Group items tagged

The virus kept spreading. By early April officials were logging an average of around 15,000 new cases a day. A spike in deaths followed. In Hong Kong alone, nearly 9,000 people have died since mid-February. To be clear, that’s a fraction of the infections and deaths that countries with fewer restrictions tallied during the worst of their own COVID surges. What’s so worrying in China is the trend—and the potential for cases, and deaths, to keep going up and up.

“It could be that we are seeing the resurgences in China, including the emergence and spread of new sub-strains, primarily because the population there never achieved high levels of natural immunity,”

You can’t build up natural antibodies across a large population if no one is ever exposed to the virus. That’s the downside of total lockdowns

The antibodies in recovered COVID patients lend strong immunity that, combined with vaccinations across large groups of people, can help blunt the impact of a new lineage. Michael for one said he believes natural immunity is stronger and longer-lasting than immunity resulting from even the best messenger-RNA vaccines.

“They also used inactivated viruses in their Sinovac and Sinopharm vaccines, which I had expected to be more robust than mRNA vaccines in terms of producing a more diversified immune response that could counter new mutants, et cetera,” Michael said, “but apparently it would seem that this response has waned, making people susceptible again to new strains.”

even if they are reasonably effective, the vaccines are unevenly distributed in China. The government’s attacks on foreign jabs has had the effect of encouraging anti-vax attitudes, especially among older Chinese who might be less media-savvy than their younger counterparts.

just half of the most vulnerable age group–over-80s–is fully vaccinated. That plus the lack of natural immunity has left millions of Chinese exposed to aggressive lineages that can punch right through lockdowns.

. “Any place can be a source of new variants, but those places with low levels of population immunity and unchecked spread of the virus are the most likely,”

Each individual infection, unchecked by antibodies, tends to produce two mutations every two weeks,

“What if we had 50 million people pull slot-machine levers simultaneously at the same time?” Moshiri asked. “We would expect at least one person would hit the jackpot pretty quickly. Now, replace the slot machine with ‘clinically-meaningful SARS-CoV-2 mutation,’ and that’s the situation we're in.”

All that is to say, the longer COVID rates remain high in the world’s most-populous country, the greater the chance that the next major lineage will be Chinese.

New lineages are inevitable from one country or another, of course. The trick is to slow the rate of mutation so that fresh vaccine formulations, therapies and public-health policies can at least keep pace with major changes in the virus.

billion people with uneven rates of vaccination by potentially low-quality jabs and very little natural immunity to back up the shots.

What began as a revolutionary set of technologies ended up concentrating enormous private power over key services and locking in business models that come at extraordinary cost to our privacy and security.

The trajectory of the Web 2.0 era was not inevitable — it was instead shaped by a broad range of policy choices. And we now face another moment of choice. As the use of A.I. becomes more widespread, public officials have a responsibility to ensure this hard-learned history doesn’t repeat itself.

the Federal Trade Commission is taking a close look at how we can best achieve our dual mandate to promote fair competition and to protect Americans from unfair or deceptive practices.

we already can see several risks. The expanding adoption of A.I. risks further locking in the market dominance of large incumbent technology firms. A handful of powerful businesses control the necessary raw materials that start-ups and other companies rely on to develop and deploy A.I. tools. This includes cloud services and computing power, as well as vast stores of data.

Enforcers have the dual responsibility of watching out for the dangers posed by new A.I. technologies while promoting the fair competition needed to ensure the market for these technologies develops lawfully.

generative A.I. risks turbocharging fraud. It may not be ready to replace professional writers, but it can already do a vastly better job of crafting a seemingly authentic message than your average con artist — equipping scammers to generate content quickly and cheaply.

bots are even being instructed to use words or phrases targeted at specific groups and communities. Scammers, for example, can draft highly targeted spear-phishing emails based on individual users’ social media posts. Alongside tools that create deep fake videos and voice clones, these technologies can be used to facilitate fraud and extortion on a massive scale.

we will look not just at the fly-by-night scammers deploying these tools but also at the upstream firms that are enabling them.

these A.I. tools are being trained on huge troves of data in ways that are largely unchecked. Because they may be fed information riddled with errors and bias, these technologies risk automating discrimination

We once again find ourselves at a key decision point. Can we continue to be the home of world-leading technology without accepting race-to-the-bottom business models and monopolistic control that locks out higher quality products or the next big idea? Yes — if we make the right policy choices.

“It is genius for the current consumer culture,” Christine Whelan, a clinical professor of consumer science at the University of Wisconsin at Madison, told me. “It encourages and then meets the need for the thing, so we then continue on the hedonic treadmill: Buy the latest thing we want and then have it delivered immediately and then buy the next latest thing.”

With traditional retail, “there’s the friction of having to go to the store, there’s the friction of will the store have it, there’s the friction of carrying it,” Whelan said. “There’s the friction of having to admit to another human being that you’re buying it. And when you remove the friction, you also remove a lot of individual self-control. The more you are in the ecosystem and the easier it is to make a purchase, the easier it is to say yes to your desire rather than no.”

“It used to be that being a consumer was all about choice,”

But now, “two-thirds of people start their product searches on Amazon.

Prime discourages comparison shopping—looking around is pointless when everything you need is right here—even as Amazon’s sheer breadth of products makes shoppers feel as if they have agency.

“Consumerism has become a key way that people have misidentified freedom,”

what Amazon represents is a corporate infrastructure that is increasingly directed at getting as many consumers as possible locked into a consumerist process—an Amazon consumer for life.”

Amazon offers steep discounts to college students and new parents, two groups that are highly likely to change their buying behavior. It keeps adding more discounts and goodies to the Prime bundle, making subscribing ever more appealing. And, in an especially sinister move, it makes quitting Prime maddeningly difficult.

the United States now has more Prime memberships than households. In 2020,

In 2019, Amazon shaved a full day off its delivery time, making one-day shipping the default, and also making Prime an even more tantalizing proposition: Why hop in the car for anything at all when you could get it delivered tomorrow, for free?

