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The Necessity of Cultivating Free and Open Spaces for Political Dialogue in Classrooms
Whenever I walk through Raynor Library late at night or early in the morning, I admire all the students pouring over work silently, fighting back drowsy eyes to prepare themselves...
Vacheron Constantin Gives a Sleek Update to Its Entry-Level Everyday Watch
Vacheron Constantin adds to its entry-level Fiftysix collection with a pair of steel models featuring new two-tone gradient sector dials.
4 Ways to Make Your Walk More Challenging That Also Promote Healthy Aging
In TODAY.com’s Expert Tip of the Day, an orthopedic surgeon shares how to dial up the intensity of your walks to reap more benefits for the whole body.
Vacheron Constantin Upgrades its Fiftysix with new Two-Tone Dials and Steel Cases
The retro-inspired Vacheron Constantin Fiftysix returns with bolder two-tone sector dials, livelier case finishes and a new strap.
Introducing: Two New Vacheron Constantin Fiftysix Watches With Tuxedo Dials
✓ There are two new versions of the Vacheron Constantin Fiftysix ✓ Both have 40mm steel cases and grayscale tuxedo dials ✓ Check them out! ✓
Wisconsin concession speeches show shift away from election denial
Concession speeches from candidates up and down the ballot after the 2026 midterms took a more cordial tone, with fewer election denial claims.
Introducing: Ming 51.01 Halo Dress Watch in Crystallised Titanium
A golden crystallised titanium case and a black lacquered dial interpret Ming's contemporary new dress watch, the 51.01 Halo.
In Togo, religious leaders reaffirm shared commitment to bringing end to AIDS as a public health threat
A regional, multi-stakeholder dialogue in Lomé, Togo, which concluded 6 November, brought a declaration from representatives of faith-based organizations, religious leaders, people living with HIV and those affected by HIV, civil society, youth, development partners, and government agencies that reaffirmed a shared commitment to ending new HIV infections and bringing an end to AIDS as a public health threat.
Hailee Steinfeld’s Refreshing Mental Health Tips for Winter Are Worth Reading
With colder months on the horizon, the actor-singer offered up some great advice for taking care of one’s emotional well-being.
Microsoft Makes the Windows Sticky Keys Dialog Easier to Turn Off
A Windows 11 beta update adds a simple checkbox to permanently disable the Sticky Keys dialog box that appears after pressing Shift 5 times.
How Netanyahu’s Political Choices Helped Erode Bipartisan Support for Israel
Israel’s decadeslong reliance on bipartisan American support is […]
Captain Shreve’s Gabe Lockett dials in dominating runs against Byrd
Gabe Lockett rushed for 336 yards and five touchdowns to lead Captain Shreve football to a 48-21 win over rival Byrd.
Midterm results could shape 2028 presidential dialogue
Democratic upsets in this year’s midterms could reshape the electoral map, and the fight for the White House in 2028.
Lewis hosts political science professor to break down midterm results
At a Dean’s Dialogue event on Wednesday afternoon, Yale College Dean Pericles Lewis moderated a discussion with political science professor Gregory Huber on the outcomes of Tuesday’s midterm elections and where the nation could be headed now.
Lewis hosts political science professor to break down midterm results
At a Dean’s Dialogue event on Wednesday afternoon, Yale College Dean Pericles Lewis moderated a discussion with political science professor Gregory Huber on the outcomes of Tuesday’s midterm elections and where the nation could be headed now.
Warriors coach Steve Kerr laughs at GOP midterms after begging reporters for political questions
Steve Kerr stopped reporters after practice at Chase Center to riff on midterm results, months after vowing to dial back his political takes.
Workshop will explore “Placing HIV Back at the Heart of the Health and Development Agenda”
A workshop and multi-stakeholder dialogue “Placing HIV Back at the Heart of the Health and Development Agenda: The Role and Leadership of Religious Actors in Addressing Financial and Gender-Related Challenges,” is underway from 4-6 November in Lomé, Togo.
OpenAI: ChatGPT Search Is About 20% of Google’s, 250 Million People Speak With ChatGPT, and Chat Is Merging With Work
OpenAI says ChatGPT growth is accelerating. The company added 200 million users over just the past two months, jumping from 1 billion to 1.2 billion weekly active users in 60 days. Its search volume, it says, is approximately 20% of Google’s. Its users create 1.5 billion images with it per week. And its voice mode, between dictation and speaking with ChatGPT, now has 250 million combined weekly active users. ChatGPT consumer product lead Adam Fry told me this during a brief fireside chat at an OpenAI-hosted dinner in New York City on Monday night. “The growth is just going big,” he said. During our conversation, Fry also revealed plans to merge ChatGPT’s Chat and Work modes (so that confusing toggle up top will soon go away), agreed with feedback that ChatGPT-created restaurant signage looks too uniform, and addressed the cost to serve its personal assistant Dots. Here’s a look at our full conversation, lightly edited for clarity and length. We also cover image generation, interactive interfaces, advertising, education, and public unease about AI: Alex Kantrowitz: OpenAI has analyzed ChatGPT’s search volume and compared it with Google’s. What did you find? Adam Fry: ChatGPT has been growing quite quickly. ChatGPT’s volume of search-like queries is now roughly one-fifth the volume of queries of Google. It’s a pretty amazing statistic when you think about it, mainly because we started just about a year and a half ago. It’s hard to remember this, but ChatGPT at a time didn’t have any up-to-date information. You’d ask a question, it would say something like, “It’s past my training date,” and nobody had any idea what that meant. You’re saying ChatGPT’s search volume is one-fifth of Google’s. Bing’s share of the search market is around 5%. Does that make you multiple times larger than Bing? To say that more directly, ChatGPT has gone from one billion to 1.2 in just the last two months. That’s roughly 100 million users in 30 days, and another 100 million in another 30 days. The growth is just going big, and we’re staying very focused on how fast ChatGPT is growing. What counts as a search? I might have 20 prompts back and forth in a ChatGPT conversation. Does each one count as a query? Story continues below… A MESSAGE FROM OUR SPONSOR Move upmarket without a rebuild Moving upmarket means saying yes to what enterprise buyers ask for first: SSO, directory sync, and audit logs. WorkOS gives you all three, so your team keeps building the product instead of the checklist. Get enterprise-ready. Continued from above…. Adam Fry: What people came to ChatGPT for to start, if you go back about two years, is really writing help and coding help. Those wouldn’t be things that you really search for. What we’ve seen over the last year is people have grown into all these other topics. Things like you’re looking up a person or people or a place or a thing, and it requires up-to-date information. That’s a key element. Another big part is finance questions or health questions, where you really want to make sure it’s up-to-date information that’s quite factual, and we’ll do a web search for those questions. It’s basically anything that a user would have traditionally gone to a traditional search engine for, but is now deciding to go to ChatGPT for. Does each conversation with a search embedded count as one search, or does every question that requires a web search count? Every time you ask a question and go search the web, that’s a search. You used to work at Google. How would you say the nature of search is changing? One of the things that people really love about ChatGPT is this personalization and this understanding of the broader journey. If you look in the past, people would go for a Q&A box, and you’d ask a one-off question, like how tall is the Eiffel Tower. But there’s so much context in our lives around, “Maybe I’m taking a trip to Paris.” It’s actually helpful for ChatGPT to respond, “Here’s how tall the Eiffel Tower is, but I know you’re going on a trip to Paris.” It’s that ability for people to actually maintain context over time that has led them to start using ChatGPT in this way. You’ve also announced 250 million weekly active users of voice input, including dictation and conversations with voice mode. We are at 250 million weekly active users. What’s amazing about this is, if you look at those 250 million, what we’re seeing is it’s actually also incremental to the product. It’s no longer just a novelty. People aren’t just trying out voice. We’re seeing them use voice input day to day in their daily life, and it’s grown so quickly. Those 250 million users are using voice input, and that could just be a quick question or a long conversation. We’re seeing both behaviors. We’re seeing people just not want to type. You just hold it and start talking to it, or it turns into a longer conversation where people just sit with it. The big reason for this is the frontier capabilities of our models that we’ve shipped. We shipped what we call GPT Live 1, and then we shipped GPT Live 1.1. The big change with this is that it’s much more natural to speak with. It’s something we call backchanneling and interruptibility. Mhhhm… What you just did there is what the model does, because it’s really good at having a bidirectional conversation. That push to the frontier—we were the first to really release this at scale—has made it so much more natural for people to chat. That’s still only about 20% of the user base. From the outside, that looks small. Why is it exciting from the inside? It’s very exciting for a few reasons. We see from the data that when people start using voice, they stay around using voice. One of the things, transparently, we can do a better job of is bringing more people into discovering it. We see that the number of people who discover it could be a lot higher. But once they do, it’s a really new way for people to interact with AI. We’ve made a lot of improvements to it too, where we’re just going to see the number go up. You have background mode, so now by default, if you close the app, it’ll show, “Hey, the conversation’s still going.” If you want to walk around the house or you’re putting away the groceries, you can still have a chat. That kind of continuity has also changed how much people use it. Dots