Weird Medicine: The Podcast - 416 - Pressure Drop on You (in mmHg)

Episode Date: July 30, 2020

Dr Steve and Tacie discuss more mask wearing shenanigans, SARS-CoV-2 aerosol transmission and other modes, how BP is measured, acetaminophen vs ibuprofen, and more. PLEASE VISIT: stuff.doctorsteve.com (for all your online shopping needs!) simplyherbals.net (While it lasts!) noom.doctorsteve.com (lose weight, gain you-know-what) Get Every Podcast on a Thumb Drive (all this can be yours!) hellofresh.com/weird80 (America’s #1 meal kit and get $80 off!) feals.com/fluid (50% off your first order of premium CBD sent to your home!) Learn more about your ad choices. Visit podcastchoices.com/adchoices

I've got diphtheria crushing my esophagus. I've got Ebola spripping from my nose. I've got the leprosy of the heartbound, exacerbating my imbettable woes. I want to take my brain out, clasped with the wave, an ultrasonic, ecographic, and a pulsating shave. I want a magic pill. All my ailments, the health equivalent of citizen cane, and if I don't get it now in the tablet. I think I'm doomed and I'll have to go insane. I want a requiem for my disease. So I'm

paging Dr. Steve. It's weird medicine, the first and still only uncensored medical show in the history broadcast radio, now a podcast. I'm Dr. Steve with my wife Tacey. What did we say? Oh, did you turn your microphone off? Yes, you did. My wife Tacey, queen of the WebEx. I am the Queen of WebEx and assume. Thank you for joining us. You're welcome. This is a show for people who would never listen to a medical show on the radio or the internet. If you've got a question, you're embarrassed to take to a regular medical provider.

If you can't find an answer anywhere else, give us a call at 347-7-66-4-323. That's 347 Pooh Head. Visit our website at Dr. Steve.com for podcast, medical news and stuff you can buy or go to our merchandise store at cafepress.com slash weird medicine. And most importantly, we are not your medical providers. Nope. Take everything you hear with a grain of salt. Don't act on anything you hear on this show without talking it over with your doctor, nurse practitioner, physician assistant, clinical laboratory scientist, registered dietitian or whatever. Are we their medical providers?

Tice. Nope. Okay, very good. Check out stuff. Dot, Dr.steve.com. Stuff, stu-f, dot, Dr. Steve.com. Get you some stuff. For all your, hence the name, for all of your Amazon needs.

please use that link whenever you can. You can just click right through to Amazon or you can scroll down and see all the different products we talk about on this show. And don't forget Noom, N-O-O-M dot Doctrsteve.com. We're back on it and doing insanely well. Noom has not ever failed me, and it's not a diet. It's a psychology app.

There's accountability. You've got a counselor. You've got a group. You've got a group counselor. It's free for two weeks. and 20% off if you decide to do it, and it's just a three-month program, so it's not very expensive at Noom, N-O-O-O-M dot Dr. Steve.com. I'm on Noom, and I'm drying out. Yeah.

Except for on the weekends, because that's ridiculous. Well, and I showed my counselor my weight graph, because I have a withings, and they are going to be a sponsor of the show pretty soon, too, a withing scale, and you step on it. It communicates through Wi-Fi with your N-M app, and then, just plots your weight. And I showed her, it was hilarious. My weight had come down during the week and go up on the weekend, come down on the week and go up on the weekend. And I was basically, for a while there, it's kind of stagnant because I was doing great

during the week and just blowing it out my, you know, you know what on the weekend. So I have modified that because I had that ability to look at it and to determine where I was not helping myself, and my counselor was very helpful in that. So there you go. And if you want one of these face masks... What are you doing? This is a weird medicine COVID-19 face mask taste. Not guaranteed to do anything except make you look cool.

Or stupid. What do you think of that? I think that's... I think it looks awesome. Well, I can tell you I don't have one. Well... But I'm good. No, don't...

There you go. Now you do. No, I'm good. You can get a COVID-19, not guaranteed to do anything. Weird Medicine Face Mask with the Weird Medicine logo on it by going to Dr. Steve.com. And for 30 bucks, you get the mask for free. You get a 32-gig hard drive with every show to date on there,

including the laugh button shows and the riot cast shows. And if you ask nicely, I'll even give you access to the, Dropbox file for a week that has all of the Serious XM stuff on it. And all you have to do is go to Dr.steve.com in the middle of the page. It just says, get every show on a thumb drive. Just click on that, and it's right there. And I'll send it out to you. And you get a little other extra special thing, which is basically autographed cartoon of you and me.

Me? Yep. Yep, you're on it. I haven't seen that. It's right here. And then I crossed out Scott's face and put ugh on some of them. There you go. And then it's got Lady Diagnosis on there.

Who we had a delightful weekend with or Sunday with. Is that my real autograph? Yes. Yeah, you did that. Oh. We've got a lot of phone calls, but you had a couple of things that you wanted to talk about today. I did my homework today. Yeah, awesome.

So just a... Give yourself a bill. There you go. Just a little reminder that... not to be a douchebag and to wear your mask because a Texas representative, Louis Gohmert. I'm giving you that for what you said. Okay, yep. Refuse to wear a mask.

Test positive. This is not made up shit, people. I don't want him to be ill. No, of course not. And I don't know how old he is, but if he's, you know, been around for a while, he's probably my age, so he's at a high-risk group. So, listen, if you're in a high-risk group, at least protect yourself. How about protect others? It's not just about you.

