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AFGHS co-signatory countries ask health care users to help fill the financing gap
Hundreds of thousands of Ugandans living with HIV on antiretrovirals could be targeted for user fees or community health insurance schemes requiring modest premium payments, according to the April 2026 version of the country’s America First Global Health Strategy implementation narrative.1 As part of the “sustainable financing for the private not for profit sector” strategy, 491 facilities will be targeted for a phased introduction of user fees and scale up of community health insurance programs.2 In the Ugandan context, PNFP facilities include faith-based hospitals and other health facilities, US missionary organizations and centers of excellence—services that are often co-located at government facilities but run with additional financial and technical resources. 402,000 people—or about 28 percent of the total Ugandan adult PLHIV population on treatment—get ART from the private not for profit sector. The selected facilities provide the majority of ART and prevention of mother to child transmission (PMTCT) services. The plan doesn’t give the total number of clients served by the 491 facilities, so it is not possible to give a precise number. But the majority of 402,000 is a figure in the hundreds of thousands—hence the estimate I’m using.3 The April draft of the Ugandan implementation plan narrative is the only one I’ve been able to review. But the government of Uganda is not alone in turning to health care users to help fill the financing gaps caused by the abrupt withdrawal of US funds. In July 2025, the Government of Liberia introduced user fees for previously free services including “registration, accommodation, patient feeding, hospitalization, and a wide range of surgical and diagnostic procedures.”4 Earlier that year, Liberia rolled out a revolving drug fund designed to stabilize drug supplies by “allowing patients to pay a small fee for standardized, quality medications,” according to a Ministry of Health press release.5 (Both of these approaches had been proposed in the National Health Policy 2022-2031; media coverage explicitly connects the launch with the US foreign aid cuts.) The health financing strategies proposed by Uganda and established in Liberia are qualitatively different from user fees officially adopted by specific health facilities to cover funding shortfalls caused by the new US approach.6 The latter is a stopgap, adhoc change. The former is a national governmental adoption of policies that pass costs on to health care users, despite evidence that such approaches can exacerbate inequities and leave deficits unfilled. Two countries does not make a pattern, but they do point to urgent questions: Have other countries, including Liberia, included user fees or community health insurance schemes in their implementation plans? If so, do any of these narratives have what Uganda’s lacks: a fall-back plan in place in case these strategies for sustainable health systems fail to deliver—as they have before? I wonder if you think about it Subscribe Predictable pitfalls Both community-based health insurance and user fees are as old as the hills. And after decades of people climbing up these hills, duking it out, climbing back down—neither strategy has shown the results the Ugandan implementation plan is counting on. This is, in fact, a hill some folks are willing to die on. (You knew I’d get there, right?) In November 2025, an African-led team of health system experts published a paper directed at low- and middle income country governments trying to figure out how to create self-sustaining health systems. The money wasn’t coming back. It had been more than nine months since the season of freezing, waivering and wood-chippering; two months since AFGHS tumbled into the world touting co-financing requirements and reductions in future US government health aid. Governments were looking for strategies for sustainable, self-financed health systems, the authors wrote. For countries considering user fees and community health insurance to fill the financing gaps, they had a simple message: Don’t. On user fees, the paper states: “Reliance on user fees is ultimately a regressive and inequitable approach. It places a disproportionate burden on the poor and undermines health system goals of equity and financial protection. […] There is overwhelming evidence that user fees mobilise very limited resources for the public health sector, making it an inefficient mechanism for revenue mobilisation.” On community health insurance: “Attempting to shift the burden of funding previously donor-funded services, such as HIV care and management, and TB treatment, onto contributory schemes would exacerbate their fragility and fail to protect the population.”7 The WHO says that community-based health insurance “cannot be expected to provide a major source of funding or coverage,” and noted that most schemes offer only moderate benefit to individuals paying into them, and exclude the poorest segment of the population.8 And yet, the US-Ugandan implementation plan says that community health insurance is “the central pillar of this [PNFP] sustainability strategy” and that this approach that will generate “pre-paid pooled funding at facility and community level [that] improves financial risk protection for households, reduces catastrophic out-of-pocket expenditure, and generates structured, transparent revenue streams that can progressively absorb recurrent costs including health worker salaries.” Unfortunately, Uganda’s own history suggests the pillar might not be able to bear this weight. Ugandans Have Been to this Rodeo Before—and Some Want Their Money Back Uganda introduced its first community health insurance scheme in 1996 with support from international donors.9 Thirty years later, somewhere between 0.2 and 0.3 percent of the population is covered by CHI; just over 1 percent has any kind of health insurance.10 User fees were universally introduced in 1993 as a condition of a World Bank loan.11 They were abandoned in 2001, and in 2004—the year I moved to Uganda to watch the free HIV program get underway—a definitive study found that the fees did not improve health systems and outcomes.12 In 2004, most clinics and hospitals had ‘free’ and ‘fee for service’ options for getting care.13 The fee for service, or “cash and carry” programs had often been established in the years prior to PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria. People who could afford to paid for the drugs, often at facilities in the private-not-for-profit (PNFP) sector. When free drugs arrived, some people who’d been paying kept on doing so, perhaps because of shorter wait times, greater confidentiality, convenience or other factors. But in the year that I spent visiting the same clinics around the country week after week—including a “center of excellence” that maintained separate days for cash and carry clients and those accessing free ARVs—lots of people who had been paying tried to switch to the free option. They’d paid because they had no other choice. They’d sold pieces of family land, begged family members for loans, bought pills by the week, and sometimes by the day. Or they were just cash-strapped, like most of us, and wanted the funds for other things. 14 Twenty-two years later, this hasn’t changed. Ugandans pay out of pocket for 30-40 percent of their health care costs, leading one paper to declare that “falling ill is more than a health crisis. It is a financial emergency.”15 One recent study found that up to 48.5 percent of households dealing with tuberculosis sold something, took out a loan or dug into savings to defray the costs of TB care—which is supposed to be universally free.16 The Ugandan implementation plan does anticipate challenges. It proposes a phased approach, with 187 facilities introducing user contribution systems in Year 1, 152 in Year 2, and 153 in Year 3. Willingness to pay and feasibility studies will precede roll out; fees will be tiered by region, and a waiver system is proposed to ensure that no one has to pay who is unable to. Moreover, the plan provides for quarterly reviews of epidemiological data to “ensure that user contributions do not compromise epidemic control gains, ART continuity for the client cohort, TB case management, or PMTCT services.” Alt text: A screenshot of a table included in the implementation plan narrative that is the subject of this stack. It’s got a fetching pink bar at the top. It uses the abbreviation “CHI” which is Community Health Insurance, and FBO which is Faith Based Organizations, and it details the number of facilities that will implement user fees with waivers and community health insurance schemes over the five years of the agreement. As I said in the footnote, this is a super interesting document with a lot of other rich material. Tell me what you see—and what you would have focused on. And if you’ve seen something like this, or anything else that strikes you, in another implementation plan, tell me that too. You can use the Substack message platform or try me on Signal at @endaplague_again.25 (because @mercoonfan was, weirdly, taken). But the plan doesn’t fully explain what will happen if this approach doesn’t work out. Yes, progress will be monitored, and corrective action triggered. However, there is no specified funding replacement if premium and fee revenue prove inadequate. Instead, the authors write, “Currently, COEs serve a total client cohort of over 180,000 across 28 facilities. In the initial years, the U.S. Government (USG) will provide financial support for clients; over time, user fees generated by COEs will become the primary source of funding for sustaining their services.” Failure does not really seem to be an option. Health insurance schemes are more acceptable to the Ugandan population than user fees. Members of Parliament and civil society traveled to Ethiopia to see how that country’s scheme worked. In a follow up report, a veteran civil society group recommended allowing the “health insurance ecosystem to grow organically and [to] keep reviewing the law and regulations as this growth takes root.”17 One study found that more than three-quarters of Ugandans were willing to join a health insurance program.18 However, coverage of community-based health insurance is minimal, as is coverage of any kind of insurance—including private plans.19 A national health insurance scheme bill has been stalled for several years and presently sits with President Yoweri Museveni.20 Community-based health insurance scheme that do exist are expanding in number, but losing enrollees. Between 2022 and 2026, the number of community-based health financing schemes across the country increased by 42 percent, while the number of people enrolled decreased by nearly 11 percent.21 None of this means that community-based health insurance should not happen in Uganda—or that people do not want insurance. It doesn’t even mean that user fees and waivers won’t ever work. But there is highly relevant evidence from Uganda and the surrounding region that it is quite optimistic to describe community health insurance and user fees as central supports for sustainable financing in any sector of the health system. And now for the best-case scenario In the best-case scenario22, the Ugandan approach does exactly what it sets out to do, and so does the Liberian fee structure and revolving pharmacy fund—though I’ve not confirmed that these are in the MoU. In one best-case scenario, Uganda is an outlier, and user fees and community health insurance are not recurrent pillars of self-sustaining financing in other countries’ implementation plans. In another best-case scenario, all countries that include these strategies enjoy success beyond anyone’s evidence-informed wildest dreams: reliable funding generated by health care users fees, great health care outcomes for everyone, no exacerbation of inequities, no crippling household debt. No sold land, repurposed school tuition or high-interest loans. In the best-case scenario, not one of the hundreds of thousands of Ugandans living with HIV receiving antiretrovirals from 491 PNFP facilities misses a refill or leaves care because of user fees or community health insurance premiums. This is the best-case scenario for these people for their own health, and for their families. It is also the best-case scenario if Uganda wants to stay on the path to eliminating HIV as a public health threat. According to the country’s most recent data, 96.5 percent of people living with HIV on antiretrovirals are virologically suppressed. Epidemic control depends ensuring that 95% of people living with HIV know their status, 95 percent of those individuals are on ART, and 95% of those individuals are virologically suppressed. Uganda is still struggling with the first “95"—a frankly abysmal 85.3 percent. If HIV epidemic control and the attendant prevention of new infections, avoidable suffering and premature death matter, the country cannot afford to lose any clients who are currently in care.23 As I write this a couple hours before the polls close for the US elections in the city I live in, I say with soul-deep sincerity: I am rooting for the best-case scenario. I think it’s safe to say that we all are.24 I think it’s also safe to say that if the US and co-signatory governments have inked plans that lead to successful expansion of community health insurance and strategic use of user fees, we all would like to know, now, so that we don’t miss the opportunity to celebrate when success happens. The implementation plan narratives have to enter the public domain. They are the fullest expression of a strategy co-created by two governments. There are assumptions and details that people living in the US and co-signatory countries need to understand that are not available in the MoUs or, to date, in the Congressional Notifications. Some of these details can help other countries that are, as I write this, still working on implementation plans. Others, like a solid count of how many other countries have plans for expanding user fees or health insurance, are important for regional and global health architecture reform initiatives. No matter how this election night turns out, there will be a slew of new Congressional member orientations, briefings and talking points papers in the next few months. Release of implementation narratives should be a bullet point in every context that AFGHS is discussed. These documents can be redacted so that procurement sensitive information isn’t disclosed. There is much more historical precedent for sharing such documents than there is for relying on user fees to fill health financing gaps. Let’s look at the information together so we can hope for the best and prepare for, you know, the other thing. Alt text: A substack first: a bicep selfie! It’s my arm - peachy-white skin, black shirt (flannel, notch neck, too hot for this appallingly balmy November weather, if you’re wondering) and a sticker that says I VOTED 2026. Beige letters on red for I voted. Beige on blue for 2026. You bet I did.25 In your wildest dreams. Subscribe 1 This is a really, really rich 95 page document. There are fascinating ideas and detailed plans in it. It is all worth reading AND I have, in this post, highlighted an instance of content that could pose challenges and certainly posits success of strategies that haven’t worked before. I would love to hear what readers’ see that’s interesting and should be lifted up as something to check for in other implementation plans. I will also shortly be adding a static page to the substack site where implementation plan documents will live. I will put the url into this footnote and it will also be there on emilybass.substack.com by the end of the week. Uganda Implementation Narrative Section 4 April 22 2026 Draft 1.51MB ∙ PDF file Download Download 2 User fees are costs charged for visits, labs, medicines or other health services, usually at the time they are provided. Community health insurance, or community-based health insurance, is what the World Health Organization calls “micro insurance,” which is health insurance targeted at low-income people. 