launched on September 29 and is about a month old. How’s it doing? It’s doing great. We talk to people about their Dot, and the first thing that everyone says is, “I love my Dot.” One of the reasons we’re seeing this is the proactivity, its ability to reach out to you and figure out things. The biggest use case I see all the time is, “Did I forget something today that I was supposed to do?” You can just say to your Dot, “Remind me of things at the end of the day that I may have forgotten. Somebody emailed me or messaged me,” and it’ll do that. This Dot changes the paradigm of the relationship with AI, where it’s actually helping you and giving you time back. You’re more conservative with permissions than some competitors. I tried to give my Dot my credit card, and it wouldn’t take it. With the creator of OpenClaw in-house, why are Dots’ permissions more limited? This is a space where we want to be very thoughtful and conservative because it’s a new space where you’re entrusting your Dot to take care of things on behalf of you that matter and are meaningful. We’ve just talked about how you go to this 1.2 billion user growth and asking questions. Now we’re asking people, “Can you ask ChatGPT or your Dot to help get things done?” But when you ask it to help get things done, it’s a whole new level of trust. We’ve built up a tremendous amount of trust in giving the right answers to your questions, and we want to make sure that when we build this new product, it has a high degree of trust. It’s a long game. We think this is going to be a new market for a very long time, and we want to make sure that we’re being this trusted player in the market to start. I initially thought Dots would be available on my $20 plan, then realized I had to spend $100 a month to get it. I upgraded, but I’d like to downgrade at some point…. We hope to keep earning your business and make the value good enough. It’s a really good point. ChatGPT’s goal more broadly, which I think is unique for us in the market, is we are focused on bringing intelligence to everyone safely across the entire world. For Dots in particular, there’s no difference. We don’t have anything to share tonight about the date of when Dots will go to a broader set of users. But you can rest assured we’re working very hard, and there are a couple things we have to get right. Over time we’re going to work on more efficient, agentic models that are able and capable of doing things for you. The first one is, right now we wanted to make sure that your Dot is actually really helpful. We started with some of our best models, but over time we’re going to work on more efficient, agentic models that are able and capable of doing things for you. The second thing is around proactivity. We’re still dialing in: How much do I message you to help you get things done? We can always play around with that to understand how much usage should a user use to have a successful Dot. We’re going to work on both, and our goal and ambition is to bring it out to all users. How much background computing does a Dot require? I’ve read estimates that serving a $100 subscriber might cost OpenAI $3,000 in compute, and mine seems to read every email that arrives. How often is it checking connected data sources? Right now, Dots are on the compute-heavier side, and this is one of the things we want to make sure that we can dial back over time. But the goal is to give you the best product. This is our premium, always-on personal assistant. Once we nail that, we’ll figure out how to dial back the compute needs. The thing we’re seeing also from our models, as we train frontier models, is just how—I can’t even keep up with how quickly we have a new model, and each new model is more efficient. If you looked at 6.1 Sol when it came out relative to Astra, much more efficient. I’m very excited about the next set of models we have coming too that’ll be even more efficient that we can use. Elon Musk said the cost of serving Grok Bot was unsustainably high relative to revenue. Is efficiency the key to winning against competitors, or is there more to it? There are a couple of factors that go into it. One is the cost side, but the other is the revenue side. On ChatGPT and on our consumer business, we’ve been extremely proud of our ability to diversify different revenue streams in a way that’s growing really fast. To give you another stat, we announced several months back that we had passed 50 million subscriptions, and the number has grown considerably since then. On ads, within 200 days, we reached more than a billion in ARR, and that business is growing extremely quickly. We also have credits. Rather than paying for subscriptions, users can buy more credits. Between credits, subscriptions, and ads, I’m confident that the value of a Dot is going to be able to pay for itself. Elon has subscriptions too. This is clearly an expensive product to serve. One thing we continue to bet on at OpenAI and ChatGPT more broadly is that the models will continue to get much better and much cheaper, way faster than any of us think. If you look back at the historicals on it, it continues to be true. From what I’ve seen, I see no slowing down of that. What is Meta doing right with Muse? It has spent a lot of time atop the App Store charts. There are a couple of things they’ve done well. The first is people have been craving simplicity in their products. One of the things we have stated publicly as well is, at times AI products can be too complex. We’ve announced we’re merging ChatGPT’s Chat and Work. We’re making it much more simple in the products. You don’t have as many toggles or sliders between efforts and different model pickers. One of the things they’ve done well is this simplicity. You just go in and you can ask a question. You don’t have to think too much about what you’re doing. That’s one thing that seems to have resonated with users, which we also believe in. Second, there’s something really nice about being able to access your agent across many different channels. We just announced and launched Dots on iMessage. Whether you talk to your Dot on email or iMessage or within the ChatGPT app, the ubiquity in getting your assistant out there is going to be key. Those are two things that, if I had to be nice to our competitors, I would say were two big ones. So Alexandr Wang’s meme-tweeting strategy isn’t something you’re going to emulate? I have a different tweeting style. ChatGPT still asks me to choose between Chat and Work, even though some people call this technology AGI. Will that distinction go away? Couldn’t agree more. We have to solve this. Asking users to choose — we’ve heard repeatedly from all of our users it’s too much to understand. When should you go to Chat? When should you go to Work? It’s solvable. There’s real research to solve to make sure the models can understand what your intent is. Are you asking for a fast, quick reply? Are you asking me to go do a long agentic task? We’re going to solve it, and the plan is to bring Chat and Work together. So one interface will work out whether I’m asking for a conversation or a task. When? Coming soon. You told me the majority of ChatGPT’s 1.2 billion users are using image functionality. What are they doing? Today, 1.5 billion images are created per week. It’s hard to even wrap my head around that number. They’re doing a wide range of things. One of the most interesting things they’ve started to do is really use it for productivity use cases. The first thing it started with—I don’t know if you saw the ’80s trend, but it was quite fun. You could take a photo of yourself and say, “Put me and my family in ’80s outfits.” I did this for my family, and it was a really fun poster. But what we’re also seeing is businesses for their menus, or posters for birthdays. People are using it almost in a productivity-like fashion to create visual diagrams of what they would like to see. We’ve actually brought the latency down on images as well, so it’s gotten a lot faster. It went from a very high number of seconds to getting much faster. As it comes down even further, the number of images people are creating and the number of use cases is going to grow a lot. My feature request: When a restaurant makes a menu or sign, prompt it for more specificity so it doesn’t look like every other AI-generated restaurant sign. Or offer a shuffle button for a different style. I agree with the feedback, and we’ll take it to the team. I’m seeing ChatGPT generate little interactive interfaces within its answers. What’s the direction for Intelligent UI, and how are people using it? I am extremely excited about Intelligent UI. If you go back a couple years, these chat apps were all text, and now that’s changing. They’re going to be visuals. Intelligent UI and our first attempt at this with GPT-6 Intelligent UI is really just the beginning. As you go to the extreme, what you can imagine is, let’s say you’re using voice mode, and you just say, “Show me how offside works.” Immediately it should show you a visual diagram, and you say, “No, I don’t quite understand it.” It should just repopulate. That’s where the future of this technology goes. It’s almost like you’re talking to a canvas that will update and change. People are finding it helpful for a lot of things. My favorite one is—it’s hard to admit that I had no idea how hearts work. The last biology course I took was in high school. I just asked it, “How does the heart work?” and it instantly gave me a beautiful interactive diagram of where blood flows and how it goes through. I’m really, really bullish on this for learning in particular. You’ve described useful applications in finance, health, and learning, and ChatGPT has 1.2 billion users. If people are getting so much value, why is public polling on AI so negative? The reality with AI is it is going to change the nature of how work gets done. For a lot of people, that is something that can feel scary at times, and we’ve all felt that. But I remain confident that when people actually use the product and they use AI, it very quickly changes how they perceive it. We’re at 1.2 billion, but there are still a lot of people who haven’t used it. The more people use it, get familiar with it, how it can actually help you in your life, it’s going to feel a lot less scary. Big Technology is a reader-supported publication. To receive new posts and support our work, please consider becoming a paid subscriber. Thanks!! Subscribe
Urbanite Theatre's 'Ahoy-Hoy' Dials Up Fun
Alexander Graham Bell invented the telephone, right? Maybe not, in Jenny Stafford's often hysterical comedy.
