Why aren’t actors like Jon Bernthal, Oscar Isaac and Walton Goggins “the biggest movie stars in the world right now?,” someone wondered on social media recently, comparing their talents to Robert De Niro and his peers in the 1970s.

Hollywood has weathered shifting tides since the dawn of cinema. But it’s only more recently that stardom itself, as a pop cultural force, has taken such a hit. Even so, the question gave me pause. What are we being denied, if anything, when actors we admire aren’t “the biggest movie stars in the world”? What are actors themselves being denied?

Maybe audiences are feeling nostalgic for a time when the world around us, even notions of stardom, seemed more simple. What’s the difference between a famous actor and movie star, anyway? I tend to think it has something to do with an aura that builds around a performer when they reach a certain level of commercial and artistic success. It’s also something about their persona — a compelling force of nature — both on screen and off.

Fame has its perks. Kevin Bacon recently told Vanity Fair that, as an experiment, he went out in disguise, experienced anonymity and wasn’t impressed: “People were kind of pushing past me, not being nice. Nobody said, ‘I love you.’ I had to wait in line to, I don’t know, buy a coffee or whatever. I was like, ‘This sucks. I want to go back to being famous.’” But even Bacon isn’t considered a global movie star.

There’s an endless gap between being recognizable and well-liked and a star who is the sole reason audiences flock to a movie. If you consider Bernthal, Isaac and Goggins, each has found success across the professional metrics that matter. How much more stardom is required of them? They seem to be doing just fine, lacking neither opportunities, nominations nor financial stability. Maybe it’s healthier for actors, as human beings, to not carry the mantle of Movie Star?

Either way, the importance of cinema has become diminished. Films don’t occupy our preoccupations the way they once did. If an actor’s stardom is still measured by ticket sales, it’s worth considering which movies were the highest earners in the past. In the ’70s, it wasn’t just the popcorn films that made money (though they certainly did). It was also movies that offered something different than spectacle. Stories that created room for leading actors to stretch their talents were regularly among the top earners: “One Flew Over the Cuckoo’s Nest,” “A Star is Born,” “Kramer vs. Kramer” (the latter of which was the No. 1 grosser of 1979; try imagining a movie about divorce and single parenthood achieving that today).

Hollywood has done its best in recent years to diminish the power movie stars once had, relying instead on intellectual property and the franchise-ification of familiar titles. Turns out, that will only get you so far. Now those same industry executives are embracing the movie stars that are still around, from Will Smith to Tom Cruise to Denzel Washington, but they remain flummoxed as to how to recreate an enduring system for newer, younger actors. Look how hard Glen Powell’s team is trying and … it’s proving to be a challenge. If you’re wondering why the likes of Bernthal aren’t considered major movie stars today, you also have to contend with the fact that non-white actors have had these same frustrations for years.

“Maybe this is controversial but I don’t think we live in a very glamorous era,” Izzy Custodio says in a recent video for Be Kind Rewind, her YouTube channel about Hollywood history. The lack of Hollywood glamor extends to a subject that may surprise you: The Muppet known as Miss Piggy. But Custodio calls her “the ultimate reflection of Hollywood ambition, obsession and glamor run rampant.” Some aspects of the character are timeless, but it’s been a struggle to adapt her to the current era because “many of the references that originally made her resonate” — her distinctive movie star aspirations and affectations — “aren’t really relevant anymore.”

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Premiering this weekend on HBO, a documentary about Faye Dunaway touches on some of these elusive qualities.  “Faye is perhaps someone I have created,” Dunaway says, referring to herself in the third person. “It’s a persona that is related very much to my work, that’s specific to my career — that’s the actress, I suppose.”

We don’t often hear stars talk about how they navigate this psychologically. We all have a public self. But for celebrities, this is exaggerated and intensified — a deliberate and calibrated performance all its own.

“In a lot of my films, the clothes have created statements,” she says. Yes, that seems to be missing right now, too. She also talks about Steve McQueen, who was her co-star in 1968’s “The Thomas Crown Affair.” The pair had a “wonderful chemistry,” she says, “because he was an actor, for sure, but he was also Steve. He had a persona that was something that defined him perhaps more than this quote-unquote acting.”

