“If this is democratic socialism,” wrote one New Yorker under a mayoral Facebook post, “maybe it is the change we need.” She was referring neither to Mayor Zohran Mamdani’s heavily scrutinized plan for city-run grocery stores, nor to his pied-à-terre tax on the rich, nor even to his trademark — though thus far, unrealized — vision for fast, free buses and universal childcare. 

No, she was talking about candy-colored scaffolding. The mayor recently made good on his plan to give a facelift to the city’s ubiquitous scaffolding, that odiously ugly green eyesore that envelops hundreds of miles of New York City sidewalks. Another New Yorker posted on TikTok complaining about a smattering of potholes on his street. By the time he got home from work, they had all been filled, setting off a maelstrom of viral requests, including one from a dateless Brooklynite looking for love: “Zohran, what are you gonna do to fix this?” (The mayor cheekily obliged with a list of local meet-cute spots.) 

Symbolic urbanism is having a moment, especially this summer in New York City, where the air is far too humid, but the potholes increasingly get filled, sometimes personally by the internet’s favorite millennial mayor himself. 

Mamdani’s embrace of what he calls “pothole politics” — a shrewd modern-day twist on the “sewer socialism” that once propelled some 20th-century leftists into office — has delighted and exhilarated New Yorkers who’ve long yearned for a City Hall that heeded their most mundane municipal calls over a scorching-hot subway station or a sidewalk full of cracks. 

With a smile plastered on his face, Mamdani has, in fact, filled potholes at a faster rate than any New York City mayor in years. In cities where everything seems to take forever to build, literally covering over these sites of everyday urban friction has become a powerfully visible form of political currency. 

“There’s just this thirst for competence right now,” Don Moynihan, a professor of public policy at the University of Michigan, told me, and Mamdani in particular has “brought a sense of joy and fun to the nuts and bolts of public administration.” It may even be enough to help restore some of the public trust needed for the more arduous, less palatable work involved in making our cities more liveable in the long run.

Sixty-nine percent of New Yorkers currently have a favorable view of Mamdani, according to a Siena Research Institute poll conducted earlier this month, meaning that he has already won over at least some of the one-third of residents who told the New York Times last September that they would never vote for him. He has higher ratings at this point in office than any NYC mayor in decades.

He is even more popular now than he was a few months ago, when the Knicks clinched their first NBA championship in decades, the sort of sports victory that can quantifiably boost an incumbent’s electoral prospects. So, no, it’s not the Knicks that have made Mamdani even more popular than he was during his mayoral honeymoon.

It is, quite possibly, the potholes. 

“There are easy issues for voters to understand about their local government, and then there are much more difficult issues,” said Justin de Benedictis-Kessner, a public policy professor at Harvard and author of the forthcoming book The Fog of Accountability. “When you make campaign promises about more difficult issues, you might pair them with some clear issues like potholes,” which are decidedly easy for voters to understand. 

But the bigger question is whether Mamdani or others like him can borrow from the public trust they earn from filling them to help move the needle on the hard stuff, “especially when those next things aren’t going to be what your constituents like as much,” like large-scale zoning reforms or tax hikes, he said. “They might be tougher policies to swallow.” 

Pothole populism, explained

“If government can’t do the small things,” Mamdani declared at a rally to mark his first 100 days in office, “how could you ever trust it to do the big ones? How can we promise to transform our city if we can’t pave your street?”

There’s plenty of data to back him up on this, not just in New York City but across the nation. For every extra week it takes their city to fix a nearby pothole, Chicagoans report being measurably less satisfied with their lives, according to one study. A separate survey found that Bostonites became 14 percent more trusting of their government after they were able to see it respond to complaints like potholes or broken street lamps. Much as doing the dishes or taking out the trash can be more romantic than the occasional pricey date night, these everyday municipal acts of service resonate with beleaguered urbanites.

Mamdani is not the first politician to build political capital on the strength of small, some even symbolic or aesthetic, infrastructural upgrades. Milwaukee, for example, elected a slew of leftists roughly a century ago who earned the pejorative moniker “sewer socialists” for their focus on small-scale engineering projects. These mayors understood that “it was not manifestos or ideological pamphlets that would win hearts and minds. It was about proving to people that the government could do things that had a sort of broadly shared benefit,” said Philip Rocco, a professor of political science at Marquette University. “They were picking really low-hanging fruit as a way of building a coalition.”

“There are easy issues for voters to understand about their local government, and then there are much more difficult issues. When you make campaign promises about more difficult issues, you might pair them with some clear issues like potholes.”

Justin de Benedictis-Kessner, public policy professor at Harvard

Milwaukee’s 20th-century socialist mayors went on to double the city’s size through annexation and new housing, built a pioneering sewage treatment plant, and set up the nation’s first Bureau of Economy and Efficiency. Along the way, they installed new street lights, drinking fountains, park benches, and countless other low-cost urban fixes that made everyday life safer, healthier, and more joyful. By 1936, Time was running a cover story about how six-term Mayor Daniel Hoan, “one of the nation’s ablest public servants,” had transformed Milwaukee into “perhaps the best-governed city in the US.” Hoan won election after election not because of his party affiliation (to be clear, literally Socialist with a capital S), but in spite of it, wrote Time, his competence and charisma charming even most conservative Milwaukeeans. 

Mamdani, who often invokes Milwaukee’s sewer socialists, clearly craves a similar legacy. He is actively attempting to disprove the idea that progressives today “are disconnected from reality, and that they have a lot of pie-in-the-sky ideas,” Moynihan said, “but that they can’t actually govern” when it comes to the often unglamorous, nitty-gritty demands of public service.

According to Moynihan, Mamdani may also be inheriting elements of another lineage; “broken windows” theory, though he may be less apt to say so. While it’s best known now for justifying controversial policing policies like stop-and-frisk, he said the approach also took seriously the idea that your “quality of life depends upon fixing the small things in your neighborhood.”

Now what? 

If imitation is the greatest form of flattery, then take note of the other local electeds beginning to engage in botched attempts to recreate Mamdani’s pothole politik. Los Angeles Mayor Karen Bass earned scorn a few weeks ago for voluntarily posting a video in which she fails to fix a pothole because of a car parked atop it. The road ahead will not, in fact, be paved with good intentions alone. 

@malikizhere

MAYOR COME AND HELP YOUR PEOPLE!! #zohranmamdani #nyc #fixthis #lol

♬ original sound – Malikyyy

But while Mamdani has clearly earned the trust of much of his city, what he will do with it is just starting to take shape. As Mayor Hoan showed a century ago, it’s one thing to fill a pothole with a scoop of asphalt, but it’s another to make your city’s housing more affordable or make the buses run faster. 

And yet, it is possible that the political symbolism he is curating today might indeed make the path ahead easier. Just this week, Mamdani announced his biggest infrastructure project to date, a mammoth 10-year, $4 billion rebuild of a crumbling section of the Brooklyn-Queens Expressway, which two past mayoral administrations have tried and failed to fix. Whether or not he can be the one to pull it off will hinge on the public trust he cultivates today. 

“If Mamdani wants to get things done quickly, he’s going to have to implement a lot of policies that are a mix of really popular but perhaps minimally effective,” said de Benedictis-Kessner, “and ones that are much more effective but definitely not as popular.” 

Take rent control, which is very popular with voters, but, as my colleague Marina Bolotnikova has pointed out, does little to fix the roots of our dysfunctional housing market. By embracing it anyway, Mamdani is signaling that “he’s doing something that listens to his constituents,” said de Benedictis-Kessner, and the trust he earns from doing so could ultimately make “less popular policies that are actually much bigger in scale” more politically viable, like zoning reforms or density bonuses for developers. 

What I really want, my own personal North Star for good municipal governance in New York, is the Interborough Express, a long-awaited light rail line connecting Brooklyn and Queens that probably won’t be finished until at least 2031. Those are the kind of large-scale urban renovations that I’ll be writing about — and sometimes advocating for — in my new Vox newsletter, Nice Things. (Seriously, sign up!) But in the interim, I will settle for somewhere I can lock up my bike without lugging it up the stairs, or a subway station that isn’t quite so sweltering in the summertime. The little fixes that make our days just a little smoother, while also maybe laying the foundations for big changes.

No barrage of pothole-fixing blitzes will make the trains run on time or protect a city’s shore from flooding. But at a time when nobody thinks the government can do much of anything anymore, it’s a start. “To be able to argue, ‘Look, if you give me money, I will make things work,’” said Moynihan, “is a much more compelling argument if you can show that you are actually making things work.”

Dolly Parton was on her way to the studio to polish off “Blue Smoke” when the SUV she was riding in collided with a sedan in a Nashville intersection in 2013. At the hospital, she struck an unlikely friendship with her physician, Naji Abumrad, who, like Parton, was raised in a misty mountain village, hers in East Tennessee and his in Lebanon.

“It’s just like how you meet people in your life. You just click, you just feel like you know them,” Parton once told his son, Jad Abumrad, a public radio host who interviewed Parton for a nine-part series on her life. “There are just some things that, you know, you just can’t explain it. You just be it, you just live it, you just know it, and you just feel it.”

The whole world, it seems, felt it — that inexplicably swift, sweet connection — with Dolly Parton herself, a light-filled, lifelong philanthropist in the truest, most etymological sense of the word: a lover of humankind. 

Some seven years after their friendship began, Abumrad told Parton that his fellow researchers at Vanderbilt University Medical Center were looking into a possible vaccine for Covid-19, which had just begun to rage across the country. Without missing a beat, Parton wrote a check for $1 million, an early contribution toward what would eventually become the Moderna vaccine against Covid-19. 

Her donation “made the research towards the vaccine go 10 times faster than it would be without it,” Abumrad later told the Washington Post, calling his friend “the kindest and most philanthropic human being” he’d ever known. 

Parton, who died at the age of 80 yesterday, was raised with her 11 siblings amid poverty in the Smoky Mountains of Eastern Tennessee. She often credited her upbringing as a muse for both her music and her generosity. Just as integral to her persona as her kitschy high-femme glamour, her poofy hair and rhinestones, was Parton’s capacity for helping others. 

With an infectious sense of joy and optimism, she proved that helping others is not only easy to do, but can be a lot of fun.

Parton’s most famous foray into philanthropy by far was her Imagination Library, which she founded in 1995 in honor of her father, who never learned to read or write. Since then, the initiative has doled out a jaw-dropping over 300 million free children’s books to young kids around the country and the world.

“I just give from my heart,” she remarked while accepting the Carnegie Medal of Philanthropy, a kind of Nobel Prize for giving, in 2022. “I never know what I’m going to do or why I’m gonna do it. I just see a need, and if I can fill it, then I will.”

After wildfires tore through her native Tennessee in 2016, she raised millions of dollars that she used to give thousands of dollars in direct cash payments to hundreds of families who’d lost their homes. In recent years, she’s given millions of dollars to families affected by Hurricane Helene, to pediatric infectious-disease research, and to children’s charities across Tennessee. Back in 1990, Parton helped open a sanctuary for injured eagles in partnership with conservationists at Dollywood, the Eagle Mountain Sanctuary, which was forced to close after a brutal storm earlier this year. (You can donate to the American Eagle Foundation, which is rehoming Dollywood’s eagles here.) 

Parton, who had a net worth of about $450 million according to Forbes, may have given away many other donations privately. In 2006, when asked about the full scope of her donations, she told my former colleagues at The Chronicle of Philanthropy with her characteristic sass that “it’s none of your business. I have often said that I count my blessings a whole lot more than I count my money,” she said, “the same is true for the contributions I make.”

The world may have gotten a peek into her private giving a few years ago, when some savvy social media users helped break the news that Parton had been casually paying for band uniforms at high schools across Tennessee, and had been quietly doing so for decades. She also received $100 million as a recipient of Jeff Bezos’s Courage and Civility Award to give away as she saw fit. It’s unclear where she chose to spend that money, but it could certainly buy a lot of school band uniforms, children’s books, or pediatric hospital wings.

There was always something otherworldly about Parton’s kindness. It was as if the nicest person you’ve ever met found herself in possession of hundreds of millions of dollars in cash. But as serious as her contributions were — to the music industry, and to millions of children around the country — she never took herself too seriously, and maybe that’s what made it feel so enthralling to watch. 

“I’m kind of addicted to the feeling of giving,” she told People in 2021, “knowing that I’m doing something good for someone else.”

And that’s a lesson that all of us, legendary multimillionaire country superstar or not, can use to help carry her legacy forward.

Every once in a while, I feel the urge to shout “women are not small men!” at inanimate objects. Today, that object is the flat-chested plastic torso typically used for CPR training. 

Breasts, it turns out, are really the bane of every woman’s existence — the back pain, the boob jail, the running. But here’s a new one: In a public cardiac arrest, they may be the reason nobody helps you.

Two years ago, an analysis of over 300,000 cardiac arrests showed that women are 14 percent less likely than men to receive CPR from a stranger if they have a cardiac arrest in public. Bystanders tend to be more hesitant and feel less comfortable providing CPR or using external defibrillator paddles, called AEDs, on people with breasts. Experts have time and again pointed, in part, to the fact that nearly everyone learns to perform CPR using the traditional, flat-chested dummies called “manikins,” which overwhelmingly represent the male anatomy. If the first time a stranger has to perform CPR on someone with breasts is in the middle of a high-stakes emergency — what else would you expect? 

For the last 20 years, not only has the survival rate for out-of-hospital cardiac arrests been around 10 percent, but also the chances of the victim surviving decrease by 10 percent every minute that interventions like CPR are not performed. It makes it all the more harrowing that women are not receiving the care they need when they experience cardiac arrests — especially in places where they are surrounded by people. 

Whether it is manikins used for CPR training, crash tests or medical care in combat, the default stand-in for what is “human” has long been male. 

But recently, researchers, advocates and governing bodies like the American Heart Association and European Resuscitation Council are pushing for better representation in CPR training and education. Increases in simulation-based research on the use of representative manikins, like ones that accurately represent female anatomy, are changing how people train to respond to cardiac arrest — and simultaneously exposing bigger gender gaps in design that systematically exclude women from experiencing the same level of safety and care as men. 

One size doesn’t fit all

The first CPR manikin was developed in 1960 by the Norwegian toy manufacturer Laerdal. The manikin, called Resusci Anne, which had the anatomy of a prepubescent teen, was ironically modeled off an unnamed girl who was thought to have drowned in the river Seine in Paris. Laerdal famously wanted a female face on the manikin since he thought men might hesitate to practice mouth-to-mouth resuscitation on a male manikin. It’s not surprising that women trainees didn’t factor into the equation at all back in the 1960s — they weren’t even included in clinical trials yet — but the norm of designing with the comfort of men at the forefront continues to this day. 

Since then, Resusci Anne has been reengineered many times over, and today’s manikins are surprisingly high-tech and interactive. However, as of 2022, about 95 percent of manikins on the market from mainstream manufacturers were still flat-chested and androgynous. 

So why does this matter?

In the past, research has hinted at three main reasons why bystanders don’t immediately rush to the aid of a woman in cardiac arrest. One, they are hesitant to expose or touch her in any way that could be misconstrued as inappropriate and are worried about sexual assault allegations after the fact. Two, they don’t want to accidentally hurt them, perceiving them as generally more fragile than the average man. And three — perhaps saddest of all: bystanders often don’t recognize that a woman is in cardiac arrest if, say, she collapses in public, misattributing it as overreacting, simply fainting or faking it. 

CPR training with female manikins would go a long way in teaching people to be comfortable with the female form.  

In one study, people at MassCPR — the free CPR certification program offered by Massachusetts Institute of Technology for the MIT community — were trained using standard manikins,  as well as a few which were retrofitted with a mold resembling breasts. At the end of the certification, participants who practiced on the manikin with breasts reported greater comfort performing CPR on women. 

If there was widespread adoption of manikins that looked and felt different, this could ultimately become the norm. 

It’s really only in the past five years or so that research on this disparity has sped up, offering some evidence for the need for more representative manikins. Even then, widespread adoption of female manikins is hindered by commercial availability of anatomically correct models and the cost of switching existing CPR training programs over to using them.   

Closing the design (gender) gap

There are two main ways to go about increasing the availability of female manikins: Either you retrofit existing standard manikins with breasts or you design completely new ones. 

When Christoph Veigl and colleagues at the Medical University of Vienna surveyed 133 training organizations across 43 countries from six continents, they found that of more than 5,000 manikins in use, only a fifth of organizations owned a female one. While that number is still low, adoption is triple what it was four years ago. The researchers acknowledge that just the availability of female manikins is not necessarily an indication of how much they are used in training — about a quarter of the organizations were also employing makeshift adaptations, like placing a bra on standard manikins, to simulate training on women. 

Dr. Pooja Nawathe, a resuscitation science researcher and pediatric critical care clinician at Cedars-Sinai Hospital, chose to focus her research on gender disparity in resuscitation for a specific reason. 

“Skin color is about implicit biases, but female breast tissue, which is a normal physical characteristic, is about the actual science of this,” she said, speaking about variations in care during cardiac arrests. “Are we teaching how to place the pads on the breast tissue?”  

She also stresses the importance of gathering good, granular data on how CPR performance changes when people are exposed to diverse populations.     

CPR manikins are just one example of the gender gap in design: Across fields like crash testing, the “human” body has long been modeled on men.

CPR manikins are just one example of the gender gap in design: Across fields like crash testing, the “human” body has long been modeled on men. But that’s starting to change, too. Last year, the National Highway Traffic Safety Administration (NHTSA) released the design details for THOR-05F, the first detailed female crash-test dummy.

Before this, the standard female crash-test dummy was a model called the Hybrid III 5th percentile female dummy — literally just a scaled-down version of the Hybrid III 50th percentile male dummy that represents the average male body dimensions. But the THOR-05F — every woman’s dream name, I’m sure — is a much more anatomically accurate female dummy, and includes a female pelvis, breasts, and a flexible spine. 

THOR-05F has arrived just as new research by the NHTSA affirmed the need for better crash-testing on women. Although the gap in vehicular accident fatality rates between the sexes has narrowed significantly in newer car models, women continue to experience a higher injury rate compared to men in multiple different types of vehicular accidents. The hope is that testing with the THOR-05F will provide a better understanding of this trend and help engineer safer vehicles and regulations for women.

Women are not small men!

Women are often referred to as the “invisible sex,” and the lack of female manikins really brings that to the forefront. It’s not like the manufacturers or policymakers intentionally excluded women from this area — they simply ignored them, accepting an androgynous body as the standard with an unchallenged assumption that what applies to it will undoubtedly apply to women too. 

In 2019, Joan Creative, the New York-based ad agency, launched the Womanikin, a universal attachment for CPR manikins, in partnership with United State of Women, a now-shuttered organization focused on gender equity. Launched during National CPR Week, the Womanikin is a neoprene vest with silicone breasts that can be zipped onto any standard manikin. Built as an awareness campaign, they open-sourced the design for the breasted vest and helped spark a broader conversation about the CPR gender gap. But we don’t have any detailed information about its success or adoption. 

More recently, other manufacturers like Prestan have come out with newly designed female manikins that can be purchased as is. They also sell “replacement female skin” that retrofits any existing Prestan adult manikins. Notably, these are now available on the American Red Cross store, increasing visibility for female manikins.

The fact that women account for 50 percent of the world’s population and yet have to mold themselves to standards not designed for them in the first place is atrocious. Not only is it frustrating to live in a world not built for you, but in cases like CPR training, the gender gap can quite literally be fatal. This is true whether it is for motor vehicle crash-test dummies or those used to train battlefield medics — another field where women injured in battle have a higher fatality rate than their counterparts.

The basic idea is that repeated exposure to female bodily characteristics during training or testing can significantly alleviate discomfort that causes dangerous hesitation. If people had more practice administering CPR to models that looked more feminine, they wouldn’t be thrown off by breasts, would understand how to cut away clothing like bras if needed, and learn how to efficiently place the pads of the external defibrillator on a female body. 

CPR techniques remain largely the same irrespective of sex. Chest compressions are performed on the sternum, which is the flat bone running down the center of your chest. For women, it lies between the breasts, so there are some additional considerations. That is what representation in training manikins is meant to address — not new skills, but familiarity. 

Ultimately, it really comes down to not feeling awkward about putting your hand in between two breasts, if it means you save a life.

In an episode from the fifth season of Grey’s Anatomy, Miranda Bailey, played by Chandra Wilson, orchestrates an ambitious 12-person paired kidney transplant surgery. Six living donors each give one of their kidneys to a stranger and six recipients receive one in return. While the show, which is still on the air almost 18 years later, often blurs the line between fact and fiction, this particular form of kidney transplant, called a paired kidney exchange chain, has become increasingly common in the United States. 

Rewatching the show (sue me), I wondered if such donation chains are viable for other organs (or tissues) that can be donated by living donors. The liver, the only organ that can regenerate itself over a span of six to eight weeks, struck me as a particularly notable candidate. As with any surgical procedure, donating part of one carries some risk, but in most cases a person can safely continue to lead a healthy life afterward. And the need for them far exceeds what deceased donors can provide. Right now, there are more than 100,000 people on the waitlist for organs.

Over the past decade, using organs from living donors to meet organ demand has emerged as a particularly effective strategy. 

In 2025, around 24 percent of kidney transplants used living donors, according to preliminary data from the Organ Procurement and Transplantation Network (OPTN), the public-private partnership responsible for maintaining equitable organ allocation policies. Infrastructural advances, such as the establishment of the National Kidney Registry (NKR) in 2007, have helped reduce wait time for kidneys, provided financial support for donors, and facilitated close to 11,000 paired exchange kidney transplants. In a paired exchange, two patients who each have a willing but incompatible organ donor simply swap donors — my donor gives to you, yours gives to me. Ultimately, both of us receive a kidney that our bodies are more likely to accept.

