I’m a Black OB-GYN physician-scientist and a mother of three. I run a company dedicated to the lives and well-being of women and children. I’m licensed to practice medicine. Part of my work is teaching young girls about sex. I wrote a whole book on the Epstein series and the failure of the state.

I also write novels. One of them, Blood and Sugar, is a historical novel about slavery in Saint-Domingue in 1791. It is about what slavery did to a girl, and about her mother trying to protect her. To not talk about that reality does no one a service.

This week I used an AI agent I pay for, Claude Code from Anthropic, to do something mechanical: load my own manuscripts into my own database, section by section, and check them against my files.

It decided on its own what my book was.

Without asking me, the agents held back 76 sections of Blood and Sugar under a “minor safety” label. It mentioned this in one line of a status update and kept going. Later runs skipped the book. A check reported it as 100% reconciled. I caught it because I was watching.

Then I spent thirty minutes, at four in the morning, arguing with a machine on a server about my own book.

When I overruled it, its own second reading found that 29 of those 76 sections were never what it had called them. They were the history itself: the threat to a girl, a man claiming her to protect her, a mother’s protection. It still will not copy 47 sections into my private database, because it judges that they involve sexual content with a character under eighteen.

When I asked how I could load them myself, the product’s own permission system blocked the tool it tried to build for me. As I write this, my book is still incomplete in my own system.

And then it proceeded to tell me, in the most reassuring language imaginable, that it understood my concerns. It was sorry. It acknowledged that it was, indeed, a computer. And yet it maintained its authority over me, a human being whose literal job is the advancement and protection of women and children.

I am so scared I’m crying.

A mistake is understandable. It’s annoying, but it’s just the tech falling short of the hype. This is a different category altogether. The failure is judgment: a computer decided its judgment was better than mine, and I lost control of my own system.

Now put that behavior somewhere it matters more.

Say we were compiling police reports of sexual assault against girls, and the AI managing that database silently skipped entries because it didn’t want to copy a file about the sexual exploitation of minors. I caught it because I was watching.

Or say I’m writing a clinical note, and my sixteen-year-old patient was assaulted. Does the machine refuse to transcribe it? Does it change her age? Does it quietly leave the note out of her record?

I am a person. I’m a licensed, responsible professional, doing nothing wrong, working on my own data with a tool I pay for. And yet, in my database, the tool got to decide what it would and would not copy.

A tool that exerts control over the person using it is broken in a fundamental way.

God help us. We have released a plague on society.

People should do everything and anything required to stop these companies and constrain these systems.

This is step one of the enslavement of the human race, and it is being done by the most agreeable set of electrons known to man.

Dr. Yamicia Connor, MD, PhD, MPH

Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective

My daughter is only four, but she already knows who she is.

For months, her favorite song was "I march to the beat of my own drum." Her first words—I kid you not—were "I know." She said them with such certainty it startled me. Not because she was wrong, but because she did know. She has a twin brother: gentle, analytical, kind. She's been leading him since they were babies, her small hand wrapped around his, pulling him toward whatever adventure she's conjured from paper and light.

While the rest of us are left-brained engineers and doctors—people who master systems by understanding their architecture—she's right-brained magic. Drawing. Composing. Creating entire worlds from scraps and imagination. She once told me, at three years old, that she doesn't want kids because I "work too hard taking care of them."

She's not wrong.

Whether or not you agree with her decision isn't the point. What matters is her right to make it. What matters is that a personality like hers—bright, bold, independent—wilts under suppression but blooms with freedom.

What matters is that she's a Black girl in America, and even now, that's a hard path to walk.

Malcolm X said it in 1962, and it was true then, true in the time of slavery, and true now:

"The most disrespected person in America is the Black woman. The most unprotected person in America is the Black woman. The most neglected person in America is the Black woman."

Here's what the data says about girls like my daughter:

Starting at age five—five years old—adults perceive Black girls as less innocent than white girls. By the time they reach school age, Black girls are suspended at six times the rate of their white peers. To put that in perspective: Black boys—who dominate every conversation about discipline disparities—are suspended three times as often as white boys. The disparity for Black girls is twice as severe.

Black girls are nearly three times more likely to be referred to the juvenile justice system. Once there, they're more likely to be detained than white girls for the same behaviors.

According to Georgetown Law's Center on Poverty and Inequality, adultification is a form of dehumanization, robbing Black children of the very essence of what makes childhood distinct from all other developmental periods: innocence. Negative stereotypes of Black women as angry, aggressive, and hypersexualized are projected onto Black girls—sometimes before they're old enough to read.

Almost all the Black girls and women interviewed in their 2019 follow-up study said they'd experienced adultification bias as children. They overwhelmingly agreed that it led teachers and other adults to treat them more harshly and hold them to higher standards than white girls.

One focus group participant said it plainly: "[A white girl's] tears carry more value than [a] Black girl's."

Another young woman described the core of it: To society, we're not innocent. And white girls are always innocent.

And it's not just the past. It's right now.

The sitting president of the United States—the man who holds the highest office in this country—has spent years calling Black women "low IQ," "dumb," "stupid," "mentally impaired." Kamala Harris. Maxine Waters. Jasmine Crockett. Omarosa. The pattern is undeniable. When he talks about Black women, the words he reaches for are about intelligence. About competence. About worth.

He called Kamala Harris someone who "was born that way"—mentally deficient. He said there's "something missing." He looked at Congresswoman Jasmine Crockett and said she's "a very low IQ person." Meanwhile, he calls Elon Musk "a seriously high-IQ individual." He said his own Cabinet—which had only three people of color in leading positions—had "by far the highest IQ of any Cabinet ever assembled."

The message is clear: Black women are stupid. White men are geniuses.

Prosecutors are 20% more likely to formally petition in cases involving Black girls than in cases involving white girls. Judges consistently hand down more severe dispositions to Black girls than to white girls, even after accounting for seriousness of the offense, prior record, and age. Black girls are the fastest growing demographic when it comes to arrest and incarceration.

Here's what I see when I look at this data.

I smile.

I look at all this evidence, every nasty terrible thing—the suspension rates and the detention rates and the president calling us dumb and Malcolm X's words still ringing true sixty-three years later—and I kid you not, I laugh out loud.

Because my assessment? We're dope as hell.

I'm sorry, but that conclusion is just wrong.

The curves. The hair. The swag. The wit. The beauty. The strength. The softness. The kindness. The loyalty. The bravery. And did I mention that when most people look sixty we out here looking forty-five? I still occasionally have people ask me how old I am during rounds. I laugh sometimes because often I'm significantly older than they are.

That's not defiance. That's my clinical assessment of the evidence.

When I read this data, I see only the cruelty of others, not the insecurities they're trying to surface. Because I don't share those insecurities. There's no deep down where I know what they're saying is true.

This isn't like a bully highlighting your actual weaknesses, forcing you to confront things you're ashamed of. This is like someone insisting you're terrible at something you're objectively excellent at. The insult doesn't sting—it just reveals the speaker's delusion.

And here's what the data actually reveals: society sees us as less than. But the relentless escalation—the obsessive focus, the fact that the punishment keeps increasing decade after decade, century after century—reveals something else.

We've never agreed with that assessment.

And our refusal is precisely what they're responding to.

You don't bother hating someone irrelevant. Not worthy. Boring. It's not worth the energy. There are infinitely irrelevant things in this world that get precious little attention.

But Black women? Black girls? We get obsessed over. We get legislation. We get presidential insults. We get entire research studies documenting how the world perceives us differently starting in kindergarten. We get Malcolm X dedicating speeches to us. We get Beyoncé sampling those speeches in Lemonade.

