TL;DR  Sinus infections resist antibiotics and your immune system by physically walling themselves off with biofilms.  Destroy this biofilm with any gentle surfactant, such as baby shampoo mixed into ordinary saline sinus rinse, and a normal immune system will quickly take out the undefended infection.  You can accelerate this further by adding topical antibiotic to the saline wash *after* first breaking up the biofilm.  Limit future reinfection by deliberately infecting yourself with lactobacillus, in the form of lacto-fermented foods.

Introduction

Many doctors outside tropical Asia appear to be unaware of certain features of sinus infections, even though the information is widely available from Singapore and elsewhere.

Certain home remedies work well, but are usually so poorly explained or misunderstood, even by their purveyors, that they seem flaky or suspect.

Engineers and scientists don’t want to simply trust.  They want to understand mechanisms.

I suffered, and eventually cured, a ridiculously painful series of sinus infections several years ago — months of incapacitating pain day and night.  This post boils down years of reading and self-experimentation to a single explanation of how sinus infections work, and how to kill them. This is not a how-to-do-it, but just a how-I-did-it.  Your mileage may vary.

Understand these six mechanisms

Biofilms block antibiotics.

• Sinus infections construct biofilms around themselves as a physical barrier that limits contact with your immune system and antibiotics.
• Antibiotics and immune cells don’t pass through the biofilm, so the infection survives.
• Hence oral antibiotics tend to kill every bacteria in your body except the sinus infection.

Surfactants easily defeat biofilms.

• Biofilms are robust against antibiotics, but vulnerable to surfactants.
• Johnson’s Baby Shampoo, for example, easily breaks up biofilms, and is specifically designed to be relatively painless on mucus membranes (“no more tears”).
• Without its biofilm, the infection is defenseless against antibiotics or your immune system.
• The delivery mechanism for the surfactant is saline sinus rinse, aka “neti pot.”

Sinuses are like your belly button.

• Sinuses are an exterior but concave surface of your body, like your belly button.
• Belly buttons get dirty unless you wash them, because of concavity.  Sinuses even more so, because they are more concave.
• Viewed this way, there is nothing odd about washing your sinuses, and in fact it starts to seem weird not to wash there occasionally.
• Hence sinus rinse, aka neti pot, is not weird.

Your body is a bacteria farm.

• Many different strains, some harmful, some benign.
• Benign bacterial strains limit the growth of harmful strains by competing for resources.

Oral antibiotics carpet-bomb the farm.

• Oral and intravenous antibiotics kill all strains in your whole body indiscriminately.
• This eliminates competition for resources, allowing surviving harmful bacteria to come roaring back, this time with little resource competition.
• Topical antibiotics (unlike oral or intravenous) are precision weapons that don’t blow up the whole farm.

You can replant your bacterial farm to limit future infection.

• The strains of lactobacillus bacteria found in everything from yogurt to kimchee are harmless to your body, yet compete for resources with other, more harmful bacteria.
• Eating fermented foods has been shown to spread lactobacillus throughout your body, including your sinuses.
• At least one strain of lactobacillus (lactobacillus sakei, the one in kimchee), when present in the sinuses, has been shown to limit sinusitis, again by competing for resources.