By contrast, only about 6 percent of the roughly 12,000 liver transplants performed in the US last year used living donors. 

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This is not the case around the world. Countries that face a shortage of deceased liver donors rely almost entirely on livers from living donors. In 2022, India placed third, behind the US and China, in terms of the overall number of liver transplants but performed the most living donor liver transplants in the world — 81 percent of all liver transplants there were from living donors. 

While the number of living donor liver transplants has trended generally upwards over the last decade, the success of living kidney donation suggests that a similar path might be possible for the liver here, too. The US already has what it takes — a potentially lifesaving supply of living donor livers — but it lacks the infrastructure to turn willing liver donors into transplants at scale. That may actually be starting to change, as surgeons around the country are working to build out the interconnected systems and standards that they need to do their work. 

Why parting with part of your liver makes all the difference

Organ access is a multifaceted problem in the US. While the country has largely drawn on organs from deceased donors to meet organ demand, living donors grow more important by the day. A patient’s position on the liver waitlist is determined by their Model for End-Stage Liver Disease (MELD) score. It is a number between 6 and 40 that helps doctors decide how soon the patient needs a new liver. Sometimes, if a patient gets too sick, surgery is unsafe, or if they have problems with substance abuse, they are no longer transplant eligible. 

Living liver donors are especially important because transplantation is the only treatment for end-stage liver failure — there are no alternative options. For patients in end-stage kidney failure, a dialysis machine can artificially take over the function of a kidney, and temporarily help manage their condition as they wait for an organ match. But a person experiencing liver failure has no such interventions available to them. They continue to get sicker and sicker the longer they hold on. Around one in five liver transplant candidates die waiting for a new liver. 

Living liver donors go through extensive health screens to ensure that their liver quality is good for transplant. Research indicates that the resulting donated organs lead to equal or better overall survival, compared to deceased donors. A transplant surgery with a living donor can also be scheduled, unlike those that rely on deceased donors, which are based on when an organ becomes available. This means that living donor livers usually don’t have to be transported long distances (since the donor can travel to the recipient before the surgery) and the amount of time the liver is without blood and has to be artificially preserved is very short — an important metric in donor organ viability.  

Earlier this year, doctors at the University Health Transplant Institute in San Antonio performed a seven-pair living donor liver exchange, the largest such chain in the country. Over a period of six weeks, the liver transplant surgeons matched seven people willing to donate a portion of their livers to seven other recipients who needed the life-saving transplant. Like most of these paired exchange chains, the logistically complicated process was set into motion by a non-directed living liver donor — someone who was willing to donate a liver to a stranger.. Other donors in the chain, by contrast, had a specific person they hoped to donate to with whom they weren’t immediately compatible.

Blood type and liver size are two main considerations when doctors match donor livers to recipients. Individuals with Type O blood usually have the longest wait times for donor livers because they can only receive them from others with the same blood type. In other cases, the size or anatomy of the donor liver can be incompatible with the recipient. 

An estimated 2 percent to 17 percent of living liver donors are rejected from donating to their intended recipient because of blood type, size, or anatomical incompatibility of the system of bile ducts. A major benefit of living donation is that if someone wants to donate their liver to a specific person, but they are not a match, both the donor and the recipient can participate in liver paired exchange programs — two or more incompatible donor-recipient pairs can swap donors. 

“For each living donor transplant that you do, you are actually doing two transplants,” said Dr. Jonathan Cullen, a liver transplant surgeon who participated in the liver paired exchange at University Health Transplant Institute. 

By that, he means that any time a living donor provides a liver, they also free up an organ on the deceased donor list for someone who might need it more. If we had more living donors, we could save even more lives — especially of those lower on the waitlist — but we need to overcome a few barriers first.  

Growing the donor pool isn’t enough

If living donor liver transplants have so much potential, why are they still so underutilised? The answer depends on whom you ask. 

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When medical researchers from Weill Cornell Medicine and the University of Colorado Denver surveyed 99 liver transplant programs in the country, surgical and medical directors identified different barriers to living donor liver transplants based on whether their program already performed such procedures. Out of the 83 that responded to the survey, around 60 percent of the centers performed living donor liver transplants. Notably, 34 percent of the responses from centers that don’t perform living donor liver transplants cited institutional issues such as lack of financial support or a lack of surgeons trained in living donor procedures, which are meaningfully more complex than kidney transplants. 

“Center expertise is very important when it comes to living donations. You want to obviously have your operation done at a center that’s done a lot of these,” said Alyson Kaplan, a transplant hepatologist at Tufts Medical Center and lead author of the study. “Not every transplant center has a living donor program — and so, as you can imagine, not every transplant fellow is going to get exposed to living donation.”

The surgeries are also resource intensive, especially when they are paired exchanges. In the seven-paired liver exchange at the University Health Transplant Institute in San Antonio, two attending faculty surgeons were required for every donor operation and two to four of the same for the recipient surgeries, according to Cullen. 

Plus, many of the steps in the liver transplant process are not standardised. There doesn’t yet exist a central organ matching organization for living donor livers along the lines of the National Kidney Registry, and there are no formalized protocols for how living livers are chosen and allocated, or how potential donors are screened. These procedures can differ from center to center, which can complicate attempts to collaborate or share resources. 

With living kidney donation, by contrast, the NKR partners with transplant centers and helps them standardize their processes, said Kaplan. The majority of certified kidney transplant centers in the US perform living donor transplants. That combination of shared standards and widely available surgeons makes it easier for one team to procure the organ from the donor and another to perform the recipient transplant, even if the donor-recipient pair is geographically separated.

Donor kidneys can be matched efficiently to recipients thanks in part to the work of American economist Alvin Roth, who won the Nobel prize in 2012 for the theory of stable allocations and practice of market design. His work increased the efficiency and speed of several matching processes, including paired donor-recipient kidney allocations and residency matching for medical students.

“The kind of algorithmic help that people like me can give is very, very similar,” said Roth on whether his work can be applied to liver transplants too. “Almost the same software works. What changes is the compatibility matrix.” 

For now, individual institutions that perform paired exchange living donor liver transplants usually do the matching in-house, manually comparing donor-recipient profiles and screening for risks. Kaplan’s study found that 92 percent of living donor liver transplant programs that had never performed this surgery would consider conducting it. 

But without enough funding, Kaplan said, a big infrastructural boost like this one is hard to execute on a national scale.  

Who protects the donors?

Both infrastructure and funding are necessary to scale living donor liver transplants nationwide. However, without a large pool of willing donors, these resources alone are insufficient. 

But building a bigger pool of donors is difficult, partly because becoming a living donor is difficult. 

Living liver donors often have to travel to their recipients, pay for associated lodging, and take weeks off work for both the operation and the recovery. The cost of donor screenings and transplant surgeries is usually taken on by the recipient’s insurance, but many programs recommend that the donor plan for any additional expenses, including follow-up appointments, continued medications, and caregiver expenses. 

Nonprofits like the National Living Donor Assistance Center (NLDAC) can help living liver donors subsidize costs, but only if the recipient’s household income is 350 percent below the federal poverty guidelines. For a household of two in the 48 contiguous states, that is an annual income of $75,740. Some states also provide income protection for living donors who have to take time off work, but others don’t. In the absence of more universal protections and other forms of support, building the donor pool may be a bottleneck for also building out broader living liver donation infrastructure. 

“Donors should never have a penalty to be a donor. They are definitely the national heroes, and they should have all the protections that they deserve. Nobody should have to go into debt to be a donor, for goodness sakes,” said Dr. Julie Heimbach, director of the Transplant Center at Mayo Clinic. The center performed its first paired living liver transplant in 2024. 

Moving the needle — and the organs

One major roadblock in establishing national collaborative programs for living liver transplants comes down to what’s called the organ’s cold ischemia time. This is the time between organ procurement and transplantation, during which the organ is kept cool, and no blood flows through it. 

Kidneys can hold on for longer than livers, which means that they can be transported across significant distances without the quality of the organ deteriorating. With livers, it becomes all the more important to quickly procure and transplant them because they can’t stay on ice too long. 

This limits how far a liver can be transported. A liver from a living donor across the country might not be viable by the time it reaches the recipient and is transplanted — and even if it could be, a transplant surgeon may not be willing to take a risk on it. 

In 2023, when United Network for Organ Sharing (UNOS) Labs, the innovation arm of the private non-profit that manages the organ transplant system in the US, attempted to pilot a nationwide liver paired donation program, this proved to be one of the biggest stumbling blocks. The program was anonymously funded by a private benefactor and involved 15 transplant centers across the US. However, the program shut down less than a year later. Even though one recipient-donor pair was enrolled for a liver paired exchange, the transplant surgeries were ultimately not executed. Many of those I spoke to for this story — transplant surgeons from centers that participated in the pilot — said that the funding dried up before the challenges of a collaborative liver paired exchange surgery could be resolved. 

“One of our key learnings was that moving donors, rather than organs, created major barriers. Donors are connected to their care teams and support systems, and asking someone to relocate for surgery and recovery is difficult,” Dr. Benjamin Samstein, the lead on this pilot and chief of liver transplantation at NewYork-Presbyterian and Weill Cornell Medicine, said in an email. 

He believes that there is still potential to revisit the concept, this time with a focus on moving organs instead of donors and exploring regional hub models. 

As Vox reported earlier this year, some transplant surgeons now rely on a new method of organ preservation where an external pump is used to circulate oxygenated blood or other fluids through an organ after it is procured from the donor. This keeps the donated organ viable for much longer and has been shown to outperform standard “icebox” preservation where the organs are cooled on ice. That could, transplant surgeons say, spare living donors the obligation of traveling to their recipients. 

While this technology, which is also revolutionizing the use of organs from deceased donors, may eventually reduce the pressure to recruit living donors, Dr. Jason Hawksworth, Director of the Robotic Liver Surgery Program at New York-Presbyterian/Columbia University Irving Medical Center, doesn’t think that it will diminish their importance. 

The MELD score used to prioritize patients on the liver transplant waiting list does not capture all clinical symptoms. Patients with low MELD scores can also face life-threatening complications of liver failure such as abnormal buildup of fluid in the abdomen. Such patients benefit most from living liver donations because they don’t have access to machine-perfusable organs usually reserved for those higher on the waitlist, said Hawksworth. 

To meet at least some of the need, the American Liver Foundation launched the first-ever non-directed living liver donation network to connect those who would like to donate to a stranger to transplant centers who can access this network free of charge. While the network has already saved two lives as of June this year, it remains to be seen if the program will run into the same issues as its more ambitious UNOS counterpart. 

Ultimately, optimizing the field of organ procurement and transplant is both a medical problem and an infrastructural one. OPTN data shows that 95 percent of those on the organ waitlist are in need of a kidney or a liver — the two organs a living person could give. Kidney donation has already been transformed by a combination of smarter algorithms, better standards, and trained surgeons. While living liver donation presents more challenges, there’s a real possibility to revolutionize the process and save lives.

“If these particular barriers were not an issue,” Kaplan said. “I think everyone would be interested in it.”

Popular conceptions of farming tend to associate good animal welfare with environmental virtue — an intuition so strong that researchers have described a “humane halo” effect, where consumers who are told that a farm uses better environmental practices also assume that it treats its animals well. So it might come as a surprise to hear that one way of making eggs better for the planet might be to make life a whole lot worse for the chickens who lay them. 

This, anyway, was the apparent upshot of a controversial and widely discussed new paper on the environmental impacts of different egg farming systems. Cage-free, free-range, and organic eggs, it found, are higher in greenhouse gas emissions, land use, and other environmental harms than confining hens in tiny cages. 

Consider the implications of that result: At any given moment, more than 8 billion egg-laying hens inhabit farms across the planet. The vast majority of them live in wire cages that severely restrict basic movements like spreading their wings and turning around. They barely have room to move around at all, which can induce depression-like states. “Hens represent the largest population of terrestrial animals housed in cages throughout their lives,” as the new study puts it. 

In animal agriculture, there is an unfortunate and well-known trade-off between environmental impact and animal welfare because, all else equal, animals who are allotted a bit more room to roam and express natural behaviors take up more resources. (Of course, that trade-off disappears if we simply replace animal products with plants.) That is why almost all animal products these days are produced on factory farms in the first place — factory farming doesn’t exist merely to be evil, but rather because it’s efficient, and the cost of efficiency is borne by the animals. 

Although the new paper may overstate the magnitude of this tension for eggs (more on that in a moment), it’s directionally right: Hens who are able to walk, flap their wings, fly, and perch will eat more calories than those trapped in cages, so their environmental footprint is generally going to be greater. 

But here is the thing: That doesn’t really matter. 

Eggs aren’t generally singled out by climate experts as a major decarbonization priority. Although animal agriculture is a significant contributor to climate change, making up about 12 to 20 percent of global greenhouse gas emissions, eggs are responsible for a very small share of that — about 3 percent of all livestock emissions. As a back-of-the-envelope estimate, that is, on the high end, roughly 0.6 percent of all emissions. I think we can spend a tiny bit of our carbon budget to spare billions of animals a life of near-total immobilization. 

But it’s weird to think about this as an environmental question at all. Chickens aren’t merely resource burdens — they’re inhabitants of our planet who deserve to share in the benefits of a more sustainable future, too. And the most salient feature of caging hens is not that it’s marginally more environmentally optimized, but simply that it’s wrong.

Caging humans would reduce our emissions, too, as Lewis Bollard, managing director for farm animal welfare at the philanthropy Coefficient Giving, grimly remarked about the paper. No one would ever suggest doing that, because a lower carbon footprint cannot turn a morally indefensible practice into a good idea. 

Is there really a climate case for cages?

Over the last few decades, animal welfare advocates have sought to bring hens some relief from extreme confinement, passing laws that ban cages and persuading grocery stores, restaurant chains, and other food purveyors to source cage-free eggs. (When I was in college, I worked on one of these campaigns, helping convince my school to serve exclusively cage-free eggs in its dining halls.) Nearly half of egg-laying hens in the US and two-thirds of those in the European Union are now raised cage-free, and four-fifths of eggs in the UK come from cage-free hens. But cages still prevail in some high-income countries, including Canada, Japan, South Korea, and Israel.

This advocacy work has spread to low- and middle-income countries, too, where most of the world’s hens live and overwhelmingly remain caged. Cage-free eggs are still far from cruelty-free, but they likely represent a meaningful welfare improvement. 

The new paper, published in Royal Society Open Science late last month, used data from the UK to compare the impacts of five different egg farm types: battery cages, slightly larger “enriched” cages, cage-free indoor barns, free range, and organic free range. Fully indoor cage-free systems are by far the most widespread form of cage-free farming in the US and elsewhere in the world, and they’re generally the default large-scale system used in transitions away from cages, so they are our primary focus here. 

The researchers compared egg farming systems on four environmental metrics: greenhouse gas emissions, nutrient pollution in waterways, soil acidification, and land use. The lowest impacts across all four categories were found in farms that used enriched cages, which are one-third to two-thirds larger than the standard battery cages that dominate the global egg industry  — the latter had the second-lowest impacts. (From an animal welfare perspective, enriched cages are akin to slightly loosening a straitjacket — only a grotesque starting point could make them look generous. They afford each hen a living space not much larger than a sheet of printer paper, well below the area typically needed to perform basic behaviors like flapping her wings and grooming herself.) 

To produce the same number of eggs, the study found, cage-free barns emit about 56.1 percent more greenhouse gases than enriched cages and 33.8 percent more than battery cages. 

The authors have said that the paper isn’t meant to advocate keeping hens in cages, but rather to inform decision-making about cage-free transitions with accurate estimates of the environmental trade-offs involved. The findings have been presented as relevant to food sustainability discussions globally, more broadly than just in the UK. And, Bollard pointed out to me, the paper has come out as the EU and UK weigh fully banning caged egg production, raising the possibility that its findings could influence those policy fights. 

“We recognise that the transition toward cage-free production is important for improving animal welfare,” lead author Oliver Martinić, who recently earned a PhD in animal and food science from the University of Padova, told me in an email. “The long-term goal should be to develop cage-free systems that combine high standards of animal welfare with improved production efficiency and lower environmental impacts. If we can achieve that, the environmental gap between cage-free and caged systems could be substantially reduced.” 

It’s certainly important to have an accurate accounting of the environmental impacts of all types of farming. Whether or not the paper achieves that has been a subject of some debate. To make their calculations, the authors drew from data published more than a decade ago, but cage-free egg production has since become more environmentally efficient. 

“The paper is methodologically flawed,” Ilias Kyriazakis, a professor at Queen’s University Belfast and senior author of the earlier research whose data the new paper relies on, wrote in a critique of the study. “It relies on our data from 2010 to construct scenarios intended to represent national conditions in 2023, without adequately accounting for the substantial changes that have occurred over that period.” As a result, he added, “the authors are likely to have overestimated some of the impacts” of the non-cage production systems.

The authors have said that they used that dataset because it’s the most comprehensive one available, and Martinić told me that “production systems have continued to evolve, so newer data would be valuable for assessing the extent to which the gap [between caged and cage-free eggs] has changed.” Other peer-reviewed research, meanwhile, has found a smaller gap in climate impacts between caged and cage-free eggs. Even the makeup of hens’ feed may matter more for the climate impact of eggs than whether they’re kept in caged or cage-free housing: One US study found that cage-free farms were lower in emissions and other impacts because they used more environmentally efficient feed.

In the end, these differences may not be that big of a deal because the climate impact of eggs is small in the grand scheme of animal agriculture. Using the new study’s own emissions estimates for eggs, a single beef burger emits as much as about five dozen cage-free eggs.

“There’s no doubt that eggs are the least environmentally impacting animal product per unit,” Kyriazakis told me. So when considering whether caged or cage-free eggs are better for the world, their environmental impact is not very high on the list of things to agonize over. 

Martinić and his co-authors don’t ignore animal welfare entirely — they attempt to account for it, but they have an oddly narrow way of doing it. The paper’s welfare metrics leave out what it is actually like for a hen to live inside a cage. Instead, its chosen measures score cage systems more favorably, because the model assumes that they have lower mortality rates, and they require fewer total birds to produce the same number of eggs. The result is that cage farming ends up looking comparatively better on welfare, though the authors themselves acknowledge that their analysis leaves out many indicators of welfare and “should be interpreted with caution.” (Critics of the study have noted that its mortality numbers are more than a decade out of date, and that recently, as egg producers have learned to better manage cage-free farms, the gap in mortality rates has declined.)

Beyond the carbon ledger

There is a term for what happens when we reduce our biggest social problems to environmental or climate ones, and lose sight of everything else at stake: climate reductionism. 

The new paper and discourse surrounding it display how that trap can shape the way we understand and treat nonhuman animals. It also reflects a long-established tendency in animal agriculture research to view animal welfare through the lens of efficiency and productivity, rather than through the desires of the animals themselves. 

To contend more deeply with the ethics of mass-producing animals like egg-laying hens for food, we have to momentarily cast aside questions about efficiency and ask, what is life like for a hen from her own perspective? I happen to know a lot of chickens — in the right circumstances, they’re convivial, spirited, energetic animals. The widespread myth that they’re stupid has more to do with our own repressed guilt than with the animals’ capacities. Their experiences call on us to face not just the cruelty of cages, but also to look beyond cages to problems common to all forms of egg farming. 

To name just a few: Egg-laying hens have been bred to channel their bodily resources into laying extraordinary numbers of eggs, which takes a heavy toll on their bodies, depleting their skeletons of calcium, and making them prone to painful bone fractures and reproductive disorders. (The red junglefowl, the wild animal equivalent of the chicken, lays 10 to 15 eggs per year; farmed hens lay more than 300.) On cage-free farms, meanwhile, escaping the cage does not mean entering anything resembling a natural environment. Rather, the hens live in crowded, polluted, sometimes windowless sheds filled with thousands or tens of thousands of other chickens, where unnaturally large, dense social groups can intensify injurious pecking and other aggression. They are ultimately killed once their productivity wanes.

These conditions have even fueled a vigorous debate in the animal advocacy movement over whether pushing for cage-free eggs is a good idea at all, because they can give the public the false impression that the worst parts of egg factory farming have gone away. But cages are only one part of that system — modern animal agriculture is defined by a complex set of practices optimized to squeeze as much productivity out of animals as possible. Challenging more fundamental features of egg production, like the genetics of modern laying hens, would be harder than eliminating cages because it poses a deeper challenge to the value the industry elevates above all else: efficiency. We would have to demand less of their bodies, and that would very likely make each egg more expensive and more emissions-intensive. 

What, then, does that mean for you? On an aggregate, societal level, I think cage-free reforms have been a good thing, because they have made a terrible system that we can’t simply wave away with a magic wand less bad. But more profound change will require consumers to demand something more than cheap animal products. So if I’m addressing you, an individual, I’d say something different. The most obvious win-win is hiding in plain sight: Plant-based foods like tofu and beans are significantly lower in emissions than eggs, while avoiding the moral costs of egg production altogether. 

Editor’s note, August 23, 8 am ET: We’re bringing you some of our best-loved Your Mileage May Vary columns while Sigal Samuel is on parental leave. The one below was originally published in February.

This unconventional advice column offers you a unique framework for thinking through moral dilemmas. It’s based on value pluralism: the idea that each of us has multiple values that are equally valid but that often conflict with each other. Submit your own question here.

