With thousands of illegal e-cigarettes for sale in the U.S., both the Trump and Biden administrations have vowed to crack down on the illicit fruit- and candy-flavoredvapes that hold particular appeal to minors. But a new government report suggests law enforcement efforts by the Department of Justice lag far behind the scope of the problem.
Most DOJ enforcement actions between fiscal year 2022 and fiscal year 2025 — 50 out of a total of 88 — were to add the names of remote e-cigarette sellers to a list of unauthorized businesses, according to the report from the Government Accountability Office. The second-most common type of enforcement actions (20 out of 88) noted in the report were injunctions to stop legal violations.
Is it the Department of Defense or the Department of War? The Gulf of Mexico or the Gulf of America? A vaccine—or an “individualized neoantigen treatment”?
That’s the Trump-era vocabulary paradox facing Moderna, the covid-19 shot maker whose plans for next-generation mRNA vaccines against flus and emerging pathogens have been dashed by vaccine skeptics in the federal government. Canceled contracts and unfriendly regulators have pushed the Massachusetts-based biotech firm to a breaking point. Last year, Robert F. Kennedy Jr., head of the Department of Health and Human Services, zeroed in on mRNA, unwinding support for dozens of projects—including a $776 million award to Moderna for a bird flu vaccine. By January, the company was warning it might have to stop late-stage programs to develop vaccines against infections altogether.
That raises the stakes for a second area of Moderna’s research. In a partnership with Merck, it’s been using its mRNA technology to destroy tumors through a very, very promising technique known as a cancer vacc—
“It’s not a vaccine,” a spokesperson for Merck jumped in before the V-word could leave my mouth. “It’s an individualized neoantigen therapy.”
Oh, but it is a vaccine. And here’s how it works. Moderna sequences a patient’s cancer cells to find the ugliest, most peculiar molecules on their surface. Then it packages the genetic code for those same molecules, called neoantigens, into a shot. The patient’s immune system has its orders: Kill any cells with those yucky surface markers.
Mechanistically, it’s similar to the covid-19 vaccines. What’s different, of course, is that the patient is being immunized against a cancer, not a virus.
And it looks like a possible breakthrough. This year, Moderna and Merck showed that such shots halved the chance that patients with the deadliest form of skin cancer would die from a recurrence after surgery.
In its formal communications, like regulatory filings, Moderna hasn’t called the shot a cancer vaccine since 2023. That’s when it partnered up with Merck and rebranded the tech as individualized neoantigen therapy, or INT. Moderna’s CEO said at the time that the renaming was to “better describe the goal of the program.” (BioNTech, the European vaccine maker that’s also working in cancer, has shifted its language too, moving from “neoantigen vaccine” in 2021 to “mRNA cancer immunotherapies” in its latest report.)
The logic of casting it as a therapy is that patients already have cancer—so it’s a treatment as opposed to a preventive measure. But it’s no secret what the other goal is: to distance important innovation from vaccine fearmongering, which has been inflamed by high-ranking US officials. “Vaccines are maybe a dirty word nowadays, but we still believe in the science and harnessing our immune system to not only fight infections, but hopefully to also fight … cancers,” Kyle Holen, head of Moderna’s cancer program, said last summer during BIO 2025, a big biotech event in Boston.
Not everyone is happy with the word games. Take Ryan Sullivan, a physician at Massachusetts General Hospital who has enrolled patients in Moderna’s trials. He says the change raises questions over whether trial volunteers are being properly informed. “There is some concern that there will be patients who decline to treat their cancer because it is a vaccine,” Sullivan told me. “But I also felt it was important, as many of my colleagues did, that you have to call it what it is.”
But is it worth going to the mat for a word? Lillian Siu, a medical oncologist at the Princess Margaret Cancer Centre, in Toronto, who has played a role in safety testing for the new shots, watches US politics from a distance. She believes name change is acceptable “if it allows the research to continue.”
Holen told me the doctors complaining to Moderna were basically motivated by a desire to defend vaccines—which are, of course, among the greatest public health interventions of all time. They wanted the company to stand strong.
But that’s not what’s happening. When Moderna’s latest results were published in February, the paper’s main text didn’t use the word “vaccine” at all. It was only in the footnotes that you could see the term—in the titles of old papers and patents.
All this could be a sign that Kennedy’s strategy is working. His agencies often appear to make mRNA vaccines a focus of people’s worries, impede their reach, devalue them for companies, and sideline their defenders.
Still, Moderna’s strategy may be working too. So far, at least, the government hasn’t had much to say about the company’s cancer vacc— I mean, its individualized neoantigen therapy.
This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.
We had crash-landed on the planet. We were far from home. The spaceship could not be repaired, and the rescue beacon had failed. Besides me, only the astrogator, part of the captain, and the ship’s AI mind were left.
Outside, the atmosphere registered as hostile to most organisms. We huddled in the lifeboat, which was inoperable but still held air. Vast storms buffeted our cockleshell shelter, although we knew from prior readings that other areas remained calm. All that remained to us was to explore, if we wanted to live. The captain gave me the sole weapon. She tasked the astrogator with carrying some tools that would not unduly weigh him down.
Little existed on the planet except deserts of snow. But alien artifacts lay in an area near us. We were an exploration team, so this discovery had oddly comforted us, even though we had been on our way elsewhere. The massive systems failure had no discernible source, and the planet had been our only choice for landfall.
The artifacts took the form of 13 domes, spread out over that hostile terrain. The domes had been linked by cables just below shoulder level, threaded through the tops of metal posts at irregular intervals. Whether intended or not, these cables and rods formed a series of paths between the domes.
Before our instruments failed, the AI had reported that the domes appeared to have a heat signature. The cables pulsed under our grip in a way that teased promised warmth far ahead. It took some time to get used to the feeling.
The shortest path between domes was a thousand miles long. The longest path was 10 thousand miles long. Our suit technology was good: A suit could recycle water, generate food, create oxygen. It could push us into various states of near hibernation while motors in the legs drove us forward. For the captain, the suit would compensate for having lost her legs and ease her pain. We estimated we could reach the nearest path and follow it to the nearest dome … and that was it. If the dome had life support capabilities, or even just a way to replenish our suits, we would live. Otherwise, we would probably die.
We revised the estimate of our survival downward when we reached the path and soon encountered the skeletons of dead astronauts littering the way. In all shapes and sizes, cocooned within their suits. Their huddled forms under the snow displayed a serenity at odds with their fate. But when I wiped the frost from face plates, we saw the extremity of their suffering.
It is difficult to explain how we felt walking among so many fatalities. So many dead first contacts.
We no longer had to puzzle over the systems failure. Spaceships came here to crash, and intelligent entities came here to die, for whatever reason. We could not presume our fate would be any different, and adjusted our expectations accordingly. The AI’s platitudes about courage did not raise morale. There were too many lost there in the frozen wastes.
Here were the ghastly emissaries of hundreds of spacefaring species we had never before encountered.
The number of the bodies and their haphazard positioning hampered our ability to make progress to the dome. The AI estimated our chances of survival at below 50% for the first time. We would starve in our suits as the motors propelled us forward. We would become desiccated and exist in an elongation of our thoughts that made us weak and stupid until the light winked out. But still, we had no choice. So even in places where the dead in their suits were piled high, we would simply plunge forward, over and through them, headed for the dome.
What we would find there, as I have said, we did not know. But we were in an area of the galaxy where ancient civilizations had died out millions of years ago. We had been on our way to a major site, an ancient city on a moon with no atmosphere in a wilderness of stars.
Although our emotions fluctuated, a professional awe and curiosity about the dead eventually came over us. This created much debate over the comms. We had made a discovery for the ages, but our satisfaction was bittersweet. Even if we lived longer than expected, we would never return home, never see our friends or family again. The AI might continue on after we were dead, but I doubt it envied being the one to report on our discovery centuries hence. And to who?
Here were the ghastly emissaries of hundreds of spacefaring species we had never before encountered. Their suits displayed an extraordinary range, although our examination was cursory. Some even appeared to be made out of scales and other biological substances from their home worlds, giving us further clues as to their origins.
The burial of the suits by snow and the lack of access to anything other than a screaming face or faces, often distorted by time and ice, worked against recording much usable data. This issue was compounded in those cases where the suit was part of the organism and they had not needed any “artificial skin,” as the AI put it, to survive harsh conditions. That many had died despite appearing well-prepared for the planet’s environment sobered us up even before our own suits dispensed drugs to help our mental states.
After a time, each face seemed to express some aspect of our own stress and terror at the seriousness of our situation. After a time, the sheer welter of detail defeated us and caused us extreme distress. The captain made the observation that even one instance of alien contact might cause physiological and mental conditions, including anxiety, stress, fatigue. Here, we were constantly encountering the alien dead of what seemed at times an infinite number of civilizations.
We stopped recording. We recommitted ourselves to the slog toward the nearest dome.
The captain’s drugs unit had failed, but the AI found a way to help her by turning off the heating element in select panels of her suit. Some parts of her would soon be lost to the cold, but the system would allow her to live on with some measure of comfort.
I must admit, we were just glad the screaming had stopped and welcomed her counsel.
II.
For a long time, as we labored in our spacesuits on that planet—following the path, beleaguered by snowstorms—we could not understand why we found so many dead astronauts, of so many unknown alien types, and yet no spaceships. During good visibility, our line of sight reached, unbroken, for 500 miles. Where were the crash sites?
But one day we chanced upon an antenna sticking up out of the ground. Clumsy attempts at excavation soon revealed that below this antenna lay a vast dead spaceship of a kind we had never seen before. The gash that had opened it to the elements had laid bare its unique architecture, but also gave the illusion that the snow had spilled out of it to create the world around us rather than having infiltrated and accumulated inside over time.
Aspects of the spaceship’s texture gave the startling suggestion that it had been made of some ultra-hard wood or wood equivalent. Clambering partway up to stare at the inner compartments, we all felt the strangeness of the dimensions and proportions of the living quarters. There was no sign of the occupants. Perhaps, I suggested, they had headed for the domes. Perhaps they had even made it to the domes. I tried and failed to keep hope from my voice.
