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Populous and Brooklyn Sports & Entertainment Debut Phase Three of Barclays Center Transformation
Brooklyn-inspired hospitality spaces and a reimagined fan arrival experience advance a long-term vision for the arena.——–A reimagined 9,000-square-foot hospitality destination was also debuted and inspired by the layered evolution of Brooklyn’s Dumbo neighborhood and Barclays Center’s tradition of celebrating the borough through thoughtfully designed spaces. Steel trusses span the high ceilings, while brick and concrete finishes […]
Populous and Brooklyn Sports & Entertainment Debut Phase Three of Barclays Center Transformation
Brooklyn-inspired hospitality spaces and a reimagined fan arrival experience advance a long-term vision for the arena.——–A reimagined 9,000-square-foot hospitality destination was also debuted and inspired by the layered evolution of Brooklyn’s Dumbo neighborhood and Barclays Center’s tradition of celebrating the borough through thoughtfully designed spaces. Steel trusses span the high ceilings, while brick and concrete finishes […]
People are using AI to turn their smart TVs into dumb TVs — and you might want to do the same
Smart TV owners are now taking matters into their own hands
People Using AI to Make Smart TVs Dumb Again Is the Most 2026 Thing Ever
That's not to say it's not a noble cause, though.
People are using AI to make their smart TVs dumb again
Fed up with ads, tracking and sluggish interfaces, some smart TV owners are turning to AI agents to strip away bloatware and take back control of their TVs.
Mazzulla’s group is ahead of schedule
Preseason overreaction’s are dumb — most of the time. But the Celtics have earned it.
Michael Olise Banned For Arsenal Clash After 'Super Dumb' Action
Bayern Munich forward Michael Olise will miss next week’s Champions League meeting with Arsenal after he was sent off at Viking on Tuesday night.
Nick Sirianni’s kickoff decision against the Jaguars wasn’t as dumb as it looked. Here’s why
The Dumbest Week in Texas Politics, a Saga in Five Acts
James Talarico took some sick days. The right-wing X-iverse lost its collective mind. Here's what happened.
Biggest waste of money in your home gym may surprise you, fitness expert says
Fitness coach Jacob Zemer reveals the three home gym essentials — bands, dumbbells and a bench — that let you train every muscle group on a budget.
I’m a personal trainer. This compact dumbbell set is the best addition to my home gym
If you want to step up your strength training at home, snag this compact set at a deal
iPhone 18 Pro Max users on AT&T: Take these steps to save your service
If you still have service, update ASAP.
September Monthly Review: Health MCP Guy?
For all the time I spend talking about APIs and data exchange, this newsletter has had embarrassingly little interoperability of its own. It’s old-school SaaS, baby - UI or bust. Not all of that is my fault! Substack, for all its popularity, is (as mentioned before) really frustrating as my system of record. The primary user it optimizes towards is the reader, whose attention feeds the app, the Notes feed, and the recommendation network that Substack is actually selling. Health API Guy is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe They’re falling into the same trap that Medium once sprinted into, albeit at a much more glacial speed. Younger generations may not remember (or never knew) it, but Medium once lured publications like The Ringer and Signal v. Noise onto its platform, only to lose them as it rebuilt itself around a paywall and an algorithmic feed. Substack’s original pitch circa 2020 was the antidote (you own your list), but every new feed feature chips away at it. I get it: writers are generic supply in the eyes of the Substack product team. Generic supply follows demand, so the consistent pressure on the PMs is to generate demand, which leads to every product cycle going toward discovery (Notes, recommendations, the app, live video). The end result lackluster author tools (laggy and broken analytics are truly crippling) all despite the premium price point. The archive is where it crosses from authorial gripes to actual reader impact, though. Across Substack and LinkedIn, I’ve published 1,218 posts and nearly 900,000 words since 2018. Substack’s native search can see only the 464 posts that live on Substack, and even there it’s woefully inadequate at surfacing relevant content (even for the guy who wrote it)! Readers have the same problem, writ large. Ask the Archive Fixing search (for both my readers and my own use) turned out to be extremely non-trivial, unfortunately: There’s no public API for readers to access content RSS exists for new content notification, but it only carries the 20 most recent posts and cuts paid ones off at the preview The only Substack MCP is an admin tool for analytics The export exists for authors, but it’s painfully awkward and slow. So I built something to work around that: the Health API Guy MCP. It’s a private MCP server holding the full text of everything I’ve written across Substack and LinkedIn. Add it to Claude or ChatGPT as a connector and you can ask things like: It pairs keyword search (for acronyms and case names, of which we have many) with semantic search. Every post is also labeled by topic, form, and court case, so you can pull a lawsuit’s (or multiple cases’) entire docket across Substack and LinkedIn in one query: Hail, Healthapiguyhydra This is also a bit of me eating my own cooking. I’ve spent the year arguing that headless healthcare is arriving and that developers want primitives over abstractions. Last week in Hail, Benihydra, I watched Salesforce plug its platform into Claude and bet that the records underneath outlive whatever interface sits on top: Salesforce must believe that the Hydra’s immortal head is the records, permissions, and business logic (in that they will survive whatever happens to the interface). It felt a bit hypocritical to keep my own archive behind a Substack search bar. The archive is the body. Substack is one head, and now whatever tool you might use is another. Will the EHRs follow my lead? Probably not imminently, but one can hope! Why Founding Members Only The MCP is available to Founding Member subscribers. A few reasons: It costs money and time to run. Hosting, the database, Clerk usage and AI compute for search and labeling are significant operational costs (that increase with usage). Substack gives me no way to automate access. There’s no API to check whether someone is a paid subscriber, so every user is manual operations for now. It’s a beta. We’ll need to improve things and parts will break. I’d rather they break for a small group of dedicated readers who will tell me about it. The Founding tier deserved a real benefit. Until now it was mostly a generous tip. Now it comes with something. If you’re already a Founding Member, reply to this email with the address you’d like provisioned. If you’re not and want in, upgrade here. Larger teams (such as companies) can get access too: group subscriptions at the Founding tier come with the group discount. The admin for the subscription can reply with the list of addresses to provision. Get 20% off a group subscription Pricing Founding membership is now a flat $200 a year, replacing the old suggested $150 that readers could adjust. Existing Founding Members will have access grandfathered in at their previous rate. Month in Review Articles Published Make Networks Dumb Again (Sep 11): AI is making old analog networks cheaper to use and flooding them with machine traffic in the process. A plea for agent-native rails with the intelligence at the endpoints, and for Washington to drag them to ubiquity. Interoperability, Unbuttoned (Sep 29): Interoperability is a series of workflows in a trenchcoat, and this post finally takes the trenchcoat off. A color-coded map shows which provider workflows went digital, which are fragmented, and which still run on fax. Video Content Antitrust’s System of Record Problem (Sep 3): The FTC’s investigation into Epic prompted a ninety-minute webinar, now posted with chapters and a smoothed transcript. We get into why market definition, missing B2B share data, and the SSNIP test leave antitrust poorly suited to systems of record, plus why information blocking may be doing more than any pending lawsuit. The Information Exchange: Cerner Milking Edition (Sep 18): This was so fucking fun. Ryan Tucker, Ryan Brickner, Brad Thorson, and I try an Around the Horn format, complete with points, penalties, and a mute button. We debate whether Oracle Health is dead, who would actually buy Cerner (IBM enters the chat), p(Doom), and why the front desk still hands you a clipboard. Regulatory Ask Not What Your Network Can Do (Sep 23): CDC’s RFI on public health data intermediaries lists use cases already served, unevenly, by eCR, lab reporting, IZ Gateway, and syndromic surveillance. The real opportunity sits in one question about AI: a network that