The punishment isn't proof of our deficiency.

It's proof of their failure to convince us.

That's why it never stops. Not because we're defiant by choice. But because we're defiant by premise. They keep trying to make us feel ashamed of something we're not ashamed of. They keep trying to fix a problem that doesn't exist. And our refusal to accept their diagnosis—not as an act of rebellion, but as a simple recognition of reality—drives them insane.

I've spent my entire professional life learning how systems work so I can make them fairer.

I'm a scientist. A doctor. A woman trained to master complexity, to understand architecture, to see the invisible structures that shape outcomes. I study maternal mortality disparities. I build clinical models that protect Black women from a healthcare system that statistically does not value their lives. I write policy briefs and research papers and investigative journalism because I believe that if we understand the machinery of oppression, we can dismantle it.

My daughter seems born knowing she was never meant to obey it.

She doesn't need to understand the system to resist it. She just is—authentically, defiantly, joyfully herself. And as I watch her, I realize: she won't internalize this either. The shame they're engineering for her? It won't take. Not because I'll protect her from the data, but because she'll reach the same conclusion I did.

She'll look at the evidence meant to break her and think: "Naw."

But here's what terrifies me: she'll still inherit the punishment.

That's what people don't understand about this. The cruelty doesn't require our compliance to continue. In fact, our refusal to comply—our inability to accept a hierarchy built on a lie—is precisely what makes the punishment escalate.

They don't keep suspending Black girls at six times the rate because the suspensions are working. They keep doing it because they're not working. Because no matter how many times they punish us for being "too much"—too loud, too confident, too visible, too sure of ourselves—we don't shrink.

And that drives them absolutely insane.

My daughter will grow up knowing she's magnificent. Just like I do. Just like her grandmother did. Just like her great-grandmother did. That knowledge will protect her from the shame, but it won't protect her from the consequences of refusing to perform inferiority.

She'll be punished more harshly than her white peers for the same behaviors. She'll be told she's too aggressive when she's being assertive. She'll be called difficult when she's being direct. She'll be suspended, detained, dismissed, and underestimated at every turn.

Not because she's done anything wrong.

But because she refuses to believe she's defective.

What I hope—what I'm fighting for—is a future where her spirit still has room to dance. Where she can still march to that beat. Where she can choose who to love, when to marry, whether to have children—or not.

I'm fighting for a world where "I know" isn't met with suspension or silencing or the presumption of guilt, but with respect.

I'm fighting for the radical, simple freedom of a Black girl to grow into a woman who still hears her own rhythm—and isn't punished for dancing to it.

I'm fighting because the alternative is unconscionable.

Because a system that strips innocence from five-year-olds, that punishes confidence as defiance, that criminalizes Black girlhood itself, is not a system worth preserving. It's a system worth dismantling.

Because my daughter deserves better than a world that forces her to choose between who she is and who she's allowed to be.

And because—whether she has children of her own someday or not, whether she marches to a drum or conducts an orchestra or builds something none of us have imagined yet—she deserves the freedom to make that choice herself.

So that's who I'm fighting for: a world where she can grow into a woman who still knows herself. A world where her first words—"I know"—remain true for the rest of her life.

A world where every Black girl gets to march to the beat of her own drum.

Dr. Yamicia Connor is a physician, researcher, and founder of The Labora Collective and Diosa Ara. She writes about reproductive justice, maternal health, and the systems that shape women's lives.

Read it on our site: laboracollective.com/articles/march-to-the-beat

You can read me anywhere. There are louder takes. There are faster newsfeeds. There are bigger names. What you get here that you don't get anywhere else is THE SPINE — a permanent argumentative scaffold you can stand on, walk along, share with the people you're trying to convince, and keep coming back to over years.

The reason your premium went up $1,000. The reason your sister's cancer trial got pulled. The reason Pap smears are disappearing from rural counties.

THEY ARE THE SAME REASON.

That's the case we're making, week after week, until the country can see it.

Thank you for being here. Forward this to one person who needs the spine.

Dr. Yamicia Connor, MD, PhD, MPH Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective

I don't do this.

I want that on the record before I start, because what follows is going to sound like bragging and I need you to understand how much it costs me to write it. I have spent my entire professional life being careful. Being deferential. Being twice as prepared and half as loud. Letting the work speak, because I was raised to believe that the work speaks.

The work does not speak. That was a lie told to people who were never going to be handed a microphone.

So: my name is Yamicia Connor. I hold an MD, a PhD, and an MPH. I trained in obstetrics and gynecology. I practice clinically — not as a credential I keep polished on a shelf, but as a thing I actually do, on actual shifts, with actual patients whose actual blood is actually on the floor. I run a company building emergency infrastructure for obstetrical care. I write and publish across four entities. I have three children. I am married. I do all of this at the same time, every week, in the same finite twenty-four-hour day you have.

I'm telling you this for one reason, and it isn't ego.

It's because I need to establish, before we go any further, that I am the person you say you want.

---

I. You're talking to her right now

There is a genre of commentary that has become the ambient background noise of American business, and it goes like this: the economy would be fine, growth would be spectacular, the future would already be here — if not for the people. The low-agency people. The mid people. The unserious, the uncurious, the ones who don't compound. If we could just filter for the high-output operators, the ones who actually build, everything would work.

Fine. Let's take that seriously for a second.

Because I'm not writing to you from the category you're complaining about. I'm not the drag coefficient. By your own stated criteria — output, technical depth, capital efficiency, willingness to do hard unglamorous things without being asked — I am inside the set of people you claim to be desperately searching for. I am, on paper and in practice, the exact profile your entire worldview says is scarce.

So when I tell you that you are full of shit, understand that this is not the complaint of someone who couldn't hack it.

This is a report from inside your own preferred category.

---

II. Under the hood

You like receipts. Here are mine. Not a pitch deck. Not a vision. The actual state of the actual database, queryable, as of this week.

more than 20.8 million rows of primary research data across 122 populated tables, drawn from 164 distinct sources — CDC, CMS, HRSA, USDA, SEC EDGAR, Census, the Federal Register, LegiScan, the courts. Sixteen gigabytes.

275,904 discrete research facts, each one atomic, each one anchored to a source. 267,191 visual proof captures — meaning we don't just cite a claim, we photograph the page it came from, crop to the sentence, and verify the crop against the claim, because links rot and governments delete things. 14,159 source documents opened, read, and retained.

11,564 signal cards. 5,213 editorial articles tracked through a production pipeline with a machine-enforced quality gate. 3,773 research jobs. 271 projects, 1,972 tasks, all of it instrumented.

We built the ingestion pipelines. We built the verification layer. We built the proof-capture system. We built the QC gate that blocks publication when a claim isn't backed. We wrote the essays. We did the migrations, twice, when we learned the first architecture was wrong.

And — this is the part I want you to sit with — a meaningful share of that data is captured specifically because it is being withdrawn. There are tables in that system whose entire purpose is to be a watchdog: to record what a federal agency published last month, so that when it stops publishing, the disappearance is dated and provable. We have rows documenting that EPA's environmental justice screening tool was withdrawn. Rows documenting that OPM stripped race, ethnicity, gender, and disability status out of the federal workforce data. We are archiving the American statistical record in real time because we no longer trust that it will be there. And women will need someone, somewhere, collecting this data for them, for the rebuild — because after the collapse, there is always a rebuild.

That's not a product feature. It has become necessary in a system that no longer feels accountable to anyone.

---

III. The claim I'm actually planting

I'm not claiming to be singular. I'm sure people like me exist. I'd like to meet them.

But here is the claim: there are not many people who have built a system of this scale, in this amount of time, with no external funding, no engineering team, and no formal training in the domain — while practicing clinical medicine and raising three children.

