Category Archives: health

Almost no one over 50 has normal blood pressure now.

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Four years ago, when the average lifespan of American men was 3.1 years longer than today, the American Heart Association and the American College of Cardiology dropped the standard for normal- acceptable blood pressure for 50+ years olds from 140/90 to 120/80. The new standard of normal was for everyone regardless or age or gender despite the fact that virtually no one over 50 now reached it. Normal is now quite un-common.

By the new definition, virtually everyone over 50 now is diagnosed with high blood pressure or hypertension. Almost all require one or two medications — no more baby aspirin. Though the evidence for aspirin’s benefit is strong, it doesn’t lower blood pressure. AHA guidance is to lower a patients blood pressure to <140/90 mmHg or at least treat him/her with 2–3 antihypertensive medications.4 

Average systolic blood pressures for long-lived populations of men and women without drugs.

The graphs shows the average blood pressures, without drugs in a 2008 study of the longest-lived, Scandinavian populations. These were the source of the previous targets: the natural pressures for the healthiest populations at the time, based on the study of 1304 men (50-79 years old) and 1246 women (38-79 years old) observed for up to 12 years. In this healthy population, the average untreated systolic pressure is seen till age 70, reaching 154 for men, and over 160 for women. By the new standards, these individuals would be considered highly unhealthy, though they live a lot longer than we do. The most common blood-pressure drug prescribed in the US today is atenolol, a beta blocker. See my essay on Atenolol. It’s good at lowering blood pressure, but does not decrease mortality.

The plot at left shows the relationship between systolic blood pressure and death. There is a relationship, but it is not clear that the one is the cause of the other, especially for individuals with systolic pressure below 160. Those with pressures of 170 and above have significantly higher mortality, and perhaps should take atenolol, but even here it might be that high cholesterol, or something else, is causing both the high blood pressure and the elevated death risk.

The death-risk difference between 160 and 100 mmHg is small and likely insignificant. The minimum at 110 is rather suspect too. I suspect it’s an artifact of a plot that ignores age. Only young people have this low number, and young people have fewer heart attacks. Artificially lowering a person’s blood pressure, even to this level does not make him young, [2][3] and brings some problems. Among the older-old, 85 and above, a systolic blood pressure of 180 mmHg is associated with resilience to physical and cognitive decline, though it is also associated with higher death rate.

The AHA used a smoothed version of the life risk graph above to justify their new standards, see below. In this version, any blood pressure looks like it’s bad. The ideal systolic pressure seems to be 100 or below. This is vastly too low a target, especially for a 60 year old. Based on the original graph, I would think that anything below 155 is OK.

smoothed chart of deaths per 1000 vs blood pressure. According to this chart, any blood pressure is bad. There is no optimum.

Light exercise seems to do some good especially for the overweight. Walking helps, as does biking, and aerobics. Weight loss without exercise seems to hurt health. Aspirin is known to do some good, with minimal cost and side effects. Ablation seems to help for those with atrial fibrillation. Elequis (a common blood thinner) seems to have value too, for those with atrial fibrillation — not necessarily for those without. Low sodium helps some, and coffee, reducing gout, dementia and Parkinson’s, and alcohol. Some 2-3 drinks per day (red wine?) is found to improve heart health.

I suspect that the Scandinavians live longer because they drink mildly, exercise mildly, have good healthcare (but not too good), and have a low crime rate. They seem to have dodged the COVID problem too, even Sweden that did next to nothing. it’s postulated that the problem is over medication, including heart medication.

Robert Buxbaum, January 4, 2023. The low US lifespan is startling. Despite spending more than any other developed countries on heath treatments, we have horribly lower lifespans, and it’s falling fast. A black man in the US has the same expected lifespan as in Rwanda. Causes include heart attacks and strokes, accidents, suicide, drugs, and disease. Opioids too, especially since the COVID lockdowns.

Eliquis, over-prescribed but better than Coumadin.

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

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

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

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

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

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

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

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

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

Arctic Ice has shrunk 1.5% since ’99 and Gore’s inconvenient truth. Is this bad?