can handle the next emergency without another interface project. Court cases Particle v. Epic: The Naughty Schoolteacher (Sep 4): After a summer-long vigil, the answer on Epic’s early summary judgment bid is two paragraphs and a remedial assignment. Particle advances to the next grade, and market definition gets another year of discovery. The Epic Discovery Files (Sep 8): Texas’s motions to compel arrive with a 251-page appendix of requests, objections, and meet-and-confer letters with Cravath. Inside: Epic using generative AI for document review, denied interoperability requests in scope, and Noerr-Pennington raised against lobbying discovery. Epic v. Health Gorilla: “Working as Designed” (Sep 9): Epic wants nothing to do with the data breach MDL, and explaining why puts fresh discovery on the public docket. The spiciest allegation: Health Gorilla told GuardDog to scrub its law firm business from its website instead of cutting off access. Veeva v. Epic: Legal Bypass Surgery (Sep 15): Veeva asks the Wisconsin Supreme Court to skip the Court of Appeals, while law professors and three policy groups line up as amici. Meanwhile, Epic’s lawyers apologize for another round of citation errors, including a quote that never existed. Texas v. Epic: Behind the Black Bars (Sep 17): The court portal served up Epic’s unredacted filings, revealing a $5 million document review budget and the AI workflow behind it. Also inside: the 200-plus company names Texas wants searched, and one very expensive Zoom invitation. OpenEvidence v. Doximity: Consequences Will Follow (Sep 25): OpenEvidence tells the court it will not comply with a discovery order, and its own lawyers at Quinn Emanuel say they won’t defend the choice. Add years of Slack reported unrecoverable, and Rule 37 sanctions come into view. Health Tech Keeps Choosing Violence (Sep 28): Doximity moves to end OpenEvidence’s case, Epic asks Texas to show its work, and a sleepy Audacious Inquiry patent fight sprouts antitrust and information blocking counterclaims. The main event is a long-sealed Cognizant v. Infosys ruling that hints where system of record antitrust claims can survive. EHRs One Verb for Oracle Health (Sep 14): Oracle’s earnings call quantifies every data center to the decimal point, while Oracle Health gets a single verb: “accelerate.” Panning the few healthcare mentions turns up an agentic care management system, a research-to-care ledger play, and the question of whether healthcare gets Larry’s patience. Epic’s Forretress Under Siege (Sep 30): Judy Faulkner tells a panel Epic paused hundreds of projects to harden its software and calls it a “shame,” while a spokesperson insists the roadmap hasn’t changed. Project Glasswing, a Pokémon-branded QAN sprint, and a trove of Jodel grievances reconcile the two Epics and preview the Jevons paradox coming for all software. Industry Analysis Scanning for a Network (Sep 1): Scan.com raises $220M to build the imaging network labs never got, speedrunning Zocdoc’s consumer-to-B2B pivot. Its wedge to network density may be the most American one available: personal injury litigation. The Front Desk Wants the Damn Whole Building (Sep 16): Hello Patient buys Converse Health, pushing its AI front desk into referrals, chart work, and prior auth. The copilot categories keep blurring, and your distribution partner is still your final boss. Cross-industry Comparisons A Different Patchwork Quilt (Sep 10): Healthcare loves to envy open banking, but the US version has no mandate, a toll booth at Chase, and data quality problems of its own. The grass isn’t greener; it’s another American patchwork quilt, and perhaps a worse one. Hail, Benihydra (Sep 21): Salesforce brings its platform into Claude, Slack, and its own agent, inviting the interfaces that might replace it. Cut off one head and more grow back, so long as the records underneath stay put. Living on A Trade Secret Prayer (Sep 22): Six credit unions are suing Fiserv, the Epic of core banking, by claiming their own member records as trade secrets. Banking has no Cures Act, so its lawyers reach for legal alchemy that healthcare has already tried. Other News None this month External Media Nabla Accelerate NYC: I kicked off fall conference season at Nabla’s Accelerate event in New York, where Delphine Groll opened by asking the room to picture the company it wants to become and the one it doesn’t. I liked her framework of bureaucracy, fear, and ego as the blockers. I also love vendor conferences/events in general - different vibe than industry biggies. Healthcare 101 with Nikhil Krishnan: I briefly guest lectured Out-Of-Pocket’s Healthcare 101 class. Appreciated Nikhil’s takeaways cover whether AI doctors can query HIEs, why healthcare’s data-liberation rules beat most industries’, and the hi-res graphic is in the comments. HCN: Epic Probed by the FTC: I joined the HCN guys to talk through the FTC’s investigation into Epic. Cedric’s new hairdo was an unexpected plot twist. The episode also covers MFN drug pricing, healthcare M&A and Eli Lilly’s acquisition streak. Fall Conferences: At eHealth Exchange’s Annual Meeting in Austin on Oct 27, I’ll moderate a panel on the tensions between AI, HIEs, and timely patient access with Jean Ross (Primary Record), Therasa Bell (Kno2), Byron Crowe (Doctronic), and Michael Marchant (Freenome). Here’s the rest of my schedule if you want to meet up: CommonWell (Redwood Shores, CA): Oct 13-14 Will be participating in a fun Jeopardy event Open@Epic (Madison, WI): Oct 20-23 Will be enjoying Verona, Willy Street, and other local adventures eHealth Exchange and Sequoia Project (Austin, TX): Oct 27-29 Yeehaw HLTH (Vegas): Nov 15-18 Groundhog Day, Venetian Edition RSNA (Chicago): Nov 30-Dec 2 See me at “Governing AI in Breast Imaging: What Health Systems Are Actually Doing” Digital Health Counsel 2026 AI Summit (Seattle): December 2-3 Will likely be speaking to a bunch of lawyers about information blocking Posts I Liked ChatGPT’s Epic integration: game changer or nothing burger?: Joshua Liu, MD offers five thoughts on OpenAI’s Epic launch, starting from the point that it rides the same open APIs available to anyone. He argues read-only access leaves ordering to Art and the ambient startups, and asks why HCA is piloting it alongside Commure. He’s sorta a must-follow at this point - consistently excellent, thought-provoking takes. Epic, Lilly, and the Discovery pass: Seth Chaney reads Epic’s first major Discovery deal (with Eli Lilly), as well as its revised developer terms on commercial displays, as the pipe finally opening between EHRs and pharma. Life sciences and health continue to collide. Scott Rossignol on EHR payer platforms and ePA fees: Scott argues the top ambulatory EHR vendors are turning the prior auth mandate into a per-member-per-year toll on payers, for an API whose operating cost has nothing to do with covered lives. His fix is two lines of regulatory text: put the CRD/DTR/PAS certification criteria in the Base EHR definition, and bring payer-facing ePA connectivity under § 170.404’s cost-based fee rules. It’s a good solution. Health API Guy is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe
Lil Wayne’s ‘dumb’ Packers suggestion ripped after loss to Falcons
Lil Wayne’s suggestion to Green Bay Packers sparks backlash.
Sean McVay acknowledges Rams’ Australian travel plans were ‘dumbass’
Sean McVay addressed one reason his team may have looked better in Week 2 than Week 1
Are you outraged by Sydney Sweeney
Today it’s a silly sports betting ad, but I can’t see anything she’s done that’s worth this ire. She’s in her twenties: she does dumb things. Enjoy! says Guardian columnist Marina Hyde
What’s the proper reaction to a dumb loss?
Should we panic about the result or look a bit deeper?
Is calisthenics as good as weight training? Here’s what the science says
Your muscles can’t tell the difference between a dumbbell and a push-up
How burnt coconut helped discover new to science endemic species in Sri Lanka
COLOMBO — As dusk settled over the paddy fields at Puwakpitiya, a village on the northern edge of Knuckles Mountain Range locally known as Dumbara mountains in Central Sri Lanka, researchers began laying traps along the uneasy boundary between farmland and forest. They were targeting small terrestrial mammals moving through the landscape. On the ground, […]
Report: Fetterman apologized for dismissal of CHOP leaders, calling a leaked text message a ‘dumb joke’
In his statement to CNN, John Fetterman called a recent report from The Wall Street Journal a “hit piece from disgruntled staffers."
Trump’s ‘dumb’ story makes no sense
There are far more important issues to discuss. But in these divided times, surely we can all come together for a brief moment and agree that President Donald Trump’s “dumb” story makes no sense.
How a former ARPA-H director's startup is tackling AI's ‘dumb problems’
In this edition of STAT's AI Prognosis: A startup tackling the 'dumb problems' at the intersection of AI and bio, accuracy of AI scribes, and more.
