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Efforts to train China's rural village doctors.How a company Haoyisheng which means Good Doctor has setup 6000 clasrooms across rural China to educate rural doctors who have little medical training. The Chinese Ministry of Health has brought in 120,000 doctors to educate and is paying the company 1200 yuan out of the 3400 yuan fee for 3 years of classes. It is video and internet based and students progress on questions is monitored via intenet and the program is run from Beijing. Tests show students are making significant progress especially since the Chinese system of rural doctors is fallig apart with the intoroduction of privatized medicine and rural doctor training has suffered badly.The company was founded by Mark Engel and Gao Zhan.. Gao studied at the University of Munich for his PHD in Biochemistry and grew up in Shanghai. They own several health related businesses in China.

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Glaxo's ad campaign behind Alli its over the counter weight control drug. Details about a novel internet program designed by Glaxo for Alli and now in use by many customers.

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The reasons Exubera was conceived by Pfizer, the events leading to the persistance with backing Exubera with large investments in manufacturing and marketing and buying out Sanofi's stake in the face of repeated setbacks, the difficulties posed by a insulin inhaler from the very beginning. Bulkiness the size of a flashlight this inhaler was embarrassing to use in public, it required regular lung exams because the FDA placed a warning on theproduct because only 10% of the product went where it was intended and 90% was inhaled into the lungs and who knows what that could do especially for asthmatics but also for others. It cost twice as much instead of $2 or 3 it cost $5 per day. And the 3 milligram packet had to be loaded into the inhaler which required instructions on how to use, one doctor saying it woul take an hour to educate a patient compared to 5 minutes for an insulin pen. Abbott and Lilly have insulin inhalers that they are bringing to market in 2009. Abbott's uses aerosol insulin instead of powder, Lilly's is the size of a cellphone. Will they work for customers? Pfizer attributed as key cause of the failure to the need for regular lung exams because of the regulator's warnings for insulin inhaled into the lungs. Are Lilly and Abbott taking this problem seriously?...

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How many jobs will leak out for the fiscal stimulus if a lot of them, like 40% of manufacturing ouput in the US consisting of imported goods, are jobs created in China and Europe or other countries that make the parts for the wind energy and the solar energy products made in the USA? There will be domestic content rules but the international economy is better off if some of the jobs that result from a USA stimulus are offset by the jobs created here from the stimulus packages of Europe, China and other countries. China's infrastructure spending would lead to jobs in the US making some of the infastructure equipment that is exported or in the case of India the nuclear plants equipment that is exported.

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Jurgen Kroger, is the chief negotiator for the European Commission, and Poul Thomsen, heads the IMF negotiating team, for the 78 billion euros in loans extended to Portugal under a bailout agreement. Kroger offered his views on the agreement in Lisbon. Kroger said he was convinced that the program gives Portugal the means to boost growth and jobs, as it builds a sustainable and competitive economy. Two thirds of the loans come from the EU at an interest rate that is yet to be set. The yield on Portugal's 10 year bonds keeps rising and is now at 10.20%. The IMF will provide one third of the funds. The IMF's Thomsen said the issue of interest rates was addressed by arranging for two thirds of the loan package money coming in the first of the three years of the program. What this does is to take Portugal out of the markets for medium and long term debt for a "little over two years" he said and gives Portugal the "breathing space" it needs to restore credibility before going to the financial markets. The fear expressed by analysts is that the tough austerity measures in the programs of the EU and IMF can cause the economies of these countries to worsen, making it even harder to repay the much larger debts when the loan package money is added to the original debt. The IMF and the EU negotiators had to create a credible program for recovery in the light of these facts. Already Portugal's finance minister is predicting a contraction in the Portuguese economy of 2% in 2011, and 2% in 2012. The negotiators appear to have taken this into account in setting interest rates. Portugal will pay the IMF an interest rate of 3.25% for the first 3 years, with the rate going to 4.25 in the fourth year. By comparison Greece's loans are for seven years with an average interest rate of 4.2%. Ireland's seven year loans carry an interest rate of 5.8%, which it is working to renegotiate. To give Portugal more breathing space the terms of the loans set a slower reduction in the budget deficit than originally planned. Portugal gets to cut its budget deficit to 5.9% of GDP in 2011, and 4.5% of GDP in 2012. The 3% target is set for 2013, one year later. Economists such as Carl Weinberg of High Frequency Economics, say the loan package will only increase Portugal's debt and lead to a larger default later on when the debt amount owed is larger. The debt restructuring solution is being actively debated in the EU, including the risks that European banks would take large hits. Negotiators are also mindful of keeping any negative impact on Spain as low as possible. As Portugal's financing costs have risen, Spain's have risen also. Spain offered higher rates to sell 3.4 billion euros of five year bonds on May 5, with the average yield on Spain's bond sale rising to 4.55%, up from 4.39% on March 3. ...

