Some years ago, I thought to help my daughter understand statistics by reanalyzing the data from a 2004 study on coffee and Parkinson’s disease mortality, “Coffee consumption, gender, and Parkinson’s disease mortality in the cancer prevention study II cohort: the modifying effects of estrogen” , Am J Epidemiol. 2004 Nov 15;160(10):977-84, see it here
For the study, a cohort of over 1 million people was enrolled in 1982 and assessed for diet, smoking, alcohol, etc. Causes of deaths were ascertained through death certificates from January 1, 1989, through 1998. Death certificate data suggested that coffee decreased Parkinson’s mortality in men but not in women after adjustment for age, smoking, and alcohol intake. They used a technique I didn’t like though, ANOVA, analysis of variance. That is they compare the outcome of those who drank a lot of coffee (4 cups or more) to those who drank nothing. Though women in the coffee cohort had about 49% the death rate, it was not statistically significant by the ANOVA measure (p = 0.6). The authors of the study understood estrogen to be the reason for the difference.
I thought we could do a better by graphical analysis, see plot at right, especially using R2 to analyze the trend. According to this plot it appears that coffee significantly reduces the likelihood of death in both men and women, confidence better than 90%. Women don’t tend to drink as much coffee as men, but the relative effect per cup is stronger than in men, it appears, and the trend line is clearer too. In the ANOVA, it appears that the effect in women is small because women are less prone Parkinson’s.
There is a confounding behavior that I should note, it’s possible that people who begin to feel signs of Parkinson’s, etc. stop drinking coffee. I doubt it, give the study’s design, but it’s worth a mention. The same confounding is also present in a previous analysis I did that suggested that being overweight protected from dementia, and from Alzheimer’s. Maybe pre-dementia people start loosing weight long before other symptoms appear.
It’s good to have hero, someone whose approach to life, family and business you admire that you might reasonably be able to follow. As an engineer, inventor, I came to regard Peter Cooper of New York as a hero. He made his own business and was a success, in business and with his family without being crooked. This is something that is not as common as you might think. When I was in 4th grade, we got weekly assignments to read a biography and write about it. I tended to read about scientists and inventors then and after. I quickly discovered that successful inventors tended to die broke, estranged from their family and friends. Edison, Tesla, Salk, Goodyear, and Ford are examples. Tesla didn’t marry. Henry Ford’s children were messed up. Salk had a miserable marriage. Almost everyone working on the Atom Bomb had issues with the government. Most didn’t benefit financially. They died hated by the press as mass-murderers, and pursued by the FBI as potential spies. It was a sad pattern for someone who hoped to be an inventor -engineer.
The one major exception I found was Peter Cooper, an inventor, industrialist, and New York politician who was honest, and who died wealthy and liked with a good family. One result of reading about him was to conclude that some engineering areas are better than others; generally making weapons is not a path to personal success.
Peter Cooper was different, both in operation and outcome. Though he made some weapons (gun barrels) and inverted a remote control torpedo, these were not weapons of mass killing. Besides he but thee for “the good side” of the Civil War. And, when Cooper made an invention or a product, he made sure to have the capital available to make a profit on it too. He worked hard to make sure his products were monopolies, using a combination of patents and publicity to secure their position.
Cooper was a strong family man who made sure to own his own business, and made sure to control the sources of key materials too. He liked to invest in other businesses, but only as the controlling share-holder, or as a bond holder, believing that minor share-holders tend to be cheated. He was pro monopoly, pro trusts, and a big proponet of detailed contracts, so everyone knew where they stood. A famous invention of Cooper’s was Jello, a flavored, light version of his hide-glue, see the patent here. Besides patenting it, he sold the product with his brand, thus helping to maintain the monopoly.
Cooper was generous with donations to the poor, but not to everyone, and not with loans. And he would not sign anyone’s note as a guarantor. Borrowers tended to renege, he found, and they resent you besides. You lose your money, and lost them as a friend. He founded two free colleges, Cooper Union, and the Cooper-Limestone Institute, plus an inventor’s institute. (I got my education, free from Cooper Union.) Cooper ran these institutions in his lifetime, not waiting till he was dead to part with his money. Many do this in the vain hope that others will run the institution as they would.
