Tag Archives: death

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.

Estimating the strength of an atom bomb

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As warfare is a foundation of engineering, I thought I’d use engineering to evaluate the death-dealing power of North Korea’s atomic/hydrogen bomb, tested September 3, 2017. The key data in evaluating a big bomb is its seismic output. They shake the earth like earthquakes do, and we measure the power like earthquakes, using seismometers. I’ve seen two seismographs comparing the recent bomb to the previous. One of these, below, is from CTBTO, the Center for Test Ban Treaty Oversight, via a seismometer in western Kazakhstan (see original data and report).

Seismic output of all North Korean nuclear tests.

Seismic output, to scale, of all declared DPNK nuclear tests as observed from IMS station AS-59 in Western Kazakhstan

North Korea’s previous bomb, exploded 9 September 2016, was reported to be slightly more powerful than the ones we dropped on Hiroshima and Nagasaki, suggesting it was about 20 kilotons. According to CTBTO, it registered 5.3 on the Richter scale. The two tests before that appear somewhat less powerful, perhaps 7-10 kilotons, and the two before that appear as dismal failures — fizzles, in atomic bomb parlance. The MOAB bomb, by comparison, was 9 Tons, or 0.009 kiloTons, a virtual non-entity.

To measure the output of the current bomb, I place a ruler on my screen and measure the maximum distance between the top to bottom wiggles. I find that this bomb’s wiggles measure 5 cm, while the previous measures 5 mm. This bomb’s wiggles are ten times bigger, and from this I determine that this explosion registered 6.3 on the Richter scale, 1.0 more than the previous — the Richter scale is the logarithmic measure of the wiggle amplitude, so ten times the shake magnitude  is an addition of 1.0 on the scale. My calculation of 6.3 exactly matches that of the US geological survey. The ratio of wiggle heights was less on the, NORSAR seismometer, Norway, see suggesting 5.8 to 5.9 on the Richter scale. The European agencies have taken to reporting 6.1, an average value, though they originally reported only the 5.8 from NORSAR, and a bomb power commensurate with that.

We calculate the bomb power from the Richter-scale measure, or the ratio of the wiggles. Bomb power is proportional to wiggle height to the 3/2 power. Using the data above, ten times the wiggle, this bomb appears to be 10^3/2 = 31.6 times as powerful as the last, or 31.6 x 20kTon = 630kTon (630,000 tons of TNT). If we used the European value of 6.1, the calculated power would be about half this, 315 kTons, and if we used the NORSAR’s original value, it would suggest the bomb had less than half this power. Each difference of 0.2 on the Richter scale is a factor of two in power. For no obvious reason we keep reporting 120 to 160 kTons.

NORSAR comparison of North Korean bomb blasts

NORSAR comparison of North Korean blasts — suggests the current bomb is smaller; still looks like hydrogen.

As it happens, death power is proportional to the kiloton power, other things being equal. The bombs we dropped on Hiroshima and Nagasaki were in the 15 to 20 kTon range and killed 90,000 each. Based on my best estimate of the bomb, 315 kTons, I estimate that it would kill 1.6 million people if used on an industrial city, like Seoul, Yokohama, or Los Angeles. In my opinion, this is about as big a bomb as any rational person has reason to make (Stalin made bigger, as did Eisenhower).

We now ask if this is an atom bomb or a hydrogen-fusion bomb. Though I don’t see any war-making difference, if it’s a hydrogen bomb that would make our recent treaty with Iran look bad, as it gave Iran nuclear fusion technology — I opposed the treaty based on that. Sorry to say, from the seismic signature it looks very much like a hydrogen bomb. The only other way to get to this sort of high-power explosion is via a double-acting fission bomb where small atom bomb sets off a second, bigger fission bomb. When looking at movies of Eisenhower-era double-acting explosions, you’ll notice that the second, bigger explosion follows the first by a second or so. I see no evidence of this secondary-delay in the seismic signature of this explosion, suggesting this was a hydrogen bomb, not a double. I expect Iran to follow the same path in 3-4 years.

