Category Archives: physiology

Disney was a narcissist, like Trump, Putin, Musk, and Martin Luther King. It’s not a disease.

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Among TV psychiatrists, the universal opinion of Trump, Putin, and Musk, that these individuals are narcissists, a psychological disease related to “toxic masculinity.” Musk, for his part claims the excuse of Asperger’s disease, high-functioning Autism. I half agree with the Narcissist diagnosis, and I’m confused by the Asperger’s claim because I don’t believe these folks are diseased. My sense is they have a leadership personality trait, common in all visionary leaders including Disney, Martin Luther King, and Genghis Khan. I’ve argued that it is important for a president to be a narcissist, and have explained Trump’s vision, “Make America great again” as independence.

Psychological narcissism, short for Narcissistic Personality Disorder, is a disease when it hurts the narcissists life. It is defined as a pattern of exaggerated feelings of self-importance, along with an excessive need for admiration. If it just annoys people it/s a disease, but it’s found among leaders, suggesting it’s not all bad. To get you to follow them, leaders present themselves as mini-messiahs, and try to get you to see them that way. They have a plan, a vision. If it’s successful, they’re visionaries. They fight to bring the vision into reality, which is very annoying to anyone who doesn’t see it or want it. But that’s leadership. Without it nothing big gets done.

Disney’s vision. Not everyone was pleased; quite a few considered him a tyrant.

For the narcissist to succeed, he or she must sell the vision, and his ability to get it done. The plan to get there is often vague and unattractive. These details are shared with only a few. You must see the leader there and yourself too, if you’re to fight for it. Disney was particularly visual, see photo. He got folks to buy into a building a magical kingdom with a private police force, where everyone is happy and cartoon characters glide among the paying visitors.

The majority of those who run into a narcissist reject both the vision and the narcissist. They fear any change, and fear that the success of the visionary will diminish them. For that reason, they run to no-bodies. But some see it, and follow, others throw stones. Disney got state officials to exempt him from state laws, and extend normal copyrights. Others smirked, and worked to stop him, but with less energy: it’s hard to be enthusiastic about no Disneyland. The conflict between doers and the smirkers is the subject of several Ayn Rand books, including The Fountainhead and Atlas Shrugged. She calls the opposing smirkers, “parasites”, “looters”, “moochers,” and my favorite: “do gooders.” It’s for the common good that the narcissist should fail, they claim.

Often these opponents have good reasons to oppose. The Ayatollah Khomeini had a vision similar to Disney: an Islamic Republic in Iran where everyone is happy being a devout Muslim of his stripe. The opponents feared, correctly, that everyone who was not happy would be flogged, hanged, or beheaded. I think it’s legitimate to not want to be forced to be devout. Similarly, with Genghis Khan, or Vladimir Putin. Putin compares himself to Peter the Great who expanded Russia and conquered Crimea. The opponents have legitimate fears of WWII and claim that Ukrainian independence is semi legit. Regarding Musk’s plans to colonize Mars, I note that Neil Armstrong and Gene Cernan have come out against it. There is no right or wrong here, but I have a soft spot for the visionaries, and a suspicion of the “smirkers” and “do gooders.”

Genghis Khan. He saw himself as a world changer. Some followed, some didn’t. Those who followed didn’t think he was crazy.

The smirkers and do-gooders include the most respectable people of today. They are thought leaders, who lose status if someone else exceeds them. They are surprised and offended by Martin Luther King’s dream, and Musk’s, Khomeini’s, Trump’s, and Lenin’s. Trump became president against formidable odds, and the smirkers said it was a fluke, he then lost, and they claimed it showed they were right. He may get a second term, though, and Musk may yet build a community on Mars. To the extent that the visionary succeeds, the smirkers claim it was easy; that they could have done the same, but faster and better. They then laud some fellow smirker, and point out aspects of the vision that failed. In any case, while the narcissist is definitely abnormal, it’s not a disease, IMHO. It’s what makes the world go round.

Robert Buxbaum, June 7, 2023

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.

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.”

