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Pioneer of China NewCo model sued in US over trade secret misuse, double-dealing
A legal feud unfolding in New York is putting a spotlight on the work of a business development veteran who is credited for pioneering one of biopharma’s hottest dealmaking mechanism: the China “NewCo” model. In a lawsuit originally filed in New York state court and recently moved to federal court, China’s Lepu Medical Technology has alleged that biopharma business development consultant Su Zhang, who was hired to help shop its GLP-1 weight-loss candidates to Western partners, engaged in corporate double-dealing and trade secret leaks. According to the complaint, while acting as Lepu’s primary dealmaking liaison for a group of obesity and metabolic disease drug candidates, Zhang was secretly double-dipping as the acting chief business officer for a direct competitor, BrightGene Pharmaceutical. “She never adequately disclosed the role, never sought Lepu’s consent, and never proposed any safeguard,” Lepu alleged in its complaint, which was filed in July after Zhang’s consulting firm, CoDevCo, sought certain transaction-based success fees from its angry customer through an arbitration process in Singapore. Lepu, the parent company of Lepu Biopharma, has asked Zhang to pay back its $500,000 retainer and disgorge all benefits she received during the alleged breaches of fiduciary duty, plus other damages and relief. The company has also requested the court grant injunctions to protect Lepu’s trade secrets. The ill-fated partnership officially kicked off in December 2024, when Lepu tapped CoDevCo as its “exclusive business development mechanism” to identify collaborators for the company’s drug candidates. According to Lepu’s complaint, Zhang personally negotiated and signed the agreement as managing director for CoDevCo, which used her home address. Before the Lepu deal, Zhang made a name following a short stint as the global head of business development for Hengrui Pharmaceuticals. It was during her tenure that Hengrui signed a landmark deal granting exclusive rights for a portfolio of GLP-1 assets to Hercules, which was at that time newly established by a group of private equity and venture capital firms. In addition to the regular upfront and milestone payments, Hengrui also gained an equity stake in Hercules, which later became Kailera Therapeutics. The Hengrui-Hercules deal opened a new paradigm, where a Chinese biopharma company spins off certain early-stage assets to investors for further development through the creation of a new company abroad. The “NewCo” model quickly came into vogue as it allows Western investors to access high-potential assets originating from China at an early stage while giving the Chinese licensors an opportunity to reap long-term benefits through equity stakes in the new firms. The NewCo model proved its value when Kailera staged a record-breaking $625 million IPO on Nasdaq this April, merely two years into the Hengrui deal. Related Kailera CEO 'knew we were in a good spot' before obesity biotech's record-breaking $625M IPO On her LinkedIn page, Zhang described her work at Hengrui as “[b]uilding team and capability from the ground up,” forming NewCo and major pharma partnerships worth billions of dollars. Lepu clearly wanted that kind of track record to help boost its own cardiometabolic portfolio, which includes a range of assets for obesity, Type 2 diabetes, fatty liver disease and muscle preservation during weight loss treatment. “Lepu’s pipeline is very valuable, but only if Lepu could secure the right international partner to expand into the overseas market during the available commercial window,” the company argued in its complaint. The Chinese biotech said it had little knowledge of U.S. laws, customs or business practices in the business development field, and therefore “needed to rely entirely” on the expertise of Zhang and her team as the firm’s first engagement of a U.S.-based BD consultant. “Zhang’s dominating influence on the business development strategy is further evidenced by the fact that she personally controlled the business-development communications on behalf of Lepu with potential partners,” Lepu said in its complaint. After entering the deal, Zhang introduced Lepu to her four associates. According to Lepu’s version of events, all of them were allegedly employed at different time points to perform similar jobs at other Chinese companies that Lepu described as its competitors, while having access to Lepu’s confidential information. As such, Lepu described Zhang’s team as “a roster of individuals whose primary professional loyalty, by virtue of their concurrent full-time employment, ran to Lepu’s competitors.” As well as the specific examples set out in the case, a look at Lepu’s deals over the period suggests Zhang may have been involved in at least one transaction. During their partnership, Lepu, through its subsidiary Shanghai Minwei Biotechnology, also out-licensed its GLP-1/GIP/FGF21 agonist MWN105 to a NewCo called Sidera Bio in the fall of 2025. The deal included an upfront and near-term payment of $35 million, up to $1.01 billion in milestones, and a 9.99% stake in the Danish startup. It seems likely that Zhang facilitated the Minwei deal given that Lepu is on record as having used CoDevCo as its “exclusive business development mechanism.” The big shock for Lepu came in the form of a news article on June 25, 2025. The article, reporting on phase 2 data for BrightGene’s GLP-1/GIP receptor agonist BGM0504, identified Zhang as acting chief business officer of the Lepu rival. Blindsided by her association with BrightGene, Lepu confronted Zhang in July 2025. “Lepu was given assurances that there was nothing to be concerned about and told that Zhang would explain the matter to Lepu,” Lepu alleged in its complaint. “Zhang never did.” Lepu claimed that Zhang had the motive and opportunity to steer potential prospective partners toward BrightGene or other competitors. Later, in February 2026, one of Zhang’s associates joined BrightGene as the vice president for global business development, according to the complaint. Around the same time, Lepu sent written demand letters asking Zhang to account for her BrightGene role, identify what confidential data were shared with the rival firm, and provide any conflict-of-interest or firewall policies during the engagement. According to Lepu, neither CoDevCo nor Zhang answered the questions in their responses. Related Novo vs. KBP: How a $1.3B deal turned into a fraud accusation and an international legal fight In a motion to dismiss filed with the U.S. District Court in the Eastern District of New York on Sept. 4, Zhang’s legal team argued that Lepu’s agreement was signed with CoDevCo, and that an employee of the contractor does not owe fiduciary duties to the client. In its complaint, Lepu said: “That CoDevCo was the contracting entity does not insulate Zhang from personal liability for duties she personally undertook and personally breached.” Taking the argument one step further, the defending party argued that the consulting agreement “does not create a fiduciary relationship even between CoDevCo and Lepu; instead, it identifies CoDevCo as an independent contractor retained to market Lepu’s business to potential western partners.” Although CoDevCo was Lepu’s exclusive business-development contractor, there were no terms stipulating that the consulting firm should serve only Lepu, Zhang’s lawyer noted. As to Lepu’s claims that Zhang misappropriated trade secrets, the defendant argued that Lepu authorized the use of the information so Zhang’s team could perform their service per the agreement. In a rebuttal filed on Sept. 11, Lepu’s lawyer set out why they believe the Chinese biotech satisfied New York law’s misappropriation definition by alleging that the defendant used a trade secret “in breach of a duty or through improper means.” As an alternative to dismissing the suit, the defendant suggested the action should be stayed pending outcomes from the arbitration of a separate case in Singapore. While NewCo pioneer Zhang is defending her business arrangements, momentum behind the NewCo trend has continued unabated into 2026. Through August, Chinese biotech assets have spurred 15 NewCo deals this year, according to local trade publication PharmaDJ.