Sinus recovery plan

• Buy equipment.
  • NeilMed sinus rinse squeeze bottle and salt packets.  My experience has been that off-brand and store-brand squeeze bottles don’t work right.  NeilMed works.
  • Johnson’s Baby Shampoo (or the NeilMed equivalent, which I haven’t tried).
  • (Optional but awesome) Find a doctor that will prescribe (and a compounding pharmacy that will mix) a small amount of topical antibiotic into sterile saline solution, to use as a secondary nasal rinse, as described below.  I invented this myself and am proud of it (though undoubtedly others have thought of it too).
• Repeat the following every day, until cured.
  • Fill NeilMed bottle with water, add one drop shampoo and one packet salt.  Shake.
  • Rinse sinuses gently per package instructions.  Don’t squeeze the bottle too hard.
  • Wait 30 minutes for the surfactant to break up biofilm.
  • Repeat the above rinse cycle;  this second round will be much more effective at washing away the infection, because the biofilm is broken up.
  • (Optional) For this second cycle, instead of the normal mix, rinse with topical antibiotic described above.  This will put the antibiotic in direct contact with the infection you just exposed in the first cycle above.  In my experience, this is a neutron bomb, instantly destroying the exposed sinus infection while leaving buildings standing.
  • Recovery takes 3-5 days without the topical antibiotic, or just 1-2 days with it.
• Replant the farm.
  • Buy kimchee, sauerkraut and yogurt.
  • Only works if it is a live culture:  when you first open kimchee or sauerkraut, gas should escape, and the contents should bubble up a little.
  • Eat these daily.
  • Feed the farm by also eating whatever the bacteria likes to eat.  I.e. for kimchee, eat steamed bok choy.  For sauerkraut, eat steamed cabbage.  For yogurt, drink milk (organic to make sure it doesn’t have trace antibiotic).
• Redo the above procedures every time the infection recurs.

Things to worry about (and not to worry about)

• The scare stories about Naegleria fowleri in nasal rinses are wildly overblown.  Yes, there is a nasty waterborne amoeba that kills you if it finds a hole from your sinus into your brain.  However:
  • Naegleria only occurs in warm untreated standing water, above 70 degrees.
  • Only a few hundred reported cases reported worldwide in 50 years.
  • Your odds of getting this from chlorine-treated urban tap water are very low.
  • If you use distilled water, the odds are lower still.
  • You are probably much more likely to die in a car crash driving to the supermarket for distilled water than you are to die from Naegleriasis.
• Squeeze the NeilMed bottle gently.  If your sinus is blocked, water may flow through slowly, so if you squeeze too hard, water will seek other paths out, including your Eustacian tubes.  This can cause an ear infection.  If you are gentle, no ear infection.
• After sinus rinse, wait 30 minutes before lying down, to let any water drain.  If you lie down too soon, water can drain into your Eustacian tubes or middle ear, creating conditions for an ear infection.
• Recurrent sinus infection, as the name suggests, is never fully cured.  When it comes back, you just treat it again, and are fine again for a few months or years.

I do not assert works for anyone else, but it totally, completely works for me.  It seems to have the added benefit of making colds less severe, probably by washing away the nasal component of the infection.

Using my topical antibiotic idea in particular, lasting relief came in 1 to 2 days, after months of chronic sinus pain.

As early as preschool, I remember boys arguing about cars. Allegiances fell into simple A/B categories: Ford vs Chevy, Ferrari vs Porsche (our preschool was in Newport Beach, after all).

These arguments were sometimes heated. Yet even then, at age five, it was clear they argued over nothing. Obviously so, in the sense that our feet did not yet reach the pedals. Less obviously so, in that Ford and Chevy were not meaningfully different from each other, and presented a false choice between only two options, at a time when Toyota and Honda were quietly eating their lunch.

American politics today are like my preschool, and not only in their maturity level. Democrats and Republicans are superficially more polarized than at any time since WWII. But polarized over what? Party platforms look like an army of straw men, false choices trumped up to stoke false outrage, shallowly argued, as legitimate issues are ignored.

Take public safety. For most “coastal elites” like myself, public safety means gun control. Let’s stipulate that owning a gun is statistically not worth the risk. That’s why I don’t own one and don’t want one. But that’s not the question. The question is, are guns so dangerous that I should make it a political priority to force my personal choice on everyone else? The answer is no.

Large numbers of voters want their guns. America represents us both; their voices matter as much as mine. The Supreme Court has already ruled for gun rights. The great majority of gun deaths are suicides, household accidents, or inner-city mayhem. With the first two, consequences fall on the owners themselves; with the third, the problem is lawlessness in urban areas that already have tight gun laws, so more regulation would have no effect. High-profile events like mass shootings are statistically not meaningful.

