Latest / Morning Medical with Dr. Chow / Heat and Medication Safety, Dental Care Plan Controversy, and U.S. Drug Pricing Debate

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Heat and Medication Safety, Dental Care Plan Controversy, and U.S. Drug Pricing Debate · Morning Medical with Dr. Chow

• 0:00
  Good morning and welcome to another episode of Morning Medical with Dr.
• 0:04
  Chow.
• 0:05
  I am your host, Dr.
• 0:06
  Chi-Ming Chow.
• 0:08
  Today, we have an important and timely topic to discuss—extreme heat and how it can interact
• 0:14
  with various medications.
• 0:16
  This is crucial information, especially as we navigate through the summer months.
• 0:24
  Extreme heat can raise the danger of heat-related illnesses and threaten health in a
• 0:29
  more subtle way—by amplifying the side effects of many common medications.
• 0:34
  Hot weather can also damage medicines such as insulin that require refrigeration.
• 0:40
  Inhalers can explode.
• 0:42
  Epinephrine injectors, such as EpiPens, can malfunction.
• 0:46
  Medicines delivered in the mail can deteriorate.
• 0:50
  Let's take a look at some common problems and solutions related to heat and medicine.
• 0:55
  First, which medicines could cause problems in the heat?
• 0:58
  Blood pressure pills that reduce fluid in the blood can lead to dehydration.
• 1:03
  Beta blockers for heart conditions can decrease blood flow to the skin and make you less aware
• 1:08
  of dangerous heat.
• 1:10
  Some antidepressants can hinder your ability to stay cool.
• 1:14
  Aspirin and other over-the-counter pain relievers decrease fluid and sodium levels,
• 1:20
  making it harder to deal with high temperatures.
• 1:22
  The combination of heat and drug side effects can lead to lightheadedness and falls.
• 1:29
  Alcohol increases the danger, said pharmacist Bradley Phillips, Doctor of Pharmacy, of the
• 1:35
  University of Florida College of Pharmacy in Gainesville.
• 1:39
  You can learn more about your medications' side effects and storage requirements at the
• 1:43
  National Library of Medicine's MedlinePlus website.
• 1:47
  Or talk to your doctor or pharmacist.
• 1:49
  Ask about how much water you should be drinking if you are on medications that increase
• 1:54
  dehydration.
• 1:55
  Phillips recommends staying hydrated and 'not relying on your body's ability to tell you that
• 2:00
  you're thirsty.'
• 2:02
  Some medicines, such as antibiotics, antifungals, and acne drugs, can heighten
• 2:08
  sensitivity to the sun, causing rashes and sunburns.
• 2:12
  If you are taking them, stay under an umbrella or wear sun-protective fabrics and sunscreen,
• 2:18
  said Mike Ren, Doctor of Medicine, a family physician at Baylor College of Medicine in
• 2:23
  Houston.
• 2:25
  'You might be on antibiotics, not think too much of it, go down to the beach and then come
• 2:29
  back with a whopping sunburn,' Ren said.
• 2:33
  How should medications be stored for travel?
• 2:35
  Medication generally should be kept in a cool, dry place, unless it needs refrigeration.
• 2:41
  That can be challenging while traveling.
• 2:43
  Before a summer road trip, check labels for the storage requirements of your medications.
• 2:48
  Carry medicine in a cooler when traveling by car, even if it does not require refrigeration.
• 2:53
  The car's trunk or glove box could get too hot for even room temperature storage.
• 2:58
  Traveling by plane?
• 3:00
  It is always best to keep medications in your carry-on bag in case your checked luggage is
• 3:04
  delayed or lost, and it can get too cold in the cargo hold.
• 3:09
  What about prescriptions delivered by mail?
• 3:11
  Mail-order pharmacies are responsible for keeping your drugs at safe temperatures during
• 3:16
  storage and transit.
• 3:18
  The best practice is to ship sensitive medicine in special packaging with ice packs and
• 3:22
  temperature monitors.
• 3:24
  But that does not always happen.
• 3:26
  Or a delivery can come at a bad time, said Ren, who recently helped his vacationing mother by
• 3:32
  bringing her delivery of supplements into her Houston home as the region faced soaring heat.
