Let's Know Things

This week we talk about Russia, Ukraine, and the Warsaw Pact.
We also discuss Patriot interceptors, Hungary, and Article 5.
Recommended Book: The Alternative by Nick Romeo
Transcript
The North Atlantic Treaty Organization, or NATO, was founded in the wake of WWII, in 1949, in order to affirm unity between non-Soviet European nations, Atlantic nations like Greenland and Iceland, and the US and Canada, over in North America.
The main purpose of this unity was to establish a sort of firewall around the western perimeter of the Soviet Union, which at the time was the only global superpower other than the US, because much of the world, but especially Europe, was struggling to recover from the destruction wrought during the second world war, and the Soviets had made pretty clear that they intended to take over everything: they’d already gobbled up most of their neighbors, creating an increasingly expansive buffer zone of Soviet states around their central, Russian territory, and most of the conflicts still playing out, or threatening to play out, globally at this point were either overt or slightly concealed proxy fights between the capitalist democratic forces of the West and the authoritarian, Stalinist forces of the Eastern Soviet bloc.
NATO was thus a wall of nations that said, hey, if you attack any of us, that will mean you’re attacking all of us. And that ‘all of us’ included the United States, which was the only individual force capable of standing up to the Soviets at this point, due to its massive conventional military force, and the threat posed by its huge, and still growing, nuclear weapons arsenal.
The Soviet counter to NATO was called the Warsaw Pact, which formed in 1955, and these rival alliances carved up Europe during the latter half of the 20th century, until the Soviet Union collapsed in 1991.
As military alliances go, NATO has been fairly successful—Article 5, the portion of the agreement that triggers if a NATO member is attacked, calling the other members to come to their aid, was only activated once, following the terrorist attacks on the US on September 11, 2001; that led to NATO involvement in the US’s attacks on Afghanistan in subsequent years, though NATO forces also periodically got involved in other regional conflicts, like the Kosovo War in 1999, and the Libyan Civil War in 2011, in both cases working with the UN to protect civilians from the actions of violent leaders or assailants. But beyond that, no one, including the Soviets, messed with NATO.
NATO has since accepted sixteen new member states, and that expansion is one of the supposed rationales for Russian President Putin’s invasion of Ukraine. During Putin’s first presidency, Russia and NATO had been on pretty solid, even cooperative terms, which had some questioning the point of the treaty, since it was originally formed to counter Russian aggression. In Putin’s second presidency, though, things took an antagonistic turn, and when Russia illegally invaded and annexed a part of Ukraine, called Crimea, back in 2014, NATO ceased all cooperation with Russia.
When Russian forces launched a full invasion of Ukraine in 2022, NATO suddenly seemed more important than ever, as a reinvigorated Russia, with the stated purpose of, in Putin’s words, reclaiming portions of Europe that were previously part of the extended Soviet Union, parts of the Warsaw Pact, that posed a serious threat to just about everyone, especially European nations that border Russia and Russian allies, like Belarus.
What I’d like to talk about today is the 2026 meeting of NATO leaders, and the general state of affairs on the ground in Ukraine, as of mid-2026.
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Leaders of NATO member nations typically meet for a summit each year, though the schedule varies a bit, depending on the needs of the moment, and whether there are any NATO-relevant crises that might nudge things forward or cause them to be delayed.
The 2026 NATO summit was held in Turkey’s capitol city, Ankara, on July 7 and 8. It was the second such summit hosted by Turkey, and the 36th NATO summit, overall.
This meeting was notable for several reasons, many of them directly related to Russia’s ongoing invasion of Ukraine, but also the US’s continued ambivalence, at times bordering on active antagonism, toward the treaty, under the Trump administration.
Over the course of the past 4 years, Russia has continued to make threats toward the rest of Europe, implying or suggesting that it might have to act militarily against its NATO-member neighbors. During the same period, the US has criticized European NATO member states for not carrying their own weight, most of these nations not spending enough of their GDP on their military and defense infrastructure, in accordance with their treaty obligations, and most more or less relying on the US’s military (and nuclear) umbrella to threaten would-be attackers.
This has long been the NATO state of affairs, but under the Trump administration, the US made it a point of contention. And though it’s been a relatively slow process—it’s not easy for a government to pivot toward that scale of remilitarization—these nations have agreed to a 5% of GDP target for defense and defense-related spending by 2035, and in the last year alone, European and Canadian defense spending has increase by 20%; not all of which is immediately convertible into useful, front-line assets and soldiers, but it does represent a significant change to the status quo, which could eventually, in less than a decade, result in a European front-line that’s more European and less NATO, for the first time since that immediate post-WWII period.
This meeting also featured a reaffirmation of Article 5, which has always been there and in effect, but some analysis has questioned whether NATO allies, including the US, would actually step up if Russia were to attack the Baltics, for instance. This is a seemingly small move that serves to underline that stance of, if you attack one of us, you’ve attacked all of us, at a moment in which Russia seems to be toying with the idea of picking off pieces of the alliance, to see if they can get away with it, like they did with Crimea back in 2014.
There were also announcements related to a fresh $50 billion in defense industry deals, NATO members investing heavily in US-made arms and new assets from elsewhere across the bloc, and a lot of that money is going to drone-war infrastructure and militarized AI models that they hope will prepare NATO for current and next-generation conflicts. Another $217 billion in additional financing commitments from banks across the bloc have also been announced.
Ukraine scored some pretty big wins at this year’s NATO summit, getting a license from the US to build Patriot interceptors, the lack of which have resulted in big gaps in the country’s defense system, and about $80 billion in military equipment, assistance, and training for Ukrainian forces was committed by the bloc. There was also a verbal commitment that NATO and its allies “stand united in our unwavering support for Ukraine in defending its freedom, sovereignty, and territorial integrity.” Which isn’t nothing, at a moment in which the US is led by Trump, a person who has frequently sided with Putin in Ukraine-related matters.
Ukraine has also signed some bilateral drone deals with NATO member states, reaffirming that Ukraine has become one of the most in-demand experts on this subject, at a moment in which it’s becoming clearer and clearer that low-cost, high-impact drones and similar technologies are likely to dominate battlefields for the foreseeable future.
There were also some tensions, mostly sparked by Trump, over his administration’s desire to buy Greenland, which is not a notion that’s supported by anyone else in the bloc, and the lack of NATO support for the US’s war in Iran.
Overall, though, there was a decent sense of unity and progress, and Ukraine, again, not a NATO member state, but a nation that hopes to eventually join NATO, received a warm welcome and a bunch of support, which hasn’t always been the case at recent summits.
Part of that warmth is likely the consequence of Ukraine’s recent victories on and off the battlefield.