3 As usual (by which I mean always), please prove me wrong. 4 https://smartnewsliberia.com/liberias-ministry-of-health-announces-2025-hospital-service-fees-for-public-facilities/?utm 5 https://moh.gov.lr/news/2025/grand-cape-mount-leaders-residents-embrace-new-community-pharmacy-program/?utm 6 https://www.christianitytoday.com/2026/09/hiv-usaid-pepfar-africa-foreign-aid-cuts-mission-hospitals/?utm 7 https://gh.bmj.com/content/10/11/e021270 8 https://www.who.int/news-room/fact-sheets/detail/community-based-health-insurance-CBHI 9 https://pmc.ncbi.nlm.nih.gov/articles/PMC2827475/ 10 https://pmc.ncbi.nlm.nih.gov/articles/PMC10861328/#b3-jpmph-23-110 11 https://pmc.ncbi.nlm.nih.gov/articles/PMC527704/ 12 Same citation as the footnote 2 - the article is called “Learning from failed health care reform in Uganda.” To which I say: If only. If. Only. 13 There is a whole taxonomy of user fees to be aware of, if not commit to memory. Out of pocket costs are everything that someone pays for themselves. In this Stack, user fees are planned and policy-supported out of pocket costs. There are also out of pocket costs that people pay to buy drugs or receive tests or health care assessments that would be free if the drugs were on the shelves, or the machines or kits were available, or the staff were on site. A user fee is usually designed to be modest, pegged to willingness to pay, and may be waiveable at the point of care for anyone who is unable to do so. The costs for things that would otherwise be free are whatever the market will bear and people either have to pay them or go without. Out of pocket costs for services and stuff that aren’t available in public facilities are different again from bribes or unofficial fees that some health workers may impose, even though most are indefatigable, tireless and tired, and devoted to their clients. 14 For the record—which really is these footnotes—I would give a whole stack of fridge magnets for a systematic analysis of the economic and social impact of the Mass Unemployment Event in AFGHS countries among the very people who used to be able to afford and cover user fees, both for themselves and vast family networks. Locally employed USAID technical staff, house cleaners, caregivers, drivers and technicians were financial anchors for cousins, friends, friends’ children, friends’ childrens’ cousins, teachers, pastors, neighbors and so many other kinds of kin. Aid recipients lost direct funding; many other people who had not been aid recipients, but parts of the elaborate care webs that function as safety nets for so many people, lost crucial support too. And that’s even before we get to the people who worked at the hotels and restaurants and bars where people employed by the US and its implementing partners used to spend disposable income. Those businesses have lost revenue; those folks have lost jobs. It will be some time coming—and someone will have to fund this work—but I do hope it happens. And I hope, as usual, to be proven wrong. 15 https://eprcug.org/blog/how-out-of-pocket-healthcare-costs-keep-driving-ugandans-into-poverty/ 16 Another straight-to-the-point journal article title. Households experiencing catastrophic costs due to tuberculosis in Uganda: magnitude and cost drivers. https://pubmed.ncbi.nlm.nih.gov/32938411 17 https://www.cehurd.org/download/technical-policy-brief-on-community-health-insurance-scheme/?wpdmdl=13661&refresh=6ae9122f5d4ed1793659439 18 https://pmc.ncbi.nlm.nih.gov/articles/PMC10125197/ 19 https://pmc.ncbi.nlm.nih.gov/articles/PMC10861328/#b3-jpmph-23-110 20 https://ugandapost.news/uganda-to-make-health-insurance-mandatory-by-2026/ 21 https://shu.org.ug/download/235 22 With a nod, tip of the stack hat, and wag of the Mercoon tail to a deeply valued reader who told me that I have a tendency to speculate about the worst-case scenarios a little too much of the time. 23 https://news.mak.ac.ug/2026/10/uphia-2025-shows-ugandas-hiv-status-awareness-gap-despite-strong-treatment-outcomes/ As you’ll see in the next footnote, I’ve already written a subSubstack on another topic, so I will be brief with regard to the study referenced in this article. The Uganda Population-Based HIV Impact Assessment, or UPHIA, will never happen in this way again. For more than a decade, PHIAs have been supported by the US government as a way to generate accurate estimates of country progress on key HIV indicators. They are a holdover from the PEPFAR program that was laser focused on ensuring US taxpayer dollars subsidized progress in pandemic control. There may be other population-level surveys and the data may even be publicly released, as the entire set of FY2026 MER data have not. But PHIAs will never happen again. If you’re wondering whether the estimates of HIV progress at country level might get less reliable….you’re not alone. 24 Ooh baby, I hate “we” in almost all forms. But sometimes I go there, when I am looking for company, which I am. Because this Stack moves into the somewhat-uncharted territory of assessing what the implementation plan narratives may suggest about co-signatory countries’ roles and responsibilities to the people living within their borders. The MoUs, specimen and data sharing agreements were templates. Countries’ answers fit into pre-specified questions that did not include, “how are you going to fill financing gaps and stabilize your health system as this plan unfolds?” In contrast, the implementation narratives are open form—the product of co-creation between the two governments. Co-creation can mean lots of things, but nothing leads me to believe that implementation plans are ghost-written by the US government, or that contents were imposed by the US counterparts. Instead, I think the parts of the plans that read like country government initiatives are endorsed, if not initiated by, those governments. For instance, the Ugandan implementation plan narrative describes plans for revenue-generation through fees charged for equipment calibration, repair and maintenance provided through Uganda’s National Equipment Calibration Laboratory, and laboratory accreditation through the Uganda National Accreditation Service (UGANAS), targeting private sector, PNFP, research and academic clients. That’s super specific and also quite ambitious. It doesn’t read like an American idea. There’s also a provision for solar panels, and other stuff that feels country owned and driven. This is where it gets interesting. If co-creation is the case, then both the US and co-signatory governments are accountable for the contents and the outcomes. Most discourse about AFGHS to date has focused on the decisions that America has made, or demanded that other countries make. The AFGHS architects have monopolized the hot seat. As they should, in so many ways. America absolutely created the conditions under which countries needed to come up with health financing strategies to fill unanticipated, catastrophic funding gaps. And with not-too-long a lens, we can look back and see that America is also on the hook for its role in the Bretton Woods institutions that made user fees and health system fiscal austerity conditions of loans during the era of structural adjustment. But in the here and now, it is not at all clear to me that the US is requiring Uganda or any other country to implement specific approaches to sustainable financing. Instead, it is as the authors of that paper up in footnote 6 suggest: African governments have agency. As implementation plans roll out—whether or not the narratives are shared—it will be important to understand what this agency looks like and what it means for people, including the poorest of the poor. And it will be important to figure out how to talk about it safely, respectfully and critically in places other than the literal and metaphorical footnotes. 25 This week’s song is “Once upon a time” by the Moody Blues. (I know, this is gonna be a weird, largely banger-free end of 2026 playlist. HMU with requests.) AND please do watch the video and appreciate the truly amazing opening sequence—a drum kit wasteland, a coupla plastic bags, a bit of sand. Sort of like the hill where fiscal austerity policies that put costs on health care users might go to perish. But then there’s a lady with amazing hair. It’s worth it.
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The Israel debate reshaping Jewish American politics
“There are plenty of people who believe, as I do, that Israel has a right to protect itself,” says David to Lauren, both pictured below, over the dinner table. Subscribe “How does starving children protect Israel?” she replies. “I don’t think Israel is intentionally starving children.” “It’s a little bit absurd to be sitting here talking about all of these very specific things,” Lauren says, “as opposed to looking at the totality of him as a candidate, and the 90% of things that you agree with him on.” This is a snapshot from a conversation between a Jewish father and daughter in Michigan ahead of the crucial Senate race. Lauren supports the Democratic candidate, Abdul El-Sayed. Her father is undecided. That is mainly because of El-Sayed’s stance on Israel, one that mirrors a growing wing of the party that has become critical of the US-Israel relationship following the war in Gaza. You’re reading FourSight, a newsletter from Channel 4 News’ expert journalists explaining the complexities of the biggest global stories Could that alienate Jewish American voters who have a strong connection to Israel - and the majority of whom have voted Democratic? A shifting stance on Israel “An ally that takes your money to push you into wars you shouldn’t be fighting is not an ally,” El-Sayed recently told ABC News, referring to the Iran war and how some Americans believe that Israel pushed President Trump into the conflict. Foreign policy has become an economic issue that’s hitting Americans’ pockets, with the soaring cost of petrol and diesel. El-Sayed, pictured below, has opposed military aid for Israel and accused the nation of genocide in Gaza. That led to the pro-Israel lobby group, AIPAC, funding his opponent, Hayley Stevens, to the tune of $30m during the Democratic primary here. “I frequently criticise AIPAC because I think the way that they are pouring dollars into defeating Abdul and others around the country… is really corrosive to American democracy,” Brad Lander says at a canvassing event in Detroit. Lander, a Jewish Democratic congressional candidate in New York, is an ally of Mayor Zohran Mamdani and has come to campaign for El-Sayed. “Democrats and Americans don’t want to keep paying for Netanyahu’s wars,” he says. “They want a reset in the US relationship with Israel.” The 2026 election has clearly been a bruising one for AIPAC; the Wall Street Journal reported that, in an unpublished letter, the group described the cycle as one of the “most challenging environments in recent memory”. Share And significantly, after the midterms, the group will stop direct contributions to candidates through one of its political action committees. Voters’ concerns We followed a group of Jewish canvassers around one suburb in Detroit. They think that among the 130,000 Jewish voters in Michigan, between 20 and 30,000 are undecided. In a swing state where El-Sayed beat his primary rival by just 13,000, that could prove pivotal. We meet one voter, Jen Friedman, pictured below, who has a “Democrats for Rogers” sign, referring to the Republican candidate. The issue of Israel is very important to her because “having a safe haven is crucial”, she tells me. “What I see is one candidate, Mike Rogers, who is associating himself with people who are very proudly American,” says Jen. “Abdul, on the other hand, is associating with people who say they are anti-American.” Friedman raises two issues. Firstly, Hasan Piker, a left-wing streamer who has campaigned alongside El-Sayed and has been criticised for his comments on the US and Israel. [ ](https://channel4news.substack.com/p/who-is-hasan-piker-the-socialist) [ Why Hasan Piker thinks the US needs a socialist Trump ](https://channel4news.substack.com/p/who-is-hasan-piker-the-socialist) Anushka Asthana · Aug 19 [ Read full story ](https://channel4news.substack.com/p/who-is-hasan-piker-the-socialist) The other concern regards an attack on a Michigan synagogue back in March. The FBI said the man was inspired by Hezbollah and had lost relatives in an Israeli airstrike on Lebanon. El-Sayed condemned the antisemitic attack, but also said “hurt people hurt people”. That upset many here, with El-Sayed apologising numerous times for his choice of language. Jews for Abdul As we follow the canvassers, there are still plenty of lawn signs supporting El-Sayed. Elissa Driker, pictured below, runs out of her house wearing a “Jews for Abdul” t-shirt. “I feel like the values that Abdul has align with how I live my Judaism,” she tells me. She says “Abdul is not Hasan Piker, so I don’t conflate them”. I ask why Piker keeps coming up. “It gets weaponised. I don’t know if you watched the debate the other night, but talk about… weaponising fear and weaponising anxiety and all that Islamophobic dog-whistling that was coming towards Abdul.” I also talk to Elissa about how Americans more broadly appear to be questioning the US-Israel relationship and whether American Jews were ready to do that too. “A lot of American Jews are. My experience is absolutely the tide is turning.” For the first time, Gallup found this year that Americans now sympathise more with the Palestinians than the Israelis. In another poll of Jewish American voters, 65% said they were pro-Israel but also critical of Israeli government policies, 52% support cutting or eliminating aid to Israel. Father and daughter Back at the dinner table, I bring up those polls with David Fink. Why does he think Americans sympathise less with Israelis? [ ](https://channel4news.substack.com/p/how-support-for-israel-in-us-is-declining) [ How support for Israel in US is declining ](https://channel4news.substack.com/p/how-support-for-israel-in-us-is-declining) Kiran Moodley · May 4 [ Read full story ](https://channel4news.substack.com/p/how-support-for-israel-in-us-is-declining) “Because the news media and the extremes of both parties are so willing to tell what I think is a false narrative.” Lauren chimes in: “Do you really think the actions of Israel have nothing to do with the shift in the sympathies?” “I think that’s very relevant,” he replies. “I just don’t think that people really have a full understanding.” Lauren again: “It sounds like you’re saying that the shift is due to how the atrocities are being described, as opposed to what the actual atrocities are.” “There have been some things that shouldn’t have happened,” David says. “I think the polling is being driven by politicians who are taking advantage of this issue.” Lauren then asks, “I’m curious what your response would be if my children were killed in an Israeli airstrike and someone said there have been some things that shouldn’t have happened?” A long pause from her father. “Any reference to my grandchildren has a very deep emotional impact on me. Well done,” he says. “I have an empathy for any civilian in war and I don’t mean to belittle those losses. The loss of any one life is a horrible thing. But it doesn’t make it a war crime and it doesn’t make it genocide.” Lauren and David cannot agree but tell me how proud they are of one another for sticking to their convictions and for agreeing to let me sit in on their conversation. I cannot thank them enough for their time, and hope their honesty informs and educates many people during such a fraught election. Abdul El-Sayed: The candidate testing the US - Israel relationship Thanks for reading our latest FourSight newsletter. Subscribe to receive free weekly newsletters from Channel 4 News. Subscribe Share Channel 4 News Leave a comment
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Texas health agency proposes eliminating children’s autism program
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Florida Surgeon General Joseph Ladapo is a well-known vaccine skeptic.
