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Trust In Science Falls Fastest Among Those Left Behind
Poor access to healthcare, limited local influence over research priorities, and an unequal distribution of scientific benefits are undermining public
Letitia James is the most 'political' AG in the country: Jonathan Turley
Constitutional law expert Jonathan Turley and criminal defense attorney Donna Rotunno analyze the Cornell sexual assault investigation and the federal probe into Congresswoman Ilhan Omar on 'Fox News Sunday.'
Obama calls Trump administration’s investigation into Ilhan Omar ‘appalling’
Former President Barack Obama on Sunday called the Justice Department’s investigation into Rep. Ilhan Omar “appalling,” saying the government is attempting to intimidate and deport one of President Donald Trump’s most outspoken critics.
Streaming’s Biggest Show Returns…and a Buzzy Genre Struggles
(Welcome to my weekly streaming ratings report, the single best guide to what’s popular in streaming TV and what isn’t. I’m the Entertainment Strategy Guy, a former streaming executive who now analyzes business strategy in the entertainment industry. If you were forwarded this email, please subscribe to get these insights each week.) Obviously, the big news of the week (if not month) is Netflix letting go of executive Bela Bajaria, their chief content officer. I’m going to cover this in my next “Most Important Story of the Week”, but I also have a data angle that I might publish before then. (Too much news this month, am I right?) But first, I have a bonus Streaming Ratings Report issue for you. Today’s article is a bit of a grab bag of topics I’ve wanted to write about, but couldn’t squeeze into the (already very long) Streaming Ratings Report issues. The NFL drives huge viewership numbers, so I’ve got a look at that. A whole bunch of TV shows returned to the traditional broadcast channels, and I have thoughts. And I have a quick look at adult animated shows, since a couple flopped earlier this month. Plus, the Emmys aired earlier this month, and we got some fun data bout how popular those nominated shows are and why I’m not optimistic about the show’s future. That’s a lot, so let’s dive right in. Subscribe Sports - Football Remains the King of Streaming Over the last two Streaming Ratings Reports, I sorta ignored the biggest “show” each week. (I was tempted to say “piece of content” but I know that word bugs folks.) In my database, I call these “specials”, and they sure are special. I speak of the king of American TV: football!!! Streaming football is back and, unlike some other sports, it routinely dominates all viewership. Probably the best way to show this is to update one of my favorite graphics, the “40 Million Hour Club”1 since football games have joined that club each week they’ve premiered: (Yep, that’s the data through 28-Sep, the first four weeks of the season. As a reminder, I take the average minute audience provided by Nielsen, factor out a percentage of linear TV viewers in home markets, and multiply the run time by the three-hour runtime.) Again, the numbers are huge. Let’s start with Netflix. They grabbed the rights to the bonus opening week NFL Kickoff game (which was on YouTube last year) and it put up 18.5 million viewers on average. That nets out to 47.4 million hours of estimated streaming hours. That’s good! Though, notably, it’s well below Christmas Day games from previous years. Compared to other streamers/broadcasters, that’s a bit of a mixed result. On one hand, Netflix’s 18.5 million average is about what YouTube claimed last year, though Nielsen used a bespoke methodology at that time, so I trust this viewership figure more. So that’s good. (The game also shifted from a Friday to a Thursday and that could have helped the viewership as well.) And Netflix continues to best Prime Video in total viewership—as you’ll see next—though Netflix has had much higher-profile (opening week and Christmas Day) games. NBC/Peacock’s opening game the night before averaged 25.1 million average viewers, which is just much bigger than Netflix (or Prime Video). That’s the big caveat to all streaming viewership records: even in success, they can’t compete with traditional linear TV. Previously, I called this my “hierarchy of viewership”, and the data keeps supporting that thesis. The downside for NBC is that this game’s viewership was down compared to previous years, though it may be a counting issue. Here’s a great chart from Sports Media Watch: Indeed, looking at all the opening week games across all windows, Netflix