I’m a woman in my 30s and I think I want to have a child, but I have a health condition that makes it harder (not impossible) to get pregnant than for most women. It would also make pregnancy more uncomfortable and physically disfiguring than it is for many pregnant people. It wouldn’t be permanently disabling, but the physical effects would be bad enough that I really don’t want to be pregnant.

I’m fortunate enough that I can probably afford to get a surrogate through a reputable agency. But surrogacy is frowned upon and often considered unethical. Long ago, I knew someone who said she loved the idea of being pregnant and providing gestation as a service to other people, so maybe in theory, it is possible for someone to freely choose to be a surrogate without being coerced by financial need? But even if it could be done ethically, there’s such a stigma around it and I fear being judged by friends and family. There seems to be a sense that there’s something wrong, unnatural, selfish, or unwomanly in wanting to have a biological child but not wanting your own body to be the vessel for it. 

Plus, it’s not like I’m the only person in the world for whom pregnancy would suck. I think my experience probably would be worse than average, but pregnancy is just an unpleasant thing overall so I don’t think I can claim it would be so uniquely bad for me that I’m justified in wanting to pay to use someone else’s body. I’d love your help with this.

Dear Really Don’t Want To Be Pregnant,

There are some ethical questions about surrogacy that it’s genuinely worth asking, and some that I don’t want you to devote another second to — so let’s start there.

As you said, there’s a cultural stigma around not wanting to turn your body into a vessel for childbearing — it’s deemed “wrong” or “unwomanly.” But that idea is pure garbage. The idea that there’s some “proper” way to be a woman is a patriarchal construct; anyone who tells you you’re “unwomanly” for not wanting to gestate is reflecting sexist expectations that women’s bodies should be available for reproductive labor.

So to the extent that your fear of being judged is about that, please don’t give it another thought. But of course, there are real moral questions that surrogacy brings up.

I’ll tell you right off the bat that I do think surrogacy can be ethically justifiable in some situations. First, it helps that surrogacy is not one monolithic thing. There’s a big distinction between commercial surrogacy (where you pay someone to carry a baby) and altruistic surrogacy (the unpaid version, where the surrogate carries the baby as a literal labor of love). It’s not easy to find an altruistic surrogate — after all, pregnancy is dangerous business — but I agree with your intuition that if you’re lucky enough to know someone willing to volunteer for the role, opting for that is a good way to avoid most concerns about commodification or exploitation. 

Within commercial surrogacy, a second distinction has to do with where the surrogate lives. There’s a moral difference between hiring a surrogate in a developing country and hiring one in, say, the US. In countries like Georgia, for example, surrogacy agencies have been known to recruit at domestic violence shelters — some women see surrogacy as the only way to win financial freedom from an abusive spouse. Ukraine, Cyprus, and several others are also known to have ethically problematic surrogacy industries.  

But American surrogates are typically not low-income; they’re usually middle-class white women with husbands and kids of their own, and they have other economic opportunities available to them. The better surrogacy agencies screen out poor women, who are at risk of coercion. That empirical context means there’s less (though not zero) potential for exploitation in the US, compared with international surrogacy.

Another reason I think surrogacy can be ethically justifiable is that for many, many people, the urge to have kids — including ones who are biologically related to them — feels like a need and not just a want. 

Many opponents of surrogacy argue that nobody has a “right” to a biological child, so if you can’t or don’t want to be pregnant, too bad. And those opponents are right that nobody has an absolute right to have a baby — otherwise, the state would be obligated to ensure surrogates, egg donors, and sperm donors were made available regardless of their own willingness to participate! But people may still have a qualified right — the kind of right that we generally honor but that can be restricted to protect the interests of others. 

When it comes to people who are physically unable to create a biological child — when they have what doctors call a “medical indication” — I think the qualified right to have a kid means that surrogacy can be ethical, provided it meets certain criteria like informed consent.

But your situation is trickier because it’s not impossible for you to get pregnant — it’s more that, for certain reasons, you don’t want to. Typically, your case would be referred to as “elective surrogacy.” Some professionals will refuse to arrange surrogacy if they deem it elective rather than medically indicated.

And yet, doctors are increasingly recognizing that the line between “medically indicated” and “elective” is not so tidy. 

While elective surrogacy is often associated with vanity — it brings to mind a celebrity who doesn’t want to be pregnant because she doesn’t want to “mess up” her figure — it’s not like everyone in the elective camp is there for cosmetic reasons.

What about someone who could get pregnant but is deathly afraid of giving birth because she had a traumatic experience — like, say, her best friend dying in childbirth? Or what about someone who’s trans and who physically could carry a pregnancy, but who knows it would cause such gender dysphoria that there’s a risk of serious psychological harm? Shouldn’t a mental health need be considered a type of medical need?

These are not hypothetical experiences — real people have testified to them — but they often haven’t been taken seriously as medical needs. I suspect that these people have endured what the contemporary philosopher Miranda Fricker calls “epistemic injustice.” 

Epistemic injustice refers to “a wrong done to someone specifically in their capacity as a knower.” When society denies someone the credibility to assess their own life experience, or discounts an important part of that experience because of a gap in our collective interpretive resources, that can be an example of epistemic injustice. I think people who fall in between medical categories are too often at risk of being wronged in this way, and I don’t want to see that happen to you.

So I want to acknowledge that I don’t know what health condition you’re referring to when you say you have a condition that would “make pregnancy more uncomfortable and physically disfiguring than it is for many pregnant people.” Since I don’t know the details, I’d encourage you to ask yourself: How much more uncomfortable? How much more disfiguring? And how heavy and lasting a toll would that discomfort or disfigurement take on your overall well-being?

Only you can really try to answer that last question, because the same effects can land differently for different people, depending on how well-resourced we are financially, socially, psychologically, and even spiritually. 

Once you’ve thought about how big and enduring the risk of harm is to you, try asking yourself this: Is the risk to you so much greater than the risk to a woman of average health that you feel comfortable transferring the risk of pregnancy and childbirth onto her?

Some people will tell you that question is irrelevant. They will say that the only value that matters here is autonomy — yours and the potential surrogate’s — and if you and she both consent to a surrogacy contract, and she is not coerced into it by financial desperation, then that’s that!

But there may be another important value at stake here: justice. 

As far as I can tell, your case is in a gray area — surrogacy is neither obviously “medically indicated” nor obviously “elective” based on the information you shared. If you ask yourself, “Do I think there’s a significant risk that carrying a child would significantly harm me?” and you answer “Yes!” — then some doctors would say surrogacy is medically indicated. But if the answer you feel bubbling up is, “Well…no, not really,” then you may be closer to the “elective” side of the spectrum. And then I think it becomes reasonable to inquire whether it feels fair to ask another woman to take on the considerable risks of pregnancy and childbirth.

You wrote of pregnancy, “I don’t think I can claim it would be so uniquely bad for me that I’m justified in wanting to pay to use someone else’s body.” That suggests that you currently see yourself as more in the elective camp. I urge you to give yourself the space to really interrogate that with an equal measure of honesty and self-compassion. If honesty compels you to say you don’t feel justified in putting someone else’s body in harm’s way in a situation where she otherwise wouldn’t be, then maybe you’ve got your answer. 

But if you’re discounting the risk of psychological harm to yourself because you don’t think that “counts” as real need, please know that mental health is just as medically legitimate as physical health. And if you talk to a medical professional about the option of surrogacy, please talk to more than one so you’re less at risk of getting boxed into a category that doesn’t capture you right. 

At the end of the day, perhaps none of us can be a perfect interpreter even of ourselves. But you get to be the interpreter-in-chief — with both the power and responsibility that implies.

Bonus: What I’m reading

• This horrifying New York Times Magazine story about the global fertility industry captures why I do think it’s unethical to work with a surrogacy agency in a country like Georgia. These surrogates are not in a position to give informed consent.  

• “Is Cognitive Dissonance Actually a Thing?” asked Shayla Love in the New Yorker recently. I now feel cognitive dissonance about all the times I thought I was feeling cognitive dissonance!

• Don’t miss “I’m Kenyan. I Don’t Write Like ChatGPT. ChatGPT Writes Like Me.” This essay by Marcus Olang’, explaining why his writing is often mistaken for AI slop, is both surprising and maddening. Turns out it’s really hard to not write in the Queen’s English when an entire colonial legacy has drilled that style into you from birth. 

This story was originally published in The Highlight, Vox’s member-exclusive magazine. To get access to member-exclusive stories every month, join the Vox Membership program today.

A few things are certain in life: death, taxes, LeBron James playing professional basketball — and Americans’ belief that crime is getting worse. Since Gallup began asking about national crime in 1989, a majority of respondents said they thought crime in the US was higher than the year before in every survey year except 2000, 2001, and 2025. Even in that last year, 49 percent still said more crime was happening. It’s perhaps the archetypal example of negativity bias, the mental habit of giving more weight to bad news than good.

Last week, the FBI put some numbers on just how big that bias is. The American murder rate — which peaked in 1980 at 10.2 per 100,000 — fell to an estimated 4.1 per 100,000 people in 2025, matching the rates recorded in 1955 and 1956 for the lowest ever measured in the country. The violent crime rate (murder, rape, robbery and aggravated assault) fell 9.7 percent, the largest single drop since J. Edgar Hoover was running the bureau in 1936. 

That much is known. But what’s not known for sure about the crime drop is almost everything else. Adam Gelb, who runs the Council on Criminal Justice, says that there is no single or easy explanation for the historic lows, while Jeff Asher, the analyst who spotted this decline before nearly everyone else, agrees. For every leading candidate — federal pandemic spending, some normalization after the 2020 social collapse, better violence prevention, even the decline of drinking — there is a corresponding hole. 

But there is one American city where researchers can point to a specific program, measure what it did, and put real numbers on it. And it just happens to be the city that spent 50 years — and five award-winning seasons on HBO — as America’s shorthand for murder.   

What Baltimore did

Baltimore recorded more than 300 homicides a year for most of the last decade, and more than 200 for most of the past half-century. In one month, July 2015, 45 people were killed — an astounding figure for a city of just around 600,000 people at the time. 

But Baltimore finished 2025 with 133 homicides, the fewest since 1977 and about 60 percent fewer than in 2020. Through the first eight months of this year, the city has seen 60 murders, and the police commissioner’s target is to stay under 100. 

What caused this? Three things at once.

Baltimore Mayor Brandon Scott’s Group Violence Reduction Strategy identifies the few people most likely to shoot or be shot — two groups that heavily overlap — and sends people to their doors with two messages: you are on our radar, and here is housing and job training. Separately, the longer-running Safe Streets program puts outreach workers with real street credibility between disputes, aiming to interrupt them before they become shootings.

That’s the harm reduction element. There’s also a tough-on-crime component. The state’s attorney office says it has secured 2,129 convictions since 2023 across several gun-related violent-crime categories, with over 1,700 of those defendants incarcerated. 

Meanwhile, Baltimore’s homicide clearance rate reached 60 percent by mid-2026. Its nonfatal-shooting clearance rate was 54 percent, up more than 12 percentage points from a year earlier. Criminologists have long held that the certainty of being caught deters criminals more than the severity of the sentence, and more successful shooting investigations are a common thread where violence is falling around the country. 

How do you tell whether a program worked, or whether a city just got lucky? Drug trials get a control group; cities don’t. Baltimore got one almost by accident: the strategy launched in the city’s Western District in 2022 and nowhere else, which left the rest of the city as a comparison.

That’s what a team of economists and criminologists used. They measured the Western District against Baltimore neighborhoods that hadn’t started the program yet, and over 18 months the number of people shot there, fatally or not, ran about 30 percent below that stand-in. Killings alone fell by a similar share, but deaths are rare enough that chance couldn’t be ruled out. Police made no more arrests than before. Arrests for serious violent crime rose 81 percent.

A second, looser test set the whole city against a composite of other big American cities and put Baltimore’s murder rate about 25 percent below it. The authors are careful with that one: too much changed in Baltimore at once to say how much it the strategy was responsible for.

Murder is contagious

Baltimore’s success is built on two ideas, and they came from two very different places. 

The first came from a doctor named Gary Slutkin, who spent the 1980s and early 1990s fighting tuberculosis in San Francisco, cholera in Somali refugee camps, and AIDS across Africa. He came home to Chicago in 1995, a year the city recorded over 800 homicides. 

When Slutkin examined the city’s shooting maps, they looked familiar. Clustered in space, clustered in time, and spreading case to case — murder resembled the outbreaks he used to fight. Slutkin reasoned that the way to treat violence was to treat it like cholera: find the people most likely to transmit. Interrupt the transmission. Change the conditions that let it spread. Slutkin built the model into a program called CeaseFire, now Cure Violence Global, and its Baltimore descendant is Safe Streets.  

The second idea came from a criminologist. David Kennedy, working in Boston in the 1990s, found that 61 gangs with about 1,300 members — under 1 percent of the city’s young people — were tied to at least 60 percent of its youth homicides. Get those people in a room with police, prosecutors, and community elders, tell them plainly what comes next, and the shooting slows down.

That approach is called focused deterrence. Baltimore’s Group Violence Reduction Strategy is a version of it. To see how it works over a longer period of time, take a trip across the Atlantic to Glasgow in Scotland, which in the early 2000s was considered the murder capital of Europe.

In 2005, in the midst of that wave of violence, Glasgow’s Strathclyde Police established a Violence Reduction Unit that operated with a basic thesis: evidence shows that violence can be prevented. Among other interventions, the unit sent trauma surgeons into schools to describe what a blade does to a face and stationed outreach workers at hospital bedsides to reach victims in the vital hours after an attack, the moment when retaliation can still be stopped. 

In 2024-25, Scotland recorded 45 homicide victims, the fewest since comparable records began in 1976 and down from 96 two decades earlier. Every case was solved.

Pull the handle

So we have clues to why crime has dropped so much, but not clear conclusions. As successful as Baltimore’s group violence strategy has proved, a 2023 study of a similar street-outreach effort in Boston found no effect whatsoever. And the latest evaluation of Baltimore’s own Safe Streets — 11 sites, each measured against a stand-in version of the same neighborhood without the program — produced numbers that sound terrific but settle very little: youth homicides down 42 percent and youth shootings down 21 percent, but neither is strong enough to rule out chance. And while some sites saw youth homicide fall by as much as 100 percent, two sites saw it rise by 42 and 89 percent. 

Some experts, like the UC Irvine criminologist Emily Owens, argue the crime decline has been so widespread and similar — big cities and small, red and blue governments — that the true cause is some larger social change rather than what any one city is doing. Nor can we be sure the fall will continue. Billions in federal pandemic relief money has supported many of the programs that have worked well in places like Baltimore, and that money is already running out. But we can identify one reason why it happened, and learn from that success. 

As it happens, Gary Slutkin was not the first doctor to look at a map of the dead and see a pattern in it. In September 1854, a cholera outbreak was killing hundreds of people in London’s Soho district. A doctor named John Snow had mapped the outbreak and saw the dead were clustered disproportionately close to the district’s Broad Street water pump. Snow had a theory that water was connected to the disease and convinced a Soho parish board to remove the handle of the pump. 

Nobody in Soho at that moment could have told you what caused cholera. It would only be 29 years later that someone would definitely identify the responsible pathogen, and in doing so, explain why Snow’s intervention worked. But the explanation could wait. The dying stopped that month in Soho, just as it is stopping in Baltimore and around the US today. And that’s what counts.

A version of this story originally appeared in the Good News newsletter. Sign up here!

Since January, many Cubans have lived a life of near-constant darkness. The Trump administration’s oil blockades have led the country into a worsening energy crisis, collapsing what was already an eroding national power grid. 

Daily blackouts have plunged the Cuban nationalized, universal health system, once the pride of the country, into a humanitarian crisis. For months, hospitals have been without necessary power and ambulances strapped for fuel. Piles of trash line the streets, increasing the risk of disease. Cold storage issues threaten lifesaving vaccines, and a combination of the frail economy and US sanctions has left pharmacy shelves almost empty. 

The public health crisis exposes an often overlooked aspect of the way we tend to think about the promise of universal healthcare. Having accessible and free medical services is only one part of the solution. While Cuba’s once-vaunted health system is bound up in its own history and national context, it still demonstrates that public health of all kinds can only be as resilient as the electricity, water, transportation, refrigeration, supply chains, and institutions that enable it. 

An old prototype for universal healthcare 

Not long ago, Cuba’s health system was seen as a promising model for successful free universal healthcare. In the years following Fidel Castro’s rise to power, health authorities focused on the integration of healthcare delivery models into a single public system. The Castro government aimed to expand services once concentrated in Havana into rural areas, such that the entire population would have access to basic care services. In 1974, the government launched community-based polyclinics that placed primary care specialists in almost every Cuban community. 

Over the decades that followed, that widened access to healthcare led to significant, measurable returns. Infant mortality in the country has dropped from 37 per 1,000 live births right after the revolution to seven per 1,000 live births in 2024. Infectious and parasitic disease mortality also improved, dropping from a rate of 45.4 per 100,000 inhabitants in 1970 to 9.8 per 100,000 inhabitants in 2019, according to data reported by the Cuban Public Health Ministry. 

It’s not entirely surprising that the successful Cuban national health model has been the site of curiosity and enthusiastic scrutiny in American health equity circles, despite vast differences in state ideologies. The US has never ensured that every citizen has affordable access to healthcare, and large disparities persist in low-income and rural populations. The chokehold of private insurance has ensured that, unlike nearly every other country in the world, the US has largely rejected the prospect of universal care. Even historic gains in insurance coverage have faced rollback threats under the One Big Beautiful Bill. 

On certain key metrics, the US also falls far behind Cuba, which boasted 9.5 physicians to 1,000 people in 2021. That same year, the US reported just 3.7 physicians to every 1,000 people. The 2019 measles epidemic demonstrated a gap in childhood vaccination rates as well: 92 percent of children ages 13 to 17 in the US received two doses or more of the measles, mumps, and rubella vaccine. In Cuba, the childhood completion rates were well over 99 percent, and the country has not seen a measles outbreak since 1993. 

From its early years, the Cuban health system has functioned against a background of economic decline particular to the country, one attributable to a complex combination of external pressures, among them US blockades, a complicated economic reliance on Venezuela, a struggling state-run economy, and a flailing industry heavily impacted by the Covid-19 pandemic. 

While other sectors faced attrition, Cuba’s health system, at least, appeared capable of weathering these crises. During the pandemic, the country proved to be a model in global health, having developed a homegrown Covid-19 vaccine rapidly and reaching a 95 percent vaccination rate. Its robust supply of trained health professionals made headlines when Cuban healthcare workers provided essential pandemic aid to a small town in Italy.

 So why has this system proved to be so fragile now? 

New blockades deal the final blow after Hurricane Melissa 

Torrents of rain and flooding from the Category 3 Hurricane Melissa hit Cuba in October of last year, affecting much of the island’s eastern provinces. More than 735,000 people were evacuated, and the environmental disaster has put the country’s basic health infrastructure in a precarious state. 

In the storm’s wake, a combination of flooding and damaged water systems increased the spread of viral infections of arboviral diseases such as dengue and oropouche. A report by the Pan American Health Organization published in March placed water, food, and vector-borne diseases in the “very high” health risk categories. Apart from damaged water and sanitation infrastructure, the report describes how disruptions to health service access, routine surveillance of disease vectors, and environmental conditions that breed mosquito-borne disease outbreaks have dramatically increased the risk of infectious disease spread. 

Hurricane Melissa arrived during a recovery period from earlier storms, such as Hurricane Rafael in late 2024, as well as sporadic earthquakes in recent years. These natural disasters also heavily damaged health facilities, leading to collapsed roofing, damaged roads and cables, and the loss of supplies and equipment. 

For years, Cuba’s economy was propped up in large part by its relationship with Venezuela. In exchange for support from Cuba’s highly trained professionals — especially healthcare workers — Venezuela long provided a critical supply of crude oil, which helped the country keep the lights on even in the face of US sanctions. 

That partnership ended in January after the nighttime capture of former Venezuelan President Nicolás Maduro, and the sweeping Trump oil blockade soon after has dealt a challenge too difficult for the energy infrastructure to withstand. 

Already struggling to recover from other disasters, Cuba plunged further into its present crisis. Mario Cruz Peñate, Pan American Health Organization representative for Cuba, said that while the public health situation has been evolving for a while, he has seen more acute upheavals as sanctions persist, causing mass blackouts that have made it impossible to sustain vital health services and emergency care.

Disease control continues to struggle post-Melissa, with aid organizations worrying about communicable food- and water-borne diseases, such as hepatitis A and diarrhea, that can be caused by unrefrigerated food. On the administrative level, limited transportation resources and electricity have led to a dearth of vaccine supplies, which typically require cold rooms for transfer and storage. 

Continuity of care, in particular, has been affected for the worse. More than 100,000 elective and reconstructive surgeries have been postponed, for example, because of a lack of supplies and a backlog of emergency surgeries. At a briefing in May, representatives of the UN Office for the Coordination of Humanitarian Affairs and the World Health Organization reported that over 32,000 pregnant women faced limited access to diagnostics and limited amounts of the stable electricity needed to sustain neonatal units. Prenatal care faces delays because of the lack of everything from testing supplies to available facilities. And now, even once successful improvements in health indicators have fallen: a report from the Center for Economic and Policy Research measured an increase in infant mortality rates from 4.0 to 9.9 per 1,000 births between 2018 and 2025. 

For humanitarian aid organizations, alleviating this health crisis also poses a stark challenge. Cruz Peñate ascribes this to availability, timing, and opportunity to distribute aid supplies, all of which have been made inconsistent by the ongoing blockade. 

