• Tell Us the Speakers and Headphones You Like to Listen On

    Take the Speakers, Headphones, and Earphones SurveyTake other PCMag surveys. Each completed survey is a chance to win a Amazon gift card. OFFICIAL SWEEPSTAKES RULESNO PURCHASE NECESSARY TO ENTER OR WIN. A PURCHASE WILL NOT INCREASE YOUR CHANCES OF WINNING. VOID WHERE PROHIBITED. Readers' Choice Sweepstakesis governed by these official rules. The Sweepstakes begins on May 9, 2025, at 12:00 AM ET and ends on July 27, 2025, at 11:59 PM ET.SPONSOR: Ziff Davis, LLC, with an address of 360 Park Ave South, Floor 17, New York, NY 10010.ELIGIBILITY: This Sweepstakes is open to individuals who are eighteenyears of age or older at the time of entry who are legal residents of the fiftyUnited States of America or the District of Columbia. By entering the Sweepstakes as described in these Sweepstakes Rules, entrants represent and warrant that they are complying with these Sweepstakes Rules, and that they agree to abide by and be bound by all the rules and terms and conditions stated herein and all decisions of Sponsor, which shall be final and binding.All previous winners of any sweepstakes sponsored by Sponsor during the ninemonth period prior to the Selection Date are not eligible to enter. Any individualswho have, within the past sixmonths, held employment with or performed services for Sponsor or any organizations affiliated with the sponsorship, fulfillment, administration, prize support, advertisement or promotion of the Sweepstakesare not eligible to enter or win. Immediate Family Members and Household Members are also not eligible to enter or win. "Immediate Family Members" means parents, step-parents, legal guardians, children, step-children, siblings, step-siblings, or spouses of an Employee. "Household Members" means those individuals who share the same residence with an Employee at least threemonths a year.HOW TO ENTER: There are two methods to enter the Sweepstakes:fill out the online survey, orenter by mail.1. Survey Entry: To enter the Sweepstakes through the online survey, go to the survey page and complete the current survey during the Sweepstakes Period.2. Mail Entry: To enter the Sweepstakes by mail, on a 3" x 5" card, print your first and last name, street address, city, state, zip code, phone number, and email address. Mail your completed entry to:Readers' Choice Sweepstakes - Audio 2025c/o E. Griffith 624 Elm St. Ext.Ithaca, NY 14850-8786Mail Entries must be postmarked by July 28, 2025, and received by Aug. 4, 2025.Only oneentry per person is permitted, regardless of the entry method used. Subsequent attempts made by the same individual to submit multiple entries may result in the disqualification of the entrant.Only contributions submitted during the Sweepstakes Period will be eligible for entry into the Sweepstakes. No other methods of entry will be accepted. All entries become the property of Sponsor and will not be returned. Entries are limited to individuals only; commercial enterprises and business entities are not eligible. Use of a false account will disqualify an entry. Sponsor is not responsible for entries not received due to difficulty accessing the internet, service outage or delays, computer difficulties, and other technological problems.Entries are subject to any applicable restrictions or eligibility requirements listed herein. Entries will be deemed to have been made by the authorized account holder of the email or telephone phone number submitted at the time of entry and qualification. Multiple participants are not permitted to share the same email address. Should multiple users of the same e-mail account or mobile phone number, as applicable, enter the Sweepstakes and a dispute thereafter arises regarding the identity of the entrant, the Authorized Account Holder of said e-mail account or mobile phone account at the time of entry will be considered the entrant. "Authorized Account Holder" is defined as the natural person who is assigned an e-mail address or mobile phone number by an Internet access provider, online service provider, telephone service provider or other organization that is responsible for assigned e-mail addresses, phone numbers or the domain associated with the submitted e-mail address. Proof of submission of an entry shall not be deemed proof of receipt by the website administrator for online entries. When applicable, the website administrator's computer will be deemed the official time-keeping device for the Sweepstakes promotion. Entries will be disqualified if found to be incomplete and/or if Sponsor determines, in its sole discretion, that multiple entries were submitted by the same entrant in violation of the Sweepstakes Rules.Entries that are late, lost, stolen, mutilated, tampered with, illegible, incomplete, mechanically reproduced, inaccurate, postage-due, forged, irregular in any way or otherwise not in compliance with these Official Rules will be disqualified. All entries become the property of the Sponsor and will not be acknowledged or returned.WINNER SELECTION AND NOTIFICATION: Sponsor shall select the prize winneron or about Aug. 11, 2025,by random drawing or from among all eligible entries. The Winner will be notified via email to the contact information provided in the entry. Notification of the Winner shall be deemed to have occurred immediately upon sending of the notification by Sponsor. Selected winnerwill be required to respondto the notification within sevendays of attempted notification. The only entries that will be considered eligible entries are entries received by Sponsor within the Sweepstakes Period. The odds of winning depend on the number of eligible entries received. The Sponsor reserves the right, in its sole discretion, to choose an alternative winner in the event that a possible winner has been disqualified or is deemed ineligible for any reason.Recommended by Our EditorsPRIZE: Onewinner will receive the following prize:OneAmazon.com gift code via email, valued at approximately two hundred fifty dollars.No more than the stated number of prizewill be awarded, and all prizelisted above will be awarded. Actual retail value of the Prize may vary due to market conditions. The difference in value of the Prize as stated above and value at time of notification of the Winner, if any, will not be awarded. No cash or prize substitution is permitted, except at the discretion of Sponsor. The Prize is non-transferable. If the Prize cannot be awarded due to circumstances beyond the control of Sponsor, a substitute Prize of equal or greater retail value will be awarded; provided, however, that if a Prize is awarded but remains unclaimed or is forfeited by the Winner, the Prize may not be re-awarded, in Sponsor's sole discretion. In the event that more than the stated number of prizebecomes available for any reason, Sponsor reserves the right to award only the stated number of prizeby a random drawing among all legitimate, un-awarded, eligible prize claims.ACCEPTANCE AND DELIVERY OF THE PRIZE: The Winner will be required to verify his or her address and may be required to execute the following documentbefore a notary public and return them within sevendaysof receipt of such documents: an affidavit of eligibility, a liability release, anda publicity release covering eligibility, liability, advertising, publicity and media appearance issues. If an entrant is unable to verify the information submitted with their entry, the entrant will automatically be disqualified and their prize, if any, will be forfeited. The Prize will not be awarded until all such properly executed and notarized Prize Claim Documents are returned to Sponsor. Prizewon by an eligible entrant who is a minor in his or her state of residence will be awarded to minor's parent or legal guardian, who must sign and return all required Prize Claim Documents. In the event the Prize Claim Documents are not returned within the specified period, an alternate Winner may be selected by Sponsor for such Prize. The Prize will be shipped to the Winner within 7 days of Sponsor's receipt of a signed Affidavit and Release from the Winner. The Winner is responsible for all taxes and fees related to the Prize received, if any.OTHER RULES: This sweepstakes is subject to all applicable laws and is void where prohibited. All submissions by entrants in connection with the sweepstakes become the sole property of the sponsor and will not be acknowledged or returned. Winner assumes all liability for any injuries or damage caused or claimed to be caused by participation in this sweepstakes or by the use or misuse of any prize.By entering the sweepstakes, each winner grants the SPONSOR permission to use his or her name, city, state/province, e-mail address and, to the extent submitted as part of the sweepstakes entry, his or her photograph, voice, and/or likeness for advertising, publicity or other purposes OR ON A WINNER'S LIST, IF APPLICABLE, IN ANY and all MEDIA WHETHER NOW KNOWN OR HEREINAFTER DEVELOPED, worldwide, without additional consent OR compensation, except where prohibited by law. By submitting an entry, entrants also grant the Sponsor a perpetual, fully-paid, irrevocable, non-exclusive license to reproduce, prepare derivative works of, distribute, display, exhibit, transmit, broadcast, televise, digitize, perform and otherwise use and permit others to use, and throughout the world, their entry materials in any manner, form, or format now known or hereinafter created, including on the internet, and for any purpose, including, but not limited to, advertising or promotion of the Sweepstakes, the Sponsor and/or its products and services, without further consent from or compensation to the entrant. By entering the Sweepstakes, entrants consent to receive notification of future promotions, advertisements or solicitations by or from Sponsor and/or Sponsor's parent companies, affiliates, subsidiaries, and business partners, via email or other means of communication.If, in the Sponsor's opinion, there is any suspected or actual evidence of fraud, electronic or non-electronic tampering or unauthorized intervention with any portion of this Sweepstakes, or if fraud or technical difficulties of any sortcompromise the integrity of the Sweepstakes, the Sponsor reserves the right to void suspect entries and/or terminate the Sweepstakes and award the Prize in its sole discretion. Any attempt to deliberately damage the Sponsor's websiteor undermine the legitimate operation of the Sweepstakes may be in violation of U.S. criminal and civil laws and will result in disqualification from participation in the Sweepstakes. Should such an attempt be made, the Sponsor reserves the right to seek remedies and damagesto the fullest extent of the law, including pursuing criminal prosecution.DISCLAIMER: EXCLUDING ONLY APPLICABLE MANUFACTURERS' WARRANTIES, THE PRIZE IS PROVIDED TO THE WINNER ON AN "AS IS" BASIS, WITHOUT FURTHER WARRANTY OF ANY KIND. SPONSOR HEREBY DISCLAIMS ALL FURTHER WARRANTIES, EXPRESS, IMPLIED, OR STATUTORY INCLUDING BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE WITH RESPECT TO THE PRIZE.LIMITATION OF LIABILITY: BY ENTERING THE SWEEPSTAKES, ENTRANTS, ON BEHALF OF THEMSELVES AND THEIR HEIRS, EXECUTORS, ASSIGNS AND REPRESENTATIVES, RELEASE AND HOLD THE SPONSOR its PARENT COMPANIES, SUBSIDIARIES, AFFILIATED COMPANIES, UNITS AND DIVISIONS, AND THE CURRENT AND FORMER OFFICERS, DIRECTORS, EMPLOYEES, SHAREHOLDERS, AGENTS, SUCCESSORS AND ASSIGNS OF EACH OF THE FOREGOING, AND ALL THOSE ACTING UNDER THE AUTHORITY OF THE FOREGOING, OR ANY OF THEM, HARMLESS FROM AND AGAINST ANY AND ALL CLAIMS, ACTIONS, INJURY, LOSS, DAMAGES, LIABILITIES AND OBLIGATIONS OF ANY KIND WHATSOEVERWHETHER KNOWN OR UNKNOWN, SUSPECTED OR UNSUSPECTED, WHICH ENTRANT EVER HAD, NOW HAVE, OR HEREAFTER CAN, SHALL OR MAY HAVE, AGAINST THE RELEASED PARTIES, INCLUDING, BUT NOT LIMITED TO, CLAIMS ARISING FROM OR RELATED TO THE SWEEPSTAKES OR ENTRANT'S PARTICIPATION IN THE SWEEPSTAKES, AND THE RECEIPT, OWNERSHIP, USE, MISUSE, TRANSFER, SALE OR OTHER DISPOSITION OF THE PRIZE. All matters relating to the interpretation and application of these Sweepstakes Rules shall be decided by Sponsor in its sole discretion.DISPUTES: If, for any reason, the Sweepstakes is not capable of being conducted as described in these Sweepstakes Rules, Sponsor shall have the right, in its sole discretion, to disqualify any individual who tampers with the entry process, and/or to cancel, terminate, modify or suspend the Sweepstakes. The Sponsor assumes no responsibility for any error, omission, interruption, deletion, defect, delay in operation or transmission, communications line failure, theft or destruction or unauthorized access to, or alteration of, entries. The Sponsor is not responsible for any problems or technical malfunction of any telephone network or lines, computer online systems, servers, providers, computer equipment, software, or failure of any e-mail or entry to be received by Sponsor on account of technical problems or traffic congestion on the Internet or at any website, or any combination thereof, including, without limitation, any injury or damage to any entrant's or any other person's computer related to or resulting from participating or downloading any materials in this Sweepstakes. Because of the unique nature and scope of the Sweepstakes, Sponsor reserves the right, in addition to those other rights reserved herein, to modify any dateor deadlineset forth in these Sweepstakes Rules or otherwise governing the Sweepstakes, and any such changes will be posted here in the Sweepstakes Rules. Any attempt by any person to deliberately undermine the legitimate operation of the Sweepstakes may be a violation of criminal and civil law, and, should such an attempt be made, Sponsor reserves the right to seek damages to the fullest extent permitted by law. Sponsor's failure to enforce any term of these Sweepstakes Rules shall not constitute a waiver of any provision.As a condition of participating in the Sweepstakes, entrant agrees that any and all disputes that cannot be resolved between entrant and Sponsor, and causes of action arising out of or connected with the Sweepstakes or these Sweepstakes Rules, shall be resolved individually, without resort to any form of class action, exclusively before a court of competent jurisdiction located in New York, New York, and entrant irrevocably consents to the jurisdiction of the federal and state courts located in New York, New York with respect to any such dispute, cause of action, or other matter. All disputes will be governed and controlled by the laws of the State of New York. Further, in any such dispute, under no circumstances will entrant be permitted to obtain awards for, and hereby irrevocably waives all rights to claim, punitive, incidental, or consequential damages, or any other damages, including attorneys' fees, other than entrant's actual out-of-pocket expenses, and entrant further irrevocably waives all rights to have damages multiplied or increased, if any. EACH PARTY EXPRESSLY WAIVES ANY RIGHT TO A TRIAL BY JURY. All federal, state, and local laws and regulations apply.PRIVACY: Information collected from entrants in connection with the Sweepstakes is subject to Sponsor's privacy policy, which may be found here.SOCIAL MEDIA PROMOTION: Although the Sweepstakes may be featured on Twitter, Facebook, and/or other social media platforms, the Sweepstakes is in no way sponsored, endorsed, administered by, or in association with Twitter, Facebook, and/or such other social media platforms and you agree that Twitter, Facebook, and all other social media platforms are not liable in any way for any claims, damages or losses associated with the Sweepstakes.WINNERLIST: For a list of nameof prizewinner, after the Selection Date, please send a stamped, self-addressed No. 10/standard business envelope to Ziff Davis, LLC, Attn: Legal Department, 360 Park Ave South, Floor 17, New York, NY 10010.BY ENTERING, YOU AGREE THAT YOU HAVE READ AND AGREE TO ALL OF THESE SWEEPSTAKES RULES.
    #tell #speakers #headphones #you #like
    Tell Us the Speakers and Headphones You Like to Listen On
    Take the Speakers, Headphones, and Earphones SurveyTake other PCMag surveys. Each completed survey is a chance to win a Amazon gift card. OFFICIAL SWEEPSTAKES RULESNO PURCHASE NECESSARY TO ENTER OR WIN. A PURCHASE WILL NOT INCREASE YOUR CHANCES OF WINNING. VOID WHERE PROHIBITED. Readers' Choice Sweepstakesis governed by these official rules. The Sweepstakes begins on May 9, 2025, at 12:00 AM ET and ends on July 27, 2025, at 11:59 PM ET.SPONSOR: Ziff Davis, LLC, with an address of 360 Park Ave South, Floor 17, New York, NY 10010.ELIGIBILITY: This Sweepstakes is open to individuals who are eighteenyears of age or older at the time of entry who are legal residents of the fiftyUnited States of America or the District of Columbia. By entering the Sweepstakes as described in these Sweepstakes Rules, entrants represent and warrant that they are complying with these Sweepstakes Rules, and that they agree to abide by and be bound by all the rules and terms and conditions stated herein and all decisions of Sponsor, which shall be final and binding.All previous winners of any sweepstakes sponsored by Sponsor during the ninemonth period prior to the Selection Date are not eligible to enter. Any individualswho have, within the past sixmonths, held employment with or performed services for Sponsor or any organizations affiliated with the sponsorship, fulfillment, administration, prize support, advertisement or promotion of the Sweepstakesare not eligible to enter or win. Immediate Family Members and Household Members are also not eligible to enter or win. "Immediate Family Members" means parents, step-parents, legal guardians, children, step-children, siblings, step-siblings, or spouses of an Employee. "Household Members" means those individuals who share the same residence with an Employee at least threemonths a year.HOW TO ENTER: There are two methods to enter the Sweepstakes:fill out the online survey, orenter by mail.1. Survey Entry: To enter the Sweepstakes through the online survey, go to the survey page and complete the current survey during the Sweepstakes Period.2. Mail Entry: To enter the Sweepstakes by mail, on a 3" x 5" card, print your first and last name, street address, city, state, zip code, phone number, and email address. Mail your completed entry to:Readers' Choice Sweepstakes - Audio 2025c/o E. Griffith 624 Elm St. Ext.Ithaca, NY 14850-8786Mail Entries must be postmarked by July 28, 2025, and received by Aug. 4, 2025.Only oneentry per person is permitted, regardless of the entry method used. Subsequent attempts made by the same individual to submit multiple entries may result in the disqualification of the entrant.Only contributions submitted during the Sweepstakes Period will be eligible for entry into the Sweepstakes. No other methods of entry will be accepted. All entries become the property of Sponsor and will not be returned. Entries are limited to individuals only; commercial enterprises and business entities are not eligible. Use of a false account will disqualify an entry. Sponsor is not responsible for entries not received due to difficulty accessing the internet, service outage or delays, computer difficulties, and other technological problems.Entries are subject to any applicable restrictions or eligibility requirements listed herein. Entries will be deemed to have been made by the authorized account holder of the email or telephone phone number submitted at the time of entry and qualification. Multiple participants are not permitted to share the same email address. Should multiple users of the same e-mail account or mobile phone number, as applicable, enter the Sweepstakes and a dispute thereafter arises regarding the identity of the entrant, the Authorized Account Holder of said e-mail account or mobile phone account at the time of entry will be considered the entrant. "Authorized Account Holder" is defined as the natural person who is assigned an e-mail address or mobile phone number by an Internet access provider, online service provider, telephone service provider or other organization that is responsible for assigned e-mail addresses, phone numbers or the domain associated with the submitted e-mail address. Proof of submission of an entry shall not be deemed proof of receipt by the website administrator for online entries. When applicable, the website administrator's computer will be deemed the official time-keeping device for the Sweepstakes promotion. Entries will be disqualified if found to be incomplete and/or if Sponsor determines, in its sole discretion, that multiple entries were submitted by the same entrant in violation of the Sweepstakes Rules.Entries that are late, lost, stolen, mutilated, tampered with, illegible, incomplete, mechanically reproduced, inaccurate, postage-due, forged, irregular in any way or otherwise not in compliance with these Official Rules will be disqualified. All entries become the property of the Sponsor and will not be acknowledged or returned.WINNER SELECTION AND NOTIFICATION: Sponsor shall select the prize winneron or about Aug. 11, 2025,by random drawing or from among all eligible entries. The Winner will be notified via email to the contact information provided in the entry. Notification of the Winner shall be deemed to have occurred immediately upon sending of the notification by Sponsor. Selected winnerwill be required to respondto the notification within sevendays of attempted notification. The only entries that will be considered eligible entries are entries received by Sponsor within the Sweepstakes Period. The odds of winning depend on the number of eligible entries received. The Sponsor reserves the right, in its sole discretion, to choose an alternative winner in the event that a possible winner has been disqualified or is deemed ineligible for any reason.Recommended by Our EditorsPRIZE: Onewinner will receive the following prize:OneAmazon.com gift code via email, valued at approximately two hundred fifty dollars.No more than the stated number of prizewill be awarded, and all prizelisted above will be awarded. Actual retail value of the Prize may vary due to market conditions. The difference in value of the Prize as stated above and value at time of notification of the Winner, if any, will not be awarded. No cash or prize substitution is permitted, except at the discretion of Sponsor. The Prize is non-transferable. If the Prize cannot be awarded due to circumstances beyond the control of Sponsor, a substitute Prize of equal or greater retail value will be awarded; provided, however, that if a Prize is awarded but remains unclaimed or is forfeited by the Winner, the Prize may not be re-awarded, in Sponsor's sole discretion. In the event that more than the stated number of prizebecomes available for any reason, Sponsor reserves the right to award only the stated number of prizeby a random drawing among all legitimate, un-awarded, eligible prize claims.ACCEPTANCE AND DELIVERY OF THE PRIZE: The Winner will be required to verify his or her address and may be required to execute the following documentbefore a notary public and return them within sevendaysof receipt of such documents: an affidavit of eligibility, a liability release, anda publicity release covering eligibility, liability, advertising, publicity and media appearance issues. If an entrant is unable to verify the information submitted with their entry, the entrant will automatically be disqualified and their prize, if any, will be forfeited. The Prize will not be awarded until all such properly executed and notarized Prize Claim Documents are returned to Sponsor. Prizewon by an eligible entrant who is a minor in his or her state of residence will be awarded to minor's parent or legal guardian, who must sign and return all required Prize Claim Documents. In the event the Prize Claim Documents are not returned within the specified period, an alternate Winner may be selected by Sponsor for such Prize. The Prize will be shipped to the Winner within 7 days of Sponsor's receipt of a signed Affidavit and Release from the Winner. The Winner is responsible for all taxes and fees related to the Prize received, if any.OTHER RULES: This sweepstakes is subject to all applicable laws and is void where prohibited. All submissions by entrants in connection with the sweepstakes become the sole property of the sponsor and will not be acknowledged or returned. Winner assumes all liability for any injuries or damage caused or claimed to be caused by participation in this sweepstakes or by the use or misuse of any prize.By entering the sweepstakes, each winner grants the SPONSOR permission to use his or her name, city, state/province, e-mail address and, to the extent submitted as part of the sweepstakes entry, his or her photograph, voice, and/or likeness for advertising, publicity or other purposes OR ON A WINNER'S LIST, IF APPLICABLE, IN ANY and all MEDIA WHETHER NOW KNOWN OR HEREINAFTER DEVELOPED, worldwide, without additional consent OR compensation, except where prohibited by law. By submitting an entry, entrants also grant the Sponsor a perpetual, fully-paid, irrevocable, non-exclusive license to reproduce, prepare derivative works of, distribute, display, exhibit, transmit, broadcast, televise, digitize, perform and otherwise use and permit others to use, and throughout the world, their entry materials in any manner, form, or format now known or hereinafter created, including on the internet, and for any purpose, including, but not limited to, advertising or promotion of the Sweepstakes, the Sponsor and/or its products and services, without further consent from or compensation to the entrant. By entering the Sweepstakes, entrants consent to receive notification of future promotions, advertisements or solicitations by or from Sponsor and/or Sponsor's parent companies, affiliates, subsidiaries, and business partners, via email or other means of communication.If, in the Sponsor's opinion, there is any suspected or actual evidence of fraud, electronic or non-electronic tampering or unauthorized intervention with any portion of this Sweepstakes, or if fraud or technical difficulties of any sortcompromise the integrity of the Sweepstakes, the Sponsor reserves the right to void suspect entries and/or terminate the Sweepstakes and award the Prize in its sole discretion. Any attempt to deliberately damage the Sponsor's websiteor undermine the legitimate operation of the Sweepstakes may be in violation of U.S. criminal and civil laws and will result in disqualification from participation in the Sweepstakes. Should such an attempt be made, the Sponsor reserves the right to seek remedies and damagesto the fullest extent of the law, including pursuing criminal prosecution.DISCLAIMER: EXCLUDING ONLY APPLICABLE MANUFACTURERS' WARRANTIES, THE PRIZE IS PROVIDED TO THE WINNER ON AN "AS IS" BASIS, WITHOUT FURTHER WARRANTY OF ANY KIND. SPONSOR HEREBY DISCLAIMS ALL FURTHER WARRANTIES, EXPRESS, IMPLIED, OR STATUTORY INCLUDING BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE WITH RESPECT TO THE PRIZE.LIMITATION OF LIABILITY: BY ENTERING THE SWEEPSTAKES, ENTRANTS, ON BEHALF OF THEMSELVES AND THEIR HEIRS, EXECUTORS, ASSIGNS AND REPRESENTATIVES, RELEASE AND HOLD THE SPONSOR its PARENT COMPANIES, SUBSIDIARIES, AFFILIATED COMPANIES, UNITS AND DIVISIONS, AND THE CURRENT AND FORMER OFFICERS, DIRECTORS, EMPLOYEES, SHAREHOLDERS, AGENTS, SUCCESSORS AND ASSIGNS OF EACH OF THE FOREGOING, AND ALL THOSE ACTING UNDER THE AUTHORITY OF THE FOREGOING, OR ANY OF THEM, HARMLESS FROM AND AGAINST ANY AND ALL CLAIMS, ACTIONS, INJURY, LOSS, DAMAGES, LIABILITIES AND OBLIGATIONS OF ANY KIND WHATSOEVERWHETHER KNOWN OR UNKNOWN, SUSPECTED OR UNSUSPECTED, WHICH ENTRANT EVER HAD, NOW HAVE, OR HEREAFTER CAN, SHALL OR MAY HAVE, AGAINST THE RELEASED PARTIES, INCLUDING, BUT NOT LIMITED TO, CLAIMS ARISING FROM OR RELATED TO THE SWEEPSTAKES OR ENTRANT'S PARTICIPATION IN THE SWEEPSTAKES, AND THE RECEIPT, OWNERSHIP, USE, MISUSE, TRANSFER, SALE OR OTHER DISPOSITION OF THE PRIZE. All matters relating to the interpretation and application of these Sweepstakes Rules shall be decided by Sponsor in its sole discretion.DISPUTES: If, for any reason, the Sweepstakes is not capable of being conducted as described in these Sweepstakes Rules, Sponsor shall have the right, in its sole discretion, to disqualify any individual who tampers with the entry process, and/or to cancel, terminate, modify or suspend the Sweepstakes. The Sponsor assumes no responsibility for any error, omission, interruption, deletion, defect, delay in operation or transmission, communications line failure, theft or destruction or unauthorized access to, or alteration of, entries. The Sponsor is not responsible for any problems or technical malfunction of any telephone network or lines, computer online systems, servers, providers, computer equipment, software, or failure of any e-mail or entry to be received by Sponsor on account of technical problems or traffic congestion on the Internet or at any website, or any combination thereof, including, without limitation, any injury or damage to any entrant's or any other person's computer related to or resulting from participating or downloading any materials in this Sweepstakes. Because of the unique nature and scope of the Sweepstakes, Sponsor reserves the right, in addition to those other rights reserved herein, to modify any dateor deadlineset forth in these Sweepstakes Rules or otherwise governing the Sweepstakes, and any such changes will be posted here in the Sweepstakes Rules. Any attempt by any person to deliberately undermine the legitimate operation of the Sweepstakes may be a violation of criminal and civil law, and, should such an attempt be made, Sponsor reserves the right to seek damages to the fullest extent permitted by law. Sponsor's failure to enforce any term of these Sweepstakes Rules shall not constitute a waiver of any provision.As a condition of participating in the Sweepstakes, entrant agrees that any and all disputes that cannot be resolved between entrant and Sponsor, and causes of action arising out of or connected with the Sweepstakes or these Sweepstakes Rules, shall be resolved individually, without resort to any form of class action, exclusively before a court of competent jurisdiction located in New York, New York, and entrant irrevocably consents to the jurisdiction of the federal and state courts located in New York, New York with respect to any such dispute, cause of action, or other matter. All disputes will be governed and controlled by the laws of the State of New York. Further, in any such dispute, under no circumstances will entrant be permitted to obtain awards for, and hereby irrevocably waives all rights to claim, punitive, incidental, or consequential damages, or any other damages, including attorneys' fees, other than entrant's actual out-of-pocket expenses, and entrant further irrevocably waives all rights to have damages multiplied or increased, if any. EACH PARTY EXPRESSLY WAIVES ANY RIGHT TO A TRIAL BY JURY. All federal, state, and local laws and regulations apply.PRIVACY: Information collected from entrants in connection with the Sweepstakes is subject to Sponsor's privacy policy, which may be found here.SOCIAL MEDIA PROMOTION: Although the Sweepstakes may be featured on Twitter, Facebook, and/or other social media platforms, the Sweepstakes is in no way sponsored, endorsed, administered by, or in association with Twitter, Facebook, and/or such other social media platforms and you agree that Twitter, Facebook, and all other social media platforms are not liable in any way for any claims, damages or losses associated with the Sweepstakes.WINNERLIST: For a list of nameof prizewinner, after the Selection Date, please send a stamped, self-addressed No. 10/standard business envelope to Ziff Davis, LLC, Attn: Legal Department, 360 Park Ave South, Floor 17, New York, NY 10010.BY ENTERING, YOU AGREE THAT YOU HAVE READ AND AGREE TO ALL OF THESE SWEEPSTAKES RULES. #tell #speakers #headphones #you #like
    ME.PCMAG.COM
    Tell Us the Speakers and Headphones You Like to Listen On
    Take the Speakers, Headphones, and Earphones SurveyTake other PCMag surveys. Each completed survey is a chance to win a $250 Amazon gift card. OFFICIAL SWEEPSTAKES RULESNO PURCHASE NECESSARY TO ENTER OR WIN. A PURCHASE WILL NOT INCREASE YOUR CHANCES OF WINNING. VOID WHERE PROHIBITED. Readers' Choice Sweepstakes (the "Sweepstakes") is governed by these official rules (the "Sweepstakes Rules"). The Sweepstakes begins on May 9, 2025, at 12:00 AM ET and ends on July 27, 2025, at 11:59 PM ET (the "Sweepstakes Period").SPONSOR: Ziff Davis, LLC, with an address of 360 Park Ave South, Floor 17, New York, NY 10010 (the "Sponsor").ELIGIBILITY: This Sweepstakes is open to individuals who are eighteen (18) years of age or older at the time of entry who are legal residents of the fifty (50) United States of America or the District of Columbia. By entering the Sweepstakes as described in these Sweepstakes Rules, entrants represent and warrant that they are complying with these Sweepstakes Rules (including, without limitation, all eligibility requirements), and that they agree to abide by and be bound by all the rules and terms and conditions stated herein and all decisions of Sponsor, which shall be final and binding.All previous winners of any sweepstakes sponsored by Sponsor during the nine (9) month period prior to the Selection Date are not eligible to enter. Any individuals (including, but not limited to, employees, consultants, independent contractors and interns) who have, within the past six (6) months, held employment with or performed services for Sponsor or any organizations affiliated with the sponsorship, fulfillment, administration, prize support, advertisement or promotion of the Sweepstakes ("Employees") are not eligible to enter or win. Immediate Family Members and Household Members are also not eligible to enter or win. "Immediate Family Members" means parents, step-parents, legal guardians, children, step-children, siblings, step-siblings, or spouses of an Employee. "Household Members" means those individuals who share the same residence with an Employee at least three (3) months a year.HOW TO ENTER: There are two methods to enter the Sweepstakes: (1) fill out the online survey, or (2) enter by mail.1. Survey Entry: To enter the Sweepstakes through the online survey, go to the survey page and complete the current survey during the Sweepstakes Period.2. Mail Entry: To enter the Sweepstakes by mail, on a 3" x 5" card, print your first and last name, street address, city, state, zip code, phone number, and email address. Mail your completed entry to:Readers' Choice Sweepstakes - Audio 2025c/o E. Griffith 624 Elm St. Ext.Ithaca, NY 14850-8786Mail Entries must be postmarked by July 28, 2025, and received by Aug. 4, 2025.Only one (1) entry per person is permitted, regardless of the entry method used. Subsequent attempts made by the same individual to submit multiple entries may result in the disqualification of the entrant.Only contributions submitted during the Sweepstakes Period will be eligible for entry into the Sweepstakes. No other methods of entry will be accepted. All entries become the property of Sponsor and will not be returned. Entries are limited to individuals only; commercial enterprises and business entities are not eligible. Use of a false account will disqualify an entry. Sponsor is not responsible for entries not received due to difficulty accessing the internet, service outage or delays, computer difficulties, and other technological problems.Entries are subject to any applicable restrictions or eligibility requirements listed herein. Entries will be deemed to have been made by the authorized account holder of the email or telephone phone number submitted at the time of entry and qualification. Multiple participants are not permitted to share the same email address. Should multiple users of the same e-mail account or mobile phone number, as applicable, enter the Sweepstakes and a dispute thereafter arises regarding the identity of the entrant, the Authorized Account Holder of said e-mail account or mobile phone account at the time of entry will be considered the entrant. "Authorized Account Holder" is defined as the natural person who is assigned an e-mail address or mobile phone number by an Internet access provider, online service provider, telephone service provider or other organization that is responsible for assigned e-mail addresses, phone numbers or the domain associated with the submitted e-mail address. Proof of submission of an entry shall not be deemed proof of receipt by the website administrator for online entries. When applicable, the website administrator's computer will be deemed the official time-keeping device for the Sweepstakes promotion. Entries will be disqualified if found to be incomplete and/or if Sponsor determines, in its sole discretion, that multiple entries were submitted by the same entrant in violation of the Sweepstakes Rules.Entries that are late, lost, stolen, mutilated, tampered with, illegible, incomplete, mechanically reproduced, inaccurate, postage-due, forged, irregular in any way or otherwise not in compliance with these Official Rules will be disqualified. All entries become the property of the Sponsor and will not be acknowledged or returned.WINNER SELECTION AND NOTIFICATION: Sponsor shall select the prize winner(s) (collectively, the "Winner") on or about Aug. 11, 2025, ("Selection Date") by random drawing or from among all eligible entries. The Winner will be notified via email to the contact information provided in the entry. Notification of the Winner shall be deemed to have occurred immediately upon sending of the notification by Sponsor. Selected winner(s) will be required to respond (as directed) to the notification within seven (7) days of attempted notification. The only entries that will be considered eligible entries are entries received by Sponsor within the Sweepstakes Period. The odds of winning depend on the number of eligible entries received. The Sponsor reserves the right, in its sole discretion, to choose an alternative winner in the event that a possible winner has been disqualified or is deemed ineligible for any reason.Recommended by Our EditorsPRIZE: One (1) winner will receive the following prize (collectively, the "Prize"):One (1) $250 Amazon.com gift code via email, valued at approximately two hundred fifty dollars ($250).No more than the stated number of prize(s) will be awarded, and all prize(s) listed above will be awarded. Actual retail value of the Prize may vary due to market conditions. The difference in value of the Prize as stated above and value at time of notification of the Winner, if any, will not be awarded. No cash or prize substitution is permitted, except at the discretion of Sponsor. The Prize is non-transferable. If the Prize cannot be awarded due to circumstances beyond the control of Sponsor, a substitute Prize of equal or greater retail value will be awarded; provided, however, that if a Prize is awarded but remains unclaimed or is forfeited by the Winner, the Prize may not be re-awarded, in Sponsor's sole discretion. In the event that more than the stated number of prize(s) becomes available for any reason, Sponsor reserves the right to award only the stated number of prize(s) by a random drawing among all legitimate, un-awarded, eligible prize claims.ACCEPTANCE AND DELIVERY OF THE PRIZE: The Winner will be required to verify his or her address and may be required to execute the following document(s) before a notary public and return them within seven (7) days (or a shorter time if required by exigencies) of receipt of such documents: an affidavit of eligibility, a liability release, and (where imposing such condition is legal) a publicity release covering eligibility, liability, advertising, publicity and media appearance issues (collectively, the "Prize Claim Documents"). If an entrant is unable to verify the information submitted with their entry, the entrant will automatically be disqualified and their prize, if any, will be forfeited. The Prize will not be awarded until all such properly executed and notarized Prize Claim Documents are returned to Sponsor. Prize(s) won by an eligible entrant who is a minor in his or her state of residence will be awarded to minor's parent or legal guardian, who must sign and return all required Prize Claim Documents. In the event the Prize Claim Documents are not returned within the specified period, an alternate Winner may be selected by Sponsor for such Prize. The Prize will be shipped to the Winner within 7 days of Sponsor's receipt of a signed Affidavit and Release from the Winner. The Winner is responsible for all taxes and fees related to the Prize received, if any.OTHER RULES: This sweepstakes is subject to all applicable laws and is void where prohibited. All submissions by entrants in connection with the sweepstakes become the sole property of the sponsor and will not be acknowledged or returned. Winner assumes all liability for any injuries or damage caused or claimed to be caused by participation in this sweepstakes or by the use or misuse of any prize.By entering the sweepstakes, each winner grants the SPONSOR permission to use his or her name, city, state/province, e-mail address and, to the extent submitted as part of the sweepstakes entry, his or her photograph, voice, and/or likeness for advertising, publicity or other purposes OR ON A WINNER'S LIST, IF APPLICABLE, IN ANY and all MEDIA WHETHER NOW KNOWN OR HEREINAFTER DEVELOPED, worldwide, without additional consent OR compensation, except where prohibited by law. By submitting an entry, entrants also grant the Sponsor a perpetual, fully-paid, irrevocable, non-exclusive license to reproduce, prepare derivative works of, distribute, display, exhibit, transmit, broadcast, televise, digitize, perform and otherwise use and permit others to use, and throughout the world, their entry materials in any manner, form, or format now known or hereinafter created, including on the internet, and for any purpose, including, but not limited to, advertising or promotion of the Sweepstakes, the Sponsor and/or its products and services, without further consent from or compensation to the entrant. By entering the Sweepstakes, entrants consent to receive notification of future promotions, advertisements or solicitations by or from Sponsor and/or Sponsor's parent companies, affiliates, subsidiaries, and business partners, via email or other means of communication.If, in the Sponsor's opinion, there is any suspected or actual evidence of fraud, electronic or non-electronic tampering or unauthorized intervention with any portion of this Sweepstakes, or if fraud or technical difficulties of any sort (e.g., computer viruses, bugs) compromise the integrity of the Sweepstakes, the Sponsor reserves the right to void suspect entries and/or terminate the Sweepstakes and award the Prize in its sole discretion. Any attempt to deliberately damage the Sponsor's website(s) or undermine the legitimate operation of the Sweepstakes may be in violation of U.S. criminal and civil laws and will result in disqualification from participation in the Sweepstakes. Should such an attempt be made, the Sponsor reserves the right to seek remedies and damages (including attorney's fees) to the fullest extent of the law, including pursuing criminal prosecution.DISCLAIMER: EXCLUDING ONLY APPLICABLE MANUFACTURERS' WARRANTIES, THE PRIZE IS PROVIDED TO THE WINNER ON AN "AS IS" BASIS, WITHOUT FURTHER WARRANTY OF ANY KIND. SPONSOR HEREBY DISCLAIMS ALL FURTHER WARRANTIES, EXPRESS, IMPLIED, OR STATUTORY INCLUDING BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE WITH RESPECT TO THE PRIZE.LIMITATION OF LIABILITY: BY ENTERING THE SWEEPSTAKES, ENTRANTS, ON BEHALF OF THEMSELVES AND THEIR HEIRS, EXECUTORS, ASSIGNS AND REPRESENTATIVES, RELEASE AND HOLD THE SPONSOR its PARENT COMPANIES, SUBSIDIARIES, AFFILIATED COMPANIES, UNITS AND DIVISIONS, AND THE CURRENT AND FORMER OFFICERS, DIRECTORS, EMPLOYEES, SHAREHOLDERS, AGENTS, SUCCESSORS AND ASSIGNS OF EACH OF THE FOREGOING, AND ALL THOSE ACTING UNDER THE AUTHORITY OF THE FOREGOING, OR ANY OF THEM (INCLUDING, BUT NOT LIMITED TO, ADVERTISING AND PROMOTIONAL AGENCIES AND PRIZE SUPPLIERS) (EACH A "RELEASED PARTY"), HARMLESS FROM AND AGAINST ANY AND ALL CLAIMS, ACTIONS, INJURY, LOSS, DAMAGES, LIABILITIES AND OBLIGATIONS OF ANY KIND WHATSOEVER (COLLECTIVELY, THE "CLAIMS") WHETHER KNOWN OR UNKNOWN, SUSPECTED OR UNSUSPECTED, WHICH ENTRANT EVER HAD, NOW HAVE, OR HEREAFTER CAN, SHALL OR MAY HAVE, AGAINST THE RELEASED PARTIES (OR ANY OF THEM), INCLUDING, BUT NOT LIMITED TO, CLAIMS ARISING FROM OR RELATED TO THE SWEEPSTAKES OR ENTRANT'S PARTICIPATION IN THE SWEEPSTAKES (INCLUDING, WITHOUT LIMITATION, CLAIMS FOR LIBEL, DEFAMATION, INVASION OF PRIVACY, VIOLATION OF THE RIGHT OF PUBLICITY, COMMERCIAL APPROPRIATION OF NAME AND LIKENESS, INFRINGEMENT OF COPYRIGHT OR VIOLATION OF ANY OTHER PERSONAL OR PROPRIETARY RIGHT), AND THE RECEIPT, OWNERSHIP, USE, MISUSE, TRANSFER, SALE OR OTHER DISPOSITION OF THE PRIZE (INCLUDING, WITHOUT LIMITATION, CLAIMS FOR PERSONAL INJURY, DEATH, AND/OR PROPERTY DAMAGE). All matters relating to the interpretation and application of these Sweepstakes Rules shall be decided by Sponsor in its sole discretion.DISPUTES: If, for any reason (including infection by computer virus, bugs, tampering, unauthorized intervention, fraud, technical failures, or any other causes beyond the control of the Sponsor which corrupt or affect the administration, security, fairness, integrity, or proper conduct of this Sweepstakes), the Sweepstakes is not capable of being conducted as described in these Sweepstakes Rules, Sponsor shall have the right, in its sole discretion, to disqualify any individual who tampers with the entry process, and/or to cancel, terminate, modify or suspend the Sweepstakes. The Sponsor assumes no responsibility for any error, omission, interruption, deletion, defect, delay in operation or transmission, communications line failure, theft or destruction or unauthorized access to, or alteration of, entries. The Sponsor is not responsible for any problems or technical malfunction of any telephone network or lines, computer online systems, servers, providers, computer equipment, software, or failure of any e-mail or entry to be received by Sponsor on account of technical problems or traffic congestion on the Internet or at any website, or any combination thereof, including, without limitation, any injury or damage to any entrant's or any other person's computer related to or resulting from participating or downloading any materials in this Sweepstakes. Because of the unique nature and scope of the Sweepstakes, Sponsor reserves the right, in addition to those other rights reserved herein, to modify any date(s) or deadline(s) set forth in these Sweepstakes Rules or otherwise governing the Sweepstakes, and any such changes will be posted here in the Sweepstakes Rules. Any attempt by any person to deliberately undermine the legitimate operation of the Sweepstakes may be a violation of criminal and civil law, and, should such an attempt be made, Sponsor reserves the right to seek damages to the fullest extent permitted by law. Sponsor's failure to enforce any term of these Sweepstakes Rules shall not constitute a waiver of any provision.As a condition of participating in the Sweepstakes, entrant agrees that any and all disputes that cannot be resolved between entrant and Sponsor, and causes of action arising out of or connected with the Sweepstakes or these Sweepstakes Rules, shall be resolved individually, without resort to any form of class action, exclusively before a court of competent jurisdiction located in New York, New York, and entrant irrevocably consents to the jurisdiction of the federal and state courts located in New York, New York with respect to any such dispute, cause of action, or other matter. All disputes will be governed and controlled by the laws of the State of New York (without regard for its conflicts-of-laws principles). Further, in any such dispute, under no circumstances will entrant be permitted to obtain awards for, and hereby irrevocably waives all rights to claim, punitive, incidental, or consequential damages, or any other damages, including attorneys' fees, other than entrant's actual out-of-pocket expenses (i.e., costs incurred directly in connection with entrant's participation in the Sweepstakes), and entrant further irrevocably waives all rights to have damages multiplied or increased, if any. EACH PARTY EXPRESSLY WAIVES ANY RIGHT TO A TRIAL BY JURY. All federal, state, and local laws and regulations apply.PRIVACY: Information collected from entrants in connection with the Sweepstakes is subject to Sponsor's privacy policy, which may be found here.SOCIAL MEDIA PROMOTION: Although the Sweepstakes may be featured on Twitter, Facebook, and/or other social media platforms, the Sweepstakes is in no way sponsored, endorsed, administered by, or in association with Twitter, Facebook, and/or such other social media platforms and you agree that Twitter, Facebook, and all other social media platforms are not liable in any way for any claims, damages or losses associated with the Sweepstakes.WINNER(S) LIST: For a list of name(s) of prizewinner(s), after the Selection Date, please send a stamped, self-addressed No. 10/standard business envelope to Ziff Davis, LLC, Attn: Legal Department, 360 Park Ave South, Floor 17, New York, NY 10010 (VT residents may omit return postage).BY ENTERING, YOU AGREE THAT YOU HAVE READ AND AGREE TO ALL OF THESE SWEEPSTAKES RULES.
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  • Apple challenges Europe’s interoperability demands

    Facing huge fines, Apple on Monday began a legal challenge to the European Commission’s “unreasonable” demand that it open up its platforms to rivals, arguing any such move threatens the foundations of its platforms with a costly process that also undercuts its ability to serve customers.

    The company is, in a word, furious. It argued that it has cooperated with the Commission’s demands under the Digital Markets Act and points to the investments it has already made in complying with that act.

    What Apple said

    “At Apple, we design our technology to work seamlessly together, so it can deliver the unique experience our users love and expect from our products,” the company said in a statement. “The EU’s interoperability requirements threaten that foundation, while creating a process that is unreasonable, costly, and stifles innovation. These requirements will also hand data-hungry companies’ sensitive information, which poses massive privacy and security risks to our EU users.”

    The company also noted that there is a real risk that people’s most sensitive information could be accessed, partially because it becomes so much harder to defend. These attempts are already taking place, Apple said.

    “Companies have already requested our users’ most sensitive data — from the content of their notifications to a full history of every stored Wi-Fi network on their device — giving them the ability to access personal information that even Apple doesn’t see. In the end, these deeply flawed rules that only target Apple — and no other company will severely limit our ability to deliver innovative products and features to Europe, leading to an inferior user experience for our European customers. We are appealing these decisions on their behalf, and in order to preserve the high-quality experience our European customers expect.”

    A one-sided approach

    What seems to really upset Apple is that some aspects of the demands mean the company will effectively be forced to hand its innovations out to businesses with which it is in direct competition — at no charge. That means Apple does not get to draw the full benefits of its work and makes it far more difficult to introduce products in Europe.

    What makes matters worse is that while Apple is being forced to open up in ways that advantage competitors, quite literally at its expense, it is not being given the opportunity to do the same back. Apple is the only company that these demands have been made of, meaning it is being forced to give its intellectual property away to others who do not need to play by the same rules.

    Some data hungry companies are already attempting to exploit the DMA to gain unfettered access to sensitive customer data. All the while, Apple is left alone and isolated in its quest to ensure user privacy consistent with GDPR regulation. It’s attempts to protect privacy are about protecting customers.

    Compliance? We are compliant

    While critics will continue to sneer and jeer at the company in their quest to rid the world of the “Apple Tax” only the world’s largest developers actually pay, Apple would argue that it has been making serious efforts to comply with the DMA. The company has opened up a portal developers can use to request additional interoperability with hardware and software features inside iPhones and iPads. Apple consistently opens up API access to iPhone, including opening up SMS messaging to RCS, HomeKit features and messaging services support.

    It has also put in place numerous other enhancements in response to the DMA, and while the warning messages it places when using third-party stores may be stark, this makes them no less true. Europe seems to want customers to use third-party stores with no warning at all that this is what is going on, which seems weird.

    Malicious regulatory compliance

    There is a degree to which much of the situation seems to reflect political, rather than economic or moral pressures. The fact that Europe is using Apple as a high profile example, while also refusing to be totally transparent about what it wants before levying any fines, suggests that the Commission is not so much deciding on facts as implementing a political decision using a set of laws that seem designed almost solely to punish one company.

    That’s the kind of malicious regulatory compliance Apple is furious about — a compliance regime that will now be tested in the courts.

    Will it make a difference? 

    Who knows? But the existential battle will decide the future of technology in Europe, and if the market is worth doing business in when compared to the cost of doing so. It will also determine the future of Apple, which will use its considerable resources to find some way to change the nature of the game.

    One group it seems unlikely to help will be those of Apple’s European customers who are happy and accustomed to the Apple ecosystem, and don’t particularly want to use third-party services, as Apple’s right to offer that “pure Apple” experience seems a likely sacrifice to Europe’s politically-driven zeal. That is, unless cooler heads do curtail the Commission’s attacks.