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At the 1999 Copenhagen Climate Change Summit, Al Gore announced an inconvenient truth: “There is a 75 per cent chance that the entire north polar ice cap, during the summer months, could be completely ice-free within five to seven years.” It was a bold prediction, part of a campaign that got Mr Gore a Nobel Prize and motivated the US to devote billions to stopping global warming. Supposedly 98% of scientists agreed with Mr. Gore and his remedies. Prince Charles and Bill Gates too. Twenty three years later there is still arctic ice, 98.5% as much as in 1999. Two questions arise: 1. Is the ice loss bad? and 2. Why were those 98% of scientists so wrong?

Arctic sea ice extent 1999-2021
Arctic sea ice extent when Al Gore spoke (1999) and since. Not much change, nor clearly for the worse

The second question is far easier than the first: the 98% number was bogus, a lie, like many other climate lies that followed. it was effective at stopping argument, and could not be checked immediately. It bullied scientists who argued that global warming wasn’t bad, or wasn’t man-made, and it gave do-gooders the ability to label their opponents “liars” and “science deniers”. The claim of 98% was used to silence scientists with long, prominent careers. Deniers lost their funding and were no longer published. Other scientists learned to keep quiet. Twenty years later, when the arctic ice wasn’t gone and antarctic ice hit a record extent, the deniers’ careers largely were gone.

Scientists are not stupid, nor independently rich, for the most part. They are dependent on government funding and their employers, the universities are too. As a group they (we) are incapable of stemming the tide of public opinion. This week Biden signed a nearly 1 trillion dollar bill to stop climate change. Every scientist with a chance to get the money will go for it. Whether or not they think a colder earth is good, they will claim it is in their proposals, and imply that their work can stop the natural chaos that is climate. They will ask for their share of the $1T to study the appropriate things: solar cells, corn-based power, and wind turbines. The proposals will not mention the huge costs in mining or land use. Scientists already know they can not get funded for nuclear power, though it works and produces no CO2, nor should can scientists benefit by criticizing China, as the largest source of CO2. That is seen as undermine the green effort at home. When we stop manufacturing at home, BTW, we end up buying the same materials manufactured in China, where they really generate lots of pollution. When asked about this, Biden’s climate chief said not to worry about it, we had to do our part, and Biden would speak to the Chinese. The result is the biggest buildup in coal-fired power plants in the world, with more coming on line.

This second question is at least as important as the first one: is less arctic ice bad? Or, asking more generally, is a warm earth bad? It’s an opinion question; it’s in no way science, impossible to answer definitively. Cold weather is bad for food production, and that’s bad for people, in general. Most people prefer to live where it’s warm, I find. Supposedly polar bears prefer it cold, but I don’t know for sure. I’m not keen to go back to the climate of the ice ages, 10,000- 100,000 years ago when ice covered Canada and you could walk from France to England. I’m not convinced that life was better when the world was 1°C colder. The sea was lower in 1900, but had been higher in the year zero. Less arctic ice means easier shipping. For all I know we may want to make a Northwest Passage. More food and a easier shipping are the convenient truths about global warming.

Robert Buxbaum, August 19, 2022. If you believe any of what I said about Gore/Biden’s green energy, you may like a movie by Michael Moore, Planet of the Humans, see it here. The political greens are not saving energy or cooling the planet, and they know it. It’s a money maker.

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

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

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

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

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

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

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

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

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

Robert Buxbaum, August 14, 2022

Exercise helps fight depression, lithium helps too.

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With the sun setting earlier, and the threat of new COVID lockdowns, there is a real threat of a depression, seasonal and isolation. A partial remedy is exercise; it helps fight depression whether you take other measures not. An article published last month in the Journal of Affective Disorders reviewed 22 studies of the efficacy of exercise, particularly as an add-on to drugs and therapy. Almost every study showed that exercise helped, and in some studies it helped a lot. See table below. All of the authors are from the University of British Columbia. You can read the article here.

From “Efficacy of exercise combined with standard treatment for depression compared to standard treatment alone: A systematic review and meta-analysis of randomized controlled trials.” by JacquelineLee1 et al.In virtually every study, exercise helps fight depression.