As a political thought, it seems to me that the obvious way to stop North Korea would be to put pressure on China by making a military pact with Russia. Until that is done, China has little to fear from a North Korean attack to the south. Of course, to do that we’d likely have to cut our support of NATO, something that the Germans fear. This is a balance-of-power solution, the sort that works, short of total annihilation. It was achieved at the congress of Vienna, at the treaty of Ghent, and by Henry Kissinger through détente. It would work again. Without it, I see the Korean conflict turning hot again, soon.

Robert Buxbaum, September 11, 2017.

Thinking the unthinkable

Do you know how you go about thinking the unthinkable?

 

With an ithberg, of course.

 

Robert Buxbaum. April 12, 2016. I thought it was time for another “dad joke.” Besides, the Titanic sank on April 14th. I spend a fair about of time thinking the unthinkable. On a vaguely similar note:

After Boris died, everyone gathered at his funeral.

The minister started to speak: “He was a model husband, a decent man, a terrific father..”

The widow then makes a motion for her son to come to her.

“What is it mother?” he whispers.

“Dear, go check the casket, I think we’re at the wrong funeral…”

The Italian funeral joke.

One day, while having a latte at my favorite Starbucks, I noticed a most unusual Italian funeral. Instead of one hearse, there were two, one after the other, moving slowly down the street. Behind the hearse, there walked a man with a dog an a leash. Perhaps 80 other men walked behind him, single file.

As this was very unusual, I went up to the man with the dog and asked about it as respectfully as I could. I don’t want to intrude on your sorrow, sir, but I couldn’t help notice this funeral procession. Who passed away, if I may ask. The man looked at me and said that the first hearse contained his wife. “She’d gotten real mad at the dog, and the dog attacked her and killed her.” “I see,” I said, but what about the second hearse? After a pause, the man said, “That’s my mother-in-law. She started to beat the dog, and and the dog went and killed her too.” There then passed a moment of silent brotherhood between me and the fellow.

“Can I borrow the dog?”

“Get in line.”

Robert Buxbaum, January 7, 2014. It’s another shaggy dog story. Long story, sort of pointless; common phrase at the end. It’s funny because it’s a mini-mystery. All the clues were there from the start. Every now and again, I post jokes: engineering jokes, buddhist jokes, a dwarf joke and a Canadian joke, art, architecture.

Statistics of death and taxes — death on tax day

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Strange as it seems, Americans tend to die in road accidents on tax-day. This deadly day is April 15 most years, but on some years April 15th falls out on a weekend and the fatal tax day shifts to April 16 or 17. Whatever weekday it is, about 8% more people die on the road on tax day than on the same weekday a week earlier or a week later; data courtesy of the US highway safety bureau and two statisticians, Redelmeier and Yarnell, 2014.

Forest plot of individuals in fatal road crashes over 30 years. X-axis shows relative increase in risk on tax days compared to control days expressed as odds ratio. Y-axis denotes subgroup (results for full cohort in final row). Column data are counts of individuals in crashes. Analytic results expressed with 95% confidence intervals setting control days as referent. Results show increased risk on tax day for full cohort, similar increase for 25 of 27 subgroups, and all confidence intervals overlapping main analysis. Recall that odds ratios are reliable estimates of relative risk when event rates are low from an individual driver’s perspective.

Forest plot of individuals in fatal road crashes for the 30 years to 2008  on US highways (Redelmeier and Yarnell, 2014). X-axis shows relative increase in risk on tax days compared to control days expressed as odds ratio. Y-axis denotes subgroup (results for full cohort in final row). Column data are counts of individuals in crashes (there are twice as many control days as tax days). Analytic results are 95% confidence intervals based on control days as referent. Dividing the experimental subjects into groups is a key trick of experimental design.

To confirm that the relation isn’t a fluke, the result of well-timed ice storms or football games, the traffic death data was down into subgroups by time, age, region etc– see figure. Each groups showed more deaths than on the average of the day a week before and after.

The cause appears unrelated to paying the tax bill, as such. The increase is near equal for men and women; with alcohol and without, and for those over 18 and under (presumably those under 18 don’t pay taxes). The death increase isn’t concentrated at midnight either, as might be expected if the cause were people rushing to the post office. The consistency through all groups suggests this is not a quirk of non-normal data, nor a fluke but a direct result of  tax-day itself.Redelmeier and Yarnell suggest that stress — the stress of thinking of taxes — is the cause.

