VoxModify

2025-06-23 20:00:00

The border wall between the US and Mexico is, of course, a barrier meant to prevent human migrants from crossing into America as they seek work, family, or refuge from violence.  

It’s also a significant barrier to ranging wildlife. 

The border wall, a centerpiece of President Donald Trump’s agenda, cuts through a rugged, unique ecosystem home to hundreds of native species, from jaguars and pumas to black bears and deer. These animals often need to move to survive, whether to find a source of water or a mate. 

We know the wall is impassable for many species, potentially lowering their chance of survival. How exactly the border affects this rich ecosystem, however, has largely been a mystery. 

A new study, among the first of its kind, finally offers some answers — by essentially spying on animals near the border. For the research, ecologist and lead author Ganesh Marín, then a doctoral researcher at the University of Arizona, set up 85 motion-sensing cameras in northeastern Sonora, Mexico, along and south of the US border in Arizona and New Mexico. Throughout the course of the research, when animals walked by, the cameras began recording. 

Over roughly two years, from 2020 to 2022, the cameras captured hundreds of hours of footage, including more than 21,000 clips with mammals, said Marín, a National Geographic Explorer and postdoctoral scientist at the nonprofit Conservation Science Partners. 

“This place is so special because you see these tropical species, like ocelots and jaguars, at the same time as beavers and black bears,” Marín told me earlier this year when I was reporting on borderland jaguars.  

Some of the recordings are pretty incredible. In this clip, for example, a young puma, or mountain lion, makes a chirping sound, likely calling for its mother. 

Or check out this jaguar approaching the camera. This particular cat is known as Bonito. Scientists first detected this cat in 2020 and can identify him by his markings. 

Marín’s cameras detected another jaguar, as well, called Valerio. He was seen by cameras multiple times in a protected area known as Cuenca Los Ojos just south of the border in Sonora. 

The camera traps caught black bears and their cubs… 

…bobcats and coyotes… 

…and even an ocelot, an elusive predatory cat. 

Analyzing the videos ultimately revealed several important details about wildlife in the borderlands. Marín found that large mammals, such as black bears and deer, as well as some smaller herbivores, spend less time near the border than in other, more remote stretches of his study region. That suggests these animals avoid border infrastructure. 

Other species, like the pronghorn, which have been seen on the US side of the border, didn’t appear in his cameras at all. That may be because they have trouble crossing a highway that runs roughly parallel to the border in Sonora, according to Marín and his co-author, John L. Koprowski, a biologist at the University of Wyoming.

Meanwhile, smaller common predators like coyotes and bobcats appeared more tolerant to human activity: They were more likely to use habitats with cattle, cars, and dirt roads, according to the footage. 

The study adds to a growing body of research showing that the border and infrastructure around it is disrupting wild animal communities.

“Amazing wildlife is present in the borderlands due to the binational efforts to protect and restore the flow of life between both countries,” Marín said in an email. “We should not define this beautiful region and the creatures that roam by the existence of an imposed division.”

2025-06-23 19:30:00

There is a lot of advice out there about how much alcohol one should drink. There is research suggesting that drinking could be dangerous, and research that indicates drinking is good for you.

Which is it? Obviously, too much drinking is bad for one’s health — and drinking to excess can destroy the human body. But is moderate drinking good — or, at least, fine?

Dylan Scott, Vox’s senior health reporter, has been looking into this matter for some time, and I recently asked him to sum up what he’s learned. Here’s what he had to say:

You’ve done some reporting on alcohol recently and whether it’s safe. Is it?

There is widespread agreement that heavy drinking is not good for you — doctors and scientists have known for literally centuries that a lot of drinking is dangerous. 

And the more you drink, the greater your risk. Your risk starts to increase pretty exponentially once you’re having more than one or two drinks at a given sitting, especially if you’re drinking every day. 

There is still a lot of debate about the safety of drinking small amounts of alcohol and whether it can have very small health benefits. On that front, studies can seem to contradict themselves.

I talked to one scientist who has published some research documenting cardiovascular benefits from drinking a little bit of alcohol, and I also recently talked to the author of a 2017 statement from the leading cancer physician medical society, which was basically intended to be a wake-up call to the public that alcohol is a carcinogen. 

Yet those two people, despite appearing to be on opposite sides of the debate, would basically be in total agreement, about the negative consequences of more than one drink for a woman every day or more than two drinks for a man every day. 

Alcohol is a carcinogen? 

Yes, but let me take a step back. 

What has stuck out to me in reporting about alcohol is that the problem isn’t so much the substance itself as it is widespread misunderstanding about what moderate drinking means.

That’s 12 oz. of a 5 percent beer, 1.5-oz. glass of 80-proof liquor, and 5 oz. of a 12 percent glass of wine. 

There’s a trope among doctors that most people think they’re moderate drinkers but aren’t thinking about those numbers as they drink. I might pour a glass of wine and think I’m having one glass of wine, but a doctor would see two glasses of wine if it’s a really generous pour.

Coming back to your question, if you didn’t know alcohol is a carcinogen, you’re not alone. I learned in my reporting that only 40 percent of people know alcohol is a carcinogen, which shows there’s still a lot of work to do in educating people about the health risks.

Public health experts told me that they want to be more vocal about some of alcohol’s risks, especially about it being something that builds a dependency. Between that, and alcohol being a carcinogen, you can start to see why knowing what levels of drinking are actually moderate is really important.

That’s interesting, and it makes me wonder about those headlines that claim a new study has found a glass of red wine a day is the key to longevity or something like that. Is there anything to those?

After my reporting, I do think there is some room for debate about whether a very modest amount of alcohol consumed in a very particular way might confer some small cardiovascular benefit.

That said, even the doctor I talked to who’s authored studies finding some benefit, said, “This is not an elixir.” He was clear that his work shouldn’t be read as saying, “Alcohol is going to reduce your chance of diabetes, improve your heart health, or what have you.”

So, you’re saying I shouldn’t start drinking, hoping it will make me a healthier person.

Yes. The doctors I’ve spoken to have said things like, “I would never tell somebody to start drinking because it’s not going to help you.”

The basic thing to remember, though, is if you’re a light drinker, any potential problems caused by alcohol aren’t something worth worrying about. 

People should be aware of the risks but shouldn’t panic about them. Really, my two big takeaways on alcohol are: Heavy drinking is dangerous, and it’s easy to drink too much. Those are the things to watch out for. 

2025-06-23 19:00:00

A series of high-profile incidents of political violence — targeting members of both major political parties — have grabbed the nation’s attention.

Earlier this month, a gunman shot two Minnesota Democratic lawmakers in their homes. State Rep. Melissa Hartman and her husband were killed, and state Sen. John Hoffman and his wife were injured.

