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Scot: Mic check here.

Mitch: Oh my god. This is . . .

Scot: Mitch, give me a little something.

Mitch: What kind of . . . like a something something? What are we thinking?

Scot: Like, the volume you're going to talk at.

Mitch: Like the volume I'm going to talk at? I can do this. Hello, dah, dah, dah.

Scot: You know what you're doing.

Mitch: I know.

Troy: You're a professional. This is what you do.

Mitch: This is my job.

Troy: Act like you've been here before.

Mitch: I'm just glad I have a microphone finally.

Scot: The podcast is called "Who Cares About Men's Health?" You know, they say men don't care about their health, and that may or may not be true, but we are on a mission to make sure men do care about their health.

And also, we're on a mission to take our health back, right? It's enough of other people telling us what we should do, enough of other people instructing us, "Oh, this could be wrong with you. That could be wrong with you." It is time for us to learn these lessons on our own.

My name is Scot Singpiel. I am the Senior Producer at thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Dr. Allred: And my name is . I'm a general cardiologist at the University of Utah. I have a strong interest in preventive health.

Scot: Okay. Do you care about men's health?

Dr. Allred: Sure.

Scot: Okay, good. Because, I mean, if you don't, then that's kind of the ticket to admission around here.

Dr. Allred: I'm a man, and I care about my health and other guys' health.

Scot: Good. You know, we have yet to have somebody that has come on and said, "You know what, guys? I don't care about my health."

Troy: I keep waiting for that.

Scot: I don't know where this . . .

Troy: I think I'm going to just slip it in one of these times and you're not going to notice. I'm just going to say, " don't care about men's health."

We All Know Smoking is Bad

Scot: Today, it's smoking, because we talk about our Core Four Plus One More, which is for good health now and later down the road, you need to watch your activity, what you're eating, sleep, manage your mental health, and you've got to be aware what your genetics is. But before any of that, if you're smoking, that's one of the things you've probably should take care of right away.

So, Dr. Allred, I want to just briefly touch on this because I think we all know smoking is bad. People that smoke know it's bad, right?

Dr. Allred: I think for the most part.

Scot: Yeah. Let's just go through some of the things that smoking causes.

Dr. Allred: Sure. The big ones that come to mind for me is there is a clear increase in cardiovascular Сòòò½APP associated with smoking. Further, there's a clear increase in respiratory Сòòò½APP, so the Сòòò½APPs of our lungs, notwithstanding the increased risk for cancer. There's many other things as well, but those are a few big ones that come to mind.

Scot: And high blood pressure would be another one.

Dr. Allred: Definitely.

Scot: Cancer. You already hit lung Сòòò½APP.

Dr. Allred: Vascular Сòòò½APP, not breathing well, increase in infections, lots of different things.

How Mitch Became a Smoker

Scot: All right. We have our producer, Mitch, here today. We're going to dedicate this show to Mitch.

Mitch: Oh my god. Hi, I'm Mitch. I produce this show, and I care about my health.

Scot: Mitch is a smoker, or was a smoker, right?

Mitch: Yeah.

Scot: You're trying to quit. How many times have you tried to quit?

Mitch: I'm currently on attempt number seven.

Scot: All right. So, let's talk to Mitch a little bit about his story with smoking. Do you find that that's important for people to be in touch with their story, like why they want to quit, those types of things? And then we're going to get later into the show the best research-supported methods to quitting.

Dr. Allred: Yeah. So the more insight that the patient has into where they are in their healthcare journey and where they're at with respect to their personal use of tobacco products helps them have that much more insight into why they want to stop.

Scot: So what got you smoking? And let's just kind of briefly go through what got you smoking, and how many times you've quit, and where you're at now?

