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Streaming’s Biggest Show Returns…and a Buzzy Genre Struggles
(Welcome to my weekly streaming ratings report, the single best guide to what’s popular in streaming TV and what isn’t. I’m the Entertainment Strategy Guy, a former streaming executive who now analyzes business strategy in the entertainment industry. If you were forwarded this email, please subscribe to get these insights each week.) Obviously, the big news of the week (if not month) is Netflix letting go of executive Bela Bajaria, their chief content officer. I’m going to cover this in my next “Most Important Story of the Week”, but I also have a data angle that I might publish before then. (Too much news this month, am I right?) But first, I have a bonus Streaming Ratings Report issue for you. Today’s article is a bit of a grab bag of topics I’ve wanted to write about, but couldn’t squeeze into the (already very long) Streaming Ratings Report issues. The NFL drives huge viewership numbers, so I’ve got a look at that. A whole bunch of TV shows returned to the traditional broadcast channels, and I have thoughts. And I have a quick look at adult animated shows, since a couple flopped earlier this month. Plus, the Emmys aired earlier this month, and we got some fun data bout how popular those nominated shows are and why I’m not optimistic about the show’s future. That’s a lot, so let’s dive right in. Subscribe Sports - Football Remains the King of Streaming Over the last two Streaming Ratings Reports, I sorta ignored the biggest “show” each week. (I was tempted to say “piece of content” but I know that word bugs folks.) In my database, I call these “specials”, and they sure are special. I speak of the king of American TV: football!!! Streaming football is back and, unlike some other sports, it routinely dominates all viewership. Probably the best way to show this is to update one of my favorite graphics, the “40 Million Hour Club”1 since football games have joined that club each week they’ve premiered: (Yep, that’s the data through 28-Sep, the first four weeks of the season. As a reminder, I take the average minute audience provided by Nielsen, factor out a percentage of linear TV viewers in home markets, and multiply the run time by the three-hour runtime.) Again, the numbers are huge. Let’s start with Netflix. They grabbed the rights to the bonus opening week NFL Kickoff game (which was on YouTube last year) and it put up 18.5 million viewers on average. That nets out to 47.4 million hours of estimated streaming hours. That’s good! Though, notably, it’s well below Christmas Day games from previous years. Compared to other streamers/broadcasters, that’s a bit of a mixed result. On one hand, Netflix’s 18.5 million average is about what YouTube claimed last year, though Nielsen used a bespoke methodology at that time, so I trust this viewership figure more. So that’s good. (The game also shifted from a Friday to a Thursday and that could have helped the viewership as well.) And Netflix continues to best Prime Video in total viewership—as you’ll see next—though Netflix has had much higher-profile (opening week and Christmas Day) games. NBC/Peacock’s opening game the night before averaged 25.1 million average viewers, which is just much bigger than Netflix (or Prime Video). That’s the big caveat to all streaming viewership records: even in success, they can’t compete with traditional linear TV. Previously, I called this my “hierarchy of viewership”, and the data keeps supporting that thesis. The downside for NBC is that this game’s viewership was down compared to previous years, though it may be a counting issue. Here’s a great chart from Sports Media Watch: Indeed, looking at all the opening week games across all windows, Netflix still lags the other primetime windows, but does well compared to the afternoon games: I saw a few folks make the case that streamers still lag traditional broadcasters in reach, and I’d add they really lag compared to “broadcast plus streaming” options like NBC/Peacock, ESPN/Disney+ and CBS/Paramount+. The best data I saw for this came from Samba TV, who charted reach through the 2025 season, and, wow. (Samba TV’s numbers are historically lower than Nielsen’s, so don’t compare their household figures to Nielsen’s hours, but use them as a proxy for the relative reach of the streamers.) The good news is Prime Video is NOT having a down year. Their opening Thursday Night Football game reached 18.6 million viewers (about what Netflix got), but that’s a high for Prime Video on Thursdays and the biggest Thursday night game since 2015. The TNF games the weeks of 21-Sep and 28-Sep continued this streak, getting 43.1 (16.8 million average viewers) and 42.5 total hours (16.6 million average viewers), which were both up from last year. Still, that continues the (typical) season slide: (For those new-to-streaming-football-numbers folks, the viewership declines for Thursday Night Football as the year goes along.) Overall, it appears as if Prime Video is now part of the “football habit”, be it for customers at home or out at places like bars and restaurants. And its viewership is slowly catching up to broadcast. One last chart shows this. Last