#benefits of workforce planning

[smartscaliing]

Maximizing Business Efficiency with HR Outsourcing: The Benefits of Workforce Planning and Employee Management Services

In today’s competitive business landscape, companies need to find ways to streamline operations while ensuring employee satisfaction and productivity. One effective way to achieve this is by leveraging the services of an HR outsourcing company. These companies offer a variety of solutions that can significantly improve an organization’s HR functions, from recruitment to compliance. Central to these services are workforce planning and employee management services, two key strategies that enhance operational efficiency, reduce costs, and promote long-term growth.

[why-animals-do-the-thing]

The Woodland Park Zoo is my home zoo, and the possibility of a strike has been brewing for a while. The staff at the zoo have been working without a union contract for over 200 days because the zoo is unwilling to pay them a living wage.

Zookeepers around the country are consistently underpaid, and Seattle is an incredibly expensive place to live. The zoo is losing animal care staff rapidly - I've been told they'd lost five keepers and a vet tech to another nearby AZA zoo this year alone - because they can't afford to live here. And I've been told that because there's no contract, the zoo is on a hiring freeze, which means they're perpetually understaffed.

Photo credit: Yulia Issa

There was an informational picket outside of a big event last month, which got a ton of community support. Then the only content the zoo put out for National Zookeepers Week was a single post about how much gratitude the staff are owed, which... hmmmm, came off a little tone-deaf in the current moment.

Now it looks like staff might end up striking to make their point, after almost a year of negotiations.

"Workers at Woodland Park Zoo, who are members of the Joint Crafts Council (JCC) Coalition of Unions, have been making plans to protect the animals if they go on strike. If the group of 200 workers is unable to reach an agreement with their employer over a new contract, they say they will run a skeleton crew that would provide necessary care to the animals but require the Zoo to close its doors to the general public. “We are making contingency plans to ensure the continued well-being of the animals if we are forced to strike,” said Janel Kempf, a learning coordinator who has been with the Zoo for 25 years and is a Shop Steward with Teamsters 117. “A strike is an absolute last resort and one that none of us takes lightly, but the Zoo keeps pushing us in that direction. If the Zoo doesn’t change course soon, we will have no other choice than to withhold our labor.” Negotiations between the Coalition of Unions and the Zoo have been ongoing for the last ten months with workers growing increasingly frustrated at what they say is the Zoo’s failure to value and retain an experienced workforce. “We are hemorrhaging critical animal care experience which directly affects the standard of care we can provide for our animals,” said Allison Cloud, an animal keeper and member of Teamsters 117. “The Zoo is forcing us to choose between our livelihoods and our animals, a heartbreaking decision no zookeeper ever wants to make.” Workers say low wages, the skyrocketing cost of healthcare, low morale, and high turnover have put the Zoo’s AZA accreditation at risk. Loss of accreditation could cripple the Zoo’s resources and lead to the transfer of animals to other accredited facilities. "Woodland Park Zoo cannot maintain AZA accreditation without us,” said Joe Gallenbach, an Exhibit Technician with IATSE Local 15. “The loss of AZA accreditation would demonstrate catastrophic mismanagement on the part of the Woodland Park Zoological Society.” The Coalition of Unions and the Zoo have one more bargaining session on the calendar: Friday, August 9. If the Zoo does not make an acceptable proposal next Friday, workers say they will take their case for fair wages and benefits to the public through direct, concerted action."

Now, when you bring the risk of AZA accreditation loss into the conversation, things get interesting. I've written before about how some zoos are legally or contractually obligated to maintain AZA accreditation and couldn't choose to leave. Woodland Park Zoo is one of those facilities: the agreement with the city that allows the Woodland Park Zoological Society requires them to be AZA accredited. If they lose it, they default on the agreement.

So, would there actually be a chance the facility could lose accreditation if the staff struck? I couldn't find any recent information about staff at other AZA zoos striking and how it related to their accreditation cycle, but I did find this, in an AZA press release about how the Aquarium of the Bay lost accreditation a few months ago.

"Silver Spring, Md. (May 24, 2024) –  The Association of Zoos and Aquariums (AZA) Accreditation Commission unanimously voted to rescind the accreditation of the Aquarium of the Bay.  The independent Commission notified the institution on May 13, 2024, following its conclusion that the aquarium was not meeting accreditation standards in a number of key areas, including financial stability, staffing capabilities, and employee morale and turnover. Aquarium of the Bay has until June 13 to appeal the Commission’s decision."

So it looks like staffing issues and employee morale can definitely be things taken into consideration. Let's look at the AZA standards for more info. I found a couple standards that appear to be relevant:

7.3 "There must be an adequate number of trained paid and unpaid staff to care for the animals and to manage the institution’s diverse programs." Justification: "Although there is no set formula for prescribing the size of the staff (paid and unpaid), some of the criteria that may be used to define what is considered “adequate” include the number and type of species within the institution, the general condition of the animals and exhibits, and past staffing practices."

7.4 "Compensation for paid staff should be competitive with other similar positions in the local/regional/national market, as appropriate." Justification: "Institutions must be able to recruit and retain qualified paid staff. Competitive compensation is a key component in recruitment and retention of paid staff. Some positions can be successfully recruited for locally, while others are competitive on a more regional or national basis (e.g., animal care specialists)."

Both of those look like they could quite reasonably be an issue for WPZ at this point. They're losing paid staff due to low wages and operating understaffed due to the hiring freeze. Staff obviously aren't getting appropriate compensation if they're looking for jobs at nearby facilities that pay better.

Now, would the zoo actually lose accreditation if a strike came to pass? Honestly, I doubt it, because WPZ is too big a feather in AZA's cap for them to penalize them that harshly. Columbus - an equally prominent institution - got kicked because of a major public animal use scandal, but it was pretty clearly political because of how quickly they were re-accredited. I'd expect AZA might give WPZ a slap on the wrist, some stern public comment, maybe some minor penalties, but I'd be very surprised if they were willing to kick WPZ to the curb over something "just" as minor as a staffing problem.

Regardless, zoo staff deserve to be paid a living wage. I'll be really sad if the zoo is closed to a strike once the snow leopard cubs get old enough to debut - but I'd still rather the staff be paid a living wage than be able to see the fluffballs immediately. I want the people working at the zoos I visit to not be living in poverty. Zoo staff pub in an incredible amount of effort to care for animal collections and to facilitate the guest experience, and they should be able to do that without multiple roommates or three jobs. I know that the practical reality is that not all facilities can afford to pay their staff as highly as is ideal, but I'd expect a big zoo with reliable city funding to be able to do better. Supporting the zookeepers (and other zoo staff) is supporting the zoo.

I'll be keeping an eye on this going forward, both from a personal perspective (I'm a member, and I have a vested interest in what the organization I give money to does) and a professional interest in industry politics (what does AZA choose to do). I'll update if there's anything interesting on either end.

[mostlysignssomeportents]

Paying for it doesn't make it a market

I'm touring my new, nationally bestselling novel The Bezzle! Catch me SATURDAY (Apr 27) in MARIN COUNTY, then Winnipeg (May 2), Calgary (May 3), Vancouver (May 4), and beyond!

Anyone who says "If you're not paying for the product, you're the product" has been suckered in by Big Tech, whose cargo-cult version of markets and the discipline they impose on companies.

Here's the way that story goes: companies that fear losing your business will treat you better, because treating you worse will cost them money. Since ad-supported media gets paid by advertisers, they are fine with abusing you to make advertisers happy, because the advertiser is the customer, and you are the product.

This represents a profound misunderstanding of how even capitalism's champions describe its workings. The purported virtue of capitalism is that it transforms the capitalist's greed into something of broad public value, by appealing to the capitalist's fear. A successful capitalist isn't merely someone figures out how to please their customers – they're also someone who figures out how to please their suppliers.

That's why tech platforms were – until recently – very good to (some of) their workforce. Technical labor was scarce and so platforms built whimsical "campuses" for tech workers, with amenities ranging from stock options to gourmet cafeterias to egg-freezing services for those workers planning to stay at their desks through their fertile years. Those workers weren't the "customer" – but they were treated better than any advertiser or user.

But when it came to easily replaced labor – testers, cleaning crew, the staff in those fancy cafeterias – the situation was much worse. Those workers were hired through cut-out shell companies, denied benefits, even made to enter via separate entrances on shifts that were scheduled to minimize the chance that they would ever interact with one of the highly paid tech workers at the firm.

Likewise, advertisers may be the tech companies' "customers" but that doesn't mean the platforms treat them well. Advertisers get ripped off just like the rest of us. The platforms gouge them on price, lie to them about advertising reach, and collude with one another to fix prices and defraud advertisers:

https://pluralistic.net/2020/10/05/florida-man/#wannamakers-ghost

Now, it's true that the advertisers used to get a good deal from the platforms, and that it came at the expense of the users. Facebook lured in users by falsely promising never to spy on them. Then, once the users were locked in, Facebook flipped a switch, started spying on users from asshole to appetite, and then offered rock-bottom-priced, fine-grained, highly reliable ad-targeting to advertisers:

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3247362

But once those advertisers were locked in, Facebook turned on them, too. Of course they did. The point of monopoly power isn't just getting too big to fail and too big to jail – it's getting too big to care:

https://pluralistic.net/2024/04/04/teach-me-how-to-shruggie/#kagi

This is the thing that "if you're not paying for the product, you're the product" fails to comprehend. "If you're not paying for the product" is grounded in a cartoonish vision of markets in which "the customer is king" and successful businesses are those who cater to their customers – even at the expense of their workers and suppliers – will succeed.

In this frame, the advertiser is the platforms' customer, the customer is king, the platform inflicts unlimited harm upon all other stakeholders in service to those advertisers, the advertisers are so pleased with this white-glove service that they willingly pay a handsome premium to use the platform, and so the platform grows unimaginably wealthy.

But of course, if the platforms inflict unlimited harms upon their users, those users will depart, and then no amount of obsequious catering to advertisers will convince them to spend money on ads that no one sees. In the cargo-cult conception of platform capitalism, the platforms are able to solve this problem by "hacking our dopamine loops" – depriving us of our free will with "addictive" technologies that keep us locked to their platforms even when they grow so terrible that we all hate using them.

This means that we can divide the platform economy into "capitalists" who sell you things, and "surveillance capitalists" who use surveillance data to control your mind, then sell your compulsive use of their products to their cherished customers, the advertisers.

Surveillance capitalists like Google are thus said to have only been shamming when they offered us a high-quality product. That was just a means to an end: the good service Google offered in its golden age was just bait to trick us into handing over enough surveillance data that they could tune their mind-control technology, strip us of our free will, and then sell us to their beloved advertisers, for whom nothing is too good.

Meanwhile, the traditional capitalists – the companies that sell you things – are the good capitalists. Apple and Microsoft are disciplined by market dynamics. They won't spy on you because you're their customer, and so they have to keep you happy.

All this leads to an inexorable conclusion: unless we pay for things with money, we are doomed. Any attempt to pay with attention will end in a free-for-all where the platforms use their Big Data mind-control rays to drain us of all our attention. It is only when we pay with money that we can dicker over price and arrive at a fair and freely chosen offer.

This theory is great for tech companies: it elevates giving them money to a democracy-preserving virtue. It reframes handing your cash over to a multi-trillion dollar tech monopolist as good civics. It's easy to see why those tech giants would like that story, but boy, are you a sap if you buy it.

Because all capitalists are surveillance capitalists…when they can get away with it. Sure, Apple blocked Facebook from spying on Ios users…and then started illegally, secretly spying on those users and lying about it, in order to target ads to those users:

https://pluralistic.net/2022/11/14/luxury-surveillance/#liar-liar

And Microsoft spies on every Office 365 user and rats them out to their bosses ("Marge, this analytics dashboard says you're the division's eleventh-worst speller and twelfth-worst typist. Shape up or ship out!"). But the joke's on your boss: Microsoft also spies on your whole company and sells the data about it to your competitors:

https://pluralistic.net/2020/11/25/the-peoples-amazon/#clippys-revengel

The platforms screw anyone they can. Sure, they lured in advertisers with good treatment, but once those advertisers were locked in, they fucked them over just as surely as they fucked over their users.

The surveillance capitalism hypothesis depends on the existence of a hypothetical – and wildly improbably – Big Data mind-control technology that keeps users locked to platforms even when the platform decays. Mind-control rays are an extraordinary claim supported by the thinnest of evidence (marketing materials from the companies as they seek to justify charging a premium to advertisers, combined with the self-serving humblebrags of millionaire Prodigal Tech Bros who claim to have awakened to the evil of using their dopamine-hacking sorcerous powers on behalf of their billionaire employers).

There is a much simpler explanation for why users stay on platforms even as they decline in quality: they are enmeshed in a social service that encompasses their friends, loved ones, customers, and communities. Even if everyone in this sprawling set of interlocking communities agrees that the platform is terrible, they will struggle to agree on what to do about it: where to go next and when to leave. This is the economists' "collective action problem" – a phenomenon with a much better evidentiary basis than the hypothetical, far-fetched "dopamine loop" theory.

