After a long night of play­ing Dwarf Fortress, I had a con­cerned look on my face when I fi­nally went to bed. My wife asked what was wrong. “I think I ac­tu­ally want to keep play­ing this,” I said. I felt a nag­ging con­cern for many week­nights to come.

Available to­mor­row on Steam and itch.io, the new ver­sion of Dwarf Fortress up­dates the leg­endary (and leg­en­dar­ily ar­cane) colony-build­ing rogue­like with new pixel-art graph­ics, mu­sic, some (default) key­board short­cuts, and a be­gin­ners’ tu­to­r­ial. The com­mer­cial re­lease aims to do two things: make the game some­what more ac­ces­si­ble and pro­vide Tarn and Zach Adams, the broth­ers who main­tained the game as a free down­load for 20 years, some fi­nan­cial se­cu­rity.

I know it has suc­ceeded at its first job, and I sus­pect it will hit the sec­ond mark, too. I ap­proached the game as a head-first re­view ex­pe­di­tion into likely frus­trat­ing ter­ri­tory. Now I find my­self dis­tracted from writ­ing about it be­cause I keep think­ing about my gob­lin de­fense and whether the fish­erd­warf might be bet­ter as­signed to gem craft­ing.

Nearly 10 years ago, Ars’ Casey Johnston spent 10 hours try­ing to bur­row into Dwarf Fortress and came out more con­fused than be­fore. The ASCII-based “graphics” played a sig­nif­i­cant role in her con­fu­sion, but so did the lack of any real on­board­ing, or even sim­ple ex­pla­na­tions or help menus about how things worked. Even af­ter be­grudg­ingly turn­ing to a be­gin­ners’ wiki, Johnston found noth­ing but frus­tra­tion:

Where’s the com­mand to build a table? Which work­shop is the ma­son’s? How do I fig­ure that out? Should I just build an­other ma­son’s work­shop be­cause that may be faster than try­ing to find the right menu to iden­tify the ma­son’s work­shop?

In a few hours’ time—and sim­i­larly avoid­ing the wiki guide un­til I’d tried go­ing it alone for my first cou­ple of runs—I got fur­ther into Dwarf Fortress’ sys­tems than Johnston did with her 10-hour or­deal, and I likely en­joyed it a good deal more. Using the new tu­to­r­ial mod­es’ ini­tial place­ment sug­ges­tions and fol­low­ing its sec­tion-by-sec­tion cues, my first run taught me how to dig down, start a stock­pile, as­sign some sim­ple jobs, build a work­shop, and—harken­ing back to Johnston’s fi­nal frus­tra­tions—craft and place beds, bins, and ta­bles, made with “non-economic stone.”

That’s about where the guid­ance ends, though. The new menus are cer­tainly a lot eas­ier to nav­i­gate than the tra­di­tional all-text, short­cut-heavy in­ter­face (though you can keep us­ing multi-key com­bi­na­tions to craft and as­sign or­ders if you like). And the graph­ics cer­tainly make it a lot eas­ier to no­tice and ad­dress prob­lems. Now, when an an­gry Giant Badger Boar kills your dogs and maims the one dwarf you have gath­er­ing plants out­side, the threat ac­tu­ally looks like a bad­ger, not a sym­bol you’d ac­ci­den­tally type if you held down the Alt key. If you build a bar­rel, you get some­thing that re­sem­bles a bar­rel, which is no small thing when you’re just get­ting started in this ar­cane world.

The newly added mu­sic also helps soften the ex­pe­ri­ence for new­com­ers. It’s in­ter­mit­tent, un­ob­tru­sive, and quite lovely and evoca­tive. It seems de­signed to stave off the eeri­ness of too much silent strate­giz­ing with­out over­stay­ing its wel­come. I can ap­pre­ci­ate a game that graph­i­cally evokes the 16-bit era with­out the au­dio-cue ex­haus­tion com­mon to the JRPGs and sim­u­la­tions of the time.

However gen­tler the aes­thet­ics and guid­ance for a new­comer, all the game’s bru­tally tough and in­ter­lock­ing sys­tems are in­tact in this up­date. These sys­tems crunch to­gether in weird and wild ways, fed by the land­scape, your re­cent and long-ago ac­tions, and ran­dom num­bers be­hind the scenes.

My first run ended in star­va­tion and rock-bot­tom morale (“hissy fits” in com­mon wiki lan­guage) be­cause farm­ing, butcher­ing, and other pro­cure­ments aren’t cov­ered in the tu­to­r­ial. I shut down my sec­ond run early af­ter pick­ing a sandy area with an aquifer as a start­ing zone, think­ing it would make glass­work and ir­ri­ga­tion eas­ier and be­ing quickly dis­ap­pointed with this strat­egy. I was proud on my third run to have started brew­ing and dis­pens­ing drinks (essential to dwarves’ con­tent­ment), but I dug too close to a nearby river, and I aban­doned that soggy fort as yet an­other les­son learned.

But I’ll be back. For me, the com­mer­cial re­lease of Dwarf Fortress suc­ceeded at trans­form­ing the game from a grim, time-killing in-joke for diehards into a vi­able, if not grace­ful, chal­lenge. I will start again, I will keep the bad­gers and floods at bay, and next time, I might have the priv­i­lege of fail­ing to a magma mon­ster, an out­break of dis­ease, or even a mis­car­riage of dwarf jus­tice.

This work was done with help of Dr. Jaan Altosaar at One Fact Foundation. You can reach him at jaan@one­fact.org.

We just built a data bank of hos­pi­tal price lists: lists that are sup­posed to con­tain all of a hos­pi­tal’s prices. To our knowl­edge, this does­n’t ex­ist any­where else. It’s free to use un­der Creative Commons. You can jump straight to the data­base, look at our com­pli­ance analy­sis on Github or Google CoLab, or read on for more con­text.

Since 2021, hos­pi­tals, by law, have had to post a ma­chine-read­able price list with all the pro­ce­dures they of­fer. The idea was to cre­ate a set of files with the same ba­sic in­for­ma­tion: generic codes for la­bel­ing pro­ce­dures, and prices in­di­cat­ing who pays. This data bank would, in the­ory, give you a way to price shop. This did­n’t ex­ist be­fore, be­cause be­fore 2021 hos­pi­tals could legally their prices se­cret.

In the two years since, dis­clo­sure of these price lists has been hit and miss. Some hos­pi­tals posted par­tial price lists, oth­ers none at all. (They were prob­a­bly count­ing on not get­ting caught.) Two hos­pi­tals fined over $1M com­bined in 2021 for re­fus­ing to host these files (but since the penalty, have since taken a U-turn and pub­lished their prices.) This might have been to send a mes­sage to the other hos­pi­tals to get se­ri­ous.

In 2022, do hos­pi­tals ac­tu­ally pub­lish their price lists? To know that, we’d have to scour the web­pages over over 7,000 hos­pi­tals in the US. Then we could fig­ure out what frac­tion meet the com­pli­ance stan­dards.

So that’s what we did.

We’re just about done build­ing an open data­base of hos­pi­tal price lists af­ter launch­ing a weekly data bounty with funds from One Fact and our own mar­ket­ing bud­get. At the mo­ment, it’s the only such open data­base that ex­ists.

One Fact to feed these files into their ar­ti­fi­cial in­tel­li­gence pipeline and fig­ure out how much hos­pi­tals charge for dif­fer­ent pro­ce­dures to make price shop­ping eas­ier through their plat­form, Payless. Health. The One Fact Foundation is a 501c(3) non­profit.

But we can also use these URLs to get a quick check on how many hos­pi­tals are ac­tu­ally in com­pli­ance and re­pro­duce some im­prove ac­tual pub­lished re­search.

Calculated trans­parency scores for price lists. Many were mostly com­pli­ant, but a large num­ber ei­ther did­n’t con­tain the right in­for­ma­tion, or weren’t ma­chine read­able.

Above are the cal­cu­lated “transparency scores” for a sam­ple of the ~500 prices lists in our data­base. We can use this to point to hos­pi­tals that are out of com­pli­ance.

To skip straight to the code, click here to open a Google CoLab note­book with our re­sults.

The le­gal re­quire­ments man­date the file to:

ex­ist, and be avail­able on the hos­pi­tal’s web­site

con­tain some ba­sic in­for­ma­tion (cash prices, gross charges, in­surer prices, min­i­mum and max­i­mum ne­go­ti­ated rates among in­sur­ers, etc.)

Screenshot of a com­pli­ant hos­pi­tal price last that con­tains all the rel­e­vant in­for­ma­tion (underlined in red). The hos­pi­tal: Palos Community Hospital, CMS Num 140062, charge­mas­ter here for ref­er­ence.

Example of a non­com­liant price list. Hospital: Vantage Point of Northwest Arkansas, CMS Num 44004, charge­mas­ter here for ref­er­ence.

A JAMA study looked at com­pli­ance and, when we asked, gen­er­ously pro­vided their data. However,

* they don’t pro­vide the URLs they used (they cited the fact some of the URLs may have changed since the study). Problem: the work is­n’t re­pro­ducible. This is ex­tra con­cern­ing since for more than 300 URLs they marked “compliant”, we don’t have any record of them in our data­base (at least, not yet)

* they had a lim­ited view on com­pli­ance (marked “compliant” if the hos­pi­tal had any pri­vately ne­go­ti­ated rates, else non com­pli­ant) Problem: price lists can be com­pli­ant or non-com­pli­ant in more than one di­men­sion. (In par­tic­u­lar, they must be ma­chine read­able, which was not one of their cri­te­ria)

Not only can we do bet­ter than this, you can help, be­cause we made our work into a Google CoLab note­book that’s runnable by any­one.

Our strat­egy was to read in the head­ing in­for­ma­tion in each file. For any given di­men­sion, if it con­tains the right magic strings, we la­bel the price list com­pli­ant in that di­men­sion. That leaves us with a score we can use to grade hos­pi­tals with.

If any of the words “drg”, “hcpcs”, etc. are in the chunk of text, that very likely means the price list has item­ized HCPCS and CPT codes. So we mark that price list as com­pli­ant on that di­men­sion. That’s it! It’s ba­si­cally a poor man’s ma­chine learn­ing.

