The Body of Evidence

Chris and Jonathan speak to Ken Milne, the host of the Skeptics’ Guide to Emergency Medicine and a physician who practices rural emergency medicine in Ontario. What is it like treating patients away from major urban centres? It may actually be better in some ways! Also, the trio tackles the unfolding crisis in which Canadian emergency departments are temporarily closing due to a lack of proper resources. When doctors complain they lack beds, they don’t mean furniture. (2:06) The Batdoc and the Flash (2:50) What is rural emergency medicine? (19:52) ER vs. Scrubs vs. M*A*S*H vs. House, MD (24:45) The crisis in Canada’s emergency medicine departments (48:48) The future of our healthcare system   * Theme music: “Fall of the Ocean Queen“ by Joseph Hackl. To contribute to The Body of Evidence, go to our Patreon page at: http://www.patreon.com/thebodyofevidence/. Patrons get a bonus show on Patreon called “Digressions”! Check it out!    Links: 1) Ken’s website: https://thesgem.com/ 2) Ken’s Twitter profile: https://twitter.com/TheSGEM  

Exceptionally, we are releasing this month's patron-only bonus episode, Digressions, on the main feed. Chris answers a patron's question about fever delirium (is that really a thing or a Hollywood invention?), and we dig into a paper that claims to show that a cheap diabetes drug, metformin, can be used to prevent long COVID. We do this type of bonus episode every month for our patrons. If you would like to contribute to the show and gain access to future Digressions (as well as our extensive back catalogue of patron-only bonuses), sign up at Patreon: https://www.patreon.com/thebodyofevidence/overview Thank you!

What does the body of evidence say on fevers and whether or not we should treat them? Plus: more and more children are getting invasive streptococcal disease, and Chris fulfills two dreams of his: to become Dr. House and to write a book! Block 1: (1:47) Fever: what a fever is; the role the hypothalamus plays; why we shiver Block 2: (7:36) Fever: why fevers start; whether high fevers mean a worse condition; whether fevers help you fight an infection; febrile seizures; whether you should treat a fever; what a normal body temperature is; where you should stick that thermometre Block 3: (22:32) A rise in cases of invasive streptococcal disease in children Block 4: (32:21) Chris becomes House, MD. Play along!   * Jingle by Jillian Correia of Roctavio Canada * Theme music: “Fall of the Ocean Queen“ by Joseph Hackl * Assistant researcher: Nicholas Koziris   To contribute to The Body of Evidence, go to our Patreon page at: http://www.patreon.com/thebodyofevidence/. To make a one-time donation to our show, you can now use PayPal! https://www.paypal.com/donate?hosted_button_id=9QZET78JZWCZE Patrons get a bonus show on Patreon called “Digressions”! Check it out!   References: 1) XKCD cartoon on killing cancer cells: https://xkcd.com/1217/ 2) Meta-analysis on the risks and benefits of fever reduction in adults: https://pubmed.ncbi.nlm.nih.gov/35820685/ 3) Prognosis of febrile seizures in children: https://pubmed.ncbi.nlm.nih.gov/18692714/ 4) The use of fever medication to prevent recurrent febrile seizures in children: a) https://pubmed.ncbi.nlm.nih.gov/23702315/ b) https://publications.aap.org/pediatrics/article/142/5/e20181009/38533/Acetaminophen-and-Febrile-Seizure-Recurrences?autologincheck=redirected# c) https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003031.pub3/full 5) Normal variation in body temperature: https://www.bmj.com/content/359/bmj.j5468 6) Diagnostic accuracy of ear thermometers: https://pubmed.ncbi.nlm.nih.gov/32398036/ 7) CBC’s report on streptococcal disease in Waterloo, Ontario: https://www.cbc.ca/amp/1.6847676 8) The Medscape Emergency Medicine Case Challenge: https://reference.medscape.com/viewarticle/855744   It’s Not Twitter, But It’ll Do: 1) Jonathan’s article on the Big Pharma gambit: https://www.mcgill.ca/oss/article/medical-critical-thinking-health-and-nutrition/what-big-pharma-accusation-gets-right-and-wrong-about-drug-industry 2) Conspirituality: How New Age Conspiracy Theories Became a Public Health Threat: https://www.penguinrandomhouse.ca/books/713402/conspirituality-by-derek-beres-matthew-remski-and-julian-walker/9781039005532 3) Chris’ Gazette article on coronary artery calcium: https://montrealgazette.com/opinion/columnists/christopher-labos-calcium-deposits-in-the-arteries-not-always-a-worry 4) Chris wrote a book called Does Coffee Cause Cancer? Pre-order it now! https://ecwpress.com/products/does-coffee-cause-cancer?_pos=1&_sid=e672b52c1&_ss=r  