In April, a man who allegedly “harbored hatred” for Pennsylvania Gov. Josh Shapiro set fire to the Democrat’s home while he and his family were sleeping inside.

President Donald Trump faced two assassination attempts during his 2024 campaign. A former Coast Guard officer who identified with Antifa, a far-left antifascist militant movement, was also arrested earlier this month for issuing violent death threats against Trump. 

In October 2022, former House Speaker Nancy Pelosi’s husband was attacked by an assailant who broke into their home looking for her. 

And on January 6, 2021, rioters descended on the US Capitol to stop the certification of Joe Biden’s 2020 election victory, threatening to hang then-Vice President Mike Pence for allowing it to move forward.

It might feel like, based on the severity and frequency of these headline incidents, American political violence is surging. Members of Congress appear to think so: Lawmakers from both parties are now asking for more funding to enhance security and investigate and prosecute more threats made against them.

But while there are signs in the data that indicate political violence is indeed on the rise, depending on how you define it, it’s challenging to determine exactly by how much. 

“It’s more anecdotal than anything else,” said Katherine Keneally, director of threat analysis and prevention at the Institute for Strategic Dialogue. “There’s some data to back up that the tensions are increasing and creating a more volatile environment, but to say it’s increased by X amount since 2023 is a little trickier.”

A volatile political environment and changes in social media policies that have caused misinformation to spread more quickly appear to be what’s driving the increase, at least in part. But understanding the root causes requires ascertaining the scale of the problem in a way that researchers have struggled to capture comprehensively. 

Is political violence actually rising significantly?

There are all sorts of difficulties associated with measuring political violence. 

First, there’s the definitional dilemma of what incidents to include when counting acts of political violence. For instance, some might count arrests for disrupted plots; others might not. 

Then, there is the challenge of actually gathering the data. Some sources may overly rely on media reports in an era when local news is under-resourced and might not reliably record every incident. And in the US, individuals unaffiliated with armed groups have become the primary perpetrators of political violence. That makes political violence even harder to track because perpetrators are often interacting in fragmented, low-transparency spaces online, from private chats to forums, rather than congregating in a single organized group. 

Despite the difficulties with measurement, some sources — particularly those looking at specific forms of political violence — suggest that overall levels of political violence have increased in recent years. 

US Capitol Police have been recording concerning statements and direct threats made against members of Congress, their families, and their staff since 2017, seeing significant spikes after the 2020 and 2024 presidential elections.

Researchers at Princeton University’s Bridging Divides Initiative also recorded a similar spike in threats to local officials in 2024. 

In 2025 so far, they identified more than 170 total incidents across nearly 40 states, with national issues such as LGBTQ+ rights and the war in Gaza being major bipartisan drivers. About a quarter of them involved hate speech. And in a sign of how political discourse has devolved, about 20 of them involved local officials threatening or harassing each other. 

However, researchers acknowledge that they are only scratching the surface and that a broader analysis of the threat environment must begin well before anyone reaches the point of directly threatening to harm someone or actually harming them.

“The data only looks at the point at which people successfully conduct acts of violence,” said Jon Lewis, a research fellow at George Washington University’s Program on Extremism. “I think we need to start far earlier in the process and far more holistically to really capture the root causes of this issue, which is rhetoric.”

Why is political violence on the rise?

American political violence looks different now than it did during major periods of political upheaval in the past.

In the 1970s, it was driven predominantly by far-left, anti-war groups such as the Weather Underground, which were primarily engaged in the destruction of property. But the nature of political violence, as well as its perpetrators, has changed in the decades since.

“I think the modern iteration of mainstream right-wing political violence is targeting individuals, mass violence, targeted assassinations, which I think takes on a very different tenor than the destruction of property,” Lewis said. 

There are several reasons for this shift, with the proliferation of conspiracy theories and hate speech online being a major one.

Content moderation on mainstream social media sites was never a complete cure for that, but studies have suggested that it was a mitigating factor. Twitter (now X), Meta, YouTube, and others have scaled back content moderation staff or rolled back policies designed to root out misinformation that might motivate political violence. In the months after Elon Musk bought X and implemented those policies, hate speech on the platform rose by 50 percent, according to a study by researchers at the University of California Berkeley, UCLA, and the University of Southern California.

“I think that we really need to recognize the fact that there is a significant subset of people, especially online, especially on these social media platforms, that do not share our common understanding of reality,” Lewis said. “If you spend your weekend on Twitter, which I would not recommend doing, you would genuinely say that the suspect [in the Minnesota shootings] shot these Democratic politicians because they went against the leftist, Marxist party line.”

In truth, federal prosecutors have declined to state a specific motive. But if anything, the evidence suggests he identified with the far-right rather than the far-left: His friends described him to Fox News as a Trump supporter, his social media posts embraced extreme anti-abortion views, and he had a hit list of 45 elected Democrats.

There’s also, according to researchers, a cultural shift — and not a healthy one.

People also now seem more willing to see political violence as a solution to the policies and beliefs they disagree with, regardless of party affiliation, Keneally said. 

During the 2024 presidential election, polling from NORC and the University of Chicago Project on Security and Threats found 7 percent of Americans agreed that the “use of force is justified” to help Trump claim the presidency; 10 percent said it was justified to prevent him from doing so.

Now that Trump is president again, many communities feel under threat from his policies, which may make them more accepting of political violence. A March Scientific American survey of predominantly Democratic voters at two major protests found that about a third said political violence may be necessary to “save” America. It’s worth noting that these respondents aren’t representative of Democrats overall, but it shows that acceptance of political violence isn’t just a right-wing phenomenon.

“We’re in a very pretty difficult position in the country right now,” Keneally said. “I think this combination of this changing political environment, social media, and people feeling like they don’t have any other solution is making it at least feel like it’s worse.”

2025-06-23 18:07:00

It’s never good when an alarm surprises you in the middle of the night.

I was recently on vacation with my family, and a weird beeping woke everyone up around 2 am. My wife thought it was a carbon monoxide detector. I thought it might be the baby monitor. It was actually a signal from a little sensor on the back of my arm prompting an app on my phone to go berserk. My blood sugar was low, and my fitness program was in jeopardy.

A few months ago, I started tracking everything I could about my health. In the dark bedroom of that vacation house, I was wearing smart rings on both hands and a smartwatch on my wrist. On my other wrist was a band that basically does the same thing as the smartwatch but without a screen. I’d been weighing myself with a body scanner and taking my blood pressure with a wireless cuff for weeks.