Three identical strangers, and the genetics of personality

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Inheritability of traits is one of the greatest of insights; it’s so significant and apparent, that one who does not accept it may safely be called a dullard. Personal variation exists, but most everyone accepts that if your parents are tall, you are likely to be tall; If they are dark, you too will likely be dark, etc., but when it comes to intelligence, or proclivities, or psychological leanings, it is more than a little impolite to acknowledge that genetics holds sway. This unwillingness is glaringly apparent in the voice-over narration of a popular movie about three identical triplets who were raised separately without knowing of one another. The movie is “Three identical strangers”, and it recounts their meeting, and their life afterwards.

Triplets, raised separately, came out near identical.

As one might expect, given my introduction, though raised separately, the three showed near identical intelligence, and near identical proclivities: two of them picked the same out-of-the way college. All of them liked the same sort of clothes and had the same taste in women. There were differences as well: one was a more outgoing, one was depressed, but in many ways, they were identical. Meanwhile, the voice-over kept saying things like, “isn’t it a shame that we never saw any results on nature/nurture from this study.” Let me clear this us: genetics applies to psychology too. It’s not all genetics, but it is at least as influential as upbringing/ nurture.

This movie also included pairs of identical twins, raised separately, they also showed strong personality similarities. It’s a finding that is well replicated in broader studies involving siblings raised separately, and unrelated adoptees raised together. Blood, it seems, is stronger than nurture. See for example the research survey paper, “Genetic Influence on Human Psychological Traits” Journal of the American Psychological Society 13-4, pp 148-151 (2004). A table from that paper appears below. Genetics plays a fairly strong role in all personal traits including intelligence, personality, self-control, mental illness, criminality, political views (even mobile phone use). The role is age-dependent, though so that intelligence (test determined) is strongly environment-dependent in 5 year olds, almost entirely genetic in 25-50 year olds. One area that is not strongly genetic, it seems, is religion.

In a sense, the only thing surprising about this result is that anyone is surprised. Genetics is accepted as crucial for all things physical, so why not mental and social. As an example of the genetic influence on sports, consider Jewish chess genius, Lazlo Polgar: he decided to prove that anyone could be great at chess, and decided to train his three daughters: he got two grand masters and an international master. By comparison, there are only 2 chess grand masters in all of Finland. Then consider that there are five all-star, baseball players named Alou, all from the same household, including the three brothers below. The household has seven pro baseball players in all.

Most people are uncomfortable with such evidence of genetic proclivity. The movie has been called “deeply disturbing” as any evidence of proclivity contradicts the promise of education: that all men are equal, blank slates at birth that can be fashioned into whatever you want through education. What we claim we want is leaders — lots of them, and we expect that education will produce equal ratios of woman and men, black and white and Hispanic, etc. and we expect to be able to get there without testing for skills, — especially without blind testing. I notice that the great universities have moved to have testing optional, instead relying on interviews and related measures of leadership. I think this is nonsense, but then I don’t run Harvard. As a professor, I’ve found that some kids have an aptitude and a burning interest, and others do not. You can tell a lot by testing, but the folks who run the universities disagree.

The All star Alou brothers share an outfield.

University heads claim that blind testing is racist. They find that some races score poorly on spacial sense, for example, or vocabulary suggesting that the tests are to blame. There is some truth to these concerns, but I find that the lack of blind testing is more racist. Once the test is eliminated, academia finds a way to elevate their friends, and the progeny of the powerful.

The variety of proclivities plays into an observation that you can be super intelligent in one area, and super stupid in others. That was the humor of some TV shows: “Big Bang Theory” and “Fraser”. That was also the tragedy of Bobby Fischer. He was brilliant in chess (and the child of brilliant parents), but was a blithering idiot in all other areas of life. Finland should not feel bad about their lack of great chess players. The country has produced two phone companies, two strong operating systems, and the all time top sniper.

Robert Buxbaum, May 15, 2022

C-PAPs do not help A-Fib, and seem to make heart health worse.