    You can follow me on social media! Join me on BlueSky,  LinkedIn, and Mastodon.
    #apple #challenges #europes #interoperability #demands
    Apple challenges Europe’s interoperability demands
    Facing huge fines, Apple on Monday began a legal challenge to the European Commission’s “unreasonable” demand that it open up its platforms to rivals, arguing any such move threatens the foundations of its platforms with a costly process that also undercuts its ability to serve customers. The company is, in a word, furious. It argued that it has cooperated with the Commission’s demands under the Digital Markets Act and points to the investments it has already made in complying with that act. What Apple said “At Apple, we design our technology to work seamlessly together, so it can deliver the unique experience our users love and expect from our products,” the company said in a statement. “The EU’s interoperability requirements threaten that foundation, while creating a process that is unreasonable, costly, and stifles innovation. These requirements will also hand data-hungry companies’ sensitive information, which poses massive privacy and security risks to our EU users.” The company also noted that there is a real risk that people’s most sensitive information could be accessed, partially because it becomes so much harder to defend. These attempts are already taking place, Apple said. “Companies have already requested our users’ most sensitive data — from the content of their notifications to a full history of every stored Wi-Fi network on their device — giving them the ability to access personal information that even Apple doesn’t see. In the end, these deeply flawed rules that only target Apple — and no other company will severely limit our ability to deliver innovative products and features to Europe, leading to an inferior user experience for our European customers. We are appealing these decisions on their behalf, and in order to preserve the high-quality experience our European customers expect.” A one-sided approach What seems to really upset Apple is that some aspects of the demands mean the company will effectively be forced to hand its innovations out to businesses with which it is in direct competition — at no charge. That means Apple does not get to draw the full benefits of its work and makes it far more difficult to introduce products in Europe. What makes matters worse is that while Apple is being forced to open up in ways that advantage competitors, quite literally at its expense, it is not being given the opportunity to do the same back. Apple is the only company that these demands have been made of, meaning it is being forced to give its intellectual property away to others who do not need to play by the same rules. Some data hungry companies are already attempting to exploit the DMA to gain unfettered access to sensitive customer data. All the while, Apple is left alone and isolated in its quest to ensure user privacy consistent with GDPR regulation. It’s attempts to protect privacy are about protecting customers. Compliance? We are compliant While critics will continue to sneer and jeer at the company in their quest to rid the world of the “Apple Tax” only the world’s largest developers actually pay, Apple would argue that it has been making serious efforts to comply with the DMA. The company has opened up a portal developers can use to request additional interoperability with hardware and software features inside iPhones and iPads. Apple consistently opens up API access to iPhone, including opening up SMS messaging to RCS, HomeKit features and messaging services support. It has also put in place numerous other enhancements in response to the DMA, and while the warning messages it places when using third-party stores may be stark, this makes them no less true. Europe seems to want customers to use third-party stores with no warning at all that this is what is going on, which seems weird. Malicious regulatory compliance There is a degree to which much of the situation seems to reflect political, rather than economic or moral pressures. The fact that Europe is using Apple as a high profile example, while also refusing to be totally transparent about what it wants before levying any fines, suggests that the Commission is not so much deciding on facts as implementing a political decision using a set of laws that seem designed almost solely to punish one company. That’s the kind of malicious regulatory compliance Apple is furious about — a compliance regime that will now be tested in the courts. Will it make a difference?  Who knows? But the existential battle will decide the future of technology in Europe, and if the market is worth doing business in when compared to the cost of doing so. It will also determine the future of Apple, which will use its considerable resources to find some way to change the nature of the game. One group it seems unlikely to help will be those of Apple’s European customers who are happy and accustomed to the Apple ecosystem, and don’t particularly want to use third-party services, as Apple’s right to offer that “pure Apple” experience seems a likely sacrifice to Europe’s politically-driven zeal. That is, unless cooler heads do curtail the Commission’s attacks. You can follow me on social media! Join me on BlueSky,  LinkedIn, and Mastodon. #apple #challenges #europes #interoperability #demands
    WWW.COMPUTERWORLD.COM
    Apple challenges Europe’s interoperability demands
    Facing huge fines, Apple on Monday began a legal challenge to the European Commission’s “unreasonable” demand that it open up its platforms to rivals, arguing any such move threatens the foundations of its platforms with a costly process that also undercuts its ability to serve customers. The company is, in a word, furious. It argued that it has cooperated with the Commission’s demands under the Digital Markets Act (DMA) and points to the investments it has already made in complying with that act. What Apple said “At Apple, we design our technology to work seamlessly together, so it can deliver the unique experience our users love and expect from our products,” the company said in a statement. “The EU’s interoperability requirements threaten that foundation, while creating a process that is unreasonable, costly, and stifles innovation. These requirements will also hand data-hungry companies’ sensitive information, which poses massive privacy and security risks to our EU users.” The company also noted that there is a real risk that people’s most sensitive information could be accessed, partially because it becomes so much harder to defend. These attempts are already taking place, Apple said. “Companies have already requested our users’ most sensitive data — from the content of their notifications to a full history of every stored Wi-Fi network on their device — giving them the ability to access personal information that even Apple doesn’t see. In the end, these deeply flawed rules that only target Apple — and no other company will severely limit our ability to deliver innovative products and features to Europe, leading to an inferior user experience for our European customers. We are appealing these decisions on their behalf, and in order to preserve the high-quality experience our European customers expect.” A one-sided approach What seems to really upset Apple is that some aspects of the demands mean the company will effectively be forced to hand its innovations out to businesses with which it is in direct competition — at no charge. That means Apple does not get to draw the full benefits of its work and makes it far more difficult to introduce products in Europe. What makes matters worse is that while Apple is being forced to open up in ways that advantage competitors, quite literally at its expense, it is not being given the opportunity to do the same back. Apple is the only company that these demands have been made of, meaning it is being forced to give its intellectual property away to others who do not need to play by the same rules. Some data hungry companies are already attempting to exploit the DMA to gain unfettered access to sensitive customer data. All the while, Apple is left alone and isolated in its quest to ensure user privacy consistent with GDPR regulation. It’s attempts to protect privacy are about protecting customers. Compliance? We are compliant While critics will continue to sneer and jeer at the company in their quest to rid the world of the “Apple Tax” only the world’s largest developers actually pay, Apple would argue that it has been making serious efforts to comply with the DMA. The company has opened up a portal developers can use to request additional interoperability with hardware and software features inside iPhones and iPads. Apple consistently opens up API access to iPhone, including opening up SMS messaging to RCS, HomeKit features and messaging services support. It has also put in place numerous other enhancements in response to the DMA, and while the warning messages it places when using third-party stores may be stark, this makes them no less true. Europe seems to want customers to use third-party stores with no warning at all that this is what is going on, which seems weird. Malicious regulatory compliance There is a degree to which much of the situation seems to reflect political, rather than economic or moral pressures. The fact that Europe is using Apple as a high profile example, while also refusing to be totally transparent about what it wants before levying any fines, suggests that the Commission is not so much deciding on facts as implementing a political decision using a set of laws that seem designed almost solely to punish one company. That’s the kind of malicious regulatory compliance Apple is furious about — a compliance regime that will now be tested in the courts. Will it make a difference?  Who knows? But the existential battle will decide the future of technology in Europe, and if the market is worth doing business in when compared to the cost of doing so. It will also determine the future of Apple, which will use its considerable resources to find some way to change the nature of the game. One group it seems unlikely to help will be those of Apple’s European customers who are happy and accustomed to the Apple ecosystem, and don’t particularly want to use third-party services, as Apple’s right to offer that “pure Apple” experience seems a likely sacrifice to Europe’s politically-driven zeal. That is, unless cooler heads do curtail the Commission’s attacks. You can follow me on social media! Join me on BlueSky,  LinkedIn, and Mastodon.
    0 Комментарии 0 Поделились
  • ExpressVPN review 2025: Fast speeds and a low learning curve

    ExpressVPN is good at its job. It's easy to be skeptical of any service with a knack for self-promotion, but don't let ExpressVPN's hype distract you from the fact that it keeps its front-page promise of "just working."
    Outside of solid security, the two best things ExpressVPN offers are fast speeds and a simple interface. Our tests showed only a 7% average drop in download speed and a 2% loss of upload speed, worldwide. And while the lack of extra features may frustrate experienced users, it makes for a true set-and-forget VPN on any platform.
    This isn't to say ExpressVPN is without flaws — it's nearly bereft of customization options and it's notably more expensive than its competition — but it beats most VPNs in a head-to-head matchup.
    For this review, we followed our rigorous 10-step VPN testing process, exploring ExpressVPN's security, privacy, speed, interfaces and more. Whether you read straight through or skip to the sections that are most important for you, you should come away with all the information you need to decide whether to subscribe.
    Editors' note: We're in the process of rebooting all of our VPN reviews from scratch. Once we do a fresh pass on the top services, we'll be updating each review with a rating and additional comparative information.

    Table of contents

    Findings at a glance
    Installing, configuring and using ExpressVPN
    ExpressVPN speed test: Very fast averages
    ExpressVPN security test: Checking for leaks
    How much does ExpressVPN cost?
    ExpressVPN side apps and bundles
    Close-reading ExpressVPN's privacy policy
    Can ExpressVPN change your virtual location?
    Investigating ExpressVPN's server network
    Extra features of ExpressVPN
    ExpressVPN customer support options
    ExpressVPN background check: From founding to Kape Technologies
    Final verdict

    Findings at a glance

    Category
    Notes

    Installation and UI
    All interfaces are clean and minimalist, with no glitches and not enough depth to get lost in Windows and Mac clients are similar in both setup and general user experience Android and iOS are likewise almost identical, but Android has a nice-looking dark mode

    Speed
    Retains a worldwide average of 93% of starting download speeds Upload speeds average 98% of starting speeds Latency rises with distance, but global average stayed under 300 ms in tests

    Security
    OpenVPN, IKEv2 and Lightway VPN protocols all use secure ciphers Packet-sniffing test showed working encryption We detected no IP leaks Blocks IPv6 and WebRTC by default to prevent leaks

    Pricing
    Base price: per month or per year Lowest prepaid rate: per month Can save money by paying for 28 months in advance, but only once per account 30-day money-back guarantee

    Bundles
    ExpressVPN Keys password manager and ID alerts included on all plans Dedicated IP addresses come at an extra price ID theft insurance, data removal and credit scanning available to new one-year and two-year subscribers for free 1GB eSIM deal included through holiday.com

    Privacy policy
    No storage of connection logs or device logs permitted The only risky exceptions are personal account dataand marketing dataAn independent audit found that ExpressVPN's RAM-only server infrastructure makes it impossible to keep logs

    Virtual location change
    Successfully unblocked five international Netflix libraries, succeeding on 14 out of 15 attempts

    Server network
    164 server locations in 105 countries 38% of servers are virtual, though most virtual locations are accessed through physical servers within 1,000 miles A large number of locations in South America, Africa and central Asia

    Features
    Simple but effective kill switch Can block ads, trackers, adult sites and/or malware sites but blocklists can't be customized Split tunneling is convenient but unavailable on iOS and modern Macs Aircove is the best VPN router, albeit expensive

    Customer support
    Setup and troubleshooting guides are organized and useful, with lots of screenshots and videos Live chat starts with a bot but you can get to a person within a couple minutes Email tickets are only accessible from the mobile apps or after live chat has failed

    Background check
    Founded in 2009; based in the British Virgin Islands Has never been caught selling or mishandling user data Turkish police seized servers in 2017 but couldn't find any logs of user activity Owned by Kape Technologies, which also owns CyberGhost and Private Internet Access A previous CIO formerly worked on surveillance in the United Arab Emirates; no evidence of shady behavior during his time at ExpressVPN Windows Version 12 leaked some DNS requests when Split Tunneling was active

    Installing, configuring and using ExpressVPN
    This section focuses on how it feels to use ExpressVPN on each of the major platforms where it's available. The first step for any setup process is to make an account on expressvpn.com and buy a subscription.
    Windows
    Once subscribed, download the Windows VPN from either expressvpn.com or the Microsoft Store, then open the .exe file. Click "Yes" to let it make changes, wait for the install, then let your computer reboot. Including the reboot, the whole process takes 5-10 minutes, most of it idle. To finish, you'll need your activation code, which you can find by going to expressvpn.com and clicking "Setup" in the top-right corner.

    You can install ExpressVPN's Windows app from the Microsoft store, but we found the website more convenient.

    Sam Chapman for Engadget

    Extreme simplicity is the watchword for all ExpressVPN's designs. The Windows client's launch panel consists of three buttons and less than ten words. You can change your location or let the app pick a location for you — the "Smart Location" is the server with the best combination of being nearby and unburdened.
    Everything else is crammed into the hamburger menu at the top left. Here, in seven tabs, you'll find the Network Lock kill switch, the four types of content blockers, the split tunneling menu and the option to change your VPN protocol. You can also add shortcuts to various websites, useful if you regularly use your VPN for the same online destinations.
    To sum up, there's almost nothing here to get in the way: no delays, no snags, no nested menus to get lost in. It may be the world's most ignorable VPN client. That's not a bad thing at all.
    Mac
    ExpressVPN's app for macOS is almost identical in design to its Windows app. The process for downloading and setting it up is nearly the same too. As on Windows, it can be downloaded from the App Store or sideloaded directly from the expressvpn.com download center. Only a few features are missing and a couple others have been added. Split tunneling is gone, and you won't see the Lightway Turbo setting.

    ExpressVPN recommends some servers, but it's easy to search the whole list.

    Sam Chapman for Engadget

    Mac users do gain access to the IKEv2 protocol, along with the option to turn off automatic IPv6 blocking — Windows users have to leave it blocked at all times. Almost every website is still accessible via IPv4, but it's useful if you do need to access a specific IPv6 address while the VPN is active.
    Android
    Android users can download ExpressVPN through the Google Play Store. Open the app, sign in and you're ready to go. The Android app has a very nice dark-colored design, only slightly marred by an unnecessary information box about how long you've used the VPN this week.

    ExpressVPN's Android app puts a little more information on the screen than it needs to, but still runs well.

    Sam Chapman for Engadget

    There's a large button for connecting. Clicking on the server name takes you to a list of locations. On this list, you can either search or scroll and can choose individual locations within a country that has more than one. We connected to as many far-flung server locations as we could, but not a single one took longer than a few seconds.
    The options menu is organized sensibly, with no option located more than two clicks deep. You will see a couple of options here that aren't available on desktop, the best of which is the ability to automatically connect to your last-used ExpressVPN server whenever your phone connects to a non-trusted wifi network.
    There are also a few general security tools: an IP address checker, DNS and WebRTC leak testers and a password generator. These are also available on the website, but here, they're built into the app. With the exception of the latter, we'd recommend using third-party testing tools instead — even a VPN with integrity has an incentive to make its own app look like it's working.
    iPhone and iPad
    You can only install ExpressVPN's iOS app through the app store. During setup, you may need to enter your password to allow your phone to use VPN configurations. Otherwise, there are no major differences from the Android process.

    ExpressVPN looks good on iPhone and iPad.

    Sam Chapman for Engadget

    The interface is not quite as pleasing as the dark-mode Android app, but it makes up for that by cutting out some of the clutter. The tabs and features are similar, though split tunneling and shortcuts are absent. Also, both mobile apps make customer support a lot more accessible than their desktop counterparts — plus, mobile is the only way to send email support tickets.
    Browser extension
    ExpressVPN also includes browser extensions for Firefox and Chrome. These let you connect, disconnect and change server locations without leaving your browser window. It's nice, but not essential unless you have a very specific web browser flow you like.
    ExpressVPN speed test: Very fast averages
    Connecting to a VPN almost always decreases your speed, but the best VPNs mitigate the drop as much as possible. We used Ookla's speed testing app to see how much of your internet speed ExpressVPN preserves. For this test, we emphasized the locations ExpressVPN uses for most of its virtual servers, including the Netherlands, Brazil, Germany and Singapore.
    Some terms before we start:

    Latency, measured in milliseconds, is the time it takes one data packet to travel between your device and a web server through the VPN. Latency increases with distance. It's most important for real-time tasks like video chatting and online gaming.
    Download speed, measured in megabits per second, is the amount of information that can download onto your device at one time — such as when loading a web page or streaming a video.
    Upload speed, also measured in Mbps, is the amount of information your device can send to the web at once. It's most important for torrenting, since the amount of data you can seed determines how fast you can download in exchange.

    The table below shows our results. We conducted this on Windows, using the automatic protocol setting with the Lightway Turbo feature active — a recent ExpressVPN addition that keeps speed more consistent by processing connections in parallel.

    Server location
    LatencyIncrease factor
    Download speedPercentage dropoff
    Upload speedPercentage dropoff

    Portland, Oregon, USA18
    --
    58.77
    --
    5.70
    --

    Seattle, Washington, USA26
    1.4x
    54.86
    6.7%
    5.52
    3.2%

    New York, NY, USA
    156
    8.7x
    57.25
    2.6%
    5.57
    2.3%

    Amsterdam, Netherlands
    306
    17x
    53.83
    8.4%
    5.58
    2.1%

    São Paulo, Brazil
    371
    20.6x
    53.82
    8.4%
    5.65
    0.9%

    Frankfurt, Germany
    404
    22.4x
    55.71
    5.2%
    5.67
    0.5%

    Singapore, Singapore
    381
    21.2x
    52.76
    10.2%
    5.64
    1.0%

    Average
    274
    15.2x
    54.71
    6.9%
    5.61
    1.6%

    These are extremely good results. ExpressVPN is a winner on both download and upload speed. No matter where we went in the world, we never lost more than about 7% of our download speeds, and upload lost an astoundingly low average of 2%. This suggests that ExpressVPN deftly distributes its user load between servers to eliminate bottlenecks.

    This Ookla speedtest shows you can still get fast internet while connected to ExpressVPN -- our unprotected speeds are around 58 Mbps.

    Sam Chapman for Engadget

    The latency numbers look worse, but the rise in the table is less sharp than we projected. Ping length depends far more on distance than download speed does, so we expect it to shoot up on servers more than 1,000 miles from our location. Keeping the average below 300 ms, as ExpressVPN does here, is a strong showing.
    ExpressVPN security test: Checking for leaks
    A VPN's core mission is to hide your IP address and make you untraceable online. Our task in this section is to figure out if ExpressVPN can carry out this mission every time you connect. While we can't be 100% certain, the tests we'll run through below have led us to believe that ExpressVPN is currently leak-proof.
    Available VPN protocols
    A VPN protocol is like a common language that a VPN server can use to mediate between your devices and the web servers you visit. If a VPN uses outdated or insecure protocols, or relies on unique protocols with no visible specs or source code, that's a bad sign.

    Not all protocols are available on all apps, but Mac has the full range.

    Sam Chapman for Engadget

    ExpressVPN gives you a selection of three protocols: IKEv2, OpenVPN and Lightway. The first two are solid choices that support the latest encryption algorithms. OpenVPN has been fully open-source for years and is the best choice if privacy is your goal. While IKEv2 started life as a closed project by Microsoft and Cisco, ExpressVPN uses an open-source reverse-engineering, which is both better for privacy and quite fast.
    Lightway is the odd one out, a protocol you'll only find on ExpressVPN, though its source code is available on Github. It's similar to WireGuard, in that both reach for faster speeds and lower processing demands by keeping their codebases slim. However, Lightway was recently rewritten in Rust to better protect the keys stored in its memory.
    Ultimately, you can't go wrong with any of ExpressVPN's protocol options. 99% of the time, your best choice will be to set the controls to Automatic and let the VPN decide which runs best.
    Testing for leaks
    ExpressVPN is one of the best services, but it's not leak-proof. Luckily, checking for DNS leaks is a simple matter of checking your IP address before and after connecting to a VPN server. If the new address matches the VPN server, you're good; if not, your VPN is leaking.
    First, we checked the Windows app with split tunneling active to ensure the flaw really had been patched. We tested several servers and didn't find any leaks, which suggests the patch worked, though leaks were rare even before ExpressVPN fixed the vulnerability.

    We checked our IP while connected to the virtual India location, which is run from a physical server in Singapore. Don't worry -- it still looks like India to streaming services.

    Sam Chapman for Engadget

    In fact, we didn't find any leaks on any ExpressVPN server we tested on any platform. Though questions remain about iOS, as you'll see later in this section, that's a problem on Apple's end that even the best VPNs can do very little about for now.
    The most common cause of VPN leaks is the use of public DNS servers to connect users to websites, which can mistakenly send browsing activity outside the VPN's encrypted tunnel. ExpressVPN avoids the risks of the public system by installing its own DNS resolvers on every server. This is the key factor behind its clean bill of health in our leak testing.
    Two other common flaws can lead to VPN leaks: WebRTC traffic and IPv6. The former is a communication protocol used in live streaming and the latter is a new IP standard designed to expand domain availability. Both are nice, but currently optional, so ExpressVPN automatically blocks both to ensure there's no opportunity for leaks to arise.
    One note about VPN security on iOS: it's a known and continuing problem that iOS VPNs do not prevent many online apps from communicating with Apple directly, outside the VPN tunnel. This risks leaking sensitive data, even with Lockdown Mode active in iOS 16. A blog post by Proton VPN shares a workaround: connect to a VPN server, then turn Airplane Mode on and off again to end all connections that were active before you connected to the VPN.
    Testing encryption
    We finished up our battery of security tests by checking out ExpressVPN's encryption directly. Using WireShark, a free packet sniffer, we inspected what it looks like when ExpressVPN transmits data from one of its servers to the internet. The screenshot below shows a data stream encrypted with Lightway UDP.

    After connecting to ExpressVPN, HTTP packets were rendered unreadable while in transit.

    Sam Chapman for Engadget

    That lack of any identifiable information, or even readable information, means encryption is working as intended. We repeated the test several times, always getting the same result. This left us satisfied that ExpressVPN's core features are working as intended.
    How much does ExpressVPN cost?
    ExpressVPN subscriptions cost per month. Long-term subscriptions can bring the monthly cost down, but the great deals they offer tend to only last for the first billing period.
    A 12-month subscription costs and includes three months for free with your first payment, costing a total of per month. The bonus disappears for all subsequent years, raising the monthly cost to You can also sign up for 28 months at a cost of but this is also once-only — ExpressVPN can only be renewed at the per year level.
    There are two ways to test ExpressVPN for free before making a financial commitment. Users on iOS and Android can download the ExpressVPN app without entering any payment details and use it free for seven days. On any platform, there's a 30-day money-back guarantee, which ExpressVPN has historically honored with no questions asked. You will have to pay before you can use it, though.
    In our opinion, ExpressVPN's service is solid enough that it's worth paying extra. Perhaps not this much extra, but that depends on what you get out of it. We recommend using the 30-day refund period and seeing how well ExpressVPN works for you. If it's a VPN you can enjoy using, that runs fast and unblocks everything you need, that's worth a server's weight in gold.
    ExpressVPN side apps and bundles
    ExpressVPN includes some special features that work mostly or wholly separate from its VPN apps. Some of these come free with a subscription, while others add an extra cost.
    Every subscription includes the ExpressVPN keys password manager. This is available under its own tab on the Android and iOS apps. On desktop, you'll need to download a separate extension from your browser's store, then sign in using your account activation code. It's available on all Chromium browsers, but not Firefox.
    Starting in 2025, new subscribers get an eSIM plan through holiday.com, a separate service linked to ExpressVPN. The baseline 1GB holiday eSIM plans last for 5 days and can apply to countries, regions, or the entire world. Longer-term plans include larger eSIM plans.
    You can add a dedicated IP address to your ExpressVPN subscription for an additional cost per month. A dedicated IP lets you use the same IP address every time you connect to ExpressVPN. You can add the address to whitelists on restricted networks, and you're assured to never be blocked because of someone else's bad activity on a shared IP.
    Unlike many of its competitors, ExpressVPN doesn't currently offer antivirus or online storage services, but there is a comprehensive bundle of ID protection tools called Identity Defender. We haven't reviewed any of these products in detail, but here's a list for reference:

    ID Alerts will inform you if any of your sensitive information is leaked or misused online. It's free with all plans, but you'll have to enter your personal information on your ExpressVPN account page or a mobile app.
    ID Theft Insurance grants up to million in identity theft reimbursement and comes free with new ExpressVPN one-year or two-year subscriptions. It's not yet available to those who subscribed before it launched in October 2024.
    Data Removal scans for your information in data brokerages and automatically requests that it be deleted. It's also free with one-year and two-year plans.
    Credit Scanner is only available for United States users. It monitors your activity on the three credit bureaus so you can quickly spot any suspicious transactions.

    The Identity Defender features are currently only available to new ExpressVPN customers in the US.
    Close-reading ExpressVPN's privacy policy
    Although we worry that the consolidation of VPN brands under the umbrella of Kape Technologieswill make the industry less competitive, we don't believe it's influencing ExpressVPN to take advantage of its users' privacy. To confirm, and get a full sense of what sort of privacy ExpressVPN promises its users, we set out to read ExpressVPN's privacy policy in detail. It's long, but thankfully aimed at casual users instead of lawyers. You can see it for yourself here.
    In the introduction, ExpressVPN states that it does not keep either activity logsor connection logs. It then specifies the seven types of data it's legally allowed to collect:

    Data used to sign up for an account, such as names, emails and payment methods.
    VPN usage data which is aggregated and can't be traced to any individual.
    Credentials stored in the ExpressVPN Keys password manager.
    Diagnostic data such as crash reports, which are only shared upon user request.
    IP addresses authorized for MediaStreamer, which is only for streaming devices that don't otherwise support VPN apps.
    Marketing data collected directly from the app — a "limited amount" that's kept anonymous.
    Data voluntarily submitted for identity theft protection apps.

    Of those seven exceptions, the only ones that count as red flags are account data and marketing data. Both categories are highly personal and could be damaging if mishandled. Fortunately, complying with subpoenas is not one of the allowed uses listed for either data category, nor does the policy let ExpressVPN sell the data to other private parties.
    The only really annoying thing here is that if you ask ExpressVPN to delete your personal data, you won't be able to use your account from then on. You aren't even eligible for a refund in this case, unless you're within 30 days of your initial subscription.
    As for marketing data, ExpressVPN collects device fingerprints and location data when you sign up for an account on its website. The privacy policy also claims this is anonymized, as its "systems are engineered to decouple such data from personally identifiable information." Audits corroborate this, as we'll see in the next section. So, while it would be better if ExpressVPN didn't collect any personal data at all, its practices don't appear to pose a risk to anything you do while using the VPN — just the ExpressVPN website.
    Privacy audits
    VPN providers often get third-party accounting firms to audit their privacy policies. The idea is that a well-known firm won't mortgage its reputation to lie on behalf of a VPN, so their results can be trusted.
    For the last several years, ExpressVPN has had KPMG look over its privacy policy and relevant infrastructure. KPMG's most recent report, completed in December 2023 and released in May 2024, found that ExpressVPN had enough internal controls in place that users could trust its privacy policy.
    The report is freely available to read. This is a very good sign, though we're looking out for a more up-to-date audit soon.
    TrustedServer
    "TrustedServer" is a marketing term ExpressVPN uses for its RAM-only server infrastructure. RAM-only servers have no hard drives for long-term storage and return to a standard disk image with every reboot. This makes it theoretically impossible to store user activity logs on them, even if ExpressVPN wanted to do that.
    The KPMG audit, linked above, reports that TrustedServer works as advertised. Between its many clean privacy audits and the Turkish server incident in 2017, we're prepared to say ExpressVPN is a private VPN, in spite of its aggravating exception for marketing.
    Can ExpressVPN change your virtual location?
    Next, we tested whether ExpressVPN can actually convince websites that you're somewhere other than your real location. Our security tests have already proven it can hide your IP address, but it takes more than leak-proofing to fool streaming sites these days — Netflix and the others have gotten very good at combing through metadata to sniff out proxy users.
    The process for testing this is a lot like how we handled the DNS leak tests: try several different servers and see if we get caught. We checked five sample locations outside the U.S. to see if we a) got into Netflix and b) saw different titles in the library. The results are below.

    Server Location
    Unblocked Netflix?
    Library changed?

    Canada
    Y
    Y

    United Kingdom
    YY

    Slovakia
    Y
    Y

    India
    Y
    YAustralia
    Y
    Y

    In fifteen tests, ExpressVPN slipped up only once. Docklands, the UK server it chose as the fastest, wasn't able to access Netflix. We switched to a server labeled simply "London" and unblocked it without issue.

    ExpressVPN can change your virtual location so you can explore the wonderful world of K-drama.

    Sam Chapman for Engadget

    All the other locations got us access to an alternate Netflix library on the first try. We even checked whether the India server, which is physically located in the UK, showed us different videos than the UK servers. It did, which makes us even more confident that ExpressVPN's virtual locations are airtight.
    Investigating ExpressVPN's server network
    ExpressVPN users can connect to a total of 164 server locations in 105 countries and territories. These locations are reasonably well distributed across the globe, but as with all VPNs, there's a bias toward the northern hemisphere. There are 24 locations in the U.S. alone and a further 66 in Europe.
    That isn't to say users in the Global South get nothing. ExpressVPN has IP addresses from nine nations in South Americaand six in Africa. The network even includes Kazakhstan, Uzbekistan and Mongolia, impressive since central Asia may be the region most often shafted by VPNs.
    However, many of these servers have virtual locations different from their real ones. For those of you choosing a server based on performance instead of a particular IP address, ExpressVPN's website has a helpful list of which servers are virtual. The bad news is that it's a big chunk of the list. A total of 63 ExpressVPN locations are virtual, or 38% of its entire network.
    To reduce the sting, ExpressVPN takes care to locate virtual servers as close to their real locations as possible. Its virtual locations in Indonesia and India are physically based in Singapore. This isn't always practical, leading to some awkwardness like operating a Ghana IP address out of Germany. But it helps ExpressVPN perform better in the southern hemisphere.
    Extra features of ExpressVPN
    Compared to direct competitors like NordVPN and Surfshark, ExpressVPN doesn't have many special features. It's aimed squarely at the casual market and will probably disappoint power users. Having said that, what they do include works well. In this section, we'll run through ExpressVPN's four substantial features outside its VPN servers themselves.
    Network Lock kill switch
    "Network Lock" is the name ExpressVPN gives to its kill switch. A VPN kill switch is a safety feature that keeps you from broadcasting outside the VPN tunnel. If it ever detects that you aren't connected to a legitimate ExpressVPN server, it cuts off your internet access. You won't be able to get back online until you either reconnect to the VPN or disable Network Lock.

    ExpressVPN's kill switch is called Network Lock on desktop, and Network Protection on mobileSam Chapman for Engadget

    This is important for everyone, not just users who need to hide sensitive traffic. The recently discovered TunnelVision bug theoretically allows hackers to set up fake public wi-fi networks through which they redirect you to equally fake VPN servers, which then harvest your personal information. It's unlikely, but not impossible, and a kill switch is the best way to prevent it — the switch always triggers unless you're connected to a real server in the VPN's network.
    Like most of ExpressVPN's features, all you can do with Network Lock is turn it on and off. You can also toggle whether you'll still be able to access local devices while the kill switch is blocking your internet — this is allowed by default.
    Threat manager, ad blocker and parental controls
    ExpressVPN groups three tools under the heading of "advanced protection" — Threat Manager, an ad blocker and parental controls. Threat Manager consists of two checkboxes: one that blocks your browser from communicating with activity tracking software and one that blocks a list of websites known to be used for malware.

    Check any of these boxes to use the pre-set blocklists whenever you're connected to ExpressVPN.

    Sam Chapman for Engadget

    You can't customize the lists, so you're limited to what ExpressVPN considers worthy of blocking. They share their sources on the website. While the lists are extensive and open-source, they rely on after-the-fact reporting and can't detect and block unknown threats like a proper antivirus.
    The adblock and parental control options work the same way: check a box to block everything on the list, uncheck it to allow everything through. In tests, the ad blocker was nearly 100% effective against banner ads, but failed to block any video ads on YouTube or Netflix.
    The parental control option blocks a list of porn sites. It's an easy option for concerned parents, but only works while ExpressVPN is connected. As such, it's meant to be used in conjunction with device-level parental controls that prevent the child from turning off or uninstalling the VPN client.
    Split tunneling
    Sometimes, you'll find it helpful to have your device getting online through two different IP addresses at once — one for your home services and one for a location you're trying to spoof. That's where split tunneling is helpful: it runs some apps through the VPN while leaving others unprotected. This can also improve your speeds, since the VPN needs to encrypt less in total.

    You can configure split tunneling through either a blocklist or an allowlist.

    Sam Chapman for Engadget

    ExpressVPN includes split tunneling on Windows, Android and Mac. You can only split by app, not by website, but it's still pretty useful. For example, you can have BitTorrent handling a heavy download in the background while you use your browser for innocuous activities that don't need protecting.
    ExpressVPN Aircove router
    By now, it should be clear that we find ExpressVPN to be a highly reliable but often unexceptional VPN service. However, there's one area in which it's a clear industry leader: VPN routers. ExpressVPN Aircove is, to our knowledge, the only router with a built-in commercial VPN that comes with its own dashboard interface.
    Usually, installing a VPN on your router requires tinkering with the router control panel, which turns off all but the most experienced users — not to mention making it a massive pain to switch to a new server location. Aircove's dashboard, by contrast, will be instantly familiar to anyone who already knows how to use an ExpressVPN client. It even allows different devices in your home to connect to different locations through the router VPN.
    Aircove's biggest drawback is its price. Currently retailing at, it's around three times more expensive than an aftermarket router fitted with free VPN firmware. Some of you might still find the convenience worth the one-time payment.
    ExpressVPN customer support options
    ExpressVPN's written help pages are some of the best on the market. Its live chat is more of a mixed bag, and complex questions may cause delays. However, it is at least staffed with human agents who aim to reply accurately, rather than resolve your ticket as quickly as possible.

    You can directly access both live chat and email from ExpressVPN's mobile apps.

    Sam Chapman for Engadget

    We approached ExpressVPN's support features with a simple question: "If I requested that ExpressVPN delete all my personal data, would I be able to get a refund for my unused subscription time?"Our first stop was expressvpn.com/support, the written support center and FAQ page. It's divided into setup guides, troubleshooting, account management and information on each of ExpressVPN's products. The setup guides are excellent, including screenshots and clearly written steps; each one includes a video guide for those who learn better that way.
    Troubleshooting is just as good — no videos, but the same standards of clarity and usefulness prevail. The section starts with general problems, then delves into specific issues you might face on each operating system. Each article clearly derives from a real customer need.
    The live support experience
    To get answers on our refund question, we visited the account management FAQs. This section stated that the refund policy only applies within 30 days of purchase. Pretty clear-cut, but we still wanted an answer on our special case, so we contacted live chat by clicking the button at the bottom-right of every FAQ page.

    Live chat is in the bottom-right corner of every page of expressvpn.com.

