The Shingles Vaccine Reduces Dementia
In 2023 in Can the Shingles Vaccine Prevent Dementia? I wrote:
A new paper provides good evidence that the shingles vaccine can prevent dementia, which strongly suggests that some forms of dementia are caused by the varicella zoster virus (VZV), the virus that on initial infection causes chickenpox.
We now have three more studies–from America, Australia and Canada–that find similar results using large numbers and credible research designs. Thus, I think we can up this to the Shingles vaccine reduces dementia.
Eric Topol summarizes the new evidence and writes:
If you are 50+ and have not gotten Shingrix vaccinated, you may want to consider that. You get protection vs Shingles (which can be dreadful), slowing of your biological aging (by methylation and RNA metrics), and ~20% reduction of dementia, predominantly related to Alzheimer’s disease. All of this benefit is magnified in women compared with men, but 3 of the studies showed some reduction of dementia in men. As a tradeoff, men appear to derive more cardiovascular benefit, but that evidence is not as compelling as protection from dementia from natural experiments.
Montana’s SB535 and a Potential Biotech Renaissance in America
In 2024, China’s NMPA approved 83 new drugs, the FDA approved 50. China’s share of new commercial clinical trials jumped from 8% globally in 2013 to 30% in 2024, just behind the US at 35%. Last year, China-based Jiangsu Hengrui Pharmaceuticals overtook AstraZeneca as the top clinical trial sponsor in the world.
What’s remarkable is how China is winning: deregulation and capitalism. It’s faster and easier to set up a clinical trial in China than in the United States. China is even experimenting with the peer approval model I’ve long advocated. The Medical Tourism Pilot Zone on Hainan island lets medical institutions import and use any pharmaceutical or device approved in the EU, US, or Japan — no separate Chinese approval needed. China is using our own regulatory judgments to get treatments to its patients faster than we do.
The core problem is that our clinical trial and drug approval system is slow and expensive. Getting a new drug to market in the US takes billions of dollars and a decade or more of clinical trials — and all of that before a company earns a single dollar. The consequence is drug lag and drug loss and also learning loss. Innovation is a dynamic process. You must build to build better.
It’s not over for the United States, however. Montana’s SB535, signed into law in May 2025, is the most important regulatory innovation in drug approval in my lifetime. The law authorizes investigational drugs and therapies that have cleared Phase I trials to be prescribed and sold — bypassing the traditional FDA approval pathway. It makes Montana the first state to license experimental treatment centers, “one stop shops” for otherwise hard-to-access care.
This is a very big deal.
SB535 makes Montana the only state in the nation where firms can move more quickly from a successful Phase I trial into limited commercialization. This positions Montana as a highly attractive location for biopharma, biotherapeutics, and other life sciences companies that want to accelerate time-to-market while continuing the federal FDA approval process.
Montana’s regulatory system creates the possibility of a self-funding clinical pipeline: companies using early commercial revenues to finance the path to full FDA approval. You get treatments to patients faster, and you keep companies alive long enough to prove their treatments work. Experimental treatments are not for everyone–these treatments are cash based–no Medicaid or Medicare and probably no private insurance either–but after conventional treatments have failed experimental treatments should be available for some patients, both for their benefit and for ours.
Montana is not alone. Florida now allows non-FDA approved stem cell therapies:
A new law in Florida, CS/CS/SB 1768, allows physicians to market and administer stem cell therapies that have not been approved by the U.S. Food and Drug Administration (FDA) for orthopedic conditions, wound care and pain management.
These experiments in regulatory federalism are vital and not just for patients but also for geopolitical competition. I am thrilled China is pursuing medical innovation (I predicted and applauded this in my TED talk) but I also don’t want to see America falling behind.
The Trump administration has been supportive. I would like to see HHS and the FDA working with companies operating under state right-to-try frameworks — sharing data, clarifying federal-state boundaries favorably, and treating these experiments as the biotech competitiveness infrastructure they are.