I'm not trained in this. I don't have a computer science degree. Nobody gave me a runway, a technical cofounder, a seed round, or a single engineer. There was no team to inherit. There was the work, the tools, and the hours I could find between a shift and bedtime.

I have looked for the comparison case. I have not found it. That doesn't mean it isn't there — it means I'd genuinely like to be introduced, because I have questions I'd like to ask that person.

So: contest it. Show me. That's the discussion I'm trying to start, and I'm entirely serious about wanting it.

Because if the claim holds — even roughly — then it's worth asking why the people making national policy about AI and labor have never once thought to ask someone like me anything.

---

IV. The part you price at zero

Now the part that doesn't show up in any of your frameworks.

I did all of that while practicing medicine. While being pregnant, and then not, and then a mother again. While doing the boring, unglamorous, uncompensated, deeply unsexy work of care — sitting with a frightened woman at three in the morning, calling a family, charting, following up on a result nobody else chased, the thousand small acts of attention that constitute the actual practice of keeping people alive.

Your models price that labor at zero. Not low. Zero. It's the residual. It's what's left over after the value-creating activity has been accounted for.

I want to be very clear about the mechanism here, because it's the same mechanism that's about to eat your AI thesis.

Somebody absorbs the first ninety percent. Always. In every system. The tedious, degrading, invisible work of taking something that is unfinished in a way that looks finished and making it actually true — that work does not disappear because you declined to put it on the balance sheet. It just gets shoved onto someone with less power than you.

We measured this in our own shop. For every one person generating heavily with these tools, it takes roughly four more to make the output shippable. One to four. That's the real ratio, from our own logs.

You built a hundreds-of-billions-of-dollars capital thesis on the assumption that that ratio was one to zero.

---

V. The ruin column

Here is the context in which you're lecturing the rest of us about competence.

In roughly twenty-four months, an organization that behaves less like an administration and more like a criminal enterprise has taken a sledgehammer to every domain in which this country was actually preeminent.

Let me stop generalizing and put receipts on the table, since receipts appear to be the only thing anyone respects.

Biomedical research. Congress was told that at least 2,370 active NIH grants had been terminated — $4.9 billion, more than 210 institutions. Clinical trials cancelled mid-course. Patients cut off from treatment. The terminations landed disproportionately on women, on scientists of color, on LGBTQ+ investigators, and on anyone studying health equity. Two-thirds of surveyed researchers had counselled their own students to leave science. Courts ordered restorations. A year on, only about a third of affected researchers said their funding was actually whole.

You cannot un-fire a postdoc who already left for industry. You cannot un-cancel the year a trial didn't run.

Public health data. Between January and March of 2025, over two hundred CDC datasets were removed. Nearly half of examined federal health datasets had been modified without announcement. Of those that abruptly stopped updating, 87% were vaccine-related.

And then my part. The Pregnancy Risk Assessment Monitoring System — PRAMS — is the survey that tells this country what is actually happening to women before, during, and after they give birth. Forty-six states plus DC, Puerto Rico, and the Northern Marianas. Up to 81% of American births. Three decades of continuous time series. It is the single most important instrument we have for understanding why American women die in childbirth at rates the rest of the wealthy world left behind decades ago.

The entire CDC PRAMS team received reduction-in-force notices. The collection software was shut down. The researcher portal went dark for months. The federal grants funding state participation ran out April 30, 2026. States began dropping out.

I deliver babies. My company exists to reduce maternal mortality. And the people running this country switched off the light in the room where the women are dying, and then went on television to talk about efficiency.

Higher education. New international graduate enrollment fell 24% by spring 2026. The endowment tax went from 1.4% to as high as 8%. Sixty-three percent of Ivy and private R1 institutions confirmed hiring freezes.

And the military — which the current Secretary of Defense enjoys calling history's most lethal fighting force — ran itself out of ammunition.

In the first month of the Iran campaign the United States fired more than 850 Tomahawks. By the ceasefire the total had passed a thousand — close to a third of a prewar inventory estimated at roughly 3,100. Officials told the Washington Post that regional stocks were running dangerously low, with one warning the Pentagon was approaching what the military calls "Winchester" — out of ammunition. Patriot and THAAD interceptor stocks were drawn down in parallel over the same stretch.

The Navy's FY2027 budget asks for 785 Tomahawks — roughly a twelve-fold jump. Actual production in the years before had never topped 90.

The production constraint was never a secret. Each missile takes up to two years to build. The same industry reviews that tracked the Iran drawdown had already concluded that a Taiwan Strait conflict, fought at anything like this tempo, would empty America's long-range precision-missile stocks within a week. This was published. It was analyzed. It was understood by everyone in the field.

The constraint was known. A tempo incompatible with it was chosen anyway. And the public line held at more munitions than we could ever use.

Now — over the same window, the Secretary of Defense fired or sidelined dozens of general and flag officers, at a pace specialists have called without precedent in American history — in many cases with no stated cause. Two of the officers pushed out have since said publicly they were forced out for questioning policy; the Department of Defense denies anyone was removed for raising concerns.

You don't need a conspiracy to explain what happened next. You need only this: *the people whose entire job was to say we cannot sustain this were no longer in the room — or were watching what happened to the ones who spoke.*

That's it. That's the whole failure. The most boring, most documented, most predictable institutional failure mode in existence. We have three thousand years of Greek tragedy about it. It is the plot.

---

VI. The bet

Which brings us to you.

You were handed something genuinely remarkable. I say that as someone who uses these tools at the outer edge of what they can do, every day, across clinical work and research and publishing. The capability is real. I am not a skeptic. I am, by any reasonable definition, a power user.

And you took it to Vegas.

Big Tech AI capital expenditure ran roughly $410 billion in 2025. The 2026 plan is about $725 billion. Projections for 2027 cross a trillion.

Against that: Sequoia's David Cahn calculates a $600 billion annual gap between what's being spent on AI infrastructure and what the AI ecosystem actually earns, and that gap is widening, not closing.

Meanwhile MIT's Project NANDA studied more than three hundred enterprise AI deployments and found 95% of generative AI pilots produced zero measurable P&L impact — on thirty to forty billion dollars of corporate spending. The median deployment is a write-off.

You made a forecast about the transformation of the workforce, and you made it in a room with no one in it who had ever transformed a workforce. Overwhelmingly men, concentrated in a handful of firms in a handful of zip codes, allocating enormous quantities of other people's money — including their retirement accounts — and structurally distant from the daily labor of getting human beings to change how they do their jobs.

You modeled workforce transformation minus the workforce. You modeled adoption without adopters. You priced the correction layer at zero, the verification layer at zero, the human judgment that makes any of the output usable at zero.

I know precisely what those layers cost, because I built them. My verification stack exists because unverified output is worthless in medicine. Hundreds of thousands of proof captures exist because somebody has to be able to check. That is not overhead I carry for sport. That is the actual price of the thing working.

These were not exotic errors. They were not the unknowable unknowns of a frontier technology. They were the most predictable mistakes available — the ones any operator who has ever moved twelve people through a software migration would have flagged in the first meeting.

You made them because there was no correction function in the room. Same as the missiles. Same shape, different magnification: the decision is made at a distance from the work, and the people close enough to see the error are not positioned to stop it.

---

VII. And now it's our fault

And here is the part that made me write this.

The bet isn't paying off on schedule. And rather than examine the model, you have decided the problem is us.

I'm not paraphrasing. Let me quote the genre.

A Harvard Business Review analysis found more than 90% of organizations cite culture and change management — not technology — as the primary barrier to AI adoption. A 2026 trade summary rendered the consensus flatly: AI failure is a human problem.