Mitch: So I guess I first started . . . it was college. You know, you go to the parties. You go to the metal shows. I was a little punk rocker, and it was just you have a couple beers and then someone is like, "Hey, why don't we go out and have a smoke real quick?" And it seems pretty harmless and suddenly, the next thing you know, you're having a cigarette every time you go out, every time you drink. And every time I'm out partying with friends, "Oh, it's just something social. Oh, it's just something whatever." And then suddenly, finals are coming up, and they're super duper hard and you're stressed out of your mind and you think back to like, "Oh, man"

And that was something I found interesting, is that I was like, "Oh, I'm stressed. I'm not going to get into a beer, but I'll have a cigarette." And then next thing you know, you're two, three years later and you're smoking every time you get in the car, and you're smoking right after breakfast, you're putting on a jacket to go out into the cold for a quick smoke break, all those things you never thought you would do.

Scot: And you smoked for 10 years.

Mitch: Ten years.

Scot: And what have you tried to quit?

Mitch: Oh my god, I've tried cold turkey. That was not so great. I was dating someone who was into some woo-woo stuff. And I was trying some of this kind of mental exercises and mindfulness exercise. I know I keep harping on it, mindfulness. It works, it's good, do it, but it was visualizing yourself being a non-smoker. And it felt strange, I guess.

And the recent, I guess, successful thing that I tried was I switched to vaping. And now, I am trying to quit the vaping, and it is a million times harder than any of the times I've tried before.

Troy: And it's tough for me to relate to this because I've never smoked. I've never had to deal with that. Is there anything you can compare it to, like anything else you've tried to quit or anything else that you crave when you're not smoking that you can compare this to?

Mitch: No.

Troy: Or is this just the most difficult thing you've had to deal with in terms of trying to quit something and change a habit?

Mitch: It has been the most difficult, but it's . . . I can't think of anything else. There's something different about my nicotine addiction, which is unlike anything I've had to try to quit before.

Why Is it So Hard to Quit Smoking?

Scot: Dr. Allred, why is it so hard to quit?

Dr. Allred: Well, there are so many common elements to Mitch's story that I'm hearing, the fact of him starting at a very young age and it being a very social activity. The sheer nature of the social aspect of it makes it very difficult for many individuals. Many individuals find it enjoyable, aside from the way that it makes them feel, but oftentimes they're around people who they really get along with, be it friends, co-workers, and it's a moment of relaxation when they're on a break. And so, oftentimes, they associate it with something that's very pleasurable for them.

And then there's the chemical component of it as well with the nicotine and the effect that that has on the brain and being highly addictive. And your story is very familiar with . . . I've had many, many patients tell me that it is among the most difficult things that they have ever tried to do, to quit smoking.

Scot: That marriage of the social and the chemicals, like the one-two punch, right?

Dr. Allred: It really is. And then there's also the nuances of . . . you mentioned putting on a jacket, or after you eat breakfast, or the first thing that you do when you wake up. It becomes habitual as well of just putting your hand towards your mouth, getting in your car, the smell of the car, seeing the ashtray, seeing the cigarette lighter, having it with a beer. There are just so many different triggers that will influence the individual to reach for the cigarette.

Mitch: And that habitualization got almost worse with switching to vaping. You know, I was back when the vaping craze first started, and it's like, "Oh, it's a healthy alternative." And then, all of a sudden, it doesn't smell bad. All of a sudden, I don't have to put on a jacket and go outside.

And you just suck on it all day long and you don't even realize how much you're ingesting. There's one thing about being told, "You're smoking 20 cigarettes a day," versus, "I'm having one JUUL . . ." Okay, am I allowed to do brands? Like, "I'm having one JUULpod a day." That doesn't equate, but a JUULpod has more nicotine than a pack of cigarettes. So all of a sudden, it's just something you do all day, and it tastes like mango, and it tastes like Swedish fish, or whatever you're eating.

Vaping is Not A Good Alternative to Smoking

Scot: Is vaping a good alternative to smoking?

Dr. Allred: Well, from this individual's perspective, no. And I think one not need to look too far from the recent influx of news stories and the vaping-associated illnesses, with infections and individuals being hospitalized for that. And the FDA and the government, they are definitely taking notice of that as well.