To understand whom a platform treats well and whom it abuses, look not to who pays it and who doesn't. Instead, ask yourself: who has the platform managed to lock in? The more any stakeholder to a platform stands to lose by leaving, the worse the platform can treat them without risking their departure. Thus the beneficent face that tech companies turn to their most cherished tech workers, and the hierarchy of progressively more-abusive conditions for other workers – worse treatment for those whose work-visas are tied to their employment, and the very worst treatment for contractors testing the code, writing the documentation, labelling the data or cleaning the toilets.

If you care about how people are treated by platforms, you can't just tell them to pay for services instead of using ad-supported media. The most important factor in getting decent treatment out of a tech company isn't whether you pay with cash instead of attention – it's whether you're locked in, and thus a flight risk whom the platform must cater to.

It's perfectly possible for market dynamics to play out in a system in which we pay with our attention by watching ads. More than 50% of all web users have installed an ad-blocker, the largest boycott in the history of civilization:

https://doc.searls.com/2023/11/11/how-is-the-worlds-biggest-boycott-doing/

Ad-supported companies make an offer: How about in exchange for looking at this content, you let us spy on you in ways that would make Orwell blush and then cram a torrent of targeted ads into your eyeballs?" Ad-blockers let you make a counter-offer: "How about 'nah'?"

https://www.eff.org/deeplinks/2019/07/adblocking-how-about-nah

But ad-blocking is only possible on an open platform. A closed, locked-down platform that is illegal to modify isn't a walled garden, a fortress that keeps out the bad guys – it's a walled prison that locks you in, a prisoner of the worst impulses of the tech giant that built it. Apple can defend you from other companies' spying ways, but when Apple decides to spy on you, it's a felony to jailbreak your Iphone and block Apple's surveillance:

https://pluralistic.net/2023/02/05/battery-vampire/#drained

I am no true believer in markets – but the people who say that paying for products will "align incentives" and make tech better claim to believe in the power of markets to make everyone better off. But real markets aren't just places where companies sell things – they're also places where companies buy things. Monopolies short-circuit the power of customer choice to force companies to do better. But monopsonies – markets dominated by powerful buyers – are just as poisonous to the claimed benefits of markets.

Even if you are "the product" – that is, even if you're selling your attention to a platform to package up and sell to an advertiser – that in no way precludes your getting decent treatment from the platform. A world where we can avail ourselves of blockers, where interoperablity eases our exodus from abusive platforms, where privacy law sets a floor below which we cannot bargain is a world where it doesn't matter if you're "the product" or "the customer" – you can still get a square deal.

The platforms used to treat us well and now treat us badly. That's not because they were setting a patient trap, luring us in with good treatment in the expectation of locking us in and turning on us. Tech bosses do not have the executive function to lie in wait for years and years.

Rather, as tech platforms eliminated competition, captured their regulators and expanded their IP rights so that interoperability was no longer a threat, they became too big to care whether any of their stakeholders were happy. First they came for the users, sure, but then they turned on the publishers, the advertisers, and finally, even their once-pampered tech workers:

https://pluralistic.net/2023/09/10/the-proletarianization-of-tech-workers/

MLK said that "the law can't make a man love me, but it can stop him from lynching me." It's impossible to get tech bosses to believe you deserve care and decency, but you can stop them from abusing you. The way to do that is by making them fear you – by abolishing the laws that create lock-in, by legally enshrining a right to privacy, by protecting competition.

It's not by giving them money. Paying for a service does not make a company fear you, and anyone who thinks they can buy a platform's loyalty by paying for a service is a simp. A corporation is an immortal, transhuman colony organism that uses us as inconvenient gut-flora: no matter how much you love it, it will never love you back. It can't experience love – only fear.

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2024/04/22/kargo-kult-kaptialism/#dont-buy-it

[mortuarybees]

I don't want to set unrealistic expectations for folks, not every union will be able to win things like a $42/hour wage. That has to do with the strength of the teamsters and the outrageous profits ups has seen in recent years. I'm union and I don't even make half that, but before our new contract (which we were able to win because we have had a surge of new members and activism within the union) I made even less. But beyond that we have been able to win things specific to our work, like compensation for speaking multiple languages, training new staff during our regular shifts, additional sick time, and a new, fairer, standardized system for requesting time off.

A union also offers you protection, it's pretty standard to my understanding that you have a right for a steward be present with you for any disciplinary meeting with management, and through the union's intervention, we were able to get severance when we were laid off last year with a week's notice when management planned to offer us nothing, and I also gained priority when I applied to other positions at the company, which is why I'm still fortunate enough to be part of this amazing union. Being part of a union doesn't make your workplace perfect, and a union requires work and involvement--it doesn't happen in the background, its strength comes from the commitment of everyone in it--and it can ask a lot of you if you are someone who's willing to be more involved.

But I think something my generation can barely fathom is the concept of being at a workplace for years and years and years, something that was so common for our grandparents. It's virtually impossible to do it and it's not even desirable; most places are a revolving door of dissatisfied, overworked staff and I think a lot of people have experienced working at a place and every single one of your coworkers turning over by the time youre fed up with the poor conditions and treatment and leave for another job where the same thing happens. Through a union, though, you can shape a place you want to stay at for a long time, or shape a place you care about and make it better for people who will be there after you. Union employees are more likely to stay at our workplace for longer, we form a stronger community at our site. We're better paid, get better benefits, and have an avenue to shape the place we spend so much of our lives. We aren't powerless. Yes, something like $25 is taken out of all my paychecks, but I think to anyone in this nightmare of a workforce, that has to sound well worth it for all the benefits being part of a union gives you and your coworkers.

[kp777]

By Jessica Corbett

Common Dreams

March 20, 2024

"Trump has tried to walk back his support for Social Security and Medicare cuts," said the head of Social Security Works. "This budget is one of many reasons why no one should believe him."

Defenders of Social Security and Medicare on Wednesday swiftly criticized the biggest caucus of Republicans in the U.S. House of Representatives for putting out a budget proposal for fiscal year 2025 that takes aim at the crucial programs.

The 180-page "Fiscal Sanity to Save America" plan from the Republican Study Committee (RSC) follows the release of proposals from Democratic President Joe Biden and U.S. House Budget Committee Chair Jodey Arrington (R-Texas)—who is leading the fight to create a fiscal commission for the programs that critics call a "death panel" designed to force through cuts.

The RSC document features full sections on "Saving Medicare" and "Preventing Biden's Cuts to Social Security," which both push back on the president's recent comments calling out Republican attacks on the programs that serve seniors.

The caucus plan promotes premium support for Medicare Advantage plans administered by private health insurance providers as well as changes to payments made to teaching hospitals. For Social Security, the proposal calls for tying retirement age to rising life expectancy and cutting benefits for younger workers over certain income levels, including phasing out auxiliary benefits.

The document also claims that the caucus budget "would promote trust fund solvency by increasing payroll tax revenues through pro-growth tax reform, pro-growth energy policy that lifts wages, work requirements that move Americans from welfare to work, and regulatory reforms that increase economic growth."

In a lengthy Wednesday statement blasting the RSC budget, Social Security Works president Nancy Altman pointed out that last week, former President Donald Trump, the presumptive Republican nominee to face Biden in the November election, "toldCNBC that 'there's a lot you can do' to cut Social Security."

"Everyone who cares about the future of these vital earned benefits should vote accordingly in November."

"Now, congressional Republicans are confirming the party's support for cuts—to the tune of $1.5 trillion. They are also laying out some of those cuts," Altman said. "This budget would raise the retirement age, in line with prominent Republican influencer Ben Shapiro's recent comments that 'retirement itself is a stupid idea.' It would make annual cost-of-living increases stingier, so that benefits erode over time. It would slash middle-class benefits."

"Perhaps most insultingly, given the Republicans' claim to be the party of 'family values,' this budget would eliminate Social Security spousal benefits, as well as children's benefits, for middle-class families. That would punish women who take time out of the workforce to care for children and other loved ones," she continued. "This coming from a party that wants to take away women's reproductive rights!"

The caucus, chaired by Rep. Kevin Hern (R-Okla.), included 285 bills and initiatives from 192 members in its budget plan—among them are various proposals threatening abortion care, birth control, and in vitro fertilization (IVF) nationwide.

"The RSC budget would also take away Medicare's new power to negotiate lower prices on prescription drugs, putting more money into the pockets of the GOP's Big Pharma donors," Altman warned. "And it accelerates the privatization of Medicare, handing it over to private insurance companies who have a long history of ripping off the government and delaying and denying care to those who need it."

"In recent days, Trump has tried to walk back his support for Social Security and Medicare cuts," she noted. "This budget is one of many reasons why no one should believe him. The Republican Party is the party of cutting Social Security and Medicare, while giving tax handouts to billionaires."

"The Democratic Party is the party of expanding Social Security and Medicare, paid for by requiring the ultrawealthy to contribute their fair share," Altman added. "Everyone who cares about the future of these vital earned benefits should vote accordingly in November."

Biden campaign communications director Michael Tyler also targeted the Republican presidential candidate while slamming the RSC plan, saying that "Donald Trump's MAGA allies in Congress made it clear today: A vote for Trump is a vote to make the MAGA 2025 agenda of cutting Social Security, ripping away access to IVF, and banning abortion nationwide a hellish reality."

"While Trump and his allies push forward their extreme agenda, the American people are watching," Tyler added, suggesting that the RSC proposal will help motivate voters to give Biden and Vice President Kamala Harris four more years in the White House.

[feminismisstillahatemovement]

Over the past few months, we’ve watched as major corporations such as Disney , Anheuser-Busch, and Target have hopped on the LGBT train and alienated their traditional client bases as a result. Regardless of the often swift and brutal backlash they know will follow, others, including North Face, Nike, and Kohl’s, are always waiting in the wings to become the next sacrificial lamb.

It turns out there’s a reason for this counterintuitive behavior that goes far beyond virtue signaling: Companies are trying to raise their Corporate Equality Index. The more woke issues a company supports, the higher their score.

A CEI is essentially a “woke” credit score that is determined by the Human Rights Campaign , a 501(c)(4) organization that describes itself as “the largest LGBTQ political lobbying organization within the United States.” No one will be surprised to hear that George Soros’s Open Society Foundations is HRC’s largest donor. Other donors include the Planned Parenthood Federation of America and the labor unions for the National Education Association and the United Food and Commercial Workers, according to Influence Watch .

Influence Watch reports HRC’s public charity arm, the Human Rights Campaign Foundation, plays an influential role in Democratic Party politics by pressuring companies to comply with its social agenda.

A company’s CEI is derived from its performance in five areas :

Workforce Protections (5 points possible).

Inclusive Benefits (50 points possible).

Supporting an Inclusive Culture (25 points possible).

Corporate Social Responsibility (20 points possible).

Responsible Citizenship (-25).

The New York Post reports that “HRC sends representatives to corporations every year telling them what kind of stuff they have to make visible at the company. They give them a list of demands and if they don’t follow through there’s a threat that you won’t keep your CEI score.”

James Lindsay, editor of the website New Discourses, told the New York Post, “HRC administers the CEI ranking ‘like an extortion racket, like the Mafia.’”

In a 2018 letter to CEOs from BlackRock CEO Larry Fink, whom Fortune magazine has dubbed the “ face of ESG ,” he emphasizes a “new model of governance” in harmony with ESG values.

Fink wrote , “Society is demanding that companies, both public and private, serve a social purpose. To prosper over time, every company must not only deliver financial performance, but also show how it makes a positive contribution to society. … [I]f a company doesn’t engage with the community and have a sense of purpose, it will ultimately lose the license to operate from key stakeholders.”

Fink is mistaken. Society is not demanding that companies serve a social purpose. Rather, ESG is being forced upon society by the global elites who wield it as a weapon and a control mechanism they can use to consolidate power over the masses.

[zvaigzdelasas]

[The East African is Kenyan Private Media]

The United States has officially struck off Uganda and three other African countries as beneficiaries of the African Growth and Opportunity Act (Agoa), effectively ending Kampala’s ability to export certain commodities to the US duty-free.

In a decree dated December 29, President Joe Biden said he had “determined” that the four countries “do not meet the requirements” necessary to allow them to continue benefiting from the trade deal, effecting his earlier stated plans to delist them.

“Accordingly, I have decided to terminate the designations of the Central African Republic, Gabon, Niger, and Uganda as beneficiary sub-Saharan African countries for purposes of section 506A of the Trade Act, effective January 1, 2024,” read the statement by the US President.

In an October 2023 letter to the speaker of the US Congress expressing his intention to remove the four countries from the list of Agoa beneficiaries, Mr Biden said Uganda has “engaged in gross violations of internationally recognised human rights.”