Russian continues to pummel Ukrainian cities and kill Ukrainian soldiers and civilians en masse, but Ukraine has managed to keep them from gobbling up territory on scale, and in some recents months, has actually taken territory back. They’ve also gotten very good at successfully attacking Russian infrastructure, especially energy infrastructure, like oil refineries, cargo tankers, and energy storage facilities, across the entire expanse of Russia; something few experts would have predicted that Ukraine would be capable of doing at the beginning of this conflict. This has dramatically weakened Russia’s economy, at least in the short-term.
Ukraine now has a thriving defense industry, predicated on the rapid iteration of inexpensive but disproportionately sophisticated arms, especially drones and other aerial weapons, but also autonomous speed boats and other such asymmetric systems. Russia has been frantically upgrading its systems, too, but now that Ukraine has figured out methods for bypassing or overwhelming Russian defenses, it’s been able to strike, quickly and repeatedly, high-value targets that have brought the war home to normal Russians who live far from the front lines, even in Moscow. That combined with strategies and weapons that have turned the frontlines into a meat-grinder for Russian soldiers has weighed heavily on Russian morale, at least for those with boots on the ground.
As a consequence of those energy infrastructure attacks, the Russian government has been forced to ration some types of energy product—a huge embarrassment for a country that has at times been called a gas station run by a mafia, their energy products are fundamental to who they are, and their economy—and Russians in Crimea, which was taken from Ukraine more than a decade ago, have been fleeing, as this peninsula is close to Ukraine, is part of Ukraine, just occupied by Russia right now, and has several vulnerable arteries through which people and supplies are shipped from Russia, and those arteries have been frequently attacked and are difficult to protect.
Ukraine is still persistently on the back foot, then, and still facing an enemy that has essentially every advantage, from money to manpower to foreign support to the size of its arsenal.
Against all odds, though, Ukraine continues to not just hold its ground, but to build up its military capabilities, innovate on existing models, and perform high-leverage attacks against its in every way superior invader; which is, in turn, netting it more support from outside allies that have, at times, wavered—and that’s especially true of the US under the Trump administration, but until recently the EU’s support has also been hamstrung by the recently usurped Hungarian leader, and Putin ally, Viktor Orbán. Following Orbán’s ouster, the EU was able to move forward with paused support commitments, though, and while Trump is still holding back on much of the same from the US, there’s a chance that more success by Ukraine will continue to tip the balance away from total freeze-out, to more, and more substantial, if perhaps still grudging, support.
Show Notes
https://en.wikipedia.org/wiki/NATO
https://en.wikipedia.org/wiki/2026_Ankara_NATO_summit
https://understandingwar.org/research/russia-ukraine/russian-occupation-update-july-9-2026/
https://acleddata.com/monitor/ukraine-conflict-monitor
https://en.wikipedia.org/wiki/Russo-Ukrainian_war_(2022%E2%80%93present)
https://www.nytimes.com/2026/07/08/world/europe/a-license-to-make-patriot-defense-systems-may-be-a-big-boost-for-ukraine.html
https://www.nytimes.com/2026/07/06/world/europe/ukraine-russia-patriot-air-defense.html
https://www.nytimes.com/interactive/2026/07/04/world/europe/ukraine-russia-crimea-war-strikes.html
https://www.nytimes.com/2026/07/09/world/europe/ukraine-patriots-trump-russia.html
https://www.nytimes.com/2026/07/08/world/europe/russia-nato-europe-ukraine.html
https://www.nytimes.com/2026/07/07/world/europe/nato-trump-rutte-ankara-turkey.html
https://www.nytimes.com/2026/07/03/world/europe/putin-ukraine-donbas-battlefield-visit.html
https://www.nytimes.com/2026/07/03/world/europe/russia-gas-shortages.html
https://www.nytimes.com/2026/07/02/world/europe/russia-ukraine-military-battlefield.html
https://apnews.com/article/russia-ukraine-war-oil-trump-zelenskyy-putin-6cb5602f1cf309533ed0cf5c734e19d8
https://www.bbc.com/news/articles/c70yd1g67z5o
https://www.france24.com/en/russia-bans-oil-exports-as-ukraine-strikes-cause-fuel-shortages
https://uk.finance.yahoo.com/news/ukraine-creates-long-range-military-071810180.html
https://www.cnbc.com/2026/07/10/ukraine-russia-crimea-fuel-oil.html
https://www.dw.com/ru/reuters-rf-perekryla-azovodonskoj-kanal-posle-atak-bpla/a-77913327
https://www.cnn.com/2026/07/10/politics/senators-agreement-trump-administration-russia-sanctions
https://www.theguardian.com/world/2026/jul/10/ukraine-war-briefing-kyiv-reaches-political-agreement-with-us-on-patriot-interceptor-production-licences
https://www.cnbc.com/2026/07/09/nato-trump-rutte-ukraine-russia-us-iran.html
https://www.atlanticcouncil.org/dispatches/eleven-takeaways-from-the-nato-summit-in-ankara/
https://www.aljazeera.com/news/2026/7/8/five-key-takeaways-from-the-nato-summit-in-ankara
https://www.aljazeera.com/news/2026/7/8/nato-pledges-70-billion-euros-for-ukraine-as-trump-praises-peace-progress


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This week we talk about Sony, Nintendo, and the Playstation.
We also discuss Grand Theft Auto, the 3DO, and digital dark ages.
Recommended Book: 3 Days, 9 Months, 27 Years by John Scalzi
Transcript
The earliest video game consoles that were made to be used in the home, as opposed to being set up in an arcade, were hardwired like their arcade kin. That means rather than being able to play a bunch of different games, they were basically just single-game boxes: you would buy a machine that allowed you to play Pong, for instance, and if you wanted to play another game, even by the same maker, Atari, you would have to buy another whole console with its own screen, controls, etc, to do so.
That was the state of the art in the early to mid 1970s. By the late-70s, the concept of swappable games became reality with the introduction of what are called ROM cartridges. ROM stands for read-only memory and is a type of storage common in computers and other devices, which allows whatever you store on it to persist, which is a contrast to RAM, which is the type of memory that determines how much you can do on a device at any given moment, and which disappears when the device is turned off.
So these ROM cartridges were kind of like the portion of the hard drive that’s used to boot up your computer, storing the bare-basics of the system so it can be initialized and understand how to run all the other software that builds upon that baseline. And that memory was stored in durable, plastic cases that made them usable by ordinary, non-techy people. You could buy a game and handle the cartridge, popping it into your game console hardware and removing it, to make way for another game, over and over and over again, and that use would be unlikely to damage the ROM chip.
This same general format was flexible enough that it lasted through the mid-90s, the capacity of the ROM chip continuing to grow as the associated tech improved, and the capabilities of the central console hardware that used these cartridges became more sophisticated. Upgrades were slowly added to the innards of the plastic case, as well, including things like battery backups that enabled saved games, and the Super Nintendo’s Super FX chip, which enabled 3D graphics that would have otherwise been impossible with the contemporary state of the art.