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Health Care Partnership outlines workforce progress
More local nursing graduates are staying in the region, according to officials offering an update on the progress of the New Hanover Healthcare Career Partnership at a public forum last night. According to Jack Watson, dean of UNCW’s College of Health & Human Services, the number of UNCW nursing graduates choosing to remain in the area after graduation has climbed from 27% to the mid-40% range. The New Hanover Healthcare Career Partnership aims to address the region’s healthcare worker shortage, with a key focus on nursing through strategic partnerships between UNCW, Cape Fear Community College (CFCC), New Hanover County Schools and the Wilmington Chamber of Commerce Foundation. "Each of the partners had pathway programs,” said Watson, “but they were almost at times done in a silo." One of the New Hanover Community Endowment's largest commitments to date, the collaborative received a $22.3 million grant in 2023, to be disbursed over three years, beginning in 2024. At the public forum, leadership addressed the nursing bottleneck created by the pandemic, and Laurie Whalin, president of the Novant Health Coastal Region, acknowledged that Novant Health had relied heavily on travel nurses during that period, with travel nurses making up about 47% of staff and nursing turnover at 35% at the height of the pandemic. "I can say we are in a tremendously different place today,” Whalin said at the forum. The number of travel nurses employed by the Novant Health Coastal Region has dropped to around 100 today, which Whalin says accounts for less than 4% of the workforce. Roughly two years into the grant term, major stakeholders in the collaboration pointed to various accomplishments tied to the initiative. According to Stephen Hill, vice president of talent development with the Greater Wilmington Chamber of Commerce, 250 more nurses live in New Hanover County in 2026 than in 2023. Whalin added that between 2021 and 2025, the Novant Health Coastal Region has hired close to 1,200 registered nurses. Additionally, according to Whalin, over the past two years, hiring and retention of nursing graduates from UNCW increased by 103%, while hiring and retention of nursing graduates from CFCC increased by 70%. Mandy Mills, director of career & technical education at New Hanover County Schools, pointed to the launch of its first Health Sciences Academy program, established across the county's four traditional high schools (Hoggard High School, Laney High School, Ashley High School and New Hanover High School), which started with 38 students last year. Mills also pointed to growth in the district’s Nursing Fundamentals course, which grew from 10 seats in 2023 to 50 in 2025-2026 and is now offered at all four traditional high schools. Watson emphasized the growing nursing class sizes and offered an update on the school’s accelerated nursing degree, which launched last year. Eleven students graduated in the first class, and all passed their boards on the first try, Watson said. This year’s class has 24 students. When the endowment announced its $22.3 million grant for the collaborative in 2023, UNCW and CFCC were each slated to receive the bulk of the funds, at about $10 million each. UNCW’s plans for the grant money included expanding its simulation lab, Watson said. He added that construction is expected to begin on the simulation lab this year and will likely extend through next year. According to Mary Ellen Naylor, dean of Health & Human Services at CFCC, the college has experienced growth in its associate degree nursing retention, rising from 59% in 2023 to 76% for the May 2026 class. CFCC used part of its endowment funding to support wraparound services, including a housing stipend, tuition assistance, exam assistance, emergency assistance, drop-in daycare and clinical and educational supplies. "We have very strong … students, but once they get into the program, there are competing priorities,” Naylor said. “They are working multiple jobs. They have children. They're single parents." According to Naylor, in 2026, 94% of students who used support services are still enrolled or have graduated. Addressing a question from an audience member about an approaching “enrollment cliff,” driven largely by dropping birth rates, Watson and Naylor said demand remains strong at both schools. “Right now … we do have more applicants than we have spots in our nursing program, and it is still a competitive process to get into,” Watson said. “I do not foresee that changing.” "(We've) doubled enrollment in our nursing programs over the last few years, but just as Dean Watson said, we still have very robust applicant pools, so it is still very competitive to get in,” Naylor said. "We have the applicant pool to support that, but again, it's not as easy as just saying, 'Okay … we're going to take another 90 students.' It's making sure all the resources and infrastructure that we need to educate the students outside the classroom is there as well." In response to a question about applying the collaborative model to other healthcare positions besides nursing, Sophie Dagenais, CEO and president of the endowment, said she sees the potential for the model to expand to other healthcare jobs and even other industries, but that the endowment hopes to learn from this model first. “This is a grant that is in year two of three years, and first we wanted to learn what is this going to demonstrate, what will we learn and then how may we scale it possibly,” she said. According to endowment spokesperson Amber Rogerson, funds for the program are set to expire after June 2027. “It's too early to discuss what happens after that,” wrote Rogerson in an email, “though we know the partners are considering the future, and some of the work supported by the grants is now built into their regular operations.”