This came after President Yoweri Museveni assented to the anti-gay law passed by the Ugandan lawmakers, which introduced serious repercussions, including life imprisonment or death, for same-sex relations in the country.

Uganda’s expulsion from the deal could destroy thousands of jobs, cause a foreign-exchange earnings drought, and low utilisation of raw materials locally, experts have warned.[...]

Over 80 percent of Uganda’s exports under Agoa were from the agricultural sector, which employs about 72 percent of the country’s workforce, indicating that the expulsion could have a significant hit on jobs.[...]

In the region, Uganda now joins South Sudan, Somalia, and Burundi on the list of countries unable to benefit from the preferential trade agreement with the US. Juba was suspended in 2015 due to the rise of ethnic conflicts.

Other countries in sub-Saharan Africa that have been removed from the list are Ethiopia, Guinea, Mali, Gabon, Cameroon, Burkina Faso, The Gambia, Central African Republic, [Niger,] Zimbabwe and Sudan.

2 Jan 24

[lostinpleasantview]

Sick? Injured? Unable to work? Pleasantview's new Benefit and Employment Center is here to help. Recently launched as the flagship of Mayor Hatfield's Uplift Initiative as part of her Ten Point Economic Plan, with the goal of simplifying and streamlining access to social benefits for eligible Sims while providing access to the tools for Sims to reenter the workforce on their own terms. Childcare is provided for applicants while they are onsite. Supporters of Mayor Hatfield's Uplift Initiative claim that these new Benefit and Employment Centers will assist those most in need—such as single parents with young children. Opponents claim the opposite—claiming bombastically that the mayor is merely coddling Pleasantview's dregs er, citizens—and that these so-called benefit centers will breed a new culture of moochers and layabouts.

City Councilman Ambrose Elias Patooty IV, noted curmudgeon and centenarian stated in a comment to Pleasantview News Center (PVNC) that: "Once again, Mayor Hatfield has shown the citizens of Pleasantview that she is a tax and spend liberal like her bedfellows within the... whatever party she's part of! Today she hands out money to all those who ask for it; tomorrow she will give homosexual amphibians the same rights as you and I! It is OUR children—well, not MY children, my children are grown and have the benefit of a trust fund—who shall foot the bill down the line for the mayor's so-called generosity. There is nothing wrong with grit and hard work! Our citizens don't need a handout, what they need is for Mayor Hatfield to reopen the MINES! ...What do you mean, the mines closed down eighty years ago? I have no idea what you're talking about. Who are you and why are you in my office?"

[vren-diagram]

The Nordic model has been characterized as follows:[16]

An elaborate social safety net, in addition to public services such as free education and universal healthcare[16] in a largely tax-funded system.[17]

Strong property rights, contract enforcement and overall ease of doing business.[18]

Public pension plans.[16]

High levels of democracy as seen in the Freedom in the World survey and Democracy Index.[19][20]

Free trade combined with collective risk sharing (welfare social programmes and labour market institutions) which has provided a form of protection against the risks associated with economic openness.[16]

Little product market regulation. Nordic countries rank very high in product market freedom according to OECD rankings.[16]

Low levels of corruption.[19][16] In Transparency International's 2019 Corruption Perceptions Index, Denmark, Finland, Norway and Sweden were ranked among the top 10 least corrupt of the 179 countries evaluated.[21]

A partnership between employers, trade unions and the government, whereby these social partners negotiate the terms to regulating the workplace amongst themselves, rather than the terms being imposed by law.[22][23] Sweden has decentralised wage co-ordination while Finland is ranked the least flexible.[16] The changing economic conditions have given rise to fear among workers as well as resistance by trade unions in regards to reforms.[16]

High trade union density and collective bargaining coverage.[24] In 2019, trade union density was 90.7% in Iceland, 67.0% in Denmark, 65.2% in Sweden, 58.8% in Finland, and 50.4% in Norway; in comparison, trade union density was 16.3% in Germany and 9.9% in the United States.[25] Additionally, in 2018, collective bargaining coverage was 90% in Iceland, 88.8% in Finland (2017), 88% in Sweden, 82% in Denmark, and 69% in Norway; in comparison collective bargaining coverage was 54% in Germany and 11.7% in the United States.[26] The lower union density in Norway is mainly explained by the absence of a Ghent system since 1938. In contrast, Denmark, Finland and Sweden all have union-run unemployment funds.[27]

The Nordic countries received the highest ranking for protecting workers rights on the International Trade Union Confederation 2014 Global Rights Index, with Denmark being the only nation to receive a perfect score.[28]

Sweden at 56.6% of GDP, Denmark at 51.7%, and Finland at 48.6% reflect very high public spending.[29] Public expenditure for health and education is significantly higher in Denmark, Norway, and Sweden in comparison to the OECD average.[30]

Overall tax burdens as a percentage of GDP are high, with Denmark at 45.9% and both Finland and Sweden at 44.1%.[31] The Nordic countries have relatively flat tax rates, meaning that even those with medium and low incomes are taxed at relatively high levels.[32][33]

The United Nations World Happiness Reports show that the happiest nations are concentrated in Northern Europe. The Nordics ranked highest on the metrics of real GDP per capita, healthy life expectancy, having someone to count on, perceived freedom to make life choices, generosity and freedom from corruption.[34] The Nordic countries place in the top 10 of the World Happiness Report 2018, with Finland and Norway taking the top spots.[35]

x

I think a lot of people are missing that the Nordic model is:

generally very friendly to businesses

composed of largely organically set standards (workers rights secured by collective bargaining and trade-unions, not by a centralized authority) (as opposed to a centralized bureaucracy)

Largely structured to provide citizens with benefits that make workforce participation easier. The ordering of the social safety net and welfare state make it relatively easy to upskill and hold a job.

[covid-safer-hotties]

A better approach to mitigate the risk of airborne infections in workplaces - Published Sept 13, 2024

A ‘let them rip’ attitude towards the mitigation of the risk of common airborne infections in the workplace is unacceptable in terms of law, good occupational medicine practice and public health. A proactive strategy underpinned by a better paradigm is urgently needed for the benefit of society and especially to protect those vulnerable through significant exposure or those susceptible for reasons such as co-morbidity. Even if the will to do what is needed at a national level remains lacking, forward-looking workplaces and other stakeholders should still take proactive steps to mitigate the risk of airborne infection. Thus they would fulfil the duty of care to workers and others as well as improve the resilience and productive potential of workplaces.

In 2010, this journal highlighted the potential challenge of a pandemic in the ensuing decade [1] and so it came to pass. During the peak of the pandemic, ‘Occupational Medicine’ played its part both in disseminating new knowledge and in expressing authoritative opinion. Looking to the future, many observers are awaiting cues from the outcomes of the coronavirus disease 2019 (COVID-19) Public Inquiry. The Module 1 report showed that the UK Government failed its citizens with its lack of preparation or a preventive strategy [2]. The report also emphasized the need to build resilience in government, associated institutions and their plans, but it has yet to address the resilience built into traditional occupational health control measures such as ventilation [3]. Module 3 [4] might address these measures but the limitations of the Inquiry could disappoint those concerned with workplace health, such as by addressing only health and social care workplaces (HSCW). Analyses of ‘lessons learned’ from COVID-19 [5–7] indicate various but sufficient reasons to eschew attitudes of ‘living with the virus’ or of reversion to ‘business as usual’ when facing common airborne infections at work such as coronaviruses, influenza and respiratory syncytial virus (RSV).

Several studies attest to the increased risk of COVID-19 for many workers besides in HSCW [8]. Long COVID has had a profound impact on the UK’s workforce and economy [9]. Regrettably, the UK Government has considerably scaled down COVID-19 monitoring. Despite this, the data show persistent significant COVID-19 infection with recurrent waves, fuelled both by waning immunity and by new variants, and which are not limited to the winter during which seasonal influenza and RSV also contribute significantly [10]. Perhaps unsurprisingly in 2022, the UK sickness absence rate rose to 2.6% (the highest since 2004) [11]. The contribution of airborne infections to this absence may be variously coded as ‘minor illnesses’ (includes coughs, colds and flu), ‘other’ (includes coronavirus and infectious diseases) as well as ‘respiratory conditions’- comprising, respectively, 29%, 24% and 8% of the total sickness absence occurrences in 2022 [11]. Measures to reduce the risk of contracting airborne infections should, therefore, contribute to any strategy to reduce sickness absence and presenteeism and thus to improve productivity and benefit the economy. However, better data collection and analyses are needed for the quantification of the employment cost of common airborne infections in workplaces, as well as for monitoring interventions.

The COVID-19 pandemic has illustrated both the legal duty and the means for employers to ensure, so far as is reasonably practicable, the health at work of all their employees by reducing their exposure to a common airborne infection at work [12]. Similarly, employers are also obliged to ensure that other persons who may be affected are not exposed to risks to their health from the work being undertaken [12]. These could include children at school, passengers using public transport, the public in retail premises and hospitality venues, as well as in hospitals where the risk and burden of transmission are perhaps most obvious [13]. Schools, catering establishments and hospitals need to tackle the risk of airborne infection with the same commitment with which they currently address infestations, food hygiene and wound infection, respectively. Special considerations also apply to protect individuals who are more susceptible, according to Equality law [12,14].

On the basis of extant knowledge [6,7], if a workplace were to be truly ‘health promoting’ [3], then it would have to exceed mere compliance with the law and would have to rise to the challenge of having less exposure to airborne pathogens within the workplace than the average in the community outside. Such an endeavour would contribute to public health through a reduction in the overall incidence of airborne infection and in the pool of replicating and mutating pathogens. It would also make workplaces and society much more resilient in the face of the next airborne infection outbreak, especially during the lag period before a reliable vaccine or other pharmaceutical intervention were to become available.

Many might baulk at the challenge of developing a proactive strategy to mitigate the risk of airborne infection in the workplace perhaps because of the ubiquitous exposure throughout the community and the multifactorial contributions to the individual or societal burdens. However, the occupational health community has successfully dealt with analogous heterogeneous and complex challenges through a combination of good science and good policy in the past. The development and successful implementation of the Health and Safety Executive’s (HSE) ‘Tackling work-related stress using the Management Standards approach’ with its emphasis on prevention is an excellent example [15]. Such a national strategic approach would require widespread and systematic consultation involving a range of stakeholders such as regulators, notably the HSE, researchers, practitioners, workers’ representatives and employers. Extensive collaboration would be needed for the background research and development as well as to monitor the implementation of the strategy. The multiple actions that would result might include an ‘Approved Code of Practice’ or an approach as in the ‘Management Standards’ [15].

Whilst it might be premature to pre-empt the conclusion of the development of such broad-based and wide-ranging initiatives, some considerations regarding a better paradigm for mitigating airborne infection risk in the workplace can already be highlighted on the basis of current evidence. The traditional ‘hierarchy of control’ as applied to airborne hazards needs adaptation for airborne infection hazards (e.g. the hazard is not amenable to substitution) and a ‘source/pathway/receptor’ approach is better suited [16,17]. Although the World Health Organisation had a flawed position which denied airborne transmission from the onset of the COVID-19 pandemic [17], it has progressed and is developing risk assessment tools for ‘aerosolized infectious respiratory particles’ [18].

Lessons learnt during the pandemic regarding source control [17] such as ‘working from home’ would need to be built into codes of practice. Moreover, evidence needs to be reviewed, for example, regarding the extent to which respirators can limit transmission from infected people [19] since such mitigation could protect health workers exposed to the source [17,19] or help them fulfil legal duties [12,14] towards susceptible patients or co-workers. However, the main emphasis would have to be on pathway control to reduce exposure to airborne pathogens through building design and engineering means notably ventilation ‘as a primary tool for controlling transmission of respiratory pathogens’ [6,7] and other measures such as germicidal ultraviolet light [6]. These measures would likely need supplementation by statutory air quality standards [20] as surrogates for pathogen exposure—analogous to the long-standing but specific exposure limits for airborne chemical agents. Thus society would progressively achieve a ‘clean air revolution’ in workplaces, through a structural engineered resilience. This would add a much-needed dimension to the resilience [2] of institutions and organizations in response to a pandemic. The best efforts in controlling the sources and pathways of transmission of airborne pathogens should reduce the need for personal protection of the ‘receptor’, notably respiratory protective equipment [3,19] as the first or main line of defence. Guidance would be needed as to the role of specific types of respirators such as facepieces or powered devices [3], especially when they might remain indispensable during high exposure in the ‘near field’ [5,17]. The Joint Committee on Vaccination and Immunisation [21] is refraining from advising on occupational health vaccination programmes and is deferring this consideration to HSCW employers. Therefore, it is incumbent on the relevant regulator, that is, the HSE, in consultation with stakeholders to include vaccination guidance as part of a national mitigation strategy.

