Obama resolute in showdown with GOP over 'fiscal cliff'

WASHINGTON — President Obama brushed off the latest Republican gambit to gain leverage in averting the so-called fiscal cliff, bluntly telling business chief executives in a speech Wednesday, "I'm not going to play that game."

That flash of swagger reflects growing White House confidence about its position in the year-end showdown over scheduled spending cuts and tax increases. With less than a month to act and the wind of an electoral victory at their back, White House officials think they are boxing in Republicans.

The White House credits its strategy crafted from painful lessons of past go-rounds with the Republican-led House. Rather than engaging intensely with the GOP leadership in high-profile meetings, Obama has sought to isolate Republicans and pump up the pressure from all sides. He has picked a red line and is sticking to it. And now he's waiting.

"The only time these guys have ever moved on something is when they have felt the outside pressure," said an Obama advisor who requested anonymity to discuss strategy.

Both sides say they are working to defuse the scheme of tax increases and budget cuts they enacted to force themselves to reach a larger deficit reduction deal. Experts say that if nothing is done, the double blow could send the economy back into recession.

For now, though, the president has reason to be resolute, even as Republicans call on him to counter their latest offer.

Treasury Secretary Timothy F. Geithner underscored that position Wednesday in an interview on CNBC. The administration is "absolutely" ready to go over the "fiscal cliff" if Republicans refuse to raise tax rates on the wealthy, he said.

"There's no prospect in an agreement that doesn't involve those rates going up on the top 2% of the wealthiest Americans," he said.

Public polling shows a majority of Americans not only support the president's push to allow tax rates to rise on top earners but are prepared to hold the GOP responsible if negotiations fail. A new poll from the Washington Post and Pew Research Center found that 53% of Americans said Republicans should be blamed if there is no deal, compared with 27% who would blame the president.

Obama's stance has bred discord and frustration among Republicans on Capitol Hill who find themselves in the politically awkward position of threatening a tax increase for all to preserve lower taxes for the wealthy. Tension bubbled up this week as Republicans floated a new strategy that would involve reviving a threat to let the U.S. default on its debt payments.

Under that scenario, Republicans would agree to raise taxes on the wealthiest 2% of taxpayers, as the president has demanded, but would defer talks about a larger deficit reduction package until the new year, when Obama would need their votes to avoid a federal default on the debt. Republicans could then demand concessions on the federal budget in return for voting to raise the nation's debt limit.

"The debt ceiling is hanging out there, and the debt ceiling is the next point of leverage," said Rep. Steve King, a conservative Republican from Iowa. "The president does not fear the fiscal cliff. He's concerned about who's going to get the blame. But he doesn't fear the cliff."

A spokesman for House Speaker John A. Boehner (R-Ohio) also suggested that Republicans would try to extract spending cuts in return for a debt limit increase. "We agree there is no reason for drama surrounding a debt limit increase. All that is required is the president getting serious about spending cuts," said Boehner spokesman Brendan Buck.

In his CNBC interview, Geithner said the administration would insist that any agreement include an increase in the debt ceiling.

Obama and Boehner spoke on the phone Wednesday. Neither side disclosed details of the call.

Obama's strategy involves risks. His repeated attempts to bludgeon Republicans on taxes while offering no new concessions has engendered little goodwill, and he will need some Republican votes soon.

And his declaration that he won't play chicken with the vote to raise the debt ceiling? Though that is the tough talk that some Democrats have craved, it has little practical meaning. Unless Republicans agree to his request to largely cede authority to raise the limit, he will need Congress to do it.

For Obama, the lesson on how to gain and use leverage began with the summer of 2011, when a marathon of high-level bargaining sessions with Republicans failed to produce a grand bargain on the federal budget.

After that, Obama set out to negotiate on the campaign trail, announcing his terms publicly as he rallied people behind them.

The Obama team added social media campaigns and testimonials from middle-class Americans, and managed to pass an extension of the payroll tax break in February. That's when aides came to believe the president could shift the dynamic in talks with Capitol Hill.

