Category Archives: Health

Vitamin A and E, killer supplements; B, C, and D are meh.

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It’s often assumed that vitamins and minerals are good for you, so good for you that people buy all sorts of supplements providing more than the normal does in hopes of curing disease. Extra doses are a mistake unless you really have a mis-balanced diet. I know of no material that is good in small does that is not toxic in large doses. This has been shown to be so for water, exercise, weight loss, and it’s true for vitamins, too. That’s why there is an RDA (a Recommended Daily Allowance). 

Lets begin with Vitamin A. That’s beta carotene and its relatives, a vitamin found in green and orange fruits and vegetables. In small doses it’s good. It prevents night blindness, and is an anti-oxidant. It was hoped that Vitamin A would turn out to cure cancer too. It didn’t. In fact, it seems to make cancer worse. A study was preformed with 1029 men and women chosen random from a pool that was considered high risk for cancer: smokers, former smokers, and people exposed to asbestos. They were given either15 mg of beta carotene and 25,000 IU of vitamin A (5 times the RDA) or a placebo. Those taking the placebo did better than those taking the vitamin A. The results were presented in the New England Journal of Medicine, read it here, with some key findings summarized in the graph below.

Comparison of cumulative mortality and cardiovascular disease between those receiving Vitamin A (5 times RDA) and those receiving a placebo. From Omenn et. al, Clearly, this much vitamin A does more harm than good.

The main causes of death were, as typical, cardiovascular disease and cancer. As the graph shows, the rates of death were higher among people getting the Vitamin A than among those getting nothing, the placebo. Why that is so is not totally clear, but I have a theory that I presented in a paper at Michigan state. The theory is that your body uses oxidation to fight cancer. The theory might be right, or wrong, but what is always noticed is that too much of a good thing is never a good thing. The excess deaths from vitamin A were so significant that the study had to be cancelled after 5 1/2 years. There was no responsible way to continue. 

Vitamin E is another popular vitamin, an anti-oxidant, proposed to cure cancer. As with the vitamin A study, a large number of people who were at high risk  were selected and given either a large dose  of vitamin or a placebo. In this case, 35,000 men over 50 years old were given either vitamin E (400 to 660 IU, about 20 times the RDA) and/or selenium or a placebo. Selenium was added to the test because, while it isn’t an antioxidant, it is associated with elevated levels of an anti-oxidant enzyme. The hope was that these supplements would prevent cancer and perhaps ward off Alzheimer’s too. The full results are presented here, and the key data is summarized in the figure below. As with vitamin A, it turns out that high doses of vitamin E did more harm than good. It dramatically increased the rate of cancer and promoted some other problems too, including diabetes.  This study had to be cut short, to only 7 years, because  of the health damage observed. The long term effects were tracked for another two years; the negative effects are seen to level out, but there is still significant excess mortality among the vitamin takers. 

Cumulative incidence of prostate cancer with supplements of selenium and/or vitamin E compared to placebo.

Cumulative incidence of prostate cancer with supplements of selenium and/or vitamin E compared to placebo.

Selenium did not show any harmful or particularly beneficial effects in these tests, by the way, and it may have reduced the deadliness of the Vitamin A.. 

My theory, that the body fights cancer and other disease by oxidation, by rusting it away, would explain why too much antioxidant will kill you. It laves you defenseless against disease As for why selenium didn’t cause excess deaths, perhaps there are other mechanisms in play when the body sees excess selenium when already pumped with other anti oxidant. We studied antioxidant health foods (on rats) at Michigan State and found the same negative effects. The above studies are among the few done with humans. Meanwhile, as I’ve noted, small doses of radiation seem to do some good, as do small doses of chocolate, alcohol, and caffeine. The key words here are “small doses.” Alcoholics do die young. Exercise helps too, but only in moderation, and since bicycle helmets discourage bicycling, the net result of bicycle helmet laws may be to decrease life-span. 

What about vitamins B, C, and D? In normal doses, they’re OK, but as with vitamin A and E you start to see medical problems as soon as you start taking more– about  12 times the RDA. Large does of vitamin B are sometimes recommended by ‘health experts’ for headaches and sleeplessness. Instead they are known to produce skin problems, headaches and memory problems; fatigue, numbness, bowel problems, sensitivity to light, and in yet-larger doses, twitching nerves. That’s not as bad as cancer, but it’s enough that you might want to take something else for headaches and sleeplessness. Large does of Vitamin C and D are not known to provide any health benefits, but result in depression, stomach problems, bowel problems, frequent urination, and kidney stones. Vitamin C degrades to uric acid and oxalic acid, key components of kidney stones. Vitamin D produces kidney stones too, in this case by increasing calcium uptake and excretion. A recent report on vitamin D from the Mayo clinic is titled: Vitamin D, not as toxic as first thought. (see it here). The danger level is 12 times of the RDA, but many pills contain that much, or more. And some put the mega does in a form, like gummy vitamins” that is just asking to be abused by a child. The pills positively scream, “Take too many of me and be super healthy.”

It strikes me that the stomach, bowel, and skin problems that result from excess vitamins are just the problems that supplement sellers claim to cure: headaches, tiredness, problems of the nerves, stomach, and skin.  I’d suggest not taking vitamins in excess of the RDA — especially if you have skin, stomach or nerve problems. For stomach problems; try some peniiiain cheese. If you have a headache, try an aspirin or an advil. 

In case you should want to know what I do for myself, every other day or so, I take 1/2 of a multivitamin, a “One-A-Day Men’s Health Formula.” This 1/2 pill provides 35% of the RDA of Vitamin A, 37% of the RDA of Vitamin E, and 78% of the RDA of selenium, etc. I figure these are good amounts and that I’ll get the rest of my vitamins and minerals from food. I don’t take any other herbs, oils, or spices, either, but do take a baby aspirin daily for my heart. 