The development and application of a national strategy to individual workplaces would rely heavily on a range of disciplines from microbiology to engineering. However, implementation in workplaces would be driven mainly by occupational health professionals such as hygienists and physicians as they have long-standing competencies and experience in applying control measures for airborne hazards [3] ranging from asbestos and crystalline silica to Legionella and Mycobacteria. The COVID-19 pandemic taught us that the uncritical application of fallacious public health guidance resulted in a lack of protection for workers [5,17,22] as well as others in workplaces such as patients [13] whose airborne exposure is inextricably linked to that of workers. Occupational health standards of control tend to be higher [17] than those in a public health context and can contribute to the good practice of infection control and public health [22] as part of the collaboration between specialists in all these disciplines. Occupational health specialists should be able to advise employers on aspects of employers’ legal obligations including with reference to those in workplaces who are not workers [12] as well as on adjustments relating to susceptible individuals that may be needed to comply with Equality legislation [12,14].

A ‘let them rip’ attitude towards the mitigation of the risk of common airborne infections in the workplace is unacceptable in terms of law, good occupational medicine practice and public health. A proactive strategy underpinned by a better paradigm is urgently needed for the benefit of society and especially to protect those vulnerable through significant exposure or those susceptible for reasons such as co-morbidity. Even if the will to do what is needed at a national level remains lacking, forward-looking workplaces and other stakeholders should still take proactive steps to mitigate the risk of airborne infection. Thus they would fulfil the duty of care to workers and others as well as improve the resilience and productive potential of workplaces.

References 1. Agius R. Occupational medicine in the first decade of this millennium: looking to the future. Occup Med 2010;60:585–588.

2. UK Covid-19 Inquiry. Module 1: The Resilience and Preparedness of the United Kingdom. 2024. A Report by the Rt Hon the Baroness Hallett DBE Chair of the UK Covid-19 Inquiry. 2024. covid19.public-inquiry.uk/wp-content/uploads/2024/07/18095012/UK-Covid-19-Inquiry-Module-1-Full-Report.pdf (19 July 2024, date last accessed).

3. Agius R and Seaton A. Reduction of the risks of work-related ill-health & health promotion in the workplace. In: Agius R, Seaton A. eds. Practical Occupational Medicine. 2nd edn. London: Hodder Arnold, 2006; 129–160 and 253–269.

4. UK Covid-19 Inquiry. Module 3 Provisional Outline of Scope. 2022. covid19.public-inquiry.uk/wp-content/uploads/2023/05/Module-3-Provisional-Outline-of-Scope-in-English.pdf (22 July 2024, date last accessed).

5. Agius R. COVID-19 in workplace settings: lessons learned for occupational medicine in the UK. Med Lav 2023;114:e2023055.

6. Marr LC, Samet JM. Reducing transmission of airborne respiratory pathogens: a new beginning as the COVID-19 emergency ends. Environ Health Perspect 2024;132:55001.

7. Morawska L, Li Y, Salthammer T. Lessons from the COVID-19 pandemic for ventilation and indoor air quality. Science 2024;385:396–401. www.science.org/doi/10.1126/science.adp2241

8. Burdorf A, Rugulies R. The importance of occupation in the development of the COVID-19 pandemic. Scand J Work Environ Health 2023;49:231–233.

9. Reuschke D, Houston D. The impact of Long COVID on the UK workforce. Appl Econ Letters 2022;30:2510–2514.

10. UK Health Security Agency. UKHSA Data Dashboard. ukhsa-dashboard.data.gov.uk/ (19 July 2024, date last accessed).

11. Office for National Statistics. Sickness Absence in the UK Labour Market: 2022. 2023. www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2022/pdf (19 July 2024, date last accessed).

12. Agius RM, Kloss D, Kendrick D, Stewart M, Robertson JFR. Protection from covid-19 at work: health and safety law is fit for purpose. BMJ 2021;375:n3087.

13. Cooper BS, Evans S, Jafari Y et al. . The burden and dynamics of hospital-acquired SARS-CoV-2 in England. Nature 2023;623:132–138.

14. Pump Court Chambers: Employment and Discrimination Team. Covid-19, Service Providers, and Reasonable Adjustments. www.pumpcourtchambers.com/2024/06/03/does-equality-act-2010-impose-obligations-on-service-providers-in-light-of-covid-19/ (5 August 2024, date last accessed)

15. MacKay CJ, Cousins R, Kelly PJ, Lee S, McCaig RH. ‘Management Standards’ and work-related stress in the UK: policy background and science. Work Stress 2024;18:91–112.

16. McCullough NV, Brosseau LM. Selecting respirators for control of worker exposure to infectious aerosols. Infect Control Hosp Epidemiol 1999;20:136–144.

17. Agius RM. Prevention of COVID-19 in workers: preparation, precaution and protection. Ann. Work Expo Health 2024;68:1–7.

18. World Health Organization. Indoor Airborne Risk Assessment in the Context of SARS-CoV-2: Description of Airborne Transmission Mechanism and METHOD TO develop a New Standardized Model for Risk Assessment. 2024. ISBN 978-92-4-009057-6 iris.who.int/handle/10665/376346 (24 July 2024, date last accessed).

19. Greenhalgh T, MacIntyre CR, Baker MG et al. . Masks and respirators for prevention of respiratory infections: a state of the science review. Clin Microbiol Rev 2024;37:e0012423.

20. Morawska L, Allen J, Bahnfleth W et al. . Mandating indoor air quality for public buildings. Science 2024;383:1418–1420. www.science.org/doi/full/10.1126/science.adl0677

21. Joint Committee on Vaccination and Immunisation. JCVI Statement on the COVID-19 Vaccination Programme for Autumn 2024. 2024. www.gov.uk/government/publications/covid-19-autumn-2024-vaccination-programme-jcvi-advice-8-april-2024/jcvi-statement-on-the-covid-19-vaccination-programme-for-autumn-2024-8-april-2024 (4 August 2024, date last accessed).

22. Godderis L, Lerouge L, Samant Y, Noone P. Lessons learned from the COVID-19 pandemic—what occupational safety and health can bring to public health . J Public Health Pol 2023;44:138–146.

[smartscaliing]

Maximizing Business Success with HR Advisory Services and Employee Management Solutions

In today’s competitive business landscape, companies need to ensure that their employees are managed effectively and in compliance with ever-evolving labor laws. However, not all businesses have the in-house expertise or resources to handle the complexities of human resources (HR). This is where HR advisory services, employee management services, and HR outsourcing companies come into play. These solutions provide businesses with the tools, strategies, and expertise needed to manage their workforce efficiently while also boosting productivity and reducing costs.

[justinspoliticalcorner]

Matt Shuham at HuffPost:

Donald Trump has no greater enemy than the United States’ federal bureaucracy — what he calls the “deep state.” And he has a plan to bend it to his will if he’s elected in November. The plan, to create something called “Schedule F,” would make tens of thousands of civil servants easier to fire, fundamentally changing the nature of the federal government — and, some worry, paving the way for authoritarianism.

Schedule F is a new category, or schedule, of federal workers who are exempt from codified job protections, like being hired and fired based on merit and having the ability to appeal disciplinary action. The majority of federal civil service employees, from climate scientists to bank examiners to IT specialists, are covered by these protections; some positions, like postal workers and intelligence officers, are currently exempt. That system ensures that experience and skill, rather than political favoritism or personal connections, guide hiring and firing decisions within the federal government. But conservatives have long complained that the president should exercise more control over the federal bureaucracy, and Trump in particular has said it needs to be “brought to heel.” Trump created Schedule F in an October 2020 executive order. Under that order, federal workers involved in “confidential, policy-determining, policy-making and policy-advocating positions” — a vague description that would include at least tens of thousands of people — would be stripped of their civil service protections and reclassified as “at-will” appointees, meaning they could be hired or fired for any reason, or none at all.

Because the order came so late in Trump’s presidency, only a handful of agencies created lists of specific jobs that would be eligible for conversion to Schedule F. And President Joe Biden reversed the order before any jobs could actually be converted. But Trump has explicitly said he’ll pursue Schedule F again if he’s elected. In a campaign video last year, Trump referred to Schedule F as an effort to “remove rogue bureaucrats.” “I will wield that power very aggressively,” he said.

Federal employees, political scientists, union leaders and watchdog groups told HuffPost that Schedule F could lead to a “chilling” effect. At-will employment, they said, would make it harder for government workers to raise concerns that go against their bosses’ political loyalties. That could lead to a degradation of public services like disaster relief, financial regulation and the administration of government benefits. “You can see where it can grind work to a halt, because even people who are trying to do the right thing [would] be afraid that if they do something wrong, they’ll be out of a job,” said Joe Spielberger, a policy counsel at the Project on Government Oversight who has raised alarms over how the implementation of Schedule F would harm key welfare programs like Social Security, Medicare and Medicaid. Schedule F would be the “fundamental element of an authoritarian agenda,” he said, allowing Trump to take control of the vast federal bureaucracy and reverse generations of reforms.

Donald Moynihan, a professor of public policy at Georgetown University, signed on to an open letter in April arguing Schedule F would open the door to “politicization and patronage throughout the federal workforce.” He told HuffPost, “This feels like the biggest problem that the fewest people understand about a potential second Trump administration.”

[...]

The ‘Lightbulb Moment’

The push for Schedule F started with what one Trump staffer called a “lightbulb moment.” In 2019, James Sherk, a top White House adviser on civil service and labor policy, was frustrated by reports of federal workers pushing back against the Trump policy agenda. He started reading through existing U.S. law on federal labor rights, and realized that the language about exceptions from civil service protections could actually be interpreted quite broadly. Such a change in interpretation would be a break from decades of precedent. Presidents only bring around 4,000 political appointees with them at the start of a new term, and many additionally require Senate confirmation. These appointees are generally classified as “excepted” — they aren’t required to complete standardized competitive civil service exams, but they also aren’t afforded standard civil service protections. (The “excepted” portion of the federal workforce includes more than a million federal workers under various schedules, though the vast majority of them come from the United States Postal Service, the military, and Department of Veterans affairs.)

But Sherk argued that the “excepted” service should grow much larger, to include “the most important” federal workers — “the people who are telling all the rest of the bureaucracy what to do,” he said in a 2022 interview. In his view, the change would make the federal government more accountable to the White House, and therefore, the American people. “Nothing in [federal law] says that you can only take away the civil service protections of political appointees,” Sherk said. Sherk estimated that Schedule F would have applied to 1% to 3% of the federal workforce, or about 50,000 workers, had Biden not unwound it. But the number actually affected if Trump pursues Schedule F again could be much larger. A Government Accountability Office review of the few agencies that did start making Schedule F conversion lists found that agencies thought anywhere from 2% to 68% of their employees were eligible to be “rescheduled.”

[...]

Project 2025, the 900-page right-wing agenda-in-waiting for Trump cooked up by the Heritage Foundation and dozens of other arch-conservative organizations, refers to plans to reintroduce Schedule F in several sections. And one member of the project’s three-person leadership team is Paul Dans, the former chief of staff at the OPM during the Trump administration. The Project 2025 team has signaled that potential staffers in a second Trump White House would need to be on board: A questionnaire for potential new hires in a Trump administration asks applicants if they agree that “the President should be able to advance his/her agenda through the bureaucracy without hinderance from unelected federal officials.”

HuffPost has a story on how Project 2025 and Schedule F could chill dissent against a potential 2nd Trump.

This is why Americans should vote Joe Biden to stop Project 2025 from taking effect!

Read the full article at HuffPost.

[mostlysignssomeportents]

Private equity plunderers want to buy Simon & Schuster

Going to Defcon this weekend? I'm giving a keynote, "An Audacious Plan to Halt the Internet's Enshittification and Throw it Into Reverse," on Saturday at 12:30pm, followed by a book signing at the No Starch Press booth at 2:30pm!

https://info.defcon.org/event/?id=50826

Last November, publishing got some excellent news: the planned merger of Penguin Random House (the largest publisher in the history of human civilization) with its immediate competitor Simon & Schuster would not be permitted, thanks to the DOJ's deftly argued case against the deal:

https://pluralistic.net/2022/11/07/random-penguins/#if-you-wanted-to-get-there-i-wouldnt-start-from-here

When I was a baby writer, there were dozens of large NY publishers. Today, there are five - and it was almost four. A publishing sector with five giant companies is bad news for writers (as Stephen King said at the trial, the idea that PRH and S&S would bid against each other for books was as absurd as the idea that he and his wife would bid against each other for their next family home).

