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1Password Surpasses $500 Million in Revenue as AI Agents Drive Growth
As businesses and consumers increasingly adopt artificial intelligence agents, 1Password is aiming to position itself to deliver solutions for growing challenges around security, access and trust.
Amazon employee files explosive lawsuit claiming senior executive raped her on NYC business trip
Kings’ Murray ‘Happy’ To Start the Season Healthy
After enduring a surgical recovery and a career-low 23 games last year, Sacramento’s vital X-factor returns to the hardwood aiming to reclaim his elite two-way form.
Trump's crackdown on immigrant voting in California is a ploy to influence election
President Donald Trump wants California to segregate 20,000 ballots, claiming they may come from noncitizens. Federal officers charged 28 suspects with voter fraud this week.
How ‘You Can See Everything’ can get an Oscar acting nomination for [SPOILER]
‘You Can See Everything’ is aiming for historic Oscar nominations, including in Best Picture and acting.
Ten Hag opens up on Ronaldo fallout at Man Utd
Erik Ten Hag has opened up about his fractured relationship with Cristiano Ronaldo during his time at Manchester United, claiming the Portuguese forward was not prepared to meet the physical demands o...
Costco’s ‘100% agave’ tequila lawsuit thrown out
A judge, deferring to Mexico's authority over tequila regulation, dismissed a proposed class-action lawsuit claiming that Costco’s Kirkland tequilas labeled 100% agave" are mixed with low-grade booze. The law firm
Franklin Publishes Book Review in <em>Political Theory</em>
A. Todd Franklin, the Eugene M. Tobin Distinguished Professor of Philosophy & Africana Studies, has published a review of Michael J. Illuzzi's Mending the Nation: Reclaiming "We the People" in a Populist Age (University Press of Kansas, 2025) in Politica
Foundation to hold trials this October
The Leeds United Foundation will be holding open trials for aspiring players on Friday 30 October, aiming to potentially recruit any promising players to the Academy system and Foundation centres.Thes...
Weekly Recap: Open-science AV partnership and benchmark performance pledge
Valeo SE (EURONEXT:FR) is partnering with KE:SAI to co-develop an open-science autonomous driving system for general vehicles, aiming to match and surpass major public driving benchmarks while committing to reproducible AI research and openly publishing results.Previous Week RecapThis is an AI-gene…
Hooksett sewer project aims to spur Route 3A business growth
Hooksett approved a $1 million underwater sewer extension near I-93 Exit 10, aiming to support future Route 3A business growth without using residents’ property...
Haunted attraction in Kathleen adds mental health mission, with part of sales donated
As Halloween shadows lengthen across Middle Georgia, a haunted attraction in Kathleen is aiming for more than screams, turning fright into support for mental he
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.
OrbiMed raises two new life sciences funds worth $3B with one aiming for Asia
The sixth cycle of OrbiMed’s Asia Partners fund included one with more than $1 billion earmarked for life science companies based on the Eastern continent.
OKC Public Safety Partnership to fund mental health coordinator using human services grant
Oklahoma City is using a $293,250 human services grant from the Inasmuch Foundation to fund a mental health project coordinator, aiming to improve the city’s mental health systems.
Reclaiming the Politics of the Possible
Washington is stuck in a cycle of performative conflict. The incentives seem to reward outrage, not outcomes that last; purity tests, not problem‑solving. So it’s no surprise that after three shutdowns in less than a year, public approval of Congress collapsed to just 10 percent this spring. (Gallup...
Reese Witherspoon Is Buying Back Hello Sunshine 5 Years After Its $900 Million Deal
The actress and entrepreneur is reportedly reclaiming her business at a fraction of the price she sold it for.
No, Siri AI is not coming to the original HomePod mini
Siri AI will be exclusive to HomePod mini 2, it‘s not coming to the original HomePod mini despite a report temporarily claiming otherwise.
Right-Winger Behind Talarico Mental Health Hoax Fears Legal Fallout
Rhein Amacher dodged an interview, claiming he was told by a lawyer not to participate for fear of getting in legal "hot water."
Kamala Harris’ political future in question amid report on husband’s concerns
A panel discusses a report claiming Kamala Harris’ husband privately expressed that he does not want her to run for president again and more on ‘Hannity.’
Jessica Lange Says FX Was ‘Too F**king Cheap’ During Her ‘American Horror Story’ Days
Lange surprised fans when she returned to the horror anthology series this fall, despite previously claiming she had no interest.
Albertsons launches business review, pulls outlook as profit falls
Albertsons launches a broad business review and suspends its financial outlook after a sharp profit decline, aiming to improve cost structure and shareholder returns.
Texans land Marvin Harrison Jr. after first win, aiming for a quick impact
Stroud ranks third in the NFL with 1,402 yards passing.
Brooklyn store responds to Kelly Clarkson once again, claims she was in their store for ‘5 minutes’
Clarkson slammed the shop on social media over the weekend, claiming they treated her “like Julia Roberts’ character in ‘Pretty Woman.’”
The Stickiness of Bonnie Blue: Online Disgust and Ahmed’s Cultural Politics of Emotions
Adult performer Bonnie Blue went viral in early 2025 after claiming to have had sex with 1,057 men in twelve hours. This article takes the online backlash against her as a case study in how disgust circulates and becomes attached to bodies. Drawing on Sara Ahmed’s (2004; 2014) accounts of affec ...
Politics Unplugged (Full Episode) Oct. 11, 2026
On "Politics Unplugged," political editor Dennis Welch sits down with Republican gubernatorial candidate Andy Biggs for a wide-ranging interview weeks before election day. The conversation is dominated by Governor Katie Hobbs' multi-million-dollar ad campaign accusing Biggs of protecting Warren Jeffs' FLDS cult while he was Arizona Senate President. Biggs forcefully denies the allegations, defending his legislative record and accusing the interviewer of carrying Hobbs' water. He escalates further, claiming Hobbs' rhetoric has led to death threats and that she would be "thrilled" if he were physically harmed. The interview also covers his vote against honoring Capitol Police on January 6th, his call to Rusty Bowers about decertifying the 2020 election, and whether he'd certify results as governor in 2028. Hobbs' office responds with a statement denying the claims. The show closes with a teaser for a Hobbs interview the following week.