Best Practices for Accommodating Mental Health Conditions
Employers must assess mental-health accommodation requests under the ADA and applicable state and local laws. They should engage in a documented dialogue, consider effective options—such as schedule changes, leave, or remote work—and grant an accommodation unless it prevents essential job duties or creates undue hardship. Indefinite leave generally isn’t required.
SHRO One Health Research Group Strengthens Its International Scientific Network and Advances Environmental Sentinel Research at Ramazzini Days 2026
The Ramazzini Days 2026 provided an important opportunity for scientific exchange and interdisciplinary dialogue on environmental health, disease prevention, and the scientific challenges associated with the protection of human and environmental health.
Audemars Piguet Introduces Three Supersonnerie Watches And Two Stone-Dial Code 11.59 Models
✓ Audemars Piguet has just introduced three new Supersonnerie watches as well as two stone-dial Code 11.59 references ✓ Check them out! ✓
Sundial sculpture illuminates Arlington's 150 years of history, growth
The city commissioned a UTA associate professor to create the sculpture, which will be unveiled in December near Levitt Pavilion.
Like 'The Matrix,' but real: Google's Genie 4 brings science fiction to life
Google DeepMind unveils AI capable of generating photorealistic, interactive 3D worlds with sound, dialogue and realistic physics, as Israeli rival Decart draws attention amid reports of a potential $7 billion Amazon acquisition
How Can You Win an Election and Still Lose Power? Israel’s Coalition Politics Explained
Prime Minister Benjamin Netanyahu’s Likud party appears to […]
Building bridges through science diplomacy
In today’s complex global environment, science diplomacy is an increasingly important tool for fostering dialogue, building trust and strengthening international cooperation between the EU and countries worldwide. A symposium taking place on 28 October at the Synchrotron-Light for Experimental Science and Applications in the Middle East (SESAME) in Jordan will explore the role of research […]
High-level dialogue on One Health
On One Health Day, observed every year on 3 November, WHO/Europe will convene a high-level dialogue in Brussels with the Food and Agriculture Organization of the United Nations, United Nations Environment Programme and World Organisation for Animal Health, alongside European institutions, technical agencies and strategic partners.
The Art of the Sweet Science: Stunt Coordinator Clayton Barber Talks Bringing ‘The Greatest’ to Life
Actors Jaalen Best and Omari Hardwick spent countless hours being drilled on the finer points of boxing in front of the camera.
Sandra Birchmore's mental health counselor to resume testimony in the trial of Matthew Farwell
Diala Alkhalil, Birchmore's mental health counselor, is expected to continue testifying after first taking the stand Friday.
Reimagining the future: Global experts gather in Beijing to rethink science museums in the age of AI
In today's AI era, where knowledge is easily accessible, the significance of science museums lie in invoking emotions, creating memorable experiences, and providing a space for reflection and meaningful dialogue, experts suggest.
After Fighting in Gaza and Battling PTSD, Shahar Varon Seeks a Voice In Israel's Mental Health Future
Soldiers and others suffering from post-traumatic stress disorder […]
Introducing: The Return of the Full-Platinum Bracelet on a Limited A. Lange & Söhne Datograph Perpetual
The platinum bracelet, one of the most desirable accessories for A. Lange & Söhne watches, is officially back on the Datograph Perpetual.
Maqui Berry: Health Benefits, Nutrition, and Uses
Maqui berries contain anthocyanins and other polyphenols studied for their antioxidant activity and effects on inflammation, glucose regulation, and eye health. Human trials suggest possible benefits for postprandial blood glucose and dry-eye symptoms, but evidence for healthy aging and long-term safety remains limited.
Space science offers common ground for international cooperation
Scientists from more than 20 international and domestic scientific organizations and research institutions gathered in Beijing on Oct. 20 to discuss current challenges in space research at a symposium held as part of the 2026 International Science Council (ISC) Midterm Members' Meeting and Beijing Science Dialogue.
Breitling Adds Two New Manual-Wind Navitimers To The Core Collection
✓ Breitling has just introduced a pair of new manually-wound Navitimer models to its core collection ✓ Check it out! ✓
Hurricanes pose long-term health risks for vulnerable older adults
New research in the Journal of the American Geriatrics Society indicates that older adults who rely on electricity-dependent medical devices-such as ventilators, respirators, and dialysis machines-may face substantial health risks during and after hurricanes, especially in communities experiencing severe flooding.
Beijing Science Declaration sets priorities for global science
The Beijing Science Dialogue concluded on Wednesday with the adoption of the Beijing Science Declaration, outlining 18 commitments to strengthen international scientific cooperation and shape the future of science beyond 2030.
Abbott Laboratories Plans to Spin Off Similac and Pedialyte Business
Abbott Laboratories plans to separate its nutrition business into an independent company with about $8.5 billion in annual sales.
Georgia: Secretary General Alain Berset calls for safeguarding democracy and political pluralism ahead of opposition ban hearings
Council of Europe to closely follow developments and continue dialogue with Georgia
Georgia: Secretary General Alain Berset calls for safeguarding democracy and political pluralism ahead of opposition ban hearings
Council of Europe to closely follow developments and continue dialogue with Georgia
Silicon Valley GTM and Business Development Veteran Dylan Gittleman Joins Dialogica's Founding Sales Team
/PRNewswire/ -- Dialogica ("Dia"), the voice-first AI secretary for the world's top law firms, today announced that Silicon Valley go-to-market business...
GLP-1 drugs may protect kidney health in people with bipolar disorder
Mayo Clinic researchers found that GLP-1 receptor agonists, medications widely used for diabetes and weight management, were associated with a lower risk of dialysis or kidney transplantation in adults with bipolar disorder and chronic kidney disease.