For those who are willing to exercise, there are benefits aside from mental health. Even a daily walk around the block helps with bone strength, weight control, heart disease, plus the above mentioned improvement in mood. More exercise does more. If you bicycle without a helmet, you’re likely to live longer than if you drive.

For those who can’t stand exercise, or if exercise isn’t quite enough to send away the blues, you can try therapy, medication, and/or diet. There is some evidence that food that are high in lithium help fight depression. These food include nuts, beans, tomatoes, some mineral waters, e.g. from Lithia springs, GA. The does is about 1/100 the dose given as a bipolar treatment, but there is evidence that even such small doses help. Lithium was one of the seven ingredients in seven up — it was the one that was supposed to cheer you up. See some research here.

Robert Buxbaum, October 7, 2021.

The delta variant is no big deal if you’re young or vaccinated.

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The toll of COVID-19 has been terrible: 660,000 dead by my count, based on excess deaths, graph below, or 620,000 according to the CDC based on hospital records. Death rates appear to have returned to pre-pandemic levels, more or less*, but folks are still getting very sick and going to the hospital, mostly for “the delta variant.”

Weekly US death rates since October 2015.

As the following chart shows, severe symptoms of COVID are now almost entirely in the old, and unvaccinated. The risk to the young and middle aged is low, but even there, vaccination helps. According to the CDC, 72.2% of the adult US population is vaccinated with at least one shot. The vaccination, doesn’t prevent you from getting the delta variant nor from spreading it; it just protects from the most serious consequences of the disease. It seems a previous infection has the same effect, though less so.

Vaccination helps prevent hospitalization – at all ages (Israeli data)

If you’re over 60 and unvaccinated, I recommend getting vaccinated with at least one shot; the inconvenience and side-effects are few, and the benefit is large. The second shot seemswothshile too, and for all I know a third will too. Sooner or later there is a diminishing return. The benefit of masks seems is smaller, as I judge things. I notice that the disease is spreading at about the same rate in masked and unmasked states, and that the death numbers are as high, or higher in heavily masked, blue states as in red. New York and NJ are the top COVID death states, with Michigan not far behind. Masks seem to help, just not very much.

For those who want further advice, I can suggest dilute iodine gargle. I did this when I got a sore throat, I also suggest got a pneumonia vaccination, and take and adult aspirin every other day for COVID and heart-attack prevention. I also take a vitamin D tablet every few days.

If you wish to check my analysis, go here to get the raw data: https://gis.cdc.gov/grasp/fluview/mortality.html. Then, to calculate the COVID effect, I subtracted the weekly death rates in 2020 and 2021 from the corresponding week rates in 2019, correcting the deaths by 1%/year for population growth and aging. *I find that there are about 500 excess deaths per week, and I assume those are among the unvaccinated. If you are vaccinated, I’d worry about something else besides COVID-delta: heart attack, cancer, suicide, or Afghanistan.

Robert Buxbaum August 18, 2021. I made a video of cute iodine reactions, including the classic “iodine clock”, where I use vitamin C as as the anti-oxidant (reducing agent).

New York and San Francisco rents fall, Detroit rises for now.

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Rents in New York and San Francisco are far less expensive than before the pandemic. It’s been a boon for the suburbs, the south and the midwest, one that’s likely to continue unless Biden steps in. Before the pandemic, rent in San Francisco for a one bedroom apartment averaged over $3700 per month. New York rent was similar. People paid it because these cities offered robust business and entertainment, the best restaurants and bars, the best salons and clubs, the best music, museums, universities, and theater. New York was Wall Street, Madison Avenue and Broadway; San Francisco was Silicon valley and Hollywood. These cities were the place to be, and then the pandemic hit.

Post COVID-19, the benefits of big city life are gone, and replaced by negatives. The great restaurants are mostly gone; the museums, theaters, and salons, shut along with Hollywood. Wall Street and Madison Ave have gone on-line, as have the universities. If you can work and study from anywhere, why do it from an expensive hotbed of Corona.

