You thought your toddler was a handful. Have you heard of the She-Hulk toddler? You will learn what GPA means in a patient chart and how menstruation can be used to judge the health of a country, while Chris tries to figure out what is wrong with this tiny but ferocious patient.

Also: an announcement that will change The Body of Evidence forever….

Warning: this episode contains medical discussion of genitals.

A Block: The Case of the She-Hulk Toddler

(0:58) She has the strength of two toddlers! Also, puberty seems to have kicked in. What is going on with her?

B Block: Announcement

(32:29) Chris and Jonathan announce something.

* Theme music: “Fall of the Ocean Queen“ by Joseph Hackl

* Assistant researcher: Aigul Zaripova

To contribute to The Body of Evidence, go to our Patreon page at: http://www.patreon.com/thebodyofevidence/.

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Jonathan and Chris speak to Dr. Andrea Love, a microbiologist, immunologist, science communicator, and the director of the American Lyme Disease Foundation. The tick-borne illness known as Lyme disease is everywhere: on the news, on social media… but is it really near you? Dr. Love separates facts from fiction when it comes to Lyme disease, both the acute infection and the alleged chronic condition.

Correction (2024/07/24): Dr. Love wanted to correct a statement she made. She said that tick-borne relapsing fever does not occur in the U.S., but she meant that it did not occur in the eastern U.S. It does occur in western U.S. states but is caused by a different Borrelia species and spread by different ticks, so there is no overlap with Lyme disease.

* 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!

1) Andrea Love’s Substack, Immunologic: https://www.immunologic.org

2) American Lyme Disease Foundation website: https://aldf.com

Chris and Jonathan speak to Dr. Ian Hussey, the Chief Recommender for the ERROR project. It turns out that scientific papers are not flawless: they can contain mistakes. What happens when people are paid to go and find these mistakes? You’re about to find out!

* 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!

1) The ERROR project website: https://error.reviews/

What does the body of evidence say on LASIK, the use of lasers to correct vision? Plus: many men on PreP are abandoning condoms as STIs are becoming more common, and Chris tells us if krill oil can cure arthritis of the knee. Also, Jonathan briefly imitates Alex Jones.

A Block: LASIK

(0:59) How lasers are used in medicine; LASIK and its cousins; how to choose; effectiveness, satisfaction, and side effects.

B Block: HIV PrEP and STIs

(28:18) How does pre-exposure prophylaxis against HIV works, and what is simultaneously happening with condom use (going down) and rates of STIs (going up). Also, what is Doxy-PEP?

C Block: Krill Oil for Knee Osteoarthritis

(44:45) An Australian trial of krill oil for arthritis of the knee came to the conclusion that… well, what do you think?

* Theme music: “Fall of the Ocean Queen“ by Joseph Hackl

* Assistant researcher: Aigul Zaripova

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:

Comparisons of LASIK and its related techniques:

1) DOI: 10.1371/journal.pone.0174810

2) DOI: 10.1016/j.jcrs.2007.07.026

3) DOI: 10.1136/bjo.2007.131748

4) DOI: 10.1016/j.ajo.2017.03.013

5) DOI: 10.1002/14651858.CD012687.pub2

Outcomes from LASIK:

6) DOI: 10.1016/s0161-6420(99)00148-7

7) DOI: 10.1016/s0161-6420(00)00528-5

8) doi:10.1001/jamaophthalmol.2016.4587

UpToDate entries pertaining to HIV, PrEP, and Doxy-PEP:

9) https://www.uptodate.com/contents/hiv-pre-exposure-prophylaxis

10) https://www.uptodate.com/contents/primary-care-of-gay-men-and-men-who-have-sex-with-men

11) https://www.uptodate.com/contents/prevention-of-sexually-transmitted-infections

12) https://www.uptodate.com/contents/hiv-infection-risk-factors-and-prevention-strategies

13) Statistics Canada survey of sexually active 15-to-24-year-olds: https://www150.statcan.gc.ca/n1/pub/82-003-x/2020009/article/00001-eng.htm

14) Increased rates of STIs according to Public Health Agency of Canada: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/report-sexually-transmitted-infection-surveillance-canada-2019.html

15) Systematic review and meta-analysis on sexual risk behaviour in men who use PrEP: https://doi.org/10.1093/cid/ciy182

16) Australian trial on krill oil for knee osteoarthritis: https://doi.org/10.1001/jama.2024.6063

It’s Not Twitter But It’ll Do:

1) Jonathan’s article about Lumina to avoid dental cavities: https://www.mcgill.ca/oss/article/medical-critical-thinking-technology/reports-death-dental-cavities-are-greatly-exaggerated

2) The Skeptics’ Dictionary: https://www.skepdic.com/

Jonathan and Chris speak to Dr. Matthew Cameron, a local anesthesiologist who does a lot more than local anesthesias! They discuss the ins and outs of putting people to sleep; how safe epidurals really are; and whether or not you need to worry about waking up paralyzed in the middle of an operation (spoiler alert: no). Also, Jonathan is told about “blood patches” for the first time and can’t believe this is a real thing.