AS Roma XI vs Como – Predicted lineup and team news
AS Roma head to Como on Sunday aiming to reclaim outright first place in Serie A from Inter Milan.Under Gian Piero Gasperini, Roma have made a strong start to their league campaign. They sit at the to...
Seminole Tribe Sues DraftKings for Running Illegal Sports Betting in Florida - WRUF 98.1 FM | 850 AM
The battle over sports betting rights in Florida is heading to court with the Seminole Tribe defending its exclusive rights to sports gambling in the state. The Seminole Tribe is suing DraftKings and CEO Jason Robins, claiming the company violated Florida’s 2021 Gaming Compact and is operating an illegal sports betting business. Through the 2021
Seminole tribe files lawsuit against DraftKings claiming it's illegal sports betting business
CNN guest calls out ‘The View’ to Ana Navarro’s face during on-air debate
CNN guest Scott Jennings called out ‘The View’ to Ana Navarro’s face during a live debate on the news network, claiming the show ‘is able to do whatever it wants.’
News and notes from Iowa Startup Week
Last week’s Iowa Startup Week event featured a packed four days of keynotes, panels, and networking opportunities, all aiming to spotlight and celebrate entrepreneurship in Iowa. The Business Record attended several sessions and gathered reactions from attendees. Here are snapshots of what we heard. Iowa is an ‘incredibly rich community’ to help startups Joseph Nelson, co-founder…
Lehigh Acres residents voice support for proposed Lee Health emergency department
Lee Health has revealed plans for a new emergency department and outpatient medical offices in Lehigh Acres, aiming to meet the growing community's healthcare needs.
Colonie Police raise concerns over mental health crisis response and aftercare
The Colonie Police Department responded to a domestic incident on Tattersall Lane Wednesday morning. It all happened after a woman called police claiming that her partner was committing acts of sel…
DNC sues to block Trump administration from using government funds for political ad
The Democratic National Committee (DNC) on Wednesday sued the Trump administration claiming they misused congressional appropriations in using government funding to run a new ad featuring the presi…
Sony Pictures Entertainment Launches Crunchyroll Storyworks, Aiming To Boost Japanese Anime
Sony Pictures Entertainment has unveiled a new division of its Crunchryroll subsidiary, Crunchyroll Storyworks, which will look to boost Japanese anime.
Samsung backtracks on SmartTag 3 Android support — still locked to Galaxy phones
After earlier this week claiming that its new SmartTag 3 would support non-Galaxy Android phones, Samsung says that won't happen, after all.
South Korea unveils $747 billion energy transition plan through 2035
South Korea's government on Wednesday unveiled a 1,000 trillion won ($747 billion) energy transition and decarbonisation strategy through 2035, aiming to expand renewable power, transform heavy industry and create new drivers of growth.
Arsenal star in contention for Golden Boy 2026 award
Myles Lewis-Skelly is among the leading Premier League youngsters nominated for the 2026 Golden Boy award, after reclaiming his place in the Arsenal and England teams.During the second half of last se...
Enabling, Denying, and Spiking the Proverbial Political Football
ANDOVER TOWNSHIP – Republicans are claiming victory over a proposed data center. But it really isn’t that simple. As one critical observer noted on a Stop Andover Data Center social media page: It was the all-Republican township committee that “opened the door (to a data center) in the first place.” This is a local issue to be sure,[...]
Jeffries says House Democrats aiming to repeat 2018 sweep by flipping Trump districts
The Democratic Party is working to expand the map by going on offense in Republican-held districts, while President Donald Trump hits the trail in a red-state sprint to boost voter enthusiasm and shore up support from his base.
Reclaiming 'Health Sovereignty': EU Gastein Forum Confronts A Fragmenting Global Order
Health, long treated as a sanctuary of diplomatic consensus, has entered an era of high politics and ideological division. Leading the closing panel of the EU Health Forum Gastein (EHFG) on Friday (2 October), session chair Ilona Kickbusch, founder of the Global Health Centre at the Graduate Institute in Geneva, highlighted how recent votes at the UN General Assembly demonstrate that nation-states increasingly split and vote instead of searching for consensus.
To Make More Money, Rolls-Royce Is Aiming Higher on Price, Not Production
The luxury carmaker is expanding its factory in Britain to focus on rarefied custom cars. First up is a $3.5 million-plus electric roadster.
Germany XI vs Greece – Predicted lineup and team news
Germany will meet Greece again in the UEFA Nations League on Sunday, with Jürgen Klopp’s side aiming to make up for their defeat in the opening meeting between the two teams.Klopp’s time in charg...
Valorant Player Banned Due To Previous GPU Owner’s Cheating
In a wild coincidence a German player was penalized over the playing habits of their Ryzen 7's previous owner, claiming that nothing short of replacing the entire PC will overcome Riot's infamous anti-cheat detection
Anthropic Is Aiming To Transform Healthcare—Here’s How
Anthropic is pushing Claude into prior authorization, medical records, drug discovery and global health. A physician explains what it means for doctors and patients.
These Texas doctors want to make sure people know their abortion rights during medical emergencies
Texas passed the Life of the Mother Act in 2025, aiming to clarify the narrow medical exception to the state's abortion ban. Advocates are still working to spread the word.
As quantum’s presence grows on the southeast side, Chicago State University students eye future careers
Chicago State University staked its claim in quantum research nearly a decade ago, aiming to attract research and talent to the Southeast Side.
