Most people know that aspirin can reduce blood clots and thus the risk heart attack, as shown famously in the 1989 “Physicians’ Health Study” where 22,000 male physicians were randomly assigned to either a regular aspirin (325 mg) every other day or an identical looking placebo. The results are shown in the table below, where “Myocardial Infarction” or “MI” is doctor-speak for heart attack.
Treatment
Myocardial Infarctions
No Infarction
Total
fraction with MI
Aspirin
139
10,898
11,037
139/11,037 = 0.0126
Placebo
239
10,795
11,034
239/11,034 = 0.0217
Over the 5 years of the study, the physicians had 378 MI events, but mostly in the group that didn’t take aspirin: 1.28% of the doctors who took aspirin had a heart attack as opposed to 2.17% for those with the placebo. The ratio 1.28/2.17 = 0.58 is called the risk ratio. Apparently, aspirin in this dose reduces your MI risk to 58% of what it was otherwise — at least in white males of a certain age.
A blood clot showing red cells held together by fibrin fibers. Clots can cause heart attack, stroke, and breathing problems. photo: Steve Gschmeissner.
Further study showed aspirin benefits with women and other ethnicities, and benefits beyond hear attack, in any disease that induces disseminated intravascular coagulopathy. That’s doctor speak for excessive blood clots. Aspirin produced a reduction in stroke and in some cancers (Leukemia among them) and now it now seems likely that aspirin reduces the deadliness of COVID-19. Data from Wuhan showed that excessive blood clots were present in 71% of deaths vs. 0.4% of survivors. In the US, some 30% of those with serious COVID symptoms and death show excessive blood clots, particularly in the lungs. Aspirin and Vitamin D seem to help.
.The down-side of aspirin use is a reduction in wound healing and some intestinal bleeding. The intestinal bleeding is known as aspirin burn. Because of these side-effects it is common to give a lower dose today, just one baby aspirin per day, 81 mg. While this does does some good, It is not clear that it is ideal for all people. This recent study in the Lanset (2018) shows a strong relationship between body weight and aspirin response. Based on 117,279 patients, male and female, the Lanset study found that the low dose, baby aspirin provides MI benefits only in thin people, those who weigh less than about 60 kg (130 lb). If you weigh more than that, you need a higher dose, perhaps two baby aspirin per day, or a single adult aspirin every other day, the dose of the original doctors study.
In this study of COVID patients, published in July, those who had been taking aspirin fared far better than those who did not A followup study will examine the benefits of one baby aspirin (81 mg) with and without Vitamin D, read about it here. I should note that other pain medications do not have this blood-thinning effect, and would not be expected to have the same benefit.
While it seems likely that 2 baby aspirins might be better in fat people, or one full aspirin every other day, taking a lot more than this is deadly. During the Spanish flu some patients were given as much as 80 adult aspirins per day. It likely killed them. As Paracelsus noted, the difference between a cure and a poison is the dose.
I learned a lot about social interactions from a comic of my youth called “Archie“. A very popular comic for 65 years, from 1941 through the 2010s, the social structure of Archie remained remarkably constant from when I first read it, in the early 60’s to when I read it to my children in the late 90’s. The comic mostly follows the title character, a love struck teenager with two (or more) gorgeous girlfriends, shown below, and his various relationships. I find the original stories to have been hyper-true, that is more true than truth. There are also several spin-offs, including a TV series, “Riverdale“, and an underground comic “Anarchie“. Both have a degree of charm, but the original stands out for it’s wide readership and long run; clearly, it resonated. Riverdale is a far grittier take, further from hyper-reality.
Archie enjoys a malt with Veronica left and Betty right. Archie prefers Veronica. Betty is a doormat. Though Veronica is rich, she never pays.
In Archie comics, the poorer folks worked, as in real life, at relatively dull jobs. Their parents do too, and the poorer kids are visible poorer. Archie always wore the same clothes and drives (or drove) a junker car. The few rich folks do not work in the same way, as one might expect. In the TV series, and in most TV series’s, everyone has food, friends and a car, without any serious jobs, and little social hierarchy. It’s an ideal world of sorts, but somehow everyone’s messed up.
In the old time comic, one rich character in particular, Reggie Mantle, like to flaunt his wealth and make fun of Archie and his proletarian friend, Jughead. The comic book Veronica was also something of a bitch. Her dad, while occasionally charming, could be a bully as well. He certainly displayed, and benefitted from his exceptional wealth. Meanwhile, in the comic at least, while all the poorer folks worked (except Jughead), not all of them did a good job, most of those who worked did not enjoy it. There was humor in this engaging, realistic take on life.
The school lunch lady, Miss Beasley, was relatable in her extreme dislike for her job. What pleasure she gets, seems to come from making and serving bad food. Though the details of her employment are scarce, my guess was that she was unionized. Otherwise, she would have been fired years ago. There is no similar character in TV’s Riverdale.
Weatherbee and Flootsnoot
The principal, Mr. Weatherbee, also seemed to have trouble with his job, though his relationships were more nuanced. He takes his job seriously and runs an effective school, but he’s overweight, and over-stressed — a walking heart attack. Unlike most of the people at the school, “the bee” does not take out his anger on the kids, or on his fellow faculty. He keeps it in, while tormented by the students, by the parents, by the janitor, Svenson, and in particular by Mr. Flootsnoot, the science teacher. Flootsnoot seems to delight in causing trouble, giving Archie explosives, acid, and animals. My guess is that Flootsnoot is angling for Weatherby’s job, and is not patient enough to wait for Weatherbee’s heart to give out on its own. He’s a character right out of Hitchcock, IMHO.