Mitch: Some might say those are limited isolated cases, though, right?

Troy: I personally, in the emergency department, have seen some crazy cases. You know, it's not like we're seeing this every day or maybe even once a week, but just in the limited time since vaping has really taken off, I've seen just some eye opening, just pretty unbelievable cases of respiratory Сòòò½APP from vaping.

Mitch: Kind of the reason why I'm trying to quit vaping is very similar to the reason I wanted to quit smoking. I want to get healthy. I want to know my lungs are going to be okay in the next 10, 15 years. I want to stop having coughing fits or feeling like waking up, and freaking out, and trying to find where my pack of cigarettes or my JUUL stick is. It's taking control of my own health again, and unfortunately, it's with a quite addictive substance.

Best Researched Ways to Quit Smoking for Good

Scot: So let me kind of redirect a little bit. I think somebody that wants to quit smoking moves to vaping thinking that's a good idea, and I think that leads into our topic. What are the best researched ways to quit smoking, and can this be applied to vaping? What do we know?

Coaching and Behavioral Support

Dr. Allred: Yeah. That's a great question. And there's been a lot of research put into this very question. And it's not too terribly complex, which is great for the clinician because so many of the things that we do are very complex. But there are a few products available as well as we'll call it cognitive behavioral therapy that can be very effective for helping the individual stop smoking.

First and foremost, I guess we'll start with the cognitive behavioral approach, and that can encompass coaching. And across the country, there are quit lines that exist that the individual patient can call. It's a free hotline that the patient can call, and then they can receive coaching services from an individual to help them talk through the psychological aspect of things.

Mitch: And what does coaching sound like, I guess? Because I've never tried coaching. What is coaching? If I call up, what are they going to tell me to do?

Dr. Allred: I don't know that I could speak exactly to what they are telling the individual on the other line.

Scot: But research supports that it works.

Mitch: Yeah, definitely. And I have patients who have told me that they have found it to be beneficial, where the individual, they can send them a text message. There are apps out there as well that are commercial in nature, which are free, but they're commercial in nature, where you can communicate with a health coach as well. So it can be by text message. It can be by phone. There's a variety of things out there.

Scot: Specifics aside, what are these coaches? What's the problem that they're trying to solve?

Dr. Allred: Well, in large part, I believe they're trying to talk with the individual during moments of "weakness," if you will.

Scot: Gotcha.

Dr. Allred: The individual feels that they need somebody to help them through a pinch. And that's where the text message can be helpful or just a friendly voice.

Scot: This would be like the time that Mitch told me the story that he drove around the convenience store five or six times, or, you know, saw a group of smokers and decided, "I bet you I could bum a cigarette off of one of those people."

Mitch: And it's so strange because I'm trying . . . we'll get to it in a minute, but I'm trying the patch this time, and I forgot it one day. And it was for real. I'm just sitting there. I'm like, "I bet I could go ask them for a smoke." And I'm literally walking back and forth and back and forth like a caged animal. And I'm just embarrassed. I'm like, "No. I'm not going to do this." And ultimately, it was the shame that got me to not take one.

Scot: And it sounds like that would be the time you'd pick up the phone and call one of these numbers.

Troy: And I'm guessing, you know, in your practice, a lot of people you're seeing are probably the large majority of people who have already had a heart attack or have heart Сòòò½APP and probably fairly motivated to quit smoking. But with these individuals, how many times . . . you know, Mitch has tried . . . this is his seventh time. Is there a number you're finding where across the board people are generally trying at least 10 times to quit, or is it just all over the place? Some people go cold turkey, they're done. Some people, it's 20 times and they're still trying.

Dr. Allred: Yeah. It depends on which research study you read through, but it's in the number of 7, 10, 15. These are common numbers. High quitting attempt rates.

Troy: And are you finding each attempt maybe it gets a little better, like, "Okay, this time they went for a week. Next time it's two weeks. Next time is three weeks," or is it just, again, all across the board?