    Sam Chapman for Engadget

    Live chat starts with an AI assistant, which is not too hard to get past — just ask it a question it can't answer, then click "Transfer to an Agent." We got online witha human in less than a minute. Answering the question took longer and involved an uncomfortable 10-minute silence, but we did get a clear verdict from a real person: refunds are within 30 days only, no matter what.
    If the live chat agent can't answer your question, you'll be redirected to open an email support ticket. Annoyingly, there's no way to go directly to email support through the website or desktop apps, though mobile users have the option to skip directly there.
    ExpressVPN background check: From founding to Kape Technologies
    ExpressVPN launched in 2009, which makes it one of the oldest consumer VPNs in continual operation. In more than 15 years of operation, it's never been caught violating its own privacy policy, though its record isn't free of more minor blemishes.
    Headquarters in the British Virgin Islands
    Founders Dan Pomerantz and Peter Burchhardt registered the company in the British Virgin Islands from the start to take advantage of that territory's favorable legal environment for online privacy. The BVIs have no law requiring businesses to retain data on their users, and the process for extraditing data is famously difficult, requiring a direct order from the highest court.
    In 2021, the BVI implemented the Data Protection Act, which prevents companies based in the territory from accessing data on their users anywhere in the world. It's a great privacy law in theory, modeled on best-in-class legislation in the EU. However, we couldn't find any evidence that its supervising authority — the Office of the Information Commissioner — has a leader or staff.
    In other words, while ExpressVPN is not legally required to log any data on its users, there's technically nobody stopping them from doing so. Whether you trust the jurisdiction depends on whether you trust the company itself. Let's see what the other evidence says.
    Security and privacy incidents
    Two significant incidents stand out from ExpressVPN's 16-year history. In 2017, when Andrei Karlov, Russia's ambassador to Turkey, was shot to death at an art show. Turkish police suspected someone had used ExpressVPN to mask their identity while they deleted information from social media accounts belonging to the alleged assassin. To investigate, they confiscated an ExpressVPN server to comb for evidence. They didn't find anything.
    A police seizure is the best possible test of a VPN's approach to privacy. The provider can't prepare beforehand, fake anything, or collude with investigators. The Turkey incident is still one of the best reasons to recommend ExpressVPN, though eight years is a long time for policy to change.
    The second incident began in March 2024, when a researcher at CNET informed ExpressVPN that its version 12 for Windows occasionally leaked DNS requests when users enabled the split tunneling feature. While these users remained connected to an ExpressVPN server, their browsing activity was often going directly to their ISP, unmasked.
    The bug only impacted a few users, and to their credit, ExpressVPN sprang into action as soon as they learned about it. The team had it patched by April, as confirmed by the researcher who initially discovered the vulnerability. But while their quick and effective response deserves praise, it's still a mark against them that a journalist noticed the bug before they did.
    Kape Technologies ownership and management questions
    In 2021, an Israeli-owned, UK-based firm called Kape Technologies purchased a controlling interest in ExpressVPN. In addition to ExpressVPN, privately held Kape owns CyberGhost, Private Internet Access, and Zenmate. As shown on its website, it also owns Webselenese, publisher of VPN review websites WizCase and vpnMentor, which poses an apparent conflict of interest.
    When reached for comment, a representative for ExpressVPN said that "ExpressVPN does not directly engage with, nor seek to influence, the content on any Webselenese site," and pointed us to disclosure statements on the websites in question — here's one example. Even so, it's a good reminder not to take VPN reviews at face value without knowing who's behind them.
    Diving deeper into the background of Kape's ownership will lead you to owner Teddy Sagi. Go back far enough, and you'll see he did prison time in Israel and was mentioned in the Pandora Papers, among other things. More recently, headlines about the billionaire have focused more his businesses in the online gambling and fintech arenas, as well as his real estate ventures. An ExpressVPN representative told us that "Kape's brands continue to operate independently," and our investigation bore that out — we couldn't find any proof that Kape or Sagi have directly attempted to influence ExpressVPN's software or daily operations.
    Closer to the immediate day-to-day operations of ExpressVPN was the company's employment of Daniel Gericke as CTO from 2019 through 2023. During that time, the US Justice Department announced it had fined Gericke and two others for their previous employment on a surveillance operation called Project Raven, which the United Arab Emiratesused to spy on its own citizens.
    The revelation prompted a public response from ExpressVPN defending its decision to hire Gericke, arguing that "he best goalkeepers are the ones trained by the best strikers." ExpressVPN's representative confirmed that the company still stands by that linked statement.
    Gericke parted ways with ExpressVPN in October 2023, per his LinkedIn profile. While we don't know what we don't know, we can say that ExpressVPN has not notably changed its public-facing security and privacy policies during the time it's been connected to Kape, Sagi, or Gericke.
    In the end, how much ExpressVPN's history matters to you is a personal choice. If you object to any current or past actions by Kape Technologies or Teddy Sagi, there are other premium VPN options you might prefer. If you need more information to make up your mind, we recommend reading through CNET's 2022 deep dive on ExpressVPN's corporate history.
    Final verdict
    ExpressVPN is the VPN we most often recommend to beginners. It takes zero training to use, and consistently gets past filters on streaming sites. It also runs in the background with virtually no impact. If anything is worth the high price of admission, it's the excellent speeds distributed evenly across the worldwide server network.
    However, for certain specific cases, ExpressVPN may not be the best choice. There's no way to set up your own server locations, like NordVPN offers, and no double VPN connections, like you can build for yourself on Surfshark. Its corporate background is more suspect than the entities backing Proton VPN, and unlike Mullvad, ExpressVPN doesn't work in China — it's so well-known that the government targets its servers specifically.
    We suggest going with ExpressVPN for general online privacy, for spoofing locations in your home country while traveling, or if you regularly need to unblock sites in other countries. That encompasses 19 of every 20 users, which is fine by us, as ExpressVPN is a great service. It's just more of a reliable old screwdriver than a multi-tool.
    This article originally appeared on Engadget at
    #expressvpn #review #fast #speeds #low
    ExpressVPN review 2025: Fast speeds and a low learning curve
    ExpressVPN is good at its job. It's easy to be skeptical of any service with a knack for self-promotion, but don't let ExpressVPN's hype distract you from the fact that it keeps its front-page promise of "just working." Outside of solid security, the two best things ExpressVPN offers are fast speeds and a simple interface. Our tests showed only a 7% average drop in download speed and a 2% loss of upload speed, worldwide. And while the lack of extra features may frustrate experienced users, it makes for a true set-and-forget VPN on any platform. This isn't to say ExpressVPN is without flaws — it's nearly bereft of customization options and it's notably more expensive than its competition — but it beats most VPNs in a head-to-head matchup. For this review, we followed our rigorous 10-step VPN testing process, exploring ExpressVPN's security, privacy, speed, interfaces and more. Whether you read straight through or skip to the sections that are most important for you, you should come away with all the information you need to decide whether to subscribe. Editors' note: We're in the process of rebooting all of our VPN reviews from scratch. Once we do a fresh pass on the top services, we'll be updating each review with a rating and additional comparative information. Table of contents Findings at a glance Installing, configuring and using ExpressVPN ExpressVPN speed test: Very fast averages ExpressVPN security test: Checking for leaks How much does ExpressVPN cost? ExpressVPN side apps and bundles Close-reading ExpressVPN's privacy policy Can ExpressVPN change your virtual location? Investigating ExpressVPN's server network Extra features of ExpressVPN ExpressVPN customer support options ExpressVPN background check: From founding to Kape Technologies Final verdict Findings at a glance Category Notes Installation and UI All interfaces are clean and minimalist, with no glitches and not enough depth to get lost in Windows and Mac clients are similar in both setup and general user experience Android and iOS are likewise almost identical, but Android has a nice-looking dark mode Speed Retains a worldwide average of 93% of starting download speeds Upload speeds average 98% of starting speeds Latency rises with distance, but global average stayed under 300 ms in tests Security OpenVPN, IKEv2 and Lightway VPN protocols all use secure ciphers Packet-sniffing test showed working encryption We detected no IP leaks Blocks IPv6 and WebRTC by default to prevent leaks Pricing Base price: per month or per year Lowest prepaid rate: per month Can save money by paying for 28 months in advance, but only once per account 30-day money-back guarantee Bundles ExpressVPN Keys password manager and ID alerts included on all plans Dedicated IP addresses come at an extra price ID theft insurance, data removal and credit scanning available to new one-year and two-year subscribers for free 1GB eSIM deal included through holiday.com Privacy policy No storage of connection logs or device logs permitted The only risky exceptions are personal account dataand marketing dataAn independent audit found that ExpressVPN's RAM-only server infrastructure makes it impossible to keep logs Virtual location change Successfully unblocked five international Netflix libraries, succeeding on 14 out of 15 attempts Server network 164 server locations in 105 countries 38% of servers are virtual, though most virtual locations are accessed through physical servers within 1,000 miles A large number of locations in South America, Africa and central Asia Features Simple but effective kill switch Can block ads, trackers, adult sites and/or malware sites but blocklists can't be customized Split tunneling is convenient but unavailable on iOS and modern Macs Aircove is the best VPN router, albeit expensive Customer support Setup and troubleshooting guides are organized and useful, with lots of screenshots and videos Live chat starts with a bot but you can get to a person within a couple minutes Email tickets are only accessible from the mobile apps or after live chat has failed Background check Founded in 2009; based in the British Virgin Islands Has never been caught selling or mishandling user data Turkish police seized servers in 2017 but couldn't find any logs of user activity Owned by Kape Technologies, which also owns CyberGhost and Private Internet Access A previous CIO formerly worked on surveillance in the United Arab Emirates; no evidence of shady behavior during his time at ExpressVPN Windows Version 12 leaked some DNS requests when Split Tunneling was active Installing, configuring and using ExpressVPN This section focuses on how it feels to use ExpressVPN on each of the major platforms where it's available. The first step for any setup process is to make an account on expressvpn.com and buy a subscription. Windows Once subscribed, download the Windows VPN from either expressvpn.com or the Microsoft Store, then open the .exe file. Click "Yes" to let it make changes, wait for the install, then let your computer reboot. Including the reboot, the whole process takes 5-10 minutes, most of it idle. To finish, you'll need your activation code, which you can find by going to expressvpn.com and clicking "Setup" in the top-right corner. You can install ExpressVPN's Windows app from the Microsoft store, but we found the website more convenient. Sam Chapman for Engadget Extreme simplicity is the watchword for all ExpressVPN's designs. The Windows client's launch panel consists of three buttons and less than ten words. You can change your location or let the app pick a location for you — the "Smart Location" is the server with the best combination of being nearby and unburdened. Everything else is crammed into the hamburger menu at the top left. Here, in seven tabs, you'll find the Network Lock kill switch, the four types of content blockers, the split tunneling menu and the option to change your VPN protocol. You can also add shortcuts to various websites, useful if you regularly use your VPN for the same online destinations. To sum up, there's almost nothing here to get in the way: no delays, no snags, no nested menus to get lost in. It may be the world's most ignorable VPN client. That's not a bad thing at all. Mac ExpressVPN's app for macOS is almost identical in design to its Windows app. The process for downloading and setting it up is nearly the same too. As on Windows, it can be downloaded from the App Store or sideloaded directly from the expressvpn.com download center. Only a few features are missing and a couple others have been added. Split tunneling is gone, and you won't see the Lightway Turbo setting. ExpressVPN recommends some servers, but it's easy to search the whole list. Sam Chapman for Engadget Mac users do gain access to the IKEv2 protocol, along with the option to turn off automatic IPv6 blocking — Windows users have to leave it blocked at all times. Almost every website is still accessible via IPv4, but it's useful if you do need to access a specific IPv6 address while the VPN is active. Android Android users can download ExpressVPN through the Google Play Store. Open the app, sign in and you're ready to go. The Android app has a very nice dark-colored design, only slightly marred by an unnecessary information box about how long you've used the VPN this week. ExpressVPN's Android app puts a little more information on the screen than it needs to, but still runs well. Sam Chapman for Engadget There's a large button for connecting. Clicking on the server name takes you to a list of locations. On this list, you can either search or scroll and can choose individual locations within a country that has more than one. We connected to as many far-flung server locations as we could, but not a single one took longer than a few seconds. The options menu is organized sensibly, with no option located more than two clicks deep. You will see a couple of options here that aren't available on desktop, the best of which is the ability to automatically connect to your last-used ExpressVPN server whenever your phone connects to a non-trusted wifi network. There are also a few general security tools: an IP address checker, DNS and WebRTC leak testers and a password generator. These are also available on the website, but here, they're built into the app. With the exception of the latter, we'd recommend using third-party testing tools instead — even a VPN with integrity has an incentive to make its own app look like it's working. iPhone and iPad You can only install ExpressVPN's iOS app through the app store. During setup, you may need to enter your password to allow your phone to use VPN configurations. Otherwise, there are no major differences from the Android process. ExpressVPN looks good on iPhone and iPad. Sam Chapman for Engadget The interface is not quite as pleasing as the dark-mode Android app, but it makes up for that by cutting out some of the clutter. The tabs and features are similar, though split tunneling and shortcuts are absent. Also, both mobile apps make customer support a lot more accessible than their desktop counterparts — plus, mobile is the only way to send email support tickets. Browser extension ExpressVPN also includes browser extensions for Firefox and Chrome. These let you connect, disconnect and change server locations without leaving your browser window. It's nice, but not essential unless you have a very specific web browser flow you like. ExpressVPN speed test: Very fast averages Connecting to a VPN almost always decreases your speed, but the best VPNs mitigate the drop as much as possible. We used Ookla's speed testing app to see how much of your internet speed ExpressVPN preserves. For this test, we emphasized the locations ExpressVPN uses for most of its virtual servers, including the Netherlands, Brazil, Germany and Singapore. Some terms before we start: Latency, measured in milliseconds, is the time it takes one data packet to travel between your device and a web server through the VPN. Latency increases with distance. It's most important for real-time tasks like video chatting and online gaming. Download speed, measured in megabits per second, is the amount of information that can download onto your device at one time — such as when loading a web page or streaming a video. Upload speed, also measured in Mbps, is the amount of information your device can send to the web at once. It's most important for torrenting, since the amount of data you can seed determines how fast you can download in exchange. The table below shows our results. We conducted this on Windows, using the automatic protocol setting with the Lightway Turbo feature active — a recent ExpressVPN addition that keeps speed more consistent by processing connections in parallel. Server location LatencyIncrease factor Download speedPercentage dropoff Upload speedPercentage dropoff Portland, Oregon, USA18 -- 58.77 -- 5.70 -- Seattle, Washington, USA26 1.4x 54.86 6.7% 5.52 3.2% New York, NY, USA 156 8.7x 57.25 2.6% 5.57 2.3% Amsterdam, Netherlands 306 17x 53.83 8.4% 5.58 2.1% São Paulo, Brazil 371 20.6x 53.82 8.4% 5.65 0.9% Frankfurt, Germany 404 22.4x 55.71 5.2% 5.67 0.5% Singapore, Singapore 381 21.2x 52.76 10.2% 5.64 1.0% Average 274 15.2x 54.71 6.9% 5.61 1.6% These are extremely good results. ExpressVPN is a winner on both download and upload speed. No matter where we went in the world, we never lost more than about 7% of our download speeds, and upload lost an astoundingly low average of 2%. This suggests that ExpressVPN deftly distributes its user load between servers to eliminate bottlenecks. This Ookla speedtest shows you can still get fast internet while connected to ExpressVPN -- our unprotected speeds are around 58 Mbps. Sam Chapman for Engadget The latency numbers look worse, but the rise in the table is less sharp than we projected. Ping length depends far more on distance than download speed does, so we expect it to shoot up on servers more than 1,000 miles from our location. Keeping the average below 300 ms, as ExpressVPN does here, is a strong showing. ExpressVPN security test: Checking for leaks A VPN's core mission is to hide your IP address and make you untraceable online. Our task in this section is to figure out if ExpressVPN can carry out this mission every time you connect. While we can't be 100% certain, the tests we'll run through below have led us to believe that ExpressVPN is currently leak-proof. Available VPN protocols A VPN protocol is like a common language that a VPN server can use to mediate between your devices and the web servers you visit. If a VPN uses outdated or insecure protocols, or relies on unique protocols with no visible specs or source code, that's a bad sign. Not all protocols are available on all apps, but Mac has the full range. Sam Chapman for Engadget ExpressVPN gives you a selection of three protocols: IKEv2, OpenVPN and Lightway. The first two are solid choices that support the latest encryption algorithms. OpenVPN has been fully open-source for years and is the best choice if privacy is your goal. While IKEv2 started life as a closed project by Microsoft and Cisco, ExpressVPN uses an open-source reverse-engineering, which is both better for privacy and quite fast. Lightway is the odd one out, a protocol you'll only find on ExpressVPN, though its source code is available on Github. It's similar to WireGuard, in that both reach for faster speeds and lower processing demands by keeping their codebases slim. However, Lightway was recently rewritten in Rust to better protect the keys stored in its memory. Ultimately, you can't go wrong with any of ExpressVPN's protocol options. 99% of the time, your best choice will be to set the controls to Automatic and let the VPN decide which runs best. Testing for leaks ExpressVPN is one of the best services, but it's not leak-proof. Luckily, checking for DNS leaks is a simple matter of checking your IP address before and after connecting to a VPN server. If the new address matches the VPN server, you're good; if not, your VPN is leaking. First, we checked the Windows app with split tunneling active to ensure the flaw really had been patched. We tested several servers and didn't find any leaks, which suggests the patch worked, though leaks were rare even before ExpressVPN fixed the vulnerability. We checked our IP while connected to the virtual India location, which is run from a physical server in Singapore. Don't worry -- it still looks like India to streaming services. Sam Chapman for Engadget In fact, we didn't find any leaks on any ExpressVPN server we tested on any platform. Though questions remain about iOS, as you'll see later in this section, that's a problem on Apple's end that even the best VPNs can do very little about for now. The most common cause of VPN leaks is the use of public DNS servers to connect users to websites, which can mistakenly send browsing activity outside the VPN's encrypted tunnel. ExpressVPN avoids the risks of the public system by installing its own DNS resolvers on every server. This is the key factor behind its clean bill of health in our leak testing. Two other common flaws can lead to VPN leaks: WebRTC traffic and IPv6. The former is a communication protocol used in live streaming and the latter is a new IP standard designed to expand domain availability. Both are nice, but currently optional, so ExpressVPN automatically blocks both to ensure there's no opportunity for leaks to arise. One note about VPN security on iOS: it's a known and continuing problem that iOS VPNs do not prevent many online apps from communicating with Apple directly, outside the VPN tunnel. This risks leaking sensitive data, even with Lockdown Mode active in iOS 16. A blog post by Proton VPN shares a workaround: connect to a VPN server, then turn Airplane Mode on and off again to end all connections that were active before you connected to the VPN. Testing encryption We finished up our battery of security tests by checking out ExpressVPN's encryption directly. Using WireShark, a free packet sniffer, we inspected what it looks like when ExpressVPN transmits data from one of its servers to the internet. The screenshot below shows a data stream encrypted with Lightway UDP. After connecting to ExpressVPN, HTTP packets were rendered unreadable while in transit. Sam Chapman for Engadget That lack of any identifiable information, or even readable information, means encryption is working as intended. We repeated the test several times, always getting the same result. This left us satisfied that ExpressVPN's core features are working as intended. How much does ExpressVPN cost? ExpressVPN subscriptions cost per month. Long-term subscriptions can bring the monthly cost down, but the great deals they offer tend to only last for the first billing period. A 12-month subscription costs and includes three months for free with your first payment, costing a total of per month. The bonus disappears for all subsequent years, raising the monthly cost to You can also sign up for 28 months at a cost of but this is also once-only — ExpressVPN can only be renewed at the per year level. There are two ways to test ExpressVPN for free before making a financial commitment. Users on iOS and Android can download the ExpressVPN app without entering any payment details and use it free for seven days. On any platform, there's a 30-day money-back guarantee, which ExpressVPN has historically honored with no questions asked. You will have to pay before you can use it, though. In our opinion, ExpressVPN's service is solid enough that it's worth paying extra. Perhaps not this much extra, but that depends on what you get out of it. We recommend using the 30-day refund period and seeing how well ExpressVPN works for you. If it's a VPN you can enjoy using, that runs fast and unblocks everything you need, that's worth a server's weight in gold. ExpressVPN side apps and bundles ExpressVPN includes some special features that work mostly or wholly separate from its VPN apps. Some of these come free with a subscription, while others add an extra cost. Every subscription includes the ExpressVPN keys password manager. This is available under its own tab on the Android and iOS apps. On desktop, you'll need to download a separate extension from your browser's store, then sign in using your account activation code. It's available on all Chromium browsers, but not Firefox. Starting in 2025, new subscribers get an eSIM plan through holiday.com, a separate service linked to ExpressVPN. The baseline 1GB holiday eSIM plans last for 5 days and can apply to countries, regions, or the entire world. Longer-term plans include larger eSIM plans. You can add a dedicated IP address to your ExpressVPN subscription for an additional cost per month. A dedicated IP lets you use the same IP address every time you connect to ExpressVPN. You can add the address to whitelists on restricted networks, and you're assured to never be blocked because of someone else's bad activity on a shared IP. Unlike many of its competitors, ExpressVPN doesn't currently offer antivirus or online storage services, but there is a comprehensive bundle of ID protection tools called Identity Defender. We haven't reviewed any of these products in detail, but here's a list for reference: ID Alerts will inform you if any of your sensitive information is leaked or misused online. It's free with all plans, but you'll have to enter your personal information on your ExpressVPN account page or a mobile app. ID Theft Insurance grants up to million in identity theft reimbursement and comes free with new ExpressVPN one-year or two-year subscriptions. It's not yet available to those who subscribed before it launched in October 2024. Data Removal scans for your information in data brokerages and automatically requests that it be deleted. It's also free with one-year and two-year plans. Credit Scanner is only available for United States users. It monitors your activity on the three credit bureaus so you can quickly spot any suspicious transactions. The Identity Defender features are currently only available to new ExpressVPN customers in the US. Close-reading ExpressVPN's privacy policy Although we worry that the consolidation of VPN brands under the umbrella of Kape Technologieswill make the industry less competitive, we don't believe it's influencing ExpressVPN to take advantage of its users' privacy. To confirm, and get a full sense of what sort of privacy ExpressVPN promises its users, we set out to read ExpressVPN's privacy policy in detail. It's long, but thankfully aimed at casual users instead of lawyers. You can see it for yourself here. In the introduction, ExpressVPN states that it does not keep either activity logsor connection logs. It then specifies the seven types of data it's legally allowed to collect: Data used to sign up for an account, such as names, emails and payment methods. VPN usage data which is aggregated and can't be traced to any individual. Credentials stored in the ExpressVPN Keys password manager. Diagnostic data such as crash reports, which are only shared upon user request. IP addresses authorized for MediaStreamer, which is only for streaming devices that don't otherwise support VPN apps. Marketing data collected directly from the app — a "limited amount" that's kept anonymous. Data voluntarily submitted for identity theft protection apps. Of those seven exceptions, the only ones that count as red flags are account data and marketing data. Both categories are highly personal and could be damaging if mishandled. Fortunately, complying with subpoenas is not one of the allowed uses listed for either data category, nor does the policy let ExpressVPN sell the data to other private parties. The only really annoying thing here is that if you ask ExpressVPN to delete your personal data, you won't be able to use your account from then on. You aren't even eligible for a refund in this case, unless you're within 30 days of your initial subscription. As for marketing data, ExpressVPN collects device fingerprints and location data when you sign up for an account on its website. The privacy policy also claims this is anonymized, as its "systems are engineered to decouple such data from personally identifiable information." Audits corroborate this, as we'll see in the next section. So, while it would be better if ExpressVPN didn't collect any personal data at all, its practices don't appear to pose a risk to anything you do while using the VPN — just the ExpressVPN website. Privacy audits VPN providers often get third-party accounting firms to audit their privacy policies. The idea is that a well-known firm won't mortgage its reputation to lie on behalf of a VPN, so their results can be trusted. For the last several years, ExpressVPN has had KPMG look over its privacy policy and relevant infrastructure. KPMG's most recent report, completed in December 2023 and released in May 2024, found that ExpressVPN had enough internal controls in place that users could trust its privacy policy. The report is freely available to read. This is a very good sign, though we're looking out for a more up-to-date audit soon. TrustedServer "TrustedServer" is a marketing term ExpressVPN uses for its RAM-only server infrastructure. RAM-only servers have no hard drives for long-term storage and return to a standard disk image with every reboot. This makes it theoretically impossible to store user activity logs on them, even if ExpressVPN wanted to do that. The KPMG audit, linked above, reports that TrustedServer works as advertised. Between its many clean privacy audits and the Turkish server incident in 2017, we're prepared to say ExpressVPN is a private VPN, in spite of its aggravating exception for marketing. Can ExpressVPN change your virtual location? Next, we tested whether ExpressVPN can actually convince websites that you're somewhere other than your real location. Our security tests have already proven it can hide your IP address, but it takes more than leak-proofing to fool streaming sites these days — Netflix and the others have gotten very good at combing through metadata to sniff out proxy users. The process for testing this is a lot like how we handled the DNS leak tests: try several different servers and see if we get caught. We checked five sample locations outside the U.S. to see if we a) got into Netflix and b) saw different titles in the library. The results are below. Server Location Unblocked Netflix? Library changed? Canada Y Y United Kingdom YY Slovakia Y Y India Y YAustralia Y Y In fifteen tests, ExpressVPN slipped up only once. Docklands, the UK server it chose as the fastest, wasn't able to access Netflix. We switched to a server labeled simply "London" and unblocked it without issue. ExpressVPN can change your virtual location so you can explore the wonderful world of K-drama. Sam Chapman for Engadget All the other locations got us access to an alternate Netflix library on the first try. We even checked whether the India server, which is physically located in the UK, showed us different videos than the UK servers. It did, which makes us even more confident that ExpressVPN's virtual locations are airtight. Investigating ExpressVPN's server network ExpressVPN users can connect to a total of 164 server locations in 105 countries and territories. These locations are reasonably well distributed across the globe, but as with all VPNs, there's a bias toward the northern hemisphere. There are 24 locations in the U.S. alone and a further 66 in Europe. That isn't to say users in the Global South get nothing. ExpressVPN has IP addresses from nine nations in South Americaand six in Africa. The network even includes Kazakhstan, Uzbekistan and Mongolia, impressive since central Asia may be the region most often shafted by VPNs. However, many of these servers have virtual locations different from their real ones. For those of you choosing a server based on performance instead of a particular IP address, ExpressVPN's website has a helpful list of which servers are virtual. The bad news is that it's a big chunk of the list. A total of 63 ExpressVPN locations are virtual, or 38% of its entire network. To reduce the sting, ExpressVPN takes care to locate virtual servers as close to their real locations as possible. Its virtual locations in Indonesia and India are physically based in Singapore. This isn't always practical, leading to some awkwardness like operating a Ghana IP address out of Germany. But it helps ExpressVPN perform better in the southern hemisphere. Extra features of ExpressVPN Compared to direct competitors like NordVPN and Surfshark, ExpressVPN doesn't have many special features. It's aimed squarely at the casual market and will probably disappoint power users. Having said that, what they do include works well. In this section, we'll run through ExpressVPN's four substantial features outside its VPN servers themselves. Network Lock kill switch "Network Lock" is the name ExpressVPN gives to its kill switch. A VPN kill switch is a safety feature that keeps you from broadcasting outside the VPN tunnel. If it ever detects that you aren't connected to a legitimate ExpressVPN server, it cuts off your internet access. You won't be able to get back online until you either reconnect to the VPN or disable Network Lock. ExpressVPN's kill switch is called Network Lock on desktop, and Network Protection on mobileSam Chapman for Engadget This is important for everyone, not just users who need to hide sensitive traffic. The recently discovered TunnelVision bug theoretically allows hackers to set up fake public wi-fi networks through which they redirect you to equally fake VPN servers, which then harvest your personal information. It's unlikely, but not impossible, and a kill switch is the best way to prevent it — the switch always triggers unless you're connected to a real server in the VPN's network. Like most of ExpressVPN's features, all you can do with Network Lock is turn it on and off. You can also toggle whether you'll still be able to access local devices while the kill switch is blocking your internet — this is allowed by default. Threat manager, ad blocker and parental controls ExpressVPN groups three tools under the heading of "advanced protection" — Threat Manager, an ad blocker and parental controls. Threat Manager consists of two checkboxes: one that blocks your browser from communicating with activity tracking software and one that blocks a list of websites known to be used for malware. Check any of these boxes to use the pre-set blocklists whenever you're connected to ExpressVPN. Sam Chapman for Engadget You can't customize the lists, so you're limited to what ExpressVPN considers worthy of blocking. They share their sources on the website. While the lists are extensive and open-source, they rely on after-the-fact reporting and can't detect and block unknown threats like a proper antivirus. The adblock and parental control options work the same way: check a box to block everything on the list, uncheck it to allow everything through. In tests, the ad blocker was nearly 100% effective against banner ads, but failed to block any video ads on YouTube or Netflix. The parental control option blocks a list of porn sites. It's an easy option for concerned parents, but only works while ExpressVPN is connected. As such, it's meant to be used in conjunction with device-level parental controls that prevent the child from turning off or uninstalling the VPN client. Split tunneling Sometimes, you'll find it helpful to have your device getting online through two different IP addresses at once — one for your home services and one for a location you're trying to spoof. That's where split tunneling is helpful: it runs some apps through the VPN while leaving others unprotected. This can also improve your speeds, since the VPN needs to encrypt less in total. You can configure split tunneling through either a blocklist or an allowlist. Sam Chapman for Engadget ExpressVPN includes split tunneling on Windows, Android and Mac. You can only split by app, not by website, but it's still pretty useful. For example, you can have BitTorrent handling a heavy download in the background while you use your browser for innocuous activities that don't need protecting. ExpressVPN Aircove router By now, it should be clear that we find ExpressVPN to be a highly reliable but often unexceptional VPN service. However, there's one area in which it's a clear industry leader: VPN routers. ExpressVPN Aircove is, to our knowledge, the only router with a built-in commercial VPN that comes with its own dashboard interface. Usually, installing a VPN on your router requires tinkering with the router control panel, which turns off all but the most experienced users — not to mention making it a massive pain to switch to a new server location. Aircove's dashboard, by contrast, will be instantly familiar to anyone who already knows how to use an ExpressVPN client. It even allows different devices in your home to connect to different locations through the router VPN. Aircove's biggest drawback is its price. Currently retailing at, it's around three times more expensive than an aftermarket router fitted with free VPN firmware. Some of you might still find the convenience worth the one-time payment. ExpressVPN customer support options ExpressVPN's written help pages are some of the best on the market. Its live chat is more of a mixed bag, and complex questions may cause delays. However, it is at least staffed with human agents who aim to reply accurately, rather than resolve your ticket as quickly as possible. You can directly access both live chat and email from ExpressVPN's mobile apps. Sam Chapman for Engadget We approached ExpressVPN's support features with a simple question: "If I requested that ExpressVPN delete all my personal data, would I be able to get a refund for my unused subscription time?"Our first stop was expressvpn.com/support, the written support center and FAQ page. It's divided into setup guides, troubleshooting, account management and information on each of ExpressVPN's products. The setup guides are excellent, including screenshots and clearly written steps; each one includes a video guide for those who learn better that way. Troubleshooting is just as good — no videos, but the same standards of clarity and usefulness prevail. The section starts with general problems, then delves into specific issues you might face on each operating system. Each article clearly derives from a real customer need. The live support experience To get answers on our refund question, we visited the account management FAQs. This section stated that the refund policy only applies within 30 days of purchase. Pretty clear-cut, but we still wanted an answer on our special case, so we contacted live chat by clicking the button at the bottom-right of every FAQ page. Live chat is in the bottom-right corner of every page of expressvpn.com. Sam Chapman for Engadget Live chat starts with an AI assistant, which is not too hard to get past — just ask it a question it can't answer, then click "Transfer to an Agent." We got online witha human in less than a minute. Answering the question took longer and involved an uncomfortable 10-minute silence, but we did get a clear verdict from a real person: refunds are within 30 days only, no matter what. If the live chat agent can't answer your question, you'll be redirected to open an email support ticket. Annoyingly, there's no way to go directly to email support through the website or desktop apps, though mobile users have the option to skip directly there. ExpressVPN background check: From founding to Kape Technologies ExpressVPN launched in 2009, which makes it one of the oldest consumer VPNs in continual operation. In more than 15 years of operation, it's never been caught violating its own privacy policy, though its record isn't free of more minor blemishes. Headquarters in the British Virgin Islands Founders Dan Pomerantz and Peter Burchhardt registered the company in the British Virgin Islands from the start to take advantage of that territory's favorable legal environment for online privacy. The BVIs have no law requiring businesses to retain data on their users, and the process for extraditing data is famously difficult, requiring a direct order from the highest court. In 2021, the BVI implemented the Data Protection Act, which prevents companies based in the territory from accessing data on their users anywhere in the world. It's a great privacy law in theory, modeled on best-in-class legislation in the EU. However, we couldn't find any evidence that its supervising authority — the Office of the Information Commissioner — has a leader or staff. In other words, while ExpressVPN is not legally required to log any data on its users, there's technically nobody stopping them from doing so. Whether you trust the jurisdiction depends on whether you trust the company itself. Let's see what the other evidence says. Security and privacy incidents Two significant incidents stand out from ExpressVPN's 16-year history. In 2017, when Andrei Karlov, Russia's ambassador to Turkey, was shot to death at an art show. Turkish police suspected someone had used ExpressVPN to mask their identity while they deleted information from social media accounts belonging to the alleged assassin. To investigate, they confiscated an ExpressVPN server to comb for evidence. They didn't find anything. A police seizure is the best possible test of a VPN's approach to privacy. The provider can't prepare beforehand, fake anything, or collude with investigators. The Turkey incident is still one of the best reasons to recommend ExpressVPN, though eight years is a long time for policy to change. The second incident began in March 2024, when a researcher at CNET informed ExpressVPN that its version 12 for Windows occasionally leaked DNS requests when users enabled the split tunneling feature. While these users remained connected to an ExpressVPN server, their browsing activity was often going directly to their ISP, unmasked. The bug only impacted a few users, and to their credit, ExpressVPN sprang into action as soon as they learned about it. The team had it patched by April, as confirmed by the researcher who initially discovered the vulnerability. But while their quick and effective response deserves praise, it's still a mark against them that a journalist noticed the bug before they did. Kape Technologies ownership and management questions In 2021, an Israeli-owned, UK-based firm called Kape Technologies purchased a controlling interest in ExpressVPN. In addition to ExpressVPN, privately held Kape owns CyberGhost, Private Internet Access, and Zenmate. As shown on its website, it also owns Webselenese, publisher of VPN review websites WizCase and vpnMentor, which poses an apparent conflict of interest. When reached for comment, a representative for ExpressVPN said that "ExpressVPN does not directly engage with, nor seek to influence, the content on any Webselenese site," and pointed us to disclosure statements on the websites in question — here's one example. Even so, it's a good reminder not to take VPN reviews at face value without knowing who's behind them. Diving deeper into the background of Kape's ownership will lead you to owner Teddy Sagi. Go back far enough, and you'll see he did prison time in Israel and was mentioned in the Pandora Papers, among other things. More recently, headlines about the billionaire have focused more his businesses in the online gambling and fintech arenas, as well as his real estate ventures. An ExpressVPN representative told us that "Kape's brands continue to operate independently," and our investigation bore that out — we couldn't find any proof that Kape or Sagi have directly attempted to influence ExpressVPN's software or daily operations. Closer to the immediate day-to-day operations of ExpressVPN was the company's employment of Daniel Gericke as CTO from 2019 through 2023. During that time, the US Justice Department announced it had fined Gericke and two others for their previous employment on a surveillance operation called Project Raven, which the United Arab Emiratesused to spy on its own citizens. The revelation prompted a public response from ExpressVPN defending its decision to hire Gericke, arguing that "he best goalkeepers are the ones trained by the best strikers." ExpressVPN's representative confirmed that the company still stands by that linked statement. Gericke parted ways with ExpressVPN in October 2023, per his LinkedIn profile. While we don't know what we don't know, we can say that ExpressVPN has not notably changed its public-facing security and privacy policies during the time it's been connected to Kape, Sagi, or Gericke. In the end, how much ExpressVPN's history matters to you is a personal choice. If you object to any current or past actions by Kape Technologies or Teddy Sagi, there are other premium VPN options you might prefer. If you need more information to make up your mind, we recommend reading through CNET's 2022 deep dive on ExpressVPN's corporate history. Final verdict ExpressVPN is the VPN we most often recommend to beginners. It takes zero training to use, and consistently gets past filters on streaming sites. It also runs in the background with virtually no impact. If anything is worth the high price of admission, it's the excellent speeds distributed evenly across the worldwide server network. However, for certain specific cases, ExpressVPN may not be the best choice. There's no way to set up your own server locations, like NordVPN offers, and no double VPN connections, like you can build for yourself on Surfshark. Its corporate background is more suspect than the entities backing Proton VPN, and unlike Mullvad, ExpressVPN doesn't work in China — it's so well-known that the government targets its servers specifically. We suggest going with ExpressVPN for general online privacy, for spoofing locations in your home country while traveling, or if you regularly need to unblock sites in other countries. That encompasses 19 of every 20 users, which is fine by us, as ExpressVPN is a great service. It's just more of a reliable old screwdriver than a multi-tool. This article originally appeared on Engadget at #expressvpn #review #fast #speeds #low
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    ExpressVPN review 2025: Fast speeds and a low learning curve
    ExpressVPN is good at its job. It's easy to be skeptical of any service with a knack for self-promotion, but don't let ExpressVPN's hype distract you from the fact that it keeps its front-page promise of "just working." Outside of solid security, the two best things ExpressVPN offers are fast speeds and a simple interface. Our tests showed only a 7% average drop in download speed and a 2% loss of upload speed, worldwide. And while the lack of extra features may frustrate experienced users, it makes for a true set-and-forget VPN on any platform. This isn't to say ExpressVPN is without flaws — it's nearly bereft of customization options and it's notably more expensive than its competition — but it beats most VPNs in a head-to-head matchup. For this review, we followed our rigorous 10-step VPN testing process, exploring ExpressVPN's security, privacy, speed, interfaces and more. Whether you read straight through or skip to the sections that are most important for you, you should come away with all the information you need to decide whether to subscribe. Editors' note: We're in the process of rebooting all of our VPN reviews from scratch. Once we do a fresh pass on the top services, we'll be updating each review with a rating and additional comparative information. Table of contents Findings at a glance Installing, configuring and using ExpressVPN ExpressVPN speed test: Very fast averages ExpressVPN security test: Checking for leaks How much does ExpressVPN cost? ExpressVPN side apps and bundles Close-reading ExpressVPN's privacy policy Can ExpressVPN change your virtual location? Investigating ExpressVPN's server network Extra features of ExpressVPN ExpressVPN customer support options ExpressVPN background check: From founding to Kape Technologies Final verdict Findings at a glance Category Notes Installation and UI All interfaces are clean and minimalist, with no glitches and not enough depth to get lost in Windows and Mac clients are similar in both setup and general user experience Android and iOS are likewise almost identical, but Android has a nice-looking dark mode Speed Retains a worldwide average of 93% of starting download speeds Upload speeds average 98% of starting speeds Latency rises with distance, but global average stayed under 300 ms in tests Security OpenVPN, IKEv2 and Lightway VPN protocols all use secure ciphers Packet-sniffing test showed working encryption We detected no IP leaks Blocks IPv6 and WebRTC by default to prevent leaks Pricing Base price: $12.95 per month or $99.95 per year Lowest prepaid rate: $4.99 per month Can save money by paying for 28 months in advance, but only once per account 30-day money-back guarantee Bundles ExpressVPN Keys password manager and ID alerts included on all plans Dedicated IP addresses come at an extra price ID theft insurance, data removal and credit scanning available to new one-year and two-year subscribers for free 1GB eSIM deal included through holiday.com Privacy policy No storage of connection logs or device logs permitted The only risky exceptions are personal account data (which doesn't leave the ExpressVPN website) and marketing data (which the policy says should be anonymized) An independent audit found that ExpressVPN's RAM-only server infrastructure makes it impossible to keep logs Virtual location change Successfully unblocked five international Netflix libraries, succeeding on 14 out of 15 attempts Server network 164 server locations in 105 countries 38% of servers are virtual, though most virtual locations are accessed through physical servers within 1,000 miles A large number of locations in South America, Africa and central Asia Features Simple but effective kill switch Can block ads, trackers, adult sites and/or malware sites but blocklists can't be customized Split tunneling is convenient but unavailable on iOS and modern Macs Aircove is the best VPN router, albeit expensive Customer support Setup and troubleshooting guides are organized and useful, with lots of screenshots and videos Live chat starts with a bot but you can get to a person within a couple minutes Email tickets are only accessible from the mobile apps or after live chat has failed Background check Founded in 2009; based in the British Virgin Islands Has never been caught selling or mishandling user data Turkish police seized servers in 2017 but couldn't find any logs of user activity Owned by Kape Technologies, which also owns CyberGhost and Private Internet Access A previous CIO formerly worked on surveillance in the United Arab Emirates; no evidence of shady behavior during his time at ExpressVPN Windows Version 12 leaked some DNS requests when Split Tunneling was active Installing, configuring and using ExpressVPN This section focuses on how it feels to use ExpressVPN on each of the major platforms where it's available. The first step for any setup process is to make an account on expressvpn.com and buy a subscription. Windows Once subscribed, download the Windows VPN from either expressvpn.com or the Microsoft Store, then open the .exe file. Click "Yes" to let it make changes, wait for the install, then let your computer reboot. Including the reboot, the whole process takes 5-10 minutes, most of it idle. To finish, you'll need your activation code, which you can find by going to expressvpn.com and clicking "Setup" in the top-right corner. You can install ExpressVPN's Windows app from the Microsoft store, but we found the website more convenient. Sam Chapman for Engadget Extreme simplicity is the watchword for all ExpressVPN's designs. The Windows client's launch panel consists of three buttons and less than ten words. You can change your location or let the app pick a location for you — the "Smart Location" is the server with the best combination of being nearby and unburdened. Everything else is crammed into the hamburger menu at the top left. Here, in seven tabs, you'll find the Network Lock kill switch, the four types of content blockers, the split tunneling menu and the option to change your VPN protocol. You can also add shortcuts to various websites, useful if you regularly use your VPN for the same online destinations. To sum up, there's almost nothing here to get in the way: no delays, no snags, no nested menus to get lost in. It may be the world's most ignorable VPN client. That's not a bad thing at all. Mac ExpressVPN's app for macOS is almost identical in design to its Windows app. The process for downloading and setting it up is nearly the same too. As on Windows, it can be downloaded from the App Store or sideloaded directly from the expressvpn.com download center. Only a few features are missing and a couple others have been added. Split tunneling is gone (unless you're still on a macOS lower than 11), and you won't see the Lightway Turbo setting. ExpressVPN recommends some servers, but it's easy to search the whole list. Sam Chapman for Engadget Mac users do gain access to the IKEv2 protocol, along with the option to turn off automatic IPv6 blocking — Windows users have to leave it blocked at all times. Almost every website is still accessible via IPv4, but it's useful if you do need to access a specific IPv6 address while the VPN is active. Android Android users can download ExpressVPN through the Google Play Store. Open the app, sign in and you're ready to go. The Android app has a very nice dark-colored design, only slightly marred by an unnecessary information box about how long you've used the VPN this week. ExpressVPN's Android app puts a little more information on the screen than it needs to, but still runs well. Sam Chapman for Engadget There's a large button for connecting. Clicking on the server name takes you to a list of locations. On this list, you can either search or scroll and can choose individual locations within a country that has more than one. We connected to as many far-flung server locations as we could, but not a single one took longer than a few seconds. The options menu is organized sensibly, with no option located more than two clicks deep. You will see a couple of options here that aren't available on desktop, the best of which is the ability to automatically connect to your last-used ExpressVPN server whenever your phone connects to a non-trusted wifi network. There are also a few general security tools: an IP address checker, DNS and WebRTC leak testers and a password generator. These are also available on the website, but here, they're built into the app. With the exception of the latter, we'd recommend using third-party testing tools instead — even a VPN with integrity has an incentive to make its own app look like it's working. iPhone and iPad You can only install ExpressVPN's iOS app through the app store. During setup, you may need to enter your password to allow your phone to use VPN configurations. Otherwise, there are no major differences from the Android process. ExpressVPN looks good on iPhone and iPad. Sam Chapman for Engadget The interface is not quite as pleasing as the dark-mode Android app, but it makes up for that by cutting out some of the clutter. The tabs and features are similar, though split tunneling and shortcuts are absent. Also, both mobile apps make customer support a lot more accessible than their desktop counterparts — plus, mobile is the only way to send email support tickets. Browser extension ExpressVPN also includes browser extensions for Firefox and Chrome. These let you connect, disconnect and change server locations without leaving your browser window. It's nice, but not essential unless you have a very specific web browser flow you like. ExpressVPN speed test: Very fast averages Connecting to a VPN almost always decreases your speed, but the best VPNs mitigate the drop as much as possible. We used Ookla's speed testing app to see how much of your internet speed ExpressVPN preserves. For this test, we emphasized the locations ExpressVPN uses for most of its virtual servers, including the Netherlands, Brazil, Germany and Singapore. Some terms before we start: Latency, measured in milliseconds (ms), is the time it takes one data packet to travel between your device and a web server through the VPN. Latency increases with distance. It's most important for real-time tasks like video chatting and online gaming. Download speed, measured in megabits per second (Mbps), is the amount of information that can download onto your device at one time — such as when loading a web page or streaming a video. Upload speed, also measured in Mbps, is the amount of information your device can send to the web at once. It's most important for torrenting, since the amount of data you can seed determines how fast you can download in exchange. The table below shows our results. We conducted this on Windows, using the automatic protocol setting with the Lightway Turbo feature active — a recent ExpressVPN addition that keeps speed more consistent by processing connections in parallel. Server location Latency (ms) Increase factor Download speed (Mbps) Percentage dropoff Upload speed (Mbps) Percentage dropoff Portland, Oregon, USA (unprotected) 18 -- 58.77 -- 5.70 -- Seattle, Washington, USA (best server) 26 1.4x 54.86 6.7% 5.52 3.2% New York, NY, USA 156 8.7x 57.25 2.6% 5.57 2.3% Amsterdam, Netherlands 306 17x 53.83 8.4% 5.58 2.1% São Paulo, Brazil 371 20.6x 53.82 8.4% 5.65 0.9% Frankfurt, Germany 404 22.4x 55.71 5.2% 5.67 0.5% Singapore, Singapore 381 21.2x 52.76 10.2% 5.64 1.0% Average 274 15.2x 54.71 6.9% 5.61 1.6% These are extremely good results. ExpressVPN is a winner on both download and upload speed. No matter where we went in the world, we never lost more than about 7% of our download speeds, and upload lost an astoundingly low average of 2%. This suggests that ExpressVPN deftly distributes its user load between servers to eliminate bottlenecks. This Ookla speedtest shows you can still get fast internet while connected to ExpressVPN -- our unprotected speeds are around 58 Mbps. Sam Chapman for Engadget The latency numbers look worse, but the rise in the table is less sharp than we projected. Ping length depends far more on distance than download speed does, so we expect it to shoot up on servers more than 1,000 miles from our location. Keeping the average below 300 ms, as ExpressVPN does here, is a strong showing. ExpressVPN security test: Checking for leaks A VPN's core mission is to hide your IP address and make you untraceable online. Our task in this section is to figure out if ExpressVPN can carry out this mission every time you connect. While we can't be 100% certain, the tests we'll run through below have led us to believe that ExpressVPN is currently leak-proof. Available VPN protocols A VPN protocol is like a common language that a VPN server can use to mediate between your devices and the web servers you visit. If a VPN uses outdated or insecure protocols, or relies on unique protocols with no visible specs or source code, that's a bad sign. Not all protocols are available on all apps, but Mac has the full range. Sam Chapman for Engadget ExpressVPN gives you a selection of three protocols: IKEv2, OpenVPN and Lightway. The first two are solid choices that support the latest encryption algorithms. OpenVPN has been fully open-source for years and is the best choice if privacy is your goal. While IKEv2 started life as a closed project by Microsoft and Cisco, ExpressVPN uses an open-source reverse-engineering, which is both better for privacy and quite fast. Lightway is the odd one out, a protocol you'll only find on ExpressVPN, though its source code is available on Github. It's similar to WireGuard, in that both reach for faster speeds and lower processing demands by keeping their codebases slim. However, Lightway was recently rewritten in Rust to better protect the keys stored in its memory. Ultimately, you can't go wrong with any of ExpressVPN's protocol options. 99% of the time, your best choice will be to set the controls to Automatic and let the VPN decide which runs best. Testing for leaks ExpressVPN is one of the best services, but it's not leak-proof (as you can read in the Background Check below). Luckily, checking for DNS leaks is a simple matter of checking your IP address before and after connecting to a VPN server. If the new address matches the VPN server, you're good; if not, your VPN is leaking. First, we checked the Windows app with split tunneling active to ensure the flaw really had been patched. We tested several servers and didn't find any leaks, which suggests the patch worked, though leaks were rare even before ExpressVPN fixed the vulnerability. We checked our IP while connected to the virtual India location, which is run from a physical server in Singapore. Don't worry -- it still looks like India to streaming services. Sam Chapman for Engadget In fact, we didn't find any leaks on any ExpressVPN server we tested on any platform. Though questions remain about iOS, as you'll see later in this section, that's a problem on Apple's end that even the best VPNs can do very little about for now. The most common cause of VPN leaks is the use of public DNS servers to connect users to websites, which can mistakenly send browsing activity outside the VPN's encrypted tunnel. ExpressVPN avoids the risks of the public system by installing its own DNS resolvers on every server. This is the key factor behind its clean bill of health in our leak testing. Two other common flaws can lead to VPN leaks: WebRTC traffic and IPv6. The former is a communication protocol used in live streaming and the latter is a new IP standard designed to expand domain availability. Both are nice, but currently optional, so ExpressVPN automatically blocks both to ensure there's no opportunity for leaks to arise. One note about VPN security on iOS: it's a known and continuing problem that iOS VPNs do not prevent many online apps from communicating with Apple directly, outside the VPN tunnel. This risks leaking sensitive data, even with Lockdown Mode active in iOS 16. A blog post by Proton VPN shares a workaround: connect to a VPN server, then turn Airplane Mode on and off again to end all connections that were active before you connected to the VPN. Testing encryption We finished up our battery of security tests by checking out ExpressVPN's encryption directly. Using WireShark, a free packet sniffer, we inspected what it looks like when ExpressVPN transmits data from one of its servers to the internet. The screenshot below shows a data stream encrypted with Lightway UDP. After connecting to ExpressVPN, HTTP packets were rendered unreadable while in transit. Sam Chapman for Engadget That lack of any identifiable information, or even readable information, means encryption is working as intended. We repeated the test several times, always getting the same result. This left us satisfied that ExpressVPN's core features are working as intended. How much does ExpressVPN cost? ExpressVPN subscriptions cost $12.95 per month. Long-term subscriptions can bring the monthly cost down, but the great deals they offer tend to only last for the first billing period. A 12-month subscription costs $99.95 and includes three months for free with your first payment, costing a total of $6.67 per month. The bonus disappears for all subsequent years, raising the monthly cost to $8.33. You can also sign up for 28 months at a cost of $139.72, but this is also once-only — ExpressVPN can only be renewed at the $99.95 per year level. There are two ways to test ExpressVPN for free before making a financial commitment. Users on iOS and Android can download the ExpressVPN app without entering any payment details and use it free for seven days. On any platform, there's a 30-day money-back guarantee, which ExpressVPN has historically honored with no questions asked. You will have to pay before you can use it, though. In our opinion, ExpressVPN's service is solid enough that it's worth paying extra. Perhaps not this much extra, but that depends on what you get out of it. We recommend using the 30-day refund period and seeing how well ExpressVPN works for you. If it's a VPN you can enjoy using, that runs fast and unblocks everything you need, that's worth a server's weight in gold. ExpressVPN side apps and bundles ExpressVPN includes some special features that work mostly or wholly separate from its VPN apps. Some of these come free with a subscription, while others add an extra cost. Every subscription includes the ExpressVPN keys password manager. This is available under its own tab on the Android and iOS apps. On desktop, you'll need to download a separate extension from your browser's store, then sign in using your account activation code. It's available on all Chromium browsers, but not Firefox. Starting in 2025, new subscribers get an eSIM plan through holiday.com, a separate service linked to ExpressVPN. The baseline 1GB holiday eSIM plans last for 5 days and can apply to countries, regions, or the entire world (though it's not clear whether the package deal applies to the regional and global plans). Longer-term plans include larger eSIM plans. You can add a dedicated IP address to your ExpressVPN subscription for an additional cost per month. A dedicated IP lets you use the same IP address every time you connect to ExpressVPN. You can add the address to whitelists on restricted networks, and you're assured to never be blocked because of someone else's bad activity on a shared IP. Unlike many of its competitors, ExpressVPN doesn't currently offer antivirus or online storage services, but there is a comprehensive bundle of ID protection tools called Identity Defender. We haven't reviewed any of these products in detail, but here's a list for reference: ID Alerts will inform you if any of your sensitive information is leaked or misused online. It's free with all plans, but you'll have to enter your personal information on your ExpressVPN account page or a mobile app. ID Theft Insurance grants up to $1 million in identity theft reimbursement and comes free with new ExpressVPN one-year or two-year subscriptions. It's not yet available to those who subscribed before it launched in October 2024. Data Removal scans for your information in data brokerages and automatically requests that it be deleted. It's also free with one-year and two-year plans. Credit Scanner is only available for United States users. It monitors your activity on the three credit bureaus so you can quickly spot any suspicious transactions. The Identity Defender features are currently only available to new ExpressVPN customers in the US. Close-reading ExpressVPN's privacy policy Although we worry that the consolidation of VPN brands under the umbrella of Kape Technologies (ExpressVPN's parent company) will make the industry less competitive, we don't believe it's influencing ExpressVPN to take advantage of its users' privacy. To confirm, and get a full sense of what sort of privacy ExpressVPN promises its users, we set out to read ExpressVPN's privacy policy in detail. It's long, but thankfully aimed at casual users instead of lawyers. You can see it for yourself here. In the introduction, ExpressVPN states that it does not keep either activity logs (such as a user's browsing history while connected to the VPN) or connection logs (such as the duration of a user's session and their IP address, which can be used to extrapolate browsing activity). It then specifies the seven types of data it's legally allowed to collect: Data used to sign up for an account, such as names, emails and payment methods. VPN usage data which is aggregated and can't be traced to any individual. Credentials stored in the ExpressVPN Keys password manager. Diagnostic data such as crash reports, which are only shared upon user request. IP addresses authorized for MediaStreamer, which is only for streaming devices that don't otherwise support VPN apps. Marketing data collected directly from the app — a "limited amount" that's kept anonymous. Data voluntarily submitted for identity theft protection apps. Of those seven exceptions, the only ones that count as red flags are account data and marketing data. Both categories are highly personal and could be damaging if mishandled. Fortunately, complying with subpoenas is not one of the allowed uses listed for either data category, nor does the policy let ExpressVPN sell the data to other private parties. The only really annoying thing here is that if you ask ExpressVPN to delete your personal data, you won't be able to use your account from then on. You aren't even eligible for a refund in this case, unless you're within 30 days of your initial subscription. As for marketing data, ExpressVPN collects device fingerprints and location data when you sign up for an account on its website. The privacy policy also claims this is anonymized, as its "systems are engineered to decouple such data from personally identifiable information." Audits corroborate this, as we'll see in the next section. So, while it would be better if ExpressVPN didn't collect any personal data at all, its practices don't appear to pose a risk to anything you do while using the VPN — just the ExpressVPN website. Privacy audits VPN providers often get third-party accounting firms to audit their privacy policies. The idea is that a well-known firm won't mortgage its reputation to lie on behalf of a VPN, so their results can be trusted. For the last several years, ExpressVPN has had KPMG look over its privacy policy and relevant infrastructure (see "TrustedServer" below). KPMG's most recent report, completed in December 2023 and released in May 2024, found that ExpressVPN had enough internal controls in place that users could trust its privacy policy. The report is freely available to read. This is a very good sign, though we're looking out for a more up-to-date audit soon. TrustedServer "TrustedServer" is a marketing term ExpressVPN uses for its RAM-only server infrastructure. RAM-only servers have no hard drives for long-term storage and return to a standard disk image with every reboot. This makes it theoretically impossible to store user activity logs on them, even if ExpressVPN wanted to do that. The KPMG audit, linked above, reports that TrustedServer works as advertised. Between its many clean privacy audits and the Turkish server incident in 2017, we're prepared to say ExpressVPN is a private VPN, in spite of its aggravating exception for marketing. Can ExpressVPN change your virtual location? Next, we tested whether ExpressVPN can actually convince websites that you're somewhere other than your real location. Our security tests have already proven it can hide your IP address, but it takes more than leak-proofing to fool streaming sites these days — Netflix and the others have gotten very good at combing through metadata to sniff out proxy users. The process for testing this is a lot like how we handled the DNS leak tests: try several different servers and see if we get caught. We checked five sample locations outside the U.S. to see if we a) got into Netflix and b) saw different titles in the library. The results are below. Server Location Unblocked Netflix? Library changed? Canada Y Y United Kingdom Y (second try; Docklands failed) Y Slovakia Y Y India Y Y (different from UK library) Australia Y Y In fifteen tests, ExpressVPN slipped up only once. Docklands, the UK server it chose as the fastest, wasn't able to access Netflix. We switched to a server labeled simply "London" and unblocked it without issue. ExpressVPN can change your virtual location so you can explore the wonderful world of K-drama. Sam Chapman for Engadget All the other locations got us access to an alternate Netflix library on the first try. We even checked whether the India server, which is physically located in the UK, showed us different videos than the UK servers. It did, which makes us even more confident that ExpressVPN's virtual locations are airtight. Investigating ExpressVPN's server network ExpressVPN users can connect to a total of 164 server locations in 105 countries and territories. These locations are reasonably well distributed across the globe, but as with all VPNs, there's a bias toward the northern hemisphere. There are 24 locations in the U.S. alone and a further 66 in Europe. That isn't to say users in the Global South get nothing. ExpressVPN has IP addresses from nine nations in South America (Argentina, Brazil, Bolivia, Chile, Colombia, Ecuador, Peru, Uruguay and Venezuela) and six in Africa (Algeria, Egypt, Ghana, Kenya, Morocco and South Africa). The network even includes Kazakhstan, Uzbekistan and Mongolia, impressive since central Asia may be the region most often shafted by VPNs. However, many of these servers have virtual locations different from their real ones. For those of you choosing a server based on performance instead of a particular IP address, ExpressVPN's website has a helpful list of which servers are virtual. The bad news is that it's a big chunk of the list. A total of 63 ExpressVPN locations are virtual, or 38% of its entire network. To reduce the sting, ExpressVPN takes care to locate virtual servers as close to their real locations as possible. Its virtual locations in Indonesia and India are physically based in Singapore. This isn't always practical, leading to some awkwardness like operating a Ghana IP address out of Germany. But it helps ExpressVPN perform better in the southern hemisphere. Extra features of ExpressVPN Compared to direct competitors like NordVPN and Surfshark, ExpressVPN doesn't have many special features. It's aimed squarely at the casual market and will probably disappoint power users. Having said that, what they do include works well. In this section, we'll run through ExpressVPN's four substantial features outside its VPN servers themselves. Network Lock kill switch "Network Lock" is the name ExpressVPN gives to its kill switch (though it's called "Network Protection" on mobile). A VPN kill switch is a safety feature that keeps you from broadcasting outside the VPN tunnel. If it ever detects that you aren't connected to a legitimate ExpressVPN server, it cuts off your internet access. You won't be able to get back online until you either reconnect to the VPN or disable Network Lock. ExpressVPN's kill switch is called Network Lock on desktop, and Network Protection on mobile (Android pictured) Sam Chapman for Engadget This is important for everyone, not just users who need to hide sensitive traffic. The recently discovered TunnelVision bug theoretically allows hackers to set up fake public wi-fi networks through which they redirect you to equally fake VPN servers, which then harvest your personal information. It's unlikely, but not impossible, and a kill switch is the best way to prevent it — the switch always triggers unless you're connected to a real server in the VPN's network. Like most of ExpressVPN's features, all you can do with Network Lock is turn it on and off. You can also toggle whether you'll still be able to access local devices while the kill switch is blocking your internet — this is allowed by default. Threat manager, ad blocker and parental controls ExpressVPN groups three tools under the heading of "advanced protection" — Threat Manager, an ad blocker and parental controls. Threat Manager consists of two checkboxes: one that blocks your browser from communicating with activity tracking software and one that blocks a list of websites known to be used for malware. Check any of these boxes to use the pre-set blocklists whenever you're connected to ExpressVPN. Sam Chapman for Engadget You can't customize the lists, so you're limited to what ExpressVPN considers worthy of blocking. They share their sources on the website. While the lists are extensive and open-source, they rely on after-the-fact reporting and can't detect and block unknown threats like a proper antivirus. The adblock and parental control options work the same way: check a box to block everything on the list, uncheck it to allow everything through. In tests, the ad blocker was nearly 100% effective against banner ads, but failed to block any video ads on YouTube or Netflix. The parental control option blocks a list of porn sites. It's an easy option for concerned parents, but only works while ExpressVPN is connected. As such, it's meant to be used in conjunction with device-level parental controls that prevent the child from turning off or uninstalling the VPN client. Split tunneling Sometimes, you'll find it helpful to have your device getting online through two different IP addresses at once — one for your home services and one for a location you're trying to spoof. That's where split tunneling is helpful: it runs some apps through the VPN while leaving others unprotected. This can also improve your speeds, since the VPN needs to encrypt less in total. You can configure split tunneling through either a blocklist or an allowlist. Sam Chapman for Engadget ExpressVPN includes split tunneling on Windows, Android and Mac (though only on versions 10 and below). You can only split by app, not by website, but it's still pretty useful. For example, you can have BitTorrent handling a heavy download in the background while you use your browser for innocuous activities that don't need protecting. ExpressVPN Aircove router By now, it should be clear that we find ExpressVPN to be a highly reliable but often unexceptional VPN service. However, there's one area in which it's a clear industry leader: VPN routers. ExpressVPN Aircove is, to our knowledge, the only router with a built-in commercial VPN that comes with its own dashboard interface. Usually, installing a VPN on your router requires tinkering with the router control panel, which turns off all but the most experienced users — not to mention making it a massive pain to switch to a new server location. Aircove's dashboard, by contrast, will be instantly familiar to anyone who already knows how to use an ExpressVPN client. It even allows different devices in your home to connect to different locations through the router VPN. Aircove's biggest drawback is its price. Currently retailing at $189 (not including an ExpressVPN subscription), it's around three times more expensive than an aftermarket router fitted with free VPN firmware. Some of you might still find the convenience worth the one-time payment. ExpressVPN customer support options ExpressVPN's written help pages are some of the best on the market. Its live chat is more of a mixed bag, and complex questions may cause delays. However, it is at least staffed with human agents who aim to reply accurately, rather than resolve your ticket as quickly as possible. You can directly access both live chat and email from ExpressVPN's mobile apps (on desktop, you'll have to go to the website). Sam Chapman for Engadget We approached ExpressVPN's support features with a simple question: "If I requested that ExpressVPN delete all my personal data, would I be able to get a refund for my unused subscription time?" (Remember from the Privacy Policy section that submitting a full deletion request also cancels your ExpressVPN account.) Our first stop was expressvpn.com/support, the written support center and FAQ page. It's divided into setup guides, troubleshooting, account management and information on each of ExpressVPN's products. The setup guides are excellent, including screenshots and clearly written steps; each one includes a video guide for those who learn better that way. Troubleshooting is just as good — no videos, but the same standards of clarity and usefulness prevail. The section starts with general problems, then delves into specific issues you might face on each operating system. Each article clearly derives from a real customer need. The live support experience To get answers on our refund question, we visited the account management FAQs. This section stated that the refund policy only applies within 30 days of purchase. Pretty clear-cut, but we still wanted an answer on our special case, so we contacted live chat by clicking the button at the bottom-right of every FAQ page. Live chat is in the bottom-right corner of every page of expressvpn.com. Sam Chapman for Engadget Live chat starts with an AI assistant, which is not too hard to get past — just ask it a question it can't answer, then click "Transfer to an Agent." We got online with (what claimed to be) a human in less than a minute. Answering the question took longer and involved an uncomfortable 10-minute silence, but we did get a clear verdict from a real person: refunds are within 30 days only, no matter what. If the live chat agent can't answer your question, you'll be redirected to open an email support ticket. Annoyingly, there's no way to go directly to email support through the website or desktop apps, though mobile users have the option to skip directly there. ExpressVPN background check: From founding to Kape Technologies ExpressVPN launched in 2009, which makes it one of the oldest consumer VPNs in continual operation. In more than 15 years of operation, it's never been caught violating its own privacy policy, though its record isn't free of more minor blemishes. Headquarters in the British Virgin Islands Founders Dan Pomerantz and Peter Burchhardt registered the company in the British Virgin Islands from the start to take advantage of that territory's favorable legal environment for online privacy. The BVIs have no law requiring businesses to retain data on their users, and the process for extraditing data is famously difficult, requiring a direct order from the highest court. In 2021, the BVI implemented the Data Protection Act (DPA) [PDF link], which prevents companies based in the territory from accessing data on their users anywhere in the world. It's a great privacy law in theory, modeled on best-in-class legislation in the EU. However, we couldn't find any evidence that its supervising authority — the Office of the Information Commissioner — has a leader or staff. In other words, while ExpressVPN is not legally required to log any data on its users, there's technically nobody stopping them from doing so. Whether you trust the jurisdiction depends on whether you trust the company itself. Let's see what the other evidence says. Security and privacy incidents Two significant incidents stand out from ExpressVPN's 16-year history. In 2017, when Andrei Karlov, Russia's ambassador to Turkey, was shot to death at an art show. Turkish police suspected someone had used ExpressVPN to mask their identity while they deleted information from social media accounts belonging to the alleged assassin. To investigate, they confiscated an ExpressVPN server to comb for evidence. They didn't find anything. A police seizure is the best possible test of a VPN's approach to privacy. The provider can't prepare beforehand, fake anything, or collude with investigators. The Turkey incident is still one of the best reasons to recommend ExpressVPN, though eight years is a long time for policy to change. The second incident began in March 2024, when a researcher at CNET informed ExpressVPN that its version 12 for Windows occasionally leaked DNS requests when users enabled the split tunneling feature. While these users remained connected to an ExpressVPN server, their browsing activity was often going directly to their ISP, unmasked. The bug only impacted a few users, and to their credit, ExpressVPN sprang into action as soon as they learned about it. The team had it patched by April, as confirmed by the researcher who initially discovered the vulnerability. But while their quick and effective response deserves praise, it's still a mark against them that a journalist noticed the bug before they did. Kape Technologies ownership and management questions In 2021, an Israeli-owned, UK-based firm called Kape Technologies purchased a controlling interest in ExpressVPN. In addition to ExpressVPN, privately held Kape owns CyberGhost, Private Internet Access, and Zenmate (before it merged into CyberGhost). As shown on its website, it also owns Webselenese, publisher of VPN review websites WizCase and vpnMentor, which poses an apparent conflict of interest. When reached for comment, a representative for ExpressVPN said that "ExpressVPN does not directly engage with, nor seek to influence, the content on any Webselenese site," and pointed us to disclosure statements on the websites in question — here's one example. Even so, it's a good reminder not to take VPN reviews at face value without knowing who's behind them (Engadget is owned by Yahoo, which does not own any VPNs). Diving deeper into the background of Kape's ownership will lead you to owner Teddy Sagi. Go back far enough, and you'll see he did prison time in Israel and was mentioned in the Pandora Papers, among other things. More recently, headlines about the billionaire have focused more his businesses in the online gambling and fintech arenas, as well as his real estate ventures. An ExpressVPN representative told us that "Kape's brands continue to operate independently," and our investigation bore that out — we couldn't find any proof that Kape or Sagi have directly attempted to influence ExpressVPN's software or daily operations. Closer to the immediate day-to-day operations of ExpressVPN was the company's employment of Daniel Gericke as CTO from 2019 through 2023. During that time, the US Justice Department announced it had fined Gericke and two others for their previous employment on a surveillance operation called Project Raven, which the United Arab Emirates (UAE) used to spy on its own citizens. The revelation prompted a public response from ExpressVPN defending its decision to hire Gericke, arguing that "[t]he best goalkeepers are the ones trained by the best strikers." ExpressVPN's representative confirmed that the company still stands by that linked statement. Gericke parted ways with ExpressVPN in October 2023, per his LinkedIn profile. While we don't know what we don't know, we can say that ExpressVPN has not notably changed its public-facing security and privacy policies during the time it's been connected to Kape, Sagi, or Gericke. In the end, how much ExpressVPN's history matters to you is a personal choice. If you object to any current or past actions by Kape Technologies or Teddy Sagi, there are other premium VPN options you might prefer. If you need more information to make up your mind, we recommend reading through CNET's 2022 deep dive on ExpressVPN's corporate history. Final verdict ExpressVPN is the VPN we most often recommend to beginners. It takes zero training to use, and consistently gets past filters on streaming sites. It also runs in the background with virtually no impact. If anything is worth the high price of admission, it's the excellent speeds distributed evenly across the worldwide server network. However, for certain specific cases, ExpressVPN may not be the best choice. There's no way to set up your own server locations, like NordVPN offers, and no double VPN connections, like you can build for yourself on Surfshark. Its corporate background is more suspect than the entities backing Proton VPN, and unlike Mullvad, ExpressVPN doesn't work in China — it's so well-known that the government targets its servers specifically. We suggest going with ExpressVPN for general online privacy, for spoofing locations in your home country while traveling, or if you regularly need to unblock sites in other countries. That encompasses 19 of every 20 users, which is fine by us, as ExpressVPN is a great service. It's just more of a reliable old screwdriver than a multi-tool. This article originally appeared on Engadget at https://www.engadget.com/cybersecurity/vpn/expressvpn-review-2025-fast-speeds-and-a-low-learning-curve-160052884.html?src=rss
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  • Colorado’s landfills generate as much pollution as driving 1 million cars for a year

    Remember the banana peels, apple cores, and leftover pizza you recently threw in the garbage? Today, your food waste—and your neighbors’—is emitting climate-warming greenhouse gases as it decomposes in a nearby municipal landfill.