Wear a mask. Yeah, that's right. My mask protects you. Your mask protects me. So even if he were wearing a mask, somebody around him wasn't. But there's lots of ways. And we've got a bunch of questions about Airborne versus Droplet this week. So we'll defer.

We'll table that discussion until we get to those questions. All right. What else you got? Former FDA head, Scott Goble-B-B-B-L-B-L-B-L-B, says hydroxychloroquine. How do you spell that name? G-O-T-L-I-E-B. Oh, Gottlieb. Yeah, whatever.

Okay. Says hydroxychloroquine doesn't work. And Dr. Fauci? Is that how he said? Yep, Fauci. Also said this. Yeah. Okay.

But then Dr. Emanuel, you wanted to talk about her because they're arguing in the media. Oh, didn't know that. Well, that's who you were talking about the, the, uh, physicians, front-line doctors. Oh, doctor on front lines. Man, it is all over my Facebook, and it is deleted every time it shows up. Yeah, it's called America's Frontline Doctors. It's very controversial.

They started, they did a press conference where Dr. Emmanuel, who is, I guess one of their leaders, or at least one of the spokespeople, said that she's treated 350 people with hydroxychloroquine, azithromycin, and zinc, and they all got better. And she's saying, we have a cure. Nobody needs to get sick. And then you got Fauci and other people saying it doesn't work. Well, the data, which, look, I'm not going to go into the politics of this because there's a lot of politics. A lot of politics involved.

And politics plus medicine equals what, tastes? I don't know. Oh, politics. Oh. If you add politics to medicine, all you get out the other end. of the equation is politics. There's, you know, so I'm interested in the science of medicine. Man, it is everywhere.

One girl even transposed what everybody said in that little video. And it was like pages, yes, pages and pages and page, thank you for a correctness. Sorry, I just want to make sure that she didn't, you didn't, okay, anyway. Yes, that's right. And so anyway, just pages and pages long. And I almost responded to this lady. Please don't put anything this long on Facebook. I mean, there's too much scrolling.

It's ridiculous. No one wants to look at a wall of words anywhere in their social media. I get a lot of questions on the Reddit, on our subreddit, and some of them are just so long. It's like, dude, I'm not, I can't read all of this. Just give me the TLDR. Way too lazy. So here's the thing. There are some prospective studies of hydroxychloroquine that were quite disappointing in their results.

And that's what we're interested in, isn't it? We're interested in data. We're interested in the truth. If I give 1,000 people hydroxychloroquine and 1,000 people a sugar pill, and it's not unethical at this point because we don't have any suspicion or data that shows that hydroxychloroquine is better than, standard treatment. So we would give hydroxychloroquine plus a sugar pill and standard treatment. Whatever that is. It could be remdesivir now and dexamethosone, whatever it happens to be. And then nobody knows. I don't know if you got it. The patient doesn't know. And at the end of

this trial, you decode all the numbers. And you can determine whether there's a statistically significant difference between the placebo arm and the treatment arm. And if there is, then you can maybe make a claim about it. So they've done some of these studies. People are arguing, well, they didn't do zinc plus azithromycin plus hydroxychloroquine because that's the thing that's sort of... Well, why haven't they done that then? Well, I think that one is being done in some places. If you go to clinical trials.gov, you can find different hydroxychloroquine studies that are still ongoing. But I just, I'm not counting hydroxychloroquine out just yet. And here's why. Henry Ford Hospital is, I think that's the hospital I was born in. But if it's not, I know it's

the one that when my dad worked for the automobile industry, he used to go have his executive physicals done at Henry Ford Hospital. This is not some slouchy, you know, operation. And they did a hydroxychloroquine study. I'm just going to read it to you. I've got the abstract here. This isn't the whole study. Oh, yes. Please don't read all that. The purpose of this study was to evaluate the role of hydroxychloroquine alone and in combination with azithromycin in hospitalized patients positive for COVID-19. Now, they didn't do the zinc arm. So there are already people out there that are most of them, you know, are not scientists. Some of them are say, well, then that's the study we're really interested in. I'm interested in seeing that study, too. So don't give me.

me wrong, but I'm going with the data that we have. This was a multi-center, which is good, retrospective, not so good, observational study, also not so good. So this does not have the power of a prospective, in other words, where you're looking forward with these patients rather than looking backward, and where you've controlled, you've controlled all the, as many variables as you can, and placebo controlled. But you can get some data from observational retrospective studies to let you know where to look to do your prospective studies because you can match these patients. Patient for patients, you got one with diabetes.

In this group that got hydroxychloroquine, we'll find one that didn't, that didn't get it and try to match them the best you can. So this is the Henry Ford Health System in Southeast Michigan, large six hospital integrated health system. Let me say I will call you back later. Consecutive patients hospitalized with COVID-related admission in the health system from March 10th, 2020 to May 2, 2020, were included. Only the first admission was included for patients with multiple admissions, good. All patients evaluated were 18 years of age and older and were treated as in-patients for at least 48 hours unless they expired within 24 hours. So these are all people that were sick enough to go into the hosp, but not so sick that they died within the first 24 hours.

