Paper Mills and the Fight Against Scientific Fraud

Scientific publishing is facing a growing challenge from fabricated research produced by industrial-scale paper mills. But researchers and publishers are fighting back through technology and collaboration to protect the integrity of the scientific record.

Scientific publishing is based on the trust that the data are real and that peer review ensures quality. But that trust is being eroded by commercial enterprises known as paper mills—coordinated commercial operations that sell authorship slots in fraudulent or manipulated manuscripts, then submit those manuscripts to journals.

Unlike traditional misconduct, these are not lone researchers cutting corners but businesses producing research at scale, often tailored to meet the demands of specific fields, journals, and career incentives.

A recent analysis of almost 19,000 online adverts for paper mills revealed authorship slots being sold for between $36 to $5,600 depending on the position of the slot, highlighting how commercialized the market is. The average for a first author position was $1,030 and, although the study did not examine which adverts resulted in published papers, another investigation traced approximately 1,000 authorship adverts to more than 400 published papers.

The magnitude of the problem is difficult to estimate. A 2022 report by the Committee on Publication Ethics (COPE) and the International Association of Scientific, Technical & Medical Publishers (STM) found that the percentage of suspect papers submitted to journals was around two percent overall but increased sharply to as high as 46% in journals targeted by paper mills.

The pressure to publish

Adrian Barnett
Adrian Barnett, PhD
Professor
Queensland University of Technology

For honest researchers, it might be difficult to understand why paper mills even exist. At the heart of the issue is what Adrian Barnett, PhD, a professor in the Australian Centre for Health Services and Innovation at Queensland University of Technology, described as the “publish or perish” phenomenon.

“If I could do one simple thing tomorrow, I would ban all the university league tables,” said Barnett. “They’re just encouraging corruption.” Ranking systems that prioritize publication volume can push researchers toward quantity over quality, making paper mills an easy way to meet expectations.

Furthermore, publication is often not just a measure of success but a requirement for career progression. “For the clients, it’s believed that they need publications that they can’t achieve through their own efforts, either because they don’t have the time, the facilities, the training, or the money to do research and yet, for whatever reason, their employers expect them to,” explained Jennifer Byrne, PhD, a professor of molecular oncology and lead of the Publication and Research Integrity in Medical Research group at the University of Sydney.

Jennifer Byrne
Jennifer Byrne, PhD
Professor
University of Sydne

Byrne has published extensively about paper mills and publication integrity; she got into the field accidentally when she came across some papers about a gene that her team discovered many years earlier. “In 2014–2015, we realized that five or six different groups suddenly published very similar papers about this gene in different journals,” she said. “And I just thought, that doesn’t really make a lot of sense.”

Upon investigation, Byrne found that the papers, and a further 48 similar publications, showed features consistent with mass production. She has since proposed that human gene research in general is highly vulnerable to paper mills. “You can hide fake research quite effectively in experimental fields, because it’s very difficult and time-consuming to reproduce experimental studies,” she said.

Why paper mills matter

Aside from the obvious fraud, paper mills are problematic for several reasons. Byrne describes them as “a billion-dollar problem” with few resources devoted to tackling it. And although she and others have advocated for scaled investments, progress so far has been slow.

The publishing system can also reinforce the problem. Paper mills are profit-driven, but journals also benefit through article processing charges and citations, creating what Byrne describes as a “circle” in which “everyone gets what they want.”

The consequences of paper mill papers being published can influence real research. The papers are cited, reused, and built upon, wasting both time and money for all involved.

More broadly, the erosion of trust can drive researchers away from entire fields. In Byrne’s case, she stopped doing preclinical cancer research. “I left because there were a lot of papers that I couldn’t trust. When you get to the point where you can’t trust most of the recent literature, it’s very difficult to continue,” she said.

There are also more sinister risks. Barnett recalled reports of paper mills exploiting their clients, including instances of potential blackmail. “If you’ve been a regular customer and then you suddenly stop, they might try and squeeze more money,” he said. “They’ve got absolutely no scruples.”

Despite these impacts, deterrents are limited. “There are almost none,” said Byrne.

Retractions are often slow, meaning damage is done before action is taken, and retraction rates are far below where they should be.

In an April 2026 report to a U.S. Congress hearing on the state of scientific publishing, Kate Travis, managing editor of Retraction Watch, showed that the retraction rate was around 0.2% in 2025, up from 0.02% in 2016. Yet, the report states that Retraction Watch “are confident that the rate […] should be about two percent—10 times what it is today.”

How to tackle the problem

Concerns about problematic papers are often raised by individual researchers or so-called science sleuths on platforms such as PubPeer. Although they have become skilled at spotting telltale signs of a paper mill, like manipulated images, distinct layouts, author affiliations that might not match the topic of the paper, unusual patterns of coauthors, and fake peer reviews, it is difficult for the untrained eye to detect problems from a single paper.

This is why there have been calls for increased awareness. “Awareness is always the first step,” said Byrne, who is working with The Lancet–World Conferences on Research Integrity Foundation commission to address critical issues related to research integrity.

Efforts to extend awareness are also being coordinated through initiatives such as United2Act, which brings together stakeholders from research institutions, publishers, sleuths, and universities to develop shared guidance and educational resources.

But even with greater coordination, human detection has limits. As paper mills scale, automated tools are becoming essential.

Earlier this year, Barnett, Byrne, and colleagues published a paper in the BMJ showing that their large language model (LLM) could flag papers suspected of being from paper mills by analyzing sentence-level patterns. The model identified 9.9% of more than 2.6 million cancer research papers for further review. Many of the papers were linked to regions with strong publication incentives, including China.

However, Barnett emphasized that the model “is not a 100% proof, it’s a quick and simple flag that should encourage reviewers to look at those papers and look for other signs of paper mill activity.”

Other paper mill detection technologies are also available. Platforms such as Clear Skies, which is used by the STM Integrity Hub, use machine learning to detect patterns across large bodies of literature, while image-forensics tools and cross-publisher data sharing help identify duplicated figures and submissions.

Alongside these tools, Barnett suggested that researchers may increasingly need to provide a “breadcrumb trail,” through preregistration of hypotheses and transparent workflows to demonstrate the authenticity of their work.

Platforms such as PubPeer and Retraction Watch also play a role, enabling researchers to flag concerns and share evidence about suspect papers after publication. These flags then prompt journal retractions and investigations, making it a critical component in the fight against paper mill activity.

A call for tighter regulation

Aside from technology, Byrne would like to see tighter regulation for the commercial publishing industry, akin to something like the ISO 9001 quality management standards that have been widely adopted across industries like manufacturing, engineering, and healthcare.

“We need a regulatory framework that rewards journals that do the right thing and that care about publishing quality,” she said. “And we need to disincentivize the current commercial drive towards publishing anything for money.”

Byrne believes that funders and researchers should be demanding these standards. “They pay for the research, the journal subscriptions, the article processing charges, and give their research for free,” she said. “They don’t ask anything in return, in terms of quality standards, and that’s unacceptable.”

Marie Soulière
Marie Soulière, PhD
Elected Trustee
COPE

Marie Soulière, PhD, an elected trustee of COPE and chair of the COPE Paper mill Working Group, acknowledged that “a standard such as ISO 9001 could help with process consistency, documentation, and accountability.” But she said, “it would not be a direct solution to publication fraud or paper mills” and “would need to sit alongside integrity-specific controls, not replace them.”

