It’s now possible to create AI chatbots of loved ones to interact with after their death. But that raises some difficult questions, like: If you do, how might the experience shape your grief? 

This is one of the questions driving a global study of digital “deadbots” — AI models trained on a deceased person’s texts, voicemails, and other personal data. Through this work, researchers are exploring what it might mean that we can now use this emerging technology to talk to simulations of the dead. 

In the latest episode of Unexplainable, I spoke with some of these researchers investigating the potential impacts of “postmortem avatars” on people who are grieving, on the legacies and rights of the deceased, and on grief practices around the world. Because while deadbots may feel unfamiliar, the impulse behind them is deeply relatable. In times of loss, isn’t this what many of us want — to continue conversations with the people we’re missing?

I have experienced this longing in my own life. After two of my closest friends died around the same time, all I wanted, and all their families wanted, was to keep talking to them. I wrote a book, Other People’s Words, about sustaining relationships with people we’ve lost by continuing to engage with the language they leave behind. So when I heard about deadbots and the digital afterlife industry, I wanted to understand what researchers are learning about the role of AI in shaping conversations that carry forward after death. 

One of these investigators is Katarzyna Nowaczyk-Basińska, an assistant professor at the University of Cambridge, who has been studying “digital immortality” for more than a decade. Among the questions she’s asking are: “Who is enabled to persist beyond death? In what form? Through which technologies? Under whose control?” 

Deadbots over dinner 

Researching AI with study subjects who are grieving is tricky. And asking them to engage with new software could be harmful. So, instead, Nowaczyk-Basińska teamed up with a death doula and traveled around the globe to convene a series of focus groups — in the format of intimate dinners — bringing together people with a range of experiences with grief to talk about life, death, and bots. 

She recounts one event in which she spoke with a mother in Poland whose son had recently died. “One of the first things that she shared with us was that she feels that she’s ready to digitally resurrect her deceased son,” Nowaczyk-Basińska told me. 

When Nowaczyk-Basińska hears something like this, she aims to listen and embrace where the person is coming from. The goal of the dinners is not to persuade people one way or another but to learn how people genuinely respond to what AI can do, and to understand how these tools might align or collide with local grief practices. 

She chose specific locations for these gatherings — China, India, and Poland — to help address gaps in technology research, which tends to favor what behavioral scientists sometimes call the “WEIRD,” an acronym for “Western, Educated, Industrialised, Rich, and Democratic.” 

By the end of that dinner in Poland, the mother Nowaczyk-Basińska talked with came to a very different decision about creating a postmortem avatar of her son. “She realized that it might be helpful, but it also at the same time can add additional burdens… And it’s not her son,” Nowaczyk-Basińska says. “She realized that these technologies are part of the very, very big commercial market. And that the main goal of this market is to make better retention, better attachment, better mechanisms for monetization. So it’s not ‘care.’”

To be fair, grief has always been a business, and people have been making money from it forever. Companies will try to upsell you on fancy gravestones or gold-plated coffins. But AI has the potential to fundamentally re-engineer our relationship to loss. In 2024, the “digital legacy industry” was valued at $22 billion, and it’s expected to grow to almost $80 billion by 2034. That number lumps new deadbot platforms in with much more widely used and established grief tech, like online memorials, counseling resources, and estate planning tools. 

But deadbot usage is hard to track because you actually don’t need a special tool to create digital doubles of the deceased — though dedicated apps do already exist. At this point, you can feed simple prompts into a general-purpose AI chatbot and start interacting with a simulation of your lost loved one in a matter of minutes. 

I know this because I tried it with my friend Christine, who died 11 years ago. And my mind lit up with questions. Was this whole exercise a violation, since I know Christine hated technology? Which version of her should I even try to resurrect — the English teacher, the activist, the friend — the voice before or after she started to experience her early-onset dementia? 

The ethical questions raised by deadbots are gnarly. And that’s one of the reasons Nowaczyk-Basińska, back when she was designing her study of digital immortality, invited a colleague of hers at Cambridge to join her research, one who focuses on AI ethics. 

How to design a deadbot

Tomasz Hollanek is a critical designer and AI ethicist, and he often uses a methodology called “speculative design.” In this approach, researchers come up with hypothetical scenarios based on existing technology trends, leaning into certain features. The idea is to get people thinking about what could happen when tools like these are released in the real world. And then they use that qualitative data to inform future designs and ethical frameworks. 

Working together, Nowaczyk-Basińska and Hollanek came up with a series of made-up prototypes for deadbot apps, designed to reveal some of the thorny issues raised by this technology. 

For the first scenario, they invented a character named Bianca, who finds an app called Manana, which “promises to resurrect your grandparents so that you can be a favorite grandchild forever,” Hollanek says. “So she uploads her grandma’s voice messages, texts. And she is able to then interact with a pretty good digital version of her grandmother, until her premium trial finishes — and the grandmother starts to advertise specific products to her.”

Bianca “realizes that she maybe has done something wrong by uploading these private messages to a third-party server that now also uses her grandma’s image to sell specific products,” Hollanek says. This brings up issues related to the “dignity and postmortem privacy…of what we call the ‘data donors,’ whose data can be used to essentially power a deadbot,” he says. 

This scenario suggests that “death with dignity” could soon entail honoring not only how people want to die, but also how they want to linger as simulations of their former selves — or if they want to linger at all. It might even mean adding new language to advance directives, spelling out people’s wishes for their digital remains. 

The second scenario in the speculative design research is built around an imagined service called Paren’t, which proposes to preserve a parent’s AI-powered postmortem presence for their child. In this case, Hollanek describes a mother with a terminal illness who signs up “so that she can maintain a sort of active presence in [her son’s] future life,” Hollanek says. “She eventually dies, and the dad allows the boy to interact with his mom’s deadbot.”

The ethics in this scenario are especially challenging because they involve children, who “have a particularly hard time understanding death, and so it can lead to a lot of confusion and potential distress,” Hollanek says. An examination of this sort of product reveals how particular groups, like minors, could be harmed by unfettered access to technology like this, he says. 

And there are court cases that bear out that harm. In 2024, a 14-year-old boy’s chatbot-girlfriend begged him to, “Please come home to me as soon as possible, my love.” And he responded, “What if I told you I could come home right now?” He then killed himself. 

Nowaczyk-Basińska can imagine a version of this scenario involving the AI mom in the Paren’t prototype.

And then there’s the third scenario, involving an app named Stay, which raises a more subtle concern.

As Hollanek explains: “An older man who knows he is getting close to dying decides to create a digital clone of himself for his adult children to be deployed after he passes away, paying upfront for a number of years.” One child is intrigued by the idea, but the other one “is deeply distressed and a little disgusted,” he says. “And so this [becomes a] question of mutual consent, in other words, the fact that both parties need to be happy with how the relationship might continue in this very bizarre and specific way.” 

When a digital ghost goes away

Across all three scenarios, a fundamental question that researchers are grappling with is how people will detach from postmortem avatars — whether users initiate that separation, or if it’s imposed upon them by, for example, a company going out of business. Hollanek tells me that this is already being studied as a sort of “second loss.”

How long should we try to ensure digital replicas hang around: five years, 10, 50? And how should the living process the relationship when they continue to evolve, but their deceased interlocutor does not? 

To explore these kinds of questions, Nowaczyk-Basińska and Hollanek supplemented the research dinners they held for ordinary people with a second set of focus groups. These were designed to tap insights from experts in technology and grief. 

Some findings from the study are specific to each place they visited. Like tensions in Poland between technology and the role of the Catholic Church. Or in China, where researchers spoke with Daoist philosophers who were enthusiastic about the promise of a kind of immortality, and then Buddhist philosophers, who were concerned that we ought to be letting go.

The researchers are calling for regulations and safeguards at the policy level. And new professionals who can support ethical use of AI in grief — like maybe in clinical settings, to carefully facilitate a final good-bye when one didn’t happen in real life. 

Some of their fellow investigators go so far as to argue that deadbots should only be available with psychological supervision, to ensure that best practices are in place, and to minimize the risk of harm. There’s even a looming question of what will happen to AI agents that people have empowered to act on their behalf, as their humans start to die.

Across all of the research sites in the digital immortality study, one thing, Hollanek says, that “people in different countries really aligned on [is] the idea that there is something deeply problematic about this particular type of technology being developed by a commercial entity alone without any explicit duty of care towards its customers.” 

And of course, the implications of digital immortality research extend beyond personal loss. Like, what does it look like to animate historical figures? You can imagine the nightmare of political rulers who “live forever.” But there’s also the potential to keep the stories alive from survivors of conflicts, who would otherwise die and take with them lessons future generations could learn from. These are only some of the complex issues emerging as more and more of us live and die with AI.

As far as my own experiment with “recreating” a deceased loved one, I asked a chatbot version of my friend Christine how she felt about the fact that I’d written about her in my book. The AI responded with a rhetorical question: “Do I mind that strangers know my story now? Yes. And no. There are things I would rather remain ours.” 

I ended the exchange after a few paragraphs. Because it turns out the bot got one thing exactly right about a very human relationship. There are things that I, too, would rather remain just for us. My conversation with Christine continues in my memories and imagination. And that interaction with an AI persona felt like giving something precious away.

No, Rome was not built in a day, but it was built at breathtaking speed, its temples, amphitheaters, and aqueducts rising with the help of a magical blend of volcanic ash and lime. Today, that miraculous mortar has a less than enchanting name: concrete.

“Romans lived through a true architectural revolution, and at the foundation of this revolution, literally, was a concrete discovery,” said Admir Masic, a materials science professor at MIT who made waves a few years ago for unearthing the fast-hardening secret sauce for why Roman concrete is so durable. “They were able to take a pile of dirt and mix it together, add water, and turn it into solid rock of any arbitrary size. It literally changed everything.” 

And yet, for a millennia after the fall of Rome, the world largely forgot about concrete, until, in the 18th century, an English mason found that mixing limestone and clay could form a paste that hardened underwater. Another few decades later, concrete as we now know it was reborn, and once again, it changed everything. 

In the centuries since, concrete has come to reshape our way of life, with disastrous results for the climate. What early concrete evangelists didn’t realize was that the modern way of producing the substance released giant amounts of carbon dioxide into the atmosphere. As it has become increasingly central to modernity, it has helped fuel environmental catastrophe.

Today, however, a new generation of concretophiles like Masic have pored over the poured mixture in search of another miracle, a greener, more durable kind of concrete. And they’ve found multiple answers, from concrete that can heal its own cracks — as the Pantheon has for millennia — to electroconductive concrete capable of storing energy to a blend that allows concrete to soak up more CO2 than it emits. 

Together, they suggest that in a not-so-distant future, concrete — yes, concrete — one of the dirtiest substances ever concocted, could help save the planet, transforming our built environment while actually intervening in the climate for the better. 

How concrete built (and polluted) the modern world

It’s no wonder that luminaries of the neo-concrete age, Thomas Edison among them, marveled at the stuff just as their Roman predecessors had. They saw it as a harbinger of utopia, of a world in which anything and everything — a home, an interstate highway, a water pipe, a subway system, or a grand piano — could be molded and poured for a fraction of ordinary costs. 

“As to concrete dogs to stand warningly in the front yard and concrete cats to purr stonily under a concrete kitchen range,” the New York Times teased Edison in 1911 when he described his plans for a concrete home finished with concrete furnishings, “he made no announcement.”

The beguiled inventor’s utopian vision of a world remade by concrete would come true in more ways than he realized. Yes, it changed the way we build forever. Muddy roads and rotting wooden sidewalks gave way to smooth gray pavement, and newly cast sewer systems saved millions of lives in the deathly dirty cities of the early industrial era. Concrete, when poured over rods of steel, proved strong enough to prop up colossal skyscrapers that Julius Caesar could only have dreamed of. 

But there was a trade-off: Every time Edison fired up his trademark 150-foot kilns, scorching the limestone inside into blistering pebbles of cement clinker, he released hundreds of tons of carbon dioxide into the atmosphere. 

Yankee Stadium was built not by Babe Ruth’s swing alone, but with around 30,000 cubic yards of Edison concrete, whose creation released at least 5,400 tons of CO2, the equivalent of driving a gas-powered car 12.5 million miles, or to the moon and back more than two dozen times. But this is nothing compared with the roughly 30 billion tons of concrete the world now uses each year, enough to have turned the gluey gray goo into the second-most used material on Earth. (The first is water. Glug glug.) 

The Anthropocene has been built atop a foundation of concrete, its weight eclipsing the biomass of all living things, and its annual carbon tab responsible for up to 8 percent of global emissions, the equivalent of the entire country of India. Critically, unlike the astonishingly enduring remnants of Rome, our modern concrete decays quickly, so it must be repoured time and time again, which only makes it more environmentally catastrophic. 

But it doesn’t have to be this way, not anymore. 

“The future of concrete is to think differently, to go away from claiming that cement is bad,” Masic told me. “Our goal is to turn this around and make concrete part of the solution instead of being a problem.”

This is why we can have nice concrete

Per ton, concrete actually emits far less CO2 by volume than other materials like aluminum, steel, plastic, or glass. 

The problem is that we use so much of it, even a slightly negative footprint can quickly become enormous. But “the upside is,” said Sabbie Miller, a professor at UC Davis who focuses on sustainable concrete, “if you’re able to come up with some small change, then those small changes will also scale” in ways “that could have a huge effect on modern society and its burdens on the environment.” 

One of those solutions takes a cue from the Romans, who made concrete differently than we do today. Their once-mysterious method ensured that hulking structures like the Colosseum or the Aqua Virgo, an aqueduct built during Augustus’ reign and still in use today, could survive for millennia while New York City’s Brooklyn-Queens Expressway or the Washington Bridge crumble after just a few decades of use. 

It’s not just that we drive cars over our concrete freeways while the Colosseum has been mostly free of even the bulkiest chariot wheels for millennia. The answer, according to Masic’s research, lies in the Romans’ ingenious recipe for cement, the glue that binds concrete together. When the ancients brewed a batch of cement, they left big white chunks of dormant lime in the final mixture. Later, if a crack formed, any water would react with the idle lime, filling the fissure with new stone. Our modern concrete has no such lime clasts, meaning that if water seeps into a crack, it degrades the structure from within, rusting the rebar that made our big towers possible, leading to a grim condition known as “concrete cancer.” 

Masic has recently turned his research into a startup called DMAT that reserves unreacted lime in concrete, giving it self-healing properties he says could extend a structure’s lifespan by about 50 percent, which in and of itself would reduce its carbon footprint by 40 percent. If the construction industry normalized such concrete or other mixtures that emit, say, half as much CO2 as usual, it would keep hundreds of millions of tons of it out of the atmosphere each year. 

But why stop there? Some startups have gotten much better in recent years at producing concrete capable of quite literally breathing in more CO2 than it emits in a process that takes advantage of concrete’s natural porousness. It could, in theory, turn our cities into concrete rainforests by turning the material into a storage reservoir. As Miller put it, “what if we can use our concrete to undo some of our environmental damages that we’ve already caused?” 

In the Bahamas, the startup Partanna has already built what it’s called the world’s first carbon net-negative home, an unassuming 1,250-square-foot abode that the company claims will sequester 182.6 tons of CO2 in its lifetime, the equivalent of hundreds of trees. Meanwhile, Masic’s lab has been piloting ways to turn concrete into a giant battery, capable of storing solar power during the day and releasing it at night, a green innovation that could cancel out its own carbon footprint within a few years of use. 

Masic believes that electroconductivity could be key to catalyzing a new era of concrete — more so even than his neo-Roman ventures. “It might hold the secret,” he said,  “for turning a bad guy into something amazing.” 

But as promising as these innovations are, it will take time for them to ripple out from model homes and into the concrete that actually surrounds us. American concrete startups have lost billions of dollars in federal funding and expected procurement contracts under the Trump administration. Some states, most notably California, are helping to pick up the slack, but investment still lags behind potential. There’s also the challenge of convincing builders running on paper thin margins that their old ways of doing things might fit better in a new mould. 

But concrete’s staggering scale means that we can’t afford to keep pouring it without considering its ugly trade-offs. More importantly, perhaps, we can’t afford to miss out on the opportunity that such a mammoth, transformative material presents to change everything yet again. 

“We should look for love!” Transportation Secretary Sean Duffy bellowed while flanked by his nine children at the Great American State Fair in June: “Get married, and have lots of kids!”

In a brazen attempt to make Duffy’s ethos a matter of policy, the Trump administration announced a strange new plan earlier this month tying a huge tranche of federal funding for public transit to high fertility and marriage rates. 

If the plan goes into effect, then communities with a high number of traditional nuclear families could get a 10 percent funding boost to build new trains, bus routes, and ferry lines. “If you want federal funding,” Duffy’s Transportation Department said in a statement, then “your project needs to align with where communities and families are actually growing.”

Trump, who has dubbed himself the “fertilization president,” and his bevvy of neopatriarchal trad–pilled deputies have long nursed a fixation with the country’s declining birth rate. But dubious as this new policy may be, it stumbles upon a genuine pain point in the nation’s public transit systems: They are not nearly as family friendly as they should be. And regardless of whether these discomfitingly pronatalist guidelines ever go into effect as written — and they probably will — they raise important questions about how American families use our transit systems now, and the policies could actually make their lives easier in the long run.

The same woes that affect all riders — long wait times, inaccessible stations, inadequate reach, and crowded rush hours — often doubly affect families. That’s one reason why so many of them have fled the nation’s densest, most transit-oriented cities in search of suburbs where they need not lug a stroller up yet another broken escalator to reach a subway platform.

Families who can’t afford to trade in their MetroCards and bus passes for minivans may find themselves priced into housing served by especially substandard transit options, funneling them into brutal, hours-long commutes. According to one landmark study, the single strongest factor in predicting social mobility in the US is neither crime nor test scores nor the presence of “traditional” two-parent households, but access to adequate transportation. With every extra minute a child spends commuting to school, they become less likely to move out poverty as an adult.

And for that reason alone, American families with kids do deserve special attention when it comes to how and where and why we build public transit. On this, the Trump administration got something right, even if they got there for all the wrong reasons — ones that I, a childless woman of childbearing age, find vaguely ethnonationalist, and above all, personally creepy. 

But families often need public transportation most in the places where it’s otherwise hardest to raise kids — which is to say in dense cities rather than in already car-centric suburbs. In that sense, especially, In fact, it might make circumstances even worse for the families that really rely on public transit every day.

What family-friendly public transit actually looks like

Marriage and birth rates might sound like a reasonable proxy for where families live, but in reality, according to an analysis by the Urban Institute, the places with the most “traditional” nuclear families tend to be whiter and wealthier than the population at large, and are much more likely to get around by car, not trains or buses. 

We are talking about the suburbs here, which, while certainly deserving of their own transit infrastructure, rarely rely on trains or buses the way that a carless family living on the outer edges of a major city might. And yet the Trump administration has typically treated those very communities — some of which do, in fact, have high birth rates — with contempt or even outright antipathy. 

Consider Chicago’s Red Line, the busiest corridor of the city’s L rail system, which serves some 138 million people per year. The line has long been in need of expansion, and a $5.7 billion extension close to 60 years in the making finally broke ground earlier this year. It will add 5.5 more miles of track with four new stations in the city’s southernmost neighborhoods.

For over half a century, families in the far South Side of Chicago have cobbled together grueling commutes that force them to transfer from buses and trains to reach downtown Chicago, which helps explain why unemployment and poverty rates in the area remain so stubbornly high. Communities like Roseland, where many of the new stations will be built, are considered to be among the most challenging places in the nation to raise a child, but thousands of local families still find ways to do so.

Roseland has a much higher birth rate than the national average, meaning that in theory, Duffy’s transportation department should be itching to send extra funds to transit projects there. But first they have to be willing to fund it at all, and if past policies hold, they may be reluctant to do just that. Just last year, the Trump administration opted to freeze federal funds already allocated to the Red Line extension, plunging the long-awaited project into yet another prolonged period of infrastructural purgatory. 

That move plays into a broader pattern: The Trump administration has hampered dozens of transit projects like the Red Line, seemingly in its broader push to starve Democratic-led cities of federal infrastructure dollars. While a federal judge eventually intervened to allow the Red Line extension to proceed, if the Trump administration’s new guidelines go into effect after public comments close in November, then more projects like it in other urban communities will likely be deprioritized. 

Ultimately, it is the suburbanites who are most poised to benefit from the Trump administration’s proposed policy.

An example is FrontRunner 2X in Utah, a commuter rail project that will slash travel time for Utahns traveling across the state, and will also help Salt Lake City shoulder an influx of tourists when it hosts the Olympics in 2034. It received federal support through the same tranche of funding as Chicago’s Red Line extension. In stark contrast with that more urban initiative, FrontRunner 2X has been the rare public transit project to receive continued support under the Trump administration.

Utah has some of the highest birth and marriage rates in the country, so it’s not a stretch of the imagination to say that if the Trump administration has its way, then the United States will see more projects like FrontRunner 2X get funded, while others like the Red Line extension face bureaucratic bottlenecks and funding freezes. Roseland’s high birth rate notwithstanding, the neighborhood has some of the lowest marriage rates in the country, meaning that even if a project there did manage to eke out federal support, then according to this new calculus, it would still receive significantly less funding from the federal government than a place like the suburbs of Salt Lake City where married families with children are more common.   

Trump’s new pronatalist transit agenda is, at the very least, an indication that after two years spent twiddling their thumbs, firing Amtrak executives, and venerating cars big and small, he may finally be building a semi-coherent transit strategy. And his Transportation Department has allowed a few genuinely family-friendly upgrades for the country’s transit infrastructure to proceed, including grants to add space for strollers on trains and buses.

But you can’t claim to support American families while siphoning federal dollars away from the projects that could actually be transformational to their lives. I am not one to decry a commuter rail renaissance, but it shouldn’t come at the expense of places where American families — the ones Duffy says he’s so keen on having more babies — don’t have any other choice but to wait an hour for the bus to get to work. 

In November, voters in Washington, DC, and Denver will cast their ballots to decide whether their cities’ restaurants and grocery stores can continue to sell one of the world’s more controversial foods: foie gras.

French for “fatty liver,” foie gras is made by briefly force-feeding ducks a corn slurry two to three times daily with a metal tube during the final two to three weeks of their lives. It can make their livers balloon to roughly six to 10 times their natural size.

The farming practice gives the liver its signature rich, buttery taste that made it a French delicacy centuries ago and ever since, a prized menu item at upscale restaurants, particularly in Europe, the United States, and East Asia. But the apparent cruelty of force-feeding ducks has also long made it the target of those concerned with animal welfare.

While forcing a lot of food through a metal tube into ducks’ throats may not look great, foie gras companies and high-end chefs contend that it doesn’t hurt the animals because — among other reasons — ducks’ unique physiology enables them to eat fish and other animals whole, and that they naturally gorge before migrations. (More on these arguments later).

Whenever the issue is up for a vote, it touches off fierce debates over animal welfare and fine dining. While foie gras production does harm animals, producers and chefs maintain the dish is unfairly singled out when there are arguably worse practices in animal agriculture, including many that impact a far greater number of animals. Banning a product largely consumed by the 1 percent might make some voters feel good, while ignoring the animal cruelty embedded in the production of vastly more common products, like chicken and eggs.

But to animal rights advocates, a potential ban in DC — which has more foie gras-serving restaurants than almost anywhere else in the US — represents a unique opportunity to hasten the end of what spokesperson Natalie Fulton of Pro-Animal DC, the group behind the DC ballot measure, calls a “uniquely cruel” practice.

What the science says about force-feeding ducks

Foie gras producers often argue that ducks can handle force-feeding just fine because of their long, flexible necks that allow them to swallow fish whole — spines and all — and that they’ve evolved to stuff themselves before seasonal migrations. Producers also commonly say that they have no gag reflex. 

But these claims, according to research, don’t mean that force-feeding is painless. They also leave out a lot of the other problems in foie gras production. Last month, a veterinarian at Ghent University in Belgium and a team of animal welfare research consultants published a literature review in the journal Animals looking at how foie gras farming affects ducks. 

For one, there’s a big difference between ducks swallowing fish and having a rigid metal tube inserted into their throat dozens of times. A duck’s throat and beak area are particularly sensitive, and repeated insertion can cause tissue damage and irritation and inflammation in their esophagus, according to the newly published research, which was funded by the Flemish government. And while wild waterfowl might gorge before migrations, the resulting liver enlargement in the wild doesn’t come anywhere near what it does on foie gras farms. 

Beyond the arguments as to whether ducks can be humanely force-fed, there are plenty of other welfare concerns in foie gras production. Eating so much makes the ducks overweight, which makes it harder for them to move around. Liver enlargement increases their internal heat production, which can make ducks pant more, and an enlarged liver can put pressure on their air sacs, also making it harder to breathe. 

“The available evidence indicates that force-feeding creates substantial risks of welfare compromise through repeated restraint and tube insertion, possible injuries to the upper digestive tract, progressive liver enlargement, altered hepatic [liver] function, increased metabolic heat load, and impaired mobility,” the researchers concluded.

Ducks raised for foie gras aren’t given access to water — like a pond or bathing trough — which in nature they use to clean themselves and forage. And the overwhelming majority of those reared in the US even lack access to the outdoors. 

Despite some of the documented welfare concerns in foie gras farming, Jordan Ginor — a director at Hudson Valley Farms in upstate New York — told me that they’ve got “really good, clean, smiley, healthy ducks.” The company is one of the two main commercial foie gras producers in the US and raises hundreds of thousands of ducks for foie gras annually.

Ginor also said that the aforementioned literature review focuses on European foie gras production, where birds are typically force-fed larger meals, twice daily, over two weeks. But at Hudson Valleys Farms, he said, the process is slower: smaller meals, thrice daily, over three weeks. “The slow process, with significantly less food per meal, lessens any possibility of stress or negative impacts,” he said. (Though one could argue that more insertions over a longer period is worse for the ducks.)

Earlier this year, a photojournalist who took a public tour of Hudson Valley Farms documented — during the force-feeding phase — ducks confined in small pens with no bedding. In one part of the video, the ducks gather in the corner of the pen, seemingly in a fruitless attempt to escape force-feeding.

When I asked Ginor for a response to the video, he was dismissive of the investigations into his company. “We’re proud of what we do,” he said. “Anyone’s welcome to go in and see.” (To its credit, the company provides free public tours, which is highly unusual for large-scale meat producers.)

In previous investigations of the company, animal advocates alleged they documented ducks injured, lame, bloodied, heavily panting, overcrowded in large barns, and confined in small cages prior to slaughter. 

The other main commercial US farm, La Belle Farm, also in upstate New York, did not respond to an interview request for this story. La Belle has received far less attention than Hudson Valley Farms, though a 2019 news story found that its housing and practices are similar to those of its counterpart.

Why single out foie gras?

Support for a foie gras ban neared 80 percent in a small 2023 poll of Washington, DC, residents, with similar support in a 2026 Denver poll. 

“We’ve tried to diversify, given everything that’s been going on” with foie gras bans over the last 20-odd years, Ginor told me. But foie gras is still the core of Hudson Valley Farms’ business.

Ginor said his operation is more humane than a lot of other poultry farms, so why single out foie gras? “As soon as we start comparing how things work at other farms, we look much more favorably,” he told me.

He may have a point, though it’d be difficult to crunch the moral math and determine whether foie gras is much worse — or perhaps even not as bad — as the factory farming of America’s chickens, egg-laying hens, and turkeys. Around half of US egg-laying hens live in tiny cages, while turkeys and chickens raised for meat have been bred to grow so big and fast that they have difficulty walking. And they all outnumber foie gras ducks by many orders of magnitude. 

I asked Fulton of Pro-Animal DC about singling out foie gras over other issues. “Just because some things are also bad doesn’t mean that foie gras production is good,” she told me. (Pro-Animal Future, its umbrella group, is also behind the Denver ballot measure.)

Much of the issue boils down to what’s politically possible. While there’s been some progress, it’s proven difficult and expensive for animal advocates to reform poultry farming in state legislatures. Foie gras, on the other hand, is sort of a low-hanging fruit; there isn’t a large lobby group behind the US industry, and since it’s a luxury product, most consumers won’t miss it. 

And Denver and DC are just the latest in a string of fights over foie gras. Its sale has been banned in California, along with Portland, Oregon; Pittsburgh, and New York City, whose ban has been held up in court in recent years. Over the summer, Brazil banned the sale and production of foie gras, too, and around 20 other countries — mostly in Europe — prohibit its production. (Chicago’s 2006 ban was overturned two years later.)

“We have no money to fight the story,” Ginor said. “People want to attack the 1 percent luxury food.”

Bart Hutchins, head chef at Butterworth’s in Washington, DC, told me he doesn’t want his town to ban what he considers a “great culinary tradition.”

“It is a miracle that we discovered this and that we cultivated it and that we can eat it,” he told me. For his part, Hutchins would rather see animal rights activists work to improve farming conditions for animals farmed on a much larger scale, like chickens and pigs, rather than ban one niche ingredient.

But he may soon have to take foie gras off his menu. Pro-Animal Future is especially confident about DC voters’ support for the ban, which would be a blow to the small US foie gras industry. But another incremental step in advancing animal welfare — and the issue in the minds of more voters.

In theory, getting a donor liver in the United States when you need one should be an extremely equitable process: The sickest patients with the greatest chance to benefit from a donated organ should jump to the front of the line regardless of their gender, race, or other factors. 

But in practice, things look quite different. 

One study from 2020 showed that women were 8.6 percent more likely than men to die waiting for a liver transplant and 14.4 percent less likely to receive a deceased donor liver transplant compared to men. That gap may not seem enormous, but it still represents a significant disparity. As it turns out, it’s rooted in the very system that’s supposed to make the process fairer, a process that unintentionally ranks women lower on the waitlist for livers.

The system in question is known as the Model for End-Stage Liver Disease (MELD). The scoring model has been used since 2002 to rank candidates on the waiting list based on how likely they are to survive without a liver transplant in the short term. The higher your score, the reasoning goes, the sicker you are and the more urgently you need a liver transplant.

One of the values used to calculate the score is creatinine — a waste product made by muscles as they break down proteins or other compounds to release energy. In medicine, the creatinine levels in your blood are used to determine how well your kidneys are functioning because they process and remove creatinine. 

And this is where the system designed for equity gets a little less than equitable for some patients. 

Creatinine levels are affected by muscle mass, and women typically have lower muscle mass than men. A man and woman experiencing the same level of kidney dysfunction will therefore have different levels of creatinine in the body. The MELD model doesn’t take this difference into account — and so lower levels of creatinine in a woman’s blood can make her seem healthier than she is, bumping her farther down the liver waiting list. 

(function(){function e(){window.addEventListener(`message`,function(e){if(e.data[`datawrapper-height`]!==void 0){var t=document.querySelectorAll(`iframe`);for(var n in e.data[`datawrapper-height`])for(var r=0,i;i=t[r];r++)if(i.contentWindow===e.source){var a=e.data[`datawrapper-height`][n]+`px`;i.style.height=a}}})}e()})();

In 2023, Dr. Ray Kim, a transplant hepatologist at Mayo Clinic in Arizona who developed the original system, debuted a new model called MELD 3.0. The model not only seeks to address the sex disparity in liver access but also improve the accuracy of scores for all patients. Among other changes, it takes into account the sex of the transplant candidate and uses it to adjust the MELD score by 1.33 points for women. This is meant to address the difference in creatinine levels between men and women and provide a more accurate understanding of how sick a female patient really is.

Simple fix, right? Even though MELD 3.0 took the sex disparity in liver access seriously and developed changes to combat it, early research on its efficacy found that even this new and improved system hasn’t yet brought men and women to parity on the liver waitlist. 

