Some years ago, I thought to help my daughter understand statistics by reanalyzing the data from a 2004 study on coffee and Parkinson’s disease mortality, “Coffee consumption, gender, and Parkinson’s disease mortality in the cancer prevention study II cohort: the modifying effects of estrogen” , Am J Epidemiol. 2004 Nov 15;160(10):977-84, see it here
For the study, a cohort of over 1 million people was enrolled in 1982 and assessed for diet, smoking, alcohol, etc. Causes of deaths were ascertained through death certificates from January 1, 1989, through 1998. Death certificate data suggested that coffee decreased Parkinson’s mortality in men but not in women after adjustment for age, smoking, and alcohol intake. They used a technique I didn’t like though, ANOVA, analysis of variance. That is they compare the outcome of those who drank a lot of coffee (4 cups or more) to those who drank nothing. Though women in the coffee cohort had about 49% the death rate, it was not statistically significant by the ANOVA measure (p = 0.6). The authors of the study understood estrogen to be the reason for the difference.
Based on R2, coffee appears to significantly decrease the risk of Parkinson’s mortality in both men and women.
I thought we could do a better by graphical analysis, see plot at right, especially using R2 to analyze the trend. According to this plot it appears that coffee significantly reduces the likelihood of death in both men and women, confidence better than 90%. Women don’t tend to drink as much coffee as men, but the relative effect per cup is stronger than in men, it appears, and the trend line is clearer too. In the ANOVA, it appears that the effect in women is small because women are less prone Parkinson’s.
There is a confounding behavior that I should note, it’s possible that people who begin to feel signs of Parkinson’s, etc. stop drinking coffee. I doubt it, give the study’s design, but it’s worth a mention. The same confounding is also present in a previous analysis I did that suggested that being overweight protected from dementia, and from Alzheimer’s. Maybe pre-dementia people start loosing weight long before other symptoms appear.
Doctor Anthony Fauci has been giving graduate addresses at colleges around the country for the past few months, telling students about his struggles and successes in the medical research world, hammering a moral point that they should expect the unexpected and have no tolerance for “the normalization of untruth”, and for “egregious twisting and lies” as were leveled against his approach to COVID (and global warming, it seems). Untruths, racism, and lies spread by “some elected officials”, presumably his exboss. Here is his speech to the Princeton graduates, or see a brief summary of his talk st the University of Michigan.
Dr. Fauci may have the best intentions in criticizing others and deputizing students to enforce the truth.He certainly seems sure that his truth and intentions are 100% pure, but what if Fauci wasn’t quite right, or what if you thought his cure to the pandemic was less than marvelous. His truth may mot be real truth, or real truth for everyone. Beyond that, even if he were always 100% right on science, I believe that people have a fundamental right to make mistakes. “I have a right to be wrong,” as Joss Stone says (see music video). Freedom from imposed righteousness is a fundamental good. Even assuming that Fauci’s lockdowns were the height of righteousness, we have a right to take risks and to act against our own best interests, in my opinion. Consider a saint who really knows what’s right and only wants to do only what’s right. I doubt that even the saint wants a jailer to force it upon him and remove his free will. And the right of the rest of us may not want to do what’s ideal and healthy. We like ice cream even thought we know it’s fattening, and we should have the right to smoke too.
This right to our mistakes is something we deserve, even assuming that Fauci knows the truth for everyone, and that everyone has the same truth, and that all of his rules were for the best. But different people are different, and people’s preferences are different. “A sadist is a masochist who follows the golden rule,” as the saying goes, and Fauci may have been out-and-out wrong.
Humor from a time when one could tolerate hearing that their truths might not be true.
Concerning COVID, I’ve noted that, despite Fauci’s lockdowns and mask mandates, The US did worse than Sweden, and my home state of Michigan did worse than Sweden — worse in terms of deaths, and far worse economically. Michigan has the same size population as Sweden and the same climate and population density so it’s a good comparison. Florida did better than we did too, though they too didn’t close the schools or have mask mandates. Their economy did better too, and children’s education.