The FDA approval process has long been treated as the only legitimate path to market. The cost of that orthodoxy is measured in companies that never reached viability, innovations that never got off the ground, and patients who died when they didn’t have to. I have spent thirty years trying to get people to see the invisible graveyard. That’s hard. Most remain blind. But China’s bursting pipeline of new drugs is visible — could this be a Sputnik moment for biotech?
An American biotech renaissance — driven by AI, federalism, and regulatory innovation — is possible. The path forward is to double down on what makes America great: the laboratories of democracy are working, and in Montana and Florida, so are the labs.
The Cultural War is a Civil War
Kevin Bryan riffs on on my post The Nationalization of American Science. He is rightfully incensed:
AT is right this is a red tape-filled science policy of “losers”. If you think “cut funds from DEI-driven professors in the small departments no one cares about” is more important than “make sure the world’s strongest fundamental science continues”, you’re an idiot.
And yes, this is also the policy of “right-wing JD-brain” folks. They haven’t worked in a lab. They don’t know how we got AI, and recent cancer breakthroughs, and on and on. It’s all culture war, all the time – just the right-wing equivalent of the worst left-wing habits.
One last thing: I *hate* the term “administration priorities” or “President’s priorities”. Totally Unamerican! The President *executes* the law created by Congress, who represent the people, and who see turnover every two years. Period. “Oh, but Democrats do this too!” Grow up!
Owning the libs may feel good today but please look just one move ahead in the game tree. When AOC controls the executive branch, she will inherit every tool Trump normalized. Look a few moves further and see the damage to American institutions.
The culture war is a civil war. If we don’t end it, American science will be collateral damage.
Here Comes the Sun(screen)
I have been banging on about FDA delay in approving new sunscreens since 2013. Well it has finally happened. Twenty six years after being approved by the European Union and thirteen years after then-FDA Commissioner Margaret A. Hamburg told lawmakers that sorting out the sunscreen issue was “one of the highest priorities” the FDA has approved a new sunscreeen ingredient.
The US has been slow because it regulates sunscreens under the the more expensive, time consuming and rigorous drug standard rather than the less expensive cosmetic standard. Does this mean that our sunscreens are safer? No.
In fact, American sunscreens may be less safe.
Sunscreens protect by blocking ultraviolet rays from penetrating the skin. Ultraviolet B (UVB) rays, with their shorter wavelength, primarily affect the outer skin layer and are the main cause of sunburn. In contrast, ultraviolet A (UVA) rays have a longer wavelength, penetrate more deeply into the skin and contribute to wrinkling, aging and the development of melanoma, the deadliest form of skin cancer. In many ways, UVA rays are more dangerous than UVB rays because they are more insidious. UVB rays hit when the sun is bright, and because they burn they come with a natural warning. UVA rays, though, can pass through clouds and cause skin cancer without generating obvious skin damage.
The problem is that American sunscreens work better against UVB rays than against the more dangerous UVA rays. That is, they’re better at preventing sunburn than skin cancer. In fact, many U.S. sunscreens would fail European standards for UVA protection. Precisely because European sunscreens can draw on more ingredients, they can protect better against UVA rays. Thus, instead of being safer, U.S. sunscreens may be riskier.
European sunscreens are also more pleasant to apply, and because they work better with makeup they are probably used more often as part of a skin care regimen, which may reduce the prevalence of skin cancer. Once again, the United States’ slower and seemingly more risk-averse approach actually increases risk.
The lesson, for those who are listening, is general.
The Nationalization of American Science
OMB, joined by some forty grantmaking agencies—NSF, HHS, DOE, NASA, DOD among them—has proposed a sweeping rewrite of the rules governing all federal grants, the Regulation for Federal Financial Assistance.
American science has long been state funded but not state directed. Since Vannevar Bush, money has flowed through many agencies to independent universities, allocated largely by peer review. The system has flaws—conformity, gerontocracy, waste—but it had one great virtue, the system was decentralized and not under state control. This rule proposes to bring science funding under top-down, state control.
