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Half an hour before bed, Adnan Jinnah sits on a chair and straps on a headband. It looks like something a tennis player might wear, save for a large rectangular button on the front. When he feels ready to sleep, he lies down, presses the button, and starts an app on his phone. “That’s pretty much it,” he says.

As he sleeps, sensors in the device pick up Jinnah’s brain activity, heart rate, and blood flow and oxygen to his brain. The signals are then interpreted by algorithms that spit out data on his sleep quality that he can look at in the morning.

The device, known as a Muse headband, was developed by the Canadian consumer neurotechnology company Interaxon. On and off for more than 4 years Jinnah, who lives in Leicester, England, has had trouble falling asleep. He says daily reports from the device allow him to monitor how well he slept the night before and how poor sleep affects his mood. It also provides him with long-term data about his sleep that have helped him understand how different factors, including medication or stress, can influence his rest.

What Jinnah didn’t know, however, was that data from his headband may have been feeding an artificial intelligence (AI) model of the brain. Interaxon is building the model—known in the industry as a “brain foundation model”—to sharpen its picture of how the brain works, especially during sleep and times of focus. The company says this would allow it to provide a better service to its users and develop a product to help support brain research. The data used to train it are overwhelmingly coming from users like Jinnah.

So far, Interaxon has trained its model on about 50,000 hours of electroencephalography (EEG) data from users of the technology, the company says. The data are stripped of personal details, such as people’s names and emails. The company plans to keep expanding this figure. “We aim to use as much of that eligible corpus as possible,” says Chief Marketing Officer Nadia Kumentas.

Yet Interaxon’s privacy policy did not explicitly tell users their data might be used to train AI brain models. After Science pointed this out, the company updated the policy. “We agree users should be explicitly informed,” Kumentas says.

For Jinnah and potentially tens of thousands of other Muse users like him, it was too little too late: The training had already happened, without his explicit informed consent. When user data get embedded into an AI system they are near-impossible to remove.

Jinnah felt a sense of “resignation” when Science told him his neural data may have been used to train an AI system that he had never heard about. “I suppose it’s very similar to when big tech companies consume your data.” But he thought users should be asked for their consent.

Interaxon is not unusual. In a yearlong investigation, Science reviewed dozens of consumer neurotech privacy policies and spoke to neurotech experts, companies, and users to understand how consumers’ brain data are being used around the world. The investigation reveals a largely unregulated global ecosystem in which tens of millions of hours of EEG data have already been collected by consumer neurotech companies. Multiple firms are using these data in the race to build a brain foundation model.

The findings come as researchers and policymakers argue that the massive accumulation of brain data constitutes a broader privacy risk. Multilateral organizations such as UNESCO and the Organisation for Economic Co-operation and Development have recently highlighted the rise of consumer-grade brain-computer interfaces as a special concern. In October, United Nations Secretary-General António Guterres presented a report warning that the rapid development of neurotechnologies could give governments access to our innermost thoughts, posing a threat to human rights.

Some experts argue that because consumer neurotechnology devices don’t collect clinical-grade data, it’s unlikely that companies—or governments with access to the data—can glean much about users. But most agree that users have the right to know how their neural data are being used, and that more needs to be done to protect the data.

“Brain signals aren’t heartbeats. Monitoring them is meaningfully different,” says Owen Jones, professor of law and biological sciences at Vanderbilt University. “We are the sum of our brain’s activities in a way that we are never the sum of our other organs’ functions.”

Over the past decade, wearable neurotechnologies have caught on around the world. Consumers can buy devices that promise to monitor stress, fatigue, focus, sleep, meditative states, and more from a growing number of companies. The neurotechnology market value is also steadily on the rise: It is estimated at about $19.19 billion this year and expected to reach nearly $33 billion by 2034. Recently, tech giants have also entered the arena. In 2023, Apple filed a patent for earbuds that could collect EEG data. And last year, Meta launched its Neural Band, which collects data on tiny electrical signals from wrist muscles.

The majority of these wearable neurotechnologies are stripped-down versions of EEG headsets commonly used in hospitals. Clinical-grade headsets tend to gather data using 19 to 25 electrodes spaced across the skull, but brain wearables usually have between one and six. These generally cover a limited part of a person’s brain region—for example, the front of the head or around the ears—depending on what the device is meant to track.

Although some devices have been rigorously tested and used in thousands of scientific studies, the vast majority lack scientific underpinning. One study published in 2018 examined the scientific evidence behind claims made by consumer EEG companies that providing people with real-time information about their brain waves can help them improve their concentration, sleep, and other behaviors. Of more than 3000 publications cited by these companies, only 11 used gold-standard research methods, and 10 of these found no real benefits compared with a control condition.

Because consumer-oriented devices tend to be lighter, simpler, and more user-friendly than clinical tools, the quality of the data is often compromised. EEG is also inherently limited. It’s great for understanding when brain activity takes place, but not for telling you exactly where, particularly when the activity originates in deeper parts of the brain, such as the amygdala, hippocampus, or thalamus, which play important roles in emotion, memory, and sensory processing. As such, some experts say that although brain data collected by consumer devices might reveal broad changes in neural activity, such as when someone falls asleep, they can’t reveal much about a person’s mental state.

But although EEG might not read people’s thoughts, “it would be equally misleading to suggest that it cannot reveal meaningful information about their cognitive states,” says Pietro Aricò, professor of bioengineering at the Sapienza University of Rome. And as consumer EEG devices begin to incorporate AI and are able to conduct increasingly sophisticated analyses, data collected on the outer surface of the brain could be enough to decode intimate features of our mental lives, including our thoughts, emotions, and personality, says Rafael Yuste, co-founder of the Neurorights Foundation, a nonprofit dedicated to protecting people’s brain data rights.

For the companies that make these devices, the data are gold, and they have amassed millions of hours of them. They are used to train algorithms, help companies offer personalized insights to users, and generate evidence they can use to market their products. “Our brain data is the most valuable part of the company,” Kumentas says.

Increasingly, brain data are valued for a specific purpose: training AI brain models. In many ways these models are analogous to large language models such as ChatGPT or Claude, but they are trained on neural data rather than text. After being fed an enormous amount of data, a model recognizes key patterns of brain activity. Researchers can then easily adapt this model to perform different tasks, such as identifying patterns associated with sleep or neurological conditions. The goal is to build a flexible model of the brain that can be used for various tasks with little or no additional training.

The companies building these models believe they could become a breakthrough technology, by helping researchers better understand how the brain works and automating some doctors’ tasks so they can focus on more critical work. “The model is there in order to serve the world for so many things,” said Tan Le, founder and CEO of Emotiv, a San Francisco–based neurotech startup that has developed multiple EEG wearables.

These models are still at a relatively early stage. But they have already shown promise. The AI neurotech startup Piramidal, for instance, has developed a brain foundation model using EEG data from publicly available sources and hospital partnerships, rather than consumer devices. Last year, the startup partnered with the Cleveland Clinic to develop a way to automatically detect seizures in hospital patients. After the model was fine-tuned on the clinic’s library of seizure-related EEG data, it correctly identified nine out of 10 seizures in a pilot study.

Some experts say these models may be useful in specific cases, but doubt that an all-encompassing AI brain model is feasible—particularly one relying on consumer data. It would have to generalize across different kinds of brain states, diseases, and populations—from people with Parkinson’s disease all the way to paralyzed patients wanting to communicate. “It’s still a very, very long way off,” says Adam Caplan, founder and general partner at Jumpspace Ventures, a venture capital firm focusing on neurotechnologies.

He and others say building such a model would require high-quality data that consumer neurotechnology devices often do not collect. Yet nine consumer neurotechnology and AI software companies have publicly acknowledged building a brain foundation model, and others may be doing so quietly.

They face few constraints in exploiting their users’ data. Science reviewed the privacy policies of 57 consumer-oriented companies from around the world that collect EEG data. Four had no privacy policy at all, potentially breaching data privacy laws, whereas 11 had a policy focused just on website visitor data. Among those that did have a broader privacy policy, about two-thirds explicitly mentioned collecting brain data. “That is not just deeply disturbing, it is cause for alarm and corrective action,” Jones says.

Initially, none of the consumer neurotech companies building a foundation model explicitly disclosed this in their privacy policies, although the efforts were disclosed elsewhere, for example in press releases. Emotiv, for example, told Science it trains its foundation model—referred to as its “large brain model”—in part on data from users of the company’s higher end devices. (Emotiv also draws on other sources such as public EEG data sets and partnerships with universities and multinational companies for neuromarketing research.) After Science’s inquiries, the company updated its privacy policy to disclose the use of deidentified data for brain foundation model training subject to opt-in consent from users. “This update represents a forward-looking commitment,” Le says.

Similar concerns arise when companies exploit data from other sources. Piramidal has trained its model on more than 4 million hours of EEG data from open-source data sets and partnerships with hospitals and institutions. “We did these automated searches on the internet in order to find publicly available and curated data that is not proprietary,” says Dimitris Fotis Sakellariou, the company’s founder and CEO.

These include sources such as Temple University’s EEG Corpus, which contains 60,000 recordings, including seizure-related data, and is open to researchers. Participants in such studies consent to providing their data for research, but neuroethicists warn they are unlikely to have envisioned their data being used to train sophisticated AI brain models. “It matters if you agree to something and then there’s a totally different context of use that you never contemplated,” says Nita Farahany, professor of law and philosophy at Duke University.