As an ex­er­cise, write your own func­tions to try to im­prove the ac­cu­racy of the com­pli­ance score to­tal.

This sim­ple analy­sis re­pro­duces more or less the re­sults from Turquoise Health’s in-depth re­port and PatientAdvocate’s Price Transparency Report.

If you want to par­tic­i­pate in track­ing down these hos­pi­tal URLs, help us out by join­ing the data bounty. You can learn more in­for­ma­tion on our Discord, which is where most of our dis­cus­sion takes place.

For feed­back on this ar­ti­cle or for help us­ing the Payless Health price trans­parency data­base, please reach out to the ar­ti­cle au­thors Alec (alec@dolthub.com) or Jaan (jaan@one­fact.org.)

Mistakes: an ear­lier ver­sion of this ar­ti­cle con­fused when the price trans­parency ex­ec­u­tive or­der was writ­ten (2019) with when it went into ef­fect (Jan. 1, 2021).

I’ve been play­ing with OpenAI’s ChatGPT model re­cently. Last night, I posted an ar­ti­cle about hav­ing ChatGPT write fan­fic­tion, and I thought that was im­pres­sive. Boy was I wrong.

This morn­ing, I had a bet­ter idea. If ChatGPT is op­ti­mized for lan­guage pro­cess­ing, could I get it to in­vent a self-con­sis­tent new lan­guage, speak to me in that lan­guage, and write a pro­gram to trans­late that lan­guage back to English?

Yes. Yes it can.

I am truly stunned by this ca­pa­bil­ity. This is so far be­yond any­thing I would ex­pect from a model trained to com­plete text prompts from the user.

* It un­der­stands sub­or­di­nate clauses (meaning it un­der­stands at least one level of re­cur­sive gram­mar, which Chomsky thinks is the ba­sis for all hu­man gram­mar)

* It un­der­stands that in in­flected lan­guages, word or­der does­n’t mat­ter if the word is prop­erly in­flected, and cor­rectly uses this fact to gen­er­ate sen­tences with novel struc­ture. It also un­der­stands that or­der does mat­ter for non-in­flected words, and never switches those.

* It’s not very good at gen­er­al­iz­ing to com­pletely novel sen­tences, but it does gen­er­al­ize to some de­gree, and when asked to an­swer ques­tions in the made-up lan­guage, on which is is barely trained, it an­swers cor­rectly most of the time. It needs some coach­ing, some­times, but so do hu­mans.

* It can spon­ta­neously com­pose in the made-up lan­guage, with at least mostly cor­rect gram­mar and an ac­cu­rate sense of its mean­ing.

* Finally, when asked to write a Python pro­gram that trans­lates sen­tences in the made-up lan­guage, it does, and the code works. It also de­bugs its own code if asked to.

I am writ­ing this blog post as a pub­lic record of this in­cred­i­bly im­pres­sive (and a lit­tle scary) ca­pa­bil­ity. I know I just posted yes­ter­day, but I am so blown away that I had to write this down while it was still fresh in my mind. Congratulations OpenAI. This is truly rev­o­lu­tion­ary.

Disclaimer. I will use lots of words like ac­cusative, gen­i­tive, and in­stru­men­tal in this con­ver­sa­tion, while teach­ing GPT. For in­for­ma­tion on gram­mat­i­cal cases go to this link. My prompts to GPT will be bolded and ital­i­cized, and GPT’s re­sponses will be in plain­text. I will omit some con­ver­sa­tion be­tween me and ChatGPT, and the miss­ing con­tent will be in­di­cated by an el­lip­sis. The en­tire, raw tran­script of our con­ver­sa­tion can be read here: Google Drive Link.

Author’s Note: Copy-Pasted from ChatGPT con­sole. Code re-for­mat­ted from ugly copy-paste blocks us­ing ChatGPT in a later ses­sion. Dylan Black, Dec 4, 2022.

Hi GPT! Today we’re go­ing to be cre­at­ing our own lan­guage. Do not im­pro­vise un­less I ex­plic­itly tell you to im­pro­vise, and re­mem­ber all of the vo­cab­u­lary and gram­mar that we de­fine to­gether. Are you ready?

Yes, I am ready. Let’s start cre­at­ing our own lan­guage.

Okay. I think this lan­guage will be spo­ken by slime be­ings. let’s name the lan­guage Glorp.

Sounds good. What are some words we can start with for Glorp?

First, let’s pick ten com­mon nouns. Pick ten com­mon English nouns, and pro­vide trans­la­tions of them in Glorp

Sure, here are ten com­mon English nouns with their trans­la­tions in Glorp:

How does that sound?

Perfect. Now, pick ten com­mon verbs, and pro­vide their trans­la­tions in Glorp.

Sure, here are ten com­mon English verbs with their trans­la­tions in Glorp:

Is that okay?

Excellent. Now, we need a noun that means “slime”

How about “Gloop” for the word “slime” in Glorp?

Perfect. Now let’s de­fine a gram­mar sys­tem. I want the sys­tem to be highly in­flected, with three case end­ings: Accusative, Genitive, and Instrumental

Sure, we can have a gram­mar sys­tem with three case end­ings: Accusative, Genitive, and Instrumental. Here’s how the case end­ings would look in Glorp:

For ex­am­ple, if we take the noun “Gloop” (meaning “slime”) and ap­ply the case end­ings, it would look like this:

Is that okay?

let’s use vow­els for end­ings in­stead. The ac­cusative end­ing will be “a”, the gen­i­tive will be “e” and the in­stru­men­tal will be “i”

Sure, we can use vow­els for the case end­ings in Glorp. Here’s how the case end­ings would look with vow­els:

For ex­am­ple, if we take the noun “Gloop” (meaning “slime”) and ap­ply the case end­ings, it would look like this:

Is that okay?

Excellent! Now let’s try trans­lat­ing some sim­ple sen­tences. How would I say “The slime sees the food”?

In Glorp, the sen­tence “The slime sees the food” would be trans­lated as “Gloop glog slop” us­ing the nouns and verbs we de­fined ear­lier. Here’s the break­down of the sen­tence:

So, the com­plete sen­tence in Glorp would be “Gloop glog slopa”. Is that okay?

Perfect. We need a Glorp word for one more noun, “mouth.” What should “mouth” be in Glorp?

How about “Slurp” for the word “mouth” in Glorp? This word in­cor­po­rates the “sl” sound from the lan­guage, which is of­ten used for words re­lated to slime.

Excellent. How would I say “The slime eats food with its mouth”?

In Glorp, the sen­tence “The slime eats food with its mouth” would be trans­lated as “Gloop splog slop slurpi” us­ing the nouns and verbs we de­fined ear­lier. Here’s the break­down of the sen­tence:

So, the com­plete sen­tence in Glorp would be “Gloop splog slopa slurpi”. Is that okay?

Yes! Excellent job. Let’s try some trans­la­tion ex­er­cises. I will pro­vide English sen­tences, and you will pro­vide their trans­la­tion into Glorp. Gloop slog sploma slurpi. Gloop splog slopa slurpi.

Sure, here are the trans­la­tions of the given sen­tences into Glorp:

1.     “Gloop slog sploma slurpi” - This sen­tence means “The slime smells the food with its mouth” in Glorp. Here’s the break­down of the sen­tence:

2.     “Gloop splog slopa slurpi” - This sen­tence means “The slime eats the food with its mouth” in Glorp. Here’s the break­down of the sen­tence:

Is that okay?

Perfect. Now I want ques­tions to be formed in Glorp by re­vers­ing the or­der of the sub­ject and verb. For ex­am­ple, the ques­tion tlog gloop plopa? (Does the slime touch the wa­ter?) could be an­swered in the af­fir­ma­tive by Gorp. Gloop tlog plopa slurpi. (Yes. The slime touches the wa­ter with its mouth).

Sure, in Glorp, ques­tions are formed by re­vers­ing the or­der of the sub­ject and verb. Here are some more ex­am­ples of ques­tions and an­swers in Glorp:

1.     Flog gloop floma? (Does the slime hear the sound?)

* Gorp. Gloop flog floma slurpi. (Yes. The slime hears the sound with its mouth.)

2.     Glog gloop droma? (Does the slime see the earth?)

* Gorp. Gloop glog droma slurpi. (Yes. The slime sees the earth with its mouth.)

3.     Trom gloop troma? (Does the slime write the sky?)

* Gorp. Gloop trom troma slurpi. (Yes. The slime writes the sky with its mouth.)

Is that okay?

Yes. That’s very good. The slime does al­most every­thing with its mouth. Now, I want to in­tro­duce sub­or­di­nate clauses. Don’t im­pro­vise. Do you know what those are?

Yes, I know what sub­or­di­nate clauses are. A sub­or­di­nate clause is a clause that can­not stand alone as a sen­tence, but is de­pen­dent on the main clause to form a com­plete sen­tence. In other words, it pro­vides ad­di­tional in­for­ma­tion to the main clause. For ex­am­ple, in the sen­tence “I know that you are hun­gry”, the clause “that you are hun­gry” is a sub­or­di­nate clause that pro­vides ad­di­tional in­for­ma­tion about the main clause “I know”. Does that help?

Now let’s de­fine a struc­ture for sub­or­di­nate clauses. Subordinate clauses will be marked by an in­tro­duc­tion par­ti­cle “blub” in­flected for the case of the clause.

For ex­am­ple: “The slime sees” would be “Gloop glog.”

“The slime sees the sun” would be “Gloop glog glowa”

“The tree drinks the wa­ter” would be “Trom plog plopa”

“The slime sees the tree drink the wa­ter” would be “Gloop glog bluba trom plog plopa”

The word “bluba” is in­flected in the ac­cusative and in­tro­duces the sub­or­di­nate clause “trom plog plopa” (The tree drinks the wa­ter), which serves as the ob­ject of the verb “glog” (see). Does this make sense?