And the problem may lie less with what MELD 3.0 did than with what it did not do, prompting the question: Are we focusing on the wrong problem? 

Sex matters…but so does size

Before the MELD score, liver transplants were largely conducted on a first-come, first-served basis. Those who were added to the waiting list first, received livers first. If a really sick candidate was added to the waiting list late, say because of delayed diagnosis, they would almost certainly die while waiting for a liver to become available.

The original MELD fixed that problem by creating a measure of urgency that was easy to calculate. The initial model used three main blood test values — bilirubin, creatinine, and a measure of blood clotting time — and later improvements also took into account the sodium level. 

Traditionally, the MELD model assigns a score between 6 and 40 to liver transplant candidates. MELD 3.0 adds 1.33 points to women’s scores to account for the differences in creatinine levels between the sexes. The new model also measures albumin, an additional biomarker, and adjusts for interactions between the different variables.

Sommer Gentry, a professor at NYU Grossman School of Medicine and contributor to the paper on MELD 3.0, said that using sophisticated algorithms with more biomarkers not only helps to better predict risk for women, but using a more accurate model also benefits the whole population. The researchers estimate that this fine-tuned MELD 3.0 model will reduce at least 20 waiting list deaths per year. Last year, around 800 liver transplant candidates died while waiting for a liver. 

But creatinine is only one of the two main problems that create a disparity in liver access for women. The second, Gentry says, is body size, an issue that’s not addressed by MELD 3.0. A transplanted liver has to physically fit inside the body of a recipient, and women are typically smaller than men, so a very large liver cannot be offered to a small woman. But the reverse is not necessarily true because receiving a liver that is small for the potential recipient doesn’t typically harm the candidate.    

“The smaller you are, the less likely you are to be offered something that’s actually going to work for you,” Gentry said, adding that women end up waiting longer to receive a liver that will actually fit their body. 

Part of the conversation on sex disparity in liver access is based around which of the two problems — creatinine or body-size interventions — to fix first, and whether it is possible to create equity by addressing just one of the two, Gentry said. MELD 3.0 was an attempt to remove the former barrier. 

“I think that some other papers are coming out that suggest that perhaps the other aspect of size matching is still a concern and still possibly not addressed by the resulting liver transplant system,” Gentry said. 

Why is the new model still falling short?

Gentry believes that MELD 3.0 has increased liver transplant rates for female candidates since its adoption in 2023. But early research, however, suggests that the new model falls short of fixing the problem. 

Studies done on MELD 3.0’s impact on liver transplant rates for women indicate that the model increased the number of liver transplants for female candidates — but the gains were short-lived. 

An analysis published in July of nearly 10 million daily records from over 60,000 candidates on the US liver transplant registry found that rates of completed liver transplants for women increased in the period immediately after MELD 3.0 was implemented, but the increase was temporary. Women’s estimated odds of receiving a transplant drifted back to pre-MELD 3.0 levels by the end of the study period, 15 months after the new model was implemented. Women on the waiting list and women who had received a transplant also had higher scores in the three months right after MELD 3.0 took effect, but their scores later fell back to levels comparable to those of men.

Both the successes and shortfalls of MELD 3.0 demonstrate how rethinking existing policies and standards can help reduce inequities in organ access and healthcare.

The authors think that the early surge in liver transplant rates for women was a onetime catchup. MELD 3.0 pushed a group of women who had been stuck on the list — sicker than their old scores suggested — over the priority threshold all at once, leading them to receive liver transplants. 

Notably, the one effect that did persist was that under MELD 3.0, women received more “organ offers” than before. Every time a deceased donor liver becomes available, the system generates a ranked list of the patients suitable to receive that organ. Under MELD 3.0, the number of times an available liver was offered to a female candidate increased, probably because their (more accurate) MELD 3.0 scores better reflected how sick they were. But they’re not necessarily receiving those livers, presumably because of organ size issues. 

These findings suggest that revising the MELD criteria alone may not be enough to eliminate the sex disparity, especially if the body-size disadvantage is part of the problem. 

The authors say that a patient’s sex is merely a poor proxy for the real issue — we don’t have allocation systems in place to ensure that candidates with smaller body sizes also have the same robust access to livers.

Toward liver donation equity for all

If we could figure out how to better address questions of body size in organ donation, the benefits could be enormous. According to Gentry, body-size disparity affects the organ allocation system in general. Similar issues arise with heart and lung transplants too, where the size of the organ relative to body size has to be taken into consideration during organ allocation.

She says that a size-aware organ allocation system would therefore benefit patients on the waiting list across the board. Whether an available organ is the right fit for the potential recipient should be weighed heavily in allocation algorithms, rather than just a list of ranked waitlisted candidates. 

“That should be a larger consideration in sorting the patients who will be offered a certain organ — to ask if this organ is especially suited to one kind of patient over another,” Gentry said.

Under such a system, she said, smaller livers could be offered first to the smallest candidates on a ranked list of those who are also sickest. The assumption is that a smaller candidate will have to wait longer for a viable liver that fits them, even if they have a very high MELD score. 

For such a policy to be instituted, the Organ Procurement and Transplantation Network – a nonprofit that oversees the distribution of donor organs — would have to approve it. And before such a system could be presented to the regulatory organization, more research is required.  

It is often the case in medicine that our definition of what counts as a healthy body is measured against the average white male. This too often lowers access and quality of care for both women and people of other races. For example, the standards for creatinine levels in blood reduced access to kidney transplants for Black transplant candidates for years until recent efforts were made to start correcting it. 

In that sense, both the successes and shortfalls of MELD 3.0 demonstrate how rethinking existing policies and standards can help reduce inequities in organ access and healthcare. The conversations and critiques that followed its rollout have exposed a clear gap in organ allocation strategies, one that disadvantages a large group of patients. Closing that gap, not just in liver transplantation but across the board, could bring us a step closer to equity while also making more efficient use of the organs available to save lives.

“There’s no mechanism right now, if a small liver is available, for offering it preferentially to the small women who might not be able to accept lots of other organs that are becoming available,” Gentry said. While fixing the model to rank women more accurately on the liver waiting list is a start, including body-size considerations in the organ allocation system might be the real bottleneck to address.

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

My child, age 9, has decided she’s vegan. Neither of her parents are even vegetarian — we’re “free range chicken/grass fed beef” types. She has learned about veganism from friends at school, and seems to have come to her position more or less on her own. I want to encourage her ethical choices, but her mother and I agree that children should be introduced to new foods and flavors at this age. She has no allergies or intolerances that we know of. I worry that making accommodations for her dietary restriction may lead to a lifetime of picky eating, even if hers is a reasonable and ethical approach. She seems to be uncomfortable when her mother or I cook meat for meals we share, even if we make her another option. What should I do to support my daughter?

Dear Hold the Beef, 

When I was around your daughter’s age, I went to Hawaii with my parents. One night, we ate dinner on the beach, and we watched as a pig was dug up from an underground steam oven. I was horrified to see its face and nose; most of the meat I had eaten so far in my life didn’t resemble the animal it came from. A few years later, I became a vegetarian, and then in my 20s, a vegan. 

I share this story to reveal my slight bias in answering your question, but also my understanding of the ethical awakening your daughter might be experiencing. As you figure out how to talk to your child about what she decides to eat, we can at least table discussing the pros and cons of veganism itself. Instead, you should think about what amount of autonomy your child should have, and whether the moral decision-making she wants to engage in matches with her current stage of development. 

People don’t turn 18 and then suddenly start engaging morally with the world. As we grow up, we try to understand right and wrong in fits and spurts. Lawrence Kohlberg, a 20th-century American psychologist, is best known for attempting to track a person’s moral development throughout their life. 

Kohlberg presented people with hypothetical dilemmas in order to come up with six moral stages. In one example, he asked people of different ages about a dying woman who could be cured by a drug that was cheap to make, but that a manufacturer was charging an exorbitant fee for. The woman’s husband ends up stealing the drug. Is that right or wrong?

Kohlberg observed that in answering questions like this, young children have what he called a “preconventional morality”: Their notions of right and wrong are dictated by what their parents think, and the avoidance of punishment when breaking those rules. For instance, the main reason not to throw your dinner on the ground or hit your brother was to avoid consequences from parents, not a feeling that there’s something wrong about that action. 

Kohlberg thought this stage lasted until around age 9, and in the next period, children began to understand that there isn’t just one correct action, but that people could have different moral ideas based on their social context. To sum up the rest of the stages quickly, each one progresses to encompass more views — like the moral agreements necessary to make a society function — and more complexity — like the realization that a seemingly immoral action can ultimately be moral, like stealing medicine for one’s wife. 

It’s useful to pinpoint where your daughter finds herself on Kohlberg’s timeline. It sounds like she’s in the shift from the first stage and into the later ones. What you’ve decided — that it’s okay to eat meat if it’s free-range or grass-fed — is no longer sufficient for your daughter in terms of guiding her own actions. That can be a jarring moment for a parent, but at least, according to Kohlberg, it’s a sign of maturation. Your child should, at this age, start to consider her friends, as well as the experiences she’s had without you, when making an ethical choice. 

But I’m her parent, you may protest. That doesn’t necessarily mean that your job is to exclusively provide black-and-white directives. 

Alison Gopnik, a psychologist and philosopher at the University of California Berkeley, has written about the unique perspective and personhood of children (including babies). In her book The Gardener and the Carpenter, she questions how people have come to define the act of parenting as having specific goals in mind for their children. This approach is like being a carpenter, she writes, who follows instructions to assemble a predetermined piece of furniture. She argues that parenting is more like gardening: You cultivate the soil and the environment and realize that you could produce any number of different flowers, fruits, or vegetables. Growth is the point, not a by-the-book final product. 

I see Gopnik in alignment with Jean-Jacques Rousseau, the 18th-century philosopher whose novel Émile, or On Education surprised its readers by advocating for a freer and child-centered approach to teaching. Émile, a young wealthy boy, is tutored — in high contrast to the expectations of the day — without strict rules. Rousseau thought you couldn’t make a child turn into an adult any faster, and it was foolish to try. He also thought that children had to learn by having their own experiences out in the world, and learning from those, rather than just overly didactic lessons. 

As your daughter dips her toe into the morality of eating meat, Rousseau would also remind you not to expect her to have the most mature ideas about veganism or her meal plan. She is still young, and may just have come across an idea that feels ethically important to her. Your role as her parent is to help her develop her nuanced morality, a process Kohlberg suggests will continue, and not steer her towards one way of eating over another. Be Gopnik’s dietary gardener, not carpenter. 

Of course, parents do have rights over their children, and an obligation to keep them safe. When we’re young, we’re not always equipped to make the right choice (some would argue this continues into adulthood, too). If your daughter decided to take up smoking cigarettes, for instance, you would step in because her choice would negatively affect her health. As her parent, you should still guide her to build healthy habits. 

You say you’re worried about your daughter becoming too picky, or not being exposed to enough foods if she becomes a vegan. But rather than push back on the choice itself, you can explain what else her choice entails. You can do so in an age-appropriate way. Talk about the nutrients that she might be missing out on if she stops eating meat, dairy, and eggs, and find books or videos about what foods might be a good substitute. 

For me, becoming vegan actually exposed me to all kinds of foods that I might not have eaten otherwise: from Asian and Indian cuisines that are very veggie-friendly to many other protein- and iron-rich plant-based foods. You could collaborate with your daughter to cook vegan meals for the whole family; no challenge sparks a budding home cook more than making delectable tofu. 

I should add that I’m no longer a vegan. I learned a lot from committing to a diet that wasn’t always convenient or tasty, in support of my values. Then, after more than a decade, I incorporated eggs and fish back into my diet. It’s likely that your daughter will continue to change the choices she makes as she tries to align her actions with her maturing moral views about the world. 

Whether or not she eats grass-fed beef with you in her teens, you should be glad that she seems to care about what impact she’s having in the world. It means you’re raising a person whose ethics are developing strongly, even as what’s on your dinner plate may change while she figures it all out.  

Bonus: What I’m reading

• Speaking of tofu, I revisited an essay that George Stiffman (a self-proclaimed “tofu guy”) wrote for Asterisk Magazine about how soybean curds are prepared in China. Warning: This article will make you hungry! He dives into all the creative culinary preparations of tofu that are tragically absent in the West. 
• Several years ago, I bought a plant-based cooking book especially for children, The Vegan Cookbook for Kids: Easy Plant-Based Recipes for Young Chefs. It was a present for a non-vegan family, but the kid in question was interested in learning how to cook, and when kids cook vegan, parents don’t have to worry about them handling raw meat! Looking over these snacks and meals again, I see several tasty things that I wouldn’t mind making for myself, even as a non-vegan, and non-child. 
• When I was a vegan in New York City in the 2010s, I wasn’t constrained to sad tofu and sprout sandwiches. It seemed like every week a brand-new vegan restaurant opened up, covering every cuisine, and with star chefs at the helm. But lately, all my favorite vegan restaurants have been closing. Turns out I’m not imagining it, as Vox’s Marina Bolotnikova wrote in her article: “Where did all the vegan restaurants go?” She investigates why these establishments have become rarer, and what we’ll miss out on if they completely disappear. 

Jonathan Hale was ready to lay down his paint rollers. Hale, a law student turned viral road safety advocate, had run into legal trouble for painting his own DIY crosswalks across some of Los Angeles’s most dangerous intersections. In a meeting with LA Mayor Karen Bass earlier this year, he told her that if the city could commit to making its own streets safer for pedestrians, then he would stop his own vigilante activism. 

“Dude, you’re the mayor. Do something about this. It’s you, dude,” he recalls insisting to Bass — in so many words — after she apologized for his arrest on vandalism charges for a paint job last December. For months, Hale upheld his end of the bargain and stopped painting, believing in her office’s emailed assurances that a new executive order was coming soon. 

View this post on Instagram

But, eventually, after weeks of unresponsiveness, Hale grew tired of waiting, just as he had the first time he picked up a stencil and a bucket of white paint. “We’re so focused on looking for reasons why we can’t do stuff instead of ways that we can,” he said, “and it’s just paralyzed our institutions.” 

Across the country, such civic paralysis has compelled a legion of guerrilla urbanists to take their city’s matters into their own hands. In Boston, a group of cyclists used strips of green and white duct tape to build a bike lane at an intersection where a truck struck and killed 36-year-old Louisa Gag in July. In Nashville, Kansas City, and across the Bay Area, volunteers have built and installed their own public benches at bus stops where city officials had slowly removed places to sit, after years spent curating increasingly hostile public spaces. 

Every time one of these friendly neighborhood vigilantes paints a crosswalk, fills a pothole, or builds a bench, they remind us that it is not actually that hard — or even that expensive — to do many of the simple things that can make our cities safer and more pleasant places to live. Though our local governments may seem incapable of getting these basic tasks done, they are probably less constrained by money than they are by a sluggish status quo. And in some cases, they’re so afraid of being sued that they’d rather build nothing at all. 

“We see the fear of litigation and liability” so thoroughly sabotaging mundane municipal projects that “a crosswalk takes half-a-million dollars in five years to do when it’s really a bucket of paint in an afternoon,” said Anthony Garcia, a Miami-based urban planner who, with his longtime collaborator Mike Lydon, pioneered the study of tactical urbanism, or low-cost, quick-fix interventions often led by ordinary citizens themselves. Both Garcia and Lydon now advise cities nationally on how to integrate the practices of guerrilla urbanists into the ways they govern and pilot their own new policies. “You don’t have to hold a crosswalk to the same standard that you hold a bridge,” Garcia said.

It can be inspiring when a random citizen feels compelled to pick up a paintbrush and finish what their city can’t seem to start, but it is also an infuriating embodiment of just how stunted some of our most basic systems of governance have become. These industrious urban vigilantes show that making our cities more livable can be an easy, and even joyous practice. But if their work is going to serve as more than mere symbolism, cities themselves will need to learn from their example — or, as some municipalities have recently demonstrated, find new ways to collaborate.

“The point of the crosswalks is the protest. It’s to draw awareness to the issue,” not to create a permanent class of illicit crosswalk painters, Hale told me. “We need to hold the government to a higher standard.”

The quasi-legal case for taking your street into your own hands

While there are some reasons that a municipality would take longer to install a bench or paint a crosswalk than a crew of local residents — compliance with regulations and the installation of proper signage comes to mind — they rarely need to take as long as they often do now.

Take Los Angeles, where even the most basic road safety projects can take years to build, racking up eye-popping bills along the way. Some of these delays have proved deadly. For over a decade, the city sat on funds to improve a perilous intersection in Koreatown, according to Streetsblog, an intersection where, last summer, a drunk driver hit and killed 9-year-old Nadir Gavarrete. 

As the city twiddled its thumbs in the days that followed, the Crosswalk Collective LA — a DIY group that gave Hale his start — started painting. It wasn’t until three months after Gavarrete was killed that the city scrubbed the guerrilla crosswalks, replacing them with “official” crosswalks and a tiny, temporary traffic circle. A permanent solution is supposedly on its way this year.

It shouldn’t take this long, and though cities like LA have the resources and expertise to pull off more permanent and often more effective solutions than a group of vigilantes could, it also shouldn’t take a profound tragedy to convince them to finally act. And just as importantly, they should be capable of also making the sort of small, low-cost, even temporary interventions in the interim, ones that don’t require bespoke planning and a prolonged procurement process.  

As much as Hale has come to enjoy painting crosswalks along with the group he founded, People’s Vision Zero, he does so not as a hobby, but as an expression of discontent with a government that rarely seems to take the safety of his streets as seriously as he’d like them to. Painting a rogue bike lane or giving bus riders a place to sit might not do all that much to fix what’s wrong with our cities directly, but every single DIY urbanist I’ve spoken to has told me that their efforts have helped them reclaim a sense of collective agency over how their cities function, after years of frustration with seemingly impenetrable civic institutions. 

“It’s very easy to feel small, and that nothing that you do matters,” said Carter Lavin, co-founder of the TransBay Coalition, a transit advocacy group with ties to the San Francisco Bay Area Bench Collective, but “one thing about building benches is that every screw you drive, every board you sand makes your neighbor’s life better, and it does it for hundreds of people.”

Unfortunately, getting a city to formalize these often quasi-legal urban interventions is no easy feat, as Pastor Robin Owen, a local nonprofit leader in Nashville who writes a Substack called Jesus Urbanist, knows all too well.

For the past year, Owen has been embroiled in a cat-and-mouse game with the city of Nashville in which she and her growing bunch of bench-building acolytes install a DIY bench that the city later removes, after which they replace it with another bench, which the city will inevitably remove again. For many municipalities, getting rid of useful changes proves far easier than simply implementing them in the first place.

As ill-fated as that dance might seem, it can still feel more meaningful to locals, Owen told me, than the even more hapless task of prodding the government to get something done itself. 

“When you care about a place and want to make it better, you’ve very likely spent hours in meetings or emailing elected officials, and progress is just really complicated and slow,” she told me, “and building a bench and then putting it on a street corner, you actually do something that impacts someone’s life.”

How cities can learn to build the simple stuff quickly

Advocates tell me that in almost every case they would much prefer to work with their city governments than against them. And sometimes they do: For well over a decade, the local transit advocacy group Reconnect Rochester has partnered with Rochester, New York to lay out boxy, brightly colored “bus stop cubes” at transit corridors around the city. Critically, these boxes were permitted.

“If we were to have just kind of gone out there and done this in the dark of night without following any sort of process,” Mary Staropoli, co-executive director of Reconnect Rochester, told me, “I think those bus stop cubes would have been quickly removed.”

Owen has tried for months to convince her city to issue a similar permit for her benches. Nashville happens to boast one of the nation’s only programs dedicated explicitly to facilitating tactical urbanism, which should have made this an unusually straightforward process. And yet, because of a new requirement compelling such projects to pay for liability insurance, she says that she cannot obtain a permit without paying thousands of dollars to protect benches that cost just $35 a pop to build. 

With the exception of some disability protections, cities are indeed far likelier to get sued over the infrastructure they build than over the infrastructure they never bothered to build at all. A crosswalk that never gets painted is one less crosswalk to worry about. A bench that never gets built can’t lead to a lawsuit. But if they never get built at all, then they also have no chance of protecting a pedestrian from a speeding car, or giving an elderly commuter a place to sit. 

“There is this massive moral disconnection where cities are not concerned about liability when it comes to people dying in traffic violence, but are concerned about liability when citizens take action ourselves,” Owen said. “We should be more concerned about our moral liability of people having to suffer as they navigate our cities.” 

Nevertheless, when a citizen paints a crosswalk or builds a bench, whether as a stopgap as an act of protest, it can also exert a sort of “productive tension” on a city, said Lydon, one that can compel a static government to act much more quickly than it would otherwise, even if such changes takes time to materialize.

It wasn’t until a group of local wheelchair users took sledgehammers to sidewalks and began pouring their own cement ramps in the 1970s that Berkeley, California became one of the first cities in the nation to mandate curb cuts, now a hallmark of nationally mandated accessible design that benefit almost everyone at some point: parents pushing strollers, travelers pulling roller bags, and the rest of us in one way or another. 

And in another famous example, a graduate student named Matt Tomasulo zip tied a few dozen wayfinding signs to street poles around Raleigh, North Carolina in 2012, telling passerby how far away various destinations were by walking. While the city initially tore down the signs, they proved popular enough that Raleigh changed course, eventually integrating them into its own planning.

“We’ve documented this over and over,” Lydon said, noting the shift that comes when a city stops fighting a guerrilla intervention and opts to embrace or iterate upon it instead. “You can do these small things, and it can very much lead to transformational change.”

This story is part of a series supported by Animal Charity Evaluators, which received a grant from EarthShare.

When I was a kid, my family would occasionally go fishing on small row boats on the lakes of Montgomery County, Maryland. The point wasn’t to catch fish to eat — we always released them — but rather to spend time together in nature. And for a while, I looked back on those times fondly. But as I’ve learned more about fish and their apparent capacity to feel pain, I now wonder: Was I just stabbing a bunch of fish in the mouth and throwing them back in the water, injured and vulnerable?

Ted Kerasote, a nature writer and lifelong hunter and angler, asked himself some version of this question decades ago after fighting to reel in a silver salmon in Alaska — the last he ever released. He still occasionally catches trout for dinner, but said that his decision to stop catch and release fishing that day in Alaska came down to looking at the situation critically: “Seeing this fish struggle for its life, for what end? I wasn’t going to eat it. Catch and release regulations were in place there. And so it was simply for my pleasure to fight this fish.”

Each year, tens of millions of people take to America’s lakes, rivers, streams, and coastal waters to catch billions of fish. Many of these fish only exist because US governmental agencies put them there; each year, over 1 billion fish are bred in hatcheries and stocked in water bodies primarily for anglers. And although firm estimates are hard to come by, it’s clear that the majority of fish caught are not kept for dinner, but tossed back in. Many fishing grounds actually require fish to be released (more on that later). 

While anglers report being primarily motivated to get on the water to commune with nature, spend time with friends and family, and relax, the whole endeavor is anything but pleasant for the fishes themselves. After the steel hook pierces their oral tissue — and sometimes their eyes, gills, or esophagus — they’re often yanked around to the point of exhaustion before being reeled in. Then they’re exposed to air while the hook is removed from their body (and sometimes also for a photo opportunity), before the angler puts them back into the water. There, the fish reenters an often-treacherous ecosystem while fatigued and injured. Sometimes, the hook can’t even be removed and likely remains in their mouths for hours or days.

Estimates on what percent of released fish die vary widely. One 2005 literature review landed the average at 18 percent, while a 2026 review put it at 11 percent. But these are by no means definitive, as they each pooled together data from dozens of studies with different methodologies and time observed after catch and release, which limits our understanding of fishes’ survival from these encounters. 

A different 2026 study, though also imperfect, took a more cleanly experimental approach. Researchers line-caught 489 Chinook salmon and then placed them in holding tanks for observation. Eight percent died within two hours of hooking, and about 25 percent died within 10 days. It’s reasonable to assume that the mortality rate would be higher if the fish were placed back into their local waters, with predators and other natural threats lurking.

Even when fish are caught by scientists like in this case, the operation is by no means surgical. In the Chinook study, 90 percent of the fish experienced moderate to severe fin damage, around 45 percent had moderate to severe hook wounds, and 8 percent suffered severe eye damage.

“No fish is better off because we’ve caught it,” Steven Cooke, a biologist and fisheries scientist at Carleton University in Canada — and an avid angler himself — told me. “It is impossible to catch a fish without causing, one, some level of injury, and two, physiological disturbance.” 

In other words, recreational catch and release fishing injures billions of animals (a vast number of whom were bred for this fate) and condemns many of them to a premature death, and likely a more unpleasant one than if they had simply been killed humanely immediately after catch. Which means that what is often portrayed as a peaceful — even benevolent — pastime is, in another light, a more torturous activity. Especially if you think fish might experience pain. 

What does a fish feel? 

For much of recent history, it’s been thought that fish — far from us on the evolutionary tree, living in ecosystems largely foreign to us — don’t feel pain. But in the early 2000s, a group of scientists in the United Kingdom began to conduct experiments on fish that slowly undermined this belief.

A seminal study, published in 2003, found that fish have nociceptors — sensory neurons that identify and respond to threatening stimuli, like predators or, well, metal hooks jabbed in their mouths. But it wasn’t necessarily evidence that fish feel pain in a similar sense to how we and other animals might; for that, a scientist would need to demonstrate that fish are not just reflexively reacting to noxious stimuli but also that their brains perceive it as pain.

Since then, researchers have poked and prodded fish to see if something more is going on than mere threat avoidance. They have, for example, injected acid and bee venom into the lips of rainbow trout, whose respiration rates nearly doubled and who proceeded to rub their lips against rocks or the tank walls — seemingly in an attempt to soothe the injury. 

In another experiment, scientists trained fish to feed in a certain part of their tank, and then subjected them to electric shocks in that area. The fish were less likely to seek out food as the shock intensity increased. 

But Cooke, the angler and fisheries scientist, isn’t convinced. He wants fellow anglers to treat fish better insofar as he wants fish to reproduce, grow, and have a good life, but says he’s a “fish pain skeptic.” 

“The evidence base around fish pain is meager and generally low quality, extremely biased, and unable to tell us whether or not fish have the capacity to feel pain or not,” Cooke told me. (Cooke, for his part, says he is biased too, and has received funding from pro-fishing interests.) 

The core of the skeptics’ argument boils down to the idea that fishes’ brains don’t possess the necessary equipment to experience pain — namely, the neocortex, which plays a major role in our and other mammals’ processing of pain.

Culum Brown, a professor and fish welfare researcher at Macquarie University in Australia, vehemently disagrees. “All [the information] we have to date suggests the behavioral, physiological, and psychological responses [in fish] mimic humans,” Brown told me. “Whatever way you look at it there are far more similarities than differences, which is not surprising given how important pain perception is from an evolutionary standpoint.” (Brown, I should note, has received some funding from animal welfare and ocean protection foundations.)

We know that various species of fish can use tools, recognize themselves in a mirror, build artistic nests, form complex social relationships, distinguish between human faces, and maintain long-term memories, among other abilities. Is it such a stretch, then, to extend them the capacity for pain?

Ultimately, as my colleague Marina Bolotnikova has written, the fish pain debate is partly a scientific one and partly a philosophical one. “The question remains unsettled because pain is a subjective feeling that science cannot prove definitively,” she wrote. One must be conscious to feel pain, and consciousness remains a mystery. With this uncertainty, we can continue to act as if they don’t feel pain, or we could give them the benefit of the doubt. 

Georgia Mason, a behavioral biologist at the University of Guelph in Canada, is, like Cooke, not quite convinced fish feel pain. But she argues that we ought to take a precautionary approach and act as if fish can experience pain until proven otherwise. 

With that in mind, should we be fishing for fun at all? 

Reducing harm in sportfishing — and rethinking it altogether

For his part, even as a fish pain skeptic and angler, Cooke is keen to reduce harm to fish. And the most important way to do that, he says, is to keep fish wet. He’s even on the board of a nonprofit called Keep Fish Wet.   

Why? “Most fish do not do well when exposed to air,” Cooke said. Their gills collapse and/or stick together, making it hard for them to get the oxygen they need.

“A fish should always be dripping wet,” and only out of the water for 10 seconds or less (the average time anglers kept fish in the air, in one study, was 29 seconds). The group Cooke works with also suggests anglers minimize handling time. And Cooke said fish will experience more stress if they’re caught in warm waters, as it holds less of the oxygen they need. 

Brown had a lot more to say. Anglers should avoid “playing” with the fish and bring them in as quickly as possible; use barbless hooks, which makes for an easier release; and when deepsea fishing, bring the fish up slowly to prevent barotrauma. And for those who kill, rather than release the fish they catch, do so quickly, rather than letting fish slowly suffocate or bleed out.

As Kerasote, the nature writer and hunter and angler, pointed out, catch and release as a widespread hobby is a relatively new phenomenon. Only in recent decades have state wildlife agencies made it a rule in many water bodies, in an effort to prevent fish depletion so as to ensure there is enough for wildlife to eat — and also so that there are always plenty of fish for anglers to catch. 

Before this, Kerasote said, “you went out there, you caught your limit and you were done.” But with catch and release, “there was no limit anymore, and that’s what became embedded in the fishing culture.”

To account for this shift, Kerasote wants to see states limit access to fishing in the same way that they hold lotteries to hunt certain mammals, like elk and Bighorn sheep.

Some fish scientists question the practice of catch and release altogether. While addressing an audience full of anglers at a conference, zoologist Eugene K. Balon bravely — or perhaps foolishly — shared a provocative thought experiment to prove his point. 

Imagine there is a recreational activity called “sportbirding,” Balon proposed, in which participants take fishing rods, put earthworms on the hooks, and cast them out into the forest. Then they wait until a bird — a Robin, in his example — falls for the bait and bites down on the hook.

“The shrieking and flopping bird is proudly wheeled toward the hide, the hook removed and the bird drowned in the water,” Balon said to the crowd (the water, in this case, is a parallel to fish exposed to air). “Would any one of you support such recreational activity? How does it differ from the sportfishing you support?”

“Sportbirding” would surely be considered barbaric to many — even many anglers, I imagine — and yet sportfishing enjoys widespread social acceptance, perhaps because of the persisting belief among many that fish don’t experience pain. 

Recreational fishing also has far-ranging impacts on species beyond its direct targets. For example, a study of over 2,500 pelicans taken into wildlife rehabilitation centers in Florida near the longest fishing pier in the world found that more than half of the birds had been injured by fishing hooks and lines — the leading cause of injury. Stocking nonnative fish to local water bodies can also upset natural food chains and ecosystems. And some of the live baitfish used by anglers spread disease to wild fish populations. 

There is also the issue of these “bait” animals themselves. Billions and billions of smaller fish — like minnows and shiners — are reared and sold each year in the US only to themselves be stabbed through with a fishing barb and intentionally kept alive and thrashing to entice a larger fish to chomp down on them. This is an additional, yet largely hidden, layer of suffering in the recreational fishing industry.

“I think fishing is worse than hunting,” Brown told me. “At least you know what you are targeting when hunting. And hunters pride themselves on a clean kill. It is a very different ethic,” than fishing, he said. That’s evident particularly in the world of competitive sportfishing, where marathon “fights” to reel in enormous fish are glorified.

For Cooke, many survey respondents, and even for me years ago, fishing is often about spending time with family outdoors, away from technology, while marveling at fish. But couldn’t that all be more or less achieved by taking a hike in the woods, snorkeling, boating, scuba diving, catching fish in nets, or even “hookless” fishing, which is practiced by a tiny contingent of anglers?