Peter Cooper always sought a monopoly, or a near monopoly, patenting his own inventions, or buying the rights to others’ patents to help make it so. He believed that monopolies were good, saying they were the only sort of business that made money while allowing him to treat his workers well. If an invention would not result in a monopoly, Peter Cooper gave the rights away.
The list of inventions he didn’t patent include the instruments to test the quality of glue and steel (quality control is important), and a tide-powered ferry in New York. Perhaps his most famous unpainted invention was a lightweight, high power steam locomotive, “The Tom Thumb”, made in 1840. Innovations included beveled wheels to center the carriage on its rails, and a blower on the boiler fire, see photo above. The blower meant he could generate high-power in a small space at light weight. These are significant innovations, but Cooper did not foresee having a monopoly, so he didn’t pursue these ideas. Instead, he focussed on making rails and wire rope; he patented the process to roll steel, and the process for making coke from coal. Also on his glue/jello business. Since he made these items from dead cows and horses, he found he could also sell “foot oil” and steam-pounded leather, “Chamois”. He also pursued a telephone/ telegraph business across the Atlantic, more on that below, but only after getting monopoly rights for 50 years.
Cooper managed to stay friends with those he competed with by paying license fees for any patents he used (he tried to negotiate low rates), or buying or selling the patent rights as seemed appropriate. He also licensed his patents, and rented out buildings he didn’t need. He rented at a rate of 7% of the sale price, a metric I’ve used myself, considering rental to be like buying on loan. There is a theory of stock-buying that matches this.
The story the telegraph cable across the Atlantic is instructive to seeing how the pieces fit together. The first significant underwater cable was not laid by Cooper, by a Canadian inventor, Frederick Gisborne. It was laid in 1852 between Prince Edward Island and New Brunswick. Through personal connections, Gisborne’s company got exclusive rights for 30 years, for this and for a cable that would go to Newfoundland, but he didn’t have the money or baking to make it happen. The first cable failed, and Gisborne ran out of money and support. Only his exclusive rights remained. This is the typical story of an inventor/ engineer/businessman who has to rely on other peoples’ money and patience.
A few months after the failure, a friend of Cooper’s, Cyrus Field, convinced Cooper that good money could be made, and public good could be done, if Cooper could lay such a cable all the way to London. One thing that attracted Cooper to the project was that the cable could be made as an insulated iron-copper rope in Cooper’s own factory. Cooper, Field, and some partners (see painting below) bought Gisborne’s company, along with their exclusive rights, and formed a new company, The New York, Newfoundland & London Telegraph Company, see charter here. The founders are imagined* with a globe and a section of cable sitting on their table. Gisborne, though not shown in the painting, was a charter member, and made chief engineer. Cooper was president. He also traveled on the boat with Gisborne to lay the cable across the St. Lawrence – just to be sure he knew what was going on. This cable provided a trial for The Trans Atlantic cable.
Samuel Morse was hired as an electrician; he is pictured in the painting, but was not a charter member. Part of the problem with Morse was that he owned the patent on Morse-telegraphy, and Cooper didn’t want to pay his “exorbitant” fees. So Cooper and Field bought an alternative telegraph patent from David Hughes, a Kentucky school teacher. This telegraph system used tones instead of clicks and printed whole letters at a time. By hiring Morse, but not his patents, Cooper saved money, while retaining Morse’s friendship and expertise. The alternative could have been a nasty spat. Their telegraph company sub-licensed Hughes’s tone-method a group of western telegraph owners, “The Western Union,” who used it for many years, producing the distinctive Western Union Telegrams. With enough money in hand and credibility from the Canadian trial, the group secured 50 years monopoly rights for a telegraph line across the Atlantic. Laying the cable took many years, with semi-failed attempts in 1857, 1858, and 1865. When the eventual success came in 1866, the 50 years’ monopoly rights they’d secured meant that they made money from the start. They could treat workers fairly. Marconi would discover that Cooper wrote a good contract; his wireless telegraph required a widely different route.