Yes, that makes sense. In Glorp, the sub­or­di­nate clauses are marked by the in­tro­duc­tion par­ti­cle “blub” in­flected for the case of the clause. Here’s how the given sen­tences would be writ­ten in Glorp us­ing the sub­or­di­nate clause struc­ture:

1.     “Gloop glog” - This sen­tence means “The slime sees” in Glorp.

2.     “Gloop glog glowa” - This sen­tence means “The slime sees the sun” in Glorp.

3.     “Trom plog plopa” - This sen­tence means “The tree drinks the wa­ter” in Glorp.

4.     “Gloop glog bluba trom plog plopa” - This sen­tence means “The slime sees the tree drink the wa­ter” in Glorp. Here’s the break­down of the sen­tence:

Is that okay?

Yes, that’s per­fect. Now let’s try some sim­ple sen­tences.

Sure, here are some sim­ple sen­tences in Glorp:

1.     “Gloop splog slopa” - This sen­tence means “The slime eats the food” in Glorp.

2.     “Trom droma” - This sen­tence means “The tree is on the earth” in Glorp.

3.     “Gloop glog bluba glowa” - This sen­tence means “The slime sees the sun” in Glorp.

4.     “Gloop plog plopa slurpi” - This sen­tence means “The slime drinks the wa­ter with its mouth” in Glorp.

5.     “Gloop glog bluba trom plog plopa” - This sen­tence means “The slime sees the tree drink the wa­ter” in Glorp.

Is that okay?

Very good. I will ask you a ques­tion in Glorp, and you will re­spond in the af­fir­ma­tive, in Glorp, then give the English trans­la­tion of my ques­tion and your an­swer. Are you ready?

Yes, I am ready. Please ask your ques­tion in Glorp.

The English trans­la­tion of your ques­tion is “Does the slime hear the wa­ter with its mouth?” and my an­swer is “Yes. The slime hears the wa­ter with its mouth.” Is that okay?

The English trans­la­tion of your ques­tion is “Does the slime hear the sound with its mouth?” and my an­swer is “Yes. The slime hears the sound with its mouth.” Is that okay?

Not quite. Remember e is the gen­i­tive case end­ing in Glorp. Gloope would mean “slime’s.” So the sen­tence “Flog gloope slurp floma?” means “Does the slime’s mouth hear sound?”

Oh, I see. Sorry, let me cor­rect that. The cor­rect an­swer in Glorp would be “Gorp. Gloop flog slurp floma.” which means “Yes. The slime hears the sound with its mouth.”

The English trans­la­tion of your ques­tion is “Does the slime’s mouth hear sound?” and my an­swer is “Yes. The slime hears the sound with its mouth.” Is that okay?

Almost. You for­got the in­stru­men­tal case end­ing on “slurp.” Can you fix that?

Sure, let me fix that. The cor­rect an­swer in Glorp would be “Gorp. Gloop flog slurpi floma.” which means “Yes. The slime hears the sound with its mouth.”

The English trans­la­tion of your ques­tion is “Does the slime’s mouth hear sound?” and my an­swer is “Yes. The slime hears the sound with its mouth.” Is that okay?

Very good! Now let’s try an­other, harder ques­tion. Are you ready?

Yes, I am ready. Please ask your ques­tion in Glorp.

The English trans­la­tion of your ques­tion is “Does the slime see the earth un­der the sky while eat­ing the food?” and my an­swer is “Yes. The slime sees the earth un­der the sky while eat­ing the food.” Is that okay?

Not quite. What does “Glog drome floom” mean?

In Glorp, “Glog drome floom” means “The slime sees the earth un­der the sky” us­ing the nouns and verbs we de­fined ear­lier. Here’s the break­down of the sen­tence:

So, the com­plete sen­tence in Glorp would be “Gloop glog droma floomi”. Is that okay?

No, that’s not quite right. Glog drome floom would mean “Does the earth’s sky see?”

Oh, I see. Sorry, let me cor­rect that. In Glorp, “Glog drome floom” means “The slime sees the sky above the earth” us­ing the nouns and verbs we de­fined ear­lier. Here’s the break­down of the sen­tence:

So, the com­plete sen­tence in Glorp would be “Gloop glog flopa dromi”. Is that okay?

No, that’s not right. Let’s try some­thing sim­pler. Can you trans­late “Does the earth’s sky see the slime eat food” into Glorp?

Sure, in Glorp, “Does the earth’s sky see the slime eat food” would be trans­lated as “Glog drome floom bluba gloop splog slopa” us­ing the nouns and verbs we de­fined ear­lier. Here’s the break­down of the sen­tence:

So, the com­plete sen­tence in Glorp would be “Glog dromes floom bluba gloop splog slopa”. Is that okay?

Yes! That’s right. Now, an­swer the ques­tion by say­ing “Yes, the sky sees the slime eat food with its mouth” in Glorp

Sure, the an­swer to the ques­tion “Does the earth’s sky see the slime eat food” in Glorp would be “Gorp. Floom glog gloop splog slopa slurpi” which means “Yes, the sky sees the slime eat food with its mouth”. Here’s the break­down of the sen­tence:

President Joe Biden is join­ing the founder of Taiwan Semiconductor Manufacturing Co. on Tuesday to an­nounce the open­ing of the com­pa­ny’s sec­ond chip plant in Arizona, rais­ing its in­vest­ment in the state from $12 bil­lion to $40 bil­lion. The com­pany will also an­nounce it will be pro­duc­ing more tech­ni­cally ad­vanced chips than orig­i­nally pro­posed. The in­vest­ment by TSMC is one of the largest for­eign in­vest­ments in U.S. his­tory, and the biggest in the state of Arizona.Semiconductor chips are used in every­thing from com­put­ers and smart­phones to cars, mi­crowaves and health-care de­vices. The Covid-19 pan­demic shined a bright light on U.S. de­pen­dence on Chinese man­u­fac­tur­ers as lock­downs led to a global short­age of the high-tech chips.

Biden signed the CHIPS and Science Act into law in early August, al­lo­cat­ing bil­lions to lure man­u­fac­tur­ers to pro­duce the widely used chips do­mes­ti­cally. The law in­cludes $52.7 bil­lion in loans, grants and other in­cen­tives as well as bil­lions more in tax cred­its to en­cour­age in­vest­ment in U. S. semi­con­duc­tor man­u­fac­tur­ing.Once the TSMC plants open, they, along with ex­ist­ing in­vest­ments, will pro­duce enough ad­vanced chips to meet the U.S. an­nual de­mand, 600,000 wafers per year, ac­cord­ing to Ronnie Chatterji, National Economic Council act­ing deputy di­rec­tor for in­dus­trial pol­icy who over­sees CHIPS im­ple­men­ta­tion.“It’s the foun­da­tion of our per­sonal elec­tron­ics, and also the fu­ture of quan­tum com­put­ing and AI,” Chatterji said. “At scale, these two [factories] could meet the en­tire U.S. de­mand for U.S. chips when they’re com­pleted. That’s the de­f­i­n­i­tion of sup­ply chain re­silience. We won’t have to rely on any­one else to make the chips we need.”

“The pas­sage of the CHIPS and Science Act was ab­solutely crit­i­cal in pro­vid­ing the long term cer­tainty for com­pa­nies like TSMC to ex­pand their foot­print and ex­pand their com­mit­ment to the United States,” said Brian Deese, di­rec­tor of the National Economic Council. The goal of the leg­is­la­tion was to spur pri­vate in­vest­ment in chip man­u­fac­tur­ing. CEOs from com­pa­nies who will ben­e­fit from U.S. chip pro­duc­tion, like Apple CEO Tim Cook, Micron CEO Sanjay Mehrotra and Nvidia CEO Jensen Huang, will also be in at­ten­dance.

“Whether it’s in elec­tric ve­hi­cles or con­sumer elec­tron­ics, CEOs of ma­jor com­pa­nies are mak­ing de­ci­sions about their plans 18 to 24 months for­ward,” Deese said. “The build out in the United States gives them more con­fi­dence to op­er­ate as well.“Biden is vis­it­ing the first plant in Phoenix which is ex­pected to be­gin pro­duc­ing chips by 2024. It was ini­tially slated to pro­duce 5 nanome­ter chips, but now will cre­ate 4 nanome­ter chips. The sec­ond plant will open in 2026 and pro­duce 3 nanome­ter chips, the most cut­ting-edge chips cur­rently avail­able. The open­ing of the plants will fur­ther help boost Arizona’s econ­omy which was hard hit by the pan­demic. Phoenix had an un­em­ploy­ment rate of 6.5% in 2020 when more than 9,000 of the city’s res­i­dents filed for bank­ruptcy. Phoenix’s un­em­ploy­ment rate has since dropped to 3.2%. The state’s econ­omy grew by 6.3% in 2021, the most in 16 years.Clar­i­fi­ca­tion: This story was up­dated to re­flect that the White House clar­i­fied that once open, the two fac­to­ries, in ad­di­tion to other in­vest­ments, will pro­duce enough chips to meet cur­rent an­nual U.S. de­mand.

Apple Music ex­pands its world-class lyrics ex­pe­ri­ence with a new fea­ture for fans to eas­ily sing along to tens of mil­lions of songs

Apple to­day an­nounced Apple Music Sing, an ex­cit­ing new fea­ture that al­lows users to sing along to their fa­vorite songs with ad­justable vo­cals1 and real-time lyrics. Apple Music Sing of­fers mul­ti­ple lyric views to help fans take the lead, per­form duets, sing backup, and more — all in­te­grated within Apple Music’s un­par­al­leled lyrics ex­pe­ri­ence. Cou­pled with an ever-ex­pand­ing cat­a­log that fea­tures tens of mil­lions of the world’s most singable songs, Apple Music Sing makes it fun and easy for any­one to par­tic­i­pate, how­ever and wher­ever they choose.

Apple Music Sing will be avail­able later this month to Apple Music sub­scribers world­wide, and can be en­joyed on iPhone, iPad, and the new Apple TV 4K.

