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Developing a workshop to close the gap between community and academic oncologists is critical to address institutional concerns about administering CAR T-cell therapy and bispecific antibodies to patients with multiple myeloma and other malignancies, according to Al-Ola A. Abdallah, MD.

At the 2025 National Immune Cell Effector Therapy (ICE-T) Conference, CancerNetwork^® spoke with Abdallah about prevalent ideas related to the use of novel cellular therapies highlighted throughout the meeting. Specifically, Abdallah focused on themes that appeared in the meeting’s “Myeloma & Other Plasma Cell Disorders” session, which included a series of oral presentations as well as a live panel discussion between the speakers and audience.

Abdallah, an associate professor of Medicine and the director of the Plasma Cell Disorder Clinic in the Division of Hematologic Malignancies and Cellular Therapeutics at the University of Kansas Medical Center, emphasized the importance of educating community oncologists to bolster the use of new cellular therapies in an outpatient setting. He also described strategies for sequencing these agents across multiple lines of therapy and sustaining quality of life in patients who experience toxicities such as cytopenia and infection.

“We need to start focusing on community oncologists and see exactly how we can provide more access for treatment with these [agents]. There has to be a better pathway to do that,” Abdallah stated. “Improving access through the community oncologists will be the best thing we have to develop newer strategies and [ensure] that community oncologists cover their basics, treat [toxicities], feel more comfortable, and increase referrals if needed.”

CancerNetwork: What were some key themes that emerged across the different presentations featured in the “Myeloma & Other Plasma Cell Disorders” session?

Abdallah: Our major focus was about the cellular therapies, the main 2 major treatments, the CAR T-cell [therapies] that are approved right now, and some clinical trials that we believe will have a potential approval in the future. Also, we had a great discussion about the bispecific treatments that focus on the 3 BCMA-directed [therapies] as well the GPRC5D treatments that we have approved. Majorly, we talked about the challenges that we saw, especially the concerns of community oncologists [regarding] access to either the CAR T-cell [therapy] or access to management for bispecific treatments, especially with some of the [adverse] effects that are concerning. [These toxicities include] a risk of grade 3/4 infection down to disturbance of the quality of life for patients who receive drugs like talquetamab-tgvs [Talvey] that affect their taste—like dysgeusia—and nail and skin changes. That was our biggest focus on these cases, more about updates about these standard-of-care treatments and management of some of these [adverse] effects.

What points stood out to you the most during the session’s panel discussion? How can these ideas be applied to clinical practice?

The biggest focus was about how we can apply most treatment [in the] outpatient [setting]; that was the biggest challenge. If we apply it outpatient, we have a big chance that more community oncologists will be able to administer the treatment. One of the biggest points was that every institution is starting to use drugs like tocilizumab [Actemra] as a cytokine release syndrome [CRS] prophylaxis in order to prevent reactions or any [adverse] effects. That helps a lot to improve [or] decrease the hospitalization for these patients. That can be a potential impact for administering the treatment outpatient and [among] community oncologists, which was the biggest goal of this discussion.

As new data continuously emerge for these novel cellular therapies and immunotherapies, what should practices keep in mind as part of the clinical decision-making process?

The CAR T-cell [therapies] and the bispecifics are emerging quickly. We do not have a great answer [for sequencing]. The challenges here are that when CAR T-cell [therapy] has been approved, it was after 4 lines of therapy. It was an easy decision about how to give it to these patients. Now, CAR T has moved to a second line of therapy. The challenges are, do we give that to patients directly, or wait until they relapse a second or third time? Mainly, [that is because] there are some [adverse] effects that we are still concerned about, and we are not talking about the CRS and immune effector cell-associated neurotoxicity syndrome [ICANS]. Mainly, we are talking about other long-term [adverse] effects like risk of infection as well as secondary malignancy.

One of the major questions here is, “Do we have to give every single patient who [has] relapsed after a second line of therapy CAR T-cell [therapy]?”The word is that it’s a no-brainer. I do not think that’s the right answer. We should have to evaluate case-by-case in order to provide the best benefit for our patients when using the CAR T-cell therapy.

What are some common toxicities associated with these cellular therapies, and what strategies can help mitigate them while maintaining quality of life?

We try to evaluate these patients after the CAR T-cell therapy to decrease their risk [by] giving growth factor shots and administering other medications that help their cytopenia. Stem cell boost has been one of the best treatments; unfortunately, it’s not always available for each patient.