Was Fauci right to shut K-12 schools, or to send college students home? Maybe he was only half-right, or totally wrong and blinded by politics. The more Fauci and friends deny having political interests, the more they seem political. Many Fauci’s emails have become public, and he seems highly political, and very often wrong. He also does not take seriously the economic or mental or educational problems caused to the workers that he now blames on his critics. He also seems takes it as a given that those pushing hydroxychloroquine or surface disinfection were liars, despite scientific opinion on the other side.
Fauci’s push for masks went with his claim that surfaces were not major spreaders. I think the opposite is true, and used my blog and YouTube to push iodine as a surface sanitizer and hand wash. Most diseases are spread by surfaces, and I see no reason for COVID to be different. Iodine is known to kill COVID virus, and all virus, fungus, and bacteria. It’s far more lang-lasting than alcohol, too. Maybe I’m wrong, but maybe I’m right, and I have a right to express my science without fear of censure from Fauci’s deputies. As I see it, when an infected person coughs out-spews big droplets and small droplets. The big drops contain far more virus particles. They fall quickly and dry, ready to be picked up by someone who touches the residue. As for the smaller drops, some are certainly locked by masks, but these have fewer virus particles. Besides, the mask just becomes a new surface; you’ll touch your mask to adjust it or take it off. Unless you disinfect your hands with something strong like iodine the virus on your hands will go to your eyes or nose. Trump favored Chlorox for surfaces, and was skewered for it by Fauci and his experts. I think that was wrong, made worse by claims that he was not telling you to inject the Clorox.
On climate too, we do students a disservice by closing the discussion. It’s clear that Gore’s inconvenient truth isn’t completely true, nor are his remedies beneficial, in my opinion. To stop someone’s ability to make mistakes is to wrong him, and limit him. The same applies to many things; the fellow in power always thinks he’s right, and will always have allies to back him. When Robespierre was the enforced virtue and truth during the French Revolution, everyone agreed, but we now think he was wrong. Robespierre removed the head of France’s greatest scientist, Lavoisier. It would take another generation to grow another head like that.
In terms of interesting speeches to the graduates, As Marx said (Groucho), “I thought my razor was dull, till I heard his speech.” There here’s a speech against something.
Freedom is the right to be wrong, and stubborn, like Groucho. Now that’s a graduation speech!
It is a particular skill of management to hog the glory and cast the blame; if a project succeeds, executives will make it understood that the groups’ success was based on their leadership (and their ability to get everyone to work hard for low pay). If the project fails, a executive will cast blame typically on those who spotted the problem some months early. These are the people most likely to blame the executive, so the executive discredits them first.
This being the dynamic of executive oversight, it becomes difficult to look over the work of a group and tell who is doing good and who is coasting. If someone’s got to be fired in the middle of a project, or after, who do you fire? My first thought is that, following a failure, you fire the manager and the guy at the top who drew the top salary. That’s what winning sports teams do. It seems to promote “rebuilding” it’s a warning to those who follow. After the top people are gone, you might get an honest appraisal of what went wrong and what to do next.
A related problem, if you’re looking to hire is who to pick or promote from within. In the revolutionary army, they allowed the conscripts to pick some of their commanders, and promoted others based on success. This may not be entirely fair, as there are many causes to success and failure, but it seemed to work better than the British system, where you picked by birth or education. Here’s a lovely song about the value of university education in a modern major general.
A form of this feedback about who knows what he’d doing and who does not, is to look at who is listened to by colleagues. When someone speaks, do people who know listen. It’s a method I’ve used to try to guess who knew things in a field outside my own. Bull-shitters tend to be ignored when they speak. The major general above is never listened to.
In basketball or hockey, the equivalent method is to see who the other players pass to the most, and who steals the most from the other side. It does not take much watching to get a general sense, but statistics help. With statistics, one can set up a hierarchical system based on who listens to whom, or who passes to whom with a logistic equation as used for chess and dating sites. A lower-paid person at the center-top is a gem who you might consider promoting.
In terms of overall group management, it was the opinion of W Edwards Deming, the name-sake of the Deming prize for quality, that overall group success was typically caused by luck or by some non-human cause. Thus that any manager would be as good as any other. Deming had a lovely experiment to show why this is likely the case– see it here. If one company or team did better year after year, it was common that they were in the right territory, or at the right time. As an example, the person who succeeded selling big computers in New York in the 1960s was not necessarily a good salesman or manager. Anyone could have managed that success. To the extent that this is true, you should not fire people readily, but neither worry that your highest paid manager or salesman is irreplaceable.