Early signs are that the formula may be working again. The latest Twitter campaign has elicited more than 100,000 emails from people explaining how the middle-class tax increase would affect them.

And Obama's outreach to interested parties is showing progress. Business leaders are worrying openly about the uncertainty around the fiscal cliff and debt ceiling.

At the Business Roundtable on Wednesday, Boeing's chief executive introduced Obama by suggesting that business leaders could "serve a useful purpose in the dialogue."

To be sure, there's grousing about Obama's negotiating posture. Sen. Mitch McConnell (R-Ky.), the chamber's Republican leader, has complained that Obama is campaigning rather than working out the issues with his negotiating partners.

But the strategy is worth the aggravation, administration officials think. The president isn't avoiding private negotiations, but doesn't plan to start them until there is some movement.

"Once Republicans acknowledge that rates are going up for top earners," White House Press Secretary Jay Carney said, "we believe that an agreement is very achievable."

christi.parsons@latimes.com

kathleen.hennessey@latimes.com

Melanie Mason, Michael A. Memoli and Lisa Mascaro in the Washington bureau contributed to this report.

Read More..

U.S. agency backs Apple in essential patent battle

WASHINGTON (Reuters) – Google unit Motorola Mobility is not entitled to ask a court to stop the sale of Apple iPhones and iPads that it says infringe on a patent that is essential to wireless technology, the U.S. Federal Trade Commission said on Wednesday.

In June, Judge Richard Posner in Chicago threw out cases that Motorola, now owned by Google, and Apple had filed against each other claiming patent infringement. Both companies appealed.

In rejecting the Google case, Posner barred the company from seeking to stop iPhone sales because the patent in question was a standard essential patent.

This means that Motorola Mobility had pledged to license it on fair and reasonable terms to other companies in exchange for having the technology adopted as a wireless industry standard.

Standard essential patents, or SEPs, are treated differently because they are critical to ensuring that devices made by different companies work together.

Google appealed to the U.S. Court of Appeals for the Federal Circuit. The FTC said in its court filing that Posner had ruled correctly.

The commission, which has previously argued against courts banning products because they infringe essential patents, reiterated that position on Wednesday.

“Patent hold-up risks harming competition, innovation, and consumers because it allows a patentee to be rewarded not based on the competitive value of its technology, but based on the infringer’s costs to switch to a non-infringing alternative when an injunction is issued,” the commission wrote in its brief.

The case is Apple Inc. and NeXT Software Inc. V. Motorola Inc. and Motorola Mobility Inc., in the U.S. Court of Appeals for the Federal Circuit, no. 2012-1548, 2012-1549.

(Reporting By Diane Bartz)

Tech News Headlines – Yahoo! News

Read More..

Michael Strahan makes his Broadway debut in 'Elf'

NEW YORK (AP) — Michael Strahan has tackled something few football stars have attempted — Broadway.

The gap-toothed co-host of "Live with Kelly and Michael" made three short appearances at Wednesday's matinee of "Elf" and said he has new respect for Broadway performers.

"I was surprised at how nervous you get and the adrenaline and that feedback from the audience — it really was an amazing thing," the former football player said after the show. "To see these performers who do it every day — eight or nine times a week — is really amazing. I take my hat off to them."

Fans can see a behind-the-scenes recap on Thursday's TV show.

The musical is adapted from the Will Ferrell film from 2003 about Buddy, a human raised in the North Pole who travels to New York in search of his parents.

Strahan thought making his Broadway debut would be fun and represented a new experience for a guy who holds the single season sack record. He found himself more nervous than he has been for high-stakes football games or live TV.

"It's a little nerve-wracking because so many people depend on you, you want to get your line across and you have to play to the crowd. It's a lot more intricate with everyone hitting their marks. You don't want to be the guy that messes everyone up," he said.

Strahan, 41, played both a police officer and a Salvation Army Santa in the first act and later came on as himself in a scene with the real Santa in the second act. As he waited in the wings of the Al Hirschfeld Theatre, he saw the toll the musical takes on its dancers.

