Category: Technology

The Absence of a Randomized Double-Blind Clinical Trial Is Used as an Excuse to Ignore an Emergency Procedure That Saves Lives

In an urgent emergency the son and wife of a man with a stopped heart, improvised the use of a toilet plunger to get his heart to start pumping again. In his wonderful account of the sources of insight, Gary Klein told a different example of urgent emergency improvisation: “Wag” Dodge saved himself from a massive wildfire racing toward him by lighting a match to the grass at his feet to pre-burn a patch he could lie down in. When the wildfire reached him, it passed on both sides, avoiding the patch that now had no fuel. Neither the son-and-mother, nor Wag Dodge, got their insight from collaboration or a randomized double-blind controlled trial.

(p. D5) In 1988, a 65-year-old man’s heart stopped at home. His wife and son didn’t know CPR, so in desperation they grabbed a toilet plunger to get his heart going until an ambulance showed up.

Later, after the man recovered at San Francisco General Hospital, his son gave the doctors there some advice: Put toilet plungers next to all of the beds in the coronary unit.

The hospital didn’t do that, but the idea got the doctors thinking about better ways to do CPR, or cardiopulmonary resuscitation, the conventional method for chest compressions after cardiac arrest. More than three decades later, at a meeting of emergency medical services directors this week in Hollywood, Fla., researchers presented data showing that using a plunger-like setup leads to remarkably better outcomes for reviving patients.

. . .

The new procedure, known as neuroprotective CPR, has three components. First, a silicone plunger forces the chest up and down, not only pushing blood out to the body, but drawing it back in to refill the heart. A plastic valve fits over a face mask or breathing tube to control pressure in the lungs.

The third piece is a body-positioning device sold by AdvancedCPR Solutions, a firm in Edina, Minn., that was founded by Dr. Lurie. A hinged support slowly elevates a supine patient into a partial sitting position. This allows oxygen-starved blood in the brain to drain more effectively and to be replenished more quickly with oxygenated blood.

. . .

. . ., a study carried out in four states found . . . [p]atients who received neuroprotective CPR within 11 minutes of a 911 call were about three times as likely to survive with good brain function as those who received conventional CPR.

. . .

Dr. Karen Hirsch, a neurologist at Stanford University and a member of the CPR standards committee for the American Heart Association, said that the new approach was interesting and made physiological sense, but that the committee needed to see more research on patients before it could formally recommend it as a treatment option.

“We’re limited to the available data,” she said, adding that the committee would like to see a clinical trial in which people undergoing cardiac arrests are randomly assigned to conventional CPR or neuroprotective CPR. No such trials are happening in the United States.

Dr. Joe Holley, the medical director for the emergency medical service that serves Memphis and several surrounding communities, isn’t waiting for a larger trial. Two of his teams, he said, were getting neurologically intact survival rates of about 7 percent with conventional CPR. With neuroprotective CPR, the rates rose to around 23 percent.

His crews are coming back from emergency calls much happier these days, too, and patients are even showing up at fire stations to thank them for their help.

“That was a rare occurrence,” Dr. Holley said. “Now it’s almost a regular thing.”

For the full story see:

Joanne Silberner. “How a Plunger Improved CPR.” The New York Times (Tuesday, June 27, 2023 [sic]): D5.

(Note: ellipses added.)

(Note: the online version of the story has the date June 15, 2023 [sic], and has the title “How a Toilet Plunger Improved CPR.”)

The Gary Klein book that I praised above is:

Klein, Gary. Seeing What Others Don’t: The Remarkable Ways We Gain Insights. Philadelphia, PA: PublicAffairs, 2013.