As subscription numbers grew through the 2010s, the revenue from them helped Amazon pump more money into building fulfillment centers (to get products to people even faster), acquiring new businesses (to control even more of the global economy), and adding more perks to the bundle (to encourage more people to sign up)

“Every decision we make is based upon the fact that Amazon can get these books cheaper and faster. The prevailing expectation is you can get anything online shipped for”— he scrunched his fingers into air quotes—“‘free,’ in one or two days. And there’s really only one company that can do that. They do that because they’re willing to push and exploit their workers.”

Thanks in large part to the revenue from Prime subscriptions and from the things subscribers buy, Amazon’s value has multiplied roughly 97 times, to $1.76 trillion, since the service was introduced. Amazon is the second-largest private employer in the United States, after Walmart, and it is responsible for roughly 40 percent of all e-commerce in the United States.

It controls hundreds of millions of square feet across the country and is opening more fulfillment centers all the time. It has acquired dozens of other companies, most recently the film studio MGM for $8.5 billion. Its cloud-computing operation, Amazon Web Services, is the largest of its kind and provides the plumbing for a vast swath of the internet, to a profit of $13.5 billion last year.

Amazon has entered some 40 million American homes in the form of the Alexa smart speaker, and some 150 million American pockets in the form of the Amazon app

“Amazon is a beast we’ve never seen before,” Alimahomed-Wilson told me. “Amazon powers our Zoom calls. It contracts with ICE. It’s in our neighborhoods. This is a very different thing than just being a large retailer, like Walmart or the Ford Motor Company.”

I find it useful to compare Big Tech to climate change, another force that is altering the destiny of everyone on Earth, forever. Both present themselves to us all the time in small ways—a creepy ad here, an uncommonly warm November there—but are so big, so abstract, so everywhere that they’re impossible for any one person to really understand

Both are the result of a decades-long, very human addiction to consumption and convenience that has been made grotesque and extreme by the incentives and mechanisms of the internet, market consolidation, and economic stratification

Both have primarily been advanced by a small handful of very big companies that are invested in making their machinations unseeable to the naked eye.

Speed and convenience aren’t actually free; they never are. Free shipping isn’t free either. It just obscures the real price.

Next-day shipping comes with tremendous costs: for labor and logistics and transportation and storage; for the people who pack your stuff into those smiling boxes and for the people who deliver them; for the planes and trucks and vans that carry them; for the warehouses that store them; for the software ensuring that everything really does get to your door on time, for air-conditioning and gas and cardboard and steel. Amazon—Prime in particular—has done a superlative job of making all those costs, all those moving parts, all those externalities invisible to the consumer.

The pandemic drove up demand for Amazon, and for labor: Last year, company profits shot up 70 percent, Bezos’s personal wealth grew by $70 billion, and 1,400 people a day joined the company’s workforce.

Amazon is so big that every sector of our economy has bent to respond to the new way of consuming that it invented. Prime isn’t just bad for Amazon’s workers—it’s bad for Target’s, and Walmart’s. It’s bad for the people behind the counter at your neighborhood hardware store and bookstore, if your neighborhood still has a hardware store and a bookstore. Amazon has accustomed shoppers to a pace and manner of buying that depends on a miracle of precision logistics even when it’s managed by one of the biggest companies on Earth. For the smaller guys, it’s downright impossible.

Amazon’s revenue from subscriptions alone—mostly Prime—was $25.2 billion, which is a 31 percent increase from the previous year

Just as abstaining from flying for moral reasons won’t stop sea-level rise, one person canceling Prime won’t do much of anything to a multinational corporation’s bottom line. “It’s statistically insignificant to Amazon. They’ll never feel it,” Caine told me. But, he said, “the small businesses in your neighborhood will absolutely feel the addition of a new customer. Individual choices do make a big difference to them.”

Whelan teaches a class at UW called Consuming Happiness, and she is fond of giving her students the adage that you can buy happiness—“if you spend your money in keeping with your values: spending prosocially, on experiences. Tons of research shows us this.”

agents will open up many more learning opportunities.

Already, AI can help you pick out a new TV and recommend movies, books, shows, and podcasts. Likewise, a company I’ve invested in, recently launched Pix, which lets you ask questions (“Which Robert Redford movies would I like and where can I watch them?”) and then makes recommendations based on what you’ve liked in the past

Productivity

copilots can do a lot—such as turn a written document into a slide deck, answer questions about a spreadsheet using natural language, and summarize email threads while representing each person’s point of view.

I don’t think any single company will dominate the agents business--there will be many different AI engines available.

Helping patients and healthcare workers will be especially beneficial for people in poor countries, where many never get to see a doctor at all.

To create a new app or service, you won’t need to know how to write code or do graphic design. You’ll just tell your agent what you want. It will be able to write the code, design the look and feel of the app, create a logo, and publish the app to an online store

Agents will do even more. Having one will be like having a person dedicated to helping you with various tasks and doing them independently if you want. If you have an idea for a business, an agent will help you write up a business plan, create a presentation for it, and even generate images of what your product might look like

For decades, I’ve been excited about all the ways that software would make teachers’ jobs easier and help students learn. It won’t replace teachers, but it will supplement their work—personalizing the work for students and liberating teachers from paperwork and other tasks so they can spend more time on the most important parts of the job.

Mental health care is another example of a service that agents will make available to virtually everyone. Today, weekly therapy sessions seem like a luxury. But there is a lot of unmet need, and many people who could benefit from therapy don’t have access to it.

Entertainment and shopping

The real shift will come when agents can help patients do basic triage, get advice about how to deal with health problems, and decide whether they need to seek treatment.

They’ll replace word processors, spreadsheets, and other productivity apps.

Education

For example, few families can pay for a tutor who works one-on-one with a student to supplement their classroom work. If agents can capture what makes a tutor effective, they’ll unlock this supplemental instruction for everyone who wants it. If a tutoring agent knows that a kid likes Minecraft and Taylor Swift, it will use Minecraft to teach them about calculating the volume and area of shapes, and Taylor’s lyrics to teach them about storytelling and rhyme schemes. The experience will be far richer—with graphics and sound, for example—and more personalized than today’s text-based tutors.

your agent will be able to help you in the same way that personal assistants support executives today. If your friend just had surgery, your agent will offer to send flowers and be able to order them for you. If you tell it you’d like to catch up with your old college roommate, it will work with their agent to find a time to get together, and just before you arrive, it will remind you that their oldest child just started college at the local university.

