Hail Harris: the Democratic convention begins

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The Economist. Hello and welcome to the Intelligence from the Economist. I'm Jason Palmer.

And I'm Rosie Blore. Every weekday we provide a fresh perspective on the event shaping your world.

A close look at hospital data from Canada has shown that patients can expect better outcomes if their doctor was a woman, both in terms of surviving and the chances of being quickly readmitted. The question is why that might be the case.

And scientists love researching how elephants communicate. Now there's a new incredible finding that the creatures seem to refer to each other by a particular set of frequencies, suggesting they may actually have names. But first, The real and true measure of the strength of a leader is based on who you lift up. That's what we see as strength. We know what strength looks like. This weekend, Vice President Kamala Harris was in Pennsylvania warming up her vocal cords and her attacks Donald Trump. Anybody who's about beating down other people is a coward. Since Joe Biden stepped down as the Democratic nominee a month ago, Harris has been riding a wave of renewed enthusiasm. Today, the Democratic National Convention begins in Chicago and will end with Harris coronation as the party's official candidate. The euphoria has seemingly won over a lot of American voters, too. But polls suggest the race is four far from over.

The Democrats now gathered in Chicago for their convention are really in a very upbeat, ebullient, almost euphoric mood.

Daniel Franklin is a senior editor at the Economist.

Because the race has been completely transformed in just a few weeks from when Joe Biden was their candidate. And now they think they have a real chance of defeating Donald Trump with Kamala Harris as their standard bearer. And the Economist's election model shows Harris ahead, but by a whisker.

By a whisker. Let's dig into that number a bit. How does the election model work?

Well, we have two things, actually, and it's useful to distinguish between them. First, of all, there's the poll tracker, which simply aggregates opinion polls and looks at the averages. And that already shows that there's been a complete turnaround in the race, that Democrats, from being alarmingly behind from their point of view, are suddenly actually ahead by new nearly three points nationwide. So that's one thing. But actually, because the nationwide popular vote is not what actually elects presidents in America, it's the Electoral College. We also have an election forecast model which looks at polls, yes. But also looks at more fundamental factors that are slightly more stable than opinion polls, such as the state of the economy, presidential approval rating, the number of swing voters and such like. And that allows us to produce a forecast of where we think, given current circumstances, the result is likely to end up. And that has also transformed and shows that in reality, it's pretty much neck and neck. Kamala Harris is just a tad ahead of Donald Trump right now, but it's in effect a toss up. So everything is perfectly poised for a very nail biting end to this race.

So clearly replacing Biden was the right call then.

Oh, no questioner. It's been completely transformative. If you just cast your mind back to where things were at the time of the Republican convention in Milwaukee, there seemed a sense of inevitability about Donald Trump. He just had his brush with death, the attempt to assassinate him. He'd had a triumphant debate with Joe Biden. Biden was sinking in the polls according to our model at the time. When Biden pulled out, his chances of winning had sunk to about one in five. So it was a real disaster for the Democrats. And now it's a completely different picture. So they are at least in with a very good shot of winning. But I think the important point is it's still, with all that said, neck and neck. So it's going to be a very, very close race.

Right. It's interesting to hear you talk about how transformative this shift to Kamala Harris has been, and yet it's a coin toss. So what are the policies that might shift people in one way or the other? Or is it nothing to do with policy?

Up until now, it's been very little to do with policy. It's been a policy like campaign, actually on both sides. Donald Trump doesn't particularly go for policies. It's much more mood music and identity and stances. And I think that Kamala Harris has been quite content to be policy light up until now and ride the wave of enthusiasm, the vibes, the online memes that have been working to her favor. But we're starting to see a little bit of policy creep in both campaigns were talking about economic policies in recent days, I have to say, not in very convincing details. But you had the two of them matching each other for populism, for example, on having no tax on tips. That's an attempt to appeal to some voters in particularly in Nevada and swing state, but also some kind of giveaway economic policies, some of them perfectly sensible in their own right but not fully costed by Kamala Harris. And I think the more scrutiny you have on these policies, the more difficulty her campaign is likely to have because it's not her strong point. But voters are entitled to know really what she would be like running the economy and running the country's national security and being the commander in chief. And she has so far managed to avoid saying very much about that at all.

