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Eliquis, over-prescribed but better than Coumadin.

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Eliquis (apixaban) is blood thinner shown to prevent stroke with fewer side effects than Warfarin (Coumadin). Aspirin does the same, but not as effectively for people over 75. My problem with eliquis is that it’s over-prescribed. The studies favoring it over aspirin found benefits for those over 75, and for those with A-Fib. And even in this cohort the advantage over aspirin is small or non-existent because eliquis has far more serious side effects; hemorrhage, or internal bleeding.

Statistically, the AVERROES study (Apixaban Versus Acetylsalicylic Acid to Prevent Stroke in AF Patients Who Have Failed or Are Unsuitable for Vitamin K Antagonist Treatment) found that apixaban is substantially better than aspirin at preventing stroke in atrial fibrillation patients, but worse at preventing heart attack.

Taking 50 mg of Eliquis twice a day, reduces the risk of stroke in people with A-Fib by more than 50% and reduces the rate of heart attack by about 15%. By comparison, taking 1/2 tablet of aspirin, 178 mg, reduces the risk of stroke by 17% and of heart attack by 42%. The benefits were higher in the elderly, those over 75, and non existent in those with A-Fib under 75, see here, and figure. Despite this, doctors prescribe Eliquis over aspirin, even to those without A-Fib and those under 75. I suspect the reason is advertising by the drug companies, as I’ve claimed earlier with Atenolol.

The major deadly side-effect is hemorrhage, brain hemorrhage and GI (stomach) hemorrhage. Here apixaban is far worse than with aspirin (but better than Warfarin). The net result is that in the AVERROES random-double blind study there was no difference in all-cause mortality between apixaban and aspirin for those with A-fib who were under 75, see here. Or here.

To reduce your chance of GI hemorrhage with Eliquis, it is a very good idea to take a stomach proton pump drug like Pantoprazole. If you have A-Fib, the combination of Eliquis and pantoprazole seems better than aspirin alone, even for those under 75. If you have no A-Fib and are under 75, I see no benefit to Eliquis, especially if you find you have headaches, stomach aches, back pain, or other signs of internal bleeding, you might switch to aspirin or choose a reduced dose.

A Japanese study found that half the normal dose of Eliquis, was approximately as effective as the full dose, 50 mg twice a day. I was prescribed Eliquis, full dose twice a day, but I’m under 70 and I have no A-Fib since my ablation.

Life expectancy has dropped in the US to undeveloped world levels. Biden blames COVID and racism. I think it’s too much drugs, and too few opportunities.

I’m struck by the fact that US life expectancy is uncommonly low, lower than in most developed countries. Lower too than in many semi-developed countries, and our life expectancy is decreasing while other countries are not seeing the same. It dropped by about 3 years over the last 2 years as shown. I wonder why the US has suffered more than other countries, and suspect we are over-prescribed. Too much of a good thing, typically isn’t good.

Robert Buxbaum, September 16, 2022. As a side issue, low dose aspirin may forestall Alzheimers and other dementias. See current article here. Also another study here.

Atenolol, not good for the heart, maybe good for the doctor.

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Atenolol and related beta blockers have been found to be effective reducing blood pressure and heart rate. Since high blood pressure is a warning sign for heart problems, doctors have been prescribing atenolol and related beta blockers for all sorts of heart problems, even problems that are not caused by high blood pressure. I was prescribed metoprolol and then atenolol for Atrial Fibrillation, A-Fib, beginning 2 yeas ago, even though I have low-moderate blood pressure. For someone like me, it might have been deadly. Even for patients with moderately high blood pressure (hypertension) studies suggest there is no heart benefit to atenolol and related ß-blockers, and only minimal stroke and renal benefit. As early as 1985 (37 years ago) the Medical Research Council trial found that “ß blockers are relatively ineffective for primary treatment of hypertensive outcomes.”

End point. Relative risk. 95% CI. All-cause mortality Cardiovascular mortality MI Stroke Carlberg B et al. Lancet 2004; 364:1684–1689.

There lots of adverse side-effects to atenolol, as listed at the end of this post. More recent studies (e.g. Carlsberg et al., at right) continue to find no positive effects on the heart, but lots of negatives. A review in Lancet (2004) 364,1684–9 was titled, “Review: atenolol may be ineffective for reducing cardiovascular morbidity or all cause mortality in hypertension” (link here). “In patients with essential hypertension, atenolol is not better than placebo or no treatment for reducing cardiovascular morbidity or all cause mortality.” It further concluded that, “compared to other antihypertensive drugs, it [atenolol] may increase the risk of stroke or death.” I showed this and related studies to my doctor, and pointed out that I have averaged to low blood pressure, but he persisted in pushing this drug, something that seems common among medical men. My guess is that the advertising or doctor subsidies are spectacular. By contrast, aspirin has long been known to be effective for heart problems; my doctor said to go off aspirin.