But the captain had ordered the AI to perform a materials analysis. The “snow” in this region had been contaminated by ash and tiny particles of bone. The AI estimated that more than 70% of the white surrounding us was made of the remains of vertebrate sentient life and the remnants of suits. Of invertebrates there was no telling. A thaw might bring not just the drip, drip of water but a shushing sound indicative of bone particulate in the mixture. I imagined there might even be the clink of small objects not rendered down by whatever intense heat had created the ash.
The astrogator had insisted on digging deeper into the ship, with the idea that some recognizable commonality between technologies might yield a part or parts with which he could fix our ship. The rest of us allowed this delusion for the obvious reasons. But upon his return, he held in his hands ovals of snow not much larger than the space formed by the circle between a thumb and finger. Many of them had soft indentations, as one might find in the afterbirth of reptiles from eggs. A kind of ghostly cilia-like tread appeared along the bottoms of these objects.
The astrogator did not find any technology of use to us. Instead, he discovered that the species piloting the spaceship had been so different from us as to be safely encapsuled in suits the size of eggs. Much of what had spilled into or spilled out of the gash constituted the bodies of the crew, in their hundreds of thousands. Their suits had been inadequate to the conditions. They had died en masse attempting to escape their own ship.
The AI speculated that it had been a generation ship, perhaps fleeing a planet with a dying star. If we wondered how the AI had reached this conclusion, it was because we did not want it to be true.
The captain became silent upon receiving this further news and did not speak to us for more than 100 miles of further progress.
As we left that site, unsure exactly what we stepped upon, we also knew that since the spaceship was entirely covered by snow, it had been falling into the sediment for days or months or years. We knew then that our ship might not be visible against the horizon should we retrace our steps. The already bleak probability of rescue through visual identification of a crash site from above would be lost to us in time, even as the line of cables remained perpetually visible to the horizon. We now thought of the planet as a trap. But of what sort?
III.
We could not be sure, but in the absence of the captain’s voice, it may have been the AI that put forward the idea of the planet’s being “duplicitous.” The phrasing concerned us, for there was a duplicity in using the planet as the subject of the spoken sentence. A sphere rotating around a sun in deep space could not exhibit forethought or premeditation or other qualities of sentience.
The AI meant whoever or whatever had created the conditions on the planet that allowed spacecraft to be trapped and then the occupants placed in a perilous situation with no recourse. But I distinctly recall the AI using the words “the planet.” In addition to being inaccurate, this also let us know that the AI did not have any analysis available that might help us understand the agency and motivations acting upon us.
But in a sense, the AI only voiced something I had felt for several miles: that there existed an overlay to the planet’s surface, an area or space or different landscape unavailable to us. This overlay had also not been available to any of the prior astronauts who had died here. In this area or space or different landscape existed a wealth of the usual hoped-for things: a breathable atmosphere and abundant food and water.
While we struggled with the line through the snow and through the storms that welled up, others could see us but chose to ignore us for reasons or perhaps just for their own well-being. For hundreds, possibly thousands of years, as explorers had died here in merciless and terrible ways, there raged a sumptuous feast for the senses, as excessive as it was ancient and unending.
I cannot tell you how powerfully the AI’s words struck us, so that our mouths watered at the thought of real food and of clean, unrecycled water, of a freedom unencumbered by suits and breathing apparatus. Even at our intended destination, we would have spent most of our days aboard a small space station. This tedium would have been broken only by the arduous process of reaching the unbreathable surface and its ancient ruins of jagged black stone.
This vision that overtook us functioned not just as tantalizing delusion. It scared us so much that we could not compartmentalize it in our thoughts. It continued to overwhelm us like a wave.
We fought for the first time, with the astrogator expressing the wish to return to the ruined spacecraft and explore nearby areas for parts, while the captain broke silence to order us to continue to make progress toward the nearest dome. The AI, which had brought us to this point, stole the captain’s silence and said no more.
For each of us, those endless white plains with no real elevation, just the metal rope and the metal posts, had become a kind of repetition that hurt the brain, and the mind with it.
As I looked out across the white, I could not help seeing the impression of shapes in the wind, as if invisible entities fled by, carried there by gusts, unable to get purchase, swept up for hundreds and hundreds of miles before being dashed to the ground.
We did not give up, however.
IV.
About halfway to the nearest dome, amid a storm that reduced our progress incrementally and our line of sight to nothing, we came upon a peculiar tableau.
Six astronaut suits had fallen across and around the metal rope. With the flurries of snow, it took us, even with our powerful headlamps, some minutes to determine the nature of the obstruction. The six suits had been created for a humanoid species that must have had torsos like nine-foot-long slabs, attached to six limbs, three for walking. Their heads had flared out like thick fans. All the helmets were cracked open, and curled inside were the skeletons of some other intelligent species no larger than 40 or 50 pounds, possibly warm-blooded. With no sign of the original occupants.
After a brief analysis cut short by the conditions, we postulated that the warm-blooded species had worn breathable skin suits that, as they failed, required these intruders to seek shelter. All they could find were these six dead astronauts. Because we could discover no trace of the original occupants, the AI put forward the theory that this smaller species had eaten every scrap of the remains within the suits.
Then they too had perished, and in time, the AI suggested, something smaller would take up residence inside those bodies, then smaller still within those, and smaller still—
At this point, the captain attempted a soft reboot of the AI using a coded question. We could hear the concern in her voice.
Yet the AI continued undeterred, suggesting that we might find this to be a common situation. It might be replicated across the planet, depending on a system’s ability to break down and process meat that had not evolved alongside the devourer for millions of years. In all likelihood, most who attempted to eat in this way died soon after, poisoned by alien flesh.
The astrogator had taken to muttering inside his suit, off comms, as if he no longer thought we functioned as a team. No amount of castigation from the captain served to change his mind.
In the terse harshness of the captain’s reprimand, I recognized that her pain levels had spiked once again.
V.
The AI began to talk to us in strange alien voices at mile 700, as we labored through the snowstorm to hold onto the cables and thus the path. The AI warbled and chirped and howled and hummed and clucked. The AI spoke in voices like fossilized choruses of beasts, vast and harmonious. And in voices like dry grass spun to fire by the sun. And in voices like the dissolution of all things, darkness in the blinding white that scared me.
At first we thought the AI was deranged. Then that the AI channeled voices from the dome 300 miles ahead. But finally, the AI managed to make known to us that these were the voices of the dead astronauts we had come across from time to time. Huddled frozen. The suits in so many shapes and sizes. That the voices of the dead were channeled through the AI, and nothing could stop them.
We chose to believe that the AI had begun to malfunction. We did not waste time with a response. The captain asked the AI to perform self-shutdown and whispered the numbers in the correct sequence. We knew what we lost with this act, and yet we knew if we did not shut down the AI it might become harmful to us beyond the mental distress of what it had just conveyed to us.
Soon after, the AI gave up its own voice, and all that came from it were the sounds of the others.
A little later, the AI no longer spoke at all.
VI.
The snow began to betray us, as the storms created different forms of ice. Often, our arms became weary, our legs cramping, and we had to rest with greater frequency. We came to accept the solid crunch that could support our weight. We came to reject the feather-light freshness that felt effortless underfoot but could give way just as easily as if it were air. In some places, slick purple-hued ice welled up in sluggish layers as if something half-alive. In others, we discovered strange islands of elevation, with brutal curls and curves that suggested two continental shelves had clashed in that space.
As we adapted to these conditions, and as conditions worsened and still we adapted, we came to feel an illusion of competency, one that made even the astrogator temporarily cheerful. The sounds through the comms of our efforts, the deeper breathing, the occasional muffled curse, seduced us in this regard. We felt that we were becoming adroit at handling the snow. We began to believe if we could only make it to the dome, we would be saved.
Yet this uptick in morale ran parallel to, rather than intersected with, the idea of our ultimate survival.
VII.
We lost track of the distance left to us without the AI to tell us. Or the captain, in her pain, no longer thought to issue updates. But across the distance left to us came sights beyond reckoning: three giant astronauts spaced 50 miles apart. Larger than most starships, each body lay sprawled across an area larger than several fields and in very different conditions.
The first had been badly burned and was thus unrecoverable, even in terms of salvage. The astronaut had crawled or pulled itself along for some distance. It had left a long smudge of black and red across that expanse. The alien species was, as ever, unknown to us, but the five arms were sunk in the ground as if in agony. The skull had once held three eyes, and the face plate had been cracked by force so strong it resembled a meteor strike. The body was bloated, the fabric of the suit gray with a shimmer of green that came and went, linked to photosensitive skin cells. The way the flesh took up space, and how it exhibited aspects more plant than animal, made it impossible to study further.
The second was a sprawl of limbs, with the suggestion of a defensive posture. The debris of conflict flared out to the side in an incomprehensible display. The suit had an intactness that surprised us, but a similar crack in the face plate without any trace of body within. The rest of the suit had become inhabited by a wealth of other dead astronauts of varying sizes and shapes, who had sought shelter or sustenance and then become trapped or simply … given up. As the AI had predicted, we had once again encountered bodies providing other bodies with temporary sustenance and shelter.
I felt like a parasite who beheld a god. Or was the scale even more ludicrous?
But this condition was not at first evident to us, becoming apparent only after we had clambered for an hour to reach the cracked face plate and the entry hole extended like a broken archway before us.
Despite the number of remains within, and the difficulty in moving through them to explore, the captain ordered an exhaustive recon. Her pulse in the readings had a thready quality. Sometimes I felt, and the astrogator too when we took private comms, that the captain had begun to say things similar to the AI’s delusions. Yet we obeyed the order, on the chance that some internal calculation on the captain’s part meant she believed this was the only way we would survive.
What did we expect to find in the dead body of a once-intelligent giant? Food? Oxygen? Some cause of death? To put off the thought of our own death by seeking shelter with a death so large we could not comprehend it?
I felt like a parasite who beheld a god. Or was the scale even more ludicrous? I had trouble envisioning the way the body must have twisted as it pitched forward into that icy ground. I had trouble holding onto my own thoughts.
More and more pressure moved through my skull as I contemplated that scene. We were in the midst of something none of my kind had ever known. We might be the only ones, ever. I better understood the unraveling of the AI and of the captain. My sharpness had dulled, taking my calm with it.
It was impossible to tell how long the astronaut had taken to die. Unless somewhere within that fallen figure some hint of life hid that we would never find.
The storms fell away, rose, then fell away again.