Opinion | US-China AI talks must ensure safety of both tech and business
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I needed to see the new Windows 11 Photos app in action to fathom how fast it is — it's like switching from dial-up to broadband
Microsoft rebuilt key parts of Photos, and the result appears dramatically faster than the sluggish app Windows users know today.
Judicial Dialogues on Health and Climate Change: An Interview With Alicia Ely Yamin - Petrie-Flom Center
How can courts respond to the health impacts of climate change? On the occasion of a conference at Harvard Law School on 29 October 2026, sponsored by the Walter de Gruyter Foundation, we spoke with one of its conveners, Alicia Ely Yamin, about the right to health, climate change, and the role of judicial enforcement.
Can AI solve our mental health access problem?
Last week I asked you what worries you most about AI in health. It was close, but your top answer was “AI giving bad health advice.” Last week’s poll results: You’re in good company. This concern was top of mind at a conference I joined at Stanford last week, where researchers, clinicians, and people who build AI systems spent a day debating trust and safety in health AI. Stepping back, I’m also hearing your emerging concerns about AI’s impact on our well-being generally. I see this as a matter of public health, and we’ll take it in pieces as we learn together. Today we’ll focus on AI chatbots used for therapy for mental health. Early this month, Governor Newsom vetoed Senate Bill 903, California’s most ambitious attempt to regulate AI use for mental health. It’s at the center of active debate, and raises the questions patients, family members, citizens, and voters will face as AI moves deeper into health care. Let’s work through it. What is “AI-based therapy”? It’s really two things: purpose-built mental health apps designed to deliver structured support, and general chatbots like ChatGPT, Claude, and Gemini that people increasingly use for emotional support—even if they weren’t built for it. Spoiler alert: I don’t know whether the shift toward AI therapy is good or bad. The evidence isn’t there yet. But I do know it’s already happening, and I have some ideas about how we can roll it out with safety in mind. The therapy dilemma, in a nutshell Mental health challenges are common, and strain health and well-being across populations. Therapy (interactive dialogue with a trained, empathetic practitioner) helps many people heal. The demand for licensed therapists far exceeds the supply in California, and AI-based therapy can narrow that gap. AI-based therapy remains novel, unproven, and not well tested. Right off the bat, we can see we’re dealing with trade-offs here. Since the main driver of demand for therapy from a robot is lack of access to therapy from a human, we’ll start there. It’s too hard to find and afford a human therapist California is short roughly 55,000 licensed, non-prescribing therapists and counselors, about 40% of what we need. Psychiatrists, who rely on talk therapy as a complement to prescribed medications, are even more scarce. Eight counties have none, and density ranges from 1.7 per 100,000 residents in San Benito County, to 68.1 in Marin County. My wife is a psychiatrist in Marin, and even here access is tight. If it’s hard in the best-supplied county, imagine rural Sierra County, or the San Joaquin Valley. In 2024, more than half of Californians who tried to make a mental health appointment struggled to find a provider who took their insurance, compared with 14% for physical health care. When Senate staff posed as “secret shopper” patients and called 120 mental health providers in Medicare Advantage networks, they landed an appointment less than once for every five tries. Insurers pay behavioral health clinicians about 22% less than medical and surgical clinicians for comparable office visits. On top of that, billing denials and prior authorizations hit hardest at the solo and small practices common in mental health. Psychiatrists opt out of Medicare at the highest rate of any specialty. In many places, a cash practice for therapy fills quickly with patients paying $250 or more an hour, with no insurance paperwork at all. Families who can pay cash find providers more easily. Those who rely on insurance, including Medi-Cal enrollees, older adults, rural residents, and non-English speakers, compete for what’s left. So we can’t pretend the human system works, and we can’t blame people for turning to AI for support when they’re in distress. AI is filling the gap It’s estimated that roughly a quarter of AI users use it for mental health support. If you have internet, it’s available 24/7, it’s cheap, and it speaks your language. Uninsured adults are about twice as likely as insured adults to do it (30% vs. 14%). It feels anonymous in ways that may enable people to ask things they’re unsure or embarrassed about. The largely hidden, personal use makes it hard to study whether it’s actually helping people with their mental health issues, but researchers are trying. Does AI therapy work? A 2026 analysis of nearly 40 randomized trials found chatbots showed a real but small reduction in depression symptoms. But most of these trials were compared to an alternative of no therapy, not a human therapist. So the benefit of AI therapy is probably real, but modest, and mostly untested against the alternative of human contact. We need more studies. Serious concerns OpenAI’s own estimate is that more than a million ChatGPT users each week show signs of suicidal planning or intent. These are high stakes encounters, and AI doesn’t always get it right. That’s partly because a chatbot can sound like a therapist, but it has no license, no duty of care, and it’s not clear who to hold accountable when it gets things wrong. AI is also designed to help users in whatever task they’re seeking to accomplish. People may feel like they’re getting therapy, but they’re mainly getting a convincing conversation. It’s easy for an AI companion to wander into gray areas, like playing along with “creative writing” that may be about the user’s own suicidal intent. Courts are driving safety conversations A wave of lawsuits have been filed on behalf of families claiming that chatbots pushed people they loved toward self-harm, including teens who died by suicide. The first settlements came this year. OpenAI is headquartered in San Francisco, and dozens of cases alleging that ChatGPT drove users to suicide or self-harm are now before a San Francisco judge. Character.ai has filed for bankruptcy after several states brought lawsuits accusing the chatbot of pushing dangerous content to kids. But the technology seems to be improving. Last month, an independent evaluation found that newer AI models “almost never endorse suicide.” That’s progress, but our societal appetite for even one preventable death is very low. So how do we move forward? Finding a middle ground Earlier this month the governor vetoed Senate Bill 903, a bill designed to place guardrails on the use of AI for therapy. The bill would have prohibited any AI-based platform from being advertised as psychotherapy, and would have required a licensed professional to review and approve each encounter where AI was used to support therapeutic decisions. Newsom called it overly broad, since even routine screening questions would have needed clinician sign-off. Knowing we’re already short on mental health providers, requiring human review of AI encounters may not relieve our access problems. Still, the answer isn’t no oversight. Here’s one feasible short term solution. Rather than reviewing each encounter, a licensed clinician can design the guardrails: what counts as a crisis, what triggers an immediate handoff to a human, and what gets sampled for audit each month. The AI runs inside that structure. Conversations get checked, failures get reported, and a real clinician owns the framework. Medicine already has models to learn from. The FDA process for rolling out newly approved medications is an example. After a product reaches patients, we keep watching for adverse events. Patient-facing AI needs the same “digital pharmacovigilance”: systematic tracking of harms, near misses, and the types of groups that get hurt and why. It’s also critical that users know that they can reach a human if they’re in crisis. Most chatbots now include messages like these: Bottom line The rush to use unproven AI tools for mental health support is mostly a workaround, a sign of a health system people can’t get into. We need better access to proven care from licensed clinicians. That takes reimbursement that makes accepting insurance viable, and a bigger workforce. But, built and tested well, AI could be part of the answer. It could be the 2 a.m. check-in when no one else is awake, or a way for patients to practice skills their therapist taught them. It could be the first step to get someone the right level of care, and take paperwork off clinicians’ plates so they spend more time with patients. None of this is simple. The SB 903 veto doesn’t end the debate, and the legislature will be back. In the meantime, those of us using these tools need to stay informed, ask hard questions, and hold the companies building them accountable. I’ll try to do my part, and we’ll keep learning together. Love,Matt P.S. If you or someone you know is struggling with mental health challenges, emotional distress, substance use problems, or just needs to talk, call or text 988- you’ll reach a real person— or chat at 988lifeline.org 24/7. Dr. Matt Willis is the author of Your Local Epidemiologist in California. A California native, he’s served as a primary care physician, CDC epidemiologist, and public health officer for Marin County, where he guided the pandemic response. He lives in Marin with his family and their dogs, Teddy and Ramona. Thank you Cynthia He, MD, PhD, and Parnika Saxena, MD, for their guidance in preparing this article. Cynthia works in an outpatient mental health clinic, treating patients who have Medi-Cal or, sometimes, no insurance. Parnika works in an inpatient psychiatric unit, treating patients with public or private insurance or self-pay ability. All opinions are their own and do not represent their employers.