still lags the other primetime windows, but does well compared to the afternoon games: I saw a few folks make the case that streamers still lag traditional broadcasters in reach, and I’d add they really lag compared to “broadcast plus streaming” options like NBC/Peacock, ESPN/Disney+ and CBS/Paramount+. The best data I saw for this came from Samba TV, who charted reach through the 2025 season, and, wow. (Samba TV’s numbers are historically lower than Nielsen’s, so don’t compare their household figures to Nielsen’s hours, but use them as a proxy for the relative reach of the streamers.) The good news is Prime Video is NOT having a down year. Their opening Thursday Night Football game reached 18.6 million viewers (about what Netflix got), but that’s a high for Prime Video on Thursdays and the biggest Thursday night game since 2015. The TNF games the weeks of 21-Sep and 28-Sep continued this streak, getting 43.1 (16.8 million average viewers) and 42.5 total hours (16.6 million average viewers), which were both up from last year. Still, that continues the (typical) season slide: (For those new-to-streaming-football-numbers folks, the viewership declines for Thursday Night Football as the year goes along.) Overall, it appears as if Prime Video is now part of the “football habit”, be it for customers at home or out at places like bars and restaurants. And its viewership is slowly catching up to broadcast. One last chart shows this. Last season, Nielsen started adding out-of-home viewership to the charts, so I try not to do season-to-season comparisons as I did for the first few years. And while Nielsen added Big Data viewing this year, I’m going to compare the last two seasons. Here’s that chart, which shows the season-over-season gains: When it comes to streaming football, we have to keep a few seemingly contradictory thoughts in our head… First, streaming doesn’t come close to matching broadcast’s reach and, thus, viewership. Second, even with that gap, football is still the biggest “thing” on streaming. It’s very, very popular. Third, while some methodology changes have likely helped Prime Video’s numbers, their viewership does appear to be growing. Lastly, yeah, the NFL started the season off poorly, with week one dragging down the numbers in year-over-year comparisons. However—and again, methodology changes may have helped this—the viewership grew compared to previous seasons over the next couple of weeks. So football is still king. On streaming and off. Television - Adult Animation Continues to NOT Make the Streaming Charts In the last two reports, two adult-animated shows whiffed: Netflix’s animated comedy, Dang! Paramount+’s Sega-video-game-inspired fantasy/comedy, Golden Axe. Neither made the charts, but that’s usually the case for animated shows. I mean, here’s literally every animated show that’s made the Nielsen Original charts since the start of 2025: And one of those shows is G_abby’s Dollhouse_! A kids show! The problem with charts like this is that they don’t give you a sense of how many shows miss the charts. Netflix had at least eleven animated flops, including comedies like Big Mouth (a show everyone assumed was popular in the pre-Streaming Ratings Era), Long Story Short, Haunted Hotel, Mating Season, Strip Law, and Alley Cats, and action shows like Blood of Zeus, Castlevania: Nocturne, Devil May Cry, Splinter Cell: Deathwatch, and Tomb Raider: The Legend of Lara Croft. Prime Video had at least six animated misses, two in the same universe (Hazbin Hotel, Helluva Boss), three more comedies (#1 Happy Family USA, The Second Best Hospital in the Galaxy and Kevin) and an action show (The Mighty Nein). Disney+ had MCU and Star Wars animated misses (Eyes of Wakanda, Marvel Zombies, Star Wars: Visions, Star Wars: Maul – Shadow Lord, and Star Wars: Tales of the Underworld) but I can’t tell how many of those shows were geared towards adults. HBO Max had Harley Quinn and Hulu had Solar Opposites. None of these shows made the charts! That’s a lot of misses! If I remade the chart with all those misses, here’s how it would look: Listen, I know the counter arguments. First, it’s cheaper to produce animated shows than live action. Fair enough, but with viewership this low, even that cheaper price point starts to not matter. Second, just look at the acquired charts. Hit animated comedies can generate viewership for years! Shows like The Simpsons, South Park, Family Guy, and Bob’s Burgers do really, really well. Fair enough, but streaming has failed to recreate the dynamic that Fox has mastered so well. That’s a problem for streaming