August Monthly Review: ChatGPT In Epic
Death, taxes, another frontier lab healthcare launch inspiring truly insane LinkedIn takes. As much as I want to stay away, I repeatedly am the crewman unplugging his ears whenever we pass these sirens. So it’s not the first and probably not the last time we dial up the typewriter rather than tie ourselves to the mast. The full blow-by-blow timeline: Health API Guy is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe The End of the Standalone PHR (Jan 8): ChatGPT Health arrives for consumers, at the time powered by b.well. I was bullish on the approach in that the best way for the PHR to finally solve distribution was to meet consumers were they already are (i.e. When Horizontal Meets Healthcare (Jan 9): OpenAI for Healthcare puts out the shingle for enterprises, with SharePoint ingestion standing in for the EHR integration the product actually needed. Another One: Anthropic’s Healthcare Debut (Jan 16): Claude's version, on HealthEx rails instead of b.well, with Agent Skills for FHIR development as the one true vertical-specific investment. ChatGPT for Clinicians: The Trap Sprung (Apr 24): OpenAI filled in the missing GTM middle with a free product for verified clinicians, effectively peeling the enterprise wrapper off ChatGPT for Healthcare and taking the PLG fight directly to OpenEvidence. OpenAI’s Second Attempt at Health (Jul 31): a relaunch of their patient specific app, now branded Health in ChatGPT, where the privacy partition came out, the connectors thinned, and b.well disappeared in favor of first-party FHIR work against a smaller network Beyond a Shingle So what was announced now? Today, we’re introducing a new electronic health record integration that brings authorized patient context from Epic into ChatGPT for Healthcare, along with the Healthcare Public Data plugin for direct, structured access to official healthcare datasets like PubMed, DailyMed, and CMS Coverage. Together, these capabilities bring ChatGPT closer to the systems and sources healthcare teams trust, while supporting the controls and compliance healthcare work requires. The core portfolio is unchanged from prior announcements we delineated and discussed (aside from the relaunch of patient-facing). Since trade publications still seem to be confusing them by using the wrong names: Enterprise sales motion: ChatGPT for Healthcare Protecting their core product / PLG: ChatGPT for Clinicians Consumer/patient-facing product: Health in ChatGPT So really, this is a feature release (specifically for ChatGPT for Healthcare when it comes to EHR integration). What’s cool about it, though, is that we are moving beyond just putting out a shingle. Everything in the January enterprise launch was horizontalizable: Horizontal tech companies thus generally start verticalization with their “putting out a shingle phase”. Telling the world you’re open for business as a horizontal tech company reliably attracts early inbound interest from buyers who are already trying to force-fit horizontal tools into domain-specific workflows and are eager for any signal that the vendor intends to support their use case more directly. Nothing was really vertical specific, which is exactly what you'd expect from the ultimate hypergrowth horizontal company dipping their toes into specific industries. But eventually you have to stop changing the sign on the door and start changing the product. Can you guess where the horizontal product was going to run out of road? This is the core dilemma writ large: verticalization requires differentiation, while scale economics of consumer and horizontal push toward unification. I’ve buried the lede so deep here it will be painful to some readers, but what should be shocking to no one is that my perspective is that EHR integration is the only path that meaningfully resolves this tension for ChatGPT for Healthcare. Integration with Microsoft Sharepoint is fine, but it is categorically insufficient for any product that hopes to influence clinical decision-making. SMART Money Well here we are, eight months later! Real vertical investment has begun, which surprised a few people. One friend in the industry messaged me: “Absolutely no way Epic gave ChatGPT API access.” Looking forensically at the announcements, the integration is notably read-only across appointment notes, laboratory results, medications, and specialist documentation. So while I’m not a betting man, I'd wager the house this is a SMART on FHIR launch: That sounds a lot like USCDI! The recommended path for the workflow they outline would be SMART on FHIR Their Health AI lead’s post is evocative of both standalone and EHR launch SMART, which another termed “ChartGPT” and “EHR Plugin” The implementation burden for SMART on FHIR is the lowest of the available integrative paths This is the team who literally did patient-facing SMART on FHIR with Epic last month Most importantly, if you’re a horizontal company, you generally still haven’t taken the full plunge and thus (overly) value reusability. SMART on FHIR is the logical compromise: healthcare-specific enough to matter, but standardized enough to reuse. Nobody Asked Judy Another friend asked “I thought they had to go to each health system, or did they go direct to Epic and now health systems opt in?” Given the trust paradigms in healthcare, this functionally cannot be Epic hoovering up all the data for OpenAI and shoving ChatGPT in their customers’ faces (or they would revolt). However, I do believe the aforementioned terrible coverage by TechCrunch and other outlets is probably responsible for that question, given the 325 million reference. When using FHIR as a business associate to an Epic customer, there is no EHR gatekeeping to speak of, as that isn’t how fhir.epic.com works: You register an app You pick your APIs You test against the sandbox APIs You list as “Ready for Production” Hospitals pick your app You test and go live with them Bluntly, nobody had to say yes or no in Verona (nor were they given the chance). Vendor Services (their next developer tier up that I doubt OpenAI is using quite yet in this initial release) certainly has contractual paperwork that some resent, but even there, the twin pressures of mounting antitrust and information blocking make outright gatekeeping increasingly fraught. My friend’s sentiment is, to me, representative of a broader industry neurosis, perhaps a sort of scar tissue of prior eras: people assume the gate is still there and never actually try the door. There are certainly other ways Epic (and any EHR) can put its thumb on the scale, but they are not so dumb as to stand in front of a federally mandated API and play bouncer at this exact moment in time. So I think they can and probably should go deeper, as this release is at best parity and at worst behind vertical-specific competition. OpenEvidence did a basic SMART launch with Sutter Health in February, allowing for more convenient evidence search by providers. They then add patient-context (the equivalent SMART on FHIR flow to what we see here) when Cedars-Sinai went enterprise-wide in May. UpToDate has four distinct applications across deeper workflows like patient engagement listed in Epic Showroom and announced a partnership with Epic to power Art at UGM Abridge and other ambient scribes have invested deeply into the deepest bidirectional clinical copilot workflow with integrations well beyond SMART on FHIR. In that light, the “Who is OpenAI primarily targeting here?” is clear. This release brings them into striking distance of OpenEvidence, but not the others quite yet. They are the only one of the three you can reach without building something truly Epic-specific. When will they go further? Competition is a great motivator to overcome the horizontal demons and start building things that can’t be reused: not across industries, not across EHRs, maybe not past the customer you built them for. That’s the price of actually verticalizing. The question is if and when OpenAI will be willing to pay it. Month in Review Here is the monthly review. As a reminder, this is a regular round-up of the month’s posts and other content to surface things you may have missed across regulation, litigation, interoperability, and beyond. AI assistance is used in these bullet summaries so I can focus on articles. Articles Published: None this month Video Content: The Information Exchange: Standards-based Thruple Edition (Aug 14): Back to school for us too, with Brad reporting in from the CMS Health Tech Ecosystem’s one year anniversary in DC. We get into the January CMS-0057 deadline, the fall rulemaking reading list, and why enrollment still keeps most apps off FHIR. The Information Exchange: Epic Dúnadan Edition (Aug 25): A UGM roundup with Ryan Brickner joining for the first time to check our takes against what the building actually thinks. Rangers, Ergo sitting on top of EHI, and a down-market lineup that needs some cuts. Regulatory: Stacked Deck, Bad Hand (Aug 05): ONC’s website refresh took the entire HIT Policy Committee record with it, so I rebuilt the archive and went looking for the regulatory capture story everyone assumes is buried in there. Stacking the deck and winning the hand turn out to be very different things. The Sixth Generation of Patient Access (Aug 19): A quick catalog of the five generations of patient access we’ve layered on since HIPAA, and the two candidates now competing to be the sixth. One is planned. The other is the market routing around the plan entirely. Court cases: Three Cases Walk Into a Docket (Aug 06): Two surprise settlements cleared the board in a single week, and then Judge Maddox dropped ninety-four pages on Vyne v. Henry Schein. The sleeper is a DMCA holding that makes direct-to-database a considerably riskier business model. Epic v. Health Gorilla: Into the MDL (Aug 10): Nine class actions are headed to Miami, and the Panel signaled it wants to bring the case that spawned them along too. That would leave Epic arguing the requests were obviously fraudulent in one courtroom and unknowable in the other. Amazon v. Perplexity: Agents Are Legalized! (Aug 11): The Ninth Circuit vacated the injunction against Comet, holding that the user is the one accessing the servers rather than the company that built the agent. A real win for agentic access, and a much narrower one than the headline suggests. Veeva v. Epic: Come At Me, Bro (Aug 26): Epic’s response brief wants the dismissal affirmed and, unusually, wants the opinion published as precedent. Buried in it is Epic’s own description of what its non-competes actually