Regarding the risk of infection, our standard of care has been giving intravenous immunoglobulin [IVIG] for all patients, which, unfortunately, is not the same as patients receiving CAR T-cell therapy, not receiving any other treatments, and not coming every month for that. That impacts the promise of quality of life. We should provide it [through] fewer office visits. But these are the things, like stem cell boost for patients who have prolonged cytopenia, that can hopefully preserve their quality of life. [Regarding] IVIG, the benefit of coming every month is better than having a higher risk of infection, so that can help a lot for the future.

What are some key themes that other should take away from this year’s National ICE-T Conference?

The whole purpose of [the meeting] is to close that gap [between community and academic oncologists]. Our goal here is to develop that bridge, our network between academic and community oncologists. We are not planning just for education; we are planning for engagement and trying to develop [an] actual workshop between our academic centers and the community oncologists in order to address their concerns about providing bispecifics and CAR T-cell [therapy] at other institutions. That’s our biggest goal. This is not like we are going to give some presentations and leave. This is going to be, hopefully, a future collaboration between us and the community oncologists.

Majorly, we hope to have more collaboration about the potential role of the cellular therapy. It’s extensive not only in multiple myeloma and lymphoma, [but] also in solid cancers. This means there has to be a future development of access to treatment, how to manage the [adverse] effects, and how to overcome all obstacles. It’s tough to provide CAR T-cell and cellular therapy right away, but it’s something that we have to think about in the future, especially [because] we have many cancers other than multiple myeloma and lymphoma. We are going to start using more cellular therapies in the future.

Study aims

Participants in AgeWISE-AP will be compared to a no treatment control group. There are three primary aims of the present study as well as a fourth exploratory aim.

• Aim 1: To determine whether AgeWISE-AP increases older Veterans’ engagement in lifestyle factors that promote brain health. AgeWISE provides information about the differences between normal and diseased brain aging and lifestyle factors that contribute to brain health. The action plan (AP) component will use this foundation to collaboratively create an individualized brain health plan to increase Veteran engagement in brain healthy lifestyle activities. We hypothesize that AgeWISE-AP participants will demonstrate increased engagement in brain-healthy lifestyle activities compared to the control group.

• Aim 2: To determine whether AgeWISE-AP improves psychological wellness. AgeWISE provides information about the relationship between cognitive aging and affective states (e.g., depression) and attitudes about aging, and teaches stress reduction techniques. The action plan (AP) will provide additional individualized supports to improve psychological well-being with personalized goals and lifestyle modifications (e.g., diet, exercise, sleep, cognitive stimulation). We hypothesize that AgeWISE-AP participants will show increases in perception of control over cognitive aging, meaning and purpose in life, quality of life, and self-efficacy, as well as improved attitudes toward aging and decreased loneliness, depression, and anxiety compared to the control group.

• Aim 3: To determine whether AgeWISE-AP improves cognition. Cognitive strategies to improve cognition and functioning are presented and practiced over three AgeWISE sessions, with homework to improve generalization to day-to-day life. Engagement in brain-healthy lifestyle activities will be accomplished through the action plan (AP). We hypothesize that self-reported memory contentment, ability, and compensatory strategy use will increase. We also hypothesize that objective cognitive performance will be better for AgeWISE-AP participants compared to the control group.

• Exploratory Aim 4: To determine whether AgeWISE-AP influences biomarkers of brain health using structural neuroimaging methods. We hypothesize that at one-year follow-up, AgeWISE-AP participants will have less volumetric decline in brain regions of interest compared to the control group.

Study overview

The current study is a Phase III randomized controlled clinical trial. The study will employ two arms: the AgeWISE-AP intervention arm and a no treatment control group arm.

AgeWISE-AP intervention arm

AgeWISE-AP includes engagement in the original 12-week, one hour per week AgeWISE group plus an additional 8-session individualized action plan. Group AgeWISE sessions include education, discussion, and in-class exercises designed to practice introduced skills. Out of session homework assignments are given weekly to promote generalization of training into daily life. Table 1 displays an outline and summary for the 12 sessions in the intervention (as seen in O’Connor et al., 2018 [52]). During week 9 of the AgeWISE group, Veterans will begin the novel AP component of the intervention.

