Most people know that aspirin can reduce blood clots and thus the risk heart attack, as shown famously in the 1989 “Physicians’ Health Study” where 22,000 male physicians were randomly assigned to either a regular aspirin (325 mg) every other day or an identical looking placebo. The results are shown in the table below, where “Myocardial Infarction” or “MI” is doctor-speak for heart attack.
Treatment
Myocardial Infarctions
No Infarction
Total
fraction with MI
Aspirin
139
10,898
11,037
139/11,037 = 0.0126
Placebo
239
10,795
11,034
239/11,034 = 0.0217
Over the 5 years of the study, the physicians had 378 MI events, but mostly in the group that didn’t take aspirin: 1.28% of the doctors who took aspirin had a heart attack as opposed to 2.17% for those with the placebo. The ratio 1.28/2.17 = 0.58 is called the risk ratio. Apparently, aspirin in this dose reduces your MI risk to 58% of what it was otherwise — at least in white males of a certain age.
A blood clot showing red cells held together by fibrin fibers. Clots can cause heart attack, stroke, and breathing problems. photo: Steve Gschmeissner.
Further study showed aspirin benefits with women and other ethnicities, and benefits beyond hear attack, in any disease that induces disseminated intravascular coagulopathy. That’s doctor speak for excessive blood clots. Aspirin produced a reduction in stroke and in some cancers (Leukemia among them) and now it now seems likely that aspirin reduces the deadliness of COVID-19. Data from Wuhan showed that excessive blood clots were present in 71% of deaths vs. 0.4% of survivors. In the US, some 30% of those with serious COVID symptoms and death show excessive blood clots, particularly in the lungs. Aspirin and Vitamin D seem to help.
.The down-side of aspirin use is a reduction in wound healing and some intestinal bleeding. The intestinal bleeding is known as aspirin burn. Because of these side-effects it is common to give a lower dose today, just one baby aspirin per day, 81 mg. While this does does some good, It is not clear that it is ideal for all people. This recent study in the Lanset (2018) shows a strong relationship between body weight and aspirin response. Based on 117,279 patients, male and female, the Lanset study found that the low dose, baby aspirin provides MI benefits only in thin people, those who weigh less than about 60 kg (130 lb). If you weigh more than that, you need a higher dose, perhaps two baby aspirin per day, or a single adult aspirin every other day, the dose of the original doctors study.
In this study of COVID patients, published in July, those who had been taking aspirin fared far better than those who did not A followup study will examine the benefits of one baby aspirin (81 mg) with and without Vitamin D, read about it here. I should note that other pain medications do not have this blood-thinning effect, and would not be expected to have the same benefit.
While it seems likely that 2 baby aspirins might be better in fat people, or one full aspirin every other day, taking a lot more than this is deadly. During the Spanish flu some patients were given as much as 80 adult aspirins per day. It likely killed them. As Paracelsus noted, the difference between a cure and a poison is the dose.
I’m not crazy about the COVID isolation, but there are up-sides that I’ve come to appreciate. You might too. Out of boredom, I was finally got into meditation. It was better than just sitting around and doing nothing.
It’s best not to look at isolation as a problem, but an opportunity. I’ve developed a serious drinking opportunity.
And it’s an opportunity to talk to myself. I told myself I’ should quit drinking. Then I figured, why should I listen to a drunk who talks to himself.
A friend of mine was on drugs, but then quit. Everyone in his house is happy, except for the lamp. The lamp won’t talk to him anymore.
The movies are closed, and the bars, and the gyms. It gives me another reason not to go to the gym.
Did you know that, before the crowbar was invented, crows used to drink at home.
The real reason dogs aren’t allowed in bars: lots of guys can’t handle their licker.
There’s time to spend with my children. And they look like me.
I like that I don’t commute. Family events are over zoom, funerals (lots of funerals), meetings, lectures. They come in via the computer, and I don’t have to dress or attend. No jacket, no pants… no travel …. no job.
My children are spending more time with us at home. We have virtual meals together. I discovered that I have a son named Tok. He seems to like my dad-jokes.
My wife is finding it particularly tough. Most every day I see her standing by the window, staring, wondering. One of these days, I’ll let her in.