Ms Grundy, Archie’s teacher was also drawn a victim of playing by the rules in a crooked game. In the original comic, as i read it in the mid 60s, she’s a puritan spinster in a black dress with a tall, laced collar. She seems to dislike Archie and Jughead, but not the other kids, nor her job as such. It makes sense that she’d dislike Archie and Jughead, since Jughead is lazy, and Archie is a skirt chasing cad. By the 90’s when I read Archie with my daughters, Miss Grundy had become a Ms, and was more at peace with her position, and a lot of the humor is gone. In the TV version, Riverdale, Ms Grundy, is in a sexual relationship with Archie. It’s a lot less healthy, and not very humorous.
The main focus, of course is Archie, a workin-class teen, and straight D student. How does he have two (or more) gorgeous girlfriends? After a few years of reading, the explanation becomes obvious, and fairly depressing. Each of his many girlfriends are motivated by jealousy for the others. His first girl is Betty. She’s pretty, poor, hard-working, and a doormat. She’s always there to help out. She is treated like dirt by her richer, “best friend,” Veronica. As best I can tell, Veronica and the others mostly like Archie because Betty does. To some extent Veronica also likes to annoy her rich dad, who is portrayed as confident and proud, except when dealing with his spoiled daughter. This is old-time humor that you’ll also see in Spongebob, or (going further back) Balzac’s “Pere Goriot“.
Veronica bosses her dad around but also makes his life worthwhile, it seems. I assume he once had a wife that he loved. Now he’s got a white-haired companion, a butler, and some rich friends. The love-of-his-life is his daughter, it seems, and she is dating a free-loading cad. Veronica’s rival Betty comes from the same stable, modest backroad as Archie, but. Archie prefers life at Veronica’s house. The food is better, and there is a pool. Mr Lodge barely tolerates Archie and friends. The butler, Smithers, is less excitable, but not as tolerant.
The school also has two psychopaths, Midge and Moose, a dangerous pair. Moose Mason is a football player, dumb or brain damaged, and violently jealous of Midge. Midge, of course, flirts with everyone, and does it in front of Moose. The result is that Moose beats up any boys who respond, much to Midge’s delight. They are a sick and dangerous pair, but very realistic. Jughead, the only normal person in the comic, dislikes the pair, and dislikes both Veronica and Reggie. Jughead has a dog, and a little sister “Jellybean,” who he adores. he also has, to his chagrin, a female stalker, “Big” Ethel. She’s ugly and chases Jughead; Jughead avoids her. Jughead seems to like Archie, though, and is always loyal to him; it’s another of Jughead’s good traits. He’s always pointing Archie to Betty, as a good friend would. Meanwhile, Moose-the-homicidal is protected by “Coach Kleats,” a highly flawed character who’s obsessed with winning, and seems to have been hit in the head one time too many.
A bit more about Jughead (he got his own spinoff comic for a while). Jughead is a classic humor character from antiquity. He’s the Harlequin, the semi-loyal servant: poor, clever, resourceful, and always hungry. He’s the bird man of The Magic Flute. He’s Figaro, and the servant in Don Giovani. He’s Harlie Quinn in Batman. A harlequin makes his own clothes from patchwork, and true to type, Jughead is seen, virtually always wearing a sort-of crown, a “whoopee cap” of his own construction. Because Jughead is poor and lazy, everyone thinks him stupid, but he’s the only one clever enough to size up Midge and Veronica. Jughead’s crown is appropriate since he’s his own master. Archie comics were banned in Saudi Arabia because the Saudis took offense at the concept of a self-crowned king. It’s an unusual concept. In Riverdale, Jughead is a tortured poet who still wears a handmade crown for no obvious reason.
All these relationships had a surreal character. The relationships are funny because they are more real than reality. They also presented a simpler form of humor in that the lowly usually win, while the high and talented usually lose. Reggie commonly loses, as does Weatherbee. Then things began to change in the 2000’s when two token black characters were added: a top scholar/athlete, Chuck Clayton, and his dad, Floyd (or Harry) a wise, athletic, co-coach. These are characters without major flaws, and as such they are not funny. If a writer feels he must include a character like this, a writer should use him as a straight-man, Zeppo Marx for example. And even Zeppo Marx is presented as having a horrible flaw. In Marx Bros. movies, Zeppo is presented as being Groucho’s son. Comedy is built on flawed characters like this, who succeed, and on arrogant ones who fail. With the Claytons, you’re left wondering what comedy do they bring to the situation. Also, why do these individuals tolerate crazy Moose on the team?
In 2010, the writers added an openly gay character, Kevin Keller. A nice fellow, with no flaws who everyone likes. Really? Is there a teenager so comfortable with himself? Are there no homophobes anywhere in this school? By 2012, Kevin has grown up and is an anti-gun senator. Archie dies taking an assassin’s bullet for him. That’s heroic, and it solves some other ugly problems, but it killed the series. You don’t want an unhappy ending for a comedy. For a hint of what to do, consult Shakespeare.
Anarchy Andrews deals with his cool, pot-smoking father, Fred.
Turning now to my favorite spin-off, the underground comic, Anarchie. It’s the same batch of teenagers, more or less, navigating the same issues, but theirs is an ideal, socialist world where the revolution has won. In this world, everyone has plenty, drugs are legal, and there is no sexism, agism, racism, or shape-ism. This is a color-blind world where black and white live together, and where the gay fellow would fit right in, if anyone thought to draw them in. There is no work, but even without that pressure, and the old problems, everything isn’t great for the kids. There is still school, and Weatherby still hates Archie. The kids still have to deal with parents, even when the parents have turned-on to drugs and act cool. It’s good comedy, an up-ending of the social expectations. Most teens of my day seemed to think that socialism would solve all their problems.
Jughead in the socialist future is a broken druggie, but still something of his own man.
