Category Archives: healthcare

Canada’s doctor-assisted suicide killed 10,064 in 2021

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Canada’s healthcare is free to the user. It’s paid for by taxes, and it includes a benefit you can’t get in the US: free, doctor assisted suicide, euthanasia. This is a controversial benefit, forbidden in the Hippocratic oath because it’s close to murder, and includes the strong possibility of misuse of trust. Assistance by a trusted professional can be a bit likes coercion, and that starts to look like murder — especially since the professional often has a financial incentive to see you off.

From Charlie Hebdot (a French, humor magazine): The medical association refuses to participate in euthanasia — Why? People are already dining quite well on their own waiting in the emergency room.

In 2021, according to Statistics Canada, Canada assisted the suicide of 10,064 people, 3.3% of all Canadian deaths. There were about 4,000 more, non-assisted suicides. In Quebec, the Canadian Provence where Medical Assistance in Dying (MAiD) is most popular, 5.1% of deaths result from MAID. The Netherlands has a similar program that results in 4.8% of deaths. In Belgium, it’s 2.3%. These countries’ suicide rates are far higher than in the US, and account for far more deaths, per capita than from guns in the US. My guess is that suicide is common because it is free and professional. It’s called “Dignity in Dying,” in Europe, a title that suggests that old folks who don’t die this way are undignified.

In Canada, about 80% of those who requested MAiD were approved. A lot of the remainder were folks who died or changed their mind before receiving the fatal dose. If you attempt suicide on your own, it’s likely you won’t succeed, and you may not try again. With doctor assisted suicide, you’re sure to succeed (even if you change your mind after you get your lethal shot?)

In Canada you don’t have to be terminally ill to get MAiD, you just have to be in pain, and extreme psychological pain counts. Beginning March 17, 2024, depression will be added as a legitimate reason. According to Canadian TV news, depressives are lining up (read some interviews here). Belgium and Netherlands allows elders to be euthanized for dementia, and children to be euthanized on the recommendation of their parents. France passed similar legislation, but the doctors refused to go along, see cartoon. I applaud the French doctors.

Rodger Foley says he’s being pressured to ask for medical suicide, picture from the NY Post

There have been persistent claims that Canadian doctors and nurses push assisted suicide on poor patients, telling them how much bother they are and how much resources they are using. There has been an outcry in British and American newspapers, e.g. here in the Guardian, and in the NY Post, but not in Canada, so far. Rodger Foley, a patient interviewed by the NY Post, recorded conversations where his doctors and nurses put financial pressure on him. “They asked if I want an assisted death. I don’t. I was told that I would be charged $1,800 per day [for hospital care]. “I have $2 million worth of bills. Nurses here told me that I should end my life.” He claims they went so far as to send a collection agency to further pressure him. In another case, a disabled Canadian veteran asked for a wheelchair ramp, and was told to apply for MAiD.

Even without outside pressure, many people seeking MAiD often cite financial need as part of the reason. A 40 year old writer interviewed by Canadian television said that he can’t work and lives in poverty on a disability payment of just under $1,200 a month. “You know what your life is worth to you. And mine is worthless.”

The center of the argument is the value of a person in a social healthcare state when their economic value is less than the cost of keeping them alive. Here, Sabine Hossenfelder, an excellent physicist, argues that the best thing one could do for global warm and to preserve resources is to have fewer people. Elon Musk says otherwise, but Ms Hossenfelder claims this only shows he is particularly unworthy. There’s a Germanic logic here that gave us forced euthanasia in the 1940s.

I find euthanasia abhorrent, especially when it’s forced on children, the elderly, and depressed folks. I also reject the scary view of global warming, that it is the death of the earth. I’ve argued that a warm earth is good, and that a cold earth is bad. Also, that people are good, that they are the reason for the world, not its misfortune. It seems to me that, if suicide aid must be provided, state-funded hospitals should not provide it. They have a financial incentive to drop non-paying, annoying patients. That seems to be happening in Canada. A patient must be able to trust his or her doctor, and that requires a belief that the doctor’s advice is for his or her good. Unfortunately, Canadian politicians have decided otherwise. I say hurray for the doctors of France for not going along.