Health Care Partnership outlines workforce progress
More local nursing graduates are staying in the region, according to officials offering an update on the progress of the New Hanover Healthcare Career Partnership at a public forum last night. According to Jack Watson, dean of UNCW’s College of Health & Human Services, the number of UNCW nursing graduates choosing to remain in the area after graduation has climbed from 27% to the mid-40% range. The New Hanover Healthcare Career Partnership aims to address the region’s healthcare worker shortage, with a key focus on nursing through strategic partnerships between UNCW, Cape Fear Community College (CFCC), New Hanover County Schools and the Wilmington Chamber of Commerce Foundation. "Each of the partners had pathway programs,” said Watson, “but they were almost at times done in a silo." One of the New Hanover Community Endowment's largest commitments to date, the collaborative received a $22.3 million grant in 2023, to be disbursed over three years, beginning in 2024. At the public forum, leadership addressed the nursing bottleneck created by the pandemic, and Laurie Whalin, president of the Novant Health Coastal Region, acknowledged that Novant Health had relied heavily on travel nurses during that period, with travel nurses making up about 47% of staff and nursing turnover at 35% at the height of the pandemic. "I can say we are in a tremendously different place today,” Whalin said at the forum. The number of travel nurses employed by the Novant Health Coastal Region has dropped to around 100 today, which Whalin says accounts for less than 4% of the workforce. Roughly two years into the grant term, major stakeholders in the collaboration pointed to various accomplishments tied to the initiative. According to Stephen Hill, vice president of talent development with the Greater Wilmington Chamber of Commerce, 250 more nurses live in New Hanover County in 2026 than in 2023. Whalin added that between 2021 and 2025, the Novant Health Coastal Region has hired close to 1,200 registered nurses. Additionally, according to Whalin, over the past two years, hiring and retention of nursing graduates from UNCW increased by 103%, while hiring and retention of nursing graduates from CFCC increased by 70%. Mandy Mills, director of career & technical education at New Hanover County Schools, pointed to the launch of its first Health Sciences Academy program, established across the county's four traditional high schools (Hoggard High School, Laney High School, Ashley High School and New Hanover High School), which started with 38 students last year. Mills also pointed to growth in the district’s Nursing Fundamentals course, which grew from 10 seats in 2023 to 50 in 2025-2026 and is now offered at all four traditional high schools. Watson emphasized the growing nursing class sizes and offered an update on the school’s accelerated nursing degree, which launched last year. Eleven students graduated in the first class, and all passed their boards on the first try, Watson said. This year’s class has 24 students. When the endowment announced its $22.3 million grant for the collaborative in 2023, UNCW and CFCC were each slated to receive the bulk of the funds, at about $10 million each. UNCW’s plans for the grant money included expanding its simulation lab, Watson said. He added that construction is expected to begin on the simulation lab this year and will likely extend through next year. According to Mary Ellen Naylor, dean of Health & Human Services at CFCC, the college has experienced growth in its associate degree nursing retention, rising from 59% in 2023 to 76% for the May 2026 class. CFCC used part of its endowment funding to support wraparound services, including a housing stipend, tuition assistance, exam assistance, emergency assistance, drop-in daycare and clinical and educational supplies. "We have very strong … students, but once they get into the program, there are competing priorities,” Naylor said. “They are working multiple jobs. They have children. They're single parents." According to Naylor, in 2026, 94% of students who used support services are still enrolled or have graduated. Addressing a question from an audience member about an approaching “enrollment cliff,” driven largely by dropping birth rates, Watson and Naylor said demand remains strong at both schools. “Right now … we do have more applicants than we have spots in our nursing program, and it is still a competitive process to get into,” Watson said. “I do not foresee that changing.” "(We've) doubled enrollment in our nursing programs over the last few years, but just as Dean Watson said, we still have very robust applicant pools, so it is still very competitive to get in,” Naylor said. "We have the applicant pool to support that, but again, it's not as easy as just saying, 'Okay … we're going to take another 90 students.' It's making sure all the resources and infrastructure that we need to educate the students outside the classroom is there as well." In response to a question about applying the collaborative model to other healthcare positions besides nursing, Sophie Dagenais, CEO and president of the endowment, said she sees the potential for the model to expand to other healthcare jobs and even other industries, but that the endowment hopes to learn from this model first. “This is a grant that is in year two of three years, and first we wanted to learn what is this going to demonstrate, what will we learn and then how may we scale it possibly,” she said. According to endowment spokesperson Amber Rogerson, funds for the program are set to expire after June 2027. “It's too early to discuss what happens after that,” wrote Rogerson in an email, “though we know the partners are considering the future, and some of the work supported by the grants is now built into their regular operations.”
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Tippie College of Business to undergo $60 million construction project.
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I started drinking at 12. It took multiple DUIs, serious health issues, and homelessness for me to quit at 44.
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Is 50 the new 60?
Subscribe TL;DR: Younger generations are showing signs of worse health compared to earlier-born cohorts at the same age This backward “drift” is showing up both in mortality risk and chronic disease Worsening trends in obesity and diabetes are the most consistent signals Taking the long view, we’ve made astonishing gains in health and life expectancy in the last century. Global average life expectancy has more than doubled from 32 years in 1900 to 73 years in 2024. (But don’t forget, there were still old people when life expectancy was 32). As people lived longer, they also generally lived healthier along the way. It turns out that avoiding things that can kill you early, like malnutrition and lots of childhood infections, also keeps you healthier later in life. In a classic 2004 paper, Finch and Crimmins proposed that cohorts of children who benefited from fewer early life infections had less lifetime exposure to inflammation and cardiovascular disease later in life, accelerating mortality improvements at older ages. Poor nutrition in the womb has also been linked to a higher risk of later chronic disease. The upshot is that improvements in childhood health can pay dividends many decades later. The combination of better living conditions (nutrition, sanitation) and medical advances (antibiotics, vaccines, blood pressure meds, etc) meant that people’s healthy lifespan generally expanded, even as they lived longer. Aging researchers call this best-case scenario “compression of morbidity”—meaning we delay the onset of disease and disability even faster than the years of life we are adding. During my 20+ year research career, we could generally bank on the idea that younger generations would not only live longer but also keep getting healthier along the way. “60 is the new 50” as they say… Enter “Generational Health Drift” Sadly, this expectation of steady progress may be changing. You’ve probably heard that US life expectancy gains have slowed to a crawl in the past couple of decades. Mortality improvements are also slowing (though less dramatically) in many other high-income countries (you can read more about that in a review paper I wrote here). Mortality is a very blunt health measure, but it is often a good barometer for the broader population health trends happening underneath. And we are now seeing that younger generations may be in worse health at similar ages compared to earlier born cohorts. My collaborator Prof. George Ploubidis at University College London coined this worsening health in more recently born cohorts “generational health drift.” “Generational health drift” is bad news on multiple fronts. Most obviously, we don’t want our health progress to go backward. But the timing is also bad, since our populations are aging. In demographic terms, “population aging” means that the proportion of the population at older ages (i.e >65 years) is increasing. Fun demography fact: Current