For those who have not seen it, how would you expect the Archie to relate to a perfect socialist world. The answer is not well. His father smokes dope, but that doesn’t help. He’s also into recycling and yoga (yuck). Archie remains the same love stuck, philanderer disinterested in most everything else but girls. His friend, Jughead fares far worse, he’s a pock-marked, druggie, a far more likely outcome than Riverdale’s where Jughead is a tortured poet. Without societal pressures and a normal family, Jughead becomes an anarchis’s anarchist. A ruined misfit surrounded in the workers’ paradise. Jughead (now called “Ludehead” still has his crown, and is still his own person, after a fashion, but there is little room for that in a socialist utopia where all are equal.
California likely leads the nation in socially activist government kindness. It also leads the nation in homelessness, chronic homelessness, and homeless veterans. The US Council on Homelessnesses estimates that, on any given day, 129,972 Californians are homeless, including 6,702 family households, and 10,836 veterans; 34,332 people are listed among “the chronic homeless”. That is, Californians with a disability who have been continuously homeless for one year or cumulatively homeless for 12 months in the past three years. No other state comes close to these numbers. The vast majority of these homeless are in the richer areas of two rich California cities: Los Angeles and San Francisco (mostly Los Angeles). Along with the homeless in these cities, there’s been a rise in 3rd world diseases: cholera, typhoid, typhus, etc. I’d like to explore the relationship between the policies of these cities and the rise of homelessness and disease. And I’d like to suggest a few cures, mostly involving sanitation.
A homeless encampment in LosAngeles
Most of the US homeless do not live in camps or on the streets. The better off US homelessness find it is a temporary situation. They survive living in hotels or homeless shelters, or they “couch-serf,” with family or friends. They tend to take part time jobs, or collect unemployment, and they eventually find a permanent residence. For the chronic homeless things are a lot grimmer, especially in California. The chronic unemployed do not get unemployment insurance, and California’s work rules tend to mean there are no part time jobs, and there is not even a viable can and bottle return system in California, so the homeless are denied even this source of income*. There is welfare and SSI, but you have to be somewhat stable to sign up and collect. The result is that California’s chronic homeless tend to live in squalor strewn tent cities, supported by food handouts.
Californians provide generous food handouts, but there is inadequate sewage, or trash collection, and limited access to clean water. Many of the chronic homeless are drug-dependent or mentally ill, and though they might benefit from religion-based missions, Los Angeles has pushed the missions to the edges of the cities, away from the homeless. The excess food and lack of trash collection tends to breed rats and disease, and as in the middle ages, the rats help spread the diseases.
Total homelessness by state, 2018; California leads the nation. The better off among these individuals do not live on the streets, but in hotels or homeless shelters. For most, this is a short term situation. The rest, about 20%, are chronically homeless. About half of these live on the streets without adequate sewage and water. Many are drug-dependent.
The first major outbreaks of the homeless camps appeared in Los Angeles in August and September of 2017. They reappeared in 2018, and by late summer, rates were roughly double 2017’s. This year, 2019, looks like it could be a real disaster. The first case of a typhoid infected police officer showed up in May. By June there were six police officers with typhoid, and that suggests record numbers are brewing among the homeless.
To see why sanitation is an important part of the cure, it’s worth noting that typhoid is a disease of unclean hands, and a relative of botulism. It is spread by people who go to the bathroom and then handle food without washing their hands first. The homeless camps do not, by and large, have hand washing stations. and forced hygiene is prohibited. Los Angeles has set up porta-potties, with no easy hand washing. The result is typhoid epidemic that’s even affecting the police (six policemen in June!).
R-naught, reproduction number for some diseases, CDC.
Historically, the worst outbreaks of typhoid were spread by food workers. This was the case with “typhoid Mary of the early 20th century.” My guess is that some of the police who got typhoid, got it while trying to feed the needy. If so, this fellow could become another Typhoid Mary. Ideally, you’d want shelters and washing stations where the homeless are. You’d also want to pickup the dirtier among the homeless for forced washing and an occasional night in a homeless shelter. This is considered inhumane in Los Angeles, but they do things like this in New York, or they did.
Typhus is another major disease of the California homeless camps. It is related to typhoid but spread by rodents and their fleas. Infected rodents are attracted to the homeless camps by the excess food. When the rodents die, their infected fleas jump to the nearest warm body. Sometimes that’s a person, sometimes another animal. In a nastier city, like New York, the police come by and take away old food, dead animals, and dirty clothing; in Los Angeles they don’t. They believe the homeless have significant squatters rights. California’s kindness here results in typhus.
Reproduction number and generation time for some diseases.
The last of the major diseases of the homeless camps is cholera. It’s different from the others in that it is not dependent on squalor, just poor health. Cholera is an airborne disease, spread by coughing and sneezing. In California’s camps, the crazy and sick dwell close to each other and close to healthy tourists. Cholera outbreaks are a predictable result. And they can easily spread beyond the camps to your home town, and if that happens a national plague could spread really fast.
I’d discussed R-naught as a measure of contagiousness some months ago, comparing it to the reproductive number of an atom bomb design, but there is more to understanding a disease outbreak. R-naught refers merely to the number of people that each infected person will infect before getting cured or dying. An R-naught greater than one means the disease will spread, but to understand the rate of spread you also need the generation time. That’s the average time between when the host becomes infected, and when he or she infects others. The chart above shows that, for cholera, r-naught is about 10, and the latency period is short, about 9 days. Without a serious change in California’s treatment of the homeless, each cholera case in June will result in over 100 cases in July, and well over 10,000 in August. Cholera is somewhat contained in the camps, but once an outbreak leaves the camps, we could have a pandemic. Cholera is currently 80% curable by antibiotics, so a pandemic would be deadly.