So they got a receipt of hydroxychloroquine alone, hydroxychloroquine in combination with azithromycin, azithromycin alone, or neither. So there's four arms to this retrospective study, and they pretty much looked at everything. It doesn't mention zinc, sorry for the zinc fans out there. So the primary outcome was in hospital mortality. So when you're doing a study, you've got to decide what your outcome measure is going to be.

You know, what's your end point? What are you measuring for? Because it's not fair to say, well, we're going to look at in-hospital mortality and then find through the data that these people that took hydroxychloroquine had better erections and then saying, oh, well, that's an erection drug now. See, you'd have to do a separate study. That would give you enough information to say, well, that's an interesting finding. We can't make any claims about it, but we could do another study looking at the end point of meteor erections, for example. Okay. Does that make sense?

Well, you jumped far there. Well, no, on purpose, because I wanted to be something completely unrelated. Okay. Okay. So sometimes that kind of thing will come out of a study like this, but you can't make claims based on it because that's not what you were testing for. It's not what you were studying. But it can light a candle saying, hey, go down this road. That happened with seldenafil, speaking of erections.

Unless they're looking for that as a secondary. That's exactly right. If they identified it ahead of time, you're exactly right. So syldenafil, that's what happened with that. Sildenafil being the active ingredient in Viagra, they had initially developed it as a blood pressure drug, and we do use it for pulmonary hypertension now. But what they found is all these people that were in the test groups had these meaty erections, and they went, wow, this might be an impotence drug.

And then they had to go do the other studies that looked at prospectively compared to placebo with the endpoint being better erections. Then you have to decide, well, how do you measure that? Do you just go by what the guy says or is there an objective measurement that you, that kind of stuff? Okay. So endpoint choice is a big deal. So their primary outcome was in hospital mortality. So they had 2,541 patients. That's a lot.

mean total hospitalization time of six days. The median age was, oh, no, 64 years. That sounds familiar. I'll be 65 in what, two months? Yep. Eligible for Medicare. No, not eligible, actually, already signed up for Medicare. Oh, good for you.

Tacey used to make fun of me when I turned 50, and I would get things from AARP, and if she got the mail, she would write ha-ha in big letters in the front line and leave it for me. She's a shit. I can't wait until you start getting AARP letters. Okay, so overall, hospital mortality was 18.1 percent by treatment hydroxychloroquine plus azithromycin. Wait a minute. Wait, I'm having a heart. The way that they're reporting this.

Okay, well, let me skip forward. Primary cause of mortality was respiratory failure. No patient. Remember, we talked about Torsad de Poix. Everybody was worried, oh, gosh, if you give hydroxychloroquine with azithromycin, they're going to get Torsad de Poe. That's that weird heart rhythm. Yes. That I made the point of saying, even in methadone patients, it's like one in a million.

And when you're treating somebody for 10 days, the odds are almost zero. So they said when controlling for COVID-19 risk factors, treatment with hydroxychloroquine alone and in combination with azithromycin was associated with a reduction in COVID-19 associated mortality. And then they turned around and said correctly prospective trials are needed to examine this impact. I'm going to see if I can quickly tease out the numbers here. so that I can tell you, it looks like hydroxychloroquine plus azithromycin was 20%. Hydroxychloroquine alone, 13% azithromycin alone, 22% in neither drug, 26.4%. So in the hydroxychloroquine alone, it was exactly half.

Okay? So people who got nothing, a quarter of them died, and these are people who were sick enough to be in the hospital. and of the people that got hydroxychloroquine alone, 13% died. So, okay? So what were those two number differences? 26% and 13%. Okay. So 26% died with none of that, and 13% died if they got hydroxychloroquine alone.

Now, if you added azithromycin, It was 20%, so that was only a 6% decrease. Does it say if that's statistically significant? Okay, thank you. Oh, very good. Give yourself a bill. Let's see here. Well, it gave a confidence interval, but it didn't list statistical significance.

Oh, yeah. Okay, yes it does. P of 0.001 for 66% hazard ratio reduction. Yeah, so, yeah, so that was highly statistically significant. So that was one chance in a thousand that this would be by chance alone. Okay. Okay. So there you go.

So that is what all of the controversy is about. I am not counting out hydroxychloroquine. Don't get me wrong. The prospective data is not good, but it may be that there are just certain populations that hydroxychloroquine will be successful for. I'm still holding out for Favapyrovir, but the longer that it's taking to get the data out, I'm starting to, my enthusiasm is waning a little bit

just because I would have thought that if they had had massively awesome data in these studies, we would have heard about it by now. You were expecting that to come out when we were on vacation. That is correct. That is correct. So we are two weeks beyond where I thought we were going to have hard data on Favapyrivir. and now there are lots of studies undergoing the one in Egypt was completed and I don't know why they're not reporting you know the Remdesivir trial was stopped midway be oh let's talk a little bit about how independent monitors work so you know we talked about the placebo controlled trials where nobody can know what anything is right the patient can't know and the person giving it can't know if they're getting

placebo or active drug, but there are independent monitors who can know. And you need to have those, particularly in a drug like remdesivir, because you're looking for, are we killing people with this? Is there a statistically significant negative effect? Are we harming people doing this trial and they have to stop it? Or is it showing such a great positive effect that we have to stop it because now it becomes unethical for us to continue the placebo arm. And that's what happened with Remdesivir. Remdesivir's independent monitors halfway through the study said

you are showing a statistically significant improvement in the people who are getting remdesivir intravenously. You can no longer proceed with the placebo arm and it was terminated at that point. And that's why they don't have statistically significant data on mortality improvement with Remdesivir from that trial because they had to stop it so early. they didn't have enough people die, which is good. But they did show a numerical reduction in deaths, but they couldn't reach statistical significance because it was stopped so early.

