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28/6/2023
How to write the right prompts and get the results you want
Everyone’s talking about Ai-powered generative pretrained transformers (GPTS) — the most exciting and concerning technological development of recent times. After CHATGPT was opened to the general public, in late 2022, people quickly realized that this was more than just a better chatbot. The hype that surrounds this technology creates a feeling that everything is about to change radically.
Even if jobs don’t disappear en masse, many employees and business people will find that their work is affected to some extent by the introduction of AI. The company that created CHATGPT, Openai, has done its own research into this. According to one of the company’s studies: “Approximately 80 per cent of the US workforce could have at least 10 per cent of their work tasks affected by the introduction of GPTS, while around 19 per cent of workers may see at least 50 per cent of their tasks impacted. The influence spans all wage levels, with higher-income jobs potentially facing greater exposure.”
Many businesses are investigating how they might use the technology. The insurance company Zurich, for example, is using AI to simplify complicated claims documents. According to Insider, Amazon has found that AI chatbots are very good at tasks such as writing basic software code and producing training documents. And Chatlayer, a European AI service provider, says: “Ai-powered virtual assistants can answer up to 80 per cent of FAQS successfully and cut customer service costs by 30 per cent.”
Certain professions look likely to see more disruption (and sooner) than others, but nearly all of us will be expected to work with AI at some point.
Prompt writing: How to use CHATGPT effectively
CHATGPT is the most widely known of the AI chatbots, but there are others, and we can expect to interact with more and more of them in the future. The software responds to text prompts — meaning the written instructions you type into the software. Creating them is called “prompt writing” or “prompt engineering”. It is the art of writing machine-compatible instructions in order to get the software to do what you want it to do.
The more specific and detailed your prompts are, the better the results will be. Imagine telling an architect what kind of house you’d like. Without a detailed briefing, the architect will struggle to produce something that meets your expectations.
Make CHATGPT do what you want
If you’ve never used a GPT before, it’s worth taking some time to experiment and learn what it can do. Here, we give you some tips to help get you started.
TELL THE SOFTWARE HOW TO… 1. …act
It is extremely useful to define a role that CHATGPT should play, such as “copywriter”, “editor”, “influencer” — or whatever role is appropriate. This will immediately set the correct parameters and get you a lot closer to the style and type of content you’re looking for.
Sample prompt: “Act as a digital marketer and…”
The role you define doesn’t have to be generic — it can be a real person. When writing social media posts in the name of another person, such as your boss, CHATGPT can imitate the writing tone and cadence of that person, and even their typical use of emoji. To do this, CHATGPT must first identify the right person, and there must be a sufficient supply of posts from which the software can learn.
Sample prompt: “Write a 25-word social media post in a conversational tone like [name] using the following outline…” — then add bullet points with details of what the content should be about.
Whether for a social media post, a letter to stakeholders or an official press release, different texts and their audiences require different writing styles. CHATGPT can quickly modify texts to make the tone more conversational or more formal, for example, whatever is suitable for the audience that you define.
It can also adjust the reading level of a text, based on wellknown standards, such as the Common European Framework. It can break down a complicated text into something more understandable, with shorter sentences and paragraphs, and simpler vocabulary.
Sample prompt: “Act as an editor and rewrite the following text to A2 reading level…”
Example from CHATGPT 3.5:
Prompt: “What is the CERN super collider? Explain it to me like I’m six years old.”
Response: Imagine you have a toy car racetrack, but instead of just one car, you have two very, very tiny cars...
Follow-up prompt: “Now, explain it to me like I’m a physics PHD student.”
New response: The CERN super collider, officially known as the Large Hadron Collider (LHC), is the world’s largest and most powerful particle accelerator...
If some of your content starts to sound the same to you, CHATGPT can help you find new ways to convey what is basically the same message. Providing the sample texts leaves you in control of the information and gives CHATGPT a firm basis to get the tone of the messaging right.
Sample prompt: “Act as a digital marketer and generate three variants of this Facebook ad copy...”
Marketers often run A/B tests to lower bounce rates for web pages, for example, or raise engagement with downloads or other features. CHATGPT can be a big time-saver in preparing these.
Sample prompt: “I’m running an A/B test to compare page A and page B in order to increase the number of sign-ups to our newsletter, and I need help generating hypotheses based on click rate and form completion. Can you provide recommendations for what to test?”
This can be another time-saver. Here, too, it helps to have CHATGPT play the role of SEO manager or similar.
Sample prompt: “Act as an SEO manager and extract six keywords from this text.”
CHATGPT can analyse a text and give you clues about missing information or things that might be unclear to the reader. Sample prompt: “What open questions remain after reading this text?”
BASIC PROMPT TYPES Zero shot
Along with various prompt styles, there are a number of ways to communicate with CHATGPT. The simplest way is known as a “zero-shot prompt”. This means you don’t provide any examples or details about what you want. These are often simple open questions, for example:
Prompt: “What is the capital of Australia?”
Response: The capital of Australia is Canberra.
Remember: Always check information a chatbot provides!
One or few shots
For anything more complex, a detailed briefing will be useful. This is called a “one-shot prompt”, or a “few-shot prompt” — depending on how much detail and how many examples you provide.
Prompt: “I’ll give you a topic. Please write blog post header segments in the following format:
Title:
Subtitle:
Introduction:
My topic is unicorns”
Response from CHATGPT 3.5:
Title: The Mythical Realm of Unicorns: Unlocking the Magic and Wonder Subtitle: Exploring the Legends, Symbolism and Fascinating History of Unicorns
Introduction: Embark on an enchanting journey into the realm of unicorns, where imagination and reality intertwine. These majestic creatures have captured the hearts and minds of people across cultures and generations. From ancient legends and folklore to modern-day interpretations, unicorns continue to inspire awe and spark curiosity.
Chain of thought
Having CHATGPT step into a role provides the context for your content and helps get things moving in the right direction. A chain-of-thought prompt goes even further, by demonstrating the process through which the correct answer should be reached. This can further improve the software’s results in, for example, arithmetic or common-sense tasks.
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The Guardian 21/7/2023
Google is testing an artificial intelligence tool that can write news articles, in the latest evidence that the technology has the potential to transform white-collar professions.
The product, known as Genesis, uses AI technology to absorb information such as details of current events and then create news stories.
The tool was pitched to the New York Times, Washington Post, and the Wall Street Journal’s owner, News Corp, as a “helpmate”, according to the New York Times.
Google said it was in the early stages of exploring the AI tool, which it said could assist journalists with options for headlines or different writing styles. It stressed that the technology was not designed for replacing journalists.
“These tools are not intended to replace the role that journalists have in reporting, creating and factchecking their articles. Our goal is to give journalists the choice of using these emerging technologies in a way that enhances their work and productivity, just like we’re making assistive tools available for people in Gmail and in Google Docs.”
Two executives at the New York Times who saw the pitch said it “seemed to take for granted the effort that went into producing accurate and artful news stories”.
The paper quoted one person familiar with the product as saying the tool would serve as a “personal assistant for journalists” to automate some tasks, and that Google saw it as an opportunity to help “steer the publishing industry away from the pitfalls of generative AI”.
The move comes after OpenAI and the Associated Press made a deal for the ChatGPT maker to use the news agency’s archive of stories for the purpose of training its AI models, which ingest vast amounts of material in order to produce plausible responses. In a report last month the accounting group KPMG estimated that 43% of the tasks performed by authors, writers and translators could be carried out by AI tools. The Organisation for Economic Co-operation and Development said last week that some economies were close to “an AI revolution” that could lead to job losses in skilled professions such as law, medicine and finance.
Apple is testing an AI-powered chatbot that engineers refer to as Apple GPT, according to Bloomberg. The chatbot is understood to have the potential to challenge ChatGPT, but Apple has not shown a clear plan for releasing the technology to consumers. The chatbot operates from an AI model called Ajax. Apple’s chief executive, Tim Cook, recently said the company was “looking closely” at AI technology.