• 3:37
  'If you know you're going to be at work all day, or if you're on vacation, and you get
• 3:42
  medications delivered, you definitely don't want that sitting outside in the hot 100-degree
• 3:47
  sun,' Ren said.
• 3:49
  If you think your mail-order medication has been damaged by the heat, call the pharmacy to
• 3:53
  report the problem.
• 3:55
  Is more research needed?
• 3:57
  Yes.
• 3:58
  Researchers in the United States and Australia say some of the common warnings about heat and
• 4:02
  drugs do not have a lot of scientific evidence behind them.
• 4:05
  Ollie Jay, Doctor of Philosophy, at the University of Sydney found backing for only
• 4:11
  four of the eleven medication categories that the World Health Organization lists as concerns
• 4:16
  with high heat.
• 4:18
  He suggests changing behavior, not medications, like staying out of the heat.
• 4:24
  'Be a bit more cautious,' he said.
• 4:27
  Renee Salas, Doctor of Medicine, Master of Science, Master of Public Health, an emergency
• 4:34
  room physician at Massachusetts General Hospital in Boston, said as climate change
• 4:39
  accelerates, there is a need to know which medicines are the riskiest in the heat.
• 4:45
  'We do not have that answer yet, and it is one that we need to rapidly figure out,' Salas
• 4:51
  said.
• 4:53
  A group of oral health-care providers has banded together against what they call
• 4:58
  misinformation about the Canadian Dental Care Plan (CDCP) being spread in part by the
• 5:04
  associations representing dentists.
• 5:09
  "I don't understand how dentists are saying it's an administrative burden when they haven't
• 5:14
  even registered or tried to submit a claim," said Kelly Mansfield, president of the Canadian
• 5:19
  Dental Assistants' Association.
• 5:21
  "We're not seeing any issues."
• 5:24
  The national associations for dental assistants, hygienists, and denturists say
• 5:29
  their professions have had positive experiences overall with the program, which started
• 5:33
  covering seniors on May 1.
• 5:36
  The groups plan to offer an online information session this Tuesday for dental professionals,
• 5:41
  hosted by the Canadian Health Coalition, an advocacy group for public health care.
• 5:46
  They hope to dispel what they call myths about the CDCP and encourage more dentists to sign
• 5:52
  on.
• 5:53
  Dental associations, which represent dentists, have continued to raise concerns about the
• 5:59
  national insurance program.
• 6:01
  Many of their associations' presidents — dentists themselves — have said they will not
• 6:06
  sign up to treat CDCP patients through their own clinics.
• 6:11
  The $13 billion Canadian Dental Care Plan helps cover the cost of dental procedures for low-
• 6:17
  and middle-income residents who do not have private insurance plans.
• 6:22
  Health Canada says just under 50 percent of all oral health care providers have now signed up
• 6:27
  for the program — 12,000 in total.
• 6:30
  They include dentists, independently practicing hygienists, denturists, and dental specialists.
• 6:37
  Health Canada said it could not give CBC News a breakdown by provider type, but other oral
• 6:42
  health associations say they are seeing high rates of participation compared to dentists.
• 6:50
  About 70 percent of eligible independent hygienists are taking part, said Sylvie Martel,
• 6:55
  director of dental hygiene practice at the Canadian Dental Hygienists Association.
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  "We embrace the program," she said.
• 7:03
  "It's not perfect, but it is helping so many vulnerable Canadians that have never stepped
• 7:08
  foot in a dental clinic before.
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  "We hear so much misinformation, so much of the negative.
• 7:15
  Dentistry is the one that is probably providing more of that negative message." Martel said
• 7:21
  dental associations have argued the program is complicated, time-consuming, and an
• 7:26
  administrative burden.
• 7:27
  "What we've heard from our members is, really ...
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  it is no different than processing a dental claim from another dental insurance company,"
• 7:35
  she said.
• 7:37
  Denturists are also signing up at a higher rate than dentists, with about 80 percent of them
• 7:43
  participating, said Denturist Association of Canada president Jaro Wojcicki, who runs a
• 7:49
  denture clinic in Penetanguishene, Ontario.
