tried to increase patient's abilities to make choices. Providers are given more incentives to improve quality. Transparency and accountability are increasing. \n \n But as with almost all these episodes, it\u2019s important to remember that Britain is a free and democratic nation. They chose the NHS and they do so again and again.  They love their healthcare system.  Even elected officials from the conservative parties support it.  There are trade-offs to healthcare systems as there are with so many things in medicine.  It\u2019s easy to demonize socialized medicine for its short-comings.  We can't ignore its financial benefits, though.  The NHS may not always be the best, but it certainly can lay claim to being efficient.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/qMNuxPByEW0"},{"c_name":"healthcare triage","v_id":"wzVaa557I9k","title":"Sometimes Faster is Better","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nIn past episodes, I've talked about how accidents are the number one killer of children, and how car accidents represent a fairly large part of accidents in general. In response, a number of you asked me why we don't reduce the speed limits of many roads nationwide in an attempt to bring that number down. I'm glad you asked. That's the topic of this week's Healthcare triage.\n\nThose of you who want to read more and see references can go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=55712\n\nI also addressed a lot of the questions in comments in an additional blog post. Go here to read it: http:\/\/theincidentaleconomist.com\/wordpress\/healthcare-triage-sometimes-not-always-faster-is-better-ctd\/\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1401128923","likes":"2656","duration":"326","transcripttext":"In past episodes I've talked about how accidents are the number one killer of children. Now car accidents represent a fairly large part of accidents in general, so why don't we just lower the speed limits? I'm glad you asked, that's the topic of this weeks Healthcare Triage.\n\n(Intro)\n\nThere seems to be a widespread belief that faster driving is unsafe, and slower driving is much better. Certainly the fact that we have speed limits reinforces this perception, but were national speed limits set for safety? Hmm, no.\n\nThe National Speed limit of 55 mph was created by the Emergency Highway Energy Conservation Act of 1974.\n\nAs the name implies, the law wasn't a response to safety concerns, it was a response to the OPEC oil embargo of the 1970s. The hope was that driving slower would cause Americans to consume less gasoline, and be less dependent on foreign oil.\n\nMany people, and states, didn't like this, but Congress basically tied federal highway money to compliance with the law, even then a number of states pushed the limits. And in the end though, it was estimated that the law reduced consumption by about 1%.\n\nIn 1987, Congress relaxed some of the limits, and let the speed limit go to 65 mph on certain interstate highways. The law was fully repealed in 1995, and speed limits reverted to state control. Speed limits went up in many states, and concern arose about an increase in accidents and fatalities. After the repeal, the number of fatalities went up by 90 in 1996, and by 60 more in 1997. This wasn't too much of a surprise for those of us who had read a 1992 report by the Federal Highway Administration, which studied 22 states over 5 years, and found that raising the speed limit didn't increase accidents, or even really speeds; people don't really follow speed limits as much as we'd like anyway. And back in 1987, when they relaxed the maximums for the first time, fatalities went down.\n\nBut what we really care about isn't the number of deaths, but the rate of deaths. After all, if more people are driving, or if they're driving for more miles, we should expect there to be more accidents. In 1995, before the National Speed Limit was repealed, the fatality rate was 1.7 per 100 million miles traveled. In 1997, two years later, it was 1.6. There were also lower rates of injuries in 1997 than 1995. The injury rate before the repeal of the speed limit was 143 per 100 million miles traveled. Two years after repeal, it was down to 133. Yes, there are studies that point to the fact that fatalities are higher in states that have raised their speed limits, than in states that haven't, but fatality rates were higher in those states even before they repealed the law. Moreover, the fatality rates in the states that have repealed the law have still dropped since repealed.\n\nNow I'm not advocating that we don't need regulation on the highway, we don't want people driving unsafely, but there is a decent amount of evidence that shows that it's not driving fast that's the real danger, it's driving a very different speeds.\n\nIn a seminal paper published in the America Economic Review in 1985, Charles Lane showed that there's no real association between the fatality rate and the average speed of drivers. As long as the cars are all traveling at the same relative speed, fast or slow, the fatality rate is low. When speed limits are set artificially low then more variation occurs. This can lead to more accidents, it can lead to more deaths. Which leads me to one of the more frustrating bits of policy research asynchrony I've seen. It involves Route 3 in Massachusetts.\n\nThe speed limit for Route 3 used to be 60 mph, and it had been for decades, before the national law reduced it to 55 in 1973. When the law was repealed, the State Highway Commissioner to keep the limit at 55 though, because it was thought that if the rate was raised and then an accident happened, the state might be sued.\n\nMore than a decade ago, Route 3 was rebuilt, and when it was, it was designed for a speed of 68 mph. That means that it's totally safe to drive it at that speed, even in less than desirable conditions.\n\nIn 2006, Massachusetts traffic engineers recommended an increase in the speed limit. Evidently, state police fought it, since they can make a lot of money writing tickets for those who ignore the limit. They won.\n\nBut in 2008, a report was prepared for the Massachusetts highway system. Why? Turns out that the fatality rate on Route 3 is way higher than the national average. They came up with a number of suggestions, including this, and I am quoting; \"A more substantive change is to possibly change the legal posted speed from 55 mph to 65 mph. The thesis is that with speed limits raised, the speed differential will be effectively reduced. Discussion by the RSA team noted that the large speed range could in fact be influencing the frequency of lane-change maneuvers that currently occur increasing the risk of an incident. The more lane-changes that occur increase the possibility of driver error or errant vehicles.\"\n\nI know it makes intuitive sense to many of you, that driving slower is somehow safer, I wish it were that simple. But as with many things in life, what seems intuitive sometimes isn't the case. We have to be willing to let go of our biases. Sometimes, but not always, faster is safer.\n\nTake 1. *drops clapperboard* ALL RIGHT.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/wzVaa557I9k"},{"c_name":"healthcare triage","v_id":"sK-E_d1MGtU","title":"Malpractice, Healthcare Costs, and Tort Reform","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nFor better or for worse, whenever many are asked about how they would help control spending in the US health-care system, tort reform always seems to be one of the first things offered as a solution. That's because there's a malpractice crisis! And tort reform will cure it! Except, neither of those things is really true. Watch and learn why not.\n \nThose of you who want to read more and see references can go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=55842\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1401730463","likes":"1375","duration":"317","transcripttext":"(0:00) When we talk about how to control spending in the United States health-care system, tort reform always seems to be one of the first things offered as a solution. That's because there's a malpractice crisis and tort reform will cure it. Yeah, no. Tort reform is the topic of this week's healthcare triage.\n\n(Intro)\n\n(0:21) The argument goes, that doctors, afraid of being sued, order lots of extra tests and procedures to protect themselves. This is known as defensive medicine. Tort reform assumes that if we put a cap on the damages plaintiffs can win, then filing cases will be less attractive, fewer claims will be made, insurance companies will save money, malpractice premiums will come down, doctors will feel safer and they'll practise less defensive medicine and health-care spending will go way down. Ergo, tort reform equals cost control.\n\n(0:51) But there's not much reason to think this is how insurance companies would act. Florida passed its flavor of tort reform in 2003. Insurance companies had to pay out way less in indemnity payments, and they saw their profits go up 4300% from 2003 to 2010.\n\n(1:06) They didn't pass the savings on to doctors, who continued to see their malpractice insurance rates remain sky high. In Miami-Dade County, an obstetrician pays more than $190,000 for just $1 million in coverage. In other parts of the state, it's about half that amount.\n\n(1:22) Missouri passed tort reform and its neighbor, Iowa, didn't. And then premiums went up faster in Missouri than they did in Iowa. \n\n(1:28) And remember, if doctors don't see a change in their premiums, this whole thing falls apart. They won't stop practising defensive medicine. But I'm getting ahead of myself. Let's start with some basics.\n\n(1:38) Contrary to what you hear, malpractice claims are really uncommon. Out of all hospitalizations, about 3-4% result in injuries due to medical care. Only about 1% of all hospitalizations are due to sub-standard care. And of this 1%, only 2% of those result in actual claims. Of those, about half wind up getting paid, and of those, only 20% are actually valid.\n\n(2:02) But that means that 98% of injuries that result from sub-standard care never result in claims! So one way the malpractice system fails us is by bringing far too few real cases to light. This is a real problem for people who have been legitimately harmed by malpractice. \n\n(2:17) But doctors have some pretty valid complaints about the malpractice system too. Some of them pay unbelievably high premiums to practise medicine. \n\n(2:24) And lots of cases don't have merit. I know cos I've actually done some of the research on this. Somewhere between 61% and 66% of all claims made are dropped, withdrawn or dismissed. Malpractice claims are expensive to defend: on average, about $27,000 each. And defending the many claims that get dropped, withdrawn or dismissed actually costs more each year than defending the few that do go to trial.\n\n(2:48) Moreover, getting sued sucks for doctors. Even when they're found to be not at fault, it takes an emotional, financial, and even a physical toll on them. It shouldn't be minimized. \n\n(2:57) So we've got a system where too few real cases get heard, and too many nuisance cases potentially get brought forward. And here's the big irony: almost nothing about tort reform, which is basically setting a cap on pay-outs, would fix these issues. Tort reform is pitched as a way to save money on health-care spending. That's how it's sold. \n\n(3:16) How much does the malpractice system really cost in the United States? The most recent, comprehensive estimate, which was published in Health Affairs not too long ago, estimated that medical liability system costs were about $55.6 billion in 2008, or about 2.4% of all US health-care spending. \n\n(3:32) Some of that's indemnity payments and some of it's the cost of components of the system, like lawyers, judges, stuff like that. Most of it, however, or about $47 billion, is defensive medicine. So yes, that's real money and it theoretically could be reduced. \n\n(3:45) The question is, will tort reform do that? \n\n(3:48) That's actually an answerable question. You can look at areas where tort reform has already happened and see how things have changed. For instance, you can look at Texas, where non-economic damages on malpractice lawsuits were capped at $250,000 about 9 or 10 years ago. \n\n(4:03) So what happened in Texas to costs of care after the law was put in place? Public Citizen analyzed just that using data from the Dartmouth Atlas of Health-Care. Texas is blue, the nation is red, and the law went into place at the dotted line. If anything, Texas's Medicare spending seems to have gone up faster than the nation's since 2003. Hardly a persuasive argument for tort reform equals cost control. \n\n(4:24) Another thing you could do is compare areas with high and low malpractice premiums and see whether doctors practise differently there. Guess what, to the research! \n\n(4:33) In the same issue of Health Affairs, another study showed that tort reform, which might lead to a 10% reduction in malpractice premiums, which is not small, might translate into a health-care spending reduction of 0.1%.\n\n 0.1%.\n\n(4:49) I'm not going to disagree that the malpractice system needs fixing. I believe that too many claims are filed that have no merit. In addition, I believe many more are never brought to trial that absolutely do have merit. I completely support efforts at reform to address these issues.\n\n(5:04) But this is not the solution to our high health-care spending. Tort reform does not equal cost control.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/sK-E_d1MGtU"},{"c_name":"healthcare triage","v_id":"gKO9s0zLthU","title":"GMOs","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nSince our first episode, you've begged us to cover Genetically Modified Organisms, or GMOs. Honestly, I often can't tell if those of you who are asking us to do this expect us to tell you're they're awesome of the worst thing to happen to humanity. Ever. This is one of those topics people feel so passionately about, that I'm guaranteed to make a lot of you angry, no matter what I say.\n\nBut we never let that stop us. GMOs are the topic of this week's Healthcare Triage.\n\nThose of you who want to read more and see references can go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=56068\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1402332328","likes":"3882","duration":"335","transcripttext":"Aaron Carroll: Since our first episode, you've begged us to cover genetically modified organisms, or GMOs.  Honestly, I can't tell if those of you who are asking us to do this expect us to tell you they're awesome or the worst thing to happen to humanity ever.  This is one of those topics people feel so passionately about that I'm guaranteed to make a lot of you angry no matter what I say.  But we never let that stop us.  GMOs are the topic of this week's Healthcare Triage.\n\n(Intro plays)\n\nGMOs are food made from stuff that's had its DNA changed by genetic engineering.  For the last 12,000 years or so, farmers or scientists have changed plants or animals by breeding them carefully to get the traits they wanted.  Today, scientists have the ability to change DNA directly.  They've been doing so for decades.  How?  Well, first they find some organism that has an ability that they like--maybe there's a bacteria that's resistant to a certain poison.  It does so by manufacturing an enzyme that breaks down the poison before it can do any harm.  Scientists want to make crops that are resitant to this poison.  So they get in the DNA and harvest the gene, then they stick it into the genes of crops.  This really happens!  Science made certain crops more resistant to certain weed killers.  Then, farmers can spray fields indiscriminately and be sure that everything dies but the crops.  This practice could also theoretically make crops that are more nutritious or able to grow in different climates.  There's a lot of potential for good here.\n\nIt's important to recognize that this kind of thing does occur in nature.  DNA mutations are one example of the kind of stuff just occurring naturally.  The science of GMOs just speeds it up, albeit dramatically, and allows for more specific changes than nature usually allows.  GMOs are really, really common.  More than 90% of the soybeans planted in the United States are GMOs.  About 80% of corn and cotton, too.  Well over half of the processed foods that you buy every day have some GMO in them.  \n\nMost of the GMO crops are grown in the United States.  Second place goes to Brazil.  Then Argentina, then India and Canada.  Last year, about 12% of all farmland in the world was growing GMOs.  The controversy comes from the fact that a lot of people believe that GMOs are dangerous.  They think that altering genes is a messy business that can have unintended consequences.  But it's important to remember that genes get altered all the time.  It's how random mutations occur that lead to evolution, plus, how else do you think we're gonna get the X-Men?  Don't take my word for it, to the research!\n\nThe Institute of Medicine and the National Research Council of the National Academies put out a report in 2004 reviewing all of the available data.  They concluded that there was no evidence at all that GMO food posed any greater danger to people than conventionally grown crops.  The European Union conducted its own research into the safety of GMOs.  Let me quote from their report: \"The main conclusion to be drawn from the efforts of more than 130 research projects covering a period of more than 25 years of research and involving more than 500 independent reseach groups is that biotechnology and, in particular, GMOs, are not persay more risky than conventional plant breeding technologies.\"  The American Medical Association agrees.  So does the US National Academy of Sciences, the British Royal Society, and the World Health Organization.  That doesn't make many GMO objectors feel safe.  It likely doesn't make many of you feel safe either.\n\nOne concern comes from people who are worried that there could be new allergies to these foods, and although companies usually do test for allergies, they could do more.  I don't disagree.  But some argue that since it's impossible to test for all allergies, then we should be wary.  That's somewhat defeatist.  You can't test for all allergies for everything, even if it's not genetically modified.  That's a standard no one applies ever.  \n\nSome other people think that GMO crops lead to increased use of herbicides, which could be toxic.  That's worth monitoring and studying, but it's certainly not proven.  But this brings up a larger question about whether GMOs are bad for the environment.  The evidence is conflicted here.  GMOs can, in many ways, lead to fewer chemicals being used, as farmers can use powerful stuff they know won't kill their crops.  Of course, this can lead to the development of resistant strains of pests.  That's happened recently when farmers didn't plant crops liike they were supposed to.  Moreover, it's possible that the genes that we stick into crops can get out of the lab.  This does happen, as it did in Oregon last year, when a strain of wheat that hadn't yet been approved was found growing in a field.  \n\nOf course, and this is critcal, this kind of thing happens without GMOs, too.  Bacteria develop resistance to antibiotics without any genetic modification on our part.  Weeds get resistant to herbicides without out tinkering as well.  Life adapts and evolves.  This debate gets down to arguments about who has the evidence behind them.  But it gets complicated by the fact that much of the research is done by companies that have an inherent conflict of interest.  \n\nThe Genetic Engineering Risk Atlas has collected more than 1,080 studies, in general, about a third of them, no small amount, are independent.  They published a systematic review in 2013.  They looked at the most recent decade of studies to describe the scientific consensus as of now.  I'll quote them: \"The scientific research conducted so far has not detected any significant hazards directly connected with the use of GE crops; however, the debate is still intense.\"  They also said, \"An improvement in the efficacy of scientific communication could have a significant impact on the future of agricultural GE.\"\n\nWe agree.  We hope this video helps.  \n\n(Endscreen)","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/gKO9s0zLthU"},{"c_name":"healthcare triage","v_id":"WtuXrrEZsAg","title":"Healthcare in Singapore","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nSingapore is a small city-state that likely isn't as well known to you as some of the other countries we've discussed before. But they've got one of the most fascinating health care systems around. It's cheap, it's pretty much universal, and it achieves some amazingly strong outcomes. It's also much different in structure than other systems we've covered before. Watch and learn - you'll be glad you did.\n\nIf you want to learn more, there's pretty much only one book you need to read. It's short, it's awesome, and it's still free in Kindle format. It's called Affordable Excellence: The Singapore Health System, and you can get a copy here: http:\/\/www.amazon.com\/gp\/product\/B00CDUS7WS\/ref=as_li_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=B00CDUS7WS&linkCode=as2&tag=dotswyogu-20\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1402939910","likes":"2162","duration":"493","transcripttext":"Singapore is a city state off the southern tip of the Malay peninsula. It's just 276 square miles in area, with a population of about 5.4 million people. The GDP per capita is over $60,000 a year. Which is HUGE. And its government is a unitary, parliamentary, constitutional republic. It's also got one of the most interesting healthcare systems around. That's the topic of this week's Healthcare Triage.\n\n(Intro)\n\nI'm not an international political expert, but sources I trust do not describe Singapore as a dictatorship. Yeah, it only has one political party, but control has not been held by force. The country remains stable because its government has been unusually responsive to the wishes of its people.\n\nFor instance, the Ministry of Health, literally doubled its 5 year budget a couple years ago in response to citizen concerns. Just last year it said it would expand its coverage of the poor, and those with pre-existing conditions. It would reduce out of pocket payments and strengthen control of premium increases.\n\nBut I'm getting ahead of myself. Singapore's healthcare system is remarkable. It spends far, far less than we do. It achieves outcomes that would make most experts weep with joy. And it does so with a combination or public and private inputs that I think many wonks on both sides of the political spectrum would swoon over.\n\nLife expectancy at birth is 2 to 3 years longer than in the UK or the US. Its infant mortality rate is among the lowest in the world, about half of the US, and just over half of the UK, Australia, Canada, and France.\n\nGeneral mortality rates are awesome, compared to pretty much all other countries as well. The W.H.O, which ranked the US 37th in the world in quality in 2000, ranks Singapore 6th. France was number 1.\n\nRemember how the US spent about 18% of GDP on healthcare? Remember how France spent about 11.6%? Singapore spends about 4% of GDP on healthcare.  In 2009, Singapore spent about $2,000 per person compared to the United States more than $7,000.\n\nBut the public and private portions of healthcare spending are very different in Singapore. About 2\/3 of healthcare spending is private, and only about 1\/3 is public. That's even more private spending than in the United States.\n\nSingapore is also a mix of private and public healthcare delivery systems. There are private and public hospitals.  And after that there are lots of tiers of healthcare. If you want to get specific there are five classes: A, B1, B2+, B2, and C. A gets you a private room, your own bathroom, air conditioning, and your choice of doctor. C gets you an open ward, with 7 to 8 other patients, a shared bathroom, and whatever doctor is assigned to you. \n\nIf you choose A you pay for everything. If you choose C, the government pays up to 80% of the costs.\n\nWhat make Singapore unique, and what makes it beloved among many conservative wonks, is its reliance on health savings accounts.\n\nAll workers are mandated to put a decent percent of their earnings into savings for the future. In 2012, workers up to age 50 had to put 20% of their wages into these accounts, matched by another 16% of wages from their employer. \n\nMoneys are divided amongst three types of accounts. There's the ordinary account, to be used to buy a home, pay for insurance against death or disability, or to pay for investment or education. There's the special account, for old age and investment in retirement related financial products, and then there's the Medisave account to be used for healthcare expenses and approved healthcare insurance.\n\nThe contribution to Medisave is about 7-9.5% of wages, depending upon your age. It earns interest, set by the government. And it has a maximum cap, at around $43,500, at which point you divert your mandatory savings into some other account.\n\nYou can use your Medisave account to pay for in-patient care and some out-patient care. There are some gaps in what you are allowed to pay for with it, but those are getting smaller. \n\nIf you can't pay for care out of Medisave, you pay for it out of your regular savings.\n\nSingapore's trying to incentivize people to have children. If you have a baby with a congenital condition, there's now a program to give you additional money. There's a Marriage and Parenthood Package, where you get $6000 cash for each of your 1st and 2nd children, and $8000 for your 3rd and 4th children.\n\nThe government will also match, dollar for dollar, a fairly large amount that you contribute to a child development account. Every once and a while, the government tops up the Medisave accounts if it thinks costs have gone up faster than expected, or if it wants to expand coverage. 2011, for instance, lower and middle income people, age 45 and above got $200 to $700 each depending on income and home ownership.\n\nThe second healthcare program is Medishield. This is a catastrophic illness program. And while it's not mandatory, more than 90% of the population is covered. It's really cheap, from $33 a year for a 29 year old to $372 a year for a 69 year old. \n\nMedishield kicks in when you've covered the deductibles for the year and after you've paid your co-insurance. Those vary by the class of care you choose. Medishield has an annual benefit limit of $50,000 and a lifetime limit of $200,000.\n\nMedishield is expected to cover about 80 to 90% of a hospitalization in a class B2 or C ward. The rest would come out of Medisave. Or you could buy further coverage if you like. This will allow you to get a higher class of care. Some plans are offered by the government, and you can use your Medisave money to pay for those. Other plans are purely private. Sometimes they're offered by employers as benefits.\n\nThe third healthcare program is Medifund, which is Singapore's safety net program. Only citizens are eligible, and it only covers the lowest class of wards, and it's only available after you've depleted your Medisave account and Medishield coverage.\n\nElderly patients are prioritized. The amount of help you get depends on a patient's and a family's income, conditions, expenses, and social circumstances. Decisions are made about that at a very local level.\n\nThere's also Eldershield. Money for Eldershield starts being withdrawn from your wages at age 40, and the system is run by 3 private insurers. You're randomly assigned to one of them, and you'll pay until you're 65. When you need the money to help pay for disability care, you can take up to $400 a month out for a maximum of 72 months for nursing home or home care.\n\nBut why is Singapore so cheap? Some think that it's the strong use of health savings accounts and cost sharing. You may remember from our rant Health Insurance Experiment episode, that people who have to use their own money usually spend less than people that don't. But that's not the whole story here. There's lots of government regulation as well.\n\nThrough the tiered care system and its public hospitals, the government has a lot of control over in-patient care. It allows a private system to challenge the public one, but the public system plays the dominant role in providing services.\n\nInitially, Singapore let hospitals compete more, believing that the free market would bring down costs. But when the hospitals competed, they did so by buying new technology, offering expensive services, paying more for docs, decreasing services to lower class wards, and focusing more on A-class wards. This lead to increased spending.\n\nIn other words, they found that the market fails in healthcare, as it so often does in the United States. So you know what they did? They got the government more involved. They fixed the proportion of each type of ward in hospitals. They kept them from focusing too much on profits and they required approval to buy new, expensive technology.\n\nSingapore heavily regulates the number of physicians, and they have some control over salaries as well. The country uses bulk purchasing power to spend less on drugs. It also has a lot of mandates, as I mentioned before.\n\nThe most frustrating part about Singapore is that as an example it's easily misused by those who want to see their own healthcare system change. More conservative types will point to the Medisave accounts and the stress on individual contributions, but ignore the heavy government involvement in regulation. More liberal types will point to the public's ability to hold down costs and achieve quality, but ignore the class system or the system's reliance in individual decision making.\n\nSingapore's very small. And very homogeneous. It's a little easier to run a healthcare system like that. But what makes Singapore really special is that their system seems to open to change. They seem to recognize that everything has a trade-off. They seem willing to try new things. And they seem willing to change when those things don't work. They don't seem stuck. We can all learn a lot from that.\n\n\n","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/WtuXrrEZsAg"},{"c_name":"healthcare triage","v_id":"DA536xRzlYw","title":"Citronella, Poison Potato Salad, and other Summer Myths","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nTwo announcements. First, HCT is going to VidCon! All of us are going, and we hope that some of you are among the 15,000 attendees that are expect to be there. Aaron will be on a panel on Friday morning talking about \"Making people smarter through online video.\" Come say hello!\n\nSecond, Aaron's next book comes out in less than two weeks. It's entitled, \"Don't Put That in There!\" and it's focused on sex myths. You can pre-order copies all over the place. There's a nice review from Publisher's Weekly. He'll post more information in the days to come on his blog, but it's time for you to start buying. Please.\n\nNow, to business. Warm weather is finally here. Time to bust some summer myths here at Healthcare Triage.\n\nIf you would like references, help on getting them is here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=56275\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1403469949","likes":"1851","duration":"403","transcripttext":"I don't know about where you live, but here in Indianapolis, it felt like summer was never going to arrive. But now that it has, it's time to rejoice in the fact that consistent warm weather is finally here and bust some myths about summer. This is Healthcare Triage.\n\n[Intro plays]\n\nMyth: If you get stung by a bee, you have to scrape, not squeeze out the stinger.\n\nWhen a bee stings you, the stinger can break off. But it can continue to pump out venom, so it's important to get it out since more venom equals a worse reaction. Some people believe that pinching the stinger squeezes the venom sack and effectively gives you a bigger dose of venom.\n\nTo the research!\n\n[To the Research theme plays]\n\nA study published by UC Riverside and Penn State University, published in The Lancet in 1996, settled this topic. They got volunteers to allow themselves to be stung, and then removed the stinger from immediately to eight seconds later.\n\nBy the way, who signs up for studies like this? They should do a study on that.\n\nAnyway, they removed the stinger in one of two ways. They either scraped it out or pinched it out, and then they had another person, who didn't know what method that was used, rate the wheel. There was no difference between the two methods.\n\nHowever, time did matter. Substantial amounts of venom appeared to be delivered in only five to ten seconds. So the take-home message is, don't waste time looking for something to scrape with. Get the stinger out.\n\n\nMyth: If you get stung by a jellyfish, you should have someone urinate on the sting.\n\nTurns out, there's a lot of research on jellyfish stings, much of it from Australia. If you're stung by a Portuguese man of war, a randomized controlled trial published in 2006 in the Medical Journal of Australia showed that putting the sting in hot water - hot as you can stand - may actually reduce the pain. Contrary to what many people advise, putting ice on it did not.\n\nOther people have recommended using vinegar, because it's been shown in some laboratory studies to keep jellyfish stingers from firing. However, it did nothing for those that have already fired. You'll get no pain relief. Even worse, for some jellyfish, cause different jellyfish exist in different parts of the world, vinegar makes things worse. It's really only recommended for tropical jellyfish stings.\n\nAll other remedies, including urine, are unstudied. However, there's no good reason to think that urine would be good. In fact, it dilutes the salt water around the stingers, and may cause more of them to fire. Plus, ewww. Don't do it.\n\n\nMyth: It's unsafe to eat foods with mayonnaise at summer picnics.\n\nIn 2000, a very comprehensive review was published in the Journal of Food Protection looking at all reports and studies on illness and death caused by food pathogens in commercially prepared, or store bought, mayonnaise. There was none.\n\nSee, mayo, gets a bad rap because when people used to make it at home, back in \"oldy times\", they used raw eggs, which can contain salmonella. That would be bad. But commercial mayonnaise is pasteurized and sterile. You're much more likely to get sick from unwashed fruit or vegetables, or under-cooked meat than you are from mayo you bought at a store.\n\nOf course, avoid foods that have been out of the refrigerator for two hours or more. Less if it's really hot out. But don't fear mayo specifically.\n\n\nMyth: Citronella candles effectively repel mosquitoes.\n\nCitronella is a natural or herbal repellent. The candles don't really work that well. A study in the Journal of the American Mosquito Control Association tested citronella candles against plain old candles. They found that those within a few feet of the citronella candles had about 42% fewer bites than those without them. However, those near regular candles had 23% fewer bites.\n\nGet any further away, which almost all of us will be, and you have almost no protection.\n\nThis is a reduction in numbers of bites. You will still get bit. That pales in comparison to DEET, which offers complete, universal protection, like 100%, for 5 hours at usual concentrations.\n\n\nMyth: You can catch poison ivy from someone else who has it.\n\nPoison ivy creates a horrible, itchy rash that oozes across your skin and makes you miserable. When people see the rash on other people's arms, they avoid them as though they have the plague. But how contagious is poison ivy? Can you really catch it from someone else?\n\nThe oil, called \"urushiol\", from the poison ivy plant, is indeed incredibly contagious. If that oil is still on your clothes or on your skin or anything else, someone who touches it can get the rash too. Even after the oil dries, it can still make your skin react.\n\nBut once that oil is washed off, you aren't contagious anymore. No matter how bad your rash looks or spreads or oozes, the rash itself is not contagious. And it's normal for the rash to keep spreading even days after your contact with the plant. This is a delayed reaction from your initial contact with the oil.\n\nIt's normal for the rash to appear 24 or 48 hours after contact with plant oils. How bad the rash gets depends on the sensitivity of the skin and the oil's concentration. Scratching the blisters won't spread the rash. The fluid in the blisters won't spread the rash. You cannot spread poison ivy from one part of your body through anything but the oil itself.\n\nHowever, even dead poison ivy can contain active oil for a long time. And that will give you a rash. Wearing clothing doesn't necessarily protect you because the oil can stick to clothes and you might rub up against it at a later time.\n\nMyth: You have to wait an hour after eating before you can go swimming safely.\n\nThis one had to have been invented by adults who just didn't want to supervise swimming kids right after lunch. Regardless, there seems to be a genuine fear that if you so much stick a foot in the water while food is in your belly, you could be gripped with horrible cramps that would lead to your drowning.\n\nThere's no proof to back up this claim. In our searches of the medical literature, and in searches of other investigating this claim, we can't find any cases of drownings or near drownings attributed to eating. While that doesn't mean it could never happen, there's no proof that this is a real danger.\n\nExpert groups don't really say that you have to wait to go swimming either. Neither the American Academy of Pediatrics nor the American Red Cross has any recommendations at all about how much you should wait after eating to swim.\n\nHow would this work, anyway? Is it because you'll get horrible cramps because your body is so busy trying to digest the food in your stomach? Look, it's true that some of your circulating goes away from your muscles and towards your gut when you've eaten, but it's certainly not enough to cause any big differences.\n\nAnd, as with any exercises immediately after eating, you might feel somewhat uncomfortable after a big meal, but even if you did get some cramps, it's very unlikely that you'd be completely incapacitated. And if you get a cramp, just get out of the water, and give your body a rest.\n\nWhether you've been wolfing down sandwiches or not, you shouldn't be swimming anywhere from which you have no ability to escape if your body is tired or has a muscle cramp or two. Making sure that you or your children only swim in safe places should keep you safe, even if you're the unlucky person who gets a cramp.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/DA536xRzlYw"},{"c_name":"healthcare triage","v_id":"eHxaDQNyfV4","title":"Number Needed to Treat: Treatments Don't Work Like You Think They Work","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nOne of the problems with the way we discuss health interventions is that we see them in black and white. Something is either good for you or bad for you. Things are rarely that simple, though. Moreover, there's \"good for you\" and \"GOOD FOR YOU\". How do you tell the difference? Watch and learn.\n\nAlmost all of the data for this came from the amazing website TheNNT (http:\/\/thennt.com). You can go there to see those and more.\n\nAdditionally, Aaron's new book is out! Please consider buying a copy. He'd really appreciate it! http:\/\/dontputthatinthere.com\/#buy_the_book\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1404687999","likes":"2031","duration":"412","transcripttext":"One of the problems with the way we discuss health interventions is that we see them in black or white. Something works or it doesn't, something is good for you or it's bad for you. Things are rarely that simple though. Moreover, there's good for you and GOOD for you. How do you know the difference? That's the topic of this weeks' Healthcare Triage.\n\n[INTRO]\n\nLet's say your chance of having a heart attack this year is 50%. Let's say I have a new drug that'll reduce that chance to 25%. Since we went for 50% to 25%, I've effectively halved your chance of having a heart attack. That's great, right?\n\nLet's say your chance of developing brain cancer this year is .5%. Let's say I have a new drug that'll reduce that chance to .25%. Again, I've effectively halved your chance of brain cancer. Is that great?\n\nIn both cases I've halved your chance of disease. This is known as a relative risk reduction. You take the new risk and divide it by the old risk. In the first instance it's 25 over 50. In the second case it's .25 over .5. In both cases it's one half or 50%. If the drugs are free and have no side effects, then who cares? You should take any kind of risk reduction. \n\nBut let's say the drugs are really expensive: then are they worth it? Are those two things the same? \n\nOf course not! In the first case, you had a one in two chance of having a heart attack, those are terrible odds. You absolutely want to avoid that. In the second case, you started with a 1 in 200 chance of having brain cancer. Those are much better odds. You're much more likely to take a chance there, especially if the drugs are expensive or dangerous. \n\nRelative risks are somewhat useless but those are the risks most often reported in news stories or trials. That's because they almost always sound more impressive. \n\nWhat we really should care about it absolute risk reduction. To calculate that you take the old risk, subtract the new risk, and then divide by 100. Let's work through these two scenarios I've already given you.\n\nWith respect to heart attacks we went from 50% to 25%: that's 50 minus 25, or 25, divided by 100. That's .25. So our absolute risk reduction is 25%.\n\nWith respect to the brain cancer example, we went from .5% to .25%. That .5 minus .25, or .25, divided by 100. That's .0025 or .25%. \n\nThose numbers aren't even close. The drug for heart attack had an absolute risk reduction of 25%. The drug for brain cancer had a risk reduction of .25%. One is a miracle. The other is much more debatable.\n\nHere's the thing though: almost all the therapies we regard as awesome or necessary have shockingly low absolute risk reductions. They've been sold to you in terms or relative risk reduction but that isn't telling you the whole story. \n\nTo the research!\n\nLast you the New England Journal of Medicine published a study touting the positive effects of the Mediterranean diet. Its conclusion was, and I'm quoting: \"Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events.\" How much of a benefit was actually seen though? The absolute risk reduction of having a stroke, heart attack, or dying was 1.7%.\n\nA study of high-risk smokers published also in the New England Journal of Medicine in 2011, and I'm quoting again: \"Screening with the use of low-dose CT reduces mortality from lung cancer.\" How much though? The absolute risk reduction was .5%. \n\nWhat about aspirin to prevent a first heart attack or stroke. No brainer right? I'm sure all of you have heard of that recommendation. The evidence shows though that the absolute risk reduction is .06%. \n\nBut let's take absolute risk reduction a step forward. That number can be used to calculate what we call the number needed to treat or NNT. This refers to the number of people we need to give a drug or therapy to in order for one person to receive the benefit. \n\nI know that sounds a little odd. But that's because you've been lead to believe that therapies, like benefits, are black and white. They work or they don't. That's now how the world works. In reality things work on a spectrum. Some people receive a benefit and some people don't. And in the vast majority of cases way more people receive no benefit that people who do. \n\nYou calculate a number needed to treat or NNT by taking 100 and dividing it by the absolute risk reduction.\n\nSo going back to the heart attack drug which had an absolute risk reduction of 25%: you take 100 and divide it by 25: you get 4. The NNT or number needed to treat is 4. That is, we have to give four people the drug in order for one person to receive the benefit. In this case, a prevented heart attack. That means three of the four people got no benefit at all. None! Two of them would never have had a heart attack and one had a heart attack anyway. Even this miracle drug is three time more likely to give you no benefit than to do what it's supposed to. \n\nThe brain cancer drug is much worse! The absolute risk reduction was .25%. So the NNT is 100 divided by .25, or 400. That mean we need to treat 400 people with this drug in order to have one person receive the benefit of a prevented case of brain cancer. 399 out of the 400 who take this drug receive no benefit at all. That's fine if the drug is cheap or it has not side effects. But almost no drugs have those characteristics! So you have to ask yourself: are you OK with being one of the 399? Is a 1 in 400 chance worth it.\n\nThe Mediterranean diet, that 1.7% absolute risk reduction translates into an NNT of 61. That means 61 people have to keep to this strict diet for five years for one of them to see a benefit. The other 60 people saw no benefit at all. Is that worth it? I'm not sure. That's for each person to decide. But I bet few people have been told that they're much, much more likely to be doing this for nothing than for something. Lung cancer screening for high-risk smokers with CAT scans has an NNT of 217 to prevent one death. That means that 216 people got scans and all the radiation with no benefit. Worth it?\n\nAnd you need to treat 1667 people with aspirin for a whole year to prevent ONE first heart attack or stroke. That means 1666 people got treated with the drug for a whole year with no benefit at all. None.\n\nSome of you may think any risk reduction is worth it. Maybe. But you're not considering the harms. That's the topic of NEXT week's Healthcare Triage.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/eHxaDQNyfV4"},{"c_name":"healthcare triage","v_id":"e_ytF2-4NkI","title":"Number Needed to Harm: Treatments Can Hurt You","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nLast week, we discussed the NNT, or number needed to treat. I'm sure it made a lot of you upset to realize that many therapies you've been sold as \"awesome\" were, in fact, somewhat incremental with respect to benefits. But another problem is that a lot of those therapies are anything but benign. They come not only with costs, but also with side effects or problems.\n\nWe can quantify harms, too. Watch and learn about NNH!\n\nAlmost all of the data for this came from the amazing website TheNNT (http:\/\/thennt.com). You can go there to see those and more.\n\nAdditionally, Aaron's new book is out! Please consider buying a copy. He'd really appreciate it! http:\/\/dontputthatinthere.com\/#buy_the_book\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1405288851","likes":"1887","duration":"359","transcripttext":"Last week we discussed the NNT, or number needed to treat. I'm sure it made a lot of you upset to realize that many therapies you've been sold as \"awesome\", were in fact somewhat incremental with respect to benefits, but it's gonna get worse.\n\n\n      A lot of those therapies are anything but benign: they come not only with costs, but also with side-effects or problems. We can quantify harms, too. That's the topic of this week's Healthcare Triage.\n\n\n      *Intro Music and Graphics*\n\n\n      Every time you take a drug, or engage in some sort of treatment, *pause* you take a risk. Exercise, for instance, can lead to some injuries. Drugs have side effects, too. They can cause rashes, diarrhea, or other issues. Surgeries can lead to infections, or even death.\n\n\n      Sometimes those harms are calculated in terms of relative percentages; \"your risk doubles!\" and such. As with benefits, we should avoid relative risks. We care about absolute risk increases; those are reported in many trials, too.\n\n\n      *Graphics come on*\n\n\n      Let's make up an example. Let's say that twenty percent of people who take a certain antibiotic develop bad diarrhea. In the same study, ten percent of those who didn't take the drug develop diarrhea, too.\n\n\n\n       If you go with a relative risk, then the drug doubled your chance of having diarrhea. If you go with an absolute risk, then the drug increased your risk of diarrhea from ten percent to twenty percent. So your absolute risk went up by twenty minus ten, or ten percent.\n\n\n      Here's another example. Let's say that point one percent of people who don't have surgery for a certain illness get diarrhea. Let's say that point two percent who have the surgery develop diarrhea.\n\n\n      If you go with relative risk, then surgery doubles your risk of diarrhea. If you go with an absolute risk, then surgery increased your risk of diarrhea from point one percent to point two percent, so your risk went from point two to point one, or point one percent.\n\n\n      In relative risks these are similar, they both doubled the risk of diarrhea, but in absolute risks, they are way far apart. The drug increased your risk by ten percent, surgery increased it by point one percent.\n\n\n      *switches back to view of Dr.Carroll*\n\n\n     Just like we calculated numbers needed to treat, we can calculate numbers needed to harm.\n\n\n      *Graphics come on*\n\n\n     We can calculate the NNH by taking one-hundred and dividing it by the absolute harm increase. Let's start with the drug; it had an absolute risk increase of ten percent. Therefore, the NNH is one-hundred divided by ten, or ten. \n\n\n      *Switches back to view of Dr.Carroll*\n\n\n      That means that for every ten people we give the drug to, one extra person will have diarrhea. Granted, more won't, but it's important to understand that one in ten people will have the bad outcome.\n\n\n      *Graphics come on*\n\n\n      With the surgery, the absolute risk increase was point one percent. Therefore, the NNH is one-hundred divided by point one, or one-thousand. That means that for every one thousand people who have surgery, one extra will have diarrhea.\n\n\n      *Switches back to view of Dr.Carroll*\n\n\n      That's much better than for the drug. Just as NNT is rarely discussed, so is NNH. But we should, because comparing the NNT and the NNH provide people with a simple and objective way to determine if therapy is worth it.\n\n\n      Let's take some examples.\n\n\n      *Graphics come on*\n\n\n      Last week, I told you that the NNT for Aspirin to prevent a first heart attack or stroke was one-thousand, six-hundred, and sixty-seven. But the NNH is three-thousand, three-hundred, and thirty-three for a major bleeding event.\n\n\n      *Switches back to view of Dr.Carroll*\n\n\n      Granted, the chance of you having a benefit is greater than that of you having a harm, but the harms are real. Remember how I told you the NNT for a chest CT to prevent death in one year among high-risk smokers was two-hundred seventeen? I bet a lot of you thought that sounded okay, because it's, well, death. \n\n\n      But what about harms? It turns out that the NNH for a false-positive diagnosis was four. That means one in four people will have a positive scan that turns out not to be disease. \n\n\n      The NNH for unnecessary surgery was thirty. The NNH for a surgical complication was one-hundred and sixty one.\n\n\n     *Graphics come on*\n\n\n      So one in two-hundred seventeen will see a benefit in death prevented, but one in one-hundred and sixty one will have a surgical complication, one in thirty will have unnecessary surgery, and one in four will have a lot of needless worry. Not as clear, now.\n\n\n      *Switches back to view of Dr. Carroll*\n\n\n      So lots and lots of people without know heart disease are put on statins. I recently discussed this in a piece in The New York Times. But statins have never been shown to prevent death in this population; period. The number needed to treat is, effectively, infinity.\n\n\n      The NNT to prevent a heart attack in this population sixty. The NNT to prevent a stroke is two-hundred sixty-eight. Realize that this means that fifty-nine of sixty people who take the drug get no heart attack benefit, and two-hundred sixty-seven of two-hundred sixty-eight people who take it get no stroke benefit.\n\n\n      And there are harms! The number needed to harm for developing diabetes is fifty! The number needed to harm for developing muscle damage was ten.\n\n\n      Think about that: one in sixty may see a heart attack prevented, but one in fifty will get diabetes! You're more likely to get diabetes than to see the benefit. Worth it?\n\n\n      The world is full of examples like this. I'm a pediatrician, and I see a lot of kids with ear infections. When parents want antibiotics, I like to talk in these terms.\n\n\n      You could give ten-thousand kids antibiotics, and none would be less likely to see serious complications. None would have less pain in twenty-four hours. Antibiotics don't work there, and NNT is, again, effectively infinity.\n\n\n      But yes, some kids will see less pain within a week if they take antibiotics. The NNT is sixteen.\n\n\n      *Graphics come on*\n\n\n      We have to treat sixteen kids with antibiotics for one to see that benefit. Fifteen of them will see no benefit at all, and one out of every nine kids given antibiotics, that's the NNH, is likely to develop diarrhea.\n\n\n      *Switches back to Dr.Carroll*\n\n\n      So by giving your child antibiotics, I'm more likely to give them diarrhea, than to reduce their pain in a week. Alternatively, you could give them pain meds, which don't have those side effects, and won't build up resistance in bacteria.\n\n\n      Guess which option my patient's parents choose most of the time. The pain meds; thinking about benefits and harms in this way makes a difference.\n\n\n      *Outro Music and Graphics*\n\n\n\n\n\n      \n\n\n  \n\n\n\n      \n\n      \n\n      \n\n      \n\n      \n\n\n\n\n      \n\n      \n\n      \n\n      \n\n","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/e_ytF2-4NkI"},{"c_name":"healthcare triage","v_id":"bvG4sy_YfXM","title":"Sunscreen Works, If You Use it Right","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nThanks to Audible.com for supporting this episode of Healthcare Triage. You can download a free audio book of your choice at Audible.com: http:\/\/www.audible.com\/triage\n\nWhen I was a kid, I remember people talking about putting on suntan lotion to help them absorb the sun's rays. Those days are over. Too much sun can be terrible for you. Besides the fact that it significantly increases the risk of skin cancer, the sun will age your skin and make you look older, too. Who wants that? Today, we use sunscreen to protect us from the sun. But most of us are doing it wrong. How so? Watch and learn.\n\nThose of you who want to read more and see references can go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=56836\nAdditionally, Aaron's new book is out! Please consider buying a copy. He'd really appreciate it! http:\/\/dontputthatinthere.com\/#buy_the_book\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1405887816","likes":"2743","duration":"357","transcripttext":"When I was a kid I remember people talking about putting on sun tan lotion to help them absorb the sun's rays. Those days are over. Too much sun can be terrible for you.\n\nBesides the fact that it increase the risk of skin cancer, the sun will age your skin and it'll make you look older too. Who want's that!?\n\nToday we use sunscreen to protect us from the sun, but most of us are doing it wrong. How so? Sunscreen is the topic of this week's healthcare triage\n\nRight off the bat before I say anything else I want you to hear that you absolutely should use sunscreen. Exposure to the sun's ultraviolet rays, both UV-A and UV-B causes damage to the skin which can lead to skin cancer. UV-B are rays the ones that cause most sunburn but UV-A rays, which penetrate deeper into the skin, cause the skin to wrinkle, and sag, and get leathery and all those other things we'd like to avoid. So use sunscreen!\n\nSunscreens with an SPF of 15 or higher really do protect your skin against the sun. And I know there was a recent study showing that women that didn't get enough sun have an overall higher mortality than women who do. I've seen all the articles on Facebook. So let's spend a minute talking about that.\n\nTo the research! Researchers followed almost 30,000 women in the Melanoma in Southern Sweden (or MISS) cohort. Over 20 years, 2545 of them died. Women who avoided the sun completely were twice as likely to die as women who sunbathed - scary, right?\n\nFirst of all the absolute rate difference was 3% to 1.5%. Yes the headline said DOUBLED but that's a relative risk, and we all know the difference, right?\n\nNext, even this study found that sun exposure was significantly linked to melanoma risk. That's still true.\n\nThird, observational studies like this are gonna be confounded, meaning that there could be something they're NOT measuring that's causing the results. For instance, is it that hard to imagine that active people are more likely to be exposed to sun than totally sedentary people? And sedentary people can have a higher risk of death.\n\nAnd a lot of the articles you all keep sending me on Facebook seem to be obsessed with the idea that this is somehow caused by vitamin D. This study had nothing to do with vitamin D. There's no measurement of vitamin D, no way to know if anyone is vitamin D deficient, no vitamin D variables at all. None!\n\nFinally, this is not a randomized control trail. There's no causality here. There are, however, randomized controlled trials showing that sunscreen prevents melanoma and skin aging.\n\nSunscreen works. Use it! Comes in 2 types, organic and inorganic. Organic doesn't mean natural, like it does with food, it refers to the chemical definition; organic compounds are carbon-based, and that's true of sunscreens as well.\n\nOrganic sunscreens are absorbed into the skin. There they absorb the UV rays of the sun and then let the energy dissipate in more safe ways.\n\nInorganic sunscreen, on the other hand, are physical blockers. They sit on top of the skin and reflect UV rays away from the body.\n\nThe organic kind are much more common. but both are fine. The problem is that we don't use nearly enough. You should be using at least 1 ounce or the equivalent to 1 shot glass full. This is the official recommendation; you should use 2 mg of sunscreen per cm2 of your body, which equates to 2 finger lengths of product applied to all 11 areas of the body.\n\nYou also need to keep reapplying the stuff to make it work.\n\nRecommendations say that you should put sunscreen on 30 minutes before you go out in the sun to let the ingredients bind to the skin. And then ideally, you should put on another application on 20 minutes later.\n\nStudies show that this early reapplication is even better than waiting 2 hours, which is also a usual recommendation. Then you only need to reapply the sunscreen again if you go swimming, if you towel off, if you vigorously sweat, basically if you are outside in the sun.\n\nI'd like to point out that it's somewhat ridiculous to expect people to follow recommendations like this. They just won't do it. If you stay at the beach all day that would mean you should use up most of your bottle of sunscreen - who does that?!\n\nOne could argue - and I'm happy to raise this argument - that the amount of protection promised on the bottle of sunscreen should be based on the actual amounts that people usually apply to their skin. Not the amount people used in the lab under unrealistic conditions.\n\nUsing average application amounts, the protection from sunscreen is probably half or less than half of what's listed on the bottle.\n\nMoving on, if you believe what you see on TV you might think that you need SPF 1 gazillion to be protected. Is THAT so?\n\nNO! First of all the difference between sunscreens of SPF 30, 45, 50 and 60 is 1.6% or less. Sunscreen with SPF 15 blocks approximately 94% of all incoming UV rays.\n\nSunscreen with SPF 30 block 96% of the UV rays. Sunscreen with SPF 40 block 97% of the rays.\n\nHigher SPF sunscreen does block more UV rays, and they're better in that sense, but they're really not THAT much better, and it's not clear how much better they can get if you go above 50. Not that that's stopped companies from selling sunscreen SPF 100 and more.\n\nAdditionally, I know plenty of people who think that if they use SPF 60 instead of SPF 30 they only need half as much. That's just not true at all.\n\nYou've gained a few percentage points of protection at best and only if you're applying it in huge amounts over and over and over again. Ironically, besides being more expensive, the higher SPF formulations seem to come in smaller and smaller bottles, making using the correct amounts almost impossible. You'd probably be better off using the SPF 15 or 30 by the gallon and then applying it over again and again. THAT'S how you protect yourself from the sun. Stop worrying about the SPF and start worrying about how you put it on - that's how you do it right.\n\nBy the way, this episode of Healthcare Triage is sponsored by audible.com, a leading provider of premium digital and spoken audio information and entertainment on the internet.\n\nAudible.com allows its user to choose the audio versions of their favorite books with a library of over 150,000 titles. We recommend The Sun Also Rises by Ernest Hemingway because it involves the sun. You can download a free audio version of The Sun Also Rises or another of your choice, at audible.com\/triage.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/bvG4sy_YfXM"},{"c_name":"healthcare triage","v_id":"NdarqEbDeV0","title":"Healthcare in Germany","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nThe last international health care system we covered \u2013 Singapore \u2013 got a great response from all of you. This week. We head back to Europe. Specifically, we're going to Germany. Their universal health care system is based on the principles of Bismark, which say that the state should provide only for those unable to provide for themselves. It's a private insurance system, and it's the topic of this week's Healthcare Triage.\n\nThose of you who want to read more and see references can go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=57058\nAdditionally, Aaron's new book is out! Please consider buying a copy. He'd really appreciate it! http:\/\/dontputthatinthere.com\/#buy_the_book\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1406567802","likes":"1742","duration":"447","transcripttext":"[beginning of German National Anthem]\n\nThe last international healthcare system we covered -- Singapore -- got a great response from all of you. This week we head back to Europe. Specifically, we're going to Germany. \n\nTheir universal healthcare system is based on the principles of Bismarck, which say that the state should provide only for those unable to provide for themselves. It's a private insurance system. And it's the topic of this week's Healthcare Triage. \n\nHealth insurance is mandatory in Germany. Everyone has to get it. Before 2009, some of the richest people in Germany could choose not to buy insurance, but that's no longer the case.\n\nInsurance is sold only by non-profit private companies. There are more than 130 of them, and they are also known as \"sickness funds.\" \n\nThere's statutory health insurance or SHI or voluntary private health insurance or PHI. PHI covers some of the benefits that SHI doesn't, but most are minor. It also gets you access to some better amenities, and covers some co-pays for others services. 86% of Germans are covered by SHI, and 11% by PHI.\n\nAs with other universal systems, the insurance is pretty comprehensive. Coverage includes preventive services, hospitalizations, out-patient visits, prescription drugs, mental health, dental care, eye care, rehab, hospice care, physical therapy, even sick leave is covered.\n\nLong-term care is covered by a different insurance, but that's mandatory, too. There are limits to this, though, and some people buy supplemental private long-term care insurance.\n\nAny employed citizens and pensioners who make less than 52,200 euros a year, and their dependents, are covered by SHI. Anyone who makes more than that, or who is self-employed, can choose to get the SHI or buy PHI. About three quarters of people choose the SHI path.\n\nThere used to be no co-pays for SHI, but some were added in 2004. They were about 10 euros for a doctor's visit. But in 2013, most of those were removed again. There are still co-pays, 5 to 10 euros for prescriptions, but lots of drugs are still free, 10 euros a day for hospitalizations, and 5 to 10 euros for medical aids. Deductibles can vary by plan.\n\nThere's no cost sharing at all for kids. And a cap on out-of-pocket payments to 2% of household income. That number is 1% if you have a chronic illness. Out-of-pocket spending accounts for just over 13% of all health care spending in Germany, making it slightly less than Canada, comparable to the US, but much more than France.\n\nAbout 72% of health care spending is public spending, and just over 57% comes from SHI. Employees or pensioners pay an 8.2% tax on the wages up to 47,250 euros. Wages above that are exempt from the tax. Employers contribute an additional 7.3% tax. The contributions are all put together and then spread out amongst the non-profit SHI funds.\n\nIf a fund runs low on money, it can charge the members a bit extra. In 2011, 13 of the 156 funds did so to the tune of about 100 to 180 euros a year. \n\nPHI are considered private health spending. There were 42 of them in 2011. Slightly more than half of them are for-profit. The other slightly less than half are non-profit. The premiums are risk-based entry into the program, meaning that older and sicker people pay more.\n\nEmployers make contributions to PHI as they do for SHI, but the employee contribution is higher. PHI is still tightly regulated by the government to protect consumers, though. Laws also encourage competition between the funds.\n\nDoctors belong to regional associations which negotiate contracts with the various sickness funds. Out-patient docs work in private practice, for the most part, with 60% in solo practices, 25% in dual practices, and the rest in group practices.