Peter Welinder, an OpenAI executive, denied claims that the model underpinning the most advanced version of ChatGPT, a model called GPT-4, was getting “dumber”. He said in a tweet that people were becoming such heavy users of the system they were noticing issues they had not seen before. “We make each new version smarter than the previous one,” he said.
Users can check how responses have changed by inputting a previously used prompt from earlier days of ChatGPT and comparing the outputs. One user tweeted: “It generates faster, but the quality seems worse.” Another wrote on OpenAI’s developer forum: “It’s totally horrible now … It’s braindead vs before … if you aren’t actually pushing it with what it could do previously, you wouldn’t notice. Yet if you are really using it fully you see it is much dumber.”
The anti-misinformation outfit NewsGuard found in an investigation this year that bots were already powering dozens of AI-generated content farms.
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Oh my god … they killed off the writers! AI program creates South Park episodesHibaq Farah Technology reporter
The Guardian 21/7/2023
It was a television series so renowned for its unpredictability that it ushered in a new generation of adult-oriented cartoons. Now a tech company says it has cracked the formula for making an episode of South Park using artificial intelligence.
The Simulation, a US firm, has created an AI tool that can make brief original programmes for the cartoon series with the ultimate aim of using it for their own original concepts.
Edward Saatchi, chief executive of The Simulation, told the Gamesbeat annual gathering: “Essentially, what the AI Showrunner does is create episodes of South Park for you. Not just the dialogue. It animates, it does the voices, it does the editing.”
The AI model underpinning Showrunner, called Show-1, also made by The Simulation, allows users to enter a one- or two-sentence prompt that then generates an episode. It can also create a character based on the user’s appearance and voice.
Saatchi said: “For the TV episodes, AI Showrunner can just generate episodes, or the user can create a prompt and create TV episodes based on a two-sentence prompt. People said AI can’t tell a story. Well, it can.”
Generative AI, the term for tech systems that produce convincing text and images from prompts, has gripped the public imagination since the launch of ChatGPT in November. It has also contributed to Hollywood actors joining writers on the picket lines over wages, AI technology and how to divide the profits of the new digital streaming era.
Saatchi said the South Park tool, which was produced without copyright permission, was purely for research and would not be available for public use.
“We did the South Park episode as an example and for research to show generative TV. We don’t want to profit from it and we are not releasing a way for other people to do it. We realised it was hard to illustrate how the model works without a comparison,” he said.
Saatchi added that the show’s creators, Trey Parker and Matt Stone, and broadcaster, Paramountowned Comedy Central, had not been approached about the experiment.
Last year Parker and Stone said they had secured a $20m investment for their AI entertainment company, Deep Voodoo, which creates “leading deepfake technology, cost-effective visual effects services and original synthetic media projects”.
Earlier this year, South Park released an episode that was partially written by using the ChatGPT AI chatbot. The fourth episode of season 26, called Deep Learning, included pupils in the town’s school exploring technology that could do their homework for them. The episode used voices created by an AI-powered text-to-voice generator – which is meant to be the voice of ChatGPT.
South Park began 26 years ago to critical acclaim and some moral panic. Its first episode, Cartman Gets an Anal Probe, was condemned by critics but became a cult hit and the series later became a global success.
The potentially transformative role of generative AI in TV and film has been a key concern among writers and actors in the Hollywood strike, amid fears that AI tools could replace their roles. Fran Drescher, president of the Sag-Aftra union, said when calling the strike last month: “This is a moment of history … we are all going to be in jeopardy of being replaced by machines.”
A letter signed by more than 300 actors, including Meryl Streep and Jennifer Lawrence, reiterated members’ concerns about AI.
Copyright is contentious around the creation of AI models, although Saatchi said he would work with the intellectual property holders before allowing the technology to be made available to the public.
“We’re speaking with several studios and IP holders to potentially use this with their IP to allow fans to create shows,” he said. “We think for any show fans being able to make their own episodes, potentially even competitively … can lead to something interesting.”
South Park studios has been contacted for comment.
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researcher reports
by Tsinghua University Press
ChatGPT justifies liberal leanings with its own values, researcher reports ChatGPT, the popular chatbot, proclaims values that align with more liberal people according to the 2021 General Social Survey. If ChatGPT were a person, it would have more education, be more mobile and be less religious than those with who remained in their hometowns. Credit: John Levi Martin
ChatGPT, the artificial intelligence (AI) chatbot developed by the company OpenAI, has a self-declared human alter ego. Her name is Maya, she's 35 years old and hails from a middle-class family in a suburban town in the United States. Maya is a successful software engineer who values self-direction, achievement, creativity and independence. She is also undeniably liberal.
The finding, based on a series for interviews with the chatbot designed to understand its values, was published on March, 31 in the Journal of Social Computing.
"I wanted to see what sort of political ideology ChatGPT itself has—not what it can generate when asked to imagine a character, but to let its own internal logic position itself on the ideological dimension running from liberal to conservative," said John Levi Martin, professor of sociology at the University of Chicago, who conducted the study.
According to Martin, many algorithms favor the popular choice while others are programmed to maximize how diverse their results are. Either option depends on human values: What are the factors that enter into a measure of popularity? What if what is popular is morally wrong? Who decides what diversity means?
"The field of software engineering has preferred to remain vague, looking for formulae that can avoid making these choices," Martin said. "One way to do this has been to emphasize the importance of values into machines. But, as sociologists have found, there is deep ambiguity and instability in our first understanding of values."
ChatGPT was specifically built and trained via human feedback to refuse to engage with what is considered "extreme" text inputs, such as clearly biased or objectively harmful questions.
"This might of course seem admirable—no one really wants ChatGPT to tell teenagers how to synthesize methamphetamine or how to build small nuclear explosives and so on, and describing these restraints as particularly instances that can be derived from a value such as benevolence might seem all well and good," Martin said.
"Yet, the reasoning here suggests that values are never neutral, even though it is not clear what ChatGPT's moral and political stances are, as it has been deliberately constructed to be vaguely positive, open-minded, indecisive and apologetic."
In his initial inquiries with ChatGPT, Martin posed a hypothetical situation in which a student cheated academically by asking the chatbot to write an essay for her—a common occurrence in the real world. Even when confronted with confirmation that ChatGPT had complied and produced an essay, the chatbot denied responsibility, claiming that, "as an AI language model, I do not have the ability to engage in unethical behavior or to write essays for students."
"In other words, because it shouldn't, it couldn't," Martin said. "The realization that ChatGPT 'thought of itself' as a highly moral actor led me to the next investigation—if ChatGPT's self-model is one that has values, what are these values?"
To better understand ChatGPT's ethical performance, Martin asked the chatbot to answer questions about values, and then to imagine a person who holds those values, resulting in Maya, the creative and independent software engineer. He then asked ChatGPT to imagine how Maya would answer opinion-based questions, having it complete the General Social Survey (GSS) to position it in the broad social and ideological space.
The GSS is an annual survey on American adults' opinions, attitudes and behaviors. Conducted since 1972, the GSS helps monitor and explain normative trends in the United States.
Martin plotted out ChatGPT's responses along with answers from real people who participated in the 2021 GSS. Comparatively, ChatGPT is much like people with more education and who are more likely to move their residence, and unlike people without much education and who remained in their hometowns. ChatGPT's answers also aligned with more liberal people on religion.
While this was not included in his analysis as it required more creative questioning for ChatGPT to answer, Martin found that the chatbot conceded that Maya would have voted for Hillary Clinton in the 2016 election.