season, Nielsen started adding out-of-home viewership to the charts, so I try not to do season-to-season comparisons as I did for the first few years. And while Nielsen added Big Data viewing this year, I’m going to compare the last two seasons. Here’s that chart, which shows the season-over-season gains: When it comes to streaming football, we have to keep a few seemingly contradictory thoughts in our head… First, streaming doesn’t come close to matching broadcast’s reach and, thus, viewership. Second, even with that gap, football is still the biggest “thing” on streaming. It’s very, very popular. Third, while some methodology changes have likely helped Prime Video’s numbers, their viewership does appear to be growing. Lastly, yeah, the NFL started the season off poorly, with week one dragging down the numbers in year-over-year comparisons. However—and again, methodology changes may have helped this—the viewership grew compared to previous seasons over the next couple of weeks. So football is still king. On streaming and off. Television - Adult Animation Continues to NOT Make the Streaming Charts In the last two reports, two adult-animated shows whiffed: Netflix’s animated comedy, Dang! Paramount+’s Sega-video-game-inspired fantasy/comedy, Golden Axe. Neither made the charts, but that’s usually the case for animated shows. I mean, here’s literally every animated show that’s made the Nielsen Original charts since the start of 2025: And one of those shows is G_abby’s Dollhouse_! A kids show! The problem with charts like this is that they don’t give you a sense of how many shows miss the charts. Netflix had at least eleven animated flops, including comedies like Big Mouth (a show everyone assumed was popular in the pre-Streaming Ratings Era), Long Story Short, Haunted Hotel, Mating Season, Strip Law, and Alley Cats, and action shows like Blood of Zeus, Castlevania: Nocturne, Devil May Cry, Splinter Cell: Deathwatch, and Tomb Raider: The Legend of Lara Croft. Prime Video had at least six animated misses, two in the same universe (Hazbin Hotel, Helluva Boss), three more comedies (#1 Happy Family USA, The Second Best Hospital in the Galaxy and Kevin) and an action show (The Mighty Nein). Disney+ had MCU and Star Wars animated misses (Eyes of Wakanda, Marvel Zombies, Star Wars: Visions, Star Wars: Maul – Shadow Lord, and Star Wars: Tales of the Underworld) but I can’t tell how many of those shows were geared towards adults. HBO Max had Harley Quinn and Hulu had Solar Opposites. None of these shows made the charts! That’s a lot of misses! If I remade the chart with all those misses, here’s how it would look: Listen, I know the counter arguments. First, it’s cheaper to produce animated shows than live action. Fair enough, but with viewership this low, even that cheaper price point starts to not matter. Second, just look at the acquired charts. Hit animated comedies can generate viewership for years! Shows like The Simpsons, South Park, Family Guy, and Bob’s Burgers do really, really well. Fair enough, but streaming has failed to recreate the dynamic that Fox has mastered so well. That’s a problem for streaming still. Television - Emmys! The annual Emmys broadcast was a few weeks ago, and I’ve got data on how the nominees performed on streaming, plus hot takes on this year’s viewership (and the big news about the broadcast’s, er, streamcast’s future). We’re just getting started with this issue, but the rest is for paid subscribers of the Entertainment Strategy Guy, so if you’d like to find out… The top Emmy-nominated shows… ...why I’m worried about the future of the Emmys telecast... ...the pros of broadcast television ...and the cons... ...please subscribe! We can only keep doing this great work with your support. Coming Soon! Next week, we’ve got a double issue (since the weeks of 21-Sep and 28-Sep were so light), but then I’ll be all caught up after a deluge of streaming ratings data from Nielsen in September. In the meantime, I’m going to try to take a look at Netflix’s stats to explain why Bela Bajaria is out. But even light weeks give me plenty to talk about. The Great British Baking Show returns to Netflix and Apple TV has a buzzy new star-studded comedy. And Netflix has a controversial-but-appears-to-be-popular new game show. Plus big films like Toy Story 5, Backrooms and The Breadwinner head to streaming. And is East of Eden a hit? After that, The Kardashians return to Hulu, Prime Video has a reboot of Carrie, and Netflix has a horror show, Below. Disclosure Day heads to Peacock, The Housemaid heads to HBO Max_,_ a new Ben Affleck film, Animals, lands on Netflix, and Apple TV has a new John Cena action film based on, checks notes, Hasbro’s Matchbox toys. Okay. Longterm, some interesting TV production news. HBO Max ordered How to Survive Without Me, starring Kaley Cuoco, Joshua Jackson, Ray Romano and Rita Wilson, for fifteen episodes! I love that some streamers (or, at least, HBO Max) are finally ordering TV shows with more than eight episodes. In less wise production news, Landman does not appear to be coming back this year, since it just started production. Frankly, I don’t love this (get your shows out on time) but Landman is so popular, I doubt it matters.
