Category Archives: healthcare

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.

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.

Why Warren Buffett pays 0% social security tax

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Social Security is billed along with Medicare (health care for the poor) as an anti-flat tax called FICA where middle class workers pay 7.65 -15.3%, and rich people pay essentially 0%. The reason that Warren Buffet and other rich people pay 0%, on a percentage basis, far less than their secretaries, is that there is a FICA cap of $127,200 currently, and he earns far more than $127,200. Buffett’s secretaries pays 7.65%, or which 6% approximately is social-security payment, and the rest Medicare. Buffett’s company then matches the 7.65% — a situation that applies to virtually every employee in the US.

A self employed person though, a gardener say, pays both the employee and employer portion or 15.3%. The same $127,200 cap applies, but since few gardeners make more than this amount, they are likely to pay 15.3% on all earnings, with no deductions. FICA really socks the poor and middle class, and barely touches a rich man like Buffett. This is the tax-inequality that most needs addressing, in my opinion, and one I have not heard discussed.

A short history of FICA

A visual history of FICA rates (right), and of the salary cap (left). Medicare contributions were added in 1966.

As I write this, there is a debate about tax reform that mostly involves income tax, but not at all FICA. Income tax could be improved, in my opinion, and should be. We could remove some exemptions that are being abused, and we should lower the general rates, especially for foreign-earnings, but the current income tax isn’t that bad, in my opinion. Buffett likes to brag about the high rate he pays, but it’s not a bad rate compared to the rest of the world. And Buffett benefits from a lot of things we don’t. His income is taxed at a lower rate than a worker’s would be since most of it is unearned. And, like most rich folks, he has exemptions and deductions that do not apply to most. He can deduct cars, private airplanes, and interest; most folks don’t deduct these things since they don’t spend enough to exceed the “standard deduction”. I’m happy to say these issues are being addressed in the current tax re-write.

The current, House version of the GOP tax proposal includes a raise in the standard deduction and a cap on interest and other deductions. There is a general decrease in the tax rate for earnings, and a decrease for earnings made abroad and repatriated. I’d like to see tariffs, too but they do not appear in the versions I’ve seen. And I’ve very much like to see a decrease in the FICA rate coupled with a removal of the salary cap. Pick a rate, 4% say, where we collect the same amount, but spread the burden uniformly. Why should 7.65%-15.3% or the workmanship wages got to the window, the orphan, and healthcare of the poor, while 0% of Buffett’s go for this?

Some other tax ideas: I’d like to see shorter criminal sentences, especially for drugs, and I’d like to see healthcare addressed to reduce the administrative burden.

Robert E. Buxbaum, November 17, 2017. In the news today, the senate version puts back the tax exemption on private jets. The opposite of progress, they say, is congress.

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.

Rethinking fluoride in drinking water

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Fluoride is a poison, toxic tor a small child in doses of 500 mg, and toxic to an adult in doses of a few thousand mg. It is a commonly used rat poison that kills by robbing the brain of the ability to absorb oxygen. In the form of hydrofluoric acid, it is responsible for the deaths of more famous chemists than any other single compound: Humphrey Davy died trying to isolate fluorine; Paul Louyet and Jerome Nickles, too. Thomas Knox nearly died, and Henri Moissan’s life was shortened. Louis-Joseph Gay Lussac, George Knox, and Louis- Jacques Thenard suffered burns and similar, George Knox was bedridden for three years. Among the symptoms of fluoride poisoning is severe joint pain and that your brain turns blue.

In low doses, though, fluoride is thought to be safe and beneficial. This is a phenomenon known as hormesis. Many things that are toxic at high doses are beneficial at low. Most drugs fall into this category, and chemotherapy works this way. Diseased cells are usually less-heartythan healthy ones. Fluoride is associated with strong teeth, and few cavities. It is found at ppm levels many well water systems, and has shown no sign of toxicity, either for humans or animals at these ppm levels. Following guidelines set by the AMA, we’ve been putting fluoride in drinking water since the 1960s at concentrations between 0.7 and 1.2 ppm. We have seen no deaths or clear evidence of any injury from this, but there has been controversy. Much of the controversy stems from a Chinese study that links fluoride to diminished brain function, and passivity (Anti-fluoriders falsely attribute this finding to a Harvard researcher, but the Harvard study merely cites the Chinese). The American dental association strongly maintains that worries based on this study are groundless, and that the advantage in lower cavities more than off-sets any other risks. Notwithstanding, I thought I’d take another look. The typical US adult consumes 1-3 mg/day the result of drinking 1-3 liters of fluoridated water (1 ppm = 1 mg/liter). This < 1/1000 the toxic dose,

