Showing posts with label Medicine. Show all posts
Showing posts with label Medicine. Show all posts

Friday, June 5, 2026

In Support of Mandatory Nucleic Acid Synthesis Screening and Recordkeeping

As life sciences researchers, builders of AI and biotechnology, and experts with a wide range of views on how to approach AI policy, we call on legislators to make screening of orders for synthetic nucleic acids — and the equipment needed to make them — mandatory.

The ability to order synthetic DNA online has accelerated vaccine development, powered basic research, and made it possible for small teams to access capabilities that used to be confined to major institutions. Since the publication of protocols to reconstruct viruses from strands of DNA more than two decades ago, it has also been recognized as a point in the biotechnology supply chain where a bad actor could cause outsized harm. Recognizing the vulnerability, synthesis companies formed the International Gene Synthesis Consortium in 2009 to develop and implement voluntary safeguards against misuse.

While the issue is not new, the pace of progress in artificial intelligence is. AI systems now outperform PhD-level virologists on questions about highly technical laboratory procedures in their own domains of expertise. The evidence about what this means for present-day biosecurity threats is genuinely mixed, but the trend is hard to dispute. AI systems are improving rapidly, and alongside incredible benefits to science and medicine, there is a real possibility that the knowledge barriers which have historically prevented bad actors from obtaining biological weapons will meaningfully erode.

Support for screening does not depend on any particular view of AI; the biosecurity case has been recognized by scientists and governments for decades. Screening is also one of the best understood and least disruptive biosecurity measures available. It asks providers of synthesized DNA and manufacturers of synthesis machines to check synthesis requests for sequences of concern and to verify customer legitimacy before shipping orders. Providers should also record synthesis orders and sequence data to support legitimate biosecurity investigations, so that any threat that might evade initial screening can be traced back to its source — including when individual sequences would not raise concern in isolation. Awareness of traceability itself deters misuse.

Many of the largest and most responsible providers in the industry already screen and record orders voluntarily because it is well understood that they have an important role to play in maintaining public trust in and mitigating potential misuse of this important technology.

For these reasons, the undersigned support mandatory nucleic acid synthesis screening, including recordkeeping, in the United States.

Given the pace at which the underlying technology is changing, we believe the need is urgent. Congress should act this session, and we applaud the legislative efforts currently underway. To ensure a consistent national standard rather than a patchwork of conflicting laws, states should also consider implementing requirements based on existing federal and industry guidelines.

This is a rare moment of agreement across stakeholders that are often at odds. We hope policymakers will meet it with decisive action.

Sincerely,
Signatories: — *Everybody*
[ed. No brainer, right? You don't just leave potential life-threatening bio-warfare components laying around with no oversight. Right?]
***
Amrith Ramkumar (WSJ): Top artificial-intelligence executives are joining security experts in calling for Congress to protect against biological threats posed by AI, adding to growing pressure on lawmakers to address the technology’s risks.

Three major chief executive officers—OpenAI’s Sam Altman, Anthropic’s Dario Amodei and Demis Hassabis of Google’s DeepMind AI lab—are among the signatories of a letter urging Congress to require safeguards when companies order synthetic DNA and RNA, a key step in developing certain vaccines and biotech breakthroughs.

… It was organized by two tech-focused think tanks that said the topic is a rare source of agreement among libertarians, progressives, researchers and rival executives.

Dean W. Ball: I am honored to have signed on to this letter. This is an urgent priority for near-term action by Congress. Biotech is advancing rapidly on its own, and I—and many others—believe the “Mythos moment” in AI/bio is coming soon. It is time for action.

revisions to existing nucleic acid screening requirements were mandated by an EO POTUS signed a year ago; I worked on them while in govt. I genuinely don’t know what happened to that work after I left but it is nine months behind schedule. Congress acting is better anyway.

Joshua Teperowski Monrad: People are so astounded when I tell them this isn't already law

Alec Stapp: it really is insane [...]
Other signatories include Patrick Collison, Paul Graham, Mustafa Suleyman, Alexandr Wang and a lot more where that came from.

We need such letters, despite this having ~100% support among those who understand any side of this, this is such a slam dunk that we should be doing this even before considerations of AI making malicious action vastly easier.

Why? Because political awareness is basically still near zero:
Will Poff-Webster: When I was a Senate staffer and occasionally got the chance to bring up biosecurity risks from AI, the response was often, “What? AI might be able to do that?”

This letter shows how easy it’d be for Congress to act on this

Wednesday, May 27, 2026

Dognosis

At a former pomegranate farm on the outskirts of Bengaluru, a team of specially trained dogs is doing something that some of the world's most sophisticated medical machines cannot — detecting multiple types of cancer from a single breath, at early stages, for two dollars a test.

Dognosis, the Indian startup behind this system, published the results last week of its Phase 2 clinical trial in the Journal of Clinical Oncology — the world's most influential cancer journal — making it the largest study of its kind ever conducted and placing canine-based diagnostics firmly into the mainstream of medical science.

What Dognosis Does

The company was co-founded by Akash Kulgod, who built on his Honours thesis at Berkeley, and Itamar Bitan, who brings a decade of Special Ops K9 training experience from Israel. What the two founders realised was that the solution to early cancer detection had been living in our homes the whole time — the dog's nose, a product of fifteen millennia of co-evolution with humans, can detect the faint chemical trace of cancer in breath at a resolution that machines, algorithms, and laboratory tests have never come close to matching.

Therefore, Dognosis is building an ultra-affordable, non-invasive breath-based multi-cancer early detection test that combines trained dogs' exceptional olfactory abilities with brain-computer interfaces and machine learning to create quantitative signatures of disease.

How the Test Works

The test is straightforward: a person breathes normally into a cotton face mask for 10 minutes. The mask is sealed, stored, and later evaluated by trained detection dogs at a central laboratory. Each sample is assessed independently by at least three dogs and their assessments are combined using an advanced Bayesian statistical model that weighs each dog's track record and the participant's background information. No blood is drawn, no scan is needed, and no fasting is required.
 
The Science: What the Dogs Are Smelling

The dogs are detecting changes in volatile organic compounds — substances produced by the body when diseases like cancer are present. These VOCs create a unique odour signature or volatilome that trained dogs can identify, just as they are trained to detect explosives and drugs.

According to Dognosis, over 40 double-blind trials published in peer-reviewed journals have demonstrated that dogs can detect various diseases, including different types of cancer, with high accuracy, and this ability is now well-established in scientific literature spanning journals including Nature and The Lancet.

The Phase 2 Trial: What It Found

According to the paper published in the Journal of Clinical Oncology, the study was conducted across six hospitals in Karnataka — three each in Hubballi and Bengaluru — in an assessor-masked, multi-centre case-control format. A total of 3,275 participants were enrolled, with 1,773 used for training and 1,502 for testing. The test cohort included 283 treatment-naïve, biopsy-confirmed cancer cases spanning seven major cancer groups and 1,219 controls including healthy volunteers.

The Phase 2 data showed 91% accuracy in detecting cancer-associated VOC breath signals across seven cancer groups, with accuracy stable across cancer types as well as in early stages — when detecting cancer early matters the most. The study was conducted in collaboration with Medical Detection Dogs, a UK-based charity and world leader in canine bio-detection research. 

"We've known for over two decades that dogs are capable of detecting multiple types of cancers with high accuracy," said Akash Kulgod, chief executive officer of Dognosis. "The challenge has always been building a system around canine olfaction that is reproducible, scalable, and aimed at a clinical problem worth solving."

"Multi-cancer risk stratification from a single breath sample in countries like India is that problem, and this study shows that it can be done," Kulgod said.
 
Why It Matters

The rise of multi-cancer early detection tests and AI-powered imaging has created an acute need for effective first-tier screening, which breath-based testing is uniquely positioned to fulfil — particularly in low- and middle-income countries where expensive imaging infrastructure remains out of reach for the majority of patients.

At $2 per test, Dognosis's system costs a fraction of existing screening tools, many of which also fail to detect cancer at its earliest and most treatable stages.

by NDTV Profit News |  Read more:
Image: uncredited via

Monday, May 25, 2026

Doctors, This Is Why Our Patients Are Using ChatGPT

Several months ago, I got the results back from some routine blood tests, and let’s just say several numbers were a tad too high. My doctor advised “continued diet and exercise” and signed off on the results.