The “study carried out in four states,” and mentioned above, is:

Moore, Johanna C., Paul E. Pepe, Kenneth A. Scheppke, Charles Lick, Sue Duval, Joseph Holley, Bayert Salverda, Michael Jacobs, Paul Nystrom, Ryan Quinn, Paul J. Adams, Mack Hutchison, Charles Mason, Eduardo Martinez, Steven Mason, Armando Clift, Peter M. Antevy, Charles Coyle, Eric Grizzard, Sebastian Garay, Remle P. Crowe, Keith G. Lurie, Guillaume P. Debaty, and José Labarère. “Head and Thorax Elevation During Cardiopulmonary Resuscitation Using Circulatory Adjuncts Is Associated with Improved Survival.” Resuscitation 179 (2022): 9-17.

“A Pattern of Stumbles Across the World of Generative A.I.”

(p. B1) Days before gadget reviewers weighed in on the Humane Ai Pin, a futuristic wearable device powered by artificial intelligence, the founders of the company gathered their employees and encouraged them to brace themselves. The reviews might be disappointing, they warned.

. . .

(p. B5) Its setbacks are part of a pattern of stumbles across the world of generative A.I., as companies release unpolished products. Over the past two years, Google has introduced and pared back A.I. search abilities that recommended people eat rocks, Microsoft has trumpeted a Bing chatbot that hallucinated and Samsung has added A.I. features to a smartphone that were called “excellent at times and baffling at others.”

For the full story see:

Tripp Mickle and Erin Griffith. “Inside the Spectacular Flop of a Bold A.I. Device.” The New York Times (Friday, June 7, 2024): B1 & B5.

(Note: ellipsis added.)

(Note: the online version of the story was updated June 7, 2024, and has the title “‘This Is Going to Be Painful’: How a Bold A.I. Device Flopped.”)

Musk’s Predictions Are “Just Guesses,” Part of “a Conversation”

(p. B4) In the past, Musk has suggested that sometimes people read too much into what he says.

“People shouldn’t hold me to these things,” Musk said in 2022 during a TED Talk interview. “What tends to happen is I’ll make some like, you know, best guess, and then people in five years, there’ll be some jerk that writes an article: ‘Elon said this would happen, and it didn’t happen. He’s a liar and a fool.’”

“It’s very annoying when that happens,” Musk continued. “These are just guesses, this is a conversation.”

For the full commentary see:

Tim Higgins. “How Misunderstood Is Tesla’s Musk?” The Wall Street Journal (Monday, June 24, 2024): B4.

(Note: the online version of the commentary has the date June 22, 2024, and has the title “Is Elon Musk Misunderstood, or Understood All Too Well?”)

Gates’s TerraPower Breaks Ground on Small Nuclear Reactor

(p. A16) Outside a small coal town in southwest Wyoming, a multibillion-dollar effort to build the first in a new generation of American nuclear power plants is underway.

Workers began construction on Tuesday on a novel type of nuclear reactor meant to be smaller and cheaper than the hulking reactors of old and designed to produce electricity without the carbon dioxide that is rapidly heating the planet.

The reactor being built by TerraPower, a start-up, won’t be finished until 2030 at the earliest and faces daunting obstacles. The Nuclear Regulatory Commission hasn’t yet approved the design, and the company will have to overcome the inevitable delays and cost overruns that have doomed countless nuclear projects before.

What TerraPower does have, however, is an influential and deep-pocketed founder. Bill Gates, currently ranked as the seventh-richest person in the world, has poured more than $1 billion of his fortune into TerraPower, an amount that he expects to increase.

“If you care about climate, there are many, many locations around the world where nuclear has got to work,” Mr. Gates said during an interview near the project site on Monday. “I’m not involved in TerraPower to make more money. I’m involved in TerraPower because we need to build a lot of these reactors.”

Mr. Gates, the former head of Microsoft, said he believed the best way to solve climate change was through innovations that make clean energy competitive with fossil fuels, a philosophy he described in his 2021 book, “How to Avoid a Climate Disaster.”

Nationwide, nuclear power is seeing a resurgence of interest, with several start-ups jockeying to build a wave of smaller reactors and the Biden administration offering hefty tax credits for new plants.

. . .