Robert Buxbaum, April 25, 2023. The medical profession is shady even when you pay for services, see Elvis Presley’s prescription. There’s always a financial interest. Even based on old data, the US is not a particularly high-murder country if suicide is considered murder.

Of walking sticks, canes, scepters, and wands.

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Franklin’s walking stick, willed to General Washington. Now in the Smithsonian.

Many famous people carried walking sticks Washington, Churchill, Moses, Dali. Until quite recently, it was “a thing”. Benjamin Franklin willed one, now in the Smithsonian, to George Washington, to act as a sort of scepter: “My fine crab-tree walking stick, with a gold head curiously wrought in the form of the cap of liberty, I give to my friend, and the friend of mankind, General Washington. If it were a Scepter, he has merited it, and would become it. It was a present to me from that excellent woman, Madame de Forbach, the dowager Duchess of Deux-Ponts”. A peculiarity of this particular stick is that the stick is uncommonly tall, 46 1/2″. This is too tall for casual, walking use, and it’s too fancy to use as a hiking stick. Franklin himself, used a more-normal size walking stick, 36 3/8″ tall, currently in the collection of the NY Historical Society. Washington too seems to have favored a stick of more normal length.

Washington with walking stick

Walking sticks project a sort of elegance, as well as providing personal protection. Shown below is President Andrew Jackson defending himself against an assassin using his walking stick to beat off an assassin. He went on to give souvenir walking sticks to friends and political supporters. Sticks remained a common political gift for 100 years, at least through the election of Calvin Coolidge.

Andrew Jackson defends himself.

I started making walking sticks a few years back, originally for my own use, and then for others when I noticed that many folks who needed canes didn’t carry them. It was vanity, as best I could tell: the normal, “old age” cane is relatively short, about 32″. Walking with it makes you bend over; you look old and decrepit. Some of the folks who needed canes, carried hiking sticks, I noticed, about 48″. These are too tall to provide any significant support, as the only way to grasp one was from the side. Some of my canes are shown below. They are about 36″ tall, typically with a 2″ wooden ball as a head. They look good, you stand straight, and they provides support and balance when going down stairs.

Some of my walking sticks.

I typically make my sticks of American Beech, a wood of light weight, with good strength, and a high elastic modulus of elasticity, about 1.85 x106 psi. Oak, hickory, and ash are good options, but they are denser, and thus more suited to self-defense. Wood is better than metal for many applications, IMHO, as I’ve discussed elsewhere. The mathematician Euler showed the the effective strength of a walking stick does not depend on the compressive strength but rather on elastic constant via “the Euler buckling equation”, one of many tremendously useful equations developed by Leonhard Euler (1707-1783).

For a cylindrical stick, the maximum force supported by a stick is: F = π3Er4/4L2, where F is the force, r is the radius, L is the length, and E is the elastic modulus. I typically pick a diameter of 3/4″ or 7/8″, and fit the length to the customer. For a 36″ beech stick, the buckling strength is calculated to be 221 or 409 pounds respectively. I add a rubber bottom to make it non–scuff and less slip-prone. I sometimes add a rope thong, too. Here is a video of Fred Astaire dancing with this style of stick. It’s called “a pin stick”, in case you are interested because it looks like a giant pin.

Country Irishmen are sometimes depicted with a heavy walking stick called a Shillelagh. It’s used for heavier self-defense than available with a pin-stick, and is generally seen being used as a cudgel. There are Japanese versions of self defense using a lighter, 36″ stick, called a Han-bo, as shown here. There is also the wand, as seen for example in Harry Potter. It focuses magical power. Similar to this is Moses’s staff that he used in front of Pharaoh, a combination wand and hiking stick as it’s typically pictured. It might have been repurposed for the snake-on-a-stick that protects against dark forces. Dancing with a stick, Astaire style, can drive away emotional forces, while the more normal use is elegance, and avoiding slips.