For the past couple of years, though, my numbers had been inching up, and I was frustrated that I couldn’t seem to do much about them. I requested a phone call from my doctor — surely, she had better advice than what she wrote — but she messaged back that if I wanted to discuss my results, I had to set up another appointment.

So, I did what everyone does in this day and age: I turned to artificial intelligence. With low expectations, I typed my lab results into ChatGPT.

As both a physician and a patient, I found the experience startling. Not because ChatGPT dazzled me with its scientific knowledge, but because it behaved the way I wish modern medicine, and its practitioners, still would.

I had always assumed the “human side” of medicine was the part A.I. couldn’t touch. Sure, I know doctors are turning to A.I. to help them break bad news, since patients seem to find messages crafted by bots more empathetic than those written by doctors. But, in practice, what I thought really mattered was that a person was delivering that care.

The chatbot didn’t just spit back generic advice. It asked questions about my daily life and figured out what I could realistically change. It suggested a short walk immediately after eating, something I’d never taken seriously. When I inquired about doing a longer activity, it told me that would likely offer only marginal benefit. Its recommendations were manageable and easy to follow. [...]

As a doctor, I was a little embarrassed to be using ChatGPT. But every interaction with, say, OpenEvidence, a professional medical A.I. tool, felt cold and sterile. It referred to me as if I were a case report, not a person with preferences and habits. I realized what was winning me over about ChatGPT wasn’t its ability to sift through the latest studies, or diagnose my ailments; but its unwavering messages of empathy and encouragement, and its endless willingness to listen and its patience. It’s not human, but it can model some traits we value most in human interaction.

I followed ChatGPT’s advice, and when my blood work improved, ChatGPT affirmed my progress and urged me to keep going. I doubt I would have made those changes — much less stuck with them — without that sustained back-and-forth. I certainly hadn’t before.

It’s a grim fact of American medicine today that doctors can’t come close to a chatbot’s availability. And when the health care system can’t reliably offer time, attentiveness and compassion, patients will go searching for them somewhere else, even from a machine we assumed could never feel human. A.I. may not replace doctors, but it will change what patients expect from us. Doctors need to adapt.

Before I used a chatbot for my own health concerns, the thought of telling a patient to “ask ChatGPT” was inconceivable — or at least something I considered terrible care. Now I’m not so sure. In certain situations, A.I. offers something patients clearly need and medicine has trouble fulfilling.

The reality is, many patients are already consulting A.I. Doctors can keep fearing or condemning those interactions, or they can figure out how to support people using A.I. tools for their health care — cautiously, with clear guardrails. I would never tell patients to ask ChatGPT or Claude for a diagnosis, but perhaps I would suggest they use it to make sense of a new condition or keep up with routine screenings — or translate “diet and exercise” into steps that actually fit into their lives, as I did. At the same time, we need safeguards built into these systems to protect people from real harm from dangerous advice.

My experience with the chatbot has already shifted how I interact with patients in the E.R., with only minutes to piece together fragments of their circumstances. When a patient asks the same question repeatedly, I try to listen for what’s behind it. Maybe she’s not after more medical facts.

by Dr. Helen Ouyang, NY Times | Read more:
Image: María Medem
[ed. I had this exact experience a month or so ago. Asked for a full blood workup to see if there were any problems. Called back two weeks later for results. No answer. Waited another week and went to the clinic in person to make sure my first request hadn't somehow gotten lost in the bureaucracy (which happens, frequently). Except, this time I was smart enough to ask for a print-out of my lab results. Again, after receiving no response from my doctor, I took a picture of the results, uploaded them to Anthropic's Claude and asked it to interpret them. At first I got the standard disclaimer that it doesn't do diagnoses, but then I asked it to just interpret the results so I'd know what all the coding meant, the various ranges of acceptability etc., and it gave me a detailed response. Much better than I'd ever gotten from doctors before who'd mostly just say (if they responded at all) "oh yeah, everything looks ok, some things look a bit high, but others ok". And that's it. No explanation or guidance on anything, like follow-ups were a burden (that couldn't be billed for an office visit). I'll always use AI from now on to evaluate my results. Doctors (and hospitals) have brought this upon themselves.]

Sunday, May 17, 2026

Ben Sasse's Warning

When Ben Sasse walked onto the Senate floor in November 2015 to deliver his first speech as a member of the upper chamber, he did something unusual: He had waited a full year to speak. It’s part of a Senate tradition known as the “maiden speech.” A historian by training and a management consulting associate by early vocation, he had spent his first year in the chamber interviewing colleagues, studying how the institution functioned, and developing a diagnosis before offering it publicly. When he finally spoke, the speech landed with enough force that Sen. Mitch McConnell (R-KY) distributed the text to every Republican senator, a gesture the Senate GOP leader at the time rarely made.

“No one in this body thinks the Senate is laser-focused on the most pressing issues facing the nation,” Sasse told his colleagues. “No one.”

The indictment was bipartisan, surgical, and delivered with the calm of a man who had considered it carefully before speaking. The Senate, he argued, had surrendered its institutional identity to the rhythms of the 24-hour news cycle, to the demand for sound bites, and to the incentive to grandstand for a narrow base and raise money rather than legislate for a country. “The people despise us all,” he said. “And why is this? Because we’re not doing our job.”

It served as a warning that went unheeded, and 11 years later, we’re watching more dysfunction in government than ever before. Sasse, now dying of Stage 4 pancreatic cancer at 54, is still saying the same thing. The diagnosis has not changed the message. It has sharpened it.

Whether Sasse was a “good” or “effective” senator is debatable. Whether Washington currently has enough senators like him is not a close question.

The criticism that followed him throughout his eight-year tenure is almost entirely subjective. His critics on the Left saw a man willing to deplore Trumpism in public while voting with President Donald Trump‘s agenda in practice. His critics on the Right, particularly as the party realigned, saw a posturing institutionalist more interested in making points and serving as a pundit than in getting on board fully with the president’s policies. The most durable version of this critique runs something like: He gave great speeches and passed no significant legislation.

Yuval Levin, founding editor of National Affairs and director of Social, Cultural, and Constitutional Studies at the American Enterprise Institute, largely rejects both sets of criticisms. On the Trump question specifically, Levin is direct: “The notion that there was much more he could have done to hold Trump to account is misdirected and mistaken. He took on Trump when he disagreed with him, and when he thought Trump had exceeded his authority or violated his oath. And unlike most Senate Republican critics of Trump, he ran for reelection and won after doing that.”

The objection to the lack of signature legislation mistakes the Senate’s function for a body it was never designed to be. In the framework Sasse spent years articulating, the Senate is not primarily a factory for producing legislation. It is a deliberative institution meant to apply friction to democratic impulses in the House of Representatives, to slow things down when people want to move too fast, and to force the executive and judiciary to operate within appropriate constitutional limits. By that standard, which is closer to the Founders’ intent than the one applied by Sasse’s critics, he understood and performed his role better than most of his colleagues.

The “pundit” critique oversimplifies his actual record. Sasse served on the Senate Intelligence Committee throughout his tenure, and his work on China there was substantive and largely ahead of the political mainstream. When it was still unfashionable for a Republican to identify Beijing as a generational geopolitical threat rather than an irritating trade partner, Sasse was making that case in the committee rooms that mattered. He had genuine expertise in China’s intelligence operations and, accordingly, used his position, spending considerable time in secure facilities at times when most of his colleagues were busier developing a social media strategy.

Sen. Mark Warner (D-VA), who worked alongside him on the intelligence committee, offered perhaps the most precise characterization of what made Sasse different, telling Scott Pelley on 60 Minutes in April that Sasse “never really thought about things as conservative, liberal. He thought much more about issues, such as the future and the past.” Senate Majority Leader John Thune (R-SD) said Sasse had a “concern not just for today, but for tomorrow and the future” and that he “wasn’t distracted by all the noise that goes around us on a daily basis.” [...]

Levin, who watched Sasse’s tenure closely, offers a candid accounting of his legislative limitations. “It’s true that Ben was not an active legislator, advancing proposals, sponsoring and co-sponsoring legislation, and building coalitions,” he said. “He was active in some key committees, especially the Intelligence Committee, where it seemed to him that active engagement could make a difference. But I think he concluded this was not the case in some of his other committees and that he might be more useful as a critic and observer of the institution. No individual senator gets a lot done right now, and of course, that’s part of the frustration he had.”