Atenolol and related beta blockers have been found to be effective reducing blood pressure and heart rate. Since high blood pressure is a warning sign for heart problems, doctors have been prescribing atenolol and related beta blockers for all sorts of heart problems, even problems that are not caused by high blood pressure. I was prescribed metoprolol and then atenolol for Atrial Fibrillation, A-Fib, beginning 2 yeas ago, even though I have low-moderate blood pressure. For someone like me, it might have been deadly. Even for patients with moderately high blood pressure (hypertension) studies suggest there is no heart benefit to atenolol and related ß-blockers, and only minimal stroke and renal benefit. As early as 1985 (37 years ago) the Medical Research Council trial found that “ß blockers are relatively ineffective for primary treatment of hypertensive outcomes.”
End point. Relative risk. 95% CI. All-cause mortality Cardiovascular mortality MI Stroke Carlberg B et al. Lancet 2004; 364:1684–1689.
There lots of adverse side-effects to atenolol, as listed at the end of this post. More recent studies (e.g. Carlsberg et al., at right) continue to find no positive effects on the heart, but lots of negatives. A review in Lancet (2004) 364,1684–9 was titled, “Review: atenolol may be ineffective for reducing cardiovascular morbidity or all cause mortality in hypertension” (link here). “In patients with essential hypertension, atenolol is not better than placebo or no treatment for reducing cardiovascular morbidity or all cause mortality.” It further concluded that, “compared to other antihypertensive drugs, it [atenolol] may increase the risk of stroke or death.” I showed this and related studies to my doctor, and pointed out that I have averaged to low blood pressure, but he persisted in pushing this drug, something that seems common among medical men. My guess is that the advertising or doctor subsidies are spectacular. By contrast, aspirin has long been known to be effective for heart problems; my doctor said to go off aspirin.
The graph at right is from “Trial of Secondary Prevention with Atenolol after transient Ischemic Attack or Nondisabling Ischemic Stroke”, published in Stroke, 24 4 (1993), (see link here). a Thje study involved 1473 at-risk patients, randomly prescribed atenolol or placebo. It found no outcome benefit from atenolol, and several negatives. After 3 years, in two equal-size randomized groups, there were 64 deaths among the atenolol group, 58 among the placebo group; there were 11 fatal strokes with atenolol, versus 8 with placebo. There were somewhat fewer non-fatal strokes with atenolol, but the sum-total of fatal and non-fatal strokes was equal; there were 81 in each group.
“Trial of Secondary Prevention with Atenolol after transient Ischemic Attack or Nondisabling Ischemic Stroke”, published in Stroke, 24 4 (1993).
Newer beta blockers seem marginally better, as in “Effect of nebivolol or atenolol vs. placebo on cardiovascular health in subjects with borderline blood pressure: the EVIDENCE study.” “Nebivolol (NEB) in contrast to atenolol (ATE) may have a beneficial effect on endothelial function …. there was no significant change in the ATE and PLAC groups.” My question: why not use one of these, or better yet aspirin. Aspirin is shown to be beneficial, and relatively side-effect free. If you tolerate aspirin, and most people do, beneficial has to be better than maybe beneficial.
Among atenolol’s ugly side effects, as listed by the Mayo Clinic, there are: tiredness, sweating, shortness of breath, confusion, loss of sex drive, cold fingers and toes, diarrhea, nausea, and general confusion. I had some of these. There was no increase in heart stability (decrease in A-fib). My heart rate went as low at 32 bpm at night. My doctor was unconcerned, but I was. I suspected the low heart rate put me at extreme risk. Eventually, the same doctor gave me ablation therapy, and that seemed to cure the A-Fib.
Following my ablation, I was told I could get off atenolol. I then discovered another negative effect of atenolol: you have to ease off it or your heart will race. If you have A-fib, or modest hypertension, consider aspirin, eliquis, ablation, or exercise. If you are prescribed atenolol for heart issues and don’t have symptoms of very-high blood pressure, consider other options and/or changing doctors.
