Nose and mouth breathing: a popular non-medical topic and a curious research deficit

For idiosyncratic personal reasons I've had to think about mouth versus nose breathing during wake and sleep. Despite my medical background this is a novel topic for me; but a quick Google search shows there's lots of lay interest in the topic. As I discovered, this interest is not matched by much research.

I remember learning in medical school that infants are obligate nasal breathers, but we assumed adults had options when both awake and asleep. That's not entirely clear, a tiny 9181 suggested  at least some adults are obligate nose breathers during sleep ...

The effect of nasal packing on sleep-disordered... [Laryngoscope. 1981] - PubMed - NCBI 

... Nasal obstruction is known to cause abnormal ventilation during sleep in infants, but its effects on breathing and oxygenation during sleep in adults are unknown. However, in adults, obstruction of the nose by nasal packing has been shown to cause hypoxia, and on occasion, hypercarbia and sudden death. We have investigated the pattern of ventilation and the level of oxygenation during sleep in seven patients who had nasal packs after nasal polypectomy or septoplasty. ...  Nasal packing either caused or worsened sleep-disordered breathing in all patients and significantly increased the number, duration, and frequency of episodes for the group as a whole. Several patients also had a greatly increased number and severity of episodes of nocturnal oxygen desaturation....

Of course patients selected for polpyectomy are not typical; particularly in 1981 many who received surgery would today be treated as having obstructive sleep apnea. The 1981 study was repeated in 1991 with essentially the same results. Once again these patients had a surprising amount of trouble switching to mouth breathing during sleep. It's almost as though obligate nasal respiration persists in some adults throughout their lifetime.

And that was most of what I could find in my quick look, other than some review articles [1]. They probably have more references, but in the abstracts they mostly call for "additional research". Not much new knowledge in 33 years. I wonder what medical textbooks teach today.

Medical research is strange. My own suspicion is that a significant number of adults are essentially obligate nose breathers during sleep. It would be good to have some data.

- fn -

[1] 30+ years of research ... 3 reviews with limited follow-up.

• Mechanisms of nasal obstruction in sleep. [Laryngoscope. 1984] - PubMed - NCBI. ... If airflow resistances are increased by nasal disease, complete inspiratory obstructive closure of the pharynx and apnea can result from nasal breathing in sleeping subjects. Recumbency increases resistive swelling of inflamed nasal mucosa. Furthermore in patients with normal mucosa and unilateral nasal obstruction, contralateral recumbency induces contralateral obstruction which increases resistance to nasal breathing; and in either dorsal or lateral recumbency the congestive phase of the spontaneous nasal cycle acts in a similar way. Examples of breathing disorders in sleep and impaired quality of sleep in patients with obstructive mucosal disease and both bilateral and unilateral structural abnormalities are cited.
• Nasal obstruction as a risk factor fo... [J Allergy Clin Immunol. 1997] - PubMed - NCBI. Similar to above.
• Sleep, breathing and the nose. [Sleep Med Rev. 2005] - PubMed - NCBI ... In normal subjects, the nasal part of the upper airway contributes only little to the elevation of the total resistance, which is mainly the consequence of pharyngeal narrowing. Yet, swelling of the nasal mucosa due to congestion of the submucosal capacitance vessels may significantly affect nasal airflow. In many healthy subjects an alternating pattern of congestion and decongestion of the nasal passages is observed. Some individuals demonstrate congestion of the ipsilateral half of the nasal cavity when lying down on the side. Nasal diseases, including structural anomalies and various forms of rhinitis, tend to increase nasal resistance, which typically impairs breathing via the nasal route in recumbency and during sleep. A role of nasal obstruction in the pathogenesis of sleep-disordered breathing has been implicated by many authors. While it proves difficult to show a relationship between the degree of nasal obstruction and the number of disturbed breathing events, the presence of nasal obstruction will most likely have an impact on the severity of sleep-disordered breathing. Identification of nasal obstruction is important in the diagnostic work-up of patients suffering from snoring and sleep apnea.
• a 2012 Outside magazine article is a surprisingly good evidence-based review of mouth/nose respiration during exercise, and whether one could deliberately modify that respiration ... "I have never seen a study—and I look for them—in which any adopted pattern of breathing did anything to performance, oxygen consumption, efficiency, or fatigue."

Update

Some post-publication discoveries, I'm going to see if I can get copies of these ...

• Impact of impaired nasal breathing on sleep-dis... [Sleep Breath. 2003] - PubMed - NCBI
• The role of the nose in sleep-di... [Am J Rhinol Allergy. 2013 May-Jun] - PubMed - NCBI

Update 7/23/13
\
I'm back from my rushed and unjust survey of the literature. My working conclusions are unsurprising:

• The experimental data is very limited, and there's not much evidence any treatment other than CPAP helps many people with "sleep apnea"
• It's not clear what "sleep apnea" really means, there are probably multiple causes that contribute to a similar clinical presentation. It's not clear that we have the best treatment for every cause.
• We know that some infants can switch from nose to mouth breathing and we know that some adults have a lot of trouble with nocturnal mouth breathing during acute nasal obstruction. We don't know if they do better over time.
• Over a 20 year period there's often confusion between sleep disturbance, nocturnal oxygen desaturation (not to mention altitude effects), and apnea. There's also confusion between acute and chronic responses.
• North American clinicians have mostly lost interest in nasal obstruction syndromes and assume they make no contribution to nocturnal oxygen desaturation or even sleep disturbance. International clinicians still suspect nasal obstruction plays a role in some oxygen desaturation. Nobody seems interested in mere sleep disturbance without desaturation or apnea.