• 7:52
  Some denture offices are being asked to verify claims by showing their chart notes from their
• 7:57
  appointments, something private insurance usually does not ask, Wojcicki said.
• 8:02
  That is adding some extra work for staff.
• 8:06
  "I don't really mind the idea, mostly because it's them just making sure I've done what I
• 8:10
  said I did," he said.
• 8:12
  "It's taxpayers' funds." However, certain denturists are being asked to verify their
• 8:17
  claims more than others, an issue the Denturist Association of Canada has raised with Health
• 8:22
  Canada.
• 8:24
  "Overall, I think it's been very, very positive as far as denturists go," he said, adding they
• 8:30
  are being reimbursed within 48 hours, which is faster than some private insurance plans.
• 8:36
  "For me and my practice, it's been excellent.
• 8:40
  Patients are coming in, they're excited, they're thrilled, they're thankful.
• 8:44
  Most of them are very emotional." Wojcicki said there have been issues with "patient
• 8:50
  experience" when dentists are not part of the program.
• 8:53
  "If there are dentists that are not accepting the program, that have a mutual patient with
• 8:57
  myself, when I refer that patient back to the dentist and they are not accepting the CDCP, it
• 9:03
  does create a little bit of friction," he said.
• 9:07
  "I really encourage providers to really do their own research, talk to their colleagues
• 9:11
  and really make an educated decision instead of just maybe relying on what the associations are
• 9:16
  saying," he said.
• 9:19
  The Canadian Dental Association, which represents dentists, says the misinformation is
• 9:23
  being caused by the federal government.
• 9:26
  The association says Ottawa's lack of clarity about how the program works is leading to
• 9:34
  confusion and anger among patients, which dental clinics are often on the receiving end
• 9:39
  of.
• 9:41
  The association says dental offices are also spending significant time clarifying with
• 9:46
  patients what dental work is covered through the CDCP — time the group argues could be
• 9:52
  better spent on providing dental care.
• 9:55
  It has put out its own public education program it says is meant to address Canadians'
• 10:00
  misconceptions about the plan.
• 10:03
  In a statement issued to CBC News, the association's president Doctor Joel Antel
• 10:08
  acknowledged the work Ottawa has done to simplify the plan's terms and conditions,
• 10:13
  improve the treatments it covers and address concerns about patient privacy.
• 10:18
  "We are optimistic these changes may encourage more dentists to consider participating," Antel
• 10:24
  wrote.
• 10:25
  "Each dentist will have to decide whether to participate in the CDCP and what is best for
• 10:30
  their practice and their patients."
• 10:33
  The founder of a group advocating for publicly-funded dental care says the pushback
• 10:38
  from dentists today is similar to opposition from doctors when universal health care was
• 10:44
  introduced in the 1960s.
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  "Dentists know they cannot come out and just straight-up be against this program because
• 10:52
  they would come across as very out of touch," said Doctor Brandon Doucet, a Halifax dentist
• 10:57
  and founder of the Coalition for Dental Care.
• 11:01
  "Basically, what they are doing is saying, 'We cannot support the program.' Health Canada will
• 11:06
  hear them out, address those concerns, and then they will just move the goal post and say they
• 11:12
  still do not support the program." Doucet said the CDCP is incredibly friendly to dentists and
• 11:19
  their private businesses, in part because it allows them to "balance bill" — to charge
• 11:25
  patients any extra the government program does not cover.
• 11:29
  "This treats dentists very fairly, but there has been a lot of misinformation being spread
• 11:34
  about the program in the dental community, so a lot of dentists do not know that."
• 11:40
  Without buy-in from more dentists, the program cannot work, he warned.
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  "If dentists do not sign up for this program and people gain coverage but are not able to
• 11:50
  use it, the program is going to be viewed as a failure," he said.
• 11:54
  "It is going to be easier for the Conservatives to take this program away, whether that be in
• 11:59
  whole or in part.
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  And the dental associations and many dentist colleagues of mine are happy to go along with
• 12:08
  this and use their leverage to make this program a failure, despite millions of
• 12:13
  Canadians desperately needing it."