The next generation of gaming consoles relied on another medium, though, and one that had several benefits over the long-lived game cartridge.
CD-ROM discs, which were flat, circular, and contained information that was encoded and read with lasers, had been around in some form since the late-1980s, and were even used in a few early gaming consoles, like the PC Engine CD-ROM, which barely anyone bought, and the Sega-CD add-on for the Sega Genesis, and 3DO consoles, which a few more, but still relatively few people purchased.
The release of the first Sony Playstation, now known as the PS1, in 1994 changed that, though, and this shift was partially the result of Sony’s impressive game lineup, but was also due to the strength of the CD medium. Each CD-ROM could hold 650-700 MB of information, which was more than 100-times the capacity of the competing Nintendo 64’s cartridges.
There were downsides to this new standard; CD-ROMs were less durable than plastic-encased cartridges, and they were very slow to load, as well, because information stored in ROM chips could be more or less instantly booted, while the info stored on discs had to be spun up and read first, resulting in sluggish load screens throughout the gaming experience, and especially on the initial boot-up of the system.
That said, the far superior storage, and the dramatically reduced cost of these laser-etched discs—cartridges could cost $15-20 apiece to manufacture, while CD-ROMs often cost pennies apiece—that triggered a rapid transition in the gaming world to this new medium. Handheld consoles stuck with cartridges for a lot longer, due to the nature of the use-case and difficulties associated with trying to use spinning discs in portable hardware, but everyone else moved to discs pretty rapidly, after Sony proved the utility of the model, and many aspects of video gaming were upgraded as a result of all that additional storage capacity.
That capacity continued to grow as CD-ROM were replaced with DVDs, which could hold 4.7-8.5 GB per disc, again, up from 650-700 MB; the industry made that change in the years 2000 and 2001, with the PS2 and Xbox consoles. And then in 2006, the PS3 moved to Blu-ray discs, which could hold a whopping 25-50 GB per disc, once again resetting gaming expectations—though Xbox stuck with DVDs, and Nintendo’s Wii, Wii U, and Gamecube consoles used proprietary disc formats that had a lot lower capacity compared to their competition.
Leading into the 2010s, even those Blu-rays were straining under the weight of some big-name, AAA games, some of which required multiple discs and mandatory hard drive installs from those discs, because the scope of these gaming worlds and their high-end graphics required just a stunning amount of space.
Video game companies had already started making the shift to digital products in the early 2000s, though, Xbox Live Arcade and the Playstation Store emerging in 2005 and 2006 respectively, and Steam, which popped up in 2003, was making digital downloads for games common on PCs several years earlier.
Digital became even more popular in the 20-teens, and in 2020, digital sales of console games surpassed physical sales for the first time. The PS5 and Xbox Series S shipped console versions without disc drives for the first time, and many physical games became basically methods of checking a game’s license, to ensure it’s not pirated, because the discs installed the game on the console’s hard drive, just like a download, anyway.
What I’d like to talk about today is the perhaps natural next step in this transition: a recent announcement by Sony that they’ll no longer be making disc-based Playstation games beginning in 2028, and why some critics are calling this a worrying and anti-consumer move.
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On July 1, 2026, Sony announced that’s it’s going all-in on digitally delivered games. It will halt production of game discs beginning in January of 2028, and after that, customers will only be able to purchase new games digitally, via their Playstation Store and retailers.
This follows another recent announcement by game company Rockstar Games that their massively anticipated Grand Theft Auto VI game, which is set to hit digital shelves on November 19 of this year, will not be available on disc at all; it will be downloadable, and the physical copies customers can buy in stores won’t be physical copies at all: it will be a box with a download code inside, which amounts to the same thing—you use the code to download the game, exactly the same as if you had bought it online, but with packaging for that code.
That’s a big deal because the Grand Theft Auto series is one of the biggest and most popular series in gaming history; other game makers have been scrambling to adjust their own release dates so as not to overlap with this new, highly anticipated game’s release; it’s expected to be an absolutely massive moment in the gaming world when this new entry in the series finally lands.
That said, the writing has been on the wall for the transition to digital games for a while, now. Game company Capcom recently announced that 93% of its game sales were digital in its last fiscal year, and other companies have reported similar numbers; it’s currently around 85% for Sony. As a result, many consoles are now shipping models without disc drives, and some, like the recently announced Steam Machine, don’t even have a disc-drive version.
Digital games are also cheaper to make because the company behind them only has to provide download keys, rather than having to pay some amount for each and every physical item produced, packaged, and shipped, and these companies, and the retailers that sell their games, will never run out of a popular game, which might otherwise be an issue for big released like the aforementioned Grand Theft Auto.
There are quite a few downsides to the digitization of games, though, including that in many cases, you don’t actually own the games you buy, you just own a license to download and play them. That means if licensing changes, or the storefront through which you bought a game closes, you will likely lose access to that game you bought, without getting any kind of refund.
If your account is banned or you lose access to your account for some reason, all your games will suddenly be inaccessible, too. If you don’t have access to the internet, allowing your console to phone home and check to make sure you’re not pirating things on a regular basis, that might also mean no gaming for you.
Almost always, you can’t sell or trade digital games, while physical games allow for a thriving secondary market, often allowing gamers to buy old discs and cartridges decades after a game was released, and often for far lower prices. Many of these games can even be played by later consoles that have back-compatibility.
Doing away with discs and other physical media is great for companies like Sony, then, because they no longer have to pay to create the individual discs, no longer have to pay for the drives that play the discs, so the price of making consoles drops a bit, and it also means that secondary market for games goes away: if you want to play old games, you have to buy them from Sony, and all those used games already on the secondary market, or a game disc borrowed from a friend, are no longer competition for them, serving as alternatives to the digital version they’d prefer to sell you.
Another bigger-picture concern here, though, is that this will make game preservation efforts a lot more difficult, and for many of the same reasons it will make maintaining a library and back-catalog of games difficult for consumers.
Often, when a video game store shuts down, either for economic reasons or because it sells content for devices that are no longer maintained, those games and other content also go away. Sometimes they can remain on those older devices, and sometimes the digital rights management software, the DRM in that content and on those devices auto-deletes games from the hardware.
Right now, for instance, Sony is saying that after it halts digital sales of PS3 and Vita games, that halting taking place over the next year, players will still be able to download their previously purchased content for the foreseeable future. That ‘foreseeable future’ phrasing is doing a lot of work, there, though, and historically this kind of shut down has eventually become a full shut down, a lot of games, those that haven’t been carried over to new stores to be played as vintage options on newer consoles, have simply disappeared; maybe still existing on some old hardware somewhere, if it wasn’t deleted by DRM, but maybe not. In either case, preserving that software for historic research and archiving purposes becomes very difficult and expensive, at least compared to archiving the same game on a disc or cartridge.