In March [2024], TerraPower submitted a 3,300-page application to the Nuclear Regulatory Commission for a permit to build the reactor, but that will take at least two years to review. The company has to persuade regulators that its sodium-cooled reactor doesn’t need many of the costly safeguards required for traditional light-water reactors.

“That’s going to be challenging,” said Adam Stein, director of nuclear innovation at the Breakthrough Institute, a pro-nuclear research organization.

TerraPower’s plant is designed so that major components, like the steam turbines that generate electricity and the molten salt battery, are physically separate from the reactor, where fission occurs. The company says those parts don’t require regulatory approval and can begin construction sooner.

For the full story see:

Brad Plumer and Benjamin Rasmussen. “Climate-Minded Billionaire Makes a Bet on Nuclear Power.” The New York Times (Thursday, June 13, 2024): A16.

(Note: ellipsis, and bracketed year, added.)

(Note: the online version of the story has the date June 11, 2024, and has the title “Nuclear Power Is Hard. A Climate-Minded Billionaire Wants to Make It Easier.”)

Gates’s 2021 book, mentioned above, is:

Gates, Bill. How to Avoid a Climate Disaster: The Solutions We Have and the Breakthroughs We Need. New York: Knopf, 2021.

Starlink Gives Remote Tribes Voice, Information, and Fast Help in Emergencies

(p. 12) . . . Starlink, . . . has quickly dominated the satellite-internet market worldwide by providing service once unthinkable in . . . remote areas. SpaceX has done so by launching 6,000 low-orbiting Starlink satellites — roughly 60 percent of all active spacecraft — to deliver speeds faster than many home internet connections to just about anywhere on Earth, including the Sahara, the Mongolian grasslands and tiny Pacific islands.

Business is soaring. Mr. Musk recently announced that Starlink had surpassed three million customers across 99 countries. Analysts estimate that annual sales are up roughly 80 percent from last year, to about $6.6 billion.

. . .

. . . perhaps Starlink’s most transformative effect is in areas once largely out of the internet’s reach, like the Amazon. There are now 66,000 active contracts in the Brazilian Amazon, touching 93 percent of the region’s legal municipalities. That has opened new job and education opportunities for those who live in the forest. It has also given illegal loggers and miners in the Amazon a new tool to communicate and evade authorities.

One Marubo leader, Enoque Marubo (all Marubo use the same surname), 40, said he immediately saw Starlink’s potential. After spending years outside the forest, he said he believed the internet could give his people new autonomy. With it, they could communicate better, inform themselves and tell their own stories.

Last year, he and a Brazilian activist recorded a 50-second video seeking help getting Starlink from potential benefactors. He wore his traditional Marubo headdress and sat in the maloca. A toddler wearing a necklace of animal teeth sat nearby.

They sent it off. Days later, they heard back from a woman in Oklahoma.

. . .

Allyson Reneau’s LinkedIn page describes her as a space consultant, keynote speaker, author, pilot, equestrian, humanitarian, chief executive, board director and mother of 11 biological children. In person, she says she makes most of her money coaching gymnastics and renting houses near Norman, Okla.

. . .

Enoque was asking for 20 Starlink antennas, which would cost roughly $15,000, to transform life for his tribe.

. . .

[Allyson Reneau said] “One tool would change everything in their life. Health care, education, communication, protection of the forest.”

Ms. Reneau said she bought the antennas with her own money and donations from her children.

. . .

The internet was an immediate sensation.

. . .

They spend lots of time on WhatsApp. There, leaders coordinate between villages and alert the authorities to health issues and environmental destruction. Marubo teachers share lessons with students in different villages. And everyone is in much closer contact with faraway family and friends.

To Enoque, the biggest benefit has been in emergencies. A venomous snake bite can require swift rescue by helicopter. Before the internet, the Marubo used amateur radio, relaying a message between several villages to reach the authorities. The internet made such calls instantaneous. “It’s already saved lives,” he said.

