Health Wanted: The Fertility Crisis

The Episode

In 1968, biologist Paul Ehrlich cautioned that by the 1980s we’d see hundreds of millions of people starving to death due to overpopulation. As it turns out, he was a bit off. 

This week on Health Wanted, the so-called “fertility crisis” is creating a panic about the fate of society and inspiring a movement for more babies. But what’s really driving our low birth rate, and what can we do to reverse it? Host Laurel Bristow also sits down with Karen Guzzo, PhD, to discuss whether it’s truly necessary to lose our minds over the low fertility rate.

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The Listener Questions

What's going on with this flu season?

Flu season is coming and it could be a bad one. 

Australia had a pretty active flu season this year, and we usually use what’s happening down under to predict what might happen in the U.S. Their dominant flu strain was a version of H1N1, but towards the end of their season a new version of H3N2 really took off. From what we see in the U.K. and Japan, it’s looking like this is what’s going to come here. It might already be here, but we haven’t had flu surveillance data since September 26 thanks to the shut down.

The big issue is that this version of H3N2 has some mutations that make it discordant from the flu shot we’ve been giving out, and we can’t update the shot to match it. 

If you got your flu shot, don’t panic! It will very likely still reduce your risk of getting super sick. But if the version of flu that’s circulating is able to evade the vaccine when it comes to getting sick at all, we’ll just inherently see more cases. Japan has already done some school closures to try to interrupt transmission and it’s only very early in the season.

H3N2 isn’t a totally new strain, but unfortunately it does, historically, cause more serious illness, particularly in older adults.

So what do we do? You can mask up. Even if you are someone who is unwilling or unable to mask constantly, even just wearing one to the grocery store or places that other people have to access can help. If you’re traveling, consider wearing them in the high contact areas of an airport like TSA and the jetway. The more you can wear a mask, the lower your risk and the risk to others will be.

It’s still worthwhile to get vaccinated to lower your risk of serious disease. I feel like people forget the flu can take you out for weeks. Be mindful and wash your hands frequently.

If I just got my COVID and flu vaccines for this season, should I get another COVID booster shot in two months?

The idea of getting an additional COVID booster after two months comes from the 2024-2025 COVID season recommendation that people 65 and over or those who are immunocompromised should be allowed to get a second dose of the vaccine, because they are at highest risk and might not mount an antibody response that lasts as long as younger, immunocompetent people.

That recommendation says they can get it no earlier than two months after the initial dose. But the data presented says the waning is most pronounced four to six months after the initial dose. So, if you got vaccinated at the start of November, four months would be mid-march, which is when we are typically coming out of winter respiratory season.

Instead, you may want to consider getting a dose in July, since we do tend to have a second wave in late summer, and then that would be a good bridge to getting the COVID vaccine for the winter season four months later.

How long can pathogens live on surfaces? Is it ever safe to share a razor or a toothbrush?

The safest thing to do is not share items that can come into contact with other people’s bodily fluids unless you know that their status is. But every virus and disease has a different length of time that it can survive on surfaces, so there’s no one magic amount of time.

• Hepatitis B can survive in very small infectious doses for up to a week on a surface.
• HIV only survives on surfaces for a few hours, but if it’s in blood that’s in a syringe, it can live for a lot longer.
• COVID does not survive on surfaces very well because it has a lipid envelope that dries out quickly when it touches things.
• Norovirus can survive on hard surfaces for weeks.

There are also aspects that determine how long it can live, like if the surface is porous or hard, wet or dry, what temperature it is at, and if it is in direct sunlight. Both high temperatures and UV light can do a lot to kill pathogens, but again, it varies depending on what the pathogen is.

So best practice is to not share items that could put you at risk.

Does microdosing weight loss drugs work?

Maybe you’ve noticed that the only places advertising “microdosing” semaglutide and GLP-1 agonists are telehealth companies. It’s not something offered by the companies that actually offer the drugs and hold the patents, and this is because these telehealth companies have deals with compounding pharmacies.

It used to be that compounding pharmacies were used when there needed to be a special version of medication. Maybe someone got prescribed something but they were allergic to a dye that was used in the widely available version, so they would get it from a compounding pharmacy that made the same drug just minus the dye. The compounding pharmacies weren’t a threat to the profits of the company that made the drug (or held the patent) because they were selling their wares to a very niche, small portion of the market.

The other thing that compounding pharmacies could do was make drugs that the original producer couldn’t make enough of to keep up with demand. They filled a critical gap to get people the medications they needed and also, again, didn’t cut into the name brand sales because the name brand didn’t have the capacity to keep up with the sales.

This is what happened with GLP-1s and compounding pharmacies a few years ago: They got permission to make these drugs because there was such a high demand that Eli Lily and Novo Nordisk couldn’t keep up. Which was particularly bad for people who needed it for the original indication, which was the control of diabetes. But when these compounds got approved for weight loss, their demand skyrocketed even further, and that was making compounding pharmacies, and the telehealth companies that prescribe them, a lot of money.

Earlier this year Eli Lily and Novo Nordisk caught up on their manufacturing, which meant that compounding pharmacies were ordered to stop making and selling their versions of the weight loss drugs. This was a lot of money to lose, so instead, many companies decided to tweak their products ever so slightly, either adding something like B12 or changing the dose to a dose not available from the manufacturers, to argue they should still be allowed to sell them because they are a specialized version of the drug.

If you ask these companies if they are creating these microdosing programs to stretch out their ability to continue to sell these products, they’ll tell you “no, we’re doing it for clinical reasons,” like to help with lowering side effects or treating less severe disease. But there’s no clinical data to support that these lower doses are doing what the companies claim they can do, which is everything from lowering metabolic risks to improving sleep apnea to helping symptoms of PCOS.

Catch all the listener questions and Laurel’s answers on the full episode of Health Wanted by:

• Streaming at wabe.org or the WABE app
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