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Fuel efficiency rules require average fuel efficiency in the U.S. of 35 mpg by 2016. The debate is now on what to do for 2017 to 2025. New technology such as the P2 systems for hybrids already used in VW, Nissan and Hyundai vehicles makes a 20% increase in fuel efficiency possible. Large investments are being made to bring new technology to bear on increasing fuel efficiency significantly. Government agencies are looking at different scenarios by which the new fuel economy standards beyond 2017-2025 could be set between 47 mpg and 62 mpg. An additional factor is the reduction in greenhouse gas emissions- at 47 mpg the reduction would be 3%, at 62 mpg the reduction would be 6%. Another factor is how much the impact is on the cost of vehicles and reduced cost on gasoline. Here there is a wide range in the numbers for average mpg rules at 62 mpg- with EPA estimates at $2800-$3500 increase in vehicle cost and $5000 savings in fuel cost, Centre for Automotive Research estimates at $9790 increase in vehicle cost. The 62 mpg translates into "real world" actual efficiency of 45 mpg. In April 2011, 17 senators put out a letter of support for the 62 mpg proposal. There is a public value involved in this that is also significant- the reduced dependence on foreign oil means savings in defense expenditures in parts of the Middle East, and an economy that is less impacted by volatility in the price of oil. As this aspect of public value or benefits cannot be quantified easily even though they are significant, this may tend to be lost in the debate and the politics of fuel efficiency. For automakers there is significant marketing value in having a visible and strong presence in fuel efficient vehicles because of perception as forward looking- something that hurt Detroit carmakers in the last decade. During periods of gasoline prices at $5 a gallon this provides carmakers with an extra cushion of safety in securing car sales. Carmakers in one country such as the U.S. also have to worry about what carmakers in other countries such as Japan and Germany are doing- if the standards in the U.S. develop a gap compared to other countries developing advanced fuel efficiency technologies this poses significant risks because of the global nature of the automobile marketplace. See the group "Asleep at the Spigot" for more details on this. Many of these less quantifiable factors do not get the attention they deserve because they are significant from experience but not easily quantified. Throw into this the large unknown of what new technologies not yet developed lie ahead with a burst of effort by one country or another, which bring cost reductions at the same time - and the debate requires as much a good sense of what is the path offering the greatest advantages in years ahead than a pure exercize in numbers. ...

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Prof. Jeffrey Wasserstrom of UC Irvine reviews Henry Paulson's "Dealing With China." Paulson was head of Goldman Sachs investment bank and Secretary of the Treasury 2006-2009, the period of the global financial crisis. He made 70 visits to China since his days at Goldman Sachs and calls Chinese leaders Jiang Zemin and Jinping "old friends." He established the Strategic Economic Dialogue in the Bush administration for dialogue on economic issues with China, and setup the Paulson Institute at the University of Chicago to focus on China-U.S. relations. One of Paulson's points is that China's financial system faces a day of reckoning, with large losses and many restructurings. Wasserstrom's review looks at Paulson's view of dealing with China and points to a sense that it needs updating because by the time the book is published a lot has changed with the new Jinping administration. The new administration in China is more assertive in foreign affairs, and less tolerant of both the corruption that became part of the Chinese capitalist development inside a state run one party system, and of the voices for more openness. It also has placed tight controls on the Internet. Jinping sees a constructive role for the Communist party in the future as China makes economic reforms away from state run enterprises, and is working to strengthen the party through discipline and anti-corruption initiative. The reckoning Paulson mentions, Krugman and other experts have described in other language- not as a reckoning but that China was no exception and would face the same problems that the U.S. and the eurozone faced since 2008 from financial excesses. In this sense Paulson's views and interactions with the Chinese leadership may represent another era, a period of exuberance when some of these financial excesses were being built up. Today's economic team of Jinping and Li Keqiang is more focussed on making sure the transition through a economic crisis is managed carefully, keeping in mind the risks for China considering its history, and the situation where China is still a "middle income country" with aspirations for further development to improve incomes and living standards. Their view is that tight control is needed as China makes this transition to a less state enterprise dependent, and more consumer economy, so that there is no loss of the gains made so far. A different set of skills and deft management of the economy is needed, making Paulson's views from another era less relevant. External influences such as managing the complex China-Japan relationship as both countries become more assertive are creating another dynamic in Asia, which Chinese leaders may see as requiring careful management, making Paulson's experience less relevant for a new period with new challenges. For the U.S. the economic cooperation with China now occurs with an added political dimension. Of concern for the tight control, seen as not forward looking and not bringing more constructive voices into the system, and the new complexities of carefully managing the changing U.S.-China-Japan relationship in Asia. ...