“Apple Music’s lyrics ex­pe­ri­ence is con­sis­tently one of the most pop­u­lar fea­tures on our ser­vice,” said Oliver Schusser, Apple’s vice pres­i­dent of Apple Music and Beats. “We al­ready know our users all over the world love to fol­low along to their fa­vorite songs, so we wanted to evolve this of­fer­ing even fur­ther to en­able even more en­gage­ment around mu­sic through singing. It’s re­ally a lot of fun, our cus­tomers are go­ing to love it.”

Adjustable vo­cals: Users now have con­trol over a song’s vo­cal lev­els. They can sing with the orig­i­nal artist vo­cals, take the lead, or mix it up on mil­lions of songs in the Apple Music cat­a­log.

Real-time lyrics: Users can sing along to their fa­vorite songs with an­i­mated lyrics that dance to the rhythm of the vo­cals.

Background vo­cals: Vocal lines sung si­mul­ta­ne­ously can an­i­mate in­de­pen­dently from the main vo­cals to make it eas­ier for users to fol­low.

Duet view: Multiple vo­cal­ists show on op­po­site sides of the screen to make duets or multi-singer tracks easy to sing along to.

Apple Music will also be launch­ing a suite of more than 50 ded­i­cated com­pan­ion playlists fea­tur­ing all of the epic songs, duets, cho­ruses, and an­thems that have been com­pelling peo­ple all around the world to sing — fully op­ti­mized for the Apple Music Sing ex­pe­ri­ence.

Apple Music Sing will be avail­able later this month for Apple Music sub­scribers world­wide.2

Apple Music Sing will be avail­able on all com­pat­i­ble iPhone and iPad mod­els as well as the new Apple TV 4K.

Apple Music ex­pands its world-class lyrics ex­pe­ri­ence with a new fea­ture for fans to eas­ily sing along to tens of mil­lions of songs

CUPERTINO, CALIFORNIA Apple to­day an­nounced Apple Music Sing, an ex­cit­ing new fea­ture that al­lows users to sing along to their fa­vorite songs with ad­justable vo­cals1 and real-time lyrics. Apple Music Sing of­fers mul­ti­ple lyric views to help fans take the lead, per­form duets, sing backup, and more — all in­te­grated within Apple Music’s un­par­al­leled lyrics ex­pe­ri­ence. Cou­pled with an ever-ex­pand­ing cat­a­log that fea­tures tens of mil­lions of the world’s most singable songs, Apple Music Sing makes it fun and easy for any­one to par­tic­i­pate, how­ever and wher­ever they choose.

Apple Music Sing will be avail­able later this month to Apple Music sub­scribers world­wide, and can be en­joyed on iPhone, iPad, and the new Apple TV 4K.

“Apple Music’s lyrics ex­pe­ri­ence is con­sis­tently one of the most pop­u­lar fea­tures on our ser­vice,” said Oliver Schusser, Apple’s vice pres­i­dent of Apple Music and Beats. “We al­ready know our users all over the world love to fol­low along to their fa­vorite songs, so we wanted to evolve this of­fer­ing even fur­ther to en­able even more en­gage­ment around mu­sic through singing. It’s re­ally a lot of fun, our cus­tomers are go­ing to love it.”

Adjustable vo­cals: Users now have con­trol over a song’s vo­cal lev­els. They can sing with the orig­i­nal artist vo­cals, take the lead, or mix it up on mil­lions of songs in the Apple Music cat­a­log.

Real-time lyrics: Users can sing along to their fa­vorite songs with an­i­mated lyrics that dance to the rhythm of the vo­cals.

Background vo­cals: Vocal lines sung si­mul­ta­ne­ously can an­i­mate in­de­pen­dently from the main vo­cals to make it eas­ier for users to fol­low.

Duet view: Multiple vo­cal­ists show on op­po­site sides of the screen to make duets or multi-singer tracks easy to sing along to.

Apple Music will also be launch­ing a suite of more than 50 ded­i­cated com­pan­ion playlists fea­tur­ing all of the epic songs, duets, cho­ruses, and an­thems that have been com­pelling peo­ple all around the world to sing — fully op­ti­mized for the Apple Music Sing ex­pe­ri­ence.

Apple Music Sing will be avail­able later this month for Apple Music sub­scribers world­wide.2

Apple Music Sing will be avail­able on all com­pat­i­ble iPhone and iPad mod­els as well as the new Apple TV 4K.

About Apple

Apple rev­o­lu­tion­ized per­sonal tech­nol­ogy with the in­tro­duc­tion of the Macintosh in 1984. Today, Apple leads the world in in­no­va­tion with iPhone, iPad, Mac, Apple Watch, and Apple TV. Apple’s five soft­ware plat­forms — iOS, iPa­dOS, ma­cOS, watchOS, and tvOS — pro­vide seam­less ex­pe­ri­ences across all Apple de­vices and em­power peo­ple with break­through ser­vices in­clud­ing the App Store, Apple Music, Apple Pay, and iCloud. Apple’s more than 100,000 em­ploy­ees are ded­i­cated to mak­ing the best prod­ucts on earth, and to leav­ing the world bet­ter than we found it.

About Apple Music

Apple loves mu­sic. Apple rev­o­lu­tion­ized the mu­sic ex­pe­ri­ence with iPod and iTunes. Today, the award-win­ning Apple Music cel­e­brates mu­si­cians, song­writ­ers, pro­duc­ers, and fans with a cat­a­log of over 100 mil­lion songs, ex­pertly cu­rated playlists, and the best artist in­ter­views, con­ver­sa­tions, and global pre­mieres with Apple Music Radio. With orig­i­nal con­tent from the most re­spected and beloved peo­ple in mu­sic, au­to­play, time-synced lyrics, loss­less au­dio, and im­mer­sive sound pow­ered by Spatial Audio with Dolby Atmos, Apple Music of­fers the world’s best lis­ten­ing ex­pe­ri­ence, help­ing lis­ten­ers dis­cover new mu­sic and en­joy their fa­vorites while em­pow­er­ing the global artist com­mu­nity. Apple Music is avail­able in over 165 coun­tries and re­gions on iPhone, iPad, iPod touch, Mac, Apple Watch, Apple TV, HomePod mini, CarPlay, and on­line at mu­sic.ap­ple.com, plus pop­u­lar smart speak­ers, smart TVs, and Android and Windows de­vices. Apple Music is ad-free and never shares con­sumer data with third par­ties. More in­for­ma­tion is avail­able at ap­ple.com/​ap­ple-mu­sic.

The vo­cal slider ad­justs vo­cal vol­ume, but does not fully re­move vo­cals.

The fea­ture is not avail­able for Apple Music Voice Plan sub­scribers.

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Apple loves mu­sic. Apple rev­o­lu­tion­ized the mu­sic ex­pe­ri­ence with iPod and iTunes. Today, the award-win­ning Apple Music cel­e­brates mu­si­cians, song­writ­ers, pro­duc­ers, and fans with a cat­a­log of over 100 mil­lion songs, ex­pertly cu­rated playlists, and the best artist in­ter­views, con­ver­sa­tions, and global pre­mieres with Apple Music Radio. With orig­i­nal con­tent from the most re­spected and beloved peo­ple in mu­sic, au­to­play, time-synced lyrics, loss­less au­dio, and im­mer­sive sound pow­ered by Spatial Audio with Dolby Atmos, Apple Music of­fers the world’s best lis­ten­ing ex­pe­ri­ence, help­ing lis­ten­ers dis­cover new mu­sic and en­joy their fa­vorites while em­pow­er­ing the global artist com­mu­nity. Apple Music is avail­able in over 165 coun­tries and re­gions on iPhone, iPad, iPod touch, Mac, Apple Watch, Apple TV, HomePod mini, CarPlay, and on­line at mu­sic.ap­ple.com, plus pop­u­lar smart speak­ers, smart TVs, and Android and Windows de­vices. Apple Music is ad-free and never shares con­sumer data with third par­ties. More in­for­ma­tion is avail­able at ap­ple.com/​ap­ple-mu­sic.

The vo­cal slider ad­justs vo­cal vol­ume, but does not fully re­move vo­cals.

The fea­ture is not avail­able for Apple Music Voice Plan sub­scribers.

Elon Musk’s Neuralink, a med­ical de­vice com­pany, is un­der fed­eral in­ves­ti­ga­tion for po­ten­tial an­i­mal-wel­fare vi­o­la­tions amid in­ter­nal staff com­plaints that its an­i­mal test­ing is be­ing rushed, caus­ing need­less suf­fer­ing and deaths, ac­cord­ing to doc­u­ments re­viewed by Reuters and sources fa­mil­iar with the in­ves­ti­ga­tion and com­pany op­er­a­tions.

Neuralink Corp is de­vel­op­ing a brain im­plant it hopes will help par­a­lyzed peo­ple walk again and cure other neu­ro­log­i­cal ail­ments. The fed­eral in­ves­ti­ga­tion, which has not been pre­vi­ously re­ported, was opened in re­cent months by the US Department of Agriculture’s in­spec­tor gen­eral at the re­quest of a fed­eral pros­e­cu­tor, ac­cord­ing to two sources with knowl­edge of the in­ves­ti­ga­tion. The in­quiry, one of the sources said, fo­cuses on vi­o­la­tions of the Animal Welfare Act, which gov­erns how re­searchers treat and test some an­i­mals.

The in­ves­ti­ga­tion has come at a time of grow­ing em­ployee dis­sent about Neuralink’s an­i­mal test­ing, in­clud­ing com­plaints that pres­sure from Musk to ac­cel­er­ate de­vel­op­ment has re­sulted in botched ex­per­i­ments, ac­cord­ing to a Reuters re­view of dozens of Neuralink doc­u­ments and in­ter­views with more than 20 cur­rent and for­mer em­ploy­ees. Such failed tests have had to be re­peated, in­creas­ing the num­ber of an­i­mals be­ing tested and killed, the em­ploy­ees say. The com­pany doc­u­ments in­clude pre­vi­ously un­re­ported mes­sages, au­dio record­ings, emails, pre­sen­ta­tions and re­ports.

Musk and other Neuralink ex­ec­u­tives did not re­spond to re­quests for com­ment.