But Sakalleriou argues people participating in these studies are precisely the kinds of patients who want to see brain foundation models come to life. “I have spent a lot of time in hospitals, and I can tell you for a fact that these people that gave consent for their EEGs are waiting for something to be built like that.”

It’s not just how data are used, but where they might end up that raises concerns. Of those companies with privacy policies, all except one allow data to be shared with third parties in anonymized, aggregated, or deidentified forms, although they often do not specify whether this includes brain data. Only six explicitly stated they would not sell the user’s brain data, although another 17 state in general terms that they don’t sell or trade personal information. All companies reviewed either explicitly permitted data to be shared with authorities—including police, government, or courts—upon request, or did not specify.

Science also found that more than two-thirds of the companies explicitly authorize corporate transfers of data—the rest do not specify. In theory this means if one company were acquired by another, its brain data could be passed on. “We heard from several companies that that is actually what they are aiming for: to build the technology and then finally be acquired,” says Laura Bernáez Timón, neurotechnology fellow with the Centre for Future Generations, a think tank focused on the future of technology. A small company might follow stringent ethical codes and privacy standards as it collects data, only to be acquired by a larger company with fewer scruples and a greater interest in the data themselves, she adds.

The accumulation of our most intimate data by neurotechnology companies is uniquely concerning, says Andrea Lavazza, professor of moral philosophy and director of the Observatory for the Ethics of New Technologies at Pegaso University. “When you start collecting brain data, you’re crossing into the final frontier,” he says. “There’s really nothing beyond that when it comes to our privacy.”

Others are less concerned because of the inherent limitations of consumer-oriented neurotechnologies. They also note that other forms of data collection that we’ve become used to can reveal as much, if not more, about our mental lives. Companies can infer what captures our attention by analyzing our clicks on social media, for example, or even by looking at eye movements picked up through eye-tracking technologies embedded in cameras. By layering multiple kinds of data, they could build up a sophisticated understanding of our thoughts and feelings, without needing to peer into our brain. “We should worry about all of the kinds of data that are being used to make increasingly more precise inferences about mental states,” Farahany says.

Regardless of the risks, experts and many consumers agree that neurotech companies cannot just assume they have users’ consent to use their data for whatever purpose they deem fit. If firms want to train AI models on user data they should get “a specific and separate consent” for that purpose, Farahany says. Science’s privacy policy analysis “reinforces very strongly the need for governments and regulators around the world to understand that this is science and not science fiction,” says Jared Genser, co-founder and general counsel of the Neurorights Foundation.

Some countries have begun to tackle the problem. In 2021, Chile became the first nation to protect brain data within its constitution, requiring special safeguards for brain activity and the information derived from it. The following year, former Chilean senator Guido Girardi sued Emotiv for collecting and using his brain activity without adequate consent. In August 2023, the Chilean Supreme Court ruled in Girardi’s favor, ordering Emotiv to delete all brain data collected from him and directing regulators to review the sale and use of the company’s five-channel Insight device in the country.

More recently, several U.S. states—including Colorado and California—have amended state consumer privacy laws to include neural data, meaning brain data are legally considered sensitive personal information and people can request access to or deletion of this information, among other safeguards. A law introduced by Senator Chuck Schumer (D–NY) would require the Federal Trade Commission to investigate gaps in protections for neural data and propose a regulatory framework for how brain data are collected, shared, used, and sold.

For now, selling brain data appears to be too bold a step for most firms. “Companies recognize that it’s a critical decision point, but I have not heard of a single company who has chosen to monetize or sell the data,” Farahany says. But it’s a regular topic of conversation in company offices, according to several insiders and researchers, including Farahany and Olivier Oullier, neurotechnology entrepreneur and professor of human-computer interaction at the Mohamed bin Zayed University of Artificial Intelligence.

The incentives are substantial. “Neurotech is not cheap,” Oullier says. Bringing neurotechnologies from early-stage research to market requires significant technical expertise and expensive hardware, making a return on investment far from guaranteed.

Some companies are also exploring paying consumers for their brain data, which could then be traded through shared digital databases built on blockchain technology. “Something that we’re going to see more and more of is people in the blockchain and crypto world creating these big data wells,” said Karen Rommelfanger, neuroethicist and director of the Institute of Neuroethics. “They want people to give them their data, want to have access to it, and sell it.”

This is the approach of Chinese company MATRIX, whose setup includes a noninvasive headset equipped with a chip that purportedly samples brain signals 1000 times per second to detect changes in attention, relaxation, and sleep. The company is currently using the headset in pilot studies, says Chief Marketing Technology Officer Eric Choy, but the next milestone is to open a commercial marketplace “where everyday users lease their sleep data and earn income.” The platform—called NeuraMATRIX—will allow users themselves to decide who gets access to their data. This could potentially include medical researchers, pharmaceutical companies, or AI developers.

Such schemes might alleviate concerns about permission and privacy. But they could exacerbate social and economic inequalities, says Philipp Kellmeyer, junior professor for responsible AI and digital health at the University of Mannheim. Vulnerable people might be more inclined to sell their brain data, he says, not unlike individuals who choose to sell their organs. “If people have to monetize their body data, their bio data, in order to keep surviving economically, it would also undermine their human dignity.” MATRIX did not respond to multiple requests for comment on these concerns.

As the neurotechnology industry continues to grow and new ways to trade or sell brain data emerge, experts like Marietjie Botes, a research fellow at the University of Texas at Austin who studies the international governance of brain data, worry regulators and ethicists will struggle to keep pace.

“Technologies move very fast,” she says. In China, for instance, companies are already harvesting hundreds of thousands of hours of EEG data from truck drivers and construction workers—in some cases without anonymization—raising privacy concerns. “Suddenly, from a governance perspective, all the risks we’ve hypothesized—everything is now happening.”

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Adnan Jinnah started using Interaxon’s Muse headband because he was having trouble falling asleep. MARK PINDER

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Kylee Wilson, a part-time bartender in the blue-collar town of Prairie City, Iowa, turned to the bar and broke the news to one of her regulars. After voting three times for President Trump, she pulled the lever for Democrats this year.

“Tim, don’t hate me for this,” she told the customer, Tim Charls, 64. But Mr. Trump had become “too brash,” too bellicose, too tied up in the war in Iran, she said, all while she and her family struggled with rising costs and health care cuts.

“Trump put a target on America’s back,” said Ms. Wilson, 29, who works in sales support at a heavy machinery company during the day. She said she was concerned about “the state of the country and the world.”

All across the country, millions of white, working-class voters such as Ms. Wilson shifted toward Democrats in the midterms, part of a lurch to the left across demographic groups that propelled the party to its biggest rout in a generation.

While a clear majority of white voters without a college degree favored Republican House candidates over Democrats (59 percent to 40 percent), the margin was 14 percentage points smaller than Mr. Trump’s was in the 2024 presidential election, according to Times Voter Trends data.

In many key Senate races, such as Iowa’s, the movement was even more pronounced. Even as other demographic groups shifted more drastically toward Democrats overall, the changing attitudes of white, working-class voters — who made up 39 percent of the electorate this year — were striking because they have been a cornerstone of Mr. Trump’s coalition for more than a decade.

Many of them vehemently oppose Democrats’ stances on issues such as abortion, L.G.B.T.Q. rights and immigration, said Alan Abramowitz, an Emory University political scientist. But in this election, “people were really focused more on what was happening to their standard of living,” he added.

Whether the Democratic gains with white, working-class voters will endure remains to be seen. But these voters’ frustrations with high costs, driven up by tariffs and the war in Iran, were a clear obstacle for the G.O.P. in the midterms.

Working-class voters “thought Trump would fix the economy,” said Alex Conant, a Republican strategist. “Two years later, they still feel like they’re falling behind.”

Democrats put inflation and corruption at the center of their midterm campaigns, arguing that the wealthy and powerful were helping themselves at the expense of everyone else. Mr. Trump, who rose to power stoking economic grievance, using anti-immigrant rhetoric, and vowing to keep the U.S. out of foreign wars, struggled this year to convince voters that he and his party had made their lives better with his agenda.

In North Carolina’s Senate race, Roy Cooper, the Democratic nominee, embarked on a “Make Stuff Cost Less” tour. In Ohio’s Senate contest, Sherrod Brown, also a Democrat, framed policy disputes as battles between workers and billionaires.

Here in Iowa, where nearly 60 percent of the electorate is white and working class, Josh Turek, the Democratic Senate nominee, often spoke about his own working-class upbringing and pinned high food and fuel prices on Mr. Trump’s tariffs and the war. He also ran as a centrist on social issues and immigration, saying politics should be less polarized.That pitch resonated with voters such as Ms. Wilson, who voted for Mr. Turek and for Rob Sand, the Democratic nominee for governor. She said she felt both centrist Democrats, who each won on Tuesday, would provide counterweights to Mr. Trump’s “war words.”

“I just want everybody to get along,” Ms. Wilson said.

Kenneth Hessen, a retired truck driver who said he was furious about Medicaid spending cuts in Mr. Trump’s tax and spending bill, also broke with his usual voting practices.

