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From anecdotes to AI tools, how doctors make medical decisions is evolving with technology

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theconversation.com – Aaron J. Masino, Associate Professor of Computing, Clemson University – 2025-01-10 07:25:00

AI tools can help doctors synthesize all the information that goes into a clinical decision.

Khanchit Khirisutchalual/iStock via Getty Images Plus

Aaron J. Masino, Clemson University

The practice of medicine has undergone an incredible, albeit incomplete, transformation over the past 50 years, moving steadily from a field informed primarily by expert opinion and the anecdotal experience of individual clinicians toward a formal scientific discipline.

The advent of evidence-based medicine meant clinicians identified the most effective treatment options for their patients based on quality evaluations of the latest research. Now, precision medicine is enabling providers to use a patient’s individual genetic, environmental and clinical information to further personalize their care.

The potential benefits of precision medicine also come with new challenges. Importantly, the amount and complexity of data available for each patient is rapidly increasing. How will clinicians figure out which data is useful for a particular patient? What is the most effective way to interpret the data in order to select the best treatment?

These are precisely the challenges that computer scientists like me are working to address. Collaborating with experts in genetics, medicine and environmental science, my colleagues and I develop computer-based systems, often using artificial intelligence, to help clinicians integrate a wide range of complex patient data to make the best care decisions.

The rise of evidence-based medicine

As recently as the 1970s, clinical decisions were primarily based on expert opinion, anecdotal experience and theories of disease mechanisms that were frequently unsupported by empirical research. Around that time, a few pioneering researchers argued that clinical decision-making should be grounded in the best available evidence. By the 1990s, the term evidence-based medicine was introduced to describe the discipline of integrating research with clinical expertise when making decisions about patient care.

The bedrock of evidence-based medicine is a hierarchy of evidence quality that determines what kinds of information clinicians should rely on most heavily to make treatment decisions.

Pyramid diagram with systematic reviews up top, followed by critically-appraised topics, critically-appriased individual articles, RCTs, cohort studies, case-controlled series and background information/expert opinion at the base

Certain types of evidence are stronger than others. While filtered information has been evaluated for rigor and quality, unfiltered information has not.

CFCF/Wikimedia Commons, CC BY-SA

Randomized controlled trials randomly place participants in different groups that receive either an experimental treatment or a placebo. These studies, also called clinical trials, are considered the best individual sources of evidence because they allow researchers to compare treatment effectiveness with minimal bias by ensuring the groups are similar.

Observational studies, such as cohort and case-control studies, focus on the health outcomes of a group of participants without any intervention from the researchers. While used in evidence-based medicine, these studies are considered weaker than clinical trials because they don’t control for potential confounding factors and biases.

Overall, systematic reviews that synthesize the findings of multiple research studies offer the highest quality evidence. In contrast, single-case reports detailing one individual’s experience are weak evidence because they may not apply to a wider population. Similarly, personal testimonials and expert opinions alone are not supported by empirical data.

In practice, clinicians can use the framework of evidence-based medicine to formulate a specific clinical question about their patient that can be clearly answered by reviewing the best available research. For example, a clinician might ask whether statins would be more effective than diet and exercise to lower LDL cholesterol for a 50 year-old male with no other risk factors. Integrating evidence, patient preferences and their own expertise, they can develop diagnoses and treatment plans.

As may be expected, gathering and putting all the evidence together can be a laborious process. Consequently, clinicians and patients commonly rely on clinical guidelines developed by third parties such as the American Medical Association, the National Institutes of Health and the World Health Organization. These guidelines provide recommendations and standards of care based on systematic and thorough assessment of available research.

Dawn of precision medicine

Around the same time that evidence-based medicine was gaining traction, two other transformative developments in science and health care were underway. These advances would lead to the emergence of precision medicine, which uses patient-specific information to tailor health care decisions to each person.

The first was the Human Genome Project, which officially began in 1990 and was completed in 2003. It sought to create a reference map of human DNA, or the genetic information cells use to function and survive.