VIII.
The third huge astronaut was full of light and life and shone out across the wasteland of snow like a beacon. For a moment, I thought we had pierced the invisible layer and could see what lay beyond the veil. We would have comforts beyond anything found on our ruined spaceship even when it had been fit to cross galactic space. There would not be recycled urine for our water. There would not be the faint stink of sweat creeping into our suits as the ventilation system began to fail. Our liquid food would not taste stale and moldy.
As we approached, the suit extended almost to the horizon in that foreshortened perspective created by the left foot. We noted through our remaining instrumentation that the suit remained intact. The pressure told us a kind of air circulated within its sealed surfaces.
We climbed with a renewed energy, the promise of sanctuary so close making us giddy. We each exhorted the others on with such exuberance that it made me a little afraid. What lay on the other side of this state of mind but a fall?
When we reached the helmet plate, we could see inside not a face or a skull, but instead such a richness of healthy growth that we fell silent before it. None of us could, I believe, understand exactly what we saw, except that it equaled ecosystem—resplendent with vibrant greens and blues, stippled with other colors. There might be some parallel to a terrarium full of moss and exotic plants. There might be some sense of life moving amongst those plants, as of jewel-like amphibians or even tiny shy sapphire birds. We could not smell or taste or hear what lay behind the face plate. We could not experience it in that way, but somehow we each imagined enough to be calmed and comforted by it.
The astrogator said he might be able to create a hole in the plate or elsewhere on the body to let us in, and then patch the surface such that not too much air or vitality would spill out. This workaround might take an hour or two, due to the delicate nature of what we saw within. But it was possible.
The captain considered the astrogator’s proposal and then agreed. The weather had begun to turn dangerous again. That we should begin immediately did not need to be said. With the proper pressure brought to bear, we would have some measure of sanctuary from which to recover for a final push to the dome. It could be the difference between life and death, the astrogator said. If the atmosphere was breathable, we might even be able to give the captain some better solution to her pain.
I unclipped the astrogator’s equipment from his waist and threw it off the mountain that was the astronaut and watched it sail through the air and into the snow. Then I used my weapon to fry it where it lay. Then I threw my weapon into the snow, too, in a place where the featheriness would cover it and hide it forever.
We were a team and I had helped my team while showing them I posed no threat—although I knew the astrogator and the captain would not see it that way. I stood there on the face plate that we could no longer open with the diminished tools at our disposal as they both yelled at me through the comms. It’s unimportant what they said to me. They were admonishing me for something that had already happened and that they had no power to stop. I did not bother to explain, but began to make the descent to the ground so we could once again take up the metal rope and make for the dome.
Will you follow, I asked them from the ground, when I saw they still stood on the heights. There came no reply, but when they saw me take up the rope, they climbed down to take up the rope too.
I waited then, and let them catch up.
IX.
The captain died not long after. The pain was too great or the wounds she had suffered too damaging. I had known for some time she would never make it to the dome, but there was no point in emphasizing that to her. Nothing she had done until the end had required her to be removed from command. Her last words were the name of our ship and giving her love to someone who would be dead of old age even if we found a way to escape this place and return home. But the astrogator told her he would carry those words forward.
Then we left her by the marker that meant we had 100 miles left to the dome. We knew the snow would cover her for burial. It had done so faithfully for all the rest.
That in that frozen hellscape, the persistence of life in that manner, an oasis in the midst of nothing, could be categorized as a miracle.
As the astrogator followed me down the rope line, he cried out for explanation. The captain’s death required it for some reason, in his mind. The captain had not deserved my betrayal. The captain would not rest easy until I told him why.
You must believe in ghosts, I replied.
ROGAN BROWN
This reply incensed him and he castigated me in words not used among members of a team that respect each other. Once more, I ignored him, but told him if our oxygen got low, he could have mine if we calculated he could make it to the base. I meant this, as I knew the odds were low anyway. I had hurt my knee taking the equipment from the astrogator and then making my way so rapidly down from the dead astronaut.
The astrogator did not reply, by which I knew he did not accept my answer.
The reason I took the tools and destroyed them is because the wind had told me something it had not whispered to the captain or the astrogator. The wind had not spoken to me before, so I believed what it told me. That the astronaut within the suit lived on, if unable to move. That what we saw on the outside and registered as ecosystem, as separate “plants” and “animals,” instead formed a composite life-form and that to crack open the suit or cut through the suit at a leg would have been a violation.
That in that frozen hellscape, the persistence of life in that manner, an oasis in the midst of nothing, could be categorized as a miracle.
I would not snuff that out. I could not allow that to be snuffed out. But I remembered too how I felt looking at that vast and alien country behind the face plate. So calm, so comforted, overcome by the depths of an emotion I could not place. Would I replace that feeling with the feeling of seeing all those explorers dead within the other vast suit? Even as I become one of them?
Because the planet had already told us the rules, the consequences, and the ultimate outcome. There are no odds so terrible that they could not be experienced, and in dozens of ways, in this place.
So I trudged on and the astrogator cursed me and cursed me and called out my childhood and how badly I must have been brought up and how I must have cheated to pass the psych exams, and yet I had thought the same of him at various points during our journey.
See how beautiful the snow is, falling now, I said to him over the comms. See how precise and geometric this line we follow across this expanse.
He did not reply, but a little later he told me he no longer believed in the line at all, and by his calculations he would get to the dome faster if he abandoned it and struck out on his own.
I could not stop the astrogator and did not want to, so I watched him become a smaller and smaller figure against the white until the white ate him up and I was alone.
X.
I have been walking a long time, visiting with the dead. Here, against an arch of heaven that appears no different than what I see directly in front of me.
Jeff VanderMeer is the author of the critically acclaimed, bestselling Southern Reachseries, translated into 38 languages. His short fiction has appeared in Vulture, Slate, New York Magazine, Black Clock, Interzone, American Fantastic Tales (Library of America), and many others.
A study of more than 400,000 posts in the social media platform Reddit has identified previously unreported side effects from the increasingly popular GLP-1 weight loss and diabetes drugs. Users reported symptoms affecting menstrual cycles and body temperature, which have not yet been described in clinical trials or included in drug labels.
Published today in Nature Health, the study covers over five years of public online posts from nearly 70,000 Reddit users discussing their personal experience taking the GLP-1 drugs semaglutide and tirzepatide.
“Some of the side effects we found, like nausea, are well known, and that shows that the method is picking up a real signal,” says Sharath Chandra Guntuku, PhD, research associate professor in computer and information science at Penn Engineering and the study’s senior author. “The underreported symptoms are leads that came from patients themselves, unprompted, and clinicians could potentially pay attention to them.”
Although the study is not representative of the broader population—Reddit users are generally younger, more likely male and based in the U.S.—the symptoms reported collectively match known side effects of semaglutide and tirzepatide. About 44% of users described at least one known side effect, most commonly symptoms of gastrointestinal distress.
“Clinical trials generally identify the most dangerous side effects of drugs, but they can fail to find what symptoms patients are most concerned about,” says Lyle H. Ungar, PhD, professor in computer and information science at Penn Engineering. “Online patient communities work a lot like a neighborhood grapevine. People who are living with these medications are swapping notes with each other in real time, sharing experiences that rarely make it into a doctor’s office visit or an official report. Even though social media is not necessarily representative, a large collection of posts may reflect additional concerns.”
The study uncovered a series of side effects that were previously unreported for these drugs. This included discussions of menstrual cycle changes, such as intermenstrual bleeding, heavy bleeding, and irregular cycles. Other users reported chills, hot flashes, fever, and other temperature-related symptoms. In addition, fatigue symptoms ranked as the second most common complaint in these online posts despite rarely being reported in clinical trials.
“We can’t say that GLP-1s are actually causing these symptoms,” says Neil K. R. Sehgal, doctoral student at the University of Pennsylvania and the study’s lead author. “But nearly 4% of the Reddit users in our sample reported menstrual irregularities, which would be even higher in a female-only sample. We think that’s a signal worth investigating.”
While efforts to scour the internet for self-reported drug side effects have been ongoing for more than a decade, screening through social media posts at scale remained challenging until the arrival of large language models such as ChatGPT or Gemini. In particular, these tools can prove instrumental in mapping the language users use to describe their symptoms to clinical terminology defined in the Medical Dictionary for Regulatory Activities (MedDRA), used to officially report symptoms in clinical trials.
“Large language models have made it possible to do this kind of analysis much faster with a level of standardization that could be difficult to achieve before,” says Sehgal.
The researchers hope these findings will encourage researchers and drug developers to investigate the side effects discussed by users online. In future work, the team plans to expand beyond Reddit and English-language discussions to confirm whether the same symptoms appear across different social media platforms and populations.
While this approach is not intended as a replacement for clinical trials, screening social media posts for clues on unreported side effects can make a significant difference in terms of speed. This can be especially relevant for drugs like semaglutide and tirzepatide, originally diabetes drugs that quickly became mainstream when the FDA granted them approval as weight loss drugs.
“Clinical trials are the gold standard, but by design, they are slow,” says Guntuku. “The whole point of this kind of approach is that it can move quickly, and that’s exactly when it’s most valuable.”
Popular low-calorie sugar substitutes can negatively affect both the balance of microbes in the gut and gene expression in a heritable way, preclinical research suggests.
The findings in mice, published in Frontiers in Nutrition, challenge long-standing assumptions that non-nutritive sweeteners (NNS) are metabolically inert and underscore their potential to influence health across generations through microbial and molecular pathways.
Both sugar alternatives studied had an impact: sucralose, a popular artificial sweetener that is around 600 times sweeter than sugar, and stevia, a no-calorie natural alternative extracted from the leaves of a South American plant.
Lead researcher Francisca Concha Celume, PhD, from the University of Chile, said the changes seen in glucose tolerance and gene expression could be interpreted as early biological signals related to metabolic or inflammatory diseases.
“For example, the animals did not develop diabetes. Instead, what we observed were subtle changes in how the body regulates glucose and in the activity of genes associated with inflammation and metabolic regulation,” she explained.
“It is possible that such changes could increase susceptibility to metabolic disturbances under certain conditions, such as a high-fat diet.”
Celume and team divided 47 male and female mice into three groups receiving either plain water, or water with sucralose or stevia added over 16 weeks at levels comparable to those seen in a usual human diet.