Maybe an actor like Austin Butler comes closes to that at the moment. But what Dunaway is describing is a larger-than-life quality, which used to have a literal meaning: Projected on a massive film screen, movie stars were larger than life. Now, we’re usually watching them on our TV screens and iPads, which have shrunk them back down to size.

In 1950’s “Sunset Boulevard,” about the vicissitudes of stardom, Norma Desmond, a grand dame of silent film who is past her prime, talks with a screenwriter who doesn’t recognize her at first — and then suddenly he does. You used to be big, he says. “I am big,” comes the retort. “It’s the pictures that got small.” A great line that has nevertheless been proven wrong two decades into the 21st century.

If Hollywood is unable to cultivate new stars, AI companies are all too happy to use this to their advantage by resurrecting old stars — from Judy Garland to James Dean to Burt Reynolds — for modern times. Their voices, at least. The possibilities are endless. And creepy.

“They took the idols and smashed them,” goes another line from “Sunset Boulevard.”

“And who’ve we got now? Some nobodies.”

Nina Metz is a Tribune critic.

Alex Brown | Stateline.org (TNS)

For decades, states have relied on gas taxes to provide much of the money to maintain roads and bridges. But as cars become more fuel efficient, and some Americans switch to electric vehicles, state leaders say the gas tax won’t pay the bills for much longer.

At the same time, many cities have seen their streets crowded with delivery trucks from Amazon and other companies, as consumers increasingly opt to have products delivered to their homes. In a few states, lawmakers think fees on those deliveries could be part of their road-funding solution.

“If you’re going to be creating wear and tear on our roads, you should help pay to maintain them,” said Colorado state Rep. Cathy Kipp, a Democrat who chairs the Energy and Environment Committee.

In July 2022, Colorado became the first state with a retail delivery fee, a charge on all vehicle deliveries to consumers within the state. The fee, which currently stands at 29 cents per delivery, provides funding for highways, bridges, tunnels, electric vehicle charging stations and projects to reduce air pollution and to electrify vehicle fleets and transit systems. It has brought in more than $160 million.

Colorado leaders have had to simplify the law to help businesses comply with it, but they say it’s largely been a success story. Minnesota enacted its own retail delivery fee in 2023, and lawmakers in New York and Illinois have proposed similar measures. Meanwhile, legislators and transportation officials in several other states have commissioned studies to consider the concept.

Some retailers and Republican lawmakers have argued that the fee hurts consumers, and many businesses in Colorado initially had trouble complying with the law.

“The 27-cent delivery fee is not trivial, its effects are not imperceptible, and it greatly affects our citizens — especially those who are already struggling to pay the bills and provide for their families,” Republican state Rep. Rose Pugliese, the House minority leader, wrote in a Colorado Springs Gazette guest column several months after the law was enacted.

But backers of the fee say they see growing interest across the country, especially as delivery trucks become ubiquitous in many neighborhoods.

‘Future-proofing’ transportation funding

State law in Colorado limits the ways in which lawmakers can expand taxes. With gas tax revenues dwindling, legislators didn’t have an obvious solution to pay for roads. They eventually settled on the retail delivery fee, which is not characterized as a tax.

Initially, the program was a struggle for many businesses, due to a requirement that they detail the fee separately on each receipt.

“For our medium and small businesses, it was a real complicated thing and very burdensome for them to have to reprogram their software with a whole extra line item,” Kipp said.

Last year, Kipp joined a bipartisan group of lawmakers to amend the program. They rescinded the requirement that businesses itemize the fee on each receipt and allowed companies to cover the fee themselves rather than breaking it out on each order. They also exempted retailers with less than $500,000 in sales.

Since the fix was adopted, Kipp said she has stopped hearing complaints about the program. Chris Howes, president of the Colorado Retail Council, said he too has not heard any recent gripes.

“We’ve got it straightened out by now,” he said. “People have accepted it and moved on.”

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Amazon did not grant a Stateline interview request, and the National Retail Federation deferred questions to state chapters. Chamber of Progress, a tech industry advocacy group, did not arrange an interview by publication time.