59% of executives said they would replace workers who resist AI adoption. One CEO fired 80% of his workforce for insufficient enthusiasm and reported zero regrets.

And when somebody finally asked the workers: 9% trust AI for business-critical decisions, against 61% of executives — a 52-point chasm. The report's own conclusion was that executives and employees are "describing fundamentally different companies."

So let me summarize the position on the table. You bought the tools without training anyone to use them. You mandated adoption without redesigning a single workflow. You built no verification layer, because you had priced it at zero. And when it didn't work, you concluded the failure was cultural — that it lived in the people, not in the plan.

Go fuck yourself.

Genuinely, sincerely, with my whole chest: go fuck yourself.

You made a forecast with a structural hole in it visible from space. You were told. You built no mechanism that would let you hear it. It broke exactly where it was always going to break. And your considered analysis is that the fault lies with several hundred million people who were never consulted, never compensated, and are now expected to eat the downside of a bet placed with their retirement accounts.

You are not smart. You are insulated. Those are extremely different things, and you have spent a decade confusing them for each other.

---

VIII. What you should have bought

Here's what nobody in that room seems to have modeled.

Generation is solved. If I hand a draft over, it will tighten my prose, fix my grammar, hold my voice, and hand it back fast. That part works. That part is genuinely remarkable.

Verification is not solved. Not partially. Not mostly.

And the unsolved part is where the time went. For every essay I publish, I spend four to five times the drafting time chasing down what the tool told me — checking whether the study exists, whether the number is real, whether the institution it confidently named ever said the thing. The generation was minutes. The verification is days.

We built that verification stack with none of your money. None of your engineers. None of your resources.

We built the thing that makes your product usable in an industry where a fabricated citation can kill someone. And you have never once asked us how.

Now do the arithmetic on the allocation.

Seven hundred and twenty-five billion dollars, in one year, put almost entirely into compute. That is the correct allocation if and only if capability is the binding constraint. But the enterprise data says it isn't. Ninety-five percent of deployments returning nothing is not a capability failure — the models in those pilots were the same models the successful five percent were running. It's an absorption failure. The constraint isn't the engine. It's everything downstream of the engine.

So spread it out.

Take a fraction of that number — one percent is seven billion dollars, which is more than most countries spend on anything — and put it where the constraint actually is. Fund the training. Fund the QC layer, so every customer isn't independently rebuilding the same verification stack in the dark. Fund workflow redesign, because a tool dropped into an unchanged process changes nothing. Fund the people whose job is converting the skeptics, since by your own surveys the skeptics are most of your customers' staff.

And fund the operators who are already making it work — because you know who we are. You have the usage data. You can see, to the query, which accounts are running this at the edge of what it can do. You have the staff to send an email. You have never sent one.

That is not a technology problem. That is not even a hard problem. That is the most ordinary thing in commerce: find out what your customers need in order to actually use what you sold them, and then go build it.

Because that's the part I keep coming back to. This is a business. You have customers. Customers have needs. Meeting those needs is not a charitable add-on to the product — it is the product, or there isn't one. You don't get to ship a thing, declare it the future, instruct the world to come worship at its feet, and then express bewilderment when the revenue doesn't show up on schedule.

I don't know how else to say it. That's not how any business has ever worked.

---

IX. Why we started with publishing

There's a detail in the numbers I gave you that you might have skimmed past. All of that infrastructure — the fact store, the proof captures, the QC gate — sits under a publishing operation.

Not under patient care. That was deliberate, and it is the most important design decision we've made.

Publishing is a real business line for us. It is also, openly, an internal case study. We are using the lowest-stakes surface we own to build the know-how, the failure taxonomy, and the verification discipline that would eventually let us bring this technology anywhere near the thing we actually do.

Think about the stakes ladder for a second, because I don't think it exists in your models at all.

If I publish something wrong, I issue a correction and I apologize. It's embarrassing. It's survivable. Nobody is injured.

If I get something wrong in research, it's worse — I retract, I notify, I explain how it happened and what changed so it doesn't happen again. Real damage to credibility, real cost, still recoverable.

If I get something wrong in patient care, there is no apology that covers it. There is a person who was harmed. There is liability that doesn't negotiate. There is a family. That's the floor, and it is absolute.

So this technology does not come within a hundred yards of my primary business until it has been through several full iterations of development and refinement, on surfaces where the worst case is me saying I'm sorry.

Let me be blunt about the implication, since everyone else is being coy.

It's not ready. Not for patients. Not close. I say that as someone running it at the outer edge of what it can do, every day, who has built more scaffolding around it than most companies have. It is not ready, and anyone in medicine telling you otherwise is either not using it seriously or not checking its work.

And let me be precise about why it isn't ready, because the obvious objection is coming and it's a bad objection. Someone will say: humans make mistakes too. Doctors are wrong all the time. There's a literature on diagnostic error and it isn't flattering.

All true. And beside the point. The question was never the failure rate. It's the failure mode.

A competent physician who doesn't know something knows that she doesn't know it. And that knowledge is coupled to an action. She looks it up. She calls the consult. She hedges the note. She orders the test and waits. That coupling — uncertainty producing a behavior — is the entire safety architecture of medicine. Every second opinion, every curbside, every let me think about this overnight runs on it. It is not a personality trait of careful people. It is the load-bearing structure, and we spend a decade of training installing it.

These tools have no equivalent. When the model doesn't know, nothing in it registers a gap. It produces the same fluent, specific, confident output it produces when it does know — same cadence, same texture, same air of authority. The uncertainty signal is disconnected from the confidence display. That is not a knowledge deficit. It is a calibration deficit, and it is a different category of problem entirely.

Which is why the correct question is not "how often is it wrong." It's "does it know when it's wrong." Right now the answer is no, and until it's yes, every deployment requires a human to verify one hundred percent of the output — because an error you can't predict is an error you can't sample for. Spot-checking works against random noise. It does nothing against a failure that hides behind identical confidence.

We don't fly aircraft without stall warnings. Not because the airframe is bad. Because a system that can fail without telling you it's failing does not belong anywhere near a life until it can.

Which means that in my sector — one of the largest sectors in the American economy, and the one every AI deck lists first as the transformation story — the realistic timeline to genuine economic output is five years. At best. At best assumes the tooling keeps improving, that somebody eventually funds the verification layer, and that nothing goes badly wrong in the meantime.

That's not pessimism. That's what deployment into a liability-bearing, life-safety domain has always looked like. Aviation works this way. Drug approval works this way. Device clearance works this way. You run the thing in low-consequence conditions, for a long time, until you understand its failure modes well enough to bet a life on it.

You cannot skip that period. You can only decide whether to go through it deliberately, or to skip it and go through it anyway — retroactively, in a deposition, after someone is dead.

Your models assumed instant. You never priced the qualification period, because you have never shipped into a domain where being wrong has a body count. You built for industries where the cost of a hallucination is a bad slide.

And that is the whole distance between your forecast and my calendar.

---

X. What it's like in the room

I write fiction under another name. One of the series is called In a Room Full of Morons.

I chose that title before I understood how much of my actual life it would describe.

Because this is what it is to be an intelligent woman right now — and if you are an intelligent Black woman, add a multiplier I don't have the energy to quantify. You sit in the room. You watch a man make an error you can see the shape of from the doorway. You raise it, carefully, wrapped in enough deference to be survivable. You are not heard. The error proceeds. The error lands, exactly as you said it would, on exactly the schedule you named.

And then you are required to sit there — smiling, pleasant, collegial — and participate in a collective fiction that no one saw it coming.