"Some of these performers are breathing as if they just went into a football game and played a 12-play drive," he joked. "I was tired walking up and down from my dressing room."

Strahan rehearsed for an hour in the morning with stage managers and associate director Casey Hushion. At 1 p.m., some in the cast came in early to work with him, including Jordan Gelber, who plays Buddy, and Beth Leavel, who plays Buddy's stepmother.

The audience was quiet when Strahan first appeared as an officer with another cop after Buddy gets kicked out of Macy's. But the seven-time Pro-Bowler and Super Bowl winner flashed his trademark smile and they went wild. More applause greeted him after he played a Salvation Army Santa as he and Buddy wrestled over the kettle bells.

In the second act, he waited to ask Santa for a present. Santa asked him his name, the newly minted actor said "Michael Strahan" and he then asked for a red Schwinn bicycle with a bell shaped like Miss Piggy. The crowd cheered when Strahan identified himself and he got another wide round of applause at the curtain call, where the cast gave him flowers.

Strahan was named in September as Kelly Ripa's permanent co-host aboard the morning show "Live with Kelly and Michael." A former defensive star who spent 15 years in the NFL, he is also a host of "Fox NFL Sunday."

He follows in the footsteps of Joe Namath, a quarterback nicknamed "Broadway Joe" who made an appearance on Broadway in 1983 as a replacement in a revival of "The Caine Mutiny Court-Martial."

Strahan would not rule out a return to the stage. "I will take it off my bucket list, but if the opportunity came across again, I might just take it up and do it again," he said. "I had a great time."

___

Online:

http://www.elfmusical.com

http://dadt.com/live

Read More..

Extended Use of Breast Cancer Drug Suggested

The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.

In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.

“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.

Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs might be taken for a longer duration as well.

“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”

Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.

Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.

About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them are in premenopausal women with estrogen receptor-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.

The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.

In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing 10 years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.

About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.

There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.

Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.

“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.

Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.

Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots, compared with 0.4 percent in the control group.

“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.

Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.

“They don’t feel well on them, but it’s their safety net,” said Dr. Garber, who added that the news would be welcomed by many patients who would like to stay on the drug. “I have patients who agonize about this, people who are coming to the end of their tamoxifen.”

Emily Behrend, who is a few months from finishing her five years on tamoxifen, said she would definitely consider another five years. “If it can keep the cancer away, I’m all for it,” said Ms. Behrend, 39, a single mother in Tomball, Tex. She is taking the antidepressant Effexor to help control the night sweats and hot flashes caused by tamoxifen.

Cost is not considered a huge barrier to taking tamoxifen longer because the drug can be obtained for less than $200 a year.

The results, while answering one question, raise many new ones, including whether even more than 10 years of treatment would be better still.

Perhaps the most important question is what the results mean for postmenopausal women. Even many women who are premenopausal at the time of diagnosis will pass through menopause by the time they finish their first five years of tamoxifen, or will have been pushed into menopause by chemotherapy.

Postmenopausal patients tend to take aromatase inhibitors like anastrozole or letrozole, which are more effective than tamoxifen at preventing breast cancer recurrence, though they do not work for premenopausal women.

Mr. Peto said he thought the results of the Atlas study would “apply to endocrine therapy in general,” meaning that 10 years of an aromatase inhibitor would be better than five years. Other doctors were not so sure.

The Atlas study was paid for by various organizations including the United States Army, the British government and AstraZeneca, which makes the brand-name version of tamoxifen.

Read More..

Netflix buys exclusive rights to Disney movies

Netflix Inc. has acquired exclusive U.S. rights to movies from Walt Disney Studios in a deal that catapults the Internet video-on-demand service into direct competition with pay TV giants such as HBO and Showtime.

The three-year agreement takes effect in 2016 and is a blow to the pay channel Starz, which currently has the rights to broadcast Disney movies, including its Pixar animated films and Marvel superhero pictures, about eight months after they are released in theaters.

Starz's sole remaining movie provider is now Sony Pictures. That partnership ends in 2016.

