ATHENS — Greece’s attempt to lure top scientists back to their homeland after the trauma of the financial crisis has stalled after an ambitious program to reverse the brain drain descended into fiasco.

A group of professors who hoped to bring back young researchers through a much-advertised program financed with EU funds are now feeling betrayed, having been left waiting for years only to find out the program won’t happen.

To rub salt into the wound, no one from the government bothered to inform them that the scheme was dead, they said.

“All this ‘brain gain’ talk isn’t just a joke; it’s a massive step backward,” Aristides Hatzis, a professor at the University of Athens, said. “During the financial crisis, there was only one area where there was money invested: research, as the EU prioritized this. Now there’s nothing; it’s at the very bottom of the list of priorities — a complete abandonment.”

An estimated 500,000 people moved abroad during Greece’s financial crisis, which began in 2008, shrinking the country’s economy by a quarter and driving unemployment to 28 percent. Greece had experienced mass migration before, including in the decades after World War II, but this time it was many citizens with high levels of education and skills who emigrated.

“Brain Regain,” an initiative by the ruling conservative New Democracy government to reverse the mass exodus of scientists and professionals, comprises several schemes, such as offering a 50 percent income tax exemption for seven years, and is expanding to include high-skilled public sector roles.

And overall, the situation has improved since the crisis era.

According to the survey OECD Diaspora Review Greece, from 2021 onward, there has been a steady increase in the number of citizens returning to Greece, with 2023 marking a milestone year when — for the first time since the start of the crisis — more people returned than left. Specifically, during the two-year period of 2023–2024, 69,000 Greeks left their country while 98,000 returned.

But when it comes to scientists, there is still a major problem.

Star-crossed project

The current fury of many researchers and scientists hinges on a Greek government project called “Trust your Stars” — an €80 million research funding program backed by funds from EU’s post-Covid recovery fund, the Recovery and Resilience Facility (RRF).

Research teams were called to submit their proposals, with 145 out of a total 1,241 submissions selected. Thirteen months later, after several complaints regarding the delay, the selected list of projects was finally published on July 22, 2025.

Then, it all started to unravel.

Those not selected for funding reacted fiercely, with some 203 submitted objections and calls for reevaluation. Scientists raised their concerns over the evaluation process itself, and some even submitted complaints to the European Public Prosecutor’s Office.

In January 2026, Greece’s development ministry then issued a statement, saying payments of some €40 million had already been made, and that the remaining half of the program’s budget was earmarked for completion by Dec. 31, 2029. But complaints only escalated, with some of those selected for funding sending formal legal notices to the education ministry, seeking details about where the money had been spent since the program had not yet started.

Then, the final bombshell dropped: Trust your Stars was not going to receive the EU funds anymore.

In a statement published in May, Greece’s education ministry said the country’s finance ministry had decided to “remove the project during the review of Greece’s National Recovery and Resilience Plan.” It was later revealed that on the day the list of selected proposals was officially published, the government also delisted the program — but no one informed the applicants for 10 months.

“It was ultimately not possible to implement the project ‘Trust your Stars’ within the time frame set out by the RRF,” said an official from the education ministry. “For this reason, the project was removed, as part of a review of the National Recovery and Resilience Plan by the Council of the European Union.”

“As regards the funds linked to the actions in question, these were redirected to finance other actions undertaken by the RRF and the Education Ministry. Consequently, under no circumstances was there any loss of resources from the RRF,” added the official.

Shattered hopes

On July 15, Greece’s finance ministry issued a statement, saying it was trying to secure funds “to settle any outstanding financial obligations arising from legal commitments entered into at the time of the revocation of the program.”

While the statement rekindled hopes that a solution would be found, Hatzis argues that it was just a legal trick and that the education ministry has no legal commitment since no contracts were signed following the initial announcement of accepted proposals.

“What happened violates a fundamental principle, one that is sacrosanct in states governed by the rule of law: ‘reliance,’ the citizen’s legitimate trust in the state,” he said. “There may be no contractual liability, since we did not sign an agreement, but there is a political, moral and even legal obligation. Many young people turned down other offers or did not take up jobs elsewhere because they hoped they would be paid through the program.”

Hatzis added that with its handling of the situation, the government had managed to turn the entire scientific community against it — both those who had been successful and those who had not.

“If you’re a young scientist and you’re abroad, stay there! If you’re a young scientist and you’re thinking of moving abroad, go for it. Don’t wait a minute!” he wrote in a lengthy social media post.

Pantelis Kammas, an associate professor at the Athens University of Economics and Business who was co-leading one of the teams that had a successful proposal, said the program was a chronicle of a death foretold.

“The perception within the scientific community was that this was EU money and that it could be handed out hastily through nontransparent procedures. There was a sense of mistrust because this was a one-off emergency program,” said Kammas. “The ministry lacked an organized framework for evaluation, the academic community’s objections were based on these well-known shortcomings, and media that seek to oppose the government jumped on that. This was the perfect storm, so the government decided to backtrack and cancel the program.”

Petros Bouras-Vallianatos, an associate professor of the history of science at the University of Athens, said he had gathered a team of 25 young scientists to come to Greece from countries like the U.K. and Germany for a study of medicines used during the Byzantine period, which could serve as inspiration for new pharmaceutical formulations. Fortunately, they had not already traveled by the time the project was canceled.

“The most offensive thing is that the government never bothered to meet us or give us a reasonable explanation about what happened,” he said, noting the government’s handling created even greater problems with the scientific community than those that already existed.

Bouras-Vallianatos himself returned to Greece in 2022 after a 15-year career in Edinburgh, and has not regretted the decision, as he wanted to raise his children in his homeland. However, he added that while many others wanted to return to Greece, the conditions for doing so were not in place. Some of them do but only for sentimental, personal reasons, he said.

“There has been no serious policy by the Greek state to get its scientists back.”

According to preliminary statistics, research spending in Greece has declined, dropping to €1.27 billion — or 0.51 percent of GDP — in 2025, from €1.30 billion in 2024.

“Funding and low salaries is a big issue,” continued Bouras-Vallianatos. “An independent body should be set up, which would allocate funds for research and adheres to international standards in terms of evaluation. We are a small country; we all know each other, so a large proportion of the evaluators should be foreigners.”

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!

Over the weekend, Rep. Alexandria Ocasio-Cortez (D-NY) announced on Instagram that she had joined the thousands of American women who freeze their eggs every year, a number that has been steadily growing for the past decade.

“This is a choice that I am making to feel more in control of my life,” Ocasio-Cortez said in her Instagram story sharing her decision. 

As politicians in the public eye often do, Ocasio-Cortez turned her personal choice into a statement:

Usually I keep my private life quite private, but I have made the decision to start freezing my eggs, and I want to share this because I was weighing it for a very long time. I was saving for it for a very long time, and there just isn’t a ton out there, I feel, and sometimes it can feel very daunting. As women in general, we are not taught about our own bodies. We are not prepared for our own lives. … We need to show more depictions of women having full lives.

At the same time, she acknowledged being “in a very privileged position” to be able to take advantage of egg freezing. The process still typically costs $10,000 or more — and most insurance still doesn’t cover it. Not even AOC’s federal health plan. Egg freezing is a luxury afforded only to the people who can pay for it and take on the significant burden of the treatment and all of the uncertainty that comes with it.

Ocasio-Cortez’s announcement underscores the awkward place that egg freezing still occupies in the landscape of fertility access — at a moment when Republicans in power are lamenting falling birth rates and searching for ways to encourage more people to start families. In theory, egg freezing gives women the flexibility to take more control of their decisions about having kids and preserve that possibility for themselves in the future. But in reality, the promises of this important procedure have often been unfulfilled. 

Beyond the intimidating price tag, as AOC alluded to, many young women don’t know some of the basics about age-related fertility decline and how to maximize their chances that egg freezing will lead to an actual pregnancy. There are some “significant gaps in fertility knowledge amongst Gen Z women in particular,” said Danielle Melfi, CEO of Resolve, a fertility treatment advocacy group. 

“That points to why someone like AOC who has such broad awareness and broad reach across her channels,” Melfi told me, “specifically younger people who aren’t tuned into any politician but would be tuned into her. Her sharing her story and journey matters.”

Egg freezing is not a panacea, and it never will be. But it can give individuals options and a sense of empowerment. And right now, as AOC acknowledged in her video, those are privileges reserved for the people who are in the know and have the means to take advantage of it. For everyone else, significant barriers still remain.

Freezing time doesn’t come cheap — or easily

On average, the cost of egg freezing averages between $10,000 and $20,000. And, for most people, including AOC, who makes $174,000 a year on her congressional salary alone, health insurance coverage is not an option. According to a 2024 KFF employer survey, just 12 percent of large employers who offer health insurance provide egg or sperm freezing.

That’s not for lack of trying.

As of now, 21 states have mandates requiring health insurers to provide some level of coverage for “fertility preservation” when it is deemed medically necessary — for a younger cancer patient who is about to undergo chemotherapy, for example, a more and more common scenario these days. But coverage for what is viewed as elective freezing, as AOC is doing, is still generally not included in those requirements.

But even the state-level mandates come with a huge carveout. Under America’s Frankenstein healthcare system, there is a very important type of health insurance plan that is exempt from such state laws: self-funded employer plans, meaning those that fully cover their workers’ medical expenses without relying on an outside insurance company. They are governed only by a federal law known as the Employee Retirement Income Security Act, and that law provides no guarantees for egg freezing or other reproductive care. 

About half of Americans get their insurance through their work, and of those employer plans, more than 60 percent are self-funded. That is a lot of people who have no guarantees for this kind of service, even when a serious medical reason is motivating them to freeze their eggs. The select few who can get egg freezing covered are typically higher-income, too, adding to the disparity between the US healthcare system’s haves and have-nots.

Support for IVF among the American public has been rising, with 70 percent saying in 2024 that access to IVF was a good thing. And fertility coverage is having a political moment, too: the HOPE With Fertility Services Act, which would require insurers to cover some basic fertility treatment when it is deemed medically necessary, was introduced this year with a bipartisan slate of more than 20 sponsors, though it remains stuck at the committee level for now. The Trump administration has fixated on dropping fertility rates, but, beyond a limited IVF executive order, they have not seriously pursued plans to expand access to egg freezing. A national mandate to cover egg freezing, even only when medically necessary, could end up being opposed by both health insurers (which have fought all kinds of benefit requirements in the past) and the religious right (which has specifically challenged mandates for reproductive healthcare, like the Affordable Care Act’s contraceptive mandate).

It will likely take a variety of policy changes to give people more financial support for this important but expensive service. So what now? Unfortunately, I think we are stuck with patchy coverage and can expect only incremental improvements for the foreseeable future. On the plus side, Melfi said, more employers may increasingly offer these benefits as a competitive advantage.

But access isn’t the only problem.

Egg freezing works best when people actually know how to take advantage of it

Even if a person is able to access egg freezing, it doesn’t always pay off. 

A study published in the American Journal of Obstetrics and Gynecology in February found that fewer than 6 percent of people who froze their eggs electively had come back to thaw them within five to seven years. Of those people, 79 percent had a usable embryo after warming and 29 percent had a pregnancy that resulted in a live birth.

Of course, just because some people haven’t warmed their eggs within seven years doesn’t mean they won’t come back in nine: The point of this service is you could freeze your eggs at 30 even if you’re not ready for kids until you are 40. Those numbers will likely grow with time. And some of those people might end up successfully getting pregnant on their own the old-fashioned way, which means they won’t need their frozen eggs at all. 

“Typically, people who are coming in to freeze their eggs haven’t actually tried to conceive yet. When they are ready to start conceiving, a lot of people may not have any issues conceiving,” said Dr. Mabel Lee, a reproductive endocrinologist and infertility specialist at HRC Fertility in Pasadena, California who led the published study. 

What is true is that getting pregnant is difficult no matter how you go about it — even conceiving through intercourse only results in a 20 to 25 percent success rate on a given try, Lee said — and success with frozen eggs depends on how young the person was when their eggs were preserved: The younger they are, the higher the chances of success. That makes it all the more important that people — particularly younger people — know about the realities of egg freezing and how to make the most of it, whether they are spending thousands of dollars of their own money or whether they are using insurance to pay for it. Awareness among young people of the basic relationship between age and fertility remains discouragingly low. Lee said she has patients come in all the time who say they wish they had known more about egg freezing sooner.

The likelihood of a live birth may go up if the eggs were younger, but is that enough to convince someone in their mid-20s to pay out of pocket to freeze their eggs? In the midst of an affordability crisis, is that even an option? It might not be; in the meantime, Lee said women could get a blood test to measure their ovarian reserves, which estimates a person’s egg count, and use that to make an informed decision about egg freezing in consultation with their doctor.

Once you have decided to freeze your eggs, using a high-quality clinic is a must: That’s the other major variable in success, Lee told me. The Society for Assisted Reproductive Technology maintains a national database covering clinics across the country and tracking birth success rates and other metrics. It’s like a report card of sorts, so you can hopefully choose the best provider for you.

There are still no guarantees. Fertility is too fickle. But by improving access and raising awareness, there are clear steps we can take to try to maximize egg freezing’s potential.

The U.K.’s medicines regulator approved Eli Lilly’s weight-loss pill on Monday, marking a first European license for the company’s drug.

The Medicines and Healthcare products Regulatory Agency authorized Foundayo (orforglipron) for weight management and type 2 diabetes, and is the “first regulator in Europe” to approve the drug. In the EU, a decision is not expected until next year.

Foundayo is Lilly’s first oral form of the popular GLP-1 drug class, which has surged in popularity with demand fueled by the backing of celebrities and influencers. Its injectable drug Mounjaro (tirzepatide) had been riding this wave.

However, with the arrival of the first GLP-1 pill Wegovy (semaglutide) from Danish competitor Novo Nordisk — which launched in the U.S. and U.K. this year and is soon expected in some EU countries — demand for the more-convenient tablet is expected to rise.

