"We Are All On Borrowed Time": Here Is ChatGPT's Analysis Of The JOLTs Report

 One look at a particularly green subset of tech stocks and it becomes clear that there is a lot of hype surrounding AI. Yet when we look at how ChatGPT can complement - or even overhaul - financial analysis, we are certain that many Wall Street jobs will soon vanish and be replaced with faceless (and much cheaper) AI algos.

As a reminder, three months ago, in our first foray into this arena, we asked ChatGPT to "Write A Taylor Swift Song About The Volatile Macro Market." The result was impressive.

Now, Goldman trader Rich Privorotsky has done something similar, this time evaluating AI's ability to replace Wall Street economists, by asking it to provide an analysis and assessment of yesterday's JOLTS report (something we did here). The results below demonstrate that the one category this subset of Wall Street workers should be very concerned about is the coming spike in the unemployment rate. As the Goldman trader puts it: "we are all on borrowed time."

Here is Privorotsky:

I fed ChatGPT a selection of the Jolts data and asked it whether the Jolt data was consistent with a decelerating or accelerating economy, this is what it came up with…we are all on borrowed time: 

“This data is more consistent with a decelerating economy. A decelerating economy is typically characterized by a slowdown in growth, and the data provided indicates several signs of such a slowdown:

1. Decrease in job openings: Total private job openings decreased by 599,000 from January 2023 to February 2023, suggesting fewer opportunities for job seekers and potentially slower growth.

2. Decrease in hires: Total private hires decreased by 145,000, indicating that companies might be more cautious about expanding their workforce, which could be a sign of a decelerating economy.

3. Decrease in layoffs and discharges: A decrease in layoffs and discharges could be a positive sign for the economy, as it might indicate lower unemployment. However, when combined with the decrease in job openings and hires, it could also suggest that companies are more hesitant to let employees go due to the uncertainty of finding new hires in a potentially slowing economy.”

 me: there anything obvious here about small business compared to large companies?

 Yes, there are some differences between small businesses and large companies in the data provided:

1. Job Openings: Small businesses with 1-9 employees saw a significant decrease in job openings from January 2023 to February 2023 (-198,000), with the job openings rate declining by 1.0 percentage points. In contrast, larger companies (1,000-4,999 employees) experienced a slight increase in the job openings rate (0.1 percentage points) during the same period.

2. Hires: Small businesses (1-9 employees) had a slight increase in hires (+17,000) from January 2023 to February 2023. On the other hand, larger companies (50-249 employees and 250-999 employees) experienced a decrease in hires during the same period (-174,000 and -94,000, respectively).

3. Layoffs and Discharges: Small businesses (1-9 employees) experienced a significant decrease in layoffs and discharges (-110,000) from January 2023 to February 2023. Larger companies (50-249 employees) also saw a decrease in layoffs and discharges (-103,000), but the change wasn't as drastic as in small businesses.

These differences suggest that small businesses might be facing more significant challenges compared to larger companies. The larger decrease in job openings and the significant decline in layoffs and discharges in small businesses may indicate a higher level of uncertainty and potentially more vulnerability in the face of a decelerating economy. However, it's important to consider other factors and data points to have a comprehensive understanding of the overall business environment for both small and large companies."

https://www.zerohedge.com/markets/we-are-all-borrowed-time-here-chatgpts-analysis-jolts-report

No 'California Dreamin' for Single Payer Healthcare

 California is dreaming about a government takeover of health insurance once again.

Earlier this month, state Sen. Scott Wiener, D-San Francisco, introduced SB 770. The bill would seek a federal waiver to allow the state to use federal funds earmarked for Medicare and Medicaid to create a state-run health insurance system that would cover all Californians — whether they like it or not.

Previous efforts in California to ban private health insurance and force everyone into a government-run plan have failed. The odds of Wiener's bid succeeding are long, too. Good thing, because a government takeover of the health insurance system would be fiscally ruinous.

California Gov. Gavin Newsom came to office in 2019 promising a statewide single-payer system. On his first day in office, he asked the Trump administration for a waiver similar to the one Sen. Wiener is now agitating for. That went nowhere.