I asked wife why she married me. Was it for my looks, or my income, or my smarts. She smiled and said it was my sense of humor. 🙂
My wife is an elementary school teacher. She teaches these days with a smart board. If the board were any smarter, it would go work for someone else. It’s necessary, I guess. If you can’t beat them, you might as well let the smart board teach. I think the smart board stole the election. It began by auto-correcting my spelling. Then it moved to auto correct my voting. The board is smarter and better than me (Hey, who wrote this?)
I’ve learned to love masks, though some of them are hot.
You’d think they’d reduce the number of administrators in the schools, given that it’s all remote. Or reduce the price of college. It would be nice if they’d up the number of folks who can attend. So far no. Today the Princeton alumni of Michigan is sponsoring video-talk by Princeton alumnus, George Will. I wanted to attend, but found there was limited seating, so I’m on the waiting list (true story). By keeping people out, they show they are exclusive. Tuition is $40,000 / year, and they keep telling us that the college is in service of humanity. If they were in the service of humanity, they’d charge less, and stream the talk to whoever wants to listen in. I have to hope this will change sooner or later.
Shopping for toilet paper was a big issue at the beginning of the pandemic, but I’ve now got a dog to do it for me. He goes to the store, brings it back. Brings back toothpaste too. He’s a lavatory retriever. (I got this joke from Steve Feldman; the crowbar joke too.)
I don’t mind that there are few new movies. There are plenty of old movies that I have not seen, and old TV shows too.
This fellow is the new head of Biden’s COVID-19 task force. He’s got a science-based plan for over-population and the disease.
I like that people are leaving New York and LA. It’s healthy, and saves on rent. Folks still travel there, mostly for the rioting, but lockdowns are nicer in Michigan.
More people are hunting, and hiking, and canoeing. These are active activities that you can do on lockdown. The old activities were passive, or going out to eat. Passive activities are almost a contradiction in terms.
We’re cooking more at home, which is healthier. And squirrel doesn’t taste half bad. If I live through this, I’ll be healthy.
I’m reading more, and have joined goodreads.com. I’ve developed a superpower: I find can melt ice cubes, just by looking at them. It takes a while but they melt.
A lot more folks have dogs. And folks have gotten into religion. Wouldn’t it be great, if after death we fond that dyslexic folks were right. There really is a dog.
Let’s love the virus. If we don’t, the next crisis will be worse.
There was an election last week. My uncles voted for Biden, which really surprised me. They were staunch Republicans when they were alive. My aunt got the ballot and convinced them. She was a Democrat when she was alive.
Before COVID, the other big crisis was global warming. Al Gore and Greta Thunberg claimed we had to shutter production and stop driving to save the planet. COVID-19 has done it. The next crisis is over-population. COVID is already curing that problem — not so much in China, but in the US, Europe, and South America.
Just As a final thought, let’s look at the bright side of the virus. If we don’t, the next crisis will be worse. Take Monty Python’s advice and Always look at the bright side of life.
A few days ago, I asked for and received the PCV-13 pneumonia vaccine, and a few days earlier, the flu shot. These vaccines are free if you are over 65, but you have to ask for them. PCV-13 is the milder of the pneumonia vaccines, providing moderate resistance to 12 common pneumonia strains, plus a strain of diphtheria. There is a stronger shot, with more side-effects. The main reason I got these vaccines was to cut my risk from COVID-19.
Some 230,00 people have died from COVID-19. Almost all none of them were under 20, and hardly any died from the virus itself. As with the common flu, they died from side infections and pneumonia. Though the vaccine I took is not 100% effective against event these 13 pneumonias, it is fairly effective, especially in the absence of co-morbidities, and has few side effects beyond stiffness in my arm. I felt it was a worthwhile protection, and further reading suggests it was more worthwhile than I’d thought at first.
It is far from clear there will be a working vaccine for SARS-CoV-2, the virus that causes COV-19. We’ve been trying for 40 years to make a vaccine against AIDS, without success. We have also failed to create a working vaccine for SARS, MERS, or the common cold. Why should SARS-CoV-2 be different? We do have a flu vaccine, and I took it, but it isn’t very effective, viruses mutate. Despite claims that we would have a vaccine for COVID-19 by early next year, I came to imagine it would not be a particularly good vaccine, and it might have side effects. On the other hand, there is a fair amount of evidence that the pneumonia vaccine works and does a lot more good than one might expected against COVID-19.