While there is no evidence that people who drink high-fluoride well water are any less-healthy than those who drink city water, or distilled / filtered water, that does not mean that our city levels are ideal. Two months ago, while running for water commissioner, I was asked about fluoride, and said I would look into it. Things have changed since the 1960s: our nutrition has changed, we have vitamin D milk, and our toothpastes now contain fluoride. My sense is we can reduce the water concentration. One indication that this concentration could be reduced is shown below. Many industrial countries that don’t add fluoride have similar tooth decay rates to the US.

World Health Organization data on tooth decay and fluoridation.

World Health Organization data on tooth decay and fluoridation.

This chart should not be read to suggest that fluoride doesn’t help; all the countries shown use fluoride toothpaste, and some give out fluoride pills, too. And some countries that don’t add fluoride have higher levels of cavities. Norway and Japan, for example, don’t add fluoride and have 50% more cavities than we do. Germany doesn’t add fluoride, and has fewer cavities, but they hand out fluoride pills, To me, the chart suggests that our levels should go down, though not to zero. In 2015, the Department of Health recommend lowering the fluoride level to 0.7 ppm, the lower end of the previous range, but my sense from the experience of Europe is that we should go lower still. If I were to pick, I’d choose 1/2 the original dose: 0.6 to 0.35 ppm. I’d then revisit in another 15 years.

Having picked my target fluoride concentration, I checked to see the levels in use in Oakland county, MI, the county I was running in. I was happy to discover that most of the water the county drinks, that provided by Detroit Water and Sewage, NOCWA and SOCWA already have decreased levels of 0.43-0.55 ppm. These are just in the range I would have picked, Fluoride concentrations are higher in towns that use well water, about  0.65-0.85 ppm. I do not know if this is because the well water comes from the ground with these fluoride concentrations or if the towns add, aiming at the Department of Health target. In either case, I don’t find these levels alarming. If you live none of these town, or outside of Oakland county, check your fluoride levels. If they seem high, write to your water commissioner. You can also try switching from fluoride toothpaste to non-fluoride, or baking soda. In any case, remember to brush. That does make a difference, and it’s completely non-toxic.

Robert Buxbaum, January 9, 2017. I discuss chloride addition a bit in this essay. As a side issue, a main mechanism of sewer pipe decay seems related to tooth decay. That is the roofs of pipe attract acid-producing, cavity causing bacteria that live off of the foul sewer gas. The remedies for pipe erosion include cleaning your pipes regularly, having them checked by a professional once per year, and repairing cavities early. Here too, it seems high fluoride cement resists cavities better.

A plague of combined sewers

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The major typhoid and cholera epidemics of the US, and the plague of the Al Qaeda camps, 2009 are understood to have been caused by bad sewage, in particular by the practice of combining sanitary + storm sewage. Medieval plagues too may have been caused by combined sewers.

Combined sewer system showing an rain-induced overflow, a CSO.

A combined sewer system showing an rain-induced overflow, a CSO.

A combined system is shows at right. Part of the problem is that the outfall is hard to contain, so they tend to spew sewage into the lakes and drinking water as shown. They are also more prone to back up during rain storms; separated systems can back up too, but far less often. When combined sewers back up, turds and other infected material flows into home basements. In a previous post, “follow the feces,” I showed the path that Oakland county’s combined sewers outfalls take when they drain (every other week) into Lake St. Clair just upstream of the water intake, and I detailed why, every few years we back up sewage into basements. I’d like to now talk a bit more about financial cost and what I’d like to do.