To see the dramatic change that agents will bring, let’s compare them to the AI tools available today. Most of these are bots. They’re limited to one app and generally only step in when you write a particular word or ask for help. Because they don’t remember how you use them from one time to the next, they don’t get better or learn any of your preferences.

The current state of the art is Khanmigo, a text-based bot created by Khan Academy. It can tutor students in math, science, and the humanities—for example, it can explain the quadratic formula and create math problems to practice on. It can also help teachers do things like write lesson plans.

Businesses that are separate today—search advertising, social networking with advertising, shopping, productivity software—will become one business.

other issues won’t be decided by companies and governments. For example, agents could affect how we interact with friends and family. Today, you can show someone that you care about them by remembering details about their life—say, their birthday. But when they know your agent likely reminded you about it and took care of sending flowers, will it be as meaningful for them?

In the computing industry, we talk about platforms—the technologies that apps and services are built on. Android, iOS, and Windows are all platforms. Agents will be the next platform.

A shock wave in the tech industry

Agents won’t simply make recommendations; they’ll help you act on them. If you want to buy a camera, you’ll have your agent read all the reviews for you, summarize them, make a recommendation, and place an order for it once you’ve made a decision.

Agents will affect how we use software as well as how it’s written. They’ll replace search sites because they’ll be better at finding information and summarizing it for you

they’ll be dramatically better. You’ll be able to have nuanced conversations with them. They will be much more personalized, and they won’t be limited to relatively simple tasks like writing a letter.

Companies will be able to make agents available for their employees to consult directly and be part of every meeting so they can answer questions.

AI agents that are well trained in mental health will make therapy much more affordable and easier to get. Wysa and Youper are two of the early chatbots here. But agents will go much deeper. If you choose to share enough information with a mental health agent, it will understand your life history and your relationships. It’ll be available when you need it, and it will never get impatient. It could even, with your permission, monitor your physical responses to therapy through your smart watch—like if your heart starts to race when you’re talking about a problem with your boss—and suggest when you should see a human therapist.

If the number of companies that have started working on AI just this year is any indication, there will be an exceptional amount of competition, which will make agents very inexpensive.

Agents are smarter. They’re proactive—capable of making suggestions before you ask for them. They accomplish tasks across applications. They improve over time because they remember your activities and recognize intent and patterns in your behavior. Based on this information, they offer to provide what they think you need, although you will always make the final decisions.

Agents are not only going to change how everyone interacts with computers. They’re also going to upend the software industry, bringing about the biggest revolution in computing since we went from typing commands to tapping on icons.

In the distant future, agents may even force humans to face profound questions about purpose. Imagine that agents become so good that everyone can have a high quality of life without working nearly as much. In a future like that, what would people do with their time? Would anyone still want to get an education when an agent has all the answers? Can you have a safe and thriving society when most people have a lot of free time on their hands?

The ramifications for the software business and for society will be profound.

In the next five years, this will change completely. You won’t have to use different apps for different tasks. You’ll simply tell your device, in everyday language, what you want to do. And depending on how much information you choose to share with it, the software will be able to respond personally because it will have a rich understanding of your life. In the near future, anyone who’s online will be able to have a personal assistant powered by artificial intelligence that’s far beyond today’s technology.

You’ll also be able to get news and entertainment that’s been tailored to your interests. CurioAI, which creates a custom podcast on any subject you ask about, is a glimpse of what’s coming.

An agent will be able to help you with all your activities if you want it to. With permission to follow your online interactions and real-world locations, it will develop a powerful understanding of the people, places, and activities you engage in. It will get your personal and work relationships, hobbies, preferences, and schedule. You’ll choose how and when it steps in to help with something or ask you to make a decision.

even the best sites have an incomplete understanding of your work, personal life, interests, and relationships and a limited ability to use this information to do things for you. That’s the kind of thing that is only possible today with another human being, like a close friend or personal assistant.

The most exciting impact of AI agents is the way they will democratize services that today are too expensive for most people

They’ll have an especially big influence in four areas: health care, education, productivity, and entertainment and shopping.

Analysts see the most optimal outcome for Israel probably consisting of degrading Hamas’s military capabilities to prevent the group from repeating such a devastating attack. But even that limited goal is considered a formidable slog.

Hamas is rooted in the ideology that Israeli control over what it regards as Palestinians lands must be opposed by force, a tenet likely to endure, experts said.

“As long as that context is there, you will be dealing with some form of Hamas,” said Tahani Mustafa, senior Palestine analyst at the International Crisis Group think tank. “To assume that you can simply uproot an organization like that is fantasy.”

The Israeli military said this week that it had killed about 8,000 Hamas fighters out of a force estimated at 25,000 to 40,000. But it is unclear how the count is being made

“They’ve been saying this for a while, that Hamas is collapsing,” Mr. Milshtein said. “But it’s just not true. Every day, we’re facing tough battles.”

The group’s top echelon are believed to be sheltering, along with most of its fighters and the remaining hostages, in deep tunnels. Although the Israeli army has said that it demolished at least 1,500 shafts, experts consider the underground infrastructure is largely intact.

The tunnels, built over 15 years, are believed to be so extensive, estimated at hundreds of miles long, that Israelis call them the Gaza Metro.

“From a professional point of view, I must give credit to their resilience,” he said. “I cannot see any signs of collapse of the military abilities of Hamas nor in their political strength to continue to lead Gaza.”

A string of Israeli assassinations of Hamas political, military and religious leaders also failed to weaken the group. It won control of Gaza in free Palestinian elections in 2006, then evicted its more moderate rival, the Palestinian Authority, in a bloody conflict the next year.

For Israel, the aim is first to dismantle the government, then to disperse the fighters and eliminate the commanders and their primary subordinates, the Israeli official said.

“The top leadership can disappear at any time because they can be killed, they can be arrested, they can be deported,” he said. “So they developed this mechanism of the easy transfer of command.”

Trying to eliminate Hamas entirely would require fighting from street to street and house to house, and Israel lacks both the time and personnel, said Elliot Chapman, a Middle East analyst with Janes, a defense analysis firm.