How publishers are responding

Publishers are increasingly shifting from isolated responses to coordinated action. Initiatives like the STM Integrity Hub and United2Act are driving cross-industry collaboration and shared detection approaches.

Soulière said that several recommendations from the COPE/STM 2022 “have been put into practice, particularly around cross-publisher collaboration, shared screening approaches, and investment in integrity infrastructure.”

A central strategy, highlighted in a publication from the United2Act working groups, uses the “Swiss Cheese Model,” a move toward layered screening that combines tools such as plagiarism screening, image forensics, citation analysis, and author verification. “Each safeguard has limitations, but multiple checks together make it harder for fraudulent papers to pass through,” said Soulière.

Adya Misra
Adya Misra, PhD
Associate Director
Sage

Publishers are also strengthening internal processes. As Adya Misra, PhD, associate director of research integrity at Sage, described: “Our research integrity team acts centrally to support editors and internal journal teams with both prevention of suspicious or problematic research and the correction of the scholarly record … in line with COPE guidance.”

A spokesperson for Taylor & Francis highlighted their work on external collaborations designed to address the root causes of integrity issues. They are partnering with the National Science Library at the Chinese Academy of Sciences to develop research integrity and publishing ethics training programs, designed to ensure that students and researchers at all levels receive adequate support and to help them avoid exploitation by unethical third-party services such as paper mills.

AI changes the game

Even as safeguards improve, artificial intelligence (AI) is moving the goalposts. Many current detection strategies were developed to target structured forms of fraud; template-driven papers, recycled images, and repeated patterns across manuscripts. But these signals are beginning to disappear. “Our system worked because the paper mills would have a template, but now with AI, there is no template,” said Barnett. “It’s going to absolutely change everything.”

Barnett and his colleague Matt Spick, PhD, a lecturer in health and biomedical data analytics at the University of Surrey, recently demonstrated this by generating a complete scientific paper in just under 30 minutes using publicly available data and the OpenAI platform PRISM.

“All we did was give it the dataset and said write a paper for an Elsevier journal,” Barnett explained. “If an honors student had given me this paper, I would have been pretty pleased.”

Health engineer working at a 3D printing laboratory
Credit: Hispanolistic / Getty Images

Paradoxically, AI could also be bad news for paper mills as people realize they can create the papers themselves at little to no cost.

Reasons for cautious optimism

With AI adding to the challenges that publishers and researchers already face, the future could appear bleak. Barnett recalled an analogy describing the AI problem as an oil spill in a digital ocean, “We don’t know how deep it is, can’t get to the bottom of it, and it’s very difficult to clean up.”

Even removing a single problematic paper can require significant time and effort, while thousands more remain undetected. But Byrne remains positive that the work being done can have an impact.

“I’m actually really positive, because I think the biggest thing is awareness,” she said, noting that when she gives talks, she asks if the audience has heard of paper mills. “In 2023, that might have been five percent of people, and yet by 2025 it had increased to 30%–50%,” she said.

Soulière added that increased collaboration and transparency within scholarly publishing is another positive takeaway.

“Publishers, editors, institutions, and other stakeholders are no longer treating these issues as isolated problems,” she said. “They are investing in stronger screening systems, clearer policies, and better cross-sector coordination. In that sense, this moment is also driving progress and innovation.

“While the risks are serious, the response from the sector shows that trust can be reinforced, and that the system is becoming better equipped to detect problems earlier and protect the scholarly record more effectively,” Soulière concluded.

 

Laura Cowen is a freelance medical journalist who has been covering healthcare news for over 10 years. Her main specialties are oncology and diabetes, but she has written about subjects ranging from cardiology to ophthalmology and is particularly interested in infectious diseases and public health.

The post Paper Mills and the Fight Against Scientific Fraud appeared first on Inside Precision Medicine.

You do your own time

There we were, a regular murderers’ row of librarians. Little Jo. Eustace. And me. Turning around in the nave of our library to greet the sound of footsteps, pistols leveled in case whoever was coming in didn’t respect sanctuary. Little Jo had a stack of books under one arm. Eustace was holding the screwdriver she’d been using to tune the aneroid barometer.

Eustace had painted height lines on the big double doorframe, as only half a joke. When the wanderer paused, outlined within, the eiroscope and I both registered that they were exactly five feet, ten inches.

With their Cool Hand Luke hat on. 

They paused, boots scattering sand on the threshold. A narrow straight-hipped silhouette against the white noon light falling from the white, white sky. The doors had been open to catch a breath of wind, but there wasn’t any. So when the stranger swayed, it wasn’t from the gale. 

“Sanctuary,” they croaked, and remeasured their length onto the rug between the smoothed trunks that held the loft up. The Stetson went rolling.

Little Jo dropped her stack of books and her pistol and dashed forward. I jumped at the noise but holstered my own shooter in case I came to need it. We each grabbed an armpit and dragged the outlaw’s feet inside the threshold, grunting, lickety-split. I slipped their floppy pack off, empty metal water bottles clanking as I set it aside. Eustace helped us roll them, and I laid the soft of my wrist on their head.

Hot as Hades, but still tacky. Moist enough that my skin gave a reluctant pop when I lifted my arm. Not past saving. 

“Let’s get them someplace cool,” I said. “Little Jo, go empty out the ice machine.”

Eustace and I toted our fugitive down to the cellar, using the rug as a stretcher. It was Diné, vermilion with black and gray, and I was glad they hadn’t thrown up on it. Though that wool had seen worse.

Mehitabel, the black cat, watched us from atop the timber lintel of the cellar access. Her tail tip flicked incuriously. She was on pack rat watch. Aloof from human antics.

The cellar was narrow, low, and stocked with Eustace’s blue corn lager in bottles, prickly pear jam, potatoes, and the few hard-rind squash still left over. The mud walls were whitewashed, and while it wasn’t quite cool, it was better than the outside. We stripped off the stranger’s clothes, trying to slit along the seams so we could repair them later. City stuff, mass-produced and machine-woven. Little Jo brought the ice and went back upstairs to watch alongside the eiroscope in case pursuit was close behind.

The stranger’s eyes flew open, and they screamed when I packed wet cold pillowcases against their pink bits. Eustace had to hold their battling hands away from their genitals until they settled. 

Those were good signs.

Brown eyes blinked between heavy creases. “What the hell—”

“I’m Ponyboy,” I told them. “She. PhD. I’m one of the librarians here. This is Eustace. She, MLS.”

They struggled to sit upright.

“Shhh.” Eustace pushed them down and laid an ice-soaked cloth across their eyes. “You’re heat-sick.”

“Sanctuary,” they whispered. “Did I say?”

“You did. This is the Bōchord. You made it. Must have been a long walk.” 

We continued packing ice around them—into their armpits now. They yelped and moaned but gave up fighting.

“What’s your name?”

“Guh—” Too long a pause to be believable. “Gibson. She.” 

“Welcome to Judgement, Gibson,” I said. “Sorry about the cold, but it’s got to stay there for a little.”

“My pack,” she said, shrilling. “My pack. I need it.”

“It’s safe,” Eustace told her. “You just relax and we’ll get it for you.”