Time lost to political haggling means lost momentum for research
While it’s not up to universities to set deadlines for EU institutions, “lost time” in the run-up to the launch of the next Horizon Europe would translate into “lost momentum” for universities, according to Dag Rune Olsen, president of the Young European Research Universities Network.“I think it's important to have [the EU budget] in place in order to be able to work on the research funding mechanisms, because we cannot afford to lose more momentum than we already have,” Olsen told Science|Business in an interview in September, just after EU research lobbies gathered in Brussels to push for a €200 billion budget for the next Horizon Europe programme.A funding gap would mean ramping down research activities, said Olsen. “You can do that quite swiftly, that’s not a problem, but ramping up again is much more difficult.”The last-minute push for an ambitious budget, and for a timely adoption of the research programme, comes at a time when the richest EU states have teamed up to call for significant cuts to European Commission’s proposal for the next multiannual budget, which allocates €175 billion for Horizon Europe. At the same gathering of research associations in September, the European Parliament’s budget rapporteur warned that the EU will need to raise its own taxes, otherwise political pressure and tighter national budgets will translate into a limited EU budget with a less ambitious envelope for research. The research sector hopes EU institutions will reach timely agreement on the budget and on Horizon Europe, but progress has been slow. Legislative progress has been delayed, partly because the European Parliament’s budget committee is still haggling over how to apply new EU-wide spending rules, known as the Performance Framework Regulation, and partly because EU governments have yet to agree on the size of the next EU budget. EU research Commissioner Ekaterina Zaharieva told Science|Business in July that she was hoping for an agreement on Horizon Europe by the end of 2026, but the timelines have been pushed back significantly, with the Parliament now aiming to announce its official position on Horizon Europe only in November. Avoid the funding gapAccording to Olsen, delayed EU funds could prompt universities and researchers to move on and do something else, potentially jeopardising years of work building consortia and collaborations. “If funding is interrupted, the networks fall apart in just a few months,” he said. Olsen also noted that an interruption would affect junior researchers first. PhD students and postdocs are on shorter term contracts and universities risk losing them if funding for EU projects is interrupted. Related articlesEU own resources ‘essential’ for future research budget, says leading MEPParliament haggle over EU-wide spending rules delays vote on Horizon EuropeZaharieva hopes for a Horizon Europe deal in 2026Universities usually have more employees, permanent and short-term staff, than they can cover with national funding, and external funding is essential to keep them all on the payroll. In case of an EU funding gap, “there will be a huge number of people that might end up without any contracts,” he said. Apart from the money issue, Olsen said EU projects forces universities to collaborate more which, in turn, increases the quality of teaching and research. In case of a funding dip, people will look around for opportunities elsewhere, in the private sector or abroad. “And then then you have to recruit again, and it's a tedious business,” said Olsen. “A gap is not a good idea, it's actually a waste of money.”According to Olsen, the difficult political context should encourage universities to make a stronger case for the EU increasing research funding, as universities can deliver on competitiveness, technological sovereignty, security and defence. “The reason why we ask for substantial investments in research is exactly what the Commission, what Europe, the Parliament have been discussing,” he said. “You really need to invest in order to thrive in the longer run.”Focus on the member statesBut EU and national R&D expenditure hasn't kept up with the times. EU governments have failed to reach a spending target set almost 25 years ago. Only six EU countries spend 3% or more of their GDP on R&D. Asked whether universities should put more effort into convincing the governments to ramp up their own spending, but also to support a strong budget for Horizon Europe in the ongoing budget negotiations, Olsen said “the answer is yes.”“We are very actively encouraging our members to talk to their ministries in order to enlighten them about the joint effort,” he said. The network is made up of 25 universities from across Europe, all established in the past 60 years or so.Who will call the shots?Budget and timing issues aside, the Parliament’s research committee has been locked in behind-the-scenes negotiations over the future structure of Horizon Europe, with MEPs disagreeing on the degree to which its collaborative research should be governed by councils of experts.The European Parliament’s lead rapporteur on Horizon Europe wants councils of independent experts to decide on the funding agenda, but the Commission, the Council, and parts of the Parliament disagree. For Olsen, it is normal for politicians to point at the big challenges, but when they start detailing how those challenges should be solved, the endeavour “fails utterly.” He does not necessarily think that “bureaucrats who don’t know the field” would be “much better at it” either. “There has to be a combination” of broad political directions and bottom-up implementation, Olsen said.
Ireland vs Austria – Predicted lineup and team news
Ireland will take on Austria in their UEFA Nations League matchday three clash on Thursday at Dublin’s Aviva Stadium, aiming to build on the momentum from their most recent victory.The Republic of I...
September Monthly Review: Health MCP Guy?
For all the time I spend talking about APIs and data exchange, this newsletter has had embarrassingly little interoperability of its own. It’s old-school SaaS, baby - UI or bust. Not all of that is my fault! Substack, for all its popularity, is (as mentioned before) really frustrating as my system of record. The primary user it optimizes towards is the reader, whose attention feeds the app, the Notes feed, and the recommendation network that Substack is actually selling. Health API Guy is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe They’re falling into the same trap that Medium once sprinted into, albeit at a much more glacial speed. Younger generations may not remember (or never knew) it, but Medium once lured publications like The Ringer and Signal v. Noise onto its platform, only to lose them as it rebuilt itself around a paywall and an algorithmic feed. Substack’s original pitch circa 2020 was the antidote (you own your list), but every new feed feature chips away at it. I get it: writers are generic supply in the eyes of the Substack product team. Generic supply follows demand, so the consistent pressure on the PMs is to generate demand, which leads to every product cycle going toward discovery (Notes, recommendations, the app, live video). The end result lackluster author tools (laggy and broken analytics are truly crippling) all despite the premium price point. The archive is where it crosses from authorial gripes to actual reader impact, though. Across Substack and LinkedIn, I’ve published 1,218 posts and nearly 900,000 words since 2018. Substack’s native search can see only the 464 posts that live on Substack, and even there it’s woefully inadequate at surfacing relevant content (even for the guy who wrote it)! Readers have the same problem, writ large. Ask the Archive Fixing search (for both my readers and my own use) turned out to be extremely non-trivial, unfortunately: There’s no public API for readers to access content RSS exists for new content notification, but it only