Okay. Okay. All right. Other questions? Let's see. I know the website for America's frontline physicians, of which I would have thought I'm one of those, being on the front lines and all, was taken down, and their Facebook thing has been taken down.

And Dr. Emanuel has some interesting hypotheses about other things. And so I'm not saying anything. Like I said, I'm not getting into the politics. I'm just looking at the data. All right. So let's talk about school starting. See, I'm ambivalent about that. Kids transmission rates.

What do you think? I don't know. That's the thing. I don't know. And a lot of people are saying kids don't transmit this. That's exactly what I've seen. seen. That's all over Facebook, too. I hope that's true, but

our kids are very close to being adults. So when they say kids, what are they talking about? I know the little ones hardly ever get symptomatic, and in the beginning there were like zero deaths in the 10 and under. Now there's a smattering, but there's not and it's tragic if you're listening

and you know somebody this happened to. It's absolutely tragic, so I'm not minimizing that. But the numbers compared to the people at high risk are minuscule, relatively speaking. So the little kids may be, you know, they could go to elementary school, they all get it, and nobody, they don't transmit it because they're all asymptomatic.

But, you know, little kids, particularly the teeny ones, are all gooey. They're so disgusting. They're gross. It's just gnaw on stuff in saliva. Licking everything. Our kids were just gooey. It's not everywhere. That's why we decided not to do our Disney trip this show.

year. You remember they would gnaw on stuff and just, like, didn't they have some sort of things that were sort of like dog bones or something? Yeah, they would gnaw on them. And then they just, dog lifts it. Yeah. So gross. Sweet dough.

Yeah, no, very sweet. And Beck would eat dog food out of the bowl. And then, and then. Liam would go, Mom, Beck's eating dog food again. He'd just be sitting there at the bowl, just putting kibbles in his mouth. Anyway, God, and now they're almost out of the house. Monsters, they're monsters now. If you are pregnant, by the way, Tacey is really the author of the one-page baby manual.

Go to Dr. Steve.com, click on one-page baby manual. And what she did was synthesize happiest baby on the block and baby wise and some advice that we got from, the mother of my CEO who was an expert on baby raising or baby rearing and took a bunch of notes, wrote it all down. We had to meet with her when we had the second kid because we'd forgotten a lot of it. That was when we figured out we needed to really codify it. And I took it and sort of mushed it into a slightly different form and put it up on our website. So Dr.Steve.com.

And in the upper right hand corner, there's a menu click on one page baby manual. baby wise is also very controversial because it's scheduling a baby and there are oh there are people on both sides of that to the extreme and yeah and all over that page i wrote this is a god do what you feel like if you're just having a baby for the first time they let you go home with it and you're like what the hell are you haven't even been in the hospital 24 hours yeah and i remember when they said well y'all can go home steve and i looked at each other like and do what you're like and do what you're supposed to you haven't even been in the hospital 24 hours yeah and i remember when they said well y'all can go home steve and i looked at each other like and do what, with this baby? And it was terrifying. And so I wrote that for people who really had no starting point and just as a god. Right. Even baby wise, which is, they seem very strict. It's, it doesn't have to be. And forget the politics of it. Basically, if you're on an airplane and your kid is fussy and feeding it will shut it off. Feed it. Feed it because you don't have to go, well, I've got 45 minutes before I can do a feeding.

That's not what that's about. This is just a general way to get your kids sleeping at night so you can get some rest because mothers who don't sleep have cognitive deficits and mood disorders and all kinds of things, mothers and fathers who don't sleep. and getting that kid to sleep all night by eight to 12 weeks is not an unrealistic goal. And it makes for a happier baby and happy baby's where it's at. And also, we had a lot of our friends had babies at the same time, and it would take them an hour, two hours to put their baby down, and we just plopped ours in the bed and its little crib and just walked away. And they were always amazed at it, but they weren't willing to.

to do the work it took to get the baby there because they felt like baby was was mean you're mean and in the reality was they were being mean to themselves it was the least mean thing yeah exactly so now our children though have the worst sleep schedules you can possibly imagine that's to be in teenagers yeah it's ridiculous i mean we had to bribe them at one o'clock to get them out of bed with food today so that's where we're at COVID-19 has not been our friend on that because they've got, they can't go see their friends. They're scared. They're bored.

So they're sleeping. Little vampires. Sleeping part of their life away because that's the only way they can escape from this. Now, we've made their lives as pleasant as we can. But, you know, it's, it is, it's been a burden on them. No question about that. They went out for spring break. They haven't been back.

That was it. I mean, I know I'm not telling people out there. anything they aren't experiencing. So anyway, all right. You got anything else? You want to answer some questions? Oh, this is cool. Dogs can sniff out COVID with 94% accuracy. I want to, that's insane.