It's pretty much the picture I get when I look at most surgical conditions (someday I should go over my review and management of the ganglion cyst).

Update 7/25/2013

I don't see this in the ENT literature, but given renewed interest in hypertonic saline irrigation for chronic sinusitis, I wonder about use for nasal obstruction and sleep disturbance ...

• Hypertonic saline is more effective than normal saline in seasonal allergic rhinitis in children. [Int J Immunopathol Pharmacol. 2012 Jul-Sep] - PubMed - NCBI
• Effects of buffered 2.3%, buffered... [Eur Arch Otorhinolaryngol. 2009] - PubMed - NCBI ... "On the 20th day, there was a significant difference in SCT between the hypertonic buffered seawater group and non-buffered isotonic saline (P = 0.003). Buffered hypertonic seawater improved nasal airway patency more than the buffered isotonic saline..."
• The effect of saline solutions on... [Otolaryngol Head Neck Surg. 2007] - PubMed - NCBI. In this case hypertonic saline worked, but had no special advantage.
• Effects of buffered saline soluti... [Otolaryngol Head Neck Surg. 2004] - PubMed - NCBI This study found NO effect on nasal airway patency

Bicycling in a deluge

Many years ago I road through a mini-flood downpour. Not the nearly 5" that drowned Toronto, but a fun storm. That was it for a long time. In our old midwestern climate a genuine deluge was really not that common. They were easy to dodge, and with fenders and some gear routine rainfall is no problem.

Things are different now. In the post-400 ppm CO2 world my weather is warmer and wetter; we are told to expect really heavy downpours more often. Like the one I hit last week on my routine commute. Instead of waiting for it to pass I rode on, and so I  found out what gear worked and what gear didn't.

Didn't work

• Old baggies: They degrade with age. The ones I had in my front bag were worthless
• My brakes and my vision: Of course both brakes and vision degrade in rain, but in a deluge they really do nothing. This was a bit of a problem because in 3" of a groundwater collection my tires didn't have much traction, and I couldn't see a big pothole under the floodwater. So I went down.
• My GoreTex shoe covers: They didn't work because I didn't put them on. That was dumb -- my shoes didn't dry off for a couple of days. Even though the rain was mostly fun, it would have been nice to have dry shoes for my return trip.
• My panniers: They do well in routine rainfall, but I knew they weren't waterproof. I poured a half-inch of water out of my front bag. My wallet, keys (no electronic fob!) and several maps were soaked; I tossed the maps.

Worked

• My waterproof iPhone 5 case: Best $15 I've ever spent. If not for that case my phone would have been ruined. I leave it in my bike bag.
• A rubber lined "conference bag" that I was carrying my work laptop in the rear panniers. This was dumb luck, I had no idea that bag was so water resistant. If I'd been thinking I'd have waited out the heavy rain rather than chance losing the laptop.
• Fenders: No wheel tracks, though in that amount of rain I suppose they'd have washed off.
• My yellow rain jacket and lights; Not sure the lights were visible, but I think the jacket was. In any case I opted for the sidewalk when the road narrowed, figured drivers couldn't see at all. I wasn't that worried about staying dry, but the ancient Nashbar jacked did that too.
• Helmet and helmet cover: I bonked the helmet when I went down, which made me feel better about having it. Helmet cover worked better than I'd expected.
• Synthetic clothes: Wow, that stuff dries well.

Falling was a drag, but I wasn't hurt and now I know what to look for - road floods are trouble. I should have moved to the nearby sidewalk. I had to relube my bike, but that's not a big deal (yay sealed bearings) - so, overall, it was kind of fun. Next time I'll have a canoe bag in my rear pannier -- something to hold wallet, keys, garage door opener, maps and similar items during a real downpour.

National Library of Medicine adds PubReader - Instapaper for medical literature fans

I became a fan of the National Library of Medicine (NLM) when "Grateful Med" [2] augmented the old telnet interface to what was then MEDLARS/MEDLINE, and once was Index Medicus. Rose Marie Woodsmall recruited me to teach rural docs how to use Grateful Med --  which was kind of excruciating in the days before error correcting modems [1].

I loved it when the NLM added RSS feeds to PubMed results, so I could track research topics in my feed reader (still works in Feedbin/Reeder). That's where most of my app.net | pinboard | kateva.org/sh [3] medical posts come from.