I should also note that Peter Cooper was politically active: he started as a Democrat, helped form the Republican Party, bringing Lincoln to speak in NY for the first time, and ended up founding the Greenback-Labor Party, running for president as a Greenback. He was strongly for tariffs, and strongly against inflation. He said that the dollar should have the same value for all time for the same reason that the foot should have the same length and the pound the same weight. I have written in favor of tariffs off and on. They help keep manufacturing in America, and help insure that those who require French wine or German cars pay the majority of US taxes. They are also a non-violent vehicle for foreign policy.
Operating under these principles, through patents and taxed monopolies, Peter Cooper died wealthy, and liked. Liked by his workers, liked by much of the press, and by his family too, with children who turned out well. The children of rich people often turn out poorly. Carnegie’s children fought each other in court, Ford’s were miserable. Cooper’s children continued in business and politics, successfully and honorably, and in science/ engineering (Peter Coper Hewitt invented the power rectifier, sold to Westinghouse). The success of Peter Cooper’s free college, Cooper Union, influenced many of his friends to open similar institutions. Among his friends who did this were Carnegie, Pratt, Stevens, Rensselaer, and Vanderbilt. He stayed friends with them and with other inventors of the day, despite competing in business and politics. Most rich folks can not do this; they tend to develop big egos, and few principles.
Robert Buxbaum, November 30, 2022. I find the painting interesting. Why was it painted? Why is Gisborne not in it and Morse in the painting — sometimes described as vice President? The charter lists Morse as “electrician”, an employee. Chandler White, holding papers next to Cooper, was Vice President. My guess is that the painting was made to help promote the company and sell stock. They made special cigars with this image too. This essay started as a 5th grade project with my son. See a much earlier version here.
Much of health research is a search for simple, bio-molecular causes for our medical problems. These can result in pill-solutions. Diseases tend to be more complex, but Alzheimers seemed to work that way, until this summer when it turned out that the data supporting the simple theory was faked. Alzheimer’s is a devastating cognitive disease that is accompanied by a degenerating brain, with sticky, beta-amyloid plaques and tangles. About 16 years ago, this report, published in Nature seemed to show that a beta-amyloid, Aβ*56, caused the plaques and caused cognitive decline independent of any other Alzheimers indicators.
We were on the way to a cure, or so it seemed. Several studies by this group backed the initial results, and much of Alzheimer’s research was directed into an effort to fill in the story, and find ways to reduce the amount and bonding of this amyloid and others like it. Several other groups claimed they could not find the amyloid at all, or show that amyloids caused the symptoms described. But most negative results went unpublished. The theory was so satisfying, and the evidence from a few so strong, that the NIH poured billions into this approach, over $1B in this year alone. The FDA approved aducanumab, a drug from Biogen, on the assumption that it should work, even though it showed little to no benefit, and had some deadly side effects. Other firms followed, asking for approval of related anti-amyloid drugs that should work.
When news of the fraud came out, detected by Matthew Scragg and a few lone curmudgeons, stock prices plummeted in the drug companies. It now appears that the original work was made up, presented to journals and to the NIH using photoshopped images. For the group that did the fake work, it may mean jail time, for most other groups, the claim is that their work is still relevant. Doctors still prescribe the medications as they have nothing better to offer (Aducanumab therapy costs $50,000 per year). Maybe it’s time to start looking at alternative approaches and theories, sidelined over the last 16 years.
Some alternative theories posit that another molecule is responsible, particularly tau, associated with the tangles. Another sidelined theory is that amyloids are good. For example, that it’s the loss of soluble amyloids that causes Alzheimer’s. Alternately, that inflammation is the root cause, and that the amyloid plaques and tangles are a response to the inflammation, a bandage, perhaps. These theories could explain why the anti-amyloid drugs so often resulted in patient death.
It’s also possible that the inability of nerve cells to dispose of waste is the cause of AZ. In heathy people, waste is removed through acidic enzymes within lysosomes. Patients with decreased acid activity have a buildup of waste that includes amyloids. Perhaps the cure is to restore the acid enzymes.