“I’ve voted Republican since I was 18 years old,” Mr. Hessen, 69, said at a polling station in Council Bluffs on Tuesday. “This year, I voted for every Democrat. If there was one under a rock, I’d vote for them today.”

Others who flipped said they did so despite Mr. Trump, not because of him.

Kevin Chadwick, 69, had his first child before graduating from high school and eventually built his own towing and repair business in Harlan, Iowa. Mr. Chadwick still supports Mr. Trump — “I wish he could run another term,” he said — and sees the war in Iran as necessary to keep the country from “pushing us around.”

Yet he voted Democratic in the Senate race, saying he was concerned that the Republican Senate nominee, Representative Ashley Hinson, had become millions of dollars richer while in office. (Ms. Hinson has said the sale of her husband’s business drove her jump in net worth.) When it came to the governor’s race, Mr. Sand’s demeanor also played a major role in Mr. Chadwick’s choice, as did his plan to legalize marijuana.

“I just like him, you know?” Mr. Chadwick said. “I think he’s down to earth. He’s honest.”

Mr. Chadwick said he was celebrating the Democratic sweep in Iowa, Texas and beyond because it “proves that money can’t buy everything,” after Elon Musk and other wealthy donors gave historic amounts to Republicans.

Many white, working-class voters still support Mr. Trump and Republicans over Democrats, including some who believe the president is looking out more for wealthier Americans.

Dave Barickman, 77, a retired law enforcement officer who lives in Council Bluffs, Iowa, voted for Republicans again this year because he favors the party’s approach to border security, the economy and social issues.

Mr. Trump “has the wheels turning right” on the economy, Mr. Barickman said, though the president is “probably taking care of the rich people more than the others.”In some cases, more aggressive Democratic efforts appeared to help them break through with white, working-class voters. American Bridge, a Democratic super PAC, turned research on the frustrations and priorities of working-class voters into a $50 million ad blitz across red-leaning states and districts.

Corey Davis, a supporter of Mr. Turek and a Democrat, said his union participated in a statewide door-knocking campaign run by the A.F.L.-C.I.O. for the first time in years. He said he personally drove two first-time voters from his union to the polls.

“This year, I was like, I’ve got to do more than I’ve ever done before, because I’m sick of getting disappointed,” Mr. Davis, a member of the Communications Workers of America who lives in Sioux City, said.

Mr. Trump blamed Republicans’ widespread midterm losses on the fact that he “wasn’t on the ticket.” Other Republicans have dismissed that notion.

At the bar in Prairie City, Mr. Charls told the bartender, Ms. Wilson, that he blamed backlash to Mr. Trump for Tuesday’s Republican wipeout.

“He’s a drama queen,” said Mr. Charls, who owns an electronics store and farms part time. “He always says, ‘Well, it’s somebody else’s fault.’ No, you lost. Like in 2020.”

Mr. Charls stuck with Republicans this election, as he has for years. He said he felt Democrats would worsen the country’s economic problems, which he attributed to inflation that began during the Biden administration, and he is worried that the party will “go woke” again when they retake power. And he predicted white, working-class voters won’t stay with Democrats for long.

If Democrats “act stupid the next two years,” Mr. Charls said, “They’ll flop the other way.”

Mr. Chadwick, the towing business owner who voted for Democrats, sounded unsure about what his vote would deliver.

“I hope it gets better,” he said. “But we hope that every election.”

More on the 2026 Midterm Elections

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• 10 Ads That Defined the Midterms: In a Democratic landslide election, here are the ads that stood out. Some were effective, while others backfired.

• Counting California’s Ballots: The state is once again processing mail ballots at a deliberate pace. Only about 65 percent of the votes had been tallied as of Thursday.

• Elon Musk: Behind the scenes, the world’s richest person spent a record amount over two years to bend the country’s politics to his will. He couldn’t.

• Average Age of Senators: Incoming senators are nearly 15 years younger than departing ones, on average. But the chamber’s overall age isn’t shifting much.

• Turning Point USA: Candidates backed by the right-wing activist group did not fare well, and the results set off recriminations from establishment Republicans.

• Shaping the Democrats’ Future: At a moment of opportunity for the party, its long-feuding factions are seizing on the midterm results to make their case for tacking to the center or to the left.

• The Blue Wave: These five races are very different, but they all explain how the Democrats won so big.

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Kylee Wilson, at her house in Prairie City, Iowa, said she voted for Democrats after voting for President Trump three times. “Trump put a target on America’s back,” she said. Credit…Rachel Mummey for The New York Times

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For two rare, understudied kidney diseases—IgA nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS)—patients have long faced uncertain diagnosis and treatment. Now, a shared biological thread is opening the door to a treatment that can address both diseases by targeting pathways they have in common—angiotensin II and endothelin-1. 

With IgAN and FSGS, damage occurs to glomeruli, or the tiny filters inside the kidneys that remove waste from the blood while keeping protein and blood cells where they belong. When the filters break down, protein can leak into the urine, which is called proteinuria.  

Proteinuria is a marker of kidney injury and a driver causing kidney function to decline, pushing the organ toward failure over time. With greater understanding of the mechanism of disease, rare kidney therapies are moving toward more personalized medicine to specifically address implicated pathways. (See “When filters fail.”)  

As with most kidney diseases, issues arise in IgAN and FSGS as the kidneys’ ability to filter waste out of the blood is comprised. As kidney disease progresses toward kidney failure, often within 5–10 years, patients head towards potential dialysis or transplant. 

Different diseases, shared pathway 

“For a long time, rare kidney diseases have been viewed as following parallel tracks, rarely intersecting once diagnosed. But while they may start with distinct patterns, kidney diseases converge on common pathways of glomerular injury and progression,” said Jula Inrig, M.D., head of R&D and CMO at Travere Therapeutics. “IgAN and FSGS begin on different paths, but both can involve podocyte injury, disruption of the glomerular filtration barrier, proteinuria and progressive loss of kidney function. Looking across diagnoses helps us identify those shared mechanisms, potentially giving us more ways to intervene before irreversible damage occurs.” 

In IgAN, the body produces a flawed version of an antibody called galactose deficient IgA1, triggering the immune system to create a second antibody to attack it. Combined, these antibodies clump together and deposit in the kidneys’ glomeruli, setting off a cascade of damage that involves the signaling molecules angiotensin II and endothelin-1.  

Angiotensin II raises pressure in the glomeruli and contributes to scarring, while endothelin-1 drives inflammation and direct injury to the podocytes. Angiotensin II and endothelin-1 can also work together to damage podocytes, contributing to inflammation, scarring and worsening proteinuria. What’s more, angiotensin II can trigger the formation of endothelin-1, creating a feedback loop that can add to kidney injury. 

FSGS arises from injury to the podocytes themselves, whether from genetic factors, immune activity, or other causes. Chronic proteinuria contributes to further injury, creating a cycle of damage that accelerates disease progression. 

The barriers facing patients and providers haven’t been easy to overcome. Diagnosis for IgAN and FSGS typically requires a biopsy. These allow physicians to clearly differentiate IgAN from FSGS, but identifying specific subtypes of FSGS can be more difficult.  

While approved treatment options are more vast in the IgAN community, doctors don’t always have a clear playbook when it comes to FSGS, where there is currently only one approved medication. And overall, the rarity of these diseases has meant that large-scale clinical trials have been difficult. 

Historically, patients have received fragmented, symptom-focused care. FSGS treatment, for example, had centered on supportive care, including blood-pressure medications and low-salt diets, with no disease-specific drug approved until April 2026. 

But progress is possible, and recent advancements are changing the story not just for IgAN and FSGS but for the way the field looks at treatments for rare kidney disease. Other fields have increasingly looked beyond traditional disease labels to shared biology, and that same shift to biology-driven care has started to happen in rare kidney disease. 

“We’ve seen in oncology how understanding the biology that cuts across traditional disease categories can change the way therapies are developed,” Inrig said. “Kidney disease is different, but the principle is relevant.” 

Targeting the biology behind kidney damage 

With IgAN and FSGS, because the angiotensin II and endothelin-1 pathways can reinforce each other, targeting both simultaneously might offer a way to interrupt the cycle of glomerular injury more comprehensively than targeting either pathway alone. FILSPARI® (sparsentan) is designed to block both biological pathways with a single molecule.  

“FILSPARI is part of a much broader evolution in how rare kidney disease is understood,” said Inrig.  

Across both diseases, clinical trials have shown that FILSPARI can produce substantial and sustained reductions in proteinuria. In IgAN, the Phase 3 PROTECT trial pointed to greater proteinuria reduction and a slowing of kidney function decline versus maximum labeled-dose irbesartan. In FSGS, the Phase 2 DUET and Phase 3 DUPLEX studies showed greater and sustained reductions in proteinuria. In each clinical study, adverse events observed with sparsentan were similar to those observed with irbesartan. 

Meanwhile, the UK’s National Registry of Rare Kidney Diseases (RaDaR)—a large-scale real-world effort—showed that IgAN patients continue to progress to kidney failure at levels of proteinuria that were traditionally thought to be “safe.” This pushed the field to target lower proteinuria goals and now complete remission—less than 0.3 grams of protein per day. For FSGS, physicians agree in principle that achieving complete remission would be ideal. 