Hygiene is the normal way to prevent all these outbreaks. To stop typhoid, make bathrooms available, with washing stations, and temporary shelters, ideally these should be run by the religious groups: the Salvation Army, the Catholic Church, “Loaveser and Fishes”, etc. To prevent typhus, clean the encampments on a regular basis, removing food, clothing, feces and moving squatters. For cholera, provide healthcare and temporary shelters where people will get clean water, clean food, and a bed. Allow the homeless to work at menial jobs by relaxing worker hiring and pay requirements. A high minimum wage is a killer that nearly destroyed Detroit. Allow a business to hire the homeless to sweep the street for $2/hour or for a sandwich, but make a condition that they wash their hands, and throw out the leftovers. I suspect that a lot of the problems of Puerto Rico are caused by a too-high minimum wage by the way. There will always be poor among you, says the Bible, but there doesn’t have to be typhoid among the poor, says Dr. Robert Buxbaum.
July 30, 2019. I ran for water commissioner in Oakland county, Michigan, 2016. If there is interest, I’ll run again. One of my big issues is clean water. Oakland could use some help in this regard.
It’s often assumed that vitamins and minerals are good for you, so good for you that people buy all sorts of supplements providing more than the normal does in hopes of curing disease. Extra doses are a mistake unless you really have a mis-balanced diet. I know of no material that is good in small does that is not toxic in large doses. This has been shown to be so for water, exercise, weight loss, and it’s true for vitamins, too. That’s why there is an RDA (a Recommended Daily Allowance).
Lets begin with Vitamin A. That’s beta carotene and its relatives, a vitamin found in green and orange fruits and vegetables. In small doses it’s good. It prevents night blindness, and is an anti-oxidant. It was hoped that Vitamin A would turn out to cure cancer too. It didn’t. In fact, it seems to make cancer worse. A study was preformed with 1029 men and women chosen random from a pool that was considered high risk for cancer: smokers, former smokers, and people exposed to asbestos. They were given either15 mg of beta carotene and 25,000 IU of vitamin A (5 times the RDA) or a placebo. Those taking the placebo did better than those taking the vitamin A. The results were presented in the New England Journal of Medicine, read it here, with some key findings summarized in the graph below.
Comparison of cumulative mortality and cardiovascular disease between those receiving Vitamin A (5 times RDA) and those receiving a placebo. From Omenn et. al, Clearly, this much vitamin A does more harm than good.
The main causes of death were, as typical, cardiovascular disease and cancer. As the graph shows, the rates of death were higher among people getting the Vitamin A than among those getting nothing, the placebo. Why that is so is not totally clear, but I have a theory that I presented in a paper at Michigan state. The theory is that your body uses oxidation to fight cancer. The theory might be right, or wrong, but what is always noticed is that too much of a good thing is never a good thing. The excess deaths from vitamin A were so significant that the study had to be cancelled after 5 1/2 years. There was no responsible way to continue.
Vitamin E is another popular vitamin, an anti-oxidant, proposed to cure cancer. As with the vitamin A study, a large number of people who were at high risk were selected and given either a large dose of vitamin or a placebo. In this case, 35,000 men over 50 years old were given either vitamin E (400 to 660 IU, about 20 times the RDA) and/or selenium or a placebo. Selenium was added to the test because, while it isn’t an antioxidant, it is associated with elevated levels of an anti-oxidant enzyme. The hope was that these supplements would prevent cancer and perhaps ward off Alzheimer’s too. The full results are presented here, and the key data is summarized in the figure below. As with vitamin A, it turns out that high doses of vitamin E did more harm than good. It dramatically increased the rate of cancer and promoted some other problems too, including diabetes. This study had to be cut short, to only 7 years, because of the health damage observed. The long term effects were tracked for another two years; the negative effects are seen to level out, but there is still significant excess mortality among the vitamin takers.
Cumulative incidence of prostate cancer with supplements of selenium and/or vitamin E compared to placebo.
Selenium did not show any harmful or particularly beneficial effects in these tests, by the way, and it may have reduced the deadliness of the Vitamin A..
My theory, that the body fights cancer and other disease by oxidation, by rusting it away, would explain why too much antioxidant will kill you. It laves you defenseless against disease As for why selenium didn’t cause excess deaths, perhaps there are other mechanisms in play when the body sees excess selenium when already pumped with other anti oxidant. We studied antioxidant health foods (on rats) at Michigan State and found the same negative effects. The above studies are among the few done with humans. Meanwhile, as I’ve noted, small doses of radiation seem to do some good, as do small doses of chocolate, alcohol, and caffeine. The key words here are “small doses.” Alcoholics do die young. Exercise helps too, but only in moderation, and since bicycle helmets discourage bicycling, the net result of bicycle helmet laws may be to decrease life-span.
What about vitamins B, C, and D? In normal doses, they’re OK, but as with vitamin A and E you start to see medical problems as soon as you start taking more– about 12 times the RDA. Large does of vitamin B are sometimes recommended by ‘health experts’ for headaches and sleeplessness. Instead they are known to produce skin problems, headaches and memory problems; fatigue, numbness, bowel problems, sensitivity to light, and in yet-larger doses, twitching nerves. That’s not as bad as cancer, but it’s enough that you might want to take something else for headaches and sleeplessness. Large does of Vitamin C and D are not known to provide any health benefits, but result in depression, stomach problems, bowel problems, frequent urination, and kidney stones. Vitamin C degrades to uric acid and oxalic acid, key components of kidney stones. Vitamin D produces kidney stones too, in this case by increasing calcium uptake and excretion. A recent report on vitamin D from the Mayo clinic is titled: Vitamin D, not as toxic as first thought. (see it here). The danger level is 12 times of the RDA, but many pills contain that much, or more. And some put the mega does in a form, like gummy vitamins” that is just asking to be abused by a child. The pills positively scream, “Take too many of me and be super healthy.”