A colleague of mine from Michigan State, Robert Root Bernstein, analyzed the effectiveness of several vaccines in the fight against COVID-19 by comparing the impact of COVID-19 on two dozen countries as a function of all the major inoculations. He found a strong correlation only with pneumonia vaccine: “Nations such as Spain, Italy, Belgium, Brazil, Peru and Chile that have the highest COVID-19 rates per million have the poorest pneumococcal vaccination rates among both infants and adults. Nations with the lowest rates of COVID-19 – Japan, Korea, Denmark, Australia and New Zealand – have the highest rates of pneumococcal vaccination among both infants and adults.” Root-Bernstein also looked at the effectiveness of adult inoculation and child inoculation. Both were effective, at about the same rate. This suggests that the the plots below are not statistical flukes. Here is a link to the scientific article, and here is a link to the more popular version.
An analysis of countries in terms of COVID rates and deaths versus pneumonia vaccination rates in children and adults. The US has a high child vaccination rate, but a low adult vaccination rate. Japan, Korea, etc. are much better. Italy, Belgium, Spain, Brazil, and Peru are worse. Similar correlations were found with child and adult inoculation, suggesting that these correlations are not flukes of statistics.
I decided to check up on Root-Bernstein’s finding by checking the state-by state differences in pneumonia vaccination rates — information available here — and found that the two US states that were hardest hit by COVID, NY and NJ, have among the lowest rates of inoculation. Of course there are other reasons at play. These states are uncommonly densely populated, and the governments of both made the unfortunate choice of sending infected patients to live in old age homes. At least half of the deaths were in these homes.
Pneumonia vaccination may also explain why the virus barely affected those under 20. Pneumonia vaccines was available only in 2000 or so. Many states then began to vaccinate about then and required it to attend school. The time of immunization could explain why those younger than 20 in the US do so well compared to older individuals, and compared to some other countries where inoculation was later. I note that China has near universal inoculation for pneumonia, and was very mildly hit.
I also took the flu shot, and had taken the MMR (measles) vaccine last year. The side effects, though bad, are less bad than the benefits, I thought, but there was another reason, and that’s mimicry. It is not uncommon that exposure to one virus or vaccine will excite the immune system to similar viruses, so-called B cells and T-cell immunity. A recent study from the Mayo Clinic, read it here, shows that other inoculations help you fight COVID-19. By simple logic, I had expected that the flu vaccine would help me this way. The following study (from Root-Bernstein again) shows little COVID benefit from flu vaccine, but evidence that MMR helps (R-squared of 0.118). Let men suggest it’s worth a shot, as it were. Similar to this, I saw just today, published September 24, 2020 in the journal, Vaccines, that the disease most molecularly similar to SARS-CoV-2 is pneumonia. If so, mimicry provides yet another reason for pneumonia vaccination, and yet another explanation for the high correlations shown above.
As a final comparison, I note that Sweden has a very high pneumonia inoculation rate, but seems to have a low mask use rate. Despite this, Sweden has done somewhat better than the US against COVID-19. Chile has a low inoculation rates, and though they strongly enforced masks and social distance, it was harder hit than we were. The correlation isn’t 100%, and masks clearly do some good, but it seems inoculation may be more effective than masks.
Today, Michigan and several other, Democrat-run states are in fairly broad COVID lockdown. The justification for this is that it is “THE science”, as if this were the only possible behavior if you believe the disease is deadly and contagious. The other fellows, the governors of Republican-run states are framed as deniers of the science. Strangely enough, although this disease is most -definitely contagious and deadly, killing 209,000 Americans so far, about 0.064% of the US this year, it is far from clear that a broad lockdown is the only way to stop the disease. Sweden avoided a general lockdown, leaving its schools and restaurants open, and has seen the disease follow an almost destructive path to that of the US, with a death rate that is currently slightly lower than ours. See the excess death plot below. Sweden seems to have avoided a second, summer spike.