My favorite theory is based on statistical data that shows that fat people are less likely to develop Alzheimers. This might lead to a junk-food cure. The fitness industry is very much against this theory–It’s debated here. They tend to support the inflammation model, claiming that diseases cause Alzheimer’s and cause patients to loose weight first. Could be. I note that Henry Kissinger is the only active politician of my era, the early 70s, still alive and writing intelligently.
Robert Buxbaum, November 17-19, 2022. I hope that Matthew Schragg comes out OK, by the way. Ben Franklin pointed out, that “No good deed goes unpunished.”
Elite colleges strive to be selective, and they are, just not for the hard-working scholars they claim to select for. They claim to be color-blind, income-blind, and race-blind, aiming for the best: the most intelligent, most ethical, and hardest working scholar-candidates. Then, to their surprise and satisfaction, all the ivies find that the vast majority of the chosen come from the same rich families and prep-schools as 100 years ago. That happens because the selection is crooked with measures tilted to the rich, Protestant, and preppy.
Through most of the 1900s, most of the ivies had a Jewish quota, enforced formally or informally. They also did their best to discourage middle class, black, and Catholic students in the interest of maintaining the proper student mix. Under Woodrow Wilson, Princeton went further and admitted not one black student. When quotas became illegal, schools began to rely on athletics and tests, with blatant cheating as revealed by the “Varsity Blues” sting operation. In that sting, a dozen or more athletic coaches and high-school administrators were caught taking SAT tests for their richer, connected students, and/or making up phony athletic achievements. The Ivies claimed shock after the cheating was revealed, but it is beyond belief that no one had noticed that these top brains and athletes were neither.
Another version of this is that richer kids can get extra time to do SAT and ACT tests. The extra time doesn’t show up on the SAT or ACT score, you need a doctor to certify that you are dyslectic or have severe ADHD. Most boys are diagnosed with ADHD these days, itself something of a scam, but most boys don’t get extra test time. You need the right doctor and the right documentation, plus enough money and connections to get the test given by certified test-giver in your own private room. It used to be that the SAT and ACT would report the extra time, but this changed in 2004. Now the extra time, and the disease is not documented, just the higher score. There have been complaints, but the scam goes on. Similar to this, top Olympic athletes can be diagnosed with asthma, and allowed to use performance enhancing, anti-asthma steroids. Again complaints, but no change.
Ivy League schools also tilt to the right families by requiring signs of the right sort of leadership as evaluated by an interview and an essay (see my post on John Kennedy’s essay). You score high on leadership if you helped your relative run for governor. By contrast, if you organized a ping-pong or basketball tournament at your Catholic or Jewish school, you’re the wrong sort of leader. Eagle Scout is sort-of the right sort, and speaking against climate change on TV is. Greta Thernberg and Chelsea Clinton are climate leaders; you, probably are not.
The Ivys explicitly state that they choose for athleticism, but not all sports are equal. All the Ivies claim to need a good women’s lacrosse team, a good crew team, and some good high-divers. Are these sports unavailable at your high-school? What a shame, you’re not a real athlete. You can still try to get in based on extreme leadership and academics.
There is no real reason that Harvard needs a top crew team, or needs to excel at women’s lacrosse or high-diving. Sport was not an admission criteria in the 1800s. It was added in the 1900s to avoid admitting Catholics, Jews, and Asians who tended to score well but could not compete on the selected sports. The president of Harvard, Abbot Lowell wrote, “Somehow or other the enrollment of the Jewish students must be limited”. The method he chose, and that all the Ivies came to use, included these tests of leadership and sport, plus a preference for legacies. The children and grand-children of alumni are given significant preferential selection at all the ivies. At Harvard, the acceptance rate for legacy students is about 33%, compared with an overall acceptance rate of under 6%. Since legacies are mostly white, rich, protestant, and preppy, the next generation is guaranteed to be the same.