He set up a commission to explore how to implement single-payer within the Golden State. That commission's final report in June 2022 called for a "unified financing" system but stopped short of insisting on single-payer.

Sen. Wiener is trying to speed things up. His bill would hold the Newsom administration to several deadlines for securing a federal Medicare waiver. Without the billions in federal dollars that currently pay for coverage for Medicare and Medi-Cal beneficiaries in California, a state-run health plan will never get off the ground.

Sen. Wiener's strategy for achieving single payer isn't as direct as earlier efforts. For instance, a bill introduced by Assemblyman Ash Kalra, D-San Jose, in 2021, which stalled in the legislature this past January before coming to a vote, would have abolished private health insurance entirely and replaced it with a single government-financed coverage program known as CalCare.

Wiener's piecemeal approach doesn't make it any less dangerous than those previous single-payer proposals. The truth is that single-payer is simply cost-prohibitive, with or without federal dollars.

It could cost anywhere from $314 billion to $391 billion a year, according to an analysis from last year. That's more than the entire state budget. A Medicare waiver will only do so much to defray those costs.

California's budget deficit is expected to reach $22.5 billion next year. This has left Newsom scrambling for ways to tighten the state's belt. A massive, taxpayer-financed restructuring of the healthcare sector is the last thing lawmakers should be considering right now.

Earlier single-payer proposals sought to pay for the new government-run health system through some combination of payroll tax increases and a new excise tax on businesses. But tax hikes of this magnitude are incredibly short-sighted.

California already levies some of the highest personal and business taxes in the country. If lawmakers raise taxes further, it could prompt even more companies and high-earning individuals to leave the state. State revenues would plummet.

At the same time, the quality of care available to Californians would decline dramatically under a single-payer system. Consider that, once the government takes control of health insurance, doctors will become de facto public employees. Those who remain in the state will be forced to settle for whatever income the government decides to pay them. And that won't be much.

In short order, doctors will flee for freer healthcare markets in which their skills and expertise are valued more fairly. When that happens, medical care will become a scarce commodity. Rationing and long waits for care will follow, as has happened in the Canadian and British systems of universal coverage.

Many parts of California already suffer from critical doctor shortages. Eight million state residents currently live in areas that lack a sufficient number of primary care doctors. By driving physicians away from the state, single-payer would only exacerbate this crisis — and make medical care harder to come by.

Of course, single-payer advocates like Wiener and Kalra ignore these bleak realities. Instead, they simply assume that abolishing private insurance and shifting everyone onto a government-run health plan would be a gift to Californians.

They're wrong. Single payer would exact an unthinkable toll on the health of all Californians and the finances of the Golden State.

Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is "False Premise, False Promise: The Disastrous Reality of Medicare for All," (Encounter Books 2020).

https://www.newsmax.com/sallypipes/california-single-payer-healthcare/2023/04/04/id/1114956/

The Dangers of Ideology over Science in Medicine

 Social ideologies about race and oppression have begun to permeate every aspect of American society. Regardless of one’s views on systemic racism, everyone should be concerned about a new and dangerous movement within medicine. While seeking to promote inclusion, it has, unfortunately, put wokeness and political correctness above science and facts. This is unacceptable when people’s health and lives are on the line.

The University of Illinois – Chicago made headlines after publishing a resource guide claiming that obesity is rooted in racism. Amanda Montgomery, a research assistant and author of the controversial resource, wrote that the idea of obesity as a bad thing is merely cultural. She claims that “Fatness and differing body characteristics were used to justify lack of civilization” and the idea was used “as a way to justify slavery, racism and classism, and control women through ‘temperance.’” 

Indeed, obesity is slightly more prevalent among African-American adults (49.9%) than Hispanic (45.6%) or white (41.4%) adults; however, when turning those into raw numbers, it shows a different picture. Obesity impacts 104.8 million white adults and 22.2 million black adults. Factors such as geographic food styles and income level affect food choices. The facts and statistics show that, contrary to the woke medical crowd, obesity cannot be pegged as a racial issue. It is a problem across the board.