Robert Buxbaum, May 23, 2019. I was responsible for the statistics on several health studies while at MichiganState University (the test subjects were rats), and I did work on nerves, and on hydrogen in metals, and nuclear stuff.  I’ve written about statistics too, like here, talking about abnormal distributions. They’re common in health studies. If you don’t do this analysis, it will mess up the validity of your ANOVA tests. That said,  here’s how you do an anova test. 

The Japanese diet, a recipe for stomach cancer.

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Japan has the highest life expectancy in the world, an average about 84.1 years, compared to 78.6 years for the US. That difference is used to suggest that the Japanese diet must be far healthier than the American. We should all drink green tea and eat such: rice with seaweed and raw or smoked fish. Let me begin by saying that correlation does not imply causation, and go further to say that, to the extent that correlation suggests causation, the Japanese diet seems worse. It seems to me that the quantity of food (and some other things) are responsible for Americans have a shorter life-span than Japanese, the quality our diet does not appear to be the problem. That is, Americans eat too much, but what we eat is actually healthier than what the Japanese eat.

Top 15 causes of death in Japan and the US in order of Japanese relevance.

Top 15 causes of death in Japan and the US in order of Japanese relevance.

Let’s look at top 15 causes of deaths in Japan and the US in order of significance for Japan (2016). The top cause of disease death is the same for Japan and the US: it’s heart disease. Per-capita, 14.5% of Japanese people die of this, and 20.9% of Americans. I suspect the reason that we have more heart disease is that we are more overweight, but the difference is not by that much currently. The Japanese are getting fatter. Similarly, we exceed the Japanese in lung cancer deaths (not by that much) a hold-over of smoking, and by liver disease (not by that much either), a holdover of drinking, I suspect.

Japan exceeds the US in Stroke death (emotional pressure?) and suicide (emotional pressure?) and influenza deaths (climate-related?). The emotional pressure is not something we’d want to emulate. The Japanese work long hours, and face enormous social pressure to look prosperous, even when they are not. There is a male-female imbalance in Japan that is a likely part of the emotional pressure. There is a similar imbalance in China, and a worse one in Qatar. I would expect to see social problems in both in the near future. So far, the Japanese deal with this by alcoholism, something that shows up as liver cancer and cirrhosis. I expect the same in China and Qatar, but have little direct data.

Returning to diet, Japan has more far more stomach cancer deaths than the US; it’s a margin of nine to one. It’s the number 5 killer in Japan, taking 5.08% of Japanese, but only 0.57% of Americans. I suspect the difference is the Japanese love of smoked and raw fish. Other diet-related diseases tell the same story. Japan has double our rate of Colon-rectal cancers, and higher rates of kidney disease, pancreatic cancer, and liver cancer. The conclusion that I draw is that green tea and sushi are not as healthy as you might think. The Japanese would do well to switch the Trump staples of burgers, pizza, fries, and diet coke.

The three horsemen of the US death-toll: Automobiles, firearms, and poisoning (drugs). 2008 data.

The three horsemen of the US death-toll: Automobiles, firearms, and poisoning (drugs). 2008 data.

At this point you can ask why our lives are so much shorter than the Japanese, on average. The difference in smoking and weight-related diseases are significant but explain only part of the story. There is also guns. About 0.7% of Americans are killed by guns, compared to 0.07% of Japanese. Still, guns give Americans a not-unjustified sense of safety from worse crime. Then there is traffic death, 1.5% in the US vs 0.5% in Japan. But the biggest single reason that Americans live shorter lives  is drugs. Drugs kill about 1.5% of Americans, but mostly the young and middle ages. They show up in US death statistics mostly as over-dose and unintentional poisoning (overdose deaths), but also contribute to many other problems like dementia in the old. Drugs and poisoning do not shown on the chart above, because the rate of both is insignificant in Japan, but it is the single main cause of US death in middle age Americans.

The king of the killer drugs are the opioids, a problem that was bad in the 60s, the days of Mother’s Little helper, but that have gotten dramatically worse in the last 20 years as the chart above shows. Often it is a doctor who gets us hooked on the opioids. The doctor may think it’s a favor to us to keep us from pain, but it’s also a favor to him since the drug companies give kickbacks. Often people manage to become un-hooked, but then some doctor comes by and re-hooks us up. Unlike LSD or cocaine, opioid drugs strike women and men equally. It is the single major reason we live 5 1/2 years shorter than the Japanese, with a life-span that is shrinking.

Drug overuse seems like the most serious health problem Americans face, and we seem intent on ignoring it. The other major causes of death are declining, but drug-death numbers keep rising. By 2007, more people died of drugs than guns, and nearly as many as from automobile accidents. It’s passed automobile accidents since then. A first suggestion here: do not elect any politician who has taken significant money from the drug companies. A second suggestion: avoid the Japanese diet.

Robert Buxbaum, April 28, 2019.

C-Pap and Apnea

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A month of so ago, I went to see a sleep doctor for my snoring. I got a take-home breathing test that gave me the worst night’s sleep in recent memory. A few days later, I got a somber diagnosis: “You are a walking zombie.” Apparently, I hold my breath for ten seconds or more every minute and a half while sleeping. Normal is supposed to be every 4 to 10 minutes. But by this standard, more than half of all middle-aged men are sub-normal (how is this possible?). As a result of my breath-holding, the wrinkled, unsmiling DO claimed I’m brain-dead now and will soon be physically dead unless I change my ways. Without spending 3 minutes with me, the sleep expert told me that I need to lose weight, and that I need a C-Pap (continuous positive airway pressure) device as soon as possible. It’s supposed to help me lose that weight and get back the energy. With that he was gone. The office staff gave me the rest of the dope: I was prescribed  a “ResMed” brand C-Pap, supplied by a distributor right across the hall from the doctor (how convenient).