Though stress seems a plausible explanation, I’d like to see if other stress-related deaths are more common on tax day — heart attack or stroke. I have not done this, I’m sorry to say, and neither have they. General US death data is not tabulated day by day. I’ve done a quick study of Canadian tax-day deaths though (unpublished) and I’ve found that, for Canadians, Canadian tax day is even more deadly than US tax day is for Americans. Perhaps heart attack and stroke data is available day by day in Canada (?).

Robert Buxbaum, December 12, 2014. I write about all sorts of stuff. Here’s my suggested, low stress income tax structure, and a way to reduce/ eliminate income taxes: tariffs– they worked till the Civil war. Here’s my thought on why old people have more fatal car accidents per mile driven.

Seniors are not bad drivers.

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Seniors cause accidents, but need to get places too

Seniors are often made fun of for confusion and speeding, but it’s not clear they speed, and it is clear they need to get places. Would reduced speed limits help them arrive alive?

Seniors have more accidents per-mile traveled than middle age drivers. As shown on the chart below, older Canadians, 75+, get into seven times more fatal accidents per mile than 35 to 55 year olds. At first glance, this would suggest they are bad drivers who should be kept from the road, or at least made to drive slower. But I’m not so sure they are bad drivers, and am pretty certain that lower speed limits should not be generally imposed. I suspect that a lot of the problem comes from the a per-mile basis comparison with folks who drive long distances on the same superhighways instead of longer, leisurely drives on country roads. I suspect that, on a per-hour basis, the seniors would look a lot safer, and on a per highway-mile basis they might look identical to younger drivers.

Canadian Vehicle Survey, 2001, Statistics Canada, includes drivers of light duty vehicles.

Deaths per billion km. Canadian Vehicle Survey, 2001, Statistics Canada, includes light duty vehicles.

Another source of misunderstanding, I find, is that comparisons tend to overlook how very low the accident rates are. The fatal accent rate for 75+ year old drivers sounds high when you report it as 20 deaths per billion km. But that’s 50,000,000 km between fatalities, or roughly one fatality for each 1300 drives around the earth. In absolute terms it’s nothing to worry about. Old folks driving provides far fewer deaths per km than 12-29 year olds walking, and fewer deaths per km than for 16-19 year olds driving.

When starting to research this essay, I thought I’d find that the high death rates were the result of bad reaction times for the elderly. I half expected to find that reduced speed limits for them helped. I’ve not found any data directly related to reduced speeds, but now think that lowered speed limits would not help them any more than anyone else. I note that seniors drive for pleasure more than younger folks and do a lot more short errand drives too — to the stores, for example. These are places where accidents are more common. By contrast, 40 to 70 year olds drive more miles on roads that are relatively safe.

Don't walk, especially if you're old.

Don’t walk, especially if you’re old. Netherlands data, 2001-2005 fatalities per billion km.

The Netherlands data above suggest that any proposed solution should not involve getting seniors out of their cars. Not only do seniors find walking difficult, statistics suggest walking is 8 to 10 times more dangerous than driving, and bicycling is little better. A far better solution, I suspect, is reduced speeds for everyone on rural roads. If you’re zipping along a one-lane road at the posted 40, 55, or 60 mph and someone backs out of a driveway, you’re toast. The high posted speeds on these roads pose a particular danger to bicyclists and motorcyclists of all ages – and these are folks who I suspect drive a lot on the rural roads. I suspect that a 5 mph reduction would do quite a lot.

For automobiles on super-highways, it may be worthwhile to increase the speed limits. As things are now, the accident fatality rates are near zero, and the main problem may be the time wasted behind the wheel – driving from place to place. I suspect that an automobile speed limit raise to 80 mph would make sense on most US and Canadian superhighways; it’s already higher on the Autobahn in Germany.

Robert Buxbaum, November 24, 2014. Expect an essay about death on tax-day, coming soon. I’ve also written about marijuana, and about ADHD.