How these census changes could threaten public health
The Trump administration wants to make three big changes to the U.S. Census, including eliminating questions about race, ethnicity, and sexual orientation and excluding anyone who is not a citizen or “lawful permanent resident."
Ladapo: Eliminating vaccine mandates isn't about science, it's about parents' rights
Florida State Surgeon General Joseph Ladapo is a well-known vaccine skeptic. But on Thursday he said the state’s drive to change its rules to eliminate four vaccines children are required to take to enter school or daycare centers has nothing to do with science or the efficacy of the vaccines. It is about putting parents […]
HubSpot cuts nearly 660 jobs as AI reshapes its business
The marketing software company is eliminating 7% of its workforce and creating a flatter organization as it shifts its strategy toward delivering customer outcomes with AI.
Northwell Health eliminating “limited number” of positions
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Bishop’s computer science chair says AI is eliminating ‘grunt work’ and reshaping digital jobs
Dr. Russell Butler, chair of Bishop’s University’s Department of Computer Science, says artificial intelligence is increasingly taking over routine digital “grunt work,” changing the skills students and workers may need in the years ahead. Photo courtesy of Bishop’s University. Click here to read our platform! Get local news like this every morning. Subscribe free below. Subscribe Pulse Newsroom Artificial intelligence is already taking over some of the routine digital work once performed by entry-level employees, according to Bishop’s University Computer Science chair Dr. Russell Butler — a shift he believes will make expertise, judgement and the ability to evaluate AI-generated work increasingly important. Butler described the change as automation reaching what he calls the “bottom of the cognitive pyramid” during an interview with The Pulse about AI, university education and the future of digital work. His argument is not that humans are disappearing from the workplace. Instead, he sees their role changing as AI becomes capable of handling more of the repetitive tasks involved in computer-based work. “Everything’s converging on just AI basically doing all the grunt work,” Butler said. The bottom of the cognitive pyramid Butler is from Lennoxville, completed his undergraduate studies at Bishop’s and later earned his PhD at the Université de Sherbrooke. He joined Bishop’s in 2019 and now chairs its Department of Computer Science. He uses AI in research, teaching and other creative work, and said the technology is increasingly capable of handling routine digital tasks that once required substantial human time. “You’ve got the grunt work, like moving things around in Excel, doing basic programming tasks,” Butler said. “That’s like the bottom grunt work that the entry-level worker would have done two or three years ago.” Butler went further, saying in his view that much of this type of work has already been absorbed by AI tools. He connected that change to a shift he sees taking place in computer science, where entry-level roles have declined while experienced workers can use AI to increase what they can produce. “A senior developer now has access to essentially an unlimited amount of junior developers on demand,” Butler said. He was describing AI systems metaphorically, not literal employees. His point was that one experienced developer can now ask AI tools to produce code or other technical work that might previously have been assigned to more junior workers. That raises a broader question for universities and employers. If some of the simpler work traditionally given to newcomers can now be done by machines, how do people gain the experience needed to become senior workers themselves? Students doing work that once required years of programming Butler said he is already seeing the change inside his classroom. He created a Bishop’s course called CS208, Coding in Plain English, to show students — including those without traditional programming backgrounds — what they can accomplish using AI. Some come from disciplines such as psychology or neuroscience with no previous programming experience. “What I’m finding is that students who have zero programming experience, they come in from another discipline like psychology or neuroscience or something, they are now able to get up and running with real data sets,” Butler said. Butler’s own doctoral work involved neuroimaging, and he said he has assigned students work he considers comparable to the kinds of analysis he performed during his PhD. He described giving students a real dataset, an expected result and instructions to use AI to complete the analysis. Butler said those students have been able to carry out work at a level he associates with tasks he once performed after years of programming experience. That does not mean a student using AI instantly acquires the same knowledge as an experienced computer scientist. But Butler sees it as evidence that AI can dramatically lower the technical barrier between having a problem to solve and producing a working result. The role of the person using the system then changes. They need to know what to ask for, understand enough about the subject to judge the answer and take responsibility for what is ultimately produced. What about AI hallucinations? One persistent concern surrounding generative AI is hallucination — when a system produces information that sounds convincing but is false or unsupported. Butler said that problem has improved substantially in newer systems and is not as severe as it was with earlier models. He pointed in particular to newer AI systems’ ability to search the web, consult scientific databases and return source links rather than simply generating a citation from their internal model. Butler nevertheless said users should verify what AI produces. “You should verify,” he said while discussing citations generated with AI. His position is that hallucinations have become less common in the systems he uses, not that incorrect AI output is impossible. Human checking remains part of the process. Hours of work compressed Butler offered another example from his administrative work at Bishop’s. The university has been comparing CEGEP courses with first-year Bishop’s courses to determine where students may qualify for advanced standing. Traditionally, Butler said, that means reviewing two sets of course descriptions and manually matching one institution’s courses with another’s. As department chair, that could require hours of reading and comparison. He said AI can now be given both sets of material and asked to generate an initial mapping automatically. “It saves me hours and hours of work,” Butler said. Butler said the AI-generated mapping can also produce a better result than he would produce himself. He sees similar opportunities in businesses. A company may receive specifications, drawings, emails or other digital material from customers and then have employees convert that information into an internal format before anything can be manufactured or delivered. AI can increasingly perform parts of that intermediate processing. In Butler’s view, the employee does not necessarily disappear. Instead, the job becomes more about checking the result. “The human is still there,” he said. Judgement could become more valuable That change is central to Butler’s view of where digital work may be headed. If AI can produce a first draft, write basic code, compare documents or process large amounts of information, he argues that knowledge and judgement become increasingly important. “The real scarce resource going forward is going to be domain knowledge, expertise, and… credentials, authority, the ability to work with other people,” Butler said. He is therefore encouraging students not only to learn AI tools but also to broaden their education. He mentioned acting, fine art and photography as examples of courses that can help develop what he described as taste and intuition — the ability to recognize what is good, what is not and what should be changed. “And that’s the skill that they need now because the grunt work has been automated and now it’s about evaluating what the AI produces and telling it how to improve or expand the output,” Butler said. That does not remove the need for technical knowledge. Butler’s argument is that the emphasis may shift away from manually completing every step of a task and toward directing, checking and improving work produced with AI assistance. He also stressed that humans remain responsible for final decisions. “At the end of the day, the human has to make the final call,” Butler said, pointing to the question of accountability. Physical work may be different Butler draws a distinction between digital work and jobs requiring people to manipulate the physical world. He expects AI to continue advancing quickly in tasks performed almost entirely on computers. He is more cautious about claims that humanoid robots will soon be able to replace workers such as plumbers or electricians. Butler said those trades would not be replaced “anytime soon” in his view and described some current robotics demonstrations as overhyped. He described the situation as counterintuitive. “It’s almost like we solved the highest level first,” he said, contrasting advances in digital AI with the harder problem of building robots capable of operating reliably in the physical world. Butler’s argument is that some digital occupations could face automation sooner than trades requiring complex physical work. The wider AI shift in the Townships Butler’s comments come as local institutions are increasingly grappling with how AI should be used. The federal government recently announced up to $162 million over five years for 10,000 AI-related placements through Mitacs. The Université de Sherbrooke told The Pulse that the number of its collaborative research and innovation projects supported through Mitacs has approximately doubled since 2018-19, while the number of placements has approximately tripled. UdeS also said it already has projects involving both AI adoption and the application of AI to other fields. At Bishop’s, Butler said part of his role involves building the Computer Science department’s local presence, connecting students with regional partners and strengthening relationships with the Sherbrooke technology ecosystem. Those developments put universities in a difficult position. They have to prepare students to use the tools employers increasingly have available while also making sure graduates understand enough to recognize when those tools are wrong, incomplete or being applied to the wrong problem. The risk of losing human skills Butler does not see AI as risk-free. Later in the interview, he raised a separate concern: as AI becomes better at reading, writing, programming and other cognitive tasks, people could lose some of the underlying skills that historically helped produce new ideas. “The other danger is that we’re going to lose the human skills,” Butler said. He specifically mentioned reading and writing and argued that people could lose some of the lower-level understanding that contributes to breakthroughs. Butler said AI systems are based on existing human knowledge and argued that they become much more powerful when paired with a capable person. That tension runs through his view of the technology. AI can remove hours of routine work. It can allow beginners to perform tasks that once required substantial technical training. It can give experienced workers significant leverage. But the more capable the technology becomes, the more important it may be for people to develop the judgement needed to decide what should be done in the first place. For Butler, that is where education may have to change. Students still need to understand their field. They still need to know when something is wrong. And they still need to be able to make the final decision. But if AI increasingly handles the bottom of the cognitive pyramid, the value of a worker may depend less on how quickly they can perform the grunt work and more on whether they understand what the work is supposed to accomplish. Don’t miss the next story that affects your community. Join thousands of readers getting The Pulse every morning—plus breaking news alerts when it matters most. If you value this kind of local journalism, consider supporting it. Subscribe, share and like! Subscribe Share
Rutgers Experts Available to Discuss Implications of Proposed 2030 Census Changes for Research and Public Health
A proposed Census Bureau rule could change the demographic information collected through the 2030 Census — eliminating questions on race, ethnicity, and sexual orientation — with potential implications for population health research and the use of Census data. The Census Bureau has invited the public to comment on this proposal by October 13, 2026. Rutgers experts available to discuss the proposed changes include Cristine Delnevo, Director of the Rutgers Institute for Nicotine and
Australian businesses raise prices as card surcharge ban takes effect
SYDNEY, Oct 1 (Reuters) - Australian businesses said a ban on card surcharges that took effect on Thursday would force them to raise prices, casting doubt on government claims the change would lower living costs by eliminating more than $1 billion in annual card fees.