\n\nMid-level practitioners, like physician assistants, are also employed in most offices. About half of the physicians in SHI programs are family docs, and about half are specialists. Patients can choose any primary care physician, specialist, or hospital that they like. \n\nThere's no real gate-keeping mandate, meaning that people can go to see specialists without first getting the permission of their primary care doctor. Although some funds do offer them, and offer incentives for using those gate-keeping functions, a relatively small number of people do though.\n\nMost docs work in a fee-for-service way based on negotiated rates. There are pre-set maximum numbers a patient for practice, as well as reimbursement points per patient. This means that there are limits on the number of patients and the number of treatments for which a doc can be paid each year. If a doctor goes over, they may not be paid.\n\nAbout half of all hospital beds are in non-profit public hospitals. An additional third are in private non-profit hands. The rest are for-profit, and that percentage has been growing.\n\nMost hospitals salary doctors, who don't also work in out-patient setting. The federal joint committee decides what to cover and how to define quality. The institute for applied quality improvement and research in health care is responsible for quality assurance. Hospitals are mandated to report on 27 indicators, so that they can be publicly compared.\n\nThe country tries to control cost in a number of ways. There are a number of voluntary insurance schemes to do better disease management. Germany uses reference pricing with respect to drugs to try to get citizens to choose cheaper options.\n\nBasically that means that the insurance will pay the amount of a cheapest drug in a class, and if patients want a more expensive one, they have to pay the difference themselves. A lot of research goes into deciding which drugs are most cost-effective.\n\nFinally, regional budgets are used to hold down spending. For instance, if a doctor goes over what's expected for prescriptions for their patients, they are held financially liable. \n\nIn 2011, Germany spent $4495 per capita on health care, or about 11.3% of GDP. That puts it on par with France. It's expensive, except for the US which is insane at $8508 per capita and 17.7% of GDP.\n\nBut unlike some other countries, Germans have great access. More than three-quarters of Germans are able to get same-day or next-day appointments with their doctor, putting them at or near the top of the developed world. \n\nQuality is generally good. Life expectancy at birth is 81 years, making them 24th in the world. That's behind Singapore at 84, Canada at 82.5, and France at 82.3, but ahead of the UK at 81 and the US at 79.8. In infant mortality, it beats most if not all of those countries.\n\nGermany has an above-average number of physicians and nurses. They have a below-average number of CT and MRI scanners. Their preventable mortality rates are well below OECD average. A 2012 study found that Germany outperforms the United States and sometimes the UK in preventing debt. It loses to France, though.\n\nDownsides? Because doctors are spread out so much, there can be gaps in knowledge in what patients have or what's been done. Surprisingly for Germans, it's somewhat inefficient. The pfeiffer service model encourages more care, which some think goes too far. And some doctors hate the system which can penalize them for doing too much.\n\nGermans worry that differences in position salaries may lead to a primary care shortage in the future. Self-employed people also pay a lot for care since they're responsible both for the employer and employee contribution. \n\nFinally, some claim that systems that employ tiers of coverage, specifically the SHI and the PHI, often lead the wealthy doing much better than the not-wealthy. But it's worth noting that the vast majority of people chose the SHI option. \n\nWhat keeps the public and the private option so close in terms of quality cost and benefits? Likely it's the German government, and there's a lot to be said for it.\n\n","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/NdarqEbDeV0"},{"c_name":"healthcare triage","v_id":"ZuiHFg_nfnE","title":"Vaccines and Herd Immunity","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nIn the last few years the rates of vaccine preventable illness have been on the rise. This isn't just something that's happening in the United States \u2013 it's happening throughout the world. Often, these outbreaks begin with unvaccinated people. They spread through them, too. Outbreaks occur because of a breakdown in herd immunity. That's the topic of this week's Healthcare Triage.\n\nThose of you who want to read more and see references can go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=57180\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1407172579","likes":"2633","duration":"276","transcripttext":"   In the last few years, the rates of vaccine-preventable illnesses have been on the rise. And this isn't just something that's been happening in the United States; it's happening throughout the world. Often, these outbreaks begin with unvaccinated people. They spread through them, too. Outbreaks occur because of a breakdown in herd immunity -- that's the topic of this week's Healthcare Triage.\n\n   Here in the United States, vaccines are often required in order for kids to attend school. The government does however respect the rights of individuals to refuse vaccinations for themselves or their children for religious and even sometimes principle reasons. Sure, they make them jump through hoops in order to get these exemptions, but they do occur. When people don't get vaccinated though, that can lead to a breakdown and what we call herd immunity.\n\n   Before we get to that though, we need to review some basic facts about vaccines. The first is that they aren't perfect. While they do significantly decrease your chance of getting a disease if you come in contact with it, there's still a risk that you could get sick. Vaccine success as a public policy depends not only on the added protection that vaccines confer upon those who get shots, but also on the decreased likelihood that anyone's going to come into contact with the disease: that's what's known as herd immunity. Once enough people are immunized, then there really can't be an outbreak. If enough people aren't immunized and someone gets sick, the disease can then spread. More people get it, more and more people are exposed, and that's how you get an outbreak. That's bad. But if lots of people are immunized, then even if someone gets sick, the likelihood of anyone else getting sick and spreading the disease is really low. That's good. And if there can't be an outbreak, then everyone is protected, even those who can't get vaccinated. This is critical, because there are people who are at increased risk for communicable diseases but they can't be given shots for various reasons. Small babies, for instance, are susceptible to certain diseases but they can't be given all vaccines. The elderly can have potentially impaired immune systems and be at higher risks for diseases, and the same goes for all immunal-compromised patients who are always under the thread of infection.\n\n   We get so caught up in the discussion about how vaccines protect those who get them that we sometimes fail to focus on the other important reason immunizations are important: they allow us to protect those who cannot protect themselves. To the research!\n\n   In 1995, the varicella vaccine, or the chicken pox vaccine, was introduced in the United States, and overtime more and more children were vaccinated. In 2011, a study was published in the journal Pediatrics that looked at how the program had affected the number of kids who died from the disease each year. The first thing the paper noted was the deaths from varicella went down significantly from before the vaccine was released to six years later. Then from 2001 through 2007, the rates of death remained much lower with just a few dozen children dying nationally from varicella each year. What's really amazing though is that from 2004 through 2007, not one kid less than one year of age died in the United States from varicella. None. This is remarkable because we can't give the varicella vaccine to babies. It's only approved for children one year of age or older. In other words, all of those really young kids were saved not because we vaccinated them against the illness, they were saved because the other children were. Enough older kids were vaccinated to grant herd immunity to protect the babies from getting sick. \n\n   Wide spread vaccination prevents outbreaks from occurring. It protects all people from getting ill, and when parents refuse vaccines for their children, they leave us at increased risk. In order to combat this threat for the last few years, some schools in New York City have been refusing to allow unvaccinated children to attend school when outbreaks occur, sometimes for weeks or more. Some parents thought that this was unfair and filed lawsuits. Just recently though federal court ruled that schools have this power. The court cited the government's right to make such decisions to protect public health. Parents want to allow their kids to remain at risk by leaving them unimmunized and they get sick, the state has to take steps to prevent outbreaks from occurring. In New York, one of the few children who developed measles earlier this year was an unvaccinated child. The state refused to allow that child's sibling who was also unvaccinated to go to school. That child also developed measles. The school maintains -- and it's hard to dispute -- that allowing that child to go to school would have put everyone at higher risk. \n\n   People who refuse to vaccinate themselves or their children aren't just putting themselves at risk; they're putting everyone else in danger, too. American courts have held, once again, while they may have the right to the former, they don't always have a right to the latter.\n\n","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/ZuiHFg_nfnE"},{"c_name":"healthcare triage","v_id":"aMG1D4Z-4oY","title":"Switzerland's Healthcare Explained!","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nSwitzerland! It's a gorgeous alpine nation of 8 million people. It's a parliamentary republic made up of 26 cantons. I've never been, but I hear great things about it. The country should free to fly us over so we can learn even more. But what I do know about its healthcare system, I'll be telling you in this episode of Healthcare Triage.\nThose of you who want to read more and see references can go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=57335\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1407789643","likes":"1081","duration":"428","transcripttext":"\n\nIntroduction\n\n\n\nSwiss national anthem plays in background\n\nSwitzerland! It\u2019s a gorgeous alpine nation of 8 million people. It\u2019s a parliamentary republic made up of 26 cantons. I\u2019ve never been, but I hear great things about it. The country should  feel free to fly us over so we can learn even more. But what I do know about its healthcare system, I\u2019ll be telling you today, here on Healthcare Triage. \n\n\n\nMain\n\n\nLike pretty much every healthcare system we've discussed, except the United States, Switzerland has universal coverage. Since 1996, the Federal Health Insurance Act has mandated that all residents buy statutory health insurance or SHI from private insurance companies. Everyone, and I mean EVERYONE, is insured. If you moved to Switzerland you have three months to buy a policy, and it's retroactive to your arrival. The country even works to cover undocumented immigrants. \n\nSHI is offered by competing non-profit insurance companies. In 2013 the average premium for a policy with a 300 Swiss Franc deductible for an adult ranged from 3591 Swiss francs  to 6070.\n\n Premiums can vary by geographic region and age. There are three groups: children up to 19, young adults 19 - 25, and adults over 25. Premiums can also vary by acceptance of a managed care scheme. In 2011, more than half of the Swiss chose basic coverage with a managed care insurer. \n\nCoverage, like in most of the countries we've discussed is comprehensive. You get physician services, drugs, medical devices, home healthcare, and preventive services like screening, immunizations, and exams. Unlike some countries, dental care is not covered. Eye glasses and contact lenses are only covered for children. \n\nInsurance is not coupled to employment. Individuals  buy policies and separate ones for their dependents. There's also voluntary health insurance or VHI, which covers stuff not in the basic plans. This can include a better choice of hospitals or doctors, or improved amenities. \n\nSwitzerland has a fairly high level of cost sharing. All plans have to have a minimum-yes, minimum-deductible of 300 Swiss Francs (or about $325) for adults. You can get a plan with a higher deductible to a maximum of 2500 Francs, which comes with the lower premiums.\n\n Plans generally come with 10 percent coinsurance above the deductible for most services, 20% charge for most brand-name drugs and a 15 Franc copay each day you're in a hospital. \n\nPrices are set by SHI, and doctors can't charge more. Maternity and preventive care are exempt from all co-pays, as are children who are in the hospital. There's a maximum on all out-of-pocket spending of about 700 Francs for adults and 350 Francs for kids. \n\nThose at the low end of the socioeconomic spectrum get the same private insurance as everyone else- they just get help buying it. Subsidies are given to the poor on a sliding scale. About 29 percent of people get such subsidies to help them buy insurance. \n\nPublic hospitals are partially paid for by canton-level governments, with insurers paying for the rest. Private hospitals are paid for more by insurers (with minimal public money coming from cantons) for services that public hospitals can't provide. Government also subsidizes many other types of outpatient care, but to a lesser extent than hospitals. \n\nIn 2011, public funding covered about 65 percent of all health care spending. The rest is private. Much of it is from VHI, which unlike SHI, can be for-profit. Often, these can come from different branches of the same insurance company - a nonprofit side for SHI and a for-profit side for VHI. \n\nNow, it's technically illegal for VHI rates and decisions to be based on information known through SHI, but it's reportedly hard to enforce this, so people can get screwed a bit. \n\nAbout 9 percent of health care spending is for VHI. Another 20 percent of spending though, is for out-of-pocket payments. That's very high as countries go- almost two to three times what some other countries are paying. \n\nThe Swiss don't have to have a primary care doctor, and have a lot of choice unless they're part of certain managed care plans. In 2012, 39 percent of doctors were primary care physicians. About 60 percent of them are still in solo practices. If they're not part of a managed care plan, the Swiss have wide access to specialists. Much care is still paid for on a fee-for-service basis. \n\nRecognizing that much of life takes place after work hours, the Swiss actually focus on after-hours care which is managed by doctors' associations. This is unlike a lot of other countries. \n\nThe Swiss system is somewhat de-centralized. Cantons, and not the federal government, are mostly in charge of health care system decisions. They are coordinated by the Swiss Conference on the Cantonal Ministers of Public Health. \n\nQuality is mostly maintained through professional self-regulation. Some quality initiatives have been begun, but almost all at a local or provider level. \n\nCosts in Switzerland are considered high. Of course, this is because they're only beat by the U.S., Netherlands, France, Germany, and Canada with respect to health care spending as a percentage of GDP. So, take \"expensive\" with a grain of salt. The Swiss are attempting to control costs with some regulated competition among the SHI insurance providers. \n\nHowever, this hasn't been working out so well. Many think that the system isn't equalizing risk enough, so some insurers are getting screwed by having to cover a much sicker population. Others think that the ways in which hospitals are funded and insurers are compelled to contract with all providers adds to cost. In 2012, risk equalization was improved. This year, incentives were also modified to increase efficiency. Managed care may also help cost control in the future. \n\nDrugs have to be evaluated for effectiveness and cost before they're covered. Older drugs are reassessed as well. \n\nSo, what do people not like about the Swiss health care system? There's a huge amount of out-of-pocket spending- more than even the United States. In fact, it's pretty much the highest in the world. There's no tax breaks for health insurance, so premiums are completely on the individual. That 20 percent copay for drugs can be pretty stiff too. There's also no special program for the elderly. \n\nSome doctors complain that they feel pressured to keep costs down. If they're prescribing too many drugs or doing too many procedures they can be investigated by insurance companies, and if they can't justify what they've done to the satisfaction of insurers, they can be forced to pay back some of the costs themselves. \n\nBut while physicians might not like the oversight, there's much less bureaucracy on the patient side, and lots of Swiss like that. \n\nThere are plenty of physicians- with 3.8 per 1000 people, compared to an OACD average of 3.1. Unlike some countries, scanning technology is common. \n\nWait times are short. In fact, in a study of 11 OACD nations, Switzerland was the second of the best to see a specialist, and third best to have elective surgery. Access there is amazing. \n\nLife expectancy at birth is 82.6, which is pretty much the highest in the world. Infant mortality, at 3.8 per 1000, beats the OACD average of 4.3 as well. Their obesity rate is 8.1 percent- that's unreal these days. \n\nOverall, in many quality metrics, Switzerland ranks among the best. In fact, it has a legitimate claim to being one of the best health care systems in the world in terms of quality. It costs more, but the Swiss seem to think it's worth it.\n","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/aMG1D4Z-4oY"},{"c_name":"healthcare triage","v_id":"LVQwUj1qP8s","title":"Medical Data Sharing and Your Tracker","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nThe news is full these days of advances in phones and personal devices that will allow us to track and share more and more information about our health. The latest big announcement came from Apple, not long ago, when they announced a partnership with Epic Systems, which is one of the biggest purveyors of electronic medical records around.\n \nEach time I see one of these announcements, it's accompanied by a claim about how any day now, patients are going to be able to share all their amazing data with physicians, and how that's going to change everything. Except it's probable not going to. Why? Watch and learn.\n \nMuch of this is adapted from a piece Aaron wrote for the NYT. All of the links you might want for supporting data and evidence are there: http:\/\/www.nytimes.com\/2014\/06\/17\/upshot\/apples-healthkit-probably-wont-bring-a-new-age.html\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1408379991","likes":"1125","duration":"411","transcripttext":"If it's not clear from the fact that you're watching this on YouTube on the internet right now, I love technology. I'm an early adopter of everything. I've got tons of Apple products, including my iPhone, always sitting right here just off-screen. And I love collecting data! I'm wearing a Nike fuel band right now!\n\nI've also been awarded many grants and published many papers on the use of mobile technology for chronic disease management. I've designed information systems for use in care, and I've studied them as tools to implement decision support. I'm as pro-IT and a pro-mobile technology as they come.\n\nBut I'm really pessimistic about any great leaps forward we might see from announcements like this [see annotation] in the near future.\n\n(Intro)\n\nThe first big problem is one of communication. More specifically, it's a lack of communication between information systems. All over the place! It's shockingly common for doctors' offices, hospitals, and emergency rooms to be unable to share data because they don't use the exact same system.\r\nLet's say Stan's doctor gets totally going with a full-bore EMR. But when he goes to the Emergency Department they have an EMR from a different company, and no way for the two systems to communicate easily. They discharge Stan home, but no data is transferred to his primary care doc. Later, when he follows up, his doctor sends him to a lab for tests. They too have a different system and it stores data in different fields than his doctor's. Turns out he needs a simple procedure at an ambulatory surgery center, with a fourth way of doing things.\n\nThen [Stan's] primary care's EMR vendor goes out of business. They need to buy a new one but there's no good way to export all the data and import it into the new system, so they have to pay someone to manually enter all the data from one to the other.\r\nThis isn't all by chance. It's actually in companies' best interest that their systems don't talk to others' easily; that way when you need to expand you need to keep adding on pieces from them and not from other companies.\n\nBut if that's the case, where are the awesome cost-savings? Where are the efficiencies? Where are the reductions in medical errors?\n\nAll these new announcements do is throw more data in new formats into the mix. There's no reason to believe it will be any different this time around.\n\nBut the issues with technology and data standards are nothing compared to the issues surrounding people themselves. In 2009, Charles Freeman (a giant in the world of medical informatics) proposed a fundamental theorem of bio-medical informatics. It stated that a human working with medical technology is better than a human alone, but the first corollary was that people are more important than technology. So many people ignore this but you can't minimize it's importance.\n\nReal change happens when people change their behavior, not when new technology appears.\n\nAnd there are lots of issues with people here.\nLet's start with patients. First of all some people are private; they don't want to share all that data with their physicians.\n\nLook, some patients don't do what we tell them. For instance, research shows us that adherence to recommendations for insulin regiments is generally poor. Doctors know this. Patients know this. I've even done some of this work myself: we were interested in using mobile technology like cell phones to help adolescents with diabetes share their glucose values with their physicians. Did it work? To the research!\n\nWe interviewed adolescents with diabetes, and their parents. One of the greatest concerns was that they were skeptical of sharing too much information. [graphic ends] No one likes to be nagged. In fact, one of our biggest concerns in doing further research was that if the technology got patients \"caught\" for not doing what they were supposed to they'd stop using it. That would defeat the purpose.\n\nFurther we need to be realistic about who's going to use this technology and how much it can help them. The people least likely to use smart phone technology are the elderly and the very poor. These are two groups who are most likely to be in poor health and need the most assistance. We should give it to them! And there's little reason to believe that this will be the way to get it to them.\n\nBut the barrier even bigger than this is doctors. No endocrinologist, no matter how awesomely dedicated they are, wants to know every glucose value of every patient every day. No primary care physician wants to know every patient's daily weight. No one wants to know every patient's hourly blood pressure measurement. Physicians are totally stressed by their workloads already. Research shows that over a third of doctors have reported personally missing test results that led to care delays to their patients, because [the doctors are] already overwhelmed by alerts and data. More data isn't the answer.\n\nWe could be smarter about how we aggregate the data. We tried that in our own research where we created new systems that automatically monitored patients' data on glucose values. We then used the system to get a Nurse Practitioner to notify a patient if something looked wrong. The results were a modest success at best, and only with respect to short term outcomes-- believe me, I'm not in the business of underselling my own work. Creating systems like these are difficult for offices to do. They require a lot of time to contact patients, and they aren't cheap.\n\nDoctors don't want to spend lots of time or money on something until lots of patients demand it. They aren't going to change the way their offices function for a few early adopters, and until they do so, the people using this products like this will have no one using the large amount of data they're collecting and sending. \n\nIt's so, so, so hard to change physician behavior. It's even harder to get them to use electronic medical records. Before the High Tech Act, back in the \"dark ages\" of 2006, only 11% of office space physicians had a EMR that would be classified as a basic system. After a ton of spending that's gone up to 48% in 2013. And that's a basic system, not one that's ready to implement data sharing from patients' iPhones!\n\nMoreover, and this can't be minimized, one of the most significant factors of leading to physician dissatisfaction isn't reduced salaries or malpractice- it's interacting with an electronic health record. \nThey hate them, and they often have good reasons for doing so. EMRs often don't work as advertised, they're expensive, and they can be difficult to use and maintain, they can interfere with clinical practice, they can decrease efficiency, they can even get in the way of a good doctor-patient relationship.\n\nI could spend hours talking about the studies that show this to be true and I encourage you to review the references below. Until all of these problems are fixed the likelihood of massive expansion into things like Apple's 'health kit sharing' seems small, no matter how excited those promoting them may be.\n\nThere's a paper in the Journal of Modern Healthcare that's entitled, 'Shared Information Can Revolutionize Healthcare'. I want to quote to you from the abstract: \"Hospitals soon may learn the value of shared information technology. The idea of \"community health information networks' is picking up steam as payers and policymakers look for ways to control costs and measure the quality of care.\"\n\nThat paper was published in 1992. Should happen any day now.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/LVQwUj1qP8s"},{"c_name":"healthcare triage","v_id":"qCuxqA0qFZY","title":"HCT News #1: Eat More Salt","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nHealthcare Triage is almost one year old. To celebrate, we're going to give you\u2026 more Healthcare Triage. Two episodes a week. Monday will be a traditional episode, full of all the detail and knowledge you've come to expect.\nBut a second episode, on Friday, will be more of a newsy episode. We're going to cover topics that have been floating around social media and your favorite websites. It's Healthcare Triage News.\n \nToday's episode is about Ebola and salt. Enjoy!\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1408714612","likes":"1898","duration":"251","transcripttext":"Healthcare Triage is almost one year old. To celebrate, we're going to give you more Healthcare Triage, two episodes a week. Monday will be a traditional episode, full of all the detail and knowledge you've come to expect from us, but a second episode, on Friday, will be more of a news-y episode. We're going to cover topics that have been floating around social media and your favorite websites. This is Healthcare Triage News.\n\n[Healthcare Triage News opening theme]\n\nOur first story is ripped from social media. Ebola. Just the name's enough to send panic through the hearts of people all over the world. Here's what you need to know. People infected with Ebola can get serious fever, vomiting, diarrhea, and even bleeding from orifices all over their body. Eventually, they can develop multiple organ failure, which causes death. There's no real treatment in terms of a cure, but that doesn't mean that medical care can't help.\n\nWe can still provide supportive care, which might include hydration, nutrition, and blood pressure support. We can also make sure people don't get secondary infections while they're sick. Those can really be dangerous. This may seem simple, but, unfortunately, outbreaks often occur in settings without the resources necessary to provide even that basic supportive care. It's why two Americans were recently flown home with the disease: to get better supportive care here.\n\nThere are five types of Ebola viruses. They have a range of survival rates. The most recent outbreak is of the Zaire variety, and it seems to have a mortality rate of about sixty percent, meaning that sixty percent of people that get it die. That's the rate in Africa. It may be lower for those treated here in the United States.\n\nThe good news is that Ebola doesn't seem to mutate much. In fact, it's pretty much the same virus that it was when we first found it in 1976. Unlike a lot of viruses, people aren't generally infectious until they're pretty sick. That means there's not much chance people will be spreading it around without knowing it. You also need to come into contact with bodily fluids to catch it, so there's not much chance of getting it from being in the same room or an airplane with someone else. Because hospitals in many developed nations have the resources necessary to quarantine patients with infections, it's unlikely an outbreak of Ebola could spread too far before it was contained. The same is not true, unfortunately, in many of the countries currently affected.\n\nOur other story is designed to make me go, \"Argh!\" It comes to us from the New England Journal of Medicine, where a recent issue focused on salt in our diets. For a long time, we've notice that high salt intake has been associated with high blood pressure. It's also been associated with an increased risk of death or cardiovascular events like stroke, heart attack, or heart failure. Because of this, many of us have called for us to drastically reduce our salt intake. The FDA calls for us to eat no more that 2.3 grams of sodium a day. The WHO says it should be 2 grams, and the American Heart Association says less than 1.5 grams a day is ideal. The average American consumes about 3.4 grams of sodium each day. But the Institute of Medicine warned us, and I'm quoting, \"...the evidence on health outcomes is not consistent with the efforts that encourage lowering of dietary sodium in the general population to 1,500 mg\/day. Further research may shed more light on the association between lower -- 1,500 to 2,300 mg -- levels of sodium and health outcomes.\" \n\nThis study showed us that, compared to people who eat three to six grams of sodium a day, people who eat more than seven grams a day do have a significantly higher rate of death or cardiovascular events. So, yes, they should eat less salt. But the study also found that again, compared to people who eat three to six grams of sodium a day, people who eat less than three grams a day have even higher rates of death or cardiovascular events. In other words, a very low-salt diet was associated with a higher risk of death or cardiovascular events than the high-salt diet, yet all of these groups keep recommending that we eat such a low-salt diet. There's no evidence that this is a good idea. There's a growing body of evidence that it's a bad idea. It's time for us to reconsider those recommendations.\n\n[Healthcare Triage News closing theme]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/qCuxqA0qFZY"},{"c_name":"healthcare triage","v_id":"sqfw2C_LBZ0","title":"You Probably Don't Need to Be on that Gluten-free Diet","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nThis is another one of those videos that I expect many of you to hate. Gluten is surprisingly polarizing. Of course, most of the evidence that many of you will throw at me are anecdotes. And we all know that the plural of \"anecdote\" is not \"data\". So let's talk about gluten, and whether a gluten-free diet is for you. \"Spoiler\" \u2013 for the vast majority of you, the answer is \"no\".\n \nFor those of you who want to read more or see references, look here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=57683\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1408977004","likes":"3690","duration":"528","transcripttext":"(00:00) This is another one of those videos that I expect many of you to hate. Gluten is surprisingly polarizing.\n\nOf course, most of the evidence that many of you will throw at me are anecdotes. And we all know that the plural of anecdote is not data.\n\nSo let's talk about gluten. And whether a gluten-free diet is for you.\n\nSpoiler... For the vast majority of you, the answer is 'no.' This is Healthcare Triage.\r\n(Intro)\n\n(00:27) What is gluten? It's the main structural protein complex of wheat, barley, rye, and triticale (which is a cross between wheat and rye).  That's a problem, because the stuff is in almost everything. Wheat is in bread, soup, pasta, cereal, sauces. and lots of other stuff; barley is in food coloring, malts, and beer! Rye is in a lot of stuff too. Eliminating gluten is not easy. \n\n(00:50) Let's start with the fact that people on gluten-free diets are usually trying to treat one of three things: celiac disease, wheat allergy, or a gluten sensitivity. These are not the same thing.\n\n(01:00) Let's do celiac disease first. It's basically an immune reaction to gluten. When it hits your small intestines, something makes your body go a little nuts; it activates the immune system to try and fix the problem but it does more harm than good. Over time, the lining of the small intestine gets chronically inflamed and you can't absorb all the nutrients you need. Celiac disease can cause weight loss, bloating and diarrhea. As other parts of the body are denied the nutrition they need you can develop other problems too. \n\n(01:30) One of the issues with diagnosing celiac disease, though, is that most people don't have any real symptoms that they notice. About 20% of people with celiac disease have constipation, and 10% are obese. As many as 75% of kids with celiac disease are overweight or obese at the time of diagnosis.\n\n(01:48) Some people are more likely to have it than others. It runs in families, so people related to people with celiac disease are at higher risk. Celiac disease is also more common in people with Type 1 diabetes, Down syndrome, and Turner syndrome. It can also be more common among those with auto-immune thyroid disease, or microscopic colitis.\n\n(02:03) There are blood tests that can help in the diagnosis of celiac disease, but the real gold standard is an endoscopy. Doctors will stick a camera and tube down your throat to look at your small intestine; they'll take a biopsy. That's the most definitive test for celiac disease. The only real treatment for celiac disease is a gluten-free diet. There is no cure. You can start to feel better pretty fast on the diet, but complete healing of the small intestine could take up to years. If you start eating gluten again it could all start over.\n\n(02:31) A recent study estimated that the prevalence of celiac disease in the United States was 0.71%, meaning that about one in a hundred-and-forty people have it. That's similar to the rates of the disease in most European countries. Unfortunately, most cases are under-diagnosed which is why there's been such a rush of publicity lately. We know it's there and too few people are being diagnosed.\n\n(02:52) I'm sympathetic to the problem here. Given the statistics I just mentioned, about three million Americans are likely to have celiac disease and tons of them have no idea. A study published in 2005 in the Journal of General Internal Medicine surveyed more than 2400 patients with celiac disease. Only 11% of them were diagnosed by their primary care providers; the rest were diagnosed by somebody else. They also surveyed primary care physicians, and only 35% of them had ever diagnosed celiac disease.\n\n(03:21) Research has also shown that doctors will often misdiagnose celiac disease as other things. People diagnosed with irritable bowel syndrome are four times as likely to have celiac disease than the general public. Patients diagnosed with iron and folic deficiency are also more likely to have celiac disease. There's even a case of autism that turned out to be celiac disease. When that happens, people start self-diagnosing. They put themselves on a new diet and say that they feel better, then they declare that gluten-free is awesome.\n\n(02:49) That's not how research or medicine works. If you think you have celiac disease, you need to see a doctor; only they can make the diagnosis. And that's celiac disease. Let's be clear, if you've got that you absolutely need a gluten-free diet. Do it. But lots of people who go on gluten-free diets don't have celiac disease; some of them have wheat allergy.\n\n(04:10) Real wheat allergy is pretty rare. In Europe the prevalence is about 0.1%, which makes it rarer than allergies to cow's milk, eggs, soy, peanut, tree nuts, fish, and shellfish. In Asia it's between 0.08% and 0.21%. In the United States it's between 0.4% and 1%.\n\n(04:30) And lots of these numbers are for children, and many of them outgrow the allergy. So wheat allergy is less common than celiac disease, especially in adults. Even then, there are people who believe we are way over-diagnosing allergies. But, if you've been diagnosed by a doctor as having a real allergy to wheat, then yes, you should avoid that too.\n\n(04:50) But the groups I've previously discussed are relatively rare. It's the rest of you who need to pay attention.You're the ones with gluten intolerance. It's not an auto-immune problem like celiac disease or an allergic problem like wheat allergy; it's a different group with some symptoms that have been attributed to gluten. And a couple years ago there was some research to support you.\n\n(05:11) In 2011, a study was published in the American Journal of Gastroenterology. They randomized 34 patients who claimed gluten-intolerance to receive either a gluten or gluten-free diet, in the form of two bread slices. They found a significant difference in symptoms, pain, bloating, tiredness, and satisfaction with stool consistency. Their conclusion was, and I quote, \"non-celiac gluten intolerance may exist, but no clues to the mechanism were elucidated.\"\n\n(05:38) This set off a firestorm. Tons of people started blaming things wrong with their life or health or stool consistency on gluten. Millions gave it up and billions of dollars were made on new diets and fads. \"Gluten-free\" became huge, and even lots of my friends began buying into the idea that gluten was horrible. You have to remember that this was a really small study of 34 people. The results were not a slam dunk in terms of absolute improvements, so lots of people argued against its findings.\n\n(06:06) Rather than rest on his laurels though, Peter Gibson, one of the main researchers involved, continued to study this. He set up a better study to confirm his findings. This time he used a much more sophisticated study design. He included cross-overs of various levels of gluten. His findings this time, and I quote, \"in a placebo-controlled cross-over rechallenge study, we found no evidence of specific or dose-dependent effects of gluten in patients with non-celiac gluten sensitivity placed on diets low in FODMAPs.\"\n\n(06:39) In other words, the gluten-free diet made no difference. He went further. In another study just recently published, he and others studied people who claimed that they had gluten-sensitivity. Of the 147 patients they looked at, 72% didn't meet the criteria for gluten-sensitivity, despite having made the self-diagnosis or been given it, most often by non-physicians. In 25% of these people, their symptoms were poorly controlled even with a gluten-free diet.\n\n(07:08) Look, I can't prove gluten-sensitivity doesn't exist; it probably does but it's likely pretty darn rare, nowhere near the one quarter of consumers who are demanding gluten-free products. Why?! It's not going to do almost all of you any good at all. If you're avoiding gluten because it leads you to eat fewer processed foods, fine. If you do it to eat fewer carbs and more proteins and vegetables, fine. But if you're substituting gluten-free products for similar gluten-containing products then the joke may be on you.\n\n(07:36) A recent article in the Wall Street Journal showed that gluten-free products sometimes are higher in carbs and sodium, and lower in fiber and protein than some gluten-containing products. Gluten-free cereals can have significantly fewer vitamins and minerals as gluten-containing cereals.\n\n(07:52) And they're making some people a ton of money. Sales of products containing a gluten-free label in the United States have gone from $11.5 billion in 2010 to $23 billion last year. $23 billion! Worldwide, companies sold $2.1 billion of gluten-free dog food last year! \n\n(08:10) If you have celiac disease you need to be on a gluten-free diet. If you have a proven wheat allergy you need to avoid wheat. But everyone else: there's almost no evidence that a gluten-free diet will do you any good at all. It will, however, make some of the food companies a ton of money. If that's your goal then well done, I guess.\n\n(08:30) As always it's best to discuss your individual case with your physician. If he or she recommends a gluten-free diet, ask for the evidence behind the decision. I bet there won't really be any.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/sqfw2C_LBZ0"},{"c_name":"healthcare triage","v_id":"G5qMC_hfGGQ","title":"Healthcare Triage News #2: Pot, Foul Language, and Pain","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nWhat are people talking about this week? Better yet, what should they be talking about? We're talking about marijuana and obscene language.\n \nThe story on cursing I mention can be found here: http:\/\/www.vox.com\/2014\/8\/26\/6066069\/swearing-science-obscenity-research\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1409324892","likes":"1434","duration":"238","transcripttext":"What are people talking about this week?  Better yet, what should they be talking about?  We're talking about marijuana and obscene language.  This is Healthcare Triage News.\n\n[Opening theme]\n\nYou may remember from our episode on marijuana that it's not nearly as dangerous, per se, as legal substances, such as alcohol or tobacco, but it's also much safer than many legal prescription drugs like opioid analgesics.\nChronic pain is unfortunately common, and the number of people who are on prescriptions for relief from that pain, with opioids, has almost doubled in the United States in the last ten years.  Unfortunately, misuse of opioids, or disorders from their misuse, and deaths from overdoses have also gone up significantly too.\nIf only there were some other, safer drugs available to treat chronic pain.  \nAs of this summer, almost half of the states in the U.S. have made medical marijuana legal.\nResearchers looked at data from 1999 to 2010 to see if making medical marijuana legal affected the overdose death rates from opioids.  Before 1999, only California, Oregon, and Washington permitted its use.  What's up with the west coast?\nOver those years, ten more states legalized medical marijuana. Here's what researchers found: States with legal medical marijuana had an opioid overdose mortality rate that was 25% lower than states without it.  Not only that, but the association got stronger over time.\nIt was estimated in the study, that in 2010 alone, medical marijuana laws were associated with more than 1700 fewer deaths than expected from opioid overdose in the United States.  This wasn't a randomized controlled trial.  Laws are different in the different states, and it's not clear if marijuana controls pain as well as opioids, but this certainly should make us think hard about what we consider safe for pain control.\nAnd the good news, and second story, is that we may have some better answers in the future.  One of the reasons we have so little information about the medical effects of marijuana is that research on it is hard to get approved.  For a long time, the federal government has only allowed 21 kilograms of it to be legally grown a year for research purposes.\nTurns out that the University of Mississippi has an exclusive contract to grow marijuana for research in the United States.  There is a secure plot of land where crops are allowed to grow.  That would be a cool field trip, no? \nIn big news this week, the DEA has increased it order from 21 kilograms to 650 kilograms.  This has a lot of researchers excited that they might get to do some better studies.  It might also signal that the federal government is considering accepting medical marijuana nationally.  But don't get too excited.  There are still tons of hurdles left to get there.\nOur final story of the week comes to us from our friends at Fox.com.  Joseph Stromberg wrote about five surprising things about swearing.  Link to the article down below.  For instance, swearing appears to be becoming more common, but the most interesting of the five concerned a study about swearing and pain tolerance.\nResearchers got 67 undergraduate students to put their hands in ice cold water for as long as they could.  Only ten of the made it to five minutes.  They all did this twice, and on one of the two times they were randomized to swear.  They could pick any curse word they wanted to, and they were told to repeat it while they kept their hands under the ice cold water.  One participant was excluded because he or she couldn't come up with a curse word.  Some people.\nAnd get this.  Participants who swore were able to withstand the pain for significantly longer.  They also reported significantly less pain overall.  The effect was seen regardless of sex or gender.  The only people who swearing didn't work for were males who had a tendency to catastrophize.  Not that we know anyone around here like that.\nSo it turns out that swearing might have a hypoalgesic effect, and the popularity of all those foul-mouthed HBO dramas might be good for our collective pain tolerance.  Maybe we shouldn't get so down on people who curse when they hurt themselves, and maybe my kid shouldn't get so angry with me for what I say when I walk into walls, which happens far more often than you think.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/G5qMC_hfGGQ"},{"c_name":"healthcare triage","v_id":"5Ezs1DPUKXA","title":"Systematic Review and Evidence-Based Medicine","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nYou've probably heard of \"evidence-based medicine\". It's the idea that we practice based on research and data. There's another way of practicing called \"eminence-based medicine\". It's the idea that we listen to the person who's been around the longest or who has somehow managed to be labelled the expert.\nIt used to be that such a person would periodically get to write a review article in some journal, and that would be how everyone learned what to do in medicine. That's a problem. We've got a solution. Systematic reviews!\n \nFor those of you who want to read more or see references, look here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=57771\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1409597047","likes":"1362","duration":"376","transcripttext":"You've probably heard of evidence-based medicine. It's the idea that we practice based on research and data. There's another way of practicing called evidence-based medicine. It's the idea that we listen to the person who has been around the longest or has somehow managed to be labeled an expert. Used to be that such a person would periodically get to write a review article in some journal and that would be how everyone learned what to do in medicine. That's a problem. We've got a solution. That's the topic of this week's Healthcare Triage.\n\n[Healthcare Triage opening theme]\n\nSee, the issue with a review article is that it's just an opinion, and just like op eds and actual news are kept in separate parts of a newspaper, so too are review articles and research. \"But Aaron,\" eagle-eyed viewers are shouting, \"you've cited review articles many times on Healthcare Triage. Have you been relying on opinion?\" No! I've relied on systematic reviews, and those are different.\n\nIf you look at an article in a research journal, you'll see that they all have a basic structure. First up is the background. It's a review of what we know about a subject, as well as what we don't know. It sets the stage for the paper you're about to read.\r\nNext comes the objective. It's short, and it tells you what the study you're reading wanted to do. If you've written the background well, the objective makes total sense.\r\nThen comes the methods. That's the section where you explain how you did the study. Depending on the study in question, this can be simple or complex. But the key is that it has to be transparent enough that someone could replicate your study, 'cause good science is science that's been tried repeatedly.\n\nNext are the results. That's where you talk about what you found. Usually, there's a table 1 that describes the group you looked at using your methods. There's also usually other key tables or figures that show what you found. The accompanying text has the rest of the details.\n\nFinally, there's the discussion, where the authors place the results in context. What do they mean in the larger picture? What are the implications? Additionally, this is where you usually talk about the limitations of your research. All studies have them, and good authors acknowledge them and talk about how they could affect the findings.\n\nAnd that's it! Systematic reviews are research because they follow this structure. They have a method section. They're reproducible. Basically, researchers doing systematic reviews set out to find all the relevant research in a field and then combine it together in one big collection. But by stipulating how they search for studies, how they determine what studies were good enough for inclusion and what they pulled from them, systematic reviews allow others to judge the merits of the work and to test its conclusions if desired.\n\nThese are the kinds of studies I bring to Healthcare Triage. They're different. One of the first pieces of research I ever did was a systematic review. It was about gastroesophageal reflux in infants. \n\nYou may have heard of gastroesophageal reflux, or GERD. It's when acid in your stomach backs up into your esophagus. It's really bad heartburn. In adults, we usually treat it with dietary changes and medications. In infants, though, it's a totally different animal. About half of all healthy infants will vomit more than twice a day. About ninety-five per cent of them completely get better without treatment. Infants vomit more often because they have an all-liquid diet. They have an immature esophageal sphincter that doesn't close off the stomach from the esophagus. They eat every few hours and they have small stomachs. Tons of infants will have symptoms of gastroesophageal reflux.\n\nThis makes parents panic. They worry that something is wrong. They agonize over whether their kids are getting enough food. When I was a resident, the hospital I worked at would construct foam wedges for these infants to sleep on. They thought that infants who were sleeping at an angle would be less likely to have milk come back up. The wedges cost about $150. I was convinced that they didn't work, though, that they cause needless worry, and that it was unfair to make people pay for them.\n\nOther doctors advocated for thickening feeds. They thought this would make it harder for kids to vomit, but this meant moms couldn't breastfeed. It also cost money. I wasn't convinced that that worked, either.\r\nSo, I did what any hugely annoying resident would do. I conducted a systematic review. I searched the medical literature for all studies that looked for treatments for GERD that were non-drug and non-surgical. I found more than 2,500 articles that might have been on point. I then excluded any articles that weren't clinical trials or weren't on conservative therapies. That wheedled the list down to thirty-five. Then, along with two other reviewers, we went through them carefully to make sure that they were really good studies. Ten of them made the cut. All of them were randomized control trials.\n\nTwo of them were on positioning infants, i.e. wedges. One of them found that putting an infant at sixty degrees in an infant seat made reflux worse. The other found that raising the bed to thirty degrees, like with the wedge, made no difference at all.\n\nOne study looked at pacifier use. Didn't help. Some studies looked at thickening feeds with rice flour. Didn't work. And thickening feeds with carob bean gum. Didn't work. And then, one study found that carob bean gum was better than rice flour, which was strange because carob bean gum wasn't better than placebo. Changing formulas didn't work, either.\n\nIn other words, none of the conventional therapies used for reflux had supporting evidence behind them. Now, since I was a resident, you might ask, \"Who cares what I say?\" But this was a systematic review. It had methods. Anyone could check my work, so it was actually published in the medical literature, and it remains one of my most cited studies.\n\nSystematic reviews are research. They're not eminence-based medicine. They're the backbone of evidence-based medicine.\n\nBut let me rant about GERD and infants for one more minute. Since I published that paper, treatment with drugs has become much more common. Today, we commonly treat infants with proton pump inhibitors, or PPIs. Between 1999 and 2004, the use of one child-friendly liquid form of PPIs increased more than sixteen-fold. This was in spite of the fact that PPIs have never been approved by the FDA for the treatment of GERD in children.\n\nIn 2009, a randomized placebo-controlled trial examining how well a PPI works for infants with symptoms of GERD was published. It found that the drug had no more of an affect than placebo. It also found that children who received the PPI had significantly more serious adverse events, including lower respiratory tract infections. In 2011, someone else published a systematic review of PPIs for GERD in children. Guess what? They don't work, either. The fight continues.\n\n[Healthcare Triage closing theme plays]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/5Ezs1DPUKXA"},{"c_name":"healthcare triage","v_id":"iKLaLaxXe7o","title":"Sex, Cars, and Food: Healthcare Triage News #3","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nThis week's news are on topics everyone loves: sex, food, and cars. But the details may not be what you expect. The last segment is so important, we may address it in more detail in a Monday HCT episode soon.\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1409924499","likes":"1307","duration":"298","transcripttext":"Sex, cars, and food: what more could you want? This is Healthcare Triage News.\n\nLast December, we posted a Healthcare Triage on how the sky isn't falling, but I don't think many of you really appreciate how much better some things are right now. \n\nI talk to parents all the time, and they are utterly convinced - and I mean CONVINCED -  that today's kids are the most sex obsessed, uninhibited, and morally corrupt generation ever to have walked the planet. They just KNOW. But you know how I feel about 'knowing.' What did the data tell us? To the research!\n\nBetween 2007 and 2013 the number of teenagers who have given birth to babies has fallen in the United States by more than 38%. And it's not because teens are getting abortions the abortion rate is dropping too. \n\nthe teen birth rate peaked recently in 1991 at 61 births per 1000 teens. But don't think that the \"good ole days\" were better. It last peaked before that in 1960 at 89 births per 1000 teens. And in 1950 it was still more than 80 births per 1000 teens. In 2012?  29 births per 1000 teens. Tell me again how the internet is corrupting teens - and get off my lawn!\n\n\nOur second story comes to us from the International Transport Forum -  part of the OECD, which released its annual road safety report. Evidently, you don't want to drive in Malaysia - which has the highest road fatality rate of 23.6 per 100,000 people. It's also not that safe to drive in Cambodia, Argentina, Colombia, Chile, Jamaica or Korea.\n\nBut, at 10.7 fatalities per 100,000 people, the US is WAY worse than pretty much all of Europe, Australia and Japan. Oh, and for those of you that are arguing we should use a different metric - the US does pretty much just as badly with fatalities per billion vehicle kilometers and per 10,000 registered vehicles. \n\nSome interesting facts I didn't know before I perused the report:\n \nDid you know the United States has pretty much the most lax regulations for blood alcohol content allowed? At 0.8 grams per liter, it's tied for the highest allowable levels; at 0.4 grams per liter for professional drivers, it's all by itself!\n\nAnd it's not the speed limits! On highways, a fairly large number of countries allow 130 km per hour or above - which is more than 80 miles per hour, for those of you who still can't work the metric system. And their fatality rates are lower than ours!\n\n\nOur final story involves a new study published in the annals of Internal Medicine. You see, for decades it's been thought that fat is going to kill you: it's the red meat, it's the butter, it's the bacon. Then along came some \"crazies\" who said it was carbs instead, \nso we tried to reduce carbs. \n\nBut, I mean, you gotta to eat SOMETHING, so which is better? a low-carb or a low-fat diet? This study was a randomized control trial of a low-carb vs. a low-fat diet.\n\nLow-carb is defined as less than 40 grams per day and low-fat was defined as less than 30% daily calories from fat and less than 7% of a diet from saturated fat.\n \nWell, those are defined differently, so let's try this: Those in the low-carb diet obtained about 30% of their calories from carbs, those in the low-fat diet shot for 30% of their calories from fats. \n\nOutcomes of interest included: weight, risk factors for cardiovascular disease, and compliance with the diet. The percentage of people who completed the study in each arm was about 80% - which is pretty good. \n\nSo, who won?\r\nWell, it turns out that people in the low-carb diet lost on average more weight - about 7.7 lbs more over a year. They also had more of a fat loss  - 1.5% more. Their ratio of total to HDL cholesterol improved more. and their triglyceride levels fell more. Their HDL cholesterol levels - or \"good\" cholesterol -  went up more. In terms of ten year Framingham risk scores: those on the low-carb diet saw significant decreases in those risk factors, while those in the low-fat diet did not.\n\nOh, and while  the low-fat group DID lose weight, it seems they lost more muscle than fat... awesome. \n\nSo, in pretty much every metric you could pick, the low-carb diet beat the low-fat diet. But I expect you'll see the usual caveats in the media. They'll warn us that \"even though cholesterol levels improved on the low-carb diet more, that eating more fats just simply MUST be bad for you.\" They'll repeat how Framingham risk scores and risk factors aren't the same thing as actual bad outcomes, while using those same factors to promote low-fat diets as better.\n\nAnd they'll attack this randomized control trial for being only one-year in design, while ignoring that almost all of their data is observational. The 2010 Dietary Guidelines for Americans recommend that 45 - 65 % of our diets be from carbohydrates, and that 20-35% from our calories be from fats. in essence they're recommending a low-fat diet for everyone and a low-carb diet for none. Will the 2015 Dietary Guidelines for Americans be any different? Don't hold your breath. \n\n","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/iKLaLaxXe7o"},{"c_name":"healthcare triage","v_id":"iOR0mxPLTvY","title":"Meta Analysis, Calcium, and Organic Food","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nLast week we discussed systematic reviews, and why they're better than review articles, or opinions. But they're not the only types of \"studies of studies\" I've presented to you. Sometimes you can go a step further. After you've collected all the appropriate studies, you can merge the data together and do one large analysis. Those studies are called meta-analyses, and they're the subject of today's Healthcare Triage\n \nFor those of you who want to read more or see references, look here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=57918\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1410210775","likes":"1511","duration":"436","transcripttext":"\n\nIntroduction\n\n\nLast week, we discussed systematic reviews, and why they\u2019re better than review articles, or opinions. But they\u2019re not the only types of \u201cstudies of studies\u201d we\u2019ve looked at. Sometimes you can go a step further. After you\u2019ve collected all the appropriate research, you can merge the data together and do one large analysis. Those studies are called meta-analyses, and they\u2019re the topic of this week\u2019s Healthcare Triage.\n\n(Theme music \/ montage)\n\n\n\n0:26 What is a meta analysis\n\n\n\nSo you've done your systematic review, you've gathered all the studies together, some show one thing, some show another, but what's truth?\n\nWell, with a meta analysis, you put all the data into one pool.  This allows for many smaller studies which might not have much power, to be merged into a large study that allows for more comprehensive analyses.  It also allows for research that on its own might not be robust to achieve some sort of statistical significance.\n\n\n\n0:50 Pools Odd Ratio Diagrams\n\n\n\nYou get a diagram like this: \n\nThis is a study that looked at whether vitamin D supplementation affected bone density.  This is called a pools odd ratio diagram.  The chart shows you the odds ratio (highlighted) for each outcome - one study per line.  If the square and error bars for a study are entirely to the right of the vertical line, then vitamin D was beneficial.  \n\nIf the square and its error bars are entirely to the left of the line, then vitamin D was detrimental.  If the square, or its error bars, in any way, touch the line then it's a non-significant result.\n\nAt the bottom, the results are summed into one large diamond with the same rules applying.  As you can see there was a small benefit, weighted mean difference 0.8%, for studies looking at the effect of vitamin D supplementation on bone mineral density of the femoral neck.  \n\nWoo-hoo (sarcastic).\n\nHip? No effect.\n\nTrochanter? No effect.\n\nLumbar spine? No effect.\n\nForearm? No effect.\n\n\n\n1:49 Vitamin D in Bone Density Comments\n\n\n\nWe covered this in a previous episode about how milk is sort of ridiculous.  Deal with it!\n\nBut that doesn't mean that systematic reviews are infallible or immune from criticism.  In fact, often the results of a systematic review or meta-analysis can be hotly contested.  \r\n\n\n2:03 Organic Food Meta Analysis from 2009\n\n\n\nAs an example, I'd like to revisit organic food.  As we discussed on the episode of Healthcare Triage about organic food, in 2009 a group of scientists published a major review of organic versus conventionally grown food, covering research from 1958 through 2008.  \n\nThey reviewed 52,471 articles and found 162 studies that compared crops and livestock products. They deemed 52 of them high enough quality for inclusion in their analyses. They found no significant difference between organic and conventionally grown food with respect to nutrient content.\n\n\n\n2:37 Organic Food Meta Analysis from 2012\n\n\n\nThis study was considered by some to be methodologically imperfect. Therefore, researchers from Stanford University published another systematic review and meta-analysis in 2012.  They reviewed research through May of 2011, found 460 studies, and identified 237 that met their inclusion criteria. They found a lack of evidence that organic foods are significantly more nutritious than conventionally grown food.\n\n\n\n3:03 Organic Food Meta Analysis from 2014\n\n\n\nBut very recently a new study in the British Journal of Nutrition declared that research said that organic fruits and vegetables are more nutritious. Press releases declared it the largest study of its kind. Because of its size, and its breadth, some declared that it trumped previous research that showed that organic food didn't appear to be any safer or more nutritious than conventionally grown food.\n\nSome of you even claimed that our episode on the topic was wrong.\n\nThe authors of this very new paper acknowledge that the previous views existed but claimed that they weren't comprehensive enough.  \n\nThey searched the literature from 1992 through 2011 and reviewed 448 studies that they found. They deemed 343 of them appropriate for inclusion, which did make this a \"larger study\".  \n\nBut this study didn't include much more newer data than the Stanford study did. It simply had more data because it was more permissive of the type of studies that it deemed of high enough quality to be included.  \n\nTheir analysis found that there were significantly higher levels of anti-oxidants in organic food than in conventionally grown food. It's on this basis that they declared organic food was more nutritious. They also found higher levels of pesticides on conventionally grown food which they said made them more unsafe.