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In this blog-post, I’d like to report on the first random study of patients with Atrial fabulation, A-Fib, and sleep apnea, comparing the health outcome of those who use a C-PAP, a “Continuous Positive Airway Pressure” device, to the outcome those who do not. The original study was published in May, 2021 (read it here) in the American Journal of Respiratory and Critical Care Medicine. The American Journal, Pulmonary Advisor published a more-popular version here.

As a background, if you are over 65 and overweight, there is a 25% chance or so that your heart rate will begin to surge semi-randomly, and that it will flutter. This is Atrial fabulation, A-Fib. It tends to get worse and tends to lead to heart attacks and strokes. People with A-fib tend to be treated with drugs, aspirin, warfarin, beta blockers, and anti arrhythmics. They also tend to be prescribed a C-PAP because overweight, older folks tend to snore and wake up a lot during the night (several times per hour: apnea).

A C-PAP definitely stops the snoring and the Apnea, and the assumption was that it would help your heart as well, if only by giving you a better night’s sleep. As it turns out, the C-PAP seems to decrease heart health — significantly.

For this study, adult patients between 18 and 75 years old diagnosed with paroxysmal A-Fib (that’s occasional AF) were screened for moderate to severe sleep apnea. Those who agreed to participate were randomly assigned to either a treatment of C-PAP plus usual care (drugs mostly) or just usual care for the next 5 months. Of the 109 who enrolled in the study, 55 got the C-PAP plus usual care, 54 got usual care alone. The outcome was that there were 9 serious, adverse heart events (strokes and heart attacks); 7 were in the C-PAP group.

The CPAP pressure was, on average, 6.8 cm H2O; mean time of use was 4.4±1.9 hours per night. The C-PAPs did their jobs on the apnea too, reducing residual apnea-hypopnea to 2.3±1.9 events per hour for those in the C-PAP group.

There was a non-statistically significant reduction is AF among the C-PAP group. They reduced their time in AF by 0.6 percentage points compared to the control group  (95% CI, -2.55 to 1.30; P =.52). That not a statistically significant difference, and is most likely random.

There was a statistically significant decrease in heart health, though. A total of 7 serious adverse events occurred in the C-PAP group and only 2 in the control group. A total of 9 is a relatively small number of events, but there is a strong statistical difference between 7 and 2.

The authors conclude: “CPAP treatment does not seem to reduce or prevent paroxysmal AF.” They should also have concluded that it reduced heart health with a statistical confidence of ~82%: (1-2(36+10)/512) =82%. See more on this type of statistics.

A possible explanation of why a C-PAP would would make heart health worse is an outcome of the this recent sleep study (link here). It appears that the C-PAP helps restore breathing, but by doing so, it interferes with a mechanism the body uses to deal with A-fib. It seems that, for people with A-Fib, their bodies use breathing stoppages to get their heart back into rhythm. For these people, many of their breathing stoppage are not obstructive, but a bio-pathway to raise the CO2 level in the blood and thus regulate heart rate. The use of a C-PAP prevents this restorative mechanism and this seem to be the reason it is destructive to the heart-health of patients with A-fib. On the other hand, a C-PAP does improve the sleep those patients whose apnea is obstructive. It seems to me that sleep studies should do a better job distinguishing the two causes of apnea. C-PAPs seem counter-indicated for patients with A-fib.

Robert Buxbaum, March 30, 2022. I was diagnosed with apnea and A-Fib some years ago. The sleep doctor prescribed a C-PAP and was adamant that I had to use it to keep my heart healthy. There were no random studies backing him up or contradicting him until now.

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.

Aspirin protection from heart attack and COVID-19 death.

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Most people know that aspirin can reduce blood clots and thus the risk heart attack, as shown famously in the 1989 “Physicians’ Health Study” where 22,000 male physicians were randomly assigned to either a regular aspirin (325 mg) every other day or an identical looking placebo. The results are shown in the table below, where “Myocardial Infarction” or “MI” is doctor-speak for heart attack.