population aging is not due to the recent declines in the birth rates making the news, but declines in fertility decades ago, after the “baby boom.” As baby boomers reach older ages, the smaller cohorts behind them mean the percentage of older adults will increase. For example, the share of the population age 65 and older in the US increased from 12.4% in 2004 to 18.0% in 2024. This story of population aging was written long ago. Many worry that population aging will put pressure on health care and pension systems. But if people reach older ages in better health than in years past, those fiscal pressures would be less dire than projected. Healthy older people can also continue to contribute to society in many valuable ways, including paid work, caregiving, community service….even high political office 🤷. On the flip side, if younger generations reach retirement age in worse health and with more disabling conditions, this could magnify the societal challenge of population aging. Evidence for worsening generational health A recent paper that I LOVED in the Proceedings of the National Academy of Sciences by Dr. Leah Abrams and colleagues examined which birth cohorts (aka generations) were behind worsening US mortality. Behold the Lexis diagram (cue swooning demographers). Calendar time is on the x-axis, age on the y-axis. Birth cohorts can be followed over time as they age on the diagonal lines moving up and to the right. This figure plots the year-on-year % change in all-cause mortality at a given age. Green shading indicates mortality improvements over time, white is stagnation, and gray shading indicates worsening mortality. Following the diagonal line for those born in 1950, you can see a noticeable shift from green to gray that follows this cohort for most of their lives. This gray shading shows generally worsening mortality for the 1950 to 1959 birth cohorts compared to their predecessors across all ages. Concerningly for my GenX and elder millennial peeps, there was also a deterioration in mortality for birth cohorts born in the 1970s and 1980s, visible as dark gray areas at ages 30 to 45 during the 2010s. While some of these mortality changes reflect specific shocks such as the opioid epidemic, most deaths still occur from major causes of death such as cardiovascular disease and cancer. For cancer, the gray in the top left corner of the figure below reflects the legacies of smoking for older cohorts, followed by a period of green with improvements in cancer mortality as smoking rates declined. But the white/gray shading in the bottom right corner highlights a stagnation and reversal of the cancer trends, with cohorts born around 1970 to 1985 experiencing worsening cancer mortality. This deterioration was most noticeable for colon cancer mortality, possibly linked to obesity or dietary factors. Not just dying more, but less healthy along the way. A recent paper by Dr. Laura Gimeno of University College London (of which I am a co-author), found evidence that more recently born cohorts in Great Britain have stagnating or worsening health. A stylized picture of what“generational health drift” might look like: The review paper found: Rates of childhood overweight and obesity were highest among Gen Z. Rates of diabetes in the 40s almost doubled from 3.1% among the Baby Boomers to 5.9% in Generation X. Gen Z reported higher rates of poor mental health in adolescence compared to earlier-born groups. These UK results are consistent with studies showing worsening health across generations in the US as well. A 2021 US study found that more recently born cohorts had worse biological markers (like blood pressure and blood sugar) than earlier generations at the same age. A separate 2022 study of Americans aged 50 and over found that more recently born generations had a higher number of chronic diseases, with younger age of disease onset. A 2024 Lancet paper found that in the US, women born in 1945 had 33% obesity prevalence at age 50, rising to 48.2% for women born in 1970 turning 50. So what’s going on, and can we turn it around? We don’t have a definitive answer for what’s causing the deteriorating health of younger cohorts, but circumstantial evidence points to worsening trends in obesity and diabetes in both the US and UK. Remember that cohort trends reflect lagged effects of early environments, and younger generations have faced both earlier onset and more severe obesity across their lifetimes. Despite these very concerning trends, the future is not set in stone. We’ve reversed poor generational health trends before: drops in smoking are a major reason cancer and heart disease deaths fell so dramatically in recent decades. GLP-1 drugs may finally turn the tide against rising rates of obesity and diabetes, though it is still early days. But things could also get worse…for example from a return to higher levels of childhood infectious diseases that can have a lasting impact on health. See for example: [ ](https://jenndowd.substack.com/p/dont-you-forget-about-measles-the) [ Don’t You Forget About Me(asles): The Virus That Erases Immune Memory ](https://jenndowd.substack.com/p/dont-you-forget-about-measles-the) Jenn Dowd, PhD · March 24, 2025 [ Read full story ](https://jenndowd.substack.com/p/dont-you-forget-about-measles-the) Even as an optimist, emerging data on the “generational health drift” has my full attention. For most of my research career, we took it for granted that each generation would be healthier than the last. But if present trends continue, **50 could be the new 60….**and Gen Z celebrities will soon look older than Paul Rudd :). Stay well, Jenn Share the Health! If you found this post useful, please share it with a friend. Share
Op-ed: Why community voices shape the future of health care
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Jiang Feng: The Unravelling of German & European Politics
A state election in eastern Germany has become a revealing test of the changing political landscapes of Germany and Europe, writes Jiang Feng, Professor and Chairman of the Council of the Shanghai Academy of Global Governance and Area Studies (SAGGAS) at Shanghai International Studies University. His analysis follows the decisive victory of the Alternative for Germany (AfD) (which has been classified as right-wing extremist by German authorities)in the state of Saxony-Anhalt on 6 September, in which it finished far ahead of its mainstream rivals. Jiang previously served as Minister-Counsellor at the Chinese Embassy in Berlin. The following article was published on 8 September 2026 on huanqiu.com, the online platform of the Global Times. On 6 September, the results of the state election in Saxony-Anhalt, Germany, were announced. The Alternative for Germany (AfD), classified as far-right by German authorities, made history by becoming the largest party in the state parliament, winning 43.8 per cent of the vote — twice its share in the previous election. The Christian Democratic Union (CDU), which had governed the state continuously for 24 years, won just 17.2 per cent, its worst result ever in Saxony-Anhalt. On the night the results were announced, the atmosphere at the CDU gathering was unusually calm. There was neither shock nor argument, as if the defeat had long been expected. Several veteran party members who had spent years working in the state government said: “Defeat is not a bad thing. It is time to make changes.” This state election has not only upended Saxony-Anhalt’s political landscape, but also laid bare the deep tensions between Germany’s traditional party structure and model of governance, on the one hand, and an increasingly polarised society on the other. Its repercussions are already being felt at the federal level, making Saxony-Anhalt a useful case study of the broader trend towards political polarisation and realignment in Europe. Governing Difficulties after Electoral Victory The most immediate consequence of the election is a historic setback for the mainstream party order that took shape in post-war Germany. In Saxony-Anhalt, the AfD has leapt from a peripheral party to the largest political force in the state. Its electoral base has expanded beyond the traditional category of “marginal protest voters” to take on the characteristics of a cross-class coalition. The party has not only consolidated its support in rural areas, but also attracted many middle-class voters and even members of the social elite with stable jobs, their own homes, and substantial incomes. It has thus evolved from a “protest party” into one with the potential to govern. Despite its commanding lead in the vote, however, the AfD faces an institutional obstacle to governing the state: the mainstream parties’ long-standing “firewall” against it. Neither of the two potential routes to forming a government appears likely to break the current political deadlock. The first would be a coalition of establishment parties, led by the CDU and bringing together the Social Democratic Party (SPD), the Greens, the Left Party (Die Linke) and the Sahra Wagenknecht Alliance (BSW) in a cross-camp government. In terms of parliamentary arithmetic, such a