It strikes me that the stomach, bowel, and skin problems that result from excess vitamins are just the problems that supplement sellers claim to cure: headaches, tiredness, problems of the nerves, stomach, and skin. I’d suggest not taking vitamins in excess of the RDA — especially if you have skin, stomach or nerve problems. For stomach problems; try some peniiiain cheese. If you have a headache, try an aspirin or an advil.
In case you should want to know what I do for myself, every other day or so, I take 1/2 of a multivitamin, a “One-A-Day Men’s Health Formula.” This 1/2 pill provides 35% of the RDA of Vitamin A, 37% of the RDA of Vitamin E, and 78% of the RDA of selenium, etc. I figure these are good amounts and that I’ll get the rest of my vitamins and minerals from food. I don’t take any other herbs, oils, or spices, either, but do take a baby aspirin daily for my heart.
Robert Buxbaum, May 23, 2019. I was responsible for the statistics on several health studies while at MichiganState University (the test subjects were rats), and I did work on nerves, and on hydrogen in metals, and nuclear stuff. I’ve written about statistics too, like here, talking about abnormal distributions. They’re common in health studies. If you don’t do this analysis, it will mess up the validity of your ANOVA tests. That said, here’s how you do an anova test.
Japan has the highest life expectancy in the world, an average about 84.1 years, compared to 78.6 years for the US. That difference is used to suggest that the Japanese diet must be far healthier than the American. We should all drink green tea and eat such: rice with seaweed and raw or smoked fish. Let me begin by saying that correlation does not imply causation, and go further to say that, to the extent that correlation suggests causation, the Japanese diet seems worse. It seems to me that the quantity of food (and some other things) are responsible for Americans have a shorter life-span than Japanese, the quality our diet does not appear to be the problem. That is, Americans eat too much, but what we eat is actually healthier than what the Japanese eat.
Top 15 causes of death in Japan and the US in order of Japanese relevance.
Let’s look at top 15 causes of deaths in Japan and the US in order of significance for Japan (2016). The top cause of disease death is the same for Japan and the US: it’s heart disease. Per-capita, 14.5% of Japanese people die of this, and 20.9% of Americans. I suspect the reason that we have more heart disease is that we are more overweight, but the difference is not by that much currently. The Japanese are getting fatter. Similarly, we exceed the Japanese in lung cancer deaths (not by that much) a hold-over of smoking, and by liver disease (not by that much either), a holdover of drinking, I suspect.
Japan exceeds the US in Stroke death (emotional pressure?) and suicide (emotional pressure?) and influenza deaths (climate-related?). The emotional pressure is not something we’d want to emulate. The Japanese work long hours, and face enormous social pressure to look prosperous, even when they are not. There is a male-female imbalance in Japan that is a likely part of the emotional pressure. There is a similar imbalance in China, and a worse one in Qatar. I would expect to see social problems in both in the near future. So far, the Japanese deal with this by alcoholism, something that shows up as liver cancer and cirrhosis. I expect the same in China and Qatar, but have little direct data.
Returning to diet, Japan has more far more stomach cancer deaths than the US; it’s a margin of nine to one. It’s the number 5 killer in Japan, taking 5.08% of Japanese, but only 0.57% of Americans. I suspect the difference is the Japanese love of smoked and raw fish. Other diet-related diseases tell the same story. Japan has double our rate of Colon-rectal cancers, and higher rates of kidney disease, pancreatic cancer, and liver cancer. The conclusion that I draw is that green tea and sushi are not as healthy as you might think. The Japanese would do well to switch the Trump staples of burgers, pizza, fries, and diet coke.
The three horsemen of the US death-toll: Automobiles, firearms, and poisoning (drugs). 2008 data.
At this point you can ask why our lives are so much shorter than the Japanese, on average. The difference in smoking and weight-related diseases are significant but explain only part of the story. There is also guns. About 0.7% of Americans are killed by guns, compared to 0.07% of Japanese. Still, guns give Americans a not-unjustified sense of safety from worse crime. Then there is traffic death, 1.5% in the US vs 0.5% in Japan. But the biggest single reason that Americans live shorter lives is drugs. Drugs kill about 1.5% of Americans, but mostly the young and middle ages. They show up in US death statistics mostly as over-dose and unintentional poisoning (overdose deaths), but also contribute to many other problems like dementia in the old. Drugs and poisoning do not shown on the chart above, because the rate of both is insignificant in Japan, but it is the single main cause of US death in middle age Americans.
The king of the killer drugs are the opioids, a problem that was bad in the 60s, the days of Mother’s Little helper, but that have gotten dramatically worse in the last 20 years as the chart above shows. Often it is a doctor who gets us hooked on the opioids. The doctor may think it’s a favor to us to keep us from pain, but it’s also a favor to him since the drug companies give kickbacks. Often people manage to become un-hooked, but then some doctor comes by and re-hooks us up. Unlike LSD or cocaine, opioid drugs strike women and men equally. It is the single major reason we live 5 1/2 years shorter than the Japanese, with a life-span that is shrinking.
Drug overuse seems like the most serious health problem Americans face, and we seem intent on ignoring it. The other major causes of death are declining, but drug-death numbers keep rising. By 2007, more people died of drugs than guns, and nearly as many as from automobile accidents. It’s passed automobile accidents since then. A first suggestion here: do not elect any politician who has taken significant money from the drug companies. A second suggestion: avoid the Japanese diet.
Men become addicted and so do women, but the view in popular movies and songs present some clear differences. Addicted men are presented as drunks or stoners. By contrast, the popular picture of an addicted woman is a middle-aged housewife who takes “mother’s little helper“: anti-depressant and pain pills, “mother’s little helper of the classic Rolling Stones song. Male addicts are presented to take their drugs in the company of friends while female addicts are pictured taking their pills in private. A question I have: is there any evidence to back these popular perceptions.