The graph at right is from “Trial of Secondary Prevention with Atenolol after transient Ischemic Attack or Nondisabling Ischemic Stroke”, published in Stroke, 24 4 (1993), (see link here). a Thje study involved 1473 at-risk patients, randomly prescribed atenolol or placebo. It found no outcome benefit from atenolol, and several negatives. After 3 years, in two equal-size randomized groups, there were 64 deaths among the atenolol group, 58 among the placebo group; there were 11 fatal strokes with atenolol, versus 8 with placebo. There were somewhat fewer non-fatal strokes with atenolol, but the sum-total of fatal and non-fatal strokes was equal; there were 81 in each group.

“Trial of Secondary Prevention with Atenolol after transient Ischemic Attack or Nondisabling Ischemic Stroke”, published in Stroke, 24 4 (1993).

Newer beta blockers seem marginally better, as in “Effect of nebivolol or atenolol vs. placebo on cardiovascular health in subjects with borderline blood pressure: the EVIDENCE study.” “Nebivolol (NEB) in contrast to atenolol (ATE) may have a beneficial effect on endothelial function …. there was no significant change in the ATE and PLAC groups.” My question: why not use one of these, or better yet aspirin. Aspirin is shown to be beneficial, and relatively side-effect free. If you tolerate aspirin, and most people do, beneficial has to be better than maybe beneficial.

Among atenolol’s ugly side effects, as listed by the Mayo Clinic, there are: tiredness, sweating, shortness of breath, confusion, loss of sex drive, cold fingers and toes, diarrhea, nausea, and general confusion. I had some of these. There was no increase in heart stability (decrease in A-fib). My heart rate went as low at 32 bpm at night. My doctor was unconcerned, but I was. I suspected the low heart rate put me at extreme risk. Eventually, the same doctor gave me ablation therapy, and that seemed to cure the A-Fib.

Following my ablation, I was told I could get off atenolol. I then discovered another negative effect of atenolol: you have to ease off it or your heart will race. If you have A-fib, or modest hypertension, consider aspirin, eliquis, ablation, or exercise. If you are prescribed atenolol for heart issues and don’t have symptoms of very-high blood pressure, consider other options and/or changing doctors.

Robert Buxbaum, August 14, 2022

Curing my heart fibrillation with ablation.

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Two years ago, I was diagnosed with Atrial fibrillation, A-Fib in common parlance, a condition where my heart would sometimes speed up to double its normal speed. I was prescribed metopolol and then atenolol, common beta blockers, and a C-Pap for sleep apnea. None of this seemed to help, as best I could tell from occasional pulse measurements with watch and a finger pulse-oxometer. Besides, the C-Pap was giving me cough and the beta blockers made me dizzy. And the literature on C-Pap did not impress.

So, some moths ago, I bought an iWatch. The current versions allows you to take EKGs and provides a continuous record of your heart rate. This was very helpful, as I saw that my heart rate was transitioning to chaos. While it was normally predictable, it would zoom to 130 or so at some point virtually every day. Even more alarming, it would slow down to the mid 30s at some point during the night, bradycardia, and I could see it was getting worse. At that point, I agreed to go on eliquis, a blood thinner, and agreed to a catheter ablation. The doctor put a catheter into my heart by way of a leg vein, and zapped various nerve centers in the heart. The result is that my heart is back into normal behavior. See the heart-rate readout from my iWatch below; before and after are dramatically different.

My heart rate for the last month, very variable before the ablation treatment, 2 weeks ago; a far less variable range of heart rates in the two weeks following the treatment. Heart rate data is from my iPhone and iwatch — a good investment, IMHO.

The reason I chose ablation over drugs or no therapy was that I read health-studies on line. I’ve go a PhD, and that training helps me to understand the papers I’ve read, but you should read them too. They are not that hard to understand. Though ablation didn’t appear as a panacea, it was clearly better than the alternatives. Particularly relevant was the CABANA study on life expectancy. CABANA stands for “Catheter ABlation vs ANtiarrhythmic Drug Therapy for Atrial Fibrillation – CABANA”. https://www.acc.org/latest-in-cardiology/clinical-trials/2018/05/10/15/57/cabana.