I picked up the C-Pap three months later. Though I was diagnosed as needing one “as soon as possible,” no one would release the device until they were sure it was covered by my insurance company. The device when I got it, was something of a horror. The first version I tried fit over the whole face and forces air into my mouth and nose simultaneously, supposedly making it easier to inhale, but harder to exhale. I found it more than a bit uncomfortable. The next version was nose only and marginally more comfortable. I found there was a major air-flow restriction when I breath in and a similar pressure penalty when I breathed out. And it’s loud. And, if you open your mouth, there is a wind blowing through. As for what happens if the pump fails or the poor goes out, I notice that there are the tiniest of air-holes to prevent me from suffocating, barely. A far better design would have given me a 0-psi flapper valve for breathing in, and a 1/10 psi flapper for breathing out. That would also reduce the pressure restriction I was feeling every time I took a deep breath. One of my first blog essays was about engineering design aesthetics; you want your designs to improve things under normal conditions and fail safe, not like here. Using this device while awake was anything but pleasant, and I found I still hold my breath, even while awake, about every 5 minutes.

Since I have a lab, and the ability to test these things, I checked the pressure of the delivered air, and found it was 3 cm of water, about 1/20 psi. The prescription was for 5 cm or water (1/14 psi). The machine registers this, but it is wrong. I used a very simple water manometer, a column of water, similar to the one I used to check the pressure drop in furnace air filters. Is 1/20 psi enough?How did he decide on 1/14 psi by the way? I’ve no idea. !/14 psi is about 1/200 atm. Is this enough to do anything? While the C-Pap should get me to breathe more, I guess, about half of all users stop after a few tries, and my guess is that they find it as uncomfortable as I have. There is no research evidence that treatment with it reduces stroke or heart attack, or extends life, or helps with weight loss. The assumption is that, if you force middle-aged men to hold their breath less, they will be healthier, but I’ve no clear logic or evidence to back the assumption. At best, anything you gain on the ease of breathing in, you lose on the difficulty of breathing out. The majority of middle-aged men are prescribed a C-Pap, if they go for a sleep study, and it’s virtually 100% for overweight men with an apple-shaped body.

I’d have asked my doctor about alternatives or for a second opinion but he was out the door too fast. Besides, I was afraid I’d get the same answer that Rodney Dangerfield got: “You want a second opinion? OK. You’re ugly, too.” Mr. Dangerfield was not a skinny comic, by the way, but he was funny, and I assume he’d have been prescribed a C-Pap (maybe he was). He died at 82, considerably older than Jim Fixx, “the running doctor,” Adelle Davis, the “eat right for health” doctor, Euell Gibbons “in search of the wild asparagus,” or Ethan Pritkin, the diet doctor. God seems to prefer fat comedians to diet experts; I expect that most-everyone does.

Benjamin Franklin and his apple-shaped body

Benjamin Franklin and his apple-shaped body; I don’t think of him as a zombie.

What really got my goat, besides my dislike of the C-Pap, is that I object to being called a walking zombie. True, I’m not as energetic as I used to be, but I manage to run a company, and to write research papers, and I get patents (this one was approved just today). And I write these blogs — I trust that any of you who’ve read this far find them amusing. Pretty good for a zombie — and I ran for water commissioner. People who use the C-Pap self-report that they have more energy, but self-reporting is poor evidence. A significant fraction of those people who start with the C-Pap, stop, and those people, presumably were not happy. Besides, a review of the internet suggests that a similarly large fraction of those who buy a “MyPillow.com” claim they have more energy. And I’ve seen the same claims from people who take a daily run, or who pray, or smoke medical marijuana (available for sleep apnea, but not from this fellow), or Mirtazapine (study results here), or  for electro-shock therapy, a device called “Inspire.” With so many different products providing the same self-reported results, I wonder if there isn’t something more fundamental going on. I’d wish the doc had spent a minute or two to speak to this, or to the alternatives.

As for weight loss, statistical analysis of lifespan suggests that there is a health advantage to being medium weight: not obese, but not skinny. I present some of this evidence here, along with evidence that extra weight helps ward off Alzheimer’s. For all I know this protection is caused by holding your breath every few minutes. It helps to do light exercise, but not necessary for mental health. In terms of mental health, the evidence suggests that weight loss is worse than nothing.

Jared Gray, author of the Alien movies, was diagnosed with apnea, so he designed his own sleep-mask.

Jared Gray, author of the Alien movies, was diagnosed with apnea, so he designed his own sleep-mask.

Benjamin Franklin was over-weight and apple-shaped, and no zombie, The same is true of John Adams, Otto Von Bismarck, and Alfred Hitchcock. All lived long, productive lives. Hitchcock was sort of morbid, it will be admitted, but I would not want him otherwise. Ed McMahon, Johnny Carson’s side-kick, apologized to America for being overweight and smoking, bu the outlived Johnny Carson by nine years, dying at 89. Henry Kissinger is still alive and writing at 95. He was always fatter than any of the people he served. He almost certainly had sleep apnea, back in the day, and still has more on the ball, in my opinion, than most of the talking-head on TV. The claim that overweight, middle-aged men are all zombies without a breath assisting machine doesn’t make no sense to me. But then, I’m not a sleep doctor. (Do sleep doctors get commissions? Why did he choose, this supplier or this brand device? With so little care about patients, I wonder who runs the doctor’s office.)

I looked up my doctor on this list provided by the American Board of Sleep Medicine. I found my doctor was not certified in sleep medicine. I suppose certified doctors would prescribe something similar  but was disappointed that you don’t need sleep certification to operate as a sleep specialist. In terms of masks, I figure, if you’ve got to wear something, you might as well wear something cool. Author Jared Gray, shown above (not the author of the Alien) was diagnosed with Apnea 6 months ago and made his own C-Pap mask to make it look like the alien was attacking him. Very cool for an ex-zombie, but I’m waiting to see a burst of creative energy.

What do we zombies want? Brains.

When do we want them? Brains.

What do vegetarian zombies want? Grains.