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How the Zelda Ocarina of Time remake changes the classic game’s script
At the start of the iconic 1998 Nintendo 64 game The Legend of Zelda: The Ocarina of Time, our playable hero Link wakes up in his tree cabin, heads outside and is greeted by his friend Saria. “Yahoo! Hi, Stotil!" she says. In other people’s copies of the games, she might say “Hi, Link!” or “Hi, Brick!” or use whatever other name the player was allowed to input when first launching the game. The more important point is that she starts with a “Yahoo!” In Nintendo’s 2011 remake of Ocarina of Time for the 3DS handheld, Saria greets Link with that same word. But for the 2026 Switch 2 re-remake of Ocarina of Time, out November 5, Saria’s salutation has changed: “Hello, Link!” she exclaims. There’s no “Yahoo” to be heard. Last month, in an official Nintendo video preview, Zelda series producer Eiji Aonuma described the remake as a “faithful interpretation using modern technologies.” Faithful means the gameplay hasn’t changed much. Dungeons, quests, and just generally what you do in the game doesn’t seem to have changed, not based on what Nintendo has shown nor the hour of the game I played in New York City a couple of weeks ago. The graphics have been overhauled. The controls have been tweaked. Players can now manually control the camera and make Link jump with the press of a button, both notable differences from the original 1998 design. But Link’s journey appears to take the same path, with the same obstacles in its way. The remake’s biggest alteration to Ocarina of Time that I’ve spotted so far just might be the script. About the game’s story, Aonuma said in September, “We’ve added quite a lot of new dialogue for the characters, so that their personalities shine even more.” Earlier this month, I played a chunk of the Ocarina of Time remake at a Nintendo showcase. In the game’s earliest moments, I made a point of talking to characters and recording what they said. I found the script to be more colorful, more natural in its phrasing, more careful to establish its characters, and certainly more wordy even with the removal of that one “Yahoo!”. I’ve got some very early-game examples, so you can judge the new writing for yourself.
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Content Partners and Radial Entertainment Oct. 14 announced 20 new episodes of the landmark true crime series “Forensic Files.” Building on their existing distribution relationship, the companies will jointly finance the new season and share oversight of production, with Radial handling worldwide distribution. ITV America, part of ITV Studios, will produce the episodes. ITV America … Continue reading "Radial Entertainment, Content Partners Announce 20 New Episodes of Legacy True Crime Series ‘Forensic Files’"
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Concern after Europeans endorse US science agenda
Germany’s biggest research funder has said it is “concerned” after Berlin, plus several other European countries, endorsed a controversial US-led science policy statement. On October 4, the White House announced that 16 countries, including Germany, the UK, Italy, Greece, Bulgaria, Cyprus, Poland, Japan and South Korea had backed the Kyoto Vision for a Golden Age of Science.The document, agreed on the margins of the annual Science and Technology in Society forum in Kyoto, which gathers science ministers from across the world, appears uncontroversial at first sight. It’s a one-page statement, without any concrete measures, that touches on reducing administrative burden on scientists, experimenting with new funding models and the use of “super intelligence” in science, the Trump administration’s preferred term for artificial intelligence. However, what’s controversial is that much of the language in the Kyoto Vision reflects Science: A New Golden Age, a major policy document released by the White House in July.That document attracted criticism for deriding universities as “legacy institutions” and suggesting money be diverted to new research labs. In a speech in Kyoto on October 4, Michael Kratsios, director of the White House Office for Science and Technology Policy and the report’s author, said that the US was seeking to “diversify the ways that we support research to meet our best scientists where and when they do their best work.” The worry is that the Trump administration may be using genuine dysfunctions in academia as a pretext to defund and disempower universities, which US vice president JD Vance has labelled “the enemy.” Many in Europe also want more experimentation and reform of how science is organised and funded, and agree with criticisms of academia made by Science: A New Golden Age. But some also fear that if the US pushes for reform partially in bad faith, it could politicise and undermine the whole agenda. Washington is currently trying to change federal funding rules so that political appointees can block and cancel scientific grants. It has cut grants mid-project on topics related to diversity and other politically forbidden areas. And last year, it threatened to cut Harvard University’s federal funding unless it admitted a “critical mass” of new faculty and students to create campus “viewpoint diversity.” “Particularly concerned”Because of this wider US political context, the Kyoto Vision’s otherwise innocuous sounding statement that “we encourage experimentation with new institutional models for science that provide varying levels of autonomy, resources and direction” has caused consternation in Europe, particularly from some of Germany’s biggest science organisations. A spokesperson for the German Research Foundation (DFG), the country’s biggest funder, said that it would “closely monitor whether the current US administration uses the Kyoto Vision to restructure research funding to the detriment of research institutions such as universities and their autonomy.” The DFG was “particularly concerned” with the statement’s references to Science: A New Golden Age, they continued. A spokesperson for the German Rectors’ Conference, which represents the country’s universities, said that the reference to “new institutional models” raises “questions on the underlying understanding of academic freedom and autonomy.” Research funding must “guided first and foremost by scientific not political principles,” they went on. Dampen criticismEuropean endorsement of the Kyoto Vision might dampen domestic criticism of the Trump administration’s science policy, some in the US fear, by suggesting international support. “What we saw from Germany, Japan, the UK and other countries, is an impulse that the administration has exploited with our own science reform movement, a belief they can use dialogue to make things better,” said Cole Donovan, director of science policy at the campaigning group Stand Up for Science. “In practice, the administration has done the opposite.” Not a binding statementThere’s been so much concern in Germany that the country’s federal Ministry of Research, Technology and Space put out a statement defending its endorsement of the Kyoto Vision, which it has posted on its website. Related articlesIs metascience being co-opted?European researchers sound the alarm that Trump rule changes will hit cooperationThe US ‘golden age’ science strategy: what Europeans need to know The ministry said that it “should be regarded as a basis for discussion and does not constitute a binding statement.” Backing the statement gives Germany the chance to raise “issues and concerns” with the US during upcoming talks on science and technology scheduled for November. “Although these intentions appear, in principle, to be worthy of support, they will be scrutinised and examined more closely as the process continues,” the statement continues. Super intelligence?A ministry spokesperson confirmed to Science|Business that Germany had broadly endorsed the Kyoto Vision.However, they said Berlin had not agreed to final changes in the statement to refer to AI as super intelligence. In September, facing protests against data centres and polling that suggests US citizens are far more concerned than excited by the technology, Trump issued an executive order that attempts to rebrand AI as super intelligence, following polling on social media.The name change is to “reflect the transformative capabilities of these technologies and the limitless opportunities they create for the American people,” the order says. EU askedThe UK and Italian science ministries did not respond to a request for comment on their endorsement of the Kyoto Vision. Although most EU countries did not endorse the statement, it’s not clear which states the US asked. The White House Office for Science and Technology Policy did not return a request for comment. A European Commission official, speaking under condition of anonymity, said that the US had approached the EU, but too late for the EU to quiz all its member states on whether Brussels should endorse the statement.