Novo Nordisk has been attempting to reach as many patients as possible with its pill to capture market share, said CEO Mike Doustdar last week.

Doustdar also said the company would soon launch in Germany at its chosen price, ignoring pressure from the U.S. administration to raise prices in Europe.

Washington has been pressuring EU countries to pay more for medicines to offset pharma revenue losses from lower U.S. drug prices. The U.K. is the only country to agree to pay more for medicines via a bilateral deal with the U.S.

Foundayo’s arrival in the U.K. will initially provide competition in the private market.  A decision on whether the National Health Service will cover the pill is not expected until Nov. 18, and will be made by the National Institute for Health and Care Excellence.

Many EU-funded health projects are on hold amid a dispute between the European Commission and capitals over support for NGOs.

At least seven countries, led by France, Spain and Belgium have twice blocked the Commission’s 2026 EU health budget proposal because they say it doesn’t contain sufficient funding for health NGOs. These organizations represent patients, doctors and public health workers in EU health policy debates, typically in opposition to sectors like tobacco, alcohol and, sometimes, the pharmaceutical industry.

The standoff means public tenders and grant applications for EU health projects — such as training more experts to assess medicines, beefing up health security and creating artificial intelligence platforms to monitor brain health — can’t yet go ahead.

“Various stakeholders have expressed frustration over the delay” as they are already putting together consortiums to bid for projects included in the draft budget, a spokesperson for Public Health Sweden told POLITICO.

The delay also has major implications for the EU’s health crisis response.

The Commission’s Health Emergency Preparedness and Response Authority published its work plan in June for the coming year, which includes the expansion of ‘ever-warm’ vaccine production facilities and the creation of a new European Diagnostics Hub to develop cutting-edge technologies — all of which is on hold until the money can flow, unless covered by funds under the 2025 budget.

European Commission spokesperson Eva Hrncirova declined to comment on the potential disruption to the EU’s health program, but told POLITICO the executive would “reflect” on the way forward. 

Root cause

The standoff stems from the Commission’s decision to ax operating grants for NGOs, confirmed in July 2025. These had been in place in Europe since the early 1990s to enable civil society to participate in policymaking on a more equal footing with profit-driven entities.

The Commission told POLITICO the grants were cut to reflect diminished funds for EU4Health after the budget fell from €5.8 billion to €4.6 billion in 2025 to reallocate funds for Ukraine. Health Commissioner Olivér Várhelyi also previously claimed behind closed doors that NGO operating grants were “illegal.”

When countries voted on the Commission’s second proposal last week — which offered €1.3 million in NGO operating grants, having omitted them altogether from its original plan — at least 14 countries voted in favor of the plan, citing the urgent need for a budget.

“The Public Health Agency of Sweden voted yes and we seconded the criticism that came from the other countries on funding for civil society, but saw that further delays in the work programme were not preferable,” the spokesperson for the Swedish public health authority said in a written comment.

But countries standing firm with NGOs worry that ending support for their day-to-day functions will weaken democratic policymaking and leave lobbying as a preserve of private interests. Some NGOs have already shuttered operations in Brussels over the lack of funds.

Spain and France have been the most vocal in their criticism, forming a blocking minority on the EU4Health Programme Committee that signs off on the budget, alongside Czechia, the Netherlands, Lithuania and Malta. Others, including Ireland and Luxembourg, abstained to signal their displeasure with the removal of NGO funds. 

NGOs play “a vital role in representing patients’ interests and ensuring a balanced policy debate alongside well-resourced industry stakeholders,” a spokesperson for Malta’s ministry of health told POLITICO.

A joint statement read out on behalf of Belgium, Czechia, France, Luxembourg, Spain and the Netherlands at the July 31 meeting, and seen by POLITICO, called for “more adequate level of funding for operating grants while safeguarding other low-budget but high-impact actions from further reductions.”

They argue the Commission is at fault for the impasse and ignored multiple warnings from countries that they would not accept the defunding of civil society groups. 

“Several Member States have raised the same concerns for two years, but these have not been adequately reflected. At the same time, the delay increases pressure from stakeholders to approve the programme regardless of those concerns, because important public-health actions and considerable expert work are involved,” a spokesperson for Luxembourg’s Ministry of Health and Social Security, which abstained in support of NGOs, said in a written comment.

‘Symbolic’ offering

The blocking countries didn’t put a figure on how much they wanted for NGOs, but pointed out the €1.3 million on offer was one-seventh what it was in 2023 and 2024, before the grants were scrapped.

Cyprus was among the countries ready to accept the latest proposal, with the country’s ministry of health telling POLITICO it “viewed positively the efforts made to address concerns regarding NGO funding and welcomed the allocation of dedicated funding.”

But Milka Sokolović, director general of the European Public Health Alliance, said the Commission should ensure the grants “provide meaningful support rather than a symbolic contribution.”

“Budget constraints are real, but so is the need to sustain the organizations that bring expertise, accountability and public engagement to Europe’s health ambitions,” Sokolović said.

The Commission has also angered countries with how late in the year it is seeking approval for the work program, combined with what they see as insufficient consultation in the run-up to the vote.

The Luxembourg ministry spokesperson said the Commission “traditionally” prepared the work program a year in advance. “This gave authorities and potential beneficiaries a reasonable indication of forthcoming priorities and call dates. For both the 2025 and 2026 programs, however, the first drafts reached Member States much later, reducing predictability for all concerned.”

Speaking for the Commission, Hrncirova said countries had been consulted. “In line with the EU4Health regulations and its procedures for the preparation, member states are consulted at several stages with several meetings. This has happened,” she said.

The Commission hasn’t yet scheduled another meeting to try to get a budget over the line. “We are now awaiting the invitation to the next EU4Health Programme Committee for the, hopefully, final meeting for the 2026 work programme,” the spokesperson for the Public Health Agency of Sweden said.

“At this stage, the matter is in the hands of the European Commission,” the Maltese spokesperson added.

Brussels is bracing for an unusual fight between the EU’s smallest country and a British ex-footballing legend.

Peter Shilton, the England goalkeeper who conceded the “Hand of God” goal from Diego Armando Maradona in 1986, has started a new life as an anti-gambling advocate after overcoming a decades-long addiction.

Despite being a diehard Brexit supporter, he’s become the poster boy of the European Parliament’s push to tax online betting in a bid to raise some much-needed funds to finance the bloc’s next €2 trillion budget.

But the campaign has run into strong opposition from Malta. The tiny island in the Mediterranean Sea, with a population of just over half a million people, is home to a burgeoning betting sector. It says that higher taxes will cripple its gambling industry, boost illegal operators and drive firms outside the bloc.

“[Malta] will not accept the introduction of any EU-level taxes designed to sustain the bloc’s spending,” the country’s Prime Minister, Robert Abela, told the Maltese Parliament in June.

But Shilton, who lost more than £1 million in betting on horse racing over 45 years and now runs his own gambling addiction charity, dismisses the arguments by Malta and the gambling lobbies as “window dressing.” He’s in favor of higher taxes as he wants to shrink advertising revenue that is used to lure in new gamblers.

“Deep down they’re after everybody’s money. Simple as that,” he told POLITICO during a visit to Brussels in June.

The topic has split the EU’s 27 governments, pitting gambling-heavy Southern European countries against their more supportive Western European peers, led by France. Capitals are already fighting even though the Commission hasn’t yet issued a formal proposal for the possible tax, which would ultimately need to be unanimously approved by governments.

It’s one of numerous budget battle lines being drawn, with Ireland — which is steering the talks as chair of the rotating Council presidency — set to restart negotiations to facilitate an overall deal on the EU budget before the end of the year.

That’s no mean feat given Dublin’s task to mesh competing spending priorities into a single budget — financing everything from farmers’ subsidies to foreign aid — that is acceptable for each of the EU’s 27 governments.

National capitals will have to unanimously approve new EU-wide taxes — known as own resources — to pay for soaring defense spending and post-Covid debt repayments if they want to avoid drastically increasing national contributions to Brussels.

Supporters of the gambling levy point to the fact that it would rake in over €13 billion throughout the next budget cycle and — for some, more importantly — address a serious public health issue. An estimated 80 million adults globally have experienced a gambling addiction, according to experts.

“We look on it [gambling] as an illness. It’s something that’s inborn in you and that can be ignited,” Shilton said.

Malta’s game plan

Malta has invested heavily in the gambling industry — including lotteries, betting and casinos increasingly operating online — which now accounts for around 12 percent of its gross domestic product.

These firms have relocated to Malta because of its light-touch licensing regime, business-friendly tax regime and balmy weather.

The country is “as dependent on the online gambling industry as Germany is on cars,” said an EU diplomat, granted anonymity to speak freely.

While gambling firms need local authorization to operate in most other European countries, securing the Maltese license is crucial to access banking services and gain a foothold in the EU market.

Malta-based firms dominated the German and Austrian online gambling markets before national regulators cracked down. This has prompted the Maltese government to refuse to recognize some court rulings and sanctions issued by other EU countries against its gambling firms.

Given its influence, it is hardly surprising that the gambling industry has found a friendly ear among Malta’s politicians in Brussels.

The Maltese president of the European Parliament, Roberta Metsola, last year gave the opening speech at an international gambling conference in Rome that also featured Italian Foreign Affairs Minister Antonio Tajani.

“I’m more than a little proud that it started in my island home of Malta,” she said, referring to SiGMA, a Maltese events company that focuses on online gambling founded by Eman Pulis, a university friend of Metsola.

Betting lobbies say they oppose higher gambling rates on the grounds that they will fuel appetite for the illegal market, away from the grasp of EU rules.

“A higher tax would lead to worse odds for the customers … and it is relevant because access to the illegal markets in Europe is, obviously, one click away,” said secretary general of the European Gaming and Betting Association, Maarten Haijer.

Nicola Matteucci, an economist at the Università Politecnica delle Marche in Italy who has undertaken extensive research on the gambling sector, argued there is a “point where prices exceed a certain level and the demand [for gambling] diminishes. But it’s not as immediate as suggested by the industry.”

Matteucci said that most gamblers will be undeterred by slightly higher taxes and worse odds as they are not fully rational consumers.

Anti-gambling groups reason instead that higher taxes will reduce the sector’s spending on commercials, preventing would-be punters from getting sucked in to gambling in the first place.

“Higher taxes will therefore mean less gambling advertising overall and many people would regard that as a public benefit,” said Derek Webb, the founder of the Campaign for Fairer Gambling advocacy group.

Club Med joins Malta

Malta has joined forces with fellow Mediterranean countries — Italy, Portugal and Spain — to challenge the mooted tax which was first proposed by the Parliament’s socialist lawmaker Victor Negrescu, said four diplomats with knowledge of the discussions.

According to the European Commission’s estimates, seen by POLITICO, a 3 percent tax on the net turnover of the online gambling sector would generate an estimated €1.9 billion per year.

With its big online gambling market, Spain is expected to be among the biggest financial losers, should the tax go ahead. It is estimated to be on the hook for €414 million per year, almost a quarter of the total amount. That compares to a projected bill of €165 million per year for Malta— a disproportionality high amount for such a small country.

Portugal is also reluctant to back the levy. It fears that higher taxes would eat into revenue brought in by state-run betting and lotteries that is currently channeled to the charity Santa Casa da Misericórdia de Lisboa‘s healthcare and youth support programs, said a Portuguese official.

Meanwhile, given the relatively low uptake of online gambling, Italy’s misgivings have surprised anti-betting advocates. Rome is expected to pay a mere 7 percent of the proposed new levy — a significantly lower proportion than its regular EU budget contributions.

However, Prime Minister Giorgia Meloni’s Brothers of Italy party has previously been receptive to the gambling industry. Last year its MPs passed a resolution encouraging the reversal of a ban on professional football clubs advertising gambling firms.  

BRUSSELS — When French and German security chiefs announced plans last month to develop a “European sovereign digital backbone,” tech and defense industry insiders on both sides of the Atlantic knew what they really meant: Adieu Palantir.  

Across Europe, the hunt is on for alternatives to the U.S.-based data analytics company that a growing number of government officials believe is too deeply lodged in some of the most sensitive areas of government, from local policing and global intelligence to national defense and health systems. 

Yet it is precisely Palantir’s crucial functions in daily workflows, and its largely unmatched data expertise, that will make it extremely hard for Europe to cut it off in pursuit of greater digital sovereignty. 

“Let’s be honest, Palantir’s product is very good and addictive, it’s pretty much like the sugar in Coca-Cola,” said French digital sovereignty advocate, Philippe Latombe. “Palantir can treat massive amounts of data with great precision and with their experience, they had time to improve their algorithms with many clients and adapt them to many use cases.” 

Still, the drive to break free from Palantir is sweeping across the continent, from Madrid, where the government of Pedro Sánchez has instructed state-backed companies to block Palantir from future public procurement contracts, to France’s domestic intelligence services (DGSI) selecting French company ChapsVision over Palantir. In Britain, the next test may come in February 2027, when the new Labour government of Andy Burnham will face a choice of whether to cut off Palantir’s £330 million National Health Service Federated Data Platform contract. 

Last month’s decision by the French and German intelligence agencies to choose ChapsVision was a double-blow for Palantir’s leadership. CEO Alex Karp showed little patience for the sudden turn away from his company’s wares, declaring that he wasn’t worried about European competitors. “We have a model of what doesn’t work,” he quipped last week on Fox Business. “It’s called Europe.” 

Olivier Dellenbach, ChapsVision’s chief executive, told POLITICO that his company has benefited from what he calls a “visceral rejection of Palantir” in Europe.  

But he also cautioned that he did not want ChapsVision reduced to an anti-Palantir way out. Digital sovereignty, he argues, will remain an empty phrase unless governments turn it into industrial policy. “We need more public procurement,” Dellenbach said. 

Belgium, Germany, Luxembourg, Romania, the Netherlands and Canada have already shown interest in the French Army’s Artemis AI, according to Patrick Moreau, one of the architects of the solution built by French aerospace and defense company Thales. 

