Nationally, abortion has faded as a campaign issue. Four years after it helped Democrats stave off a red wave, candidates in battleground races are focusing their attention on cost-of-living issues, immigration, and policing. As of mid-August, abortion was mentioned in less than 5 percent of Democratic Senate ads, a key difference from the past two cycles, according to the Wesleyan Media Project.

Maine is different. As of September 16, Democratic advertisers had spent roughly 15 percent of their $40.8 million broadcast TV and streaming dollars on ads focused on abortion rights, according to Nate Schwartz from AdImpact. It’s one of the biggest topics there, he told me, after ads about President Donald Trump and healthcare. Planned Parenthood’s political arm is also making its biggest ad buy of 2026 against Susan Collins, at $600,000, and WinSenate, a super PAC aligned with Senate Democratic leadership, has spent 70 percent of its TV, streaming, and digital money in Maine on abortion-focused ads.

The target is Collins, the only Republican senator up for reelection in a state Trump lost in 2024, and one of Democrats’ best chances to flip a seat. Seeking her sixth term, Collins is running in a year when Democrats lead the generic congressional ballot by about 9 points. It’s also the first time she will face voters since Roe v. Wade was overturned — a decision Justice Brett Kavanaugh helped deliver after Collins, who has long described herself as “pro-choice,” cast the pivotal vote to confirm him in 2018. 

For the abortion rights movement, this is the race that has to work. Groups are pouring their biggest investments of the cycle into a state where fewer than half a percent of voters call abortion their top issue, in a year when Democrats have opportunities to win nearly everywhere. If a blue wave arrives and lifts every Democrat except the one running to avenge Roe v. Wade and remove the senator who famously sealed its fate, the organizations will have a harder time telling donors the issue still moves voters, and a harder time arguing that Republicans will pay a political price — even in blue states — for votes that restrict access to abortion.

“We know that abortion is the number one negative in Maine voters’ mind,” Lisa Margulies, a Maine spokesperson for Planned Parenthood Votes, told me. “It’s really the No. 1 dealbreaker.”

The first job for Democrats and abortion rights advocates is convincing Mainers the issue is still a pressing one. Seventy-two percent of Maine adults say abortion should be legal “in all or most” circumstances, and since Democrats took control of Maine’s government in 2018, the state has expanded who can provide abortions, required and subsidized insurance coverage for the procedure, eliminated most patient cost-sharing, loosened restrictions on care after viability, and shielded patients and providers from prosecution and lawsuits.

Collins has made that her defense. The Dobbs v. Jackson decision, she said in June, “has not had an impact on the state of Maine in that Maine actually expanded its law.” Advocates call that the central misunderstanding. 

“There’s this perception — and Sen. Collins herself has said it — that somehow Maine is immune, and that’s just not true,” Margulies said, pointing to their state-level efforts to keep access intact and to federal Medicaid cuts that have already hit Maine providers.

Also muddying the waters is the senator’s Democratic opponent. Collins is facing off against Troy Jackson, a longtime fixture in Maine politics who rose from the state House to the Senate presidency but fell short in bids for Congress in 2014 and governor this year. Early in his career, Jackson said that abortion “should never be legal” and that women should be required to view an ultrasound if they want to end a pregnancy. He has since renounced those positions and has earned 100 percent ratings from Planned Parenthood since 2017. (Jackson replaced Graham Platner, the original Democratic Party nominee, who quit the race after being accused of rape, an allegation he denies.)

While Collins prevailed for reelection in 2020 despite voting to confirm Kavanaugh, Democrats say her decision is much more salient for voters now that Americans live in a post-Roe world, one where more than 15 states have near-total abortion bans. 

If Collins loses, Democrats and abortion rights groups will say her Kavanaugh vote is no doubt partly why. A win for Collins would be harder to read, though the explanations that leave out abortion are already being prepared, including a messy nomination process that produced a candidate fewer voters were excited about, and a “unicorn” incumbent with decades of personal relationships across a small state and a long record of bringing federal money back home.

The abortion rights bet hinges on two things: that the Kavanaugh vote cost Collins something on top of what an unpopular president and rising gas prices already have, and that voters will judge Jackson by the positions he’s renounced rather than the ones he once held. 

The vote Collins won’t apologize for

When Collins voted to confirm Kavanaugh, she said she believed his assurances that he considered Roe v. Wade settled precedent. She had previously said that she would not vote for any nominee who expressed “hostility” toward the 1973 decision that established the constitutional right to an abortion.

As many observed at the time, Kavanaugh’s record gave strong signals that he would in fact vote to overturn Roe v. Wade. In her floor speech announcing her vote, Collins dismissed those warnings, suggesting opponents had been whipped into a “frenzy” by advocacy groups. When he ultimately did side with the conservative majority in Dobbs, Collins issued a statement calling the ruling “ill-considered.”

Four years later, though, Collins is doubling down on her vote for Kavanaugh, telling local media this summer that she does “not regret” it. “Given what subsequently happened to Roe, I don’t think that simply fades into the background,” Robert Glover, a political scientist at the University of Maine, told me.

Democrats are zeroing in on the fact that Collins has continued to confirm anti-abortion federal judges, even as recently as this month. Last fall she voted to confirm Joshua Dunlap, a Maine attorney, to the US Court of Appeals for the First Circuit over objections from 20 Maine organizations citing his record on abortion and marriage equality. 

“Susan Collins says she has no regrets about confirming the judges who overturned Roe v. Wade, and has proved it by continuing to vote for Trump’s right-wing judges,” Maine Democratic Party spokesperson Misha Linnehan told me in an emailed statement. “Now, her approvals are underwater, and she’s trailing with women voters because Maine women have had enough of being betrayed.” 

George Hill, the president and CEO of Maine Family Planning, told me Collins “defied” them with her vote for Kavanaugh, causing “irreparable harm” across the country. He emphasized how vulnerable Mainers are if Republicans retake control of state government.

Blake Kernen, a spokesperson for Collins’s campaign, dismissed the criticism about anti-abortion judges, emphasizing that her pro-choice boss also voted for 188 judges nominated by President Joe Biden, including Julie Rikelman, who served as litigation director of the Center for Reproductive Rights. Collins, she noted, is the only Republican who voted to confirm all three of the court’s liberal justices, and she voted against Amy Coney Barrett.

Margulies rejects this accounting. “We deserve better than, ‘Well, she’s not as bad,’” she said. “When it comes to reproductive rights, she’s not a moderate anymore.”

While her judicial votes are facing scrutiny, Collins has also spent decades building up a brand as a Republican willing to buck her party on abortion when the issue comes up in the Senate. 

In May 2025, Planned Parenthood Maine Action Fund published a memo online titled, “Senator Susan Collins’ long history of supporting Planned Parenthood and access to essential health care.” Among other things, the memo highlighted Collins for speaking out against proposed Medicaid cuts, for co-sponsoring a bill in 2022 to codify Roe v. Wade, and for opposing a 20-week abortion ban bill in the Senate. This past summer, the memo was quietly taken down from their website.

Asked about the removed page, Margulies didn’t say when or why it was taken down, but pointed to what she described as a sharp shift in Collins’s record over the past year, particularly on judicial confirmations. “There are times when she’s been true to her word and put Mainers ahead of politics, but she closed that chapter this year,” she told me.

“Because she is a Republican, the national groups continue to twist themselves into a pretzel to support these male candidates with terrible records,” Kernen said, referring to Platner and Jackson. 

So far, Mainers appear to have split Collins in two in their minds: There’s the dedicated public servant who puts her state first on one side, and the partisan Republican who sometimes disappoints them on the other. A University of New Hampshire poll over the summer found Collins rated far better on bringing federal dollars home to Maine than on her Supreme Court confirmation votes. Maine voters, Glover said, “have historically been willing to separate Collins from the national Republican Party and evaluate her through a broader lens of incumbency, independence, and constituent service.” 

The turnout math

Even if Democrats can win the argument on abortion around Collins, it’s an open question how much it will move votes. “Right now, I feel quite confident that affordability, healthcare, and good jobs trump abortion access by a long shot,” Dan Shea, a political scientist at Colby College, told me.

But abortion rights advocates believe the ranking obscures how the issue actually works. Mini Timmaraju, president of Reproductive Freedom for All, said her group has spent years testing how to talk to voters about abortion, consistently finding that it overperforms as an attack. “If you go to a voter in Maine and you say, what are your top three or five issues, they may not name abortion,” she told me. “But if you say to them, Susan Collins took the following vote — and one of them is Brett Kavanaugh, which led to overturning Roe — it is extremely salient, and it moves that voter.”

The Kavanaugh vote works, she argued, as a character verdict — “an indicator that you’re willing to side with extremism over your own constituents.” That, she said, is the piece that’s missing in the analysis of what voters say they care about. “It is one of the most salient attacks in Maine and in a lot of other parts of the country.”