All this tech promised to tell me how well my body was working, but as I immersed myself in the alluring, sometimes dystopian future of health tracking, things got weird. Health trackers started as a way to keep a record of straightforward metrics, like the number of steps you take in a day; the industry has since matured into gadgets that promise to glean deeper insights into the essential functioning of your biological systems. Many of these new trackers take the data they collect and churn out a variety of scores — recovery scores, sleep scores, attention scores — to understand your body’s performance and give you benchmarks to chase. 

The sensor on my arm was a continuous glucose monitor, or CGM, which is a wearable device that measures blood sugar. This kind of biosensor has long been a lifesaving tool for diabetic patients, but tech companies are increasingly marketing them to everyone in the name of “metabolic health.” One such company, Levels, was co-founded by Casey Means, a wellness influencer who is a central figure in the Make America Healthy Again movement and now the United States surgeon general nominee. 

I am not diabetic. I’m also not an athlete, although I once was. I’m a tech journalist who, at the beginning of this year, started to feel quite old. Things that used to not hurt started hurting, and I felt tired constantly. Diabetes and heart disease, among the most prevalent chronic diseases in the United States, also run in my family, which made it seem wise to keep a closer eye on risk factors like my blood pressure and cholesterol. 

My sharpening sense of mortality ultimately led me to explore the frontiers of health tracking to investigate my aches and strains — and maybe help me live healthier and longer.

What I can tell you is that over the course of my months-long experiment, covering my body with sensors and drowning my attention with fitness scores did occasionally make me feel better — when it didn’t make me feel worse. 

Fitness trackers, as we understand them, have been around since the 1960s, when a Japanese company hoped to capitalize on the 1964 Tokyo Olympics by selling a pedometer called the Manpo-Kei — “manpo” means 10,000 steps in Japanese. The science behind that number has always been iffy, but the figure went mainstream in 2009, when the original Fitbit hit the market in the form of a thumb-size accelerometer that clipped onto your clothing. 

Step-counting was only the beginning. In the early 2010s, tech companies flooded the market with fitness trackers. Apple released its health app in 2014 and then released the first Apple Watch the following year. That device used LED lights to measure your pulse, and eventually, Apple added sensors for your body temperature and electrodes to record electrocardiograms and track blood oxygen levels. Fitness-tracking became health tracking. The tracking devices themselves still performed the same basic measurements, but in the coming years, all of that data would get pumped through various algorithms to draw conclusions about your overall health. In theory, health-tracking software could spot — or even prevent — disease.

“For that to work, you have to have the largest data set on a person possible,” said Victoria Song, who covers wearables for The Verge. “But it’s pretty invasive, if you really think about it.”

The amount of data all of these devices collect is massive and extremely personal. Many devices need to know your age, height, and weight, not to mention where you are and how you’re moving at all times — which leads to heart rate, temperature, and blood oxygen readings. If you add a glucose monitor in the mix, health trackers can now get moment-to-moment updates about what’s happening in the fluid between your cells.

Safeguarding the sensitive health information these devices collect is a whole other challenge. The data is typically stored in the cloud. The privacy policies for these companies vary, but suffice it to say, it’s possible that data from your health tracker, probably anonymized, ends up in the hands of an advertiser. There have also been major data breaches involving health-tracking companies, including Fitbit.

Nonetheless, about 30 percent of Americans in one survey said they wear these kinds of health trackers, and there’s evidence that the tech can be good for you. In 2022, The Lancet published a systematic review that looked at dozens of studies involving over 160,000 participants of all ages and found that those wearing fitness trackers walked 40 more minutes per day — or about 1,800 steps — on average. A review into the mental health benefits of wearables published in 2024 found some research showing that wearables have a positive effect on well-being, but overall determined that the issue was understudied. 

People must think wearables are helpful because they keep buying them. Perhaps that’s no surprise given levels of chronic illness remain stubbornly high in the United States and a wellness industry has primed consumers to buy their way to better physical and mental health. The market for these devices includes everyone from fitness obsessives looking to optimize their performance in the gym to tech bros toying with the idea of living forever to anxious dads, like me. Health trackers give us the sense that we might just be able to exert control over the uncontrollable — our very mortality — or to at least momentarily allay our fears about it. And the industry keeps coming up with new things to sell us. 

“We have so much information about everything all the time,” Thea Gallagher, a clinical psychologist at NYU Langone Health, told me recently. “So many of us, probably all of us, feel like this is going to be an iterative process for the rest of our life: navigating our relationship with the tech.”

The most popular wearable has been the Apple Watch since its release, but in our screen-saturated world, many people are turning to devices that lack displays and buzzing notifications. That includes the Oura ring, which discreetly measures your heart rate, body temperature, and movement from a single finger, and the Whoop band, which does the same thing from your wrist. Although their lack of screens makes these devices theoretically easier to ignore, the Oura and Whoop apps are essentially endless feeds of your health data. 

When you log on in the morning, Oura produces a “Readiness Score,” which it says is a “holistic picture of your health” that combines several signals, including resting heart rate and body temperature, into what feels like a grade for the day. Whoop gives you a similarly confusing “Recovery” percentage. If I want to improve those scores, Oura, Whoop, and a growing number of their competitors now have AI-powered coaches built into their apps to nudge your behavior. But it’s not always clear what exactly those nudges hope to accomplish.

“There’s not a lot of time and effort spent on figuring out what is the actual question,” said Gary Wolf, founder of Quantified Self, a community of people who have been tracking their health metrics since the mid-2000s, and also a tech journalist. “It’s kind of obvious why people come through these tools without learning anything.”

In theory, your doctor could look at a readout of all your wearable data to get a clearer picture of your health. But in reality, few patients even share this data with their doctors, and many physicians have said it isn’t very helpful. Heart-rate variability, a measure of the change in time between your heartbeats, is one of the most critical metrics used in the scoring algorithms, but there’s some debate over how accurately wearables can measure it. There’s also just too much data, and it’s hard to isolate the signal from the noise.

“Just seeing the data can be anxiety-inducing,” said Tanzeem Choudhury, a professor of integrated health and technology at Cornell Tech. “You have all this information that you don’t know what to do with.”

In other words, if you think of your overall health as an equation (which, to be clear, it is not), the types of variables a watch or a ring can collect are limited to the right side of the equal sign. You’re doing your thing, and then things like breathing patterns, heart rate, and body temperature are all the end result. What happens on the left side of that equation — what’s causing all of these fluctuations — is much harder to figure out.

Health trackers ultimately put the onus on the user to decide what changes to make to get their desired results. And when it comes to smartwatches, smart rings, and smart bands, the recommendations tend to be pretty simple: Move more or sleep more. These devices know the rhythms of your body, but they can’t really know what’s happening internally. 

The first time I installed a continuous glucose monitor into my arm, I expected it to hurt. The coin-size biosensors use a spring-loaded plunger of sorts that dips a needle into your skin and leaves a tiny piece of filament behind that measures your blood glucose. The process is surprisingly painless. 