This map of the human genome enabled scientists to discover genes linked to thousands of rare diseases, understand why people respond differently to the same drug, and identify mutations in tumors that can be targeted with specific treatments. Increasingly, clinicians are analyzing a patient’s DNA to identify genetic variations that inform their care.

Columns of thin, luminescent bars against a black background

Output from the DNA sequencer used by the Human Genome Project.

National Human Genome Research Institute/Flickr

The second was the development of electronic medical records to store patient medical history. Although researchers had been conducting pilot studies of digital records for several years, the development of industry standards for electronic medical records began only in the late 1980s. Adoption did not become widespread until after the 2009 American Recovery and Reinvestment Act.

Electronic medical records enable scientists to conduct large-scale studies of the associations between genetic variants and observable traits that inform precision medicine. By storing data in an organized digital format, researchers can also use these patient records to train AI models for use in medical practice.

More data, more AI, more precision

Superficially, the idea of using patient health information to personalize care is not new. For example, the ongoing Framingham Heart Study, which began in 1948, yielded a mathematical model to estimate a patient’s coronary artery disease risk based on their individual health information, rather than the average population risk.

One fundamental difference between efforts to personalize medicine now and prior to the Human Genome Project and electronic medical records, however, is that the mental capacity required to analyze the scale and complexity of individual patient data available today far exceeds that of the human brain. Each person has hundreds of genetic variants, hundreds to thousands of environmental exposures and a clinical history that may include numerous physiological measurements, lab values and imaging results. In my team’s ongoing work, the AI models we’re developing to detect sepsis in infants use dozens of input variables, many of which are updated every hour.

Researchers like me are using AI to develop tools that help clinicians analyze all this data to tailor diagnoses and treatment plans to each individual. For example, some genes can affect how well certain medications work for different patients. While genetic tests can reveal some of these traits, it is not yet feasible to screen every patient due to cost. Instead, AI systems can analyze a patient’s medical history to predict whether genetic testing will be beneficial based on how likely they are to be prescribed a medication known to be influenced by genetic factors.

Another example is diagnosing rare diseases, or conditions that affect fewer than 200,000 people in the U.S. Diagnosis is very difficult because many of the several thousand known rare diseases have overlapping symptoms, and the same disease can present differently among different people. AI tools can assist by examining a patient’s unique genetic traits and clinical characteristics to determine which ones likely cause disease. These AI systems may include components that predict whether the patient’s specific genetic variation negatively affects protein function and whether the patient’s symptoms are similar to specific rare diseases.

Future of clinical decision-making

New technologies will soon enable routine measurement of other types of biomolecular data beyond genetics. Wearable health devices can continuously monitor heart rate, blood pressure and other physiological features, producing data that AI tools can use to diagnose disease and personalize treatment.

Related studies are already producing promising results in precision oncology and personalized preventive health. For example, researchers are developing a wearable ultrasound scanner to detect breast cancer, and engineers are developing skinlike sensors to detect changes in tumor size.

Research will continue to expand our knowledge of genetics, the health effects of environmental exposures and how AI works. These developments will significantly alter how clinicians make decisions and provide care over the next 50 years.The Conversation

Aaron J. Masino, Associate Professor of Computing, Clemson University

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Texas is already policing the Mexican border − and will play an outsize role in any Trump plan to crack down on immigration

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theconversation.com – Dan DeBree, Associate Professor of the Practice, Texas A&M University – 2025-01-17 15:29:00

Maverick County Sheriff’s Office Deputy Sgt. Aaron Horta, EMT operators and Border Patrol officers carry a body out of a canal on June 28, 2023, in Eagle Pass, Texas.
Brandon Bell/Getty Images

Dan DeBree, Texas A&M University

Over the past half-decade, the state of Texas has been pushing an evolution in the administration and enforcement of immigration law. Stepping into a traditional federal role, state lawmakers in 2023 passed Senate Bill 4, allowing Texas police to arrest those illegally crossing the border from Mexico.

But that law, which survived court challenges, is not the only place where the state has taken on traditional federal responsibilities. The Conversation’s senior politics editor, Naomi Schalit, spoke with Texas A&M professor Dan DeBree, a former Homeland Security official and Air Force veteran, about the other moves Texas has made that likely put it in a position to be a key player in carrying out immigration enforcement actions by the Trump administration.