Mortality is Sweden vs the US; Ignore the last 2-3 weeks, it takes time for this data to be compiled
It’s bad enough for “THE SCIENCE” when you see the anti-science, no-lockdown solution provide the same result, or close. Earlier in the summer I noted that Sweden and Michigan had near the same outcome, with Sweden slightly better. It’s now the case that Sweden is doing better than the US, and much better than the D-lead lockdown states. The highest six death rate states are all D-lead, lockdown states, NY, NJ, Mass, Conn, LA, and RI, and rates are double the US average in New York and New Jersey. Perhaps the solution is a general opening, like in Sweden, but before we rush to this, it’s probably worthwhile to do some re-thinking.
Deaths per week, under 18. Any excess deaths caused by COVID-19 are invisible here, lost in the scatter.
One thing that Swedes seem to have appreciated that the US experts didn’t is that the disease hardly affects those the under 18, and that’s basically the entire K-12 student body. Sweden therefore left their K-12 schools open, while we closed ours in the US beginning in early April. At right I’ve plotted the US deaths per week for under 18 for the last three years, that is from before COVID till now. There is no evidence of excess COVID-19 deaths for this group. If anything anything, the under 18 death death rate is lower after COVID than before. This resistance of this group helps explain part of why the Swedish approach didn’t cause increased deaths. Kids in Sweden got the disease, but didn’t die of it, and likely infected their parents. The Swedes didn’t bother trying to protect everyone, but only the most vulnerable, the old people. Sweden was not completely successful at this, but we were perhaps worse, despite the general lockdown.
The excess deaths US for the 65+ bracket plotted by week of the year for 2020 (blue), 2019 (grey) and 2018 (yellow). Nearly 200,000 of the excess deaths of 2020 — the vast majority — are in this age bracket.
But what about the middle-age people that the kids would have infected, the parents and teachers. For middle age people, those in the 18-65 range, it seems to make a difference how physically fit you are, and the Swedes tend to be fit. Obesity is a big co-morbidity for this disease, and Americans tend to be obese, with things getting worse during the lockdown. Swedes also wash their hands more than we do (or so is their reputation) and they go out in the sun. There is evidence that the sun helps, and vitamin D too. A stark way of seeing how much fitness helps, for even those over 18 is to consider that, of the 1.3 million men and women of the US military, there have been only 7 COVID deaths. That is a rate 1/100 of the national average for a population that is entirely over 18. This is not to say that the death rate is quite 5 per million, (7/ 1.3 million = 5 per million), but it’s probably below 50 per million. That is to say, at least 10% of the military was likely infected.
I’m inclined to agree with Dr. Fauchi that we are not yet at herd immunity, or even close, even in states like Michigan where death rates have leveled out. Only 20% of the state shows antibodies and real herd immunity would require 75% or so. Further supporting this, our death rates are 1/2 that of New Jersey. If we were at herd immunity, that could not have happened. It is possible though that we have a sort of pseudo herd immunity, where many people in the MI population have some level of T-cell immunity. T-cells do a good job eating disease (here’s a video) but they get overwhelmed when we are exposed to more than a low dose of virus. This dose-response is common in respiratory diseases, and Dr. Fauchi has related it to T-cell immunity, though he does not speak in these directions often.
Michigan death rates to September 2020 The disease seems to be over, though only about 20% of the state shows antibodies.
T-cells can cause someone to be immune to a few viral hits, but not immune to higher doses. Assuming that’s what’s going on in MI and MA, and NJ, I’m inclined to suggest we can open up these states a bit, according to the Swedish model. That is make careful efforts to clean public transport, and encourage hand washing and surface cleaning. That we prohibit large gatherings, and we take care isolate those over 65 and protect old age homes. In the US, virtually all the deaths were of people over 65, and about half were people over 85, with men being particularly vulnerable. A heterogeneous opening of this sort has been recommended by scientists as early as March.
There are three major problems with lockdowns that keep us from all virus particles. These lockdowns kill the economy, they leave us with lousy education, and they likely leave us as at-risk for the disease later on, when the lockdown is lifted. Instead a heterogeneous opening leaves the economy running and exposes us to some small exposure, at a level that our typical level of T-cell immunity may be able to handle. Over time we expect our T-cell immunity will rise and we’ll be able to take off our masks entirely. It’s a nice route to a cure that does not require a vaccine.