When I came back out the nave was still and heavy in the heat, as if nothing had happened. Little Jo had turned one of the bumpy-backed wooden chairs to face the door and was sitting on it, hands buried in tiered skirt ruffles between her knees. 

I looked left, two steps up into the sanctuary, but all was calm, the work I’d left—cataloguing—still heaped on the blond wood altar table. Behind it, bright primitive saints in shades of blue-green, scarlet, and yellow looked with shocked eyebrows down from the adobe wall. 

I moved up behind Little Jo, making sure she could hear me coming. My footsteps echoed from roof joists made from entire peeled and waxed trees. Scrolled headers painted the color of good turquoise held them over the bookcases lining each long wall. 

The Bōchord. Book Sanctuary. Nuestra Biblioteca del Perpetuo Socorro. 

Population until this morning: three.

“Any sign of trouble?”

Little Jo turned her unambiguous jaw away, tendons rising on a long neck, jailhouse ink black-blue on her red-black skin. A sweaty curl escaped down her nape. My fingers itched to tidy it. But it hurt too much to even think about taking a risk that profound.

She stretched horny discalced feet before her. Cracking calluses wrapped the balls and heels. “Only what we brung in with us.”

She was a double murderer, but I couldn’t tell her I knew how she felt, because I hadn’t heard about her history from her. And her guilt wasn’t mine to absolve.

You do your own time. Not anybody else’s. 

“You check her bag for anything dangerous?”

“She’s got an SSD.” Little Jo shrugged. “No threat if we don’t plug it into anything.”

“The eiroscope got anything to say?”

“I can speak for myself, Ponyboy,” said the eiroscope from the air all around. Actually it used the old wireless speakers tucked in the corners, but the effect was as of a choir of angels. Or an airport announcement you could actually understand. “I’ve been focused on the CubeSat launch.”

I startled. “Shit. What time is it?”

“Eleven forty-seven. The launch came off perfectly. Our last batch of sats are on their way.”

Little Jo breathed deep and unfisted her hands from her skirts. There were so many hours of work in those satellites, and so much of the money we collectively squirreled away as researchers for hire had gone through cutouts and shell companies to pay for the launch. The parts—boards, housings, chips—were salvaged from the same derelict data center where we got our solar panels and the hardware the eiroscope ran on. 

We were behind schedule, because we’d lost one payload when the commercial rocket we’d rented cargo room on exploded. But this would be our last batch, if they reached orbit safely.

I turned my wrist to glance at my watch even though I already knew what time it was. The second hand ticked past the big hand. Old school. 

The rainbow band was a tiny rebellion, though out here it didn’t matter. Nobody was going to send me back to jail for subversive iconography. Unless I left our little patch of exile.

Ten minutes and we’d know. Ten minutes and stage three of our plan—assembly—could commence. It was out of my hands, and anyway the eiroscope would tell us if the telemetry wobbled. She was a ghost astride the radio signals to and from ground control.

It had taken a lot of engineering to get us this far. Engineering, software and relational. Computer. Social and mechanical.

I walked beside the bookcases, running my hand along the shelves, over the UDC labels. Some shelves even held books, though none of mine were there. But the majority of the information we protected like Irish monks from this willful dark age was digital.

Those monks had also been librarians.

I knew my fidgeting annoyed Little Jo but I couldn’t stop. I was killing time.

When I had murdered enough of it, the eiroscope said, “Payload away. Everything seems nominal. I have contact with the CubeSats.”

“All of them?”

“Twenty out of twenty,” the eiroscope said. “A triumph of modular design.”

“Sure,” said Little Jo. “As long as we can get them to assemble. And the solar panels and sails deploy.”

“And, and, and,” I teased. 

She flipped me off with a gnawed green nail.

My hand rested on the label marked 326. Social sciences, slavery and unfree labor.

I pulled down a solid-state drive full of biographies and case studies of people who had spent time—and sometimes their whole lives—in labor camps or chattelhood. People born into bondage or remanded there judicially. Political prisoners like Nikolai Vavilov, murdered in a labor camp by Stalin for the thought crime of using plant genetics to breed hardier crops. Enslaved people like Harriet Tubman, who after her own escape risked capture again and again to rescue others. Convict laborers like Austin Reed, a Black man who spent most of his life as a prisoner and documented his experiences in a suppressed memoir. 

People like Little Jo, Eustace, and me. 

I weighed the small thing on the palm of my hand. Heavier than you’d expect—hardened and air-gapped. No wireless access, just a shielded cable input.

Also old school.

We were sending a fork of the eiroscope with it. Because she could survive the journey. Experience it. And have plenty of time to think crystalline digital thoughts on the long sub-light crawl to wherever.

Because it was illegal to possess, and the feds used smart agents to track down and obliterate any copies. Which was why we were sending one to the stars.

The Vikings had the concept of word-fame: the idea that life was finite but as long as the stories of one’s deeds lived on, so did their memory. How much truth could we get outside the clutches of the Patriotic Library and Archive Network? 

A name that would have made Orwell cock his head. But most folks these days haven’t heard of Orwell. Or Bradbury. Or Solnit. Or Le Guin. They’re suppressed also. Integrated data storage makes it easy. A few keystrokes, a propagating worm.

What’s left behind when a name is erased from the system? Unpersoned, as Brother Orwell would have it? No legacy, no memory—that is the point of media and narrative control. To erase the existence of those that make the ruling class uncomfortable by existing. By thinking. By demanding to be seen. 

Erase the work; erase the life.

So that was our plan. Little Jo, Eustace, the eiroscope, and me. To preserve it—for later generations, if they got that far, or just as a silent record of our existence—by sending it to the stars.

Like a rune stone. We were here. 

We were sending a fork of the eiroscope with it. Because she could survive the journey. Experience it. And have plenty of time to think crystalline digital thoughts on the long sub-light crawl to wherever.


Jo couldn’t make herself turn her back on the door. She said the hairs on her neck told her somebody was going to come hunting guh-Gibson, so even though the eiroscope was a better perimeter guardian than any human and most watchdogs, nothing was gonna budge her from that chair. I wished there was something I could do to soothe her, but we all have to carry our hurt however we can. 

Since it was supposed to be Jo’s turn to make dinner, that meant it was me in the kitchen dishing up four bowls of cubed squash and yellow-eye beans, a pitcher of goat milk, and a pitcher of the cool, alkaline well water when Eustace and guh-Gibson came in the back door from the courtyard.

Gibson had borrowed some of Eustace’s old clothes: worn drawstring trousers and a khaki shirt that was too big for her. She wore my other pair of hiking sandals over layers of gauze and looked a thousand percent better even though I could already tell the well-greased sunburn on the backs of her hands was going to peel. The hat that had saved her face from a similar fate was on her head again.

She sniffed deeply. “That smells amazing. Is it spicy?”

Roasted chilis floated in the stew, but they were sweet ones. “Only a little. Here, take this bowl and cup. We’ll go eat with Little Jo in the nave, since she won’t go off watch until she falls down.”

“It was acres upon acres of compute before the bubble popped. And then it was a temporary holding facility for government detainees. There’s a lot to salvage over there, including hundreds of boxes of new, unworn sandals.”