VIDEO: Disney buys Lucasfilm - Mickey meet Darth Maul

Disney has also agreed to give Netflix nonexclusive streaming rights to more of its older titles — including "Dumbo," "Pocahontas" and "Alice in Wonderland" — starting immediately.

Netflix's chief content officer, Ted Sarandos, called the deal "a bold leap forward for Internet television."

"We are incredibly pleased and proud this iconic family brand is teaming with Netflix to make it happen," he said.

Netflix stock soared on the news, rising $10.65, or 14%, to $85.65.

Shares in Starz's parent company, Liberty Media Corp., fell $5.49, or 5%, to $105.56.

Currently, Netflix has nonexclusive rights to movies from Paramount Pictures, Lionsgate and Metro-Goldwyn-Mayer via a deal with pay channel Epix, as well as an array of library titles from other studios. Its only exclusive movie rights come from independent studios such as Relativity Media and DreamWorks Animation. It also has a wide variety of television reruns.

Sarandos and Netflix Chief Executive Reed Hastings have long said the company wanted to get exclusive pay TV rights to films from one of Hollywood's six major studios to boost its online entertainment service.

PHOTOS: Disney without Pixar

However, Hastings has also at times downplayed the importance of new movies. Netflix previously had streaming rights to Disney and Sony movies via a deal with Starz. In January, investors expressed their concerns that the pending disappearance of those movies would hurt the service. Hastings said in a letter to investors that Disney films accounted for only 2% of domestic streaming and the loss would not be felt.

Since then, though, the Disney movie slate has become more attractive. At that time, Netflix did not have access to movies from Disney's Marvel superhero unit or the "Star Wars" titles from its pending acquisition of Lucasfilm Ltd.

The end of the Starz agreement accelerated a trend that has seen Netflix evolve into a television company, with reruns of shows such as "Mad Men" accounting for about two-thirds of the content streamed by users.

With several original programs launching next year, including the Kevin Spacey political drama "House of Cards," and a direct connection to a growing number of Internet-enabled televisions, Netflix is on the verge of standing on par with many TV networks.

Netflix charges $8 a month for its streaming service, while premium cable networks such as HBO cost $13 to $18 a month, and that's on top of a monthly bill for other channels that typically exceeds $50. It remains to be seen whether the addition of Disney products and more original programming could lead Netflix to increase its price.

PHOTOS: Hollywood back lot moments

The Netflix spending spree could continue, with Sarandos telling Bloomberg News on Monday that his company would bid for rights to Sony movies when its Starz deal expires.

Netflix might have a tougher time wresting away the rights to Warner Bros., 20th Century Fox or Universal Pictures releases from their current deals with HBO, which like Warner is part of Time Warner Inc. Paramount, Lionsgate and MGM are almost certain to stick with Epix, of which the trio are co-owners.

Read More..

Debut of repainted sign is Hollywood event

If there's anything Tinseltown excels at, it's turning a ho-hum event into a made-for-TV spectacle. Witness the fanfare that unfolds each time the Hollywood sign gets a fresh coat of paint.

It's not written off as routine maintenance. No, it's a civic event.

A media scrum gathers. Elected officials gush. Someone cracks jokes about face-lifts. (In 1995, nipped-and-tucked actress Phyllis Diller did the honors.)

PHOTOS: Hollywood sign history

So it was on Tuesday, when reporters were whisked to just below the nearly 90-year-old sign, one of the few landmarks in the crazy quilt of neighborhoods that is Los Angeles.

In a clearing, VIPs fidgeted on white folding chairs. At least a dozen cameras were trained on Chris Baumgart, chairman of the nonprofit Hollywood Sign Trust, who wore a dark suit and sneakers. Behind him loomed the nine 45-foot-tall letters that together, he said, cost about $175,000 to gussy up.

Beginning in October, workers stripped the letters of weathered paint, smeared them with 105 gallons of primer and coated them with 255 gallons of new paint (color: No. 7757, high-reflective white). It's made by Sherwin-Williams, which picked up most of the sign restoration bill.