In short, the gun owner in Ohio may be objectively illogical, but I don’t see a compelling reason to abridge his freedom, when both the courts and big chunk of the population are on his side. Fighting over this is an unproductive waste of energy.

While we hyperventilate about this unresolvable and useless gun debate, we leave synthetic opioids untouched. Should they be a public safety priority? Well, they now kill about as many people as guns or car accidents, and are still rising exponentially. Opioids are not defended by the Constitution. They do not provide benefits anywhere near the costs. They have no eager constituency in either party. There is no debate. Everybody agrees they are bad. It should be easy to collaborate to shut them down. Yet nothing happens.

There are many false choices like this — more in future posts.

The whole purpose of the internet was to avoid overcentralization of communication networks.  The system automatically re-routes packets around broken nodes, so you get information slowdowns, but not shutdowns.

Yet the services built on top of the internet today are increasingly centralized.  The odds of an eventual widespread business shutdown are probably going up, not down.

A huge percentage of the Web runs on Amazon Web Services.  When that goes down, tons of things break.  Netflix.  Twitter.  Maybe more fundamental things.

A huge percentage of Web traffic runs through a few huge trunk lines.  If they goes down, internet traffic doesn’t quite stop, but almost.

A growing number of companies keep all their files in cloud servers, which claim to use decentralized storage, but from the client’s perspective are a single point of failure.

Such failures have happened before.  Remember the Sidekick, produced by the presciently named Danger, Inc.?  It was an early mobile-and-messaging device. One day in 2009, all 800,000 users irretrievably lost all data, including all contacts, messages, photos and calendar events.

That was a decade ago.  Today, the cloud providers are more stable, but we’re also more centralized, and more vulnerable to system failure, than ever…

When the facts change, I change my mind.  What do you do, sir?

– John Maynard Keynes (according to Paul Samuelson)

Trump proposes to end “birthright” citizenship by executive order. Xenophobic and illegal, as usual.

Yet it would not be unconstitutional, nor a bad idea, to seek careful legislative clarification to  the 14th Amendment. Read it. There is clearly room to ask whether automatic citizenship should be granted to all children born to any non-citizen who merely happens to be in the US at time of birth.

And interpretation can change with needs.  When the 14th Amendment was ratified 150 years ago, the US was a vast empty continent, with 30% fewer people than California alone today.  Nearly all jobs were unskilled or semi-skilled.  Reaching America from other countries was slow and expensive, limiting the rate of flow.  It was logical, under those circumstances, to have a loose and expansive definition of citizenship.

It is not “closing the door behind you” to recognize that conditions change.  Today, the US is the world’s third-largest country by population.  We don’t obviously need more people with the urgency of a century ago.  Where we do need more, we need only skilled people.

“Birthright” citizenship makes no distinction between skilled and unskilled.  It is probably the biggest single incentive for unskilled illegal immigration, so it makes sense at least to re-examine what we are doing at this margin.  Instead, we get blind xenophobia on the right, and blind opposition to new limits from a left that has forgotten its labor roots.

Let’s stipulate that nearly all immigrants are hardworking, honest and deserving.  That alone is not sufficient reason to allow undocumented immigration.  The US needs more skills, not more bodies.  We are already oversupplied with underskilled US citizens.  We lack effective systems to retrain them.  The more unskilled workers that come into the country, the greater this imbalance becomes.

It can be hard for coastal elites (like myself) and Baby Boomers to grasp, but America’s resources are not infinite.  Since we cannot help everyone in the world, we must prioritize who we help.  We owe our greatest responsibility to our own current citizenry.

Thus it makes sense to question, within constitutional limits, the incentives that attract unskilled workers here outside the rule of law.

As the world grows wealthier, births by Caesarian section are growing common.

This sends human evolution in a new direction.