TreatmentMyocardial InfarctionsNo InfarctionTotalfraction with MI
Aspirin13910,89811,037139/11,037 = 0.0126
Placebo23910,79511,034239/11,034 = 0.0217

Over the 5 years of the study, the physicians had 378 MI events, but mostly in the group that didn’t take aspirin: 1.28% of the doctors who took aspirin had a heart attack as opposed to 2.17% for those with the placebo. The ratio 1.28/2.17 = 0.58 is called the risk ratio. Apparently, aspirin in this dose reduces your MI risk to 58% of what it was otherwise — at least in white males of a certain age.

A blood clot showing red cells held together by fibrin fibers. Clots can cause heart attack, stroke, and breathing problems. photo: Steve Gschmeissner.

Further study showed aspirin benefits with women and other ethnicities, and benefits beyond hear attack, in any disease that induces disseminated intravascular coagulopathy. That’s doctor speak for excessive blood clots. Aspirin produced a reduction in stroke and in some cancers (Leukemia among them) and now it now seems likely that aspirin reduces the deadliness of COVID-19. Data from Wuhan showed that excessive blood clots were present in 71% of deaths vs. 0.4% of survivors. In the US, some 30% of those with serious COVID symptoms and death show excessive blood clots, particularly in the lungs. Aspirin and Vitamin D seem to help.

.The down-side of aspirin use is a reduction in wound healing and some intestinal bleeding. The intestinal bleeding is known as aspirin burn. Because of these side-effects it is common to give a lower dose today, just one baby aspirin per day, 81 mg. While this does does some good, It is not clear that it is ideal for all people. This recent study in the Lanset (2018) shows a strong relationship between body weight and aspirin response. Based on 117,279 patients, male and female, the Lanset study found that the low dose, baby aspirin provides MI benefits only in thin people, those who weigh less than about 60 kg (130 lb). If you weigh more than that, you need a higher dose, perhaps two baby aspirin per day, or a single adult aspirin every other day, the dose of the original doctors study.

In this study of COVID patients, published in July, those who had been taking aspirin fared far better than those who did not A followup study will examine the benefits of one baby aspirin (81 mg) with and without Vitamin D, read about it here. I should note that other pain medications do not have this blood-thinning effect, and would not be expected to have the same benefit.

While it seems likely that 2 baby aspirins might be better in fat people, or one full aspirin every other day, taking a lot more than this is deadly. During the Spanish flu some patients were given as much as 80 adult aspirins per day. It likely killed them. As Paracelsus noted, the difference between a cure and a poison is the dose.

Robert Buxbaum, November 27, 2020.

Pneumonia vaccine in the age of COVID

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A few days ago, I asked for and received the PCV-13 pneumonia vaccine, and a few days earlier, the flu shot. These vaccines are free if you are over 65, but you have to ask for them. PCV-13 is the milder of the pneumonia vaccines, providing moderate resistance to 12 common pneumonia strains, plus a strain of diphtheria. There is a stronger shot, with more side-effects. The main reason I got these vaccines was to cut my risk from COVID-19.

Some 230,00 people have died from COVID-19. Almost all none of them were under 20, and hardly any died from the virus itself. As with the common flu, they died from side infections and pneumonia. Though the vaccine I took is not 100% effective against event these 13 pneumonias, it is fairly effective, especially in the absence of co-morbidities, and has few side effects beyond stiffness in my arm. I felt it was a worthwhile protection, and further reading suggests it was more worthwhile than I’d thought at first.

It is far from clear there will be a working vaccine for SARS-CoV-2, the virus that causes COV-19. We’ve been trying for 40 years to make a vaccine against AIDS, without success. We have also failed to create a working vaccine for SARS, MERS, or the common cold. Why should SARS-CoV-2 be different? We do have a flu vaccine, and I took it, but it isn’t very effective, viruses mutate. Despite claims that we would have a vaccine for COVID-19 by early next year, I came to imagine it would not be a particularly good vaccine, and it might have side effects. On the other hand, there is a fair amount of evidence that the pneumonia vaccine works and does a lot more good than one might expected against COVID-19.