carries the 20 most recent posts and cuts paid ones off at the preview The only Substack MCP is an admin tool for analytics The export exists for authors, but it’s painfully awkward and slow. So I built something to work around that: the Health API Guy MCP. It’s a private MCP server holding the full text of everything I’ve written across Substack and LinkedIn. Add it to Claude or ChatGPT as a connector and you can ask things like: It pairs keyword search (for acronyms and case names, of which we have many) with semantic search. Every post is also labeled by topic, form, and court case, so you can pull a lawsuit’s (or multiple cases’) entire docket across Substack and LinkedIn in one query: Hail, Healthapiguyhydra This is also a bit of me eating my own cooking. I’ve spent the year arguing that headless healthcare is arriving and that developers want primitives over abstractions. Last week in Hail, Benihydra, I watched Salesforce plug its platform into Claude and bet that the records underneath outlive whatever interface sits on top: Salesforce must believe that the Hydra’s immortal head is the records, permissions, and business logic (in that they will survive whatever happens to the interface). It felt a bit hypocritical to keep my own archive behind a Substack search bar. The archive is the body. Substack is one head, and now whatever tool you might use is another. Will the EHRs follow my lead? Probably not imminently, but one can hope! Why Founding Members Only The MCP is available to Founding Member subscribers. A few reasons: It costs money and time to run. Hosting, the database, Clerk usage and AI compute for search and labeling are significant operational costs (that increase with usage). Substack gives me no way to automate access. There’s no API to check whether someone is a paid subscriber, so every user is manual operations for now. It’s a beta. We’ll need to improve things and parts will break. I’d rather they break for a small group of dedicated readers who will tell me about it. The Founding tier deserved a real benefit. Until now it was mostly a generous tip. Now it comes with something. If you’re already a Founding Member, reply to this email with the address you’d like provisioned. If you’re not and want in, upgrade here. Larger teams (such as companies) can get access too: group subscriptions at the Founding tier come with the group discount. The admin for the subscription can reply with the list of addresses to provision. Get 20% off a group subscription Pricing Founding membership is now a flat $200 a year, replacing the old suggested $150 that readers could adjust. Existing Founding Members will have access grandfathered in at their previous rate. Month in Review Articles Published Make Networks Dumb Again (Sep 11): AI is making old analog networks cheaper to use and flooding them with machine traffic in the process. A plea for agent-native rails with the intelligence at the endpoints, and for Washington to drag them to ubiquity. Interoperability, Unbuttoned (Sep 29): Interoperability is a series of workflows in a trenchcoat, and this post finally takes the trenchcoat off. A color-coded map shows which provider workflows went digital, which are fragmented, and which still run on fax. Video Content Antitrust’s System of Record Problem (Sep 3): The FTC’s investigation into Epic prompted a ninety-minute webinar, now posted with chapters and a smoothed transcript. We get into why market definition, missing B2B share data, and the SSNIP test leave antitrust poorly suited to systems of record, plus why information blocking may be doing more than any pending lawsuit. The Information Exchange: Cerner Milking Edition (Sep 18): This was so fucking fun. Ryan Tucker, Ryan Brickner, Brad Thorson, and I try an Around the Horn format, complete with points, penalties, and a mute button. We debate whether Oracle Health is dead, who would actually buy Cerner (IBM enters the chat), p(Doom), and why the front desk still hands you a clipboard. Regulatory Ask Not What Your Network Can Do (Sep 23): CDC’s RFI on public health data intermediaries lists use cases already served, unevenly, by eCR, lab reporting, IZ Gateway, and syndromic surveillance. The real opportunity sits in one question about AI: a network that can handle the next emergency without another interface project. Court cases Particle v. Epic: The Naughty Schoolteacher (Sep 4): After a summer-long vigil, the answer on Epic’s early summary judgment bid is two paragraphs and a remedial assignment. Particle advances to the next grade, and market definition gets another year of discovery. The Epic Discovery Files (Sep 8): Texas’s motions to compel arrive with a 251-page appendix of requests, objections, and meet-and-confer letters with Cravath. Inside: Epic using generative AI for document review, denied interoperability requests in scope, and Noerr-Pennington raised against lobbying discovery. Epic v. Health Gorilla: “Working as Designed” (Sep 9): Epic wants nothing to do with the data breach MDL, and explaining why puts fresh discovery on the public docket. The spiciest allegation: Health Gorilla told GuardDog to scrub its law firm business from its website instead of cutting off access. Veeva v. Epic: Legal Bypass Surgery (Sep 15): Veeva asks the Wisconsin Supreme Court to skip the Court of Appeals, while law professors and three policy groups line up as amici. Meanwhile, Epic’s lawyers apologize for another round of citation errors, including a quote that never existed. Texas v. Epic: Behind the Black Bars (Sep 17): The court portal served up Epic’s unredacted filings, revealing a $5 million document review budget and the AI workflow behind it. Also inside: the 200-plus company names Texas wants searched, and one very expensive Zoom invitation. OpenEvidence v. Doximity: Consequences Will Follow (Sep 25): OpenEvidence tells the court it will not comply with a discovery order, and its own lawyers at Quinn Emanuel say they won’t defend the choice. Add years of Slack reported unrecoverable, and Rule 37 sanctions come into view. Health Tech Keeps Choosing Violence (Sep 28): Doximity moves to end OpenEvidence’s case, Epic asks Texas to show its work, and a sleepy Audacious Inquiry patent fight sprouts antitrust and information blocking counterclaims. The main event is a long-sealed Cognizant v. Infosys ruling that hints where system of record antitrust claims can survive. EHRs One Verb for Oracle Health (Sep 14): Oracle’s earnings call quantifies every data center to the decimal point, while Oracle Health gets a single verb: “accelerate.” Panning the few healthcare mentions turns up an agentic care management system, a research-to-care ledger play, and the question of whether healthcare gets Larry’s patience. Epic’s Forretress Under Siege (Sep 30): Judy Faulkner tells a panel Epic paused hundreds of projects to harden its software and calls it a “shame,” while a spokesperson insists the roadmap hasn’t changed. Project Glasswing, a Pokémon-branded QAN sprint, and a trove of Jodel grievances reconcile the two Epics and preview the Jevons paradox coming for all software. Industry Analysis Scanning for a Network (Sep 1): Scan.com raises $220M to build the imaging network labs never got, speedrunning Zocdoc’s consumer-to-B2B pivot. Its wedge to network density may be the most American one available: personal injury litigation. The Front Desk Wants the Damn Whole Building (Sep 16): Hello Patient buys Converse Health, pushing its AI front desk into referrals, chart work, and prior auth. The copilot categories keep blurring, and your distribution partner is still your final boss. Cross-industry Comparisons A Different Patchwork Quilt (Sep 10): Healthcare loves to envy open banking, but the US version has no mandate, a toll booth at Chase, and data quality problems of its own. The grass isn’t greener; it’s another American patchwork quilt, and perhaps a worse one. Hail, Benihydra (Sep 21): Salesforce brings its platform into Claude, Slack, and its own