Obviously the human species is optimized for intelligence.  That is its competitive advantage.  Intelligence requires brain capacity, which requires a big head.  The correlation is not perfect, but a strong predictor of an adult’s intelligence is head size at birth.

Head size has not changed much for millennia.  This, in turn, implies that human head size has been at an equilibrium.  If the head got much smaller, offspring would tend to be too dumb to survive and/or compete for mates.  If the head got much bigger, the baby wouldn’t fit through the birth canal, and mother and child would both die at birth.

The evolutionary advantage of large head size is implicit in the high death rates that prevailed in childbirth before modern medicine.  Big heads were so competitively valuable that they were worth a material risk of the mother dying on every single birth.

With widespread C-sections, that risk is no longer material, and human head size is now unbounded.  If high intelligence is still reproductively valuable (I don’t know the answer to that), then we should now expect human heads to grow larger and larger.

If that happens, then we also take on a new civilizational instability.  If humans adapt to produce babies that do not fit through the birth canal, and if C-sections for some reason became unavailable for a period of decades…

What do “inclusion” and “celebrating diversity” mean specifically?  Arguably, both are misunderstandings of a much older and more powerful idea:  tolerance.

My neighborhood is overwhelmingly Confucian East Asian, and thus is homogeneous, the opposite of diverse.  I am not Asian or Confucian.  Should I care?  Should it be important to me that my neighborhood become more “diverse,” i.e. more proportionally representative of my own ethnic, religious or cultural groups?

No.  The important thing is not equal representation, but openness and tolerance.  It’s important that I am treated no differently from anyone else, have the same access, the same opportunities, as anyone else.  It’s important that am not judged.

What’s important, then, is not equal representation, but simply freedom from unjust judgment by the majority.  In short, tolerance.

Three years ago I posted the world’s simplest diet:  avoid sweet flavors.

This diet is simple, works great, but is shockingly difficult for people addicted to sweets.  Here is a phrase I overhear all the time:  “I need something sweet.”  Almost without exception, the utterer is fat and prediabetic.  Yet the connection between the two — uncontrollable craving for sweet flavors, and health problems — is invisible to almost everyone.

This boy is Ignorance. This girl is Want. Beware them both,
and all of their degree, but most of all beware this boy,
for on his brow I see that written which is Doom, unless the
writing be erased.   — Charles Dickens, “A Christmas Carol”

America is witnessing the consequences of a failure to educate and retrain globalization’s losers.  For 25 years, the globalists, including myself, have presumed that technology and trade will eventually make everyone better off.  It’s taking too long, and the natives are restless.  Americans without the right kind of education, increasingly unemployable in a world of low-wage offshore manufacturing and low-skill illegal immigration, are rebelling.

This, more than anything else, is why Trump won.  As his administration appears to go down in flames, don’t be too sure that we’ve seen the end of the forces that unleashed him.  One charlatan may go, but the basic problem is not addressed.

In designing policy, we must first understand that globalization is inevitable, because it is driven by technology, not policy.  Globalization has been under way, slowly but inexorably, throughout recorded history.  Horses and carts allowed regional trade, which created larger economic regions.  Then shipping.  Then canals.  Then rail.  Then telegraph.  Then phone.  Then superhighways.  Then the Web.  Each step increased the size, and lowered the transaction costs, of trade areas.

Larger trade areas have always made everyone better off on average.  This comes straight from Adam Smith:  the bigger the trade region, the greater the economies of scale for a given specialization, hence higher productivity than otherwise would be possible.  This has always been true, and will continue to be true.  It’s an arithmetic truism.

But larger trade areas don’t make every individual better off.  If you’re uncompetitive, you get whacked.  The US, and especially Clinton-era Democrats, gambled for a quarter-century that globalization would eventually make everyone better off.  It hasn’t happened yet.  That’s what brought the Trump/Sanders rebellions.

Unfortunately, both Trump and Sanders have the wrong answer:  retreat.  Both mistakenly think of globalization as a policy choice, rather than a technological inevitability.  Withdrawing from a large trade area would only ensure the US is left behind in future trade-driven prosperity.