Once installed, the biosensor syncs to an app that shows you a real-time visualization of your blood sugar. It looks a little bit like a roller-coaster with spikes for high-glucose periods after eating and stable stretches. This helps people with diabetes manage their condition, but a growing number of companies and influencers say these biosensors can help anyone gain insight into their metabolic health. 

What I didn’t know when I started receiving real-time and sometimes alarming updates about my own blood sugar was that metabolic health is the latest buzz phrase not only in the health-tracking industry but among adherents of the Make America Healthy Again movement. 

While the concept of metabolic disorders, which include conditions like diabetes or heart disease, has evolved over the past century, “metabolic health” only started showing up in medical literature in the last decade or so. Someone is considered metabolically healthy if a certain set of their biomarkers — namely blood glucose levels, cholesterol, triglycerides, and blood pressure — are within the desired range. 

Historically, your doctor checked these levels when you got your annual bloodwork done and that was enough to give most people peace of mind about their health — particularly their risk for heart disease and diabetes. But in recent years, pharmaceutical companies like Abbott and Dexcom have begun to market over-the-counter continuous glucose monitors to everyone. Oura recently launched a glucose-tracking program of its own that uses Dexcom’s Stelo biosensors. Abbott has its own app.

Then there’s Levels, the metabolic health company co-founded by Means, President Donald Trump’s pick for US surgeon general, with the mission to “bring biowearables into the mainstream.” Means, a Stanford-trained physician and wellness influencer, is also the co-author of Good Energy, a bestselling book that bills itself as “the simple answer to achieving incredible health,” which she wrote with her brother, Calley Means, a former lobbyist and current White House adviser on health policy. The book operates on the claim that every chronic disease stems from metabolic dysfunction, or “bad energy,” and the American health care system, which Calley Means calls a “sick-care system,” is profiting from treating the symptoms.

“You are the primary person in charge of understanding your body,” Casey Means says on her website. “You may have been indoctrinated to think you’re not capable of understanding your body or your lab tests, but this stops here.” That philosophy — and the philosophy undergirding health tracking in general — fits into MAHA’s ethos, which is that good health is your personal responsibility and can be engineered by doing all the right things. 

Other prominent figures in the MAHA movement have been raising the alarm about metabolic health, too, and touting high-tech health tracking as a solution. Robert Lustig, professor emeritus of pediatric endocrinology at UCSF who is an adviser and early investor in Levels, signed an open letter endorsing Robert F. Kennedy Jr. to lead Health and Human Services. So did Mark Hyman, the co-founder of the membership-based concierge lab test provider Function Health who’s pushed Levels to his followers.

Perhaps the most influential of the health-tracking evangelists, however, is Marty Makary, the new commissioner of the Food and Drug Administration. In his Senate confirmation hearing in March, Makary, a pancreatic surgeon from Johns Hopkins, talked quite a bit about the promise of health trackers in the midst of America’s chronic disease epidemic. Makary said we have a “generational opportunity to usher in radical transparency” and to “help people take care of their own health.” 

“We don’t just want to limit continuous glucose monitoring to people with diabetes. We want to prevent diabetes,” Makary told senators. “Why are we holding these tools to help people empower them with knowledge about their health until after they’re sick?” 

Regardless of the recent buzz around metabolic health in the wellness community, the medical community does not seem convinced that glucose monitors are useful for people without diabetes. Because there’s not much research into tracking blood sugar in healthy people, “we won’t know whether the cost and time it takes to implant one of these systems is accomplishing anything or is just the latest health monitoring fad wasting effort and money,” according to Harvard Medical School associate professor Robert Shmerling.

I tested several glucose-monitoring apps — including Levels, Lingo, Oura — over the course of a few months, and the negative effects of watching my blood sugar levels were almost immediately obvious to me. Within a week of wearing a glucose monitor, I started to notice some borderline disordered behavior. The Levels app sent me push alerts when my blood sugar spiked, which happened about five times a day, and each notification felt like a zap of anxiety. My morning bowl of cereal sent my blood glucose off the charts. My tuna sandwich at lunch did it again. A beer at happy hour? Forget it, the app made me think I was dying. 

So I started eating weird. I’d shovel nuts into my mouth before breakfast, skip lunch to avoid stressful push alerts, and once I ate a mixing bowl full of romaine lettuce to feel better about a single slice of pizza. My wife drew the line when I started taking pictures of my meals, so that some app’s AI could analyze the nutrients in them.

Glucose spikes after a meal are extremely normal. This is your body converting food into energy, or sugar, and then releasing insulin to instruct your cells to consume that energy. Over time, a pattern of large, prolonged spikes can lower your insulin resistance and raise your risk for Type 2 diabetes and heart disease. Some research indicates that continuous glucose monitors could be a helpful tool for the early detection of prediabetes in high risk patients, but again, there is little evidence that healthy people benefit from using the technology. 

At a certain point, I wasn’t thinking about my long-term health or sanity. I definitely wasn’t thinking about the future of the American health care system. I was just trying to get a good score in the app and reduce the number of anxiety zaps. 

I spend a lot of time thinking about how technology makes our lives better — and worse. I’ve wondered the same about the American health care system, as I’ve gotten older and more involved in the health care decisions of my parents, kids, and myself. It’s not a great comparison. After all, there is no Hippocratic oath for tech companies.

In the six months I spent hooked up to every health tracker I could find, feeding my morbid curiosity, I drove myself slightly crazy. Each hit of dopamine I enjoyed by getting good scores on a health-tracking app was offset by long periods of self-doubt that came from not fully understanding how to make sense of the torrent of data without my doctor’s help. I also became obsessive — checking the apps was the first thing I did in the morning and started occupying hours of my day.

“There’s something called orthorexia, where being perfectionistically healthy can just take over your life,” Gallagher, the NYU psychologist, explained. “You can get really rigid, maybe with what you eat and how you do things, when we typically find rigidity is not sustainable for most people.” 

That’s the contradiction embedded in this cutting-edge technology: It can often lead to panic rather than peace of mind.

I decided to take off my last biosensor as spring was turning to summer and felt a weight lifted. I put away the Whoop band, which is explicitly designed to be worn 24/7, so much so that the newest model comes with a wearable charger so that you don’t have to take it off. The only thing that I kept wearing was the Oura ring when I slept. As a tired young parent, getting to see a breakdown of my sleep data somehow made me feel more in control. There was, it appeared, the right amount of data to make me feel better.

But what if, instead of too much data about my body, I had almost nothing. That’s the case for many people in the United States. If you’re lucky enough to have regular access to health care — over 100 million Americans do not — you might get one annual visit with a primary care doctor. That might include one check of your vitals, including your blood pressure and resting heart rate. Basic bloodwork would tell me about my blood sugar and cholesterol. Your doctor might prescribe medication, like a statin, if those numbers are out of whack.