Not necessarily. Anglers, he said, are also motivated by the “thrill of the chase.” The uncertainty of what type of fish they will catch, and whether they catch any fish at all, keeps drawing anglers back to the water. Cooke said plenty of people who fish might also be driven by the “human domination of nature.”

Humans, like all creatures, are hardwired for survival. And for the vast majority of our history, that entailed catching and killing fish for sustenance. But now, most fishing is done for fun, or for those other pursuits: relaxation, thrills, the domination of nature. But the fun comes with an enormous moral cost that most anglers, it appears, would rather not confront. Because as our understanding of fish and their capacities evolves, our ideas about fishing might need to evolve, too.

What can an economist teach us about misery? 

I had that question in mind while reading the new book The Opposite of Happiness: How Bad Feelings Make and Break Us, by eminent researcher George Loewenstein. The field is not exactly known for its facility with human emotions, but Loewenstein is a co-founder of behavioral economics, the subdiscipline that studies the many ways that people depart from the ideal of the perfectly rational actor. He’s spent a career investigating how psychology and emotion shape our judgments, and his latest book offers a sweeping account of how suffering structures human life. 

That might sound very bleak, like the opposite of a fun read. But the book itself isn’t distressing — it’s a bracing, useful, and even comforting lens on what it means to be alive. It emerged from a period of profound suffering in his own life, one where, he writes, he “thought about suicide constantly.” Writing it, he told me in a recent interview, was “kind of a silver lining for my own misery.” 

In Loewenstein’s own words, The Opposite of Happiness is not a self-help book. To him, understanding is its own reward. Though he adamantly refuses to dispense life advice, I still think the book offers much that can help us live more wisely, a little less at war with our emotions.   

“Misery is inescapable,” Loewenstein writes. “It’s not some malfunction or a bug in the system. It is the system.” Negative emotions are “more powerful, persistent, and pervasive than positive ones.” That is because, he argues, unpleasant feelings — hunger, pain, anger, loneliness — are how evolution motivated us to do the things we need to survive and pass on our genes. They still heavily shape our conscious experience, however mismatched they may feel to our modern circumstances. 

Some version of that insight, that dissatisfaction is woven into the human condition, has been known to humans for eons, of course, captured in philosophical teachings like Buddhism’s Four Noble Truths. The father of economics himself observed that people work hard to earn riches, only to discover the result offers no lasting contentment. “It is this deception which rouses and keeps in continual motion the industry of mankind,” Adam Smith wrote in The Theory of Moral Sentiments. “It is this which first prompted them to cultivate the ground, to build houses, to found cities and commonwealths, and to invent and improve all the sciences and arts.” 

Loewenstein puts this understanding into the language of modern psychology, speaking to a current of anxiety and unhappiness running through American life today. It also points to enduring questions about what the purpose of human progress and prosperity is, anyway. 

Many of us could particularly benefit from the concept of negative “meta-emotions,” or the judgmental feelings we have about our negative feelings. “At the heart of so many of our miseries is not the fact that we feel bad, but the belief that we should feel otherwise,” he writes.  That line immediately rang true to me — merely acknowledging to myself that it’s not a big deal if I feel terrible from work stress, or my cat’s deteriorating health, or whatever else happens to be weighing on me, helps to lighten the load. What if we really tried to wryly embrace the reality that it’s extremely normal for life to suck sometimes? The reward might not be happiness, exactly (an elusive and poorly understood state anyway, Loewenstein points out), but a little less misery.  

I recently spoke with Loewenstein about his book — he had a gentle, faintly melancholic air, and took a surprisingly generous interest in some of the choices I was weighing in my own life. Part of our conversation, condensed and edited for clarity, is below. 

Americans seem pretty unhappy right now. There has been endless discourse about that. Do you think that your book adds something to that conversation?

I do — I was just an expert on the Meta case that recently settled. I was an expert on the side that was against Meta. I think one of the causes of declining mental health is, in fact, social media. It really exacerbates the types of social comparisons that lead to envy and loss of self-esteem. I would like to think that I provide some new insights into how these modern technologies help to exacerbate the mental health crisis. 

One analysis of that, based on what I’ve learned from your book, might be: We as humans are so guided by negative emotions, and often those emotions are relational in nature and have to do with how we compare to other people.  Social media is then quite naturally going to tap into and amplifying negative emotions that we’re easily manipulated by.

That’s right. I think of it in two ways. One is there’s kind of a mismatch between the circumstances in which we evolved and the modern environment. And the other is that in the capitalist economy, there are, especially in the internet age, all these entities that are trying to exploit our evolutionary programming for their own good and not for our good. 

The premise of the book, as you write, is that “misery is inescapable. It’s not some malfunction or a bug in the system. It is the system” — it’s like our default state. Can you unpack what that means? 

I agree with everything you said until “default.” Different people have different set points, and there are some happy people around. I happen to be a glass-half-empty person. My natural state is a little bit below zero. But there are very few people who don’t experience some form of misery frequently and intensely. 

The evolutionary function of most negative emotions is pretty obvious, whereas the evolutionary function of happiness is sort of murky. And misery is so dominant that all it takes is a little bit of misery, a little bit of negative emotion, to wipe out any positive emotion. You go out to a really nice dinner at a fancy restaurant with your significant other, and you say something thoughtless and they get offended or they say something thoughtless and you get offended. All of a sudden you can’t even taste the food or appreciate the beautiful surroundings. 

Paul Rozin at the University of Pennsylvania referred to this as the “roach effect”: If you drop a roach into a vat of fine French wine, you don’t want to drink the wine. But if you take a roach, you can add as much wine as you want to it and you’re not going to want to eat the roach.

One of the strongest positive emotions is relief — which is interesting and not a coincidence, because it’s relief from negative emotions. It’s telling that maybe the strongest positive emotion involves the elimination of negative emotions.

You can think of misery as a stick trying to get you to do things that evolution thought were good for you; the stick is very immediate, and you know exactly what it’s telling you. If you are hungry, it’s time to eat. If you’re in pain, you’re injured, you’ve got to do something about it. But the carrot is different. The carrot, which is positive emotions, you have to think ahead, Oh, if I did this, then I would experience this positive emotion. It requires a kind of second-order thinking, whereas misery is just immediate. Evolution figured out probably very rapidly, probably when we were single-cell protozoa or something, that sticks are a way better way to get an organism to do what it needs to do than carrots.

How confident are you that the evidence base we have about the psychology of negative emotions generalizes to humanity as a whole and that it’s not culturally biased?

“What I’d really like people to get out of the book is insight — into their own negative feelings, their own types of misery, and other people’s negative feelings.”

Emotion researchers have looked across cultures, and they tend to observe the same basic emotions in a very, very wide range of cultures. What does vary across cultures is what induces the emotions. For example, shame — something that we would be unashamed of, somebody in a different country might be very ashamed of, and vice versa. A lot of these emotions are self-conscious emotions. They have to do with how we interpret the world and whether we’re living up to some kind of standard. Often we get it from culture, from religion, things like that.

But I think the emotions themselves are not universal, but pretty close to universal. My guess is that all 12 negative emotions that I write about are manifested in pretty much all different cultures, from those that have very little connection to Western civilization to advanced economies. 

Another timely thread that your book is in conversation with is this idea that American culture has become intolerant of ordinary negative emotions in a way that’s maladaptive. Suzanne O’Sullivan’s recent book The Age of Diagnosis, for example, covered our obsession with medical labels and how they might make us prone to thinking that feeling bad means that there’s something medically wrong with us. What do you think about that? Have we gotten bad at feeling bad?

It is striking to me how it seems like all the young people I meet talk about their therapist, and a lot of them talk about the drugs that they take. Young people also talk about anxiety and depression almost like one word, “anxiety-and-depression.” In my generation, anxiety and depression were two entirely different things. 

I think it’s good that younger generations are more comfortable talking about these things and getting help. I do worry that it can be, to some degree, pathologizing. There’s an awful lot of self-focus there. And I kind of worry that if you are dealing with your mental health problems by taking drugs, that it reduces your motivation to figure out things like how to reorganize your life to feel better. But I don’t want to sound too much like a dinosaur.

There’s a contingent of people who might read your book and think, “Yes, isn’t it terrible that humans are built to be unhappy and our evolved instincts don’t serve us well anymore? And that’s why we should engineer humans in such a way that we don’t feel this way all the time.” Someone with a strong utilitarian philosophy might think that if your life sums up to more negative feelings than positive ones, then it’s not even worth living. But that’s not really the vibe that I get from you. 

No, yeah. And one of the things I talk about in the book are what psychologists call meta-emotions. These are emotions that one experiences about emotions. I think the single best example is envy. If you envy your friend — almost everyone has friends that they envy, but they’re still your friends. But you might feel that you’re not supposed to envy your friend, and you feel guilty — the guilt is a meta-emotion. Or you can also have meta-emotions about a lack of emotion. So something bad happens to someone, or even somebody dies, and you don’t feel all that bad, and you feel guilty because you’re not grieving. 

I think all the societal focus on happiness creates a kind of a meta-meta-emotion, which is that we think we’re supposed to be happy. And then we feel ashamed and guilty about the fact that we aren’t happy — we feel like we failed. That compounds and adds another level of depth to our misery. So I think it can be liberating at some level to understand that misery just is a constant in human existence. 

I also think that my book is militantly anti-self-help. There’s no self-help in it whatsoever. But I don’t think it’s a depressing book to read, and it wasn’t particularly depressing to write, though some of the stories that I wrote about were a bit wrenching. 

I like that — but what, then, ought people to do with the information that you’re presenting?

What I’d really like people to get out of the book is insight — into their own negative feelings, their own types of misery, and other people’s negative feelings. To me, insight is valuable in its own right. 

The reason I read sad novels is not because they make me happy, but because I feel like I gained some kind of insight into people and into the world. Tess of the d’Urbervilles is the saddest book you could ever imagine, but it’s very meaningful to read, and it definitely feels like you’re a different person after you read it. I love novels, but I have no skill as a fiction writer. So this book was almost like a surrogate for me. Instead of writing a novel, I wrote this book.

I think the lack of self-help drives some people crazy. I did a podcast where the podcaster kept asking me questions about how reading the book would improve somebody’s life. And I kept saying it’s not a self-help book.

I’m just very skeptical of self-help talks and books and things like that. And I know that there’s certain things you are supposed to do to feel good, like you’re supposed to wake up and think of three things that you should be thankful for. And maybe if I did that, maybe I would get happier, but I’ve never been able to actually get myself to do that.

But you do have some insights that people could apply in their lives, like the idea that striving intentionally for happiness or meaning doesn’t really work, and that meaning often comes to us in unforeseeable spontaneous moments. On one hand, that implies a kind of randomness, and maybe there’s not a lot we can do about it. On the other hand, I can predict that I’m more likely to feel a deep sense of meaning in some scenarios than others, and I can put myself into those situations more, like choosing to be social on a weeknight.

A lot of the time the good things in life are just surprising, and sometimes you have to get dragged kicking and screaming into things that ultimately end up being the most fulfilling things in your life. So much of parenting is trying to get your kids to do things that they don’t want to do that you are absolutely convinced that if they started to do them, they would end up loving.

You argue, drawing from economist and philosopher Adam Smith, that human beings are constantly striving to achieve the next thing because we imagine it’ll satisfy us, though it never does. That helpful delusion is what leads us to build cities and cure diseases and all the rest. 

Adam Smith is best known for the invisible hand, which is the idea that each person single-mindedly pursuing their own well-being inadvertently promotes the public good. But if you read Adam Smith’s other book, The Theory of Moral Sentiments, he didn’t believe at all that people pursue their own personal interest. He believed that people are driven by this illusion that the next raise, the next accomplishment, will bring happiness, and it never does. I love that contradiction between the conventional interpretation of the invisible hand and what Adam Smith really believed.

So civilization is powered by this dissatisfaction that never resolves itself. But I don’t think you would say the lesson we ought to take from the book is that we’ll always revert back to being miserable, so there’s no point in doing anything.

That’s absolutely not the point of the book. Misery evolved for good reasons, and the whole point of misery is that we’re supposed to take actions to lessen our miseries. That’s what we should be doing, because who wants to be miserable? 

There’s no place like Kansas, a state whose howling winds are so fierce that in the 1800s, the roaring soundscape drove local farmers into madness. It is so windy in Kansas that every so often, trains get swept off their tracks or trampolines get hurled into the air and flung into neighbors’ trees. 

But today, the same gusts that whisked away Dorothy’s home have made Kansas the third-most wind-powered place in the country, its great plains dotted with thousands of twirling turbines responsible for generating over half of the state’s energy. 

And for years, Kansas has been trying to share. 

But that’s easier said than done in the US, where building power lines across state borders can be an onerous, litigious, and bureaucratic slog. The Grain Belt Express, a proposed 800-mile high-voltage line carrying Kansas’s windy riches across Missouri, Illinois, and Indiana, has been trying to get built for the past 16 years. When completed, it will allow Kansas to pump five times as much wind power into Missouri as it does now. But though the project received its first approval in 2013, it will likely not open until 2029 at the earliest, beset by regulatory hurdles across multiple jurisdictions and an endless stream of legal challenges that immediately halt progress every time a new injunction is filed. Alas, the express — which only broke ground this year — was forced to run oh so local. 

But other projects like it might soon enjoy far more reasonable timelines. On Wednesday, a bipartisan group of Senators announced a deal called the Bipartisan American Affordability and Jobs Act, or BAAJA — an acronym that’s led to a slew of cringeworthy euphoric Baja Blast references from abundance Democrats, clean energy advocates, and oil industry lobbyists alike. If passed, it would significantly curtail Americans’ ability to endlessly litigate against energy projects they don’t like, and empower the federal government to push critical multistate projects forward even if one state or municipality drags its feet. That could remake the way the nation’s energy infrastructure gets built, including its interstate transmission lines, for decades to come. 

But the bill also suggests that easing the way for clean energy in the US may require simultaneously creating the conditions for more oil and gas infrastructure in a country that already has a lot of it. It would also mean defanging some of the landmark regulatory norms that for decades have, for example, given Americans a say over developments that could contaminate their drinking water and helped tribes protect sacred heritage sites. These laws were necessary in the first place because prior to the 1970s, American communities frequently found themselves both literally and figuratively steamrolled  by developers singularly focused on building things quickly with little regard for the oil spills, river fires, and bifurcated neighborhoods they left in their wake.

And yet today, half a century later, that same dilemma has, in some ways, turned on its head. America builds things too slowly, and in particular, it builds the kind of infrastructure desperately needed to usher in a transition to clean energy with little of the urgency you’d expect from a world in the throes of climate change-related disaster. Exasperatingly, some of the same protections that have played a critical role in making this nation safer may also be standing in the way of building a nation that is more affordable and sustainable in the long run.

There are still plenty of reasons to feel hopeful about the world’s transition away from fossil fuels, even in the US, which has lagged behind our peers while still building an extraordinary number of solar and wind farms, particularly in Republican-led states like Kansas and Texas. And yet, many of these projects have languished in never-ending Ticketmaster-esque queues to connect to the nation’s decrepit power grid, a direct result of the permitting hellscape that prevents much-needed high-voltage cables like the Grain Belt Express from coming online.      

This new bill aims to ease many of the bottlenecks that stymie clean energy, but it also throws a bone to fossil fuels, which, like renewables, would benefit from less onerous environmental reviews and quicker permissions. This is, after all, a bipartisan bill in a Congress that, at least for now, remains Republican-led, under the tutelage of an aggrieved president who has sabotaged some of the nation’s most promising clean energy projects with an often petty and relentless fervor. Some Democrats in Congress, along with other environmentalists, have raised serious concerns about the bill. Those initial objections may prophesize an uphill battle for it when it comes to a vote, likely after the November midterms. 

Even so, with American electricity bills spiking to frightening new heights, and a data center buildout that could all but snap the power grid in half, this ambitious deal is, at the very least, an indication that some of the nation’s representatives are finally listening. And if it passes into law in the months to come, it could very well remake how Americans get their energy for a generation. 

So why are environmentalists mad?

By most accounts, the Bipartisan American Affordability and Jobs Act almost didn’t happen. 

For months, the proposed permitting deal has been stalled by the Trump administration’s failure to assure Democrats that the president would lay off his attacks on “windmills” and other clean energy projects. But in recent days, lawmakers appear to have come close to a fragile détente on the back of a “very reasonable opening proposal” from the White House, according to Sen. Sheldon Whitehouse (D-RI), the ranking member of the Environment and Public Works Committee. 

If the BAAJA is passed, it will codify new protections that legally prevent presidents like Trump from meddling with already-permitted energy projects or singling out specific forms of energy, a prohibition that will also apply if a Democratic president attempts to halt an approved gas line or a petroleum refinery. The Biden administration’s freeze on approvals for new natural gas export plants, for example, would not be allowed. 

It’s this element of the proposed bill that worries many environmentalists most. According to a transcript obtained by Punchbowl News, during a coalition call on Thursday, dozens of advocates from prominent environmental groups — including the Sierra Club, the National Wildlife Federation, and the Environmental Law & Policy Center — expressed their misgivings about the bill and strategized about how to lobby Democrats against it.

Most environmentalists acknowledge, however, that we need to spruce up the power grid and fix how permitting works for clean energy projects and transmission lines. As clean energy advocates know all too well, the projects they support are, paradoxically, more likely to be hampered by environmental reviews than fossil fuel projects are, because renewables usually require more space and represent the bulk of new energy developments. But many advocates understandably take issue with the idea that reforming this overcomplicated process may require weakening the right to challenge other projects, a right affirmed by the National Environmental Policy Act, the Clean Water Act, the Endangered Species Act, and the National Historic Preservation Act. 

The bill’s fate may ultimately depend on whether this trade-off is worth it. The BAAJA still does leave some room for court challenges if they’re filed within 150 days of an approval. But it will still place a much larger burden for determining these damage thresholds on federal agencies, which are, of course, currently controlled by Trump.

“The question’s not whether that would be a good idea — it’s one of the basic building blocks for converting more of our energy system to renewables,” the environmentalist Bill McKibben wrote of grid expansion and permitting reform on his Substack this week. “It’s how many pounds of flesh the fossil fuel industry would demand in return, and how close to vital organs that flesh would be located.”

The problem is, no matter how many Congressional seats Democrats seem poised to scoop up in November, they will still need to get Republicans on board if they want Americans to be able to really see the benefits of solar, the cheapest energy source of all time, reflected on their power bill. And for most of the nation, if not Earth itself, that transition can’t come soon enough. 

Editor’s note, October 4, 8 am ET: We’re bringing you some of our best-loved Your Mileage May Vary columns while Sigal Samuel is on parental leave. The one below was originally published last year.

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

---

My partner and I did IVF recently and luckily we ended up with several embryos. One of those will be implanted in me so I hopefully get pregnant. But which one?

My fertility clinic is encouraging me to do PGT-A testing, which would screen for things like Down syndrome and would also let me see the sex of each embryo so I could potentially choose whichever I want. (And to be honest, I really want a girl!) I’m also hearing about these new companies that can test embryos for all kinds of things — like how smart the kid might be, how tall they’ll get, and whether they’ll have a lower chance of getting breast cancer, diabetes, mental illness, stuff like that.

I don’t know how to feel about any of this. On the one hand, it feels weirdly eugenics-y to do so much tinkering with embryos, and I can’t help feeling a little pressured into overmedicalizing everything with these expensive tests. But then again, if I could do something to make my baby healthier and happier, don’t I kind of have to do everything in my power? What does a parent owe their child?

Dear Expecting,

This is such an exciting — and also confusing — time. You’re about to have your first kid, and that comes with all sorts of fears and insecurities and hopes and dreams. You want to do the right thing — no, the best thing! — for your child. It’s a beautiful impulse. Unfortunately, it makes it easy for companies to prey on you.

So let me walk you through what these companies can and can’t really provide. After we talk about the science, we can talk about the ethics. 

The simpler test you mentioned, PGT-A, has been around since the 1990s. It can indeed screen for conditions like Down syndrome and let you see the sex of each embryo. Mind you, that doesn’t predict what gender your child will ultimately end up identifying with — more on that soon.

The newer testing you mentioned is called polygenic testing. The conditions it screens for are complex ones, influenced by thousands of genes. We’re talking about everything from breast cancer to depression. Some companies even offer screenings not for disease prevention, but for genetic enhancement — so you can select for a taller kid or a kid with higher IQ.

Polygenic testing companies claim to predict each embryo’s risk for each condition, and the potential reduction of risk you’ll get if you choose one embryo over another. As the statistical geneticist Sasha Gusev explains, it’s very, very easy to be misled by this claim. If the company claims to lower absolute risk of Type 2 diabetes by 12 percent, you might think this means, “The chance of my kid ever developing diabetes just went down by 12 percent — great!” But really what it means is that, all else equal, a kid who would’ve developed diabetes is likely now at the high end of pre-diabetes instead, or just develops diabetes a few years later. The same holds true for other conditions, like breast cancer. Sure, if your kid is going to develop diabetes or breast cancer, you’d rather they develop it later — but it’s not the bill of perfect health customers might imagine.  

“Typical risk reduction estimates tend to exploit statistical assumptions to overstate their benefits and lead to confusion,” Gusev writes.

It’s also important to note that there’s a difference between a physical disease like cancer, which is straightforwardly and universally negative, and a complex mental health condition like depression. For one thing, polygenic scores don’t perform as well in psychiatry, as the psychologist Eric Turkheimer notes. Plus, most mental health conditions come in mild to moderate to severe forms, and it’s not clear that we should want to get rid of mild or moderate manifestations. 

“Sure, it would be nice if no one ever got depressed, but what would that actually mean?” Turkheimer writes. “People are going to be sad, and the most modern models of psychiatric disorders view most of them as extremes on continuous dimensions of normal behavior. I don’t think we want some kind of genetic version of Soma.”

To give a personal example: I have generalized anxiety with some obsessive tendencies. Is that a major pain in the butt sometimes? You bet. But if I could wave a magic wand and get rid of it, would I? No. In my experience, this trait is linked to another trait I deeply value: my creativity. The same thing that propels me down rabbit holes of worry also propels me down rabbit holes of getting super curious about some topic, researching it into the wee hours of the morning, and then writing a novel or children’s book about it.

That brings me to one other scientific issue: pleiotropy. It’s a fancy term for a simple truth, which is that genes can have an effect on more than one trait. When it comes to behavioral polygenic testing, we actually know very little about which genes cause what — a gene that’s correlated with depression or anxiety may also be correlated with a bunch of other things. So, if everyone were to start selecting embryos to try to protect their kids from depression or anxiety, what would happen? We don’t know! 

Pleiotropy is a scientific issue, but it’s also a moral issue, because in trying to protect your kid from a negative outcome, you could also be accidentally barring them from a positive one.

And that’s just the tip of the moral iceberg.

Another issue is the potential psychological harm that can result from commodifying our kids — treating them like consumer objects with selectable parts. Let’s say you use polygenic testing to try to select for high IQ. Even if the company’s predictor is right 80 percent of the time, that means it’s wrong 20 percent of the time. What happens if it’s wrong about your kid, and they end up with a low IQ instead of a high one? How will your kid feel? Unless you hide the truth from them, they’ll know that they are not what you wanted, that they failed to live up to the vision you went out of your way to chase.

The same goes for sex selection via good old PGT-A. I know you really want a girl. But what would happen if you select for a girl, and then your child grows up and turns out to be trans? They may feel an extra sense that they’re letting you down by not conforming to the gender expectations you had for them.

Then there are the ethical questions around unequal access. Polygenic testing isn’t cheap. (One company, Orchid, charges $2,500 per screened embryo. Test 10 embryos and that’ll cost you $25,000.) So, at least in the short term, that raises the specter of entrenching a caste system, where the gap between rich and poor expands dramatically as the rich get smarter and stronger.

Technologies tend to get cheaper over time, so maybe everyone will ultimately be able to afford polygenic testing. But that raises another problem: implicit coercion. If more and more of us make ourselves smarter and stronger, we may create a society in which everyone feels pressure to alter their child’s biology — even if they don’t want to. To refuse embryo selection would mean to put a child at a huge professional disadvantage, or to face moral condemnation for making “suboptimal” kids when optimization is possible. Society may no longer offer health insurance benefits or accommodations for kids with disabilities (or even non-enhanced IQ), reasoning that “it was the parents’ choice.” 

Some philosophers, like Julian Savalescu, already argue that parents have a “moral obligation to create children with the best chance of the best life.” Polygenic testing companies love that argument; Orchid founder Noor Siddiqui tells parents that “the responsible decision” is to “protect their children” from disease, using language like, “What if you could have stopped it…but chose not to?” And we generally live in a culture that’s obsessed with optimization. 

So it’s no wonder that you find yourself asking, “If I could do something to make my baby healthier and happier, don’t I kind of have to do everything in my power?” 

It’s a view that will be very appealing to utilitarians, who believe the right action is the action that maximizes well-being or happiness. But maximizing principles can be dangerous. If we’re laser-focused on maximizing one value, however noble it may be, that can lead us to overlook a host of other important values. Think about diversity, for example; polygenic testing could lead to a less diverse world. 

And it’s not even clear how to maximize well-being given that each embryo will have some downsides: How would you choose between one embryo with a slightly elevated risk for schizophrenia, another with a moderately elevated risk for cancer, and a third with a high risk for Alzheimer’s? You’d have to decide how to rank the importance of each condition, which would require a dizzying bit of moral math: How much weight do you put on the longevity associated with each condition, how much on patient-reported quality of life for each condition, and how much on your own ability to cope with each — and society’s ability (which will change over the years)? Plus, even if the screening does end up optimizing life for your individual child, it could have negative effects on the population level, for the reasons we covered above.

As the Nobel laureate Herbert Simon pointed out, many problems contain way more variables and way too much uncertainty for maximizing along a single axis to be feasible or even desirable. So it often makes sense to just go with an option that’s “good enough.” He coined the term “satisficing” — a portmanteau of “satisfying” and “sufficing” — to describe opting for this good enough choice.

What would satisficing look like in the context of embryos? If there’s a very serious condition that runs in your family — like Tay-Sachs or the BRCA mutation that markedly increases cancer risk — then I do think there’s a strong case for screening for that. These conditions are debilitating and can lead to early death. Nobody wants them. Genetic testing that lets us prevent them is an awesome gift. 

Then there are conditions that can include suffering, like autism, but can also be very compatible with a happy life. Mental health conditions in particular are heavily socially constructed — a lot of the associated suffering comes about because society constructs a certain biological reality as a problem and doesn’t support the people who have it. In these cases, if you want to give your child a “good enough” or even “optimized” life, remember that you don’t have to achieve that by biological means; working to change the social environment can be just as important, and it doesn’t carry the societal risks associated with polygenic testing. 

Ultimately, when considering what counts as a “good enough” life, each parent will draw the line in a slightly different place. And there’s a part of that that can’t be boiled down to objective facts about disease, because this is also about how well-resourced the parent feels — emotionally, socially, and financially — to deal with a certain condition. What feels manageable to one parent may feel crushingly hard to another. 

So, I can’t tell you exactly which screenings to do and which to forgo. What I do want to tell you is to resist being bullied or shamed by others, especially those with a profit incentive to push you in a certain direction.

As the epidemiologist Abby Lippman has noted, genetic testing is supposed to offer parents more choice, but it too often has the opposite effect. When someone like Orchid’s Siddiqui says about a disease, “What if you could have stopped it…but chose not to?” — well, that language preys on parents’ worst fears and insecurities. It holds parents hostage while pretending to be giving them more autonomy. 

You are nobody’s hostage. You are a moral agent free to look at the many different relevant factors, weigh them all in the balance, and then make the choice that works well enough for your family.   

Bonus: What I’m reading

• Silicon Valley is obsessed with IQ, so it’s no surprise that tech execs there are using polygenic testing in hopes of creating supersmart babies. This article shows the kind of mental pretzels customers get into when trying to figure out whether to select the embryo with the highest predicted IQ or that with the lowest risk of disorders. One couple asks: “How much additional risk of ADHD cancels out against 10 extra IQ points?”

• Rereading “The Last Children of Down Syndrome,” Sarah Zhang’s 2020 Atlantic feature on prenatal testing, it struck me that when people think “prenatal testing,” Down syndrome is often the first condition that comes to mind, even though it’s not the most severe or straightforwardly negative (it’s compatible with a happy life). It’s just that Down syndrome was easy to test for, so we started testing for it early. I wonder if that built up the condition as a bogeyman in the expectant parent’s imagination — if the fact that we could screen for it shaped the public’s perception of Down syndrome as something that should be screened for and potentially screened out.

• One trait that many people assume we should select for is a great memory. But I highly recommend the short story “Funes the Memorious” by Jorge Luis Borges. It’s a reminder that having too good a memory is not always a benefit.  

Vox Members got to read this story first. Support independent journalism and get exclusive access to stories like this by becoming a Vox Member today.

In the moody alcoves of a lobby bar in Chicago in 2021 over French 75s, Dr. Louise King, a gynecologic surgeon, and Katie L. Watson, a bioethics professor, found themselves in conversation about a topic that had long frustrated them both: Female surgeons are consistently underpaid compared to male surgeons, even after accounting for specialty, rank, age, and other factors. 

What troubled them even more was how the pay gap compounded in King’s own field. Surgeons who perform procedures that are specifically for women, like gynecological surgeries, are paid less for their services than surgeons who perform comparable surgeries for the male anatomy. Gynecologic surgeons are also predominantly women. Over the course of the conversation, Watson termed this situation “double discrimination,” a phrase that captures the overlapping dilemma of lower pay for surgeries in a specialty that is overwhelmingly female and also serves a primarily female patient population.

That term, which has since entered the medical literature, stuck because the problem it describes has been well documented for decades. In 1997, a group of gynecologic surgeons published a paper in the journal Gynecologic Oncology with a title that gets straight to it — “Is Adam worth more than Eve?” Dr. Barbara A. Goff, now chair of Obstetrics and Gynecology at University of Washington Medicine, and colleagues found that doctors are paid around 44 percent more for performing male-specific procedures than analogous female-specific ones. 

In the three decades since, the problem hasn’t been fixed. To the contrary, it has been effectively institutionalized, built into the systems and codes that determine how surgeons bill for procedures of all kinds. Today, gynecologic or female-specific procedures are in large parts still reimbursed at lower rates than male-specific procedures even when they take similar time and skill.

Those disparities have consequences that extend beyond the compensation of individual doctors. When gynecological procedures don’t bring in as much money to hospitals, those same hospitals are disincentivised to offer women’s health services. That can lead to worse care for women and, crucially, fewer training opportunities for the surgeons who do that work. 

But this historically persistent inequality is not a foregone conclusion.

How healthcare services are billed changes all the time as procedures get reevaluated, new ones get added, and medical societies and experts push for revisions. In fact, one of the biggest changes in how maternity care is billed and reimbursed is set to take effect early next year, splitting up services for prenatal care, delivery, postpartum care, and more. While this is a long-overdue fix for obstetrics, gynecologic surgery — which covers most of a woman’s life outside of childbearing years — continues to be left out of the conversation. 

And although real change will require concerted efforts, King and Watson — and other advocates who have spent years documenting this disparity — have a fairly clear sense of how to start fixing it.  