2,204 individuals with persistent AF were followed for 5 years after treatment, 37% female, 63% male, average age 67.5. Prior hospitalization for AF: 39%. The results were as follows:

  • Death: 5.2% for ablation vs. 6.1% for drug therapy (p = 0.38)
  • Serious stroke: 0.3% for ablation vs. 0.6% for drug therapy (p = 0.19)
  • All-cause mortality: 4.4% for ablation vs. 7.5% for drug therapy (p = 0.005)
  • Death or CV hospitalization: 51.7% for ablation vs. 58.1% for drug therapy (p = 0.002)
  • Pericardial effusion with ablation: 3.0%; ablation-related events: 1.8%
  • First recurrent AF/atrial flutter/atrial tachycardia: 53.8% vs. 71.9% (p < 0.0001)

I found all of this significant, including the fact that 27.5% of those on the drug treatment crossed over to have ablation while only 9.2% on the ablation side crossed to have the drug treatment.

I must give a plug for doctor Ahmed at Beaumont Hospital who did the ablation. He does about 200 of these a year, and does them well. Do not go to an amateur. I was less-than impressed with him pushing the beta-blocker hard; I’ll write about that. Also, get an iWatch if you think you may have A-Fib or any other heart problem. You see a lot, just by watching, so to speak.

Robert Buxbaum, August 3, 2022.

Girls are doing better, Boys are doing far worse.

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When I began college in 1972, the majority of engineering students and business students were male. They from the top of their high school classes, and from stable homes mostly; they went on to high paying jobs. Boys also dominated at the bottom of society. They were the majority of the criminals, drug addicts, and high-school dropouts. Many went off to Vietnam. Some, those who were handy, went to trade schools and a reasonable life, productive life. Society did not seem bothered by the destruction of boys in prison, or Vietnam, or by drugs, but there was an outcry that so few women achieved high academic levels. A famous presentation of the problem was called “for every 100 girls.” An updated version appears below showing the status as of October, 2021. A more detailed version appears further down.

From the table above, you can see that women are now the majority of those in college, the majority of those with a bachelors degree or higher, and a majority of those with advanced degrees. Colleges added special tutoring, special grants, and special programs. Each college had a Society of Women Engineers office, and similar programs in law and math. All of these explicitly excluded men or highly discouraged their presence. The curriculum was changed too; made more female-friendly. Dirty, and physical experiments were removed, replaced with group analysis of the social interactions — important aspects of engineers that boys were far-less adept at doing well. Perhaps society and engineering is better off now, but boys (men) are far worse off. This is particularly seem by the following chart, looking at the bottom. Boys/men provide the vast majority of the prison population, of those diagnosed as learning disabled, of those expelled, or overdosed, and among the war dead.

I’ve previously noted that a majority of boys in school are considered disruptive, and that these boys are routinely diagnosed as ADHD and drugged. It is not at all clear that this is a good thing, or that the drugs help anyone but the teacher. I’ve also noted that artwork and attitudes that were considered normal for boys are now considered disturbing and criminal like saying I wish the school was blown up. The cure here, perhaps is worse than the disease. I’m not saying that we should encourage boys to say such things, but that we should acknowledge a difference between an active and a passive wish. And we should find a way to educate boys/men so they don’t end up unemployed, addicted, or dead. Currently boy, particularly those at the bottom are on the scrap-heap of society.

Here is some source material for the above:

Robert Buxbaum, May 28, 2022

Biden stops fracking and gas prices go up 300% — Surprise!

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Natural gas prices for June 2022 as of May 6, 2022.

Natural gas prices have quadrupled in the last 17 months. It’s gone from $2.07 per million BTU in mid January 2021 when Joe Biden took office, to nearly $9 today. It’s a huge increase in the cost to heat your home, and adds to the cost of any manufactured product you buy. Gasoline prices have risen too, going from $2/gallon when Biden took office to about $4.40 today. Biden blames the war with Russia, but the rise began almost as soon as he took office, and it far outstrips the rise in the price of wheat shown below (wheat is grown in Ukraine — it’s their major export). The likely cause is Biden’s moratorium on fracking, including his decision to stop permitting oil exploration and drilling on federal land. In recent weeks Biden has walked back some of this, to the consternation of the environmentalists. On April 15, 2022, the Interior Department announced this significant change including its first onshore lease sale since the moratorium.