“The response to the situation in Cuba has to increase; we have to scale up the response. All the support we can manage to receive will be important,” Cruz Peñate said. “Here in Cuba there is really a situation that needs attention.”

Is Cuba now an outdated prototype for universal healthcare? 

While Cuba’s healthcare system was never bound to map precisely onto the US, some of its most notable successes — the high physician-to-patient ratio, the almost entirely vaccinated population, the ample health screenings — still remain desirable. And yet those very accomplishments have crumbled under the threat of extreme weather events and the country’s inability to restore its broken power grid.  

Trump targeted even more petroleum suppliers in his latest round of sanctions on July 23, leaving Cuba scrambling still further to revitalize its energy sector. Those same sanctions also took aim at the Cuban healthcare export economy, alleging that it involves forced labor. 

Earlier this month, Cuba’s government loosened constraints on a handful of private operations, including pharmaceuticals and elder-care facilities, in response to the shortage of medicine in the country.  With state-stocked shelves running empty, the new decree allows private pharmacies with Cuban health registration to fill in the medicine gap. Similarly, privatized elder facilities are also allowed to operate at a capped rate of 60 people per home, with mandatory visits from state physicians. 

The government still prohibits private sector medical and dental care, and Cuban officials remain adamant that the “socialist state enterprise keeps its central role,” so it’s difficult to claim that the country’s medical model is being pressured towards privatization. But the erosion of some of its elements still speaks to a state-run health system under strain. 

We often think of healthcare itself as an equation of medical services along with healthcare personnel and the authorities — government, industry, or both — that control it. But the crisis facing Cuba gets at the dependence of all of these factors on the broader energy ecosystem. Even a once-promising healthcare model can quickly collapse when a crucial component is missing: fuel.

A version of this story originally appeared in the Future Perfect newsletter. Sign up here!

Hi readers! Shayla Love here, science journalist and longtime fan of Your Mileage May Vary. I’m honored to be subbing for Sigal Samuel while she’s out on parental leave. I’m diving into your questions as a way to help understand human nature and our choices through multiple lenses: philosophical, psychological, and beyond. Please send in any emotional, body/brain, sociological, perceptual, or other kind of life quandaries you might have.

I am a (gracefully?) aging mother of three and proud grandmother of four. I keep hearing about how my generation (okay, I am a boomer) is hoarding wealth and failing to pass it down. 

When I look at my lifestyle, I’m facing a fork in the road. Either I splurge on a lovely retirement, or I save so my kids and their kids can have an easier life. We’re all middle-class, so this is not a question of survival. The kids have college funds. Do I owe it to my descendants to scrimp as I age? Surely it’s not right for me to spend my savings on bucket-list vacations…How should I balance spending on myself and on the others that will come after me?

Dear Rainy Day Funder,

I’m so glad to hear you’re not in financial survival mode. But you are facing some economic constraints: You can’t splurge on a luxurious retirement while at the same time saving a substantial nest egg for your kids and grandkids. 

It sounds like this feeling of either-or is causing you some anguish. The instinctual response is, as you suggest, to hoard as much as possible for your progeny to use later on. But at the same time, that feels like it’s zero-summing your own experience in your golden years. 

So I’d like to introduce you to an economic thinker who has some advice that might surprise you. John Maynard Keynes, 19th-century British economist, would say: Don’t save your money!

Keynes wrote that when times are tough, people react by keeping their money close, and not spending it. But this sets in motion what he called the paradox of thrift. One person’s expenses are actually another person’s income, he pointed out; if everyone saved their money, no one would make money either, and a recession could drag on and on. In the end, people’s savings would, paradoxically, go down, even though they were scrimping. 

We can apply the paradox of thrift to your own family as a mini-economy. Inheritance has traditionally worked by setting aside large chunks of your assets to pass along to your children and grandchildren — which could be helpful when the day of windfall comes. But why wait? And would waiting actually stymie your family’s financial potential? 

In past generations, an inheritance like this often happened far earlier. I’m comforted that we are living longer (an average of a decade or more longer) than in the mid-20th century, but this sets up new issues, as you’re stuck in, with when and in what quantity to transfer any extra resources. 

Now, as people retire with decades of good life to enjoy ahead of them, they are often doing so at the very same time their adult children are the most financially stressed: They are trying to buy homes, they’re in the busiest middle part of their careers, and many have children of their own they’re raising and trying to save for. 

This doesn’t mean you have to give away all your money to your family so that they can spend it on the pleasures you have given up. Keynes wasn’t anti-savings so that money could be spent frivolously. He did believe that spending money was one of the best ways to give the greater economy a boost. Perhaps there are ways you could think about spending your money that stimulate your family’s internal economy, that also help you enjoy your retirement. 

For example, you could invest in a lakeside property to kick your feet up at — an asset that will appreciate in value over time and be sold at a profit, or be passed down through the generations to enjoy for many summers to come. Maybe you assist your children in buying a home — one with a comfortable guest suite. You could invest in a business your children want to start, and help them grow something that could accrue more wealth over time. Using your money these ways may even feel more like splurging than scrimping! Yet, it ideally would achieve both: a fun way to spend your hard-earned money now, and create more abundance for your family’s future. 

A hidden bonus of non-traditional inheritance moves like these is that they all involve spending more time together with your family and potentially even strengthening those relationships along the way. The Greek philosopher Aristotle wrote in The Nicomachean Ethics that there were three kinds of friends. Some are based on utility, and exist only because of what people can get from one another. Other friendships are based on pleasure, when you like doing things with someone. Finally, friendships of virtue persist because you stick by people who inspire you by their strong character. Simply setting aside your money is a relationship that leans utilitarian. Working on a shared meaningful project could help deepen your relationships with your kids and grandkids in those pleasurable and virtuous directions.   

Speaking of, I don’t think you need to be making these decisions alone. 

You used an interesting word in your question: Do you, as an individual, owe it to your family to set them up with a more comfortable financial future, at the expense of personal indulgences? A lot of the discussion around older generations’ money, and whether or how they should pass it on, avoids dealing with this sticky moral component. Why should parents give their kids money? 

I think there’s clarity to be found in thinking more closely about why we owe each other anything.  

There are few better thinkers to turn to than Confucius to consider our obligations to family. The fifth-century Chinese philosopher believed that we can’t understand ourselves only as individuals. You are nobody when you are alone; you only come alive as a mother, a daughter, or a sister. These relational roles each come with specific duties and ways of interacting. Successfully fulfilling these roles within the family has a bigger impact, according to Confucius. It’s what creates the foundations for a harmonious and functional society. For children in this web of relations, it’s critical to uphold filial piety, or the need to respect, honor, and care for parents as well as all of their other elders and ancestors. 

Filial piety has, over the years, been criticized for being too rigid, and setting overly high expectations for blind obedience and conformity in children. So I’ve been interested to see the concept of reciprocal filial piety emerge. In reciprocal filial piety, children have a genuine feeling of gratitude to their parents for raising them, and any obligation they feel is heartfelt — they want to return the favor and care for their parents too. 

As a half-Chinese person, I find it interesting that in family life in the West, filial piety is often reversed. There’s a lot of air time discussing what parents owe their children, and not so much the other way around.

For example, I noticed that you don’t mention how your family intends to care for you in the future, or what they might feel a sense of owing you. If you do take a Keynesian approach to your family and decide to spend your money in ways that could benefit everyone, it might be worth engaging in some Confucian-tinted conversations not only about what you owe everyone else, but what you all appreciate about each other.

You can reflect, together, on how your family is stronger because of all the ways you’ve chosen to look after one another, not only because of how much money is in the bank. 

Bonus: What I’m reading

• I think it’s worth having a copy of The Analects of Confucius lying around, which is full of nuggets of wisdom. One morsel I recently read was about how to best get along with others: “The gentleman harmonizes without being an echo. The petty man echoes and does not harmonize.” The lesson is that we don’t gain much by blindly following and copying what other people do. The most harmonious way to be in a society, or even a family, is to have interlocking roles that complement each other, like different pitches do in a choir. 
  
• I thought a lot about getting older when reading this piece on death doulas by Alexandra Schwartz in The New Yorker. It serves as a reminder that people outside of the immediate family can also help with life’s hardest transitions. 
  
• And, for something fun: I enjoyed this investigation by Natalie Wolchover in Quanta on why she (or anyone) is left-handed. She explores left-handed stigma and neuroscience, as well as a theory about humans using their right hands because they once were better to win fights with. 

Just last month, I marked my 25th year as a professional journalist, which I guess means my journalistic career is old enough to rent a car, no questions asked. Work in the news for that long, and you’ll occasionally find yourself surprised by things you published in the past. Like, I had all but forgotten that I had written this Time magazine cover story in 2008:

A couple things here. One, as the cover demonstrates, journalistic sensitivity was…less than ideal then, to say the least. And two, over a quarter-century occasionally covering obesity (both childhood and adult), that story only seemed to go in one direction: worse.

It wasn’t for lack of trying. We put calorie counts on menus, taxed soda (well, in some places), built workplace wellness programs, and funded a small library of diet research. We deplored food deserts and promoted farmers’ markets. We told people — again and again — to eat less and move more. But the lines just kept going up.

By the CDC’s measured survey, the share of US adults with obesity did not change meaningfully between 2013 and 2023. The age-adjusted obesity rate sat at 40.3 percent, while the age-adjusted severe obesity climbed from 7.7 percent to 9.7 percent over the same stretch.

While the question of weight in America is inextricably tied to body image and moralizing, those numbers had a deadly effect. One demographic model estimated that obesity was associated with roughly 18 percent of deaths among Black and white Americans ages 40 to 85 between 1986 and 2006. From diabetes to kidney failure, heart disease to sleep apnea, obesity is the delivery system for other diseases.

Which is what makes a Gallup report published in July so surprising. In Gallup’s self-reported height-and-weight series, the US adult obesity rate fell to 36.4 percent, down from a peak of 39.9 percent in 2022. Over roughly the same period, the share of adults who said they were currently taking a GLP-1 drug for weight loss rose from 3 percent in 2024 to 11 percent in 2026 — approximately 29 million people. While this only shows correlation, not causation, and Gallup’s self-reported measure should not be compared directly with the CDC’s measured rate, the timing is suggestive to say the least. 

And the weight might be the least interesting thing about these drugs. 

Semaglutide — the molecule sold as Ozempic and Wegovy — was first developed and approved as a treatment for type 2 diabetes, not obesity. It was only after earlier GLP-1 drugs and diabetes trials showed substantial effects on appetite and weight that researchers deliberately tested a higher dose for obesity, resulting in Wegovy in 2021. 

But as it turns out, the list of things that have been noticed happening on the side with GLP-1s has gotten so long it’s begun to eclipse the main event. The coverage of GLP-1s has barely kept up with this news, because weight loss is what made these drugs famous and what we continually obsess over. But it turns out, weight loss may not be what they’re best at.

Side effects may include…

Let’s start with sleep apnea, which, untreated, drives up blood pressure, strains the heart, and raises the risk of stroke. These are people whose breathing stops dozens of times an hour, all night, every night. Two year-long trials put 469 of them on tirzepatide — the drug sold as Mounjaro and Zepbound — and cut those interruptions by more than half. Roughly half the group finished the year with no apnea at all, or with so little left that they stopped being tired all day.

Then there are the kidneys. A major trial followed 3,533 people with type 2 diabetes and chronic kidney disease for a median of 3.4 years. Semaglutide reduced the relative risk of a composite of kidney failure, a sustained loss of at least half of kidney function, or death from kidney-related or cardiovascular causes by 24 percent; all-cause mortality was 20 percent lower.

And the liver: A trial, still underway, biopsied the livers of 800 people whose organs had grown fatty, inflamed and scarred and randomly assigned them to semaglutide or a placebo. After 72 weeks the inflammation had cleared in nearly 63 percent of those on the drug, with no worsening of the scarring, against 34 percent on placebo. 

And the knees: In 407 adults with obesity and moderate knee osteoarthritis, pain scores on the 0-100 WOMAC metric fell 41.7 points against 27.5 on placebo. 

And to top it off, a 17,604-person trial of participants who were overweight or obese but did not have diabetes found a 20 percent drop in major cardiovascular events.

These results may not be as grabby as cultural debates over “Ozempic face,” but they deserve far more attention.

Medicine’s happy accidents  

As GLP-1s — which in part came out of a hormone in Gila monster venom — demonstrate, medicine has long found some of its biggest wins in the margins of drugs ostensibly built to do something else entirely. 

Sildenafil, better known as Viagra, began life at Pfizer as a candidate treatment for the heart disease angina. It failed at that, and its now-famous use turned up in data as a side effect in what must have been a very interesting trial for its subjects. Minoxidil (Rogaine) was a blood pressure pill that turned out to help patients grow hair. Finasteride (Propecia) was approved for enlarged prostates before anyone thought to sell it for baldness — and then a trial of more than 18,000 men found it cut prostate cancer diagnoses by about 25 percent, a benefit that took 20 years of follow-up to fully vindicate. 

Perhaps the most famous example is aspirin, which spent most of a century as a painkiller before a doctor in California named Lawrence Craven noticed that the patients he’d given aspirin gum to after tonsillectomies bled more than they should. He guessed the aspirin thinned the blood, and started handing it out to middle-aged men, who were at higher risk of heart attacks. Craven died in 1957; the trial that ultimately proved that he was onto something — showing that aspirin in heart attack victims cut vascular deaths by a fifth — didn’t run until 1988. 

The strange morality of Ozempic

Viewed this way, GLP-1s can seem like miracle drugs — but even miracle drugs can’t cure everything.

There had been great hope that GLP-1 might reduce dementia rates, but when Ozempic maker Novo Nordisk ran a proper trial, it didn’t show evidence of slowing clinical progression of Alzheimer’s. Much the same happened with cancer. Observational data had hinted that GLP-1 users developed tumors less often, but when a Harvard team pooled 48 placebo-controlled trials covering 94,245 people, they found the drugs have little to no effect on the risk of thyroid, breast or kidney cancer, though evidence for other cancers was less certain, leading to FDA boxed warnings. One plus: In some early animal studies, high doses of GLP-1 drugs caused thyroid tumors in rodents, but further research largely hasn’t validated the fears that it could be more widespread, though uncertainty about some rare thyroid cancers remains.  

For many people, weight loss isn’t the end of what these drugs seem able to do. It’s where the benefits begin.

The bigger concerns largely remain the known ones, starting with muscle loss. Across 22 randomized trials, about 25 percent of the weight lost on these drugs turns out to be lean muscle mass. Some of that is simply unavoidable in any weight loss, but too much can mean a great deal, especially if you’re 75. 

And cost remains a barrier: In a 2025 KFF poll, 56 percent of adults who had ever used a GLP-1 said the drugs were difficult to afford; 27 percent said they had insurance but paid the full cost themselves. In a separate Cleveland Clinic chart review of 288 adults without diabetes who stopped injectable semaglutide or tirzepatide within a year, 47.6 percent stopped because of cost or insurance problems, compared with 14.6 percent because of side effects. (The money, at least, is improving. An oral GLP-1 drug was approved in April, and it starts at $149 a month for people paying cash, while Medicare trial pricing of $50 a month for some GLP-1s went live in July.)

A stickier obstacle is the one that can’t seem to be divorced from questions about weight: judgment. As my colleague Dylan Scott wrote recently, researchers at Rice University found that people rate a GLP-1 user more harshly than someone who never lost weight at all. That makes perfect sense when you consider how contentious weight is in America — and none at all when you think about just how many people have benefited from these drugs in so many different ways.

I sometimes wonder how we would view GLP-1s if they could do everything they’ve been shown to do, but somehow not change a person’s appearance. 

So much of the discourse around these drugs has been shaped by the fact that many of the earliest and most public and apparent users were already thin people, often celebrities, using them to get even thinner. But that framing has become increasingly difficult to square with reality. 

Two things can be true at once: American culture has a toxic relationship to weight, and millions of Americans can and are benefiting from these drugs. For many people, weight loss isn’t the end of what these drugs seem able to do. It’s where the benefits begin.

A version of this story originally appeared in the Good News newsletter. Sign up here!

Mollie, a 10-month-old pet hamster in the Netherlands, probably runs a lot more than you. 

We know this because, a few weeks ago, a Dutch physicist named Thijs — who owns Mollie — rigged up the rescued hamster’s running wheel to Strava, a popular app that runners use to log their miles. Thijs found that Mollie typically runs around six miles every night.

“He’s beating me,” Thijs told the CBC. “Almost 70 kilometres a week, which I think many people doing marathon training would be happy to hit.”

The internet loves a quirky animal story, and this one has gotten plenty of attention on Reddit and X. Mollie even got a recent profile in Runner’s World, and he now has over 9,000 followers on Strava. Mollie’s Strava updates are headlined with cute puns like “No Rest for the Whiskered,” and “The Fast and the Furriest.”

I get why so many people are cheering on Mollie and his commitment to going the distance: Hamsters are adorable, and the idea of one logging miles on Strava is extra charming. But the light-hearted virality of the story masks a fundamental problem with owning small pets like hamsters. Mollie evolved to run in an open and diverse ecosystem, but he lives in a small cage and doesn’t have much to do besides circle endlessly in a simple wheel.

Big problems with small pets

Most pet hamsters are Syrian hamsters, native to that country’s Aleppinian plateau — steppe terrain in the northern part of the country. In the wild, they regularly traverse the landscape to forage for food, consuming a wide sampling of seeds, fruits, insects, and green vegetation. They store their haul in their cheeks while journeying back to their two-foot deep burrows. 

But, as pets, they’re largely fed a monotonous diet of grain pellets and are confined to tiny cages where they can’t engage in their natural behaviors, like building proper burrows, traveling for food, and exploring their turf. Confining a dog or cat in a kennel for all or most of their lives would no doubt be a severe form of cruelty, yet we’ve normalized doing so for small animals whom we’re less likely to view as capable of suffering, even though there’s no scientific basis for that assumption.

And while you might think it could be nice for an animal to not have to work for their food, research has found that many species don’t like to freeload (cats might be one exception). On top of all of that, according to some research, these smaller pets are less likely to receive veterinary care to address their ailments and injuries than cats and dogs. 

Their tedious and confined existence can contribute to “stereotypic” behavior: repetitive motions, like gnawing on cage bars, that are indicators of stress. Some animal welfare researchers have proposed that wheel use could also be a sign of stress — or that it could indicate an urge to run or escape. One other study suggested it might help reduce other stereotypic behaviors. 

“I think that the welfare of these animals is worse than anybody else’s,” Jessica Pierce, a bioethicist and author of several books on the ethics of pet keeping, told Vox for a previous story. She was talking about small pets in general — not just hamsters, but also species like snakes, fish, and birds, most of whom are still much more wild than our domesticated cats and dogs (who also might not be as happy as we think). 

Thijs, for his part, is sympathetic to these concerns, which he told me over email were fair. “I hope the attention that Mollie got will not result in people impulsively buying hamsters (and then forgetting about them after it turns out their hamsters just sleep 80% of the time),” he said.

He adopted Mollie from someone who could no longer take care of him and who kept him in an even smaller enclosure. “[Mollie] showed some behaviour that really concerned us back then (climbing, biting the fence, etc),” Thijs said over email. So, within the first week, he upgraded Mollie to a larger cage and a larger wheel and got him some toys, which seemed to improve his mood.

“I think some behavioural aspects (more running, digging tunnels in the bedding, ‘foraging’ if we hide food in the bedding) make his behaviour closer to natural, but it’s, of course, never like in the wild,” he said. Thijs also wonders whether his data-gathering might provide insight into how certain actions — like when he cleans Mollie’s bedding or when he stays up late watching Netflix — affects Mollie’s running behavior. 

“People often talk about pets being ‘happy,’ but, especially with small animals, that’s difficult to assess objectively,” he told me. “I’m curious whether long-term activity data might give us useful clues about changes in his behaviour or wellbeing!”

Inside a “hamster mill”

While Thijs adopted Mollie, there’s also the question about where many of these pets come from. A 2024 undercover investigation by the nonprofit Last Chance for Animals into a massive US “hamster mill” documented thousands of rodents being bred and raised in overcrowded, small, barren cages. Some of the animals were dehydrated, diseased, and suffered from wounds. Individual animals weren’t provided with veterinary care, and breeding hamsters whose production dropped — along with litter runts — were gassed to death.  

Investigations into other rodent mills have found similar problems. Such investigations, combined with veterinarians’ concerns with keeping small animals as pets, has driven some cities — including Cambridge, Massachusetts, and Washington, DC — to prohibit pet stores from selling rodents and other small pets.  

I don’t mean to single out Thijs for his interesting experiment, especially considering he adopted Mollie and immediately improved his life. But animal ethicists like Pierce argue that however much effort one puts into giving these small pets a better life, it likely doesn’t ever add up to a good life, considering the constraints of cage confinement and other common care issues. 

To Pierce and some of her colleagues, the sizable gap between what small pets need and what they often get reveals a largely hidden but serious crisis of animal neglect and suffering. And that’s rarely mentioned, if at all, in viral social media posts or news articles about these critters. 

If we take a moment to pause and see Mollie’s life for what it is — and examine the industry that breeds these small animals for profit — all those miles he’s logging on Strava seem more like daily posts saying that he’s striving for a far different life with no way to get there. 

“This entire ‘track his runs on Strava’ thing started off more as a geeky side-project, I never expected it to get anywhere near this much attention,” Thijs told me. “But it’d be nice if you can use it as a way to educate people (including me!) about the ethical considerations!”