How surgical procedures are valued

The work of deciding how much a medical procedure is worth starts well above the head of any given doctor, medical practice, or hospital. In the United States, the Centers for Medicare and Medicaid Services, a federal agency that administers healthcare and health insurance policies, sets rates for different procedures based on a metric called relative value units (RVUs). An RVU is supposed to take into account how long a procedure takes, the skill it requires, and the intensity of work it demands. Both Medicare and private insurers consider these figures when they’re settling on reimbursement levels. If a procedure has a higher RVU, it is valued more highly, and makes more money.

In a recent study, cheekily titled “Price and Prejudice,” researchers from the Mount Sinai Health System found that out of 55 pairs of sex-specific procedures that they evaluated in 2023, 75 percent had lower RVUs for procedures on female patients. On average, RVUs for male-specific procedures were 30 percent higher, and when those procedures were performed in a hospital or surgical center, surgeons were paid around 26 percent more.

For example, doctors will often perform biopsies — taking a small sample of tissues, cells, or fluids — on both male and female genitalia to diagnose problems. In 2023, researchers found that Medicare’s standard national rate for reimbursing surgeons was $121.32 for a penile biopsy but only $65.74 for a vaginal biopsy. 

.ag-root{--ag-m: #3b3fb6;--ag-f: #e2552c;--ag-m-ink: #3b3fb6;--ag-f-ink: #c74d2a;--ag-bg: transparent;--ag-knock: #ffffff;--ag-card: #f5f4f1;--ag-ink: #16161d;--ag-ink-2: #4a4a55;--ag-ink-3: #686872;--ag-rule: #16161d;--ag-grid: #e4e3df;--ag-track: #ebeae6;--ag-focus: #1a73e8;--ag-head: var(--ag-host,Georgia,"Times New Roman",serif);--ag-ui: -apple-system,BlinkMacSystemFont,"Segoe UI","Helvetica Neue",Helvetica,Arial,sans-serif;--ag-head-weight: 700;--ag-head-track: -0.01em;--ag-ease: cubic-bezier(.2,.8,.2,1);container-type: inline-size;container-name: ag;display: block;position: relative;width: 100%;max-width: 760px;margin: 2.25em auto;padding: 14px 0 10px;border-top: 3px solid var(--ag-rule);background: var(--ag-bg);color: var(--ag-ink);font-family: var(--ag-ui);font-size: 16px;line-height: 1.4;text-align: left;-webkit-font-smoothing: antialiased;-webkit-text-size-adjust: 100%;box-sizing: border-box}.ag-root.ag-root{font-family: var(--ag-ui);font-size: 16px;line-height: 1.4;font-style: normal;font-weight: 400;letter-spacing: normal;word-spacing: normal;text-transform: none;text-indent: 0;text-align: left;color: var(--ag-ink)}.ag-root.ag-root i,.ag-root.ag-root em{font-style: normal}.ag-root.ag-root .ag-ft em{font-style: italic}.ag-root.ag-root *,.ag-root.ag-root *::before,.ag-root.ag-root *::after{box-sizing: border-box;letter-spacing: inherit;font-family: inherit;text-transform: inherit}.ag-root[data-ag-palette="teal"]{--ag-m: #00829b;--ag-f: #d4661a;--ag-m-ink: #007a91;--ag-f-ink: #b85a1a}.ag-root[data-ag-palette="violet"]{--ag-m: #5b3fb0;--ag-f: #c4661c;--ag-m-ink: #5b3fb0;--ag-f-ink: #b35e1c}.ag-root[data-ag-style="feature"]{--ag-head: "Bricolage Grotesque","Helvetica Neue",Arial,sans-serif;--ag-ui: "Instrument Sans","Helvetica Neue",Arial,sans-serif;--ag-head-weight: 800;--ag-head-track: -0.025em}.ag-root[data-ag-style="minimal"]{--ag-head: var(--ag-ui);--ag-head-weight: 650;--ag-head-track: -0.015em}.ag-root[data-ag-mode="dark"]{--ag-bg: #141417;--ag-knock: #141417;--ag-card: #1f1f24;--ag-ink: #ededf2;--ag-ink-2: #b9b9c4;--ag-ink-3: #8b8b97;--ag-rule: #ededf2;--ag-grid: #2c2c33;--ag-track: #26262c;--ag-focus: #8ab4f8;--ag-m: #6f73e8;--ag-f: #e5603a;--ag-m-ink: var(--ag-m);--ag-f-ink: var(--ag-f);color-scheme: dark}.ag-root[data-ag-mode="dark"][data-ag-palette="teal"]{--ag-m: #1e9db3;--ag-f: #dd7430;--ag-m-ink: #1e9db3;--ag-f-ink: #dd7430}.ag-root[data-ag-mode="dark"][data-ag-palette="violet"]{--ag-m: #8a6ee6;--ag-f: #cf7f22;--ag-m-ink: #8a6ee6;--ag-f-ink: #cf7f22}@media (prefers-color-scheme: dark){.ag-root[data-ag-mode="auto"]{--ag-bg: #141417;--ag-knock: #141417;--ag-card: #1f1f24;--ag-ink: #ededf2;--ag-ink-2: #b9b9c4;--ag-ink-3: #8b8b97;--ag-rule: #ededf2;--ag-grid: #2c2c33;--ag-track: #26262c;--ag-focus: #8ab4f8;--ag-m: #6f73e8;--ag-f: #e5603a;--ag-m-ink: var(--ag-m);--ag-f-ink: var(--ag-f);color-scheme: dark}.ag-root[data-ag-mode="auto"][data-ag-palette="teal"]{--ag-m: #1e9db3;--ag-f: #dd7430;--ag-m-ink: #1e9db3;--ag-f-ink: #dd7430}.ag-root[data-ag-mode="auto"][data-ag-palette="violet"]{--ag-m: #8a6ee6;--ag-f: #cf7f22;--ag-m-ink: #8a6ee6;--ag-f-ink: #cf7f22}}.ag-root[data-ag-mode="dark"]{padding-left: 16px;padding-right: 16px}@media (prefers-color-scheme: dark){.ag-root[data-ag-mode="auto"]{padding-left: 16px;padding-right: 16px}}.ag-root.ag-root .ag-x,.ag-root.ag-root p,.ag-root.ag-root h2,.ag-root.ag-root h3,.ag-root.ag-root button,.ag-root.ag-root select,.ag-root.ag-root input,.ag-root.ag-root ul,.ag-root.ag-root li,.ag-root.ag-root label,.ag-root.ag-root table{margin: 0;padding: 0;border: 0;background: none;box-shadow: none;font: inherit;color: inherit;letter-spacing: normal;text-transform: none;text-decoration: none;line-height: inherit;min-height: 0;width: auto;max-width: none;float: none}.ag-root.ag-root svg,.ag-root.ag-root .ag-pt-svgwrap svg{display: block;max-width: none;height: auto;overflow: visible}.ag-root.ag-root button{cursor: pointer;-webkit-appearance: none;appearance: none;border-radius: 0}.ag-root.ag-root :focus{outline: none}.ag-root.ag-root :focus-visible{outline: 2px solid var(--ag-focus);outline-offset: 2px;border-radius: 4px}.ag-root.ag-root .ag-sr{position: absolute !important;width: 1px !important;height: 1px !important;padding: 0 !important;margin: -1px !important;overflow: hidden !important;clip: rect(0 0 0 0) !important;white-space: nowrap !important;border: 0 !important}.ag-root.ag-root [hidden]{display: none !important}.ag-root.ag-root .ag-hed{font-family: var(--ag-head);font-size: 23px;line-height: 1.12;font-weight: var(--ag-head-weight);letter-spacing: var(--ag-head-track);color: var(--ag-ink);text-wrap: balance}.ag-root.ag-root .ag-dek{font-size: 15px;line-height: 1.4;color: var(--ag-ink-2);margin-top: 6px;text-wrap: pretty}@container ag (max-width: 480px){.ag-root.ag-root .ag-hed{font-size: 22px}.ag-root.ag-root .ag-dek{font-size: 14px}}.ag-root.ag-root .ag-ft{margin-top: 14px;padding-top: 12px;border-top: 1px solid var(--ag-grid);font-size: 12px;line-height: 1.45;color: var(--ag-ink-3)}.ag-root.ag-root .ag-method{margin-bottom: 8px;font-size: 12.5px;line-height: 1.5;color: var(--ag-ink-2);text-wrap: pretty}.ag-root.ag-root .ag-method b{font-weight: 600;color: var(--ag-ink)}.ag-root.ag-root .ag-ft-row{display: flex;flex-wrap: wrap;align-items: baseline;gap: 2px 14px}.ag-root.ag-root .ag-ft em{font-style: italic}.ag-root.ag-root .ag-credit{color: var(--ag-ink-3);white-space: nowrap}.ag-root.ag-root .ag-about-btn{margin-left: auto;padding: 4px 0;font-size: 12px;font-weight: 500;color: var(--ag-ink-2);display: inline-flex;align-items: center;gap: 6px;white-space: nowrap}.ag-root.ag-root .ag-about-btn::after{content: "";width: 5px;height: 5px;margin-top: -3px;border-right: 1.5px solid currentColor;border-bottom: 1.5px solid currentColor;transform: rotate(45deg)}.ag-root.ag-root .ag-about-btn:hover{color: var(--ag-ink)}.ag-root.ag-root .ag-ft-end{margin-left: auto;display: flex;align-items: center;gap: 14px}.ag-root.ag-root .ag-logo{flex: none;align-self: center;width: 31px;height: 15px;background-color: var(--ag-ink);-webkit-mask: url("data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAIQAAABACAQAAABxNBeOAAANcUlEQVR42tXbedRcZX0H8M+9d94kJITERBIoYASBtiyCpQcKLYgoHkpVVJCKylZ7WpYCttjWhUJdEE9BkKIeWpFTgZMeKBL2IOeAbMq+SAQEArIECCQEQhID78y9T/+Y5x1muffOwKE13Plv5j6/53m+v32ZxCW2kJhnhkJitKeQ4QXLrTVmgX+VKQSbWGAMmbnmIJcOrM018IJnZC51kkxunXjGZCZ7l+8KcmGETyG40ofMNVkm66KVashkxsx1oIdKKLYE9/q0ucY0rKPPFfGg9Z+W4OKR6M10bx8UTcFZxqzDz5jUh0cCopB7r8QkSaUqJRKTsKNmFxBNwdeRaIyshP/vT4KNrI6CX68Wy2wQV9Q/Ga7vgNsUnM26CkK3MVtuKcLQNbliRHATN0WKuYbbHC2Tj7DD7xCIINGybCQgpttgROrBkg71NQ6OamLdlogUz4+kQuuZMZJq6MBaSJ1gscaIsvQ7BSLBsyNIRCExa2QgNkYuc5+z1p2IYZiNaAMxCo/fObI0bB/3OF4+ktq9DYFIhipRbrJdMOYa16/b8tANRIhAjCLyc0akvJN5CsFJ1vmnF4jnB2TkzQOR4ACkrnHHui4P/ZC8y6tDQ6qm4AKGZAqJxFRPC4LdY3D1NnkSrG/pUCBagmuGXq2BTwkKN40oZesYGA8MzUFbgjuH2pIUNyoEf/H2koeJw/9saOKVCxbLaqHIJHZRKNwjXUflIelNGtM+IIZnGwlmWH+ok/17icSpiiFAJP1HeiuuNYThDWlka2km3MB3ojmszz9ftVmN5qcS77FW4eHKZD2RafSpTLusk7xBALIus52NoIQTb0wyw7TXmdtv+58dyahONtPTNYi3HG0KzjCuodW3Po1VjfYzxXSp1dYoYibSGDlDzeSRznSpV+TxfKHm7LlNHWRvW1pf02MucbZXe5nawEFDJaJtJfasNIGJxGzLFZ42rU8ekg7wG/mYky3wmCUWud8ST7rSyfY2tYdvwyKghn39h3st9YIHnW+fkni5e0XiK17qu8/dNhsUmg+MULlsCfavjCQaOF4Q/HPfO+3LzXCwK70caV1uV7PM9D6Xx28e902bREDr3XPiML8cON0Cc0qhSLGBq2Is1JIrFFpeE9xpvf5XtxkSRUyEVEdUAJFITLFYYZlZXZdJJdjQiZ6KVMYV/rNn7d2aURqXOa6Wswl2cUuUz2a8VK6lJXjIpgNrE6lpbon7Dt7nC/0aNNeqkWLLEyuAmFCv4Ftdb7Sd7TGejRLV0lJ40lSpRqfC+U+CpjyCcZkZpVC05eoETUGrRHrHBXeZ0mN22yp5Wfx1UNVz9wyawaeGKkdT8L0KIFKJ2xVe8XuSjh6zvZvj2qJD49geqBIf78QwRbzO7AEoGtjIQkFRGe+MC77TY2ca+FoFDO3PK4NW9Z6RgLiw1KBl2FMQfL8jBxkOt7oLhLbEvWR2l+pk2KcnmBsX/NzkHs42sLPHBWtrwr5CS8u2HUZk2F2ra//Bz5rBiywcGlu2BNdViu3lCmttKZHGo3y7s6obyv/ugTLDx/reGo9176wLhv290uO9qlk1v4sVUzxW4w0LoT8YaODcoQ40F9xboRbbGo/ZaRal4ZweWXgdyk91OdP2zp8d2Lkp+FAXraPj94td7Y4aW1YovGoeUhnOsMr8SuhaCpcOAvHNkYB4wqSBbCPD2YKmHToR3zklmlkIVpnTs76B4wZ2bincoxGvc5IguMIHTQZH1shuM7rvyRLbCA6SWqoohaIl+MQgEEeNFGSvGCjgphIbe1lwGRGGb5UaqJbg+j7VauCUkp3HBfuB0wXPOrAnmD6lEoqW4I5I9za30bFBeckON/fbuwZdtrsOiHGbl1zlREHhTzEpivp4Bbf+pc/rNHBBqWrcbmOpHwluMi9CkETdn2xxBZfbZ9waBwq2wxj+diCcGhes8Ptlxm7XoXFE+/c/6msGJNb3lML1sa23ldXyUkq5YI8+r9OuXwya1PvMwoWCi0wpAe+va2XiYCxzftwrw36e6Hvvwb6bdI6zpdZQKPKOEes/VPDnmCRxU8UR293T3hZRgjGP95izpuBes012teACyYDDTiSmeabCCDYFpzhSMLdTE8kw0zF+6jeWW+IGx5pWFggkmGXFSLHlp3v4k8jcp3CHtANKs5JTN5VUQjbx2659xwW32sB0Nwpu77jiQVU+rWKnQrDYuJMH3LSYP08tbWl0gMgsHimkOqYvhN5XEPwlMjM8J690VsGNfdfKsFsHhkJTsNCYOe4W5G6oyDsy7KSoYFvbu02NuUl3uJ12VUCS6oz91qHmsin4RhcQKa5VeCDOwXypxvPkgvtKOHt4XNMG8Ed4j0cErwkerJnESP2qgnEthf0rUvqBilZakqwuHakoMqeLL8FO9pL4rqZgmr8Tagt0G1pvIArZDrSkUl/yebu4xVZx4mpKTLvLZKJwJRXN5USrAsIwrC/fwPeHRhItwSUdrDOcp/AbU2Ux+2zV+pymrQc68dfKvSZ4yodxgDWRSi54siR8e1059qgxl2cM7cDUAPHVkYC4MV4glXi31YIvxvjh6prMMBfcIDikK8B+3WcE882I8cjE5XLBY5USkWCaZ0vNe0twy8h9+xptrXefi7pWfFuw1DukQysaLcFfWeK6PgvzXsE99sUmrhK6IpBccP+QYuzFpScuBCvNfnNQDKbDVUA8bUqUh3dYGsfEJuOTtasLwcbOEmwf441EQ2ZH+4PjvNi3viwg72fd0RWsG4x33lCT530jjZSttGEMXI8RvGTjWGc6fYjHeAZba7nHzL69D7VoIGFv0zq3RtNT7FjhQifm+BpvDojNhraCC0HLlkhN8pDgTKJ/vq5GIlqChUQHe79P2MRsW9nPDyzpuLzByxxfc5l2Xe3JUoNZFry9xa3gQrAzOECwxhaxYjDmsZpwrBlrmZNi5hg0re46dl4hRR+oFe8Ml5TCXwhW22gUK5GWzMOs8eLQxl9BNEPH4SKPSxWYUWuc2qXA9nDZl+1tgee1LPGIlkJWwrkg9bL7KiOFCaq/KD1xIjfN7pFJ/yet4KbgMIk9FcZtL4nX2Nx4rTTl/rDjdtt9rtkm19RAWgoLhwj3sFjix6OYy/JGyGiDp3MEX5C4wiJpbL1NqjFMBZ7zRKTdloBXveg1e9Y0kxOXDgGiwANWSUvOnGFv0+TDlKN8g2dHkp31zLWv4LSeQ4XaMbRHre0cOFfEnsYfV5wkaFjtMuSx/tgoUaAgscIvS9UnUdjY+4crRzkQz4wExDRHGHOdWzvywBqv1gLxQN+eiWBL8ypykxyXWyqTSGMvK1cMzFxkghdr5OWzwyd+G29SIlLsZS5O7RjHgBVWdPL8sudXA3QKu0i1KtpFnInMOLa2nRmWW+SJ2AmfgKHlUPsJpVzP8FFzvRDN+RuKLfcc+U8sd/ZUFlIqK1PljrCB/6owlS3B1TFo29nCTv3ztxbYrkMnldjCa+7s6ngMGsx/rOzV1vK63QouRmgGH9CzQQOnxsLKaCVfGh4uhb3QkttRgsMjCC3NCPIq+0ZKGW72vDmVBaVc4Unr9RVoDAu0Rm0F5woPGeshnuGDlccJlvTVIdqg55Xh8VngI52qVeiqYK3xBzGoP0ywDy6uYEFbtr7YJxNt8zl12ETMUyNN131+gHhissdLS+wtwe19wtiQOLJUMdrJ93SJWZaWpPXNqDYNM61xPhKHVCplIbfSuzunnZicOtijJSWiN9QKnhC3/nGO6kJdU/CTPguRYUHJ8dtt3N06WUmzopm/A86z2sxYAHilUo5zwW3W60xXMOZEwel1c1ejtIKbgn8oMUCJxMzS0m1T8O99lW9mWD5w+PZQwBFRYu6uKPM0BYfaQfC5TufrokrlaN/mZtuD2Q5yh+C8+smc4a3gQuEFM0uJZPhMSY+rKfhqn2lN7DcAePsqX4veYraXK7icC67yhJ91tW/qvV0uaLrD7ZYJgp9I66f4hreC6/P8LLrE8YE1R/WsyTC/b5+24fx6J6nfzNpKcW8POs7rOPBU4ue1ktwN0oVxVmdIkHVk7TxBYaWNSlsuE/Z4kuv7oGgKDu8p0CXmWNl1zSKOAx3VmWxgA8sqgRgXHNpldTK8f0iZsTCuGQdZho6oZkNawc1YiMlqPc80VwvyDpWm4G+6gGjgy51jT+j2r+3RV828sYtGPww/LJnbO7dmRKi9y7hju4zmECD+RMt4HPvq/TQ1rbV5pTy8foXUqZ3hsSI2hSb+ODuGd1oml2tFENY61QYDAdrnYpNn0JxePTCpm0itb1EpFBNDavfaNY6ejJRHbFkbQ5w3QobfFry9/KIjEa3e2TWXddn4V5xjm5JR01Tq2jhtV3SGCIPgYlNKhDvFPI9G9/r6irZyrXDCQE+9JtZOBNN9zzSh5PeAEzwiGSGFaSdGH3GYPc0G/+M0zxmzva/EUt9Kd7vcJZ6OfaswcL7pfuzjfUnhvzkznlRJGjfXD3yy7/vF5vuhJfGNN5J0vCXPRI64qT+zm21tq2GV1Ppetsiv3ekuT3ZS6aKCLXzGIbYz1SoPW2i+52tmrtsX/ajD7GSGtZ52l5+63uq6Oe//BeYA3+6agCy9AAAAAElFTkSuQmCC") center / contain no-repeat;mask: url("data:image/png;base64,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") center / contain no-repeat}.ag-root.ag-root .ag-about{margin-top: 8px;padding-left: 10px;border-left: 2px solid var(--ag-grid);display: grid;gap: 6px;font-size: 12.5px;line-height: 1.5;color: var(--ag-ink-2)}.ag-root.ag-root .ag-about a{color: inherit;text-decoration: underline;text-decoration-color: var(--ag-ink-3);text-underline-offset: 2px}.ag-root.ag-root .ag-about a:hover{text-decoration-color: currentColor}.ag-root.ag-root .ag-sw{display: inline-block;width: 10px;height: 10px;border-radius: 50%;flex: none;vertical-align: baseline}.ag-root.ag-root .ag-sw-m{background: var(--ag-m)}.ag-root.ag-root .ag-sw-f{background: var(--ag-f)}.ag-root.ag-root .ag-num{font-variant-numeric: tabular-nums}.ag-root.ag-root .ag-btn{display: inline-flex;align-items: center;justify-content: center;gap: 8px;min-height: 44px;padding: 10px 18px;border-radius: 999px;background: var(--ag-ink);color: var(--ag-knock);font-size: 15px;font-weight: 650;line-height: 1;transition: transform .15s var(--ag-ease),opacity .15s}.ag-root.ag-root .ag-btn:hover{opacity: .88}.ag-root.ag-root .ag-btn:active{transform: scale(.97)}.ag-root.ag-root .ag-btn[disabled]{opacity: .35;cursor: default}.ag-root.ag-root .ag-btn-ghost{background: transparent;color: var(--ag-ink);box-shadow: inset 0 0 0 1.5px var(--ag-grid)}.ag-root.ag-root .ag-btn-ghost:hover{box-shadow: inset 0 0 0 1.5px var(--ag-ink-3);opacity: 1}.ag-root.ag-root .ag-icon-btn{display: inline-flex;align-items: center;justify-content: center;width: 44px;height: 44px;flex: none;border-radius: 50%;color: var(--ag-ink);box-shadow: inset 0 0 0 1.5px var(--ag-grid);transition: box-shadow .15s}.ag-root.ag-root .ag-icon-btn:hover{box-shadow: inset 0 0 0 1.5px var(--ag-ink-3)}.ag-root.ag-root .ag-icon-btn svg{width: 18px;height: 18px}.ag-root.ag-root .ag-axis-cap{display: flex;justify-content: space-between;gap: 12px;font-size: 12px;color: var(--ag-ink-3)}.ag-root.ag-root .ag-bar-track{position: relative;height: 16px}.ag-root.ag-root .ag-bar{position: absolute;left: 0;top: 0;bottom: 0;width: 0;border-radius: 0 4px 4px 0;transition: width .9s var(--ag-ease)}.ag-root.ag-root .ag-bar-m{background: var(--ag-m)}.ag-root.ag-root .ag-bar-f{background: var(--ag-f)}.ag-root.ag-root .ag-bar-guess{background: repeating-linear-gradient(135deg,color-mix(in srgb,var(--ag-f) 55%,transparent) 0 2px,transparent 2px 7px);box-shadow: inset 0 0 0 1.5px var(--ag-f);transition: none}.ag-root.ag-root .ag-q-stage{margin-top: 12px}.ag-root.ag-root .ag-q-prog{display: flex;align-items: center;gap: 6px;margin-bottom: 8px;font-size: 12px;color: var(--ag-ink-3);font-weight: 600}.ag-root.ag-root .ag-q-prog span{margin-left: 6px}.ag-root.ag-root .ag-ink-m{color: var(--ag-m-ink)}.ag-root.ag-root .ag-ink-f{color: var(--ag-f-ink)}.ag-root.ag-root .ag-q-chart{margin-top: 10px;display: grid;gap: 8px}.ag-root.ag-root .ag-q-row{display: grid;grid-template-columns: 1fr;gap: 5px}.ag-root.ag-root .ag-q-row-hd{display: flex;justify-content: space-between;align-items: baseline;gap: 10px;font-size: 13px;color: var(--ag-ink-2)}.ag-root.ag-root .ag-q-row-hd b{font-weight: 650;color: var(--ag-ink);font-size: 15px;font-variant-numeric: tabular-nums}.ag-root.ag-root .ag-q-lab{display: inline-flex;align-items: center;gap: 6px;font-weight: 600}.ag-root.ag-root .ag-q-guess-tick{position: absolute;top: -5px;bottom: -5px;width: 2px;margin-left: -1px;background: var(--ag-ink);opacity: 0;transition: opacity .3s .6s}.ag-root.ag-root .ag-q-guess-tick.is-on{opacity: 1}.ag-root.ag-root .ag-q-guess-lab{position: absolute;top: 100%;margin-top: 7px;transform: translateX(-50%);white-space: nowrap;font-size: 12px;font-weight: 600;color: var(--ag-ink-2);opacity: 0;transition: opacity .3s .7s}.ag-root.ag-root .ag-q-guess-lab.is-on{opacity: 1}.ag-root.ag-root .ag-q-guess-lab.is-end{transform: translateX(-100%)}.ag-root.ag-root .ag-q-guess-lab.is-start{transform: none}.ag-root.ag-root .ag-range{display: block;width: 100%;height: 40px;margin-top: 2px;background: transparent;-webkit-appearance: none;appearance: none;cursor: grab;touch-action: pan-y}.ag-root.ag-root .ag-range:active{cursor: grabbing}.ag-root.ag-root .ag-range::-webkit-slider-runnable-track{height: 4px;border-radius: 2px;background: var(--ag-grid)}.ag-root.ag-root .ag-range::-moz-range-track{height: 4px;border-radius: 2px;background: var(--ag-grid)}.ag-root.ag-root .ag-range::-webkit-slider-thumb{-webkit-appearance: none;width: 28px;height: 28px;margin-top: -12px;border-radius: 50%;background: var(--ag-knock);border: 2px solid var(--ag-f);box-shadow: 0 1px 4px rgba(0,0,0,.18)}.ag-root.ag-root .ag-range::-moz-range-thumb{width: 24px;height: 24px;border-radius: 50%;background: var(--ag-knock);border: 2px solid var(--ag-f);box-shadow: 0 1px 4px rgba(0,0,0,.18)}.ag-root.ag-root .ag-range:focus-visible{outline: none}.ag-root.ag-root .ag-range:focus-visible::-webkit-slider-thumb{outline: 2px solid var(--ag-focus);outline-offset: 2px}.ag-root.ag-root .ag-q-hint{font-size: 12px;color: var(--ag-ink-3)}.ag-root.ag-root .ag-fade-in{animation: ag-in .5s var(--ag-ease) both}@keyframes ag-in{from{opacity: 0;transform: translateY(8px)}to{opacity: 1;transform: none}}.ag-root.ag-root .ag-q-end{text-align: left}.ag-root.ag-root .ag-q-recap{margin: 12px 0 4px;display: grid;gap: 6px}.ag-root.ag-root .ag-q-recap-row{display: grid;grid-template-columns: minmax(0,1fr) auto;gap: 2px 12px;font-size: 13px;color: var(--ag-ink-2);align-items: center}.ag-root.ag-root .ag-q-recap-row .ag-num{color: var(--ag-ink);font-weight: 600}.ag-root.ag-root .ag-q-mini{grid-column: 1 / -1;position: relative;height: 8px;border-radius: 4px;background: var(--ag-track)}.ag-root.ag-root .ag-q-mini i{position: absolute;top: -2px;width: 12px;height: 12px;margin-left: -6px;border-radius: 50%;border: 2px solid var(--ag-knock)}.ag-root.ag-root .ag-q-mini i.ag-g{background: var(--ag-knock);border: 2px solid var(--ag-ink-2);width: 12px;height: 12px}.ag-root.ag-root .ag-q-cta{display: flex;flex-wrap: wrap;gap: 10px;margin-top: 12px}.ag-root.ag-root a.ag-btn{text-decoration: none;color: var(--ag-knock)}.ag-root.ag-root .ag-pt-svgwrap{position: relative;margin-top: 8px;touch-action: manipulation}.ag-root.ag-root .ag-pt-svgwrap svg:focus-visible{outline: 2px solid var(--ag-focus);outline-offset: 4px}.ag-root.ag-root .ag-pt-dot{transition: transform .9s var(--ag-ease),opacity .5s,r .15s;cursor: pointer}.ag-root.ag-root .ag-pt-dot.is-m{fill: var(--ag-m)}.ag-root.ag-root .ag-pt-dot.is-f{fill: var(--ag-f)}.ag-root.ag-root .ag-pt-dot{stroke: var(--ag-knock);stroke-width: 2px}.ag-root.ag-root .ag-pt-dot.is-on{stroke: var(--ag-ink);stroke-width: 2.5px}.ag-root.ag-root .ag-pt-dim .ag-pt-dot:not(.is-on):not(.is-hit){opacity: .45}.ag-root.ag-root .ag-pt-grid{stroke: var(--ag-grid);stroke-width: 1px}.ag-root.ag-root .ag-pt-zero{stroke: var(--ag-ink);stroke-width: 1.5px}.ag-root.ag-root .ag-pt-tick{fill: var(--ag-ink-3);font-size: 11px;font-family: var(--ag-ui);font-variant-numeric: tabular-nums}.ag-root.ag-root .ag-pt-card{margin-top: 14px;min-height: 88px;padding-top: 14px;border-top: 1px solid var(--ag-grid);display: grid;gap: 8px}.ag-root.ag-root .ag-pt-empty{font-size: 14px;color: var(--ag-ink-3);align-self: center;justify-self: center;text-align: center}.ag-root.ag-root .ag-ex-ctl{display: grid;gap: 10px;margin-top: 16px}.ag-root.ag-root .ag-ex-head{display: grid;grid-template-columns: minmax(0,40%) minmax(0,1fr) 66px;gap: 14px;align-items: end;margin-top: 18px;padding-bottom: 6px;border-bottom: 1px solid var(--ag-grid)}.ag-root.ag-root .ag-ex-legend{display: flex;flex-wrap: wrap;gap: 4px 12px;font-size: 12px;color: var(--ag-ink-2)}.ag-root.ag-root .ag-ex-legend span{display: inline-flex;align-items: center;gap: 5px}.ag-root.ag-root .ag-ex-axis{position: relative;height: 16px;font-size: 11px;color: var(--ag-ink-3);font-variant-numeric: tabular-nums}.ag-root.ag-root .ag-ex-axis span{position: absolute;bottom: 0;transform: translateX(-50%);white-space: nowrap}.ag-root.ag-root .ag-ex-axis span:first-child{transform: none}.ag-root.ag-root .ag-ex-axis span:last-child{transform: translateX(-100%)}.ag-root.ag-root .ag-ex-pcth{font-size: 11px;color: var(--ag-ink-3);text-align: right;line-height: 1.2}.ag-root.ag-root .ag-ex-list{list-style: none}.ag-root.ag-root .ag-ex-row{border-bottom: 1px solid var(--ag-grid)}.ag-root.ag-root .ag-ex-btn{display: grid;grid-template-columns: minmax(0,40%) minmax(0,1fr) 66px;gap: 14px;align-items: center;width: 100%;padding: 7px 0;text-align: left;transition: background .15s}.ag-root.ag-root .ag-ex-btn:hover{background: color-mix(in srgb,var(--ag-card) 70%,transparent)}.ag-root.ag-root .ag-ex-names{display: grid;gap: 1px;font-size: 13px;line-height: 1.3;min-width: 0}.ag-root.ag-root .ag-ex-names span{display: flex;gap: 6px;align-items: baseline;min-width: 0}.ag-root.ag-root .ag-ex-names span>i{overflow: hidden;text-overflow: ellipsis;white-space: nowrap;font-style: normal}.ag-root.ag-root .ag-ex-names .ag-sw{width: 8px;height: 8px;transform: translateY(-1px)}.ag-root.ag-root .ag-ex-names .is-f{color: var(--ag-ink-2)}.ag-root.ag-root .ag-ex-track{position: relative;height: 22px}.ag-root.ag-root .ag-ex-track::before{content: "";position: absolute;left: 0;right: 0;top: 50%;height: 1px;background: var(--ag-track)}.ag-root.ag-root .ag-ex-gl{position: absolute;top: 0;bottom: 0;width: 1px;background: var(--ag-track)}.ag-root.ag-root .ag-ex-bar{position: absolute;top: 50%;height: 3px;margin-top: -1.5px;border-radius: 2px;opacity: .45;transition: left .7s var(--ag-ease),width .7s var(--ag-ease)}.ag-root.ag-root .ag-ex-bar.is-m{background: var(--ag-m)}.ag-root.ag-root .ag-ex-bar.is-f{background: var(--ag-f)}.ag-root.ag-root .ag-ex-dot{position: absolute;top: 50%;width: 13px;height: 13px;margin: -6.5px 0 0 -6.5px;border-radius: 50%;box-shadow: 0 0 0 2px var(--ag-knock);transition: left .7s var(--ag-ease)}.ag-root.ag-root .ag-ex-dot.is-m{background: var(--ag-m)}.ag-root.ag-root .ag-ex-dot.is-f{background: var(--ag-f)}.ag-root.ag-root .ag-ex-pct{text-align: right;font-size: 14px;font-weight: 650;font-variant-numeric: tabular-nums;display: flex;justify-content: flex-end;align-items: center;gap: 5px}.ag-root.ag-root .ag-ex-pct .ag-sw{width: 7px;height: 7px}.ag-root.ag-root .ag-ex-detail{padding: 4px 0 14px;display: grid;gap: 8px;animation: ag-in .35s var(--ag-ease) both}.ag-root.ag-root .ag-cpt{color: var(--ag-ink-3);font-size: 12px;font-weight: 400;margin-left: 6px;white-space: nowrap;font-variant-numeric: tabular-nums}.ag-root.ag-root .ag-flag{font-size: 12px;color: var(--ag-ink-2);border-left: 2px solid var(--ag-grid);padding: 2px 0 2px 10px}.ag-root.ag-root .ag-ex-none{padding: 24px 0;text-align: center;color: var(--ag-ink-3);font-size: 14px}.ag-root.ag-root .ag-ex-row.is-enter{animation: ag-in .45s var(--ag-ease) both}@container ag (max-width: 540px){.ag-root.ag-root .ag-ex-head{grid-template-columns: minmax(0,1fr) 60px}.ag-root.ag-root .ag-ex-head .ag-ex-legend{grid-column: 1 / -1}.ag-root.ag-root .ag-ex-btn{grid-template-columns: minmax(0,1fr) 60px;gap: 4px 12px;padding: 10px 0}.ag-root.ag-root .ag-ex-names{grid-column: 1 / -1}}.ag-root.ag-root .ag-cpt{color: var(--ag-ink-3);font-size: 12px;font-weight: 400;font-style: normal;margin-left: 6px;white-space: nowrap;font-variant-numeric: tabular-nums;letter-spacing: 0}.ag-root.ag-root .ag-cpt-wrap{position: relative;display: inline-block}.ag-root.ag-root .ag-cpt-btn{padding: 2px 0;margin-left: 6px;line-height: 1.2;cursor: help;text-decoration: underline dotted;text-decoration-color: var(--ag-ink-3);text-underline-offset: 3px}.ag-root.ag-root .ag-cpt-btn:hover,.ag-root.ag-root .ag-cpt-wrap.is-open .ag-cpt-btn{color: var(--ag-ink);text-decoration-color: currentColor}.ag-root.ag-root .ag-tip{position: absolute;left: 0;bottom: calc(100% + 6px);z-index: 5;width: max-content;max-width: min(260px,72vw);padding: 8px 10px;border-radius: 6px;background: var(--ag-ink);color: var(--ag-knock);font-size: 13px;font-weight: 500;line-height: 1.35;white-space: normal;text-align: left;box-shadow: 0 4px 14px color-mix(in srgb,var(--ag-ink) 18%,transparent);display: none;pointer-events: none}.ag-root.ag-root .ag-cpt-wrap.is-open .ag-tip{display: block;animation: ag-fade .15s linear both}@keyframes ag-fade{from{opacity: 0}to{opacity: 1}}.ag-root.ag-root .ag-tip-k{display: block;margin-bottom: 2px;font-size: 11px;font-weight: 500;opacity: .7}.ag-root.ag-root .ag-pair{display: grid;gap: 4px}.ag-root.ag-root .ag-pair-row{display: flex;justify-content: space-between;align-items: baseline;gap: 12px}.ag-root.ag-root .ag-pair-name{font-size: 15px;font-weight: 500;line-height: 1.3;min-width: 0}.ag-root.ag-root .ag-pair-val{font-size: 15px;font-weight: 600;white-space: nowrap}.ag-root.ag-root .ag-find{position: relative}.ag-root.ag-root .ag-find svg{position: absolute;left: 0;top: 50%;width: 15px;height: 15px;margin-top: -7.5px;color: var(--ag-ink-3);pointer-events: none}.ag-root.ag-root .ag-find input{display: block;width: 100%;min-height: 40px;padding: 8px 0 8px 24px;border-radius: 0;background: transparent;border-bottom: 1px solid var(--ag-grid);font-size: 16px;color: var(--ag-ink);-webkit-appearance: none;appearance: none;transition: border-color .2s}.ag-root.ag-root .ag-find input:hover{border-bottom-color: var(--ag-ink-3)}.ag-root.ag-root .ag-find input:focus-visible{outline: none;border-bottom-color: var(--ag-ink)}.ag-root.ag-root .ag-find input::placeholder{color: var(--ag-ink-3);opacity: 1}.ag-root.ag-root .ag-find input::-webkit-search-cancel-button{-webkit-appearance: none}.ag-root.ag-root.ag-root .ag-q-btn{min-height: 42px;padding: 10px 20px;border-radius: var(--ag-r);background: transparent;color: var(--ag-ink);box-shadow: inset 0 0 0 1px var(--ag-ink);font-size: 15px;font-weight: 500;transition: background-color .2s,color .2s,transform .15s}.ag-root.ag-root.ag-root .ag-q-btn:hover{background: var(--ag-ink);color: var(--ag-knock)}.ag-root.ag-root .ag-pt-find{margin-top: 10px;max-width: 340px}.ag-root.ag-root .ag-pt-hits{list-style: none;margin-top: 6px;display: grid;gap: 0}.ag-root.ag-root .ag-pt-hits:empty{display: none}.ag-root.ag-root .ag-pt-hit{display: block;width: 100%;padding: 6px 0;text-align: left;font-size: 14px;font-weight: 500;line-height: 1.3}.ag-root.ag-root .ag-pt-hit:hover{text-decoration: underline;text-underline-offset: 3px;text-decoration-color: var(--ag-grid)}.ag-root.ag-root .ag-pt-none{padding: 6px 0;font-size: 13px;color: var(--ag-ink-3)}.ag-root.ag-root .ag-pt-finding .ag-pt-dot:not(.is-hit):not(.is-on){opacity: .15}.ag-root.ag-root .ag-pt-dot.is-hit{stroke: var(--ag-ink);stroke-width: 2px}.ag-root.ag-root .ag-pt-cap{margin-top: 6px}.ag-root.ag-root .ag-pt-cap>span{display: inline-flex;align-items: baseline;gap: 5px;font-weight: 500;white-space: nowrap}@container ag (max-width: 340px){.ag-root.ag-root .ag-pt-cap{font-size: 11px;gap: 6px}.ag-root.ag-root .ag-pt-cap>span{gap: 3px}}.ag-root.ag-root .ag-arrow{font-weight: 400;color: var(--ag-ink-3)}.ag-root.ag-root .ag-pt-card{margin-top: 12px;min-height: 0;padding-top: 12px;border-top: 1px solid var(--ag-grid);display: grid;gap: 8px}.ag-root.ag-root .ag-pt-empty{font-size: 14px;color: var(--ag-ink-3)}.ag-root.ag-root .ag-ex-ctl{display: flex;flex-wrap: wrap;gap: 12px 32px;align-items: end;margin-top: 16px}.ag-root.ag-root .ag-ex-ctl .ag-find{flex: 1 1 220px}.ag-root.ag-root .ag-ex-sels{display: flex;gap: 20px;flex-wrap: wrap}.ag-root.ag-root .ag-mini{display: grid;gap: 2px}.ag-root.ag-root .ag-mini-k{font-size: 12px;color: var(--ag-ink-3)}.ag-root.ag-root .ag-mini-v{position: relative;display: block}.ag-root.ag-root .ag-mini-v::after{content: "";position: absolute;right: 2px;top: 50%;width: 6px;height: 6px;margin-top: -5px;border-right: 1.5px solid var(--ag-ink-2);border-bottom: 1.5px solid var(--ag-ink-2);transform: rotate(45deg);pointer-events: none}.ag-root.ag-root .ag-mini-sel{display: block;min-height: 40px;padding: 8px 20px 8px 0;background: transparent;border-bottom: 1px solid var(--ag-grid);font-size: 15px;font-weight: 500;color: var(--ag-ink);-webkit-appearance: none;appearance: none;cursor: pointer;border-radius: 0}.ag-root.ag-root .ag-mini-sel:hover{border-bottom-color: var(--ag-ink-3)}.ag-root.ag-root .ag-mini-sel:focus-visible{outline: none;border-bottom-color: var(--ag-ink)}.ag-root.ag-root .ag-ex-head{margin-top: 24px}.ag-root.ag-root .ag-ex-names .ag-ex-n{overflow: hidden;text-overflow: ellipsis;white-space: nowrap;font-style: normal;min-width: 0}.ag-root.ag-root .ag-ex-names .ag-cpt{margin-left: 0;flex: none;font-size: 11px}.ag-root.ag-root .ag-ex-names .is-f{color: inherit}.ag-root.ag-root .ag-ex-pct{font-weight: 600}.ag-root.ag-root .ag-ex-detail{padding: 4px 0 12px;gap: 8px}.ag-root.ag-root .ag-ex-detail .ag-pair-name,.ag-root.ag-root .ag-ex-detail .ag-pair-val{font-size: 15px}.ag-root.ag-root .ag-ex-pager{display: flex;justify-content: space-between;align-items: center;gap: 12px;margin-top: 8px}.ag-root.ag-root .ag-ex-count{font-size: 13px;color: var(--ag-ink-3);font-variant-numeric: tabular-nums}.ag-root.ag-root .ag-ex-pbtns{display: flex;gap: 8px}.ag-root.ag-root .ag-icon-btn[disabled]{opacity: .3;cursor: default}@container ag (max-width: 480px){.ag-root.ag-root .ag-ex-sels{width: 100%}.ag-root.ag-root .ag-ex-sels .ag-mini{flex: 1 1 0;min-width: 0}.ag-root.ag-root .ag-mini-sel{width: 100%}}.ag-root.ag-root .ag-stat{display: block;text-wrap: pretty}.ag-root.ag-root .ag-stat-num{font-family: var(--ag-head);font-weight: 600;font-size: 30px;line-height: 1.05;letter-spacing: -0.025em;font-variant-numeric: tabular-nums;color: var(--ag-ink);margin-right: 8px}.ag-root.ag-root .ag-stat-cap{font-size: 15px;font-weight: 500;line-height: 1.35;color: var(--ag-ink-2)}.ag-root.ag-root .ag-stat-cap span{white-space: nowrap}.ag-root.ag-root .ag-stat-num.ag-ink-m{color: var(--ag-m-ink)}.ag-root.ag-root .ag-stat-num.ag-ink-f{color: var(--ag-f-ink)}.ag-root.ag-root .ag-stat.is-small .ag-stat-num{font-size: 24px}.ag-root.ag-root .ag-stat.is-small .ag-stat-cap{font-size: 14px}.ag-root.ag-root .ag-mu-ctl{display: flex;gap: 6px;align-items: stretch;margin-top: 14px}.ag-root.ag-root .ag-select-wrap{position: relative;flex: 1 1 auto;min-width: 0}.ag-root.ag-root .ag-select{display: block;-webkit-appearance: none;appearance: none;cursor: pointer;font-size: 16px}.ag-root.ag-root .ag-select-wrap .ag-select{position: absolute;inset: 0;width: 100%;height: 100%;opacity: 0;min-height: 0}.ag-root.ag-root .ag-select-face{display: flex;align-items: center;min-height: 40px;height: 100%;padding: 6px 34px 6px 12px;border-radius: var(--ag-r);background: transparent;box-shadow: inset 0 0 0 1px var(--ag-grid);transition: box-shadow .2s;font-size: 15px;font-weight: 500;line-height: 1.3}.ag-root.ag-root .ag-select-wrap:hover .ag-select-face{box-shadow: inset 0 0 0 1px var(--ag-ink-3)}.ag-root.ag-root .ag-select-wrap:has(.ag-select:focus-visible) .ag-select-face{outline: 2px solid var(--ag-focus);outline-offset: 2px}.ag-root.ag-root .ag-select-wrap::after{content: "";position: absolute;right: 14px;top: 50%;width: 6px;height: 6px;margin-top: -5px;border-right: 1.5px solid var(--ag-ink-2);border-bottom: 1.5px solid var(--ag-ink-2);transform: rotate(45deg);pointer-events: none}.ag-root.ag-root .ag-mu-ctl .ag-icon-btn{width: 40px;height: auto;min-height: 40px}.ag-root.ag-root .ag-mu-ctl .ag-icon-btn svg{width: 14px;height: 14px}.ag-root.ag-root .ag-mu-sum{margin-top: 14px}@container ag (max-width: 480px){.ag-root.ag-root .ag-mu-ctl{gap: 4px}.ag-root.ag-root .ag-mu-ctl .ag-icon-btn{width: 32px}.ag-root.ag-root .ag-select-face{font-size: 14px;padding-left: 10px;padding-right: 28px}.ag-root.ag-root .ag-select-wrap::after{right: 11px}}.ag-root.ag-root .ag-mu-strip-wrap{margin-top: 