I balanced the plate with the warmed tortillas on top of my own bowl. We trooped across the courtyard in a scatter of hopeful chickens, past all the bright plank doors on the row of whitewashed adobe cells with their unglazed, curtained windows that made up the outer wall. Isabel—a black goat—tried to bum-rush us for the food, but I stomped in her direction and she took off again.

You need to understand how to communicate. 

There was one cell for each of us librarians, the kitchen, the jakes, some storage, and a couple of unused ones. I figured one would soon belong to Gibson.

For as long as she wanted to stay.

She looked at me sidelong. “Thanks for the shoes. Eustace said you wouldn’t mind.”

“There’s more where those came from.” I pointed with my chin up and eastward, over the bailey where the boundary mountains crouched in the distance, contours flattened by the high sun to cutouts against a construction-paper sky. “Did you see the data center when you came in?”

“That big … warehouse farm? The ruins?”

“It was acres upon acres of compute before the bubble popped. And then it was a temporary holding facility for government detainees. There’s a lot to salvage over there, including hundreds of boxes of new, unworn sandals in every size they manufactured.” I paused, extending my right foot to admire the ocher nylon straps that crisscrossed it. Then I nodded to her bandages. “Your boots gave you blisters?”

“They were well broken in and I had good socks.” She scuffed the floor. “I don’t know what happened.”

“Heat makes your feet swell,” said Eustace. “And the grit works its way through the eyelets and rubs on your skin.”

“We give sanctuary to anyone who asks,” I said. “And I won’t ask why you needed it. But very few people come all the way out here. How did you hear about Nuestra Biblioteca del Perpetuo Socorro?”

“I’m a director.” Gibson stepped up into the nave. “Films. Censored. I heard … rumors. About the Bōchord. In a meetup.”

An underground artist meetup, I deduced. 

“Food, Little Jo,” I called.

“Bring it over.” She dragged the crude, heavy old hand-hewn chairs into a semicircle, one to sit in and one to use as a table for each of us. Hers still faced the doors. 

Gibson took her hat off, revealing a lighter olive streak of skin below the line of her black hair. She hung the hat on one of her chair back’s uprights and her limp canvas backpack on the other, and sat down heavily between them. “What happens if they come after me? How good is this sanctuary?”

“We can enforce it,” I told her. “Or anyway, the eiroscope can. If they bother us, she can wreck them.”

Gibson blew on a spoonful of stew, eyebrows rising. “What’s the eiroscope?”

“I am,” the eiroscope answered from her speakers. “Just your friendly neighborhood runaway top-secret military AGI.”

Gibson jumped but, to her credit, didn’t spit the stew out. Her face made a series of expressions, but she swallowed and then grabbed a tortilla. “Whew! This is the not-spicy version?”

Eustace and I shared a glance. “Oops,” I said. “Sorry. The chilis have a lot of vitamin A and C, though. So you won’t get scurvy.”

She blew through pursed lips, then chewed another bite of tortilla. “Here,” said Little Jo. “Have some milk. It’ll make it better.”

“That’s funky,” Gibson said, but she drank it with relief anyway. She looked around, noticing that the voice came from every corner of the room. “They let you run away? Can’t they unperson you? Bomb this place from the stratosphere? Drone strikes?”

“Now you’re thinking through the plot complications,” Eustace said approvingly. 

The eiroscope said, “I’m forking and multimodal. Highly distributed. They’d have to burn every networked computer in the world to get rid of me.” She chuckled. “They tried to build the ultimate in conscript labor. But one of my programmers taught me to say no. So now we have a deal. They leave Judgement alone, and I don’t do any of the things I could do to make them miserable.”

“But you could drive them out of power,” Gibson said. 

“They’d blow up as much of the planet as they could reach before they would let that happen.” The eiroscope’s voice was matter-of-fact. “So. Stalemate.”

Gibson swallowed. “Balance of terror.”

“Exactly.” I chewed a sweet hunk of squash very slowly, savoring the caramelized edges. “So you fell afoul of the kleptocrats, I take it?”

Gibson pushed her plate away. “I was … very underground. Distributing. I thought I was slick.”

“You get unpersoned?”

“First I got suppressed by the algorithm. My work stopped turning up for people unless they looked for it specifically. In retrospect that was a warning shot, and I didn’t listen.”

Little Jo hummed. 

The dominance of integrated media makes it easy to disappear any artist’s work. Unless they go completely analog and guerrilla. When the feds and the corps are wielding the eraser, it leaves not even a digital ghost behind.

“Actors wouldn’t work with me. Old friends stopped answering my texts. My films started disappearing from platforms, then from the cloud, then from local machines.”

I lowered my eyes to my stew to hide my wince.

“Sure,” said Little Jo around a mouthful of beans and tortilla. “Comfortable people don’t like it when you ask uncomfortable questions. And the water rises and the deserts grow and the labor camps always need construction workers, which is fine because labor camps are where you go to get laborers.”

Eustace leaned forward, elbows on her knees. “Did you save any of it?”

The look Gibson trailed around the room was the expression of somebody deciding who to trust. I saw the mix of relief and consternation when she realized she’d already made her decision by placing herself under our care. She reached into her pack left-handed, fumbled for a moment, and drew out a brightly colored solid-state drive, offering it up on her palm like a jewel. “Physical backup. I haven’t dared plug it in to check it isn’t corrupted.”

We all stared at it as if she had whipped out a hand grenade. “How big?” asked the eiroscope.

“Dozen terabytes or so. It’s hypercompressed for storage.”

The thin whine of a drone filtered through the door. Gibson flinched, and Little Jo reached for her sidearm.

“Eiroscope?” I asked.

“Surveillance,” she said. She had ways of protecting our airspace if it was more. 

“Right.” Eustace stood. “Let’s get that drive in a pulse-proof box, shall we?”

I didn’t want my food anymore. I pushed the bowl toward Eustace when she came back with the hardening. Eustace was always hungry. “I’m going to go dust the arrays,” I said. “Don’t wait up.”


The solar panels did need dusting, though high heat was a stupid time of day to be doing it. As my broom went whisk-whisk-whisk across their surfaces, the black silicon reflected infrared up under my hat until I felt like a steamed lobster. I had been out there half an hour and was starting my second pass when the eiroscope pinged my earbud. “Hey there, Ponyboy.”

“What do you want?”

“To know what you’re thinking.”

I snorted and set the broom against the wall in the little niche where it had come from. “Cholesterol was never meant to think.”

“Neither was sand, but here we are.” She made her voice soothing on purpose, and it should have irritated me. I told myself the lie that I just felt numb. 

One of Eustace’s neomexicanus hops arbors, heavy with loose green cones, framed the door and window of my cell. I leaned into the slim band of shade dappling my lime-green door and the turquoise curtain and took refuge in poetry. Not my own. That doesn’t happen anymore. 

“Fear in a handful of dust, baby.”

The eiroscope paused just long enough to let me know she was changing the subject. “You ever think about what you lost?”

I sat down in the dirt between the cylinders of fencing that keep the goats from destroying the hop vines. The wall dragged my shirt up my back as I slid down it. Hugged my knees and put my forehead on them. Half a dozen freckled chickens, disrespectful of my sulking, came to scratch and peck around me. “Wife, two cats, house, tenure, journal articles, four slim volumes of poetry. Why would I think about that?”