What role has Texas taken in immigration enforcement at what levels of government?

Texas is the epicenter of the struggle between federal and state entities.

Traditionally, immigration and border security has been the role of federal law enforcement agencies, first and foremost Customs and Border Protection, which includes the Border Patrol.

Another essential federal agency is Immigration and Customs Enforcement, more commonly known as ICE. One portion of ICE – enforcement and removal operations – is responsible for conducting deportations and taking people back to their country of origin.

Customs and Border Protection is concentrated along the southern border. They cooperate closely with Texas and its Department of Public Safety.

By the nature of law enforcement, they’re generally cooperating very closely with them at all times. As an example, in a search and rescue mission, whichever agency is closest – the local sheriff’s department or state Department of Public Safety or federal Border Patrol – cooperates on a very granular level with the nearest available assets to find the missing person.

A woman in a uniform searches a man dressed in black who is leaning against a van outside.
A Maverick County sheriff searches a migrant as a group of migrants of different nationalities arrive at the Mexico-U.S. border in Maverick County, Texas, on Feb. 4, 2024.
Lokman Vural Elibol/Anadolu via Getty Images

Traditionally, the Texas Department of Public Safety would not be primarily responsible for apprehending border crossers. On the border, that is purely the purview of Customs and Border Patrol. And for a long time now, the National Guard, whether it be the Texas National Guard or from other states, has had a role in border security too. The Texas National Guard is deployed within Texas.

But there’s also National Guard from around the country who, in small batches, usually are deployed to either take some of the pressure off of a state, whether it be Arizona or Texas, to help them with that mission. Those are not federal troops. They’re state troops, serving under and deployed by the governor. There are also some federal troops in a joint task force used primarily for support purposes and not deployed in the field to do apprehensions.

It’s not every border state that has its police function getting involved in border enforcement. How did that develop over the past five years?

That developed mainly because this is an unprecedented migration. So at times – both geographically and temporally – Border Patrol would be overwhelmed. They’ve got a thin green line out there – they wear green uniforms – that just can’t hold it all back. And obviously there was tension between the administration in Texas, with the Biden administration in particular.

Some of these cities on the border were quite overwhelmed. You know, I remember seeing at a conference a representative from El Paso speaking to a representative from New York City, and the person from New York City was complaining about being overwhelmed by migrants. The detective from El Paso, from the Department of Public Safety, calmly responded with his corresponding numbers, and they were just staggering for a city of that size.

And you know, in El Paso, you can say, “Hey, this is a federal responsibility to take care of this all you want.” But if, in reality, it’s not happening because the federal assets are being overwhelmed through no fault of their own, then something needs to be done, right?

So that’s basically a political conflict between the state government and the federal government over what’s not being done. And I do have sympathy for all border states, but Texas in particular, and these border areas. There is a humanitarian crisis. That’s what I call it. It’s a humanitarian crisis going on on the border – caused by an unprecedented worldwide migration – and it does need to be addressed.

A large crowd of people in military uniforms standing outside.
Texas Tactical Border Force guardsmen arrive at the Million Air El Paso, Texas, airport on March 26, 2024, to provide extra security along El Paso’s southern border.
Brandon Bell/Getty Images

Besides the federal presence, this state involvement includes everything from the National Guard down to local police. It’s pretty much every level of government in Texas that’s involved in this?

I have a capstone research project with the Brooks County Sheriff’s Department. The immigration or humanitarian crisis on the border is overwhelming them. They have many, many, many unrecovered remains out in the desert over 942 square miles.

With few deputies patrolling that wide area, it will take generations to address that. And then, every day, particularly in the summer, they must conduct search and rescues for migrants who are in distress. There’s a steady flow of migrants through Brooks County. When they realize that they’re not going to make it they call 911, and every level of law enforcement is involved at some point or can be involved.

How do you see what Texas is doing meshing with a new federal immigration and border policy from the Trump administration?