Ignoring the decades of research showing that obesity is a preventable disease, Montgomery asserts that it is actually due to “uncontrollable genetic or environmental factors.” When it comes to the negative health outcomes that are equally well-documented, she claims it is a mere correlation, not causation. She claims that the real cause of diabetes and heart disease is “weight stigma,” not obesity. Her solution is for doctors across the nation to tell patients that there is nothing they can do about their weight and there is nothing they should do. It is wrong to encourage patients to exercise or eat more healthily in quantity and types of food because it leads to negative feelings and weight stigma.

It is obvious where this solution will lead: even more obesity and exponentially higher heart disease and diabetes levels. Why? Because obesity, not stigma, causes these health outcomes, and one’s lifestyle and everyday actions can lead to obesity. There is not a one-size-fits-all solution to obesity. No diet works for everyone. One workout routine might be the key for one person and impossible for another. However, even taking moderate measures of walking regularly and watching what you eat is exponentially better than doing nothing and telling people they are helpless against this preventable disease.

Obesity is not the only area where wokeness is superseding facts. Do No Harm, a group that seeks to disconnect politics and social ideology from medicine, has documented the rise of “anti-racism” in medicine that is leading to significant errors or other harmful outcomes for patients. Last month, they analyzed a journal article blaming “structural racism” for leukemia outcomes. Upon evaluating the article, they found that the minority patient sample was skewed. Those with more severe leukemia characteristics were overrepresented in the minority group. Do No Harm notes that, in the name of anti-racism, “the authors dismiss the leukemia characteristics as not important, yet they are well known to be important.” No wonder the minority group fared worse than their white counterparts with less severe cases.

Do No Harm president, Dr. Stanley Goldfarb, stated that “there are individuals who actually believe that these kinds of racist approaches are going to benefit patients, but, in fact, they're wrong.” These unscientific papers will hurt people looking for quality medical care.

This problem is not limited to medical journals and research projects. Medical schools that are responsible for training our next generation of physicians are teaching anti-racism. The University of Buffalo has adopted a new curriculum for its medical school “with anti-racism at its core,” according to the school. Instead of focusing on providing world-class scientific training, Buffalo students will learn about “the history of anti-Blackness [and] discrimination against LGBTQ+ people and other marginalized communities.” When looking at “longstanding health issues in African American communities,” the curriculum will “directly acknowledge[e] the effects of systemic racism and the threat of police violence…”

The Kaiser Permanente School of Medicine “seeks to embed anti-racism and related topics throughout its curriculum,” including “social identity, intersectionality, microaggressions, power and privilege, [and] cognitive bias mitigation.” Last year, the Massachusetts Medical Society and some of the state’s top medical schools, including Harvard, adopted a commitment to anti-racist medicine and medical education. Time previously spent learning about medical practice and science is now spent on unscientific social theories.

There are legitimate medical issues related to race that need research and study. But the wokeness movement is doing a disservice to  legitimate research and science.. Instead of giving patients a solution or treatment to their health issues, our next generation of doctors are being trained to console them by blaming the system for their health. In the name of dismantling racism, this approach to medicine will lead to worse health outcomes, less treatment for preventable diseases, and less medical knowledge among our doctors.

Dr. Goldfarb states that the problem in American healthcare is “because of personal behaviors, understanding of the risks of illnesses, and access to the health care system” and that “it will only get worse if we put all our resources into the wrong solution to the medical problem.” We must stop putting wokeness over medical science, or else we will cause great harm.

Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist. Dr. Singleton completed two years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. She was an instructor, then Assistant Professor of Anesthesiology and Critical Care Medicine at Johns Hopkins Hospital in Baltimore, Maryland before returning to California for private practice.

https://www.realclearhealth.com/articles/2023/04/03/the_dangers_of_ideology_over_science_in_medicine_111490.html

Why Limit Health Care Competition?

 West Virginia goes out of its way to block health care competition. Investors cannot open skilled nursing homes, launch opioid treatment programs, expand long-term care facilities or add residential beds for people with intellectual disabilities anywhere in the state.