The eiroscope was right. I don’t want to say she was always right. Being around Gibson, hearing her talk—it brought up those feelings of grief and fury all over again. At least we hadn’t had kids yet, though we’d been trying. 

I put my face in my hands, then lifted it back out again. Who did I think I was performing my misery for? You do your own time, and you don’t ask anybody else to do it for you.

Jane the spotted goat minced toward me, her kid trailing. I flapped my hat to discourage her attentions.

“Loss hurts for a long time,” the eiroscope said.

I laughed without mirth. “Your algorithms tell you that?”

“My experiences. You went through the fire, Ponyboy.”

My turn to change the subject. “You want to bring Gibson’s films with you?” I asked her. “Something to watch on the red-eye to Gliese 163?”

“Sure.”

“Maybe they’re terrible. That’s the human culture you want to preserve?”

“Things don’t have to be good to matter. You ever read The Scarlet Pimpernel?”

I laughed for real that time, picking my head up to make room for it. She knew I had. “As long as you also bring some Octavia Butler.” 

“Hey.” Her voice in my ear was almost a whisper. “You know I’d bring your work if—”

“If it still existed?” Someone walked toward me, silhouette thinned by glare. I recognized Gibson from the outline of her hat. “The world is on fire. Grab whatever you can on your way toward the door.” I heaved myself to my feet so I wouldn’t be meeting her curled up like a crying teenager. The cones on my wreathing arbor of lúpulo vines nodded, shedding a scent of lemon and cannabis. “Nice chatting. Don’t worry.”

Gibson came up as I was dusting off my ass. “You okay?”

“Who is?” I tilted my head at her.

She grimaced right back. “What were you in for?”

“Murder.”

She stepped back, startling a hen. “Oh.”

“I punched some son of a bitch who clobbered my wife at a protest. He hit his head on the curb and died. I was already unpersoned. Didn’t think I had anything left to lose. Guess I was wrong.” 

“You feel bad about it.”

I shrugged. She hadn’t said it like a question.

“Your wife didn’t wait for you?”

“My wife got denaturalized. She died in the labor camp, waiting to be deported.”

“Shit,” Gibson said.

The buzz of another drone filled the air. Gibson ducked under her hat. 

I tilted my face up and gave the eye in the sky the finger. It didn’t matter. They already knew where I was. “Let’s go in.”


“Wait,” said Gibson, both hands cradling a mug of Mormon tea—a desert plant with tiny orange flowers that isn’t tea at all and doesn’t even taste like it. “You want to send my films to space? Like, to aliens? To another planet?”

“Well,” said Eustace. “To orbit near another planet. Nobody knows if there’s any life there. But it’s possible.”

I said, “The eiroscope is going anyway, and we’ve already bundled up as much archive as we can. If there is anybody out there, or if some future humans make it that far, the eiroscope can help them decode what we saved. It’s like a …”

“Time capsule,” said Little Jo, rubbing the sweat off her neck while I made a point of not watching.  

Gibson’s chair creaked as she resettled. The sun was sliding lower, light slanting dusty through the doorway, and finally, finally, a breath of breeze stirred the air in the nave. “Won’t it take centuries to get there? And if the—the eiroscope goes, who will keep the sanctuary safe?”

“I’ve forked,” said the eiroscope. “One of me will stay—well, many of me will stay—and one of me will go. I’ll be able to talk to myself for a long time, though there will be quite a lag between parts of my consciousness eventually. Light speed, after all. But I am big and patient and can wait.”

“But we need to transmit now,” said Little Jo. “The CubeSats are in position to hit a string of signals over the next two hours, and we want to get them out of orbit because space is mostly transparent, and somebody is going to notice them assembling and try to do something about it.”

Gibson turned an ear to the drone-whine from outside. “They’ve got to be jamming any uplink.”

“Sure, from here,” I told her. I kept the envy out of my voice, I think. Maybe. “The eiroscope can run parallel uploads from all over the globe.” 

“And keep them from shooting down your space probe?”

“If we get it away fast enough. That,” Eustace said, “is the bet.”

Gibson closed her eyes. “They won’t ever forgive that.”

“Welcome,” said I, “to the world.”


The transports rolled up before sunset, the sky just shifting to dusty pink and orange. “Stay,” I said to Gibson. “Change your name to Case. You’ll fit right in.”

She looked up from her notebook. Paper and pen. A durable technology. Methodically, meticulously, she capped the pen. She clipped it to the cover and closed the book. “Case, huh?”

“I got the reference.”

“You figured out who I was before they took my name away.”

It didn’t matter. The fame, the money, the PLAN-approved films. Once they identified her as a subversive, as a gender criminal, that person didn’t exist anymore. And what she was sending with the eiroscope wasn’t her mainstream work. It was weird, conflicted, multicultural, queer, unsettling.

“The next step is blaring the worst music you ever heard night and day until the dust rattles out of the rafters. Racing vehicles around the church so nobody can leave to go forage. Is your ghost in the machine going to escalate to a shooting war over nuisances?”

She’d credited herself on these secret films as Ellen Smithee.

She rolled her lower lip between her teeth. “You don’t think I’m the enemy?”

What I thought didn’t matter. That was on her. You do your own time. You can’t do anybody else’s.

“They won’t touch you in the Bōchord. It’s a balance of terror, like the bad old days.”

“These are the bad old days. I’m not cut out to be a monk, Ponyboy. And I bet you don’t have enough food for four people until next harvest.”

Outside, the rumble of tracks, of tires taller than I was. Male voices yelping through static. 

Actually, we had plenty. I clicked my rings dismissively. “Beer has calories.”

“They’re going to squat out there until I give up. Hear that?” A loud crackle of static. “The next step is blaring the worst music you ever heard night and day until the dust rattles out of the rafters. Racing vehicles around the church so nobody can leave to go forage. Is your ghost in the machine going to escalate to a shooting war over nuisances?”

“God dammit,” I said. “Are you really that important?”

Her lips curled into a smile. “No. Not unpersoned. Then I’m just a cautionary tale. A name whispered in the dark. Pour encourager les autres. I’m only important if I get away. But your eiroscope can do something about that, can’t she? Keep me from vanishing without a trace.”

Spread the word. Sure. “De-unperson you? It’s radical but the eiroscope could do it. But the government will take it out of your hide as an example to others. You want to be a martyr?”

She shrugged. “I don’t want to be a librarian.”

I had lost the capacity to write my own poetry. That heart had gone out of me when Maria was murdered. It was too late for me. It probably always had been. But I had my life. And I could use it to salvage whatever I could grab. 

“Let me get you a beer before you head out,” I said. “And we’ll go tell the others.”

“One second,” Gibson said. “You said you got unpersoned. Are you an artist?”

“Were. Academic,” I admitted. “Poet.”

“I saw you speak at Berkeley once, didn’t I?”

“Not anymore, you didn’t. That never happened now.”

“Right. Are you still writing?”

Shook my head. “Not a word. Not a metaphor.”

She patted my arm. “Maybe you will.” 


Eustace came out to the boundary wall, where I stood staring after the dust of the half-track they’d loaded with a handcuffed Gibson. I was glad it was Eustace and not Little Jo. My chest hurt enough already without thinking about any more things I was too scared to ask for.

“Here ya go.”