“FILSPARI was developed in parallel with the growing understanding that rare kidney disease progression has been flying under the radar,” Inrig said. “In that sense, it reflects the same shift among nephrologists: toward recognizing risk earlier, treating more proactively and setting more ambitious goals for reducing proteinuria and help preserve kidney function.” 

The medication is approved for use in both IgAN and FSGS, though for distinct purposes. In IgAN, FILSPARI is indicated to slow kidney function decline in adults with primary IgAN who are at risk for disease progression. In FSGS, it reduces proteinuria in adult and pediatric patients ages 8 years and older with FSGS without nephrotic syndrome.  

FILSPARI has Boxed Warnings for hepatotoxicity and embryo-fetal toxicity. It is contraindicated in patients who are pregnant and should not be co-administered with angiotensin receptor blockers, endothelin receptor antagonists, or aliskirin. Please see below for additional Warnings and Precautions and Important Safety Information. 

FILSPARI reflects a more mechanism-based approach to rare kidney disease. Simultaneously blocking ET-I and Ang-II addresses shared drivers of glomerular injury that are relevant in both IgA nephropathy and FSGS. 

“The future of rare kidney disease development will increasingly depend on identifying shared mechanisms of progression and asking where they may be therapeutically relevant,” said Inrig. “That approach could allow us to develop medicines more strategically across conditions and extend advances from one area of kidney disease into others.” 

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California Governor Gavin Newsom has commuted the death sentences of all 548 people on death row in the state, changing them instead to life in prison.

“We can now let these offenders die in obscurity while we forever remember and honour the victims,” he said in a letter.

The decision to spare death row inmates is largely symbolic in a state that has not executed an inmate since 2006, though experts say it could save millions of dollars in court costs each year. Only 13 inmates have been executed since voters reinstated the death penalty in 1978.

The decision comes as Newsom, the Democratic leader of the most populous US state, has been discussed as a possible 2028 contender for president.

Newsom, who is term limited, is winding down his final months in office. Fellow Democrat Xavier Becerra is projected to take over after the midterm elections on Tuesday.

Newsom explained in his letter that he is exercising his constitutional clemency authority to commute the sentences to life without the possibility of parole.

“After nearly 30 years in public office, I have come to understand the limits of what government can justly accomplish,” Newsom said. “I take this action because I firmly believe that state-sanctioned killing is incompatible with California’s values, undermines the foundations of our legal system and diminishes each of us”.

California has historically had the largest population of death row inmates. Newsom had previously ordered a halt to the death penalty in the state in 2019.

Describing his decision as a difficult but “righteous action”, Newsom said that although many Californians feel that those who commit brutal crimes deserve to die, he has concluded that “the state cannot morally kill them”.

He said that by every measure, California’s system for administering the death penalty “is a failure”, and that it has not and cannot be fairly applied, resulting in the conviction of innocent people.

Life without the possibility of parole is the most severe punishment he can lawfully impose and that the state can ethically enforce, he said.

He acknowledged that his clemency action will anger and hurt some Californians and said that it will “always weigh heavily on me”.

“As governor, I alone bear responsibility for this decision and its impact, just as I alone would bear responsibility for each execution,” he wrote.

“For this reason, I am compelled to follow my conscience and, as authorised by our Constitution, take this action for the welfare of the State of California.”

Because individual states have the power to prosecute crimes and order executions, much of the power lies with state governors.

Bernard E Harcourt, a law and civil liberties professor at Columbia University, told the BBC that it is not unprecedented for a potential presidential candidate to come out as an abolitionist in the run up to elections – despite the overall popularity of the death penalty in the US.

He noted that François Mitterrand did precisely that in his presidential campaign in France in 1981, taking “the higher ethical ground and was rewarded by the public for that”.

“I detect a very similar ethical positioning in Governor Newsom’s statements about the commutations. And here too, it may well be something that the voters respect,” he said.

Newsom’s decision comes after the high-profile botched execution of a woman in Tennessee in late September and while executions have been on the rise in the US. There are three executions scheduled for Thursday in Indiana, Florida and Alabama.

At least four of seven judges on the California Supreme Court will have to sign off on the commutations, CalMatters reported.

It is unclear how Newsom’s decision will affect condemned inmates like Keith Doolin, 53, who was sentenced to death in 1996 for murdering two sex workers, Inez Espinoza and Peggy Tucker, and shooting four others. He maintains his innocence.

Doolin lived on death row at San Quentin for decades, until he was moved to another prison in 2025 when the governor announced the state would reform the prison for all but those on death row.

Doolin’s mother, Donna Larsen, told the BBC that the news of Newsom’s commutations – which includes Doolin – brought mixed emotions.

“At least the execution chamber will not be reconstructed, and no more killing by the people of the state of California,” she said.

Anthony D Romero, the executive director of the American Civil Liberties Union, applauded Newsom’s action.

“These commutations reflect what justice demands: an end to a racist, error-prone, and inhumane punishment that has burdened California for far too long,” Romero said.

“By taking this step, Gov. Newsom has affirmed that the death penalty has no place in California and he showed real courage by confronting racialised injustice head-on.”

Nathan Hochman, the top prosecutor in Los Angeles County, said that while Newsom has the power to commute sentences, only state legislature or voters can eliminate the death penalty.

“Californians have been asked on two separate ballot initiatives to abolish the death penalty and both times they have chosen to keep it for the most serious crimes,” Hochman said in a statement.

On the federal level, President Donald Trump, a long-time supporter of the death penalty, has described capital punishment as “an essential tool for deterring and punishing those who would commit the most heinous crimes and acts of lethal violence against American citizens”.

In 2020, during his first term, he ended a nearly two-decade moratorium on the federal death penalty, by ordering 13 executions over a six-month period.

While the moratorium returned under President Biden, on the first day of Trump’s second term in 2025, he signed an executive order that re-instated the death penalty.

No federal executions have been carried out since he signed it, however. In the US, both the federal government and local states authorities can order executions.

The death penalty is legal in 27 states, but has been abolished in 23 states and Washington DC, according to the Death Penalty Information Center, a national non-profit.

California, which primarily uses lethal injection for executions, used to house male death row prisoners in San Quentin State Prison north of San Francisco, and female inmates in the Central California Women’s Facility in the Central Valley.

But a 2016 ballot measure allowed for their transfer to other facilities that provide a necessary level of security, according to the California Department of Corrections and Rehabilitation.

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California Governor Gavin Newsom’s term in office comes to an end in January

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Representative Robert Garcia, the California Democrat who is poised to lead the House Oversight Committee in the next Congress, said that he planned to investigate Stephen Miller for his involvement in the Trump administration’s aggressive deportation efforts.

“Just days after the American people rejected his corrupt and lawless presidency, Donald Trump is doubling down,” Garcia said in a statement. “Stephen Miller is the architect of the unconstitutional ICE raids that have terrorized our communities and kidnapped and killed American citizens and immigrant families.”

“Stephen Miller should lawyer up,” he added.

Susie Wiles is one of the most powerful women to have served in Trump’s second term. And she is the latest in a wave of powerful women who have left the Trump administration amid an internal power struggle. On Thursday, Harmeet Dhillon, one of the top officials in the Justice Department, resigned after conflicts with department leaders.One of the disconnects right now is that the Republican midterm losses were a decisive rebuke of the president and his actions in office. But Trump has two years left of the term, and elevating Miller — who is deeply ideological and also the most powerful policy staff member in the modern history of the presidency — is doubling down on Trump’s agenda, not switching course.

Bill Pulte, the administration’s finance housing chairman who Wiles allies believed was undermining her with the president, was quick to praise Miller as the new choice. “Congratulations to my dear friend and colleague, Stephen Miller, on your promotion to Chief of Staff,” Pulte wrote on social media. “I can’t wait to work with you!”

Miller’s pitch for the job, according to people who heard it, was that the president needed to wind down the Iran war, a conflict that the president’s core supporters viewed as a betrayal.

Miller has also echoed Trump’s effort to undermine the legitimacy of the federal judiciary. When judges blocked the president’s tariffs last year, Miller attacked the decision as a “judicial coup” on social media. He has also attacked other judges scrutinizing Trump administration policies as Marxists and “crazy” communists.

Susie  Wiles posted on social media that today was her last day as chief of staff. “Serving President Trump in the White House has been the honor of a lifetime,” she wrote. “I’m so proud to have been a part of what we’ve accomplished together from securing our border and cutting taxes to strengthening our economy and putting America First. More than anything, I’m grateful for the extraordinary people I’ve had the privilege of working alongside. While my role may be changing, my commitment to the president and the mission never will.

”Stephen Miller, a deputy chief of staff, has been the architect of some of the most radical domestic policies in Trump’s second term, particularly on immigration. He has also served as a fiery surrogate for the president’s most divisive moves. Earlier this year, as Trump publicly toyed with the idea of invading Greenland, Miller laid out a vision of American imperialism in which the United States could freely overthrow national governments and take foreign territory and resources so long as it was deemed in the national interest.

In his Truth Social post, Trump said Wiles would be moving over to his political operation. He said Miller would take over as White House chief of staff starting on Monday.

Wiles was diagnosed with breast cancer in early 2026. She stayed in her role as she started treatment and recently announced that she was cancer free.