“They all want to be able to choose a sovereign solution that is compatible with NATO standards,” he said. “Unlike Palantir’s black box.” 

But for now, even officials who want sovereign alternatives acknowledge that Europe’s replacement market remains fragmented and European companies are yet to match Palantir’s scale and track record.

Admiral Pierre Vandier, NATO’s supreme allied commander transformation, recently told POLITICO the alliance has no viable alternative to Palantir’s battlefield AI technology.  

Another NATO official, granted anonymity to speak frankly, said that Palantir’s system has an unmatched capacity to sift through mountains of satellite imagery to help identify a target, advise on the weapon to strike it, inform how much ammunition is required — and automatically put in an order to replenish the stock. 

“As far as I know, today there is no real competitor for Palantir,” Vandier said in May. 

Freedom or democracy? 

Co-founded by Karp and billionaire investor Peter Thiel, Palantir built its reputation inside the U.S. national security apparatus. Today, the company has a market capitalization of $330 billion.

Thiel has been one of Silicon Valley’s most prominent supporters of U.S. President Donald Trump, while the company’s work with U.S. Immigration and Customs Enforcement (ICE) and the Israeli military has come in for criticism from Amnesty International and others for alleged human rights violations. Adding to unease about Palantir’s ideology-driven business were recent revelations of Thiel’s secretive Dialog society, an invitation-only ideas club for the global elite, and Karp’s manifesto arguing that Palantir is the democratic West’s best hope to stay ahead of authoritarian rivals.

“Peter Thiel explains that the defense of freedom does not necessarily require democracy,” French member of Parliament Aurélien Saintoul, who wrote a report on foreign military dependencies, told POLITICO. “He is clearly putting technical means to serve his political project, and we are talking about technofascists here.” 

A Palantir spokesperson who declined to be named dismissed such accusations as “ludicrous,” noting that similar characterizations about the company have been made recently by the Russian foreign ministry.

“We know what side we’re on, and who we’re standing with,” the spokesman said, citing ongoing work to support the Ukrainian military. “Since our inception, protecting privacy and civil liberties has served as the foundation for how we conduct our work across both public and private sector institutions. Western politicians should think hard about who the real enemy is and not allow themselves to be ventriloquized by the Kremlin.”

Many of the company’s European critics maintain that the Palantir question is much more about tech sovereignty than political ideology. Extracting the company from some of the most delicate corners of European security structures would offer a blueprint for claiming more technological independence.

Instead, if governments in Europe cannot wean themselves off a company that provides software solutions, it would reveal how unrealistic hopes are to reduce dependence on U.S. technology giants that provide cloud infrastructure and hardware.

There is also the uncomfortable reality that at the same time that political leaders are calling for a break from Palantir, Europe’s biggest banks and asset managers have dramatically increased their investments in the U.S. company over the past year as it positions itself to profit from the AI gold rush, reports investigative outlet Follow the Money.

From crisis tool to critical infrastructure

Palantir’s European foothold was built long before the current boom in AI. A hallmark of its growth was that it never wasted a crisis to demonstrate its value for governments in need.  

In France, for instance, Palantir arrived in the aftermath of the November 2015 Paris terrorist attacks as security services scrambled to respond to a fervent public backlash on how they could have allowed such a tragedy to happen. The domestic intelligence agency signed a contract with the data analytics giant in 2016. 

A similar pattern played out in Germany, where Palantir’s first major deployment came in Frankfurt, in the central state of Hesse, where police purchased Palantir’s Gotham in 2017 and deployed it under the name hessenDATA. It proved to be a crucial tool for officers to turn sprawling information into leads to help solve crimes.

Germany remains deeply divided over whether to use Palantir’s software. At the national level, Interior Minister Alexander Dobrindt has pushed to expand the use of Palantir and introduced legislation that could pave the way for broader federal use. But the move has run into opposition from coalition partners the Social Democrats, as well as senior security officials.

The same crisis-to-contract pattern appeared in the U.K. during the Covid-19 pandemic. Palantir’s relationship with the National Health Service (NHS) began when it was paid a nominal £1 fee to help aggregate data during the crisis, according to Palantir’s U.K. lead Louis Mosley. 

Europol, the EU’s police agency, used Palantir’s Gotham platform from 2016 to 2021 before ultimately dropping it. For one Europol official who was granted anonymity to discuss the matter freely, the problem with Palantir is less ideological than practical. Yes, the platform is expensive, raises sovereignty concerns and leaves clients dependent on Palantir for updates, the official said. But the more basic question is whether every agency needs the full Palantir machine. 

“[Palantir] is really good when you have massive amounts of data and want to connect everything,” they said. “But that is not the case for us. In many cases, the alternatives are close enough. If we used it, I’m not sure our efficiency would increase dramatically.” 

Part of Palantir’s approach in Europe is to hire former officials from the institutions it wants as customers. OpenDemocracy reported that Palantir hired four former officials from the U.K.’s Ministry of Defence before winning a £240 million MoD contract.

The influence drive 

Moreover, Palantir is now seeking new business on the continent in defense.

On Jul. 1, Palantir’s Maven Smart System — which was first used by the Pentagon — became fully operational at NATO, meaning it’s been given security clearance to operate on the classified network. According to a NATO statement, the platform links command-and-control systems across the Alliance. 

“I think this is a very important milestone for European defense,” said Palantir’s U.K. chief Louis Mosley. 

But Palantir’s grip on Europe does not stop at the doors of government or army barracks. It also runs through some of the continent’s industrial crown jewels. Airbus signed with Palantir in 2015, making Palantir’s Foundry the backbone of its aviation data platform. Automaker BMW, energy company British Petroleum and media publisher Axel Springer — POLITICO’s parent company — all use Foundry to improve their business productivity as well. 

Looking for alternatives 

Even if Europe manages to loosen Palantir’s grip, the company’s model built on top of the latest AI large-language systems appears to only be getting stronger. On Jun. 30, Amazon Web Services said it would invest $1 billion in a new “Forward Deployed Engineering” organization, embedding teams of engineers inside customer headquarters to build AI systems alongside them.  

Days later, Microsoft announced a $2.5 billion push to send 6,000 engineers and industry specialists into client organizations. Both initiatives echo Palantir’s pioneering model to not simply sell software but put engineers inside a buyer’s operation. 

Both the strength of its products and the sensitive areas where they’re applied, make Palantir Europe’s sovereign test case par excellence. If governments and companies can replace a software layer that helps turn data into decisions, they may have a blueprint for clawing back some digital sovereignty. If they cannot, the next generation of AI tools from U.S. tech giants may prove even harder to quit. 

“Europe’s public institutions cannot become dependent on software built by a small circle of U.S. tech billionaires with an obscure political worldview,” said German Green MEP Hannah Neumann, who sits on Parliament’s defense committee. “It would be like outsourcing part of the democratic state to a private intelligence service that answers neither to voters nor to parliament.”

David Pargamin contributed reporting from Paris.

Poland on Monday appealed a Brussels court judgment ordering it to take delivery of roughly 64 million unwanted Covid-19 doses and pay Pfizer about €1.3 billion. Warsaw also asked judges to freeze the ruling’s provisional enforcement while the challenge is heard.

“The decision of the court of first instance does not take into account all the relevant factual and legal circumstances of the case,” the Health Ministry said in a statement. It added that Poland would use “all legal means of defense,” but declined to disclose its arguments or evidence, citing the need to protect the state’s interests.

The ruling which Poland appealed relates to a 2021 agreement the European Commission negotiated with Pfizer on behalf of EU countries. Poland stopped accepting vaccine deliveries in 2022, citing collapsing demand and the impact of Russia’s war against Ukraine. Pfizer sued Poland and Romania the following year. In April 2026, a Brussels court ruled that Warsaw remained bound by the contract and ordered it to pay roughly €1.3 billion, plus interest and legal costs, for the undelivered doses.

Pfizer defended the Belgian judgment, which it told POLITICO reflected “the importance of the contractual obligations that underpinned a successful European pandemic response, built on the principle of solidarity between Member States.” The company said it was taking “appropriate steps” to ensure compliance through “established legal enforcement mechanisms,” adding that those efforts followed “years of discussions and significant flexibility to accommodate Member States’ circumstances.”

Washington is again ratcheting up the pressure on the European Union with new tariff threats. Brussels’ response is strikingly different from a year ago: Don’t retaliate, don’t put on a show for Donald Trump, and don’t let him dictate the timetable.

Trump’s recent threat to “immediately initiate” a trade investigation over the European Commission’s $1 billion fine against Google came on top of new tariffs on the EU and dozens of other trading partners, and continuing pressure from Washington over drug pricing.

But rather than sounding alarms and scrambling to respond to this new phase of Trump’s global trade war, the EU has shown public restraint — a reaction that suggests that the 27-member bloc has become less susceptible to Trump’s pressure tactics.

This year, European capitals saw their united rejection of Trump’s Greenland ambitions fail to trigger a wider transatlantic rupture. His most sweeping tariffs were struck down by the Supreme Court, and their successors have drawn legal challenges. Now, with a chance that Trump’s grip on Washington loosens in the November midterm elections, Europeans are happy to play for time.

“It is a strategy of buying time through dialogue,” Bernd Lange, a German member of the European Parliament and chair of its Committee on International Trade, said in an interview. “The Commission’s approach is to move away from anything that could be seen as legally binding and focus instead on dialogue forums, consultation and areas where cooperation is possible.”

Last year, Brussels repeatedly bristled at Trump’s tariff threats, which at times reached as high as 50 percent, before agreeing to a trade truce at the U.S. president’s golf resort in Turnberry, Scotland. After months of delays that tested Washington’s patience, the EU fulfilled its side of the bargain by passing legislation in June to allow U.S. industrial and some agricultural goods to enter the bloc duty-free.

A USTR official, granted anonymity to share the administration’s thinking, credited the EU for implementing “key commitments,” in the Turnberry deal, “such as massive tariff reductions for U.S. exports, and has made concrete commitments on a number of other burdensome regulatory matters.”

“Any technical talks will be about implementing the remaining commitments, and the U.S. side anticipates this will move at pace,” the official added.

The White House did not respond to a request for comment.

The EU law, however, also includes guardrails should Trump threaten the bloc again.

It didn’t take long for him to do so.

While the 10 percent tariff the U.S. government rolled out July 23 does not violate the Turnberry agreement, which caps U.S. duties on most EU goods at 15 percent, Trump’s threats to investigate Europe’s digital restrictions in the wake of the Google fine would likely do so. The Office of the U.S. Trade Representative has yet to launch an official investigation, but the official there confirmed to POLITICO that the agency expected “to initiate the investigation soon”. That could allow the White House to layer on more tariffs on EU imports.

U.S. Trade Representative Jamieson Greer is also conducting a separate trade investigation into Germany’s pharmaceutical pricing and has suggested he could launch similar reviews of other European countries’ drug pricing practices as well.

Those investigations, however, will take months to resolve, if not longer.

“The second phase of the trade war touches a nerve in Europe: sovereignty. Whether it concerns taxation, health care systems or competition policy, these are areas the EU sees as core to its autonomy,” said Jeromin Zettelmeyer, a former International Monetary Fund and German government official who now heads Brussels-based think tank Bruegel.

“At the same time, Trump no longer appears as politically untouchable as he did at the start of his presidency. Weakening poll numbers ahead of the midterms, controversy over the Iran war and legal setbacks in the U.S. Supreme Court have exposed vulnerabilities,” Zettelmeyer said.

In the meantime, EU officials are keeping channels to Washington open. The thinking in Brussels is that every public confrontation plays to Trump’s preferred negotiating style, whereas slower legal and technical processes give the EU more room to manage disputes on its own terms.

Nor is German Chancellor Friedrich Merz in a rush to offer concessions to the Trump administration on drug pricing, according to a European official familiar with the issue who was granted anonymity to discuss the sensitive talks. Berlin expects the U.S. trade investigation to take at least a year, the person noted.

Brussels is in close touch with Berlin on the probe, which it believes could be a blueprint for other possible U.S. trade investigations into France and Italy’s pharmaceutical policies. Ditte Juul Jørgensen, head of the Commission’s trade department, recently met with German officials in Berlin to focus on a way forward on drug pricing.

The Commission has adopted a similar strategy on transatlantic disagreements on digital policy.

While the Trump administration has pressed for broader talks, including on the enforcement of the EU’s competition rules governing Big Tech platforms, Brussels has taken pains to keep the discussions at a technical level.

In early July, a group of officials from the European Commission’s trade and tech departments headed to Washington for what a Commission spokesperson described as “a dialogue on the dialogue.”

A senior Commission official said the meeting was about seeing where the two sides could “partner up,” with Brussels looking at holding a “high-level” meeting with Washington in the fall and a series of technical rounds in between.

“From the EU’s perspective, both sort of genetically as an organization and tactically, they would be happy if as many of the discussions as possible moved to the technical level in dialogue committees rather than have it be, like, Donald Trump and somebody going at it on Twitter or in competing press statements,” said Dmitry Grozoubinski, a former trade diplomat for the Australian government and the founder of ExplainTrade, an outlet based in Geneva.

The Commission responded with characteristic restraint after Trump threatened retaliation over the latest Google fine. After the U.S. president’s Truth Social post, Brussels emphasized it would seek “technical-level contact” between the EU and the U.S., said deputy chief spokesperson Olof Gill. A meeting at a higher, political level hasn’t yet been confirmed.

However, several people familiar with the matter confirmed they were expecting a reaction from the U.S., possibly in the form of a new 301 investigation.

“I have not heard anything yet on timing for the launch or scope of the Section 301 investigation,” said a U.S. tech industry representative, who was granted anonymity to discuss the conversations with administration officials. “But I believe this has been in the works for some time as a means of leverage in U.S. negotiations with the EU.”

Europe’s strategy depends on shifting disputes out of Trump’s preferred arena of public confrontation. But officials acknowledge that this bet rests on one unpredictable factor: Trump himself.