agent, inviting the interfaces that might replace it. Cut off one head and more grow back, so long as the records underneath stay put. Living on A Trade Secret Prayer (Sep 22): Six credit unions are suing Fiserv, the Epic of core banking, by claiming their own member records as trade secrets. Banking has no Cures Act, so its lawyers reach for legal alchemy that healthcare has already tried. Other News None this month External Media Nabla Accelerate NYC: I kicked off fall conference season at Nabla’s Accelerate event in New York, where Delphine Groll opened by asking the room to picture the company it wants to become and the one it doesn’t. I liked her framework of bureaucracy, fear, and ego as the blockers. I also love vendor conferences/events in general - different vibe than industry biggies. Healthcare 101 with Nikhil Krishnan: I briefly guest lectured Out-Of-Pocket’s Healthcare 101 class. Appreciated Nikhil’s takeaways cover whether AI doctors can query HIEs, why healthcare’s data-liberation rules beat most industries’, and the hi-res graphic is in the comments. HCN: Epic Probed by the FTC: I joined the HCN guys to talk through the FTC’s investigation into Epic. Cedric’s new hairdo was an unexpected plot twist. The episode also covers MFN drug pricing, healthcare M&A and Eli Lilly’s acquisition streak. Fall Conferences: At eHealth Exchange’s Annual Meeting in Austin on Oct 27, I’ll moderate a panel on the tensions between AI, HIEs, and timely patient access with Jean Ross (Primary Record), Therasa Bell (Kno2), Byron Crowe (Doctronic), and Michael Marchant (Freenome). Here’s the rest of my schedule if you want to meet up: CommonWell (Redwood Shores, CA): Oct 13-14 Will be participating in a fun Jeopardy event Open@Epic (Madison, WI): Oct 20-23 Will be enjoying Verona, Willy Street, and other local adventures eHealth Exchange and Sequoia Project (Austin, TX): Oct 27-29 Yeehaw HLTH (Vegas): Nov 15-18 Groundhog Day, Venetian Edition RSNA (Chicago): Nov 30-Dec 2 See me at “Governing AI in Breast Imaging: What Health Systems Are Actually Doing” Digital Health Counsel 2026 AI Summit (Seattle): December 2-3 Will likely be speaking to a bunch of lawyers about information blocking Posts I Liked ChatGPT’s Epic integration: game changer or nothing burger?: Joshua Liu, MD offers five thoughts on OpenAI’s Epic launch, starting from the point that it rides the same open APIs available to anyone. He argues read-only access leaves ordering to Art and the ambient startups, and asks why HCA is piloting it alongside Commure. He’s sorta a must-follow at this point - consistently excellent, thought-provoking takes. Epic, Lilly, and the Discovery pass: Seth Chaney reads Epic’s first major Discovery deal (with Eli Lilly), as well as its revised developer terms on commercial displays, as the pipe finally opening between EHRs and pharma. Life sciences and health continue to collide. Scott Rossignol on EHR payer platforms and ePA fees: Scott argues the top ambulatory EHR vendors are turning the prior auth mandate into a per-member-per-year toll on payers, for an API whose operating cost has nothing to do with covered lives. His fix is two lines of regulatory text: put the CRD/DTR/PAS certification criteria in the Base EHR definition, and bring payer-facing ePA connectivity under § 170.404’s cost-based fee rules. It’s a good solution. Health API Guy is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe
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Bobby Kotick’s lawyers sent me a bad email (and later apologized)
The message I had received was unsettling—for a moment. Then it was just really confusing. Back on January 20 of this year, at 5:15pm ET, I received an email with the subject line “Legal Correspondence re Bobby Kotick.” It was from the law firm Clare Locke, a firm I’d heard had been emailing reporters in recent years about their coverage of Kotick, the former, longtime CEO of Activision Blizzard. The letter was threatening. A lawyer from the firm introduced themselves as “defamation counsel to Bobby Kotick.” They issued a “demand” that I “correct” a Game File article I’d published a week prior. The article that had irked them had been a scoop of sorts. I’d written about a a 2022 lawsuit brought by a Swedish pension fund, AP7, over Microsoft’s purchase of Activision Blizzard. The suit wasn’t news, but I was first to review and report about Kotick’s extensive pushback to the fund’s claims. The pension fund’s core contention was that the sale had been rushed by Kotick to avoid the consequences of sexual misconduct scandals swirling around the company in 2021. (He’d not been accused of misconduct himself in those suits, to be clear.) As I wrote at the time, Kotick had denied the allegations of the rushed sale. Beyond that, Kotick used a December 2025 reply to the Swedish fund’s lawsuit to assign blame for those workplace scandals, the bad press and even for the AP7 lawsuit. I’d found Kotick’s arguments novel and newsworthy. Across nearly 3,000 words, I explained Kotick’s take: that a Swedish gaming company was behind the Swedish fund’s lawsuit (the Embracer group; they denied it); that the Microsoft-Activision deal was not rushed and was secured at what Kotick felt history had proven to be an optimal price for shareholders; that he believed a conspiracy of people at unions government agencies, PR firms and the media had spun up claims of widespread workplace misconduct at Activision Blizzard in 2021. The article gave context for all of this, letting readers assess the claims and weigh their credibility. As I’d later write to Kotick’s lawyers: I would be surprised if you could point to any news article about Bobby Kotick in the last five years that has spent more of its wordcount articulating his point of view. He is welcome to do an interview with Game File any time. Nonetheless, there they were in my inbox that Tuesday evening: Clare Locke, the law firm that secured a $787.5 million settlement from Fox News over false statements about voting machines. They were emailing me, threatening that failure to comply with their demand could support a claim of “actual malice,” a legal standard for libel. Unless… Unless, they said, I added a key paragraph to my article. This was a paragraph that I already knew Kotick’s lawyers had been emailing reporters about for at least a year, and it was a paragraph that was already in my article. The paragraph they wanted is from a 2023 settlement that California’s Civil Rights Department struck with Activision Blizzard. The settlement had closed a two-year-old lawsuit over alleged sexual discrimination at the game maker. The paragraph basically said that claims of systemic or widespread sexual harassment—or of execs like Kotick tolerating such behavior—had never been proven. I’d already seen proof that Kotick’s lawyers had pushed for the settlement’s language to be added to reports about 2021 sexual discrimination and misconduct lawsuits brought against Activision Blizzard by California and, separately, by the U.S. federal government (both suits were since settled). I knew that Kotick and his lawyers felt that the California settlement language should be mentioned in the same breath as references to an article he hated and denied, a November 2021 Wall Street Journal article claiming Kotick knew “for years” of sexual misconduct at Activision Blizzard. So, in the Game File article that Clare Locke emailed me about, in the interest of ensuring I was being fair and balanced regarding the person I was covering, I had already included the following excerpt from the California settlement [emphasis added in bold]: (Kotick has repeatedly pushed back against that November article in the Wall Street Journal, citing among other things, language from a court-approved consent decree as part of Activision’s 2023 $54 million settlement over the California suit. It states: “no court or any independent investigation has substantiated any allegations that: there has been systemic or widespread sexual harassment