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Reform and the UAE – a threat to British politics
By Alex Carlen The United Arab Emirates likes to present itself as part of the solution to the climate crisis. The oil-rich Gulf state has committed to Net Zero by 2050, hosted COP 28, and even declared “championing climate action” as one of three strategic objectives for this week’s session of the United Nations General Assembly. But behind the scenes the UAE has quietly built one of its closest political relationships in Europe with the party most hostile to climate action in Britain: Nigel Farage’s Reform UK. There is no evidence that the UAE is funding Reform. But a new FairSquare report, Petro-populism: the UAE–Reform threat, published today, documents a growing political relationship that should concern anyone interested in the integrity of British democracy. Reform’s leaders have embraced the UAE’s political model and promoted positions that align closely with the Emirati government’s priorities, while the UAE has given Farage and his party unusually warm access and public backing. What is emerging is not simply a relationship between British politicians and a wealthy Gulf state, but a channel through which an authoritarian government can cultivate political influence here, and abroad. Democracy for Sale relies on its readers. If you already support us, thanks so much. If you don’t, sign up to support fearless independent investigative journalism. Subscribe Back in January, Nigel Farage appeared at a GB News event in Dubai. On the 50th floor of a tower overlooking the luxury resorts and upscale residences of Palm Jumeirah, the Reform leader declared: “I want Clacton to look like this.” At the event – which Farage never declared on his official register of interests – senior Emirati officials mixed with British expats. Farage was keen to flatter. “We recognise you are our friends”, he said, assuring them that “a Brexit London, a Reform London, will remember you.” Controversy surrounding Reform’s finances and its susceptibility to foreign influence have centred around high-profile donations from billionaire crypto donors, and the jailing of Nathan Gill, Reform’s former leader in Wales, for accepting bribes to give pro-Russia speeches. Far less attention has been paid to Reform’s blossoming new alliance with the UAE, an oil-rich authoritarian state with a track record of ruinous anti-democratic interventions. Farage wasn’t always so fond of the UAE. Back in 2023 he called it an “absolute monarchy with an abysmal human rights record.” Now Reform’s hierarchy calls the UAE home. Deputy leader Richard Tice splits his time between his constituency and Dubai and has called on the UK to learn from the UAE. The party’s treasurer Nick Candy runs a firm which has been in partnership with a UAE-state linked firm since 2024. Nadhim Zahawi sits on the board of an Abu Dhabi think tank alongside an array of the most senior UAE officials and is reportedly close to three brothers of the country’s despotic ruler Mohammed Bin Zayed. Reform’s leading lights have effusively praised the UAE’s governance model, defended it from criticism, and advanced its political agenda in the UK. GB News, whose two major shareholders – the Legatum Foundation and Paul Marshall – have strong links to the UAE, has been more than happy to broadcast UAE propaganda and was forced to pay damages in 2025 after airing a false claim about a UK charity by the UAE “disinfluencer” Amjad Taha. The UAE has responded in kind. When the UAE Minister for Foreign Affairs conducted an official visit to the UK in May, Farage was the only non-government figure granted an audience. UAE state media publicised the meeting, and said that they discussed “the strategic relations between the two countries and ways to enhance them in a manner that serves mutual interests.” For the UAE these ‘mutual interests’ largely concern its paranoia over political Islam, and in this regard the UAE-Reform alliance is part of a broad and troubling pattern. Following a crackdown on dissent at home in the aftermath of the Arab Spring, the UAE has offered material and political support to a range of violent and authoritarian actors willing to oppose the Muslim Brotherhood with no regard for the consequences. Its meddling in Egypt, Tunisia, Yemen, and most notably Sudan, have been devastating. The UAE’s strategy of seeking out partners on the political fringes who it believes will advance its interests is not unique to Britain – it extends beyond the Middle East to Europe and the US. In France, it has offered clandestine support to Marine Le Pen through secret meetings, as well allegedly funding trips to the region after which Le Pen returned with a renewed focus on the UAE’s perceived enemies – Qatar and the Muslim Brotherhood. Left-wing opposition leader Jean-Luc Mélenchon has accused the UAE of smearing him and of “encouraging discrimination, hatred or violence”. In the US, the UAE actively supported the rise of Donald Trump, establishing itself as a key ally during both his first and second terms. Around these relationships sits a wider ecosystem of figures willing to amplify UAE narratives, that even extends to Andrew Tate and Tommy Robinson. Subscribe In Britain, the UAE has used a combination of aggressive diplomacy and illicit, disruptive tactics to achieve its policy goal of eliminating any perceived threat from political Islam. In 2012, for instance, it threatened to block billion-pound arms deals with the UK and stop inward investment if David Cameron did not act against the Muslim Brotherhood and rein in the BBC’s coverage of the group – going so far as to suggest, with no supporting evidence, that the group had infiltrated the BBC. It has financed smear campaigns against a high-profile UK charity and funded a mercenary to secretly surveil, and possibly assassinate, a British national on British soil. In Reform UK, the UAE has finally found an ally willing to not only ban the Muslim Brotherhood, but to publicly vilify the group and repeat the UAE’s claims that dangerous Muslims are a fifth column in British society, a narrative that aligns with the Islamophobia and anti-immigration sentiments that underpin Reform’s populist politics. The Rycroft review into foreign interference concluded that “hostile states and non-state actors have a clear incentive to attempt to undermine UK democracy.” The UAE’s network and alliance with Reform must be understood within that framework. It is a powerful, disruptive and deeply authoritarian actor with the resources and networks to intervene in our politics, and a track-record of doing so in a multitude of other countries. The evidence of the threat the UAE poses is overwhelming. The question is whether parliamentarians are willing to call the UAE out and demand action using the tools that the government has to respond. Placing the UAE on the “Enhanced Tier” of the Foreign Registration scheme alongside Russia and Iran would send a powerful signal to the UAE that its meddling will no longer be tolerated, and would place Farage’s next trips to the UAE under the scrutiny they deserve. Alex Carlen is research and advocacy manager at London based human rights organisation FairSquare and author of its new report Petro-populism: the UAE–Reform threat. Subscribe
More Xbox Layoffs; Activision Takes Over 'Halo'
The Microsoft-owned gamemaker is in the process of eliminating 3,200 jobs.
More Xbox Layoffs; Activision Takes Over 'Halo'
The Microsoft-owned gamemaker is in the process of eliminating 3,200 jobs.
No 'magic bullet' for malaria—elimination will require a combination of tools, say global health expert
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The Big Holes in Wearable Heart Rate Variability And Readiness Scores
On September 9th, Apple announced it was revamping its Apple Watch Health Sensing System, rolling out a Readiness score (0 to 10), and increasing the frequency of heart rate variability (HRV) outputs 24-fold. This can be viewed as upping its competition with various other consumer wearable sensors. These “readiness scores” as a composite of multiple metrics, with heart rate variability (HRV) being front and center for most. The majority of Americans are now using wearable sensors, which equates to well over 100 million adults. HRV and Readiness scores are increasingly being marketed as a measurement of autonomic nervous system health, a digital marker for future disease, a clock for biological age, and a holistic metric to promote healthspan and even longevity. (Apple also introduced a new longevity tab and “Health Age”.) None of this has been proven. In this edition of Ground Truths I am going to review what we know about heart rate variability and readiness scores. Heart Rate Variability HRV is the variation in normal heart cycle timing. The variability of the heart rate, the barely perceptible millisecond changes in time between consecutive heart beats (see R-R intervals in the Figure below, left panel), is due to interplay between the sympathetic and parasympathetic (vagal nerve) inputs. Distinct from heart rate, individuals with the same heart rate can have very different HRVs. It is a rough reflection of the autonomic nervous system (ANS) activity, inadequate to say whether a person’s ANS function is abnormal. For more than three decades, heart rate variability (HRV) has been measured and several studies have found an association of low HRV and clinical outcomes, particularly a link with higher all-cause and cardiovascular mortality. There have also been less well established links of low HRV to risk of early cognitive impairment, dementia, mental illness, Type 2 diabetes and substance abuse. An important reminder is that HRV is a surrogate marker without any established cause-and-effect relationship. If you increase your HRV, that doesn’t mean it will improve health outcomes. In fact, there is no hard evidence for that. All that work linking to health outcomes was done with electrocardiogram (ECG) derived HRV. Now, in the era of consumer wearables, this is getting assessed differently, by optical pulse (yes, the lights you see) plethysmography (PPG) or what is called pulse rate variability (PRV). They are not the same, as shown below (right panel) and only concordant when the delay between the ECG and pulse is kept constant, which basically means at rest. I should mention there’s also what I will call MPV, a mattress mechanical movement sensor, a derived heart rate variability, that companies like Eight Sleep use, even further away from directly measuring HRV. HRV has not one uniform measurement but many different types of quantification, such as RMSSD, the magnitude of difference between successive R-R intervals of normal sinus beats (N-N) or SDNN, the standard deviation of NN intervals, both in milliseconds. SDNN is one of the so-called frequency domain HRVs (others are LF, HF, LF/HF). Different wearable sensors use different metics; Apple has relied on SDNN and nearly all of the others use RMSSD, which is generally considered the more accurate metric. There’s also the different length of time measured, such as for a matter of minutes, all day, or an overnight’s sleep. Short measurements are especially problematic since they don’t capture enough of respiratory modulation and other factors that influence HRV. Share Ground Truths How well does HRV correlate with PRV? There are very limited studies, especially independently done. One that is commonly cited was conducted by Air Force researchers in only 13 healthy adults assessing Oura ring 3 and 4, Whoop 4.0, and Garmin Fenix 6 and showed a correlation coefficient of 0.88 to 0.97 and a mean absolute percentage error from 6 to 10%. The correlation is not a perfect 1.0, but there’s at least a fairly high level of correlation. HRV is supposed to increase during the night due to takeover of the parasympathetic nervous system, and higher during deep sleep. A recent example of my 1 week, all day “HRV,” and one during sleep is shown below. As you can see, the N of 1 data are inconsistent for the same days from different sensors (Oura, AppleWatch, Fitbit Air, and Eight Sleep) by patterns, absolute numbers, and comparison with prior days and weeks. The largest study in over 8 million Fitbit users (the old version, not Google Fitbit Air, introduced in May 2026) gives you a sense of the effect of age, sex, and the 2 different main HRV (here PRV) metrics, with RMSSD on the left and SDRR (=SDNN) on the right below. That study, from data collected in 2018, is a major outlier, since all the more recent ones are tiny with respect to sample size. Many of the companies have not had independent evaluation of their HRV, such as Eight Sleep, but have published a low standard error on their website. There are some other published studies on the correlation between HRV and PRV, but they are all small and only in healthy adults. A scoping review emphasized the lack of study in underrepresented individuals, including the aged, people of color (which affects the PPG signal), and individuals who are underweight or obese. Add the typical adult age 60 plus with one or more chronic diseases. For example, one study in over 900 adults found poor correlation of HRV and PRV, non-uniformly underestimated across many chronic diseases (cardiovascular, endocrine, neurological, respiratory, and others), concluding PRV is “an invalid surrogate for HRV.” A recent systematic review of 43 studies comparing HRV and PRV found reasonable pooled absolute standardized error (HRV as gold standard) but only 10 of the studies provided quantitative synthesis in ideal conditions. Their main conclusion was similarly cautious: “PPG-derived HRV [PRV] should not be regarded as universally interchangeable with ECG-derived HRV across all devices, populations, and recording contexts.” Factors Affecting HRV and PRV That gets me to the long list of factors that affect HRV (and PRV) besides the device, the type of measurement (RMSSD, SDNN or others), the person’s signal, the sensor site, the duration of data capture, if weighting by sleep stage is used, how artifact is processed and corrected. And this list is not complete!: Oura puts out data from their community of users (who input data) on what affects their overnight HRV. The factors currently provided are: no alcohol (increase 8%), melatonin (increase 2%, float tank (increase 2%), wine (decrease 4%), and party (decrease 14%) in overnight HRV. Must be some big parties! Subscribe What is a PRV measurement good for? It has been falsely characterized as an index of “autonomic balance” and a specific indicator of stress. A 2018 review of the studies available for HRV and its relationship to stress, not using any of the current wearables, found that stress can lower HRV. But so can many other factors. The non-specificity of the signal, indexed to the table above, is striking. Evidence from a UK Biobank study of over 46,000 participants with actual HRV looked at genetically predicted HRV, a genetic risk score, that failed to show the expected HRV-mortality link, indicating that _HRV is likely not causa_l, but rather a reflection of person’s physiologic state. A review of consumer wearable HRV data from 5 longitudinal studies showed that nighttime PRV was not associated with perceived stress, and surprisingly higher HRV, in the largest cohort (N=717 participants), was correlated with higher stress. An Oura ring cohort of 525 first-year college students found a link between overnight PRV and perceived stress, but that was also seen with resting heart rate, sleep, and respiratory rate. Several very small studies have examined the relationship of HRV and athletic injuries or guiding training with mixed, and predominantly negative results. HRV biofeedback training with paced breathing had no significant effect on reducing stress or raising HRV, as demonstrated with sham controlled trials. When HRV for multiple days showed a decline in conjunction with body temperature, the Oura ring published data for prediction of Covid. The WHOOP company sponsored an observational study, published in 2026, of 30,000 users for 72 weeks, without a control group, that reported reduced alcohol intake (5.8 % points) by self-report. That doesn’t tell us much, and particularly about the merits of HRV for behavioral change. If you use the same device and conditions as longitudinal trends for multiple (at least 2-3) weeks that may be the one way to get something useful from the measurements. Data for overnight sleep with minimal motion and using RMSSD is the best proxy for real HRV. The reason to look at trends rather than any given night is that it more likely represents something, even though you won’t know with certainty what the “it” is. Keep in mind there are no data, no peer-reviewed evidence, to show that HRV fluctuation in-person