Two years ago, I was diagnosed with Atrial fibrillation, A-Fib in common parlance, a condition where my heart would sometimes speed up to double its normal speed. I was prescribed metopolol and then atenolol, common beta blockers, and a C-Pap for sleep apnea. None of this seemed to help, as best I could tell from occasional pulse measurements with watch and a finger pulse-oxometer. Besides, the C-Pap was giving me cough and the beta blockers made me dizzy. And the literature on C-Pap did not impress.
So, some moths ago, I bought an iWatch. The current versions allows you to take EKGs and provides a continuous record of your heart rate. This was very helpful, as I saw that my heart rate was transitioning to chaos. While it was normally predictable, it would zoom to 130 or so at some point virtually every day. Even more alarming, it would slow down to the mid 30s at some point during the night, bradycardia, and I could see it was getting worse. At that point, I agreed to go on eliquis, a blood thinner, and agreed to a catheter ablation. The doctor put a catheter into my heart by way of a leg vein, and zapped various nerve centers in the heart. The result is that my heart is back into normal behavior. See the heart-rate readout from my iWatch below; before and after are dramatically different.
My heart rate for the last month, very variable before the ablation treatment, 2 weeks ago; a far less variable range of heart rates in the two weeks following the treatment. Heart rate data is from my iPhone and iwatch — a good investment, IMHO.
The reason I chose ablation over drugs or no therapy was that I read health-studies on line. I’ve go a PhD, and that training helps me to understand the papers I’ve read, but you should read them too. They are not that hard to understand. Though ablation didn’t appear as a panacea, it was clearly better than the alternatives. Particularly relevant was the CABANA study on life expectancy. CABANA stands for “Catheter ABlation vs ANtiarrhythmic Drug Therapy for Atrial Fibrillation – CABANA”. https://www.acc.org/latest-in-cardiology/clinical-trials/2018/05/10/15/57/cabana.
2,204 individuals with persistent AF were followed for 5 years after treatment, 37% female, 63% male, average age 67.5. Prior hospitalization for AF: 39%. The results were as follows:
Death: 5.2% for ablation vs. 6.1% for drug therapy (p = 0.38)
Serious stroke: 0.3% for ablation vs. 0.6% for drug therapy (p = 0.19)
All-cause mortality: 4.4% for ablation vs. 7.5% for drug therapy (p = 0.005)
Death or CV hospitalization: 51.7% for ablation vs. 58.1% for drug therapy (p = 0.002)
Pericardial effusion with ablation: 3.0%; ablation-related events: 1.8%
First recurrent AF/atrial flutter/atrial tachycardia: 53.8% vs. 71.9% (p < 0.0001)
I found all of this significant, including the fact that 27.5% of those on the drug treatment crossed over to have ablation while only 9.2% on the ablation side crossed to have the drug treatment.
I must give a plug for doctor Ahmed at Beaumont Hospital who did the ablation. He does about 200 of these a year, and does them well. Do not go to an amateur. I was less-than impressed with him pushing the beta-blocker hard; I’ll write about that. Also, get an iWatch if you think you may have A-Fib or any other heart problem. You see a lot, just by watching, so to speak.
Inheritability of traits is one of the greatest of insights; it’s so significant and apparent, that one who does not accept it may safely be called a dullard. Personal variation exists, but most everyone accepts that if your parents are tall, you are likely to be tall; If they are dark, you too will likely be dark, etc., but when it comes to intelligence, or proclivities, or psychological leanings, it is more than a little impolite to acknowledge that genetics holds sway. This unwillingness is glaringly apparent in the voice-over narration of a popular movie about three identical triplets who were raised separately without knowing of one another and who turned out virtually identical. The movie is “Three identical strangers”, and it recounts their separate upbringing, their meeting, and their lives afterwards.
Triplets, raised separately, came out near identical.
Although raised separately, one in a rich family, one in a poor family, and one middling, the three showed near identical intelligence, and near identical proclivities. Two of them picked the same out-of-the way college. All of them liked the same sort of clothes and had the same taste in women. There were differences too, showing that genetics isn’t everything: one was more outgoing, one less, and depressed, but in many ways, they were identical. Meanwhile, the voice-over kept saying things like, “isn’t it a shame that we never saw any results on nature/nurture from this study.” The movie looked at some twins, raised separately, saw the same commonalities, and restated that they saw nothing remarkable. My clear takeaway was genetics applies to psychology too. That it’s not all genetics, but it is at least as influential as upbringing/ nurture.