People of means left the big cities with the first lockdowns. Wall Street moved on line, with offices in New Jersey, and many followed, along with college students, and hotel and restaurant workers. New York’s unemployment rate increased from 4-5% to over 9.5% today, among the highest rates in the nation, 9.5%. It would be higher if not for the departures. Crime spiked; the murder rate doubled. To keep people from leaving, landlords have lowered rents and many will now forgive a month or two of rent to keep apartments full with some rent coming in and an illusion of exclusivity. This is good for tenants, but tough on landlords.

Detroit rent history, 2014 to January 2021. Rents fell a lot on election day, maybe because of Biden, or because we think the pandemic is over.

As things stand, the suburbs and smaller cities are the beneficiaries of the exodus. Among the cities benefiting the most are cities in the south and mid-west: states that are more open and are relatively low cost: Phoenix, Oakland, Cleveland, St. Petersburg, and even Detroit. Detroit’s rents were already moving up as auto manufacturing returned from Mexico, see chart. Between early 2017 and October 2020, they went from $500/month to $1250/month for a 1 bedroom apartment, according to Zumper. Detroit rents fell after election day, but are still up 20% on the year. The influx of wealthier working folk to Detroit is welcome to some, unwelcome to tenants who find their rents are raised. I think it’s is a sign of a healthy economy that people follow life-quality, and that rents follow people. Our landlords are happy, but there are a lot of Detroit renters who are not

Joe Biden has promised to step in to make things right for everyone. He promised to have the government pay people’s rent so they don’t get evicted. I presume that means paying about double to people in NY and SF as to those in Detroit. He claims he will shutter smokestack industries too, and create the good jobs of the future in computers and high tech. It’s a nice claim. I suspect it’s a bailout of big city landlords, but what would I know. I suspect that the US would be better off if Joe just sat back and let New York rents fall, while allowing Detroit to gentrify. Detroiters need not worry about rents getting too pricy here. We’ve1500 shootings per year, that 15 times more than NYC, per capita. Unless that ratio changes, Detroit will continue to be the lower rent city.

Robert Buxbaum, January 17, 2021.

China keeps building coal-fired plants so we can close ours.

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Part of the mandate to the 2020 election was to join with Europe and the rest of the western world in agreeing to stop the use of coal. It’s a low cost way to generate energy. Of course we still like to buy things, and we’ve largely turned to China, a country that still burns coal, and thus makes things cheap. The net result of this shift to Chinese goods is that China keeps building coal-fired plants while we shut ours. As it happens, China is worse than the US in terms of CO2 per output, but at least when China pollutes, we don’t see the smoke directly, and we don’t see their new coal plants at all. So we feel better buying things from China than from the US. Besides, slave labor is cheap.

From th eEconomist, December 2020.

Buying Chinese goods is good for the importers, and for the non-manufacturing consumer, at least in the short term. It has the effect of exporting jobs though, and eventually we have to support the displaced workers. It also means we don’t keep up our manufacturing technology. Long term, that affects innovation, and that starts to displace other industries. Antibiotic production has already left the US and along with it semiconductors. Still, we feel good about it since the Chinese don’t let us see the slave labor camps. We do get to see the haze of the pollution.

The Chinese expect this pattern to continue. China is building new coal-fired plants at a furious rate. Presently China has most of the world’s coal-fired power plants. Mostly these are only 4 to 12 years old, far younger than our forty year old plants China plans to build more, and keeps encouraging us to shut down ours. Even 10 years ago, China lead the world in CO2 output. And their fraction of the CO2 keeps climbing.

China is popular with the press. In part, I expect, that’s because they pay the international experts. lAlso, writers and editors are consumers industrial products, but not manufacturers. Consumers benefit from slave labor, or maybe not, but displaced American workers certainly suffer. Also, of course, the news requires pictures and personal stories to keep viewer interest. If you can’t get pictures of young protesters, like Grey Thunberg, you can get an interesting story. Our Chinese pollution is out of sight, and not in the press.

Robert Buxbaum, January 6, 2021. BTW, if we wanted preserve jobs and stop CO2 pollution, we’d go nuclear.

Aspirin protection from heart attack and COVID-19 death.

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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.

TreatmentMyocardial InfarctionsNo InfarctionTotalfraction with MI
Aspirin13910,89811,037139/11,037 = 0.0126
Placebo23910,79511,034239/11,034 = 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.