Ashley Kirzinger, a pollster at KFF based in Maine, said priority rankings are a weak guide anyway, noting “the economy” means different things to different voters, and issues compete with candidate dynamics and party loyalty. What has changed since Roe’s overturn, she told me, is who the single-issue abortion voter is.

“Before the Dobbs decision, abortion was a motivating issue for Republican conservative voters,” Kirzinger said. “Now what we’ve seen is a complete shift.” Those voters are more likely to be Democrats, younger women and women of color, and include more people who don’t reliably show up in midterms.

Abortion messaging, therefore, is doing two jobs. The first is turnout. Kirzinger said the Kavanaugh vote is aimed at Democratic women “who are not as enthusiastic about Jackson as a candidate” and who “may be more motivated to turn out as a vote against Collins’ record on abortion rather than for Jackson.” In a tight race inside the margin of error, a couple of points of turnout could make the difference.

The second job is persuasion, and the target is older women, who reliably vote. Women made up nearly 60 percent of Maine’s turnout in 2020, and Collins won them by 3 points. What Democrats need from them is a switch, which is why many of the abortion ads are built around regret. One Planned Parenthood ad features a woman who voted for Collins and “will not make the same mistake twice”; WinSenate’s features a voter who “felt [Collins] was the better choice” and doesn’t anymore. 

Jackson’s change of heart

Complicating the race is Collins’ opponent, Troy Jackson, who is in some ways a mirror image of her own political persona: a Democrat with a history of culturally right-leaning positions to appeal to voters in the other party.

Jackson, who started his political career in the rural and fairly conservative county of Aroostook, used to earn 100 percent ratings from Maine Right to Life. In 2010, as CNN’s KFILE reported, when he filled out the group’s candidate questionnaire saying he thought abortion should never be legal, he declined to say whether there should be exceptions even to protect the life of the mother, for rape or incest, or because of fetal disability. Maine Right to Life, which has not issued an endorsement in the Senate race, did not return requests for comment.

Jackson told MS NOW he evolved on the issue thanks to “a lot of conversations over time” with women, doctors, and community members. “It became more and more clear to me that abortion access was healthcare,” he said.

In 2023, while serving as Senate president, he co-sponsored a bill allowing abortions after fetal viability when a physician deems them necessary, one of the most expansive such laws in the country. In 2024, he shepherded through the Senate a shield law protecting Maine providers and patients of reproductive and gender-affirming care from other states’ bans, despite bomb threats that emptied the statehouse and a letter from 16 Republican attorneys general threatening to sue. “Troy stood up for and never wavered in his commitment to reproductive rights during some really harrowing moments,” Margulies said, “when it would have been a lot easier to step down.”

“I’m rock solid on this now, and Susan has been the opposite,” Jackson said in an interview with Maine Public Radio this summer. Kernan, Collins’s spokesperson, has charged Jackson with flip-flopping for “political convenience.”

The national environment is looking strong for Democrats, and Jackson has been narrowly ahead in recent polls, though all have been within the margin of error. A CNN poll released this month found nearly two-thirds of Mainers feel negatively about the Dobbs decision, including about half saying it makes them angry. A Fox News poll in August found 55 percent worried Collins votes with Trump too often. 

Whatever happens, the explanations are ready. If Collins loses, abortion rights groups will cast it as proof that the issue still moves voters even where it doesn’t top their lists, and as a warning to all Republicans running in 2028. Timmaraju previewed the argument in our conversation: A loss would signal “a crack in the armor” of so-called moderates, and show that voters “are not going to tolerate” incumbents complicit with an extremist administration. 

If Collins wins, the groups that spent millions on abortion ads are unlikely to conclude that doing so was a mistake. Kirzinger pointed to the turmoil that followed the Democratic primary and the late swap of Platner for Jackson, which she said benefited Collins “in a way that is hard to capture in polls.” Glover, the political scientist, noted the things Mainers have always weighed alongside her votes, including decades of relationships, the Senate Appropriations gavel, and federal money. Even Timmaraju, the abortion rights leader, offered the same hedge in advance: A Collins win, she told me, “says more about Susan Collins and Maine than it does about 2028.”

A win wouldn’t show that judicial votes carry no consequences, Glover added. But if Collins holds substantial support among voters who support abortion rights despite the Kavanaugh vote and the fall of Roe, “that would certainly suggest limits” for retrospective accountability for downstream consequences of Supreme Court confirmations.

Though the race is supposed to clarify whether voters will punish elected officials for taking actions that restrict abortion access, it probably can’t — at least not definitively. It will decide, though, who holds the seat, and reproductive rights leaders have been clear that without a Democratic Senate, nothing they want gets a vote.

When we think about the stakes in healthcare, we tend to think of them in terms of life and death, being sick or being healthy. The conversation is about your physical well-being and maybe your mental health — and it pretty much stops there.

But health affects so much more than your body’s biology or even just you personally, as a new survey from Gallup and Pivotal, a philanthropic group founded by Melinda French Gates, shows. That’s especially true for women, who frequently report negative experiences with the health system and ongoing struggles to get their concerns taken seriously; poor health affects the trajectory of their careers and their ability to be engaged with their families, friends, and wider community.

It starts at the doctor’s office or hospital: 51 percent of women say they have had a negative healthcare experience in the past five years, versus 39 percent of men. About one in three said that a doctor did not take them seriously when they said they were feeling pain or other symptoms, versus 21 percent of men, and 33 percent said that they either were misdiagnosed or did not receive a diagnosis. The cost of paying for care is another deterrent: 32 percent of women said they have skipped or delayed care in the past year because of the cost, compared to 25 percent of men.

“To see that half of women in the United States who sought care in the last five years came out feeling like they hadn’t gotten the help or care they needed, that’s frankly staggering,” French Gates told me in an email. “It says a lot about how little we’ve invested in women’s health and how much we expect them to just push through pain or accept uncertainty.”

And the effects of those experiences, the failure to receive proper treatment, ripples out into the rest of the women’s lives. More than half of US women, 54 percent, said they had experienced at least one health-related impact on their family life or relationships; 42 percent said their health had led to a negative effect on their career or work. It also affects their community: 32 percent said their health had affected their ability to participate in civic life.

The toll is not only physical but mental: 48 percent of women said they’d dealt with a mental health condition like depression or anxiety. And socioeconomic disparities abound. Black and Hispanic women are more likely to report being in poor or fair health. Women who have lower incomes are more likely to face career struggles because of their health than those who make more.

I had the opportunity to interview French Gates, who has made women’s health a priority in her work, over email about the survey; its findings on community engagement, menopause, caregiving, and more; and what could be done to address the problems that it reveals. Our exchange is below, lightly edited for clarity and length.

Which of these survey findings surprised you most and why?

The number of women [54 percent] who said they experienced a mental health challenge during or after pregnancy should stop us all in our tracks. And the fact that less than one in three women who sought care found it helpful is really concerning. It’s why I feel so strongly about integrating women’s mental and physical healthcare, especially during pregnancy and postpartum. Mental and physical health are so linked together.

Too much of the burden is placed on women to get answers. All of us deserve so much better.

Nearly one-third of women said in the survey that health problems limited their ability to be involved in their community. What does that look like in practice, and what do communities lose when women can’t fully participate?

Women are so often the backbones of their communities, whether they’re rallying their neighbors around a cause, leading the PTA, or serving in elected office. Without having women — and their ideas and voices — in those roles, we’re missing half of the conversation. Issues that affect women and families are less likely to get on the agenda. They’re less likely to be solved.

When a woman has a health challenge, and she has to spend so much of her time and resources chasing down answers, that makes it harder for her to show up in those spaces. We saw that in the survey: 30 percent of women said their health limited their ability to be involved in their communities. And when women couldn’t get the care they needed, that percentage doubled.

Women’s health is often talked about as a personal issue, but this data is helping us prove that it’s also an economic issue, a family issue, a community issue — it affects all of society.

Caregiving and family responsibilities prevent many women from getting medical care, in particular Hispanic and Black women. That seems to create a vicious cycle: Women are often so busy being the caregivers in their families that they neglect their own health. Eventually, they are the ones who will need care.

What do you think can be done to break that pattern? Is there a philanthropic solution? What public policy changes could be made?

Women are often taught to put themselves last and minimize their own needs. They don’t always have time to care for themselves because they’re so busy caring for others. And they might not be able to afford childcare or home health support for their aging parents. Our survey showed one in six women delayed healthcare because of their responsibilities caring for their family members. For Black women it’s one in five, and Hispanic women one in four. Too many women are facing an uphill road to even just get to a doctor’s office.