Dr. Allred: Yeah, that's all across the board. Maybe the higher the number of quit attempts, the more intent the individual is at actually stopping.

Nicotine Replacement Therapy (NRT)

Scot: So the line, that is one research way. What are some of the other approaches that the research really supports, or is that it?

Dr. Allred: No. And then there's pharmacologic strategies as well. And so, Mitch mentioned that he's wearing a patch right now. So that's definitely one of the strategies, and this is known as nicotine replacement therapy. NRT is the other term that we use for it. And that comes in a variety of types.

There are patches that can provide a sustained release of nicotine for the individual, kind of a baseline amount of nicotine to try and curb those craves. And then when there are moments of a more intense crave, then there are short-acting type of products available as well, and these are gums, lozenges. There are cartridges that look like a cigarette that have some nicotine in them. And there's even a nasal spray. There are inhalers. There are many different products out there whereby nicotine can be delivered into the system to help curb that crave that the brain is powerfully sending.

So those are not needing a prescription per se from a physician, and they fall under the umbrella term of nicotine replacement therapy.

And I guess the last thing I'll say about those is they are most effective when used in combination. By combination, I mean there is the patch which provides the basal amount of nicotine, and then there's the short-acting product that the individual can use in a pinch.

Scot: Gotcha. So, Mitch, you said you're going to be going to the next level patch down, which has less nicotine. So would that be one of those moments where it'd be nice to have that . . . I don't know what you'd call it. The accessory?

Dr. Allred: The rescue agent.

Scot: Yeah, the rescue agent. That's a good way. So when he makes that transition, if he has a rough day, you can . . .

Dr. Allred: I advocate my patients having the "rescue agent" from the get-go. There are three different strengths of nicotine patches, and usually you'll prescribe it depending on how many cigarettes per day the individual smokes. But in any case, most individuals who have a strong addiction to tobacco use will need something in a pinch as well, regardless of the strength of the patch that they're using.

Troy: So, Mitch, right now, are you in the strongest one? Is it 21?

Mitch: Yeah, I'm on the strongest one. And that's another question I was going to ask. The step down from a JUULpod a day to the strongest patch available was rough. It was a lot rougher than it was when I tried patches once before with quitting cigarettes. You know, we're going from instead of however much a pack of cigarettes is to 21 milligrams, which is the biggest. A JUULpod is 56 milligrams, and I went from 56 to 21 and I didn't realize it was going to be that hard of a crash.

Troy: I guess with that in mind, do you ever advocate that people just double up with several patches on various parts?

Scot: I'm going to guess no, but I don't have an M.D.

Troy: These are all interesting questions. It brings to memory the Simpsons episode with Krusty the Clown and all the patches on his body.

Mitch: That's what I wondered. You do what you've got to do to get that start.

Dr. Allred: It's a good question, but that's, again, highlighting where the benefit of the replacement or the rescue agent could be of strong benefit.

Scot: Gotcha.

Mitch: And what are some of the side effects that are often seen with some of these pharmacological interventions?

Dr. Allred: Sure. So nicotine in and of itself can be stimulating to the body. And so, in surges, that can cause effects on your blood pressure, on your pulse rate in particular, your mood.

Scot: Yeah. Mitch, you were saying you get cold.

Mitch: I get really cold. I stay cold. But the thing that kind of has been really hard is I have the most intense vivid dreams every single night, and I've never had them like this.

Dr. Allred: While using the patches?

Mitch: Yeah.

Dr. Allred: That's very interesting to hear.

Dr. Allred: And I was told, "Oh, well, just take them off when you sleep," and then I wake up feeling miserable. So I've been dealing with the bad dreams, but that's crazy. I never thought that I would put this patch on and suddenly have difficulty sleeping.