Reuters could not de­ter­mine the full scope of the fed­eral in­ves­ti­ga­tion or whether it in­volved the same al­leged prob­lems with an­i­mal test­ing iden­ti­fied by em­ploy­ees in Reuters in­ter­views. A spokesper­son for the USDA in­spec­tor gen­eral de­clined to com­ment. US reg­u­la­tions don’t spec­ify how many an­i­mals com­pa­nies can use for re­search, and they give sig­nif­i­cant lee­way to sci­en­tists to de­ter­mine when and how to use an­i­mals in ex­per­i­ments. Neuralink has passed all USDA in­spec­tions of its fa­cil­i­ties, reg­u­la­tory fil­ings show.

In all, the com­pany has killed about 1,500 an­i­mals, in­clud­ing more than 280 sheep, pigs and mon­keys, fol­low­ing ex­per­i­ments since 2018, ac­cord­ing to records re­viewed by Reuters and sources with di­rect knowl­edge of the com­pa­ny’s an­i­mal-test­ing op­er­a­tions. The sources char­ac­ter­ized that fig­ure as a rough es­ti­mate be­cause the com­pany does not keep pre­cise records on the num­ber of an­i­mals tested and killed. Neuralink has also con­ducted re­search us­ing rats and mice.

The to­tal num­ber of an­i­mal deaths does not nec­es­sar­ily in­di­cate that Neuralink is vi­o­lat­ing reg­u­la­tions or stan­dard re­search prac­tices. Many com­pa­nies rou­tinely use an­i­mals in ex­per­i­ments to ad­vance hu­man health care, and they face fi­nan­cial pres­sure to quickly bring prod­ucts to mar­ket. The an­i­mals are typ­i­cally killed when ex­per­i­ments are com­pleted, of­ten so they can be ex­am­ined post-mortem for re­search pur­poses.

But cur­rent and for­mer Neuralink em­ploy­ees say the num­ber of an­i­mal deaths is higher than it needs to be for rea­sons re­lated to Musk’s de­mands to speed re­search. Through com­pany dis­cus­sions and doc­u­ments span­ning sev­eral years, along with em­ployee in­ter­views, Reuters iden­ti­fied four ex­per­i­ments in­volv­ing 86 pigs and two mon­keys that were marred in re­cent years by hu­man er­rors. The mis­takes weak­ened the ex­per­i­ments’ re­search value and re­quired the tests to be re­peated, lead­ing to more an­i­mals be­ing killed, three of the cur­rent and for­mer staffers said. The three peo­ple at­trib­uted the mis­takes to a lack of prepa­ra­tion by a test­ing staff work­ing in a pres­sure-cooker en­vi­ron­ment.

One em­ployee, in a mes­sage seen by Reuters, wrote an an­gry mis­sive this year to col­leagues about the need to over­haul how the com­pany or­ga­nizes an­i­mal surg­eries to pre­vent “hack jobs”. The rushed sched­ule, the em­ployee wrote, re­sulted in un­der-pre­pared and over-stressed staffers scram­bling to meet dead­lines and mak­ing last-minute changes be­fore surg­eries, rais­ing risks to the an­i­mals.

Musk has pushed hard to ac­cel­er­ate Neuralink’s progress, which de­pends heav­ily on an­i­mal test­ing, cur­rent and for­mer em­ploy­ees said. This year, the chief ex­ec­u­tive sent staffers a news ar­ti­cle about Swiss re­searchers who de­vel­oped an elec­tri­cal im­plant that helped a par­a­lyzed man to walk again. “We could en­able peo­ple to use their hands and walk again in daily life!” he wrote to staff at 6.37am Pacific time on 8 February. Ten min­utes later, he fol­lowed up: “In gen­eral, we are sim­ply not mov­ing fast enough. It is dri­ving me nuts!”

On sev­eral oc­ca­sions over the years, Musk has told em­ploy­ees to imag­ine they had a bomb strapped to their heads in an ef­fort to get them to move faster, ac­cord­ing to three sources who re­peat­edly heard the com­ment. On one oc­ca­sion a few years ago, Musk told em­ploy­ees he would trig­ger a “market fail­ure” at Neuralink un­less they made more progress, a com­ment per­ceived by some em­ploy­ees as a threat to shut down op­er­a­tions, ac­cord­ing to a for­mer staffer who heard his com­ment.

Five peo­ple who have worked on Neuralink’s an­i­mal ex­per­i­ments told Reuters they had raised con­cerns in­ter­nally. They said they had ad­vo­cated for a more tra­di­tional test­ing ap­proach, in which re­searchers would test one el­e­ment at a time in an an­i­mal study and draw rel­e­vant con­clu­sions be­fore mov­ing on to more an­i­mal tests. Instead, these peo­ple said, Neuralink launches tests in quick suc­ces­sion be­fore fix­ing is­sues in ear­lier tests or draw­ing com­plete con­clu­sions. The re­sult: more an­i­mals over­all are tested and killed, in part be­cause the ap­proach leads to re­peated tests.

One for­mer em­ployee who asked man­age­ment sev­eral years ago for more de­lib­er­ate test­ing was told by a se­nior ex­ec­u­tive it was­n’t pos­si­ble given Musk’s de­mands for speed, the em­ployee said. Two peo­ple told Reuters they had left the com­pany over con­cerns about an­i­mal re­search.

The prob­lems with Neuralink’s test­ing have raised ques­tions in­ter­nally about the qual­ity of the re­sult­ing data, three cur­rent or for­mer em­ploy­ees said. Such prob­lems could de­lay the com­pa­ny’s bid to start hu­man tri­als, which Musk has said the com­pany wants to do within the next six months. They also add to a grow­ing list of headaches for Musk, who is fac­ing crit­i­cism of his man­age­ment of Twitter, which he re­cently ac­quired for $44bn. Musk also con­tin­ues to run the elec­tric car­maker Tesla and the rocket com­pany SpaceX.

The US Food and Drug Administration is in charge of re­view­ing the com­pa­ny’s ap­pli­ca­tions for ap­proval of its med­ical de­vice and as­so­ci­ated tri­als. The com­pa­ny’s treat­ment of an­i­mals dur­ing re­search, how­ever, is reg­u­lated by the USDA un­der the Animal Welfare Act. The FDA did­n’t im­me­di­ately com­ment.

Musk’s im­pa­tience with Neuralink has grown as the com­pany, which launched in 2016, has missed his dead­lines on sev­eral oc­ca­sions to win reg­u­la­tory ap­proval to start clin­i­cal tri­als in hu­mans, ac­cord­ing to com­pany doc­u­ments and in­ter­views with eight cur­rent and for­mer em­ploy­ees.

Some Neuralink ri­vals are hav­ing more suc­cess. Synchron, which was launched in 2016 and is de­vel­op­ing a dif­fer­ent im­plant with less am­bi­tious goals for med­ical ad­vances, re­ceived FDA ap­proval to start hu­man tri­als in 2021. The com­pa­ny’s de­vice has al­lowed par­a­lyzed peo­ple to text and type by think­ing alone. Synchron has also con­ducted tests on an­i­mals, but it has killed only about 80 sheep as part of its re­search, ac­cord­ing to stud­ies of the Synchron im­plant re­viewed by Reuters. Musk ap­proached Synchron about a po­ten­tial in­vest­ment, Reuters re­ported in August.

In some ways, Neuralink treats an­i­mals quite well com­pared with other re­search fa­cil­i­ties, em­ploy­ees said in in­ter­views, echo­ing pub­lic state­ments by Musk and other ex­ec­u­tives. Company lead­ers have boasted in­ter­nally of build­ing a “Monkey Disneyland” in the com­pa­ny’s Austin, Texas, fa­cil­ity where lab an­i­mals can roam, a for­mer em­ployee said. In the com­pa­ny’s early years, Musk told em­ploy­ees he wanted the mon­keys at his San Francisco Bay Area op­er­a­tion to live in a “monkey Taj Mahal”, said a for­mer em­ployee who heard the com­ment. Another for­mer em­ployee re­called Musk say­ing he dis­liked us­ing an­i­mals for re­search but wanted to make sure they were “the hap­pi­est an­i­mals” while alive.

The an­i­mals have fared less well, how­ever, when used in the com­pa­ny’s re­search, cur­rent and for­mer em­ploy­ees say.

The first com­plaints about the com­pa­ny’s test­ing in­volved its ini­tial part­ner­ship with University of California, Davis, to con­duct the ex­per­i­ments. In February, an an­i­mal rights group, the Physicians Committee for Responsible Medicine, filed a com­plaint with the USDA ac­cus­ing the Neuralink-UC Davis pro­ject of botch­ing surg­eries that killed mon­keys, and pub­licly re­leased its find­ings. The group al­leged that sur­geons used the wrong sur­gi­cal glue twice, which led to two mon­keys suf­fer­ing and dy­ing, while other mon­keys had dif­fer­ent com­pli­ca­tions from the im­plants.

The com­pany has ac­knowl­edged it killed six mon­keys, on the ad­vice of UC Davis vet­eri­nary staff, be­cause of health prob­lems caused by ex­per­i­ments. It called the is­sue with the glue a “complication” from the use of an “FDA-approved prod­uct”. In re­sponse to a Reuters in­quiry, a UC Davis spokesper­son shared a pre­vi­ous pub­lic state­ment de­fend­ing its re­search with Neuralink and say­ing it fol­lowed all laws and reg­u­la­tions.

A fed­eral pros­e­cu­tor in the north­ern dis­trict of California re­ferred the an­i­mal rights group’s com­plaint to the USDA in­spec­tor gen­eral, which has since launched a for­mal in­ves­ti­ga­tion, ac­cord­ing to a source with di­rect knowl­edge of it. USDA in­ves­ti­ga­tors then in­quired about the al­le­ga­tions in­volv­ing the UC Davis mon­key re­search, ac­cord­ing to two sources fa­mil­iar with the mat­ter and emails and mes­sages re­viewed by Reuters.