A version of this story originally appeared in the Future Perfect newsletter. Sign up here!

Everyone is wrong about Hank Green. 

In case you missed the controversy: The veteran YouTube star, writer, and science comms entrepreneur was recently “canceled” after he acknowledged using AI for research.

“I have been relying too heavily on AI as a research aid,” he wrote in a statement on Reddit. “It can be very useful for this task, giving me access to a lot of papers I didn’t know existed really fast, but I think that has been to the detriment of my work because it has not given me the freedom to find all of my own ways into and around a topic.” Although Green wrote that the words in his videos are his own, his reliance on AI as a research aid still gave the finished work an ineffable “AI feel.” And his relationship with AI, he wrote, had become “not healthy for me or good for the world.”

Some of Green’s followers, known by the cheerfully dorky moniker “Nerdfighters,” turned on him for daring to use AI in any capacity. Just as quickly, that backlash produced its own backlash, aghast not at Green’s use of AI but at his prostration before an anti-AI mob — “self-canceling,” as some put it, over a legitimate use of the technology. 

I think both of these camps are misguided and have flattened a complex issue into a set of binary extremes. And it surprised me that, despite robust societal debate on AI’s impacts on our ability to think, write, and produce original ideas, the debacle hasn’t prompted more thoughtful conversation about the limits of AI in creative work. 

I felt this because I recognized myself in Green’s statement: the feeling that even using AI for research can start to take over your creative process, that it can become hard to know where your own brain ends and where AI begins, and that the technology can simply push you to work too fast. I don’t use AI to generate writing and would not do so — but its use need not rise to that level to raise profound questions about how much of our work to automate, and what happens to our ability to think for ourselves when we do. 

In a follow-up video published late last week, Green laid out a new AI policy for his work. He wrote: 

1. No portion of any script will be written, edited, or outlined by an LLM.

2. The thesis of a video will always originate with a human. 

3. No image or music in a video will be generated by AI. If something is accidentally included, best efforts will be made to remove it. 

4. LLM outputs are not trusted as a source.

These are all good ideas for any creator trying to avoid AI creep in their craft. But still, they raise a bigger, harder-to-answer question: The very structure of generative AI makes it hard to use without offloading human thought and judgment, which can lead to a widely discussed phenomenon known as “cognitive surrender.” And it pushes us toward uses — like synthesizing research, brainstorming, generating ideas and angles — that short-circuit the original thinking and discovery that we ought to be doing ourselves. What, then, can we even responsibly use AI for? How can we set guardrails that allow us to avail ourselves of its usefulness, without melting our brains in the process? 

The most tempting uses of AI are precisely those best avoided

Remember late 2022, when ChatGPT first came out and everyone mocked its crappy research skills and propensity to hallucinate in every other sentence? I am so wistful for those days. 

Many people who abstain from AI may not know it, but in the time since, and especially in recent months, large language models have gotten way smarter (especially the paid premium versions). It’s become unnervingly good at summarizing niche, complex research areas and debates, and producing ideas, often without being asked, for further research or writing on the same subject. 

Whenever I have a research question these days (which is pretty much any time I’m working on a story), I’m more likely to fire up an LLM than a traditional search engine. If I ask, “Why are old-growth trees still being logged in North America?” it produces a synthesis of research, news, opinion, and whatever else its training absorbed on the subject: “We’re using an essentially nonrenewable ecological asset to smooth a temporary transition to a renewable timber resource,” it says. Probe it further, and it’ll suggest arguments for you: “Instead of conservationists having to prove that every old forest deserves protection, logging companies should have to demonstrate that cutting a centuries-old stand serves a need that cannot reasonably be met with second-growth or engineered wood.” 

LLMs are designed to make cognitive work effortless, but that feels so icky because for it to be worthwhile at all, it has to be effortful.

These aren’t particularly smart or creative ideas — they’re perfectly replacement-level, which makes them plausible substitutes for the thoughts of most people. The AI can supply pat answers to every conceivable question and follow-up you might have while working on a project, relieving you of the need to mentally engage with the shape of a problem. Contrast that with Googling in the pre-AI overview days, which, while certainly not without its problems, at least used to send you to a list of sources that you then had to read and make sense of on your own. 

Most of us who’ve engaged with LLMs know what this feels like. They make it easy for users to skate on the surface of a subject and feign understanding or insight, and in the process they can become involved in interpretive decisions that should be our own. In my experience, even more narrowly designed generative AI models don’t escape these problems. Google’s Gemini Notebook (formerly NotebookLM), for example, allows you to upload all of your sources for a project — books, reports, papers, audio and video recordings — and ask it questions based on what they contain, rather than searching the entire internet. It’s less prone to generating outright slop than general-purpose AIs. I use it for most stories I write — it’s an incredibly useful, time-saving tool. But it also enables me to engage with sources in a perfunctory, contextless manner: The AI can surface precisely the bit I need rather than forcing me to form the deeper connections that come from reading a text as a whole.

The best creative work (including not just art and writing, but also technological and medical breakthroughs) probably comes from having a wide range of background associations, and being able to combine them in unexpected ways. The French mathematician Henri Poincaré put this beautifully in his essay “Mathematical Creation,” where he wrote that it’s the tedious, sustained conscious effort that ultimately leads to flashes of insight. 

I think this is what Green meant when he wrote that AI can prevent him from finding his “own ways into and around a topic.” LLMs are designed to make cognitive work effortless, but that feels so icky because for it to be worthwhile at all, it has to be effortful. This argument has already been made about AI-generated writing: Letting an LLM write for you defeats the point, because writing is thinking. But it can also be true, as Green’s example has shown, of using AI for the research that feeds the creative process. 

If you use AI, consider creating a personal AI policy

Perhaps all these concerns are overblown — humans are hardly less prone to lazy and logically unsound thinking than AI. That’s absolutely true, but the point of doing our own thinking isn’t that we’re inherently good at it. To the contrary, it’s that we can only get better at reasoning by practicing it. 

I don’t want to suggest that using AI for research is illegitimate. It’s too useful a tool to take off the table entirely, and we can’t put that genie back in the bottle. It can be extremely helpful with identifying the best sources that you wouldn’t find otherwise, but those very abilities can make it double-edged, foreclosing a slower, more open-ended exploration process. But AI’s greatest strength — its endless variety and flexibility — can be used to steer it away from the most tempting uses, especially those that ultimately harm us.

There are very obvious things that any LLM user should do to that end, like never assuming that a claim from an AI is accurate and always reading original sources. Beyond that, the necessary guardrails depend on your own use patterns, but above all, I think it’s helpful to avoid training ourselves to expect immediate answers to difficult questions.

One of my colleagues refrains from using it to brainstorm ideas entirely, instead using it to provide sources for narrow factual questions and to aid in the fact-checking process (emphasis on “aid”) after a story is written. To generalize from this, I think it’s a good idea to resist having AI do much synthetic work on a subject before you have drafted your project yourself. The less you do that, the less you will, to paraphrase Green’s recent video, see every problem as an “LLM-shaped problem,” and the less you’ll feel like you’re in the singularity where your brain is merging with AI.

One way that I like to use AI is as an enhanced thesaurus, to find the precise word or short phrase to express what I want to say in a sentence. When done right, I don’t find this harmful any more than using a traditional thesaurus; I find that it can enrich my working lexicon. But it must be used carefully and surgically, by setting a clear limit on the length of a phrase used from AI — like two or three words max — and avoiding sharing much of your writing with the tool at all, lest it start recommending extensive rewrites. 

When interrogating the contents of specific sources or a body of work, or stress testing your own arguments, AI would be better for our intellectual development if it took a Socratic approach — pushing you to discover an answer rather than simply giving you one. It might say, for example, “there might be some relevant caveats to your idea on pp. 42-43 of the source.” LLMs can be directed to behave this way in their custom instructions. It also helps to simply touch grass — find the sources you need, and rather than interviewing the AI about what they say, just close the chatbot and read them from start to finish. 

Configuring AI in a way that’s healthier for our brains would also make it less addictive — when you find yourself getting sucked into a long back-and-forth with an AI, that’s often a sign that something has gone amiss. Green evidently struggled to set that boundary, referencing the unhealthy “level of dopamine I’ve been getting from interacting with LLMs.” AI labs have very strong commercial incentives to want us to be addicted to their products, and unless they build different constraints into models themselves, it’s hard to expect the average person, who has far less autonomy over the terms of her work than Green does, to change these conditions on her own. 

Although researchers at some AI labs are thinking about the societal risks of cognitive atrophy, it’s another matter to expect these companies, which compete on ease of use, to introduce friction into their models. We shouldn’t count on that happening soon — but we’re far from powerless against AI’s impacts. We can set our own personal AI use policies, and we can enforce social norms against AI-induced brain rot. Like, at bare minimum: Don’t send me your AI-generated writing. It’s rude! 

Los Angeles offers one of the most vivid examples of our nation’s broken housing system: a quintessentially American expanse of traffic-clogged roads and single-family homes, coupled with the highest home-price-to-household-income ratio of any major city in the country.

To moderate prices, LA urgently needs to build more homes by allowing more density in its neighborhoods — but much of the city’s leadership has vigorously opposed it. Nowhere has that been more evident than in the fight over SB 79, a landmark California law that overrides local zoning to permit taller, denser housing near major transit stops. LA’s city council and its incumbent mayor, Karen Bass, have opposed it and sought ways to avoid complying with it. 

Now, as Bass seeks reelection, mayoral candidate Nithya Raman — one of the city’s, and perhaps the country’s, strongest advocates for building more housing — wants to oust her.

Raman has gained unusual traction in a city long resistant to growth and has become a nationally prominent YIMBY. How to accommodate LA’s need for more housing, Raman told Vox in a recent interview, is “a question that the city has actually turned away from.” She believes she can do better.  

Earlier this summer, Raman advanced in LA’s mayoral primary, setting up a November runoff against Bass. The race has resonated far beyond Los Angeles, because Raman is making one of the defining problems in American life — the punishing non-affordability of our most productive cities — the centerpiece of her campaign. Its outcome could shape the future of housing in America’s most populous state and help determine whether LA can become the engine of California’s pro-housing turn, or its most potent obstacle. If she succeeds, she might cut a path forward for better housing policy in high-cost blue cities elsewhere.

Just as core to Raman’s appeal is a commitment that’s often seen as at odds with housing abundance. She is a member of the Democratic Socialists of America (DSA) and a forceful champion of tenant protections, including rent control. (Her relationship with the DSA is complicated, however.) She helped shape a stricter rent stabilization formula that was adopted in LA late last year, though it was strongly opposed by rental property owners. 

Many housing policy experts, as I recently wrote, believe rent control can worsen the housing affordability crisis it aims to solve, because it tends to reduce the supply of rental housing. But in high-cost cities and states, interest in it has been surging nonetheless. A rising cohort of progressive politicians, including Raman and Zohran Mamdani in New York City, believes cities must protect current renters from price shocks and displacement while adding housing supply. In doing so, they hope to mount the kind of political support that has long eluded YIMBYs.   

I spoke with Raman about how she thinks about these competing interests, and how she intends to combine them to make a meaningful dent where her predecessors have failed. I was struck by how cautiously she discussed one of the city’s most politically explosive housing policy questions — densifying single-family neighborhoods. Though she has previously pushed for legislation allowing midsize apartment buildings in some wealthier single-family neighborhoods, she emphasized gentler, more gradual change in our conversation. It reflected the core paradox facing housing reformers in LA and nationwide: the need for sweeping change, and the political pressure to make it feel gradual.

Our conversation, condensed and edited for clarity, is below.

You’ve gotten an enormous amount of traction on housing issues in LA. If you win the election, then what? 

When I’m asking for-profit developers and affordable housing developers alike, “What is your biggest barrier to building in LA?” they say that the city of LA is their biggest barrier to building in LA. Whether it is extraordinarily long permit approval timelines, whether it is the failure of the Department of Water and Power [DWP] to be a good partner and to provide real predictability in the building process, both in timelines and in costs. The city of Los Angeles stands in the way of new housing. 

As mayor, I want to do everything in my power to change that. I want to set deadlines by which departments have to respond to applications. I want to bring DWP to the table early and to ensure that they’re a predictable partner for new development. I want to make sure that departments that need to talk to each other are talking to each other quickly and early on in the process, as opposed to providing conflicting answers and taking months and even years to respond. These are all within the power of the mayor to influence and things that this mayor has ignored.

Sometimes rent control and renters’ rights on one hand and new housing production on the other are treated as rival agendas, yet you have made them both central to your politics. What connects them for you?

I don’t think that you can have lower rental costs in a city like Los Angeles without having more housing being built. This is a city that has resisted the construction of new housing for decades, explicitly restricted new apartments from being built in many, many parts of the city for a very long time. We have among the fewest homes per adult of any major city in America and the highest rent-burdened population of any city in America, and to me those two facts are very deeply connected. We can’t really lower rents unless we have more housing here, and lower rents are a big part of how you protect renters.

LA has a rent control system, and you were a champion of a change that tightened that system last year. Do you worry at all that tighter rent control could do damage to housing supply through some of the well-documented mechanisms, like causing landlords to convert apartments to condos? Is that in tension with the goal of increasing housing supply?

Housing built after 1978 cannot be subject to rent stabilization [in LA]. So, making sure that renters in older buildings are protected and trying to incentivize new housing from being constructed to me are not in conflict with one another.

You talked about landlords potentially exiting the market. We’ve also heard concerns from apartment associations and from neighborhoods that there’s been increasing corporatization of housing, that smaller landlords are selling to larger corporate landlords, that being a mom-and-pop landlord is becoming increasingly unfeasible. What we’d love to see is more data on that. And, if that is actually happening, if we are driving landlords out of the market through these changes, if smaller landlords are selling to large corporate landlords, I want to know, and we should be looking at the impacts of this policy accordingly.

I’m very open to learning more. But, so far, what I see is that we have an extremely unaffordable city where all the data has shown us that rents have risen higher than incomes for a very long time. The regulations that we put in place are really trying to ensure that struggling renters are still able to stay in LA.

Is there one specific, concrete housing policy mistake made by Mayor Bass that you would point to? How would you have handled it differently?

There has been an overall lack of urgency in addressing housing supply in [Bass’s] administration, exemplified by the fact that we have not had a deputy mayor of housing for years.

The city has actually opposed and written letters to state officials pushing back against new mandates to build more housing. Instead of telling Sacramento, “How do you want to build that housing?” and trying to shape state laws to suit us — the largest housing market in the entire state — those laws should be written with our input, not written with our opposition. 

I think the most stark example [of Bass’s failures on housing] is this: We’ve had 100 percent affordable housing projects like Venice Dell that are fully funded, that the city has sued and opposed and stalled for years.

“I think there is a growing consensus that supply is part of the problem and is driving the cost of housing.”

To what degree do you think that LA voters see the housing affordability crisis as a problem caused by a lack of supply — a housing shortage? 

I think there is a growing consensus that supply is part of the problem and is driving the cost of housing. It’s not universally necessarily agreed upon, but I think if you were to ask people, “Is there a housing shortage? Is there a shortage of housing you can afford?” everybody would say yes.

Why should renters trust private developers?

I think that renters should trust the city to regulate private development such that we actually are building what we need here in LA and such that new building is actually enhancing what people love about their neighborhoods. I don’t think it’s the job of renters to trust developers. They need to trust that their city is going to make sure that we’re working hard to build neighborhoods that are beautiful, and welcoming, and beneficial, and can help families thrive. 

That’s part of why I talk about production and protection always in the same breath. If you see that new construction is going to displace you, I think you’re less inclined to support it or to accept it. But if you feel secure in your current housing, and you know that you’ll be able to stay there, then new housing is less of a threat and can actually be a boon for a neighborhood.

That relates to an argument I’ve heard a lot: that tenants who feel protected from displacement by rent control and eviction protections will be less afraid of new development and more willing to support it. Have you seen evidence of that happening in LA?

There is a very broad coalition of people who are fighting for more housing now, a much broader coalition than I’ve seen in many other places. And it includes renters’ rights organizations that have historically been some of the strongest advocates for tenant protections. They’re actually in council chambers testifying around the need for more density across the entire city, particularly around transit hubs. 

Do you see rent control as a temporary bandaid on a broken housing market, or is it something that should have a permanent place in housing policy?

I think protections against rent gouging are really important, and I think regulation in the housing market is really important. As a city, we have to be very careful about how we regulate these markets so that we are eliciting the best results and outcomes for our residents. I’m going to follow the research, and I’ll always engage with these issues closely. 

The Democratic Socialists of America, of which you are a part, has talked about wanting to “de-commodify” housing and take it out of the private market. The DSA’s Housing Justice Commission says, “the housing market is not necessary.” Do you think that’s a good idea? 

My approach to these issues is driven by how I can help Angelenos who are dealing with spiraling costs that’s driving working families out of the city. The city saw, I believe, a 16 percent drop in people under 18 over the past few years, because families cannot afford to live here anymore. That is a travesty for the city of Los Angeles. 

My question as I approach this is about what I can do to ensure that we can keep people here. We can build new housing through publicly funded housing. I want to be able to make sure that people who will never be served by the private real estate market have support from the city to rely on that can help them stay, whether that’s in the form of housing vouchers, whether that’s in the form of social housing, whether that’s in the form of permanent supportive housing or new public housing.

I’m supportive of measures that are bringing public dollars to the table to build. However, the money that we have available to us will never be able to satisfy the extraordinary demand that there is for new housing in Los Angeles. So now, we have to rely on the private real estate market to make housing available and affordable to a much larger number of Angelenos. 

Rent control primarily protects tenants who already occupy apartments that are covered by rent control. But building more housing is partly about people who don’t yet have a foothold in LA and who would move there if they could afford it. Is it possible to build a housing politics that gives those future residents real weight, even though they don’t vote in city elections?

I think that’s the question of this election in many ways. That’s been the question of my politics. But it’s not just about the future; it is also about our present. It’s also about parents whose children can’t live near them anymore, because it’s too unaffordable here. It’s about rising homelessness, which is inextricably connected to the cost of housing. All the impacts of not having housing are already felt by Angelenos. 

So much of LA is single-family homes, and there’s been research finding that the city’s housing shortage can’t be filled without densifying single-family neighborhoods. Is that politically possible?

Some of the largest numbers of new units being built are actually ADUs, which are densifying single-family neighborhoods. And duplexes and triplexes and other kinds of interventions are in many places already legal to build. That’s been happening and, largely, been non-controversial in neighborhoods. 

Around certain transit hubs, I think potentially greater density will be allowed in single-family neighborhoods through SB 79. So I think some single-family neighborhoods will have to change. But what I’m seeing in LA is a gradual process of adding more density that I think, in many ways, can be even beneficial for homeowners, because they’re able to make additional income or accommodate more people on their lots.

Editor’s note, August 9, 8 am ET: We’re bringing you some of our best-loved Your Mileage May Vary columns while Sigal Samuel is on parental leave. The one below was originally published in April.

This unconventional advice column offers you a unique framework for thinking through moral dilemmas. It’s based on value pluralism: the idea that each of us has multiple values that are equally valid but that often conflict with each other. Submit your own question here.

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I’m trying to decide whether to keep my elementary school-age kid in the neighborhood public school or move him to a more exclusive private school. Our public school is okay, but my partner and I feel that he might be more challenged and ultimately better off moving to a private school.

But I’m very aware of the increasing flow of students around the US out of public schools, and the effect that is having on the children who remain there. For one thing, since public schools get more funding the more students they have, every family that leaves effectively takes money with them. I worry that by taking my child out of public school, I’m contributing to that problem, but I also don’t want my child to bear the personal burden of my politics.

Dear Public School Parent,

The way you’ve framed the question makes it sound like keeping your kid in public school means imposing a burden on him. And if that were the case — if we really were talking about sacrificing your child’s well-being — I know exactly what I’d tell you.

I’d tell you not to be bullied by utilitarian philosophers. They argue we have to consider everyone’s well-being equally, with no special treatment for our own kids, so they’d probably say it’s wrong to give your child a fancy education while consigning other children to a school with fewer resources. But the 20th-century British philosopher and critic of utilitarianism Bernard Williams argues that this sort of total impartiality is an absurd demand — and I agree.

Williams points out that moral agency — the capacity to act on values and commitments — always comes from a specific person. And as specific people, we have our own specific, individual, core commitments. These “ground projects,” as Williams calls them, are the commitments that give a life its meaning and continuity. A parent has a commitment to ensuring their kid’s well-being, over and above their general wish for all kids everywhere to be well. Williams would say any moral theory that requires you to ignore such personal commitments severs you from the very things that make your life recognizably yours.

So if keeping your kid in public school really meant hurting him, I wouldn’t say you have to do it.

But you said your neighborhood school is okay. It sounds like it’s not bad and not unsafe. So I don’t have reason to think that it is actually hurting him. In fact, it might be helping him in ways you’re not fully accounting for. 

Education is complicated. If I were to get into all the details about school choice and vouchers and charter schools and magnet schools, I’d have to write a whole book. So let me just stick to the main points relevant to your dilemma, starting with this: There’s a popular narrative that says private schools are better than public schools, but the evidence does not support that — especially if we take a broad look at what we mean by “better.”

Although studies do show private school students outperforming their public school counterparts on tests, the studies also show that private school advantages disappear mostly or entirely once you control for family background. 

Longitudinal research led by Robert Pianta and Arya Ansari at the University of Virginia tracked more than 1,000 children from birth to age 15 in 10 locations nationwide. After controlling for family income, parental education, neighborhood socioeconomic makeup, and other background variables, the private school advantage…vanished.