Stephen Miller has worked for Trump since his first presidential campaign, served all four years in the White House during the president’s first term and has amassed immense power since Trump retook office. He has been the driving force behind Trump’s hardline immigration policy and his crackdown on liberal institutions.

On election night, the president blamed Wiles for the midterm disaster in front of others. He has been furious at his political team. Trump had been asking people privately in recent days what they thought about Stephen Miller for the job. He was also asking people’s views on Jay Clayton, the director of national intelligence.

For weeks, Miller had been making known his interest in the job if Susie Wiles left, through proxies. But he has deep relationships with a number of key cabinet officials, which may have added to Trump’s consideration.

President Trump announced Friday he would make Stephen Miller, the powerful domestic policy adviser who has helped drive the administration’s immigration crackdown, his new chief of staff, replacing Susie Wiles following sweeping Republican losses in the midterm elections.

Ms. Wiles is moving to the president’s political operation, Mr. Trump said. But her departure and the ascent of Mr. Miller will fundamentally shift the circle of advisers around Mr. Trump as the White House absorbs the shock of the midterm elections.

It also signals an aggressive doubling-down by the president, after losses of Republican majorities in the House and Senate that served as a rebuke of Mr. Trump’s handling of issues ranging from the economy to the war with Iran to tariffs to his push for a mid-decade redistricting effort.

“I wanted to make a change,” Mr. Trump told reporters as he departed the White House for a trip to Florida. She had done a “great job,” he said. “Sometimes in life you have to make moves,” he added.

Asked what he wanted Mr. Miller to do differently than Ms. Wiles, who he had previously claimed wasn’t going anywhere, the president said, “Just run things well.”

The Republican wipeout had further inflamed tensions within the administration, with officials bracing for a slew of congressional investigations by Democrats and turnover in the West Wing and the cabinet.

It also signals an aggressive doubling-down by the president, after losses of Republican majorities in the House and Senate that served as a rebuke of Mr. Trump’s handling of issues ranging from the economy to the war with Iran to tariffs to his push for a mid-decade redistricting effort.

“I wanted to make a change,” Mr. Trump told reporters as he departed the White House for a trip to Florida. She had done a “great job,” he said. “Sometimes in life you have to make moves,” he added.

Asked what he wanted Mr. Miller to do differently than Ms. Wiles, who he had previously claimed wasn’t going anywhere, the president said, “Just run things well.”

The Republican wipeout had further inflamed tensions within the administration, with officials bracing for a slew of congressional investigations by Democrats and turnover in the West Wing and the cabinet.

Mr. Trump’s decision elevates one of the most deeply ideological members of the White House, someone known for flexing his power, to a prime role. Mr. Miller is one of the few people in the current West Wing who spent years preparing for a second Trump term from the standpoint of executive power, and who knows how the levers of government function. He is also one of two top West Wing staff members to have been part of the first administration when the House majority flipped in 2018, prompting a blitz of subpoenas from Congress.

People familiar with his views say he is likely to steer the president away from his early instinct after Tuesday’s losses to seek deals with Democrats. That could involve leaning even more into culture war issues, such as hard-line immigration enforcement and efforts to target diversity initiatives.

“Stephen is and always has been the eternal flame of the MAGA movement — putting the president’s words and policy into action,” Hunter Morgen, who worked as a deputy to Mr. Miller during the president’s first term and is now a lobbyist at Ballard Partners, wrote in a text message. “Since the earliest days of the 2016 campaign, he has been a steadfast torchbearer of the president’s agenda.”

In the short term, Mr. Miller’s focus is said to be the Iran war, which has been viewed by the president’s base as a betrayal of the president’s campaign promises.

Mr. Miller has relationships with some of the key cabinet officials involved in Mr. Trump’s top priorities, such as Attorney General Todd Blanche, Commerce Secretary Howard Lutnick and Defense Secretary Pete Hegseth. His arrival may help Mr. Hegseth, at least in the short term, as the president has heard myriad complaints about him from Republicans on Capitol Hill.

Mr. Hegseth celebrated Mr. Miller’s promotion with several posts on social media. “Huge CONGRATS,” he wrote, calling Mr. Miller “a true patriot and America First fighter.” He followed that up with a post that said, “Patriots in control,” and a subsequent one that included a picture of himself and Mr. Miller.

Mr. Trump, in his private conversations as well as his public remarks, has not accepted blame for the election results.

Instead, he repeatedly blasted Ms. Wiles and his other political advisers, insisting he was poorly served in the lead-up to the midterms. He criticized Ms. Wiles in front of several people at an East Room election watch party this week, according to people with knowledge of the incident, who spoke on the condition of anonymity to describe internal conversations.

Mr. Trump has also been privately critical of James Blair, Ms. Wiles’s ally, who ran the president’s outside political operation, people with knowledge of the comments said. And for the last several months, Mr. Trump has berated Ms. Wiles in front of other staff members about his frustrations that his administration has not moved faster to find people he brands as “leakers,” as well as the stalled prosecutions of his perceived political enemies, they said. In front of several advisers, he would accuse her of being among the leakers.

Allies of Ms. Wiles described her as prepared to leave her role. Her supporters saw the criticism of her as an effort to assign blame for a political strategy largely driven by Mr. Trump himself. And they faulted her detractors inside and outside the administration for spreading information meant to undercut her with Mr. Trump, including stories about her daughter’s lobbying work.

In her own statement posted on social media, Ms. Wiles described working for Mr. Trump in the White House as the “honor of a lifetime.”

“While my role may be changing, my commitment to the President and the mission never will,” she added.

Ms. Wiles, the first woman to hold the top staff job in the West Wing, helped steer Mr. Trump to his election victory in 2024, playing a central role in his return to power four years after his loss to Joseph R. Biden Jr.

She was diagnosed with breast cancer in early 2026. Ms. Wiles stayed in her role as she started treatment and recently announced that she was cancer free.

Ms. Wiles came into the job having established a rapport with Mr. Trump and a level of trust that none of his four first-term chiefs of staff had enjoyed.

Unlike some of Mr. Trump’s previous chiefs of staff, Ms. Wiles made clear she did not consider her job as trying to fundamentally change the president. But she tried to influence his decisions on core issues including his immigration crackdown, even if only on the margins, according to people with knowledge of her role. She pushed for the appointments of Secretary of State Marco Rubio and Treasury Secretary Scott Bessent, and both have been seen by many outside the government as stabilizing figures.

But Mr. Trump has relied primarily on his own instincts this term, and few advisers have engaged him in the kind of direct confrontations over policy that characterized his first administration.

Mr. Trump has publicly expressed his confidence in Ms. Wiles in recent months. But behind the scenes, there were signs that her standing with the president was shaky, according to officials with knowledge of the dynamics.

Mr. Trump began cutting Ms. Wiles out of hiring decisions, including when he chose an inexperienced television pundit to replace the departing press secretary, Karoline Leavitt.

And Mr. Trump started to criticize his chief of staff in front of other staff members, including over decisions he had approved, according to people familiar with his remarks.

After the elections, Mr. Trump made it clear to some advisers that he was unhappy with Ms. Wiles and his political team, who persuaded him to sign off on his super PAC’s spending $400 million to help Republicans in the midterms. The president had been reluctant to approve the spending and agreed to it only in September.

Stephen Miller is the architect of Trump’s mass deportation effort and a perennial target of liberal critics of the administration.Maggie Haberman, Tyler Pager and I had reached out to the White House with reporting that the president was replacing Susie Wiles. Shortly before the deadline we had given for the administration to comment, Trump posted on Truth Social.President Trump announced on Friday that Susie Wiles was leaving as White House chief of staff after sweeping Republican losses in the midterm elections. She will be replaced by Stephen Miller, who has worked for Trump since his first presidential campaign and served all four years in the White House during his first term.

Calley Means, who resigned as a top federal health official two weeks ago after clashing with the White House, on Friday accused President Trump’s chief of staff, Susie Wiles, of bowing to “unrelenting” pressure from industry lobbyists while prioritizing political fund-raising over Americans’ health.

In a two-hour interview with the podcaster Joe Rogan, Mr. Means said that Ms. Wiles withheld support from his efforts to make children’s diets healthier, citing the need for sugar industry money. He said her team demanded more approvals of flavored e-cigarettes, a top priority for major tobacco companies that donated at least $20 million to the G.O.P. in 2026. And he said they gave in to heavy lobbying from the kratom industry to relax proposed restrictions on products often referred to as “gas station heroin.”

“Susie said to me many times: ‘We need money for the midterms, Calley. We need money for the midterms,’” Mr. Means said.

In recent days, Ms. Wiles has become a target of criticism and finger-pointing in an escalating blame game after Republicans’ stunning losses in the midterm elections. In a post on Truth Social on Friday afternoon, Mr. Trump announced that Ms. Wiles would leave her post on Monday and Stephen Miller, a top White House adviser, would replace her.

“Susie Wiles, who has done an outstanding job, will be moving over to the Trump Political Operation. I want to thank her for her service as Chief of Staff — She has done a great job!”