Program goals must now be “aligned with administration policies and priorities” (§ 200.202). Merit review is subordinated to politics: “senior appointees must conduct these reviews,” ensuring “that discretionary awards advance the President’s policy priorities,” while “peer review remains advisory and does not replace agency discretion” (§ 200.205). And every grant becomes terminable at will, whenever it “no longer effectuates program goals, Federal agency priorities, or the national interest *as they exist at the time of the termination*” (§ 200.340, emphasis added). Universities must even ensure their subrecipients don’t “significantly damage the reputation of… the Federal Government” (§ 200.332)—a loyalty clause for scientists.
All this is sold as cutting “burdensome conditions,” a goal I would support, but sadly that is bullshit. The proposed rules add more paperwork and many more layers of bureaucratic review. Payment requests must include written justifications. Every disbursement gets screened through Treasury’s “Do Not Pay” system. Every recipient must run E-Verify. Applicants must disclose any employee who worked at the awarding agency within two years. And on top of the existing review machinery sits a new pre-issuance review committee of “senior appointees” second-guessing the experts. Fixed amount awards—pay for outputs, not inputs—an innovative reward mechanism are *eliminated*, so every award now gets routine cost monitoring and financial reporting.
Political review of every award, peer review demoted, agency review promoted, termination whenever “priorities” change. Chilling. It’s a nightmare of petty low-trust review of the kind that is already drowning science. I must deal with this kind of nonsense all the time. More is not better.
The machinery is centralized too. OMB’s guidance becomes binding regulation, effective government-wide with no agency rulemaking. One dial in the White House now turns every grant program in the country.
The new rules will be sold as getting rid of DEI but that is an excuse to bring in the commissars. The new rules don’t depoliticize science they create even more politicization with the sign flipped, and the drafters admit it:
In the previous administration, executive agencies frequently chose to subsidize and expressly prioritize projects based on their ideological alignment with the categories of activities discussed in the proposed version of § 200.300. See, for example, E.O. 13985, sec. 1, 86 FR 7009, 7009 (Jan. 25, 2021) (“It is therefore the policy of [the Biden] Administration that the Federal Government should pursue a comprehensive approach to advancing equity . . . .”). In this administration, executive agencies will continue to use their discretionary authorities in a manner consistent with current Executive Branch policy. If executive agencies were entitled to subsidize those types of activities during the previous administration, there is no constitutional basis to prevent the government from reaching a different policy determination regarding which activities to fund during this administration.
Read that twice. Tip your hat to the new constitution, take a bow for the new revolution. Will science prosper when it is whipped by political turnover? Research runs on decade timescales; administrations run on four-year ones.
A decentralized funding system is inefficient the way markets and federalism are inefficient—we give up some economies of scale and get experimentation, error correction, and robustness in return. A system in which every award advances “the President’s policy priorities” is efficient the way ministries of science are efficient. We know how that experiment ends.
America is moving in the wrong direction. We should double down on what made America great. Instead we are adopting all of the loser policies of authoritarian nations.
The Labor Share Fell. So What?
The share of Gross Domestic Income accruing to labor has been declining in recent decades while the share accruing to capital has been rising. In the graph below, I show labor compensation as a share of GDI (left axis). Labor share has indeed been trending down–some of this could be an artifact of the data, e.g. an increase in proprietor’s income (labor) mislabeled as capital income, more pass throughs and so forth—but for the purposes of this post I will accept that the labor share has declined. What does this mean?
The natural response is to think that because the share going to labor has fallen and the share going to capital has risen that there has been a transfer of income from labor to capital. That is possible but it is not the only interpretation and it does not follow mechanically from the share data.
I have also plotted total compensation to labor (in real terms) in the graph above and far from shrinking it is higher than ever and growing. Moreover the right axis is logged so you can also see that outside of recessions the growth rate of labor compensation looks quite steady (similar slope over time). (Labor compensation per member of the labor force is noisier but looks similar).
The recessions in 2008 and 2020 are worth noting because these are periods when the labor share was high and locally at a maximum! The reason, of course, is that GDI was shrinking in these periods more than labor compensation. In other words, capital takes a bigger hit than labor in a recession. This is a good reminder that a high share of GDI is not what workers most care about–a high absolute level of GDI is more important for the bottom line.