The Gaza fight has been compared to the campaign to wrest Mosul, Iraq, from the Islamic State less than a decade ago, but there are significant differences.

Notably, Hamas is organic to Gaza — it grew out of frustration with the mainstream factions abandoning the armed struggle against the Israeli occupation. Hamas refuses to recognize Israel, and according to its founding charter, is committed to its destruction.

Some Gazans curse Hamas, even taking to the airwaves or social media to do it, despite the organization’s history of repressing opponents. Other Gazans, however, say that they still back “the resistance,” and Hamas has long attracted support by providing services like schools and clinics.

“The right way to think about it is to degrade the organization to the point that it is no longer a sustainable threat,” said Marc Polymeropoulos, a retired C.I.A. officer who specialized in Middle East counterterrorism.

“You cannot just have a strategy of killing everybody,” he added. “You have to have that day-after scenario.”

More than one million people have died from Covid, a once unimaginable figure

An increase in drug deaths, combined with Covid, has led overall life expectancy in America to decline to a degree not seen since World War II.

Police killings of unarmed Black men continue long past vows for reform.

“You can’t underestimate the need for belonging,” she said. When something terrible happens, people want to connect with their “in-group,” she said, where they feel they belong, which can push people further into partisan camps.

Rabbi Mychal B. Springer, the manager of clinical pastoral education at NewYork-Presbyterian Hospital, has found herself returning to an ancient Jewish writing in the Mishnah, which says that when God began creating, God created a single person.

“The teaching is, each person is so precious that the whole world is contained in that person, and we have to honor that person completely and fully,” she said. “If a single person dies, the whole world dies, and if a single person is saved, then the whole world is saved.”

We can only value life if we are willing to truly grieve, to truly face the reality of suffering

“It’s not that we don’t care. We’ve reached the limit of how much we can cry and hurt,” she said. “And yet we have to. We have to value each life as a whole world, and be willing to cry for what it means that that whole world has been lost.”

The mountain of calamities, and the paralysis over how to overcome it, points to a nation struggling over some fundamental questions: Has our tolerance as a country for such horror grown, dusting off after one event before moving on to the next? How much value do we place in a single human life?

Valuing life and working for healing means going outside of one’s self, and one’s own group, she said.

“This will require collective action,” she said. “And part of the problem is we are very divided right now.”

American culture often prizes individual liberty above collective needs. But ultimately humans are born to care about others and to not turn away,

“Human beings are born for meaning,” she said. “We have very, very large souls. We are born for generosity, we are born for compassion.”

What is standing in the way of a proper valuation of life, she said, is “our very, very disordered relationship with death.”

n the United States, denial of death has reached an extreme form, she said, where many focus on themselves to avoid the fear of death.

That fear cuts through “all tendrils of conscience, and common good, and capacity to act together,” she said, “because in the final analysis we have become animals saving our own skin, the way we seem to save our own skin is repression and dissociation.”

The United States is an outlier in the level of gun violence it tolerates. The rate and severity of mass shootings is without parallel in the world outside conflict zones.America has “a love affair with violence,”

Violence is an almost a normal part of life in the United States, she said, and valuing life takes consistently asking how am I committed to nonviolence today? It also means giving some things up, she said — many people think of themselves as nonviolent, but consume violence in entertainment.

“The question that should scare us is, what will it take to make us collectively bring about this change?

“Maybe this is our life’s work,” she said. “Maybe this is our work as humans.”

“But when I slow down I realize there is something alive in our culture that has harmed those people,” she said. “Whatever that something is, it is harming all of us, we are all vulnerable to it, it wields some sort of influence upon us, no matter who we are.”

The decision has to come this month “because of the time required for manufacturing the necessary doses,” three of FDA’s top officials – FDA Commissioner Robert Califf, vaccine expert Peter Marks and principal deputy commissioner Janet Woodcock – wrote in a paper published by the journal JAMA in May.Both Pfizer and Moderna are studying vaccines designed to combat omicron and other strains. However, data on the shots remains scarce.

Despite mounting anticipation for the decision, the percentage of parents who will get their young children vaccinated is likely to be low compared to other age groups. A survey from February found that 31% of parents of children in the age range will get their kid vaccinated right away if a vaccine is authorized.

Clinical data from Moderna’s shot is expected this month, according to the company. Moderna in April released findings to support its booster shot development strategy, but the data comes after research in animals suggested the omicron-specific shot might not provide additional protection. A study from scientists at the National Institutes of Allergy and Infectious Diseases’s Vaccine Research Center found that primates boosted with the original vaccine had similar levels of protection as monkeys who got an omicro

The Biden administration has warned of potential fall and winter surges infecting up to 100 million Americans as it gears up for a fall booster shot campaign, whether that is with an omicron-specific shot or not. The FDA authorized a fourth vaccine dose for people ages 50 and older in March, and expanding the shot to more age groups is under consideration.“Administering additional COVID-19 vaccine doses to appropriate individuals this fall around the time of the usual influenza vaccine campaign has the potential to protect susceptible individuals against hospitalization and death, and therefore will be a topic for FDA consideration,” the officials wrote.In fact, the officials said that coronavirus booster shots could be on their way to becoming a yearly occurrence.

It is time to “accept that the presence of SARS-CoV-2, the virus that causes COVID-19, is the new normal,” according to the officials.“It will likely circulate globally for the foreseeable future, taking its place alongside other common respiratory viruses such as influenza,” they wrote.But paying for the shots remains an issue for the Biden administration as Congress shows little appetite for approving more COVID-19 funding.

“This is a complete misrepresentation of the definition of abuse in the family code,” Christian Menefee, the Harris County attorney, said in an interview.

“We don’t believe that allowing someone to take puberty suppressants constitutes abuse,”

Governor Abbott’s effort to criminalize medical care for transgender youth is a new front in a broadening political drive to deny treatments that help align the adolescents’ bodies with their gender identities and that have been endorsed by major medical groups.

Arkansas passed a law making it illegal for clinicians to offer puberty blockers and hormones to adolescents and banning insurers from covering care. But the law was temporarily blocked by a federal judge in July after the American Civil Liberties Union sued on behalf of four families and two doctors.