Robert Buxbaum, March 15, 2019. In case real zombies should attack, here’s what to do.  An odd legal/insurance issue: in order to get the device, I had to sign that, if I didn’t use it for 20 days in the first month of 4 hours per night, and thus if the insurance did not pay, I would be stuck with the full fee. I signed. This might cost me $1000 though normally in US law, companies can only charge a reasonable restock fee, but it can’t be unreasonable, like the full  price. I also had to sign that I would go back to the same, quick-take doctor, but again there has to be limits. We’ll see how the machine pans out, but one difference I see already: unlike my pillow.com, there is no money back guarantee with the C-Pap treatment.

Disease, atom bombs, and R-naught

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A key indicator of the speed and likelihood of a major disease outbreak is the number of people that each infected person is likely to infect. This infection number is called R-naught, or Ro; it is shown in the table below for several major plague diseases.

R-naught - communicability for several contagious diseases, CDC.

R-naught – infect-ability for several contagious diseases, CDC.

Of the diseases shown, measles is the most communicable, with an Ro of 12 to 18. In an unvaccinated population, one measles-infected person will infect 12- 18 others: his/her whole family and/ or most of his/her friends. After two weeks or so of incubation, each of the newly infected will infect another 12-18. Traveling this way, measles wiped out swaths of the American Indian population in just a few months. It was one of the major plagues that made America white.

While Measles is virtually gone today, Ebola, SARS, HIV, and Leprosy remain. They are far less communicable, and far less deadly, but there is no vaccine. Because they have a low Ro, outbreaks of these diseases move only slowly through a population with outbreaks that can last for years or decades.

To estimate of the total number of people infected, you can use R-naught and the incubation-transmission time as follows:

Ni = Row/wt

where Ni is the total number of people infected at any time after the initial outbreak, w is the number of weeks since the outbreak began, and wt is the average infection to transmission time in weeks.

For measles, wt is approximately 2 weeks. In the days before vaccine, Ro was about 15, as on the table, and

Ni = 15w/2.

In 2 weeks, there will be 15 measles infected people, in 4 weeks there will be 152, or 225, and in 6 generations, or 12 weeks, you’d expect to have 11.39 million. This is a real plague. The spread of measles would slow somewhat after a few weeks, as the infected more and more run into folks who are already infected or already immune. But even when the measles slowed, it still infected quite a lot faster than HIV, Leprosy, or SARS (SARS is a form of Influenza). Leprosy is particularly slow, having a low R-naught, and an infection-transmission time of about 20 years (10 years without symptoms!).

In America, more or less everyone is vaccinated for measles. Measles vaccine works, even if the benefits are oversold, mainly by reducing the effective value of Ro. The measles vaccine is claimed to be 93% effective, suggesting that only 7% of the people that an infected person meets are not immune. If the original value of Ro is 15, as above, the effect of immunization is to reduce the value Ro in the US today to effectively 15 x 0.07 = 1.05. We can still  have measles outbreaks, but only on a small-scale, with slow-moving outbreaks going through pockets of the less-immunized. The average measles-infected person will infect only one other person, if that. The expectation is that an outbreak will be captured by the CDC before it can do much harm.

Short of a vaccine, the best we can do to stop droplet-spread diseases, like SARS, Leprosy, or Ebola is by way of a face mask. Those are worn in Hong Kong and Singapore, but have yet to become acceptable in the USA. It is a low-tech way to reduce Ro to a value below 1.0, — if R-naught is below 1.0, the disease dies out on its own. With HIV, the main way the spread was stopped was by condoms — the same, low tech solution, applied to sexually transmitted disease.

Image from VCE Physics, https://sites.google.com/site/coyleysvcephysics/home/unit-2/optional-studies/26-how-do-fusion-and-fission-compare-as-viable-nuclear-energy-power-sources/fission-and-fusion---lesson-2/chain-reactions-with-dominoes

Progress of an Atom bomb going off. Image from VCE Physics, visit here

As it happens, the explosion of an atom bomb follows the same path as the spread of disease. One neutron appears out of somewhere, and splits a uranium or plutonium atom. Each atom produces two or three more neutrons, so that we might think that R-naught = 2.5, approximately. For a bomb, Ro is found to be a bit lower because we are only interested in fast-released neutrons, and because some neutrons are lost. For a well-designed bomb, it’s OK to say that Ro is about 2.

The progress of a bomb going off will follow the same math as above:

Nn = Rot/nt

where Nn is the total number of neutrons at any time, t is the average number of nanoseconds since the first neutron hit, and nt is the transmission time — the time it takes between when a neuron is given off and absorbed, in nanoseconds.

Assuming an average neutron speed of 13 million m/s, and an average travel distance for neutrons of about 0.1 m, the time between interactions comes out to about 8 billionths of a second — 8 ns. From this, we find the number of neutrons is:

Nn = 2t/8, where t is time measured in nanoseconds (billionths of a second). Since 1 kg of uranium contains about 2 x 1024 atoms, a well-designed A-bomb that contains 1 kg, should take about 83 generations (283 = 1024). If each generation is 8 ns, as above, the explosion should take about 0.664 milliseconds to consume 100% of the fuel. The fission power of each Uranium atom is about 210 MeV, suggesting that this 1 kg bomb could release 16 billion Kcal, or as much explosive energy as 16 kTons of TNT, about the explosive power of the Nagasaki bomb (There are about 38 x10-24 Kcal/eV).

As with disease, this calculation is a bit misleading about the ease of designing a working atomic bomb. Ro starts to get lower after a significant faction of the atoms are split. The atoms begin to move away from each other, and some of the atoms become immune. Once split, the daughter nuclei continue to absorb neutrons without giving off either neutrons or energy. The net result is that an increased fraction of neutrons that are lost to space, and the explosion dies off long before the full power is released.