• 12:16
  Earlier this month, President Joe Biden and Senator Bernie Sanders published an opinion
• 12:20
  editorial about “the outrageous prices that the pharmaceutical industry charges the American
• 12:26
  people for prescription drugs.” It is the latest step in Sanders’s ongoing campaign about
• 12:31
  drug prices.
• 12:35
  In June, Sanders, who is chairman of the Senate Committee on Health, Education, Labor and
• 12:40
  Pensions, announced that Lars Jorgensen, chief executive officer of Novo Nordisk, one of the
• 12:46
  world’s largest pharmaceutical companies, had agreed to testify voluntarily before Congress.
• 12:53
  That hearing, according to Sanders’s office, will focus on the “high prices Novo Nordisk
• 12:59
  charges Americans for their blockbuster drugs, Ozempic and Wegovy.”
• 13:05
  Both drugs attract extensive press coverage these days, mostly because their ability to
• 13:09
  control diabetes (Ozempic) and aid weight loss (Wegovy) has made them popular with
• 13:15
  celebrities, whose use has helped popularize them to the general public.
• 13:20
  Clearly, Sanders hopes the drugs’ notoriety will afford him a large audience, to which he
• 13:25
  can make one of his perennial talking points, as he did with the president in their opinion
• 13:31
  editorial: the cost of drugs in the United States is too high.
• 13:36
  “The American people,” Sanders said recently, “are sick and tired of paying, by far, the
• 13:41
  highest prices in the world for prescription drugs.” Sanders likes to single out Ozempic as
• 13:47
  an example.
• 13:48
  According to Sanders, “Novo Nordisk currently charges Americans with Type 2 diabetes nine
• 13:54
  hundred sixty-nine dollars a month for Ozempic, while this same exact drug can be purchased for
• 13:59
  just one hundred fifty-five dollars in Canada and just fifty-nine dollars in Germany.”
• 14:06
  When Jorgensen appears before the Senate committee, Sanders says he “looks forward to
• 14:10
  [him] explaining why Americans are paying up to ten or fifteen times more for these medications
• 14:16
  than people in other countries.” Actually, there is a fairly straightforward reason why
• 14:21
  Americans are paying more for drugs in general — and Ozempic in particular — compared to other
• 14:26
  countries.
• 14:28
  The problem is the Pharmacy Benefit Manager, commonly known as a PBM.
• 14:33
  The first Pharmacy Benefit Managers came into existence in the late 1950s and handled mundane
• 14:39
  tasks such as processing reimbursements on certain drugs for patients and drug stores.
• 14:45
  But the PBM morphed into its current-day version in 2018 as a direct result of the
• 14:51
  Affordable Care Act, which was signed into law by President Barack Obama eight years earlier,
• 14:56
  in 2010.
• 14:59
  One of the myriad stipulations in Obamacare said an insurance company was required to spend
• 15:04
  eighty-five percent of each dollar on the patient, meaning a company could devote only
• 15:08
  fifteen percent of each dollar to overhead and profit.
• 15:12
  The rule was an obvious attempt by lawmakers to cap an insurance company’s ability to post huge
• 15:19
  profits at the expense of patients.
• 15:22
  Since insurance companies now saw their profit-making ability limited, the modern
• 15:27
  Pharmacy Benefit Manager emerged to provide the same management as the insurance company, but
• 15:32
  with one catch: a PBM has no cap on the profit it can make because it is not an insurance
• 15:39
  company.
• 15:41
  In a recent expose about drug costs, The New York Times detailed how insurance companies
• 15:46
  have invented, acquired or merged with PBMs to get around Obamacare’s eighty-five percent rule
• 15:54
  in order to post substantial profits.
• 15:57
  “The giant health insurers Aetna and Cigna,” according to The Times, “were trying to achieve
• 16:03
  the growth demanded by Wall Street.
• 16:05
  They sought to merge with the PBMs, whose profits were soaring.
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  Aetna and CVS combined.
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  Cigna bought Express Scripts.
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  …
• 16:13
  UnitedHealth had built its own PBM.”
• 16:16
  Under this new scheme, for a pharmaceutical company to be able to sell a drug through a
• 16:21
  pharmacy, the company must go through a PBM, and the PBM is allowed to demand the
• 16:26
  pharmaceutical company pay a rebate, which does not go to the patient but to the PBM.