Jonathan and Chris speak to Julie Robitaille, a Ph.D. student investigating endocrine disruptors in waste water and the president of the student committee of the Intersectoral Centre for Endocrine Disruptors Analysis. We’ve all heard of them: chemicals that mimic hormones and that are found in everyday products. What are they doing to human health? Many of these endocrine disruptors play important roles in the products we buy, but what we are learning about many of them makes us wonder why they have been so poorly studied given their ubiquity. Should you avoid BPA in plastic? What if its replacement is worse? (1:11) What the endocrine system is (6:06) What endocrine disruptors are (7:00) Julie’s academic background (8:19) The role of plastic in our lives (10:02) Why we use BPA and what we know about its risk (14:38) The difficulty of studying the effects of endocrine disruptors in humans and other potential culprits of ill health (16:58) What the contraceptive pill does to fish (20:49) The public discourse on endocrine disruptors (23:07) Banning endocrine disruptors and the problem with current regulatory approaches (29:56) How to avoid endocrine disruptors when shopping and what we know about paper receipts (33:30) Some compounds have a reason to be there. Others, not so much. (37:25) Who is most vulnerable to the effects of endocrine disruptors   * Theme music: “Fall of the Ocean Queen“ by Joseph Hackl. To contribute to The Body of Evidence, go to our Patreon page at: http://www.patreon.com/thebodyofevidence/. Patrons get a bonus show on Patreon called “Digressions”! Check it out!   Links: 1) The website of the Intersectoral Centre for Endocrine Disruptor Analysis: https://www.ciape-iceda.ca/?lang=en 2) The Centre’s Facebook page: https://www.facebook.com/ciape.iceda/ 3) The Centre’s Twitter account: https://twitter.com/CIAPE_ICEDA 4) The McGill study on BPS migrating from labels into food: https://www.mcgill.ca/newsroom/channels/news/fresh-produce-contaminated-toxic-bpa-chemicals-found-food-labels-study-finds-346889  

