Category Archives: Health

When prostitution was legal in America, 1863-65.

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Readers of this blog know that I am not a fan of very harsh punishments for crime, in particular for crimes that have no direct victim, e.g. drug possession and sales. Prostitution is another crime with no direct victim. One could argue that society as a whole is the victim, but my sense is that punishments should be minimal and targeted, e.g. to prevent involuntary human trafficking and disease. Our current laws, depicted here, are clearly not designed for this, but there was a brief period where prostitution laws did make more sense. During the civil war, civil war, prostitution was legal and regulated to prevent disease.

In 1862, Union forces captured the southern cities of Nashville and Memphis, Tenn. Major Gen. William Rosecrans set up headquarters in Nashville. Before the war, Nashville was home to 198 white prostitutes and nine  “mulatto,” operating in a two-block area known as “Smoky Row.” 

By the end of 1862,  Smokey row had grown and these numbers swelled to 1,500 “public women”. White southern women turned to prostitution out of poverty, largely. Their husbands were dead, or ill paid, and they were joined by recently freed slaves. Benton E. Dubbs, a Union private, reported a saying that “no man culd [sic] be a soldier unless he had gone through Smokey Row,” … “The street was about three-fourths of a mile long and every house or shanty on both sides was a house of ill fame. Women had no thought of dress or decency. They say Smokey Row killed more soldiers than the war.” 

By 1863, venerial disease was becoming a major problem. The Surgeon General would document 183,000 cases of venereal disease in the Union Army alone, “…the Pocks and the Clap. The cases of this complaint is numerous, especially among the officers.”  

Permit for Legal prostitution signed by Col George Spaulding.

At first General Rosecrans directed his assistant, Colonel Spaulding, to remove the women by sending them to other states, first by train, and then by boat commandeering the ship, Idaho for the purpose. The effect was horrible, not only was the ship turned back by every city, but the departure of these ladies just resulted in the appearance of a new cohort of sex-workers. By the time the Idaho had returned, Rosecrans had been relieved of command following embarrassing defeats at Chickamauga and Chattanooga . Col. Spaulding now tried a new technique to stop the plague of VD: legalized prostitution. It worked.

Women’s hospital during the war, Nashville.

For a $5/month fee a “public woman” could become a legal prostitute, or “Public Woman” so long as she submitted to monthly health inspections for a certificate of her soundness. If found infected, she was to report to a hospital dedicated to this treatment, was subject to imprisonment if she operated without the license and certificate. The effect was a major decline in sexually-transmitted disease, and an improvement (so it is claimed) in the quality of the services. The fees collected were sufficient to cover the cost of the operation and hospital, nearly.

At the end of the war, Col Spaulding and the union soldiers left Nashville, and prostitution returned to being illegal, if tolerated. One assumes that the VD rates went up as well.

George Spaulding, Congressman..

Colonel Spaulding and Maj. General Rosecrans are interesting characters beyond the above. Spaulding had entered the war as a private and rose through the ranks by merit. The rise didn’t stop at colonel. After the war, he became postmaster of Monroe Michigan, 1866 to 1870, US Treasury agent, 1871 to 1875, Mayor of Monroe, 1876 to ?, President of the board of education, a lawyer in 1878, and congressman for the MI 2nd district (Republican) 1894 -1898. He also served as board member of the Home for Girls 1885 to 1897, and postmaster of Monroe, 1899 to 1907.

William Rosecrans was a Catholic, engineer-inventor from West Point. Before the war, in 1853, he designed St. Mary’s Roman Catholic Church, one of the largest US churches at the time, site of the wedding of John Kennedy and Jacqueline Bouvier. He also designed and installed one of the first lock systems in Western Virginia. He and two partners built an early oil refinery. He patented a method of soap making and the first kerosene lamp to burn a round wick, and was one of the eleven incorporators of the Southern Pacific Railroad. After the war, he served as Ambassador to Mexico, 1868-69 and was congressman from California, 1st district (Democrat) 1880 – 1884. A true Democrat, Rosecrans could not stand either Grant or Garfield, and fought against Grant getting a retirement package.

Robert Buxbaum, June 5, 2020. There are other ways to stop the spread of sexual diseases. During the AIDS epidemic, condoms were the preferred method, and during the current COVID crisis, face masks are being touted. My preference is iodine hand wash. All methods work if they can reduce the transmission rate, Ro below 1.

Iodine is far better than soap or alcohol sanitizer.