The above approach requires us to trust that people will do the right thing, and requires us to accept that each may do it in his/her own way. Some may not wear the mask all the time, but may chose exercising, or staying in the sun and taking vitamin D. Some may keep to masks, or focus on hand washing. Some may try unapproved drugs, like hydroxychloroquine. We will have to be able to accept that, and our experts will have to be able to step back from running everything. In China and Russia, the experts tried run every aspect of farm production, using only science methods. The result was famine. A similar thing happened in Ireland and got a potato famine. It’s good to have expert advice, but as far as making the actual decision in each location, I put a lot of weight on the choices of those who will bear the consequences.
Robert Buxbaum September 30, 2020. As a summary, I’m for opening schools, opening most states, with masks, and hand-sanitizer, at lower occupancy ( ~50%), limiting large gatherings, going to zoom as much as possible, and isolating the aged particularly the old age homes. I also recommend vitamin D and iodine hand sanitizer.
Brazil has decided to go its own route in response to the Corona virus pandemic. They’re using minimal social distancing with a heavy reliance on hydroxychloroquine (HCQ), a cheap drug that they claim is effective (as has our president). Brazil has been widely criticized for this, despite so far having lower death rate per million than the US, Canada, or most of Europe. In an open letter, copied in part below, 25 Brazilian scientists speak out against the politicalization of science, and in favor of their approach to COVID-19. The full letter (here). The whole letter is very worth reading, IMHO, but especially worthwhile is their section on hydroxychloroquine (HCQ), copied below.
….. Numerous countries such as the USA, Spain, France, Italy, India, Israel, Russia, Costa Rica and Senegal use the drug (HCQ) to fight covid-19, whereas other countries refrain from using HCQ as one of the strategies to contain the pandemic, betting on other controversial tactics.
Who then speaks here in the name of “science”? Which group has a monopoly on reason and its exclusive authorization to be the spokesperson of “science”? Where is such authorization found?One can choose an opinion, and base his strategy on it, this is fine, but no one should commit the sacrilege of protecting his decision risking to tarnish with it the “sacred mantle of science”.
Outraged, every day I hear mayors and governors saying at the top of their lungs that they “have followed science”. Presidents of councils and some of their advisers, and of academies and deans in their offices write letters on behalf of their entire community, as if they reflect everyone’s consensual position. Nothing could be more false.Have they followed science? Not at all! They have followed the science wing which they like, and the scientists who they chose to place around them. They ignore the other wing of science, since there are also hundreds of scientists and articles that oppose their positions and measures.
Worse, scientists are not angels. Scientists are people, and people have likes and dislikes, passions and political party preferences. Or wouldn’t they? There are many scientists, therefore, who do good without looking at whom, I know and admire many of them. But there are also pseudoscientists who use science to defend their opinion, their own pocket, or their passion. Scientists have worked and still work hard and detached to contribute to the good of humanity, many of whom are now in their laboratories, risking their lives to develop new methods of detecting coronavirus, drugs and vaccines, when they could stay “safe at home”. But, to illustrate my point, I know scientists who have published articles, some even in major journals such as “Science” or “Nature”, with data they have manufactured “during the night”; others who have removed points from their curves, or used other similar strategies. Many scientists were at Hitler’s side, weren’t they? Did they act in the name of “science”? Others have developed atom bombs. Others still develop chemical and biological weapons and illicit drugs, by design.
The Manaus’ study with chloroquine (CQ) performed here in Brazil and published in the Journal of the American Medical Association (JAMA) [1], is emblematic to this discussion of “science”. Scientists there used, the manuscript reveals, lethal doses in debilitated patients, many in severe conditions and with comorbidities. The profiles of the groups do not seem to have been “randomized”, since a clear “preference” in the HIGH DOSE group for risk factors is noted. Chloroquine, which is more toxic than HCQ, was used, and it seems that they even made “childish mistakes” in simple stoichiometric calculations, doubling the dosage with the error. I’m incapable of judging intentions, but justice will do it. The former Brazilian Health Minister Luiz Henrique Mandetta quoted this study, supported it, and based on it, categorically stated: “I do not approve HCQ because I am based on ‘science, science, science’!”.