That closure of the PS3 and Vita stores, for example, is expected to result in the loss of about 2,200 digital-only games that will no longer be available for purchase, and of those, about 138 are not available on any other platform, and will thus essentially disappear.
This game industry concern echoes larger concerns about what’s called a digital dark age: a moment in time, maybe just a few years, maybe a few decades long during which a whole lot of the content that was created and available, disappears, possibly because of outdated file formats, maybe because the storage mediums that were used didn’t hold up over time, or possibly because the data from the era was somehow corrupted, encrypted, or decayed.
There’s concern that a whole lot of information from the early personal computing era will disappear from historical records, for instance, because the floppy disks on which a lot of that information was stored are obsolete and thus increasingly difficult to access; few people have hardware that allows them to use floppy disks, these days.
CD-ROMs, DVDs, and other optical discs are also a concern because of so-called disc rot, which refers to the chemical degradation of this storage medium. Many such discs are prone to failure because of light damage, the oxidation of their reflective layer, and the de-bonding of the adhesive that was used to hold the disc’s multiple layers together.
A lot of seemingly archival media might then degrade, even after being stored in a seemingly long-term fashion, which could also contribute to a dark age moment, a whole period’s worth of data and entertainment and art lost because the CDs and DVDs on which they were stored simply fell apart before they could be converted to a longer-form medium. This could serve as an argument in favor of digitization, then, because many of the mediums on which these games are currently stored might degrade, anyway, and moving them to hard drives, rather than discs, could serve as a superior long-term home.
That said, the concern with digitizing everything is similar, in that media made available for online purchase is simply stored in a hard drive somewhere else on the planet. If something happens to the data centers in which these games are stored, or those data centers are needed for another, more profitable purpose, or a bunch of them are destroyed in a conflict, that could result in the same outcome as disc rot and the storage of data in formats that are no longer accessible.
It also makes these games susceptible to economics, though, because if the company behind them decides it’s time to move on, there won’t be physical copies archivists can scoop up and save; they could try to download these games, but often the nature of the software, of the DRM that keeps them from being pirated, hinders or prevents such efforts.
The digitization of gaming and the shift away from physical copies of games seems to be inevitable at this point, and there are a lot of good economic, technological, and convenience reasons for it.
There are quite a few downsides to this evolution as well, though, including those that negatively impact game consumers, alongside many of the same issues that threaten other types of media and data. And we don’t, technologically or civilizationally, have solutions for those problems yet. And that gap could someday result in massive gulfs in our knowledge and documentation of this moment in video gaming history.
Show Notes
https://blog.archive.org/2026/04/23/gone-but-not-forgotten-recovering-the-dead-web/
https://www.engadget.com/2207297/playstation-just-struck-a-hammer-blow-to-game-preservation/https://www.engadget.com/forza-horizon-4-will-be-pulled-from-digital-stores-and-game-pass-in-december-134510642.html
https://arstechnica.com/gaming/2023/03/why-game-archivists-are-dreading-this-months-3ds-wii-u-eshop-shutdown/
https://www.engadget.com/2205792/sony-will-stop-making-disc-based-playstation-games-starting-2028/
https://www.engadget.com/2207546/sony-repurposing-austrian-playstation-disc-factory/
https://www.engadget.com/2206315/xbox-is-reportedly-testing-a-way-to-digitize-your-disc-based-games/
https://www.engadget.com/2205792/sony-will-stop-making-disc-based-playstation-games-starting-2028/
https://www.theverge.com/report/960173/microsoft-xbox-disc-to-digital-feature-physical-game-collection
https://www.theverge.com/games/956389/grand-theft-auto-6-gta-digital-code-in-box-physical-games
https://en.wikipedia.org/wiki/Digital_dark_age
https://longnow.org/ideas/shining-a-light-on-the-digital-dark-age/
https://www.americanscientist.org/article/avoiding-a-digital-dark-age
https://en.wikipedia.org/wiki/History_of_video_game_consoles
https://www.videogameconsolelibrary.com/history-of-game-media/
https://en.wikipedia.org/wiki/Disc_rot


This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit letsknowthings.substack.com/subscribe

This week we talk about air conditioners, pressure systems, and heat stress.
We also discuss weather memes, climate change, and dirty grids.
Recommended Book: Battle of the Linguist Mages by Scotto Moore
Transcript
An air conditioner, or AC, or maybe air con if you’re in the UK, is a device that moves heat from one location to another. In doing so, it usually dehumidifies the air, as well, so it can rapidly cool a room or entire building by shifting both heat and humidity from that room or building, elsewhere—usually outside.
This is basically the same technology used in refrigerators, a process called vapor compression allowing the device to circulate a substance called refrigerant using a compressor, a condenser, an evaporator, and an expansion valve, which—and this is a very superficial explanation of what’s happening—but these components take advantage of forced circulation and a phase-change between gas and liquid to transfer heat from the room you want to cool, or the inside of the refrigerator, and move that heat outside your building, or to the back and/or bottom of the fridge.
This is a far more active mode of air conditioning, of cooling and dehumidifying the air, than has been used throughout history. Most early methods relied on passive approaches, including but not limited to architectural elements, the use of plants and optimization of air flow, or creating basement areas for things that needed to stay cool.
Researchers have dabbled with more active methods of conditioning air for centuries, though, and several 19th century inventions served as precursors for the first iteration of modern ACs, some of which were used to create ice, which was useful unto itself, but could also be used to cool a room, if far less effectively and efficiently than an actual, holistic AC unit.
In 1894, industrial-grade ammonia compressors, powered by electricity, made this category of device suitable for urban environments; previously they just were far too bulky and difficult to power for city use. By 1896, the Hungarian engineer who came up with this new riff on the theme, István Röck, was manufacturing what he called dry air cooling apparatuses for hospitals, theaters, and other large spaces.
Just five years later, in 1901, an American inventor named Willis H Carrier developed what’s widely considered to be the first modern electrical AC unit, selling the first one to a lithography company in New York, before patenting the term air conditioning in 1906. The first residential version of this device was installed in 1914, and in 1915 the Carrier Air Conditioning Company of America was formed—a business that still exists today.
The impact of air conditioning, and this general technology category, as again, it’s also used in modern refrigeration units, cannot be overstated. This tech didn’t become widespread in the US, which is where it initially took off, in large part due to Carrier and other AC businesses’ presence in the States, until the mid-20th century, and before that, before the 1950s, the state of Florida was technically occupied, but only just barely because of its extreme heat and humidity and abundance of mosquitos. The population of Florida in 1950 was about 2.7 million, and today it’s about 23.5 million—that influx of people began after AC units became standard in buildings across the state, and the country. We’ve seen similar migrations as a result of too-hot places sudden becoming a lot more pleasant.