This is an optimistic estimate of what health care currently looks like in America, where primary care is in crisis and many patients feel lucky to get 15 minutes of face time once a year or pay high prices to see someone right away at an urgent care center. 

This must be a factor in the rising popularity of wearables, such as the Oura ring and Apple Watch, as well as new health-tracking services, like Levels and Lingo. That and the simple fact that Americans love independence and immediacy. Perhaps in the absence of available professional medical advice and guidance, we’re turning to these gadgets for quick and constant reassurance. Combined with googling symptoms or closely following wellness influencers, it almost feels like we’re better off taking our health into our own hands. 

But health tracking in its current form is not a science or even an art. It’s certainly not the near future of the American health care system, as some MAHA followers might make you believe. Health tracking, at its core, is a self-driven experiment in better living for those who can afford these products and have the time to spare to comb through their own data. In some ways, it’s just an expensive hobby. Like running or perfecting your smoothie recipes, it can be good for you. Wearing a smart ring or a glucose monitor alone won’t make you feel better.

If it doesn’t, take the tracker off. Too much of anything can make you feel sick.

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

2025-06-23 18:06:00

Your Mileage May Vary is an advice column offering you a unique framework for thinking through your moral dilemmas. To submit a question, fill out this anonymous form or email [email protected]. Here’s this week’s question from a reader, condensed and edited for clarity:

I am a university teaching assistant, leading discussion sections for large humanities lecture classes. This also means I grade a lot of student writing — and, inevitably, see a lot of AI writing too. 

Of course, many of us are working on developing assignments and pedagogies to make that less tempting. But as a TA, I only have limited ability to implement these policies. And in the meantime, AI-generated writing is so ubiquitous that to take course policy on it seriously, or even to escalate every suspected instance to the professor who runs the course, would be to make dozens of accusations, some of them false positives, for basically every assignment.

I believe in the numinous, ineffable value of a humanities education, but I’m also not going to convince stressed 19-year-olds of that value by cracking down hard on something everyone does. How do I think about the ethics of enforcing the rules of an institution that they don’t take seriously, or letting things slide in the name of building a classroom that feels less like an obstacle to circumvent?

Dear Troubled Teacher,   

I know you said you believe in the “ineffable value of a humanities education,” but if we want to actually get clear on your dilemma, that ineffable value must be effed! 

So: What is the real value of a humanities education? 

Looking at the modern university, one might think the humanities aren’t so different from the STEM fields. Just as the engineering department or the math department justifies its existence by pointing to the products it creates — bridge designs, weather forecasts — humanities departments nowadays justify their existence by noting that their students create products, too: literary interpretations, cultural criticism, short films. 

But let’s be real: It’s the neoliberalization of the university that has forced the humanities into that weird contortion. That’s never what they were supposed to be. Their real aim, as the philosopher Megan Fritts writes, is “the formation of human persons.” 

In other words, while the purpose of other departments is ultimately to create a product, a humanities education is meant to be different, because the student herself is the product. She is what’s getting created and recreated by the learning process. 

This vision of education — as a pursuit that’s supposed to be personally transformative — is what Aristotle proposed back in Ancient Greece. He believed the real goal was not to impart knowledge, but to cultivate the virtues: honesty, justice, courage, and all the other character traits that make for a flourishing life. 

But because flourishing is devalued in our hypercapitalist society, you find yourself caught between that original vision and today’s product-based, utilitarian vision. And students sense — rightly! — that generative AI proves the utilitarian vision for the humanities is a sham. 

As one student said to his professor at New York University, in an effort to justify using AI to do his work for him, “You’re asking me to go from point A to point B, why wouldn’t I use a car to get there?” It’s a completely logical argument — as long as you accept the utilitarian vision. 

The real solution, then, is to be honest about what the humanities are for: You’re in the business of helping students with the cultivation of their character. 

I know, I know: Lots of students will say, “I don’t have time to work on cultivating my character! I just need to be able to get a job!”

It’s totally fair for them to be focusing on their job prospects. But your job is to focus on something else — something that will help them flourish in the long run, even if they don’t fully see the value in it now. 

Your job is to be their Aristotle. 

For the Ancient Greek philosopher, the mother of all virtues was phronesis, or practical wisdom. And I’d argue there’s nothing more useful you can do for your students than help them cultivate this virtue, which is made more, not less, relevant by the advent of AI.

Practical wisdom goes beyond just knowing general rules — “don’t lie,” for example — and applying them mechanically like some sort of moral robot. It’s about knowing how to make good judgments when faced with the complex, dynamic situations life throws at you. Sometimes that’ll actually mean violating a classic rule (in certain cases, you should lie!). If you’ve honed your practical wisdom, you’ll be able to discern the morally salient features of a particular situation and come up with a response that’s well-attuned to that context. 

This is exactly the sort of deliberation that students will need to be good at as they step into the wider world. The breakneck pace of technological innovation means they’re going to have to choose, again and again and again, how to make use of emerging technologies — and how not to. The best training they can get now is training in how to wisely make this type of choice. 

Unfortunately, that’s exactly what using generative AI in the classroom threatens to short-circuit, because it removes something incredibly valuable: friction. 

AI is removing cognitive friction from education. We need to add it back in.

Encountering friction is how we give our cognitive muscles a workout. Taking it out of the picture makes things easier in the short term, but in the long term, it can lead to intellectual deskilling, where our cognitive muscles gradually become weaker for lack of use. 

“Practical wisdom is built up by practice just like all the other virtues, so if you don’t have the opportunity to reason and don’t have practice in deliberating about certain things, you won’t be able to deliberate well later,” philosopher of technology Shannon Vallor told me last year. “We need a lot of cognitive exercise in order to develop practical wisdom and retain it. And there is reason to worry about cognitive automation depriving us of the opportunity to build and retain those cognitive muscles.” 

So, how do you help your students retain and build their phronesis? You add friction back in, by giving them as many opportunities as possible to practice deliberating and choosing. 

If I were designing the curriculum, I wouldn’t do that by adopting a strict “no AI” policy. Instead, I’d be honest with students about the real benefit of the humanities and about why mindless AI cheating would be cheating themselves out of that benefit. Then, I’d offer them two choices when it comes time to write an essay: They can either write it with help from AI, or without. Both are totally fine. 

But if they do get help from AI, they have to also write an in-class reflection piece, explaining why they chose to use a chatbot and how they think it changed their thinking and learning process. I’d make it shorter than the original assignment but longer than a paragraph, so it forces them to develop the very reasoning skills they were trying to avoid using.