The Texas state government will probably be lined up more closely with the new administration in their contention that there’s an invasion at the border. While I personally don’t like that term, I think there are sympathetic ears in the Trump administration to that argument, so I think that there will be cooperation or more support or funding from federal agencies.

I think, though, at the tactical level, such as the Brooks County sheriff dealing with the state Department of Public Safety and dealing with Customs and Border Patrol, I don’t think there’ll be much change.

When I was at the Department of Homeland Security, I worked for the Obama administration. Then I worked for the Trump administration, and then at the end I worked for the Biden administration. And you know, you would have thought that there would be drastic changes and big rudder movements, but there really weren’t.

The behemoth of a federal bureaucracy is pretty tough to move. Every administration comes in promising big, big changes, and in the end it usually falls short of the drastic promises.

There will be executive orders on immigration at the federal level, and we have seen the same tool used at the state level. And I understand this is part of politics. As an example, Texas Gov. Greg Abbott declared Mexican drug cartels or criminal organizations as terrorist organizations via executive order. I’m not necessarily on board with that – again, definitions are important – but sometimes words are used for emphasis or to even be inflammatory. I think we’ll see less of that from the state, because I think that the two administrations will be more aligned, so there won’t be a need for it.

My border security classes tends to result in more emotion than almost any other class I teach. When I talk to the students, I like to back up a second and go, “Whatever we think about this, it is a humanitarian crisis.”

I don’t know that it can be solved, but we have got to figure out a way to mitigate it, and what we’re doing when we mitigate a humanitarian crisis is we’re reducing human suffering. And I don’t think there’s anybody on any side of the aisle who can’t get on board with that, and that’s the way I frame it.The Conversation

Dan DeBree, Associate Professor of the Practice, Texas A&M University

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Biden helped bring science out of the lab and into the community − emphasizing research focused on solutions

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theconversation.com – Arthur Daemmrich, Professor of Practice in the School for the Future of Innovation in Society, Arizona State University – 2025-01-17 08:17:00

Biden began his presidency in the throes of the COVID-19 pandemic.
Evan Vucci/AP Photo

Arthur Daemmrich, Arizona State University

President Joe Biden was inaugurated in January 2021 amid a devastating pandemic, with over 24 million COVID-19 cases and more than 400,000 deaths in the U.S. recorded at that point.

Operation Warp Speed, initiated by the Trump administration in May 2020, meant an effective vaccine was becoming available. Biden quickly announced a plan to immunize 100 million Americans over the next three months. By the end of April 2021, 145 million Americans – nearly half the population – had received one vaccine dose, and 103 million were considered fully vaccinated. Science and technology policymakers celebrated this coordination across science, industry and government to address a real-world crisis as a 21st-century Manhattan Project.

From my perspective as a scholar of science and technology policy, Biden’s legacy includes structural, institutional and practical changes to how science is conducted. Building on approaches developed over the course of many years, the administration elevated the status of science in the government and fostered community participation in research.

Raising science’s profile in government

The U.S. has no single ministry of science and technology. Instead, agencies and offices across the executive branch carry out scientific research at several national labs and fund research by other institutions. By elevating the White House Office of Science and Technology Policy to a Cabinet-level organization for the first time in its history, Biden gave the agency greater influence in federal decision-making and coordination.

Formally established in 1976, the agency provides the president and senior staff with scientific and technical advice, bringing science to bear on executive policies. Biden’s inclusion of the agency’s director in his Cabinet was a strong signal about the elevated role science and technology would play in the administration’s solutions to major societal challenges.

Under Biden, the Office of Science and Technology Policy established guidelines that agencies across the government would follow as they implemented major legislation. This included developing technologies that remove carbon dioxide from the atmosphere to address climate change, rebuilding America’s chip industry, and managing the rollout of AI technologies.