Last year, lawmakers in Minnesota enacted their own retail delivery fee, a 50-cent charge on purchases of more than $100. Lawmakers heard from local governments that they were struggling to maintain their roads and badly needed state aid to make up the gap.

“This is trying to future-proof our transportation funding,” said Democratic state Rep. Erin Koegel, who sponsored the bill. “We keep getting performance grades from civil engineers saying we’re at a C- or D for our infrastructure. We needed to think about ways to get more revenue in the system.”

Koegel said the measure was a compromise. Her initial draft, which did not have a $100 threshold for purchases, was intended to be a deterrent, much like cigarette taxes. She said delivery trucks are increasing congestion in many cities and damaging streets that weren’t built to support large vehicles. However, lawmakers ultimately decided to limit the fee to more expensive purchases in order to protect lower-income consumers.

Minnesota’s fee is projected to generate $59 million in its first fiscal year. The funding will be distributed to cities, counties and towns to help with their road-funding needs.

Traffic throughout the day

Cities and counties in Washington state also have asked for help, and some local leaders have asked state lawmakers to consider a retail delivery fee — or to authorize cities to collect one. State lawmakers commissioned an analysis, published last month, looking at the potential for such a program. The report found that a fee could generate $45 million to $112 million in revenue in 2026, depending on which businesses and orders were covered.

“We’re now seeing that there’s traffic on our system throughout the day, and the growth of these delivery services is a part of that,” said Democratic state Sen. Marko Liias, who chairs the Transportation Committee. “We’ve had a history in transportation of user-based fees. This feels like a mechanism that could help in that regard.”

Liias emphasized that some version of the fee is likely to be a big topic of discussion in the next legislative session. He said he’s already heard strong arguments on both sides of the issue.

In some areas, the rise in retail deliveries has put the greatest burden on the infrastructure surrounding shipping facilities. Illinois’ CenterPoint Intermodal Center, the nation’s largest inland port, connects interstate trucking, railway lines and Mississippi River barges.

“There really needs to be a shift in the tax structure, since many of these facilities are not generating the local sales tax you’d get at a brick and mortar,” said Democratic state Sen. Rachel Ventura, whose district includes the CenterPoint facility. “We have a lot of traffic going in and out, and the environmental burden and road repairs and the tax burden fall locally.”

Ventura has drafted a bill that would allow communities to assess fees on intermodal facilities — locations that transfer products from one type of transportation to another. Local governments that opted in would be able to spend the funds on roads within five miles of the facilities. The fee, which would be based on the weight of each shipment, is projected to generate $33 million to $68 million per year.

The bill has not passed out of committee, and Ventura said lawmakers are still discussing the path forward amid opposition from the trucking industry.

In New York, a Democratic bill to impose a 25-cent fee on deliveries within New York City has been introduced but remains in committee. Meanwhile, state agencies in Nevada and Ohio have commissioned studies examining the feasibility of retail delivery fees. Those reports have not yet led to legislative action.

©2024 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

The history of medical diagnosis is a march through painstaking observation. Ancient Egyptian physicians first diagnosed urinary tract infections by observing patterns in patients’ urine. To diagnose diseases of the heart and lungs, medieval doctors added core elements of the physical examination: pulse, palpation and percussion. The 20th century saw the addition of laboratory studies, and the 21st century of sophisticated imaging and genetics.

Despite advances, however, diagnosis has largely remained a human endeavor, with doctors relying on so-called illness scripts — clusters of signs, symptoms and diagnostic findings that are hallmarks of a disease. Medical students spend years memorizing such scripts, training themselves to, for example, identify the sub-millimeter variations in electrocardiogram wave measurements that might alert them to a heart attack.

But human beings, of course, err. Sometimes, misdiagnosis occurs because a doctor overlooks something — when the patterns of illness fit the script, but the script is misread. This happens in an estimated 15% to 20% of medical encounters. Other times, misdiagnosis occurs because the illness has features that do not match known patterns — they do not fit the script, such as when a heart attack occurs without telltale symptoms or EKG findings.

Artificial intelligence can help solve these two fundamental problems — if it’s given enough financial support and deployed correctly.