prohibit, which current and former employees should read closely. EHRs: The Contract Epic Would Never Sign Today (Aug 04): A 1999 SEC exhibit catches Epic licensing nearly its entire product line, Tapestry included, to the company that became TriZetto. The marketing services menu attached to it is the part that will make you blink. Forecast from Verona (Aug 07): The Epic Almanac makes one argument six different ways: the AI is only as good as the networks behind it. Emmie headlines, Art’s context stack is the most ambitious part, and Penny finally gets an autonomous coding date on the calendar. Works With Epic MyChart (Aug 17): Epic’s first new Showroom category since the death of Workshop certifies hardware instead of software, badge on the box and all. Made for iPhone, but for blood pressure cuffs, and rough news for anyone selling the RPM stack sitting in between. UGM Hot Takes 2026 (Aug 20): Everyone else covered the AI announcements, so I went after Savvy deleting the payment gateway, Rangers as Boost with the timer removed, and a down-market lineup with too many entries. Plus the Health Grid tidbits I cannot help myself on. MyChart Central Grows Up (Aug 24): Device data and Emmie turn Epic’s identity hub into a full consumer platform, which is both a logical answer to ChatGPT and a bit of a mistake. It also happens to be the best scraping target Epic has ever shipped. Industry Analysis: The Wrong Yardstick (Aug 12): Vertical software keeps getting judged against Superhuman and Notion, which is the wrong bar entirely. Your user is comparing your product to a whiteboard and forty phone calls before lunch. Primitives vs. Abstractions (Aug 27): Developers want building blocks, systems of record prefer to hand out business logic, and both sides have a real case. There’s no test from the outside that separates the engineering reason from the competitive one, which is why this keeps ending up in court. Cross-industry Comparisons: The Two Kinds of Platform Power (Aug 18): Attention power and record power are different problems that keep getting handed the same regulatory toolkit. Congress’s latest swing at Big Tech shows both what’s possible and where it falls apart. The Dogs of (Platform) War (Aug 21): A CourtListener alert turned up a property management fight with healthcare’s exact shape and none of the Cures Act. Shell prospects, ghost accounts, a notetaker bot that came back to haunt someone, and a lawyer arguing both sides of the same theory in two states. Fractals All the Way Down (Aug 31): Yardi dominates property management right up until you zoom into one segment, where AppFolio owns it outright and Yardi doesn’t appear at all. Where you draw the line around a B2B software market is about to decide an awful lot of cases. Other News: If Judy Had the Courage (Aug 13): A short eulogy for the era when software was allowed to look insane: WinAMP, bold colors, and everything the grey chatbot era has taken from us. External Media: Portland Monthly Health Tech Meetup: Erin O’Brien channeled my own feelings - maybe it’s just because it’s August and beautiful, but the monthly edition of the PDX Health community meetup was a ripper. Make sure to reach out if interested to join for the next one. STAT’s Coverage of Epic This Month: Brittany Trang of STAT did a fantastic job of breaking the FTC investigation that’s been lurking, as well as UGM related coverage, so I had to give her her wish of a meme. Fall Conferences: I’m pumped to be kicking off my fall conference season in NYC at Nabla Accelerate next month, which Chrissy provided the link to apply for. Here’s the rest of my schedule in case you want to meet up: Commonwell (Redwood Shores, CA): Oct 13-14 Open@Epic (Madison, WI): Oct 21-22 eHealthExchange (Austin, TX): Oct 27 Sequoia Project (Austin, TX): Oct 28-29 HLTH (Vegas): Nov 15-18 RSNA (Chicago): Nov 29-Dec 3 Posts I Liked: HTI-6 Should Unbundle API Certification: Josh Mandel makes the case that HTI-6 should split (g)(10) into separate authorization and data certifications, so a PACS or a genomics platform can certify only the role it actually performs. Imaging is the urgent example, but the structure solves a much bigger problem. On implementing ePrior Auth with Epic: Scott Rossignol’s field notes from a live ePrior Auth build on Epic, including the two app registrations nobody warns you about and the CPT mapping problem waiting at the end. CMS-0057 implementations are going to be such a beast. Healthcare point solutions are starting to look a lot like streaming services: Spencer Dorn runs the cable-to-streaming arc against health IT and lands squarely on the bundling half of the cycle. Bundling can be good! It can also be bad! Life is nuanced. Health API Guy is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe
Republican Candidate in Key House Race Bet on Her Own Campaign
The trading platform Kalshi issued a three-year suspension to the candidate, Laurie Buckhout, and fined her nearly $2,600. Ms. Buckhout said she had made a “dumb mistake.”
The Literacy Crisis Reaches Dog-Bear Science
“New analysis of more than 300 bear encounters suggests our canine companions often increase odds of conflict and rarely serve as early warning systems many recreationists assume,” reads a subhead in Mountain Journal. The thing is, that study reaches no such conclusion. But you have to read beyond the abstract to understand that. Mountain Journal is not alone. Let’s look at a brief list of takeaways published elsewhere just to establish that none of them seem to know how to read science. Wes Siler’s Newsletter is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe Here’s CBC: “A new peer-reviewed study, The Canine Conundrum: Is a Dog a Help or Hindrance in Bear Country?, dug into conflicts similar to what the video depicts, by analyzing 326 reported human-bear conflicts from 1901 to 2023 involving dogs.” “The study found 54 per cent of conflicts were started by dogs. In the encounters researchers included in the study, five people and 56 dogs were killed, and 170 people were injured.” “Lana Ciarniello, an independent researcher who co-authored the study, said researchers found when a person goes hiking with at least one other person, the odds of a negative bear encounter decrease by 50 per cent.” “However, when a dog is involved, the chances of a negative bear encounter increase because ‘a dog really adds a chaotic factor into the mix of recreation,’ said Ciarniello.” Again, the study finds no data supporting that conclusion. “Hiking with your pet dog may make you feel safer in bear country—but a hiker’s recent encounter and a new study prove that the numbers don’t add up,” writes Backpacker, which is now part of Outside. The numbers don’t add up to support this take. There’s plenty more examples, but all are equally dumb, so I’ll stop there. How did so many people get this so wrong? Three reasons: 1) the study is published behind a paywall, with only the abstract freely available. 2) the methodology sets out to create work relevant to a hyper-specific audience, not the public. And 3) the dataset studied is almost absurdly limited and doesn’t bear (get it?!) comparison to wider information. Let’s work through all three. The Problem is Money I understand the irony, since I’m writing about this on a subscription-model newsletter, but information wants to be free. The study is published by The Wildlife Society and costs $16 to access. Reprinting it is specifically prohibited by the terms of use, so I can only share snippets and my conclusions with you here. Having worked as a journalist for 24 years, I can report with some authority that journalists are both lazy and cheap. I don’t think it’s a stretch to say that much of the material you’re seeing written about this study is drawn from the freely-available abstract (above) only, and not a deep dive into its methodology or data. And that’s a problem, because abstracts are where researchers are able to break from their numbers and editorialize their opinions about conclusions. So what’s getting reported isn’t based on numbers, it’s based on an opinion designed for a specific audience, not the general public. Hell yeah ladies, kick that bear’s ass. The Methodology is Designed to Support a Predetermined Conclusion One of the biggest issues with the science that everyone likes to cite about bear spray’s efficacy is that no one understands that study was designed for a specific audience, looking for a specific answer. And since that audience is not the public, and our safety was not the question being asked, its conclusion is rendered irrelevant to our needs. Yes, I’m talking about Efficacy of Bear Deterrent Spray in Alaska, which was created by Tom Smith and Stephen Herrero, two of the same scientists who put together this dog-bear conflict analysis. In the spray study, the purpose was to present relevant agencies with the information they needed to issue their field workers with bear spray. As such, incidents where people were unable to access the spray or similarly failed to get it deployed in time were excluded from the results, and only incidents they deemed successful were included. Could a ranger roll down their vehicle’s window and scare a bear away from a dumpster by spraying it? Turns out the answer was yes, and that was good enough for the purposes of that study. The sample size of actual bear attacks—the thing you and I would want bear spray to provide a solution to, was too small to draw conclusions from, and didn’t indicate success in that role. Is a Dog a Help or Hindrance in Bear Country? has similar limitations. “Insights provided here are intended to help wildlife managers create effective guidelines regarding the presence of domestic dogs in bear habitat,” is explained clearly by the study’s text. To conduct the study, Smith and Herrero went looking for publicly available reports of dog-bear conflicts: “All incidents included in our analysis involved at least one bear, one dog, and one person who was at immediate risk of injury (e.g., not in a protective structure such as a cabin or vehicle), injured, or killed,” explains the report’s methodology. Why is that a problem? “We recognize that data used in this study are biased in that people generally only report adverse interactions with bears, not benign ones. Consequently, we assume that for the most part, people and their dogs pass through bear country without incident.” As was the problem with the bear spray study, people are drawing conclusions here from a study that was never intended to be relevant to the general public. The Smith-Herrero database famously excludes Alaska’s Defense of Life and Property records, which are elsewhere considered the largest and most authoritative source on human-bear conflict. The Dataset is Absurdly Limited A 2009 study conducted by the Washington Department of Fish & Wildlife estimates that each year there are at least 43,000 documented complaints of human-bear conflict across North America. Is a Dog a Help or Hindrance in Bear Country? Examined those reports for years ranging from 1901 to 2023, and only managed to find 326 such incidents that met the criteria explained above. Let’s do some quick math, poorly. 