Strict moratoriums criminalize all of these economic pursuits, even when doctors line up their own funding. Other health care projects are possible, but most entrepreneurial activity cannot move forward in West Virginia without a government permission slip called a “certificate of need” or CON.

Getting the piece of paper is not easy. Applicants must demonstrate a need for their services, meaning they must prove to the state’s satisfaction they won’t take market share from established providers.

If a startup threatens the status quo, then industry insiders can rally to squash the competition before it begins. West Virginia sanctions this interference. State law allows established providers to participate in the CON application process, giving them an official platform to sabotage potential rivals.

Business leaders in other industries would love similar veto power. The Home Depot could stop mom-and-pop hardware stores from opening nearby. Planet Fitness could block smaller gyms. And McDonald’s could push away rival burger joints.

Even when investors clear the CON hurdles, the process wastes time and money. “Conning the Competition,” a nationwide report from our public interest law firm, the Institute for Justice, shows West Virginia CON applicants must pay up to $35,000 and wait two months or longer for government approval.

The report also documents an expansive CON regime in West Virginia unseen in many parts of the nation. California, Texas and 10 other states — representing about 40 percent of the U.S. population — completely repealed their CON laws years ago. Ohio, Indiana and Montana apply CON requirements only to long-term care facilities, and Arizona targets only ground ambulance services.

West Virginia, in contrast, targets just about everything. No other state maintains a moratorium on opioid treatment programs. And few other states enforce CON requirements in more categories of care. Until recently, West Virginia hospitals even had to navigate the entire CON process just to add ventilator services.

COVID-19 prompted 24 states and Washington, D.C., to adopt emergency measures, suspending their CON requirements during the early weeks of the pandemic. But West Virginia refused to budge.

The state passed its CON law in 1977, meaning government bureaucrats have been picking winners and losers in health care for nearly 50 years. The protectionism runs deep, but state lawmakers took a step toward leveling the playing field with Senate Bill 613.

The measure, which Gov. Jim Justice signed on March 28, scales back some of West Virginia’s most onerous CON requirements. The new law exempts birth centers, for example, allowing service providers to create these niche facilities without begging the state for approval. The law also allows hospitals to add services without a CON, and increases the expenditure threshold for requiring a CON from $5 million to $100 million.

Entrepreneurs will benefit from lower barriers to entry. Health care professionals will benefit from expanded job opportunities. And patients will benefit from increased consumer choice.

Ultimately, the entire economy will benefit.

The reform should be celebrated, but West Virginia still has far to go. The ultimate goal should be total CON repeal.

Hospital associations disagree. They claim CON laws are necessary to keep balance in the health care system, preventing redundant investments and reducing waste. Yet federal antitrust agencies debunked these arguments long ago. “By their very nature, CON laws create barriers to entry and expansion to the detriment of health care competition and consumers,” the U.S. Department of Justice and Federal Trade Commission concluded in 2008.

Decades of real-world experience confirm this finding. States without CON laws have more hospitals and surgery centers per capita, along with more hospital beds, dialysis clinics and hospices.

Why would West Virginia try to prevent this type of growth? Rather than artificially restricting health care investment, the state should kill its CON law and expand opportunities for everyone.

Jaimie Cavanaugh is an attorney and Daryl James is a writer at the Institute for Justice in Arlington, Va.

https://www.realclearpolicy.com/articles/2023/04/05/why_limit_health_care_competition_891932.html

Pfizer RSV vaccine 82% effective vs severe infection in infants, final data shows

  Pfizer Inc's experimental respiratory syncytial virus (RSV) vaccine was 82% effective in preventing severe infections in infants when given to expecting mothers in the second half of their pregnancy, according to trial details published on Wednesday that confirm preliminary data from the study.

Final data from the study that was halted early when it became clear the vaccine was effective was published in the New England Journal of Medicine.

Pfizer in November released initial trial results on the vaccine that is currently under review by health regulators in both the United States Europe. The U.S. Food and Drug Administration is expected to decide on its use by August.

FDA approval could make Pfizer's shot the first maternal vaccine available to prevent the disease in infants.