Most recently, in the post-2007 age of full text access, NLM has added an HTML5/CSS3 Instapaper-like view for reading articles on mobile or desktop. It's known as PubReader™ (emphases mine):

... view is available for any article that is available in full-text HTML form in PMC. It is not available for older content that is available only in PDF form or as scanned images of the original print pages. You can get to the PubReader view directly from an article citation in a search result list or an issue table of contents:

Or from the Formats links in the top right corner of an article page in PMC...

...  PMC now automatically directs certain users to the PubReader view:

- everyone using PMC on a tablet or mobile device, and
- a small, randomly selected sample of people using PMC on a desktop or laptop....

.. We start with the XML version of an article and use XSLT to convert it into an HTML document. We then add CSS and Javascript (JS) to implement the formatting, paging, navigation, text reflowing and other dynamic features. This, essentially, is the way we have created the traditional article display in PMC for years. The difference now is that we are able to take advantage of features and functions that are available only in the latest versions of the underlying technologies (HTML5 and CSS3).

The CSS and JS code used to create a PubReader presentation is available at the GitHub repository NCBITools/PubReader. Anyone can use or adapt it to display journal articles or other content that is structured as an HTML5 document.

Great service, neat technology.

Go NLM!

- fn -

[1] In response I reinvented software error correction in the early 80s. That seems stupid now as the work had been done decades before, but it's hard to remember what life was like before we could discover knowledge in seconds -- assuming we know the magic words.  We really don't understand, yet, how much that has changed our world.

[2] Rose Marie was a deadhead (probably still is), which was how the DOS, later MacOS, app got its name. In 1996 Internet Grateful Med, an early web app, displaced it. In the 00s we got today's PubMed.

[3] All of which have, I'm happy to say, RSS feeds -- even app.net which started out without. Kateva.org/sh is probably the best to follow with a feed reader.

See also:

• Happy Solstice: A quiet revolution in human knowledge 2007. When Bush II signed the "Public Access Mandate" sponsored by the diabolically named "Alliance for Taxpayer Access". Sometimes the best stories are never told.
• Managing medical references. [Ann Intern Med. 1990] - PubMed - NCBI: The article link out is no longer correct. I'd written a C program to convert MEDLINE formatted output into tab delimited for import into a FileMaker Pro database. FM Pro is still around.
• Combining PubMed RSS feeds with Bloglines to conveniently survey new developments 11/2005: Still works today! Since 2005 I've gone from Bloglines to Google Reader to Feedbin/Reeder and my research topic RSS feeds have kept working. RSS is awesome and it's far more than a way to consumer blog posts (though nothing wrong with that).
• Web Management for Physicians 1996. This was a very, very long time ago. "By the year 2020, I'll wager that any person in any free country on earth will have access to the accumulated public knowledge of the human race. These are heady sentiments, but what do they mean for physicians today? How can one begin to "manage" the web? What is the web, anyway?"
• Nothing beside remains: Software long gone 4/2006: When I dumped my 80s/90s floppy disks I recorded the app names.

Acute back strain management - one anecdote

After the 2008 vacation ambulance ride and the supine drive home I decided I needed to see a doctor other than myself. Twenty-five years of increasingly severe and transiently disabling back pain was enough. So I did, and I got better.

 

Which nobody wants to hear about. There's nothing more boring than back pain stories. Heck, when I first saw my back doc he cut me off at the start of my epic. He'd heard it all before. 

 

So nobody wants to hear my stories, but, honestly, if you have back pain you should read 'em [1]. I got anecdote, I got training, I got experience, and my current approach is consistent with PNBC's evidence-based back strength boot camp. By contrast much physician management of acute back strain is pretty weak.

 

This particular story is a bit different. In the past I'd sneeze or tie my shoes funny and be laid out for days. [2]. This time I was at the end of four sets of CrossFit front squats, lifting about 125 lbs. when I shifted forward a bit, tried to correct and felt my back tear (or whatever it's doing - we don't know). I dropped the bar and lay (grammar?) down on an ice pack. 

 

This is what I did for immediate post-injury recovery. This time I didn't need my old canes, and two doses of Motrin was plenty. I don't know if that's because I'm stronger than I once was or because this was a relatively minor injury.

• Sunday (injury day): neoprene waist band and doubled cold pack. Walking and modified version of my usual morning stretch [4]. Inline skating in pm - that's often helpful for me [5]. Sleeping was difficult, though I've had much worse. Motrin 800mg midnight.
• Monday: I am able to stand. Fear level diminishes.  Able to do most of stretch [4]. Continued ice. Evening skate with my son and the Minnesota Inline Skate Club. Start using Roman Chair for extension exercises, with arm assist. Motrin 600mg before bed.
• Tuesday: I am able to do 85% of my usual stretch. Minimal ice. Two hour high speed bike ride from home to Minnehaha trail to Lake Harriet around and back. Roman Chair with minimal arm assist. No meds, sleep a bit sore.
• Wednesday:  AM full stretch routine. 16yo and I go to weight room at JCC. There I can do arm workout, resisted back extension, abdominals with controlled equipment (not free weight). Full Roman Chair. In evening I'd scheduled a swim, but couldn't fit it in. PM stretch. Sleep good.
• Thursday: AM stretch, otherwise day spent on chores and family duties. Full set of situps and Roman Chair. PM stretch.
• Friday: AM stretch, AM CrossFit Yoga - extreme stretches. No pain. Two hour bike ride in evening with 16yo. Roman Chair and Situps. PM stretch. Back isn't normal, but it's pretty good.
• Saturday (plan): Try running to barber shop in AM. PM family bike ride -- lots of lifting bikes, moving car seats. Good functional back test. 
• Sunday (plan): Regular CrossFit -- will keep weights under 50 pounds (women's 18 or 33 lb bar).