These mice were then bred, with each of the two subsequent generations just receiving plain water.
The team found there were no differences in glycemic response in the initial group, but that it had mildly altered in the male offspring of those fed sucralose in both successive generations. By the second generation, female mice with stevia-consuming grandparents had elevated fasting blood sugar.
Fecal microbiomes in both sets of animals receiving sweeteners were more diverse than in those given plain water. But sweetener-fed mice also had lower levels of short-chain fatty acids, which could signal epigenetic changes and could indicate that bacteria may be generating less beneficial metabolites and that this was passed on to subsequent generations.
Mice that had consumed sucralose were particularly affected and had more pathogenic bacteria and fewer beneficial species in their fecal microbiomes. The impact of this sweetener tended to be more consistent and persistent across generations.
The researchers also examined the impact of five genes relating to inflammation, gut barrier function, and metabolism in the liver and intestines.
Overexpression in the inflammation-linked toll-like receptor-4 (tlr4) and tumor necrosis factor (tnf) genes was seen both in animals that consumed sucralose and stevia. This was also seen in the immediate offspring of the former but not the latter.
The expression of sterol regulatory element-binding protein 1 (Srepb1), which is linked with regulation of lipid and carbohydrate metabolism, was decreased in the liver of sucralose-fed animals and subsequent generations.
“In summary, our findings demonstrate that parental consumption of sucralose or stevia induces persistent, intergenerational changes in host metabolism, intestinal and hepatic gene expression, gut microbiota composition, and microbial metabolite production in unexposed offspring,” the researchers concluded.
They added: “Given the widespread use of NNS during critical developmental periods, these findings raise important questions about their safety and long-term impact.”
Dr. Edna Foa served for decades as a professor of clinical psychology in psychiatry at the University of Pennsylvania, where she also directed the Center for the Treatment and Study of Anxiety (CTSA), the internationally renowned program she founded in 1979. Through the CTSA, Edna created not only a hub for groundbreaking research, but also a training ground that would shape the future of evidence-based treatment for anxiety, obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).
At a time when OCD was poorly understood and often ineffectively treated, Edna helped establish and rigorously validate exposure and response prevention (ERP) as a gold-standard intervention. Building on the early behavioral work of pioneers before her, she brought a level of empirical precision, clinical sophistication, and dissemination that transformed ERP from a promising approach into a cornerstone of modern treatment. In doing so, she fundamentally changed what recovery could look like for millions of people living with OCD.
Her influence extended well beyond OCD. Dr. Foa was also a central figure in the development of cognitive-behavioral models and treatments for PTSD, including prolonged exposure therapy, which has become one of the most widely used and effective interventions for trauma-related disorders. Across both domains, her work exemplified a rare integration of theory, research, and clinical application—always grounded in a singular goal: to reduce suffering and restore lives.
Her connection to the International OCD Foundation (IOCDF) was a natural extension of her commitment to bridging science and real-world impact. Edna was deeply engaged with the IOCDF community over many years, contributing to its mission of improving access to effective treatment and advancing understanding of OCD. The Foundation awarded her with the Outstanding Career Achievement Award in 2011. She was a frequent presence at conferences, where she not only shared her research but also helped elevate the standards of clinical care through teaching, mentorship, and collaboration.
The IOCDF’s growth into a global leader in OCD advocacy, education, and training reflects, in many ways, the scientific foundation that Edna helped build. Her work made it possible for organizations like the IOCDF to promote treatments that are not only evidence-based, but truly life-changing. And through her direct involvement, she helped ensure that the connection between research and practice remained strong, dynamic, and accessible.
Edna Foa showed us what it means to dedicate a life to advancing knowledge in the service of humanity. She illuminated a path forward for so many, and her influence will continue to guide the field for generations to come.
Below are several tributes to Dr. Foa from IOCDF community members.
From Jonathan Grayson, PhD
My mentor, Tom Borkovec, used to talk about our psychological lineage; that in 1979, you only had to go back a few generations of your “forefathers” to reach the founders of American psychology. In this respect, Tom is my psychology father – he taught me to discipline my thinking – he encouraged wild flights of speculation, but to always temper it in print with what could be researched and proved. With this in mind, Edna is my psychology mother. As I noted elsewhere, for all of us who work with OCD, we are her children, grandchildren and so on.
I first met Edna in 1979 at Joseph Wolpe’s Behavior Therapy Unit at Temple University. She hired me as an adjunct research assistant professor. This was in the ancient days at the height of the first wave. There was no cognitive behavioral therapy. ABCT was AABT, American Association of Behavior Therapy. The disorder we were studying was OC, the DSM labeling it obsessive compulsive disorder doesn’t yet exist. Edna was on the first of her landmark OC grants.
She was the flashpoint for all that we do with OCD. Don’t get me wrong, she didn’t invent ERP, but her work was/is the basis of all OCD treatment today. In the same way that cognitive therapy techniques existed before Aaron Beck, but his work was the flashpoint of that second wave; and the techniques of ACT pre-exist Stephen Hayes, but his work and thinking were the flashpoint of the third wave. There was no OC Foundation.
I joined Edna and Gail Steketee and to work with Edna was always a collaboration. So many hours of discussing, designing and analyzing research. Writing papers together often until midnight and beyond. You may have heard that Edna was demanding. She was, but that had nothing to do with the hours we worked. The same clinical skills she used with patients, she used in choosing those who worked with her. We were all driven. There are those who found her direct delivery difficult, but it wasn’t anger or belittling, it wasn’t intimidating (okay, maybe a little), she was simply direct without sugar coating. The truth about Edna was that she was caring and very generous.
As I said, our research was a collaboration and the order of authors on publications reflected our contributions. If you had a research idea that was tangential to her main projects, she would support you. When I told her I thought we should have support groups to help sufferers maintain their gains, I was given a free hand to develop and run GOAL as I saw fit. When my son was nine months old and I told Edna that I was going to change my work hours to: one and a half daytime hours and the rest of my hours after 4 pm, she accepted this. She didn’t have to admonish me or warn me to do my job, Edna knew the kind of people she had chosen. She wanted the people who worked with her to grow. When it came time for me to move on, she was like any parent, sorry for me to go, but happy for me to pursue my life. She was like that with all of us. So many of those who have shaped the OCD world worked with Edna. While I was there, Michael Kozak joined the team and later Edna and Michael published their ground breaking paper on emotional processing. Alec Pollard, Charly Mansueto and Rich McNally also passed through our center. Marty Franklin and Jon Abramowitz came after me making up the many generations of her “children.”
For those whom I’ve neglected to mention, forgive me, but the list is too long. My OCD career began in 1979. Her loss is a hole in the fabric of reality, but her legacy and wisdom lives on through all of us whose OCD psychological lineage can be traced back to Edna Foa.
From Marty Franklin, PhD
I am writing this tribute while waiting at an airport gate for a flight to a national conference. Over the course of the next few days I will have the opportunity to present applied research data, participate in a clinical roundtable about OCD and its treatment, & engage with colleagues as we toss around ideas for how best to move the field forward. Edna’s profound influence on my career, my life, and even my thinking is most often accessible during relatively quiet moments like this, where opportunities for reflection make their way forward amidst the work I have committed to myself to doing. Indeed, I learned of Edna’s passing a few weeks ago while right in the middle of presenting a clinical training about exposure-based treatments for OCD. I paused for a moment to take it all in, but before I could decide how best to proceed under the circumstances, I heard Edna’s voice, in her characteristic and unmistakable Israeli accent, telling me that these clinicians took time out of their busy schedules to receive this training, and therefore I must continue straight through to the end. My feelings? You can process those later. Classic Edna.
My very first day of internship in 1991 at the Medical College of Pennsylvania was spent in Edna’s presence at her Center for the Treatment and Study of Anxiety, the unit she established in 1979 to develop, test, and disseminate cognitive-behavioral interventions for anxiety and related conditions. Edna’s work even by then was highly influential, and her legend was already well in the making. At that initial meeting, Edna slid a formidable stack of old-school medical charts across the table to me and said, “Marty, is it? These are your OCD cases for this rotation.” I thanked her, then asked the first of myriad naïve questions in the legendary Tuesday Meetings: “When will I receive the training to treat these cases?” She pivoted back to look at Michael Kozak, her Clinical Director, as if to wax nostalgic about the process of indoctrinating yet another green intern. Edna then gestured at the pile, and said, “The training is in there.” Edna was a fine clinician too, and thus read well my horrified expression, then offered, “But don’t worry: we’ll help you.” True to her word, she did exactly that.
Edna’s influence on the field broadly speaking, on the development and expansion of cognitive-behavioral theory, on using clinical science to alleviate human suffering, and in pushing the proverbial envelope, has been chronicled elsewhere and cannot ever be overstated. Edna was one of the true pillars of clinical psychology, and the effects of her work will live on in perpetuity, of that I have little doubt. What was less well known except for those of us fortunate enough to have been mentored by Edna was the incredible amount of time and emotional investment she made in seeding the field with the next generation of theorists, scholars, and clinicians who would carry that work forward in the years to come. I count myself in that incredibly lucky group, all of whom were blessed by her personal investment in our training and careers. Edna had exacting standards for herself and for us, and fully expected that same level of investment and intensity on our part. Vigorous debate was just part of the process, where occasionally the fur would fly. But Edna also knew us well enough to understand what each of us needed in order to help us make the commitment needed to join her in the vanguard. In one of our many career development conversations back in the mid 1990s, likely in her East Falls office well after 8 pm, I was fretting about the “soft money” environment of academic psychiatry, and openly wondering if it was time to pivot to hard-line academic psychology or even to private practice. Edna stopped my rumination dead in its tracks, looked into the depths of my soul (which she did regularly), and said, “It’s only soft money if you can’t get it…and I know you can get it. Plus, academia is a really fun way to make a living, and a life.” Edna Foa believed in me: it was about damn time to believe in myself as well, and to make the commitment required to honor that belief. And to always keep pushing to get better at the work, which is truly a never-ending process.
Sitting in this airport now, on my way to give another set of talks on topics I have come to know very well and continue to pursue with the passion that comes from also believing that this work is vital, I concur with Edna’s assessment of academia, and am truly grateful that I listened. Thank you, Edna, for illuminating a path forward for me, as I know you did for countless others. You were unforgettable, and your work will continue on in the hands of those you mentored and trained to carry on the legacy.