Robert Buxbaum, April 20, 2023.

Every food causes cancer, and cures it, research shows.

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Statistical analysis, misused, allows you to prove many things that are not true. This was long a feature of advertising: with our toothpaste you get 38% fewer cavities, etc. In the past such ‘studies’ were not published in respectable journals, and research supported by on such was not funded. Now it is published and it is funded, and no one much cares. For an academic, this is the only game in town. One result, well known, is the “crisis of replicability”– very few studies in medicine, psychology, or environment are replicable (see here for more).

In this post, I look at food health claims– studies that find foods cause cancer, or cure it. The analysis I present comes from two researchers, Schoenfeld and Ioannides, (read the original article here) who looked at the twenty most common ingredients in “The Boston Cooking-School Cook Book”. For each food, they used Pub-Med to look up the ten most recent medical articles that included the phrase, “risk factors”, the word “cancer”, and the name of the food in the title or abstract. For studies finding effect in the range of 10x risk factors to 1/10 risk factors, the results are plotted below for each of the 20 foods. Some studies showed factors beyond the end of the chart, but the chart gives a sense. It seems that most every food causes or cures cancer, often to a fairly extreme extent.

Effect estimates by ingredient. From Schoenfeld and Ioannides. Is everything we eat associated with cancer? Am J. Clin. Nutrition 97 (2013) 127-34. (I was alerted to this by Dr. Jeremy Brown, here)

A risk factor of 2 indicates that you double your chance of getting cancer if you eat this food. Buy contrast, as risk factor of 0.5 suggests that you halve your cancer risk. Some foods, like onion seem to reduce your chance of cancer to 1/10, though another study say 1/100th. This food is essentially a cancer cure, assuming you believe the study (I do not).

Only 19% of the studies found no statistically significant cancer effect of the particular food. The other 81% found that the food was significantly cancer-causing, or cancer preventing, generally of p=0.05 to 0.05. Between the many studies done, most foods did both. Some of these were meta studies (studies that combine other studies). These studies found slightly smaller average risk factors, but claimed more statistical significance in saying that the food caused or cured cancer.

0.1 0.2. 0.5 1. 2 5 10
Relative risk

The most common type of cancer caused is Gastrointestinal. The most common cancer cured is breast. Other cancers feature prominently, though: head, neck, genetilia-urinary, lung. The more cancers a researcher considers the higher the chance of showing significant effects from eating the food. If you look at ten cancers, each at the standard of one-tailed significance, you have a high chance of finding that one of these is cured or caused to the standard of p=0.05.

In each case the comparison was between a high-dose cohort and a low-dose cohort, but there was no consistency in determining the cut-offs for the cohort. Sometimes it was the top and bottom quartile, in others the quintile, in yet others the top 1/3 vs the bottom 1/3. Dose might be times eaten per week, or grams of food total. Having this flexibility increases a researcher’s chance of finding something. All of this is illegitimate, IMHO. I like to see a complete dose-response curve that shows an R2 factor pf 90+% or so. To be believable, you need to combine this R2 with a low p value, and demonstrate the same behaviors in men and woman. I showed this when looking at the curative properties of coffee. None of the food studies above did this.

From Yang, Youyou and Uzzi, 2020. Studies that failed replication are cited as often as those that passed replication. Folks don’t care.

Of course, better statistics will not protect you from outright lying, as with the decades long, faked work on the cause of Alzheimers. But the most remarkable part is how few people seem to care.

