We really need to panic more - FDA inspection of Chinese drug suppliers

I remember the good old days. Back then, the public panicked about apple's sprayed with relatively harmless insecticides. In those days we panicked about everything.

Ok, so we still see insane full page ads in the NYT accusing immunization of inducing a plague of autism. On the other hand, where's the panic about our drug supplies?

The FDA would take 40-50 years at its current rate to inspect today's Chinese drug manufacturers?! Plants like the one producing defective Heparin?! ...

F.D.A. Broke Its Rules by Not Inspecting Chinese Plant With Problem Drug - New York Times

... Baxter International announced on Monday that it was suspending sales of its multidose vials of heparin after four patients died and 350 suffered complications, many of them serious. Baxter bought the active ingredient for this product from Scientific Protein Laboratories, which has plants in Waunakee, Wis., and Changzhou City, China...

... Ms. Gardiner said that recent tests by Baxter had found subtle chemical differences among the lots that Scientific Protein shipped to Baxter “but it is unclear what impact the differences would have” on Baxter’s heparin product.

Dr. Ajay Singh, director of dialysis at the Brigham and Women’s Hospital in Boston, said he was astonished by what he called the many failures to ensure a safe supply of heparin. There are 450,000 people in the United States on dialysis, and nearly all of them need copious doses of heparin, he said. Heparin is also used in cardiac surgery and among chronic care patients.

“We need to ensure that this country has access to the crucial medicines it needs,” Dr. Singh said. “This is a national security issue.”

The heparin scare comes at a particularly delicate time for the F.D.A. Over the past year, a wave of tainted goods from China, including deadly pet food ingredients and tainted fish, has prompted concern about whether regulators are adequately monitoring imports’ safety.

The Government Accountability Office released three reports in recent months that found that the drug agency provided little oversight of the increasing number of foreign plants that export food, drugs and devices to the United States.

Although the agency must inspect domestic drug plants once every two years, the investigators found that it inspected foreign drug plants at best once every 13 years. The agency’s record in China, now one of the biggest drug suppliers in the world, is even worse. Of the 700 approved Chinese drug plants, the agency has been able to inspect only 10 to 20 each year and would need 40 to 50 years to inspect them all.

Really, this would be a great time for panic.

Instead the American public behaves like a pithed frog -- a study in learned helplessness.

We really, really, need to get the GOP completely out of power.

Update 2/15/2008: If our medication supply is having quality issues, they would not all be as obvious as fatalities. They might only show up in large scale studies ...

The Fibonnaci sequence, In Our Time and why digital cameras should adopt the 35 mm aspect ratio forever

Not to mention my old neglected web pages. All intimately connected through the 1/Golden Ratio of "1.6180339887". That's a smidgen more than 8/5.

How connected?

To begin with, here's a (slightly revised) discussion from an ancient web page of mine about photographic aspect ratios, long the bane of the art:

John's Digital Photography Page

I thought printing was a peculiar curse of digital photography, but "Socrates" corrected me:

Printing is the curse of ALL photography and has been for a hundred years. 35 mm. has been the most popular format for probably fifty years. Until very recently (with 4X6 paper), there was NO paper available that matched the 3X2 aspect ratio. We had a choice of 3.5X5 or 5X7 or 8X10. The 8X10 was perfect for a 4X5 view camera used by professional portrait photographers. The smaller sizes were "almost" the 4X5 aspect ratio ...

In the case of digital photography, consumer camera sensors follow the convention of monitors: 640:480 = 4:3; on the other hand 35 mm film has a ratio of 3:2. Digital SLRs most often go with the 35 mm ratio of 3:2 (width to height), and some oddball Panasonic cameras use the video ratio of 16:9.

Not quite the same. The most popular print size, 4x6, is a good match to 35mm film, but not to most digital sensors. (BUT, Apple's photo books expect the 4:3 ratio.) If you print to a 4x6 paper; either there's cropping (most common) or dark bands are seen (better really, but unsightly).