Rubio heads to Central Asia as some wonder if he's keeping the most pressing matters at a distance
This tour is intended to promote U.S. economic and security ties with Central and South Asia. But it has only tangential links to the Trump administration’s current main foreign policy dilemmas in the Middle East and with the Russia-Ukraine war.
Importing Russian diesel is 'incentive' to end war: energy secretary
US Energy Secretary Chris Wright said Trump's decision to waive new sanctions on Russia would motivate it to end its war with Ukraine.
The Elizabeth Holmes documentary is crushing it at the box office. See how much it's made so far.
Nathan Fielders nearly three-hour documentary about disgraced entrepreneur Elizabeth Holmes is running up numbers at the box office
'You Can See Everything' is crushing it at the box office
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Video game ownership bill introduced in Congress
The Power To The Players Act would guarantee buying a game means you own it, not license it.
Essentia Health Highlights Importance of Knowing Care Options
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Tripp Skipper: What Alabama Republicans should remember about Doug Jones and Roy Moore
I regularly talk with elected officials, business leaders, farmers, and everyday voters. Many are longtime Republicans who have helped elect conservative candidates for decades. They’re frustrated.
Politics chat: Zelenskyy on Trump, Democrats bring in the money for midterms
From Russia to AI to Iran, President Trump has taken political stances that put him at odds with much of the electorate.
Consumer apprehension grows as US retailers adopt AI-assisted pricing tools
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Brow: I've been a mom for nearly 10 years. I've never lied to my kid.
I've never lied to my daughter, even about Santa Claus. I believe being honest with kids builds trust, even when the truth is uncomfortable.
13 Years Ago, Rockstar Suffered a Leak Worse Than GTA 6
Before unauthorized clips of GTA 6 scandalized fans, GTA 5 made video game leak history for Rockstar and Sony
Russia-US diesel deal delivery to take 15-20 days: Russia
Shipping Russian diesel to the US market will take 15 to 20 days once contracts are signed, a senior Russian official said in an interview broadcast Sunday, though a date
At the center of the state’s growing measles outbreak, it’s business as usual
In hard-hit Mifflin County, concern for the potentially deadly virus has yet to catch up to national alarm.
Scientists Find Evidence That Earth's Core Is Still Leaking Hydrogen, Helium and Tungsten
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Money20/20: Where Banks, Big Tech and Regulators Do Business
Jessica Blue, Executive Vice President of Money20/20 USA, explains why convergence, partnerships and trust will define the next era of financial services
UAlbany football rips Golden Apple Trophy away from Stony Brook
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U23 Celebrates Fourth Straight Win
Compared to the last-minute victory against SG Wattenscheid 09, head coach Daniel Rios made four changes to his starting lineup. Kevin Mutove, Luca Reggiani, Enzo Duarte dos Santos, and Daniel Sumbu r...
Postgame Reactions: “Need to Play with More Courage”
(in the mixed zone): “We’re obviously disappointed. I think the team rose to the challenge, playing with great intensity and physicality from the start. Of course, that also made the game a bit di...
Graham breaks with Trump over Russia sanctions law her brother championed
Darline Graham has only been a senator for a few months, but she has cited her role in passing the sanctions package, a major part of her brother’s legacy, as a top achievement.