So what are they sniffing out, though? Are they sniffing out people or are they sniffing out? I didn't read the article. I just looked at the top of it. So if you Google it, I'm sure there's information there. And then there's also this documentary that's coming up that I think would be very interesting and it was on the today show this morning oh boy which is my morning show of choice Michael Phelps is doing a documentary on HBO about depression in um athletes

Olympic athletes to be exact and I think that that would be a great thing for a lot of people to watch especially the middle-aged man who grew up in a world where it wasn't manly to be depressed and maybe can gain some insight from that. Yep. Yeah, depression's a real thing. So I would definitely like to watch that at some point. I remember when your friends, some of your friends stopped liking me because we got an argument over depression.

Yes. Where they were saying, oh, just get off that medicine. Get off that medicine. Depression doesn't kill anyone. I mean, are you kidding me? It's like, you ever heard of suicide? It's like, stop. trying to be a medical professional without a license.

That's what pissed him off is when you said that. I don't give a damn. They were telling you what to do with your medication. Yes, exactly. And the thing about depression. And they knew you. The thing about, and they knew that I was depressed. The thing about it is it is hard to find the right medication, so it's hard to not give up.

But the right medication is out there for people. But there are so many options, and it's just like growing up. pain on a wall. Yeah, you're not sure what's going to stick. You don't need that. Exactly. And so just if you're in that place and your medicine's not working, don't give up, call your doctor, get put on something else. Yeah. Those are my two cents.

There you go. Thank you, Tais. I'm also a fan of the Xanax. Wow. Whoops. Uh-oh. Hey, after just a few days of training, dogs in Germany proved capable of identifying people infected with COVID. COVID-19, according to researchers.

Of course, they took a bunch of healthy people, then a bunch of other people snotting and coughing and stuff, and the dogs just, you know, looked at their behaviors maybe. But let's see. The dogs, part of a study by a veterinary university in Germany, were able to sniff out coronavirus with stunning accuracy. According to the pilot study, published Thursday in British Medical O, a BMC infectious diseases by the University of veterinary medicine of Hanover,

eight dogs from Germany's armed forces, trained for five. days before they could identify the virus in humans. Oh, now wait a minute. Okay, they sniffed the saliva of more than 1,000 people, both healthy and infected, identifying the coronavirus with a 94% success rate. We think this works because the metabolic process is in the body of a disease patient completely changed. We think the dogs are able to detect a specific smell of metabolic changes that occur in these patients. Yes.

So here's the issue of this. in my opinion, they need to control it for other infections that cause inflammation in the upper or the lower respiratory tract to see if there, are they really smelling coronavirus? Are they just smelling sick, sick? Snots stuff. Right, right, right, right. Because they may be smelling, and their noses are incredibly sensitive, components of inflammation, like cytokines or how they, the cytokines maybe are changing.

proteins in the saliva and they can smell that. I would really want to know if they can really tell the difference between coronavirus, say, in influenza or the common cold. And then you got something. Good point on influenza because it's almost flu shot, Tom.

Yep. Everybody needs to get your flu shot. Get ready. And if you think it's dumb, let me put you in touch with R.D. Smith, the owner of hyperphysics with his wife, Shatai. very good because I'm awful preachy today telling people what to do me too but you know what

wear a mask get your flu shot and shut up just do it I had to take boards today and that was this is a new board that I'm taking and it was the crappiestly that's not even a word written but it's apropos crapiously written questions I've ever seen where they'd give you four they'd ask you a question then give you four crummy answers and you had to pick the best one of the for, it's like, which turd is the prettiest? You know, it was really awful, and I am going to complain about it. And I'm all hopped up today because I drank, I didn't want to fall asleep taking the exam, so I drank a lot of iced tea before I went in.

And when as soon as it was over, it was right across the street from Mahoney's, which is a huge gun place. This is good. And I went and bought my concealed carry weapon right afterward because I was so pissed. So that's what you should do, everyone. I got hyped up and go buy a gun. Yes. Yeah.

Well, I got hyped up today, too. I got a large... We're going to have one of these kind of podcasts or shows today. I asked coffee from Duncan. Oh, did you? You didn't have a flupy, did you? Oh, no, I didn't have a flupy, and it was the best thing. I haven't had one in months.

And the guy recognized me, and he said, cold brew black. Wow. That's right. He recognized your voice? I guess. After not being there for months? I guess. I mean, I was there every day for years.

He has the hods for you. No, I don't think so. I think so. If people don't know what that flupy reference is, that's Tacey's mom thinks McDonald's Freep Hayes are called flupies, and she orders one like that every day. Every day. Every single day. And she tells other people about, oh, it's called a flupy. And I order one every day.

All right, you ready? Yeah, let's do this. Number one thing, don't take advice from some asshole on the radio. Which is Steve. Yep, that would be right, which should be me. Here we go. Hi, Dr. Steve. Hey, man.

Got a question for you. Okay. Is COVID-19 airborne? I've been hearing a lot about that it is airborne. I've heard too. I'd hear your answer. That it just hangs in the air for like up to 10 minutes. Is that true?

Or do you know? Okay. Yes and no. So under certain controlled conditions, if there's no air moving, and you aerosolize it, you can detect it in the air for some time afterward. And this is under experimental conditions. Now, in a small room like we're in in the Weird Medicine Studios, if I were to yell or laugh really loud or sing,

I could aerosolize enough that would make it airborne that could travel across to you, which you're farther away than normally you would be at a danger to me because you're more than six feet away. But it's possible, and the air in here is not moving right now, although we have that fan trained on you because, you know, you're... More important. Yeah, exactly right. If I want you to come up here every week, I need to make you more comfortable.