still. Television - Emmys! The annual Emmys broadcast was a few weeks ago, and I’ve got data on how the nominees performed on streaming, plus hot takes on this year’s viewership (and the big news about the broadcast’s, er, streamcast’s future). We’re just getting started with this issue, but the rest is for paid subscribers of the Entertainment Strategy Guy, so if you’d like to find out… The top Emmy-nominated shows… ...why I’m worried about the future of the Emmys telecast... ...the pros of broadcast television ...and the cons... ...please subscribe! We can only keep doing this great work with your support. Coming Soon! Next week, we’ve got a double issue (since the weeks of 21-Sep and 28-Sep were so light), but then I’ll be all caught up after a deluge of streaming ratings data from Nielsen in September. In the meantime, I’m going to try to take a look at Netflix’s stats to explain why Bela Bajaria is out. But even light weeks give me plenty to talk about. The Great British Baking Show returns to Netflix and Apple TV has a buzzy new star-studded comedy. And Netflix has a controversial-but-appears-to-be-popular new game show. Plus big films like Toy Story 5, Backrooms and The Breadwinner head to streaming. And is East of Eden a hit? After that, The Kardashians return to Hulu, Prime Video has a reboot of Carrie, and Netflix has a horror show, Below. Disclosure Day heads to Peacock, The Housemaid heads to HBO Max_,_ a new Ben Affleck film, Animals, lands on Netflix, and Apple TV has a new John Cena action film based on, checks notes, Hasbro’s Matchbox toys. Okay. Longterm, some interesting TV production news. HBO Max ordered How to Survive Without Me, starring Kaley Cuoco, Joshua Jackson, Ray Romano and Rita Wilson, for fifteen episodes! I love that some streamers (or, at least, HBO Max) are finally ordering TV shows with more than eight episodes. In less wise production news, Landman does not appear to be coming back this year, since it just started production. Frankly, I don’t love this (get your shows out on time) but Landman is so popular, I doubt it matters.
New Tools Let Users Edit and Load Modified VBIOS on GeForce RTX GPUs Without Flashing
A developer who goes by Panchovix has released three tools that let NVIDIA GeForce RTX 50, RTX 40, and RTX 30-series owners run a modified VBIOS without writing anything to the card's flash chip. The first is a VBIOS editor for Windows and Linux that can change power limits, voltage ceilings,...
OnPoint Helps Small Businesses in Oregon and SW Washington Defend Against Latest Cyber Scams - The Source
Cyber threats are becoming harder for small businesses to detect as criminals use artificial intelligence, stolen credentials, and increasingly sophisticated impersonation tactics. Half of small and midsize businesses reported a cybersecurity incident in the past year, according to the National Cybersecurity Alliance’s 2026 Small Business Cybersecurity Awareness & Practices Survey. OnPoint Community Credit Union is highlighting emerging […]
‘This is disgusting’: Nebraska’s independent Senate candidate rips dark money in politics
Democrats are hoping to whittle away at the Republican Senate majority in unexpectedly vulnerable red states like Nebraska. Incumbent Senator Pete Ricketts, a multimillionaire former governor, is defending his seat against independent challenger Dan Osborn, a Navy veteran and industrial mechanic. Osborn says he wants Congress to take back its power, end the war in Iran, lower fuel costs, so we “can worry about little league and bake sales.”
Poll: Americans are anxious, pessimistic and deeply unhappy with Trump ahead of the midterms
The share of Americans who believe the country is on the wrong track is at the highest level of the president’s second term, according to the NBC News Decision Desk Poll.
U.S. taking Putin’s side would be a ‘historic mistake,’ says Zelenskyy
The Ukrainian leader told NBC News’ “Meet the Press” that Ukrainian officials believe the decision to limit Starlink, imposed by Elon Musk’s SpaceX, came from the U.S. government.
Always on, always listening: New AI devices are pushing legal limits and could put users in jeopardy
AI always-listening wearables from Apple, Amazon, Meta and other startups are getting creative with privacy rules and fueling concerns about covert recordings.
Michael and Lori Milken Honored for Transformative Philanthropy | Milken Institute School of Public Health
Michael and Lori Milken received the GW Philanthropy Award at the 2026 Spirit of GW Awards, recognizing their transformative support of public health education.