“We cannot let our guard down,” another Commission official said. “Trump may change course at any moment. His focus is on how markets react to his policies, not on how the EU behaves.”

Stefanie Bolzen reported from Washington and Camille Gijs reported from Brussels. Oliver Ward contributed to this report.

AI is the hottest thing in medical care right now — but many of us feel trepidation about it. Just one illustrative public survey sample: An October 2025 KFF poll found just 8 percent of Americans reported feeling a “great deal” of trust in AI managing their appointments or analyzing their health records, and only 32 percent said they would trust an online health tool that uses AI to access their medical records to provide personalized health information.

But many clinicians and healthcare administrators see AI as a powerful new tool that offers myriad opportunities to streamline and improve treatment. A 2026 survey found that more than 80 percent of US doctors use AI professionally — doubling the share from 2023. Physicians are excited by AI’s potential to keep more accurate notes of interactions with patients, to act as a second pair of eyes for human doctors, and to monitor people at risk of deteriorating and ending up in a dangerous situation.

The disconnect between what people and their providers want from AI could create more distrust, at a time when faith in the healthcare system and the medical profession have slid. Patients today want to feel empowered and in control. How can that be possible when these seemingly godlike machines are becoming more and more entrenched in our hospitals and doctors offices?

The answer comes in four words: “human in the loop.” It’s the principle upon which the ethical integration of AI depends and it could help to bridge the gap between lay people and the professionals on AI in medicine. In surveys, people are much more comfortable with the idea of their doctor using AI as an assistant than with AI acting on its own. And most clinicians want to use AI in that way, as a second opinion or passive monitor, not as a replacement for their judgment. There are real fears among the healthcare workforce about that possibility: A group of NYC nurses who were recently laid off claim it’s because their labor was going to be replaced by AI. “Human in the loop” appears to be a point of agreement between doctors and patients at this pivotal moment.

“Doctors…and nurses and staff always have been interested in primarily making the best decision for the people under their care — and these tools can help with that,” Alison Callahan, a research scientist at Stanford University who works on AI programs used in the university’s health system, told me. “The interest in making sure those tools are accurate is high.”

But what does “human in the loop” really mean in practice? How can you know when and how your doctor is using AI? And what is the best way to talk to your provider about the sudden influx of artificial intelligence in healthcare before a robot starts taking appointment notes or analyzing your MRI? I called some leading experts to find out. 

How AI is currently being used in medicine

Patients and providers alike are incorporating AI into healthcare. Individuals are using commercial AI chatbots to ask about their symptoms or the health metrics tracked by their Apple Watch, while large academic medical centers are developing sophisticated programs and protocols to try to improve medical care at the population level.

It starts with ChatGPT, Claude, etc. — the large language models that are available to the public. People are increasingly turning to them to try to understand what’s going on with their own bodies. Individual physicians are also consulting with large language models to answer questions or get up-to-date on the latest research as they figure out how to best care for their patients. 

Then there are ways in which hospitals and doctors offices are adopting AI at the institutional level. Many facilities are using AI as a way to take, collate, and summarize notes on a patient; in theory, it’s a more organized way to keep track of the informal interactions and observations that doctors have when checking on their own patients. Hospitals are also using AI to handle some administrative tasks, like scheduling follow-up appointments; some health systems have even started to use AI to help patients get ready for appointments — to send reminders about colonoscopy prep, for example.

And finally, you have maybe the most ambitious use of AI by health systems right now: as a diagnostic and risk prediction tool. In these cases, AI might offer a second opinion when, for example, a doctor is triaging a patient in the emergency room. It might help the ER staff figure out how to prioritize patients. Or these programs could monitor people either during a hospital stay or out in the real world (by drawing data from the person’s wearable) and make predictions about who may be at higher risk of complications and require further care. AI could recommend that somebody would benefit from seeing certain specialists or receiving a specific medicine or lab test, and generally offer proactive advice about the patient’s medical care.

But at this point, AI adoption is still “highly localized,” said Jennifer Goldsack, CEO of the Digital Medicine Society, a nonprofit that works with healthcare providers, drug makers, and government agencies on how to incorporate new tech (including AI) into clinical care. It depends on the individual doctor or health system. A lot of them are setting up their own programs and their own protocols for how to use these tools.

That is a big reason why it is so important for patients to be proactive about understanding how AI is being used for their health care. You can’t make assumptions; the only way you’re going to know for sure is to ask.

The questions you should ask your doctor about AI

By and large, experts say, patients should feel confident: Doctors and nurses want to keep a human in the loop, even as they integrate AI into their workflows.

“It will be a doctor who is going to be reading that summary or a nurse who is going to be reading that summary and then taking an action to order a lab or put a recommendation in for a follow-up appointment,” Callahan said. “There is high interest in making sure that that is the right decision for that person. That hasn’t changed.” 

Still, many patients say they’d be more comfortable with AI use if their doctor fully explained it in advance. And health systems may have their own priorities that push their facilities toward more rapid AI adoption and delegating more tasks to these AI tools, as seen in the recent NYC nurse layoffs.

So if you want to be informed on exactly where this technology is present and have the ability to consent to its use, you have every right to ask your doctor, experts say. 

“AI is new, but the trust that serves as the foundation of the physician-patient relationship is not,” Timothy Keyes, a machine learning scientist at Stanford Health Care, told me over email. “To that end, I think that conversations about medical AI use should be open, honest, and transparent — just like any other conversations about shared decision-making in the clinical environment should be.”

For some things, your doctor should be asking you proactively if you consent to AI use — note-taking, for example. At my most recent primary care appointment, my doctor asked me if it’d be okay for him to use AI to take and summarize notes from our conversation; Goldstack told me she’d experienced the same at recent physician visits. (This is probably the most common AI use that you will encounter, and Keyes said it’s worth considering giving your consent: “There is growing evidence that they reduce physician burnout and save them at least a bit of time each day writing notes.”)

There are also a number of direct questions that you can ask:

• Will AI be used in my care and how?
• How is my data being protected?
• Can I opt out of any AI services that I do not feel comfortable with? (Keyes noted that patients should be allowed to opt out of any care, AI-related or not; if opting out is not an option, ask how a human provider will be involved.)
• How is the health system or clinic making sure that any AI system they use is working as intended?

And the transparency goes both ways. If you’re asking a question because you consulted ChatGPT before your appointment, tell your doctor. If you’ve talked with a chatbot because of mental health struggles, tell your doctor. And at the same time, feel free to ask your physician how you yourself could actually use AI in a responsible and productive way to improve your health.

“This opens up the opportunity for both the physician and the patient to be humans-in-the-loop,” Keyes said, “in different parts of the loop, with different perspectives, using an AI system to better understand the bigger picture.”

In a way, the novelty of AI and its rapid adoption is an opportunity for all of us to be nosier and more inquisitive patients. What all of these questions really come down to, Callahan said, is how your doctor is making decisions about your health care. That is relevant to all of us, no matter how AI is involved or even if there is no AI being used at all. 

Callahan said she always has a list of questions for her doctor when they recommend a course of treatment: “What are the factors in my health that are informing this recommendation that you have? Would you be making this recommendation for other patients who are similar to me? What can you tell me about the outcomes that I might expect to experience if I say yes to this?”

“I actually think if they can point to the part of your health that is connected to the decision, whether or not an AI tool helped to make that connection is secondary to their ability to communicate effectively to me about it, and help me to feel engaged in making a decision about my own care,” she said.

AI is changing medicine quickly, for both patients and their doctors. The best way to stay ahead is to talk about it.

Were she to run for the Democratic presidential nomination in 2028, Kamala Harris would enter the race with formidable advantages. Thanks to four years as vice president and two presidential bids, her name identification is universal, and she has demonstrated the ability to raise mounds of money. But she would not clear the field. 

The list of possible contenders for the Democratic nomination is a mile long and includes governors (California’s Gavin Newsom, Kentucky’s Andy Beshear, Maryland’s Wes Moore, Pennsylvania’s Josh Shapiro and Illinois’ J.B. Pritzker), lawmakers (Arizona Sens. Mark Kelly and Ruben Gallego, New York Rep. Alexandria Ocasio-Cortez and California Rep. Ro Khanna), former Transportation Secretary Pete Buttigieg and former Chicago mayor Rahm Emanuel, to name a few. In an Emerson College poll released July 23, Harris came in fifth with 8%, trailing Buttigieg (19%), Newsom (17%), Georgia Sen. Jon Ossoff (13%) and Ocasio-Cortez (13%). 

But as she weighs a third presidential bid, Harris stands to face a bigger and more formidable opponent: herself.

Harris was done dirty by the Biden White House. It was nothing short of political malpractice to handicap and undercut a loyal veep who, according to actuarial tables, could have easily been elevated to the Oval Office in the event of the aging president’s death. (Considering Joe Biden’s post-presidency diagnosis of aggressive metastatic cancer, his staff’s treatment of Harris looks even more outrageous in hindsight.) This was particularly true because, after enduring brutal press cycles in her first two years as vice president, Harris ended up becoming a secret weapon of sorts for Biden, passionate and nimble on the stump in defending reproductive rights in the wake of the 2022 Dobbs decision that overturned Roe v. Wade, and making skillful strides on the world stage.

But if she was not set up for success by the administration while in office, Harris now appears to be falling into a trap of her own making, even as she is “holding lengthy, closed-door meetings” with progressive activists and groups.

In a recent New York magazine feature, a supporter of the vice president — identified as someone “who had recently spoken with her and came away convinced [she] is running in 2028” — inadvertently revealed what, if accurate, looks likely to be her Achilles’ heel. “She is looking for where the wave is going and is determined to ride it,” they said.

Left unsaid was that this is what Harris has long been accused of doing — again and again. 

There’s a balance every politician must strike: retaining one’s authenticity while remaining open to recalibrating policy positions in response to new evidence or simply evolving, or to match shifts in the public mood. Some, like Biden, are particularly skilled at this. But charges of flip-flopping cling to other politicians like barnacles on a sailboat, becoming a drag on their campaigns and threatening long-term structural damage to their brand.

This is where Harris is at right now. Despite her national profile, there remains a nagging suspicion that she lacks an internal compass and the courage of her convictions. Since she was first elected to public office as San Francisco district attorney in 2003, she has sometimes shifted positions according to which rung of the political ladder she was climbing. 

As the junior senator from California, a progressive state, Harris was vocal in her support for Medicare for All. Famously, in a June 2019 Democratic presidential primary debate, she raised her hand when the moderator asked candidates if they would support eliminating private insurance. Her campaign quickly attempted to walk back her response, and she began softening her position by releasing a plan that called for expanding access to Medicare while maintaining private insurance options. As Biden’s running mate, she supported his position of expanding the Affordable Care Act. 

Harris’ shifts on healthcare, while anathema to some progressives, are easier to justify: Her core value of wanting universal healthcare didn’t change, she might explain, only her approach did. But her shift on fracking is much harder to square.

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During her 2020 presidential bid, Harris expressed support for an outright ban on fracking, and she brought along a record as California attorney general of investigating oil companies for environmental abuses. But in the face of heat from Donald Trump and Republicans, and needing to put Pennsylvania in the Democratic column on election night, Harris clumsily reversed her position while claiming her “values have not changed” and that she was “seeking consensus.” The explanation didn’t seem to ring true for many voters, and she lost Pennsylvania to Trump by 1.7%.

There have been other policy reversals as well, ranging from the death penalty and cash bail to marijuana and immigration, which have left her vulnerable to Republican attacks and made some Democrats wary. 

The New York magazine story indicated that Harris was blaming political consultants for her loss in 2024. “Her mindset is that I should have won,” a supporter told the outlet, “and I am going to do it my way because my way would have won, and it was all these consultants that were telling me to take this position or that position, and it was their fault.”

The problem is that this mindset further adds to the perception of Harris as a political opportunist, and should she eventually enter the primary, it will raise questions about her judgment and management that she will have to confront.

The Democratic Party has changed in the two years since her presidential campaign. The ideological fissures are more apparent, with democratic socialist candidates winning primaries — and elections, in the case of New York City Mayor Zohran Mamdani, whom Harris notably called in June — and nearly two years into the Trump’s second term, the party has become much more restive and angry.

For 2028, Democrats aren’t wanting someone who is searching for a wave to ride to victory. They want someone to instead be that wave.

The post Kamala Harris’ biggest opponent in 2028? Herself appeared first on Salon.com.

Last week, the Food and Drug Administration (FDA) approved a small pill called enlicitide. It is a tablet you swallow once a day on an empty stomach with a sip of black coffee, water, or tea. But it does something that until now took a needle and a specialist’s prescription: It lowers the most dangerous kind of cholesterol by nearly 60 percent, about as much as the strongest injectable drugs on the market.

If that sounds less innovative than some of the medical advances I sometimes cover here — there’s no AI or gene editing involved — you’re missing the story. Enlicitide is just the latest example of how medicine has been quietly making progress against the deadliest thing in the modern world.

That thing is heart disease. It has been the leading cause of death in the United States for essentially a century, and in 2025 it killed 694,708 Americans — about one in five deaths — more than every form of cancer combined. Around the world, cardiovascular disease kills roughly 20 million people a year, the biggest cause of death on the planet.

But today, our enemy is on the retreat. In the US, the age-adjusted death rate from cardiovascular disease has fallen about three-quarters since 1950. In plain terms: A 60-year-old today is roughly four times less likely to die of heart disease this year than a 60-year-old was when Harry Truman was president. As I wrote last year, deaths specifically from heart attacks are down 89 percent since 1970.

That progress comes down to a single number. Low-density lipoprotein, or LDL, aka the “bad” cholesterol your doctor always wants you to lower. Until recently, a high LDL score was all but inescapable, something you could nudge lower with a better diet and willpower but struggle to really fix. What has changed is that we can now lower LDL for nearly anyone who needs it — further, more easily, and earlier in life than before.

