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Declining Sperm Count: Much More Than You Wanted To Know [Scott Alexander, Astral Codex Ten]

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  • Is Sperm Count Declining? – People say it is, and Levine et al 2017 and 2022 find average sperm count has declined from 99 million sperm/ml to 47 million.
  • Is Declining Sperm Count Really “Imperiling The Future Of The Human Race”? – Swan’s point is that if sperm counts get too low, presumably it will be hard to have babies. A graph shows fertility rate plateaus around 30 million sperm, and average ejaculation is 3ml, so total sperm count is 3x sperm/ml. If Levine’s linear model is correct, we have 10-20 years before median reaches plateau’s edge, and 10 years after that before it reaches zero.
  • How Long Has This Been Going On? – The first recorded claim was Nelson & Bunge, 1974, and a few small studies suggest it may have started declining between 1951 and 1974.
  • How Sure Are We That This Is Even Real? – Not too sure. Levine et al do good statistics, but the data is very noisy and there are many confounders (different types of people giving sperm samples, changes in ejaculation frequency, aging population, etc). Auger et al find six studies that are well done and five of them show declining sperm counts. Fisch and the Harvard Gender Science Laboratory paper point out the difficulty in collecting sperm samples and measuring sperm quality and make a few other points, but Auger’s is the best source.
  • Did The Hypothesis Start By Mistake? – It seems like basically every person who proposed this hypothesis before Levine et al was mistaken, and had no right to conclude this from their small samples. Carlsen et al, the first to make it to the mainstream, should have found an increase, not a decrease, in sperm concentration.
  • Where Is The Decline Most Pronounced? – Levine et al don’t compare developed vs. developing world counts, but unofficially it looks like sperm count is declining faster in the developed than in the developing world.
  • Argued about it for the first forty years or so was working off of useless data, but by coincidence they happened to be right anyway – This is key to understanding the debate about declining sperm counts, as it shows how unreliable the data is.
  • Where Is The Decline Most Pronounced? – Studies have found that the decline is pronounced in different regions around the world, and some countries are more affected than others.
  • If Sperm Count Is Declining, What Could Be Causing This? – Possible causes of declining sperm count include plastics, pesticides, sunlight and circadian rhythm, diet and obesity, and porn.
  • What About Animals? – Studies of farm animals bred through artificial insemination show inconsistent results of declining sperm count.
  • Conclusions And Predictions – It is difficult to predict the future of sperm count, but some predictions include a consensus that sperm count is declining in 20 years, and that the most important factor is plastics or pesticides.

Published February 17, 2023
Visit Astral Codex Ten to read Scott Alexander’s original post Declining Sperm Count: Much More Than You Wanted To Know

The Booming Market for Backdoor Ozempic [Olivia Reingold, The Free Press]

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  • Off-label Ozempic, a diabetes drug that also helps users lose weight, is being sold at med spas across the U.S.
  • The active ingredient, semaglutide, is being obtained from compounding pharmacies, which mix and combine active ingredients to create custom formulations.
  • Rich, connected people can get a prescription for Ozempic and Wegovy, its higher dose form, but it’s not cheap.
  • The drug has become the “magic bullet” for getting skinny, with celebrities such as Kim Kardashian and Khloe Kardashian rumored to have used it.
  • Off-brand semaglutide, which is not FDA-approved and is of unknown origin, is being peddled by medical spas and telehealth clinics for about $300-$600/month.
  • Using off-brand semaglutide comes with a number of drawbacks, such as diarrhea, nausea, and vomiting, as well as the possibility of developing thyroid cancer.
  • The FDA has approved Wegovy for kids aged 12 and up, but there has been limited research on its effects on them.
  • New England Journal of Medicine had a pool of only about 200 participants, confirming the limited effectiveness of Wegovy for kids.
  • Calley Means, a healthcare entrepreneur, suggests the government invest in revamping school lunches to target the source of all obesity: diet.
  • The New York Times and the Centers for Disease Control (CDC) describe childhood obesity as “complicated” and impacted by “social determinants of health.”
  • The UK’s National Health Service states more clearly that “Obesity is generally caused by eating too much and moving too little.”
  • Body positivity messages have been around for years, but many of the loudest advocates lost weight when Ozempic came out.
  • Emily, a stay-at-home mom in Eastern Ohio, was 5 feet 5 and 189 pounds the day her doctor handed her semaglutide.
  • Kate Barone, an Atlanta salon owner, is itching to get back on semaglutide, saying “Everyone around me is getting skinnier.”

Published February 16, 2023
Visit The Free Press to read Olivia Reingold’s original post The Booming Market for Backdoor Ozempic

Panic Headlines: A New Series [Emily Oster, ParentData]

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• ParentData introduces a new series, “Panic Headlines”, to address topics that are too long or in-depth for a Q&A but not significant enough for their own post.
• The first two Panic Headlines are infant screen time and processed foods and cancer.
• Infant screen time is associated with executive functioning at age 9, but this is likely due to family characteristics rather than a causal impact of screens.
• A study on ultra-processed foods suggests a small increase in cancer, particularly ovarian cancer, but the data is flawed due to differences in family background, behaviors, and underlying health conditions.
• Eating processed foods is not recommended, but this study does not provide enough evidence to conclude that family pizza night should be cancelled.