I can live with being a little overheated. But so, yes, but here's the thing. So it is theoretically possible, and it's almost likely that some people have been infected, through the airborne mechanism. But this is like a bell curve. So a few people will get sick from fomites, which are inanimate objects, where you cough on something and then somebody touches it, and then they put their finger in their mouth,

which is another thing, by the way, that masks are good for. It keeps you from sticking your fingers in your nose and your mouth. You know, it never fails. I go to the grocery store. I come out. I always forget my sanitizing stuff. Yeah, well, you hate hand sanitizer, but now you need to learn. And then I rub my eyes.

It never fails or wipe my nose. And so if I get it, that's how it's going to happen. Yep. Well, my boss, whenever we have a meeting, she takes the fingernail of her pinky and sticks it right in her mouth. So you can get it from touching stuff and putting it in your mouth. Theoretically, absolutely. Because if it's fresh and the virus has not decayed, Remember that on surfaces there is exponential decay based on the half-life of the virus on that surface and the temperature and a lot of different factors.

So if you got enough viable stuff, you could. But that's a very small number of people. The vast majority is going to be droplet transmission when you're close proximity to people in crowds. And then there will be another, at the other end of that bell curve, there will be a few people. that get it through airborne transmission. But those numbers are vanishingly small compared to the gigantic number of people that are going to get this through droplets.

Now, so it's all about risk mitigation, right? If there's this huge risk from one method, then doing whatever you want to do whatever you can to reduce that risk. If there's a small risk over here, well, I mean, any, if it's already small, Well, let's say that the risk of you getting it through airborne transmission is 2%. So that means 98% of the time you won't get it that way.

Doing all kinds of measures to reduce that risk may only reduce it down. What if you reduce it by 50%? Well, now it's only 1%. You really haven't done anything. Whereas if you've got a 98% chance, if you were going to get it to get it through droplets, if you can reduce that by 50%, by social. distancing and wearing a mask and washing your hands and all those kinds of things because somebody could droplet onto your hands. You stick those in your mouth. All of those things,

if you could reduce that by 50 percent, now you're talking about something. You really did something there. You see? So yes, airborne is possible, fomite is possible, probably likely it's happened, but the vast majority of the transmission of this virus is through droplets. Droplets from coughing? Yes. Coughing and sneezing, snodding, that kind of stuff. All right. Thank you. Excellent question. Good morning, Dr. Steve.

Hi, Tase. Hey, I have a not good question. Stacey Deloche, everybody. We don't, still don't have music for him. We'll do. All right. Okay, okay. That's Stacey Deloge.

Oh, yeah. Over-the-counter pain meds. We're talking like ibuprofen, aspirin, aspirin, acetamin. Phil. Can you list some more? Things such as that. Are there certain classes or certain drugs that work better for different things? For instance, like a headache.

Which one would work better for a headache? Such a good question. If I ever quit being stupid and thought that I could go back to exercising, which one would be better for a muscle strain? Yeah, no, it's a great question. So the difference between acetaminophen and ibuprofen is that acetamine is an antipyretic, meaning it reduces fever, and an analgesic, meaning it decreases pain. And I always stay away from it because of drinking.

Drinking. Yes. Yes. Because of binge drinking, right? Exactly. So, yeah, binge drinking and Tylenol don't mix. And drinking in general in Tylenol don't mix. Tylenol is metabolized in the liver as is alcohol.

If they compete with each other, you can get some problems. So please don't mix alcohol on acetaminophen. But ibuprofen. Ibuprofen. Way to go. Is an antipyretic, an analgesic, but it's also anti-inflammatory. So it's a non-steroidal anti-inflammatory. And it actually works on a prostate gland in mechanism.

Don't worry about what that means. But because of that, it can affect the lining of the stomach and can increase gastric bleeding and things like that. So both of them, you know, everything has downside. So, and you just use whichever one seems to work for you, but the thing I want to really talk about is if you go to the store, they'll have motron, well, I probably shouldn't say brand names, ibuprofen migraine, ibuprofen headache, ibuprofen menstrual symptoms. And if you look at the bottle, every single one of them says ibuprofen 200 milligrams. That's it. not other ingredients added? Not on those. Not on the ones I'm talking about. Now, there are things like

Anison that has caffeine and aspirin that's pretty decent. Caffeine's pretty good for headaches for people who have, you know, caffeine-sensitive headache syndromes. But these ones, it's just pure marketing because they want people to get, well, I've got menstrual pain. So, oh, look, here's ibuprofen. menstrual formula, whatever, and it's just a way for them to put the indication on the box, but the medicine inside is exactly the same. Go look for yourself. Now, is that FDA regulated? It is, right? Of course. I wonder how they get away with that. Because it's indicated for those things, and they can just call it anything they want. But it's not different. Right. Well, OTC stuff is a little

different than prescription. So they can put what it does on the front. For example, the drug previsid probably couldn't be called previsid in 2020 because it's a concatenation of prevents acid, right? And the new FDA rules say you can't name something after what it does. And as a matter of fact, on the bottle, you can't say what it does. Now, you can have a package insert that says what the indications are, right? Do I have that right?