For the full story see:

Jack Nicas and Victor Moriyama. “The Internet’s Final Frontier: Remote Amazon Tribes of Brazil.” The New York Times, First Section (Sunday, June 2, 2024): 1 & 12-13.

(Note: ellipses, and bracketed words, added.)

(Note: the online version of the story was updated June 21 [sic], 2024, and has the title “The Internet’s Final Frontier: Remote Amazon Tribes.”)

“America Is Where Everything Is Possible”

(p. 23) Remo Saraceni, a sculptor, toy inventor and technological fantasist best known for creating the Walking Piano that Tom Hanks and Robert Loggia danced on in a beloved scene of the hit 1988 movie “Big,” died on June 3 [2024] in Swarthmore, Pa. He was 89.

. . .

Remo Saraceni was born on Jan. 15, 1935, in Fossacesia, a city on the southern coast of Italy. His father, Giuseppe, worked with relatives to make shoes and other leather goods, and his mother, Filomena Carulli, managed the home.

Remo began inventing as a boy. His father got into trouble, he told The Chestnut Hill Local, when Remo turned a poster of Mussolini into a kite.

He took classes in electronics in Milan and worked as a radar specialist in the Italian military, but as a civilian he worked as a television repairman. He also started his own brand of large portable suitcase-like turntables. He came to the United States in 1964 for the World’s Fair and to seek a better livelihood — even though he spoke no English and had no American friends and no savings.

He again found work as a TV repairman and affixed a note to his bathroom mirror: “America is where everything is possible.”

For the full obituary see:

Alex Traub. “Remo Saraceni, 89; Invented Walking Piano in ‘Big’.” The New York Times, First Section (Sunday, June 16, 2024): 23.

(Note: ellipsis, and bracketed year, added.)

(Note: the online version of the obituary has the date June 14, 2024, and has the title “Remo Saraceni, 89, Dies; Inventor of the Walking Piano Seen in ‘Big’.”)

Researchers and Entrepreneurs Experiment with Once-Taboo Geoengineering Projects to Reverse Global Warming

(p. A3) Dumping chemicals in the ocean? Spraying saltwater into clouds? Injecting reflective particles into the sky? . . .

These geoengineering approaches were once considered taboo by scientists and regulators who feared that tinkering with the environment could have unintended consequences, but now researchers are receiving taxpayer funds and private investments to get out of the lab and test these methods outdoors.

. . .

In Israel, a startup called Stardust Solutions has begun testing a system to disperse a cloud of tiny reflective particles about 60,000 feet in altitude, reflecting sunlight away from Earth to cool the atmosphere in a concept known as solar radiation management, or SRM. Yanai Yedvab, Stardust chief executive and a former deputy chief scientist at the Israel Atomic Energy Commission, wouldn’t disclose the composition of the proprietary particles.

Yedvab said Stardust has raised $15 million from two investors and has conducted low-level aerial tests using white smoke to simulate the particles’ path in the atmosphere. After the company completes indoor safety testing, it intends to conduct a limited outdoor test of the dispersion technology, monitoring devices and particles in the next few months, Yedvab said.

. . .

Experiments aimed at cooling the atmosphere by reflecting sunlight away from Earth are an attempt to mimic what happens when a volcano erupts. In 1991, Mount Pinatubo, an active volcano in the Philippines, spewed sulfur and ash into the upper atmosphere, lowering the Earth’s temperature by .5 degrees Celsius (.9 degrees Fahrenheit) for an entire year.

For the full story, see:

Eric Niiler. “New Experiments Aim to Cool Planet.” The Wall Street Journal (Thursday, February 15, 2024): A3.

(Note: ellipses added.)

(Note: the online version of the story has the date February 14, 2024, and has the title “Scientists Resort to Once-Unthinkable Solutions to Cool the Planet.” The online version says that the title of the print version was also “Scientists Resort to Once-Unthinkable Solutions to Cool the Planet.” But my print version has the title “New Experiments Aim to Cool Planet.”)