Not all who are addicted consider their addiction a liability. Though Churchill was addicted to drink, starting the day with a tumbler of whiskey, he imagined it as a virtue. One would be hard-pressed to prove otherwise.
As it happens, if you look at the statistics in a certain way, they do bear out the popular perceptions. About three times as many men as women are in treatment for alcohol or pot, voluntary or court-mandated. Meanwhile, as a percentage of the addicted, women are nearly twice as likely as men to claim pills as their primary addiction. Percentage data is plotted below. The problem with the percentage graph is that it ignores the fact that twice as many men as women are in treatment: 1,233,000 men vs 609,000 women, as of 2011. Multiply the total numbers by the percentages and you find that there are more men than women with primary addiction to pills, or to cocaine, heroin, or meth-amphetamines. For any drug you mention, the real sex-difference is that more men are addicts.
It could be argues that rehab attendance is a bad measure of addiction, but I would argue that this is the best measure, not only are the numbers are more accurate, rehab is an indication that the addict feels that his or her addiction is a problem. It is a mistake, I think, to include people who feel their addiction is not ruining their lives with people who do not, e.g. Churchill. Any person who believes he or she is benefiting, and who has managed to avoid running afoul of the police, it could be argued, does not have a serious problem. Friends and employers may disagree in terms of diagnosis, but in terms of statistics, other measures like self-reporting come to the same conclusion: if it’s a stupid addiction, more men do it than women. Men self-report that they smoke more, binge-drink more, and use drugs more. Men also commit suicide more and end up in jail more.
Main addiction of men and women. percent based on rehab records, 2011. From the TEDS Report on substance abuse. 4/3/14. The most significant sex difference, as I see it: twice as many men as women go to rehab.
In terms of age of prescription drug use, the graph below shows a difference between men and women. There is a slight tendency for women to persist with prescription drugs, but that may reflect the tendency for men to move on to some other stupid behavior.
While more female than male addicts consider opioids their main addiction, since there are twice as many male addicts as female, it comes out that the number using opioids is about the same. A greater fraction of men switch out from opioids, perhaps to another addiction. Source: ibid.
A few cheerful bits of news are in order. One is that smoking, the most deadly of the addictions, is on the decline. It seems like vaping is a contributor to this, and much safer. Similarly, with illicit drug addictions, while use is on the upswing, and while an amazingly large share of Americans have used such drugs — see graph below from Statista — only a small fraction remain users into middle age. Most seem to quit on their own — they even seem to quit heroin when it ceases to serve a purpose. At present, only 60,000/year total die of overdose out of some 120,000,000 who’ve used illicit drugs. Ringo Starr’s song, “I don’t smoke it no more“may be cited, especially when paired with his “Oh my my” song about quitting through dance. If you want to quit and dance doesn’t work for you, I’d suggest AA or NA. To quote Ringo: “You can do it if you try.”
Number of people in the US who have used different illegal drugs as of 2016. It’s about 1/3 of America. The vast majority from every category have quit, and are not using. 89% of heroin uses have quit. You can too. Statista.
As for why men more than women do drugs, all I can say is that they do all sorts of stupid things. They fight in wars more often, they go over Niagara Falls in barrels more often, and they start new businesses more often. Sometimes it works for them; usually not. Here is a more detailed article with the same semi-conclusion: men are stupid, risk takers. I suspect that’s their language of love.
For those who suspect that the medical profession may bear some responsibility for the opioid epidemic, I present a prescription written for Elvis Presley, August 1977. Like many middle age folks, he suffered from back pain and stress. And like most folks, he trusted the medical professionals to “do no harm” prescribing nothing with serious side effects. Clearly he was wrong.
Elis prescription, August 1977. Opioid city.
The above prescription is a disaster, but you may think this is just an aberration. A crank doctor who hooked (literally) a celebrity patient, but not as aberrant as one might think. I worked for a pharmacist in the 1970s, and the vast majority of prescriptions we saw were for these sort of mood altering drugs. The pharmacist I worked for refused to service many of these customers, and even phoned the doctor to yell at him for one particular egregious case: a shivering skinny kid with a prescription for diet pills, but my employer was the aberration. All those prescriptions would be filled by someone, and a great number of people walked about in a haze because of it.
The popular Stones song, Mother’s Little Helper, would not have been so popular if it were not true to life. One might ask why it was true to life, as doctors might have prescribed less addicting drugs. I believe the reason is that doctors listened to advertising then, and now. They might have suggested marijuana for pain or depression — there was good evidence it worked — but there were no colorful brochures with smiling actors. The only positive advertising was for opioids, speed, and Valium and that was what was prescribed then and still today.
One of the most common drugs prescribed to kids these days is speed, marketed as “Ritalin.” It prevents daydreaming and motor-mouth behaviors; see my essay is ADHD a real disease?. I’m not saying that ADD kids aren’t annoying, or that folks don’t have back ached, but the current drugs are worse than marijuana as best I can tell. It would be nice to get non-high-inducing pot extract sold in pharmacies, in my opinion, and not in specialty stores (I trust pharmacists). AS things now stand the users have medical prescription cards, but the black sellers end up in jail..
As I write this, the price of a single bitcoin is approximately $11,100 yesterday, up some 2000% in the last 6 months. The rise rate suggests it is a financial bubble. Or maybe it’s not: just a very risky investment suited for inclusion in a regularly balanced portfolio. These are two competing views of bitcoin, and there are two ways to distinguish between them. One is on the basis of technical analysis — does this fast rise look like a bubble (Yes!), and the other is to accept that bitcoin has a fundamental value, one I’ll calculate that below. In either case, the price rise is so fast that it is very difficult to conclude that the rise is not majorly driven by speculation: the belief that someone else will pay more later. The history of many bubbles suggests that all bubbles burst sooner or later, and that everyone holding the item loses when it does. The only winners are the brokers and the last investors who get out just before the burst. The speculator thinks that’s going to be him, while the investor uses rebalancing to get some of benefit and fun, without having to know exactly when to get out.