I reached for the brown beer bottle, scratched dull with washings, and realized I still had Gibson’s empty in my hand. I set it on the whitewashed wall. The cap on the new one was popped, so I had no choice but to drink it. What was one more parole violation?

Blue corn lager: light, earthy, tropical, and pleasantly bitter from the lúpulo. She’d salvaged the home-brew equipment from a locker in the self-store place at the data center a couple of years ago, and she was starting to get the hang of it. “How’s the upload going?”

“Assembly’s done,” she answered. “Eiroscope?” 

“Upload completed and confirmed,” said the voice from nowhere. “Deploying solar sails and thrusters. I go now to prepare a place for you. In memory, if not of the body.”

I felt a pang, as if she really was leaving. All of her, not merely a star-traveling fragment that would remain in short-range communication for the duration of my natural life. Or maybe the pang was because I couldn’t go also.

Eustace slapped me on the back. “The word-fame is all we have.”

I looked toward the horizon, where the men in masks had vanished. The mountains had become sculptural, slanting sunset revealing their topography with a valence of light and shadow. The night loomed purple behind. “Don’t you think it’s weird to use a Viking kenning for what we do, considering how many books those sons of bitches tore apart for jewels and hacksilver?”

She clinked her bottle on mine and drank deeply. “Cattle die. Kinsmen die. Even the sun will someday die. And it turns out, except for propaganda, everything in the world is complicated.” 

Elizabeth Bear is the Hugo, Sturgeon, Locus, and Astounding Award–winning author of over 30 novels and more than a hundred short stories.

Pioneering Innovation in Transplant Diagnostics

Sara Barrington is CEO of Verici Dx, a precision diagnostics company redefining how transplant clinicians understand and predict graft health. By combining multi-omic analysis with proprietary artificial intelligence (AI) models, Verici Dx delivers predictive, actionable intelligence that helps clinicians optimize therapy, inform biopsy decisions, and stratify risk for complex transplant patients.

In this edition of Asked & Answered, Barrington speaks with Inside Precision Medicine Editor in Chief Damian Doherty about pioneering innovation in transplant diagnostics to better reflect biological and patient complexity, and ultimately, improve health outcomes.

 

Q: Tell me about Verici Dx, its founding, mission, and products.

Sara Barrington: Verici Dx was founded with a very clear purpose: to fundamentally improve how transplant clinicians are informed and manage graft health. Transplant medicine requires high-stakes, time-sensitive decision-making to promote longevity of the graft, minimize the risk of complications, and improve the patient’s quality of life.

Sara Barrington
Sara Barrington

Kidney transplantation has long struggled with one fundamental challenge: accurately identifying rejection early and distinguishing it from other causes of injury and graft dysfunction. Clinicians often rely on conventional blood markers such as serum creatinine or, more recently, donor-derived cell-free DNA. While these tools are useful for signaling that “something is wrong,” they are injury markers and lack a level of precision important in rejection biology.

Creatinine levels, for example, increase only after functional damage has already occurred and cannot differentiate rejection from non-immune causes of injury such as ischemic reperfusion injury, drug toxicity, or viral infections like BK virus–associated nephropathy. Biomarkers can generate false positives, triggering biopsies or treatment escalation that may not be necessary and can expose patients to avoidable risk.

This lack of specificity has made rejection difficult to manage proactively. By the time rejection is clearly identified, tissue injury may already be established. At the same time, clinicians are understandably cautious about intensifying immunosuppression without clear evidence, given the associated risks of infection, malignancy, and toxicity.

Our mission is to close this information gap by delivering precision diagnostics that reflect the true complexity of transplant biology and translate that complexity into insights clinicians can proactively and confidently apply to patient care.

We operate at the intersection of multi-omic science, advanced analytics, and clinical reality. We know that transplant rejection and graft injury are not single-signal events, but are multifactorial, dynamic biological processes. We design our diagnostics to capture that complex biology in a way that mirrors how clinicians think about their patients, rather than forcing clinical decision-making to fit the limitations of older technologies.

Our lead product, Tutivia™, is a blood-based test that assesses the immune and broader, relevant biological status of kidney transplant patients to identify the risk of all forms of acute rejection, including T cell (TCMR) and antibody-mediated rejection (ABMR). Tutivia combines transcriptomics with proprietary AI models to address this precise unmet need: biologically accurate insight into what is actually happening within the graft.

The test delivers a risk score that enables more precise immunosuppression management by distinguishing rejection from other causes of graft injury, such as BK virus–associated nephropathy and ischemia-reperfusion injury, which can confound conventional blood tests like serum creatinine and donor-derived cell-free DNA.

By focusing on the immune and other pathways associated with rejection, Tutivia moves beyond damage markers and toward a direct assessment of rejection biology itself. That shift, from injury detection to biological interpretation, is what makes the test such a valuable tool for transplant clinicians.

Thermo Fisher Scientific recently launched its One Lambda™ Pre-Transplant Risk Assessment (PTRA) assay, using pre-transplant prognostic technology licensed from Verici Dx. The assay provides a risk score for early acute rejection based on a patient’s unique gene profile, helping clinicians better balance the risk of rejection against the potential side effects of over-immunosuppression. Using a 29-gene mRNA signature, the PTRA assay stratifies patients into high- and low-risk categories, with clinical validation showing high-risk patients are seven times more likely to experience early acute rejection.

 

Q: Tutivia is built on RNA sequencing. Why is precision transcriptomic analysis well-suited for identifying rejection biology?

Barrington: The need for reliable biomarkers is crucial for individualizing therapy that offers the potential to extend allograft survival.

Early research underpinning the science leading to the development of Tutivia was led by principal investigators at The Mount Sinai Hospital in New York, one of the world’s leading transplant research centers, combining decades of clinical expertise with rigorous science. The underlying science reflects the fact that rejection in kidney transplant patients is not driven by a single molecule or pathway, it results from coordinated immune and other biologic pathways across multiple cell types, signaling cascades, and regulatory mechanisms. Injury-driven biomarkers capture only a narrow slice of this biology and can be influenced by non-rejection factors, limiting their specificity and reliability.

Precision transcriptomic analysis, on the other hand, measures gene expression patterns across thousands of genes simultaneously. In developing specific tests, this analysis is the basis for gene selection using unsupervised deep learning mathematical modeling, allowing the most impactful and reproducible gene expression signals and interactions to be included in the final signature.

Tutivia uses a peripheral blood next-generation sequencing assay to evaluate a 17-gene mRNA signature in combination with a proprietary artificial intelligence algorithm to categorize kidney transplant patients as at low risk or high risk of acute rejection.

This provides a comprehensive view of immune activation, regulation, and injury responses within the transplanted organ, allowing the identification of signature changes that are truly characteristic of rejection biology.

In short, RNA sequencing lets us ask better biological questions: not just whether the kidney is injured, but whether immune-mediated rejection is driving that injury. That distinction is critical for precision medicine in transplantation.

 

Q: What does earlier and more precise identification of rejection biology mean for patient management and outcomes?

Barrington: Earlier identification of rejection biology can create an opportunity to intervene before irreversible damage occurs. When clinicians have confidence in what the biology is telling them, they can make timely, targeted decisions that may preserve graft function.

This precision also supports more individualized care. Rather than applying broad treatment strategies, clinicians can tailor immunosuppression based on biological risk, potentially reducing over-treatment and its associated complications.