• 16:32
  The rebate can be modest or, more often than not, sizable.
• 16:37
  The amount of money that must be paid to the PBMs through what is essentially a shakedown
• 16:42
  process — if the pharmaceutical company does not pay the rebate, the PBM will not allow the
• 16:48
  drug to be sold in the pharmacy — has made PBMs profit centers of astonishing proportions.
• 16:54
  Just how much a pharmaceutical company has to pay as a rebate normally remains unknown, since
• 17:00
  (and this detail is hard to imagine) rebates are considered trade secrets and thus
• 17:06
  undisclosable.
• 17:08
  These rebates, in short, are the main reason why drug costs are so high in the United
• 17:13
  States.
• 17:14
  Consider the numbers.
• 17:16
  In 2016, two hundred sixty-six million Americans saw their drug purchases handled by a
• 17:22
  PBM and, to quote one source, “manufacturer rebates to PBMs increased from thirty-nine
• 17:28
  point seven billion dollars in 2012 to eighty-nine point five billion dollars in
• 17:33
  2016.” The Times notes that “the three biggest PBMs would each rank among the top forty United
• 17:39
  States companies by revenue.
• 17:41
  The largest, Caremark, generates more revenue than Ford or Home Depot.”
• 17:46
  And in a perverse move, some PBMs are now creating another level of middle-management
• 17:51
  called a group purchasing organization, or GPO, which can also become a profit center.
• 17:56
  For all this revenue, what value do PBMs add?
• 18:00
  Attorney General David Yost, a Republican in Ohio, believes PBMs are “seeking to extract
• 18:05
  from the system, without creating any corresponding value for the system.
• 18:10
  The patients are the ones that are suffering.”
• 18:13
  So, when Sanders convenes his committee in early September, perhaps a logical place to
• 18:18
  start the questioning would be: What percentage of the nine hundred sixty-nine dollars Novo
• 18:23
  Nordisk charges for a months’ supply of Ozempic in the United States constitutes rebates to
• 18:30
  Pharmacy Benefit Managers?
• 18:32
  Some estimates place it at around seventy percent, which more than explains why the price
• 18:38
  of Ozempic is so high in the United States, where PBMs are allowed to operate, as compared
• 18:43
  to the rest of the world, where PBMs do not exist.
• 18:47
  Only then can we get at the real reason for high drug costs in America.
• 18:53
  Is your office freezing?
• 18:54
  Do you need to keep cool to stay healthy?
• 18:57
  Should you set your thermostat based on recommendations from your utility?
• 19:01
  If you are lucky enough to have air conditioning, there are a number of factors to
• 19:05
  consider when choosing the right temperature.
• 19:08
  Comfort and avoiding negative health impacts that come with heat exposure are key.
• 19:13
  But the hotter it is outside compared to your thermostat setting, the more power air
• 19:17
  conditioners guzzle.
• 19:19
  That could strain electricity grids and increase the risk of deadly blackouts during
• 19:23
  heat waves.
• 19:24
  In places with a dirty grid, the energy used to cool buildings can make power plants burn more
• 19:30
  fossil fuels, which in turn impacts global heating from climate change.
• 19:35
  Plus, using lots of power can generate big energy bills.
• 19:40
  So what to do?
• 19:42
  There is no shortage of recommendations and guidelines for your thermostat setting —
• 19:46
  spanning a wide range.
• 19:49
  For example, the Japanese Ministry of the Environment recommends setting your thermostat
• 19:54
  to twenty-eight degrees Celsius to save energy.
• 19:58
  This recommendation has been implemented in offices and shops, along with encouragement to
• 20:03
  wear less formal office attire.
• 20:06
  Similarly, South Korea recommends twenty-eight degrees Celsius, with exemptions for some kinds
• 20:12
  of buildings such as schools and daycares, senior centres, and hotels.
• 20:17
  Toronto Hydro recommends twenty-eight degrees Celsius as the temperature to set when you are
• 20:23
  away from home.