That bitcoin is a bubble may be seen by comparing the price three years ago. At that point it was $380 and dropping. A year later, it was $360 and rising. One can compare the price rise of the past 2-3 years with that for some famous bubbles and see that bitcoin has risen 30 times approximately, an increase that is on a path to beat them all except, perhaps, the tulip bubble of 1622.
A comparison between Bitcoin prices, and those of tulips, 1929 stocks, and other speculative bubbles; multiple of original price vs year from peak.
That its price looks like a bubble is not to deny that bitcoin has a fundamental value. Bitcoin is nearly un-counterfeit-able, and its ownership is nearly untraceable. These are interesting properties that make bitcoin valuable mostly for illegal activity. To calculate the fundamental value of a bitcoin, it is only necessary to know the total value of bitcoin business transactions and the “speed of money.” As a first guess, lets say that all the transactions are illegal and add up to the equivalent of the GDP of Michigan, $400 billion/year. The value of a single bitcoin would be this number divided by the number of bitcoin in circulation, 15,000,000 currently, and by the “speed of money,” the number of business transactions per year per coin. I’ll take this to be 3 per year. It turns out there are 5 bitcoin transactions total per year per coin, but 2/5 of that, I’ll assume, are investment transactions. Based on this, a single bitcoin should be worth about $8890, slightly below its current valuation. The gross speed number, 5/year, includes bitcoin transactions that are investments and never traded for goods, and those actively being used in smuggling, drug-deals, etc.
If the bitcoin trade will grow to $600 billion year in a year with no other change, the price rise of a single coin would surpass that of Dutch tulip bulbs except that more coins are bing minted, and that the speed is increasing. If you assume that coin use will reach $1,600 billion/year, the GDP of Texas in the semi-near future, before the Feds jump in, the fundamental value of a coin should grow no higher than $44,000 or so. There are several problems for bitcoin investors who are betting on this. One is that the Feds are unlikely to tolerate so large an unregulated, illegal economy. Another is that bitcoin transactions are not likely to go totally legal. It is very hard (near impossible) to connect a bitcoin to its owner. This is a plus for someone trying to deal in drugs or trying hide profits from the IRS (or his spouse), but a legal merchant will want the protection of courts of law. For this, he or she needs to demonstrate ownership of the item being traded, and that is not available with bitcoin. The lack of a solid, legitimate business need suggests to me that the FBI will likely sweep in sooner or later, and that the value of a coin will never reach $44,000.
Yet another problem for those wishing to invest in bitcoin is the existence of more bitcoins (undiscovered, or un-mined so far) and the existence of other cryptocurrencies with the same general qualities: Litecoin (LTC), Ethereum (ETH), and Zcash (ZEC) as examples. The existence of these coins increases the divisor one should use when calculating the value of a bitcoin. The total number of bitcoins is capped at 21,000,000, that is 6,000,000 coins more than known today. Assuming more use and more acceptance, the speed (turnovers per year) is likely to increase to four or five, similar to that of other currencies. Let’s assume that the bitcoin will control 1 trillion dollars per year of a $1.6 trillion/year illegal market. One can now calculate the maximum long term target price of a bitcoin by dividing $1 trillion/year by the number of bitcoins, 21,000,000, and by the speed of commercial use, 4.5/year. This suggests a maximum fundamental value of $10,582 per coin. This is just about the current price. Let the investment buyer beware.
The penicillin molecule is a product of the penicillin mold
Many people believe they are allergic to penicillin — it’s the most common perceived drug allergy — but several studies have shown that most folks who think they are allergic are not. Perhaps they once were, but when people who thought they were allergic were tested, virtually none showed allergic reaction. In a test of 146, presumably allergic patients at McMaster University, only two had their penicillin allergy confirmed; 98.6% of the patients tested negative. A similar study at the Mayo Clinic tested 384 pre-surgical patients with a history of penicillin allergy; 94% tested negative. They were given clearance to receive penicillin antibiotics before, during, and after surgery. Read a summary here.
Orange showing three different strains of the penicillin mold; some of these are toxic.
This is very good news. Penicillin is a low-cost, low side-effect antibiotic, effective against many diseases including salmonella, botulism, gonorrhea, and scarlet fever. The penicillin molecule is a common product of nature, produced by a variety of molds, e.g. on the orange at right, and in cheese. It is thus something people have been exposed to, whether they realize it or not.
Penicillin allergy is a deadly danger for the few who really are allergic, and it’s worthwhile to find out if that means you. The good news: that penicillin is found in common cheeses suggests, to me, a simple test for penicillin allergy. Anyone who suspects penicillin allergy and does not have a general dairy allergy can try eating appropriate cheese: brie, blue, camembert, or Stilton. That is any of the cheeses made with penicillin molds. If you don’t break out in a rash or suffer stomach cramps, you’re very likely not allergic to penicillin.
There is some difference between cheeses, so if you have problems with Roquefort, but not brie or camembert, there’s still a good chance you’re not allergic to penicillin. Brie and camembert have a white fuzzy mold coat of Penicillium camemberti. This mold exudes penicillin — not in enough quantity to cure gonorrhea, but enough to give taste and avoid spoilage, and enough to test for allergy. Danish blue and Roquefort, shown below, have a different look and a sharper flavor . They’re made with blue-green, Penicillium roqueforti. This mold produces penicillin, but also a small amount of neurotoxin, roquefortine C. It’s not enough to harm most people, but it could cause an allergic reaction to folks who are not allergic to penicillin. Don’t eat a moldy orange, by the way; some forms of the mold produce a lot of neurotoxin.