I love the election strategy of just avoiding saying anything about anything. What kind of convention can we expect from the Democrats now then?

I think you can very much expect a feel good convention. That's if the demonstrations that are happening outside the convention hall, particularly Gaza related, don't spoil the party. But inside the convention hall today, Monday, we're going to hear Joe Biden speak as well as Hillary Clinton. So that'll be the sort of praising Biden for his record and for also doing what Democrats would see as the statesmanlike thing and stepping down on Tuesday. It'll be the turn of Barack Obama on Wednesday, Tim Walsh, the vice presidential nominee, Bill Clinton and Nancy Pelosi and then the grand finale, Kamala Harris talks on Thursday. So it'll be a non stop celebrity tour and whipping up the enthusiasm of the Democratic base and in effect trying to have a several day long advertisement for the Democratic Party and the Democratic ticket.

And how has Trump responded to the change in candidate? Obviously this is a very different convention from the Republican one in July when as you say, Trump had just survived the assassination attempt.

I think it's been really hard for Donald Trump. He has struggled to find a consistent line of attack on Kamala Harris. He struggled to nail a nickname on her that really cuts through. He still talks rather obsessively about Joe Biden. I think he feels that he was deprived of the race that he thought he was going to have and that he thought he was going to win. So he sounds very resentful, very gloomy. I fully expect that that will start to change as we get beyond the convention. He will want to grab back the limelight. One of the things that really irks him is the size of Kamala Harris's crowds, the enthusiasm, the fact that the media spotlight has been on her rather than where he likes it, which is of course on him. And then we will have a presidential debate in September. So they will go head to head. And I think he will start to be much more focused and probably will have more material to work with coming out of this convention to attack Kamala Harris. But he's struggled, he's visibly struggled to adjust to the new reality.

Of course, in American terms, this is a very late candidacy, but in most elections this would be kind of where things begin. What can we expect from the next 80 days?

It's going to be really challenging, I think, for both campaigns and both face real dangers. I think the danger for the Democrats is that they get a false sense of almost inevitability coming out of this convention. They'll presumably be ahead, perhaps even a bit further ahead in the polls. They'll think the wind is at their backs, but it really is a toss up. So because it's so close right now, any small swing either way could prove decisive. It's going to be small differences, particularly in the swing states, which will make all the difference. And it's going to be fascinating to see how it works out. One thing we've learned, I think, so far in this extraordinary election year is that things can change incredibly quickly and very dramatically.

Daniel, thank you so much for your time. Really appreciate it.

Thank you, Rosie.

As the Democratic convention starts, don't forget that the Economist has much, much more to offer on the backdrop to this unexpectedly riveting election. Our special six part series Boom is now streaming and episode one is free. It's completely brilliant. Do listen.

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Let's do a little thought experiment. I'm going to tell you that I went to see a doctor recently. Now, as long as you're not operating heavy machinery or whatever, close your eyes and picture the scene. White coat, right. Stethoscope, maybe. Now, is the doctor a man or a woman? New research suggests that I should have aimed to be seen by a woman and to be on the safest side. You should.

Too many factors influence life or death in the hospital. There's the quality of drugs you might get, how well your condition is monitored, what kind of technology the hospital is using.

Ainslie Johnston is a data journalist for the Economist.

But there's one thing that increasingly scientists are realising is really quite important, and that seems to be the gender of the physician who's treating you. It's pretty unclear why, but researchers are increasingly finding that female doctors seem to have better outcomes.

When you say better outcomes, though, what do you mean? How do we know this?