Several such bills were also introduced in Texas. None passed.

Professional medical groups and transgender health experts have overwhelmingly condemned legal attempts to limit “gender-affirming” care and contend that they would greatly harm transgender young people.

“Our nation’s leading pediatricians support evidence-based, gender-affirming care for transgender young people.”

A growing number of transgender adolescents have sought medical treatments in recent years. Transgender teenagers are at high risk for attempting suicide, according to the Centers for Disease Control and Prevention. Preliminary research has suggested that adolescents who receive such medical treatments have improved mental health.

“What is clear is that politicians should not be tearing apart loving families — and sending their kids into the foster care system — when parents provide recommended medical care that they believe is in the best interest of their child.”

“It’s designed to make parents scared,” he said. “It’s designed to make doctors scared for even facilitating gender-affirming health care.”

“Minors are prohibited from purchasing paint, cigarettes, alcohol, or even getting a tattoo,” Jonathan Covey, director of policy for the group Texas Values, said in an emailed statement. “We cannot allow minors or their parents to make life-altering decisions on body-mutilating procedures and irreversible hormonal treatments.”

She said that blocking gender-affirming care and forcing teenagers to go through the physical changes of puberty for a gender they don’t identify with was “inhumane.”

“Gender-affirming care saved my life,” they said in a statement. “Trans kids today deserve the same opportunity by receiving the highest standard of care.”

When a French warship bristling with cannons sailed into the port of the Haitian capital in 1825, an emissary from King Charles X came ashore and delivered an astonishing demand: France wanted reparations from the people it had enslaved.

The demand was for 150 million French francs, to be turned over in five annual payments, far more than Haiti could pay.

So France pushed Haiti to take a loan from a group of French banks to start paying. That Sisyphean weight came to be known as the double debt.

Every franc shipped across the Atlantic to an overseas bank vault was a franc not circulating among Haiti’s farmers, laborers and merchants, or not being invested in bridges, schools or factories — the sort of expenditures that help nations become nations, that enable them to prosper.

For a decade, a quarter of Haiti’s total revenue went to paying debts controlled by National City Bank and its affiliate, according to nearly two dozen annual reports prepared by American officials and reviewed by The Times.

After half a century of crushing payments tied to the double debt, Haitians celebrated the news that at last the country would have its own national bank, the sort of institution that in Europe had financed railroads and factories.

“Isn’t it funny,” one Haitian economist wrote, “that a bank that claims to come to the rescue of a depleted public treasury begins not by depositing money but by withdrawing everything of value?”

When the American military invaded Haiti in the summer of 1915, the official explanation was that Haiti was too poor and too unstable to be left to its own devices. Secretary of State Robert Lansing made little effort to mask his contempt for the “African race,” casting the occupation as a civilizing mission intended to end “anarchy, savagery and oppression.”

“I helped make Haiti and Cuba a decent place for the National City Bank boys to collect revenues,” the general who led the U.S. forces in Haiti, said years later, describing himself as a “racketeer for capitalism.”

For decades to come, the United States was the dominant power in Haiti, dissolving parliament at gunpoint, killing thousands and shipping a big portion of Haiti’s earnings to bankers in New York while the farmers who helped generate the profits often lived near starvation.

“Neocolonialism through debt,” is how Thomas Piketty, one of the economists we spoke with, put it. “This drain has totally disrupted the process of state building,” he said.

“They were betrayed by their own brothers, and then by foreign powers.”

In an 1875 loan, the French bankers took a 40 percent cut off the top.

The double debt has largely faded into history. Generations of French profited richly from the financial exploits of their forebears, but that is rarely taught in classrooms.

“This is part of my family history I never knew,” said one sixth-generation descendant of Napoleon’s first wife.

Even in Haiti, the full story was long unknown. Then in 2003, President Jean-Bertrand Aristide stunned Haitians by denouncing the debt imposed by France and demanding reparations.

They also died of covid at higher rates than other health-care workers, and they experience high rates of burnout, “an occupational syndrome characterized by a high degree of emotional exhaustion and depersonalization, and a low sense of personal accomplishment at work,” according to the World Health Organization

high stress and anxiety are the “antecedents” to burnout. But you know you’ve hit the nadir when you become emotionally detached from your work. “It’s almost like a loss of meaning,” she said.

In April 2020, Miller said the public was “exalting nurses as these superheroes and angels,” while nurses themselves were tweeting about “the horrible working conditions, enormous amount of death without any break … being mentally and completely worn down and exhausted.”

Miller said nurses are experiencing “collective trauma,” a conclusion she reached by studying their social media usage through the pandemic

Before the pandemic, between a third and half of nurses and physicians already reported symptoms of burnout. A covid impact study published in March 2022 by the American Nurses Foundation found this number had risen to 60 percent among acute-care nurses. “Reports of feeling betrayed, undervalued, and unsupported have risen,

Miller and Groves also found a fivefold increase in references to quitting between the 2020 study and the 2021 study. “Our profession will never be the same,” Miller told me. “If you talked to any nurse who worked bedside through the pandemic, that’s what they’ll tell you.” From this, she says, has grown a desire to be heard. “We feel emboldened. We’re not as willing to be silent anymore.”

then, in late February 2013, Duke was abruptly fired. She’d posted a photo on Instagram showing an ER where hospital staff had just saved the life of a man hit by a subway train. It looked like a hurricane had blown through. There were no people in the photo, but Duke titled the post, “Man vs. 6 train.” She told me she wanted to showcase “the amazing things doctors and nurses do to save lives … the f---ing real deal.”

Duke says her superiors called her an “amazing nurse and team member” before they told her that “it was time to move on.” Her director handed her a printout of the Instagram post. According to Duke, he acknowledged that she hadn’t violated HIPAA or any hospital policies but said she’d been insensitive and unprofessional. She was escorted out of the building by security. When the episode aired, it showed Duke crying on the sidewalk outside the hospital.

