Category Archives: Detroit

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

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

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

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

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

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

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

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

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

Robert Buxbaum, August 14, 2022

Curing my heart fibrillation with ablation.

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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.

My heart rate for the last month, very variable before the ablation treatment, 2 weeks ago; a far less variable range of heart rates in the two weeks following the treatment. Heart rate data is from my iPhone and iwatch — a good investment, IMHO.

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.

Robert Buxbaum, August 3, 2022.

Girls are doing better, Boys are doing far worse.

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When I began college in 1972, the majority of engineering students and business students were male. They from the top of their high school classes, and from stable homes mostly; they went on to high paying jobs. Boys also dominated at the bottom of society. They were the majority of the criminals, drug addicts, and high-school dropouts. Many went off to Vietnam. Some, those who were handy, went to trade schools and a reasonable life, productive life. Society did not seem bothered by the destruction of boys in prison, or Vietnam, or by drugs, but there was an outcry that so few women achieved high academic levels. A famous presentation of the problem was called “for every 100 girls.” An updated version appears below showing the status as of October, 2021. A more detailed version appears further down.

From the table above, you can see that women are now the majority of those in college, the majority of those with a bachelors degree or higher, and a majority of those with advanced degrees. Colleges added special tutoring, special grants, and special programs. Each college had a Society of Women Engineers office, and similar programs in law and math. All of these explicitly excluded men or highly discouraged their presence. The curriculum was changed too; made more female-friendly. Dirty, and physical experiments were removed, replaced with group analysis of the social interactions — important aspects of engineers that boys were far-less adept at doing well. Perhaps society and engineering is better off now, but boys (men) are far worse off. This is particularly seem by the following chart, looking at the bottom. Boys/men provide the vast majority of the prison population, of those diagnosed as learning disabled, of those expelled, or overdosed, and among the war dead.

I’ve previously noted that a majority of boys in school are considered disruptive, and that these boys are routinely diagnosed as ADHD and drugged. It is not at all clear that this is a good thing, or that the drugs help anyone but the teacher. I’ve also noted that artwork and attitudes that were considered normal for boys are now considered disturbing and criminal like saying I wish the school was blown up. The cure here, perhaps is worse than the disease. I’m not saying that we should encourage boys to say such things, but that we should acknowledge a difference between an active and a passive wish. And we should find a way to educate boys/men so they don’t end up unemployed, addicted, or dead. Currently boy, particularly those at the bottom are on the scrap-heap of society.

Here is some source material for the above:

Robert Buxbaum, May 28, 2022

Vaccines have not decreased the US COVID death rate

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I’m not sure why this is, but a quick look at the death statistics shows that it is no lower today than it was a year ago. Vaccines seem to help the individual, but they don’t seem to do much for society as a whole.

Johns Hopkins data. COVID 19 death rate in the USA.

That the death rates are the same as last November is bad, especially since one major effect of COVID has been to wipe out nearly all our old folks, decreasing the lifespan of US men by 2-3 years. With a 70% vaccination rate (adults, 60% overall), and few old people, you ‘d expect our death rate this year would be lower than last.

Currently, at least, the trend-line looks positive, but that’s likely a mirage. It is common to add more deaths to the tally, retroactively a few weeks out as many deaths take weeks to report and more weeks to be counted as COVID. For what it’s worth, I’m vaccinated, two shots and a booster. I also take aspirin, and have gotten a pneumonia shot. I think it helps. What do I know?

Robert Buxbaum, November 18, 2021

Deadly incurable viruses abound: The plagues to come.

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As we discuss the effectiveness of the various COIVD vaccines, and ask if we will need another booster in a year, this time for the delta variant, or epsilon, it’s worth noticing that none of these is that deadly, especially if you’ve had a previous version. There are far worse viruses out there, like Ebola-Zaire, for example. This virus kills 60-90% of the people infected, typically by causing the body’s connective tissue to dissolve. Now that’s a deadly virus; imagine an ebola pandemic.

We live surrounded by many really deadly viruses, most of them incurable. In general our protection from them is that they usually show a slow infection rate or a slow progress to death. Drug resistant leprosy is one of these. Here’s the beginnings of a list of deadly viruses we could worry about: Lassa, Rift Vally, Oropouche, Rocio Q Guanarito, VEE, Marburg, Herpes B, Monkey Pox, Dengue, Chikunguanya, Hantavirus, Machupo, Junin, Rabies-like Mokola, drug-resistant leprosy, Duvenhage, LeDantec, Kyasanur, Forest Brain virus, HIV-AIDs, Simliki, Crimean-Congo virus, Sindbis, O’nyongnyong, Sao Paulo, SARS, Ebola Sudan, Ebola Zaire, Ebola Reston, Mid-East Respiratory (MERS), Zika, Delta-COVID. (I got 2/3 of this list from a 1993 book called “The Hot Zone” about the first US outbreak of Ebola — Washington DC in 1989 — a good book, worth a read).