Similarly, refrigeration enabled a boggling amount of change within the food and beverage industry, the chemicals and industrial materials industries, and the healthcare and life science industries, because before the advent of the cold chain—the system of refrigerated spaces, including boxes and trucks and planes and ships that allowed medicines and foods and other substances to stay cold from their origin to their end-consumer—it simply wasn’t possible to sell or create or work with many of these products and materials.
The distribution of this technology is not universal or equal, however, and in some cases that inequality, that lack of access to this technology in some spaces, is the result of choice, not inaccessibility. And that’s what I’d like to talk about today: the spread, or lack thereof, of AC technologies and products, and how a recent heat wave in Europe may lead to more installations of this type of product across the continent.
—
Beginning in late-May of 2026, a series of severe heatwaves engulfed Europe, and especially Western Europe, breaking all sorts of temperature records and leading to a bunch of heat-related deaths.
A recent meme gives a good sense of just how bad this heat wave has been.
Back in 2014, as part of a campaign by the World Meteorological Organization, dozens of weather presenters from around the world were invited to record fictionalized weather reports from 2050, with the intention of giving people a sense of how global climate change might impact daily life even as soon as just 36 years in the future.
One of these presenters, from France, gave a report of an imagined scenario in which a heat wave descended upon Europe, showing temperatures of 40 degrees celsius, which is about 104 degrees Fahrenheit, with some areas seeing temperatures as high as 43 C or 109.4 degrees F.
This was generally considered to be a baffling, maybe even sci-fi sort of prediction at the time. But this clip has resurfaced and widely shared, as, just 12 years later, not 36, this recent heat wave has not just met, but in some cases surpassed that imagined, too-crazy-to-be-real European heat wave scenario.
Across much of Western Europe, those temperatures milestones were hit, and in a few locations they were beat by as much as 20 degrees F.
For a few days in France, temperatures were higher than in Las Vegas, Nevada and Phoenix, Arizona, coming within 2 degrees F of temperatures in famously too-hot Death Valley, California.
All-time high temperature records were broken in Germany, and a handful of other countries are waiting to see if provisionally recorded high-temperatures they experienced hold up, to see if their own records will be broken. The UK recorded a temperature of 37.1 C (98.78 F), the Netherlands saw a top temperature of 39.4 C (nearly 103 F), Belgium hit 40 C (104 F), and Germany recorded 41.3 C (106.3 F)—all temperatures that are 5-12 C above seasonable averages, and this has led to all manner of infrastructural issues, as well.
A nuclear power plant in Switzerland had to take both reactors off the grid because the temperature of the river that cools it got too hot, a Eurostar train broke down east of Brussels with about 400 people on board, and 3 people had to be taken to the hospital. A bunch of big public events were cancelled, hospitals were filled to the point of having to triage visitors, and, if these on-the-ground issues weren’t enough, researchers in Switzerland have warned that almost all of the winter reserves built up on their glaciers are gone, which suggests the glaciers themselves will begin melting soon—something that usually doesn’t start happening until August.
This heat wave was the result of a potent heat dome, which is a pocket of high pressure that developed as a result of jet stream fluctuations that pulled hot air north, out of warmer portions of Africa. This type of high pressure pocket can then cause the heat it gathers to just sit there, unmoving, whereas typically it would be pushed around, causing it to disperse, and to thus not have such a significant impact on people and other life on the ground.
Unfortunately, these sorts of disruptions to the previous climatic norm are becoming more common as the climate shifts, due to the accumulation of CO2 and other heat-trapping gases in the atmosphere. The regulating systems we’ve evolved with are changing because there’s more overall energy, more heat, powering these systems across the planet, and that means we’re no longer able to predict them as accurately, but also that some of these systems could fundamentally change or disappear, possibly in the near future.
Events like this, which are currently rare, then, could soon become common. And meteorologists in Europe have warned, during this major heat wave, that this sort of event could be a regular thing, and soon, and could even last a lot longer; not a matter of days or weeks, but possibly spanning months at a time, without reprieve.
That’s not great news for a continent that, until now, has generally been pretty okay with its existing heat and weather infrastructure. Unlike the US and other countries that have some incredibly hot regions, leading to the widespread installation of AC units, only about 20% of homes across Europe have AC installed. As a result, as this heat wave descended on the area, trapping heat inside buildings that were constructed with cooler weather in mind, people have been unable to remain indoors, to work, to sleep; it’s been miserable. And in some cases, deadly; the combination of heat and humidity making it more difficult for peoples’ bodies to regulate heat via sweat, and that’s led to an increase in heat stress on their bodies—which is just a miserable thing to deal with, but it also means a lot of people, including but not limited to the very young and very old, are more likely to die, their bodies simply incapable of handling that level of persistent temperature strain.
Back in the summer of 2022, during another, less intense heat wave, more than 60,000 people died across Europe due to heat stress and related ailments. The numbers are still out on this more recent heat wave, but the stats are expected to be pretty grim, as in addition to the individual strain people in these afflicted areas are suffering, infrastructure tends to collapse in unprepared areas, hospitals not functioning or not functioning well, their machines and IT systems failing due to the heat, and the medical professionals working in these places suffering alongside everyone else, their bodies under constant heat stress, not getting enough sleep, and so on. There have already been a lot of reports of children dying of heat stress after being left in cars for short periods, and people drowning in large numbers, trying to cool off un-moderated bodies of water.
The conversation that tends to bubble up in the wake of such incidents is representative of the larger conversation around climate change and its impacts.
Air conditioning, and lower-powered, but just as effective heating and cooling options like heat pumps, which are basically ACs that work in both directions, but which tend to consume less energy than conventional AC units, these devices are amazing short-term solutions and help people survive and thrive in even the hottest, most humid and unwelcoming environments and climates.
They also require, especially in the case of conventional ACs, a whole lot of power. And across much of the world right now, that means burning fossil fuels.
The sad irony is that in powering these devices that are more necessary because of climate change impacts, people and institutions are contributing more to that large-scale problem, worsening the impacts of climate change, which then necessitates more artificial, power-hungry cooling.
Experts continue to remind lawmakers and others in the position to make big-picture decisions on these sorts of matters that there are a lot of opportunities to reduce ground-level temperatures in passive, non-energy-hungry ways.
Painting large surfaces brighter colors so more heat is reflected rather than absorbed, planting more trees and other greenery, installing solar panels, using passive building materials and architectural techniques to improve insulation and air flow; there’s a lot of low-hanging fruit for areas that are becoming warmer, and which would otherwise require a lot more energy and fossil fuel burning just to keep life tolerable and survivable.