For people who are not allergic, a thought I had is that one could, perhaps treat heartburn or ulcers with cheese; perhaps even cancer? H-Pylori, the bacteria associated with heartburn, is effectively treated by amoxicillin, a penicillin variant. If a penicillin variant kills the bacteria, it seems plausible that penicillin cheese might too. And since amoxicillin, is found to reduce the risk of gastric cancer, it’s reasonable to expect that penicillin or penicillin cheese might be cancer-protective. To my knowledge, this has never been studied, but it seems worth considering. The other, standard treatment for heartburn, pantoprazole / Protonix, is known to cause osteoporosis, and increase the risk of cancer, and it doesn’t taste as good as cheese.
The blue in blue cheese is Penicillium roqueforti. Most people are not allergic.
Penicillin was discovered by Alexander Fleming, who noticed that a single spore of the mold killed the bacteria near it on a Petrie dish. He tried to produce significant quantities of the drug from the mold with limited success, but was able to halt disease in patients, and was able to interest others who had more skill in large-scale fungus growing. Kids looking for a good science fair project, might consider penicillin growing, penicillin allergy, treatment of stomach ailments using cheese, or anything else related to the drug. Three Swedish journals declared that penicillin was the most important discovery of the last 1000 years. It would be cool if the dilute form, the one available in your supermarket, could be shown to treat heartburn and/or cancer. Another drug you could study is Lysozyme, a chemical found in tears, in saliva, and in human milk (but not in cow milk). Alexander Fleming found that tears killed bacteria, as did penicillin. Lysozyme, the active ingredient, is currently used to treat animals, but not humans.
Robert Buxbaum, November 9, 2017. Since starting work on this essay I’ve been eating blue cheese. It tastes good and seems to cure heartburn. As a personal note: my first science fair project (4th grade) involved growing molds on moistened bread. For an incubator, I used the underside of our home radiator. The location kept my mom from finding the experiment and throwing it out.
Despite years of marijuana decriminalization, arrest rates for marijuana are up from 20-25 years ago, and hardly down from last year. Why?
There are a couple of troubling patterns in US drug arrests. For one, though marijuana has been decriminalized in much of the USA, marijuana arrest rates are hardly down from five years ago, and higher than 20-30 years ago — see graph at right. Besides that, it’s still mostly black-people and Latinos arrested. And the crime is, 4/5 the of the time, drug possession, not sale.
At the same time that violent crime rates are falling, marijuana possession arrests are rising (see graph below). Currently, according to FBI statistics, more people are arrested for marijuana possession than for all violent crime combined. You’d expect it would not be this way, and a question I’d like to explore is why. But first, let’s look at more data. I note that part of an explanation is that marijuana use is up (18% in 2015 vs 12% in 1990). This still doesn’t explain the racial imbalance but it could explain the general rise. Marijuana isn’t quite legal, and if use is up, you’d expect arrests to be up. But even here, something is fishy: use rates are the same as in 1980, 35+ years ago in the midst of the “war on drugs,” but arrest rates have more than doubled since. Why? Take New York City as an example, 17,762 people were arrested for low-level marijuana possession in 2016 (smoking in public or possession of 25 gm to 2 oz). The low-level arrest rate is twice the national average in this Democratic-bastion city, where the drug was decriminalized years ago. Arrest rates in NYC went up an additional 10% in 2016, with black people arrested at 11 times the rate of white people. How could this be?
The race discrepancy of arrests persists across the US. Though black citizens use drugs only 15% or so more often than whites, and make up only 13% of the US population, they are arrested for drugs about three times as often and incarcerated about 4 times as often. It’s mostly for marijuana possession too, and the discrepancy varies very strongly by location In Louisiana, Illinois, and New York City arrests are particularly weighted to people of color. When New York City police precinct captains were asked about this, they explained that their instructions come from above. It’s a curious answer, I’d say, reflecting perhaps their dislike of the mayor.
Drug arrests are mostly for possession, not sale and the spread is rising. More than half the time, it’s marijuana.
One of the race-affecting instructions is that the police are instructed to patrol black neighborhoods, but not the student unions of majority-white colleges like NYU. They’re mandated to stop and search junky cars but not nice ones, and to search people who have outstanding parking tickets, but not generally. They even get raises that depend on the number of tickets given, a practice that does not lead to a pattern of looking the other way — one many New Yorkers would prefer. Another issue: in many states, including New York, the police can keep money or cars, if they can claim that the asset was purchased with drug money or used in the drug trade. This leads to a practice where the city budget benefits when the police arrest persons they don’t expect will be convicted. It’s a practice called civil asset forfeiture, one lampooned, on Last Week Tonight, but jealously guarded. Since it is near impossible to prove that the money or car was not used in any way illegally, once they arrest someone, the police can expect to keep his or her money or cars indefinitely. The annoyance of lawyers perhaps encourages the arrest of people who do not seem to have them — people of color. New York mayor deBlassio justifies his arrests as a way to protect the neighborhoods, as his version of former mayor, Guilliani’s broken window approach. Maybe. But I think the profit motive is at least as relevant.
Drug arrests hit black folks a lot more than white.
I note that strict justice tends to land hardest on the poor and defenseless. I also note that many important people have used marijuana without it damaging their lives in any obvious way. Both Jeb! Bush and Bill Clinton claimed to have smoked it; as did Barak Obama, Al Gore, and the Beatles. My bottom line: while marijuana decriminalization is worthwhile, it must go along with the repeal of civil asset forfeiture laws, and other means that make arrests into profit centers – or so it appears to me. Otherwise we’ll keep on flushing lives down the drain for no good reason.