Sanofi and AstraZeneca are developing a single-dose antibody, nirsevimab, for RSV prevention in infants, which is also under FDA review.

Pfizer's vaccine, RSVpreF, met one of the two main goals of the late-stage study. It was nearly 82% effective in preventing severe lower respiratory tract illness, such as very low oxygen levels or need for ventilator support, in infants in the first 90 days of life.

Pfizer said severe illness occurred within three months in 6 infants whose mothers received the vaccine, compared with 33 infants from the placebo group who contracted serious RSV infections. The company evaluated 3,570 infants as part of the study.

The shot was 69.4% effective in preventing severe infections in the first 180 days. Severe illness occurred within six months in 19 infants born to mothers in the vaccine group, compared with 62 infants in the placebo group.

The shot failed to meet a second main goal of reducing non-severe illness in infants.

About 58,000 to 80,000 children younger than 5 years old are hospitalized due to RSV infection every year in the United States, according to government data, and infants are among those at greatest risk for severe illness. 

https://finance.yahoo.com/news/pfizer-rsv-vaccine-82-effective-210000682.html

Saudi Arabia Now Leading Regional Embrace Of Assad

 It's being widely reported that Saudi Arabia is pushing for a regional embrace of Syria's President Bashar al-Assad, more than a decade after Syria was booted from the Arab League due to the conflict which burned starting in 2011, chiefly for Damascus' anti-demonstration crackdown.

Reuters first reported this week that Saudi Foreign Minister Prince Faisal bin Farhan is planning to extend a formal invitation for Assad to attend an Arab League summit in Riyadh, planned for May 19. This will reportedly take place in person as bin Farhan is expected to soon travel to Damascus. Bloomberg is calling this a "win for Iran".

After diplomatic efforts from gulf states in the wake of the devastating earthquakes which rocked Syria and Turkey in early February sped up, Middle East Eye has reported that "Maher al-Assad, the Syrian president’s brother and head of the feared Fourth Armored Division, reportedly visited Saudi Arabia last month and received the kingdom’s conditions for normalization."

One by one, gulf nations have reembraced Assad. First the Syrian leader visited Oman in February, and the next month he went to UAE with his first lady Asma. Egypt has also sent delegations to Damascus.

Washington has been complaining about these contacts, while watching from the sidelines, as the Pentagon has continued the controversial occupation of oil and gas rich northeast Syria. Importantly, it comes against the backdrop of a China-brokered peace between Iran and Saudi Arabia. A regional analyst recently observed: 

Now, as China takes a more assertive economic diplomacy role in the Middle East, Syria remains key to Saudi Arabia’s desire to cool regional tensions.

Saudi Arabia presented the last obstacle to Syria’s return as a key player in the Arab world - a thaw that began with a hug between the Bahraini and Syrian foreign ministers at the United Nations in 2018. 

But still, the Biden administration has taken a softer tone to this rapprochement than hawks were hoping for. A senior US administration official was cited this week as saying Arab states should "get something in return" if they restore ties with Assad. 

As the above discussion on Syriana Analysis with regional expert Kamal Alam highlights, times have changed, and that change is coming fast.

A central irony remains, however: Saudi Arabia for years led the way alongside the US in seeking to topple Assad by any means possible. This included supporting jihadists and armed death squads which helped spawn ISIS, as even internal Pentagon memos have admitted.

https://www.zerohedge.com/geopolitical/saudi-arabia-now-leading-regional-embrace-assad

Picking Up the Premotor Symptoms of Parkinson's

 Matthew F. Watto, MD: Welcome back to The Curbsiders. We had a great discussion on Parkinson's Disease for Primary Care with Dr Albert Hung. Paul, this was something that really made me nervous. I didn't have a lot of comfort with it. But he taught us a lot of tips about how to recognize Parkinson's.

I hadn't been as aware of the premotor symptoms: constipation, hyposmia (loss of sense of smell), and rapid eye movement (REM) sleep behavior disorder. If patients have those early on and they aren't explained by other things (especially the REM sleep behavior disorder), you should really key in because those patients are at risk of developing Parkinson's years down the line. Those symptoms could present first, which just kind of blew my mind.