\n\n\n\n4:14 Explanation of Anti-Oxidants\n\n\n\nIt's important to be realistic about what anti-oxidants can and can't do. They're a type of compound, used by our body, to fight against \"free radicals,\" or chemicals that can cause damage to many structures by stealing electrons from certain molecules. Antioxidants can give electrons to free radicals, so they don't take them from our bodies. But antioxidants aren't nutrients. They also aren't all the same. Each one works in a certain way in different parts of the body. More importantly, there's very little evidence that supplementation with them leads to better health.\n\nVitamin E has shown mixed results in the Women's Health Study, the Heart Outcomes Prevention Evaluation trial, and the GISSI-Prevenzione trial. Beta-carotene was shown to have no effect on heart disease or cancer. Mixtures of antioxidants didn't prevent cardiovascular events in women or cancer, heart disease, or death in anyone.\n\nThese studies all included much larger doses of antioxidants than would likely be received by eating organic fruits and vegetables as well.\n\n\n\n5:12 Protein levels in organic foods\n\n\n\nSecond, this much more recent meta-analysis also found that organic crops are lower in protein. That's an actual nutrient, and it's being ignored in much of the reporting on this study.\n\n\n\n\n5:23 Pesticide levels in conventionally grown foods\n\n\n\nThird, while levels of pesticide may be higher in conventionally grown food, none of the studies have detected levels of chemicals that approach anything near what we would be classified as an \"unsafe level\".\n\n\n\n5:33 Thinking about systematic reviews and meta-analyses\n\n\n\nFinally, though, this study provides an opportunity to understand how we might think about systematic reviews and meta-analyses in general. If it were patently obvious that organic foods were nutritionally superior, we would need no meta-analysis. Large studies would find clear benefits with respect to nutrients, and that would be that. We're having this argument because it is hard to find a benefit.\n\nMoreover, when a new systematic review or meta-analysis finds a benefit that an old study didn't by being more permissive of the research it includes, that should give us pause. It's entirely possible, of course, for previous work to be flawed, and to have left out critical research. But that doesn't appear to be the case here. The new study included everything the old study did, and then added to it research that didn't make the cut the first time. That's potentially problematic.\n\nOf course, it's a judgment call as to which analysis is correct. I tend to favor the Stanford study because it seems like it was more rigorous in excluding studies with weaker methodologies.\n\nThis is one of those times, however, when people's predisposed beliefs will likely color their interpretations of which study is correct. Even if you favor the newer one, the differences, while statistically significant, have no evidence to support their leading to any real health benefits.\n\nI would be remiss if I neglected to mention one more thing. The Stanford study was done with no extra funding at all. The newer study, though, cost $429,000., and was funded by the charity that supports organic farming research. That doesn't mean that a conflict of interest tainted the methods or results, but it should at least be acknowledged.\n\n[outro]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/iOR0mxPLTvY"},{"c_name":"healthcare triage","v_id":"-wOPd-Qp7W0","title":"PANIC! - HCT News - 09\/12\/2014","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nAccording to my Facebook and twitter feeds this week, everyone seems to be in a panic. Too many of you are worried that if the respiratory virus plaguing the Midwest doesn't get you, Ebola will. I'm going to try and calm you down.\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics","uploaded-unix":"1410529922","likes":"1200","duration":"206","transcripttext":"According to my Facebook and twitter feeds this week, everyone seems to be in a PANIC! I'm going to try and calm you down. This is Healthcare Triage News. \n\n[intro]\n\nThis week's first story is for more than a few of my worried friends out there. There's an outbreak of a respiratory virus in the Midwest that has a lot of you panicking. I'm not surprised at that, given the tone that much of the media has taken while reporting about it. To catch the few of you unaware up to speed, there have been hundreds of children hospitalized with a bad respiratory infection over the last few weeks. It's caused by EVD-68, which is a form of enterovirus.\n\nFor the uninitiated, enteroviruses are a group of germs that cause colds and respiratory disease, mostly in kids, often in the summer months. Once in a while, they can cause a case of viral meningitis, as they did not long ago for a certain internet star and author who may be known to some of you. \n\nIn this case it's affecting kids pretty severely. A more than usual number are needing to be hospitalized. Those with asthma, or other underlying respiratory diseases, are being hit the hardest.\n\nThere's no vaccine for this, and no special precautions that you should take. I say \"special\" because you all should be washing your hands frequently, especially before eating! So if you aren't, start doing that! But if you're around a person with enterovirus a lot, i.e., a family member, it's hard to avoid it. The good news is that this isn't usually a deadly virus. Way, way, way more people will die from influenza this year and every year, even in the United States, than will even be severely ill with enterovirus. It's scary, but there's just no reason to panic.\n\nSpeaking of panic, Ebola continues to be a source of it. A third doctor has become sick with it, and there's a new study out there that talks about how the disease could spread outside of west Africa. In a paper that should have been published in a journal called \"PANIC!\", which I'm absolutely going to begin to publish, a group of researchers modeled how Ebola could escape by infected people on planes and get to countries all over the world. The country in this study most likely to see an Ebola outbreak was Ghana. Number two was the United Kingdom. France was number seven. The United States was thirteenth. PANIC!!\n\nBut, just as I told you before with respect to enterovirus, don't let the media oversell this. Ebola is terrible, and this is the worst outbreak of Ebola we've ever seen. But way, way more people die of HIV-AIDS in Africa each year. Way, way, way more people die of diarrheal illnesses in Africa each year. And there's still a pretty low chance that the disease will get out of west Africa. \n\nBut what if it did? Odds are, there'd still be a pretty minimal impact in the developed world. Unlike many resource-strapped settings, we'd probably catch it pretty quickly. Anyone who had a flu-like or diarrheal illness who had been in an Ebola-affected country recently would be quarantined pretty fast. And people with Ebola aren't contagious until they're symptomatic. So sick people get quarantined. People they might have come into contact with will be found, and they will be watched for symptoms closely. They, too, wouldn't be contagious as long as they were still not ill. After that, it's mostly keeping sick people hospitalized until they're not a danger to anyone else. In most developed countries, that's not difficult to do. Ebola is a terrible disease that's killing a lot of people in west Africa, but it's not that much of a threat to people outside that area. \n\nThere are plenty of things to panic about. These are not two of them. Normal precautions are fine. Go about your lives.\n\n[outro]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/-wOPd-Qp7W0"},{"c_name":"healthcare triage","v_id":"sOEuwhgohGM","title":"Guinea Worm Eradication and Health Technology","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nIf you've been paying attention to recent news, you might think that we're entering a time when leaps forward in health care only happen at great expense. That misses the point. It also, once again, confirms the incorrect impression that we can only make leaps through advances in technology. As I said in previous episodes, people are more important than technology. To illustrate this point, we'll discuss the guinea worm.\n \nThis is adapted from a piece Aaron wrote for the NYT. Links and references are embedded in that piece: http:\/\/www.nytimes.com\/2014\/08\/12\/upshot\/lessons-from-the-low-tech-defeat-of-the-guinea-worm-.html?abt=0002&abg=1\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1410794950","likes":"1297","duration":"271","transcripttext":"If you\u2019ve been paying attention to recent news, you might think that we\u2019re entering a time when leaps forward in health care only happen at great expense. That misses the point. It also, once again, confirms the incorrect impression that advances can only through great leaps in technology. As I've said in previous episodes, people are more important than technology. To illustrate the point, I'd like to tell you the story of the guinea worm - that's the topic of this week's Healthcare Triage. \n\n(Intro reel)\n\n(0:30) The guinea worm is a parasite that plagues humans, and only humans. People get infected with them when they drink water that's infested with their larvae, which then mate inside our GI tracts, and then start to grow.\n\nEventually, female worms burrow their way out to our skin, where they can create incredibly painful sores, by which they can exit the body. They exit very slowly, causing a burning pain as they do so. There's no treatment for guinea worms, there's no vaccine. The best we can do is wrap the part of the worm that's exposed around a stick and slowly pull it out. That can take weeks, and it's not pleasant at all.\n\nWhat if the only thing that soothes the pain is to submerge the worm and sore in water? Which is of course exactly what you DON'T wanna do, as it allows the worm to release its larvae and start the cycle all over again.\n\nPeople who are infected are incapacitated, it's hard for them to work, it's hard for them to care for their families, it rarely kills, but it can leave people ill for months. Those who are afflicted can easily develop secondary infections. Rupturing the worm can lead to severe allergic reactions, depending upon where the worm emerges, it can lead to life-long disability.\n\nIn 1986, it was estimated that more than 3.5 million people in Africa and Asia were infected with guinea worms. This year, so far, there have been only 17 cases worldwide. SEVENTEEN! It's thought that very soon guinea worm disease will be only the second human disease eradicated in human history. Smallpox was the first.\n\nHOW?! There's been no technological breakthrough, there are no new medicines, there are no new therapies. Guinea worm infection has been beaten almost entirely through behavioral change, at a shockingly low cost.\n\nTwo things needed to happen to achieve this feat. The first is that people needed to be taught to filter their drinking water and keep it clean, often with something as simple as a cloth filter. Second is that people had to learn NOT to go near drinking water sources once they were infected.\n\nI'm not trying to make light of how hard it was to accomplish. Getting so many people to change their behavior took decades, and it took a lot of wrangling, political maneuvering and a LOT of boots in the ground to get the message across.\n\nThe Carter Center founded by former president Jimmy Carter in 1982 has been instrumental in these efforts. Many doubted that you could eradicate a problem like this without some sort of medical breakthrough, they were wrong. Clean your water! Practice hygiene. Quarantine the infected. These ideas sound simple, they sound like common sense, (whispers) they also work.\n\nThese general problems are are all too common in developed healthcare systems as well. The CDC estimates that about 48 million Americans get sick from food-borne illnesses  each year. More than 125,000 hospitalizations are caused by food-borne illnesses, and about 3,000 deaths. Many, if not most of these illnesses could be prevented if people properly stored, cleaned, cooked and refrigerated their food.\n\nBetween 1976 and 2007, deaths in the United States from influenza ranged from 3,000 to 49,000 people a year. The vast majority of those deaths occur in people who are 65 years of age or older. Proper hygiene and staying home during the infectious stage of the illness are STILL mainstays of flu care.\n\nWe even have a VACCINE for influenza, but too few people get it. It's estimated that two years ago, if we had just gotten the influenza vaccination rate up to 70%, we could've prevented 4.4 million illnesses and 30,000 hospitalizations.\n\nPhysicians know how important hand-washing is, but we fail to do it correctly the majority of the time. This is in spite of the fact that patients in the hospital get more than 700,000 infections a year, and that hand-hygiene is thought to be one of BEST ways to prevent that from happening.\n\nWe spend so much time focusing on the new, the flashy and the innovative, it's important not to neglect the simple things that matter. Eradicating the guinea worm didn't require research, new technology, or billions of dollars of investment. It took determination, focus, and dedication. It required people and talking and educating.\n\nThose things are still important in every healthcare system, they can save millions of lives. We need to invest in them, too, now and in the future.\n\n(Outro)","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/sOEuwhgohGM"},{"c_name":"healthcare triage","v_id":"PedX0g4RQ30","title":"Sugar Ban, Driving Regulations Work, and the Apple Watch","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nHospitals banning sugar sweetened beverages, provinces cracking down on dangerous drivers. And get me an Apple Watch!\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1411147571","likes":"920","duration":"189","transcripttext":"     Hospitals banning sugar-sweetened beverages, provinces cracking down on dangerous drivers, and get me an Apple Watch! This is Healthcare Triage News.\n    We've talked about the New York City soda ban on Healthcare Triage before; I still think it's a pretty bad idea. It was focused only on large soda sizes, wasn't applied equally to all businesses, and had lots of loopholes, and was passed as a matter of public policy. I still think it wouldn't have worked. Plus, it just seemed wrong in some ways for the government to ban something sort of random, like \"large\" sodas. That doesn't mean that organizations can't do what they want.\n     In 2011, Nationwide Children's Hospital in Columbus, Ohio, banned sugar-sweetened beverages. Recently, researchers published a paper on what happened in the year after they did so. In December of 2010, they started reducing their orders of sugar-sweetened beverages, and they ran out of sugared soda by the end of the month. January of 2011, they removed all sugar-sweetened beverages from the hospital cafeteria, the food court, the coffee shop, and their gift shops. They still sold diet sodas, enhanced water, and fruit juice. They also continued to sell skim, low-fat, low-fat chocolate, and whole milk - such is the power of the milk industrial complex.\n     What happened? Beverage sales went up 2.7%! Yeah, soda sales went down, but all the other types of beverages went up! They reported that 11 complaints were lodged over the course of the year by employees and patients, which they handled individually. I want to stress that this was an individual organization, making a decision about whether to sell sugar-sweetened beverages on its property. They are free to do whatever they want. Anyway, they banned sugar-sweetened beverages, and the world didn't end. I don't know if it resulted in any major health changes, but it's an interesting data point.\n\n     Two weeks ago I talked about car accidents, and for this week's second story, I want to talk to you about trying to do something about them. A recent study in the American Journal of Public Health looked at the effects of laws targeting speeding and drunk drivers. Some drivers are dangerous. Some provinces in Canada passed laws to target them. Then they compared what happened there to provinces that didn't pass such laws. And they also looked at Washington State, which of course didn't do anything.\n    What did they find? In the provinces that passed the laws, fatal car crashes decreased 21%. Hospital admissions decreased 8%. Even ambulance calls decreased 7%. Because the number of alcohol-related crashes pretty much halved, they were pretty confident that the improvements they saw were because of reduced levels of drinking and driving. And you'll remember that the US has pretty much the most relaxed regulations of driving and alcohol in the world.\n\n    Finally, I want to thank all of you who tweeted or emailed me, asking me snarkily if I was going to buy an Apple Watch after I spent an entire Healthcare Triage episode talking about why they will likely fail to move the needle on the collective health of the public. The answer is YES, I will preorder one the second they're available. I've been going without a watch for years waiting for one. Just because I'm skeptical about their ability to revolutionize the healthcare system, doesn't mean they won't be awesome. Oh, I preordered an iPhone 6 too; in fact, it may have arrived by the time you're watching this. Keep your fingers crossed!","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/PedX0g4RQ30"},{"c_name":"healthcare triage","v_id":"6Hml1CL0Idk","title":"Fluoride in the Water Isn't Going to Hurt You","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nThanks to audible.com for supporting Healthcare Triage. Sign up and get a free audiobook at http:\/\/www.audible.com\/triage.\n\nEvery once in a while chain emails or Facebook posts make their way back into prominence. It happened last year with HPV killing girls. Recently, it seems to be Fluoride. A number of you have been forwarding  me a post from last year which features a meta-analysis published a few years ago on Fluoride and IQ. So let's talk about Fluoride!\n \nFor those of you who want to read more or see references, look here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=58286\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1411426025","likes":"2428","duration":"519","transcripttext":"Every once in a while, chain emails or Facebook posts make their way back into prominence. It happened last year with HPV \"killing girls.\" Recently, it seems to be fluoride.\n\nA number of you have been forwarding me a post from last year, which features a meta-analysis published a few years before that on fluoride and IQ. \n\nFluoride is the topic of this week's Healthcare Triage.\n\n[Healthcare Triage intro]\n\nSo let's talk about the Facebook post and the study it's covering. Researchers wanted to look at studies examining a relationship between fluoride exposure and delayed neural behavioral development. They found 27 epidemiological studies that were on point. When they combined the results, they found that people who were supposed to high levels of fluoride had an IQ which was lower by 0.45 points. It was statistically significant.\n\nNow let's discuss. Of the 27 studies, 25 appear to be from China. The other two are from Iran. I bring this up not to disparage those countries' ability to do research, but to point out that they have very different background levels of fluoride then we might see in the United States.\n\nIn some of these studies, fluoride levels reached 11.5 mg\/L. Compare that to New York City, which shoots for 0.7 to 1.2 mg\/L. Moreover, some of the kids got their fluoride from inhaling it from coal burning, or because it was a pollutant.\n\nThat's not the same thing as fluoridation here in the United States. These were not randomized controlled trials, but epidemiologic studies. Lots of other factors could be contributing: schooling, arsenic, iodine. Even lead, which often wasn't measured in these studies, could be in play here. We can't say which of these things is \"causing\" the result.\n\nAnd what does a difference of 0.45 IQ points really mean? That is really small. In fact, as the researchers point out in the paper, it may be within the measurement error of the test itself.\n\nThis isn't the first time people have gotten up in arms about fluoride. Some argue that it has many risks, including those to the brain, thyroid gland, and bones. Others make much more alarmist statements, calling fluoride a \"corrosive poison\".\n\nWebsites and publications raising concerns about fluoride offer \"scientific references\" and \"expert quotes\" that really could cause concern that the fluoride in your water not only doesn't help you, but it could also be hurting you.\n\nYou know where this is going, right? To the research!\n\nOverwhelming evidence has existed for over 60 years that proves the efficacy of water fluoridation. Some of the best studies come from the early days of fluoridation, because it was easier then to find groups of people who were not exposed to any fluoride sources.\n\nIn a 15-year landmark study from Grand Rapids, Michigan, children who received fluoridated water from birth had 50-63% less tooth decay than children from a nearby city in Michigan who drank non-fluoridated water.\n\nEvidence for how well fluoride works is massive. A compilation of the results of 113 studies in 23 countries showed reductions in tooth decay for both baby teeth and adult teeth. People with fluoride in their water had 40\u201349% less tooth decay in baby teeth and 50\u201359% less tooth decay in adult teeth.\n\nAnother compilation of studies, conducted between 1976 through 1987, showed reduction and tooth decay between 15 and 63%, with the highest benefit for those with baby teeth, but significant benefits for adults who already had their permanent teeth.\n\nThe 350 peer-reviewed references compiled by the American Dental Association in their publication Fluoride Facts, also support how well fluoride works.\n\nOf course, preventing cavities might not be worth endangering your help in other ways. So is fluoride really safe?\n\nOnce again, the scientific evidence overwhelmingly supports the safety of adding fluoride to a community water supply. Reviews of the safety of fluoride by the Institute of Medicine, the Food and Nutrition Board, the National Research Council of the United States, the US Department of Human Services, Public Health Service, and the World Health Organization, have all led to the conclusion that fluorite supplementation is safe, effective, and recommended for community water supplies.\n\nA systematic review published in 2000 in the BMJ analyze 214 studies on fluoridation and found no evidence of potential adverse effects except for dental fluorosis, which I'll get to in a moment. Periodic reviews every six years by the US Environmental Protection Agency, or the EPA, continue to find no harmful effects related to fluoride in drinking water.\n\nGood scientific studies demonstrate that drinking fluoridated water doesn't increase the risk of hip fractures. More than 50 extremely large studies do not show any association between fluoridation and the risk of cancer.\n\nOne small study from the 1950's, which is surprisingly large number of you have read, looked at 15 patients with an overly active thyroid gland, which tried to use large amounts of fluoride as a treatment, and found that it seems to help some patients. On that basis, concerns have been raised about whether fluoride in drinking water adversely affects the thyroid gland. \n\nAgain, much better science shows that the answer is no. Studies from people with drinking water with naturally high levels of fluoride found that it had no effect on their thyroid gland size or function, and this matches results from animal studies. Furthermore, two studies found that no association exists between the level of fluoride in water and thyroid cancer.\n\nThe National Research Council of the National Academy of Sciences supports the conclusion that drinking optimally fluoridated water is not a genetic hazard. There is no known association between drinking fluoridated water and Down's syndrome.\n\nOne psychiatrist in the 1950's published two studies claiming that the two were connected, but four subsequent studies have found no connection, and experienced researchers have noted significant problems with how that psychiatrist analyzed his data.\n\nThere's also no generally accepted scientific evidence establishing a link between fluoridated water and other neurological disorders, including attention deficit disorder. There's a study in which rats were administered fluoride at 125 times the level in community fluoridated water, and concluded that the rats showed some behavioral changes. However, this study did not use any sort of controlled group to compare rats who had the fluoride to rats that had not. And scientists who reviewed the results of the study have concluded that it is significantly flawed and cannot be used to draw conclusions about problems with fluoridated water.\n\nThere is one real problem that can result from too much fluoride, and that's dental fluorosis. This is a discoloration of the teeth that can occur when a child ingests more fluoride than is recommended. With mild dental fluorosis, the teeth get white flecks or spots, but with severe fluorosis the teeth can get a permanent brown stain.\n\nAbout 10% of the mild fluorosis seen in children does probably come from the fluoridation of water, although the dentists argue that the small white flecks are a small price to pay for avoiding cavities, tooth decay, missed school and so on.\n\nThe bigger cause of fluorosis is likely that kids do sometimes have a habit of swallowing their toothpaste. Fluorosis is the reason that the American Dental Association recommends that children under six do not use more than a pea-sized amount of toothpaste. We assume that little kids are going to follow it, and if they swallow a lot more than that pea-sized amount, they're more likely to get fluorosis. Toothpaste delivers a much more concentrated amount of fluoride than drinking water does, so the biggest cause of fluorosis is likely swallowed toothpaste, not water.\n\nMany experts have concluded the fluoride both beneficial and safe in the drinking water of our communities, and they agree that the risk of fluorosis is far outweighed by the benefits of preventing tooth decay. The American Dental Association, The Centers for Disease Control, the American Medical Association, and the US Surgeon General have all issued statements supporting how well adding fluoride to water works to prevent tooth decay.\n\nIn fact, the CDC declared fluoridation of public drinking water to be one of the 10 biggest public health achievements of the 20th century. \n\nToo much of anything can be bad, including fluoride. I don't dispute that. But we shouldn't overlook the fact that dental caries are the most common chronic disease in kids age 6-19. Let's not go backwards. Ignore this chain e-mail.\n\nThis episode of Healthcare Triage is supported by audible.com, a leading provider of premium digital spoken audio information and entertainment on the Internet. Audible.com allows users to choose the audio versions of their favorite books, with a library over 150,000 titles. We recommend White Teeth by Zadie Smith. You can download a free audio version of White Teeth, or another of your choice, at audible.com\/triage.\n\n[outro]\n\n\n\n","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/6Hml1CL0Idk"},{"c_name":"healthcare triage","v_id":"NVbFGMS-0NM","title":"Shrooms and Smoking, Adult Drug Abuse, and Ebola: Healthcare Triage News","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nShrooms to quit smoking, who's using drugs, and a clarification on Ebola. This is Healthcare Triage News.\n \nFor those of you who want to read more, go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=58424\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1411761106","likes":"1237","duration":"262","transcripttext":"Shrooms to quit smoking, drug use in America, and a clarification on Ebola. This is Healthcare Triage News.\n\n[intro]\n\nFirst up is a story that you might've missed because it didn't get nearly the coverage of many other \"panic\" type stories. But I think it's worth your attention.\n\nThe Journal of Psycho-pharmacology recently published a manuscript entitled, \"Pilot Study of the 5HT2AR-Agonist Psilocybin and the Treatment of Tobacco Addiction.\" The gist of this study was that they gathered 15 otherwise-healthy, including mental health, smokers, who had all tried and failed to quit smoking in the past.\n\nThey were all given a moderate dose of psilocybin on their intended quit date. Later, they were given a high dose of psilocybin--the active ingredient in magic mushrooms.\n\nThe drug was given to patients in a controlled session which lasted six to seven hours. They were all monitored by the research team while they were, well, tripping. The subjects generally wore eye-shades and listen to music, and they were encouraged to \"relax and focus on their inner experiences.\"\n\nLook, I was as skeptical as many of you likely are right about now. I mean, how is this even legal? I couldn't help but snicker when one of the authors said, and I'm quoting, \"When administered after careful preparation and in a therapeutic context, psilocybin can lead to deep reflection about one's life and spark motivation to change.\" Right.\n\nBut the results were somewhat amazing. 12 of the 15, or 80% of participants, reported abstinence--complete abstinence!--from smoking at six months. That's an insanely large quit rate! All but two of the participants said that the psilocybin sessions were among the ten most meaningful experiences of their lives.\n\nIt was a small study. It was open-label. And it had no controls. It involves using an abused drug to treat dependence on another. But it's really hard to quit smoking. 80% in six months? Someone better do some follow-up work.\n\nSpeaking of drug abuse, though, our second story comes from the US Department of Human Health and Services, which just released its results from the 2013 National Survey on Drug Use and Health. They interview about 67,500 people each year, and it's the best source for information on the rates of illegal drugs, alcohol, and tobacco in the United States.\n\nIt's not all good news, but not in the ways you might thing. The use of illicit drugs in adults age 50 to 54 has risen from 3% of people in 2003 to 7.9% ten years later in 2013. In 55 to 59-year-olds, it went up 2% to 5.7%. In adults age 60 to 64 years old, it went up from 1.1% to 3.9%. What's up with Grandma and Grandpa?\n\nEven people 26 and older went up, from 5.6% to 7.3%. Young adults age 18 to 25 rose just a bit, from 20.3% to 21.5%.\n\nBut kids age 12 to 17 dropped, from 11.2% to 8.8%. Yes, kids were the only group that went down in illicit drug use.\n\nEven in marijuana use, kids dropped. Boys went from 8.6% to 7.9%, and girls from 7.2% to 6.2%.\n\nBut when pundits and the media people talk about \"rising drug use,\" do you think that the public imagines adults over age 50? or kids? Someday kids are going to tell us to shut up, and they'll have every right to. \n\nFinally, I want to clarify some things I've said in the past few weeks about Ebola. When I say that people in developed countries should stop panicking about the disease in their backyards, I'm referring to their catastrophizing about their own predicaments. They're all fine.\n\nBut that doesn't mean that the Ebola outbreaks in Western Africa aren't a crisis. Or that people in those areas shouldn't be concerned. And for goodness' sakes, people in the developed world should be concerned for them, too. This outbreak is simply terrible, and if we don't get a handle on it soon, it's going to get much, much worse.\n\nAs two physicians recently said in the New England Journal of Medicine, this outbreak is, and I'm quoting, the \"result of the combination of dysfunctional health systems, international indifference, high population mobility, local customs, densely populated capitals, and a lack of trust in authorities after years of armed conflict.\" It's also because we've been responding to the crisis far too slowly. \n\nThis is a horrific crisis for the people of West Africa. We should be focusing on them, and get them the help that they need. We should stop worrying about ourselves. When I tell you to quit panicking about Ebola, that's what I'm referring to.\n\n[outro]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/NVbFGMS-0NM"},{"c_name":"healthcare triage","v_id":"hdY-NJq6zVQ","title":"Diets! Which Ones Work for Losing Weight and Keeping it Off?","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nThere are so, so many diets out there. Some are low in fat, others are low in carbs. Some involve special foods, others tell you to avoid them. So what's the best diet for you? Watch and learn!\n \nMost of the data for this episode comes from this recent paper in JAMA: http:\/\/jama.jamanetwork.com\/article.aspx?articleid=1900510\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1412031280","likes":"1701","duration":"390","transcripttext":"There are so so so many diets out there. Some are low in fat, others are low in carbs, some involve special foods, and others tell you to avoid them. So what's the best diet for you? That's the topic of this week's Healthcare Triage.\n\n[intro]\n\nA couple of weeks ago on health care triage news I told you about a study that compared a low carb diet to a low-fat one.\n\r\n\r\n\r\n \r\nThe low carb diet performed better on almost every metric, which exasperated me because many organizations continue to promote the idea that low-fat is the best way to go.\n\nWe should recognize, though, that the levels of \"low carb\" on this diet were really low. People kept their carb consumption to about 30% of calories a day, and they were eating a reasonably low number of calories. And they kept this up for a year! Most diets out there, even the low carb ones, don't hit that level.\n\nInitially, this study was focused on a lot of outcomes besides weight. And let's be honest: the reason most people watch this video will go on a diet is to  lose weight. So let's talk about that.\n\nThere have been a lot of studies comparing named diets. So many that a bunch of researchers were able to conduct a meta analysis of these studies--a battle royale, if you will, of named diets.\n\nSo: to the research!\n\nThe authors of this meta-analysis reviewed the medical literature for any randomized controlled trials of obese or overweight adults who were placed on popular self-administed named diets for at least 3 months. The main outcome of interest was weight loss at 6 and 12 months.\n\nFor those of you who watched the systematic review and meta-analysis videos, and you really should have, the researchers identified 20,835 potential studies. Of these, 889 were promising enough to merit a full review. Of these, 59 met criteria, and they described 48 randomized controlled trials of 11 branded diets.\n\nThese were grouped into 3 diet classes. The low carb diets generally kept carbohydrate consumption below 40% of calories, protein consumption below about 30% of calories, and fat from 30-55% of calories.\n\nThe moderate macronutrient diets kept carbs to about 55-60% of calories, protein to about 15% of calories, and fat between 21 and 30% of calories. \n\nFinally, low fat diets kept carbs at around 60% of calories, protein to 10-15% of calories, and fat below 20% of calories.\n\nFor the record, the 2010 Dietary Guidelines for Americans recommends that adults get 45-65% of calories from carbs, 10-35% from protein, and 20-35% from fat. So the moderate macronutrient diet is closest to that.\n\nLow-carb diets included Atkins, South Beach, and the Zone diet. Moderate Macronutrient diets included Biggest Loser, Jenny Craig, Nutrisystem, Volumetrics, and Weight Watchers. Low-fat diets included Ornish and Rosemary Conley. Two diets defied grouping: the LEARN diet was analyzed as both a low fat and a moderate macronutrient diet, and the Slimming World diet fit no definitions at all.\n\nLet's start by talking about diet classes. First thing you should know is that all of these diets, and I mean all of them, were better than nothing at six months. \n\nThe low carb diet performed better than all of the others, with median \nsix-month weight loss at 8.7 kilograms, or about 19 pounds.Although the low fat diet was so close at 8 kilograms, or 17.6 pounds, that the difference wasn't statistically significant. \n\nAnother way of looking at it was this: at 6 months, the low-carb diet had an 83% chance of having the best performance. The low-fat diets had a 17% chance of being the best.\n\nAt one year, things changed up a bit. In general, weight loss was rarely better at 12 months than it had been at 6 months. Low-carb and low-fat diets were still best, but now low-fat diets were just a tiny bit better. The difference, though, was 20 grams.\n\nYeah, you heard me right. 7.27 kilograms for low-fat, and 7.25 kilograms for low-carb. For the metrically challenged, that's 16.03 pounds versus 15.98 pounds.\n\nIn other words, at one year, the low-fat diets had a 50% chance of being best. The low-carbs had a 48% chance at being best, and the LEARN diet had a 2% chance. So basically a coin flip between low-carb and low fat.\n\nBut how about the individual name diets? At six months, the best performing was Atkins, at 10.1 kilograms, followed by Volumetrics at 9.9 kilograms, and Ornish at 9 kilograms.\n\nI'm gonna talk really slowly here, so you can look at at this nice chart Mark made to see where your favorite diet fell in the spectrum. Remember, they all worked, but to different degrees. \n\nAt twelve months, though, the differences were not nearly as big. Here's that chart. The best-performing diet was a generic low-fat diet. Atkins lost its top spot by quite a bit, and others like Jenny Craig and Weight Watchers pulled into the pack.\n\nThere were no significant differences in serious adverse events in any of these trials, although they were only reported in five trials, all of them were Atkins trials, which seems unfair, because why would you assume that only the Atkins diet could lead to problems? Anyway, of those five, only one found any issues at all, and they were all minor.\n\nSo what do you take from this? Anyone hoping for a silver bullet should be totally disappointed. There isn't one. The one thing all of these diets have in common is that they involve calorie restriction in some way. Even in the Atkins studies, men consumed 1400-2200 calories, and women consumed 1200-1600 calories. That's less than most people eat. Generally, when you eat fewer calories, you lose more weight. \n\nThere are plenty of caveats here. It's possible that the types of carbs and the types of fats consumed here made a difference...maybe. It's possible that the effects of exercise and behavioral support, like with meetings, could make a difference...probably.\n\nSo here's the truth: the best diet for you is likely the one you're going to keep. If the idea of a low-carb diet appeals to you, go with that one. If low-fat foods appeal to you, go with that one. It really doesn't seem to matter that much.\n\nThe ideal diet is the one you're going to adhere to. This is especially true in the long term, as almost all of these diets had weight gain in the second six month period. \n\n The good news is that almost all of them work. There's hope. You just need to find the one that works for you. And then you really really need to stick to it, for a long, long time.\n\n[outro]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/hdY-NJq6zVQ"},{"c_name":"healthcare triage","v_id":"5WaAVcxNbzo","title":"Diabetes Declining? Switzerland Votes on Single Payer: Healthcare Triage News","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nDiabetes on the decline? Switzerland votes on single payer!\n \nFor those of you who want to read more, go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=58565\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1412351504","likes":"800","duration":"196","transcripttext":"Diabetes on the decline? Switzerland votes on single-payer. This is Healthcare Triage News.\n\n[Healthcare Triage News opening theme]\n\nOur first story's actually some good news. Rare, I know. When we talk about obesity or diabetes, it's almost always bad news, but last week, a paper was published in JAMA with something to smile about.\n\nResearchers used the National Health Interview Survey to examine trends in the prevalence and incidence of diabetes in the United States. In the 1980s, those rates were pretty steady. Not surprisingly to anyone who hasn't been living under a rock, rates started to rise after that, and in each year from 1990 to 2008, there was a pretty dramatic increase in the age-adjusted prevalence and incidence of diabetes. But what is surprising is that starting in 2008 and continuing through 2012, there was no significant change. In fact, the incidence seems to be dropping.\n\nLook at these charts. The one on the left is prevalence, or the number of people per one hundred persons per year who have diabetes: stable in the '80s, rising scarily in the '90s into the 2000s, but starting in 2008, the number of people has flattened. That's progress.\n\nThis chart's the incidence of diabetes, or the number of new cases per one thousand persons per year: same rise as with prevalence, but starting in 2008, the rate's been dropping. Dropping!\n\nThere are always caveats. There have been changes to how diabetes is diagnosed over this time, but the 1997 changes were well into the increase and didn't seem to affect the rate much. The 2010 change shouldn't have affected things that dramatically, either, and there are still subgroups, such as Hispanic and African American adults, for whom incidence is still rising, and even if the incidence continues to drop, the increased prevalence will mean that diabetes-related health issues and costs will continue to be a problem in the US.\n\nThat said, any good news about diabetes in the United States is welcome. If this is real, then something has changed. A continued decrease in the incidence of diabetes in the future will have major implications for our health and our spending on health care.\n\nIn international news, the Swiss just took a vote on whether to completely overthrow their health care system. Hey, Stan, can we borrow that Switze-reel from CrashCourse World History?\n\n[music]\n\nFans of our series on international health care may remember that Switzerland has a universal system that relies on the mandated purchase of private health insurance. There's a number of similarities to what we in America just established with Obamacare, minus the Medicare and Medicaid. If you want to stop here and go watch the Switzerland video to catch up, we'll wait. Actually, no, we won't, but you can pause me and come back on your own.\n\nThe knock against Switzerland's system is that it's expensive, somewhat inefficient, and relies a lot on out-of-pocket spending. Its outcomes and access are really great, though. Some advocates collected more than a hundred thousand signatures to compel a vote on turning their system into a single-payer one. Think Canada. You did watch that video, right? I mean, these international health care system videos are a hit. The prime minister of Singapore tweeted about our one on his country. You really should be watching them.\n\nAnyway, although some initial polling made this look like it might happen, it's not going to. About two thirds of voters opposed the change. They made the decision that they'd rather pay the extra money for what they're getting. So be it.\n\nOn a personal note, we appreciate not having to redo the Switzerland video, so, thanks, I guess.\n\n[Healthcare Triage news closing theme]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/5WaAVcxNbzo"},{"c_name":"healthcare triage","v_id":"D6u96jL-8l8","title":"Doctors, Quality of Care, and Pay for Performance","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\n\"Pay for performance\" is one of those slogans that seem to upset no one. But as with so many things in health care, it's much more complicated than it appears at first glance. Watch and learn!\n \nThis episode was adapted from a NYT piece Aaron wrote for The Upshot. All references can be found in links there: http:\/\/www.nytimes.com\/2014\/07\/29\/upshot\/the-problem-with-pay-for-performance-in-medicine.html\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1412612359","likes":"975","duration":"394","transcripttext":"Pay for performance is one of those slogans that seems to upset no one. But as with so many things in health care, it\u2019s much more complicated than it appears at first glance. It's also the topic of this week's Healthcare Triage.\n\n(Intro)\r\n \r\nTo most people it's a no brainer that we should pay for quality and not quantity. We all know that paying doctors based on the amount of care they provide, as we do with traditional fee for service setup, creates incentive for them to give more care. It leads to increased healthcare spending. \r\n \r\nChanging the payment structure to pay doctors for achieving goals instead should reduce wasteful spending. So it's no surprise that pay for performance has been an important part of recent reform efforts. But in reality, we're seeing disappointingly mixed results. \r\n \r\nSometimes it's because doctors don't change the way they practice medicine. Sometimes its because even when they do, outcomes don't really improve.\r\n \r\nThe idea behind pay for performance is simple: we'll give providers more money for achieving a goal. That goal can be defined in various ways, but at its heart we want to see the system hit some target. This could be a certain number of patients receiving preventative care, a certain percentage of people whose chronic disease is being properly managed or even a certain number of people avoiding a bad outcome. Providers who reach these targets earn more money.\r\n \r\nThe problem, one we've discussed before, is that changing physician behavior is hard. Sure, it's possible to find a study in the medical literature that shows that pay for performance worked in some small way here or there. For instance, a study published last fall found that paying doctors two hundred dollars more per patient for hitting certain performance criteria resulted in improvements in care. It found that the rate of recommendations for aspirin or for prescriptions for medications to prevent clotting for people who needed it increased six percent in clinics without pay for performance but twelve percent in clinics with it.\r\n \r\nGood blood pressure control increased 4.3 percent in clinics without pay for performances, but 9.7 percent in clinics with it. But even in the pay for performance clinics, thirty-five percent of patients still didn't have the appropriate anti-clotting advice or prescriptions and thirty-eight percent of patients didn't have proper hypertensive care. And that's success!\r\n \r\nIt's also worth noting that the study was only for one year, and many improvements and actual outcomes would need to be sustained for much longer to matter. It's not clear whether that will happen.\r\n \r\nA study published in the journal Health Affairs examined the effects of a government partnership with Premier Inc., a national hospital system, and found that while the improvements seen in 260 hospitals in a pay-for-performance project outpaced those of 780 not in the project, five years later all of those differences were gone.\r\n \r\nThe studies showing failure are also compelling. A study in The New England Journal of Medicine looked at 30-day mortality in the hospitals in the Premier pay-for-performance program compared with 3,363 hospitals that weren't part of the pay-for-performance intervention. We're talking about a study of millions of patients taking place over a six-year period in twelve states. Researchers found that 30-day mortality, or the rate at which people died within a month after receiving certain procedures or care, was similar at the start of the study between the two groups and that the decline in mortality over the next six years was also similar. Moreover, they found that even among the conditions that were explicitly linked to incentives, like heart attacks and coronary artery bypass grafts, pay for performance resulted in no improvements compared with conditions without financial incentives.\r\n \r\nIn Britain, a program was begun over a decade ago that would pay general practitioners up to twenty-five percent of their income in bonuses if they met certain benchmarks in the management of chronic diseases. The program made no difference at all in physician practice or patient outcomes, and this was with a much larger financial incentive than most programs in the United States might offer.\r\n \r\nEven refusing to pay for bad outcomes doesn't appear to work as well as you might think. A 2012 study published again in The New England Journal of Medicine looked at how the 2008 Medicare policy to refuse to pay for certain hospital-acquired conditions affected the rates of such infections. Those who devised the policy imagined that it would lead hospitals to improve their care of patients to prevent these infections. That didn't happen. The policy had almost no measurable effect. \r\n \r\nThere have even been two systematic reviews in this area. The first of them suggested that there's some evidence that pay for performance could change physician's behavior. It acknowledged, though, that the studies were limited and how they could be generalized and might not be able to be replicated. It also noted that there was no evidence that pay for performance improved patient outcomes, which is what we really care about.\r\n \r\nThe second review found that with respect to primary care physicians, there was no evidence that pay for performance could even change physician behavior, let alone patient outcomes.\r\n \r\nOne of the reasons that paying for quality is hard is that we don't even really know how to define \"quality.\" What is it really? Far too often we approach quality like the drunkard search - looking where it's easy rather than where it's necessary. But it's very hard to measure the things we really care about, like quality of life and improvements in functioning. \r\n \r\nIn fact, the way we keep setting up pay for performance demands easy-to-obtain metrics, otherwise the cost of data gathering could overwhelm any incentives. Unfortunately, as a recent New York Times article described, this has drawbacks. \r\n \r\nThe National Quality Forum, described in the article as an influential, non-profit, non-partisan organization that endorses healthcare standards, reported that the metrics chosen by Medicare for their programs included measurements that were outside the control of a provider; in other words, factors like income, housing, and education can affect the quality metrics more than what doctors and hospitals might do.\r\n \r\nThis means that hospitals in resource-starved setting caring for the poor might be penalized because what we measure is out of their hands. A panel, commissioned by the current United States administration recommended that the Department of Health and Human Services change the program to acknowledge this flaw. To date, it hasn't agreed to do so.\r\n \r\nSome fear that pay for performance could even backfire. Studies in other fields show offering extrinsic rewards, like financial incentives, can undermine intrinsic motivations, like a desire to help people. Many physicians choose to do what they do because of the latter. It would be a tragedy if pay for performance wound up doing more harm than good.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/D6u96jL-8l8"},{"c_name":"healthcare triage","v_id":"5w_mp925s6M","title":"Overtreating Kids, and the Shocking Truth About Alcohol in the US: Healthcare Triage News","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nSome kids are getting too many antibiotics, and some Americans are drinking WAY too much\n \nFor those of you who want to read more, go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=58682\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1412951585","likes":"1210","duration":"253","transcripttext":"Some kids are getting too many antibiotics, and some Americans are drinking way too much. This is Healthcare Triage News. \n\n(Intro)\n\nOur first story's about pharyngitis, or sore throats. \n\n#1: Even when we overtreat, we overtreat\n  \nIf kids have strep throat then sure, they should probably get antibiotics. Penicillin works great, 'cause resistance is still almost non-existent. But only about a third of sore throats are caused by strep, the rest are pretty much viral, and no antibiotics should be used for that. \n  \nIn a study published recently in JAMA Pediatrics, researchers used data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 1997 through 2010, to look at visits to the doctor for sore throat, and they also looked at whether antibiotics were prescribed. They found almost 12 million pediatric visits for pharyngitis. That's about 200 per 1000 children, or 20%. Sore throats are common! About 70% of the visits were for kids less than 12 years of age. \n  \nYou know where this is going, right? \n  \nAntibiotics were prescribed in 60% of the visits. Penicillin, which is all that's needed for Group A strep, was used only 61% of the time. Its use decreased from 65% at the beginning of the study to 52% at the end. \n  \nSince only about a third of those visits likely needed any antibiotics at all, that means that many of the 60% of kids who were given antibiotics, did not need them. Since Penicillin is all that's required to treat strep throat, that means that many of the kids given antibiotics were prescribed a drug that's way more broad-spectrum than they need. Even when we over-treat, we over-treat.\n\n#2: Most people don't drink much\n\nOur second story's about alcohol, and boy it's a doozy. A recent article by Christopher Ingraham in the Washington Post covered some information in a new book called \"Paying the Tab\" by Philip J. Cook. He used data from the National Epidemiologic Survey on Alcohol and Related Conditions to examine alcohol use in the United States.\n  \nLet's start with the fact that the most tee-totalling 30% of Americans drink no alcohol whatsoever. None! The next 10% consume, on average, about one drink a year. The next 10% consume only seven drinks a year.\r\nSo if you have two alcoholic drinks every three months, you're likely in the top half of alcohol consumers in the United States. I mean, wow!\n\nThe next 10% still drink, on average, less than a drink a week. The 10% after that (putting you between the 60th and 70th percentile) consume two alcoholic drinks a week. To remain in the eighth decile, you still have to drink less than one drink a day.\n\nBut then it gets more interesting. The ninth decile consumes, on average, 15 drinks a week, or just a bit more than two drinks a day. The National Institute for Alcohol Abuse and Alcoholism defines \"social drinkers\" as women who consume no more than seven drinks a week and three in a day. For men, it's no more than 14 drinks a week and four in a day.\n\nThat means that even in the ninth decile, it's likely that most drinkers aren't problem drinkers. It's much, much more alcohol than the rest of Americans are drinking, but it's still in the range of okay.\n\nIt's in that last decile that things go off the rails. Remember, that the ninth decile consumes 15 drinks a week, but that last decile? 74 drinks a week on average. 74!\n\nA glass of wine with dinner every night puts you in the top 30% of drinkers in America. But to make the top 10% you need to drink two bottles of wine a night, and that would still put you in the bottom part of that top 10%.\n\nWe're talking about 24 million Americans here. 74 drinks a week is more than four and half bottles of Scotch a week. It's three cases of beer a week. It's ten beers every day. On average!\n\nThese 10% of Americans drink more than half of all the alcohol consumed in the United States every year. These 10% are not healthy. They're costing us a lot of money in health problems, and they're spending a ton on alcohol itself. If those 10% of Americans could reduce their drinking to that of the next decile, then overall alcohol sales in the United States would fall by 60%.\n\nThey need help! We should make sure they get it.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/5w_mp925s6M"},{"c_name":"healthcare triage","v_id":"9_npl3A3KHQ","title":"You Should Get a Flu Shot","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nOne of the arguments you hear most often by people who don't want to get immunized against influenza is that the flu just isn't a big deal; it's just a bad cold. It's not. There are lots of other things people often get wrong about flu shots, too.\n\nFor those of you who want references or more information, go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=58721\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1413218834","likes":"1813","duration":"408","transcripttext":"What are the arguments you hear most often from people who don't wanna get immunized against influenza? Is that \"the flu just isn't that big a deal, I mean isn't it just a bad cold?\" Really? The flu shot is the topic of this week's Health Care Triage.\n\nOpening Sequence\n\nLook, there are a number of things the flu and a cold have in common. They both involve a respiratory system, and they both include a cough and a runny or stuffy nose, and of course they both make you feel sick! But that's where the similarities end. \n\nColds are caused by a variety of viruses, mostly rhinoviruses (30-50%) and coronaviruses (10-15%). The flu on the other hand, is caused only by the influenza virus. Cold are defined as a short and mild illness first characterized by headache, sneezing, chills, and sore throat; later on you get runny or stuff nose, cough and you feel a little crabby.\n\nUsually things move fast and colds are at their worst two to three days after infection. Most people start to feel better in a week to ten days after the cold starts. But some symptoms can last for weeks. Very few people with colds develop fevers.\n\nInfluenza, on the other hand, feels more like getting hit by a truck. Influenza also comes on fast, with more symptoms, like fever, cough, sore throat, headache, muscle pain, stuffy nose, weakness, and even a loss of appetite. You're likely to feel much much worse with the flu.\n\nA lot of people think of the flu, or influenza, as stomach flu. While you might have a loss of appetite or an upset stomach, the main effect from the influenza is to make you achy, weak, and tired, with a bad cough, fever, and congestion.\n\nColds rarely do much more then annoy us and slow us down. I don't mean to minimize how bad you feel when you have a cold, but you can be pretty sure as to how bad it will get. Flu, on the other hand, can kill. In fact, the flu kills up to 500,000 people around the world each year. The number of people who die from colds is almost zero. \n\nWhile there's no cure for the cold, there actually are antiviral medications that can help the flu to go away faster. In order for these medications to work, you need to start taking them in the first day or two after you get sick. That's why it's important to talk to your doctor as soon as possible after you feel sick in flu season.\n\nOnce those first few days have passed, the medications really won't do you any good. Although it's difficult to tell a flu from a cols at the beginning, the best predictors are cough and fever; having both of these symptoms has a positive predictive value of 80% in differentiating one from the other. So if you have a cough and a fever during flu season, there's a pretty darn good chance you've got influenza.\n\nMost importantly, there's a vaccine for the flu. The flu shot works; it prevents illness and it saves lives. To the research! One recent study showed that from 2010 to 2012 kids who got the flu shot had a 74 percent lower risk of being admitted to a pediatric intensive care unit during flu season. Another showed that getting the vaccine was associated with a 71 percent reduction in adult flu-related hospitalizations, 77 percent in people fifty and above!\n\nStudies show it's associated with the 79 percent reduction of hospitalization for people with diabetes, 52 percent reduction in people with chronic lung disease. Giving the vaccine to pregnant women is 92 percent effective for preventing hospitalizations of infants with the flu.\n\nYes, the flu vaccine changes from year to year and it's based on a best guess as to what strains will be most prevalent this season. Some years they do a better job predicting than others, but research shows consistently that the benefits outweigh any potential harm. The CDC currently recommends that every single person six months of age or older should get the flu shot. That includes pregnant women and people with lots of chronic illnesses.\n\n There are some people who shouldn't get flu shots. If you have an allergy to chicken's eggs, if you've had a serious allergic reaction to a previous flu shot, if you have had the rare condition Guillain-Barre syndrome after a previous flu shot or if you have a moderate or severe illness with a fever at the time you want the shot, you probably shouldn't be vaccinated and you should at least talk to your doctor about it. Otherwise, recommendations say that you should get it.\n\nSome people may tell you that the flu vaccine can give you the flu. It can't; the flu shot uses the dead viruses to protect you from influenza. Dead viruses can't make you sick. Dead viruses can't be resurrected to cause infections; they're dead. I know there's likely someone out there who is arguing with the video right now. maybe someone who thinks the flu shot gave them the flu in the past but it didn't happen. If you've ever thought that the flu shot gave you the flu, you might have experienced the side effect from the vaccine. Vaccines can cause soreness, redness, and swelling where you get the shot. Some people also experience some low-grade fever and aches. That's not the flu; that's just the lousy part of getting a shot, even though it's potentially saving your life. It's also possible you might have gotten sick right after the flu shot just by coincidence; maybe you were exposed to another virus around that time or even to influenza itself before you got the shot. When you get a shot and get sick at the same time, it's normal to put two and two together and assume that one caused the other. But once again, there's a difference between causation and association. Even if they happened at the same time, one event did not necessarily cause the other.\n\nNow the nasal spray influenza vaccine doesn't have a dead virus; it has a live attenuated virus. But this live attenuated virus is a special genetically modified version of the influenza virus specifically designed not to cause infection. It doesn't revert back to the original virus that can cause infection. It's never happened, not is scientific studies, nor in the millions of people who have gotten the influenza nasal spray vaccine since 2003. Still, some people worry that the nasal spray version of the influenza vaccine can come out of your nose and be transmitted to someone else. Shedding of the vaccine from the nose can occur, but the amount of the vaccine virus that comes outta there is incredibly small, much less than you would need to infect someone else and, in the many many studies that have been done, transmission of this attenuated vaccine virus has only been seen in one person as far as I can tell by looking at the medical literature. Once child in a study of 197 children had influenza from someone else's vaccine detected in their nose in a single day but it never caused any symptoms. In all the other studies, no one transmitted the vaccine virus at all. Even among HIV-infected children and adults, who would be at a higher risk for infection, no one was infected. Of course, you should still wash your hands and try to stay away from close contact with sick people to avoid both the cold and the flu, but the vaccine can make a big difference. As I said a few weeks ago here on Healthcare Triage, it's estimated that, just two years ago, if we had just gotten the influenza vaccination rate up to 70%, we could have prevented 4.4 million illnesses and 30,000 hospitalizations in the United States alone. There's a reason the CDC recommends this vaccine for everyone; listen to them.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/9_npl3A3KHQ"},{"c_name":"healthcare triage","v_id":"77avQCYVZEk","title":"Contagious Infections, Free Birth Control, and Unregulated Supplements: HCT News","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nHow infectious is that virus? How good is free birth control? How much should you worry about supplements? Watch and learn!\n \nFor those of you who want to read more, go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=58849\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1413567080","likes":"966","duration":"230","transcripttext":"How infectious is that virus? How good is free birth control? And what are in those supplements you're taking? This is Healthcare Triage News.\n\nOur first story comes to us courtesy of NPR. They recently put out an awesome graphic that shows how contagious different human viruses are.\n\nThe gist of it is something known as R0. It's a mathematical term that describes the average number of people who are made sick by another person in an outbreak. The higher the R0 is, the more infectious the disease is.\n\nA number of things can affect R0. The amount of time you're infectious, how much virus is needed to cause an infection, and even how it's spread; these things can all matter.\n\nMeasles one of the most contagious human diseases has an R0 of eighteen. That means without vaccination a person with measles will give it to eighteen other people. You can imagine how quickly that could spread through a community, but when you vaccinate the number drops to about zero.Mumps has an R0 of 10. SARS and HIV are 4, but Ebola is 2. That's 'cause Ebola is hard to transmit. \n\nOf course, Ebola is really, really deadly. There's a reason people are afraid of it, but diseases with a lower R0 are easier to contain, especially when we work to do so, like we are right now.\n\nOur second story comes from a recent study published in the New England Journal of Medicine. It described results from the Choice Project, which gave free contraception to 9,000 teenage women. Choice differed from many other projects in that of most teens chose a long-acting, reversible contraceptive or LARC.