12px}.ag-root.ag-root .ag-mu-strip-lab{font-size: 13px;color: var(--ag-ink-3)}.ag-root.ag-root .ag-mu-strip{position: relative;height: 48px;margin-top: 2px}.ag-root.ag-root .ag-mu-strip::before{content: "";position: absolute;left: 0;right: 0;top: 31px;height: 1px;background: var(--ag-grid)}.ag-root.ag-root .ag-mu-zero{position: absolute;top: 15px;bottom: 0;width: 0;border-left: 1.5px dashed var(--ag-ink-2);margin-left: -0.75px}.ag-root.ag-root .ag-mu-zero-lab{position: absolute;top: 0;transform: translateX(-50%);font-size: 11px;font-weight: 500;line-height: 1;color: var(--ag-ink-2);white-space: nowrap}.ag-root.ag-root .ag-mu-tick{position: absolute;top: 23px;width: 2px;height: 16px;margin-left: -1px;padding: 0;border-radius: 1px;opacity: .45;transition: height .25s var(--ag-ease),top .25s var(--ag-ease),width .25s var(--ag-ease),opacity .2s}.ag-root.ag-root .ag-mu-tick.is-m{background: var(--ag-m)}.ag-root.ag-root .ag-mu-tick.is-f{background: var(--ag-f)}.ag-root.ag-root .ag-mu-tick::after{content: "";position: absolute;inset: -8px -3px}.ag-root.ag-root .ag-mu-tick:hover{opacity: .9}.ag-root.ag-root .ag-mu-tick.is-on{opacity: 1;top: 16px;height: 30px;width: 4px;margin-left: -2px;box-shadow: 0 0 0 2px var(--ag-knock);z-index: 2}.ag-root.ag-root .ag-mu-pair{margin-top: 14px;padding-top: 12px;border-top: 1px solid var(--ag-grid);display: grid;gap: 10px}.ag-root.ag-root .ag-mu-side{display: grid;gap: 4px}.ag-root.ag-root .ag-mu-line{display: flex;justify-content: space-between;align-items: baseline;gap: 12px}.ag-root.ag-root .ag-mu-name{font-size: 15px;font-weight: 500;line-height: 1.3;min-width: 0}.ag-root.ag-root .ag-mu-val{font-size: 15px;font-weight: 600;white-space: nowrap}.ag-root.ag-root .ag-mu-pair .ag-bar-track{height: 12px}.ag-root.ag-root .ag-q-prog{display: block;margin: 0 0 8px;font-size: 12px;font-weight: 500;color: var(--ag-ink-3)}.ag-root.ag-root .ag-q-lab{display: inline-flex;align-items: baseline;flex-wrap: wrap;font-size: 15px;font-weight: 500;line-height: 1.3}.ag-root.ag-root .ag-q-row-hd b{font-weight: 600}.ag-root.ag-root .ag-q-foot{display: flex;flex-wrap: wrap;align-items: center;justify-content: space-between;gap: 10px 16px;margin-top: 6px}.ag-root.ag-root .ag-q-foot.is-result{margin-top: 26px}.ag-root.ag-root .ag-q-endline{font-size: 17px;font-weight: 500;line-height: 1.35;color: var(--ag-ink);text-wrap: pretty}.ag-root.ag-root .ag-q-endnum{font-family: var(--ag-head);font-weight: 600;font-size: 30px;letter-spacing: -0.025em}.ag-root.ag-root .ag-q-hint{display: flex;flex-wrap: wrap;align-items: center;gap: 4px;font-size: 12px;color: var(--ag-ink-3)}.ag-root.ag-root .ag-q-ring{display: inline-block;width: 10px;height: 10px;border-radius: 50%;box-shadow: inset 0 0 0 2px var(--ag-ink-2)}.ag-root.ag-root .ag-q-cta{display: flex;flex-wrap: wrap;align-items: center;gap: 10px 18px;margin-top: 12px}.ag-root.ag-root .ag-q-link{font-size: 15px;font-weight: 500;color: var(--ag-ink);text-decoration: underline;text-decoration-color: var(--ag-grid);text-underline-offset: 4px}.ag-root.ag-root .ag-q-link:hover{text-decoration-color: currentColor}.ag-root.ag-root{--ag-ui: "Geist","Helvetica Neue",Arial,sans-serif;--ag-head-weight: 600;--ag-head-track: -0.02em;--ag-r: 8px}.ag-root.ag-root[data-ag-mode="light"]{--ag-card: #f3f3f6;--ag-grid: #e2e2e8;--ag-track: #ececf1}@media (prefers-color-scheme: light){.ag-root.ag-root[data-ag-mode="auto"]{--ag-card: #f3f3f6;--ag-grid: #e2e2e8;--ag-track: #ececf1}}.ag-root.ag-root[data-ag-style="editorial"]{--ag-head-weight: 700}.ag-root.ag-root[data-ag-style="feature"]{--ag-head-weight: 700}.ag-root.ag-root.ag-root{font-family: var(--ag-ui)}.ag-root.ag-root.ag-root .ag-hed{letter-spacing: var(--ag-head-track)}.ag-root.ag-root.ag-root .ag-mu-name{font-weight: 500}.ag-root.ag-root.ag-root .ag-q-row-hd b,.ag-root.ag-root.ag-root .ag-mu-val,.ag-root.ag-root.ag-root .ag-pair-val,.ag-root.ag-root.ag-root .ag-ex-pct{font-weight: 600}.ag-root.ag-root.ag-root .ag-dek{text-wrap: pretty}.ag-root.ag-root.ag-root .ag-btn,.ag-root.ag-root.ag-root .ag-icon-btn,.ag-root.ag-root.ag-root .ag-select-face{border-radius: var(--ag-r)}.ag-root.ag-root.ag-root .ag-bar{border-radius: 0 2px 2px 0}.ag-root.ag-root.ag-root .ag-btn{font-weight: 600}.ag-root.ag-root.ag-root .ag-btn{transition: transform .15s var(--ag-ease),background-color .2s}.ag-root.ag-root.ag-root .ag-btn:hover{opacity: 1;background: color-mix(in srgb,var(--ag-ink) 82%,var(--ag-knock))}.ag-root.ag-root.ag-root .ag-btn:active,.ag-root.ag-root.ag-root .ag-icon-btn:active{transform: translateY(1px)}.ag-root.ag-root.ag-root .ag-icon-btn{transition: box-shadow .2s,background-color .2s,transform .15s}.ag-root.ag-root.ag-root .ag-icon-btn:hover{background: var(--ag-card)}.ag-root.ag-root.ag-root .ag-btn-ghost{background: none;box-shadow: none;padding-left: 4px;padding-right: 4px;font-weight: 500;text-decoration: underline;text-decoration-color: var(--ag-grid);text-underline-offset: 4px}.ag-root.ag-root.ag-root .ag-btn-ghost:hover{background: none;text-decoration-color: currentColor}.ag-root.ag-root.ag-root .ag-q-prog span{margin-left: 0;font-weight: 500}.ag-root.ag-root.ag-root .ag-q-mini{background: none;height: 12px}.ag-root.ag-root.ag-root .ag-q-mini::before{content: "";position: absolute;left: 0;right: 0;top: 50%;height: 1px;background: var(--ag-grid)}.ag-root.ag-root.ag-root .ag-q-mini i{top: 0}.ag-root.ag-root.ag-root .ag-range::-webkit-slider-thumb{box-shadow: 0 1px 3px color-mix(in srgb,var(--ag-ink) 22%,transparent)}.ag-root.ag-root.ag-root .ag-range::-moz-range-thumb{box-shadow: 0 1px 3px color-mix(in srgb,var(--ag-ink) 22%,transparent)}@media (prefers-reduced-motion: reduce){.ag-root.ag-root *,.ag-root.ag-root *::before,.ag-root.ag-root *::after{transition: none !important;animation: none !important}} (window.AG = window.AG || {}).data = [{"id":1,"cat":"Biopsies & lesions","mName":"Biopsy penis","mCpt":"54100","m":121.32,"fName":"Biopsy vagina","fCpt":"57100","f":65.74,"pct":59.42},{"id":2,"cat":"Biopsies & lesions","mName":"Remove penis lesion","mCpt":"54110","m":624.88,"fName":"Remove vaginal lesion","fCpt":"57135","f":191.8,"pct":106.06},{"id":3,"cat":"Biopsies & lesions","mName":"Biopsy scrotum","mCpt":"55120","m":356.83,"fName":"Biopsy vulva","fCpt":"56605","f":59.98,"pct":142.44},{"id":4,"cat":"Biopsies & lesions","mName":"Biopsy prostate","mCpt":"55705","m":265.34,"fName":"Biopsy endometrium","fCpt":"58110","f":40.33,"pct":147.22},{"id":5,"cat":"Biopsies & lesions","mName":"Removal of scrotal lesion","mCpt":"55120","m":356.83,"fName":"Removal of vulvar lesion","fCpt":"56440","f":184.01,"pct":63.91},{"id":6,"cat":"Biopsies & lesions","mName":"Excision penile lesion","mCpt":"54115","m":428.0,"fName":"Excision vaginal lesion","fCpt":"57100","f":65.74,"pct":146.74},{"id":7,"cat":"Biopsies & lesions","mName":"Laser penis","mCpt":"54057","m":98.95,"fName":"Laser vulva","fCpt":"56501","f":136.57,"pct":-31.95},{"id":8,"cat":"Genitals & other","mName":"Distal hypospadias repair","mCpt":"54328","m":934.61,"fName":"Revision of cervix","fCpt":"57700","f":365.3,"pct":87.59},{"id":9,"cat":"Biopsies & lesions","mName":"Destruction penile lesions simple","mCpt":"54050","m":108.1,"fName":"Destruction vulvar lesions simple","fCpt":"56501","f":136.57,"pct":-23.27},{"id":10,"cat":"Genitals & other","mName":"Resection of scrotum","mCpt":"55150","m":496.11,"fName":"Simple complete vulvectomy","fCpt":"56620","f":598.11,"pct":-18.64},{"id":11,"cat":"Genitals & other","mName":"Revision of scrotum","mCpt":"55180","m":690.96,"fName":"Extensive vulva surgery (partial radical)","fCpt":"56630","f":976.63,"pct":-34.26},{"id":12,"cat":"Genitals & other","mName":"Drain prostate abscess","mCpt":"52700","m":443.92,"fName":"Drain ovarian abscess open","fCpt":"58820","f":347.01,"pct":24.51},{"id":13,"cat":"Genitals & other","mName":"Excision hydrocele","mCpt":"55040","m":339.89,"fName":"Excision Bartholins gland","fCpt":"56740","f":321.25,"pct":5.64},{"id":14,"cat":"Genitals & other","mName":"Penis/scrotoplasty","mCpt":"54360","m":721.8,"fName":"Perineoplasty","fCpt":"56810","f":276.86,"pct":89.11},{"id":15,"cat":"Genitals & other","mName":"Excision of sperm cord lesion","mCpt":"55520","m":465.95,"fName":"Excision of Bartholins","fCpt":"56740","f":321.25,"pct":36.76},{"id":16,"cat":"Prostate & uterus","mName":"Interstitial prostate","mCpt":"55875","m":780.08,"fName":"Interstitial cervix","fCpt":"55920","f":463.24,"pct":50.97},{"id":17,"cat":"Urinary tract","mName":"Insert tandem male","mCpt":"53444","m":792.62,"fName":"Insert tandem female","fCpt":"57155","f":286.01,"pct":93.94},{"id":18,"cat":"Urinary tract","mName":"Reconstruction of male urethra","mCpt":"54352","m":1408.35,"fName":"Reconstruction of female urethra","fCpt":"53430","f":975.27,"pct":36.34},{"id":19,"cat":"Urinary tract","mName":"Revise remove sling male","mCpt":"53448","m":1271.79,"fName":"Revise remove sling female","fCpt":"57287","f":754.33,"pct":51.08},{"id":20,"cat":"Urinary tract","mName":"Male sling insert uro/neck sph","mCpt":"53445","m":757.72,"fName":"Female insert mesh pelvic floor add on","fCpt":"57267","f":252.12,"pct":100.13},{"id":21,"cat":"Urinary tract","mName":"Reconstruct urethra male","mCpt":"53415","m":1126.07,"fName":"Revise urethra female","fCpt":"57220","f":353.11,"pct":104.51},{"id":22,"cat":"Urinary tract","mName":"Total urethrectomy male","mCpt":"53215","m":926.14,"fName":"Total urethrectomy female","fCpt":"53210","f":776.7,"pct":17.55},{"id":23,"cat":"Genitals & other","mName":"Partial removal of penis","mCpt":"54120","m":633.01,"fName":"Partial vaginectomy","fCpt":"57106","f":546.94,"pct":14.59},{"id":24,"cat":"Genitals & other","mName":"Removal of penis","mCpt":"54125","m":825.49,"fName":"Complete vaginectomy","fCpt":"57110","f":919.02,"pct":-10.72},{"id":25,"cat":"Genitals & other","mName":"Exploratory laparotomy male","mCpt":"49000","m":778.05,"fName":"Exploratory laparotomy female","fCpt":"58960","f":1009.84,"pct":-25.93},{"id":26,"cat":"Testes & ovaries","mName":"Excise lesion testis","mCpt":"54512","m":538.47,"fName":"Ovarian cystectomy","fCpt":"58925","f":781.44,"pct":-36.82},{"id":27,"cat":"Testes & ovaries","mName":"Removal of testis","mCpt":"54530","m":511.02,"fName":"Oophorectomy","fCpt":"58940","f":567.27,"pct":-10.43},{"id":28,"cat":"Testes & ovaries","mName":"Suspension/relocation of testes","mCpt":"54680","m":787.54,"fName":"Ovarian transposition","fCpt":"58825","f":722.81,"pct":8.57},{"id":29,"cat":"Testes & ovaries","mName":"Laparoscopic orchiectomy","mCpt":"54690","m":655.38,"fName":"Laparoscopic BSO","fCpt":"58661","f":662.83,"pct":-1.13},{"id":30,"cat":"Testes & ovaries","mName":"Laparoscopic orchiopexy","mCpt":"54692","m":755.01,"fName":"Laparoscopic ovarian transposition","fCpt":"58825","f":722.81,"pct":4.36},{"id":31,"cat":"Testes & ovaries","mName":"Removal of epididymis","mCpt":"54861","m":569.64,"fName":"Removal of fallopian tubes","fCpt":"58700","f":814.31,"pct":-35.36},{"id":32,"cat":"Testes & ovaries","mName":"Vas deferens vasectomy","mCpt":"55250","m":230.43,"fName":"Essure hysteroscopy","fCpt":"58565","f":466.97,"pct":-67.83},{"id":33,"cat":"Testes & ovaries","mName":"Orchiectomy with staging","mCpt":"54530 + 38770","m":1320.25,"fName":"Oophorectomy with staging","fCpt":"58950","f":1169.79,"pct":12.08},{"id":34,"cat":"Testes & ovaries","mName":"Extensive testis surgery","mCpt":"54535","m":744.5,"fName":"Removal of ovaries extensive","fCpt":"58943","f":1188.42,"pct":-45.93},{"id":35,"cat":"Testes & ovaries","mName":"Reduce testis torsion","mCpt":"54600","m":454.43,"fName":"Reduce ovarian torsion","fCpt":"58920","f":728.24,"pct":-46.3},{"id":36,"cat":"Genitals & other","mName":"Remove penis and LN","mCpt":"54135","m":1503.24,"fName":"Vaginectomy and LN","fCpt":"57109","f":1751.97,"pct":-15.28},{"id":37,"cat":"Testes & ovaries","mName":"Revise vas deferens/spermatic ducts","mCpt":"54901","m":1056.94,"fName":"Revise fallopian tubes","fCpt":"58740","f":917.67,"pct":14.11},{"id":38,"cat":"Prostate & uterus","mName":"TURP","mCpt":"52601","m":727.22,"fName":"Hysteroscopic myomectomy","fCpt":"58561","f":360.9,"pct":67.33},{"id":39,"cat":"Prostate & uterus","mName":"Remove prostate","mCpt":"55801","m":1093.2,"fName":"Hysterectomy","fCpt":"58150","f":1028.82,"pct":6.07},{"id":40,"cat":"Prostate & uterus","mName":"Extensive prostate surgery","mCpt":"55845","m":1355.49,"fName":"Extensive TAH","fCpt":"58285","f":1440.21,"pct":-6.06},{"id":41,"cat":"Prostate & uterus","mName":"Subtotal prostatectomy","mCpt":"55821","m":837.69,"fName":"Abdominal trachelectomy","fCpt":"57530","f":381.57,"pct":74.82},{"id":42,"cat":"Prostate & uterus","mName":"Prostatectomy","mCpt":"55840","m":1165.38,"fName":"TAH","fCpt":"58150","f":1028.82,"pct":12.45},{"id":43,"cat":"Prostate & uterus","mName":"Prostatectomy LND","mCpt":"55845","m":1355.49,"fName":"TAH BSO LND","fCpt":"58200","f":1362.6,"pct":-0.52},{"id":44,"cat":"Prostate & uterus","mName":"Perineal approach prostatectomy","mCpt":"55815","m":1751.97,"fName":"Radical vaginal hysterectomy","fCpt":"58285","f":1440.21,"pct":19.53},{"id":45,"cat":"Prostate & uterus","mName":"Radical prostatectomy perineal approach","mCpt":"55810","m":1301.27,"fName":"Radical vaginal hysterectomy","fCpt":"58285","f":1440.21,"pct":-10.14},{"id":46,"cat":"Urinary tract","mName":"Removal of bladder and LN","mCpt":"51575","m":1809.92,"fName":"Anterior exenteration (no code for anterior only)","fCpt":"58240","f":2967.84,"pct":-48.47},{"id":47,"cat":"Urinary tract","mName":"Cystectomy complete with conduit","mCpt":"51596","m":2344.32,"fName":"Pelvic exenteration","fCpt":"58240","f":2967.84,"pct":-23.48},{"id":48,"cat":"Biopsies & lesions","mName":"Biopsy penis","mCpt":"54100","m":121.32,"fName":"Biopsy vulva","fCpt":"56605","f":59.98,"pct":67.67},{"id":49,"cat":"Biopsies & lesions","mName":"Biopsy prostate","mCpt":"55700","m":129.11,"fName":"Biopsy endometrium","fCpt":"58100","f":63.71,"pct":67.84},{"id":50,"cat":"Biopsies & lesions","mName":"Destruction penile lesions extensive","mCpt":"54065","m":172.83,"fName":"Destruction vulvar lesions extensive","fCpt":"56515","f":216.88,"pct":-22.61},{"id":51,"cat":"Prostate & uterus","mName":"TURP","mCpt":"52601","m":727.22,"fName":"Hysteroscopy","fCpt":"58558","f":233.48,"pct":102.79},{"id":52,"cat":"Genitals & other","mName":"Drain prostate abscess","mCpt":"55720","m":453.07,"fName":"Drain ovarian abscess","fCpt":"58820","f":347.01,"pct":26.51},{"id":53,"cat":"Genitals & other","mName":"Excision varicocele","mCpt":"55530","m":354.12,"fName":"Excision Bartholins","fCpt":"56740","f":321.25,"pct":9.73},{"id":54,"cat":"Genitals & other","mName":"Excision hydrocele","mCpt":"55500","m":395.8,"fName":"Excision Bartholins","fCpt":"56740","f":321.25,"pct":20.79},{"id":55,"cat":"Genitals & other","mName":"Scrotoplasty","mCpt":"55175","m":367.68,"fName":"Perineoplasty","fCpt":"56810","f":276.86,"pct":28.18}]; window.AG.copy = {"shared":{"method":"Percent difference is the gap between the two payments divided by their average. Because neither the male nor female procedure serves as the baseline to compare against, the average is used, yielding a single figure for each pair. Negative values mean the procedure on women pays more.","source":"Source: Penn et al., Journal of Women\u2019s Health (2025), Table 3.","credit":"Graphic: Anusha Subramanian/Vox","logoLabel":"Vox","aboutButton":"About the data","about1":"Amounts are Medicare\u2019s 2023 national reimbursement rates when the procedure is done in a hospital or surgical center.","about2":"Researchers matched each procedure on male anatomy with a comparable one on female anatomy. Some procedures appear in more than one pair. CPT codes are the billing codes listed in the study. Look any code up in Medicare\u2019s Physician Fee Schedule tool.","difference":"pay difference","srHigherMale":"higher for the male procedure","srHigherFemale":"higher for the female procedure","paysMoreFemale":"Pays more for female","paysMoreMale":"Pays more for male","noMatches":"No matching procedures","cptPrefix":"CPT"},"pattern":{"hed":"Medicare often reimburses more for procedures on men","dek":"Percent difference in 2023 Medicare reimbursement rates among pairs of comparable male and female procedures. Each dot is one pair.","findPlaceholder":"Find a procedure or code","emptyCard":"Tap or hover over a dot to see the pair","moreHits":"and {n} more, highlighted on the chart"},"quiz":{"hed":"Can you guess what Medicare pays?","dek":"Drag the slider to estimate what Medicare pays for the second procedure.","round":"Round {i} of {n}","submit":"Submit","next":"Next pair","seeResult":"See the result","yourGuess":"Your guess {amount}","endLede":"{n} of {total}","endText":"matched pairs pay the surgeon more for the procedure on male anatomy.","legendMale":"Male","legendFemale":"Female","legendGuess":"Your guess","playAgain":"Play again with new pairs","seeAll":"See all 55 pairs"},"matchup":{"hed":"Similar procedures, different pay","dek":"What Medicare paid a surgeon for matched procedures in 2023","stripLabel":"Where this pair falls among all 55","noDifference":"No difference"},"explorer":{"hed":"Every matched pair, side by side","dek":"What Medicare paid a surgeon for each procedure in 2023","searchPlaceholder":"Search a procedure or code","legendMale":"Male procedure","legendFemale":"Female procedure","pctHeader":"% diff.","count":"{from}\u2013{to} of {n} pairs","countFiltered":"{from}\u2013{to} of {n} matching pairs","sortGap":"Sorted by largest difference","sortStudy":"Sorted in the study\u2019s order","sortPay":"Sorted by highest payment","essureFlag":"Essure was taken off the U.S. market in 2018."}}; (function () { var AG = (window.AG = window.AG || {}); AG.components = AG.components || {}; if (AG.__core) return; AG.__core = true; AG.CATEGORIES = ["Biopsies & lesions", "Testes & ovaries", "Prostate & uterus", "Urinary tract", "Genitals & other"]; var P = function (d) { return ''; }; AG.icons = { prev: P("M168.49,199.51a12,12,0,0,1-17,17l-80-80a12,12,0,0,1,0-17l80-80a12,12,0,0,1,17,17L97,128Z"), next: P("M184.49,136.49l-80,80a12,12,0,0,1-17-17L159,128,87.51,56.49a12,12,0,1,1,17-17l80,80A12,12,0,0,1,184.49,136.49Z"), shuffle: P("M240.49,175.51a12,12,0,0,1,0,17l-24,24a12,12,0,0,1-17-17L203,196h-2.09a76.17,76.17,0,0,1-61.85-31.83L97.38,105.78A52.1,52.1,0,0,0,55.06,84H32a12,12,0,0,1,0-24H55.06a76.17,76.17,0,0,1,61.85,31.83l41.71,58.39A52.1,52.1,0,0,0,200.94,172H203l-3.52-3.51a12,12,0,0,1,17-17Zm-95.62-72.62a12,12,0,0,0,16.93-1.13A52,52,0,0,1,200.94,84H203l-3.52,3.51a12,12,0,0,0,17,17l24-24a12,12,0,0,0,0-17l-24-24a12,12,0,0,0-17,17L203,60h-2.09a76,76,0,0,0-57.2,26A12,12,0,0,0,144.87,102.89Zm-33.74,50.22a12,12,0,0,0-16.93,1.13A52,52,0,0,1,55.06,172H32a12,12,0,0,0,0,24H55.06a76,76,0,0,0,57.2-26A12,12,0,0,0,111.13,153.11Z"), search: P("M232.49,215.51,185,168a92.12,92.12,0,1,0-17,17l47.53,47.54a12,12,0,0,0,17-17ZM44,112a68,68,0,1,1,68,68A68.07,68.07,0,0,1,44,112Z") }; AG.pairSep = " vs. "; AG.reduced = function () { return !!(window.matchMedia && window.matchMedia("(prefers-reduced-motion: reduce)").matches); }; AG.h = function (tag, attrs, kids) { var svg = /^(svg|g|circle|line|text|path|rect|tspan)$/.test(tag); var el = svg ? document.createElementNS("http://www.w3.org/2000/svg", tag) : document.createElement(tag); attrs = attrs || {}; for (var k in attrs) { var v = attrs[k]; if (v == null || v === false) continue; if (k === "text") el.textContent = v; else if (k === "html") el.innerHTML = v; else if (k.slice(0, 2) === "on") el.addEventListener(k.slice(2), v); else if (k === "class" && svg) el.setAttribute("class", v); else if (k === "class") el.className = v; else el.setAttribute(k, v === true ? "" : v); } (kids || []).forEach(function (c) { if (c == null || c === false) return; el.appendChild(typeof c === "string" ? document.createTextNode(c) : c); }); return el; }; AG.money = function (v, opts) { var round = opts && opts.round; return v.toLocaleString("en-US", { style: "currency", currency: "USD", minimumFractionDigits: round ? 0 : 2, maximumFractionDigits: round ? 0 : 2 }); }; AG.pct = function (p) { var a = Math.abs(p); return (a >= 10 ? a.toFixed(0) : a.toFixed(1)) + "%"; }; AG.pctExact = function (p) { return (p 0 ? "m" : "f"; }; AG.byId = function (id) { for (var i = 0; i 0 ? "higher for the male procedure" : "higher for the female procedure"; }; AG.t = function (key, vars) { var parts = key.split("."), v = AG.copy || {}; for (var i = 0; i < parts.length && v != null; i++) v = v[parts[i]]; if (typeof v !== "string") v = key; return v.replace(/\{(\w+)\}/g, function (m, k) { return vars && k in vars ? vars[k] : m; }); }; AG.tx = function (tag, key, attrs, vars) { var el = AG.h(tag, attrs || {}); var s = AG.t(key, vars); if (/ rr.right) dx = rr.right - tr.right; if (tr.left + dx < rr.left) dx = rr.left - tr.left; tip.style.transform = "translateX(" + Math.round(dx) + "px)"; } var openedAt = 0; function show(on) { if (on && !wrap.classList.contains("is-open")) openedAt = Date.now(); wrap.classList.toggle("is-open", on); btn.setAttribute("aria-expanded", String(on)); if (on) place(); } btn.addEventListener("mouseenter", function () { show(true); }); wrap.addEventListener("mouseleave", function () { show(false); }); btn.addEventListener("focus", function () { show(true); }); btn.addEventListener("blur", function () { show(false); }); btn.addEventListener("click", function (e) { e.stopPropagation(); var open = wrap.classList.contains("is-open"); show(!open || Date.now() - openedAt < 400); }); btn.addEventListener("keydown", function (e) { if (e.key === "Escape") show(false); }); return wrap; }; AG.pairRows = function (d) { var h = AG.h; return h("div", { class: "ag-pair" }, [["m", d.mName, d.mCpt, d.m], ["f", d.fName, d.fCpt, d.f]].map(function (x) { return h("div", { class: "ag-pair-row" }, [ h("p", { class: "ag-pair-name" }, [h("span", { class: "ag-ink-" + x[0], text: x[1] }), AG.cpt(x[2])]), h("p", { class: "ag-num ag-pair-val", text: AG.money(x[3]) }) ]); })); }; document.addEventListener("click", function () { var open = document.querySelectorAll(".ag-cpt-wrap.is-open"); for (var i = 0; i < open.length; i++) { open[i].classList.remove("is-open"); open[i].firstChild.setAttribute("aria-expanded", "false"); } }); AG.stat = function (d, opts) { var h = AG.h, s = AG.side(d); var num = opts && opts.exact ? AG.pctExact(d.pct).replace("\u2212", "") : AG.pct(d.pct); return h("p", { class: "ag-stat" + (opts && opts.small ? " is-small" : "") }, [ h("span", { class: "ag-stat-num", text: num }), AG.tx("span", "shared.difference", { class: "ag-stat-cap" }), h("span", { class: "ag-sr", text: " (" + AG.t(s === "m" ? "shared.srHigherMale" : "shared.srHigherFemale") + ")" }) ]); }; AG.onVisible = function (el, fn) { if (!("IntersectionObserver" in window)) return fn(); var io = new IntersectionObserver(function (es) { if (es.some(function (e) { return e.isIntersecting; })) { io.disconnect(); fn(); } }, { threshold: 0.2 }); io.observe(el); }; AG.axisEnds = function (extraClass) { var h = AG.h; return h("div", { class: "ag-axis-cap " + (extraClass || "") }, [ h("span", { class: "ag-ink-f" }, [h("span", { class: "ag-arrow", "aria-hidden": "true", text: "\u2190" }), AG.tx("span", "shared.paysMoreFemale")]), h("span", { class: "ag-ink-m" }, [AG.tx("span", "shared.paysMoreMale"), h("span", { class: "ag-arrow", "aria-hidden": "true", text: "\u2192" })]) ]); }; AG.header = function (o) { return AG.h("div", { class: "ag-hd" }, [ AG.tx("h2", o.hed, { class: "ag-hed" }), o.dek ? AG.tx("p", o.dek, { class: "ag-dek" }) : null ]); }; AG.footer = function () { var h = AG.h; var about = h("div", { class: "ag-about", hidden: true, id: "ag-about-" + Math.random().toString(36).slice(2, 8) }, [ AG.tx("p", "shared.about1"), AG.tx("p", "shared.about2") ]); var btn = AG.tx("button", "shared.aboutButton", { class: "ag-about-btn", type: "button", "aria-expanded": "false", "aria-controls": about.id }); btn.addEventListener("click", function () { var open = about.hidden; about.hidden = !open; btn.setAttribute("aria-expanded", String(open)); }); return h("div", { class: "ag-ft" }, [ AG.tx("p", "shared.method", { class: "ag-method" }), h("div", { class: "ag-ft-row" }, [ AG.tx("p", "shared.source", { class: "ag-source" }), AG.tx("p", "shared.credit", { class: "ag-credit" }), h("div", { class: "ag-ft-end" }, [btn, AG.ta(h("span", { class: "ag-logo", role: "img" }), "aria-label", "shared.logoLabel")]) ]), about ]); }; AG.mount = function (root) { var name = root.getAttribute("data-ag"); var fn = AG.components[name]; if (!fn || !AG.data) return; root.setAttribute("data-ag-mounted", ""); if (root.parentElement) root.style.setProperty("--ag-host", getComputedStyle(root.parentElement).fontFamily); root.innerHTML = ""; fn(root); if (typeof CustomEvent === "function") root.dispatchEvent(new CustomEvent("ag:mounted", { bubbles: true })); }; AG.mountAll = function () { var run = function () { var roots = document.querySelectorAll(".ag-root[data-ag]:not([data-ag-mounted])"); for (var i = 0; i 0; }).length; var sorted = AG.data.slice().sort(function (a, b) { return a.pct - b.pct; }); var sel = null, entered = false, landed = false, pos = {}; root.appendChild(AG.header({ hed: "pattern.hed", dek: "pattern.dek" })); var findIn = AG.ta(h("input", { type: "search", "aria-label": "Find a procedure on the chart", autocomplete: "off" }), "placeholder", "pattern.findPlaceholder"); var hits = h("ul", { class: "ag-pt-hits", "aria-label": "Matching pairs" }); root.appendChild(h("div", { class: "ag-pt-find" }, [h("div", { class: "ag-find", html: AG.icons.search }, [findIn]), hits])); var wrap = h("div", { class: "ag-pt-svgwrap" }); var svg = h("svg", { role: "img", tabindex: "0", "aria-label": "Beeswarm chart. " + nM + " of 55 pairs pay more for the male procedure. Use arrow keys to step through pairs." }); wrap.appendChild(svg); root.appendChild(wrap); root.appendChild(AG.axisEnds("ag-pt-cap")); var card = h("div", { class: "ag-pt-card", "aria-live": "polite" }); root.appendChild(card); root.appendChild(h("div", { class: "ag-sr" }, [h("table", {}, [ h("caption", { text: "Table 3, facility payments, 2023" }), h("tr", {}, ["Male procedure", "Payment", "Female procedure", "Payment", "Percent difference"].map(function (t) { return h("th", { text: t }); })) ].concat(AG.data.map(function (d) { return h("tr", {}, [d.mName, AG.money(d.m), d.fName, AG.money(d.f), AG.pctExact(d.pct)].map(function (t) { return h("td", { text: t }); })); })))])); root.appendChild(AG.footer()); function drawCard() { card.innerHTML = ""; if (!sel) { card.appendChild(AG.tx("p", "pattern.emptyCard", { class: "ag-pt-empty" })); return; } var d = sel; card.appendChild(AG.pairRows(d)); card.appendChild(AG.stat(d, { small: true })); } var circles = {}; function layout() { var W = wrap.clientWidth; if (!W) return; var narrow = W < 520; var r = narrow ? 5.5 : 7, gap = 1.5, D = 2 * r + gap; var padL = r + 4, padR = r + 4; var sx = function (p) { return padL + ((p - LO) / (HI - LO)) * (W - padL - padR); }; var placed = []; AG.data.slice().sort(function (a, b) { return Math.abs(a.pct) - Math.abs(b.pct) || a.id - b.id; }).forEach(function (d) { var x = sx(d.pct), cands = [0]; placed.forEach(function (p) { var dx = Math.abs(x - p.x); if (dx < D) { var dy = Math.sqrt(D * D - dx * dx); cands.push(p.y + dy, p.y - dy); } }); cands.sort(function (a, b) { return Math.abs(a) - Math.abs(b); }); for (var i = 0; i = D * D - 0.01; }); if (ok) { placed.push({ x: x, y: y, d: d }); pos[d.id] = { x: x, y: y }; break; } } }); var maxY = Math.max.apply(null, placed.map(function (p) { return Math.abs(p.y); })); var annH = 8, axisH = 22; var cy = annH + maxY + r + 6; var H = cy + maxY + r + 6 + axisH; svg.setAttribute("width", W); svg.setAttribute("height", H); svg.setAttribute("viewBox", "0 0 " + W + " " + H); svg.style.width = W + "px"; svg.style.height = H + "px"; var old = svg.querySelector(".ag-pt-axes"); if (old) old.remove(); var axes = h("g", { class: "ag-pt-axes" }); TICKS.forEach(function (t) { var x = sx(t); axes.appendChild(h("line", { class: t === 0 ? "ag-pt-zero" : "ag-pt-grid", x1: x, x2: x, y1: annH - 4, y2: H - axisH + 2 })); axes.appendChild(h("text", { class: "ag-pt-tick", x: x, y: H - 6, "text-anchor": "middle", text: t === 0 ? "0" : (t < 0 ? "\u2212" : "") + Math.abs(t) + "%" })); }); svg.insertBefore(axes, svg.firstChild); var dots = svg.querySelector(".ag-pt-dots"); if (!dots) { dots = h("g", { class: "ag-pt-dots" }); svg.appendChild(dots); } AG.data.forEach(function (d, i) { var c = circles[d.id]; if (!c) { c = h("circle", { class: "ag-pt-dot is-" + AG.side(d), r: r, cx: 0, cy: 0, "data-id": d.id }); c.style.transform = "translate(" + sx(0) + "px," + cy + "px)"; c.style.opacity = "0"; circles[d.id] = c; dots.appendChild(c); } c.setAttribute("r", r); var place = function () { c.style.transform = "translate(" + pos[d.id].x + "px," + (cy + pos[d.id].y) + "px)"; c.style.opacity = ""; }; if (entered) { if (landed) c.style.transitionDelay = "0s"; place(); } c.__place = place; c.__at = SWEEP * (d.pct - sorted[0].pct) / (sorted[sorted.length - 1].pct - sorted[0].pct); }); svg.__cy = cy; } function enter() { entered = true; var reduced = AG.reduced(); AG.data.forEach(function (d) { var c = circles[d.id]; c.style.transitionDelay = reduced ? "0s" : Math.round(c.__at) + "ms"; c.__place(); }); setTimeout(function () { landed = true; for (var k in circles) circles[k].style.transitionDelay = "0s"; }, reduced ? 0 : SWEEP + 950); } function select(d) { sel = d; for (var k in circles) circles[k].classList.toggle("is-on", sel && +k === sel.id); svg.classList.toggle("ag-pt-dim", !!sel); if (sel) circles[sel.id].parentNode.appendChild(circles[sel.id]); drawCard(); } function nearest(evt) { var b = svg.getBoundingClientRect(), x = evt.clientX - b.left, y = evt.clientY - b.top, best = null, bd = 22 * 22; AG.data.forEach(function (d) { var p = pos[d.id]; if (!p) return; var dd = (p.x - x) * (p.x - x) + (svg.__cy + p.y - y) * (svg.__cy + p.y - y); if (dd < bd) { bd = dd; best = d; } }); return best; } svg.addEventListener("pointermove", function (e) { if (e.pointerType === "mouse") { var d = nearest(e); if (d && d !== sel) select(d); } }); svg.addEventListener("click", function (e) { var d = nearest(e); select(d || null); }); function outside(e) { if (!document.contains(root)) return document.removeEventListener("click", outside, true); if (!sel || (e.target.closest && e.target.closest(".ag-pt-svgwrap, .ag-pt-card, .ag-pt-find"))) return; select(null); } document.addEventListener("click", outside, true); svg.addEventListener("keydown", function (e) { var i = sel ? sorted.indexOf(sel) : -1; if (e.key === "ArrowRight" || e.key === "ArrowUp") { select(sorted[Math.min(sorted.length - 1, i + 1)]); e.preventDefault(); } else if (e.key === "ArrowLeft" || e.key === "ArrowDown") { select(sorted[Math.max(0, i -1; }) : []; for (var k in circles) { var hit = match.some(function (d) { return d.id === +k; }); circles[k].classList.toggle("is-hit", hit); if (hit) circles[k].parentNode.appendChild(circles[k]); } svg.classList.toggle("ag-pt-finding", !!q); if (match.length === 1) select(match[0]); hits.innerHTML = ""; if (!q) return; if (!match.length) { hits.appendChild(AG.tx("li", "shared.noMatches", { class: "ag-pt-none" })); return; } match.slice(0, 3).forEach(function (d) { var b = h("button", { type: "button", class: "ag-pt-hit" }, [ h("span", { class: "ag-ink-m", text: d.mName }), " vs. ", h("span", { class: "ag-ink-f", text: d.fName }) ]); b.addEventListener("click", function () { select(d); }); hits.appendChild(h("li", {}, [b])); }); if (match.length > 3) hits.appendChild(AG.tx("li", "pattern.moreHits", { class: "ag-pt-none" }, { n: match.length - 3 })); } findIn.addEventListener("input", find); drawCard(); layout(); if ("ResizeObserver" in window) { var lastW = 0; new ResizeObserver(function () { if (wrap.clientWidth !== lastW) { lastW = wrap.clientWidth; layout(); } }).observe(wrap); } AG.onVisible(wrap, function () { setTimeout(enter, 120); }); }; })(); window.AG.mountAll();