From Gail Steketee, PhD, MSW
I had the pleasure and helpful educational challenge of training under Dr. Edna Foa beginning in 1976 and continuing for a decade during which I worked closely with her studying OCD and co-authoring manuscripts and federal grant applications. Edna generously provided me with excellent clinical supervision during my training at the Behavior Therapy Unit at Temple University where I learned how to treat phobias, agoraphobia and panic, and especially OCD. Edna’s encouragement and specific feedback guided my understanding of patients and how to provide effective treatment. Her supervision coincided with the end of her important early study of the impact of exposure and response prevention, following in the steps of Victor Meyer, Isaac Marks, and Jack Rachman. I treated the last few patients with OCD in her study and co-authored a case report stemming from that work – my first published paper in the field in 1977.
Edna opened many doors for me to join colleagues around the world who were studying OCD and behavioral treatment methods. Together we wrote and published 26 papers and 14 book chapters. And I mean “together”. We would schedule writing times during which Edna generated ideas and spoke aloud in her heavily accented Israeli English while I contributed my thoughts and sharpened the language as we went along. Grant applications were a special challenge as NIMH became strict about page limits. More than once we stayed up all night writing grants to meet the deadline – we were both younger then – and once we actually drove to Bethesda to deliver a grant application just in time for the deadline. I joined Edna at many conferences in the U.S. (especially AABT [now ABCT] and OCF [now IOCDF]) and in Europe at EABCT and WCBCT (the World Congress of CBT). We met many delightful OCD researchers and clinicians – it was an exhilarating time. I traveled with Edna and friends to her home country of Israel where she treated us to delightful sights and experiences including the Dead Sea.
The 10 year period with Edna was a heady time as my career unfolded. She supported my decision to get a PhD in social work at Bryn Mawr while working full time with her on our research. Eventually, I left Temple to take a full-time faculty position at Boston University, arriving with a strong publication record already in hand thanks to Edna’s masterful training and modeling of how to design and conduct research, how to write papers that accurately reflected the study and its findings, how to write strong grant applications, and how to connect with energizing colleagues around the world. I am grateful for her mentoring that enabled me to establish my own career and become a mentor to others. She was a brilliant theoretician who spawned impressive thinking and research on OCD, PTSD, behavior therapy, and related topics. Hers was a long and full life. She will be sorely missed.
At 51, the mother of four from Wichita Falls, Texas, was busy,
Mary Royal, Patient
tired, and juggling the overlapping demands of work, family, and everyday life. The appointment felt routine—easy to reschedule and easy to dismiss. In a decision that would change everything, she went.
In 2023, Royal was diagnosed with stage 2B multicentric invasive lobular and ductal carcinoma. What followed was a cascade familiar to many cancer patients but deeply personal in its toll: a double bilateral mastectomy, months of chemotherapy and radiation, and the discovery of a nodule in her chest cavity. Another scan later revealed a mass on her ovary, prompting a preventative radical hysterectomy. By the end of the year, Royal had endured positron emission tomography (PET) scans, injections, fasting, and what she called “all that nuclear medicine.”
For many patients, completing treatment is supposed to signal relief. In reality, it often marks the beginning of a new phase—one defined by uncertainty. Surveillance imaging, blood tests, and follow-up visits can feel like checkpoints in an endless waiting game. Every scan carries both hope and fear.
Royal knows this phase well. Like many survivors, she lives with what patients and clinicians call scan anxiety. “I’ve never met a person diagnosed with cancer who did not live with scan anxiety,” she said.
That anxiety eventually led her to consider a different way of monitoring her disease—one that looks not for tumors large enough to be seen on a scan, but for microscopic traces of cancer that may remain in the body after treatment. These traces are known as measurable, or minimal, residual disease (MRD).
MRD basics
MRD refers to the small number of cancer cells that can persist after treatment, even when imaging and conventional tests show no evidence of disease. These cells are often invisible to computed tomography (CT), magnetic resonance imaging (MRI), or PET scans, yet they can drive relapse months or years later.
Historically, MRD testing has been best established in hematologic malignancies such as leukemia, lymphoma, and multiple myeloma. In these diseases, molecular and flow-based techniques can detect one malignant cell among tens of thousands, or even millions, of normal cells. In solid tumors, however, detecting MRD has been far more challenging. That is now changing.
Advances in liquid biopsy technologies allow researchers to analyze circulating tumor DNA (ctDNA): tiny fragments of DNA shed by cancer cells into the bloodstream. With increasingly sensitive assays, it is now possible to detect residual disease at levels far below what imaging can reveal.
MRD matters because cancer recurrence is often a race against time. The earlier residual disease is detected, the greater the opportunity to intervene—whether by intensifying therapy, switching treatments, or, in some cases, sparing patients from unnecessary additional therapy if no disease is detected.
Regulators are taking note. In January 2026, the U.S. Food and Drug Administration (FDA) issued draft guidance supporting the use of MRD negativity as an endpoint in clinical trials for multiple myeloma. The move signaled growing confidence in MRD as a meaningful surrogate for long-term outcomes, potentially accelerating clinical trials and access to new therapies.
Deciding to look closer
When Royal’s oncologist suggested the Personalis NeXT Personal® test, a blood-based MRD assay, her initial reaction was hesitation.
“I said, ‘Let me think about it,’” she recalled. As she researched the test online, her anxiety rose. “I thought, ‘No, thank you. I have had so much anxiety already.’”
Her husband disagreed. “You are insane,” he told her, “Why would you not want to do that?” Her oncologist offered a different perspective: “What is the point of science if we don’t use it?”
“That really resonated with me,” Royal said.
She agreed to the test and had her first ctDNA draw in early 2024. Since then, she has taken it 13 times.
“Seeing that zero in the results is a huge relief,” she said. “I really appreciate how much easier the test is on me, both mentally and physically. Now, I cannot believe anyone would say ‘no’ to this. It brings me so much comfort. And I want to know what to do next. I don’t want to just sit around waiting for something when I have the ability to see things early on.”
Her experience reflects a growing shift in survivorship—from episodic imaging to continuous molecular monitoring.
An ultrasensitive approach
For Richard Chen, MD, CMO at Personalis, the goal of ultrasensitive MRD testing has always been to address the uncertainty patients live with after treatment.
Richard Chen, MD Chief Medical Officer Personalis
“Our NeXT Personal test pioneered ‘ultrasensitive MRD’ down to about one part per million of ctDNA, designed to be a leap forward in detecting very small traces of cancer from a blood sample earlier,” Chen said.
The test is tumor-informed, meaning that it begins with whole-genome sequencing of a patient’s tumor. From that data, up to approximately 1,800 tumor-specific mutations are identified to create a personalized molecular signature. Blood samples are then analyzed for that signature.
“The groundbreaking clinical data that we have published in lung and breast cancer shows that the ultrasensitive capabilities of NeXT Personal enable it to detect cancer many months to years ahead of imaging,” Chen said, “potentially allowing for earlier intervention and treatment of the patient.” Equally important, he added, is the reassurance that a highly sensitive negative result can provide.
Personalis is expanding MRD testing beyond simple detection. A new opt-in feature, the Real-Time Variant Tracker®, allows clinicians and patients to view potentially actionable mutations detected in ctDNA, including those associated with treatment resistance.
MRD testing is increasingly viewed not just as a prognostic tool, but as a way to actively guide care. Chen outlines three major applications: earlier detection of residual or recurrent disease; earlier de-escalation of therapy for patients who have cleared their cancer at a molecular level; and real-time monitoring of treatment response.
“Cancer is often a race against time,” he said. “If you can detect cancer that’s coming back much earlier than before, then you have the opportunity to intervene earlier with additional treatment for the patient.”
Adding biological precision
Sensitivity alone, however, is not the only challenge in MRD detection. Biological precision—understanding which cells persist and why—is equally important.
Zivjena Vucetic, MD, PhD Chief Medical Officer Mission Bio
Zivjena Vucetic, MD, PhD, CMO at Mission Bio, points to the limitations of bulk sequencing approaches, which average signals across mixed-cell populations.
Mission Bio’s single-cell MRD assay simultaneously detects genetic mutations and surface protein expression across thousands of individual cells in acute myeloid leukemia. This approach reveals whether mutations coexist in the same cell and how they relate to cellular phenotypes.
“Our integrated single-cell approach provides a more biologically precise definition of measurable residual disease,” Vucetic said, which might improve risk stratification beyond conventional molecular or flow-based methods.
By identifying rare, therapy-resistant clones, single-cell MRD technologies offer insight into clonal evolution and emerging resistance. This information can guide treatment selection and drug development.
Decentralizing monitoring
Accessibility and turnaround time are also shaping the MRD landscape. For example, QIAGEN is advancing MRD monitoring by pairing tumor-informed assay design with decentralized digital polymerase chain reaction (dPCR), aiming to make longitudinal molecular monitoring faster, more accessible, and more informative for research and drug development.
In June 2025, QIAGEN announced a partnership with Tracer Biotechnologies to integrate Tracer’s tumor-informed assay design with QIAGEN’s QIAcuity dPCR platform. The approach begins with sequencing a patient’s tumor, often leveraging existing next-generation sequencing (NGS) data, to identify somatic mutations. Tracer then designs personalized multiplex dPCR assays to detect ctDNA carrying those mutations in blood samples.
Richard Watts Vice President QIAGEN
Running these assays on QIAcuity enables absolute quantification of rare tumor-derived molecules by partitioning samples into thousands of reactions. According to Richard Watts, vice president of partnering for precision diagnostics at QIAGEN, “The result is a decentralized, high-frequency monitoring solution,” with turnaround times measured in hours to days rather than weeks. He noted that this model significantly reduces cost and logistical complexity compared with centralized NGS-based MRD testing while enabling earlier detection of molecular recurrence, often before radiographic changes are visible.
While currently intended for exploratory research use, the platform has clear implications for oncology drug development. By allowing assays to be run on standard dPCR instruments at clinical trial sites, sponsors can avoid centralized sample shipping, simplify global study design, and more rapidly generate data. Frequent sampling also provides detailed insight into tumor kinetics and treatment response, potentially enabling earlier assessments of drug activity.