has any correlation with health outcomes. Share Readiness Scores These are proprietary scores that integrate different metrics for each of the wearables: no algorithms have been disclosed. They are unvalidated against health outcomes. In a review of 14 composite health scores of readiness and recovery, HRV contributed 86% to the scores, followed by reading heart rate (79%), physical activity and sleep duration (both at 71%). That review noted the substantial variability in measurement protools and lack of standardization. Sleep staging is notoriously inconsistent and inaccurate by these sensors, which adds further to the HRV uncertainties for what the scores, which use sleep stage data, mean. Only resting heart rate has been shown consistently across devices to be extremely accurate. I’ve made a Table to summarize what we know about which metrics are included, the scores, any peer-reviewed studies that compared the readiness score with health outcomes, and the corresponding (if any, NA-not available) citation. You will note that some companies do not use the term “readiness," such as WHOOP for recovery, and Garmin, which has 2 different scores, one of which is Body Battery. Eight Sleep uses the term “Fitness Score.” They all include HRV; Apple includes a new metric they call “Recovery HRV” which among other components uses 7-days of sleep, but it is unclear what this means or how it is differentiated from other scores (there are clearly no data for outcomes). We have no knowledge of how the different components are weighted or whether any of these scores are better than resting heart rate, HRV alone, physical activity, or any other single metric. Since none of these are standardized, they are not interchangeable, so if you get a 90 for Oura that has no relationship to a 90 on a Google Fitbit Air. Notably, the company can update its algorithm for readiness score at any point without notification to device users. Without any useful evidence of actionability for these scores or established relationship with health outcomes, it is hard to make a case for their value. At the Apple recent announcement they showed their Readiness score (0-10) on the watch (Figure below) but there are no published data on this score, not even on their website. It’s available only on their new Watch Series 12 or Ultra 4 [of course, ;-)]. That exemplifies the problems with these scores, lack of data and evidence for being meaningful to promote health. Perhaps the best study (which isn’t saying much) is the WHOOP Recovery for golfer performance, because it did correlate with an objective outcome, even though there was no control group and the authors were all from the company. Among the 389 pro golfers, an absolute 10-per cent point increase in Recovery score was associated with about 0.5 fewer strokes per round. But that’s hardly a health outcome! WHOOP is also conducting a study in over 2,700 runners to see if their recovery score will be linked to less injuries and improved performance, but that is not yet published and has no control group or randomization. Putting This in Context For two decades I’ve been enthusiastic about the potential for digital health and particularly wearable biosensors. Over the years, we’ve seen some great progress for their ability to promote physical activity and accurately detect atrial fibrillation (the first FDA cleared deep learning AI for consumers). That work was the subject of rigorous research. But there are holes in the data and evidence for other metrics. One notable one is the “VO2 max” story that I wrote about earlier this year. At that time many subscribers asked me to cover heart rate variability, which I finally got to here. When I dived into the research and publication for HRV and readiness scores, I expected to find at least some that were of high quality and demonstrated their utility by linkage to health outcomes. To my surprise, I found none. The wearable sensor measurements for HRV (PRV) are, for the most part, accurate, but that validation work has only been done in small studies of healthy adults and does not take into account the long list of factors, from the device, software side, and the user side, that affect HRV measurements. Moreover, this metric chiefly relies on optical sensing and, as we have learned for heart rate PPG sensing, may be less accurate in people of color. Keep in mind that all of the health outcome association evidence comes from ECG-derived HRV; none are from wearable sensor data. I will repeat the key point: there's no peer-reviewed evidence to show that in-person HRV fluctuation—or efforts to raise your HRV— has any correlation with health outcomes. For those of you who look at your HRV on awakening, or even 2+ week trends of it being low, I hope this context helps to relieve any anxiety. Yes, low HRV (not PRV) has been shown to increase risk of some diseases as summarized above. But efforts to raise your HRV—a surrogate metric— has not been established for improving any health outcomes. HRV does not have any evidence of causality (the genetic evidence actually goes against this possibility). In this summary, I have not included data for other wearable sensors such as Polar, Samsung, Withings, Suunto, Amazfit, Coros, Ultrahuman, or additional mattress sensors. These are beyond my first-hand experience, and as far as I know from my in-depth review none have any peer-reviewed published data that differ from the 6 sensors I’ve reviewed here. From the points I’ve gone over above, we’re not ready for readiness scores. Besides being proprietary, they are predominantly based on metrics that have their own issues. It’s compounding the problem, like building a house without a solid foundation that has never undergone a rigorous inspection, and then selling it. Like I mentioned for PRV, you can look at trends over weeks rather than any single day, to get a handle, but even that may not be helpful. There’s simply no evidence that these scores meaningfully relate to health outcomes. I’d emphasize they might, but that requires doing prospective or randomized studies to prove it. None exist. There’s great promise for HRV/PRV utility_. For example**,**_ Prof Maiken Nedergaard, who discovered the brain glymphatics that are essential in eliminating metabolic waste products from the brain during sleep, has posited that HRV could be a non-invasive marker for neuromodulator oscillations, brain-body regulatory circuits, and brain clearance. That would be extremely useful, but like everything else on HRV and readiness scores it requires solid research and validation. The lay media isn’t helping much to get the story straight. Earlier this year The Economist published a piece entitled “The most useful indicator of your overall health” which ordained HRV as an “accumulated stress score.” That’s akin to the false assertion about VO2max: “V02 max is the singular most powerful marker for longevity.” As I’ve summarized here, that is not established. The fact is that so many things can lower HRV, including physical exercise (especially an intense workout), reduced sleep quality, stress, the list above, no less the device, signal, and software. Whatever fluctuations observed have not been correlated with any health outcome. Sadly, “datamaxxers” are widely using HRV and readiness scores that have never been validated to mean anything. We already know that for some people using the sensors for sleep metrics, it can induce “orthosomnia,” an obsession to get high sleep quality, with associated high levels of anxiety. In an experiment done by a company to promote sleep quality for its employees, “For those employees who did use the trackers, many reported feeling perfectly rested until their tracker told them they had had a terrible night. Others were told that they had slept like a baby when they had actually been lying awake worrying about the quality of their sleep. “ The same problem can result from preoccupation with HRV or readiness scores, with anxiety that would lead to further reduction in both. It you are using a wearable like >100 million American adults, it’s OK to look at these data, but contextualized with the major caveats reviewed here. If you are one to require evidence that HRV or readiness scores are linked to health outcomes, you may not even want to look. The companies make it hard to turn them off! Let me end with the companies that make and sell wearables. Apple’s doubling down on HRV (24-fold more reporting and heart rate very 5 seconds) and introduction of a Readiness score tells us that consumers have bought into these metrics and they are joining the club. However, all of this is occurring with a backdrop of tens millions of users, claims about the data that are not backed up by adequate evidence, marketing way out in front of whatever limited data exists, and not being transparent about their readiness score algorithms. The companies can well afford to do the research that is needed to connect these metrics with health outcomes show, once and for all, that increasing HRV or using readiness scores promotes our health. If they believed and invested in the products they are selling, we’d not be in this position of not knowing. That’s essentially where we are with HRV and readiness scores. Perhaps someday this will change and we’ll have good reason to embrace them. NB: I wrote this post. No AI. I have no conflicts of interest with any of its content. Loading... Ground Truths has 215,000 subscribers from every US state and 214 countries. There are over 300,000 followers of Ground Truths so more than 90,000 folks who can easily convert to be free subscribers. Your subscription to these free essays and podcasts makes my work in putting them together worthwhile. If you’re not a subscriber, please join! If you found this interesting PLEASE share it! Share Ground Truths The proceeds from all voluntary paid subscriptions go to support our summer internship program. It enabled us to accept and support a record number of 62 summer interns that joined us in 2026! These are high school, college and medical students selected from thousands of applicants. We couldn’t do this expanded program without the funds coming in through Ground Truths. Thank you!
FY2027 Funding Elimination Proposed for SBA Women’s Centers
The Trump administration proposes eliminating FY2027 funding for SBA Women’s Business Centers after Congress approved $27 million for FY2026. Read more.
Houston consulting and recruitment firm reveals layoffs, HQ closure plans after acquisition
Airswift acquires some New Tech Global divisions in Houston. NTG Staffing headquarters to close, eliminating 121 jobs in the energy staffing sector.
Dartmouth Health announces over 100 layoffs, elimination of 300 open positions
Dartmouth Health announced Tuesday that over 100 employees are getting laid off, and they are eliminating over 300 open positions.
She Can’t Feel Pain or Anxiety. Her Genetic Mutations Hold the Key to Eliminating Human Suffering, Scientists Claim.
A life without pain seems miraculous. But denying this hallmark of human existence could come with its own set of challenges.
Bangladesh fights world's worst measles outbreak as vaccination gaps fuel spread
Bangladesh, which once came close to eliminating measles, is facing its worst outbreak on record, with 999 suspected and confirmed measles-related deaths reported since March as hospitals struggle with overcrowding, shortages and a continuing influx of sick children.
My National Championship Contenders After Week 1
It’s only Week 1. I’m not eliminating anybody from the College Football Playoff conversation yet, but after finally getting to watch these teams play, nine programs stand above the rest as my national championship contenders. This isn’t a ranking. There is no particular order. Ohio State Ohio State looked exactly like the No. 1 team…
Immune Cells’ Role as Quality Control Boosts Tissue Health
Macrophages maintain the function of certain organs by eliminating waste products. Studying this process could lead to clues for healthier aging.
WHO South-East Asia Region recognizes major public health achievements across Member States
The World Health Organization (WHO) South-East Asia Region today celebrated major public health achievements by Member States, highlighting important milestones in disease elimination, maternal, newborn and child health, immunization, and the prevention and management of noncommunicable diseases. The awards were presented by the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, to Ministers of Health or Heads of Delegation during the Seventy-ninth Session of the WHO Regional Committee for South-East Asia. Three major disease elimination milestones were celebrated. Timor-Leste was felicitated for achieving WHO validation for the elimination of trachoma as a public health problem. With Timor-Leste’s achievement, the South-East Asia Region has achieved the global target of eliminating trachoma as a public health problem.
Thailand verified for eliminating rubella as a public health problem
The World Health Organization today announced that Thailand has been verified for eliminating rubella as a public health problem, marking a major milestone in the country’s efforts to protect children, women and families from vaccine-preventable diseases.
The Public Health Cost of Eliminating Race and Ethnicity Data
This is bigger than a singular elimination of race and ethnicity questions. It could accelerate the second wave of widespread reductions to demographic data, leaving public health officials with even less information to deliver better health outcomes for all Americans.
Loudoun seeks legal opinion before ending data center grandfather protections
Loudoun County supervisors are hitting a pause on potentially eliminating grandfather protections for 17 data center applications, instead seeking legal
Penobscot Community Health Care announces consolidation and layoffs amid financial challenges
Penobscot Community Health Care says it's closing its Adult Wellness Center in Bangor in November and will transition patients to other locations. It's also eliminating 16 administrative positions, though 11 employees will transfer to new roles.
Stanford Health Care, John Muir Health to cut 173 Bay Area jobs
Stanford Health Care is eliminating 95 technology and administrative jobs in Palo Alto, while John Muir Health plans to cut 78 positions across several East Bay locations.
Your Pixel's built-in PA system is finally easy to find in Android 17 QPR2 Beta 4
Android 17 QPR2 Beta 4 makes Pixel's Voice broadcast feature easier to enable, eliminating the need to jump through hoops.
Sen. Tammy Baldwin Pushes to End High Streaming Costs and Sports Blackouts
U.S. Sen. Tammy Baldwin met with local sports bar owners in Eau Claire on Friday to promote her “For the Fans Act,” a piece of legislation aimed at tackling rising sports streaming costs and eliminating broadcast blackouts for local games.
ESPN eliminating the ticker on college football broadcasts in 2026
College football games on ESPN will look different in the 2026 season after the network announced a major change for its ABC, ESPN, ESPN2 broadcasts.
Surging Unemployment Is Milei’s Biggest Political Threat in Argentina
President Javier Milei lowered inflation and poverty in Argentina, while eliminating its budget deficit. But the nation’s labor market is still mired in the crisis he was elected to confront.
World’s first superconducting quantum heat engine could help unlock massive quantum computers
A tiny superconducting engine has successfully converted heat near absolute zero into useful work, demonstrating the first cyclic quantum heat engine of its kind. Future versions could operate autonomously inside quantum computers, potentially eliminating huge numbers of costly, noise-producing microwave cables.
Senate confirms Hamilton to lead FEMA
Hamilton temporarily led the agency last year only to be fired after he publicly opposed eliminating it
Senate confirms Hamilton to lead FEMA
Hamilton temporarily led the agency last year only to be fired after he publicly opposed eliminating it
Senate confirms Hamilton to lead FEMA
Hamilton temporarily led the agency last year only to be fired after he publicly opposed eliminating it
Visualizing Bangladesh's Massive Measles Outbreak
Policy failures in Bangladesh dismantled decades of progress toward eliminating measles, creating the conditions for the explosive 2026 outbreak
Google is canceling an unreleased app after 800,000 people pre-ordered it
The company says it will bring AI-powered app creation directly into the Gemini app, eliminating the need for a separate app.
Supreme Court decision could help Whatley financially in Senate race
The court struck down federal limits on how much money political parties can spend in coordination with federal candidates, eliminating limits.