Scientists Uncover a Hidden Factor That Could Change How We Manage Diabetes
Timing may matter in insulin-treated type 2 diabetes; patients with the steadiest daily rhythms were 2.3 times as likely to meet blood sugar goals, while afternoon activity was linked to smaller swings. People with type 2 diabetes who use insulin need to keep blood glucose from climbing too high or falling too low. In a
Panthers fans optimistic, in spite of short term concerns
What happens when an injured team meets a hopeful fanbase?
‘Astounded’: DOJ vets shocked by timing of Ilhan Omar search
The investigation into a longtime Trump target just weeks before the election broke long-standing Justice Department traditions
Chinese scientists develop nanoparticles to improve pesticide
In a study published in the Journal of Controlled Release, researchers mimicked gut bacteria pili-hair-like structures that function as hooks-to design hollow, rough-surfaced silica nanoparticles
Equatorial Guinea is expanding an ambitious malaria elimination plan
Equatorial Guinea has tackled malaria with a successful strategy on Bioko Island
Why we investigated donations behind Ohio commissioner races
There's no contribution limits for county commissioner candidates under Ohio law.
Thousands rally with Bernie Sanders and Angie Nixon in rainy Ybor City
Their message was helping the working class deal with rising inflation, a lack of health care and unlimited campaign financing by "the oligarchy."
NFL predictions: can Ravens run over injured Browns’ D-line?
On Sunday against the Browns, the Ravens will be looking to execute a similar formula to last week’s win in Atlanta.
Haunted attraction in Kathleen adds mental health mission, with part of sales donated
As Halloween shadows lengthen across Middle Georgia, a haunted attraction in Kathleen is aiming for more than screams, turning fright into support for mental he
House Speaker Mike Johnson draws on faith as he fights to hold the Republican majority
Ever the optimist, Speaker Mike Johnson said he believes Republicans will hold on to their U.S. House majority, defying a surge of Democratic momentum in the final stretch of the midterm elections that will determine control of Congress.
Criminal Justice Reform Isn’t Dead, Despite GOP Attack Ads
A familiar tough-on-crime election strategy is making a comeback, even as Republican and Democratic lawmakers keep passing reforms across the country.
Trump's decision to waive Russian sanctions outrages Congress, but no quick counter seen
Lawmakers from both parties blasted the executive order late Friday, the latest in a series of steps that the Republican president has taken drawing the United States closer to Russia's Vladimir Putin.
Trump's Diesel Deal With Russia Won't Lower Gas Prices for Americans
Donald Trump's diesel deal with Russia is a big favor to Vladimir Putin, but it won't lower prices for Americans ahead of the midterm elections.
Bar Harbor in limbo as legal disputes over cruise ships continue
The disputes stem from an ordinance that aimed to limit disembarkations to 1,000 passengers per day.
Global survey links financial hardship to lower trust in science
Poor access to health care, limited local influence over research priorities and an unequal distribution of scientific benefits are undermining public confidence in science, experts warn, following the ...
Seahawks Handed Blunt Sam Darnold Take Amid Turnover Concerns
Seattle Seahawks QB Sam Darnold is at the center of criticism as the Seahawks offense couldn’t get anything going against the Denver Broncos defense, resulting in a 17-14 Week 6 loss to the Denver Broncos on Oct. 15. Despite the defense limiting the Broncos’ offense to 17 points, that wasn’t enough to get the win. […] The post Seahawks Handed Blunt Sam Darnold Take Amid Turnover Concerns appeared first on HEAVY.
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(ANALYSIS) Political shamelessness threatens democracy by weakening leaders’ respect for ethical principles and the rule of law. Drawing on Plato’s Laws, this article explores reverence as a virtue that encourages humility, self-restraint and recognition of human limitations, arguing that responsibl
Aaron Judge Says Yankees Need Polarizing Teammate To Win
The New York Yankees are looking for answers after another failed season saw them eliminated without a World Series trophy. A new record of at least 17 years in between MLB World Series victories has fans questioning the team’s future. Aaron Judge remains the most important player and the captain of the team. The injury […] The post Aaron Judge Says Yankees Need Polarizing Teammate To Win appeared first on HEAVY.