Graham Breaks With Trump Over Russia Sanctions Law Her Brother Championed
Senator Darline Graham, appointed to fill the Senate seat of her late brother, Lindsey, gently disagreed with the president’s decision to exempt Russia from the sanctions legislation.
Miley Cyrus makes a comeback of sorts at the Hollywood Bowl
The musician and actor played her first full headlining show in years Friday night at the Hollywood Bowl.
Miley Cyrus cries sharing 'gold' memory of Dolly Parton at comeback show
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U.S. Floats Lifeline to Russia: Allowing More Gas Sales to Europe
The Trump administration is pitching the idea as part of a peace deal with Ukraine, but Europe is wary and critics say Russia would be strengthened.
The Mills-Pingree machine crushed small business in Maine. Hannah Pingree will finish the job.
To protect us against more bureaucratic overreach by Augusta, we need Bobby Charles as our next governor.
Business Bulletin: Are those “Cloud storage is full” messages real?
If you receive an email warning appearing to be from a company you know and trust that states your online storage is full and your family photos, important documents and other files could soon be deleted ... would you click on the "fix" button?
Trump's decision to waive Russian sanctions outrages Congress, but no quick counter seen
Lawmakers from both parties blasted the executive order late Friday, the latest in a series of steps that the Republican president has taken drawing the United States closer to Russia's Vladimir Putin.
Trump's decision to waive Russian sanctions outrages Congress, but no quick counter seen
President Trump’s abrupt decision to waive sanctions on Russia is drawing outrage and concern from members of Congress
Kenya confirms four new Ebola cases, bringing total number to seven
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Trust TV on Instagram: "“Pilgrimage is a strategy to win votes ahead of 2027 Elections” – Analyst speaks on clerics in politics & the battle for Influence Watch Full Interview: https://youtu.be/oBu4CqReTV0 #trusttvnews #insidethenorth"
1 likes, 0 comments - trusttv_news on October 17, 2026: "“Pilgrimage is a strategy to win votes ahead of 2027 Elections” – Analyst speaks on clerics in politics & the battle for Influence Watch Full Interview: https://youtu.be/oBu4CqReTV0 #trusttvnews #insidethenorth".
Miley Cyrus breaks down in tears while paying tribute to Dolly Parton at her Los Angeles concert: ‘I miss her’
She played “Jolene” to honor the late country singer, who died on Aug. 25.
Trump’s decision to waive Russian sanctions outrages Congress, but no quick counter seen
WASHINGTON (AP) — President Donald Trump's abrupt decision to waive sanctions on Russia days before they were to take effect drew outrage Saturday from members
Orphaned walrus calf rescued from nearby polar bears in Alaska
The calf was transported over 800 miles to safety—without becoming a snack.
Trump's Diesel Deal With Russia Won't Lower Gas Prices for Americans
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Keri Russell on politics, escapism and 'Diplomat' twists she literally forgot
Keri Russell and Rufus Sewell talk Season 4 of Netflix's "The Diplomat," its real-world parallels and too many twists to remember.
Keri Russell on politics, escapism and 'Diplomat' twists she literally forgot
Keri Russell and Rufus Sewell talk Season 4 of Netflix's "The Diplomat," its real-world parallels and too many twists to remember.
Keri Russell on politics, escapism and 'Diplomat' twists she literally forgot
Spoiler alert! The following contains spoilers for Season 4 of "The Diplomat" on Netflix."
Global survey links financial hardship to lower trust in science
Poor access to health care, limited local influence over research priorities and an unequal distribution of scientific benefits are undermining public confidence in science, experts warn, following the ...
This bird flies thousands of miles, but its wings have a catch
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Beyond politics
"I trust Malena Stevens with that responsibility. I believe the people of Summit County can, too."
Week in Politics: Trump's Russian diesel deal update; why the DOJ is suing California
We look at where things are in the deal President Trump says he made to import Russian diesel, plus the reason why the Justice Department is suing California.
Packers’ Micah Parsons Fires Strong Message Before Cowboys Matchup
Green Bay Packers edge rusher Micah Parsons shared cryptic but strong message on Instagram late Friday night. The post Packers’ Micah Parsons Fires Strong Message Before Cowboys Matchup appeared first on HEAVY.