Biden also cancelled the Keystone XL oil pipeline that would have brought tar-sands oil from Canada and North Dakota to Texas for refining. Blocking the pipeline helped increase gas prices here and helped cause a recession in Alberta and North Dakota. The protesters who claimed to speak for the natives are not affected.

Another issue fueling price increases is that Biden is printing money. Bidenflation is running at 8%/year. It’s not hyperinflation, but it’s getting close. It’s money taken from your pocket and from your savings. Much of the money is given to friends: to groups that Biden thinks will use it virtuously, but inflation is money taken from us, from our pockets and savings. Another beneficiary are those who are rich enough to take no salary, but live by borrowing against their real estate and corporate equity. The richest people in the US do this, earning $1 per year or less, (here’s a list compiled by Bloomberg, it’s basically every rich person). They pay no taxes, as they have no income. The only way to tax them is by tariffs, taxing what they import, but the government is against tariffs.

What you can do, personally about energy-cost inflation is not much. I would recommend insulating your home. I plan to repaint the roof white, and put in a layer of roof insulation. I also have fruit trees: an apple tree and a peach tree, grapes and a juneberry. They provide summer shade, and you get a lot of fruit with minimal work. Curtains are a good investment. Another thought is to buy solar cells. A vegetable garden is fun too, but it’s unlikely to pay you back.

Winter wheat prices are up by about 40%, likely due to the loss of supply from Ukraine and Russia

Speaking of wheat prices, they are up. They increased 40% when Russian troops invaded Ukraine, and have held steady at that level since. This is far less increase than for natural gas. Corn and rice prices are up too, but nowhere near as much. Fertilizer prices are up 300%, though, and Biden has indicated he’d like to push for a sustainable alternative; is that poop? There is a baby formula shortage too. We can handle it, I think, unless Biden get involved, or starts a hot war with Russia.

Robert Buxbaum May 10, 2022. As a fun sidelight, here is Biden answering questions about Pakistan when someone in a Bunny costume grabs him and walks him away from the reporters. Who is that masked handler? What’s going on in Pakistan?

A clever range extender for EVs

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Electric vehicles work well for short trips between places where you can charge with cheap electricity. Typically that’s trips from home to a nearby place of work, and to local shopping malls and theaters with low-cost charge spots. If you drive this way, you’ll pay about 3.2¢/mile for home electricity, instead of about 17¢/mile for gasoline transport (e.g. 24 mpg with $4/gallon gas). Using an EV also saves on oil changes, transmission, air filters, belts, etc., and a lot of general complexity. Battery prices are still high, but much lower than they were even a few years ago.

The 10 kW Aquarius Engine is remarkably small and light, about 10kg (22 lb).

EVs are less attractive for long trips, especially in the cold. Your battery must provide the heat, as there is no waste heat from the engine. Expect to have to recharge every 200 -250 miles, or perhaps twice in the middle of a long trip. Each charge will take a half-hour or more, and fast charging on the road isn’t low cost. Expect to pay about 15¢/mile, nearly as much as for gasoline. See my full comparison of the economics here.

One obvious solution is to have two cars: a short commuter and an EV. Another solution is a hybrid. The Toyota’s Prius and the Chevy Volt were cutting edge in their day, but people don’t seem to want them. These older hybrids provided quick fill-ups, essentially infinite range, and about double the gas milage of a standard automobile, 30-45 mpg. The problem is you have even more complexity and maintenance than with even a gas automobile.

Aquarius liner engine as a range extender

I recently saw a small, simple, super-efficient (they say) gas engine called Aquarius. It provides 9.5 kW electric output and weighs only 22 lbs (10 kg), see picture above. A Tesla S uses about 16 kW during highway driving, implying that this engine will more than double the highway range of a Tesla S at minimal extra weight and complexity. It also removes the fear of being stranded on the highway, far from the nearest charge-station.

The energy efficiency is 34%, far higher than that for normal automobile engines, but fairly typical of floating piston linear engines. The high efficiency of these engines is partly due to the lack of tapper valves, risers, crank-shaft, and partially due to the fact that the engine always runs at its maximum power. This is very close to the maximum efficiency point. Most car engines are over sized (200 hp or so) and thus must run at a small fraction of their maximum power. This hurts the efficiency, as I discuss here. The Aquarius Engine makes electricity by the back-forth motion of its aligner rods moving past magnetic stator coils. Slots in the piston rod and in the side of the cylinder operate as sliding valves, like in a steam engine. First versions of the Aquarius Engine ran on hydrogen, but the inventors claim it can also run on gasoline, and presumably hythane, my favorite fuel, a mix of hydrogen and natural gas.