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I’m a fan of iodine both as a hand sanitizer, and as a sanitizer for surfaces. II’ve made gallons of the stuff for my own use and to give away. Perhaps I’ll come to sell it too. Unlike soap washing or alcohol sanitizer, iodine stays on your hands for hours after you use it. Alcohol evaporates in a few seconds, and soap washes off. The result is that iodine retains killing power after you use it. The iodine that I make and use is 0.1%, a concentration that is non-toxic to humans but very toxic to viruses. Here is an article about the effectiveness of iodine against viruses and bacteria Iodine works both on external surfaces, and internally, e.g. when used as a mouthwash. Iodine kills germs in all environments, and has been used for this purpose for a century.

With normal soap or sanitizer it’s almost impossible to keep from reinfecting your hands almost as soon as you wash. I’ve embedded a video showing why that is. It should play below, but here’s the link to the video on youtube, just in case it does not.

The problem with washing your hands after you receive an item, like food, is that you’re likely to infect the sink faucet and the door knob, and the place where you set the food. Even after you wash, you’re likely to re-infect yourself almost immediately and then infect the towel. Because iodine lasts on your hands for hours, killing germs, you have a good chance of not infecting yourself. If you live locally, come by for a free bottle of sanitizer.

For those who’d like more clinical data to back up the effectiveness of iodine, here’s a link to a study, I also made a video on the chemistry of iodine relevant to why it kills germs. You might find it interesting. It appears below, but if it does not play right, Here’s a link.

The video shows two possible virus fighting interactions, including my own version of the clock reaction. The first of these is the iodine starch interaction, where iodine bonds forms an I<sub>3</sub><sup>-</sup> complex, I then show that vitamin C unbinds the iodine, somewhat, by reducing the iodine to iodide, I<sup>-</sup>. I then add hydrogen peroxide to deoxidize the iodine, remove an electron. The interaction of vitamin C and hydrogen peroxide creates my version of the clock reaction. Fun stuff.

The actual virus fighting mechanism of iodine is not known, though the data we have suggests the mechanism is a binding with the fatty starches of the viral shell, the oleo-polysaccharides. Backing this mechanism is the observation that the shape of the virus does not change when attacked by iodine, and that the iodine is somewhat removable, as in the video. It is also possible that iodine works by direct oxidation, as does hydrogen peroxide or chlorine. Finally, I’ve seen a paper showing that internal iodine, more properly called iodide works too. My best guess about how that would work is that the iodide is oxidized to iodine once it is in the body.

There is one more item that is called iodine, that one might confuse with the “metallic” iodine solutions that I made, or that are sold as a tincture. These are the iodine compounds used for CAT-scan contrast. These are not iodine itself, but complex try-iodo-benzine compounds. Perhaps the simplest of these is diatrizoate. Many people are allergic to this, particularly those who are allergic to sea food. If you are allergic to this dye, that does not mean that you will be allergic to a simple iodine solution as made below.

The solution I made is essentially 0.1% iodine in water, a concentration that has been shown to be particularly effective. I add potassium iodide, plus isopropyl alcohol, 1%, 1% glycerine and 0.5% mild soap. The glycerine and soap are there to maintain the pH and to make the mix easier on your hands when it dries. I apply 5-10 ml to my hands and let the liquid dry in place.

Robert Buxbaum April 27, 2020; I’m running for water commissioner again. Wishing you a safe and happy lockdown,

COVID-19 is worse than SARS, especially for China.

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The corona virus, COVID-19 is already a lot worse than SARS, and it’s likely to get even worse. As of today, there are 78,993 known cases and 2,444 deaths. By comparison, from the first appearance of SARS about December 1 2002, there have been a total of 8439 cases and 813 deaths. It seems the first COVID-19 patient was also about December 1, but the COVID-19 infection moved much faster. Both are viral infections, but it seems the COVID virus is infectious for more days, including days when the patient is asymptomatic. Quarantine is being used to stop COVID-19; it was successful with SARS. As shown below, by July 2003 SARS had stopped, essentially. I don’t think COVID-19 will stop so easily.

The process of SARS, worldwide; a dramatic rise and it’s over by July 2003. Source: Int J Health Geogr. 2004; 3: 2. Published online 2004 Jan 28. doi: 10.1186/1476-072X-3-2.