Another study published by Chinese researchers in the British Medical Journal (BMJ) and which is still persistently used against HCQ was also at least revolting [2]. In it, the authors declared: “we administer 1,200 mg for 3 days, followed by 800 mg for 12 to 21 days, in patients with moderate to severe symptoms”. In other words, they gave a huge dosage of the drug that could reach the absurdity of 20 grams in the end, and it given was too late to patients (HCQ should be administered in the first symptoms or even earlier). And even worse, overdosing on HCQ or any other drug for severe cases is poisonous. What do you think, was it good science? The recommended dosage in Brazil, since May 20th, 2020, by the new Ministry of Health, for mild symptoms is 2 times 400 mg in the first day (every 12 hours) and 400 mg for 5 days for a total of 2.8 grams.
In other published studies, also in these internationally renowned journals such as The New England Journal of Medicine, JAMA and BMJ [3-5], once again, “problems” are clearly noted, since or the patients were randomized in irregular ways, placing older, more susceptible or most severe and hypoxemic patients in the higher (lethal) dose groups, or more men (almost 3 times more deadly by covid than women), or more black people (in the USA, black people have displayed higher mortality) and more smokers, and where most of the deaths occurred in the first days of the studies (signs that were deaths of critically ill patients, who at this stage would be more “intoxicated” than “treated” with HCQ), or they administered HCQ isolated, when it is known that it is necessary to associate HCQ at least with azithromycin. One of these studies [5] administered HCQ only on the sixteenth day of symptoms (for really early treatment, HCQ administration should be started up to fifth day), in other words, at the end of the disease, when the drug can do little good or nothing to the patient.
These studies indicate that some scientists either forgot how “science” is done or that there is a huge effort to disprove, whatever it takes, that HCQ works. How can someone or even Councils and Academies of Medicine cite such studies as the “science” of their decisions? How can that be?
On the contrary, the study published – and today with more than 3 thousand patients tested – and carried out by Dr. Didier Raoult in France [6], using the correct dosage and at the right time, with a very low mortality rate (0.4%), and the Prevent Senior’s clinical experience in Brazil – also quite encouraging – are disqualified with very “futile” arguments such as: “Didier Raoult is a controversial and unworthy researcher”, “At Prevent Senior Clinic they were not sure of the diagnosis” (but none of the hospitalized patients with clear COVID symptoms died), “Placebo effect” (what a supernatural power of inducing our mind that reduces mortality from 40% to zero, I want this placebo!), “Study performed by a health plan company” (I do not doubt that this people indeed want to save lives, because the patients were their customers who pay their bills), and similar ephemeral arguments.…
I admire the spunk of these fellows going agains the doctors, WHO. Beyond being a critique of bad research on a particular drug, it is a defense of science. Science is a discussion, a striving for truth. It is not supposed to demand blind allegiance to a few politically appointed experts. They’ve convinced me that the tests sponsored by the world health organization seem designed to show failure, and reminded me that there is rarely a one-size-fits-all for problems and all times.
I also find striking the highly critical response of my local newspapers and TV reporters. While they both like to highlight efforts by South America as they try entering the first world, with help from Bill gates and leftist politicians, they have been uniformly condemned Brazil for its non-left approach and now for use of HCQ. They want Sous Americans to think, but only if their conclusions are no different from those of their favorite, liberal thinkers.
While several towns have had problems with lead in their water, the main route for lead entering the bloodstream seems to be from the soil. The lead content in the water can be controlled by chemical means that I reviewed recently. Lead in the soil can not be controlled. The average concentration of lead in US water is less than 1 ppb, with 15 ppb as the legal limit. According to the US geological survey, of lead in the soil, 2014., the average concentration of lead in US soil is about 20 ppm. That’s more than 1000 times the legal limit for drinking water, and more than 20,000 times the typical water concentration. Lead is associated with a variety of health problems, including development problems in children, and 20 ppm is certainly a dangerous level. Here are the symtoms of lead poisoning.
Several areas have deadly concentrations of lead and other heavy metals. Central Colorado, Kansas, Washington, and Nevada is particularly indicated. These areas are associated with mining towns with names like Leadville, Telluride, Silverton, Radium, or Galena. If you live in an areas of high lead, you should probably not grow a vegetable garden, nor by produce at the local farmer’s market. Even outside of these towns, it’s a good idea to wash your vegetables to avoid eating the dirt attached. There are hardly any areas of the US where the dust contains less than 1000 times the lead level allowed for water.
Lead content of US soils, from the US geological survey of soils, 2014. Michigan doesn’t look half bad.