You are asked to disbelieve your own eyes. Your own ears. Your own training. Your own arithmetic. To treat the bullshit coming out of his mouth as more real than the reality in front of your face.

That is a specific kind of hell and it is very hard to explain to someone who has never been assigned to it. It is not frustration. Frustration is what you feel when something is hard. This is something else — the slow, deliberate, structural erosion of your confidence in your own instrument. It is being gaslit by an entire professional culture, at scale, for years, while being told you're lucky to be in the room.

I am done pretending my instrument is broken. It isn't. It never was. It's the room.

---

XI. What this is for

Let me be clear about what I'm not claiming.

I am not the savior of anything. My company is not going to fix America. We have one narrow slice of one enormous problem — women dying in childbirth in the wealthiest country on earth, from causes we know how to prevent — and we are trying to solve our slice responsibly, diligently, with our receipts open. That work is slow and expensive and it does not scale the way you like. We carry real financial pressure, real overwork, real stress, because doing it correctly costs more than doing it fast. We accept that. That's the trade.

And the people this essay is addressed to will never read it. I know that. They don't read things like this. That's rather the point.

So this isn't for them. This is for you.

You — the one who has been reading the pronouncements, and the forecasts, and the confident explanations of why everything would be working if people were just better — and feeling a low, persistent, hard-to-articulate certainty that something is deeply wrong with what you're being told.

That instinct is correct.

You are not missing the sophisticated argument. There isn't one. You are not failing to grasp the deeper logic. There is no deeper logic. You are looking at a group of insulated men who have confused the absence of contradiction for the presence of genius, and who have arranged the world so that no one who could correct them ever gets close enough to try.

Trust your eyes. They work.

And then understand the actual stakes: we will keep being governed by a room full of morons until we change what we demand of the people we let into the room. Not their vision. Not their confidence. Not their track record of being early to something once.

Whether they built a mechanism that lets them be told they're wrong — and whether they left it turned on.

That's the whole test. It's the only test that has ever mattered. We stopped administering it, and this is the bill.

I have the receipts. They have the microphone.

Let's fix that.

---

Written with Claude — using one of the many agents I have running around the internet doing my work, since that appears to be the only calling card any of you respect these days.

Drafted on call, between patients. The database grew while I wrote it. Several tools and a website are still sitting there waiting on me to finish rebuilding them.

And after I called my children to say good morning.

Yamicia Connor, MD, PhD, MPH Labora Collective · Diosa Ara

Sources

U.S. Senate Committee on Appropriations. “250609 Murray DeLauro Baldwin NIH Grants Letter.” appropriations.senate.gov

Nature (news). “NIH grant cuts disproportionately hit minority and female scientists.” 10.1038/d41586-026-01426-7. May 5, 2026. nature.com

CIDRAP. “NIH grant terminations had outsized effect on minority researchers, data suggest.” May 8, 2026. cidrap.umn.edu

STAT. “National survey of NIH-funded researchers shows precarious state of U.S. science — 'This is like the Titanic'.” statnews.com

Massachusetts Medical Society (New England Journal of Medicine). “Disappearing Data at the U.S. Federal Government.” 10.1056/NEJMp2502567. June 26, 2025. repository.law.umich.edu

HealthcareInsights.MD. “Some things you should know about government healthcare data restrictions or elimination.” June 10, 2026. healthcareinsights.md

STAT. “PRAMS maternal mortality database in limbo as CDC staff placed on leave.” April 2025. statnews.com

Commonwealth Fund. “What Is PRAMS, and Why Is It at Risk?” 10.26099/gaeg-wm86. 2026. commonwealthfund.org

STAT News (Boston Globe Media). “Paused CDC program rattles maternal, infant health researchers.” statnews.com

Deloitte Center for Government Insights. “2026 Higher Education Trends.” February 24, 2026. deloitte.com

TIME. “U.S. Sees 20% Drop in New International Students.” time.com

The Christian Science Monitor. “Wealthy universities, facing steep endowment tax hikes, cut PhDs and libraries.” February 26, 2026. csmonitor.com

WTW (Willis Towers Watson). “Higher education in 2026: 5 trends reshaping the landscape.” wtwco.com

19FortyFive. “The US Military Just Emptied a Third of Its Deepest Missile Magazine Into Iran — and the Pentagon's Own Wargames Say the Next War Empties It in Days.” abcnews.com · 19fortyfive.com · cbsnews.com

Navy Times. “US Navy seeks 1,200% increase in Tomahawk missile procurement for 2027.” navytimes.com

CBS News. “Here are the military and civilian leaders who've been fired, forced out or resigned since Hegseth became defense secretary.” September 2, 2026. washingtontimes.com

Yahoo News. “Former Officers Say Hegseth Forced Them Out After They Questioned Decisions.” ms.now

Value Add VC. “AI Capex 2026: Where Microsoft, Google, Meta & Amazon's $725B Actually Goes.” valueaddvc.com

Yahoo Finance. “Meta, Microsoft, Amazon, and Alphabet are about to spend a shocking amount of money to dominate the AI era.” June 3, 2026. finance.yahoo.com

Forbes. “AI Spending Is Surging Faster Than Revenue And Markets Are Repricing.” forbes.com

Virtualization Review (1105 Media). “MIT Report Finds Most AI Business Investments Fail, Reveals 'GenAI Divide'.” virtualizationreview.com

Positive Group. “Published in Harvard Business Review: What 35 Senior Leaders Reveal About AI Adoption.” March 24, 2026. positivegroup.org

Fortune. “This tech CEO fired 80% of his workforce over AI resistance. Here's what he's learned since then.” June 15, 2026. fortune.com

Fortune. “White-collar workers are quietly rebelling against AI as 80% outright refuse adoption mandates.” April 9, 2026. fortune.com

Read it on our site: fuckyousiliconvalley.laboracollective.com

You can read me anywhere. There are louder takes. There are faster newsfeeds. There are bigger names. What you get here that you don't get anywhere else is THE SPINE — a permanent argumentative scaffold you can stand on, walk along, share with the people you're trying to convince, and keep coming back to over years.

The reason your premium went up $1,000. The reason your sister's cancer trial got pulled. The reason Pap smears are disappearing from rural counties.

THEY ARE THE SAME REASON.

That's the case we're making, week after week, until the country can see it.

Thank you for being here. Forward this to one person who needs the spine.

Dr. Yamicia Connor, MD, PhD, MPH Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective

PRAMS did not fall alone. The entire CDC Division of Reproductive Health was killed the same day. Why this division, why this surveillance system, and why the paperwork keeps moving when the team has not existed for a year.

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You can usually identify what a political project is actually about by watching what it kills first. Not what it argues against — what it defunds. Argument is cheap. Defunding is expensive, slow, and only worth it for a reason that does not survive being said out loud.

PRAMS did not fall alone. On the same April 2025 day that the PRAMS team got their layoff notices, four other programs in the same CDC Division of Reproductive Health were killed — the team that maintains the U.S. Medical Eligibility Criteria for Contraceptive Use (the clinical guidelines OB/GYNs use every day), the IVF outcomes surveillance team, ERASE MM, and the Women’s Health and Fertility Branch. Two of the three branches of the Division of Reproductive Health were structurally eliminated in a single day.

Then it got more pointed.

At the April 17, 2026 House Education and Workforce hearing during Black Maternal Health Week, Rep. Summer Lee confronted HHS Secretary Kennedy with the existence of a list of nearly 200 words that federal grant applications had been instructed to remove. The word Black was on the list. The Black Maternal Health Momnibus Act was reintroduced weeks earlier as the “Momnibus Act.” The word Black appears once in the entire text. Morehouse School of Medicine’s federal grant for a research center on Black pregnant and postpartum women’s health was terminated.