\n\nUnlike condoms or even the pill, LARCs like IUDs of estrogen implants, require a doctor's visit and are more expensive, but they also work much better. More than 3\/4 of teens age 14-17 in the Choice Project chose one of those two methods and more than 2\/3 of teens age 18-19 did.\n\nSexually active teens in the United States have a pregnancy rate of about 159 per 1000. Those in the choice program had a pregnancy rate of only 34 per 1000. Sexually active teens nationally have a birth rate of about 94 per 1000, verses 19 in the choice program. And sexually active teens in the US have an abortion rate of about 42 per 1000. Those in the Choice Program had a rate less than 10.\n\nIf you remove the financial and access barriers to long acting birth control, more girls get it and fewer teen pregnancies, births, and abortions occur, something to think about.\n\nAnd our last story is a quick warning about supplements. In the United States, dietary supplements aren't regulated nearly as thoroughly as drugs. Because of this, the ingredients in supplements can vary widely. \n\nIn the past some nutritional supplements contained 1,3-dimethylamylamine or DMAA, which is a stimulant. Recently though that was banned in the United States, United Kingdom, and other countries, 'cause it's associated with heart failure, stroke, and sudden death. DMAA had become more popular after ephedrine was banned in supplements in 2005, 'cause that was bad for you too.\n\nSo be it! But now savvy supplement makers are introducing a new substance known as 1,3-dimethylbutylamine or DMBA. DMBA hasn't been outlawed yet but 1,3-dimethylbutylamine is a really close analogue of 1,3-dimethylamylamine. I'd say \"to the research,\" but DMBA has never been studied in humans, never, no studies.\n\nSupplements are a huge business. Stimulants are added because they make you feel good, but they are unregulated, unstudied, and keep turning out to be harmful.\n\nI'm often baffled by the fact that many of the same people who are so worried about artificial sweeteners or gluten can be so blas\u00e9 about supplements. The former are well studied and safe for almost everyone, the later, you don't always know.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/77avQCYVZEk"},{"c_name":"healthcare triage","v_id":"UJtLUaeEkbk","title":"Doctors, Money, and Conflicts of Interest","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nI'm a doctor. My father is a doctor. My colleagues are doctors, the people I train are doctors, lots and lots of my friends are doctors. But that doesn't meant that doctors sometimes aren't blind to certain issues like their own financial conflicts of interest. Sometimes we have to poke doctors with a stick. That's how we show our love. Conflicts of interest are the topic of this week's Healthcare Triage.\n\nThis episode is adapted from Aaron's NYT piece on the topic. References can be found in the links there: http:\/\/www.nytimes.com\/2014\/09\/09\/upshot\/doctors-magical-thinking-about-conflicts-of-interest.html?abt=0002&abg=1\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1413816660","likes":"1243","duration":"356","transcripttext":"I\u2019m a doctor. My father is a doctor. My colleagues are doctors, the people I train are doctors, lots and lots of my friends are doctors. But that doesn\u2019t meant that doctors sometimes aren\u2019t blind to certain issues like their own financial conflicts of interest. Sometimes we have to poke doctors with a stick. That\u2019s how we show our love. Conflicts of interest are the topic of this week\u2019s Healthcare Triage. \n\nWhen the Food and Drug Administration creates an advisory committee to help it decide whether or not to approve drugs, it often asks academic physicians to serve on the committees as external experts. This is supposed to help the committee render judgments that are unbiased and scientific. \n\nPhysicians can therefore hold a fair amount of sway in how decisions are made. One would hope that they would be above reproach, coming to the committees deliberations with equipoise and an open mind. \n\nA study published by Genevieve Pham-Kanter in The Milbank Quarterly reviewed the voting behavior and financial interests of almost 1,400 FDA advisory committee members who took part in decisions for the Center for Drug and Evaluation Research from 1997 to 2011. Over this time, 15,739 votes took place in 379 meetings.\n\nOn average 13% of participants on each committee had some reported financial interest in a drug company whose product was up for review by that committee. About half of all meetings had at least one participant with such a financial interest.\n\nAbout a third of these interests involve consulting of some kind, but one quarter included an ownership interest, and 14% involved a committee member who served as a member of an industry advisory board or steering committee.\n\nShe found that over all committee members had a 52 percent chance of voting in favor of a sponsor of a drug. But members who had financial interests in only the company whose product was under deliberation were more likely to vote for it's approval, with a probability of 63 percent.\n\nIf members served on advisory boards for only the company whose product was up for review then the chance they'd vote in favor of it shot up to 84 percent! It's hard to look at data like these and not be concerned about conflicts of interest. There's a reason that 10 cent coupons exist, it's because they work! Financial interests absolutely do influence our decision making. \n\nSince 2008 the FDA has worked to reduce the number of committee members with financial conflicts of interest and the Pham-Kanter study indicates that this effort has met with some significant success. Other conflicts of interest like professional or ideological ones can also influence our behavior but those haven't been studied as well. The FDA is not the only place that financial conflicts of interest are a concern.\n\nFinancial relationships between doctors and industry are not uncommon. In 2007 research showed that 94 percent of physicians in the United States had such relationships. More than 80 percent of doctors had accepted gifts, and 28 percent had received payments for consulting or research. Sixty percent of those physicians were in medical education, and 40 percent were involved in writing practice guidelines.\n\nPhysicians sometimes travel to nice resorts for education. A study published sometime ago in the journal Chest followed doctors who went on two all-expenses-paid symposia on new drugs. Eighty-five percent of the physicians interviewed stated that accepting such invitations would not influence their use of the drugs. Nevertheless, their prescriptions for those drubs nearly tripled after the meetings, far above increases in the use of those drugs seen nationally. Other studies have shown that physicians who meet with and accept gifts from drug companies are significantly more likely to ask that their drugs be added to hospital formularies.\n\nIn the past potential conflicts of interest were not discussed widely in public. Many patients were unaware that physicians accept gifts from pharmaceutical companies. When they learned that such exchanges occur they reported that it \"altered their perception of the medical profession.\" Patients also felt that gifts are more influential and less appropriate than doctors did.\n\nThis sentiment is one of the reasons the Physician Payments Sunshine Act was passed with bipartisan support in the United States. The law, which went into effect last year, requires that almost all payments made by industry to physicians be reported to a public database. These include things like meals; travel; honorariums for speaking; grants for research; and ownership in companies. It's hoped that by making these types of relationships public, we might mitigate some of their effects.\n\nDoctors have had mixed reactions to those changes. Data like those now required by law to be reported were recently used to show that top Medicare prescribers of the expensive drug Acthar had financial ties to it's maker. The doctors mentioned by name in that article probably didn't appreciate their loss of anonymity. Many others have already begun to limit their acceptance of gifts, knowing that they'll soon be made public.\n\nSome physicians, especially those opposed to the Sunshine Act, believe that they should be responsible for regulating themselves. But our thinking about conflicts of interest isn't always rational. A study of radiation oncologists found that only five percent thought that they might be affected by gifts. But a third of them thought that other radiation oncologists would be affected. Another study asked medical residents similar questions. More than sixty percent of them said that gifts could not influence their behavior but only sixteen percent believed that other residents could remain uninfluenced.\n\nThis \"magical thinking\" that somehow we ourselves are immune to what we're sure will influence others is why conflict of interest regulations exist in the first place. We simply cannot be accurate judges of what's affecting us. \n\nConflicts of interest are real, and they are still influencing decisions from the level of the patient all the way up to national health policy. We won't ever be able to eliminate them all. But acknowledging them and talking about them openly is an important first step toward minimizing their impact.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/UJtLUaeEkbk"},{"c_name":"healthcare triage","v_id":"ACKeEJIy-tw","title":"Green Coffee Extract Doesn't Reduce Weight, and Travel Bans Won't Stop Ebola","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nResearch fails to show that green coffee extract works. It also fails to show travel bans are a good idea for Ebola. \n \nFor those of you who want to read more, go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=58938\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1414161003","likes":"1019","duration":"268","transcripttext":"Research fails to show that green coffee extract works. It also fails to show travel bans are a good idea for Ebola. This is Healthcare Triage News.\n\n(Intro)\n\nOur most popular Healthcare Triage episode is on vaccines and autism, and in it I mention that the Lancet paper that started the whole craze had been retracted from the medical literature. And that such a retraction was rare. That's still true. But it does happen and it did so again this week.\n\nIn 2012, a paper was published entitled, \"Randomized, double-blind, placebo-controlled, linear dose, crossover study to evaluate the efficacy and safety of a green coffee bean extract in overweight subjects.\" It claimed that six weeks of use of GCA, a green coffee extract product, led to an average weight loss of more than eight kilograms. That's impressive. In fact a certain well known TV doctor claimed that it was \"magic\", \"staggering\", \"unprecedented\" and \"a miracle pill\". Yeah, not so much.\n\nThis week the blog Retraction Watch covered the issue. In 2010, Austin, Texas-based AFS paid researchers in India to conduct a clinical trial on overweight adults to test whether Green Coffee Antioxidant (GCA), a dietary supplement containing green coffee extract, reduced body weight and body fat. The FTC charges that the study's lead investigator repeatedly altered the weights and other key measurements of the subjects, changed the length of the trial, and misstated which subjects were taking the placebo or GCA during the trial. When the lead investigator was unable to get the study published, the FTC says that AFS hired researchers Joe Vinson and Bryan Burnham at the University of Scranton to rewrite it. Despite receiving conflicting data, Vinson, Burnham, and AFS never verified the authenticity of the information used in the study, according to the complaint.\n\nThese two researchers now claim the study sponsors can't assure them that the data are valid, so they retracted the paper. Bottom line, when something is called a miracle it should be on the front page of every newspaper. And the lead story on every news show. Otherwise, be skeptical. Consider conflicts of interest. Think about the source. Remember that not all research is rigorous. And never, ever forget that the plural of anecdote is not data.\n\nOur second story is about Ebola. First, the good news. It appears that both Spain and the United States are getting a handle on their outbreaks. In even better news both Senegal and Nigeria have successfully contained and ended their outbreaks. The bad news is that much of West Africa still needs a lot of help. But you know what won't work? Travel bans.\n\nIn a recent piece at vox.com, Julia Belluz and Steve Hoffman went through the evidence on travel bans to contain epidemics. Their arguments are pretty compelling. First of all let's look at what happened with HIV\/AIDS. The US only lifted its Entry, Stay and Residents restrictions after President Obama came into office. The disease still became a pandemic in the 1990s. And a review article published in 1989 found that travel restrictions were expensive, hard to enforce, discriminatory, and harmful. One of the biggest problems was identifying people traveling who might have the disease. That same problem exists with Ebola. \n\nTheir second argument uses a natural experiment. After September 11th 2001, temporary flight bans went in to place all over. They had pretty much no impact on the flu season. It delayed it and actually led to it being prolonged. Oddly enough flu deaths spiked that year. There's no way to know if that was due to the travel ban, but the ban certainly didn't reduce deaths. \n\nA study published in 2006 in the Proceedings of the National Academy of Sciences, in the United States, showed that travel restrictions wouldn't work for avian flu. Another study in PLoS One showed that travel restrictions put in place in 2009 to prevent the spread of swine flu, didn't work. A Canadian study showed that airport screening for SARS in 2003 caught literally zero cases.\n\nNow it's likely that travel bans will have some effect. They'll make the epidemic worse in Africa. Travel bans make it harder to get supplies and help to those who need it. They'll hurt the economies of affected countries. They'll make it potentially more likely that the epidemic will rage out of control in West Africa. Which would put the rest of the world in increased risk.\n\nTravel bans make for good theater. They sound like they make sense. But they may do more harm than good. We can do better.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/ACKeEJIy-tw"},{"c_name":"healthcare triage","v_id":"48mil-jr-Pk","title":"Wellness Programs Don't Seem to Work as Advertised","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nThe latest Kaiser Family Foundation survey on employer sponsored health insurance focused on the fact that growth in premiums in 2013 was as low as it has ever been in the 16 years of the survey. And that's awesome. Health insurance premiums have been rising more quickly than we'd like for a long time. But buried in the details of the report were some interesting insights into how employers think about controlling health care costs. One example is that they're very fond of workplace wellness programs. This is surprising, because while such programs sound great, research shows they rarely work as advertised. Watch and learn!\n \nThis episode is adapted from Aaron's and Austin's NYT piece on the topic. References can be found in the links there: http:\/\/www.nytimes.com\/2014\/09\/12\/upshot\/do-workplace-wellness-programs-work-usually-not.html\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1414433175","likes":"919","duration":"405","transcripttext":"Aaron: Every year, the Kaiser Family Foundation puts out a survey on employer sponsored health insurance in the United States.  Most news coverage of the most recent survey seemed on the fact that growth in premiums in 2013 was as low as it's ever been in the 16 years of the survey.  And that's awesome.  Health insurance premiums have been rising more quickly than we'd like for a long time.  But buried in the details of the report were some interesting insights to how employers think about controlling healthcare costs.  One example is that they're very fond of workplace wellness programs.  This is surprising, because while such programs sound great, research shows they rarely work as advertised.\n\nWellness programs are the topic of this week's Healthcare Triage.\n\n(HCT Intro plays)\n\nWellness programs aim to encourage workers to be more healthy.  Many use financial incentives to motivate workers to monitor and improve their health, sometimes through lifestyle modification programs, aimed at lowering cholesterol or blood pressure, for instance.  Some programs offer a carrot, like discounts on health insurance, to employees who complete Health Risk Assessments.  Others use a stick, penalizing poor performance or charging people more for smoking or having a high Body Mass Index, for example.\n\nWellness programs are very popular among employers.  An analysis by the RAND Corporation found that half of all organizations with 50 or more employees have them.  The new survey by the Kaiser Family Foundation found that 36% of firms with more than 200 workers, and 18% of firms overall use financial incentives tied to health objectives like weight loss and smoking cessation.  Even more large firms, 51% of those with 200 workers or more, offer incentives for employees to complete Health Risk Assessments intended to identify health issues.  Medium to large employers in the United States spent an average of $521 per employee on wellness programs last year, double the amount they spent five years ago, according to a February report by Fidelity Investments and the National Business Group on Health.  The programs are generally not offered directly by insurance companies, but instead by specialist firms that tell employers they will reduce spending on employees' care by encouraging the employees to take better care of their health.  \n\nWellness programs have grown into a $6,000,000,000 industry, because employers believe this.  In fact, asked which programs are most effective at reducing cost, more firms picked wellness programs than any other approach.  The Kaiser survey found that 71% of all firms think such programs are very or somewhat effective compared with only 47% for greater employee cost sharing and 33% for tighter networks of doctors.  \n\nWhat research exists on wellness programs doesn't support this optimism.  This is, in part, because most studies of wellness programs are of poor quality, using weak methods that suggest that wellness programs are associated with lower spending but don't prove causation.  Or they consider only short-term effects that aren't likely to be sustained.  Many such studies are written by the wellness industry itself.  A meta analysis published in the journal Health-Affairs in 2010 reported that wellness programs had a pretty impressive return on investment.  Medical costs fell by about $3.27 for every $1 spent, and absenteeism costs fell by about $2.73 for every $1 spent.  But many of the studies they examined were older and used less rigorous study designs.\n\nMore rigorous studies, including a more recent systematic review published in 2012 in the American Journal of Managed Care, tend to find that wellness programs don't save money, and, with few exceptions, do not appreciably improve health.  This is often because additional health screenings built into the programs encourage overuse of unnecessary care, pushing spending higher without improving health.  However, this doesn't mean that employers aren't right, in a way.  Wellness programs can achieve cost savings, for employers, by shifting higher costs of care onto workers. In particular, workers who don't meet the demands and goals of wellness programs end up paying more, whether by not participating at all or by failing to meet benchmarks like a reduction in Body Mass Index.  \n\nFinancial incentives to get healthier sometimes simply become financial penalties on workers who resist participation or who aren't as fit.  Some believe this can be a form of discrimination.  The Affordable Care Act encourages this approach.  It raises the legal limit on penalties that employers can charge for health-contingent wellness programs to 30% of total premium cost.  Employers can also charge tobacco users up to 50% more in premiums.  Needless to say, this strikes some people as unfair and has led to objections by workers at some organizations as well as lawsuits.  \n\nAnother way that wellness programs can help employers is by putting a more palatable loss on other changes in health coverage.  For instance, workers might complain if a company tried to reduce costs through higher cost-sharing, or narrower networks, that limit doctor and hospital choice.  But if these are quietly phased in at the same time as a wellness program that's marketed as helping people become healthier, a company might be able to achieve those cost-reductions with less grumbling.  \n\nAt least one study has shown that a wellness program can achieve long-term savings.   In 2003, PepsiCo introduced what was to become its Healthy Living program.  This program included lifestyle management, such as weight, nutrition, and stress management, along with smoking cessation and fitness, along with disease management components, such as targeting participants with asthma, coronary heart disease, atrial fibrillation, heart failure, stroke, hyperlipidemia, low back pain, and other issues.  A study published in the journal Heath Affairs examined the outcomes of the program seven years after implementation, the longest such study of a wellness program to date.  The researchers found that participation in the PepsiCo program was associated with lower healthcare costs, but only after the third year, and all from the disease management components of the program.   \n\nThis suggests that wellness programs that target specific diseases that may drive employer costs could achieve savings, though perhaps only after several years.  When more broadly implemented, and focused on lifestyle management, as many wellness programs are, savings may not materialize and certainly not in the short-term.  Employers may misunderstand the research, if they think that just any wellness program, by itself, is the surest route to reducing overall healthcare spending.  That just isn't the case.  It may be true that if designed well, some programs can save money for both the employer and employees in the long run, but not by focusing on lifestyle changes.  Programs that merely do that may cut employer cost, but only by shifting them onto employees.  If firms wish to count that as a victory in the battle against healthcare costs, they can do so, but they're employees may look at it differently.\n\n(HCT Endscreen)","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/48mil-jr-Pk"},{"c_name":"healthcare triage","v_id":"3RLzR85vK68","title":"Ebola in America and Placebos Work! Healthcare Triage News","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nA few more patients are cured of Ebola in the US, and placebos can help kids with the cold. This is Healthcare Triage News.\n \nFor those of you who want to read more, go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=59076\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1414770499","likes":"893","duration":"226","transcripttext":"A few more patients are free of Ebola in the US, and placebos can help kids with the cold. This is Healthcare Triage News.\n\nWe can't seem to get away from Ebola in the news, and we'd be remiss if we didn't tell you what's going on. Another few patients have been declared Ebola-free in the United States, and have been released from the hospital. In fact, as of taping, only one person in the United States, a doctor in New York, is infected with Ebola. \n\nWhat's remarkable is that eight of the nine people who have been treated in the United States have survived. And everyone who was picked up quickly, once they had symptoms, has survived. So why is the mortality rate so much lower here than in Africa, where mortality has hovered around 70% for this outbreak? \n\nOne reason is that we have access not to Ebola-specific drugs, but to regular old drugs that we sometimes take for granted. Patients with Ebola can get terrible secondary infections. Sometimes they need antibiotics, and we've got them in spades. Sometimes patients suffer from organ failure, their blood pressure plummets. When that happens, we have drugs and fluids and devices that can keep people alive. That matters. \n\nFurther, when things go wrong, We have scanners and tests that diagnose the issue. Other countries don't. And let's not ignore the personnel differences. We complain about the doctor shortage here in the United States, but we have about 245 doctors per 100,000 people. Liberia has 1.4. We have a whole series on international health care systems here at Healthcare Triage. \n\nBut it's important to recognize that when we talk about one versus the other, I'm mostly complaining about first world problems. Literally. Poverty, real poverty, makes a huge difference in so many ways. Ebola included. \n\nOur second story is about treating kids with colds. Colds are awful, especially when a small child has one. They're not very very good at sucking it up, and there's so little you can do for them. Most of the over-the-counter medicines have been pulled from the shelves because they don't work, and they had lots of side effects. \n\nPeople are always trying to look for help, even from complementary medicine. A study published this week in JAMA Pediatrics tried to look at just that. To the research! \n\nIt was a randomized controlled trial of an agave nectar formulation. One third of the kids got that, one third of the kids got a placebo, and one third got nothing at all. Everyone got a baseline measurement the night before they got their randomized \"therapy.\" On the next night, kids in the trial got a single dose of their \"therapy\" before bedtime. \n\nThe main outcomes were cough, congestion, runny nose, and sleep. Both for the child, and for the parents. The first thing to notice that in all groups, even in the \"no therapy\" group, there were improvements from baseline. Even \"being studied\" seemed to have an effect. The second thing to notice the kids were significantly better on the agave nectar than in the \"no therapy\" group. But there was no difference between kids in the agave nectar group and the placebo group. The placebo group also did significantly better than the \"no therapy\" group.\n\nThis is why I tell parents who have kids with colds to try anything that I don't think has a harm. I include cost in the harm category. If you want to tell your child you're giving them a \"special drink of warm tea,\" that's awesome. If you have a special moisturizer that \"soothes their chest,\" that's great. If you want to put a little agave nectar in water and tell them it's medicine, I'm okay with that too. \n\nOf course, in the study, the placebo effect was likely working on the parents as well as the kids. Which of them received the bigger benefit isn't clear. But the effect is there. In fact, I think the placebo effect is so important, we're gonna cover it in detail in future Healthcare Triage episodes. \n\nBut when we tell you that no medicines work for colds, we're not telling you to do nothing, we're telling you that nothing works better than placebos, you absolutely should use placebos. They work!","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/3RLzR85vK68"},{"c_name":"healthcare triage","v_id":"v-LzLGjNi18","title":"Obamacare First Anniversary Update","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nJust over a year ago, Healthcare Triage's first video was on the opening of the exchanges mandated by the Affordable Care Act, and what people in the US should do about that. It's a year later, and we thought you might enjoy an update.\nHow are things going with the ACA, or Obamacare? What's changing? What do you need to be worried about now? We'll answer all that, and more, on this week's Healthcare Triage.\n \nMany of the references for this can be found at a recent piece Aaron wrote for the JAMA Forum: http:\/\/newsatjama.jama.com\/2014\/10\/29\/jama-forum-the-2014-midterm-elections-is-the-aca-still-a-political-flashpoint\/\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1415040977","likes":"1341","duration":"345","transcripttext":"Just over a year ago, Healthcare Triage's first video was on the opening of the exchanges mandated by the Affordable Care Act, and what people in the U.S. should do about that. It's a year later, and we thought you might enjoy an update. How are things going with the ACA, or ObamaCare? What's changing? What do you need to be worried about now? We'll answer all that and more on this week's Healthcare Triage.\n\nLast year around this time, the news was saturated with how bad the roll out of the exchange websites were going. Not only were they nearly impossible to use, and slow as stink, but when someone was actually (and rarely) able to complete an application, the data on the back end were often corrupted. It seemed likely at the time that those setbacks would significantly reduce how many people would be able to sign up for insurance plans.\n\nBut the administration made a number of moves to ensure that didn't happen. By April, when open enrollment ended, about 8 million people had signed up for exchange plans. This was more than the 7 million people that had been predicted to sign up for private insurance plans in the first year. In other words, things went even better than expected. The exchanges surpassed their benchmarks.\n\nOpponents of ObamaCare argued that many of those who signed up for plans might not pay for them. They'd just go through the motions of signing up, but balk when the bill came. And of course, paying for a plan is the real metric of obtaining insurance. But by the summer, data showed that about 7.3 million people had payed their bills, meaning still, the benchmarks had been beat.\n\nOther opponents claim that those signing up for plans were already insured- in other words, we weren't helping the uninsured as much as we'd hope. That turned out to be wrong too. Surveys by the Kaiser Family Foundation show that most of those who got insurance under the ACA didn't have it before. Further, poll after poll from organizations such as Gallup and the Commonwealth Fund show that the uninsured rate in the United States has dropped significantly this year.\n\nSo what was the next argument against the ACA? Some said that sicker or older people would preferentially sign up for insurance. Others said that regulations would make insurance much more costly than expected. Both of these issues would show up as significantly increased premiums for 2015 than we saw in 2014.\n\nDid that happen? No. A number of different analyses, using a number of different methods, have shown that premiums appear to be increasing much less than you'd predict historically. In some areas, they're going down. Amazingly enough, overall healthcare spending is growing at one of the lowest rates we've ever seen. Now it's not clear whether this is because of the Affordable Care Act, or because of transient factors outside of its control, but given that spending growth is lower than expected, it's hard to argue that the ACA has made health care much more expensive.\n\nAnd that's only the exchanges. What about the medicaid expansion? It, too, has only grown in the last year. Although many states have still refused to accept it, since a year ago, many states have joined the program: Indiana, Michigan, Pennsylvania, Iowa, Utah, even Tennessee, all appear to be moving towards, or have achieved some sort of compromise with the federal government. Why? Cause for many of them, it makes really goo economic sense. Hospitals and states with the Medicaid Expansion are reporting real increases in patients with Medicaid insurance and even larger decreases in patients who are uninsured. It's better for them, or course, to have patients with any insurance at all than no insurance. \n\nIn fact, states that have refused the expansion have seen their uninsured admissions go up. Research shows that states that don't expand Medicaid are not only leaving billions of federal dollars on the table, they'll also see increased state spending on uncompensated care, to the tune of more than a billion dollars in 2016 alone.\n\nBut that doesn't mean that things don't remain somewhat precarious. There are still a number of factors threatening the long-term viability of the affordable care act, including many politicians who are still wanting to see it repealed. These include a legal threat that still could lead to subsidies being denied to eligible individuals in many states.\n\nBut what does this mean for you? That's what we really care about here at Healthcare Triage, so let's spend a few minutes focused on that. There are still many people out there who qualify for Medicaid who have not signed up for it. You should check. Go to healthcare.gov and fill in your information. That should tell you if you can get it. There's no open enrollment period for Medicaid, so don't wait. Just go. \n\nEveryone else who doesn't have insurance, or who got it during the open enrollment last year- you need to go to the website between November 15h and February 15th. That's the open enrollment period for 2015. Even if you've already got insurance from the exchange already, you really, really should go again. It's true that if you don't, you'll just be re-signed up for the insurance you chose last year, but it's possible that some of those plans aren't there anymore. It's also possible that the plan you chose last year cause it was cheap is much more expensive this year. Benefits and prices can change. You all- all of you- should go and check.\n\nThe enrollment period is shorter this year than last year. And, it seems that 9 out of 10 Americans are unaware than open enrollment is about to start. We assume that you Healthcare Triage viewers are more informed than the average person, but it's still likely that a lot of you don't know about it.\n\nOf course, if you have insurance through your job, or if you have Medicare, or if you have VA insurance, or if you're already on Medicaid (and all of those, that's the vast majority of of people in the United States)- there's nothing for you to do right now. \n\nBut as I said earlier, all 7.3 million people who have exchange plans need to go look at them again. If a better option is available, you might want to change. Millions more are still uninsured. You need to go check out your options, and claim the subsidies that may be available to you. Everything I said last year still holds true. Open enrollment starts November 15th, and it's a great opportunity. Don't miss it.\n\n\n\n\n\n\n\n\n\n\n\n\n","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/v-LzLGjNi18"},{"c_name":"healthcare triage","v_id":"FjlZO2UkT8Q","title":"Get Vaccinated Against Measles, Don't Drink Milk, and Don't Eat That Halloween Candy!","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nWe have merch! Buy it here: http:\/\/dft.ba\/-HCTmerch\n\nThanks to Audible.com for supporting this episode. You can get a free trial of Audible at http:\/\/www.audible.com\/triage\n\nMeasles is back, the milk industrial complex takes another hit, and how does your favorite Halloween candy rank? This is Healthcare Triage News.\n\nUpdated Measles Graph: https:\/\/pbs.twimg.com\/media\/B17NbVzCYAAVvcw.jpg:large\n \nFor those of you who want to read more, go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=59244\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1415386264","likes":"1233","duration":"308","transcripttext":"Our top story today is that Healthcare Triage merchandise is finally available. You can get posters and mugs at dftba.com. Links down in the description.\n\nBut in real news, measles is back, the milk industrial complex takes another hit, and how does your favorite Halloween candy rank? This is Healthcare Triage News.\n\n(Intro)\n\nMeasles! Did you know that in the United States, indigenous measles was declared eliminated in 2000? It was declared eliminated in all of the Americas in 2002, but this year, 2014, more measles cases have been reported in the United States than in any year in the last two decades. There were 592 cases through August. Why? Well, one reason we have to acknowledge is that more people are traveling to countries where measles isn't eliminated. When exposed, people are more likely to get infected and then bring it back to the United States. But the second reason, and the one we can't ignore, is that more and more people aren't vaccinating their children.\n\nAs we've discussed in prior episodes of Healthcare Triage News, measles is one of the most contagious viruses with an R0 of eighteen. With something that infectious, we need about 92-94% of people to be vaccinated to achieve herd immunity. That's higher than for almost all other vaccine-preventable illnesses.\n\nComplications from measles are common. Even in the United States, up to 0.3% of kids with measles can die. In the developing world, death is much more common, and in 2012, about 122,000 kids died of measles worldwide. Vaccinate your kids! Please!\n\nOur second story is an old favorite of ours. You all know of my fascination with the milk industrial complex. Recently, a new paper was published in the BMJ that points another finger towards the fact that the milk emperor has no clothes. Seriously, how much do you love the Milk Emperor? Props to Mark on that one.\n\nIn this study, researchers took 2 huge groups of Swedes, one with more than 61,000 women, and the other one with more than 45,000 men, and then followed them for an average of 20 years. They wanted to see if milk intake was related to fractures or to death. 'Cause, you, know, milk is awesome for bones. Except there's pretty much no evidence for that. It also turns out that there's a growing concern that excessive milk intake could be related to bad cardiovascular outcomes. So what did these researchers find?\n\nWomen who had 3 or more glasses of milk a day had an increased risk of death compared to those who drank less than one glass a day, with a hazard ratio of 1.9. You heard that right. Increased risk of death. For every glass of milk drunk per day, the hazard ratio of death went up 1.15 in women and 1.03 in men.\n\nBut what about fractures? In men, no difference was seen anywhere. In women, it turns out that for each glass of milk drunk, the hazard ratio was 1.09 higher for hip fractures. It was 1.02 overall, but the 95% confidence interval was 1 to 1.04, so potentially non-significant, so the best we can say is that milk wasn't associated with any benefits in men with respect to fractures and a higher risk of hip fractures in women. Oh, and it's associated with an increased risk of mortality in everyone.\n\nThe paper also gets into some biomarkers that try to explain the mechanism for why milk might be harmful. I'll leave that to more basic science experts.\n\nMy point is this: The purported benefits of milk are unproven. There's a growing body of evidence that there's an association between more milk consumption and bad outcomes. Why does milk get a pass? Why do we push it so hard?\n\nFinally, over to our friends at vox.com for an awesome article on how relatively unhealthy Halloween candy is. For each candy, they compared the amount of fat, sugar, and calories in a fun size, snack size, or single piece.\n\nThe least unhealthy: Sweet Tarts, followed by Hershey's Kisses, Tootsie Rolls, Laffy Taffy, and Jelly Belly Jelly Beans. Of course, \"least unhealthy\" is relative, but there you go. The most unhealthy: Number five was Butter Finger, four was Whoppers, three was Take Five, and if I'm being honest, that one really hurts cause I love the pretzel and chocolate thing. That just sucks. Number two unhealthy: Reese's Peanut Butter Cups, which is almost enough to make me despair, but the worst: Twizzlers, and my faith is restored cause I hate licorice.\n\nAnyway, if you ate just one piece of each of the 29 candies ranked, you would have consumed almost 67 grams of fat, 255 grams of sugar, and 1936 calories, and we realize it's probably too late for this year, but hopefully you can use this information next Halloween.\n\nThis episode of Healthcare Triage is supported by audible.com, a leading provider of premium digital spoken audio information and entertainment on the Internet. audible.com allows users to choose the audio versions of their favorite books, with a library of over 150,000 titles. We recommend Candy Freak by Steve Almond. He goes around and talks to the last independent holdouts in the candy manufacturing industry. Stan tells me that it's funny and chock-full of good information. You can download a free audio version of Candy Freak or another of your choice at audible.com\/triage.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/FjlZO2UkT8Q"},{"c_name":"healthcare triage","v_id":"9sAM7a_OLE4","title":"The Placebo Effect is Real, Man!","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nYou can get Healthcare Triage mugs and posters just in time for holiday gift giving: http:\/\/store.dftba.com\/collections\/healthcare-triage\n\nIn one of our first episodes of Healthcare Triage, we discussed how placebo controlled randomized controlled trials showed that sugar doesn't make kids hyper. Placebos, or fake therapies, are important because people who think they're getting a treatment will often feel an effect. Watch and learn!\n \nMany of the references for this can be found in a recent piece friend-of-the-show Austin Frakt wrote for the NYT. His twitter is http:\/\/www.twitter.com\/afrakt, so go thank him for letting us adapt that piece for this episode : http:\/\/www.nytimes.com\/2014\/10\/14\/upshot\/placebos-help-just-ask-this-health-economist.html?_r=0&abt=0002&abg=1\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1415738205","likes":"1181","duration":"349","transcripttext":"\n\nIntro\n\n\nIn an earlier episode of healthcare triage, we discussed how placebo controlled random randomized controlled trials showed that sugar doesn\u2019t make kids hyper. Placebos, or fake therapies, are important because people who think they\u2019re getting a treatment will often feel an effect. \n\nIn the last trial discussed in that video, I talked about how parents who thought their kids had consumed a sugared beverage thought their kids were more hyper even when that beverage was really sugar-free. Sometimes treatment is all in your head. The placebo effect is powerful. It's also the topic of this weeks healthcare triage. \n\n(Intro plays)\n\n\n\nBody\n\n\nMy colleague and friend, Austin Frakt has written extensively on the placebo effect. Links down below. \nWhen we compare a treatment with a placebo, it's important to keep in mind that a placebo is not the same thing as an absence of treatment. In research settings, placebos are specifically designed to mimic treatment without the hypothesized few \"active\" ingredients, or procedural steps. \nThey still include a lot of components of care. Sometimes, we even compare one treatment with another, or with \"usual care,\" the care that would be given in the absence of the treatment being tested. \nIn evaluating treatments, researchers go to considerable lengths to provide elaborate sham treatments for comparison, because care delivers cure by two pathways. \nOne is through our bodies. The other involves our minds: When we believe we are receiving care, we get better. Moreover, we do so more quickly and at a higher rate than if we receive no care at all. \nThe question addressed by placebo control trials is whether the second effect, the effect that operates only through belief, is the only effect of a given treatment. Does the active part of the treatment do anything more? Placebo control trials try to tease that out. \nLook, there's no question that some treatments are better than placebos, but those cure through both pathways, including the one activated by placebos. At the same time, the placebo effect is not universal. Some studies show no difference between placebo control groups and no-treatment groups. \nAlthough some of the ways in which placebos work are known, for instance, by activating natural neurochemicals that make us feel good, we don't truly understand when and how they do or don't. \nEmergency physician David Newman, in his book, Hypocrites' Shadow, highlights some great examples of how placebos work. \nTo the research!\nStudies of placebo pills show that taking more is better. Two sugar pills relieve more pain than one. Two pills provide more sedation than one, and two sugar pills heal stomach ulcers more quickly than one. Sugar pills! \nResearch shows that if you take a placebo pill and put a brand name on it, it works better than the exact same pill without the brand name printed on it. \nStudies show that patients who don't skip doses of their placebo medication for cholesterol reduction survive longer than those who do skip doses. Of their placebo medication!\nFinally, research shows that taking placebos has been associated with measurements of increased endorphins, which are our bodies natural pain relievers. Believing the pill works get the brain to do the job for us. \nIt's hard to reject the hypothesis that when we believe placebos will heal, they do, at least to some extent. Perhaps for this reason, our childhoods are full of placebo effects, and as parents, we deliver them to our children all the time. \nI can't tell you how many times I've used moisturizer to cure all kinds of aches and pains for my boys. A bandage over my girl's scrape that didn't even break the skin can end her tears. Hugs and sympathetic tones go a long way too. These are all placebos. \nGiven all of this, it shouldn't be surprising that many physicians prescribe placebos. A study last year found that more than 10% of doctors in the United Kingdom used pure placebos, and nearly all used impure placebos, or unproven remedies in their careers. This mirrored other research which showed that 45% of German docs had used pure placebos, and 76% had used impure placebos in the last year. \nIn fact, doing so was common practice before World War Two, with supportive publications in the medical literature as late as the mid-50s. One of the reasons was that back then we had fewer recognized active-ingredient therapies. This practice faded away after the rise of placebo controlled trials that yielded treatments that were shown to be better than placebos, but it has resurfaced in new forms. \nToday, our use of antibiotics for conditions that don't require them is a form of placebo prescribing. Acetaminophen, or Tylenol, for back pain appears to be a placebo effect as well. These may help patients feel better, but only because they believe they will do so. The active ingredient adds nothing.\nTo that extent, some doctors trick patients in an effort to achieve a placebo effect, most patients don't seem to mind. In a study published last year, only 22% of patients thought it was never OK for a doctor to prescribe some sort of placebo therapy. \nNevertheless, deliberately harnessing just the placebo effect by prescribing a treatment that does not have any additional direct physical effect is an ethically gray area. \nThe lesson of placebos is simple. The mind-body connection is strong. A lot of good can come from caring and feeling cared for. Sometimes we need, and can find, additional help from other therapies, but for a wide range of common problems, from earaches to knee pains to headaches, sometimes we don't. \nWhen a clinical trial tells us that a therapy is equivalent to placebo, that doesn't necessary tell us that the therapy does little. It may tell us that the placebo does a lot. The therapy merely does nothing additional. The placebo effect can do a lot of the work, even when it comes to surgery - but that's for next week. \n(Theme song plays)","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/9sAM7a_OLE4"},{"c_name":"healthcare triage","v_id":"PLw9GHiZuBM","title":"Sugar Tax and Canadian Travel Ban","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nHealthcare Triage has merchandise! Get your mugs and posters here: http:\/\/store.dftba.com\/collections\/healthcare-triage\n\nBerkeley passes a tax on sugary drinks, and Canada passes a ban on Ebola travel. Neither will work. This is Healthcare Triage News.\n \nFor those of you who want to read more, go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=59417\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/realjohngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1415988535","likes":"831","duration":"163","transcripttext":"\n\nIntroduction\n\n\n Berkeley, California passes a tax on sugary drinks, Canada passes a ban on Ebola travel; neither will work. This is Healthcare Triage News.\n \n \n\nSugar Tax\n\n\n We made a Healthcare Triage episode about why I thought the New York City soda ban was a bad idea. The courts made that go away. But recently, voters in Berkeley, California voted for a pretty big soda tax instead. How much? One cent per ounce. And it's not just on soda - the tax is on any drinks that are sugar sweetened. And it's pretty big. Previous taxes like that in Washington State were only two cents for a whole 12 ounce can. And that got repealed after just six months of use.\n\n Let's start with the economics. It's absolutely true that when things cost more, people buy less of them. Research shows that when the price of soda goes up, sales decline. When the price goes down, sales go up. So it's likely that this tax will have an effect on sales of sugar sweetened beverages.\n\nBut that's not the true goal of this tax. What people really want is to effect obesity. And on that front, the evidence is far less clear. To the research!\n\n In 2013, a systematic review was published in the journal ClinicoEconomics and Outcomes Research that examined all studies that looked at how price increases on non-alcoholic beverages changed consumption, caloric intake, and weight. There were 55 studies that met inclusion criteria. They found that while price increases led to reduced consumption of specific products, people often replaced the calories elsewhere. In other words, people's caloric intake didn't go down as much as expected. There was almost no evidence of weight loss. And when it was found, it was really small and often insignificant.\n\n Obesity is a complex problem that requires holistic solutions. I understand the desire to target scapegoats and it's hard to defend sugar sweetened beverages. But it's unlikely that this policy is gonna work as desired.\n \n \n\nCanadian Travel Ban\n\n\n And not three weeks after we talked about why a travel ban was a terrible idea to control the Ebola epidemic, Canada went ahead and enacted a travel ban. Really, Canada? Don't you watch Healthcare Triage News? And don't smirk too much, Australia, 'cause they were only following your lead. Neither country will issue visas to people who live in countries in West Africa hit by the Ebola epidemic. Didn't Canada learn anything from the SARS outbreak? As Canadian news outlets have reported, advisories against travel during the SARS outbreak hurt their economy significantly and likely did little good. We've already gone through the arguments as to why this is a bad idea. Go watch the episode: it still is. Health policy should make us healthier. Let's try a bit harder next week, OK?","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/PLw9GHiZuBM"},{"c_name":"healthcare triage","v_id":"P_pAdg8Y70Y","title":"The Shocking Truth About Surgical Placebos","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nhttp:\/\/store.dftba.com\/collections\/healthcare-triage\n\nIn order for a drug to be approved by the FDA, it must prove itself better than a placebo, or fake drug. But when it comes to medical devices and surgery, the requirements aren't the same. Placebos aren't required. That is likely a mistake. On the other hand, how might placebos work in surgery?\n\nIt actually turns out that fake, or \"sham\" procedures, have been around for quite some time. And, they're important. Watch this episode and learn.\n\nFor those of you who want to read more, go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=59441\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1416241631","likes":"1328","duration":"372","transcripttext":"In order for a drug to be approved by the FDA, it must show itself better than a placebo, or a fake drug. This is because of the placebo effect, which we discussed last week, where patients often improve just because they think they're being treated with something. If we don't have a placebo, or fake therapy, then the benefits seen by a new drug may be nothing more than wishful thinking. \n\nBut when it comes to medical devices in surgery, the requirements aren't the same. Placebos aren't required. That's likely a mistake. On the other hand, how might placebos work in surgery? It actually turns out that fake, or sham, procedures have been around for quite some time. And they're important. Surgical placebos are the topic of this week's Healthcare Triage. \n\n(Intro music)\n\nAt the turn of this century, arthroscopic  surgery for osteoarthritis in the knee was common. Basically, surgeons would clean out the knee using arthroscopic  devices. They'd make small incisions, and then insert tools to do the job.\n\nAnother common procedure for the issue was lavage, where a needle would inject saline into the knee to irrigate it. The thought was that these procedures likely removed fragments of cartilage and calcium phosphate crystals that were causing inflammation. A number of studies have shown that people who underwent both of these procedures improved more than people who didn't. \nHowever: a growing number of people were concerned that this was really no more than placebo effect, and in 2002, a study was published that proved it. \n\nOne hundred and eighty patients who had osteoarthritis of the knee were randomly assigned to one of three groups. The first had a standard arthroscopic procedure, and the second had lavage. The third, however, had sham surgery. \n\nThey had an incision, and then a procedure was faked so that they didn't know that they actually had nothing done. Then the incision was closed. The results were stunning: those who had the actual procedures did not better than those who had the sham surgery. They all improved the same amount. The results were all in people's head. \n\nMany were angry that this study occurred. They thought it was unethical that people underwent an incision and likely got a scar for no benefit. But, of course, the same was actually true for the people who had arthroscopy or lavage. They received no benefit either. \nMoreover, the results did not make the procedure scarce. Years later, more than a half million Americans underwent arthroscopic surgery for osteoarthritis in the knee. They spent about three billion dollars a year for a procedure that was no better than placebo. \nSham procedures for research aren't new. As far back as 1959, the medical literature was reporting on small studies that showed that procedures like internal mammary artery ligation were no better than fake incision for angina. \n\nAnd yet, in 2005, a study was published in the Journal of the American College of Cardiology, proving that percutaneous laser myocardial revascularization didn't improve angina better than placebo either. We continue to work backwards and use placebo controlled research to try and convince people not to do procedures, rather than use it to prove conclusively that they work in the first place. \n\nA study published in 2003, without a sham placebo control, showed that vertebroplasty, or cement, worked better than no procedure at all. From 2001 through 2005, the number of Medicare beneficiaries who underwent vertebroplasty each year almost doubled, from 45 to 87 per 100,000. \n\nSome of them had the procedure performed more than once, because they failed to achieve relief, but in 2009, not one but two different placebo-controlled studies were published, proving that vertebroplasty for osteoporotic vertebral fractures worked on better than faking the procedure. \n\nOver time, after the 2002 study showing that arthroscopic surgery didn't work for osteoarthritis in the knee, the number of arthroscopic procedures performed for this indication did begin to go down, but at the same time, the number of arthroscopic procedures for meniscal tears began to go up fast. Soon, about 700,000 of them were being performed each year, with direct costs of about 4 billion dollars. Ironically, less than a year ago, many were shocked when arthroscopic surgery for meniscal tears in the knee performed no better than sham surgery. This procedure was the most common orthopedic procedure performed in the United States. \n\nThe ethical issues aren't easily dismissed. Theoretically, a sugar pill carries no risk, and a sham procedure does. This is especially true if the procedure requires anesthesia. The surgeon must go out of his or her way to fool the patient. Many have difficulty doing that. But we continue to ignore the real potential that many of our surgical procedures and medical devices aren't doing much good. \n\nRit Redbergs, in a recent New England Journal of Medicine Perspectives article on sham controls in medical device trials, noted that in a recent systematic review of migraine prophylaxis, while 22% of patients had a positive response to placebo medications, and 38% had a positive response to placebo acupuncture, 58% had a positive response to placebo surgery. The placebo effect of procedures is not to be ignored.\n\nEarlier this year, researchers published a systematic review of placebo controls in surgery. They searched the medical literature from its inception all the way through 2013, and in all that time, they could find only 53 randomized controlled trials that included placebo surgical arms. In more than half of them, though, the effect of sham surgery was equivalent to that of the actual procedure. \nThe authors noted, though, that with the exception of the studies of osteoarthritis in the knee and internal mammary artery ligation that I already talked about, and I'm quoting, \"most of the trials did not result in a major change in practice.\" \n\nWe have known about the dangers of ignoring the need for placebo controls and research on surgical procedures for some time. When the few studies that are performed get published, we ignore the result and their implications. Too often, this is costing us many, many billions of dollars a year and potentially harming patients for no apparent gain. \n\n(Healthcare Triage outro plays)","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/P_pAdg8Y70Y"},{"c_name":"healthcare triage","v_id":"dlyju8TFsWg","title":"The Stuff We Worry About, and the Stuff That Actually Kills Us","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nGet your Healthcare Triage merch here: http:\/\/dft.ba\/-HCTMerch\n\nWhat are we worried about in terms of health? What's really gonna kill us? How different is that from the past? All this and more on this week's Healthcare Triage News.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=59567\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1416611376","likes":"1137","duration":"181","transcripttext":"What are we worried about in terms of health? What's really going to kill us? How different is that from the past? All this and more on this week's Healthcare Triage news.\n \n(Healthcare Triage music) \n\nOur first story comes to us from Gallup, which repeated a survey asking Americans what the most urgent health problem facing this country at the present time is. They also did this survey a year ago. \n\nIn both times, the most common concern was the cost of healthcare, and whether people could afford care. The second was access to healthcare, and whether we had universal coverage.\n\nLet's take a pause and recognize that inarguably, the richest country in the world still almost 40% of people are most worried that they don't have access to healthcare or can't afford it if they need it. We still have a lot of work to do here.\n\nBut the number three most urgent health  problem facing this country right now: Ebola. Yep. Ebola.\n\nEbola beat obesity! It beat cancer! It beat diabetes, flu, AIDS, drug or alcohol abuse... only two people treated in the United States for Ebola have died. No people who have caught Ebola in the United States have died. None!\n\nBut as Julia Belluz over at vox.com points out, diabetes is associated with more than 73,000 deaths in the United States a year. Cancer? more than 575,000. Heart disease? Almost 600,000 deaths a year.\n\nLast year, Ebola wasn't even on the radar! This year, 17% of us think Ebola is the most urgent health problem facing this country. I still think we should be concerned about the things that are actually going to kill us.\n\nSpeaking of what kills us, our second story comes to us from the New England Journal of Medicine, the link to which was sent to me by a Healthcare Triage fan. It seems that they did an analysis some time ago that looked at what killed people in the United States back in 1900 versus 2000. Here's the chart. \nFirst of all, yay, way more people died per population back then than today. So, you know, progress. But there are still things we can learn.\n\nBack then, infectious disease was a real problem. More than half of deaths were from TB, flu, pneumonia, GI infections or diphtheria. The advent of antibiotics, better infection control, and vaccinations have reduced those deaths significantly. But what's left are sort of the same. Chronic diseases, like heart disease and cancer, are still getting us. Strokes, kidney diseases, Alzheimer's disease, accidents - these are all still a problem!\n\nSure, we're living longer, but you have to recognize when it's time to change up your game! Focusing on infectious diseases was, and still is, important, but it's not the problem now that it was a hundred years ago.\n\nThe authors of the piece note that the medical systems we have are perhaps best suited to the diseases of the past, not the present and the future! Lots of them we can't treat with a drug and a pat on the back. We need to adapt, but first we need to recognize what the real threats are.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/dlyju8TFsWg"},{"c_name":"healthcare triage","v_id":"PEWCUVnng6Q","title":"How Many Calories Are in Your Thanksgiving Dinner?","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nNow you can get Healthcare Triage merchandise! We have coffee mugs and posters, and our merch partner, DFTBA.com is having a black Friday sale. Get the deals here: http:\/\/dft.ba\/-HCTmerch\n\nIt's Thanksgiving this week in America. Last year, we talked about the myth that turkey makes you sleepy. I argued that there's nothing special about turkey that would make you tired. But, we pointed out that a super large meal, and excessive alcohol consumption, could make you want to take a nap. But how caloric is the feast? Let's get some answers. This is Healthcare Triage.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=59660\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1416868120","likes":"1027","duration":"314","transcripttext":"\n\nIntroduction\n\n\n It's Thanksgiving this week in America. Last year we at Healthcare Triage talked about the myth that turkey makes you sleepy. We argued that there's nothing special about turkey that would make you tired. But we pointed out that a super large meal and excessive alcohol consumption could make you want to take a nap. But how caloric is the feast? Let's get some answers. This is Healthcare Triage.\n \n(Intro)\n\n \n\nThanksgiving\n\n\n A couple of years ago the Calorie Control Council made news by stating that the average American consumed more than 4,500 calories and 229 grams of fat at Thanksgiving celebrations. For the record, that was 3,000 calories at dinner and another 1,500 in snacks and drinks before and after. But is that accurate? Tara Parker-Pope from the Well blog at the New York Times did the math. Here's what she found.\n Six ounces of turkey; four of them dark, two of them white, with skin - 299 calories. Sausage stuffing - 310 calories. Dinner roll and butter - 310 calories. Sweet potato casserole made with butter, brown sugar and topped with marshmallows - 'cause how else are you going to do it - 300 calories. A half cup of mashed potatoes and gravy - 140 calories. Two thirds of a cup of green bean casserole - 110 calories. A nice dollop of cranberry sauce will get you 15 calories. Roasted Brussels sprouts - 'cause you'd better have something green - 83 calories. For dessert, one slice of pumpkin pie - 316 calories. One slice of pecan pie - 503 calories. And of course, whipped cream on both - 100 calories. Add that all up: 2,486 calories for your Thanksgiving meal.\n Now she argues that most people wouldn't eat that much. I'm not so sure. I could see people including myself eating a bit more. It's not a big stretch to get to the 3,000 calories that the CCC said Americans eat in a Thanksgiving meal.\n Plus, two glasses of wine might get you another 250 calories. A pre-dinner drink could bring that up to 500. Couple crackers with cheese - 210 calories. Quarter cup of mixed nuts - 220 calories. An ounce of chips with dip - 225 calories.\n We just added another 1,150 calories. So let's just own that this is a gluttonous day. I haven't even included breakfast, lunch or a late night snack. Or any soda, juice or other caloric beverages, including milk. For the record, if we go conservative and assume that instead of the triple C's 4,500 calories and 229 grams of fat, people really only eat 3,500 calories and 178 grams of fat, that's still a lot. That's the same as six and a half Big Macs. Or if you prefer, four and a half Big Macs plus two orders of large fries. And that's just the meal itself.\n \n \n\nThe Rest of the Year\n\n\nBut lest you think that this is the only way to consume a crazy amount of calories in one meal, let's remember that this is America. We should also acknowledge the hard work of the Center for Science in the Public Interest. I've been blogging about their extreme eating awards for years, and 2014 was no disappointment. A premier favorite of the awards is the restaurant chain The Cheesecake Factory. For instance, they highlighted the Bruleed French Toast, which, along with a side of bacon, is 2,780 calories and 93 grams of saturated fat. Would you sit down and eat 24 slices of frozen French toast with a side of two and a half eight-ounce tubs of cream cheese? 