She’d reposted the photo, with permission, from a male doctor’s Instagram account. He faced no repercussions. She now admits her caption was rather “cold” — especially compared with the doctor’s, “After the trauma.” In hindsight, she said, she might have been more sensitive. Maybe not even posted the photo at all. And yet this frustrates her. Why shouldn’t the public see nursing culture for what it really is? Man vs. 6 Train. “That’s ER speak,” she told me. “We say ‘head injury in room five.’ We don’t say ‘Mr. Smith in room five. We talk and think by mechanism of injury.”

But this is at odds with the romanticized image of the nurturing nurse — which hospitals often want to project. In some cases, nurses are explicitly told not to be forthright with their patients. “I know nurses in oncology who are not allowed to say to a patient and their family, ‘This will be the fourth clinical trial, but we all know your family member is dying,”

“The most frequent question is, ‘Katie, I have to get out of the hospital, but I don’t know what else to do.’” Her advice: “You have to create your own definition of what being a nursing professional means to you.” She has a ready list of alternative jobs, including “med spa” owner, educational consultant and YouTuber.

Jansen's fascination with medicine began at a young age, thanks to her father's ability to cure her frequent throat infections and coughs. "You're a small person, and you have this violent cough, and you feel sick as a dog," she recalls. "And then you get this drug. And it makes you feel better."

A few years after earning her Ph.D. in 1984, Jansen accepted a job at Merck's vaccine division. Her first challenge was to create a vaccine for the human papillomavirus, which was believed to cause cervical cancer in the 1980s. Jansen faced significant opposition, both from researchers — who thought the vaccine would not work— and Merck's finance gurus — who believed it would not be profitable. But she persisted. The Gardasil vaccine, approved in 2006, now earns Merck billions of dollars annually.

an "ACA for All" system would prevent government from operating health insurance while allowing it to regulate and finance health insurance for most Americans. The ACA for All would not be "socialized medicine" -- where government not only finances healthcare but supplies it through public hospitals, clinics, and the direct employment of clinicians. ACA for All would continue to rely on private industry (private doctors and private hospitals) and personal responsibility, and would limit the government's role in healthcare delivery.

A Republican plan for universal healthcare would offer those with non-employer-based coverage an adequately sized tax deduction, big enough to cover the cost of a family health insurance plan. And, for the first time since the 1940s, individuals would pay taxes on the value of employer-based health insurance above a certain threshold (based on the average costopens in a new tab or window of a family health insurance plan).

For researchers concerned with more immediate AI risks, such as bias, disinformation and job displacement, the voices of doom are a distraction. Professor Brent Mittelstadt, director of research at the Oxford Internet Institute, said the warnings of “the existential risks community” are overblown. “The problem is you can’t disprove the future scenarios . . . in the same way you can’t disprove science fiction.” Emily Bender, a professor of linguistics at the University of Washington, believes the doomsters are propagating “unhinged AI hype, helping those building this stuff sell it”.

Those urging us to stop, pause and think again have a useful card up our sleeves: the people building these models do not fully understand them. AI like ChatGPT is made up of huge neural networks that can defy their creators by coming up with “emergent properties”.

Google’s PaLM model started translating Bengali despite not being trained to do so

Let’s not forget the excitement, because that is also part of Moloch, driving us forward. The lure of AI’s promises for humanity has been hinted at by DeepMind’s AlphaFold breakthrough, which predicted the 3D structures of nearly all the proteins known to humanity.

Noam Shazeer, a former Google engineer credited with setting large language models such as ChatGPT on their present path, was asked by The Sunday Times how the models worked. He replied: “I don’t think anybody really understands how they work, just like nobody really understands how the brain works. It’s pretty much alchemy.”

The industry is turning itself to understanding what has been created, but some predict it will take years, decades even.

Alex Heath, deputy editor of The Verge, who recently attended an AI conference in San Francisco. “It’s clear the people working on generative AI are uneasy about the worst-case scenario of it destroying us all. These fears are much more pronounced in private than they are in public.” One figure building an AI product “said over lunch with a straight face that he is savoring the time before he is killed by AI”.

Greg Brockman, co-founder of OpenAI, told the TED2023 conference this week: “We hear from people who are excited, we hear from people who are concerned. We hear from people who feel both those emotions at once. And, honestly, that’s how we feel.”

A CBS interviewer challenged Sundar Pichai, Google’s chief executive, this week: “You don’t fully understand how it works, and yet you’ve turned it loose on society?

In 2020 there wasn’t a single drug in clinical trials developed using an AI-first approach. Today there are 18

Consider this from Bill Gates last month: “I think in the next five to ten years, AI-driven software will finally deliver on the promise of revolutionising the way people teach and learn.”

If the industry is aware of the risks, is it doing enough to mitigate them? Microsoft recently cut its ethics team, and researchers building AI outnumber those focused on safety by 30-to-1,

The concentration of AI power, which worries so many, also presents an opportunity to more easily develop some global rules. But there is little agreement on direction. Europe is proposing a centrally defined, top-down approach. Britain wants an innovation-friendly environment where rules are defined by each industry regulator. The US commerce department is consulting on whether risky AI models should be certified. China is proposing strict controls on generative AI that could upend social order.

Part of the drive to act now is to ensure we learn the lessons of social media. Twenty years after creating it, we are trying to put it back in a legal straitjacket after learning that its algorithms understand us only too well. “Social media was the first contact between AI and humanity, and humanity lost,” Yuval Harari, the Sapiens author,

Others point to bioethics, especially international agreements on human cloning. Tegmark said last week: “You could make so much money on human cloning. Why aren’t we doing it? Because biologists thought hard about this and felt this is way too risky. They got together in the Seventies and decided, let’s not do this because it’s too unpredictable. We could lose control over what happens to our species. So they paused.” Even China signed up.

One voice urging calm is Yann LeCun, Meta’s chief AI scientist. He has labelled ChatGPT a “flashy demo” and “not a particularly interesting scientific advance”. He tweeted: “A GPT-4-powered robot couldn’t clear up the dinner table and fill up the dishwasher, which any ten-year-old can do. And it couldn’t drive a car, which any 18-year-old can learn to do in 20 hours of practice. We’re still missing something big for human-level AI.” If this is sour grapes and he’s wrong, Moloch already has us in its thrall.