Breathing the dust near high-lead towns is a problem too. The soil near Telluride Colorado contains 1010 mg/kg lead, or 0.1%. On a dust-blown day in the area, you could breath several grams of the dust, each containing 1 mg of lead. That’s far more lead than you’d get from 1000 kg of water (1000 liters). Tests of blood lead levels, show they rise significantly in the summer, and drop in the winter. The likely cause is dust: There is more dust in the summer.
Recalled brand of curry powder associated with recent poisoning.
Produce is another route for lead entering the bloodstream. Michigan produce is relatively safe, as the soil contains only about 15 ppm, and levels in produce are generally far smaller than in the soil. Ohio soils contains about three times as much lead, and I’d expect the produce to similarly contain 3 times more lead. That should still be safe if you wash your food before eating. When buying from high-lead states, like Colorado and Washington, you might want to avoid produce that concentrates heavy metals. According Michigan State University’s outreach program, those are leafy and root vegetables including mustard, carrots, radishes, potatoes, lettuce, spices, and collard. Fruits do not concentrate metals, and you should be able to buy them anywhere. (I’d still avoid Leadville, Telluride, Radium, etc.). Spices tend to be particularly bad routes for heavy metal poisoning. Spices imported from India and Soviet Georgia have been observed to have as much as 1-2% lead and heavy metal content; saffron, curry and fenugreek among the worst. A recent outbreak of lead poisoning in Oakland county, MI in 2018 was associated with the brand of curry powder shown at left. It was imported from India.
Marijuana tends to be grown in metal polluted soil because it tolerates soil that is too polluted fro most other produce. The marijuana plant concentrates the lead into the leaves and buds, and smoking sends it to the lungs. While tobacco smoking is bad, tobacco leaves are washed and the tobacco products are regulated and tested for lead and other heavy metals. If you choose to smoke cigarettes, I’d suggest you chose brands that are low in lead. Here is an article comparing the lead levels of various brands. . Better yet, I’s suggest that you vape. There are several advantages of vaping relative to smoking the leaf directly. One of them is that the lead is removed in the process of making concentrate.
Some states test the lead content of marijuana; Michigans and Colorado do not, and even in products that are tested, there have been scandals that the labs under-report metal levels to help keep tainted products on the shelves. There is also a sense that the high cost encourages importers to add lead dust deliberately to increase the apparent density. I would encourage the customer to buy vape or tested products, only.
The number and cash value of bitcoin transactions has surged in the last two years, and it seems that a lot of the driving motivation is avoidance of Trump’s tariffs. If you want to avoid Trump’s tariffs, claim that the value of the shipment is less than it really is. Pay part via the normal banking system through the bill of lading (and pay tariffs on that) and pay the rest in bitcoin with no record and no taxes paid. The average bitcoin transaction amount has increased to $33,504, and that seems to be the amount of taxable value being dodged on each shipment. As pointed outAs noted in Cryptopolitan, “smugglers attempting to export Chinese goods to the USA illegally have been found to be among the largest purchasers of Bitcoin.” https://www.cryptopolitan.com/is-us-china-trade-war-fueling-bitcoin-price-rally-to-7500/
Average transaction amount for several crypto currencies. The amount has surged for Bitcoin, blue line.
Bitcoin isn’t the only beneficiary, of course, but it is the largest. The chart at right shows the average transaction value of the major cryptocurrencies. The average for most are in the dollar range that you’d expect for someone evading tariffs in containerized shipments. Someone who wants to import $100,000 worth of Chinese printers will arrange to have them shipped with a lower price bill of lading. The rest of the payment, 1/3 say, would be paid by a bitcoin transfer whose escrow is tied to the legally binding bill of lading.
Number of transactions per day for several cryptocurrencies, data available from Bitinfocharts.com
Bitcoin does not stand out from the other cryptocurrencies so much in the amount of its average transaction, but in the number of transactions per day. As shown at left there are 333,050 bitcoin transactions per day at an average value of $33,504 per transaction. Multiplying these numbers together, we see that Bitcoin is used for some $11.2 billion in transactions per day, or $4.1 trillion dollars worth per year. The legitimate part of the US economy is only $58 billion per day, or $21 trillion per year. The amount will certainly rise if further tariffs are put into effect.