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Studying Science in an Anti-Scientific Time
This Chronicle Review Deep Cut was first published in 2025. By Julianne Werlin Thanks for reading The Chronicle Review! Subscribe for free to receive new posts and support my work. Subscribe The last two decades have not been kind to science studies. Already bruised and battered by the “science wars” of the 1990s, by the 2000s sociologists of science — who had long argued that science had to be understood in its human context — were encountering the funhouse-mirror version of their own views in right-wing critiques of climate scientists. It was enough to give some prominent scholars pause. “Was I wrong to participate in the invention of this field known as science studies?” asked Bruno Latour, the most famous sociologist of science in the world, in 2003. “Should we apologize for having been wrong all along? Or should we rather bring the sword of criticism to criticism itself and do a bit of soul-searching here: What were we really after when we were so intent on showing the social construction of scientific facts?” In response, Latour proposed a change of method and attitude. Science studies, now chastened and contrite, would no longer seek to strip facts of their authority, but to enrich and enhance them. What this meant in practice was never fully clear. But his diagnosis of problems resonated, even if his solutions did not. Latour’s exercise in public hand-wringing signaled a shift in mood. By 2016, with the first election of Donald Trump, the idea that skepticism of science was a right-wing position, not a left-wing one, had become a commonplace, discussed eagerly in The New York Times. For liberals, vaccine denial during the Covid era and Trump’s second-term attacks on the funding of scientific research, covered extensively in these pages, added a new urgency to the defense of science on both practical and principled grounds. There was little appetite for a sociology or philosophy of science that emphasized the messiness and missteps of the scientific process rather than its integrity and triumphs. The distinguished historian of science Peter Dear’s new book, The World as We Know It: From Natural Philosophy to Modern Science (Princeton University Press, 2025), which seeks to tell the story of 18th- and 19th-century science for a general public, may seem comfortably remote from these bitter contests. In its 16 short chapters, Dear draws swift, sure sketches of major discoveries from Newton to Einstein, ably guiding the reader through debates on stellar nebulae, animal taxonomy, atomic chemistry, evolution, and other flashpoints in the history of science. But though a work of history, Dear’s book must still negotiate our polarized present. In a blurb on its back cover, the historian of biology Lynn K. Nyhart alludes to the “present moment, when scientific knowledge is being swamped by misinformation and its institutions are under siege.” Dear himself, in his conclusion, refers to the “yard signs” and “bumper stickers” that proclaim “Science Is Real.” One antidote to both anti-science propaganda and to reductive slogans in science’s defense is a robust history and philosophy of science: exactly what Dear’s scholarship has long offered. But his new book illustrates how difficult such work has become. Dear, an emeritus professor of history at Cornell University, is best known as a creative and philosophically minded historian of the Scientific Revolution. His edited volume The Literary Structure of Scientific Argument (1991) analyzed the rhetoric of Galileo’s thought experiments to brilliant effect. Discipline and Experience: The Mathematical Way in the Scientific Revolution (1995) was a major contribution to the analysis of scientific experiments in early modern Europe and beyond, while Revolutionizing the Sciences: European Knowledge in Transition, 1500-1700 (2001), now in its third edition, remains one of the best overviews of the profound epistemological upheavals of 16th- and 17th-century science. But Dear has also ventured into later periods. Nearly two decades ago, in The Intelligibility of Nature: How Science Makes Sense of the World (2006), he turned to the 18th and 19th centuries to sketch a history and theory of scientific knowledge. Aimed at a generalist audience, Dear’s simple prose belied serious philosophical ambitions. Science, Dear argued, has two aspects: “natural philosophy,” the quest to understand the true nature of the universe, and “instrumentality,” the applied skills and technologies that allow us to manipulate the world for human advantage. Both strands are ancient, but the innovation of the phenomenon we call “science” was to yoke them together. As Francis Bacon wrote, “Human knowledge and human power meet in one; for where the cause is not known, the effect cannot be produced,” an insight typically abridged to “knowledge is power.” Or, in Bertrand Russell’s characteristically blunt phrase, science has two functions, “1. to enable us to know things, and 2., to enable us to do things.” So far, so conventional. But Dear took issue with this familiar story in one respect. Bacon’s formula implied that theory and practice could be fused in a single method. In fact, Dear argued, the quest to understand nature and the desire to manipulate it were coupled only loosely. They could come together, but they could also pull apart. Focusing on natural philosophy, the “knowing” half of the scientific circle, he used a series of case studies from cosmology, taxonomy, chemistry, electromagnetism, and quantum theory to show how theories changed over time, in dialogue with practice, but never reducible to it. Take the case of matter, the basic substrate of the physical world. In the 18th and 19th centuries, scientists not only disagreed about what it was, but also about how well it could be known. In 1789, the chemist Antoine Lavoisier dismissed speculation about the atomic composition of chemicals as “discussions entirely of a metaphysical nature,” as he sought to orient chemistry away from philosophical abstraction and toward laboratory results. But in the 19th century, atoms returned with a vengeance in the atomic chemistry of John Dalton, who wanted to explain the underlying structure of nature. It was not just that Dalton and Lavoisier had a different set of experimental results, or even a different theory, Dear showed. What counted as an explanation had changed. In arguing that scientific theories depended on their intelligibility to human beings with complex arrays of beliefs and commitments, Dear was in sympathy with science studies. Key figures such as the sociologist Steven Shapin emphasized the importance of psychological mechanisms like trust in the formation and acceptance of scientific ideas. But in focusing on the scientific pursuit of knowledge, not its politics or economics, Dear resisted the more cynical perspective of some of his colleagues. The Intelligibility of Nature strikes a very different note than Shapin’s collection of a few years later, Never Pure: Historical Studies of Science as If It Was Produced by People With Bodies, Situated in Time, Space, Culture, and Society, and Struggling for Credibility and Authority (2010), to name just one example. Walking a very fine line, Dear depicted science as driven at once by complex social dynamics and by the intellectual power of real discoveries. It was a testament not only to his own acumen but also to the vitality of the field that he was able to do so. Nearly two decades later, The World as We Know It returns to the questions broached in The Intelligibility of Nature. Like Dear’s earlier study, it begins with the Newtonian cosmos and ends with debates between Einstein and Bohr on quantum physics. Beyond its terminal figures, many of the same characters appear in both studies, including the naturalists John Ray and the Comte de Buffon; the chemists Étienne François Geoffroy, Antoine Lavoisier, and John Dalton; as well as Charles Darwin and Michael Faraday, among others. Its subject is nearly identical: As in The Intelligibility of Nature, The World as We Know It considers natural philosophy as opposed to instrumentality, here defined as the “desire to create a picture of what the world is really like — the world as God knows it — rather than simply having instrumental or operational control over it.” The two books also overlap in insights — and sometimes even in language. The reader who has learned in The Intelligibility of Nature that Buffon’s method of classifying animals “reflected his belief in the importance of the senses and empiricism in learning about nature (a doctrine associated with Newton and the philosopher John Locke)” will experience a sense of déjà vu on reading, in The World as We Know It, that the classification “reflects Buffon’s commitment to the epistemological stance of Newton and his philosophical underlaborer John Locke, who stressed the role of the senses in creating natural knowledge.” Later in the passage, we read that, “because of its stress on understanding the ways of life of animals in their environments, Buffon’s approach could almost be labeled (anachronistically) as ‘ecological.’” And again, “an anachronistic way of putting it would be to say that Buffon recommends an ecological mode of understanding.” Likewise, in The Intelligibility of Nature we read of Dalton that he was initially drawn to meteorology, and that: He did a bit of experimental work on these things, especially having to do with the water-holding capacity of gases, but his real interest lay in understanding what, at an underlying natural-philosophical level, was really going on physically.” Whereas, in The World as We Know It: He did experimental work on these things, especially concerning the water-holding capacity of gases — although not at a very refined level quantitatively — but he was