People want to see their favorite food or molecule as a poison or cure and will cite anything that says so. Irreplicable studies are cited at the same rate as replicated studies, as shown in this 2020 study by Yang Yang, Wu Youyou, and Brian Uzzi. We don’t stop prescribing bad heart medicines, or praising irreplaceable studies on foods. Does pomegranate juice really help? red wine? there was a study, but I doubt it replicated. We’ve repeatedly shown that aspirin helps your heart, but it isn’t prescribed much. Generally, we prefer more expensive blood thinners that may not help. Concerning the pandemic. It seems our lockdowns made things worse. We knew this two years ago, but kept doing it.

As Schoenfeld and Ioannides state: “Thousands of nutritional epidemiology studies are conducted and published annually in the quest to identify dietary factors that affect major health outcomes, including cancer risk. These studies influence dietary guidelines and at times public health policy… [However] Randomized trials have repeatedly failed to find treatment effects for nutrients in which observational studies had previously proposed strong associations.” My translation: take all these food studies with a grain of salt.

Robert Buxbaum, April 4, 2023

Abortion and Childbirth in the US vs China

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There are a lot of abortions in China, and not many births. Last year, there were about 9.7 million abortions in the major clinics and almost 12 million live births. That’s about 8.5 live births per 1000 Chinese population and 79.7 abortions per 100 live births. If you include the minor clinics and the abortion pill, it’s likely that there are more abortions than live births in China. It’s the preferred method of birth control. In the US, the ratio of abortions to births has grown but we have only about 1/4 as many abortions as births.

Births and abortions per year in China to 2020, from The Economist, 2023. The biggest change is decreased births, not increased abortions.

The birthrate in China is low and decreasing. China had pushed for one-child families as a cure for overpopulation and a route to a richer China with abortion promoted as a safe, painless way to end an unwanted pregnancy. Billboard ads continue to show happy women who are leading their best life now that they’ve had an abortion. Of course, during the one-child years, if you had that extra baby, the state might take your baby him or her. Condom ads were forbidden, and remain so to this day.

China seems to have succeeded too well. The population has leveled out, and has began to decline this year — likely too fast. Meanwhile the economy has grown by an average of 10% per year for 40 years, so that China is now, likely the second largest economy on the planet, but has such an old population that this is unlikely to continue. One down-side of the heavy reliance on abortion is that it’s produced a severe sex imbalance. The Chinese chose to abort mostly girls. It’s also resulted in an active sex trade. I’ve claimed it will lead to war, famine, or an economic collapse in the next ten years.

Add for a Chinese abortion clinic. See how happy the lady is. Chinese ads have English because it’s cool — it suggests that this clinic serves Americans and British too.

In the US, there were 3,664,000 births in 2022, 12.012 births per 1000 people. That’s 1.5 times the birth rate of China, and a 1% increase from 2020, but significantly below the birthrate of the boomer generation. In the last year, there were 928,000 abortions, see graph below, or 25.3 abortions per 100 live births. Our population is as old as China’s, but the additional children suggests that our society will continue longer.

In America, the case for abortion is that it’s a woman’s right, see ad below. Anti-abortion is presented as slavery and a Republican plot for male domination. Politically, this has been a winning argument for Democrats; helping them win big in elections. They made good on the argument and amended the Michigan constitution to allow abortion till birth with the father having no say. The legal and religious establishment has gone along. They may want some limitations, but there is no consensus on what the limitation should be.

Abortions per year, US, Guttmacher Inst. report, 2022.

It’s been suggested that a good way to lower the abortion rate would be higher taxes to provide more healthcare and child benefits. That may be, though I’m not sure it’s the direct, sure route. China has free healthcare and benefits. I suspect that the preachers should do more personally to deal with the vulnerable. Another thought is to promote is rural living. In the US and China, rural areas have higher birth rates, while the cities have low birth rates and high abortion rates. The highest abortion rate in the US is in Washington DC.

In the US, abortion is presented as a right, and as a Republican anti-woman plot.

My overall sense is that Children are good: Admittedly, they are expensive hobbies, but they are worth it, for the parents, for the nation, and in particular for the child. Children are a beautiful part of life and a beautiful part of any environment, IMHO. They like to grow amid sunshine and fresh air.