coalition could prevent the AfD from forming a government and preserve the outward stability of the traditional political order. Yet these parties are fundamentally divided over key issues including immigration, the energy transition, economic management, and cultural and education policy. Coalition negotiations would therefore be extremely difficult, and even if a government could be formed, it would most likely prove short-lived. More importantly, an alliance of establishment parties aimed at keeping the largest party out of government would play directly into the AfD’s narrative that “political elites are suppressing public opinion”. It could deepen perceptions of political unfairness, further strengthening the AfD’s political capital, and creating a dynamic in which “the more it is suppressed, the more people vote for it”. Ulrich Siegmund, the AfD’s candidate for state premier, has said that if efforts to form a government fail because other parties refuse to cooperate, the AfD will push for a fresh election, which he believes could deliver the party an absolute majority of seats. This points to more intense political battles ahead. The second option would be a coalition between the AfD and the BSW. Together, the two parties would command a simple majority in parliament, making this, on paper, the quickest route to forming a government. The BSW is the only elected party that has not ruled out cooperation with the AfD, and the two parties share some common ground, including on policy towards Russia. There is therefore a degree of political basis for cooperation. Were such a coalition to materialise, Germany would see its first state government jointly formed by a party defined as far-right and one with a far-left background, creating what might be called a “bipolar anti-establishment alliance”. Such an outcome would fundamentally break with the ideological boundaries of post-war German party politics. It is worth noting that even if the AfD ultimately fails to enter the state government, its roughly 47 per cent share of parliamentary seats would give it a powerful blocking minority. Without its consent, major decisions requiring a two-thirds majority — including constitutional amendments, significant budgetary adjustments, and state-level institutional reforms — would be extremely difficult to pass. Therefore, whoever ultimately forms the government, the AfD will be an unavoidable force in Saxony-Anhalt politics, with a direct influence on the state’s legislative process. Systemic Failures in Germany’s Governance Model The Saxony-Anhalt election result reflects a systemic failure of Germany’s post-war mainstream-party model of governance to adapt to rapidly changing socioeconomic conditions. It stems from multiple, mutually reinforcing structural tensions and highlights the existing political system’s difficulty in adapting to “an increasingly polarised society First, collective anxiety has replaced individual material hardship as a central driver of political mobilisation. The rise of the AfD can no longer be explained simply by poverty or social marginalisation. Its increasingly cross-class electoral base suggests that what is driving voters towards the party is, above all, concern about the broader direction of society. This anxiety about the future of the political community goes beyond individual gains and losses. In political discourse, economic anxiety has become closely intertwined with immigration, while immigration and refugee issues are, in essence, questions of social fairness. This perception turns conflicts over the distribution of social resources into negative assessments of governing parties, providing a broad social basis for far-right political narratives. Second, regional disparities and East German identity have undermined the strategy of addressing eastern Germany’s structural challenges at the regional level. More than three decades after German reunification, eastern states such as Saxony-Anhalt have experienced periods of economic growth, but their underlying economic structures remain weak, and household incomes and wealth remain significantly below those in western Germany. At the same time, they continue to face population outflow, an ageing population, labour shortages, and other structural challenges. At a deeper level, historical experiences — including the collapse of the former East German economic system, mass unemployment during the transition, and the westward shift of decision-making power over major issues — have left some residents with a sense of being “second-class citizens” and of being excluded. For years, the German government treated the “syndrome” of reunification as a regional problem to be gradually addressed at the local level. That approach is becoming increasingly unsustainable, as regional development disparities emerge as a core structural factor shaping national politics. Third, the erosion of institutional trust is perhaps the most decisive factor. AfD supporters tend to distrust establishment institutions, including parliament, government, and the mainstream media. Their concerns about economic security, pensions, and social fairness are significantly greater than the social average. Increasingly, their support for the AfD reflects not an expectation that the existing system can be improved, but a search for an alternative to the current political order. Such a systemic deficit of trust will be extremely difficult for the traditional parties to repair in the short term. Fourth, a generational shift in political mobilisation has amplified political polarisation. Unlike traditional parties, which rely heavily on offline rallies and mainstream media coverage, the AfD has developed a social-media mobilisation strategy built around “raising an issue — identifying who is responsible — offering a simplified solution — building a shared identity”. It turns complex social tensions into concise political narratives, rapidly channelling public sentiment into political support. The contrast on the eve of the election was particularly telling. The establishment parties, together with trade unions and churches, organised an offline march attended by more than 10,000 people, but its reach was largely confined to those present and to traditional media coverage. The AfD held a much smaller indoor event, yet livestreaming on TikTok, YouTube, and other platforms, combined with the involvement of online influencers, gave it a reach and mobilising capacity far beyond that of the march. The contrast illustrates how the traditional parties’ methods of political mobilisation are increasingly struggling to keep pace with a political environment transformed by changes in media technology. A Microcosm of Structural Political Change in Europe The shockwaves from the Saxony-Anhalt election quickly travelled beyond the state to the federal level. Calls for political accountability followed immediately after the results were announced. The governing CDU and SPD are now under enormous pressure, while Chancellor Friedrich Merz and Vice Chancellor Lars Klingbeil face an unprecedented test. Political polarisation in Germany is no longer simply a regional phenomenon. The post-war model of multiparty government by establishment parties is breaking down and being reshaped. Viewed in a broader European context, the Saxony-Anhalt election is part of a continent-wide wave of party polarisation, mainstream-party decline, and rising right-wing forces. Far from an isolated phenomenon, it is a microcosm of the structural political changes unfolding across Europe. Weak economic growth, cultural tensions over immigration, and declining trust in institutions are fuelling the rise of right-wing forces in several countries, challenging the liberal internationalist order established in post-war Europe. As a core member state of the European Union, Germany’s ability to adapt its political system and the direction of its politics will have profound implications for both European integration and the evolution of the international order. Subscribe [ Pekingnology China’s Germany watchers take stock of Berlin’s uneasy turn On 7 December 2025, nearly 50 Chinese scholars and policy researchers gathered in Beijing for the 2025年德国形势年终研讨会 “2025 Year-End Seminar on the Situation in Germany… Read more 9 months ago · 31 likes · 1 comment · YIRUI LI and Yuxuan JIA ](https://www.pekingnology.com/p/chinas-germany-watchers-take-stock?utm_source=substack&utm_campaign=post_embed&utm_medium=web&embedding_publication_id=1151841) [ Jiang Feng on Germany's 2025 and beyond: no easy exit ](https://www.eastisread.com/p/jiang-feng-on-germanys-2025-and-beyond) Yirui LI and Yuxuan JIA · Jan 24 The following is an op-ed by Jiang Feng, published on 29 December 2025 at Shanghai Observer 上观新闻, the digital platform of Jiefang Daily, the official newspaper of the Shanghai Municipal Committee of the Communist Party of China (CPC). [ Read full story ](https://www.eastisread.com/p/jiang-feng-on-germanys-2025-and-beyond)
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Bar Harbor Parents Again Raise Concerns About How Some Science Education In Sixth Grade.