But it's also bad news for publishing workers, a historically exploited and undervalued workforce whose labor conditions have only declined as the number of employers in the sector dwindled, leading to mass resignations:

https://lithub.com/unlivable-and-untenable-molly-mcghee-on-the-punishing-life-of-junior-publishing-employees/

It should go without saying that workers in sectors with few employers get worse deals from their bosses (see, e.g., the writers' strike and actors' strike). And yup, right on time, PRH, a wildly profitable publisher, fired a bunch of its most senior (and therefore hardest to push around) workers:

https://www.nytimes.com/2023/07/18/books/penguin-random-house-layoffs-buyouts.html

But publishing's contraction into a five-company cartel didn't occur in a vacuum. It was a normal response to monopolization elsewhere in its supply chain. First it was bookselling collapsing into two major chains. Then it was distribution going from 300 companies to three. Today, it's Amazon, a monopolist with unlimited access to the capital markets and a track record of treating publishers "the way a cheetah would pursue a sickly gazelle":

https://pluralistic.net/2023/07/31/seize-the-means-of-computation/#the-internet-con

Monopolies are like Pringles (owned by the consumer packaged goods monopolist Procter & Gamble): you can't have just one. As soon as you get a monopoly in one part of the supply chain, every other part of that chain has to monopolize in self-defense.

Think of healthcare. Consolidation in pharma lead to price-gouging, where hospitals were suddenly paying 1,000% more for routine drugs. Hospitals formed regional monopolies and boycotted pharma companies unless they lowered their prices - and then turned around and screwed insurers, jacking up the price of care. Health insurers gobbled each other up in an orgy of mergers and fought the hospitals.

Now the health care system is composed of a series of gigantic, abusive monopolists - pharma, hospitals, medical equipment, pharmacy benefit managers, insurers - and they all conspire to wreck the lives of only two parts of the system who can't fight back: patients and health care workers. Patients pay more for worse care, and medical workers get paid less for worse working conditions.

So while there was no question that a PRH takeover of Simon & Schuster would be bad for writers and readers, it was also clear that S&S - and indeed, all of the Big Five publishers - would be under pressure from the monopolies in their own supply chain. What's more, it was clear that S&S couldn't remain tethered to Paramount, its current owner.

Last week, Paramount announced that it was going to flip S&S to KKR, one of the world's most notorious private equity companies. KKR has a long, long track record of ghastly behavior, and its portfolio currently includes other publishing industry firms, including one rotten monopolist, raising similar concerns to the ones that scuttled the PRH takeover last year:

https://www.nytimes.com/2023/08/07/books/booksupdate/paramount-simon-and-schuster-kkr-sale.html

Let's review a little of KKR's track record, shall we? Most spectacularly, they are known for buying and destroying Toys R Us in a deal that saw them extract $200m from the company, leaving it bankrupt, with lifetime employees getting $0 in severance even as its executives paid themselves tens of millions in "performance bonuses":

https://memex.craphound.com/2018/06/03/private-equity-bosses-took-200m-out-of-toys-r-us-and-crashed-the-company-lifetime-employees-got-0-in-severance/

The pillaging of Toys R Us isn't the worst thing KKR did, but it was the most brazen. KKR lit a beloved national chain on fire and then walked away, hands in pockets, whistling. They didn't even bother to clear their former employees' sensitive personnel records out of the unlocked filing cabinets before they scarpered:

https://memex.craphound.com/2018/09/23/exploring-the-ruins-of-a-toys-r-us-discovering-a-trove-of-sensitive-employee-data/

But as flashy as the Toys R Us caper was, it wasn't the worst. Private equity funds specialize in buying up businesses, loading them with debts, paying themselves, and then leaving them to collapse. They're sometimes called vulture capitalists, but they're really vampire capitalists:

https://www.motherjones.com/politics/2022/05/private-equity-buyout-kkr-houdaille/

Given a choice, PE companies don't want to prey on sick businesses - they preferentially drain off value from thriving ones, preferably ones that we must use, which is why PE - and KKR in particular - loves to buy health care companies.

Heard of the "surprise billing epidemic"? That's where you go to a hospital that's covered by your insurer, only to discover - after the fact - that the emergency room is operated by a separate, PE-backed company that charges you thousands for junk fees. KKR and Blackstone invented this scam, then funneled millions into fighting the No Surprises Act, which more-or-less killed it:

https://pluralistic.net/2020/04/21/all-in-it-together/#doctor-patient-unity

KKR took one of the nation's largest healthcare providers, Envision, hostage to surprise billing, making it dependent on these fraudulent payments. When Congress finally acted to end this scam, KKR was able to take to the nation's editorial pages and damn Congress for recklessly endangering all the patients who relied on it:

https://pluralistic.net/2022/03/14/unhealthy-finances/#steins-law

Like any smart vampire, KKR doesn't drain its victim in one go. They find all kinds of ways to stretch out the blood supply. During the pandemic, KKR was front of the line to get massive bailouts for its health-care holdings, even as it fired health-care workers, increasing the workload and decreasing the pay of the survivors of its indiscriminate cuts:

https://pluralistic.net/2020/04/11/socialized-losses/#socialized-losses

It's not just emergency rooms. KKR bought and looted homes for people with disabilities, slashed wages, cut staff, and then feigned surprise at the deaths, abuse and misery that followed:

https://www.buzzfeednews.com/article/kendalltaggart/kkr-brightspring-disability-private-equity-abuse

Workers' wages went down to $8/hour, and they were given 36 hour shifts, and then KKR threatened to have any worker who walked off the job criminally charged with patient abandonment:

https://pluralistic.net/2023/06/02/plunderers/#farben

For KKR, people with disabilities and patients make great victims - disempowered and atomized, unable to fight back. No surprise, then, that so many of KKR's scams target poor people - another group that struggles to get justice when wronged. KKR took over Dollar General in 2007 and embarked on a nationwide expansion campaign, using abusive preferential distributor contracts and targeting community-owned grocers to trap poor people into buying the most heavily processed, least nutritious, most profitable food available:

https://pluralistic.net/2023/03/27/walmarts-jackals/#cheater-sizes

94.5% of the Paycheck Protection Program - designed to help small businesses keep their workers payrolled during lockdown - went to giant businesses, fraudulently siphoned off by companies like Longview Power, 40% owned by KKR:

https://pluralistic.net/2020/04/20/great-danes/#ppp

KKR also helped engineer a loophole in the Trump tax cuts, convincing Justin Muzinich to carve out taxes for C-Corporations, which let KKR save billions in taxes:

https://pluralistic.net/2020/06/02/broken-windows/#Justin-Muzinich

KKR sinks its fangs in every part of the economy, thanks to the vast fortunes it amassed from its investors, ripped off from its customers, and fraudulently obtained from the public purse. After the pandemic, KKR scooped up hundreds of companies at firesale prices:

https://pluralistic.net/2020/03/30/medtronic-stole-your-ventilator/#blackstone-kkr

Ironically, the investors in KKR funds are also its victims - especially giant public pension funds, whom KKR has systematically defrauded for years:

https://pluralistic.net/2020/07/22/stimpank/#kentucky

And now KKR has come for Simon & Schuster. The buyout was trumpeted to the press as a done deal, but it's far from a fait accompli. Before the deal can close, the FTC will have to bless it. That blessing is far from a foregone conclusion. KKR also owns Overdrive, the monopoly supplier of e-lending software to libraries.

Overdrive has a host of predatory practices, loathed by both libraries and publishers (indeed, much of the publishing sector's outrage at library e-lending is really displaced anger at Overdrive). There's a plausible case that the merger of one of the Big Five publishers with the e-lending monopoly will present competition issues every bit as deal-breaking as the PRH/S&S merger posed.

(Image: Sefa Tekin/Pexels, modified)

I’m kickstarting the audiobook for “The Internet Con: How To Seize the Means of Computation,” a Big Tech disassembly manual to disenshittify the web and bring back the old, good internet. It’s a DRM-free book, which means Audible won’t carry it, so this crowdfunder is essential. Back now to get the audio, Verso hardcover and ebook:

http://seizethemeansofcomputation.org

If you’d like an essay-formatted version of this post to read or share, here’s a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2023/08/08/vampire-capitalism/#kkr

[deletedaccd]

politics

disclamer: i am not american. this does not affect me, at least for now. this perhaps may decrease my following but my friends are in danger, and im drinking a beer, i dont give a shit at the moment

"Project 2025 is a strategic initiative aimed at transforming the US Army into a more lethal, agile, and adaptable fighting force by the year 2025. This ambitious plan encompasses a wide range of modernization efforts across all aspects of the Army, from its personnel and training to its equipment and technology. A key element of Project 2025 is the development and integration of advanced technology, such as artificial intelligence, robotics, and autonomous systems. These technologies are intended to enhance the Army's ability to collect and analyze information, conduct operations in complex environments, and engage adversaries effectively. The project also emphasizes the importance of network modernization and cyber security, recognizing the growing role of cyber warfare and the need for resilient and secure communication systems. In addition to technological advancements, Project 2025 prioritizes the development of human capital by focusing on training, education, and recruitment. The goal is to cultivate a workforce that is skilled, adaptable, and capable of operating effectively in a rapidly changing world. By combining these technological and human elements, Project 2025 aspires to create an Army that is prepared to meet the challenges of future conflicts and maintain its position as the premier military force in the world. " - Unknown name

I am not american. I will not say my views, whether republican, liberal, democrat or whatever views and titles there are

But i will simply say what i have heard and what i have read

Project 2025, a nefarious agenda cloaked in a veil of progress, looms over society, threatening to erode fundamental freedoms and plunge us into a dystopian nightmare. At its core is a sinister plot to restrict access to reproductive healthcare, stripping women of their control over their own bodies. Abortion, a fundamental human right, is deemed a heinous crime, with draconian punishments meted out to those who dare to seek or provide it. I do not doubt they will be going after birth control as well, which is also a human right.

Furthermore, Project 2025 viciously targets the LGBTQ+ community, attempting to erase their very existence. Marriage equality is revoked, and same-sex couples are denied the right to love, raise families, or live their lives openly. Hateful rhetoric spews from the highest offices, fostering an atmosphere of fear and persecution.

Education is also under attack, with curricula twisted to promote a narrow, intolerant worldview. Critical thinking and open discussion are stifled, replaced with indoctrination and propaganda. Young minds are poisoned with messages of hate and exclusion, shaping a generation destined for ignorance and intolerance.

The arts, once a bastion of free expression, are now subject to censorship. Artists who dare to challenge the status quo are silenced, their works banned or destroyed. Culture is homogenized and controlled, leaving no room for diversity or dissent.

Trump's tax cuts, primarily benefiting wealthy individuals and corporations, have been criticized for increasing the national debt and widening income inequality. Trump's administration has rolled back environmental regulations, including those addressing climate change and pollution control, drawing criticism from scientists and environmentalists.

Trump's immigration policies, such as the border wall and family separations, have been condemned as inhumane and ineffective, exacerbating tensions at the U.S.-Mexico border.

Trump's attempts to repeal and replace the Affordable Care Act, known as Obamacare, were unsuccessful. However, his administration's actions, such as weakening the mandate and Medicaid expansion, have led to concerns about reduced healthcare access.

Trump's rhetoric and policies have been criticized for fueling racial tensions and promoting gender discrimination. The travel ban targeting majority-Muslim countries and the separation of families at the border have drawn accusations of racism and xenophobia.

Trump's presidency and the Republican Party's support of his policies have contributed to deep political polarization in the United States. His divisive rhetoric and inflammatory tweets have exacerbated existing divisions and made it harder to find common ground. Trump's attacks on the media, the judiciary, and law enforcement have raised concerns about the erosion of democratic institutions. His refusal to concede defeat in the 2020 election and his supporters' storming of the Capitol on January 6, 2021, have further undermined public trust in the electoral process.

This is what i have heard

I have women friends, gay friends, trans friends that live in america

I suggest not voting for trump, but lets be honest, thats been said a dozen timew, doesnt make it any less hwlpful of advice

your all off your heads (or perhaps faces) if ye think project 2025 is good

[jake-whatthefisgoingon-kiszka]

I don’t even know what to say about this except… sorry? Here you are, part 11! How did we get to all this? Check it out in part 1 here.

Pairings: Jake Kiszka x fem OC, Sam Kiszka x Danny Wagner *slash per the usual

Warnings and tags: please only 18+, absolutely no minors this is not for you!, lots of sexual content, m/f sex including some cock warming and unprotected sex (please be safe out there guys), m/m sex including fingering and rimming (yep!), slight infidelity, smoking and drinking, talking of sensitive material such as death, jealousy, love triangles, restaurant AU, third person POV Sam, Jake, Danny, and some Kim, if I missed anything, I’m sorry, please lmk!

Word count: 7.3k

Danny and Sam were a giggling mess when they came barreling back into the Kiszka house, Sam dramatically retelling a story about the time when they stole all of Jake’s underwear, got them wet, and stood them up outside in the snow. It was a tradition for Sam and Danny to get up to no good the night before Christmas, playing pranks on the twins that only got more elaborate over the years especially with the added fuel of alcohol when they got older. This year they’d decided it would be fun to pick on Josh since he didn’t get enough hell from them all the way up in New York.

Before they could sneak off again Danny’s name was called. “There you are, I want you to meet someone” Danny’s dad intercepted them in the hallway and pulled him off into the dining room. Sam followed, thinking they would only be stalled for a moment then they could continue planning their big move.