    Buried food scraps and yard waste at 51 dumps across Colorado generate an amount of methane equivalent to driving 1 million gasoline-powered cars for a year. About 80 times as potent as carbon dioxide as a greenhouse gas over a period of 20 years, methane accounts for 11% of global emissions that scientists say are warming the atmosphere and contributing to more intense and severe weather, wildfires, and drought.

    Landfills are the third-largest source of methane pollution in Colorado, after agriculture and fossil fuel extraction. Draft methane rules released last month by the state’s Department of Public Health and Environment would, for the first time, require some dump operators to measure and quantify methane releases and to fix leaks. The proposal mandates that waste managers install a gas collection system if their dump generates a certain amount of the climate-warming gas. 

    It also addresses loopholes in federal law that allow waste to sit for five years before such systems are required—even though science has shown that half of all food waste decays within about three and a half years. The draft rule surpasses U.S. Environmental Protection Agency standards in the amount of landfill area operators must monitor for emissions. It’s set to be heard by the state’s Air Quality Control Commission in August.

    Proposed regulations require the elimination of open gas flares—burning emissions directly into the atmosphere—and urge the use of biocovers and biofilters, which rely on bacteria to break down gases. The 70-page draft also calls for more routine and thorough monitoring of a dump surface with advanced technologies like satellites, which recently recorded large plumes of methane escaping from a Denver-area landfill.

    “We’ve had our eyes opened thanks to technology that has made the invisible, visible—now we know the extent of the problem, which is much greater than what estimates have portrayed,” said Katherine Blauvelt, circular economy director at Industrious Labs, a nonprofit working to decarbonize industry. 

    “When landfill operators fail to control leaks, we know harmful pollutants are coming along for the ride.”

    Cancer-causing volatile organic compounds, such as benzene and toluene, escape with methane leaching from landfills. These chemicals also contribute to the formation of lung-damaging ozone pollution, an increasing problem for the 3.6 million people who live in the greater Denver metropolitan area.

    Indeed, the region along the eastern slope of the Rocky Mountains ranked sixth in the nation for the most polluted air—with unhealthy ozone levels reported on one out of every 10 days, on average, according to the American Lung Association’s 2025 “State of the Air” report. The state is also woefully behind in its compliance with federal air quality standards.

    State officials and environmental advocates agree that reducing methane emissions from landfills, which are easier to mitigate than cow burps, for example, is one of the quickest and most efficient ways to slow warming in the short term.

    “Waste deposited in landfills continues producing methane for decades as it breaks down—and it’s one sector where Colorado has yet to directly take action to reduce these greenhouse gases,” said Tim Taylor, a supervisor in the state’s air pollution control division, in an online hearing last February on the proposed landfill methane rules.

    Colorado’s draft regulations are similar to those in California, Oregon, Maryland, and Washington, he added. More than 10 landfills in the state are already required under federal rules to have gas collection and control systems. Yet even with such technology in place, disposal facilities routinely exceed federal methane emissions caps.

    The state’s health department has also identified a dozen municipal solid waste landfills, based on a preliminary analysis, that would be required to put such systems in place under the proposed rules, Zachary Aedo, an agency spokesman, said in an email to Capital & Main.

    Many of these facilities are operated by counties, some of which expressed concerns about their ability to pay for such systems.

    “We are a small rural county, and a multimillion-dollar containment system is going to be more than we can build,” testified Delta County Commissioner Craig Fuller at the February hearing. “The financial equation of this whole thing is absolutely mind-boggling—we are struggling as it is to provide health and human services.”

    Other county officials embraced the proposed tightening of rules.

    “Landfills across Colorado, including in Eagle County, are leading sources of methane pollution,” said Eagle County Commissioner Matt Scherr in a March 6 statement. “As a local elected official I support a robust rule that embraces advanced technologies to cut pollution, protect public health and help the methane mitigation industry thrive.”

    For larger landfill companies, like Waste Management, which operates 283 active disposal sites nationwide, figuring out which technology works to best monitor emissions from a dump’s surface is proving a complex challenge. The company is testing technologies at facilities with different topographies and climate fluctuations to understand what causes emissions releases, said Amy Banister, Waste Management senior director of air programs.

    “Landfills are complicated, emissions vary over time, and we have emissions 24/7,” said Banister at an online meeting last September of a technical group created by Colorado health department officials. “Drones produced a lot of false positives—and we need more work understanding how fixed sensors can be applied in a landfill environment.”

    State health officials suggested municipalities could offset the costs of installing gas collection systems at disposal sites by converting methane into energy. Several landfill operations in Colorado currently have such waste-to-energy systems—which send power they generate to the state’s power grid.

    “We are mindful of the costs of complying with this rule and how tipping fees may be impacted,” said Taylor, an air quality supervisor, at the February hearing. “Analyses conducted in other states of their landfill methane rules found there wasn’t an increase in tipping fees as a result of regulations over time.”

    Tipping fees are paid by those who dispose of waste in a landfill. If operators passed on compliance costs to households, a state analysis found, the yearly average annual fee would increase per household.

    Colorado’s push comes as the EPA issued an enforcement alert in September that found “recurring Clean Air Act compliance issues” at municipal solid waste landfills that led to the “significant release of methane,” based on 100 inspections conducted over three years. 

    Such violations included improper design and installation of gas collection and control systems, failure to maintain adequate “cover integrity,” and improper monitoring of facilities for emissions.

    To address gaps in federal regulations, which require operators to measure emissions four times a year by walking in a grid pattern across the face of the landfill with a handheld sensor, Colorado’s draft rules require third-party monitoring. Such measurements must be conducted offsite by an entity approved by the state’s air pollution control division that uses a satellite, aircraft or mobile monitoring platform.

    The infrequency of such grid walks—which skip spots that operators deem dangerous—contributes to the undercounting of methane emissions from landfills, according to a satellite-based analysis. An international team of scientists estimated potent greenhouse gas emissions from landfills are 50% higher than EPA estimates. Satellites like one operated by nonprofit Carbon Mapper found large methane plumes outside the quarterly monitoring periods over the Tower Landfill in Commerce City, northeast of Denver.

    The satellite allowed scientists to see parts of the landfill not accessible with traditional monitoring—measurements that found that such landfills are underreporting their methane emissions to state regulators, said Tia Scarpelli, a research scientist and waste sector lead at Carbon Mapper.

    “Landfill emissions tend to be quite persistent—if a landfill is emitting when it’s first observed, it’s likely to be emitting later on,” she added. Scarpelli cautioned that it’s important for regulators to investigate with operators what was happening on the landfill surface at the time the leak was measured.

    Tower Landfill’s operator, Allied Waste Systems of Colorado, provided reasons for such large methane releases in a January 2024 report to the state’s health department, including equipment malfunctions. The fix for about 22 emissions events over the federal methane limits detected in August 2023 by surface monitoring: “Soil added as cover maintenance.”

    Like many dumps across Colorado and the nation, the Tower Landfill is located near a community that’s already disproportionately impacted by emissions from industrial activities.

    “These landfills are not only driving climate change, they are also driving a public health crisis in our community,” said Guadalupe Solis, director of environmental justice programs at Cultivando, a nonprofit led by Latina and Indigenous women in northern Denver. “The Tower Landfill is near nursing homes, clinics, near schools with majority Hispanic students.”

    Physicians in the state warned that those who live the closest to dumps suffer the worst health effects from pollutants like benzene and hydrogen sulfide, which are linked to cancer, heart, and other health conditions.

    “People living near landfills, like myself, my family and my patients, experience higher exposure to air pollution,” testified Dr. Nikita Habermehl, a specialist in pediatric emergency medicine who lives near a landfill in Larimer County, at the February 26 public hearing, “leading to increased rates of respiratory issues and headaches and asthma worsened by poor air quality.”

    —By Jennifer Oldham, Capital & Main

    This piece was originally published by Capital & Main, which reports from California on economic, political, and social issues.
    #colorados #landfills #generate #much #pollution
    Colorado’s landfills generate as much pollution as driving 1 million cars for a year
    Remember the banana peels, apple cores, and leftover pizza you recently threw in the garbage? Today, your food waste—and your neighbors’—is emitting climate-warming greenhouse gases as it decomposes in a nearby municipal landfill. Buried food scraps and yard waste at 51 dumps across Colorado generate an amount of methane equivalent to driving 1 million gasoline-powered cars for a year. About 80 times as potent as carbon dioxide as a greenhouse gas over a period of 20 years, methane accounts for 11% of global emissions that scientists say are warming the atmosphere and contributing to more intense and severe weather, wildfires, and drought. Landfills are the third-largest source of methane pollution in Colorado, after agriculture and fossil fuel extraction. Draft methane rules released last month by the state’s Department of Public Health and Environment would, for the first time, require some dump operators to measure and quantify methane releases and to fix leaks. The proposal mandates that waste managers install a gas collection system if their dump generates a certain amount of the climate-warming gas.  It also addresses loopholes in federal law that allow waste to sit for five years before such systems are required—even though science has shown that half of all food waste decays within about three and a half years. The draft rule surpasses U.S. Environmental Protection Agency standards in the amount of landfill area operators must monitor for emissions. It’s set to be heard by the state’s Air Quality Control Commission in August. Proposed regulations require the elimination of open gas flares—burning emissions directly into the atmosphere—and urge the use of biocovers and biofilters, which rely on bacteria to break down gases. The 70-page draft also calls for more routine and thorough monitoring of a dump surface with advanced technologies like satellites, which recently recorded large plumes of methane escaping from a Denver-area landfill. “We’ve had our eyes opened thanks to technology that has made the invisible, visible—now we know the extent of the problem, which is much greater than what estimates have portrayed,” said Katherine Blauvelt, circular economy director at Industrious Labs, a nonprofit working to decarbonize industry.  “When landfill operators fail to control leaks, we know harmful pollutants are coming along for the ride.” Cancer-causing volatile organic compounds, such as benzene and toluene, escape with methane leaching from landfills. These chemicals also contribute to the formation of lung-damaging ozone pollution, an increasing problem for the 3.6 million people who live in the greater Denver metropolitan area. Indeed, the region along the eastern slope of the Rocky Mountains ranked sixth in the nation for the most polluted air—with unhealthy ozone levels reported on one out of every 10 days, on average, according to the American Lung Association’s 2025 “State of the Air” report. The state is also woefully behind in its compliance with federal air quality standards. State officials and environmental advocates agree that reducing methane emissions from landfills, which are easier to mitigate than cow burps, for example, is one of the quickest and most efficient ways to slow warming in the short term. “Waste deposited in landfills continues producing methane for decades as it breaks down—and it’s one sector where Colorado has yet to directly take action to reduce these greenhouse gases,” said Tim Taylor, a supervisor in the state’s air pollution control division, in an online hearing last February on the proposed landfill methane rules. Colorado’s draft regulations are similar to those in California, Oregon, Maryland, and Washington, he added. More than 10 landfills in the state are already required under federal rules to have gas collection and control systems. Yet even with such technology in place, disposal facilities routinely exceed federal methane emissions caps. The state’s health department has also identified a dozen municipal solid waste landfills, based on a preliminary analysis, that would be required to put such systems in place under the proposed rules, Zachary Aedo, an agency spokesman, said in an email to Capital & Main. Many of these facilities are operated by counties, some of which expressed concerns about their ability to pay for such systems. “We are a small rural county, and a multimillion-dollar containment system is going to be more than we can build,” testified Delta County Commissioner Craig Fuller at the February hearing. “The financial equation of this whole thing is absolutely mind-boggling—we are struggling as it is to provide health and human services.” Other county officials embraced the proposed tightening of rules. “Landfills across Colorado, including in Eagle County, are leading sources of methane pollution,” said Eagle County Commissioner Matt Scherr in a March 6 statement. “As a local elected official I support a robust rule that embraces advanced technologies to cut pollution, protect public health and help the methane mitigation industry thrive.” For larger landfill companies, like Waste Management, which operates 283 active disposal sites nationwide, figuring out which technology works to best monitor emissions from a dump’s surface is proving a complex challenge. The company is testing technologies at facilities with different topographies and climate fluctuations to understand what causes emissions releases, said Amy Banister, Waste Management senior director of air programs. “Landfills are complicated, emissions vary over time, and we have emissions 24/7,” said Banister at an online meeting last September of a technical group created by Colorado health department officials. “Drones produced a lot of false positives—and we need more work understanding how fixed sensors can be applied in a landfill environment.” State health officials suggested municipalities could offset the costs of installing gas collection systems at disposal sites by converting methane into energy. Several landfill operations in Colorado currently have such waste-to-energy systems—which send power they generate to the state’s power grid. “We are mindful of the costs of complying with this rule and how tipping fees may be impacted,” said Taylor, an air quality supervisor, at the February hearing. “Analyses conducted in other states of their landfill methane rules found there wasn’t an increase in tipping fees as a result of regulations over time.” Tipping fees are paid by those who dispose of waste in a landfill. If operators passed on compliance costs to households, a state analysis found, the yearly average annual fee would increase per household. Colorado’s push comes as the EPA issued an enforcement alert in September that found “recurring Clean Air Act compliance issues” at municipal solid waste landfills that led to the “significant release of methane,” based on 100 inspections conducted over three years.  Such violations included improper design and installation of gas collection and control systems, failure to maintain adequate “cover integrity,” and improper monitoring of facilities for emissions. To address gaps in federal regulations, which require operators to measure emissions four times a year by walking in a grid pattern across the face of the landfill with a handheld sensor, Colorado’s draft rules require third-party monitoring. Such measurements must be conducted offsite by an entity approved by the state’s air pollution control division that uses a satellite, aircraft or mobile monitoring platform. The infrequency of such grid walks—which skip spots that operators deem dangerous—contributes to the undercounting of methane emissions from landfills, according to a satellite-based analysis. An international team of scientists estimated potent greenhouse gas emissions from landfills are 50% higher than EPA estimates. Satellites like one operated by nonprofit Carbon Mapper found large methane plumes outside the quarterly monitoring periods over the Tower Landfill in Commerce City, northeast of Denver. The satellite allowed scientists to see parts of the landfill not accessible with traditional monitoring—measurements that found that such landfills are underreporting their methane emissions to state regulators, said Tia Scarpelli, a research scientist and waste sector lead at Carbon Mapper. “Landfill emissions tend to be quite persistent—if a landfill is emitting when it’s first observed, it’s likely to be emitting later on,” she added. Scarpelli cautioned that it’s important for regulators to investigate with operators what was happening on the landfill surface at the time the leak was measured. Tower Landfill’s operator, Allied Waste Systems of Colorado, provided reasons for such large methane releases in a January 2024 report to the state’s health department, including equipment malfunctions. The fix for about 22 emissions events over the federal methane limits detected in August 2023 by surface monitoring: “Soil added as cover maintenance.” Like many dumps across Colorado and the nation, the Tower Landfill is located near a community that’s already disproportionately impacted by emissions from industrial activities. “These landfills are not only driving climate change, they are also driving a public health crisis in our community,” said Guadalupe Solis, director of environmental justice programs at Cultivando, a nonprofit led by Latina and Indigenous women in northern Denver. “The Tower Landfill is near nursing homes, clinics, near schools with majority Hispanic students.” Physicians in the state warned that those who live the closest to dumps suffer the worst health effects from pollutants like benzene and hydrogen sulfide, which are linked to cancer, heart, and other health conditions. “People living near landfills, like myself, my family and my patients, experience higher exposure to air pollution,” testified Dr. Nikita Habermehl, a specialist in pediatric emergency medicine who lives near a landfill in Larimer County, at the February 26 public hearing, “leading to increased rates of respiratory issues and headaches and asthma worsened by poor air quality.” —By Jennifer Oldham, Capital & Main This piece was originally published by Capital & Main, which reports from California on economic, political, and social issues. #colorados #landfills #generate #much #pollution
    WWW.FASTCOMPANY.COM
    Colorado’s landfills generate as much pollution as driving 1 million cars for a year
    Remember the banana peels, apple cores, and leftover pizza you recently threw in the garbage? Today, your food waste—and your neighbors’—is emitting climate-warming greenhouse gases as it decomposes in a nearby municipal landfill. Buried food scraps and yard waste at 51 dumps across Colorado generate an amount of methane equivalent to driving 1 million gasoline-powered cars for a year. About 80 times as potent as carbon dioxide as a greenhouse gas over a period of 20 years, methane accounts for 11% of global emissions that scientists say are warming the atmosphere and contributing to more intense and severe weather, wildfires, and drought. Landfills are the third-largest source of methane pollution in Colorado, after agriculture and fossil fuel extraction. Draft methane rules released last month by the state’s Department of Public Health and Environment would, for the first time, require some dump operators to measure and quantify methane releases and to fix leaks. The proposal mandates that waste managers install a gas collection system if their dump generates a certain amount of the climate-warming gas.  It also addresses loopholes in federal law that allow waste to sit for five years before such systems are required—even though science has shown that half of all food waste decays within about three and a half years. The draft rule surpasses U.S. Environmental Protection Agency standards in the amount of landfill area operators must monitor for emissions. It’s set to be heard by the state’s Air Quality Control Commission in August. Proposed regulations require the elimination of open gas flares—burning emissions directly into the atmosphere—and urge the use of biocovers and biofilters, which rely on bacteria to break down gases. The 70-page draft also calls for more routine and thorough monitoring of a dump surface with advanced technologies like satellites, which recently recorded large plumes of methane escaping from a Denver-area landfill. “We’ve had our eyes opened thanks to technology that has made the invisible, visible—now we know the extent of the problem, which is much greater than what estimates have portrayed,” said Katherine Blauvelt, circular economy director at Industrious Labs, a nonprofit working to decarbonize industry.  “When landfill operators fail to control leaks, we know harmful pollutants are coming along for the ride.” Cancer-causing volatile organic compounds, such as benzene and toluene, escape with methane leaching from landfills. These chemicals also contribute to the formation of lung-damaging ozone pollution, an increasing problem for the 3.6 million people who live in the greater Denver metropolitan area. Indeed, the region along the eastern slope of the Rocky Mountains ranked sixth in the nation for the most polluted air—with unhealthy ozone levels reported on one out of every 10 days, on average, according to the American Lung Association’s 2025 “State of the Air” report. The state is also woefully behind in its compliance with federal air quality standards. State officials and environmental advocates agree that reducing methane emissions from landfills, which are easier to mitigate than cow burps, for example, is one of the quickest and most efficient ways to slow warming in the short term. “Waste deposited in landfills continues producing methane for decades as it breaks down—and it’s one sector where Colorado has yet to directly take action to reduce these greenhouse gases,” said Tim Taylor, a supervisor in the state’s air pollution control division, in an online hearing last February on the proposed landfill methane rules. Colorado’s draft regulations are similar to those in California, Oregon, Maryland, and Washington, he added. More than 10 landfills in the state are already required under federal rules to have gas collection and control systems. Yet even with such technology in place, disposal facilities routinely exceed federal methane emissions caps. The state’s health department has also identified a dozen municipal solid waste landfills, based on a preliminary analysis, that would be required to put such systems in place under the proposed rules, Zachary Aedo, an agency spokesman, said in an email to Capital & Main. Many of these facilities are operated by counties, some of which expressed concerns about their ability to pay for such systems. “We are a small rural county, and a multimillion-dollar containment system is going to be more than we can build,” testified Delta County Commissioner Craig Fuller at the February hearing. “The financial equation of this whole thing is absolutely mind-boggling—we are struggling as it is to provide health and human services.” Other county officials embraced the proposed tightening of rules. “Landfills across Colorado, including in Eagle County, are leading sources of methane pollution,” said Eagle County Commissioner Matt Scherr in a March 6 statement. “As a local elected official I support a robust rule that embraces advanced technologies to cut pollution, protect public health and help the methane mitigation industry thrive.” For larger landfill companies, like Waste Management, which operates 283 active disposal sites nationwide, figuring out which technology works to best monitor emissions from a dump’s surface is proving a complex challenge. The company is testing technologies at facilities with different topographies and climate fluctuations to understand what causes emissions releases, said Amy Banister, Waste Management senior director of air programs. “Landfills are complicated, emissions vary over time, and we have emissions 24/7,” said Banister at an online meeting last September of a technical group created by Colorado health department officials. “Drones produced a lot of false positives—and we need more work understanding how fixed sensors can be applied in a landfill environment.” State health officials suggested municipalities could offset the costs of installing gas collection systems at disposal sites by converting methane into energy. Several landfill operations in Colorado currently have such waste-to-energy systems—which send power they generate to the state’s power grid. “We are mindful of the costs of complying with this rule and how tipping fees may be impacted,” said Taylor, an air quality supervisor, at the February hearing. “Analyses conducted in other states of their landfill methane rules found there wasn’t an increase in tipping fees as a result of regulations over time.” Tipping fees are paid by those who dispose of waste in a landfill. If operators passed on compliance costs to households, a state analysis found, the yearly average annual fee would increase $22.90 per household. Colorado’s push comes as the EPA issued an enforcement alert in September that found “recurring Clean Air Act compliance issues” at municipal solid waste landfills that led to the “significant release of methane,” based on 100 inspections conducted over three years.  Such violations included improper design and installation of gas collection and control systems, failure to maintain adequate “cover integrity,” and improper monitoring of facilities for emissions. To address gaps in federal regulations, which require operators to measure emissions four times a year by walking in a grid pattern across the face of the landfill with a handheld sensor, Colorado’s draft rules require third-party monitoring. Such measurements must be conducted offsite by an entity approved by the state’s air pollution control division that uses a satellite, aircraft or mobile monitoring platform. The infrequency of such grid walks—which skip spots that operators deem dangerous—contributes to the undercounting of methane emissions from landfills, according to a satellite-based analysis. An international team of scientists estimated potent greenhouse gas emissions from landfills are 50% higher than EPA estimates. Satellites like one operated by nonprofit Carbon Mapper found large methane plumes outside the quarterly monitoring periods over the Tower Landfill in Commerce City, northeast of Denver. The satellite allowed scientists to see parts of the landfill not accessible with traditional monitoring—measurements that found that such landfills are underreporting their methane emissions to state regulators, said Tia Scarpelli, a research scientist and waste sector lead at Carbon Mapper. “Landfill emissions tend to be quite persistent—if a landfill is emitting when it’s first observed, it’s likely to be emitting later on,” she added. Scarpelli cautioned that it’s important for regulators to investigate with operators what was happening on the landfill surface at the time the leak was measured. Tower Landfill’s operator, Allied Waste Systems of Colorado, provided reasons for such large methane releases in a January 2024 report to the state’s health department, including equipment malfunctions. The fix for about 22 emissions events over the federal methane limits detected in August 2023 by surface monitoring: “Soil added as cover maintenance.” Like many dumps across Colorado and the nation, the Tower Landfill is located near a community that’s already disproportionately impacted by emissions from industrial activities. “These landfills are not only driving climate change, they are also driving a public health crisis in our community,” said Guadalupe Solis, director of environmental justice programs at Cultivando, a nonprofit led by Latina and Indigenous women in northern Denver. “The Tower Landfill is near nursing homes, clinics, near schools with majority Hispanic students.” Physicians in the state warned that those who live the closest to dumps suffer the worst health effects from pollutants like benzene and hydrogen sulfide, which are linked to cancer, heart, and other health conditions. “People living near landfills, like myself, my family and my patients, experience higher exposure to air pollution,” testified Dr. Nikita Habermehl, a specialist in pediatric emergency medicine who lives near a landfill in Larimer County, at the February 26 public hearing, “leading to increased rates of respiratory issues and headaches and asthma worsened by poor air quality.” —By Jennifer Oldham, Capital & Main This piece was originally published by Capital & Main, which reports from California on economic, political, and social issues.
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  • What AI’s impact on individuals means for the health workforce and industry