But that writing is so little on those package insets that nobody can read them. But that's the rule, though, right? You can't advertise it on the bottle. I believe so. Whereas OTC stuff, you have to advertise it because people are not pharmacologists and they don't, when they go to the store, if they just see, you know, Lansopazole next to rinididine, next to acetaminophen, unless it says on here, this one, one's for acid, this one's for acid, this one's for analgesia. If they couldn't market on it, nobody'd know what the hell they were buying.

So you can technically save money by going with the store brand. Sure. Okay. So is there like a difference between, like, say, generic drugs versus branded drugs, is there a percentage of how efficacious it can be? Is there a difference there? Do you get what I'm saying? You would know better than I would on that.

Don't know, though. But if you're going to have a generic drug, let's just say a generic prescription drug, it has to be within a certain tolerance compared to the branded drug. Is it 20%? I think it's less than that. I thought it was five, but let me look. I would hope that it was five. On, what am I looking up, generic drugs? Versus branded.

versus branded and efficacy or strength or whatever here we go generic medicine okay this is from the FDA generic medicine is the same as brand name medicine in dosage safety effectiveness

strength stability and quality as well as in the way it is taken and should be used and let me see if they give a percentage okay the FDA requires companies to demonstrate the generic medicine can be effectively substitute and provide the same clinical benefit as brand name medicine that it copies.

It must show the generic medicine is the same in the following ways. Number one, the active ingredient is the same as the brand name. The generic medicine has the same strength. Use indications form, such as tablet or injectable, and route of administration, such as oral or topical. The inactive ingredients of the generic medicine are acceptable. Yeah, so you can't be putting, you know, deadly nightshade as your binder. The generic medicine is manufactured under the same strict standards as the brand name medicine. I used to think that they had actual numbers, but now they're just saying, look, it's got to be the same.

Isn't that interesting? That is interesting. I know that some medications from China are made, well, just crappy compared to, yes. Is it just the Chinese ones, I think? No, that's what some psychiatrists would say. They would write on prescriptions not to – for the pharmacist not to fill a medication if it came from a certain – Huh, really? Pharmaceutical – generic pharmaceutical company because of the additional ingredients.

They may or may not have a reason to say that. It doesn't mean that all physicians write things based on facts. that it was just a I'm with you just a couple here's here's one debunking the common pharmacy myth the 8125 bioequivalence rule so this is where you said 20% that was probably where you heard this one of the most common myths from pharmacists is that a generic product must contain between 80% and 125% of the brand name product in order to be considered bioequivalent in reality that isn't how the FDA determines bioequivalence um the reality is in order to determine bioequivalence, a randomized crossover trial is conducted with both the generic drug being assessed and the brand name drug as a control.

In these studies, a number of pharmacokinetic parameters are assessed, including maximum serum concentration, and the drug exposure over time. That's also called the AUC, that's area onto the curve. These parameters help assess how the rate and extent of the availability of the generic drug compares to the control. so they give them and make sure that it, what in the hell happened to our time? What do you mean? Well, the clock, okay, well, we're just going to have to do the best we can. The clock just stop.

That's what I'm doing right now. Look at that. Okay, all right, whatever. These parameters help assess how the rate and extent of availability the generic drug compares the control. So in other words, so they give them the regular, the branded medication, and the generic medication, and then you draw blood.

I did one of these studies in medical school where I was the container. I took a drug, and then they would come in every half hour and take blood to look at how it peaked in my bloodstream and how it got out of the bloodstream and all that stuff. It says it's true that the pharmacokinetic values are required to fall between 80% 125 of the reference value in these randomized crossover trials. Most importantly, however, the entire 90% confidence interval of the observed PK value must also fall between those two numbers. So to explain this with an example, imagine a brand name product was shown to have an area under the curve of 100 units in a crossover study. In the same study, let's say that the generic product was shown to have observed mean area under the curve of 93. Oh, boy, this is really getting into the weeds here.

with a calculated 90% confidence interval of 84 to 110 because the FDA requires the product as well as its entire 90% confidence interval must fall between 80 and 125 units. This would meet the bio-equivalence requirement. Okay, so it's a little more complicated than we thought, but that's where the 80-125 comes from. It's actually the pharmacokinetics. Speak on that in...

Yes. Yeah, I know. I'm sorry. It's not the strength, quote unquote. It's the pharmacokinetic. So when they give it, the parameters, in other words, the upsweep of the medication, where it peaks and how it goes down, that curve has to be within 80 to 125% of the generic. Now, it says, finally, because the bioequivalence requirements are so frequently misinterpreted, many pharmacies, schools are perpetuating the myth. And so anyway, all right.

Okay. So take your drugs from China. You're fun. No. But the FDA does look at generic drugs, and they'll pull them off the market if they don't meet these requirements. Okay. So, you know, I've known some cookie physicians, so I would say that, yeah, that fits.

Yeah. Brand-named drugs over a three-year period in the United States cost $100. $147 billion with brand name, oh, brand name drug overuse. Now, this is a political screed accounting for as much as $73 billion, but at least they didn't say it at all was. So, yeah. Okay. So it's subtle.

The difference is kind of subtle, but it has more to do with the pharmacokinetics than it does with efficacy. Well, it's just like with anything else if a physician tries something in it a couple of times and it doesn't work or whatever. That is so true. They're going to get the attitude or the perception that this drug. is not good because you're not going to keep using something that hasn't worked for a couple of patients. I saw this in a medical practice. Someone prescribed a very common sulfate drug for

urinary tract infection. The patient got a very severe reaction called Stevens-Johnson syndrome, and the whole practice stopped writing that drug, even though it's the drug of choice, and that reaction was exceedingly rare. And really could happen with us. other drugs as well. But they just got freaked out about it. And they said, well, we're not writing that anymore. So that happens. And that is sort of a bias that is hard to defeat.