The only thing that could save us from more Trumps and Sanderses:  access to free Web-based education.  Huge shortages exist in skill sets that can be learned online for free.  Making those skills even a little more accessible to globalization’s losers could make a huge difference politically.

What kind of accessibility?

• Universal internet access.  Just as the Rural Electrification Act in the 1930s brought Kentucky and Tennessee into the industrial age, a Rural Webification Act might bring them into the internet age.  Computers are already cheap:  $100 will buy you enough computing power to do real work.  The roadblock is the internet service provider:  $80/mo for decent bandwidth is an insurmountable barrier for a poor family.  But imagine if someone demonstrating an income under $40k could get 1Mbps internet for $10/mo.  It could permanently transform his fortunes, at low cost to the rest of us.
• Road map to skill shortages and free resources.  How do you know where to start? or what to study?  There are endless online resources to learn, for example, Ruby on Rails coding — but to begin, you need to know, first, that Rails coders are in tremendous shortage, and, second, where to find the free online resources to learn Rails coding.  Government and charitable foundations could provide this road map.
• Awaken globalist American charitable foundations to an existential threat. For all their brilliance at providing the greatest good to the greatest number worldwide, groups like the Gates Foundation seem not to appreciate that they cannot function, nor even survive, unless the United States remains politically stable and engaged with the world.  Thus it is in their existential self-interest to participate in the rescue of globalization’s losers.

Notice what I’m not advocating:  universal income, trade barriers, immigration barriers.  These are all forms of retreat, and should be viewed with skepticism.

I’m also not advocating for “free college,” which is a high-cost, uncertain-benefit misapplication of archaic forms of general education to address the narrow, specific skill shortages, learnable for free, that would most rapidly improve the fortunes of globalization’s losers.  A degree in English remains socially useful as ever, and classroom debate is as enriching as ever.  However,  on average, it will not reliably improve the fortunes of Pennsylvania’s urban unemployed at minimum cost.

The highest-leverage solution is to point people to free sources of useful skills, and give them just enough resources to access them.  It’s the lowest-cost, highest-benefit approach, and we should maintain laser focus on it.

US immigration policy is deeply confused.  Neither party thinks clearly about it, and as a result, laws have gone unenforced for decades, corroding the integrity of our rule of law.

Democrats, traditionally the party of labor, would once have opposed low-skill immigration:  it brings in ultra-low-cost labor, weakens unions, and ultimately hollows out the traditional base.  We’ve watched that hollowing for decades.  Yet Dems have mostly wanted to go easy on illegal low-skill immigration, partly for fear of offending constituencies, and partly because of a well-founded belief that free trade and loose immigration will eventually make most Americans better off.  The Democratic party has been staunchly globalist for 25 years, and they’re not wrong.  But they haven’t acknowledged, nor taken decisive action to mitigate, the consequences for their traditional labor base.  The strain is showing.

Meanwhile, traditional pro-business Republicans should logically support unskilled immigration, because it brings low wages, making everything cheaper to produce.  Yet they generally oppose it — partly, it seems, out of simple xenophobia.  The GOP has pandered to xenophobes for some time, and naturally this won’t be publicly admitted either.

Result:  the two parties are not just unable to hammer out a compromise they can stick to, but unable even to openly acknowledge their own de facto platforms to their own constituents.

For lack of openness and compromise, we are left with laws on the books we don’t actively enforce.  That’s a failure of democracy, and corrosive to the rule of law.

What laws are not enforced?  The simplest example is that it is a crime to be in this country without permission.  We’ve let this slide so long that we almost forget.  We begin to draw a mental distinction between “in the country for 10 years without permission,” and “actual crimes.”  But there is no such distinction in law.  Illegal immigration is illegal.