Computers are very helpful in the analysis of bombs and plagues, as are smart people. The Manhattan project scientists got it right on the first try. They had only rudimentary computers but lots of smart people. Even so, they seem to have gotten an efficiency of about 15%. The North Koreans, with better computers and fewer smart people took 5 tries to reach this level of competence (analyzed here). They are now in the process of developing germ-warfare — directed plagues. As a warning to them, just as it’s very hard to get things right with A-bombs, it’s very hard to get it right with disease; people might start wearing masks, or drinking bottled water, or the CDC could develop a vaccine. The danger, if you get it wrong is the same as with atom bombs: the US will not take this sort of attack lying down.

Robert Buxbaum, January 18, 2019. One of my favorite authors, Issac Asimov, died of AIDS; a slow-moving plague that he contacted from a transfusion. I benefitted vastly from Isaac Asimov’s science and science fiction, but he wrote on virtually every topic. My aim is essays that are sort-of like his, but more mathematical.

Measles, anti-vaxers, and the pious lies of the CDC.

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Measles is a horrible disease that contributed to the downfall that had been declared dead in the US, wiped out by immunization, but it has reappeared. A lot of the blame goes to folks who refuse to vaccinate: anti-vaxers in the popular press. The Center for Disease Control is doing its best to promote to stop the anti-vaxers, and promote vaccination for all, but in doing so, I find they present the risks of measles worse than they are. While I’m sympathetic to the goal, I’m not a fan of bending the truth. Lies hurt the people who speak them and the ones who believe them, and they can hurt the health of immune-compromized children who are pushed to vaccinate. You will see my arguments below.

The CDC’s most-used value for the mortality rate for measles is 0.3%. It appears, for example, in line two of the following table from Orenstein et al., 2004. This table also includes measles-caused complications, broken down by type and patient age; read the full article here.

Measles complications, death rates, US, 1987-2000, CDC.

Measles complications, death rates, US, 1987-2000, CDC, Orenstein et. al. 2004.

The 0.3% average mortality rate seems more in tune with the 1800s than today. Similarly, note that the risk of measles-associated encephalitis is given as 10.1%, higher than the risk of measles-diarrhea, 8.2%. Do 10.1% of measles cases today produce encephalitis, a horrible, brain-swelling disease that often causes death. Basically everyone in the 1950s and early 60s got measles (I got it twice), but there were only 1000 cases of encephalitis per year. None of my classmates got encephalitis, and none died. How is this possible; it was the era before antibiotics. Even Orenstein et. al comment that their measles mortality rates appear to be far higher today than in the 1940s and 50s. The article explains that the increase to 3 per thousand, “is most likely due to more complete reporting of measles as a cause of death, HIV infections, and a higher proportion of cases among preschool-aged children and adults.”

A far more likely explanation is that the CDC value is wrong. That the measles cases that were reported and certified as such are the ones that are the most severe. There were about 450 measles deaths per year in the 1940s and 1950s, and 408 in 1962, the last year before the MMR vaccine was developed and by Dr. Hilleman of Merck (a great man of science, forgotten). In the last two decades there were some 2000 measles cases reported US cases but only one measles death. A significant decline in cases, but the ratio does not support the CDC’s death rate. For a better estimate, I propose to divide the total number of measles deaths in 1962 by the average birth rate in the late 1950s. That is to say, I propose to divide 408 by the 4.3 million births per year. From this, I calculate a mortality rate just under 0.01% in 1962, That’s 1/30th the CDC number, and medicine has improved since 1962.

I suspect that the CDC inflates the mortality numbers, in part by cherry-picking its years. It inflates them further by treating “reported measles cases.” as if they were all measles cases. I suspect that the reported cases in these years were mainly the very severe ones. Mild case measles clears up before being reported or certified as measles. This seems the only normal explanation for why 10.1% of cases include encephalitis, and only 8.2% diarrhea. It’s why the CDC’s mortality numbers suggest that, despite antibiotics, our death rate has gone up by a factor of 30 since 1962.

Consider the experience of people who lived in the early 60s. Most children of my era went to public elementary schools with some 1000 other students, all of whom got measles. By the CDC’s mortality number, we should have seen three measles deaths per school, and 101 cases of encephalitis. In reality, if there had been one death in my school it would have been big news, and it’s impossible that 10% of my classmates got encephalitis. Instead, in those years, only 48,000 people were hospitalized per year for measles, and 1,000 of these suffered encephalitis (CDC numbers, reported here).

To see if vaccination is a good idea, lets now consider the risk of vaccination. The CDC reports their vaccine “is virtually risk free”, but what does risk-free mean? A British study finds vaccination-caused neurological damage in 1/365,000 MMR vaccinations, a rate of 0.00027%, with a small fraction leading to death. These problems are mostly found in immunocompromised patients. I will now estimate the neurological risk for actual measles based on the ratio of encephalitis to births, as before using the average birth rate as my estimate for measles cases; 1000/4,300,000 = 0.023%. This is far lower than the risk the CDC reports, and more in line with experience.

The risk for neurological damage from measles that I calculate is 86 times higher risk than the neurological risk from vaccination, suggesting vaccination is a very good thing, on average: The vast majority of people should get vaccinated. But for people with a weakened immune system, my calculations suggest it is worthwhile to not immunize at 12 months as doctors recommend. The main cause of vaccination death is encephalitis, but this only happens in patients with weakened immune systems. If your child’s immune system is weakened, even by a cold, I’d suggest you wait 1-3 months, and would hope that your doctor would concur. If your child has AIDS, ALS, Lupus, or any other, long-term immune problem, you should not vaccinate at all. Not vaccinating your immune-weakened child will weaken the herd immunity, but will protect your child.

We live in a country with significant herd immunity: Even if there were a measles outbreak, it is unlikely there would be 500 cases at one time, and your child’s chance of running into one of them in the next month is very small assuming that you don’t take your child to Disneyland, or to visit relatives from abroad. Also, don’t hang out with anti-vaxers if you are not vaccinated. Associating with anti-vaxers will dramatically increase your child’s risk of infection.