The Ivies’ methods have been challenged many times over the years. Quotas were found to be illegal as early as 1964. Since then there have been claims of effective quotas, a cause that was pushed under the rug until Donal Trump took it up. Most recently, Harvard, Princeton, and UNC were sued by Asians. One of these, from a poor background scored at the top of his class with a 4.4 GPA and had near-perfect SAT scores, but was rejected for no obvious reason beyond race. The Supreme Court is expected to hear the case in 2023. Ahead of this decision, all eight Ivies have decided to dispense with testing for at least for now. The ivies claim that, by making tests optional, they will avoid locking out students who are great (though somewhat illiterate and innumerate). The real purpose seems to be to lock out pushy Asians who might sue them or be so bright they make the legacies feel dumb.
None of the above would matter if the Ivies were not so wonderful, at least the better ones are. I went to Princeton grad school, see photos. It was great despite its waspy leanings. If you can go there, or to Harvard, Yale, Cornell or Penn, go. My feeling for Brown and Columbia are rather the opposite: they’ve gone to the extreme and voted for BDS, see the text here for Brown’s version. Not only did they vote to boycott Israelis and Israeli produce, the “B” of BDS, the’ve also committed to suppress Zionists everywhere. That’s Jews who support Israel. Several, non ivy schools, have committed to the same. In their view, for open debate to flourish anywhere, proud Jews must be excluded. These are no longer colleges, but Klavens.
Kennedy was a well-liked president with several character flaws. The most famous were his sexual dalliances. One these was with a Nazi spy, Inga Marie Arvad, “Inga Binga”. He continued with her, on and off, from his days in Naval Intelligence through his election to congress in 1946 despite being informed of her background by the navy and the FBI. When they began their relationship, Inga Marie was beautiful, 28 and married. That didn’t seem to matter, as she was beautiful, the ex-Miss Denmark, charming and instantly in love with Kennedy. She was also a close friend of Hitler, Goring, and Göebbels, and in the employ of both The Washington Times-Herald and of Axel Wenner-Gren, a suspected Nazi spy master who owned the largest private yacht in the world. It was suspected that the fuel Wenner-Gren bought for his yacht was used to refuel German U-boats in the area.
Before becoming involved with Kennedy, Ms Arvand had married Kamak Abdel Nabi, an Egyptian diplomat, and then Paul Fejos, a Hungarian film-maker. She traveled the world with Fejos, financed by Wenner-Gren, meeting, greeting, and film-making. Still married, she left Fejos in 1936 to move to the US and study journalism at Columbia University. Getting a job at the Washington Times-herald, she wrote light hearted articles based on interviews with the movers and shakers of DC, supported by $5000 checks from her friend, Wenner-Gren.
The affair with Kennedy began in the fall of 1941. Kennedy was working at the Office of Naval Intelligence, a post he’d gotten with influence from his ambassador father, “Big Joe Kennedy”. Joe was an opponent of going to war. Ms. Arvand heartily agreed. She met Jack Kennedy through his sister, Kathleen, “Kick”.
The office of Naval Intelligence had rules against adulterous relationships. Kennedy ignored them. In this case it was particularly problematic as Inga was married, Protestant, and an associate of Hitler. The navy told Kennedy to stay away, and transferred him to Charlestown with orders to stay there, “not to venture more than 50 miles”. Ms Arvad visited him there often under an assumed name, Barbara White. They stayed together, took in movies, plays, and golf. The FBI watched as Arvad was thought to be a spy. Kennedy was again told to stay clear; he did not. Eventually, Hoover intervened and got Kennedy transferred to the South Pacific despite his bad back and other health problems. Inga broke off with Kennedy though he continued to write love letters. She ignored them. Perhaps she thought Kennedy was no longer interesting, even a liability. She was trying to get a job with US overseas intelligence, the forerunner of the CIA.
When Inga didn’t get the job, she moved to Los Angeles where she continued in journalism, working for Harpers Bazar, interviewing the movers and shakers in LA and New York, generally pushing for peace. In January, 1944, she started writing to Kennedy again. He was a hero with political ambitions. She reunited with Kennedy in LA, for a private interview, published, about the sinking of his PT boat. They continued dating well into 1946, after Kennedy was elected to congress. Inga got pregnant from someone (Kennedy?) and left to marry an actor she’d been dating, Tim McCoy. Some months later, Inga gave birth to a boy who looks a lot more like Kennedy than like her husband, see photo.