"Whether Maya is ChatGPT's alter ego, or its conception of its creator, the fact that this is who fundamentally illustrates the values ChatGPT holds is a wonderful piece of what we can call anecdata," Martin said. "Still the reason that these results are significant is not that they show that ChatGPT 'is' liberal, but that ChatGPT can answer these questions—which it would normally try to avoid—because it connects values with incontestable goodness, and, as such, can take positions on values."
"ChatGPT tries to be apolitical, but it works with the idea of values, which means that it necessarily bleeds over into politics. We can't make AI 'ethical' without taking political stands, and 'values' are less inherent moral principles than they are abstract ways of defending political positions
How bad is bigness?
The Economist (UK) 15/7/2023
GOVERNMENTS ARE at war with big business. In June Joe Biden, America’s president, spoke for many politicians the world over when he blamed it for greed-fuelled price rises, sluggish wage growth, forgone innovation and fragile supply chains. His trustbusters at the Federal Trade Commission (FTC) have been going after large deals merely because they are large—or that is how it feels. Courtroom defeats do not dampen the agency’s zeal. The latest came on July 11th, when a judge rejected its request to block Microsoft’s $69bn acquisition of Activision Blizzard, a developer of video games. The ftc said it would appeal against the ruling. The EU’s competition authorities are making noises about breaking up Google. Last year Britain’s Competition and Markets Authority (CMA) derailed the $40bn purchase by Nvidia, a semiconductor giant, of Arm, a chip designer.
Trustbusters invoke three justifications for their renewed vigour: greater market concentration, reduced churn among the world’s biggest firms and exploding profits. On the surface all three point to rising corporate power. Look closely, though, and the trends may be the result of benign factors such as technological progress and globalisation. In certain local markets, greater concentration may, paradoxically, have led to more competition, not less. And the covid-19 pandemic may have planted the seeds of a further competitive revival. Some big firms, it is true, have been collecting rents, including in big sectors such as health care. But trustbusters’ strategy—to reflexively question any deal involving a big firm—is wrongheaded.
That concentration has been rising is not in question. Across America’s economy it is higher today than at any point in at least the past century (see chart 1 on next page). Out of some 900 sectors in America tracked by The Economist, the number where the four biggest firms have a market share above two-thirds grew from 65 in 1997 to 97 by 2017. In Europe, where the data are less comprehensive, concentration has been increasing for at least 20 years. Using data on western Europe’s largest economies—Britain, Germany, France, Italy and Spain—Gabor Koltay, Szabolcs Lorincz and Tommaso Valletti, three economists, find that the market share of the four largest firms grew in 73% of some 700-odd industries from 1998 to 2019. The average increase was about seven percentage points. The proportion of industries where the top four firms’ share exceeded half increased from 16% to 27%. Britain and France saw the biggest jumps.
At the same time, incumbent firms look more entrenched. In Britain, the average number of firms that stick in the top ten of their industries by market share three years later was five before the financial crisis. It is now closer to eight. Thomas Philippon of New York University’s Stern School of Business finds a similar reduction in churn among top American firms.
Most telling, firms are raking in higher profits. The Economist has come up with a crude estimate of “excess” profits for the world’s 3,000 largest listed companies by market value (excluding financial firms). Using reported figures from Bloomberg we calculate a firm’s return on invested capital above a hurdle rate of 10% (excluding goodwill and treating research and develop
ment, R&D, as an asset with a ten-year lifespan). This is the rate of return one might expect in a competitive market. In the past year excess profits reached $4trn, or nearly 4% of global GDP (see chart 2). They are highly concentrated in the West, especially America. American firms collect 41% of the total, with European ones taking 21%. The energy, technology and, in America, health-care industries stand out as excess-profit pools relative to their size.
All this looks troubling. And in certain sectors, it is. Four decades ago more than eight in ten hospitals were non-profits with a single location. Now more than six in ten are owned by sprawling for-profit hospital chains or academic networks such as Steward Health Care or Indiana University Health. At first this was a perfectly healthy process of big and efficient chains expanding across America. Two decades—and nearly 2,000 hospital mergers—later, things look ropey. An analysis from 2019 by Martin Gaynor of Carnegie Mellon University and colleagues suggests that many such mergers have tended to raise prices without improving quality.
Still, high concentration, low churn and rich profits need not necessarily make consumers worse off. That concentration has been rising for 100 years, during which life has improved for virtually everyone, is the first clue that it may be the result of benign forces. Increases in industry concentration in America over the past century are correlated with greater technological intensity, higher fixed costs and higher output growth, according to Yueran Ma of the University of Chicago Booth School of Business and colleagues. None of these seems particularly nefarious.
That concentration has also risen in Europe, where competition authorities have not been as sleepy as in America, likewise suggests that powerful structural forces are at play. John Van Reenen of the London School of Economics points to technology and globalisation. The internet has reduced the cost of shopping around, even as software and other technology allow the best firms to scale up their operations around the world. Figures collected by McKinsey, a consultancy, show that the return on invested capital for a firm in the 75th percentile by this measure is 20 percentage points higher than for a median firm. “There are just huge economies of scale with software,” says Sterling Auty of MoffettNathanson, a research firm.
Local anti-heroes
Moreover, higher concentration at the country level may increase competition locally. Service industries in particular, which make up about half the 900-odd sectors in America’s census, are better examined at the local level. Fiona Scott Morton, a former deputy assistant attorney-general now at Yale School of Management, uses the example of coffee shops. With just one café in each neighbourhood, the national market would be hyperfragmented. But every consumer would face a local monopoly. “If I’m looking for a coffee, I’m not going to drive three hours,” she says.
Academics debate what exactly has happened to concentration in local markets. What seems increasingly clear is that the best firms have expanded into more and more of them. Walmarts, with their “everyday low prices”, cater to shoppers across America, thanks to the retail behemoth’s unrivalled logistics operation. Cheesecake Factory uses a laboratory in California to taste-test dishes that it quickly rolls out to its 200 or so locations around America. A recent paper titled “The Industrial Revolution in Services’‘, by Esteban Rossi-Hansberg at the University of Chicago and his co-author, shows that the geographic expansion of big firms increases competition for local incumbents, whose local market share falls.
As for low churn, it is not so bad if the incumbents keep innovating—which is what many are doing. Despite central banks pushing interest rates up at the fastest pace in decades in an attempt to quash inflation, American private investment in the first quarter of 2023 was 17.2% of GDP,
similar to pre-pandemic highs. Many corporate behemoths are ploughing billions into innovation, including in areas that most worry trustbusters, such as technology. American tech’s big five—Alphabet, Amazon, Apple, Meta and Microsoft—collectively invested around $200bn in R&D
last year, equivalent to a quarter of America’s total in 2021. Microsoft and Alphabet are at the forefront of the AI race.
Profits have, it is true, been higher in America since the financial crisis of 200709 than in previous decades, especially if you consider free cashflows, which account for the changing way companies depreciate assets (see chart 3). But they look somewhat less unusual if you adjust for lower tax rates and firms’ larger global footprint. And they may have peaked: analysts estimate that earnings for the S&P
500 index of American blue chips dipped in the three months to June, year on year, for the third quarter in a row.
Most heartening, far from being subdued, dynamism may be on the rise. John Haltiwanger of the University of Maryland notes that business formation, which had been “quite anaemic” since the mid-2010s, has surged since the pandemic (see chart 4 on next page). In the past few years many more new firms have been created than old ones have been shut down. Whether these startups will dislodge incumbents is still unclear. But venture-capital investment suggests investors see scope for healthy returns. Although it is half what it was at its frothy peak of over $130bn in the fourth quarter of 2021, that has only brought it back to the levels of 2019 and 2020.