43,000 incidents x 122 years = 5,246,000 total incidents of documented human-bear conflict. Smith and Herrero were only able to find 326 incidents that met their criteria for dog+human+bear+risk or occurrence of injury. That means there’s a 0.006 percent chance that the study’s conclusion—that dogs make bear encounters more dangerous—even gets a chance of occurring. And remember, that’s only in documented conflicts. There’s no way to know how many people across North America run into a bear in any given year without any conflict, but it’s probably safe to assume that the total number is well in excess of 43,000. And, dig deeper into the study and you can find further restrictions that skew its conclusions even more. “While the people involved in these incidents did not report the level of training their dogs had received, it is our assumption that most were untrained companion dogs as opposed to well-trained bear dogs, such as Karelians and livestock guardian breeds that have proven to be significant aids in bear country,” the study’s methodology explains. And that’s a problem, because an ongoing study here in Montana is finding that the simple presence of a Kangal like our youngest dog Teddy can reduce visits to private property from grizzly bears by 87.8 percent. In addition to being a badass, Teddy is also a companion animal. And in my admittedly limited sample size of the three dogs currently present in our living room, she’s no more effective than her mutt brothers. Plenty of people own a dog capable of deterring bears, even if they didn’t set out to own a bear dog. The real purpose of this study appears to be a recommendation that leashes are mandated and recreationists pursue training in their deterrent of choice. But that doesn’t make for sensational headlines. Are There Any Real Takeaways Here? Let’s throw some numbers around, just to try and get our hands around what the larger picture might look like for bears and dogs here. The American Veterinary Medical Association estimates that 42.6 percent of American households own a dog. The Canadian Animal Health Institute says roughly 35 percent of households in Canuckistan own a dog. In an attempt to create the worst possible result for dogs, let’s run with that 35 percent number. And given that outdoorsy and rural people are more likely to both own a dog, and have bear encounters, let’s just make a giant assumption and apply that number to those 43,000 conflicts documented annually. If 35 percent of 43,000 human-bear encounters involve a dog, then we can assume that at least 15,050 dog-bear conflicts are occurring annually in North America. 15,050 x 122 = 1,836,100. Smith and Herrero were only able to find 326 incidents that met their human, dog, chance or occurrence of injury criteria across 122 years. And only 170 documented human injuries. So, with all the obvious caveats about these numbers in no way describing reality beyond narrow study parameters, what they actually found is that your risk of injury if your dog tangles with a bear is only 0.009 percent. I’ll take those odds next time I’m hiking my dogs in bear country. Top photo: “Superintendent Horace Albright, eating pancakes with bears, at Lake Lodge, Yellowstone National Park.” NPS. A journalist with more than two decades of experience working around the world, Wes Siler is here to cut through the outrage and disinformation to bring you the factual, insightful, actionable reporting you need to understand what’s going on. Upgrading to a paid subscription supports this reporting, and buys personal access to Wes, who will help you save money on gear, plan outdoor adventures, and prepare for real life, and who promises he’s less salty in real life than he sometimes comes across as on the Internet. Wes Siler’s Newsletter is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe
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The Beauty Of Settled Science
Commenters convinced me I made a subtle mis-step in my framing of Psychology Research Is Mostly Fine. My framing emphasized that social priming studies had failed to replicate, but that many other subfields of psychology hadn’t. This naturally led commenters to point to failed replications in other subfields. Although none of these were as bad as social priming, few or none were entirely problem-free. Instead of emphasizing the difference between social priming and other subfields, I should have emphasized the difference between settled science and novel research. Here are some of my favorite psychology findings: The brain is sculpted by reinforcement learning, and a key driver of this learning is a prediction-error-based algorithm located in the nucleus accumbens and implemented through dopamine. Psychedelic drugs exert their effects through 5-HT2A receptors, pointing to a role for these receptors in some sort of construct like the balance between priors and new evidence. Certain cognitive functions are localized to certain brain areas (for example, impulse control to the frontal lobes; linguistic structure to Broca’s area, linguistic meaning to Wernicke’s area. But injure one of these areas, or render a certain function useless (eg a blind person having no more use for their visual cortex), and these mappings can gradually shift - suggesting that neurons are general-purpose compute whose specialization is a contingent fact about convenience and efficiency rather than a necessity. Most personality traits and general capabilities are about 50% genetic and 50% random, with little role for family environment or childhood history, with a few notable exceptions like partisan preference. Recent research complicates this story, but the further you go from this basic picture, the gnarlier the chains of indirect causation you require. Neurons fire together in “brain waves”, whose exact frequency corresponds with the character of consciousness; These divide neurons into natural subpopulations and linked graphs. The gamma rhythm corresponds surprisingly well to items in conscious awareness. GABA receptors seem to be involved in something like relaxation. By hitting different GABA receptors in different ways, you can modulate the exact type of relaxation you produce. Hitting GABA-A directly is too powerful and can cause dangerous levels of sedation, but allosteric modulation of GABA is an incredibly fruitful strategy that underlies drugs from benzos to barbituates to alcohol. If you know your GABA-A subunits, you can target specific subtypes of relaxation; for example, Ambien hits GABA-A1 and induces sleep. Memory divides somewhat fuzzily into bins of immediate-sensory, short-term, and long-term, with separate retrieval and storage functions, and separate systems for declarative vs. procedural learning. These can be harmed selectively, usually by hippocampal injury, so that some patients can remember their life stories but not form new long-term memories, or learn new skills like bike-riding but not new facts. The exact substrate of memory is unclear but seems to involve new synaptic connections between neurons in at least some way. The ability of modern psychology and psychiatry to treat mental illness is real but limited. SSRIs work for half or slightly fewer than half of patients; antipsychotics work with extreme side effects; benzodiazpines work but produce addiction and tolerance in many (not all) people. Most supplements are stuck in Poor Quality Study Replication Crisis Hell, but melatonin and l-theanine stand out as especially promising. Psychotherapy works with moderate effect size, but (with a few exceptions) seems to be more about the relationship with the provider than the details of the therapy itself. Mental hospitalization can sometimes defuse immediate crises but work less well than mental hospitals would like, with some studies showing overall negative effects. Schizophrenia is mostly genetic, but risk also increases with prenatal infection (especially rubella) and obstetric complications; there is suggestive evidence for roles of social stress and drug use (with psychedelics and marijuana making things worse, and nicotine if anything making things better). Bipolar and schizophrenia are so closely linked on a pathophysiological level that it seems like they might be the same disease; on the clinical level, they do seem to follow two separate courses/prognoses but can sometimes surprise clinicians by eg someone who seemed condemned to permanent schizophrenia unexpectedly recovering. The brain’s native reinforcement learning algorithms cash out in the phenomena of classical and operant conditioning; different reinforcement schedules reinforce at different levels, which can be exploited by bad actors to make especially compelling products (eg slot machines). None of these are immune to doubt. A few are speculative; one or two are genuinely unorthodox. But they’re all a step above one p = 0.049 paper that might not replicate. If they get overturned, they’ll be overturned by the same sort of genuine scientific shift that replaced Ptolemy with Copernicus or Lamarck with Darwin, not some sort of sordid discovery about someone entering random numbers into a spreadsheet. In 2008, Eliezer Yudkowsky wrote about The Beauty Of Settled Science: If you only care about scientific issues that are controversial, you will end up with a head stuffed full of garbage. The media thinks that only the cutting edge of science is worth reporting on. How often do you see headlines like “General Relativity still governing planetary orbits” or “Phlogiston theory remains false”? So, by the time anything is solid science, it is no longer a breaking headline. “Newsworthy” science is often based on the thinnest of evidence and wrong half the time—if it were not on the uttermost fringes of the scientific frontier, it would not be breaking news. Scientific controversies are problems so difficult that even people who’ve spent years mastering the field can still fool themselves. That’s what makes for the heated arguments that