A lifesaving genetic mutation

It’s a story that goes back 20 years. In the early 2000s, two geneticists at University of Texas Southwestern, Helen Hobbs and Jonathan Cohen, wanted to solve a medical mystery: Why did some individuals have striking low cholesterol levels? They combed the Dallas Heart Study for an answer. They found a handful — many of them Black Americans — carrying a broken copy of a gene called PCSK9. Their bodies cleared LDL from the blood with unusual efficiency, and the payoff was staggering: carriers of the strongest variant had about 28 percent lower LDL and roughly 88 percent lower risk of heart disease than people who did not carry the mutation.

That finding proved lowering LDL prevents heart attacks, and it handed drugmakers a target: copy that gene. Every PCSK9 drug since — including the new enlicitide — imitates a mutation a few people in Dallas were simply born with.

Millions of Americans still take the old cholesterol-lowering workhorses, statins, and they’ve proven highly effective at reducing heart disease for most people. But not everyone: Some people can’t tolerate the muscle aches; others take them faithfully and still don’t get their LDL low enough. Enlicitide is built for exactly those people: a pill as cholesterol-lowering as an injection but without the needle, and a drug that spares them the statin muscle aches.

Closing the loop

If the pill is today, gene editing is tomorrow — and it may be the answer to a problem no pill can reliably solve: getting people to keep taking their medicine.

About half of patients on statins quit them within a year, and a daily pill, however potent, only helps the people who actually take it. So that demands a fix you can’t forget. A company called Verve Therapeutics, now owned by Eli Lilly, has been testing a treatment that makes a single-letter edit to the PCSK9 gene in the liver — one infusion, in theory for life. In its first human trial, published over the spring in the New England Journal of Medicine, a single dose cut LDL by as much as 62 percent, and held it there for more than a year. Instead of a pill mimicking the effects of the genetic mutation that protected those people in Dallas, gene editing just switches off the gene.

As important as it is, cholesterol isn’t the whole story when it comes to heart disease. There’s smoking, which declined from about 40 percent of US adults in the 1960s to under 15 percent today, sparing countless arteries. High blood pressure — the silent condition that killed President Franklin D. Roosevelt at 63 in 1945, when doctors had few effective ways to treat it — can now be caught early and treated with cheap generic pills.

And then there are the GLP-1s. More than one in 10 US adults say they are currently on an anti-obesity drug, and whatever else you may think of them, they’ll make a significant dent in heart disease. In one major trial semaglutide cut cardiovascular events by 20 percent.

The war continues

Still, the war on heart disease won’t be easy to win.

Just because a pill like enlicitide has been proven to lower a lab value does not mean it’s yet proven to lower deaths. They should — the injectable versions of these drugs cut heart attacks and strokes by about 20 percent in long trials. But enlicitide’s own outcomes study won’t conclude for years.

Precisely because the condition itself so widespread, treatments for heart disease will only be effective if they are equally widespread.

Heart disease is shifting, too. The same research showing heart-attack deaths down 89 percent found deaths from other heart conditions — heart failure, arrhythmias, hypertensive disease — up 81 percent since 1970, though because heart attacks were killing several times as many people, overall heart-disease deaths have still dropped by about two-thirds since 1970.  Some of that shift is perversely the result of success: people who might have died of an initial heart attack now live long enough for the heart to wear out in other ways. And some of this is the reverse of progress: As smoking and cholesterol fell, obesity climbed to about 40 percent of US adults, pulling diabetes and high blood pressure with it.

And then there’s perhaps the biggest problem in medicine: access. A 60 percent drop in cholesterol helps only the people who can actually get the drug. Half of patients abandon cheap statins within a year. Enlicitide arrives at about $300 a month with uncertain insurance coverage. The gene edit, whenever it becomes available, will certainly cost far more, and at first will reach only the sickest.

More than 60 percent of US adults are projected to have some form of heart disease over the course of their life. Precisely because the condition itself so widespread, treatments for heart disease will only be effective if they are equally widespread.

Which brings us back to that unassuming little pill. It’s just a tablet, doing what a generation of scientists spent their careers trying to do: turning one of the deadliest numbers in medicine into one you can change. It’s the kind of progress that’s too easy to miss — until it saves your life.

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

Abdul El-Sayed is among America’s most prominent proponents of Medicare-for-all. 

The frontrunner in Michigan’s Democratic Senate primary literally wrote the book on that policy (or at least, a book on it). In El-Sayed’s view, Medicare should cover “all necessary healthcare” for every American — without co-pays, premiums, or deductibles — and be “accepted everywhere.”

Alas, despite his many years of advocacy, El-Sayed has seemingly failed to persuade his wife of that last point: According to a recent report from the Washington Free Beacon, El-Sayed’s partner, the psychiatrist Sarah Jukaku, does not accept Medicare as a form of payment at her private practice.

This bit of gossip is of little importance, in and of itself. The Free Beacon’s story does nothing to refute the case for El-Sayed’s candidacy or his healthcare plan (his wife’s business is, well, her business). As hit pieces go, it’s weak tea.

Nevertheless, the tension between El-Sayed’s healthcare proposals and his wife’s business practices is real. And it is illustrative of a major challenge facing anyone who wishes to reform our nation’s misbegotten healthcare system: To meet the medical needs of all Americans, reformers will need to defy the interests of most doctors — and in many cases reduce their compensation. 

And that won’t be easy. Few people feel a deep fondness for insurance companies. But El-Sayed is far from the only American who loves a physician.

The biggest obstacle to Medicare-for-all

To understand why Medicare-for-all would be bad news for many doctors — and how the Free Beacon’s story illustrates that point — we must first dwell on one fundamental fact about America’s healthcare system: It’s a rip-off. 

The US spends about twice as much per person on medical goods and services as other wealthy countries. And yet, all that money does not actually buy us much more care. Compared to our peers abroad, Americans are less likely to see a doctor, secure a long hospital stay, or access a timely appointment for medical treatment. On the other hand, we do have the privilege of paying radically higher healthcare prices.

To take just one telling example: In the United States, a coronary bypass surgery will typically cost more than $89,000; in Australia, it costs just $17,741.

Such exorbitant prices are the chief obstacle to any version of universal healthcare. Even with one-third of working-age Americans uninsured or underinsured — and thus, consuming too little medical care — the bill for America’s health sector ran to $5.7 trillion in 2025. 

In El-Sayed’s vision, Americans would consume vastly more medical services than they do today: The uninsured would suddenly have access to every doctor in the country, while everyone else would see their co-pays and deductibles drop to zero, encouraging them to schedule far more doctors’ visits.

This would be a costly proposition in any country. At America’s current healthcare prices, it would be prohibitively expensive. There is simply no way to realize anything approaching the left’s healthcare ambitions without slashing the amount of money that Americans pay per medical service. 

Doctors will pay a price for universal healthcare

Medicare-for-all advocates are aware of this fact. And they’re typically eager to talk about one source of America’s high healthcare prices: The inefficiencies of our private health insurance model. 

In America’s byzantine system, each insurer needs its own teams of auditors, claims reviewers, and myriad other specialists, while every major healthcare provider needs a horde of administrators to navigate the idiosyncratic rules of all these different insurance companies. Americans pay dearly for this bureaucratic bloat. By one estimate, our system’s administrative costs are $500 billion higher than they would be if the insurance industry was consolidated into a single public insurer. 

And yet, as large as that figure may seem, it still represents a fraction of America’s excess healthcare costs. The primary cause of our nation’s exorbitant medical prices is simpler than administrative redundancies: our healthcare providers charge exceptionally high rates.

Hospitals are the biggest culprits on this front. But physicians are also part of the problem.

According to a 2026 study from economists at the University of Chicago, Stanford, and the US Census Bureau, American physicians earn about twice as much as Canadian ones — and four times as much as Swedish doctors. 

Critically, this does not merely reflect America’s greater wealth or wage inequality. It is true that educated professionals of all kinds — financial analysts, lawyers, software engineers, etc. — earn more in the US than they do in other rich countries. But American doctors don’t just earn unusually high absolute incomes — they also occupy an atypically rarified place within their own country’s class hierarchy. About 42 percent of American specialty physicians are in the top 1 percent of their nation’s income earners. Among Canadian specialists, that figure is just 27 percent; for Swedish ones, it is 7 percent.

The main driver of these disparities is straightforward: America imposes fewer price controls on its healthcare sector than other nations do. 

And this is where Jukaku’s practice reenters the picture. 

The public parts of America’s insurance system — Medicare and Medicaid — pay rates that are only modestly above international norms. It is when American doctors bill private insurers — or the rich consumers of boutique medicine — that they really make bank.

As a result, top clinicians like Jukaku often decline to take Medicare. If you’ve got affluent patients beating down your door, accepting Uncle Sam’s rates just doesn’t pay.

Unless the government forces doctors and hospitals to swallow steep pay cuts, however, Medicare-for-all won’t pencil out. According to a widely cited 2018 analysis by the economist Charles Blahous, if a single-payer system kept provider payments constant, national health spending would rise by $3.25 trillion over a decade, even with administrative savings taken into account. By contrast, if all providers were forced to accept Medicare’s rates, health spending would actually fall by $2.05 trillion over the same period.

Soaking physicians is tough politics

Thus, there is a clear conflict between progressives’ healthcare ambitions and medical providers’ material interests. 

Yet the left is often reluctant to acknowledge this reality. El-Sayed tends to portray insurers as the sole economic beneficiaries — and political defenders — of America’s inequitable healthcare system. The fact that hospitals and doctors also profit off the status quo’s dysfunctions does not feature prominently in his rhetoric. To the contrary, El-Sayed suggested in 2020 that doctors like his wife are actually underpaid, even though American psychiatrists earn far higher salaries than their counterparts abroad. 

To be fair, progressives aren’t alone in eliding providers’ culpability. Virtually all Democratic politicians do the same. And not without reason. Politically speaking, it is one thing to denounce the greed of private insurers — the faceless bureaucracies standing between Americans and their desired treatments. It’s quite another to call for reducing the wages of doctors, men and women who perform laudatory work and enjoy widespread admiration. 

Precisely for this reason, however, reformers must grapple with healthcare providers’ investment in the current system. The American Medical Association (AMA), the lobby representing our nation’s physicians, was instrumental in killing past attempts to move toward single-payer. And at least some segments of the medical profession would surely mobilize against any contemporary Medicare-for-all bill that imposed substantial cost controls on the healthcare sector. What’s more, in doing so, they would be able to draw on a resource the private insurance industry lacks — the public’s trust.

How to make healthcare less expensive right now

There is no easy answer to the problems all this presents. But part of the solution is to chip away at providers’ payment rates where progressives already have the power to do so. This would not only help drive down costs for existing healthcare in the short term, an urgent priority all its own, but also would smooth the path to universal coverage in the long run.

That project can take many forms. One would be state-level payment regulations. In Maryland, hospitals receive the same rates, no matter whether their patients pay with Medicare, private insurance, or cash. And their budgets are also fixed, so that they aren’t able to milk fees out of unnecessary care. Rhode Island, meanwhile, caps the growth of its hospital reimbursement rates at the pace of overall inflation. Other states could follow their lead. 

But policymakers should also address the supply constraints that undergird American doctors’ high salaries. US physicians’ ability to command high pay doesn’t just reflect America’s weak cost controls but also a persistent shortage of working doctors. The US has roughly 2.7 physicians for every 1,000 of its residents; the average among comparable countries is 3.9, according to a Kaiser Family Foundation analysis.

In this context, forcing down doctors’ pay might seem perilous. After all, doing so would reduce young people’s incentive to pursue a medical career, potentially deepening the shortage. 

In reality, however, there is no dearth of qualified people who want to practice medicine in the US. We just don’t let many of them do so.

This is partly because American policymakers consciously sought to restrict the number of doctors in the country, beginning in the 1980s. As Robert Orr of the Niskanen Center explains, the US government issued a report in 1981 warning of an imminent “physician surplus” and recommending “immediate action to curtail both the domestic training of physicians as well as the admittance of those trained outside of the country.”

The report’s argument rested on false premises; it failed to anticipate that Americans’ demand for healthcare would rise sharply as they grew wealthier. Nonetheless, its recommendations were largely implemented: Federal support for medical-school scholarships was pared back while funding for residencies has been capped since 1997. 

At the same time, policymakers maintained high barriers to the immigration of fully-trained foreign doctors: Even physicians with years of experience, and credentials in nations with high medical standards, are typically required to complete a multi-year residency before being able to practice in the US.

Ending the federal freeze on residency funding will require congressional action. But states can immediately make it easier for foreign doctors to practice within their borders. In fact, Tennessee established a pathway for such physicians to ply their trade in the state, without having to repeat a residency, in 2023. And many states subsequently enacted similar reforms.

Removing the bottlenecks on America’s doctor supply won’t eliminate the political hurdles to Medicare-for-all. But it would put downward pressure on doctors’ salaries, reduce the risks of capping physician pay, and make the left’s vision of healthcare abundance more feasible. After all, you can’t actually eliminate the care rationing that so many Americans resent by extending insurance coverage or enacting price controls alone. No matter how we pay for our medical services, we can only deliver as much care as our health sector’s resources allow. 

Don’t hate the doctor, love the sick

In saying all this, I don’t mean to convey disdain for the medical profession. Like El-Sayed, some of my best friends are doctors! In fact, my mother, father, brother, and sister-in-law are all physicians. And they all have contributed far more to American society than I ever will. My brother spends his workdays providing lifesaving treatments to cancer patients; I often spend mine sitting at a desk in my pajamas, arguing about politics on the internet. 

Physicians deserve to be well-paid for their strenuous labor. But if we want healthcare in America to be universally affordable and widely accessible, we will need to pay many of them a bit less.

What caused the ongoing outbreak of cyclospora, the diarrhea-causing parasite currently spreading across the United States? Michigan officials have been saying for weeks that they believed the outbreak may be linked to bagged salad or salad kits. What we were waiting to learn was the specific brands and specific products in question. 

And late last week, it looked like we finally had the answer — but then things quickly got cloudy. 