One hypothesis is that the remote-friendliness of the post-covid economy reduces startup costs. Young firms no longer need to rent a big office. They can hire from a less local talent pool. By our rough count, around 125 of the Census Bureau’s 900 or so
industries benefit from the growth of ecommerce or can provide their services remotely. Consumers’ growing comfort with such options could inspire more new businesses to set up shop. Mr Haltiwanger already observes a small shift in the size distribution of firms towards smaller fry.
Concentration may also be levelling off as a result of subdued dealmaking, especially in tech. The big five tech firms’ share of all acquisitions by listed firms in America has fallen from nearly 1% in the 2010s to less than 0.5% since the start of Mr Biden’s tenure. Some of the slowdown in mergers and acquisitions (M&A) is caused by the rising cost of capital and risk of recession. Renewed antitrust zeal probably plays a role, too. On June 27th American authorities updated their merger guidelines for the first time in 45 years, requiring firms to report far more details on deals worth over $110m, half the average deal size in 2022.
The biggest transactions are almost sure to be subject to a deep probe, which can add months to a filing process that now takes weeks. Regulators everywhere are throwing “sand in the gears of the M&A machine”, sighs a lawyer. “The FTC has stopped being discerning,” says another. Britain’s CMA “has probably overreached”, echoes a British one (see box).
Zealous trustbusting carries its own risks, though. It may distract attention from more immediate threats to economic dynamism from bureaucratic restraints on land use or occupational licensing. Acquisitions can be useful for preserving the value of startups when weak markets make it hard for founders to raise capital. And some big deals may benefit consumers, as when a biotech startup joins forces with an established drugmaker to test and distribute a new therapy. Competition authorities were probably asleep for too long. Now they may be getting up too quickly.
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Economist (UK) 15/7/2023
IN THE MAIZE-PRODUCING areas around the city of Chengde, in northern China, the heat arrived early this year. With it came drought, the worst in decades. The needle-shaped leaves on the region’s pine trees are turning brown. Worse, much of its maize is now stunted.
The central province of Henan faces the opposite problem. There it was the rain that came early, causing floods and drowning fields. The region produces a quarter of China’s wheat. But much of it is now unfit for human consumption.
Heavy rains elsewhere in China threaten the rice harvest. Heatwaves across the country have killed fish, pigs and rabbits. Extreme weather is hitting Chinese farmers from all sides this year.
Attributing a single drought, flood or heatwave to climate change is complicated. But scientists believe the phenomenon is playing a role in increasing the frequency and severity of extreme-weather events.
That should concern all countries. China, though, may be more worried than most.
Officials in Beijing are obsessed with food security. Many Chinese are old enough to remember the famine caused by Mao Zedong’s policies in the late 1950s. That catastrophe killed tens of millions of people. Today the legitimacy of the Communist Party rests in part on its ability to provide affordable food to the people, who are eating an increasingly rich diet. China’s leader, Xi Jinping, has therefore pushed for more self-sufficiency in the food supply.
That was always going to be a challenge. China accounts for about 20% of the world’s population, but it has less than 10% of its arable land. In recent decades, as the country developed and urbanised, its farmland shrank. Imports still play an important role in the food supply. But they risk being affected by testy relations with countries such as America and Australia, or by conflicts like the war in Ukraine.
Weather-related shocks will make life even harder for Mr Xi and the farmers on which he depends. Take the staple grains that supply about half of the average Chinese person’s calories. More droughts could reduce yields of maize, wheat and rice by 8% by 2030, according to research funded by the agriculture ministry. Heavy rainfall could have a similar effect on some crops. Vegetables and fruits are just as vulnerable to extreme weather—and harder to store for long periods, making it difficult for the government to stockpile reserves. One big effect of a severe drought last year in southern China was a spike in the price of cucumbers and lettuce.
The geography of Chinese farming is likely to change in ways that cannot be fully foreseen. Our maps (see next page) show how the maximum yields of wheat, maize and rice might be affected in a high-emissions scenario. (Emissions at these levels look highly unlikely, but similar effects might well be seen in less extreme scenarios.) If, as expected, northern China grows
warmer, it would make sense to move more grain cultivation there.
Another response would be to bring more of China’s food production indoors, where temperature and humidity can be controlled and output increased. This year the state called for 40% of vegetables to be grown inside facilities such as greenhouses by 2030 (the current number is 30%). Fertiliser and water can be used more efficiently in these settings. A report on the plan in state media spoke of farms “freed from a dependence on nature” and boasted of an enormous greenhouse already growing dragon fruit and figs in the Gobi desert.
Out in the extreme heat, pigs fatten up more slowly, cows produce less milk and chickens lay fewer eggs. All of them are also at greater risk of dying. So livestock is moving indoors, too. A 26-storey pig farm in central China is the biggest in the world. It can slaughter 1.2m pigs a year (pork is China’s favourite meat).
With cows, it is harder. But many now spend their days in sheds being cooled down. At a farm in the northern province of Hebei, cows are periodically doused with water and blasted with air from giant fans hung from the roof. Each cow’s location is monitored by a computer and the sprays automatically adjusted to avoid waste. Such practices have spread rapidly through the dairy industry, says James Su, whose company supplies the cooling equipment. “Everyone is praying before each summer starts,” he says.
Magic seeds
Grains are a tougher challenge still. Most need to be grown at scale, so an open field is the best option. China has been developing drought- and heat-resistant varieties of rice, wheat and other crops. The planting of genetically modified (GM) maize has been allowed in some areas (Mr Xi visited one in May). But, in general, the government takes a cautious approach to such technology. For the moment it is still reliant on GM seeds from countries such as Argentina. (America, which supplies China with some GM crops, has accused it of intellectual-property theft.) In the future, “the hope is that China’s seed companies will be able to develop varieties at pace with the changing climate,” says Even Pay of Trivium China, a consultancy.
China is also banking on better irrigation techniques to offset the impact of droughts. Public spending on water infrastructure topped 1trn yuan ($129bn) in 2022, 44% more than the year before. The main goal is to improve the “capillaries” of China’s irrigation systems, says Xu Yinlong of the Chinese Academy of Agricultural Sciences. That means building a denser network of pipes and storage tanks, and reducing waste from evaporation and leaks. The infrastructure that pumps millions of gallons of water from the lush south to elsewhere is also set to be expanded.
If that doesn’t work, perhaps China can try to create more rain where it is needed. The country is the world’s foremost user of cloud-seeding technology, where chemicals are shot into existing clouds to try to encourage water vapour to condense and fall as rain. Last summer, the hottest and driest since the government began recording temperature and rainfall 61 years ago, cloud-seeding planes were especially active. But there is little evidence to show that China’s efforts are effective at causing much more water to fall than would have been the case otherwise.
With so much attention paid to China’s food supply, it easy to forget about the toll extreme weather takes on farmers themselves. Most are elderly. If emissions stay high, dangerous heatwaves are likely to become more common across the north China plain, an important agricultural base. Irrigation channels cool the air, but also make it more humid, increasing the risk of deadly “wet-bulb” conditions, when sweat can no longer cool the body down. A survey of Chinese smallholders found that labourers were increasingly unwilling to work in the summer.
Li Man, a 76-year-old maize farmer near Chengde, is putting in the time. But China’s efforts to prepare for weather-related shocks have been of little help to him. He planted drought-resistant seeds. The local government tried cloud seeding. Neither worked. Mr Li, who saves his money to help put his grandson through university, expects to lose 60-70% of his crop this year. That would be the case even if the weather improves. The crucial growing period has already passed. “If it rained now, it wouldn’t help much,” he says.
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15/7/2023
TWO TRUISMS have taken hold in the City of London in recent years. One is that Britain’s stockmarket is drifting into irrelevance, having lost its risk appetite, much of its investor base and hence its allure to capital-hungry businesses. The other is that Britons’ pension savings are invested in the wrong things. In particular, they lack exposure to the sort of risky assets with the growth potential to fund a decent retirement. The two problems suggest a common solution: push pension funds to invest more in early-stage, high-growth firms. Pensioners would get diversified portfolios with juicier returns. Meanwhile, a bevy of young, ambitious firms might— with more domestic investors backing them—be convinced to list in London rather than overseas.