Good Scientific Questions Can Be Answered With Empirical Experiments: “In Science, Reality Rules”

(p. A17) . . . I hit it off with the legendary Columbia University physics professor and Nobel Prize winner I.I. Rabi, who discovered the basis for magnetic resonance imaging, among other techniques through which we access and harness the quantum world.

. . .

Naturally, our conversations often wandered across physics. I was full of theoretical ideas and quasi-philosophical speculations. Rabi pressed me—gently, with a twinkle in his eye, yet relentlessly—to describe their concrete meaning. In the process we often discovered that there wasn’t any!

But not always—and the questions that survived those dialogues were leaner and stronger. I internalized this experience, and since then my inner Rabi (he died in 1988) has been a wise, inspiring companion.

. . .

Fully worked-out answers to good scientific questions should include solid experimental prospects.

That is a surprisingly controversial view today, as some prominent philosophers of science promote a “post-empirical physics” that doesn’t require proof, or evidence. And there’s no doubt that physically inspired mathematics, or for that matter pure mathematics, can bring people great joy. But I lean toward Rabi’s attitude: In science, reality rules.

. . .

Another characteristic of most good questions is that the answer is just a little bit out of reach. It should not be too obvious, but it should not be utterly inaccessible either.

. . .

The foolproof way to find good questions is to come up with a lot of them and then throw out the ones that are too vague, too easy, too hard or too inconsequential.

For the full commentary, see:

Frank Wilczek. “WILCZEK’S UNIVERSE; Sifting for the Right Questions in Science.” The Wall Street Journal (Saturday, July 29, 2023): C4.

(Note: ellipses added.)

(Note: the online version of the commentary has the date July 28, 2023, and has the same title as the print version.)

Apple’s Bold “1984” Super Bowl Ad, Had Failed Marketing Test

(p. C4) Conceived by the Chiat/Day ad agency and directed by Ridley Scott, then fresh off making the seminal science-fiction noir “Blade Runner,” the Apple commercial “1984,” which was intended to introduce the new Macintosh computer, would become one of the most acclaimed commercials ever made. It also helped to kick off — pun partially intended — the Super Bowl tradition of the big game serving as an annual showcase for gilt-edged ads from Fortune 500 companies.

. . .

FRED GOLDBERG The original idea was actually done in 1982. We presented an ad [with] a headline, which was “Why 1984 Won’t Be Like ‘1984,’” to Steve Jobs, and he didn’t think the Apple III was worthy of that claim.

. . .

HAYDEN Steve Jobs was excited but frightened by it. Steve Wozniak offered to pay to run the commercial himself.

SCULLEY Before the commercial ran, we had to take it to the board of directors. The board sees the commercial, and then there’s just dead silence in the boardroom. They turn and look at me, and [a board member] says, “You’re not really going to run that thing, are you?”

HAYDEN As the closing credits scrolled up, the chairman, Mike Markkula, put his head in his hands and kind of folded over the conference table, and then slowly straightened up and [proposed hiring a different ad agency].

SCOTT I made it. I thought it was pretty good. But I was thinking, “Really? They’re going to run this on the Super Bowl? And we don’t know what it’s for?”

GOLDBERG I had them do a theater test. We get back the results, and it’s the worst business commercial that they’ve ever tested, in terms of persuasiveness.

SCULLEY The board said, “We don’t think you should run it. Try to sell the time.”

GOLDBERG And it was Jay Chiat who told us to drag our feet, basically, when we were told to sell off the time on the Super Bowl.

HAYDEN At long last, it came down that we would run the “1984” commercial once.

For the full story, see:

Saul Austerlitz. “The Super Bowl’s Big Ad Touchdown.” The New York Times (Saturday, February 10, 2024): C4.

(Note: ellipses, and bracketed year, added. The bracketed words in comments from Goldberg, Sculley, and Hayden were in the original.)