This list of aspect ratios helps clarify the problem (here I use height/width as it makes the ratio easier to compare):

4x5: 0.80 (view camera and 8x10 prints)
3x4: 0.75 (most digital cameras and Apple's PhotoBook)
5x7: 0.71 (print size)
3.5x5: 0.7 (print size)
2x3: 0.67 (35mm and 4x6 prints - 35 mm is the diagonal for the old netatives) 
5x8: 0.63 (Golden Ratio, more or less)
9x16: 0.56 (video ratio, widescreen monitors)..

So, we clearly see that the so-called 4x6 aspect ratio of 35 mm film and dSLRs is closest to the Golden Ratio. Which makes that the best choice for digital photography sensor size.

Huh? How did I make that leap? Well, it turns out the "Golden Ratio" is baked into the mathematics of the universe, and it has some odd aesthetic appeal to the human brain (Parthenon, art, architecture, music, etc).

The Golden Ratio is derived by looking at the convergence of the ratio of number pairs in the Fibonacci sequence. That sequence was introduced to Northern Europe in the early 13 century by Fibonacci (In Our Time: 11/29/2007), who might have come across them while learning about Arabic (Indian actually*) numbers when adventuring in Northern Africa. The sequence goes like this:

1, 1, 2, 3, 5, 8, 13, 21, 34 and so on (each digit is the sum of the preceding pair).

the ratios look like this (note the 3/2 -- the 35 mm negative size:

1/1, 2/1, 3/2, 8/5, 13/8, 21/13, 34/21 and so on ..

So we see that our familiar 4x6 photographs are the 3rd item in the ratio sequence, and not too far from the covergent value of the Golden Ratio: 1.6180339887.

There's no arguing with the fundamental structure of the universe, adjusting slightly for tradition.

The 4 x 6 printed image rules. Let no pretender emerge.

* I thought our digits were an Arabic invention. They turn out to be Indian, but they came to Europe via Arabia. This is an interesting example of wrong things I learned as a child that I have not since revisited, an increasingly common phenomena.

My favorite OS X headline

TidBITS Macs & Mac OS X: Leopard Emerges from Beta as 10.5.2 Ships. 

That's about right. 

When 10.5 slipped from its original release date of Feb 2007 I figured it would be ready for release by March of 2008. Instead Apple released the beta version in October of 2007 to people eager to pay for the honor of beta testing.

That's a bit rich, even for Apple.

Apple managed to beat my prediction by about two weeks -- so maybe all those unwitting beta testers helped move things along a bit. Based on the many fixes in 10.5.2 it looks 10.5.3 will be the release I'll upgrade to -- the first service pack after the true "gold" release. 

As predicted.

eBay admits it has a problem

I don't trust eBay. I think the management has known for a long time that they had a lot of crooked sellers, but they did nothing as long as the money came in.

Now, as reviewed by Nicholas Carr, eBay is worried:

Rough Type: Nicholas Carr's Blog: Crowd control at eBay: 

... overall, the current feedback system isn't where it should be. Today, the biggest issue with the system is that buyers are more afraid than ever to leave honest, accurate feedback because of the threat of retaliation. In fact, when buyers have a bad experience on eBay, the final straw for many of them is getting a negative feedback, especially of a retaliatory nature.

Now, we realize that feedback has been a two-way street, but our data shows a disturbing trend, which is that sellers leave retaliatory feedback eight times more frequently than buyers do ... and this figure is up dramatically from only a few years ago...

No joke. I was blackmailed by a crooked seller myself. Of course that only ensured I left scrupulously honest and accurate feedback, which resulted in retaliatory negative comments on my profile. (Since I don't use eBay any more that didn't matter too much.)

Craigslist, Amazon and specialty shops are better choices for selling and buying used goods. eBay deserves to be liquidated.