The Bar Harbor Story is generously sponsored by Restaurant Barn. BAR HARBOR—Parents again raised concerns this week about how Bar Harbor students receive science instruction after fifth grade, months after the same issue came before the Bar Harbor School Board. The concern centers on a past scheduling change at Conners Emerson School that gives fifth graders a full year of science rather than switching between science and social studies at midyear. Principal Dr. Heather Weir Webster told the board that the school has been monitoring test scores, teacher feedback, and the experience of students as it considers whether the current approach is working. If it is not, the approach may be changed, but that would not likely occur this school year. In fifth and sixth grade, the school used to have one semester of social studies and one of science in each year. That schedule shifted because switching at midyear often broke up the learning units. So, approximately two-three years ago, they decided to shift that a bit. Science became a dedicated focus in fifth grade. Social studies was the dedicated focus in sixth grade. The school staff members are hoping to dive deeply into the data and see if the students are having a more quality experience throughout their time in those grades when it comes to science and social studies. If not, things could shift again. This year, Dr. Webster said at the September meeting, potential changes to curricula have been a bit complicated by moving into the school’s new building in late October and early November. “There have been no changes this year because it’s hard enough to handle the move. That allows them to have consistency,” Dr. Webster said. Dr. Webster said that after the Covid pandemic which prevented students from attending school in person, many fifth graders were struggling. “We tried several different configurations,” she said, including a co-teaching model to help with that struggle, but to also see how to best schedule and support those students. “We found that a January switch” where classes switched from social studies to science was really difficult. Part of the decision making stemmed from science being more hands-on and accessible to fifth graders. Social studies was a bit more abstract content, which was why the school tried the current configuration. In a letter submitted as public comment, parent Beth Dumont wrote, “In May 2026, I wrote to express my concern that our middle school students are not receiving consistent instruction in science and social studies. I appreciate that the Board took this concern seriously and requested a presentation from Principal Webster. I am also grateful for the opportunity to meet with Principal Webster and Julie Keblinsky in July to learn more about the current curriculum and scheduling. “During that meeting, I learned that the current model is intended to integrate science and social studies into other subjects during the years or semesters when they are not offered as standalone courses. “While I appreciate the intent behind this model, I remain concerned about its premise. Science and social studies are core academic disciplines that provide students with essential knowledge, skills, and ways of thinking. Yet under the current schedule, students are not guaranteed consistent instructional time in these subjects. Instead, exposure to content in these disciplines may depend on whether opportunities for integration arise within other classes. “To be clear, I strongly support interdisciplinary learning. Integrating science and social studies across the curriculum can enrich students’ educational experiences and help them make meaningful connections across subject areas. My concern is not with integration itself, but with relying on integration as a substitute for dedicated instruction in core disciplines.” Dr. Webster said that they’ve been monitoring test scores, talking to teachers, seeing how the pilot program works. It’s in its third year now of this schedule. One science teacher, she said, told her he’d seen positive outcomes with full year science and that there was a stronger classroom community. Another science teacher had concerns over the readiness last year, but she isn’t feeling that way about this year’s current class. A third teacher for social studies said he loves the full year. A fourth teacher of social studies hasn’t said that anything has changed. For the three fathers who spoke at the school committee meeting, the fractured science curriculum caused concerns. One father said that when he spoke to others, “all were surprised and confused as to why there was no dedicated, continuous science education,” at the school. Though students are testing well in science and math, he worried that without continuity in education, learning is lost. “We shouldn’t have to choose between key learning disciplines,” he said. Matthew Bergin, another father, agreed, adding, “I’m just a little concerned.” In her letter, Dumont wrote, “As the parent of a recent sixth grader who completed an entire year without a dedicated science course, I saw very little evidence that this integration was occurring in a consistent, systematic, or readily identifiable way. This is not a criticism of our middle school teachers, who have been uniformly excellent. Rather, it is a structural criticism of the current schedule.” Dr. Webster gave an update about all aspects of the schedule and how it’s created and she also spoke to social and emotional learning (SEL) in middle school. It’s explicitly taught but also embedded. Science is embedded as well and explicitly taught at all but that one grade. The school schedule is built from lunch out, then electives like art and physical education are placed, before going into the instruction time, teacher planning time, multi-tier support systems (MTSS), and then social and emotional learning. Teachers have to have 250 minutes a week of planning time per their contracts. That’s the minimum and occurs when their students are at specials. “The schedule is really not the purview of the board,” School Board Chair Marie Yarborough reminded the other board members and the public and thanked Dr. Webster for the presentation. The parents were also thanked for coming. LINK TO LEARN MORE [ ](https://barharborstory.substack.com/p/despite-strong-rankings-some-bar) [ Despite Strong Rankings, Some Bar Harbor Parents Raise Concerns About School's Science Education ](https://barharborstory.substack.com/p/despite-strong-rankings-some-bar) Carrie Jones · Jun 4 [ Read full story ](https://barharborstory.substack.com/p/despite-strong-rankings-some-bar) HELP SUPPORT THE BAR HARBOR STORY When we started The Bar Harbor Story, we didn’t know if anyone would read it. But you showed up. You shared. You sent tips. Now—over 400,000 views every month later—it’s clear: people here care about their community and each other. We’ve kept everything free because news should never be out of reach, but every one of our stories takes time to write, and your support keeps The Bar Harbor Story going. If you value our work, please consider a paid subscription, a founding membership, or a sponsorship. It truly helps us cover one more meeting, tell one more story, shine one more light. Even $5 a month makes a difference. Click here to become a one-time supporter now. Thank you so much for being here. Founding member information can be found here. Have questions about sponsorships? Just send Shaun an email at sfarrar86@gmail.com, he’d love to hear from you. Subscribe Share Bar Harbor Story Share Leave a comment
The Big Holes in Wearable Heart Rate Variability And Readiness Scores