We see that COVID-19 started in November, like SARS, but we already have 10 times more cases than the SARS total, and 150 times more than we had at this time during the SARS epidemic. If the disease stops in July, as with SARS, we should expect to see about a total of 150 times the current number of cases: about 12 million cases by July 2020. Assuming a death rate of 2.5%, that suggests 1/4 million dead. This is a best case scenario, and it’s not good. It’s about as bad as the Hong Kong flu pandemic of 1968-69, a pandemic that killed 60,000 approximately in the US, and which remains with us, somewhat today. By the summer of 69, the spreading rate R° (R-naught) fell below 1 for and the disease began to die out, a process I discussed previously regarding measles and the atom bomb, but the disease re-emerged, less infectious the next winter and the next. A good quarantine is essential to make this best option happen, but I don’t believe the Chinese have a good-enough quarantine.

Several things suggest that the Chinese will not be able to stop this disease, and thus that the spread of COVID-19 will be worse than that of the HK flu and much worse than SARS. For one, both those disease centered in Hong Kong, a free, modern country, with resources to spend, and a willingness to trust its citizens. In fighting SARS, HK passed out germ masks — as many as anyone needed, and posted maps of infection showing places where you can go safely and where you should only go with caution. China is a closed, autocratic country, and it has not treated quarantine this way. Little information is available, and there are not enough masks. The few good masks in China go to the police. Health workers are dying. China has rounded up anyone who talks about the disease, or who they think may have the disease. These infected people are locked up with the uninfected in giant dorms, see below. In rooms like this, most of the uninfected will become infected. And, since the disease is deadly, many people try to hide their exposure to avoid being rounded up. In over 80% of COVID cases the symptoms are mild, and somewhat over 1% are asymptomatic, so a lot of people will be able to hide. The more people do this, the poorer the chance that the quarantine will work. Given this, I believe that over 10% of Hubei province is already infected, some 1.5 million people, not the 79,000 that China reports.

Wuhan quarantine “living room”. It’s guaranteed to spread the disease as much as it protects the neighbors.

Also making me think that quarantine will not work as well here as with SARS, there is a big difference in R°, the transmission rate. SARS infected some 2000 people over the first 120 days, Dec. 1 to April 1. Assuming a typical infection time of 15 days, that’s 8 cycles. We calculate R° for this stage as the 8th root of 2000, 8√2000 = 2.58. This is, more or less the number in the literature, and it is not that far above 1. To be successful, the SARS quarantine had to reduce the person’s contacts by a factor of 3. With COVID-19, it’s clear that the transmission rate is higher. Assuming the first case was December 1, we see that there were 73,437 cases in only 80. R° is calculated as the 5 1/3 root of 73,437. Based on this, R° = 8.17. It will take a far higher level of quarantine to decrease R° below 1. The only good news here is that COVID-19 appears to be less deadly than SARS. Based on Chinese numbers the death rate appears to be about 2000/73,437, or about 3%, varying with age (see table), but these numbers are overly high. I believe there are a lot more cases. Meanwhile the death rate for SARS was over 9%. For most people infected with COVID-19, the symptoms are mild, like a cold; for another 18% it’s like the flu. A better estimate for the death rate of COVID-19 is 0.5-1%, less deadly than the Spanish flu of 1918. The death rate on the Diamond Princess was 3/600 = 0.5%, with 24% infected.

The elderly are particularly vulnerable. It’s not clear why.

Backing up my value of R°, consider the case of the first Briton to contact the disease. As reported by CNN, he got it at conference in Singapore in late January. He left the conference, asymptomatic on January 24, and spent the next 4 days at a French ski resort where he infected one person, a child. On January 28, he flew to England where he infected 8 more before checking himself into a hospital with mild symptoms. That’s nine people infected over 3 weeks. We can expect that schools, factories, and prisons will be even more hospitable to transmission since everyone sits together and eats together. As a worst case extrapolation, assume that 20% of the world population gets this disease. That’s 1.5 billion people including 70 million Americans. A 1% death rate suggests we’ll see 700,000 US deaths, and 15 million world-wide this year. That’s almost as bad as the Spanish flu of 1918. I don’t think things will be that bad, but it might be. The again, it could be worse.