Scot: I guess what I'm asking is, because of that, would you be likely to go . . . like, if you knew that's going to end in 30 days, all right, I can deal with it, but I don't want to have bad dreams the rest of my life, so I'm just going to keep smoking.

Dr. Allred: I wonder if it underscores maybe some of this strength difference between the pod that you were using and the step-down that you took. And, again, you don't have a rescue agent available to you, right? You just have a patch.

Mitch: I mean, I could go buy it. I just didn't get it.

Dr. Allred: Sure, but you haven't been using a rescue agent.

Mitch: No.

Dr. Allred: You've purely been using the patch.

Mitch: I have been eating chocolate cinnamon bears when I am particularly having a bad craving.

Scot: That's his rescue agent.

Mitch: Yeah. I have a sack of the bargain bin cheap chocolate. And I have one of those any time I'm having a breakthrough thing under suggestion of my very loving and supportive boyfriend, who's one of the reasons I'm sticking to this.

Dr. Allred: Yeah. Well, you know, again, I think it highlights the profound impact that nicotine has on the brain.

Prescription Medications

Scot: Yeah, and how hard it can be. What about prescription solutions? Are they better than over-the-counter solutions, and is involving a health professional going to increase the chances you're actually going to be able to quit?

Dr. Allred: So involving a healthcare professional as part of your strategy to quit is, I think, a fantastic idea. First and foremost, you get that reinforcement from that healthcare professional that what you're doing is, in fact, the best thing that you can do for your health. And then, again, in moments of a crave, that's one other thing that you can think about, of what my physician said to me in that moment.

Second, in order to get certain prescriptions, you need to have that from a physician. So maybe that dovetails nicely into what some of those agents are. And there are two that are approved for smoking cessation. And the one is called Varenicline, more commonly known as Chantix, and the other is called Bupropion. Some will know that by the name of Zyban.

So when we look at scientific studies comparing the effectiveness of these agents, then Chantix, or Varenicline, has proven to be the most effective. When we look at a whole bunch of studies and lump them all into one, then we see that there's not really a difference between Chantix alone versus combination nicotine replacement therapy, again, the patch plus gum, something like that.

And so, those entities, combination nicotine replacement therapy and Chantix, are the best of the best. The Zyban or Bupropion is also effective, but statistically speaking not quite as effective as those other two.

Troy: To kind of summarize that, it sounds like you're saying that whether you're doing Chantix or the nicotine replacement, they're equally effective.

Dr. Allred: Yes, as standalone options. And there are some who advocate for combining Chantix and nicotine replacement therapy.

Troy: So, I mean, I'm putting myself in Mitch's shoes here, and I don't want to tell Mitch what to do. Sometimes I've been known to go a little overboard on things. But from what I'm hearing from you, and tell me if this sounds crazy, if you really want to quit smoking, it seems like you go see a physician, start Chantix, get nicotine replacement therapy to take along with the Chantix, and ideally, that's how you're going to really hopefully set yourself up for success.

Scot: I'm going to throw in get a rescue agent and also . . .

Troy: And get the rescue agent to.

Scot: . . . have that number on your phone to get the support that you need.

Troy: Yeah, have the gum in your pocket. Any time that craving hits or you're driving around the convenience store, just go all in and say, "This is how I'm going to do this, and I'm going to make this happen." I don't know. It seems like . . .

Dr. Allred: That's probably the best of the best, in particular for the individual who has smoked a lot, who smokes many cigarettes per day, a pack or more per day.

How You Can Help Others Quit Nicotine

Mitch: I want to step in for two seconds here. Are there certain strategies that work better for certain types of patients, certain personalities? The idea of calling some stranger on the phone when I'm having a hard time, I don't know if I could do that. For me, I'd rather just suck on this cinnamon bear and, you know, power through.

Scot: Or go to total strangers and ask for a cigarette.

Mitch: I know. I recognize, but yeah, that's . . .

Troy: And I'm not trying to tell you to do what . . . I'm kind of OCD. If I'm going to do it, I'm saying, "I would do that, that, that, and that," and maybe I'm going overboard, but . . .