What does the body of evidence say on the topic of gluten, celiac disease, and non-celiac gluten sensitivity? Plus: a puzzling finding in nutritional epidemiology is painted as a conspiracy, and the FDA is getting sued by people who claim the abortion drug mifepristone was wrongly approved… twenty years ago. Block 1: (2:26) Gluten: what gluten is, what celiac disease is, whether or not it’s an allergy, the genetic cause, the solution, and how to test for it Block 2: (10:04) Gluten: gluten sensitivity (NCGS) and other explanations for its symptoms, including FODMAPs Block 3: (26:12) A mystery for the ages: is ice cream… good for you? Block 4: (43:53) The lawsuit against the abortion drug mifepristone   * Jingle by Joseph Hackl * Theme music: “Fall of the Ocean Queen“ by Joseph Hackl * Assistant researcher: Nicholas Koziris   To contribute to The Body of Evidence, go to our Patreon page at: http://www.patreon.com/thebodyofevidence/. To make a one-time donation to our show, you can now use PayPal! https://www.paypal.com/donate?hosted_button_id=9QZET78JZWCZE Patrons get a bonus show on Patreon called “Digressions”! Check it out!   Jingle Lyrics: FODMAPs! Woo-oo! It’s not gluten, it really is FODMAPs! Woo-oo! Unless you have celiac, it’s really FODMAPs! Woo-oo!   F-f-f fructose, lactose, fructans Found in bread and dairy and fruits If you feel ill, just avoid these   FODMAPs! Woo-oo! Some foods have a lot of them, it’s  FODMAPs! Woo-oo! Other foods are low in them, it’s FODMAPs! Woo-oo!   References: 1) Alan Levinovitz’s The Gluten Lie: https://www.goodreads.com/book/show/23280245-the-gluten-lie 2) Cancer incidence in people with celiac disease: https://doi.org/10.1053/gast.2002.36585 3) Testing for gluten-related disorders: https://doi.org/10.1155/2011/642452 4) Trends in gluten avoidance: https://doi.org/10.1016/j.mayocp.2016.10.012 5) First gluten sensitivity trial mentioned: https://doi.org/10.1038/ajg.2010.487 6) Second gluten sensitivity trial mentioned, with FODMAPs: https://doi.org/10.1053/j.gastro.2013.04.051 7) Crossover trial of non-celiac gluten sensitivity in children: https://doi.org/10.1038/ajg.2017.483 8) The Atlantic article on the ice cream problem: https://www.theatlantic.com/magazine/archive/2023/05/ice-cream-bad-for-you-health-study/673487/ 9) Scientific American’s write-up on the legal case surrounding mifepristone: https://www.scientificamerican.com/article/mifepristone-is-safe-a-court-ruling-reducing-access-to-it-is-dangerous/   It’s Not Twitter, But It’ll Do: 1) Jonathan’s interview in the Tribune: https://www.thetribune.ca/sci-tech/combatting-pseudoscience-with-reason-and-rationality-030423/ 2) Dr. Jonathan Howard’s book, We Want Them Infected: https://redhawkpublications.com/We-Want-Them-Infected-p547021769 3) Chris’ article on the misguided use of honey to treat allergies: https://montrealgazette.com/opinion/christopher-labos-no-eating-honey-wont-help-your-seasonal-allergies   Music Credits: The following music was used for this media project: Music: Wish For Victory by MusicLFiles Free download: https://filmmusic.io/song/8102-wish-for-victory License (CC BY 4.0): https://filmmusic.io/standard-license  

Chris and Jonathan speak to Professor Carla Sharp, the director of both the Developmental Psychopathology Lab and the Adolescent Diagnosis Assessment Prevention and Treatment Center at the University of Houston. Glenn Close in Fatal Attraction. Benedict Cumberbatch’s Sherlock. Batman’s rogues gallery. Hollywood loves to both glamourize and stigmatize psychopathology, including personality disorders. But what do we really know about personality disorders? Does histrionic personality disorder even exist? Why is one such disorder called “borderline?” Is psychopathy a real diagnosis? And can we really put people and all their complexities into such clear boxes as the ten official personality disorders? (2:03) How Hollywood exploits mental illness and how the diagnosing of personality disorders is shifting (11:00) Psychopaths and the 10 personality disorders (14:14) What even is a personality disorder? (19:19) The origin of histrionic personality disorder (21:00) The difference between schizophrenia and schizoid/schizotypal personality disorders (23:39) When a personality disorder emerges and the differences between men and women (27:38) Personality disorders run in families and parents can make a real difference (35:47) Personality disorders are sometimes misdiagnosed as autism (37:26) Are people with antisocial personality disorder drawn to surgery?  (41:03) Why is it called “borderline personality disorder?” (44:29) Does multiple personality disorder exist? (47:00) Do personality disorders improve over time?   * Theme music: “Fall of the Ocean Queen“ by Joseph Hackl. To contribute to The Body of Evidence, go to our Patreon page at: http://www.patreon.com/thebodyofevidence/. Patrons get a bonus show on Patreon called “Digressions”! Check it out!   Links: 1) Carla Sharp’s review of personality disorders in the New England Journal of Medicine: https://doi.org/10.1056/nejmra2120164 2) The National Education Alliance for Borderline Personality Disorder: https://www.borderlinepersonalitydisorder.org/ 3) The Sashbear Foundation: https://sashbear.org/ 4) Emotions Matter: https://emotionsmatterbpd.org/  

