Software Bug Causes Toyota Recall of Almost Half a Million New Hybrid Cars [Cars]

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Toyota just announced a recall of its 2010 hybrid cars. Four hundred thousand worth. The reason? A change in "brake feeling" caused by faulty antilock braking software. There is no fix for cars on the road yet.

This problem, unrelated to the sticky gas pedal issue that other drivers complained about. But I'm still wondering what exactly is bothering our Prius-loving friend Woz, who claims he has a faulty cruise control issue that is software related, not mechanical.

Remember that old joke about if cars were as crash prone as computers? Yeah, not funny in 2010. [CNN]


Time to Care: Personal Medicine in the Age of Technology

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In 1925, Francis Peabody famously said “The secret of the care of the patient is in caring for the patient.” A new book by Norman Makous, MD, a cardiologist who has practiced for 60 years, is a cogent reminder of that principle.

In Time to Care: Personal Medicine in the Age of Technology, Dr. Makous tackles a big subject. He attempts to show how modern medicine got to where it is today, what’s wrong with it, and how to fix it. For me, the best part of the book is the abundance of anecdotes showing how medicine has changed since Dr. Makous graduated from medical school in 1947. He gives many examples of what it was like to treat patients before technology and effective medications were introduced. He describes a patient who died of ventricular fibrillation before defibrillators were invented, the first patient ever to survive endocarditis at his hospital (a survival made possible by penicillin), a polio epidemic before polio had been identified as an infectious disease, the rows of beds in the tuberculosis sanitariums that no longer exist because we have effective treatments for TB. He tells funny stories: the patient who was examined with a fluoroscope and told the doctor he felt much better after that “treatment.” He describes setting up the first cardiac catheterization lab in his area. No one who reads this book can question the value of scientific medicine’s achievements between 1947 and 2010. Today we can do ever so much more to improve our patients’ survival and health. But in the abundance of technological possibilities, the crucial human factor has been neglected.

Individualized care, which involves the use of science-inspired technology, is not personal care. Alone, it is incomplete. It does not provide the necessary reassurance that can only be provided through a trusted physician who focuses upon the totality of the person and not just upon a narrow technological application to a disease. Time and personal commitment are needed to build the mutual understanding and trust that are fundamental to personal care….the continued acceleration of science, technology, and cost has intruded on personal care in our country. This has also occurred during a time in which American individualism and its accompanying sense of entitlement have become more of a cult than ever before. In the absence of personal attention, patients demand more testing, but testing does not satisfy the need for personal interaction.

Makous invokes the Golden Rule: “Over the course of my career, I learned to treat patients as I would like to be treated under similar circumstances.”

Some of his recommendations:

  • Unhurried visit
  • Undivided attention to patient (not to chart or recording device)
  • Sitting down to talk to the patient
  • Laying on of hands
  • Humor
  • And finally, “Most patients will choose a doctor who enjoys their company.”

Makous points out that the “holistic” approach to medicine is nothing new: Hippocrates introduced the concept in the 5th century BC and good clinicians have always used it.

Medicine is an applied science, not an exact science, and often the best the physician can do is make an educated guess. The better the doctor knows the patient and the better he incorporates the personal element of care, the more educated the guess. For instance, knowing whether a patient is typically stoic or a complainer helps us decide how seriously to take his complaints. The “worried well” typically complain about every little thing; the stoic may not realize they are ill until they can’t get out of bed.

He thinks that evidence-based medicine only helps with about 5% of a physician’s work. Surely evidence-based medicine constitutes a larger percentage than that, but perhaps what he means is that when he is trying to make a difficult clinical decision there is only a pertinent, useful clinical study to guide him in about 5% of cases. Study populations may not be representative of the individual in the doctor’s office. Studies isolate one condition: your patient may have many others. “No study has been done that can’t be faulted in its extrapolation to the individual.” Most studies generate as many questions as they answer.

I agree with much of what he says, but then he goes too far:

The assumption is that physicians relying on personal experience have been on the wrong track and their practices need to be changed. In reality, the opposite is true.

No, relying on personal experience is a recipe for self-deception, and those practices need to be tested. There’s a danger in too much “personalization” of medicine: the doctor can be seduced into believing he is wiser than he really is and into rejecting science. If you think every patient is so different that scientific studies don’t apply, then anything goes. You can find an excuse to try any treatment you can think of. This is similar to the pitfalls of CAM’s claims of individualized treatment, as recently described by David Gorski.