As a TA, you could suggest this to professors, but they may not go for it. Unfortunately, you’ve got limited agency here (unless you’re willing to risk your job or walk away from it). All you can do in such a situation is exercise the agency you do have. So use every bit of it.

Since you lead discussion sections, you’re well-placed to prompt your students to work their cognitive muscles in conversation. You could even stage a debate about AI: Assign half of them to argue the case for using chatbots to write papers and half of them to argue the opposite.

If a professor insists on a strict “no AI” policy, and you encounter essays that seem clearly AI-written, you may have little choice but to report them. But if there’s room for doubt about a given essay, you might err on the side of leniency if the student has engaged very thoughtfully in the discussion. At least then you know they’ve achieved the most important aim.

None of this is easy. I feel for you and all other educators who are struggling in this confusing environment. In fact, I wouldn’t be surprised if some educators are suffering from moral injury, a psychological condition that arises when you feel you’ve been forced to violate your own values.

But maybe it can comfort you to remember that this is much bigger than you. Generative AI is an existential threat to a humanities education as currently constituted. Over the next few years, humanities departments will have to paradigm-shift or perish. If they want to survive, they’ll need to get brutally honest about their true mission. For now, from your pre-paradigm-shift perch, all you can do is make the choices that are left for you to make. 

Bonus: What I’m reading

• This week I went back to Shannon Vallor’s first book, Technology and the Virtues: A Philosophical Guide to a Future Worth Wanting. If there’s one book I could get everyone in the AI world to read, it would be this one. And I think it can be useful to everyone else, too, because we all need to cultivate what Vallor calls the “technomoral virtues” — the traits that will allow us to adapt well to emerging technologies. 

• A New Yorker piece in April about AI and cognitive atrophy led me to a 2024 psychology paper titled “The Unpleasantness of Thinking: A Meta-Analytic Review of the Association Between Mental Effort and Negative Affect.” The authors’ conclusion: “We suggest that mental effort is inherently aversive.” Come again? Yes, sometimes I just want to turn off my brain and watch Netflix, but sometimes thinking about a challenging topic is so pleasurable! To me, it feels like running or weight lifting: Too much is exhausting, but the right amount is exhilarating. And what feels like “the right amount” can go up or down depending on how much I practice.

• Astrobiologist Sara Imari Walker recently published an essay in Noema provocatively titled “AI Is Life.” She reminds us that evolution produced us and we produced AI. “It is therefore part of the same ancient lineage of information that emerged with the origin of life,” she writes. “Technology is not artificially replacing life — it is life.” To be clear, she’s not arguing that tech is alive; she’s saying it’s an outgrowth of human life, an extension of our own species.

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

2025-06-23 18:00:00

Below is a graph showing a trend that exploded during the 2020s:

What is this depicting? Compute use for AI? Crispr gene edits per year?

No, this is another, much less-known example of massive growth these past several years. This is a chart of the number of pancreases (or, to use the correct plural, “pancreata”) collected each year from dead bodies in the US for research purposes:

How this happened is no mystery. The surge is, by all accounts, due to a regulation that took effect in 2021 focused on groups called organ procurement organizations (OPOs).

You probably haven’t heard of OPOs, but if you or anyone you know has ever received an organ transplant, they’re the ones who procured it. OPOs are nonprofit, nongovernmental bodies to which the US outsources the job of collecting organs from deceased organ donors. Each OPO has a monopoly on recovery of all organs in a particular geographic area; there are 55 groups, some of which only cover part of a state and some of which cover multiple states.

For some time now, critics have argued that OPOs are massively underusing deceased donor organs. One report from 2019 estimated that every year 28,000 usable organs (mostly badly needed kidneys but also pancreata, hearts, livers, etc.) are removed from deceased donors but never used; another put the number at 75,000. This, when the national waitlist for organs is more than 100,000 people long.

OPOs are not paid to collect these organs per se: They are entitled to 100 percent reimbursement of costs they report related to retrieving, preserving, and delivering organs, with ultimate payment coming from Medicare or transplant centers (which in turn charge Medicare and other insurers). This system, critics have long charged, does not provide enough incentive to procure harder-to-retrieve organs from patients who may be older or have certain medical conditions.

To get OPOs to collect more organs, the Trump administration in 2019 issued an executive order calling for new rules governing how the organizations are certified by the federal government, rules that were finalized two years later. This was high stakes: If an OPO loses certification, it has to shut down, and another OPO gets its territory. The rules were meant to more strictly grade OPOs on the share of organs they eventually transplant than the earlier, laxer rules did.

But there was a catch. In addition to organs recovered from deceased donors and transplanted, pancreata recovered and used for research would count toward recertification as well. Not any other organs for research — just pancreata.

What happened next can be see in the chart above: a massive, sudden surge in the number of research pancreata being recovered by OPOs, beginning in 2022, the precise year the new evaluation system took effect.

I’ve long been fascinated by this trend, which OPO critics call the “pancreas loophole” and OPO defenders describe as a perfectly legal response to overly onerous regulations. The numbers represent thousands of real, physical human pancreata, taken from real, recently deceased donors, that wouldn’t have been taken from those bodies without this regulation.

I’ve tried in recent months to make sense of how this happened, and what it means. I’m not the only one; the Senate Finance Committee has been investigating, and released a report in early June on the problem.

There is still plenty that remains unknown about the fate of these pancreata (if you work at an OPO or research center and know more details, please email me). But what is clear is that they represent an approach by the federal government toward increasing organ supply that absolutely no one is happy with. If the point of the regulations is to help people in need — including the millions of Americans with diabetes, a disease of the pancreas — evaluating OPOs based on the number of pancreata they donate to researchers simply doesn’t make any sense. 

But to understand how we started judging them this way regardless, you have to go all the way back to an obscure law passed in George W. Bush’s first term.

A cure for diabetes

For decades, researchers searching for effective diabetes treatments have experimented with an approach called islet cell transplantation.

Rather than transplant the whole pancreas, the procedure merely transplants insulin- and glucagon-producing islet cells into the recipient’s liver. It’s far less invasive, and can be done with local anesthesia and without an overnight hospital stay (though, skeptics argue, often less effective than whole pancreas transplantation too). If the islet cells come from a deceased donor, it does mean a lifetime of immunosuppression, but in “autograft” procedures, which use a subset of still-healthy islets from one’s own impaired pancreas, immunosuppression isn’t necessary.

Islet cell transplantation, though, remains little-used and mostly experimental in the US. Unlike its big brother surgery, though, islet cell transplantation remains little-used and mostly experimental. Part of the reason why is regulatory: While pancreases are legally “organs,” and therefore excluded from regulation by the Food and Drug Administration, the FDA has asserted its authority to also regulate islet cells as human tissues and to require premarket approval before they can be transplanted into a patient, just like a drug would.  