The AP component will be run by a doctoral level occupational therapist serving as the Brain Health Interventionist. The Brain Health Interventionist meets with Veterans individually, once a week over the first month (final 4 weeks of AgeWISE) to define at least three specific goals across lifestyle factors associated with dementia risk (exercise, diet, sleep, socialization, cognitive stimulation) and create an actionable plan to meet those goals. The Brain Health Interventionist then meets with the Veteran every other week (4 additional sessions for a total of 8 individual sessions) to monitor progress, identify barriers to progress, and revise the plan as needed. The Brain Health Interventionist uses the Whole Health Personal Health Inventory and Personal Health Plan worksheets, modified for the current study to focus on brain health, to help determine targeted goals for change. Motivational interviewing techniques are incorporated throughout individual sessions. The Brain Health Interventionist assists with coordination of referrals to existing programs within and outside of the VA system specific to Veteran-identified goals. For example, a Veteran who identifies increased exercise as a goal might be encouraged to join the VA GeroFit program or attend classes at their local YMCA. As needed, the Brain Health Interventionist may make the referral, provide the phone number for YMCA membership, print a copy of the class schedule, and help the Veteran brainstorm solutions to barriers such as transportation.

Control group arm

The control condition is a no treatment control. Although other control conditions could have been proposed, no treatment was chosen for this study for a number of reasons including (a) the desire to fully capture what occurs in the real lives of older Veterans, which typically involves no active treatment (minimal education and skills training related to cognitive aging concerns from other professionals may occur, as may self-generated acquisition of knowledge regarding cognitive aging), and (b) the desire to minimize the influence of increased socialization with other older Veterans having similar concerns, as we suspect that such interaction is one active ingredient of the intervention. Following study completion, control group Veterans will be invited to participate in the AP intervention as a clinical service.

Participants

A total of 128 Veterans will be recruited into the study staggered across Years 1 and 2 to ensure that the workload is manageable (an average of 16 participants will be recruited per study quarter). Recruitment takes place at the Bedford VA Healthcare System. All potentially eligible Veterans are asked if they would like to hear information about a study related to cognitive aging. Those who agree are given a study flyer and provided with a brief description of the study and procedures. Those who express interest are screened for eligibility and will complete the informed consent process and HIPAA authorization (see Table 2 for a schedule of enrollment, interventions, and assessments). During the informed consent process, participants are given the option of undergoing brain imaging at baseline and one-year follow-up for Aim 4. Participants that agree to neuroimaging undergo an additional informed consent process during the first of two brain imaging sessions, and complete a screening questionnaire specific to brain imaging safety. The informed consent processes occur in a private office setting and the information is presented both verbally and in written format. Veterans are asked to paraphrase informed consent information to ensure adequate understanding. Veterans are given ample time to ask questions about the study. After the informed consent, Veterans undergo a study screening that includes administration of the Montreal Cognitive Assessment (MoCA). Inclusion criteria for the present study includes Veterans ≥ 60 years old with concerns about brain aging who want to learn more about cognitive aging; and English speaking as all intervention materials are written in English. Exclusion criteria for the present study includes Veterans with impairment on a cognitive screening measure, as determined using a MoCA cutoff score for dementia of < 24 [53], or self or other reported diagnosis of a brain disorder affecting cognition such as Alzheimer’s disease, Parkinson’s disease, other dementia, major stroke, brain injury, or diagnosis of psychotic disorder such as schizophrenia; and active alcohol or substance abuse.

Procedures

After eligible Veterans complete informed consent, screening, and baseline measures for study inclusion, each is randomized to one of the two study arms: AgeWISE-AP (intervention arm) or the control condition. Randomization uses two computer-generated numbered lists; one for each condition. The lists are generated through a permuted block design. With this approach, each randomization list consists of two AgeWISE-AP assignments and two control condition assignments in random order. This approach not only guarantees balance in the two conditions, but also balances assignments due to the time of recruitment.