• 20:24
  The World Health Organization recommends twenty-seven degrees Celsius, suggesting adding
• 20:29
  a fan to make it feel four degrees cooler.
• 20:33
  Spain has made it illegal to set thermostats lower than twenty-seven degrees Celsius in
• 20:38
  public places, although it is only a recommendation at home.
• 20:43
  Greece and Italy, excluding hospitals, also use this set point for public buildings.
• 20:50
  The maximum summer thermostat setting recommended by Toronto Hydro and the Canadian
• 20:55
  Standard Association's standard for workplace ergonomics in occupied buildings is twenty-six
• 21:01
  degrees Celsius.
• 21:03
  Some groups also want to legislate this as the maximum allowable indoor temperature in
• 21:09
  Toronto.
• 21:11
  Energy Star, an energy efficiency-labelling partnership between the United States
• 21:17
  Environmental Protection Agency and private companies that make appliances, recommends
• 21:22
  twenty-five point five degrees Celsius.
• 21:25
  The Hong Kong Government also recommends this temperature, aiming to strike a balance between
• 21:30
  energy savings and carbon dioxide emissions reductions, as well as thermal comfort.
• 21:37
  BC Hydro recommends twenty-five degrees Celsius and suggests shutting off the air conditioner
• 21:43
  when you are not home for an hour or more.
• 21:46
  The optimum summer temperature, according to the Canadian Standards Association's standard
• 21:51
  for workplace ergonomics, is twenty-four point five degrees Celsius, with a suggested range of
• 21:57
  twenty-three to twenty-six degrees Celsius.
• 22:00
  The American Society of Heating, Refrigerating and Air Conditioning Engineers recommends
• 22:06
  twenty-four degrees Celsius when you are home during the day and a higher temperature at
• 22:10
  night.
• 22:11
  In North America, twenty-two degrees Celsius is considered the typical temperature for
• 22:17
  air-conditioned spaces.
• 22:19
  This is based on what studies have found comfortable, but there are criticisms that
• 22:24
  these studies are based on small groups of men in suits, and women generally prefer it warmer.
• 22:30
  Brendan Haley, director of policy for Efficiency Canada, notes that there is no magic
• 22:36
  set point.
• 22:37
  It can depend on many factors, including some that can change over time, such as age and
• 22:42
  health status.
• 22:44
  Seniors and those with certain chronic health conditions such as heart or kidney disease, as
• 22:49
  well as those with schizophrenia, are more likely to die during heat waves and are
• 22:54
  considered more vulnerable to heat.
• 22:57
  Glen Kenny, professor of human physiology at the University of Ottawa, said health agencies
• 23:03
  have generally considered indoor temperatures of twenty-four to twenty-eight degrees Celsius
• 23:08
  to be safe for vulnerable people, but that is based on statistics.
• 23:14
  He recently ran a test on a group of seniors aged sixty-five to eighty-five.
• 23:20
  After eight hours at twenty-six degrees Celsius, they had no increase in core body
• 23:25
  temperature, heart rate, or blood pressure, suggesting that twenty-six degrees is a safe
• 23:30
  room temperature for day-long exposure.
• 23:33
  However, he acknowledged that twenty-six degrees is still a very warm temperature and
• 23:38
  potentially uncomfortable for people.
• 23:42
  Longer exposures could disrupt vulnerable people's sleep, potentially worsening their
• 23:46
  overall health.
• 23:48
  Temperature recommendations can be higher than twenty-six degrees in some countries, depending
• 23:53
  on factors such as the capacity of their power grids and their climates.
• 23:58
  Kenny acknowledged that people in some countries are used to hotter temperatures, and
• 24:02
  there is a level of adaptation and acclimatization to that environment, although
• 24:06
  that can take weeks.
• 24:09
  Too many air conditioners running too hard have led to deadly outages in countries such as
• 24:14
  Pakistan.
• 24:16
  In Canada, they have been blamed for small outages like one in Ottawa's west end last
• 24:21
  year.
• 24:22
  In British Columbia last year, some landlords warned tenants against installing air
• 24:27
  conditioners, saying older buildings do not have the electrical capacity to handle them.
• 24:32
  That may be why many utilities recommend keeping your thermostat set closer to
• 24:37
  twenty-six degrees Celsius than twenty-two degrees.