Dr. Allred: I would say as well that whether it's a trained health coach on the other end of the line or just a trusted ally, a friend, a family member, a co-worker, somebody who you could also call upon to be your coach in that time of need could also serve that role very well.

Mitch: I've got Jonathan. We're good.

Scot: All right. So best of the best, you still might be trying five or six times before it takes. I mean, I guess what I'm getting at is this is a hard thing. Nicotine is a nasty thing to get rid of, an addiction like that.

Dr. Allred: It's super tough. And we know that the more that a physician encourages, and counsels, and recommends that their patient stop smoking, then the more likely that individual is to stop smoking as well.

Troy: And it seems like one takeaway too is just because you've tried and failed, it's not failure. I mean, it's a process, and it takes many, many times. And it's kind of cliché, but just as it took a long time to develop the habit of smoking, certainly, it's probably going to take a while to develop the habit of not smoking and really being comfortable with that.

Dr. Allred: And the individual has to be on guard as well that once they feel like they've kicked that habit, then they have to be careful not to return to some of the very familiar settings or activities that will tip them back into where they don't want to be. I mean, it's similar to someone who struggles with alcoholism or any addiction for that.

Scot: Mitch, how are you doing?

Mitch: I'm okay.

Scot: Was this helpful?

Mitch: I have two doctors and an amazing boss who care, and I get it. No, it's good. It's good to hear . . . I mean, for me, I went online, I decided to try something different, and maybe I should have called my doctor. But at the very least, I know that I'm about to step down to the next lower dose of nicotine. I'm a little anxious about that because the first step was hard. Maybe I'll go get some of that gum or those lozenges.

Scot: Get some of that gum.

Mitch: Get some of that gum.

Scot: How can I support Mitch? If I get a call from Mitch, what do I say?"You've got this, man. You've got this."

Mitch: Yeah, this is hypothetical.

Dr. Allred: I guess it depends on what he says to you in terms of, you know, how . . .

Scot: "I'm circling the convenience store again, man. I'm like a shark."

Troy: "Just leave. Just go and get a Big Gulp."

Mitch: I'm going to go in, I'm going to buy one candy bar, and I'm going to buy a Big Gulp, and I'm going to get out.

Scot: Man, I would tell him, "Don't even go in."

Dr. Allred: This is where I think that it's helpful for the individual patient to share their goals and their intent with their coach and also to share with them what some of their goals are.

I tell my patients to set a very specific goal of what it is that you're going to do with maybe to save money or other very specific goals that you have in mind. And then, when you're faced with a dilemma, your coach can help you think about, "Okay, let's focus on that trip to Machu Picchu that we're planning to take with that saved money," or various strategies that you could take.

I guess one last thing that I might say as well about . . . you said, "Well, what would influence somebody to choose one versus another?" Insurance can definitely play a role here. Depending on whether someone has insurance or not will dictate whether or not they're able to receive a commercial product like Chantix.

The nice thing about the quit line . . . and the number is uniform across the country. It's 1-800-quit-now. They have free nicotine products available to them via patch or gum. It depends on the state. Some of the states even have some Chantix available to their patient at no cost.

Troy: And speaking of cost, Mitch, are you saving money now with nicotine replacement products versus the vaping products and cigarettes? How does the . . .

Mitch: Yes, I am, quite a lot.

Troy: Okay. So it actually does . . .

Mitch: It took having a partner sit down with me, and I'm like, "Oh, it's just . . . you know, I buy a pack. A pod last me a day. I'm buying, like, two a week. It's less than a pack of cigarettes was, blah, blah, blah." And it took him a sitting and . . . because that's what he does. He crunches numbers, and he's like, "Look at how much it's actually costing you," and I was like, "Wow."

Troy: So even paying for the patch right now, it's definitely saving you money over what you were spending before.

Mitch: It's about half.

Troy: Half of what you're . . .