The manualized AgeWISE group classes are run by doctoral level psychologists within the Bedford VA Healthcare System’s Neuropsychology Department. The study team discusses any issues related to the intervention sessions during weekly meetings. The AP component is run by a doctoral level occupational therapist serving as the Brain Health Interventionist to increase older Veteran participation in lifestyle activities associated with healthy brain aging. The Brain Health Interventionist helps the Veteran complete the Whole Health Personal Health Inventory and Personal Health Plan worksheets, which were modified to focus on brain health, to determine personalized goals, create an actionable plan to meet goals, and provide assistance with program referrals as needed (4 initial weekly sessions, 1 h per week). The Brain Health Interventionist then meets with the individual Veteran every other week for the final 8 weeks (4 additional sessions, 1 h every other week, for a total of 8 AP sessions) to review goals, boost motivation through accountability check-ins, determine any barriers to behavior change, and modify and adjust goals accordingly.

The study has been approved by the VA’s Central Institutional Review Board (cIRB) and Scientific Review Committee. Participant recruitment is at a target rate of 1–2 Veterans a week, projected at approximately 16 Veterans per study quarter during months 4 through 27 (see Table 3). The Bedford VA Healthcare System is a Category 3 facility located in the north-west suburbs of Boston serving approximately 20,000 Veterans with the bulk of clinical services in mental health, primary care, and geriatrics and extended care. Participants will be recruited from neurological, psychological, geriatric, and primary care services.

For Aims 1 through 3 (Primary Aims), the baseline evaluation takes participants an average of 1.25 h (1 h and 15 min) to complete the following measures, including collection of the demographic data (see below); sessions can be broken into two sessions as needed to minimize any fatigue. Follow-up evaluations take place immediately after the AgeWISE-AP intervention has ended (immediate post intervention), 3-months post intervention, and 6-months post intervention (i.e., 1 year after enrollment) and take an estimated hour and a half to complete. Structural imaging data is collected at baseline and again at one year, taking an estimated hour and a half to complete, with 30–45 min preparation for scanning and another 45 min of time spent in the scanner.

Assessments

The outcome measures for this study were chosen to inform our specific aims. We seek to investigate whether AgeWISE-AP boosts older Veterans’ engagement in lifestyle activities that promote brain health (Aim 1) and improves psychological wellbeing (Aim 2) and cognition (Aim 3) compared to a treatment as usual (no intervention) control group. We will additionally explore whether there is an intervention effect on biomarkers of brain health using structural neuroimaging methods (exploratory Aim 4). The following measures will be used to test the hypotheses associated with each aim. A detailed description of each measure is provided below. A demographic questionnaire will be administered only at baseline that captures basic data including age, gender, race, educational history, occupational history, medical history, and psychiatric history.

Outcome measures

The following instruments will be administered at baseline (pre-intervention), immediately post intervention, and 3- and 6-months post intervention (see Table 4).

Aim 1: lifestyle factors

Community Healthy Activities Model Program for Seniors Questionnaire (CHAMPS) [54] is a 41-item scale that explores the frequency and duration of light, moderate, and vigorous physical activities assessed using weekly frequency and duration. Test-retest reliability was acceptable (ICCs 0.56-0.70).

Single Item Global Quality of Life Scale (SIG-QOL) [55] is a single item question measuring quality of life using a visual analogue scale ranging from 0 to 100. The single-item scale has high test-retest reliability (ICC was 0.87) and has shown high correlations with multi-item scales.

Health-Promoting Lifestyle Profile II (HPLP II) [56] is a 52-item questionnaire composed of six subscales including health responsibility, nutrition, physical activity, stress management, interpersonal relations, and spiritual growth. The English version of HPLP-II has shown high internal consistency and test-retest reliability.

Global Sleep Assessment Questionnaire (GSAQ) [57] is 11 items covering mood, life activities, and medical issues as they relate to sleep and symptoms associated with disorders of sleep. The GSAQ test-retest reliability reported the ICC ranged from 0.51 to 0.92.

Aim 2: psychological wellbeing

General and Memory Specific Control Beliefs Scale [58] measures perceived control over cognitive health. The scale is composed of two sets of items focusing on general and memory-specific control beliefs.

Philadelphia Geriatric Center Morale Scale (PGCMS) [59] is a 17-item scale measuring dimensions of emotional adjustments in persons aged 70 to 90. It provides a multidimensional approach to assessing the state of psychological wellbeing and perceived morale using three factors: agitation, attitude toward own aging, and loneliness dissatisfaction. Test-retest reliability ranged from 0.91 after five weeks to 0.75 after three months.