    Transcript    
    PETER LEE: “In American primary care, the missing workforce is stunning in magnitude, the shortfall estimated to reach up to 48,000 doctors within the next dozen years. China and other countries with aging populations can expect drastic shortfalls, as well. Just last month, I asked a respected colleague retiring from primary care who he would recommend as a replacement; he told me bluntly that, other than expensive concierge care practices, he could not think of anyone, even for himself. This mismatch between need and supply will only grow, and the US is far from alone among developed countries in facing it.”      
    This is The AI Revolution in Medicine, Revisited. I’m your host, Peter Lee.   
    Shortly after OpenAI’s GPT-4 was publicly released, Carey Goldberg, Dr. Zak Kohane, and I published The AI Revolution in Medicine to help educate the world of healthcare and medical research about the transformative impact this new generative AI technology could have. But because we wrote the book when GPT-4 was still a secret, we had to speculate. Now, two years later, what did we get right, and what did we get wrong?    
    In this series, we’ll talk to clinicians, patients, hospital administrators, and others to understand the reality of AI in the field and where we go from here.     The book passage I read at the top is from “Chapter 4: Trust but Verify,” which was written by Zak.
    You know, it’s no secret that in the US and elsewhere shortages in medical staff and the rise of clinician burnout are affecting the quality of patient care for the worse. In our book, we predicted that generative AI would be something that might help address these issues.
    So in this episode, we’ll delve into how individual performance gains that our previous guests have described might affect the healthcare workforce as a whole, and on the patient side, we’ll look into the influence of generative AI on the consumerization of healthcare. Now, since all of this consumes such a huge fraction of the overall economy, we’ll also get into what a general-purpose technology as disruptive as generative AI might mean in the context of labor markets and beyond.  
    To help us do that, I’m pleased to welcome Ethan Mollick and Azeem Azhar.
    Ethan Mollick is the Ralph J. Roberts Distinguished Faculty Scholar, a Rowan Fellow, and an associate professor at the Wharton School of the University of Pennsylvania. His research into the effects of AI on work, entrepreneurship, and education is applied by organizations around the world, leading him to be named one of Time magazine’s most influential people in AI for 2024. He’s also the author of the New York Times best-selling book Co-Intelligence.
    Azeem Azhar is an author, founder, investor, and one of the most thoughtful and influential voices on the interplay between disruptive emerging technologies and business and society. In his best-selling book, The Exponential Age, and in his highly regarded newsletter and podcast, Exponential View, he explores how technologies like AI are reshaping everything from healthcare to geopolitics.
    Ethan and Azeem are two leading thinkers on the ways that disruptive technologies—and especially AI—affect our work, our jobs, our business enterprises, and whole industries. As economists, they are trying to work out whether we are in the midst of an economic revolution as profound as the shift from an agrarian to an industrial society.Here is my interview with Ethan Mollick:
    LEE: Ethan, welcome.
    ETHAN MOLLICK: So happy to be here, thank you.
    LEE: I described you as a professor at Wharton, which I think most of the people who listen to this podcast series know of as an elite business school. So it might surprise some people that you study AI. And beyond that, you know, that I would seek you out to talk about AI in medicine.So to get started, how and why did it happen that you’ve become one of the leading experts on AI?
    MOLLICK: It’s actually an interesting story. I’ve been AI-adjacent my whole career. When I wasmy PhD at MIT, I worked with Marvin Minskyand the MITMedia Labs AI group. But I was never the technical AI guy. I was the person who was trying to explain AI to everybody else who didn’t understand it.
    And then I became very interested in, how do you train and teach? And AI was always a part of that. I was building games for teaching, teaching tools that were used in hospitals and elsewhere, simulations. So when LLMs burst into the scene, I had already been using them and had a good sense of what they could do. And between that and, kind of, being practically oriented and getting some of the first research projects underway, especially under education and AI and performance, I became sort of a go-to person in the field.
    And once you’re in a field where nobody knows what’s going on and we’re all making it up as we go along—I thought it’s funny that you led with the idea that you have a couple of months head start for GPT-4, right. Like that’s all we have at this point, is a few months’ head start.So being a few months ahead is good enough to be an expert at this point. Whether it should be or not is a different question.
    LEE: Well, if I understand correctly, leading AI companies like OpenAI, Anthropic, and others have now sought you out as someone who should get early access to really start to do early assessments and gauge early reactions. How has that been?
    MOLLICK: So, I mean, I think the bigger picture is less about me than about two things that tells us about the state of AI right now.
    One, nobody really knows what’s going on, right. So in a lot of ways, if it wasn’t for your work, Peter, like, I don’t think people would be thinking about medicine as much because these systems weren’t built for medicine. They weren’t built to change education. They weren’t built to write memos. They, like, they weren’t built to do any of these things. They weren’t really built to do anything in particular. It turns out they’re just good at many things.
    And to the extent that the labs work on them, they care about their coding ability above everything else and maybe math and science secondarily. They don’t think about the fact that it expresses high empathy. They don’t think about its accuracy and diagnosis or where it’s inaccurate. They don’t think about how it’s changing education forever.
    So one part of this is the fact that they go to my Twitter feed or ask me for advice is an indicator of where they are, too, which is they’re not thinking about this. And the fact that a few months’ head start continues to give you a lead tells you that we are at the very cutting edge. These labs aren’t sitting on projects for two years and then releasing them. Months after a project is complete or sooner, it’s out the door. Like, there’s very little delay. So we’re kind of all in the same boat here, which is a very unusual space for a new technology.
    LEE: And I, you know, explained that you’re at Wharton. Are you an odd fit as a faculty member at Wharton, or is this a trend now even in business schools that AI experts are becoming key members of the faculty?
    MOLLICK: I mean, it’s a little of both, right. It’s faculty, so everybody does everything. I’m a professor of innovation-entrepreneurship. I’ve launched startups before and working on that and education means I think about, how do organizations redesign themselves? How do they take advantage of these kinds of problems? So medicine’s always been very central to that, right. A lot of people in my MBA class have been MDs either switching, you know, careers or else looking to advance from being sort of individual contributors to running teams. So I don’t think that’s that bad a fit. But I also think this is general-purpose technology; it’s going to touch everything. The focus on this is medicine, but Microsoft does far more than medicine, right. It’s … there’s transformation happening in literally every field, in every country. This is a widespread effect.
    So I don’t think we should be surprised that business schools matter on this because we care about management. There’s a long tradition of management and medicine going together. There’s actually a great academic paper that shows that teaching hospitals that also have MBA programs associated with them have higher management scores and perform better. So I think that these are not as foreign concepts, especially as medicine continues to get more complicated.
    LEE: Yeah. Well, in fact, I want to dive a little deeper on these issues of management, of entrepreneurship, um, education. But before doing that, if I could just stay focused on you. There is always something interesting to hear from people about their first encounters with AI. And throughout this entire series, I’ve been doing that both pre-generative AI and post-generative AI. So you, sort of, hinted at the pre-generative AI. You were in Minsky’s lab. Can you say a little bit more about that early encounter? And then tell us about your first encounters with generative AI.
    MOLLICK: Yeah. Those are great questions. So first of all, when I was at the media lab, that was pre-the current boom in sort of, you know, even in the old-school machine learning kind of space. So there was a lot of potential directions to head in. While I was there, there were projects underway, for example, to record every interaction small children had. One of the professors was recording everything their baby interacted with in the hope that maybe that would give them a hint about how to build an AI system.
    There was a bunch of projects underway that were about labeling every concept and how they relate to other concepts. So, like, it was very much Wild West of, like, how do we make an AI work—which has been this repeated problem in AI, which is, what is this thing?
    The fact that it was just like brute force over the corpus of all human knowledge turns out to be a little bit of like a, you know, it’s a miracle and a little bit of a disappointment in some wayscompared to how elaborate some of this was. So, you know, I think that, that was sort of my first encounters in sort of the intellectual way.
    The generative AI encounters actually started with the original, sort of, GPT-3, or, you know, earlier versions. And it was actually game-based. So I played games like AI Dungeon. And as an educator, I realized, oh my gosh, this stuff could write essays at a fourth-grade level. That’s really going to change the way, like, middle school works, was my thinking at the time. And I was posting about that back in, you know, 2021 that this is a big deal. But I think everybody was taken surprise, including the AI companies themselves, by, you know, ChatGPT, by GPT-3.5. The difference in degree turned out to be a difference in kind.
    LEE: Yeah, you know, if I think back, even with GPT-3, and certainly this was the case with GPT-2, it was, at least, you know, from where I was sitting, it was hard to get people to really take this seriously and pay attention.
    MOLLICK: Yes.
    LEE: You know, it’s remarkable. Within Microsoft, I think a turning point was the use of GPT-3 to do code completions. And that was actually productized as GitHub Copilot, the very first version. That, I think, is where there was widespread belief. But, you know, in a way, I think there is, even for me early on, a sense of denial and skepticism. Did you have those initially at any point?
    MOLLICK: Yeah, I mean, it still happens today, right. Like, this is a weird technology. You know, the original denial and skepticism was, I couldn’t see where this was going. It didn’t seem like a miracle because, you know, of course computers can complete code for you. Like, what else are they supposed to do? Of course, computers can give you answers to questions and write fun things. So there’s difference of moving into a world of generative AI. I think a lot of people just thought that’s what computers could do. So it made the conversations a little weird. But even today, faced with these, you know, with very strong reasoner models that operate at the level of PhD students, I think a lot of people have issues with it, right.
    I mean, first of all, they seem intuitive to use, but they’re not always intuitive to use because the first use case that everyone puts AI to, it fails at because they use it like Google or some other use case. And then it’s genuinely upsetting in a lot of ways. I think, you know, I write in my book about the idea of three sleepless nights. That hasn’t changed. Like, you have to have an intellectual crisis to some extent, you know, and I think people do a lot to avoid having that existential angst of like, “Oh my god, what does it mean that a machine could think—apparently think—like a person?”
    So, I mean, I see resistance now. I saw resistance then. And then on top of all of that, there’s the fact that the curve of the technology is quite great. I mean, the price of GPT-4 level intelligence from, you know, when it was released has dropped 99.97% at this point, right.
    LEE: Yes. Mm-hmm.
    MOLLICK: I mean, I could run a GPT-4 class system basically on my phone. Microsoft’s releasing things that can almost run on like, you know, like it fits in almost no space, that are almost as good as the original GPT-4 models. I mean, I don’t think people have a sense of how fast the trajectory is moving either.
    LEE: Yeah, you know, there’s something that I think about often. There is this existential dread, or will this technology replace me? But I think the first people to feel that are researchers—people encountering this for the first time. You know, if you were working, let’s say, in Bayesian reasoning or in traditional, let’s say, Gaussian mixture model based, you know, speech recognition, you do get this feeling, Oh, my god, this technology has just solved the problem that I’ve dedicated my life to. And there is this really difficult period where you have to cope with that. And I think this is going to be spreading, you know, in more and more walks of life. And so this … at what point does that sort of sense of dread hit you, if ever?
    MOLLICK: I mean, you know, it’s not even dread as much as like, you know, Tyler Cowen wrote that it’s impossible to not feel a little bit of sadness as you use these AI systems, too. Because, like, I was talking to a friend, just as the most minor example, and his talent that he was very proud of was he was very good at writing limericks for birthday cards. He’d write these limericks. Everyone was always amused by them.And now, you know, GPT-4 and GPT-4.5, they made limericks obsolete. Like, anyone can write a good limerick, right. So this was a talent, and it was a little sad. Like, this thing that you cared about mattered.
    You know, as academics, we’re a little used to dead ends, right, and like, you know, some getting the lap. But the idea that entire fields are hitting that way. Like in medicine, there’s a lot of support systems that are now obsolete. And the question is how quickly you change that. In education, a lot of our techniques are obsolete.
    What do you do to change that? You know, it’s like the fact that this brute force technology is good enough to solve so many problems is weird, right. And it’s not just the end of, you know, of our research angles that matter, too. Like, for example, I ran this, you know, 14-person-plus, multimillion-dollar effort at Wharton to build these teaching simulations, and we’re very proud of them. It took years of work to build one.
    Now we’ve built a system that can build teaching simulations on demand by you talking to it with one team member. And, you know, you literally can create any simulation by having a discussion with the AI. I mean, you know, there’s a switch to a new form of excitement, but there is a little bit of like, this mattered to me, and, you know, now I have to change how I do things. I mean, adjustment happens. But if you haven’t had that displacement, I think that’s a good indicator that you haven’t really faced AI yet.
    LEE: Yeah, what’s so interesting just listening to you is you use words like sadness, and yet I can see the—and hear the—excitement in your voice and your body language. So, you know, that’s also kind of an interesting aspect of all of this. 
    MOLLICK: Yeah, I mean, I think there’s something on the other side, right. But, like, I can’t say that I haven’t had moments where like, ughhhh, but then there’s joy and basically like also, you know, freeing stuff up. I mean, I think about doctors or professors, right. These are jobs that bundle together lots of different tasks that you would never have put together, right. If you’re a doctor, you would never have expected the same person to be good at keeping up with the research and being a good diagnostician and being a good manager and being good with people and being good with hand skills.
    Like, who would ever want that kind of bundle? That’s not something you’re all good at, right. And a lot of our stress of our job comes from the fact that we suck at some of it. And so to the extent that AI steps in for that, you kind of feel bad about some of the stuff that it’s doing that you wanted to do. But it’s much more uplifting to be like, I don’t have to do this stuff I’m bad anymore, or I get the support to make myself good at it. And the stuff that I really care about, I can focus on more. Well, because we are at kind of a unique moment where whatever you’re best at, you’re still better than AI. And I think it’s an ongoing question about how long that lasts. But for right now, like you’re not going to say, OK, AI replaces me entirely in my job in medicine. It’s very unlikely.
    But you will say it replaces these 17 things I’m bad at, but I never liked that anyway. So it’s a period of both excitement and a little anxiety.
    LEE: Yeah, I’m going to want to get back to this question about in what ways AI may or may not replace doctors or some of what doctors and nurses and other clinicians do. But before that, let’s get into, I think, the real meat of this conversation. In previous episodes of this podcast, we talked to clinicians and healthcare administrators and technology developers that are very rapidly injecting AI today to do various forms of workforce automation, you know, automatically writing a clinical encounter note, automatically filling out a referral letter or request for prior authorization for some reimbursement to an insurance company.
    And so these sorts of things are intended not only to make things more efficient and lower costs but also to reduce various forms of drudgery, cognitive burden on frontline health workers. So how do you think about the impact of AI on that aspect of workforce, and, you know, what would you expect will happen over the next few years in terms of impact on efficiency and costs?
    MOLLICK: So I mean, this is a case where I think we’re facing the big bright problem in AI in a lot of ways, which is that this is … at the individual level, there’s lots of performance gains to be gained, right. The problem, though, is that we as individuals fit into systems, in medicine as much as anywhere else or more so, right. Which is that you could individually boost your performance, but it’s also about systems that fit along with this, right.
    So, you know, if you could automatically, you know, record an encounter, if you could automatically make notes, does that change what you should be expecting for notes or the value of those notes or what they’re for? How do we take what one person does and validate it across the organization and roll it out for everybody without making it a 10-year process that it feels like IT in medicine often is? Like, so we’re in this really interesting period where there’s incredible amounts of individual innovation in productivity and performance improvements in this field, like very high levels of it, but not necessarily seeing that same thing translate to organizational efficiency or gains.
    And one of my big concerns is seeing that happen. We’re seeing that in nonmedical problems, the same kind of thing, which is, you know, we’ve got research showing 20 and 40% performance improvements, like not uncommon to see those things. But then the organization doesn’t capture it; the system doesn’t capture it. Because the individuals are doing their own work and the systems don’t have the ability to, kind of, learn or adapt as a result.
    LEE: You know, where are those productivity gains going, then, when you get to the organizational level?
    MOLLICK: Well, they’re dying for a few reasons. One is, there’s a tendency for individual contributors to underestimate the power of management, right.
    Practices associated with good management increase happiness, decrease, you know, issues, increase success rates. In the same way, about 40%, as far as we can tell, of the US advantage over other companies, of US firms, has to do with management ability. Like, management is a big deal. Organizing is a big deal. Thinking about how you coordinate is a big deal.
    At the individual level, when things get stuck there, right, you can’t start bringing them up to how systems work together. It becomes, How do I deal with a doctor that has a 60% performance improvement? We really only have one thing in our playbook for doing that right now, which is, OK, we could fire 40% of the other doctors and still have a performance gain, which is not the answer you want to see happen.
    So because of that, people are hiding their use. They’re actually hiding their use for lots of reasons.
    And it’s a weird case because the people who are able to figure out best how to use these systems, for a lot of use cases, they’re actually clinicians themselves because they’re experimenting all the time. Like, they have to take those encounter notes. And if they figure out a better way to do it, they figure that out. You don’t want to wait for, you know, a med tech company to figure that out and then sell that back to you when it can be done by the physicians themselves.
    So we’re just not used to a period where everybody’s innovating and where the management structure isn’t in place to take advantage of that. And so we’re seeing things stalled at the individual level, and people are often, especially in risk-averse organizations or organizations where there’s lots of regulatory hurdles, people are so afraid of the regulatory piece that they don’t even bother trying to make change.
    LEE: If you are, you know, the leader of a hospital or a clinic or a whole health system, how should you approach this? You know, how should you be trying to extract positive success out of AI?
    MOLLICK: So I think that you need to embrace the right kind of risk, right. We don’t want to put risk on our patients … like, we don’t want to put uninformed risk. But innovation involves risk to how organizations operate. They involve change. So I think part of this is embracing the idea that R&D has to happen in organizations again.
    What’s happened over the last 20 years or so has been organizations giving that up. Partially, that’s a trend to focus on what you’re good at and not try and do this other stuff. Partially, it’s because it’s outsourced now to software companies that, like, Salesforce tells you how to organize your sales team. Workforce tells you how to organize your organization. Consultants come in and will tell you how to make change based on the average of what other people are doing in your field.
    So companies and organizations and hospital systems have all started to give up their ability to create their own organizational change. And when I talk to organizations, I often say they have to have two approaches. They have to think about the crowd and the lab.
    So the crowd is the idea of how to empower clinicians and administrators and supporter networks to start using AI and experimenting in ethical, legal ways and then sharing that information with each other. And the lab is, how are we doing R&D about the approach of how toAI to work, not just in direct patient care, right. But also fundamentally, like, what paperwork can you cut out? How can we better explain procedures? Like, what management role can this fill?
    And we need to be doing active experimentation on that. We can’t just wait for, you know, Microsoft to solve the problems. It has to be at the level of the organizations themselves.
    LEE: So let’s shift a little bit to the patient. You know, one of the things that we see, and I think everyone is seeing, is that people are turning to chatbots, like ChatGPT, actually to seek healthcare information for, you know, their own health or the health of their loved ones.
    And there was already, prior to all of this, a trend towards, let’s call it, consumerization of healthcare. So just in the business of healthcare delivery, do you think AI is going to hasten these kinds of trends, or from the consumer’s perspective, what … ?
    MOLLICK: I mean, absolutely, right. Like, all the early data that we have suggests that for most common medical problems, you should just consult AI, too, right. In fact, there is a real question to ask: at what point does it become unethical for doctors themselves to not ask for a second opinion from the AI because it’s cheap, right? You could overrule it or whatever you want, but like not asking seems foolish.
    I think the two places where there’s a burning almost, you know, moral imperative is … let’s say, you know, I’m in Philadelphia, I’m a professor, I have access to really good healthcare through the Hospital University of Pennsylvania system. I know doctors. You know, I’m lucky. I’m well connected. If, you know, something goes wrong, I have friends who I can talk to. I have specialists. I’m, you know, pretty well educated in this space.
    But for most people on the planet, they don’t have access to good medical care, they don’t have good health. It feels like it’s absolutely imperative to say when should you use AI and when not. Are there blind spots? What are those things?
    And I worry that, like, to me, that would be the crash project I’d be invoking because I’m doing the same thing in education, which is this system is not as good as being in a room with a great teacher who also uses AI to help you, but it’s better than not getting an, you know, to the level of education people get in many cases. Where should we be using it? How do we guide usage in the right way? Because the AI labs aren’t thinking about this. We have to.
    So, to me, there is a burning need here to understand this. And I worry that people will say, you know, everything that’s true—AI can hallucinate, AI can be biased. All of these things are absolutely true, but people are going to use it. The early indications are that it is quite useful. And unless we take the active role of saying, here’s when to use it, here’s when not to use it, we don’t have a right to say, don’t use this system. And I think, you know, we have to be exploring that.
    LEE: What do people need to understand about AI? And what should schools, universities, and so on be teaching?
    MOLLICK: Those are, kind of, two separate questions in lot of ways. I think a lot of people want to teach AI skills, and I will tell you, as somebody who works in this space a lot, there isn’t like an easy, sort of, AI skill, right. I could teach you prompt engineering in two to three classes, but every indication we have is that for most people under most circumstances, the value of prompting, you know, any one case is probably not that useful.
    A lot of the tricks are disappearing because the AI systems are just starting to use them themselves. So asking good questions, being a good manager, being a good thinker tend to be important, but like magic tricks around making, you know, the AI do something because you use the right phrase used to be something that was real but is rapidly disappearing.
    So I worry when people say teach AI skills. No one’s been able to articulate to me as somebody who knows AI very well and teaches classes on AI, what those AI skills that everyone should learn are, right.
    I mean, there’s value in learning a little bit how the models work. There’s a value in working with these systems. A lot of it’s just hands on keyboard kind of work. But, like, we don’t have an easy slam dunk “this is what you learn in the world of AI” because the systems are getting better, and as they get better, they get less sensitive to these prompting techniques. They get better prompting themselves. They solve problems spontaneously and start being agentic. So it’s a hard problem to ask about, like, what do you train someone on? I think getting people experience in hands-on-keyboards, getting them to … there’s like four things I could teach you about AI, and two of them are already starting to disappear.
    But, like, one is be direct. Like, tell the AI exactly what you want. That’s very helpful. Second, provide as much context as possible. That can include things like acting as a doctor, but also all the information you have. The third is give it step-by-step directions—that’s becoming less important. And the fourth is good and bad examples of the kind of output you want. Those four, that’s like, that’s it as far as the research telling you what to do, and the rest is building intuition.
    LEE: I’m really impressed that you didn’t give the answer, “Well, everyone should be teaching my book, Co-Intelligence.”MOLLICK: Oh, no, sorry! Everybody should be teaching my book Co-Intelligence. I apologize.LEE: It’s good to chuckle about that, but actually, I can’t think of a better book, like, if you were to assign a textbook in any professional education space, I think Co-Intelligence would be number one on my list. Are there other things that you think are essential reading?
    MOLLICK: That’s a really good question. I think that a lot of things are evolving very quickly. I happen to, kind of, hit a sweet spot with Co-Intelligence to some degree because I talk about how I used it, and I was, sort of, an advanced user of these systems.
    So, like, it’s, sort of, like my Twitter feed, my online newsletter. I’m just trying to, kind of, in some ways, it’s about trying to make people aware of what these systems can do by just showing a lot, right. Rather than picking one thing, and, like, this is a general-purpose technology. Let’s use it for this. And, like, everybody gets a light bulb for a different reason. So more than reading, it is using, you know, and that can be Copilot or whatever your favorite tool is.
    But using it. Voice modes help a lot. In terms of readings, I mean, I think that there is a couple of good guides to understanding AI that were originally blog posts. I think Tim Lee has one called Understanding AI, and it had a good overview …
    LEE: Yeah, that’s a great one.
    MOLLICK: … of that topic that I think explains how transformers work, which can give you some mental sense. I thinkKarpathyhas some really nice videos of use that I would recommend.
    Like on the medical side, I think the book that you did, if you’re in medicine, you should read that. I think that that’s very valuable. But like all we can offer are hints in some ways. Like there isn’t … if you’re looking for the instruction manual, I think it can be very frustrating because it’s like you want the best practices and procedures laid out, and we cannot do that, right. That’s not how a system like this works.
    LEE: Yeah.
    MOLLICK: It’s not a person, but thinking about it like a person can be helpful, right.
    LEE: One of the things that has been sort of a fun project for me for the last few years is I have been a founding board member of a new medical school at Kaiser Permanente. And, you know, that medical school curriculum is being formed in this era. But it’s been perplexing to understand, you know, what this means for a medical school curriculum. And maybe even more perplexing for me, at least, is the accrediting bodies, which are extremely important in US medical schools; how accreditors should think about what’s necessary here.
    Besides the things that you’ve … the, kind of, four key ideas you mentioned, if you were talking to the board of directors of the LCMEaccrediting body, what’s the one thing you would want them to really internalize?
    MOLLICK: This is both a fast-moving and vital area. This can’t be viewed like a usual change, which, “Let’s see how this works.” Because it’s, like, the things that make medical technologies hard to do, which is like unclear results, limited, you know, expensive use cases where it rolls out slowly. So one or two, you know, advanced medical facilities get access to, you know, proton beams or something else at multi-billion dollars of cost, and that takes a while to diffuse out. That’s not happening here. This is all happening at the same time, all at once. This is now … AI is part of medicine.
    I mean, there’s a minor point that I’d make that actually is a really important one, which is large language models, generative AI overall, work incredibly differently than other forms of AI. So the other worry I have with some of these accreditors is they blend together algorithmic forms of AI, which medicine has been trying for long time—decision support, algorithmic methods, like, medicine more so than other places has been thinking about those issues. Generative AI, even though it uses the same underlying techniques, is a completely different beast.
    So, like, even just take the most simple thing of algorithmic aversion, which is a well-understood problem in medicine, right. Which is, so you have a tool that could tell you as a radiologist, you know, the chance of this being cancer; you don’t like it, you overrule it, right.
    We don’t find algorithmic aversion happening with LLMs in the same way. People actually enjoy using them because it’s more like working with a person. The flaws are different. The approach is different. So you need to both view this as universal applicable today, which makes it urgent, but also as something that is not the same as your other form of AI, and your AI working group that is thinking about how to solve this problem is not the right people here.
    LEE: You know, I think the world has been trained because of the magic of web search to view computers as question-answering machines. Ask a question, get an answer.
    MOLLICK: Yes. Yes.
    LEE: Write a query, get results. And as I have interacted with medical professionals, you can see that medical professionals have that model of a machine in mind. And I think that’s partly, I think psychologically, why hallucination is so alarming. Because you have a mental model of a computer as a machine that has absolutely rock-solid perfect memory recall.
    But the thing that was so powerful in Co-Intelligence, and we tried to get at this in our book also, is that’s not the sweet spot. It’s this sort of deeper interaction, more of a collaboration. And I thought your use of the term Co-Intelligence really just even in the title of the book tried to capture this. When I think about education, it seems like that’s the first step, to get past this concept of a machine being just a question-answering machine. Do you have a reaction to that idea?
    MOLLICK: I think that’s very powerful. You know, we’ve been trained over so many years at both using computers but also in science fiction, right. Computers are about cold logic, right. They will give you the right answer, but if you ask it what love is, they explode, right. Like that’s the classic way you defeat the evil robot in Star Trek, right. “Love does not compute.”Instead, we have a system that makes mistakes, is warm, beats doctors in empathy in almost every controlled study on the subject, right. Like, absolutely can outwrite you in a sonnet but will absolutely struggle with giving you the right answer every time. And I think our mental models are just broken for this. And I think you’re absolutely right. And that’s part of what I thought your book does get at really well is, like, this is a different thing. It’s also generally applicable. Again, the model in your head should be kind of like a person even though it isn’t, right.
    There’s a lot of warnings and caveats to it, but if you start from person, smart person you’re talking to, your mental model will be more accurate than smart machine, even though both are flawed examples, right. So it will make mistakes; it will make errors. The question is, what do you trust it on? What do you not trust it? As you get to know a model, you’ll get to understand, like, I totally don’t trust it for this, but I absolutely trust it for that, right.
    LEE: All right. So we’re getting to the end of the time we have together. And so I’d just like to get now into something a little bit more provocative. And I get the question all the time. You know, will AI replace doctors? In medicine and other advanced knowledge work, project out five to 10 years. What do think happens?
    MOLLICK: OK, so first of all, let’s acknowledge systems change much more slowly than individual use. You know, doctors are not individual actors; they’re part of systems, right. So not just the system of a patient who like may or may not want to talk to a machine instead of a person but also legal systems and administrative systems and systems that allocate labor and systems that train people.
    So, like, it’s hard to imagine that in five to 10 years medicine being so upended that even if AI was better than doctors at every single thing doctors do, that we’d actually see as radical a change in medicine as you might in other fields. I think you will see faster changes happen in consulting and law and, you know, coding, other spaces than medicine.
    But I do think that there is good reason to suspect that AI will outperform people while still having flaws, right. That’s the difference. We’re already seeing that for common medical questions in enough randomized controlled trials that, you know, best doctors beat AI, but the AI beats the mean doctor, right. Like, that’s just something we should acknowledge is happening at this point.
    Now, will that work in your specialty? No. Will that work with all the contingent social knowledge that you have in your space? Probably not.
    Like, these are vignettes, right. But, like, that’s kind of where things are. So let’s assume, right … you’re asking two questions. One is, how good will AI get?
    LEE: Yeah.
    MOLLICK: And we don’t know the answer to that question. I will tell you that your colleagues at Microsoft and increasingly the labs, the AI labs themselves, are all saying they think they’ll have a machine smarter than a human at every intellectual task in the next two to three years. If that doesn’t happen, that makes it easier to assume the future, but let’s just assume that that’s the case. I think medicine starts to change with the idea that people feel obligated to use this to help for everything.
    Your patients will be using it, and it will be your advisor and helper at the beginning phases, right. And I think that I expect people to be better at empathy. I expect better bedside manner. I expect management tasks to become easier. I think administrative burden might lighten if we handle this right way or much worse if we handle it badly. Diagnostic accuracy will increase, right.
    And then there’s a set of discovery pieces happening, too, right. One of the core goals of all the AI companies is to accelerate medical research. How does that happen and how does that affect us is a, kind of, unknown question. So I think clinicians are in both the eye of the storm and surrounded by it, right. Like, they can resist AI use for longer than most other fields, but everything around them is going to be affected by it.
    LEE: Well, Ethan, this has been really a fantastic conversation. And, you know, I think in contrast to all the other conversations we’ve had, this one gives especially the leaders in healthcare, you know, people actually trying to lead their organizations into the future, whether it’s in education or in delivery, a lot to think about. So I really appreciate you joining.
    MOLLICK: Thank you.  
    I’m a computing researcher who works with people who are right in the middle of today’s bleeding-edge developments in AI. And because of that, I often lose sight of how to talk to a broader audience about what it’s all about. And so I think one of Ethan’s superpowers is that he has this knack for explaining complex topics in AI in a really accessible way, getting right to the most important points without making it so simple as to be useless. That’s why I rarely miss an opportunity to read up on his latest work.
    One of the first things I learned from Ethan is the intuition that you can, sort of, think of AI as a very knowledgeable intern. In other words, think of it as a persona that you can interact with, but you also need to be a manager for it and to always assess the work that it does.
    In our discussion, Ethan went further to stress that there is, because of that, a serious education gap. You know, over the last decade or two, we’ve all been trained, mainly by search engines, to think of computers as question-answering machines. In medicine, in fact, there’s a question-answering application that is really popular called UpToDate. Doctors use it all the time. But generative AI systems like ChatGPT are different. There’s therefore a challenge in how to break out of the old-fashioned mindset of search to get the full value out of generative AI.
    The other big takeaway for me was that Ethan pointed out while it’s easy to see productivity gains from AI at the individual level, those same gains, at least today, don’t often translate automatically to organization-wide or system-wide gains. And one, of course, has to conclude that it takes more than just making individuals more productive; the whole system also has to adjust to the realities of AI.
    Here’s now my interview with Azeem Azhar:
    LEE: Azeem, welcome.
    AZEEM AZHAR: Peter, thank you so much for having me. 
    LEE: You know, I think you’re extremely well known in the world. But still, some of the listeners of this podcast series might not have encountered you before.
    And so one of the ways I like to ask people to introduce themselves is, how do you explain to your parents what you do every day?
    AZHAR: Well, I’m very lucky in that way because my mother was the person who got me into computers more than 40 years ago. And I still have that first computer, a ZX81 with a Z80 chip …
    LEE: Oh wow.
    AZHAR: … to this day. It sits in my study, all seven and a half thousand transistors and Bakelite plastic that it is. And my parents were both economists, and economics is deeply connected with technology in some sense. And I grew up in the late ’70s and the early ’80s. And that was a time of tremendous optimism around technology. It was space opera, science fiction, robots, and of course, the personal computer and, you know, Bill Gates and Steve Jobs. So that’s where I started.
    And so, in a way, my mother and my dad, who passed away a few years ago, had always known me as someone who was fiddling with computers but also thinking about economics and society. And so, in a way, it’s easier to explain to them because they’re the ones who nurtured the environment that allowed me to research technology and AI and think about what it means to firms and to the economy at large.
    LEE: I always like to understand the origin story. And what I mean by that is, you know, what was your first encounter with generative AI? And what was that like? What did you go through?
    AZHAR: The first real moment was when Midjourney and Stable Diffusion emerged in that summer of 2022. I’d been away on vacation, and I came back—and I’d been off grid, in fact—and the world had really changed.
    Now, I’d been aware of GPT-3 and GPT-2, which I played around with and with BERT, the original transformer paper about seven or eight years ago, but it was the moment where I could talk to my computer, and it could produce these images, and it could be refined in natural language that really made me think we’ve crossed into a new domain. We’ve gone from AI being highly discriminative to AI that’s able to explore the world in particular ways. And then it was a few months later that ChatGPT came out—November, the 30th.
    And I think it was the next day or the day after that I said to my team, everyone has to use this, and we have to meet every morning and discuss how we experimented the day before. And we did that for three or four months. And, you know, it was really clear to me in that interface at that point that, you know, we’d absolutely pass some kind of threshold.
    LEE: And who’s the we that you were experimenting with?
    AZHAR: So I have a team of four who support me. They’re mostly researchers of different types. I mean, it’s almost like one of those jokes. You know, I have a sociologist, an economist, and an astrophysicist. And, you know, they walk into the bar,or they walk into our virtual team room, and we try to solve problems.
    LEE: Well, so let’s get now into brass tacks here. And I think I want to start maybe just with an exploration of the economics of all this and economic realities. Because I think in a lot of your work—for example, in your book—you look pretty deeply at how automation generally and AI specifically are transforming certain sectors like finance, manufacturing, and you have a really, kind of, insightful focus on what this means for productivity and which ways, you know, efficiencies are found.  
    And then you, sort of, balance that with risks, things that can and do go wrong. And so as you take that background and looking at all those other sectors, in what ways are the same patterns playing out or likely to play out in healthcare and medicine?
    AZHAR: I’m sure we will see really remarkable parallels but also new things going on. I mean, medicine has a particular quality compared to other sectors in the sense that it’s highly regulated, market structure is very different country to country, and it’s an incredibly broad field. I mean, just think about taking a Tylenol and going through laparoscopic surgery. Having an MRI and seeing a physio. I mean, this is all medicine. I mean, it’s hard to imagine a sector that ismore broad than that.
    So I think we can start to break it down, and, you know, where we’re seeing things with generative AI will be that the, sort of, softest entry point, which is the medical scribing. And I’m sure many of us have been with clinicians who have a medical scribe running alongside—they’re all on Surface Pros I noticed, right?They’re on the tablet computers, and they’re scribing away.
    And what that’s doing is, in the words of my friend Eric Topol, it’s giving the clinician time back, right. They have time back from days that are extremely busy and, you know, full of administrative overload. So I think you can obviously do a great deal with reducing that overload.
    And within my team, we have a view, which is if you do something five times in a week, you should be writing an automation for it. And if you’re a doctor, you’re probably reviewing your notes, writing the prescriptions, and so on several times a day. So those are things that can clearly be automated, and the human can be in the loop. But I think there are so many other ways just within the clinic that things can help.
    So, one of my friends, my friend from my junior school—I’ve known him since I was 9—is an oncologist who’s also deeply into machine learning, and he’s in Cambridge in the UK. And he built with Microsoft Research a suite of imaging AI tools from his own discipline, which they then open sourced.
    So that’s another way that you have an impact, which is that you actually enable the, you know, generalist, specialist, polymath, whatever they are in health systems to be able to get this technology, to tune it to their requirements, to use it, to encourage some grassroots adoption in a system that’s often been very, very heavily centralized.
    LEE: Yeah.
    AZHAR: And then I think there are some other things that are going on that I find really, really exciting. So one is the consumerization of healthcare. So I have one of those sleep tracking rings, the Oura.
    LEE: Yup.
    AZHAR: That is building a data stream that we’ll be able to apply more and more AI to. I mean, right now, it’s applying traditional, I suspect, machine learning, but you can imagine that as we start to get more data, we start to get more used to measuring ourselves, we create this sort of pot, a personal asset that we can turn AI to.
    And there’s still another category. And that other category is one of the completely novel ways in which we can enable patient care and patient pathway. And there’s a fantastic startup in the UK called Neko Health, which, I mean, does physicals, MRI scans, and blood tests, and so on.
    It’s hard to imagine Neko existing without the sort of advanced data, machine learning, AI that we’ve seen emerge over the last decade. So, I mean, I think that there are so many ways in which the temperature is slowly being turned up to encourage a phase change within the healthcare sector.
    And last but not least, I do think that these tools can also be very, very supportive of a clinician’s life cycle. I think we, as patients, we’re a bit …  I don’t know if we’re as grateful as we should be for our clinicians who are putting in 90-hour weeks.But you can imagine a world where AI is able to support not just the clinicians’ workload but also their sense of stress, their sense of burnout.
    So just in those five areas, Peter, I sort of imagine we could start to fundamentally transform over the course of many years, of course, the way in which people think about their health and their interactions with healthcare systems
    LEE: I love how you break that down. And I want to press on a couple of things.
    You also touched on the fact that medicine is, at least in most of the world, is a highly regulated industry. I guess finance is the same way, but they also feel different because the, like, finance sector has to be very responsive to consumers, and consumers are sensitive to, you know, an abundance of choice; they are sensitive to price. Is there something unique about medicine besides being regulated?
    AZHAR: I mean, there absolutely is. And in finance, as well, you have much clearer end states. So if you’re not in the consumer space, but you’re in the, you know, asset management space, you have to essentially deliver returns against the volatility or risk boundary, right. That’s what you have to go out and do. And I think if you’re in the consumer industry, you can come back to very, very clear measures, net promoter score being a very good example.
    In the case of medicine and healthcare, it is much more complicated because as far as the clinician is concerned, people are individuals, and we have our own parts and our own responses. If we didn’t, there would never be a need for a differential diagnosis. There’d never be a need for, you know, Let’s try azithromycin first, and then if that doesn’t work, we’ll go to vancomycin, or, you know, whatever it happens to be. You would just know. But ultimately, you know, people are quite different. The symptoms that they’re showing are quite different, and also their compliance is really, really different.
    I had a back problem that had to be dealt with by, you know, a physio and extremely boring exercises four times a week, but I was ruthless in complying, and my physio was incredibly surprised. He’d say well no one ever does this, and I said, well you know the thing is that I kind of just want to get this thing to go away.
    LEE: Yeah.
    AZHAR: And I think that that’s why medicine is and healthcare is so different and more complex. But I also think that’s why AI can be really, really helpful. I mean, we didn’t talk about, you know, AI in its ability to potentially do this, which is to extend the clinician’s presence throughout the week.
    LEE: Right. Yeah.
    AZHAR: The idea that maybe some part of what the clinician would do if you could talk to them on Wednesday, Thursday, and Friday could be delivered through an app or a chatbot just as a way of encouraging the compliance, which is often, especially with older patients, one reason why conditions, you know, linger on for longer.
    LEE: You know, just staying on the regulatory thing, as I’ve thought about this, the one regulated sector that I think seems to have some parallels to healthcare is energy delivery, energy distribution.
    Because like healthcare, as a consumer, I don’t have choice in who delivers electricity to my house. And even though I care about it being cheap or at least not being overcharged, I don’t have an abundance of choice. I can’t do price comparisons.
    And there’s something about that, just speaking as a consumer of both energy and a consumer of healthcare, that feels similar. Whereas other regulated industries, you know, somehow, as a consumer, I feel like I have a lot more direct influence and power. Does that make any sense to someone, you know, like you, who’s really much more expert in how economic systems work?
    AZHAR: I mean, in a sense, one part of that is very, very true. You have a limited panel of energy providers you can go to, and in the US, there may be places where you have no choice.
    I think the area where it’s slightly different is that as a consumer or a patient, you can actually make meaningful choices and changes yourself using these technologies, and people used to joke about you know asking Dr. Google. But Dr. Google is not terrible, particularly if you go to WebMD. And, you know, when I look at long-range change, many of the regulations that exist around healthcare delivery were formed at a point before people had access to good quality information at the touch of their fingertips or when educational levels in general were much, much lower. And many regulations existed because of the incumbent power of particular professional sectors.
    I’ll give you an example from the United Kingdom. So I have had asthma all of my life. That means I’ve been taking my inhaler, Ventolin, and maybe a steroid inhaler for nearly 50 years. That means that I know … actually, I’ve got more experience, and I—in some sense—know more about it than a general practitioner.
    LEE: Yeah.
    AZHAR: And until a few years ago, I would have to go to a general practitioner to get this drug that I’ve been taking for five decades, and there they are, age 30 or whatever it is. And a few years ago, the regulations changed. And now pharmacies can … or pharmacists can prescribe those types of drugs under certain conditions directly.
    LEE: Right.
    AZHAR: That was not to do with technology. That was to do with incumbent lock-in. So when we look at the medical industry, the healthcare space, there are some parallels with energy, but there are a few little things that the ability that the consumer has to put in some effort to learn about their condition, but also the fact that some of the regulations that exist just exist because certain professions are powerful.
    LEE: Yeah, one last question while we’re still on economics. There seems to be a conundrum about productivity and efficiency in healthcare delivery because I’ve never encountered a doctor or a nurse that wants to be able to handle even more patients than they’re doing on a daily basis.
    And so, you know, if productivity means simply, well, your rounds can now handle 16 patients instead of eight patients, that doesn’t seem necessarily to be a desirable thing. So how can we or should we be thinking about efficiency and productivity since obviously costs are, in most of the developed world, are a huge, huge problem?
    AZHAR: Yes, and when you described doubling the number of patients on the round, I imagined you buying them all roller skates so they could just whizz aroundthe hospital faster and faster than ever before.
    We can learn from what happened with the introduction of electricity. Electricity emerged at the end of the 19th century, around the same time that cars were emerging as a product, and car makers were very small and very artisanal. And in the early 1900s, some really smart car makers figured out that electricity was going to be important. And they bought into this technology by putting pendant lights in their workshops so they could “visit more patients.” Right?
    LEE: Yeah, yeah.
    AZHAR: They could effectively spend more hours working, and that was a productivity enhancement, and it was noticeable. But, of course, electricity fundamentally changed the productivity by orders of magnitude of people who made cars starting with Henry Ford because he was able to reorganize his factories around the electrical delivery of power and to therefore have the moving assembly line, which 10xed the productivity of that system.
    So when we think about how AI will affect the clinician, the nurse, the doctor, it’s much easier for us to imagine it as the pendant light that just has them working later …
    LEE: Right.
    AZHAR: … than it is to imagine a reconceptualization of the relationship between the clinician and the people they care for.
    And I’m not sure. I don’t think anybody knows what that looks like. But, you know, I do think that there will be a way that this changes, and you can see that scale out factor. And it may be, Peter, that what we end up doing is we end up saying, OK, because we have these brilliant AIs, there’s a lower level of training and cost and expense that’s required for a broader range of conditions that need treating. And that expands the market, right. That expands the market hugely. It’s what has happened in the market for taxis or ride sharing. The introduction of Uber and the GPS system …
    LEE: Yup.
    AZHAR: … has meant many more people now earn their living driving people around in their cars. And at least in London, you had to be reasonably highly trained to do that.
    So I can see a reorganization is possible. Of course, entrenched interests, the economic flow … and there are many entrenched interests, particularly in the US between the health systems and the, you know, professional bodies that might slow things down. But I think a reimagining is possible.
    And if I may, I’ll give you one example of that, which is, if you go to countries outside of the US where there are many more sick people per doctor, they have incentives to change the way they deliver their healthcare. And well before there was AI of this quality around, there was a few cases of health systems in India—Aravind Eye Carewas one, and Narayana Hrudayalayawas another. And in the latter, they were a cardiac care unit where you couldn’t get enough heart surgeons.
    LEE: Yeah, yep.
    AZHAR: So specially trained nurses would operate under the supervision of a single surgeon who would supervise many in parallel. So there are ways of increasing the quality of care, reducing the cost, but it does require a systems change. And we can’t expect a single bright algorithm to do it on its own.
    LEE: Yeah, really, really interesting. So now let’s get into regulation. And let me start with this question. You know, there are several startup companies I’m aware of that are pushing on, I think, a near-term future possibility that a medical AI for consumer might be allowed, say, to prescribe a medication for you, something that would normally require a doctor or a pharmacist, you know, that is certified in some way, licensed to do. Do you think we’ll get to a point where for certain regulated activities, humans are more or less cut out of the loop?
    AZHAR: Well, humans would have been in the loop because they would have provided the training data, they would have done the oversight, the quality control. But to your question in general, would we delegate an important decision entirely to a tested set of algorithms? I’m sure we will. We already do that. I delegate less important decisions like, What time should I leave for the airport to Waze. I delegate more important decisions to the automated braking in my car. We will do this at certain levels of risk and threshold.
    If I come back to my example of prescribing Ventolin. It’s really unclear to me that the prescription of Ventolin, this incredibly benign bronchodilator that is only used by people who’ve been through the asthma process, needs to be prescribed by someone who’s gone through 10 years or 12 years of medical training. And why that couldn’t be prescribed by an algorithm or an AI system.
    LEE: Right. Yep. Yep.
    AZHAR: So, you know, I absolutely think that that will be the case and could be the case. I can’t really see what the objections are. And the real issue is where do you draw the line of where you say, “Listen, this is too important,” or “The cost is too great,” or “The side effects are too high,” and therefore this is a point at which we want to have some, you know, human taking personal responsibility, having a liability framework in place, having a sense that there is a person with legal agency who signed off on this decision. And that line I suspect will start fairly low, and what we’d expect to see would be that that would rise progressively over time.
    LEE: What you just said, that scenario of your personal asthma medication, is really interesting because your personal AI might have the benefit of 50 years of your own experience with that medication. So, in a way, there is at least the data potential for, let’s say, the next prescription to be more personalized and more tailored specifically for you.
    AZHAR: Yes. Well, let’s dig into this because I think this is super interesting, and we can look at how things have changed. So 15 years ago, if I had a bad asthma attack, which I might have once a year, I would have needed to go and see my general physician.
    In the UK, it’s very difficult to get an appointment. I would have had to see someone privately who didn’t know me at all because I’ve just walked in off the street, and I would explain my situation. It would take me half a day. Productivity lost. I’ve been miserable for a couple of days with severe wheezing. Then a few years ago the system changed, a protocol changed, and now I have a thing called a rescue pack, which includes prednisolone steroids. It includes something else I’ve just forgotten, and an antibiotic in case I get an upper respiratory tract infection, and I have an “algorithm.” It’s called a protocol. It’s printed out. It’s a flowchart
    I answer various questions, and then I say, “I’m going to prescribe this to myself.” You know, UK doctors don’t prescribe prednisolone, or prednisone as you may call it in the US, at the drop of a hat, right. It’s a powerful steroid. I can self-administer, and I can now get that repeat prescription without seeing a physician a couple of times a year. And the algorithm, the “AI” is, it’s obviously been done in PowerPoint naturally, and it’s a bunch of arrows.Surely, surely, an AI system is going to be more sophisticated, more nuanced, and give me more assurance that I’m making the right decision around something like that.
    LEE: Yeah. Well, at a minimum, the AI should be able to make that PowerPoint the next time.AZHAR: Yeah, yeah. Thank god for Clippy. Yes.
    LEE: So, you know, I think in our book, we had a lot of certainty about most of the things we’ve discussed here, but one chapter where I felt we really sort of ran out of ideas, frankly, was on regulation. And, you know, what we ended up doing for that chapter is … I can’t remember if it was Carey’s or Zak’s idea, but we asked GPT-4 to have a conversation, a debate with itself, about regulation. And we made some minor commentary on that.
    And really, I think we took that approach because we just didn’t have much to offer. By the way, in our defense, I don’t think anyone else had any better ideas anyway.
    AZHAR: Right.
    LEE: And so now two years later, do we have better ideas about the need for regulation, the frameworks around which those regulations should be developed, and, you know, what should this look like?
    AZHAR: So regulation is going to be in some cases very helpful because it provides certainty for the clinician that they’re doing the right thing, that they are still insured for what they’re doing, and it provides some degree of confidence for the patient. And we need to make sure that the claims that are made stand up to quite rigorous levels, where ideally there are RCTs, and there are the classic set of processes you go through.
    You do also want to be able to experiment, and so the question is: as a regulator, how can you enable conditions for there to be experimentation? And what is experimentation? Experimentation is learning so that every element of the system can learn from this experience.
    So finding that space where there can be bit of experimentation, I think, becomes very, very important. And a lot of this is about experience, so I think the first digital therapeutics have received FDA approval, which means there are now people within the FDA who understand how you go about running an approvals process for that, and what that ends up looking like—and of course what we’re very good at doing in this sort of modern hyper-connected world—is we can share that expertise, that knowledge, that experience very, very quickly.
    So you go from one approval a year to a hundred approvals a year to a thousand approvals a year. So we will then actually, I suspect, need to think about what is it to approve digital therapeutics because, unlike big biological molecules, we can generate these digital therapeutics at the rate of knots.
    LEE: Yes.
    AZHAR: Every road in Hayes Valley in San Francisco, right, is churning out new startups who will want to do things like this. So then, I think about, what does it mean to get approved if indeed it gets approved? But we can also go really far with things that don’t require approval.
    I come back to my sleep tracking ring. So I’ve been wearing this for a few years, and when I go and see my doctor or I have my annual checkup, one of the first things that he asks is how have I been sleeping. And in fact, I even sync my sleep tracking data to their medical record system, so he’s saying … hearing what I’m saying, but he’s actually pulling up the real data going, This patient’s lying to me again. Of course, I’m very truthful with my doctor, as we should all be.LEE: You know, actually, that brings up a point that consumer-facing health AI has to deal with pop science, bad science, you know, weird stuff that you hear on Reddit. And because one of the things that consumers want to know always is, you know, what’s the truth?
    AZHAR: Right.
    LEE: What can I rely on? And I think that somehow feels different than an AI that you actually put in the hands of, let’s say, a licensed practitioner. And so the regulatory issues seem very, very different for these two cases somehow.
    AZHAR: I agree, they’re very different. And I think for a lot of areas, you will want to build AI systems that are first and foremost for the clinician, even if they have patient extensions, that idea that the clinician can still be with a patient during the week.
    And you’ll do that anyway because you need the data, and you also need a little bit of a liability shield to have like a sensible person who’s been trained around that. And I think that’s going to be a very important pathway for many AI medical crossovers. We’re going to go through the clinician.
    LEE: Yeah.
    AZHAR: But I also do recognize what you say about the, kind of, kooky quackery that exists on Reddit. Although on Creatine, Reddit may yet prove to have been right.LEE: Yeah, that’s right. Yes, yeah, absolutely. Yeah.
    AZHAR: Sometimes it’s right. And I think that it serves a really good role as a field of extreme experimentation. So if you’re somebody who makes a continuous glucose monitor traditionally given to diabetics but now lots of people will wear them—and sports people will wear them—you probably gathered a lot of extreme tail distribution data by reading the Reddit/biohackers …
    LEE: Yes.
    AZHAR: … for the last few years, where people were doing things that you would never want them to really do with the CGM. And so I think we shouldn’t understate how important that petri dish can be for helping us learn what could happen next.
    LEE: Oh, I think it’s absolutely going to be essential and a bigger thing in the future. So I think I just want to close here then with one last question. And I always try to be a little bit provocative with this.
    And so as you look ahead to what doctors and nurses and patients might be doing two years from now, five years from now, 10 years from now, do you have any kind of firm predictions?
    AZHAR: I’m going to push the boat out, and I’m going to go further out than closer in.
    LEE: OK.AZHAR: As patients, we will have many, many more touch points and interaction with our biomarkers and our health. We’ll be reading how well we feel through an array of things. And some of them we’ll be wearing directly, like sleep trackers and watches.
    And so we’ll have a better sense of what’s happening in our lives. It’s like the moment you go from paper bank statements that arrive every month to being able to see your account in real time.
    LEE: Yes.
    AZHAR: And I suspect we’ll have … we’ll still have interactions with clinicians because societies that get richer see doctors more, societies that get older see doctors more, and we’re going to be doing both of those over the coming 10 years. But there will be a sense, I think, of continuous health engagement, not in an overbearing way, but just in a sense that we know it’s there, we can check in with it, it’s likely to be data that is compiled on our behalf somewhere centrally and delivered through a user experience that reinforces agency rather than anxiety.
    And we’re learning how to do that slowly. I don’t think the health apps on our phones and devices have yet quite got that right. And that could help us personalize problems before they arise, and again, I use my experience for things that I’ve tracked really, really well. And I know from my data and from how I’m feeling when I’m on the verge of one of those severe asthma attacks that hits me once a year, and I can take a little bit of preemptive measure, so I think that that will become progressively more common and that sense that we will know our baselines.
    I mean, when you think about being an athlete, which is something I think about, but I could never ever do,but what happens is you start with your detailed baselines, and that’s what your health coach looks at every three or four months. For most of us, we have no idea of our baselines. You we get our blood pressure measured once a year. We will have baselines, and that will help us on an ongoing basis to better understand and be in control of our health. And then if the product designers get it right, it will be done in a way that doesn’t feel invasive, but it’ll be done in a way that feels enabling. We’ll still be engaging with clinicians augmented by AI systems more and more because they will also have gone up the stack. They won’t be spending their time on just “take two Tylenol and have a lie down” type of engagements because that will be dealt with earlier on in the system. And so we will be there in a very, very different set of relationships. And they will feel that they have different ways of looking after our health.
    LEE: Azeem, it’s so comforting to hear such a wonderfully optimistic picture of the future of healthcare. And I actually agree with everything you’ve said.
    Let me just thank you again for joining this conversation. I think it’s been really fascinating. And I think somehow the systemic issues, the systemic issues that you tend to just see with such clarity, I think are going to be the most, kind of, profound drivers of change in the future. So thank you so much.
    AZHAR: Well, thank you, it’s been my pleasure, Peter, thank you.  
    I always think of Azeem as a systems thinker. He’s always able to take the experiences of new technologies at an individual level and then project out to what this could mean for whole organizations and whole societies.
    In our conversation, I felt that Azeem really connected some of what we learned in a previous episode—for example, from Chrissy Farr—on the evolving consumerization of healthcare to the broader workforce and economic impacts that we’ve heard about from Ethan Mollick.  
    Azeem’s personal story about managing his asthma was also a great example. You know, he imagines a future, as do I, where personal AI might assist and remember decades of personal experience with a condition like asthma and thereby know more than any human being could possibly know in a deeply personalized and effective way, leading to better care. Azeem’s relentless optimism about our AI future was also so heartening to hear.
    Both of these conversations leave me really optimistic about the future of AI in medicine. At the same time, it is pretty sobering to realize just how much we’ll all need to change in pretty fundamental and maybe even in radical ways. I think a big insight I got from these conversations is how we interact with machines is going to have to be altered not only at the individual level, but at the company level and maybe even at the societal level.
    Since my conversation with Ethan and Azeem, there have been some pretty important developments that speak directly to this. Just last week at Build, which is Microsoft’s yearly developer conference, we announced a slew of AI agent technologies. Our CEO, Satya Nadella, in fact, started his keynote by going online in a GitHub developer environment and then assigning a coding task to an AI agent, basically treating that AI as a full-fledged member of a development team. Other agents, for example, a meeting facilitator, a data analyst, a business researcher, travel agent, and more were also shown during the conference.
    But pertinent to healthcare specifically, what really blew me away was the demonstration of a healthcare orchestrator agent. And the specific thing here was in Stanford’s cancer treatment center, when they are trying to decide on potentially experimental treatments for cancer patients, they convene a meeting of experts. That is typically called a tumor board. And so this AI healthcare orchestrator agent actually participated as a full-fledged member of a tumor board meeting to help bring data together, make sure that the latest medical knowledge was brought to bear, and to assist in the decision-making around a patient’s cancer treatment. It was pretty amazing.A big thank-you again to Ethan and Azeem for sharing their knowledge and understanding of the dynamics between AI and society more broadly. And to our listeners, thank you for joining us. I’m really excited for the upcoming episodes, including discussions on medical students’ experiences with AI and AI’s influence on the operation of health systems and public health departments. We hope you’ll continue to tune in.
    Until next time.
    #what #ais #impact #individuals #means
    What AI’s impact on individuals means for the health workforce and industry
    Transcript     PETER LEE: “In American primary care, the missing workforce is stunning in magnitude, the shortfall estimated to reach up to 48,000 doctors within the next dozen years. China and other countries with aging populations can expect drastic shortfalls, as well. Just last month, I asked a respected colleague retiring from primary care who he would recommend as a replacement; he told me bluntly that, other than expensive concierge care practices, he could not think of anyone, even for himself. This mismatch between need and supply will only grow, and the US is far from alone among developed countries in facing it.”       This is The AI Revolution in Medicine, Revisited. I’m your host, Peter Lee.    Shortly after OpenAI’s GPT-4 was publicly released, Carey Goldberg, Dr. Zak Kohane, and I published The AI Revolution in Medicine to help educate the world of healthcare and medical research about the transformative impact this new generative AI technology could have. But because we wrote the book when GPT-4 was still a secret, we had to speculate. Now, two years later, what did we get right, and what did we get wrong?     In this series, we’ll talk to clinicians, patients, hospital administrators, and others to understand the reality of AI in the field and where we go from here.     The book passage I read at the top is from “Chapter 4: Trust but Verify,” which was written by Zak. You know, it’s no secret that in the US and elsewhere shortages in medical staff and the rise of clinician burnout are affecting the quality of patient care for the worse. In our book, we predicted that generative AI would be something that might help address these issues. So in this episode, we’ll delve into how individual performance gains that our previous guests have described might affect the healthcare workforce as a whole, and on the patient side, we’ll look into the influence of generative AI on the consumerization of healthcare. Now, since all of this consumes such a huge fraction of the overall economy, we’ll also get into what a general-purpose technology as disruptive as generative AI might mean in the context of labor markets and beyond.   To help us do that, I’m pleased to welcome Ethan Mollick and Azeem Azhar. Ethan Mollick is the Ralph J. Roberts Distinguished Faculty Scholar, a Rowan Fellow, and an associate professor at the Wharton School of the University of Pennsylvania. His research into the effects of AI on work, entrepreneurship, and education is applied by organizations around the world, leading him to be named one of Time magazine’s most influential people in AI for 2024. He’s also the author of the New York Times best-selling book Co-Intelligence. Azeem Azhar is an author, founder, investor, and one of the most thoughtful and influential voices on the interplay between disruptive emerging technologies and business and society. In his best-selling book, The Exponential Age, and in his highly regarded newsletter and podcast, Exponential View, he explores how technologies like AI are reshaping everything from healthcare to geopolitics. Ethan and Azeem are two leading thinkers on the ways that disruptive technologies—and especially AI—affect our work, our jobs, our business enterprises, and whole industries. As economists, they are trying to work out whether we are in the midst of an economic revolution as profound as the shift from an agrarian to an industrial society.Here is my interview with Ethan Mollick: LEE: Ethan, welcome. ETHAN MOLLICK: So happy to be here, thank you. LEE: I described you as a professor at Wharton, which I think most of the people who listen to this podcast series know of as an elite business school. So it might surprise some people that you study AI. And beyond that, you know, that I would seek you out to talk about AI in medicine.So to get started, how and why did it happen that you’ve become one of the leading experts on AI? MOLLICK: It’s actually an interesting story. I’ve been AI-adjacent my whole career. When I wasmy PhD at MIT, I worked with Marvin Minskyand the MITMedia Labs AI group. But I was never the technical AI guy. I was the person who was trying to explain AI to everybody else who didn’t understand it. And then I became very interested in, how do you train and teach? And AI was always a part of that. I was building games for teaching, teaching tools that were used in hospitals and elsewhere, simulations. So when LLMs burst into the scene, I had already been using them and had a good sense of what they could do. And between that and, kind of, being practically oriented and getting some of the first research projects underway, especially under education and AI and performance, I became sort of a go-to person in the field. And once you’re in a field where nobody knows what’s going on and we’re all making it up as we go along—I thought it’s funny that you led with the idea that you have a couple of months head start for GPT-4, right. Like that’s all we have at this point, is a few months’ head start.So being a few months ahead is good enough to be an expert at this point. Whether it should be or not is a different question. LEE: Well, if I understand correctly, leading AI companies like OpenAI, Anthropic, and others have now sought you out as someone who should get early access to really start to do early assessments and gauge early reactions. How has that been? MOLLICK: So, I mean, I think the bigger picture is less about me than about two things that tells us about the state of AI right now. One, nobody really knows what’s going on, right. So in a lot of ways, if it wasn’t for your work, Peter, like, I don’t think people would be thinking about medicine as much because these systems weren’t built for medicine. They weren’t built to change education. They weren’t built to write memos. They, like, they weren’t built to do any of these things. They weren’t really built to do anything in particular. It turns out they’re just good at many things. And to the extent that the labs work on them, they care about their coding ability above everything else and maybe math and science secondarily. They don’t think about the fact that it expresses high empathy. They don’t think about its accuracy and diagnosis or where it’s inaccurate. They don’t think about how it’s changing education forever. So one part of this is the fact that they go to my Twitter feed or ask me for advice is an indicator of where they are, too, which is they’re not thinking about this. And the fact that a few months’ head start continues to give you a lead tells you that we are at the very cutting edge. These labs aren’t sitting on projects for two years and then releasing them. Months after a project is complete or sooner, it’s out the door. Like, there’s very little delay. So we’re kind of all in the same boat here, which is a very unusual space for a new technology. LEE: And I, you know, explained that you’re at Wharton. Are you an odd fit as a faculty member at Wharton, or is this a trend now even in business schools that AI experts are becoming key members of the faculty? MOLLICK: I mean, it’s a little of both, right. It’s faculty, so everybody does everything. I’m a professor of innovation-entrepreneurship. I’ve launched startups before and working on that and education means I think about, how do organizations redesign themselves? How do they take advantage of these kinds of problems? So medicine’s always been very central to that, right. A lot of people in my MBA class have been MDs either switching, you know, careers or else looking to advance from being sort of individual contributors to running teams. So I don’t think that’s that bad a fit. But I also think this is general-purpose technology; it’s going to touch everything. The focus on this is medicine, but Microsoft does far more than medicine, right. It’s … there’s transformation happening in literally every field, in every country. This is a widespread effect. So I don’t think we should be surprised that business schools matter on this because we care about management. There’s a long tradition of management and medicine going together. There’s actually a great academic paper that shows that teaching hospitals that also have MBA programs associated with them have higher management scores and perform better. So I think that these are not as foreign concepts, especially as medicine continues to get more complicated. LEE: Yeah. Well, in fact, I want to dive a little deeper on these issues of management, of entrepreneurship, um, education. But before doing that, if I could just stay focused on you. There is always something interesting to hear from people about their first encounters with AI. And throughout this entire series, I’ve been doing that both pre-generative AI and post-generative AI. So you, sort of, hinted at the pre-generative AI. You were in Minsky’s lab. Can you say a little bit more about that early encounter? And then tell us about your first encounters with generative AI. MOLLICK: Yeah. Those are great questions. So first of all, when I was at the media lab, that was pre-the current boom in sort of, you know, even in the old-school machine learning kind of space. So there was a lot of potential directions to head in. While I was there, there were projects underway, for example, to record every interaction small children had. One of the professors was recording everything their baby interacted with in the hope that maybe that would give them a hint about how to build an AI system. There was a bunch of projects underway that were about labeling every concept and how they relate to other concepts. So, like, it was very much Wild West of, like, how do we make an AI work—which has been this repeated problem in AI, which is, what is this thing? The fact that it was just like brute force over the corpus of all human knowledge turns out to be a little bit of like a, you know, it’s a miracle and a little bit of a disappointment in some wayscompared to how elaborate some of this was. So, you know, I think that, that was sort of my first encounters in sort of the intellectual way. The generative AI encounters actually started with the original, sort of, GPT-3, or, you know, earlier versions. And it was actually game-based. So I played games like AI Dungeon. And as an educator, I realized, oh my gosh, this stuff could write essays at a fourth-grade level. That’s really going to change the way, like, middle school works, was my thinking at the time. And I was posting about that back in, you know, 2021 that this is a big deal. But I think everybody was taken surprise, including the AI companies themselves, by, you know, ChatGPT, by GPT-3.5. The difference in degree turned out to be a difference in kind. LEE: Yeah, you know, if I think back, even with GPT-3, and certainly this was the case with GPT-2, it was, at least, you know, from where I was sitting, it was hard to get people to really take this seriously and pay attention. MOLLICK: Yes. LEE: You know, it’s remarkable. Within Microsoft, I think a turning point was the use of GPT-3 to do code completions. And that was actually productized as GitHub Copilot, the very first version. That, I think, is where there was widespread belief. But, you know, in a way, I think there is, even for me early on, a sense of denial and skepticism. Did you have those initially at any point? MOLLICK: Yeah, I mean, it still happens today, right. Like, this is a weird technology. You know, the original denial and skepticism was, I couldn’t see where this was going. It didn’t seem like a miracle because, you know, of course computers can complete code for you. Like, what else are they supposed to do? Of course, computers can give you answers to questions and write fun things. So there’s difference of moving into a world of generative AI. I think a lot of people just thought that’s what computers could do. So it made the conversations a little weird. But even today, faced with these, you know, with very strong reasoner models that operate at the level of PhD students, I think a lot of people have issues with it, right. I mean, first of all, they seem intuitive to use, but they’re not always intuitive to use because the first use case that everyone puts AI to, it fails at because they use it like Google or some other use case. And then it’s genuinely upsetting in a lot of ways. I think, you know, I write in my book about the idea of three sleepless nights. That hasn’t changed. Like, you have to have an intellectual crisis to some extent, you know, and I think people do a lot to avoid having that existential angst of like, “Oh my god, what does it mean that a machine could think—apparently think—like a person?” So, I mean, I see resistance now. I saw resistance then. And then on top of all of that, there’s the fact that the curve of the technology is quite great. I mean, the price of GPT-4 level intelligence from, you know, when it was released has dropped 99.97% at this point, right. LEE: Yes. Mm-hmm. MOLLICK: I mean, I could run a GPT-4 class system basically on my phone. Microsoft’s releasing things that can almost run on like, you know, like it fits in almost no space, that are almost as good as the original GPT-4 models. I mean, I don’t think people have a sense of how fast the trajectory is moving either. LEE: Yeah, you know, there’s something that I think about often. There is this existential dread, or will this technology replace me? But I think the first people to feel that are researchers—people encountering this for the first time. You know, if you were working, let’s say, in Bayesian reasoning or in traditional, let’s say, Gaussian mixture model based, you know, speech recognition, you do get this feeling, Oh, my god, this technology has just solved the problem that I’ve dedicated my life to. And there is this really difficult period where you have to cope with that. And I think this is going to be spreading, you know, in more and more walks of life. And so this … at what point does that sort of sense of dread hit you, if ever? MOLLICK: I mean, you know, it’s not even dread as much as like, you know, Tyler Cowen wrote that it’s impossible to not feel a little bit of sadness as you use these AI systems, too. Because, like, I was talking to a friend, just as the most minor example, and his talent that he was very proud of was he was very good at writing limericks for birthday cards. He’d write these limericks. Everyone was always amused by them.And now, you know, GPT-4 and GPT-4.5, they made limericks obsolete. Like, anyone can write a good limerick, right. So this was a talent, and it was a little sad. Like, this thing that you cared about mattered. You know, as academics, we’re a little used to dead ends, right, and like, you know, some getting the lap. But the idea that entire fields are hitting that way. Like in medicine, there’s a lot of support systems that are now obsolete. And the question is how quickly you change that. In education, a lot of our techniques are obsolete. What do you do to change that? You know, it’s like the fact that this brute force technology is good enough to solve so many problems is weird, right. And it’s not just the end of, you know, of our research angles that matter, too. Like, for example, I ran this, you know, 14-person-plus, multimillion-dollar effort at Wharton to build these teaching simulations, and we’re very proud of them. It took years of work to build one. Now we’ve built a system that can build teaching simulations on demand by you talking to it with one team member. And, you know, you literally can create any simulation by having a discussion with the AI. I mean, you know, there’s a switch to a new form of excitement, but there is a little bit of like, this mattered to me, and, you know, now I have to change how I do things. I mean, adjustment happens. But if you haven’t had that displacement, I think that’s a good indicator that you haven’t really faced AI yet. LEE: Yeah, what’s so interesting just listening to you is you use words like sadness, and yet I can see the—and hear the—excitement in your voice and your body language. So, you know, that’s also kind of an interesting aspect of all of this.  MOLLICK: Yeah, I mean, I think there’s something on the other side, right. But, like, I can’t say that I haven’t had moments where like, ughhhh, but then there’s joy and basically like also, you know, freeing stuff up. I mean, I think about doctors or professors, right. These are jobs that bundle together lots of different tasks that you would never have put together, right. If you’re a doctor, you would never have expected the same person to be good at keeping up with the research and being a good diagnostician and being a good manager and being good with people and being good with hand skills. Like, who would ever want that kind of bundle? That’s not something you’re all good at, right. And a lot of our stress of our job comes from the fact that we suck at some of it. And so to the extent that AI steps in for that, you kind of feel bad about some of the stuff that it’s doing that you wanted to do. But it’s much more uplifting to be like, I don’t have to do this stuff I’m bad anymore, or I get the support to make myself good at it. And the stuff that I really care about, I can focus on more. Well, because we are at kind of a unique moment where whatever you’re best at, you’re still better than AI. And I think it’s an ongoing question about how long that lasts. But for right now, like you’re not going to say, OK, AI replaces me entirely in my job in medicine. It’s very unlikely. But you will say it replaces these 17 things I’m bad at, but I never liked that anyway. So it’s a period of both excitement and a little anxiety. LEE: Yeah, I’m going to want to get back to this question about in what ways AI may or may not replace doctors or some of what doctors and nurses and other clinicians do. But before that, let’s get into, I think, the real meat of this conversation. In previous episodes of this podcast, we talked to clinicians and healthcare administrators and technology developers that are very rapidly injecting AI today to do various forms of workforce automation, you know, automatically writing a clinical encounter note, automatically filling out a referral letter or request for prior authorization for some reimbursement to an insurance company. And so these sorts of things are intended not only to make things more efficient and lower costs but also to reduce various forms of drudgery, cognitive burden on frontline health workers. So how do you think about the impact of AI on that aspect of workforce, and, you know, what would you expect will happen over the next few years in terms of impact on efficiency and costs? MOLLICK: So I mean, this is a case where I think we’re facing the big bright problem in AI in a lot of ways, which is that this is … at the individual level, there’s lots of performance gains to be gained, right. The problem, though, is that we as individuals fit into systems, in medicine as much as anywhere else or more so, right. Which is that you could individually boost your performance, but it’s also about systems that fit along with this, right. So, you know, if you could automatically, you know, record an encounter, if you could automatically make notes, does that change what you should be expecting for notes or the value of those notes or what they’re for? How do we take what one person does and validate it across the organization and roll it out for everybody without making it a 10-year process that it feels like IT in medicine often is? Like, so we’re in this really interesting period where there’s incredible amounts of individual innovation in productivity and performance improvements in this field, like very high levels of it, but not necessarily seeing that same thing translate to organizational efficiency or gains. And one of my big concerns is seeing that happen. We’re seeing that in nonmedical problems, the same kind of thing, which is, you know, we’ve got research showing 20 and 40% performance improvements, like not uncommon to see those things. But then the organization doesn’t capture it; the system doesn’t capture it. Because the individuals are doing their own work and the systems don’t have the ability to, kind of, learn or adapt as a result. LEE: You know, where are those productivity gains going, then, when you get to the organizational level? MOLLICK: Well, they’re dying for a few reasons. One is, there’s a tendency for individual contributors to underestimate the power of management, right. Practices associated with good management increase happiness, decrease, you know, issues, increase success rates. In the same way, about 40%, as far as we can tell, of the US advantage over other companies, of US firms, has to do with management ability. Like, management is a big deal. Organizing is a big deal. Thinking about how you coordinate is a big deal. At the individual level, when things get stuck there, right, you can’t start bringing them up to how systems work together. It becomes, How do I deal with a doctor that has a 60% performance improvement? We really only have one thing in our playbook for doing that right now, which is, OK, we could fire 40% of the other doctors and still have a performance gain, which is not the answer you want to see happen. So because of that, people are hiding their use. They’re actually hiding their use for lots of reasons. And it’s a weird case because the people who are able to figure out best how to use these systems, for a lot of use cases, they’re actually clinicians themselves because they’re experimenting all the time. Like, they have to take those encounter notes. And if they figure out a better way to do it, they figure that out. You don’t want to wait for, you know, a med tech company to figure that out and then sell that back to you when it can be done by the physicians themselves. So we’re just not used to a period where everybody’s innovating and where the management structure isn’t in place to take advantage of that. And so we’re seeing things stalled at the individual level, and people are often, especially in risk-averse organizations or organizations where there’s lots of regulatory hurdles, people are so afraid of the regulatory piece that they don’t even bother trying to make change. LEE: If you are, you know, the leader of a hospital or a clinic or a whole health system, how should you approach this? You know, how should you be trying to extract positive success out of AI? MOLLICK: So I think that you need to embrace the right kind of risk, right. We don’t want to put risk on our patients … like, we don’t want to put uninformed risk. But innovation involves risk to how organizations operate. They involve change. So I think part of this is embracing the idea that R&D has to happen in organizations again. What’s happened over the last 20 years or so has been organizations giving that up. Partially, that’s a trend to focus on what you’re good at and not try and do this other stuff. Partially, it’s because it’s outsourced now to software companies that, like, Salesforce tells you how to organize your sales team. Workforce tells you how to organize your organization. Consultants come in and will tell you how to make change based on the average of what other people are doing in your field. So companies and organizations and hospital systems have all started to give up their ability to create their own organizational change. And when I talk to organizations, I often say they have to have two approaches. They have to think about the crowd and the lab. So the crowd is the idea of how to empower clinicians and administrators and supporter networks to start using AI and experimenting in ethical, legal ways and then sharing that information with each other. And the lab is, how are we doing R&D about the approach of how toAI to work, not just in direct patient care, right. But also fundamentally, like, what paperwork can you cut out? How can we better explain procedures? Like, what management role can this fill? And we need to be doing active experimentation on that. We can’t just wait for, you know, Microsoft to solve the problems. It has to be at the level of the organizations themselves. LEE: So let’s shift a little bit to the patient. You know, one of the things that we see, and I think everyone is seeing, is that people are turning to chatbots, like ChatGPT, actually to seek healthcare information for, you know, their own health or the health of their loved ones. And there was already, prior to all of this, a trend towards, let’s call it, consumerization of healthcare. So just in the business of healthcare delivery, do you think AI is going to hasten these kinds of trends, or from the consumer’s perspective, what … ? MOLLICK: I mean, absolutely, right. Like, all the early data that we have suggests that for most common medical problems, you should just consult AI, too, right. In fact, there is a real question to ask: at what point does it become unethical for doctors themselves to not ask for a second opinion from the AI because it’s cheap, right? You could overrule it or whatever you want, but like not asking seems foolish. I think the two places where there’s a burning almost, you know, moral imperative is … let’s say, you know, I’m in Philadelphia, I’m a professor, I have access to really good healthcare through the Hospital University of Pennsylvania system. I know doctors. You know, I’m lucky. I’m well connected. If, you know, something goes wrong, I have friends who I can talk to. I have specialists. I’m, you know, pretty well educated in this space. But for most people on the planet, they don’t have access to good medical care, they don’t have good health. It feels like it’s absolutely imperative to say when should you use AI and when not. Are there blind spots? What are those things? And I worry that, like, to me, that would be the crash project I’d be invoking because I’m doing the same thing in education, which is this system is not as good as being in a room with a great teacher who also uses AI to help you, but it’s better than not getting an, you know, to the level of education people get in many cases. Where should we be using it? How do we guide usage in the right way? Because the AI labs aren’t thinking about this. We have to. So, to me, there is a burning need here to understand this. And I worry that people will say, you know, everything that’s true—AI can hallucinate, AI can be biased. All of these things are absolutely true, but people are going to use it. The early indications are that it is quite useful. And unless we take the active role of saying, here’s when to use it, here’s when not to use it, we don’t have a right to say, don’t use this system. And I think, you know, we have to be exploring that. LEE: What do people need to understand about AI? And what should schools, universities, and so on be teaching? MOLLICK: Those are, kind of, two separate questions in lot of ways. I think a lot of people want to teach AI skills, and I will tell you, as somebody who works in this space a lot, there isn’t like an easy, sort of, AI skill, right. I could teach you prompt engineering in two to three classes, but every indication we have is that for most people under most circumstances, the value of prompting, you know, any one case is probably not that useful. A lot of the tricks are disappearing because the AI systems are just starting to use them themselves. So asking good questions, being a good manager, being a good thinker tend to be important, but like magic tricks around making, you know, the AI do something because you use the right phrase used to be something that was real but is rapidly disappearing. So I worry when people say teach AI skills. No one’s been able to articulate to me as somebody who knows AI very well and teaches classes on AI, what those AI skills that everyone should learn are, right. I mean, there’s value in learning a little bit how the models work. There’s a value in working with these systems. A lot of it’s just hands on keyboard kind of work. But, like, we don’t have an easy slam dunk “this is what you learn in the world of AI” because the systems are getting better, and as they get better, they get less sensitive to these prompting techniques. They get better prompting themselves. They solve problems spontaneously and start being agentic. So it’s a hard problem to ask about, like, what do you train someone on? I think getting people experience in hands-on-keyboards, getting them to … there’s like four things I could teach you about AI, and two of them are already starting to disappear. But, like, one is be direct. Like, tell the AI exactly what you want. That’s very helpful. Second, provide as much context as possible. That can include things like acting as a doctor, but also all the information you have. The third is give it step-by-step directions—that’s becoming less important. And the fourth is good and bad examples of the kind of output you want. Those four, that’s like, that’s it as far as the research telling you what to do, and the rest is building intuition. LEE: I’m really impressed that you didn’t give the answer, “Well, everyone should be teaching my book, Co-Intelligence.”MOLLICK: Oh, no, sorry! Everybody should be teaching my book Co-Intelligence. I apologize.LEE: It’s good to chuckle about that, but actually, I can’t think of a better book, like, if you were to assign a textbook in any professional education space, I think Co-Intelligence would be number one on my list. Are there other things that you think are essential reading? MOLLICK: That’s a really good question. I think that a lot of things are evolving very quickly. I happen to, kind of, hit a sweet spot with Co-Intelligence to some degree because I talk about how I used it, and I was, sort of, an advanced user of these systems. So, like, it’s, sort of, like my Twitter feed, my online newsletter. I’m just trying to, kind of, in some ways, it’s about trying to make people aware of what these systems can do by just showing a lot, right. Rather than picking one thing, and, like, this is a general-purpose technology. Let’s use it for this. And, like, everybody gets a light bulb for a different reason. So more than reading, it is using, you know, and that can be Copilot or whatever your favorite tool is. But using it. Voice modes help a lot. In terms of readings, I mean, I think that there is a couple of good guides to understanding AI that were originally blog posts. I think Tim Lee has one called Understanding AI, and it had a good overview … LEE: Yeah, that’s a great one. MOLLICK: … of that topic that I think explains how transformers work, which can give you some mental sense. I thinkKarpathyhas some really nice videos of use that I would recommend. Like on the medical side, I think the book that you did, if you’re in medicine, you should read that. I think that that’s very valuable. But like all we can offer are hints in some ways. Like there isn’t … if you’re looking for the instruction manual, I think it can be very frustrating because it’s like you want the best practices and procedures laid out, and we cannot do that, right. That’s not how a system like this works. LEE: Yeah. MOLLICK: It’s not a person, but thinking about it like a person can be helpful, right. LEE: One of the things that has been sort of a fun project for me for the last few years is I have been a founding board member of a new medical school at Kaiser Permanente. And, you know, that medical school curriculum is being formed in this era. But it’s been perplexing to understand, you know, what this means for a medical school curriculum. And maybe even more perplexing for me, at least, is the accrediting bodies, which are extremely important in US medical schools; how accreditors should think about what’s necessary here. Besides the things that you’ve … the, kind of, four key ideas you mentioned, if you were talking to the board of directors of the LCMEaccrediting body, what’s the one thing you would want them to really internalize? MOLLICK: This is both a fast-moving and vital area. This can’t be viewed like a usual change, which, “Let’s see how this works.” Because it’s, like, the things that make medical technologies hard to do, which is like unclear results, limited, you know, expensive use cases where it rolls out slowly. So one or two, you know, advanced medical facilities get access to, you know, proton beams or something else at multi-billion dollars of cost, and that takes a while to diffuse out. That’s not happening here. This is all happening at the same time, all at once. This is now … AI is part of medicine. I mean, there’s a minor point that I’d make that actually is a really important one, which is large language models, generative AI overall, work incredibly differently than other forms of AI. So the other worry I have with some of these accreditors is they blend together algorithmic forms of AI, which medicine has been trying for long time—decision support, algorithmic methods, like, medicine more so than other places has been thinking about those issues. Generative AI, even though it uses the same underlying techniques, is a completely different beast. So, like, even just take the most simple thing of algorithmic aversion, which is a well-understood problem in medicine, right. Which is, so you have a tool that could tell you as a radiologist, you know, the chance of this being cancer; you don’t like it, you overrule it, right. We don’t find algorithmic aversion happening with LLMs in the same way. People actually enjoy using them because it’s more like working with a person. The flaws are different. The approach is different. So you need to both view this as universal applicable today, which makes it urgent, but also as something that is not the same as your other form of AI, and your AI working group that is thinking about how to solve this problem is not the right people here. LEE: You know, I think the world has been trained because of the magic of web search to view computers as question-answering machines. Ask a question, get an answer. MOLLICK: Yes. Yes. LEE: Write a query, get results. And as I have interacted with medical professionals, you can see that medical professionals have that model of a machine in mind. And I think that’s partly, I think psychologically, why hallucination is so alarming. Because you have a mental model of a computer as a machine that has absolutely rock-solid perfect memory recall. But the thing that was so powerful in Co-Intelligence, and we tried to get at this in our book also, is that’s not the sweet spot. It’s this sort of deeper interaction, more of a collaboration. And I thought your use of the term Co-Intelligence really just even in the title of the book tried to capture this. When I think about education, it seems like that’s the first step, to get past this concept of a machine being just a question-answering machine. Do you have a reaction to that idea? MOLLICK: I think that’s very powerful. You know, we’ve been trained over so many years at both using computers but also in science fiction, right. Computers are about cold logic, right. They will give you the right answer, but if you ask it what love is, they explode, right. Like that’s the classic way you defeat the evil robot in Star Trek, right. “Love does not compute.”Instead, we have a system that makes mistakes, is warm, beats doctors in empathy in almost every controlled study on the subject, right. Like, absolutely can outwrite you in a sonnet but will absolutely struggle with giving you the right answer every time. And I think our mental models are just broken for this. And I think you’re absolutely right. And that’s part of what I thought your book does get at really well is, like, this is a different thing. It’s also generally applicable. Again, the model in your head should be kind of like a person even though it isn’t, right. There’s a lot of warnings and caveats to it, but if you start from person, smart person you’re talking to, your mental model will be more accurate than smart machine, even though both are flawed examples, right. So it will make mistakes; it will make errors. The question is, what do you trust it on? What do you not trust it? As you get to know a model, you’ll get to understand, like, I totally don’t trust it for this, but I absolutely trust it for that, right. LEE: All right. So we’re getting to the end of the time we have together. And so I’d just like to get now into something a little bit more provocative. And I get the question all the time. You know, will AI replace doctors? In medicine and other advanced knowledge work, project out five to 10 years. What do think happens? MOLLICK: OK, so first of all, let’s acknowledge systems change much more slowly than individual use. You know, doctors are not individual actors; they’re part of systems, right. So not just the system of a patient who like may or may not want to talk to a machine instead of a person but also legal systems and administrative systems and systems that allocate labor and systems that train people. So, like, it’s hard to imagine that in five to 10 years medicine being so upended that even if AI was better than doctors at every single thing doctors do, that we’d actually see as radical a change in medicine as you might in other fields. I think you will see faster changes happen in consulting and law and, you know, coding, other spaces than medicine. But I do think that there is good reason to suspect that AI will outperform people while still having flaws, right. That’s the difference. We’re already seeing that for common medical questions in enough randomized controlled trials that, you know, best doctors beat AI, but the AI beats the mean doctor, right. Like, that’s just something we should acknowledge is happening at this point. Now, will that work in your specialty? No. Will that work with all the contingent social knowledge that you have in your space? Probably not. Like, these are vignettes, right. But, like, that’s kind of where things are. So let’s assume, right … you’re asking two questions. One is, how good will AI get? LEE: Yeah. MOLLICK: And we don’t know the answer to that question. I will tell you that your colleagues at Microsoft and increasingly the labs, the AI labs themselves, are all saying they think they’ll have a machine smarter than a human at every intellectual task in the next two to three years. If that doesn’t happen, that makes it easier to assume the future, but let’s just assume that that’s the case. I think medicine starts to change with the idea that people feel obligated to use this to help for everything. Your patients will be using it, and it will be your advisor and helper at the beginning phases, right. And I think that I expect people to be better at empathy. I expect better bedside manner. I expect management tasks to become easier. I think administrative burden might lighten if we handle this right way or much worse if we handle it badly. Diagnostic accuracy will increase, right. And then there’s a set of discovery pieces happening, too, right. One of the core goals of all the AI companies is to accelerate medical research. How does that happen and how does that affect us is a, kind of, unknown question. So I think clinicians are in both the eye of the storm and surrounded by it, right. Like, they can resist AI use for longer than most other fields, but everything around them is going to be affected by it. LEE: Well, Ethan, this has been really a fantastic conversation. And, you know, I think in contrast to all the other conversations we’ve had, this one gives especially the leaders in healthcare, you know, people actually trying to lead their organizations into the future, whether it’s in education or in delivery, a lot to think about. So I really appreciate you joining. MOLLICK: Thank you.   I’m a computing researcher who works with people who are right in the middle of today’s bleeding-edge developments in AI. And because of that, I often lose sight of how to talk to a broader audience about what it’s all about. And so I think one of Ethan’s superpowers is that he has this knack for explaining complex topics in AI in a really accessible way, getting right to the most important points without making it so simple as to be useless. That’s why I rarely miss an opportunity to read up on his latest work. One of the first things I learned from Ethan is the intuition that you can, sort of, think of AI as a very knowledgeable intern. In other words, think of it as a persona that you can interact with, but you also need to be a manager for it and to always assess the work that it does. In our discussion, Ethan went further to stress that there is, because of that, a serious education gap. You know, over the last decade or two, we’ve all been trained, mainly by search engines, to think of computers as question-answering machines. In medicine, in fact, there’s a question-answering application that is really popular called UpToDate. Doctors use it all the time. But generative AI systems like ChatGPT are different. There’s therefore a challenge in how to break out of the old-fashioned mindset of search to get the full value out of generative AI. The other big takeaway for me was that Ethan pointed out while it’s easy to see productivity gains from AI at the individual level, those same gains, at least today, don’t often translate automatically to organization-wide or system-wide gains. And one, of course, has to conclude that it takes more than just making individuals more productive; the whole system also has to adjust to the realities of AI. Here’s now my interview with Azeem Azhar: LEE: Azeem, welcome. AZEEM AZHAR: Peter, thank you so much for having me.  LEE: You know, I think you’re extremely well known in the world. But still, some of the listeners of this podcast series might not have encountered you before. And so one of the ways I like to ask people to introduce themselves is, how do you explain to your parents what you do every day? AZHAR: Well, I’m very lucky in that way because my mother was the person who got me into computers more than 40 years ago. And I still have that first computer, a ZX81 with a Z80 chip … LEE: Oh wow. AZHAR: … to this day. It sits in my study, all seven and a half thousand transistors and Bakelite plastic that it is. And my parents were both economists, and economics is deeply connected with technology in some sense. And I grew up in the late ’70s and the early ’80s. And that was a time of tremendous optimism around technology. It was space opera, science fiction, robots, and of course, the personal computer and, you know, Bill Gates and Steve Jobs. So that’s where I started. And so, in a way, my mother and my dad, who passed away a few years ago, had always known me as someone who was fiddling with computers but also thinking about economics and society. And so, in a way, it’s easier to explain to them because they’re the ones who nurtured the environment that allowed me to research technology and AI and think about what it means to firms and to the economy at large. LEE: I always like to understand the origin story. And what I mean by that is, you know, what was your first encounter with generative AI? And what was that like? What did you go through? AZHAR: The first real moment was when Midjourney and Stable Diffusion emerged in that summer of 2022. I’d been away on vacation, and I came back—and I’d been off grid, in fact—and the world had really changed. Now, I’d been aware of GPT-3 and GPT-2, which I played around with and with BERT, the original transformer paper about seven or eight years ago, but it was the moment where I could talk to my computer, and it could produce these images, and it could be refined in natural language that really made me think we’ve crossed into a new domain. We’ve gone from AI being highly discriminative to AI that’s able to explore the world in particular ways. And then it was a few months later that ChatGPT came out—November, the 30th. And I think it was the next day or the day after that I said to my team, everyone has to use this, and we have to meet every morning and discuss how we experimented the day before. And we did that for three or four months. And, you know, it was really clear to me in that interface at that point that, you know, we’d absolutely pass some kind of threshold. LEE: And who’s the we that you were experimenting with? AZHAR: So I have a team of four who support me. They’re mostly researchers of different types. I mean, it’s almost like one of those jokes. You know, I have a sociologist, an economist, and an astrophysicist. And, you know, they walk into the bar,or they walk into our virtual team room, and we try to solve problems. LEE: Well, so let’s get now into brass tacks here. And I think I want to start maybe just with an exploration of the economics of all this and economic realities. Because I think in a lot of your work—for example, in your book—you look pretty deeply at how automation generally and AI specifically are transforming certain sectors like finance, manufacturing, and you have a really, kind of, insightful focus on what this means for productivity and which ways, you know, efficiencies are found.   And then you, sort of, balance that with risks, things that can and do go wrong. And so as you take that background and looking at all those other sectors, in what ways are the same patterns playing out or likely to play out in healthcare and medicine? AZHAR: I’m sure we will see really remarkable parallels but also new things going on. I mean, medicine has a particular quality compared to other sectors in the sense that it’s highly regulated, market structure is very different country to country, and it’s an incredibly broad field. I mean, just think about taking a Tylenol and going through laparoscopic surgery. Having an MRI and seeing a physio. I mean, this is all medicine. I mean, it’s hard to imagine a sector that ismore broad than that. So I think we can start to break it down, and, you know, where we’re seeing things with generative AI will be that the, sort of, softest entry point, which is the medical scribing. And I’m sure many of us have been with clinicians who have a medical scribe running alongside—they’re all on Surface Pros I noticed, right?They’re on the tablet computers, and they’re scribing away. And what that’s doing is, in the words of my friend Eric Topol, it’s giving the clinician time back, right. They have time back from days that are extremely busy and, you know, full of administrative overload. So I think you can obviously do a great deal with reducing that overload. And within my team, we have a view, which is if you do something five times in a week, you should be writing an automation for it. And if you’re a doctor, you’re probably reviewing your notes, writing the prescriptions, and so on several times a day. So those are things that can clearly be automated, and the human can be in the loop. But I think there are so many other ways just within the clinic that things can help. So, one of my friends, my friend from my junior school—I’ve known him since I was 9—is an oncologist who’s also deeply into machine learning, and he’s in Cambridge in the UK. And he built with Microsoft Research a suite of imaging AI tools from his own discipline, which they then open sourced. So that’s another way that you have an impact, which is that you actually enable the, you know, generalist, specialist, polymath, whatever they are in health systems to be able to get this technology, to tune it to their requirements, to use it, to encourage some grassroots adoption in a system that’s often been very, very heavily centralized. LEE: Yeah. AZHAR: And then I think there are some other things that are going on that I find really, really exciting. So one is the consumerization of healthcare. So I have one of those sleep tracking rings, the Oura. LEE: Yup. AZHAR: That is building a data stream that we’ll be able to apply more and more AI to. I mean, right now, it’s applying traditional, I suspect, machine learning, but you can imagine that as we start to get more data, we start to get more used to measuring ourselves, we create this sort of pot, a personal asset that we can turn AI to. And there’s still another category. And that other category is one of the completely novel ways in which we can enable patient care and patient pathway. And there’s a fantastic startup in the UK called Neko Health, which, I mean, does physicals, MRI scans, and blood tests, and so on. It’s hard to imagine Neko existing without the sort of advanced data, machine learning, AI that we’ve seen emerge over the last decade. So, I mean, I think that there are so many ways in which the temperature is slowly being turned up to encourage a phase change within the healthcare sector. And last but not least, I do think that these tools can also be very, very supportive of a clinician’s life cycle. I think we, as patients, we’re a bit …  I don’t know if we’re as grateful as we should be for our clinicians who are putting in 90-hour weeks.But you can imagine a world where AI is able to support not just the clinicians’ workload but also their sense of stress, their sense of burnout. So just in those five areas, Peter, I sort of imagine we could start to fundamentally transform over the course of many years, of course, the way in which people think about their health and their interactions with healthcare systems LEE: I love how you break that down. And I want to press on a couple of things. You also touched on the fact that medicine is, at least in most of the world, is a highly regulated industry. I guess finance is the same way, but they also feel different because the, like, finance sector has to be very responsive to consumers, and consumers are sensitive to, you know, an abundance of choice; they are sensitive to price. Is there something unique about medicine besides being regulated? AZHAR: I mean, there absolutely is. And in finance, as well, you have much clearer end states. So if you’re not in the consumer space, but you’re in the, you know, asset management space, you have to essentially deliver returns against the volatility or risk boundary, right. That’s what you have to go out and do. And I think if you’re in the consumer industry, you can come back to very, very clear measures, net promoter score being a very good example. In the case of medicine and healthcare, it is much more complicated because as far as the clinician is concerned, people are individuals, and we have our own parts and our own responses. If we didn’t, there would never be a need for a differential diagnosis. There’d never be a need for, you know, Let’s try azithromycin first, and then if that doesn’t work, we’ll go to vancomycin, or, you know, whatever it happens to be. You would just know. But ultimately, you know, people are quite different. The symptoms that they’re showing are quite different, and also their compliance is really, really different. I had a back problem that had to be dealt with by, you know, a physio and extremely boring exercises four times a week, but I was ruthless in complying, and my physio was incredibly surprised. He’d say well no one ever does this, and I said, well you know the thing is that I kind of just want to get this thing to go away. LEE: Yeah. AZHAR: And I think that that’s why medicine is and healthcare is so different and more complex. But I also think that’s why AI can be really, really helpful. I mean, we didn’t talk about, you know, AI in its ability to potentially do this, which is to extend the clinician’s presence throughout the week. LEE: Right. Yeah. AZHAR: The idea that maybe some part of what the clinician would do if you could talk to them on Wednesday, Thursday, and Friday could be delivered through an app or a chatbot just as a way of encouraging the compliance, which is often, especially with older patients, one reason why conditions, you know, linger on for longer. LEE: You know, just staying on the regulatory thing, as I’ve thought about this, the one regulated sector that I think seems to have some parallels to healthcare is energy delivery, energy distribution. Because like healthcare, as a consumer, I don’t have choice in who delivers electricity to my house. And even though I care about it being cheap or at least not being overcharged, I don’t have an abundance of choice. I can’t do price comparisons. And there’s something about that, just speaking as a consumer of both energy and a consumer of healthcare, that feels similar. Whereas other regulated industries, you know, somehow, as a consumer, I feel like I have a lot more direct influence and power. Does that make any sense to someone, you know, like you, who’s really much more expert in how economic systems work? AZHAR: I mean, in a sense, one part of that is very, very true. You have a limited panel of energy providers you can go to, and in the US, there may be places where you have no choice. I think the area where it’s slightly different is that as a consumer or a patient, you can actually make meaningful choices and changes yourself using these technologies, and people used to joke about you know asking Dr. Google. But Dr. Google is not terrible, particularly if you go to WebMD. And, you know, when I look at long-range change, many of the regulations that exist around healthcare delivery were formed at a point before people had access to good quality information at the touch of their fingertips or when educational levels in general were much, much lower. And many regulations existed because of the incumbent power of particular professional sectors. I’ll give you an example from the United Kingdom. So I have had asthma all of my life. That means I’ve been taking my inhaler, Ventolin, and maybe a steroid inhaler for nearly 50 years. That means that I know … actually, I’ve got more experience, and I—in some sense—know more about it than a general practitioner. LEE: Yeah. AZHAR: And until a few years ago, I would have to go to a general practitioner to get this drug that I’ve been taking for five decades, and there they are, age 30 or whatever it is. And a few years ago, the regulations changed. And now pharmacies can … or pharmacists can prescribe those types of drugs under certain conditions directly. LEE: Right. AZHAR: That was not to do with technology. That was to do with incumbent lock-in. So when we look at the medical industry, the healthcare space, there are some parallels with energy, but there are a few little things that the ability that the consumer has to put in some effort to learn about their condition, but also the fact that some of the regulations that exist just exist because certain professions are powerful. LEE: Yeah, one last question while we’re still on economics. There seems to be a conundrum about productivity and efficiency in healthcare delivery because I’ve never encountered a doctor or a nurse that wants to be able to handle even more patients than they’re doing on a daily basis. And so, you know, if productivity means simply, well, your rounds can now handle 16 patients instead of eight patients, that doesn’t seem necessarily to be a desirable thing. So how can we or should we be thinking about efficiency and productivity since obviously costs are, in most of the developed world, are a huge, huge problem? AZHAR: Yes, and when you described doubling the number of patients on the round, I imagined you buying them all roller skates so they could just whizz aroundthe hospital faster and faster than ever before. We can learn from what happened with the introduction of electricity. Electricity emerged at the end of the 19th century, around the same time that cars were emerging as a product, and car makers were very small and very artisanal. And in the early 1900s, some really smart car makers figured out that electricity was going to be important. And they bought into this technology by putting pendant lights in their workshops so they could “visit more patients.” Right? LEE: Yeah, yeah. AZHAR: They could effectively spend more hours working, and that was a productivity enhancement, and it was noticeable. But, of course, electricity fundamentally changed the productivity by orders of magnitude of people who made cars starting with Henry Ford because he was able to reorganize his factories around the electrical delivery of power and to therefore have the moving assembly line, which 10xed the productivity of that system. So when we think about how AI will affect the clinician, the nurse, the doctor, it’s much easier for us to imagine it as the pendant light that just has them working later … LEE: Right. AZHAR: … than it is to imagine a reconceptualization of the relationship between the clinician and the people they care for. And I’m not sure. I don’t think anybody knows what that looks like. But, you know, I do think that there will be a way that this changes, and you can see that scale out factor. And it may be, Peter, that what we end up doing is we end up saying, OK, because we have these brilliant AIs, there’s a lower level of training and cost and expense that’s required for a broader range of conditions that need treating. And that expands the market, right. That expands the market hugely. It’s what has happened in the market for taxis or ride sharing. The introduction of Uber and the GPS system … LEE: Yup. AZHAR: … has meant many more people now earn their living driving people around in their cars. And at least in London, you had to be reasonably highly trained to do that. So I can see a reorganization is possible. Of course, entrenched interests, the economic flow … and there are many entrenched interests, particularly in the US between the health systems and the, you know, professional bodies that might slow things down. But I think a reimagining is possible. And if I may, I’ll give you one example of that, which is, if you go to countries outside of the US where there are many more sick people per doctor, they have incentives to change the way they deliver their healthcare. And well before there was AI of this quality around, there was a few cases of health systems in India—Aravind Eye Carewas one, and Narayana Hrudayalayawas another. And in the latter, they were a cardiac care unit where you couldn’t get enough heart surgeons. LEE: Yeah, yep. AZHAR: So specially trained nurses would operate under the supervision of a single surgeon who would supervise many in parallel. So there are ways of increasing the quality of care, reducing the cost, but it does require a systems change. And we can’t expect a single bright algorithm to do it on its own. LEE: Yeah, really, really interesting. So now let’s get into regulation. And let me start with this question. You know, there are several startup companies I’m aware of that are pushing on, I think, a near-term future possibility that a medical AI for consumer might be allowed, say, to prescribe a medication for you, something that would normally require a doctor or a pharmacist, you know, that is certified in some way, licensed to do. Do you think we’ll get to a point where for certain regulated activities, humans are more or less cut out of the loop? AZHAR: Well, humans would have been in the loop because they would have provided the training data, they would have done the oversight, the quality control. But to your question in general, would we delegate an important decision entirely to a tested set of algorithms? I’m sure we will. We already do that. I delegate less important decisions like, What time should I leave for the airport to Waze. I delegate more important decisions to the automated braking in my car. We will do this at certain levels of risk and threshold. If I come back to my example of prescribing Ventolin. It’s really unclear to me that the prescription of Ventolin, this incredibly benign bronchodilator that is only used by people who’ve been through the asthma process, needs to be prescribed by someone who’s gone through 10 years or 12 years of medical training. And why that couldn’t be prescribed by an algorithm or an AI system. LEE: Right. Yep. Yep. AZHAR: So, you know, I absolutely think that that will be the case and could be the case. I can’t really see what the objections are. And the real issue is where do you draw the line of where you say, “Listen, this is too important,” or “The cost is too great,” or “The side effects are too high,” and therefore this is a point at which we want to have some, you know, human taking personal responsibility, having a liability framework in place, having a sense that there is a person with legal agency who signed off on this decision. And that line I suspect will start fairly low, and what we’d expect to see would be that that would rise progressively over time. LEE: What you just said, that scenario of your personal asthma medication, is really interesting because your personal AI might have the benefit of 50 years of your own experience with that medication. So, in a way, there is at least the data potential for, let’s say, the next prescription to be more personalized and more tailored specifically for you. AZHAR: Yes. Well, let’s dig into this because I think this is super interesting, and we can look at how things have changed. So 15 years ago, if I had a bad asthma attack, which I might have once a year, I would have needed to go and see my general physician. In the UK, it’s very difficult to get an appointment. I would have had to see someone privately who didn’t know me at all because I’ve just walked in off the street, and I would explain my situation. It would take me half a day. Productivity lost. I’ve been miserable for a couple of days with severe wheezing. Then a few years ago the system changed, a protocol changed, and now I have a thing called a rescue pack, which includes prednisolone steroids. It includes something else I’ve just forgotten, and an antibiotic in case I get an upper respiratory tract infection, and I have an “algorithm.” It’s called a protocol. It’s printed out. It’s a flowchart I answer various questions, and then I say, “I’m going to prescribe this to myself.” You know, UK doctors don’t prescribe prednisolone, or prednisone as you may call it in the US, at the drop of a hat, right. It’s a powerful steroid. I can self-administer, and I can now get that repeat prescription without seeing a physician a couple of times a year. And the algorithm, the “AI” is, it’s obviously been done in PowerPoint naturally, and it’s a bunch of arrows.Surely, surely, an AI system is going to be more sophisticated, more nuanced, and give me more assurance that I’m making the right decision around something like that. LEE: Yeah. Well, at a minimum, the AI should be able to make that PowerPoint the next time.AZHAR: Yeah, yeah. Thank god for Clippy. Yes. LEE: So, you know, I think in our book, we had a lot of certainty about most of the things we’ve discussed here, but one chapter where I felt we really sort of ran out of ideas, frankly, was on regulation. And, you know, what we ended up doing for that chapter is … I can’t remember if it was Carey’s or Zak’s idea, but we asked GPT-4 to have a conversation, a debate with itself, about regulation. And we made some minor commentary on that. And really, I think we took that approach because we just didn’t have much to offer. By the way, in our defense, I don’t think anyone else had any better ideas anyway. AZHAR: Right. LEE: And so now two years later, do we have better ideas about the need for regulation, the frameworks around which those regulations should be developed, and, you know, what should this look like? AZHAR: So regulation is going to be in some cases very helpful because it provides certainty for the clinician that they’re doing the right thing, that they are still insured for what they’re doing, and it provides some degree of confidence for the patient. And we need to make sure that the claims that are made stand up to quite rigorous levels, where ideally there are RCTs, and there are the classic set of processes you go through. You do also want to be able to experiment, and so the question is: as a regulator, how can you enable conditions for there to be experimentation? And what is experimentation? Experimentation is learning so that every element of the system can learn from this experience. So finding that space where there can be bit of experimentation, I think, becomes very, very important. And a lot of this is about experience, so I think the first digital therapeutics have received FDA approval, which means there are now people within the FDA who understand how you go about running an approvals process for that, and what that ends up looking like—and of course what we’re very good at doing in this sort of modern hyper-connected world—is we can share that expertise, that knowledge, that experience very, very quickly. So you go from one approval a year to a hundred approvals a year to a thousand approvals a year. So we will then actually, I suspect, need to think about what is it to approve digital therapeutics because, unlike big biological molecules, we can generate these digital therapeutics at the rate of knots. LEE: Yes. AZHAR: Every road in Hayes Valley in San Francisco, right, is churning out new startups who will want to do things like this. So then, I think about, what does it mean to get approved if indeed it gets approved? But we can also go really far with things that don’t require approval. I come back to my sleep tracking ring. So I’ve been wearing this for a few years, and when I go and see my doctor or I have my annual checkup, one of the first things that he asks is how have I been sleeping. And in fact, I even sync my sleep tracking data to their medical record system, so he’s saying … hearing what I’m saying, but he’s actually pulling up the real data going, This patient’s lying to me again. Of course, I’m very truthful with my doctor, as we should all be.LEE: You know, actually, that brings up a point that consumer-facing health AI has to deal with pop science, bad science, you know, weird stuff that you hear on Reddit. And because one of the things that consumers want to know always is, you know, what’s the truth? AZHAR: Right. LEE: What can I rely on? And I think that somehow feels different than an AI that you actually put in the hands of, let’s say, a licensed practitioner. And so the regulatory issues seem very, very different for these two cases somehow. AZHAR: I agree, they’re very different. And I think for a lot of areas, you will want to build AI systems that are first and foremost for the clinician, even if they have patient extensions, that idea that the clinician can still be with a patient during the week. And you’ll do that anyway because you need the data, and you also need a little bit of a liability shield to have like a sensible person who’s been trained around that. And I think that’s going to be a very important pathway for many AI medical crossovers. We’re going to go through the clinician. LEE: Yeah. AZHAR: But I also do recognize what you say about the, kind of, kooky quackery that exists on Reddit. Although on Creatine, Reddit may yet prove to have been right.LEE: Yeah, that’s right. Yes, yeah, absolutely. Yeah. AZHAR: Sometimes it’s right. And I think that it serves a really good role as a field of extreme experimentation. So if you’re somebody who makes a continuous glucose monitor traditionally given to diabetics but now lots of people will wear them—and sports people will wear them—you probably gathered a lot of extreme tail distribution data by reading the Reddit/biohackers … LEE: Yes. AZHAR: … for the last few years, where people were doing things that you would never want them to really do with the CGM. And so I think we shouldn’t understate how important that petri dish can be for helping us learn what could happen next. LEE: Oh, I think it’s absolutely going to be essential and a bigger thing in the future. So I think I just want to close here then with one last question. And I always try to be a little bit provocative with this. And so as you look ahead to what doctors and nurses and patients might be doing two years from now, five years from now, 10 years from now, do you have any kind of firm predictions? AZHAR: I’m going to push the boat out, and I’m going to go further out than closer in. LEE: OK.AZHAR: As patients, we will have many, many more touch points and interaction with our biomarkers and our health. We’ll be reading how well we feel through an array of things. And some of them we’ll be wearing directly, like sleep trackers and watches. And so we’ll have a better sense of what’s happening in our lives. It’s like the moment you go from paper bank statements that arrive every month to being able to see your account in real time. LEE: Yes. AZHAR: And I suspect we’ll have … we’ll still have interactions with clinicians because societies that get richer see doctors more, societies that get older see doctors more, and we’re going to be doing both of those over the coming 10 years. But there will be a sense, I think, of continuous health engagement, not in an overbearing way, but just in a sense that we know it’s there, we can check in with it, it’s likely to be data that is compiled on our behalf somewhere centrally and delivered through a user experience that reinforces agency rather than anxiety. And we’re learning how to do that slowly. I don’t think the health apps on our phones and devices have yet quite got that right. And that could help us personalize problems before they arise, and again, I use my experience for things that I’ve tracked really, really well. And I know from my data and from how I’m feeling when I’m on the verge of one of those severe asthma attacks that hits me once a year, and I can take a little bit of preemptive measure, so I think that that will become progressively more common and that sense that we will know our baselines. I mean, when you think about being an athlete, which is something I think about, but I could never ever do,but what happens is you start with your detailed baselines, and that’s what your health coach looks at every three or four months. For most of us, we have no idea of our baselines. You we get our blood pressure measured once a year. We will have baselines, and that will help us on an ongoing basis to better understand and be in control of our health. And then if the product designers get it right, it will be done in a way that doesn’t feel invasive, but it’ll be done in a way that feels enabling. We’ll still be engaging with clinicians augmented by AI systems more and more because they will also have gone up the stack. They won’t be spending their time on just “take two Tylenol and have a lie down” type of engagements because that will be dealt with earlier on in the system. And so we will be there in a very, very different set of relationships. And they will feel that they have different ways of looking after our health. LEE: Azeem, it’s so comforting to hear such a wonderfully optimistic picture of the future of healthcare. And I actually agree with everything you’ve said. Let me just thank you again for joining this conversation. I think it’s been really fascinating. And I think somehow the systemic issues, the systemic issues that you tend to just see with such clarity, I think are going to be the most, kind of, profound drivers of change in the future. So thank you so much. AZHAR: Well, thank you, it’s been my pleasure, Peter, thank you.   I always think of Azeem as a systems thinker. He’s always able to take the experiences of new technologies at an individual level and then project out to what this could mean for whole organizations and whole societies. In our conversation, I felt that Azeem really connected some of what we learned in a previous episode—for example, from Chrissy Farr—on the evolving consumerization of healthcare to the broader workforce and economic impacts that we’ve heard about from Ethan Mollick.   Azeem’s personal story about managing his asthma was also a great example. You know, he imagines a future, as do I, where personal AI might assist and remember decades of personal experience with a condition like asthma and thereby know more than any human being could possibly know in a deeply personalized and effective way, leading to better care. Azeem’s relentless optimism about our AI future was also so heartening to hear. Both of these conversations leave me really optimistic about the future of AI in medicine. At the same time, it is pretty sobering to realize just how much we’ll all need to change in pretty fundamental and maybe even in radical ways. I think a big insight I got from these conversations is how we interact with machines is going to have to be altered not only at the individual level, but at the company level and maybe even at the societal level. Since my conversation with Ethan and Azeem, there have been some pretty important developments that speak directly to this. Just last week at Build, which is Microsoft’s yearly developer conference, we announced a slew of AI agent technologies. Our CEO, Satya Nadella, in fact, started his keynote by going online in a GitHub developer environment and then assigning a coding task to an AI agent, basically treating that AI as a full-fledged member of a development team. Other agents, for example, a meeting facilitator, a data analyst, a business researcher, travel agent, and more were also shown during the conference. But pertinent to healthcare specifically, what really blew me away was the demonstration of a healthcare orchestrator agent. And the specific thing here was in Stanford’s cancer treatment center, when they are trying to decide on potentially experimental treatments for cancer patients, they convene a meeting of experts. That is typically called a tumor board. And so this AI healthcare orchestrator agent actually participated as a full-fledged member of a tumor board meeting to help bring data together, make sure that the latest medical knowledge was brought to bear, and to assist in the decision-making around a patient’s cancer treatment. It was pretty amazing.A big thank-you again to Ethan and Azeem for sharing their knowledge and understanding of the dynamics between AI and society more broadly. And to our listeners, thank you for joining us. I’m really excited for the upcoming episodes, including discussions on medical students’ experiences with AI and AI’s influence on the operation of health systems and public health departments. We hope you’ll continue to tune in. Until next time. #what #ais #impact #individuals #means
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    What AI’s impact on individuals means for the health workforce and industry
    Transcript [MUSIC]    [BOOK PASSAGE]  PETER LEE: “In American primary care, the missing workforce is stunning in magnitude, the shortfall estimated to reach up to 48,000 doctors within the next dozen years. China and other countries with aging populations can expect drastic shortfalls, as well. Just last month, I asked a respected colleague retiring from primary care who he would recommend as a replacement; he told me bluntly that, other than expensive concierge care practices, he could not think of anyone, even for himself. This mismatch between need and supply will only grow, and the US is far from alone among developed countries in facing it.” [END OF BOOK PASSAGE]    [THEME MUSIC]    This is The AI Revolution in Medicine, Revisited. I’m your host, Peter Lee.    Shortly after OpenAI’s GPT-4 was publicly released, Carey Goldberg, Dr. Zak Kohane, and I published The AI Revolution in Medicine to help educate the world of healthcare and medical research about the transformative impact this new generative AI technology could have. But because we wrote the book when GPT-4 was still a secret, we had to speculate. Now, two years later, what did we get right, and what did we get wrong?     In this series, we’ll talk to clinicians, patients, hospital administrators, and others to understand the reality of AI in the field and where we go from here.      [THEME MUSIC FADES] The book passage I read at the top is from “Chapter 4: Trust but Verify,” which was written by Zak. You know, it’s no secret that in the US and elsewhere shortages in medical staff and the rise of clinician burnout are affecting the quality of patient care for the worse. In our book, we predicted that generative AI would be something that might help address these issues. So in this episode, we’ll delve into how individual performance gains that our previous guests have described might affect the healthcare workforce as a whole, and on the patient side, we’ll look into the influence of generative AI on the consumerization of healthcare. Now, since all of this consumes such a huge fraction of the overall economy, we’ll also get into what a general-purpose technology as disruptive as generative AI might mean in the context of labor markets and beyond.   To help us do that, I’m pleased to welcome Ethan Mollick and Azeem Azhar. Ethan Mollick is the Ralph J. Roberts Distinguished Faculty Scholar, a Rowan Fellow, and an associate professor at the Wharton School of the University of Pennsylvania. His research into the effects of AI on work, entrepreneurship, and education is applied by organizations around the world, leading him to be named one of Time magazine’s most influential people in AI for 2024. He’s also the author of the New York Times best-selling book Co-Intelligence. Azeem Azhar is an author, founder, investor, and one of the most thoughtful and influential voices on the interplay between disruptive emerging technologies and business and society. In his best-selling book, The Exponential Age, and in his highly regarded newsletter and podcast, Exponential View, he explores how technologies like AI are reshaping everything from healthcare to geopolitics. Ethan and Azeem are two leading thinkers on the ways that disruptive technologies—and especially AI—affect our work, our jobs, our business enterprises, and whole industries. As economists, they are trying to work out whether we are in the midst of an economic revolution as profound as the shift from an agrarian to an industrial society. [TRANSITION MUSIC] Here is my interview with Ethan Mollick: LEE: Ethan, welcome. ETHAN MOLLICK: So happy to be here, thank you. LEE: I described you as a professor at Wharton, which I think most of the people who listen to this podcast series know of as an elite business school. So it might surprise some people that you study AI. And beyond that, you know, that I would seek you out to talk about AI in medicine. [LAUGHTER] So to get started, how and why did it happen that you’ve become one of the leading experts on AI? MOLLICK: It’s actually an interesting story. I’ve been AI-adjacent my whole career. When I was [getting] my PhD at MIT, I worked with Marvin Minsky (opens in new tab) and the MIT [Massachusetts Institute of Technology] Media Labs AI group. But I was never the technical AI guy. I was the person who was trying to explain AI to everybody else who didn’t understand it. And then I became very interested in, how do you train and teach? And AI was always a part of that. I was building games for teaching, teaching tools that were used in hospitals and elsewhere, simulations. So when LLMs burst into the scene, I had already been using them and had a good sense of what they could do. And between that and, kind of, being practically oriented and getting some of the first research projects underway, especially under education and AI and performance, I became sort of a go-to person in the field. And once you’re in a field where nobody knows what’s going on and we’re all making it up as we go along—I thought it’s funny that you led with the idea that you have a couple of months head start for GPT-4, right. Like that’s all we have at this point, is a few months’ head start. [LAUGHTER] So being a few months ahead is good enough to be an expert at this point. Whether it should be or not is a different question. LEE: Well, if I understand correctly, leading AI companies like OpenAI, Anthropic, and others have now sought you out as someone who should get early access to really start to do early assessments and gauge early reactions. How has that been? MOLLICK: So, I mean, I think the bigger picture is less about me than about two things that tells us about the state of AI right now. One, nobody really knows what’s going on, right. So in a lot of ways, if it wasn’t for your work, Peter, like, I don’t think people would be thinking about medicine as much because these systems weren’t built for medicine. They weren’t built to change education. They weren’t built to write memos. They, like, they weren’t built to do any of these things. They weren’t really built to do anything in particular. It turns out they’re just good at many things. And to the extent that the labs work on them, they care about their coding ability above everything else and maybe math and science secondarily. They don’t think about the fact that it expresses high empathy. They don’t think about its accuracy and diagnosis or where it’s inaccurate. They don’t think about how it’s changing education forever. So one part of this is the fact that they go to my Twitter feed or ask me for advice is an indicator of where they are, too, which is they’re not thinking about this. And the fact that a few months’ head start continues to give you a lead tells you that we are at the very cutting edge. These labs aren’t sitting on projects for two years and then releasing them. Months after a project is complete or sooner, it’s out the door. Like, there’s very little delay. So we’re kind of all in the same boat here, which is a very unusual space for a new technology. LEE: And I, you know, explained that you’re at Wharton. Are you an odd fit as a faculty member at Wharton, or is this a trend now even in business schools that AI experts are becoming key members of the faculty? MOLLICK: I mean, it’s a little of both, right. It’s faculty, so everybody does everything. I’m a professor of innovation-entrepreneurship. I’ve launched startups before and working on that and education means I think about, how do organizations redesign themselves? How do they take advantage of these kinds of problems? So medicine’s always been very central to that, right. A lot of people in my MBA class have been MDs either switching, you know, careers or else looking to advance from being sort of individual contributors to running teams. So I don’t think that’s that bad a fit. But I also think this is general-purpose technology; it’s going to touch everything. The focus on this is medicine, but Microsoft does far more than medicine, right. It’s … there’s transformation happening in literally every field, in every country. This is a widespread effect. So I don’t think we should be surprised that business schools matter on this because we care about management. There’s a long tradition of management and medicine going together. There’s actually a great academic paper that shows that teaching hospitals that also have MBA programs associated with them have higher management scores and perform better (opens in new tab). So I think that these are not as foreign concepts, especially as medicine continues to get more complicated. LEE: Yeah. Well, in fact, I want to dive a little deeper on these issues of management, of entrepreneurship, um, education. But before doing that, if I could just stay focused on you. There is always something interesting to hear from people about their first encounters with AI. And throughout this entire series, I’ve been doing that both pre-generative AI and post-generative AI. So you, sort of, hinted at the pre-generative AI. You were in Minsky’s lab. Can you say a little bit more about that early encounter? And then tell us about your first encounters with generative AI. MOLLICK: Yeah. Those are great questions. So first of all, when I was at the media lab, that was pre-the current boom in sort of, you know, even in the old-school machine learning kind of space. So there was a lot of potential directions to head in. While I was there, there were projects underway, for example, to record every interaction small children had. One of the professors was recording everything their baby interacted with in the hope that maybe that would give them a hint about how to build an AI system. There was a bunch of projects underway that were about labeling every concept and how they relate to other concepts. So, like, it was very much Wild West of, like, how do we make an AI work—which has been this repeated problem in AI, which is, what is this thing? The fact that it was just like brute force over the corpus of all human knowledge turns out to be a little bit of like a, you know, it’s a miracle and a little bit of a disappointment in some ways [LAUGHTER] compared to how elaborate some of this was. So, you know, I think that, that was sort of my first encounters in sort of the intellectual way. The generative AI encounters actually started with the original, sort of, GPT-3, or, you know, earlier versions. And it was actually game-based. So I played games like AI Dungeon. And as an educator, I realized, oh my gosh, this stuff could write essays at a fourth-grade level. That’s really going to change the way, like, middle school works, was my thinking at the time. And I was posting about that back in, you know, 2021 that this is a big deal. But I think everybody was taken surprise, including the AI companies themselves, by, you know, ChatGPT, by GPT-3.5. The difference in degree turned out to be a difference in kind. LEE: Yeah, you know, if I think back, even with GPT-3, and certainly this was the case with GPT-2, it was, at least, you know, from where I was sitting, it was hard to get people to really take this seriously and pay attention. MOLLICK: Yes. LEE: You know, it’s remarkable. Within Microsoft, I think a turning point was the use of GPT-3 to do code completions. And that was actually productized as GitHub Copilot (opens in new tab), the very first version. That, I think, is where there was widespread belief. But, you know, in a way, I think there is, even for me early on, a sense of denial and skepticism. Did you have those initially at any point? MOLLICK: Yeah, I mean, it still happens today, right. Like, this is a weird technology. You know, the original denial and skepticism was, I couldn’t see where this was going. It didn’t seem like a miracle because, you know, of course computers can complete code for you. Like, what else are they supposed to do? Of course, computers can give you answers to questions and write fun things. So there’s difference of moving into a world of generative AI. I think a lot of people just thought that’s what computers could do. So it made the conversations a little weird. But even today, faced with these, you know, with very strong reasoner models that operate at the level of PhD students, I think a lot of people have issues with it, right. I mean, first of all, they seem intuitive to use, but they’re not always intuitive to use because the first use case that everyone puts AI to, it fails at because they use it like Google or some other use case. And then it’s genuinely upsetting in a lot of ways. I think, you know, I write in my book about the idea of three sleepless nights. That hasn’t changed. Like, you have to have an intellectual crisis to some extent, you know, and I think people do a lot to avoid having that existential angst of like, “Oh my god, what does it mean that a machine could think—apparently think—like a person?” So, I mean, I see resistance now. I saw resistance then. And then on top of all of that, there’s the fact that the curve of the technology is quite great. I mean, the price of GPT-4 level intelligence from, you know, when it was released has dropped 99.97% at this point, right. LEE: Yes. Mm-hmm. MOLLICK: I mean, I could run a GPT-4 class system basically on my phone. Microsoft’s releasing things that can almost run on like, you know, like it fits in almost no space, that are almost as good as the original GPT-4 models. I mean, I don’t think people have a sense of how fast the trajectory is moving either. LEE: Yeah, you know, there’s something that I think about often. There is this existential dread, or will this technology replace me? But I think the first people to feel that are researchers—people encountering this for the first time. You know, if you were working, let’s say, in Bayesian reasoning or in traditional, let’s say, Gaussian mixture model based, you know, speech recognition, you do get this feeling, Oh, my god, this technology has just solved the problem that I’ve dedicated my life to. And there is this really difficult period where you have to cope with that. And I think this is going to be spreading, you know, in more and more walks of life. And so this … at what point does that sort of sense of dread hit you, if ever? MOLLICK: I mean, you know, it’s not even dread as much as like, you know, Tyler Cowen wrote that it’s impossible to not feel a little bit of sadness as you use these AI systems, too. Because, like, I was talking to a friend, just as the most minor example, and his talent that he was very proud of was he was very good at writing limericks for birthday cards. He’d write these limericks. Everyone was always amused by them. [LAUGHTER] And now, you know, GPT-4 and GPT-4.5, they made limericks obsolete. Like, anyone can write a good limerick, right. So this was a talent, and it was a little sad. Like, this thing that you cared about mattered. You know, as academics, we’re a little used to dead ends, right, and like, you know, some getting the lap. But the idea that entire fields are hitting that way. Like in medicine, there’s a lot of support systems that are now obsolete. And the question is how quickly you change that. In education, a lot of our techniques are obsolete. What do you do to change that? You know, it’s like the fact that this brute force technology is good enough to solve so many problems is weird, right. And it’s not just the end of, you know, of our research angles that matter, too. Like, for example, I ran this, you know, 14-person-plus, multimillion-dollar effort at Wharton to build these teaching simulations, and we’re very proud of them. It took years of work to build one. Now we’ve built a system that can build teaching simulations on demand by you talking to it with one team member. And, you know, you literally can create any simulation by having a discussion with the AI. I mean, you know, there’s a switch to a new form of excitement, but there is a little bit of like, this mattered to me, and, you know, now I have to change how I do things. I mean, adjustment happens. But if you haven’t had that displacement, I think that’s a good indicator that you haven’t really faced AI yet. LEE: Yeah, what’s so interesting just listening to you is you use words like sadness, and yet I can see the—and hear the—excitement in your voice and your body language. So, you know, that’s also kind of an interesting aspect of all of this.  MOLLICK: Yeah, I mean, I think there’s something on the other side, right. But, like, I can’t say that I haven’t had moments where like, ughhhh, but then there’s joy and basically like also, you know, freeing stuff up. I mean, I think about doctors or professors, right. These are jobs that bundle together lots of different tasks that you would never have put together, right. If you’re a doctor, you would never have expected the same person to be good at keeping up with the research and being a good diagnostician and being a good manager and being good with people and being good with hand skills. Like, who would ever want that kind of bundle? That’s not something you’re all good at, right. And a lot of our stress of our job comes from the fact that we suck at some of it. And so to the extent that AI steps in for that, you kind of feel bad about some of the stuff that it’s doing that you wanted to do. But it’s much more uplifting to be like, I don’t have to do this stuff I’m bad anymore, or I get the support to make myself good at it. And the stuff that I really care about, I can focus on more. Well, because we are at kind of a unique moment where whatever you’re best at, you’re still better than AI. And I think it’s an ongoing question about how long that lasts. But for right now, like you’re not going to say, OK, AI replaces me entirely in my job in medicine. It’s very unlikely. But you will say it replaces these 17 things I’m bad at, but I never liked that anyway. So it’s a period of both excitement and a little anxiety. LEE: Yeah, I’m going to want to get back to this question about in what ways AI may or may not replace doctors or some of what doctors and nurses and other clinicians do. But before that, let’s get into, I think, the real meat of this conversation. In previous episodes of this podcast, we talked to clinicians and healthcare administrators and technology developers that are very rapidly injecting AI today to do various forms of workforce automation, you know, automatically writing a clinical encounter note, automatically filling out a referral letter or request for prior authorization for some reimbursement to an insurance company. And so these sorts of things are intended not only to make things more efficient and lower costs but also to reduce various forms of drudgery, cognitive burden on frontline health workers. So how do you think about the impact of AI on that aspect of workforce, and, you know, what would you expect will happen over the next few years in terms of impact on efficiency and costs? MOLLICK: So I mean, this is a case where I think we’re facing the big bright problem in AI in a lot of ways, which is that this is … at the individual level, there’s lots of performance gains to be gained, right. The problem, though, is that we as individuals fit into systems, in medicine as much as anywhere else or more so, right. Which is that you could individually boost your performance, but it’s also about systems that fit along with this, right. So, you know, if you could automatically, you know, record an encounter, if you could automatically make notes, does that change what you should be expecting for notes or the value of those notes or what they’re for? How do we take what one person does and validate it across the organization and roll it out for everybody without making it a 10-year process that it feels like IT in medicine often is? Like, so we’re in this really interesting period where there’s incredible amounts of individual innovation in productivity and performance improvements in this field, like very high levels of it, but not necessarily seeing that same thing translate to organizational efficiency or gains. And one of my big concerns is seeing that happen. We’re seeing that in nonmedical problems, the same kind of thing, which is, you know, we’ve got research showing 20 and 40% performance improvements, like not uncommon to see those things. But then the organization doesn’t capture it; the system doesn’t capture it. Because the individuals are doing their own work and the systems don’t have the ability to, kind of, learn or adapt as a result. LEE: You know, where are those productivity gains going, then, when you get to the organizational level? MOLLICK: Well, they’re dying for a few reasons. One is, there’s a tendency for individual contributors to underestimate the power of management, right. Practices associated with good management increase happiness, decrease, you know, issues, increase success rates. In the same way, about 40%, as far as we can tell, of the US advantage over other companies, of US firms, has to do with management ability. Like, management is a big deal. Organizing is a big deal. Thinking about how you coordinate is a big deal. At the individual level, when things get stuck there, right, you can’t start bringing them up to how systems work together. It becomes, How do I deal with a doctor that has a 60% performance improvement? We really only have one thing in our playbook for doing that right now, which is, OK, we could fire 40% of the other doctors and still have a performance gain, which is not the answer you want to see happen. So because of that, people are hiding their use. They’re actually hiding their use for lots of reasons. And it’s a weird case because the people who are able to figure out best how to use these systems, for a lot of use cases, they’re actually clinicians themselves because they’re experimenting all the time. Like, they have to take those encounter notes. And if they figure out a better way to do it, they figure that out. You don’t want to wait for, you know, a med tech company to figure that out and then sell that back to you when it can be done by the physicians themselves. So we’re just not used to a period where everybody’s innovating and where the management structure isn’t in place to take advantage of that. And so we’re seeing things stalled at the individual level, and people are often, especially in risk-averse organizations or organizations where there’s lots of regulatory hurdles, people are so afraid of the regulatory piece that they don’t even bother trying to make change. LEE: If you are, you know, the leader of a hospital or a clinic or a whole health system, how should you approach this? You know, how should you be trying to extract positive success out of AI? MOLLICK: So I think that you need to embrace the right kind of risk, right. We don’t want to put risk on our patients … like, we don’t want to put uninformed risk. But innovation involves risk to how organizations operate. They involve change. So I think part of this is embracing the idea that R&D has to happen in organizations again. What’s happened over the last 20 years or so has been organizations giving that up. Partially, that’s a trend to focus on what you’re good at and not try and do this other stuff. Partially, it’s because it’s outsourced now to software companies that, like, Salesforce tells you how to organize your sales team. Workforce tells you how to organize your organization. Consultants come in and will tell you how to make change based on the average of what other people are doing in your field. So companies and organizations and hospital systems have all started to give up their ability to create their own organizational change. And when I talk to organizations, I often say they have to have two approaches. They have to think about the crowd and the lab. So the crowd is the idea of how to empower clinicians and administrators and supporter networks to start using AI and experimenting in ethical, legal ways and then sharing that information with each other. And the lab is, how are we doing R&D about the approach of how to [get] AI to work, not just in direct patient care, right. But also fundamentally, like, what paperwork can you cut out? How can we better explain procedures? Like, what management role can this fill? And we need to be doing active experimentation on that. We can’t just wait for, you know, Microsoft to solve the problems. It has to be at the level of the organizations themselves. LEE: So let’s shift a little bit to the patient. You know, one of the things that we see, and I think everyone is seeing, is that people are turning to chatbots, like ChatGPT, actually to seek healthcare information for, you know, their own health or the health of their loved ones. And there was already, prior to all of this, a trend towards, let’s call it, consumerization of healthcare. So just in the business of healthcare delivery, do you think AI is going to hasten these kinds of trends, or from the consumer’s perspective, what … ? MOLLICK: I mean, absolutely, right. Like, all the early data that we have suggests that for most common medical problems, you should just consult AI, too, right. In fact, there is a real question to ask: at what point does it become unethical for doctors themselves to not ask for a second opinion from the AI because it’s cheap, right? You could overrule it or whatever you want, but like not asking seems foolish. I think the two places where there’s a burning almost, you know, moral imperative is … let’s say, you know, I’m in Philadelphia, I’m a professor, I have access to really good healthcare through the Hospital University of Pennsylvania system. I know doctors. You know, I’m lucky. I’m well connected. If, you know, something goes wrong, I have friends who I can talk to. I have specialists. I’m, you know, pretty well educated in this space. But for most people on the planet, they don’t have access to good medical care, they don’t have good health. It feels like it’s absolutely imperative to say when should you use AI and when not. Are there blind spots? What are those things? And I worry that, like, to me, that would be the crash project I’d be invoking because I’m doing the same thing in education, which is this system is not as good as being in a room with a great teacher who also uses AI to help you, but it’s better than not getting an, you know, to the level of education people get in many cases. Where should we be using it? How do we guide usage in the right way? Because the AI labs aren’t thinking about this. We have to. So, to me, there is a burning need here to understand this. And I worry that people will say, you know, everything that’s true—AI can hallucinate, AI can be biased. All of these things are absolutely true, but people are going to use it. The early indications are that it is quite useful. And unless we take the active role of saying, here’s when to use it, here’s when not to use it, we don’t have a right to say, don’t use this system. And I think, you know, we have to be exploring that. LEE: What do people need to understand about AI? And what should schools, universities, and so on be teaching? MOLLICK: Those are, kind of, two separate questions in lot of ways. I think a lot of people want to teach AI skills, and I will tell you, as somebody who works in this space a lot, there isn’t like an easy, sort of, AI skill, right. I could teach you prompt engineering in two to three classes, but every indication we have is that for most people under most circumstances, the value of prompting, you know, any one case is probably not that useful. A lot of the tricks are disappearing because the AI systems are just starting to use them themselves. So asking good questions, being a good manager, being a good thinker tend to be important, but like magic tricks around making, you know, the AI do something because you use the right phrase used to be something that was real but is rapidly disappearing. So I worry when people say teach AI skills. No one’s been able to articulate to me as somebody who knows AI very well and teaches classes on AI, what those AI skills that everyone should learn are, right. I mean, there’s value in learning a little bit how the models work. There’s a value in working with these systems. A lot of it’s just hands on keyboard kind of work. But, like, we don’t have an easy slam dunk “this is what you learn in the world of AI” because the systems are getting better, and as they get better, they get less sensitive to these prompting techniques. They get better prompting themselves. They solve problems spontaneously and start being agentic. So it’s a hard problem to ask about, like, what do you train someone on? I think getting people experience in hands-on-keyboards, getting them to … there’s like four things I could teach you about AI, and two of them are already starting to disappear. But, like, one is be direct. Like, tell the AI exactly what you want. That’s very helpful. Second, provide as much context as possible. That can include things like acting as a doctor, but also all the information you have. The third is give it step-by-step directions—that’s becoming less important. And the fourth is good and bad examples of the kind of output you want. Those four, that’s like, that’s it as far as the research telling you what to do, and the rest is building intuition. LEE: I’m really impressed that you didn’t give the answer, “Well, everyone should be teaching my book, Co-Intelligence.” [LAUGHS] MOLLICK: Oh, no, sorry! Everybody should be teaching my book Co-Intelligence. I apologize. [LAUGHTER] LEE: It’s good to chuckle about that, but actually, I can’t think of a better book, like, if you were to assign a textbook in any professional education space, I think Co-Intelligence would be number one on my list. Are there other things that you think are essential reading? MOLLICK: That’s a really good question. I think that a lot of things are evolving very quickly. I happen to, kind of, hit a sweet spot with Co-Intelligence to some degree because I talk about how I used it, and I was, sort of, an advanced user of these systems. So, like, it’s, sort of, like my Twitter feed, my online newsletter. I’m just trying to, kind of, in some ways, it’s about trying to make people aware of what these systems can do by just showing a lot, right. Rather than picking one thing, and, like, this is a general-purpose technology. Let’s use it for this. And, like, everybody gets a light bulb for a different reason. So more than reading, it is using, you know, and that can be Copilot or whatever your favorite tool is. But using it. Voice modes help a lot. In terms of readings, I mean, I think that there is a couple of good guides to understanding AI that were originally blog posts. I think Tim Lee has one called Understanding AI (opens in new tab), and it had a good overview … LEE: Yeah, that’s a great one. MOLLICK: … of that topic that I think explains how transformers work, which can give you some mental sense. I think [Andrej] Karpathy (opens in new tab) has some really nice videos of use that I would recommend. Like on the medical side, I think the book that you did, if you’re in medicine, you should read that. I think that that’s very valuable. But like all we can offer are hints in some ways. Like there isn’t … if you’re looking for the instruction manual, I think it can be very frustrating because it’s like you want the best practices and procedures laid out, and we cannot do that, right. That’s not how a system like this works. LEE: Yeah. MOLLICK: It’s not a person, but thinking about it like a person can be helpful, right. LEE: One of the things that has been sort of a fun project for me for the last few years is I have been a founding board member of a new medical school at Kaiser Permanente. And, you know, that medical school curriculum is being formed in this era. But it’s been perplexing to understand, you know, what this means for a medical school curriculum. And maybe even more perplexing for me, at least, is the accrediting bodies, which are extremely important in US medical schools; how accreditors should think about what’s necessary here. Besides the things that you’ve … the, kind of, four key ideas you mentioned, if you were talking to the board of directors of the LCME [Liaison Committee on Medical Education] accrediting body, what’s the one thing you would want them to really internalize? MOLLICK: This is both a fast-moving and vital area. This can’t be viewed like a usual change, which [is], “Let’s see how this works.” Because it’s, like, the things that make medical technologies hard to do, which is like unclear results, limited, you know, expensive use cases where it rolls out slowly. So one or two, you know, advanced medical facilities get access to, you know, proton beams or something else at multi-billion dollars of cost, and that takes a while to diffuse out. That’s not happening here. This is all happening at the same time, all at once. This is now … AI is part of medicine. I mean, there’s a minor point that I’d make that actually is a really important one, which is large language models, generative AI overall, work incredibly differently than other forms of AI. So the other worry I have with some of these accreditors is they blend together algorithmic forms of AI, which medicine has been trying for long time—decision support, algorithmic methods, like, medicine more so than other places has been thinking about those issues. Generative AI, even though it uses the same underlying techniques, is a completely different beast. So, like, even just take the most simple thing of algorithmic aversion, which is a well-understood problem in medicine, right. Which is, so you have a tool that could tell you as a radiologist, you know, the chance of this being cancer; you don’t like it, you overrule it, right. We don’t find algorithmic aversion happening with LLMs in the same way. People actually enjoy using them because it’s more like working with a person. The flaws are different. The approach is different. So you need to both view this as universal applicable today, which makes it urgent, but also as something that is not the same as your other form of AI, and your AI working group that is thinking about how to solve this problem is not the right people here. LEE: You know, I think the world has been trained because of the magic of web search to view computers as question-answering machines. Ask a question, get an answer. MOLLICK: Yes. Yes. LEE: Write a query, get results. And as I have interacted with medical professionals, you can see that medical professionals have that model of a machine in mind. And I think that’s partly, I think psychologically, why hallucination is so alarming. Because you have a mental model of a computer as a machine that has absolutely rock-solid perfect memory recall. But the thing that was so powerful in Co-Intelligence, and we tried to get at this in our book also, is that’s not the sweet spot. It’s this sort of deeper interaction, more of a collaboration. And I thought your use of the term Co-Intelligence really just even in the title of the book tried to capture this. When I think about education, it seems like that’s the first step, to get past this concept of a machine being just a question-answering machine. Do you have a reaction to that idea? MOLLICK: I think that’s very powerful. You know, we’ve been trained over so many years at both using computers but also in science fiction, right. Computers are about cold logic, right. They will give you the right answer, but if you ask it what love is, they explode, right. Like that’s the classic way you defeat the evil robot in Star Trek, right. “Love does not compute.” [LAUGHTER] Instead, we have a system that makes mistakes, is warm, beats doctors in empathy in almost every controlled study on the subject, right. Like, absolutely can outwrite you in a sonnet but will absolutely struggle with giving you the right answer every time. And I think our mental models are just broken for this. And I think you’re absolutely right. And that’s part of what I thought your book does get at really well is, like, this is a different thing. It’s also generally applicable. Again, the model in your head should be kind of like a person even though it isn’t, right. There’s a lot of warnings and caveats to it, but if you start from person, smart person you’re talking to, your mental model will be more accurate than smart machine, even though both are flawed examples, right. So it will make mistakes; it will make errors. The question is, what do you trust it on? What do you not trust it? As you get to know a model, you’ll get to understand, like, I totally don’t trust it for this, but I absolutely trust it for that, right. LEE: All right. So we’re getting to the end of the time we have together. And so I’d just like to get now into something a little bit more provocative. And I get the question all the time. You know, will AI replace doctors? In medicine and other advanced knowledge work, project out five to 10 years. What do think happens? MOLLICK: OK, so first of all, let’s acknowledge systems change much more slowly than individual use. You know, doctors are not individual actors; they’re part of systems, right. So not just the system of a patient who like may or may not want to talk to a machine instead of a person but also legal systems and administrative systems and systems that allocate labor and systems that train people. So, like, it’s hard to imagine that in five to 10 years medicine being so upended that even if AI was better than doctors at every single thing doctors do, that we’d actually see as radical a change in medicine as you might in other fields. I think you will see faster changes happen in consulting and law and, you know, coding, other spaces than medicine. But I do think that there is good reason to suspect that AI will outperform people while still having flaws, right. That’s the difference. We’re already seeing that for common medical questions in enough randomized controlled trials that, you know, best doctors beat AI, but the AI beats the mean doctor, right. Like, that’s just something we should acknowledge is happening at this point. Now, will that work in your specialty? No. Will that work with all the contingent social knowledge that you have in your space? Probably not. Like, these are vignettes, right. But, like, that’s kind of where things are. So let’s assume, right … you’re asking two questions. One is, how good will AI get? LEE: Yeah. MOLLICK: And we don’t know the answer to that question. I will tell you that your colleagues at Microsoft and increasingly the labs, the AI labs themselves, are all saying they think they’ll have a machine smarter than a human at every intellectual task in the next two to three years. If that doesn’t happen, that makes it easier to assume the future, but let’s just assume that that’s the case. I think medicine starts to change with the idea that people feel obligated to use this to help for everything. Your patients will be using it, and it will be your advisor and helper at the beginning phases, right. And I think that I expect people to be better at empathy. I expect better bedside manner. I expect management tasks to become easier. I think administrative burden might lighten if we handle this right way or much worse if we handle it badly. Diagnostic accuracy will increase, right. And then there’s a set of discovery pieces happening, too, right. One of the core goals of all the AI companies is to accelerate medical research. How does that happen and how does that affect us is a, kind of, unknown question. So I think clinicians are in both the eye of the storm and surrounded by it, right. Like, they can resist AI use for longer than most other fields, but everything around them is going to be affected by it. LEE: Well, Ethan, this has been really a fantastic conversation. And, you know, I think in contrast to all the other conversations we’ve had, this one gives especially the leaders in healthcare, you know, people actually trying to lead their organizations into the future, whether it’s in education or in delivery, a lot to think about. So I really appreciate you joining. MOLLICK: Thank you. [TRANSITION MUSIC]   I’m a computing researcher who works with people who are right in the middle of today’s bleeding-edge developments in AI. And because of that, I often lose sight of how to talk to a broader audience about what it’s all about. And so I think one of Ethan’s superpowers is that he has this knack for explaining complex topics in AI in a really accessible way, getting right to the most important points without making it so simple as to be useless. That’s why I rarely miss an opportunity to read up on his latest work. One of the first things I learned from Ethan is the intuition that you can, sort of, think of AI as a very knowledgeable intern. In other words, think of it as a persona that you can interact with, but you also need to be a manager for it and to always assess the work that it does. In our discussion, Ethan went further to stress that there is, because of that, a serious education gap. You know, over the last decade or two, we’ve all been trained, mainly by search engines, to think of computers as question-answering machines. In medicine, in fact, there’s a question-answering application that is really popular called UpToDate (opens in new tab). Doctors use it all the time. But generative AI systems like ChatGPT are different. There’s therefore a challenge in how to break out of the old-fashioned mindset of search to get the full value out of generative AI. The other big takeaway for me was that Ethan pointed out while it’s easy to see productivity gains from AI at the individual level, those same gains, at least today, don’t often translate automatically to organization-wide or system-wide gains. And one, of course, has to conclude that it takes more than just making individuals more productive; the whole system also has to adjust to the realities of AI. Here’s now my interview with Azeem Azhar: LEE: Azeem, welcome. AZEEM AZHAR: Peter, thank you so much for having me.  LEE: You know, I think you’re extremely well known in the world. But still, some of the listeners of this podcast series might not have encountered you before. And so one of the ways I like to ask people to introduce themselves is, how do you explain to your parents what you do every day? AZHAR: Well, I’m very lucky in that way because my mother was the person who got me into computers more than 40 years ago. And I still have that first computer, a ZX81 with a Z80 chip … LEE: Oh wow. AZHAR: … to this day. It sits in my study, all seven and a half thousand transistors and Bakelite plastic that it is. And my parents were both economists, and economics is deeply connected with technology in some sense. And I grew up in the late ’70s and the early ’80s. And that was a time of tremendous optimism around technology. It was space opera, science fiction, robots, and of course, the personal computer and, you know, Bill Gates and Steve Jobs. So that’s where I started. And so, in a way, my mother and my dad, who passed away a few years ago, had always known me as someone who was fiddling with computers but also thinking about economics and society. And so, in a way, it’s easier to explain to them because they’re the ones who nurtured the environment that allowed me to research technology and AI and think about what it means to firms and to the economy at large. LEE: I always like to understand the origin story. And what I mean by that is, you know, what was your first encounter with generative AI? And what was that like? What did you go through? AZHAR: The first real moment was when Midjourney and Stable Diffusion emerged in that summer of 2022. I’d been away on vacation, and I came back—and I’d been off grid, in fact—and the world had really changed. Now, I’d been aware of GPT-3 and GPT-2, which I played around with and with BERT, the original transformer paper about seven or eight years ago, but it was the moment where I could talk to my computer, and it could produce these images, and it could be refined in natural language that really made me think we’ve crossed into a new domain. We’ve gone from AI being highly discriminative to AI that’s able to explore the world in particular ways. And then it was a few months later that ChatGPT came out—November, the 30th. And I think it was the next day or the day after that I said to my team, everyone has to use this, and we have to meet every morning and discuss how we experimented the day before. And we did that for three or four months. And, you know, it was really clear to me in that interface at that point that, you know, we’d absolutely pass some kind of threshold. LEE: And who’s the we that you were experimenting with? AZHAR: So I have a team of four who support me. They’re mostly researchers of different types. I mean, it’s almost like one of those jokes. You know, I have a sociologist, an economist, and an astrophysicist. And, you know, they walk into the bar, [LAUGHTER] or they walk into our virtual team room, and we try to solve problems. LEE: Well, so let’s get now into brass tacks here. And I think I want to start maybe just with an exploration of the economics of all this and economic realities. Because I think in a lot of your work—for example, in your book—you look pretty deeply at how automation generally and AI specifically are transforming certain sectors like finance, manufacturing, and you have a really, kind of, insightful focus on what this means for productivity and which ways, you know, efficiencies are found.   And then you, sort of, balance that with risks, things that can and do go wrong. And so as you take that background and looking at all those other sectors, in what ways are the same patterns playing out or likely to play out in healthcare and medicine? AZHAR: I’m sure we will see really remarkable parallels but also new things going on. I mean, medicine has a particular quality compared to other sectors in the sense that it’s highly regulated, market structure is very different country to country, and it’s an incredibly broad field. I mean, just think about taking a Tylenol and going through laparoscopic surgery. Having an MRI and seeing a physio. I mean, this is all medicine. I mean, it’s hard to imagine a sector that is [LAUGHS] more broad than that. So I think we can start to break it down, and, you know, where we’re seeing things with generative AI will be that the, sort of, softest entry point, which is the medical scribing. And I’m sure many of us have been with clinicians who have a medical scribe running alongside—they’re all on Surface Pros I noticed, right? [LAUGHTER] They’re on the tablet computers, and they’re scribing away. And what that’s doing is, in the words of my friend Eric Topol, it’s giving the clinician time back (opens in new tab), right. They have time back from days that are extremely busy and, you know, full of administrative overload. So I think you can obviously do a great deal with reducing that overload. And within my team, we have a view, which is if you do something five times in a week, you should be writing an automation for it. And if you’re a doctor, you’re probably reviewing your notes, writing the prescriptions, and so on several times a day. So those are things that can clearly be automated, and the human can be in the loop. But I think there are so many other ways just within the clinic that things can help. So, one of my friends, my friend from my junior school—I’ve known him since I was 9—is an oncologist who’s also deeply into machine learning, and he’s in Cambridge in the UK. And he built with Microsoft Research a suite of imaging AI tools from his own discipline, which they then open sourced. So that’s another way that you have an impact, which is that you actually enable the, you know, generalist, specialist, polymath, whatever they are in health systems to be able to get this technology, to tune it to their requirements, to use it, to encourage some grassroots adoption in a system that’s often been very, very heavily centralized. LEE: Yeah. AZHAR: And then I think there are some other things that are going on that I find really, really exciting. So one is the consumerization of healthcare. So I have one of those sleep tracking rings, the Oura (opens in new tab). LEE: Yup. AZHAR: That is building a data stream that we’ll be able to apply more and more AI to. I mean, right now, it’s applying traditional, I suspect, machine learning, but you can imagine that as we start to get more data, we start to get more used to measuring ourselves, we create this sort of pot, a personal asset that we can turn AI to. And there’s still another category. And that other category is one of the completely novel ways in which we can enable patient care and patient pathway. And there’s a fantastic startup in the UK called Neko Health (opens in new tab), which, I mean, does physicals, MRI scans, and blood tests, and so on. It’s hard to imagine Neko existing without the sort of advanced data, machine learning, AI that we’ve seen emerge over the last decade. So, I mean, I think that there are so many ways in which the temperature is slowly being turned up to encourage a phase change within the healthcare sector. And last but not least, I do think that these tools can also be very, very supportive of a clinician’s life cycle. I think we, as patients, we’re a bit …  I don’t know if we’re as grateful as we should be for our clinicians who are putting in 90-hour weeks. [LAUGHTER] But you can imagine a world where AI is able to support not just the clinicians’ workload but also their sense of stress, their sense of burnout. So just in those five areas, Peter, I sort of imagine we could start to fundamentally transform over the course of many years, of course, the way in which people think about their health and their interactions with healthcare systems LEE: I love how you break that down. And I want to press on a couple of things. You also touched on the fact that medicine is, at least in most of the world, is a highly regulated industry. I guess finance is the same way, but they also feel different because the, like, finance sector has to be very responsive to consumers, and consumers are sensitive to, you know, an abundance of choice; they are sensitive to price. Is there something unique about medicine besides being regulated? AZHAR: I mean, there absolutely is. And in finance, as well, you have much clearer end states. So if you’re not in the consumer space, but you’re in the, you know, asset management space, you have to essentially deliver returns against the volatility or risk boundary, right. That’s what you have to go out and do. And I think if you’re in the consumer industry, you can come back to very, very clear measures, net promoter score being a very good example. In the case of medicine and healthcare, it is much more complicated because as far as the clinician is concerned, people are individuals, and we have our own parts and our own responses. If we didn’t, there would never be a need for a differential diagnosis. There’d never be a need for, you know, Let’s try azithromycin first, and then if that doesn’t work, we’ll go to vancomycin, or, you know, whatever it happens to be. You would just know. But ultimately, you know, people are quite different. The symptoms that they’re showing are quite different, and also their compliance is really, really different. I had a back problem that had to be dealt with by, you know, a physio and extremely boring exercises four times a week, but I was ruthless in complying, and my physio was incredibly surprised. He’d say well no one ever does this, and I said, well you know the thing is that I kind of just want to get this thing to go away. LEE: Yeah. AZHAR: And I think that that’s why medicine is and healthcare is so different and more complex. But I also think that’s why AI can be really, really helpful. I mean, we didn’t talk about, you know, AI in its ability to potentially do this, which is to extend the clinician’s presence throughout the week. LEE: Right. Yeah. AZHAR: The idea that maybe some part of what the clinician would do if you could talk to them on Wednesday, Thursday, and Friday could be delivered through an app or a chatbot just as a way of encouraging the compliance, which is often, especially with older patients, one reason why conditions, you know, linger on for longer. LEE: You know, just staying on the regulatory thing, as I’ve thought about this, the one regulated sector that I think seems to have some parallels to healthcare is energy delivery, energy distribution. Because like healthcare, as a consumer, I don’t have choice in who delivers electricity to my house. And even though I care about it being cheap or at least not being overcharged, I don’t have an abundance of choice. I can’t do price comparisons. And there’s something about that, just speaking as a consumer of both energy and a consumer of healthcare, that feels similar. Whereas other regulated industries, you know, somehow, as a consumer, I feel like I have a lot more direct influence and power. Does that make any sense to someone, you know, like you, who’s really much more expert in how economic systems work? AZHAR: I mean, in a sense, one part of that is very, very true. You have a limited panel of energy providers you can go to, and in the US, there may be places where you have no choice. I think the area where it’s slightly different is that as a consumer or a patient, you can actually make meaningful choices and changes yourself using these technologies, and people used to joke about you know asking Dr. Google. But Dr. Google is not terrible, particularly if you go to WebMD. And, you know, when I look at long-range change, many of the regulations that exist around healthcare delivery were formed at a point before people had access to good quality information at the touch of their fingertips or when educational levels in general were much, much lower. And many regulations existed because of the incumbent power of particular professional sectors. I’ll give you an example from the United Kingdom. So I have had asthma all of my life. That means I’ve been taking my inhaler, Ventolin, and maybe a steroid inhaler for nearly 50 years. That means that I know … actually, I’ve got more experience, and I—in some sense—know more about it than a general practitioner. LEE: Yeah. AZHAR: And until a few years ago, I would have to go to a general practitioner to get this drug that I’ve been taking for five decades, and there they are, age 30 or whatever it is. And a few years ago, the regulations changed. And now pharmacies can … or pharmacists can prescribe those types of drugs under certain conditions directly. LEE: Right. AZHAR: That was not to do with technology. That was to do with incumbent lock-in. So when we look at the medical industry, the healthcare space, there are some parallels with energy, but there are a few little things that the ability that the consumer has to put in some effort to learn about their condition, but also the fact that some of the regulations that exist just exist because certain professions are powerful. LEE: Yeah, one last question while we’re still on economics. There seems to be a conundrum about productivity and efficiency in healthcare delivery because I’ve never encountered a doctor or a nurse that wants to be able to handle even more patients than they’re doing on a daily basis. And so, you know, if productivity means simply, well, your rounds can now handle 16 patients instead of eight patients, that doesn’t seem necessarily to be a desirable thing. So how can we or should we be thinking about efficiency and productivity since obviously costs are, in most of the developed world, are a huge, huge problem? AZHAR: Yes, and when you described doubling the number of patients on the round, I imagined you buying them all roller skates so they could just whizz around [LAUGHTER] the hospital faster and faster than ever before. We can learn from what happened with the introduction of electricity. Electricity emerged at the end of the 19th century, around the same time that cars were emerging as a product, and car makers were very small and very artisanal. And in the early 1900s, some really smart car makers figured out that electricity was going to be important. And they bought into this technology by putting pendant lights in their workshops so they could “visit more patients.” Right? LEE: Yeah, yeah. AZHAR: They could effectively spend more hours working, and that was a productivity enhancement, and it was noticeable. But, of course, electricity fundamentally changed the productivity by orders of magnitude of people who made cars starting with Henry Ford because he was able to reorganize his factories around the electrical delivery of power and to therefore have the moving assembly line, which 10xed the productivity of that system. So when we think about how AI will affect the clinician, the nurse, the doctor, it’s much easier for us to imagine it as the pendant light that just has them working later … LEE: Right. AZHAR: … than it is to imagine a reconceptualization of the relationship between the clinician and the people they care for. And I’m not sure. I don’t think anybody knows what that looks like. But, you know, I do think that there will be a way that this changes, and you can see that scale out factor. And it may be, Peter, that what we end up doing is we end up saying, OK, because we have these brilliant AIs, there’s a lower level of training and cost and expense that’s required for a broader range of conditions that need treating. And that expands the market, right. That expands the market hugely. It’s what has happened in the market for taxis or ride sharing. The introduction of Uber and the GPS system … LEE: Yup. AZHAR: … has meant many more people now earn their living driving people around in their cars. And at least in London, you had to be reasonably highly trained to do that. So I can see a reorganization is possible. Of course, entrenched interests, the economic flow … and there are many entrenched interests, particularly in the US between the health systems and the, you know, professional bodies that might slow things down. But I think a reimagining is possible. And if I may, I’ll give you one example of that, which is, if you go to countries outside of the US where there are many more sick people per doctor, they have incentives to change the way they deliver their healthcare. And well before there was AI of this quality around, there was a few cases of health systems in India—Aravind Eye Care (opens in new tab) was one, and Narayana Hrudayalaya [now known as Narayana Health (opens in new tab)] was another. And in the latter, they were a cardiac care unit where you couldn’t get enough heart surgeons. LEE: Yeah, yep. AZHAR: So specially trained nurses would operate under the supervision of a single surgeon who would supervise many in parallel. So there are ways of increasing the quality of care, reducing the cost, but it does require a systems change. And we can’t expect a single bright algorithm to do it on its own. LEE: Yeah, really, really interesting. So now let’s get into regulation. And let me start with this question. You know, there are several startup companies I’m aware of that are pushing on, I think, a near-term future possibility that a medical AI for consumer might be allowed, say, to prescribe a medication for you, something that would normally require a doctor or a pharmacist, you know, that is certified in some way, licensed to do. Do you think we’ll get to a point where for certain regulated activities, humans are more or less cut out of the loop? AZHAR: Well, humans would have been in the loop because they would have provided the training data, they would have done the oversight, the quality control. But to your question in general, would we delegate an important decision entirely to a tested set of algorithms? I’m sure we will. We already do that. I delegate less important decisions like, What time should I leave for the airport to Waze. I delegate more important decisions to the automated braking in my car. We will do this at certain levels of risk and threshold. If I come back to my example of prescribing Ventolin. It’s really unclear to me that the prescription of Ventolin, this incredibly benign bronchodilator that is only used by people who’ve been through the asthma process, needs to be prescribed by someone who’s gone through 10 years or 12 years of medical training. And why that couldn’t be prescribed by an algorithm or an AI system. LEE: Right. Yep. Yep. AZHAR: So, you know, I absolutely think that that will be the case and could be the case. I can’t really see what the objections are. And the real issue is where do you draw the line of where you say, “Listen, this is too important,” or “The cost is too great,” or “The side effects are too high,” and therefore this is a point at which we want to have some, you know, human taking personal responsibility, having a liability framework in place, having a sense that there is a person with legal agency who signed off on this decision. And that line I suspect will start fairly low, and what we’d expect to see would be that that would rise progressively over time. LEE: What you just said, that scenario of your personal asthma medication, is really interesting because your personal AI might have the benefit of 50 years of your own experience with that medication. So, in a way, there is at least the data potential for, let’s say, the next prescription to be more personalized and more tailored specifically for you. AZHAR: Yes. Well, let’s dig into this because I think this is super interesting, and we can look at how things have changed. So 15 years ago, if I had a bad asthma attack, which I might have once a year, I would have needed to go and see my general physician. In the UK, it’s very difficult to get an appointment. I would have had to see someone privately who didn’t know me at all because I’ve just walked in off the street, and I would explain my situation. It would take me half a day. Productivity lost. I’ve been miserable for a couple of days with severe wheezing. Then a few years ago the system changed, a protocol changed, and now I have a thing called a rescue pack, which includes prednisolone steroids. It includes something else I’ve just forgotten, and an antibiotic in case I get an upper respiratory tract infection, and I have an “algorithm.” It’s called a protocol. It’s printed out. It’s a flowchart I answer various questions, and then I say, “I’m going to prescribe this to myself.” You know, UK doctors don’t prescribe prednisolone, or prednisone as you may call it in the US, at the drop of a hat, right. It’s a powerful steroid. I can self-administer, and I can now get that repeat prescription without seeing a physician a couple of times a year. And the algorithm, the “AI” is, it’s obviously been done in PowerPoint naturally, and it’s a bunch of arrows. [LAUGHS] Surely, surely, an AI system is going to be more sophisticated, more nuanced, and give me more assurance that I’m making the right decision around something like that. LEE: Yeah. Well, at a minimum, the AI should be able to make that PowerPoint the next time. [LAUGHS] AZHAR: Yeah, yeah. Thank god for Clippy. Yes. LEE: So, you know, I think in our book, we had a lot of certainty about most of the things we’ve discussed here, but one chapter where I felt we really sort of ran out of ideas, frankly, was on regulation. And, you know, what we ended up doing for that chapter is … I can’t remember if it was Carey’s or Zak’s idea, but we asked GPT-4 to have a conversation, a debate with itself [LAUGHS], about regulation. And we made some minor commentary on that. And really, I think we took that approach because we just didn’t have much to offer. By the way, in our defense, I don’t think anyone else had any better ideas anyway. AZHAR: Right. LEE: And so now two years later, do we have better ideas about the need for regulation, the frameworks around which those regulations should be developed, and, you know, what should this look like? AZHAR: So regulation is going to be in some cases very helpful because it provides certainty for the clinician that they’re doing the right thing, that they are still insured for what they’re doing, and it provides some degree of confidence for the patient. And we need to make sure that the claims that are made stand up to quite rigorous levels, where ideally there are RCTs [randomized control trials], and there are the classic set of processes you go through. You do also want to be able to experiment, and so the question is: as a regulator, how can you enable conditions for there to be experimentation? And what is experimentation? Experimentation is learning so that every element of the system can learn from this experience. So finding that space where there can be bit of experimentation, I think, becomes very, very important. And a lot of this is about experience, so I think the first digital therapeutics have received FDA approval, which means there are now people within the FDA who understand how you go about running an approvals process for that, and what that ends up looking like—and of course what we’re very good at doing in this sort of modern hyper-connected world—is we can share that expertise, that knowledge, that experience very, very quickly. So you go from one approval a year to a hundred approvals a year to a thousand approvals a year. So we will then actually, I suspect, need to think about what is it to approve digital therapeutics because, unlike big biological molecules, we can generate these digital therapeutics at the rate of knots [very rapidly]. LEE: Yes. AZHAR: Every road in Hayes Valley in San Francisco, right, is churning out new startups who will want to do things like this. So then, I think about, what does it mean to get approved if indeed it gets approved? But we can also go really far with things that don’t require approval. I come back to my sleep tracking ring. So I’ve been wearing this for a few years, and when I go and see my doctor or I have my annual checkup, one of the first things that he asks is how have I been sleeping. And in fact, I even sync my sleep tracking data to their medical record system, so he’s saying … hearing what I’m saying, but he’s actually pulling up the real data going, This patient’s lying to me again. Of course, I’m very truthful with my doctor, as we should all be. [LAUGHTER] LEE: You know, actually, that brings up a point that consumer-facing health AI has to deal with pop science, bad science, you know, weird stuff that you hear on Reddit. And because one of the things that consumers want to know always is, you know, what’s the truth? AZHAR: Right. LEE: What can I rely on? And I think that somehow feels different than an AI that you actually put in the hands of, let’s say, a licensed practitioner. And so the regulatory issues seem very, very different for these two cases somehow. AZHAR: I agree, they’re very different. And I think for a lot of areas, you will want to build AI systems that are first and foremost for the clinician, even if they have patient extensions, that idea that the clinician can still be with a patient during the week. And you’ll do that anyway because you need the data, and you also need a little bit of a liability shield to have like a sensible person who’s been trained around that. And I think that’s going to be a very important pathway for many AI medical crossovers. We’re going to go through the clinician. LEE: Yeah. AZHAR: But I also do recognize what you say about the, kind of, kooky quackery that exists on Reddit. Although on Creatine, Reddit may yet prove to have been right. [LAUGHTER] LEE: Yeah, that’s right. Yes, yeah, absolutely. Yeah. AZHAR: Sometimes it’s right. And I think that it serves a really good role as a field of extreme experimentation. So if you’re somebody who makes a continuous glucose monitor traditionally given to diabetics but now lots of people will wear them—and sports people will wear them—you probably gathered a lot of extreme tail distribution data by reading the Reddit/biohackers … LEE: Yes. AZHAR: … for the last few years, where people were doing things that you would never want them to really do with the CGM [continuous glucose monitor]. And so I think we shouldn’t understate how important that petri dish can be for helping us learn what could happen next. LEE: Oh, I think it’s absolutely going to be essential and a bigger thing in the future. So I think I just want to close here then with one last question. And I always try to be a little bit provocative with this. And so as you look ahead to what doctors and nurses and patients might be doing two years from now, five years from now, 10 years from now, do you have any kind of firm predictions? AZHAR: I’m going to push the boat out, and I’m going to go further out than closer in. LEE: OK. [LAUGHS] AZHAR: As patients, we will have many, many more touch points and interaction with our biomarkers and our health. We’ll be reading how well we feel through an array of things. And some of them we’ll be wearing directly, like sleep trackers and watches. And so we’ll have a better sense of what’s happening in our lives. It’s like the moment you go from paper bank statements that arrive every month to being able to see your account in real time. LEE: Yes. AZHAR: And I suspect we’ll have … we’ll still have interactions with clinicians because societies that get richer see doctors more, societies that get older see doctors more, and we’re going to be doing both of those over the coming 10 years. But there will be a sense, I think, of continuous health engagement, not in an overbearing way, but just in a sense that we know it’s there, we can check in with it, it’s likely to be data that is compiled on our behalf somewhere centrally and delivered through a user experience that reinforces agency rather than anxiety. And we’re learning how to do that slowly. I don’t think the health apps on our phones and devices have yet quite got that right. And that could help us personalize problems before they arise, and again, I use my experience for things that I’ve tracked really, really well. And I know from my data and from how I’m feeling when I’m on the verge of one of those severe asthma attacks that hits me once a year, and I can take a little bit of preemptive measure, so I think that that will become progressively more common and that sense that we will know our baselines. I mean, when you think about being an athlete, which is something I think about, but I could never ever do, [LAUGHTER] but what happens is you start with your detailed baselines, and that’s what your health coach looks at every three or four months. For most of us, we have no idea of our baselines. You we get our blood pressure measured once a year. We will have baselines, and that will help us on an ongoing basis to better understand and be in control of our health. And then if the product designers get it right, it will be done in a way that doesn’t feel invasive, but it’ll be done in a way that feels enabling. We’ll still be engaging with clinicians augmented by AI systems more and more because they will also have gone up the stack. They won’t be spending their time on just “take two Tylenol and have a lie down” type of engagements because that will be dealt with earlier on in the system. And so we will be there in a very, very different set of relationships. And they will feel that they have different ways of looking after our health. LEE: Azeem, it’s so comforting to hear such a wonderfully optimistic picture of the future of healthcare. And I actually agree with everything you’ve said. Let me just thank you again for joining this conversation. I think it’s been really fascinating. And I think somehow the systemic issues, the systemic issues that you tend to just see with such clarity, I think are going to be the most, kind of, profound drivers of change in the future. So thank you so much. AZHAR: Well, thank you, it’s been my pleasure, Peter, thank you. [TRANSITION MUSIC]   I always think of Azeem as a systems thinker. He’s always able to take the experiences of new technologies at an individual level and then project out to what this could mean for whole organizations and whole societies. In our conversation, I felt that Azeem really connected some of what we learned in a previous episode—for example, from Chrissy Farr—on the evolving consumerization of healthcare to the broader workforce and economic impacts that we’ve heard about from Ethan Mollick.   Azeem’s personal story about managing his asthma was also a great example. You know, he imagines a future, as do I, where personal AI might assist and remember decades of personal experience with a condition like asthma and thereby know more than any human being could possibly know in a deeply personalized and effective way, leading to better care. Azeem’s relentless optimism about our AI future was also so heartening to hear. Both of these conversations leave me really optimistic about the future of AI in medicine. At the same time, it is pretty sobering to realize just how much we’ll all need to change in pretty fundamental and maybe even in radical ways. I think a big insight I got from these conversations is how we interact with machines is going to have to be altered not only at the individual level, but at the company level and maybe even at the societal level. Since my conversation with Ethan and Azeem, there have been some pretty important developments that speak directly to this. Just last week at Build (opens in new tab), which is Microsoft’s yearly developer conference, we announced a slew of AI agent technologies. Our CEO, Satya Nadella, in fact, started his keynote by going online in a GitHub developer environment and then assigning a coding task to an AI agent, basically treating that AI as a full-fledged member of a development team. Other agents, for example, a meeting facilitator, a data analyst, a business researcher, travel agent, and more were also shown during the conference. But pertinent to healthcare specifically, what really blew me away was the demonstration of a healthcare orchestrator agent. And the specific thing here was in Stanford’s cancer treatment center, when they are trying to decide on potentially experimental treatments for cancer patients, they convene a meeting of experts. That is typically called a tumor board. And so this AI healthcare orchestrator agent actually participated as a full-fledged member of a tumor board meeting to help bring data together, make sure that the latest medical knowledge was brought to bear, and to assist in the decision-making around a patient’s cancer treatment. It was pretty amazing. [THEME MUSIC] A big thank-you again to Ethan and Azeem for sharing their knowledge and understanding of the dynamics between AI and society more broadly. And to our listeners, thank you for joining us. I’m really excited for the upcoming episodes, including discussions on medical students’ experiences with AI and AI’s influence on the operation of health systems and public health departments. We hope you’ll continue to tune in. Until next time. 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  • Will Pornhub Get Blocked in Europe? EU Regulators Open Age-Verification Probe