What should they have done differently? For one thing, anonymity doesn't work in commerce. It was too easy in eBay to create and destroy fake personas. Reputations matter, and they need time to be established.

Gwynne Dyer: Kosovo, Climate Change, US Defense budget

My Dyer Detector fired today. Sure nuff, he's added three high value essays:

• Kosovo update: Independence pending in next few weeks
• America's half-trillion dollar defense budget is not driven by the 'war on terror', it's in anticipation of resource and climate conflicts with China
  

and a favorite of his -- Climate change:

Over the past few weeks, in several countries, I have interviewed a couple of dozen senior scientists,government officials and think-tank specialists whose job is to think about climate change on a daily basis. And NOT ONE of them believes the forecasts on global warming issued by the Intergovernmental Panel on Climate Change
just last year. They think things are moving much faster than that.

The IPCC's predictions in the 2007 report were frightening enough. Across the six scenarios it considered, it predicted "best estimate" rises in average global temperature of between 1.8 and 4.0 degrees Celsius (3.2 and 7.2 degrees F) by the end of the 21st century, with a maximum change of 6.4 degrees Celsius (11.5 degrees F) in the "high scenario". But the thousands of peer-reviewed scientific papers that the IPCC examined in order to reach those conclusions dated from no later than early 2006, and most relied on data from several years before that.

It could not be otherwise, but it means that the IPCC report took no notice of recent indications that the warming has accelerated dramatically. While it was being written, for example, we were still talking about the possibility of the Arctic Ocean being ice-free in late summer by 2042. Now it's 2013.

Nor did the IPCC report attempt to incorporate any of the "feedback" phenomena that are suspected of being responsible for speeding up the heating, like the release of methane from thawing permafrost. Worst of all, there is now a fear that the "carbon sinks" are failing, and in particular that the oceans, which normally absorb half of the carbon dioxide that is produced each year, are losing their ability to do so.

Dyer points out the five degree average increase includes cool supra-ocean air, so the inland increase is rather higher than five degrees.

Manipulating the hairless ape: applied mimicry

A little mimicry, but not too much ...

Psychology - Mimicry - Persuasion - How to Build Rapport - New York Times

The technique involved mirroring a person’s posture and movements, with a one- to two-second delay. If he crosses his legs, then wait two seconds and do the same, with opposite legs. If she touches her face, wait a beat or two and do that. If he drums his fingers or taps a toe, wait again and do something similar.

The idea is to be a mirror but a slow, imperfect one. Follow too closely, and most people catch it — and the game is over....

...Social mimicry can and does go wrong. At its malicious extreme, it curdles into mockery, which is why people often recoil when they catch of whiff of mimicry, ending any chance of a social bond. Preliminary studies suggest that the rules change if there is a wide cultural gap between two people. For almost everyone else, however, subtle mimicry comes across as a form of flattery, the physical dance of charm itself. And if that kind of flattery doesn’t close a deal, it may just be that the customer isn’t buying.

I'm going to test my boss, who I suspect is good at this sort of thing (consciously or not). I'll try changing my hand position and see if she mimics it ...

Big iPhone SDK slip?

Rumor of an end-of-February Apple event are offset with rumors of a major SDK delay ...

iPhone SDK rumors suggest delays, inclusion of simulator

Speaking of taking longer, another more ominous rumor suggests that the iPhone SDK may not be arriving in February after all. Delays in packaging, documenting, and testing the SDK could push the release back as far as WWDC in June. Delays could also be caused by Apple spending tweaking the security "features" of the SDK.

I've been figuring I'd buy an iPhone if Apple came out with a real SDK (access to internal data stores, sync framework, etc), so my purchase time is post-SDK. If it slipped that far I'd wait for the 3G version of the phone.

More money, fewer children. The paradox gets another look.

Almost thirty years ago I was a Watson Fellow. In between recreational diversions in various corners of the world I made a serious study of how one might try to change fertility behaviors.