The NIH Toolbox Meaning and Purpose Short Form [60] is an 8-item, form that assesses the degree to which participants feel their lives matter/make sense. Each item is rated on a 5-point Likert scale with responses ranging from “strongly disagree” to “strongly agree” and from “not at all” to “very much.” The internal consistency is high (Cronbach alpha was 0.92).

Patient Health Questionnaire-9 (PHQ-9) [61] is a reliable and valid (in a variety of patient populations) multipurpose instrument for screening, diagnosing, monitoring, and measuring the severity of depression.

Generalized Anxiety Disorder 7-item (GAD-7) Scale [62] is a commonly used measure of anxiety with 7 total items with high internal consistency (Cronbach alpha was 0.92) and test-retest reliability (ICC was 0.83).

General Self-Efficacy Scale (GSE) [63] is a 10-item psychometric scale that assesses optimistic self-beliefs to cope with a variety of difficult demands in life. Empirical evidence suggests that the GSE is a reliable and valid unidimensional measure across different cultural contexts.

Aim 3: cognition

Multifactorial Memory Questionnaire (MMQ) [64] is a measure constructed to reflect aspects of memory that are potentially amenable to clinical intervention. The Contentment subscale contains 18 statements that assess emotions and perceptions about current memory ability including anxiety, embarrassment, and irritability. The Ability subscale contains 20 items phrased as memory failures in everyday memory situations (e.g., forgetting an appointment). The Strategy subscale measures self-reported cognitive strategy use. The MMQ has been shown to have adequate content validity, test-retest reliability (0.86-0.93), internal consistency (0.83-0.95), and convergent and discriminant validity.

Montreal Cognitive Assessment (MoCA) [65] is a screening instrument that assesses multiple cognitive domains with total score ranging from 0 to 30 points, and a cut score of 24 has demonstrated very good specificity (by correctly identifying 87% of healthy participants) and excellent sensitivity when differentiating Mild Cognitive Impairment (90%) and Alzheimer disease (100%) from healthy comparisons. Test-retest reliability (patients tested 35 days apart) was high, with an intraclass correlation coefficient of 0.92. The internal consistency was also found to be high (Cronbach alpha on standardized items = 0.83).

Data collection and plan

Research staff will be trained by the PI and responsible for all baseline and follow-up evaluations. At each assessment, staff will schedule the next assessment, check current contact information, and get updates on the Veterans’ status to promote retention. Research staff are responsible for entering all data into VA Research Electronic Data Capture (REDCap), a HIPAA-secure, web-based data collection and management platform managed by the VA. The PI will perform monthly audits on the database beginning after baseline data entry to ensure that data entry timelines are on target. Drs. Tripodis and Frank will only have access to de-identified data. Drs. Tripodis and Frank will assist with analysis after data collection and at each follow-up time point. Drs. O’Connor and Moo will meet monthly with Drs. Tripodis and Frank to review data as it is analyzed.

The statistical analyses will be broken down by study aim. For study aims 1 through 3, linear mixed regression models will be used to test the effect of AgeWISE-AP. The models will include linear effects of time with random intercepts and slopes for time. The dependent variables will include baseline measures and all the scores in all the follow-up visits. The primary models, run in all participants, will also include the following predictors: baseline age, sex, education (years), time (years from baseline), and the interaction (cross-product) of each predictor with time. For these models, the intervention x time interactions, reflecting differences in slopes between the intervention and the control group will be of primary interest. We do not expect any missingness in baseline covariates, and imputations will not be performed for longitudinal models since linear mixed effects models assume missingness at random. Factor analyses will be conducted to assess the validity of our approach (i.e., measurement structure and invariance). For power calculations, we used a simulation-based approach with an alpha of 5%, and an assumed participant dropout rate of 15% over the follow-up period. Our proposed sample size of 64 participants per group (128 total) will allow us to detect at least an 8% group difference in all our main outcomes over 6 months, with at least 80% power.

For exploratory Aim 4, we will acquire structural imaging data at baseline and one year on a subset (15 per group) of participants to determine volumetric changes in regions of interest. Neuroimaging data will be acquired on a 3 T Siemens Magnetom Prismafit scanner (Trio-upgrade). Prismafit data will be collected with a 20‐channel head coil. Two‐high resolution whole‐brain T1‐weighted images using Magnetization‐Prepared Rapid Gradient Echo (MP‐RAGE) volumes (TR/TE = 2.53 s/3.35 ms, flip angle = 7°, 1 mm isotropic) will be acquired. Scans will be 3D sagittal acquisitions with 176 contiguous slices (imaging matrix = 256 × 176, in‐plane resolution = 1 mm, slice thickness = 1 mm). Vertex‐wise general linear models will be performed using FreeSurfer to examine longitudinal changes in regional cortical thickness and volume throughout the cerebral cortex and subcortical gray and white matter in the intervention and control groups.