A colleague of mine from Michigan State, Robert Root Bernstein, analyzed the effectiveness of several vaccines in the fight against COVID-19 by comparing the impact of COVID-19 on two dozen countries as a function of all the major inoculations. He found a strong correlation only with pneumonia vaccine: “Nations such as Spain, Italy, Belgium, Brazil, Peru and Chile that have the highest COVID-19 rates per million have the poorest pneumococcal vaccination rates among both infants and adults. Nations with the lowest rates of COVID-19 – Japan, Korea, Denmark, Australia and New Zealand – have the highest rates of pneumococcal vaccination among both infants and adults.” Root-Bernstein also looked at the effectiveness of adult inoculation and child inoculation. Both were effective, at about the same rate. This suggests that the the plots below are not statistical flukes. Here is a link to the scientific article, and here is a link to the more popular version.

An analysis of countries in terms of COVID rates and deaths versus pneumonia vaccination rates in children and adults. The US has a high child vaccination rate, but a low adult vaccination rate. Japan, Korea, etc. are much better. Italy, Belgium, Spain, Brazil, and Peru are worse. Similar correlations were found with child and adult inoculation, suggesting that these correlations are not flukes of statistics.

I decided to check up on Root-Bernstein’s finding by checking the state-by state differences in pneumonia vaccination rates — information available here — and found that the two US states that were hardest hit by COVID, NY and NJ, have among the lowest rates of inoculation. Of course there are other reasons at play. These states are uncommonly densely populated, and the governments of both made the unfortunate choice of sending infected patients to live in old age homes. At least half of the deaths were in these homes.

Pneumonia vaccination may also explain why the virus barely affected those under 20. Pneumonia vaccines was available only in 2000 or so. Many states then began to vaccinate about then and required it to attend school. The time of immunization could explain why those younger than 20 in the US do so well compared to older individuals, and compared to some other countries where inoculation was later. I note that China has near universal inoculation for pneumonia, and was very mildly hit.

I also took the flu shot, and had taken the MMR (measles) vaccine last year. The side effects, though bad, are less bad than the benefits, I thought, but there was another reason, and that’s mimicry. It is not uncommon that exposure to one virus or vaccine will excite the immune system to similar viruses, so-called B cells and T-cell immunity. A recent study from the Mayo Clinic, read it here, shows that other inoculations help you fight COVID-19. By simple logic, I had expected that the flu vaccine would help me this way. The following study (from Root-Bernstein again) shows little COVID benefit from flu vaccine, but evidence that MMR helps (R-squared of 0.118). Let men suggest it’s worth a shot, as it were. Similar to this, I saw just today, published September 24, 2020 in the journal, Vaccines, that the disease most molecularly similar to SARS-CoV-2 is pneumonia. If so, mimicry provides yet another reason for pneumonia vaccination, and yet another explanation for the high correlations shown above.

As a final comparison, I note that Sweden has a very high pneumonia inoculation rate, but seems to have a low mask use rate. Despite this, Sweden has done somewhat better than the US against COVID-19. Chile has a low inoculation rates, and though they strongly enforced masks and social distance, it was harder hit than we were. The correlation isn’t 100%, and masks clearly do some good, but it seems inoculation may be more effective than masks.

Robert Buxbaum, November 7, 2020.

COVID-19 in Sweden vs the US; different approaches, near identical outcomes.

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Today, Michigan and several other, Democrat-run states are in fairly broad COVID lockdown. The justification for this is that it is “THE science”, as if this were the only possible behavior if you believe the disease is deadly and contagious. The other fellows, the governors of Republican-run states are framed as deniers of the science. Strangely enough, although this disease is most -definitely contagious and deadly, killing 209,000 Americans so far, about 0.064% of the US this year, it is far from clear that a broad lockdown is the only way to stop the disease. Sweden avoided a general lockdown, leaving its schools and restaurants open, and has seen the disease follow an almost destructive path to that of the US, with a death rate that is currently slightly lower than ours. See the excess death plot below. Sweden seems to have avoided a second, summer spike.