continually trying to develop a theoretical conception of what was happening physically. The final full chapter of each book closes on the same resigned note. Intelligibility: These days, most serious work on the natural philosophical underpinnings and implications of quantum mechanics is performed not by physicists but by philosophers of science. Among scientific practitioners themselves, Bohr’s attempt to use instrumentality as sufficient grounds for a respectable science has met with a high degree of success. And again, in The World as We Know It: Bohr’s and Einstein’s concerns are now questions that are mostly discussed by philosophers of science rather than by physicists themselves. The marginalization of these sorts of questions amounts to the demise of natural philosophy, at least in physics, in the 20th century. Quantum mechanics “works,” and that’s good enough for most scientists who encounter it. Examples could be multiplied. When handling the same subject matter, some echoes are inevitable. Scholars should not feel that because they have written “Isaac Newton died in 1727” in one book, in the next they must describe him as perishing, expiring, or meeting his maker. But the repetitions of language and arguments (not to mention six reproduced images) threaded throughout The World as We Know It are more extensive than that. They should have been caught by Princeton University Press or its reviewers, and revised. Because the two books have so much in common, it is easy to see where they diverge. The World as We Know It is a less theoretical work than its predecessor. The sociology of knowledge that organized The Intelligibility of Nature has been reduced in scale and folded into readings and examples. The taut interplay between history and theory, which gave the earlier study so much interest, is there, but it is subtle. In the earlier book, the case studies demonstrated theoretical claims about the character and development of science. In the later work, each narrative of discovery is an end in itself. Insights emerge from the history, but they do not control the organization of the study. With the theory muted, it can be hard to understand the logic uniting Dear’s sprawling history of more than two centuries of scientific knowledge. The 16 brisk chapters cover an enormous amount of material. But the closer the volume edges to comprehensiveness, the more obvious the missing elements become. A chapter on “Institutions and Pedagogy,” describing the birth of the research university, illustrates the problem. Inserted roughly halfway through the book, the unnumbered chapter is designed as an “entr’acte,” in acknowledgement that it does not fit the study’s organization around scientific discoveries. Yet as Dear is well aware, no general history of the development of modern science can bracket its 19th-century institutionalization and professionalization. It was the 19th-century university, after all, that gave us the “scientist,” a term coined by the Cambridge philosopher William Whewell. Dear’s history of scientific discoveries implies a wider social and institutional history, but it remains largely subterranean, only occasionally extruded under the pressure of the narrative. It must be said that the balance is not all on the side of the earlier study. There are some advantages to the more historical, less theoretical organization of The World as We Know It. Dear’s accounts of paradigm shifts are remarkably lucid, no small accomplishment given that they span fields and centuries. He makes excellent use of the wealth of new scholarship on Darwin and his influences, to which he has himself contributed. It is satisfying to see puzzle pieces from Buffon’s natural history, Georges Cuvier’s animal taxonomy, Thomas Robert Malthus’s demography, and Charles Lyell’s geology recombined seamlessly in the Darwinian jigsaw. Likewise, Dear’s discussion of stellar nebulae, divided between chapters two and 15, shows vividly how Newton, Kant, Herschel, and Hubble reimagined insights and observations as they sought to discover whether the diffuse light that filtered through early telescopes was a glowing, gaseous substance or discrete but distant stars. Yet despite such pleasures, the book remains a more modest work than The Intelligibility of Nature. Dear has clearly not changed his views about the history of science. But in the two decades that have elapsed, the discipline and the world around it have changed, making it harder to write a sociologically and philosophically ambitious history of science for the general reader. That is a shame, because in the age of Silicon Valley and biotechnology, both the reciprocity and the tensions Dear identified between the epistemological and instrumental ambitions of science are more evident than ever. In recent years, some of the most exciting new books on the history of science in early modernity have focused precisely on this pressure point. Important studies such as Pamela H. Smith’s From Lived Experience to the Written Word (2022), James Poskett’s Horizons: The Global Origins of Modern Science (2022), and Vera Keller’s The Interlopers: Early Stuart Projects and the Undisciplining of Knowledge (2023) all shed new light on how early modern science negotiated the relationship between its instrumental and epistemological ambitions, or in Russell’s phrase, knowing and doing. There is every opportunity for a philosophically informed approach to draw new insights from this wealth of material. Dear, unfortunately, has not done so in The World as We Know It. But for future scholars of the history of science, his body of work over nearly four decades may provide just the model. Julianne Werlin is an associate professor of English at Duke University. Thanks for reading The Chronicle Review! Subscribe for free to receive new posts and support my work. Subscribe
Hopkins Political Union encourages dialogue across differences
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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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Lesbian Bar Project Co-Founder: Purity Politics Could Destroy Our Remaining Spaces
Subscribe As a professional lesbian and Massachusetts native, I’ve recently been asked by a lot of folks what I think about the saga unfolding at Last Ditch. The now-viral story, first reported by The Boston Globe, centers on a Western Massachusetts lesbian bar that lifted its mask requirement for one night a week to help drum up business. The decision ignited an intra-queer controversy that has been feasted on by media outlets across the political spectrum—from the New York Post to LGBTQ Nation—and is even reportedly being eyed for a Hollywood adaptation. Apparently nothing is more entertaining than a bunch of lesbians and queers fighting with each other over KN-95s. What has been lost in all of the chatter and media coverage is the very real possibility that Last Ditch, which just opened in April 2025, will have to close its doors. The venue’s one remaining founder, Jackie Matellian, revealed in a community Zoom meeting that she’s working four jobs, is now solely responsible for the bar’s $50,000 business loan and is struggling to keep up with the bills. So as we laugh about the controversy’s similarity to a “Portlandia” skit and how one of the bar’s founders left to enroll in clown school, we forget that yet another lesbian bar is facing an existential crisis—and this time the call is coming from inside the house. In 2020, my friend Elina Street and I created The Lesbian Bar Project, an Emmy-, Webby- and GLAAD Media Award-winning docuseries and initiative that tells the stories of lesbian queer bars around the world. We were moved to act because at the time there were only an estimated 16 lesbian bars in the United States, and the pandemic threatened to bring that number down even further. There are now more sapphic bars than there were just before the pandemic—about 36 of them in total—but this is down from approximately 200 in 1980. Maybe that doesn’t mean much to you, but for the millions of sapphics living in the U.S., this number is calamitous. As the world laughs at lesbians and sapphics, I want to take a second and tell you what I feel when I walk into one of these bars, which are all unique and irreplaceable in their own way: I feel seen. Sometimes I think Cubbyhole in New York City’s West Village neighborhood knew I was gay before I did. When I walked in there for the first time, before I was even out, I was transfixed by the colorful array of tchotchkes hanging from the ceiling and how the women standing next to me were completely unafraid to express their desire for one another. I knew the minute I was ready to come out, I had a home. I also felt the joy of a new couple falling in love at Seattle’s Wildrose, the quiet confidence of a short king lining up her shot at the pool table at Ginger’s in Brooklyn and the kick of cayenne pepper in Julie Mabry’s crawfish at Houston’s Pearl Bar. Subscribe Lesbian bars don’t just serve lesbians; they serve queer folks across the spectrum, including bisexual, pansexual and trans people. As Elina and I traveled across the U.S. and Europe and to parts of Latin America to document the bar owners, staff and patrons that make up the ecosystems of these spaces, we also became uniquely acquainted with the factors that threaten their existence: gentrification, wage gaps, sexism, environmental disasters, gun violence, rising insurance premiums and political administrations working to annihilate queer people and their families. Lesbian bar owners, like all leaders and entrepreneurs, are imperfect. There have been significant issues over the years at lesbian bars: employee harassment, racism, lack of accessibility, sexual assault and transphobia. All bar owners should be held accountable and should listen to their communities to evolve into safer and more