Michigan Proposal 2 aims to limit corporate money in politics
Michigan voters will decide in November whether to overhaul the state’s campaign finance laws through a citizen-led ballot initiative that would ban utility companies and certain government contractors from donating to state candidates.
Trump suspends new Russia sanctions following deal to purchase diesel, citing ‘national interests’
Passed by Congress with bipartisan support, the sanctions were intended to limit Russia’s revenue streams as the country continues its war against Ukraine.
Inter Kashi vs Odisha FC, NorthEast United vs Kerala Blasters in ISL; Preliminary rounds in Asian Para Games: Indian Sports LIVE, October 17
Here are all the updates from Indian sports on October 17, 2026.
M42 CEO on AI, genomics and the future of healthcare
M42 Group CEO Dimitris Moulavasilis discusses how the Abu Dhabi-based healthcare company is combining artificial intelligence, genomics and clinical services to reshape healthcare. He explores the group’s international expansion, the Emirati Genome Programme and the potential for technology to help doctors identify health risks earlier and move healthcare towards prevention rather than treatment.
Frost Science Museum explores the science behind Pixar’s movie magic with limited-time exhibit - WSVN 7News | Miami News, Weather, Sports
We love a good Pixar movie for the fun and the feels. They make us laugh, they make us cry. But there’s more just aRead More
Vandalia Health Davis Medical Center to offer free workshop for dementia caregivers
Vandalia Health Davis Medical Center will offer a free dementia-caregiver workshop November 4 in Elkins. Registration is required by October 19, and space is limited.
DOJ says California officials who process ballots from suspected noncitizens risk prosecution
The Trump administration is escalating its fight with California ahead of next month's midterm election, warning that local officials who process and tabulate ballots submitted by suspected noncitizen voters are putting themselves at risk of criminal investigation and potential prosecution.
Downtown Portland businesses weigh safety and signs of progress after deadly shooting
Downtown Portland business owners react after police fatally shot a man on SW Broadway. Merchants describe chaos, shifting street behavior, and cautious optimism as crime data shows assaults up, homicides down.
The Leap Second Is No More
The metric might not mean much to laypeople, but leap seconds have been a source of contention in the timekeeping community for years. Now, they’re dead.
UI receives grant for business student wellness
A multimillion-dollar donation to the University of Iowa’s business college, alongside a matching gift challenge to generate even more funds, will help support a student mental health and success initiative
Mountain Dreamers series aims to connect Summit County’s Latino business community
What began as an effort to help Summit County residents navigate their taxes has grown into a broader initiative to support local Latino entrepreneurs. Mountain Dreamers launched its first Café y Emprendimiento in August, inviting...
Bucs’ Josiah Trotter questionable for Steelers game with knee injury
Bucs rookie linebacker Josiah Trotter was limited in practice Friday with a knee injury and is listed as questionable for Sunday’s game against the Steelers. Trotter ranks first on the club in tackles (41) and passer rating allowed (66.
New Mexico judge tosses charges against actor Timothy Busfield, citing prosecutor misconduct
(AP) — A New Mexico judge has dismissed an indictment against “West Wing” and “Field of Dreams” actor Timothy Busfield that accused him of criminal sexual contact with a child, citing prosecutorial misconduct and errors that undermined the grand jury process.State District Judge Joseph Montano granted a defense motion to toss the charges in a decision released Friday.
How healthy are your feet?
Many of us take our feet for granted — until they hurt! In Good Shape finds out how to keep our feet healthy and strong, and what happens when they're pushed to the limit on a 100-kilometer hike.
Small business optimism dips in September NFIB survey
Small business optimism slipped in September as owners grappled with rising costs, higher interest rates and a persistent shortage of qualified workers, according to a monthly survey released by the National Federation of Independent Business. The NFIB Small Business Optimism Index fell 0.8 points to 97.9, just below the survey’s 52-year average of 98.0. The […]
Carriage drivers, union leaders oppose NYC plan to eliminate industry by mid-2028
Horse-drawn carriage drivers, business owners, and union leaders gathered near Central Park on Friday to push back against plans to phase out New York City's horse carriage industry.
