Science
Cancer diagnosis and a new book fuel questions about Biden's decision to run in 2024
WASHINGTON — The revelation that former President Biden has advanced prostate cancer generated more questions than answers on Monday, prompting debate among experts in the oncology community over the likely progression of his disease and resurfacing concerns in Washington over his decision last year to run for reelection.
Biden’s private office said Sunday afternoon that he had been diagnosed earlier in the week with an “aggressive form” of the cancer that had already spread to his bones, after urinary symptoms led to the discovery of a nodule on his prostate.
But it was not made clear whether Biden, 82, had been testing his prostate-specific antigens, known as PSA levels, during his presidency — and if so whether those results had indicated an elevated risk of cancer while he was still in office or during his campaign for reelection.
Biden’s diagnosis comes at a difficult time for the former president, as scrutiny grows over his decision to run for a second term last year — and whether it cost the Democrats the White House. Biden ultimately dropped out of the race after a devastating debate performance with Donald Trump laid bare widespread concerns over his age and health, leaving his successor on the Democratic ticket — Vice President Kamala Harris — little time to run her own campaign.
A book set to publish this week titled “Original Sin,” by journalists Jake Tapper and Alex Thompson, details efforts by Biden’s aides to shield the effects of his aging from the public and the press. The cancer diagnosis only intensified scrutiny over Biden’s health and questions as to whether he and his team were honest about it with the public.
“I think those conversations are going to happen,” said David Axelrod, a former senior advisor to President Obama.
President Trump, asked about Biden’s diagnosis during an Oval Office event Monday, said it was “a very, very sad situation” and that he felt “badly about it.”
But he also questioned why the cancer wasn’t caught earlier, and why the public wasn’t notified earlier, tying the situation to questions he has long raised about Biden’s mental fitness to serve as president.
PSA tests are not typically recommended for men over 70 due to the risk of false positive results or of associated treatments causing more harm than good to older patients, who are more likely to die of other causes first.
But annual physicals for sitting presidents — especially of Biden’s age — are more comprehensive than those for private citizens. And a failure to test for elevated PSA levels could have missed the progression of the disease.
A letter from Biden’s White House physician from February of last year made no mention of PSA testing, unlike the most recent letter detailing the results of Trump’s latest physical, which references a normal measurement. Biden’s current aides did not respond to requests for comment on whether his office would further detail his diagnostic testing history.
Even if his doctors had tested for PSA levels at the time, results may not have picked up an aggressive form of the cancer, experts said.
Some specialists in the field said it was possible, if rare, for Biden’s cancer to emerge and spread since his last physical in the White House. Roughly 10% of patients who are newly diagnosed with prostate cancer are found with an advanced form of the disease that has metastasized to other parts of the body.
Dr. Mark Litwin, the chair of UCLA Urology, said it is in the nature of aggressive prostate cancers to grow quickly. “So it is likely that this tumor began more recently,” he said.
Litwin said he does not doubt that Biden would have been screened for elevated PSA levels. But, he said, he could be among those patients whose cancers do not produce elevated PSA levels or whose more aggressive cancers rapidly grow and metastasize within a matter of months.
“The fact that he has metastatic disease at diagnosis, to me, as an expert in the area and as a clinician taking care of guys with prostate cancer all the time, just says that he is unfortunate,” Litwin said.
Litwin and other experts in prostate cancer from USC, Stanford, Johns Hopkins, Cedars-Sinai and the Dana-Farber Cancer Institute all told The Times that Biden’s diagnosis — at least based on publicly available information — was not incredibly unusual, and similar to diagnoses received by older American men all the time.
They said he and his doctors absolutely would have discussed testing his PSA levels, given his high level of care as president. But they also said it would have been well within medical best practices for him to decide with those doctors to stop getting tested given his age.
Dr. Howard Sandler, chair of the Department of Radiation Oncology at Cedars-Sinai, said he sees three potential explanations for Biden’s diagnosis.
One is that Biden and his doctors made a decision “to not screen any longer, which would be well within the standard of care” given Biden’s age, he said.