Mortality is Sweden vs the US; Ignore the last 2-3 weeks, it takes time for this data to be compiled

It’s bad enough for “THE SCIENCE” when you see the anti-science, no-lockdown solution provide the same result, or close. Earlier in the summer I noted that Sweden and Michigan had near the same outcome, with Sweden slightly better. It’s now the case that Sweden is doing better than the US, and much better than the D-lead lockdown states. The highest six death rate states are all D-lead, lockdown states, NY, NJ, Mass, Conn, LA, and RI, and rates are double the US average in New York and New Jersey. Perhaps the solution is a general opening, like in Sweden, but before we rush to this, it’s probably worthwhile to do some re-thinking.

Deaths per week, under 18. Any excess deaths caused by COVID-19 are invisible here, lost in the scatter.

One thing that Swedes seem to have appreciated that the US experts didn’t is that the disease hardly affects those the under 18, and that’s basically the entire K-12 student body. Sweden therefore left their K-12 schools open, while we closed ours in the US beginning in early April. At right I’ve plotted the US deaths per week for under 18 for the last three years, that is from before COVID till now. There is no evidence of excess COVID-19 deaths for this group. If anything anything, the under 18 death death rate is lower after COVID than before. This resistance of this group helps explain part of why the Swedish approach didn’t cause increased deaths. Kids in Sweden got the disease, but didn’t die of it, and likely infected their parents. The Swedes didn’t bother trying to protect everyone, but only the most vulnerable, the old people. Sweden was not completely successful at this, but we were perhaps worse, despite the general lockdown.

The excess deaths US for the 65+ bracket plotted by week of the year for 2020 (blue), 2019 (grey) and 2018 (yellow). Nearly 200,000 of the excess deaths of 2020 — the vast majority — are in this age bracket.

But what about the middle-age people that the kids would have infected, the parents and teachers. For middle age people, those in the 18-65 range, it seems to make a difference how physically fit you are, and the Swedes tend to be fit. Obesity is a big co-morbidity for this disease, and Americans tend to be obese, with things getting worse during the lockdown. Swedes also wash their hands more than we do (or so is their reputation) and they go out in the sun. There is evidence that the sun helps, and vitamin D too. A stark way of seeing how much fitness helps, for even those over 18 is to consider that, of the 1.3 million men and women of the US military, there have been only 7 COVID deaths. That is a rate 1/100 of the national average for a population that is entirely over 18. This is not to say that the death rate is quite 5 per million, (7/ 1.3 million = 5 per million), but it’s probably below 50 per million. That is to say, at least 10% of the military was likely infected.

I’m inclined to agree with Dr. Fauchi that we are not yet at herd immunity, or even close, even in states like Michigan where death rates have leveled out. Only 20% of the state shows antibodies and real herd immunity would require 75% or so. Further supporting this, our death rates are 1/2 that of New Jersey. If we were at herd immunity, that could not have happened. It is possible though that we have a sort of pseudo herd immunity, where many people in the MI population have some level of T-cell immunity. T-cells do a good job eating disease (here’s a video) but they get overwhelmed when we are exposed to more than a low dose of virus. This dose-response is common in respiratory diseases, and Dr. Fauchi has related it to T-cell immunity, though he does not speak in these directions often.

Michigan death rates to September 2020 The disease seems to be over, though only about 20% of the state shows antibodies.

T-cells can cause someone to be immune to a few viral hits, but not immune to higher doses. Assuming that’s what’s going on in MI and MA, and NJ, I’m inclined to suggest we can open up these states a bit, according to the Swedish model. That is make careful efforts to clean public transport, and encourage hand washing and surface cleaning. That we prohibit large gatherings, and we take care isolate those over 65 and protect old age homes. In the US, virtually all the deaths were of people over 65, and about half were people over 85, with men being particularly vulnerable. A heterogeneous opening of this sort has been recommended by scientists as early as March.

There are three major problems with lockdowns that keep us from all virus particles. These lockdowns kill the economy, they leave us with lousy education, and they likely leave us as at-risk for the disease later on, when the lockdown is lifted. Instead a heterogeneous opening leaves the economy running and exposes us to some small exposure, at a level that our typical level of T-cell immunity may be able to handle. Over time we expect our T-cell immunity will rise and we’ll be able to take off our masks entirely. It’s a nice route to a cure that does not require a vaccine.