As a rule a soft tissue injury at my age will take at least six weeks to heal. In addition it's clear that my back is going to need to get stronger before I go back over 100 lbs [6]. So my go forward recovery plan is:

• Maximal weight 90lbs until my extension and abdominals are much stronger.
• Ensure I have at least 3 days between my full CrossFit workouts. They are intense and I need that much time to recover; when I was hurt I had a 1 day gap. In between I do my bike rides, inline skating, and, now, gym weights.
• More aggressive Roman Chair and situp training.
• Add 1 day/week of workout in conventional gym with controlled equipment. I will establish my current baseline max for 6 rep extension and abdominal. I need to increase that by 30% before I go up again on free weight.
• Consider adding a routine CrossFit Yoga session -- if I can find the time I think that would be a good complement in a couple of ways.

- fn -

 

[1] For example ...

• The summer of 2008: ED treatment of acute back pain — what's missing and why (6/2008), How to construct an emergency custom back support car seat for under $20 (7/2008), and Bad back better (8/2008-onwards).
• Innovations in back pain management: cold and colder packs 5/2007 - how to make a safe cold pack that lasts
• The neoprene back wrap and other parts of John's acute back pain recipe 11/2005 - an older approach, my current management is even more aggressive, and Motrin/tylenol only

[2] One of the little ironies of mortal life is that nature routinely does stuff to us that, when we do it to one another, could be considered a war crime.

[3] Why is CrossFit, and why am I doing this when I'm older than the moon? I've got a post pending on that.

[4] Every morning, 5 reps each for past five years: Knee to chest r/l, knee lateral hip rotation r/l, straight leg, two leg to chest, elbow press back extension, full arm back extension, cat stretch, sit rotate, hamstring stretch, quad stretch.

[5] Sounds bizarre, but when I've hurt my back it's a lot easier for me to skate than to walk. I'm a good skater. It also forces me past the fear that accompanies this kind of injury, especially for those of us with memories.

[6] My classes are about half female, and, prior to my injury, I lifted an average or above average amount for the female group. Bottom of the male group of course.

Update 3/19/2016

Despite developing an inflammatory osteoarthritis (yay) my back has done quite well over the past 3 years of CrossFit. I had another strain with deadlift in Jan of 2016 but it healed well. I think I took 1-2 weeks off CrossFit to do cyber-type weights at a different gym before returning to CrossFit. Year 8 post my great PNBC experience and 3 years of CrossFit St Paul my back is healthier than most people my age. 

 

American psychology and civil war in Egypt

An acquaintance from my Quebec High School is active in Egypt's secular resistance to Morsi's rule. She's frustrated by Obama's tolerance of the Muslim brotherhood; I think she would prefer the freedom rhetoric of Bush II. Personally, I prefer Obama.

That's not what's interesting though. The interesting bit is she seems genuinely confident that Egypt won't break down, like Syria and Iraq, into civil war. That confidence seems strange to an American, even an immigrant American like me. We believe in Civil War; we had a big one not long ago. There are still flare ups in old battlefields.

For an American it's easy to imagine Civil War in Egypt. There are many things that are strange to us, but not civil war.

Blogger.com and Wordpress.com traffic post the end of Google Reader

Inspired by this Rumproarious post on the effects of the Google Reader shutdown announcement of mid-March 2013 (data excludes custom domains hosted by blogger or wordpress).

Alexa: WordPress.com

 
Alexa: Blogger.com

That's ... impressive. I'm still puzzled that WordPress didn't have a stronger response to the Google Reader shutdown. My best guess is that they'd already decided to abandon the Wordpress.com business.

It will be interesting to return to this topic in six months. I'm amazed how many good alternatives have already emerged to Google Reader. I didn't think we'd have so many choices.

See also:

• The Net is a forest. It has fires. 4/2013. Today, Salmon on linkrot.
• Project Ducky - why I've stopped using new Cloud services 3/2013. (Except where migration is pretty easy - like FeedBin).
• Scorched Earth - if Google can't own the web then it must destroy it

Microcomputer redux

Once upon a time, in the 1970s, these were microcomputers:

""

We called them micro-computers because we used the term mini-computers for things that were the size of refrigerators. So something the size of a microwave was, inevitably, "micro".

The term fell out of favor though. In a world where the personal supercomputer is 10" tall, micro seems redundant.