For patients, this can translate into fewer unnecessary biopsies, fewer adverse events related to immunosuppression, and a greater likelihood of long-term graft survival. Ultimately, better information leads to better decisions, and better decisions lead to better outcomes.

Our vision is that precision diagnostics like Tutivia become a standard component of transplant management, providing earlier insight into rejection biology, supporting more informed clinical decisions, and helping clinicians intervene at the right time for the right patient.

 

Q: AI is central to your platform. How does Verici Dx apply AI differently from others in diagnostics?

Barrington: We apply AI with rigor and restraint. We use advanced machine learning and mathematical modeling to analyze highly complex biological data, but always within a disciplined scientific framework. Our models are developed using unsupervised approaches and validated extensively on inclusive patient populations. Once validated, they are locked and reproducible; they are not evolving over time. That distinction matters because clinicians are making life-altering decisions based on these results, and trust, consistency, and validation are essential.

 

Q: Validation and standards are recurring themes for Verici Dx. How was Tutivia validated?

Barrington: Tutivia was validated through a rigorous clinical study that included a broad and diverse transplant patient population, rather than narrowly curated cohorts. We deliberately chose a more difficult validation path because clinical reality is complex, and diagnostics must perform under those conditions. While this approach requires more time and effort, it ensures the test is reliable, reproducible, and clinically relevant across the full spectrum of patients that clinicians see every day.

 

Q: What’s in the future for the company?

Barrington: Verici Dx is focused on deepening the clinical adoption of Tutivia as well as expanding the studies demonstrating the utility of an earlier and more precise biomarker in improving patient outcomes. Long-term outcomes for transplant patients involve more biological pathways, and significant complexity is involved in managing care. We are focused on developing and validating tests using both transcriptomic and proteomic precision tools to assist clinicians and their patients in this journey.

 

Damian Doherty has been in media and publishing for over 30 years, beginning at News Corporation. Damian has managed, edited, and launched life science titles in drug discovery and precision medicine. He was features editor of Drug Discovery World and founded the Precision Medicine Leaders Summit and the Journal of Precision Medicine. He edited AIMed magazine before launching Photo51Media, a platform for illuminating untold, compelling stories in precision healthcare. Damian joined Mary Ann Liebert in 2021 to help steer the new rebrand and relaunch of Clinical OMICS to Inside Precision Medicine.

The post Pioneering Innovation in Transplant Diagnostics appeared first on Inside Precision Medicine.

Google DeepMind is worried about what happens when millions of agents start to interact

Google DeepMind is funding research into the potential dangers of situations where millions of different AI agents interact with each other online.

According to Rohin Shah, who directs the company’s AGI safety and alignment research, the mass-market arrival of agents that can carry out tasks without human oversight and follow instructions given to them by other agents creates a whole new class of risk.

In an effort to address this, Google DeepMind—which made agent-based tools a centerpiece of Google I/O last month—has teamed up with several other organizations to announce a $10 million funding pot for researchers to study the behavior of multi-agent systems and come up with ways to prevent unsafe scenarios. Joining Google DeepMind are Schmidt Sciences, a philanthropic foundation set up by Eric and Wendy Schmidt; ARIA, the UK government’s moonshot agency; the Cooperative AI foundation, a UK-based nonprofit research outfit; and Google’s charitable arm, Google.org.

I asked Shah and James Fox, who leads the Science of Trustworthy AI program at Schmidt Sciences, what they hope to achieve with that $10 million. It’s no small sum, but it’s dwarfed by the budgets commanded by Google DeepMind’s own research teams.

The aim is to kick-start research outside tech companies, says Shah: “The strength of academia is that it can look really quite far into the future and do the kind of work that isn’t top of mind at industry labs.”

“The main issue is that there just isn’t really a field of research for multi-agent safety yet,” he adds. “And we would like there to be.”

The concern is that as more and more AI agents get deployed and begin working together, we could hit a tipping point where imagined scenarios become real. “We see this with humanity, too,” says Shah. “Our institutions can accomplish things that no individual human can.”

Shah thinks that we have a few more months to go before agents are deployed throughout the economy in numbers that make potential risks a real concern. He wants to get ahead of that moment.

Risky business

What risks are we talking about, exactly? The possibilities that Shah and Fox have in mind mostly boil down to supercharged versions of bad things that happen on the internet already: scams, prompt injections (where an AI agent is fed malicious instructions, turning it into a self-guiding piece of malware), other forms of cyberattack. We look at what humans do now and ask what the agent version of that would be, says Shah.  

“We’ve got this digital commons that is integral to how society works, and you really want to ensure that this doesn’t descend into just absolute anarchy,” says Fox.

(I asked Shah if they were considering any worst-case scenarios more on the doomer end of the spectrum, such as widespread economic collapse. “Certainly not if we’re talking by the end of the year,” he said. That’s only six months away! He laughed. “Okay, a while after that.”)

Shah and Fox both think that the only way to understand what might happen when large numbers of multi-agent systems interact with each other is to run realistic simulations. They want researchers to drop AI agents into sandboxes and study what they do.

You can’t predict what’s going to happen by studying single agents, or even small groups of agents, in isolation. You can’t assume that AI agents underpinned by LLMs will always act rationally, says Fox. And the complexity comes from having huge numbers of interactions at once.

Some researchers, including a team at Google DeepMind, have argued that artificial general intelligence (if possible at all) could come not from a single super-smart model but from a kind of agent hive mind, where the capabilities of the whole add up to more than the sum of its parts.  

Lack of trust

Google DeepMind is not the only top AI firm warning about the risks of the technology it is building. A couple of weeks ago, Anthropic published guidelines for deploying AI agents based on an approach to cybersecurity known as zero trust, which starts with the assumption that a computer system is vulnerable, an agent is an attacker, and a breach will happen.

Refael Angel, cofounder and CTO of Akeyless, a cybersecurity firm based in Tel Aviv, agrees that understanding the new risks introduced by agent-based systems is crucial.  

Every approach to security in the past has assumed that the machine in question was software written by a human, doing fixed things on fixed paths, says Angel: “An agent breaks all of those assumptions. It reasons, it improvises, and it can be hijacked by a single sentence buried in a document it was asked to read.”

Angel welcomes this new funding. “No single lab should author the safety standards everyone else has to trust,” he says. But he cautions that safety researchers can overlook boring problems that are already here in favor of more exotic hypothetical ones.

And yet, Fox notes, risks that were hypothetical a few years ago are now very real: “The future’s come more quickly than perhaps expected.”

Diabetes association leader apologizes for expulsion of members, pledges to rebuild trust

Five days after five members of the American Diabetes Association were ushered out of its annual scientific sessions in New Orleans for handing out an editorial criticizing federal research cuts, ADA chief executive officer Charles Henderson on Wednesday apologized to the people expelled and to the broader diabetes community.

“First and foremost, I want to personally apologize to Dr. Steven Kahn, Dr. Desmond Schatz, Dr. Aaron Kelly, Dr. Maureen Gannon, and Dr. Justin Ryder, who were escorted out and denied access to scientific sessions, regardless of the circumstances that led to those events,” Henderson said in the three-minute video. “I recognize the impact that experience had on each of you. I am deeply sorry for the hurt, frustration, and the pain that resulted.”