On September 9th, Apple announced it was revamping its Apple Watch Health Sensing System, rolling out a Readiness score (0 to 10), and increasing the frequency of heart rate variability (HRV) outputs 24-fold. This can be viewed as upping its competition with various other consumer wearable sensors. These “readiness scores” as a composite of multiple metrics, with heart rate variability (HRV) being front and center for most. The majority of Americans are now using wearable sensors, which equates to well over 100 million adults. HRV and Readiness scores are increasingly being marketed as a measurement of autonomic nervous system health, a digital marker for future disease, a clock for biological age, and a holistic metric to promote healthspan and even longevity. (Apple also introduced a new longevity tab and “Health Age”.) None of this has been proven. In this edition of Ground Truths I am going to review what we know about heart rate variability and readiness scores. Heart Rate Variability HRV is the variation in normal heart cycle timing. The variability of the heart rate, the barely perceptible millisecond changes in time between consecutive heart beats (see R-R intervals in the Figure below, left panel), is due to interplay between the sympathetic and parasympathetic (vagal nerve) inputs. Distinct from heart rate, individuals with the same heart rate can have very different HRVs. It is a rough reflection of the autonomic nervous system (ANS) activity, inadequate to say whether a person’s ANS function is abnormal. For more than three decades, heart rate variability (HRV) has been measured and several studies have found an association of low HRV and clinical outcomes, particularly a link with higher all-cause and cardiovascular mortality. There have also been less well established links of low HRV to risk of early cognitive impairment, dementia, mental illness, Type 2 diabetes and substance abuse. An important reminder is that HRV is a surrogate marker without any established cause-and-effect relationship. If you increase your HRV, that doesn’t mean it will improve health outcomes. In fact, there is no hard evidence for that. All that work linking to health outcomes was done with electrocardiogram (ECG) derived HRV. Now, in the era of consumer wearables, this is getting assessed differently, by optical pulse (yes, the lights you see) plethysmography (PPG) or what is called pulse rate variability (PRV). They are not the same, as shown below (right panel) and only concordant when the delay between the ECG and pulse is kept constant, which basically means at rest. I should mention there’s also what I will call MPV, a mattress mechanical movement sensor, a derived heart rate variability, that companies like Eight Sleep use, even further away from directly measuring HRV. HRV has not one uniform measurement but many different types of quantification, such as RMSSD, the magnitude of difference between successive R-R intervals of normal sinus beats (N-N) or SDNN, the standard deviation of NN intervals, both in milliseconds. SDNN is one of the so-called frequency domain HRVs (others are LF, HF, LF/HF). Different wearable sensors use different metics; Apple has relied on SDNN and nearly all of the others use RMSSD, which is generally considered the more accurate metric. There’s also the different length of time measured, such as for a matter of minutes, all day, or an overnight’s sleep. Short measurements are especially problematic since they don’t capture enough of respiratory modulation and other factors that influence HRV. Share Ground Truths How well does HRV correlate with PRV? There are very limited studies, especially independently done. One that is commonly cited was conducted by Air Force researchers in only 13 healthy adults assessing Oura ring 3 and 4, Whoop 4.0, and Garmin Fenix 6 and showed a correlation coefficient of 0.88 to 0.97 and a mean absolute percentage error from 6 to 10%. The correlation is not a perfect 1.0, but there’s at least a fairly high level of correlation. HRV is supposed to increase during the night due to takeover of the parasympathetic nervous system, and higher during deep sleep. A recent example of my 1 week, all day “HRV,” and one during sleep is shown below. As you can see, the N of 1 data are inconsistent for the same days from different sensors (Oura, AppleWatch, Fitbit Air, and Eight Sleep) by patterns, absolute numbers, and comparison with prior days and weeks. The largest study in over 8 million Fitbit users (the old version, not Google Fitbit Air, introduced in May 2026) gives you a sense of the effect of age, sex, and the 2 different main HRV (here PRV) metrics, with RMSSD on the left and SDRR (=SDNN) on the right below. That study, from data collected in 2018, is a major outlier, since all the more recent ones are tiny with respect to sample size. Many of the companies have not had independent evaluation of their HRV, such as Eight Sleep, but have published a low standard error on their website. There are some other published studies on the correlation between HRV and PRV, but they are all small and only in healthy adults. A scoping review emphasized the lack of study in underrepresented individuals, including the aged, people of color (which affects the PPG signal), and individuals who are underweight or obese. Add the typical adult age 60 plus with one or more chronic diseases. For example, one study in over 900 adults found poor correlation of HRV and PRV, non-uniformly underestimated across many chronic diseases (cardiovascular, endocrine, neurological, respiratory, and others), concluding PRV is “an invalid surrogate for HRV.” A recent systematic review of 43 studies comparing HRV and PRV found reasonable pooled absolute standardized error (HRV as gold standard) but only 10 of the studies provided quantitative synthesis in ideal conditions. Their main conclusion was similarly cautious: “PPG-derived HRV [PRV] should not be regarded as universally interchangeable with ECG-derived HRV across all devices, populations, and recording contexts.” Factors Affecting HRV and PRV That gets me to the long list of factors that affect HRV (and PRV) besides the device, the type of measurement (RMSSD, SDNN or others), the person’s signal, the sensor site, the duration of data capture, if weighting by sleep stage is used, how artifact is processed and corrected. And this list is not complete!: Oura puts out data from their community of users (who input data) on what affects their overnight HRV. The factors currently provided are: no alcohol (increase 8%), melatonin (increase 2%, float tank (increase 2%), wine (decrease 4%), and party (decrease 14%) in overnight HRV. Must be some big parties! Subscribe What is a PRV measurement good for? It has been falsely characterized as an index of “autonomic balance” and a specific indicator of stress. A 2018 review of the studies available for HRV and its relationship to stress, not using any of the current wearables, found that stress can lower HRV. But so can many other factors. The non-specificity of the signal, indexed to the table above, is striking. Evidence from a UK Biobank study of over 46,000 participants with actual HRV looked at genetically predicted HRV, a genetic risk score, that failed to show the expected HRV-mortality link, indicating that _HRV is likely not causa_l, but rather a reflection of person’s physiologic state. A review of consumer wearable HRV data from 5 longitudinal studies showed that nighttime PRV was not associated with perceived stress, and surprisingly higher HRV, in the largest cohort (N=717 participants), was correlated with higher stress. An Oura ring cohort of 525 first-year college students found a link between overnight PRV and perceived stress, but that was also seen with resting heart rate, sleep, and respiratory rate. Several very small studies have examined the relationship of HRV and athletic injuries or guiding training with mixed, and predominantly negative results. HRV biofeedback training with paced breathing had no significant effect on reducing stress or raising HRV, as demonstrated with sham controlled trials. When HRV for multiple days showed a decline in conjunction with body temperature, the Oura ring published data for prediction of Covid. The WHOOP company sponsored an observational study, published in 2026, of 30,000 users for 72 weeks, without a control group, that reported reduced alcohol intake (5.8 % points) by self-report. That doesn’t tell us much, and particularly about the merits of HRV for behavioral change. If you use the same device and conditions as longitudinal trends for multiple (at least 2-3) weeks that may be the one way to get something useful from the measurements. Data for overnight sleep with minimal motion and using RMSSD is the best proxy for real HRV. The reason to look at trends rather than any given night is that it more likely represents something, even though you won’t know with certainty what the “it” is. Keep in mind there are no data, no peer-reviewed evidence, to show that HRV fluctuation in-person has any correlation with health outcomes. Share Readiness Scores These are proprietary scores that integrate different metrics for each of the wearables: no algorithms have been disclosed. They are unvalidated against health outcomes. In a review of 14 composite health scores of readiness and recovery, HRV contributed 86% to the scores, followed by reading heart rate (79%), physical activity and sleep duration (both at 71%). That review noted the substantial variability in measurement protools and lack of standardization. Sleep staging is notoriously inconsistent and inaccurate by these sensors, which adds further to the HRV uncertainties for what the scores, which use sleep stage data, mean. Only resting heart rate has been shown consistently across devices to be extremely accurate. I’ve made a