“Thomas, this is my boy” Danny’s dad wrapped his arm proudly around his shoulders as he introduced him to someone Sam had never seen before. Their parents were making acquaintances with people all the time, so it was never a surprise to him to see a dozen new faces at the Christmas party every year.

“This is the man I was telling you about” his Dad continued, talking to Danny about a conversation they must have already had. “His company is building a new office over in Bay City. Supposed to be a bunch of new jobs, pays well, benefits, paid time off, the works”.

“Nice to meet you” Danny shook hands with him and Sam pretended to be interested in straightening a few pictures on the wall while he eavesdropped on them talking about what classes he’d been taking and how his degree could be applied in the workforce once he graduated in the spring.

“Well I’ll certainly keep all of that in mind. Thank you so much for the opportunity. I’ll let you get back to enjoying the party now”.

Sam could tell Danny didn’t sound too interested in the job he was being offered, but he was still overly nice and respectful when he spoke to the man, trying to please his Dad as well for getting him the set up. He couldn’t help but feel a little twinge of irritation though. Danny hadn’t mentioned a job opportunity after graduation, and by the sounds of it he all but had it in the bag as long as he agreed to move back up to Michigan when their office opened in June. The same month Sam’s internship started in LA.

“Sorry, you want to go upstairs now?” Danny asked Sam after he snuck away. He seemed tense now, like he hadn’t expected to be caught discussing jobs and moving before he had a chance to talk to Sam about it first. Too late for that now.

“Actually, I want another drink” Sam replied, pushing past Danny and making his way into the kitchen for a new cup filled with more cocktail. He was glad Josh offered to make one great big bowl to serve drinks from, so he could get a break from pouring glasses for once and just enjoy the drinking.

Danny followed Sam this time, and they found that Jake, Josh, and Kim had all congratulated into the kitchen as well.

“You see love, I can act just as well as my counterpart here. Only he can’t cook a meal to save a life” Jake spoke to Kim in a terrible faux British accent, Josh trying to interject any chance he got but continually being cut off and ignored.

“And where have you two been?” Josh finally noticed their arrival, leaving Jake and Kim with a huff who were too busy giggling and flirting with each other over their drinks.

“Around” Sam replied, sounding anything but innocent in his quick response.

Josh shared looks between the both of them, suspicious but with good reason considering their track record on this night.

“Well before you two disappear again, want to head to the garage for a bit?”

They all knew what that meant, Kim and Jake also peaking up at the offer.

The five of them trailed off through the backyard and into the garage, more folding chairs being pulled out to accommodate everyone as Josh lit up the first roll.

“So what’s new?” Jake ditched the accent in favor for his normal conversation voice. Though it was twinged with a little more midwestern than usual since he was sufficiently tipsy enough for it to come out.

Josh was the first to jump at the question, rambling on about the big city and how much he was loving his job as they passed along the piece.

“Well, sounds to me like Daniel is going to be moving back up here pretty soon” Sam spoke up once he got the chance. “Got himself an office job in Bay City”.

“Wow, never pegged you as an office kind of guy” Josh replied, handing off to Danny next.

Danny took a hit before replying “I’m not” with his exhale, quickly passing back off to Kim. Though getting pretty messed up sounded appealing right now, something told him he needed to be somewhat coherent for this conversation. “My dad told me last night he’d made friends with this big corporate guy at the golf course. Said he talked about me a lot and the guy mentioned a new branch with a bunch of openings for high positions as long as you had any kind of college degree”.

“Well what did you say? Did you tell him you don’t want to work in an office? That you want to actually do something with your degree? Not just use it as a fancy piece of paper?” Sam pushed, a little bit of hostility in his tone which had Jake and Josh adjusting in their seats. Clearly this wasn’t a conversation Sam wanted them to be getting in between.

“No” Danny sighed knowing what he was about to say next was not going to be what Sam wanted to hear. “I told him I’d think about it. Finding a good job right after college is difficult. Besides I still don’t even know what I want to do after graduation”.

“Yeah, this is a good opportunity for you. Take some time to figure out what you want. I’m sure your parents will be thrilled to have you back home for a while”. Jake ended up butting in anyways. He knew Danny had some apprehension about his life after school, they’d talked about it on more than one occasion, and it was pissing him off a bit that Sam wasn’t being supportive of his boyfriend.

Had he even told Danny about his plans yet?

Jake decided to bring it up and see. Either Danny knew and it would be out in the open amongst all of them now, or Sam would have to come clean. Which in Jake’s mind he should have a long time ago. Either way, Jake was too drunk and faded to care anymore.

“I mean it’s either that or move to LA with Sam”.

“Woah woah woah, LA?!” Josh piped up, shooting Jake a look for not sharing this information with him sooner. He expected as much from Sam, but Jake usually turned around and clued him in on everything.

Sam kicked Jake in the shin. He’d promised he wouldn’t tell Danny, but Sam had taken too long with trying to sort out in his mind how he was going to bring it up. So now here it was.

Danny looked over at Sam, nothing in his expression yet a silent ask for him to explain.

“I’m still sorting some things out which is why I haven’t told you yet, but I got accepted into a paid summer internship with a record label in LA” Sam finally revealed to everyone. He knew they should have been excited for him, just like he should have been excited for Danny’s job offer, but there was an overlaying tension in the air as they waited with bated breath for Danny’s response.

“So when exactly were you planning on telling me?” Danny questioned, but Sam started to shy away, looking down at his hands wrapped around the cup in his lap.

Danny nodded at his silence, breathing in a shaky breath to try and fight off the rampaging sea of emotions he’d spent the entire evening trying to put at bay. They were all flooding back to him now, threatening to explode in some way that Danny couldn’t anticipate yet if it would be with tears, more fear, or finally anger. “Were you even going to ask me to move with you?”

“Of course I was!” Sam answered quickly this time to defend himself, though immediately returned back to the cup in his lap. “Sounds to me like you want to move back here though” he countered, trying to remind him that they had started the conversation there.

“Yeah I want to move back home. I never wanted to leave in the first place, but I did, for you”.

He just had to bring that up again, Sam thought to himself. He was so tired of being reminded by both Jake and Danny that everything Danny had done up until now had all been because of Sam. Because he was in love with him.

He understood the grand gesture of it all, but it was starting to feel like they were using it as a means to control him now. Like he owed Danny something for all he’d done when in truth, Sam had never asked Danny to come to Nashville in the first place. He was glad he did. Sam didn’t know where he’d be in this life without his best friend with him every step of the way, but he was starting to wish that things could just go back to the way they were before.

Danny could see the distance in Sam’s eyes, see him retreating into his head away from all the progress they’d made tonight. In turn, he started to lose his own sense of control. “What else have you not told me?”

Jake and Josh shared a look then turned their attention back to the youngest, hoping Sam hadn't done something they needed to scold him for later.

Kim started to feel a little sick. She knew that Danny was insinuating Sam was keeping another secret, and she hoped that he didn’t mention that she was the reason Danny knew what Sam had to hide.

Josh seemed to pick up on her discomfort, sighing as he leaned over to put the little remaining end of their joint out on the concrete then stood from his chair to offer her his hand. “Come on mama, let’s go back inside and let the children fight this one out hmm?”

Once she took his hand he stood her up and threw his arm around her shoulder, walking her out the garage as he leaned in to ask her “have you tried any of my secret Christmas punch yet?”.

Jake was thankful Josh was here to whisk Kim away, because he didn’t think he could tear himself from this conversation right now. He felt defensive, partly because Sam was his little brother and he’d always felt a sense of responsibility for him even in the stupidest mistakes he’d made. The other part was because he knew there was still a piece of himself that cared deeply for Danny and wanted to make sure he was okay. Because no one, even his own brother, was allowed to hurt Danny.

“Come on Sam, out with it” Jake demanded once he was sure Kim was safe inside with Josh.

“I don’t know what you’re trying to get out of me” Sam replied even more defensively. This was the exact situation he didn’t want to find himself in. Stuck in an interrogation between his brother and his best friend. “I’m sorry, I know I should have said something sooner about LA, but I’ve just had a lot going on right now and I needed a minute to soak it all in. Figure some things out, make sure I’ve been making the right decisions for me”.

Danny couldn’t help but feel like Sam wasn't just talking about accepting the internship, but that Sam was also still trying to figure out whether deciding to be with him was the right decision. Maybe that’s what he’d been doing with Savanna at the party? Trying to check if he’d picked the right one.

“Kim told me she saw you and Savanna kissing” Danny finally spilled it out, and felt immediately relieved when he did so. He wasn’t sure why he’d kept it in for so long now, other than he was afraid of hearing what Sam had to say about it.

“Wait! No! She kissed me!” Sam was caught off guard. He’d had no idea anyone had seen the brief exchange between them, and Danny heard about it… why didn’t he say anything?

“Please Daniel, you have to believe me. When she kissed me I stopped her and I told her that we’re together”.

Jake scoffed, if Sam had just told the whole truth originally then he wouldn’t have been in this mess in the first place.

“What the fuck do you think you have to say about this Jake? You’re not the one dating him, so you don’t have a say in how we deal with what’s going on in our relationship” Sam spat out, irritated that Jake had chosen to stay when Josh and Kim had read the room and already left.

“What do I have to say Sam?” Jake raised his voice to match the level Sam was already at, making Danny’s ears thump as their words bounced off the thick walls of the garage and hit him dead on. “Only that you’ve been fucking this up from the get go”.

“Is that what you told him?” Sam turned his venom back towards Danny, worried now that he’d been going behind his back to complain to Jake about their torpid relationship when it had been Danny who wanted to take things slow to begin with.

“I didn’t say anything to Jake. I didn’t say anything to anyone because I didn’t know how I should react to that information” Danny replied. He was worked up as well, but still the calmest remaining. “I know you’re not over her Sam”.

“How could you even come to that conclusion? There was no time to get over her. I went straight from one person to another” Sam sighed, already exhausted from the amount of effort this was taking so he took it down a notch as he continued . “It was me and Savanna, and you, my best friend. Then all of a sudden it was us together, and it’s great. At least I thought it was but now I’m starting to second guess things”.

Danny felt like all his fears were coming true. That Sam had only agreed to date him because he felt like he had no other choice. “Why second guess things now? I don’t want you to feel trapped in this with me just because it’s me”.

Sam’s heart dropped, because that’s exactly the opposite of how he felt. He didn’t feel trapped by Danny, only pressured to act like this all wasn’t very overwhelming for him at some times.

When it was just the two of them he felt comfortable, valued, loved. When others, like Jake, got involved though feelings he had as a child started to rear up again like possessiveness, jealousy, and envy.

Savanna too, he wasn’t exactly sure how he felt about her anymore. Maybe Danny was right, maybe he wasn’t over her. That didn’t mean he would ever go behind Danny’s back and get with her again, or whatever it was Danny thought he was doing with her. Now that Sam was thinking about it, he wondered if any of the emotion he felt towards Savanna had bled into the beginnings of his and Danny’s relationship.

“I just wish we would have talked about this sooner”. They clearly had a lot to work out, and he thought deep down they both knew that and just chose to ignore it. Neither one of them were at fault more or less than the other, and he could admit that while still being upset. “I wish you would have said something to me about Savanna if you were concerned about her. So I could have tried to give you some kind of assurance. Especially before we up and left to have sex earlier”.

Jake cleared his throat and Danny’s face started to burn bright red. Sure he didn’t mind Jake sticking around when he was in his corner, but now he was embarrassed to be called out like that. Because looking at it this way, he had used the appeal of sex to attempt to fill in the cracks that were slowly starting to form in the foundation he had tried so hard to lay down easily.

“You’re right” Danny sighed after they all took a moment to gather themselves. He reached over from where he sat on one end of the couch, an empty spot between him and Jake where Kim was before, and hesitantly took one of Sam’s hands. “Let's try not to keep things like this from each other anymore okay? I want you to be able to come to me with anything. Savanna included”.

“I’m sorry Dan” Sam sniffled a little bit, not even realizing he’d worked himself up to the point of near tears, but squeezed his hand in response.

“I’m sorry too” Jake stood up, deciding it was officially appropriate for him to give them some alone time. He scratched the back of his head, thinking he actually had stayed a little too long and heard some things he wished he didn’t. “I don’t mean to get in the middle of things, I just care about you both you know”.

“I understand Jake,” Danny gave him a small glance before fixing his gaze back on Sam, “we care about you too, right?”

“Yeah” Sam croaked out, barely raising a brow towards his brother's direction.

Though the tide seemed to recede for now, Sam still had his doubts and reservations.

When the party finally died down and the last of the guests made their way out the door, Danny and his parents being the only ones left behind until they too retreated back to their home, everyone filed away one by one off to sleep the evening's festivities away. Jake laid in his bed, staring up at the ceiling waiting impatiently for sleep to come when it was clear it wasn’t. A soft knock at his door caused him to sit up, watching as the door creaked open and a fluffy head stuck inside.