UW Health becomes one of select few centers in nation offering proton therapy
MADISON — UW Health has joined an exclusive group of medical centers across the country by opening a proton therapy facility, eliminating the need for Wisconsin patients to travel to
Texas hemp regulations: Lubbock shop owner says new rules threaten her business
Jennifer Garza, owner of CBD American Shaman in Lubbock and a member of the Texas Hemp Business Council, said the Department of State Health Services has been systematically eliminating her inventory.
Disney cuts several hundred jobs across entertainment divisions
The Walt Disney Company is eliminating several hundred positions across its entertainment businesses in its ... Read More
Backlash against Sony over PlayStation's all-digital future gets louder — here's how things could play out in court
By eliminating physical game discs in 2028, Sony may be setting itself up for antitrust battles reminiscent of Epic's monopoly claims against mobile app stores.
Socialists launch radical platform to abolish the US Senate in bid to fundamentally transform America
The Democratic Socialists of America plans to unveil a platform eliminating the Senate and replacing the president with an executive chosen by Congress.
Meet Biomni
In creating a comprehensive, AI-enabled research agent for the biomedical sciences, Stanford researchers hope to speed innovation by eliminating the tedium of scientific legwork.
‘The Odyssey’ star Matt Damon reveals strict diet choice that 'changed my life' after hidden health issues
Oscar winner Matt Damon says eliminating this from his diet changed his life after finding a food sensitivity during intense training for "The Odyssey."
Alliance Entertainment eliminates Class E voting rights
Alliance Entertainment approved eliminating Class E voting rights, effective ~July 27, 2026, shifting voting power and raising unrestricted shareholder percentage to ~6.6%.
Despite Eliminating 15% of Its Workforce, Xbox Wants a Billion Players Per Day
"I know we can achieve this goal"
Long Reads for the Long Weekend
(Welcome to the Entertainment Strategy Guy, a newsletter on the entertainment industry and business strategy. I write a weekly Streaming Ratings Report and a bi-weekly strategy column, along with occasional deep dives into other topics, like today’s article. Please subscribe.) Happy Fourth of July weekend! As has been a tradition of mine going back to the beginning of the EntStrategyGuy website, I’m sharing my favorite long reads of the last year, like I did in 2019, 2020, 2021, 2024, and 2025. Let’s dive right in! Subscribe “Different Prices for the Same Ride: How Uber and Lyft Use AI to Get More Money Out of You“ by Derek Kravitz in Consumer Reports I don’t think surveillance pricing, like the kind described in this brilliant Consumer Reports article, is long for the world—it’s toxically unpopular—but we’ll see if either party takes on this issue. If I ran a political party focused on affordability, I would focus on a few pro-consumer and pro-market policies: Banning non-compete agreements. Ending surveillance pricing Eliminating junk fees (read more here...) Ensuring “right to repair” for consumer (and military!) products Capping excessive app store fees Stopping digital/algorithmic price-fixing tools. Preventing automatic subscription price increases. And more. If you want to fight inflation, there are a lot of great ways to do it quickly. Speaking of higher prices... “Secret Documents Show Pepsi and Walmart Colluded to Raise Food Prices Across the Economy“ by Matt Stoller in BIG Again, I think a political party should focus on lowering prices for consumers. And deals like this—Walmart making a deal/forcing Pepsi to offer the lowest prices at its stores and nowhere else—hypothetically lower prices at Walmart...but raise them everywhere else. “15 DUIs, still driving: California’s failure to take repeat drunk drivers off the road“ by Robert Lewis and Lauren Hepler in CalMatters CalMatters does terrific reporting in California, something the Golden State desperately needs more of, and this article is a great example of that. “PugLips: The next insanely popular thing you’ve never heard of…” by Simon Carless in Game Discover Co I thought that this parody article (and yes, it’s a parody, but I was definitely unsure at first) was hilarious and totally nailed how much tech/business journalism feels these days. Actually, three of my favorite articles this year were on hype in the video game industry, including Georg Zoller’s “The Video Game Industries Very Dark Night”—which I linked to recently and wrote a follow-up here—and Owen Mahoney’s “Derek Zoolander, Videogame Exec”. In particular, I like Mahoney’s focus on user experience as a guide to what trends will actually grab hold of customers. “The Matrix Lies“ by Evan Shapiro in Media War & Peace Evan Shapiro’s first person account of his experience with AI was hilarious. I think LLMs capabilities have significantly grown from last summer, and yet...my editor/researcher just had an abysmal experience using an LLM to do a quite basic task (which our LLM normally does each week) and the LLM made a mistake on every single data entry...along with seven different mistakes affecting twelve of the twenty or so entries, including mistakes that are explicitly spelled out in the prompt. That’s a brutal failure rate. Again, if you use AI/LLM for data collection, you need to take a lot of extra steps to verify and check the data. “Ghosts in the Balcony: A Cross-Country Trip to 58 Theaters Fighting to Survive“ by Matthew Frank in The Ankler I thought Matthew Frank’s pitch to head across America to visit theaters sounded insane aggressive at the time—at least it felt that way to someone a decade older than him; man, to be in your twenties again, am I right?—but I knew the result would be great. And it was, a terrific feature by a great young writer. Also, I loved Matthew’s recent article on who’s getting the precious few entry level jobs in Hollywood. (Hint: nepotism.) “Disney erased FiveThirtyEight“ and “Did Las Vegas get too greedy?” by Nate Silver in Silver Bulletin I love media history and analysis, and there’s no one better to get the history of FiveThirtyEight than from Nate Silver, who wrote about his personal experience in one of my favorite pieces from this year. I also loved Nate’s breakdown of what’s causing Vegas’ woes, but I’ll offer one criticism, summarized as “Might I suggest antitrust?” Many centrists/center-right/libertarian thinkers (Nate is self-described as the latter) often don’t consider consolidation or antitrust as factors in policy issues like housing, America’s military readiness, or, in this case, Las Vegas. Even if libertarians want to debunk antitrust/consolidation concerns, I’d love to read that debunking. In this case, Vegas is incredibly consolidated (though it also has been for a long time) and I’d have loved to read Nate at least contending with this factor, since he addresses almost every other potential factor for Vegas’ decline. “Why Microsoft’s Carbon Removal Pullback Is Such a Big Deal“ by Robinson Meyer in Heatmap News I’m a big supporter of carbon removal efforts, but this nascent industry faces a lot of headwinds, including this big move most recently. I think it’s clear that solar panels and batteries should be able to get the world to its carbon footprint goals, but effective carbon renewal remains necessary to prevent the worst impacts of global warming. “AI is killing the cheap smartphone“ by David Oks LLMs and AI will impact the world in ways we’re not ready for, and already, third world countries are seeing the prices of cheap cellphones skyrocket due to the cost of chips skyrocketing. This article by David Oks is a terrific breakdown. “100 Days of Madness: Netflix, Paramount, Warner and the Future of Hollywood“ by Wade Major at Hollywood Heretic Wade Major dove deep into Hollywood/streaming’s financials in this must read piece. Not that I agree with everything in this article (read my take on Warner Bros./Paramount here) but the analysis is top notch. I think many people discount how quality thinking, regardless of the argument/conclusion, will make you a better thinker. “Erased by the UFC: Frank Shamrock, The MMA GOAT of the 20th Century“ by Nate Wilcox in The MMA Draw Newsletter Growing up playing the UFC fighting game on the Dreamcast, Frank Shamrock was my favorite MMA fighter, and this history/tribute to him was great. Other Fun Reads “The Hardest Part Of History To Tell Is How It Felt“ by Craig Fehrman at Defector “Unmasking the Sea Star Killer“ by Craig Welch at bioGraphic “What Could Save the Industry? Fin-Syn“ by Richard Rushfield in The Ankler Alex Rollins Berg in Underexposed on movie bumpers, pillow shots, Disney trash cinema, cult films, and Casablanca. David H. Montgomery in YouGov’s The Surveyor on punctuation marks, condiments, dinosaurs, and comic strips and kids media. “How Medium finally pivoted its way to profitability“ and “Why the best journalists on YouTube are all former Vox employees“ by Simon Owens in Simon Owens’s Media Newsletter “It’s Not Just You, Netflix Shows Have Gotten Slightly Shorter: Here’s What the Data Says“ by Kasey Moore at What’s on Netflix “Numlock Awards: How Diane Warren became the biggest loser in Oscar history“ by Nathaniel Rakich and “Numlock Awards: The Oscar Bait era is over. The Oscar Chum era is here.” by Walt Hickey & Michael Domanico at Numlock Awards
Cape Fear Valley Health cuts nearly 200 positions
Cape Fear Valley Health is eliminating approximately 200 positions as it faces declining federal reimbursements and rising healthcare costs.
Replika founder warns of 'crazy protests' over AI's jobs impact
Eugenia Kuyda, the founder of the AI chatbot startup Replika, says fears about AI eliminating jobs are justified — and will lead to backlash.
MLB proposes massive draft overhaul in CBA negotiations, including eliminating high school eligibility
The league's proposal would also create an international draft and cut the number of draft rounds
Zero sugar, more problems? Study reveals surprising gut health effects
A study presented at ENDO 2026 suggests that completely eliminating sugar from a low-fat diet may harm gut health and increase inflammation.
Eliminating dietary sugar may disrupt gut health and promote inflammation
Eliminating sugar from your diet may be more detrimental than previously thought, according to an animal study being presented Saturday at ENDO 2026, the Endocrine Society's annual meeting in Chicago, Ill.
Scientists found a surprising problem with sugar-free diets
A surprising new study suggests that completely eliminating sugar may backfire. Mice on a sucrose-free low-fat diet showed worse blood sugar control, increased inflammation, disrupted gut bacteria, and signs of fatty liver compared with mice that consumed some sucrose. Researchers say the results highlight the importance of a balanced diet and a healthy gut microbiome rather than focusing solely on cutting out sugar.
Scientists built a battery-free device that turns sunlight into fuel
Scientists have developed an artificial photosynthesis system that essentially regulates itself, eliminating the need for batteries used in many current designs. The key innovation is an electrolyzer that automatically adapts to changing sunlight by altering its electrical properties as it heats up. This keeps solar fuel production more stable while reducing cost and complexity.
Commentary: Eliminating contracting preferences hampers long-term growth
Two converging forces are reshaping American small business, and federal procurement policy just turned its back on both.