Even then we'd known for a long time that as nations "industrialized" (became technocentric) families became smaller (Mormons are an interesting exception).

This disturbed me. Back then what's now "evolutionary psychology" was "sociobiology" (name change for branding reasons), and within that framework I couldn't understand how the heck wealth produced infertility. I thought the usual theories [2] were nonsensical in the long term, but they were widely accepted.

My best guess was that technocentric wealth was so different from anything in human evolutionary history that we were "outside system bounds"  and that women (in particular) were behaving "irrationally" [3]. In time we'd adapt to our new technocentric world, fertility would climb and we'd be back to the core business of churning out copies of our genes (children). [1]

I've been waiting thirty years for biologists and behavioral economists to recognize that this was an unsolved mystery. Now, at last, some new thinking has come along ...

Demography and genetics | Kissing cousins, missing children | Economist.com

...Now yet another explanation has been added to the pot. This is that the mixing-up of people caused by the urbanisation which normally accompanies development is, itself, partly responsible. That is because it breaks up optimal mating patterns. The demographic transition is thus, in part, a pure accident...

This is a variation of my "out of bounds" theory. It implies that we'll eventually adapt to urbanisation and that family size will again increase.

It's good to see this topic is in play. Took long enough!

[1] I was looking for ways to reduce fertility, so this suggested that we shouldn't rely on the wealth effect to shrink family size forever.

[2] Lowered infant mortality, economic benefit of education and employment of women, etc, etc.

[3] In a Darwinian sense.

Update 2/14/08: Another new theory. It's nice to see this paradox getting a bit of attention!

Zillow.com: first, have a beverage at hand

Zillow does real estate estimates. Type in your address and check it out.

I did my check after reading this NYT Times post:

... 77 percent of homeowners from around the country believe the value of their home has increased or stayed the same...

... This in spite of a recent Merrill Lynch prediction that “housing prices will remain in free fall,” declining 15 percent in 2008 and 10 percent in 2009, “with more depreciation likely beyond the forecast period,” even if the Federal Reserve continues to cut interest rates.

Stan Humphries, Zillow.com’s vice president of data and analytics, said the results of the survey could be attributed to the fact that most Americans have yet to try selling their homes. “Most people are not really affected by declining values unless they absolutely must sell or need to immediately refinance or withdraw equity,” he said. “This has contributed to the healthy investment intent, particularly in home upgrades, despite the downward trending markets.”

I think I need a Scotch now ...

The GOP isn't the torture party any more

Mitt "thumbscrews" Romney is gone. Even Ron Paul is gone. Only McCain and Huckabee are left.

McCain's opposition to torture is well known. But what about Huckabee?

In December he declared waterboarding was indeed torture.

Huckabee Chafes at 'Front-Runner' Label - washingtonpost.com

... Huckabee joined Sen. John McCain (R-Ariz.) in declaring his opposition to the interrogation procedure known as "waterboarding," and said he would support closing the U.S. military prison at Guantanamo Bay, Cuba, a contrast with the other leading Republicans...

I'm surprised to be saying this, but the GOP isn't the pro-torture party they were in May of 2007, or even in November of 2007.

Every single GOP candidate that backed torture has been eliminated from contention.

Sure, the rabid right winguts of talk radio still pant ecstatically about the secret joys of agony, but their candidates are gone. Republican voters, after all, have a voice in what the GOP is.

Shockingly, it seems they don't like torture any more -- if they ever really did.

I'm surprised nobody else has mentioned this.

I'm even more surprised to be saying something complimentary about the GOP -- or at least today's Republican voters.

The disposable decade: and the economics of the extended warranty: iMac, phones, camera and homes?

The LCD screen of my 2.5 yo $2000 iMac is coming apart. The average cell phone costs about $400 (hidden in the monthly fee) and lasts 1-2 years. My 1.5 yo Canon (made in Japan!) SD600 digital camera's mode switch is failing. The February 2008 Atlantic (not yet online) describes the construction techniques of $600,000 (made in America) McMansions -- they won't outlast their mortgages. Nothing made in China lasts much beyond the warranty period -- if that.