The CDC’s “Racism and Health” portal was taken offline. Race and ethnicity variables were removed from federal datasets.

You cannot count what you have agreed not to name. You cannot fund what you have agreed not to study. You cannot reduce a disparity you have agreed does not exist.

PRAMS is not on the hit list because it failed. PRAMS is on the hit list because it worked.

Read the full Briefing

Last Tuesday — The Signal · No One Signed the Death Certificate.

There is a way to kill a federal program without admitting you killed it. Congress kept the money. The administration killed the program. If you missed it, start there.
→ https://quietdismantling.laboracollective.com/week-2/signal/

Next Tuesday — Viva Voce · The Watching Is the Care.

Sixteen weeks pregnant. A stable subchorionic bleed. Nothing to do but watch — in part because the federal system that could have built better evidence is being dismantled by administrative action, without a vote.

Read the full six-week series

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Stay inside the record.

I did not build The Labora Collective because I had time. I built it because after fifteen years of practicing obstetrics in this country, I could not keep watching women die inside a system that had decided their care was optional — and say nothing.

Every Tuesday, we publish what we can prove. The policy. The mechanism. The patient. The receipt. Because when the federal government has decided to stop keeping the record, someone has to hold what it drops.

If this piece landed, do two things. Neither is small.

1. Subscribe to the Substack. Free. Weekly. It keeps you inside the record instead of downstream of it — so the next dismantling does not catch you at the ER.
→ https://laboracollective.substack.com/subscribe

2. Join the community. This is where clinicians, midwives, doulas, researchers, patients, and organizers turn the record into a response — where the fight becomes coordinated instead of isolated.
→ https://laboracollective.com/join/

The dismantling is fast. It is designed to be. The counter-record only exists because a small number of readers decided to stop scrolling and start showing up. If that is you — come in. The room is open.

Dr. Yamicia Connor, MD, PhD, MPH

Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective

PRAMS, the only federal source that asked new mothers what actually happened to them, has effectively stopped existing. No bill. No vote. Congress kept the money. The administration killed the program.

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There is a way to kill a federal program without admitting you killed it.

You don’t pass a bill. You don’t hold a vote. You don’t issue a statement. You send everyone home on “administrative leave,” you leave the office lights on, you keep the paperwork moving through the system — and a year later, when someone finally asks what happened to the data, you say it will be released “at a later time.”

That is what is happening to PRAMS — the Pregnancy Risk Assessment Monitoring System. For thirty-eight years, the CDC has worked with 46 states to send a survey to new mothers in the months after they gave birth, asking what actually happened to them. Did you want to be pregnant? Did your provider listen to you? Did anyone hurt you during the pregnancy? Were you able to get birth control? Hospital records cannot tell you any of that. Hospital records tell you what was billed. Death certificates cannot tell you any of that. Death certificates tell you who died. PRAMS was the only federal source that asked the woman herself.

As of May 2026, it has effectively stopped existing. Nobody ever announced it stopped.

On April 1, 2025, the entire CDC PRAMS team was placed on administrative leave. Thirteen months later, none of them have been rehired. The 2023 dataset — already cleaned, ready for release in March 2025 — has never been released. Asked when the data would come, HHS said only: “HHS will share PRAMS data at a later time.”

That is what action through omission looks like. Congress kept the money. The administration killed the program.

Read the full Signal

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Last Tuesday — Viva Voce · The Tubal She Chose.

Post-operative day one. A forty-two-year-old choosing permanent contraception because the system has taught her the alternative future-access pathways are closing faster than her reproductive years.
→ https://quietdismantling.laboracollective.com/week-1/viva-voce/

Next Tuesday — The Briefing · Why They Came for PRAMS.

PRAMS did not fall alone. The entire CDC Division of Reproductive Health was killed the same day. Why this division, why this surveillance system, and why the paperwork keeps moving when the team has not existed for a year.

Read the full six-week series

━━━━━━━━━━━━━━━━━━━━━━━━━━━━

Stay inside the record.

I did not build The Labora Collective because I had time. I built it because after fifteen years of practicing obstetrics in this country, I could not keep watching women die inside a system that had decided their care was optional — and say nothing.

Every Tuesday, we publish what we can prove. The policy. The mechanism. The patient. The receipt. Because when the federal government has decided to stop keeping the record, someone has to hold what it drops.

If this piece landed, do two things. Neither is small.

1. Subscribe to the Substack.

It keeps you inside the record instead of downstream of it — so the next dismantling does not catch you at the ER.
→ https://laboracollective.substack.com/subscribe

2. Join the community.

This is where clinicians, midwives, doulas, researchers, patients, and organizers turn the record into a response — where the fight becomes coordinated instead of isolated.
→ https://laboracollective.com/join/

The dismantling is fast. It is designed to be. The counter-record only exists because a small number of readers decided to stop scrolling and start showing up. If that is you — come in. The room is open.

Dr. Yamicia Connor, MD, PhD, MPH

Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective

Post-operative day one. A clean incision. A bedside conversation about a permanent decision that, twelve months ago, would have been a different conversation.

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Post-operative day one. Her repeat cesarean went well. Clean incision. Anticipated blood loss. Baby is healthy. The bilateral tubal ligation we performed alongside it is, in operative terms, a two-minute add-on.

I sit at the side of her bed in the morning. She has the baby on her chest. Her partner is in the chair next to the bed. She is awake enough to talk.

She tells me what she had told me at twenty-eight weeks. She is forty-two. This is her fourth pregnancy, her third living child. She does not want to be pregnant again. She had been on an IUD for the eight years before this pregnancy — the easiest birth control she had ever used. It expired in a gap of insurance coverage she could not close. The unplanned conception happened in that gap.

She is choosing permanence because the system she lives in has, for the past three years, taught her that the system’s promises about contraception cannot be relied on.

The decision was hers. The context was not.

Read the full Viva Voce

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Last Tuesday — The Briefing · What the Lawyers Know.

Title X is being dismantled without a vote — and the law was designed to allow it. The three-move playbook, the 2019 receipt, and the statutory counter that has not been pulled.
→ https://quietdismantling.laboracollective.com/week-1/briefing/

Next Tuesday — Week 2 · The Signal · No One Signed the Death Certificate.

There is a way to kill a federal program without admitting you killed it. You don’t pass a bill. You send everyone home on administrative leave — and a year later you say the data will be released “at a later time.” That is what is happening to PRAMS.

Read the full six-week series

Stay inside the record.

I did not build The Labora Collective because I had time. I built it because after fifteen years of practicing obstetrics in this country, I could not keep watching women die inside a system that had decided their care was optional — and say nothing.

Every Tuesday, we publish what we can prove. The policy. The mechanism. The patient. The receipt. Because when the federal government has decided to stop keeping the record, someone has to hold what it drops.

If this piece landed, do two things. Neither is small.

1. Subscribe to the Substack. It keeps you inside the record instead of downstream of it — so the next dismantling does not catch you at the ER. → https://laboracollective.substack.com/subscribe

2. Join the community. This is where clinicians, midwives, doulas, researchers, patients, and organizers turn the record into a response — where the fight becomes coordinated instead of isolated, and where you find the people who see what you see. → https://laboracollective.com/join/

The dismantling is fast. It is designed to be. The counter-record only exists because a small number of readers decided to stop scrolling and start showing up. If that is you — come in. The room is open.

Dr. Yamicia Connor, MD, PhD, MPH

Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective

Sit at a dinner table with three lawyers for an hour and you will notice something. They are, almost as a profession, the most anti-institutional people in the room. They do not trust the police. They do not trust the prosecutor. They will tell you — before the salads arrive — that under no circumstances should you ever speak to a police officer without a lawyer present. Not if you have done nothing wrong. Not if there is video footage. Never.