It’s possible to make it easier for people to balance healthcare and family responsibilities — but it’s going to take action from many angles. That’s exactly why I invest in both women’s health and in caregiving, and I’d encourage more philanthropists to do the same. Businesses can also support employees with good paid leave policies and reliable but flexible schedules.

But for women everywhere to benefit, we need government leaders to prioritize increasing access to affordable childcare, home health supports, and paid family medical leave. These are policies that have the support of large majorities of Americans because these are issues that affect everyone. So there’s a real opportunity here to offer meaningful help to families.

I am struck by our collective failure on menopause: Women report that they aren’t aware of menopause symptoms until they experience them on their own, that they struggle to get their doctor to take menopause symptoms seriously, and that their menopause experience has held them back in their career. What are some short-term and long-term steps we can take to address those problems?

“Right now, women need better care at critical moments in their lives.”

If more than a third of women only learn about menopause symptoms when they go through them, the system is clearly not working. Women need to learn about menopause from their doctors before they experience it. But doctors aren’t getting the education and training they need on menopause while they are in school. One doctor told me she got just one lecture on menopause across all her years in medical school. One said it was mentioned one time. They are seeking out better training but it can be hard to find. That’s why Pivotal is partnering with the Menopause Society to expand physician training on menopause so doctors, nurses, and other healthcare providers can access the information they’re looking for to better help their patients.

Because menopause isn’t just about being uncomfortable; it can also bring anxiety, heart palpitations, insomnia — significant symptoms that can really hold women back. More than a quarter of women who’ve experienced menopause or perimenopause said it made it harder to live up to their full potential at work. One in 10 had to take leave or leave their jobs entirely. That just shouldn’t be. Women shouldn’t have to step back right at the moment when they could be stepping into leadership roles.

The most immediate steps can come from policymakers, especially at the state level. They can include menopause care in insurance and Medicaid coverage and offer workplace protections to women in menopause the way they do for pregnancy, so women can get the care they need without losing their jobs. I’m also focused on longer-term solutions, like expanding training for healthcare providers and investing in research to accelerate treatment options.  

Women are at the forefront of a lot of wellness trends these days and yet, as the survey reveals, women also report encountering a ton of health misinformation on social media. Why do you think women are so often the targets of this kind of content? What can be done to point women toward and build their trust in sound medical information?

One in three women said she left an appointment without a diagnosis, with her pain being dismissed, or with no answers or next steps. You can understand why those women would start looking for information online. And because women’s health has been underfunded and under-researched, there just isn’t as much reliable information out there as there should be, which leaves a lot of room for people to come in with misinformation. Investing in credible scientific research to fill that vacuum will give both women and their doctors more information going into their appointments.

In terms of your own organization’s work, which investments are you making that you think can make progress on the underlying problems revealed in this survey?

We need to address the right now and we need to address the longer term. Right now, women need better care at critical moments in their lives.

One way we’re investing in that at Pivotal is by making it easier for women to get the mental healthcare they need during and after pregnancy. So we are investing in integrated models that put mental and physical healthcare under one roof. I visited a health clinic in Alabama earlier this year where they identify issues like depression and anxiety right at the outset and then help the mom all the way through her pregnancy care, all in the same place. That model is something we strongly believe in.

Better care for menopause will require better training, which we are thinking about in both the immediate and long term. I mentioned that we’re making more menopause training available to doctors who are currently practicing. That is something I’m really excited about because I’ve heard from physicians who really want to better support their patients and are looking for better information so they can do that. And longer-term, menopause needs to be a much bigger part of the curriculum at medical schools moving forward.

Another longer-term focus of ours is trying to make up for decades of lost time in research. We are funding medical research focused on how diseases specifically impact women, in partnership with an innovative organization called Wellcome Leap. They are working to accelerate progress in women’s health on everything from autoimmune diseases to cardiovascular disease in years, not decades, which is how long health breakthroughs usually take. That’s the kind of urgency women need and deserve.

Even before the latest batch of alarming AI news, a lot of Americans were souring on AI. That may be for big, existential reasons — concerns about widening inequality, mass job loss, and the still-unclear environmental impact of data centers — or for very specific, personal, everyday ones, like being forced to use a worse version of Google search. 

None of this is to say that AI cannot be a useful tool for some people some of the time. It’s just that the untested technology was thrust upon millions of people who didn’t necessarily ask for it and really seem to not like it. More than twice as many Americans distrust AI as trust it, and a growing number of people think it will have a negative impact on productivity and economic growth, according to a recent survey by Gallup and the Special Competitive Studies Project. While about half of Americans now report using chatbots, a majority also think that AI will put their personal information at risk and nearly half think it will have a negative impact on society, according to a 2026 Pew study.

“It’s being forced on users, there’s no clear way to turn it off, and it feels like this unwelcome addition to their lives,” Rory Mir of the Electronic Frontier Foundation (EFF), a nonprofit that defends digital privacy and free speech, told me. “It’s this kind of continued pattern of disrespect to users that I think is part of the pushback.”

If you want less AI in your life, opting out is not always easy. But there are things you can do to minimize your exposure. 

There are ways to turn off AI features, although the process can be tedious. There are also steps you can take to prevent your data from being used to train AI models, though it’s difficult to keep all of your online data away from web scrapers. 

I talked to five experts — including a computer scientist and a researcher studying AI resistance — who offered distinctive perspectives on what AI is doing to us, and who shared some simple and concrete steps you can take to push back against AI’s creep into our daily lives.

The AI that’s suddenly everywhere

In the early days, which were just a few years ago, you really had to know what you were doing if you wanted to test out AI. Now, it’s impossible to avoid. 

“More and more AI use is through its integration into digital products like search, email, camera apps, and social media,” Arvind Narayanan, a computer science professor at Princeton University, told me. “It will become increasingly hard to strip these out unless one is willing to forgo digital products altogether.”

What you’re specifically encountering is generative AI, and one of the most common types is a subset called large language models (LLMs), which ingest huge amounts of data and learn statistical patterns to predict and generate text. ChatGPT is powered by an LLM. The AI Overviews that sit on top of your Google search results come from an LLM. The grammar checker in your email app is likely powered by an LLM. Other subsets of generative AI include models that can produce images, video, audio, and software code. 

The data that makes many of these tools work has been scraped from the open web, pirated books, and rare print books that are subsequently being destroyed. Everything from Wikipedia articles to YouTube videos has become training data for LLMs, and in order for the models themselves to get better, AI companies need more fresh data, which is in increasingly short supply. (Disclosure: Vox Media is one of several publishers that have signed partnership agreements with OpenAI. Our reporting remains editorially independent. Future Perfect is also funded in part by the BEMC Foundation, whose major funder was also an early investor in Anthropic; they don’t have any editorial input into our content.)

As a result, some of these companies are venturing into their users’ profiles to find more data. Meta, for example, sparked global outrage in 2024 when it informed some Facebook and Instagram users that it was using their public photos and text to train its AI models. Meta still does this. That your family photos or social media updates are being used to train AI to look and sound more human is, at the very least, very dehumanizing.

Generative AI, of course, is not the only type of AI that’s invisibly moving levers in your digital life. Recommendation algorithms are arguably even more inescapable. They power everything from Amazon to Netflix to Spotify and dictate what we buy, what we watch, and what we listen to. If you have trouble picking out an outfit in the morning, it might be because your brain is used to having algorithms around to help make decisions. This is also dehumanizing. 

All of this — the societal harm, climate impact, the cognitive surrender — should be on your mind as you consider whether it’s worth enlisting these tools to write emails for you or to generate memes, according to Tania Duarte, founder of We and AI, a nonprofit focused on critical AI literacy. 

“People are becoming increasingly aware of not just the impact on themselves but on the impact on the society they want to live in and the future that they want to have,” Duarte told me. “Is it worth all of that?”

How to minimize your AI exposure

If you’re reading this, you’re probably doing so on a smartphone or a computer. So let’s start with the assumption that you’d like to continue using devices like these. 

If you’d like to minimize your exposure to AI, that presents a bit of a paradox. It’s seemingly impossible to use mainstream tech products without engaging with AI. But you can take steps to remove as much of it from your life as possible without going completely off the grid.

“You look for the spaces of agency rather than lamenting the fact that you can’t escape everything,” Dylan Orchard, a researcher at King’s College London who studies everyday resistances to AI, told me. “You can’t expect a perfect escape.”

Let’s start with the easiest options: You don’t have to use ChatGPT or Claude or Copilot. The same goes for Google Gemini and Apple Intelligence. If you’re happy with the way you access information online, save yourself the time. (Note: This will be much harder to do if you’re being required to use these tools at work or at school, so for the sake of this article, we’ll focus on the things you can control.) 