    Four of the world's biggest pornography websites are facing formal investigations around age verification in the European Union. European regulators will determine whether Pornhub, Stripchat, XNXX, and XVideos are doing enough to to protect minors from harmful content, as required by the Digital Services Act. Preliminary investigations already found that the four sites aren’t complying with two elements of the DSA, both of which focus on younger internet users.First, the EU finds that the sites aren't providing appropriate measures to “ensure a high level of privacy, safety and security for minors.” This includes the companies not going far enough for age-verification methods suitable enough to stop minors being able to access adult material. Many of these sites allow access by entering a date of birth, which can be easily faked.The European Commission is working with EU member states to develop a “white label age-verification app” to help provide better implementation to access adult material. It says it will then use the EU Digital Wallet by the end of 2026.The second element of the investigation is whether the companies are including "mitigation measures of any negative effects" on kids who do manage to access the sites. Recommended by Our EditorsAll four sites were all given “very large online platform”designation at different stages since 2023, which means they’re under strict guidance in the European market. As part of this announcement, the Commission also announced Stripchat will be losing its VLOP designation later this year after a drop in users for the last year. But even when the VLOP title is removed, the company will need to abide by rules to protect minors.“The online space should be a safe environment for children to learn and connect,” said Henna Virkkunen, EVP for Tech Sovereignty, Security and Democracy at the European Commission. “Our priority is to protect minors and allow them to navigate safely online."In a statement, Pornhub parent company Aylo says it's "aware of the European Commission's investigation and are fully committed to ensuring the safety of minors online.""Our sites are fully RTA compliant as rated by the Association of Sites Advocating Child Protection, and are strictly reserved for those of legal age only. We will always comply with the law, but we hope that governments around the world will implement laws that protect the safety and security of users," it adds. "We believe that the real solution for protecting minors and adults alike is to verify users’ ages at the point of access—the users’ devices—and for websites to deny or permit access to age-restricted materials based on that verification."Aylo makes the same argument in the US, where it has blocked access to its sites in states with age-verification laws, though a VPN should help you get around those bans. Requiring people to provide things like selfies with government IDs to verify their ages will only drive people to less scrupulous sites, which "put minors and your privacy at risk," it says.
    #will #pornhub #get #blocked #europe
    Will Pornhub Get Blocked in Europe? EU Regulators Open Age-Verification Probe
    Four of the world's biggest pornography websites are facing formal investigations around age verification in the European Union. European regulators will determine whether Pornhub, Stripchat, XNXX, and XVideos are doing enough to to protect minors from harmful content, as required by the Digital Services Act. Preliminary investigations already found that the four sites aren’t complying with two elements of the DSA, both of which focus on younger internet users.First, the EU finds that the sites aren't providing appropriate measures to “ensure a high level of privacy, safety and security for minors.” This includes the companies not going far enough for age-verification methods suitable enough to stop minors being able to access adult material. Many of these sites allow access by entering a date of birth, which can be easily faked.The European Commission is working with EU member states to develop a “white label age-verification app” to help provide better implementation to access adult material. It says it will then use the EU Digital Wallet by the end of 2026.The second element of the investigation is whether the companies are including "mitigation measures of any negative effects" on kids who do manage to access the sites. Recommended by Our EditorsAll four sites were all given “very large online platform”designation at different stages since 2023, which means they’re under strict guidance in the European market. As part of this announcement, the Commission also announced Stripchat will be losing its VLOP designation later this year after a drop in users for the last year. But even when the VLOP title is removed, the company will need to abide by rules to protect minors.“The online space should be a safe environment for children to learn and connect,” said Henna Virkkunen, EVP for Tech Sovereignty, Security and Democracy at the European Commission. “Our priority is to protect minors and allow them to navigate safely online."In a statement, Pornhub parent company Aylo says it's "aware of the European Commission's investigation and are fully committed to ensuring the safety of minors online.""Our sites are fully RTA compliant as rated by the Association of Sites Advocating Child Protection, and are strictly reserved for those of legal age only. We will always comply with the law, but we hope that governments around the world will implement laws that protect the safety and security of users," it adds. "We believe that the real solution for protecting minors and adults alike is to verify users’ ages at the point of access—the users’ devices—and for websites to deny or permit access to age-restricted materials based on that verification."Aylo makes the same argument in the US, where it has blocked access to its sites in states with age-verification laws, though a VPN should help you get around those bans. Requiring people to provide things like selfies with government IDs to verify their ages will only drive people to less scrupulous sites, which "put minors and your privacy at risk," it says. #will #pornhub #get #blocked #europe
    ME.PCMAG.COM
    Will Pornhub Get Blocked in Europe? EU Regulators Open Age-Verification Probe
    Four of the world's biggest pornography websites are facing formal investigations around age verification in the European Union. European regulators will determine whether Pornhub, Stripchat, XNXX, and XVideos are doing enough to to protect minors from harmful content, as required by the Digital Services Act (DSA). Preliminary investigations already found that the four sites aren’t complying with two elements of the DSA, both of which focus on younger internet users.First, the EU finds that the sites aren't providing appropriate measures to “ensure a high level of privacy, safety and security for minors.” This includes the companies not going far enough for age-verification methods suitable enough to stop minors being able to access adult material. Many of these sites allow access by entering a date of birth, which can be easily faked.The European Commission is working with EU member states to develop a “white label age-verification app” to help provide better implementation to access adult material. It says it will then use the EU Digital Wallet by the end of 2026.The second element of the investigation is whether the companies are including "mitigation measures of any negative effects" on kids who do manage to access the sites. Recommended by Our EditorsAll four sites were all given “very large online platform” (VLOP) designation at different stages since 2023, which means they’re under strict guidance in the European market. As part of this announcement, the Commission also announced Stripchat will be losing its VLOP designation later this year after a drop in users for the last year. But even when the VLOP title is removed, the company will need to abide by rules to protect minors.“The online space should be a safe environment for children to learn and connect,” said Henna Virkkunen, EVP for Tech Sovereignty, Security and Democracy at the European Commission. “Our priority is to protect minors and allow them to navigate safely online."In a statement, Pornhub parent company Aylo says it's "aware of the European Commission's investigation and are fully committed to ensuring the safety of minors online.""Our sites are fully RTA compliant as rated by the Association of Sites Advocating Child Protection (ASACP), and are strictly reserved for those of legal age only. We will always comply with the law, but we hope that governments around the world will implement laws that protect the safety and security of users," it adds. "We believe that the real solution for protecting minors and adults alike is to verify users’ ages at the point of access—the users’ devices—and for websites to deny or permit access to age-restricted materials based on that verification."Aylo makes the same argument in the US, where it has blocked access to its sites in states with age-verification laws, though a VPN should help you get around those bans. Requiring people to provide things like selfies with government IDs to verify their ages will only drive people to less scrupulous sites, which "put minors and your privacy at risk," it says.
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  • Why Medicaid work requirements place extra burdens on low-income families