Well, everybody's like that in life, you know? Yeah. If I go somewhere to eat and it sucks one time. One time you're not going back. Probably don't want to go back. Yeah. All right. Oh, it's pizza.

Hey, Dr. Steve. I was wondering if you could help me understand. blood pressure a little bit better. Let's take the average 120 over 80. How much pressure is that? Is that just like a squirt gun or is it like a kitchen faucet?

I love this question. And then my blood pressure used to be like 210 over 90. How much more pressure is that on the system? I can't imagine that your veins and arteries have to be extremely tough to be able to handle the consistent

pressure of something that Oh, yeah, and just think about the heart. The heart beats 72 times a minute, 60 minutes an hour, 24 hours a day for 80-some years. It's amazing, but I didn't hear the question because I was thinking about pizza. So we could actually ask Echo, but I don't have her plugged in. But that's a lot of heartbeats in one lifetime. And if you have, I've talked about this on Dudley and Bob show. I don't know if I've talked about it elsewhere, but the most gruesome death that I've ever seen was an esophageal aortic fistula, which means a communication between the aorta, which is the highest pressure vessel in the body, where that's just as it's coming out of the heart and it's got to distribute all that blood to every single little capillary.

your fingers and toes and ears and the scalp and everywhere else and it's got to feed your brain and all your organs and all that stuff. So it's under a lot of pressure. And when you get a hole between that and the esophagus, of course, fluid's going to follow the path of least resistance. Four pumps, one, two, three, four, out of the mouth, 10 feet across the room, hitting the wall, and that's it. So it's incredible the amount of pressure.

that the human body with this fluidic system is able to, you know, is able to handle. So, but what he's asking is, what does blood pressure translate into? Because it's just these two numbers, right? 120 over 90. Well, what does that mean? Well, 120 over 90. Let's say, so 120 would be the systolic. That's the top number.

Let's just take it in isolation. So the units of that are millimeters of mercury. So the way that they used to judge blood pressure is you put this cuff on and you pumped it up, and it would pump up this column of mercury, liquid metal, into this glass tube. And then you would measure it. And it's more sensitive if you do it in millimeters than it does in inches or centimeters because it's not a very high tube. You know, 120 millimeters, 12 centimeters.

So this is, you know, my finger's 10 centimeters long. As a matter of fact, oh, by the way, if you want to measure in centimeters, you'll get really close if you're an adult and have normal size hands. The tip of your finger to your knuckle is about 10 centimeters. And then that means that since the middle knuckle or the middle joint is about half, that's about five and a half of that's two and a half. right so and if you if you want to be more accurate measure it using a centimeter thing and then I just use my finger and I put it like if I've got a scar and I want to measure 20 the scar and it's just one finger two finger and then a little bit of a third that cool you always have a centimeter thing that's the only way I can think in metric I can think in grams kind of but

when it comes to volume yeah I know what a leader is and I know what a two leader is is, thanks to Pepsi and Coke, don't you know? Thank God. But as far as how many gallons that is, a leader's kind of like a quart, sort of. But it just gets, we just need to either commit to it or never even think about it ever again. But when it comes to temperature, like somebody's temperature is 40 degrees. I know that's a fever, but that's, I only know that because somebody told me 38 degrees Celsius is a fever. And I've been doing this 35 years, but I'm all about Fahrenheit, you know, because I'm dumb.

That's a little bit of a tangent there. Well, as is my watt. So anyway, 12, so 120 millimeters of mercury. And it turns out that that equals two pounds per square inch, two PSI, two point something PSI. And which doesn't seem like a lot in fluidics, particularly with these tiny, vessels that we have, you know, two pounds per square inch. When you've got a vessel that's a millimeter across, that's a lot of pressure. So anyway, that's what that is.

And the aorta is not an inch across for, and most people, let's see what the diameter of the aorta is for most people. Diameter of the aorta is, um, okay. Okay, well, yeah, just under an inch, less than 2.1 centimeters per meter square. I want to know the diameter. Okay, the normal diameter of the abdominal aorta is regarded to be less than three centimeters. So it's right, an inch is two and a half centimeters, right? So it's right around an inch.

Okay. All right, there you go. I guess that's it. Are we done? You got anything else? Nope. Well, thanks always. Tacey, thanks to everyone at Sirius XM, who's steadfast support of the show, has sustained

us over the years, particularly Lewis Johnson, Jim McClure, Sam Roberts, James Norton, Travis Teff, Troy Hinson, Paul Ophcharski, and Roland Campos. Many thanks to our listeners whose voicemail and topic ideas make this job very easy. Thanks always go to Matt Kleinshmidt at the Laugh button for bringing us along on that project. Many thanks for our listeners whose voicemail and topic ideas make this job very easy. Go to our website, Dr. Steve.com, for schedules and podcasts and other crap and listen to our podcast at riotcast.com or wherever podcasts are found. Until next time, check your stupid nuts for lumps, quit smoking, get off your asses, and get some exercise. We'll see you in one week for the next edition of Weird Medicine.

Goodbye, everybody. Thanks, Tice. Oh, yeah.