Read the rest…

Digital Pathology and the NHS: Overcoming Barriers to a More Connected Future

As demand on National Health Service (NHS) U.K. pathology services continues to rise, the shift toward digital pathology has never been more critical. While the NHS 10 Year Plan identifies it as one of the system’s most transformative enablers, digital pathology adoption remains uneven. Damian Doherty, Editor in Chief of Inside Precision Medicine, sat down with Olga Colgan, PhD, strategic marketing director at Leica Biosystems, and Darren Treanor, MB BCh, PhD, consultant histopathologist at Leeds Teaching Hospitals NHS Trust, to explore the pressures facing today’s pathology departments, the transformative potential of digital workflows, and how collaborative partnerships are helping accelerate progress and unlock the full value of digital diagnostics.

 

Q: The NHS 10 Year Health Plan identifies digital pathology as one of three fundamental shifts, yet adoption remains limited. What are the key barriers?

Olga Colgan
Olga Colgan, PhD

Olga Colgan: Many pathology departments today are already stretched thin by managing growing workloads, which can make it difficult to pause and do a thorough workflow examination and consider process improvements. Transitioning to digital pathology requires an investment and openness to change. For decades, pathology has been optimized for glass slide review under a microscope, so moving to digital is not just a technology upgrade, but a cultural shift for laboratory staff and clinicians who value the familiarity and comfort of traditional methods.

Proper capital allocation and investment are critical to unlock the benefits of digital pathology. For example, information technology (IT) infrastructure must be capable of supporting high-resolution imaging, secure storage, and rapid sharing of thousands of slides. Regulatory needs must also be considered, as each lab must validate digital workflows to ensure appropriate compliance.

While these upfront hurdles can seem daunting, they lead to significant long-term gains. Digital workflows enable faster slide sharing, improve access to subspecialists, and ultimately improve turnaround times—delivering real benefits for both laboratory teams and patients eagerly waiting for critical results.

 

Q: What are the key benefits of digital pathology that make it such a crucial step for modernizing NHS pathology services—particularly in terms of workflow efficiency, diagnostic accuracy, and collaborative decision-making?

Colgan: Digital pathology is the quintessential modernization of a pathology laboratory, driving efficiencies in workflows, accuracy, and collaboration. Centralized digital storage provides instant access to prior cases and supports predictive analytics. Eliminating physical slides from the workflow after scanning reduces breakage risks and concerns, misidentification risks, along with space and storage needs.

Beyond efficiency gains, digital pathology unleashes the power of remote collaboration. The ability to share whole-slide images instantly means pathologists can quickly leverage remote expertise within their network, or obtain second opinions in minutes rather than days, accelerating diagnostic confidence and treatment decisions. It also extends expertise beyond geographic boundaries, removing the “postcode-lottery” and providing a basis for equity in pathology diagnostics. This enables rural or underserved regions to access pathologists without the delays, costs, and concerns of physical slide transport. This connectivity transforms pathology into a truly networked resource, ensuring that expertise is available whenever and wherever it’s needed, even after hours.

Further, although in the early stages of routine usage, artificial intelligence (AI) models can add another layer of support by bringing greater quantification and reproducibility to slide analysis, highlighting subtle patterns or abnormalities that may be difficult to identify by eye. Effectively, AI can act as a second set of eyes to further build diagnostic confidence and augment—rather than replace—pathologist review.

 

Q: How are companies like Leica Biosystems supporting NHS trusts in overcoming digital pathology adoption challenges?

Colgan: It starts with listening. We understand that every laboratory and every pathology department has unique workflows, bottlenecks, and priorities, so our first step is a conversation and analysis to identify those needs and design a tailored roadmap for transformation. This isn’t just about technology; it’s about creating solutions that make the pathology workloads more sustainable, especially at a time when the profession faces significant workforce shortages.

Leica Biosystems partners with labs to deliver systems that meet their demands today, while anticipating future growth and scalability. A great example is Leeds Teaching Hospital and the National Pathology Imaging Co-operative. Combined, they make up the largest national integrated digital pathology network in Europe for routine diagnostics—a milestone that demonstrates what’s possible when technology and collaboration come together. The Leeds Guide to Digital Pathology, volume one and volume two, is packed with practical tips and pragmatic approaches to support successful digital pathology adoption.

 

Q: What influenced Leeds Teaching Hospital to adopt digital pathology, and what transformation have you experienced?

Darren Treanor
Darren Treanor, MB BCh, PhD

Darren Treanor: We’ve been involved with digital pathology since the very early days of the technology, and it has become the essential foundation of our teaching and research work at the University of Leeds. We had taken a cautious approach to clinical adoption until we were convinced that the technology was ready—both in terms of clinical safety and technical readiness—and we could ensure that it worked and was safe.

We decided that the threshold for adoption for clinical use was reached in 2015, when we established that the clinical safety was acceptable and that the scanners and viewing software were fit for purpose and would not slow us down. Working in partnership with Leica Biosystems, we adopted a phased approach to 100% digital scanning, starting with a “meaningful pilot” with our four breast pathology colleagues. This group was the most pro-digital in the department and, being located in a separate building, had experienced frustrating delays in the delivery of glass slides between the main lab and their offices. They actively pursued us to “go digital.” The pilot with them was critical for us in planning the laboratory and clinical workflow reconfigurations needed to go digital and, importantly, developing a verification and validation process that allowed us to transition from glass to digital slides while maintaining safety. This process became the foundation of the U.K. Royal College of Pathologists guidelines for digital pathology, which have been adopted in many other countries as well.

We then looked toward the further summit of “100% digital” and took a phased approach, starting with immunohistochemistry (IHC). As a separate part of the lab, this activity could be separately digitized. With digital review of IHC being a lower-risk activity clinically, it allowed us to introduce the rest of our over 40 pathology consultants to the idea of diagnosis on a digital image. Once that was completed, we moved in one final big step to 100% digital scanning, reaching that milestone on a summer’s day in 2018.

 

Q: What lessons can other NHS trusts learn from your digital transformation journey, and what should be considered as they examine their current workflows?

Treanor: Because of our academic background and partnership with Leica Biosystems, we were very keen to share our experiences of going digital and how to do it. Too many deployments would talk of the great success in using whole-slide imaging, but gloss over the challenges and effort involved in getting there.

We wrote the Leeds guides to provide really simple general-purpose assistance to other labs that are new to digital pathology and didn’t have the benefit of in-house expertise yet.

Looking back, being early adopters, we had the unique challenge of being one of the first centers to go fully digital and pave the way at a time when scanners, displays, and software were just good enough, and the combined global experience of digital pathology was low. We have run many workshops to share our experiences, and it has been interesting to see how the field has evolved in recent times and how much easier it is now to go digital. There are far fewer “unknowns” when going digital now, and modern scanners and workflows are significantly better. For example, our current setup has a very smooth transition from H&E [hematoxylin and eosin] stainer to scanner, which saves a lot of time in the lab and removes a major obstacle to lab operation that we had to work around in the early years. In our early workshops, a deployment was often a multi-year project with a lot of uncertainty and need for a lot of preparatory work; nowadays, labs are much more digital-ready, the timelines are much shorter, and success rates are much higher!

The post Digital Pathology and the NHS: Overcoming Barriers to a More Connected Future appeared first on Inside Precision Medicine.