To gain such approval, it would be necessary to conduct clinical studies to demonstrate that the islet cells are “safe and effective”; ones approved they would need to be produced in compliance with “good manufacturing practices.” To receive islet cells not approved by FDA, a patient would need to join a clinical study (if one is being conducted) or go to a country (including Canada, Australia, and several EU and Asian countries) with different regulations.

FDA’s requirements have unsurprisingly slowed the islet cell transplant field down. The most recent data comes from 2021, when only 10 such procedures were performed in the US. In 2012, 111 were performed, but the number has steadily fallen ever since. It’s orders of magnitude rarer than a whole-pancreas transplant.

But islet cell transplants have some champions, including politicians. In 2004, Congress passed, and George W. Bush signed, the Pancreatic Islet Cell Transplantation Act. It was sponsored by Rep. George Nethercutt Jr. (R-WA), who said he was driven by his daughter’s diabetes to try to expand access to islet cell transplants so patients could “live without being dependent on insulin injections.”

Nethercutt’s bill sought to speed up research progress by, among other measures, ensuring adequate supply of pancreata for scientists. The law includes a provision stating, “Pancreata procured by an organ procurement organization and used for islet cell transplantation or research shall be counted for purposes of certification or recertification.”

That meant that when regulators in 2019 were reconfiguring certification rules for OPOs to encourage them to effect more transplants, they had to include a carve-out for pancreata used for islet cell research. The carve-out existed from the very first draft proposal that Trump’s Centers for Medicare and Medicaid Services (CMS) released, and stayed into the final rule in 2021.

The mysterious pancreas boom

That rule’s changes applied for evaluations of organ procurement organizations starting in August 2022. In the years 2018 through 2021, OPOs collected around 500–600 pancreata for research each year. In 2022, that figure was 1,432, a three-fold increase. In 2024, the number hit 2,053. The effect of the new regulation was clear.

It’s important to note that there are no indications that the pancreata being collected by OPOs for research are cutting into the supply of pancreata for donation. The share of dead people whose pancreata are suitable for transplant is incredibly low, because of the exacting standards for donor age and health.

“Only a certain number of donors are going to be young enough (probably less than 50, maybe less than 45) and lean enough (maybe less than 30 BMI, probably less than 27 or 28),” Jonathan Fridell, a transplant surgeon and director of the pancreas transplant program at IU Health in Indianapolis, told me. “We’re still going to look at the people that are older, still look at the people that are heavier, but the likelihood that they’re going to have a transplantable pancreas is lower.” There are thus plenty of non-transplantable pancreata left over that could be used for research once the prime ones are taken away for surgery.

The problem with the surge in research pancreata, then, isn’t that it’s taking pancreata away from recipients who need them. It’s subtler than that. By racking up large numbers of pancreata for research, OPOs are improving the grades they receive from federal regulators, and avoiding the risk of losing certification and having to turn over territory to another OPO. This grading and decertification process was meant to incentivize OPOs to collect more organs for transplant, especially kidneys, which are both easier to transplant than pancreata and more desperately needed. But the research pancreata provide a way around that incentive.

Calculate the grades that OPOs would get without these pancreata versus the ones they are getting now, and you’ll find the results are radically different. 

CMS classifies OPOs into three tiers: 1, 2, and 3, with tier 3 OPOs facing decertification. Using data obtained from the organ procurement transplant network, we are able to calculate which tier each OPO would be in with and without their research pancreata based on their performance in 2023. The year that is actually binding for OPOs and determines whether they will be decertification is 2024, for which data does not yet exist, but the 2023 data gives us some indication of which OPOs are using pancreata to save themselves.

For two OPOs, including research pancreata meant they went from tier 3, which would result in decertification, to tier 2: Donor Network of Arizona, which covers that whole state; and OneLegacy, which includes most of Southern California including Los Angeles and Orange counties. Another, Kentucky Organ Donor Affiliates, went from tier 2, where it could face pressure to improve performance, to tier 1, suggesting it excels.

These are not small institutions. OneLegacy is by far the largest OPO in the country by volume of organs collected and population covered. Its CEO, Prasad Garimella, earned $1.1 million in total compensation in 2023, the last year for which public IRS filings are available. It stood a real chance of being decertified if it did not meet the new organ collection standards. And it went from reporting 83 pancreata collected for research in 2021 to 441 in 2022 and 492 in 2023. An over fivefold increase, in one year — and no wonder, given its existence was at stake.

(In response to a request for comment, OneLegacy stated, “When recovering organs for transplant, OneLegacy will allocate pancreata to reputable islet cell research agencies only if they are not viable for transplant into patients. Over 99.6% of pancreata recovered by OneLegacy for research between 2018-2022 were allocated to two National Institute of Diabetes and Digestive and Kidney Diseases (NIH-NIDDK) laboratories.”)

Again, the 2023 data is not binding. The 2024 data will be. But unless something changes with the way the government evaluates these pancreata, some major OPOs will avoid dire consequences for the sole reason that they started collecting hundreds of pancreata for research.

Where did all the pancreata go?

The increase is so obviously a result of the new rules that OPOs don’t even bother to deny it. Responding to the Senate report earlier this month, the Association of Organ Procurement Organizations, which lobbies for the groups and against the CMS’s stricter rules, said simply, “Today, pancreata recovered for research remain part of the performance evaluation metrics, and OPOs have operated in accordance with the rule.” In other words: yeah, we found a loophole. And what are you going to do about it?

It’s an attitude that has pervaded the industry since the loophole came to light. In a listserv thread discussing the new rules, leaked to the Senate Finance Committee, an OPO employee wrote, “If you have a donor with only a pancreas for research, that is an organ donor for the Donor Rate. Otherwise, a donor is any donor with at least 1 organ transplanted. Savvy (or cynical?) OPOs ought to start a pancreas for research program immediately.”

But there’s a question that remains unanswered: Where did all these thousands of pancreata go?

It is clear that the vast majority of research pancreata did not go into islet transplants. We are talking about thousands of organs, not the few dozen that plausibly could have been transplanted as part of islet procedures in the past couple of years.

Indeed, OPOs have admitted as much. The Centers for Medicare and Medicaid Services asks OPOs for data on organs recovered every year, and in August 2024 clarified that it would only count pancreata as “‘used’ for research if they are accepted for use in bona fide islet cell research conducted by a qualified researcher, such as research approved by the National Institutes of Health.” It then asked OPOs to resubmit their data, clarifying which organs were for islet cell research specifically.

Once they did, the number of reported pancreata fell dramatically:

In 2023, the total went from 3,338 pancreata before the guidance, to 1,812 after, a drop of 46 percent. Some OPOs, like Legacy of Hope in Alabama, now reported zero pancreata for research; before the guidance narrowed qualifying purposes, Legacy of Hope had claimed 226 pancreata.