First, AI is less susceptible to common factors that lead doctors to make diagnostic errors: fatigue, lack of time and cognitive bandwidth when treating many patients, gaps of knowledge and reliance on mental shortcuts. Even when illnesses conform to scripts, computers will sometimes be better than humans at identifying details buried within voluminous health care data.

Using AI to improve the accuracy and timeliness with which doctors recognize illness can mean the difference between life and death. Ischemic stroke, for example, is a life-threatening emergency where a blocked artery impedes blood flow to the brain. Brain imaging clinches the diagnosis, but that imaging must be performed and interpreted by a radiologist quickly and accurately. Studies show that AI, through superhuman pattern matching abilities, can identify strokes seconds after imaging is performed — tens of minutes sooner than by often-busy radiologists. Similar capabilities have been demonstrated in diagnosing sepsis, pneumonia, blood clot in the lungs (pulmonary embolism), acute kidney injury and other conditions.

Second, computers can be useful for illnesses for which we haven’t developed the right scripts. AI can, in fact, diagnose disease using new patterns too subtle for humans to identify. Consider, for example, hypertrophic cardiomyopathy, a rare genetic condition in which the heart’s muscle has grown more than it should, leading to eventual heart failure and sometimes death. Experts estimate that only 20% of those affected are diagnosed, a process that requires consultation with a cardiologist, a heart ultrasound and often genetic testing. What, then, of the remaining 80%?

Researchers across the country, including at the Mayo Clinic and UC San Francisco, have demonstrated that AI can detect complex, previously unrecognized patterns to identify patients likely to have hypertrophic cardiomyopathy, meaning AI-driven algorithms will be able to screen for the condition in routine EKGs.

AI was able to recognize these patterns after examining the EKGs of many people with and without the disease. The rapid growth in health care data — including detailed electronic health records, imaging, genomic data, biometrics and behavioral data — combined with advancements in artificial intelligence technology has created a major opportunity. Because of its unique ability to identify patterns from the data, AI has helped radiologists to find hidden cancers, pathologists to characterize liver fibrosis and ophthalmologists to detect retinal disease.

One challenge is that AI is expensive, requiring large-scale data to train computer algorithms and the technology to do so. As these resources become more ubiquitous, that can make the associated intellectual property difficult to protect, discouraging private investment in these products. More generally, diagnostics have long been considered unattractive investments. Unlike their therapeutic counterparts, which see around $300 billion in research and development investment a year, diagnostics receive a modest $10 billion in private funding.

Then there’s the question of who pays for the use of AI-based tools in medicine specifically. Some applications, such as detecting strokes, save insurers money (by preventing costly ICU stays and subsequent rehabilitation). These technologies tend to get reimbursed more quickly. But other AI solutions, such as detecting hypertrophic cardiomyopathy, may lead to increased spending on costly downstream therapies to treat newly identified chronic illness. Although the use of AI may improve quality of care and long-term outcomes in such cases, without financial incentives for insurers, reimbursement and thus adoption may be slow.

Life sciences companies have on rare occasion agreed to subsidize development or reimbursement of AI-based diagnostics. This will help bridge the gap, but the federal government may need to play a greater role. Federal support for COVID diagnostics during the pandemic drove rapid development of critical tests, and the cancer moonshot project has helped drive R&D in screening and new treatments.

It is usually tough to marshal funding at the scale needed for new medical frontiers. But the National Academies of Medicine has estimated that tens of billions of dollars and countless lives could be saved from improving diagnosis in medicine.

Artificial intelligence offers a path toward that. It should complement, rather than replace, the human expertise that already saves so many lives. The future of medical diagnosis doesn’t mean handing over the keys to AI but, rather, making use of what it can do that we can’t. This could be a special moment for diagnosis, if we invest enough and do it right.

Gaurav Singal is a computer scientist and physician at Harvard Medical School and was previously the chief data officer of Foundation Medicine, a cancer diagnostics company. Anupam B. Jena is an economist, physician and professor at Harvard Medical School and co-author of ” Random Acts of Medicine: The Hidden Forces That Sway Doctors, Impact Patients, and Shape Our Health” and the Random Acts of Medicine Substack. They wrote this column for the Los Angeles Times.

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