Robert Buxbaum, November 27, 2020.

Tale of a fast, accurate home COVID test

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My son works at a company called Homodeus. It’s part of 4Catalyzer, an umbrella of seven medical biotechnology companies with a staff of 300 scientists and engineers. One of the Homodeus products, still waiting FDA guidance is a COVID-19, RNA self-tester called Homodeus Detect. It tests for COVID RNA directly, not for antibodies, with tests are much faster than hospital tests, taking 45 minutes, but more complex than the unreliable test strips. So far, the Detect tests have shown no false positives or false negatives. That would suggest 100% reliable, except but there are a fair number of invalid tests. The invalid tests are lares due to the complexity, and also to the fact that you are testing snot, essentially. There is no blood-taking involved, unlike with the test strips, but  just a nasal swab, and the cost is moderate, about $35 per test. However you have to do some lab work. After you swab your nose, you put the swab in a heated liquid bath where chemicals break up the snot and dissolve the shells on any viruses or pollen present. After 30 minutes, you pass the liquid onto a detector strip that contains a conjugate protein that binds to SARS-CoV-2 RNA. Your answer appears 15 minutes later as one of three lines: one for positive, one for negative, or one indicating an invalid test. Invalid tests show up more often than they like, about half the time, especially when the test is done by amateurs. 

Getting an invalid test result is a downside of the current product, but I don’t think it should prevent sales. You get better at doing the test, and speed and lack of false positives and negatives is a bigger plus. It seems worthwhile to fast-track offer this test for doctors offices and hospital admissions, at least. I’d also like to see it used for airplane boarding and interstate travel, so that a person traveling might avoid the two week quarantine that many states impose. I’d certainly pay $200 or more to avoid a two-week quarantine, and if I have to do a second or third test, I’d do that too. 

At least some people realize it’s a big advantage to know if you are currently infections.

Because this test measures virus RNA, and not antibodies, it indicates infection virtually as soon as you’re infected. That’s a benefit for those wishing to fly, or to meet with people, an advantage that is not lost on Elon Musk at least (see tweet). The test also shows negative as soon as the virus is gone, and that’s big. In recent months the FDA has fast-track approved an antibody indicating test from Abbott Labs, but that test has many false readings and only indicates infection several days afterward, and it does not indicate when you are no longer infectious. 

The FDA has not offered to fast track this test, or any other like it for approval. They have not even indicated what sort of reporting and privacy requirements they want, so things sit in limbo, both for Homodeus, and for competing companies. Here is a story in USA today: https://www.usatoday.com/story/news/2020/07/29/fda-opens-door-rapid-home-covid-19-tests/5536528002. One big issue that the FDA is contact tracing. The FDA would like to be able to trace all the contacts of anyone who tests positive, while maintaining privacy as demanded by the 4th Amendment.

One way around the 4th amendment concerns would be to require anyone who uses the test to sign a waiver allowing the government to trace their contacts. Alternately there could be a block-chain enabled app that would come with the test. An app coms already providing a timer for when to move to the next step, and it includes a machine-vision system to help analyze dim lines on the indicator. Perhaps the FDA would accept block chain as a way to allow full reporting while maintaining privacy The FDA has yet to provide guidance on what they want, though. Without guidance or fast-track approval, things sit in limbo. Here is a scathing legal analysis from the Yale Law Journal.

You can get a free test, but have to do it at Homodeus headquarters in Guilford, Connecticut. It’s free, and results appears in about 45 minutes.. Homodeus has been manufacturing the test in quantity; if you are interested, use the following link to sign up: https://www.homodeusinc.com/research. Healthcare providers are particularly welcome.

The Homodeus detect test kit. Picture from this article in the New Haven Register.

Why did the FDA fast-track approve Abott’s antigen/ antibody test. Maybe because the tests rethought to not lead to lower mask use. Alternately, Abott has more political pull. You can read the FDA’s explanation here. In my biassed opinion the Homodeus product is good enough to fast track especially for hospitals and healthcare providers. It could save lives while allowing the economy to reopen.

Robert Buxbaum, November 15, 2020 (with massive help from Aaron M. Buxbaum)