Looking ahead, QIAGEN anticipates MRD evolving beyond detection toward biological characterization. Emerging single-cell technologies, supported by QIAGEN’s recent acquisition of Parse Biosciences, could reveal why residual disease persists by distinguishing resistant cell populations and non-genetic resistance mechanisms. Watts emphasized that future clinicians will not only ask whether MRD is present, but “why it persists and which pathways sustain it,” signaling a shift toward more precise, biology-driven intervention strategies.
The expanding ecosystem
Beyond ultrasensitive and single-cell approaches, a growing number of companies are contributing complementary technologies that are broadening how MRD is detected, characterized, and monitored across cancer types.
Twist Bioscience, for example, has developed scalable target enrichment solutions for MRD monitoring that support highly personalized approaches to disease surveillance. Its MRD Rapid 500 Panel enables fast design and manufacture of customized capture panels using silicon-based DNA synthesis. By offering panels that range from dozens to hundreds of tumor-specific probes and fast turnaround times, this approach allows researchers to assess adjuvant treatment response at a genomic level while remaining compatible with established NGS library preparation and hybrid capture workflows.
Whole-genome sequencing-based plasma assays are also playing an expanding role in solid tumor MRD detection. Labcorp offers a plasma-based assay for colorectal cancer that uses whole genome sequencing to identify ctDNA associated with MRD. This approach enables the detection of recurrence at a molecular level before clinical symptoms, biological markers, or radiographic evidence emerge, creating an opportunity for earlier and more proactive intervention.
In hematologic malignancies, ultrasensitive liquid biopsy platforms are demonstrating the ability to dramatically shorten the time required to detect residual disease. For instance, Foresight Diagnostics has developed a ctDNA-based MRD platform that achieves exceptionally high sensitivity across multiple cancers. In patients with large B-cell lymphoma, this approach can detect ctDNA immediately after treatment, rather than waiting for months or even years for disease recurrence to become apparent through PET or CT imaging.
Comprehensive NGS-based MRD solutions are also advancing in myeloid malignancies. Thermo Fisher Scientific offers an integrated research-use testing solution that combines highly sensitive DNA and RNA assays on a single sequencing platform. This enables the simultaneous assessment of single-nucleotide variants, insertions and deletions, and gene fusions alongside streamlined informatics and reporting designed to simplify MRD data interpretation in research settings.
Meanwhile, dPCR continues to play a crucial role in MRD monitoring, where absolute quantification and extreme sensitivity are required. Bio-Rad Laboratories has long supported droplet dPCR technologies that are well suited for tracking low-abundance disease markers. These capabilities are particularly valuable in both hematologic malignancies and solid tumors, where MRD signals in blood can be vanishingly small yet clinically meaningful.
Pre-analytical precision
As MRD assays push detection limits ever lower, pre-analytical steps such as sample collection and cell-free DNA (cfDNA) extraction become increasingly important.
Anagha Kadam, PhD Scientist, NEB
As one example, Anagha Kadam, PhD, applications and product development scientist at New England Biolabs (NEB), highlights how the Monarch Mag Cell-free DNA Extraction Kit addresses crucial challenges in liquid-biopsy workflows and MRD research.
This kit is a magnetic bead-based solution designed for the reproducible isolation of circulating cfDNA from biofluids like plasma, urine, and cerebrospinal fluid. “The kit can be used to isolate cfDNA for discovery and detection workflows, including ctDNA profiling, cancer biomarker discovery, and oncology diagnostics research,” Kadam explained. This technology efficiently recovers cfDNA fragments in the typical sizes of 150–300 base pairs, and even as small as 50 base pairs, while remaining compatible with common anticoagulant and preservative collection tubes. According to Kadam, “The silica-coated magnetic beads, combined with optimized buffer chemistry, help ensure maximum binding and recovery of cfDNA in manual or automation formats.”
Sensitivity and reproducibility are especially crucial for MRD applications. “A cfDNA isolation method that is compatible with different sample types, and that faithfully isolates cfDNA, is a key consideration when establishing MRD workflows,” Kadam noted. She added that the kit delivers “reproducible, high-quality cfDNA yields from different biofluid samples, without additional post-extraction cleanups,” enabling consistent fragment profiles while saving time. When integrated with NEB’s sequencing and amplification tools, the kit supports streamlined, end-to-end workflows for generating high-quality data from challenging clinical samples.
From waiting to watching
For Mary Royal, MRD testing has not eliminated uncertainty, but has transformed it.
Instead of waiting passively for scans, she feels engaged in her care. Instead of fearing every appointment, she has access to information that helps her understand what is happening inside her body in near real time.
“I want to know what to do next,” she said. “I don’t want to just sit around waiting for something when I have the ability to see things early on.”
As MRD technologies continue to mature, the desire to replace waiting with knowledge is becoming central to modern oncology. MRD is no longer just a research endpoint or laboratory metric. It is becoming a bridge between science and survivorship, offering patients, clinicians, and researchers a clearer signal in the noise of uncertainty.
And sometimes, that signal is a simple zero—small, powerful, and profoundly reassuring.
Mike May, PhD, is a freelance writer and editor with more than 30 years of experience. He earned an MS in biological engineering from the University of Connecticut and a PhD in neurobiology and behavior from Cornell University. He worked as an associate editor at American Scientist, and he is the author of more than 1,000 articles for clients that include GEN, Nature, Science, Scientific American, and many others. In addition, he served as the editorial director of many publications, including several Nature Outlooks and Scientific American Worldview.
Top of the morning to you, and a fine one it is. Sunny skies and mild breezes are enveloping the Pharmalot campus once again. And to celebrate, we are brewing still more cups of stimulation and inviting you to join us. Our choice today is Jack Daniel’s. Yes, this is a real thing. And remember, a prescription is not required. So no need to mess with rebates, coupons, or TrumpRx. Meanwhile, here are a few items of interest. Hope you have a smashing day and conquer the world. And of course, do stay in touch. We appreciate feedback, criticism and tips. …
Steve Ubl, the chief executive of Pharmaceutical Research and Manufacturers of America, plans to step down at the end of the year, after more than a decade of leading the main trade group for brand-name drug makers, STAT notes. Ubl led the organization during tumultuous times that included the Covid-19 pandemic and aggressive political attacks on prescription drug pricing. Democrats passed a law directing Medicare to negotiate drug prices and the Trump administration struck voluntary deals with individual drugmakers aimed at lowering U.S. prices to levels in other high-income countries. The next head of PhRMA will face increasing political pressure on prices and an increasingly populist mood.
Specific changes in two genes appear to help predict whether patients will lose substantial weight on GLP-1 drugs used to treat obesity — and whether the drugs will cause nausea or vomiting, which are some of their most common side effects, STAT writes, citing a paper in Nature. “I think we have proof of concept here that genetics is playing a role in terms of GLP-1 efficacy and side effects,” said Adam Auton, a vice president at the 23andMe Research Institute and the senior author on the paper. Outside researchers were impressed and intrigued by the findings, but some doubted whether the genetic results would impact patient care. Still, consumers who use what 23andMe calls its Total Health platform will have access to information about these genes and what they predict about GLP-1 use.
This is today’s edition of The Download, our weekday newsletter that provides a daily dose of what’s going on in the world of technology.
Is fake grass a bad idea? The AstroTurf wars are far from over.
In 2001, Americans installed just over 7 million square meters of synthetic turf. By 2024, that number was 79 million square meters—enough to carpet all of Manhattan and then some. The increase worries folks who study microplastics and environmental pollution.
This story is from the next issue of our print magazine, packed with stories all about nature. Subscribe now to read the full thing when it lands on Wednesday, April 22.
Mustafa Suleyman: AI development won’t hit a development wall anytime soon—here’s why
—Mustafa Suleyman, Microsoft AI CEO and Google DeepMindco-founder
The skeptics keep predicting that AI compute will soon hit a wall—and keep getting proven wrong. To understand why that is, you need to look at the forces driving the AI explosion.
Three advances are enabling exponential progress: faster basic calculators, high-bandwidth memory, and technologies that turn disparate GPUs into enormous supercomputers. Where does all this get us? Read the full op-ed on the future of AI development to learn more.
Desalination technology, by the numbers
—Casey Crownhart
When I started digging into desalination technology for a new story, I couldn’t help but obsess over the numbers.
I knew on some level that desalination—pulling salt out of seawater to produce fresh water—was an increasingly important technology, especially in water-stressed regions including the Middle East. But just how much some countries rely on desalination, and how big a business it is, still surprised me.
This story is from The Spark, our weekly newsletter on the tech that could combat the climate crisis. Sign up to receive it in your inbox every Wednesday.
The must-reads
I’ve combed the internet to find you today’s most fun/important/scary/fascinating stories about technology.
1 Meta has launched the first AI model from its Superintelligence Labs Muse Spark is the company’s first model in a year. (Reuters $) + The closed model brings reasoning capabilities to the Meta AI app. (Engadget) + It’s built by Meta’s Superintelligence Labs, the unit led by Alexandr Wang. (TechCrunch)
2 Anthropic has lost a bid to pause the Pentagon’s blacklisting An appeals court in Washington, DC denied the request. (CNBC) + A California judge had temporarily blocked the blacklisting in March. (NPR) + The mixed rulings leave Anthropic in a legal limbo. (Wired $) + And open doors for smaller AI rivals. (Reuters $)
3 New evidence suggests Adam Back invented Bitcoin The British cryptographer may be the real Satoshi Nakamoto. (NYT $) + Back denies the claims. (BBC) + There’s a dark side to crypto’s permissionless dream. (MIT Technology Review)
4 Gen Z is cooling on AI The share feeling angry about it has risen from 22% to 31% in a year. (Axios) + Anti-AI protests are also growing. (MIT Technology Review)
5 War in the Gulf could tilt the cloud race toward China Huawei is pitching “multi-cloud” resilience to Gulf clients. (Rest of World)
6 Meta has killed a leaderboard of its AI token users It showed the top 250 users. (The Information $) + Meta blamed data leaks for the shutdown. (Fortune) + It encouraged “tokenmaxxing,” a growing phenomenon in Big Tech. (NYT $)
7 Did Artemis II really tell us anything new about space? Or was it primarily a PR exercise? (Ars Technica)
8 Israeli attacks have brutally exposed Lebanon’s digital infrastructure It’s managing a modern crisis without modern technology. (Wired $)
9 AI models could offer mathematicians a common language They hope it will simplify the process of verifying proofs. (Economist)
10 A “self-doxing’ rave is helping trans people stay safe online It’s among a series of digital self-defenses. (404 Media)
Quote of the day
“I feel like anything that I’m interested in has the potential of maybe getting replaced, even in the next few years.”