Matchday 31: Who can clinch playoffs or be eliminated?
By MLSsoccer staffThis weekend during Matchday 31:Six teams can clinch an Audi 2026 MLS Cup Playoffs spot.One team can be eliminated from Audi 2026 MLS Cup Playoffs contention.Nashville SC can clinch ...
We’re Living in a Golden Age of Hot-Guy Politicians
From Zohran Mamdani and Abdul El-Sayed to Jon Ossoff and Pete Buttigieg, a new generation of politicians is going hard on policy while being easy on the eyes.
In immigrant-heavy Georgia city, Trump to test limits of his midterm message
The visit to Dalton is especially complicated for GOP gubernatorial candidate Rick Jackson, who increasingly has emphasized his independence from the president.
Registration is open for high school winter sports
Registration is now officially open for high school winter sports for the City School District of Albany! Any student in grades 9-12 who is interested in trying out for boys' basketball, girls' basketball, bowling, cheerleading, boys' indoor track, girls' indoor track, spirit team, boys' swimming and diving, boys' wrestling and girls' wrestling is invited to register via Final Forms. Important: please note that registration for winter sports ends on Friday, Nov. 13. Practices and tryouts for winter sports begin on Monday, Nov. 16. FINAL FORMS Each season, the following must be done prior to the first day of tryouts and practices: A parent or guardian must initiate the registration process for their student-athlete in Final Forms, filling out the required forms such as Interval Sports Health History and the Athletic Consent Form. The student-athlete must sign and complete their required forms. A reminder that all students who would like to play an interscholastic sport need to have a current physical conducted within a year on file. PHYSICALS A physical conducted within the last 12 months is mandatory for any student interested in trying out for an athletic team and must be uploaded into the Final Forms platform. Families are encouraged to get a completed physical from their child's physician. If you are unable to get a physical from your child's physician, you can schedule a free physical with Whitney Young's school-based health center by calling (518) 573-2556. Additionally, the district physician will also be available to facilitate sports physicals at Albany High in room 4253 on the following dates: Thursday, Nov. 12 from 10:30 a.m.-2:30 p.m. Friday, Nov. 13 from 10:30 a.m.-2:30 p.m. Sports physicals on Nov. 12 and 13 are free and no appointment is necessary. ACADEMIC ELIGIBILITY REQUIREMENTS Please note that students must have a good attendance record and be in good standing academically to be eligible to participate in an athletic team. Eligibility is determined based on quarterly grades, and interim progress reports will serve as an important academic checkpoint for all student‑athletes. For additional details about academic eligibility, please see our Athletic Code of Conduct. For our winter teams, academic eligibility to start the season will be based on final first-quarter grades. The first marking period ends Nov. 13. Albany High offers free tutoring facilitated by Albany High teachers Monday-Thursday from 3:30-5 p.m. for students who need extra help with their academics. See this flyer for additional details. IMPORTANT DATES Seniors, please mark your calendars for Senior Media Day for winter sports, which will take place on Monday, Nov. 30. All student-athletes playing winter sports will also participate in our winter sports picture days, which will take place Tuesday, Dec. 15–Thursday, Dec. 18. Specific dates and times for each team will be shared once rosters are finalized. OPEN GYM SESSIONS Student-athletes are encouraged to check out our open gym sessions as they prepare for upcoming sports seasons. We’re looking forward to a rewarding winter sports season this year! If you have any questions, please contact the Athletic Department at (518) 475-6310. Go Falcons!
Skubal Refused to Discuss Future After Dodgers Elimination
After a stunning NLCS sweep, Tarik Skubal faces a high-stakes free agency that could shatter records and ignite a bidding war between the Los Angeles Dodgers and New York Mets.
Turn Calf Health Records Into Herd Improvements
There is a cycle of incomplete calf health records and limited veterinary feedback. Breaking it requires practical recordkeeping systems and a commitment to turning data into management decisions.
Starlink a 'major card' for Ukraine, sudden speed limits show risk
The recent disruption of Ukraine's military-grade Starlink service has spotlighted the risks, as well as efforts to diversify communications options.