But even after the change in guidance, we’re left with smaller numbers that are still much too big to be explained by bona fide islet cell transplants. There simply were not 1,812 islet cell transplants in the US in 2023, but there were 1,812 pancreata credited as donated for islet cell research. And that number is still over triple the number claimed in 2021, meaning the increase sparked by the new OPO rules largely remains even after the government’s clarification. Research by David Goldberg, Erin Tewksbury, and Matthew Wadsworth has shown that the number of pancreata reported as recovered by OPOs also swamps the number that the Integrated Islet Distribution Program (IIDP), a consortium that collects and extracts islet cells from pancreata, reports receiving from these OPOs.

One of the points of the Senate investigation was to determine where exactly these pancreata went. The Senate Finance Committee, with the benefit of subpoena power, went about asking major OPOs for what actual purpose the research pancreata were used. The main answer they received was “we don’t know.”

“Many of the OPOs stated that it is the responsibility of the research facilities or institutions receiving the pancreata to inform the OPOs on the purpose, methods, and efficacy of the research being conducted on the pancreata and other organs that OPOs supply,” the report states. In other words, OPOs themselves don’t keep track. “Many of these OPOs,” the report continues, “have sent pancreata to biobanks and other institutions or facilities that hold pancreata for an unknown period to be used for purposes that may be undefined or nonexistent.”

Put another way: These pancreata could, for all the OPOs or the Senate knows, be sitting on a freezer somewhere, not transplanted into anyone. Or maybe not even sitting there at all. Greg Segal, an activist advocating for reform to the pancreas loophole, testified before a House committee that staff at one OPO, joked “that they’re conducting research on the efficacy of garbage disposal A versus garbage disposal B” when disposing of pancreata.

Exploiting the loophole

Throughout all this, OPOs have had one consistent message: They’ve complied with the law, as they see it.

“Pancreata recovered for research remain part of the performance evaluation metrics, and OPOs have operated in accordance with the rule,” the Association of Organ Procurement Organizations, the groups’ lobbying shop in Washington, said in its statement after the Senate investigation was released. “When CMS issued clarifying guidance in 2024 limiting this metric to pancreata used for islet cell research, OPOs responded immediately and worked with the agency to validate data and ensure compliance.”

Jedd Lewis, CEO of the Organ Preservation Alliance and a decades-long veteran of the transplant field, notes that CMS’s rule neglected to define what it means to use a pancreas for research, despite many OPOs and industry experts specifically flagging the problem for CMS before that rule took effect. And CMS’s new guidance last year did little to solve the problem, he argues.

“Last years’ memos simply identified the scope of pancreas donations that OPOs would be judged on as those for ‘islet cell research.’ But CMS didn’t define what that actually means …and on its face it’s a huge scope of research,” Lewis wrote in an email. “There are so many … ways that researchers are looking at how those cells function: studying the pancreas whole, slicing it into thin sections, isolating the individual islet cells, even breaking the cells into the component parts.” That’s all valuable research, he argues, and clearly relates to islet cells, even if the pancreata are never actually used in islet cell transplants.

Wadsworth, a coauthor on the study finding a surge in research pancreata and CEO of the LifeConnection OPO in northwest Ohio, concedes that counting pancreata that did not produce islet cells for transplant may technically be legal. But he still thinks it’s wrong. 

“I worked with this surgeon early on in my career who said ‘just because you can do something doesn’t mean you should,’ Wadsworth noted. “Based on what’s written, maybe they didn’t do anything wrong, but you don’t have to look far back in history to find examples where something wasn’t illegal, but it definitely wasn’t right either.”

LifeConnection, Wadsworth says, was able to comply with the spirit of the CMS regulations by finding counties in its jurisdiction where low numbers of organs were being procured, and working on fixing the problem hospital-by-hospital. It’s harder than just harvesting pancreata, but it means organs get transplanted to people who need them.

One irony of the controversy is that most OPOs, and their representatives, don’t believe that research pancreata should count for their evaluations. “AOPO has concerns about including pancreata utilized for research in the data used to calculate the numerator of either proposed measure,” the Association of Organ Procurement Organizations wrote in an early 2020 comment as the regulations were being developed. “The utilization of pancreata for research is driven by demand of local researchers. Inclusion of pancreata for research in the data utilized for the numerator may skew comparisons of OPOs in that category and potentially lead to inaccurate conclusions.”

But both the OPOs and their regulator, CMS, were bound by the 2004 law requiring that research pancreata, at least that for islet cell research, must count for these evaluations.

Close the pancreata gap

We are running out of time to fix this problem. If nothing changes, OPOs will be evaluated on the basis of data they’ve submitted now, including hundreds of pancreata that were never used for islet cell transplants. Whether you think that reflects OPOs complying in good faith, or subverting the system, it’s not a policy anyone should think makes much sense.

CMS has some ability to act here — but perhaps the best fix would come from Congress in the form of a legal provision clarifying the 2004 act. Simply repealing the provision restricting how OPOs can be evaluated would be simplest — but even better would be pairing it with a legal change that could help islet transplantation research far more than the 2004 has to date.

Recall that islet transplants currently don’t count as organ transplants in the US. They count as treatments with biological tissue “”If islet cells are solely organs, because they are a subpart of the pancreas, which  is an organ under transplant law, then the FDA should not have  jurisdiction,” Gail Javitt, a veteran lawyer working on FDA regulatory issues at the firm Hyman, Phelps & McNamara, told me. “However, FDA has taken a different position, that islet cells are a cellular therapy and  must undergo premarket approval just like a drug would.”   If you want to use it for treatment of a patient,  you have to go through them. That has had the practical impact of slowing down the availability of islet cells for transplantation in this country.”

Legally clarifying that islet cells are organs, not cellular therapies, and that they are excluded from FDA oversight then, could go a long way to promoting the treatment. Last Congress, Sen. Mike Lee (R-UT) and Rep. Matthew Rosendale (R-MT) each introduced bills making this change, with exclusively Republican co-sponsors.

But this need not be a partisan issue at all, and if you paired this provision with a repeal of the 2004 law permitting OPOs to count pancreata for research as part of its transplant metrics, you could arrive at a close to ideal system. OPOs would be evaluated on their ability to transplant islet cells, because they’d be organs like any other. They would not be able to get higher ratings by recovering pancreata for research that might just languish on a shelf.

This does require Congress to make a small change. But it’s a small change that should be basically uncontroversial. There’s nothing for most OPOs or for advocates trying to maximize donations to dislike here, and there’s lots for islet cell researchers to love. It’s a small fix that could go a very long way.