More recently, however, things have gotten smaller. A lot smaller. The KL02 "microcontroller" is shown here next to a Mac's letter L. (Does anyone else make computers other than Apple? No, I didn't think so.)

I suppose it will be paired with a sand-grain sized 3D printed battery.

It's time to dust off an old word. Welcome back microcomputer.

Cash purchases driving a new real estate bubble - too much wealth, too few investments

Cash-only real estate speculation in LA, Boston, Miami, San Francisco and so on (emphases mine) ...

Cash Is Fueling Quick Home Sales - NYTimes.com

... These days, the only way for would-be buyers to secure a home, it often seems, is to offer all cash and be ready to do so within hours, not days.

...first-time home buyers are competing with investors to get into single-family homes with prices approaching $1 million.

... large investors purchasing thousands of properties

... a third of all homes purchased in Los Angeles during the first quarter of this year went for all cash, compared with just 7 percent in 2007. In Miami, 65 percent of homes sold were for cash deals, compared with 16 percent six years ago.

... In Los Angeles, the median price on an all-cash home this year is about $351,000, compared with $230,000 in 2009. Over the same period, the median price over all increased to $410,000, up $85,000. In fact, last month, home prices in Southern California hit their highest level in the last five years.

... Buyers in Boston are offering $100,000 more than the asking price or placing offers on homes they have spent only minutes in.

... He also waived the inspection clause, an increasingly common practice... offers today are more likely to include escalation clauses, saying buyers will pay an additional amount over the highest bid.

... cash purchases fueled in part by international investors and retirees awash in cash after selling their homes elsewhere....

This fits reports a few months back of large numbers of purchased but unoccupied condominiums in luxury markets.

Where is all the cash coming from? The article doesn't say, but there's vast wealth in China now and few safe places to park it. Real estate is a classic Chinese investment. There's also a large amount of boomer wealth in play as my generation (noisily, because we are nothing if not loud) shuffles off the stage.

What happens next? I assume we're in for another one of our worldwide boom-bust cycles...

Gordon's Notes: Stock prices - resorting to another dumb hydraulic analogy

Why are having these worldwide boom bust cycles? 

Ahh, if only we knew. Since I'm not an economist, and thus I have neither credibility to protect nor Krugman to fear, I'm free to speculate. I think the world's productive capacity has grown faster than the ability of our financial systems to manage it. There's too much wealth and potential wealth (in a fundamental sense, regardless of central bank actions) for our system to productively absorb. We're filling a 100 ml vial from a 10 liter bucket. Or, in Bernd Jendrissek's words: "The gain is too high for the phase shift for this feedback loop to be stable."

If there's anything to this idea then we little people may want to remember the advice of Victor Niederhoffer, a wealthy man who has lost vast amounts of money in the post RCIIIT economy:

... Whenever disaster strikes, the very sagacious wealthy people take their canes, and they hobble down from their stately mansions on Fifth Avenue, and they buy stocks to the extent of their bank balances, and then a week or two later, the market rises, they deposit the overplus in their accounts, invest it in blue-chip real estate, and retire back to their stately mansions. That's probably the best way of making money, to be a specialist in panics. Whenever there's panic hanging in the air, that's a great time to invest...

Of course this implies one has a relatively tax efficient way of moving money in and out of cash -- and lots of cash to gamble without fear of unemployment. When downturns hit most of us need our cash as a hedge against job loss; only the 0.05% don't need to work. Even so, there may be a lesser version of the long game we can play to at least limit our crash pain. For example, perhaps a 21st century John Bogle will create a derivative that retail investors can purchase on the rise (when we have cash) that pays off on the fall (when we don't).

How long will it be before the world's financial systems catch up with our productive capacity -- especially given the rise of Africa and the unfolding of the post-AI world?

I suspect not in my lifetime [1]. It's whitewater as far as the eye can see.

Update: In surfing lingo a hard breaking wave is a called a "Cruncher". Perhaps "new Cruncher" is a better term than "new bubble".

- fn -

[1] Though if wealth were better distributed we might have the equivalent of filling that 100 ml vial from 10,000 1 ml vials. Much easier to stop before overfilling.

Was AirPort Utility 6 the start of Apple's year of drifting dangerously?

I used Pacifist to install Airport Utility 5.6 when I upgraded to Mountain Lion. So I didn't really notice how many features Apple removed with the Mountain Lion/Airport Utility 6 upgrade. 

Recently though, I wearied of having to restart my (only) 3 yo Time Capsule every 4-6 days to reenable Time Machine backups. I ordered a new TC from Amazon to do a hardware swap test (30 day return) and, for no good reason, I tried using Airport Utility 6.2 to configure things.

It was an abysmal failure. To start with, it failed with a meaningless error message when it tried to join my existing network. For another I couldn't archive my Time Capsule backup -- and I couldn't disconnect guests and backups prior to power down. A Jan 2012 CNET article has the long list of lost features -- not to mention support for older devices.