But the moments that defined Sasse as a senator were the ones that did not produce legislation, and those are the moments worth examining without the usual condescension.

On the first day of Justice Brett Kavanaugh‘s Supreme Court confirmation hearings in September 2018, the chamber descended almost immediately into the theater that had by then become customary. Protesters disrupted proceedings from the gallery. Democratic senators jockeyed for camera time. The atmosphere was more performance than inquiry. Into this circus, Sasse delivered a 12-minute statement that went viral because it said plainly what almost no one in that room was willing to say: The hysteria around confirmation hearings is a symptom, not the disease. Congress had spent decades delegating its legislative authority to executive agencies and now blamed the courts for filling the vacuum.

“It is predictable now that every confirmation hearing is going to be an overblown, politicized circus,” he said. “And it’s because we’ve accepted a bad new theory about how our three branches of government should work.” The corrective he offered was simple: Congress should pass laws and stand before voters. The executive should enforce those laws. Judges should apply them, not write them. Naturally, no one disagreed out loud.

He delivered a version of the same argument at Justice Amy Coney Barrett‘s hearing in 2020. Neither speech moved the institution. Both captured something true and important about why the institution was failing, and both were widely shared by people who had largely stopped expecting a sitting senator to say anything worth sharing. The Kavanaugh statement was described in this publication at the time as the civics lesson Washington desperately needed. That it needed to be given by a freshman senator to the full Senate Judiciary Committee was Sasse’s real point.

He also understood, more clearly than most of his colleagues, that the Senate’s dysfunction was not incidental but structural. The cameras, he argued, were a bad incentive. The constant travel and time spent fundraising corroded the relationships that make effective governing possible. Most tellingly, he believed that senators had come to treat their office as the purpose of their lives rather than a temporary form of service to something larger. When Pelley noted on 60 Minutes that many senators he knew “would not be able to breathe without that job,” Sasse replied that he feared that was true and that it represented “a much, much deeper problem.” The best title a person could hold, he said, was dad, mom, neighbor, friend. Senator was “a great way to serve. It should be your 11th calling or maybe sixth, but never top.”

When he resigned from the Senate in January 2023 with four years remaining in his term to become president of the University of Florida, many observers treated it as confirmation of the pundit critique: He could not stay the course. The more honest reading is that he had concluded the institution was, as he told Pelley, “very, very unproductive” and that there were better things for him to do. “We didn’t do real things,” he said. “And it felt like the opportunity cost was really high.” He moved to Florida, then stepped down from that post roughly a year and a half later when his wife, Melissa, was diagnosed with epilepsy and required full-time care. The man who had argued that being a senator should rank no higher than sixth on a person’s list of priorities was living accordingly.

Then, on Dec. 23, 2025, he posted the news to X. “Last week I was diagnosed with metastasized, stage-four pancreatic cancer, and am gonna die.” He was 53. Doctors at MD Anderson Cancer Center had cataloged the full spread: lymphoma, vascular cancer, lung cancer, liver cancer, and pancreatic cancer, the point of origin. He had been given three to four months to live. He called it what it was: “Advanced pancreatic is nasty stuff; it’s a death sentence.”

What followed was unexpected, at least to anyone who had expected Sasse to retreat from public life. He launched a podcast called Not Dead Yet. He sat down for a conversation with New York Times columnist Ross Douthat on the latter’s Interesting Times podcast in April, which was released just days after the interview aired and subsequently circulated widely. He appeared on 60 Minutes with Pelley on April 26, his face visibly marked by his medication, a drug called daraxonrasib from Revolution Medicines that had shrunk his tumors by 76% and extended his life by months that were not supposed to exist. He credited the extra time to “providence, prayer, and a miracle drug.”

The Douthat interview was the more intimate of the two conversations and the more remarkable. Douthat asked Sasse at the close whether he felt ready to die. Sasse said he did not feel ready but that he had hope, grounded in his Reformed Christian faith, that he would be with God. The response moved Douthat visibly to tears, something Sasse responded to with his characteristic dry humor. Earlier in the conversation, Sasse reflected on what the disease had given him alongside what it had taken. “I hate pancreatic cancer,” he told Douthat. “I would never wish it on anyone, but I would never want to go back to a time in my life where I didn’t know the prayer of pancreatic cancer. I can’t keep the planets in orbit. I can’t even grow skin on my face.”

The “prayer of pancreatic cancer,” as Sasse uses the phrase, is something like the acknowledgment of dependence that most people spend their healthiest years avoiding. He is not unusual among the terminally ill in arriving at that acknowledgment. He is unusual in the way he has extended it outward, into public argument, into the same institutional critique he was making in November 2015. On 60 Minutes, he was asked what Congress was missing, and he named the artificial intelligence revolution, the future of work, and the complete absence of 2030 or 2050 thinking in either party. Then, without prompting, he returned to the frame he had always used. “The Senate needs to be less like Instagram. The Senate needs to be more deliberative, and that means less smack-down nonsense,” he told Pelley, adding, “The Senate should be plodding, and steady, and boring, and trustworthy.”

by Jay Caruso, Washington Examiner |  Read more:
Image: uncredited via
[ed. I knew very little about Ben Sasse before reading an article about daraxonrasib, the new breakthrough drug given to him in his treatment for aggressive pancreatic cancer. It goes without saying that Congress would be an entirely different place if there were more people like him. See also: Pancreatic cancer just met its match (Works in Progress):]

***
"For most of the last half-century, a diagnosis of metastatic pancreatic cancer was a death sentence. In December 2025, former Nebraska Senator Ben Sasse announced he had been diagnosed with stage four pancreatic cancer that had spread to his lungs, liver and other organs, and was given three to four months to live from the time of diagnosis. With little to lose, he enrolled in a clinical trial for an experimental drug. Four months later, he reported a 76 percent reduction in tumor volume, describing the drug, daraxonrasib, as a ‘miracle’. His face, ravaged by a severe skin rash from the treatment, told a more complicated story. Yet he was alive and grateful to be able to talk to his family.

A few days after Sasse’s interview, in April 2026, Revolution Medicines announced Phase 3 trial results for daraxonrasib showing the drug had roughly doubled survival in patients with metastatic pancreatic cancer compared to standard chemotherapy. For a disease where median survival has long been measured in months and where little had changed for decades, that result represents a genuine turning point.

But the significance extends beyond pancreatic cancer. Daraxonrasib is among the first drugs in an emerging generation designed to target RAS, a protein implicated in roughly a quarter of all human cancers and long considered beyond reach, in all its mutant forms. And it belongs to a broader class of medicines, molecular glues, that are beginning to show what becomes possible when drugs no longer depend on finding a ready-made pocket in their target. Several compounds in this class are now in clinical development, each probing a different protein that previous generations of drugs could not touch."

Saturday, May 9, 2026

Why Consciousness Researchers Have Failed (So Far)

Oh god, I barely made it through.

Experienced sensations while reading: frustration, dread, restless legs, and overwhelming waves of weariness. At one point I felt physically nauseous.

I’ve been trying to figure out why, since (a) Michael Pollan is a great writer who has proven his chops over countless other topics, and (b) this is objectively quite a good book about the science of consciousness. Indeed, I should be happy! Consciousness is clearly having “a moment” right now—a science book about consciousness has been on The New York Times bestseller list for nine weeks, and meanwhile, the online world is abuzz with debates about AI consciousness.

And yet… I hated Pollan’s book.

I felt that every next chapter or section could have been predicted by some statistical machine for producing books about consciousness (“Okay, here’s the part about David Chalmers coming up”). And yes, I have the advantage of being a researcher in the same subject and have even worked with some of the figures Pollan writes about, which is why in my own The World Behind the World (we all seem to gravitate to the same titles, huh) I broadly told much the same story. But you can even go back to science journalist John Horgan’s The Undiscovered Mind, published in 1999, to get similar progress beats and quite familiar names. It’s been 27 years, during which the discussion has (as many fields of science do) centered around major figures like neuroscientists Christof Koch or Giulio Tononi or Antonio Damasio or philosophers like David Chalmers. There’s always the part where Alison Gopnik makes an appearance. Karl Friston pops his head in. And all these people are intellectual titans. Truly. But honestly, this stage of consciousness research feels played out.