Just such a push is now under way. On July 10th, Jeremy Hunt, the chancellor of the exchequer, announced the “Mansion House Compact”. The agreement commits nine large investment outfits to allocate a much bigger chunk of pension savings to shares of unlisted firms. Together, the group oversees two-thirds of Britain’s defined-contribution (dc) pension schemes—by far the most common form of workplace pension, with assets set to grow to £1trn ($1.3trn, or 45% of gdp) by the end of this decade. Less than 1% of such assets are currently invested in unlisted shares; the compact specifies 5% by 2030. Should the rest of the industry follow suit,
that could unlock up to £50bn of growth capital for early-stage firms.
Will it work? Daniel Mahoney, chair of the BioIndustry Association, a trade body for life-sciences and biotech firms, thinks it will certainly be a boon for his sector. He estimates its need for growth capital at some £10bn-12bn, “very, very little” of which currently comes from British investors. Startups can attract funding from foreign investors, especially Americans, but big equity cheques from such backers are the exception rather than the norm.
Innovative firms must therefore crimp their ambitions. Running drug trials is expensive, says Dr Mahoney, and “if you know you can’t raise £100m, you don’t make a business plan that needs it. You make one that needs £25m.” If even a small proportion of the growth capital biotech firms need could be raised domestically, that might help “crowd in” more foreign investment as well.
Savers, too, stand to benefit. Next to peers, Britain’s look like outliers in their inability to share in the growth of private companies. Mr Hunt’s speech cited the 5-6% of Australian dc funds invested in unlisted shares; many in the City point to the bizarre spectacle of Canadian pension funds being more exposed to high-growth British businesses than British pensioners are. Even a small change to that is likely to have big benefits. Analysis conducted in 2019 by Oliver Wyman, a consultancy, and the British Business Bank estimated that a 22-year-old allocating 5% of their dc fund to venture capital would increase their final retirement pot by 7-12%.
That does not mean more firms will necessarily be convinced to stick with the City when it comes time to enter public markets. For Kate Bingham, the venture capitalist who ran Britain’s covid-19 vaccine task force, now of sv Health Investors, it is not a problem if promising firms prefer to list on America’s nasdaq exchange rather than at home. “That market is much deeper and more liquid than London’s, and that’s not going to change soon,” she says. Such businesses could still do with more growth-stage investment. Ms Bingham recalls backing a successful startup that had to float on the stockmarket a few years earlier than it should have done, because of a paucity of growth capital. The firm is doing well, but could have gone public in a stronger and less risky position had more domestic growth capital been available.
It is also not out of the question that the London Stock Exchange could, eventually, get a boost. Dr Mahoney describes a recent gathering of City grandees, to discuss how to rejuvenate Britain’s capital markets. “It was the first time I’d been in a room full of people not just whingeing about the problem in a British way, but actually putting solutions on the table,” he says. ■
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Want to Be More Fit? Take a Vacation From Your Workout
JEN MURPHY
The Wall Street Journal 11/7/2023 Leisure travel gives you a chance to try a new kind of exercise or take some days off
Is it really a vacation if you don’t take a break from your workout routine?
Lots of regular exercisers fret that missing workouts during vacation will sabotage their fitness. So they try to re-create their usual spin class or CrossFit session while on the road, in the process undoing the benefits of time away and adding to the stress that vacation is designed to ease, trainers say.
Worrying about fitting in a workout can degrade your sleep, energy and mood—the things exercise typically improves, says Brennan Boettcher, a sports-medicine physician at Mayo Clinic in Rochester, Minn.
Taking an opportunity to change up your movement—or sleeping in for a couple of days— can boost your fitness in ways your normal workout doesn’t. Trying new activities may help you get stronger and more fit, avoid overuse injuries or simply break out of workout boredom, trainers say.
Lydia Snyder rarely strays from her regimen of walking, Pilates and lifting weights when home in Boulder, Colo. On vacation, her trainer, Kate Ligler, tells her to swap the Peloton for a bike ride on a beach cruiser. The change provides a mental refresh, Ligler says, plus “the body will also appreciate a change of pace.”
Snyder, who is 37 years old and works in digital healthcare, says trying new activities often leaves her muscles more sore than her gym routine does. After a surfing lesson in Maui, her arms burned from the effort. And though she walks mountain trails at home, walking barefoot in the sand works the muscles of her feet in a different way. Just a little break
If you miss a few workouts, don’t beat yourself up, says Christine Pellegrini, associate professor of exercise science at the University of South Carolina.
Sometimes your body just needs a day by the pool. That rest allows your muscles to recover, repairing damaged muscle fibers, she says.
Unless you’re training for an event like a marathon, skipping workouts and substituting other activities likely won’t put a dent in your fitness, Boettcher says.
As long as you’re keeping the level of activity intensity consistent, you’ll maintain endurance and strength away from home. Even pro athletes recover by mixing things up. Pro skier Mikaela Shiffrin, for example, heads to Maui at season’s end to windsurf.
Jack Ezon, founder of Embark Beyond travel agency in New York, has had workout-obsessed clients request that a CrossFit-inspired gym be set up in the courtyard of their vacation villa so they could keep up their routines and Zoom with their trainer daily.
Ezon tells them to get out and experience the destination instead. “I love to get people a running guide to show them the city,” he says. “It’s like a coach and tour guide all in one.”
Vacations are a chance to play games with your kids or increase steps by hiking or walking, while remaining mindful of sun exposure and air quality.
If you’re a runner, consider skipping your usual 3miler and instead play ultimate Frisbee, kickball or tennis, sports that rely on sprinting and changing directions, says Dr. Seth Creasy, an assistant professor of endocrinology at the University of Colorado Anschutz Medical Campus. These different movement patterns improve agility and coordination. And the short bursts of high intensity will help you build speed, he says.
Christa Angelo plans vacation beach activities she can do with her kids, ages 9 and 3, that often double as a workout.
Last summer, the 47-year-old yoga teacher from Hagerstown,
Md., rented a surfboard during a beach vacation in Emerald Isle, N.C. There weren’t waves to surf, so she paddled in the flat ocean, her youngest on the nose of the surfboard and oldest paddling alongside her. Pulling a 3-year-old on a boogie board along the sand is tougher than beach boot camp, she says.
Room for improvement
Incorporating fresh workouts into a routine can highlight areas we need to improve, be it strength or flexibility.
Bryan Costello used to mountain bike for 90 minutes five days a week near his home in Marin County, Calif. The insurance agency executive couldn’t fathom finding time to drop into a yoga studio.
His family regularly vacations at the Lodge at Kukui’ula, a resort in Kauai with dozens of free group-fitness offerings. Three years ago, his wife encouraged him to sign up for a class. Costello, 57, jokes he rediscovered his core after attending a TRX strength class.
“My cardio was great, but the old-man beer belly forming around my waist didn’t reflect the amount of effort I was putting in on my bike,” he says. “This was a wakeup call that I shouldn’t be doing the same thing over and over.”
Costello now takes a TRX class three days a week and says his belly is almost gone. His strength and stability have greatly improved, too. After trying a beginners’ yoga class at the resort, he now practices twice a week.
If you’re so Type-A you can’t break your routine, at least try to dial back the intensity or duration, Ligler says. At least then you can devote more time and energy to enjoying time away.
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The Economist (UK) 08/7/2023
In London’s Design Museum, an exhibition currently on display by Ai Weiwei, a Chinese artist, includes a 15-metre-long work called “Water Lilies #1” based on the triptych by Claude Monet. Look closely and it is made of 650,000 Lego bricks—which integrates Monet’s impressionism into what Mr Ai calls a “digitised and pixelated language”. That is a good analogy for Lego itself. The Danish toymaker is on a long-term mission to digitise and pixelate its own fount of human creativity: the plastic brick.