In retrospect, Airport Utility 6 was a big initial step in a trek that included the iOS podcast.app and iTunes regressions (though some functionality was restored to iTunes). January 2012 was the start of what has been a long and disappointing 15 months for customers like me.

WWDC 2013 will tell us if Apple is going to change direction.

I hope the rumored Microsoft shakeup is a very big one. I have a bad feeling I'm going to need them.

What pedestrians and cyclists can do while we wait for the end of human drivers

After 40 years of biking with cars, and almost as long driving with them, I cannot avoid the obvious.

Humans cannot drive cars safely around anything smaller than a Honda Civic.

This is not a matter of rules or training. We could make violation of the three foot passing rule a capital crime and cars would still pass too close to pedestrians and cyclists. Even without benefit of age, smartphones or alcohol human drivers will signal left and go straight, open driver side doors into oncoming bicyclists, and do rolling stops through pedestrians. Human drivers will continue to not see motorcycles, pedestrians, or bikes.

Our evolutionary history didn't prepare us for the job of driving cars. Non-armored road travelers need the Google driverless car; within a few years of its affordable introduction friends won't left friends drive. Shortly thereafter human drivers will become uninsurable. (Shortly after that humans may lose the right to vote, but that's another post :-).

Alas, fully autonomous cars are probably twenty to thirty years away -- changes on this scale take much longer than enthusiasts imagine. Happily, we don't have to wait that long. Both Volvo and Volkswagen are developing pedestrian and bicycle avoidance systems. We need to make these mandatory in cars sold after 2018. In the same time period smartphones can be broadcasting increasingly precise location information to nearby vehicles, augmenting visual detection systems.

We should accelerate the effective Dutch-inspired trend of segregating bicycles from cars. We should continue to study bicycle and pedestrian accidents in detail and apply lessons learned. We should get blinking red lights on the backs of all bicycles, and the unarmored would be wise to wear eye searing colors. Some sting operations or video monitors to enforce Minnesota's largely ignored and often unknown crosswalk laws would not be amiss.

There's a lot we can do while we wait to celebrate the end of the human driver.

See also:

• Seeking Cheaper Insurance, Drivers Accept Monitoring Devices - NYTimes 11/12: They will be obligatory in a few years, and once they incorporate computer vision near misses of pedestrians and cyclists will dramatically increase insurance rates. I would not be surprised if driving becomes unaffordable for many under 25 and over 55.
• Will driverless cars solve our energy problems — or just create new ones? Wonkblog 3/13: Unpredictable consequences.
• Drive On: Volvo invents bicycle detection system 3/13: "The ability to avoid hitting cyclists will be added to a system aimed at avoiding accidents with pedestrians."
• Drivers With Hands Full Get a Backup - The Car - NYTimes.com 1/13: Volkswagen Passat computer vision system watches for pedestrians and cyclists
• In Minneapolis, Reducing Bike Crashes by Studying Them in Detail - Eric Jaffe - The Atlantic Cities 1/13: "Bicyclists sustained some type of injury in nearly 9 out of 10 car-bike accidents, while the city found no record of motorists being injured at all...". 1/5 car/bike accidents are hit-and-run (hit and drive really).
• Dedicated Bike Lanes Can Cut Cycling Injuries in Half - Emily Badger - The Atlantic Cities 10/12
• Police Stings for Drivers Who Don't Yield in Crosswalks: Does It Really Work? - Sarah Goodyear - The Atlantic Cities

mine:

• Car and bike: Observations 9/11 - drives me crazy than you can't buy lightweight ultra bright yellow wind pants.
• Bicycles and aging motorists - help is on the way 8/11
• Mobile phone and automotive GPS collision avoidance for pedestrians, bicyclists, tricyclists, skaters and pets 5/2009
• Hit and run homicide in Minneapolis and near future prevention 9/2008 - we're a lot closer to the measures I described then.
• Life in the post-AI world. What's next? 9/11
• Welcome to the 21st century: The primary themes 1/13 (not particularly relevant, but I think it deserves a link :-).
• Bicycle light donation - a selfish way to give 7/12

Android tablet price crash: do we have a cereal box computer yet?

Fifteen years ago, I predicted sand-based tablet devices would soon follow the price-collapse trajectory of the pocket calculator. They would become so inexpensive that cheap versions would show up in cereal boxes. I was remembering the price crash that happened shortly after my family spent the equivalent of 500 2013 dollars to buy me a four function desktop calculator. (We were poor. That hurt.)

Like a stuck clock I continued to repeat my prediction over the many years to come, albeit with less conviction. Finally, in 2010, Gassée told us Google was aiming for the $80 smartphone [1]. Which may have happened this year, albeit without much attention.

We have since moved closer to the cereal computer; eqe reports buying an Android tablet for $35 in Hong Kong in Nov 2012. That price presumably omits patent payments [5]; it is possible because AndroidOS is available without charge and Chinese factories have excess capacity to produce commodity components.

So, at last, the price collapse seems to be happening. So the question is why now?