A second is that Biden’s was tested, and his PSA level “was elevated, maybe not dramatically but a little bit elevated, but they said, ‘Well, we’re not gonna really investigate it,’” again because of Biden’s age, Sandler said.
The third, which Sandler said was “less likely,” is that Biden’s PSA was checked “and was fine, but he ended up with an aggressive prostate cancer that doesn’t produce much PSA” and so wasn’t captured.
Zeke Emanuel, an oncologist serving as vice provost for global initiatives at the University of Pennsylvania and a former health policy official in the Biden administration, told MSNBC that Biden has likely had cancer for “more than several years.”
“He did not develop it in the last 100, 200 days. He had it while he was president. He probably had it at the start of his presidency, in 2021,” Emanuel said.
But Litwin, who said he is a friend of Emanuel’s, said most men in their 70s or 80s have some kind of prostate cancer, even if it is just “smoldering along” — there but not particularly aggressive or quickly spreading — and unlikely to be the cause of their death.
He said Biden may well have had some similar form of cancer in his prostate for a long time, but that he did not believe that the aggressive form that has metastasized would have been around for as long as Emanuel seemed to suggest.
Departing Rome aboard Air Force Two, Vice President JD Vance told reporters he was sending his best wishes to the former president, but expressed concern that his recent diagnosis underscored concerns over Biden’s condition that dogged his presidency.
“Whether the right time to have this conversation is now or in the future, we really do need to be honest about whether the former president was capable of doing the job,” Vance said. “I don’t think that he was in good enough health. In some ways, I blame him less than I blame the people around him.”
Trump’s medical team has also faced questions of transparency.
When Trump was diagnosed with COVID-19 during his first term, at the height of the pandemic, he was closer to death than his White House acknowledged at the time. And his doctors and aides regularly use superlatives to describe the health of the 78-year-old president, with Karoline Leavitt, his White House press secretary, referring to him as “perfect” on Monday.
“Cancer touches us all,” Biden posted on social media alongside a photo with his wife, Jill Biden, in his first remarks on his diagnosis.
“Like so many of you, Jill and I have learned that we are strongest in the broken places,” he added. “Thank you for lifting us up with love and support.”
Science
Trump administration, Congress move to cut off transgender care for children
The Trump administration and House Republicans advanced measures this week to end gender-affirming care for transgender children and some young adults, drawing outrage and resistance from LGBTQ+ advocacy organizations, families with transgender kids, medical providers and some of California’s liberal leaders.
The latest efforts — which seek to ban such care nationwide, strip funding from hospitals that provide it and punish doctors and parents who perform or support it — follow earlier executive orders from President Trump and work by the Justice Department to rein in such care.
Many hospitals, including in California, have already curtailed such care or shuttered their gender-affirming care programs as a result.
Abigail Jones, a 17-year-old transgender activist from Riverside, called the moves “ridiculous” and dangerous, as such care “saves lives.”
She also called them a purely political act by Republicans intent on making transgender people into a “monster” to rally their base against, and one that is “going to backfire on them because they’re not focusing on what the people want,” such as affordability and lower healthcare costs.
On Wednesday, the House passed a sweeping ban on gender-affirming care for youth that was put forward by Rep. Marjorie Taylor Greene (R-Ga.), largely along party lines.
The bill — which faces a tougher road in the U.S. Senate — bars already rare gender-affirming surgeries but also more common treatments such as hormone therapies and puberty blockers for anyone under 18. It also calls for the criminal prosecution of doctors and other healthcare workers who provide such care, and for penalties for parents who facilitate or consent to it being performed on their children.
“Children are not old enough to vote, drive, or get a tattoo and they are certainly not old enough to be chemically castrated or permanently mutilated!!!” Greene posted on X.
“The tide is turning and I’m so grateful that congress is taking measurable steps to end this practice that destroyed my childhood,” posted Chloe Cole, a prominent “detransitioner” who campaigns against gender-affirming care for children, which she received and now regrets.
Queer rights groups denounced the measure as a dangerous threat to medical providers and parents, and one that mischaracterizes legitimate care backed by major U.S. medical associations. They also called it a threat to LGBTQ+ rights more broadly.