So the first results that showed this pattern came from Harvard Medical School, from a study in 2017. They studied the medical data of 1.5 million older adults who were admitted to hospital and they found that the patients who were treated by female Doctors were actually 4% less likely to die or to be readmitted to hospital in the next month. That benefit of 4% was roughly equivalent to the difference in mortality that you might expect being hospitalized in 2013 rather than 2003. Accounting for all of the improvements in drugs and medical technologies since then, there have been multiple similar studies that have looked at patients going in for surgery, patients in gastroenterology departments, and all of them have found a similar pattern. Patients who are treated by female doctors tend to do better.

And so it's as simple as that. It's a statistically sound finding across all of these people.

Well, there is one slight complication. All of these studies are what scientists call retrospective, rather than the gold standard of a randomised controlled trial. What that means is these studies are all just looking back at patients who went through their medical care as per usual, rather than being randomly sorted into being treated by a man or a woman. And what this means is that there could be some underlying factors that are influencing this result that aren't just purely about the physician's gender. It could be, for example, that female doctors might just be given healthier patients, and the studies won't necessarily see that. All of the studies do try to account for this. They try to compare within groups of doctors who get very similar patients or have very similar amounts of experience or practice, and they still find the same results. But this is still a problem.

Some of the serious shortcomings here are that it's retrospective studies and not RCTs. Is there appetite for. Is there scope for. Can one even be done? Is that like the next step or. No.

The researchers I spoke to thought that that would be a very difficult trial to try and run, something like a randomised controlled trial where you're assigning surgeons of a different gender. They felt that patients just wouldn't really sign up to that, particularly given the data that already exists, indicating that it could be potentially worse for them to have a male doctor.

Well, I'm wondering about the disparity on the other side of the equation, the degree to which, whether you're a female or a male patient matters in all this.

So it does. Female patients seem to get a particularly big benefit out of having a female doctor. So, for example, in one study, they found that all older patients are less likely to die after being treated by a female doctor. But for female patients, the difference was particularly stark. So for female patients, the difference was around 3% in this study, and for male patients, the difference was less than 1%. Again, similar things have been found in surgery. One study found that female surgery patients were 25% less likely to die with female surgeons, whereas male patients were only 13%. It could be that female patients just tend to communicate better with female doctors, or maybe they have a better rapport. There's also this sort of underlying trend underneath all of this, that female patients tend to respond better to care. In general, the researchers don't fully understand why that is. It could be that female patients are coming into hospital a little bit earlier when they're maybe not quite as ill, but in all of the analyses, this is controlled for, and so it shouldn't impact this overall result of female doctors tending to produce better outcomes for their patients.

So it sounds as if you're kind of kicking around some hypotheses there about why some of these specific statistics might be the way they are. But what's the idea in general why there should be a disparity at all?

So researchers are not really sure. Some of the researchers I spoke to said that they're pretty sure it's not really just being a female that makes you a better doctor. They think that maybe there's some kind of underlying traits that are particularly common in women compared with men that just happens to make them better doctors in some way. So there's been previous research that has shown that female doctors tend to spend more time with their patients, they tend to stick more closely to clinical guidelines, which perhaps together means that they have more of a focus on prevention of illnesses rather than just treating them once they arise. But all of this needs to be explored more. Researchers right now just really aren't sure. The researchers think that by trying to understand more about what it is that's driving this effect, then this can be fed back into medical schools and all doctors can receive training on how to make them the best physicians they can be.

Ainsley, thanks very much for joining us.

Thank you, Jason.

Right, so you know me, I go by Jason, my producer behind the glass over there, he's Rory. I've got a cat named Jerry and he kind of sorta answers to it, though none of the other neighborhood cats call him by it yet. Some animals do use names of a kind. Bottlenose dolphins are known to repeat a specific whistle and others use that same whistle to refer to them. Parrots have a similar thing going on and now a new species joins the.

You've just heard the name of an elephant, specifically an African savanna elephant.

That human there goes by the name of Jeffrey Carr, and he's our senior editor for Science and Technology.