Table to summarize what we know about which metrics are included, the scores, any peer-reviewed studies that compared the readiness score with health outcomes, and the corresponding (if any, NA-not available) citation. You will note that some companies do not use the term “readiness," such as WHOOP for recovery, and Garmin, which has 2 different scores, one of which is Body Battery. Eight Sleep uses the term “Fitness Score.” They all include HRV; Apple includes a new metric they call “Recovery HRV” which among other components uses 7-days of sleep, but it is unclear what this means or how it is differentiated from other scores (there are clearly no data for outcomes). We have no knowledge of how the different components are weighted or whether any of these scores are better than resting heart rate, HRV alone, physical activity, or any other single metric. Since none of these are standardized, they are not interchangeable, so if you get a 90 for Oura that has no relationship to a 90 on a Google Fitbit Air. Notably, the company can update its algorithm for readiness score at any point without notification to device users. Without any useful evidence of actionability for these scores or established relationship with health outcomes, it is hard to make a case for their value. At the Apple recent announcement they showed their Readiness score (0-10) on the watch (Figure below) but there are no published data on this score, not even on their website. It’s available only on their new Watch Series 12 or Ultra 4 [of course, ;-)]. That exemplifies the problems with these scores, lack of data and evidence for being meaningful to promote health. Perhaps the best study (which isn’t saying much) is the WHOOP Recovery for golfer performance, because it did correlate with an objective outcome, even though there was no control group and the authors were all from the company. Among the 389 pro golfers, an absolute 10-per cent point increase in Recovery score was associated with about 0.5 fewer strokes per round. But that’s hardly a health outcome! WHOOP is also conducting a study in over 2,700 runners to see if their recovery score will be linked to less injuries and improved performance, but that is not yet published and has no control group or randomization. Putting This in Context For two decades I’ve been enthusiastic about the potential for digital health and particularly wearable biosensors. Over the years, we’ve seen some great progress for their ability to promote physical activity and accurately detect atrial fibrillation (the first FDA cleared deep learning AI for consumers). That work was the subject of rigorous research. But there are holes in the data and evidence for other metrics. One notable one is the “VO2 max” story that I wrote about earlier this year. At that time many subscribers asked me to cover heart rate variability, which I finally got to here. When I dived into the research and publication for HRV and readiness scores, I expected to find at least some that were of high quality and demonstrated their utility by linkage to health outcomes. To my surprise, I found none. The wearable sensor measurements for HRV (PRV) are, for the most part, accurate, but that validation work has only been done in small studies of healthy adults and does not take into account the long list of factors, from the device, software side, and the user side, that affect HRV measurements. Moreover, this metric chiefly relies on optical sensing and, as we have learned for heart rate PPG sensing, may be less accurate in people of color. Keep in mind that all of the health outcome association evidence comes from ECG-derived HRV; none are from wearable sensor data. I will repeat the key point: there's no peer-reviewed evidence to show that in-person HRV fluctuation—or efforts to raise your HRV— has any correlation with health outcomes. For those of you who look at your HRV on awakening, or even 2+ week trends of it being low, I hope this context helps to relieve any anxiety. Yes, low HRV (not PRV) has been shown to increase risk of some diseases as summarized above. But efforts to raise your HRV—a surrogate metric— has not been established for improving any health outcomes. HRV does not have any evidence of causality (the genetic evidence actually goes against this possibility). In this summary, I have not included data for other wearable sensors such as Polar, Samsung, Withings, Suunto, Amazfit, Coros, Ultrahuman, or additional mattress sensors. These are beyond my first-hand experience, and as far as I know from my in-depth review none have any peer-reviewed published data that differ from the 6 sensors I’ve reviewed here. From the points I’ve gone over above, we’re not ready for readiness scores. Besides being proprietary, they are predominantly based on metrics that have their own issues. It’s compounding the problem, like building a house without a solid foundation that has never undergone a rigorous inspection, and then selling it. Like I mentioned for PRV, you can look at trends over weeks rather than any single day, to get a handle, but even that may not be helpful. There’s simply no evidence that these scores meaningfully relate to health outcomes. I’d emphasize they might, but that requires doing prospective or randomized studies to prove it. None exist. There’s great promise for HRV/PRV utility_. For example**,**_ Prof Maiken Nedergaard, who discovered the brain glymphatics that are essential in eliminating metabolic waste products from the brain during sleep, has posited that HRV could be a non-invasive marker for neuromodulator oscillations, brain-body regulatory circuits, and brain clearance. That would be extremely useful, but like everything else on HRV and readiness scores it requires solid research and validation. The lay media isn’t helping much to get the story straight. Earlier this year The Economist published a piece entitled “The most useful indicator of your overall health” which ordained HRV as an “accumulated stress score.” That’s akin to the false assertion about VO2max: “V02 max is the singular most powerful marker for longevity.” As I’ve summarized here, that is not established. The fact is that so many things can lower HRV, including physical exercise (especially an intense workout), reduced sleep quality, stress, the list above, no less the device, signal, and software. Whatever fluctuations observed have not been correlated with any health outcome. Sadly, “datamaxxers” are widely using HRV and readiness scores that have never been validated to mean anything. We already know that for some people using the sensors for sleep metrics, it can induce “orthosomnia,” an obsession to get high sleep quality, with associated high levels of anxiety. In an experiment done by a company to promote sleep quality for its employees, “For those employees who did use the trackers, many reported feeling perfectly rested until their tracker told them they had had a terrible night. Others were told that they had slept like a baby when they had actually been lying awake worrying about the quality of their sleep. “ The same problem can result from preoccupation with HRV or readiness scores, with anxiety that would lead to further reduction in both. It you are using a wearable like >100 million American adults, it’s OK to look at these data, but contextualized with the major caveats reviewed here. If you are one to require evidence that HRV or readiness scores are linked to health outcomes, you may not even want to look. The companies make it hard to turn them off! Let me end with the companies that make and sell wearables. Apple’s doubling down on HRV (24-fold more reporting and heart rate very 5 seconds) and introduction of a Readiness score tells us that consumers have bought into these metrics and they are joining the club. However, all of this is occurring with a backdrop of tens millions of users, claims about the data that are not backed up by adequate evidence, marketing way out in front of whatever limited data exists, and not being transparent about their readiness score algorithms. The companies can well afford to do the research that is needed to connect these metrics with health outcomes show, once and for all, that increasing HRV or using readiness scores promotes our health. If they believed and invested in the products they are selling, we’d not be in this position of not knowing. That’s essentially where we are with HRV and readiness scores. Perhaps someday this will change and we’ll have good reason to embrace them. NB: I wrote this post. No AI. I have no conflicts of interest with any of its content. Loading... Ground Truths has 215,000 subscribers from every US state and 214 countries. 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