Study timeline

The proposed study timeline is outlined in Table 2. The first 3 months of the project (Year 1, Q1) were dedicated to study start up activities, including staff hiring and training, designing recruitment materials, printing study data collection packets and AgeWISE group manuals, and developing the manual and workbook used by the Brain Health Interventionist. Recruitment and baseline data collection began in Year 1, Q2 at an anticipated rate of 1–2 Veterans a week, projected at approximately 16 Veterans a quarter. Veterans are randomly assigned to AgeWISE-AP or control (n = 8 intervention, n = 8 control each quarter). The AgeWISE-AP intervention (20-weeks total), consisting of 12 weeks of the AgeWISE group and 8 sessions (held over 12 weeks) of the individualized AP, will began in Year 1, Q3, with months 7–9 (Q3) engagement in the first AgeWISE group and months 9–11 (Q3, Q4) engagement in the first AP. Approximately 8 AgeWISE-AP intervention groups will run in total, beginning each quarter thereafter (Y1 Q4 through Y3 Q2) comprising approximately 7–8 Veterans each for a total of 64 intervention Veterans, meeting the recruitment goals based on power calculations. Three-month follow-up data collection will begin in Year 2, Q1, and 6-month follow-up data collection will begin in Year 2, Q2. All data will be collected by Year 4, Q1, month 3. Year 4 Q1 and Q2 will be devoted to final data analysis, manuscript preparation, and submission, with Year 4 dedicated to grant preparation to further develop AgeWISE-AP with the goal of establishing mechanisms for sustained intervention adherence. We will seek funding opportunities looking to examine the effectiveness of rehabilitation interventions that include Veteran self-management components and/or clinician-directed adjunct approaches that allow for longer term monitoring of adherence and functional outcomes in participants.

The implications, according to David Kelly, chief global strategist at JPMorgan Asset Management, are profound for the Federal Reserve and for investors—chief among them, the need for exceptional caution before lowering interest rates.

Kelly used his regular “Notes on the Week Ahead” research note to survey the implications—perhaps assess the damage—of Friday’s shocking jobs report, which revised downward job creation in May and June by 258,000 jobs. Furthermore, employers added just 73,000 jobs in July, well below the 110,000 consensus estimate. This left the average monthly increase for the past quarter at a paltry 35,000 jobs. The unemployment rate ticked up to 4.2% in July, as both employment numbers and labor force participation slipped further.

Kelly also highlighted signs of tightness in the labor market, namely the decline in the labor participation rate from 62.65% in July 2024 to 62.22% in July 2025. That translates to almost 1.2 million fewer people ages 16 and over who are working or actively looking for a job.

He attributed about half this decline to Americans aging into retirement, but noted the participation rate has also fallen among those ages 18 to 54.

Kelly commented on these signs of labor tightness as pivotal context for the wider question of the labor supply in the economy, with long-running trends implying that the Federal Reserve and embattled Chair Jerome Powell will face major challenges fighting inflation going forward—meaning ever-slimmer chances of the all important rate cut the market wants so much.

The worker problem in the economy

The aging population and declining labor participation also speak to a deeper, structural challenge that will persist well into the future.

According to Census projections, he noted the working-age population will actually contract in coming years without immigration returning to previous levels.

Kelly highlights the Census prediction that the population ages 18 to 64 would actually fall by over 300,000 people in the year ending July 2026, and continue to fall at roughly that pace through 2030. He notes that the retirement wave and recent changes to major immigration programs are further sapping labor supply, reducing potential growth.

Fed’s dilemma: inflation, growth, and political pressure

This squeeze comes at a time when the Federal Reserve is under immense political pressure to lower interest rates, with President Trump and his allies calling for easier money to offset the effects of new tariffs and support flagging markets.

Yet Kelly argues the central bank must tread carefully, as cutting rates into a structurally tight labor market risks spurring wage and price inflation rather than accelerating economic growth.