Dear Abby: Daughter with grudges makes herself hard to love
Dear friend regularly attends funerals of people she does not know
Hochul's second-term test and Blakeman's crusade to stop it
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Political scientist: 'The darkest moment' in the war in Ukraine
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I’ve spent most of the year talking to MAGA supporters. Here are 5 things I’ve learned
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Has there ever been a mountain taller than Everest?
Mount Everest may be the king of the planet today, but has Earth ever thrust a larger mountain from its surface?
Trump signs Executive Order waiving sanctions against Russia
President Donald Trump cited “national interests” for the decision to waive a punishing sanctions package targeting Russian exports and leaders.
CT Culture Corner: K-Pop, RUSH, ‘Mamma Mia’ and more
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Kenya dispatch: health ministry confirms first imported Ebola virus case as fears and suspicions collide
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Trump suspends new Russia sanctions following deal to purchase diesel, citing ‘national interests’
Passed by Congress with bipartisan support, the sanctions were intended to limit Russia’s revenue streams as the country continues its war against Ukraine.
Trump puts new Russia sanctions that he recently signed into law on hold, citing national interest
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Trump puts new Russia sanctions passed by Congress on hold, saying waiver is in U.S. national interest
President Donald Trump has signed an executive order that puts on hold a sweeping new sanctions package targeting the Russian economy, telling Congress the pause was in the national interest.
Valkyries set tremendous entertainment offerings for Finals Games 1 and 2
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Trump puts new Russia sanctions passed by Congress on hold, saying waiver is in US national interest
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Horror, electronic music and Russian politics: Brittany Roberts connects them all
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Workshop provides training to start and grow small businesses
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What causes sleep paralysis; health indicators of Alzheimer's diagnosis; sober October; plus other stories with Vanderbilt Health sources
(iStock) Food and Wine interviewed Peter Martin, MD, Professor of Psychiatry and Behavioral Sciences, for a story about sober October. William Schaffner, MD, Professor of Preventive Medicine, was quoted in CNN International’s Connect the World with Becky Anderson and NewsNation Morning in America for stories about the reported plague situation in Russia, after a laboratory worker at an institute in Siberia dedicated to studying the plague and other infectious diseases died of a mysterious illness. Prevention interviewed James McGuirk, MD, Assistant Professor, Division of Sleep Medicine, for a story about what causes sleep paralysis. Modern Healthcare interviewed Daniel Fabbri, PhD, Associate Professor of Biomedical Informatics and Computer Science, for a story about how health systems are managing AI token costs. WNKY interviewed Ziv Beckerman, MD, Associate Chief of Pediatric Cardiac Surgery, Surgical Director of Pediatric Heart Transplantation in the Golisano Pediatric Heart Institute at Monroe Carell Jr. Children’s Hospital at Vanderbilt about rapid recovery with extended ultra oxygenated preservation (REUP) that is a new form of preservation for heart organs. Ray Romano, PhD, MPH, MSN, Nurse Practitioner, Vanderbilt Memory & Alzheimer’s Center, was quoted Prevention about research that found other health issues may be an early indicator of Alzheimer’s.
Build Stakeholder Trust Before You Need It
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How Rockmaster Entertainment Group tailors DJ services to every single need on Coast Live
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Russia Appears to Step Up Efforts to Influence U.S. Voters
One campaign has created social media posts focusing on U.S. support for Israel to sow discord ahead of the midterm elections.
Mayor Johnson’s campaign cash dips below $380,000, while frontrunner Giannoulias has $19 million on hand
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Pokémon TCG Pocket Is Finally Fixing One Of Its Most Frustrating Features
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Cook Political Report moves 11 more House races toward Democrats
The election prognosticator says more races are becoming competitive in traditional GOP strongholds because of voter frustration with the economy.
Long Beach student advances to national science competition finals
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Arizona Cardinals Daily Links:
The Cardinals select South Carolina edge rusher Dylan Stewart in a new 2027 NFL mock draft.