What does the body of evidence say on whether violent video games cause violence in real life? Plus: a Slate article argues that long COVID just isn’t that bad, and can you biopsy the prostate without going up the bum? Block 1: (2:18) Violent video games: what the AAP and APA say about violent video games; court case; the review at the heart of the debate; what is violence; the evolution of video games Block 2: (8:25) Violent video games: the Bobo doll experiments; measuring aggressive behaviour and attitudes; little data on children; what we don’t know; what Chris would do Block 3: (24:20) Long COVID Comes Into the Light Block 4: (43:53) A new way of getting a prostate biopsy / The Last of Us’ bad science   * Jingle by Jillian Correia of Roctavio Canada * Theme music: “Fall of the Ocean Queen“ by Joseph Hackl * Assistant researcher: Nicholas Koziris   To contribute to The Body of Evidence, go to our Patreon page at: http://www.patreon.com/thebodyofevidence/. To make a one-time donation to our show, you can now use PayPal! https://www.paypal.com/donate?hosted_button_id=9QZET78JZWCZE Patrons get a bonus show on Patreon called “Digressions”! Check it out!   References:   1) The American Academy of Paediatrics statement on video games: https://publications.aap.org/pediatrics/article-abstract/108/5/1222/63763/Media-Violence?redirectedFrom=fulltext?autologincheck=redirected 2) The American Psychological Association’s 2015 Task Force report: https://psycnet.apa.org/record/2017-07146-003 3) Brown v. Entertainment Merchants Association: https://en.wikipedia.org/wiki/Brown_v._Entertainment_Merchants_Association#cite_note-49 & http://mediacoalition.org/mediaimages/Schwarzenegger%20v.%20EMA_Social%20Science%20Brief_09.17.10.pdf 4) The Bobo doll experiments: https://simplypsychology.org/bobo-doll.html 5) Long COVID Comes Into the Light: https://slate.com/technology/2023/03/long-covid-symptoms-studies-research-variant.html 6) Reaction to Jeff Wise’s previous article on long COVID: https://www.meaction.net/2022/11/10/elementor-59066/ 7) Request for the retraction of the Slate article: https://docs.google.com/document/d/1QqVjAIvklDhp7BgCKsaz3ftiful9utUKNBDeBGxwxg4/edit 8) Transperineal prostate biopsies: https://www.medscape.com/viewarticle/989696?ecd=WNL_confwrap_230322_MSCPEDIT&uac=207389HY&impID=5267564#vp_2   It’s Not Twitter, But It’ll Do:   1) Jonathan interviewed for The Skeptic Zone: https://youtu.be/iHZ8z9eigK8 2) Jonathan’s article on 911 call analysis: https://www.mcgill.ca/oss/article/critical-thinking/caller-killer-911-call-analysis-cant-give-you-right-answer 3) Chris on CBC’s morning show about Candida auris: https://www.cbc.ca/player/play/2187559491808  

Jonathan and Chris speak to Dr. Justin Sanders, the director of palliative care at McGill, on the topic of medical assistance in dying (MAiD). What are the arguments for and against MAiD? And what do we make of the thornier aspects of euthanasia, like its intersection with disability rights and the conflict of interest at the heart of a government that funds both assisted suicide and palliative care?   (2:30) What is palliative care? (10:21) The history of MAiD in Canada (15:34) Sedation vs. MAiD (19:30) The need for control at the end of life (21:15) The arguments for MAiD (23:34) Feeling like a burden (27:33) MAiD vs. disability rights (36:20) The social safety net and the government’s conflict of interest (41:55) Most people don’t want to die (44:22) MAiD for mental illness (49:25) Tenfold increase in Canadians receiving MAiD     * Theme music: “Fall of the Ocean Queen“ by Joseph Hackl.   To contribute to The Body of Evidence, go to our Patreon page at: http://www.patreon.com/thebodyofevidence/.   Patrons get a bonus show on Patreon called “Digressions”! Check it out!     Links: 1) Carter v. Canada: https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/14637/index.do 2) Information on medical assistance in dying in Canada: https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html 3) CTV’s coverage of the expansion into mental illness: https://www.ctvnews.ca/politics/the-issue-of-expanding-assisted-dying-eligibility-has-already-been-decided-senator-1.6313740 4) The 2021 report on MAiD services in Canada: https://www.canada.ca/en/health-canada/services/medical-assistance-dying/annual-report-2021.html  