Like you have Christof Koch, one of the highest-profile figures, who broke open the field in the 1990s with Francis Crick (co-discoverer of DNA’s structure) and gave one of the first proposals for a neural correlate of consciousness: gamma oscillations in the ~40Hz range in the cortex.

Koch, who is soon to turn seventy, was for a while after the death of Francis Crick a staunch supporter of Integrated Information Theory (I was part of the team that worked on developing that theory after Giulio Tononi proposed it, and even once did a conference submission with Koch himself). But now Koch has apparently moved on to other approaches to consciousness, mentioning his attendance of an ayahuasca ceremony and his accessing of a “universal mind.”

Here’s Pollan talking to Koch at the end of the book:
When I confessed to Koch my fear—that after my five-year journey into the nature and workings of consciousness, I somehow knew less than I did when I started—he simply smiled.

“But that’s good,” he said. “That’s progress.”
No, it isn’t!

Consciousness is not here for our personal therapy. It’s not tied to our life journeys. And I’m guilty of all that artsy and personal stuff too! But it’s no longer about how the grand mystery makes us feel, or the friends we made along the way.

It’s all changed.

HOW WE FAILED

Right now, there’s some college student falling in love with a chatbot instead of the young woman who sits next to him in class, all because science literally cannot tell him that the chatbot is lying about experiencing love. On the other hand, if somehow AIs are conscious, either right now (to some degree), or near-future ones will become so, then they deserve rights and protections, and the entire legal and social apparatus of our civilization must expand rapidly to include radically different types of minds (or we must choose to restrict what kinds of minds we create). There are immediate practical matters here. Long term, we also need to protect against extremely bad futures where only non-conscious intelligences remain—the worst of all possible worlds is that our civilization acts like a reverse metamorphosis, where something weaker but more beautiful, organic consciousness, gets shed in the birth of some horrible star-devouring insect made of matrix multiplication. And then it turns out there is nothing it is like to be two matrices multiplying.

While it’s my opinion that modern LLMs operate more like tools right now, or at best like a lesser statistical approximation of what a good human output would be (with their main advantage being search, not insight), this is all just the beginning of the technology. The door is open and will never be closed again.

Of course, consciousness matters far beyond just AI. Table stakes for actual scientific progress on consciousness include shifting neuroscience and psychiatry from pre-paradigmatic to post-paradigmatic sciences (and all the pile-on effects from that). This was always true. But my point here is that LLMs act like a forcing function. Before everything changed, consciousness research was an unhurried subfield of neuroscience that was always a little weird and niche; therefore academics are guilty of treating consciousness like an academic exercise. [...]

Due to the rise of behaviorism and logical positivism, “consciousness” became a dirty word in science for half a century or more—precisely when the rest of the sciences rocketed ahead! The consciousness winter only really ended in the 1990s because of the collective weight of several Nobel Prize winners (like Francis Crick and Gerald Edelman) determined to make it acceptable again.

The two major scientific conferences (which are how scientists organize) devoted to consciousness also only started in the mid-90s. That’s just 30 years ago! Modern science is incredibly powerful, maybe the most powerful force in existence, but in the grand scheme of things, 30 years is not long at all. That’s just one generation of scientists and thinkers. Kudos to them. Pretty much all of the big names (including definitely Koch) deserve their laurels, and contra Pollan, I do think consciousness actually has made progress over the last 30 years, in that our conceptions are a lot cleaner, the definitional problem is pretty much solved, a lot of the space of initial possible theories is mapped, the problems and difficulties are much better known and clearly outlined, and there is organizational and behind-the-scenes structure that exists in the form of established conferences and labs and minor amounts of funding, etc.

And that’s another thing: no one has tried throwing money at the consciousness problem, at all—and for many problems, from AI to cancer cures, a necessary component often ends up being finance and scale and concentrating talent.

Humanity spends something like a billion dollars a year on CERN. To compare, let’s look at the biggest scientific funder in the United States, the NIH. Out of 103,280 grants awarded to scientists during the 2007-2017 decade, want to guess how many were about directly studying the contents of consciousness?

Five.

That’s probably, at most, a couple million dollars in funding over a decade. Total. So if you’re a consciousness researcher, what can you do, cheaply? What can you do, for free? You can pontificate. You can propose your own theory of consciousness! That requires no funding whatsoever. And so for 30 years the meta in consciousness research has been to create your own theory of consciousness. We’ve let a thousand flowers bloom. The problem is that, if any flower is at all true or promising, you can’t identify it, as its sweet subjectivity-solving scent is completely masked by the bunches of corpse flowers around it. We have too many flowers, and one more just isn’t meaningful anymore. As is sometimes said at the end of fairy tales: “Snip, snap, snout. This tale’s told out.”

What we need are efforts at field-clearing, and methods that can actually make progress on consciousness in ways not tied to just promoting or trying to find evidence for some pre-chosen pet theory—which means finding ways to select over theories, to test theories en masse, so you don’t reinvent the wheel each time, and, perhaps most importantly, you have to do all this while scaling institutions with funding to specifically get a bunch of smart people in a room working together on this.

ME GETTING OFF MY ASS

If the 2020s were all about intelligence, then necessarily the 2030s will be all about consciousness. Intelligence is about function, while consciousness is about being, and forays and progress into understanding (and shaping) function will in turn force our attention toward a better understanding of being. And if the answer to “Why has consciousness not been solved?” is secretly “Material and historical conditions made it hard for anyone to actually try!” then the answer is to actually try.

I refuse to live in a civilization where we consciousness researchers have so obviously failed. I refuse to live in a civilization where we cannot tell consciousness from non-consciousness. Where we can offer no guidance for the future. Where we cannot explain the difference between actually experiencing things vs just processing them. In the short term, this is destabilizing and harmful. In the long term, it may be literally existentially dangerous.

by Erik Hoel, Intrinsic Perspective |  Read more:
Image: Michael Pollan/Penguin Random House
[ed. I thought consciousness research was going great guns since it's central to determining AGI (artificial general intelligence). Huh. See also: His ‘Machine’ Could Uncover the Origin of Human Consciousness—And if It Truly Connects to the Whole Universe (Popular Mechanics)]

Thursday, May 7, 2026

Hantavirus Update

A working timeline: 
  • Mid-March: Dutch couple possibly contract virus on bird watching landfill excursion.
  • April 1: MV Hondius departs southern Argentina.
  • April 6: Dutch man falls ill.
  • April 11: He dies.
  • April 24: St. Helena. Man’s body is taken off ship and wife flies with it to South Africa. The Dutch woman is already sick before boarding flight to South Africa.
  • April 26: The Dutch woman dies in SA at a hospital.
  • April 27: A British man who is sick is flown from Ascension Island to South Africa.
  • May 2: A German woman dies on the MV Hondius.
Meanwhile, we have people leaving the ship and flying all over the world:

Some Hantavirus Cruise Passengers Are Back in the U.S. MedPage Today

Two British people self isolating at home after leaving cruise ship in St Helena BBC. “The UKHSA also said British people currently on the ship would be flown home on a charter flight, probably from the Canary Islands, as long as they didn’t have symptoms.”

Patient with a hantavirus infection being treated in hospital Switzerland Federal Office of Public Health (press release)

Passenger with hantavirus was briefly on board a KLM aircraft in Johannesburg KLM (press release)

Spanish passenger on the ‘Hondius’: ‘There are 23 people who got off on Saint Helena and have been wandering around El Pais

by Conor Gallagher, Naked Capitalism | Read more:
[ed. Time to pull that old "definition of insanity" cliche' out again. Even if this does eventually burn out, it appears we've learned very little in the last few years.]

Wednesday, April 29, 2026

On Health Care Price Transparency

(from the comments)...

A doctor on billing practices:

Generally such figures do not reside within the physicians’ office. On our side of the table we do some procedure with multiple specifications and generate some CPT code(s) (e.g. a lap cholycystectomy is 47562, add on a common bile duct exploration and it becomes a 47564, and if you just do cholangiography it becomes a 47563). Generally, we couple that with an ICD-10 code that specifies your exact disease (K80 for simple stones, K81 for cholecystitis, etc.). We then dump those codes into a computer.