In short, the data are consistent—not proof of, but consistent with—a story in which capital has become more productive, raising output. More productive capital also raises the demand for labor, so while more of the new output goes to capital in the first instance, the pie is growing and labor’s absolute compensation has grown with it. Yes, if the shares had stayed constant and output had grown just as much, labor compensation would have been higher still. And if my grandmother had wheels, she would have been a bicycle.
Hayekian Literary Criticism
In economics, Marx is relegated to the history of thought as his ideas were an economic dead end and a political disaster. Yet Marx-influenced literary criticism is a dominant mode of analysis in nearly every English department in the country. It’s not that the English professors are all Marxists, it’s that even the non-Marxists reach for Marxian concepts–class, ideology, alienation, material conditions, commodification–when analyzing texts. These concepts may be useful for analyzing a Victorian novel of the landed classes but they have become a default economics for all of literature. That default is odd. Class analysis predates Marx and society can be divided into more than one set of classes; material conditions do not supersede all artistic agency; and capitalism contains figures—entrepreneurs, speculators, intermediaries, innovators, discoverers—who are great subjects for art yet fit poorly into the Marxist moral geometry. Not surprisingly, Marxism handles capitalism’s protagonists badly.
Is Marxian economics the only economic lens one can apply to literature? What would a Hayekian literary criticism look like? The place to start is the great Paul Cantor’s pioneering essay on Thomas Mann’s “Disorder and Early Sorrow,” a slight-seeming story set in Weimar Germany during the hyperinflation. Cantor shows that when one reads the novella through Hayek and Mises rather than Marx, the story opens up.
Start with inflationary psychology and its ramifications. Inflation shortens time horizons. When money loses value by the hour, saving is foolish and the rational move is to spend as fast as you earn—Mises’s “flight into real goods.” Prudence, discipline, and respect for the past become maladaptive. Speed, improvisation, risk-taking, and a certain youthful irresponsibility become survival traits.
Thus, Cantor/Mann tell us that inflation changes psychology and inverts the authority of age over youth. The old are set in their ways and often living on fixed incomes that inflation has wiped out; they cannot adapt. The young have known nothing but instability and go with the inflationary flow effortlessly. So the conservative virtues that once commanded respect are in decline while youthful recklessness starts to look like competence. Thus, Mann’s world has “gone mad in the worship of youth”: the children call their father by his first name, the teenagers are “the big folk,” and Professor Cornelius literally crouches down to his children’s height as the hierarchy collapses around him.
Money is a society’s primary measure of value, so Cantor/Mann argue that when you shake a people’s faith in their money, you shake their other faiths. Thus Cantor ties the conviction-less skepticism of Cornelius—and the broader Weimar nihilism and disequilibrium that helped feed the rise of Nazism—to monetary disequilibrium.
In short, inflation converts economic disorder into moral, social, psychological, and finally ontological disorder. Prices become unstable, then values, then identities, then reality. The modern feeling of absurdity and inauthenticity that critics reflexively pin on capitalism, Cantor/Mann argue is due to government-created inflation and paper money.
A Marxist could read the same story and find the inevitable contradictions of capitalism. Cantor reads it and finds the consequences of the state debasing the currency. Both are economic readings of literature. Only one of them has the economics correct.
Cantor is the place to begin but a Hayekian literary criticism could go much further. Atavism, the impossibility of social justice, products of human action but not of human design, spontaneous order, the fatal conceit, subjectivism, the sensory order–there is a lot of Hayekian ideas that literary interpretation could draw upon.
A Hayekian criticism would ask questions like how do characters acquire and process knowledge? Which institutions transmit information successfully, and which corrupt it? How do money, law, language, and custom function as social coordination mechanisms? Why do some attempts at rational redesign end in disaster? Read War and Peace as a critique of the great-man theory of history, Brazil and The Lives of Others as the fatal conceit degenerating into ignorance, fear, and absurdity. The Wire as a Hayekian epic of spontaneous order that demonstrates the illusion of social justice. Cantor’s essay on Mann shows the method, the broader project remains underdeveloped.