attract all the media attention. Worse, if you aren’t in the field and part of the game, controversies aren’t even fun. Don’t be embarrassed to read elementary science textbooks, either. If you want to pretend to be sophisticated, go find a play to sneer at. If you just want to have fun, remember that simplicity is at the core of scientific beauty [...] A steady diet of science news is bad for you: You are what you eat, and if you eat only science reporting on fluid situations, without a solid textbook now and then, your brain will turn to liquid. Psychology isn’t centrally the new paper in Annals Of Recently-Breaking News saying that an n=5 study showing that large portion sizes increase support for terrorism. Psychology is centrally ideas like brain waves, GABA receptors, reinforcement learning, twin studies, and connectionism. People who think differently are worrying too much about BREAKING NEWS!!!, and should stop. The key distinction isn’t “recent research in social psychology” vs. “recent research in cognitive/bio/behavioral psychology”, as my essay last week unfortunately implied. It’s recent research in general vs. the deposit of settled science, battle-tested hypotheses, and carefully-earmarked speculation. And part of the reason social priming in particular was such a disaster was that it defied that heuristic, building itself up over hundreds of studies until it approached or even entered the pantheon of settled science - before collapsing (5-HTTLPR was also sort of like this). This isn’t a claim that settled science is always right - Freud was “settled science” for a long time - just that there’s an intuitive distinction between the level of credence you should have in the existence of power posing vs. the existence of Broca’s Area. (I compounded this error by calling the last post “Psychology Research Is Mostly Fine”, which suggested I was talking about the new research rather than the settled science. I actually meant to distinguish between research-psychology-the-field vs. clinical-psychology-aka-therapy, but this framing unintentionally pushed against the point I wanted to make) Some commenters on the previous article understood this point, but challenged its weight. It’s very cool, they said, to know how many neurons are in which brain lobe, but the main way that Psychology affected their lives was through bad clickbait studies used to buttress dumb policies; some p = 0.049 study says that exposure to microaggressions makes minorities’ brains shrivel into raisins, and now their company has to implement punitive DEI or be sued for hazardous work conditions. I won’t dispute this as an accurate description of how the sausage gets made, but it’s worth examining the trains of thought that connect this observation to a campaign against psychology in general: The dumb woke psychology was wrong and bad, and I don’t have good heuristics for distinguishing dumb woke psychology from other psychology, so I’m going to assume it’s all wrong and bad. The dumb woke psychology was wrong and bad; it seems useful to punish/discredit psychology as a whole to assist my campaign against it, so for propaganda purposes I will try to discredit psychology as a whole. To people in the first camp, my response is: come on, your heuristics aren’t that bad. “Microaggressions makes minorities’ brains shrivel up like raisins” is in the woke category; “the hippocampal theta rhythm seems to be associated with both memory and pathfinding, suggesting an unexpected yet surprisingly compelling relationship between the two” is in the not-woke category, don’t play dumb here. To people in the second camp, my response is: deliberately exaggerated propaganda campaigns are bad and this is a confession, not an excuse. Inability to view science through anything but a political lens was what got us into this problem; doubling down on it is a temporary solution but a recipe for permanent disaster. If you pronounce entire fields of science to be acceptable collateral damage in your campaign against bad political actors, you will alienate not just scientists but patients, clinicians, and general lovers of truth. Instead, you can say the thing you mean - that woke partisans shouldn’t try to occupy and exploit the otherwise-noble science of psychology for their own political gain - and wage the same campaign with a halo rather than a comic-book-villain goatee. From the font of oracular wisdom that is Weird Sun Twitter: [ Vessel Of Spirit@VesselOfSpirit i love you all conditionally but i love the good part of you unconditionally. even if it becomes a very small part 2:11 AM · Jan 22, 2015 1 Reply · 5 Reposts · 29 Likes ](https://x.com/VesselOfSpirit/status/558084551772471298) This is how I feel about psychology1, too, but with a touch more optimism. The good part of psychology is enormous, a hoard of endless treasures. You just have to look past the headlines! 1 To play devil’s advocate - should one always be so magnamious? Astrology? Phrenology? These seem different in that their entire orientation was flawed from the start; they didn’t simply fail to find the correct constellation-personality connections, the whole project of searching for connections between constellations and personality was doomed from the start. More difficult might be asking the same question about education research, which is notoriously bad. I don’t know enough about education research to know if there’s some settled science of correct and enlightening results lurking in the background beyond the day-to-day froth of poorly-conducted and politically-motivated studies. I think if it’s 90% bad, 10% good, it’s correct to call it bad as a compact way of communicating a useful truth; I think psychology is better than that, but admit it’s a tough judgment call.
The Science Behind the AI Panic Is Shakier Than You Think
A column by Sascha Lobo Is AI making us dumb? So asked DER SPIEGEL on its cover a while ago. After a few weeks of recovery and a therapeutic intervention with the help of my AI, I feel able to respond. That’s a bit unfair, of course; the article itself is more nuanced than the loud cover, the image of a schoolkid with dull prompt questions, or the subtitle: “AI is conquering the schools, and educators fear a disaster.” The short answer to “Is AI making us dumb?” is: no. The long answer is more interesting, and even carries a preliminary glimmer of the spectacular. Unfortunately, it requires a detour into the sphere of artificial intelligence, into the mogul-field terrain of technology assessment, the attention economy, and the destructive virus of cultural pessimism. Along with narrowing the scope to AI’s effects on education and work rather than on intelligence. Because the honest version of the question would be: Does AI help us learn and work, or not? Generative AI, which set off the still-ongoing hype with ChatGPT, has only existed in relevant distribution since late 2022, early 2023. For a technology-driven transformation of people and society, that is extremely short. For that reason alone, research is still in its infancy. And technology assessment is not a fast discipline anyway. Prominent voices from Elizabeth Eisenstein to RAND to Tom Wheeler say we still cannot conclusively judge the consequences of the printing press. Its invention is a mere 580 years back, and some scholars would rather not circulate assessments that might have to be retracted in two or three hundred years. We’re Going Through Growing Pains A phenomenon that already caused upheaval in social media research makes serious assessment of AI’s consequences even harder: the “moving target” problem of LLM-ology, as the linguist Sean Trott called it in 2025. AI develops so quickly and so unpredictably that researchers often end up studying snapshots of the past. There are concepts, from morphological analysis to anticipatory governance, for keeping research, planning, and regulation halfway meaningful anyway. But even with those, universally valid statements are rare. DER SPIEGEL - The German View is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Subscribe We should therefore treat findings about the interplay between humans and AI as far more procedural and situational. Unfortunately, this challenge comes at the worst possible time. We are going through growing pains: AI’s everyday impact has grown very large very fast, and with it the longing for guidance. Annoyingly, the body of solid knowledge has not exploded along with it. Experts cannot be moved to broad consensus on even banal statements about AI. Sascha Lobo, born in 1975, is an author and strategy consultant focusing on the internet and digital technologies. Together with Jule Lobo, he explores the debates of the day in the podcast “Feel the News – Was Deutschland bewegt” (”What Moves Germany”). Nvidia CEO Jensen Huang says software developers are dying out. Bill Gates considers coders one of only three professions that will survive the AI tsunami. Top tech economists find virtually irrefutable arguments both for and against an AI bubble. The same naturally applies to the structurally youth-hostile debate over whether AI is good or bad for young people. The gap between the demand for insight and the supply of solid knowledge creates an orientation vacuum. This vacuum of AI cluelessness is filled, as the attention economy described by Georg Franck in 1998 would have it, with half-knowledge (funnily enough, often AI-generated), marketing, and self-marketing. After all, infinite money is at stake, along with academia’s best current shot at global fame. But this iridescent froth of interpretation operates more by the algorithmic principles of the digital public sphere than by seriously earned insight. That is why dramatized, fear-feeding claims about AI are so promising. It tempts parts of academia into distorted drivel, and parts of the media then sensationalize the published drivel once more. Was the Research Aimed at a Desired Result? How badly this can influence academia and public perception is demonstrated by one of the most-discussed studies on AI’s effects: “Your Brain on ChatGPT.” The MIT study by Nataliya Kosmyna also gets plenty of space in the SPIEGEL cover story. What was measured and interpreted: lower brain activity in people who write with AI assistance, compared to people who only google or write without any tools. As is common with preprints, the study has not yet been peer-reviewed, and it contains substantial weaknesses that experts have sharply criticized. The first round had 54 participants in three groups, the second only 18, who reportedly also came