How Science Works
The 2nd Weather and Climate Livestream is now underway. It is organized by a group of early-career researchers concerned about declining funding for the field and eager to demonstrate how weather and climate research makes a difference in our lives. Last year’s event was a great success, drawing terrific press coverage including a piece in the NY Times. This year features a strong lineup of talks aimed at a general audience — I highly recommend tuning in. Share I gave a talk yesterday about How Science Works in Three Steps. You can see the short presentation here (I’ve appended a transcript below): And please tune into the livestream here. It runs through tomorrow at 6 pm ET. Thanks for reading The Climate Brink! Subscribe for free to receive new posts and support our work. Subscribe Cleaned up transcript: Thank you, and thanks to everyone tuning in. I want to talk about something I think a lot of people don’t really understand: how science actually works. Arguments over any scientific topic — climate change, vaccines, you name it — revolve around competing claims. For climate change, the claims are: Is the Earth warming? Are humans to blame? What will the impacts be? Over the last 150 years, the scientific community has developed a remarkably robust method for sorting out which claims are true and which aren’t. That method is what I want to walk through. So how does science generate knowledge? If you ask a high schooler, they’ll give you the version they learned in ninth grade: an individual scientist forms a hypothesis, runs an experiment, and draws a conclusion. That’s more or less what happens at the individual level, though in practice it’s more iterative — you design, test, and refine all at once, landing on a slightly different idea each time until you reach a conclusion about whatever hypothesis you’ve ended up with. But this isn’t science. It’s only step one. Any individual scientist can make mistakes — scientists are human. Maybe there’s a bug in the code, maybe there’s an error in the experiment. Just because someone ran an experiment and reached a conclusion doesn’t mean it’s right, and scientists don’t treat a single result as settled truth. Step two is peer review, the first layer of quality control. The scientist writes up what they did and submits it to a journal, which sends the paper to other experts in the field. Those experts judge whether the methods are sound, whether it properly references prior work, and whether the conclusions actually follow from the data. Ask any scientist and they’ll tell you peer review is miserable — the comments come back brutal, often harsh, and you have to revise and resubmit, sometimes multiple times, before an editor finally accepts the paper. Peer review catches an immense amount of bad science, but it can’t catch all of it. Reviewers get sloppy or overworked, they miss obvious mistakes, and they can’t catch hidden errors — a bug in the code, a misread instrument. So a peer-reviewed paper making it into a journal doesn’t mean the paper is right. Nobody treats a single paper as the final word. That’s where step three comes in: the crucible of science. Important results get retested by the broader community. If you publish something interesting, it gets dissected. Sometimes people try to reproduce your work directly but more often they test its implications. If someone claims X is true, and that implies that Y is also true, then scientists will go check Y. If a claim survives this gauntlet long enough, it becomes accepted. That’s how we generate knowledge. Let me give an example: the ozone hole. In 1985 — and I doubt many people watching were around then, but I remember it well — Joe Farman and his colleagues published observations from Antarctica showing that a huge chunk of ozone was disappearing every year. This was shocking because most atmospheric chemists had expected ozone loss to occur at mid-latitudes and high altitudes, not over the South Pole. When scientists see something they don’t understand, they rush to explain it, and several competing hypotheses quickly appeared in the peer-reviewed literature. One pointed to chlorine chemistry from chlorofluorocarbons. A second blamed nitrogen chemistry, possibly driven by solar proton events — meaning the sun was responsible. A third argued it wasn’t chemistry at all but dynamics: winds were carrying naturally low-ozone air from the lower atmosphere up into the stratosphere. Then the community went to work testing which theory could survive the crucible. Aircraft flew into the ozone hole and found no nitrogen, ruling out the nitrogen theory. Measurements showed the air in the polar vortex was descending, not rising — which would bring high-ozone air down, eliminating the dynamics theory. Meanwhile, those same flights measured enormous amounts of chlorine, strongly correlated with exactly the regions where ozone was being destroyed. That became known as the “smoking gun” paper, and it established that chlorine chemistry was the cause. Through this process, a consensus emerged. And it’s worth being clear that this consensus is organic. There’s no vote, no poll, no meeting where it gets decided. Scientists go to conferences, talk to one another, and independently arrived at the same answer. It’s the ultimate free market of ideas. After the consensus was established, the peer-reviewed literature doesn’t even mention the rival theories — it simply takes chlorine chemistry as given. That’s what a consensus looks like. It doesn’t mean every single scientist agrees, but it does mean there’s no longer any legitimate debate. So where can you see what scientists actually think? It’s all in the peer-reviewed literature, which contains the entire historical record of the argument: the discovery, the competing theories, the debate, the testing, and finally the community coalescing around one answer. But there’s a lot of room for misrepresentation. You can dig up an old paper claiming the ozone hole was caused by dynamics and wave it around as if there still was a debate about the cause of the ozone hole — without mentioning that the idea was disproven long ago and that even its own authors no longer believe it. There’s a bigger problem, though: the peer-reviewed literature is written in a language I call “nerd.” It’s extremely hard to read — honestly, some of it is hard for me to follow. It takes graduate students years to work through the literature in a single field, so we can’t expect policymakers or ordinary people to do it. This is where scientific assessments come in. The most famous is the IPCC — the Intergovernmental Panel on Climate Change. The job of an assessment is to read and summarize the peer-reviewed literature, synthesizing what’s settled, what’s been disproven, and what remains genuinely debated. To ensure the assessments accurately summarize the peer-reviewed literature, assessments are written by large teams, which are far less prone to bias than individuals and which dilute the influence of any one scientist with an axe to grind. The teams are deliberately assembled to avoid stacking the deck, and the reports themselves go through multiple rounds of peer review. That rigorous process is exactly why you can trust them and why people consider the IPCC to be the gold standard of what we know about the climate system. An assessment produced through a different process may well not be credible. You can even watch the consensus evolve across assessments. Take the attribution of warming. The 1990 IPCC report said the observed warming was broadly consistent with model predictions but also comparable to natural variability — in other words, we don’t know whether humans are responsible. By 1995, it concluded that the balance of evidence suggested a discernible human influence — a sentence only a committee could write, and one that barely commits to anything. By 2001, most of the warming over the previous 50 years was judged “likely” due to greenhouse gases; by 2007, “very likely”; by 2013, “extremely likely.” The 2023 report says essentially the same as 2013 — there’s not much stronger language available. So, to wrap up: science is our ultimate tool for deciphering the universe — the most successful method we’ve ever developed for determining what’s true and what isn’t. Our understanding is written into the peer-reviewed literature, so if you want to know what scientists think, that’s where to look. And for those of us who don’t speak nerd, scientific assessments are the Rosetta Stone — they translate nerd into English. Let me open the floor to questions. Thank you.
Top-seeded UCLA eliminated from NCAA baseball tournament
Makoa Sniffen's run-scoring single in the 10th inning gave the Saint Mary's Gaels an improbable 6-5 victory over UCLA on Sunday in Los Angeles, eliminating the top-seeded Bruins, who were 51-6 headed into the weekend, from the NCAA baseball tournament.
Louisiana Approves Map Eliminating a Majority-Black District
A Supreme Court court ruling last month rejected the state’s previous congressional map as an illegal racial gerrymander and set off a redistricting race across the South.
SEC to Eliminate 'Cupcake Weekend' in 2027 Scheduling Overhaul
The Southeastern Conference is eliminating “cupcake weekend."
'Food Noise' and the Science of Interoceptive Awareness
Eliminating "food noise" comes with a cost. True health requires mindful nourishment rather than total control.
Voice of Business: Property tax changes impact businesses
Proponents for eliminating property taxes in Ohio are gathering signatures from over 400,000 registered voters to place a proposed constitutional amendment on the Nov. 3, 2026, ballot. However, they stated
Cleveland City Council helping out small entertainment venues
Cleveland City Council approved eliminating the entertainment tax on small capacity live entertainment venues that hold up to 750 people.
Meta to lay off 8,000 employees, move 7,000 to new initiatives related to AI
As part of the restructuring, the company will also be eliminating managerial roles....
Free sports physicals eliminating barriers, preventing future injuries
With summer approaching, it’s time for athletes to get their yearly physical.
Governor signs bill eliminating need for health insurance companies to authorize cancer screenings
The new bill eliminates the requirement for approval for cancer screenings from insurance companies.
Louisiana GOP lawmakers advance map eliminating one Democratic House district
Republicans currently have a 4-2 advantage in the state’s congressional delegation. The map would push that edge to 5-1, dropping one of Louisiana’s two majority-Black districts.
Milwaukee Congresswoman wants to fund Job Corps
President Donald Trump, in his budget for the next fiscal year, once again proposes eliminating it.
Milwaukee Congresswoman wants to fund Job Corps
President Donald Trump, in his budget for the next fiscal year, once again proposes eliminating it.
Knicks eliminate Hawks with a 140-89 Game 6 blowout
OG Anunoby scored 29 points in 27 minutes, Karl-Anthony Towns had his second triple-double of the series and the New York Knicks had their biggest playoff victory in franchise history, overwhelming and eliminating the Atlanta Hawks 140-89 in Game 6 on Thursday night. The Knicks broke several NBA records by halftime. Dyson Daniels and Mitchell Robinson were ejected after fighting following a pair of free throws from Anunoby that gave the Knicks a 50-point lead in the second quarter.
Alexander Blockx reacts after shocking Casper Ruud upset
Alexander Blockx secured a 6-4, 6-4 win over Casper Ruud in the Madrid Open quarter-finals. The Belgian put together another impressive showing, eliminating the defending champion in straight sets.
The Trump team is quietly eliminating U.S. support for birth control abroad
Congress has allocated more than $500 million for family planning work internationally. The Trump administration hasn't spent it — and the consequences are already being felt.
Australia becomes the 30th country to eliminate trachoma as a public health problem
The World Health Organization (WHO) has validated Australia for eliminating trachoma as a public health problem, marking a significant milestone in the health of indigenous peoples and in global efforts to combat neglected tropical diseases (NTDs). Trachoma, the world’s leading infectious cause of blindness, no longer represents a public health problem in the country.Australia is among a growing number of countries that have successfully eliminated trachoma, contributing to global progress towards the targets set out in the WHO road map for NTDs 2021–2030.Trachoma is caused by the bacterium Chlamydia trachomatis and spreads through close contact with infected individuals, contaminated surfaces, and flies that carry eye and nose discharge. Repeated infections can lead to scarring of the eyelids, turning eyelashes inward, and ultimately causing blindness if untreated.“WHO congratulates Australia on this important achievement,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This success reflects sustained commitment, strong partnerships, and a focus on reaching populations most affected by health inequities. It brings us closer to a world free from the suffering caused by trachoma.”Australia’s journey to eliminationAustralia’s achievement reflects decades of targeted public health action, particularly in remote Aboriginal and Torres Strait Islander communities, where trachoma persisted despite its earlier disappearance from the rest of the country.National efforts intensified with the establishment of the National Trachoma Management Programme in 2006, which implemented the WHO-recommended SAFE strategy: surgery for trichiasis, antibiotics to treat infection, promotion of facial cleanliness, and environmental improvement. Regular screening of all communities classified as at-risk of trachoma by teams of qualified health workers formed an important part of the Programme. Interventions were delivered through coordinated partnerships between federal and state governments, Aboriginal community-controlled health services, and local communities.Over time, sustained screening, treatment, and prevention activities, including improvements in housing, water, sanitation and hygiene, led to a steady decline in trachoma prevalence. Australia’s approach included adaptations to reflect its context, such as targeted treatment based on community-level data rather than mass drug administration, and strong integration with environmental health programmes.“Elimination of trachoma is a win for the eye health of communities across Australia, particularly those whose lives have been impacted by a disease that is entirely preventable,” said Mark Butler, Minister for Health and Ageing, Australia. “This major milestone is thanks to Aboriginal and Torres Strait Islander leadership, community commitment and sustained investment over many decades.“The lessons from this work will inform how we approach other preventable health conditions in remote and regional Australia. Aboriginal Community Controlled Health Organisations and local health workers have been central to this success, delivering culturally safe care and community-led solutions.”“This recognition from the World Health Organization reflects decades of work led by Aboriginal Community Controlled Health Organisations, alongside local health workers in remote First Nations communities,” said Malarndirri McCarthy, Minister for Indigenous Australians. “Their work has been critical to eliminating trachoma as a public health problem in Australia.”Advancing global efforts against neglected tropical diseases (NTDs)Trachoma is one of 21 diseases and disease groups that are regarded by WHO as NTDs. Together, NTDs affect more than 1 billion people worldwide, primarily in underserved populations with limited access to essential services such as clean water, sanitation, and health care.Australia’s elimination of trachoma as a public health problem highlights the importance of sustained political commitment and cross-sectoral collaboration in addressing the underlying determinants of health. It also underscores the feasibility of eliminating trachoma even in geographically challenging settings.In addition to trachoma, Australia has several endemic NTDs, including Buruli ulcer, leprosy and scabies. Validation of elimination of trachoma as a public health problem marks the first time that WHO has confirmed the elimination of an NTD in Australia, which becomes the 63rd country globally and 16th in the Western Pacific Region to have eliminated at least one NTD.“Tackling neglected tropical diseases in the Western Pacific Region has long been a challenge for countries across the socioeconomic spectrum, given the complexities in reaching the most vulnerable communities, including in remote areas,” said Dr Saia Ma’u Piukala, WHO Regional Director for the Western Pacific. “As a doctor from Tonga, I’ve experienced these challenges for myself. But I also know that with strategic commitment underpinned by optimal resources and partnerships in health, success is possible as other countries in our region have also demonstrated. I commend Australia on eliminating trachoma as a public health problem and urge all involved to remain vigilant to ensure this status is maintained.”WHO continues to support countries working to eliminate trachoma and other NTDs, ensuring that progress reaches those most in need and that gains are sustained through strong surveillance, appropriately integrated into national health systems, and mainstreamed within the wider health sector and beyond.Editor’s notesNeglected tropical diseases and trachoma elimination effortsNeglected tropical diseases are associated with devastating health, social and economic consequences. Their burden is mainly felt among impoverished communities in tropical areas.Public health targets for the control, elimination and eradication of these conditions were set in the road map for neglected tropical diseases 2021–2030 (https://www.who.int/publications/i/item/9789240010352).In 1996, WHO launched the WHO Alliance for the Global Elimination of Trachoma by 2020 (GET2020), creating a network of governments, non-governmental organizations and academic institutions dedicated to the fight against trachoma. WHO continues to support endemic countries to accelerate progress towards the global target of eliminating trachoma as a public health problem worldwide; 2030 is the new target date.Elimination of trachoma as a public health problem is defined as: (i) a prevalence of trachomatous trichiasis (TT) “unknown to the health system” of < 0.2% in ≥15-year-olds; and (ii) a prevalence of trachomatous inflammation—follicular (TF) in children aged 1–9 years of < 5%, in each formerly endemic district, plus (iii) the existence of a system to identify and manage incident cases of TT.Other countries validated by WHO as having eliminated trachoma as a public health problem are: Algeria, Benin, Burundi, Cambodia, China, Egypt, Fiji, Gambia, Ghana, India, Iraq, Islamic Republic of Iran, Lao People’s Democratic Republic, Libya, Malawi, Mali, Mauritania, Mexico, Morocco, Myanmar, Nepal, Oman, Pakistan, Papua New Guinea, Saudi Arabia, Senegal, Togo, Vanuatu and Viet Nam.