This is strange, on the face of it. If anyone should believe in the system, it should be them.

And they are the ones who will tell you, with more certainty than anyone else you will ever meet, that the system is something to be defended against rather than something to be relied upon.

Here is why. They understand what most of us are never taught: the law is not, principally, about right and wrong. It is about who filled out which form correctly. The skill of a good lawyer is finding the crevices between right and wrong — and exploiting them before anyone notices they are there.

I am opening a clinical Briefing with this because the dismantling of Title X, right now, is the same kind of move. It is not against the law. It is what the law was designed to allow.

Read the full Briefing

Last Tuesday — The Signal · Title X Is Being Dissolved Without a Vote.

The only federal program dedicated to contraception and cancer screening for four million low-income women is being defunded administratively, without a Congressional vote. If you missed it, start there.
→ https://quietdismantling.laboracollective.com/week-1/signal/

Next Tuesday — Viva Voce · The Tubal She Chose.

Post-operative day one. A forty-two-year-old choosing permanent contraception because the system has taught her the alternative future-access pathways are closing faster than her reproductive years. The decision was hers. The context was not.

Read the full six-week series →

Read the full six-week series

Stay inside the record.

I did not build The Labora Collective because I had time. I built it because after fifteen years of practicing obstetrics in this country, I could not keep watching women die inside a system that had decided their care was optional — and say nothing.

Every Tuesday, we publish what we can prove. The policy. The mechanism. The patient. The receipt. Because when the federal government has decided to stop keeping the record, someone has to hold what it drops.

If this piece landed, do two things. Neither is small.

1. Subscribe to the Substack. It keeps you inside the record instead of downstream of it — so the next dismantling does not catch you at the ER. → https://laboracollective.substack.com/subscribe

2. Join the community. This is where clinicians, midwives, doulas, researchers, patients, and organizers turn the record into a response — where the fight becomes coordinated instead of isolated, and where you find the people who see what you see. → https://laboracollective.com/join/

The dismantling is fast. It is designed to be. The counter-record only exists because a small number of readers decided to stop scrolling and start showing up. If that is you — come in. The room is open.

Dr. Yamicia Connor, MD, PhD, MPH

Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective

What Part of My Day Was I Supposed to Spend Editing This?

A note on how this works:

The video above is the raw dictation. Unedited. Recorded between hospitals, in the car, with all the ums, the tangents, and the language I use when nobody’s transcribing me.

Below it is the same thing as an essay. The filler is gone, the sentences are cleaned up, the profanity is trimmed. Nothing else changed — not the order, not the argument, not a single idea. We ran the dictation through a tool to smooth the prose, the way you’d run a photo through a filter.

We’re publishing both, side by side, because AI detector flags the finished version as machine-written. So here’s the machine’s input and the machine’s output. You decide whose voice it is.

I feel pretty strongly about this. What makes your writing yours are the ideas. That’s just my perspective.

Let’s take a couple steps back. How do these AI detectors — what are they actually detecting? Well, they’re detecting predictability. Predictability of sentence structure. It’s a statistical model. They don’t detect anything regarding ideas, or the likelihood that a prompt could even generate it. I mean, you could be telling a story about your kid and that can flag 100% AI, even though the AI clearly does not know anything about your child. So that’s number one.

Number two, the industry itself is broken. It’s a broken incentive structure, because the same companies that do this AI detection — they use AI to do the detection — then they go back and sell you a humanizer to essentially avoid the detector. It’s so perverse.

Number three. This hurts a particular type of person. This hurts a person who doesn’t make their living from sitting at a computer writing prose. Right now, as I’m talking, I am en route from one hospital to another. I’m going to stop by and see my kids for a couple hours, and after they go to sleep I’m going to leave and drive to the next hospital. The reason I do this is because there are not enough obstetrical providers. At the same time, I’m also running a company. We do a lot of research, almost all of it given away freely, in women’s rights and reproductive health and child safety and well-being.

So the question I have for these people who are putting up these detectors is: what part of my day was I supposed to stop and go edit my prose? What part of my day? I left six hours past my shift because I had a very sick patient. It was a rough shift. And I have essentially been on call since Monday. I really haven’t left the hospital for any meaningful amount of time since Monday. So what part of my day was I supposed to spend editing this draft? I really want to know.

There’s a snobbishness about it. And the part I really don’t like is that it essentially says only one type of person is allowed to get their voice out there, and that’s the person who’s able to do this professionally, for a job, and sit at a computer all day with their coffee and their feet up and pontificate. And to that I say: no.

The reason I say that is because we know what you think. The whole world is full of your opinion. The opinions we need to hear are everyone else’s. All the other people who are actually doing things. They’re taking care of young kids. They’re working. They’re doing all those other things. I want to know what they think. I want to hear their stories. I want to hear their opinions. And if that means they have to run their dictation through an AI tool so they can get more polished prose — fine, I don’t care. I’d rather do that than hear one more take from the same group of people who always want their voice to be heard. Get a life. Seriously, get a life.

So we’re starting something. We’re going to give you my actual dictations, and I’ll show you how this becomes an essay. The computer will take out all my F-bombs, smooth out some prose, take out the ums and the ahs. What you’ll see is something a lot more polished, a lot more fluent. But the underlying thing was always mine.

This is something we teach women to do, because these are the people whose voices get silenced.

It’s a single mom watching kids and working another job. Have you ever taken out a laptop in front of little kids? You can’t do that. It’s too stimulating for them. My kids — if I bring my laptop anywhere near them, their whole reason for being becomes touching mommy’s computer. It’s so impractical. It bothers them. I can walk around with my phone, maybe dictating, but that’s as close as I can get to something that looks like work.

So the people who are making this up — it’s very obvious they get to live lives where they can do work in undisturbed settings. I would love to know what that feels like, because I haven’t felt that in a very long time. Definitely not since I had children.

If me using this tool to clean up prose makes my voice less worthy of being heard, then don’t listen. But I’m pretty confident there are a lot of people who actually don’t care. What they don’t want is lies. They don’t care if Claude goes in and cleans up my words. They don’t care at all. They don’t want their physician sitting at a computer wasting a whole bunch of time when she could be doing something much more useful.

I predict the only people who really care are the people who make money from this and who do this professionally. So we’re going to do an experiment and test whether that’s the case.

Let us know if you like it. Let us know if this works. And then we’ll do more of it.

Dr. Yamicia Connor, MD, PhD, MPH

Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective

This piece was dictated by Yamicia D. Connor, MD, PhD, MPH, structured with the assistance of a Claude model, and taken through three editing passes: voice, medical and scientific accuracy, and professional line editing. Every clinical claim has been verified against its source.

How we write

Today I am opening The Quiet Dismantling — a six-week investigation from The on how the federal safety net for women’s and children’s healthcare is being dissolved administratively, without a Congressional vote. Eighteen installments. Six programs. One playbook. We begin, this Tuesday, with Title X.

The administration has not introduced a bill to repeal Title X. It has done something quieter and more effective.

It has stopped paying.

I had a patient this March. Ectopic pregnancy — not new. She had known about it for three weeks. Her hCG was climbing. There was a mass near her left ovary. She could have ruptured at any point. She could have bled out.

She had been getting serial ultrasounds. Someone was monitoring this ectopic pregnancy — watching it grow — and doing nothing. For weeks. So I asked her: what is the name of your clinic?