Published February 16, 2023
Visit ParentData to read Emily Oster’s original post Panic Headlines: A New Series

What Not to Ask Me About My Long COVID [Jennifer Senior, The Atlantic]

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• Long COVID is a condition that millions of people suffer from, and it is often worse than the physical symptoms.
• Asking “Are you doing any better?” is not helpful, as it is a chronic illness with an unknown recovery timetable.
• People with long COVID often experience depression, shame, and resentment.
• To pass for well, people with long COVID may need to take a combination of medications.
• Doctors often underestimate the quality of life issues associated with long COVID.
• The Mount Sinai Hospital in New York has a long-COVID team that thinks holistically, but many people don’t have access to the same resources.
• Be gentle with people who have long COVID, as it can be a difficult and isolating experience.

Published February 15, 2023
Visit The Atlantic to read Jennifer Senior’s original post What Not to Ask Me About My Long COVID

Americans have been gaining weight for as long as records exist [Matthew Yglesias, Slow Boring]

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• Obesity has been a growing problem since the late 19th century, not just since 1980.
• The population aging has a mechanical impact on average obesity that is unrelated to changes in diet and nutrition.
• The average Americans’ weight change since the 1980s is startling, but the data suggests a much more boring story about a long-term increase in average weight punctuated by the Great Depression and World War II.
• Food insecurity was incredibly common for most of human history, but now spending on groceries has plummeted as a share of household spending.
• Food is also better across many dimensions of betterness, from ultra-processed junk food to home cooking.
• The downside to living in a society with a great deal of material abundance is that it is much less common to need to choose between going hungry and eating something you don’t like.

Published February 2, 2023
Visit Slow Boring to read Matthew Yglesias’s original post Americans have been gaining weight for as long as records exist

Prenatal Testing Deep Dive [Emily Oster, ParentData]

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• Dr. Aaron Carroll is a professor of pediatrics at Indiana University School of Medicine and a health policy researcher.
• He has written extensively on the evolution of prenatal testing, including cell-free fetal DNA testing, amniocentesis, CVS tests, and PGT.
• He explains that cell-free fetal DNA testing is extremely accurate for detecting the primary trisomies (21, 13, 18), with a 99.4% detection rate and a 0.1% false-positive rate.
• Invasive testing is also highly accurate, but carries a small risk of miscarriage.
• Ultrasound findings rarely provide much information if cell-free fetal DNA testing has already been done, and no additional information if invasive testing has been done.

Published January 30, 2023
Visit ParentData to read Emily Oster’s original post Prenatal Testing Deep Dive

Alcohol and Health [Emily Oster, ParentData]

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• Alcohol is a significant contributor to death, with liver disease, alcohol poisoning, and drunk-driving-related deaths being the most common causes.
• We do not have good data on the relationship between alcohol and health at lower levels of drinking due to observational data bias.
• The most comprehensive study of the link between alcohol and long-term health was published in The Lancet in 2018, which showed an upward-trending relationship between alcohol and colon/rectal cancer, and a dip initially between light drinking and heart health.
• The New York Times article on alcohol last week suggested that five years of drinking two alcoholic beverages a day can damage the liver, but this is not supported by data.
• A randomized trial of light drinking was shut down due to funding from alcohol manufacturers.
• Despite the lack of evidence that alcohol is good for health, it can still be enjoyed in moderation.
• If one feels like their alcohol consumption is too much, it is a time to re-evaluate.

Published January 26, 2023
Visit ParentData to read Emily Oster’s original post Alcohol and Health

Fevers 101 [Emily Oster, ParentData]

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• Fever is a body’s response to infection and is not necessarily a sign of a worse illness.
• Treating fever does not affect recovery in a positive or negative way.
• Treat fever if it makes your child feel better, and not if they seem fine.
• If a child is totally unconsolable or is very hard to wake up or hasn’t been peeing at all, this is when you worry.
• Ibuprofen seems to work better on fever in randomized trials.

Published January 23, 2023
Visit ParentData to read Emily Oster’s original post Fevers 101

Should Adults Nap? [Emily Oster, ParentData]

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• 34% of people surveyed in 2009 reported napping in the past 24 hours, with the highest rate (52%) among those over 80 years old.
• Studies suggest that napping can improve cognitive performance and reduce subjective sleepiness, but may also be linked to cardiovascular disease.
• The optimal nap length is 15 minutes, and the ideal time to nap is mid-afternoon.
• The “coffee nap” combines a cup of caffeinated coffee with a 15-minute nap, and has been shown to reduce driving impairments.
• A study of urban poor in India found that napping improved overall feelings of well-being, but decreased earnings due to lost time.

Published January 19, 2023
Visit ParentData to read Emily Oster’s original post Should Adults Nap?

What To Do About Chronic Constipation [Emily Oster, ParentData]

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• Constipation in kids is very common, affecting 10-30% of children over the course of childhood.
• Symptoms include frequency of bowel movements less than three per week, fecal incontinence, large stools, painful defecation, and withholding behaviors.
• Causes include introducing solid foods, toilet training, and school-related anxiety.
• Treatment involves clearing any existing stool blockage, using laxatives and behavior modification, and increasing fiber and water intake.
• Miralax is the medication of choice, as it has been shown to be more effective than a placebo and other alternatives.
• Side effects are mostly related to digestion, and there is no evidence that it causes behavioral problems.

Published January 16, 2023. Visit ParentData to read Emily Oster’s original post [What To Do About Chronic Constipation]

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