Doctors today must please two masters: the patient and the healthcare organization. Care is fragmented, and specialists feel obligated to do more tests. Consultants often assume they are expected to do certain tests rather than to decide for themselves if the tests are really warranted. They are concerned about liability if they fail to do a test. They are reimbursed for doing the test, but are not reimbursed for the time needed to evaluate the patient holistically and determine if the test is really in his best interest. They are content to assume that the referring physician has already done that. But the referring physician may not know enough about the test to decide, and he may be assuming the consultant will decide appropriately. Costs and malpractice litigation rise as a result. Poor Medicare reimbursement means many doctors are refusing to accept new Medicare patients. We need a system to get more compassionate care to geriatric patients, more time with their doctors, not more technology.

Physicians are reimbursed lavishly for doing procedures but not for spending extra time talking to patients. They are not reimbursed adequately for counseling about preventive measures. Makous suggests that detailed advice on obesity and smoking might be better addressed as a public health concern and provided by non-physicians.

This is a thoughtful book by a wise old soul who has “been there, done that.” It is well worth reading for the insight it provides into recent medical history and for its reminder that doctors should treat patients as they themselves would want to be treated.


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Some Good News, and Some Bad News, About Adobe Flash 10.1 [Flash]

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The good news first: Adobe's promising Flash 10.1 is going to hit smartphones—Android, WebOS, Windows Mobile—and desktops in the "first half" of this year, a slightly less squishy date. And it'll come over the air. The bad part?

Well it's bad for Android, anyway: You're gonna need Android 2.1. At least. Because it provides some access Adobe needs to make the Flash magic happen. So, sorry everything but the Droid and Nexus One, at least for the moment. The "over the air" thing is also kind of "up in the air" as to what that means: It could come from your carrier, it could come from your phonemaker, or failing all else, it could come from Adobe. Which means, Flash isn't necessarily going to hit your phone at the same time as everybody else's. Depends on your phone. But, they're betting that over half of smartphones—53 percent—will have Flash Player by 2012. Not surprisingly, Adobe says Flash 10.1 is going to be all over some tablets, too, with accelerated performance on Nvidia's Tegra 2, Qualcomm's Snapdragon (like what's in the Nexus One), and Freescale's i.MX515.

Lastly, Adobe would like you to know that this whole Adobe vs. HTML5 thing is silly, since they totally support HTML5, like all web standards. They love them some web standards, they say. But! They would also like you to note that HTML5 standardization is years away, and Flash works right now. And the reason you notice crappier performance on the Mac is sorta the Mac's fault, they say, because they need more access to APIs and they get half-assed crash reports. Plus, Adobe claims, apps tend to run faster in Windows than OS X generally, because performance is about 20 percent worse using OS X's GCC compiler, not to mention performance varies even within an OS, since Flash runs 20 percent faster in IE8 than Firefox, for instance. Either way, performance will be better on Mac with Flash 10.1, since it's shifting over to using CoreAnimation.

Okay, you can resume your "death to Flash!" chants now (even though it's not going anywhere for a while, people!). [Adobe]


Seeking Electrical Power Supply Guidance

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1-Can we use ACB for a 600KW LT motor which is feeding through 690v ac power supply. if so then what will be the appropriate ACB rating ? needs ur guidance thanking u.

2-What is the advantage of HT motor over Lt motor which is costly and what is the cosst difference for a 600kw HT moor &

Publishers Tell Google and Their Ebook Plans to Get Bent [Rumor]

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The vision of ebooks Google has presented to publishers: allowing people to print copies, cut and paste portions, and paying publishers 63 percent of the revenue. The vision the publishers presented in return: Go eff yourself.

That's right, Google's finally getting around to opening an ebook store too—called Google Editions, and it's been in the works for a while—the idea being that people will be able to read the books on any internet-connected device.

What's incredible is how the Times says negotiations are now proceeding. Now that Apple and Amazon are fighting over publishers and their books—imagine how oh-so-hotly desired they must suddenly feel—publishers have real power to negotiate, and it comes with wondrous effects, like getting an information monolith like Google to actually back down. There will be no printing, no cutting and pasting. And 70 percent, like what Apple and Amazon are now offering, is apparently starting to sound dandier to Google. Another point Google gave in on, surprisingly, is search. Previously, they planned to make up to 20 percent of every book they sold through the store searchable, but that wasn't kosher with some of the publishing execs, so now they can choose to opt out of search.

Google finally jumping into selling ebooks, with the idea of being the ebook seller to everyone—or at least, everyone not toting a special reading device, just your average thing with a screen and internet access—could definitely shake things up even more than they already are. And you know, a Chrome OS tablet with an ebook store would be slightly more interesting as a cheaper iPad rival.

Publishers should enjoy the attention, and power, while it lasts. Because it won't. [NYT]


Synopsys to Acquire CoWare, Inc.

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Synopsys, Inc., a world leader in software and IP for semiconductor design, verification and manufacturing, today announced it has signed a definitive agreement to acquire CoWare, Inc., a global supplier of software and services for electronic systems design.