If COVID-19 follows the 1918 flu model, the disease will go into semi-remission in the summer, and will re-emerge in the fall to kill another few hundred thousand Americans in the next fall and winter, and the next after that. Woodrow Wilson got the Spanish Flu in the fall of 1918, after it had passed through much of the US, and it nearly killed him. COVID-19 could continue to rampage every year until a sufficient fraction of the population is immune or a vaccine is developed. In this scenario, quarantine will have no long-term effect. My sense is that quarantine and vaccine will work enough in the US to reduce the effect of COVID-19 to that of the Hong Kong flu (1968), so that the death rate will be only 0.1 – 0.2%. In this scenario, the one I think most likely, the US will experience some 100,000 deaths, that is 0.15% of 20% of the population, mostly among the elderly. Without good quarantine or vaccines, China will lose at least 1% of 20% = about 3 million people. In terms of economics, I expect a slowdown in the US and a major problem in China, North Korea, and related closed societies.

Robert Buxbaum, February 18, 2020. (Updated, Feb. 23, I raised the US death totals, and lowered the totals for China).

The main route of lead poisoning is from the soil by way of food, dust, and smoke.

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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.

Here is a little song, “pollution” from Tom Lehrer, to lighten the mood.

Robert Buxbaum, November 24, 2019. I ran for water commissioner in 2016 and lost. I may run again in 2020. Who knows, this time I may win.

Ladder on table, safe till it’s not.

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via GIFER

Two years ago I wrote about how to climb a ladder safely without fear. This fellow has no fear and has done the opposite. This fellow has chosen to put a ladder on a table to reach higher than he could otherwise. That table is on another table. At first things are going pretty well, but somewhere about ten steps up the ladder there is disaster. A ladder that held steadily, slips to the edge of the table, and then the table tips over. It’s just physics: the higher he climbs on the ladder the more the horizontal force. Eventually, the force is enough to move the table. He could have got up safely if he moved the tables closer to the wall or if he moved the ladder bottom further to the right on the top table. Either activity would have decreased the slip force, and thus the tendency for the table to tip.

Perhaps the following analysis will help. Lets assume that the ladder is 12.5′ long and sits against a ten foot ledge, with a base 7.5′ away from the wall. Now lets consider the torque and force balance at the bottom of the ladder. Torque is measured in foot-pounds, that is by the rotational product of force and distance. As the fellow climbs the ladder, his weight moves further to the right. This would increase the tendency for the ladder to rotate, but any rotation tendency is matched by force from the ledge. The force of the ledge gets higher the further up the ladder he goes. Let’s assume the ladder weighs 60 lbs and the fellow weighs 240 pounds. When the fellow has gone up ten feet up, he has moved over to the right by 7.5 feet, as the diagram shows. The weight of the man and the ladder produces a rotation torque on the bottom of 60 x 3.75 + 240 x 7.5 = 1925 foot pounds. This torque is combatted by a force of 1926 foot pounds provided by the ledge. Since the ladder is 12.5 feet long the force of the ledge is 1925/12.5 = 154 pounds, normal to the ladder. The effect of this 154 lbs of normal force is to push the ladder to the left by 123.2 lbs and to lift the ladder by 92.4lbs. It is this 123.2 pounds of sideways push force that will cause the ladder to slip.

The slip resistance at the bottom of the ladder equals the net weight times a coefficient of friction. The net weight here equals 60+240-92.4 = 217.6 lbs. Now lets assume that the coefficient of friction is 0.5. We’d find that the maximum friction force, the force available to stop a slip is 217.6 x 0.5 = 108.8 lbs. This is not equal to the horizontal push to prevent rotation, 123.2 lbs. The net result, depending on how you loot at things, is either that the ladder rotates to the right, or that the ladder slips to the left. It keeps slipping till, somewhere near the end of the table, the table tips over.

Force balance of man on ladder. Based on this, I will go through the slippage math in gruesome detail.

I occasionally do this sort of detailed physics; you might as well understand what you see in enough detail to be able to calculate what will happen. One take home from here is that it pays to have a ladder with rubber feet (my ladders do). That adds to the coefficient of friction at the bottom.

Robert Buxbaum, November 6, 2019.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Japanese diet, a recipe for stomach cancer.

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

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

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

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

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

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

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

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

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

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

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

Robert Buxbaum, April 28, 2019.

C-Pap and Apnea

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

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

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

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

Benjamin Franklin and his apple-shaped body

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

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

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

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

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

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

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

What do we zombies want? Brains.

When do we want them? Brains.

What do vegetarian zombies want? Grains.

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

Disease, atom bombs, and R-naught

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

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

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

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

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

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

Ni = Row/wt

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

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

Ni = 15w/2.

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

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

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

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

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

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

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

Nn = Rot/nt

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Robert E. Buxbaum, December 9, 2018.