The combined sewer system shown above includes a small weir dam. During dry periods and small rain events, the dam keeps the sewage from the lake by redirecting it to the treatment plant. This protects the lakes so that sometimes the beaches are open, but there’s an operation cost: we end up treating a lot of rain water as if it were sewage. During larger rains, the dam overflows. This protects our basements (usually) but it does so at the expense of the drinking water, and of the water in Lake St. Clair and Lake Erie.

As a way to protect our lakes somewhat Oakland county has added a retention facility, the George W. Kuhn. This facility includes the weir shown above and a huge tank for sewage overflows. During dry periods, the weir holds back the flow of toilet and sink water so that it will flow down the pipe (collector) to the treatment plant in Detroit, and so it does not flow into the lake. Treatment in Detroit is expensive, but nonpolluting. During somewhat bigger rains the weir overflows to the holding tank. It is only during yet-bigger rains (currently every other week) that the mixture of rain and toilet sewage overwhelms the tank and is sent to the river and lake. The mess this makes of the lake is shown in the video following. During really big rains, like those of August 2014, the mixed sewage backs up in the pipes, and flows back into our basements. With either discharge, we run the risk of plague: Typhoid, Cholera, Legionnaires…

Some water-borne plagues are worse than others. With some plagues, you can have a carrier, a person who can infect many others without becoming deathly sick him or herself. Typhoid Mary was a famous carrier of the 1920s. She infected (and killed) hundreds in New York without herself becoming sick. A more recent drinking water plague, showed up in Milwaukee 25 years ago. Some 400,000 people were infected, and 70 or so died. Milwaukee disinfected its drinking water with chlorine and a bacteria that entered the system was chlorine tolerant. Milwaukee switched to ozone disinfection but Detroit still uses chlorine.

Combined sewers require much larger sewage treatment plants than you’d need for just sanitary sewage. Detroit’s plant is huge and its size will need to be doubled to meet new, stricter standards unless we bite the bullet and separate our sewage. Our current system doesn’t usually meet even the current, lower standards. The plant overflows and operation cost are high since you have to treat lots of rainwater. These operation costs will keep getter higher as pollution laws get tougher.

In Oakland county, MI we’ve started to build more and more big tanks to hold back and redirect the water so it doesn’t overwhelm the sewage plants. The GWK tank occupies 1 1/2 miles by about 100 feet beneath a golf course. It’s overwhelmed every other week. Just think of the tank you’d need to hold the water from 4″ of rain on 900 square mile area (Oakland county is 900 square miles). Oakland’s politicians seem happy to spend money on these tanks because it creates jobs and graft and because it suggests that something is being done. They blame politics when rain overwhelms the tank. I say it’s time to end the farce and separate our sewers. My preference is to separate the sewers through the use of French drains or bio-swales, and through the use of weir dams. I’m running for drain commissioner. Here’s something I’ve written on the chemistry of sewage, and on the joy of dams.

Dr. Robert E. Buxbaum, July 1-Sept 16, 2016.

Political tensegrity: the west is best

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We are regularly lectured about the lack of kindness and humility of the western countries. Eastern and communist leaders in Russia, Iran, Saudi Arabia point to Western pollution, consumerism, unemployment as prof you need a strong leader and central control to do good by regulation, thought policing, and wealth redistribution.

Let me point out that the good these leaders provide is extracted from the populace, and the advantage of central control is rarely as clear to the populous as to the leadership. When leaders redistribute wealth or place limits on the internet, movies or books, the leaders are generally exempted, and the populous are not made more moral or generous either. One does not say a prisoner or slave-worker is more generous of moral than one on the outside despite the prisoner working for free. The leaders feel certain they are protecting their people from thought and greed, but it isn’t clear outside of the leadership that these dangers are as great as the danger of despotism or rule by whim.

Authors and thoughts are blocked in the East by the whim of a supreme leader who also determines who is an infidel or enemy, or friend, and which businesses should flourish, and who should be rich (his buddies). By contrast, two fundamentals of western society — things that lead to purported immorality, are citizen rights and the rule of law: that citizens can possess things and do things for their own reasons, or no reason at all, and that citizens may stand as equals before a bar of law, to be judged by spelled-out laws or freed, with equal believability and claim.