Things get more complicated when you consider how your existing devices or software have recently been AI-ified. If you’re using an iPhone, for instance, you might be aware that the latest operating system comes with an updated version of Apple Intelligence, a layer of AI that does everything from summarize your notifications to power a new Siri. Earlier this year, Google launched its own version of this layer called Google Intelligence, which it says will make Android transition “from an operating system into an intelligence system.” The same push toward cramming AI into every corner is also happening on Windows 11, where Microsoft Copilot promises to be helpful.

If you were happy with your phone or laptop when it was slightly dumber, however, you can turn these features off. You can also opt out of other AI features built into your device’s operating system. Here’s a helpful guide that gets into the weeds of how to do it; it covers Apple Intelligence; Google Gemini, including AI Overviews and AI writing help in Gmail; Microsoft Copilot; Meta AI; and Samsung Galaxy AI. Turning off the AI features on Android devices is more complicated than flipping a single switch, but it can be done.

A lot of your AI exposure will happen in your web browser, though, so you should consider ways to bypass those features or switch browsers. Here’s another helpful guide that explains how to remove AI content from search results as well as AI features built into Chrome and other browsers, along with Microsoft Office. If you want a quick fix, adding “-ai” to a Google search should get rid of AI Overviews and some AI content in the search results, but none of these hacks will guarantee that you avoid AI slop altogether. Using a privacy-focused browser, like DuckDuckGo, might do a better job at it than Google, though.

When it comes to other online activities, like shopping or scrolling on social media, avoiding AI gets even harder. TikTok, Instagram, Facebook, and YouTube lack a master switch that lets you opt out of all the many AI features on offer. Still, you can try to tone down the algorithmic sorting that all the apps use to serve you content by switching to a chronological feed or removing suggested content from your feed. (Try tapping the Instagram logo in the app and then hit “Following” to see just the accounts you follow.)

Unfortunately, once you dig into the various user agreements and privacy policies, you’ll find that it’s very difficult to avoid AI exposure on social media platforms. If you’re posting publicly, you should assume your content is being used to train that company’s AI models. (You can keep some of your data away from Meta’s crawlers by setting your Facebook or Instagram account to private. X also allows you to opt out of having your data used for training its AI.) If you want to turn off video summaries on Instagram Reels, too bad. You can’t. If you want to turn off comment summaries on Facebook, you’ll have to go four menus deep in your settings to find the right switch. The most straightforward way to avoid being used as training data is to stop using these apps entirely. Or at least stop posting your own content, which is easier said than done, but worth considering if you really want to resist the AI takeover.

There’s a programming term that describes the inundation of AI features and slog of opting out: “user-hostile.” It’s a play on the term “user-friendly,” and it describes software that values the company’s priorities over the end users. You may love AI, although that’s doubtful if you’ve read this far. If it drives you crazy, though, you should feel at least a little bit empowered to know that there’s a way to reclaim the experience you had and loved without AI — or to use AI on your own terms. 

“Ultimately, I think the important thing for folks to keep in mind is that AI is just a tool,” said Mir from EFF, “and it makes sense to want control over your own tools, including the option to not use a tool if it’s not right for you.”

It’s frustrating that we have to deal with this at all, if only because most of us did not ask for our cyber existences to be sullied by untested tech. But it’s actually refreshing to consider that, because of a never-ending onslaught of annoying features, AI might actually discourage us from using social media so much.

If anything, the extent to which we feel the need to flee from AI also reflects our craving for something real, that makes us feel more connected and more human. So when AI summaries interrupt your time on Instagram, consider texting your friends a handful of photos from your week or calling them on the phone. If you’ve finally seen one too many AI slop videos on TikTok, put on a classic movie or TV show. 

At the very least, put down your phone and take a walk outside; your attention span will thank you for it. Yes, your individual rejection of AI might be a drop in the bucket for these huge tech companies, but that doesn’t mean it’s not worth doing anyway.

Correction, September 21, 2:10 pm: The way this story originally represented Tania Duarte’s comments has been revised to clarify her concerns with AI.

Wildfires are popularly considered wild — restricted to the remote wilderness or the edge of forests, and to most, a problem for the dry and hot states of the Western US. But over the past few years, and now across the country, these fires are getting less wild and far more urban. 

This summer, fires in Spokane, Washington, demolished over 800 homes in a suburban neighborhood, and earlier in the season, the northeast coast was engulfed in smog from fires in Ontario. The Hawk Fire in Nevada razed more than 15,000 acres near Reno, destroying 47 homes before it was extinguished. The Los Angeles fires of last year remain some of the most devastating in recent memory, with over 37,000 acres burned — much of it densely built residential neighborhoods — and displacing 205,000 people from their homes. In Boulder, Colorado, the 2021 Marshall Fire destroyed nearly 1,000 homes. 

This changing geography of fires is affecting the health risks they present, too. 

When vegetation burns, it releases particulate matter, or PM 2.5, and with over 46 million homes in the continental US — this is approximately one-third of all homes — on the edge of fire-prone wildland, many more of us are being exposed to air filled with that soot. This alone is a major health risk. According to the World Health Organization, PM 2.5, is associated with premature death, severe damage to respiratory health, and cognitive impairment. It is especially dangerous for aging populations: a study published in February found that accumulated exposure to wildland smoke was associated with greater hospitalization risk for various cardiovascular diseases in older Americans, including irregular heart rhythms and heart failure, even when they are only exposed to moderate levels of PM 2.5.   

But the urban landscape has also changed the very composition of the smoke that increasingly hangs over all of us. As human structures and vehicles burn, the fires expose us not just to particulate matter but also to the chemical toxins of urbanization itself, from plastic to metal oxides and vehicle fuel. The changing nature of this smoke, in fire zones but also in surrounding regions as it drifts outward, exposes us to a new class of health risks. 

While researchers are still learning what exactly those risks might entail, early research suggests long-term dangers that are deeply troubling, especially as exposed populations age.   

The changing fire frontier 

In 2020, the worst California fire year on record, ate up 4.2 million acres of land, most of it wild, spewing huge amounts of PM 2.5 into the air as the blazes raged. Emergency rooms, already short-staffed by the ongoing pandemic, buckled under the burden immediately. Northern California’s Stanford Health Care system saw a 12 percent jump in hospital admissions over the weeks following the fires, and a 43 percent increase in cardiovascular conditions. In Oregon that same year, 10 percent of emergency room visits were due to asthma-like conditions induced by smoke as fires migrated north.  

Unfortunately, in a world of warming temperatures and drying conditions, that story is becoming all too common. In 2025, a total of 5.2 million acres of land burned across the US, and this year that number has already climbed to 8.5 million, before we’ve even hit the winter dry seasons that plague parts of the Southwest. 

Despite this, the global footprint of human housing continues to expand, and with it the danger.  

For centuries, human development has breached wildfire territory. However, over the last three decades, the zone that links the wild to cities and towns, called the wildland-urban interface (WUI), has grown substantially due to suburban construction. The US Forest Service found a 46 percent increase in the number of houses in the risky WUI zone between 1990 and 2020. By 2020, a third of US homes had been built in this highly vulnerable landscape. The math is simple: As suburbia expands into wilder regions, the more houses are exposed to wildland, and the fire risk grows greater. And when houses and other human-made goods burn, different and potentially more toxic forms of smoke can be produced. 

The Los Angeles County fires in January 2025, which saw large urban regions devastated by flames, were an unfortunate case study for these risks. The Palisades and Eaton fires began on the northern edge of the LA foothills, where dense housing meets more wild, and more fire-prone, terrain. In a retrospective analysis, Underwriters Laboratories’ Fire Safety Research Institute detailed how the urban-wildland makeup of Los Angeles County has not only put more communities physically in fire-prone zones, but also has historically made the geographic region itself more vulnerable to fires. 

As those fires spread into LA’s more urban areas in 2025, the smoke they produced became more dangerous, largely because of what was burning: more than 16,000 buildings, household items, and electric vehicles. The resulting emissions were thus far more complex than typical vegetation-only fires. 

“What’s burning is now very different,” said Jackie Goodrich, an epidemiology professor at the University of Michigan. “So now modern homes have tons of plastic, metals, and all of our electronic appliances, and electric vehicles have these batteries that have a lot of rare metals and other toxic materials we don’t even know about.” 

As a result, these emissions contain higher concentrations of volatile organic compounds (VOCs), metals, and carbon monoxide. PFAS, commonly dubbed “forever chemicals,” are also released through fire extinguishing foam and damaged firefighting gear, which traditionally contains PFAS to protect the skin from fuel that may soak through. These chemicals are associated with adverse health effects, including higher risk of certain cancers and weakening of the immune system. Many of these compounds are dangerous carcinogens. 

These urban fires have a dangerous impact on indoor air quality, too, as chemicals and metals are absorbed into soft surfaces like pillows or textiles. Studies conducted in the aftermath of the LA fires found that post-wildfire VOC levels were elevated inside evacuated homes during the months following the fires. All of this goes to show that Americans can face the health risks of WUI smoke exposure, even when their homes emerge from the blaze relatively undamaged.