Can either of those change? Absolutely, we find a bunch of friable neovasculature around the gallbladder, congrats you likely have cancer which means this surgery is now both a different CPT code and a different ICD-10 set. Maybe only one does – we find the gallbladder lacks an obstructing stone, but does have transmural inflammation then you get a new ICD-10 code. If we find that you actually have multiple obstructing stones and we need to go deeper into the biliary tree, then those are different CPTs.

Regardless, we do what is medically indicated, document the codes used.

At this point, unless your physician keeps billing fully in house, those get handled by a processer. Often, bills from multiple providers get handled by one processor who in turn gives insurance companies bills to their specifications. Often this involves a bunch things – where was the surgery done (through very complicated rules, critical access hospitals, for example, can charge more for the same surgery because the government wants to keep them solvent lest a bunch of people lose their local emergency room and OR), who was doing it (e.g. there is a different rate if you have medical trainees involved), and of course stuff about you (e.g. complex patients get reimbursed at higher rates with the expectation that, on average, the higher rates cover higher complication rates and insurance doesn’t incentvize surgeons to make all their complex patients drive for hours and hours). Then we get to the big buys – buyers. For Medicare, there are some committees that appear to be overwhelmingly ignorant of actual medical practice but they set baseline reimbursements for these CPT/ICD-10 combos. Those then get adjusted to account for regional costs, equity concerns, and only God knows what all else. These are normally set near the break even point on national average. Medicaid, typically, uses those rates as a baseline and then cuts them (hence why many physicians won’t take new Medicaid patients, the reimbursement rates often leave folks at a net loss). Private insurers add another layer of negotiation where they use their monopsony power to extract lower rates while, allegedly, assuring physicians of volume. The range of these negotiations can be exceedingly wide – insurers can have modifiers for quality of care (e.g. how many folks come back in the perioperative period), timeliness of care, and so on and so forth.

Okay, so somebody has haggled set a rate and we just assume that get the bog standard lap chole we have a price?

Of course not.

See that is just what has agreed, in theory, these medical services will be reimbursed at. Actual reimbursement involves a non-negligable risk on non-payment (e.g. insurance denies and the patient cannot or will not pay), delayed payment (and having to utilize credit lines to cover payroll when a large insurer has an IT glitch and doesn’t pay for two weeks is quite expensive), and of course variable legal and compliance costs. You might also be hit with clawbacks, partial payments, and a host of other payment uncertainty.

Okay, but’s lest assume a single CPT/ICD-10 setup, a prenegotiated rate that is paid on time without further processing costs, and everything is chill there. We got a price yet?

Of course not.

See all of the above is for just the surgeon’s professional fees – i.e. what is being paid for use of his hands. The OR itself? That’s a completely different bucket of money that has its own set of billing and negotiations. Facility fees make the professional fees look straight forward and simple.

But we are done now? Right?

Of course not.

See those were the professional fees for your surgeon. You also need an anesthesiologist (and/or his minions). And guess what, yep completely different bucket of money and price negotiation.

But we are done now?

Well, no. There may be different negotiations for lab fees (e.g. where does the CBC get billed), for tissue pathology, for any post-operative hospital services, and of course medications (which are billed completely differently if outpatient or inpatient) to name a few of the more common options.

There isn’t “a” price for a surgery. There are, potentially, a dozen diferent prices that can be combined in a multitude of ways with some buckets covered by one payer and other parts covered by another (and things get crazy fun when you have overlapping payers).

But aren’t there cash only surgical places with listed prices? Yes. And they have an extremely limited set of procedures with everything owned in house – i.e. a setup that is pretty much illegal to set up de novo post Obamacare.

Why does everyone have all these bizarre negotations. Why don’t you just pay the surgeon everything and then he pays the hospital, the anesthesiologist, the pathologist, etc. from that cut? Because that is an invitation for your surgeon to be charged with a crime. It is federal crime to underbill or to underbill when it comes to government monies (and in many states, private insurance monies). We are required not just to I Pencil up a price, but to make that price transparent to regulators. If a hospital wants to grant me cheaper OR time because I have reliable stream of patients, keep the OR cleaner (reducing turnaround time enough to fit another case per day in), and don’t create ancillary malpractice risk at the going rate … the hospital risks being tagged with inducement. If I negotiate a cheaper rate with the lab for my patients’ tests, it is considered prima facie evidence for kickbacks and I then have a positive burden to prove that I am not getting clandestine remuneration from the lab.

Separate, disjointed, billing through bureaucratic negotiation is legible. It is legible to the courts, to regulators, and to malpractice insurers.

But doesn’t all this massive change efficiency of care delivery?

Not that I can easily see. I have personal experience with IHS, TriCare, Kaiser, the VA, and for-profit, non-profit, and even prison care; full Beveridge like IHS is often the least efficient.

So where do cash prices come from? Outside of cash only practices, those are overwhelmingly fictions that somebody pulled out of their nether regions in a likely futile attempt to BS the counterparty to an insurance negotiation.

Why is this all so complicated:

1. Principle agent. The patient has a wildly different incentive structure than the collective payer (insurance or government) and American healthcare is insanely deferential to the patient compared to alternatives. The folks with the most direct control feel at most a small fraction of the price pain have near zero incentive to economize for anything big.
2. Taxes. The original sin of American healthcare was making insurance, rather than medical procedures themselves, tax deductible. This creates very strong incentives for people to bundle non-healthcare into insurance premiums in hard to define manners (e.g. is a health insurer offering a rebate for gym membership incentivizing exercise, allowing folks who would already have gym memberships to pay pre-tax, or just selecting for healthier patients).
3. People are terrified of physician abuse. Most folks, even other physicians, have a very hard time knowing if their physician is taking them for a ride. So they turn to something powerful to regulate physicians. But, not knowing what actually matters, these folks find it extremely hard to navigate market transactions. Healthcare would far rather have 100 unattributable deaths and 2x costs than to have 1 attributable death that regulation could avoid.
4. A complete disconnect between what folks experience for prices (e.g. my tape easily costs 10x more than department store specials, my EMR internal word processor is an order of magnitude more expensive than MSWord let alone Emacs or the like) and how medical expenses run.
5. A failure to appreciate the costs of having things on standby. We have folks ready incase a simple IR procedure perfs the vessel walls. We have countless folks handy in case your infusion leads to anaphylaxis. Or your blood transfusion moves on to TRALI. Just opening the doors typically means that we need to have a few dozen physicians and their support staff available at all times. I’ve seen a simple gallbladder turn into a massive transfusion with staging, SICU, and the whole works. I have seen STD treatment turn into a catastrophic emergency of the sort that gets Derm to come in at oh ass hundred.

None of those go away if we post prices. And a lot of people will be upset – somebody will decry us pricing differently for different patients – everyone deserves the same care at the same cost. Somebody will decry us for not pricing differently enough – people should be reward for making good decisions.

Long run, healthcare is going to get more expensive. I expect it will eventually be on part with mortgage payments (you know you live in your body 24/7). But there is an evergreen fantasy that … if only … then we could reduce prices.

You can’t. You can, maybe, make them rise more slowly, normally for harsh tradeoffs Americans won’t stand. And just about every significant intervention that really moves the price needle … is either selection (e.g. health share ministries have wildly healthier populations because they are heavily selected about drugs, promiscuity, and the rest) or given entirely back by the patient dying later. And the handful of things to do pass muster (e.g. HPV vaccination, Hep C treatment) … it becomes yet another morass of how much to pay whom.

Healthcare is not a normal market. We should stop pretending it could be one.

[ed. Hence single payer, or Mediare for All. It won't solve everything, but having the government and all its various compliance mechanisms working to cut costs can't hurt.]

***
Comment: There is plenty of data from which to compute averages and provide a published estimate against which performance can be tracked. That's what consumers of professional services do in actual free markets. Making every transaction in this sector a Persian rug bazaar involving third parties with no input from the actual consumer is not how you lower costs.

Response:

It is, however, one of the more common ways to comply with regulations, liability mitigation, and uncompetitive negotiations.

The other alternative is to vertically integrate a market under and a mono(dou)poly and put all the service lines and fee sources under one roof. This has the advantage that one entity on the provider side does have all the costs and profits on one balance sheet ... but so far it is, at best, a complete bust for lowering prices (and at worst actively raises them through local monopoly power).

There is one set of constraints on healthcare that makes this a hash. It is the nature of payments, the nature of regulations, the nature of malpractice risk, and a heavy dose of inertia.