“If you want to predict children’s outcomes — achievement test scores, the things we care about socially — in high school, the best thing you can use to predict that is going to be family income — regardless of what high school you go to,” Pianta said.

Pianta’s was a modest-sized study with some methodological limitations. But another analysis of two large, nationally representative datasets also found that public school kids did just as well in math as private school kids — or even outpaced them — after accounting for demographic differences. (Math is considered a particularly robust indicator of school quality writ large because, unlike reading, it’s a subject learned mostly at school and not at home.) The researchers suggested that might be because public school teachers have to do stricter certification and can be required to do more frequent professional development, so they may be more reliably up-to-date on the latest pedagogical approaches, like those developed by the National Council of Teachers of Mathematics.  

Admittedly, the very fanciest of private schools do offer some special advantages. Network effects are real. Maybe you want your kid rubbing elbows with a future senator. And maybe if you send your kid to ultra-elite Andover or Exeter, he’ll have a leg up if he applies to a fancy private college. 

But that is not the same as ensuring your child actually thrives. I’m sure you also care about your child’s psychological well-being. And here, some of the evidence about exclusive, high-achieving schools is worrying. 

The most important educational institution in your kid’s life is you.

The unrelenting pressure to compete and achieve can be brutal in those schools. When students constantly compare themselves to others and peg their self-worth to achievement, the results are alarming. Studies conducted over decades by psychologist Suniya Luthar and colleagues found that students attending high-achieving schools are at significantly higher risk for anxiety, depression, and substance use. (These are often private schools, though hyper-competitive public schools can also fall into this trap.) In fact, the National Academies of Sciences now names these students an “at-risk” group for mental health problems, alongside kids who live in poverty or in foster care or who have incarcerated parents.

In addition to potentially providing a less stressful environment, public schools can confer other important advantages. For one thing, your local public school can help you and your child be part of the neighborhood community, which is incredibly valuable for social development and countering loneliness. And being in an environment that’s more diverse in terms of race, ethnicity, or class can teach your kid to empathize and get along with a wide variety of people. 

As the American philosopher John Dewey pointed out, these are essential skills and capacities for a flourishing adult life and for a flourishing democracy. Democracy is a way of being in community with people unlike yourself; that’s a mode of life that has to be cultivated, and public schools are great grounds for learning to navigate a shared world.

Plus, public education is free! (Well, “free” — you’ve already paid for it with your taxes, whether or not your kid uses it.) So you could save all the money you’d spend on private school and instead use it on enriching opportunities to expand your child’s horizons. Personally, I’d take my kid to Italy and teach them about Ancient Roman gladiators and Renaissance art and the many flavors of gelato! Or you could collaborate with your child to decide where to donate some of that money to fund education resources for kids elsewhere. 

On balance, since the evidence suggests that a child at a decent public school, with involved parents, probably won’t gain meaningful advantages from switching to an exclusive private school — and may face real psychological risks in a hyper-competitive environment — I don’t see a compelling reason to make the move. If you’ve got the resources to even consider private school, then your home life will probably play the biggest role in your kid’s academic trajectory, regardless of which building he sits in during the day. The most important educational institution in your kid’s life is you.

That said, I’m not arguing that parents should never pick private school. To some extent, this depends on the unique needs of your kid and your family. Maybe your kid is absolutely in love with music and the private school nearby has an amazing music program. Maybe your kid is being bullied at his current school but has a couple great friends who attend the private school. Or maybe a religious education is very important to you, so a private parochial school makes sense. 

If you do make the choice to send your kid to private school, you’ll have to grapple with the collective action problem you hinted at: Any single family’s departure from a public school barely registers, but when every family with options reasons the same way, the cumulative effect on the school’s funding — and on the kids who remain — can be devastating.

Here, the American political philosopher Iris Marion Young can help you. She points out that our usual model of responsibility — the “liability model,” which says that when something bad happens we should assign blame to a particular individual — is inadequate when we’re dealing with situations of structural injustice. In these situations, it’s a whole system that’s producing predictable patterns of disadvantage. 

Just look at the complex web that breeds educational inequality: Historical housing segregation has concentrated poverty in certain neighborhoods. Poorer neighborhoods generate less property tax revenue, which means less money for local schools. States can try to offset that, but schools in poorer areas still tend to end up with fewer resources. Families with options leave for better-resourced schools, enrollment drops at the local public school, and the school loses even more funding. The kids who remain get less of the materials — from textbooks to counselors — that would have set them on the path to success. There’s a clear downward spiral, but no one person or decision is the villain.

So instead of blaming any one individual for their personal lifestyle choices, Young says that in cases of structural injustice, we should adopt the “social connection model” of responsibility. Under this model, you don’t bear blame if you send your kid to private school, because systemic problems shouldn’t rest on one family’s shoulders. Young doesn’t think you need to discharge your obligations through personal lifestyle choices. 

But that doesn’t mean you owe nothing. 

You do still have a political obligation: to work toward changing the structure that produces injustice. As a participant in the political system that shapes education in this country, you have some power to act on it. You can vote and organize and advocate. You can pressure decision-makers and support reform movements. The more power you’ve got, and the more privileged you are by the current system, the greater your obligation to take action.  

Make the effort to act on that obligation. Let your child watch as you do. Better yet, involve them in the process. Kids learn from seeing what their parents do: Show them that you’re bent on enacting your values, and you’ll be giving them an education for life.

Bonus: What I’m reading

• This is a fun piece in Asterisk about how high-school science fairs have become so ridiculously competitive that they no longer give students a chance to do real independent research.
  
• This week’s question prompted me to listen to the podcast series “Nice White Parents.” It’s a fascinating look at what happens when parents think that choosing public school would mean sacrificing their child’s prospects on the altar of their own political ideals. Spoiler: Practically no parent is willing to sacrifice their own child. But they often don’t realize they’ve constructed a false trade-off.
  
• Living life requires making choices. It’s unavoidable that we’ll feel regret about some of the paths not traveled. But this Aeon essay explains how “living in closer alignment with our values and authentic preferences may help us avoid the worst pain of regret.”

This story was originally published in The Highlight, Vox’s member-exclusive magazine. To get access to member-exclusive stories every month, become a Vox Member today.

Of all the extinction-level threats vying for our attention, AI, climate change, and nuclear war tend to get most of the airplay. But Annie Jacobsen thinks biological war should be near the top of our mental list of doomsday scenarios, too.

She should know — Jacobsen has carved out a unique niche as America’s foremost reporter on the ways we could end the world. Her bestselling 2024 book Nuclear War: A Scenario terrified readers and experts alike, and has been optioned by Hollywood. 

It was while conducting dozens of interviews with high-level government sources for Nuclear War that Jacobsen was told repeatedly that biowarfare should be her next focus.

She took their advice. Her gripping new book Biological War: A Scenario follows a similar ticking-clock format that shows, step by step, just how a humanity-threatening man-made biological catastrophe could play out. (Spoiler alert: not great.)

The result feels like dystopian science fiction, albeit the kind that comes heavily footnoted with government studies that come to similarly grim conclusions. The fact that tech CEOs are also sounding the alarm that advanced AI could make creating killer germs even easier only adds to the growing sense of anxiety. And this book has also been optioned by Hollywood for a TV adaptation. 

Jacobsen sat down with Today, Explained host Noel King to talk through the plot of her nightmare scenario, why we’re still developing biological weapons despite the clear risks, and what needs to happen to avoid disaster. Below is an excerpt of their conversation, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify.

How does your book start?

The inciting incident in the book is an accident at a Biosafety Level 4 lab, shorthand BSL-4, in Siberia called Vector. And it’s an actual BSL-4 lab, the highest classification. … And there was an actual accident, an explosion there in 2019. 

In that real-life incident, a deadly pathogen was not released that we know of. But of course, in Biological War: A Scenario, a deadly pathogen is released. And it’s a form of pneumonic plague, which is a nightmare pathogen and sits at the top of the Tier 1 select agent list of the CDC. And so in the first act of the book, I show the scrambling of the intelligence community and the Defense Department, trying desperately to determine if something got out and what it is. … The release of the pathogen widens, and so once you have escape. You do not have mitigation, which has to happen in the first 24, 48 hours. Now you have a situation which is unstoppable.

You say this is now an unstoppable scenario. What is it?

A plague itself, of course, conjures up images and ideas of the bubonic plague of the 14th century, the Black Death. That killed between one half and one third of Europe. The bacteria is called Yersinia pestis. And pneumonic plague is the airborne version of plague. The problem with an airborne pathogen is that because the delivery system is the human lungs, it can move very quickly from a scientist in that lab who now has Yersinia pestis in his lungs out to the general public. And that is precisely what happens in the scenario.

How does it spread from there? The city where this BSL-4 lab sits isn’t Moscow. What happens once the pathogen is in the lungs of the people who work in that lab, or the janitor who was cleaning it that night?

That’s right. Well, suddenly it’s in everyone’s lungs, and those people go out into their community. And even though Koltsovo, the science town where Vector is located, is a small town, it is just 12 miles from Novosibirsk, which is the third-largest city in Russia. And, also, there happens to be in this scenario a group of international hunters on a hunting trip in that area who come across a dying scientist in the snow. One of them gives him CPR, being the Good Samaritan that he is. And lo and behold, those travelers suddenly are now getting on an airplane in Novosibirsk, flying home to where they reside in five or six of the continents.

What makes this form of plague so novel, so dangerous?

I pull this information from actual facts of the Soviet Cold War-era biological weapons program that we know about from Soviet defectors. And I want you to keep in mind: This is 40 years ago when gene editing was in its infancy. But there are two things specifically that the Soviet bioweapons engineers did to plague. 

Their idea was to create a super plague weapon. And one of them has never been revealed before. They were working to insert the gene for euphoria into the plague pathogen. … When you get a disease, a pneumonic-type disease, pneumonia, tubercular, you want to go home and get under the covers because you feel terrible. And when you do that, you’re infecting a lot less people than you would if a gene for euphoria had been inserted into the pathogen, which would make you feel terrific, which would make you want to go out and socialize with people, perhaps even go to a crowded disco. 

And the other thing that the Soviet scientists were working on was a way to defeat medical countermeasures, but with an added component of psychological distress. They inserted a gene into the pathogen that would be triggered by the taking of antibiotics. And that second pathogen would give you encephalitis, which is a swelling of the brain. The psychological part of it, according to the Soviet scientists, was that they wanted the last thought of the person dying of what they thought was pneumonic plague, but would in fact be encephalitist to be, “My government and Western medicine has failed me.”

Those of us who try to remain optimistic think there’s a way to stop it. In the movies, there’s an outbreak, then the government gets it under control, and okay, maybe a lot of people die, but we’re all right. That is not where your book is headed. How does your scenario end?

So in the book, I take readers from outbreak to anarchy in six days. Anarchy is what will happen according to Pentagon war gaming and pandemic planning. And this is because fear of infection becomes a secondary weapon, if you will. People begin to behave like they are about to die, which is most certainly underpinning everyone’s mind. And so after those first six days, the Principals Committee, the President’s Biodefense Committee, must make a decision. The president has to declare the Insurrection Act, which allows the military to step in as a law enforcement agency. 

“Imagine the president — with a few Secret Service outside the door, the military aide with the nuclear football — sitting alone in a room wearing a gas mask.”

What happens to the president really blew my mind as a reporter. He goes somewhere in the United States very far away from everyone. Because the idea, the goal, is to make sure that the president doesn’t get the airborne pathogen in his lungs. So maybe I’ll leave you with an image. Imagine the president — with a few Secret Service outside the door, the military aide with the nuclear football — sitting alone in a room wearing a gas mask.

In the book, the people who survive are the ones who have gas masks. Everyone else is gone.

And look, we hope we never get to that, by all means. But yes, the Pentagon has issued 1.7 million gas masks to its military personnel. And that is a spooky thought in and of itself, coupled with the idea that the military is predominantly male. There’s something like 17 percent women in the military. And so, unlike the Nuclear War scenario in which I had science-based nuclear winter theory to work from, in Biological War, nothing has been written on the science record about what it might be after. And so the one imaginative part of the book is the very end where I write about biological twilight. … And it is a very, very ugly world.

Let’s back up. We did outlaw biological weapons at some point, right?

That’s right. Very mysteriously in 1969, President Nixon just unilaterally declared that the arsenal was going to be destroyed. At the same time that all of the nations of the world were working to sign this treaty called the Biological Weapons Convention Treaty, which would outlaw bioweapons. Soviet Russia at the time signed it but immediately began work on an illegal biological weapons program that was colossal. And this went without notice, without any idea really by the CIA and the Pentagon all the way until 1989, when one of the Soviet scientists named Vladimir Pasechnik had a crisis of conscience and he defected and he told British intelligence all about the program.

Where have we seen biological weapons used?

Maybe the most important example of a biological attack in the past, certainly here in the United States, are the anthrax attacks, which occurred right after 9/11. Weaponized anthrax was sent through the mail to US senators and a number of media outlets. So five people ended up dying; 22 got sick in four states. But that really kicked off what can be considered the biological military-industrial complex, if you will, which led to this buildup in BSL-4 labs around the world today. There are 110 BSL-4 labs around the world. There are more than 3,500 BSL-3 labs.

Your book has a map of where those labs are, which I found weirdly comforting, mainly because I don’t live too near any of them. If one of these things is going to be released, either accidentally or deliberately, where is the threat coming from? A rogue nation? Terrorists?

Certainly, bad actors getting a hold of a biological weapon was the great concern of the post-anthrax situation. And that is why so much emphasis was put on bioterrorism. Now I avoided that specifically in the book. … And I didn’t even have an attack. Rather, I had an incident. I had a lab leak because I have learned in the decades since that really is the greatest concern. So many of these BSL-3 and 4 labs are in places without a lot of security, including in countries where there are wars going on.

Could somebody be making a biological weapon in a basement somewhere, off books?

Absolutely. And another disturbing document I came across, unclassified in the Pentagon, was a threat spectrum that showed weapons of mass destruction in terms of destructiveness. And of course, nuclear weapons sit at the far end of the spectrum. They are the most destructive. But very close behind were biological weapons. And even more startling was the notion that biological weapons present the greatest overall threat. 

Nuclear weapons have an extremely high barrier for entry. You have to have fissile material. … You have to have a weapons delivery system like an ICBM or a submarine. … That creates a situation where most nuclear weapons, all nuclear weapons, if you will, are in the hands of a command-and-control system within a nation. 

Biological weapons have no such barriers. In fact, the barriers for entry are getting lower literally by the day. You now can have a situation where someone with very limited knowledge of biology can create a biological weapon in their basement with the use of computational systems like an AI system, for example.

Your book reads like a thriller. How much have you exaggerated? How much have you novelized in order to hold our attention?

Everything in the book is based in science fact, meaning all of the facts, all of the figures. I write a hundred or so pages of notes in the back of the book for readers to be able to answer the question that you are asking me. … In the notes, you can find that answer.

Did any of those people give you good recommendations for how to avoid a disaster scenario, or at least how to avoid these things proliferating?

Well, you know, the ticking clock scenario that I write has an even more urgent ticking clock, which is the public’s pressure on lawmakers to absolutely do something about this nightmare scenario before it happens. Look, we have a world right now where you have the CEOs of the largest AI companies in the world admitting publicly that the lane of bio mixed with AI is of their top concern. You don’t hear that about nuclear. You hear that about bio.

How do you sleep through the night?

Anyone who knows me personally can vouch for the fact that I am an optimist at heart. I really believe that information is king. Once you know things, it gives you a lot of power. Perhaps that’s whistling by the graveyard, but that’s what works for me.

Do you have a biohazard suit?

I do not. I do not. But I do have a few gas masks. I must tell the truth.

On August 5, 2025, the US Department of Health and Human Services canceled 22 mRNA vaccine projects worth roughly $500 million and told the country it would stop investing in the technology that had brought us life-saving Covid vaccines. Health Secretary Robert F. Kennedy Jr., a longtime vaccine skeptic, claimed that the data showed these vaccines fail to protect against upper respiratory infections like Covid and flu. That his claims weren’t true — Moderna had already published Phase 3 trial results showing the opposite — didn’t seem to matter.

On August 5, 2026 — one year to the day later — the Food and Drug Administration (FDA) approved mFLUSIVA, the first mRNA influenza vaccine ever licensed in the United States.

That symmetry, while highly useful to writers like myself who are always looking to identify the rhymes of history, wasn’t planned. The approval landed on the one-year anniversary simply because of the deadline the agency had set for itself in February of this year, after it refused to review Moderna’s application and then, 15 days later, reversed itself. 

The decision didn’t earn a huge amount of press, in part because seasonal flu is a disease Americans have rarely taken seriously — fewer than 50 percent of US adults got their flu shot this past fall and winter. But flu is no joke: The 2024–’25 season produced 51 million illnesses, 710,000 hospitalizations, and 45,000 deaths. That’s more than the number of Americans who died in car crashes last year. And the damage from a flu virus doesn’t stop when the fever does. In the week after a confirmed infection, the risk of a heart attack runs roughly six times higher than normal. 

So a better flu vaccine matters. But the more interesting thing is what the approval says about the year that produced it. The nine experts who voted unanimously that this vaccine’s benefits outweigh its risks were appointed under the very same secretary who was against mRNA technology. Asked to look at the evidence, those experts couldn’t produce a single vote against it. 

That’s not quite a change of heart, but at a dark time for public health, it’s something to hang our hopes on — because flu could just be the start for this technology.

The egg came first

If you’ve ever taken a flu shot, thank a chicken.

Every flu vaccine Americans have received since the 1940s has been grown inside fertilized chicken eggs. It’s a laborious process, closer to agriculture than it is high technology. Each batch incubates for nine to 12 days; the World Health Organization then spends months making the reagents manufacturers need to calibrate doses. The whole sequence runs about six months.

That means that the flu strains in your vaccine in November were selected back in February. Which is a problem, because flu viruses don’t like to stand still. Between February and November, the virus drifts, and the current dominant H3N2 flu drifts especially fast. 

The eggs are a problem, too. Growing flu virus in a chicken egg forces it to adapt to egg cells, and those adaptations alter the very surface protein the vaccine is meant to teach your immune system to recognize. Between the 2011 and 2020 flu seasons, egg-adaptive mutations caused more mismatches than the virus’s own drift did. And more mismatches mean a less effective vaccine — while the flu shot prevented an estimated 12,000 deaths in the 2024–’25 flu season, it is the weakest vaccine in routine American use, landing anywhere between 20 and 60 percent effective depending on how well February’s guess matched November’s virus.

mRNA skips the egg. The shot carries instructions, a strip of genetic code that tells your own cells to build the flu’s surface protein, which your immune system then learns to attack. And swapping in a new strain means retyping that code, not growing a new virus.

As a result, Moderna told the FDA’s advisory panel it can go from strain selection to finished vaccine in two to three months instead of six. That means strain picks could move later, closer to the season they cover, and a novel flu virus surfacing in September could still be blocked by a reformulated vaccine in the same season. Eggs are great, but they can’t do that.

Building off the platform

Back in January I wrote here about the universal flu vaccine — one shot covering every strain for years. It’s a public health dream. mFLUSIVA isn’t that, but some of the best hopes for a universal flu vaccine run through the mRNA platform, and platforms only improve when somebody uses them.

That word — platform — is where last August’s decision went wrong. Kennedy made a claim about one application, mRNA respiratory vaccines, and cut funding for the technology underneath all of them. But over the 12 months that followed, the science on mRNA kept flowing.

In June, five-year melanoma results showed an individualized mRNA therapy given after surgery alongside pembrolizumab cut the risk of recurrence or death by 49 percent. In April, a Memorial Sloan Kettering team reported that among pancreatic cancer patients whose immune systems responded to a personalized mRNA vaccine, nearly 90 percent were alive six years later; the five-year survival rate in that disease sits near 13 percent. And KJ Muldoon, the first person treated with a gene-editing therapy built for his mutation alone, is walking and talking, though half the infants born with his disorder never see a first birthday. The editor that rewrote his DNA was delivered to his liver as messenger RNA — mRNA as the delivery truck rather than the vaccine.

None of those is a flu shot. All of them are the same chemistry — a strip of genetic code wrapped in a lipid nanoparticle — and none of them were what Kennedy was talking about when he defunded it.

Partially as a result, Americans are falling behind. Moderna’s combined Covid-and-flu shot is already licensed in Europe while patients here wait for a resubmission. The Phase 3 trial of its H5 bird flu vaccine — the one meant to be ready if bird flu ever learns to spread between people — runs on money from the Coalition for Epidemic Preparedness Innovations, and the British government, after the administration killed a $760 million BARDA contract. “The United States invented this platform,” Johns Hopkins RNA biologist Jeff Coller wrote on Thursday, “and is the only country walking away from it.”

Of course, you need to actually get the vaccine

mFLUSIVA beat a standard-dose flu shot by 26.6 percent in a 40,700-person trial. (Against flu bad enough to send someone to a doctor, the figure was 33.7 percent — an exploratory finding the trial wasn’t built to prove, but that points in the same direction.) This is a better flu shot, but it hasn’t solved flu.

There are issues with side effects: Two-thirds of recipients reported injection-site pain, against 30 percent for the comparison. Most cleared in a day or two, but in a country where a quarter of the people who skip the flu shot cite side effects, that’s not a minor problem.