'Cause that would have the same nutritional content. Just one piece of their Reese's Peanut Butter Chocolate Cake cheesecake is 1,500 calories. Or head on over to Red Robin, get a Monster A.1. Peppercorn Burger, they always have bottomless fries at 370 calories per serving. Couple it with a Monster Salted Caramel Milkshake and you've hit 3,540 calories and 69 grams of saturated fat. That's if you don't get seconds on fries. One of my favorites, 'cause I think I've actually eaten this, came from the 2011 awards. A porterhouse steak at Morton\u2019s has 1,390 calories, 36 grams of saturated fat, and 1,200 milligrams of sodium. Add in a side of their mashed potatoes and half a side of cream spinach and your dinner is 2,570 calories, 85 grams of saturated fat, and 2,980 milligrams of sodium. That's with no salad, no appetizers, no dessert and no drinks. As the report concludes, that's the calories of eight pieces of original recipe chicken, plus mashed potatoes and gravy, coleslaw and four biscuits at KFC, with an extra one and a half days of saturated fat on the side.\n \n \n\nConclusion\n\n\n My point is that yes, we're all going to overeat on Thanksgiving. Own it. That might be OK if we weren't doing it all the time. The problem is that there are plenty of ways, on any day of the year, to consume an insane number of calories. Obesity is a complex problem requiring a holistic solution. We need to work on it all 365 days of the year, not just this one. 'Cause this one ain't gonna change. We also wanted to tell you that dftba.com is having a big Black Friday sale. It's your chance to get all their merch on the cheap. Make sure you pick up a Healthcare Triage mug and poster for everyone in your life.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/PEWCUVnng6Q"},{"c_name":"healthcare triage","v_id":"ylsO0VVy29U","title":"Australian Health Care","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nHealthcare Triage has merchandise! Get mugs and posters here: http:\/\/dft.ba\/-HCTmerch\n\nIt's been a while since we've done an international health care system episode. We thought you might need a break. That break ends now. Australia has the only continental, universal health care system, and it's topic of this week's Healthcare Triage.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=59785\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1417458862","likes":"1117","duration":"418","transcripttext":"\n\nIntroduction\n\n\nIt's been a while since we've done an international healthcare system episode. We thought you might need a break. That break ends now. Australia has the only continental universal healthcare system, and it's the topic of this week's Healthcare Triage.\n\n(Intro)\r\n\n\nOverview\n\n\n Like pretty much every other country we've covered, say, the United States, Australia has a universal healthcare system. It's called Medicare. What is the deal with that? Seriously, do none of these countries have a thesaurus or something? Medicare, Medicare, Medicare. Anyway, Australia's national public system provides coverage for citizens, permanent residents, and even many people with temporary visas. There's a program for visiting students and even people seeking asylum get coverage while their cases are under review. Australia also has a voluntary private health insurance system which complements and supplements the public one. It can give citizens access to private hospitals and some services not covered by the public system. The tax system incentivizes the purchase of private insurance for many individuals and families. Medicare also allows people to get free inpatient care in public hospitals, free access to most medical services, and prescription drugs. The federal government also works with more local governments to provide population health, mental health, some dental care, some physical therapy, and services for veterans. Medicare pays for somewhere between 85% and 100% of outpatient services. It also pays for 75% of the medical fees schedule for private patients who use public hospitals. Whatever isn't covered must be paid for by patients. \n \n \n\nFinances\n\n\n Doctors can charge whatever they want, although incentives are in place to make bulk billing more likely for the elderly, poor people, children and people who live in rural areas. Members of those groups also get a discount on drugs. Their co-pays on prescriptions are around $5.90 Australian, versus $36.10 for everyone else. There are out of pocket maximums. When an Australian has paid out $421.70, then Medicare covered 100% of the fees scheduled for doctors for the rest of the year. When they reach $1,221.90, then 80% of all out of pocket costs are covered for the rest of the year. For people in the special groups I mentioned before, the threshold is lowered to $610.70. Yes, that's complicated. Thanks, Australia.\n\n There are also ways for families to pool such spending and to hit the limits faster. There are pharmaceutical subsidies for those who reach of $1,391 in a calendar year too, for drugs. The threshold is also lower for those in the special groups at $354. \n Australia has one of the cheaper healthcare systems at 8.9% of GDP. Medicare is paid for mostly from general taxes, patient fees, and a 1.5% levy on taxable income. In 2010 - 11, the government funded about 69% of spending. 43% at the federal level, and 26% from states and territories. The rest, for about 31% of healthcare spending, comes from non-government sources. About 18% is out of pocket spending, in co-pays or services not covered by insurance. Private health insurance accounted for about 8% of spending. About half of people have private insurance, which allows them more options in practitioners, hospitals and care that they receive.\n\n Those who opt for private insurance before their 31st birthday get a reduction in premiums for the rest of their lives. Each year an Australian waits to start buying private insurance after they're 30 sees their rates go up 2% from a base rate, again, for as long as they live. Subsidies have been available to many Australians based on income since 1999.\n \n \n\nDoctors, Services and Facilities\n\n\n Most primary care doctors are self-employed in working groups. About 8% of them are under contract with private agencies. Most work in a fee-for-service system. Most also get incentive payments for meeting standards set by the Royal Australian College of General Practitioners. In other words, they have a pay for performance system to try to improve quality. I know you watched that video, right?\n\n Patients can see any general practitioner they like. GPs do however, need to refer them to specialists. Specialists also work on a fee-for-service basis and many of them work in both the public and private parts of the system. After hours care is available either from primary care docs themselves, or from private companies set up among various practices. Grants are available from the government to run after hours care.\n\n Hospitals come in all flavors. In 2011 about 55% were public, 23% were private day hospitals, and 21% were other types of private hospitals. Private hospitals come in both non-profit and for-profit types. Docs that work in public hospitals are usually salaried, although they can work in other reimbursement settings when seeing private patients. Long-term care is mostly provided by families with some people getting subsidies to help with the expenses. Some homes or care centers are available for those who are very dependent on assistance. Support is both means tested and dependence tested. The majority of long-term care facilities are non-profit. About a third a private, for-profit, and about 10% are run by the government.\n \n \n\nOversight\n\n\n Quality is generally measured and reported on by the Australian Commission on Safety and Quality in Healthcare. About 85% of general practices are credited against standards. And, as I mentioned before, pay for performance systems are in place to encourage better care. Some healthcare organizations and professional boards also have quality improvement programs. All citizens and permanent residents can get a personally controlled electronic health record if they want it. A fairly large amount of infrastructure exists to make such records interoperable at many facilities across the continent. Costs are controlled in a number of ways. The market uses generic drugs to keep pharmaceutical spending down. Almost all brand-name drugs are bulk purchased by the government which can also control pricing. New drugs have to prove their cost effectiveness before they're bought. Public spending is under global budgets, but as with some other countries, this can lead to increased wait times for elective things. There are also broadly negotiated fees for many services.\n \n \n\nCriticisms\n\n\n The knocks against the system will be familiar to those who are familiar with the series. Australia is worried about a shortage of professionals, but who isn't? In terms of quality, Australia sometimes comes behind some other countries we've discussed, but certainly beats others - like the US. The private overlay makes some people very concerned by a two-tiered system of care. It's interesting though that only about half of people opt for private insurance. Australia also has a disparities problem, with many indigenous populations having lower quality outcomes and poor health than other citizens. But, life expectancy is high, infant mortality is low, obesity is extremely low, and preventable deaths are rarer than in a lot of other countries. And Australia does it for a reasonably small amount of money.\n \n \n\nConclusion\n\n\n In summary, Australia has a pretty robust healthcare system, with a private overlay that half of people use for better access and services. If that sounds familiar, it's 'cause it's a lot like other systems we've talked about, including France.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/ylsO0VVy29U"},{"c_name":"healthcare triage","v_id":"G0o_g_F2DBw","title":"Good News! Smoking is on the Decline, and You Don't Need that Vitamin D Test!","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nHealthcare Triage merchandise! Mugs and Posters! They're awesome! http:\/\/store.dftba.com\/collections\/healthcare-triage\n\nSmoking prevalence is way down in the US, and you likely don't need to be screened about Vitamin D deficiency. It's good news all around on Healthcare triage News.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=59833\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1417796792","likes":"895","duration":"218","transcripttext":"\n\nIntroduction\n\n\n Smoking prevalence is way down in the US, and you likely don't need to be screened for vitamin D deficiency. It's good news all around on Healthcare Triage News.\n\n(Intro)\n \n \n\nSmoking Prevalence is Down in the US\n\n\n I feel like I bring you a lot of bad news on Healthcare Triage. So when we have the opportunity to give you some good news, we jump at it. And with respect to smoking, there's a decent amount of good news to go around.\n\n In 2005, almost 21% of adults in the United States smoked cigarettes. In 2013, that number dropped to less than 18%. That's three million fewer smokers in the United States in less than a decade. That's the lowest percentage of adults smoking in the United States since the CDC started collecting data in 1965. Even those who are still smoking are smoking less. Almost 81% of smokers smoked every day in 2005. That's down to 77% in 2013. Among those people, the average number of cigarettes smoked in a day dropped from almost 17 in 2005 to just above 14 in 2013.\n\n That doesn't mean that there still isn't a lot to do; too many people still smoke. It's still the leading preventable cause of death in the United States, killing almost half a million people a year. There are more than 30 million adults who have a smoking-related disease in the United States right now. Brian King, a senior scientific advisor at the CDC said that smokers who quit before they're 40 can get back almost all of the 10 years of life expectancy that smoking would otherwise take away.\n \n \n\nYou Don't Need to be Screened for a Vitamin D Deficiency\n\n\n Our second story, and I don't know if you saw, but I got to attack the milk emperor in the New York Times a few weeks ago. The comments are awesome, you should go read 'em. People really, really do love their milk. They're sure that you need the calcium and the vitamin D that's added to it. So I was thrilled to see that the US Preventative Services Task Force had my back last week with their new recommendation on vitamin D deficiency screening.\n They said that for healthy adults, we shouldn't do it. It may do more harm than good.\n\nLook, everyone needs vitamin D. It helps to keep your bones healthy by regulating calcium and phosphorus, and yes, being deficient in vitamin D is bad and causes problems with bone health as well as many other health issues. But here's the thing: most people have plenty of vitamin D. They have this without even worrying about it. They have this without even eating a ton of vitamin D. The studies that look at problems for vitamin D deficiency often use very low cut-off points - much lower than you'd see in healthy people. There's so little consensus on what constitutes 'low', that many tests that are available for screening don't even agree on how to work. There's no internationally recognized reference standard. The USPSTF report found that results are all over the map, based not only on the testing method, but also between different labs that used the same methods.\n\nFurther, they found no studies that looked at whether there was any direct benefit from screening for vitamin D deficiency in adults. None! They did find studies though showing that there's no proven benefit for treating asymptomatic vitamin D deficiency to improve outcomes for cancer, diabetes, fractures or even death. Since there was no evidence of harms for screening, they came out and said that they can't make a recommendation.\n\n But we're allowed to consider things that they can't. Screening costs money. Supplements to treat the results we don't understand costs money. And taking too much vitamin D can cause you harm. This is a good example of where we have a hammer and we're looking for a nail. We don't need to do the screening. Most people aren't vitamin D deficient, and they don't need to be screened or treated. They also don't need milk.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/G0o_g_F2DBw"},{"c_name":"healthcare triage","v_id":"P6GYQyJEIeg","title":"Your Cell Phone Won't Give You Cancer","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nWe have Healthcare Triage merchandise! Mugs and posters here: \n\nI can't speak for you, but lots my friends go into a tizzy when groups like the WHO classify cell phones as \"possibly carcinogenic\". Should you panic? Cell phones and cancer are the topic of this week's Healthcare Triage.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=59926\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1418142686","likes":"1560","duration":"324","transcripttext":"I can't speak for you but lots of my friends go into a tizzy when groups like the World Health Organization classify cell phones as possibly carcinogenic. Should you panic? Cell phones and cancer are the topic of this week's Healthcare Triage.\n\n*theme music*\n\nLet's start by making sure that you all understand that the WHO statement doesn't mean that there's a clear link. It's more akin to saying that there could be some risk and that more research is needed. Putting cell phones in this category means they've now joined the ranks of pickled vegetables and coffee as possibly carcinogenic.\n\nSo no, I wouldn't panic yet. But what should you make of all this? Let's start with some facts. Cell phones are hugely popular. Worldwide estimates put cell phone usage at more than three billion users. In the United States, more than 270 million people use cell phones including about half of children age 8-12. And yes, phones do emit radiation, specifically in the 800-2,000 megahertz range. So it's not a surprise that there's an ongoing debate as to whether the widespread use of a device that emits radiation causes cancer.\n\nBut the radiation from cell phones is non-ionizing. That puts it in the camp of things like radar, and microwave ovens, and radio waves. This is different than ionizing radiation like that of x-rays, radon, and cosmic rays. Those things lead to DNA changes and cause cancer. There's no evidence that non-ionizing radiation does.\n\nBy the way, Wi-Fi and Bluetooth are also forms of non-ionizing radiation. There's no evidence for their causing cancer either. Many, many studies have been published in this area. The vast majority of them are what we call case control studies. Let's review how those work.\n\nFor a case control study in this domain, you'd gather a group of people with brain tumors. Then you'd gather a group of people without brain tumors. Then you'd ask them all various questions like \"do you use a cell phone?\" to see if there are differences between the two groups. While a retrospective case control study like this can be an important study design, it's essential to recognize that they are among the weaker types of studies you can do. Unlike randomized control trials, you can't prove causation with this type of study. Unlike in prospective cohort studies, there's a real problem with what's known as recall bias. This is a type of bias that can alter your results because people with an issue, like a brain tumor, are more likely to recall things that might have caused their brain tumors than those who don't have that same problem. So the danger with case control studies is that people with brain tumors may have heard about this theory that cell phones cause cancer and therefore may remember that they used a cell phone more than people who don't have brain tumors.\n\nSo let's try and summarize what we know. To the research!  *music* In 2008 a scientist summarized data in a systematic review of 33 studies in the peer-reviewed literature that looked at cell phones and brain tumors. A surprising number of these studies come from one group in Sweden. The reviewer found major flaws in the research that would make it difficult to draw a convincing conclusion about cell phones and brain tumors. The next year, another group published a meta-analysis of the literature in the Journal of Clinical Oncology. They felt that 23 articles were good enough to be included in the review. All of them were case control studies. They found, overall, that compared to rarely or never using a cell phone, regularly using a cell phone was not significantly related to the development of malignant and benign brain tumors. Even the most recent large study in the review known as the Interphone study found that, and I quote, \"cell phone users have no increased risk for two of the most common types of brain tumor-glioma and meningioma\".  \n\nThe plural of anecdote is not data. As human beings, we make decisions every day that trade off benefits with harms. As we've discussed before, pretty much the biggest killer of children in the United States is car accidents. Yet, no one thinks we should ban cars in order to reduce that to zero. We as a society accept that the quality of life derived from driving outweighs the increase in deaths of children from car accidents. If you disagree, don't drive. Almost no one makes that choice. Similarly, cell phones provide a lot of good to many of people. Given the controversy, even if there was an association between cell phones and brain tumors it would have to be really small. If such a very, very small association exists, few would likely forgo their cell phone to eliminate it completely. Just like they won't forgo their cars.\n\nMoreover, we know that at a population level, there's been no explosion of brain tumors recently. A study published in the Journal of the National Cancer Institute in 2009 examined data for cancers in four countries with registries from 1974 through 2003. Over that time, almost 60,000 people in a population of 16 million adults between 10 and 79 years were diagnosed with brain tumors. While a slow increase in the rates of gliomas and meningiomas was seen throughout the time period, no changes in incident trends were seen from 1998 to 2003 when you'd expect to see an increase because of cell phone use after 5-10 years.\n\nCase control studies are necessary for rare diseases. But cell phone use is so common that if they were dangerous right now, we'd be able to see the effect easily. That's not happening. Future work will be needed to see if they cause long-term harm but as for now, there's very little evidence that they do.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/P6GYQyJEIeg"},{"c_name":"healthcare triage","v_id":"RTCa3sRniWU","title":"HPV Vaccine Doesn't Promote Promiscuity: Healthcare Triage News","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nHealthcare Triage Merchandise! http:\/\/dft.ba\/-HCTmerch\n\nHPV vaccines and girls having sex. The flu shot and the difficulties combating myths. This is Healthcare Triage News.\n \nFor those of you who want to read more, go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=60087\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1418396681","likes":"851","duration":"236","transcripttext":"\n\nIntroduction\n\n\n HPV vaccine and girls having sex, the flu shot, the difficulties combating myths. This is Healthcare Triage News.\n\n(Intro)\n \n \n\nHPV Vaccines and Girls Having Sex\n\n\n First up, a new study on whether the HPV vaccine makes girls more promiscuous. I covered the vaccine in one of our first episodes, you should go watch it if you didn't before. There are people who argue that if we vaccinate girls against a sexually transmitted infection, those girls will be more likely to have sex. The study I'm talking about made use of Ontario's administrative health database before and after the grade eight HPV vaccination program was begun. The researchers looked at whether a girl was vaccinated and then checked records to see if they got pregnant or got an STI in the next year. They controlled for a lot of stuff like you'd normally do.\n\n There were more than 260,000 girls in this study, almost evenly split between girls who were eligible for the vaccine after it began or those who were ineligible because they weren't in eighth grade before it went into effect. Just over half of eligible girls got the vaccine, but only 1% of ineligible girls got it. So there's a clear difference there.\n\n In the study period there were 15,441 pregnancies and\/or sexually transmitted infections affecting 5.9% of the girls. There was no relationship between getting the vaccine and having one of those outcomes though. There was also no relationship between the eligible or ineligible group in having a bad outcome. There was no difference when they were analyzed together or when they were analyzed separately.\n\n The conclusion states, and I quote, \"we present strong evidence that HPV vaccination does not have any significant effect on clinical indicators of sexual behavior among adolescent girls. These results suggest that concerns over increased promiscuity following HPV vaccination are unwarranted and should not deter from vaccinating at a young age\". Yeah!\n \n \n\nThe Flu Shot and Difficulties Combating Myths\n\n\n Speaking of vaccines, you all watched the Healthcare Triage episode on the flu shot, right? If not, go back and do so, then come back and get depressed. Anyone who's watched that episode, or reads my blog, or who's read one of my books knows that the flu shot cannot cause the flu. It can't. Yet, in a national survey published this week in the journal Vaccine by one of my New York Times colleagues, Brendan Nyhan, about 43% of Americans answered that it could. When I read that, my head hit the desk, I screamed loudly enough to frighten my co-workers, and I pledged to look for a Twitter avatar that's even more outraged than Marceline with fire shooting out of her eyes.\n But the researchers went a step further; they gave people who answered the survey one of two interventions. The 'correction' intervention involved language adapted from the CDC which told people you can't get the flu from the flu shot. The 'danger' intervention tried to scare people about the flu by presenting them with facts about its risks. Both of these were intended to correct people's misconceptions about the flu and the flu shot and encourage them to go get it. The correction path did reduce false beliefs about the flu vaccine. The percentage of people who endorsed that flu shots cause the flu fell from 39% to 27% for low-concern people. And from 70% to 51% for high-concern people. Correction also reduced beliefs overall that the vaccine is unsafe. Danger didn't do much.\n\n Then things get weird. Neither correction or danger led overall to more people getting the flu shot. In the subgroup of people most concerned about the vaccine's side effects though, correction actually led to fewer people getting the vaccine. Beforehand, 46% of people with high side effect concerns said that they were likely to get the vaccine. After reading 'correction', that percentage dropped to 28%.\n\n In other words, when talking to people who don't want to get a flu shot because of myths, my efforts to correct their beliefs may be leading to fewer of them getting one. Even though I'm actually getting through to them. Maybe I'm making things worse, but seriously, I don't know what else to do.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/RTCa3sRniWU"},{"c_name":"healthcare triage","v_id":"WKtWE5F2cJs","title":"Cold Weather Myths: Healthcare Triage","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nGet Healthcare Triage merchandise! http:\/\/dft.ba\/-HCTmerch\n\nIs there a mother out there who doesn't warn their children that going out in the cold is going to make them sick? Have you heard that old chestnut about losing all of your body's heat through your head? Do you think drinking alcohol will warm you up?\n\nAll myths! We'll discuss them on this week's Healthcare Triage.\n\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=60130\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1418760534","likes":"1699","duration":"285","transcripttext":"Aaron Carroll:\n   Is there a mother out there who doesn't warn their children that going out in the cold is gonna make 'em sick? Do you think that drinking alcohol will warm you up? Myths about cold weather are the subject of this week's Healthcare Triage. \n  \n   [Healthcare Triage Intro]\n\n   Myth! Going out in cold weather makes you more likely to get sick.\n   What's up with this belief? Do people think the cold hurts our immune system and makes us more susceptible to getting sick? 'cause the opposite seems to be true. In a small study of how the body's immune system reacts to cold exposure, scientists actually found that the immune system was stimulated when people were exposed to the cold. The cold increased the number and the activity level of some of the body's key sickness-fighting cells, things like leukocytes, granulocytes, natural killer cells, and other chemicals necessary to fight off infection. So, cold weather actually may help your body to fight getting sick. \n   So why do people seem to get sick more in the winter? Well, one explanation is that people spend more time indoors when it's cold outside. They stay in relatively close proximity to each other. That allows them to pass colds and other viruses around with their sneezing and coughing. So staying inside may actually make things worse.\n   Myth! Bundling up makes it less likely that you'll get a cold. \n   There are days even I'm amazed at what gets studied. To the research!\n   In a study published back in 1958, volunteers were divided into two groups. One group had to sit in very cold conditions but were allowed to wear warm coats. The second group had to sit in their underwear in 60-degree temperatures, and a third lucky group hung out in a balmy 80 degrees of warmth. Then all of them had a sick person's mucus dripped into their nose. Yes, maybe someday you'll be lucky enough to enjoy a glamorous career in science. \n   Anyway, it turns out that it didn't matter at all how cold it was or what you were wearing. Everyone with the virus stuck into their nose had the same risk of getting sick. The temperature and what you were wearing made no difference at all. \n   Myth! Going out wet makes you more likely to get a cold.\n   Again, I'm not condoning this research, but let's go to it anyway.\n   1968, a study was published in the New England Journal of Medicine that looked at inmates in Texas prisons. They were put in all kinds of temperatures and all kinds of dress. They were even put in water baths at near-freezing temperatures. And then cold virus was put into their noses. And it made no difference at all. Infection rates were similar, no matter how damp you were. Wetness and wet hair makes you no more likely to get sick.\nNow, there was a similar study published in 2005 in the Journal of Family Practice. They randomized 180 people to either go about their business, or have their feet placed in water at 10 degrees Celsius for 20 minutes. And that's all! No infections were introduced.\n   Later, it turned out that those who had their feet chilled were more likely to report cold symptoms later on. Some touted this as evidence that cold, wet feet made you more likely to get a cold. But this study didn't look at infection, it looked at reported symptoms. It could be that people just noticed their runny nose more because they remembered how cold their feet were and were terrified about getting sick. There's no evidence to prove you're more likely to get a cold from letting a part of you get wet and cold. Yeah, the older studies are, well, older, but they're exactly how you'd design a trial if you wanted to test this hypothesis. Look, I don't know who volunteered to have mucus put in their nose, but they went ahead and did it. Let's take their work and accept it.\n   Myth! Drinking alcohol warms you up. Okay, let's start with those Saint Bernards running around with casks of alcohol around their neck. First of all, do they think people get lost in the Alps with mugs? And why barrels? Why not a blanket? First aid kit? Maybe materials to start a fire? Plus, it's a total myth that drinking alcohol warms you up.\n  Alcohol lowers the vasoconstriction threshold, and leaves you vasodilated. In other words, you get more blood rushing to your skin. This might make you feel warmer in the very short run. But in the long run, it does the opposite. All that blood exposed to the cold means that it gets cooled off. That lowers your core body temperature, it doesn't raise it. And of course there's research!\n  A study published in the British Journal of Clinical Practice in 1995 got a bunch of men to drink either alcohol or placebo and then immersed them in cold water for an hour. When they drank the alcohol, their temperatures went down more, by a bit. A similar study published the next year tried to quantify this effect. It also found that drinking alcohol led to a lower overall core temperature, but again, the difference is pretty small. They concluded that the idea that drinking might lead to hypothermia (which many also think is a real thing) is likely also untrue. But there's no evidence for alcohol warming you up, and some minimal evidence for it doing the opposite. Myth busted.\n\n   [closing music]\n\n","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/WKtWE5F2cJs"},{"c_name":"healthcare triage","v_id":"zcmwFAW-Wis","title":"Bike Safety is Legit, Y'all!","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nHealthcare Triage merch is available now! http:\/\/dft.ba\/-HCTmerch\n\nIt's all bike safety today! New studies and old on Healthcare Triage News.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=60259\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1419020122","likes":"934","duration":"227","transcripttext":"\n\nIntroduction\n\n\n It's all bike safety today! This is Healthcare Triage News.\n \n \n\nEffects of Bicycle Helmet Laws on Children's Injuries\n\n\n Today's first story come from an interesting new paper in Health Economics, it's called Effects of Bicycle Helmet Laws on Children's Injuries.\n Look, lots of people ride bikes, lots of kids ride bikes, but they can be dangerous. In 2009 alone, bike accidents led to 782 deaths and more than 518,000 visits to emergency rooms in the United States. Kids ages 19 and under account for 57% of those injuries. A lot of the danger is due to head injuries, especially in children. In recent decades we've done a lot to promote the use of bike helmets. We've done such a good job that not wearing a bike helmet is only second to smoking cigarettes in public in arousing the wrath of my children. Even so, according to this paper, less than half of riders are using helmets regularly nationwide. Some places have implemented laws to make their use mandatory. Do those laws work to reduce head injuries?\n This study examined the association between bike helmet laws and head injuries. But they also looked at the effect of bike helmet laws on bike-related non-head injuries, and injuries from other wheeled activities not affected by helmet laws like skateboards and inline skates. They found that in kids aged 5-19 years, helmet laws were associated with a 13% reduction in the incidence of bike-related head injuries. But they were also associated with a 9% reduction in bike-related non-head injuries. This means that wearing a helmet either protected the body as well as the head or made people just ride more safely in general. Or that bike helmet laws worked by getting fewer kids to ride bikes. Now the researchers also saw an 11% increase in injuries from other wheeled activities. This would support the idea that some kids just started riding other devices and still kept getting injured.\n Now it is still possible to look at these results and argue that bike helmet laws and campaigns lead to safer riding practices, and that has reduced injuries in bikes overall. The data are consistent with that story. But they're also consistent, and perhaps more so when adding in the increase in other wheeled injuries, with the story that bike helmet laws merely get fewer kids to ride bikes and move to other activities where they're being injured just as much. This isn't to say that bike helmets don't work, and I don't know what the answer is to this whole law problem; I don't think this will stop me from getting my kids to wear helmets when they ride their bikes no matter what the laws are in Indiana. For the record, I also make them wear their helmets when they ride their scooters - it's the pediatrician in me. But I do hope people look into this further; we don't want to think we're solving the problem, especially with laws and regulations, if we're really not.\n \n \n\nSafety Effects of Permanent Running Lights for Bicycles\n\n\n Speaking of bike helmets, someone on Twitter sent me a link to another study called Safety Effects of Permanent Running Lights for Bicycles: a controlled experiment. This was actually a randomised controlled trial of putting permanent or daytime running lights on bicycles. It was what we call cluster-randomised, or where they do it in groups. And over the course of the year, the incidence of accidents for those with the running lights was 19% lower. The incidence of multiparty accidents with injury to the participating cyclist was 47% lower. The study was published in 2013, how do I not know about this? How is this not common knowledge?\n Policy sometimes baffles me. This was a randomised controlled trial of almost 4,000 participants. They found a real reduction in an important outcome. There are no randomised controlled trials for bike helmets, because people argue that it would be unethical to do so. In fact I think most of the research is case-controlled. Don't get me wrong, I understand why that is and I'm not recommending that people stop wearing their bike helmets. The odds ratios for preventing head injury are compelling in those studies. But we have a randomised controlled trial here for another intervention with a real reduction in accidents, why aren't we acting on that?","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/zcmwFAW-Wis"},{"c_name":"healthcare triage","v_id":"IXJivxYPB7E","title":"Do Any Common Cold Remedies Work? Probably Not.","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nWe have merchandise: http:\/\/dft.ba\/-HCTMerch\n\nThere's a flu shot for the flu. But what about colds? Does anything work? Let's find out. .\n\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=60270\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1419284383","likes":"1733","duration":"472","transcripttext":"\n\nIntroduction\n\n\nThere's a flu shot for the flu, but what about colds? Does anything work? Let's find out. This is Healthcare Triage.\n\n[Healthcare Triage Intro]\n\n\n\nEchinacea\n\n\nEchinacea. Studies including as many as 3000 people have looked at whether Echinacea prevents colds or whether it treats them. For neither purpose does Echinacea stand up to scrutiny. It's hard to do a meta-analysis (and I hope you watched that episode) because studies look at different parts of the plant, they use different methods for each of the studies.\n\n But, in 2006, a Cochrane systematic review was published. In 16 studies of the herb, Echinacea did no better than placebo for preventing or treating colds. In the best studies, which were randomised controlled trials, the majority of studies still found no benefit for Echinacea in preventing colds. Studies done since then aren't any more convincing. In 2007, a group of researchers claimed that the evidence from 14 studies suggested that Echinacea did shorten cold symptoms by a day or so. Unfortunately, other researchers claim that those scientists didn't combine the studies and that the results can't be trusted. \n\nBottom line, even in the weakest studies the evidence isn't really compelling. And let's face it, results from the better quality studies are more trustworthy. Those studies say that Echinacea doesn't prevent or treat colds.\n\n\n\nGarlic\n\n\nGarlic. Taking garlic to prevent or treat colds requires some serious trade-offs. Is it better to smell terrible and be accused of excessive paranoia about avoiding vampires or to have the occasional cough or cold? \n\nIn a comprehensive review of scientific trials of garlic, only one of the five studies identified was of really high quality. In that study, 146 volunteers were randomly assigned to take a garlic supplement every day for 12 weeks or to take a fake placebo pill. Interestingly enough, the volunteers who were taking garlic had significantly fewer colds than the volunteers who were taking the placebo. The garlic group also had fewer days of illness overall. But the number of days it took for people to recover from their illnesses was the same for both groups. \n\nSo garlic just might work. Of course, those taking garlic did have some serious side effects. They reported more rashes and, not surprisingly, having a bad odour. Because this was just one study, the verdict on garlic is still out. But, the one small study suggests that garlic might prevent you from getting a cold if you take it regularly for a long period of time.\n\n\n\nVitamin C\n\n\nVitamin C. On the other hand, there's been a lot of research on Vitamin C. When researchers combine the results of 23 studies investigating whether Vitamin C prevents colds in normal people, there's no significant improvement. Vitamin C doesn't prevent you from getting a cold. In studies involving over 11 000 people, taking 200mg or more of Vitamin C a day, it didn't prevent colds. \n\nWe're being totally thorough, though. And there is a study that showed that people who engaged in extreme exercise in extreme conditions (think, like, marathon runners, soldiers training in the Arctic, and skiers), Vitamin C almost looked like it worked to prevent colds. But it still made an insignificant difference. So if you plan on engaging in seriously strenuous exercise in very cold conditions, you might consider taking Vitamin C in the hope that it might work. But otherwise, don't waste your time.\n\nVitamin C also doesn't treat colds. In 7 studies looking at the treatment of the common cold, scientists found it to be no better than placebo. Based on the results of 11 studies of more than 6000 people, taking Vitamin C also didn't make colds any shorter or any less severe. It doesn't work.\n\n\n\nZinc\n\n\nZinc. There's a systematic review of 7 studies that look at whether zinc lozenges effectively treat the common cold. The results are mixed. In about half of them, zinc did nothing. And in the other half, it did. The authors concluded that there might be a small help from taking zinc, but they acknowledged that most studies are of pretty poor quality. \n\nBut zinc's got issues. One of the problems is that it tastes terrible. Researchers couldn't make a placebo pill that tasted as uniquely bad as zinc. So studies are often poorly blinded. It's also important to note the other downsides. It's more likely to make you feel nauseous than it is to improve cold symptoms. People who use zinc lozenges are also more likely to have distortions in their sense of taste and irritation of the mucosa in their mouths. \n\nThere's an added zinc-related caution. Older studies of zinc nasal gel showed it actually improved cold symptoms and how long colds last. But, putting zinc nasal gel in your nose permanently damaged your sense of smell. Losing your sense of smell and your sense of taste, which is affected by how well you can smell, is a terrible price to pay for shortening a cold. Makers of zinc nasal gels have actually paid out over $12 million in lawsuits from people who damaged their sense of smell permanently because of zinc. Don't do it. Bottom line is that zinc might help your cold a bit but the downsides likely outweigh the benefits.\n\n\n\nAirborne\n\n\nAirborne is a popular supplement among school teachers who claim that it prevents them from picking up all the germs spread around their classrooms full of sick children. The Airborne package even tells the moving story of how it was created by a school teacher who was frustrated with just that problem. Given what it says on the package, it may surprise you to hear that Airborne hasn't been studied scientifically. \n\nSince Airborne is an herbal supplement, it's not regulated by the FDA and it's makers aren't required to tell us exactly what's in it. All we know is that Airborne contains a mixture of vitamins, minerals and herbs, including large amounts of Vitamin C and Vitamin A as well as some zinc. And we know those things don't really work. \n\nThe package used to talk about a \"double-blinded, placebo-controlled trial of 120 patients\" that showed that Airborne worked to make colds better. It's not there anymore. Why? The makers of Airborne had to remove that claim because, as it turns out, the \"study\" was conducted unscientifically. An investigative report by ABC News found that the scientific team at GNG Pharmaceutical Services was, in fact, two men working in a garage. Well, that's not a problem in and of itself but it turns out lots of other stuff wasn't as good as originally sold either. The makers of Airborne agreed to pay more than $24 million to settle a class action lawsuit in regard to their false advertising about this garage \"study\" and the lack of evidence for their product. Airborne is not Healthcare Triage approved.\n\n\n\nChicken soup\n\n\nChicken soup. Let's start off by saying that chicken soup hasn't been tested at rigorous clinical studies. There are no randomised controlled trials or even any real clinical trials. That said, one group of researchers did carefully investigate the impact of chicken soup on the specific cells of the immune system that increase inflammation when you have an infection. \n\nSo, when you have an infection, immune cells called neutrophils migrate to the area to help fight an infection. One of those things the neutrophils do is release chemicals that increase the amount of inflammation going on in your body. This inflammation is part of why you develop more mucus and phlegm when you have a cold. Scientists studied whether chicken soup had an impact on the inflammation response. They looked at homemade chicken soup as well commercially prepared soups to determine whether they prevented the inflammatory cells from migrating or moving to a source of infection. Amazingly enough, they did! Various dilutions of the homemade soup and the majority of the store made soups inhibited the movement of the neutrophil cells, which might give chicken soup some anti-inflammatory properties. \n\nAnd we own that this isn't a randomised controlled trial with clinical outcomes but chicken soup has other properties that might help you to feel a bit better. Even if those are placebo effects. Having soup prepared for you by a loved one or associating chicken soup with memories of someone taking care of you may play a powerful role in making you feel better. Chicken soup is not a cure for the common cold but it might be worthwhile to listen to grandma on this one. You just might feel a bit better, and there's really no downside and that's the important point. Unless you don't like chicken soup, and then, god, I don't even want to know you.\n\n[Healthcare Triage Outro]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/IXJivxYPB7E"},{"c_name":"healthcare triage","v_id":"eOFf9FjglM0","title":"Antibiotics are Overused","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nThe best way to prevent transmission of Ebola in the United States, or any country for that matter, is to identify and quarantine those with the disease as soon as possible. However, the first person diagnosed with Ebola in the US was, unfortunately, released after coming to an emergency department, even though he had symptoms indicative of the disease.\n \nHe was sent home on antibiotics. The inappropriate use of antibiotics is the subject of this week's Healthcare Triage.\n \nThis was based heavily on a piece I wrote for the Upshot, which you can go read here: http:\/\/www.nytimes.com\/2014\/10\/21\/upshot\/on-an-antibiotic-you-may-be-getting-only-a-false-sense-of-security.html. All the refs and links are there.\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/olsenvideo\nhttp:\/\/www.twitter.com\/johngreen","uploaded-unix":"1420490598","likes":"1418","duration":"328","transcripttext":"Aaron Carroll:\n   The best way to prevent transmission of Ebola in the United States, or any country, for that matter, is to identify and quarantine those with the disease as soon as possible. However, the first person diagnosed with Ebola in the United States was, unfortunately, released after coming to an emergency department, even though he had symptoms indicative of the disease. \n   He was sent home on antibiotics. The inappropriate use of antibiotics is the subject of this week's Healthcare Triage.\n\n   [Healthcare Triage Intro]\n\nAaron Carroll:\n   You can argue that antibiotics could help treat secondary infections in people who have Ebola, but remember, those docs didn't think he had Ebola, and the antibiotics wouldn't, of course, be effective in treating Ebola.\n   They'd be of no use for any viral infection, for that matter, yet antibiotics are routinely described in this manner. In this case, their use highlights a real but often ignored danger from their overuse: a false sense of security.\n   As a pediatrician and a parent, I've seen many protocols and procedures that require the use of antibiotics for a number of illnesses that may not necessitate them. Those plans are in place, ostensibly, to protect other children from getting sick. They rest on the idea that someone on antibiotics is no longer contagious.\n   That is, tragically, often not the case. If you've had a small child with pinkeye, you know that few diseases can get your toddler banned from preschool faster. Most of the time, he won't be able to go back to school till he's been on antibiotic drops for 24 hours. \n   This assumes, of course, that the pinkeye is caused by bacteria. Often it's not! Up to 20% of conjunctivitis can be caused by adenovirus alone, and that's just one of the viral causes. Pinkeye caused by a virus will be completely unaffected by any antibiotic drops; children will be infectious long after receiving them.\n   Physicians are pretty much unable to distinguish between bacterial and viral conjunctivitis. Studies show we can't tell the difference. Even if we could, there's little evidence that 24 hours of antibiotic drops do much of anything to render a child non-contagious. Most of the outcomes studied include things like \"early microbiological remission\" by day two to five of therapy. However, some children still haven't achieved this outcome even by day six to ten.\n   Strep throat isn't much better. Resistance in Group A streptococcus, the cause of strep throat, yet even with proper therapy, it can be very difficult to eradicate the pathogen from carriers. This has led to outbreaks among family members and closed communities, even when people are properly treated.\n  Even in the best-case scenario, being \"on an antibiotic\" isn't much protection for others. Often, though, antibiotics offer no protection at all. Only about a quarter of children who have acute respiratory tract infections have an illness caused by bacteria, but about twice that number are prescribed antibiotics for their symptoms. These extra drugs provide no useful benefit. They certainly don't prevent transmission of non-bacterial pathogens from one person to another. \n   So if they give people a false sense of reassurance that they're no longer contagious, leading them to relax their usual sick precautions, they're likely doing harm. Every time a parent comes in the office with a child with an upper respiratory infection and we prescribe an antibiotic, we imply that we've taken care of the problem. We give patients an incorrect impression that the drug will make them better and will begin to kill off the germs infecting them. We also give the impression that they will be less of a risk to their friends, family and close contacts. After all, they're \"on an antibiotic.\"\n   Confronted with this information, physicians will often fall back on the excuse that their patients demand it, but too often, it's physicians, not patients or parents, who are the problem. A study published in 1999 in the journal Pediatrics examined expectations and outcomes around visits to the pediatrician for a child's cold symptoms. The only significant predictor for an antibiotic prescription was if a physician thought a parent wanted one. They wrote one 62% of the time when they assumed a parent expected a prescription, but only 7% of the time when they thought parents didn't. \n   Turned out the physician prescribing behavior was not associated with what parents actually wanted. The doctors often guessed wrong as to what parents actually desired. Another study published in 2003 in the Annals of Emergency Medicine had similar findings. Doctors were more likely to prescribe an antibiotic for diarrhea when they assumed that patients expected it, but they correctly guessed patients' expectations only a third of the time.\n   Physicians were also more likely to prescribe antibiotics for patients with bronchitis or other respiratory infections if they believed patients wanted them but correctly identified those expectations only a quarter of the time. In yet another study, physicians even prescribed antibiotics to 29% of patients who didn't want them.\n   It's time we stop viewing the overuse of antibiotics as a victim's crime. According to reports, Thomas Eric Duncan, the one patient who died of Ebola in the United States, presented to the emergency department with a 103-degree fever, a headache, and abdominal pain. He stated that the pain was 8 on a scale of 1 to 10. After receiving tests, he was thought perhaps to have sinusitis and was given an antibiotic. I can't guess as to what was in the physicians' heads that day, but I think it's likely they thought the antibiotics would do little harm and potentially some good. In this case, that doesn't appear to be true.\n  We may believe that antibiotic prescriptions are what patients want, but it may be time to recognize that sometimes there's more for physicians than for patients.  Moreover, the false sense of security they provide may do more harm than good.\n\n   [Healthcare Triage Outro]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/eOFf9FjglM0"},{"c_name":"healthcare triage","v_id":"tVvONUMeYIc","title":"Cardiologists on Vacation, and Concussion Victims Walk it Off","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nHealthcare Triage has merchandise: http:\/\/dft.ba\/-HCTmerch\n\nThis week's Healthcare Triage News is likely to upset some docs. Get your popcorn ready!\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=60498\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1420829280","likes":"819","duration":"282","transcripttext":"This week's Healthcare Triage news is likely to upset some docs. Get your popcorn ready.\n\n(Healthcare Triage intro)\n\nI'm sure our first story ticked off a lot of people over the holiday. It was published in JAMA Internal Medicine, and here's the gist: there are two big cardiology meetings every year, and when they occur, lots of cardiologists go to them. Few of them are left behind to take care of patients at home. So researches looked at how patients admitted to the hospital fared during those meeting dates compared to the three weeks before and after the conferences. Specifically, the looked at 30-day mortality for patients admitted with acute MIs, heart failure, or cardiac arrest.\n\nWhen I first looked at the study, I assumed they were concerned that patients would fare worse during the meetings. I thought they were worried that with all the cardiologists at the meetings, patients might have worse outcomes. But the opposite happened. High risk patients admitted with heart failure during meetings had a 30-day mortality rate of 17.5%, compared to 24.8% when more cardiologists were there. Cardiac arrest 30-day mortality was 59% during meetings and 69% at other times. Not surprisingly, the rates of percutaneous coronary intervention were lower during meetings, too at 21% versus about 28%.\n\nSo since you've watched all of our videos on research methods, you recognize that there are some concerns here. And the researchers addressed a number of them. Maybe any meeting affects patient care. But they found that cardiac mortality wasn't effected by oncology, gastroenterology, or orthopedic meetings. \nThey also found that mortality from GI or orthopedic issues wasn't effected by hospitalization during the cardiology meetings. This was strictly a cardiology meeting associated with cardiologic outcomes.\n\nThe researches had no measurement of staffing during those meetings, so we can't really know what was the cause of the finding. Were fewer cardiologists really available? We don't know. \n\nThere are a number of ways to interpret this study. Maybe the best cardiologists were the ones who stayed home. Maybe with fewer cardiologists available, fewer invasive procedures got done, and that leads to better outcomes. Maybe they tell more low-risk patients to wait when fewer cardiologists are available, which gets the high-risk patients more attention and better outcomes. Maybe it's something else.\n\nBut here's the thing: whatever's different during the meetings, it's associated with lower intensity care and better outcomes. That's probably worth looking into.\n\n(2:13)\nOur second story is based on a paper published just this week. It's about concussions in kids and how we should care for them. If I had a cohort study of kids with concussions, and I showed you that kids who were told to rest for 1-2 days had fewer symptoms than kids who were told to rest for 5 days, it'd be a mistake to immediately assume that 1-2 days is better. After all, it's just an association, and causation is not the same as association.\n\nMaybe the kids who were injured less severely were assigned 1-2 days of rest, and those who were injured more severely were assigned 5 days of rest. In that case, it's the injury -- and outcomes -- driving the recommendation, as opposed to the recommendation driving the symptoms.\n\nIn order to establish causality, you need a randomized control trial! To the research!\n\nResearches enrolled kids 11-22 years old who came to a pediatric emergency department within 24 hours of a concussion. They were all evaluation, and then randomly assigned to either 5 days of rest or 1-2 days of rest, followed by a return to normal activity. \nPatients recorded lots of stuff and symptoms in diaries in the post-evaluation period. They were also all examined three and ten days after the injury.\n\nNot surprisingly, both groups had a decrease in energy exertion and physical activity after being seated in the emergency department. Also not surprisingly, kids assigned 1-2 days of rest reported about twice as much school and after-school attendance in the following days than the kids in the five days of rest group. But, wait for it, there were no clinically significant differences in outcomes between the two groups. Except for this: kids in the 5 days of rest group reported more daily post-concussive symptoms than kids in the 1-2 days of rest group. They also reported that their symptoms took longer to go away. In the beginning, they were more nauseous and had more headaches. Later, they had more irritability and sadness.\n\nThe CDC recommends, and International Consensus Guidelines concur, that 1-2 days of rest followed by a stepwise return to activity is appropriate. Many physicians, and some other groups, have been prescribing and calling for longer periods of rest and for more restrictions on activity. Some are even advocating \"cocoon therapy,\" where patients are put into dark rooms for multiple days.\n\n(4:16)\nI agree that concussions are significant, and that we should be concerned about them, but we should do more only when doing more makes a difference. In this randomized control trial, doing more did not improve outcomes. It did, however, cause a slower resolution of symptoms and made the kids feel worse. So why are some people doing that?","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/tVvONUMeYIc"},{"c_name":"healthcare triage","v_id":"o7FCSqVrVYo","title":"What's the Deal with E-cigarettes and Vaping?","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nHealthcare Triage has merchandise! Get it here: http:\/\/dft.ba\/-HCTmerch\n\nI've found that of almost all of the topics I write about over at my blog, the one that stirs up the most controversy, the one that generates me the most hate, the most emails and the most tweets is e-cigarettes. Defenders of them are very passionate, and surprisingly organized. Those that dislike them are no less dedicated. But let's get past the rhetoric. E-cigarettes are the topic of this week's Healthcare Triage.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=60386\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1421105236","likes":"2839","duration":"392","transcripttext":"\n\nIntroduction\n\n\n I've found that of almost all of the topics I write about over my blog, the one that stirs up the most controversy, the one that generates me the most hate, the most emails and the most tweets, is e-cigarettes. Defenders of them are very passionate and surprisingly organized. Those that dislike them are no less dedicated, but let's get past the rhetoric. E-cigarettes are the topic of this week's Healthcare Triage.\n\n(Intro)\n \n \n\nOverview\n\n\n We all know what cigarettes are, right? Tobacco rolled in a paper, lit on fire, and then inhaled, often through a filter. But all of that is a somewhat inefficient means of delivering nicotine to people. You inhale the drug, along with a ton of other crap in the smoke. E-cigarettes are different. Instead of using fire to burn tobacco, they vaporize liquid nicotine, which is then inhaled. You get almost the same hit of nicotine, but you get it through vapour instead of cigarette smoke. The e-cigarette market, only 7 years old now in the US, is about a billion dollars a year now. In 2011, more than 20% of Americans who smoked had tried e-cigarettes. That means that more than 5% of all adults in the country had tried it - kids too. Almost 7% of children in grades 6-12 tried e-cigarettes in 2012. Those who support them like them because they believe they're safer. They also think that they can be a means to help others quit smoking cigarettes. And if they're safer, that would be a good thing, right? But are those beliefs true? There's not as many studies on this topic as I'd like. A lot of them are flawed, and they often conflict with each other. For instance, a randomised, controlled trial published last year in the Lancet compared putting people on e-cigarettes, nicotine patches or placebo to quit smoking. At six months, 7.3% of those on e-cigarettes had quit, versus 5.8% with patches and 4.1% with placebo. But so many fewer people had quit than the researchers had anticipated that the difference seen wasn't statistically significant. But let's not cherry-pick. The American Heart Association published a systematic review of e-cigarette studies earlier this year, let's dig in to what they found. To the research!\n \n \n\nResearch\n\n\n One study found that the aerosols from 12 different brands of e-cigarettes contained fewer toxins from cigarette smoke in general, although they varied a lot. Other studies went further. Some looked at whether the nicotine fluid could be cytotoxic, or harmful to cells. Interestingly, it seemed that most of the cytotoxic effects were related more to additives to the liquid like flavoring, than to the nicotine itself. Studies of second-hand smoke with these cigarettes were similar. Yes, you get nicotine in the air, and yes, you can detect particulate matter. People who smoke e-cigarettes are not exhaling water vapour as many ads would like you to believe. But at this point all we have are lab studies. Those show that second-hand exposure to e-cigarettes probably means less exposure to nicotine than conventional cigarettes. But it's not as much of a difference for particulate matter. There's no carbon monoxide though, which is good.\n \n \n\nHealth\n\n\n But let's get to health. Some people will point to cigarettes and say they can cause fires or explosions, and e-cigarettes can cause those too. You may have seen a video on the internet. They can also cause throat and mouth irritation, nausea, vomiting, coughing, all of those things too.\n\n Small studies showed that there can be short term pulmonary function changes after e-cigarette use, but these may be less severe than with tobacco cigarette use. Some studies show no change at all, but many of those are promoted by the industry or advocacy groups, and they're particularly flawed. The bottom line is that there's minimal evidence that they may be safer than tobacco cigarettes. But that doesn't mean that they have no negative effects at all. There's also pretty much no evidence at all to tell us about long-term effects.\n \n \n\nQuitting\n\n\n And do they help people to quit smoking? There are five population-based studies: four longitudinal, one cross-sectional. Combining them in a meta-analysis led to a pooled odds ratio of 0.6, meaning that e-cigarette use was associated with a lower quit rate than not using them. That's not good. But it's important to recognize that these kinds of studies aren't randomised, and they didn't control for nicotine dependence. In other words, it could be that the most addicted people were the ones trying e-cigarettes and it's not the device's fault that they couldn't quit. So let's look at clinical trials, and there are four of them, including the Lancet one I already mentioned. Three of the others didn't have a control group that didn't use e-cigarettes, none added in behavioral support or other components that usually accompany smoking cessation intervention. This means we can't have a ton of confidence in them. The better trials didn't find any effects of e-cigarette use that were better than what we've seen in other smoking cessation interventions. In other words, there's no real evidence that they're better than nicotine replacement therapy or behavioral intervention.\n \n \n\nHarm Reduction\n\n\n Harm reduction is different. If e-cigarettes can get people to smoke fewer tobacco cigarettes then that might result in an improvement in health. There is some evidence that e-cigarettes may lead to people smoking less even if they don't quit. But we need more studies of good quality to see if this is really the case.\n \n \n\nRegulation\n\n\n At this point the United States, specifically the FDA, doesn't regulate e-cigarettes at all. Some states do, but not the federal government. New rules have been proposed though to change that. If they go into effect, selling e-cigarettes to minors would be illegal, health warnings would be added, and selling them in vending machines would now be prohibited. Companies would be forced to detail their ingredients, allow the FDA to review their marketing plans, and they'd get to approve any claims about the benefits they might have. Online sales would still be legal, and they'd still be able to advertise on radio or TV, which tobacco can't do. Those rules were proposed in April, there's been no movement since.\n\n In the EU on the other hand, e-cigarettes with nicotine concentrations up to that of a pack of cigarettes are regulated just like tobacco. If they have more nicotine than that, they're regulated like medical devices. But as of March, it appears that the regulations might get even tighter.\n\n In the UK, things are a bit more permissive. E-cigarettes aren't covered by smoking bans, but legislation may be coming to bar their sales to minors.\n \n \n\nConclusion\n\n\n So let's review. There's a reasonable case to be made that if all tobacco smokers converted to e-cigarette use there would likely be an overall health benefit. But the prevailing evidence shows that introducing e-cigarettes may lead to more dual smoking than quitting. And it may be getting new people to start smoking, which would be bad. It's not clear.\n\n The stuff coming out of these cigarettes is probably not as bad as tobacco smoke, but it's not harmless water vapour either. And if they were marketed as quit aids and sold as such, I think fewer people would be concerned. But they're often sold as a healthy way to get the sweet, sweet benefit of nicotine. That's not too far off from the ways that cigarettes used to be sold. That makes a lot of people uncomfortable, and it's easy to understand why.