Baumgart, a veritable encyclopedia of sign knowledge, joked with reporters that its face had been pancaked with two tons of makeup. "A lot was done to her backside, but we're leaving that secret," he said, tongue firmly in cheek.

When it was erected in 1923 with the aid of mule teams, the sign touted a high-end real estate development named Hollywoodland. Its creators expected to take it down after a year, according to the Hollywood Sign Trust, but tourists flocked to the hillside and its stunning view of Los Angeles. In the 1940s, the city folded the sign into Griffith Park and truncated it to hype, simply, "Hollywood."

Over the years, the sign has needed numerous touch-ups. In the 1970s, the termite-weakened O cartwheeled away from the rest of its kin and an L was set ablaze. A who's-who of Hollywood helped raise money to rebuild the sign completely, including Alice Cooper, Gene Autry and Hugh Hefner, who threw a fundraiser at the Playboy Mansion.

When the retooled landmark was unveiled in 1978 on live TV, the trust said, 60 million people watched. After that, it seemed, Los Angeles celebrated its every milestone with a dose of stagecraft.

In 1995, during the media event with Diller, black tarps fell to reveal gleaming letters. In 2005, Los Angeles Mayor Antonio Villaraigosa, in the words of the trust, "rappelled down the hillside and applied the final strokes of coating himself."

Tuesday's event was comparatively sedate. But as Baumgart fielded questions, a handful of people crept along the sign's base — cameramen shooting video of painters.

"They're supposed to be painting the last brush strokes on the sign," Baumgart said, "but it's for show."

He shrugged.

"Hey, it's Hollywood."

ashley.powers@latimes.com

Read More..

iOS users generate double the Web traffic of Android users

According to the latest numbers from Chitika Insights, iOS users generate more than twice the amount of Web traffic as Android users. The six-month study found that while the two operating systems were nearly tied when it came to smartphone Web traffic, Apple (AAPL) has a substantial lead with its iPad tablet. Despite Android’s commanding share of the overall mobile market, the Cupertino-based company’s platform totaled 67% of Web traffic measured in the past six months, compared to Android’s 35% share.

“Despite all the new Android and Apple devices that have been released over the past six months, little has changed in the overall Web traffic distribution between iOS and Android,” the research firm wrote. “iOS’s share has hovered around 65%, while Android largely has stayed around 35%, the OS hit a peak of 40% in late August thanks partially to strong Samsung Galaxy S III sales. Apple then regained some share with the release of the iPhone 5 in the September timeframe.”

To qualify for the study Chitika Insights analysed billions of ad impressions coming from iOS or Android devices from May 27th to November 27th.

Get more from BGR.com: Follow us on Twitter, Facebook

Gadgets News Headlines – Yahoo! News

Read More..

Huston's "Infrared" wins Bad Sex fiction prize

LONDON (AP) — It's the prize no author wants to win.

Award-winning novelist Nancy Huston won Britain's Bad Sex in Fiction award Tuesday for her novel "Infrared," whose tale of a photographer who takes pictures of her lovers during sex proved too revealing for the judges.

The choice was announced by "Downton Abbey" actress Samantha Bond during a ceremony at the Naval & Military Club in London.

Judges of the tongue-in-cheek prize — which is run by the Literary Review magazine — said they were struck by a description of "flesh, that archaic kingdom that brings forth tears and terrors, nightmares, babies and bedazzlements," and by a long passage that builds to a climax of "undulating space."

Huston, who lives in Paris, was not on hand to collect her prize. In a statement read by her publicist, the 59-year-old author said she hoped her victory would "incite thousands of British women to take close-up photos of their lovers' bodies in all states of array and disarray."

The Canada-born Huston, who writes in both French and English, is the author of more than a dozen novels, including "Plainsong" and "Fault Lines." She has previously won France's Prix Goncourt prize and was a finalist for Britain's Orange Prize for fiction by women.

She is only the third woman to win the annual Bad Sex prize, founded in 1993 to name and shame authors of "crude, tasteless and ... redundant passages of sexual description in contemporary novels."