Close-up of gloved hand holding square semiconductor chip
The CHIPS and Science Act of 2022 boosted research and manufacture of semiconductor chips in the U.S.
Narumon Bowonkitwanchai/Moment via Getty Images

Instead of treating the ethical and societal dimensions of scientific and technological change as separate from research and development, the agency advocated for a more integrated approach. This was reflected in the appointment of social scientist Alondra Nelson as the agency’s first deputy director for science and society, and science policy expert Kei Koizumi as principal deputy director for policy. Ethical and societal considerations were added as evaluation criteria for grants. And initiatives such as the AI bill of rights and frameworks for research integrity and open science further encouraged all federal agencies to consider the social effects of their research.

The Office of Science and Technology Policy also introduced new ways for agencies to consult with communities, including Native Nations, rural Americans and people of color, in order to avoid known biases in science and technology research. For example, the agency issued government-wide guidance to recognize and include Indigenous knowledge in federal programs. Agencies such as the Department of Energy have incorporated public perspectives while rolling out atmospheric carbon dioxide removal technologies and building new hydrogen hubs.

Use-inspired research

A long-standing criticism of U.S. science funding is that it often fails to answer questions of societal importance. Members of Congress and policy analysts have argued that funded projects instead overly emphasize basic research in areas that advance the careers of researchers.

In response, the Biden administration established the technology, innovation and partnerships directorate at the National Science Foundation in March 2022.

The directorate uses social science approaches to help focus scientific research and technology on their potential uses and effects on society. For example, engineers developing future energy technologies could start by consulting with the community about local needs and opportunities, rather than pitching their preferred solution after years of laboratory work. Genetic researchers could share both knowledge and financial benefits with the communities that provided the researchers with data.

Fundamentally, “use-inspired” research aims to reconnect scientists and engineers with the people and communities their work ultimately affects, going beyond publication in a journal accessible only to academics.

The technology, innovation and partnerships directorate established initiatives to support regional projects and multidisciplinary partnerships bringing together researchers, entrepreneurs and community organizations. These programs, such as the regional innovation engines and convergence accelerator, seek to balance the traditional process of grant proposals written and evaluated by academics with broader societal demand for affordable health and environmental solutions. This work is particularly key to parts of the country that have not yet seen visible gains from decades of federally sponsored research, such as regions encompassing western North Carolina, northern South Carolina, eastern Tennessee and southwest Virginia.

Community-based scientific research

The Biden administration also worked to involve communities in science not just as research consultants but also as active participants.

Scientific research and technology-based innovation are often considered the exclusive domain of experts from elite universities or national labs. Yet, many communities are eager to conduct research, and they have insights to contribute. There is a decades-long history of citizen science initiatives, such as birdwatchers contributing data to national environmental surveys and community groups collecting industrial emissions data that officials can use to make regulations more cost effective.

Going further, the Biden administration carried out experiments to create research projects in a way that involved community members, local colleges and federal agencies as more equal partners.

Hand-drawn signs displayed on a fence against a green field, with messages about climate change around a sign that reads 'It's our future'
Collaboration between the community, academia, industry and government can lead to more effective solutions.
Deb Cohn-Orbach/UCG/Universal Images Group via Getty Images

For example, the Justice40 initiative asked people from across the country, including rural and small-town Americans, to identify local environmental justice issues and potential solutions.

The National Institutes of Health’s ComPASS program funded community organizations to test and scale successful health interventions, such as identifying pregnant women with complex medical needs and connecting them to specialized care.

And the National Science Foundation’s Civic Innovation Challenge required academic researchers to work with local organizations to address local concerns, improving the community’s technical skills and knowledge.

Frontiers of science and technology policy

Researchers often cite the 1945 report Science: The Endless Frontier, written by former Office of Scientific Research and Development head Vannevar Bush, to describe the core rationales for using American taxpayer money to fund basic science. Under this model, funding science would lead to three key outcomes: a secure national defense, improved health, and economic prosperity. The report, however, says little about how to go from basic science to desired societal outcomes. It also makes no mention of scientists sharing responsibility for the direction and impact of their work.

The 80th anniversary of Bush’s report in 2025 offers an opportunity to move science out into society. At present, major government initiatives are following a technology push model that focuses efforts on only one or a few products and involves little consideration of consumer and market demand. Research has repeatedly demonstrated that consumer or societal pull, which attracts development of products that enhance quality of life, is key to successful uptake of new technologies and their longevity.