At the moment shown, slit valves in the piston rod are open to both cylinder chambers. The explosion at left will vent to the exhaust at left and out the manifold at top. The sliding valve is currently sending fresh air into the cylinder at right, but will soon send it into both cylinders to help scavenge exhaust and provide for the next cycle; engine speed and impression are determined by the mass of the piston.

A video is available to show the basic operation (see it here). The drawing at right is from that video, modified by me. Air is drawn into the engine through a sliding valve at the middle of the cylinder. The valve opens and closes depending on where the piston is. At the instant shown in the picture, the valve is open to the right. Air enters that chambered is likely exiting through slits in the hollow piston rod. It leaves through the manifold t the top, pushing exhaust along with it. When the piston will have moved enough, both the slits and the intake will close. The continued piston motion (inertially driven) will compress the air for firing. After firing, the piston will move left, generating electricity, and eventually opening the slit-valve in the piston to allow the exhaust to leave. When it moves a little further the intake will open.

The use of side-opening exhaust valves is a novelty of the “Skinner UniFlow” double-acting, piston steam engines, seen on the Badger steamship on Lake Michigan. It’s one of my favorite steam engine designs. Normally you want a piston that is much thicker than the one in the drawing. This option is mentioned in the patent, but not shown in the drawing.

Aquarius is not the only company with a free-piston range extender. Toyota built a free-piston extender of similar power and weight; it was more complex but got higher efficiency. It has variable compression though, and looks like a polluter. (the same problems might affect the Aquarius) They dropped the project in 2014. Deutsch Aerospace has a two headed version that’s more powerful, but long and heavier: 56kg and 35kW. Lotus has a crank-piston engine, also 56kg, 35kW; it’s more complex and may have service life issues, but it’s compact and relatively light, and it probably won’t pollute. Finally, Mazda is thinking of bringing back its Wankel rotary engine as a range extender. Any of these might win in the marketplace, but I like the Aquarius engine for its combination of light weight, compact size, and simplicity.

This is not to say that Aquarius motors is a good investment. Aquarius automotive went public on the Toronto exchange in December, 2021, AQUA.TA. The company has no profits to date, and the only chance of them making a profit resides in them getting a good licensing deal from an established company. The major car companies have shown no interest so far, though they clearly need something like this. Their plug in hybrids currently use standard-size, 4 stroke engines: 110-150 kW, 100-150 kg, complex, and low efficiency. Consumers have not been impressed. Tesla autos could benefit from this engine, but Musk shows no interest either.

Robert Buxbaum May 5, 2022. I have no stock in Aquarius motors, nor have I received any benefits from them, or any auto company.

Ukraine looks like Vietnam or the beginnings of WWI

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The press and our Russian experts claim we’re helping in Ukraine, protecting it from a Russian invasion. I suspect they are wrong, and that our help and protection will prove to be as deadly to all as in the Vietnam war. I’m also uncomfortable with their presentation their framing of Putin as an out of touch autocrat. Putin has popular support, and acts with a strong sense of history, as I see it, just not our version of history. In the Russian version, it was Russia that stopped the Nazis — of Germany and Ukraine. We are not the heroes of WWII in their telling; I doubt we’ll be the heroes of this conflict either.

We have a habit of seeing ourselves as saving heroes as we enter other people’s conflicts. It is how we got into Vietnam, to save the South from the North. It’s also how Europe got into WWI: Russia was saving Serbia, Germany was saving Austria, etc (see cartoon below). We meddle our way, and leave much later than we planned. The result, as in Vietnam and Afghanistan is far more death and destruction than if we’d minded our own business. And US war-dead too. In Vietnam 58,000 US deaths. In Afghanistan 2,400 US dead. and no obvious accomplishment. As Henry Kissinger famously commented: “It’s dangerous to be America’s enemy, but deadly to be America’s friend.”

European aggression in WWII started with the good intention of preventing aggression. It got out of hand, as I fear our good intentions will in Ukraine.