We live in the decade of the disposable. We no longer own material goods, we lease them for their warranty period.

Except for the McMansions, unless you consider your home insurance policy a warranty.

Ok, so there's one very big exception. Modern cars last a very long time. I wonder when that will change.

So, geezers and young-uns alike, let us wrap our minds around the new reality beginning with these guidelines:

1. Products are only as good as their warranty. So before you buy, you need to know the warranty will be honored.
2. Product lifespans are now about 120% to 300% of the extended warranty, with a median value of 140% (so there's a long tail).

In this world extended an extended warranty is not necessarily a bad deal - unless you're the company on the hook for the bill.

Apple provides AppleCare, which these days seems to be better behaved than a year or two ago (at which time Apple's outsourced repairs had severe quality problems and Apple often struggled to get off the hook for repairs). In this world Apple Care might not a bad idea, but that means you need to factor AppleCare into the cost of the product. When you do that the cost of computers is rising, not falling (though the cost/capability is still falling).

The best deal, however, are credit card buyers insurance programs. American Express, for example, doubles the original warranty up to an additional year (so it's basically an extra year unless you're foolish and buy something with a worthless 3 month warranty).

AMEX used to advertise this feature of their credit cards. They don't any more -- I couldn't find any mention of it on their web site. No mystery there. It must cost them a bundle. I wonder if they still offer it with new cards.

My card has this feature, which is why I buy everything with it. The program might be a secret now, but it still works. I couldn't use it for the iMac (I passed the two year limit), but for the Canon I called the secret number (800-225-3750) and a most excellent service person quickly walked me through the process. Here's how it went:

• I assembled the warranty proof (Canon web site), my invoice (Amazon.com web site) and the entry in my AMEX statement (AMEX web site).
• I should have noted the serial number on the camera as they asked for that, but they didn't really need it.
• I phoned.

If they decide to f/u they might request the camera or the documentation, but the last time I called they didn't. Instead the full original cost of the camera was credited to my account.

The buyers insurance program site did warn of "an extremely high call volume". I wonder how long they'll be able to keep offering this program.

In the new world, it's a great deal for me.

Now, about those McMansions ...

Update: The other question I was asked was "how did you learn of the buyers assurance program"? I assume AmEx uses that information to eliminate clues to the existence of the program.

An old post also reminds me that I bought the SD 600 through the same AmEx buyers insurance program when a Canon SD 450 mode switch failed! So AmEx has paid out on two consecutive Canon compact cameras. I'm thinking I might replace the SD 600 with something that's not from Canon.

Update 2/11/08: It took less than 8 business hours for buyers assurance to credit my AMEX card. So far they don't want the camera, though of course I'll hold on to it. Amazing response really, though it seems a risky business for AMEX to be in. (On the other hand, the buyers assurance and AMEX security programs are why we use the card for every possible transaction, so they so make a fair amount from their slice of our transactions.)

Now I get it. The McCain reaction.

Tom Tomorrow helps me feel Rush Limbaugh's pain. That's an impressive feat ...

This Modern World - Why they hate him

Imagine how you’d feel if Joe Lieberman had just captured the Democratic nomination.

That’s how the far right sees McCain.

Of course it's not only the far left of the Dems that would be horrified by a Leiberman nomination -- he'd never even get to first base.

Migraine: how often do meds work?

Siri Hustvedt writes of a life with very severe migraines. After many referrals and medication trials she gets by with biofeedback-trained relaxation techniques and, I would guess, some over the counter analgesic.

This prompts me to confess that, in my days of seeing patients, I felt very unsuccessful treating migraine.

Now that was over 10 years ago, but the medications haven't changed all that much. I used the medications I'd read about, and some of my patients even sat through several rotations, but nothing seemed to stick.