This is true in every country.  If I drove to Mexico and stayed there for a year with no visa, I would be in that country illegally.  That is a crime.  El Policía Federal could arrest and deport me. Would it become less a crime if I stayed there 10 years, learned fluent Spanish, and obeyed all other Mexican laws?  No.  If anything, would become more a crime, because I had stayed there illegally for longer. This is obvious. Yet in the US, municipalities often direct police not to enforce this law.  The years turn into decades, and we begin to forget what is legal and what is illegal.  Dangerous precedent.

We rationalize this lack of enforcement because it would be cruel to deport someone who has already built a life here — or, even crueler, to deport someone to who came here as a child, and may know nothing of their legal home country or language.  It’s true.  That would be cruel.

But it’s important to understand that this cruelty is not caused by suddenly enforcing the law.  It is caused, instead, by the systemic failure to enforce the law, for decades, allowing lives to be built in the US outside the rule of law.  This is a fundamentally shady way of operating, anathema to the rules-based approach that made the US successful in the first place.

The only non-shady way to operate is to legislate a policy we are prepared to enforce, and actually enforce it.  That requires a process of open legislative debate and compromise.

Which brings up the second point:  we got to here by a failure of democracy.

To reach a policy compromise on immigration, Republicans and Democrats would first have to openly reconcile their own platforms with the interests of their constituencies.  This reconciliation been so long in coming that it feels foreign.

For example, one thing does make sense about the surprise Trump victory:  his opposition to illegal unskilled immigration and manufacturing imports, right or wrong, was popular with unskilled men, whose jobs are most at risk.  Traditional union Democrats, abandoned by a globalist Democratic Party that offered no solutions to their plight, defected to Trump.  Yes, there are racists and xenophobes out there too, but that would not explain the suddenness of the defection.  The logical explanation is that unskilled men finally found a candidate who claimed he would eliminate their toughest competition in the unskilled labor market.

When Trump proposes to enthusiastically enforce existing law, he puts Democrats and Republicans alike in an untenable position.  He is calling them out for failing to compromise and enforce.  What possible counterargument is there?  “No, we will continue to let municipalities ignore existing law, fail to produce laws we can stick to, and fail to confess our own party platforms.”  Checkmate.  It is ironic that the US president most likely to undermine the rule of law has gotten this one thing right, even if by accident.

Dems in particular are suffering from a failure to be open about their pro-trade, pro-immigration globalism, and to offer real alternatives for Americans who are left behind.  Coming clean about this, and offering help to globalization’s losers, would be a first step to real legislative compromise, which could then be more enthusiastically enforced on the ground.  This would then restore the rule of law that brought America so far.

Later today, I’ll post a potential platform to help those left behind by globalization.

The “fewer, nicer” credo — elegant simplicity, few assets — is partly generational.  People born before 1960 simply do not get it.  Like past generation gaps, this is driven by changes in tech.

1960s:  the Generation Gap was essentially “before pills” and “after pills.”  After World War II, changes in technology rendered venereal diseases curable, and pregnancy avoidable.  People who reached puberty after about 1960 then simply acted on human instinct, unrestrained by a millennia-old social rule, “don’t commit adultery,” that suddenly carried no real consequences.  Older people, acting on the old social rules out of habit rather than rationale, were shocked.

2017:  here we go again.  The mobile internet has turned old assumptions upside down.  For any type of knowledge work, you can now live and work anywhere you can find high-speed internet.  So-called “millennials” are simply responding to this new landscape of capabilities and constraints.

Houses and cars look like boat anchors, limiting flexibility and mobility.  Luxury goods in particular are unmasked:  while aesthetics still have value, luxuries are in effect much more expensive than before, because they reduce mobility.  Fixed offices have less utility when you can work and collaborate from anywhere.  Landlines, checkbooks, bank branches, cable TV — there is a very long list of things that suddenly don’t make sense in the modern technological landscape.

And people born before about 1960, or even 1965, simply do not get it.  Since most politicians are on the wrong side of that divide, they are unable to forge policy that makes sense in today’s conditions.