Ebola is a string-like virus with loops. It causes your body to dissolve and bleed out from every pore. The strings form crystals that are virtually immortal.

As an ilk, these viruses are far older than we are, older than the first cellular creatures, and far tougher. They are neither dead nor alive, and can last for years generally without air, water or food if the temperature is right. Though they do not move on their own, nor eat in any normal sense, they do reproduce, and they do so with a vengeance. They also manage to evolve by an ingenious sexual mechanism. In a sense, they are the immune system of the earth, protecting the earth from man or any other invasive life form. We humans have only survived the virus for 100,000 years or so. Long term, the viruses are likely to win.

Zika is a ball-shaped virus. Incurable, it causes encephala. Ball-viruses are not as immortal as string viruses. COVID is a ball virus with spikes, a crown virus.

Some viruses are string shaped; Marburg and Ebola are examples. Such viruses can crystalize and live virtually forever on dry surfaces. Other viruses are ball-shaped, COVID and Zika, for example. These are more easily attacked on surfaces, e.g. by iodine. They become inactive after just a few minutes in air– and are killed instantly by iodine, alcohol, bleach, or peroxide.

Most viruses enter by cuts and body fluids. This is the case with AIDS and herpes. Others, like measles, shingles, and Zika, enter by way of surfaces and the hands. Virus-laden droplets collect on surfaces and are brought to a new host when the surface is touched and hand-transported to the nose or eyes. A few viruses, like SARS, Ebola, and COVID-19 can enter the body by breathing too. I’ve collected some evidence in favor of Iodine as a surface wipe, a hand wipe and as mouthwash in this previous essay.

Dr. Robert E. Buxbaum, November 3, 2021. The US has three facilities where they deal with the most deadly, contagious viruses. One is in Washington DC; they had leak in 1989, a part of the ebola outbreak. China has only one such facility, in Wuhan, China. It’s one block from where the COVID-19 outbreak supposedly originated. Have a nice day.

People would rather get electric shocks than think for 15 minutes.

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A review of some studies on the difficulty of sitting in one’s own thoughts.

There is a joke: what is the opposite of speaking?

It’s waiting to speak.

Most people find it uncomfortable to sit still and be quiet. Even listening is a pain. People sit brewing in their thoughts of what they are going to say. Silence is uncomfortable enough that solitary confinement for a few days is torture.

But what about a few minutes. Almost everyone can sit still and listen for 15 minutes as their friend drones on, especially if they are paid for it. Still, it’s uncomfortable, and a study set out to understand how uncomfortable. It turns out that a majority of men, 67% would rather give themselves electric shocks than sit and think or listen. Women, too find it unpleasant; some 25% of women preferred to give themselves electric shocks rather than sit and think. You’ll find a brief review of this and similar work copied above, or you can read the full study: Wilson et al 2014, “The challenge of the disengaged mind“.

The effect of the COVID-19 lockdowns was to remove virtually every bit of agreeableness, extroversion, conscientiousness, and openness, while fueling neuroticism. Data for 2020.

The effect of the COVID-19 lockdowns has been massive. Those involved in government discussions don’t seem to realize how massive, perhaps because they’re in constant contact with people, speaking and being spoken too. Most of us were not so lucky. We experienced partial isolation. A recent study suggests that almost every measure of happiness disappeared during the summer months of 2020: US agreeableness, extroversion, conscientiousness, and openness all declined dramatically, see data above. Decisiveness too; a lingering effect is an inability to make decisions. My hope is that government officials can resist the temptation for more lockdowns and mandates; mental health is health too.

If lockdowns do come, or if you are depressed for any other reason, you might consider exercise, or lithium, or counseling. At least decide to wake up at a fixed time every morning. Under COVID watch conditions, depression is the new normal. Here’s a joke on marriage counseling.

Robert Buxbaum, October 27, 2021

Exercise helps fight depression, lithium helps too.

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

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

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

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

Robert Buxbaum, October 7, 2021.

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

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

Weekly US death rates since October 2015.

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

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

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

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

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

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

A high minimum wage killed Detroit, perhaps Seattle and NYC too.

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In July, eitght years ago, Detroit filed for bankruptcy protection. The US was well into an economic expansion, but the expansion had largely bypassed Detroit. The Detroit area unemployment rate was 9.7%, and the Detroit city rate was 17%, among the highest in the nation. Tax income was not sufficient to pay retirement or current employees. The city was riven by corruption and crime, and attendance in school was dismal, less that 25% in some districts, about 55% as an overall average. Kids no longer saw a value in education. After bankruptcy, things started to improve dramatically.

Detroit area unemployment rate, 2005 to 2021.