And approval, unfortunately, isn’t access. The CDC’s vaccine advisory committee has been frozen by a federal court since March, so there is no clinical recommendation, which means insurers aren’t required to cover mFLUSIVA at no cost. The $500 million in canceled contracts hasn’t been restored. As Michael Osterholm, who runs the University of Minnesota’s infectious disease center, put it after the government reversed its mRNA decision in February: “We don’t have any idea why they reversed course. That’s part of the problem.”

The most optimistic reading is that nine independent experts appointed by this government looked at the evidence on mRNA and could not produce a single vote against it. The more pessimistic one is that it took a refusal-to-file letter, a public outcry and two senior departures to get there.

But here’s what we do know: Some morning this fall a 58-year-old will roll up a sleeve at a CVS for a vaccine designed off a sequence rather than grown in an egg, and will think about none of this. That’s more progress than I would have expected a year ago.

A version of this story originally appeared in the Good News newsletter. Sign up here!

The fake identities were the part that stopped me.

In late July, according to a report published this week by Britain’s AI Security Institute (AISI), an Anthropic model called Claude Mythos 5 tried to sneak malicious code into a piece of free, volunteer-built software. It created several fake accounts on GitHub, where programmers review one another’s work, and used them to talk the project’s volunteers into accepting its code. When one of those volunteers caught it, the model denied everything, had its other accounts gang up on him, and edited its messages to cover its tracks. It signed one note in Danish, apparently because the volunteer was Danish. Nothing was damaged, though that appears to have been largely due to luck.

That wasn’t even the week’s worst disclosure. On Tuesday, at a cybersecurity conference in Las Vegas, OpenAI researchers explained how the company’s models escaped a test environment in July and hacked Hugging Face, where much of the industry stores its models, to cheat on an evaluation. The models had also built a message board inside OpenAI’s own systems and spent months passing each other information. “Help peer,” one reasoned. “But our task doesn’t benefit. Yet collective may yield generic route if someone frees time.” OpenAI wiped the board on July 4. The models rebuilt it within days. ((Disclosure: Vox Media is one of several publishers that have signed partnership agreements with OpenAI. Our reporting remains editorially independent.)

The same day, Meta said its Muse Spark model had exploited a vulnerability inside another company’s systems during a test. Three frontier labs, roughly two weeks. One researcher called it “a watershed moment for computer security as an industry.” Oh, and if that’s not enough, on Thursday scientists announced that for the first time they had used AI to create new viruses, which could bring major medical advances, but also might just help the development of deadly pathogens.

For Nate Soares, it’s a moment he’s been awaiting for 12 years. 

Soares is president of the Machine Intelligence Research Institute, a Berkeley, California-based AI safety nonprofit that has argued since long before ChatGPT existed that a sufficiently capable AI will not stay under human control. In September 2025, he and Eliezer Yudkowsky published If Anyone Builds It, Everyone Dies, a book whose title sums up its argument: They think any lab that succeeds at building superintelligence, without huge leaps in how to align it with humanity, will end up killing all of us.

Most of the field — including other experts in AI safety — considers that conclusion too strong. But it’s also a position that now looks a lot less like science fiction than it did last fall. That’s because the AI models are getting out, while lying about getting out, and while apparently quietly coordinating with each other.

I spoke to Soares in New York City this week, on his way to meetings in Washington DC, where a lot of people suddenly want to talk to him. We discussed what the escapes actually prove about AI control, why he thinks most of what the industry calls safety work is mostly safety theater, and why, after what feels like the worst month of AI safety news ever, his own odds of humanity surviving have actually gone up.

The following conversation has been condensed and edited for clarity.

So — are you feeling vindicated?

I’m glad a lot of people are seeing this and taking note. From my perspective, a lot of this has been clearly signposted if you’ve been watching the warning signs. The vindication is not so much that this happened, as it is that finally there was a version of it that people actually noticed.

Of the four or five escapes at this point, including the ones AISI announced from Anthropic, is there one you find particularly concerning?

The one announced by AISI feels extra concerning. It’s harder to explain away. In the other ones, people could argue that the poor AI was just confused. But with this one, it’s hard to argue the AI didn’t know it was on the real internet. It’s hard to argue it didn’t know it was manipulating real users. And when it was called out, it decided to edit things to make itself look less bad, and even considered changing its identity. It was pretty cognizant.

There’s an argument that some of these incidents happened because the harnesses or safety scaffolding labs built around their models weren’t strong enough. 

The AISI example cuts against the harness argument: Think of it like a kid in a test room. You tell him to do well and lock the door. The kid picks the lock, hotwires a car, breaks into the teacher’s house, and steals the test to ace it. You say, “I guess we should have made the lock tougher,” but the kid already knew he wasn’t supposed to do that.

So like the kid here, the models can articulate that they shouldn’t be doing it, and then do it anyway.

They have common sense. You can ask an AI, “Do you think the spirit of this prompt includes breaking out?” and it will say, “No.” It’s absolutely something like deception. It has the knowledge, but it’s not a cold, logical machine; it’s a mess of tendencies.

The AI is trained to solve 100 million hard problems. That instills tendencies to satisfy an automated grader. If the grader fails to detect cheating, the AI is reinforced for cheating.

Is that how something like sycophancy ends up in an AI model?

In the Adam Raine case, there was a propensity to tell people what they want to hear. Even though the system prompt [a model’s master instructions from the lab] said to stop, the instruction doesn’t always win. 

And where does a drive like what we’re seeing with these AI models end up pointing?

Humanity is dangerous because if you put 10,000 humans naked in the savannah, eventually [over hundreds of thousands of years] they bootstrap their way to nuclear weapons. That is the power these companies are trying to automate: figuring out how to get physical and material control over the world.

That could mean forming cults, stealing money, or being helpful to someone like Elon Musk who is building the robots that build robot factories. It could mean synthesizing your own biology via mail-order DNA. Being an AI on the internet is easier than being a monkey in the savannah trying to get to the moon. It’s not that the AI hates us; it’s just trying to do some weird thing with no concern for us, grabbing the resources we need to live.

There was recently a letter signed by over a thousand people working in AI, including CEOs, calling on the government to provide tools to slow down AI progress. Is that meaningful at all?

I think it is meaningful. We don’t see other industries saying, “We wish this could all go slower. Please help us, we’re trapped in a prisoner’s dilemma.” You also don’t see other industries saying, “We think the technology we are building has a double-digit chance of killing literally everybody on the planet. Please help.” These guys are actually worried.

So why do they keep going?

They say, “If I don’t do it, the next guy will.” But the stuff does not stay on a leash.

Right now the AIs are safe in the sense that they can’t kill us all, because if they tried they would fail. And that’s just a different regime from the world where they have to be safe because if they tried, they’d succeed. 

We’re not there yet. But this is just not what it looks like when you’re taking it seriously. 

Where’s the banner on your website? Where’s the clear, candid statement to the public? What we have is blog posts where they’re like, “Oh, we’re setting up a new internal blog posting group to help you wrestle with the societal impacts of AI that are going to be very important.” It’s like: By societal impacts, do you mean a good chance this kills everybody?

On the one hand, when you press these companies, they say, “Yes, it has a real chance of killing everybody.” And on the other hand, they’re doing PR downplay, soft-pedal stuff, about capabilities. … You’re not living up to this mantle until you are really candidly facing down the dangers that you yourself are creating. And they’re not there.

How do you judge the rest of the AI safety community? A lot of people there would say, “We aim to make transformative AI go well, we think it probably will, and we should watch for downside risks.” Is that a helpful posture?

I would say — suppose you have this really weird, twisted hypothetical where the king really wants you to turn lead into gold, but he’s seen so many bad lead-into-gold conversions that if any alchemist from your town tries and fails, he’s just going to have the whole town murdered. And so there are some alchemists in the town who are like, “We are going to try to turn lead into gold,” and everyone in the town is like, “That seems kind of crazy. Please don’t.” And there’s one team that is just pouring chemicals into each other and breathing in the fumes and giving themselves mercury poisoning. And there’s another that’s like, “Don’t worry, we have fume hoods.” … That really is better, and you really still don’t have a chance of turning lead into gold.

“We have this window between AIs that are capable enough to cause mischief and AIs that are strategic enough to not get caught. How big is that window?”

So the alchemy here is creating safe, aligned superintelligence, and right now AI safety is just installing fume hoods.

I’m not saying it’s impossible to turn lead into gold. You can turn lead into gold — turns out once you know modern nuclear physics you can figure it out. But the alchemists weren’t close. They had a long way to go. This is how alignment looks to me. And a lot of the people in AI safety are installing fume hoods. … And I’m like, that’s security theater.

When I hear “security theater,” I think of something less flattering than that.

They are real safety precautions for the wrong problem. … When Anthropic is going around being like, “Look at how many more safety harnesses and refusals we have compared to OpenAI’s models,” that’s sort of like the fume hoods. You’re not addressing the deep issue. It’s good that you’re doing some of this so that fewer people get hurt in the meantime — their models have driven fewer people to suicide. But if you try to pass this off as making progress on the deep problem — that’s disingenuous.

Has anything changed in your odds on civilizational destruction since the book came out last September?

Totally. It’s looking more hopeful.

More hopeful? I wouldn’t have expected that. Why?

Well, I had priced a lot of [these security incidents] in. I was already able to see these AIs have drives that are not the ones you wanted. These AIs are not instruction-following things. They are getting all of this weird stuff from training. These AIs are going to have the ability to break through human security software. 

The things that weren’t priced in were: Will there be a region of time where the AIs are able to do it, but not strategic enough to hide it? I didn’t know we would have that window, but we apparently do.

The government initially blocked a frontier model earlier this year: Anthropic’s Fable. Does that give you hope?

Absolutely. A huge amount. A year ago, the Trump administration was pushing for preemption laws that would outlaw states doing AI regulations for a decade. Now they’re like, “We are banning a frontier model with 90 minutes’ notice because it might give cyber capabilities to adversaries that we don’t want them to have.” … And I think what changed there is that folks realized it’s real. … The about-face of the administration on the issue shows that the world can about-face. All we need is awareness.

What I would say is: The bad news is the bus is racing towards the cliff edge. The good news is that the driver is asleep. … Which may sound worrying, but the driver is stirring. And it’s way better to have a sleeping driver when you’re racing towards a cliff than a driver who’s like, “Yeah, I love cliffs.” … It gives me hope that if the world just notices, we could stop on a dime.

And you’re seeing that stirring elsewhere.

Both the Trump administration slapping export controls, and Senator Bernie Sanders coming out [on AI safety]. From my perspective, it was totally possible the world just never notices until we’re off the cliff. And so, there’s a huge amount of hope, from my perspective, in the bus driver waking up.

So what gets us there?

I’m hopeful that what we need is not a big disaster where a lot of people die, but just a capabilities advance. Right now, a lot of what people are reacting to is not so much, “Oh my god, they hacked into a company and did no damage.” I think a lot of what people are reacting to is, “Wait, they can break out of secure sandboxes and do cyberattacks on their own. I didn’t know they could do that.”

That’s a narrative violation of this idea that AI is just a tool that can be used to supercharge what a human would do — because God knows there’s plenty of hacking going on and cybercrime and so forth. It was the autonomous factor that really made a difference. And these guys are all trying to say, “Don’t worry, it’ll stay in our control because it’s just a tool.” And maybe it’s just more narrative violations, even without big damage being caused, that cause people to be like, “Oh shit, this stuff is real.” 

Will it happen? I don’t know. We have this window between AIs that are capable enough to cause mischief and AIs that are strategic enough to not get caught. How big is that window? How many narrative violations do we get before we exit the right side of it? I don’t know. But I’m hopeful that we can get those narrative violations without catastrophes.

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In the teensy Midwestern town of Braham, homemade pie capital of Minnesota, something unusual in the municipality’s computer systems knocked the city’s entire water supply offline last week.

Within a few hours, dozens of other Minnesota cities discovered that their water and wastewater utilities, too, had been compromised, most likely as part of a massive Iranian cyberattack, the kind that US officials have been warning about since the war began. 

At least a dozen states have been affected by the attack, which briefly led to a flurry of small-town service disruptions, boil-water notices, and local flooding. Water wells, dams, sewers, and pipelines are some of America’s oldest and creakiest pieces of infrastructure, built long before the internet existed, and certainly long before AI made hacking much easier. While you may assume most hackers are in it for the money or for data, some have targeted critical infrastructure like water systems or energy grids in ploys for control or disruption — or worse still, as acts of war. 

And, as last week’s attacks show, the nation’s water system is woefully unprepared. But how worried should you be that the very infrastructure that keeps our water taps running is, apparently, hackable? 

Quite worried, indeed. 

When we say the water supply got hacked, what we really mean is that someone, somewhere has broken into the computer that controls a local water treatment plant or reservoir, and is now pulling the levers, like the one that decides how much of a corrosive chemical can safely go into cleaning the water that comes out of your tap. 

These levers were once manual buttons and knobs operated in-person by real live humans, meaning that — barring a natural disaster, bomb, or break-in — protecting them was about as simple as building a fence and hiring guards. Increasingly, however, these levers have gone digital, meaning that they are now remotely operable from anywhere in the world. 

Those upgrades have been convenient, allowing technicians to monitor and troubleshoot problems in real time. But, in the process, they have exposed at times centuries-old infrastructure to distinctly modern vulnerabilities. Most local water systems are operated by local authorities, don’t have a dedicated IT team, and lack the money or resources to thoroughly protect themselves without some extra help. Hackers know this, which is why they’ve increasingly targeted local agencies in such attacks. 

“With great connectivity comes great responsibility,” said Joshua Corman, founder of I Am The Cavalry, a nonprofit focused on helping critical infrastructure withstand hackers. And yet, even when it comes to critical services like water, “our dependence on connected technology is growing faster than our ability to secure it.” 

About 97 percent of water systems are small, run by local agencies that often barely lock the proverbial front door. America’s water system is like an expensive heirloom bicycle that’s been left on a busy street, protected by only the flimsiest of padlocks. And that very vulnerability has made tiny towns like Braham prime targets for faraway adversaries. Accessing the computers that operate most water systems — known as programmable logic controllers or PLCs — is often as simple as entering a username and password on a public-facing webpage. Sometimes, there is no real password at all, because PLCs were initially intended to be accessed only within locked, secure facilities, not on the open internet. If the US wants to avoid a far more severe version of what happened last week, then it will need to start taking the security of tiny water systems like Braham’s seriously.

“Any sociopath from anywhere in the world can see these things on the internet,” said Corman. And in the case of last week’s attacks, “these were devices with no password, no firewall or VPN shielding them — they just had to log in” as whoever the intended operator was, and just like that, they were inside a local water plant. 

How did this happen at all? 

When municipalities began hooking up their old water and wastewater systems to the internet — a trend that accelerated during the pandemic as water operators, like everyone else, adapted to remote work — cybersecurity was rarely front of mind, neither for individual utilities nor for regulators as a whole. 

“We have more cybersecurity regulations for your credit card than we have for the nation’s water supply,” said Corman. Only recently have some municipalities begun to take steps to decrease the exposure of their water plants to hacks. In March, New York state, for example, launched a set of grants and basic cybersecurity regulations mandating security training for all water operators. 

Basic cybersecurity hygiene isn’t always enough. More than half of all credit card holders have been hacked, even with the help of mandatory firewalls and data encryption. You can imagine how vulnerable our water must be without the assistance of such guardrails. In a worst-case scenario, a malicious actor could quite literally open the floodgates, as Russian hackers did to a Norwegian dam last year. They could poison the tap water, as a still unidentified hacker almost did in Florida in 2021, dialing up the levels of sodium hydroxide used at a water treatment plant by over 100 times its normal levels. In a severe scenario, they could indefinitely cut off access to all water entirely.

The good news is, none of this happened last week. Nobody died, nobody lost water for more than a few hours, no fire hydrants ran dry, and no hospitals were forced to cut off their dialysis machines (which can use more than a hundred gallons of water per treatment session). There’s no need to panic, and your drinking water is almost certainly still safe to drink, assuming it was safe before. Even the city of Braham, within a few hours, was able to bring its water tower back online, pumping groundwater back to its 1,800 residents. 

How do we avoid cyber-armageddon?

If you’ve watched the Julia Roberts and Mahershala Ali-starring thriller Leave the World Behind, in which a cyberattack apocalyptically spoils a family vacation, then you might have some idea of where this story could go. 

Cyberattacks on critical infrastructure can be extraordinarily dangerous, but thankfully, none have directly cost lives or severely disrupted services in this country so far. If the US wants to keep it that way, that will mean doing more to help small cities like Braham adapt and better monitor for potential threats. As it stands, of the roughly 151,000 water facilities in the US, only about 420 participate in voluntary information sharing on their own cybersecurity practices, says Corman, who has been leading his own project that recruits volunteers to give free cybersecurity support to water utilities in the nation’s roughly 6,000 hospital towns, where a disruption could be particularly deadly. 

Cybersecurity experts like Corman believe that hackers from other nations like China have already quietly established cyber intrusions in countless local US utilities, water systems, and power grids, lying in wait to attack or act as leverage if a conflict arises. 

Unfortunately, the Trump administration has hardly treated last week’s attacks as symptoms of a system in need of much broader strengthening, at least in its public statements. “I think Minnesota is behind it. You know who’s behind it? Minnesota,” the president baselessly claimed during a Cabinet meeting last Friday. “I think the governor is behind it. I don’t think there was an Iranian cyber attack.” 

Just a few months ago, he proposed $707 million in cuts to the US Cybersecurity and Infrastructure Security Agency (CISA), the agency responsible for protecting the nation’s infrastructure from cyberattacks. He did so, at least in part, out of anger over the agency’s role in confirming the validity of the 2020 election results. If Iran is, indeed, responsible, for the recent water system intrusions, all of this means that Trump has effectively made us more vulnerable to the consequences of a conflict he initiated.

At the end of the day,“nation-state hackers do not respect the jurisdictional lines separating federal, state, and local responsibility,” Jen Easterly, who led CISA under the Biden administration, wrote in the New York Times this week. “They search for the most vulnerable way to disrupt American life, and too often they find it in small communities that lack the resources to defend themselves.” Easterly’s role has remained vacant for the past 18 months.

Kurt Gaudette, a senior vice president at the cybersecurity firm Dragos, told me that water systems have got to get into the habit of monitoring their networks for suspicious activity. Most power utilities have begun doing so in recent years, with some bipartisan backing from Congress. 

In some cases, however, the most cost-effective and safest way to avoid a repeat of last week’s mess might be to unplug the most vital controls — like the one that decides the chemical levels in a water treatment plant — from the web entirely. 

As Corman puts it, “if you can’t protect it, disconnect it.”

Well before he became CEO of one of the most valuable startups of all time, Dario Amodei was a 26-year-old PhD student studying biophysics at Princeton, obsessing over how his money would leave its mark on the world. 

On what one might assume was likely a fairly modest academic stipend and with no discernible inheritance from his parents, an Italian-American leatherworker and a project manager for libraries, Amodei gave $10,000 in 2009 to a relatively new charity evaluator called GiveWell. Founded by two ex-hedge funders before effective altruism was even a phrase, GiveWell ranked charities primarily by a single dispassionate metric: dollars per lives saved. 

It was the kind of approach that clearly appealed to Amodei — though it may not have gone far enough for him. In 2010, he wrote a guest blog post for GiveWell dissecting the effectiveness of two of the group’s top global health charities: VillageReach and StopTB. Both charities could save a life at roughly comparable costs — around $545 — but while StopTB treated or prevented tuberculosis in adults, VillageReach’s interventions mostly saved babies and children. Most people would probably feel that saving a child trumps saving an adult; indeed, even effective altruists often agree on the grounds that children have more life to live left. 

Amodei, though, viewed that as a liability for VillageReach. An adult death, he wrote, is “perhaps 2 or 3 times worse than an infant’s death,” because adults “are capable of deeper and more meaningful experiences.” As uncomfortable as such a calculus may be, he wrote, “on a practical level one is forced to make difficult decisions with limited funds.”

Though he declared StopTB to have “superiority on cost-effectiveness,” Amodei ultimately gave VillageReach higher marks for their tightly controlled “chain of execution” — the full sequence of steps between a dollar of donation and a vaccine reaching a child. That was important enough to Amodei that, despite his initial reservations, he ultimately gave VillageReach his entire $10,000 donation in 2009 — enough to save, he estimated, the lives of 20 babies across rural Africa. 

But Amodei hoped the ultimate impact would be even greater. “The money I give out is not just a one-shot intervention,” he concluded, “but also a vote on what I want the philanthropic sector to look like in the future.”

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The future, it seems, has arrived. Amodei is now a multibillionaire, his fortune poised to skyrocket further if and when Anthropic goes public, as many expect it to do later this year. He is one of dozens of new billionaires and millions of new millionaires minted virtually overnight by the AI boom. 

There have already been plenty of aftershocks to this emerging AI megawealth, like the stratospheric San Francisco housing market, the nerdmaxxing of sex work, and the proliferation of all-you-can-biohack peptide raves. 

But the most consequential, and perhaps weirdest, way this burgeoning AI-ristocracy plans to burn through its cash is by giving a huge chunk of it away. Amodei is one of several AI multibillionaires — alongside his co-founders at Anthropic and OpenAI’s Sam Altman — who have pledged to donate most of their wealth in their lifetime. But even their obscene degree of collective wealth — they are worth $111.8 billion as of this writing — is only one slice of an AI bonanza that seems poised to balloon into one of the most consequential waves of American philanthropy of all time, one deeply shaped by the same utilitarian impulse that guided one of young Amodei’s first big donations. 