Future administrations can further advance science and address major societal challenges by considering how ready society is to take up new technologies and increasing collaboration between government and civil society.The Conversation

Arthur Daemmrich, Professor of Practice in the School for the Future of Innovation in Society, Arizona State University

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China tech shrugged off Trump’s ‘trade war’ − there’s no reason it won’t do the same with new tariffs

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theconversation.com – Yu Zhou, Professor of Economic Geography, Vassar College – 2025-01-17 08:10:00

When it comes to slowing down China’s tech rise, tariffs won’t do the trick.
Costfoto/NurPhoto via Getty Images

Yu Zhou, Vassar College

When Donald Trump returns to the White House, he’ll be accompanied by a coterie of China hawks, all vowing to use tariffs and export bans to stop Beijing from challenging the United States’ supremacy in technology.

This isn’t entirely new; China has faced such trade pressure since Trump first became president in 2017, and it has continued through the Biden administration.

But the scale of what Trump now proposes – he has mentioned tariffs of up to 60% on goods from China – has some commentators suggesting that it could, in the words of one analyst, “keep Beijing on the defensive and permanently transform the rivalry in America’s favor.”

Such a view is premised on the belief that China’s outdated, state-subsidized, manufacturing-for-export model is ripe for disruption by U.S. tariffs.

But as someone who has studied China’s technology since the early 2000s and written and edited two books on China and innovation, I believe this portrayal of China’s economy is at least two decades out of date. China’s technological sectors have grown rapidly after 2016 by adapting to the imposition of American tariffs. Indeed, since the “trade war” launched by Trump in 2017, Chinese technology has actually emerged as a world leader.

China’s tech ascent

Thirty years ago, China barely had internet access, and its best technology company was yet to produce a competitive personal computer domestically. Fifteen years ago, it was the world’s factory – stuck at the low end of the value chain assembling iPhones and other tech gadgets, but not able to make any high-tech parts itself.

Even with the best crystal ball in the mid-2000s, no Chinese planners could have predicted the pathways to China’s technological standing today.

Fast-forward to today: China is now ahead of rival economies across broad technological fields. The think tank Information Technology and Innovation Foundation found in a 2024 report that China is leading or globally competitive in five out of nine high-tech sectors – robotics, nuclear power, electric vehicles, artificial intelligence and quantum computing – and rapidly catching up in four others: chemicals, machine tools, biopharmaceuticals and semiconductors. A Bloomberg analysis similarly identified China as leading or globally competitive in 12 out of 13 technology-intensive industries. And the Australian Strategic Policy Institute found China leading in 37 of 44 critical technologies it tracked.

Why has the Chinese tech industry advanced so quickly? Many in Washington believe it’s the result of decades of careful government planning to dominate global high-tech industries. But this, I believe, vastly overestimates Beijing’s foresight and control. The Chinese government has indeed maintained the lofty goal of catching up with the West since the 1980s, but having goals isn’t the same as being able to execute them.

A man in a white hazmat suit works at a desk.
An employee produces semiconductor chips at a factory in China’s Shandong province on Jan. 15, 2025.
STR/AFP via Getty Images

Many in the West also point at Chinese state subsidies propping up domestic tech firms. While subsidies have played a role in some tech successes, the Chinese government has also funded plenty of failures. Take semiconductors, for example: Despite enormous Chinese government investments since the 1990s, China still lags in producing cutting-edge chips and is reliant on imports.

Dare to D.R.E.A.M.

In my view, China’s technological dynamism didn’t come from the magic of central planning, but through five key elements I call D.R.E.A.M..

D denotes the dialogue between state and market.

While China’s government wields significant power, the country’s private sector is neither submissive nor powerless. In 2022, firms not owned by the state – mostly private firms but also offshore firms in which Beijing does not have a controlling share – accounted for 95% of enterprise R&D spending and 88% of urban employment.