Some critics, however, have praised the sexual passages in "Infrared." Shirley Whiteside in the Independent on Sunday newspaper said there were "none of the lazy cliches of pornography or the purple prose of modern romantic fiction" — though she conceded the book's sex scenes were "more perfunctory than erotic."

Huston beat finalists including previous winner Tom Wolfe — for his passage in "Back to Blood" describing "his big generative jockey" — and Booker Prize-nominated Nicola Barker, whose novel "The Yips" compares a woman to "a plump Bakewell pudding."

Previous recipients of the dubious honor, usually accepted with good grace, include Sebastian Faulks, the late Norman Mailer and the late John Updike, who was awarded a Bad Sex lifetime achievement award in 2008.

___

Online: http://www.literaryreview.co.uk

Read More..

Software Programs Help Doctors Diagnose, but Can’t Replace Them

SAN FRANCISCO — The man on stage had his audience of 600 mesmerized. Over the course of 45 minutes, the tension grew. Finally, the moment of truth arrived, and the room was silent with anticipation.

At last he spoke. “Lymphoma with secondary hemophagocytic syndrome,” he said. The crowd erupted in applause.

Professionals in every field revere their superstars, and in medicine the best diagnosticians are held in particularly high esteem. Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor of clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice today.

The case Dr. Dhaliwal was presented, at a medical  conference last year, began with information that could have described hundreds of diseases: the patient had intermittent fevers, joint pain, and weight and appetite loss.

To observe him at work is like watching Steven Spielberg tackle a script or Rory McIlroy a golf course. He was given new information bit by bit — lab, imaging and biopsy results. Over the course of the session, he drew on an encyclopedic familiarity with thousands of syndromes. He deftly dismissed red herrings while picking up on clues that others might ignore, gradually homing in on the accurate diagnosis.

Just how special is Dr. Dhaliwal’s talent? More to the point, what can he do that a computer cannot? Will a computer ever successfully stand in for a skill that is based not simply on a vast fund of knowledge but also on more intangible factors like intuition?

The history of computer-assisted diagnostics is long and rich. In the 1970s, researchers at the University of Pittsburgh developed software to diagnose complex problems in general internal medicine; the project eventually resulted in a commercial program called Quick Medical Reference. Since the 1980s, Massachusetts General Hospital has been developing and refining DXplain, a program that provides a ranked list of clinical diagnoses from a set of symptoms and laboratory data.

And I.B.M., on the heels of its triumph last year with Watson, the Jeopardy-playing computer, is working on Watson for Healthcare.

In some ways, Dr. Dhaliwal’s diagnostic method is similar to that of another I.B.M. project: the Deep Blue chess program, which in 1996 trounced Garry Kasparov, the world’s best player at the time, to claim an unambiguous victory in the computer’s relentless march into the human domain.

Although lacking consciousness and a human’s intuition, Deep Blue had millions of moves memorized and could analyze as many each second. Dr. Dhaliwal does the diagnostic equivalent, though at human speed.

Since medical school, he has been an insatiable reader of case reports in medical journals, and case conferences from other hospitals. At work he occasionally uses a diagnostic checklist program called Isabel, just to make certain he hasn’t forgotten something. But the program has yet to offer a diagnosis that Dr. Dhaliwal missed.

Dr. Dhaliwal regularly receives cases from physicians who are stumped by a set of symptoms. At medical conferences, he is presented with one vexingly difficult case and is given 45 minutes to solve it. It is a medical high-wire act; doctors in the audience squirm as the set of facts gets more obscure and all the diagnoses they were considering are ruled out. After absorbing and processing scores of details, Dr. Dhaliwal must commit to a diagnosis. More often than not, he is right.

When working on a difficult case in front of an audience, Dr. Dhaliwal puts his entire thought process on display, with the goal of “elevating the stature of thinking,” he said. He believes this is becoming more important because physicians are being assessed on whether they gave the right medicine to a patient, or remembered to order a certain test.

Without such emphasis, physicians and training programs might forget the importance of having smart, thoughtful doctors. “Because in medicine,” Dr. Dhaliwal said, “thinking is our most important procedure.”