    Republican lawmakers have been battling over a bill that includes massive tax and spending cuts. Much of their disagreement has been over provisions intended to reduce the cost of Medicaid.

    The popular health insurance program, which is funded by both the federal and state governments, covers about 78.5 million low-income and disabled people—more than 1 in 5 Americans.

    On May 22, 2025, the House of Representatives narrowly approved the tax, spending, and immigration bill. The legislation, which passed without any support from Democrats, is designed to reduce federal Medicaid spending by requiring anyone enrolled in the program who appears to be able to get a job to either satisfy work requirements or lose their coverage. It’s still unclear, however, whether Senate Republicans would support that provision.

    Although there are few precedents for such a mandate for Medicaid, other safety net programs have been enforcing similar rules for nearly three decades. I’m a political scientist who has extensively studied the work requirements of another safety net program: Temporary Assistance for Needy Families.

    As I explain in my book, Living Off the Government? Race, Gender, and the Politics of Welfare, work requirements place extra burdens on low-income families but do little to lift them out of poverty.

    Work requirements for TANF

    TANF gives families with very low incomes some cash they can spend on housing, food, clothing, or whatever they need most. The Clinton administration launched it as a replacement for a similar program, Aid to Families With Dependent Children, in 1996. At the time, both political parties were eager to end a welfare system they believed was riddled with abuse. A big goal with TANF was ending the dependence of people getting cash benefits on the government by moving them from welfare to work.

    Many people were removed from the welfare rolls, but not because work requirements led to economic prosperity. Instead, they had trouble navigating the bureaucratic demands.

    TANF is administered by the states. They can set many rules of their own, but they must comply with an important federal requirement: Adult recipients have to work or engage in an authorized alternative activity for at least 30 hours per week. The number of weekly hours is only 20 if the recipient is caring for a child under the age of 6.