On July 16, the Washington Post reported, citing anonymous sources, that the outbreak had been linked to shredded iceberg lettuce supplied to Taco Bell by Taylor Farms. A day later, Taylor Farms said it was withdrawing products from US stores and restaurants based on information from the FDA.

But then on July 19, per NBC News, the FDA said that there had been a false positive for cyclospora when testing a sample of Taylor Farms iceberg lettuce; Taylor Farms said in its own statement that the FDA had “apologized” for the mix-up. The next day, the company and the federal government were stuck in a semantic argument: Per NOTUS, the FDA insisted it did not “officially apologize” to Taylor Farms but “explain[ed] factually the issues” with the false positive. 

So where does that leave us right now? Officials still believe that Taylor Farms iceberg lettuce was the source of the Michigan outbreak. But whether those are the only products driving the outbreak remains unclear, with almost every state now reporting at least one cyclospora case in 2026. And on Thursday afternoon, the FDA announced that it was tracking a second outbreak linked to other unspecific products, though details were otherwise scarce.

Any outbreak of food-borne illness requires careful public communication. Officials need to tell people how to avoid contaminated food without scaring them away from eating fresh fruits and vegetables altogether.

But instead, many Americans have been left wondering what, exactly, they’re supposed to do. As one frustrated Reddit user put it: “So is the damn lettuce bad or not????” (If you need some advice on what foods are safe and what foods to be cautious about, we have a story for you.)

It may sound like a funny question, but it’s a profoundly serious one. The problem isn’t just that people are confused about their lettuce. The Trump administration’s handling of the cyclospora outbreak — from its conflicting public messages to accusations of political favoritism — has left many Americans even more confused about whether they can trust anything they’re hearing from the government. That’s a dangerous place to be during any public health emergency.

The cyclospora outbreak has become a communications nightmare

We are approaching 10,000 cyclosporiasis cases across the US this year: Michigan alone has recorded 7,664 as of this morning, Ohio has seen more than 1,200, and more than 40 states have now reported at least one case in 2026. The country usually sees a few hundred cases at most in a given year. Cyclosporiasis, the disease caused by the cyclospora parasite, leads to what public health experts describe as “watery” and “frequently explosive” diarrhea. While it isn’t typically life-threatening, it can cause serious complications: 160 people have been hospitalized in Michigan since the outbreak began.

And so for those of us who very much hope to eat fresh produce but do not want diarrhea, there’s a bit of urgency to figure out where the cyclospora is coming from. Food-borne illness investigations are already inherently difficult because of how globalized our food supply has become: Produce can travel all over the country and the world before it comes to your grocery shelf, and the process of government health workers interviewing the people who get sick and cross-checking to identify the shared foods that they might have in common is laborious.

Once investigators find a source, the information has to be shared clearly and responsibly. That is where the Trump administration has tripped up this week. 

Trump — and Health Secretary Robert F. Kennedy Jr. in particular — came into office criticizing the public health establishment. They accused officials of misleading the public about the novel coronavirus and the vaccines developed to fight it, while failing to convey the nuances of the pandemic. But now, as they grapple with the incomplete picture of the cyclospora emergency, they are making many of the same mistakes.

“They’re very similar problems, even if on the outside, they don’t look quite the same,” said Michael Mackert, director of the Center for Health Communication at the University of Texas at Austin. “The underlying commonality is very much that we are dealing with imperfect information all the time.”

In any outbreak, some uncertainty is to be expected. Investigators have struggled to identify the source of earlier cyclosporiasis outbreaks too. And the FDA maintains that the likely source of the outbreak is Taylor Farms iceberg lettuce, based on the information they have gathered from sick patients and other sources, no matter the false positive result that has sparked so much confusion.

“The epidemiological evidence is so strong that the lack of a positive test is almost meaningless,” said Francisco Diez-Gonzalez, director of the Center for Food Safety at the University of Georgia. 

But the mistake that the Trump administration made was in sharing preliminary results and then having to issue a seemingly contradictory statement shortly afterward.

“FDA should have waited for confirmation of the presumptive results before going public,” Diez-Gonzalez said.

The larger stakes of the Trump administration’s poor communication

Investigations like these are hard enough — but when you add in the public health funding cuts of the past 18 months and the casual and widespread corruption characteristic of the Trump administration, trust in the government’s public health apparatus has sunk even lower.

It’s created just the conditions for conspiracies to bloom. “Unfortunately our FDA is compromised,” wrote one top commenter on Reddit. “I would not trust what comes out of it during this administration.” 

Several news outlets and influential social media accounts noted that Taylor Farms had donated $1 million to Trump’s MAGA super PAC and, in the middle of the controversy, received a private White House meeting. According to the New York Times, Taylor Farm officials used that meeting to dispute the findings that their products were responsible for the outbreak — and shortly thereafter, the FDA made its “false positive” announcement.

The administration insists that their decision-making is being guided by science, but even the appearance of impropriety has become a common theme in the press coverage. The broader uncertainty and distrust may help to explain why it’s not only Taco Bell and Taylor Farms taking a hit right now: According to Market Watch, Chipotle and the fast-casual salad chain Chopt have also seen a decline in traffic in recent weeks.

Public health requires public confidence. Perceived influence from special interests is a problem, even if the interactions didn’t alter the FDA or CDC’s actions.

Kennedy, who helms our government’s health department, should understand this well: His Make America Healthy Again movement made restoring public trust a central part of its message while accusing the existing public health establishment as being in league with special interests. 

The cyclospora outbreak has revealed how difficult that is to do in practice. 

In trying to communicate nuanced information during an active outbreak — while consulting interested parties like Taylor Farms itself — the administration has instead fueled doubts about the credibility of its messaging

Even before cyclospora turned eating salad into a leap of faith, Trump had a poor track record: His administration has slashed CDC staff, brought on vaccine skeptics to set vaccine policy, and clashed with the scientific establishment on a number of high-profile issues, like the time Trump held a televised press conference to argue a disproven theory that Tylenol can cause autism.

“Unfortunately, this is another example of a missed opportunity to establish credible and trusted communications to prepare the public to understand the real risks from the pathogen and confidence in the food safety and information from the FDA,” Scott Ratzan, editor-in-chief of the Journal of Health Communication: International Perspectives, told me. “Faith in our institutions continues to erode. We could do better.”

We are lucky cyclospora is not a deadly disease. Next time, the stakes for these miscues could be much higher.

This story appeared in Today, Explained, a daily newsletter that helps you understand the most compelling news and stories of the day. Subscribe here.

Defense Secretary Pete Hegseth announced this week that the Pentagon would begin testing the testosterone levels of all military members over the age of 30 as part of their regular, annual physical exams. And — if their levels are low — service members could choose to receive testosterone replacement therapy.

“It’s not about artificial enhancement,” Hegseth said. “It’s about restoring and optimizing your natural capabilities, protecting your longevity, and ensuring you have the biological foundation required to sustain the fight.”

The High-T Department of War. pic.twitter.com/hlAUq3j2cD

— Secretary of War Pete Hegseth (@SecWar) July 15, 2026

It’s another example of the performative masculinity that has defined Hegseth’s time atop the US military. He has sought to rebrand the Department of Defense as the Department of “War,” preached a “warrior” ethos, rolled back DEI initiatives while blocking promotions for women, and taken an unusual interest in the beard-grooming standards of service members.

The testosterone obsession is just one of several ways that the military is having a Make America Healthy Again movement. Hegseth announced over the spring that service members would no longer be required to get an annual flu vaccine. (The military later reinstated the mandate for new recruits, after a major flu outbreak at a boot camp.) And also this week, he launched a new investigation into the Defense Department’s decision in 2021 to mandate the Covid-19 vaccine — shades of the efforts being made by Robert F. Kennedy Jr. at the US Department of Health and Human Services.

Go a little deeper

The “T” trend is not just a fixation of Kennedy’s, who has said that he takes testosterone supplements, and Hegseth. More Americans of every age group are taking testosterone. By one count, prescriptions grew from 7.3 million in 2019 to more than 11 million in 2024.

So, is getting more people to take supplemental testosterone actually a good idea? Should everybody be screened, as Hegseth is suggesting for service members over 30?

The Endocrine Society said in a statement after Hegseth’s announcement that there was “insufficient evidence” to support testosterone-level screening for asymptomatic Americans. Previous research suggests that, if anything, testosterone is already overprescribed in the US; only 12 percent of men receiving a prescription had received appropriate diagnostic testing.

Testosterone levels indeed fall as men age, and there has been a general decline in testosterone among men today compared to men of the past. But what’s not clear is whether widespread testosterone testing and supplementation is the solution. 

For one, distinguishing between a natural decline in testosterone and a decline that warrants clinical intervention is the subject of ongoing debate among doctors. Low T can also be a sign of other chronic health conditions that it would be better to treat. If your T is dropping because of obesity, for example, it would be better to lose weight (or take a GLP-1 drug instead of a testosterone supplement). The evidence is mixed on how much taking T actually improves things like mood, energy, sexual performance — or military effectiveness — and taking too much testosterone could come with its own health risks.

The dialogue around T supplements is still evolving. Doctors used to worry that extra testosterone could cause cardiovascular problems, but more recent research has allayed those fears, leading  proponents in the Trump administration to call for more prescribing. But the evidence right now does not appear to support the widespread T testing and supplementation that the military’s new program would suggest.

One link for later

How to keep your cool on a bad day: As a parent of three children, I’m always on the lookout for better ways to manage my stress — and took heart in the four strategies suggested by Vox’s Allie Volpe in her piece this week. If we can take the time to acknowledge how we’re feeling and really reflect on what has led us to feel that way, we might be able to avoid a full-blown meltdown. That’s news you can really use.

Before you go…

• Did you know: Prediction markets correctly guess the winner of reality TV shows upward of 90 percent of the time? It’s a trend that raises questions about insiders using insider knowledge to make a buck — and risks ruining the fun of following these shows.
• Today’s trivia: What is a Russian name meaning “holy”? (You can find this and other brain puzzles in Vox’s daily crossword. Look for the answer in Monday’s edition.)
• Yesterday’s trivia: Yesterday, we asked you what animal can be as narrow as a few millimeters or as wide as 13 feet. That would be crabs, the various species of which can range from tiny and adorable to monstrously terrifying.

American voters desperately want relief from rising prices — especially the increasingly unaffordable cost of healthcare. Democrats have a plan for that.

Massachusetts Sen. Elizabeth Warren recently introduced the Break Up Big Medicine Act with Sen. Josh Hawley, R-Mo., a bill that would split up the huge conglomerates that have made the current healthcare system so expensive and frustrating to navigate. Businessman Mark Cuban recently quipped that breaking up these near-monopolies could bring costs down by 40%.

If Democrats run on this healthcare affordability agenda, we stand a good chance of flipping not just the House, but the Senate too.

Insurers like UnitedHealth or Cigna don’t just sell coverage. They’ve consolidated power over virtually every part of our healthcare system, operating hospitals, clinics and pharmacy networks. And they use that control to generate billions in profits — by pushing patients toward care at the facilities they control.

UnitedHealth Group, for example, generates about 40% of its revenue — about $180 billion — from transactions between its thousands of subsidiaries. Its insurance branch steers patients to its roughly 90,000 affiliated doctors, and pressures those physicians to refer patients to its affiliated hospitals and clinics rather than lower-cost independent providers. And that’s not all. The company’s pharmacy benefit manager (PBM) arm pushes patients to affiliated pharmacies. Those pharmacies frequently upcharge patients for medicines, sometimes by 10 times the acquisition cost.

UnitedHealth Group is the largest of these conglomerates, but it’s hardly the only firm that operates this way. CVS Health owns Aetna, one of the nation’s largest insurers, in addition to the more than 9,000 CVS pharmacies it’s best known for. It also owns CVS Caremark, one of the nation’s largest PBM.

In theory, PBMs exist to save employers money by overseeing all the drug-related details of health insurance plans, and using their bulk-buying power to negotiate with pharmaceutical companies for big discounts and rebates. PBMs often tell employers that they pass along all the discounts and rebates they receive to the employer, minus a small fee for their services.

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What they typically don’t mention is that many PBMs are affiliated with foreign-based entities called “group purchasing organizations.” In 2025, the House Oversight Committee launched an investigation into whether PBMs are using these overseas entities to skirt government oversight. Lawmakers have raised concerns that these arrangements allow PBMs to retain rebate-related revenue and fees within opaque corporate structures, rather than transparently passing those savings on to employers and patients.

Meanwhile, insurers continually deny coverage for treatments and procedures that patients need. They often force doctors to get insurer approval — known as prior authorization — before prescribing, or they force patients onto less effective drugs. That places an immense administrative burden on physicians, who can spend an average of 12 hours per week completing prior authorizations, time that they’d certainly rather spend with patients.

Prior authorization can have dire consequences for patients. More than eight in 10 patients that face prior authorization simply give up on treatment. About a quarter of doctors say that prior authorization delays have led to a serious adverse event for a patient in their care — whether that’s hospitalization, permanent damage or death.

Breaking up the healthcare conglomerates that have enriched themselves by immiserating patients and cheating employers is good policy.

Polls show that voters overwhelmingly support bold healthcare reform. According to a recent poll, nearly seven in ten insured Americans identified either lowering out-of-pocket costs or nixing prior authorization as the single most important change they want from their health insurance. It would be a mistake for Democrats to content themselves with merely tweaking the Inflation Reduction Act, the party’s last major healthcare reform, which primarily focused on reducing the federal government’s pharmaceutical spending.

That kind of incrementalism won’t work — Democrats cannot win by being Republican-lite. We need to target the insurer and PBM practices that directly drive up Americans’ out-of-pocket costs and force too many people to choose between filling their prescriptions and filling their gas tanks.

If Democrats are looking for a 50-state strategy for the midterms — something I insisted on as chair of the Democratic National Committee during the 2006 blue wave — Sen. Warren’s bill offers a great place to start.

The post Democrats’ key to winning the midterms appeared first on Salon.com.