These dangers mount over time and across populations

Studies examining hospital admission rates or emergency room visits offer some perspective on the short-term health effects of wildfires. But work by Goodrich and University of Arizona public health professor Jeff Burgess is providing new insight into long-term harm by using a subset of the population repeatedly exposed to and vulnerable to fires: the people who fight them. 

In a study published last year, Goodrich and her fellow researchers examined blood samples from fire responders working in mixed urban and wild areas. They found that exposure to smoke limited the genetic expression of a tumor suppressor known to inhibit gastric cancer cell growth. It also affected regulatory expression similarly associated with tumor proliferation across cancer types, as well as neurodegenerative diseases. 

Burgess has run similar studies across 33 states with 9,000 participating firefighters, allowing the researchers to examine changes in microRNA levels, blood proteins, and DNA methylation (which controls whether genes are on or off). His research on a small cohort of new fire recruits found altered DNA methylation at various sites in the genome, many of which are similarly linked to cancers, neurological disease, and cardiovascular disease. 

It is still unclear whether these biological warning signs lead directly to cancer, Burgess said, largely due to the natural latency period between exposure to toxic substances and actual onset of disease. But as participants age, he expects to see a higher incidence of cancer, especially as exposure to big fires accumulates. 

Firefighters have more prolonged exposure to these toxins than most, of course. But the health effects of wildland-urban fires can extend beyond self-selecting groups, especially as more people move into regions exposed to fire. Residents in the WUI are exposed to the same particulate matter and chemical slurry as firefighters. Goodrich suggests that this could lead to a higher risk of asthma and respiratory problems for children, as well as cardiovascular health incidents in adults.  

Examining longer-term gene expression effects, however, is still more difficult in the general population than it is in the firefighters that her lab studies. While firefighters are often exposed to the same chemicals over and over again, it can be harder to get a clear sense of how toxins affect the average civilian who encounters them more sporadically. 

That said, researchers at UCLA have been keeping a close eye on background toxic chemicals in the aftermath of the LA fires. In a paper published in June, they identified high levels of chromium 6, a carcinogenic metal nanoparticle that can cross cell membranes easily, in wildfire cleanup zones for up to two months following the actual fire. Abnormal concentrations of these heavy metals were also found up to six to nine miles downwind from the zones themselves.

Even following the disaster and immediate recovery periods of urban destruction, the public health dangers can persist: Toxic compounds like VOCs can contaminate waterways, and damaged air filtration systems can make it harder to protect surviving homes against future incidents.

As wildfires become less confined to the chaparral and forests and more likely to rage through suburban streets, we’ll all have to prepare to face the orange haze of fire season. And as we do, we’ll have to confront new dangers that may persist long after the blaze dies down.

A decade ago, insulin became the poster child for America’s out-of-control drug prices. The 2017 death of Alec Smith, who was rationing his insulin before he died, and repeated price hikes for a 100-year-old medication (the patent for which was originally sold for $1 to a university to prevent it from being exploited commercially) sparked widespread outrage that a lifesaving medication could be unaffordable to the people who depend on it to survive.

And then politicians actually acted. Starting with a Colorado law passed in 2019, states began passing laws capping the out-of-pocket costs for many people who take insulin; 27 states (plus Washington, DC) now have such a policy. Then in 2022, Congress included a provision in the Inflation Reduction Act that established a $35 per month cap on insulin prescriptions for people on Medicare. Given the national response — drugmakers also made splashy public announcements about reducing the cash price that uninsured people pay — you would be forgiven if you thought this was the one health care cost crisis that the US had genuinely managed to solve.

But the diabetes community has a dire warning: It’s not over. Millions of people continue to struggle to pay for their insulin and having their long-term health put at risk because of, in the words of one advocate who put it bluntly, pharmaceutical greed.

“There has been so much attention and promise to action around the insulin price crisis. … There has been so much action,” said Shaina Kasper, executive director of T1 International, a global nonprofit that advocates for people with diabetes. “And shockingly, frustratingly, critically, the data from our 2024 survey showed that the rationing rates were worse than ever. Ultimately we’re facing such immense and monstrous corporate greed. … When we put a Band-Aid on one hole, another one’s going to find a way to pop out and keep profits high.”

Fixing the insulin crisis will require a multifaceted approach: drug pricing reform, insurance mandates, and possibly even public manufacturing. Out-of-pocket caps, Kasper said, were always a temporary fix for a very broken system. There is still a lot more work to do.

Why so many Americans still struggle to afford insulin

Both national and local surveys indicate that the policy changes of the past decade have not had the desired effect.

A study published last year from researchers at the Yale Diabetes Center found that people treated there were rationing insulin at the same rate in 2024 as they were in 2017; about one in four people reported some rationing due to the cost of the drug in both years. When you added in the people who rationed because of insurance delays or supply limits, more than one in three people — 38 percent — were still having trouble keeping this lifesaving medication on hand in 2024. A 2024 T1 International survey likewise found that nationwide, 34 percent of the Americans who use insulin reported rationing the medicine. (About 8.4 million people in the US rely on insulin to survive.)

Dr. Kasia Lipska, an endocrinologist and researcher who treats patients at the Yale Diabetes Center and who co-authored that study, was surprised by their findings.

“I was surprised because I’ve been looking at the policy and advocating for policy change; you think things are moving, they should be really improving,” Lipska said. “But if I talked to the nurses and our staff at the Yale Diabetes Center, they told me, ‘Of course they haven’t changed. We’re still hearing these stories.’”

How could this be? The explanation is multifaceted, according to Lipska and Kasper. 

“There’s just still a lot of holes in one who is covered by various protections and then how they’re covered and how they access this,” Lipska said. “It’s not as simple as just showing up at the pharmacy and asking for your insulin, and the sticker price is there, and that’s what you pay. It’s extremely complicated.”

For starters, millions of Americans remain uninsured and have to pay the cash price for drugs. While drugmakers make flashy announcements about helping those people, the process of enrolling for savings cards to get those lower prices can be a nightmare; one congressional investigation found in 2023 that uninsured patients were still paying an average of nearly $100 for insulin despite Eli Lilly’s pledge that its generic product would be available for $25 per vial. Even if you manage to get your discount card, the same investigation found that Lilly introduced several restrictions based on geography and needs, and that the specific insulins that are subject to these voluntary price caps are often out of stock at the pharmacy when people go to fill a prescription (while the more expensive brand name version is consistently available).

And then there are the loopholes in those existing federal and state laws. The federal $35 cap applies only to Medicare; the private insurance that covers half the country is excluded. (There have been bills proposed to extend the cap to private coverage, but they have not gone very far in Congress.) The state laws that do exist typically apply only to small-group and individual plans that are subject to state regulations; larger self-funded plans are exempt from state mandates and currently have no enforced limit on out-of-pocket insulin costs. One national estimate found that around 775,000 people who use insulin and had private insurance were protected in 2025 by the caps in states where they’d become law. But more than 1 million people in those states were not, nor were the 2.1 million commercially insured insulin users in states without a cap.

Even for people who benefit from the mandatory out-of-pocket caps instituted by Medicare and state laws, some of them still struggle to come up with $35 a month, given all of the other price hikes Americans have faced since the pandemic. They may have to navigate a complex process in order to actually receive the promised discount. And while a $35-per-month cap sounds straightforward, in practice, people can still face higher costs. Each individual person requires a unique amount of insulin and, for some of them, they might need two different kinds; the pharmacy may not have the right version and will make substitutions that lead to higher costs. That’s how one of Lipska’s patients ended up paying $140 per month for his insulin — despite being on Medicare.

“These things really add up…and frustrate people,” she said, “because what seems like a great idea is not actually how things work on the ground.”

The consequence is that, despite all the legislative activity and self-congratulations, millions of Americans are still at risk of serious health problems because they can’t get insulin.

The worst-case scenario is what happened to Alec Smith: Somebody is forced to spread their insulin so thin that they put their life is in danger. When diabetics have their blood sugar spike without insulin on hand, they can go into diabetic ketoacidosis, “which literally means your blood is turning into acid,” Kasper said. “I can speak from experience: it feels like you’re dying.”

To recover from an episode, they may have to go to the emergency room and end up taking even more insulin while eating in order to get their body back to equilibrium. But even short of an emergency, Kasper said, people who resort to rationing insulin can experience significant side effects. Prolonged high blood sugar due to rationing could lead to serious vision and nerve problems that were supposed to be a thing of the past once insulin became available.

Those were the scenarios that lawmakers wanted to prevent as they tried to make insulin more affordable. But they remain a very real threat for too many people.