at Activision Blizzard [or] that Activision Blizzard senior executives ignored, condoned, or tolerated a culture of systemic harassment, retaliation, or discrimination.”) On the evening of January 20, I was incredulous. How do you write a four page legal threat about a week-old article and miss this? While scrambling to also make my kids dinner, I wrote a lengthy reply to Clare Locke’s lawyers, basically asking them to cool it with the threats and to start making sense. In part, I wrote: I hope you can understand why I am having trouble understanding what you’re asking for, when the statement you’re demanding to see in Game File’s article already appears in Game File’s article. Actual malice, as you know, refers to a reckless disregard for the truth. I’m not sure what your argument is when my article already states your client’s position. Here is where I should remind you, the reader, that I am an independent journalist. I publish on Substack, and have availed myself of the Substack Defender program that provides writers on the platform with legal support. But I’m no Wall Street Journal or New York Times, nor even IGN or GameSpot when it comes to such things as, well, having a legal department. There are more fun things for me to do as an independent journalist than writing back to a powerful law firm representing a very rich person. On the evening of January 20th, I was just trying to cook some pasta, broccoli and chicken nuggets for hungry twins. Nevertheless, I wrote back to them. Two hours later, I got a reply. Summarizing: A lawyer for Clare Locke said they’d “reviewed an incomplete version” of my article and they “apologize for the confusion.” (My guess: Someone didn’t read past the piece’s paywall, even though they’d had a full week to scrounge up the funds to do so. What I’d published above the paywall was balanced, as was what came after.)1 That was almost that, but something about the situation bothered me. The letter had been marked “confidential.” I hadn’t agreed to that, and I disliked the idea that powerful people on the beat that I cover would act like they could unilaterally control what I might tell my readers about. On the morning of the 21st, having already gotten the powerful law firm to back off, I oh-so-wisely re-approached them with just one more thing. I thanked them for clearing things up the night before but noted that I’d never agreed to keep their letter confidential. I’m all for agreeing with a source to keep things off the record, but that’s the thing. We have to agree. You can’t just declare it. I’m not bound by that. I wrote to Clare Locke’s lawyer and said, in part: I trust the matter is resolved. It was disappointing to have to spend less time with my kids last night in order to address your legal letter. Family time’s precious. I will add, for clarity’s sake, that, while your letter stipulated that it was confidential, I did not agree to those terms. In the future, should you wish to communicate with me confidentially, I am happy to agree to classifying our communication as “off the record” prior to the actual communication—as is standard with any professional journalist. The firm’s lawyer replied, not directly addressing the confidentiality issue but asserting that the matter was resolved. Why I didn’t write about this until now In May, I told this story on an episode of Simon Parkin’s podcast My Perfect Console, but I held off on sharing it directly with Game File readers. I held off to avoid stepping on the toes of another reporter, the journalist Mikhail Klimentov. He’d interviewed me in the spring of 2025 about an investigation he was working on regarding Bobby Kotick lawyers pressing the media to add the California settlement language to stories referencing the 2021 lawsuits. And about how some outlets had changed their stories and how some simply deleted them. Initially, I was a third-party source for Klimentov’s reporting, providing on-the-record context about the state of the games media. I’d heard about the letters but hadn’t put the time into pursuing the story. I thought it was interesting, and I was glad he was covering it. When the outlet that Klimentov was going to run his reporting in dropped the story, I began talking to him about potentially publishing his reporting on Game File. This was tentative. Then, in January, when I got my own Clare Locke letter, I told Klimentov that I didn’t think it would make sense for me to publish him, not with me now being part of the story. I had my own version of this situation to tell. But I wished him well and said I’d refrain from telling my tale until he could get his reporting out there. Last Friday, Klimentov finally ran his investigation, in a nearly 48-minute video report for People Make Games. It covers various Clare Locke letters, how media outlets reacted to them and what to make of all this. His video weighs the merits of Kotick’s request and looks at some of the articles that were changed (one of which had a glaring error). I highly recommend watching it: (Note, I did some editorial consulting for a People Make Games video last year but nothing to do with this report.) While many outlets haven’t left any public evidence that they updated their Kotick coverage at Kotick’s counsel’s request, at least one has. Back in October 2025, the mainstream outlet Reuters applied the most transparent article update I’ve seen. On the 3rd of the month, they published an article about the state of the Swedish pension fund’s lawsuit. Days later, they added this: In an October 7 letter sent after publication of this article, Kotick’s defamation counsel disputed claims of widespread harassment at Activision. “Not a single investigation, court finding, verdict, or ruling ever concluded that there was any merit” to the allegations of widespread harassment at Activision, Tom Clare and Nick Brechbill of Clare Locke wrote. I’ve never added a statement to my article on Game File, because none was needed. Not for fairness’ sake, nor to meet any demands of Kotick’s lawyers. I’ve nevertheless wanted to be transparent with Game File readers. If someone powerful is questioning my reporting, is threatening a lawsuit over it… if that threat is part of a pattern involving other games media outlets and if, in my case, the whole thing ran into a ridiculous ditch, I want you to know about it. I also share this as a real example of how I handle threats to Game File. I stand up for my own reporting, even when it’s not comfortable to do so. (In that same category of standing up for the work I do, I’ll point to an incident in late August. Asocial media post I published to X/Twitter regarding reporting I did about Take Two and GTA VI was hit by bogus copyright claim by a firm working for the publisher. I pushed back and got it reversed; even while a bigger games media outlet let themselves be censored. This is the other reason I’m sharing this story: To emphasize that dealing with threats from powerful people is one of the costs of covering the video game industry independently and as fearlessly as possible. This is where you come in. Your support, through free and paid subscriptions (sign up here!), can help me keep doing that. It can ensure that I’ve got the back-up I need. And it can help make fiascoes like this even less of a worry, so I can spend my evenings dealing with more important things, such as making sure I steam the kids’ broccoli just right. 1 That pension fund lawsuit I wrote about in January has all but gone away. In May, the fund and Activision Blizzard owner Microsoft agreed to settle. Lawyers for the fund brokered a $250 million settlement for former Activision Blizzard shareholders. In the settlement, the fund’s lawyers changed their rhetoric. Where once they’d questioned the meaning of the California settlement language, they adopted a version of it for themselves. Several weeks ago, while seeking to get a court to sign off on the terms of the settlement, they proposed their fee for their work in the case: $60 million.