from MIT’s own orbit. There was no preregistration (committing in advance to what you want to find out with which data). In their analysis, Stanković et al. even discovered an opposite effect that the study does not further explain. Some measurement data has not (yet) been published. And the EEG analysis method used is considered too imprecise to support such far-reaching conclusions. The biggest criticism, though, is the suspicion of an activism-driven study. In an interview with Time, lead author Kosmyna said she published the study immediately, rather than after full peer review, because she feared politicians might otherwise decide to put ChatGPT in kindergartens. She considers that absolutely harmful. It is legitimate to hold such a view. It just seems unscientific to approach a study with it, and then to design the setup so that the chance of a fitting desired result remains as high as possible. Ideologies Collide It is not easy to separate genuine AI insights from studies that trivialize and weaken well-founded AI criticism. The same goes for the opposing, AI-enthusiastic narratives, because the pro-AI side works against it with billions in resources. Ideologies collide, fed by egos, PR strategies, moral posturing, and once-in-a-lifetime opportunities. Doomsday marketing makes the search even harder: AI companies can profit from warnings about the dangers of AI, whether through the notoriety of apocalypse narratives or because, in some target groups, danger translates into power. Some seemingly negative findings are therefore quite welcome in the AI industry. If you try to get at the findings presumably less influenced by interest groups, the picture in education seems relatively clear: AI can improve educational outcomes when the right AI is used the right way, namely pedagogically. Simply dumping an AI chatbot into a classroom, by contrast, accomplishes little. Huge surprise. But something else is also obvious: whether they are allowed to or not, kids use AI for school, which is why the controlled integration of AI tools into education is, in the medium term, entirely without alternative. In the world of work, the landscape of findings is more complex and requires more differentiation. A series of serious studies points to an AI effect that suits neither the alarmists, regulation fetishists, and AI opponents, nor the trillion-dollar corporations with their armada of paid scientists, PR professionals, and ecosystems: working with AI helps the inexperienced (at least for now) considerably more than it helps the pros, in certain fields of work, and provided they know how to use it correctly. Missing Domain Knowledge Among the experienced, the professionals, and the high flyers, by contrast, despite frequent time savings, partially negative effects and new problems are emerging. Take the jagged frontier problem: AI solves task A brilliantly and fails completely at task B, even though both look similar even to professionals. Or the verification-cost problem, in which AI’s greater productivity gets eaten up by the enormous effort of checking its output. Or the illusion of competence, because AI makes new domains seem easily penetrable, until you painfully discover that deep domain knowledge is missing. Taken as a whole, the effects of working with AI do lean positive. But the promise that AI works as a turbocharger for everyone and boosts practically everything simply refuses to materialize. The AI magic the world has been feeling since ChatGPT arrived in late 2022 has so far barely shown up in most companies’ numbers. The consulting firm McKinsey has coined a term for this, the “gen AI paradox,” and believes that work processes and corporate structures would have to be rebuilt quite fundamentally to realize AI’s benefits at scale. Reuters just reported that only 3.3 percent of Microsoft’s customers have subscribed to the AI package Copilot. That may be down to the product; in other areas we continue to see soaring successes and new AI triumphs. But after the first quarter of 2026, disillusionment is the word for all too many AI projects at traditional companies: because the promised revolution of AI agents has so far failed to arrive or been postponed, and because of the leveling effect that many of the studies cited here suggest. Against Inequality The societal effects, on the other hand, appear rather encouraging. Many previous technologies operated on the Matthew principle, named for the Gospel verse about giving to those who already have: they tended to reward the more competent and more privileged. AI, however, seems more often to have an equalizing effect once a threshold of access and education is crossed. Some anecdotal insights point in this direction, for example, how an unemployed man in Leipzig successfully defended himself in court in 2025 against fraud accusations from Germany’s federal employment agency — without a lawyer, armed only with ChatGPT. The AI made mistakes and cited invented court rulings, but in the end the man walked away unpunished. And a key capability of artificial intelligence is its capacity to learn: set up correctly and fed with data, it can keep getting better. It is a question of time, or more precisely of AI innovations and training data, until even free AI chatbots write better legal briefs than law graduates with perfect exam scores. Whether that will make anyone dumb is something the world’s press will surely inform us of in due time. Subscribe Leave a comment
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A few weeks after Donald Trump’s second presidential win, I took the train up from London (where I was living at the time) to Oxford to attend a conference on polls and forecasts of the 2024 election. Most of the attendees were pollsters or academics, but I also watched presentations from Aaru and Electric Twin, two companies that do what is interchangeably called synthetic sampling, silicon sampling, or synthetic audiences. Stripped of startup jargon, that means they use large language models (LLMs) to simulate responses to public opinion polls by having AI agents take on the role of survey respondents. I had already heard of Aaru thanks to some articles with eye-catching headlines like “No people, no problem: AI chatbots predict elections better than humans” in the months leading up to Election Day. The founders were making some big, some might even say far-fetched claims, such as: “within two years, we will simulate the entire globe — from the way crops are grown in Ukraine to how that impacts production of oil in Iraq, trade through the strait of Malacca, and elections for the mayor of Baltimore.” When Semafor asked Aaru’s cofounders — Cameron Fink and Ned Koh — about my boss, they said “we respect all those who came before us.” Nate (as he so often does) shared his thoughts on Twitter: Fink and Koh were relatively good-natured about this back-and-forth when we spoke at Oxford. They even offered to mail me one of the t-shirts featuring Nate’s quote they apparently had made. I never took them up on the offer, which I now somewhat regret. These synthetic sampling companies fell off my radar for a while, but they do still exist. In fact, Aaru recently received a $1 billion valuation. Is what they’re doing anywhere close to the most important frontier in AI development? Not by a longshot, especially when Anthropic just developed a model so adept at exploiting software vulnerabilities that it’s only being released to 40 companies. Still, silicon sampling is increasingly finding its way into public polling. Axios reported in March that “a majority of people trust their own doctors and nurses” based on findings from Aaru — without mentioning that the “people” in that sentence were actually LLMs. Around the same time, the Public Sentiment Institute “boosted” their online sample of 373 real survey respondents with 114 AI agents.1 (Spoiler alert: even the co-founder of Electric Twin doesn’t think that’s a particularly defensible approach.) Polling companies like Qualtrics and Ipsos are also developing synthetic data panels. So, what should we make of these … “polls”? Let’s get one thing out of the way: whatever they are, they’re not polls in the way that term is usually defined. Subscribe You can’t replace polls with AI On one hand, using LLMs to essentially make up fake survey respondents sort of sounds like the dumbest idea ever, one that will at best imperfectly replicate real polls while introducing all sorts of biases. On the other hand, with LLMs improving at a remarkable, perhaps even alarming rate, maybe that means I’m a dinosaur at the ripe old age of 24 because I still want to rely on polls that talk to actual people. I’m not going to argue that synthetic samples are completely useless. In fact, as I’ll return to later, there is evidence that some techniques can replicate topline survey results quickly and cheaply. But the marketing from certain companies can be slightly optimistic. “No traditional poll will exist by the time the next general election occurs,” said Fink in 2024. We’re just 206 days away from the midterms, and based on the fact that I still have to collect a bunch of polls every day, I’d say he should have run that prediction by a sample of AI agents before the interview.2 To see why synthetic samples can’t replace polls, here’s a quick primer on how they work. The simplest version of these models involves taking a LLM (like ChatGPT or Claude), giving it a demographic profile (e.g., a white, college-educated woman who lives in Utah and makes $70k a year), and then asking it to respond to a survey question. You repeat that process a few thousand times using different demographic profiles and end up with a sample of synthetic survey responses. The actual models used by private companies are more sophisticated than this, usually because they incorporate more hypothesized demographic characteristics for each agent and provide them with extra information. Aaru, for example, feeds agents a diet of news and information they’d be likely to consume, while Electric Twin incorporates their customers’ proprietary data about the audience they’re trying to replicate. The way Ben Warner, the co-founder of Electric Twin, explained it to me was “we have a large amount of data on […] for instance, 5,000 people. Can we make an accurate prediction of how they would respond to another question?” Still, it should be obvious why synthetic samples can’t replace polls. Polling is fundamentally a data collection process. We might use surveys to make predictions by feeding them into election forecasts, but the