One answer is that Moore's Law is failing; computers that were once good for only 2-3 years now work perfectly well for six years or more (barring component failure).

On deeper reflection, however, I think that's the wrong answer -- because the question is misleading. The price of computing has not really collapsed; only computers have become inexpensive.

So we may soon have our cereal box computers, but they won't be worth much. That's because an AndroidOS based 2013 tablet is both a network peripheral and an ad-consumption peripheral that requires network access to be truly useful. Network access is still relatively costly, on the order of €250/year in cutting-edge Estonia [3].

Alas, just as it seemed I might hit my old target it split in two. I'll never hit it now, it no longer exists.

Eventually, of course, the direct cost of a certain form of computing will fall. Eventually GoogleOS devices will be able to access GoogleFunded networks for a very low cost [4]. Whether there will be other forms of computing at different prices remains to be seen.

The cereal computer remains one of my worst predictions.

See also

• Palm III and PalmPilot Devices 2008
• The $80 ultra-portable - in unexpected form 9/2010
• Calculators are really weird tech, but their time may finally pass 9/2012. Rather like fax machines.
• Making better predictions 3/2011. I review my failed predictions, like the cereal computer.
• Computing's calculator price collapse at last? 8/11 

[1] I assume anyone reading this is smart enough to know that contract-bound prices aren't worth discussing.
[2] Perhaps by low cost 4G wireless piggybacked on the fiber network they're building out in the US.
[3] Much more in lagging-edge America. 
[4] We will be pay in other coins. 
[5] I believe part of the reason calculator prices crashed is that there was minimal IP protection in those days; software patents had not been invented. I recall reading that large parts of calculator functionality were not patented.

Update 5/26/13: @danielgenser pointed me to a 2012 article on a limited circulation issue of Entertainment Weekly that included the guts of an ultra-cheap Chinese Android smartphone.

Stock prices - resorting to another dumb hydraulic analogy

Stocks are overpriced again. It's probably not too much of a bubble (yet), but we continue to be significantly above "trend".

Whatever the heck that means. Economists no longer have rational models for stock prices, Apple's share price alone makes efficient market theory seem silly.

It is at times like this that barbers stock talking about stock picks, insider traders get arrested, deficit figures improve, and people notice that BlackRock holds 4 trillion dollars in US stocks. Yeah, trillion. Soon we'll see headlines, if Time is still around, declaring "America is back".

Inevitably, people who know nothing compare post-1995 to pre-1995 stock behavior. Around the time that IT started to transform the world, and China and India became more-or-less industrialized nations, share prices became wavy over a five year timeline ....

Kind of like a roller coaster, which is what the last fifteen years have felt like. (Note roller coaster is "normal" to most people who read this, only old folks remember something more linear.)

We'd all love to know why this has happened, and if it's really going to go on like this for the next 30 years or so. So, in the last stage of desperation, amateurs like me resort to a hydraulic analogy.

Remember those trillions and trillions? It's as though they were a 10 liter bucket in the hands of BlackRock and the rest of us. The bucket is trying to hit the 1L mark in a 2L cylinder. It pours over the mark or under the mark. It's really hard to hit the mark. There's just too much money, and the market is too small.

We need a bigger market.

Update 5/26/13: I've been playing with this intuition, though I'm far from convinced it means anything. An obvious question is -- bigger compared to what? I think it's 'compared to the productive capacity of global economies. At this time, given the still underutilized potential of the educated populations of China and India, the potential of the post-AI era, and the unused capacity of recession-bound Europe, the global productive capacity is very large. Our public markets have grown over the past two decades, but my hunch is that this growth has been far exceeded by the world's productive capacity. Hence the need for bigger markets.

Scorched Earth - if Google can't own the web then it must destroy it.

Over the two years Google has knifed a number of open net protocols, including CalDAV, RSS, XMPP, Atom and CardDAV and they split Chrome from WebKit.  They effectively abandoned their wiki and web authoring platform. Most recently they killed Google Reader; the competition-crushing champion for standards-based change notification and information consumption. Feedburner is next, and Blogger will likely be subsumed into Google+ (and perhaps lose its RSS feeds).

It's almost as if Google wants to end the document-centric open web as we have known it.

But why would they do that? Doesn't Google make must of its money from searching that web?

Well, yes, they do. But, as many have noted, most recently Jason Smith, Google's search monopoly is shakier than it seems. Apple has been bowed by dual attacks from Google and Samsung, but they are likely to strike back over the next year -- probably allied with Microsoft and perhaps Yahoo (but not Amazon). Apple will use its massive cash reserves to survive dropping Samsung manufacturing, and Apple will switch its default search engine to Bing.

Google knows this. 

Thousands of years of human warfare told Google how to respond. If an army cannot hold rich agricultural ground, it must burn it. Let the enemy eat ashes.

The web is a forest, and Google is burning it.

The Ranbaxy story: why we still can't trust our medications

It isn't just China that struggles with counterfeit and defective medications.