The big idea that could make insulin truly affordable

If there’s good news to be found, it’s that the advocacy community is not giving up. They are sounding the alarm about the ongoing affordability crisis and urging Congress to act. But they do worry that the issue has become less urgent: The truly comprehensive mandate for insulin out-of-pocket caps, which is typically introduced every Congress, was delayed this time. “This year, neither bill was introduced for over a year, and it was very concerning,” Kasper said.

But they are also placing bets on something much more profound than a price cap: the government itself procuring or even producing insulin and making it available to people at the lowest possible cost. 

“This idea that medicines should be for people and not for profit I feel like is really catching,” Kasper said. 

Some states are taking baby steps in that direction: Oklahoma passed a bill this year that would offer government funding for private companies that pledge to produce insulin and sell it at a low price. 

Others are going bigger. As I reported in 2023, California has launched a program that is eventually intended to lead to government-owned facilities producing insulin to be sold on the cheap, though it will take years until publicly owned production begins. The New York state Senate approved a similar plan this year, although funding for it didn’t make it into the state’s budget. Kasper said that she is optimistic the project will make it into next year’s spending plan, and says a lot of work is currently being done to ensure it happens.

In the future, public manufacturing could also help to address the supply problems that continue to pop up. There are only three insulin manufacturers in the US right now. As those for-profit pharmaceutical companies place more emphasis on GLP-1 production — which often takes place in the same facilities as insulin production — nonprofit initiatives could fill in the gaps.

“In this time of tariffs even, with these concerns around shortages and rising prices and the corporations having this monopoly and price gouging ordinary Americans for decades now, as we’ve seen on insulin, let’s just make it ourselves,” Kasper said.

This is a long-term vision; if you need help right now, T1 International has resources to help people get health insurance, access discount programs, and even find emergency insulin. But a more affordable future for insulin will only be possible if lawmakers feel compelled to act. Public outrage created one round of reform, but the risk of political complacency is real. So if you care about this issue and want to get involved, T1 International also has a tool kit for people who want to advocate for policy changes, including around public pharma.

“The general communication that we’ve been hearing is that the insulin price crisis is over,” Kasper said. “Everyone should have access to a $35 copay for insurance. As the data shows, as we’ve been talking about, that is just not true.”

On stage at Davos in the Swiss Alps earlier this year, Bill Gates, before an audience of the global do-gooding elite, announced a $50 million partnership between his foundation and an unlikely new ally, OpenAI, aimed at improving healthcare in Rwanda.

Just a month earlier, the Gates Foundation had released a harrowing report about widespread global health cuts and collapsing foreign aid infrastructure, documenting a rise in child deaths for the first time this century. But at Davos, even as the US hemorrhaged funding for vaccines, maternal healthcare, and HIV treatment, the Microsoft co-founder struck an optimistic tone. 

“Using innovation, using AI,” Gates told Reuters, “I think we can get back on track.”

As it turns out, the partnership was just an opening salvo for what’s become a wholesale embrace of AI by the world’s largest global health philanthropy. A $200 million partnership with Anthropic came just a few months later. And then, on Tuesday, the Gates Foundation announced a plan to dole out a jaw-dropping $1 billion over the next two years for scaling up AI interventions across healthcare, education, and agriculture around the world. 

The sense that AI will soon change everything, and mostly for the worse, has perhaps never felt so pressing and alarming as it does right now. But this hefty new commitment is premised on the idea that AI could eventually make our lives much better too. In a country like America, AI requires massive investments and buildout — in the grid, in power, in technology, in water. In many parts of Africa, already infrastructure-poor, the foundation is effectively betting that AI can compensate for some of the infrastructure that isn’t in place or that has been lost — and offer a new layer that can help in education, in delivering healthcare, and more. 

The Gates Foundation’s new commitments include projects to improve how farmers analyze their crops, how doctors diagnose patients, and how students learn. Some have already proven to be quite effective, according to the foundation, with one tool improving the accuracy of medical diagnoses by 16 percent across several Kenyan clinics. “In poorer countries with enormous health worker shortages and lack of health systems infrastructure,” Gates wrote on his blog earlier this year, “AI can be a game-changer in expanding access to quality care.” 

Last year’s foreign aid cuts were unfathomably destructive for some of the world’s poorest countries, shuttering thousands of clinics and perhaps hundreds of thousands of classrooms in places where critical workers and supplies were already stretched thin. No, AI cannot deliver a baby, administer a vaccine, or manage a classroom — not yet, at least — but it can, the Gates Foundation hopes, help ease the burden and augment the quality of care for nurses and teachers now tasked with serving far more people than any one person should. 

“This is the most transformative technology of our lifetime,” Mark Suzman, CEO of the Gates Foundation, told me, and while there are “very real risks and challenges” surrounding AI, it also presents genuine opportunities to tangibly improve many people’s lives.  

It is a tantalizing premise: We can’t afford to build clinics, hire teachers, or lay new power lines, but perhaps AI could create the digital infrastructure needed to help billions of people do more with what they have — or rather, with what’s left. The question is, can the right layer of innovation help bolster a buckling system, even as the physical and logistical infrastructure surrounding it crumbles?

Is AI really what global health needs right now? 

Most Americans have yet to see AI improve their lives in meaningful ways, much less those living in poverty or in countries where only a sliver of the population has ever used ChatGPT. 

But those numbers in the developing world are slowly changing, a shift enabled in part by other global health funders convinced that as foreign aid dries up, AI could soon help the world do more with less. The Trump administration itself is on board with this thinking, so long as it benefits American tech companies. Last year, the State Department announced a $150 million partnership with the drone company Zipline to transport medical supplies in several countries.

To Zipline’s credit, an NPR reporter in Rwanda last month found that the company’s drones were already saving lives in places with poor road infrastructure, where driving to the nearest hospital can take hours on winding hills, but where drones can deliver crucial blood transfusions within minutes. 

And yet, for Rwandans to benefit fully from these high-tech deliveries, they need staffed clinics to visit. As a result of foreign aid cuts, some of those literal landing spots are now on the verge of closing in some of the nation’s most vulnerable rural corridors. “Without the underlying infrastructure, like roads, energy and power and unless there is accessibility, rural and otherwise,” Enoh Ebong, president of the global development department at the Center for Strategic and International Studies, told NPR, “then all of these solutions will stop short.”

But just as medical delivery drones still need a clinic to fly to, most of these interventions require some layer of physical infrastructure — roads, schools, power, and quite obviously, broadband  — to function. Satellite imagery shows that some rural communities in sub-Saharan Africa quite literally went dark in the aftermath of USAID cuts. It will be much harder for their kids to prompt an AI math tutor, or for a local farmer to download a weather app. 

“We’re seeing this very much as a both/and,” Suzman told me, calling more traditional funding for education and healthcare “the bedrock for long-term economic growth,” which AI is meant to supplement, not replace. But, in practice, foreign aid cuts have left serious cracks across much of that bedrock, which could make it harder for state-of-the-art solutions to function as intended.  

It is obviously not incumbent on the Gates Foundation to pay for all of this alone – nor would it even be feasible for them to do so. And for the record, plenty of the foundation’s other grant programs are not AI-related at all. But this tension does speak to a broader question that may be felt most acutely in a context like global health, but ultimately one that touches us all: Do we spend our scarce resources on the digital infrastructure of the future at the peril of our needs right now? Could you justify buying the new $1,999 folding iPhone if you can barely afford to buy groceries? 

The answer is not actually always an easy one. It is not for us to say, for example, that just because a community lacks reliable running water, its people should be excluded from the benefits (and encumbrances) of the smartphone, especially if that smartphone can connect them to health advice they could never access otherwise, or guidance that could help them survive a drought. 

In some parts of the world, digital forms of banking arrived long before local brick-and-mortar branches did, instantaneously connecting countless people to a cheap and secure way to save and send their cash to family and friends in need. It is certainly possible that AI, or at least the kind of applications the Gates Foundation funds, could one day have a similarly transformative effect on how people access personalized levels of care, education, and other services in places without the resources to do so otherwise. 

That is the hope, but it is also hard right now to believe uncritically in a technology that, as Gates himself blogged just last month, “will either be the greatest equalizer ever invented, or the worst source of injustice,” ushering in “one of the most turbulent times in human history.” 

In an interview with the New York Times soon after, he seemed convinced that AI will likely do more harm than good. “I don’t like bringing bad news to people, and I don’t like saying that innovation may be a net negative,” he said. “But that’s where we are.”

Now he wants billions of people around the world to use it? Yes, Suzman said, because if not, then inevitably the best parts of AI — the potential for exponentially better cancer treatments, for example — will go only “to those who can pay for it,” while the worst parts of it will fall, as they so often do, on those who benefit the least. “These decisions are being made now,” he said, “and the decisions being made now will then probably shape the following two decades.” Here’s hoping they’re good ones.