For. It has recently been shown that elephants have something equivalent to the names that human beings invent for each other.

So this is a mode of address. A name like yours or mine, you mean?

Sort of. Yes, it's a little more complicated than that. The elephants use these very low frequency rumbles for communication. They can be heard over many kilometres and the rumbles are different when directed towards different individuals. The differences can be parsed out using sophisticated artificial intelligence. And you can tell which rumble is directed at which individual. It's the equivalent of shouting hey, Joe. To someone to get their attention and say, this message is for you.

Well, that sounds like it functions just like a name. Walks like a name, sounds like a name. Why isn't it just a name?

It's a name except in the sense that we have not been able to pick out, as you could in the sentence, hey, Mary, the name. You can only pick it out by using AI statistics. So you can work out what's directed at who, but you can't say that particular bit of the sound is the name.

So in a sense, the rumble contains a name, even if we don't know exactly which piece of the rumble is the name.

Yes, that's correct. Researchers have been looking into elephant sounds for years. Elephants famously trumpet and they also talk to each other when they're close by. But these low frequency rumbles are a relatively newly studied discovery. Exactly what they're saying long distance is not quite clear, although when they're rumbling to each other close up, you can see what the rumbles are saying sometimes, such as, you know, let's go this way, or I'm pleased to see you that Sort of thing. But this study was done looking at two groups of Kenyan elephants. One group's been studied since 1997 and they're in the north of the country, and the other has been studied since 1972 and they're in the south. But we didn't have until recently the AI tools to be able to analyze them, and now we have. So they've been put through machine learning protocols and looked for patterns and found that they seem to have these names.

Well, talk me through that in the what can't AI do files here. What exactly did they analyze? How what did they find?

They knew you can identify an elephant from its rumble. They're individual specific. What they found was that the rumbles are also receiver specific. So if elephant Fred wants to talk to elephant Frieda, then that will sound different from when elephant Fred is talking to elephant Joe. More interestingly, perhaps, if Elephant George is talking to elephant Frieda, it'll sound quite similar to Elephant Fred talking to elephant Frieda. So the name is not just one elephant's way of addressing another. It's something that's collectively understood by the group.

I'm somewhat disappointed we don't have an elephant, Elwood, but we'll go with your names. So I guess my question is why we need AI to determine that if these disposal distinct sounds are there, if these animals have been studied, as you say, as far back as 1972, why hasn't this pattern been spotted before?

Well, as I said, these are not names like human names, in the sense that you can cut out a particular bit of the stream of sound and say that means a name. So hello Mary is hello Mary, and the Mary bit only means Mary. But you can analyze sound in other ways. A piece of music, for example, could be transposed into various different keys. And you can't take a particular bit of the music and say that represents the key. You know, the key is something which is superimposed over the top of it. It's more like that, that the AI has been looking for signals that, you know, not exactly the equivalent of musical keys, but the equivalent of frequency distributions of sounds within a bigger bit of sound and found that they represent names. I mean, it would, if you wanted to take the music analogy, that C major means one person, D minor means another, even though the actual notes transposed up and down the scale are the same.

And so I guess the real surprising thing here is not just that there are kind of modes of address, but that every individual in the group agrees what it is functioning like names do for us. I mean, what does that tell you about elephants communication abilities, about elephant's intelligence more generally?

Well, we know that elephants are extremely intelligent. This is a discovery that adds to the downgrading of human beings from the uniqueness that we like to think we have. You see again and again other vertebrates, you know, mostly mammals and some birds, where an awful lot of the sorts of things that human beings do and which in the past have been thought unique to them, certainly related to intelligence and probably related to consciousness, are not unique. They evolve over and over again in the animal kingdom. I wouldn't be surprised to see other groups of intelligent mammals and birds being shown to have names. It's just that zoology is an underfunded area and we don't have done the research yet.

Jeff, thanks very much for your time.

And thank you, Jason.

Foreign.

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