As for autism: there appears to be no autism advantage to pushing off vaccination. Signs of autism typically appear around 12 months, the same age that most children receive their first-stage MMR shot, so some people came to associate the two. Parents who push-off vaccination do not push-off the child’s chance of developing autism, they just increase the chance their child will get measles, and that their child will infect others. Schools are right to bar such children, IMHO.

I’ve noticed that, with health care in, particular, there is a tendency for researchers to mangle statistics so that good things seem better than they are. Health food: is not necessarily so healthy as they say; nor is weight loss. Bicycle helmets: ditto. Sometimes this bleeds over to outright lies. Generic modified grains were branded as cancer-causing based on outright lies and  missionary zeal. I feel that I help a bit, in part by countering individual white lies; in part by teaching folks how to better read statistic arguments. If you are a researcher, I strongly suggest you do not set up your research with a hypothesis so that only one outcome will be publishable or acceptable. Here’s how.

Robert E. Buxbaum, December 9, 2018.

Sex differences in addiction.

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Men become addicted and so do women, but the view in popular movies and songs present some clear differences. Addicted men are presented as drunks or stoners. By contrast, the popular picture of an addicted woman is a middle-aged housewife who takes “mother’s little helper“: anti-depressant and pain pills, “mother’s little helper of the classic Rolling Stones song. Male addicts are presented to take their drugs in the company of friends while female addicts are pictured taking their pills in private. A question I have: is there any evidence to back these popular perceptions.

All addiction may not be bad. Though Churchill was addicted to drink, he imagined it as a virtue not a vice.

Not all who are addicted consider their addiction a liability. Though Churchill was addicted to drink, starting the day with a tumbler of whiskey, he imagined it as a virtue. One would be hard-pressed to prove otherwise.

As it happens, if you look at the statistics in a certain way, they do bear out the popular perceptions. About three times as many men as women are in treatment for alcohol or pot, voluntary or court-mandated. Meanwhile, as a percentage of the addicted, women are nearly twice as likely as men to claim pills as their primary addiction. Percentage data is plotted below. The problem with the percentage graph is that it ignores the fact that twice as many men as women are in treatment: 1,233,000 men vs 609,000 women, as of 2011. Multiply the total numbers by the percentages and you find that there are more men than women with primary addiction to pills, or to cocaine, heroin, or meth-amphetamines. For any drug you mention, the real sex-difference is that more men are addicts.

It could be argues that rehab attendance is a bad measure of addiction, but I would argue that this is the best measure, not only are the numbers are more accurate, rehab is an indication that the addict feels that his or her addiction is a problem. It is a mistake, I think, to include people who feel their addiction is not ruining their lives with people who do not, e.g. Churchill. Any person who believes he or she is benefiting, and who has managed to avoid running afoul of the police, it could be argued, does not have a serious problem. Friends and employers may disagree in terms of diagnosis, but in terms of statistics, other measures like self-reporting come to the same conclusion: if it’s a stupid addiction, more men do it than women. Men self-report that they smoke more, binge-drink more, and use drugs more. Men also commit suicide more and end up in jail more.

Main addiction of men and women. percent based on rehab records, 2011. From the TEDS Report 4/3/14. Twice as many men as women go to rehab.

Main addiction of men and women. percent based on rehab records, 2011. From the TEDS Report on substance abuse. 4/3/14. The most significant sex difference, as I see it: twice as many men as women go to rehab.

In terms of age of prescription drug use, the graph below shows a difference between men and women. There is a slight tendency for women to persist with prescription drugs, but that may reflect the tendency for men to move on to some other stupid behavior.

While more female than male addicts consider opioids their main addiction, since there are twice as many male addicts as female, it comes out that the number using opioids is about the same. Interestingly, a greater fraction of men seem capable of switching out from opioids -- likely to some other addiction.

While more female than male addicts consider opioids their main addiction, since there are twice as many male addicts as female, it comes out that the number using opioids is about the same. A greater fraction of men switch out from opioids, perhaps to another addiction. Source: ibid.

A few cheerful bits of news are in order. One is that smoking, the most deadly of the addictions, is on the decline. It seems like vaping is a contributor to this, and much safer. Similarly, with illicit drug addictions, while use is on the upswing, and while an amazingly large share of Americans have used such drugs — see graph below from Statista — only a small fraction remain users into middle age. Most seem to quit on their own — they even seem to quit heroin when it ceases to serve a purpose. At present, only 60,000/year total die of overdose out of some 120,000,000 who’ve used illicit drugs. Ringo Starr’s song, “I don’t smoke it no more“may be cited, especially when paired with his “Oh my my” song about quitting through dance. If you want to quit and dance doesn’t work for you, I’d suggest AA or NA. To quote Ringo: “You can do it if you try.”

Number of people in the US using different drugs as of 2016. The vast majority have not used in the last year.

Number of people in the US who have used different illegal drugs as of 2016. It’s about 1/3 of America. The vast majority from every category have quit, and are not using. 89% of heroin uses have quit. You can too. Statista.

As for why men more than women do drugs, all I can say is that they do all sorts of stupid things. They fight in wars more often, they go over Niagara Falls in barrels more often, and they start new businesses more often. Sometimes it works for them; usually not. Here is a more detailed article with the same semi-conclusion: men are stupid, risk takers. I suspect that’s their language of love.

Robert Buxbaum, June 11, 2018

Elvis Presley and the opioid epidemic

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For those who suspect that the medical profession may bear some responsibility for the opioid epidemic, I present a prescription written for Elvis Presley, August 1977. Like many middle age folks, he suffered from back pain and stress. And like most folks, he trusted the medical professionals to “do no harm” prescribing nothing with serious side effects. Clearly he was wrong.

Elis prescription, August 1977. Opioid city.

Elis prescription, August 1977. Opioid city.