Russ Kremer is a longtime hog farmer in the Missouri Ozarks, where his 2,000 pigs have plenty of space to roam on his 150 acres. He doesn’t feed them antibiotics, and you won’t find a single animal in a cage. Kremer is decidedly anti-industrial hog farming.

Whenever he sends his pigs to slaughter, like every hog farmer in the US, he’s legally required to give over a small share of his sales — 35 cents for every $100 — to the National Pork Board.

If you’re not a hog farmer, you might not have heard of the National Pork Board. But you’ve probably seen its ads. Its job is to promote pork to consumers, and it’s the group behind the once ubiquitous slogan “Pork. The Other White Meat.”

The idea behind the National Pork Board — financed with mandatory contributions from Kremer and virtually every other American hog farmer — is that all pork producers should benefit from this kind of prominent marketing to buoy their product. So a dollar or so from each pig should be worth it. 

The group’s funds, by law, are limited to advertising and research. They specifically can’t be used for political lobbying to influence legislation. There’s a good reason for that: While boosting pork consumption should help any pig farmer, when it comes to laws and policies, some benefit certain types of producers over others, such as more industrial producers. And because virtually all farmers have to pay into the fund, it seems only fair to keep it policy-neutral. 

It’s essentially a tax, one that consumers indirectly pay each time they buy any kind of pork, too. “I’m not opposed to paying a tax if the tax does us some good,” Kremer told me. But Kremer and many of his fellow anti-industrial hog farmers believe it is not doing good. That’s because the National Pork Board has moved millions of their dollars to the largest industrial pork lobby in America. 

It’s called the National Pork Producers Council, and over the last 70 years, it has emerged as the loudest advocate for factory-farm style hog production. 

Since 1999, NPPC has spent nearly $45 million on federal lobbying on a variety of issues — including many of the kinds of policies that more humane and sustainable hog farmers like Kremer tend to benefit from, like antibiotic restrictions, pollution regulations, and protections for independent farmers who sometimes get screwed over by big meatpackers. In recent years, the group has also thrown millions of dollars into lobbying for the very unpopular practice of keeping pregnant pigs in tiny crates — a method that big, industrial operations are much more likely to use than smaller farms. 

Kremer, for his part, is the former president of the Missouri Farmers Union — the state chapter of the National Farmers Union, which is a small but mighty counterweight to the Big Ag lobby groups like NPPC.

The two organizations — which are legally required to operate as separate — have a very close relationship that has allowed the National Pork Producers Council to capture tens of millions of dollars from the Pork Board over the past two decades. According to a new, exclusive analysis of public financial transactions gathered by the Accountability Board — a nonprofit that advocates for higher-welfare animal farming — the National Pork Board has paid the National Pork Producers Council $66 million with its farmer contributions since 2004. Of the $66 million, nearly half of these financial transactions have not been previously reported in the news media. 

Critics say the financial transactions between the two organizations have effectively created something of a reverse Robin Hood effect in the pork business, in which an industrial farming lobby group has taken millions of dollars from smaller farmers only to use it against them and their typically more responsible ways of raising animals. 

Or, as Kremer calls it, a “kick in the groin.”

And it amounts to a meaningful chunk of the pork lobby’s overall budget: According to Vox’s review of the financial documents, some 18.5 percent of NPPC’s revenue has come from farmer checkoff dollars since the early 2000s.

The money stems from two sources: highly profitable trademark deals and a sizable real estate arrangement. Over the past 22 years, the pork promotion board has paid a remarkable $59.5 million to own and license a trademark package and another $6.5 million in rent to its landlord, the National Pork Producers Council. Although one of these cash transfers has been the subject of a lawsuit — and the organizations’ intertwined relationship has been repeatedly criticized by opponents of industrial agriculture, lawmakers, federal agencies, and farmers forced to pay the money — the groups’ close relationship has persisted.

The National Pork Producers Council didn’t respond to several detailed questions about the relationship and financial arrangements over email; in a statement, a spokesperson said that the deals between the organizations had been approved by the USDA and a legal challenge to one of the deals had been dismissed in court.

The National Pork Board also didn’t respond to an interview request for this story, or to detailed questions over email. And the US Department of Agriculture, which oversees the National Pork Board and has approved these deals, declined an interview request for this story, and did not respond to detailed questions over email.

The long saga of redirected pork-industry dollars shows how the interests of industrialized farming can find ways to overwhelm the interests and values of smaller-scale producers — and operate with relatively little government scrutiny. It also raises meaningful questions about whether the USDA is protecting the interests of American food consumers and farmers across the country, or just guarding the specific agenda of the largest players in the ag industry.

How Big Pork set up its federal piggy bank

The idea of a marketing fund that farmers pay into wasn’t new in 1985, when Congress created the National Pork Board. The egg industry had one, which had made the famous “Incredible Edible Egg” slogan, while a state-level dairy program later created the “Got Milk?” slogan.

They’re called “checkoff” programs, and with those funds, there were fears from the start that the pot of money that every farmer was required to pay into might be used improperly: “We should protect against making these producers de facto members of any association that they may not wish to be involved with,” Sen. Chuck Grassley (R-IA) warned at the time.

Grassley’s concern was prescient. The National Pork Producers Council had its own voluntary checkoff program, which it set up in the 1960s and aimed to raise a modest $40,000 in its first year. It then successfully lobbied to create a mandatory checkoff program in 1985, and even drafted the regulations for it — which became the National Pork Board, the fund that farmers have to pay into. Turning it from voluntary to mandatory brought in way more money — from $40,000 in 1966 to an estimated $25 million in 1987.

And even though this new pork promotion entity was supposed to be independent, the NPPC essentially ran it. The National Pork Board had eight program areas and $500 million from farmer checkoff funds to use over its first 15 years — but only two employees. So it contracted the NPPC to execute on those programs, along with handling its accounting and operations. The two groups even shared office space in Iowa for their respective headquarters. 

They were, in effect, separate groups in name only.

“It’s very difficult to tell where NPPC ends and the Pork Board begins,” Matt Penzer, chief legal officer of the Accountability Board, who analyzed the pork groups’ financial records, said about the early years of the pork checkoff program. Which was a problem, because farmer checkoff dollars weren’t supposed to be used for political lobbying — yet here was a lobbying group making money by being the Pork Board’s primary contractor.

In the late 1990s, the arrangement drew sharp scrutiny from the Clinton administration’s USDA inspector general — an internal government watchdog — which wrote in a report that the groups “should maintain an arms-length business relationship.” 

And by 2000, hog farmers voted to end the National Pork Board altogether because, according to an organizer at the time, it had “been used to promote the interests of factory farms and corporate meatpackers and hasn’t helped independent producers increase their bottom line.” (According to reporting by the Associated Press, the NPPC had paid a PR firm $48,000 in checkoff dollars in the late 1990s to “monitor” the activities of sustainable agriculture groups that had criticized it.)

The farmers won the vote, but their celebration didn’t last long. The National Pork Producers Council sued the USDA over a procedural technicality, eventually settled the lawsuit, and the Pork Board survived. The settlement, reached in 2001, preserved the farmer checkoff fund but ordered NPPC to, basically, stop running it. It also required that any deals between the two groups be conducted at “fair market value.” 

It seemed that the flow of money from the farmer fund to the pro-industrial National Pork Producers Council might grind to a halt, but instead it just took new forms. Internal emails, obtained by Penzer through separate litigation, reveal how.

The $59.5 million question

After the USDA told the two groups they needed to cut more of their day-to-day ties, they got creative and began moving money through big, expensive trademark deals and a lucrative real estate arrangement.

In 2003, the CEO of the National Pork Board had said in an email that the National Pork Producers Council needed an extra $881,000 per year. The next year, the National Pork Board began paying it more than $800,000 per year to license the “Pork. The Other White Meat” slogan for its advertising (it had previously been licensed for $1 per year). 

Then in 2006, with farmer checkoff dollars, the National Pork Board outright bought the “Pork. The Other White Meat” trademark from the National Pork Producers Council in a $60 million deal, to be paid out at $3 million annually in farmer checkoff funds for 20 years. This $3 million made up around 20 to 25 percent of the NPPC’s annual revenue at the time. 

The deal was questionable on multiple fronts. For one, the council — the lobbying group — should never have owned the trademark in the first place. By law, it was the federal government’s. Second, according to Parke Wilde, a nutrition and food policy professor at Tufts University and former USDA agricultural economist, the value of the slogan had been built with advertising funded by farmer checkoff dollars, so “they’re double paying and they’re not protecting the interests of the farmers who paid in.”

A National Pork Producers Council spokesperson defended the sale, stating it was “fully vetted and approved by USDA.” (The USDA did not respond to Vox’s questions for this story.)