In Russia or Iran, the Commissar and Imam have special rights: they can take possessions from others at whim, shut down businesses at whim; imprison at whim  — all based on their own interpretation of God’s will, the Koran, or “the good of the state.” Only they can sense the true good, or the true God well enough to make these decisions and laws. And when they violate those laws they are protected from the consequences; the masses can be prosecuted to the full extent of the law, and then some, not even requiring a trial in many places (Gaza, for example) if the leader feels speed is needed. The rule of law with equal treatment is a fundamental of western civilization (republicanism). It is commanded by Moses in the Bible at least seven times: Numbers 15:15, Numbers 15:16, Numbers 15:29, Exodus 12:49, Numbers 9:14, and Leviticus 24:22, “One law and one ordinance you should have, for the home-born, and the foreigner who dwells among you.”

The equal treatment under the law: for rich and poor, king and commoner, citizen and foreigner is a revolutionary idea of the west; that justice is blind. Another idea is personal possessions and freedoms. There is no concept of equality under business law unless there is a business that you can own, and personal possessions and rights. These are not in place in eastern theocracies: they tend to treat the preachers (imams) better than non preachers because they are presumed smarter and better; similarly men are treated better than women, who have few rights, and the state religion is treated better than infidels. In communist countries and dictatorships the dictator can get away with anything. Admittedly, in capitalistic states the rich and powerful find loopholes while the poor find prison, but not always (our Detroit’s ex-mayor is in prison) and it’s not the law. A feature of Eastern theocracies and dictatorships is that they lack a free press, and thus no forum for public exposure of legal mischief.

Einstein on freedom producing good. I'd say freedom is also a good in itself

Einstein on freedom producing good. I’d say freedom is also a good in itself.

The strongest arguments for socialist dictatorship and theocracy is that this is needed to protect the weak. Clement Attlee (labor socialist British Prime Minister, 1945 -56) explained his government’s take over of almost all British business: “There was a time when employers were free to work little children for sixteen hours a day… when employers were free to employ sweated women workers on finishing trousers at a penny halfpenny a pair. There was a time when people were free to neglect sanitation so that thousands died of preventable diseases. For years every attempt to remedy these crying evils was blocked by the same plea of freedom for the individual. It was in fact freedom for the rich and slavery for the poor. Make no mistake, it has only been through the power of the State, given to it by Parliament, that the general public has been protected against the greed of ruthless profit-makers and property owners.”  (Quotes from Spartacus.edu). it’s a brilliant speech, and it taps into the government’s role in the common defense, but it’s not at all clear that a chinless bureaucrat will be a better boss than the capitalist who built the firm. Nor is it clear that you help people by preventing them from work at a salary you decide is too low. 

England suffered a malaise from public ownership and the distribution of profit by those close the liberal party. Under Attlee there was lack of food and coal while the rest of Europe, and particularly Germany prospered, and passed England in productivity. Germany had no minimum wage, and  still doesn’t have one. In eastern countries, ingenuity is deadened by the knowledge that whatever a genius or worker achieves is taken by the state and redistributed. A cute joke exchange: Churchill and Attlee are supposed to have found themselves in adjoining stalls of the men’s room of Parliament. Churchill is supposed to have moved as far as possible from Attlee. “Feeling standoffish, Winston” Attlee is supposed to have said. “No. Frightened. “Whenever you see something large you try to nationalize it.” Perhaps more telling is this Margret Thatcher’s comment, and exchange. Making everyone’s outcome equal does more to penalize those with real pride in their ideas and work than it does to help the truly needy.

While there is a need for government in regards to safety, roads, and standards, and to maintain that equality of law. It seems to me the state should aid the poor only to the extent that it does not turn them into dependents. There is thus a natural tension between private good and public service similar to the tensegrity that holds cells together. Capitalists can only make money by providing desired goods and services at worthwhile rate, and paying enough to keep workers; they should be allowed to keep some of that, while some must be taken from them to get great things done. I’ve related the tensegrity of society to the balance between order and disorder in a chemical system.

Robert E. Buxbaum,  August 27, 2014. This essay owes special thanks to a Princeton chum, Val Martinez. Though my training is in engineering, I’ve written hobby pieces on art, governance, history, and society. Check out the links at right.