Hat tip: Hollis Robbins for discussion.
Addendum: Don’t forget my earlier WSJ piece, Capitalism: Hollywood’s Miscast Villain which gives an economic, one might even say Marxist, explanation for why film directors in particular disdain capitalists.
Let Me Disinherit My Children, S’il vous plaît
Following John Arnold, I posted earlier about how European laws often require wealthy people to give most of their wealth to their children. Here is an example:
Pierre-Edouard Sterin, founder of Smartbox and worth about €1.4 billion, told French senators he wants to disinherit his five children and donate everything to charity. French law, under the Napoleonic Code, mandates that with five children, three-quarters of his estate must go to them, leaving only one quarter freely disposable. Sterin argued for complete freedom to decide the fate of one’s assets, saying it is ‘a real freedom to start with nothing in life’.
Tyler and Alex Speak to OpenAI
We were honored to speak to OpenAI about the economics of AI. Lots of good material here. Self-recommending.
CA Logic
In California a 17 year-old can drive a car but can’t ride alone in an Uber or a Waymo.
I long for the days when you could put a kid in the post. We have weakened as a civilization.
The US Exports Intelligence
Most Americans work in the service sector so it’s not surprising that most export-related jobs are in the service sector (The U.S. exports about $2.2 trillion of goods and $1.2 trillion of services, but services are more labor intensive than manufacturing so they support more export jobs per dollar.)
Richard Baldwin writes:
In 2022, US service exports supported 8.9 million American jobs.
US manufacturing exports supported 2.2 million.
That’s four-to-one in favour of services. Yet in the national narrative, ‘export jobs’ almost always means things done in steel mills and factories.
…When a household in Germany pays for Netflix, that is an American export. When a Brazilian retailer buys Microsoft cloud capacity, that is an American export. When JPMorgan structures a financial deal in London, or an American consulting firm advises a company in Singapore, those are American exports too.
None of these is shipped in a container. No customs official records them as they clear the customshouse. Yet they are exports since they earn foreign income for America just as surely as the ‘Boeings, Beans and Beef’ that President Trump sold on his recent China trip.
Need I remind you that when OpenAI sells intelligence to people abroad, that is a US export? N.B. this is the future.
World trade in goods expanded roughly five-fold between 1990 and 2020. Trade in digitally enabled services expanded more than eleven-fold over the same period. These are the modern services.
The trade debate is fixated on manufacturing—where America is doing fine—while largely ignoring services, where America is crushing. Increasingly, our most valuable exports travel not on container ships but at the speed of light over fiber.
Europe Demands Family Dynasties
In the US, someone with wealth is free to give it away more or less as they see fit (spousal claims excepted, which partly reflect marital co-ownership). In much of Europe, however, there is forced heirship–a large fraction of wealth must be handed down to children which makes it harder to direct large portions of wealth to charities, foundations, or non-family causes compared to the US. (Louisiana, with its French-Spanish civil law roots, is the one state with forced heirship and even it mostly gutted it in 1995.)
Here is an excellent post by John Arnold who, if he were European, would be required to give 75% of his wealth to his three children instead of spending it on philanthropy as he and his spouse are now doing.
America’s cultural ideal has been the self-made entrepreneur while Europe’s was rooted in aristocracy, with status inherited rather than earned. Europe’s inheritance laws show this divide.
Many European countries have “forced heirship” laws that require people to leave 50-75% of their estates to their children. Want to leave the majority of your wealth to charity? not allowed. Your kids are estranged from you, struggling with addiction, or irresponsible? still required to give them the money. Want your kids to avoid a life of entitlement? tough.
Incredibly, these laws look back at transfers made during your lifetime. If you have 3 children in France, you’re required to bequeath them a minimum of 75% of your estate. Because French law calculates this based on your assets at death plus all lifetime gifts, giving away more than 25% of your wealth while alive means your heirs can legally sue to force charities or foundations to return the funds. This has limited the development of the nonprofit sector on the continent.