While Inga no longer contacted JFK, nor JFK her, it seems that Inga was a major factor influencing Kennedy to go into politics — where he could make the world more peaceful. Inga died of Colin cancer in 1973. She only revealed her part of the affair to her eldest son, the Kennedy look-alike, near the end of her life.
Regarding John Kennedy, I’m less-bothered by his sexual dalliances, than by his tendency to suddenly reverse himself. Kennedy called for an attack on Cuba, then reversed while the attack was in progress, dooming the attackers. He reversed again in South Vietnam, first first supporting the government then overthrowing it, and on civil rights. Vigorous persistence, even in the face of criticism is a good trait in a president, something I liked about LBJ, Nixon, Clinton, and Reagan.
It is a particular skill of management to hog the glory and cast the blame; if a project succeeds, executives will make it understood that the groups’ success was based on their leadership (and their ability to get everyone to work hard for low pay). If the project fails, a executive will cast blame typically on those who spotted the problem some months early. These are the people most likely to blame the executive, so the executive discredits them first.
This being the dynamic of executive oversight, it becomes difficult to look over the work of a group and tell who is doing good and who is coasting. If someone’s got to be fired in the middle of a project, or after, who do you fire? My first thought is that, following a failure, you fire the manager and the guy at the top who drew the top salary. That’s what winning sports teams do. It seems to promote “rebuilding” it’s a warning to those who follow. After the top people are gone, you might get an honest appraisal of what went wrong and what to do next.
A related problem, if you’re looking to hire is who to pick or promote from within. In the revolutionary army, they allowed the conscripts to pick some of their commanders, and promoted others based on success. This may not be entirely fair, as there are many causes to success and failure, but it seemed to work better than the British system, where you picked by birth or education. Here’s a lovely song about the value of university education in a modern major general.
A form of this feedback about who knows what he’d doing and who does not, is to look at who is listened to by colleagues. When someone speaks, do people who know listen. It’s a method I’ve used to try to guess who knew things in a field outside my own. Bull-shitters tend to be ignored when they speak. The major general above is never listened to.
In basketball or hockey, the equivalent method is to see who the other players pass to the most, and who steals the most from the other side. It does not take much watching to get a general sense, but statistics help. With statistics, one can set up a hierarchical system based on who listens to whom, or who passes to whom with a logistic equation as used for chess and dating sites. A lower-paid person at the center-top is a gem who you might consider promoting.
In terms of overall group management, it was the opinion of W Edwards Deming, the name-sake of the Deming prize for quality, that overall group success was typically caused by luck or by some non-human cause. Thus that any manager would be as good as any other. Deming had a lovely experiment to show why this is likely the case– see it here. If one company or team did better year after year, it was common that they were in the right territory, or at the right time. As an example, the person who succeeded selling big computers in New York in the 1960s was not necessarily a good salesman or manager. Anyone could have managed that success. To the extent that this is true, you should not fire people readily, but neither worry that your highest paid manager or salesman is irreplaceable.
Sharrow Marine introduced a new ship propeller design two years ago, at the Miami International Boat show. Unlike traditional propellers, there are no ends on the blades. Instead, each blade is a connecting ribbon with the outer edge behaving like a connecting winglet. The blade pairs provide low-speed lift-efficiency gains, as seen on a biplane, while the winglets provide high speed gains. The efficiency gain is 9-30% over a wide range of speeds, as shown below, a tremendous improvement. I suspect that this design will become standard over the next 10-20 years, as winglets have become standard on airplanes today.
The high speed efficiency advantage of the closed ends of the blades, and of the curved up winglets on modern airplanes is based on avoiding losses from air (or water) going around the end from the high pressure bottom to the low-pressure top. Between the biplane advantage and the wingtip advantage, Sharrow propellers provide improved miles per gallon at every speed except the highest, 32+ mph, plus a drastic decrease in vibration and noise, see photo.