As if we needed one more thing to worry about so soon after the hantavirus scare, there is a new public health threat for Americans to contend with: a rapidly escalating outbreak of, of all things, diarrhea.

It’s a parasite-borne illness called cyclosporiasis. It can cause explosive and watery bowel movements — and it is wreaking havoc across the United States this summer.

How bad exactly? As of July 15, Michigan’s health department is reporting 3,762 cyclosporiasis cases, up from 1,500 late last week. Forty-four people have been hospitalized as of July 9. To put that number in context, the state normally sees about 50 cases in a year. To the south, at least 364 people have been infected in Ohio. According to a USA Today compilation of state health department data, almost every state has reported at least one cyclosporiasis case this year. 

This is not our first bout with a cyclosporiasis outbreak. In 2013, the US saw more than 600 cases, and more than 500 people were sickened across the country by contaminated McDonald’s salad meals in 2018. Cyclosporiasis is caused by the parasite cyclospora, which can infect people when it is attached to fresh produce and then consumed. It does not, fortunately, spread from person to person. We do know some likely culprits: Bagged salads, basil, cilantro, peas, and berries have been linked to prior outbreaks. 

Watery diarrhea — described by public health authorities as “frequent” and “sometimes explosive” — is the most common symptom. People can also experience cramping, bloating, nausea, and vomiting. Symptoms can start anywhere between two days and two weeks after a person eats tainted food. No one has died, and thankfully, cyclosporiasis is rarely fatal. But it is an extremely unpleasant experience that could last for up to a month without treatment, and certain people, such as folks who are immunocompromised, are at higher risk of more serious complications.

There are steps that everyone can take to protect themselves from cyclosporiasis (more on that in a moment). But the current situation is challenging, because, right now, officials don’t actually know which products are causing the outbreak. “At this time, no specific produce grower, supplier, or type of produce has been identified as the source,” Laina Stebbins, a spokesperson for the Michigan Department of Health and Human Services, said in a statement to Vox on Friday. On Monday, Michigan officials said they believed lettuce or bagged salad products were to blame, but still had not identified specific brands or items that could be linked to the growing outbreak.

It’s a public health mystery, one that results from both the sneaky nature of the parasite itself and our increasingly globalized food supply. It could be a while before we learn the answer. But, in the meantime, if you’ve found yourself spooked by some of the recent headlines, here’s what you actually need to know.

Why cyclosporiasis outbreaks are so hard to trace

Cyclosporiasis makes itself hard to find. Scientists don’t know exactly how much of the parasite a person needs to be exposed to to become infected — one of many unknowns about the basic features of the bug. The foods carrying this pathogen may not be contaminated with much of it at all, which makes any preemptive testing a challenge.

And, on top of that, there can be a long gap between the parasite being introduced to the food supply and when a person actually gets sick, which further complicates any efforts to trace the outbreak’s origins. A fruit or vegetable could be contaminated in one of the various tropical or subtropical regions of the world where cyclosporiasis is more common, well before it lands in your grocery store in the United States. 

“Oftentimes when we see these outbreaks, what happens is that somewhere in the world, a contamination event occurs, and then that produce is then shipped throughout the area and it could go anywhere in the world,” Dr. Kathleen Linder, the hospital epidemiologist at the Veterans Affairs hospital in Ann Arbor, Michigan, told Vox. 

Sometimes, the source can be closer to home: A 2020 outbreak appeared to be linked to produce grown in Florida and shipped to a plant in Illinois that produced bagged salad kits. But, as if to demonstrate the difficulty of doing this work, the FDA said it could not conclusively prove those farms were the source of the outbreak.

The point is: We have a food production supply chain that sources produce and combines ingredients from all over the country and the globe — providing more opportunities for a parasite like this to find its way in.

“We’re relying more and more on produce coming from other countries so that we can have raspberries all year round,” Joseph Eisenberg, a professor of epidemiology and global public health at the University of Michigan, told Vox. “That kind of luxury only happens when we centralize our food distribution system.”

Even once an outbreak is underway, it can be hard to pinpoint the source. Symptoms may not occur for up to two weeks after a person eats contaminated food. 

“I can barely remember what I had for dinner a couple nights ago; there’s no way I’m going to be able to remember a week ago,” Linder told me. “It takes a lot of time and a lot of manpower to get all that information collected.”

As with any outbreak under the Trump administration, the Centers for Disease Control and Prevention is responding with significantly fewer workers and resources than it used to have. To be clear: This cyclosporiasis outbreak could have happened either way. This parasite has sparked widespread infections before. But Linder said that because the CDC has rolled back some of its national reporting programs, it’s been left to the states to take the lead — and that has made it harder to pull together a complete picture of the outbreak.

“It has been very hard to get updated information,” Linder said. “The information is lagging a little bit behind because it’s being done at the state level.”

What you can do to reduce your risk of cyclosporiasis

For scientists, the work ahead involves better understanding the properties of the pathogen itself and developing surveillance tools and techniques that allow us to catch contaminated food before it reaches people. But what can the rest of us do right now, during an active outbreak?

According to various public health authorities, the short version is to cook the produce that you can — heat is the absolute best option for eliminating cyclosporiasis — and to clean your raw fruits, vegetables and herbs as thoroughly as possible. 

Wash everything with running water before eating or preparing it. Scrub the firmer fruits, like melons and cucumbers, with a produce brush if you have one. If you see damaged or bruised areas on your fruit or lettuce, cut them away. Even if a food’s package says it’s prewashed, Linder said she advises people to rewash it just to be sure.

Previous outbreaks have specifically been linked to bagged lettuce and salads, so you might consider buying whole heads of lettuce instead. If you do that, cut away the outer layers and then separate the inner leaves to wash them. For green onions, you should cut away the bulby root and the outer layer and then wash them thoroughly. Raspberries were associated with one of the first US outbreaks in the 1990s, and they are particularly tricky to clean given their bumpy surfaces; you may want to consider eating them only after cooking (to prepare a jam or compote, for example) or opt for frozen raspberries for the time being. (Freezing is believed to reduce, if not completely eliminate, the parasite.) And be careful with leftovers: You should refrigerate any unused foods that you plan to eat later within two hours. 

You could also consider buying locally sourced foods, Linder said, because cyclosporiasis is more common in food sourced from other parts of the world.

If you do start to experience extreme diarrhea, make sure to hydrate very well to avoid dehydration. Linder told me that if somebody experiences dizziness, they can’t keep fluids down, or they have very dark urine, then they should seek immediate medical attention. And anybody experiencing those symptoms should get in touch with their health care providers and their local health department. 

Sooner or later, experts will probably figure out what caused the current outbreak, whether it’s one source or several. But cyclosporiasis will still be a concern in the future; it’s a byproduct of the food system we have built. It serves as a potent reminder about the importance of good food hygiene. A little extra effort to wash your food before you eat it could save you a lot of pain later.

Update, July 15, 2026, 11:45 am ET: This story, first published July 10, has been updated with current case numbers and products linked to the outbreak.

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

Emily Hoffman was walking home from lunch in the Pittsburgh neighborhood of Squirrel Hill in February 2023, when a driver turning left struck her on the crosswalk.

Hoffman was 34. By the time paramedics arrived on the scene, she had gone into a traumatic cardiac arrest. They strapped her onto a machine that delivered automated chest compressions and rushed her to UPMC Presbyterian, a major trauma hospital in Pittsburgh.

Over the next several days, doctors performed multiple surgeries, kept Hoffman on a ventilator, and waited until she was stable enough for an MRI. The scans showed multiple strokes and severe traumatic brain injury. She was alive, but her family understood that she was not going to make a meaningful recovery to a life she would have wanted.

The next Thursday, a week after the crash, Emily’s parents and her sister Beth Hoffman met with the care team and decided to remove ventilator support to allow her to die naturally. Organ donation came up only afterward. Emily was already a registered donor, and Beth knew it was what her sister wanted.

For most of the short history of organ transplantation, Emily would not have been the usual kind of organ donor.

Almost all transplanted organs once came from patients who died in one specific and rare way called brain death, in which the brain has irreversibly stopped functioning, even as machines keep the heart beating and the organs supplied with oxygen. Brain death is extraordinarily rare,  but it happens often enough to create a workable — though far from sufficient — supply of life-saving organs.

But Emily was not one of the brain-death donors. Even after the strokes and brain injury, she still had some reflexes. She was dying, but not brain dead.

Her donation followed a different path, one that has transformed American transplantation in the last decade. It is called donation after circulatory death, or DCD. Instead of death being declared because the brain has stopped functioning, in DCD, death is declared after circulation ceases and the heart stops beating. Many more people die this way than by brain death.

Death by circulatory criteria has been legally recognized since the 1980s, but for decades, doctors rarely recovered organs this way, because, once blood stops moving through the body, organs begin to deteriorate within minutes. In recent years, however, new machines and surgical techniques have helped change that, giving doctors the ability to preserve organs outside the body, making DCD far more viable.

↗ Explore the interactive version of this chart.

Hoffman’s donation is hardly an outlier anymore. In the last decade, DCD has gone from a rare practice to something that now accounts for nearly half of all organ donors who have died in the United States. In 2000, DCD donors supplied just 219 organs (kidneys, livers, lungs, hearts, and pancreas combined) to the transplantation system in the US. In 2025, DCD brought in close to 17,000 organs. (Most transplanted organs, about 85 percent, come from dead donors, though some organs, most often kidneys, can also come from living donors.)

That growth has saved lives, but it has also pushed transplant medicine into an unusually sensitive moment: the time after a family has decided to let their loved one die but before death has actually occurred.

In brain-death donation, a patient has already been declared dead before the possibility of donation is raised with the family. Because most brain-dead donors are on ventilators, with machines supplying oxygenated blood to their organs, transplant teams can take their time with the donation process.

DCD doesn’t offer that same cushion. Because organs deteriorate so quickly after circulation ceases, the work of donation — the testing, matching, surgical teams flying in — has to be set in motion once the family has decided to withdraw life support but before the patient has died.

This is where the tension in DCD begins. The process pushes transplantation into the narrow interval between that decision to let someone die and the moment death occurs. It creates a situation with almost no parallel in medicine: one set of hands caring for the dying, even as another prepares to recover and transplant their organs.

The medical system tries to manage that complexity with a strict procedural sequence. First, hospital doctors and family conclude that no treatment will bring the patient back to a life they would have wanted. Only then, and only from a separate team, does the word donation come up. The firewall is in place so that the need for organs never shapes the decision to let someone die. 

“Ethically, you want to make sure that those two are uncoupled,” said Wade Smith, director of the Neurovascular Service at the University of California San Francisco.

But as DCD has scaled up, more weight is put on that narrow interval. What was once a rare event is now routine in hospitals across the country, carried out by teams with different levels of experience and overseen through rules that can vary from one place to another. At the same time, the organizations that handle organ donations are under new federal pressure to acquire and distribute more organs from eligible donors.

DCD has saved thousands of lives by making donations possible from patients who once wouldn’t have been donors. Hoffman’s donation improved several lives at once: Her kidneys went to two men, her liver to a third recipient, and her corneas helped give sight to a nine-month-old baby. 

But its growth has also made the fragile period before death more consequential: how families are told, which steps can be taken while the patient is still alive, how consistently hospitals and organ donation teams follow safeguards, and who has the authority to stop the process if something feels wrong.

When DCD was still rare, these questions stayed at the edges of transplantation. Now, they are moving towards its center, as a lifesaving practice becomes a routine part of how Americans die and donate.

The breakthrough

Modern transplantation is a relatively young field, only about 70 years old. And from the beginning, transplantation has depended on the novel medical achievement of keeping organs functional after a person had been declared dead.

The mechanical ventilator, developed in the 1950s, made that possible. It could keep a body breathing, and its heart beating, even after the brain had stopped for good. That created, for the first time, a situation where patients were deceased by every older measure, even as their organs were still functional.

Surgeons were initially wary of recovering organs, largely because the legal lines between life and death had never been clearly drawn. Then, in 1968, a Harvard committee proposed a definition of brain death. By 1981, a model law gave states the language to recognize two ways of legal death. Your heart and lungs could stop for good (circulatory death) or your entire brain could (brain death). Today, every state recognizes some version of that framework.

With those lines in place, transplant teams could work with more confidence, and brain death turned out to be close to ideal for them. Because a ventilator kept the heart beating and blood moving through the organs, even after death, there was no ticking clock to race against. The hospital staff had time to evaluate the organs, sometimes convince families to donate them, find the right recipients, and bring in surgical teams before recovery began.

The problem was always with the math. Brain death is rare — only about three in 1,000 deaths happen in a way that leaves organs usable for transplant. That puts a hard biological ceiling on how many ideal donors there could ever be.

But demand for the organs had no such ceiling. Nearly a million Americans are diagnosed with heart failure each year, while surgeons performed just 4,636 heart transplants in 2024, after DCD became a widely used part of transplantation, up 81.5 percent from 2013. There are “just not enough organs to go around,” said Ashish Shah, chief of cardiac surgery at Vanderbilt University. The kidney numbers are even bleaker. Over 500,000 people are on dialysis in the US, but only a fraction will ever reach the waiting list, and even among those who do, many will die before receiving a transplant offer, said Dorry Segev, a transplant surgeon and researcher at NYU Langone.

The modern DCD boom grew out of this desperation, presenting the possibility of donation in far more common cases of death that transplantation surgeons had rarely been able to draw on before: catastrophic strokes, car crashes, cardiac arrests, and other injuries that left patients with no meaningful chance of recovery but short of brain death. But with DCD, the clock suddenly became a factor. Once circulation stopped, the organs deteriorated fast, and, in many cases, they were ruined before surgeons could recover them. 

Because of those challenges, DCD stayed marginal for decades, at well under a tenth of all donations. Those numbers ultimately spiked because of several things that happened almost simultaneously.