This movie also included pairs of identical twins, raised separately, they also showed strong personality similarities. It’s a finding that is well replicated in broader studies involving siblings raised separately, and unrelated adoptees raised together. Blood, it seems, is stronger than nurture. See for example the research survey paper, “Genetic Influence on Human Psychological Traits” Journal of the American Psychological Society 13-4, pp 148-151 (2004). A table from that paper appears below. Genetics plays a fairly strong role in all personal traits including intelligence, personality, self-control, mental illness, criminality, political views (even mobile phone use). The role is age-dependent, though so that intelligence (test determined) is strongly environment-dependent in 5 year olds, almost entirely genetic in 25-50 year olds. One area that is not strongly genetic, it seems, is religion.
In a sense, the only thing surprising about this result is that anyone is surprised. Genetics is accepted as crucial for all things physical, so why not mental and social. As an example of the genetic influence on sports, consider Jewish chess genius, Lazlo Polgar: he decided to prove that anyone could be great at chess, and decided to train his three daughters: he got two grand masters and an international master. By comparison, there are only 2 chess grand masters in all of Finland. Then consider that there are five all-star, baseball players named Alou, all from the same household, including the three brothers below. The household has seven pro baseball players in all.
Most people are uncomfortable with such evidence of genetic proclivity. The movie has been called “deeply disturbing” as any evidence of proclivity contradicts the promise of education: that all men are equal, blank slates at birth that can be fashioned into whatever you want through education. What we claim we want is leaders — lots of them, and we expect that education will produce equal ratios of woman and men, black and white and Hispanic, etc. and we expect to be able to get there without testing for skills, — especially without blind testing. I notice that the great universities have moved to have testing optional, instead relying on interviews and related measures of leadership. I think this is nonsense, but then I don’t run Harvard. As a professor, I’ve found that some kids have an aptitude and a burning interest, and others do not. You can tell a lot by testing, but the folks who run the universities disagree.
The All star Alou brothers share an outfield.
University heads claim that blind testing is racist. They find that some races score poorly on spacial sense, for example, or vocabulary suggesting that the tests are to blame. There is some truth to these concerns, but I find that the lack of blind testing is more racist. Once the test is eliminated, academia finds a way to elevate their friends, and the progeny of the powerful.
The variety of proclivities plays into an observation that you can be super intelligent in one area, and super stupid in others. That was the humor of some TV shows: “Big Bang Theory” and “Fraser”. That was also the tragedy of Bobby Fischer. He was brilliant in chess (and the child of brilliant parents), but was a blithering idiot in all other areas of life. Finland should not feel bad about their lack of great chess players. The country has produced two phone companies, two strong operating systems, and the all time top sniper.
Most of science is induction. Scientists measure correlation, for example that fat people don’t run as much as thin people. They then use logic to differentiate cause from effect that is do they not run because they are fat, or are they fat because they don’t run, or is everything base on some third factor, like genetics. At every step this is all inductive logic, but that’s how science is done.
The lack of certainty shows up especially commonly in health work. Many of our cancer cures are found to not work when studied under slightly different conditions. Similarly with weight los, or heart health. I’d mentioned previously that CPAPs reduce heart fibrillation, and heart filtration is correlated with shortened life, but then we find that CPAP use does not lengthen life, but seems to shorten it. (see a reason here). That’s the problem with induction; correlation isn’t typically predictive in a useful way.
Despite these problems, this is how science works. You look for patterns, use induction, find an explanation, and try to check your results. I have an essay on the scientific methods, with quotes from Sherlock Holmes. His mysteries are a wonderful guide, and his inductive leaps are almost always true. Meanwhile, the inductive leaps of Watson and Lastrade are almost always false.
I’m writing a book about reverse psychology; please don’t buy it.
This one’s not by Rappaport
The judge said I had to keep 6 feet away from my ex-wife. So I buried her under the patio.
Robert Buxbaum: the above 3 jokes are from Jack Rappaport — He sometimes sells jokes. April 13, 2022. The ones below are from Gahan Wilson, and the one at right, I don’t know.
