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Why the U.S. surgeon general wants cancer warning labels on alcoholic drinks

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Why the U.S. surgeon general wants cancer warning labels on alcoholic drinks

Alcoholic drinks are a leading cause of cancer and should carry a warning about that risk on their labels, the U.S. surgeon general said Friday.

Alcohol is a factor in nearly 100,000 newly diagnosed cancers each year and roughly 20,000 deaths from the disease, U.S. Surgeon General Vivek Murthy said in an advisory intended to focus the public’s attention on the health risk. By comparison, traffic accidents tied to drinking kill about 13,500 Americans each year.

“Alcohol consumption is the third leading preventable cause of cancer in the United States, after tobacco and obesity,” the 22-page advisory said. “While scientific evidence for this connection has been growing over the past four decades, less than half of Americans recognize it as a risk factor for cancer.”

Labels on bottles and cans of alcoholic beverages already warn about drinking while pregnant. They also warn about drinking before driving or operating other machinery. In California, the voter-approved Proposition 65 also requires businesses that serve or sell alcoholic beverages to provide a warning about health risks, including cancer.

Any decision to update or expand the label would require congressional approval, an uncertain prospect. Murthy was appointed by President Biden, who has a little more than two weeks left in office. President-elect Donald Trump has picked Janette Nesheiwat, an executive at a New York-based chain of urgent care clinics, as his nominee for surgeon general.

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Executives in the beer, wine and spirits industry said Friday that the scientific data linking alcohol to cancer are mixed.

Amanda Berger, senior vice president at the Distilled Spirits Council, noted that a recent report by the National Academies of Sciences, Engineering, and Medicine found that alcohol was associated with a higher risk of breast cancer but did not find such associations with other types of cancer.

That report also concluded that moderate alcohol consumption is associated with lower risks of all-cause mortality and cardiovascular disease, compared with never consuming alcohol.

“The current health warning on alcohol products has long informed consumers about the potential risks of the consumption of alcohol,” Berger said. “Many lifestyle choices carry potential risks, and it is the federal government’s role to determine any proposed changes to the warning statements based on the entire body of scientific research.”

The surgeon general’s advisory said that cancers of the colorectum, esophagus, liver, mouth, throat and larynx are all tied to drinking, as is breast cancer in women. The risk of developing breast, mouth or throat cancers may increase with less than one drink per day, it said.

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(Office of the U.S. Surgeon General)

Yet more than half of Americans are unaware that their drinking behavior affects their cancer risk. A survey by the American Institute for Cancer Research found that 89% of Americans recognized that smoking causes cancer and 53% knew that obesity was a risk factor, but only 45% realized that alcohol could cause cancer as well.

Nearly half of alcohol-related cancers in the U.S. are breast cancers in women, according to a study published by the American Cancer Society. About 1 in every 6 female breast cancers is due to alcohol, and the disease accounts for about 60% of all alcohol-related cancer deaths in women.

As a result, drinking is a bigger cancer risk for women than men. In 2019, about 54,330 women were diagnosed with a cancer that resulted from drinking, as were roughly 42,400 men. About 60% of alcohol-related cancer deaths in women are due to breast cancer, while liver cancer and colorectal cancer are responsible for about 54% of alcohol-related cancer deaths in men.

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For women who consume less than one drink a week, the absolute risk of developing an alcohol-related cancer is 16.5%. Having one drink per day increases that risk to 19%, and having two drinks each day raises it to 21.8%, according to the advisory.

For men, drinking once a week is tied to a 10% absolute risk of an alcohol-related cancer. That risk rises to 11.4% by having one drink per day, and to 13.1% by having two drinks per day, the advisory says.

The World Health Organization’s International Agency for Research on Cancer says alcohol is a Group 1 carcinogen, putting it in the company of tobacco, asbestos and ultraviolet radiation. The U.S. National Toxicology Program declared in 2000 that alcohol causes cancer in humans, and organizations including the Centers for Disease Control and Prevention, the National Cancer Institute, the American Cancer Society and the American Assn. for Cancer Research agree that at least seven kinds of cancer are related to drinking.

There is also evidence to suggest that drinking contributes to skin, prostate, pancreatic and stomach cancers, though more research is needed, the surgeon general’s advisory says.

Scientists first linked alcohol consumption to certain cancers nearly 50 years ago, and the evidence showing that drinking is a risk factor for at least seven types of cancer has grown since then, the advisory says.

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For instance, an observational study of 28 million people in 195 countries and territories found that the more alcohol a person consumed, the higher their risk of cancer. A study involving more than 1 million women found that those who had up to 1 drink per day were 10% more likely to get breast cancer compared with those who abstained. Likewise, a study with 36,000 people found that those who consumed about a drink per day were 40% more likely to develop mouth cancer than people who didn’t drink.

Laboratory experiments have shown how alcohol leads to cancer.

When alcohol is metabolized in the body, it breaks down into a chemical called acetaldehyde that can attach itself to DNA. The resulting damage can trigger the uncontrolled cell growth that leads to cancer.

Drinking also creates unstable molecules called reactive oxygen species that can interfere with DNA, proteins and essential fats. They also increase inflammation, which makes the body more hospitable to cancer.

There is also evidence that alcohol fuels breast cancers by affecting levels of estrogen and other hormones, and that other kinds of carcinogens — such as those found in tobacco smoke — are more easily absorbed in the body when they are dissolved in alcohol.

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The companies selling alcoholic beverages say they have long urged consumers to drink the beverages safely.

“The U.S. beer industry has been a champion of responsible consumption for decades,” a spokesperson for the Beer Institute said Friday. “We encourage adults of legal drinking age to make choices that best fit their personal circumstances, and if they choose to drink, to consume alcohol beverages in moderation.”

Dr. Laura Catena, a winemaker and physician, said that she would “welcome any kind of alert or communication from the surgeon general about the cancer risks of heavy alcohol drinking,” but that it shouldn’t go beyond the established science.

The American Assn. for Cancer Research says alcohol use is responsible for 5.4% of all cancer cases in the U.S. That makes it a bigger risk factor than exposure to UV radiation, poor diet, and infections from pathogens like hepatitis and the human papillomavirus. (For comparison, 19.3% of U.S. cancers are attributable to smoking, according to the association.)

Studies suggest that people who cut back on alcohol or eliminate it can reduce their risk of these cancers by 8%, and reduce their overall cancer risk by 4%.

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The Dietary Guidelines for Americans from the U.S. Departments of Agriculture and Health and Human Services say there is no health reason for nondrinkers to start consuming alcohol. Those who do drink can minimize their risk by limiting their intake to no more than one drink per day for women and no more than two drinks per day for men.

A 5-ounce glass of wine, 12-ounce bottle of beer or 1.5-ounce tumbler of distilled spirits count as a single drink.

The surgeon general’s advisory says about 83% of alcohol-related cancer deaths occur in people who exceed those limits. But that means 17% of deaths were in people who engaged in moderate drinking.

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Trump administration, Congress move to cut off transgender care for children

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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.

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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.

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“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.”

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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.

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“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.

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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.”

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His computer simulations help communities survive disasters. Can they design a Palisades that never burns?

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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.

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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.”

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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 The Fires

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.

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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.

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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.

Robert Lempert holds a photo of his home before it was destroyed by the Palisades fire.

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.

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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.”

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China’s Clean Energy Push is Powering Flying Taxis, Food Delivery Drones and Bullet Trains

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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.

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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.

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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

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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Robot trucks don’t need windows

After a meal at one of Wuhan’s famous crawfish restaurants, we headed back to Hefei.

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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.

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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

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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.

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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.

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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.

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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.

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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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