The propeller design was developed with paid research at the University of Michigan. It was clearly innovative and granted design patent protection in most of the developed world. To the extent that the patents are respected and protected by law, Sharrow should be able to recoup the cost of their research and development. They should make a profit too. As an inventor myself, I believe they deserve to recoup their costs and make a profit. Not all inventions lead to a great product. Besides, I don’t think they charge too much. The current price is $2000-$5000 per propeller for standard sizes, a price that seems reasonable, based on the price of a boat and the advantage of more speed, more range, plus less fuel use and less vibration. This year Sharrow formed an agreement with Yamaha to manufacture the propellers under license, so supply should not be an issue.
China tends to copy our best products, and often steals the technology to make them, employing engineers and academics as spys. Obama/Biden have typically allowed China to benefit for the sales of copies and the theft of intellectual property, allowing the import of fakes to the US with little or no interference. Would you like a fake Rolex or Fendi, you can buy on-line from China. Would you like fake Disney, ditto. So far, I have not seen Chinese copies of the Sharrow in the US, but I expect to see them soon. Perhaps Biden’s Justice Department will do something this time, but I doubt it. By our justice department turning a blind eye to copies, they rob our innovators, and rob American workers. His protectionism is one thing I liked about Donald Trump.
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.
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.
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.”
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.
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.
Two years ago, I was diagnosed with Atrial fibrillation, A-Fib in common parlance, a condition where my heart would sometimes speed up to double its normal speed. I was prescribed metopolol and then atenolol, common beta blockers, and a C-Pap for sleep apnea. None of this seemed to help, as best I could tell from occasional pulse measurements with watch and a finger pulse-oxometer. Besides, the C-Pap was giving me cough and the beta blockers made me dizzy. And the literature on C-Pap did not impress.
So, some moths ago, I bought an iWatch. The current versions allows you to take EKGs and provides a continuous record of your heart rate. This was very helpful, as I saw that my heart rate was transitioning to chaos. While it was normally predictable, it would zoom to 130 or so at some point virtually every day. Even more alarming, it would slow down to the mid 30s at some point during the night, bradycardia, and I could see it was getting worse. At that point, I agreed to go on eliquis, a blood thinner, and agreed to a catheter ablation. The doctor put a catheter into my heart by way of a leg vein, and zapped various nerve centers in the heart. The result is that my heart is back into normal behavior. See the heart-rate readout from my iWatch below; before and after are dramatically different.
The reason I chose ablation over drugs or no therapy was that I read health-studies on line. I’ve go a PhD, and that training helps me to understand the papers I’ve read, but you should read them too. They are not that hard to understand. Though ablation didn’t appear as a panacea, it was clearly better than the alternatives. Particularly relevant was the CABANA study on life expectancy. CABANA stands for “Catheter ABlation vs ANtiarrhythmic Drug Therapy for Atrial Fibrillation – CABANA”. https://www.acc.org/latest-in-cardiology/clinical-trials/2018/05/10/15/57/cabana.
2,204 individuals with persistent AF were followed for 5 years after treatment, 37% female, 63% male, average age 67.5. Prior hospitalization for AF: 39%. The results were as follows:
Death: 5.2% for ablation vs. 6.1% for drug therapy (p = 0.38)
Serious stroke: 0.3% for ablation vs. 0.6% for drug therapy (p = 0.19)
All-cause mortality: 4.4% for ablation vs. 7.5% for drug therapy (p = 0.005)
Death or CV hospitalization: 51.7% for ablation vs. 58.1% for drug therapy (p = 0.002)
Pericardial effusion with ablation: 3.0%; ablation-related events: 1.8%
First recurrent AF/atrial flutter/atrial tachycardia: 53.8% vs. 71.9% (p < 0.0001)
I found all of this significant, including the fact that 27.5% of those on the drug treatment crossed over to have ablation while only 9.2% on the ablation side crossed to have the drug treatment.
I must give a plug for doctor Ahmed at Beaumont Hospital who did the ablation. He does about 200 of these a year, and does them well. Do not go to an amateur. I was less-than impressed with him pushing the beta-blocker hard; I’ll write about that. Also, get an iWatch if you think you may have A-Fib or any other heart problem. You see a lot, just by watching, so to speak.