What does the body of evidence say on erectile dysfunction? Plus: why was a woman in need of a heart transplant was denied the procedure, and what happens when you have advanced HIV and you catch mpox?   Block 1: (2:06) Erectile dysfunction: definitions, how common it is, causes   Block 2: (9:13) Erectile dysfunction: the psychological angle, figuring out what’s causing it, treatments, the blue haze effect, cardiac risk, prevention, all-natural sexual enhancers   Block 3: (25:38) Transplant denial because of refusal to get vaccinated   Block 4: (35:31) Mpox + advanced HIV = bad   * Theme music: “Fall of the Ocean Queen“ by Joseph Hackl * Assistant researcher: Nicholas Koziris   To contribute to The Body of Evidence, go to our Patreon page at: http://www.patreon.com/thebodyofevidence/.   To make a one-time donation to our show, you can now use PayPal! https://www.paypal.com/donate?hosted_button_id=9QZET78JZWCZE   Patrons get a bonus show on Patreon called “Digressions”! Check it out!     References:   1) The Massachusetts Male Aging Study: https://pubmed.ncbi.nlm.nih.gov/10647654/   2) Efficacy and side effects of sildenafil: https://doi.org/10.1001/archinte.162.12.1349   3) Safety of sildenafil (Viagra) after heart attack: https://doi.org/10.1016/j.amjcard.2003.09.030   4) Addition of testosterone for erectile dysfunction: https://doi.org/10.7326/0003-4819-157-10-201211200-00004   5) Natural health products contaminated with Viagra: https://jamanetwork.com/journals/jama/article-abstract/196675   6) Mother denied transplant due to vaccination status: https://www.news.com.au/lifestyle/health/health-problems/no-jab-no-heart-mother-denied-transplant-due-to-vaccination-status/news-story/5580aca526744d15fe1a25e595ef7d76   7) Mpox in people with advanced HIV infection: https://doi.org/10.1016/S0140-6736(23)00273-8   8) CBC coverage of the mpox study: https://www.cbc.ca/news/health/15-per-cent-death-rate-severe-lesions-reported-in-patients-with-mpox-alongside-advanced-hiv-study-1.6756429     It’s Not Twitter, But It’ll Do:   1) Jonathan interviewed for Fast Company on the Liver King: https://www.fastcompany.com/90839190/liver-kings-fall-ancestral-living-need-a-new-dad   2) Jonathan writing about digital amnesia: https://www.mcgill.ca/oss/article/critical-thinking-technology/digital-amnesia-has-been-exaggerated   3) Jack Lawrence’s Skeptics in the Pub talk on ivermectin: https://youtu.be/1Nvp-zyLfaQ   4) Chris’ article on biotin: https://montrealgazette.com/opinion/columnists/christopher-labos-take-biotin-for-most-better-to-save-your-money  

Chris and Jonathan talk to Vincent Denault, who researches nonverbal communication. Are there human lie detectors? Is someone lying when their eyes are shifty? And more importantly, do people in positions of power believe the pseudoscience of lie detection? (2:54) What is nonverbal communication? (7:09) Vincent thought he could become a human lie detector (9:45) Is there a clear way to know when someone is lying? (18:30) Lie to Me and The Mentalist (22:53) Hollywood’s love affair with body language (30:14) Is there a dictionary for nonverbal communication? (31:26) Reading politicians’ body language (34:57) How good are we at detecting lies? (36:00) The polygraph (44:08) Are judges, lawyers and cops aware of this BS? (49:31) Nonverbal communication in healthcare (52:51) Let’s not throw the baby out with the bathwater   * Theme music: “Fall of the Ocean Queen“ by Joseph Hackl. To contribute to The Body of Evidence, go to our Patreon page at: http://www.patreon.com/thebodyofevidence/. Patrons get a bonus show on Patreon called “Digressions”! Check it out!   Links: 1) Vincent’s website: http://vincentdenault.ca/ 2) Vincent on LinkedIn: http://www.linkedin.com/in/vincedenault/