Unfortunately, many of these options aren’t widespread or even well-known, and the short-term solutions, like conventional AC units, are quick and effective, and a lot easier, currently at least, to install than superior options, like heat pumps.
There’s a good chance, then, than the most impacted areas will become even bigger contributors to the problems they’re trying to solve; until larger-scale incentives, subsidies, and policies change that status quo, at least.
Show Notes
https://www.nytimes.com/2026/06/24/climate/europe-fastest-warming-continent.html
https://www.theguardian.com/world/live/2026/jun/24/europe-heatwave-live-news-updates-uk-record-breaking-temperatures-italy-red-alert
https://arstechnica.com/science/2026/06/the-sad-inevitability-of-europes-heat-wave/
https://www.nytimes.com/2026/06/27/climate/europe-heat-wave-nuclear-trains-infrastructure.html
https://www.nytimes.com/2026/06/26/weather/europe-heat-wave-temperatures.html
https://www.nytimes.com/2026/06/26/world/europe/europe-heat-climate-change-politics.html
https://www.nytimes.com/2026/06/26/world/europe/france-heat-alcohol-paris-ban.html
https://www.nytimes.com/2026/06/26/climate/europe-heat-wave-climate-change.html
https://www.nytimes.com/2026/06/25/world/europe/france-children-heat-cars-deaths.html
https://www.nytimes.com/2026/06/25/world/europe/heat-wave.html
https://www.nytimes.com/2026/06/25/arts/europe-museums-heat.html
https://www.nytimes.com/2026/06/25/weather/belgium-heat-wave-brussels.html
https://www.nytimes.com/2026/06/25/world/europe/paris-canal-swimming-heatwave-france.html
https://www.nytimes.com/2026/06/24/climate/europe-fastest-warming-continent.html
https://en.wikipedia.org/wiki/2026_European_heatwaves
https://en.wikipedia.org/wiki/2026_United_Kingdom_heatwaves
https://www.washingtonpost.com/weather/2026/06/25/french-tv-presenter-once-imagined-2050-heat-wave-did-france-reach-those-levels-this-week/
https://www.cnn.com/2026/06/26/climate/european-heat-wave-impossible-global-warming
https://www.cbsnews.com/news/europe-air-conditioning-deadly-heat-waves-more-common/
https://www.theatlantic.com/health/2026/06/europe-air-conditioning/687711/
https://en.wikipedia.org/wiki/Air_conditioning
https://www.theguardian.com/society/2026/jun/25/hospitals-nhs-england-critical-incidents-machines-it-fail-extreme-heat


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This week we talk about plug-in power, renewables, and Germany.
We also discuss inverters, solar arrays, and microgrids.
Recommended Book: Consider This by Chuck Palahnuik
Transcript
Most climate scientists and knowledgable folks in adjacent fields will tell you that, as a species, we’re way behind where we need to be if we’re going to avoid a whole lot of negative consequences caused by global climate change.
We’ve blazed past a bunch of tipping points already, and while the worst-case scenarios we were worried about a decade ago are no longer likely because of the energy-generation and related changes we’ve made globally, since then, the damage caused up to this point is already doing some pretty bad things to our water cycle and other temperature-regulating systems, and that’s looking like it will get even worse over the next several decades—even if worse no longer means cataclysmic in the sense of ending all life on the planet.
That said, even noting that progress has been a lot slower than most experts would prefer, progress is happening in regards to the deployment of renewable energy sources, and in the replacement and retirement of dirty, carbon- and methane-spewing sources, like coal, petroleum, and gas.
As of 2026, the global share of total electricity generation, so all electricity produced by all sources for all purposes, is about 33.8% for renewables, marking the first time renewables have been used to produce more than a third of the total electricity produced, globally; that also means renewables have surpassed coal for electricity generation for the first time.
While hydro and wind continue to contribute to the growth of renewables deployment and electricity generation, solar power is by far the biggest growth area for renewables right now, and solar, alone, covers 75% of total electricity demand growth in 2025—which means as countries around the world deploy more electricity generation assets to account for electricity demand growth, three-quarters of that demand is being met by solar. And this is notable because typically that kind of demand, the majority of which arises in huge, rapidly scaling countries like China and India, has up till recently been met by the dirtiest of energy production sources, coal.
There’s also been a 0.2% reduction in fossil fuel generation, year-on-year, which is a very small number, but that level of production is massive, and there are a lot of subsidies and other mechanisms that keep fossil fuels flourishing around the world, so every little sliver of fossil fuel energy production reduction is still a pretty significant thing.
Many of these renewables-related wins, in recent years, have been attributable to the large-scale installation of solar facilities, backed by massive, utility-scale battery backups, primarily in China.
China is by far the largest producer of solar panels and related technologies—Chinese companies produce somewhere between 80-90% of all the key components and perform the same portion of all key manufacturing stages for the global supply chain, while also controlling the vast majority of resources necessary to manufacture solar panels. And it has been on a tear over the past decade or so, installing just a silly amount of solar infrastructure. Which is good, because China is also seeing a lot of growth in energy demand, so if they weren’t deploying that much solar, they would likely be deploying that much coal infrastructure, instead.
That said, while huge solar arrays are important to renewables growth, there’s also been a recent boom in smaller-scale solar energy deployment in recent years, especially but not exclusively across Europe. And that’s what I’d like to talk about today: the emergence of so-called ‘balcony solar,’ and what it might mean for the further expansion of solar’s footprint around the world.
—
In 2025, Utah, which is a deeply Conservative, Republican state, became the first US state to pass a bill that makes it easier to legally install plug-in solar panel systems.
As of mid-2026, about 30 states have followed suit, and even more are considering it, laws allowing for the installation of such solar technologies winding their way through legislative bodies on the back of the popularity and seeming no-downsides nature of this tech product category.
Plug-in solar, also sometimes called balcony solar or garden solar, is currently most popular in Germany, which is the biggest market for this product right now, with about four million such systems installed as of 2025.
To understand the popularity of this type of solar installation, it’s useful to understand that conventional solar installations have typically required a decent amount of electrical surgery to install. They’ve usually involved a large number of panels operating as an array, and that array has produced quite a lot of electricity that then has to be funneled as a direct current either back into the local grid using what amounts to two-way wiring, which makes these arrays function like any other power plant, or that electricity is converted using an inverter into an alternating current, where AC is the electrical standard, anyway, so that it can directly power a large building like a hospital or school, or be stored in a large battery facility.
All of these options require a huge up front investment, and a reworking of local energy infrastructure so that solar can be incorporated. And that investment requirement, and the necessity to hire specialist electricians to get it all done, severely limits the range of this tech, because there are only so many entities that can afford it, only so many spaces that can deploy that number of panels, the number required to make that investment make sense, economically, is generally quite large, and there are only so many specialists of that kind in a given country, so the labor aspect of this is a big deal, too, these sorts of projects often severely backlogged.