The US troops we’ve sent to Ukraine are not called soldiers. They are “fighting advisors” sent to help the Ukrainians use our weapons. In WWI and Vietnam, fighting advisors are called invaders; it’s how we got drawn into Vietnam. The Russians claimed to send advisors when they entered the Crimea and later the Dundas. We called it an invasion. We can’t be that blind to our own words. Sooner or later, the advisors will start killing each other– something we’ll call an unprovoked attack. Our high tech aid including anti-tank missiles are reported to have killed some 10,000 Russians so far. We don’t seem to think the Russians will mind, or that they’ll give up as the body count mounts. In Vietnam, the more we killed with our high-tech weapons, the more the Vietnamese on both sides called us the villains, and the more Vietnamese joined the fight against us. That’s the future I fear for Ukraine, or worse. The conflict in WWI spiraled quickly beyond the borders of Serbia to include the whole world, and continued through WWII.

Our approach to diplomacy is counterproductive too, in my opinion, and similar to Vietnam too. We call Putin a terrorist, a madman and a narcissist, and then we begin talks with him to end the war. Biden has asked to have Putin removed by assassination.Does he think this will help, or if Putin is removed his successor will be a friend of the US? We demonized Ho Chi Minh, and propped up our favored, corrupt leaders. Minh was popular, as is Putin, and both have valid reasons for opposing us. Putin worries about the expansion of NATO. It’s not an illegitimate worry given Russian history of repeated invasions from the west.

Our desire to remove Russian leadership is a long-standing mistake. It does not lead to peace, or good negotiation, nor even peaceful co-existence.

Russia has been invaded many times. US schools mention Napoleon’s invasion in 1812 and the German’s in 1941, but there are more. They were invaded by the Germans in WWI too, and by the Ukrainian Cossacks in the days of Khmelnytsky, 1646-57. Before that the Polish Lithuanians, 1609-1618, the Swedes, 1701-1709, and in the early days, it was Tartars, Mongols, who invaded and ruled Russia from about 1225 til they joined with the Russian Tzars about 1650. Add to that, our help in the war of the Whites vs the Reds (1917-23) that produced Ukrainian independence — I talk about the relevance here. With a history like that, Russia has every reason to worry about NATO expansion. We should be cognizant of this and stop calling Putin a madman. Let’s accept the Russian version of history, and the sitting ruler of Russia.

Some cite the Budapest memorandum that lead to the removal of “Ukrainian” nuclear weapons –– read it here. It’s short, only 1 page, and deliberately vague. it was signed by Putin’s predecessor, Boris Yeltsin, for the Russian Federation, along with representatives for Ukraine, The US, and The UK. The missiles were not Ukrainian, they were Soviet, and pointed at us. As a result of that agreement, they were dismantled and moved into Russia. There is no sense that this is an invitation for us to protect Ukraine against Russia. The co-signers sort-of agree to protect Ukraine from outsiders (Germany, Turkey,..?), but that’s not clear. We commit ourselves to peace in the region, and can claim that Russia violated the peace first, but there’s no invitation for us to violate it second. Until recently, the UK provided no military aid. China and most of the EU still trades with Russia; if they see a villainy, it’s not enough to stop trade.

Robert McNamara was Secretary of Defense under Kennedy and Johnson, and a key “Whiz Kid” pushing for war in Vietnam. Years later, he decided Vietnam was a mistake. A sad cartoon: the veterans are walking past the grave monument for the 58,000 US dead. I worry we’ll have a similar cartoon after this war.

In my opinion, our best course is to reduce our military aid to providing only basics: bullets, blankets, food… We should reopen discussions with Putin, not demonize him, or try to remove him. Ukraine will likely fight on even without our high-tech weapons. Perhaps they’ll buy from Europe, or from independent dealers. The death rate on both sides will be lower and peace will come quicker without us. Crimea might remain Ukrainian or Russian, but that will not be our decision. We’ve done enough damage for now. It took many years after the end of the Vietnam war for the instigators admit is was a mistake.

Robert Buxbaum April 3, 2022. Much of my thinking about Vietnam comes from Francis Fitzgerald’s wonderful book “Fire in the Lake”. I see it all happening again here. Also worth reading is this 2014 letter by Henry Kissinger about how to negotiate a peace: “Damning Putin is not a foreign policy; it’s an alibi for the lack of one.” It’s a nice insight. He seems to understand diplomacy about as well as anyone.

C-PAPs do not help A-Fib, and seem to make heart health worse.

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In this blog-post, I’d like to report on the first random study of patients with Atrial fabulation, A-Fib, and sleep apnea, comparing the health outcome of those who use a C-PAP, a “Continuous Positive Airway Pressure” device, to the outcome those who do not. The original study was published in May, 2021 (read it here) in the American Journal of Respiratory and Critical Care Medicine. The American Journal, Pulmonary Advisor published a more-popular version here.