The above prescription is a disaster, but you may think this is just an aberration. A crank doctor who hooked (literally) a celebrity patient, but not as aberrant as one might think. I worked for a pharmacist in the 1970s, and the vast majority of prescriptions we saw were for these sort of mood altering drugs. The pharmacist I worked for refused to service many of these customers, and even phoned the doctor to yell at him for one particular egregious case: a shivering skinny kid with a prescription for diet pills, but my employer was the aberration. All those prescriptions would be filled by someone, and a great number of people walked about in a haze because of it.

The popular Stones song, Mother’s Little Helper, would not have been so popular if it were not true to life. One might ask why it was true to life, as doctors might have prescribed less addicting drugs. I believe the reason is that doctors listened to advertising then, and now. They might have suggested marijuana for pain or depression — there was good evidence it worked — but there were no colorful brochures with smiling actors. The only positive advertising was for opioids, speed, and Valium and that was what was prescribed then and still today.

One of the most common drugs prescribed to kids these days is speed, marketed as “Ritalin.” It prevents daydreaming and motor-mouth behaviors; see my essay is ADHD a real disease?. I’m not saying that ADD kids aren’t annoying, or that folks don’t have back ached, but the current drugs are worse than marijuana as best I can tell. It would be nice to get non-high-inducing pot extract sold in pharmacies, in my opinion, and not in specialty stores (I trust pharmacists). AS things now stand the users have medical prescription cards, but the black sellers end up in jail..

Robert Buxbaum, January 25, 2018. Please excuse the rant. I ran for sewer commissioner, 2016, And as a side issue, I’d like to reduce the harsh “minimum” penalties for crimes of possession with intent to sell, while opening up sale to normal, druggist channels.

Penicillin, cheese allergy, and stomach cancer

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penecillin molecule

The penicillin molecule is a product of the penicillin mold

Many people believe they are allergic to penicillin — it’s the most common perceived drug allergy — but several studies have shown that most folks who think they are allergic are not. Perhaps they once were, but when people who thought they were allergic were tested, virtually none showed allergic reaction. In a test of 146, presumably allergic patients at McMaster University, only two had their penicillin allergy confirmed; 98.6% of the patients tested negative. A similar study at the Mayo Clinic tested 384 pre-surgical patients with a history of penicillin allergy; 94% tested negative. They were given clearance to receive penicillin antibiotics before, during, and after surgery. Read a summary here.

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Orange showing three different strains of the penicillin mold; some of these are toxic.

This is very good news. Penicillin is a low-cost, low side-effect antibiotic, effective against many diseases including salmonella, botulism, gonorrhea, and scarlet fever. The penicillin molecule is a common product of nature, produced by a variety of molds, e.g. on the orange at right, and in cheese. It is thus something people have been exposed to, whether they realize it or not.

Penicillin allergy is a deadly danger for the few who really are allergic, and it’s worthwhile to find out if that means you. The good news: that penicillin is found in common cheeses suggests, to me, a simple test for penicillin allergy. Anyone who suspects penicillin allergy and does not have a general dairy allergy can try eating appropriate cheese: brie, blue, camembert, or Stilton. That is any of the cheeses made with penicillin molds. If you don’t break out in a rash or suffer stomach cramps, you’re very likely not allergic to penicillin.

There is some difference between cheeses, so if you have problems with Roquefort, but not brie or camembert, there’s still a good chance you’re not allergic to penicillin. Brie and camembert have a white fuzzy mold coat of Penicillium camemberti. This mold exudes penicillin — not in enough quantity to cure gonorrhea, but enough to give taste and avoid spoilage, and enough to test for allergy. Danish blue and Roquefort, shown below, have a different look and a sharper flavor . They’re made with blue-green, Penicillium roqueforti. This mold produces penicillin, but also a small amount of neurotoxin, roquefortine C. It’s not enough to harm most people, but it could cause an allergic reaction to folks who are not allergic to penicillin. Don’t eat a moldy orange, by the way; some forms of the mold produce a lot of neurotoxin.

For people who are not allergic, a thought I had is that one could, perhaps treat heartburn or ulcers with cheese; perhaps even cancer? H-Pylori, the bacteria associated with heartburn, is effectively treated by amoxicillin, a penicillin variant. If a penicillin variant kills the bacteria, it seems plausible that penicillin cheese might too. And since amoxicillin, is found to reduce the risk of gastric cancer, it’s reasonable to expect that penicillin or penicillin cheese might be cancer-protective. To my knowledge, this has never been studied, but it seems worth considering. The other, standard treatment for heartburn, pantoprazole / Protonix, is known to cause osteoporosis, and increase the risk of cancer, and it doesn’t taste as good as cheese.

A culture of Penicillium roqueforti. Most people are not allergic to it.

The blue in blue cheese is Penicillium roqueforti. Most people are not allergic.

Penicillin was discovered by Alexander Fleming, who noticed that a single spore of the mold killed the bacteria near it on a Petrie dish. He tried to produce significant quantities of the drug from the mold with limited success, but was able to halt disease in patients, and was able to interest others who had more skill in large-scale fungus growing. Kids looking for a good science fair project, might consider penicillin growing, penicillin allergy, treatment of stomach ailments using cheese, or anything else related to the drug. Three Swedish journals declared that penicillin was the most important discovery of the last 1000 years. It would be cool if the dilute form, the one available in your supermarket, could be shown to treat heartburn and/or cancer. Another drug you could study is Lysozyme, a chemical found in tears, in saliva, and in human milk (but not in cow milk). Alexander Fleming found that tears killed bacteria, as did penicillin. Lysozyme, the active ingredient, is currently used to treat animals, but not humans.

Robert Buxbaum, November 9, 2017. Since starting work on this essay I’ve been eating blue cheese. It tastes good and seems to cure heartburn. As a personal note: my first science fair project (4th grade) involved growing molds on moistened bread. For an incubator, I used the underside of our home radiator. The location kept my mom from finding the experiment and throwing it out.

Fat people live longer, show less dementia

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Life expectancy is hardly affected by weight in the normal - overweight- obese range. BMI 30-34.9 = obese.