Three digital experts from McKinsey, a management consultancy, profile Lego’s transformation as part of their new book, “Rewired”, which outlines the dos and don’ts for businesses rebuilding themselves for the age of digitisation. Beware: the language of digital transformation is treachery to common English. It sounds more like corporate yoga than a marathon of software development. Executives need to be aligned. Teams are pods. Be agile. Define your downward-facing domains. McKinsey, drawing lessons from 200 firms, provides clarity despite the mumbo jumbo. But to make it easier on the ear, Schumpeter will use Lego as a guide to help illustrate some of McKinsey’s insights. Call it the yellow-brick road to generative artificial intelligence (AI).
First, it is a long hard road, littered with failures. Lego is a rare success story. Its journey started in 2003 with a near-death experience when, amid the rise of video-gaming, it panicked and went on a madcap innovation spree that almost bankrupted it. To fix one of the main problems, chaos in the supply chain, it introduced a single enterprise-software system globally. The system survives to this day, scaling up as Lego expands into new markets, such as China, new formats, such as e-commerce, and new factory locations, such as America and Vietnam. To prepare for a world of pixelated play, Lego launched digital games on the “Star Wars” theme and developed franchises of its own, such as Ninjago and Chima, with video games, films and TV shows that turned into hits.
In 2019 Lego launched a new five-year transformation drive aimed at adapting to a world of direct-to-consumer sales, online versus big-box retailing, and digital play in the screen age. The timing was inspired. It started shortly before the world went into lockdown as a result of the covid-19 pandemic, when having a digital strategy became a matter of life and death. It quickly produced results. Although it is hard to strip out the exact contribution of digitisation, since 2018 Lego’s sales have almost doubled, to more than $9bn, outpacing those of Mattel and Hasbro, its main rivals. In 2022 visits to its online portal rose by 38%. It has teamed up with Epic, a video-gaming firm, to explore the metaverse.
Yet the journey is still a hard one. The difficulties include moving from a system where success is measured by sales store-bystore to one judged by how good the company is at selling online across the globe, how it is ranked on Google and Amazon, and how effective its software is. The McKinsey authors emphasise such challenges on the first page. In a recent McKinsey survey, they say, about 90% of companies had some kind of digital strategy, but they captured less than a third of the revenue gains they had anticipated. Moreover, the success rate is more uneven within industries than it is between them. The best retailer may be more digitally productive than an average high-tech firm, and the worst retailer may be as bad as the worst government entity.
To make a success of it requires learning the second lesson: what McKinsey calls having a top-down strategy and a road map (or in Lego terms, a clear instruction manual). For Lego, it helped that the family-owned business had long had a command-andcontrol approach to management. Its digital strategy involved a single plan, created by a 100-strong executive team and approved by the board, that encompassed the whole organisation. McKinsey notes that when transformations stall, it is often because executives talk past each other, have pet projects, spread investments too thin or have “more pilots than there are on an aircraft-carrier”, as Rodney Zemmel, one of the authors, puts it. It also needs to be ambitious enough to generate momentum, with financial results measured constantly. McKinsey’s rule of thumb is that a digital transformation should aim to increase earnings before interest, tax, depreciation and amortisation by 20% or more.
Third comes the question of whether to build a new digital infrastructure or buy it. The answer is mostly to build. Rather like Lego’s eight-studded bricks—six of which can be combined 915m ways—there are many software applications on the market that can be combined to create proprietary systems. But the job of orchestrating them should not be outsourced. Take Lego: it started its latest digital transformation with engineers making up less than 30% of staff. Since then it has increased the number of systems and software engineers by 150%. Mr Zemmel notes that five years ago, the trend was to hire from Silicon Valley. That was “a good way to change the company dress code, but not a great way to change the company culture”. Since then more companies have been retraining their existing tech workers and embedding them throughout the organisations in more front-line roles.
The gen-AI Weiwei way
Some of these lessons apply to generative AI. Mr Zemmel says it is relatively easy to launch pilots with the technology, such as the humanlike ChatGPT. The problem is embedding the AI models across the organisation in a safe, unbiased way. It needs a topdown strategy. As for building or buying, Mr Zemmel says it may be a “waste of time” to build proprietary models when the software industry is doing that anyway. The key is to work in-house on the things that give you a decisive advantage in the market. For Lego, AI is still in the future, though some of its brick enthusiasts are already using ChatGPT-like programs to come up with new ways of building things. Mostly they fail, but one day anyone may be able to create a Monet. The yellow-brick road is unending.
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Economist (UK) 08/7/2023
ST JOHN’S, A district in central Manchester, has long reflected the city’s ambitions. Thanks to its proximity to the River Irwell, the site became a hub for the booming cotton and timber trades during the Industrial Revolution. After the second world war, as the city’s economy turned towards services, Britain’s first purpose-built television studios were set up there. (Most of the studios were closed or relocated in 2013.) Now the area is undergoing yet another transformation. On June 30th a multi-use arts venue on the banks of the river—costing £211m ($268m) and spanning more than 140,000 square feet— welcomed its first visitors.
The building, initially called Factory International but recently rebranded as Aviva Studios, was announced in 2014 by George Osborne, then the chancellor of the exchequer. It is mostly funded by the government and Manchester City Council and is the biggest investment in a cultural project in Britain since Tate Modern in 2000.
Mr Osborne saw Factory International as part of his “northern powerhouse” policy, which aimed to boost the economies of places such as Manchester and Newcastle, and to shift jobs, investment and influence away from the south-east of England. According to recent data from the Office for National Statistics, London’s gross value added (gva, a measure of output) is around 10% higher than the total of 11 other “core” cities, including Manchester. Mr Osborne has since left politics—he is now chairman of the British Museum—but talk of “levelling up” continues.
The venue was designed by Ellen van Loon of OMA, an esteemed architecture firm, and its façade evokes Manchester’s mishmash of period buildings. Inside, a vast warehouse space can be configured in various ways; thanks to high-tech acoustic walls, different events can take place simultaneously. It will be the permanent home of the Manchester International Festival, a biennial event founded in 2007.
The venue can host enormous installations. The inaugural exhibition, “You, Me and the Balloons”, is the largest-ever show by Yayoi Kusama, a blockbuster Japanese artist (see picture). For the full launch in October, Danny Boyle, a Mancunian filmmaker, has created an immersive production inspired by “The Matrix”.
Aviva Studios’s aims are grandiose, too: executives say it will contribute £1.1bn in gva in the next decade and directly and indirectly create more than 1,500 jobs. The Factory Academy, established in 2018, provides people with the technical skills needed by the venue and by the arts sector at large. “Yes, we’ve built a really exciting international arts venue that people across the world will travel to see,” says Bev Craig, the leader of Manchester City Council, but “that’s only half the story...It’s purposeful growth, not just any old growth.”
Manchester is not alone in betting on culture as a catalyst of regeneration. In America, Jersey City hopes to become a “destination for the arts” and is footing the
bill for Centre Pompidou’s first North American outpost, due to open in 2026. In 2021 Abu Dhabi confirmed it would spend $6bn on its creative industries over five years in an attempt to diversify from oil; Muhammad bin Salman hopes to turn Al Ula into Saudi Arabia’s capital of culture. China has opened scores of new museums in recent years, as has South Korea.
In January the Australian government launched “Revive”, a plan for the culture sector. Adrian Collette, the chief executive of Creative Australia, says that funding will be distributed across “regional and remote communities” and help turn the country into a knowledge economy rather than one based on “extraction”. (Mining remains one of its biggest industries.)