Plug-in solar, in contrast, is usually sold as a kit with one or two small- to medium-sized panels and a microinverter or plug-in inverter, depending on whether the end-user’s existing electrical setup uses an AC or DC current.
A home owner or even a renter with a balcony or garden, or the right amount of space outside one of their windows, can buy one of these systems, hang or place the solar panel or panels in a location where they will get a decent amount of sun, and then plug them in, via the inverter, directly to their home’s outlet.
The electricity generated by the panels is then shared through the building’s existing wiring to all of their outlets, and this allows the resident to use that available energy, first, only drawing energy from the local grid when there isn’t enough from the solar panels available. And all of this happens automatically—the solar energy is used if available, and if not, energy is drawn from the grid like normal.
This creates a layer of essentially free, clean energy for the resident with a usually fairly small up-front cost: these plug-in solar kits can cost as little as $500, with larger systems that generate more electricity costing between $1200 and $3000; so even on the high-end, because there’s no additional installation cost, the home owner or renter setting it all up themselves, this is an investment that can easily pay for itself, usually within 2-5 years.
There are caveats here, including that not all grid systems are complaint with this use-case, so would-be plug-in solar users have to check to make sure their local setup can handle this sort of application, and there are many places where this product type still isn’t legal, in some cases because of concerns about people installing it without checking to make sure their wiring and the local grid can handle it, and in some cases because of old laws that favor local energy grid companies and their business models, or which favor fossil fuel energy production.
The explosion in use of this type of small solar setup, though, speaks volumes about how good a deal it is for many people, and even those who don’t live in particularly sunny areas—so places where traditional solar arrays wouldn’t make sense, economically—are finding them useful, because they still pay for themselves within some number of years, due to energy bill savings. It’s also possible to install home-scale battery systems alongside these balcony solar systems, which means even small trickles of solar energy production can add up, and can be used at night, when the sun isn’t shining at all.
There are quite a few possible ramifications of this trend.
At the local, household level, these sorts of systems can dampen the impact of energy price increases, due to global issues, like the gumming up of the Strait of Hormuz, and due to local issues, like the trend of energy companies increasing prices because of new data centers being added to their grid. That, in turn, can reduce the impact of certain aspects of inflation on individuals home owners and renters.
Larger-scale, though, these systems also serve as a sort of deconstructed secondary energy grid.
In Germany, for instance, as of late 2025, around 1.14 gigawatts of energy was being produced by balcony solar systems across the country. That’s 1.14 GW of pressure taken off of local energy grids, and that represents more resilience for these grids, too, as reduced pressure means fewer brown-outs and similar negative fluctuations. It also means people who have such systems won’t be as negatively impacted by issues that take down grids; and that means normal, brown-out like issues, but also problems related to potential cyberattacks and hacks and even physical conflicts. That kind of resiliency is what every nation hopes to have, because it makes strikes on them less damaging, and this is one way to achieve that kind of resiliency—a deconstructed network of microgrids, underpinning the macro-scale one—all at a relatively low cost.
These sorts of systems are also becoming more widely available, IKEA selling several kits in many countries where they’ve been made legal, and other retailers, like Lidl and Amazon are also getting in on the action, making these kits more widely available as the trend spreads.
China still controls the vast, vast majority of solar energy asset production, so there’s a chance, especially in the case of a theoretical future conflict, that they could turn off the tap on this and these types of assets would go away for a time, which would be bad if local grids come to rely on them taking some of the pressure off the local macro-grid.
Those theoretical economic warfare concerns aside, though, if legalization continues to spread, plug-in solar could be one of the best and most successful methods for deploying clean energy to areas where it hasn’t been a particularly compelling sell, and where local infrastructure or politics has made such deployment unlikely or impossible up till this point.
Show Notes
https://www.nytimes.com/2026/06/14/opinion/solar-panels-balcony-backyard-plugin.html
https://arstechnica.com/science/2026/04/globally-86-percent-of-the-new-generating-capacity-was-renewable-in-2025/
https://arstechnica.com/science/2026/05/soaring-solar-and-a-surge-in-hydro-push-more-coal-off-the-us-grid/
https://arstechnica.com/science/2026/04/global-growth-in-solar-the-largest-ever-observed-for-any-source/
https://www.iea.org/reports/sdg7-data-and-projections/modern-renewables
https://ember-energy.org/latest-insights/global-electricity-review-2026/
https://ember-energy.org/latest-insights/china-solar-cell-exports-grow-73-in-2025/
https://rhg.com/research/minerals-metals-and-megawatts-how-chinas-power-generation-drives-its-industrial-metals-ecosystem/
https://www.canarymedia.com/articles/solar/what-to-know-balcony-solar
https://www.canarymedia.com/articles/solar/balcony-solar-taking-state-legislatures-by-storm
https://www.canarymedia.com/articles/solar/balcony-panels-germany-utah
https://www.energysage.com/news/plug-in-balcony-solar-panels/
https://en.wikipedia.org/wiki/Balcony_solar_power
https://www.pv-tech.org/maine-passes-balcony-solar-law-virginia-and-colorado-to-follow/
https://www.sierraclub.org/sierra/plug-solar-power-could-be-coming-balcony-near-you
https://en.wikipedia.org/wiki/Solar_panel
https://www.ingka.com/newsroom/solar-energy-for-the-many-ikea-belgium-to-offer-balcony-solar-kits/


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This week we talk about LDL, HDL, and cardiovascular issues.
We also discuss one-time therapies, statins, and pharmaceutical economics.
Recommended Book: Blood by Dr. Jen Gunter
Transcript
Cholesterol is the most common type of what’s called a sterol, which is a type of steroid, but also structurally technically an alcohol. But functionally, and classified by scientists, cholesterol is a lipid, which in this case is similar to a fat in all but how the body uses it. Cholesterol is the type of sterol most commonly found in animals—other types are found in plants and fungi—and its function, and this is where it varies from fats, which are used to store energy, is to basically help hold the cell membrane together, and it also serves as an intracellular messenger.
Cholesterol is especially prevalent in the brain and spinal cord of animals, but it’s found throughout their bodily tissues, as well, and again, it’s vital for holding everything together and helping things communicate, in addition to being a precursor for vitamin D, steroid hormones, and bile.
You want to have cholesterol, then, as without it you would be dead.
Too much cholesterol in the blood, however, can also make you dead, especially when it’s bound to what’s called low-density lipoprotein, or LDL, as that contributes to cardiovascular disease like heart attacks and aneurysms, which can massively impact one’s overall wellness and quality of life, and at extremes lead to the whole system shutting down as a consequence of heart attack, stroke, and the like.