Ms. Wiles was not immediately available to comment. A White House spokeswoman, Allison Schuster, did not respond to questions about Mr. Means’s statements. But she said in an emailed statement that Mr. Trump had “made incredible strides to Make America Healthy Again,” citing the government’s new dietary guidelines and work to eliminate artificial ingredients from food.

Mr. Means, a close ally of Health Secretary Robert F. Kennedy Jr. who helped build the Make America Healthy Again movement, avoided criticizing Mr. Kennedy or Mr. Trump. He directed his ire almost entirely at Ms. Wiles, a former lobbyist and political consultant, who he asserted had “spent her career taking money,” including from the pharmaceutical and pesticide industries and from the Israeli prime minister, Benjamin Netanyahu, a former client.

Mr. Means framed Ms. Wiles and her top deputies as welcoming lobbyists into the White House while sidelining Mr. Kennedy and infantilizing Mr. Trump. Mr. Means made a larger argument about the corrosive role of corporate money in politics, but also suggested that the president should “exorcise” Ms. Wiles and her aides “from the White House.”

Ms. Wiles’s policy interests also aligned with those benefiting her family, Mr. Means said, claiming that any corporation that hired her daughter, Katie Wiles, a partner at the lobbying firm Continental Strategy, “was getting a high priority.”

“So if you’re a special interest and you want to get something done, the secret’s out,” Mr. Means said. “You pay Susie’s daughter, and it was openly discussed when they had a client.”

Mr. Means’s tirade against Ms. Wiles, while depicting Mr. Kennedy as a “hero,” comes as Democrats are beginning to consider their new powers to investigate what they view as the most destructive actions of the Trump administration. Senator Ron Wyden, an Oregon Democrat who will lead the influential Senate Finance Committee, has already announced an investigation into Mr. Kennedy’s role in “corruption favoring” of the tobacco and kratom industries.

In the podcast interview, Mr. Means said the administration fumbled a series of issues that had been crucial to the MAHA coalition that had helped propel Mr. Trump to the presidency.

The missteps included an executive order aimed at supporting the production of glyphosate, the herbicide tied to cancer that many MAHA supporters want to see restricted. The order was issued in February, as the Supreme Court was about to hear oral arguments in a case that would determine whether Bayer, the maker of glyphosate, could receive immunity from lawsuits alleging the weedkiller caused cancer.

Mr. Means asserted that military leaders did not believe the order was necessary to protect national security, as the White House said. He described how one of Ms. Wiles’s deputies dropped the executive order on a table and said it was nonnegotiable.

“I read it, I said, ‘This is a political disaster,’” Mr. Means recalled. The aide was insistent. “Please inform Bobby. And this is not up for discussion.” He pointedly told Mr. Means that the health secretary should not call the president, adding, “Susie then called Bobby’s office and said, ‘We’re not discussing this.’”

The executive order was announced the next day, infuriating MAHA leaders.

Mr. Means also claimed that Dr. Heidi Overton, then a White House health official whom Mr. Trump has since nominated to lead the Food and Drug Administration, had helped Justice Department officials create legal arguments urging the Supreme Court to review the glyphosate case and supporting Bayer’s position.

A White House official said that the court had asked the Trump administration to weigh in on the case. The solicitor general drafted a brief and then shared it with the White House Counsel’s Office, which circulated it to relevant policymakers, including Dr. Overton, who commented on it, the official said.

The Supreme Court sided with Bayer in a decision that gave the company broad liability protection and infuriated many in the MAHA movement.

Mr. Means joined the White House after working on Mr. Kennedy’s campaign and helping to broker the partnership between the secretary and Mr. Trump; he later went to work directly for Mr. Kennedy. He is primarily interested in the secretary’s food agenda and has not been involved in more controversial policy-making on vaccines.

But in the interview, he accused Ms. Wiles of pressuring Mr. Kennedy to downplay vaccine safety while relying on the work of a pollster, Tony Fabrizio, who receives funding from the pharmaceutical industry.

Mr. Means also described how some of his efforts to draft policies to make the food supply healthier were thwarted, such as one aimed at pushing the food industry to address whether the amount of sugar in children’s diets was appropriate.

“And that’s where Susie told me we can’t do that,” Mr. Means said. “‘I need the sugar industry money.’”

Mr. Means also said that Dr. Marty Makary, the former F.D.A. commissioner, was “pounded” in numerous meetings to approve flavored e-cigarettes, which James Blair, a former deputy of Ms. Wiles, framed as “a core midterm issue.”

Dr. Makary left the agency in May over the disputes on the matter. Mr. Means said that Dr. Overton did what Dr. Makary would not: “She wrote up a policy to relax standards on fruit-flavored vapes.”

Mr. Means said that his “last straw” came after months of delays on his effort to arrive at a definition of ultraprocessed foods, which could eventually lead to regulation. He said that he and Mr. Kennedy went to Ms. Wiles, who denied any special interest influence on the matter.

“Lied to us to our face,” he said, recounting that he later heard her say we need to “do something” about MAHA.

Mr. Means said he believed Democrats were also guilty of ceding to similar influences and said the solution could come from a presidential candidate running on the issue of amending the Constitution to take money out of politics.

“Americans need to understand that if they are getting whipped up and excited about policy promises through our existing structure, they are being duped and gaslighted and lied to,” he said. “We need to have systemic reform.”

The Latest on the Trump Administration

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• Europe’s Concerns: The Democratic victory in the midterms has brought private relief to some Europeans but no official glee, with Ukraine, Iran and NATO all hanging in the balance along with a politically wounded U.S. president.

• Communities Face Cuts: The Trump administration is scaling back or stalling investments that help disaster-prone places harden themselves to rising flood and fire threats.

• Harmeet Dhillon Resigns: The chief of the Justice Department’s civil rights division resigned after conflicts with department leaders, including disagreements over legal strategy in the midterm elections, two people familiar with the situation said.

• National Guard in D.C.: The National Guard is expected to expand its use of military trucks, Humvees and boats for armed patrols in Washington, D.C., escalating a deployment in the nation’s capital that President Trump intends to maintain for the rest of his term.
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Stephen Miller with President Trump in the Oval Office in August. Credit…Haiyun Jiang/The New York Times

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A child in upstate New York died on Monday after contracting measles. This marks the state’s first death from the disease in 30 years, as the outbreak continues to spread across the country.

In a statement, New York governor Kathy Hochul said she was “heartbroken” and that the death reflected a crisis of government and public health. Hochul declared measles a statewide disaster last month.

With fewer immune protections, children are especially at risk for measles and its more dangerous effects. And as the outbreak surges, doctors are becoming increasingly concerned about congenital measles. If a pregnant woman has measles, there’s a 25 to 30 percent chance her child will also acquire measles, according to the American Academy of Pediatrics. Congenital measles is not tracked by the Center for Disease Control and Prevention—the condition had become exceedingly rare, but rising rates are raising fears about its potential effects once more.

As of October 29, the CDC had confirmed 4,852 measles cases across the U.S. so far this year. New York State has had a total of 178 confirmed cases, mainly concentrated in the central part of the state. According to officials, the recent death in New York occurred in Lewis County, which is northeast of Syracuse and has seen 16 cases in 2026.

It is representative of a worsening national picture. The U.S. is currently in the thick of the worst measles outbreak since 1991. Case numbers this year have already doubled those of 2025—previously the worst year for the disease since 1991. (The U.S. was declared measles-free in 2000.) Technically, the country still holds its measles-free status, a title that is marked by 12 months without continuous local transmission, although experts expect that may change soon. Officials are set to meet in the next few weeks to determine whether that status—hailed for years as a symbol of excellence in public health—should be revised or eliminated.

As of October 30, the CDC has reported three deaths from measles nationally—although some states have reported deaths that have been disputed by the CDC—and an 11 percent hospitalization rate. In its milder forms, the disease can cause an itchy rash and fever, but it can also cause pneumonia and severe brain inflammation, which, without treatment, can prove fatal or disabling. The measles virus is the most contagious virus known—but it is not impossible to contain. Vaccines, particularly the measles, mumps and rubella (MMR) combined shot, had helped measles fade because of herd immunity. But dwindling vaccination rates are helping the disease break through, with dire consequences.

The MMR jab offers 97 percent protection for life after two doses given in childhood and was the major factor in eradicating measles in the U.S. But with higher levels of vaccine skepticism among the public and the upper echelons of the Trump administration, fewer children are receiving the vaccine: in the past 10 years, MMR vaccination rates among kindergarteners have fallen from 94 percent to 92.4 percent. (A 95 percent vaccination rate is the critical number to ensure community or herd immunity.) Of the cases reported by the CDC this year, 96 percent were among people who were unvaccinated or whose vaccination status was unknown. It’s unclear whether the child that died on Monday was vaccinated.

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Key points

• Socrates believed that our greatest problem is not knowing that we are ignorant.
• We resist challenges to our beliefs because we experience them as attacks on our identity.
• We are not merely ignorant; we are invested in remaining ignorant.

 

In 399 BCE, the Athenians sentenced Socrates to death. His crime? He had spent his life making people look like the fools that they were. Officially, Socrates was charged with impiety and corrupting the youth. For years, this eccentric septuagenarian had gone around asking people questions, exposing the inconsistencies and contradictions in their opinions. In his mind, he had been doing them the greatest favour.Socrates had discovered something about human nature that remains as true today as it was in antiquity: Our problem is not so much that we are ignorant, but that we are ignorant of our ignorance.