Stoner’s prison and the crack mayor

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With the release of a video of Rob Ford, the Mayor of Toronto, smoking crack while in office, and the admission that at least two US presidents smoked pot, as did the Beatles, Stones, and most of Hollywood, it seems worthwhile to consider the costs and benefits of our war on drugs, especially pot. Drugs are typically bad for productivity and usually bad for health. Thus, it seems worthwhile to regulate it, but most countries do not punish drug sale or use nearly as harshly as we do in the US.

The Freak Brothers by Gilbert Shelton. Clearly these boys were not improved by drugs, but perhaps we could do better than incarcerating them, and their fans, for years, or life.

The Freak Brothers by Gilbert Shelton. Clearly these boys were not improved by drugs, but perhaps we could do better than incarcerating them, and their fans, for years, or life.

While US penalties vary state by state, most states have high minimum penalties that a judge can not go below. In Michigan, where I live, medical marijuana is legalized, but all supply is still illegal. Marijuana cultivation, even for personal medical use, is a felony carrying a minimum punishment of 4 years in state prison and a $20,000 fine. For cultivation of more than 20 plants the minimum sentence is 7 years in prison and $500,000; and cultivating 200 or more plants results in 15 years plus a $10,000,000 fine. These are first-time, minimum sentences where the judge can not consider mitigating circumstances, like a prescription, for a drug that was accepted for use in the US in the 70s, is legal in Holland, legalized in Colorado, and is near-legal in Belgium. While many pot smokers were not served by the herb, many went on to be productive, e.g. our current president and the Beatles.

In Michigan, the mandatory minimums get worse if you are a repeat offender, especially a 3 time offender. Possession of hard drugs; and sales or cultivation of marijuana makes you a felon; a gun found on a felon adds 2 years and another felony. With three felonies you go to prison for life, effectively, so there is little difference between the sentence of a repeat violent mugger and a kid selling $10 rocks of crack in Detroit. America has more people in prison than Russia, China, or almost every industrialized nation, per capita, and the main cause is long minimum sentences.

In 2011, Michigan spent an average of $2,343 per month per prisoner, or $28,116/year: somewhat over 1.3 billion dollars per year in total. To this add the destruction of the criminal’s family, and the loss of whatever value he/she might have added to society. Reducing sentences by 10 or 20% would go a long way towards paying off Detroit’s bankruptcy, and would put a lot of useful people back into the work-force where they might do some good for themselves and the state. 60.8% of drug arrestees were employed before they were arrested for drugs, with an average income of $1050/month. That’s a lot of roofers, electricians, carpenters, and musicians — useful people. As best we can tell, the long sentences don’t help, but lead to higher rates of recidivism and increased violent behavior. If you spend years in jail, you are likely to become more violent, rather than less. Some 75% of drug convicts have no prior record of violent crime, so why does a first-time offense have to be a felony. If we need minimums, couldn’t it be 6 months and a $1000 fine, or only apply if there is violence.

Couldn’t we allow judges more leeway in sentencing, especially for drugs? Recall that Michiganders thought they’d legalized marijuana for medical use, and that even hard-drugs were legal not that long ago. There was a time when Coca-Cola contained cocaine and when Pope Leo was a regular drinker of cocaine laced wine. If the two presidents smoked pot, and the Mayor of Toronto could do a decent job after cocaine, why should we incarcerate them for life? Let’s balance strict justice with mercy; so the fabric of society is not strained to breaking.

Robert Buxbaum, Jan 16, 2014. Here are some other thoughts on Detroit and crime.

Slowing Cancer with Fish and Unhealth Food

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Some 25 years ago, while still a chemical engineering professor at Michigan State University, I did some statistical work for a group in the Physiology department on the relationship between diet and cancer. The research involved giving cancer to groups of rats and feeding them different diets of the same calorie intake to see which promoted or slowed the disease. It had been determined that low-calorie diets slowed cancer growth, and were good for longevity in general, while overweight rats died young (true in humans too, by the way, though there’s a limit and starvation will kill you).