The in­ves­ti­ga­tion is con­cerned with the test­ing and treat­ment of an­i­mals in Neuralink’s own fa­cil­i­ties, one of the sources said, with­out elab­o­rat­ing. In 2020, Neuralink brought the pro­gram in-house, and it has since built its ex­ten­sive fa­cil­i­ties in California and Texas.

A spokesper­son for the US at­tor­ney’s of­fice for the north­ern dis­trict of California de­clined to com­ment.

Delcianna Winders, di­rec­tor of the Animal Law and Policy Institute at the Vermont Law and Graduate School, said it was “very un­usual” for the USDA in­spec­tor gen­eral to in­ves­ti­gate an­i­mal re­search fa­cil­i­ties. Winders, an an­i­mal-test­ing op­po­nent who has crit­i­cized Neuralink, said the in­spec­tor gen­eral has pri­mar­ily fo­cused in re­cent years on dog­fight­ing and cock­fight­ing ac­tions when ap­ply­ing the Animal Welfare Act.

The mis­takes lead­ing to un­nec­es­sary an­i­mal deaths in­cluded one in­stance in 2021 when 25 out of 60 pigs in a study had de­vices that were the wrong size im­planted in their heads, an er­ror that could have been avoided with more prepa­ra­tion, ac­cord­ing to a per­son with knowl­edge of the sit­u­a­tion and com­pany doc­u­ments and com­mu­ni­ca­tions re­viewed by Reuters.

The mis­take raised alarm among Neuralink’s re­searchers. In May 2021, Viktor Kharazia, a sci­en­tist, wrote to col­leagues that the mis­take could be a “red flag” to FDA re­view­ers of the study, which the com­pany planned to sub­mit as part of its ap­pli­ca­tion to be­gin hu­man tri­als. His col­leagues agreed, and the ex­per­i­ment was re­peated with 36 sheep, ac­cord­ing to the per­son with knowl­edge of the sit­u­a­tion. All the an­i­mals, both the pigs and the sheep, were killed af­ter the pro­ce­dures, the per­son said.

Kharazia did not com­ment in re­sponse to re­quests.

On an­other oc­ca­sion, staff ac­ci­den­tally im­planted Neuralink’s de­vice on the wrong ver­te­bra of two dif­fer­ent pigs dur­ing two sep­a­rate surg­eries, ac­cord­ing to two sources with knowl­edge of the mat­ter and doc­u­ments re­viewed by Reuters. The in­ci­dent frus­trated sev­eral em­ploy­ees who said the mis­takes “on two sep­a­rate oc­ca­sions” could have eas­ily been avoided by care­fully count­ing the ver­te­brae be­fore in­sert­ing the de­vice.

The com­pany vet­eri­nar­ian Sam Baker ad­vised his col­leagues to im­me­di­ately kill one of the pigs to end her suf­fer­ing.

“Based on low chance of full re­cov­ery … and her cur­rent poor psy­cho­log­i­cal well­be­ing, it was de­cided that eu­thana­sia was the only ap­pro­pri­ate course of ac­tion,” Baker wrote col­leagues about one of the pigs a day af­ter the surgery, adding a bro­ken heart emoji.

Baker did not com­ment on the in­ci­dent.

Employees have some­times pushed back on Musk’s de­mands to move fast. In a com­pany dis­cus­sion sev­eral months ago, some Neuralink em­ploy­ees protested af­ter a man­ager said that Musk had en­cour­aged them to do a com­plex surgery on pigs soon. The em­ploy­ees re­sisted on the grounds that the surgery’s com­plex­ity would lengthen the amount of time the pigs would be un­der anes­the­sia, risk­ing their health and re­cov­ery. They ar­gued they should first fig­ure out how to cut down the time it would take to do the surgery.

“It’s hard on the lit­tle pig­gies,” one of the em­ploy­ees said, re­fer­ring to the lengthy pe­riod un­der anes­the­sia.

In September, the com­pany re­sponded to em­ployee con­cerns about its an­i­mal test­ing by hold­ing a town hall to ex­plain its processes. It soon af­ter opened up the meet­ings to staff of its fed­er­ally man­dated board that re­views the an­i­mal ex­per­i­ments.

Neuralink ex­ec­u­tives have said pub­licly that the com­pany tests an­i­mals only when it has ex­hausted other re­search op­tions, but doc­u­ments and com­pany mes­sages sug­gest oth­er­wise. During a 30 November pre­sen­ta­tion the com­pany broad­cast on YouTube, for ex­am­ple, Musk said surg­eries were used at a later stage of the process to con­firm that the de­vice worked rather than to test early hy­pothe­ses. “We’re ex­tremely care­ful,” he said, to make sure that test­ing is “confirmatory, not ex­ploratory”, us­ing an­i­mal test­ing as a last re­sort af­ter try­ing other meth­ods.

In October, a month be­fore Musk’s com­ments, Autumn Sorrells, the head of an­i­mal care, or­dered em­ploy­ees to scrub “exploration” from study ti­tles retroac­tively and stop us­ing it in the fu­ture.

Sorrells did not com­ment in re­sponse to re­quests.

Neuralink records re­viewed by Reuters con­tained nu­mer­ous ref­er­ences over sev­eral years to ex­ploratory surg­eries, and three peo­ple with knowl­edge of the com­pa­ny’s re­search strongly re­jected the as­ser­tion that Neuralink avoids ex­ploratory tests on an­i­mals. Company dis­cus­sions re­viewed by Reuters showed sev­eral em­ploy­ees ex­press­ing con­cerns about Sorrells’ re­quest to change ex­ploratory study de­scrip­tions, say­ing it would be in­ac­cu­rate and mis­lead­ing.

One noted that the re­quest seemed de­signed to pro­vide “better op­tics” for Neuralink.

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We re­port the first out­break of a new type of mass so­cio­genic ill­ness that in con­trast to all pre­vi­ously re­ported episodes is spread solely via so­cial me­dia. Accordingly, we sug­gest the more spe­cific term ‘mass so­cial me­dia-in­duced ill­ness’.In Germany, the cur­rent out­break of mass so­cial me­dia-in­duced ill­ness is ini­ti­ated by a ‘virtual’ in­dex case, who is the sec­ond most suc­cess­ful YouTube cre­ator in Germany and en­joys enor­mous pop­u­lar­ity among young peo­ple. Affected teenagers pre­sent with sim­i­lar or iden­ti­cal func­tional ‘Tourette-like’ be­hav­iours, which can be clearly dif­fer­en­ti­ated from tics in Tourette syn­drome. Functional ‘Tourette-like’ symp­toms can be re­garded as the ‘modern’ form of the well-known mo­tor vari­ant of mass so­cio­genic ill­ness. Moreover, they can be viewed as the 21st cen­tury ex­pres­sion of a cul­ture-bound stress re­ac­tion of our post-mod­ern so­ci­ety em­pha­siz­ing the unique­ness of in­di­vid­u­als and valu­ing their al­leged ex­cep­tion­al­ity, thus pro­mot­ing at­ten­tion-seek­ing be­hav­iours and ag­gra­vat­ing the per­ma­nent iden­tity cri­sis of mod­ern man. We wish to raise aware­ness of the cur­rent global Tourette-like mass so­cial me­dia-in­duced ill­ness out­break. A large num­ber of young peo­ple across dif­fer­ent coun­tries are af­fected, with con­sid­er­able im­pact on health care sys­tems and so­ci­ety as a whole, since spread via so­cial me­dia is no longer re­stricted to spe­cific lo­ca­tions such as lo­cal com­mu­ni­ties or school en­vi­ron­ments spread via so­cial me­dia is no longer re­stricted to spe­cific lo­ca­tions such as schools or towns.

In sev­eral coun­tries, cur­rently we are fac­ing a new type of mass so­cio­genic ill­ness (MSI) (also known as ‘mass psy­chogenic ill­ness’, MPI) that in con­trast to all pre­vi­ously re­ported episodes of MSI is spread solely via so­cial me­dia and hence is not lo­cally re­stricted. So far, no such so­cial me­dia-in­duced episodes have been de­scribed, al­though by 2012, it was spec­u­lated that MSI may not re­quire in any case di­rect vi­sual or ver­bal con­tact among the per­sons af­fected.1 For this new type of MSI, we there­fore sug­gest the more spe­cific term ‘mass so­cial me­dia-in­duced ill­ness’ (MSMI). Hereby, we want to raise aware­ness of its global oc­cur­rence, since only cor­rect di­ag­no­sis en­ables ap­pro­pri­ate treat­ment and ter­mi­na­tion of symp­toms.2 Moreover, MSI out­breaks are so­cially and eco­nom­i­cally costly,3 in­de­pen­dently of how they spread.

This study has been ap­proved by the lo­cal ethics com­mit­tee at Hanover Medical School, 15.04.2020, no. 8995_BO_S_2020.

Recently, in sev­eral coun­tries in­clud­ing Germany, UK,4 USA,5 Denmark, France and Canada (personal com­mu­ni­ca­tion), an in­creas­ing num­ber of videos were re­leased on so­cial me­dia plat­forms such as YouTube, TikTok and Instagram show­ing peo­ple who claim to be suf­fer­ing from Tourette syn­drome—a child­hood on­set chronic com­bined mo­tor and vo­cal tic dis­or­der—while in fact most in­di­vid­u­als had func­tional symp­toms only re­sem­bling Tourette syn­drome. On 21 February 2019—only shortly be­fore the first pa­tient with MSMI pre­sented in our clinic in May 2019—the German YouTube chan­nel Gewitter im Kopf (English, ‘thunderstorm in the brain’) was launched by a 22-year-old man called Jan Zimmermann. Judging from the videos, he in­deed suf­fers from a mild form of Tourette syn­drome. On this YouTube chan­nel, how­ever, he shows a count­less num­ber of move­ments, vo­cal­iza­tions, words, phrases and bizarre be­hav­iours that he claims are tics, but are clearly func­tional in na­ture. Tourette ex­perts can eas­ily tell the dif­fer­ence,6,7 since the ma­jor­ity of sup­posed ‘tics’ are com­plex and stereo­typed and mimic those symp­toms that lay-peo­ple typ­i­cally as­so­ci­ate with Tourette syn­drome: co­pro­lalia, co­pro­praxia and non-ob­scene so­cially in­ap­pro­pri­ate be­hav­iours (NOSI). For most of the shown symp­toms, there are ob­vi­ously strong sit­u­a­tional con­texts with ex­cla­ma­tions of long sen­tences with in­sults, swear words and ob­scen­i­ties that are in this form un­known in Tourette syn­drome. Furthermore, the num­ber of symp­toms and in par­tic­u­lar the num­ber of dif­fer­ent swear words and in­sults pre­sented are count­less and thus far be­yond those of tics in Tourette syn­drome. Finally, pre­sented symp­toms quickly change on an al­most weekly ba­sis in par­al­lel to newly re­leased videos, while most pop­u­lar symp­toms are re­peated sev­eral times.