He observed that U.S. economic growth has averaged 2.1% per year since the beginning of the 21st century, largely driven by a 0.8% annual increase in the workforce.

“Starting from a point of roughly full employment, given the continued retirement of the baby boom and considering the possibility that deportations and voluntary departures of immigrants entirely offset new immigration in the next few years, it is quite possible that the next five years will see no growth in workers at all,” he added.

If this happens, the economy will grow more slowly, Kelly predicted, “but will only be capable of growing more slowly without igniting higher inflation.”

For the Fed, the message is clear, he adds: Be extremely cautious about any rate cuts. For investors, it’s a warning to temper expectations for rapid economic gains or a sustained bull market driven by easy money. In other words, American “exceptionalism” isn’t a given, going forward.

Investors, Kelly said, “should no longer bet broadly on a strongly rising U.S. economic tide or lower interest rates.”

For this story, Fortune used generative AI to help with an initial draft. An editor verified the accuracy of the information before publishing. 

Tesla’s board has approved the award of $29bn (£22bn) worth of shares to its chief executive, Elon Musk, after a US court ruled against a previous pay deal for the world’s richest person.

Musk will pay $2bn to buy 96m shares in the electric carmaker at the same price per share as a 10-year pay package agreed in 2018, which is stuck in legal limbo awaiting a court date for an appeal. The award was based on a recommendation from a “special committee” of the board.

The announcement in a financial filing was accompanied by a shareholder letter from two members of the committee, Robyn Denholm, Tesla’s chair, and Kathleen Wilson-Thompson.

It described the award as a “good faith” payment to Musk after the previous pay deal, worth $56bn, was rescinded in 2024 by a judge in Delaware, where the company was incorporated until June that year.

“To recognise what Elon has accomplished and the extraordinary value he delivered to Tesla and our shareholders, we believe we must take action to honour the bargain that was struck in 2018,” the directors wrote. “After all, ‘a deal is a deal’.”

Denholm and Wilson-Thompson said they had reviewed investors’ letters and posts on X – the social media network owned by Musk – and acknowledged concerns about his focus on his job.

“From those communications, we know that one of your top concerns is keeping Elon’s energies focused on Tesla,” they wrote. “This award is a critical first step toward achieving that goal.”

As well as running Tesla, Musk also owns the SpaceX rocket company, the social media platform X, the artificial intelligence company xAI and the brain implant business Neuralink. He has also made forays into Republican politics, damaging the Tesla brand and sales and raising concerns among shareholders.

Dan Ives, an analyst at Wedbush Securities and one of the most prominent voices of concern about Musk’s political travails, said the award would remove an overhang – a surplus of availability – on Tesla shares, increasing prices.

“Musk remains Tesla’s big asset,” Ives said.

The award is worth about $29bn based on Friday’s closing share price. Musk is worth $350bn, according to the Bloomberg billionaires index.

Over the past year, Musk has become embroiled in US politics and a political relationship with Donald Trump that turned toxic after the president entered the White House for the second time, a feat assisted by the Tesla chief executive’s financial and personal support.

The furore put off left-leaning Tesla buyers inside and outside the US, though competition in the electric car market has also affected sales.

A survey from the research firm S&P Global Mobility shared with Reuters showed that Tesla’s customer loyalty has plunged since Musk endorsed Trump. It found 49.9% of Tesla-owning households in the market for a new car bought another Tesla last March. This was just below the industry average, but was down from 73% in June 2024. It edged back up to 57.4% in May this year.

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Tom Libby, an S&P analyst, said the fall was “unprecedented”, adding: “I’ve never seen this rapid a decline in such a short period of time.”

Musk is Tesla’s largest shareholder, and the new shares will take his stake from 13% to about 15%. He has said he wants greater control over the company to avoid being ousted by “activist shareholders”. The company is shifting its focus to robotaxis and humanoid robots, in a move that positions Tesla more as an artificial intelligence and robotics firm than a carmaker.

“While we recognise Elon’s business ventures, interests and other potential demands on his time and attention are extensive and wide-ranging … we are confident that this award will incentivise Elon to remain at Tesla,” wrote the directors.

The award is designed to increase gradually Musk’s voting power, something he and shareholders had consistently said was key to keeping him focused on Tesla’s mission, the directors added.

If the 2018 package is reinstated in full following an appeal to the Delaware courts, the new package will be forfeited.