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/o7FCSqVrVYo"},{"c_name":"healthcare triage","v_id":"BdwCZudSEZg","title":"Healthcare Triage Answers Your Questions!","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nGet the merch from question #1! http:\/\/dft.ba\/-HCTmerch\n\nJohn Green asks the questions you submitted, and Dr. Aaron Carroll answers them. Also, great job with the questions. They were really good.","uploaded-unix":"1421765273","likes":"1943","duration":"686","transcripttext":"\n\nIntroduction\n\n\n - Hi, I'm John Green\n - I'm Aaron Carroll\n - And today's the first of two videos where I'll be asking questions that you asked Aaron about healthcare and he'll be answering them.\n - Looking forward to it\n \n\n\nDo you guys have any merch?\n\n\n - The first question in very important, which is, do you guys have any merch?\n - We do!\n - Look at this.\n - Posters and mugs.\n - Yeah, so you can get your posters and mugs in the link in the doobly doo at dftba.com. To the research!\n - Yes. \r\n\n\nTell my mum whether or not she should keep spending her money on essential oils\n\n\n - Next question from Alex: tell my mum whether or not she should keep spending her money on essential oils.\n - That should only depend on whether you have stock in a company that sells essential oils. Otherwise, no.\n - To be fair, I've enjoyed a good essential oil here or there. But not for health reasons. Just to improve the quality of my bath.\n - Right. Ok, if you enjoy. Ok, fine, if like the smell then that is fine but you're not going to get any kind of health effect. Maybe mental health effect - maybe, maybe.\n - I love my baths. I have. Aaron, I have the most magnificent, well-planned baths. Like, I have essential oils, I have these wonderful bath salts. Um, it's just, aggh.\n - I like bath bombs.\n - I like a good bath bomb occasionally. But I really, I almost. I have it down to such a science that I essentially build the bath bomb from scratch every time. Candles, low light.\n - How often?\n - Every day.\n - Really?\n - I take a bath every day. Like a 40 minute bath. The highlight of my day.\n - That's a great life.\n \n \n\nDoes the stupendous cost of becoming a doctor in the US (vs UK) have a negative effect on healthcare quality?\n\n\n - Peter Beck asks: does the stupendous cost of becoming a doctor in the US versus the UK have a negative effect on healthcare quality?\n - Oh, nationally? Hmm. There's no evidence for that. I would imagine that it probably does keep some people out of becoming a doctor because the price tag can seem so large that perhaps it discourages some people who are probably at the lower end of the socioeconomic spectrum from getting into it. But I don't think anybody's measured whether that's impacted downstream how healthy people are in the United States.\n - Well you would think just from a macroeconomic perspective, that not having the best, most qualified people become doctors who could would negatively impact care - unless doctors are essentially just robots.\n - Or, if there are still fewer doctors being produced than there are from the pool of qualified people. And I mean, medical school acceptance levels are so low that there're probably way more qualified people than we do produce doctors. So you'd imagine.\n - But if you want the most. It's a question of whether, of whether there is such a thing as 'most qualified physician providing best care' versus like 'any qualified physician can provide vital care'.\n - Right, ok, that is true as well. Yes, if medical school is cheaper you imagine we could theoretically have a better pool of people to derive doctors from, but I'm not sure that it makes much of a difference.\n \n \n\nIs homeopathy just an elaborate placebo? Can you build collagen for your joints by consuming supplements? VitC for cancer?\n\n\n - Is homeopathy just an elaborate placebo?\n - If people are using it colloquially to talk about alternative medicine in general, no. There are some things that people do which should be alternative medicine which have been proven even in randomised controlled trials to work. But if the question is specifically about homeopathy and they're just sort of adding the thing that's bad for you in tiny amounts to try to get better - that has not even really been proven to work in a large trial. So, if anyone is getting a benefit it could be placebo.\n \n \n\nIs there any evidence for using bicycle helmets?\n\n\n - Is there any evidence for using bicycle helmets?\n - Sure! Uh, none of it is in randomised controlled trials. I mean we're not randomising kids to wear and not wear a bicycle helmet hit a, you know, letting them have an accident and seeing if they get hurt. But there are large cohort studies which show that wearing a bicycle helmet is significantly associated with a lower risk of head injury. Now whether that's because the actual helmet is protecting your head or because kids who wear bicycle helmets ride more safely or are more aware of cars, we don't know. But who cares? The act of wearing a bike helmet significantly reduces the risk of head injury.\n \n \n\nIs a \"detox\" necessary?\n\n\n - Is a detox necessary?\n - No, I mean unless you're like a real heroin addict, then maybe, but yeah. Your body is full of organs - their only jobs are to detox you. Your liver, your kidneys. I mean, when you get a hangover that's because you've had a toxin in your body - alcohol. But the body knows how to break it down and get it out. You don't need to go on a special diet for that.\n - You may recall that I did a juice fast a couple years ago.\n - Yes I do.\n - You were not terribly supportive of my juice fast.\n - No, still not.\n - And I will tell you it was a disaster. I've received no benefit. Um, I lost no weight. And all I did was feel terrible both during the juice fast and when I reintroduced solid food.\n - There you go.\n - Yeah.\n - And never one study.\n \n \n\nWhich is healthier, butter or margarine, and by how much?\n\n\n - Butter or margarine?\n - Ooo. I think these days probably we'd lean towards butter, especially if the margarine's made with trans fat.\n - Wow.\n \n \n\nAre taking multi vitamins really necessary? And do gummy vitamins work as well as other ones?\n\n\n - Nina asks: are multivitamins really necessary, and do gummy vitamins work as well as regular ones?\n - So, for the vast, vast majority of people, no. Multivitamins are not really necessary. They're getting plenty in their diet. That said, you know, as we've talked about before - they're cheap, there's almost no harms, sure. If you feel like your diet's not good enough you can eat a multivitamin. And there's no reason to believe that those gummy things are any less worthwhile than regular swallowed vitamins. So yeah, go ahead with the gummies.\n \n \n\nMyths\/truths, pros\/cons of probiotics? Can they actually prevent infection? Treat\/cure disease?\n\n\n - Bethany asks: what are the pros and cons of probiotics? Can they actually prevent infection or treat and cure disease?\n - So, there haven't been terribly many studies of probiotics, but there's a decent amount of evidence that they're not, that they're good for you if you have acute diarrhoea or if you have some sort of GI infection and you're trying to get. Especially antibiotic-induced diarrhoea, probiotics can help. There's some evidence that they could be good for things like kids with eczema or other atopic disease. Um, but, for many, many other things including the treatment of coeliac it doesn't look like there's much evidence at all.\n - I have a kid with eczema.\n - There you go, so probiotics could be of some benefit.\n - I will give him some of that kefir that my wife always makes me drink.\n - Just some yogurt's fine. Yogurt with active culture should be fine.\n \n \n\nCan sun exposure on one part of the body cause melanoma on another part of the body?\n\n\n - Kari asks: can sun exposure on one part of the body cause melanoma on another part of the body?\n - Well it can if it's a disease which metastasizes, so in other words if you get sort of melanoma from an area that has been exposed, theoretically it can move to another part of your body where it hasn't been exposed. But the primary incidence is likely to be where you get the sun exposure.\n - Ah, that's interesting. Then how do people get, like, melanoma on their like, on the inside of the toenail or something?\n - Well because it's not all related to sun exposure.\n - Ah, ok.\n - I mean some people get. But if you look, people are more likely to get melanoma on the limbs, where sun is exposed, than they are other places. But it can develop anywhere.\n - Mmm. I'm very afraid of melanoma. Also everything else.\n \n \n\nWhat do you think needs to be done to ensure greater price transparency in US healthcare?\n\n\n - This is a great question: what do you think needs to be done to ensure greater price transparency in US healthcare?\n - Like a million things. Um, so, god, I mean they're trying to do a better job with it now but it's just never gonna happen in the US healthcare system as it's built this way. Because part of the way that private insurance can actually bring down spending is by making negotiated deals with providers for lower rates for their customers. So everyone's getting a different rate. So the idea that we'll have just one universal, published rate system is very, very unlikely in the United States as it stands today.\n - But they have it in many countries in Europe?\n - Sure. And there are some states like Maryland which have all payer, where they do make those kinds of judgements and make sure that everybody pays the same rate. But the United States at large doesn't do that at all. It doesn't mean it's impossible, but we're just not building that system.\n - Do we have higher prices as a result of our lack of price transparency than countries with price transparency.\n - We have higher prices absolutely than almost any other country, and I'm sure transparency has something to do with that. Also it's just that everything just costs more in this country. We just, it's a terrible price system - bad, bad, bad, bad.\n - But, on the upside, we get way better health outcomes than those countries in Europe.\n - Ok.\n - Don't we?\n - No! No-o.\n - Dang it!\n - You know with some things in some areas, we absolutely do very well. Like if I need a heart-lung transplant, yeah, I'd like to be in the United States. But, you know, if you need regular run-of-the-mill healthcare, sometimes the big outcomes that we care about at a population level are better in many, many, many other countries than the United States.\n - Alright.\n - We do have a lot of MRIs and CAT scanners. If that's your metric of quality, go USA. We're like number 2.\n - You know who doesn't have a single MRI machine? The 90 million people in Ethiopia.\n - That is true.\n - It's amazing.\n - It is.\n - It's just astonishing.\n - Yep.\n - Uhh. We have like 50 within the city of Indianapolis.\n - There are probably some in our sightline.\n - Right, it's like they're like Starbucks.\n - Yes, exactly.\n - There's one on every corner.\n - There's probably like a roving MRI machine in a van around here somewhere.\n - I don't understand. I don't understand why we don't just fly one over.\n - We don't need to- oh, to Ethiopia.\n - To Ethiopia.\n - Well because we can't bill very much for it probably.\n - That's the problem.\n - The price would be lower.\n \n \n\nWhat is your biggest health-related challenge and what are you doing to address it?\n\n\n - Ok, this is from Troy, I think this is for both of us. What is your biggest health-related challenge and what are you doing to address it?\n - Mine is probably ulcer colitis. I, you know, I just have a chronic illness and so I take medication, and I take care of my health, and I go to the doctor, and I have my regular colonoscopy, and I do everything I'm supposed to do.\n - I also have to have regular colonoscopies because of, uh, um, polyps. But my, probably my biggest health problem is my anxiety disorder. Same thing, I'd rather have my anxiety disorder than UC. But like, uh, yeah, you just, you know, you treat it like a chronic illness.\n \n \n\nWhat do you think is the worst disease you could have?\n\n\n - What do you think is the worst disease that you could have, Kiki asks. That's something I spend a tremendous amount of time thinking about, Kiki, so thank you for your question.\n - See, well you're helping his anxiety now too, so good job. Um, that's a personal thing too, it's like, 'cause we, it dep-, worldwide or personal? I would hate any disease which removed my mental faculties, um, and left me perhaps on a slow, degenerative loss in that area. I mean, that would be really bad for me.\n - Like Alzheimer's, or?\n - Yeah, I think even worse. It's like, I just, the idea that I could, yes that would be bad. And especially if, if you were aware of it.\n - Yeah. Well thanks for the uh, thanks for the downer, Kiki.\n - We have to stop now for anxiety purposes.\n - Now we're in a dark place. There's a lot of diseases I wouldn't like to have. Thanks for mentioning how many there are. Um, dystonia. Like, one of those really weird neurological, dystonius.\n - But yeah, I think I, I would be more concerned I think about losing my mental than my physical.\n - But if you lose your physical in such a way that you lose the ability to communicate. Then, I mean it does affect. Then you're sort of stuck inside of yourself. That, that's scary to me.\n - Except that I. In again, wha- see we're debating, like, badness here. But there are some, so many great ways to help people communicate these days.\n - That's true.\n - And even people with incredibly bad dystonia still can often communicate in very effective ways in the world, so.\n - Yeah.\n - I don't know. I think I'm more afraid of the, losing the mental side than the physical side. But they're both bad, they're both bad.\n \n \n\nWhat can I do as an individual do to improve health outcomes and impact health legislation?\n\n\n - What can I as an individual do to improve health outcomes and impact health legislation?\n - Vote. Vote for people who have, are supporting legislation or policy changes that you endorse.\n \n \n\nOutro\n\n\n - Aaron, thank you for answering all of our questions.\n - Thank you for asking them.\n - I am terrified but also informed.\n - As am I.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/BdwCZudSEZg"},{"c_name":"healthcare triage","v_id":"j0mjHf-lczg","title":"Myths About Foster Care and About Abused Kids: HCT News","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nTwo studies this week bust some myths about sensitive topics and kids. This is Healthcare Triage News.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=60691\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1422052515","likes":"1005","duration":"227","transcripttext":"\n\nIntroduction\n\n\nTwo studies this week bust some myths about sensitive topics in kids. This is Healthcare Triage News.\n\n(Intro music plays)\n\n\n\nFoster Care and Academic Achievement\n\n\nA number of studies have found that kids in foster care suffer from a number of adverse outcomes, including poor academic achievement. This has led many people to believe that being placed in foster care causes poor academic achievement. In other words, foster care can't live up to regular care and you see that in school performance.\n\nBut a recent study in the journal Pediatrics questions this assumption in the aptly titled paper, \"Children's Academic Achievement and Foster Care\". Researchers looked at a large data set to try and understand this better. They found, in a simple bivariate analysis, meaning that they didn't control for other things, that kids in foster settings did have test scores more than half of a standard deviation below average. That's the kind of simple but flawed analysis that gives foster care a bad rap.\n\nBut these researchers went further. They also found that academic deficit was associated not only with current and past foster placement but also with future foster placement. And something that takes place in the future can't cause something in the past. Moreover, in the model that was preferred by the authors, which was also the most robust model because it controlled for child-specific fixed effects, foster placement had no effect at all on academic achievement. In other words, foster placement is associated with poor academic achievement but likely not causing it. Something else which is associated with foster placement is likely the cause.\n\nThis means that while we should be concerned about children in foster care, and recognize that it is perhaps a marker for kids at risk for lower academic achievement, it's not an independent predictor of school troubles. Many have often viewed it negatively for this reason, likely mistakenly so.\n\n\n\nEffect of Sexual Abuse on Future Outcomes\n\n\nOur second story helps to dispel a myth about sexual abuse. For a long time, people have assumed that being sexually abused as a child increases the chance that that child will grow up to be a sexual offender. As you can imagine, anecdotes fuel this belief. There's not a lot of good data to go on. But there is some. In a recent study in JAMA Pediatrics, researchers got into it. They examined a cohort of kids in the Midwest, some of whom had been physically or sexually abused before the age of 11 years old. They matched them to kids who had not been abused but who were the same age, sex, race or ethnicity, and social class. There were 908 cases and 667 controls. Both groups were followed until they were, on average, 51 years old - that's no small feat! The court cases were all between 1967 and 1971, and follow-up was through to 2013. The main outcome of interest was whether as adults they were arrested for a sex crime. Here's the gist of their findings.\n\nOverall, those who were abused or neglected as kids were significantly more likely to be arrested for a sex crime than those who had not been abused, even after controlling for other factors. Adults arrested for a sex crime comprised 8.3% of those who were abused or neglected but only 4.5% of those who were not. But specifically, those who were either physically abused or who were neglected were at increased risk for committing a sex crime. \n\nBut here's the surprising part: those who were sexually abused were not significantly more likely to commit a sex crime later in life. It also turned out that the significant relationships were true for men only - not women. In general, men were much more likely to be arrested for sex crimes than women, no matter what their history.\n\nWhat does this mean? We should absolutely continue to provide assistance to children who are physically abused or who are neglected to reduce their risk of future sexual crimes. But those who've been sexually abused? We should still do everything we can to help them but the stigma of concern that they're an increased risk for future sex crimes may be unwarranted.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/j0mjHf-lczg"},{"c_name":"healthcare triage","v_id":"8A3GCeScoV8","title":"Healthcare Triage Answers Your Questions, Part 2","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nOnce again, John Green joins Aaron Carroll on Healthcare Triage to answer questions submitted by you, the viewers.","uploaded-unix":"1422306206","likes":"1859","duration":"672","transcripttext":"John: Hi, I'm John Green.\n\nAaron: I'm Aaron Carroll.\n\nJohn: And we are back today to answer your questions about healthcare, specifically I'm going to ask the questions and Aaron is going to answer them because he is the doctor. \n\n[Healthcare Triage Theme Plays]\n\nJohn: Is there truly a medical benefit to circumcision?\n\nAaron: This one is going to raise anger. So, there is some good evidence that being circumcised reduces your chance of contracting HIV and some other sexually transmitted infections. There's some decent evidence that it might lower the risk of urinary tract infection or penile cancer. But all of those differences are pretty small. And-\n\nJohn: Wait, you can get cancer of the penis?\n\nAaron: Yes you can. \n\nJohn: Oh my God.\n\nAaron: I'm not laughing at penile cancer, of course. \n\nJohn: What's the treatment, Aaron?\n\nAaron: I would imagine removing the penis if it's too big and perhaps chemotherapy and\/or radiation. So again, there are some -\n\nJohn: If the penis is too big or the tumor? That was a very ambiguous \"it\"?\n\nAaron: I would say the cancer.\n\nJohn: Oh, okay.\n\nAaron: Having said that, yes, there is some statistically significant benefit but it's not high enough that we should make any kind of recommendation to say that universally we should circumcise or that it's - But it is enough of a benefit that we should make the argument that if people want to get circumcised, we should make it easy for that to happen. \n\nJohn: But a lot of time it's babies who don't have a want.\n\nAaron: Right, which is why -\n\nJohn: And that's why the ethical - \n\nAaron: Ethical and it comes in later because of course it is much more difficult and problematic to have a circumcision in life so there's a debate to be had. It is a very tricky question. \n\nJohn: I'm going to stay clear of it. \n\nAaron: There you go. \n\nJohn: What is tunnel vision and why does it happen?\n\nAaron: Hm, well there's the short term and the long term. If you're talking about chronic, then it's just the idea that you start losing your peripheral vision and can only see a circle left. That's usually caused by damage to the optic nerve, or to some other area of the nervous system in such a way, from glaucoma or high blood pressure or something else with long term damage. The way you fix that is by reversing whatever the cause is. Short term, you can get that sometimes when you get that when you're going into shock, like I once in a while will go vagal and I'll pass out.\n\nJohn: Really?\n\nAaron: It's happened to me a number of times.\n\nJohn: You just faint?\n\nAaron: I can always tell when it's coming, but yes. \n\nJohn: One of the things I like about you is that you also have some weird health problems. \n\nAaron: Oh yeah, and the anxiety and all that comes into play too. It's just not my number one. But when I know that that I'm going to faint or I know I'm going to pass out, the first thing that happens is that I can hear a ringing in my ears and I start getting tunnel vision. It starts to go like that.\n\nJohn: I get tunnel vision when I work out too hard.\n\nAaron: Do you faint?\n\nJohn: I do sometimes faint.\n\nAaron: That's happened to me more than once. I was with a friend who still makes fun of me for that.\n\nJohn: I said to my personal trainer not too long ago that \"I'm going to barf\" and he said, \"you're not going to barf. Just work through it.\" Then I was like *BLERGH*   \n\nAaron: See, I don't barf, I just say \"I'm going down\" and everybody says \"what does that mean?\" and then -\n\nJohn: And then you're down.\n\nAaron: I once said it to Amy, my wife, \"I'm going down\" and handed her our baby then passed out on the table. I wake up and she's on the phone with 911. Well, I told you I was going down, you didn't need to do this.\n\nJohn: How come we lose muscle mass over time?\n\nAaron: Well, it's funny. It's like we gain muscle mass until we're 30 then it starts to trickle off. Partially, that's hormonal changes, partially that's because people become more sedentary and they don't work out, sometimes it's dietary. It's just the way bodies are built, to develop for a while then it's a long, slow decline to death. Having said that, you can avoid that by exercise to help reduce that muscle mass loss. \n\nJohn: How's P90X3 going?\n\nAaron: It hurts. \n\nJohn: I'm very sore today.\n\nAaron: Only two days in and it hurts.\n\nJohn: When are they going to make a better unemployment insurance than COBRA?\n\nAaron: We have one already, that's what the Affordable Care Act is. \n\nJohn: It's called Obamacare.\n\nAaron: You don't have to get COBRA anymore the second you lose your job, you can get regular old insurance which is way cheaper than COBRA. \n\nJohn: I started using a standing desk at work recently. Is sitting all day really killing us?\n\nAaron: It's not causal in the sense that we don't have good randomized control trials but there are a lot of good cohort studies that show that being sedentary is really really bad for you. The observational data is good enough to make us want to get up and move around more. I endorse your standing desk. It's a good idea. \n\nJohn: How regularly should I see the doctor for a \"checkup\"?\n\nAaron: Well, that depends on your age. Babies should be going multiple times a year - \n\nJohn: How often should I go?\n\nAaron: You -\n\nJohn: 26 year old, healthy male. \n\nAaron: Where's he? Anyways, a 26 year old arguably should, well there's nothing to do every year. At your age, you're getting closer to where there are recommended things to followed every year. Having said that, there was this great piece in the New York Times by the Zeke Emanuel, who was arguing that we don't even need annual check ups. There's no evidence for it at all. But there are things that we're supposed to do every year and screening tests that should occur every year. You should be getting certain vaccines every year and the way our system is built, we need a doctor visit to do a lot of those things. So still probably every year. And women are a whole different story because you often do need often gynecological care and screening tests that absolutely require every year. Absolutely every year for a woman and probably for men. \n\nJohn: Is the BMI (Body Mass Index) really a good marker of health and weight proximity? It's an 160 year old test... really.\n\nAaron: Well, we shouldn't ding it because it's old. Having said that, BMI isn't perfect just like any one metric isn't perfect. It is very possible to be very muscular and still have a high BMI and be very healthy. But generally it still is a decent metric for obesity and that has been correlated with a lot of bad outcomes. It's one of the better ones that we have, but I totally agree that it's not perfect.\n\nJohn: Height to waist ratio is something that I hear a lot about.\n\nAaron: That is one of the ways of calculating BMI. The perfect way to calculate BMI is to put you in one of those body pod chambers where they figure out how much fat you have and how much your body mass is, but having said that, the number of height to weight or there are all these different ones, but it's all different ways of calculating BMI.\n\nJohn: You know what I've noticed is that people with abdominal fat have much higher risks of everything.\n\nAaron: Yup.\r\nJohn: I have that and it's not my fault. \n\nAaron: Well, a little - \n\nJohn: Well, I like to eat fatty foods but it's not my fault in the sense that, it just doesn't seem fair.\n\nAaron: Well, fair, I didn't say fair but I mean, yes if you exercised more and ate a healthier diet, it is likely you'd have less abdominal fat. But it's not about blame. It's not.\n\nJohn: Hella Della asks, \"are there benefits to cutting red meat out of my diet?\"\n\nAaron: If you eat a ton of red meat, yes. If you eat very little red meat, probably not much to be gained.\n\nJohn: But you shouldn't eat a lot of red meat.\n\nAaron: You shouldn't eat a ton. All the studies that show that red meat is terrible for you are all talking about reducing the number of servings with an \"s\" of a day of red meat. Most of us aren't eating multiple servings of red meat a day. If you're eating that much red meat a day, you could probably stand to cut some out. But a little bit of red meat is probably fine.\n\nJohn: Am I more at risk if my relatives have cancer?\n\nAaron: I would say depends on the cancer but the general answer would be yes. Yes, there are genetic components to many many cancers so certainly if many relatives have a certain type of cancer, it raises our index of suspicion for you. But it's also not a lock. Just because a relative has cancer doesn't mean you're going to get it.\n\nJohn: Rona asks, \"are scientists and doctors any closer to determining why nut allergies are growing so fast?\n\nAaron: No, there's a lot of theories out there. Some people think that it's the food that we eat, that somehow it's been processed in a way that's making more people have allergies. Some people believe that it has something to do with pollution and the general environment. But there are also people that not exposing kids in utero and as small babies to these things make them more likely to develop these allergies. So maybe our paranoia about it is unfortunately causing the rise in the numbers.  No one knows, it could be any or all of those things.\n\nJohn: Three more questions. Rachel asks, \"what is a hiccup exactly?\"\n\nAaron: So it's a spasm of your diaphragm, the muscle at the bottom of your lungs which helps move everything up and down, and when that happens, it results in a secondary snapping of your vocal cords that produces that \"hic\" sound.\n\nJohn: You know the people who have hiccups regularly for their entire lives?\n\nAaron: Yeah, they lose a ton of weight and are always so thin and scary.\n\nJohn: Yeah, that's one of my big anxieties, that I'm going to be a hiccup person. \n\nAaron: Or have a horrible degenerative mental illness. \n\nJohn: Or both. Besides medication, what can I do to deal with the allergy I have to my pets? [whispers] I have an idea.\n\nAaron: So there's a number of - yes, yours is going to be worse than mine. So what you could do, first of all, is to never let your pet in the bedroom. You spend a significant amount of time in the bedroom and you don't want to let them in there. The second is trying to eliminate carpets in your house, that is where the dander - it's not the hair, everyone thinks its the hair, it's not. - it's the shed skin, its the dander and it can collect in rugs. When you vacuum, you can wear a mask or you can get someone else to do your vacuuming because that's when it gets spread up into the air. Have someone else wash your pets regularly and brush them to get all that dander out. But of course, getting rid of the pet would also help your allergy. \n\nJohn: Find a great home for that pet. And our last question, from Savannah, \"how do you feel about abstinence only being taught in schools?\"\n\nAaron: So I have not seen a lot of good evidence that says that abstinence only is better than teaching kids about sex and how to do it safely. The problem is that we make it an either\/or and so we're saying when we're going to do abstinence only or we're going to do a comprehensive sex education, comprehensive sex education is better. However, adding abstinence in as an option to comprehensive sex education, I don't think many people have a problem with that at all. Just saying that you could just not, okay, but it probably needs to be part of it. The problem is when we say, let's only talk about that, that can be problematic. \n\nJohn: Aaron, thanks for answering all of our questions. I have one last question for you, when am I going to die and how?\n\nAaron: 2056 and by nuts. \n\nJohn: I'll take it. I'd take that in a second if there was a deal I could sign right now for 2056 by nuts, I would take it. \n\nAaron: How old will you be in 2056?\n\nJohn: Old enough.\n\nAaron: I'm just going to say, did I give you enough years of life?\n\nJohn: Wait, no... 42 years from now...\n\nAaron: No, I've almost robbed you. You should get more than - \n\nJohn: Oh yeah, 80, I would take 80.  \n\nAaron: We've talked about 80. You're gonna get 80. \n\nJohn: I'd be delighted to get 80. \n\nAaron: You'll get 80. I'm very confident you'll get 80. \n\nJohn: And I've always wanted to die by nuts. \n\n[Healthcare Triage Outro Music]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/8A3GCeScoV8"},{"c_name":"healthcare triage","v_id":"y4TCQCmHdBg","title":"The Flu Vaccine is Effective","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nThere's been a lot about vaccines in the news, recently, especially the flu vaccine. So we're going to concentrate on that, in today's Healthcare Triage News.\n \nFor those of you who want to read more, Aaron has two posts with links: http:\/\/theincidentaleconomist.com\/wordpress\/articles-saying-flu-shots-suck-this-year-may-not-really-get-effectiveness\/ and http:\/\/theincidentaleconomist.com\/wordpress\/once-more-unto-the-breach-influenza-effectiveness-edition\/\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1422652585","likes":"1025","duration":"250","transcripttext":"There's been a lot about vaccines in the news recently, especially the flu vaccine, so we're going to concentrate on that in today's Healthcare Triage News.\n\n[Healthcare Triage News opening theme]\n\nUnless you've been living under a rock, you've seen some headlines about how the flu shot this year is only 23% effective. Most of the headlines are panicky and angry. I don't know why.\n\nLet's start with a simple explanation of what it means that this year's flu shot is \"23% effective\". What happens is that the CDC monitors people coming to doctors' offices with acute respiratory infections and checks them for influenza by laboratory testing. It then checks the proportions: who were vaccinated or unvaccinated. Then, they calculate effectiveness as 100% x (1-(the odds of being vaccinated among those with influenza\/ the odds of being vaccinated among those without influenza)).\n\nThis is what they found: Of those with influenza, about 49% were vaccinated. Of those without influenza, about 56% were vaccinated. Converting those to odds gets you 0.957 for influenza positive people and 1.283 for influenza negative people.\n\nSo, effectiveness=100x(1-(.957\/1.283))=about 25%, but that's unadjusted, so the CDC did some adjusting and it's 23%.\n\nLet's remember the reality here: First of all, the differences in the percentages were 49% of those with flu were vaccinated vs. 56% of those without flu were vaccinated. That's a bad year. In a good year, say, 2013, the numbers were 32% and 56%, and that yields an effectiveness of 62%, but even in a good year, a third of people who were influenza positive were vaccinated.  My concern here is that people, and a lot of people in the media, have a rather poor understanding in general of what 'effective' means when it comes to healthcare.  For instance, people assume that a good flu shot is a lock against not getting the flu.  The CDC report isn't a randomized control trial, and I'm not gonna try to calculate the NNT, and you better have watched that video.  It's also not a perfect methodology to establish how the influenza vaccine reduces the absolute probability of your getting the flu.  But the differences between this year and others just really aren't as huge as many are saying they are, and it's just a shot, it's hard to see how the benefits don't still massively outweigh the harms, especially since we DO have randomized controlled trials.\n\nTo the research!  A meta-analysis of 17 flu shot studies showed that when the vaccine is well-matched, 1.2% of vaccinated people were infected with influenza, versus 3.9% of people not vaccinated.  That makes the number needed to treat, or NNT, for a well-matched flu shot to prevent one influenza infection to be 37.  When the match is poor or uncertain, however, the NNT is 77.  A couple of points here.  First of all, NNTs of 37 and 77 are pretty good, especially for something like a shot.  The NNT for many, many, many other things we consider no-brainers are much higher.  Also, 37 and 77, while different, aren't so different that we'd tell you to do one but not the other.  They're both in a class that would be recommended.  It's important to understand that even if you're vaccinated, you can still get the flu.  It's not like your chance went from 90% to 1%.  No matter what, you still need to practice good hygiene.  Wash your hands, stay home if you're sick, don't sneeze or cough on others, common sense stuff.  My issue here is that many are treating the news of this year's flu shot as if there's some monstrous difference from other years, and that we should behave differently this year than other years, and that's just not the case.  The difference between 60% effective and 23% effective is subtle.  It's real, but not that huge.  Yes, you should get a flu shot, because the NNT is still pretty great.  Herd immunity is important.  But you should always, always practice good infection control as well.\n\n(Healthcare Triage Outro plays)","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/y4TCQCmHdBg"},{"c_name":"healthcare triage","v_id":"WIaI_VYibG8","title":"Sleep: Are You Getting Enough? Probably Not","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nWe've got mugs and posters! Get 'em here: http:\/\/dft.ba\/-HCTmerch\n\nSleep! It's probably the one single thing we spend the most time doing. Sleeping eight hours a night means that you'd spend literally one third of your life asleep. But most of us are getting less than that, and we probably need more. Sleep is important! It's also the topic of this week's Healthcare Triage.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=61025\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1422906879","likes":"2192","duration":"296","transcripttext":"Sleep! It's probably the one single thing we spend the most time doing. If you do it eight hours a night it means that you spend literally one third of your life asleep. Most of us are getting less than that and we probably need more. Sleep is important. It's also the topic of this week's Healthcare Triage.\n\nSo how do you figure out how much sleep people need? These days, it's hard to know. After all, modern society has changed how and when we sleep. We have electrical lights that allow us to be productive at night. We have coffee to wake us up in the morning. We'd have to return people to a simpler life to find out how much sleep is 'natural'.\n\nYou gotta love scientists! They did just that. They got five healthy adults to live in a Stone Age style settlement for eight weeks in Southern Germany. No electricity, no running water, no internet or modern conveniences. They slept on brushwood and firs. They had no alarm clocks. They had only a campfire for light at night. Germans, man. And what happened?\n\nBefore the study, the five adults fell asleep on average at 11:42 p.m. but under Stone Age conditions, they went to bed at 9:37 p.m. After the experiment they went back to their old habits, falling asleep at 11:07 p.m. Waking time didn't change as much. Before the experiment they woke up at about 7:02 a.m., in Stone age conditions they woke up at 6:28 a.m. and afterwards they went back to 7:14 a.m.\n\nSleep time increased too. They went from an average of 5 hours and 42 minutes before the experiment to 7 hours and 12 minutes in Stone Age conditions. Then, back to 5 hours and 13 minutes after.\n\nSo they weren't sleeping naturally outside of the experiment. But the 'natural' amount wasn't eight hours. It was about seven and a quarter hours.\n\nThe National Sleep Foundation published a survey of people's sleep habits in six countries. Canadians and Mexicans sleep the most at 7.1 hours a night. Then Germans at 7 hours and citizens of the UK at 6.8 hours. At the bottom were the US at six and half hours and Japanese at 6.4 hours.\n\nPeople are also sleeping less than they used to. In the early forties almost 85% of Americans got seven hours or more of sleep. By the 1990s and continuing to today, less than 70% of people get that much sleep.\n\nRicher people also get more sleep than poorer people. Only about a third of people in the United States making 75,000 a year or more get less than six hours of sleep a night. On the other hand almost half of people making less than $30,000 a year get less than six hours a night.\n\nWe also sleep pretty inefficiently. We spend too much time in bed not sleeping. We're watching TV or surfing the internet. We're drinking at night. We even exercise before bed. And all of these things make it less likely that we're going to sleep efficiently.\r\nKids generally need more sleep. And it's easier to try to figure out how much babies need to sleep 'cause we let them be. The National Heart, Lung, and Blood Institute recommends that newborns get 16 to 18 hours of sleep a night. Lots of them get that because, again, we let them. Only a fool wakes a sleeping baby. I've had three of them and I'm telling you that's the case.\n\nPreschool age kids are recommended to get 11 to 12 hours of sleep a night, and fewer get that. School age children should get at least 10 hours of sleep a night, and they don't. And teens usually need 9 to 10 hours a night and lots of them don't get that. The median three year old gets about 11 hours of sleep in the United States. The median eight year old gets about 10 hours of sleep. The median teenager gets about 9 hours of sleep. That means about half of all these kids are getting less sleep than they likely need, especially the teens.\n\nAnd not getting enough sleep can lead to some bad and often strange consequences, but those are the topic of next week's Healthcare Triage. Let's put that off for now.\n\nThis week I'd like to end by focusing on some recent news that getting too much sleep might be bad for you. The Wall Street Journal had an article this summer entitled Why Seven Hours of Sleep Might Be Better Than Eight. It highlighted a study published in JAMA Psychiatry in 2002 entitled Mortality Associated with Sleep Duration and Insomnia. The study followed more than a million people with cancer. They found that people who slept between six and a half and seven and a half hours a night on average had a lower mortality rate than those who slept more. The article also noted some research that showed that people who slept more than seven hours a night had lower cognition scores as well.\n\nBut correlation is not the same as causation. You can't forget that it's entirely possible that sicker people might have needed more sleep and gotten it. In other words, it's possible that being sick leads people to sleep more, instead of more sleep leading to illness. But all this misses the point. People likely need very different amounts of sleep. A recent New Yorker article summarized much of the research on sleep and genetics and posited that about 80% of the variation in people's need for sleep is genetic. So maybe you're not getting enough sleep. If you're getting less than six to seven hours a night, that's probably not enough. But if you feel great and you're doing well, don't sweat it. Don't force yourself to get more just because of some published average.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/WIaI_VYibG8"},{"c_name":"healthcare triage","v_id":"62g-cpM2Dcs","title":"Cash Money Placebos and The Measles: HCT News","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nGet your awesome Healthcare Triage mugs and posters here: http:\/\/dft.ba\/-HCTmerch\n\nThe placebo effect extends to how expensive a treatment is. People tend to believe they get what they pay for when it comes to medicine, even placebos. And we talk about measles outbreaks. This is Healthcare Triage News.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=61099\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1423238016","likes":"1022","duration":"244","transcripttext":"Placebo effects and measles outbreaks. This is Healthcare Triage News.\n\n(Intro)\n\n\n\n News story #1 \n\n\n\nWe've done two episodes on the placebo effect, but there's a new study that just came out that we've gotta touch on. It's called \"Placebo effect of medication cost in Parkinson's disease.\"\n\nParkinson's disease is a chronic condition that leads to tremors or uncontrollable shaking. These can make it difficult to do lots of things, like walk or make purposeful movements. It can also lead to neurologic issues, like dementia and mood disorders.\n\nThere's no cure, but medications and surgery can sometimes provide some symptom relief. The side effects from those drugs can be pretty bad, though. That's where this study comes in.\n\nResearchers took a bunch of patients with Parkinson's disease, average age 62 years old, and gave them injectable saline, or a placebo. They told half of them they were getting a \"cheap\" new drug and the other half they told they were getting an \"expensive\" new drug.\n\nThen they measured them on a number of physical tasks. So this wasn't just \"How does it make you feel?\" They measured how much their physical movements improved. Four hours later, they reversed the groups, telling them they were getting the opposite drug.\n\nEveryone got better with both of the placebo injections--that's placebo effect number one. But those who got the \"expensive\" drug got more of an effect.\n\nIn fact, quoting the study, \"expensive placebo significantly improved motor function and decreased brain activation in a direction and magnitude comparable to, albeit less than, levodopa.\" And L-dopa's like, the real drug.\n\nNow, this is a small study. And not the kind of thing I'd promote to change our prescribing behavior or beliefs. But it's another data point. And a reminder of the power of the placebo effect. \n\n\n\n News story #2 \n\n\n\nUnless you're truly out of touch, you've probably heard that there's a measles outbreak in the United States right now. This is how an outbreak of a disease that isn't endemic to the United States occurs:\n\n1. Someone traveling or living abroad contracts the disease and comes to the United States.\n\n2. Other people who are susceptible to the disease come into contact with that person from number one, here at home.\n\n3. Those people contract the disease.\n\n4. Go back to step two.\n\nThat's it. It doesn't matter if the person from step one was an illegal immigrant, a doctor working overseas, or an Amish missionary. Since we can't control what other countries do and we live in a world where people travel, step one is going to occur at some point.\n\nWhat we can do is try to prevent other people here from getting the disease, and that's where vaccination comes in. If everyone is vaccinated against measles, for instance, then yes, a very small number of people might contract the disease when [step] two occurs, but the vast, vast majority of people who come into contact with the infected first person will be fine.\n\nThis system breaks down and outbreaks occur when more people are susceptible. Everyone, for instance, is susceptible to Ebola at a certain point in that illness. So we have to be careful to quarantine people who are infected when they're sick.\n\nBut Ebola is relatively hard to catch. It has an R0 of 2, meaning that an infected individual might infect, on average, two others. But measles has an R0 of 18. It's one of the most infectious pathogens around.\n\nQuarantining is difficult, if not impossible. The virus is unbelievably hardy and very easy to catch. So the absolutely positively best thing you can do is to be vaccinated.\n\nI should also point out that it also doesn't matter to the outbreak why people remain unvaccinated and susceptible. It can be because of religious reasons. It can be because of an irrational fear. It can be because they're hippies. I don't care; the outbreak is the same.\n\nStep one is gonna happen. But if everyone was vaccinated, then the infected person wouldn't make national news because it would be very hard for it to go much beyond themselves.\n\nThe important part of stopping an outbreak of measles isn't the traveling person--that's gonna happen every once in a while. The important part is that too many people remain unvaccinated and susceptible to measles for any number of reasons. That's what's causing the outbreak. That's what we need to focus on. Full stop.\n\nBut berating people who don't vaccinate their children won't help. Be respectful. Talk about the facts. There are plenty to be found here on Healthcare Triage.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/62g-cpM2Dcs"},{"c_name":"healthcare triage","v_id":"Ld9RlIVN57M","title":"Sleep Deprivation and its Weird Effects on the Mind and Body","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nThe Healthcare Triage mug is clinically proven to be the best vessel for holding hot drinks. Get yours here: http:\/\/dft.ba\/-HCTmerch\n\nLast week we talked about sleep. We talked about how much the average person needs, and how much they get. We also talked about how you can't just rely on \"averages\" to determine how much you need. Sleep in a personal thing, and we all need different amounts.\n \nBut sleep is incredibly important. You have to do it. Not getting enough, or sleep deprivation, is a real, and bizarre thing. It's also the topic of this week's Healthcare Triage.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=61150\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1423497807","likes":"1704","duration":"292","transcripttext":"Last week we talked about sleep. We talked about how much the average person needs, and how much they get. We also talked about how you can't just rely on averages to determine how much sleep you need. Sleep is a personal thing; we all need different amounts.\n\nSleep is incredibly important. You have to do it. Not getting enough sleep, or having sleep deprivation, is a real and bizarre thing. It's also the topic of this week's Healthcare Triage.\n\n[intro music]\n\nSleep deprivation can leave people more sensitive to pain. A study published in 2010 took people and randomized them to codeine or placebo. They also measured the quality of their sleep. They found that people who were in the sleepy group were more sensitive to pain. They also found that codeine didn't work as well in the sleepy group.\n\nAnother study published in 2012 confirmed these findings. Volunteers were randomized to normal sleep habits or extended sleep. Then they measured pain sensitivity. They also found that extended sleep was associated with reduced levels of pain sensitivity. There are lots of studies like this, so sleeping away your pain might be a thing.\n\nSleep deprivation can affect emotional empathy. A study published just last year randomized to one of three groups. The first group wasn't allowed to sleep at all. The second group was allowed to sleep normally. Both of these groups were examined early at night and then again the next morning. A third group was examined during the daytime to serve as another control. And tests were given to all participants to measure direct and indirect empathy.\n\nDirect empathy is how you feel about another, such as \"I'm angry or sad that happened to someone else.\" Indirect empathy is how it affects you, such as your heart racing or you feel nauseous. \n\nThey found that the sleep deprived group had significantly less direct and indirect emotional empathy. They measured everyone twice to confirm it.\n\nIt's hard to do long-term studies in this manner, though. You can't deprive people of sleep for months to see if they develop physical or mental problems. But there are many cohort studies that show that sleep deprivation is associated with diabetes and obesity. We don't know the causal direction, though.\n\nIt's also hard to do studies in kids. They have to go to school, after all. But there are comparative studies for them, too. Many of them show that kids who are sleep deprived are more likely to be depressed.\n\nLast year, a study with more than 100 adolescents in Korea with and without behaviorally induced insufficient sleep syndrome were studied. The academic performance of the kids with insufficient sleep was significantly worse. This also confirmed the results of many other studies that have had similar results.\n\nThe results also hold true for kids in middle school, high school, and even in college. Sleep deprivation is a bad, bad thing academically.\n\nAnd if you demand controlled trials, they do exist. In 2003, a study was published in the Journal of Sleep Research that took 50 college students and compared their performance on math effort tasks after a night of normal and sleep deprived sleep. It should come as no surprise that the sleep deprived kids were more likely to show less effort in selecting tasks.\n\nAnother study published in 2010 showed that female athletes who were sleep deprived were less likely to believe in themselves. Not getting enough sleep may strip kids of their ability to challenge themselves and become better.\n\nThere's a growing chorus that believes that we as a society are setting teens up to fail. We know they need this much sleep, but we make them get up at the crack of dawn. When I go to the gym at 6:45, all the high schoolers are already out waiting for the bus. So unless they go to bed at 9 P.M., it's almost impossible for them to get nine hours of sleep, let alone ten.\n\nBecause of this, groups like the American Academy of Pediatrics have asked for school start times to be pushed back to a more civilized hour. After all, there's no reason school has to start so early. More than 40% of high schools start before 8 A.M. The later they start, the more likely kids are to get more sleep.\n\nA study from the Center for Applied Research and Educational Improvement from the University of Minnesota found that when school started at 7:30, about a third of kids got at least eight hours of sleep a night. If school started close to 9 A.M., then two-thirds of adolescents got that much sleep.\n\nAcademic tests and athletic performance aren't the only things at stake here, though. Sleep deprivation causes lots and lots of car accidents. The American Academy of Sleep Medicine reports that more than 80,000 people fall asleep at the wheel each day in the United States.\n\nThey also report more than 250,000 sleep-related motor vehicle accidents each year. About 20% of serious injuries due to accidents are related to sleep. Alcohol use doesn't help, either.\n\nStudies show that astronauts who are sleep deprived are more likely to have errors in performance. They show the same in airline pilots and physicians. Because of this, pilots are forced to work only a certain number of hours at a time. And recent regulations have placed the same requirement on physicians-in-training.\n\nWhen people work too much and get too little sleep, accidents happen. Sometimes they cost lives. Sleep deprivation has real effects with serious consequences.\n\n[outro music]\n\n\n","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/Ld9RlIVN57M"},{"c_name":"healthcare triage","v_id":"DVQ52QoFJD8","title":"Marijuana Intoxication and Driving","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nHealthcare Triage Merchandise! http:\/\/dft.ba\/-HCTmerch\n\nHow much does weed affect your driving? Why is it on the news so much? This is Healthcare triage News.\n \nFor those of you who want to read more, here's the report  I reference:  http:\/\/www.nhtsa.gov\/staticfiles\/nti\/pdf\/812117-Drug_and_Alcohol_Crash_Risk.pdf\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1423860886","likes":"1534","duration":"228","transcripttext":"How much does weed affect your driving? Why is it on the news so much? This is Healthcare Triage news.\n\n[intro music]\n\nWe've done our own video on marijuana, and one of the things I stressed was that compared to alcohol, the stuff is hard to classify as dangerous.\n\nA new study from the National Highway Traffic Safety Administration drives that point home. Hard. They conducted a study where they collected data from drivers both in and not in car crashes over 20 months in Virginia. They matched them on a lot of factors. Then they looked to see how things differed between those who got in crashes and those who didn't.\n\nLots of accidents happen. People often test positive for various substances when they do. For instance, about 7.6% of drivers in crashes tested positive for marijuana. But so did 6.1% of people who didn't. \n\nThe key analysis looked at how different drugs changed the odds of you being in a crash. And the real analysis had to be adjusted. Why? Cuz there are other factors that are known to impact the odds of you being in a crash. \n\nMale drivers are more likely to be in a crash. So are young drivers. They're also more likely to smoke pot. See, you gotta account for that. And when you do, marijuana was not associated with an increased risk of having an accident. \n\nThe adjusted odds ratio was 1.05, but it wasn't statistically significant. In fact, none of the drugs tested reached statistical significance. But if you want to look at a chart, here's how they stack up. \n\nRemember, none of these reach statistical significance. But from the point estimate, you may see stories talking about how antidepressants or stimulants are protective, but sedatives and narcotics and marijuana are not, so they're bad. Bad's relative. And we haven't added in alcohol yet.\n\nWhat if we do the same analysis, but just adjust for alcohol? Cuz people who drive under the influence of certain drugs are also more likely to drive under the influence of alcohol at the same time. We need to tease that out. And then things sorta look different.\n\nThere's still no statistical difference. But as you can see here, even the point estimate for marijuana is now zero. No effect of marijuana independent of alcohol. But still, we're ignoring the elephant in the room: alcohol itself. How does it compare? \n\nBy the way, that's all people with a breathalyzer result of 0.05 or above, which many places don't even describe as drunk driving. That's usually, what, 0.08? 0.05 is just impaired in most places. And the effect of alcohol is so huge on this chart, you really can't even see the other drugs anymore. \n\nAnd the more alcohol you have in you, the more you're impaired. At a breathalyzer of 0.05, your odds are twice that of sober drivers of getting in a crash. At 0.10, your odds are about five and a half that of sober drivers. At 0.15, it's twelve times that of sober drivers. And once your blood alcohol hits 0.2 or more, your odds of having an accident are more than twenty-three times higher.\n\nThat's 2,300% on the chart I just showed you. Compared to negligible for most other drugs. But we have to acknowledge that our tests for pot are nowhere near as sophisticated as that for alcohol. We could be measuring use that's not acute, maybe in the past. We don't know. Lots of THC positive people might not have been impaired. Better tests are needed. \n\nAnd please hear me here: I'm not advocating that you use pot and drive. Far, far from it. Do not drive while impaired. Do not do it! That's not the take-home message from this video. Be safe.\n\nBut this study showed, regardless of all the news stories you hear about the dangers of pot in driving, after adjusting for demographic factors and alcohol use, the impact of most drug use--including pot--is very tiny with respect to accidents. The effect of alcohol, though? Massive. Don't drink and drive.\n\n[outro music]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/DVQ52QoFJD8"},{"c_name":"healthcare triage","v_id":"vjlRc1lEIvk","title":"How Long Are You Going to Live?","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nWe have merchandise! Mugs and Posters! http:\/\/dft.ba\/-HCTmerch\n\nA couple weeks ago, John had a great Vlogbrothers video on racism. It was fantastic, and I assume all of you already watched, but if you didn't, you should. One of the things he mentioned is that differences in life expectancy can be evidence of potential differences in how people of different races are treated.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=61291\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1424192783","likes":"1853","duration":"416","transcripttext":"Aaron: A couple of weeks ago, John did a Vlogbrothers video on racism. It was fantastic, and I assume all of you already watched, but if you didn't, you should. One of the things he mentioned is that differences in life expectancy can be evidence of potential differences in how people of different races are treated.\n\nLife expectancy is tricky though. It's something I'm really interested in and it's also the topic of this weeks healthcare triage.\n\n(Intro)\n\nWhat is life expectancy? Generally it's how long you can expect to live on average. Most people use it as short hand to describe what is more accurately life expectancy at birth. That's how long a baby born today can expect to live on average. \n\nIt's also the metric you hear people quote when they want to talk about how awesome everything is because life expectancy is so much better today than it was say 50 years ago. And it's true. \n\nLook at this chart showing life expectancy for all individuals at birth from 1950 to 2007. According to this, almost no-one can expect to live much past 65 in 1950. Moreover, there's been a steep climb for the past few decades. If you take this at face value, then we must be awesomely better at keeping people alive longer.\n\nThere are problems with this belief though. Let me walk you through an example to explain why. Let's take a theoretical cohort of 100 people. Let's stipulate that the life expectancy at birth of this group is 74. In this cohort there's a baby who dies soon after birth and there are 50 people who live past the age of 65. \n\nScenario A - I manage to find an excellent treatment for what kills that baby in the cohort. It's not perfect but it allows the baby to live to age 50.\n\nScenario B - I manage to find a treatment for a common illness that affects elderly people and can extend their life by an average of 1 year. \n\nIn both these scenarios I've managed to add 50 years to the cohort so the average life expectancy at birth has increased to about 74.5 years. But this hopefully shows you the enormous power of saving one baby or child, in that saving one infant for 50 years is the same as saving 50 adults for 1 year.\n\nThe take home message here is that treating children well does far more to increase life expectancy at birth than treating adults for illnesses that kill them. And we've had remarkable improvements in the treatment of children and chronic diseases in the last 60 years. Vaccines do wonders. People can live far longer with illnesses that used to kill kids at relatively young ages. Many childhood cancers can be cured and saving those children has resulted in relatively large increases in the overall life expectancy at birth. \n\nIn scenario A I'm not getting older people to live longer at all. In scenario B however, I have increased the life expectancy at 65 for a full year. And if we want to see how much better we've gotten in extending the life of people at the older end of the spectrum, we need a different metric. \n\nWe've got one. It's called life expectancy at age 65. That's how long a person who makes it to 65 can expect to live. Here's a chart. \nYou can see that even in 1950, if you made it to 65 years of age, you can expect to live on average until you were 79. I was shocked when I first learned that. That means that tonnes of people who made it to retirement were making it into their late 70s and even their 80s or more back in 1950. We've made some gains in the 60 years that followed. \n\nSo life expectancy at age 65 increased to almost 84 a couple years ago. So yeah, progress. But it's not nearly the size of the increase that many people think it is. And circling back to John's video, it's not equally shared among all people. Here's life expectancy at age 65 from 1970 through to 2007 by race. But even that doesn't tell us the whole picture.\n\nPart of the problem with data like these is that things like socio-economic status are so tied up in race and poverty is associated with pretty much every bad health outcome you can imagine. So what would be helpful might be a chart of life expectancy at age 65 by income and I found a paper published in Social Security Bulletin in 2007 that did the work for me.\n\nHere's a chart. What you're looking at is the life expectancy of a male who reached age 65 in 1977 to 2007. The blue line is the top 50% of earners. The green line is the bottom 50% and while the top half of earners saw an increase of their life expectancy at age 65 rise about 5 years over these three decades, the bottom half saw their life expectancy at age 65 rise barely a year. \n\nNot everyone is sharing in these gains. Here's another chart I made from that data comparing the life expectancy at age 65 for social security covered male workers in four different earning percentile brackets in the United States and other OECD countries. \n\nWhile the richest 25% of Americans compare favorably to almost any other country, those in the bottom 50% of earners don't. In fact, half the people in the United States can expect to live with shorter lives from age 65 on than the average person in almost all of these other countries. \n\nThink about that when arguing that the richest country in the world can afford social security and medicare starting at age 65 because everyone in this country is seeing their life expectancy increased. And also don't tell me that it's violence or homicide or drug use or accidents, we're talking about 65 year olds and older. \n\nAnd that brings us to even more depressing news. Lots of people aren't seeing their life expectancy increase, they're seeing it decrease. \n\nThis is a chart from a study published in Health Affairs 2 years ago. What you're seeing is life expectancy by years of education for a white woman at age 25 in three different years. Again, this gets you beyond the childhood period. \n\nIn general, the more educated you are, the longer you can expect to live. But I'm more interested in the trends over time. The blue column is life expectancy for these women in 1990, the green line in 2000 and the red line in 2008. \n\nIf you've been to graduate school, your life expectancy has been going up quite nicely. If you finished high school or been to college the gains are less pronounced but they're there. The horror story is if you didn't finish high school. Then in just the 18 year period, your life expectancy is dropped quite sharply.