“Nightcap brother?”

“Of course” Jake sighed in relief and tossed the blanket off, scooting over to make room in his bed next to him for his twin who carried in two mugs.

Jake took a drink and nearly choked when the hot liquid hit his tongue. “Is this hot chocolate and whiskey?”

“Close” Josh replied with a faltering grin when he took his first sip as well. “I could only find one pack of hot chocolate mix. So it’s half a cup of hot chocolate and about two and a half shots of warm whiskey. That’s all the liquor we had left… aaand a dash of cinnamon!”.

“Yeah, that’s what I said” Jake rolled his eyes and they both laughed for a minute as they continued to drink what was sure to have them drooling on their pillows for the rest of the night.

“So what was all that about earlier?” Josh asked, referring to the argument in the garage. Though he’d left he was still concerned with what had been said, especially because Sam and Jake had seemed to distance themselves from each other for the rest of the night.

“It’s a long story” Jake sighed wondering now why he hadn’t been talking to Josh about any of this up until now. He guessed he just felt like once Josh was gone, he needed to learn to start dealing with things on his own. Getting to spend this time with him and everyone else for Christmas was reminding him though that no matter what they each had going on in their lives, or the distance between them for the time being, they would always be there for each other specifically.

Josh waited for Jake to sort out his thoughts and begin telling him what happened. Although Josh was a talkative person, he always knew when it was the right time to sit quietly and just listen in return.

“You know Sam and Danny have been going out for a while now?”

Josh nodded, “yeah, Sam called me and told me a little over a month ago. Seems he knows how a phone works better than you do”.

“Shut up, I know” Jake knocked his shoulder with his own then took a steadying breath as he began again, “well, shortly before that Danny and I were kind of… messing around”.

He waited for Josh to say something. Scold him for being an idiot for getting involved with Danny when they both knew Danny had his thing for Sam for years. Instead Josh just placed a hand on his shoulder and held it there for a moment, giving a silent acknowledgement for what Jake must have gone through.

“It was never anything serious. Just a couple of friends getting together every now and then, you know, helping each other out”.

“Suuure” Josh quipped, “you’ve never been the friends with benefits type Jake. Never can keep your feelings out of it. And that’s not a bad thing, you're an emotional guy and there’s nothing wrong with that. It’s good even, hope that there’s still room for young men to return to their former glory”.

“Alright, alright” Jake cut him off. Looks like Josh’s silence was short lived, but that wasn’t anything surprising considering they were both pretty fucking drunk. “Anyways, Sam kind of saw us at work, and that’s what started the whole thing. Danny confessed to Sam, Sam broke up with Savanna, they started dating.”

“You started dating a girl that absolutely adores you” Josh stepped in again, “She’s a sweet girl, and I can tell you like her, but do you think you love her?”

Love her? He hadn’t even begun to think that far ahead yet. “I don’t know, it’s only been a few weeks, a month maybe, you can’t tell if you love someone in that amount of time”.

“Yet here she is,” Josh replied, using his little mind tricks he knew always worked on Jake to get him to see things his way and realize what he was trying to deny, “and you do know”.

Jake set his cup down on his old nightstand and slid back down until his head was resting against his pillow and he was back to staring at the ceiling. Maybe he did know, but he wasn’t quite ready to come to grips with that yet.

Shortly after Josh gave him one last good night and left for his own room. The house was quiet after the tiny sound of his door closing from across the hall, but Jake still couldn’t sleep.

Though dreamland beckoned him with tiredness in his eyes and mind, the abundance of alcohol still coursing through his veins raised a stronger problem. He was entirely too horny for sleep right now. Horny enough that he didn’t think a simple handy would do the trick.

He checked the time on his phone, one in the morning, a good hour plus some since they’d all gone off to bed.

Jake took the chance and snuck into the basement in nothing but his boxers, hoping that Kim wasn’t already asleep, or if she was that he wouldn’t be bothering her too much when waking her with his drunken need.

The blackness of the room took him by surprise until his eyes adjusted in the dark and found the curvy form rising from underneath the covers on the bed like tiny islands in a deep sea.

He slipped his boxers off, tossing them to some blank corner of the bed, then lifted the edge of the blanket and slid underneath until his legs came first into contact with a pair of smooth thighs. His hands snaked across the warm mattress, finding hips next that he gripped onto and pulled until her body was flush against his.

She stirred slowly having fallen asleep a while ago, falling into the bed after doing nothing but stripping off her pants. When she opened her mouth to ask what Jake was doing she got her question preemptively answered with a feverish kiss.

She sighed into his mouth, letting her lips fall open and welcome him inside with a flick of his talented tongue. Without wasting a beat one of his hands left her hips and slipped underneath the waistband of her panties, immediately finding its way to her sweet spot.

He groaned at the warmth and how her body immediately started to react to his touch, pooling with wetness at just a few targeted swirls of his fingers.

Kim returned the gesture by bringing a hand between their bodies and wrapping it around Jake, who she quickly realized had crawled into the bed naked. She didn’t mind one bit, in fact she found it rather hot that Jake had needed it bad enough that he’d come down in the middle of the night to find her and take it. Only as she palmed him she noticed there seemed to be one slight problem.

“Jake, is everything ok?” Kim whispered, trying hard to make out any of the facial features that were right in front of her in the darkness.

He moved his kisses to her neck, in a trance and completely unphased by her question.

She tried to ignore it, hoping that if she gave a few more concentrated tugs it would resolve itself, but when it didn’t she stopped and spoke up again. “Are you sure? It’s just you’re not hard”.

Jake paused for a moment, only just realizing himself what she pointed out. Jake played it off as the liquor, trying to lighten the mood a little bit by pulling out the British accent again. “Thas no worry love, jus need a little warm up is’all”.

He tugged her panties down until she was kicking them off the rest of the way then lifted her leg, hoisting it around his hip and nudging up against her core. “You wan’ta warm me up baby?”

Kim pulled Jake back down into a kiss, using her leg around him as leverage she angled her hips upwards to allow him to slip inside. Even soft he felt amazing, and he moaned into her mouth as he felt her clenching around him, begging for more.

After holding each other and kissing again for a bit his voice returned to normal again, only this time even more muddled with lust than before. “Can I fuck you from behind?”

“Sure” she smiled against his lips, waiting for him to slide back out before rolling over and pulling up onto her hands and knees.

She pulled a pillow underneath her chest and rested on it as she arched her back. Jake situated himself between her legs and plunged back inside, this time finally at his full potential.

Kim bit into the pillow, trying to stifle her whiny moans. Though the sounds of his hips snapping against her ass weren't much better.

Whether it was the alcohol, or the lingering high, or the fact that he was hornier than ever for no apparent reason, his mind wandered in the void that had consumed this basement. His hands gripped into the flesh below him, guiding that ass where he wanted it as he plowed his way towards his release, and the first thing that came to mind was picturing it was Danny’s.

His hips staggered when he shook his head, trying to get the image out of his mind. Thanks to the darkness of the room though, when he opened his eyes he could nearly see Danny’s form. A small waist, broad shoulders, and tuffs of curly raven hair. His face squished against the mattress as he pleaded for Jake to go easy on him… it was all too much and before he could reel himself back Jake was finishing without warning.

“I’m so sorry” he huffed, feeling a sickening wave of guilt wash over him as soon as he came down from his orgasm.

“It’s alright, I’ve got an IUD” Kim replied, thinking him finishing inside was what he was apologizing for and not the fact that he’d just cum at the idea of fucking someone else entirely. “Just don’t think we should make it a habit”.

“Yeah, no you’re right” he raked his fingers through his hair, realizing that this was the first time they’d ever been active without protection before. Drunk or not he knew better, but he just was not in his right mind.

“I wish you could stay. I don’t want to sleep alone tonight”. She rolled back onto her back, trying to keep from making too much a mess on the sheets.

Jake found his discarded boxers and used them to wipe the inside of her legs before tossing them onto the floor and lowering himself next to her.

She lifted her head and he slipped his arm underneath while she curled into his side. He grabbed the blanket and situated it back over their tangled bodies, not wanting to leave either. He was afraid of sleeping alone tonight, afraid of what or who he’d be dreaming about if he did.

“I’ll stay” he whispered into her hair, “I’ll leave early in the morning before anyone gets up. No one will know I was ever down here”.

Christmas morning Kim woke up with the sound of breakfast being made again upstairs. She rolled over and found that Jake had stayed true to his word. He’d left sometime ago, probably already dressed and waiting for her to make her way up to join them.

While eating the best stack of homemade waffles she thought she’d ever had, Kim watched in amusement as a few thoughtful gifts were exchanged. She’d been given gifts from her extended family a few Christmas before. The most she’d ever gotten was the first Christmas since her mothers passing, but they were nothing like this. Though the gifts weren’t extravagant or in abundance, she could tell they came from the heart by the looks on their smiling faces and the hugs that were exchanged afterwards. Even if she didn’t have a box to unwrap, just getting to be witness to a loving family Christmas was a gift in and of itself for her.

“Thank you so much for letting me stay” Kim hugged Jake’s mom one last time as he loaded the rest of their things into his car.

Sam had already said his goodbyes. He and Danny were driving back in his new car, so it was just going to be the two of them on the way back.

“Sweetheart, you are welcome back anytime!” She got one last squeeze in before turning to Jake, “and you! Call your mother more often”. She kissed him on the cheek and squeezed him even harder.

“I’ll make sure he does” Kim promised her after they hugged and Jake walked around to say his goodbyes to Josh who had a flight early the next morning.

“You take care of him, he may be a man now but he will always be one of my boys”.

Kim blushed, thinking if she’d gotten the approval of his mom then things might just continue to go well for them.

Jake was quiet a lot of the way home, lost in thought, though not too unusual for himself. Kim figured he was just already missing his family. She offered to drive some, which he agreed and swapped out with her after getting a good long chunk of it out of the way.

“So,” she began, finally breaking down and needing to talk a little to keep focused, “Sam and Danny huh? They’ve been friends for a long time right?”

“Since elementary school” Jake replied flatly. Sam and Danny were the last thing he wanted to be talking about right now, but she hadn’t had a chance to ask him about any of it since learning about their relationship. Surely he didn’t have a problem with them right?

“Can you tell me something?” She asked, remembering a comment Savanna had made when she told her the news. Jake looked over at her, sitting up straight in the passenger's seat like he was nervous about what she wanted to know.

“Did they get together before or after he broke up with Savanna?”

“After” Jake assured her without wasting a beat. “There’s always been something there for Danny, but they got together after. Or well the breakup was because…” he started to fumble a bit, trying to keep out his involvement in his retelling this time.

“It’s ok” she saved him from having to continue, “I get it. Must be pretty complicated for them right now”.

He thought back on the conversation between Sam and Danny in the garage. If he learned anything from that, it was that keeping secrets obviously didn’t fare well for those in a relationship.

It’s not like Jake knew much of Kim’s dating history before him either. That conversation had yet to come up between them. He supposed if she asked then he would tell her, and if she didn’t then he’d just keep it to himself.

Definitely though he’d have to keep that night to himself. While trying to rationalize it the next morning he chalked it up to his drunk mind being influenced by learning Sam and Danny were officially taking the next step into starting to have sex. He knew it would happen, he just didn’t expect to know when it happened.

“Yeah, it is pretty complicated”.

In the week since Sam and Danny arrived back at their apartment in Nashville things went relatively back to normal for the two of them. Well, with the welcome addition of being more physically intimate now.

It seemed like Sam couldn’t fall asleep in Danny’s bed anymore without at least being jerked off first. Danny was happy to oblige him, liking nothing more than the warmth against his palm, the sweet and saltiness underneath his lips as he kissed and licked and sucked on the small patch of skin on Sam’s neck he’d found was a pleasure point for him. Right above his collar and next to his Adam's apple.

Most nights ended with the both of them rutting into each other's fists. They’d already gone at least a quarter of the way through the brand new bottle of lube Danny had bought from the drug store their first day back.

Tonight though, with it being their first days off together since being back, and no class in the morning, Danny had other ideas in mind. Starting with a shower.

Danny’s hands trailed across the ridges of Sam’s shoulders like a waterfall of fingers. One by one taking the plunge over the edge as gently as the drops that rolled down his skin from the spray of the shower head. He lathered Sam’s back and chest up from behind, always insisting on being the one to clean his body in the few times they got to take a shower together.

Usually Sam whined about being doted on so much, but tonight after the few shots of tequila they’d randomly decided to bring out with dinner, Sam was loose and carefree. His head fell to the side as Danny moved his hair over with his suds free hand to keep it from getting in the soap since it wasn’t the night to wash it. Of course that barred his irresistible neck again and Danny immediately latched on, sucking over a bruise he’d only caused the night before.

