Thursday, January 28, 2010

Bernanke Confirmed, Toyota Recall. What to Do? Health Care: Who Knows Best? Flawed Dr/Patient Decisions

My comments are below. Jim

Bernanke Wins Confirmation for Fed Chairman Jan 28/2010

... But ultimately, a bipartisan majority of the Senate concluded that Bernanke's aggressive actions to combat the crisis, which many argued prevented the recession from becoming a depression, made up for regulatory and other failures by Bernanke and the Fed that contributed to the crisis in the first place. He won confirmation by a wider margin than many Congress-watchers had expected.

"Once the crisis started, he took charge in a way that was unprecedented," said Sen. Kent Conrad (D-N.D.), during the Senate debate. "I believe when the history of this period is written . . . Bernanke will prove to have been one of the heroes." ...

Facts you should consider about your Toyota Recall and Health Care Decisions
(Sec of Transportation LaHood asked Toyota to stop selling new Toyotas. Indiana company produced gas pedals and now going to replace them. The Indiana company did an extremely good job in producing good gas pedals. Just by chance, it could be the specific tolerance or space in the mechanism in the gas pedal has to vary. For example autos made in the USA including Japanese cars tend to very from the specifications more than a little bit.

In Japan the tolerance is closer to the spec so engines and other parts tend to last longer. In Japan the workers and management work more closely together to make sure procedures in production are optimize. Here it is possible that deviations from the spec is tolerated by management. My Prius is made in Japan and are not subject to the second recall.

In my Prius, I noticed that the rug gets lose quite easily because the hooks holding the rug are poorly designed. I was aware that it might interfere with the accelerator so I fixed it quickly, but I finally removed the rug when the accident alerts came out.

The degree of fear in driving your Toyota should be quite low. The incidence of accidents is extremely low compared to a number of Toyotas on the road. Secondly, just driving your car, any car, is much more dangerous, than the flaw would have on your chance of an accident. Toyota recommends braking hard when the accelerator does not work, but they probably should have recommend putting our foot under the accelerator to force it up.

Health Care: Who Knows "Best Practices," Experts or Doctors who are aware of the science and technology?

In the past doctors had plenty of time to read and attend leading medical research conferences so they were more aware of the latest science and technology. But due to a corporate takeover and the poor design of both Medicare and Medicaid, expenses have run out of control with unnecessary treatments as found by a study of millions of Medicare patient records to see which treatments or over treatments gave better or worse results. The had been available even when Hillary Clinton tried and failed to implement a change due to television propaganda lies and distortions by Health Care Insurance Companies and Big Pharma.

A must read article on healthcare bill by Dr Groopman of Harvard Medical School who wrote an earlier article about the lack of science in doctoring. It takes proven technology and science 17 years to be adopted by half the doctors. He addresses the question whether advice by experts on doctoring should be mandatory or making sure the new science and technology is widely distributed directly to doctors directing them to the government website. But experts can be wrong so it is better to let the doctor who knows the patient condition more intimately to make the final treatment decision, not by ignorance or doing what the patient wants, but actual knowledge as to what the best treatment is. For example Pancreatic cancer is normally not found well after it has spread to other organs. A new blood test can detect it early enough to save lives, but I doubt most doctors know about it.

But what I found even more interesting is how the patients themselves make decisions. They are often allowed to make the final decision by doctors to avoid lawsuits. So ignorance breeds ignorance!

It will also apply to the error prone way most Americans make decisions such as vaccinations and whether they will drive their Toyotas or not. I am really impressed at how completely the Obama Administration has looked into all that is known about health care to improve our current system. Unfortunately it is hard to explain much of this to ignorant Americans without inducing sleep.

Jim Kawakami, Jan 28, 2010,

Health Care: Who Knows 'Best'?

By Jerome Groopman

One of the principal aims of the current health care legislation is to improve the quality of care. According to the President and his advisers, this should be done through science. The administration's stimulus package already devoted more than a billion dollars to "comparative effectiveness research," meaning, in the President's words, evaluating "what works and what doesn't" in the diagnosis and treatment of patients.

But comparative research on effectiveness is only part of the strategy to improve care. A second science has captured the imagination of policymakers in the White House: behavioral economics. This field attempts to explain pitfalls in reasoning and judgment that cause people to make apparently wrong decisions; its adherents believe in policies that protect against unsound clinical choices. But there is a schism between presidential advisers in their thinking over whether legislation should be coercive, aggressively pushing doctors and patients to do what the government defines as best, or whether it should be respectful of their own autonomy in making decisions. The President and Congress appear to be of two minds. How this difference is resolved will profoundly shape the culture of health care in America.

The field of behavioral economics is rooted in the seminal work of Amos Tversky and Daniel Kahneman begun some three decades ago. Drawing on data from their experiments on how people process information, particularly numerical data, these psychologists challenged the prevailing notion that the economic decisions we make are rational. We are, they wrote, prone to incorrectly weigh initial numbers, draw conclusions from single cases rather than a wide range of data, and integrate irrelevant information into our analysis. Such biases can lead us astray. ...

Reporters and Editors of Our Press/Media De-Emphasize or Delete Important Facts on Toyota Problem Jan 28, 2010

... Toyota first acknowledged a problem with accelerators last September following the death of a California highway patrol officer and three family members in a high-speed crash. It initially blamed out-of-position floor mats.

Two months later, it said it would replace accelerator pedals on 4.2m vehicles. Earlier this week it said that further investigation had revealed "there is a possibility that certain accelerator pedal mechanisms may, in rare instances, mechanically stick in a partially depressed position or return slowly to the idle position".

The parts are supplied by Indiana-based CTS Corp, whose shares were down 16 per cent in early afternoon trading. However, Toyota said that it accepted full responsibility for the parts. ...

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