Tesla shares, which have fallen nearly 20% so far this year, rose more than 3% in early trading.

Investor confidence in the EU has fallen sharply after Donald Trump’s trade agreement with Brussels, amid mounting concern about the economic hit from the US president’s tariff war.

The latest snapshot from the Sentix index showed that investor sentiment fell significantly at the start of the month after the deal last week between Trump and the European Commission president, Ursula von der Leyen.

The data provider said its weekly survey of thousands of investors in more than 20 countries showed that the pact was a “deal that dampens the mood”, with Trump and the US viewed as “winners” at the expense of the eurozone.

“The result is devastating for the eurozone,” said Manfred Hübner, the managing director of the Sentix economic index. “The current situation and expectations are both declining. The wrinkles of concern in the economy are deepening again.”

Financial markets are braced for Washington to introduce sweeping, higher “reciprocal” tariffs on imports from dozens of countries from the middle of this week, including Brazil on Wednesday and most other nations from Thursday.

Share prices in Switzerland, which is facing a 39% export tariff from Thursday, plunged on Monday, as nations around the world continue to grapple with the fallout from Trump’s erratic global trade war.

Financial markets elsewhere rallied, including in London, Frankfurt, and Paris, after a tariff-related sell-off at the end of last week.

In tangled negotiations, with the threat of tariffs being withheld, escalated and rescinded on an almost daily basis, Washington remains locked in talks with several countries.

A tariff of 40% on US imports from Brazil will begin on Wednesday, and will be topped up to 50% from Thursday.

Canada is pushing for a deal to bring down tariffs of 35% on its exports, which was introduced from Friday, while US border taxes on imports from China and Mexico have been paused to allow more time for negotiations.

The latest snapshot from Sentix showed sharp declines in investor confidence in Germany and Switzerland in particular after the agreement reached between Trump and von der Leyen at the US president’s Turnberry golf resort in Scotland.

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The headline index fell from 4.5 in July to -3.7 in August, according to the survey conducted between 31 July and 2 August.

The US-EU trade deal drew swift condemnation from some European leaders, including the French prime minister, François Bayrou, who called it a “dark day” for the EU.

The agreement involves Washington imposing a 15% tariff on almost all European exports to the US, about triple the 4.8% tariff now in force. However, the pact limited a much higher – 30% – import duty threatened from Trump’s self-imposed 1 August deadline.

China’s super steel, officially named CHSN01, has emerged as a breakthrough material for nuclear fusion reactors, offering unmatched strength and stability under extreme conditions. Designed to function under powerful magnetic fields and temperatures near absolute zero, CHSN01 is now being used in what Chinese media claim to be the world’s first fusion power generation reactor.

This development addresses a decades-old challenge in materials science, as fusion reactors demand alloys that can withstand intense stress without compromising performance.

Chinese researchers have long anticipated the need for materials beyond the capabilities of international projects like ITER in France. While ITER’s magnets are engineered for 11.8 Tesla, scientists from the Chinese Academy of Sciences foresaw future reactors requiring even stronger materials.

In 2017, material scientist Li Laifeng presented an early version of the alloy to global experts. Despite initial skepticism from international researchers, who believed ITER-standard 316LN stainless steel was sufficient, the Chinese team continued refining their formula, incorporating vanadium and adjusting carbon-nitrogen ratios.

Breakthrough Achieved with Zhao Zhongxian’s Involvement

Progress accelerated in 2020 when cryogenic physics expert Zhao Zhongxian, a top science award recipient, joined the project. His leadership helped overcome technical barriers and emphasized the vital role of advanced materials in superconducting technologies.

By 2021, China set strict standards for its fusion materials: 1,500 MPa yield strength and over 25% elongation at cryogenic temperatures. To meet these targets, a national research alliance was formed, pooling expertise from institutes, manufacturers, and welding specialists to finalize China’s super steel CHSN01.

In August 2023, CHSN01 was certified to handle magnetic fields of up to 20 Tesla and stress levels of 1,300 MPa with high fatigue resistance. The steel is now integral to China’s BEST fusion reactor, which began assembly in May 2023 with a targeted completion in 2027.

Out of 6,000 tonnes of reactor components, 500 tonnes of conductor jackets are made from domestically produced China’s super steel. Beyond fusion reactors, China plans to apply this high-performance alloy in other advanced technology sectors.