But with no single problem we also see no hope for one singular quick fix.

If you want me to lower costs (in the short term): let me own a hospital with 50 fellow physicians, allow us malpractice liability protection provided we hit prespecified milestones (and I largely don't care what you pick as long as the traditional hospitals have to meet them too), create financial incentives for patients to economize, and allow us to charge patients more aggressive for different risk and cost profiles.

Long run, all of those will fall, but our healthcare billing system wasn't built for efficiency or even naked profit maximization. It was built for regulatory compliance and navigating the insurance premium tax exemption from WWII.

***
Comment: Wait a minute here. The reason some engineering project can't be estimated in advance is because it's hard to know how many people it will take and how long. It's because it is estimating an unknown that might take 4 years or 4 months. A SURGERY should be easier to estimate. Yes, you might cut open the patient and decide the problem is cancer and not gallstones. Or they are a woman and not a man, but the surgery isn't suddenly going to take 4 years longer.. It's not going to take 4 days longer either. Of course .... if the GOVERNMENT is involved then they might get wildly different costs. But it isn't the complex nature of surgery that makes the estimate difficult. And you might say, well finding out it's cancer means a whole new cost structure .... yes it does. But THAT given surgery shouldn't change so vastly in price because of it. The new diagnosis is an entirely new issue. My MECHANIC can figure out how to call me an give a new estimate if he's there to change the oil and finds out the engine block is cracked.

No. The problems with pricing have been CREATED by massive government regulations.


Engineering projects don't have to change workforces halfway through. I have seen a surgical procedure swap successively from IR to vascular surgery to cardiothoracic surgery to neurosurg to transplant (this did not end well for the patient).

And that is part of the thing. If your mechanic encounters a cracked engine block, he waits, orders a new one, and then recommences work at leisure. Your surgeon, is diagnosing the car, while is going 80 down the freeway, has to fix the crack (because replacement parts are generally unavailable and insanely expensive for OEM if they are) without slowing down while the engine is running, and then has to make certain that his method of repair won't compromise the running of the car.

Mind you running through different surgeons often means calling in different teams (surgical assists very often specialize de facto if not de jure). And the bills mount quickly. Last time I saw the numbers, each marginal minute of OR time works out to ~$100 of extra costs (most of which is labor). And that is excluding the cost of bumping somebody off the schedule; if you are the penultimate case of the day and the system doesn't have slack to run later into the night you might well run 80 minutes over and then force us to scrub a three hour, high cost procedure which then mucks up even more OR times the following day.

Like the OR is the hotel problem are crack. Hospitals generate massive revenue by keeping ORs in constant use (spread the overhead over more patients) and a quadrupling of OR time is not going to quadruple the cost of a surgery to the system - it will often cost far, far more than.

And there are other margins. We get a bit leery about undertaking certain, technically "elective" procedures when the SICU is too full. If we are short on anesthesia folks that can bump out other patients too. If this is not a trauma I, surgical novelty can mean burning through our blood product inventory, and if that gets bad enough that means putting the ED on diversion (in which case we are paying for a lot of ED staff who are generating no revenue).

For stuff like OR, hospital efficiency is only as good as the weakest leak and because everything is often on a tight timetable with little margin (because margin costs more money) small failures can cascade to far bigger costs.

Which, generally, is not such an issue for the engineers. After all, if work halts on building one dam, it frees up labor and resources for another.

Can we just build that into the prices? Yes. And that is what vertically integrated shops do and they average the truly horrific cases over a lot of surgeons.

But for a single surgeon's office? Yeah, no. If they quote you the full range of possible costs it will likely span three orders of magnitude for the cheap stuff.

Which is part of why separate billing works. If you go in and they find you need a different surgeon, it isn't like folks have prenegotiated every possible permutation of who else needs to take care of you. They find something wonky, they call in the cavalry, and then separate bills are generated for each.

Like I've worked with engineers to build a hospital. The number and interactions of their own unknowns was simply an order of magnitude or two lower.

***
If people want wildly cheaper healthcare they already know how to do it: don't smoke, exercise, eat not complete garbage, get married, have lots of sex, have kids, go to church, hang out in person with friends, sleep soundly with a steady schedule, get educated/earn lots of money, don't do drugs, drink no more than one standard drink a night (and like just one or two a week), don't engage in crime, get car with a bunch of safety technology, live close to work/get a remote job, don't gamble ... like all of these have good correlational data and when you do two-thirds of them you almost invariably end up having a way cheaper life course expenses (e.g. most of the above are correlated with lower odds of needing institutional memory care). Some of it is given back because you live longer ... but people know this. They just have a hard time giving up vices (i.e. things where the immediate reward is too tempting for them to hold out to get their preferred long run payout) or actually prefer the less healthy habits.

[ed. What a system, eh? Everyone in the business of billing medical reimbusement is incentivized to make it as complex and opaque as possible. Every major medical procedure now risks financial catastrophe.]

Tuesday, April 21, 2026

Into the Wood Chipper

The destruction of USAID was just as dumb as it seemed

On February 5, 2025, after USAID’s name had been taken off the building, after most of its staff had seemingly been placed on leave (it was hard to be sure—HR couldn’t confirm because they were also largely locked out of the system), Nicholas Enrich was called in to justify the agency’s global health programming to the Trump administration’s newly-appointed USAID leadership.

According to Enrich, he spoke for about five minutes about USAID’s lifesaving health work: diagnosis and treating HIV and malaria, immunizing children, responding to emerging pandemics. His presentation was met by silence, which senior official Ken Jackson eventually broke. “Wow, there really is so much that USAID does that we never knew,” Jackson said.

Joel Borkert, USAID’s Trump-appointed acting chief of staff, agreed: “I had no idea you did all this. As a Republican, when I think of what USAID does in global health, I assumed it was just, you know, abortions.”

Adam Korzeniewski, the White House liaison to USAID, was similarly enlightened, and he had an idea. To help raise attention to the importance of programs to fight drug-resistant tuberculosis, “he suggested that [they] draft a simple, ‘Barney-style’ set of slides to help the political leadership grasp the dangers, referring to the purple dinosaur of children’s television.”

Korzeniewski acknowledged that most of the relevant officials weren’t “health people,” but he didn’t think that applied to him—he had recently read a book on smallpox. Enrich writes that Korzeniewski had another idea, too:
“One thing I thought of while you were talking,” he added, gesticulating wildly with his hands to conjure the image in his mind. “If you can make one of those maps like they have in Outbreak, where it shows the red growing over time as the disease spreads? You know, like the zombie apocalypse? That would be great, very effective.”
Much of Nicholas Enrich’s new book proceeds like this, describing a process so surreal that it verges on the comical until you remember that millions of lives were in the balance. Into the Wood Chipper: A Whisteblower’s Account of How the Trump Administration Shredded USAID follows the 42-day spell that took Enrich from a relatively anonymous USAID worker to its highest-ranking health official to the author of a widely-reported memo detailing the deadly consequences of the destruction of USAID.

Into the Wood Chipper occupies the somewhat unique genre of civil service thriller, only to then verge into horror. More than anything, it was a 206-page reminder that what happened was so, so murderously dumb.

by Tim Hirschel-Burns, Together But Apart |  Read more:
Image: uncredited
[ed. See also: Everyone is misunderstanding what happened to USAID (TBA):]
***
The problem is that the development sector’s reckoning with the destruction of USAID has been largely unmoored from what actually happened. The post-mortems have tended to follow a similar recipe: a dash of lamentation and a spoonful of self-flagellation, topped with one cup of the author’s pre-existing policy preferences—all of which bear a tenuous relationship to what actually doomed USAID...

When Trump took office and DOGE went into USAID, even they didn’t plan on destroying it. But two weeks later, USAID was functionally dead. In the end, the administration terminated 83% of USAID projects, shuttered USAID as an independent agency, and kept on just 300 of USAID’s over 10,000 staff in the State Department.

Monday, April 13, 2026

Why Your Job’s Complexity Level May Affect Your Risk of Dementia

Getting an education is important for a lot of reasons, but there might be one reason you haven’t heard — it could lower your risk of dementia later in life. Decades of research have supported this claim, with one study showing that each additional year of formal education lowers the risk of Alzheimer’s disease or other types of dementia by 7 percent.