“Should this bill become law, doctors could face the threat of prison simply for doing their jobs and providing the care they were trained to deliver. Parents could be criminalized and even imprisoned for supporting their children and ensuring they receive prescribed medication,” said Kelley Robinson, president of the Human Rights Campaign, one of the nation’s leading LGBTQ+ rights groups.
On Thursday, the U.S. Department of Health and Human Services announced that the Centers for Medicare & Medicaid Services are proposing new rules that would ban such care by medical providers that participate in its programs — which includes nearly all U.S. hospitals. The health department said the move is “designed to ensure that the U.S. government will not be in business with organizations that intentionally or unintentionally inflict permanent harm on children.”
The department said officials will propose additional rules to prohibit Medicaid or federal Children’s Health Insurance Program funding from being used for gender-affirming care for children or for young adults under the age of 19, and that its Office of Civil Rights would be proposing a rule to exclude gender dysphoria as a covered disability.
The U.S. Food and Drug Administration, meanwhile, issued warning letters to manufacturers of certain medical devices, including breast binders, that marketing their products to transgender youth is illegal.
“Under my leadership, and answering President Trump’s call to action, the federal government will do everything in its power to stop unsafe, irreversible practices that put our children at risk,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a statement. “Our children deserve better — and we are delivering on that promise.”
The proposed rule changes are subject to public comment, and the Human Rights Campaign and other LGBTQ+ organizations, including the Los Angeles LGBT Center, urged their supporters to voice their opposition.
Joe Hollendoner, the center’s chief executive, said the proposed changes “cruelly target transgender youth” and will “destabilize safety-net hospitals” and other critical care providers.
“Hospitals should never be forced to choose between providing lifesaving care to transgender young people and delivering critical services like cancer treatment to other patients,” Hollendoner said. “Yet this is exactly the division and harm these rules are designed to create.”
Hollendoner noted that California hospitals such as Children’s Hospital Los Angeles have already curtailed their gender-affirming services in the face of earlier threats from the Trump administration, and thousands of transgender youth have already lost access to care.
Gov. Gavin Newsom issued a statement contrasting the Trump administration’s moves with California’s new partnership with The Trevor Project, to improve training for the state’s 988 crisis and suicide hotline for vulnerable youth, including LGBTQ+ kids at disproportionately high risk of suicide and mental health issues.
“As the Trump administration abandons the well-being of LGBTQ youth, California is putting more resources toward providing vulnerable kids with the mental health support they deserve,” Newsom said.
California Atty. Gen. Rob Bonta’s office is already suing the Trump administration for its efforts to curtail gender-affirming care and target providers of such care in California, where it is protected and supported by state law. His office has also resisted Trump administration efforts to roll back other transgender rights, including in youth sports.
On Thursday, Bonta said the proposed rules were “the Trump Administration’s latest attempt to strip Americans of the care they need to live as their authentic selves.” He also said they are “unlawful,” and that his office will fight them.
“If the Trump Administration puts forth final rules similar to these proposals, we stand ready to use every tool in our toolbox to prevent them from ever going into effect,” Bonta said — adding that “medically necessary gender-affirming care remains protected by California law.”
Arne Johnson, a Bay Area father of a transgender child who helps run a group of similar families called Rainbow Families Action, said there has been “a lot of hate spewed” toward them in recent days, but they are focused on fighting back — and asking hospital networks to “not panic and shut down care” based on proposed rules that have not been finalized.
Johnson said Republicans and Trump administration officials are “weirdly obsessed” with transgender kids’ bodies, are “breaking the trust between us and our doctors,” and are putting politics in between families and their healthcare providers in dangerous ways.
He said parents of transgender kids are “used to being hurt and upset and sad and worried about their kids, and also doing everything in their power to make sure that nothing bad happens to them,” and aren’t about to stop fighting now.
But resisting such medical interference isn’t just about gender-affirming care. Next it could be over vaccines being blocked for kids, he said — which should get all parents upset and vocal.