As a background, if you are over 65 and overweight, there is a 25% chance or so that your heart rate will begin to surge semi-randomly, and that it will flutter. This is Atrial fabulation, A-Fib. It tends to get worse and tends to lead to heart attacks and strokes. People with A-fib tend to be treated with drugs, aspirin, warfarin, beta blockers, and anti arrhythmics. They also tend to be prescribed a C-PAP because overweight, older folks tend to snore and wake up a lot during the night (several times per hour: apnea).

A C-PAP definitely stops the snoring and the Apnea, and the assumption was that it would help your heart as well, if only by giving you a better night’s sleep. As it turns out, the C-PAP seems to decrease heart health — significantly.

For this study, adult patients between 18 and 75 years old diagnosed with paroxysmal A-Fib (that’s occasional AF) were screened for moderate to severe sleep apnea. Those who agreed to participate were randomly assigned to either a treatment of C-PAP plus usual care (drugs mostly) or just usual care for the next 5 months. Of the 109 who enrolled in the study, 55 got the C-PAP plus usual care, 54 got usual care alone. The outcome was that there were 9 serious, adverse heart events (strokes and heart attacks); 7 were in the C-PAP group.

The CPAP pressure was, on average, 6.8 cm H2O; mean time of use was 4.4±1.9 hours per night. The C-PAPs did their jobs on the apnea too, reducing residual apnea-hypopnea to 2.3±1.9 events per hour for those in the C-PAP group.

There was a non-statistically significant reduction is AF among the C-PAP group. They reduced their time in AF by 0.6 percentage points compared to the control group  (95% CI, -2.55 to 1.30; P =.52). That not a statistically significant difference, and is most likely random.

There was a statistically significant decrease in heart health, though. A total of 7 serious adverse events occurred in the C-PAP group and only 2 in the control group. A total of 9 is a relatively small number of events, but there is a strong statistical difference between 7 and 2.

The authors conclude: “CPAP treatment does not seem to reduce or prevent paroxysmal AF.” They should also have concluded that it reduced heart health with a statistical confidence of ~82%: (1-2(36+10)/512) =82%. See more on this type of statistics.

A possible explanation of why a C-PAP would would make heart health worse is an outcome of the this recent sleep study (link here). It appears that the C-PAP helps restore breathing, but by doing so, it interferes with a mechanism the body uses to deal with A-fib. It seems that, for people with A-Fib, their bodies use breathing stoppages to get their heart back into rhythm. For these people, many of their breathing stoppage are not obstructive, but a bio-pathway to raise the CO2 level in the blood and thus regulate heart rate. The use of a C-PAP prevents this restorative mechanism and this seem to be the reason it is destructive to the heart-health of patients with A-fib. On the other hand, a C-PAP does improve the sleep those patients whose apnea is obstructive. It seems to me that sleep studies should do a better job distinguishing the two causes of apnea. C-PAPs seem counter-indicated for patients with A-fib.

Robert Buxbaum, March 30, 2022. I was diagnosed with apnea and A-Fib some years ago. The sleep doctor prescribed a C-PAP and was adamant that I had to use it to keep my heart healthy. There were no random studies backing him up or contradicting him until now.

A Nuclear-blast resistant paint: Starlite and co.

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About 20 years ago, an itinerate inventor named Maurice Ward demonstrated a super insulating paint that he claimed would protect most anything from intense heat. He called it Starlite, and at first no one believed the claims. Then he demonstrated it on TV, see below, by painting a paper-thin layer on a raw egg. He then blasting the egg with a blow torch for a minute till the outside glowed yellow-red. He then lifted the egg with his hand; it was barely warm! And then, on TV, he broke the shell to show that the insides were totally raw, not only uncooked but completely unchanged, a completely raw egg. The documentary below shows the demonstration and describes what happened next (as of 10 years ago) including an even more impressive series of tests.

Intrigued, but skeptical, researchers at the US White Sands National Laboratory, our nuclear bomb test lab, asked for samples. Ward provided pieces of wood painted as before with a “paper thin” layer of Starlite. They subjected these to burning with an oxyacetylene torch, and to a simulated nuclear bomb blast. The nuclear fireball radiation was simulated by an intense laser at the site. Amazing as it sounds, the paint and the wood beneath emerging barely scorched. The painted wood was not damaged by the laser, nor by an oxyacetylene torch that could burn through 8 inches of steel in seconds.