Australia becomes the 30th country to eliminate trachoma as a public health problem
The World Health Organization (WHO) has validated Australia for eliminating trachoma as a public health problem, marking a significant milestone in the health of indigenous peoples and in global efforts to combat neglected tropical diseases (NTDs). Trachoma, the world’s leading infectious cause of blindness, no longer represents a public health problem in the country.
Shaky political science: using "simulated" elections over real-world elections
[Dear DSOS readers – this article is the latest in our “Shaky Political Science” series. In our 38 page report, “Shaky political ‘science’ misses mark on ranked choice voting,” released in early December, we examined over 40 studies focused on ranked choice voting. We found that many of these studies suffered from puzzling research methodologies, poorly constructed surveys, unrealistic simulated elections, cherry picked data, and faulty analyses that often were contradicted by results from real-world elections (a link to our full paper is here). Here are links to the first three articles in our series: the first one summarizing the overall results of our report, the second one analyzing a study co-authored by University of Minnesota academic Larry Jacobs, which was one of the most error-prone of all the research we reviewed in our report, and a third article showing an admirable example of two political scientists holding two other political scientists accountable for their flawed, sloppy research]. In this fourth article in our “Shaky Political Science” series, we shine a spotlight on seven studies that were web-hosted and funded by New America’s Political Reform Program and its Electoral Reform Research Group (the ERRG is an ad hoc committee headed by New America’s Political Reform Program and joined by the American Enterprise Institute, the Unite America Institute and Stanford University’s Center on Democracy, Development, and the Rule of Law). This research consortium has been led by Lee Drutman, senior fellow with New America’s Political Reform Program. These seven studies are simply not credible from any objective standard about how political “science” is supposed to illuminate our understanding of either ranked choice voting or politics in general. The feature that six of these seven studies have in common is that they all used surveys – artificial, simulated elections -- to attempt to say something cogent or interesting about ranked choice voting (RCV) elections. None of them used real world data from actual RCV elections – either the 1000+ elections in the US or the many thousands of elections from places like Australia, Ireland and elsewhere where RCV has been used for 100 years. While a few of these studies conclude with some mixed positives about RCV, our analysis here is content neutral. The idea that, with a political reform like RCV, you can ask respondents in a mock, artificial election to vote with that method, with only the barest of explanation about how RCV works or its likely impacts (i.e. no spoiler candidates, majority winners, voters liberated to pick their favorite candidates, coalition-building), and then ask them their thoughts/reactions about voting in that system, with fake candidates and no real campaigning, no real exposure to an actual election or actual candidates, rests on some very puzzling assumptions. The findings of these seven studies actually are contradicted by the findings from many other studies based on real-world RCV elections. These New America studies also failed to list the real-world RCV studies in their own citations, instead including those studies that reinforced their conclusions. The seven studies featured in this article were chosen because they form a cohesive cohort which precisely illustrates one of the main points of our research paper, namely that using surveys, i.e. artificial elections, or mathematical/theoretical models, instead of real-world data, is in fact “shaky political science.” Below are summaries of our analysis of five of the seven New America studies. You can read our complete analysis of all seven studies at our paper, “Shaky political ‘science’ misses mark on ranked choice voting.” Choosing to “Vote As Usual” by Andre Blais, Carolina Plescia, and Semra Sevi. New America. (Blais et al., 2021). This study, web-hosted and funded by New America’s Political Reform Program and its Electoral Reform Research Group, used two surveys in which respondents completed ballots for simulated elections using plurality, approval, RCV and point (Score) voting. In both cases the authors provided the respondents with only minimal explanation of each method. For example, the entire explanation for RCV was “For this vote, rank the candidates from your first to your last choice (you do not need to rank them all). This is called the ranked vote.” That’s it. The study did not provide any context or explanation to survey respondents about why she/he might want to rank multiple candidates. Participants were not even told that ballots would be tabulated using an “instant” runoff, not to mention any description of RCVs ability to eliminate the spoiler effect or liberate voters to rank their favorite candidates without fear of helping the “greater evil” candidate to win. That’s like taking an iPhone back in time to 1970 and asking someone if they like it better than their rotary phone without explaining how it works. Their first survey targeted states that held 2020 Super Tuesday Democratic primaries and used the real candidates’ names in the survey; the second survey used fictitious candidates. In other words, they surveyed respondents who had only ever participated in plurality elections, had no history or background with using RCV or any of the other methods, had no clue about its likely impacts, and did not communicate how the alternative methods would be counted, and then asked them: “How satisfied are you with using each system?” Predictably, the winner was plurality elections, the system used for president, Congress, gubernatorial and state legislative elections – in other words, the method they have been using, year after year, all their voting lives. With so little explanation of RCV and its impacts, this study is simply not credible in discovering anything useful about real-world RCV elections. It merely shows that a basic voter education campaign is needed when adopting a new election system. Additionally, the result contradicts many other post-election surveys following real RCV elections, asking opinions from voters who had just participated in a RCV election, that showed a great deal of satisfaction with RCV (see details on that in Studies 22-25 in our paper, as well as the four studies cited in the review for Study 28). Share Other studies on “satisfaction” and “understanding” make similar mistakes, in terms of basing their surveys on inadequate explanation to respondents and lack of education about context. How could any survey ever hope to measure accurately, in essence simulate a real-world election, without actual campaigning candidates, the media writing about those candidates, organizations endorsing candidates and voters being inundated with crucial information? More than anything, what these “studies” based on surveys show is that if you ask voters about something they don’t know very much about, and fail to adequately educate them, their responses will unsurprisingly reflect their confusion. Equally puzzling is that New America’s Electoral Reform Research Group, headed by political scientist Lee Drutman, found this to be a credible enough study that they not only published it but highlighted it in Drutman’s own discussion of research related to ranked choice voting. This pattern was repeated in study after study featured by New America’s Electoral Reform Research Group. For example in Ranked-Choice Voting and Political Expression: Voter Guides Narrow the Gap between Informed and Uninformed Citizens by Cheryl Boudreau, Jonathan Colner, and Scott MacKenzie, the researchers based their analysis on a survey which found that respondents who were asked to vote in a simulated RCV election, with minimal explanation of RCV or how it works, displayed less evidence of being informed about how to use RCV effectively, with the least informed voters ranking fewer candidates. As pointed out under the study above, in a real election voters are informed by a wide variety of methods, including public education by the election administration, by interested political groups, the media, and the candidates themselves who benefit from voters being aware of how to vote in the new system. In Support for Ranked-Choice Voting across Race and Partisanship by Joseph Anthony, David C. Kimball, Jack Santucci and Jamil Scott, the researchers used respondents from different parties and races voting in simulated plurality and RCV elections, who indicated their satisfaction with each voting method. Instead of using real world election results, the authors fell back on the easy, armchair and less reliable academic research methodology of making up mock elections. As with the other studies, little explanation was given of how RCV works or what its implications might be (electing majority winners or eliminating spoilers, for example). Unsurprisingly, this study found that respondents were not very satisfied with RCV. However, when the authors added an explanation that RCV has a tendency to elect more women and people of color, they found that this greater explanation increased the preference for RCV. The more voters were familiar with it, and the more they understood potential positive impacts – surprise! -- the more they were open to switching away from the status quo. Of note, the results from this study are thoroughly contradicted by a number of other studies whose data was obtained from real RCV elections with real voters. Those studies show a great deal of satisfaction with RCV. More “fake election” research An interesting wrinkle on this “research by fake elections” approach, which only served to illustrate how unreliable such “research” can become, was taken in Ranked-Choice Voting, Runoff, and Democracy: Insights from Maine and Other U.S. States by Joseph Cerrone and Cynthia McClintock_,_ also web-hosted and funded by New America’s ERRG. It gets high marks for creativity, but an eye-roll for thinking this could possibly add anything meaningful to our understanding of real world RCV elections. This study tried to determine whether RCV, plurality or two-round runoff elections provided greater voter satisfaction and acceptance of election results. To determine that, the authors conducted a survey asking if voters were satisfied with a fictional newspaper report of an election, with three different versions given to respondents – plurality, runoff and RCV, with variations of Republican/Democrat winners and variations of “come-from-behind” winners,” i.e. candidates not initially in first place but who win the “runoff.” Again, a minimal explanation of RCV or how it works was given, and the survey showed that respondents had the greatest unfamiliarity with RCV than the other methods. The unsurprising result? Respondents were much more satisfied with “come-from-behind” victories in a traditional two-round runoff election than in RCV, even though RCV is also a runoff system but with a single round of counting. Interestingly, the dissatisfaction with RCV disappeared for those who were more familiar with RCV. In fact, among those respondents who were “very familiar” with RCV, they were equally satisfied with RCV, runoff and plurality. Surprise, surprise. Again, what this study revealed, more than anything, is not only the inadequacy of the explanation for RCV given by the authors of this study, but the failure of the research format itself, thinking that such an artificial mock election could somehow simulate what actually happens in the real world in a real RCV election. Those four studies reviewed above are fitting examples of inadequate and shaky political “science.” Other studies reviewed in our paper from the New America/Electoral Reform Research Group cohort which also used mock elections included: Ranked-Choice Voting is an Acquired Taste by Joseph Anthony and David C. Kimball. New America. (Anthony et al., 2021). Ranked-Choice Voting is No Refuge for Extreme Candidates by Melissa Baker. New America. (Baker, 2021). Also included in this New America cohort is Does Ranked-Choice Voting Reduce Racial Polarization? by Yuki Atsusaka and Theodore Landsman, which actually did use real-world election results data but applied an odd and unconventional methodology to the data which relied on shaky assumptions and non-real-world scenarios that were too divorced from reality. To determine levels of “racially polarized voting,” the researchers imagined “ethnic parties,” by which they mean political parties for each ethnic group, which was especially odd since the election data they were using came from nonpartisan RCV races. But then they made an even odder assumption, namely that since race and ethnic characteristics of studied voters were not available, the authors tried to infer that information based on who voters selected and the racial make-up of voters in each district. This amounted to little more than vague and ambiguous guesswork dressed up with a bunch of mathematical equations used to give it a veneer of scientific appearance. Indeed, it seemed to assume racial polarization in order to prove racial polarization. Based on this questionable methodology, the authors concluded that RCV doesn’t reduce racial polarization. But the premise of this study missed an obvious reality: since RCV incentivizes more candidates to run and can result in more diverse fields of candidates, one would expect more racially-polarized voting in voters’ top rankings, not less, because more voters would have someone on that ballot who represents their racial or ethnic identity and more freedom to vote for their real first choice. By encouraging more diverse candidates and eliminating the spoiler effect, RCV facilitates voting for a favorite candidate of your own race and then selecting a second choice with the best likelihood of winning. The real measure is what voters do with their additional rankings – do they consider other candidates and vote “for the best of the rest”? This study didn’t tell us anything useful about that. But readily available data shows this is common in real RCV elections, and candidates act on this knowledge by engaging with voters outside their racial group. So the authors of this study failed to consider or account for what actually happens in real-world elections, and their conclusions are tainted by this failure. New America has contributed a great deal over the past 2.5 decades to our understanding of many policy areas, including politics and political reform (full disclosure: Steven Hill, one of the authors of this article and of the “Shaky Political Science” research paper and series, is a former senior fellow and former director of New America’s political reform program, 2005-2010). So it was especially disappointing that New America funded and published such a large batch of dubious studies about ranked choice voting. The stated praiseworthy goal of its Electoral Reform Research Group was to inspire new academic research about ranked choice voting that would shed light and help the public better understand the impacts of RCV. Instead, the ERRG research did just the opposite. It produced dubious research that created more confusion and misinformation. In so doing, New America’s political reform program contributed to “shaky political science.” Steven Hill and Paul Haughey Share Upgrade to $5 subscription Thanks for reading DemocracySOS, a reader-supported digital portal for the pro-democracy movement. Subscribe for only $5 per month to receive full benefits and to support our work. Subscribe
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