main purpose of a poll isn’t prediction, it’s gathering new data about what people think and how they feel. Silicon sampling, on the other hand, produces no new data. It’s simply a model: you input LLM training data, demographic prompts, and a bunch of other information, and it spits out a prediction for what a poll would say. We love models here, but models aren’t polls. That difference is an important philosophical sticking point for most pollsters I talk to. “I think politics should stay away from [synthetic sampling], because we’re trying to […] represent the voice of the people,” said Natalie Jackson, a vice president at GQR Insights. Democratic pollster John Hagner told me: “I think I’m just incredibly skeptical of this idea. I don’t think it’s research. At that point, you’re asking the machine to tell you what you already believe.” Hagner has seen some presentations of early synthetic sampling experiments, but so far, “if it’s being used in a campaign, people are keeping it incredibly quiet.”3 But Eli, I hear you saying, aren’t polls themselves increasingly governed by modeling decisions? Indeed they are: pollsters’ choices on which sampling method to use, how to define their likely voter models, and how to weight their samples can and do lead to dramatic differences in the results they publish. Aaru even referenced these limitations in the methodology statement included with that maternal mortality “poll” — although I’m using the term “methodology statement” loosely here, because it doesn’t really explain how the model works at all. We can ignore the (frankly preposterous) implication that synthetic sampling isn’t subject to a separate set of biases. The important point is that there’s still a meaningful difference between using weighting and other statistical techniques on actual polling data and using a model to predict what a poll would say. The latter is far closer to election forecasts or techniques like MRP — potentially useful models, but not a replacement for polls.4 To be fair, other synthetic sampling companies are perfectly happy with the distinction between polls and models. Warner compared polling and synthetic sampling to different tools in a toolbox. “The mistake I think we make is we think that these new tools should either work in exactly the same way or somehow replace these old tools,” he said. “Rather than thinking of it as, okay, so we’ve always had the hammer, we’ve always had the screwdriver, now we’ve got a saw. But don’t use a saw to try [to] do the job of a hammer.” A quick comment from Nate Eli didn’t ask me for a comment — rather rude of him, don’t you think? But since I’m editing this story, I figured I’d add a few quick thoughts rather than putting words in his mouth. Beyond the frequently misleading marketing, what bothers me about the AI “poll” hype is that as AI tools make statistical inference cheaper and/or better (note that these are not synonyms) that actually increases the comparative value of collecting original data. You might be able to train a model to make a reasonable estimate of what some hard-to-reach poll respondent would say — say, a young Black man who voted for Trump. (Such a person checks a number of boxes for a voter who is usually hard to reach in surveys.) Indeed, this is closely related to what models like the Silver Bulletin forecast already do. They essentially smooth out the kinks in noisy survey data by making inferences based on past voting patterns or national polls or surveys of other states. But you don’t actually know what these voters think unless you’re reaching them directly. If there’s a shift in opinion among this subgroup, you’re not going to detect it. So if I were running a campaign, I’d invest more in going the extra mile to find a representative sample of those voters. And then I’d hire some smart quants — or Claude? — to figure out the implications for campaign strategy based on proprietary data that my competitors didn’t have access to. -Nate Silver Are these models any good? If synthetic surveys are just a new type of model, the next obvious question is whether the models are at least accurate. The answer very much depends on who you ask. On one end of the spectrum, you have the maximalist argument that synthetic sampling is more accurate than actual polls. “It’s an incredibly challenging problem to go to someone and say ‘hey, we’re going to be more accurate at predicting human behavior than you, even when you talk to your customers directly’,” Koh recently told CNBC. In his view, synthetic sampling isn’t a saw to polling’s hammer, it’s “magic.” There’s certainly evidence that synthetic samples can replicate certain survey toplines. But if Aaru does have any examples of their approach outperforming the polls, they’re keeping those to themselves.5 Aaru’s 2024 election model, for example, had Kamala Harris leading in Michigan, Nevada, Pennsylvania, and Wisconsin on November 4th. And although they’ve since taken down their forecast page, they gave Harris a 50.5 percent chance of winning the race on November 2nd.6 After the election, Fink told Semafor he was happy enough with those results because they were “within margin of error,” a term that is completely meaningless when applied to a “sample” of AI agents. And of course, Aaru says their models have improved since 2024, so supposedly now they’d be more accurate than the polls? Still, their stronger argument is on cost: “We are significantly faster and cheaper than traditional polling, and still more accurate,” said Fink. The first two claims are undeniably true, but the third brings us to the opposite end of the spectrum. Both Jackson and Hagner are skeptical that these models are reliable for anything beyond replicating common survey toplines. “I just […] don’t think the machines are what we want when we’re looking for nuanced views. My example on this is people in Arizona and Nevada in 2024 who voted for Trump and voted for expanding abortion in their states on ballot initiatives,” said Jackson. Hagner identified another issue. Maybe the synthetic respondents, like sycophantic LLMs, are inhuman in one important way: they’re too nice. “The reports that have come through at the meetings that I’ve been at are that the early experiments on this, they cannot get respondents to be as racist or sexist or, frankly, as negative as human respondents,” he said. Academic research mostly agrees on this point. While there are some papers that show promising results when using LLMs to replicate polling data, most show that LLMs suffer from various quirks like producing too few “don’t know” responses and can seriously overpredict the favorability of politicians like Donald Trump and Kamala Harris. They also seem to struggle with too little variation between demographic subgroups, so the difference in predicted opinion between Democrats and Republicans, for example, is too small. When I asked Warner about these studies, his response to these papers was that just because academics can’t get synthetic sampling to work doesn’t mean that the technique doesn’t work in general. “Actually, the argument is, okay, yours does not [work]. That does not mean […] for this complex set of machinery, which uses a lot of investment, a lot of time, a lot of money, you can’t get it to work.” Cards on the table, I’m somewhat sympathetic to this argument because academics aren’t exactly great at making election forecasts. Usually, the people with skin in the game are the most accurate. Warner’s argument is that the approach Electric Twin takes — which includes, for example, making multiple predictions for each synthetic respondent using different models and prompts and subsequently averaging those to get a final prediction in a sort of ensemble forecast — produces better results than the simpler academic models. Warner shared a comparison between his method and the method from a recent academic paper with me, and Electric Twin was indeed able to get more accurate replication. But even still, he acknowledged that synthetic sampling “is not a crystal ball.” “If you asked me, do I think using other data sources will be more accurate than asking somebody who they will vote for, I would probably say no. But if you asked me ‘would your system be useful for our turnout modeling today?’ I would say yes.” For better or worse, it looks like the method is already getting more popular in the market research world. Most of the clients Aaru touts these days are businesses like EY and McDonald’s. And AI will probably begin to pop up in other parts of the political polling process. Pollsters are already using it to code open-ended survey responses, and some firms, like YouGov, are testing using LLMs to ask survey respondents questions. More worryingly, one danger to actual polls is that AI agents can be used to infiltrate online surveys. Most online polls use various checks to prevent that from happening, but there’s conflicting evidence on how effective those filters are and how prevalent AI agents currently are in online panels. If those agents ever become impossible to detect, it might spell the end of online polling, but the solution isn’t to replace all of your respondents with ChatGPT. Silver Bulletin is a reader-supported publication. To receive new posts and support our work, consider becoming a subscriber. Subscribe 1 That particular poll obviously doesn’t meet Silver Bulletin standards for aggregation. But we exclude all Public Sentiment Institute polls from our averages because we classify them as an amateur polling firm. 2 You could argue that Fink meant the next presidential election, but (a) I’m also confident we’ll still have real polls in 2028 and (b) in that case he should have asked an LLM to define “general election.” 3 Quick caveat: that’s reporting from a Democratic pollster. It’s possible that Republicans are more willing to use AI in political campaigns. 4 Indeed, Silver Bulletin does not include “polls” produced by MRP in our forecasts or averages, and we think it’s extremely misleading when their practitioners describe them in a way that suggests original data had been collected among a large number of states or Congressional districts. 5 A recent report from Aaru and EY did show two examples of a synthetic estimate being closer than a survey to a real-world benchmark — but I’d take those findings with a grain of salt because the report reads more like an ad and didn’t involve any sort of prediction being made ahead of time. 6 For comparison, our odds for Harris on the same day were 48.2 percent.
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