Chris Murray challenges Palumbo with affordability, health care focus
Democrat Chris Murray has placed affordability, health care and environmental protection at the center of his campaign as he tries to unseat incumbent Republican state Sen. Anthony Palumbo. Mr. Murray — an attorney who was elected chairman of the Suffolk County Community College Board of Trustees in 2019 and has also chaired the Citizens Campaign...
IU Kelley School of Business Expert Weights in on Prediction Markets and Midterm Elections
As prediction markets play a growing role in election forecasting and increasingly compete with traditional polling, Russell Rhoads, clinical associate professor of finance at the Indiana University Kelley School of Business Indianapolis, is available to provide expert analysis and commentary. Rhoads can help audiences understand how prediction markets work, what market odds actually signal about election outcomes, and why investors, analysts, and political observers are payin
Can AI solve our mental health access problem?
Last week I asked you what worries you most about AI in health. It was close, but your top answer was “AI giving bad health advice.” Last week’s poll results: You’re in good company. This concern was top of mind at a conference I joined at Stanford last week, where researchers, clinicians, and people who build AI systems spent a day debating trust and safety in health AI. Stepping back, I’m also hearing your emerging concerns about AI’s impact on our well-being generally. I see this as a matter of public health, and we’ll take it in pieces as we learn together. Today we’ll focus on AI chatbots used for therapy for mental health. Early this month, Governor Newsom vetoed Senate Bill 903, California’s most ambitious attempt to regulate AI use for mental health. It’s at the center of active debate, and raises the questions patients, family members, citizens, and voters will face as AI moves deeper into health care. Let’s work through it. What is “AI-based therapy”? It’s really two things: purpose-built mental health apps designed to deliver structured support, and general chatbots like ChatGPT, Claude, and Gemini that people increasingly use for emotional support—even if they weren’t built for it. Spoiler alert: I don’t know whether the shift toward AI therapy is good or bad. The evidence isn’t there yet. But I do know it’s already happening, and I have some ideas about how we can roll it out with safety in mind. The therapy dilemma, in a nutshell Mental health challenges are common, and strain health and well-being across populations. Therapy (interactive dialogue with a trained, empathetic practitioner) helps many people heal. The demand for licensed therapists far exceeds the supply in California, and AI-based therapy can narrow that gap. AI-based therapy remains novel, unproven, and not well tested. Right off the bat, we can see we’re dealing with trade-offs here. Since the main driver of demand for therapy from a robot is lack of access to therapy from a human, we’ll start there. It’s too hard to find and afford a human therapist California is short roughly 55,000 licensed, non-prescribing therapists and counselors, about 40% of what we need. Psychiatrists, who rely on talk therapy as a complement to prescribed medications, are even more scarce. Eight counties have none, and density ranges from 1.7 per 100,000 residents in San Benito County, to 68.1 in Marin County. My wife is a psychiatrist in Marin, and even here access is tight. If it’s hard in the best-supplied county, imagine rural Sierra County, or the San Joaquin Valley. In 2024, more than half of Californians who tried to make a mental health appointment struggled to find a provider who took their insurance, compared with 14% for physical health care. When Senate staff posed as “secret shopper” patients and called 120 mental health providers in Medicare Advantage networks, they landed an appointment less than once for every five tries. Insurers pay behavioral health clinicians about 22% less than medical and surgical clinicians for comparable office visits. On top of that, billing denials and prior authorizations hit hardest at the solo and small practices common in mental health. Psychiatrists opt out of Medicare at the highest rate of any specialty. In many places, a cash practice for therapy fills quickly with patients paying $250 or more an hour, with no insurance paperwork at all. Families who can pay cash find providers more easily. Those who rely on insurance, including Medi-Cal enrollees, older adults, rural residents, and non-English speakers, compete for what’s left. So we can’t pretend the human system works, and we can’t blame people for turning to AI for support when they’re in distress. AI is filling the gap It’s estimated that roughly a quarter of AI users use it for mental health support. If you have internet, it’s available 24/7, it’s cheap, and it speaks your language. Uninsured adults are about twice as likely as insured adults to do it (30% vs. 14%). It feels anonymous in ways that may enable people to ask things they’re unsure or embarrassed about. The largely hidden, personal use makes it hard to study whether it’s actually helping people with their mental health