While Beijing has cracked down on tech giants – it banned Alibaba’s Ant Group from listing on the New York Stock Exchange in 2020, and its COVID-19 lockdown hurt its private sector – the government is not, contrary to how it is seen by many in the West, bound by strict ideology. It has recently started to voice more support for the private sector, even drafting laws to protect private companies.

Indeed, it’s more accurate to describe state-market relations in China as dynamic, adaptive interaction – more dialogue than dictatorship.

R refers to the domestic research and development (R&D).

Once reliant on imported technology, China has invested heavily in domestic research capacity over the past 20 years. Geopolitical tensions accelerated a shift toward self-reliance, but Chinese scientists and engineers remain deeply engaged in global networks.

Further, a nominally anti-espionage program brought in under Trump’s first administration has swelled the number of highly skilled workers in China. The “China initiative” introduced by the U.S. Justice Department in 2018 promoted the suspicion – often without evidence – that Chinese and Chinese American scientists might be spying for Beijing, resulting in a flood of leading scientists heading back to China. There they continued to undertake cutting-edge research and educate a new generation of Chinese scientists.

E is for the industrial ecosystem China can exploit.

China’s vast manufacturing base enables rapid creation and scaling of new technologies. In 2023, China produced 35% of the global gross manufacturing output, being the only country covering all major industrial sectors.

China may not have the innovative ecosystem of Silicon Valley, which can draw on deep venture capital and a booming stock market. But it has built comprehensive supply chains over the years, and it’s exceptionally good at repurposing them to rapidly bring new products to market.

Take the example of robotics. China took the robotics industry seriously only when labor costs rose sharply. In 2010, China’s manufacturing labor costs were about $2 per hour, similar to the Philippines or Vietnam; by 2022, that figure rose to about $8 per hour – more than double the average of Southeast Asian countries.

China now installs more industrial robots annually than the rest of the world combined, and the quality of its robots has grown by leaps and bounds.

A stands for accumulative changes.

Rather than aiming for novel breakthroughs, Chinese companies excel at incremental improvements – and this results in an accumulative transforming effect. The massive manufacturing networks create opportunities to improve upon existing products based on market feedback, rather than a few brilliant ideas from any leader’s creative mind.

Analysts in the U.S. have long expected China’s rampant intellectual property violations to doom its innovation drive, the thinking being that it takes away the impetus for individuals to innovate if they believe such innovations will be stolen. Instead, as Taiwanese tech expert and writer Kai-Fu Lee has explained, Chinese enterprises can be dynamic and innovative in an environment with less IP protection. They often rapidly expand their market share and build business ecosystems to prevent followers from catching up.

M means the middle market.

Chinese firms tend to target middle-income consumers, both domestically and globally. By prioritizing affordability and functionality over cutting-edge innovation, they avoid head-to-head competition with Western giants such as Apple.

Chinese smartphone brands such as Xiaomi and Oppo are a third to half the price of an iPhone, but with similar functionalities. Chinese electric vehicles are similarly far less expensive than Tesla but still incorporate leading features.

Chinese firms tolerate lower profit margins, as they can rely on the expanded sales in the middle market, both domestically and, increasingly, overseas.

A man and a woman look at a car.
A JIDU 07 electric car draws attention at the 2024 China International Auto Show in Tianjin, China, on Oct. 3, 2024.
CFOTO/Future Publishing via Getty Images

Tariffs as a counterproductive measure

The problem for the incoming Trump administration is that while tariffs might alter the global map of China’s manufacturing and exports, they won’t dismantle any of the D.R.E.A.M. elements. In fact, they could have the opposite effect of accelerating China’s push for self-reliance and strengthening its foothold in global middle markets.

Part of the problem is that American policymakers often see technological competition with China as a zero-sum contest. But technological competition isn’t like a race with distinct lanes and a finish line. Rather, tech transformation is a complex process in which countries and companies compete, collaborate and build on each other’s work.

Ultimately, America’s technological prowess won’t be measured by how much it manages to stop China, but by how successfully American companies can address humanity’s greatest challenges. Attempts to hobble the competition through tariffs and trade wars will do little toward that end.The Conversation

Yu Zhou, Professor of Economic Geography, Vassar College

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