He added: “Getting better at diagnosis isn’t about figuring out if someone has one rare disease versus another. Getting better at diagnosis is as important to patient quality and safety as reducing medication errors, or eliminating wrong site surgery.”

Clinical Precision

Dr. Dhaliwal does half his clinical work on the wards of the San Francisco V. A. Medical Center, and the other half in its emergency department, where he often puzzles through multiple mysteries at a time.

One recent afternoon in the E.R., he was treating a 66-year-old man who was mentally unstable and uncooperative. He complained of hip pain, but routine lab work revealed that his kidneys weren’t working and his potassium was rising to a dangerous level, putting him in danger of an arrhythmia that could kill him — perhaps within hours. An ultrasound showed that his bladder was blocked.

There was work to be done: drain the bladder, correct the potassium level. It would have been easy to dismiss the hip pain as a distraction; it didn’t easily fit the picture. But Dr. Dhaliwal’s instinct is to hew to the ancient rule that physicians should try to come to a unifying diagnosis. In the end, everything — including the hip pain — was traced to metastatic prostate cancer.

“Things can shift very quickly in the emergency room,” Dr. Dhaliwal said. “One challenge of this, whether you use a computer or your brain, is deciding what’s signal and what’s noise.” Much of the time, it is his intuition that helps figure out which is which.

Read More..

Lumberyards object to state wood tax

SACRAMENTO — Some California lumber sellers are angry about a new state tax on 2-by-4s, plywood and other forest products, and they want to make sure that their customers blame the governor and legislators for the upcoming hike in building costs.

The 1% special assessment, proposed by Gov. Jerry Brown and approved in September by lawmakers, is expected to raise $35 million a year to pay for the regulation of commercial forest lands and for firefighting and prevention.

Retailers, including home improvement mega stores such as Home Depot and Lowe's and traditional, single-store and small lumberyard chains, call the new tax unfair.

"The new 1% tax singles out the hard-hit housing industry still struggling to recover from the economic recession," said Home Depot spokesman Stephen Holmes.

"This tax is going to hurt business," said Basil Alexander, manager of Anawalt Lumber in West Hollywood. The new 1% tax hike, combined with a quarter-cent rise in the state sales tax, which will be 9% in the city of West Hollywood, for example, could cause homeowners to scale back remodeling projects, he said.

"It may change their idea of what they are going to do or how they are going to do it or how big it's going to be," Alexander said.

Newly taxable wood products represent about 60% of the cost of home remodeling additions and new residential construction, he estimated. According to his calculations, the tax could add as much as $600 to the cost of a $100,000 room addition.

Anawalt plans to post disclaimers on its cash registers, Alexander said, telling customers the fee "is not an Anawalt Lumber add-on. It's the state law."

But California home builders don't share the retailers' concerns about the small hike in lumber prices.

Mike Winn, president of the California Building Industry Assn., predicted that the tax will add only about $115 to the cost of a typical 2,000-square-foot new home. His 3,200-member organization did not oppose the governor's legislation.

The new measure, to take effect Jan. 1, shifts the cost of forest land regulation from timber companies to consumers. Supporters, including the California Forestry Assn., said it broadens financial support for the program and allows California forest products companies to better compete with out-of-state timber firms.

The bill also includes a controversial provision that put legal limits on the ability of government agencies to sue landowners, timber operators and others whose negligence might have caused forest fires.

"This legislation enacts serious bipartisan reform to even the playing field to protect California's timber industry jobs," Brown said in a Sept. 11 signing statement.

The tax applies to milled lumber, plywood, wood siding and roofing, fencing and other wood products sold in California, whether they are milled here or elsewhere.

California's sales tax collectors, the state Board of Equalization, has compiled a list of taxable products and details of how to collect the levy and remit to the state. The information is being sent in letters to about 200,000 retailers, contractors and consumers explaining how the tax works and to make sure that all affected parties know about the new obligation.

marc.lifsher@latimes.com

Read More..