Sam hissed at the slight pain, though his dick twitched at the same time. “You really like leaving hickies don��t you?” He asked rhetorically, reaching his hand through the stream and digging his fingers into Danny’s scalp to hold him there for a bit longer, surely turning the fading bruise into a fresh blazing pink and purple badge of affection.

“I can’t help myself, your skin is so inviting and silky, and it colors so beautifully” Danny replied letting his hands trail down Sam’s chest now to his stomach, though not as low as he wanted.

“Danny” Sam groaned, wiggling his hips impatiently, wanting his hands on him already.

Though Danny had given into him easily all week, tonight he wanted to take his time. Show him a thing or two.

He pulled back from the warmth of the water and the body in front of him. Wanting to make sure Sam knew he was in good careful hands before things got a little too far. “Sam, you know I want to make you feel good right?”

“Yes?” Sam looked over his shoulder, smirking a little at the glimpse of Danny’s already hardened length from just the brief touching and kissing they’d been doing. “Why do you ask?”

Danny admired the person before him, from his dripping wet locks that trailed down his back like velvety curtains, to the plunge of his waist, and then the roundness of that Kiszka ass. Everything about him was appealing, even when he didn’t even try. Some days it was annoying, and some days, more and more recently, it drove Danny absolutely mad with desire.

He reached out to touch again, this time taking a handful of Sam’s ass and squeezing tightly. “So you trust me right?”

Sam bit his lip and arched his back. He knew Danny liked admiring him from behind, he just never knew he’d like the feeling it gave him just as much. “I do. Just, be easy with me?”

“Always loverboy” Danny cooed, returning his lips to trailing along Sam’s shoulder and running through each scenario he had in his mind trying to decide on the perfect one.

Danny’s eyes flicked forward, noticing the unique tile pattern on the walls of the shower. They were mostly white with a border of larger tiles in a pattern of black and white.

“You see those black tiles in front of you?” Sam raised his head, careful not to let the water spray into his eyes and nodded his head. “Place your hands on them”.

Danny waited for Sam to obey, which he did, doing just as Danny had said by placing his left palm flat against the cold wet stone, then the right almost a shoulder's width apart.

“Good boy” Danny praised him, then grabbed his waist and gently yanked it backwards causing Sam to catch himself by shifting his weight onto his arms to hold himself up. “Now, don’t move them”.

Sam inhaled a shaky breath, closing his eyes and tilting his head back to let the water run down his neck and chest, actually shuddering at the way the warmth felt trailing down to his groin.

Sam felt all his nerve endings on fire, catching his breath when Danny’s hand slipped unceremoniously between his cheeks and pressed a slightly soapy finger to his entrance.

“Don’t hold your breath” Danny told him, but Sam was too wound up to notice he’d said anything at all. Instead his focus was on the odd feeling of having a finger petting him where he never had before. At least until Danny paused his circular movements. “Do you want me to stop?”

Sam shook his head. Though he was tense he wasn’t scared. Actually, he was a bit intrigued by this point about what Danny had in store for him. He exhaled finally, unable to hold his breath any longer and Danny pressed inside. With a groan he let his head fall forward, the shower head spraying his crown making his hair fall over his shoulders and blocking out the rest of the world.

“Do you feel okay?” Danny asked, checking in with him before he tried to move anymore. Sam nodded, but Danny could barely tell. “Use your words”.

“Yes! Yes, I’m okay” he spoke up, pressing his fingers into the black tiles to try and focus his mind on something else. Once he grounded himself he lifted his head again and rocked his hips back, inviting Danny to keep going.

“You’re doing a good job” Danny praised again, sending Sam’s mind swirling through the steam.

“Are you going to fuck me tonight?” Sam questioned out of the blue once he started to get more used to the feeling of a finger inside of him.

Danny chuckled, which caught Sam off guard. “No baby, not tonight”.

“Not tonight you say, with a whole finger in my ass” Sam scoffed, groaning again when Danny retreated. He grabbed him by the waist and turned him around, pinning him against the tile then smashing their lips together.

“Yes, not tonight” Danny repeated between toothy kisses, “but that doesn’t mean you have to be bratty about it”.

Sam wrapped his arms tightly around Danny’s shoulders and kissed him back just as hungrily. “You act like you want to fuck me, but what if I want to be the one fucking you Daniel?”

Danny reached over and shut the water off, Sam clinging onto him like a hot noodle. “I want that too” he replied with a mischievous smirk, “I just wanted you to say you wanted it first”.

“Who knew you were such a tease?” Sam pouted, but let Danny gather his hair into a loose makeshift ponytail with his hands and gently wring some of the water out.

“Only because you make it too easy”.

He helped Sam out of the shower and they walked together the short distance down the hallway and into his bedroom. Danny pushed Sam down onto the bed without a bit of concern about getting his sheets wet. “On your knees, hips in the air”.

“How am I supposed to-”

Danny cut him off, “I’m not done having my fun yet, you keep doing as you're told and I’ll give you what you want”.

Sam smirked and turned over, feeling a bit exposed in this position, though he figured that was the point. He braced himself for the return of Danny’s fingers again, but gasped loudly when he felt instead teeth sinking into the plushness of his right cheek.

“No biting!” Sam yelped, pulling away with a surprised chuckle.

“Okay, okay” Danny grabbed his hips and pulled him back, placing an apologetic kiss to the tiny teeth marks. “I won’t bite, but I will use my mouth. I know how much you like that Sammy”.

With that declaration he pulled his cheeks apart and dove right in sending a shiver up Sam’s entire spine.

Being eaten out was another first for him. By now he was sure after the end of the week he wouldn’t win a game of ‘Never Have I Ever’ again. Not that he’d played that game since he was eighteen and a freshman in college.

“Dan-Danny” Sam called out. Just when he was starting to think of asking for more, maybe a finger again, he was interrupted by the ring of a phone.

Danny recognized the ringtone as his own, pulling back to find the cellphone still sitting on his desk where he’d left it to charge before the shower.

It wasn’t the phone ringing that had shattered the mood, but the name on the screen that took him by surprise.

Jake.

@alwaysonthemend @twistedmelodies @psychedelicstardust-gvf @heckingfrick

[mariacallous]

How will AI be used in health care settings?

Artificial intelligence (AI) shows tremendous promise for applications in health care. Tools such as machine learning algorithms, artificial neural networks, and generative AI (e.g., Large Language Models) have the potential to aid with tasks such as diagnosis, treatment planning, and resource management. Advocates have suggested that these tools could benefit large numbers of people by increasing access to health care services (especially for populations that are currently underserved), reducing costs, and improving quality of care.

This enthusiasm has driven the burgeoning development and trial application of AI in health care by some of the largest players in the tech industry. To give just two examples, Google Research has been rapidly testing and improving upon its “Med-PaLM” tool, and NVIDIA recently announced a partnership with Hippocratic AI that aims to deploy virtual health care assistants for a variety of tasks to address a current shortfall in the supply in the workforce.

What are some challenges or potential negative consequences to using AI in health care?

Technology adoption can happen rapidly, exponentially going from prototypes used by a small number of researchers to products affecting the lives of millions or even billions of people. Given the significant impact health care system changes could have on Americans’ health as well as on the U.S. economy, it is essential to preemptively identify potential pitfalls before scaleup takes place and carefully consider policy actions that can address them.

One area of concern arises from the recognition that the ultimate impact of AI on health outcomes will be shaped not only by the sophistication of the technological tools themselves but also by external “human factors.” Broadly speaking, human factors could blunt the positive impacts of AI tools in health care—or even introduce unintended, negative consequences—in two ways:

If developers train AI tools with data that don’t sufficiently mirror diversity in the populations in which they will be deployed. Even tools that are effective in the aggregate could create disparate outcomes. For example, if the datasets used to train AI have gaps, they can cause AI to provide responses that are lower quality for some users and situations. This might lead to the tool systematically providing less accurate recommendations for some groups of users or experiencing “catastrophic failures” more frequently for some groups, such as failure to identify symptoms in time for effective treatment or even recommending courses of treatment that could result in harm.  

If patterns of AI use systematically differ across groups. There may be an initial skepticism among many potential users to trust AI for consequential decisions that affect their health. Attitudes may differ within the population based on attributes such as age and familiarity with technology, which could affect who uses AI tools, understands and interprets the AI’s output, and adheres to treatment recommendations. Further, people’s impressions of AI health care tools will be shaped over time based on their own experiences and what they learn from others.

In recent research, we used simulation modeling to study a large range of different of hypothetical populations of users and AI health care tool specifications. We found that social conditions such as initial attitudes toward AI tools within a population and how people change their attitudes over time can potentially:

Lead to a modestly accurate AI tool having a negative impact on population health. This can occur because people’s experiences with an AI tool may be filtered through their expectations and then shared with others. For example, if an AI tool’s capabilities are objectively positive—in expectation, the AI won’t give recommendations that are harmful or completely ineffective—but sufficiently lower than expectations, users who are disappointed will lose trust in the tool. This could make them less likely to seek future treatment or adhere to recommendations if they do and lead them to pass along negative perceptions of the tool to friends, family, and others with whom they interact.

Create health disparities even after the introduction of a high-performing and unbiased AI tool (i.e., that performs equally well for all users). Specifically, when there are initial differences between groups within the population in their trust of AI-based health care—for example because of one group’s systematically negative previous experiences with health care or due to the AI tool being poorly communicated to one group—differential use patterns alone can translate into meaningful differences in health patterns across groups. These use patterns can also exacerbate differential effects on health across groups when AI training deficiencies cause a tool to provide better quality recommendations for some users than others.

Barriers to positive health impacts associated with systematic and shifting use patterns are largely beyond individual developers’ direct control but can be overcome with strategically designed policies and practices.

What could a regulatory framework for AI in health care look like?

Disregarding how human factors intersect with AI-powered health care tools can create outcomes that are costly in terms of life, health, and resources. There is also the potential that without careful oversight and forethought, AI tools can maintain or exacerbate existing health disparities or even introduce new ones. Guarding against negative consequences will require specific policies and ongoing, coordinated action that goes beyond the usual scope of individual product development. Based on our research, we suggest that any regulatory framework for AI in health care should accomplish three aims:

Ensure that AI tools are rigorously tested before they are made fully available to the public and are subject to regular scrutiny afterward. Those developing AI tools for use in health care should carefully consider whether the training data are matched to the tasks that the tools will perform and representative of the full population of eventual users. Characteristics of users to consider include (but are certainly not limited to) age, gender, culture, ethnicity, socioeconomic status, education, and language fluency. Policies should encourage and support developers in investing time and resources into pre- and post-launch assessments, including:

pilot tests to assess performance across a wide variety of groups that might experience disparate impact before large-scale application

monitoring whether and to what extent disparate use patterns and outcomes are observed after release

identifying appropriate corrective action if issues are found.

Require that users be clearly informed about what tools can do and what they cannot. Neither health care workers nor patients are likely to have extensive training or sophisticated understanding of the technical underpinnings of AI tools. It will be essential that plain-language use instructions, cautionary warnings, or other features designed to inform appropriate application boundaries are built into tools. Without these features, users’ expectations of AI capabilities might be inaccurate, with negative effects on health outcomes. For example, a recent report outlines how overreliance on AI tools by inexperienced mushroom foragers has led to cases of poisoning; it is easy to imagine how this might be a harbinger of patients misdiagnosing themselves with health care tools that are made publicly available and missing critical treatment or advocating for treatment that is contraindicated. Similarly, tools used by health care professionals should be supported by rigorous use protocols. Although advanced tools will likely provide accurate guidance an overwhelming majority of the time, they can also experience catastrophic failures (such as those referred to as “hallucinations” in the AI field), so it is critical for trained human users to be in the loop when making key decisions.

Proactively protect against medical misinformation. False or misleading claims about health and health care—whether the result of ignorance or malicious intent—have proliferated in digital spaces and become harder for the average person to distinguish from reliable information. This type of misinformation about health care AI tools presents a serious threat, potentially leading to mistrust or misapplication of these tools. To discourage misinformation, guardrails should be put in place to ensure consistent transparency about what data are used and how that continuous verification of training data accuracy takes place.

How can regulation of AI in health care keep pace with rapidly changing conditions?

In addition to developers of tools themselves, there are important opportunities for unaffiliated researchers to study the impact of AI health care tools as they are introduced and recommend adjustments to any regulatory framework. Two examples of what this work might contribute are:

Social scientists can learn more about how people think about and engage with AI tools, as well as how perceptions and behaviors change over time. Rigorous data collection and qualitative and quantitative analyses can shed light on these questions, improving understanding of how individuals, communities, and society adapt to shifts in the health care landscape.

Systems scientists can consider the co-evolution of AI tools and human behavior over time. Building on or tangential to recent research, systems science can be used to explore the complex interactions that determine how multiple health care AI tools deployed across diverse settings might affect long-term health trends. Using longitudinal data collected as AI tools come into widespread use, prospective simulation models can provide timely guidance on how policies might need to be course corrected.