“If our kids don’t get care, they’re coming for your kids next,” Johnson said. “Pretty soon all of us are going to be going into hospital rooms wondering whether that doctor across from us can be trusted to give our kid the best care — or if their hands are going to be tied.”
Science
His computer simulations help communities survive disasters. Can they design a Palisades that never burns?
In what used to be a dry cleaner’s on Sunset Boulevard, Robert Lempert listened, hands clasped behind his back, as his neighbors finally took a moment to step away from recovery’s endless stream of paperwork, permits, bills and bureaucracy to, instead, envision a fire-resilient Pacific Palisades in 2035.
As a researcher at RAND, Lempert has spent decades studying how communities, corporations and governments can use computer simulations to understand complex problems with huge uncertainties — from how an Alaska town can better warn its residents about landslides to how climate change is worsening disasters and what strategies the United Nations can support to address them.
In January, one such complex problem ran straight through his neighborhood and burned down his house.
As Lempert and his wife process their own trauma forged by flames, Lempert has become fixated on capturing the flickers of insights from fellow survivors and, hopefully, eventually, transforming them into computer programs that could help the community rebuild the Palisades into a global leader in wildfire resilience.
“Otherwise, we won’t end up with a functional community that anybody wants to — or can — live in,” he said. “You can spin out all sorts of disaster scenarios” for the Pacific Palisades of 2035. If the community fails to confront them in rebuilding, “you make them a hell of a lot more likely.”
Lempert doesn’t see a mass exodus from high-fire-hazard areas as a viable solution. Out of the more than 12 million buildings the climate risk modeling company First Street studies in California, 4 in 10 have at least a 5% chance of facing a wildfire in the next 30 years. (Out of the nearly 10,000 buildings First Street studies in the Palisades, 82% carry that level of risk.) And the areas without significant fire risk have their own environmental challenges: flooding, earthquakes, landslides, hurricanes, tornadoes, droughts. Learning to live with these risks, consequently, is part of the practice of living in California — and really, in most of the places humans have settled on Earth.
After two of the most destructive fires in the state’s history, The Times takes a critical look at the past year and the steps taken — or not taken — to prevent this from happening again in all future fires.
So, Lempert has taken to the modus operandi he helped develop at RAND:
Identify the problem. In this case, living in Pacific Palisades carries a nonzero risk you lose your house or life to fire.
Define the goals. Perhaps it is that, in the next fire, the Palisades doesn’t lose any homes or lives (and, ideally, accomplishes this without spending billions).
Then, the real work: Code up a bunch of proposed solutions from all of the groups with wildly disparate views on how the system (i.e., Southern California wildfires) works.
Stress-test those solutions against a wide range of environmental conditions in the computer. Extreme winds, downed communication systems, closed evacuation routes — the list goes on.
Finally, sit back, and see what insights the computer spits out.
It’s easy enough to agree on the problem, goals and environmental factors. For the proposed solutions, Lempert set out to collect data.
Poster paper with residents’ handwritten ideas now fills the walls of the former dry cleaner’s, now the headquarters of the grassroots organization Palisades Recovery Coalition. It’s through these “visioning charrettes” that Lempert hopes his community can develop a magic solution capable of beating the computer’s trials.
Lempert holds a photo of his home as it looked before it was destroyed by the Palisades fire.
The streets could be lined with next-generation homes of concrete and steel where even the tiniest gaps are meticulously sealed up to keep embers from breaching the exterior. Each home could be equipped with rain-capture cisterns, hooked up to a neighborhood-wide system of sensors and autonomous fire hoses that intelligently target blazes in real time. One or two shiny new fire stations — maybe even serving as full-blown fire shelters for residents, equipped with food and oxygen to combat the smoke — might sit atop one of the neighborhood’s main thoroughfares, Palisades Drive. The street, formerly a bottleneck during evacuations, might now have a dedicated emergency lane.
Every year, the community could practice a Palisades-wide evacuation drill so the procedures are fresh in the mind. Community brigades might even train with the local fire departments so, during emergencies, they can effectively put out spot fires and ensure their elderly neighbors get out safely.