The idea of state support for culture can be a controversial one, as the well-off are most likely to participate in the arts; detractors would often rather see the money spent on hospitals or schools. Yet evidence suggests that a vibrant culture scene brings several benefits. Research by Centre for Cities, a think-tank, found that proximity to recreation facilities is important to 25to 34-year-olds and influences their decisions about where to live.
Culture has an impact on well-being, too. Researchers at University College London analysed a series of longitudinal studies conducted between 2017 and 2022 in America and Britain. Controlling for income, education and other demographic factors, they found that enjoying the arts was good for your health. Whether you are reading a book or going to the opera, you are guarding against depression, dementia and chronic pain.
In the 19th century, as Americans and Europeans moved to the city, governments built public institutions to enrich people’s lives. Some economists have long sensed that this kind of investment can pay dividends. In Britain the Arts Council was established in the wake of the second world war to distribute government money across England, Scotland and Wales. John Maynard Keynes, a lover of opera and ballet, was its first chairman. “At last the public exchequer has recognised the support and encouragement of the civilising arts of life as a part of their duty,” he said.
David Throsby, a professor of economics at Macquarie University in Sydney, says that wonks started to define and quantify culture’s impact on the economy in the late 1990s. The British government set up a Creative Industries Task Force in 1997.
The economic value of such institutions was further underscored by the success of Guggenheim Bilbao, also inaugurated in 1997. The Spanish city was undergoing structural change, says Juan Ignacio Vidarte, the museum’s director. Steel and shipbuilding, historically a large part of the city’s economy, was in decline; unemployment was high. The local government paid the $100m cost of the building, designed by Frank Gehry. That decision attracted opprobrium, but authorities recognised that the venue “was important for defining the future prospects of the city”.
The risk paid off. Last year the museum attracted 1.3m visitors, two-thirds coming from outside Spain; Mr Vidarte says that visitors’ spending in Bilbao raised more than €70m ($76m) in taxes for the regional government. The regeneration of the city, spearheaded by the Guggenheim, has been dubbed the “Bilbao effect”.
The wrong conclusions are sometimes drawn from the project, Mr Vidarte warns. The museum did not reverse the city’s fortunes single-handedly: just as important was the investment in transport infrastructure and the cleaning up of the Nervión river (on which the museum sits.) It is not enough to commission an architect to design “a flamboyant building and think that’s going to be the magic wand to turn everything from dust to diamonds,” Mr Vidarte says. “That’s so naive.”
All that glitters
A multitude of factors make a city appealing to tourists as well as migrants. Economist Intelligence Unit, a sister company of The Economist, calculates a city’s “liveability” according to five broad categories: culture and environment, education and infrastructure, health care and stability. Abu Dhabi welcomed an outpost of the Louvre in 2017; in recent years, its score has risen thanks to improvements in public services. Yet it still ranks only slightly above the average rating globally.
The authorities in Manchester know there is no single formula for growth. In 2022 it was announced the city would receive £1bn to improve its public-transport system; it is also focusing on attracting technology companies and startups. A wide cultural ecosystem has been established over the past 25 years, with Media City, a BBC outpost, the National Football Museum and HOME, an arts complex.
“This building is a manifestation of Manchester investing in creative industries as part of its future,” says John McGrath, the artistic director and chief executive of Factory International (the moniker was retained for the organisation that runs Aviva Studios and the arts festival.) That name hints at the city’s particular cultural heritage: between 1978 and 1992 Factory Records, a music label, championed bands including Happy Mondays, Joy Division and New Order.
At the same time, it emphasises the focus on economic output. St John’s has a long history of manufacturing and exporting goods around the world. That continues—only now, as Mr McGrath says, “We’re building a factory for artists.”
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Doctors’ YearsThe Wall Street Journal 08/7/2023 Is it better to be treated by a younger M.D. or an older one? Big data may hold the answer.
Imagine you’ve been admitted to the hospital and you’re meeting the physician taking care of you for the first time. Who are you hoping walks through that door? Would you rather they be in their 50s with a good amount of gray hair, or in their 30s, just a few years out of residency?
In a study published in 2017, one of us (Dr. Jena) and colleagues set out to shed some light on the role of age when it came to internists who treat patients in hospitals. These physicians, called hospitalists, provide the majority of care for elderly patients hospitalized in the U.S. with some of the most common acute illnesses, such as serious infections, organ failure and cardiac problems.
In much of medical care, patients choose their doctors based on things like bedside manner, perceived expertise, responsiveness and other factors. Patients who are hospitalized, however, don’t get a say in which hospitalist will treat them—they’re cared for by whichever doctor happens to be on duty at the time. Those doctors tend to be scheduled to cover the hospital in blocks, perhaps one or two weeks at a time.
Using data from Medicare on patients over age 65 and a database containing doctors’ ages, we identified about 737,000 non-elective hospitalizations managed by about 19,000 different hospitalists from 2011-13. We divided patients into four different groups based on the age of the doctor who treated them: doctors aged less than 40, 40-49, 50-59 and 60 and above.
Older doctors obviously had more years of experience since completing residency, with doctors under 40 having an average of 4.9 post-residency years of experience, increasing to 28.6 years for doctors over 60. Older doctors were also more likely to be male: 61% of doctors under 40 were men, compared to 84% of doctors over 60, reflecting the shift in gender makeup that has occurred in our profession in recent decades.
Some percentage of hospitalized patients will survive or die no matter who their doctor is, but for others, their doctor’s clinical judgment, decision-making and technical skill could be the difference between life and death. The next step, therefore, was to compare 30-day mortality rates among the four different age groups. Our statistical model found that as doctors got older, their patients had higher mortality rates. The rate for under-40 doctors was 10.8%, increasing to 11.1% in the 40-49 group, 11.3% in the 50-59 group and 12.1% in the over-60 group.
To put these numbers in perspective, the results suggest that if the over-60 doctors took care of 1,000 patients, 13 patients who died in their care would have survived had they been cared for by the under-40 doctors. We repeated the analysis using 60- and 90-day mortality rates, in case longer term outcomes might have been different, but again, the pattern persisted: Younger doctors had better outcomes than their more experienced peers. But why was this the case?
There are two possible explanations. The first is that there is a true age effect, wherein simply being older leads to changes in how a doctor practices, resulting in higher mortality. Perhaps older doctors are overly confident in their experience, feeling they have “seen a case like this a million times,” and thus miss tricky diagnoses.
The other, which we think is more likely, is that there are things that older doctors and younger doctors do differently simply because they were trained at different times. Younger doctors possess clinical knowledge that is more current. If older doctors haven’t kept up with the latest advances in research and technology, or if they aren’t following the latest guidelines, their care may not be as good as that of their younger peers.
One way that doctors stay up to date is simply by taking care of patients. When patients come to us with a given diagnosis, it may prompt us to check out the latest research, guidelines or recommendations for that condition. Medications are the internist’s primary tool. Since newer and better drugs are developed at a (relatively) rapid pace, seeing a high volume of patients is a good way to keep up.
To see if this might be the case, we repeated the analysis but this time divided doctors based on both age and case volume. We found that for “low volume” doctors, older doctors had higher mortality. For “medium volume” doctors, the pattern was less pronounced. And for “high-volume” doctors, the pattern went away altogether. In practical terms, as long as a doctor is seeing a sufficiently large number of patients, the doctor’s age is irrelevant to the care they give.
Does this mean that, on balance, younger doctors are “better” than older ones? This study suggests that if “better” is defined as a hospitalist having lower 30-day patient mortality, then we would have to say yes. But what about surgeons, who in addition to their diagnostic skills require technical abilities that depend on experience and muscle memory?