The group found that fish oil was generally good for you, but they found that there were several unhealthy foods that slowed cancer growth in rats. The statistics were clouded by the fact that cancer growth rates are not normally distributed, and I was brought in to help untangle the observations.

With help from probability paper (a favorite trick of mine), I confirmed that healthy rats fared better on healthily diets, but cancerous rats did better with some unhealth food. Sick or well, all rats did best with fish oil, and all rats did pretty well with olive oil, but the cancerous rats did better with lard or palm oil (normally an unhealthy diet) and very poorly with corn oil or canola, oils that are normally healthful. The results are published in several articles in the journals “Cancer” and “Cancer Research.”

Among vitamins, they found something similar (it was before I joined the group). Several anti-oxidizing vitamins, A, D and E made things worse for carcinogenic rats while being good for healthy rats (and for people in moderation). Moderation is key; too much of a good thing isn’t good, and a diet with too much fish oil promotes cancer.

What seems to be happening is that the cancer cells grow at the same rate with all of the equi-caloric diets, but that there was a difference the rate of natural cancer cell death. More cancer cells died when the rat was fed junk food oils than those fed a diet of corn oil and canola. Similarly, the reason anti-oxidizing vitamins hurt cancerous rats was that fewer cancer cells died when the rats were fed these vitamins. A working hypothesis is that the junk oils (and the fish oil) produced free radicals that did more damage to the cancer than to the rats. In healthy rats (and people), these free radicals are bad, promoting cell mutation, cell degradation, and sometimes cancer. But perhaps our body use these same free radicals to fight disease.

Larger amounts of vitamins A, D, and E hurt cancerous-rats by removing the free radicals they normally use fight the disease, or so our model went. Bad oils and fish-oil in moderation, with calorie intake held constant, helped slow the cancer, by a presumed mechanism of adding a few more free radicals. Fish oil, it can be assumed, killed some healthy cells in the healthy rats too, but not enough to cause problems when taken in moderation. Even healthy people are often benefitted by poisons like sunlight, coffee, alcohol and radiation.

At this point, a warning is in-order: Don’t rely on fish oil and lard as home remedies if you’ve got cancer. Rats are not people, and your calorie intake is not held artificially constant with no other treatments given. Get treated by a real doctor — he or she will use radiation and/ or real drugs, and those will form the right amount of free radicals, targeted to the right places. Our rats were given massive amounts of cancer and had no other treatment besides diet. Excess vitamin A has been shown to be bad for humans under treatment for lung cancer, and that’s perhaps because of the mechanism we imagine, or perhaps everything works by some other mechanism. However it works, a little fish in your diet is probably a good idea whether you are sick or well.

A simpler health trick is that it couldn’t hurt most Americans is a lower calorie diet, especially if combined with exercise. Dr. Mites, a colleague of mine in the department (now deceased at 90+) liked to say that, if exercise could be put into a pill, it would be the most prescribed drug in America. There are few things that would benefit most Americans more than (moderate) exercise. There was a sign in the physiology office, perhaps his doing, “If it’s physical, it’s therapy.”

Anyway these are some useful things I learned as an associate professor in the physiology department at Michigan State. I ended up writing 30-35 physiology papers, e.g. on how cells crawl and cell regulation through architecture; and I met a lot of cool people. Perhaps I’ll blog more about health, biology, the body, or about non-normal statistics and probability paper. Please tell me what you’re interested in, or give me some keen insights of your own.

Dr. Robert Buxbaum is a Chemical Engineer who mostly works in hydrogen I’ve published some 75 technical papers, including two each in Science and Nature: fancy magazines that you’d normally have to pay for, but this blog is free. August 14, 2013

Hormesis, Sunshine and Radioactivity

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It is often the case that something is good for you in small amounts, but bad in large amounts. As expressed by Paracelsus, an early 16th century doctor, “There is no difference between a poison and a cure: everything depends on dose.”

Aereolis Bombastus von Hoenheim (Paracelcus)

Phillipus Aureolus Theophrastus Bombastus von Hoenheim (Dr. Paracelsus).

