Going to the movies will never be the same. Call me old-fashioned, but movies today are not like movies when I was a kid.

In 1960, when I was nine years old, my parents took me and some friends to Philadelphia to celebrate my birthday, a journey of about 50 miles, to see the greatest movie ever made . It was called Ben-Hur – A Tale of the Christ.

Never before had such a movie been made on such a grand scale. This movie was so big you couldn’t see it at your local movie theater. It had to be seen on a wide-scale panoramic movie screen. It needed the big screen and the surround-sound of a big theater. It was like nothing ever before produced. It was such a big deal that they sold souvenir booklets in the lobby to tell you all about the making of the movie. I still have my booklet today, some 63 years later!

Ben-Hur had the largest budget ($15.175 million) as well as the largest sets built on any film produced at the time. Costume designer Elizabeth Haffenden oversaw a staff of 100 wardrobe fabricators to make the costumes, and a workshop employing 200 artists and workmen provided the hundreds of friezes and statues needed in the film.

Filming commenced on May 18, 1958 and wrapped up on January 7, 1959, with shooting lasting for 12 to 14 hours a day, six days a week. Pre-production began around October 1957, and post-production took six months. Under cinematographer Robert L. Surtees, MGM executives made the decision to film the picture in a widescreen format, though against the wishes of Director William Wyler. More than 200 camels and 2,500 horses were used in the shooting of the film, with some 10,000 extras.

The sea battle was filmed using miniatures in a huge tank on the back lot at the MGM Studios in Culver City, California. I can still see those slaves chained to their posts as they pulled on the oars. Who could ever forget the chariot race? One of the most spell-binding and dramatic movie sequences ever produced on an immense scale, before the time of computer graphics and simulations that today dominate movie making, it remains a cinematic triumph. The nine-minute chariot race has become one of cinema’s most famous sequences, and the film score, composed and conducted by Miklos Rozsa, is the longest ever composed for a film and was highly influential on cinema for more than 15 years.

Following a $14.7 million marketing effort, Ben-Hur premiered at Loew’s State Theatre in New York City on November 18, 1959. It was the fastest grossing as well as the highest grossing film of 1959, in the process becoming the second-highest grossing film in history at the time after Gone with the Wind. It won a record 11 Academy Awards, including Best Picture, Best Director (Wyler), Best Actor in a Leading Role (Charlton Heston), Best Actor in a Supporting Role (Hugh Griffith), and Best Cinematography (Robert Surtees), an accomplishment that was not equaled until Titanic in 1997 and then again by The Lord of the Rings: The Return of the King 2003, before any other films equaled this achievement.

Ben-Hur was a fictional story, but based on the Bible and the life of Jesus Christ. It was a dramatic story that anyone could enjoy and for some it was even a spiritual experience. I shall never forget my ninth birthday because of that movie and even today I can still imagine the roar of the crowd and the intensity of that chariot race to the finish. The final triumph of Judah Ben-Hur over his Roman antagonist shall be forever etched in my mind.

Today we have movies we can watch on our cell-phones, our I-pads, or our televisions. We can watch them in the car, on an airplane, or just sitting on a park bench. But these will never replace the impact of the wide screen, the surround-sound, and the dramatic scenes of a movie like Ben-Hur. Call me old-fashioned, but some things were just better in the old days. I’ll still think of that birthday 63 years later when I celebrate my birthday this week.

The success of charter schools in outperforming public schools is well known. Some are well known, such as The Success Academy in New York City. All across the nation, charter schools have been known to improve learning, especially in low-income neighborhoods.

A new nationwide Stanford University study documents this improvement writes the editorial board of The Wall Street Journal. While school choice is gaining momentum nationwide, charter schools are a large part of the movement. Stanford’s Center for Research on Education Outcomes (CREDO) report is the third in a series (2009, 2013, 2023) tracking charter-school outcomes over 15 years. The study is one of the largest ever conducted, covering over two million charter students in 29 states, New York City and Washington, D.C., and a control group in traditional schools.

CREDO’s judgement is unequivocal: Most charter schools “produce superior student gains despite enrolling a more challenging student population.” In reading and math, “charter schools provide their students with stronger learning when compared to the traditional public schools.” The nationwide gains for charter student were six days in math and 16 days in reading.

The comparisons in some states are more remarkable. In New York, charter students were 75 days ahead in reading and 73 days in math compared with traditional public-school peers. In Illinois they were 40 days ahead in reading and 48 in math. In Washington state, 26 days ahead in reading and 39 in math. Those differences can add up to an extra year of learning across an entire elementary education.

This wasn’t always the case. CREDO’s first study in 2009 found that charters didn’t yield better student outcomes—and has long been cited by charter opponents. Teachers unions often claim charters and choice programs betray public education because they cherry-pick children and fail to serve those in greatest need. CREDO’s results should also end that discussion. The argument of the unions was always suspicious since most charter school students are picked by lottery. But now these results prove their arguments don’t hold water.

The latest study shows that black and Hispanic students had some of the largest gains and that they “advance more than their TPS peers by large margins in math and reading.” Ditto for children in poverty. Unions should also read the section on what CREDO calls “gap-busting schools,” which show black and Hispanic students succeeding as well as white peers. CREDO says this shows that “learning gaps between student groups are not structural or inevitable.”

To be sure, not all charter schools are created equal. Like all schools, some perform better than others. The study shows a growing advantage in results for schools run by charter management organizations, which operate multiple schools. This is likely the result of a learning curve that can be applied to many locations. Around 15% of charters underperform their local public school, but lackluster charters are closed, unlike failing union schools.