\n\nThe trends for white males with less than a high school education were similarly bad. Ironically, Hispanic and black people of both sexes show that even in this under educated group life expectancy increased over time. The decrease, it's mostly in white people. Don't kid yourself. This is just a proxy for socio-economic status or something else. It's very unlikely that somehow education makes you live longer in and of itself. It's just more data on how life expectancy is going down for some. More than some. \n\nHere's the last chart I want you to think about. The red areas are where life expectancy  fell from 1987 to 2007 for women. I'm willing to bet those also happened in some of the poorest areas in the country. \n\nLife expectancy at birth is much higher than it used to be. But that's because we're doing a better job of saving kids not because we're making older people live longer. Life expectancy at age 65 is also up but not nearly as much. Those gains aren't equally shared among people of different races and they're certainly not equally shared among the rich and the poor. In far too many areas of this country life expectancy is dropping. \n\n(Outro)","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/vjlRc1lEIvk"},{"c_name":"healthcare triage","v_id":"ztFS23LtMzE","title":"Patients Bossing Doctors Around? It's a Myth: HCTriage News","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nOne of the favorite complaints of doctors when we confront them with the over using technology and overtreating patients is that they demand it. Do they? More and more evidence says that's a myth. This is Healthcare Triage News.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=61385\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1424474472","likes":"1025","duration":"204","transcripttext":"One of the favorite complaints of doctors when you confront them with overusing technology and overtreating patients is that they say patients demand it. Do they? More and more evidence says that's a myth. This is Healthcare Triage news.\n\n[intro music]\n\nPaper was just published in JAMA Oncology called, \"Patient demands and requests for cancer tests and treatments.\" Let's discuss.\n\nResearchers looked at more than 5,000 oncology, or cancer, encounters involving more than 3,600 patients and 60 clinicians. Just under 9% of them involved a patient demand or request for a medical intervention.\n\nBut about 83% of these \"demands\" were clinically appropriate. Only 11% of them were actually clinically inappropriate. \n\nBut all of these percentages of percentages miss the fact that a clinically inappropriate intervention was asked for in only about 1% of encounters. \n\nMoreover, doctors complied with only 14% of the inappropriate demands. So in only 7 out of 5,050 encounters did a clinically inappropriate intervention get done because a patient demanded it.\n\nFurther, let's acknowledge that the vast majority of patient demands were clinically appropriate. Which begs the question as [sic] why they needed to demand them.\n\nLet's also acknowledge that a very, very small number of inappropriate demands exist, and only a tiny percentage of them get done.\n\nWhen I blogged about this, I got a lot of doctors and others on Twitter claiming that this study only showed that cancer patients weren't demanding treatment. They assumed that all of the other kinds of patients are still the reason we overtreat and over-test in medicine.\n\nBut as you may remember from the video we did on antibiotic overuse, there's a lot of research that shows that patients aren't the problem in primary care either. \n\nThere's the study published in 1999 in Pediatrics that looked at expectations and outcomes around visits to the doctor for kids with cold. Docs were more likely to write prescriptions if they thought parents wanted them, but they often guessed wrong as to what patients actually desired. Turns out that docs' prescribing behavior didn't correlate with what parents actually wanted.\n\nThere's the study published in 2003 in the Annals of Emergency Medicine, which found that docs were more likely to prescribe an antibiotic for diarrhea when they assumed that patients expected it. But they were only right about what patients expected about one-third of the time.\n\nThere's the 2007 study published in the Annals of Emergency Medicine, which found that docs were more likely to prescribe antibiotics for patients with bronchitis and such if they thought patients wanted them. But they only got the expectations right about a quarter of the time.\n\nThere's even the 2003 study published in the Journal of General Internal Medicine, which found that docs got patients' demands so wrong that they prescribed antibiotics to 29% of patients who didn't want them.\n\nWe can continue to blame patients. But the evidence I see shows that these concerns aren't real. I think that this passage from the accompanying editorial is spot on:\n\n\"The real point of the study by Gogenini et al., however, is this: we have to stop blaming patients for being demanding. In reality, it is hardly happening. The myth of the demanding patient is more about our own responses and how lackluster communication skills can contribute to difficult situations that stick in our throats and our memories. And when we have calmed down enough to look up, we see that what is really happening between patients and physicians these days is something quite different.\"\n\nOr, you know, we can keep on blaming them in spite of the evidence. Which is what a lot of people on my Twitter feed seem to favor.\n\n[outro music]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/ztFS23LtMzE"},{"c_name":"healthcare triage","v_id":"UeKQ7kBc33w","title":"Assessing Utilities: How Much Risk Are You Willing to Take?","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nWhen we are judging the cost-effectiveness of a treatment or intervention, we're really asking how much bang for the buck we're getting for our healthcare spending. That can be relatively easy when we're talking about life and death. But how do we measure improvements in quality? The most widely used method is through the use of utility values, and we'll show you how we calculate those in this week's Healthcare Triage.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=61426\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1424709276","likes":"1056","duration":"350","transcripttext":"AARON: If I had a pill that could extend your life by one day, but it cost a billion dollars it\u2019s unlikely that many people would argue that health insurance should pay for it. We all understand that while the benefit might be real and quantifiable it\u2019s not worth the expense. What if the pill cost a million dollars and what if it extended your life by ten years? Such discussions are about cost effectiveness and many people hate that topic but it\u2019s important. So important that I think we need to discuss it here for two weeks on health care triage. \r\n[Jaunty intro tune plays]\r\nAARON: At its heart, cost effectiveness get at how much bang-for-the buck we\u2019re going to get from a treatment or therapy. How much it costs over how effective it is. Sometimes (rarely) these calculations are simple, but here is a made-up, straight-forward discussion. Let\u2019s say you\u2019re 42, and you believe you have about forty  years to live. Then, you find out you have a strange gene that will kill you tomorrow. It sucks, cause you\u2019ll lose forty  years of life when you die. But then a pharmaceutical company develops a pill! If you take it today you\u2019re cured. You\u2019ll get an extra forty  years of life. If the pill costs a million dollars, then we could say that you\u2019re spending about a  million dollars over forty life years, or twenty-five hundred dollars per life year gained. Now a million dollars for a pills sounds like a lot but I gotta tell you, twenty-five thousand per life year gained, that\u2019s considered pretty cost effective. Very few therapies and medicines get to that level, but if we have a therapy and we know what it costs and we know how many years of life it gets you, then we can calculate cost effectiveness. What what about the many, many, many therapies that don\u2019t necessarily extend life, they improve it? How do we measure those things? Costs are the same but we need a better measure of effectiveness. Measuring quality tho, isn\u2019t necessarily easy. The best metric we have at the moment is what we call the utility value. It\u2019s a number, somewhere between zero and one, where zero represents death and one represents perfect health, that provides a measure of how much people value life in a health state. There are two main ways to acquire utility values and they are some what time intensive but I\u2019m going to model both of them for you today. The first is the standard gamble. In this demonstration Aaron with the green jacket is going to administer the test and and Aaron with the black jacket is going to take it. \r\nGREEN JACKET AARON: For this test, I want you to imagine that you have a moderate seizure disorder and about once a month you have a seizure and during the seizure, you become unconscious and have violent shaking of your arms and legs. Your back arches and eyes roll back. It lasts three to eight minutes each time. The seizures rarely disrupt work, but you can\u2019t drive because of them, and you can\u2019t participate in many activities.\r\nBLACK JACKET AARON: Mmmm Okay.\r\nGREEN JACKET AARON: This doesn\u2019t effect your life expectancy at all. You get a full life but you have a moderate seizure disorder with everything I just described in it.\r\nBLACK JACKET AARON: Got it.\r\nGREEN JACKET AARON: Now, imagine there\u2019s a new treatment available for moderate seizure disorder. The treatment is painless, and if it works, you\u2019re instantly and completely restored to perfect health. But the treatment is risky. Some people who have the treatment can instantly die.  I want you to imagine you have to choose whether to undergo this treatment if the treatment had a fifty percent chance of making you perfectly healthy and a fifty percent chance of killing you, would you take the treatment?\r\nBLACK JACKET AARON: Are you kidding me? A fifty percent chance of killing me? I still have a job, I\u2019m still married, I still have kids, I\u2019m still making Heath Care Triage\u2014No way. Too risky. \r\nGREEN JACKET AARON: Okay, what if it had a seventy-five percent chance of making you perfectly healthy and a twenty-five percent chance of killing you, would you take the treatment?\r\nBLACK JACKET AARON: No. Still too risky. I can\u2019t take a twenty-five percent chance of it killing me.\r\nGREEN JACKET AARON: What if it had an eighty-eight percent chance of making you perfectly healthy and a twelve percent chance of killing you. Would you take the treatment?\r\nBLACK JACKET AARON: Okay, now you\u2019re making me thing. I would like to drive. I\u2019d like to do other stuff like ski\u2026 still, No.\r\nGREEN JACKET AARON: What if it had a ninety-four percent chance of making you healthy and six percent chance of killing you? Would you take the treatment?\r\nBLACK JACKET AARON: Ninety-four percent chance of success? I might do that. Yes I think I would.\r\nGREEN JACKET AARON: What about a ninety-one percent chance of making you healthy and a nine percent chance of killing you? Would you take the treatment?\r\nBLACK JACKET AARON: Mmmmmm, Yes, but that\u2019s as low as I\u2019d go. Ninety-one percent chance of success. \r\nGREEN JACKET AARON: And that\u2019s how you do a standard gamble, and what ever number you end with is considered the utility value for the health state you are investigating. IN this case ninety-one percent or point nine one is the utility value for moderate seizure disorder. Now let\u2019s go to the Time Trade Off. Let\u2019s start over. You\u2019re forty two, so let\u2019s imagine that you have about forty years left to live. You still have a moderate seizure disorder and everything that comes with it. Okay?\r\nBLACK JACKET AARON: Yup.\r\nGREEN JACKET AARON: Now, imagine there\u2019s a treatment avail be for this condition, The treatment is painless, and if it works, you will be restored to perfect health. But the treatment shortens your life. If the treatment shortens your life by twenty years would you choose the treatment or would you choose forty years with the moderate seizure disorder?\r\nBLACK JACKET AARON: Loosing twenty years? No. I\u2019d live with the moderate seizure disorder.\r\nGREEN JACKET AARON: What if the treatment shortens your life by ten years? Would you take the treatment or the forty years with the moderate seizure disorder?\r\nBLACK JACKET AARON: Thirty years of perfect health or forty years of moderate seizure disorder? Still the later.\r\nGREEN JACKET AARON: What if the treatment shortens your life by five years? Would you take the treatment or forty years of the moderate seizure disorder.\r\nBLACK JACKET AARON: I\u2019d loose what? The years when I\u2019m seventy-seven to eighty-two? And I still get to live to seventy-seven? And no more seizures ever? Yeah, I\u2019d probably do it. \r\nGREEN JACKET AARON: What about\u2026\r\nBLACK JACKET AARON: No. No. That\u2019s it. Five years is all I\u2019m going to give up.\r\nGREEN JACKET AARON: And that\u2019s the time trade off. In this case we take the ratio of the two lifespans, thirty-five years of perfect health over forty years with disease, and we get a utility of point eight eight. Now you might be wondering with the values are for many other illnesses. There is much less research in this area that I\u2019d like, but my IU colleague Steve Downes and I have conducted, what I think, is the largest Utility assessment of pediatric health states ever. We did more than four thousand of these Standard Gambles and Time Trade offs and established a dictionary of them for other researchers and clinicians to use. They are available in the journal of Pediatrics linked down below. How do we use them? That\u2019s the topic of next weeks Health Care Triage.\r\n[Outro music plays]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/UeKQ7kBc33w"},{"c_name":"healthcare triage","v_id":"RSBaEz10sQk","title":"Cost Effectiveness in Medicine is not a Dirty Word","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nHealthcare Triage has merchandise! Beautiful mugs and posters designed by Mark Olsen! http:\/\/dft.ba\/-HCTmerch\n\nLast week, we discussed how to measure the utility value of different health states. These can be used as a proxy for quality in measuring how effective therapies are. How? That's the topic of this week's Healthcare triage.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=61511\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1425332797","likes":"1076","duration":"363","transcripttext":"Last week, we discussed how to measure the utility value of different health states. These utility values can be used as a proxy for quality in measuring how effective therapies are. How? That's the topic of this week's Healthcare Triage.\n\n[intro music]\n\nLast week, we established that the utility value for moderate seizure disorder is about 0.9. By the standard gamble, that means I'd take a 10% risk of death to have a cure right now. By the time trade-off, that means I'd trade about 10% of my remaining life away to be cured for the rest of my life.\n\nWe can use that utility value to calculate what's known as a QALY, or a Quality Adjusted Life Year. That's because it takes into account both how long you're gonna live as well as the quality of the life you'd have while alive.\n\nWhen you take a utility value and multiply it by a number of years, you get a number of QALYs. Let's say moderate seizure disorder has a utility of 0.9. Then, curing me of the illness would gain me 0.9 times about 40 years of remaining life left, or 36 Quality Adjusted Life Years.\n\nSo if I had 40 years of moderate seizure disorder left, I'd have 36 QALYs. If I was cured today, I'd have 40 years of perfect health, or 40 QALYs. I've gained 4 QALYs.\n\nAnd if the treatment costs, let's say $100,000, then the cost-effectiveness would be $100,000 divided by 4 QALYs, equals about $25,000 per QALY. That's pretty cost-effective.\n\nA sample of cost effective things from the Tufts Cost Effectiveness Analysis Registry can give us some comparisons.\n\nFor instance, diabetes education and self-management for people with type 2 diabetes has a cost effectiveness of $4,000 per QALY. Daily dialysis for a 60-year-old critically injured male with a kidney injury is $6,000 per QALY. HIV counseling, testing, and referral in high risk populations is $44,000 per QALY. And we do that. Screening 60-year-old heavy smokers with annual CT scans, which I mention in our NNT video cuz it works, and which is recommended by many professional groups, is $140,000 per QALY.\n\nSo even though $100,000 seems like an exorbitant amount of money for a treatment to cure moderate seizure disorder, getting that many years of perfect health is a huge gain. Unfortunately, such a cure doesn't exist.\n\nBut there are similar real-world examples. Sovaldi, a drug for patients infected with hepatitis C, is being sold right now for about $84,000 for a full treatment. That's a lot of money for a drug. But what do ya get for it?\n\nA study last year found that compared to no treatment with no cost, Sovaldi got people an extra 2.1 QALYs for about $54,000. That's about $26,000 per QALY gained. People are really upset that the drug company is charging so much for the drug, but in the scheme of things, it's sorta cost-effective. Makes one wonder if that's how they came up with the price.\n\nBut people, especially people in the United States, are really uncomfortable with this kind of reasoning. They don't like putting a number or a dollar value on life. Some think that discussing cost-effectiveness puts us on the slippery slope to rationing or even death panels.\n\nAfter all, if we decide that the billion-dollar-for-a-day-of-life pill isn't worth it, what's to stop us from deciding that spending a couple hundred thousand dollars to extend grandma's life for a year isn't worth it either?\n\nIn fact, we in the United States are so averse to the idea of cost-effectiveness that when the Patient Centered Outcomes Research Institute was founded, the body that is explicitly tasked with doing comparative effectiveness research, the law that made it so explicitly prohibited PCORI from funding any cost-effectiveness research at all. As it says on their website, and I'm quoting: \"We don't consider cost-effectiveness to be an outcome of direct importance to patients.\"\n\nAs a physician, a health services researcher, and as a patient, I have to disagree. I think understanding how much bang for the buck I, my patients, and the general public are getting from our healthcare spending is of great importance.\n\nOther countries routinely use cost-effectiveness data to make decisions about health coverage. In the UK, the National Institute for Health and Care Excellence has a \u00a320,000 to 30,000 per QALY threshold. They don't make decisions on whether to cover therapies based on this number alone, but it's certainly considered as a factor.\n\nWe've tried in a limited way to use such data in the United States. In the 1990s, Oregon's Medicaid program began using a strict threshold ranking of 688 procedures according to their cost-effectiveness. They only covered the first 568. Doing so freed up enough money to cover many more people who were previously uninsured.\n\nBut the plan hit a snag in 2008. When a woman with recurrent lung cancer was denied a drug that cost $4,000 a month, because the proven benefits weren't enough to warrant the cost, the national backlash to this was indicative of our collective difficulty in discussing the fact that some treatments might not be worth the money.\n\nThe Oregon health plan made things worse in this case, however, by offering to cover drugs for the woman's physician-assisted suicide if she wanted it. Even supporters of the plan found the optics of this decision difficult to accept. These actions seem far closer to justifying the claims of those who fear death panels than anything the Affordable Care Act might have created.\n\nBut refusing to consider cost-effectiveness at all has implications as well. When the United States Preventive Services Task Force makes a recommendation, they almost always explicitly state that they do not consider the costs of providing a service in their assessment. Because the Affordable Care Act mandates that all insurance must cover, without any cost-sharing, all A and B recommendations the USPSTF makes, that means that we are all paying for these therapies, even if they are incredibly inefficient.\n\nIn a recent manuscript at Health Affairs, some health economists made an explicit argument that the USPSTF should begin to consider cost-effectiveness data. If we're all gonna mandate that recommendations and interventions must be covered by health insurance, then it seems logical that we at least consider their economic value.\n\nThe cost-effectiveness of a therapy need not be the only thing we use to approve coverage, but ignoring it is akin to putting our heads in the sand.\n\n[outro music]\n\n","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/RSBaEz10sQk"},{"c_name":"healthcare triage","v_id":"W5ww02Fsj-U","title":"Peanut Allergies Are Getting a Little Nuts","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\n*We are in no way advocating for you to give peanuts to your babies. And always talk to your doctor before introducing new foods to kids - including peanuts.*\n\nPeanut allergies have doubled in prevalence in the last 10 years in Western countries, and they're becoming more common in Africa and Asia, too. People have been trying to keep anything peanut related away from kids in response.\n\nWas that the right thing to do? No. This is Healthcare Triage News.\n\nFor those of you who want to read more, links and sources can be found here: http:\/\/theincidentaleconomist.com\/wordpress\/by-shielding-infants-from-stuff-we-may-be-making-allergies-worse\/\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1425678021","likes":"1208","duration":"222","transcripttext":"Peanut allergies have doubled in prevalence in the last ten years in Western countries, and they're becoming more common in Africa and Asia, too. People have been trying to keep anything peanut related away from kids in response. Was that the right thing to do? ...No. This is Healthcare Triage News.\n\n[intro music]\n\nIn 2000, the American Academy of Pediatrics published a guideline which had recommendations to help decrease the risk of a child developing an allergic disease. They recommended, and I'm quoting:\n\n\"Mothers should eliminate peanuts and tree nuts (or almonds, walnuts, etc.) and consider eliminating eggs, cow's milk, fish, and perhaps other foods from their diets while nursing. Solid food should not be introduced into the diet of high-risk infants until 6 months of age, with dairy products delayed until 1 year, eggs until 2 years, and peanuts, nuts, and fish until 3 years of age.\"\n\nIn 2006, along with colleagues like my good friend Beth Tarini, we published a systematic review of the early introduction of solid foods in the later development of allergic disease. We found, somewhat to many people's surprise, that while there was some evidence linking early solid feeding to eczema, there was no strong evidence supporting a link between early solid food exposure and the development of asthma, allergic rhinitis, allergies to animals, or persistent food allergies.\n\nIn other words, there was no good evidence to keep infants away from foods in the believe that we could spare them food allergies later. Other studies showed a similar lack of evidence for the other parts of the recommendations. And in 2008, the American Academy of Pediatrics altered its recommendations to say that there wasn't good evidence to support food avoidance to prevent allergies.\n\nA very recent study in the New England Journal of Medicine goes a step further. It says that keeping peanut proteins away from infants may be making things worse. To the research!\n\nResearchers took 640 high-risk infants and randomized them to get peanut proteins or not for the first 5 years of life. They separated kids in both intervention groups by any preexisting sensitivity to peanuts. In other words, they kept track of kids in both groups who had an existing sensitivity to peanuts throughout the trial. And then they checked them at five years of age to see if they had a peanut allergy. \n\nI have friends who already have lost their minds about this. I mean, letting kids get exposed to peanuts? Especially kids with a sensitivity to peanuts already? Insane, right? Until you see results like this.\n\nLooking at all kids, about 3% of those exposed to peanuts developed a peanut allergy. Opposed to 17% of those who were not exposed to peanuts. If you only look at the kids without prior peanut sensitivity, about 2% exposed to peanuts developed a peanut allergy, as opposed to 14% of those not exposed. But in the cohort of kids with a known peanut sensitivity already, exposure to peanuts until 5 years led to a prevalence of allergies of 11%, versus 35% in kids not exposed.\n\nIn other words, exposing kids to peanut proteins, even those with a sensitivity, led to fewer allergies. Conversely, not exposing them led to more allergies.\n\nI mean, kids with a previous sensitivity to peanuts, who were exposed to them, had a lower prevalence of peanut allergies at 5 years of age than kids who didn't have a previous sensitivity to peanuts, but were never exposed to them.\n\nThe accompanying editorial pulls no punches. They thought that the results of the trial were so compelling, and that the problem of peanut allergies so common and getting worse so fast, that new guidelines should be put forth soon. \n\nWe're seeing an alarming increase in peanut allergies worldwide, and our response appears to be making things worse. Time to change our behavior here.\n\n[outro music]\n\n","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/W5ww02Fsj-U"},{"c_name":"healthcare triage","v_id":"RhTlE5OXXzM","title":"King V. Burwell, Obamacare, and the Supreme Court","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nHealthcare Triage has merchandise! Get your \"To the Research\" mugs and posters here: http:\/\/dft.ba\/-HCTmerch\n\nThere's another case concerning the Affordable Care Act that's hitting the Supreme Court, and it's a big deal. It has the potential to strip subsidies that help buy health insurance from millions of people across the country. The case is known as King v. Burwell, and it's the topic of this week's Healthcare Triage.\n \nFor those of you who want to read more, go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=61672\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1425931028","likes":"1016","duration":"418","transcripttext":"There's another case concerning the Affordable Care Act that's hitting the Supreme Court, and it's a big deal. It has the potential to strip subsidies that help millions of Americans buy health insurance. The case is known as King v. Burwell, and it's the topic of this week's Healthcare Triage.\n\n[intro music]\n\nAs you may remember from our previous episodes on Obamacare, about half the people who gain insurance with the program get it through insurance exchanges. These are marketplaces where people who don't get government insurance, and who don't get insurance from their jobs, can buy private insurance with guaranteed issue and community ratings.\n\nThe law offered states the option of setting up individual exchanges in states, or letting the federal government do it for them. Most liberal-leaning states set up their own exchanges, and most conservative-leaning states defaulted to the federal exchange.\n\nNo matter where the exchanges lie, however, about 85% of those going to them have qualified for subsidies to help them buy insurance. Everyone making between 138% and 400% of the federal poverty line get those subsidies, and it's a lot of people.\n\nThe case, and the problem, focuses on the fact that one part of the law --one tiny section-- says that subsidies go, and I quote, \"through an Exchange established by the State.\"\n\nThe plaintiffs are arguing that this means that only a state-run exchange, and not a federally run one, can give out subsidies. The defense, which is the Obama Administration, argues that this is not what anyone intended. It's just legalese-speak. They argue that the intent of those writing the law was that everyone would get the subsidies. They also argue that many other parts of the law show that Congress did mean for subsidies to go to everyone in all states, not just those with local exchanges.\n\nFull disclosure: I'm sympathetic to the arguments of the administration. I was around and writing prolifically about the creation and passage of the ACA. And I don't remember anything at all about people thinking that only state-based exchanges would get subsidies.\n\nAnd it's not like the people who wrote the law exist only in the long, long ago. They're almost all still around; we could ask them. And when people do, almost no one endorses the idea that they meant subsidies would go only to some states.\n\nBut there's a more critical component, as my blog colleague, law professor Nicholas Bagley, has pointed out-- and you should go read his post-- \"When there's a question of ambiguity in the law, the Supreme Court has ruled in the past that when Congress isn't clear, then the interpretation defaults to those implementing it. In this case, the IRS.\"\n\nBut the plaintiffs are arguing that the IRS shouldn't even be allowed to interpret it on their own. They want the court to tell the IRS that they have to interpret the law a certain way.\n\nI've read the arguments on both sides, and again, full disclosure, I find the arguments of those who don't support the plaintiffs to be much more convincing. But I'm not a lawyer, and it's not up to me. It's up to the Supreme Court. And I've heard enough to know that this could go either way.\n\nShould the court rule against the plaintiffs, then nothing really happens. The Affordable Care Act continues to function as it has for the last year or so. No changes.\n\nIf, however, the plaintiffs win, then there's a lot that can happen. The gist would be that, absent any changes, everyone who gets a subsidy from a state that hasn't set up their own exchange would lose it. Depending on the specifics of the ruling, it's even possible that they could be forced to pay back what they've received.\n\nEven people who didn't get subsidies in those states would be affected, though. Without subsidies, it's likely that sicker people will be the only ones paying for insurance. That will make the cost of insurance go up for everyone. In other words, this would be a serious blow to the entire private insurance market in many states.\n\nOn top of the 6 million people who could lose subsidies, it's estimated that more than a million additional people might find insurance premiums suddenly out of reach, even though they were paying for insurance without subsidies before. That's more uninsured people.\n\nAnd as more healthy people drop out, the price of insurance goes up. Then more healthy people drop out. Prices go up again. And so on and so forth, until almost no one, except the very sick, are paying the exorbitant prices of insurance. It's called a death spiral.\n\nBut don't take my word for it. Let's look at data. In New York State, before the Affordable Care Act was passed, they had guaranteed issue and community ratings, but no subsidies or mandates. Basically, they had what will happen in many states if the Supreme Court rules for the plaintiffs.\n\nIn 2014, after the ACA went into full effect, they average monthly premium for individual insurance in New York was just over $500. In 2013 though, the year before, the average premium was almost $1,400. That's what could happen in states without subsidies.\n\nSo what could happen next? Well, first, any state with a federal exchange which switch [sic] to a state-run exchange, would immediately get subsidies back for its citizens. And I've got to imagine that many states, especially those that have accepted the Medicaid expansion, would make some sort of fix.\n\nThere are also likely ways that the federal government could work on regulations to allow states to fix things quite quickly. Quoting Nick, \"A state could, for example, establish an exchange and appoint a state-incorporated entity to oversee and manage it. That state-incorporated entity could then contract with HealthCare.gov to operate the exchange.\"\n\nOr, you know, Congress could just work together and fix the problem... don't think that's gonna happen.\n\nAnyway. This is a big deal. But no matter how it turns out, it's likely not the death knell for Obamacare that some think it to be. What we'll have is two different healthcare systems. In some states, people will get massive subsidies from the federal government to help them buy relatively cheap insurance. In other states, people will get nothing, and insurance will be much more expensive.\n\nBut don't panic. All of this has happened before, and will happen again. Medicare was, at one time, called the death of freedom. No one talks that way anymore. Medicaid was first passed in 1965. Not all states went along with it. Arizona was the last state to accept Medicaid, and it did so in 1982. \n\nBetween 1965 and 1982, we also had a country with two healthcare systems. One had a program which existed to cover all poor children, all poor pregnant women, the poor elderly, and many poor parents. But only in some states. The other system had nothing. The earth continued to spin on its axis; the country survived. It was ridiculously unfair for some people who lived in states that refused to accept Medicaid, but eventually, all of them did.\n\nThe same could be said of the United States if the Supreme Court finds for the plaintiffs. But as with Medicaid, I think it's likely the Affordable Care Act will survive. I also believe someday, that the Supreme Court will view the removal of the ACA as coercive, as it viewed the removal of traditional Medicaid just a few years ago.\n\nIt's hard to see how creating a two-tiered system is a winning proposition for those states that are getting left out. And I'm not sure how long elected officials will be able to pretend that there's nothing they can do about it.\n\n[outro music]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/RhTlE5OXXzM"},{"c_name":"healthcare triage","v_id":"TwpgHvO4A0E","title":"Mar. 11th, 2015 - LIVE - Does microwaving food make it less \"safe?\" Are doctors overpaid?","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nWe're experimenting with hangouts on air! Leave your comments and questions below and we'll try and get to them in the next episode. Tune in next *UPDATED* 03\/20\/2015 @9:30a EST (link:https:\/\/www.youtube.com\/watch?v=qXNbQBMNSsw).\n\n00:00 - We were tweeting the link\u2026you probably want to skip to 1:13\n1:13 - Intro\n2:04 -Thoughts on provider status for pharmacists\n3:01 - Is there any research about what the recommended fluid intake should be?\n5:13 - Does microwaving food make it less \"safe.\" Are there any studies showing it is safe?\n6:43 - Thoughts on Apple HealthKit \n9:05 -Thoughts on Soylent and other similar full time meal replacement products.\n11:08 - Are doctors overpaid?\n12:46 - Burger King is dropping soda from kids meals in favor of milk. Is this a good thing?\n14:40 - Chiropractic care - is there evidence for benefit? \n16:46- Is there hope for rural health?\n18:35 - IS there a benefit for probiotics when taking antibiotics  for prevention or treament of C-diff infection?\n20:38 - Why are mental services so hard to get?\n22:00 - Why have we not found a reliable way to turn off the pain yet?\n23:04 - Closing :)","uploaded-unix":"1426102319","likes":"665","duration":"1450","transcripttext":"","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/TwpgHvO4A0E"},{"c_name":"healthcare triage","v_id":"wbcrE8bwWh8","title":"Penis Size and Suicide: Two Unrelated Stories on Healthcare Triage News","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nPenis size and Suicide. Not two topics that normally go together. This is Healthcare Triage News. How big is the average penis?\n\nmental_floss episode on sex myths: https:\/\/www.youtube.com\/watch?v=nSNoiAnUnH0\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=61731\n\nWe have HCT merchandise! Get your mugs and posters here: http:\/\/dft.ba\/-HCTmerch\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1426350299","likes":"1069","duration":"192","transcripttext":"\n\nIntroduction\n\n\n\nPenis size and suicide. This is Healthcare Triage News.\n\n[intro music]\n\n\n\nNews story #1\n\n\n\nThe first study's PG-13, or maybe R--I don't, I don't know. Anyway, I hope you've seen the Mental Floss episode we did on sex myths. It's a huge hit, by the way. One of the myths we talked about was penis size.\n\nWhen we wrote our first book on medical myths, our agent told us we had to sex it up. That's how the first chapter came to be, \"Men with big feet have bigger penises.\" It's made for a problem when my then five-year-old son opened his copy and nearly had his eyes bug out of his head. This was how a chapter in our second book of medical myths was entitled, \"You can make your penis bigger without surgery.\" It's how the first chapter in our third book of medical myths came to be, \"Penis sizes matters.\" In fact, the first three chapters of the last book were about penises. \n\nPeople are obsessed with penises, especially their size. Penises sell books. They evidently also get manuscripts published. There was one recently entitled, \"Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15,521 men.\"\n\nThis has got to be the definitive systematic review. Here's the key take-home result in a nomogram. Let me break it down for you.\n\nIf your erect penis is 4.7 inches, you're at the 25th percentile. If your erect penis is 5.1 inches, you're at the median. Half of men have bigger penises, and half of men have smaller. If your penis is 5.6 inches, then congratulations, you're in the 75th percentile. If you have a 6 inch erect penis, which is what many people think is average, then you're in the 90th percentile.\n\nWhat's striking here though, is that most men are pretty much the same. The idea that 7-inch penises are common appears to be--wait for it--a myth. \n\n95% of men have penises smaller than 6.3 inches. More than half of men have a penis that's between 4.5 and 5.5 inches. And only 15% are smaller than 4.5 inches.\n\nEveryone should stop worrying about this. I'd love to stop writing about it.\n\n\n\nNews story #2\n\n\n\nOur second story is more serious, unfortunately. Not too long ago, I wrote a piece at The Upshot on the New York Times on how Denmark has been focusing on things that really kill kids, like suicide, which has had an impressive impact on their outcomes.\n\nRecently, the CDC released a report that shows that things haven't been going as well for similarly aged adolescents and young adults in the United States. Let me quote from it:\n\n\"Results of this analysis indicated that during 1994 to 2012, suicide rates by suffocation increased on average by 6.7% and 2.2% annually for females and males, respectively. Increases in suffocation suicide rates occurred across demographic and geographic subgroups during this period.\"\n\nTheir charts are even more compelling. This is suicides per 100,000 population for females aged 10 to 24 years in the United States. Not that you'd have trouble seeing it, but I've highlighted the increase in overall suicide rate in the last 6 years or so. It's not subtle, and it's concerning. We shouldn't ignore it.\n\nSuicide is the second leading cause of death in this age group, and accounted for more than 5,000 deaths in 2012 alone. We've gotta do better.\n\n[outro music]\n\n\n\n","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/wbcrE8bwWh8"},{"c_name":"healthcare triage","v_id":"qtqHFLcCVSs","title":"Cholesterol Isn't Quite as Bad as You've Been Told","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nCholesterol! For decades it's been demonized as the reason so many people have heart disease. We 've been watching it, and avoiding it like the plague.\n\nWhy? Does that do any good? The answer may surprise \u2013 and depress you. This is Healthcare Triage.\n\n\nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=61787\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1426600801","likes":"1539","duration":"309","transcripttext":"Aaron Carroll:\n   Cholesterol! For decades it's been demonized as the reason why so many people have heart disease. We've been watching it and avoiding it like the plague. Why? Does that do any good? The answer may surprise and depress you. This is Healthcare Triage. \n\n  ***Healthcare Triage Intro***\n\n   OK, let's start with heart disease, which is still pretty much the biggest killer in the industrial world. Most of the problems come from atherosclerosis, where the blood vessel walls thicken and fatty plaques form. Later, clots can develop, or fragments of plaques can break off and clog up other vessels. If those blockages occur in vessels that feed the heart, you have a heart attack. If those vessels feed the bran, you have a stroke. Neither is good.\n    And look, you need cholesterol; it's not poison. Your liver makes about 1000 milligrams of it a day, 'cause you need it to make certain vitamins and hormones, it's necessary to make cell walls, and it helps digest and move fat around your body. It gets around in two forms. Low density lipoprotein, or LDL cholesterol, is the bad kind. It's the one that's been implicated in causing atherosclerosis. But there's also high density lipoprotein, and that's the good cholesterol. \n    Now, there are many things that have been linked to heart disease, and serum cholesterol is just one of them. Plus, the right metric about cholesterol to focus on is debatable. Is it the total amount, the LDL level only, the ratio of LDL to HDL, something else? All hotly contested. But what wasn't contested, at least, not terribly publicly, was that we should avoid cholesterol in our food, and that is where the dietary recommendations come in.\n    For a long, long time, we've been told that we should limit our intake of cholesterol to no more than 300 milligrams a day. That's not a lot; just one egg  has about 220 milligrams of cholesterol in it, so, you know, a two-egg omelette would be a bad idea. Forget a three-egg omelette. And that's if you ate nothing else with cholesterol in it all day. \n     Cholesterol warnings have been in effect since the 1960s. Since 1994, laws required food in the United States to report cholesterol values on nutrition labels so people could make more informed choices. And we cut out eggs. We cut out meat. We cut out shrimp. Some of us even cut out milk, which was a good idea for other reasons. And that sucked. Today, the average male in the United States consumes about 340 milligrams of cholesterol a day, and experts complain that's not good enough. Plus, I ate egg white omelettes. Have you tried them? Tasteless! Was it necessary? To the research!\n      Turns out that there have been good studies on whether dietary cholesterol affects the level of cholesterol in your blood. For instance, a 2004 study took people in randomized them to one of two groups. One was given the equivalent of more than three eggs a day for 30 days, and the other got a placebo. Then they switched the groups. They measured their serum cholesterol after each intervention period. What they found and what's been found in many other studies is that about 70 percent of people are what we call hypo-responders to dietary cholesterol. This means that after consuming three eggs a day for 30 days, they'd see no real increase in their plasma-cholesterol ratios. Their cholesterol levels have almost no relationship to what they eat.\n      There have been many randomized controlled trials in this area. In 2013 researchers published a systematic review of all recent studies just from 2003 or after. 12 of them met criteria and 7 controlled for background diet. Most of the studies that controlled for background diet found that altering cholesterol consumption had no effect on the concentration of blood LDL cholesterol. A few studies could only detect differences in small subgroups of people with certain genes or a predisposition to problems. In other words, in most studies ALL people didn't respond to changes in their intake of cholesterol. In just a few, a minority of patients responded to changes in their dietary cholesterol.\n     Have recommendations changed with the publication of any of these studies? No? I still get lectures from people telling me that this or that has too much cholesterol in it. But all that may be about to change. In December, a dietary guideline subcommittee met to discuss possible changes to the next set of dietary guidelines for the United States to be released this year. After their meeting, they published a report. You can go look at it. It said, and I quote, \"Cholesterol is not considered a nutrient of concern for overconsumption.\" I'm sure that will come as a surprise for the vast majority of Americans and people worldwide, who, for decades, have been watching their cholesterol intake religiously. It's very possible that the US government might finally change their dietary guidelines this year to reflect this fact, though we don't yet know for sure.\n    Now that doesn't mean that bad levels of cholesterol in your blood aren't dangerous. It also doesn't mean that all the people on drugs to help reduce their level of cholesterol don't need them. It's now thought that it's the consumption of saturated and trans fats perhaps which make more of a difference, and that's what we should focus on. \n    But we haven't been totally fact-based in our fat recommendations either, and that's the subject of next week's Healthcare Triage. \n\n***Healthcare Triage Outro***","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/qtqHFLcCVSs"},{"c_name":"healthcare triage","v_id":"qXNbQBMNSsw","title":"Mar. 20th, 2015 - LIVE - Is limited alcohol consumption beneficial?","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nShow Notes:\n00:00- intro\n00:42- what is your stance on pharmaceutical spending? how much of an issue or conflict of interest is it that doctors can receive kick backs from pharmaceutical companies? (conflict of interest video: https:\/\/www.youtube.com\/watch?v=UJtLUaeEkbk )\n3:28 - What does the research into ECT or Electro Convulsive Therapy for the purposes of treating mental illness say? and what are your thoughts on it?\n5:22 - When nutritionists suggests limiting sugar intake, do they mean all carbohydrates or just simple sugars? Is there any significant difference in how the body processes them?\n6:30 - Mug and poster product placement. You can buy here:  http:\/\/dft.ba\/-HCTmerch :))\n6:39 - I've heard that limited alcohol consumption can be beneficial to one's health. Is there any evidence to support this?\n8:19 - Is there any hope of moving medical research in the US to a more publicly funded system? The 100k price tag on some medicines is a bit crazy. (cost effectiveness video: https:\/\/www.youtube.com\/watch?v=RSBaEz10sQk)\n11:40 - Thoughts on the new findings on artificial sugar and waistlines.\n14:31 - I am hearing from some sides that women should never take statins and others that increase the number of people who take statins. Do you have data?\n(NNH episode: https:\/\/www.youtube.com\/watch?v=e_ytF2-4NkI)\n17:19 -  Could you talk about the benefits\/risks of vegetarian and vegan diets compared to diets including meat? Which is better, avoiding meat totally, or balancing? (Diets episode: https:\/\/www.youtube.com\/watch?v=hdY-NJq6zVQ) (Milk episode: https:\/\/www.youtube.com\/watch?v=hzyFZcuHmeI)\n19:31 - Please discuss the National Residency Matching Process.  This week will be a very emotional one for medical students and graduates across the country, and the 20th is the day we find out where we go.\n24:13 - Are there any negative long term effects of taking the pill? I'm worried it could permanently throw off my hormones.","uploaded-unix":"1426860491","likes":"427","duration":"1565","transcripttext":"","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/qXNbQBMNSsw"},{"c_name":"healthcare triage","v_id":"96DrFMSGPzI","title":"Minors, E-cigarette Regulation, and Dating Violence: Healthcare Triage News","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nWe have beautiful Healthcare Triage posters and mugs that you can own! http:\/\/dft.ba\/-HCTmerch\n\nIt's way too easy for teens to buy e-cigarettes on the Internet, and too many of them are victims of teen violence. Two new studies on Healthcare Triage news.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=61843\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1426960456","likes":"806","duration":"231","transcripttext":"It's too easy for teens to get their hands on e-cigarettes and too many of them are committing dating violence. We'll talk about two new studies here on Healthcare Triage News. \n\n(Intro)\n\nWe've already done a review of the literature on e-cigarettes. You should have watched that. Watch it now if you haven't. One of the biggest ongoing issues surrounding them is the relative lack of regulation. North Carolina passed a law in 2013 that mandated that internet e-cigarette vendors confirm a customer's age through a government records database when an order is placed. How's that working out?A new study in the Journal of Pediatrics wanted to check. It's called \"Electronic Sales of Cigarettes to Minors Via the Internet.\" To the research! The authors got got 14 to 17 year olds together and watched them place orders on 98 of the 103 most popular online internet e-cigarette vendors. The minors were able to successfully get delivers of e-cigarettes from more than 75% of them. No attempts were made to check their ages, pretty much all of the deliveries were left at the door, so no age verification was made on delivery either. But it gets worse, 18 orders failed but for reasons unrelated to age verification, like the website broke or processing failed because of some site issue. \n\nOf the remaining 80 orders that could go through, only five were rejected because of some sort of age verification. This means that at functioning websites, minors were easily able to purchase e-cigarettes online about 94% of the time. This is the kind of stuff that is giving e-cigarettes a bad name.\n\nIt\u2019s the kind of stuff that even proponents of e-cigarettes could work to fix if they seriously believe in their harm reduction potential and not just their being a new easier way for many, including kids, to get their hands on nicotine products. \n\nOur second story, also from The Journal for Pediatrics is entitled \u201cTeen Dating Violence: Physical and Sexual, Among US High School Students.\u201d Findings from the 2013 National Youth Risk behavior survey.\n\nSo the Youth Risk Behavior Survey is the CDC project that many researchers use to talk about what\u2019s going on with kids and risks. My first question when I read this study was of course, how do they define teen dating violence? Because up until 2011, it was a single question and it read, and I\u2019m quoting here, \u201cin the last 12 months, did your boyfriend or girlfriend ever hit, slap, or physically hurt you on purpose?\u201d \n\nSee here\u2019s a story on that: when we tried to adapt this question into our clinical decision support system years ago, it lead to a heated argument in my research group. For instance, rough but totally consensual sex could get a yes to that question. It also only refers to a boyfriend or girlfriend and could leave out more casual acquaintances but now things are much more informative.\n\nFirst they ask, quoting again, \u201cduring the past 12 months, how many times did someone you were dating, or going out with physically hurt you on purpose? Count such things as being hit, slammed into something, or injured with an object or weapon.\u201d \n\nThen they asked, quoting again, \u201cDuring the past 12 months, how many times did someone you were dating or going out with force you to do sexual things that you did not want to do? Count such things as kissing, touching, or being physically forced to have sexual intercourse.\u201d \r\nThese questions are much more specific. The addition of \u201cthat you did not want to do\u201d to the sexual questions, removes a lot of the ambiguity. So is the removal of boyfriend or girlfriend. \nAnd the results that they found using these questions  are somewhat depressing. In 2013, about 21% of girls and 10% of boys reported some form of teen dating violence.\nFemales, had a higher prevalence of pretty much all combinations of physical and sexual teen dating violence. Students who experienced teen dating violence were more likely to have all other health risk behaviors as well. These data are much more reliable compared to those we have from the past. They also paint a picture of an issue in society that needs remedy. We know it exists, time for research to focus on reducing it.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/96DrFMSGPzI"},{"c_name":"healthcare triage","v_id":"oIPl5xPYJJU","title":"The Evidence for Low-Fat Diets Isn't Really There","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nLast week I talked to you about dietary cholesterol, and how the existing randomized controlled trials warned us that they wouldn't work. Now, it appears those guidelines might be changed, decades later. Cholesterol isn't the only recommendation that is controversial. So are the ones on fat. Prepare to get annoyed.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=61881\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1427147241","likes":"1627","duration":"367","transcripttext":"Aaron Carroll:\n    Last week I talked to you about dietary cholesterol and how the existing randomized control trials warned us that restricting our intake wouldn't work. Now it appears those guidelines might be changed -- decades later. Cholesterol isn't the only recommendation that's controversial though; so are the ones on fat. Prepared to get annoyed. This is Healthcare Triage.\n\n    (Healthcare Triage Intro)\n\n    For decades, consuming a low percentage of your daily calories from fat has been the mainstay of many, many dietary recommendations. That's because it's been widely thought that doing so would reduce your chances of having coronary heart disease. The US Select Committee on Nutrition and Human Needs announced in 1977 and the UK National Advisory Committee on Nutritional Education announced in 1983 dietary recommendations to reduce fat intake. Specifically they told everyone to reduce overall fat consumption to 30% of total energy intake and to reduce saturated fat consumption to 10%.\n    Most of the evidence for that recommendation came from epidemiologic studies, which can be flawed. Remember, they can be great at correlation, not always so much on causation.\n    And this settling for epidemiologic data happens far more often than we would like. Sometimes these kinds of studies are all we can get because you can't do a randomized control trial to prove causality. We'll never have a randomized control trial for smoking and cancer, for instance, because the evidence from cohort and case control studies is so compelling that telling a random population to smoke to see if it's harmful would be unethical. But there is no reason we couldn't randomize people to diets.\n    Turns out we have. In fact, randomized control trials existed when the low-fat diet guidelines were published, and it appears they were ignored. Just a few weeks ago a study was published in the journal Open Heart where researchers performed a systematic review and meta-analysis of the existing randomized control trials available when the guideline was announced. They wanted to explore what might have been considered by those creating the guideline back when they did so.\n    Before 1983, six randomized control trials involving more than 2400 men had been conducted. None were explicate studies of the recommended diet, but all explored the relationship between dietary fat, cholesterol, and mortality. Five of them were secondary prevention trials, meaning that they only involved men with known problems already. Only one included healthy participants, who would be at lower risk and therefore would likely have even less benefit from dietary changes.\n    That's a lot of participants. Moreover, many of them were at high risk, and in all of them there was no significant difference in the rate of death from coronary heart disease between them. There were also no differences in all caused mortality, which is the metric that matters. \n    And if you can't find a difference in people at really high risk then the chance of finding a difference doing this in the general population is even lower. Now, some of the studies did show that cholesterol levels went down more in the groups that ate low-fat diets. But these groups didn't have different clinical outcomes, and that's what we really care about. \n    Still, many will point to the fact that many of these recommendations might have been responsible for a lowering of cholesterol and justify a low-fat diet that way, but the difference between them was small. Mean cholesterol went down 13% in the intervention groups, but it went down 7% in the control groups. Overall, the difference was only 6%.\n    And it's important to remember that even if the cholesterol went down, the clinical outcomes didn't change. No difference in death from coronary heart disease, no difference in all causes of mortality, and that's why we're doing the recommendations.\n    I'm pretty immersed in the medical literature and all of this is still shocking to me. It's hard to overestimate the impact of the dietary guidelines. Hundreds of millions of people changed their diets based on these recommendations. They consumed less fat, they avoided cholesterol, and they reduced their intake of salt, and you've already seen our video on how that one's gotten off the rails. And since pretty much a lot of calories come from fat, protein, or carbohydrates reducing your consumption of one means that you have to increase your consumption of another. As meat, especially red meat, had also been shunned by guidelines, this meant that many people began to increase their consumption of carbohydrates.\n    Decades later, it's not hard to find evidence this might have been a bad move. Many now believe that excessive carbohydrate consumption many contributing to the obesity and diabetes epidemics. A Cochrane Review of all randomized controlled trials of reduced- or modified-dietary-fat interventions found that replacing fat with carbohydrates is not protective even against cardiovascular events, let alone death.\n    Now there still exists some evidence that the type of fats people are consuming might have some link to health. Reducing your consumption of saturated fat could reduce the number of cardiovascular events a person might have. It still doesn't conclusively reduce mortality or deaths but at least it appears to do something.\n    But the authors of the Cochrane Review explicitly said, and I quote, \"Dietary change to reduce saturated fat and partially replace it with unsaturated fats appears to reduce the incidence of cardiovascular events, but replacing the saturated fat with carbohydrate (creating a low-fat diet) was not clearly protective of cardiovascular events (despite small improvements in weight, body mass index, and total and LDL cholesterol). The protective effect was seen almost exclusively in those who continue to modify their diet over at least two years, and in studies of men (not those of women).\"\n    Is that what recommendations say? I don't think so. It's frustrating enough when we over-read the results of epidemiologic studies and make the mistake of believe that correlation is the same as causation. It's maddening, however, when we ignore the results of randomized control trials which are capable of proving causation, to continue down the wrong path.\n    In reviewing the literature, it's hard to come away with the sense that anyone knows for sure what diet should be recommended to all Americans. I understand people's frustration with the continuing shifting sands in nutrition recommendations. For decades they've been told what to eat because science says so. Unfortunately, that doesn't appear to be true. That's tragic not only because reduces people's faith in science as a whole but also because it may have cost some people better or potentially even their lives.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/oIPl5xPYJJU"},{"c_name":"healthcare triage","v_id":"WdU3dbdsh6U","title":"It's Hard to Change Physician Behavior: Healthcare Triage News","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nLike some kind of perpetual motion machine, it's hard to get physicians to change their behavior to do stuff. It's even harder to get them to change their behavior to stop doing stuff. This is Healthcare Triage News.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=61955\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1427473244","likes":"779","duration":"253","transcripttext":"It's hard to get physicians to change their behavior to do stuff. It's even harder to get them to change their behavior to stop doing stuff. This is Healthcare Triage News.\n\n[intro music]\n\nThis week I wanna focus on a study from JAMA Internal Medicine entitled, \"Effect of published scientific evidence on glycemic control in adult intensive care units.\"\n\nSo here's the deal. Some years ago, a study came out which said that there was a benefit to keeping people in the intensive care unit under tight glycemic control. In other words, to control the level of sugar in their blood pretty tightly. This meant that we had to monitor people's glucose levels closely and keep them between 80 and 110 milligrams per deciliter.\n\nThe rationale for this is based on lab data and observational studies that show that having tight control was associated with less hyperglycemia, fewer infections, and a greater chance of survival.\n\nWhen a large randomized control trial was finally done, it showed that providing tight glycemic control to mostly surgical patients in the ICU led to 1 life saved for every 29 patients treated. And that's pretty awesome. So this became recommended practice.\n\nOf course, this being medicine, soon we were providing tight glycemic control not only to critically ill surgical patients, but also nonsurgical patients. Cuz that's what we do.\n\nLater, another study was done, called the Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation, or NICE-SUGAR, study. This was the biggest multinational RCT to examine tight glycemic control in a varied cohort of medical and surgical ICU patients.\n\nIt showed that tight glycemic control increased, not decreased, the risk of severe hypoglycemia, and increased 90-day mortality. Needless to say, these new data made everyone pause. They also led to some big changes in international guidelines modifying the recommendations for the management of blood glucose in critically ill patients.\n\nThe original study showing a benefit was published in 2001. The bigger study showing harm was published in 2009. This research, getting back to the paper we're talking about today, looked at how practice changed before and after the publication of the first study and the second study, from January 1st, 2001 through December 31st, 2012.\n\nSo before the publication of the first trial, about 17% of admissions to the ICU had tight glycemic control, 3% had hypoglycemia, and 40% had hyperglycemia. After publication of the first trial, for each quarter of the year, there were 1.7% more patients with tight glycemic control, 2.5% more with hypoglycemia, and 0.6% fewer with hyperglycemia.\n\nThis is consistent with what we'd expect a slow but steady adoption of tight glycemic control to do. However, after the publication of the second trial, there was no change in the percent of patients with tight glycemic control or hyperglycemia. \n\nHere's a chart showing how tight glycemic control changed over time. There are a few things worth noting here. First, that it is hard to change physician behavior. Even with the first trial, it took years for people to adopt the use of tight glycemic control. But what's even more important to see, is that as hard as it is to get physicians to do something, it may be even harder to get them to stop doing something.\n\nTight glycemic control is more involved. It requires more activity, more intervention. It feels like you're caring for patients. Regular monitoring, on the other hand, especially after years of doing tight glycemic control, feels like ignoring patients and leaving them in danger. It's harder to do.\n\nBut we can't ignore this. It's why organizations like Choosing Wisely exist. Basically, they get together and point out things that doctors should stop doing in each specialty. We'll talk about it in a future episode.\n\nWe spend too much time talking about the things we should do, and too little focused on the things we should stop doing. Unfortunately, doing more often does harm. It also usually costs more money. \n\nThere's very little incentive for industry to encourage this type of research to try to get us to stop doing things. It's a public good. And we've gotta invest public money into it.\n\n[outro music]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/WdU3dbdsh6U"},{"c_name":"healthcare triage","v_id":"-GQKNIhU3JM","title":"Obamacare Helped the Uninsured, but the Underinsured, Not So Much","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nYou can own Healthcare Triage merchandise! http:\/\/dft.ba\/-HCTmerch\n\nThe Affordable Care Act in the US, like most health care reform efforts, focuses on uninsurance. That's fine, as people without insurance do face significant problems accessing the healthcare system in the United States. But underinsurance is a real issue, too, and it's often ignored. Underinsurance is the topic of the week's Healthcare Triage.","uploaded-unix":"1427823423","likes":"898","duration":"387","transcripttext":"The Affordable Care Act, like most healthcare reform efforts, focuses on uninsurance. That's fine, as people without insurance do face significant problems accessing the healthcare system in the United States. But underinsurance is a real issue too, and it's often ignored.  Underinsurance is the topic of this week's Healthcare Triage. \n\n[intro music]\n\nNow, most of the data and examples I'm gonna use today come from the United States, but underinsurance is an issue in other countries as well. Go ahead and watch some of our series we've done on international healthcare systems, and you'll see that a fair number expect people to spend quite a bit of money out of pocket for care. \n\nThe Commonwealth Fund defines a person as being underinsured if one's out-of-pocket healthcare costs exceed 10% of their income, or 5% if their income is less that 200% of the federal poverty line, or when one's insurance deductible is more than 5% of their total income. \n\nThe concept is important because research shows that those who are underinsured are more likely to go without needing care. Before the Affordable Care Act was passed, underinsurance was prevalent. If we looked at adults age 19 to 64 in 2010, then 16%, or 29 million of them, met the criteria for underinsurance. \n\nThe number of underinsured Americans had grown by 80% from 2003 to 2010. Some of the ACA's regulations, such as removing annual or lifetime limits, were aimed at reducing the potential out-of-pocket spending that people might have to make. \n\nLast fall, the political media went crazy because many people could not \"keep their policies if they like them.