issues, but researchers are trying. Does AI therapy work? A 2026 analysis of nearly 40 randomized trials found chatbots showed a real but small reduction in depression symptoms. But most of these trials were compared to an alternative of no therapy, not a human therapist. So the benefit of AI therapy is probably real, but modest, and mostly untested against the alternative of human contact. We need more studies. Serious concerns OpenAI’s own estimate is that more than a million ChatGPT users each week show signs of suicidal planning or intent. These are high stakes encounters, and AI doesn’t always get it right. That’s partly because a chatbot can sound like a therapist, but it has no license, no duty of care, and it’s not clear who to hold accountable when it gets things wrong. AI is also designed to help users in whatever task they’re seeking to accomplish. People may feel like they’re getting therapy, but they’re mainly getting a convincing conversation. It’s easy for an AI companion to wander into gray areas, like playing along with “creative writing” that may be about the user’s own suicidal intent. Courts are driving safety conversations A wave of lawsuits have been filed on behalf of families claiming that chatbots pushed people they loved toward self-harm, including teens who died by suicide. The first settlements came this year. OpenAI is headquartered in San Francisco, and dozens of cases alleging that ChatGPT drove users to suicide or self-harm are now before a San Francisco judge. Character.ai has filed for bankruptcy after several states brought lawsuits accusing the chatbot of pushing dangerous content to kids. But the technology seems to be improving. Last month, an independent evaluation found that newer AI models “almost never endorse suicide.” That’s progress, but our societal appetite for even one preventable death is very low. So how do we move forward? Finding a middle ground Earlier this month the governor vetoed Senate Bill 903, a bill designed to place guardrails on the use of AI for therapy. The bill would have prohibited any AI-based platform from being advertised as psychotherapy, and would have required a licensed professional to review and approve each encounter where AI was used to support therapeutic decisions. Newsom called it overly broad, since even routine screening questions would have needed clinician sign-off. Knowing we’re already short on mental health providers, requiring human review of AI encounters may not relieve our access problems. Still, the answer isn’t no oversight. Here’s one feasible short term solution. Rather than reviewing each encounter, a licensed clinician can design the guardrails: what counts as a crisis, what triggers an immediate handoff to a human, and what gets sampled for audit each month. The AI runs inside that structure. Conversations get checked, failures get reported, and a real clinician owns the framework. Medicine already has models to learn from. The FDA process for rolling out newly approved medications is an example. After a product reaches patients, we keep watching for adverse events. Patient-facing AI needs the same “digital pharmacovigilance”: systematic tracking of harms, near misses, and the types of groups that get hurt and why. It’s also critical that users know that they can reach a human if they’re in crisis. Most chatbots now include messages like these: Bottom line The rush to use unproven AI tools for mental health support is mostly a workaround, a sign of a health system people can’t get into. We need better access to proven care from licensed clinicians. That takes reimbursement that makes accepting insurance viable, and a bigger workforce. But, built and tested well, AI could be part of the answer. It could be the 2 a.m. check-in when no one else is awake, or a way for patients to practice skills their therapist taught them. It could be the first step to get someone the right level of care, and take paperwork off clinicians’ plates so they spend more time with patients. None of this is simple. The SB 903 veto doesn’t end the debate, and the legislature will be back. In the meantime, those of us using these tools need to stay informed, ask hard questions, and hold the companies building them accountable. I’ll try to do my part, and we’ll keep learning together. Love,Matt P.S. If you or someone you know is struggling with mental health challenges, emotional distress, substance use problems, or just needs to talk, call or text 988- you’ll reach a real person— or chat at 988lifeline.org 24/7. Dr. Matt Willis is the author of Your Local Epidemiologist in California. A California native, he’s served as a primary care physician, CDC epidemiologist, and public health officer for Marin County, where he guided the pandemic response. He lives in Marin with his family and their dogs, Teddy and Ramona. Thank you Cynthia He, MD, PhD, and Parnika Saxena, MD, for their guidance in preparing this article. Cynthia works in an outpatient mental health clinic, treating patients who have Medi-Cal or, sometimes, no insurance. Parnika works in an inpatient psychiatric unit, treating patients with public or private insurance or self-pay ability. All opinions are their own and do not represent their employers.