Robert Buxbaum, March 14, 2023

Social science is irreproducible, drug tests nonreplicable, and stoves studies ignore confounders.

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Efforts to replicate the results of the most prominent studies in health and social science have found them largely irreproducible with the worst replicability appearing in cancer drug research. The figure below, from “The Reproducibility Project in Cancer Biology, Errington et al. 2021, compares the reported effects in 50 cancer drug experiments from 23 papers with the results from repeated versions of the same experiments, looking at a total of 158 effects.

Graph comparing the original, published effect of a cancer drug with the replication effect. The units are whatever units were used in the original study, percent, or risk ratio, etc. From “Investigating the replicability of preclinical cancer biology,”
Timothy M Errington et al. Center for Open Science, United States; Stanford University, Dec 7, 2021, https://doi.org/10.7554/eLife.71601.

It’s seen that virtually none of the drugs are found to work the same as originally reported. Those below the dotted, horizontal line behaved the opposite in the replication studies. About half, those shown in pink, showed no significant effect. Of those that showed positive behavior as originally published, mostly they show about half the activity with two drugs that now appear to be far more active. A favorite web-site of mine, retraction watch, is filled with retractions of articles on these drugs.

The general lack of replicability has been called a crisis. It was first seen in the social sciences, e.g. the figure below from this article in Science, 2015. Psychology research is bad enough such that Nobel Laureate, Daniel Kahneman, came to disown most of the conclusions in his book, “Thinking, Fast and Slow“. The experiments that underly his major sections don’t replicate. Take, for example, social printing. Classic studies had claimed that, if you take a group of students and have them fill out surveys with words about the aged or the flag, they will then walk slower from the survey room or stand longer near a flag. All efforts to reproduce these studies have failed. We now think they are not true. The problem here is that much of education and social engineering is based on such studies. Public policy too. The lack of replicability throws doubt on much of what modern society thinks and does. We like to have experts we can trust; we now have experts we can’t.

From “Estimating the reproducibility of psychological science” Science, 2015. Social science replication is better than dance drug replication, about 35% of the classic social science studies replicate to some, reasonable extent.

Are gas stoves dangerous? This 2022 environmental study said they are, claiming with 95% confidence that they are responsible for 12.7% of childhood asthma. I doubt the study will be reproducible for reasons I’ll detail below, but for now it’s science, and it may soon be law.

Part of the replication problem is that researchers have been found to lie. They fudge data or eliminate undesirable results, some more some less, and a few are honest, but the journals don’t bother checking. Some researchers convince themselves that they are doing the world a favor, but many seem money-motivated. A foundational study on Alzheimers was faked outright. The authors doctored photos using photoshop, and used the fake results to justify approval of non-working, expensive drugs. The researchers got $1B in NIH funding too. I’d want to see the researchers jailed, long term: it’s grand larceny and a serious violation of trust.

Another cause of this replication crisis — one that particularly hurt Daniel Kahneman’s book — is that many social science researchers do statistically illegitimate studies on populations that are vastly too small to give reliable results. Then, they only publish the results they like. The graph of z-values shown below suggest this is common, at least in some journals, including “Personality and social psychology Bulletin”. The vast fraction of results at ≥95% confidence suggest that researchers don’t publish the 90-95% of their work that doesn’t fit the desired hypothesis. While there has been no detailed analysis of all the social science research, it’s clear that this method was used to show that GMO grains caused cancer. The researcher did many small studies, and only published the one study where GMOs appeared to cause cancer. I review the GMO study here.

From Ulrich Schimmack, ReplicationIndex.com, January, 2023, https://replicationindex.com/2023/01/08/which-social-psychologists-can-you-trust/. If you really want to get into this he is a great resource.