SpaceX launches Starship on 10-hour test flight, aiming to orbit Earth 6 times
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Grieving parents sue hospital saying staff handed them prescription slip to drive dead baby home in back seat
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Grieving parents sue hospital saying staff handed them prescription slip to drive dead baby home in back seat
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Engrams Embedding Entendre: Codesign for Efficient DRAM/SSD Offloading
Engram extends standard token embeddings with learned multi-token lookups. Recurring local patterns retrieve vectors directly, reducing the need to reconstruct them through attention and feed-forward layers. With Engram model architecture optimization, it allows for lower HBM capacity to be needed for models at the same quality. This does not mean there won’t be an insane demand for HBM but it just means that model architecture will continue to innovate around constraints. This model architecture design is naturally codesigned for parameter offloading: each token accesses a few embedding rows whose addresses depend on token IDs, not hidden states. The runtime can prefetch those rows from host DRAM while earlier layers compute, keeping the table outside HBM without transferring entire weight matrices. Our Memory model contains our latest estimates of quarter by quarter HBM, DRAM, & NAND supply and demand. Offloading frees HBM for model weights and KV cache, potentially supporting larger batches or more concurrent sessions. When DRAM becomes the next constraint, NVMe offers another tier. Recommendation systems already cache frequently or recently accessed embedding rows in faster memory while backing colder rows with SSDs. After NVIDIA roadmap had to change due to massively despec’ing Rubin Ultra from 1024GB to now ~200GB of HBM per chip, model architecture optimizations like emgram maybe helpful. Our DeepSeek-V4.1-Flash configuration uses roughly 189 GiB of memory for Engram. We replace it with a memory-mapped (mmap) file and measure serving performance with offload to SSD. Later on in our report, we will show our Engram offloading experiments along with the official InferenceX agentic inference serving results on Engram models like DeepSeekv4.1 Flash across all 6 NVIDIA GPU SKUs along with MI355X. Unsurprisingly, the CUDA Moat is still mogging MI355X on the ultra popular DeepSeekV4.1 Flash model. We also show how even on high capacity HBM SKUs, offloading emgrams to DRAM could result in even better performance for most of the pareto than keeping the emgram in HBM. Our benchmark has been widely reproduced, validated and/or supported by almost every major buyer of compute from Google Cloud to Microsoft Azure to Oracle, to Meta and many more. Furthermore, it has the support of the ML community including from vLLM, LMCache, SGLang, PyTorch, Huggingface and the support of major labs like OpenAI, MiniMax, ZAI, Qwen, Moonshot Kimi, etc. Star the InferenceX GitHub repository if you find the open-source benchmark and data useful!. InferenceX is the only inference benchmark in the world to have TPUv7, Jalapeño, Nvidia Rubin NVL72, AMD, and soon, SambaNova and Trainium. Due to how realistic AgentX scenario is to real world agentic inference workloads, AMD has committed to collaborating on MI455X UALoE72 too. DeepSeek did not release the original paper’s two trained Engram models. We replicated its setup on fineweb-edu using the released code and training hyperparameters, at an estimated 6E18 FLOPs per run. We observed the same U-shape scaling: Engram improved performance over pure MoE baselines. We also reproduced DeepSeek’s results, where earlier-layer representations with Engram resembled those of later layers. Like the original Engram paper, it is possible to probe Engram’s gate scores to see what n-grams DeepSeek-V4.1-Flash makes the most use of. Our gate scan finds names, code fragments, relational phrasing, and boilerplate. These examples prioritize interesting-ness over gate strength. One unexpected result was Wright : Ace Attorney. These examples suggest learned memory optimizes the training objective, not a judgment of which facts deserve storage. Licenses, bibliography fragments, API scaffolding, and website furniture can provide prediction shortcuts, so the value of additional Engram capacity may depend on what survives data preparation. This does not show that table capacity is “wasted”: the evaluation-corpus scan establishes neither training exposure nor the capacity occupied by each category. For offloading, strong gates do not identify cache-hot rows. Low gates do not automatically save reads either: computing the gate requires the retrieved key and undoes the performance gain of a fused kernel. Skipping reads would require a separate usefulness predictor before retrieval. In the original paper’s inference-time ablation, factual-knowledge benchmarks retained just 29–44% of their original performance, while reading comprehension retained 81–93%. This is due to the training–inference mismatch. The resulting degradation therefore measures this trained model’s dependence on Engram, not the performance difference between models trained with and without it. In our ablations, suppressing Engram worsens token likelihood across all evaluated domains, especially encyclopedia text and several code corpora. Surprisingly, GSM8K accuracy stays within measured run-to-run variation and removing Engram has no effect. Engram is not a detachable dictionary beside an unchanged MoE. Removing it changes downstream features and expert selection. We tested whether rerouting hurts or compensates by holding tokens fixed in a teacher-forced experiment on CRUXEval, a code-reasoning benchmark of small Python functions where the model predicts a function’s output from its code and an input, and scoring the reference answer. Removing Engram raised answer loss from 0.2848 to 0.3093 bits/token. Forcing the ablated model to use the original Engram-on expert choices made it worse still, at 0.3375 bits/token. Rerouting