Lempert, who now lives in a Santa Monica apartment with his wife, doesn’t entertain speculation about whether the Palisades will ever reach this optimistic vision — even though his own decision to move back someday, in part, hinges on the answer.
Right now, all that matters is that change is possible.
He pointed to an anecdote he heard once from the fire historian Stephen Pyne: American cities used to burn down — from within — all the time in the 19th century. Portland, Maine, burned in 1866 thanks to a Fourth of July firecracker. Chicago in 1871, after a blaze somehow broke out in a barn. Boston the following year, this time starting in a warehouse basement. Eventually, we got fed up with our cities burning down, so we created professional fire departments, stopped building downtowns out of wood and bolstered public water systems with larger water mains and standardized fire hydrants. Then, it stopped happening.
Now we face a new fire threat — this time, from the outside. Maybe we’re fed up enough to do something about it.
“Cities shouldn’t burn down,” Lempert said with a chuckle, amused by the simplicity of his own words. “So let’s just design them so they don’t.”
Science
China’s Clean Energy Push is Powering Flying Taxis, Food Delivery Drones and Bullet Trains
As an American reporter living in Beijing, I’ve watched both China and the rest of the world flirt with cutting-edge technologies involving robots, drones and self-driving vehicles.
But China has now raced far beyond the flirtation stage. It’s rolling out fleets of autonomous delivery trucks, experimenting with flying cars and installing parking lot robots that can swap out your E.V.’s dying battery in just minutes. There are drones that deliver lunch by lowering it from the sky on a cable.
If all that sounds futuristic and perhaps bizarre, it also shows China’s ambition to dominate clean energy technologies of all kinds, not just solar panels or battery-powered cars, then sell them to the rest of the world. China has incurred huge debts to put trillions of dollars into efforts like these, along with the full force of its state-planned economy.
These ideas, while ambitious, don’t always work smoothly, as I learned after taking a bullet train to Hefei, a city the size of Chicago, to see what it’s like to live in this vision of tomorrow. Hefei is one of many cities where technologies like these are getting prototyped in real time.
I checked them all out. The battery-swapping robots, the self-driving delivery trucks, the lunches from the sky. Starting with flying taxis, no pilot on board.
Battery-swapping robots for cars
Of course, far more people get around by car. And navigating Hefei’s city streets shows how China has radically transformed the driving experience.
Electric vehicles (including models with a tiny gasoline engine for extra range) have accounted for more than half of new-car sales in China every month since March. A subcompact can cost as little as $9,000.
They are quite advanced. New models can charge in as little as five minutes. China has installed 18.6 million public charging stations, making them abundant even in rural areas and all but eliminating the range anxiety holding back E.V. sales in the United States.
Essentially, China has turned cars into sophisticated rolling smartphones. Some have built-in karaoke apps so you can entertain yourself while your car does the driving.
You still need to charge, though.
Lunch from the sky
China’s goal with ideas like these is to power more of its economy on clean electricity, instead of costly imported fossil fuels. Beijing has spent vast sums of money, much of it borrowed, on efforts to combine its prowess in manufacturing, artificial intelligence and clean energy to develop entirely new products to sell to the rest of the world.
Drone delivery has a serious side. Hospitals in Hefei now use drones to move emergency supplies, including blood, swiftly around the city. Retailers have visions of fewer packages stuck in traffic.
But does the world need drone-delivered fast food? And how fast would it really be? As afternoon approached, we decided to put flying lunches to the test.
We decided to eat in a city park where a billboard advertised drone delivery of pork cutlets, duck wings and milk tea from local restaurants, or hamburgers from Burger King. Someone had scrawled in Chinese characters on the sign, “Don’t order, it won’t deliver.” A park worker offered us free advice: Get someone to deliver it on a scooter.
Undeterred, we used a drone-delivery app to order a fried pork cutlet and a small omelet on fried rice. Then, rather than wait in the park, we went to the restaurant to see how the system worked.
Very rapid transit
China’s bullet trains are famous for a reason. Many can go nearly 220 miles per hour — so fast that when you blast past a highway in one of these trains, cars look like they’re barely moving.