The answer to both lies in one word: satiety. It’s a concept that we don’t use much in everyday life but that we’ve all experienced at some point. It describes the sensation of having had enough and not wanting any more.

The primary reason we have gained weight at a pace unprecedented in human history is that our diets have radically changed in ways that have deeply undermined our ability to feel sated

The evidence is clear that the kind of food my father grew up eating quickly makes you feel full. But the kind of food I grew up eating, much of which is made in factories, often with artificial chemicals, left me feeling empty and as if I had a hole in my stomach

In a recent study of what American children eat, ultraprocessed food was found to make up 67 percent of their daily diet. This kind of food makes you want to eat more and more. Satiety comes late, if at all.

After he moved in 2000 to the United States in his 20s, he gained 30 pounds in two years. He began to wonder if the American diet has some kind of strange effect on our brains and our cravings, so he designed an experiment to test it.

He and his colleague Paul Johnson raised a group of rats in a cage and gave them an abundant supply of healthy, balanced rat chow made out of the kind of food rats had been eating for a very long time. The rats would eat it when they were hungry, and then they seemed to feel sated and stopped. They did not become fat.

then Dr. Kenny and his colleague exposed the rats to an American diet: fried bacon, Snickers bars, cheesecake and other treats. They went crazy for it. The rats would hurl themselves into the cheesecake, gorge themselves and emerge with their faces and whiskers totally slicked with it. They quickly lost almost all interest in the healthy food, and the restraint they used to show around healthy food disappeared. Within six weeks, their obesity rates soared.

They took all the processed food away and gave the rats their old healthy diet. Dr. Kenny was confident that they would eat more of it, proving that processed food had expanded their appetites. But something stranger happened. It was as though the rats no longer recognized healthy food as food at all, and they barely ate it. Only when they were starving did they reluctantly start to consume it again.

Drugs like Ozempic work precisely by making us feel full.

processed and ultraprocessed food create a raging hole of hunger, and these treatments can repair that hole

the drugs are “an artificial solution to an artificial problem.”

Yet we have reacted to this crisis largely caused by the food industry as if it were caused only by individual moral dereliction

Why do we turn our anger inward and not outward at the main cause of the crisis? And by extension, why do we seek to shame people taking Ozempic but not those who, say, take drugs to lower their blood pressure?

The first is the belief that obesity is a sin.

The second idea is that we are all in a competition when it comes to weight. Ours is a society full of people fighting against the forces in our food that are making us fatter.

Looked at in this way, people on Ozempic can resemble cyclists like Lance Armstrong who used performance-enhancing drugs.

We can’t find our way to a sane, nontoxic conversation about obesity or Ozempic until we bring these rarely spoken thoughts into the open and reckon with them

remember the competition isn’t between you and your neighbor who’s on weight-loss drugs. It’s between you and a food industry constantly designing new ways to undermine your satiety.

Reducing or reversing obesity hugely boosts health, on average: We know from years of studying bariatric surgery that it slashes the risks of cancer, heart disease and diabetes-related death. Early indications are that the new anti-obesity drugs are moving people in a similar radically healthier direction,

But these drugs may increase the risk for thyroid cancer.

Do we want these weight loss drugs to be another opportunity to tear one another down? Or do we want to realize that the food industry has profoundly altered the appetites of us all — leaving us trapped in the same cage, scrambling to find a way out?

Dr. Longo, who is also a professor of gerontology and director of the U.S.C. Longevity Institute in California, has long advocated longer and better living through eating Lite Italian, one of a global explosion of Road to Perpetual Wellville theories about how to stay young in a field that is itself still in its adolescence.

In addition to identifying genes that regulate aging, he has created a plant and nut-based diet with supplements and kale crackers that mimics fasting to, he argues, allow cells to shed harmful baggage and rejuvenate, without the down side of actually starving.

He has patented and sold his ProLon diet kits; published best-selling books (“The Longevity Diet”); and been called an influential “Fasting Evangelist” by Time magazine.

Last month, he published a new study based on clinical trials of hundreds of older people — including in the Calabria town from which his family hails — that he said suggests that periodic cycles of his own faux-fasting approach could reduce biological age and stave off illnesses associated with aging.

“It’s very similar to the original Mediterranean diet, not the present one,” she said, pointing at photographs on the wall of a bowl of ancient legumes similar to the chickpe

“Almost nobody in Italy eats the Mediterranean diet,”

He added that many Italian children, especially in the country’s south, are obese, bloated on what he calls the poisonous five Ps — pizza, pasta, protein, potatoes and pane (or bread).

in recent years, Silicon Valley billionaires who hope to be forever young have funded secretive labs. Wellness articles have conquered newspaper home pages and Fountains-of-Youth workout and diet ads featuring insanely fit middle-aged people teem on the social media feeds of not insanely fit middle-aged people.

he said Italy’s lack of investment in research was a disgrace.

even as concepts like longevity, intermittent fasting and biological age — you’re only as old as your cells feel! — have gained momentum, governments like Italy’s are fretting over a creakier future in which booming populations of old people drain resources from the dwindling young.

many scientists, nutritionists and longevity fanatics the world over continue to stare longingly toward Italy, seeking in its deep pockets of centenarians a secret ingredient to long life.

“Probably they kept breeding between cousins and relatives,” Dr. Longo offered, referring to the sometimes close relations in little Italian hill towns. “At some point, we suspect it sort of generated the super-longevity genome.”

The genetic drawbacks of incest, he hypothesized, slowly vanished because those mutations either killed their carriers before they could reproduce or because the town noticed a monstrous ailment — like early onset Alzheimer’s — in a particular family line and steered clear.

Dr. Longo wonders whether Italy’s centenarians had been protected from later disease by a starvation period and old-fashioned Mediterranean diet early in life, during rural Italy’s abject war-era poverty. Then a boost of proteins and fats and modern medicine after Italy’s postwar economic miracle protected them from frailty as they got older and kept them alive.

At age 16, he moved to Chicago to live with relatives and couldn’t help notice that his middle-aged aunts and uncles fed on the “Chicago diet” of sausages and sugary drinks suffered diabetes and cardiovascular disease that their relatives back in Calabria did not.