• 24:42
  Climate scientist Andrew Dessler explains that air conditioners need to work exponentially
• 24:47
  harder the hotter it is outside compared to the temperature you set inside, consuming
• 24:53
  exponentially more power and leading to higher bills.
• 24:57
  He gave the example of someone who wants to cool their house to twenty-four degrees
• 25:02
  Celsius.
• 25:03
  If the outside temperature increases from thirty-six degrees to thirty-eight degrees due
• 25:08
  to climate change, that will require forty-two percent more energy.
• 25:13
  Already, he said, the power bills for air conditioning are unaffordable for some.
• 25:18
  Jim Bolger, president of the Ontario HVAC sales and service company Waterloo Energy Products,
• 25:24
  acknowledged that for some people, a ten or twenty dollar difference in their power bill
• 25:29
  could be significant.
• 25:31
  Bolger says that adjusting your thermostat up or down may not make that much of a difference
• 25:36
  to your power consumption — it also depends on the age and efficiency of your air conditioner
• 25:43
  and how well insulated and shaded your house is.
• 25:47
  He suspects that what hydro utilities are worried about is the thousands of people who
• 25:52
  have old, inefficient air conditioners — who will also get much higher bills if they crank
• 25:57
  their air conditioners too hard.
• 26:00
  If your air conditioner relies on a geothermal or geoexchange heat pump, as his does, it will
• 26:05
  be dumping heat into the ground instead of the air.
• 26:09
  The ground is much cooler than the air in the summer, making geothermal systems extremely
• 26:14
  efficient.
• 26:15
  In that case, you are saving nothing by increasing your thermostat a few degrees.
• 26:21
  Likewise, people with newer, efficient air-source heat pumps or air conditioners
• 26:26
  probably will not see a huge impact if they keep their place a bit cooler.
• 26:31
  Those also dehumidify your home more effectively and many even have a
• 26:35
  dehumidification mode, which can make a big difference.
• 26:39
  You can feel more comfortable at twenty-four degrees with lower humidity than you can at
• 26:43
  twenty degrees with high humidity.
• 26:46
  Haley with Efficiency Canada noted that it is not just the air conditioner itself that makes
• 26:51
  a difference.
• 26:52
  It is also how well your house keeps the coolness in and the heat out — its
• 26:56
  airtightness, insulation, and how well shaded it is.
• 27:00
  When it comes to nighttime and when you are away from home, some places charge higher
• 27:05
  electricity rates during peak daytime hours and cheaper rates at night.
• 27:09
  In these cases, utilities such as Toronto Hydro recommend keeping your house cooler during
• 27:14
  off-peak hours.
• 27:17
  Haley said that could let your house store the coolness like a thermal battery, possibly for
• 27:22
  much of the day, if it is well shaded and insulated.
• 27:26
  Many utilities also suggest raising the thermostat when you are away from home.
• 27:31
  Bolger recommends against adjusting your thermostat more than a few degrees regularly,
• 27:37
  as that can force your equipment to work too hard to adjust to the change.
• 27:42
  So with all that information, how do you choose the right temperature?
• 27:46
  Bolger puts it this way: 'There always has to be a balance between operation cost savings,
• 27:52
  efficiency and creature comfort.'
• 27:54
  Confidence is key to well-being.
• 27:57
  Here are 5 ways to boost yours.
• 28:00
  Good morning and welcome to another episode of Morning Medical with Dr.
• 28:04
  Chow.
• 28:05
  I am your host, Dr.
• 28:07
  Chi-Ming Chow.
• 28:08
  Today we will be discussing an important factor that can significantly impact your well-being:
• 28:14
  confidence.
• 28:15
  We will explore five effective ways to boost your confidence, based on insights from
• 28:20
  neuroscientist and confidence expert Ian Robertson.
• 28:24
  Everyone has encountered those people who always seem to know what they are doing.
• 28:28
  They confidently take control of situations, express their opinions as if they were
• 28:33
  established facts, and dive into projects believing they will succeed, even without the
• 28:38
  required experience.
• 28:40
  So what is their secret?