Now, a growing body of evidence suggests that the jobs we hold throughout our lives may matter just as much or more than years of education. Having a job that involves high levels of decision-making or creativity, rather than repetitive or manual tasks, could help keep the mind sharp and active.

“Many studies suggest that, if people are working in complex jobs during their lifetime, they have a lower likelihood of developing dementia in later life,” said Jinshil Hyun, assistant professor of neurology at Albert Einstein College of Medicine.

Roles like managers, teachers, lawyers and doctors are considered high complexity jobs, while clerical, transportation and assembly line work have lower complexity. The findings are consistent with the idea that taking part in mentally stimulating activities throughout the lifespan can help preserve late-life brain health and boost cognitive reserve — the brain’s ability to cope with age- or disease-related changes.

But don’t worry if your job doesn’t meet the criteria — there are other things that you can do to improve your cognitive reserve, such as reading, socializing and volunteering.

Why work might be linked to dementia risk

“We spend most of our day in work, at least eight hours a day. So that’s like, a third of our time engaged in work, sometimes more,” said Naaheed Mukadam, professor of psychiatry at University College London. “That’s a large part of what our brain is engaged in and therefore will have a large contributory effect on cognitive reserve development.”

In a recent study, Mukadam and her colleagues investigated which factors could be influencing education’s protective effect against dementia. Their analysis included 384,284 participants and took note of health behaviors like drinking, smoking and exercise; medical conditions like hypertension and diabetes; occupational complexity; and income. The results uncovered that occupational complexity is actually the biggest reason more education tends to lower your risk of dementia, accounting for more than 70 percent of that link.

“We found that occupational complexity explained the biggest proportion of that relationship between education and dementia,” she said. “People who have more education tend to get into better paid, more complex jobs. Then, the benefits for their physical and cognitive health compound in that way.”

Multiple studies have found that those with higher income have a lower risk of dementia, and the researchers speculate that job complexity likely plays a major role in that relationship as well.

Similarly, Hyun and her colleagues found in a 2021 study that occupational complexity is predictive of later-life dementia, independent of education. They looked at the effects on dementia-free survival time, or how many years a person lived before being diagnosed with dementia, in 10,195 participants from six countries. As expected, high school graduates had a 26 percent increase in dementia-free survival time compared to people who only completed middle school or less.

After controlling for education, high occupational complexity, compared to low occupational complexity, was associated with a 19 percent increase in dementia-free survival time. Hyun speculates that the greater mental stimulation of a complex job builds cognitive reserve, which helps people resist cognitive decline and stay mentally sharp for longer, even in the presence of harmful plaques seen in Alzheimer’s-affected brains.

“The cognitive reserve hypothesis suggests that, if people are doing cognitively enriching activities, then their brain has a more efficient network,” Hyun said.

by Meeri Kim, The Washington Post/Seattle Times |  Read more:
Image: iStock
[ed. Or just develop a life long love of learning. Eric Hoffer would be a good example (longshoreman/philosopher). What'll happen when more people offload their thinking to an AI assistant?]

Tuesday, April 7, 2026

Intraventricular CARv3-TEAM-E T Cells in Recurrent Glioblastoma

In this first-in-human, investigator-initiated, open-label study, three participants with recurrent glioblastoma were treated with CARv3-TEAM-E T cells, which are chimeric antigen receptor (CAR) T cells engineered to target the epidermal growth factor receptor (EGFR) variant III tumor-specific antigen, as well as the wild-type EGFR protein, through secretion of a T-cell–engaging antibody molecule (TEAM). Treatment with CARv3-TEAM-E T cells did not result in adverse events greater than grade 3 or dose-limiting toxic effects. Radiographic tumor regression was dramatic and rapid, occurring within days after receipt of a single intraventricular infusion, but the responses were transient in two of the three participants. (Funded by Gateway for Cancer Research and others; INCIPIENT ClinicalTrials.gov number, NCT05660369.)
***

Glioblastoma is the most aggressive primary brain tumor, and the prognosis for recurrent disease is exceedingly poor with no effective treatment options. Chimeric antigen receptor (CAR) T cells represent a promising approach to cancer because of their proven efficacy against refractory lymphoid malignant neoplasms, for which they have become the standard of care. However, the use of CAR T cells in solid tumors such as glioblastomas has been limited to date, largely owing to the challenge in targeting a single antigen in a heterogeneous disease and to immunosuppressive mechanisms associated with the tumor microenvironment. 

In a previous clinical trial, we found that peripheral infusion of epidermal growth factor receptor (EGFR) variant III–specific CAR T cells (CART-EGFRvIII) safely mediated on-target effects in patients with glioblastoma. Despite this activity, no radiographic responses were observed, and recurrent tumor cells expressed wildtype EGFR protein and showed heavy intratumoral infiltration with suppressive regulatory T cells. To address these barriers, we developed an engineered T-cell product (CARv3-TEAM-E) that targets EGFRvIII through a second-generation CAR while also secreting T-cell–engaging antibody molecules (TEAMs) against wildtype EGFR, which is not expressed in the normal brain but is nearly always expressed in glioblastoma. We found in preclinical models that TEAMs secreted by CAR T cells act locally at the site where cognate antigen is engaged by the CAR T cells in the treatment of heterogeneous tumors. We also found in vitro that these molecules have the capacity to redirect even regulatory T cells against tumors. On the basis of these data, we initiated a first-in-human, phase 1 clinical study to evaluate the safety of CARv3-TEAM-E T cells in patients with recurrent or newly diagnosed glioblastoma. Here, we report the findings from a prespecified interim analysis involving the first three participants treated with this approach. [...]

Discussion

This study shows that antitumor CAR-mediated responses can be rapidly obtained in patients with glioblastoma, even in those with advanced, intraparenchymal cerebral disease. This finding contrasts with a previous report of a complete response that was observed in a patient with recurrent leptomeningeal disease who received treatment with 16 intracranial infusions of monospecific interleukin-13 receptor alpha 2 CAR T cells. It was hypothesized by the investigators of that study that the involvement of glioblastoma in the leptomeninges may have rendered the disease more responsive to intraventricular therapy. Our experience in the current study suggests that even a single dose of intraventricularly administered living drugs such as CAR T cells also have the capacity to access and mediate activity against infiltrative, parenchymal glioblastoma.

by Bryan D. Choi, M.D., Ph.D., Elizabeth R. Gerstner, M.D., Matthew J. Frigault, M.D., Mark B. Leick, M.D., Christopher W. Mount, M.D., Ph.D., Leonora Balaj, Ph.D., Sarah Nikiforow, M.D., Ph.D., Bob S. Carter, M.D., Ph.D., William T. Curry, M.D., Kathleen Gallagher, Ph.D., and Marcela V. Maus, M.D., Ph.D. NIH, National Center for Biotechnology Information |   Read more:
Image: via
[ed. Only three patients (so far) and it appears sustained treatments are needed to prevent recurrence. But still, pretty interesting.]

Thursday, March 19, 2026

Millions of Americans Are Going Uninsured Following Expiration of ACA Subsidies

Nearly one in 10 people who had Affordable Care Act plans last year dropped health insurance altogether, after premium costs rose sharply because of the expiration of federal subsidies, according to a new survey.

Most of those who remained in ACA plans reported larger out-of-pocket healthcare expenses in the form of higher copays, coinsurance or deductibles, according to the survey from health-research nonprofit KFF. About one-sixth of those who still have ACA coverage, or 17%, weren’t sure they would be able to afford their new premium payments for the entire year, indicating more people might drop insurance as the year goes on.

The survey is the broadest look yet at the fallout from the end of enhanced ACA subsidies, which lapsed at the start of this year, increasing premium bills for millions of enrollees. The higher healthcare costs have forced many ACA policyholders to make hard choices at a time when grocery and gas prices are also rising.

In February and early March, KFF polled 1,117 people who had ACA plans in 2025 and found that the most common reason people cited for dropping insurance was cost. Last year, more than 20 million people had ACA policies.

“Not only is there significant coverage loss, but there could be more to come,” said Cynthia Cox, a senior vice president at KFF. She said the survey results were “about on target” compared to what had been expected.

Of those surveyed, 69% still have ACA policies this year. Beyond the 9% who said they are uninsured, 22% of respondents now have some other type of coverage, such as Medicare or employer-sponsored insurance.