Some meds worked for a while, but then the patient would return. Sometimes a med stopped working, sometimes the side-effects were worse than the headaches, sometimes they were too expensive.

I know others claimed much more success, but I'm suspicious. I know quite a few people with migraine, and they mostly seem to live with them. They often have meds that help about as much as the ones I used to prescribe, and sometimes they need stronger narcotics, but by and large they, like Siri, live with migraine.

Maybe I wasn't imagining things long ago. Maybe we really don't have any great medical treatments for migraine. If so, then it might be useful to admit that in print ...

Cringely provides a sane justification for Microsoft's acquisition of Yahoo!

Cringely makes Microsoft's acquisition of Yahoo! sound potentially rational ...

I, Cringely . The Pulpit . The Men Behind the Curtain | PBS

... BUT KILLING GOOGLE ISN'T THE POINT FOR MICROSOFT.

What we have here at Microsoft is a generational transition like we've seen in many other industries as leading companies go from robber barons to industry stalwarts. ...

Cringely claims that Microsoft wants to become GE 2.0 - a finance and management company rather than a software and services company.

I imagine if this were to succeed we'd see Gates return at age 60 to oversee Microsoft's acquisition of GE 1.0.

I think he's on to something. Ballmer is many things, but stupid is not one of them.

Strict control of type II diabetes increased mortality in one (big) study

I left longitudinal primary care practice before metformin. Back then tight control of Type II diabetes was just about impossible. If we pushed insulin patients just got heavier. In the rare event that we got reasonable control we feared the that occasional hyopglycemia could be deadly.

Times changed. Metformin and subsequent medications transformed Type II DM care. Now it's possible, with a dedicated and disciplined patient, to achieve tight control. Studies of intermediate measures (heart disease, renal failure, eye disease) in patients with both Type I and Type II diabetes showed the value of tight control. Physicians were financially penalized for patients who didn't get good control, and roundly chastised for a lack of energy in pursuing this goal.

There was only one problem. We didn't really know that reducing the rates of nerve, kidney, heart, vessel and eye disease would actually reduce mortality. It certainly seemed that it should...

Diabetes Study Partially Halted After Deaths - New York Times

For decades, researchers believed that if people with diabetes lowered their blood sugar to normal levels, they would no longer be at high risk of dying from heart disease. But a major federal study of more than 10,000 middle-aged and older people with Type 2 diabetes has found that lowering blood sugar actually increased their risk of death, researchers reported Wednesday...

Even the control group, who weren't under "tight" control, had very low glucose levels by the standards of the bad old days. So we're not talking about a return to the dark ages. The question instead is how hard to push, I think this study alone will cause payors to back off on financial penalties for "good" rather than "great" glucose levels.

Incidentally, a similar finding has come up many times over the past 20 years in studies of cholesterol reduction and all cause mortality. We know that reducing cholesterol lowers the risk of heart disease, but it doesn't reduce the risk of death in patients who do not have known heart disease or diabetes (1990:

... Mortality from coronary heart disease tended to be lower in men receiving interventions to reduce cholesterol concentrations compared with mortality in control subjects (p = 0.06), although total mortality was not affected by treatment. No consistent relation was found between reduction of cholesterol concentrations and mortality from cancer, but there was a significant increase in deaths not related to illness (deaths from accidents, suicide, or violence) in groups receiving treatment to lower cholesterol concentrations relative to controls (p = 0.004).

Later studies suggest that, on balance, persons with diabetes or known vascular disease benefit from simvastatin. Maybe a lot. There's still the suspicion that the harm may outweigh the benefit for non-diabetic patients with no known vascular disease (primary prevention) though.

These are tough questions, and in this domain my much loved animal model studies aren't that helpful. All cause mortality can only be studied in humans.

2/15/2008: It occurred to me that results like these could suggest the possibility of unsuspected quality issues with the medications we consume.