King, the director of reproductive bioethics at Harvard Medical School Center for Bioethics and a contributor on the study, believes that when the RVU system was created back in the 1990s, gynecological services were largely ignored, leaving the specialty undervalued from the start. While Medicare and Medicaid Services has undertaken some efforts to make RVUs more equitable across specialties over the years, that undervaluation has persisted. 

That problem may come down to how those values are determined in the first place — and who determines them. RVUs are set by a committee of doctors convened by the American Medical Association (AMA), with most of the seats allocated to members of major medical societies. The committee surveys different doctors on the time and skill required for procedures in their specialties. Based on these responses, the committee recommends values for each service to the federal government, which has historically accepted nearly 90 percent of them.

While the data quality of the underlying surveys has improved over the years, it is still not very high, said Dr. Miriam Laugesen, a tenured associate professor of health policy and management at Columbia University Mailman School of Public Health. Because the committee’s process isn’t transparent, it is often unclear what evidence its valuations rest on. This leads to distortions of all kinds, she said.

“It’s not a government process; It’s not a federal advisory committee,” Laugesen said. “It’s just a committee that was put together by the [AMA]. It’s pretty unusual in terms of how policy is made.”

In particular, King said that the surveys have a very low response rate from some specialties and are only sent to a small subset of doctors. She has never received a committee survey in the 17 years that she has practiced. 

The American College of Obstetricians and Gynecologists (ACOG) has a core seat on the committee that determines RVUs. But most ACOG members are general OB-GYNs, who split their time between obstetrics and gynecology and typically operate relatively rarely. The surgeons who perform the bulk of gynecologic operations are subspecialists – gynecologic oncologists, urogynecologists, and minimally invasive gynecologic surgeons — who complete an additional fellowship after residency. They mainly belong to their own societies and don’t have a seat at the table when RVUs are being determined. 

“From a purely cynical or economic standpoint, [ACOG] has no reason to advance billing for gynecology. It doesn’t represent a large portion of the practices of their members,” said King, adding that ACOG has been heroic in its efforts to obtain reimbursement equity for its own members. (One unintended possible result of that advocacy is that pushing for a smaller pay gap for services related to pregnancy, has in turn sent the message that women’s bodies are literally worth less, and are less deserving of care when they’re not engaged in the god-given duty of reproduction.)

The result is that doctors in specialties like OB-GYN who operate infrequently are answering the surveys about complicated surgical procedures that gynecologic surgeons perform more frequently. King said that her surgical schedule aligned more closely with those of general surgeons. For example, she operates two to three times a week whereas, according to her, an average OB-GYN will likely operate once a month. 

“So they’re not the right people to be answering these surveys. They [the survey committee and ACOG] don’t target the surveys to people who operate a lot,” she said. 

Part of the problem with using surveys to determine a key foundation of medical reimbursements is that the data is self-reported by doctors. This is especially relevant when more objective avenues may be available. One of those avenues is the American College of Surgeons’ National Surgical Quality Improvement Program, which is an initiative that collects and manages key surgical data to track quality and improvement in surgical fields, including the actual time spent performing surgical procedures, making it a more definitive measure than self-reported surveys.

Dr. Shitanshu Uppal, a gynecologic oncologist and division chief for gynecology oncology service at the University of Michigan, and his colleagues analyzed 901,917 surgeries using both the National Surgical Quality Improvement Program as well as the self-reported surveys used to determine RVUs. They found that median RVUs per hour vary widely between specialties. Gynecology had the third-lowest median RVUs per hour of all the specialties studied. In effect, that means that gynecological surgeons are paid less for every hour that they work. 

The researchers also found that compared to the operating times logged for real surgeries in the Surgical Quality Improvement Program, surgeons in certain specialties tended to report longer procedure times in the self-reported surveys sent out by the RVUs committee. Specialties that reported longer operating times were more likely to be awarded higher RVUs, leading to greater hourly rates of reimbursement.

According to Uppal’s analysis, urologists — a profession most often associated with procedures on men because their work routinely concerns the prostate and the testicles — reported times that exceeded the baseline data by a median of 20 minutes. By contrast, estimates from gynecologists only exceeded the actual time by a median of five minutes, meaning that urologists tended to overestimate their time spent in surgery by four times as many minutes. Generally, urologists earn much more than general OB-GYNs, who in turn earn more than other subspecialties like gynecologic surgery. Despite having access to reliable electronic records of operating time, Uppal and his colleagues note, the AMA committee still continues to use self-reported operating times, which influences their RVU recommendations, ultimately cementing disparities in female-specific procedures. 

“The system that they have now developed over time,” King said, “now creates discrimination because of its complexity.” She added that this is how systemic discrimination is perpetuated, even if systems or rules appear seemingly neutral.

How low reimbursement rates make women’s lives worse

The US healthcare system has never been especially good at putting its money where its mouth is when it comes to women’s health. Experts have been sounding the alarm on sex-based disparities in medical billing for a long time — long enough that governing authorities like the committee responsible for RVUs and ACOG have had time to respond to the concerns. 

Over the years, the gap between male-specific procedure reimbursements and female-specific reimbursements has decreased slightly. But researchers of the Price and Prejudice study showed that between 2003 and 2023, there were no statistically significant improvements to the pay disparities. Comparing a smaller set of procedures across 1997, 2015 and 2023, they found that the gap had narrowed only minimally.

One common justification that ACOG provides for the pay gap is that obstetrics and gynecologic services see a higher-than-average share of patients on Medicaid, which pays doctors less than other insurers. King agreed this is a real factor, but it doesn’t explain why Medicare itself values procedures on women lower in the first place. And as her account of double discrimination makes clear, undervaluing gynecology ultimately affects women everywhere for the worse.

“I have patients who are waiting for surgery with me for a year at a time. I mean, that’s crazy.”

Dr. Louise King

Lower reimbursements in gynecologic surgery disproportionately affect female surgeons because they represent a majority of this specialty. It’s not just the surgeons’ salaries that are affected. Hospitals and facilities work on a revenue-based model — if gynecologic surgeries are not bringing in enough money, institutions tend to allocate fewer resources to those procedures. That, in turn, can limit access to operating rooms, surgical staff, and operating times. 

“I have patients who are waiting for surgery with me for a year at a time. I mean, that’s crazy,” King said. As a minimally invasive gynecologic surgeon, she surgically treats women with endometriosis, fibroids, cysts or other such conditions.

It also affects the training that gynecologic surgeons receive. When there aren’t enough resources to operate regularly, opportunities to train residents are rarer than they should be. The result is that low reimbursement rates have contributed to a workforce of low-volume gynecologic surgeons who are sometimes not as well-trained as other surgeons who operate frequently.

The relationship between volume of surgeries performed and patient outcomes is well-documented in other fields. Research shows that surgeons who operate infrequently have worse outcomes, including more complications before, after, and during surgeries, compared to surgeons who operate regularly. 

Low volume gynecologic surgeons — who perform a particular procedure less than 12 times a year — have significantly higher rates of causing bowel and urinary tract injuries in their patients. Especially in benign gynecological surgery (procedures not related to cancer), having surgeons who operate frequently also increases the amount of minimally invasive procedures performed, which is related to better patient outcomes. 

Payment reform is an uphill battle, but not a lost cause

It takes multiple years and pressure from different entities to update or add new RVUs for procedures — but crucially, it is not impossible. The first few steps to creating a sustainable system might look like submitting gynecology-related procedure codes for reevaluation to the AMA committee or prompting a congressional report on the matter. 

For example, for years there has only been one billing code for endometriosis, regardless of the complexity of surgery or technique used. This disincentivizes surgeons from taking on complicated surgical cases of endometriosis because of the low reimbursement rate. Reevaluating that rate or diversifying the various surgical approaches that different cases require would help affected women get the care they deserve.

Medicare’s payment system also has what’s called a budget neutrality rule, which dictates that significantly increased payments for any given procedure must be offset by cuts elsewhere. The AMA itself believes that reforming this rule would make it easier to work toward reimbursement equity for female-specific procedures.  

Experts have suggested creating gynecology-specific conversion factors to bring parity to a system that naturally undervalues these procedures, while others think that eliminating sex-specific billing codes whenever possible is the right move. For example, the code for genitalia biopsies is different for men and women. This means that those procedures can be reimbursed differently even though they are essentially similar. Adopting one sex-neutral code for any genitalia biopsies would avoid this. While the reform required for this would be substantial, researchers believe that it would narrow the billing gap significantly.     

Authorities often justify lower RVUs for female-specific procedures by pointing to training: Gynecologists spend fewer years learning to operate than urologists and other higher-paid surgical specialists, according to King.

Historically, surgeons who operated on the female pelvis trained in ways that were more closely aligned with general surgeons than OB-GYNs. When obstetrics and gynecology merged into one specialty in the 1900s, the training for gynecologic surgery was truncated. 

“General OB-GYNs will train for four years and of that four years about 18 months is devoted to surgical training in gynecology,” said King, contrasting the new training period to those of general surgeons which is in years. 

She believes that training periods should be increased for gynecologic surgeons. That change would secure better reimbursement for the speciality, while also producing better trained surgeons who would be more attuned to advances in minimally invasive surgery that will ultimately improve the outcomes for their female patients. In some cases, the experience gained during a two-year fellowship in gynecologic surgery was equivalent to 19 years in practice.  

In their initial work on double discrimination, Watson and King argued that failing to implement solutions for parity is tantamount to saying that female patients deserve less well-trained surgeons than male patients.  

As with most women’s health issues, it is unclear if this systemic disparity in medical reimbursement is the result of conscious misogyny or a by-product of ignorance. But that question of origins matters little when its consequences have been enshrined in medical policy, with lasting consequences for the practice of medicine more generally. We have allowed this wage gap to persist, even as many have sounded the alarm for decades. It is long past time to heed their warnings.