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.
Plague is stoppable. The next health threat may not be.
The word plague is scary. Centuries ago, the Black Death killed tens of millions of people and changed the course of history. Plague still kills people around the world, and the word still evokes catastrophe. New fears of plague surfaced on October 2, when a lab worker in Irkutsk, Russia, died of pneumonia. Reports suggested that she may have contracted plague through a laboratory exposure. Understandably, people were alarmed. On October 7, the World Health Organization called for the Russian Federation to be transparent about what it knew. WHO issued an update on October 10. Russian authorities told WHO that testing did not identify plague and that investigations found no laboratory release. WHO said confidence in its risk assessment remained limited and that further clinical, epidemiological, and laboratory information was needed. The cause of the woman’s illness remains unknown, and WHO says a laboratory-associated exposure cannot be excluded. As I explained in a recent interview, this incident is very unlikely to lead to a pandemic. Plague is still active, including in the U.S., which sees a handful of cases each year. But it is a disease we can prevent and treat. Plague doesn’t spread readily, and it responds to antibiotics. The standard response—isolate the patient, trace contacts, and administer antibiotics and monitor for symptoms among contacts for seven days—works. We have even planned for antibiotic-resistant plague. At CDC, we developed a playbook for antibiotic-resistant plague and ran exercises on how to find and stop it. CDC guidance anticipates engineered resistance and recommends two different classes of antibiotics if there’s reason to suspect it. There is no evidence that resistance—or even confirmed plague—is involved in this incident. We have thought through how to address plague, but we’re not ready for the next major health threat that emerges from a lab or from animal spillover to humans. What should concern people is how little stands between the world and the next pathogen to get loose. Since peak COVID, epidemic preparedness has fallen off the political agenda, but the risk is greater than ever. More labs handle dangerous pathogens with more ways to make those pathogens deadlier, and more people live and work in close contact with animals. There are actions we can take now: We need better lab safety in every country. The number of labs that work with dangerous pathogens has increased worldwide over two decades, but there’s no enforceable international standard and no inspection regime; the Biological Weapons Convention, fifty years on, still has no verification mechanism. Labs that study dangerous germs need strong safety systems, training, and oversight. We need to reduce spillover events. Three in four emerging human infections start in animals, and there’s a lot we can do to reduce spillover risk, but the world is doing very little of it. Live-animal markets are one place to act. For instance, closing live-bird markets helped control H7N9 influenza in China. Reducing opportunities for people to encounter infected animals can prevent infections before they become outbreaks. In The Formula for Better Health, which is now out in paperback along with the hardcover, Kindle, and audiobook versions, I argue that labs do too many risky experiments with too many dangerous pathogens in too many institutions, and that every experiment should first answer one basic question: Is the likely benefit greater than the risk? Spillover risk can also be reduced: In the book, I discuss how Brazil cut its deforestation rate by 70% from 2004 to 2012 while increasing agricultural production and reducing risky contact between people and forest animals. We need faster detection and response. Delay costs lives. Strong surveillance, good labs, and trained responders can turn a single case into a small cluster of infections instead of an epidemic. Resolve to Save Lives has worked for nearly a decade to help countries find and stop outbreaks faster. The 7-1-7 target, which Resolve to Save Lives developed with partners in Uganda and elsewhere, provides a clear standard: detect within 7 days, notify within 1 day and complete all essential early response actions within 7 days. In Uganda’s Kasese district, for example, a review of a measles outbreak using 7-1-7 identified shortages of accessible funds, fuel, and vehicles that delayed the response. District leaders established funds they could access quickly. When, a few months later, the Crimean-Congo hemorrhagic fever appeared, the district detected it in three days, notified authorities in one, and mounted an effective response in two. Only one case was confirmed, and the patient survived. Because funds were available before the emergency, authorities were prepared and able to act. This kind of preparation can’t wait until the next crisis begins. Plague is an old disease we that know how to stop. The next threat may be harder to recognize, harder to treat, and easier to spread. Safer labs, less risk of spillover, and faster outbreak detection and response need sustained investment now, while we still have time to prevent the next emergency. Share
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