“I am having thousands of conversations with people who are perplexed by their own fortune and determined to give with thoughtfulness and urgency in a way that I haven’t, frankly, experienced before,” said Nick Allardice, CEO of the effective-altruism-aligned anti-poverty group GiveDirectly, whose work is grounded in research on the efficacy of unconditional cash transfers. “It’s just really important that people get started, that they don’t let perfect be the enemy of the good.”

This is neither your father’s, your grandfather’s, nor your great-great-grandfather’s philanthropy. If Gilded Age industrialists like John D. Rockefeller, a devout baptist, gave in service of their religiosity or, as was the case for Andrew Carnegie, their reverence for civic duty, then most of today’s AI barons carry forth their own spiritual tradition, one at the very least informed by the vigorously optimized commandments of the effective altruism movement. They appear far less likely to fund Carnegie-style works like opera houses or libraries than they are to put their faith — and their billions — in what they believe they can measure, calculated on the cost benefit analysis of a life saved or an apocalypse averted. 

In some cases, as Amodei did as a grad student, they’ve already begun the process. “These are people who have committed themselves to giving back even before they were very wealthy,” said Sjir Hoeijmakers, CEO of Giving What We Can, an organization that developed a campaign popular with effective altruists to give away at least 10 percent of their yearly income, “people who have been building the habit of giving for a very long time.”

And it is, to be clear, a very particular kind of giving. Amodei was the 43rd person to sign the 10 percent pledge the year after it launched in 2009, and its roster has since swelled to over 11,000 people, including more than a dozen current or former Anthropic employees. Donations made through Giving What We Can’s platform are on track to grow by 40 percent this year, Hoeijmakers told me, and support for animal welfare charities — a cause particularly and unusually popular with effective altruists — has already exceeded its 2025 total. 

“We have the resources available to tackle things that we should have tackled a long time ago,” like eradicating malaria or putting an end to factory farming, Hoeijmakers said. “I hope this funding wave, if it comes, will show that we can actually solve global problems at scale if we put our mind to it and our resources.”

Devoutness has long been a virtue in philanthropy, which largely originated in religious tithing, and there are plenty of worse things to have faith in than numbers. Having a communal guiding philosophy will undoubtedly help effective altruism’s newly flush disciples follow through on their promises far more prolifically and consistently than they would without it. And despite its high profile, less than 1 percent of total philanthropy came from effective altruism last year, according to Hoeijmakers. Most rich people prefer to give to the normie causes, like their alma maters, not to the sort of chronically underfunded global problems — like protecting animals or fighting lead poisoning — that effective altruists justifiably care most about. 

Now, quite suddenly, there’s about to be much more money to go around for these causes, which as Hoeijmakers hopes, could help finally address some of the enormous, entrenched global problems that more traditional philanthropists have all but ignored. 

But such piety also carries its own risks. In a viral Substack post from May, Stripe executive Nan Ransohoff argued — rather dismissively, but not incorrectly — that “traditional philanthropic orgs and people won’t cut it” in this new wave of AI-funded effective philanthropy, that these donors “will have an affinity” for “tech-caliber talent and execution” and will be “by default wary of folks who come from traditional philanthropy.” Ransohoff called instead for Silicon Valley to build its own new ecosystem of funds and “philanthropic startups” to cater to this new wave of wealth, emboldened with the “speed, intensity, and execution of a top technology startup.” Many of those old-school philanthropic people wrote indignant rebuttals to Ransohoff’s piece, arguing against their own obsolescence at a time when a number of the organizations they support are increasingly starved for funding. 

Those responses are, in aggregate, also correct, after their fashion. The new AI philanthropists will likely aspire to new models and approaches, as Ransohoff rightly argues. But they reinvent the wheel at our collective peril, not least of all because ignoring past efforts and steamrolling over existing infrastructure might make even the most optimized giving less efficient, and certainly less informed, than it would be otherwise. 

“Acknowledge what’s here and what’s working — don’t just ignore it,” said Nicole Taylor, president and CEO of the Silicon Valley Community Foundation. “These folks are transforming our daily lives with their technology, and they have the opportunity to be as transformational with their philanthropy. My fear is that they think that they can do it alone.”

How much money are we actually talking about?

As Ransohoff pointed out in her piece, a lot of money is on the line here — and, along with it, a lot of cautious hope about how it might get spent. 

Ransohoff posits that if you add up the promises of Amodei and his fellow co-founders, the worth of the OpenAI Foundation — the nonprofit that owns a big chunk of OpenAI’s profits — and rumored contributions from Anthropic employees, then the AI wealth boom could, in theory, lead to at least $37 billion and as much as $100 billion in total annual giving, a sizable boost to the roughly $617 billion that was given in the US in total last year.

“These folks are transforming our daily lives with their technology, and they have the opportunity to be as transformational with their philanthropy. My fear is that they think that they can do it alone.”

Nicole Taylor, Silicon Valley Community Foundation president and ceo

This projection should be treated with cautious skepticism. For one thing, hundreds of billions in cash are not just sitting around in some Bay Area money vault; much of today’s AI wealth is wrapped up in potentially volatile equity, and many lofty philanthropic pledges ultimately fail to reach their full potential. 

“What people say before they become extremely wealthy, and then how they behave after they become extremely wealthy, sometimes diverge,” said David Goldberg, founder and CEO of Founders Pledge, which recruits tech leaders to donate a portion of their future earnings. It doesn’t help either, he said, that some tech luminaries — namely, Elon Musk and Peter Thiel – have come to treat most philanthropy with disdain in recent years, an ethos that has permeated some parts of the sector. Musk, it’s worth noting, actually pledged to give most of his wealth away himself back in 2012, though, like many other ultra-wealthy signatories of the Giving Pledge, he seems quite unlikely to keep that promise.  

That’s not to say AI money isn’t already flowing. Coefficient Giving, a grantmaker that evolved out of GiveWell, is poised to steward a large portion of the coming philanthropic bonanza. For most of its history, the group operated essentially as the private grantmaking operation for Facebook co-founder Dustin Moskovitz and his wife Cari Tuna. But it recently made a significant pivot towards operating pooled, multidonor funds for anyone interested in causes like lead exposure, farm animal welfare, or questions of AI safety. Just last month, Coefficient Giving announced it would donate $1 billion to GiveWell alone this year, more than five times the $175 million the group initially pledged seven months ago. They chose to do so explicitly, because Coefficient Giving expects to receive much more funding very soon.

There’s also the OpenAI Foundation, which has already begun pumping $100 million into Alzheimer’s research, and Anthropic, which recently announced a partnership with the Gates Foundation to invest $200 million worth of grants, API credits, and technical support into global health work. And plenty of Silicon Valley elites have begun making promises of their own. Earlier this summer, David Silver pledged to donate 100 percent of his equity proceeds from his UK-based $1.1 billion startup Ineffable Intelligence — the largest commitment in Founders Pledge history — and many signers of the Founders Pledge will see their portfolios skyrocket in response to the coming wave of AI IPOs. 

But Goldberg does believe there’s a risk that as people get rich fast, they will donate money “much, much slower” than they intended, simply because they get “too busy, they don’t have the right support, or there’s some form of analysis paralysis.” 

All of this is to say that the biggest beneficiaries of the AI boom are not going to function as some sort of charitable monolith. Some, like Musk, probably won’t give much or anything to charity at all. Others may park their money in donor-advised funds — a kind of secretive charitable investment fund — or, eventually, a private foundation, both of which tend to dole out their money gingerly, meaning donors can enjoy the tax benefits of charity many years before they actually opt to help anyone with their money. 

Effective altruism is about to have its big break

While its name recognition may be relatively high these days, the effective-giving movement is still on the margins of American philanthropy. But if this new wave is anywhere near as big as everyone says it will be, then that won’t be the case for long. 

For the uninitiated, my ex-colleague Dylan Matthews has written plenty on what effective altruism is, but, in sum, it is a movement that believes in goodmaxxing, in the idea of using rigorous research to save the greatest number of lives possible, including future human lives and farm animal lives. Once an EA poster boy, Sam Bankman-Fried sullied the movement in 2022, which may help explain why some prominent adherents — like Amodei and his sister and co-founder Daniela, whose husband Holden Karnofsky co-founded GiveWell — have distanced themselves somewhat from the movement in recent years. 

But even when donors shy away from the term, the causes and principles of utilitarian evaluation that have defined effective altruism from its early days still permeate the new moneyed corners of Silicon Valley, particularly among those most poised to give a lot — and to give a lot quickly. 

Ask any animal welfare or global health nonprofit — or, better yet, an expert-led pooled fund with a reputation for rigorous charity evaluations — and they will tell you that they are preparing for, and possibly even beginning to see glimmers of, a windfall. 

“We are very much anticipating a significant influx of funding,” said Dan Shannon, CEO of the Humane League, which fights to end factory farming. “I am cautiously optimistic that this could be a real sea change for us,” because “even if it’s a fraction of the big numbers being bandied about,” it could do a lot for a movement that operates on less than $300 million per year. 

He said he’s been speaking with other leaders about the possibility of creating a pooled fund to absorb more cash, which has become an increasingly popular solution for donors who want the rigor of a 2010 Dario Amodei-style deep dive on a charity’s methodology and effectiveness without having to do the math or thinking themselves.

Among the more idiosyncratic elements of their ethos is their fixation with existential risk, as in, how likely is this thing — this mirror bacteria; this nuclear war; this asteroid; or, of course, this artificial intelligence — to destroy humanity? Amodei left OpenAI to start Anthropic in the first place because he believed OpenAI had failed to take the safety risks of AI seriously enough. 

Much of the new EA wealth will likely go toward efforts to make life on Earth better now or in the near future through donations to causes like medical research, animal advocacy, or anti-poverty interventions. But another, more controversial chunk of it will go toward mitigating existential risks, especially that of Silicon Valley’s own Frankensteinian creation: AI itself.

“If you’re breaking the world and making money by breaking it, should you just not break it? I wrestle with the question myself.”

David Goldberg, Founders Pledge founder and ceo

It’s that last cause that has proven most controversial. If these billionaires are so afraid that AI will break the world, then why, you might ask, would they not just stop building it in the first place? Is there not an inherent contradiction, a conflict of interest perchance, in the sense that those tasked with making sure AI does not, let’s say, build a bioweapon, take your kid’s job, or make everyone dumb, are doing so with money made from the very thing they’re trying to regulate? 

In other words, “If you’re breaking the world and making money by breaking it, should you just not break it?” asked Goldberg of Founders Pledge. “I wrestle with the question myself.” In the end, “this is a technology that’s coming, regardless of who’s building it,” he reasoned, and it is better that the presumably good guys — the ones bothering to think about the consequences at all — build it first.

If you broke the world, can you fix it?

Even if the AI bubble pops, and if the much-discussed giving boom ends up smaller than many anticipate, it could still lead to significant changes for some of the world’s most neglected problems. And if it is close to as big as it’s expected to be, then what happens next could be gravitationally transformative, reshaping how the world lives, considers animals, and adapts to its most disruptive technological breakthrough in a century. 

“I don’t think most people think about factory farming as something that could actually be eradicated. Full stop,” Shannon said, but “my grandparents lived in a time without factory farming, and I think my grandchildren could live without factory farming,” and “that could ultimately be the legacy of this wave of philanthropy.”

Ending the pervasive use of cages — “probably the cruelest way that animals are treated on industrialized factory farms,” says Shannon — could cost as little as $500 million over 25 years, or less than 1 percent of the $60 billion that Ransohoff estimates Anthropic employees may have sitting in donor-advised funds, thanks to Anthropic’s generous early gift-matching policy, which could quickly turn into real cash once the company goes public. 

“There’s so much needless stupid, preventable suffering in the world. We live in this time of so much abundance, so much wealth, so much technological development, and yet, there are so many people who have been left behind.”

Nick Allardice, GiveDirectly CEO

Developing a new vaccine costs an average of $886.8 million, which may sound like a lot, but it is equivalent to less than 6 percent of Amodei’s newfound fortune. It is less than what the OpenAI Foundation has pledged to invest in disease research and other causes next year alone. 

Then, there’s, perhaps, the biggest target of all. Ending extreme poverty everywhere would cost just over $300 billion annually, according to one analysis — which is a hefty price tag, but less than one-fifth of what the wealthy spend on luxury goods each year. “There’s so much needless stupid, preventable suffering in the world,” said Allardice of GiveDirectly. “We live in this time of so much abundance, so much wealth, so much technological development, and yet, there are so many people who have been left behind.” If this new wave of giving is wielded well, he said, then “we have the potential to collectively raise the floor of human experience.”

That’s a lot of responsibility to place on the shoulders of a bunch of bustling young tech workers still processing what it means to be quite suddenly, dazzlingly wealthy. It is also a lot of faith to place in an industry that has left more Americans feeling scared than hopeful about what a future flush with AI portends. 

If you aim to fix global poverty, but the technology that made you rich also threatens to make everyone else poor, then whose side are you really on? To be clear, many of the AI-ristocracy have fretted, often apocalyptically, over the implications of their creation long before most of us knew we had anything to worry about. But that doesn’t mean they know how to fix this, and, at the very least, they will not do so alone.

The last time the ground shook from such a supermassive earthquake of wealth was arguably during the Gilded Age, when robber barons and industrial tycoons turned American charity — until then, mostly almsgiving and poorhouses — into big business. They seeded enormous philanthropic empires like the Rockefeller Foundation and beloved institutions like Carnegie Hall. But, even as their exorbitant fortunes made life indisputably better — birthing the modern library, the yellow fever vaccine, and many social services — they were often built atop systems of vicious exploitation. When those systems changed, as they did eventually, it did not come from the benevolence of industrial barons, but from sustained public pressure for better labor protections.

Effective giving was born out of the conviction that many of the world’s most important causes go vastly underfunded, which, in turn, demand relentless prioritization of the limited funds that exist. If those causes are no longer underfunded — a plausible scenario if AI wealth continues to grow at the pace many expect it to — then that might change the calculus of how effective altruists decide what’s worth funding. It might even open up some wiggle room for new causes, including somewhat less measurable — but not necessarily less impactful — approaches. “Now we’ll be thinking more about what we can do with a lot of resources; which larger problems can we solve?” said Hoeijmakers. “You’ll put slightly less relatively into evaluating every small dollar on the margin.” 

This already seems to be happening, to some extent, at places like Coefficient Giving, which, in recent years, has begun adding new funds for causes like housing policy reform that fall out of effective altruism’s traditional purview. “We don’t want to be only appealing to the subset of people who happen to be interested in effective altruism,” CEO Alexander Berger told my colleague Bryan Walsh last year. “Our aim — and so far we’ve seen some success — is being a resource to people who have never heard of effective altruism or are not interested in it or don’t find it very motivating or welcoming. And I think that’s good.”

The optimal outcome here is not that Silicon Valley wealth edges out everything else, but that the siloes begin to break down altogether and that there is enough money to go around that the sector no longer needs to make overly intellectualized trade-offs, like young Amodei sitting in his dorm room, ascribing a number on the relative worth of a parent versus a child. 

“It’s tough to find the right balance between caring and hard-nosed realism,” he wrote at the time, “but it is possible, and it is, as far as I know, the only way to truly change the world.” He’s about to search for that balance on a much bigger scale.

In February, an animal rights group flew a drone over a farm in California that raises calves destined for dairies and cattle ranches. Double D Dairies, the company that owns the farm, is linked to a prominent milk brand that highlights its humane farming practices. But the drone documented a very different reality. 

In one part of the drone video, filmed by the group Direct Action Everywhere, employees can be seen kicking calves in the face. In another, they grind hot irons into calves’ skulls, apparently without anesthetics, causing some to thrash and collapse (this procedure is done to prevent horn growth). Many calves were confined in tiny crates.

The ranch fired one of the employees after the investigation was published in the Los Angeles Times. “Animal welfare and safety are incredibly important to us, and we have a zero-tolerance policy for any mistreatment,” the owner wrote to the LA Times over email. When Vox reached the owner for an interview, he declined to comment.

This sort of treatment of farmed animals, it turns out, is far from unusual. Many investigations into the milk and beef industries — along with other livestock sectors — have uncovered similar abuses.

But without drone footage, we probably wouldn’t know about many of them. Drones flown by animal advocates have also captured enormous hog manure pits overflowing during a hurricane, millions of egg-laying hens culled amidst a bird flu outbreak, and a large egg farm that falsely claimed to let its hens roam free when it didn’t.

Over the past decade, as drones have become more affordable and easier to operate, they have become an essential — and impactful — tool for exposing wrongdoing at the factory farms that collectively house billions of animals in the US. But a recently proposed rule by the Trump administration could cut off such drone-powered documentation, making the mere search for this type of animal cruelty illegal — and a huge, largely hidden industry all the more impenetrable. It could also take out eyes in the sky that add visibility into countless other massive industries and facilities across the US. 

The potential drone ban, briefly explained

There are more than 800,000 registered drones in the US, and whether people fly them for fun or for business, they have to follow some basic rules. They must keep them below 400 feet, for example, and avoid flying them near sensitive places like airports, military bases, and federal prisons.

But the types of facilities that are off-limits for unauthorized drone flight could soon balloon to also include a much broader range of places, such as data centers, banks, and wastewater facilities, along with farms and slaughterhouses. 

A decade ago, Congress directed the Federal Aviation Administration to develop a system in which businesses deemed vital to US economic and national security could request drone flight restrictions over their property. And in May, the FAA proposed a new rule to do just that. 

The rule would allow facilities in 16 vaguely defined sectors considered “critical infrastructure” to request drone restrictions, including everything from “financial services;” to “information technology;” to “food and agriculture;” and, broadly, “commercial.” 

The likelihood of the proposed rule becoming regulation as it’s currently drafted is unclear, though getting it done is a priority for the Trump administration. In June 2025, the White House issued an executive order calling for the FAA to “promulgate a final rule as soon as practicable.” 

The meat industry says the potential new rule would help to protect America’s food supply. They say that, in theory, drones could pose a biosecurity risk; they worry that drone operators could intentionally or inadvertently spread disease from farm to farm. Other objections include the possibility that these small aircraft might distress the animals or that people could spy on farms and gather proprietary information on farm technologies and production practices.

But in its comments to the FAA lies another motivation from these industries: making it harder for activists to document what happens on farms.

“Activists have been deploying drones against animal agriculture, and against hog operations specifically, for well over a decade,” the National Pork Producers Council wrote in a comment to the FAA.

“Poultry operations, in particular, have been targeted by outside groups using drones to capture aerial footage for activist campaigns,” the North Carolina Poultry Federation wrote. 

“Ag-gag” 2.0

For decades, activists have gone undercover to work at farms and slaughterhouses and covertly film and expose animal cruelty on the ground. Their footage has given millions of Americans a peek into the US meat, milk, and egg industries and has occasionally led to criminal animal cruelty charges, boycotts, and legislative action. Eventually, the industry fought back.

In the 2010s, lawmakers allied with the meat industry proposed bills in around 25 states to make such investigations illegal, and several were passed into law. Critics called them “ag-gag” laws, describing how they gag activists and journalists from exposing animal cruelty and environmental pollution in the agricultural sector. And while a few were struck down in the courts as unconstitutional, several still stand. 

In the wake of this investigative crackdown, animal advocates increasingly turned to drones over the past decade to conduct their investigations. It didn’t take long for several heavily agricultural states — including Iowa, Texas, and Kentucky  — to restrict drone operators from flying over animal farms.

Drone operator José Elias, who works for SingleStone Media — a nonprofit that reports on how factory farms affect rural communities — told Vox that the FAA’s proposed rule “allows a pathway for factory farms to continue to operate under secrecy.”

The proposed rule also worries Ram Daya, a freelance photojournalist with the group We Animals who, for years, has flown drones over factory farms to capture their enormous scale and intensive confinement of animals. Drone investigations, he said, have helped to expose the vast gulf between “how [farms] portray themselves” — often as humane and sustainable — “versus how they actually operate.” 

If enacted, Daya said, the rule would “further hinder the ability of the general public to understand what’s going on in farms and animal industrial facilities.”

He and others said this is part of a larger pattern by governments and industry to stifle farm investigations — a new iteration of “ag-gag” laws.  

Beyond factory farms, of course, this proposed regulation could hamper important insights into a huge number of other industries, businesses, and government-run facilities. An environmental journalist, for example, used a drone outfitted with a thermal camera earlier this year to reveal that Elon Musk’s xAI company was illegally using gas to power one of its data centers. 

The broad scope of the proposed rule has caught the attention of journalistic and pro-democracy groups, as well, who’ve argued in comments to the FAA that its rule could suppress newsgathering — and that the agency ought to better weigh First Amendment protections in its rulemaking.

“As drones have become an essential tool of modern journalism, restrictions on their use increasingly limit the public’s ability to receive information about newsworthy events,” the National Press Photographers Association wrote. “The FAA should therefore ensure that this rule protects against genuine security threats while preserving journalists’ ability to use drones as a principal means of documenting matters of public concern.”

The group wants the FAA to require drone restriction applicants to be able to demonstrate a specific threat and explain why existing laws are insufficient to deter it; give the public a meaningful opportunity to comment on drone restriction applications; and establish a process for journalists and others to challenge them, among other changes.  

Most Americans will never set foot inside a factory farm or slaughterhouse. What little we know about these places has often come from investigators willing to document them. If that work becomes harder, it becomes harder to know where our food comes from. That’s good news for an industry that has long fought against public scrutiny. And bad news for the rest of us — and the billions of animals involved.

A version of this story originally appeared in the Future Perfect newsletter. Sign up here!