• 28:42
  According to Ian Robertson, confidence is probably the most important resource in human
• 28:47
  well-being and performance.
• 28:50
  Ian Robertson is a professor emeritus of psychology and the co-director of the Global
• 28:55
  Brain Health Institute at Trinity College Dublin in Ireland.
• 28:59
  He also holds the T.
• 29:01
  Boone Pickens Distinguished Chair at the Center for BrainHealth at the University of Texas at
• 29:06
  Dallas.
• 29:07
  Robertson explains that confidence is a belief with two strands: the belief that you can do
• 29:13
  something and the belief that if you do that thing, you will get a reward or an outcome you
• 29:19
  desire.
• 29:20
  When you feel confident, you are more likely to succeed because confidence activates brain
• 29:25
  circuits that produce an elevated mood, lower anxiety, and sharper thinking.
• 29:31
  These are the same brain circuits that get activated when you do succeed.
• 29:35
  So whether you have confidence or succeed, even at a small task, it leads to more success and
• 29:42
  then even more confidence.
• 29:44
  As Robertson puts it, 'The greatest source of success is success, and success, like
• 29:51
  confidence, acts like compound interest: it is exponential.
• 29:56
  A little bit grows steadily.'
• 29:58
  If confidence is on one end of the spectrum, anxiety is at the other.
• 30:03
  If you lack confidence, it generates anxiety because of the fear of failure and the negative
• 30:08
  evaluation of others.
• 30:10
  Anxiety activates circuits that disrupt the fluid synchronization of different brain
• 30:15
  regions critical for elite performance.
• 30:18
  Research shows that people who are chronically anxious do less of everything because their
• 30:22
  brains are primed into a threat mindset, anticipating negative outcomes and threats.
• 30:29
  So, how can you build confidence?
• 30:31
  Ian Robertson has five tips for boosting your confidence, even under daunting circumstances.
• 30:37
  First, take action.
• 30:39
  Taking steps to do something and then doing it, no matter how shaky you feel, will result in a
• 30:45
  burst of confidence.
• 30:47
  Confidence is linked to the action systems of the brain.
• 30:50
  Taking action, despite feeling anxious, is crucial for building confidence.
• 30:56
  Second, choose your focus carefully.
• 31:00
  What you pay attention to determines your emotional state.
• 31:04
  If you are giving a talk and there are a few people frowning or on their phones, your
• 31:08
  attention will lock onto them.
• 31:11
  Instead, deliberately choose to pay attention to the majority of people who are interested
• 31:16
  and smiling.
• 31:18
  This will feed your brain with positive thoughts and images, helping you remember past
• 31:23
  successes rather than failures.
• 31:26
  Third, adopt a growth mindset.
• 31:28
  Believe that change is possible.
• 31:31
  People with a growth mindset believe that with effort, you can learn abilities and cultivate
• 31:36
  talents.
• 31:37
  Conversely, those with a fixed mindset believe talents and abilities are innate.
• 31:42
  A fixed mindset can cripple your confidence because it discourages engagement in the slow
• 31:47
  ups and downs that learning entails.
• 31:50
  Fourth, deal with your anxiety.
• 31:53
  Reframe anxiety as excitement.
• 31:56
  The bodily and brain symptoms of anxiety are identical to those of excitement.
• 32:01
  If faced with a situation that makes you anxious, such as a difficult conversation or an
• 32:07
  interview, adopt a 'challenge' mindset.
• 32:10
  Use language to harness that energy by telling yourself, 'I am excited.'
• 32:16
  Finally, affirm your values.
• 32:19
  Define yourself and what you stand for.
• 32:21
  Who you are as a person is grounded in what you stand for and what is important to you.
• 32:27
  Take a few seconds to write down your values and why they are important to you.
• 32:31
  This will make your brain more resilient and protected against the fear of criticism,
• 32:36
  humiliation, and failure.
• 32:39
  We hope these five tips help you build up your confidence.
• 32:43
  Thank you for joining us on Morning Medical with Dr.
• 32:46
  Chow.
• 32:47
  Stay tuned for our next episode where we will continue to bring you the latest in medical and
• 32:51
  health news.
• 32:53
  Have a great day!