—Sydney Gill, a freshman at Rice University, tells the New York Times why she’s soured on AI.
One More Thing
A view inside ATLAS, one of two general-purpose detectors at the Large Hadron Collider.
MAXIMILIEN BRICE/CERN
Inside the hunt for new physics at the world’s largest particle collider
In 2012, data from CERN’s Large Hadron Collider (LHC) unearthed a particle called the Higgs boson. The discovery answered a nagging question: where do fundamental particles, such as the ones that make up all the protons and neutrons in our bodies, get their mass?
A place for comfort, fun and distraction to brighten up your day. (Got any ideas? Drop me a line.)
+ Enjoy this tale of the “joke” sound that accidentally defined 90s rave culture. + Take a nostalgic trip through the websites of the early 00s. + One for animal lovers: sperm whales have teamed up to support a newborn. + Here’s a long overdue answer to a vital question: can the world’s largest mousetrap catch a limousine?
A rare warm spell in January melted enough snow to uncover Cornell University’s newest athletic field, built for field hockey. Months before, it was a meadow teeming with birds and bugs; now it’s more than an acre of synthetic turf roughly the color of the felt on a pool table, almost digital in its saturation. The day I walked up the hill from a nearby creek to take a look, the metal fence around the field was locked, but someone had left a hallway-size piece of the new simulated grass outside the perimeter. It was bristly and tough, but springy and squeaky under my booted feet. I could imagine running around on it, but it would definitely take some getting used to.
My companion on this walk seemed even less favorably disposed to the thought. Yayoi Koizumi, a local environmental advocate, has been fighting synthetic-turf projects at Cornell since 2023. A petite woman dressed that day in a faded plum coat over a teal vest, with a scarf the colors of salmon, slate, and sunflowers, Koizumi compulsively picked up plastic trash as we walked: a red Solo cup, a polyethylene Dunkin’ container, a five-foot vinyl panel. She couldn’t bear to leave this stuff behind to fragment into microplastic bits—as she believes the new field will. “They’ve covered the living ground in plastic,” she said. “It’s really maddening.”
The new pitch is one part of a $70 million plan to build more recreational space at the university. As of this spring, Cornell plans to install something like a quarter million square feet of synthetic grass—what people have colloquially called “astroturf” since the middle of the last century. University PR says it will be an important part of a “health-promoting campus” that is “supportive of holistic individual, social, and ecological well-being.” Koizumi runs an anti-plastic environmental group called Zero Waste Ithaca, which says that’s mostly nonsense.
This fight is more than just the usual town-versus-gown tension. Synthetic turf used to be the stuff of professional sports arenas and maybe a suburban yard or two; today communities across the United States are debating whether to lay it down on playgrounds, parks, and dog runs. Proponents say it’s cheaper and hardier than grass, requiring less water, fertilizer, and maintenance—and that it offers a uniform surface for more hours and more days of the year than grass fields, a competitive advantage for athletes and schools hoping for a more robust athletic program.
But while new generations of synthetic turf look and feel better than that mid-century stuff, it’s still just plastic. Some evidence suggests it sheds bits that endanger users and the environment, and that it contains PFAS “forever chemicals”—per- and polyfluoroalkyl substances, which are linked to a host of health issues. The padding within the plastic grass is usually made from shredded tires, which might also pose health risks. And plastic fields need to be replaced about once a decade, creating lots of waste.
Yet people are buying a lot of the stuff. In 2001, Americans installed just over 7 million square meters of synthetic turf, just shy of 11,000 metric tons. By 2024, that number was 79 million square meters—enough to carpet all of Manhattan and then some, almost 120,000 metric tons. Synthetic turf covers 20,000 athletic fields and tens of thousands of parks, playgrounds, and backyards. And the US is just 20% of the global market.
Where real estate is limited and demand for athletic facilities is high, artificial turf is tempting. “It all comes down to land and demand.”
Frank Rossi, professor of turf science, Cornell
Those increases worry folks who study microplastics and environmental pollution. Any actual risk is hard to parse; the plastic-making industry insists that synthetic fields are safe if properly installed, but lots of researchers think that isn’t so. “They’re very expensive, they contain toxic chemicals, and they put kids at unnecessary risk,” says Philip Landrigan, a Boston College epidemiologist who has studied environmental toxins like lead and microplastics.
But at Cornell, where real estate is limited and demand for athletic facilities is high, synthetic turf was a tempting option. As Frank Rossi, a professor of turf science at Cornell, told me: “It all comes down to land and demand.”
In 1965, Houston’s new, domed baseball stadium was an icon of space-age design. But the Astrodome had a problem: the sun. Deep in the heart of Texas, it shined brightly through the Astrodome’s skylights—so much so that players kept missing fly balls. So the club painted over the skylights. Denied sunlight, the grass in the outfield withered and died.
A replacement was already in the works. In the late 1950s a Ford Foundation–funded educational laboratory determined that a soft, grasslike surface material would give city kids more places to play outside and had prevailed upon the Monsanto corporation to invent one. The result was clipped blades of nylon stuck to a rubber base, which the company called ChemGrass. Down it went into Houston’s outfield, where it got a new, buzzier name: AstroTurf.
Workers lay artificial turf at the Astrodome in Houston on July 13, 1966. Developed by Monsanto, the material was originally known as ChemGrass but was later renamed AstroTurf after the stadium.
AP PHOTO/ED KOLENOVSKY, FILE
That first generation of simulated lawn was brittle and hard, but quality has improved. Today, there are a few competing products, but they’re all made by extruding a petroleum-based polymer—that’s plastic—through tiny holes and then stitching or fusing the resulting fibers to a carpetlike bottom. That gets attached to some kind of padding, also plastic. In the 1970s the industry started layering that over infill, usually sand; by the 1990s, “third generation” synthetic turf had switched to softer fibers made of polyethylene. Beneath that, they added infill that combined sand and a soft, cheap shredded rubber made from discarded automobile tires, which pile up by the hundreds of millions every year. This “crumb rubber” provides padding and fills spaces between the blades and the backing.
In the early 1980s, nearly half the professional baseball and football fields in the US had synthetic turf. But many players didn’t like it. It got hotter than real grass, gave the ball different action, and seemed to be increasing the rate of injuries among athletes. Since the 1990s, most pro sports have shifted back toward grass—water and maintenance costs pale in comparison to the importance of keeping players happy or sparing them the risk of injury.
But at the same time, more universities and high schools are buying the artificial stuff. The advantages are clear, especially in places where it rains either too much or not enough. A natural-grass field is usable for a little more than 800 hours a year at the most, spread across just eight months in the cooler, wetter northern US. An artificial-turf field can see 3,000 hours of activity per year. For sports like lacrosse, which begins in late winter, this makes artificial turf more appealing. Most lacrosse pitches are now synthetic. So are almost all field hockey pitches; players like the way the even, springy turf makes the ball bounce.
Furthermore, supporters say synthetic turf needs less maintenance than grass, saving money and resources. That’s not always true; workers still have to decompact the playing surface and hose it off to remove bird poop or cool it down. Sometimes the infill needs topping up. But real grass allows less playing time, and because grass athletic fields often need to be rotated to avoid damage, synthetic ground cover can require less space. Hence the market’s explosive growth in the 21st century.
The city and town of Ithaca—two separate political entities with overlapping jurisdiction over Cornell construction projects—held multiple public meetings about the university’s new synthetic fields: the field hockey pitch and a complex called the Meinig Fieldhouse. Koizumi’s group turned up in force, and a few folks who worked at Cornell came to oppose the idea too—submitting pages of citations and studies on the risks of synthetic grass.
At two of those meetings, dozens of Cornell athletes turned out to support the turf. Representatives of the university and the athletic department declined to speak with me for this story, citing an ongoing lawsuit from Zero Waste Ithaca. But before that, Nicki Moore, Cornell’s director of athletics, told a local newspaper that demand from campus groups and sports teams meant the fields were constantly overcrowded. “Activities get bumped later and later, and sometimes varsity teams won’t start practicing until 10 at night, you know?” Moore told the paper. “Availability of all-weather space should normalize scheduling a great deal.”
That argument wasn’t universally convincing. “It’s a bad idea, but that’s from the environmental perspective,” says Marianne Krasny, director of Cornell’s Civic Ecology Lab and one of the speakers at those hearings. “Obviously the athletic department thinks it’s a great idea.”
GETTY IMAGES
Members of Cornell on Fire, a climate action group with members from both the university and the town, joined in opposing the use of artificial turf, citing the fossil-fuel origins of the stuff. They described the nominal support of the project from student athletes as inauthentic, representing not grassroots support but, yes, an astroturf campaign.
Sorting out the actual science here isn’t simple. Over time, the plastic that synthetic turf is made of sheds bits of itself into the environment. In one study, published in 2023 in the journal Environmental Pollution, researchers found that 15% of the medium-size and microplastic particles in a river and the Mediterranean Sea outside Barcelona, Spain, came from artificial turf, mostly in the form of tiny green fibers. Back in 2020, the European Chemicals Agency estimated that infill material from artificial-turf fields in the European Union was contributing 16,000 metric tons of microplastics to the environment each year—38% of all annual microplastic pollution. Most of that came from the crumb rubber infill, which Europe now plans to ban by 2031.
This pollution worries the Cornell activists. Ithaca is famous for scenic gorges and waterways. The new field hockey pitch is uphill from a local creek that empties into Cayuga Lake, the longest of the Finger Lakes and the source of drinking water for over 40,000 people.
And it’s not just the plastic bits. When newer generations of synthetic turf switched to durable high-density polyethylene, the new material gunked up the extruders used in the manufacturing process. So turf makers started adding fluorinated polymers—a type of PFAS. Some of these environmentally persistent “forever chemicals” cause cancer, disrupt the endocrine system, or lead to other health problems. Research in several different labs has found PFAS in many types of plastic grass.