The Wisest Man in Athens

According to his student Plato, Socrates had a friend called Chaerephon, who once travelled to Delphi and, on a whim, asked the oracle whether anyone was wiser than Socrates. The oracle replied in the negative: “There is no one wiser than Socrates.”

Socrates was as surprised and perplexed as everyone. He knew that he was not wise—but, surely, the god of the oracle could not have been mistaken? To find out what the god might have meant, he went around questioning people with a reputation for wisdom, beginning with the politicians, then the poets, and finally the craftsmen.

The politicians, he found, could not even explain the words that they were using. The poets wrote beautiful verses but struggled to make sense of them. The craftsmen possessed genuine expertise, but mistakenly assumed that this made them knowledgeable about everything else.

Socrates concluded that he was wiser than these supposedly wise men in one small but critical respect: He did not think he knew what he did not know.

The Trouble With Knowing Everything

From then on, Socrates devoted himself to questioning his fellow Athenians. He would ask a general to define courage, a priest to define piety, or a pair of good friends to define friendship. They would offer a confident answer, only for Socrates to expose some inconsistency or contradiction. He and they would then explore the concept in every direction until everyone threw up their hands in despair at their inability to define even the most important and apparently self-evident things.

This method of questioning, known as elenchus, or the Socratic method, aimed to bring about a state of puzzlement called aporia.

Aporia, if you like, is the honest and fertile state of knowing that you do not know.

One day, Socrates met a youth called Theaetetus, whose perplexity delighted him. Socrates said to him, “I see, my dear Theaetetus, that Theodorus had a true insight into your nature when he said that you were a philosopher, for wonder is the feeling of a philosopher, and philosophy begins in wonder.”

The Perils of Being Right

But there was a problem. As I discuss in my book, The Gang of Three, Socrates’ interlocutors did not want to be helped. Deep down, in a place unknown even to them, they did not welcome the truth.

Our beliefs are not merely propositions that we hold in our heads. They are bound up with our sense of who we are. To challenge a person’s beliefs is to challenge that person’s identity, standing, and meaning. We defend our beliefs as if we were defending ourselves.

Socrates understood this all too well. To prevent his interlocutors from getting angry or running away, he frequently feigned ignorance or used flattery. His approach rather resembles that of Lieutenant Columbo, the apparently bumbling detective who always has just one more question.

The Price of Wisdom

By exposing the ignorance of prominent Athenians, Socrates acquired admirers, especially among the young, but also powerful enemies.

At his trial, he reproached his fellow citizens for concerning themselves with wealth and reputation while neglecting wisdom, truth, and the proper care of their souls.

He compared himself to a gadfly attached by the gods to a great but listless horse: Athens needed him to sting her into wakefulness.

Even with his life at stake, Socrates refused to change his ways. If anything, he dropped the mask.

Socrates had spent his life showing people that they were fools. In condemning him, the Athenians demonstrated just how right he was.

And two-and-a-half thousand years later, what has changed? We still prefer certainty to doubt, reassurance to correction, and the appearance of wisdom to the difficult business of acquiring it.

We are not merely ignorant; we are invested in remaining ignorant.

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Six days before the election, more than two dozen of President Trump’s top strategists logged onto a private video call.

The mood was grim. The discussion began with talk of cyanide.

“Do you want the white pill first, or the black pill first?” asked Tony Fabrizio, the president’s chief pollster.

Tim Saler, one of the Republican Party’s top data consultants, laid out two scenarios. In the first, the $400 million MAGA Inc. super PAC was reaching the voters that it had wanted and expected to vote. “That’s the optimistic scenario,” he said.

The other was a wipeout.

“I’m getting my affairs in order,” James Blair, who left the White House to oversee the president’s midterm strategy, said to laughter, according to four people on the call. “I suggest everybody else do the same.”

For roughly 30 minutes, the call ran on gallows humor: funeral arrangements, prison food, presidential pardons, even a brief riff on fleeing the country.

“At least Bibi won. He’ll protect us,” Mr. Blair said sarcastically of the Israeli prime minister, Benjamin Netanyahu, whose country had voted the day before. (Mr. Netanyahu’s bloc fell short of a majority, and his party soon claimed the election had been stolen.)

“Maybe we could get asylum in Israel,” Mr. Fabrizio said.

Collapse at the Polls

The scope of the Republican wreckage would become clear a week later.

Democrats stormed to a huge House majority and won control of the Senate, a remarkable feat powered by victories in Republican strongholds — Kansas, South Carolina, Texas — that few could have imagined a year ago.

This account of the Republican Party’s collapse is based on interviews with more than 70 people — among them lawmakers, political strategists, party leaders, pollsters, White House officials and congressional aides — who were directly involved in the midterm elections, many of whom were granted anonymity to describe private conversations and decisions.

The scale of the defeat was far from inevitable.

Republicans had record fund-raising, the world’s richest man, a favorable Supreme Court ruling on campaign finance and a demoralized, unpopular opposition.

In the Senate, they had a map that required Democrats to compete in states they hadn’t won in decades.

And in the House, the Trump team demolished the tradition of redrawing congressional lines only once a decade in order to carve up new districts to help the G.O.P. bolster its narrow majority.

What Republicans could not overcome was a president who lost the public’s trust on the economy and so much more. And what they had not counted on was an unpopular war in the Middle East — one that would close the Strait of Hormuz and push gas prices past $4 a gallon — that would rage all the way through the election.

And Democrats were ready, this time, to seize on the G.O.P. stumbles.

A Stark Warning on the Iran War

The slide deck that Mr. Blair had circulated over the summer to officials in the West Wing was stark.

One slide linked Republicans’ polling numbers to an Iran war timeline.

It showed how the Democratic advantage had ballooned during active hostilities, shrunk during talks over a “memorandum of understanding” and then spiked again when the cease-fire collapsed.

By the end of July, Democrats had a 10-point edge on the congressional ballot.

The “bottom line” was hard to miss. It was in highlighter yellow: Republicans could still conceivably win the House if Democrats had only a four-point edge. “But that won’t happen without an extended cease-fire, Hormuz open & gas prices falling,” the slide warned.

“A final result approaching D+10 would likely cost us the Senate.”

The results on Tuesday were even worse: Mr. Trump’s party is on track to lose the national popular congressional vote by about 13 points, according to estimates by The New York Times. It is shaping up to be the worst loss in a half-century, since the aftermath of the Watergate scandal.

Even before the polls had closed, Mr. Trump had begun to ruminate on what might have been.

“If we never went into Iran, what do you think would happen in the midterms?” the president had asked privately, according to a person who spoke to him.

An Unchecked Second Term

What made the war such a potent force is that it told a simple story for voters.

As a candidate, Mr. Trump had promised no new wars. He started a new war.

He promised lower prices. Gas prices soared and inflation rose.

The story of the G.O.P. midterm implosion was not only a story of broken promises; it was also a story of radical overreach. After Mr. Trump came back from pariah status after Jan. 6, 2021, some advisers believed he had convinced himself that the rules of politics had been suspended for him alone. That illusion was obliterated on Tuesday night.

Over nearly two years, hubris had become the governing philosophy of Mr. Trump’s second presidency.

There was a seemingly endless string of investigative pieces revealing that Mr. Trump, his family and their close associates had used the presidency to enrich themselves brazenly. Those reports began to resonate with voters; an early October poll from Fox News showed corruption as the top voter concern. (Anna Kelly, a White House spokeswoman, said: “The President only acts in the best interest of the American people. There are no conflicts of interest.”)

In 2025, Mr. Trump began a trade war with the entire world — the pain of which was still being felt more than a year later on farms all over the suddenly competitive states of Kansas, Texas and Iowa.

Throughout it all, the president flashed indifference to the struggles of Americans that his policies had exacerbated.

Soaring gas prices? “A small price to pay,” Mr. Trump insisted.

Some members of his team grew exasperated as Mr. Trump spoke seemingly more about his new ballroom than the border, golf courses than grocery prices, interior decorations than inflation.

On the eve of the midterms, he focused his closing pitch on his refurbishment of the Reflecting Pool on the National Mall, joking that he was considering renaming it for himself rather than Abraham Lincoln.

Unlike in the past, Democrats mostly ignored the daily Trump distractions and sought to connect corruption to costs. They also told a story of a government focused on elites while average people struggled — from Jeffrey Epstein’s protected associates to the president’s $2.2 billion in personal profits.

In the House, Democrats quickly and unexpectedly countered Mr. Trump’s redistricting push and pursued strong candidates deep into red territory to spread the map. In the Senate, they found a series of blue-chip recruits who put once unthinkable states into play. In the final, frenzied weeks of the campaign, Republicans were redirecting cash from the usual swing states of North Carolina and Georgia to try to shore up traditional strongholds in South Carolina and even Mississippi.

The war in Iran, said Representative Hakeem Jeffries of New York, the Democratic leader and now the speaker-in-waiting, helped “supercharge” the contrast between the two parties.

Republicans had tried to frame the midterms as a choice between “common sense and crazy,” relentlessly attacking the rising democratic socialist wing of the left.