partially compensates for the missing memory. Memory features and expert selection work together, rather than following a clean “memory stores facts; experts reason” division. On the same CRUXeval, removing Engram during either phase reduced accuracy and increased generated tokens; removing it throughout produced the largest changes. Keeping Engram for prefill leads to more correct answers than keeping for decode likely due to semantically richer KV cache transferred to decode workers, allowing it to mitigate some of the performance loss. Engram’s table is large, but each lookup is small. DeepSeek-V4.1-Flash requests 24 rows at each of two Engram layers, about 12.4 KiB per processed token position across the model, or 3.1 KiB per GPU when split across four GPUs. Currently as of Day 7 since Model Release, MI355X is still 2-4x worse performance per dollar compared to B200 even when normalized by Mi355X’s lower TCO. Our full total cost of ownership breakdown comes from our AI Cloud TCO Model along with monthly market surveys of over 100+ gpu clouds & gpu cloud customers. On the Day 0 release of DeepSeekv4.1 Flash, NVIDIA vLLM works out of the box with zero issues across all 6 SKUs: H100, H200, B200, B300, GB200, GB300! This was thanks to the amazing work by the NVIDIA & Interact teams! In comparison, AMD vLLM did not work on day 0 for DeepSeekv4.1 Flash.Source: SemiAnalysis InferenceX AMD’s vLLM documentation points to using vllm/vllm-openai-rocm:deepseekv41-flash-0909, but from hour 0 of the model release to hour 23, AMD has not publicly released the image. AMD claims, “SPEED IS THE MOAT,” yet it has still not released it by the 23rd hour. We wish that, going forward, the AMD team has a better process for hour 0 model releases. Eventually when they did publicly release for “day 0” image support, performance-wise, it is currently up to 14.8x worse perf per dollar than H200 and up to 42x worse perf per dollar than B200/B300. The power of the CUDA MOAT is NVIDIA’s collaboration with its massive 6 million-developer community ecosystem including most of the vLLM & SGLang & Tokenspeed maintainers which means that CUDA is optimized on day 0. Overall, AMD did make significant improvements but the performance per dollar is still currently 2-4x worse than B200. AgentX Engram DRAM Offloading Improving Performance The HBM and DRAM offload use the same GPU kernel to select and dequantize rows. With HBM, it reads GPU memory; with Unified Virtual Addressing (UVA), it reads pinned host memory directly. Both support full decode graphs. Moving the table into HBM accelerates only the sparse lookup, leaving decoder computation and communication unchanged, resulting in little overall benefit while consuming memory otherwise available to KV cache. Another benefit of Engram offloaded to DRAM which means you can reduce the communication overhead by using less HBM GPUs per replica. For example, when enabling Engram offloading on B300, we are able to switch from TP4 to now TP2 which improves the pareto curve by up to 1.6x. When iso-model quality, less HBM is required as the engrams could be offloaded to host DRAM. Thus HBM bandwidth matters way more than HBM capacity. For inference workloads where memory bandwidth matters the most, 4-hi HBM provides the best $/bandwidth and therefore lowest cost per token. If China continues to make more and more revolutionary model architecture innovations, soon it could potentially 0Hi HBM stacks. [ ](https://newsletter.semianalysis.com/p/long-live-the-short-king-why-4-hi) [ Long Live the Short King: Why 4-hi HBM Wins ](https://newsletter.semianalysis.com/p/long-live-the-short-king-why-4-hi) Myron Xie, Bryan Shan, and 3 others · Sep 13 [ Read full story ](https://newsletter.semianalysis.com/p/long-live-the-short-king-why-4-hi) Moreover, on B300 and week-0 stack, moving the Engram table back to HBM did not improve results and stay within run-to-run variance. This is a result of the work optimizing DRAM offload, such as async, and overlap. SSD Offloading On B200, we created a unoptimized vLLM fork and stored the Engram tables in memory-mapped files on local SSDs. File backing lets the OS reclaim table pages when other applications need RAM. Pages already cached in memory can be served without reading the SSD again. Furthermore, note that we were unable to turn on GDS The unoptimized SSD implementation changes how rows reach the GPU. It copies row IDs to the CPU, deduplicates them, gathers the requested rows into pinned buffers, copies those rows back to the GPU and dequantizes them. This work runs between segments of the GPU execution graph. Native UVA performs row selection and dequantization directly on the GPU, avoiding the CPU round trip. A warm filesystem cache removes physical SSD reads, but leaves the coordination, row gathering and transfers. This is why a file already cached in RAM can still perform worse than a pinned DRAM table. The comparison measures the whole serving path; it does not separate the time spent on each of these operations. B200 DRAM dominates both measured SSD serving curves in total tokens per dollar and P90 interactivity. Near 125 tokens/s/user, DRAM delivers 121 million total tokens per dollar versus 52 million for SSD. For production serving, SSD offloading is likely not worth the tradeoff. On the B200 configurations we measured, SSD offloading loses on both measures: every observed SSD point has a DRAM alternative that delivers higher P90 interactivity and more total tokens per dollar. The only points where Cheaper storage does not automatically produce a cheaper inference service. Moving Engram to SSD leaves the same four expensive GPUs and the rest of the server in place. Reclaiming RAM only creates an economic benefit if it enables a cheaper server configuration or additional useful capacity. The current unoptimized path provides neither benefit, and the filesystem cache still consumes RAM when table pages are resident. Next we will look at the mechanisms and specific implementation of ngrams from DeepSeekv4.1 Flash, LongCat, Qwen3.8 Flash Next.