The first was technological. New machines, like TransMedics’ Organ Care Systems — which were first used in 2015 in the UK — could keep a recovered organ alive outside the body, pumping it with warm, oxygenated blood instead of packing it in ice, allowing a heart to beat and function as normal inside a box. This meant that even if there was delay in recovering an organ, that damage could be limited, even reversed, once the organ was put in the machine. 

Other teams found ways to use machines originally developed to support failing hearts and lungs to restart circulation inside the bodies of donors after death had been declared. Transplant teams in Spain and the UK began adapting that technology before American programs picked it up for DCD hearts around 2019. Both approaches helped extend the time to successfully perform DCD.

“As soon as the results were good, the big American centers took it on,” said John Dimarakis, a cardiac transplant surgeon at the University of Washington.

Policy changes also helped push DCD further. In Hoffman’s case, the donation process was coordinated by CORE, the nonprofit responsible for organ donation in the Pittsburgh region. Organ procurement organizations, or OPOs, cover a particular region in the US, and they work with hospitals in that region to evaluate potential donors, speak with families, arrange testing, and offer organs to transplant centers. There are 54 such OPOs in the US, which are certified and regulated by the Centers for Medicare and Medicaid Services (CMS). 

For years, critics argued that OPOs were judged according to weakly defined standards based on numbers they reported themselves, and poor performers were rarely penalized. But in 2020, new federal rules began ranking them against one another, with a mechanism to strip the worst performers of their territory. Facing the threat of losing their monopolies, many OPOs began pursuing harder cases they would’ve earlier passed over, according to Greg Segal, who founded patient advocacy group Organize. A larger share of those more complicated donors were DCD.

Still, no single force explains the speed of DCD’s rise. “Technology plays a big role in it,” said Nader Moazami, a cardiac surgeon at NYU Langone who helped pioneer one of the new techniques. “But it doesn’t explain how suddenly 50 percent of our donors are DCD.” In 2000, there were only 118 DCD donors in the United States. By 2025, there were 8,137. Brain death donation grew over that same period but far more slowly — from 5,867 donors a year to 8,416.

↗ Explore the interactive version of this chart.

Whatever the mix, it’s clear that DCD has led to more organs, shorter waits, and saved thousands of lives that otherwise would have ended on a list. “People who have been waiting now wait less,” Dimarakis said.

On a chart, it looks like an unambiguous triumph — until you step into a hospital room.

The passage

Beth Hoffman remembers her sister Emily’s last morning. She read aloud an email from Bradley Whitford, Emily’s favorite actor from the TV drama The West Wing, who had written after hearing what had happened. Then, a playlist of Emily’s favorite songs played as the breathing tube came out. Within about 10 minutes, while “For Good” from Wicked filled the room, her sister was gone.

What Beth mostly didn’t see was the second sequence unfolding around her: the referrals, tests, calls, and scheduling that would turn Emily from a dying patient into an organ donor. 

Federal rules require every hospital to alert their organ procurement organization whenever a person may be nearing death. The OPO screens those referrals, and most go nowhere. Alexandra Glazier, who runs the OPO that covers most of New England, says hers get about 50,000 such referrals a year. Only 2 or 3 percent turn out to have any medical possibility of donation at all. 

Emily was one such possible case for her Pittsburgh hospital’s OPO. The organization had to reach out to her family; explain what DCD would involve; and, then, start the work that had to happen while she was still alive: reviewing her medical history, testing whether her organs could be used, matching them to recipients, and arranging the surgical teams who might fly in to recover them.

Most families never see much of that work, but some do. Smith, the UCSF neurologist, watched a family agree to withdraw life support and donate, set a time, and gather relatives for a final goodbye, only to learn that the withdrawal had to wait because the OPO still needed more tests. Some families, after being told their dying relative must stay on machines longer for donation’s sake, walk away.

For the Hoffmans, things proceeded more quietly. When the time came, Emily was wheeled into the operating room, and the breathing tube was removed there. The surgeons who would recover her organs were kept away from the withdrawal and death declaration. They often fly in from their own hospitals — sometimes several at once for different organs — but they’re walled off from everything that comes before. “We are not involved in that process,” said Dimarakis, the cardiac transplant surgeon at the University of Washington, “because it’s not ethical for us to be involved.”

That separation is the line DCD depends on. One team cares for the dying patient, withdraws support, and declares death. The other waits outside that decision and recovers the organs only after. The OPO stands between them, coordinating the donation without letting the firewall be breached.

Then comes the waiting. Once the ventilator is out, the clock starts ticking. If the heart doesn’t stop within a window — often about two hours — the organ recovery may be called off, and the patient is returned to end-of-life care. But when circulation does stop, as it did for Emily, the team counts exactly five more minutes to make sure it won’t restart on its own. Only then can a hospital physician declare death, and only then can the transplant surgeons begin.

DCD rests on a simple promise: The need for organs never causes the death. The death is already coming, and donation only changes what can come from it. 

But a new frontier in DCD complicates that promise.

The reversal

Normally, after death is declared, most DCD organs are removed and preserved outside the body, either on ice or on machines that circulate oxygenated fluid or blood. The goal is to slow the damage that begins the moment circulation stops.

Then, around the mid-2010s, transplant teams in Spain and the UK began using a newer technique that restores circulation inside the dead donor’s body, before the organs are removed. It’s called normothermic regional perfusion, or NRP.

In one version of NRP, called abdominal NRP, blood is meant to be restored only below the diaphragm to preserve organs such as the kidneys and liver. In a more controversial version called thoracoabdominal NRP, it runs through the chest, as well, and the heart starts beating again.

For the transplant team, especially heart surgeons, the appeal is clear. Kidneys and livers can survive a stretch without circulation, but a heart is harder to preserve. Once it has stopped, there’s no easy way to know whether it will beat reliably again. NRP helps answer that question by restarting it inside the donor’s body after death has been declared, where surgeons can watch it work before deciding whether to recover it.

Shah, the Vanderbilt cardiac surgeon, says the technique lets doctors take hearts from donors who otherwise would not be able to yield a workable one.

But this kind of NRP is unsettling for the very reason that it is useful. If a death is declared because the heart has stopped, what does it mean to start it again inside a donor’s body, often only minutes later? Is that still death? Or something else?

The controversy isn’t simply that the heart beats again. A beating heart is not, by itself, the same as a living person. The heart of a brain-dead patient can beat, too, can be kept going by machines, and that doesn’t mean the person is alive. The deeper concern is whether restored circulation in the body could reach the brain, which could potentially restore consciousness.

To prevent blood from reaching the brain, surgeons clamp or cut the vessels that carry blood to the head before circulation is restored. That distinction is central to the defense of NRP, and it lets surgeons say they are restoring circulation and restarting the heart, not the person. 

But those safeguards haven’t always worked. In a safety notice last November, the Organ Procurement & Transplantation Network (OPTN), the federal system that oversees transplant policy and data, said it had received “verified reports” that blood had unintentionally reached the brain and brainstem during NRP. Such events are extremely rare, the notice said, but can occur when a clamp fails or blood reaches the head through an unrecognized route. The notice asked transplant programs using either form of NRP to strengthen their safeguards and report any failures. But those recommendations were not national requirements and as of May 2026, the OPTN was still developing formal standards for NRP. For Claire Morgan, a transplant surgeon from North Carolina who has criticized NRP’s rollout, that is a central weakness. “It’s a bulletin. It’s not a policy,” she said. “There’s no punishment for not reporting.”

But even if blood never reaches the brain, NRP can still introduce deeper ambiguity into our understanding of circulatory death. In the first few minutes after a heart stops, it can often be brought back, an event that happens every day in a busy emergency department. In conventional DCD, however, doctors don’t try to restart the heart, because a patient or family has already decided against being revived. It is that decision, not just the stopped heart itself, that turns the moment into a death. The same goes for anyone who dies under a do-not-resuscitate order.

NRP puts pressure on that logic. The circulation declared permanently gone is deliberately brought back. “There’s a misalignment between NRP practices and the legal standard for how death is defined,” said Glazier. You cannot, critics argue, pronounce someone dead because the circulation will never return — and then return it.

Robert Truog, professor of Medical Ethics, Anaesthesia, & Pediatrics at Harvard Medical School, supports NRP but thinks the possibility of blood returning to the brain is the issue that matters most. “The only questions are, is there a risk of pain or suffering in the procurement of the organs?” he said. And there’s a possibility of that if the circulation is restarted in the brain.

None of this is settled, which is why some hospitals refuse to perform NRP at all. Moazami pioneered the NRP heart technique in the US and practices it at NYU Langone. “But you cannot do it at Columbia,” he said, “just five miles away.” Glazier’s OPO, one of the country’s largest, said her organization has done roughly 650 NRP cases since adopting the practice — but only the abdominal kind, holding off on the heart version until the national protocols are better standardized.

Claire Morgan, a transplant surgeon from North Carolina who has criticized the rollout of NRP, is more worried about what happens if something goes wrong. The donor cannot complain, families may never know if there was a concern, and clinicians who speak up may have limited protection if they challenge what happened in the operating room. 

All of that matters, because NRP is already far from marginal. The Organ Procurement & Transplantation Network (OPTN), the federal system that oversees transplant policy and data, only began collecting data on whether NRP was used in a DCD recovery in October 2025. In the first five months of that reporting, from October 1, 2025, through February 28, 2026, 3,463 DCD donors were recovered nationally, according to data shared by the OPTN with Vox. More than half of those involved NRP; though, OPTN doesn’t collect data on which kind.

Vox’s analysis also found that NRP cases were concentrated among some organ procurement organizations. The top 10 OPOs accounted for 47 percent of all DCD recoveries that used NRP.

The patchwork

The core safeguard in DCD — that the decision to withdraw life support must come before questions about donation — is widely accepted. But many of the details around that sequence that shape a family’s experience, or a patient’s protection, are still handled differently from hospital to hospital, OPO to OPO.

“The entire process of DCD or donor withdrawal is not very standardized across the United States or even within states, even within different hospitals in the same city,” Moazami said.

That can mean differences in what families are told about the donation process, what medications are considered appropriate before death, whether NRP is allowed and how it is performed, and who has the clear authority to pause or stop the process if someone believes something is wrong.

That unevenness matters more now, because the transplant system has been trying, with good reason, to recover more organs. For years, many in the field, and those who depended on it, argued that the organ procurement organizations were leaving transplantable organs on the table. Greg Segal, whose advocacy group Organize helped push for stronger OPO accountability, compared the old system to a canvassing campaign where you only knock on the easiest doors. “The problem with OPOs is they were only doing the much easier ones,” he said.

A 2020 rule from the Centers for Medicare & Medicaid Services, the federal agency that oversees OPOs, was meant to change that. It ranked OPOs against one another and created a path to penalize low performers by stripping them of their territories. That policy appears to have had some impact, but it is hard to separate from other forces driving DCD’s rise including new preservation technology, like NRP and broader clinical adoption. Jeffrey Trageser and Charles Strom from the Association of Organ Procurement Organizations, the trade group that represents OPOs, argued that the metrics are too broad, evaluating OPOs partly on whether transplant centers ultimately accept organs and not fully accounting for regional differences such as age of potential donors, local rates of cancer, or how far organs must travel to reach transplant centers.

This pressure to recover more organs has also made some OPOs seem more aggressive to the clinicians working besides them. “Some people view them as vultures, which is horrible,” said Smith, the UCSF neurologist who has experienced the tension from the hospital side. “They’re trying to do their job.” Still, he added, “when you impose that [pressure], then it changes how aggressive they are.”

Both things can be true. The old system needed pressure to perform better. And pressure can create risks, or perceived risks, in a process that depends on careful judgement around a dying patient.

And the safety question isn’t a theoretical concern either. A March 2025 investigation from the Health Resources and Services Administration (HRSA), the federal agency that oversees the national transplant system, documented what can happen when those safeguards fail. In a review of attempted DCD cases at Kentucky Organ Donor Affiliates, an OPO that covered Kentucky and parts of Ohio and West Virginia, HRSA found recurring problems about staff missing vital signs in patients that raised concerns, failed to work collaboratively with hospital medical teams, failed to respect family decision-making, and documented medical data poorly. HRSA said the pattern suggested “organizational dysfunction” and a weak safety culture.

One OPO’s failure does not prove that DCD is broadly unsafe or that OPOs across the country behave the same way. But the Kentucky review showed how badly things can go when the line between patient care and organ recovery is not honored.

Since then, federal officials have been trying to close some of the gaps. HRSA has pushed for clearer family education around DCD and more standardized reporting on ventilated patients referred to OPOs, as well as opened up a reporting channel that sends misconduct concerns directly to HRSA. In a separate case, the Department of Health and Human Services also moved to shut down an OPO in South Florida after finding unsafe practices, underperformance, and paperwork errors.

Organ donation is a touchy subject, because it relies so much on the goodwill and the trust of the people who agree to give their organs so they can live on in others. But the procedural issues also matter, because there are lives at stake on both sides of the process. 

Around 13 people die each day in the US waiting for organs. In that desperate landscape, the rise in DCD has led to many lives saved and helped several more live better, fuller lives. The dearth of organs even compelled my former Future Perfect colleague Dylan Matthews to sign up as a living donor and donate his kidney to a complete stranger. (You can read his story here).

And the value of the donation is not just measured in recipients saved. For the Hoffmans, the knowledge that Emily’s organs helped others offered a solace they had not expected. Emily “gave the gift of life in her death,” Beth told me.

That is the highest ideal organ donation — and DCD – can achieve: a death already coming that still changes the lives of others in need. The case for DCD is clear, but its future depends on its proponents’ ability to protect both patients and public trust.

Clarification, July 1, 6 pm ET: A previous version of this post described how the NRP process intends to stop blood from reaching the brain, but did not acknowledge cases where that does not go according to plan. The post has been updated to include a safety notice from the Organ Procurement & Transplantation Network, which said it had received “verified reports” that blood had unintentionally reached the brain and brainstem during NRP. The post has also been updated to clarify that Dorry Segev and Nader Moazami are doctors at NYU Langone.