This Credo installment covers 2015-2019 before the pandemic. With each new report, student progress has climbed further and the long lens of the study shows that charter schools are getting better. The Credo report may even understate the success of some charter schools. In the case of Ohio, the Credo methodology dilutes the strong results of brick-and-mortar charter schools by including remote schools and other specialized schools in its results. A 2020 Fordham Institute analysis of Ohio charter school showed strong gains.

You would think these results would trigger a movement to expand charters and increase their funding. After all, everyone wants children to learn, right? Everyone except the unions. They consider charter schools an existential threat so they’re fighting for their survival. Makes you wonder where those parents send their children to school.

Nurses and doctors are now being challenged in their medical decision making by computers – called artificial intelligence or “A.I.” That’s the subject of this two-part series on changes in medicine.

In Part I, we learned that nurses and doctors face scrutiny of their decisions when computer alerts tell them to respond one way but their medical experience and training tells them to respond another. While humans are not perfect – neither are computers. Which one would you prefer to put first in decisions about your healthcare?

Lisa Bannon, writing for The Wall Street Journal, says this is a real dilemma nurses and doctors are facing every day since the implementation of A.I. algorithms into medicine.

In a survey of 1,042 registered nurses published this month by National Nurses United, a union, 24% of respondents said they had been prompted by a clinical algorithm to make choices they believed “were not in the best interest of patients based on their clinical judgment and scope of practice” about issues such as patient care and staffing. Of those, 17% said they were permitted to override the decision, while 31% weren’t allowed and 34% said they needed doctor or supervisor’s permission.

Naturally, hospitals are denying such pressure to follow A.I. algorithms but nurses and doctors feel differently. “If a nurse feels strongly this does not make sense for their patient, they should use their clinical judgment” and contact the doctor, the UC Davis Medical Center said. “The ultimate decision-making authority resides with the human physicians and nurses.” But one of their nurses said, “I’m not demonizing technology, but I feel moral distress when I know the right thing to do and I can’t do it.”

Nurses have enough stress in their jobs already without this additional burden. Since the Covid-19 pandemic, the ranks of nursing have been depleted and hospitals in our area have billboard signs begging nurses to apply for work. Hospitals are chronically understaffed and many complain of high stress and exhaustion. In a survey of more than 12,500 nurses in November 2022 by the research affiliate of the American Nurses Association, 43% of nurses said they were burned out. Add to this the growing doctor shortage and you have a real crisis in healthcare.

Jeff Breslin, a registered nurse at Sparrow Hospital in Lansing, Mich., has been working at the Level 1 trauma center since 1995. He helps train new nurses and students on what signs to look for to assess and treat a critically ill or severely injured patient quickly. “You get to a point in the profession where you can walk into a patient’s room, look at them and know this patient is in trouble,” he said. While their vital signs might be normal, “there are thousands of things we need to take into account,” he said. “Does he exhibit signs of confusion, difficulty breathing, a feeling of impending doom, or that something isn’t right?”

Like most trauma centers, Sparrow uses algorithms to alert nurses about changes in patient conditions. Over the past several years, Breslin has noticed that newer, digitally native nurses often trust the algorithm over their own observation skills. If new nurses over rely on AI-based decisions, he said, “you’re not going to have the same assessment skills to look at a patient and know, ‘I’ve got to do something right away,’ ” he said.

Hospitals defend these A.I. system algorithms as intended to support nurses’ clinical judgment, not replace it. That may be true in some cases, but not in others. Whether a nurse is confident enough to trust her own judgment to override an algorithm often depends on hospital policy. Clinicians who are penalized for making a wrong decision may start deferring to the computer, nurses say.

Cynthia Girtz, a registered nurse at Kaiser Permanente Medical Group, was on duty one afternoon at a call center in Vallejo, Calif., where she worked as what the company calls an “advice nurse,” along with more than 200 other nurses, according to proceedings from an arbitration case last year. Her job was to answer calls from Kaiser members who feel sick and offer clinical advice on what they should do next. Advice nurses at Kaiser use algorithms to categorize the illness of the caller, typing answers into a drop-down menu based on the patient’s symptoms, according to the arbitration decision. The answers determine the next steps for treatment.

When Kenneth Flach, a retired professional tennis player from Marin County, called Kaiser complaining of a cough, chest pains and fever, Girtz chose Kaiser’s cough/cold and flu algorithm. That protocol doesn’t provide an option for an emergency room or in-person doctor visit “unless the patient was spitting up at least 2 tsp of frank [visible] blood,” the arbitration decision said. Since Flach wasn’t doing so, the nurse followed the algorithm’s directions to schedule a phone appointment with a doctor several hours later.

Flach was later diagnosed with pneumonia, acute respiratory failure and renal failure and died several days later. The arbitrator in the case held the nurse responsible, deciding she should have exercised her clinical judgment to override the algorithm. “Pressured by this policy, Nurse Girtz viewed it as a directive,” the arbitrator found. The nurse, “notwithstanding the Kaiser policy, owed a duty of care to provide a reasonable nursing assessment.” Kaiser, as the nurse’s employer, was ordered to pay the family about $3 million.  In a written statement, Kaiser said the algorithmic recommendations are “guidelines for triage, not directives,” and nurses are expected to adapt them to the unique needs of each patient. Nurses have the authority to override protocols based on their clinical judgment.

Is it any wonder that hospitals are having difficulty hiring nurses and doctors are retiring early?