Some obvious examples involve foods: an apple a day may keep the doctor away. Fifteen will cause deep physical problems. Alcohol, something bad in high doses, and once banned in the US, tends to promote longevity and health when consumed in moderation, 1/2-2 glasses per day. This is called “hormesis”, where the dose vs benefit curve looks like an upside down U. While it may not apply to all foods, poisons, and insults, a view called “mitridatism,” it has been shown to apply to exercise, chocolate, coffee and (most recently) sunlight.

Up until recently, the advice was to avoid direct sun because of the risk of cancer. More recent studies show that the benefits of small amounts of sunlight outweigh the risks. Health is improved by lowering blood pressure and exciting the immune system, perhaps through release of nitric oxide. At low doses, these benefits far outweigh the small chance of skin cancer. Here’s a New York Times article reviewing the health benefits of 2-6 cups of coffee per day.

A hotly debated issue is whether radiation too has a hormetic dose range. In a previous post, I noted that thyroid cancer rates down-wind of the Chernobyl disaster are lower than in the US as a whole. I thought this was a curious statistical fluke, but apparently it is not. According to a review by The Harvard Medical School, apparent health improvements have been seen among the cleanup workers at Chernobyl, and among those exposed to low levels of radiation from the atomic bombs dropped on Hiroshima and Nagasaki. The health   improvements relative to the general population could be a fluke, but after a while several flukes become a pattern.

Among the comments on my post, came this link to this scholarly summary article of several studies showing that long-term exposure to nuclear radiation below 1 Sv appears to be beneficial. One study involved an incident where a highly radioactive, Co-60 source was accidentally melted into a batch of steel that was subsequently used in the construction of apartments in Taiwan. The mistake was not discovered for over a decade, and by then the tenants had received between 0.4 and 6 Sv (far more than US law would allow). On average, they were healthier than the norm and had significantly lower cancer death rates. Supporting this is the finding, in the US, that lung cancer death rates are 35% lower in the states with the highest average radon radiation levels (Colorado, North Dakota, and Iowa) than in those with the lowest levels (Delaware, Louisiana, and California). Note: SHORT-TERM exposure to 1 Sv is NOT good for you; it will give radiation sickness, and short-term exposure to 4.5 Sv is the 50% death level

Most people in the irradiated Taiwan apartments got .2 Sv/year or less, but the same health benefit has also been shown for people living on radioactive sites in China and India where the levels were as high as .6 Sv/year (normal US background radiation is .0024 Sv/year). Similarly, virtually all animal and plant studies show that radiation appears to improve life expectancy and fecundity (fruit production, number of offspring) at dose rates as high as 1 Sv/month.

I’m not recommending 1 Sv/month for healthy people, it’s a cancer treatment dose, and will make healthy people feel sick. A possible reason it works for plants and some animals is that the radiation may kill proto- cancer, harmful bacteria, and viruses — organisms that lack the repair mechanisms of larger, more sophisticated organisms. Alternately, it could kill non-productive, benign growths allowing the more-healthy growths to do their thing. This explanation is similar to that for the benefits farmers produce by pinching off unwanted leaves and pruning unwanted branches.

It is not conclusive radiation improved human health in any of these studies. It is possible that exposed people happened to choose healthier life-styles than non-exposed people, choosing to smoke less, do more exercise, or eat fewer cheeseburgers (that, more-or-less, was my original explanation). Or it may be purely psychological: people who think they have only a few years to live, live healthier. Then again, it’s possible that radiation is healthy in small doses and maybe cheeseburgers and cigarettes are too?! Here’s a scene from “Sleeper” a 1973, science fiction, comedy movie where Woody Allan, asleep for 200 years, finds that deep fat, chocolate, and cigarettes are the best things for your health. You may not want a cigarette or a radium necklace quite yet, but based on these studies, I’m inclined to reconsider the risk/ benefit balance in favor of nuclear power.

Note: my company, REB Research makes (among other things), hydrogen getters (used to reduce the risks of radioactive waste transportation) and hydrogen separation filters (useful for cleanup of tritium from radioactive water, for fusion reactors, and to reduce the likelihood of explosions in nuclear facilities.

by Dr. Robert E. Buxbaum June 9, 2013