The famous egg, blow torch experiment.

The inventor wouldn’t say what the paint was made of, or what mechanism allowed it to do this, but clearly it had military and civilian uses. It seems it would have prevented the twin towers from collapsing, or would have greatly extended the time they stayed standing. Similarly, it would protect almost anything from a flame-thrower.

As for the ingredients, Ward said it was non-toxic, and that it contained mostly organic materials, plus borax and some silica or ceramic. According to his daughter, it was “edible”; they’d fed it to dogs and horses without adverse effects.

Starlite coasted wood. The simulated nuclear blast made the char mark at left.

The White sands engineers speculate that the paint worked by combination of ablation and intumescence, controlled swelling. The surface, they surmised, formed a foam of char, pure carbon, that swelled to make tiny chambers. If these chambers are small enough, ≤10 nm or so, the mean free path of gas molecules will be severely reduced, reducing the potential for heat transfer. Even more insulting would be if the foam chambers were about 1 nm. Such chambers will be, essentially air free, and thus very insulating. For a more technical view of how molecule motion affects heat transfer rates, see my essay, here.

Sorry to say we don’t know how big the char chambers are, or if this is how the material works. Ward retained the samples and the formula, and didn’t allow close examination. Clearly, if it works by a char, the char layer is very thin, a few microns at most.

Because Maurice Ward never sold the formula or any of the paint in his lifetime, he made no money on the product. He kept closed muted about it, as he knew that, as soon as he patented, or sold, or let anyone know what was in the paint, there would be copycats, and patent violations, and leaks of any secret formula. Even in the US, many people and companies ignore patent rights, daring you to challenge them in court. And it’s worse in foreign countries where the government actively encourages violation. There are also legal ways around a patent: A copycat inventor looks for ways to get the same behavior from materials that are not covered in the patent. Ward could not get around these issues, so he never patented the formula or sold the rights. He revealed the formula only to some close family members, but that was it till May, 2020, when a US company, Thermashield, LLC, bought Ward’s lab equipment and notes. They now claim to make the original Starlite. Maybe they do. The product doesn’t seem quite as good. I’ve yet to see an item scorched as little as the sample above.

Many companies today are now selling versions of Starlite. The formulas are widely different, but all the paints are intumescent, and all the formulas are based on materials Ward would have had on hand, and on the recollections of the TV people and those at White Sands. I’ve bought one of these copycat products, not Thermashield, and tested it. It’s not half bad: thicker in consistency than the original, or as resistive.

There are home-made products too, with formulas on the internet and on YouTube. They are applied more like a spackle or a clay. Still, these products insulate remarkably well: a lot better than any normal insulator I’d seen.

If you’d like to try this as a science fair project, among the formulas you can try; a mix of glue, baking soda, borax, and sugar, with some water. Some versions use sodium silicate too. The Thermoshield folks say that this isn’t the formula, that there is no PVA glue or baking soda in their product. Still it works.

Robert Buxbaum, March 13, 2022. Despite my complaints about the US patent system, it’s far better than in any other country I’ve explored. In most countries, patents are granted only as an income stream for the government, and inventors are considered villains: folks who withhold the fruits of their brains for unearned money. Horrible.

Professors being replaced by videos, entertainers.

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In a previous post, I presented data to the effect that, while college is a benefit to those who major in moneymaking fields, STEM, English, and philosophy, it is a money loser for those in film, history, language, political science, etc.

Most students don’t mind if the information itself can be forgotten on graduation day, but the better students do mind. Professors in these fields motivate their better students by luring them with the chance to become professors. A vision of stylish offices, and deep satisfaction is dangled before the student, while tuition and a total commitment is asked in return. The chance of an actual job is virtually nil. This is the background to murder in popular, dark-academia stories like “The Secret History” by Danna Tartt, and a Hitchcock movie, “rope” (see my essay here).

Things are getting more depressing for those aspiring to become professors. Now, aspiring professors have to compete with taped programs made by other professors, some well known, some already dead. And some professors — those without tenure — have to compete with their own taped programs. Tapes of old lectures are available free to the university. It’s a financial boon for the university to be able to collect tuition without having to pay a living professor who gives essentially the same lecture year after year. If the professor is untenured, the university can fire him or her, and use the tape from last year, or they can purchase a series of lectures by a Nobel laureate. It’s a great deal for the majority of students and for the university, but deadly to the aspiring few.

Robert Buxbaum, December 3, 2021