But the key to assessing the threat here is exposure. Heather Whitehead, an analytical chemist then at the University of Notre Dame, found PFAS in synthetic turf at levels around five parts per billion—but estimated it’d be in water running off the fields at three parts per trillion; for context, the US Environmental Protection Agency’s legal drinking-water limit on one of the most widespread and dangerous PFAS chemicals is four parts per trillion. “These chemicals will wash off in small amounts for long periods of time,” says Graham Peaslee, Whitehead’s advisor and an emeritus nuclear physicist who studies PFAS concentrations. “I think it’s reason enough not to have artificial turf.”
This gets confusing, though. There are over 16,000 different types of PFAS, few have been well studied, and different companies use different manufacturing techniques. Companies represented by the Synthetic Turf Council now “use zero intentionally added PFAS,” says Melanie Taylor, the group’s president. “This means that as the field rolls off the assembly line, there are zero PFAS-formulated materials present.”
Some researchers are skeptical of the industry’s assurances. They’re hard to confirm, especially because there are a lot of ways to test for PFAS. The type of synthetic turf going onto the new field hockey pitch at Cornell is called GreenFields TX; the university had a sample tested using an EPA method that looks for 40 different PFAS compounds. It came back negative for all of them. The local activists countered that the test doesn’t detect the specific types they’re most concerned about, and in 2025 they paid for three more tests on newly purchased synthetic turf. Two clearly found fluorine—the F in “PFAS”—and one identified two distinct PFAS compounds. (The company that makes GreenFields TX, TenCate, declined to comment, citing ongoing litigation.)
PFAS isn’t the only potential problem. There’s also the crumb rubber made from tires. A billion tires get thrown out every year worldwide, and if they aren’t recycled they sit in giant piles that make great habitats for rats and mosquitoes; they also occasionally catch fire. Lots of the tires that go into turf are made of styrene-butadiene rubber, or SBR. In bulk, that’s bad. Butadiene is a carcinogen that causes leukemia, and fumes from styrene can cause nervous system damage. SBR also contains high levels of lead.
But how much of that comes out of synthetic-turf infill? Again, that’s hotly debated. Researchers around the world have published suggestive studies finding potentially dangerous levels of heavy metals like zinc and lead in synthetic turf, with possible health risks to people using the fields. But a review of many of the relevant studies on turf and crumb rubber from Canada’s National Collaborating Centre for Environmental Health determined that most well-conducted health risk assessments over the last decade found exposures below levels of concern for cancer and certain other diseases. A 2017 report by the European Chemicals Agency—the same people who found all those microplastics in the environment—“found no reason to advise people against playing sports on synthetic turf containing recycled rubber granules as infill material.” And a multiyear study from the EPA, published in 2024, found much the same thing—although the researchers said that levels of certain synthetic chemicals were elevated inside places that used indoor artificial turf. They also stressed that the paper was not a risk assessment.
The problem is, the kinds of cancers these chemicals can cause may take decades to show up. Long-term studies haven’t been done yet. All the evidence available so far is anecdotal—like a series for the Philadelphia Inquirer that linked the deaths of six former Phillies players from a rare type of brain cancer called glioblastoma to years spent playing on PFAS-containing artificial turf. That’d be about three times the usual rate of glioblastoma among adult men, but the report comes with a lot of cautions—small sample size, lots of other potential causes, no way to establish causation.
Synthetic turf has one negative that no one really disputes: It gets very hot in the sun—as hot as 150 °F (66 °C). This can actually burn players, so they often want to avoid using a field on very hot days.
A field hockey player from Cornell University passes the ball during a game played on artificial turf at Bryant University in 2025. Cornell’s own turf field will be ready for the 2026 season.
GETTY IMAGES
Athletes playing on artificial turf also have a higher rate of foot and ankle injuries, and elite-level football players seem to be more predisposed to knee injuries on those surfaces. But other studies have found rates of knee and hip injury to be roughly comparable on artificial and natural turf—a point the landscape architect working on the Cornell project made in the information packet the university sent to the city. Athletic departments and city parks departments say that the material’s upsides make it worthwhile, given that there’s no conclusive proof of harm.
Back in Ithaca, Cornell hired an environmental consulting firm called Haley & Aldrich to assess the evidence. The company concluded that none of the university’s proposed installations of artificial turf would have a negative environmental impact. People from Cornell on Fire and Zero Waste Ithaca told me they didn’t trust the firm’s findings; representatives from Haley & Aldrich declined to comment.
Longtime activists say that as global consumption of fossil fuels declines, petrochemical companies are desperate to find other markets. That means plastics. “There’s a big push to shift more petrochemicals into plastic products for an end market,” says Jeff Gearhart, a consumer product researcher at the Ecology Center. “Industry people, with a vested interest in petrochemicals, are looking to expand and build out alternative markets for this stuff.”
All that and more went before the decision-makers in Ithaca. In September 2024, the City of Ithaca Planning Board unanimously issued a judgment that the Meinig Fieldhouse would not have a significant environmental impact and thus would not need to complete a full environmental impact assessment. Six months later, the town made the same determination for the field hockey pitch.
Zero Waste Ithaca sued in New York’s supreme court, which ruled against the group. Koizumi and lawyers from Pace University’s Environmental Litigation Clinic have appealed. She says she’s still hopeful the court might agree that Ithaca authorities made a mistake by not requiring an environmental impact statement from the college. “We have the science on our side,” she says.
Ithaca is a pretty rarefied place, an Ivy League university town. But these same tensions—potential long-term environmental and public health consequences versus the financial and maintenance concerns of the now—are pitting worried citizens against their representatives and city agencies around the country.
New York City has 286 municipal synthetic-turf fields, with more under construction. In Inwood, the northernmost neighborhood in Manhattan, two fields were approved via Zoom meetings during the pandemic, and Massimo Strino, a local artist who makes kaleidoscopes, says he found out only when he saw signs announcing the work on one of his daily walks in Inwood Hill Park, along the Hudson River. He joined a campaign against the plan, gathering more than 4,300 signatures. “I was canvassing every weekend,” Strino says. “You can count on one hand, literally, the number of people who said they were in favor.”
But that doesn’t include the group that pushed for one of those fields in the first place: Uptown Soccer, which offers free and low-cost lessons and games to 1,000 kids a year, mostly from underserved immigrant families. “It was turning an unused community space into a usable space,” says David Sykes, the group’s executive director. “That trumped the sort of abstract concerns about the environmental impacts. I’m not an expert in artificial turf, but the parks department assured me that there was no risk of health effects.”
Artificial turf doesn’t go away. “You’re going to be paying to get rid of it. Somebody will have to take it to a dump, where it will sit for a thousand years.”
Graham Peaslee, emeritus nuclear physicist studying PFAS concentrations, University of Notre Dame
New York City councilmember Christopher Marte disagrees. He has introduced a bill to ban new artificial turf from being installed in parks, and he hopes the proposal will be taken up by the Parks Committee this spring. Last session, the bill had 10 cosponsors—that’s a lot. Marte says he expects resistance from lobbyists, but there’s precedent. The city of Boston banned artificial turf in 2022.
Upstate, in a Rochester suburb called Brighton, the school district included synthetic-turf baseball and softball diamonds in a wide-ranging February 2024 capital improvement proposition. The measure passed. In a public meeting in November 2025, the school board acknowledged the intent to use synthetic grass—or, as concerned parents had it, “to rip up a quarter million square feet of this open space and replace it with artificial turf,” says David Masur, executive director of the environmental group PennEnvironment, whose kids attend school in Brighton. Parents and community members mobilized against the plan, further angered when contractors also cut down a beloved 200-year-old tree. School superintendent Kevin McGowan says it’s too late to change course. Masur has been working to oppose the plan nevertheless—he says school boards are making consequential decisions about turf without sharing information or getting input, even though these fields can cost millions of dollars of taxpayer money.
In short, the fights can get tense. On Martha’s Vineyard, in Massachusetts, a meeting about plans to install an artificial field at a local high school had to be ended early amid verbal abuse. A staffer for the local board of health who voiced concern about PFAS in the turf quit the board after discovering bullet casings in her tote bag, she said, which she perceived as a death threat. After an eight-year fight, the board eventually banned artificial turf altogether.
What happens next? Well, outdoor artificial turf lasts only eight to 12 years before it needs to be taken up and replaced. The Synthetic Turf Council says it’s at least partially recyclable and cites a company called BestPLUS Plastic Lumber as a purveyor of products made from recycled turf. The company says one of its products, a liner called GreenBoard that artificial turf can be nailed into, is at least 40% recycled from fake grass. Joseph Sadlier, vice president and general manager of plastics recycling at BestPLUS, says the company recycles over 10 million pounds annually.
Yet the material is piling up. In 2021, a Danish company called Re-Match announced plans to open a recycling plant in Pennsylvania and began amassing thousands of tons of used plastic turf in three locations. The company filed for bankruptcy in 2025.
In Ithaca, university representatives told planning boards that it would be possible to recycle the old artificial turf they ripped out to make way for the Meinig Fieldhouse. That didn’t happen. An anonymous local activist tracked the old rolls to a hauling company a half-hour’s drive south of campus and shared pictures of them sitting on the lot, where they stayed for months. It’s unclear what their ultimate fate will be.
That’s the real problem: Artificial turf just doesn’t go away. “You’re going to be paying to get rid of it,” says Peaslee, the PFAS expert. “Somebody will have to take it to a dump, where it will sit for a thousand years.” At minimum, real grass is a net carbon sink, even including installation and maintenance. Synthetic turf releases greenhouse gases. One life-cycle analysis of a 2.2-acre synthetic field in Toronto determined that it would emit 55 metric tons of carbon dioxide over a decade. Plastic fields need less water to maintain, but it takes water to make plastic, and natural grass lets rainwater seep into the ground. Synthetic turf sends most of it away as runoff.
It’s a boggling set of issues to factor into a decision. Rossi, the Cornell turf scientist, says he can understand why a school in the northern United States might go plastic, even when it cares about its students’ health. “It was the best bad option,” he says. Concerns about microplastics and PFAS are “significant issues we have not fully addressed.” And they need to be.
Douglas Main is a journalist and former senior editor and writer at National Geographic.