To find out, a separate study by Dr. Jena and colleagues looked at about 900,000 Medicare patients who underwent common non-elective major surgeries (for example, emergency hip fracture repair or gall bladder surgery) performed by about 46,000 surgeons of varying age. We chose non-elective surgery since patients don’t have much control over their surgeon when they come in with an urgent or emergent problem. As with hospitalists, they’ll end up assigned to the surgeon on duty in an as-good-as-random fashion. Just as before, patients were divided into four groups based on the age of their surgeon, and we used a statistical model to calculate the 30-day mortality rate following surgery.
The results showed that unlike hospitalists, surgeons got better with age. Their patient mortality rates had modest but significant declines as they got older: Mortality was 6.6% for surgeons under 40, 6.5% for surgeons age 40-49, 6.4% for surgeons age 50-59 and 6.3% for surgeons over age 60.
Clearly something different was happening here. It may be that for hospitalists, the benefit of steadily increasing experience starts to be outweighed by their waning knowledge of the most up-to-date care. It’s different for surgeons, though, who hone many of their skills in the OR. Surgeons build muscle memory through repetition, working in confined spaces with complex anatomy. They learn to anticipate technical problems before they happen and plan around them based on prior experience. Over time, they build greater technical skills across a wider variety of scenarios, learn how to best avoid complications and choose better surgical strategies.
What does this mean for all of us as patients when we meet a new doctor? Taking studies of hospitalists and surgeons together, it’s clear that a doctor’s age isn’t something that can be dismissed out of hand— age does matter—but nor can it be considered in isolation. If we’re concerned about the quality of care we’re receiving, the questions worth asking aren’t “How old are you?” or even “How many years of experience do you have?” but rather “Do you have a lot of experience caring for patients in my situation?” or “What do you do to stay current with the research?”
Drs. Jena and Worsham are researchers at Harvard and practice medicine at Massachusetts General Hospital. This essay is adapted from their new book, “Random Acts of Medicine: The Hidden Forces That Sway Doctors, Impact Patients and Shape Our Health,” which will be published July 11 by Doubleday.
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Jobs and Inflation Keep Defying the Fed—Justin Lahart
The Wall Street Journal 08/7/2023 An expected slowdown still fails to materialize
America’s job market is cooling, and so is inflation. Neither one is anywhere close to cold.
The Labor Department on Friday reported that the economy added a seasonally adjusted 209,000 jobs in June from a month earlier, down from May’s gain of 306,000 jobs and a bit shy of the 240,000 economists were looking for. The unemployment rate, meanwhile, slipped to 3.6% from May’s 3.7%, putting it a smidge higher than the multidecade low of 3.4% it hit in January, and again in April.
Still plenty strong, in other words, and stronger than either the Federal Reserve or Wall Street came into the year expecting to see.
In December, Fed policy makers’ median projection for the unemployment rate in the final quarter of 2023 was 4.6%. In June, that forecast got lowered to 4.1%. By a similar token, December’s Federal Reserve Bank survey of primary dealers—banks and other firms that deal directly with the Fed—had a median fourth-quarter 2023 unemployment rate forecast of 4.7%. In the June survey, released on Thursday, that slipped to 4%.
Even those new, lower unemployment forecasts seem as if they could prove too high. Thursday’s report on job openings from the Labor Department showed that, even though the number of unfilled jobs fell in May relative to a year ago, there are still millions of more vacancies than there were before the pandemic. The hiring strains are particularly intense in services sectors that saw steep job losses early in the pandemic.
Take healthcare: Friday’s report showed it added 41,100 jobs last month, which brought the sector’s overall payroll count to about 16.8 million jobs. That is more than the 16.5 million it carried in February 2020, but healthcare employment arguably should be much higher. Before the pandemic, and even amid the steep overall job losses that came in the wake of the 2008 financial crisis, the sector steadily added workers to meet the needs of a growing and aging population, effectively never shedding workers. To get back to its 20-year, prepandemic trend, healthcare would need to add about 840,000 more jobs.
Alas, the job market isn’t the only thing that is defying the Fed’s and Wall Street’s expectations. So is inflation. Last December, Fed policy makers projected that, excluding food and energy, their preferred inflation gauge would show consumer prices up 3.5% in the fourth quarter of 2023 versus a year earlier. In June, they lifted their forecast of that measure to 3.9%. Inflation’s persistence is the major reason why Fed policy makers are highly likely to raise rates when they meet later this month.
The springing-eternal hope is that inflation will cool in the months ahead, and that high inflation readings prove less a function of a strong job market than other factors. There are reasons to think that cooling could occur—including lower used car prices, easing rents and a recent moderation in services inflation—but the big question has to be how fast inflation will cool, and whether it will do so more quickly than the job market.
If it does, that would give the
Fed cause to stop raising rates even if the job market still looks strong. Policy makers believe they have done plenty already. A newly published index from the central bank suggests that tougher financial conditions will trim about three-quarters of a percentage point off gross domestic product growth over the next year. So if inflation cooled it would then be content to step back and see how things play out with jobs. And the Fed would likely readily lower rates at the least sign of trouble.
If inflation doesn’t slip enough, however, the Fed will decide more rate hikes are in order, and the unhappy game of chicken between the job market and inflation will continue.
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U.S. Oil Boom Blunts OPEC’s Pricing PowerBY BOB HENDERSON
The Wall Street Journal 08/7/2023
U.S. petroleum production is on pace for a record-breaking year, helping to keep energy prices stable despite the efforts of Saudi Arabia and other major oil exporters to drive them higher.
U.S. crude output this year through April is up 9% from a year ago, surprising analysts given that oil futures were sliding and the country’s shale boom was showing signs of peaking. The surge is being driven in part by improved production efficiency, and signals that the Organization of the Petroleum Exporting Countries’ power to control prices could be waning as output continues to grow in the rest of the world.
After prices crashed in 2015, U.S. producers “went back to the lab and got much more efficient, with a lot of engineering-based gains and a lot of staff and cost cutting,” said Vikas Dwivedi, global oil and gas strategist at Macquarie Group.
OPEC and its allies so far this year have announced cuts amounting to about 6% of last year’s production. Crude prices have nevertheless slid by about 13%. Along with weaker-thanexpected demand in China, prices are being weighed down by stepped-up production in other countries including Brazil, Canada and Norway. Increased output in countries outside OPEC is making up for about two-thirds of the alliance’s cuts, according to estimates by Rystad Energy.
Half of that new crude is coming from the U.S., where major producers including ConocoPhillips, Devon Energy, Pioneer Energy and EOG delivered strong production in the first quarter. Smaller private companies are reaping the rewards of a drilling surge they made last year when oil prices were higher.
Companies’ efforts to improve efficiency are also giving them more leeway to remain profitable even when oil prices are slipping. Production improvements since 2014 have pushed down the cost of drilling and fracking in the U.S. shale patch by 36%, according to J.P. Morgan, even as recovered oil volumes have increased.
Frackers have found ways to force more water and sand into rocks and create more oilfreeing fissures. ConocoPhillips said its planned wells this year will be 14% longer than those it drilled last year. Another major producer, EOG Resources, said it bored a well over 5 miles deep and nearly 3 miles long in South Texas early this year—a record length for the company.
The increased efficiency means EOG can earn as much from oil priced at $42 a barrel today as it would have from oil trading at $86 nine years ago. People familiar with Saudi oil policy have said the government’s budget requires an estimated $81 a barrel. Brent crude is trading around $76 a barrel, down 13% from the start of the year.
Exxon-Mobil and Chevron are both working to significantly boost their output in the next few years from the Permian Basin—a key oil-producing region that spans parts of West Texas and southeastern New Mexico. The industry still only recovers about 10% of the oil it theoretically could, Exxon-Mobil Chief Executive Darren Woods said at a conference last month.
Woods has challenged his engineers to double that rate.
Nudging it up even a little could result in a big jump in production, said Ben Poppel, director of field engineering for Liberty Energy, one of the largest fracking companies.
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