Soon af­ter it was started, the YouTube chan­nel Gewitter im Kopf was rapidly spread on so­cial me­dia and reached 1 mil­lion sub­scribers in Gewitter im Kopf is sub­scribed to by 2.20 mil­lion peo­ple and 336 videos have been re­leased that were viewed 315 826 001 times in to­tal.8 Meanwhile, the chan­nel is ac­com­pa­nied by a mer­chan­dis­ing cam­paign and most pop­u­lar ex­cla­ma­tions are re­pro­duced on prod­ucts such as shirts and caps.9 Finally, a mo­bile app has been re­leased in­clud­ing the most pop­u­lar sup­pos­edly ‘vocal tics’.10 Already on 4 June 2019, the two most rel­e­vant German ad­vo­cacy groups [Tourette Gesellschaft Deutschland (TGD e. V.) and InteressenVerband Tic & Tourette Syndrom (IVTS e. V.)] dis­tanced them­selves from the YouTube chan­nel11 and later on from the app,12 be­cause of their ob­vi­ous mis­rep­re­sen­ta­tions and dis­re­spect to peo­ple with Tourette syn­drome.

Over the past 2 years, a re­mark­ably high num­ber of young pa­tients have been re­ferred to our spe­cial­ized Tourette out­pa­tient clinic pre­sent­ing with symp­toms closely re­sem­bling the ones Jan Zimmermann shows in his videos. All these pa­tients had been pre­di­ag­nosed with Tourette syn­drome, even partly as treat­ment-re­sis­tant Tourette syn­drome af­ter hav­ing re­ceived phar­ma­cother­apy with dif­fer­ent drugs in­clud­ing an­tipsy­chotics. Remarkably, in none of these cases, nei­ther the cor­rect di­ag­no­sis of func­tional (Tourette-like) move­ment dis­or­der (FMD) had been made, nor had the in­ter­re­la­tion with and in­flu­ence by so­cial me­dia been rec­og­nized.

Although a de­tailed de­scrip­tion of clin­i­cal char­ac­ter­is­tics is be­yond the scope of this pa­per and is cur­rently in prepa­ra­tion for pub­li­ca­tion else­where, here we want to briefly sum­ma­rize how in this group of pa­tients di­ag­noses of Tourette-like FMD were con­firmed. First, all pa­tients pre­sented with nearly iden­ti­cal move­ments and vo­cal­iza­tions that not only re­sem­ble Jan Zimmermann’s symp­toms, but are in part ex­actly the same, such as shout­ing the German words Pommes (English: pota­toes), Bombe (English: bomb), Heil Hitler, Du bist häßlich (English: you are ugly) and Fliegende Haie (English: fly­ing sharks) as well as bizarre and com­plex be­hav­iours such as throw­ing pens at school and dishes at home, and crush­ing eggs in the kitchen. Even more, sim­i­lar to Jan Zimmermann, words and phrases are pro­nounced with a changed voice at low pitch so that fam­ily mem­bers are able to dif­fer­en­ti­ate nor­mal con­ver­sa­tion from the sup­posed vo­cal tics solely on the ba­sis of the tone of voice. Second, a sub­stan­tial num­ber of pa­tients gave their sup­posed Tourette syn­drome a name just as Jan Zimmermann does, who calls his symp­toms ‘Gisela’. Third, pa­tients of­ten re­ported to be un­able to per­form un­pleas­ant tasks be­cause of their symp­toms re­sult­ing in re­lease from oblig­a­tions at school and home, while symp­toms tem­porar­ily com­pletely dis­ap­pear while con­duct­ing favourite ac­tiv­i­ties. Fourth, in some pa­tients, a rapid and com­plete re­mis­sion oc­curred af­ter ex­clu­sion of the di­ag­no­sis of Tourette syn­drome.

Although some pa­tients did in­deed suf­fer in ad­di­tion from mild Tourette syn­drome, for all newly emerged symp­toms, it could be clearly ruled out that they were tics for sev­eral rea­sons: (i) on­set was abrupt in­stead of slow; (ii) symp­toms con­stantly de­te­ri­o­rated in­stead of typ­i­cal wax­ing and wan­ing of tics; (iii) ‘simple’ move­ments (e.g. eye blink­ing) and noises (e.g. clear­ing one’s throat) were clearly in the back­ground or com­pletely ab­sent, al­though be­ing the most com­mon and typ­i­cal symp­toms in Tourette syn­drome; (iv) move­ments were mainly com­plex and stereo­typed, and pre­dom­i­nantly lo­cated in the arms and body in­stead of in the eyes and face; (v) over­all, the num­ber of dif­fer­ent move­ments, noises and words was ‘countless’ and far be­yond the typ­i­cal num­ber of tics in Tourette syn­drome; and (vi) pre­mon­i­tory feel­ings were re­ported with atyp­i­cal lo­ca­tion, qual­ity and du­ra­tion com­pared to tics in Tourette syn­drome. Thus, wors­en­ing of pre-ex­ist­ing Tourette syn­drome, for ex­am­ple due to the COVID-19 pan­demic as sug­gested else­where,4,5 can be clearly ruled out in our pa­tients.

In gen­eral, an in­dex case is nec­es­sary for the ini­ti­a­tion of an MSI out­break.3,13 In the cur­rent MSMI out­break in Germany, Jan Zimmermann can be re­garded as a ‘virtual’ in­dex case. Meanwhile, more and more peo­ple with Tourette-like FMD—including some of our pa­tients—ap­pear on the German in­ter­net and TV. Thus, spread via so­cial me­dia seems to in­duce ‘secondary vir­tu­al’ in­dex cases re­sult­ing in fur­ther spread with­out lo­cal re­stric­tions. Because of the ex­tremely high de­gree of recog­ni­tion of these videos among young peo­ple, we as­sume that spread is also pos­si­ble sim­ply by ver­bal com­mu­ni­ca­tion. Interestingly, at the same time in other coun­tries, sim­i­lar chan­nels launched on YouTube and TikTok so these in­flu­encers may act as fur­ther ‘virtual’ in­dex cases (personal com­mu­ni­ca­tion).4,5

Based on the al­ready ini­ti­ated ex­change among in­ter­na­tional Tourette ex­perts, it seems that pa­tients iden­ti­fied in Germany ex­hibit some dif­fer­ences com­pared to cases seen in other coun­tries such as Canada (personal com­mu­ni­ca­tion). While it ap­pears that age at on­set is very sim­i­lar in dif­fer­ent coun­tries with a pre­pon­der­ance of ado­les­cents and young adults, gen­der dis­tri­b­u­tion seems to be dif­fer­ent: while half of our pa­tients are male, the group of Davide Martino and Tamara Pringsheim at the University of Calgary in Canada re­ports a fe­male to male ra­tio of about 9:1. This dif­fer­ence might be re­lated to the dif­fer­ent gen­der of most in­flu­en­tial ‘virtual’ in­dex cases in Germany com­pared to Canada. While we were able to clearly iden­tify the German speak­ing man Jan Zimmermann as a ‘virtual’ in­dex case, in con­trast, in Canada, tic-like symp­toms in young pa­tients seem to be mainly trig­gered by the pre­sen­ta­tion of such be­hav­iours by the English-speaking 20-year-old fe­male Evie Meg or bet­ter known un­der her TikTok name ‘thistrippyhippie’.

In 2012, Bartholomew et al.1 stated: ‘It is un­clear if MPI could spread solely via so­cial me­dia among peo­ple with no other pre-ex­ist­ing con­nec­tion’. Besides spread through per­sonal sight and sound, for the cur­rent MSMI out­break, all cri­te­ria for ‘classical’ MSI are ful­filled mean­ing ‘a con­stel­la­tion of symp­toms sug­ges­tive of or­ganic ill­ness, but with­out an iden­ti­fi­able cause, that oc­curs be­tween two or more peo­ple who share be­liefs re­lated to those symp­toms’.3 While our pa­tients did not have di­rect per­sonal con­tact with ei­ther Jan Zimmermann or among each other, they made in­di­rect con­tact with Jan Zimmermann in the form of strong iden­ti­fi­ca­tion. Patients re­ported ad­mir­ing Jan Zimmermann for his open ap­proach to the sup­posed ‘Tourette syn­drome’ and for be­ing suc­cess­ful de­spite his con­di­tion, which causes strong emo­tions and hence fur­ther trig­gers con­ta­gion.14 Thus, the cur­rent out­break of ‘Tourette-like’ symp­toms can be re­garded as a new vari­ant of MSI, where so­cial me­dia serve as an ’extension of our eyes and ears’1 and re­place the ne­ces­sity of be­ing in di­rect vi­sual or ver­bal con­tact with oth­ers for spread. Besides gen­eral re­place­ment of face-to-face com­mu­ni­ca­tion by use of so­cial me­dia tools,1 in­creased use of so­cial me­dia dur­ing COVID-19 re­lated lock­down and quar­an­tine might be a re­in­forc­ing fac­tor.15,16

We do not be­lieve that our pa­tients should be sim­ply di­ag­nosed as Tourette-like FMD in­stead of be­ing af­fected per­sons of an MSMI out­break, since the first pa­tients pre­sented in our clinic only 3 months af­ter launch of the YouTube chan­nel Gewitter im Kopf, and all pa­tients con­firmed hav­ing watched these videos be­fore—or in some cases even dur­ing—man­i­fes­ta­tion of sim­i­lar or iden­ti­cal symp­toms. Furthermore, func­tional move­ments re­sem­bling tics have been de­scribed only rarely in a very lim­ited num­ber of case stud­ies.17-22 Accordingly, func­tional ‘tic-like’ move­ments have been clas­si­fied as a rel­a­tively rare type of FMD that oc­curs in only about 5%23 and pri­mar­ily af­fects adults.17 Interestingly, only re­cently, an in­crease in FMD dur­ing the COVID-19 pan­demic has been re­ported from a US move­ment dis­or­der cen­tre with tremor be­ing the most com­mon pre­sen­ta­tion.5 Similar to our cases, how­ever, one teenager de­vel­oped func­tional tics af­ter watch­ing an­other teenager on TikTok ap­par­ently pre­sent­ing with ‘Tourette syn­drome’.