Yet Mr. Trump’s own pollster’s final survey, taken two weeks before the election, showed that while both the MAGA Republican brand and democratic socialists were unpopular with voters, MAGA carried more baggage. When Republicans who were not planning to cast ballots were asked what it would take to earn back their vote, their top two answers were ending the war and addressing inflation.

On that final call before Election Day, Mr. Trump’s advisers were both clear-eyed and cynical about the state of the race, referring at one point to a Trump ally who ran for governor of Minnesota and demanded a recount in his primary despite losing in a landslide.

“Look, it’s fine,” Mr. Blair told the group acerbically. “I think we’ll just pull a Mike Lindell and demand a recount regardless of how many points we’re down.”

Alex Pfeiffer, a spokesman for the MAGA Inc. super PAC, said that the group’s “sober and clear-eyed view of the political environment,” led to investing in House races Republicans are leading in, in Maine, Florida, Tennessee, New York and Texas.

“The people peddling these made up quotes and false gossip not only demean and belittle the historic and generous investment by the president into the party’s midterm effort, but they also slander the hard work of the many who contributed to this effort,” he said in a statement. “They are cowards and losers.”

A White House official, who declined to speak on the record, said in response to the reporting for this article: “President Trump was not on the ballot, and it’s proven that Trump voters show up when he is on the ballot. Candidate quality matters, and President Trump did a better job promoting many of the candidates on the ballot than the candidates did themselves.”

The official repeated that the president, who acknowledged earlier on Wednesday that the war affected the midterms, had over and over again said Iran can’t procure a nuclear weapon.

The Anti-Recruiter

While Senator Chuck Schumer of New York, the Democratic leader, painstakingly recruited top-tier Senate candidates, Mr. Trump took a series of steps that endangered the Republican majority.

After Senator Joni Ernst of Iowa flirted with opposing Mr. Trump’s most controversial nominees and Senator Thom Tillis of North Carolina voted against his signature tax-and-spending bill, Mr. Trump’s allies threatened to end their careers. Both decided to retire, creating vulnerable open seats that had been held by Republicans.

In North Carolina, Mr. Trump cleared the field for Michael Whatley, a former lobbyist and Republican National Committee chairman, who proved a lackluster candidate and lost to Roy Cooper, the state’s popular Democratic former governor.

After Senator Lindsey Graham of South Carolina died in July, Mr. Trump supported tapping his sister, Darline, to not just replace him temporarily but also to run for a full six-year term. In doing so, he elevated an inexperienced candidate with no fund-raising base, and she went on to lose in a state that had not elected a Democrat to the Senate since 1998.

But no candidate proved more costly to the party than Ken Paxton, the scandal-ridden Texas attorney general. Mr. Trump endorsed him over Senator John Cornyn, the Republican incumbent, ignoring a year of warnings that Mr. Paxton would put the seat in jeopardy. Republicans were ultimately forced to spend close to $300 million in Texas — money that could have gone to shore up candidates in other states. Mr. Paxton lost by 12 points.

On another recent call, the Trump team mocked the haplessness of some of the Republicans they were trying to elect.

“I have seen the enemy,” Mr. Blair told the group a week earlier. “And it is us.”

Mr. Fabrizio replied: “In many places.”

The Democrats’ Playbook

In May 2025, Mr. Schumer arrived at Wildflower Farms, an upscale resort in New York’s Hudson Valley, for a secretive retreat with donors and party officials. He desperately needed to expand the Senate map.

At the Wildflower retreat, James Talarico, a youthful-looking state legislator in Texas, had delivered a five-minute speech for the assembled crowd on the importance of storytelling in campaigns. Mr. Schumer was smitten. He told at least two attendees afterward that he wanted to get Mr. Talarico to run for the Senate.

To win control of the Senate, Democrats needed to hold all of their seats and flip at least four, including in states that Mr. Trump won handily in 2024.

Mr. Schumer spent months wooing Mr. Cooper and took at least three trips to Ohio to coax former Senator Sherrod Brown, who had lost in 2024 but had a populist brand that matched the country’s mood.“If you retire and we lose the majority by one vote, you won’t enjoy your retirement,” Mr. Schumer recalled telling Mr. Brown, 73.

Both ran and won.

In the House, where Democrats had fallen three seats short in 2024, recruiters went hunting in districts Mr. Trump had carried by 10 points or more, betting early that the emboldened president would overreach.

An election post-mortem by the Democratic House Majority PAC circulated in April 2025 found two factors stood out among the party’s stronger 2024 candidates: being “perceived as moderate” and focusing on the economy.

“If we wanted to compete deeper in red districts, we needed to find candidates who are not immediately off-putting,” said Mike Smith, the PAC’s president.

They set about recruiting candidates with distinctive biographies: military veterans, doctors, farmers, a smokejumper, a Tejano music star — just about anyone who didn’t scream professional politician.

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President Trump at a campaign rally in Kalispell, Mont., last month. Credit…

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Major cities across the world—including hotspots such as New Orleans, Mexico City, Jakarta and Rome—are sinking by up to several inches every year.

Those are the findings of an exhaustive new survey published in Nature Cities, in which researchers used satellite radar to track 465 urban areas of more than a million people from 2014 to 2023. The results, displayed in an interactive map, shows that sinking isn’t just “a local curiosity” for a small handful of cities, but “a global urban problem,” says study coauthor Guoquan Wang, a geophysicist at the University of Houston.

Satellites can measure the land’s gradual sinking, called subsidence, by taking radar images of the same area over time to determine the shift in the radar signal’s travel—even a change of mere millimeters (twenty-fifths of an inch) of ground can result in a signal taking slightly longer to return than the past. The new work, which examined small chunks of land—just a few houses wide—all over the world, is “the most comprehensive and systematic exploration of subsidence in urban cities,” says Roland Bürgmann, a geophysicist at the University of California, Berkeley, who was not involved in the study.

Sinking was most severe in Southeast Asia, West and Central Asia and North America, but it also turned up in South America and Africa, both of which are generally less studied in regards to land subsidence; For almost half the cities in the dataset, no satellite radar study had ever been done before.

Different factors can contribute to urban subsidence. In New York City, for instance, the weight of buildings compresses the region’s soft soils. But the biggest driver is usually water utilities, industries and other groups pumping out water from under the ground. Groundwater helps hold up the soil like air in a cushion: pump it out, and the ground slowly sags.

And the real danger is uneven sinking. “If the whole city were to smoothly subside altogether by an inch or so, it wouldn’t be that big of a problem,” Bürgmann says. But when one neighborhood drops faster than the next, the strain builds.

Over time such strain can crack foundations, break sewer lines, damage subway systems and worsen flooding. In Jakarta, the sinking and flooding has become so severe that Indonesia is building a brand-new capital city on the island of Borneo.

Once it happens, sinking is “cumulative and largely irreversible,” Wang says, but cities have successfully stopped continued subsidence before. Tokyo once sank “way faster than many cities today,” says Manoochehr Shirzaei, a geoscientist at Virginia Tech, who was a peer reviewer for the study, until officials drew up policies to halt it. These included regulations around groundwater pumping and a shift toward alternative surface water sources. In China, Beijing and the nearby city of Tianjin “stopped pumping groundwater and replaced it with surface water” piped from the Yangtze River basin, Wang says, and sinking has since halted in parts of the region.

“In most places, we have plenty of time to react,” Shirzaei says, “but we have to do it.”

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Aleksandr Medvedkov/Shutterstock

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Traveling to far-off places for vacation or to visit loved ones during the holidays is fun, but the journey to get there can feel like an endurance event that entails marathon bouts of sitting or racing from one airport gate to the next. And that can leave you with achy joints or stiffness that you didn’t have when you embarked. What’s a tired traveler to do?

Your antidote: Gentle movement, like stretching, which will help you feel refreshed and ready to enjoy the rest of your trip.

“Our bodies are designed to move, and staying in the same position for hours can leave the hips, back, neck, shoulders, and legs feeling tight and uncomfortable. Stretching is a great way to give your joints and muscles some much-needed motion, and you can do it anywhere—like the airport, a rest area parking lot, the car, or even your plane or train seat,” says Lindsey Benoit O’Connell, C.S.C.S., a certified meditation teacher and breathwork facilitator and founder of The LAB Wellness. “Stretching and the breathwork involved in it can also help tame travel stress.”

Next time you take a trip, try these stretches for travel days.

Best Stretches for Travel Days

An on-the-go stretch session doesn’t just help unwind your muscles and mind. Stretching also helps increase circulation throughout your body, including to your legs. That’s important because sitting for long periods (like on a flight or road trip) is a risk factor for deep vein thrombosis, or a blood clot in the leg, particularly in people prone to them.

Aim to hold each stretch for at least 30 seconds, but feel free to hold as long as feels good.

1. Seated Figure Four

Why it works:

This stretch helps improve flexibility and range of motion in the muscles around the hips and glutes, helping to counteract stiffness or joint aches caused by a long day of sitting while traveling.

How to do it:

1. Sit toward the front of a chair, both feet flat on the ground.
2. Cross right ankle over left thigh, flex right foot, and gently hinge forward at hips until you feel a stretch along the outer hip and glute.
3. Hold for at least 30 seconds.
4. Then switch sides.

2. Seated Spinal Rotation

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Lu ShaoJi//Getty Images

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