Most other cryptocurrencies have fewer transactions per day, and the few that have similar (or higher) numbers deal in lower amounts. Etherium is used in 2.5 time more transactions, but the average Etherium transaction is only $679. This suggests that the total Etherium business is only $586 million per day. The dollar amounts of Etherium suggests that it is mostly used for drug trafficking,
Cash-money is the old fashioned way to avoid tariffs, buy drugs, and do other illegal money transfers. This method isn’t going away any time soon. A suitcase of $100 bills gets handed over and the deal is done. Though it gets annoying as the amounts get large, there is a certain convenience at the other end, when you try to spend your ill-gotten gains. Thus, when Obama wanted to ransom the ten sailors that Iran had captured in 2016, he sent paper bills. According to the LA Times, this was three airplane shipments s of all non-US currency: Euros and Swiss Francs mostly. The first payment was $400 million, delivered as soon as Iran agreed to the release. The rest, $1.3 billion, was sent after the prisoners were released. Assuming that the bundles shown below contained only 100 Euro notes, each bundle would have held about $170 million dollars. We’d have had to send ten bundles of this size to redeem ten US sailors. The US ships, the laptops of sensitive information, and the weapons were granted as gifts to the Iranians. Obama claimed that all this was smart as it was cheaper than a war, and it likely is. The British had 15 sailors captured by Iran in 2009 and paid as well. In the late 1700s, John Adams (an awful president) paid 1/4 of the US budget as ransom to North African pirates. He paid in gold.
These are supposedly the pallets of cash used to ransom our sailors. Obama has justified the need to transfer the cash this way, and indeed a ransom is a lot cheaper than a war.
Obama could have ransomed the sailors with Bitcoin as there was hardly enough Bitcoin in existence, and the Iranians would have had a hard time spending it. In general, it is hard to spend Bitcoin on anything legal. Legitimate sellers want proof that they’ve paid. As a result, a buyer generally has to exchange bitcoin for bank checks — and the financial watchdogs are always sniffing at this step. Things are simpler with paper money, but not totally simple when there is no apparent source.
Iranian released this picture of the US sailors captured. Obama ransomed them for $1.7 billion in Euros.
To get a sense of the amount of paper money used this way, consider that there are $1.1 trillion in hundred dollar bills in circulation. This is four times more money’s worth than the value of all Bitcoin in circulation. Based on the wear on our $100 bills, it seems each bill is used on average 30 times per year. This suggest there are $33 trillion dollars in trade that goes on with $100 bills. Not all of this trade is illegal, but I suspect a good fraction is, and this is eight times the trade in Bitcoin. The cost of transferring cash can be high, but it’s easy to make change for a bundle of $100 bills. There is fee charged to convert Bitcoin to cash; it’s often in excess of 1%, and that adds up when you do billion-dollar kidnappings and billion dollar arms buys. In case you are wondering how German uranium enrichment centrifuges got to Iran when there is an export embargo, I’m guessing it was done through an intermediary country via cash or Bitcoin transactions.
It’s worth speculating on whether Bitcoin prices will rise as its use continues to rise. I think it will but don’t expect a fast rise. Over a year ago, I’d predicted that the price of Bitcoin would be about $10,500 each. I’d based that on Fisher’s monetary equation, that relates the value of a currency to the amount spent and the speed of money. As it happens I got the right dollar value because I’d underestimated the amount of Bitcoin purchases and the speed of the money by the same factor of four. For the price of a Bitcoin to rise, it is not enough for it to be used more. There also has to be no parallel rise in the velocity of transactions (turnovers per year). My sense is that both numbers will rise together and thus that the bitcoin price will level out, long term, with lots of volatility following daily changes in use and velocity.
As a political thought, I expect is that Bitcoin traders will mostly support Trump. My expectation here is for the classic alliance of bootleggers and prohibition police during prohibition. The police salaries and bonuses depended on liquor being illegal, and bootleggers knew that their high prices and profits depended on the same thing. I thus expect Bitcoin dealers will support Trump as a way of protecting Bitcoin profits and value. Amazon’s owner, Jeff Bezos is strongly anti-Trump, I suspect, because Amazon profits from no-tariff imports.
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.
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.
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.
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.
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.
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; 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.
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.