A lot of things can contribute to the development of cardiovascular disease, including habits like smoking, genetic predisposition, and the enthusiastic consumption of alcohol and unhealthy foods. But high blood cholesterol, of the LDL variety, is one of the top contributors, as these low-density clusters of lipoprotein can clog the pathways that blood takes throughout our bodies. Other, denser types of lipoproteins, HDLs, can clear it, like a heavier, denser substance pushing through clogs of less-dense materials that are gumming up a pipe, but LDL is at times accumulated as a result of consuming delicious but unhealthy foods, which are hard to avoid, and for some people the only consistently available and affordable foods; and for other people LDL accumulates as a result of their genetic predispositions—two things that are devilishly difficult to change.
What I’d like to talk about today is a new type of therapy that may be very good news for people who struggle with the accumulation of LDL, and why this is being seen as very good news more broadly, at the scale of entire nations, as well.
—
Pharmaceutical company Eli Lilly is testing a new, experimental drug called VERVE-102 which is a one-time infusion that is currently administered over the course of about four hours, and once completed, it turns off a gene called PCSK9, which is responsible for making a protein that regulates cholesterol levels in humans.
As I said, this drug is still being tested, so these are early results. But in a study of 35 people with high cholesterol levels, high levels of LDL or LDL-C, which is short for lipoprotein cholesterol, they found that this infusion, which again, is a one-time treatment, so get it once and then theoretically at least you never have to get anything done ever again, it reduced those LDL and LDL-C levels by as much as 62%, and that reduction was maintained a year and a half after the infusion; that’s how far out they’re retested so far, and the hope is that each retest will continue to show the same.
On the strength of those very promising results, a Phase 2 study has been planned by the end of 2026, and the US Food and Drug Administration, the FDA, previously fast-tracked this existing study, because of the promise and potential this drug already demonstrated in early studies; all of which is considered to be very significant progress and possibility.
To understand that significance, though, it’s useful to know some health stats. And I’m going to focus on the US here, as that’s where this drug is being developed, but many wealthy countries have similar stats, at least in terms of cardiovascular disease struggles.
As of 2024, which is the last year we had good, cohesive data on this in the US, it was estimated that about 11-12% of the US adult population has high cholesterol levels. This typically doesn’t come with any symptoms, but it can contribute a higher risk for all those cardiovascular diseases, including heart attack and stroke. A further 86 million US adults have borderline or elevated cholesterol levels, which can easily tip higher, but also, even in that existing, elevated state, contribute to negative cardiovascular outcomes.
There are treatments for high cholesterol, the most common of category of which are called statins, which reduce the production of LDL by inhibiting an enzyme that produces cholesterol in the body.
Unfortunately, these drugs do come with some usually minor side effects, which can cause patients to stop using them, and they have to be taken daily, ideally at the same time each day. That necessity for consistency leads to a lot of incorrect or incomplete usage, which reduces the effectiveness of these drugs. But it’s also estimated that only about 54.5% of US adults who would benefit from statins are currently taking one—so that’s people who could benefit and who have it prescribed, and then within that number are all the people who are taking this drug incorrectly or incompletely, reducing the effectiveness. So a relatively small number of people who should probably be on these things are getting the full benefit they offer because of the nature of the drug.
And that’s not great, because in the US alone, heart disease is the leading cause of death for pretty much every adult demographic; men, women, people of most racial and ethnic and economic groups, you name it, heart disease is the biggest threat to their lives.
One US citizen dies every 34 seconds of some kind of cardiovascular condition, and as of 2023, 1 in every 3 deaths in the US was caused by the same, adding up to just over 919,000 people that year.
Between 2021 and 2022, alone, the cost of services and medications related to heart disease added up to more than $168 billion; again, that’s just in that period, and just in the US.
And once more, these are ailments that are caused or heavily influenced by high levels of cholesterol, which are themselves amplified by common lifestyle choices, environmental factors that are hard for many people to avoid, and just by raw, dumb luck because of genetics.
This treatment category, then, is being seen as a pretty big deal because a one-time infusion means those who receive it don’t have to remember to take a pill every day at the same time, and won’t experience those statin-based side-effects.
It also means that people who are currently costing the medical system a bunch of money each year, because they need treatments for all the issues they suffer as a result of high cholesterol, will suddenly cost the system a lot less money, for treatments and medications. Not for nothing, their health and quality of life will likely improve as well. So in addition to having better, healthier outcomes personally, their cost to healthcare systems will drop.
Eli Lilly’s drug isn’t the only one currently working its way through clinical trials, either.
Amgen is working on a similar treatment, and Novartis and Ionis Pharmaceuticals have drugs that are even further along in the process, their medicines that cut heart attacks, strokes, and cardiovascular deaths could be approved by the FDA as soon as next year.
There are a lot of caveats worth noting here, including that the science is still out as to whether this approach, silencing proteins that lead to the creation of more LDL and a similar substance called Lp(a)—which is more dangerous because it’s stickier and thus more likely to get stuck in important blood pathways, and it’s also more likely to be caused by genetics than lifestyle—the word is still out on whether reducing these things in the body actually reduces hearth attacks and stroke.
Some people have had this particular risk variable dramatically reduced, but have still suffered from cardiovascular events, which raises the question of whether this path is the right one to take in trying to reduce this category of health issues; the correlation between LDL and heart attacks and strokes might not be a clear-cut as long assumed.
There’s also the issue of price. Drug-makers are economically incentivized to sell treatments over cures, because that means they can continue selling their product over time, potentially for the life of the patient, and a cure, in contrast, is a one-time hit that in theory should alleviate the need for future treatment.
There’s a chance, then, that the drug-makers will decide they need to make these one-hit treatments really, really expensive in order to make their R&D dollars back and to make the kinds of profits their investors expect from them. That could then reduce the potential audience for these treatments, even if they are effective, and could further slow their deployment and future research in this space.
If these trials continue to go well, though, there’s a good chance that this combination of similar but distinct treatment types will provide a more sustainable alternative to current options, and that, like the recent bogglingly rapid and widespread deployment of GLP-1 treatments for all sorts of issues, could lead to a new paradigm in this facet of the medical world.
Show Notes
https://en.wikipedia.org/wiki/Cholesterol
https://en.wikipedia.org/wiki/Cardiovascular_disease
https://en.wikipedia.org/wiki/High_cholesterol
https://pmc.ncbi.nlm.nih.gov/articles/PMC10982736/
https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html
https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1
https://www.ama-assn.org/public-health/chronic-diseases/what-doctors-want-patients-know-about-high-cholesterol
https://en.wikipedia.org/wiki/Statin
https://pubmed.ncbi.nlm.nih.gov/42187087/
https://abcnews.com/GMA/Wellness/new-drug-game-changer-people-high-cholesterol/story


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