Finally, when the National Pork Board stopped using the slogan in 2011, it continued to pay the annual $3 million to the Pork Producers Council, even though it could have ended the contract with a year’s notice. 

In 2018, a judge ordered an end to the payments, calling them “arbitrary and capricious.” (Penzer worked on the lawsuit against the USDA while working at Humane World for Animals, where I have also worked, but I was not involved with the effort.) A year later, the National Pork Board paid the council $3 million for the termination of the $60 million deal, which hasn’t been reported elsewhere.

But here’s where things get even more unusual. After the annual payments stopped — some 12 years and $36 million into the 20-year, $60 million deal — ownership of the “Pork. The Other White Meat” trademark package, which also included a simple “Pork” logo (that had more value at the time), reverted fully back to the National Pork Producers Council. The group then sold it all back to the National Pork Board in 2020, with the NPPC this time making $17.2 million in additional checkoff dollars from the transaction. 

Penzer said the deal “couldn’t pass a basic intellectual property course.” This deal, surfaced by Penzer after he submitted a public records request and a subsequent lawsuit against the USDA, has not previously been reported.

If, by this point, you’re lost in the minutiae of dealmaking, I don’t blame you. The long and short of it is that, despite the legal requirement that farmers’ checkoff dollars can’t be used for lobbying, the NPPC lobbying group has received over $59 million of checkoff dollars for repeated deals involving the same trademark package. 

Wilde said that many of the guardrails designed to protect the integrity of the checkoff program are simply not being followed. “And that leaves us with little assurance that the programs serve either the farmers’ interests or the public interest,” he told me.

“The money for advertising is just being used as a cover to transfer wealth to the lobbying entity,” David Muraskin, who’s long tracked checkoff programs and sued the USDA over Montana’s beef checkoff program, told Vox. Muraskin is an agricultural law professor at George Washington University Law School and a lawyer at FarmSTAND, a nonprofit that advocates against industrial agriculture. 

The National Pork Board maintains that it represents all hog farmers. But both the National Pork Board and the National Pork Producers Council work to protect and expand a hyper-industrial vision of American hog farming. The board and staff of both groups, for example, are largely composed of leaders and executives from industrial pig farms, companies, and trade groups. There is also something of a revolving door between the two groups. NPPC’s current CEO, for instance, is a former Pork Board executive, while a past NPPC president held a leadership role at the National Pork Board.

The National Pork Board’s lobbying landlord

The two groups didn’t limit themselves to tossing the “Pork. The Other White Meat” trademark back and forth to each other. They have also maintained a long-term real estate arrangement, the details of which have also not been previously reported. 

Remember that Iowa office they shared? The National Pork Producers Council, the lobbying group, owns it. The property was valued at $2.9 million in 2007 and the Pork Board agreed to a 30-year rental lease, for which it’s now likely to pay more than $13 million (with farmer checkoff funds) by the lease’s end. The NPPC has increased the rent several times. Most of those hikes were modest — though in 2022, it raised the rent by 74 percent, the same year it sharply increased spending and was engaged in two lawsuits to dismantle state animal welfare laws.

Over the course of its lease, the National Pork Board had also spent $6.58 million to improve the NPPC’s building, a detail also not previously covered by the news media.

To understand whether this real estate arrangement is unusual or not, I reached out to nearly 20 real estate brokers, appraisers, and experts, including many in Iowa. No one in Iowa agreed to speak with me at all, let alone comment on the record. One expert told me that, on its face, the lease deal itself didn’t raise any major flags. “It is possible that the initial lease rent was set at a low rate, with a large future increase, which would create a ‘fair market value,’” said Brent Ambrose, a real estate professor at Penn State. “It may be a terrible deal, but…it is possible that the terms reflect current market conditions.”

The National Pork Board didn’t respond to detailed questions about its lease.

“The office rent agreement between NPB and NPPC is reviewed and adjusted on a periodic schedule and is also approved by USDA, along with all other checkoff expenditures and contracts,” a National Pork Producers Council spokesperson told Vox over email. 

In the 2001 settlement in which the two groups agreed to operate independently, a provision specifically allowed the lease to continue.

All of this money ends up going into the budget of the NPPC. And although it’s unknown exactly which dollar goes where, the proceedings of a lawsuit several years ago appeared to confirm exactly what small farmers are worried about: that there’s no clear line preventing their contributions from going to lobbying efforts.

In a 2018 opinion in the Humane World for Animals lawsuit against the USDA for wrongly approving the 2006 trademark deal, a district court judge said that “at least some portion of the money that the Board pays NPPC… ultimately goes to influencing legislation.” But just because money from the trademark deal wound up being used to influence legislation, the judge said, doesn’t mean the deal was made for that purpose. And so, according to the judge, the groups hadn’t technically violated the law.

But Muraskin argues these deals have all added up to a convenient facade to fund a pro-industrial farming lobby group with required dollars from every pig farmer. 

“It seems like they’re paying for a logo that has limited value, if [any] at all, and an office space that they’re paying well in excess of what they should be,” to move money from the National Pork Board to NPPC, which in his view, “is plainly against the statute.”

It’s not a good look for a group that represents Big Pork to be perceived as taking money from small and mid-sized farmers and using it to lobby against those farmers’ interests, and it’s been a source of controversy for decades. So how and why have they managed to continue this arrangement? 

They’re “exploiting a loophole” that the USDA has failed to address, Muraskin said. “I think the entity to blame there is USDA.”

Since 2017, Sens. Mike Lee (R-UT) and Cory Booker (D-NJ) have introduced legislation to reform the checkoff programs by prohibiting them from entering into new contracts with lobbying groups (like the NPPC), among other changes. If it were to pass, the two groups would not be able to, say, engage in a new trademark deal or renew the rental lease when it expires. 

“America’s farmers are being ripped off by federal checkoff programs that take farmers’ money and play favorites with who they serve,” said Lee in a press release last year. The bill lost a floor vote during 2018 Farm Bill negotiations; it’s been reintroduced several times since but hasn’t been taken up for a vote.

The pork lobby is using farmers’ money to try to keep pregnant pigs in tiny cages

If you want a clear idea of why Kremer and other producers are upset about helping subsidize the NPPC, look no further than the biggest, most expensive battle the lobby is currently waging: A fight centered around the publicly unpopular practice of keeping pregnant sows confined to tiny crates for nearly their entire lives. 

Called “gestation crates,” which are so small the pigs can’t even turn around, these enclosures have been widely condemned by animal welfare groups and veterinarians as inhumane, and voters tend to agree. California and Massachusetts have banned — via ballot measures — any pork sold in their states coming from farms that use these crates. (Disclosure: I worked on the Massachusetts initiative.) 

But many industrial-style pork producers are heavily invested in continuing to use the crates because it’s how they’ve bred pigs for decades, and there’s a large upfront cost to switching to a crate-free system. So the National Pork Producers Council has sued both states to overturn the anti-crate laws. One case even went to the US Supreme Court — an extremely costly endeavor — where the industry group lost.

The pork producers group has also intensively lobbied for legislation called the Save Our Bacon Act, which would overturn the state laws. This spring, the act was included in the House’s version of the Farm Bill, the legislative package that covers much of US agricultural policy. But the chance of the act making it into the Senate’s Farm Bill, and thus the finalized bill, appear slim. Senate negotiations are expected to resume this month though, so the pricey fight isn’t over yet for the NPPC. 

Smithfield Foods, the largest US pork producer — which has two seats on the National Pork Producers Council board — has supported this sort of legislation. 

Gestation crate bans help more welfare-minded farmers like Kremer compete against big industrial producers. Crate-free producers have been able to continue to sell their pork into California and Massachusetts, while farms that did use the crates had to spend money to retrofit their barns or lose out on participating in those markets. Some big producers have been going in that direction, too: One of the nation’s largest pork companies, Clemens Foods, strongly opposes the Save Our Bacon Act because the company has already moved away from gestation crates.

Talking to Kremer and other pork producers who long ago abandoned keeping pigs in small cages, I’ve gotten the sense that these dollars moving from their hog sales to the sorts of lobbying efforts behind the Save Our Bacon Act and other pro-industrial policies mean more to them than the actual monetary amount. “They’re going after producers like myself,” Kremer told me of the fight over gestation crates. “And so yes, I feel more betrayed by them than ever.”

Without reforms within USDA or forced by Congress, it’s hard to see a way out for farmers like Kremer who have no option but to continue to give up a small share of their profits to organizations that sometimes actively fight against their interests. 

But that goes for consumers, too: Each piece of bacon, rib, or pork chop purchased indirectly funds an advertising pot encouraging people to buy more pork. 

And as the latest findings on the pork checkoff program reveal, some funds also go into fighting to uphold farming approaches that put profits over animal welfare and continue practices most Americans oppose, and that many have already voted to abolish.