Mitch: It's about half. And it's temporary. I mean, I've got four more weeks after today, and I'll be giving myself the gift of nicotine-free for Christmas.

Scot: He doesn't sound excited about it, does he? Is that going to be a problem?

Mitch: I am excited about my health. I am, but I'm going to . . .

Scot: It's just hard, right?

Mitch It's hard. I mean, you deal with a lot of your own bad habits.

Scot: So we want to move towards wrapping this up. So, Mitch is five weeks in. You've got four more weeks, so it's nine weeks total?

Mitch: Yeah. So this Saturday, I switch to the next one. Yeah, it's a 10-week program. So it's six and four. So I'm finishing up my fifth week.

Scot: Does the research point to or your experience with patients, is there any point X number of weeks out it's going to get easier?

Dr. Allred: Yeah. And so, again, that's patient dependent, but the hope is the craves will diminish as the individual is stepping down from that therapy and removing themselves from the constant daily exposure, repeated episodes daily exposure that they've had. But it's tough to say what one can expect.

Scot: I guess, again, empathetically putting myself in Mitch's position, if I knew, "All right, if I can just make it to 15 weeks, it's going to start getting a little bit easier," that hope would be what would help me. You've just got to stick with it. No easy answer.

Mitch: I've got to go get some gum. It's fine.

Troy: Yeah, Mitch, I think the biggest thing is you really need to recognize what you've done and congratulate yourself. That's really incredible. I mean, this is such a huge deal. It's something obviously people are struggling with so much. So you're five weeks into it, beyond five weeks it sounds like, and ready to step down. So, I mean, that's really something to be congratulated.

Mitch: It's my seventh time trying, and I'm hoping it's my last.

Dr. Allred: And I guess I would add to that as well is you're a young guy, and this is one of the most important decisions that you can make for your ultimate healthcare future. We also know that when somebody stops smoking, the regression of the bad that it causes begins to start immediately. And within a short period of time, an individual's body can appear as almost they never smoked.

Scot: That's awesome.

Dr. Allred: So starting earlier, the better.

Scot: Dr. Allred, thank you very much for helping us through this.

Dr. Allred: Thanks. It was great.

Scot: Appreciate it. And thank you for caring about men's health.

Dr. Allred: I care.

Just Going to Leave This Here...

Scot: All right. Time for"Just Going to Leave This Here." That is where we might talk about something health-related or we just might talk about something random. Just Going to Leave This Here. Troy, why don't you kick us off?

Troy: It's an interesting thing. I actually saw a study recently where they looked at the waste in different communities, and, you know, a lot of societies over time, we've been able to tell a lot about the societies by their trash, by their waste. You look back at a lot of the Native American groups, a lot of the artifacts we pulled from the middens, the archaeologists do, which is just the trash heap in front of the site where they lived.

Well, there was one community where they were actually able to distinguish rich from poor communities based on their wastewater. They found that in poor communities . . . and this kind of gets to what we've talked about, about kind of Сòòò½APPs of despair and depths of despair. They found that in the poor communities, they had higher rates of antidepressants and opioids in their wastewater. Where they looked at the wastewater, this is sewage water, of richer communities, wealthier communities had higher rates of citrus fruits and dietary fibers in the wealthy communities.

This is actually looking at the sewage using some sort of analysis to determine what's in there. Poor communities, higher rates of opioids, antidepressants. Richer communities, more citrus fruits, higher fiber.

It's kind of frustrating to see that because I think, you know, clearly a lot of these poor communities, it is kind of leading to that despair where we do use the opioids, the antidepressants, where I think wealthier communities have access to so much of what we talk about, the better diets, the better access to the things that we recommend.

But I don't know what my takeaway from that is. It was more I think you kind of highlighted so much of what we talked about in that disparity and what that leads to. And they're seeing evidence of that just in the sewage water.

Scot: Yeah, it's kind of crazy that you could study somebody's sewage water and go, "That's probably a well-off person. That's not a well-off person."