* 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!

What does the body of evidence say on lupus, the autoimmune disease that famously imitates so many other illnesses? Plus: a new study shows that Tylenol in pregnancy is not associated with neurodevelopmental problems, and Chris revisits the topic of red meat following a listener’s question.

A Block: Lupus

(0:57) How common lupus is; what may be causing it; what lupus looks like; how complicated its diagnosis is; what treatment options exist

B Block: Tylenol in Pregnancy

(34:27) Is Tylenol use in pregnancy really responsible for autism, ADHD, and intellectual disability? A new study says no.

C Block: Red Meat

(50:13) Are the harms of eating red meat regularly nowhere near as bad as we were told?

* Theme music: “Fall of the Ocean Queen“ by Joseph Hackl

* Assistant researcher: Aigul Zaripova

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:

Lupus epidemiology:

1) https://www.lupuscanada.org/living-with-lupus/what-is-lupus/

2) https://doi.org/10.1177/096120339500400303

3) https://doi.org/10.1038/s41584-021-00668-1

Causes of lupus:

4) DOI: 10.1002/art.22510

5) DOI: 10.7326/0003-4819-142-12_part_1-200506210-00004

6) https://doi.org/10.1097/bor.0b013e32833c6297

7) https://doi.org/10.1016/0190-9622(90)70020-i

8) https://doi.org/10.1136/ard.2007.084582

9) DOI: 10.1177/0961203306069346

What lupus looks like in a patient:

10) https://dermnetnz.org/topics/cutaneous-lupus-erythematosus

11) https://dermnetnz.org/topics/discoid-lupus-erythematosus

12) doi: 10.2147/CCID.S269288

13) https://dermnetnz.org/topics/raynaud-phenomenon

14) DOI: 10.1097/01.md.0000091181.93122.55

15) DOI: 10.1002/art.39070

How to manage lupus:

16) DOI: 10.1136/annrheumdis-2015-207726

17) https://pubmed.ncbi.nlm.nih.gov/12784392/

18) DOI: 10.1016/j.jaad.2014.12.025

19) https://doi.org/10.1016/j.autrev.2017.02.005

20) DOI: 10.1191/096120398678919778

21) https://doi.org/10.1136/ard.2008.101766

22) DOI: 10.1056/NEJMoa035471

23) https://doi.org/10.1191/0961203305lu2039oa

24) DOI: 10.1002/14651858.CD010668.pub2

25) DOI: 10.1002/art.27233

26) DOI: 10.1002/art.34359

27) DOI: 10.1136/lupus-2018-000284

28) DOI: 10.1056/NEJMoa1912196

29) https://ash.confex.com/ash/2023/webprogram/Paper180547.html

30) https://doi.org/10.1016/C2009-0-02062-5

31) Study on Tylenol in pregnancy: https://doi.org/10.1001/jama.2024.3172

It’s the case of the woman who was too tired to “par-tay!” What is afflicting her? It’s something that we don’t about enough. Plus: what is happening with avian flu and should you keep using Q-tips in your ears to remove earwax?

A Block: The Case of the Woman Who Was Too Tired to Party

(0:58) A woman falls asleep at work and has a constant headache. It also took her much longer than four years to complete her undergrad. What could be causing this?

B Block: Avian Flu

(25:36) An update on the avian flu situation

C Block: Earwax

(36:03) What should you do about your earwax? Use it as lip balm? Actually….

* Theme music: “Fall of the Ocean Queen“ by Joseph Hackl

* Assistant researcher: Aigul Zaripova

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) Inspection Canada webpages on avian flu: https://inspection.canada.ca/animal-health/terrestrial-animals/diseases/reportable/avian-influenza/facts-about-avian-influenza/eng/1356193731667/1356193918453 & https://inspection.canada.ca/animal-health/terrestrial-animals/diseases/reportable/avian-influenza/latest-bird-flu-situation/hpai-in-livestock/eng/1711895796746/1711895797730

2) Nature News Explainer on avian flu: https://www.nature.com/articles/d41586-024-01036-1

3) WHO surveillance page on avian flu: https://www.who.int/westernpacific/wpro-emergencies/surveillance/avian-influenza

4) Case report on the man who caught H5N1: https://www.cdc.gov/ncird/whats-new/human-infection-H5N1-bird-flu.html