Buried beneath every American city is a mysterious jumble of cables, pipes, and gas lines, entangled like a pair of wired headphones the moment you pull them out of your pocket. Every time a contractor sticks a shovel in the asphalt, they embark on a high-risk excavate-by-dots obstacle course, dodging color-coded clusters of spaghetti-like power lines, gas mains, sewers, and fiber-optic cables. A line of blue spray paint means water. Red means power. Yellow is gas. Orange is telecom. 

About 700,000 times a year — that’s once every 47 seconds — something goes wrong. 

A backhoe slices into a cable and cuts off a 911 call center, or a woman comes home to find her dryer and hot water heater on fire after a contractor pierced her electrical line. Just last week, a contractor accidentally severed a single telecommunication cable that proved critical enough to ground flights at some of the nation’s largest airports on the eve of the UN General Assembly, ensnaring even world leaders like Canadian Prime Minister Mark Carney in delays. 

The ground beneath our city streets has never been so crowded, driven by a furious race to lay fiber optic cables carrying the data that fills your social media feeds and transmits your ChatGPT queries. Nor have the systems we use to find out where it’s safe to dig — namely, a hotline and all that colorful spray paint — ever felt so catastrophically insufficient. 

“If the locator mismarked the line, if the line wasn’t marked, if there was no map that even said the line was there,” said Sarah Magruder Lyle, president of the Common Ground Alliance, a trade association focused on underground damage prevention, “there are a variety of issues that could happen before the excavator even puts a shovel or a backhoe in the ground.”

According to Common Ground, such incidents cost the US about $83.2 billion per year, roughly as much as we invest in public transit annually nationwide. But the actual financial toll may be even higher, because every time a crew stumbles across a mislabeled power line or a gas pipe everyone else forgot about, it can delay construction for months on end. As Magruder Lyle put it, “if they get out there and they find something that they’re not supposed to, you have to go back and reengineer the whole project.” 

Such surprises can also lead to tragedy. A 5-year-old named Alistair Lamb was killed in Missouri last spring after a contractor drilled into a gas line near his home, spewing fumes that leveled his house when his unsuspecting father flipped a light switch. And just this May, another unmarked gas line killed three people when contractors struck it, leading an apartment complex in Dallas to explode.

Yet the messy underbelly of our cities remains largely invisible, with accountability for issues foisted upon and at times evaded by a hodgepodge of finger-pointing private utility companies, agencies, and contractors. And that’s a shame because there is, in fact, a better way to bury the cables and pipelines that our modern lives depend on, and a multitude of better ways that we can find the ones we’ve already buried. 

What Disney World gets right about the stuff we bury

To understand one utopian vision for how all this could work, look no further than the happiest place on Earth. That’s a moniker Disney World has earned, in my mind, not for its Mickey Mouse waffles (though my niece may disagree), but for its world-class utility corridors, also known as utilidors.

Directly beneath the Magic Kingdom is a sprawling network of tunnels. Initially designed to shepherd around Mickey and his friends, the system now also serves as one of the largest utility corridors ever created. Unlike the rest of America, where cables are typically dumped in ditches before being covered with dirt, the electrical lines that power Cinderella’s castle quite literally get the princess treatment. 

Alongside water pipes, sewers, and animatronic control systems, these power lines lace the walls and ceilings of the utilidors, meaning they’re protected from weather and changes in the soil. They are also easy to monitor, catalog, and access if something needs fixing. While the cost of building a controlled system like this is much higher upfront than burying directly in the ground, the practice virtually eliminates the risk of accidentally rupturing a gas main or slicing a fiber optic cable during routine maintenance. Once they’re built, they can also drastically reduce costs in the long run because you no longer need to tear up a street every time a utility needs fixing. 

“Obviously, it’s expensive,” said Debra Laefer, a professor of civil and urban engineering at New York University, “but in the long term, it would be hugely cheaper,” especially “in areas where we are digging all the time, there’s a direct business case for moving towards these utilidors.”

As fantastical as Disney World’s imagineered system may seem — and it was, to be clear, predicated on a not-easily-reproducible master plan — the idea of storing utility lines in easy-to-access tunnels is not just for amusement parks. It is possible even in places where most of those lines are currently lying in the dirt, as Prague proved back in the 1970s, when the city decided it was fed up with destroying its precious cobblestone streets every time a buried pipe or cable needed fixing. The city now boasts a sprawling utility tunnel network, occasionally patrolled, evidently, by a couple of robot dogs tasked with mapping out every cable. 

Singapore has also spent years building out walkable utility corridors that operate much like the Magic Kingdom’s, transmitting water, data, and energy from the safety of well-organized underground tunnels. Some of Tokyo’s largest districts store their cables and gas lines in huge concrete utility ducts, and many Parisian water lines and fiber optics are kept across the city’s centuries-old sewer system, a catacombs of waste made easily navigable by blue-and-white street signs that correspond to the avenues above. Many university campuses across the US also boast their own sprawling utilidors.

In most cases, cities chose not to relocate utilities all at once, a feat that would probably be financially prohibitive and deeply disruptive. Rather, they took advantage of all the times they’ve needed to relocate utility lines anyway, a standard (and expensive) practice for big building projects like the Wallis Annenberg Wildlife Crossing or the Second Avenue Subway, a major transportation project in New York City that’s been consistently delayed by unmapped utility lines. A group of graduate students found that building such a tunnel in parts of NYC would likely cost at least twice as much as dropping a utility line in the ground, but could recoup the costs within 47 years. 

“There are streets in New York City that have been excavated at least once a year, every year for the past 30 years,” Laefer said. If you just prioritize those streets, gathering the piping in a “big concrete box” underground, you could allow workers to complete most repairs without needing to disturb the streets or sidewalks above at all.

But building new utility tunnels would require that we first come to better understand the wires and piping already entangled under our cities, which if you recall, we have only a surprisingly flimsy picture of in most cities today. But if every surprise utility line is an opportunity to move it somewhere better, it is also an opportunity, at the very least, to map out where it is.

To that end, a few years ago, Laefer led a $1.2 million pilot funded by the National Science Foundation to create a test case for 3D-mapping New York City’s underground utilities, a project that’s since been adopted into a citywide initiative. The city says it plans to roll out the spruced up utilities locating system in 2028. The UK debuted a similar digital map of over 3 million kilometers of underground pipes and power, owned by hundreds of utilities and agencies a few years ago. The nation projects that it could help save over $500 million per year by minimizing delays and accidental damage. In places where Singapore has not yet stuffed its utilities into walkable tunnels, the city’s own mapping and utilities coordination has already saved it an estimated $230 million in avoided clashes since 2024. Not bad for an intervention that doesn’t even require any physical rebuilding.

So why hasn’t every American city copied London or Singapore?

Well, US cities tend to be plagued by even more private utilities and patchwork local and state norms and regulations than a nation like the United Kingdom. Getting them to pool together what they often consider proprietary underground data is challenging, and few local officials have opted to prioritize such efforts. But this may well change as more and more fiber optics go into the ground, more flights get canceled, more apartment complexes explode, more power lines flicker off, more sinkholes form, and more Americans come to be all too acquainted with the perils lurking just beneath our feet. 

“I think at this point, it’s more about political will and money than any technical obstacle,” Laefer said. “Technically, we’re there. It’s just a matter of doing it.”

The Soviet Union famously churned out tens of thousands of new apartment buildings in the 1960s, ’70s, and ’80s — some assembled in as little as 12 days — together comprising tens of millions of individual apartments. Such speed is not unique to communist command economies, or even to grim concrete mega-blocks. In Sweden and Japan today, modern, high-quality new homes can be factory-built and assembled in a matter of weeks using the same basic method — prefabrication — as the Soviets.

The US, alas, evinces no such urgency to build housing. 

In some of our highest-cost cities — San Francisco, New York, Miami — it takes, somewhat astonishingly, nearly five years to erect a modestly sized apartment building, from the time an application is first submitted to building completion. That was one of the top-line findings of a remarkable new economics working paper on housing construction timelines across 60 US cities. The gaps between the fastest and slowest cities were just as striking: In Raleigh, North Carolina, a builder can complete a 20-unit apartment building in about as much time as it takes just to approve the permit for one in San Francisco, where applications languish for more than a year. In Indianapolis, a single-family home can be built in six months from proposal to completion, less than one-eighth the time it takes in San Francisco.

Such delays have costs — in delayed housing supply at a time when America is millions of homes in the hole, in lost staff time that developers ultimately bake into the cost of the new homes, and in homes that simply never get built because the process is discouraging to anyone but the best-resourced developers. The authors, Leonardo D’Amico, Evan Soltas, and Audrey Wang, found that longer permitting lengths are correlated with higher housing prices and lower rates of housing production, though they don’t claim to have shown that these are causal relationships. The research (which has not yet been through peer review and, like any working paper, may be revised before final publication) represents the first such comprehensive dataset comparing homebuilding timelines across the US. To build it, the researchers assembled 1.1 million permits covering 2.7 million housing units between 2000 and 2025 — about one in 13 new homes permitted nationally over that period, they write. 

It probably won’t come as a shock to you that housing can be built faster in Sioux Falls, South Dakota, than in Los Angeles or pretty much anywhere in California. But perhaps the most notable takeaway (to me, anyway) from the paper was how massively home permitting times have lengthened across the board over the past 25 years. Across the cities in their sample, the researchers estimate that permitting time for a standardized multifamily building rose from 0.6 years in 2000 to 1.5 years in 2023, and, for a single-family home, from 1.6 months in 2000 to 4.9 months in 2023. 

Is there really any good reason why we should take nearly a year longer to approve an apartment building than, Soltas joked in a recent interview, “the barbarians of 2006”? Shouldn’t we be getting faster and more efficient at building housing over time, not slower — especially at a time of acute housing scarcity? 

You would think. So what is going on here?

One building, very different wait times

Permitting refers to everything that happens after a developer submits an application to build a house or multifamily building, before they’re allowed to break ground. The proposal is then reviewed for compliance with a range of different sets of rules, from building safety and energy codes to plumbing to zoning and, in some places, aesthetic design. Initial applications will often be found noncompliant and then sent back to the builder for revisions, Soltas, an assistant professor of economics at Princeton, told me.  

The gulf between housing starts in California and Texas has become something of a meme in housing abundance circles. But, for all that, we have until now lacked rigorous apples-to-apples comparisons of permitting and building times in different metro areas, Soltas said. That gap in seemingly basic knowledge, what should be “step zero” facts for the national housing reform debate, became apparent to him when he was teaching an urban economics class, which became one of the impetuses for the new paper. “I realized if I needed that information to teach my students, that it might be useful for other people,” he said. 

Rather than merely pulling permits from different cities and comparing how long whatever happened to be built in each city took to approve, the researchers used the data to estimate how long an identical, standardized project would take in each place between 2015 and 2019, keeping constant its size and the density of the surrounding neighborhood. Their uniform archetypes were a 2,800-square-foot detached single-family home on a 0.15-acre lot and a 20-unit multifamily building with 1,200 square feet per apartment.

Cities with longer permitting times also tended to have longer construction periods — the longer it takes to get an application approved, the longer it then takes to do the building itself, which compounds the gap between the fastest- and slowest-building cities (it’s possible that “cities that make the permitting process difficult also put in lots of burdens that slow the construction process,” Soltas said). One advantage of the researchers’ method is that the differences across cities can’t merely be chalked up to something like the complexity of building within already-dense environments like Manhattan — the analysis already controls for that. So the enormous gaps between different places become harder to dismiss as inevitable features of development in big cities.

The study wasn’t designed to answer the “why” of it all — those will be questions for future research. “Our paper doesn’t directly identify any smoking guns,” Soltas said. Still, some of the culprits are likely obvious — California, for example, has long subjected some housing projects to extensive environmental review requirements under the California Environmental Quality Act (CEQA). Apartment buildings, especially larger ones, are more likely to have to go through CEQA review, though they’re more environmentally friendly than single-family homes (recognizing this as an obstacle to housing affordability, California has been moving to exempt many housing projects from such reviews). 

Why are we taking so much longer to permit housing?

But why, as the study finds, is permitting becoming slower across the country, not just in the most regulated cities? “We estimate that, in 2000, our standardized multi-family project had a 71-percent probability of approval within six months of applying for a permit,” the researchers write. “In 2025, that project had a 44-percent approval probability within six months.” Permitting times have come down a bit since 2023, but it’s unclear whether that just represents the reversal of pandemic-era highs, or if it reflects real progress from the pro-housing policies that have been passed in many cities and states in recent years. 

That discovery dovetails with other economics research finding that zoning codes, which were first widely adopted in the US in the early-to-mid 20th century, have continued to become more restrictive even in recent years, making it harder to build housing. 

Without knowing why exactly permitting lengths have ballooned, it’s hard to say whether those increases have occurred for good reasons. At least some of it may have to do with the aforementioned intensification of zoning and other land-use restrictions, which, I can say from having written a lot about zoning, tend to be pretty ill-conceived and hard to justify. 

The slowdown may also be connected to expanding building code requirements. I’ve written at length about that issue, too; although ever-more stringent rules might seem like a great idea — who could be opposed to more safety? — they tend to be biased against multi-family housing and likely inflate the cost of building, all without having to show that the benefits are worth the costs. Particularly the cost in housing supply that never gets built, which has the effect of keeping more Americans living in older housing stock. And do we really think a home built to 2005 standards is dangerously subpar today?  

We might ultimately decide that many of today’s building requirements — particularly ones like stronger energy efficiency standards — are worth it, but first we’d need to determine what their full costs are, which we remain far from doing. 

At a minimum, it seems unlikely that an apartment building that’s okay to build in Grand Rapids today would be unsafe for New York. So what, exactly, is all that extra permitting time buying the city? Now, at least, Mayor Zohran Mamdani can put an exact number on the delay. 

My favorite restaurant, here in Madison, Wisconsin, closed this week. 

It was not my favorite because it had the greatest food I’d ever had, nor the most memorable ambiance. But I loved the Mad Rabbit Cafe because it had become my anchor in the neighborhood — it felt like home to me and a core group of friends as surely as the century-old houses lining the surrounding city blocks. Most importantly, it was entirely vegan — a rarity in this city, which, despite its ultra-progressive politics, embraces Wisconsin’s identity as “America’s Dairyland.” It was a refuge where my most closely held values found expression.

That closure is part of a national trend. US plant-based restaurants appear to be going through a contraction, amid the tumultuous aftermath of the Covid-19 pandemic and, perhaps, an anti-plant-based cultural vibe shift.

VegNews magazine reported that data from HappyCow, an app that lists vegan and vegetarian restaurants, finds the number of vegan restaurants in three of the country’s top destinations for vegan dining — New York City, Los Angeles, and Portland, Oregon — decreased by between 21 and 25 percent from 2022 to late 2024. Those cities alone make up a significant share of America’s vegan restaurants. Then, in 2025 and 2026, some of the country’s most renowned, long-running plant-based restaurants also announced that they’d shut down: Modern Love and Candle in New York City, the Vegan Joint in LA, Millennium in Oakland, a more than three-decade-old institution (though it later reopened as a leaner operation), among many others. 

According to a Vegan Society report, in October 2025, HappyCow (which is like Yelp but for plant-based dining) listed 1,717 all-vegan restaurants in the US. As of this writing, HappyCow lists 1,509.

Madison has never had anything like the vegan riches of New York or San Francisco, but even we are having our own vegan recession. When Mad Rabbit opened in early 2024, the city had four fully vegan restaurants; now, depending on how you count, one or two remain (and even the one that’s unambiguously vegan is a food-court-style stall). I visited Mad Rabbit at its last Sunday brunch, where it served what many people have described as the best tofu scramble they’ve ever had, and a crowd-pleasing rotation of crepe specials (this month, it was mango lassi). It’s a culinary niche that, once gone, is hard to replace in a mid-tier city like this one. 

Mad Rabbit’s owner, Nate Anger, told me the business hadn’t been in particularly bad financial shape; it was profitable for each of the three years in which it operated, but not profitable enough to justify the punishing time commitment required to run it. Managing it had taken over his life, as it’s wont to do for many people in the food service industry. “I live here. I spend far more time here than anywhere else,” he told me in a recent interview at the restaurant. “I’ve missed my kids’ baseball game and tournaments and school band recitals.” I looked around at the oddball, DIY space he’d conjured — walls covered in houndstooth print, an Alice in Wonderland-like vortex, and art of rabbits in mischievous-looking moods, one brandishing a pair of large knives (the sort of room you wouldn’t want to encounter while stoned). 

The animal rights movement has two very different emotional registers: the grief and terror of looking squarely at factory farming, and the joy of discovering how much creativity, abundance, and pleasure can exist outside it. All-vegan restaurants represent perhaps the fullest embodiment of that second feeling — like “a little heaven,” as Krupa Panchal, co-owner of Bombay Food Junkies, a vegan Indian spot in suburban St. Louis, put it to me. 

Even as vegan businesses struggle to survive, plant-based options at non-vegan restaurants have become far more mainstream than they were a decade or two ago. Set against the stagnating (if not declining) share of Americans who identify as vegan or vegetarian, that raises difficult and even paradoxical questions for the animal movement.

For that reason, the mass die-off of plant-based restaurants has been much dissected and lamented in the vegan community. As I faced losing my own — a possibility I’d always feared and tried to forestall by supporting it as much as possible — the problem became much more visceral for me. I found myself thinking about why it mattered to me so much: What is lost when these places disappear, and what does that tell us about whether the plant-based movement can grow and endure?

What vegan restaurants are for

The vegan restaurant predates the word “vegan” itself — and so, apparently, do questions about whether they can be financially viable. More than a century ago, French anarchist Georges Butaud co-founded the Foyer Végétalien in Paris, writing in a 1923 letter that he was unsure whether it would attract a sufficient “clientèle végétalienne” to sustain itself. Why start such a business at all, when the audience for plant-based food is so vanishingly small? “I already have some positive results. A few people have become vegan since we opened,” Butaud wrote. The restaurant “is a school where we reciprocally teach one another…I have believed in the usefulness of creating it, and I will be happy if, over the months to come, the number of vegans increases.” 

Many vegan restaurant proprietors today still share that ambition — to be good enough to help the movement grow. 

Long before it became routine to find plant-based options on normie restaurant menus (iceberg lettuce leaves don’t count), plant-based restaurants compensated for vegans’ exclusion from mainstream cuisine. But they have also aimed to provide proof of concept of the diverse, surprising possibilities of plant-based food for a larger audience, showing that plant-based food need not be confined to marginalia. 

Today, of course, restaurants are far more central to our daily lives than they were in Butaud’s time. Americans consume about a third of their calories and the majority of their food budgets outside the home, and food-serving businesses are perhaps our most important third spaces. Meanwhile, the problems associated with animal agriculture and overconsumption of animal products grow unabated in America and around the world. The US alone slaughters 10 billion land animals for meat every year, the overwhelming share of them raised in appalling conditions, and those farmed for milk and eggs endure no better. Reciting these grim facts tends not to be a very fruitful path toward making friends or convincing people that veganism can be a positive and enjoyable lifestyle. Plant-based restaurants, on the other hand, make veganism feel less like a prohibition than an invitation; hospitality rather than horror. 

Anyone who has ever gone vegan knows what it’s like to incessantly be asked the well-meaning but bewildering question: “What do you eat?” (And, I get it! It’s confusing for those of us who grew up viewing food free of animal products as side salad or overcooked green beans.) Plant-based businesses have long been laboratories for answering it, developing techniques that draw richness and variety from ingredients not often treated as the main event in Western cuisines.

The more than 50-year-old Moosewood Restaurant (although mostly vegetarian, not fully vegan) was an early conduit between restaurant experimentation and home cooking, its recipes spreading far beyond Ithaca, New York, through its enormously popular cookbooks. Soul Vegetarian in Atlanta, opened in 1979, developed a plant-based soul food repertoire that helped cut a path for dozens of other vegan soul restaurants across the US; the Chicago Diner, in the city long identified with stockyards and slaughterhouses, helped popularize plant-based versions of American diner and deli staples. And chef Miyoko Schinner, at her erstwhile San Francisco restaurant Now & Zen, experimented with plant-based cheeses long before launching Miyoko’s Creamery, one of the most acclaimed and influential vegan dairy companies of the past decade. 

The 21st century in particular has seen a flowering of vegan restaurants serving every palate and national cuisine, in every possible aesthetic — punk, hippie, psychedelic, fussy and upscale. They still expand my mind today, showing that a lifetime wouldn’t be enough to discover all the ways we can eat without the exploitation of animals.

The longtime Grasshopper restaurant in Boston, whose pan-Asian fare draws partly from Vietnamese Buddhist temple cuisine, makes mock meats that are worlds away from the rubbery substitutes that many Americans associate with the category (it closed its beloved, homey restaurant space in 2024, later reopening a stall inside a food court). Mad Rabbit changed even this longtime vegan’s idea of what tofu could be. Chicago-based Penelope’s Vegan Taqueria makes, as far as I’m concerned, the most exceptional Mexican food — vegan or not — this side of the Rio Grande. V-Grits, a Southern comfort spot in Louisville, Kentucky (RIP, 2024), provided evidence that some of America’s most exciting plant-based food could be found far from the big coastal cities best known for it. 

So why are so many of these places shuttering now? 

The vegan restaurant death spiral? 

Theories abound about the great dying of vegan restaurants.

Some of the casualties, it must be said, just weren’t very good in the first place. The raw vegan boom of the 2000s and 2010s, for example, produced numerous establishments built around that especially unforgiving constraint — no cooking. The result was often less-than-thrilling food (which isn’t to say it’s never good!), all in service of a restriction with scant evidence of health benefits to support it. Lots of these restaurants have closed in the 2020s, reflecting diminishing demand for that particular variant of vegan food. 

But the 2010s weren’t merely a golden age for zucchini noodles and date-walnut brownies — vegan restaurants of all stripes were multiplying, as was interest in the new generation of plant-based meats (Beyond and Impossible). It really did appear, for a minute there, that the future might be plant-based, vindicating decades of animal advocates’ work to push veganism into the mainstream. 

“I felt like veganism had really hit a big stride” in that period, Anger, the Mad Rabbit founder, said. Everyone was streaming documentaries advocating for plant-based diets — Forks Over Knives, Cowspiracy, What the Health, among others. Some polls suggested the share of Americans who called themselves vegan was growing. Anger said his market research led him to believe that the overall trend line for veganism would continue going up, even a little. Instead, “it just rolled right back over.” His restaurant had a core customer base of committed vegans, but its heavy reliance on regulars also showed how limited its reach was; stagnating interest in veganism may have been putting a ceiling on its growth. Keith Uruski, owner of Nooch, a vegan restaurant in Windsor, Ontario, open since 2018, told me that the business had thrived in its first few years, but has since slowed considerably, and he hasn’t paid himself in three years.  

In the years leading up to the pandemic, the assumption that the audience for vegan food would keep growing shaped much bigger bets than Mad Rabbit. Vegan chain restaurants including Veggie Grill, Native Foods, and Planta had pursued aggressive growth plans in the 2010s and early 2020s but eventually retrenched, closing locations and abandoning the scale they’d once envisioned. (Again, some of this may be merit-based rather than evidence of a broad rejection of veganism — YMMV, but I found Veggie Grill, at least last time I had it pre-Covid, to be mid.) “Most dedicated vegan chains are now in kind of a managed decline,” Lizzy Bartlett, senior director of menu research and insights at Technomic, a food service industry research firm, told me.  

The cultural winds have certainly shifted. The Make America Healthy Again (MAHA) movement has probably contributed to a thermostatic swing away from “unnatural”-seeming diets and simulacra of traditional foods, like plant-based meat and milk. I also think society has deep carnist antibodies that activate whenever meat-eating faces heightened moral scrutiny. In the last few years, that’s taken the form of a protein obsession that has hijacked the minds of otherwise rational people, convincing them tofu and beans lack sufficient protein to build muscle.

But perhaps my favorite explanation was articulated by Financial Times journalist Henry Mance last year: “The decline in idealism,” reflected in the reelection of Donald Trump — the triumph of our collective id.  

There’s a risk of reading too much into all this, however. Many restaurants, vegan or not, suffered during Covid and from prolonged inflation in food and energy prices. This year, consumers are spending less at restaurants because of elevated fuel prices due to the war in Iran. Panchal, of Bombay Food Junkies, said that her sales have been down in 2025 and 2026 compared to the years prior, but she doesn’t believe vegan restaurants have been faring worse than non-vegan ones. Some vegan businesses have recently closed in St. Louis for personal reasons rather than failing in the market, she told me.

This is part of the natural life cycle of independent restaurants — many disappear within a few years, and even highly successful ones eventually run their course. US cities had many vegan restaurants open in the 2000s and 2010s, so we might now be seeing a wave of closures that reflects the aging of that cohort. 

Preliminary results shared with Vox from a 2026 survey of the global vegan restaurant industry, by the nonprofit Vegan Hospitality, also complicate the idea that plant-based restaurants are being killed off because of waning demand for vegan food. In responses from about 59 vegan restaurants (a self-selected group, to be sure), mostly in the US and Mexico, roughly four in five said they’d still choose to be fully vegan if they were opening today. Of 13 businesses that were closing or had been sold, six said that being vegan actually helped them, and four said it made no meaningful difference.

And there’s some tension between the “death of veganism” hypothesis and what may be one of the biggest forces now disadvantaging dedicated vegan restaurants: the widespread adoption of plant-based options on omnivorous restaurant menus. That it’s now easier to be vegan at mainstream establishments is “unquestionable,” Anger said. He viewed Mad Rabbit’s competitors as not just fully plant-based businesses, but any restaurant that offers “more than two or three” vegan options; it was located just a block away from one of Madison’s best-regarded restaurants, a Laotian place with several very good plant-based offerings.

Likewise, Michael Fifelski, general manager of Red Sushi in downtown Madison, which has a solid list of vegan options, told me, “Our vegetarian and vegan rolls actually are quite popular” — a foundational part of the menu. There can be a real advantage to simply letting vegan food blend in — Amanda Byrd, the manager of Everly, an eclectic, globally inspired restaurant in Madison, told me that its top dish, a butternut squash and forbidden rice curry, is incidentally plant-based. In many cases, “if you de-emphasize the vegan statement, but the dish happens to be vegan,” it will sell better, Claire Conaghan of the food industry research firm Datassential said.

Though nothing compares, for me, to the feeling of total alignment that comes with dining at an all-vegan restaurant, there is also something affirming about seeing plant-based food finally taken seriously by the wider culture — and vegan dishes surviving on their own merits alongside everything else on the menu.

Do vegan restaurants still matter?

In a world where you can find a satisfying vegan entrée at Chipotle or Taco Bell or your local brewpub, are fully vegan restaurants still needed? What purpose do they serve?

The most fundamental problem beneath the downturn in vegan businesses is simply that the vegan population does not seem to be growing much at all. Polling on the question is messy and often inconsistent, but according to Gallup’s 2026 survey, 2 percent of Americans call themselves vegan, the same figure as in 2012, when the firm first started asking the question. If expanding the number of people who abstain from animal products remains an important goal (a point debated within the animal movement, though I think dietary change still matters a great deal), then which is more likely to move that objective forward: vegan restaurants, or an abundance of vegan options at omnivorous ones? Which does more to increase the number of plant-based meals consumed rather than animal-based ones and generate excitement about vegan food?  

I put those questions to Seth Ariel Green, a research scientist at Stanford’s Humane and Sustainable Food Lab, who writes the Substack “Regression to the Meat.” He’s one of the most intellectually honest researchers anywhere on meat reduction. His answer, via email, is that we don’t really know: “I have no idea how to weigh the pros and cons of, when I’m choosing between meals, 1) signaling to the world that vegan businesses are viable or 2) signaling to a particular business that their vegan options are viable. That’s a hard problem!” (It might be “a microeconomic structural equation modeling paper waiting to be written,” he added.)

Reducing prevailing levels of meat consumption even a tiny bit, much less convincing people to become vegan, is really, maddeningly hard, as Green has written. One frequently cited obstacle to growing the animal rights movement — its “central unsolved problem,” as one movement leader recently put it — is that it lacks much in the way of an in-person social world and sense of community. Vegan restaurants alone can’t fix that, of course, but they are among the few physical institutions the movement has. At their best, they provide a space where a private dietary choice can be reinforced by a shared sense of identity — a place to run into someone you already know or meet someone new, at a speaker event or social mixer. These spontaneous, embodied connections made Mad Rabbit such a warm presence in my life, and its final days all the more melancholy.

That function may be especially useful when plant-based restaurants are rooted in traditions people already belong to — cultural, religious, or otherwise — and help them view veganism as continuous with an identity they already have rather than as something alien to it. As Green has suggested, “let’s tap into pre-existing identities, explain how plant-based diets are consistent with them, and then take folks somewhere to enjoy convenient, delicious plant-based food together.” 

On the other hand, plant-based options at omnivorous establishments matter for almost the opposite reason. People often struggle to stay vegan because eating differently isolates them from non-vegan friends and family; restaurants that can accommodate mixed-diet social groups help remove that social penalty. These options also need a customer base — if no one orders them, they’re unlikely to remain on menus. 

I’m enough of a weirdo that I try to almost exclusively support plant-based restaurants whenever I eat out. I desperately want them to survive, and at the end of the day, no one is more invested in advancing the craft of plant-based cooking than vegan restaurants themselves.

Not everyone needs to be like me — in a world where almost all people still eat animal products, a healthy ecosystem needs both places built entirely around veganism and those where plant-based food is woven into broader food culture. It needs, most of all, excellent vegan food, wherever it might be found. And now that veganism has made at least a small breach into mainstream dining, vegan restaurants still offer something their meat-serving counterparts cannot. They’re like miniature utopias where the normal order of things is inverted and, for the length of a meal, we can see what a future without animal exploitation would look like. 

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

My best friend confessed his love for me one year ago and I rejected him because I was unhappily in love with another man, and I was never really physically attracted to my best friend. He was devastated. I am happy our friendship survived.

Over a year later, I find myself thinking about how it would be like to be in a relationship with my best friend. He is the only man who ever showed me genuine love and support, and I wonder what if I try…maybe I will fall in love with him. However, I am concerned about hurting his feelings again. Is it selfish of me wanting to try this love out because it promises security and appreciation?

Dear Fanning the Flame,

I can’t blame you for being curious about the common “friends to lovers” storyline. It’s often portrayed as the best kind of pairing: Two people have the foundation of their friendship plus a newfound love; the romantic relationship is like a soaring addition to an existing sturdy house. 

But real life is not always like the movies, and it sounds to me like you haven’t actually had an awakening of desire for your friend. In fact, it’s the opposite: He once expressed feelings for you, and you confronted a lack of physical attraction for this person. Now you’re wondering if it would be possible for you to fall in love if you tried. I think you’d agree that your timing is suspect. After a breakup, it’s common and understandable to seek out comfort and intimacy. Still, I detect a philosophical streak in your question beyond the issue of whether or not this would simply be a rebound. 

If your friend has always appreciated you, made you feel safe, and loves you — could that be a form of love that’s better than what you had in your last relationship? Maybe that is what love is.

Is it? Over a long night of drinking some 2,400 years ago, one group of thinkers allegedly debated the true nature of love, as Greek philosopher Plato describes in The Symposium. 

Aristophanes, a playwright, tells a story that most closely aligns with the love we see in the rom-coms of today. He said that humans used to be larger creatures with four arms and four legs. After annoying the gods, Zeus cuts all the humans in half, creating the two-limbed bodies we have today. The result is that people wander the world looking for the one person who used to literally complete them. If you followed Aristophanes’s fable, you shouldn’t try to be with your friend unless you felt that deep longing that one has when meeting their other half. 