Troy: I know.

Scot: My takeaway is you shouldn't be able to do that. Everybody's sewage water should be the same.

Troy: It should be the same.

Scot: It should be healthy sewage water.

Troy: That was my takeaway as well. It was really kind of sad to read that, to say,"You just go down to the most basic thing: What is the sewage in this community? And you can see that sort of disparity in the sewage in the lowest level of that community."

Scot: Just going to leave this here. It's going to start off about a story of a parking violation, but that's not what this story is about. I got this email. It says right here, "Notice of parking violation. A vehicle registered in your name was observed parking in an unauthorized spot," and then there's a little a little attachment here. It's a Word doc.

So I'm like, "Oh, this morning, I happen to see that my wife got a parking ticket." So I'm like, "I wonder if her parking ticket that she got was here at the U where her car is on my parking pass in case I ever need to come here."

So I click on the little attachment, and this is where it is no longer a story about a parking ticket, and it's a story about when I opened it, it goes, "What just happened? Don't worry . . ."

Troy: "You just got a virus."

Scot: Well, no. "Don't worry. This is an authorized phishing simulation conducted by your company."

Troy: What?

Scot: This simulation helps your company understand the effectiveness of security measures and improves the ability of staff to spot and correctly handle phishing emails.

Troy: It's like,"We're going to bait you enough that you're going to click on this to show that, yeah, you're going to click on something that says you have a parking violation."

Scot: I never would have clicked on that had I not seen that parking ticket in my house this morning. I would have been suspicious. So, I mean, this just goes to show how, you know, we all think . . . I really think I'm really super savvy at this sort of thing. So then I got that, and I'm like, "Oh, are you kidding me?" And not only that now, but I've got another email that's telling me . . .

Troy: "We're shutting down your system because clearly you are susceptible to clicking on phishing."

Scot: Go ahead and read that subject line.

Troy: "You've been assigned cybersecurity training." Oh, that's great. So they bait you into it. Now, they make you do cybersecurity training because they baited you into it.

Scot: So then the thing says, "Because you recently fell for a mock phishing attack, you have been assigned cybersecurity training. Parking, dangerous attachment education, and blah, blah, blah." And then they've got a couple more links they want me to click on, and I'm not clicking those.

Troy: No. I'm not touching it. Just say, "I'm not doing this training."

Scot: If I click it again, are they going to go, "Oh, got you again, sucker"?

Troy: Yeah. I love it. I'm glad you showed me this because now I will be sure not to click on it. I'm pretty good about these things. But I think if I saw a university email saying I had a parking ticket, I would probably click on it.

Scot: Well, here's the trick. I look at it. This was from another college I teach at, Salt Lake Community College. And, you know, it just says parking violation. It doesn't actually say it's from the college. It went to my college address, which I have forwarded to my Gmail, so it's tagged as an SLCC mail. But I looked at actually who it's from, and it's not from them.

Troy: So it's not from them. That's kind of tricky though. It was tagged as . . .

Scot: I was totally sucked in . . .

Troy: You were.

Scot: . . . and it hurts my . . . that's not who I am.

Troy: Now, you have to do cybersecurity training because of this. Nice.

Scot: So anyway, even if you think you're savvy, you can just as easily, like I did, get sucked into a phishing scam. So just be careful.

All right. Well, thank you very much for listening. It's time to say the things that people say at the end of podcasts because we are at the end of this podcast. Please subscribe wherever you like to get your podcasts. You can find the whole complete list at whocaremenshealth.com.

Troy: You can also check us out on Facebook, facebook.com/whocaresmenshealth. We'd love to hear from you. Email us at hello@thescoperadio.com.

So I'm leaving an opening for you, Scot, because you always tell me I just take it and I don't leave anything for you to say.

Scot: Well, there's nothing else left to say other than . . .

Troy: You could just say thanks for listening.

Scot: Thanks for listening, and thanks for caring about men's health.