    The dozen activities or so that can count toward this quota range from participating in job training programs to engaging in community service.

    Some adults enrolled in TANF are exempt from work requirements, depending on their state’s own policies. The most common exemptions are for people who are ill, have a disability, or are over age 60.

    To qualify for TANF, families must have dependent children; in some states pregnant women also qualify. Income limits are set by the state and range from a month for a family of three in Alabama to a month for a family of three in Minnesota.

    Adult TANF recipients face a federal five-year lifetime limit on benefits. States can adopt shorter time limits; Arizona’s is 12 months.

    An administrative burden

    Complying with these work requirements generally means proving that you’re working or making the case that you should be exempt from this mandate. This places what’s known as an “administrative burden” on the people who get cash assistance. It often requires lots of documentation and time. If you have an unpredictable work schedule, inconsistent access to child care, or obligations to care for an older relative, this paperwork is hard to deal with.

    What counts as work, how many hours must be completed, and who is exempt from these requirements often comes down to a caseworker’s discretion. Social science research shows that this discretion is not equally applied and is often informed by stereotypes.

    The number of people getting cash assistance has fallen sharply since TANF replaced Aid to Families With Dependent Children. In some states caseloads have dropped by more than 50% despite significant population growth.

    Some of this decline happened because recipients got jobs that paid them too much to qualify. The Congressional Budget Office, a nonpartisan office that provides economic research to Congress, attributes, at least in part, an increase in employment among less-educated single mothers in the 1990s to work requirements.

    Not everyone who stopped getting cash benefits through TANF wound up employed, however. Other recipients who did not meet requirements fell into deep poverty.

    Regardless of why people leave the program, when fewer low-income Americans get TANF benefits, the government spends less money on cash assistance. Federal funding has remained flat at billion since 1996. Taking inflation into account, the program receives half as much funding as when it was created. In addition, states have used the flexibility granted them to direct most of their TANF funds to priorities other than cash benefits, such as pre-K education.

    Many Americans who get help paying for groceries through the Supplemental Nutrition Assistance Program are also subject to work requirements. People the government calls “able-bodied adults without dependents” can only receive SNAP benefits for three months within a three-year period if they are not employed.

    A failed experiment in Arkansas

    Lawmakers in Congress and in statehouses have debated whether to add work requirements for Medicaid before. More than a dozen states have applied for waivers that would let them give it a try.

    When Arkansas instituted Medicaid work requirements in 2018, during the first Trump administration, it was largely seen as a failure. Some 18,000 people lost their health care coverage, but employment rates did not increase.

    After a court order stopped the policy in 2019, most people regained their coverage.

    Georgia is currently the only state with Medicaid work requirements in effect, after implementing a waiver in July 2023. The program has experienced technical difficulties and has had trouble verifying work activities.

    Other states, including Idaho, Indiana, and Kentucky, are already asking the federal government to let them enforce Medicaid work requirements.

    What this may mean for Medicaid

    The multitrillion-dollar bill the House passed by a vote of 215-214 would introduce Medicaid work requirements nationwide by late 2026 for childless adults ages 19 to 64, with some exemptions.

    But most people covered by Medicaid in that age range are already working, and those who are not would likely be eligible for work requirement waivers. An analysis by KFF—a nonprofit that informs the public about health issues—shows that in 2023, 44% of Medicaid recipients were working full time and another 20% were working part time. In 2023, that was more than 16 million Americans.

    About 20% of the American adults under 65 who are covered by Medicaid are not working due to illness or disability, or because of caregiving responsibilities, according to KFF. This includes both people caring for young children and those taking care of relatives with an illness or disability. In my own research, I read testimony from families seeking work exemptions because caregiving, including for children with disabilities, was a full-time job.

    The rest of the adults under 65 with Medicaid coverage are not working because they are in school, are retired, cannot find work, or have some other reason. It’s approximately 3.9 million Americans. Depending on what counts as “work,” they may be meeting any requirements that could be added to the program.

    The Congressional Budget Office estimates that introducing Medicaid work requirements would save around billion over a decade. Given past experience with work requirements, it is unlikely those savings would come from Americans finding jobs.

    My research suggests it’s more likely that the government would trim spending by taking away the health insurance of people eligible for Medicaid coverage who get tangled up in red tape.

    This article was updated on May 22, 2025, with details about the House of Representatives’ passage of the budget bill.

    Anne Whitesell is an assistant professor of political science at Miami University.

    This article is republished from The Conversation under a Creative Commons license. Read the original article.
    #why #medicaid #work #requirements #place
    Why Medicaid work requirements place extra burdens on low-income families
    Republican lawmakers have been battling over a bill that includes massive tax and spending cuts. Much of their disagreement has been over provisions intended to reduce the cost of Medicaid. The popular health insurance program, which is funded by both the federal and state governments, covers about 78.5 million low-income and disabled people—more than 1 in 5 Americans. On May 22, 2025, the House of Representatives narrowly approved the tax, spending, and immigration bill. The legislation, which passed without any support from Democrats, is designed to reduce federal Medicaid spending by requiring anyone enrolled in the program who appears to be able to get a job to either satisfy work requirements or lose their coverage. It’s still unclear, however, whether Senate Republicans would support that provision. Although there are few precedents for such a mandate for Medicaid, other safety net programs have been enforcing similar rules for nearly three decades. I’m a political scientist who has extensively studied the work requirements of another safety net program: Temporary Assistance for Needy Families. As I explain in my book, Living Off the Government? Race, Gender, and the Politics of Welfare, work requirements place extra burdens on low-income families but do little to lift them out of poverty. Work requirements for TANF TANF gives families with very low incomes some cash they can spend on housing, food, clothing, or whatever they need most. The Clinton administration launched it as a replacement for a similar program, Aid to Families With Dependent Children, in 1996. At the time, both political parties were eager to end a welfare system they believed was riddled with abuse. A big goal with TANF was ending the dependence of people getting cash benefits on the government by moving them from welfare to work. Many people were removed from the welfare rolls, but not because work requirements led to economic prosperity. Instead, they had trouble navigating the bureaucratic demands. TANF is administered by the states. They can set many rules of their own, but they must comply with an important federal requirement: Adult recipients have to work or engage in an authorized alternative activity for at least 30 hours per week. The number of weekly hours is only 20 if the recipient is caring for a child under the age of 6. The dozen activities or so that can count toward this quota range from participating in job training programs to engaging in community service. Some adults enrolled in TANF are exempt from work requirements, depending on their state’s own policies. The most common exemptions are for people who are ill, have a disability, or are over age 60. To qualify for TANF, families must have dependent children; in some states pregnant women also qualify. Income limits are set by the state and range from a month for a family of three in Alabama to a month for a family of three in Minnesota. Adult TANF recipients face a federal five-year lifetime limit on benefits. States can adopt shorter time limits; Arizona’s is 12 months. An administrative burden Complying with these work requirements generally means proving that you’re working or making the case that you should be exempt from this mandate. This places what’s known as an “administrative burden” on the people who get cash assistance. It often requires lots of documentation and time. If you have an unpredictable work schedule, inconsistent access to child care, or obligations to care for an older relative, this paperwork is hard to deal with. What counts as work, how many hours must be completed, and who is exempt from these requirements often comes down to a caseworker’s discretion. Social science research shows that this discretion is not equally applied and is often informed by stereotypes. The number of people getting cash assistance has fallen sharply since TANF replaced Aid to Families With Dependent Children. In some states caseloads have dropped by more than 50% despite significant population growth. Some of this decline happened because recipients got jobs that paid them too much to qualify. The Congressional Budget Office, a nonpartisan office that provides economic research to Congress, attributes, at least in part, an increase in employment among less-educated single mothers in the 1990s to work requirements. Not everyone who stopped getting cash benefits through TANF wound up employed, however. Other recipients who did not meet requirements fell into deep poverty. Regardless of why people leave the program, when fewer low-income Americans get TANF benefits, the government spends less money on cash assistance. Federal funding has remained flat at billion since 1996. Taking inflation into account, the program receives half as much funding as when it was created. In addition, states have used the flexibility granted them to direct most of their TANF funds to priorities other than cash benefits, such as pre-K education. Many Americans who get help paying for groceries through the Supplemental Nutrition Assistance Program are also subject to work requirements. People the government calls “able-bodied adults without dependents” can only receive SNAP benefits for three months within a three-year period if they are not employed. A failed experiment in Arkansas Lawmakers in Congress and in statehouses have debated whether to add work requirements for Medicaid before. More than a dozen states have applied for waivers that would let them give it a try. When Arkansas instituted Medicaid work requirements in 2018, during the first Trump administration, it was largely seen as a failure. Some 18,000 people lost their health care coverage, but employment rates did not increase. After a court order stopped the policy in 2019, most people regained their coverage. Georgia is currently the only state with Medicaid work requirements in effect, after implementing a waiver in July 2023. The program has experienced technical difficulties and has had trouble verifying work activities. Other states, including Idaho, Indiana, and Kentucky, are already asking the federal government to let them enforce Medicaid work requirements. What this may mean for Medicaid The multitrillion-dollar bill the House passed by a vote of 215-214 would introduce Medicaid work requirements nationwide by late 2026 for childless adults ages 19 to 64, with some exemptions. But most people covered by Medicaid in that age range are already working, and those who are not would likely be eligible for work requirement waivers. An analysis by KFF—a nonprofit that informs the public about health issues—shows that in 2023, 44% of Medicaid recipients were working full time and another 20% were working part time. In 2023, that was more than 16 million Americans. About 20% of the American adults under 65 who are covered by Medicaid are not working due to illness or disability, or because of caregiving responsibilities, according to KFF. This includes both people caring for young children and those taking care of relatives with an illness or disability. In my own research, I read testimony from families seeking work exemptions because caregiving, including for children with disabilities, was a full-time job. The rest of the adults under 65 with Medicaid coverage are not working because they are in school, are retired, cannot find work, or have some other reason. It’s approximately 3.9 million Americans. Depending on what counts as “work,” they may be meeting any requirements that could be added to the program. The Congressional Budget Office estimates that introducing Medicaid work requirements would save around billion over a decade. Given past experience with work requirements, it is unlikely those savings would come from Americans finding jobs. My research suggests it’s more likely that the government would trim spending by taking away the health insurance of people eligible for Medicaid coverage who get tangled up in red tape. This article was updated on May 22, 2025, with details about the House of Representatives’ passage of the budget bill. Anne Whitesell is an assistant professor of political science at Miami University. This article is republished from The Conversation under a Creative Commons license. Read the original article. #why #medicaid #work #requirements #place
    WWW.FASTCOMPANY.COM
    Why Medicaid work requirements place extra burdens on low-income families
    Republican lawmakers have been battling over a bill that includes massive tax and spending cuts. Much of their disagreement has been over provisions intended to reduce the cost of Medicaid. The popular health insurance program, which is funded by both the federal and state governments, covers about 78.5 million low-income and disabled people—more than 1 in 5 Americans. On May 22, 2025, the House of Representatives narrowly approved the tax, spending, and immigration bill. The legislation, which passed without any support from Democrats, is designed to reduce federal Medicaid spending by requiring anyone enrolled in the program who appears to be able to get a job to either satisfy work requirements or lose their coverage. It’s still unclear, however, whether Senate Republicans would support that provision. Although there are few precedents for such a mandate for Medicaid, other safety net programs have been enforcing similar rules for nearly three decades. I’m a political scientist who has extensively studied the work requirements of another safety net program: Temporary Assistance for Needy Families (TANF). As I explain in my book, Living Off the Government? Race, Gender, and the Politics of Welfare, work requirements place extra burdens on low-income families but do little to lift them out of poverty. Work requirements for TANF TANF gives families with very low incomes some cash they can spend on housing, food, clothing, or whatever they need most. The Clinton administration launched it as a replacement for a similar program, Aid to Families With Dependent Children, in 1996. At the time, both political parties were eager to end a welfare system they believed was riddled with abuse. A big goal with TANF was ending the dependence of people getting cash benefits on the government by moving them from welfare to work. Many people were removed from the welfare rolls, but not because work requirements led to economic prosperity. Instead, they had trouble navigating the bureaucratic demands. TANF is administered by the states. They can set many rules of their own, but they must comply with an important federal requirement: Adult recipients have to work or engage in an authorized alternative activity for at least 30 hours per week. The number of weekly hours is only 20 if the recipient is caring for a child under the age of 6. The dozen activities or so that can count toward this quota range from participating in job training programs to engaging in community service. Some adults enrolled in TANF are exempt from work requirements, depending on their state’s own policies. The most common exemptions are for people who are ill, have a disability, or are over age 60. To qualify for TANF, families must have dependent children; in some states pregnant women also qualify. Income limits are set by the state and range from $307 a month for a family of three in Alabama to $2,935 a month for a family of three in Minnesota. Adult TANF recipients face a federal five-year lifetime limit on benefits. States can adopt shorter time limits; Arizona’s is 12 months. An administrative burden Complying with these work requirements generally means proving that you’re working or making the case that you should be exempt from this mandate. This places what’s known as an “administrative burden” on the people who get cash assistance. It often requires lots of documentation and time. If you have an unpredictable work schedule, inconsistent access to child care, or obligations to care for an older relative, this paperwork is hard to deal with. What counts as work, how many hours must be completed, and who is exempt from these requirements often comes down to a caseworker’s discretion. Social science research shows that this discretion is not equally applied and is often informed by stereotypes. The number of people getting cash assistance has fallen sharply since TANF replaced Aid to Families With Dependent Children. In some states caseloads have dropped by more than 50% despite significant population growth. Some of this decline happened because recipients got jobs that paid them too much to qualify. The Congressional Budget Office, a nonpartisan office that provides economic research to Congress, attributes, at least in part, an increase in employment among less-educated single mothers in the 1990s to work requirements. Not everyone who stopped getting cash benefits through TANF wound up employed, however. Other recipients who did not meet requirements fell into deep poverty. Regardless of why people leave the program, when fewer low-income Americans get TANF benefits, the government spends less money on cash assistance. Federal funding has remained flat at $16.5 billion since 1996. Taking inflation into account, the program receives half as much funding as when it was created. In addition, states have used the flexibility granted them to direct most of their TANF funds to priorities other than cash benefits, such as pre-K education. Many Americans who get help paying for groceries through the Supplemental Nutrition Assistance Program are also subject to work requirements. People the government calls “able-bodied adults without dependents” can only receive SNAP benefits for three months within a three-year period if they are not employed. A failed experiment in Arkansas Lawmakers in Congress and in statehouses have debated whether to add work requirements for Medicaid before. More than a dozen states have applied for waivers that would let them give it a try. When Arkansas instituted Medicaid work requirements in 2018, during the first Trump administration, it was largely seen as a failure. Some 18,000 people lost their health care coverage, but employment rates did not increase. After a court order stopped the policy in 2019, most people regained their coverage. Georgia is currently the only state with Medicaid work requirements in effect, after implementing a waiver in July 2023. The program has experienced technical difficulties and has had trouble verifying work activities. Other states, including Idaho, Indiana, and Kentucky, are already asking the federal government to let them enforce Medicaid work requirements. What this may mean for Medicaid The multitrillion-dollar bill the House passed by a vote of 215-214 would introduce Medicaid work requirements nationwide by late 2026 for childless adults ages 19 to 64, with some exemptions. But most people covered by Medicaid in that age range are already working, and those who are not would likely be eligible for work requirement waivers. An analysis by KFF—a nonprofit that informs the public about health issues—shows that in 2023, 44% of Medicaid recipients were working full time and another 20% were working part time. In 2023, that was more than 16 million Americans. About 20% of the American adults under 65 who are covered by Medicaid are not working due to illness or disability, or because of caregiving responsibilities, according to KFF. This includes both people caring for young children and those taking care of relatives with an illness or disability. In my own research, I read testimony from families seeking work exemptions because caregiving, including for children with disabilities, was a full-time job. The rest of the adults under 65 with Medicaid coverage are not working because they are in school, are retired, cannot find work, or have some other reason. It’s approximately 3.9 million Americans. Depending on what counts as “work,” they may be meeting any requirements that could be added to the program. The Congressional Budget Office estimates that introducing Medicaid work requirements would save around $300 billion over a decade. Given past experience with work requirements, it is unlikely those savings would come from Americans finding jobs. My research suggests it’s more likely that the government would trim spending by taking away the health insurance of people eligible for Medicaid coverage who get tangled up in red tape. This article was updated on May 22, 2025, with details about the House of Representatives’ passage of the budget bill. Anne Whitesell is an assistant professor of political science at Miami University. This article is republished from The Conversation under a Creative Commons license. Read the original article.
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  • Readers Annoyed When Fantasy Novel Accidentally Leaves AI Prompt in Published Version, Showing Request to Copy Another Writer's Style

    Readers were annoyed to discover something galling: evidence that an author used AI, right in the middle of a novel.The novel, titled "Darkhollow Academy : Year 2," penned by author Lena McDonald, falls under a romance subgenre called "reverse harem," which conventionally follows a female protagonist with multiple male partners.But as eagle-eyed fans of the genre were irritated to discover, the author left glaringly obvious evidence of not only using an AI chatbot to write portions of the book — but also of a naked attempt to copy the style of a real fellow writer."I've rewritten the passage to align more with J. Bree's style, which features more tension, gritty undertones, and raw emotional subtext beneath the supernatural elements," a since-deleted passage in chapter three of the novel reads, as seen in screenshots posted to the ReverseHarem subreddit earlier this month.J. Bree is the human author of an internationally bestselling series of romance and fantasy novels.The instance is yet another illustration of how Amazon is being flooded with self-published AI slop, a trend that has been going on ever since the tech went mainstream a few years ago. It's a real problem for human authors, too, with AI-generated books drowning out their work in search results pages.In one particularly egregious example, author Jane Friedman discovered back in 2023 that roughly a dozen books were being sold on Amazon with her name on them.Understandably, the small ReverseHarem community on Reddit was outraged after McDonald was caught blatantly using AI to rip off the voice of a real author."I just about fell out of my chair when I read this!" wrote the user who shared the screenshots."I got the book to provide secondary confirmation that this is real," another user chimed in. "Which means everyone has now read part of the book, which qualifies for a Goodreads rating, and possibly even Amazon."Readers tore into the book in a storm of one-star reviews."This was written with generative AI, as is clear by the prompt that was left in the book before uploading to Amazon," one disgruntled reviewer wrote. "I will support authors in many, many ways, but generative AI is theft and it’s not a replacement for actual writing.""I would assume all of her other writing uses AI as well, as book 1 of this series released 1/24/25, book 2 on 3/13/25, and book 3 on 3/23/25," one GoodReads reviewer wrote. "That's faster than Steven King."A book reviewer account called Indie Book Spotlight put it a lot more bluntly in a Bluesky post."F**k you if you steal and copy authors’ works," the user wrote. "F**k you if you use gen ai and call yourself a writer. You’re an opportunist hack using a theft machine."McDonald's blunder is just the tip of the iceberg. Two other purported authors identified by Indie Book Spotlight were caught dabbling with generative AI to churn out novels.Earlier this year, a writer who goes by KC Crowne was also seemingly caught leaving ChatGPT prompts in the text of their work."Thought for 13 seconds," one passage of a book titled "Dark Obsession" on Amazon reads, as seen in screenshots posted to the RomanceBooks subreddit in January. "Certainly! Here's an enhanced version of your passage, making Elena more relatable and injecting additional humor while providing a brief, sexy description of Grigori."Crowne's Amazon page features a whopping 171 titles, each adorned with an AI-generated cover of topless, tattoo-covered men."International Bestselling Author and Amazon Top 8 US Bestseller," the author's bio reads.A third writer, who goes by Rania Faris, was also caught using an AI chatbot."This is already quite strong, but it can be tightened for a sharper and more striking delivery while maintaining the intensity and sardonic edge you're aiming for," reads a passage one Threads user discovered in a printed copy of Faris' book.Oddly enough, Crowne's novels are getting predominantly positive reviews on GoodReads, indicating they have found their niche, and readers may either not care or not be aware of the use of AI.Users on Bluesky were sharing theories as to why."Oh wow, I just caught up on the KC Crowne AI thing," award-winning Canadian author Krista Ball wrote in a post back in January. "So setting aside the AI prompt left in the book, I am amazed that this wasn't mentioned anywhere by the early readers, the street team, etc - which leads into my paranoid theory that a percentage of readers are just skim reading.""Remember back in the day when writing fast was like a good reputation builder?" she added. "Now it's sus as all hell."Neither McDonald nor Faris has publicly listed contact information. Crowne, at least, is taking accountability for the situation."Earlier this year, I made an honest mistake," Crowne wrote in an email to Futurism. "I accidentally uploaded the wrong draft file, which included an AI prompt. That error was entirely my responsibility, and that's why I made the tough decision to address it publicly."Crowne claimed that "while I occasionally use AI tools to brainstorm or get past writer’s block, every story I publish is fundamentally my own," saying that "I only use AI-assisted tools in ways that help me improve my craft while fully complying with the terms of service of publishing platforms, to the best of my ability."AI or not, Crowne has somehow published 171 novels over the last seven years.Whether the use of generative AI in self-published books on Amazon breaks any rules remains somewhat unclear. An Amazon spokesperson pointed us to the company's content guidelines, which govern "which books can be listed for sale, regardless of how the content was created."The guidelines have an entire subsection dedicated to the use of AI, which stipulates that "AI-assisted content" is permitted and sellers aren't even "required to disclose" its use. However, any "AI-generated images include cover and interior images and artwork" have to be labeled as such.The internet at large is also facing an existential threat in the shape of an AI slop tsunami. Do we really need to extend that trend to 300-page fantasy novels to read on the subway to work?Self-published authors who are trying to stand out in an already busy marketplace aren't hopeful."They bring down the reputation of those of us who don't touch AI to write our books," author Catherine Arthur tweeted. "Being tarred with the 'self-published = written by AI' label is not good, and if they don't stop, then that's what may happen."Share This Article
    #readers #annoyed #when #fantasy #novel
    Readers Annoyed When Fantasy Novel Accidentally Leaves AI Prompt in Published Version, Showing Request to Copy Another Writer's Style
    Readers were annoyed to discover something galling: evidence that an author used AI, right in the middle of a novel.The novel, titled "Darkhollow Academy : Year 2," penned by author Lena McDonald, falls under a romance subgenre called "reverse harem," which conventionally follows a female protagonist with multiple male partners.But as eagle-eyed fans of the genre were irritated to discover, the author left glaringly obvious evidence of not only using an AI chatbot to write portions of the book — but also of a naked attempt to copy the style of a real fellow writer."I've rewritten the passage to align more with J. Bree's style, which features more tension, gritty undertones, and raw emotional subtext beneath the supernatural elements," a since-deleted passage in chapter three of the novel reads, as seen in screenshots posted to the ReverseHarem subreddit earlier this month.J. Bree is the human author of an internationally bestselling series of romance and fantasy novels.The instance is yet another illustration of how Amazon is being flooded with self-published AI slop, a trend that has been going on ever since the tech went mainstream a few years ago. It's a real problem for human authors, too, with AI-generated books drowning out their work in search results pages.In one particularly egregious example, author Jane Friedman discovered back in 2023 that roughly a dozen books were being sold on Amazon with her name on them.Understandably, the small ReverseHarem community on Reddit was outraged after McDonald was caught blatantly using AI to rip off the voice of a real author."I just about fell out of my chair when I read this!" wrote the user who shared the screenshots."I got the book to provide secondary confirmation that this is real," another user chimed in. "Which means everyone has now read part of the book, which qualifies for a Goodreads rating, and possibly even Amazon."Readers tore into the book in a storm of one-star reviews."This was written with generative AI, as is clear by the prompt that was left in the book before uploading to Amazon," one disgruntled reviewer wrote. "I will support authors in many, many ways, but generative AI is theft and it’s not a replacement for actual writing.""I would assume all of her other writing uses AI as well, as book 1 of this series released 1/24/25, book 2 on 3/13/25, and book 3 on 3/23/25," one GoodReads reviewer wrote. "That's faster than Steven King."A book reviewer account called Indie Book Spotlight put it a lot more bluntly in a Bluesky post."F**k you if you steal and copy authors’ works," the user wrote. "F**k you if you use gen ai and call yourself a writer. You’re an opportunist hack using a theft machine."McDonald's blunder is just the tip of the iceberg. Two other purported authors identified by Indie Book Spotlight were caught dabbling with generative AI to churn out novels.Earlier this year, a writer who goes by KC Crowne was also seemingly caught leaving ChatGPT prompts in the text of their work."Thought for 13 seconds," one passage of a book titled "Dark Obsession" on Amazon reads, as seen in screenshots posted to the RomanceBooks subreddit in January. "Certainly! Here's an enhanced version of your passage, making Elena more relatable and injecting additional humor while providing a brief, sexy description of Grigori."Crowne's Amazon page features a whopping 171 titles, each adorned with an AI-generated cover of topless, tattoo-covered men."International Bestselling Author and Amazon Top 8 US Bestseller," the author's bio reads.A third writer, who goes by Rania Faris, was also caught using an AI chatbot."This is already quite strong, but it can be tightened for a sharper and more striking delivery while maintaining the intensity and sardonic edge you're aiming for," reads a passage one Threads user discovered in a printed copy of Faris' book.Oddly enough, Crowne's novels are getting predominantly positive reviews on GoodReads, indicating they have found their niche, and readers may either not care or not be aware of the use of AI.Users on Bluesky were sharing theories as to why."Oh wow, I just caught up on the KC Crowne AI thing," award-winning Canadian author Krista Ball wrote in a post back in January. "So setting aside the AI prompt left in the book, I am amazed that this wasn't mentioned anywhere by the early readers, the street team, etc - which leads into my paranoid theory that a percentage of readers are just skim reading.""Remember back in the day when writing fast was like a good reputation builder?" she added. "Now it's sus as all hell."Neither McDonald nor Faris has publicly listed contact information. Crowne, at least, is taking accountability for the situation."Earlier this year, I made an honest mistake," Crowne wrote in an email to Futurism. "I accidentally uploaded the wrong draft file, which included an AI prompt. That error was entirely my responsibility, and that's why I made the tough decision to address it publicly."Crowne claimed that "while I occasionally use AI tools to brainstorm or get past writer’s block, every story I publish is fundamentally my own," saying that "I only use AI-assisted tools in ways that help me improve my craft while fully complying with the terms of service of publishing platforms, to the best of my ability."AI or not, Crowne has somehow published 171 novels over the last seven years.Whether the use of generative AI in self-published books on Amazon breaks any rules remains somewhat unclear. An Amazon spokesperson pointed us to the company's content guidelines, which govern "which books can be listed for sale, regardless of how the content was created."The guidelines have an entire subsection dedicated to the use of AI, which stipulates that "AI-assisted content" is permitted and sellers aren't even "required to disclose" its use. However, any "AI-generated images include cover and interior images and artwork" have to be labeled as such.The internet at large is also facing an existential threat in the shape of an AI slop tsunami. Do we really need to extend that trend to 300-page fantasy novels to read on the subway to work?Self-published authors who are trying to stand out in an already busy marketplace aren't hopeful."They bring down the reputation of those of us who don't touch AI to write our books," author Catherine Arthur tweeted. "Being tarred with the 'self-published = written by AI' label is not good, and if they don't stop, then that's what may happen."Share This Article #readers #annoyed #when #fantasy #novel
    FUTURISM.COM
    Readers Annoyed When Fantasy Novel Accidentally Leaves AI Prompt in Published Version, Showing Request to Copy Another Writer's Style
    Readers were annoyed to discover something galling: evidence that an author used AI, right in the middle of a novel.The novel, titled "Darkhollow Academy : Year 2," penned by author Lena McDonald, falls under a romance subgenre called "reverse harem," which conventionally follows a female protagonist with multiple male partners.But as eagle-eyed fans of the genre were irritated to discover, the author left glaringly obvious evidence of not only using an AI chatbot to write portions of the book — but also of a naked attempt to copy the style of a real fellow writer."I've rewritten the passage to align more with J. Bree's style, which features more tension, gritty undertones, and raw emotional subtext beneath the supernatural elements," a since-deleted passage in chapter three of the novel reads, as seen in screenshots posted to the ReverseHarem subreddit earlier this month.J. Bree is the human author of an internationally bestselling series of romance and fantasy novels.The instance is yet another illustration of how Amazon is being flooded with self-published AI slop, a trend that has been going on ever since the tech went mainstream a few years ago. It's a real problem for human authors, too, with AI-generated books drowning out their work in search results pages.In one particularly egregious example, author Jane Friedman discovered back in 2023 that roughly a dozen books were being sold on Amazon with her name on them.Understandably, the small ReverseHarem community on Reddit was outraged after McDonald was caught blatantly using AI to rip off the voice of a real author."I just about fell out of my chair when I read this!" wrote the user who shared the screenshots."I got the book to provide secondary confirmation that this is real," another user chimed in. "Which means everyone has now read part of the book, which qualifies for a Goodreads rating, and possibly even Amazon."Readers tore into the book in a storm of one-star reviews."This was written with generative AI, as is clear by the prompt that was left in the book before uploading to Amazon," one disgruntled reviewer wrote. "I will support authors in many, many ways, but generative AI is theft and it’s not a replacement for actual writing.""I would assume all of her other writing uses AI as well, as book 1 of this series released 1/24/25, book 2 on 3/13/25, and book 3 on 3/23/25," one GoodReads reviewer wrote. "That's faster than Steven King."A book reviewer account called Indie Book Spotlight put it a lot more bluntly in a Bluesky post."F**k you if you steal and copy authors’ works," the user wrote. "F**k you if you use gen ai and call yourself a writer. You’re an opportunist hack using a theft machine."McDonald's blunder is just the tip of the iceberg. Two other purported authors identified by Indie Book Spotlight were caught dabbling with generative AI to churn out novels.Earlier this year, a writer who goes by KC Crowne was also seemingly caught leaving ChatGPT prompts in the text of their work."Thought for 13 seconds," one passage of a book titled "Dark Obsession" on Amazon reads, as seen in screenshots posted to the RomanceBooks subreddit in January. "Certainly! Here's an enhanced version of your passage, making Elena more relatable and injecting additional humor while providing a brief, sexy description of Grigori."Crowne's Amazon page features a whopping 171 titles, each adorned with an AI-generated cover of topless, tattoo-covered men."International Bestselling Author and Amazon Top 8 US Bestseller," the author's bio reads.A third writer, who goes by Rania Faris, was also caught using an AI chatbot."This is already quite strong, but it can be tightened for a sharper and more striking delivery while maintaining the intensity and sardonic edge you're aiming for," reads a passage one Threads user discovered in a printed copy of Faris' book.Oddly enough, Crowne's novels are getting predominantly positive reviews on GoodReads, indicating they have found their niche, and readers may either not care or not be aware of the use of AI.Users on Bluesky were sharing theories as to why."Oh wow, I just caught up on the KC Crowne AI thing," award-winning Canadian author Krista Ball wrote in a post back in January. "So setting aside the AI prompt left in the book, I am amazed that this wasn't mentioned anywhere by the early readers, the street team, etc - which leads into my paranoid theory that a percentage of readers are just skim reading.""Remember back in the day when writing fast was like a good reputation builder?" she added. "Now it's sus as all hell."Neither McDonald nor Faris has publicly listed contact information. Crowne, at least, is taking accountability for the situation."Earlier this year, I made an honest mistake," Crowne wrote in an email to Futurism. "I accidentally uploaded the wrong draft file, which included an AI prompt. That error was entirely my responsibility, and that's why I made the tough decision to address it publicly."Crowne claimed that "while I occasionally use AI tools to brainstorm or get past writer’s block, every story I publish is fundamentally my own," saying that "I only use AI-assisted tools in ways that help me improve my craft while fully complying with the terms of service of publishing platforms, to the best of my ability."AI or not, Crowne has somehow published 171 novels over the last seven years.Whether the use of generative AI in self-published books on Amazon breaks any rules remains somewhat unclear. An Amazon spokesperson pointed us to the company's content guidelines, which govern "which books can be listed for sale, regardless of how the content was created."The guidelines have an entire subsection dedicated to the use of AI, which stipulates that "AI-assisted content" is permitted and sellers aren't even "required to disclose" its use. However, any "AI-generated images include cover and interior images and artwork" have to be labeled as such.The internet at large is also facing an existential threat in the shape of an AI slop tsunami. Do we really need to extend that trend to 300-page fantasy novels to read on the subway to work?Self-published authors who are trying to stand out in an already busy marketplace aren't hopeful."They bring down the reputation of those of us who don't touch AI to write our books," author Catherine Arthur tweeted. "Being tarred with the 'self-published = written by AI' label is not good, and if they don't stop, then that's what may happen."Share This Article
    0 Комментарии 0 Поделились
  • Exclusive: New Claude Model Triggers Stricter Safeguards at Anthropic

    Today’s newest AI models might be capable of helping would-be terrorists create bioweapons or engineer a pandemic, according to the chief scientist of the AI company Anthropic.Anthropic has long been warning about these risks—so much so that in 2023, the company pledged to not release certain models until it had developed safety measures capable of constraining them.Now this system, called the Responsible Scaling Policy, faces its first real test.On Thursday, Anthropic launched Claude Opus 4, a new model that, in internal testing, performed more effectively than prior models at advising novices on how to produce biological weapons, says Jared Kaplan, Anthropic’s chief scientist. “You could try to synthesize something like COVID or a more dangerous version of the flu—and basically, our modeling suggests that this might be possible,” Kaplan says.Accordingly, Claude Opus 4 is being released under stricter safety measures than any prior Anthropic model. Those measures—known internally as AI Safety Level 3 or “ASL-3”—are appropriate to constrain an AI system that could “substantially increase” the ability of individuals with a basic STEM background in obtaining, producing or deploying chemical, biological or nuclear weapons, according to the company. They include beefed-up cybersecurity measures, jailbreak preventions, and supplementary systems to detect and refuse specific types of harmful behavior.To be sure, Anthropic is not entirely certain that the new version of Claude poses severe bioweapon risks, Kaplan tells TIME. But Anthropic hasn’t ruled that possibility out either. “If we feel like it’s unclear, and we’re not sure if we can rule out the risk—the specific risk being uplifting a novice terrorist, someone like Timothy McVeigh, to be able to make a weapon much more destructive than would otherwise be possible—then we want to bias towards caution, and work under the ASL-3 standard,” Kaplan says. “We’re not claiming affirmatively we know for sure this model is risky … but we at least feel it’s close enough that we can’t rule it out.” If further testing shows the model does not require such strict safety standards, Anthropic could lower its protections to the more permissive ASL-2, under which previous versions of Claude were released, he says.Jared Kaplan, co-founder and chief science officer of Anthropic, on Tuesday, Oct. 24, 2023. Chris J. Ratcliffe/Bloomberg via Getty ImagesThis moment is a crucial test for Anthropic, a company that claims it can mitigate AI’s dangers while still competing in the market. Claude is a direct competitor to ChatGPT, and brings in over billion in annualized revenue. Anthropic argues that its RSP thus creates an economic incentive for itself to build safety measures in time, lest it lose customers as a result of being prevented from releasing new models. “We really don’t want to impact customers,” Kaplan told TIME earlier in May while Anthropic was finalizing its safety measures. “We’re trying to be proactively prepared.”But Anthropic’s RSP—and similar commitments adopted by other AI companies—are all voluntary policies that could be changed or cast aside at will. The company itself, not regulators or lawmakers, is the judge of whether it is fully complying with the RSP. Breaking it carries no external penalty, besides possible reputational damage. Anthropic argues that the policy has created a “race to the top” between AI companies, causing them to compete to build the best safety systems. But as the multi-billion dollar race for AI supremacy heats up, critics worry the RSP and its ilk may be left by the wayside when they matter most. Still, in the absence of any frontier AI regulation from Congress, Anthropic’s RSP is one of the few existing constraints on the behavior of any AI company. And so far, Anthropic has kept to it. If Anthropic shows it can constrain itself without taking an economic hit, Kaplan says, it could have a positive effect on safety practices in the wider industry. Anthropic’s new safeguardsAnthropic’s ASL-3 safety measures employ what the company calls a “defense in depth” strategy—meaning there are several different overlapping safeguards that may be individually imperfect, but in unison combine to prevent most threats.One of those measures is called “constitutional classifiers:” additional AI systems that scan a user’s prompts and the model’s answers for dangerous material. Earlier versions of Claude already had similar systems under the lower ASL-2 level of security, but Anthropic says it has improved them so that they are able to detect people who might be trying to use Claude to, for example, build a bioweapon. These classifiers are specifically targeted to detect the long chains of specific questions that somebody building a bioweapon might try to ask. Anthropic has tried not to let these measures hinder Claude’s overall usefulness for legitimate users—since doing so would make the model less helpful compared to its rivals. “There are bioweapons that might be capable of causing fatalities, but that we don’t think would cause, say, a pandemic,” Kaplan says. “We’re not trying to block every single one of those misuses. We’re trying to really narrowly target the most pernicious.”Another element of the defense-in-depth strategy is the prevention of jailbreaks—or prompts that can cause a model to essentially forget its safety training and provide answers to queries that it might otherwise refuse. The company monitors usage of Claude, and “offboards” users who consistently try to jailbreak the model, Kaplan says. And it has launched a bounty program to reward users for flagging so-called “universal” jailbreaks, or prompts that can make a system drop all its safeguards at once. So far, the program has surfaced one universal jailbreak which Anthropic subsequently patched, a spokesperson says. The researcher who found it was awarded Anthropic has also beefed up its cybersecurity, so that Claude’s underlying neural network is protected against theft attempts by non-state actors. The company still judges itself to be vulnerable to nation-state level attackers—but aims to have cyberdefenses sufficient for deterring them by the time it deems it needs to upgrade to ASL-4: the next safety level, expected to coincide with the arrival of models that can pose major national security risks, or which can autonomously carry out AI research without human input.Lastly the company has conducted what it calls “uplift” trials, designed to quantify how significantly an AI model without the above constraints can improve the abilities of a novice attempting to create a bioweapon, when compared to other tools like Google or less advanced models. In those trials, which were graded by biosecurity experts, Anthropic found Claude Opus 4 presented a “significantly greater” level of performance than both Google search and prior models, Kaplan says.Anthropic’s hope is that the several safety systems layered over the top of the model—which has already undergone separate training to be “helpful, honest and harmless”—will prevent almost all bad use cases. “I don’t want to claim that it’s perfect in any way. It would be a very simple story if you could say our systems could never be jailbroken,” Kaplan says. “But we have made it very, very difficult.”Still, by Kaplan’s own admission, only one bad actor would need to slip through to cause untold chaos. “Most other kinds of dangerous things a terrorist could do—maybe they could kill 10 people or 100 people,” he says. “We just saw COVID kill millions of people.”
    #exclusive #new #claude #model #triggers
    Exclusive: New Claude Model Triggers Stricter Safeguards at Anthropic
    Today’s newest AI models might be capable of helping would-be terrorists create bioweapons or engineer a pandemic, according to the chief scientist of the AI company Anthropic.Anthropic has long been warning about these risks—so much so that in 2023, the company pledged to not release certain models until it had developed safety measures capable of constraining them.Now this system, called the Responsible Scaling Policy, faces its first real test.On Thursday, Anthropic launched Claude Opus 4, a new model that, in internal testing, performed more effectively than prior models at advising novices on how to produce biological weapons, says Jared Kaplan, Anthropic’s chief scientist. “You could try to synthesize something like COVID or a more dangerous version of the flu—and basically, our modeling suggests that this might be possible,” Kaplan says.Accordingly, Claude Opus 4 is being released under stricter safety measures than any prior Anthropic model. Those measures—known internally as AI Safety Level 3 or “ASL-3”—are appropriate to constrain an AI system that could “substantially increase” the ability of individuals with a basic STEM background in obtaining, producing or deploying chemical, biological or nuclear weapons, according to the company. They include beefed-up cybersecurity measures, jailbreak preventions, and supplementary systems to detect and refuse specific types of harmful behavior.To be sure, Anthropic is not entirely certain that the new version of Claude poses severe bioweapon risks, Kaplan tells TIME. But Anthropic hasn’t ruled that possibility out either. “If we feel like it’s unclear, and we’re not sure if we can rule out the risk—the specific risk being uplifting a novice terrorist, someone like Timothy McVeigh, to be able to make a weapon much more destructive than would otherwise be possible—then we want to bias towards caution, and work under the ASL-3 standard,” Kaplan says. “We’re not claiming affirmatively we know for sure this model is risky … but we at least feel it’s close enough that we can’t rule it out.” If further testing shows the model does not require such strict safety standards, Anthropic could lower its protections to the more permissive ASL-2, under which previous versions of Claude were released, he says.Jared Kaplan, co-founder and chief science officer of Anthropic, on Tuesday, Oct. 24, 2023. Chris J. Ratcliffe/Bloomberg via Getty ImagesThis moment is a crucial test for Anthropic, a company that claims it can mitigate AI’s dangers while still competing in the market. Claude is a direct competitor to ChatGPT, and brings in over billion in annualized revenue. Anthropic argues that its RSP thus creates an economic incentive for itself to build safety measures in time, lest it lose customers as a result of being prevented from releasing new models. “We really don’t want to impact customers,” Kaplan told TIME earlier in May while Anthropic was finalizing its safety measures. “We’re trying to be proactively prepared.”But Anthropic’s RSP—and similar commitments adopted by other AI companies—are all voluntary policies that could be changed or cast aside at will. The company itself, not regulators or lawmakers, is the judge of whether it is fully complying with the RSP. Breaking it carries no external penalty, besides possible reputational damage. Anthropic argues that the policy has created a “race to the top” between AI companies, causing them to compete to build the best safety systems. But as the multi-billion dollar race for AI supremacy heats up, critics worry the RSP and its ilk may be left by the wayside when they matter most. Still, in the absence of any frontier AI regulation from Congress, Anthropic’s RSP is one of the few existing constraints on the behavior of any AI company. And so far, Anthropic has kept to it. If Anthropic shows it can constrain itself without taking an economic hit, Kaplan says, it could have a positive effect on safety practices in the wider industry. Anthropic’s new safeguardsAnthropic’s ASL-3 safety measures employ what the company calls a “defense in depth” strategy—meaning there are several different overlapping safeguards that may be individually imperfect, but in unison combine to prevent most threats.One of those measures is called “constitutional classifiers:” additional AI systems that scan a user’s prompts and the model’s answers for dangerous material. Earlier versions of Claude already had similar systems under the lower ASL-2 level of security, but Anthropic says it has improved them so that they are able to detect people who might be trying to use Claude to, for example, build a bioweapon. These classifiers are specifically targeted to detect the long chains of specific questions that somebody building a bioweapon might try to ask. Anthropic has tried not to let these measures hinder Claude’s overall usefulness for legitimate users—since doing so would make the model less helpful compared to its rivals. “There are bioweapons that might be capable of causing fatalities, but that we don’t think would cause, say, a pandemic,” Kaplan says. “We’re not trying to block every single one of those misuses. We’re trying to really narrowly target the most pernicious.”Another element of the defense-in-depth strategy is the prevention of jailbreaks—or prompts that can cause a model to essentially forget its safety training and provide answers to queries that it might otherwise refuse. The company monitors usage of Claude, and “offboards” users who consistently try to jailbreak the model, Kaplan says. And it has launched a bounty program to reward users for flagging so-called “universal” jailbreaks, or prompts that can make a system drop all its safeguards at once. So far, the program has surfaced one universal jailbreak which Anthropic subsequently patched, a spokesperson says. The researcher who found it was awarded Anthropic has also beefed up its cybersecurity, so that Claude’s underlying neural network is protected against theft attempts by non-state actors. The company still judges itself to be vulnerable to nation-state level attackers—but aims to have cyberdefenses sufficient for deterring them by the time it deems it needs to upgrade to ASL-4: the next safety level, expected to coincide with the arrival of models that can pose major national security risks, or which can autonomously carry out AI research without human input.Lastly the company has conducted what it calls “uplift” trials, designed to quantify how significantly an AI model without the above constraints can improve the abilities of a novice attempting to create a bioweapon, when compared to other tools like Google or less advanced models. In those trials, which were graded by biosecurity experts, Anthropic found Claude Opus 4 presented a “significantly greater” level of performance than both Google search and prior models, Kaplan says.Anthropic’s hope is that the several safety systems layered over the top of the model—which has already undergone separate training to be “helpful, honest and harmless”—will prevent almost all bad use cases. “I don’t want to claim that it’s perfect in any way. It would be a very simple story if you could say our systems could never be jailbroken,” Kaplan says. “But we have made it very, very difficult.”Still, by Kaplan’s own admission, only one bad actor would need to slip through to cause untold chaos. “Most other kinds of dangerous things a terrorist could do—maybe they could kill 10 people or 100 people,” he says. “We just saw COVID kill millions of people.” #exclusive #new #claude #model #triggers
    TIME.COM
    Exclusive: New Claude Model Triggers Stricter Safeguards at Anthropic
    Today’s newest AI models might be capable of helping would-be terrorists create bioweapons or engineer a pandemic, according to the chief scientist of the AI company Anthropic.Anthropic has long been warning about these risks—so much so that in 2023, the company pledged to not release certain models until it had developed safety measures capable of constraining them.Now this system, called the Responsible Scaling Policy (RSP), faces its first real test.On Thursday, Anthropic launched Claude Opus 4, a new model that, in internal testing, performed more effectively than prior models at advising novices on how to produce biological weapons, says Jared Kaplan, Anthropic’s chief scientist. “You could try to synthesize something like COVID or a more dangerous version of the flu—and basically, our modeling suggests that this might be possible,” Kaplan says.Accordingly, Claude Opus 4 is being released under stricter safety measures than any prior Anthropic model. Those measures—known internally as AI Safety Level 3 or “ASL-3”—are appropriate to constrain an AI system that could “substantially increase” the ability of individuals with a basic STEM background in obtaining, producing or deploying chemical, biological or nuclear weapons, according to the company. They include beefed-up cybersecurity measures, jailbreak preventions, and supplementary systems to detect and refuse specific types of harmful behavior.To be sure, Anthropic is not entirely certain that the new version of Claude poses severe bioweapon risks, Kaplan tells TIME. But Anthropic hasn’t ruled that possibility out either. “If we feel like it’s unclear, and we’re not sure if we can rule out the risk—the specific risk being uplifting a novice terrorist, someone like Timothy McVeigh, to be able to make a weapon much more destructive than would otherwise be possible—then we want to bias towards caution, and work under the ASL-3 standard,” Kaplan says. “We’re not claiming affirmatively we know for sure this model is risky … but we at least feel it’s close enough that we can’t rule it out.” If further testing shows the model does not require such strict safety standards, Anthropic could lower its protections to the more permissive ASL-2, under which previous versions of Claude were released, he says.Jared Kaplan, co-founder and chief science officer of Anthropic, on Tuesday, Oct. 24, 2023. Chris J. Ratcliffe/Bloomberg via Getty ImagesThis moment is a crucial test for Anthropic, a company that claims it can mitigate AI’s dangers while still competing in the market. Claude is a direct competitor to ChatGPT, and brings in over $2 billion in annualized revenue. Anthropic argues that its RSP thus creates an economic incentive for itself to build safety measures in time, lest it lose customers as a result of being prevented from releasing new models. “We really don’t want to impact customers,” Kaplan told TIME earlier in May while Anthropic was finalizing its safety measures. “We’re trying to be proactively prepared.”But Anthropic’s RSP—and similar commitments adopted by other AI companies—are all voluntary policies that could be changed or cast aside at will. The company itself, not regulators or lawmakers, is the judge of whether it is fully complying with the RSP. Breaking it carries no external penalty, besides possible reputational damage. Anthropic argues that the policy has created a “race to the top” between AI companies, causing them to compete to build the best safety systems. But as the multi-billion dollar race for AI supremacy heats up, critics worry the RSP and its ilk may be left by the wayside when they matter most. Still, in the absence of any frontier AI regulation from Congress, Anthropic’s RSP is one of the few existing constraints on the behavior of any AI company. And so far, Anthropic has kept to it. If Anthropic shows it can constrain itself without taking an economic hit, Kaplan says, it could have a positive effect on safety practices in the wider industry. Anthropic’s new safeguardsAnthropic’s ASL-3 safety measures employ what the company calls a “defense in depth” strategy—meaning there are several different overlapping safeguards that may be individually imperfect, but in unison combine to prevent most threats.One of those measures is called “constitutional classifiers:” additional AI systems that scan a user’s prompts and the model’s answers for dangerous material. Earlier versions of Claude already had similar systems under the lower ASL-2 level of security, but Anthropic says it has improved them so that they are able to detect people who might be trying to use Claude to, for example, build a bioweapon. These classifiers are specifically targeted to detect the long chains of specific questions that somebody building a bioweapon might try to ask. Anthropic has tried not to let these measures hinder Claude’s overall usefulness for legitimate users—since doing so would make the model less helpful compared to its rivals. “There are bioweapons that might be capable of causing fatalities, but that we don’t think would cause, say, a pandemic,” Kaplan says. “We’re not trying to block every single one of those misuses. We’re trying to really narrowly target the most pernicious.”Another element of the defense-in-depth strategy is the prevention of jailbreaks—or prompts that can cause a model to essentially forget its safety training and provide answers to queries that it might otherwise refuse. The company monitors usage of Claude, and “offboards” users who consistently try to jailbreak the model, Kaplan says. And it has launched a bounty program to reward users for flagging so-called “universal” jailbreaks, or prompts that can make a system drop all its safeguards at once. So far, the program has surfaced one universal jailbreak which Anthropic subsequently patched, a spokesperson says. The researcher who found it was awarded $25,000.Anthropic has also beefed up its cybersecurity, so that Claude’s underlying neural network is protected against theft attempts by non-state actors. The company still judges itself to be vulnerable to nation-state level attackers—but aims to have cyberdefenses sufficient for deterring them by the time it deems it needs to upgrade to ASL-4: the next safety level, expected to coincide with the arrival of models that can pose major national security risks, or which can autonomously carry out AI research without human input.Lastly the company has conducted what it calls “uplift” trials, designed to quantify how significantly an AI model without the above constraints can improve the abilities of a novice attempting to create a bioweapon, when compared to other tools like Google or less advanced models. In those trials, which were graded by biosecurity experts, Anthropic found Claude Opus 4 presented a “significantly greater” level of performance than both Google search and prior models, Kaplan says.Anthropic’s hope is that the several safety systems layered over the top of the model—which has already undergone separate training to be “helpful, honest and harmless”—will prevent almost all bad use cases. “I don’t want to claim that it’s perfect in any way. It would be a very simple story if you could say our systems could never be jailbroken,” Kaplan says. “But we have made it very, very difficult.”Still, by Kaplan’s own admission, only one bad actor would need to slip through to cause untold chaos. “Most other kinds of dangerous things a terrorist could do—maybe they could kill 10 people or 100 people,” he says. “We just saw COVID kill millions of people.”
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