The largest cause of the problem, and of the solution, in my opinion, was a high Detroit minimum wage that applied before bankruptcy and that was voided by bankruptcy. It was called a “living wage”. In 2013 it was $16/ hour and applied to any business that dealt with the city and did not offer health insurance (see more on the specifics here).The stated purpose was to insure that all workers could support a family of four in some middle-class standard, by one wage-earner working 40 hours per week. It was a view of Detroit family life and economic need that didn’t match Detroit reality. In practice most of Detroit were not 4 person, one wage-earner households. It meant that most Detroiters could not find jobs, since most companies worked in some way with the city. The only workers who could find jobs were those with special skills or political connections. The alternative was criminal business including drug sales, prostitution and burglary. The unemployment rate was 70% among Detroit’s teenagers.

The high minimum wage bought loyalty for Detroit’s political bosses; they gave out jobs for kickbacks, and some went to jail, including the mayor. Most Detroiters could not find jobs, though, and this especially hurt those looking for their first job: the job that would demonstrate that math and spelling were important; that you had to show up on time, dressed clean, and that you were not to insult the customers. High unemployment meant low tax revenue, made worse by high city employment costs for basic services: janitors, secretaries, and mail room personnel. The city was a mess.

When Detroit went bankrupt, among the first changes was to eliminate the $!6/hour living wage for employees and others doing business with the city. This helped bring the city budget into balance, and it brought in residents, businesses, and developers. By January 2020 Detroit’s unemployment rate had fallen to 6%, and Detroit metro unemployment had fallen to 4.2%, the lowest rates on record. Employment gives a motivation to stay in Detroit and to stay in school: there are jobs to be had for those who could add and spell. I covered these improvements here.

Seattle are unemployment rate 2015 to 2021. Seattle’s unemployment rate is now higher than Detroit’s.

Meanwhile, Seattle voted to raise their minimum wage to $15, with the change law taking effect in stages. The law fully came into effect three months ago, in January, 2021. New York voted for similar changes more recently. It is hard to be sure of the effect of the high minimum wage but already it seems to have hit employment. By the latest data, Seattle’s unemployment rate has risen to 6.9%. That’s higher than in Detroit, a real reversal. While unemployment in New York City has yet to rise much, they have seen a drop in rent rates while Detroit has seen a rise. New York’s are also moving to be more out of balance, something that leads to corruption and bankruptcy. We’ll see how this works out.

Robert Buxbaum, March 25, 2021. Among my first blog posts were complaints about Detroit’s high “living wage”, see here for example. As Puerto Rico slid into bankruptcy, I complained about the same thing.

Saving the Mini, Resurrecting my MacBook.

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Our company books are done on a Mac mini 2014 that was getting slower and slower for reasons that I mis-diagnosed. I thought it was out of space on the hard drive even though the computer said there was plenty. Then my MacBook started misbehaving too, slowing to a crawl with large web-pages (Facebook) and having trouble backing up. I feared a bug of some sort. Then, 3 weeks ago, the MacBook died. It would not boot up. When I turned it on, it showed a file folder with a question mark. It was dead, but now it’s back thanks to the folks at TechBench on Woodward Ave. I lost some data, but not that much.

As it turns out, the problem was not lack of space on the hard drive, but the hard drive itself. The spinning, magnetic disc that stores my data wore out. I should have seen the problem and replaced the hard drive, but I didn’t realize you could, or should. I replaced the hard drive with a solid state memory bigger than the original, and replaced the battery too. The computer is back, faster than before, and went on to replace the hard drive on the Mini too for good measure. That was 3 weeks ago and everything is working fine.

MacBook hard drive, 120 GB. I replaced it with a solid state stick that had three times the memory and was less than half the size.

I could have bought two new computers, and I have decided to replace the 2011 desktop Mac at work, but I’m happy to have revivified these two machines. A new MacBook would have cost about $1200 while fixing this one cost should have cost $250 — $120 for the hard drive cost and $135 for the fellow who replaced it and recovered as much data as possible. Replacing the battery added another $150 with labor. I saved 2/3 the price of a new MacBook, got more hard disc, and my old programs run faster than before. Fixing up the Mini cost me $250 (no battery), and everything works fine. Because the processor is unchanged, I can still use my legacy programs (Word, pagemaker, photoshop, Quickbooks) and my music.

I’d considered trying to do the same with a 2011 Mini, but Miles at the service center said it was not worth it for a 2011 machine. I have an idea to remove the mechanism and turn this into an external, bootable drive, while transferring the data elsewhere. I’ve done this with old drives before.

In retrospect, I should have made more of an effort to backup data as soon as there was any indication that there was a problems. It was getting slower, and I needed to reboot every other day. As the disc drive wore out, data was being read less and less reliably. Data correction ate up cpu time. The fact is that I forgot I had a spinning disc-drive that could wear out. At least I learned something: hard drives wear out and need replacing. When things break, you might as well learn something. Another thing I learned is about Apple; the computers may cost more than PCs but they last. In the case of my lap book, 2014- 2021 so far.

Robert Buxbaum, March 8, 2021. This isn’t that high tech but it seems useful. As a high tech thought. It strikes me that, just as my laptop battery wore out in 7 years, an electric car battery is also likely to wear out in 7 years. Expect that to be a multi-thousand dollar replacement.