In this blog-post, I’d like to report on the first random study of patients with Atrial fabulation, A-Fib, and sleep apnea, comparing the health outcome of those who use a C-PAP, a “Continuous Positive Airway Pressure” device, to the outcome those who do not. The original study was published in May, 2021 (read it here) in the American Journal of Respiratory and Critical Care Medicine. The American Journal, Pulmonary Advisor published a more-popular version here.
As a background, if you are over 65 and overweight, there is a 25% chance or so that your heart rate will begin to surge semi-randomly, and that it will flutter. This is Atrial fabulation, A-Fib. It tends to get worse and tends to lead to heart attacks and strokes. People with A-fib tend to be treated with drugs, aspirin, warfarin, beta blockers, and anti arrhythmics. They also tend to be prescribed a C-PAP because overweight, older folks tend to snore and wake up a lot during the night (several times per hour: apnea).
A C-PAP definitely stops the snoring and the Apnea, and the assumption was that it would help your heart as well, if only by giving you a better night’s sleep. As it turns out, the C-PAP seems to decrease heart health — significantly.
For this study, adult patients between 18 and 75 years old diagnosed with paroxysmal A-Fib (that’s occasional AF) were screened for moderate to severe sleep apnea. Those who agreed to participate were randomly assigned to either a treatment of C-PAP plus usual care (drugs mostly) or just usual care for the next 5 months. Of the 109 who enrolled in the study, 55 got the C-PAP plus usual care, 54 got usual care alone. The outcome was that there were 9 serious, adverse heart events (strokes and heart attacks); 7 were in the C-PAP group.
The CPAP pressure was, on average, 6.8 cm H2O; mean time of use was 4.4±1.9 hours per night. The C-PAPs did their jobs on the apnea too, reducing residual apnea-hypopnea to 2.3±1.9 events per hour for those in the C-PAP group.
There was a non-statistically significant reduction is AF among the C-PAP group. They reduced their time in AF by 0.6 percentage points compared to the control group (95% CI, -2.55 to 1.30; P =.52). That not a statistically significant difference, and is most likely random.
There was a statistically significant decrease in heart health, though. A total of 7 serious adverse events occurred in the C-PAP group and only 2 in the control group. A total of 9 is a relatively small number of events, but there is a strong statistical difference between 7 and 2.
The authors conclude: “CPAP treatment does not seem to reduce or prevent paroxysmal AF.” They should also have concluded that it reduced heart health with a statistical confidence of ~82%: (1-2(36+10)/512) =82%. See more on this type of statistics.
A possible explanation of why a C-PAP would would make heart health worse is an outcome of the this recent sleep study (link here). It appears that the C-PAP helps restore breathing, but by doing so, it interferes with a mechanism the body uses to deal with A-fib. It seems that, for people with A-Fib, their bodies use breathing stoppages to get their heart back into rhythm. For these people, many of their breathing stoppage are not obstructive, but a bio-pathway to raise the CO2 level in the blood and thus regulate heart rate. The use of a C-PAP prevents this restorative mechanism and this seem to be the reason it is destructive to the heart-health of patients with A-fib. On the other hand, a C-PAP does improve the sleep those patients whose apnea is obstructive. It seems to me that sleep studies should do a better job distinguishing the two causes of apnea. C-PAPs seem counter-indicated for patients with A-fib.
Robert Buxbaum, March 30, 2022. I was diagnosed with apnea and A-Fib some years ago. The sleep doctor prescribed a C-PAP and was adamant that I had to use it to keep my heart healthy. There were no random studies backing him up or contradicting him until now.
I’m not sure why this is, but a quick look at the death statistics shows that it is no lower today than it was a year ago. Vaccines seem to help the individual, but they don’t seem to do much for society as a whole.
Johns Hopkins data. COVID 19 death rate in the USA.
That the death rates are the same as last November is bad, especially since one major effect of COVID has been to wipe out nearly all our old folks, decreasing the lifespan of US men by 2-3 years. With a 70% vaccination rate (adults, 60% overall), and few old people, you ‘d expect our death rate this year would be lower than last.
Currently, at least, the trend-line looks positive, but that’s likely a mirage. It is common to add more deaths to the tally, retroactively a few weeks out as many deaths take weeks to report and more weeks to be counted as COVID. For what it’s worth, I’m vaccinated, two shots and a booster. I also take aspirin, and have gotten a pneumonia shot. I think it helps. What do I know?