In less than two decades China has built a high-speed rail network some 30,000 miles long, two-thirds the length of the U.S. Interstate highway system. As many as 100 trains a day connect China’s biggest cities.
Building anything this enormous creates pollution in its initial construction, of course, using lots of concrete and steel. Construction was expensive and the system has racked up nearly $900 billion in debt, partly because it’s politically hard to raise ticket prices.
But the trains themselves are far less polluting than cars, trucks or planes. And they make day trips fast and easy. So we decided to hop over to Wuhan, more than 200 miles away.
Taxis that drive themselves
We rolled into Wuhan looking forward to catching a robot taxi. While a few U.S. cities have experimented with driverless cars, China leads in the number on the road and where they can operate.
Wuhan is one of a dozen or more Chinese cities with driverless taxis. Hundreds now roam most of the city, serving the airport and other major sites.
But train stations are a special problem. In big cities, some stations are so popular that the streets nearby are gridlocked for blocks in every direction.
That was the case in Wuhan. Autonomous cars have not been approved in the chronically gridlocked streets next to the train stations, which meant that, to meet our robot taxi at its pickup spot, we either needed to walk 20 minutes or hop on a subway. (We walked.)
Of course if you want your own personal self-driving car, dozens of automakers in China sell models with some autonomous features. However, you are required to keep your hands on the wheel and eyes on the road. Just this month, regulators told automakers to do more testing before offering hands-free driving on mass production cars.
We wanted the full robot chauffeur experience.
Robot trucks don’t need windows
After a meal at one of Wuhan’s famous crawfish restaurants, we headed back to Hefei.
We had enjoyed Hefei’s airborne lunches, but there’s a lot more autonomous delivery in that city than just food. China still has many intercity truck drivers, but is starting to replace them with robot trucks for the last mile to stores and homes.
The trucks look strangely faceless. With no driver compartment in front, they resemble steel boxes on wheels.
The smaller ones in Hefei carry 300 to 500 packages. The trucks go to neighborhood street corners where packages are distributed to apartments by delivery people on electric scooters or a committee of local residents. Larger trucks serve stores.
Robot delivery trucks now operate even in rural areas. I recently spotted one deep in the countryside as it waited for 13 water buffalo to cross a road.
Subways get a makeover
Cities across the country are rapidly building subways. So many, in fact, that China has become the world’s main manufacturer of automated tunnel-boring machines.
It has also pioneered the manufacture of prefab subway stations. They’re lowered in sections into holes in the ground. Building a new station can take as little as two months.
Nearly 50 cities in China have subway networks, compared with about a dozen in the U.S., and they tend to be popular and heavily used.
As in many Chinese cities, people in Hefei live in clusters of high-rises, and many live or work close to stations. The trains cut down on traffic jams and air pollution.
And like so many things, new ones are usually driverless.
The changes are spreading across the country.
Many Chinese cities have not only replaced diesel buses with electric ones but are also experimenting with hydrogen-powered buses. And driverless buses. And driverless garbage trucks. And driverless vending machines.
One such vending machine was operating in the Hefei park where we ordered our drone lunches. According to a nearby hot dog vendor, the brightly lit four-wheeler drove into the park every morning, though always accompanied by a person on a bike who made sure nothing went wrong.
A robotic snack machine that needs a chaperone — how practical is that? But the fact that they are rolling around the streets of Hefei at all says something about China’s willingness to test the boundaries of transportation technologies.
Some ideas may not work out, and others might suit China but not travel well. For example, Beijing can essentially order arrow-straight rail lines to be built almost to the heart of urban areas with little concern for what’s in the way. Other countries can’t replicate that. Chinese-built bullet trains in Nigeria and Indonesia, which travel from one city’s suburbs to the next, haven’t proven nearly as popular.
Still, China shows a willingness to take risks that other countries may not. In San Francisco the death of a bodega cat, killed by a self-driving taxi, has hurt the industry’s image. But in China, fleets of similar cars are operating widely and censors delete reports of accidents. The cars are improving their software and gaining experience.
As for me, after several days putting Hefei’s idea of the future to the test, it was time to head for my next reporting assignment, in Nanjing. By bullet train, of course.
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