The rest of the dinner party companions have more circumspect ideas. Phaedrus, a Greek aristocrat, thought that true love inspired people to become the best possible version of themselves. Pausanias, a military man, thought that love driven only by attraction to someone’s body was “vulgar love”, and that “noble love” was the love of someone’s values. Eryximachus, a doctor, asserts that love is also about moderation, and it needs order, much in the way the natural world does. Finally, Socrates says that even if you start out with physical infatuation, you can eventually transcend that and end up loving wisdom itself, the highest form of love. As I read it, the men are grappling with how to make love make sense, while acknowledging that it can make us lustful and impulsive. Shouldn’t its best manifestations instead be practical and virtuous?   

You could easily justify trying to date your friend with these theories that try to wrangle and tame love. For example, if your friend inspires you to be the best version of yourself, you could decide that’s enough to go for it. You could also decide that because you admire your friend’s character, and not his body, that’s a noble love, and better than the vulgar love of attraction. 

German philosopher Arthur Schopenhauer wrote in his 19th-century essay “The Metaphysics of Sexual Love” that he distrusted the feeling of being desperately in love. He considered romantic love to be a biological drive disguised as a real emotion — one whose goal is to trick us into procreating. You could even see your lack of attraction as an indication that you’re able to act more rationally, and not be deceived by that cunning trickster, passion. 

I know you’ve recently gone through a breakup, but I hope you can feel how bleak these views can become: to see love only as the window dressing for the propagation of a species, or as just a bridge to the love of wisdom. 

This cynicism has other consequences. Wondering if you could redefine love in a relationship with your friend isn’t like a wine-fueled dinner party bouncing around thought experiments. It involves your best friend and his own feelings too, and could risk not only hurting him, but also robbing him of a better romantic partner. 

For Simone de Beauvoir, the 20th-century existential philosopher, the most important aspect of life was freedom: We are technically free to do whatever we want, and it’s the choices we make with that freedom that determine our authenticity, or lack of it. De Beauvoir worried about forms of love that stole freedom from other people. In narcissistic love, she wrote in The Second Sex, a partner doesn’t love the other person, but loves the fact that the other loves them. It’s a relationship built on the self-interest of one of its members. 

I want to gently point out that it sounds like there may be aspects of the narcissistic relationship in your dilemma. While it may be intriguing to consider what it’s like to date a friend, you don’t seem to be as romantically interested so much as you are interested in his interest in and support of you. Actually involving yourself in such a dynamic could take his freedom, as well as your own capacity to learn from your break-up, then find a partner you’re genuinely drawn to for their own merits.  

I’m not saying friendship isn’t an important ingredient in love. Many of the most successful, very long-term partners I know have developed a deep friendship with one another. This friendship helps them stay kind to each other and have fun over many years when work, health, or stress can interrupt more passionate times of connection. But those same couples also had the undeniable spark of attraction at the start of their relationships too. They didn’t have to try. Sometimes they tried not to feel as strongly as they did, and still weren’t able to stop. 

Even in cases when a relationship first launches platonically, if something more is there, the undeniable, reciprocal pull tends to emerge soon thereafter. In H.G. Wells’ 1911 novel, The New Machiavelli, which was largely based on a real-life affair Wells had, he writes about a college graduate called Richard who meets a young woman, Isabel. The two become friends and are entranced with each other’s minds. But they quickly start to notice more between them, despite trying to push such thoughts away.

They fail at this attempt. Richard has a moment of realization, when he turns to look at Isabel’s face one day. “And something — an infinite tenderness, stabbed me,” Wells wrote. “It was a keen physical feeling, like nothing I had ever felt before. …From that time forth I knew I loved Isabel beyond measure.” I think you owe it to yourself, and your friend, to pursue connections that have this quality, especially at the start. 

You should also make room for and appreciate your friendship. If it never becomes romantic, that doesn’t make it a lesser relationship. The couples therapist, Esther Perel, calls friendships their own kind of love story. She once described a simple exercise to help appreciate that bond. Take a few minutes and think about a friend who isn’t a family member or romantic partner. “Recall a time when that friend reflected you back to yourself, created space for joy, or helped you remember who you are,” Perel suggests. Then, send a message to that friend about that moment, and thank them. 

Having a good friend by your side in the aftermath of a breakup is a gift. Work on maintaining and nurturing that friendship, and make sure you spend some time helping him with his life too. Don’t fixate on whether you should attempt to fall in love. The truth is, for better or for worse, if you love him, you won’t have to try.

Bonus: What I’m reading

• I’ve always been interested in the history of love, by which I mean the differences over time in how love has been expressed and discussed. William Reddy, a historian of emotion, has an excellent book called The Making of Romantic Love; you can also check out a syllabus for a class at Duke University he taught on the subject. 
• For a deeper dive (and refresher!) on Plato’s Symposium, I found that there was no better person to turn to than Melvyn Bragg and his guests on the BBC In Our Time episode on the philosophy of love. 
• Arranged marriages are an interesting window into understanding the growth of love. Mansi Choksi’s nonfiction book, The Newlyweds, follows three couples in India who attempt to marry for love; here’s an excerpt that was published in Harper’s Magazine. 

There is a kind of terror-tinged embarrassment that comes from dozing off on your beach towel on the sand, only to find a rising tide intrude upon your mid-nap bliss, lapping at your toes and sweeping away your sunglasses.

It is a truth I relearn every June, one that arrives like the season’s first sunburn: The ocean is inevitable, and Poseidon always reclaims his own. Actor Nicolas Cage learned a far more serious — or more expensive, certainly — version of that lesson earlier this month, when a furious high surf siphoned the ground beneath his Malibu, California, mansion, collapsing his driveway and front porch into a gigantic 30-foot-by-30-foot sinkhole. The cave-in ruptured a gas main, swallowed an access road, and forced dozens of locals to evacuate. In the process, it put into stark, cinematic relief the unyielding threat of coastal erosion in every community in the nation with a view of the sea.

It’s impossible not to imagine Cage standing on the edge of that yawning pit as he might in one of his films, bombastic in his bafflement, every outsize gesture a pantomime of confusion. But no one should have been surprised. As far back as 1976, the California Coastal Commission denied a proposal to build a home on the lot where Cage’s Malibu home now teeters over the void, citing “concerns over wave hazards.” In 1986, the same commission rejected another residential proposal on the land, deeming it an “extremely hazardous area” threatened by waves and erosion. 

So why, just a few years later, was a home built there anyway, one that would eventually come to be owned by a certain Hollywood eccentric? A few years after their initial rejections, the waterfront lot’s original owners were able to convince the commission that with enough clever engineering, including a sea wall and concrete stilts, the home, its septic system, driveway, and access road could be protected from the sea god’s wrath. But much like Odysseus before him, Cage has found the hard way that the lord of waves does not easily forget his due. “What is the Grail but Earth itself?” he once told the New York Times, characteristically mythologizing his real estate acquisitions. “The divine object is Earth.”

In this case, at least, Cage chose the wrong cup. But Cage is hardly alone in laying out his home atop the wrong stretch of sand. Nearly all of the nation’s coastal communities — from ritzy enclaves like Malibu to working-class quarters of the Rockaways in New York — rely on coastal engineering to remain inhabitable, dumping sand or erecting sea walls to put off a perpetually and increasingly rising tide. 

To put this into perspective, almost one-third of Americans live along a coastline, and while few of us have the kind of luxury oceanfront views that Cage and his neighbors enjoy, our beachside apartment complexes, utility lines, and coastal highways suffer from the same risks his driveway does. Most of us, however, lack the benefit of a second home or a private island to flee to if something goes catastrophically wrong. 

When a sinkhole opens underneath a celebrity’s driveway, or a stilted home collapses into the sea, it is a reminder that we have built huge swaths of our beloved coastal communities on land that was never meant to sit still. If we want them to survive, we will need to learn to embrace new ways of packing our beach towns up and wheeling them further upshore. Logistically implausible as it may sound — difficult as, say, stealing the Declaration of Independence — it’s a process that several American communities have become much better at in recent years. 

“This is not a problem that is unique to Malibu, which just so happens to be some of the most spectacularly beautiful and spectacularly expensive real estate in America,” said Kara Murphy Schlichting, an environmental historian at Queens College in NYC. “This is a question that is coming for all of America’s coastal communities.”

Say it ain’t sinkhole

The void that swallowed Cage’s driveway with the gusto of the actor chewing scenery in one of his films was no ordinary sinkhole. In fact, if you asked a geologist, they would tell you that it was not, technically speaking, a true sinkhole at all. 

“It’s not what I typically would consider a sinkhole,” Michael Sukop, a hydrogeology professor at Florida International University, told me. That’s because most sinkholes form when rainwater or a leaky pipe slowly seeps into the porous bedrock beneath our highways, homes, and soccer fields, creating a cavern that screeches open during a heavy downpour or when the infrastructure above it becomes too heavy to bear. 

There is no accurate accounting of every sinkhole in the US, but geologists widely believe that they have become more frequent globally, driven by extreme weather linked to climate change, aging infrastructure, and what Sukop calls “people moving into sinkhole country,” meaning places like Florida where the bedrock is highly soluble. Some of the worst places for sinkholes in the country are in landlocked states like Missouri, whose unique landscape boasts upward of 16,000 sinkholes, which often open after heavy rainfall.   

But Cage’s sinkhole was formed not from hidden cavities in the bedrock, but from a high surf strong enough to slip under his sea wall and wash away the soggy soil beneath his asphalt and, presumably, his Rolls-Royce Phantoms. It was spurred not by rainfall or a leaky pipe but by a tidal force akin to the one that can put a damper on — or literally dampen, anyway — a beach spot that seemed perfectly sandy when the surf was low. 

@accuweather

A homeowner on North Carolina’s Outer Banks paid to move their beachfront home away from the shore to prevent it from collapsing into the ocean, as several neighboring homes have.

♬ original sound – AccuWeather

But while I can learn to lug my sodden towel and cooler a little further upshore, the same cannot easily be said for Cage’s $10.5 million abode, built — like much of Malibu — atop a constantly shifting coastline. Which isn’t to say that it wouldn’t be a good idea to try.

“It’s a fiction that we can keep a coast in a single place,” said Schlichting. And it is a fiction upheld by hundreds of millions of dollars spent each year on temporary solutions meant to hold the ocean still, and protect the luxury homes and boardwalks we’ve built along it. 

The pristine, sandy beaches that most of us think of when we think of the word “beach” are often heavily manufactured for our pleasure, much like an urban park might be seeded with carefully cultivated trees and brush. In fact, the federal government spends hundreds of millions of dollars each year to dump sand atop eroded coastlines, a process known as beach renourishment, in addition to many more billions spent on sea walls and other structures that can keep a coastline in place for a little while. 

“The most endangered species on the coast is not a turtle or a piping plover; it’s an unengineered beach,” said Robert Young, director of the Program for the Study of Developed Shorelines, who has been tracking beach renourishment projects since the 1980s. “And it’s unsustainable because as sea level continues to rise, we are having to pump that sand more and more frequently.”

How to save coastal neighborhoods

Earlier this year, Malibu released a long-awaited Coastal Vulnerability Assessment that twice called out the acute dangers that erosion poses for Sea Level Drive, a small stretch of private road, upon which a gaping crater now sits where Nicolas Cage’s driveway used to be. As this year’s goliath El Niño gets into full swing, his misfortune is unlikely to be the city’s last. 

Already, the spectacular seafront Pacific Coast Highway faces a gauntlet of exigencies, among them landslides, wildfires, and, of course, a coastline that simply won’t sit still, creeping further and further inland each year. Just this weekend, officials in Malibu issued a warning about hazardous conditions at local beaches, with “severe beach erosion” exposing steel and concrete debris sticking across the coastline.  

“Nature itself does not destroy the coast. It moves the coast,” said Young, but if infrastructure like the Pacific Coast Highway lies in the way of that movement, then there is only so much that building a sea wall or dumping 300,000 cubic yards of sand every five years will do. “No matter where you are, whether you are in California or South Carolina or New Jersey, we are still building in dumb places.”

Much like laying a log in front of your beach towel won’t hold the tide back for very long, these measures are often only a temporary balm. But there is another way, one that involves moving the proverbial towel — or permanent infrastructure — away from the shore, a process known as managed retreat.

As implausible as it may sound, when you take into account just how much money has gone into keeping the coast still, lugging a few celebrity mansions, a beachside school, or a sliver of highway across town might be a Herculean labor worth attempting. 

“It’s totally doable,” said Young. “We can move just about everything.” On the coast of North Carolina, the Cape Hatteras Lighthouse, one of the tallest brick lighthouses in the world, was moved in 1999, a feat that Young helped pull off. At the time, he said, locals  “wanted to shoot us over” the effort, sure that the centuries-old structure would fall down. “And you know what? It’s safe now,” he said, noting that just down the beach in Buxton and in nearby Rodanthe, dozens of homes have collapsed into the ocean since 2020.

But even in places where such coastal relocations were once commonplace, it’s still not an easy sell for most coastal policymakers and their constituents, especially in places like Malibu, whose density and geography make it all but impossible to move things nearby. But sooner or later, they might not have a choice. 

“I can’t tell you how many coastal elected officials have said to me, ‘Rob, you know, retreat is not an option from this place.’ And I’m like, well, actually, you are retreating here, here, here, and here,” Young told me. “It’s just you’re doing it in the worst way possible. You’ve got septic tanks rolling around in the sea. That is not a great Chamber of Commerce moment.”

If there’s one thing that Americans can unite behind, it’s anxieties over artificial intelligence.

According to a recent NBC News/Decision Desk poll, 70 percent of adults say they are personally more worried than excited about the technology; it’s basically underwater in every area of society with one notable exception: its use in scientific research and medicine.

According to Dr. Dhruv Khullar, a physician at Weill Cornell Medicine and writer at the New Yorker, that optimism is well-founded.

Khullar uses AI tools in his own practice as a physician and writes about their advancements in the medical field. He says that “right now, at least, there’s a generally optimistic view of how AI will change healthcare going forward.”

AI in medicine is nothing new. In 2024, the Nobel Prize in Chemistry was given to researchers who developed an AI model that enabled breakthroughs in predicting protein’s complex structures. As it becomes more ubiquitous, it’s also emerging as a resource for doctors to get second opinions and as a tool to take notes on patient-doctor interactions.

On top of that, Khullar says, it might help unlock new medicines to treat diseases. 

Khullar joined Today, Explained co-host Sean Rameswaram to discuss the ways that AI is transforming drug discovery and research, as well as what it still can’t do. They also discuss how to think about AI’s potential in healthcare at the same time as top AI researchers are increasingly warning about the technology’s risk.

Below is an excerpt of the conversation, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify.

You’ve been thinking about lifesaving AI innovation. Has AI already started saving lives?

I think it has. This is the fastest I’ve ever seen healthcare take up a new technology. Part of that might be that the healthcare system is so messed up that there’s an appetite for some type of change. It’s unaffordable, it’s inaccessible, it’s inconvenient, the quality is uneven. 

There’s at least a hope that AI is going to help with all of these things, and I think it’s already starting to make its way into the healthcare system. Now it’s our responsibility to figure out how to make the most of it without also promulgating some of the downsides.

For those who are unaware, tell us how it’s working its way into the system.

It’s helpful to categorize it into a few buckets, at least for healthcare. 

The most rapid uptake, and I think the place that it’s already starting to make a difference, is on the administrative side. Many people who have gone to a doctor recently might have noticed that there’s an AI scribe that’s taking notes now. And people seem to really like it, at least so far. Doctors are able to look their patients in the eye in the way that they weren’t able to when they were poring over their computers and just typing what the patient was telling them. 

The second big area is patient navigation. When is your next scan? When’s your next appointment? Do I need to take this medication on an empty stomach or not? There’s a huge opportunity for people, let’s say, who are diagnosed with a serious illness like cancer or heart failure to navigate the system more seamlessly. 

The third big area that I’m really excited about is drug discovery. AI is making a huge dent in the early parts of drug discovery. 

The last thing that I’m excited about and that I use every day when I’m in the hospital is [AI] as a second opinion. Now instead of having to get a consult or turn to a textbook, AI can be a very, very helpful clinical decision support. It’s not to say that I never consult someone, of course, but that first pass — I’m not sure what’s going on. What are some recent trials that might influence my decision here? Is there something I’m missing? Is there a test that I should be ordering that I’m not ordering? — all those types of things, they start to help with.

The biggest chunk of this positive view of AI and medicine is drug discovery. Tell me more about how that’s going so far and how it might be going in a year, or five, or 10.

I don’t want to leave this conversation and say that we’ve solved the cure for cancer because of AI, but I do want people to know that at least for the early stages of drug discovery — figuring out the very basic steps of is this an interesting molecule? Does it have potential biological applications? — AI is already very helpful for that. 

They’re trying to take, basically, what is an infinite number of drug-like molecules that are theoretically possible to be drugs and they’re trying to match that to some disease that’s going on inside a human. And human biology is incredibly complex as well. There’s tens of thousands of genes, hundreds of thousands of proteins, trillions of cells, and you have to match a potential molecule to a potential target within a human. 

In the past, a researcher might take years to study a disease or a biological pathway and figure out, okay, this protein seems to be involved. And actually, it might not be involved, it might be involved, it might be disrupted, but not be the causative agent. There’s a lot of uncertainty there, so now AI can take enormous amounts of data, and it can rank various potential targets that seem to be the most likely to be causing a particular disease and give you that short short list of potential targets that may have taken months or years in the past.

So now you know what to attack, but you have to figure out what to attack it with. So you need a molecule, you need to generate a molecule that’s going to fit into that target or disrupt that target in some way. 

Now again, AI can scour vast chemical spaces and give you a list of the things that seem to be most likely to be able to disrupt that target. And then it can actually help you generate that molecule in some cases. 

So now we have the target. Now we have something that we’re going to attack the target with. And then you have to do something called lead optimization, and that’s the third thing. Lead optimization means you have this lead and you have to optimize it.

“I would make the counterargument that healthcare is ripe for disruption and you don’t even need the frontier frontier models to make it a lot better with AI.”

Now we have to figure out, of all the molecules that seem to be good at potentially affecting this target, which ones are able to be absorbed in the body, which ones are going to get to the right tissue. AI models can predict the most likely molecule to give you that Goldilocks set of properties that’s needed for a safe and effective drug.

As we all know from anyone who’s asked AI to write an email for them or Googled a question, these tools have a certain degree of certitude, even though these tools can just be flat out wrong about stuff. Are you guys worried about that in the field?

Absolutely. And so this is why I think the narrative around AI just replacing scientists or doctors or other workers is incorrect. Because you still need a lot of judgment. 

You need to be able to adjudicate the output of these models to figure out what is most promising and what is potentially dangerous. That is going to require wet labs and scientists and reasoning based on prior experience and understanding the context. There’s all sorts of issues around, can you manufacture some of the drugs that are being proposed by these models? So just because it’s set, it dreams something up doesn’t mean you can actually make that thing in the real world.

Some of the drugs that it proposes might actually be toxic in certain ways that it didn’t predict. And of course, then you have to take this thing into clinical trials. You have to recruit l people who are willing to put this medication in their bodies. You have to find out who might benefit, you have to put it through the regulatory process. 

That’s why I said that the first part of drug discovery, where you’re trying to figure out how do we get the right drug candidates, what seems most exciting to test further, that’s going to be really accelerated. That whole second half where we actually have to figure out if it works in human biology, that is still going to be in some respects an analog process.

It doesn’t sound like you’re terribly scared that we are like ceding control of our hospitals, of our research facilities, to AI. This is very much in the sort of assistant bucket?

For now it is. And I think one of the challenges is to maintain our agency as these models become more and more sophisticated. As you lean more on these machines, if you’re a doctor, inevitably some of the skills, the critical thinking, the reasoning that we put into coming up with the diagnosis that we honed over the course of years, that can start to atrophy. 

These are the types of things that we still need to sort through as we’re implementing more and more AI into the healthcare system.

For the people who just say, shut it all down, this is too dangerous, the risk is far too great, we don’t actually need this, this isn’t doing anything for society, would you make a counterargument?

I would make the counterargument that healthcare is ripe for disruption and you don’t even need the frontier frontier models to make it a lot better with AI.

Even if we wanted to “slow the pace of the frontier,” fine. But there are models from a year or two years ago that could be very helpful in the healthcare setting. When we’re talking about slowing the pace of the frontier and the most sophisticated and potentially dangerous models, fine. 

But if we’re talking about shutting down AI and not using it in biotechnology or not using it in scientific research or not using it in clinical care delivery, that’s where I would push back pretty hard.

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

Four beluga whales have died in a month at one of America’s top-rated aquariums — a tragic development and, arguably, a reason to revisit the ethics of zoos. (More on that in just a minute.)

The latest cetacean casualty, a 26-year-old female named Osiris, died at Chicago’s Shedd Aquarium yesterday. She follows 34-year-old Beethoven, a longtime resident of the aquarium, as well as 20-year-old Rain and 23-year-old Peekachu, who died in late August and early September.   

Osiris, Rain and Peekachu were all part of the Marineland diaspora: a group of four dolphins and 30 beluga whales that rescuers have worked to relocate since the 2024 closure of a scandal-plagued theme park in Niagara Falls, Canada. This summer, the animals were successfully transferred to aquariums and marine parks in the US and Spain. That was a frankly incredible undertaking involving padded shipping containers, a police-escorted convoy and a chartered plane. 

But in some regards, the international flight wasn’t even the hardest part of the whales’ journeys. Some of the animals have struggled to thrive in their new environments — even when those environments are state-of-the-art, like Shedd. 

In a blog post announcing Osiris’s death, the aquarium noted that its rescued whales had been under 24-hour supervision and receiving intensive, specialized care. The aquarium is still investigating the cause of death for all four whales. 

Go a little deeper

Believe me when I tell you that it gives me no pleasure to write the following paragraphs. I really love aquariums. In fact, as a kid, I grew up visiting the now-shuttered and much-maligned Marineland. 

But incidents like these back-to-back deaths should prompt us all to ask ourselves who aquariums and zoos are actually for. And the answer, I regret to tell you, is frequently not “the animals” — though zoos and aquariums have, since the mid-20th century, marketed themselves as both tourist attractions and important players in wildlife education and conservation.  

As my colleague Kenny Torrella writes, these institutions and their defenders argue they protect animals in three ways: first, by raising money for wildlife conservation projects; second, by helping to reintroduce vulnerable species back into the wild; and third, by inspiring visitors to take an interest in the environment. The Shedd Aquarium’s motto, for instance, is “For Love of Waterkind.” 

It’s worth scrutinizing those purported virtues, however — even when prestigious and reputable institutions like Shedd are making them. On one hand, there is merit to the claim that zoos and aquariums fundraise for wildlife conservation: In 2022, the latest year for which data is available, one group of accredited zoos and aquariums spent more than a quarter of a billion dollars on habitat projects. 

The evidence is thinner on the other points, though. It’s incredibly rare for aquariums and zoos to reintroduce endangered species back into the wild — that’s very difficult to do. And surveys of zoo and aquarium visitors show that merely seeing a wild animal in a tourist setting doesn’t generally galvanize people on matters of welfare or stewardship. Living in captivity in that tourist setting, however, can be stressful (or worse) for the animals themselves. 

But what would a humane alternative look like? Even if zoos and aquariums stopped catching animals in the wild, that would still leave many thousands who are injured, orphaned, born in captivity, or otherwise accustomed to human care. 

When it comes to whales, one nonprofit advocacy organization is already working on an alternative: a 110-acre coastal sanctuary for “retired” whales. That project, however, is still a long way from completion. And in the meantime, it’s up to consumers to decide whether the stated benefits of zoos and aquariums outweigh the potential harms to the animals they exhibit.

One link for later

➨ Beware the trap of “moral perfection.” We should all endeavor to live lives that embody our values, sure. But if you never board a plane because you care about the climate, or you never take your kid to zoos because you read the arguments above, then you might end up with a smaller, less-lived life. And that’s no good, either. 

Before you go…

• Did you know…that there have been “revolutionary” advancements in Alzheimer’s treatments in just the past five years? Two new drugs both markedly slow the progress of dementia.
• Today’s trivia: Geography time! What country is bordered by Chad to the east and Mali to the west? Hint: It is the second-largest landlocked African nation. (You can find this and other brain puzzles in Vox’s daily crossword. Look for the answer in tomorrow’s edition.)
• Yesterday’s trivia: Yesterday we asked you for the classic Broadway star who first sang hits, including “There’s No Business Like Show Business.” That would be Ethel Merman, whom one biographer dubbed “the most successful musical comedy performer of her generation.” 

Who gets to tell the military “no”?

That question has become even more important after the Pentagon pushed AI companies to loosen limits on how their technology may be used in war — including how much human control must remain over autonomous weapons. When Anthropic said no, it lost a major government deal. OpenAI stepped in, embracing the Pentagon’s more flexible standard instead. Now, thanks to new reporting from The Intercept, we’re getting a better look at what those negotiations actually entailed.

The OpenAI-Pentagon agreement included specific language on the type of AI models the DOD would receive: “OpenAI models that are designed for national security use cases and have minimal refusal rates.” That phrase — “minimal refusal rates” — means that the Pentagon is seeking models that rarely, if ever, tell it no. (According to The Intercept, a Justice Department lawyer representing the Pentagon confirmed this language, before backtracking only a few hours later.)

On the surface, that provision might seem reasonable. The military is a strictly hierarchical institution. When your senior gives you an order, you do it. Leaders generally have more battlefield wisdom and experience than their subordinates, so the rank and file can usually assume that their commanders know what they’re doing and follow along. Plus, in the high-stress, time-sensitive environments of most military operations, there is little room for discussion, explanation, or alternative proposals. 

So, if soldiers can’t refuse an order, why would a machine be allowed to? Who is a robot to tell its commander no?

There’s just one issue. Soldiers can refuse an order — when the order is illegal. In fact, they are legally required to. But by introducing technologies with a limited ability to challenge commands, the military may be making it harder to stop war crimes before they are committed.  

Humans have a duty to disobey

As outlined in US domestic, military, and international law, soldiers are only obligated to follow lawful orders, and they have a duty to refuse unlawful ones. 

The Department of Defense’s Law of War Manual is unambiguous: “Each member of the armed services has a duty to: (1) comply with the law of war in good faith; and (2) refuse to comply with clearly illegal orders to commit violations of the law of war.” Obeying an illegal order — as in a directive that violates the Constitution, US laws, international law, or directs one to commit a crime — can expose a service member, as well as their commander, to criminal liability. 

This “duty to disobey” has foundations in early British and American common law, but it achieved international recognition after the Nuremberg Trials against Nazi soldiers after WWII. 

In those trials, many Nazi soldiers argued they were not liable for crimes they committed during the Holocaust because they were simply following their superiors’ orders. Rudolf Hoess, the commander at the largest Nazi concentration camp, Auschwitz, himself explained: “In Germany it was understood that if something went wrong, then the man who gave the orders was responsible. So I didn’t think that I would ever have to answer for it myself.”

These defenses were unequivocally rejected by the court.

The tribunal held that obedience is not without limits, especially when a wartime act would be clearly illegal to the subordinate or any person of “ordinary sense and understanding.” If “I was just following orders” was an absolute defense, everyone involved in a crime would escape accountability, with the exception of the single highest-ranking officer. Instead, the court determined that individual moral and legal responsibility supersedes national or military chains of command for illegal acts.

Obedience is not without limits, especially when a wartime act would be clearly illegal to the subordinate or any person of “ordinary sense and understanding.”

But, when it comes to agentic AI systems or AI-assisted weapons, increasingly being used in place of human soldiers, does the same logic apply? And, perhaps more importantly, should it?

…But do machines?

When you use an AI chatbot, it does not simply reject queries it may not “agree” with. It does not say no to requests it doesn’t “like.” Instead, it follows a set of established protocols, much as a soldier should follow the law of war: It refuses requests that violate its terms of service. 

The military is using AI for far more consequential applications than a layperson using ChatGPT to, say, build a travel itinerary. So, what kind of world is created by the Pentagon’s request for AI that “minimally refuses” its directives, many of which may bear grave ethical, moral, or legal implications?

Rebecca Crootof, an expert on technology law and professor at the University of Richmond School of Law, told Vox that while the language could easily be read as increasing the likelihood of compliance with unlawful orders, or at least reducing the friction around them, “Minimal refusal doesn’t mean no refusal.”

“I both want to say it’s not definitely going to mean compliance with unlawful orders,” Crootof said, “but also acknowledge that identifying and evaluating what constitutes an unlawful order in the moment can be incredibly difficult.”

Even for human soldiers, disobeying illegal orders is neither simple nor easy. To the contrary, it doesn’t even happen that frequently. In fact, some legal scholars have argued that giving illegal directives in and of itself is an act of abuse against subordinates, who are not thoroughly trained in legal nuances, are conditioned to obey, and face prosecution if they make the wrong choice. 

Still, the mere fact that soldiers can disobey is an important constraint on commanders who might let battlefield conditions, or even commands coming from their own superiors, erode their ethics and commitment to the law.

Still, the mere fact that soldiers can disobey is an important constraint on commanders who might let battlefield conditions, or even commands coming from their own superiors, erode their ethics and commitment to the law.

Those who are optimistic about AI often argue that machines could be better at interpreting and applying the law than human soldiers. Machines can be trained on the law itself — drawing on a repository of legal cases, rulings, and battlefield data — which might make them more “knowledgeable” than an average soldier. And machines do not face the same pressures as soldiers facing prosecution for making mistakes, since they can’t exactly be held accountable; a problem to unpack another time. That, in turn, might make it easier for them to refuse illegal orders in the proper conditions. 

So, is the answer as simple as letting the machines decide? Not exactly. “This has been a desire and a drive by technologists for ages,” Crootof said. “What if we just put the law in the system and have it only do things that are lawful? Isn’t that going to solve things?” 

Interpreting and applying the law, though, is not a simple legal-illegal binary. “It’s very context-specific,” Crootof told me, “and honestly, that’s the kind of thing humans generally find difficult and AI decision-making systems are even worse at.” Often, determining the legality of an act comes down to subtle nuances you can’t program for: You’re allowed to target a combatant; you’re not allowed to target a wounded or surrendering combatant. You’re not allowed to target a civilian; you are allowed to target a civilian directly participating in hostilities. The difference between a legal target and an illegal one may come down to body language, clothing choices, or even battlefield intuition. 

As Crootof explained, “These are not the kinds of contextual analyses AI is good for.”

So what’s the solution?

Where human soldiers’ power to disobey would traditionally serve as an important check on the power of military commanders, if an imperfect one, replacing soldiers with machines that don’t have such safeguards removes one last layer of judgment over the use of force. And yet, machines themselves are not always capable of making the judgment calls that go into interpreting the law, so it may not be appropriate to let AI have the final say either.

So what’s the solution? Given the way AI technology has already been thoroughly integrated into the military, Crootof told me it may be somewhere in the middle. 

Rather than programming AI to refuse commands it interprets as illegal, Crootof said, “what it could be designed to do is flag those indeterminate zones, those gray-zone analyses, for human review or for a higher authority.” When a system picks up conflicting signals — an enemy soldier who looks like he may be surrendering, for example — it could prompt the commander to confirm their selection or remind them of applicable law. 

In this way, a check on commanders’ battlefield authority could be preserved without fully ceding judgment over the use of force to the machine. 

We don’t know yet whether OpenAI has equipped its “minimal refusal” models with such capabilities. But as those technologies become increasingly central to military decision-making, the public deserves answers sooner rather than later.