\" One of the reasons that those policies went away, though, is because they left people underinsured, even if they didn't realize it. \n\nUnfortunately, the ACA hasn't made the strides many have hoped for in reducing underinsurance. In fact, it may be helping to spread it further. A number of politicians have proposed modifications to the law, such as a new tier of copper plans, in addition to bronze, silver, gold, and platinum, which might make underinsurance worse. \n\nIn the most recent update of the Commonwealth Fund's survey, tracking the fall of 2014, investigators found that 13% of adults 19 to 64 spent more than 10% of their income on out-of-pocket healthcare costs. Poor adults were the most likely to spend this amount. \n\nMore than 30% of non-elderly adults making less than the poverty line spent more than 10% of their income in out-of-pocket costs, and 18% of those making between 100% and 200% of the poverty line did so. All of those people were insured.\n\nDeductibles remain high for many Americans. Overall, 13% of people age 19 to 64 had a deductible which was 5% of their income or more. Ironically, since Medicaid traditionally doesn't have deductibles, pretty much all of those underinsured people have private insurance. \n\nStill, those at the lowest end of the socioeconomic spectrum are hit the hardest. A full quarter of non-elderly adults below the poverty line have deductibles this large, and 20% of those making between 100% and 200% of the poverty line do too.\n\nThis is too much people for many people to spend. More than 40% of those who were surveyed said their deductibles were unaffordable. Almost two-thirds of people making between 100% and 200% of the poverty line said they were unaffordable.\n\nThe point of having insurance is to be able to get care when you need it, without too large of a financial burden. Underinsured Americans are not receiving this benefit, though. They can't get the care they need when they need it.\n\n27% of adults with a deductible rendering them underinsured didn't see the doctor when they were sick. 23% didn't get a preventive care test. 29% skipped a test, treatment, or follow-up appointment. And 22% didn't see a specialist to whom they were referred. 40% of them had at least one of these cost-related access problems.\n\nThese are people who had private health insurance for a full year. They are not the uninsured. Silver plans have what we call a 70% actuarial value. That means that the insurance company covers 70% of the cost of care after premiums are paid. You're on the hook for 30%, which can be a lot. Gold plans are 80%, and platinum are 90%. That means there's much lower out-of-pocket payments.\n\nLast year, the average deductible for a silver level plan offered in the insurance exchanges was more than $2,500. Some plans had deductibles as high as $5,000. These are likely at least 5% of income for most Americans, even for those who qualify for cost sharing subsidies.\n\nIf people chose bronze plans, then things were even worse. The average deductible for such plans was more than $5,000 a year, with some plans hitting the out-of-pocket maximum of $6,350. Almost anyone purchasing such plans would be, by definition, underinsured.\n\nMoreover, efforts are underway to go even further. The Expanded Consumer Choice Act, co-sponsored by six Democratic senators and one independent senator, seeks to add a new level of insurance coverage.\n\nCopper plans would have 50% actuarial value. Such plans would have significantly lower premium costs than bronze plans, which might increase the number of people who would buy insurance.\n\nBut this would be accomplished at the expense of higher out-of-pocket costs. Deductibles for such plans might have to be as high as $9,000, which would mean increasing the out-of-pocket maximum allowable by law. This would lead to even more people being underinsured.\n\nAs I've highlighted in other videos and articles I've written, people who have chronic illnesses fare worse when they have more cost sharing. They're also more likely to be underinsured.\n\nThe Commonwealth Fund found that 17% of people who were in fair or poor health, or who had a chronic condition, spent at least 10% of their income on out-of-pocket costs. This was on top of the cost of their insurance premiums, because all of them were insured.\n\nJust a few months ago, Gallup asked Americans what the most urgent health problem facing this country at the present time was. 18% replied that it was access to healthcare, or universal health coverage. But more, or 19%, replied that it was affordable healthcare or costs.\n\nIn the quest to achieve universal coverage, it's important that we not lose sight of coverage in order to achieve universal. The point of improving access is, after all, to make sure that people can get the care when they need it.\n\n[outro music]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/-GQKNIhU3JM"},{"c_name":"healthcare triage","v_id":"TQI3dlQP5gI","title":"Update on Supplements: Healthcare Triage News - 04\/03\/2015","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nOne of the most common things you all seem obsessed about is supplements. I get questions from Healthcare Triage viewers all the time. You're obsessed. We've covered them before here on Healthcare Triage News as well. But there's more news, so here's another episodes. Updates on supplements today on Healthcare Triage News:\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=62003\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1428073201","likes":"814","duration":"160","transcripttext":"\n\nIntro\n\n\nOne the most common things we all seem interested in is supplements. I get questions from Healthcare Triage viewers all the time. You're obsessed. We've covered them here on news episodes as well, but there's more news so we're going to make new episodes. Updates on supplements, today on Healthcare Triage News.\n\nIntro plays\n\n\nFraudulent Supplements\n\n\n(0:21) Back in February, the New York State Attorney General's Office issued a report that accused a number of big supplement producers and sellers of selling fraudulent and potentially dangerous supplements. They also told them to take their products off the shelves and stop selling them. \n\n(0:35)For those of you who want specifics, they've run tests on herbal supplements at GNC, Target, Walgreens and Walmart. And found that, and I'm not making this up: 4 of the 5 products they tested contained NONE of the herbs on the labels. NONE. \n\n(0:49)They're also full of cheap stuff, like powdered rice, houseplants, and asparagus. The Walgreen's Ginseng pills contained only powdered garlic and rice. The Walmart Ginkgo Biloba contained powdered radish, houseplants and wheat. And it even claimed that it was gluten-free! I swear you can't make this stuff up. \n\n(1:07)Now, let's face it: Walgreens, Walmart and Target have a business motto that is not entirely dependent on selling supplements. It's not so hard for them to comply, Walgreens moved to remove the products from their stores across the country, even though only New York had asked. GNC on the other hand, what else are they gonna sell?\n\n(1:24)The problem with all of this is that the FDA doesn't really check on supplements. The more stringent rules about drug approval with checks on safety and effectiveness don't apply. It's more of a trust thing, an honor code if you will. It doesn't seem to work that well though. As the FDA thinks something like 70% of supplement makers don't listen. \n\n(1:43)But, this week, GNC has agreed to change some things and it announced it would start a much more rigorous testing process on its supplements that would exceed what the government demands. Of course, going further than the government demands in this case ain't saying that much. \n\n(1:57)But let's give credit where its due. They're saying that they will now use advanced DNA testing to make sure that the plants in their supplements match what's on the label. They'll also make sure some allergens aren't sneaking in unannounced. BUT, the GNC announcement only applies to actually GNC products. Anything else you buy in the store, well you're rolling the dice. \n\n(2:16)Supplements are a $33 billion a year industry. MASSIVE! Lots of you seem to like them. Full disclosure: I take none. I don't get it, I see no good studies saying these products work even if you're actually getting what you think. According to these reports, odds are many of you aren't.\n\nOutro plays\n\n","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/TQI3dlQP5gI"},{"c_name":"healthcare triage","v_id":"xl7tZHH0kc0","title":"Overestimation of Benefit","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nIn previous episodes of Healthcare Triage, we've discussed how people often misunderstand risk and how it affects them. We've also talked about how you can calculate the explicit metrics of numbers needed to treat and harm. But people rarely use them. In spite of the existence of metrics to help patients appreciate benefits and harms, a new systematic review suggests that our expectations are not consistent with the facts.\n\nMost patients overestimate the benefits of medical treatments, and underestimate the harms; because of that, they use more care. That's the topic of this week's Healthcare Triage.\n\nThis piece was based largely on a column Aaron and Austin Frakt wrote for the Upshot at the NYT. References can be found there: http:\/\/www.nytimes.com\/2015\/03\/03\/upshot\/if-patients-only-knew-when-more-information-means-less-treatment.html\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1428356018","likes":"831","duration":"325","transcripttext":"In previous episodes of Healthcare Triage, we\u2019ve discussed how people often misunderstand risk and how it affects them. We\u2019ve also talked about how you can calculate the explicit metrics of numbers needed to treat, and numbers needed to harm. But people rarely use them. In spite of the existence of metrics to help patients appreciate benefits and harms, a new systematic review suggests that our expectations are not consistent with the facts. Most patients overestimate the benefits of medical treatments, and underestimate the harms; because of that, they use more care. That\u2019s the topic of this week\u2019s Healthcare Triage. \n\n[Healthcare Triage Theme]\n\nThis study, published in JAMA Internal Medicine, looked at the accuracy of patients expectations of benefits and harms of treatment. They examined over 30 papers that assessed whether patients understood the upsides  and\/or the downsides of certain treatments. Spoiler: They don't. In the 34 studies that assessed understanding of benefits patients overestimated their potential gain in 22 of them or 65%.\n\nTo the Research.\n\nFor instance a 2002 study published in the Journal of the National Cancer Institute asked women who had undergone a prophylactic bilateral (or double) mastectomy to estimate how much they thought the procedure had reduced their risk of breast cancer. On average, the thought they'd reduced their risk from 76% to 11%, an absolute risk reduction of 65%.   \n\nHowever, the vast majority of the women in the study didn't have a BRCA genetic mutation - which would seriously increase their risk of breast cancer. Their risk before surgery was only 17%, so there's no way they could get even close to the 65% absolute reduction they predicted. Even the women with a BRCA mutation overestimated their risk reduction, but to a lesser extent. \n\nAnother study published in 2012 in the Annals of Family Medicine asked patients to estimate the benefits of screening for bowel and breast cancer, and the use of medications to prevent hip fracture and cardiovascular disease. Two thirds of them overestimated the benefits of medications to prevent cardiovascular disease, and more than 80% of them overestimated the benefits of medications to prevent hip fracture. Further, 90% of patients overestimated the benefits of breast cancer screening and 94% overestimated the benefits of bowel cancer screening. What's more the researchers specifically asked the patients to tell them the minimum reduction in bad outcomes they would need to achieve to find the treatment worthwhile. And for three of the four studied interventions the minimum benefit demanded was higher than the actual benefit - so they shouldn't have gotten the test or therapy. \n\nHarms are misunderstood too. In the 15 studies for which harms were a focus, patients underestimated potential downsides in 10 of them or 67%. There's the study published in 2012 in the Journal of Medical Imaging and Radiation Oncology that asked patients to estimate the risks associated with a CT scan. A single CT scan exposes a patient to the same amount of radiation as 300 chest x-rays, and a potential increased risk of developing cancer from that exposure. More than 40% of patients underestimated a CT's radiation dose, and more than 60% of them underestimated the risk of cancer from getting a CAT scan.\n\nWhy do patients get it so wrong when thinking about risks and benefits? One reason could be the messages they hear. Doctors, direct to consumer ads and the media can bias our perceptions; they tend to focus on the benefits, but rarely quantify them. Healthcare centers, screening advocacy programs and drug ads all push us to talk to our doctors about getting treatment, but they don't talk about actual gains. \n\nDoctors also aren't very good about communicating risks. A study in JAMA Internal Medicine in 2013,  found that less than 10% of patients were told about the over-diagnosis and over-treatment that cancer screening brings, even though 80% of patients wanted to know about such harms. This study and others indicate that patients might go for less care if they had more information about what they might gain or lose with treatment. Shared decision making, where there is an open patient-physician dialogue about benefits and harms might help with this. But the majority of patients still say that they'd prefer to leave medical decision-making to their doctors. \n\nIt could also be that some patients would us more of a certain type of care if they had more information. Many chronic conditions are still under-managed and under-treated in the United States; it's possible that people with theses conditions who had more information would use more care which would raise spending for those patients, but make them at least better off. There's also an argument to be made that people who overestimate the benefits of medicine to treat some conditions are more likely to take that medication regularly. Which might lead to better outcomes. In that case, the misinformation might be helping. \n\nRegardless even though some patients might benefit somewhat from being ill informed, it seems wrong to argue that we should keep them in the dark. Many of the studies in the systematic review showed that people report that they'd opt for less care if they understood benefits and harms better. It's also possible that unrealistic expectations of care help patients cope with disease or provide them with some sense of control. Feeling hopeful about one's future is not to be dismissed, but those unrealistic expectations don't come cheap. We should at least consider the price that we pay for being uninformed.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/xl7tZHH0kc0"},{"c_name":"healthcare triage","v_id":"5-DfhMD6Xjc","title":"Fatigue and its Effect on Doctors & Prescriptions","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nHealthcare Triage Posters and Coffee Mugs: http:\/\/dft.ba\/-HCTMerch\nActually, you can even use these mugs for tea. Or any other hot drink. Or even a cold drink, if you don't mind bucking convention.\n\nFatigue matters. Even when it comes to doctors. Especially when it comes to doctors. We've got data. This is Healthcare Triage News.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=62020\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1428689229","likes":"737","duration":"187","transcripttext":"Fatigue matters, even when it comes to doctors. Especially when it comes to doctors--we've got data. This is Healthcare Triage News.\n\n[intro music]\n\nThis first story is a few months old, but I was recently reminded of it on Twitter. It was published in JAMA Internal Medicine and it's entitled, \"Time of day and the decision to prescribe antibiotics.\"\n\nDoctors have to make many decisions every day. Doctors also often work pretty long hours. They can be tiring. I'm not saying this to complain, but when I was a resident, I'd often have to work 36 hours straight, usually more than once a week.\n\nThere's every reason to believe that this would have some sort of impact on patient care. But we'd rather have some data to confirm or refute that, rather than rely on our guesses. This study tried to do that.\n\nAs many of you might know from watching previous episodes of Healthcare Triage, antibiotics are of no use in treating acute respiratory infections. So their use is considered inappropriate. This study wanted to look at whether physician fatigue might have any impact on how a doctor might prescribe an inappropriate antibiotic. \n\nResearchers looked at billing and electronic health record data for 23 different primary care practices over about a year and a half, in 2011 and 2012. They specifically looked at visits by adults age 18-64 years who were otherwise healthy, but were being seen for acute respiratory infections. Then they looked at whether the patients got a prescription for antibiotics.\n\nOver the study period, there were almost 22,000 visits for acute respiratory infections, and about 44% of those resulted in a prescription for antibiotics. But they saw something interesting: prescriptions for antibiotics became more common later in the day.\n\nThis happened on pretty much every weekday. When docs started working in the morning, their rates of antibiotic prescriptions were at their lowest. This was true for things where antibiotics were sometimes indicated, and for things where antibiotics were never indicated, and even overall.\n\nPrescription rates peaked three hours later, before lunch. Then, when the doctors came back from lunch, hopefully refreshed, their rates of antibiotic use had dropped. But still not to 8AM levels. And over the course of the afternoon, rates increased again, with overall and inappropriate use peaking at the end of the day.\n\nNow let's acknowledge some limitations to this kind of research. What we're seeing is a correlation, not any proof of causation. It's possible, but sort of unlikely, that the patients that come in at 11AM are different than the patients that come in at 8AM. And same for those at 4PM and 1PM. But that wouldn't account for the use of inappropriate antibiotics. \n\nIt's also possible that some other confounding factor's responsible for the differences. But I'm having a hard time thinking of one.\n\nThis looks like a fatigue issue. We know from other areas of research that people make worse decisions as they grow tired. This looks like that. We need to be aware of it. We need to devise ways of compensating for it.\n\nThat could mean better decision support. Or ways to flag the use of antibiotics for docs to tell them when they might not be doing something right. It could mean smarter schedules, more breaks, or fewer continuous work hours. \n\nBut we shouldn't ignore it. Fatigue matters, especially for those with whom we're trusting our health and our safety.\n\n[outro music]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/5-DfhMD6Xjc"},{"c_name":"healthcare triage","v_id":"E505JhAIfpg","title":"Choosing Wisely and Encouraging Effective Treatment","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nWhenever I give a talk on the sorry state of the US health care system, someone asks me what we should do. My first comment is always something along the lines of \"if we knew what to do, we'd have already done it\". But if I'm pushed, I will usually note that the best first step would be for us to stop doing things that don't work.\n\nThere's an organization dedicated to that. It's called Choosing Wisely. It's also the topic of this week's Healthcare Triage.\n\nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=62191\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen - Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1429028865","likes":"871","duration":"343","transcripttext":"Whenever I give a talk on the sorry state of the United States health care system, somebody inevitably asks me what we should do to reduce our spending. My first comment is always along the lines of \u201cif we knew what to do, we\u2019d be doing it already\u201d. But if I\u2019m pushed, I'll usually note that the best first step might be for us to stop doing things that don\u2019t work. There's an organization dedicated just to that, it's called Choosing Wisely; and, it's also the topic of this week's Healthcare Triage. \n  \n(Intro)\n  \nReducing spending without negatively affecting quality is not entirely straightforward, however, there are numerous processes of care that we know are wasteful. They have been shown be research and analyses not to improve quality - sometimes they even result in harm. Regardless they increase spending. By identifying and eliminating these wasteful processes we can meet the goals of accountable care without unintended consequences. And, if we do these things writ large it could result in an improved financial outlook for the entire healthcare system.  \n  \nA 2012 paper in JAMA explicitly singled out waste as a better way to reduce healthcare spending in the United States. In this table from the manuscript you can see that a reasonable estimate of waste in the US healthcare system could be more than 900 billion dollars a year, 300 billion dollars of which is spent by Medicare and Medicaid alone. The over-treatment category alone accounts for somewhere between 158 to 226 billion dollars each year. Focusing solely on this area could still result in large savings.  \n  \nWith that in mind it's worth talking about Choosing Wisely; it's an initiative of the ABIM foundation that, and I'm quoting, \"aims to promote conversations between physicians and patients by helping patients choose care that is: supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary.\" They first made news in 2012 when they had nine specialty societies release lists of five things physicians and patients should question. Basically, they came up with lists of things we shouldn't do when practicing medicine. They identified over-treatment as waste.  \n  \nI've been somewhat skeptical of these efforts in the past, partly that's because without coupling these ideas to payment reform the financial incentive to continue doing them remains. Additionally I felt that the scope of some of the recommendations was limited. As a pediatrician for instance, I couldn't help noticing that none of the original recommendations really focused on children. But, in the coming years and months Choosing Wisely has addressed some of my concerns. They along with 17 leading medical societies have come-out with many, many more newer tests, procedures or therapies that are common - but, likely unnecessary. Pediatrics is well represented among them. Here are the recommendations made by the American Academy of Pediatrics: \n  \nAntibiotic should not be used for apparent viral respiratory illnesses (like sinusitis, pharyngitis, or bronchitis). \n  \nCough and cold medicines should not be prescribed or recommended for respiratory illnesses in children under four years of age. \n  \nComputerized tomography (or CT) scans are not necessary in the immediate evaluation of minor head injuries; clinical observation\/Pediatric Emergency Care Applied Research Network (PECARN) criteria should be used to determine whether imaging is indicated. \n  \nNeuroimaging (CT, MRI) is not necessary in a child with simple febrile seizure. \n  \nAnd, CT scans are not necessary in the routine evaluation of abdominal pain.     \n  \nAnd here are some other highlights from various other specialties, for instance:  \n  \nDon't schedule non-medically indicated inductions of labor or C-sections before 39 weeks. (That comes from the American College of Obstetricians and Gynecologists, and American Academy of Family Physicians) \n  \nAvoid doing stress tests using echocardiographic images to assess cardiovascular risk in persons who have no symptoms and a low risk of having coronary disease. \n  \nWhen prescribing medication for most people age 65 and older with type 2 diabetes, avoid attempting to achieve tight glycemic control. \n  \nDon't routinely treat acid reflux in infants with acid suppression therapy.  \n  \nThese recommendations cover a wide swath of care options for problems that are both common and expensive. If we listen to them we'd save a HUGE amount of money. We'd also do a fair amount of good; people often forget that these tests and treatments carry potential harms. When you do them and achieve no benefit you are potential hurting quality.  \n  \nWhen I really think about it I'm forced to admit my skepticism comes from a place of cynicism. I wish that wasn't the case, but it is. Some doctors fear lawsuits, this won't change that. Some doctors see a subset of patients that aren't representative of the general population, and are conditioned to believe that more tests are necessary than really are. This won't change that either. And I still believe that as long as we continue to pay for this stuff it's gonna get performed far too often. Financial incentives drive behavior, even when they're aligned in the wrong direction. I'm more than happy to be proven wrong, but I think it's unlikely.  \n  \nBut really, I'm all for this; I think it's great. We just have to have a little perspective. None of these recommendations are news to those of us who practice medicine and follow the medical literature. Seriously, try and find a physician who doesn't know that overuse of antibiotics for sinusitis is a problem. The real issue as I've discussed before isn't that doctors don't have access to evidence. You can say that mammograms should be used less often, but when enough physicians call that \"crazy\" and \"unethical\" and label the USPSTF idiots - then it's all sort of moot.  \n  \nBut Choosing Wisely continues to give us lots of good ideas to work with. I encourage you to go explore their website, links below, to see some of the many, many things we shouldn't be doing. We should also think about giving their efforts teeth by tying Choosing Wisely's efforts to payment reform.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/E505JhAIfpg"},{"c_name":"healthcare triage","v_id":"XlCf8HEgxWQ","title":"Medicare and the Doc Fix: Healthcare Triage News","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nWe've got a permanent doc fix. It's all about the sustainable growth rate. Confused? We'll help. This is Healthcare Triage News.\n \nFor those of you who want to read more, here's a nice summary at Vox: http:\/\/www.vox.com\/2015\/3\/17\/8232071\/medicare-doc-fix-sgr\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1429296669","likes":"598","duration":"222","transcripttext":"Permanent doc fix. It's all about the Sustainable Growth Rate. Confused? We'll help. This is Healthcare Triage News.\n\n[intro plays]\n\nBasically, back in the long ago of the 1990s, Congress tried to slow the rising cost of Medicare by pegging how much they would pay doctors to a formula. They called it the Sustainable Growth Rate, or the SGR. But the formula was created during a time of strangely low growth in physician payments. Therefore, when inflation kicked back to normal, doctors quickly realized that Medicare and the SGR were trying to squeeze them. To improve this, Congress didn't fix the SGR formula, or even repeal it. They passed what came to be known as a \"doc fix,\" or a short term law that tells Medicare to ignore the SGR for a period of time. It's a patch. \n\nEach time the doc fix is about to expire, the AMA and doctors start to lose their minds. This is because so much time has passed since the SGR formula started, that if the actual SGR kicked in tomorrow, doctor reimbursements would drop more than 20% overnight. That would likely make many doctors start to refuse Medicare patients. That would make the elderly very angry. And that would make politicians miserable. \n\nPretty much nobody in Washington likes the SGR, but they've been unable to fix it for one big reason: money. Allowing the SGR to stay on the books makes the budgets look better, because politicians can always say it's current law in future budget projections. Each time they pass a patch, for six months or for a year, it costs them money. Billions. And no one wants to take credit for the spending. For a long time, many have sought a permanent doc fix, but estimates are that it would be even more expensive than the short term fixes.\n\nBut there's always been hope. For the first time in a long time, the House of Representatives has passed a bill. The Medicare Access and CHIP Reauthorization Act, passed by 212 Republicans and 180 Democrats, which is a frickin' bipartisan miracle these days, would not only fix the SGR forever, but it would also reauthorize the CHIP program for two years.\n\nThere have been, like, seventeen doc fixes since the early 2000s and I think it's always been ridiculous, and it's a waste of time, but I've always been skeptical that they'd ever permanently fix this. The bill to do so will cost $214 billion, now some of that is CHIP and other spending, but $175 billion of it is for doctors to get a slight 0.5% raise each year through 2019, and then to hold things steady until 2024. Only some of it is paid for, though, with spending cuts and such elsewhere. These include some cuts to reimbursement for post-acute care, and some cuts for payments to hospitals. They're also going to raise deductibles for some Medigap policies and premiums for wealthier seniors, but that's sort of chump change. The bill's going to add more than $140 billion to the federal deficit over the next ten years, unless other spending cuts or taxes are enacted. That was a hard pill for many Senators to swallow. There are also some Senators who wanted to call for a longer CHIP reauthorization, like four years.\n\nMany of the health policy wonks I run with were as optimistic as I've ever seen them about getting this done. They really thought that this time we'd see a permanent doc fix. Me? I'd seen this dance before. I've been burned too many times by promising moves forward, killed by politics. I was wrong! On Tuesday night, the Senate passed the House bill, 92 to 8. Ninety two to eight! That's insane! Look, I was so skeptical that this would pass, I had to rewrite the script for this episode, 'cause I was still predicting doom, even yesterday. I also tweeted this. By the time you're reading this, President Obama will have signed the bill into law. The SGR will be gone forever. No more doc fixes. Physicians all over the US rejoice. \n\n[outro music]\n\n","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/XlCf8HEgxWQ"},{"c_name":"healthcare triage","v_id":"nXJmdMoNuY4","title":"Guns, Suicide, and Legislating the Doctor-Patient Relationship","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nGuns are one of those topics that really divide Americans. It's hard to have a calm, evidence-based discussion. But one area where we really need to be able to do that is in the pediatrician's office. Why? That's the topic of this week's Healthcare Triage.\n\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=62278\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1429560335","likes":"1666","duration":"333","transcripttext":"Guns are one of those topics that really divide Americans. It's hard to have a calm and evidence-based discussion. But one place where we really need to do that is in the pediatrician's office. Why? That's the topic of this week's healthcare triage\n\n(Intro)\n\nSo every year I go to see my doctor for a checkup. And when she's running through the usual list of questions, she asks me if I'm sexually active with my wife. Then she asks me if I'm sexually active with anyone other than my wife. She's not asking to be intrusive, she's not doing it because she's nosy. She knows that having multiple sexual partners significantly increases my chance of contracting a sexual transmitted infection. Asking about that lets her see if I am at risk. And then she can address that risk with me.\n\nI'm not offended that she asks me. It's actually part of what makes her an excellent physician. Doctors are supposed to ask about sensitive things in order to help keep us safe. This is especially true for pediatricians. This kind of exchange is how we engage in prevention, sometimes called anticipatory guidance, and study after study shows it can prevent harm.  When pediatricians ask you about using car seats, they're trying to prevent injuries.  When they ask you about how your baby sleeps, they're trying to prevent injuries.  When they ask you about bike helmets, they're trying to prevent injuries.  And when they ask you about guns, they're trying to prevent injuries, too. \n\nBut not evidently everywhere.  In Florida in 2011, a law was signed that made it illegal for doctors to ask patients if they owned a gun.  If doctors violated this law, they could be disciplined, which could lead to fines, citations, and even a loss of their license.  A lower court struck down the law in 2012, but last year, a panel of judges on the United State Court of Appeals for the 11th Circuit upheld it.  In their ruling, the judges declared that the law regulates physician conduct, and I'm quoting, \"to protect patient privacy and curtail abuses of the physician-patient relationship.\"  The clear assertion of the judges is that there is no legitimate health reason to be asking about gun ownership.\n\nIn 2012, there were 33,363 deaths by firearms in the United States, but only 12,093 of those deaths were by homicide.  About 62% of deaths by firearms, or more than 20,600 of them, were suicides.  Guns are used far more often in suicides than homicides.  Access to guns can make an impulsive suicide attempt far more likely to succeed.  Research shows that almost half the patients who have survived a suicide attempt report that the time between thinking about suicide and attempting it is often 10 minutes or less.  Guns work.  Suicide attempts with a gun succeed more than 85% of the time.  Suicide attempts with poison or overdoses succeed less than 2% of the time.  Meta-analyses show that there's a significant association between having access to a firearm and a higher chance of suicide succeeding.  And that's just the deaths.  There are also injuries.  In 2009, almost 7,400 children were hospitalized in the United States because of injuries related to guns.\n\nDoctors who ask about guns aren't doing so because they're gossips.  They're doing so because the vast majority of those deaths and injuries are preventable.  They want to keep you and your children safe.  Before anyone thinks I wanna take your guns away, hear this.  It's entirely possible to keep a gun in your home safely.  This isn't a movement by physicians to remove anyone's right to own and keep guns.  But studies show that the majority of people who keep their guns in their homes do so in an unlocked space.  Few have any kind of trigger locks.  More than 10% report keeping their guns loaded or near ammunition in an unlocked area.  That's often how children get hurt.  Almost no one would argue that young children should have access to guns or ammunition, let alone unsupervised access, but that's what's happening in far too many homes in the United States.  Research shows that guns kept in the home are more likely to be involved in accidents, crimes, or suicides than in self-defense.\n\nWhen I ask patients and parents whether they own guns, if they tell me they do, I immediately follow up with questions about how they're stored.  I wanna make sure that they're kept apart from ammunition.  I wanna make sure they're in a locked box, preferably in a place out of reach of children.  Doing so minimizes the risk to kids.  That's my goal.  When we as physicians ask you if you drink or smoke, it's not so that we can judge you.  It's so that we can discuss health risks with you.  When we ask you about domestic violence, it's not to act like police detectives.  It's so that we can help you make better choices for your health.  When we ask you about what you eat, or whether you exercise, it's so we can help you live better and longer.  We're doctors.  That's our job.  And hear this.  You can calmly refuse to answer any of these questions.  You can tell your doctor you'd rather not discuss any of these topics.  You can choose to lie.  You can even just not come to the doctor in the first place.  There's nothing stopping you from preventing us from helping you.\n\nOf course, rejecting discussion of an uncomfortable topic isn't much different from rejecting discussion of what you eat or what's making you sick.  You're only hurting yourself.  What this now upheld Florida law does is prevent doctors from helping other people who might want that assistance.  Anticipatory guidance is about stopping injuries before they happen.  If the courts decide the physicians can't ask people sensitive questions, then they're putting patients, including children, at risk.  Even worse, a new law being proposed in Texas would do the same thing there.  In essence, these laws permit the government to interfere with you and your doctor's relationship.  Most people, I'd wager, would rather keep that relationship and what goes on in an examination room, out of bureaucrats hands and in their own.","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/nXJmdMoNuY4"},{"c_name":"healthcare triage","v_id":"8X9z5JSfWcI","title":"Healthcare Triage LIVE - 2015-04-22","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\n1:07 - Start!\n1:34 - There's so much dispute over multivitamins for adults & kids. Some say they are worthless, others say they are essential. I'm pregnant & there seems to be NO dispute over me taking a prenatal, why?\n4:14 - I  have recently been told by a woman that there are all these studies about bras causing breast cancer. have you heard of any? Is she just a fearmonger? Sounds awfully suspicious to me.\n5:15 - What are your thoughts on breastfeeding? Are the benefits overhyped? Are the recommendations (6 months exclusive) practical?\n7:09 - what do you think about gene therapy?\n9:12 -  is the silverchloride in anti-perspirants harmful? If yes, are there alternatives?\n10:07 -  Does The Pill have any side effect for later in life when you would like to have children?\n11:12 -  Tell me more about the government's inability to negotiate for lower prescription drug prices w.r.t Medicare Part D\n13:18 - Are Doctors of Ostheopathy (DO) as good as regular doctors (MD)?\n13:58 - Our pediatrician has been very adamant about our 14 month old drinking whole milk due to high fat requirements for the developing brain. Is this legitimate? At what point is milk no longer beneficial?\n15:43 - What is up with food dyes and adhd? Hoax or just circumstantial? Or is there actually a causational link?\n17:04 - Ok, seriously though... why is the lens of the microscope in your \"To the Research\" poster shaped like a condom?\n17:43 - What kind of evidence\/studies are there showing support for the idea that pregnant women shouldn't consume certain things such as sushi or coffee?\n19:33 - How good is the research on vegan lifestyles and their health benefits?\n21:00 - Any perspective of genetic counseling and the importance of proactive genetic testing?\n22:24 - Is aspartame as harmful as everyone says? Episode on sweeteners: https:\/\/www.youtube.com\/watch?v=Mf82FfX-wuU\n23:05 - Does your opposition to the Milk Industrialization Complex apply to soy milk, almond milk, and coconut milk too?\n24:15 - Why is there a lack of effective treatments for chronic fatigue? (questions\/titles got out of order. Ignore the title card :) )\n25:17 - How does the U.S deal with the regulation of supplementary \"medicines\"? For example, hunger control medicines used traditionally but lacking evidence. News Episode on supplements: https:\/\/www.youtube.com\/watch?v=TQI3dlQP5gI\n26:23 - Ibuprofen vs paracetamol for sore throat from a common cold? Does it matter that much? I've read that Ibuprofen increases the average length of a cold?\n28:32 - I've noticed loads of food seems to contain a huge amount of saturated fat. What are the negative health benefits?\n30:08 - Eczema! what works what doesn't?\n\nThe next Healthcare Triage LIVE is going to be 2015-04-29 @11:30a at: https:\/\/www.youtube.com\/watch?v=lBWdPt9edXA. Please leave comments\/questions in next week's show.\n\nThanks for watching!","uploaded-unix":"1429720990","likes":"358","duration":"1963","transcripttext":"","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/8X9z5JSfWcI"},{"c_name":"healthcare triage","v_id":"D1mObgVdgdU","title":"We're Probably Screening for Breast Cancer Too Much: Healthcare Triage News","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nHCT Mugs and Posters! http:\/\/dft.ba\/-HCTMerch\n\nHow often should you get a mammogram? After writing for years about how research shows we may be too aggressive in screening for breast cancer, it's only fair that I acknowledge the newer \u2013 and more conservative \u2013 recommendations from the USPSTF. This it Healthcare Triage News:\n\nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=62338\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1429894396","likes":"675","duration":"223","transcripttext":"Aaron: After writing for years about how research shows we may be too aggressive in screening for breast cancer, it's only fair that I acknowledge the newer and more conservative recommendations from the USPSTF, this is Healthcare Triage News.\n\n(HT Intro plays)\n\nFirst, the USPSTF now recommends screening mammography every two years for women age 50-74 years.  This will certainly upset many advocacy groups, which have long pushed for yearly screening to start long before age 50.  The ACA also mandates that such yearly mammograms be paid for without copayments or coinsurance, so following these new guidelines means refusing free care.  \n\nHowever, the new recommendations are an acknowledgment of the fact that the harms of yearly screening might outweigh the benefits.  The accompanying review and meta-analysis found that if 10,000 women age 50-59 are screened, there will be eight fewer deaths from breast cancer.  In 10,000 women age 60-69, there would be 21 fewer deaths from breast cancer.  But about 20% of women who are diagnosed with and treated for breast cancer are getting therapy for something that otherwise would never have caused a health problem or even been diagnosed.  One in five women is over-treated and the treatment for breast cancer is not benign.  False positives are common too, and these have costs, financial, emotional, and physical.  They happen even more often than over-treatment and over-diagnosis.  \n\nThe models that they used found that using yearly screenings instead of every other year screenings, had a pretty incremental benefit, but they had a significant increase in harms, so they recommended five, not ten, screens over a decade.\n\nSecond, the current evidence is insufficient to assess the balance of benefits and harms in screening mammography in women 75 years and older.  There are no randomized controlled trials that show a benefit in this age group at all.  The harms are still there, though, so no recommendation is made.  \n\nThird, the decision to start screening mammography in women before age 50 years should be an individual one.  Women who place a higher value on the potential benefit than the potential harms may choose to begin screening between the ages of 40 and 49 years, but they don't have to.  This is a real change, too.  It's saying it's totally fine not to start screening until age 50.  Why?  'Cause there's a reasonable case to be made here that the harms overwhelm the benefits.  It we screen 1000 women age 50-74, we may prevent seven breast cancer deaths.  If we drop the screening age to 40, then we might prevent eight breast cancer deaths.  One more death.  But it's totally possible that person might die of other causes, meaning that there's no real gain overall.  \n\nBut there are real problems here.  Each time we screen 1000 women between age 40 and 49, there are 121 false positives.  There are 10 biopsies that didn't need to happen.  There's also one false negative, or real breast cancer that's missed.  That's each time, not the whole ten years.  So multiply those harms by the number of times you screen over a decade.  It adds up, and it might overwhelm the benefit.  So the USPSTF hedges, they say that women should make personal decisions with the help of their physicians, and I think that's the right call.  Recommendations should say what we know to be true, and in this case, we know the benefits and we know the harms.  When they're not clearly overwhelmed in the direction of benefits, we should let personal preferences come into play.  \n\nObviously, women at higher than usual risk for breast cancer should be treated differently.  That's how it should be, too.  Recommendations should be applied carefully to the populations they're meant for.\n\n(Endscreen)","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/D1mObgVdgdU"},{"c_name":"healthcare triage","v_id":"WXMts38a3rc","title":"Sadly, Putting Calorie Counts on Menus is Ineffective","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nWe're eating too much. There are lots of people who think that menu labelling, or putting the number of calories in stuff up on the wall, will help people to eat more healthily. Sounds great, right? You think there might be some research on that?\n\nMenu labelling is the topic of this week's Healthcare Triage.\n\n \nFor those of you who want to read more, go here: http:\/\/theincidentaleconomist.com\/wordpress\/?p=62352\n\n\nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1430236972","likes":"987","duration":"466","transcripttext":"Aaron: We're eating too much, and there are lots of people who think that menu labeling or putting the number of calories in stuff up on the wall will help people to eat more healthily. Sounds great, right? You think there might be some research on that?  Menu labeling is the topic of this week's Healthcare Triage.\n\n(HT Intro plays)\n\nAaron: Menu labels make sense. We want to know what we're eating, and there's good reason to have those labels. We often have no idea what we're eating. When I was a kid, there was a simple rule in our house when buying cereal: sugar couldn't be the first ingredient in the list. This led to cereals being lumped into two groups: there were sugar cereals and all others. Looking back, this seems laughable, but it kept the peace. My siblings and I became masters, however, at gaming the system. We knew the ingredient list of every cereal and could quote you, at length, lists of cereals that passed the test, yet still seemed awfully sweet to us. We have no such rule in our house today, partially because my wife and I are tyrants and just don't allow some cereals even to be debated, plus, no cereal seems to have sugar as the number one ingredient anymore, and now they all boast \"whole grains\" so you might assume they're all just healthier. Years ago, though, Consumer Reports did a study. They found that 11 of the most popular brands of cereal are more than 40% sugar by weight. For instance, one cup of Cascadian Farms Organic Oats and Honey Granola has 348 calories. It has the same amount of sugar at 19 grams as a Hershey bar, and if you couple it with half a cup of low-fat milk, it has the same amount of fat as a McDonald's cheeseburger. Honestly? I'd rather have the cheeseburger.  \n\nAnyway, now that I know, I'd like to think I'd avoid the crazy bad cereal. But that's not the same thing as going into a restaurant and ordering food. Let's look at the research there. The American Journal of Preventive Medicine, 2011, \"The impact of menu labeling on fast food purchases for children and parents.\" In this study, researchers gathered a number of families in two counties in the United States and measured their ordering in restaurants. Then, in one of the counties, they implemented menu labeling. Later, they remeasured the ordering in both the county that got labeled and the one that didn't. In the county where menu labeling was implemented, calories ordered for children went from 823 on average to 822. In the county without labeling, calories ordered for children went from 984 to 949. Not an impressive difference. The calories ordered by parents for themselves did drop in the menu labeled restaurants from 823 to 720, but they also dropped in the non-labeled restaurants, just as much, from 895 to 789. Parents said that they did see the nutrition information in the labeling restaurants. Some may hold this up as a good thing, but to be honest, it makes me even more sad. They saw the calorie information, but didn't seem to care that much, or at least they didn't change their behavior that much because of it.  \n\nJAMA, 2011, \"Accuracy of stated energy contents of restaurant foods.\" Okay, in this one, researchers went into restaurants with menu labeling and bought their food. Then they took them to the lab and measured how close the stated caloric content was to the actual caloric content. To be eligible, a restaurant had to be in a chain with sales placing them in the top 400 restaurants in 2008, and had to be either quick-serve or sit-down. They also had to have calorie content reported on their website. So how accurately did they report the calories in their food items? Wait for it. Well, overall, they were pretty accurate, but individual items showed a lot more variation. Of the 269 food items that were measured, almost 20% had 100 or more actual calories than what was stated. The worst offender, a side dish, had more than 1000 calories in a portion that was reported to have only 450 calories.  \n\nNow, it's possible that the researchers got a bad sample. Perhaps there was an overeager server that night who gave them more than they were supposed to get. So in the interest of accuracy, the researchers took some of the worst offenders and went back to get a second sample. They were able to do this for 13 of the 17 foods with the largest discrepancies between the reported and measured calories. In the first pass, these foods had on average 289 more calories than reported. In the second look, they still had 258 more calories than reported. Most concerning for those trying to watch what they eat, the food items with lower reported calories, or the healthy or diet items, were significantly more likely to have higher calories than reported. This was balanced oddly enough by the high reported calorie foods sometimes having fewer calories than reported. \n\nNow, this isn't to say that I think the restaurants are lying, but if you do look at menu labels, it's gonna screw with your choices. The American Journal of Public Health, 2013, \"Supplementing menu labeling with calorie recommendations to test for facilitation effects.\" Researchers approached 1,121 McDonald's customers both before and after menu labeling began in New York City. Each had a random chance of being handed 1) information that described the recommended calories a man and woman should eat each day, 2) information that described the recommended calories a man or woman should eat each meal, or 3) nothing. The hypothesis was that giving people information about recommended intake would help them to make better choices about how much to order. After all, the whole menu labeling thing is based on the idea that giving people information will reduce obesity. The results are somewhat depressing. Giving people calorie recommendations didn't change what people ordered. In fact, although the result wasn't statistically significant (p=.07), people who were given more calorie information ordered more calories. They also did a lot of sub-analyses. For instance, looking only at those who were ordering full meals instead of just drinks yielded the same non-significant result. They also looked at whether weight changed the results, 'cause if information caused overweight people alone to order fewer calories, that would still be a win. But that model still showed that more information led to more calories ordered, p=.06.  \n\nBut let's not cherry-pick. The American Journal of Public Health, 2015, \"Systematic review and meta-analysis of the impact of restaurant menu calorie labeling.\" These researchers looked at all papers in the literature through October of 2013. If they included all 19 qualifying studies, then menu labeling led to an 18 calorie reduction per meal offered, but there was a lot of variation in the studies. 10 of them were in non-restaurant settings. Four were on the Internet, three in labs, two on sidewalks, and one in a hospital waiting room. Only three of them randomized people to order food that they'd otherwise eat from an actual menu. Seven of them, in other words, involved ordering from a hypothetical menu for a pretend meal. All of this is to say that their generalizability should be viewed with a little skepticism. If the researchers included only controlled studies, however, and there were six of them, then there was no significant effect of menu labeling. \n\nThat's disappointing, but not unexpected, given what I've already described, but here's the conclusion of the authors, and I'm quoting, \"These findings are limited by significant heterogeneity among non-restaurant studies and few studies conducted in restaurant settings.\" I just have to disagree here. I'm not sure that menu labeling regulations are low-cost. Do they give any evidence for that?  I'm sure it costs businesses quite a bit. We also know, they're often wrong. And without evidence, why would we continue to head down this path? I'm fine with further experiments and research, but it seems odd to do studies, note they don't really seem to work, and say we should keep doing the policy. It sometimes feels that that's the theme of too much nutrition policy in the United States these days.\n\n(HT endscreen)","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/WXMts38a3rc"},{"c_name":"healthcare triage","v_id":"lBWdPt9edXA","title":"Apr. 29th, 2015 - LIVE - Why is eating processed food bad for your health?","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nLeave any questions you have in next week's video: https:\/\/www.youtube.com\/watch?v=y4pZYtXwZdA\n\n00:35 - Start!\n\n2:05 - 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? \n\n3:30 - 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)\n\n4:36 - 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?\n\n6:27 - 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?\n\n8:36 - What are your thoughts on accutane (isotretinoin) and its continued use on people as an acne medication?\n\n10:09 -  Do we know anything about brain freezes? What causes them, how to prevent them, and how to stop them once they've happened?\n\n11:19 - 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?\n\n12:55 - 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)\n\n15:00 Can you talk about what adults who had their vaccinations as kids should do in areas where there are measles outbreaks?\n\n15:55 - 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?\n\n17:20 - My wife and daughter have celiac disease, and we're planning another child. Should we introduce our new child to gluten early? \n\n18:16 - What is your stance on moderate alcohol consumption by pregnant and breast feeding mothers? Is there any available research?\n\n21:06 - 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?\n\n22:58 - Codeine is available over the counter in most other countries. Why is that not the case in the US?\n\n24:19 - How do you feel the field of mental illness (specifically depression, anxiety disorders and so on) has changed since you became a pediatrician?\n\n25:03 - Does long-term use of prescription amphetamines affect cardiac or mental health in later life?\n\n26:07 - 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)\n\n27:36 - 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)\n\n29:03 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?\n\n29:53 - 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)\n\n30:19 - Regarding Diet soda, is there any danger to drinking it in larger amounts (NOT the aspartame)? \n\n31:18 How healthy is Honey in reality? Is it actually as good for you as it is made out to be?\n\nOh, also, we've got merch :) http:\/\/dft.ba\/-HCTMerch\n\nNext Wednesday we'll be live at 11:30a ET: https:\/\/www.youtube.com\/watch?v=y4pZYtXwZdA","uploaded-unix":"1430325719","likes":"336","duration":"2014","transcripttext":"","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/lBWdPt9edXA"},{"c_name":"healthcare triage","v_id":"fDPw4ZdDtUM","title":"Marketing Ploys Trump Science at PepsiCo and Chipotle: Healthcare Triage News","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nPepsi is going to remove aspartame from its sodas. Chipolte is going to stop serving GMO food. It appears lots of people still aren't watching Healthcare Triage. This is Healthcare Triage News.\n \nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=62476\n\nWe have merchandise! http:\/\/dft.ba\/-HCTMerch\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1430512227","likes":"1315","duration":"198","transcripttext":"Pepsi's gonna remove aspartame from its sodas. Chipotle's gonna stop serving GMO food. It appears lots of people aren't watching Healthcare Triage. This is Healthcare Triage News.\n\n[intro plays]\n\nFirst up, let's talk about Pepsi, or rather Pepsico Incorporated, which makes a ton of drinks, including Mountain Dew. They're changing their formulas. Specifically, they're going to stop sweetening many of their diet drinks with aspartame. \n\nYou may remember aspartame from one of a gazillion chain emails or Facebook posts labeling it a poison or a toxin. Yeah, not so much. They're going to switch over to sucralose, which you might know as Splenda, or acesulfame potassium, which I bet you don't know as Ace K. Acesulfame potassium is the sweetener also used in Coke Zero, which is my diet soda of choice, so I should stop acting all high and mighty here. \n\nNow, if you've watched our episode on artificial sweeteners, you already know that there's a ton of research on aspartame, and no one has found an association between it and cancer or any other significant health problem. I'm not going to waste your time going over the research again. Go watch the video.\n\nBut the customers have spoken. Evidently getting aspartame out of their sodas was the number one request Pepsi received from its consumers. They answered. \n\nSoda consumption has been declining pretty steadily for a decade. I don't think that this was the only reason why. And I'm not sure that this will change that trend. \n\nOur second story isn't that different. This week, Chipotle announced that soon it will only be preparing food that is free of genetically-modified ingredients, or GMOs. You may remember GMOs from our Healthcare Triage episode on... GMOs. I'm not gonna waste your time going over the research again. Go watch the video. \n\nThe bottom line is that the research to date, and there's a ton of it, and a lot of does come from non-industry sources, please go watch the video, and it shows that there is no evidence that GMO foods are any less safe than conventional foods.\n\nSo, like Pepsi, Chipotle is bowing to pressure from its customers. That's fine. This is a free country, and if Chipotle, like Pepsi, thinks it can benefit from selling food that appeals to people, even if I don't understand why, that's their right. \n\nBut as some have pointed out, all corn is pretty much GMO. Modern corn, or maize, simply cannot reproduce on its own. All its kernels are wrapped up in a tough husk that requires us to rip it open and sow it. It's an engineered crop. It can't exist in nature. \n\nChipotle doesn't care about that, and neither do a lot of other people. They're OK with the old engineered corn, just not the newer stuff. That has to be GMO-free. But they're only taking it out of their burritos and such. They'll still be selling GMO-laden soda in their stores. Maybe someday it'll be free of aspartame.\n\nIf I sound a little exasperated, it's 'cause I am. You're all free to eat whatever you want. Really. But I'd like for all of us to have some common ground in science. You can't demand and revere it in some cases, and then ignore it in others. I see too many people argue that science shows that climate change is real, and then somehow act completely differently when it comes to food. We should be consistent. \n\nThe overwhelming science to date shows us that aspartame  and GMOs are safe. Bowing to popular pressure when it runs counter to science sets a  that may come back to haunt us.\n\n[outro plays]","c_id":"83","0":"","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":"","link":"http:\/\/nerdfighteria.info\/video\/83\/fDPw4ZdDtUM"},{"c_name":"healthcare triage","v_id":"bW_V7EZNW84","title":"Frequent Lab Testing Isn't Very Useful","description":"You can directly support Healthcare Triage on Patreon: http:\/\/vid.io\/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content.\nA couple of weeks ago, Mark Cuban got into an interesting debate with much of the health wonk Twitter community (including me) over whether more lab testing is better. It began when he advocated that everyone get quarterly lab testing.\n\nWhile I'm a fan of Cuban's Shark Tank, and I respect his business acumen immensely, there are a couple of things wrong with this. It's worth discussing them in detail. We're going to do that here today, on Healthcare Triage.\n\nWe have merchandise! http:\/\/www.hctmerch.com\nWe're (finally) on Facebook! https:\/\/www.facebook.com\/healthcaretriage\nWe're on Twitter! https:\/\/twitter.com\/HCTriage\nFor those of you who want to read more, go here:  http:\/\/theincidentaleconomist.com\/wordpress\/?p=62530\n \nJohn Green -- Executive Producer\nStan Muller -- Director, Producer\nAaron Carroll -- Writer\nMark Olsen -- Graphics\n\nhttp:\/\/www.twitter.com\/aaronecarroll\nhttp:\/\/www.twitter.com\/crashcoursestan\nhttp:\/\/www.twitter.com\/johngreen\nhttp:\/\/www.twitter.com\/olsenvideo","uploaded-unix":"1430767036","likes":"884","duration":"266","transcripttext":"A couple of weeks ago, Mark Cuban got into an interesting debate with much of the health wonk Twitter community (including me) over whether more lab testing is better. It began when he advocated that everyone get quarterly lab testing. While I\u2019m a fan of Cuban\u2019s Shark Tank, and I respect his business acumen immensely, there are a couple things wrong with this. It's worth discussing them in detail. We\u2019re going to do that here today, on Healthcare Triage. \n\n[intro plays]\n\nFirst of all, too many people presume that tests are binary things. They're not. When you get a blood test, it doesn't come back \"sick\" or \"well\". It comes back with a number value.\n\nLet's say you're looking at white blood cell count, or the number of white blood cells. You might get a reading of seven, which refers to the number of thousands in a milliliter. Is that good? Maybe.\n\nWe think that most people should have a value of 4.5 or so, but there's no real meaning to the relative value. Six isn't better than nine, or vice versa.\n\nLet's say you get a 10.5, which is slightly outside the normal range, are you sick? I don't know. White blood cell levels can be affected by so many things, like infections, allergies, or even stress. Do you have symptoms? Do you have other issues? If someone got this value without any other data, I'd have no idea what to do with it - you have to interpret it in context. And that can't be done by a lay-person quarterly.\n\nThis is why I teach residents and medical students never, ever to order a blood test unless they are looking for a specific problem. Do you think the patient's anemic? Then it makes sense to check a hematocrit value, which is the number of red blood cells. Are you worried they might have diabetes? Then you should check a glucose value. But getting these tests in a vacuum is rarely helpful at all.\n\nThis leads to the second problem. When a lab test picks up something that isn't real, it's called a false positive. It's a lab value that's abnormal, but there really isn't a health issue. When someone is healthy, an abnormal value is much more likely to be a false positive, than a true positive.\n\nThis is especially true when a test has a low specificity. And you really should have watched the episodes on sensitivity, specificity, and Bayesian analysis already. They're great. Go ahead, I'll wait.\n\nSpecificity is a test characteristic which refers to the proportion of people who are healthy who have a negative test. If it's low, then it means that too many healthy people are having a positive test. A random blood test would have a very low specificity, because an abnormal value would have a disproportionately high probability of being wrong.\n\nThis leads to the third problem. What do you do with the abnormal value? As a mentor once said to me, \"Ordering a lab test is like picking your nose in public. If you find something, you better know what you're going to do with it.\"\n\nMost people, even physicians, have a hard time ignoring \"abnormal\" values. They want to work them up. This leads to excess testing, potential harm, and a lot of money wasted. False positives are just that: false.\n\nYou wind up on what a colleague of mine likes to refer to as a diagnostic odyssey, where you chase abnormal value after abnormal value, and never get to the end. I will give you an anecdote to illustrate this. \n\nWhen I was in medical school, I had some belly pain that was pretty bad. I was even admitted to the hospital, which was overkill, and the pain resolved overnight. I was absolutely fine the next day. But since I was a medical student, they didn't want to miss anything. So I got all these extra tests I didn't need caus
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