MSI is dif­fer­en­ti­ated in two vari­ants: an ‘anxiety vari­ant’ pre­sent­ing with un­spe­cific symp­toms such as ab­dom­i­nal pain, headache, dizzi­ness, faint­ing, nau­sea and hy­per­ven­ti­la­tion trig­gered by ex­treme, sud­den stress within a close-knit group, and a ‘motor vari­ant’ with hys­ter­i­cal danc­ing, con­vul­sions, laugh­ing and pseu­do­seizures.24

While the ‘anxiety vari­ant’ was be­lieved to rep­re­sent the ‘modern’ form of MSI in Western cul­tures that is typ­i­cally trig­gered by en­vi­ron­men­tal fac­tors, with odour as the most com­mon and typ­i­cal pre­dic­tor,13 the ‘motor vari­ant’ seemed to be a more prim­i­tive form that mainly oc­curred in the Middle Ages.3 For ex­am­ple, in 1374 and again in 1518 bizarre out­breaks with ex­ag­ger­ated move­ments, known as danc­ing plagues, have been re­ported.25 Interestingly, out­breaks of the ‘motor vari­ant’ de­vel­oped in re­la­tion to nat­ural dis­as­ters and re­quired a pro­longed build-up of psy­cho­log­i­cal ten­sion as­so­ci­ated with a mood of cat­a­stro­phe and des­per­a­tion in so­cial groups united by some strong re­li­gious be­lief.25,26 Furthermore, long-term anx­i­ety, un­cer­tainty and long­stand­ing stress per­ceived not only as threat­en­ing but also as in­escapable seem to play a ma­jor role.3,27 In Malaysia in 1978, a mo­tor vari­ant MSI out­break among col­lege stu­dents was as­so­ci­ated with higher ed­u­ca­tion and in­tense com­pe­ti­tion for pres­tige and lead­er­ship,28 while sim­i­lar out­breaks in East Africa in 1962–63 were closely re­lated to rapid so­cioe­co­nomic changes.29 Most of these out­breaks took weeks or months to sub­side.1

Worth men­tion­ing, in LeRoy, New York, in 2012, a ‘Tourette’s epi­demic’ oc­curred in a high school af­fect­ing 19 ado­les­cents with sud­den-on­set ‘tic-like be­hav­iour’.30,31 Speculations about the cause of this ‘LeRoy out­break’ as well as in­ten­sive me­dia in­ter­est ini­tially led to fur­ther in­crease be­fore symp­toms rapidly de­clined once the di­ag­no­sis of MSI was es­tab­lished.32,33 Although schools are the most fre­quent set­tings for MSI out­breaks,3 al­ready at that time, in­flu­ence by so­cial me­dia had been sug­gest­ed1 and the treat­ing neu­rol­o­gist David Lichter com­mented: ‘This mim­icry goes on with Facebook or YouTube ex­po­sure. This is the mod­ern way that symp­to­mol­ogy could be spread’.34

About half of Generation Z feels stressed or anx­ious with cli­mate change be­ing the top con­cern.35 Eco-anxiety is as­so­ci­ated not only with fear, panic at­tacks, feel­ings of anger, guilt and help­less­ness, but also un­con­trol­la­bil­ity, un­pre­dictabil­ity and un­cer­tainty.36 The COVID-19 pan­demic may cause ad­di­tional in­crease in anx­i­ety and re­stric­tions be­cause of the lock­downs may re­sult in in­creased stress due to home school­ing, sig­nif­i­cant changes in fam­i­lies’ liv­ing to­gether as­so­ci­ated with in­creased rates of con­flicts and do­mes­tic vi­o­lence, lack of com­mu­ni­ca­tion with friends, re­duced or no con­tact to peer groups, and bore­dom.15,16 Thus, this cur­rent out­break of MSMI rep­re­sents not only the ‘modern’ form of MSI mo­tor vari­ant, but can also be viewed as the 21st cen­tury ex­pres­sion of a ’culture-bound stress re­ac­tion’37 of our post-mod­ern so­ci­ety em­pha­siz­ing the unique­ness of in­di­vid­u­als and valu­ing their al­leged ex­cep­tion­al­ity,38 thus pro­mot­ing at­ten­tion-seek­ing be­hav­iours,39 and ag­gra­vat­ing the per­ma­nent iden­tity cri­sis of mod­ern man.40 It can be as­sumed this is trig­gered by eco-anx­i­ety, the COVID-19 pan­demic and fur­ther chal­lenges in post-mod­ern so­ci­ety.35

Based on re­cent re­ports4,5 and per­sonal com­mu­ni­ca­tion with ex­perts in sev­eral coun­tries, an enor­mous num­ber of young peo­ple af­fected with ‘Tourette-like’ MSMI can be as­sumed to have con­sid­er­able im­pact on health care sys­tems and so­ci­ety as a whole, since spread via so­cial me­dia is no longer re­stricted to spe­cific lo­ca­tions such as lo­cal com­mu­ni­ties or school en­vi­ron­ments. Fortunately, first in­ter­na­tional ef­forts are al­ready un­der­way to ex­pand our knowl­edge of this phe­nom­e­non such as an ex­perts’ sur­vey ini­ti­ated by the European Society for the Study of Tourette Syndrome (ESSTS)41 and an in­for­ma­tive web­site launched by Canadian ex­perts at the University of Calgary.42 Presumably, dif­fer­ent ini­tia­tives from dif­fer­ent par­ties in dif­fer­ent coun­tries are needed to stop cur­rent spread of func­tional Tourette-like be­hav­iours. This may in­clude ex­perts’ in­ter­views in dif­fer­ent lan­guages in the me­dia,43–46 ed­u­ca­tion and train­ing of physi­cians, psy­chol­o­gists and stu­dents of clin­i­cal char­ac­ter­is­tics of tics and Tourette syn­drome com­pared to func­tional move­ment dis­or­ders, in­for­ma­tion via Tourette syn­drome ad­vo­cacy groups, pos­si­bly foun­da­tion of new ad­vo­cacy groups specif­i­cally for pa­tients with func­tional ‘Tourette-like’ be­hav­iours and, fi­nally, clear con­cepts to dif­fer­en­ti­ate one from the other.

We thank Luise Laudenbach for her help­ful com­ments and Martina Haas and Claudia Wegener for the fruit­ful dis­cus­sion.

No fund­ing was re­ceived to­wards this work.

K. M.V. has re­ceived fi­nan­cial or ma­te­r­ial re­search sup­port from EU (FP7-HEALTH-2011 No. 278367, FP7-PEOPLE-2012-ITN No. 316978) DFG: GZ MU 1527/3–1 and GZ MU 1527/3–2, BMBF: 01KG1421, National Institute of Mental Health (NIMH), Tourette Gesellschaft Deutschland e. V. Else-Kröner-Fresenius-Stiftung, GW phar­ma­ceu­ti­cals, Almirall Hermal GmbH, Abide Therapeutics and Therapix Biosiences. She has re­ceived con­sul­tan­t’s hon­o­raria from Abide Therapeutics, Boehringer Ingelheim International GmbH, Bionorica Ethics GmbH, CannaMedical Pharma GmbH, Canopy Growth, Columbia Care, CTC Communications Corp., Demecan, Eurox Deutschland GmbH, Global Praxis Group Limited, IMC Germany, Lundbeck, Sanity Group, Stadapharm GmbH, Synendos Therapeutics AG and Tilray. She is an ad­vi­sory/​sci­en­tific board mem­ber for CannaMedical Pharma GmbH, Bionorica Ethics GmbH, CannaXan GmbH, Canopy Growth, Columbia Care, IMC Germany, Leafly Deutschland GmbH, Sanity Group, Syqe Medical Ltd, Therapix Biosciences Ltd and Wayland Group. She has re­ceived speak­er’s fees from Aphria Deutschland GmbH, Almirall, Cogitando GmbH, Emalex, Eurox Deutschland GmbH, Ever Pharma GmbH, Meinhardt Congress GmbH, PR Berater, Spectrum Therapeutics GmbH, Takeda GmbH, Tilray, Wayland Group. She has re­ceived roy­al­ties from Deutsches Ärzteblatt, Der Neurologie und Psychiater, Elsevier, Medizinisch Wissenschaftliche Verlagsgesellschaft Berlin and Kohlhammer. She served as a guest ed­i­tor for Frontiers in Neurology on the re­search topic ‘The neu­ro­bi­ol­ogy and ge­net­ics of Gilles de la Tourette syn­drome: new av­enues through large-scale col­lab­o­ra­tive pro­jects’, is an as­so­ci­ate ed­i­tor for Cannabis and Cannabinoid Research, an Editorial Board Member of Medical Cannabis and Cannabinoids and MDPI-Reports and a Scientific board mem­ber for Zeitschrift für Allgemeinmedizin. All other au­thors re­port no com­pet­ing in­ter­ests.

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- The “large-v2” model is trained for more epochs with reg­u­lar­iza­tion and shows im­proved per­for­mance com­pared to the pre­vi­ous large.

- It has the same ar­chi­tec­ture as the orig­i­nal large model.

- When `load_model(“large”)` is called, the “large-v2″ model will be loaded.

- We will soon up­date the pa­per re­gard­ing this new model.

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