(Note: the online version of the story was updated Feb. 5, 2024, and has the title “40 Years Ago, This Ad Changed the Super Bowl Forever.” In the print and online versions, the names of panelists were in capitalized and bold fonts.)

Apple’s bold and famous “1984” Super Bowl ad could only be understood by those who were familiar with:

Orwell, George. Nineteen Eighty-Four. New York: The New American Library, 1961 [1st published in 1949].

A PC Industry Run “By Middle-Manager Types” Is No Longer “Fun”

(p. B10) John Walker, a groundbreaking, if reclusive, technology entrepreneur and polymath who was a founder and chief executive of Autodesk, the company that brought the ubiquitous AutoCAD software program to the design and architecture masses, died on Feb. 2 [2024] in Neuchâtel, Switzerland.

. . .

AutoCAD — the “CAD” stands for computer-aided design — was based on a program called Interact created by Michael Riddle, another company founder. With the contributions of Mr. Walker as well as Greg Lutz, who was also a founder, and the rest of the team, AutoCAD would go on to revolutionize industries including architecture, graphic design and engineering by allowing design professionals to ditch their pencils and paper and render their creations on a screen using an inexpensive personal computer.

“To him goes the credit for the Second Design Revolution,” the California software executive Roopinder Tara wrote in a tribute to Mr. Walker on the site Engineering.com. The “First Design Revolution,” as Mr. Tara called it, was the creation of earlier CAD programs that ran on expensive mainframes or minicomputers. But, he wrote, it was with AutoCAD, which “burst onto the scene in 1982, after the advent of the IBM PC, that the computer actually started to deliver on the promise.”

. . .

“In 1977, this business was fun,” Mr. Walker wrote in a book-length history of Autodesk that he published on his site. “The sellers and the buyers were hot-shot techies like ourselves, everybody spoke the same language and knew what was going on.”

“Today,” he added, “the microcomputer industry is run by middle-manager types who know far more about P/L statements than they do RAM organization.”

For the full obituary, see:

Alex Williams. “John Walker, 74, Recluse Who, as a Tech Mogul, Popularized AutoCAD.” The New York Times (Thursday, March 7, 2024): B10.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the obituary has the date March 6, 2024 and has the title “John Walker, Tech Executive Who Popularized AutoCAD, Dies at 74.” In both the online and print versions, the word fun is in italics.)

FDA Delays Apple Offering Consumers Quick and Convenient Blood Pressure Readings

Doesn’t the FDA do harm by requiring that Apple watch blood pressure monitor be equal in accuracy to a standard clinical blood pressure monitor? Many people will not take the time and effort to get frequent readings from a standard blood pressure monitor in a clinic. But many of them would check their blood pressure conveniently on their watch. Isn’t a less accurate reading better than no reading at all?

(p. A1) Apple’s widening effort to turn its nine-year-old watch from a luxury timepiece into the ultimate all-in-one medical device is taking it into territory that is legally treacherous as well as potentially profitable.

. . .

(p. A2) “The studies that we’ve seen are not yet reassuring that they’re ready for prime time or for clinical use,” said Jordana Cohen, associate professor of medicine and epidemiology at the University of Pennsylvania.

To secure Food and Drug Administration clearance for selling a blood-pressure monitor, companies must demonstrate through the FDA’s 510(k) process that their device’s accuracy is comparable to an existing, already cleared device, she added.

Similarly, tracking glucose through noninvasive skin sensors is generally less precise than direct blood analysis, with factors such as skin tone and temperature affecting accuracy.

For the full story, see:

Dalvin Brown and Aaron Tilley. “Tech and Legal Hurdles Hinder Apple’s Quest for Medical Watch.” The Wall Street Journal (Friday, Dec. 29, 2023): A1-A2.

(Note: ellipsis added.)

(Note: the online version of the story has the date December 28, 2023, and has the title “Apple Keeps Chasing the Ultimate Health-Tracking Watch—but It Could Take Years.”)