Life expectancy is hardly affected by weight in the normal – overweight – obese range. BMI 30-34.9 = obese.

Lets imagine you are a 5’10” man and you weigh 140 lbs. In that case, you have a BMI of 20, and you probably think you’re pretty healthy, or perhaps you think you’re a bit overweight. Our institutes of health will say that you are an “average-wight” or “normal-weight” American, and then claim that the average-weight American is overweight. What they don’t tell you, is that low weight, and so-called average weight people in the US live shorter lives. Other things being equal, the morbidity (chance of death) for a thin American, BMI 18.5 is nearly triple that of someone who’s obese, BMI 32. The morbidity of the normal-weight American is better, but is still nearly double that of the obese fellow whose BMI is 32.

Our NIH has created a crisis of overweight Americans, that is not based on health. They work hard to solve this obesity crisis by telling people to jog to work, and by creating ever-more complicated food pyramids. Those who listen live shorter lives. A prime example is Jim Fixx, author of several running books including “The complete Book of Running.” He was 52 when he died of a heart attack while running. Similar to this is the diet-expert, Adelle Davis, author of “Let’s eat right to keep fit”. She died at 70 of cancer — somewhat younger than the average American woman. She attributed her cancer to having eaten junk food as a youth. I would attribute it to being thin. Not only do thin people live shorter lives, but their chances of recovering from cancer, or living with it, seem to improve if you start with some fat.

The same patter exists where age-related dementia is concerned. If you divide the population into quartiles of weight, the heaviest has the least likelihood of dementia, the second heaviest has the second-least, the third has the third-least, and the lightest Americans have the highest likelihood of dementia. Here are two studies to that effect, “Association between late-life body mass index and dementia”, The Kame Project, Neurology. 2009 May 19; 72(20): 1741–1746. And “BMI and risk of dementia in two million people over two decades: a retrospective cohort study” The Lancet, Volume 3, No. 6, p431–436, June 2015.

Morbidity and weight, uncorrected data, and corrected by removing the demented.

Morbidity and weight, uncorrected data, and corrected by removing the demented. The likelihood of dementia decreases with weight.

Now you may think that there is a confounding, cause and effect here: that crazy old people don’t live as long. You’d be right there, crazy people don’t live as long. Still, if you correct the BMI-mortality data to remove those with dementia, you still find that in terms of life-span, for men and women, it pays to be overweight or obese but not morbidly so. The study concludes as follows: “Weight loss was related to a higher mortality risk (HR = 1.5; 95% CI: 1.2,1.9) but this association was attenuated when persons with short follow-up or persons with dementia were excluded.” As advice to those who are planning a weight loss program, you might go crazy and reduce your life-span a lot, but if you don’t go crazy, you’re only reducing your life-span a little.

In terms of health food, I’ve noticed that many non-health foods, like alcohol and chocolate are associated with longevity and mental health. And while low-impact exercise helps increase life-span, that exercise is only minimally associated with weight loss. Mostly weight loss involves changing the amount you eat and changing your clothes choices to maximize radiant heat loss.

Dr. Robert E. Buxbaum, October 26, 2017. A joke: Last week I was mugged by a vegan. You may ask how I know it was a vegan. He told be before running off with my wallet.

Health vs health administration

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One of the great patterns of government is that it continually expands adding overseers over overseers to guarantee that those on the bottom do their work honestly. There are overseers who check that folks don’t overcharge, or take bribes, or under-pay. There are overseers to check shirking, and prevent the hiring of friends, to check that paperwork is done, and to come up with the paperwork, and lots of paperwork to assert that no one is wasting money or time in any way at all. There have been repeated calls for regulation reform, but little action. Reform would require agreement from the overseers, and courage from our politicians. Bureaucracy always wins.

The number of health administrators has risen dramatically; doctors, not so much.

By 2009 the number of health administrators was rising dramatically faster than the number of doctors; it’s currently about 20:1.

The call for reform is particularly strong in healthcare and the current, Obamacare rules are again under debate. As of 2009 we’d already reached the stage where there were fourteen healthcare administrators for every doctor (Harvard Business Review), and that was before Obamacare. By 2013, early in the Obamacare era, the healthcare workforce had increased by 75%, but 95 percent of those new hires were administrators: we added 19 administrators per doctor. Some of those administrators were in government oversight, some worked in hospitals filling out forms, some were in doctors offices, and some were in the government, writing the new rules and checking that the rules were followed. A lot of new employment with no new productivity. Even if these fellows were all honest and alert, there are so many of them, that there seems no way they do not absorb more resources than the old group of moderately supervised doctors would by laziness and cheating.

Overseers fill ever-larger buildings, hold ever-more meetings, and create ever-more rules and paperwork. For those paying out of pocket, the average price of healthcare has risen to $25,826 a year for a family of four. That’s nearly half of the typical family income. As a result people rarely buy healthcare insurance (Obamacare) until after they are too sick to work. Administering the system take so much doctor time that a Meritt Hawkins study finds a sharp decline in service. The hope is that Congress will move to reverse this — somehow.

With more administrators than workers, disagreements among management becomes the new normal.

With more administrators than workers, disagreements among management becomes the new normal. Doctors find themselves operating in “The Dilbert Zone”.

Both Democrats and Republicans have complained about Obamacare and campaigned to change or repeal it, but now that they are elected, most in congress seem content to do nothing and blame each other. If they can not come up with any other change, may I suggest a sharp decrease in the requirements for administrative oversight, with a return to colleague oversight, and a sharp decrease in the amount of computerized documentation. The suggestion of colleague oversight also appears here, Harvard Business Review. Colleague oversight with minimal paperwork works fine for plumbers, and electricians; lawyers and auto-mechanics. It should work fine for doctors too.

Robert Buxbaum, September 19, 2017. On a vaguely similar topic, I ask is ADHD is a real disease, or a disease of definition.