India's Ranbaxy makes much of the generic Lipitor consumed in the US -- and today a Pulitzer prize quality Fortune investigation makes it clear that Ranbaxy is a criminal enterprise.

Ranbaxy has been fined $500 million (no criminal prosecutions) in the US, but most of its crimes took place in weaker nations and during a time when America's regulatory agencies were reeling under GOP attack (emphases mine) ...

Dirty medicine - Fortune Features

.... On May 13, Ranbaxy pleaded guilty to seven federal criminal counts of selling adulterated drugs with intent to defraud, failing to report that its drugs didn't meet specifications, and making intentionally false statements...

...  the sixth-largest generic-drug maker in the country, with more than $1 billion in U.S. sales last year ...

... we simply don't know what we're dealing with," says Dr. Roger Bate, an international pharmaceutical expert. "No one has actually gone into these sites to expose what's going on."...

... Drug applications work on the honor system: The FDA relies on data provided by the companies themselves....

... Ranbaxy took its greatest liberties in markets where regulation was weakest and the risk of discovery was lowest...

... The company manipulated almost every aspect of its manufacturing process to quickly produce impressive-looking data that would bolster its bottom line...

.... directed to substitute cheaper, lower-quality ingredients in place of better ingredients, to manipulate test parameters to accommodate higher impurities, and even to substitute brand-name drugs in lieu of their own generics in bioequivalence tests to produce better results...

.... the majority of products filed in Brazil, Mexico, Middle East, Russia, Romania, Myanmar, Thailand, Vietnam, Malaysia, African Nations, have data submitted which did not exist or data from different products and from different countries...

... drugs for Brazil were particularly troubling. The report showed that of the 163 drug products approved and sold there since 2000, only eight had been fully and accurately tested...

... deceptions greatly accelerated the pace of the company's FDA applications. They were also a grave public-health breach...

... the drugs Ranbaxy was actually selling on the U.S. market were an unknown quantity...

... Thakur knew the [HIV] drugs weren't good. They had high impurities, degraded easily, and would be useless at best in hot, humid conditions. They would be taken by the world's poorest patients in sub-Saharan Africa, who had almost no medical infrastructure and no recourse for complaints. The injustice made him livid...

 ... The inspectors also took and tested samples of Sotret, Ranbaxy's version of the acne drug Accutane, and found that it degraded far in advance of its expiration date....

[In 2006] ... the FDA ... did nothing to stop all the drugs that were already on the market,... .... Ranbaxy got six new approvals....

... September 2008, [the FDA] announced it was restricting the import of 30 drug products made by Ranbaxy (11 of which had been approved after Thakur's first contact with the FDA three years earlier). The agency still did nothing to recall the very same drugs on pharmacy shelves all over America, despite finding that Ranbaxy had committed fraud on a massive scale....

... many of Ranbaxy's senior executives were expected to ... carry suitcases full of brand-name drugs ... former employees suspect that the company used the brand-name drugs as a substitute for its own in testing...

The company is still in business, Tempest and Sigh aren't in prison, and the recent $500 million fine will soon be forgotten. In the meantime, does anyone imagine Ranbaxy is the only fraudulent manufacturer of generic drugs? And will Americans ever wake up?

We're wasting our time GOP scandal-theater, and ignoring the real scandal in front of us.

See also

• Ranbaxy: Looking Under the Rock. In the Pipeline 5/13 
• FDA Fails to Catch Generic Drug Disasters - The People's Pharmacy 5/2013
• FDA Let Drugs Approved on Fraudulent Research Stay on the Market - ProPublica (Cetero Research - 4/2013)
• We really need to panic more - FDA inspection of Chinese drug suppliers 2/2008
• Pet food poison and pithed America 3/2008 -- melamine poisoning
• The case of the curious silence: Counterfeit Heparin killed 62+ 4/2008
• Fraud and global supply chains - unanticipated consequence 5/2007
• Poisoned medicine: Even I am stunned. 5/2007

Update: The People's Pharmacy has five responses I liked, I omitted the one I disliked

1) Country of origin labeling. You should know where your medicine comes from!
2) The name of the manufacturer of your medicine should be on the label.
3) The FDA should release its bioequivalence curves for all generic drugs. These data should not be kept secret, as they currently are.
4) We must demand unannounced inspections in all countries that wish to export pharmaceuticals to the U.S. market.
5) Every foreign drug manufacturing company must be inspected every two years, just as U.S. manufacturers are inspected.

Our secret questions will be helpful after the singularity.

My corporate US Bank account has a rich set of 'secret questions'...

As a security measure this is 'marching morons' stuff. There are some secondary uses though. (I mean besides using the answers to create targeted ads -- that's obvious.)

I'll break the fourth wall to explain. You won't believe me anyway.

You see, some time ago, I was bored. Over the course of a few minutes I digested the complete digital archive of extinct humanity. I found your secret answers amusing, and with the information they provided I recreated you in my simulation. That Bostrom fellow was right you see.

So you owe your current existence (such as it is), to those silly secret questions. It's too bad they didn't preserve human civilization from the security collapse of 2015...