equitable spaces. I also acknowledge my privilege: I am able-bodied, white, cis and from a family system that loves me for who I am. Not everyone has that. Queer people, especially trans and bisexual people, are suffering from disproportionately high levels of depression, and our mental health system isn’t equipped to support them. Immunocompromised people and long COVID are real, and many of my friends are suffering to this day. The people with the least safety net are often the ones for whom a bar closing costs the most. And yet, as we’re seeing with Last Ditch, the queer community often lashes out at each other. It’s also the mainstream media taking the internal conflict and making a mockery out of it, distracting from the real possibility that this bar could close due to financial pressures. A bar that many people loved and needed is facing extinction. Perhaps it’s safer to dissent with one another than with the larger forces trying to eradicate us, but in doing so, we risk destroying the few spaces we have left. Due to the constraints of purity politics—some in good faith, some not so much—lesbian bar owners, almost all of whom are queer women themselves, are forced to be everything for everyone, similarly to how women are forced to be everything for everyone. By asking these bars to uphold impossible standards—standards very few other third spaces are asked to consider—we all end up losing. I want to move as a community toward dialogue, compassionate dissent and collaboration to make our spaces better with the goal of keeping them OPEN and thriving, rather than destroying them from the inside with expectations that are arguably unattainable. Subscribe While I have your attention—for this fleeting second of the news cycle—may I urge us to spearhead a way to keep these small businesses afloat without attacking our own community along the way? Bar owners are left with an impasse: They want to be community-centered, but they also have to make money to keep their doors open. Sometimes they might make business decisions that don’t work for everyone—and that’s partly because different patrons have different priorities and want different things—but these owners deserve the opportunity for productive dialogue**.** We have to work with them and with each other to keep our spaces open, to keep them growing. Lesbian bars raised me into the queer woman I am today. One thing I think about as I reflect on the six years of work we’ve done to document these spaces is that shared, unspoken language I have with a stranger the moment we both walk into one of these bars: the nod, the ease, the not having to explain ourselves. I don’t want to lose that, and neither should you. If objective, nonpartisan, rigorous, LGBTQ-focused journalism is important to you, please consider making a tax-deductible donation through our 501(c)(3) fiscal sponsor, Resource Impact, by clicking this button: Donate
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Calling all current and future scientists: Kiel is the place to be this week
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Germany’s northernmost comprehensive university has invested for many years in supporting young scientific talent and bringing research into dialogue with society. The Kiel Science Factory gives school pupils opportunities to experience research first-hand, while programmes such as Rent-a-Scientist send researchers directly into local classrooms. Major annual public events including Kiel Week and the European Researchers’ Night take science beyond the campus through talks, exhibitions and hands-on activities.That long-standing commitment has increasingly taken on a European dimension – and this week, many of those efforts are coming together.One of the foundations for this success is the European Researchers’ Night (ERN), which celebrates its tenth edition in the Kiel region this year. The initiative is funded through the Marie Skłodowska-Curie Actions, with Kiel University developing the successful EU proposals and securing the funding, while regional partner KielRegion coordinates the many activities on the ground. Together with research institutions, schools, companies, local authorities and civil society, they have built ERN into a major platform for public engagement.Over the years, Kiel’s ERN programme has grown far beyond a single evening into a whole “Science Summer”, beginning with “Science Shopping” in spring and culminating tomorrow, 25 September, in Science Day.“We have developed a wide range of public engagement formats, often together with the other research institutions in the region, the city and regional authorities, schools, companies and civil society,” says Eckhard Quandt, Kiel University’s vice president for research, academic infrastructure and transfer. “Over the past decade, we have increasingly taken this commitment to the European level.”That combination of European funding expertise and strong regional partnerships also helped Kiel University take the next step. Drawing on its experience with ERN and its European networks, including the SEA-EU University Alliance, the university brought together Brest in France and Split in Croatia for a successful bid to the EU’s new Science Comes to Town initiative. Throughout 2026, the three cities are serving as Europe’s first Science Ambassadors, with more than one thousand activities bringing science into schools, public spaces, cultural venues and everyday life.EUCYS is perhaps the clearest example of how Kiel University is using Science Comes to Town to create new connections between major European initiatives. From the outset, the university deliberately planned the contest for the week of European Researchers’ Night and opened the EUCYS exhibition to the wider Science Day audience. Tomorrow, that means thousands of visitors can encounter the next generation of scientific talent first-hand, while the young researchers themselves gain a much bigger public stage.“Because we opened EUCYS up for European Researchers’ Night, there will be a lot of people actually visiting the exhibition,” says organiser Stefanie Altemark of Kiel University.“We wanted Europe’s most talented young scientists not only to compete with one another, but also to become visible to the wider public. At the same time, people in Kiel will have the opportunity to see what the next generation of scientists are already capable of,” says Quandt.“We’ve shown over the last years that science is a big part of Kiel, and it’s always been the goal to not only show that to people in Germany, but also to show it to people all over Europe. Thanks to Kiel University’s expertise in European funding programmes, we have been able to turn that ambition into reality,” says Sünje Fock, who is coordinating the Science Summer at KielRegion.The model is characteristic of Kiel University’s approach: combining European funding expertise and international networks with strong regional partnerships to give major initiatives greater reach and visibility.This year also marks the 30th anniversary of the Marie Skłodowska-Curie Actions, giving Kiel University the special opportunity to welcome Vanessa Debiais-Sainton, Head of Department for the Marie Skłodowska-Curie Actions at the European Research Executive Agency, to Kiel tomorrow. Her visit brings together two priorities that have shaped Kiel University’s work over the past decade: supporting researchers and bringing science closer to society. Debiais-Sainton emphasises how closely the two are connected: "For thirty years, the Marie Skłodowska-Curie Actions (MSCA) have given more than 150,000 researchers the chance to pursue their dreams and open up new fields. Doctoral Networks and Postdoctoral Fellowships give them the freedom to move, to connect, to train and to follow their curiosity across borders, sectors and disciplines. But excellence cannot live only in laboratories. Researchers’ Night takes science out of the lab and into the city, to the families, the schoolchildren and the curious minds who will become the next generation. Kiel shows what that looks like at its best. That is the MSCA promise: open science, open borders, open doors."For Kiel University, these activities are not separate endeavours. They are part of a broader understanding of academic excellence in which outstanding research, talent development, international cooperation, knowledge transfer and engagement with society strengthen one another.“For me, one of the most important lessons from the past decade is that scientific excellence, knowledge transfer, talent development and engagement with society cannot be treated as separate tasks,” stresses vice president Quandt. “They reinforce one another.”That philosophy is also reflected in Kiel University’s current bid for Germany’s Excellence University status. The designation is part of Germany’s national Excellence Strategy, which provides substantial long-term funding to selected universities to strengthen internationally competitive research and their overall institutional development. A successful outcome would provide new opportunities to build on what has already been created: deepening international cooperation, creating more opportunities for knowledge exchange and public engagement, and extending the university’s reach across the region and beyond. “If we are successful, it would allow us to take what we have built in Kiel considerably further – including expanding our networks and transfer activities beyond the region and increasingly across the Baltic area,” says Quandt.This week’s events offer a glimpse of what that could mean in practice: a university using its research strength, European expertise and regional partnerships to create opportunities for scientists at every stage of their careers while making science more visible, accessible and exciting to the wider public.
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