The cultural gap between an entrepreneurial society and one shaped by dynastic wealth is enormous. If you make it yourself, you tend to want your kids to do the same. If you inherit it, the primary goal is protecting the estate for the next gen.
Countries like Spain, France, and Italy legally entrench family dynasties, while America has historically sought to limit them through estate taxes. The result is not only a weaker culture of philanthropy and civil society in Europe, but also less economic dynamism.
It’s interesting that in Capital Piketty discusses required equal division to children as an egalitarian legacy of the revolution but, as far as I recall, never reflects on the fact that forced heirship prevents a French entrepreneur from giving his fortune away to charity. A case for laissez-faire, no?
80,000 Hours: The Book
Forty hours a week, fifty weeks a year, forty years: a career is about 80,000 hours. Yet it’s striking how little serious thought goes into career decisions relative to, say, choosing a mortgage. Indeed, you are almost supposed to tell a story about how a random incident changed your life. One summer a circus came to town—and that’s the whole reason I became an economist! (True story!). Career advice, when it exists, often amounts to the platitude of “follow your passions!” Ugh. If you ask people what their passions are, music, arts and sports top the list but guess what? There aren’t enough jobs in those categories to go around.
Benjamin Todd’s newly updated book, 80,000 Hours is a unique examination of careers that runs the numbers in a serious way. The book is framed along Effective Altruism lines and it has some good public policy material. Pandemics, for example,
The world has plenty of religious cults, despots and would-be school shooters who might decide they want to take everyone else down with them…. The world [c]ould be one lab leak away from catastrophe.
Given what we know about the pace and accessibility of bioengineering tools, the chance that there will be a pandemic that kills over 100 million people during the next century seems high, plausibly similar or greater than the risk of large-scale nuclear war or climate change above six degrees. An engineered pandemic could also kill over 90% of the population,suggesting its overall scale is significantly larger.
But risks from pandemics are, even now, far more neglected than either of these. In comparison to $6bn–$10bn of philanthropic funding for climate change, and $1.6 trillion of total climate finance, pandemic prevention only receives $1bn of philanthropic funding, and total spending aimed at reducing the chance of worst-case pandemics is probably under $10bn.
See also my paper Pandemic Preparation Without Romance on what to do about it.
The opening chapters present the EA framing but most of the book has good advice even for the purely selfish–advice on building skills, networking and how to actually get a job. From what I have said so far, one might get the impression that the idea is to rationally choose your career at age 16 and then optimize your life around that plan. Not so! Todd rightly divides career paths into explore, build and deploy categories. Most people under-explore. It’s ok to jump around jobs and places, especially when you are young, so long as you are building skills and not just accumulating items for the CV. There’s evidence, for example, that scientists’ best work tends to follow periods of exploration with exploitation.
I also appreciate that Todd specifically warns about about armchair theorizing. Pro-and-con lists, for example, are ok but far less useful than getting out of the chair and actively exploring. Go talk with people, try something for a week, go somewhere. Look for cheap tests.
Start with what’s easiest. We often find people who want to, say, try out economics, who then apply for a master’s degree. That’s a huge investment of time. Instead, think about how you can learn This could mean first reading an economics textbook, or taking a single course.
You can think about creating a ‘ladder’ of tests. Start with the cheapest ways to test your options, then after each step, re-evaluate. A ladder might look like this:
a. Read our relevant career reviews, all our research on a given topic, and talk to LLMs about what the jobs are like (two to five hours).
b. Speak to someone in the area (two hours).
c. Speak to a friend to get an outside perspective on what’s best (two hours).
d. Speak to three more people who work in the area and read one or two books (twenty hours).
e. Given your findings, look for a relevant project that might take one to four weeks of work – like applying to jobs, volunteering in a related role, or doing a side project in the area – to see what it’s like and how you perform.
f. Only then consider taking on a two- to twenty-four month commitment – like a work placement, internship or graduate study. Being offered a trial position with an organization for a couple of months can be ideal because both you and the organization want to quickly assess your fit.