He eventually earned his Ph.D in biochemistry at U.C.L.A. and did his postdoctoral training in the neurobiology of aging at U.S.C. He overcame early skepticism about the field to publish in top journals and became a zealous evangelizer for the age-reversing effects of his diet. About 10 years ago, eager to be closer to his aging parents in Genoa, he took a second job at the IFOM oncology institute in Milan.

He found a fount of inspiration in the pescatarian-heavy diet around Genoa and all the legumes down in Calabria.

he also found the modern Italian diet — the cured meats, layers of lasagna and fried vegetables the world hungered for — horrendous and a source of disease.

His private foundation, also based in Milan, tailors diets for cancer patients, but also consults for Italian companies and schools, promoting a Mediterranean diet that is actually foreign to most Italians today.

“Italy’s got such incredible history and a wealth of information about aging,” he said. “But spends virtually nothing.”

He talked about how he and others had identified an important regulator of aging in yeast, and how he has investigated whether the same pathway was at work in all organisms.

Dr. Longo said he thinks of his mission as extending youth and health, not simply putting more years on the clock, a goal he said could lead to a “scary world,” in which only the rich could afford to live for centuries, potentially forcing caps on having children

A more likely short-term scenario, he said, was division between two populations. The first would live as we do now and reach about 80 or longer through medical advancements. But Italians would be saddled with long — and, given the drop in the birthrate, potentially lonely — years burdened by horrible diseases.

The other population would follow fasting diets and scientific breakthroughs and live to 100 and perhaps 110 in relative good health.

But only a handful of cancers—of the breast, lung, colon and cervix—have screening tests recommended by the U.S. Preventive Services Task Force

Many companies are developing blood tests that can detect cancer signals before symptoms occur, and Grail’s is the most advanced. A study found it can identify more than 50 types of cancer 52% of the time and the 12 deadliest cancers in Stages I through III 68% of the time.

There’s a hitch. The test costs $949 and isn’t covered by Medicare or most private insurance.

The trouble is that this cancer is almost never caught early. There’s no routine screening for it, and symptoms don’t develop until it is advanced. Mr. Royse, 64, had no idea he was sick until he took a blood test called Galleri, produced by the Menlo Park, Calif., startup Grail. He had surgery and chemotherapy and is now cancer-free.

Mr. Royse visited Grail’s website, which referred him to a telemedicine provider who ordered a test. Another telemedicine doctor walked him through his results, which showed a cancer signal likely emanating from the pancreas, gallbladder, stomach or esophagus.

An MRI revealed a suspicious mass on his pancreas, which a biopsy confirmed was cancerous. Mr. Royse had three months of chemotherapy, surgery and another three months of chemotherapy, which ended last February. Because pancreatic cancer often recurs, he gets CT and MRI scans every three months. In addition, he has signed up for startup Natera’s Signatera customized blood test, which checks DNA specific to the patient’s cancer and can signal its return before signs are visible on the scans

Grail’s test likewise looks for DNA shed by cancer cells, which is tagged by molecules called methyl groups that are specific to a cancer’s origin. Grail uses genetic sequencing and machine learning to recognize links between DNA methyl groups and particular cancers

The test “is based on how much DNA is being shed by tumor,” Grail’s president, Josh Ofman, says. “Some tumors shed a lot of DNA. Some shed almost none.

ut slow-growing tumors typically aren’t shedding a lot of DNA.” That reduces the probability that Grail’s test will identify indolent cancers that pose no immediate danger.

Grail’s test has a roughly 0.5% false-positive rate, meaning 1 in 200 patients who don’t have cancer will get a positive signal

Its positive predictive value is 43%, so that of every 100 patients with a positive signal, 43 actually have cancer

the legislation’s price tag could reduce political support. According to one private company’s estimate, the test could cost the government $39 billion to $145 billion over a decade. Mr. Goldman counters that analysts usually overestimate the costs and underestimate the benefits of medical interventions.

Because Grail uses machine learning to detect DNA-methylation cancer linkages, the Grail test’s accuracy should improve as more tests and patient data are collected

regulators may balk at approving the test, and insurers at covering it, until it becomes cheaper and more reliable.

How would the FDA weigh the risk that a false positive on a test like Grail’s could require invasive follow-up testing against the dire but hard-to-quantify risk that a deadly cancer wouldn’t be caught until it’s much harder to treat? It’s unclear.

some experts urge the FDA to require large randomized controlled trials before approving blood cancer tests. “Multicancer screening would entail tremendous costs and potentially substantial harms,” H. Gilbert Welch and Tanujit Dey of Brigham and Women’s Hospital wrote

Dr. Welch and Mr. Dey also suggested that companies should be required to prove their tests reduce overall mortality, even though the FDA doesn’t require drugmakers to prove their products reduce deaths or extend life. Clinical trials for the mRNA Covid vaccines didn’t show they reduced deaths.

One alternative is to rely on real-world studies, which Grail is already doing. One study of patients 50 and older without signs of cancer showed that the test doubled the number of cancers detected.

One recurring problem he has seen: “Epidemiologists are always getting cancer wrong,” he says. “Epidemiologists a decade ago said U.S. overtreats cancers. Well, no, the EU undertreats cancer.”

A 2012 study that he co-authored found that the higher U.S. spending on cancer care relative to Europe between 1983 and 1999 resulted in significantly higher survival rates for American patients than for those in Europe

By his study’s calculation, U.S. spending on cancer treatments during that period resulted in $556 billion in net benefits owing to reduced mortality.

He expects Galleri and other multicancer early-detection tests to reduce deaths and produce public-health and economic benefits that exceed their monetary costs

Expanding access to multicancer early-detection tests could also help solve the chicken-and-egg problem of drug development. Because few patients are diagnosed at early stages of some cancers, it’s hard to develop treatments for them

the positive predictive value for some recommended cancer screenings is far lower. Fewer than 1 in 10 women with an abnormal finding on a mammogram are diagnosed with breast cancer.

Mr. Royse makes the same point with personal force. “I would be dead right now if not for multicancer early-detection testing,” Mr. Royse told an FDA advisory committee last fall. “The longer the FDA waits, the more people are going to die. It’s that simple.”