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The word plague is scary. Centuries ago, the Black Death killed tens of millions of people and changed the course of history. Plague still kills people around the world, and the word still evokes catastrophe. New fears of plague surfaced on October 2, when a lab worker in Irkutsk, Russia, died of pneumonia. Reports suggested that she may have contracted plague through a laboratory exposure. Understandably, people were alarmed. On October 7, the World Health Organization called for the Russian Federation to be transparent about what it knew. WHO issued an update on October 10. Russian authorities told WHO that testing did not identify plague and that investigations found no laboratory release. WHO said confidence in its risk assessment remained limited and that further clinical, epidemiological, and laboratory information was needed. The cause of the woman’s illness remains unknown, and WHO says a laboratory-associated exposure cannot be excluded. As I explained in a recent interview, this incident is very unlikely to lead to a pandemic. Plague is still active, including in the U.S., which sees a handful of cases each year. But it is a disease we can prevent and treat. Plague doesn’t spread readily, and it responds to antibiotics. The standard response—isolate the patient, trace contacts, and administer antibiotics and monitor for symptoms among contacts for seven days—works. We have even planned for antibiotic-resistant plague. At CDC, we developed a playbook for antibiotic-resistant plague and ran exercises on how to find and stop it. CDC guidance anticipates engineered resistance and recommends two different classes of antibiotics if there’s reason to suspect it. There is no evidence that resistance—or even confirmed plague—is involved in this incident. We have thought through how to address plague, but we’re not ready for the next major health threat that emerges from a lab or from animal spillover to humans. What should concern people is how little stands between the world and the next pathogen to get loose. Since peak COVID, epidemic preparedness has fallen off the political agenda, but the risk is greater than ever. More labs handle dangerous pathogens with more ways to make those pathogens deadlier, and more people live and work in close contact with animals. There are actions we can take now: We need better lab safety in every country. The number of labs that work with dangerous pathogens has increased worldwide over two decades, but there’s no enforceable international standard and no inspection regime; the Biological Weapons Convention, fifty years on, still has no verification mechanism. Labs that study dangerous germs need strong safety systems, training, and oversight. We need to reduce spillover events. Three in four emerging human infections start in animals, and there’s a lot we can do to reduce spillover risk, but the world is doing very little of it. Live-animal markets are one place to act. For instance, closing live-bird markets helped control H7N9 influenza in China. Reducing opportunities for people to encounter infected animals can prevent infections before they become outbreaks. In The Formula for Better Health, which is now out in paperback along with the hardcover, Kindle, and audiobook versions, I argue that labs do too many risky experiments with too many dangerous pathogens in too many institutions, and that every experiment should first answer one basic question: Is the likely benefit greater than the risk? Spillover risk can also be reduced: In the book, I discuss how Brazil cut its deforestation rate by 70% from 2004 to 2012 while increasing agricultural production and reducing risky contact between people and forest animals. We need faster detection and response. Delay costs lives. Strong surveillance, good labs, and trained responders can turn a single case into a small cluster of infections instead of an epidemic. Resolve to Save Lives has worked for nearly a decade to help countries find and stop outbreaks faster. The 7-1-7 target, which Resolve to Save Lives developed with partners in Uganda and elsewhere, provides a clear standard: detect within 7 days, notify within 1 day and complete all essential early response actions within 7 days. In Uganda’s Kasese district, for example, a review of a measles outbreak using 7-1-7 identified shortages of accessible funds, fuel, and vehicles that delayed the response. District leaders established funds they could access quickly. When, a few months later, the Crimean-Congo hemorrhagic fever appeared, the district detected it in three days, notified authorities in one, and mounted an effective response in two. Only one case was confirmed, and the patient survived. Because funds were available before the emergency, authorities were prepared and able to act. This kind of preparation can’t wait until the next crisis begins. Plague is an old disease we that know how to stop. The next threat may be harder to recognize, harder to treat, and easier to spread. Safer labs, less risk of spillover, and faster outbreak detection and response need sustained investment now, while we still have time to prevent the next emergency. Share
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