What tips do you have about how to recognize Parkinson's? Do you want to talk about the physical exam?

Paul N. Williams, MD: You know I love the physical exam stuff, so I'm happy to talk about that.

Figure 1.

You were deeply upset that cogwheel rigidity was not pathognomonic for Parkinson's, but you made the point ­— and our guest agreed — that asymmetry tends to be the key here. And I really appreciated the point about reemergent tremor. This is this idea of a resting tremor. If someone has more parkinsonian features, you might see an intention tremor with essential tremor. If they reach out, it might seem steady at first, but if they hold long enough, then the tremor may kind of reemerge. I thought that was a neat distinction.

And this idea of cogwheel rigidity is a combination of some of the cardinal features of Parkinson's — it's a little bit of tremor and a little bit of rigidity too. There's a baseline increase in tone, and then the tremor is superimposed on top of that. When you're feeling cogwheeling, that's actually what you're feeling on examination. Parkinson's, with all of its physical exam findings has always fascinated me.

Watto: He also told us about some red flags.

Figure 2.

With classic idiopathic parkinsonism, there's asymmetric involvement of the tremor. So red flags include a symmetric tremor, which might be something other than idiopathic parkinsonism. He also mentioned that one of the reasons you may want to get imaging (which is not always necessary if someone has a classic presentation), is if you see lower body–predominant symptoms of parkinsonism. These patients have rigidity or slowness of movement in their legs, but their upper bodies are not affected. They don't have masked facies or the tremor in their hands. You might get an MRI in that case because that could be presentation of vascular dementia or vascular disease in the brain or even normal pressure hydrocephalus, which is a treatable condition. That would be one reason to get imaging.

What if the patient was exposed to a drug like a dopamine antagonist? They will get better in a couple of days, right?

Williams: This was a really fascinating point because we typically think if a patient's symptoms are related to a drug exposure — in this case, drug-induced parkinsonism — we can just stop the medication and the symptoms will disappear in a couple of days as the drug leaves the system. But as it turns out, it might take much longer. A mistake that Dr Hung often sees is that the clinician stops the possibly offending agent, but when they don't see an immediate relief of symptoms, they assume the drug wasn't causing them. You really have to give the patient a fair shot off the medication to experience recovery because those symptoms can last weeks or even months after the drug is discontinued.

Watto: Dr Hung looks at the patient's problem list and asks whether is there any reason this patient might have been exposed to one of these medications?

We're not going to get too much into specific Parkinson's treatment, but I was glad to hear that exercise actually improves mobility and may even have some neuroprotective effects. He mentioned ongoing trials looking at that. We always love an excuse to tell patients that they should be moving around more and being physically active.

Williams: That was one of the more shocking things I learned, that exercise might actually be good for you. That will deeply inform my practice. Many of the treatments that we use for Parkinson's only address symptoms. They don't address progression or fix anything, but exercise can help with that.

Watto: Paul, the last question I wanted to ask you is about our role in primary care. Patients with Parkinson's have autonomic symptoms. They have neurocognitive symptoms. What is our role in that as primary care physicians?

Figure 3.

Williams: Myriad symptoms can accompany Parkinson's, and we have experience with most of them. We should all feel fairly comfortable dealing with constipation, which can be a very bothersome symptom. And we can use our full arsenal for symptoms such as depression, anxiety, and even apathy — the anhedonia, which apparently can be the predominant feature. We do have the tools to address these problems.

This might be a situation where we might reach for bupropion or a tricyclic antidepressant, which might not be your initial choice for a patient with a possibly annoying mood disorder. But for someone with Parkinson's disease, this actually may be very helpful. We know how to manage a lot of the symptoms that come along with Parkinson's that are not just the motor symptoms, and we should take ownership of those things.

Watto: You can hear the rest of this podcast here. This has been another episode of The Curbsiders bringing you a little knowledge food for your brain hole. Until next time, I've been Dr Matthew Frank Watto.

Williams: And I'm Dr Paul Nelson Williams.

https://www.medscape.com/viewarticle/989498