The above approach requires us to trust that people will do the right thing, and requires us to accept that each may do it in his/her own way. Some may not wear the mask all the time, but may chose exercising, or staying in the sun and taking vitamin D. Some may keep to masks, or focus on hand washing. Some may try unapproved drugs, like hydroxychloroquine. We will have to be able to accept that, and our experts will have to be able to step back from running everything. In China and Russia, the experts tried run every aspect of farm production, using only science methods. The result was famine. A similar thing happened in Ireland and got a potato famine. It’s good to have expert advice, but as far as making the actual decision in each location, I put a lot of weight on the choices of those who will bear the consequences.

Robert Buxbaum September 30, 2020. As a summary, I’m for opening schools, opening most states, with masks, and hand-sanitizer, at lower occupancy ( ~50%), limiting large gatherings, going to zoom as much as possible, and isolating the aged particularly the old age homes. I also recommend vitamin D and iodine hand sanitizer.

Virus and cancer treatment by your immune system

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There are two standard treatments for a disease. One is through a chemical, pill or shot, often using a patented antibiotic or antiviral molecule, sometimes a radioactive chemical or anti-inflammatory. There have been quite a lot of success with these molecules especially against bacterial disease. E.g. penicillin, a molecule found in cheese, was quite effective against infection, syphilis, and even the viral disease, rabies. Still, in surprisingly many cases, a molecule that you’d expect should cure a disease does not. For this reason, recent research has looked into the other approach to a cure — use your own immune system.

In the most basic version of this approach, that of Paracelcius, is to give the patient nothing beyond sunshine, a clean dressing, and good food. In surprisingly many cases, this is enough to allow the patient’s own immune system will fight the disease successfully. Currently, this seems like our best option to fight COVID-19, the new Wuhan coronavirus.; antivirals seem to have no particular effect on COVID-19, as with rabies, but patients do get better on their own with time, and there is some indication that sunlight helps too, at least in fighting the disease spread, and perhaps in effecting a cure.

Your immune system is remarkably flexible. When it is up to the task, as in the video below white blood cells multiply enormously around the invader and attack. The white cells do not harm your body cells nor those of friendly bacteria, but rally to kill nearly any invader, even one the cells have never seen before. There is a minimum of side effects (fever, tiredness) but these go away after the invader is gone. The immune system then keeps the memory of the invader alive via “Memory T cells” so that it can attack more quickly if the same invader is seen again. This is what we call immunity, and it’s a type of protection that you generally don’t get from pills.

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Unfortunately, not every disease is fought well by the immune system alone. Measles, for example, or smallpox. For several of these diseases we’ve found we can activate the patient’s immune system with a vaccination, even after the patient contacts the disease. An injection of a weaker form of the disease seems to help kick-start the patients own immune system. Vaccination tends to have bad side-effects, but for many diseases, e.g. measles, the bad is outweighed by the good. Interestingly we’ve begun to use this approach on some cancers, too, and it seems to work. Immune therapy, it’s called.

Immune therapy is not generally the first line approach to cancer, but it might be the best for slow cancers, like prostate. Generally, in the fight against cancer, the preferred method is to removes as much of cancer cells as possible, and treat any missed cells using a mix of radiation and chemicals. This works but there are a lot of side-effects. Immune therapy is sort of similar, in a way. Instead of irradiating the bad cells inside the body, one takes the cancer cells outside of the body (or the virus molecules) and uses radiation and chemicals to knock off bits. These bits, a weakened form of the cancer or of the virus, are then cultured and re-injected into the body. Sometimes it works, sometimes not. For melanoma, skin cancer, immune therapy is found to works about 1/4 of the time. Why not more? It seems that sometimes the immune system gets “exhausted” fighting a foe that’s to much for it. And sometimes the activated immune system starts attacking the host body. This is an auto-immune response.

Dr. Robert E. Buxbaum, February 21, 2020