The chart at left shows Z-scores, were Z = ∆X √n/σ. A Z score above 1.93 generally indicates significance, p < .05. Notice that almost all the studies have Z scores just over 1.93 that is almost all the studies proved their hypothesis at 95% confidence. That makes it seem that the researchers were very lucky, near prescient. But it’s clear from the distribution that there were a lot of studies that done but never shown to the public. That is a lot of data that was thrown out, either by the researchers or by the publishers. If all data was published, you’d expect to see a bell curve. Instead the Z values are of a tiny bit of a bell curve, just the tail end. The implication is that these studies with Z= >1.93 suggest far less than 95% confidence. This then shows up in the results being only 25% reproducible. It’s been suggested that you should not throw out all the results in the journal, just look for Z-scores of 3.6 or more. That leaves you with the top 23%, and these should have a good chance of being reproducible. The top graph somewhat supports this, but it’s not that simple.

Another classic way to cook the books, as it were, and make irreproducible studies provide the results you seek is to ignore “confounders.” This leads to association – causation errors. As an example, it’s observed that people taking aspirin have more heart attacks than those who do not, but the confounder is that aspirin is prescribed to those with heart problems; the aspirin actually helps, but appears to hurt. In the case of stoves, it seems likely that poorer, sicker people own gas, and that they live in older, moldy homes, and cook more at home, frying onions, etc. These are confounders that the study to my reading ignores. They could easily be the reason that gas stove owners get more asthma toxins than the rich folks who own electric, induction stoves. If you confuse association, you seem to find that owning the wrong stove causes you to be poor and sick with a moldy home. I suspect that the stove study will not replicate if they correct for the confounders.

I’d like to recommend a book, hardly mathematical, “How to Lie with Statistics” by Darrell Huff ($8.99 on Amazon). I read it in high school. It gives you a sense of what to look out for. I should also mention Dr. Anthony Fauci. He has been going around to campuses saying we should have zero tolerance for those who deny science, particularly health science. Given that so much of health science research is nonreplicable, I’d recommend questioning all of it. Here is a classic clip from the 1973 movie, ‘Sleeper’, where a health food expert wakes up in 2173 to discover that health science has changed.

Robert Buxbaum , February 7, 2023.

Use iodine against Bad breath, Bad beer, Flu, RSV, COVID, monkeypox….

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We’re surrounded by undesired bacteria, molds, and viruses. Some are annoying, making our feet smell, our teeth rot, and our wine sour. Others are killers, particularly for the middle aged and older. Despite little evidence, the US government keeps pushing masks and inoculations with semi-active vaccine that does nothing to stop the spread. Among the few things one can do to stop the spread of disease, and protect yourself, is to kill the bacteria, molds and viruses with iodine. Iodine is cheap, effective even at very low doses, 0.1% to 10 parts per million, and it lasts a lot longer than alcohol. Dilute iodine will not dye your skin, and it does not sting. A gargle of iodine will kill COVID and other germs (e.g. thrush) and it has even been shown to be a protective, stopping COVID 19 and flu even if used before exposure. On a more practical level. I also use it to cleanse my barrels before making beer — It’s cheaper than the Camden they sell in stores.

Iodine is effective when used on surfaces, and most viruses spread by surfaces. A sick person coughs. Droplets end up on door knobs, counters, or in your throat, leaving virus particles that do not die in air. You touch the surface, and transfer the virus to your eyes and nose. Here’s a video I made. A mask doesn’t help because you rub your eyes around the mask. But iodine kills the virus on the surface, and on your hands, and lasts there far longer than alcohol does. Vaccines always come with side-effects, but there are no negative side effects to sanitization with dilute iodine. Here is a video I did some years ago on the chemistry of iodine.

Robert Buxbaum, February 1, 2023. I don’t mean to say that all bacteria and fungi are bad, it’s just that most of them are smelly. Even the good ones that give us yogurt, beer, blue cheese, and sour kraut tend to be smelly. They have the annoying tendency to causing your wine to taste and smell like sour kraut or cheese, and they cause your breath and feet to smell the same. If you’re local, I’ll give you some free iodine solution. Otherwise, you’ll have to buy it through REB Research.