80000 Hours is The Random Walk Down Wall Street of career advice, the one book that really matters.
Explore, build rare and valuable skills, point them at a meaningful problem, and passion will follow rather than lead. And for those who don’t want to read a book, speak to an 80,000 Hours advisor. It’s a very cheap test.
Why are Murders Down in Baltimore?
In 2015 I wrote Baltimore Arrests are Down and Crime is Way Up and, as I predicted, Baltimore tipped into an high crime equilibrium. After the Freddie Gray riots, arrests declined and crime shot up but crime stayed high even after arrests rebounded. In my view, the surge fed on itself: higher crime strained police resources, and that strain—in and of itself—reduced the probability of punishment, sustaining the high-crime equilibrium, as in my crime wave paper.
Yet, beginning around 2022 crime in Baltimore—most especially murders—began to fall.
In April, Baltimore had four homicides, the lowest total for any single month since at least 1970. So far this year, there were 38, compared with 51 in the same period last year. At the current rate, Baltimore would end 2026 with fewer than 100 homicides. There were 323 just four years ago.
How did we get from a city in which the question was how high can crime rise, to one where the question is how low can it go? The answer might be linked to the nationwide decline in murder, spurred by a restoration of policing as the excesses of the George Floyd years recede. But that raises the question of what cities across the country are doing right.
So what caused the decline? We can’t be entirely sure as national trends confound but Charles Fain Lehman has a good piece in the FP arguing plausibly that the answer boils down to carrots, sticks and the non-random nature of murder. Begin with the latter. A significant subset of murders are highly predictable. A gang member gets gunned down today. Next week, you can expect retaliation. Moreover, you know who is going to do the murder even more than you know who is going to be murdered. Namely, a close associate—a fellow gang or family member—will be the one to do the killing. Sometimes pre-Cog is not so hard.
So with this in mind, Baltimore, under a new mayor and tough on crime prosecutor, began to intervene in the murder cycle before it happened, i.e. a focused deterrence program based on Boston’s Operation Ceasefire.
The approach involves a detailed investigation of every shooting that happens in the city. Every week, the Baltimore Police Department and its partners review the week’s incidents….For every shooting, GVRS prescribes reaching out to known associates of the victim.
…At one recent coordination meeting, about 20 people gathered around the table of the conference room at Baltimore’s Doxa Ministries Church Without Walls. Under the direction of Reginald Williams from the Mayor’s Office of Neighborhood Safety and Engagement, they talked through two new “referrals” associated with the victim of a recent shooting. One had a long criminal history and was on house arrest. Another, barely an adult, was himself a victim a few years earlier.
Both men will have their doors knocked on by several of the meeting’s attendees. They will be offered services—job training, tattoo removal, relocation, whatever they need to get out of the “life.” But they will also get a clear message, delivered verbally and in the form of a letter from Mayor Scott: Baltimore is watching them—and will come after them.
Carrots, sticks, and a little Pre-Cog. Together they appear to be working.
Doc in a Box
The first review of the pilot for AI prescriptions refills in Utah is out and it looks very reasonable. In the 72% of cases where the AI recommend a refill at least one of two physicians agreed in 97% of cases.
In the 28% of Cases Where the AI Escalated to a Physician Without Recommending Renewal
o When the AI declined to recommend renewal without further information, a human telehealth appointment was arranged.
▪ For these patients, 69% of physician reviews agreed that the escalation was appropriate, and more information was needed to authorize a renewal.
▪ In the other 31% of cases, the physician determined the escalation was overly cautious.
● For a new system like this, overcaution is appropriate and welcome. In the long term, reducing overcaution without compromising safety would improve patient access to care, but we aren’t rushing to see that happen.
The founders of Doctronic, the firm running the AI doc, write:
The cost of compute drops roughly 10x every five years. At the same time, the demand for care continues to rise. An AI consultation that costs a few dollars today will cost pennies in a few years. So if AI can safely handle even a fraction of care, we’ve turned an unsolvable supply problem into an engineering problem. And engineering problems have solutions.