Kelly Rose, 59 years old, who lives near Orlando, Fla., became uninsured this year because she couldn’t pay the roughly $1,700 monthly bill to keep the ACA plan she had in 2025. “It’s more than my mortgage,” she said. The cost is a huge jump compared to 2025, when she got help from a subsidy, she said.

Though her job at a bank offers health insurance, she said she missed the enrollment window in the fall because she had planned to keep the ACA plan, not realizing how much it would cost.

Rose is now turning to a Canadian pharmacy to get her asthma medication, which costs $800 a month in the U.S. [...]

The ACA changes, which were the subject of a political battle that led to the longest-ever government shutdown last year, are likely to become a flashpoint again in this fall’s midterm elections. Democrats have blamed Republicans for failing to renew the expanded subsidies, and for growing healthcare costs. Republicans have argued the ACA is flawed and needs to be changed.

by Anna Wilde Mathews, Wall Street Journal |  Read more:
Image: Nate Ryan for WSJ
[ed. Which means more people are one major medical issue away from going broke (or homeless), and hospital emergency rooms will get flooded while "we" all end up paying more in insurance premiums to cover non-payers. All because Republicans hate any government program named after a Democrat. Insane. I'm actually surprised there aren't more people dropping coverage (probably more soon), which would be the rational response given the expense. See also: How New Mexico Became an Obamacare Success Story (NYT). Hint: state subsidies.]

Monday, March 9, 2026

Please Hold

She called 911 for an ambulance. She got a nightmare instead.

When Pamela Hogan phoned 911 from her Seattle apartment, she was suffering from knee pain so intense she couldn’t stand up. She had been trapped in her bed all day, unable to eat, drink or get to the bathroom. Worried and alone, Hogan thought an ambulance would come quickly and take her to the hospital.

She was mistaken.

Seattle no longer is capping ambulance wait times for certain 911 patients, tracking those waits or penalizing its ambulance contractor when they run long.

Rather than send Hogan help right away, the Fire Department routed her to a nurse in Texas who determined her crisis didn’t need immediate attention.

So the 71-year-old, a retired executive assistant who loved cooking casseroles, watching “Judge Judy” and listening to The Pointer Sisters, waited one hour for a nurse-ordered ambulance, according to call recordings and court documents.

Two hours. Three hours. Four hours, phoning 911 back several times and telling the Fire Department about a heart condition. Ten hours.

By the time an ambulance arrived at Hogan’s building, it was the middle of the night and she wasn’t answering her phone. The ambulance left without her.

Weeks later, her body was found decomposing on the floor of her bedroom.

It’s not clear Hogan’s wait is what killed her, but her estate has sued and her experience raises questions about Seattle’s relationship with its for-profit ambulance contractor, American Medical Response, which also provides the city’s 911 nurse line.

“More checks and balances and accountability need to happen,” said Josephine Ensign, a professor emeritus at the University of Washington School of Nursing who called Hogan’s case concerning and upsetting. “Seattle can do better.”

Seattle and AMR have denied the lawsuit’s wrongful death allegations and say the nurse line is generally working as intended. They say it’s reducing strain on hospitals and ambulances by diverting low-level patients to more appropriate care.

But most Seattle callers triaged by the nurse line are still being sent to hospitals in AMR ambulances, rather than being diverted, program data reveals. And officials have exempted those nurse-ordered rides, like Hogan’s, from city standards that normally require the company’s ambulances to arrive on time.

It’s possible that Hogan’s experience was an aberration. But the city stopped tracking ambulance waits like hers in 2022, so officials have no way to know. [...]
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Hogan’s wait started when she dialed 911 on the afternoon of April 8, 2022.

“I’ve got really bad knees because of rheumatoid arthritis and there is damage to them as well, and I’ve gotten to the point where I can’t get up,” she told the Fire Department dispatcher who answered, according to a recording of the call obtained through a public records request. “I’d like to go to the ER and have them look at my knees.”

Hogan had used 911 for emergencies before, assuming this time would be the same. Instead, her call was transferred to the nurse line operated by AMR’s parent company, Global Medical Response, from a call center outside Dallas.

“I’m going to bring the nurse on the line here and let them kind of help figure out the best course of action,” the Fire Department dispatcher said.

Hogan told the nurse she had been stuck in bed all day and had completely filled an adult diaper, according to a recording disclosed by AMR in the Hogan litigation. She described her pain intensity as 10 out of 10.

“I will get someone out to you,” the nurse said. “To get you to the hospital.”

Then the nurse ordered an ambulance, recommending care within four hours, according to another recording disclosed in the Hogan litigation. An AMR dispatcher in Seattle said it would take three to four.

Neither of them told Hogan, who was no longer on the phone.

Strained system

In the years before Hogan’s emergency, the Seattle Fire Department and AMR were dealing with a mounting number of 911 calls from patients with low-level needs, said Michael Sayre, the Fire Department’s medical director.

A sore throat. Anxiety. A stomachache. Patients who don’t really require emergency transport and care. The city received 44% more low-level medical calls in 2021 than in 2017, according to Fire Department records.

Few 911 patients receive lifesaving interventions and most emergency room visits are for nonemergency issues, national research has shown. People sometimes dial 911 not because they’re in imminent danger but because they’re not sure whether they’re sick or not, Sayre said.

These patients put pressure on the Fire Department’s dispatchers, who work long, grueling shifts. Such calls often involve homeless people or other patients without regular doctors, noted Ensign, whose decades of Seattle-based work has focused on health and social inequities.

“They don’t know what else to do, so they call 911,” Sayre said.

For acute 911 calls, the Fire Department sends its own highly trained crews. They can transport patients in red Medic One ambulances or hand the patients off to AMR emergency medical technicians in white ambulances.

For less-acute calls, the department may simply send AMR. One way or another, the company handles most of Seattle’s ambulance responses, approximately 50,000 annually. [...]

New program

Like other cities that use ambulance contractors for 911 callers, Seattle allows AMR to bill patients. In return, the company must meet standards for patient care: For years, its ambulances were supposed to arrive within 11½ minutes for more-urgent calls and one hour for less-urgent calls, at least 90% of the time.

But in the wake of the COVID pandemic, AMR was struggling with ambulance staffing in Seattle, arriving late for many of its 911 patients and paying a price, Fire Department records show. The city assessed the company almost $1.4 million in contract penalties for ambulance delays in 2021.

Enter the Nurse Navigation program, which Seattle and AMR leaders said would relieve that strain and improve ambulance response times in the city by diverting low-level callers to cheaper, better solutions. When it launched with fanfare in February 2022, then-Mayor Bruce Harrell called it “a strong example” of how to make a system “more efficient and ensure better care at the same time.”

The idea wasn’t new: King County had been using a 911 nurse line on a smaller scale for years, and cities across the world were experimenting. When implemented well, these programs can deliver real benefits, many experts say.

Seattle preferred not to hire its own nurses, said Sayre, the medical director, citing the costs involved. So the Fire Department turned to AMR, which agreed to triage the city’s callers almost for free. AMR had launched Nurse Navigation in Washington, D.C., in 2018 and had been attracting positive attention. [...]

Requirements removed

Before Nurse Navigation, patients like Hogan could expect assistance in under an hour. That changed in 2022 with an amendment to AMR’s contract that gave nurse-ordered ambulances a reprieve from any response-time standards.

Seattle and AMR officials say this made sense, because the nurse line is allowing ambulances to prioritize critical patients over stable ones. The company is no longer incurring late penalties for its Seattle responses still subject to time standards, a representative said, citing the nurse line and better recruiting.

But the city removed a significant guardrail when it removed standards for an entire category of ambulance rides, experts contend. Last year, more than 4,600 rides ordered were completely exempt from time standards and contractual penalties.

“Your community’s leaders may think 10-hour waits are OK,” said Matt Zavadsky, a nationally recognized health care administrator who managed a 911 system and helped start a nurse line in Fort Worth. “If your community’s leaders are not OK with that, you need a contract that prevents that.”

Instead, Seattle has left itself in the dark. Response times for nurse-ordered ambulances are excluded from AMR’s monthly reports to the Fire Department, so the city doesn’t know how long patients like Hogan are waiting.

by Daniel Beekman, Seattle Times |  Read more:
Image: Jennifer Luxton / The Seattle Times