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Lipton, Austin and LaFraniere of the NYT tell the story of how the serious differences between the prime contractor for the federal healthcare website, CGI Federal, and the Obama administration officials handling the website, evolved into conflicts that could not be resolved. This led to the flawed website being rolled out on schedule ignoring serious problems with the website. The detailed report comes after interviews with Obama administration officials and specialists who worked on the project and looking into government and contractor documents. A month ago in October 2013 the healthcare website for the Obama healthcare law was up only 42% of the time with 10 hour failures happening frequently. Basic steps for the functioning of website backup systems in case there is a failure, testing to ensure negligible or no outages, were not secured. The government officials responsible for the rollout did not have the capabilities to handle such a project. Henry Chao, who worked in the Medicare agency for 19 years was left to oversee day to day questions for the website HealthCare.gov, but lacked a formal background in software engineering and no authority to make the decisions needed. The $630 million project was setup inside the Medicare Agency, instead of a separate agency specially setup for this project and staffed with the appropriate skills as originally proposed. Five different lower level government officials made decisions without the authority needed and no one person with the necessary skills was given overall responsibility and decisionmaking. A series of missteps were allowed to take place- settting many added requirements that made it difficult for contractors to focus on basic steps and get them right, use of the MarkLogic database system instead of systems from IBM or Oracle against the advice of contractors, multiple contractors without a way to control the overall project, shifting requirements from the government and bureaucratic delays for resolving basic issues such as use of social security numbers, all worked to create delays. With the delays came a deterioration of relations between Obama administration officials and the contractors. The government officials response was to stick to the deadline of Oct. 1 rollout, with Michelle Snyder, chief operating officer of Medicare agency telling people she would fire the contractor if possible. In the end no one took responsibility for a safe reliable rollout, even though the system failed a test of 500 users in late September and was down half the time in mid-October. President Obama or his advisors were either not kept fully informed, or did not grasp the significance of the collapse in relations between contractors and the government and a project out of control. His aloof distanced approach was not an asset in such matters- saying about the rollout and use of the website: "this is real simple" like using the Kayak website for travel bookings- and he saw no need to take action leading to the major failure for the administration that followed....

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Daniel Howes of the Detroit News thinks there are cultural clashes inherent in a threeway Fiat-Opel-Chrysler combination. His view is that Fiat may be biting into more than it can handle, considering the failure of the GM-Fiat alliance, and the Daimler- Chrysler combination. And the Germans at Opel are not happy with the way they see GM has treated them, so how would it help for Fiat to come into the picture? The Germans love the Italians, says one German Howe talked to, but don't respect them. And the Italians he says, respect the Germans but don't love them. Howe refers to the Renault-Nissan combination as successful, but one that took years to build to deliver commonly engineered cars. But the car industry has been poorly run, without vision and with complacent management, unwilling to try new things and recreate and renew. In other industries efforts are made to build transnational combinations with differing degrees of success. Take the work of the French, Germans and the Spanish in Airbus, in overcoming different cultural factors and pulling together to learn from each other, when given good leaders, on the Airbus 380 project. See the link to this. On Fiat's Marchionne's behalf it could be said that this is a new Fiat, run by a younger generation of Italians, who have a lot of youthful energies and freedom to innovate and improvise. Marchionne himself is more Canadian and European, places where he has spent most of his life, than Italian. And he has take a decidedly different view of things from what the old view holds as being Italian, in building the new Fiat he has done things very differently. In fact there may be less of a country view here, than a management culture view. All nationalities aspire to a good management culture of innovation, and freedom to improvise and respect for one's ideas and thinking, good places to work in. People of all nationalities, Italian, German and American, for the first time, especially the younger people, may see that the one thing they value most and share is the desire to start fresh and take initiative, improvise and work together to do the impossible. The common enemy of Germans, Italians, Americans,French, and other nationalities, may be simply the artheroschelorisis of complacent management, that freezes initiative, does not delegate more responsibility to the young and give the freedom to try new things, bureacratizes the corporation into rigid hierarchies that lack speed, and take no risks to achieve the impossible. See the link to Marchionne and Fiat's transformation. Which is why old prejudices like the one Howe states from one German he talks to, that the Italians "will steal the milk out of the coffee," may be just that - prejudice from another period, that is best left behind to build something new that has no nationality to it. ...