Birth dearth in China => collapse? war?

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China passed us in life-expectancy in 2022, and also in fertility, going the other way. In China lifespan at birth increased to 77.3 years. In the US it dropped an additional 0.9 years, to 76.8. US lifespans suffered from continuing COVID and an increase in accidents, heart disease, suicide, drugs, and alcohol abuse. Black men were hit particularly hard, so that today, a black man in the US has the same life expectancy as he would in Rwanda. China seems to have avoided this, but should expect problems due to declining fertility and birth rates.

China passed us in life expectancy in 2022.

Fertility rates will eventually burden the US too, as US fertility is only slightly greater than in China, 1.78 children per woman, lifetime, compared to 1.702 in China. But China has far fewer people of childbearing ages, relatively, and only 47% are women. Three decades of one child policy resulted in few young adults and a tendency to abort girls. Currently, the birthrate in China is barely more than half ours: 6.77 per 1000, compared to 12.01 per 1000. And the proportion of the aged keeps rising. China will soon face a severe shortage of care-givers, and an excess of housing.

Years of low birthrate preceded the “Lost decades” of financial crisis in Japan and the USSR. Between 1990 and 2011, business stagnated and house prices dropped. China faces the same; few workers and more need for care: it’s not a good recipe.

Beginning about 1991, Japan saw a major financial collapse with banks failing, and home values falling. China seems over-due.

Few children also signals a psychic lack of confidence in the country, and suggests that, going forward, there will be a lack of something to work for. Already Chinese citizens don’t trust the state to allow them to raise healthy children. They have stopped getting married, especially in the cities, and look more to have fun.

Affluent women claim they can’t find a good man to marry: one who’s manly, who will love them, and who will reliably raise their standard of life. Women seem less picky in China’s rural areas, or perhaps they find better men there. However it goes, urban women get married late and have few children, both in China and here. China produces great, sappy, soap operas though: a country girl or secretary in a high-power job meets a manly, urban manager who lovers her intensely. A fine example is “The Eternal Love” (watch it here). It involves time travel, and a noble romance from the past. Japan produced similar fiction before the crisis. And a crisis seems to be coming.

While Japan and Korea responded quietly to crisis and “the lost decades,” allowing banks to fail and home values to fall, Russia’s response was more violent. It went to war with Chechnya, then with Belarus and Ukraine, and now with NATO. I fear that China will go to war too — with Taiwan, Japan, and the US. It’s a scary thought; China is a much tougher enemy than Russia. There is already trouble brewing over new islands that they are building.

Robert Buxbaum January 25, 2023. If you want to see a Korean soap opera on the Secretary – manager theme, watch: “What’s wrong with Secretary Kim”. (I credit my wife with the research here.) I suspect that Americans too would like sappy shows like this.

Almost no one over 50 has normal blood pressure now.

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

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

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

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

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

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

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

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

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

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

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

Coffee decreases your chance of Parkinson’s, a lot.

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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.

Based on R2, coffee appears to significantly decrease the risk of Parkinson’s mortality in both men and women.

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.

The benefit of coffee has been seen as well, in this study, looking at extreme drinkers. Benefits appear for other brain problems too, like Alzheimer’s. It seems that 2-4 cups of coffee per day also reduces the tendency for suicide, and decreases the rate of gout. It seems to be a preventative against kidney stones, too.

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.

Dr. Robert E. Buxbaum, and C.M. Buxbaum, December 15, 2022

The main building block of Alzheimer’s research was faked. Now, what.

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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. 

The visual difference between an Alzheimer brain and a normal brain is that the former has shrunk. Maybe fat is relevant, fat body leads to a fat brain, and less AZ, maybe?

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 could be that high bmi protects from dementia. Either that or the diseases that cause weight loss cause dementia. It’s debated here.

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.”