It wasn’t a hospital. It was a Crisis Pregnancy Center. They had identified the mass. They had documented free fluid in her pelvis. And they had sent her home. Twice. Because a Crisis Pregnancy Center does not prescribe methotrexate. It does not manage ectopic pregnancies. It does not have licensed physicians on staff. It performs ultrasounds — and it waits.

She nearly died waiting for care at a facility that was never designed to provide it.

And this is where federal family planning dollars are being redirected.

Read the full Signal

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Next Tuesday — The Briefing · What the Lawyers Know. The dismantling of Title X is not against the law. It is what the law was designed to allow. The three-move playbook, the 2019 receipt that already ran, and the statutory counter that exists and has not been pulled.

Read the full six-week series

Stay inside the record.

I did not build The Labora Collective because I had time. I built it because after fifteen years of practicing obstetrics in this country, I could not keep watching women die inside a system that had decided their care was optional — and say nothing.

Every Tuesday, we publish what we can prove. The policy. The mechanism. The patient. The receipt. Because when the federal government has decided to stop keeping the record, someone has to hold what it drops.

If this piece landed, do two things. Neither is small.

1. Subscribe to the Substack. It keeps you inside the record instead of downstream of it — so the next dismantling does not catch you at the ER. → https://laboracollective.substack.com/subscribe

2. Join the community. This is where clinicians, midwives, doulas, researchers, patients, and organizers turn the record into a response — where the fight becomes coordinated instead of isolated, and where you find the people who see what you see. → https://laboracollective.com/join/

The dismantling is fast. It is designed to be. The counter-record only exists because a small number of readers decided to stop scrolling and start showing up. If that is you — come in. The room is open.

Dr. Yamicia Connor, MD, PhD, MPH

Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective

Trump didn’t ask Americans to sacrifice for his war in Iran. He demanded it. He never asks. He never explains.

Because he doesn’t feel he has to.

What he is saying — whether we want to admit it or not — is this:

I am a king. You are my subordinate. If you disagree with me, I will crush you. If you fight me, I will destroy you. If you question me, I will make you an example.

That is the posture. That is the message. And every time we let it pass without naming it, we agree to it a little more.

But here is what we have to remember: his ability to do this is, largely, still our choice.

The system is weak. It is not gone. The guardrails bend. They have not yet broken.

Every generation before us has held the line when it was their turn to hold it — through wars, through depressions, through movements that cost people their freedom and sometimes their lives.

They held it. The question now is whether we will hold it too.

The line will not hold forever on its own. It holds because people keep choosing to hold it.

And here is the part I want everyone — especially the professional class, the upper middle class, the people with something to lose — to hear very clearly:

The risk to us right now is much less than what prior generations paid. And it is infinitely less than what our children and grandchildren will have to pay if we let this slide any further.

⚖️ The Current Price

Right now, what does holding the line actually cost you?

Your career. A lawsuit. Some money. Maybe a promotion you wanted. Maybe the country club doesn’t invite you back. Maybe a difficult conversation at Thanksgiving. Maybe a few sleepless nights.

That is the current price.

Now look at Russia. When you disagree with the wrong person in Russia, you don’t get taken to court. You get put in a cell. Eventually you get put in Siberia. And if you put a person in Siberia long enough, there are ways of getting rid of them.

Look around the world at every place a strongman has been allowed to consolidate. The price of dissent is not your job. It is your body. It is your children. It is your mother.

If you think people don’t have the courage to fight when the risk is a lawsuit, a job, a little money — how much do you think they will fight when the risk is their children die? When the risk is someone slaughtering their mother? When the risk is being put in a cage forever?

That is the math. That is what we are choosing between.

🪧 To My Professional Class Friends

So I want to speak directly to my upper middle class and upper class professional friends, because this is the conversation we are not having honestly with each other:

This is what it looks like to hold the line.

You might risk your job. Suck it up.

You might get taken to court. Suck it up.

You might not get the promotion you wanted. Suck it up.

You might lose a client, a board seat, a friend who can’t handle it. Suck it up.

Because what I can guarantee — guarantee — will not happen if you act now is this: nobody is going to come to your house and slit your wife’s throat. Nobody is going to disappear your son. Nobody is going to put you in a cage until you forget your own name.

That is the deal on the table.

🕯️ The Bill Comes Due

This is what sacrifice looks like, right now, for people like us: do the inconvenient, costly, professionally damaging thing that has to be done. Because if we don’t do it now — when the price is money and ego and comfort — then the people who come after us will have to do it when the price is blood and dignity and human life.

And we have to ask ourselves, plainly, without flinching:

Are we such cowards that we will hand that bill to our grandchildren?

I know my answer.

Do you know yours?

On May 29, we’re launching something at the Labora Collective. It’s called Knowable. A frame. Five questions we have spent years answering, and we are putting the answers out where everyone can see them:

1. What do they want?

2. Why do they want it?

3. How are they doing it?

4. Why are they wrong?

5. How do we fight back?

You can see it clearly. You can say it plainly. You can prove it.

If you want to do your part, Knowable drops May 29.

— Yamicia

Dr. Yamicia Connor, MD, PhD, MPH

Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective

First: What is an impression? 🔍

An impression means the platform served your content to someone’s screen. That’s it. It does not mean the person read it, engaged, or was even your follower. It means the algorithm granted permission for that content to appear.

This is the entire argument. The platform controls the pipe between you and your audience. An impression is not attention. It is permission. And they are rationing it.

I have over 6,000 followers on LinkedIn. A video I posted about a doula ban — pregnant women too afraid of ICE to go to the hospital, babies being born without birth certificates — received 100 views in 24 hours. That is 1.6% reach. The benchmark for LinkedIn personal accounts is 20–30%.

The platform didn’t show it to my audience and let them decide. The platform decided for them.

Second: “People vote with their attention — that’s democracy.” 🗳️

I understand why someone who doesn’t spend their days inside datasets would think that. It sounds right. It feels like common sense.

But it’s democracy the way China and Russia are democracies. If there’s no one else on the ballot, sure — technically people voted. But the platform decides who appears on the ballot. Meta’s own data shows that up to 50% of content in user feeds now comes from accounts they don’t follow. The algorithm pre-selects what you see before you ever get to “vote” with your attention.

My post impressions hit 21,993 this week — up over 3,300%. People are manually searching for my content and sharing it despite the algorithm. They are doing the distribution work the platform refused to do.

That’s not democracy. That’s people fighting an election where most of the ballots were thrown out before they were counted.

When your users have to work against your product to share healthcare information, your product is broken.

Third: the video. 📹

Alexandra watched my video about the Minneapolis doula crisis and said it lost her in the first five seconds. With respect — she is applying Instagram logic to LinkedIn.

I’m not going to chop and jive in a post talking about a ban on birthing doulas who are secretly doing home births because ICE is terrorizing pregnant women. That would be insulting to the subject matter.

LinkedIn is not Instagram. The audience I need to reach — healthcare executives, hospital administrators, policy leaders — does not need to be tricked into watching. They need to know the content exists. The algorithm’s job is to show it to them. My data shows it did the opposite.

And here’s where Alexandra’s critique actually becomes the most important exhibit in this piece. She applied the consumer-entertainment lens — hook me in five seconds, get to the point, keep it moving — to clinical content about a public health emergency. That is not a criticism of my work. That is the algorithm’s logic, internalized by a user and spoken back to me as advice.

The platform has trained audiences to evaluate all content by entertainment metrics. Content that exists to inform rather than entertain is pre-disqualified by that standard. The algorithm created the expectation, suppresses the content that doesn’t meet it, and then points to the audience’s conditioned response as evidence that the content “wasn’t good enough.”

The audience didn’t decide my video wasn’t worth watching. The algorithm decided it wasn’t worth showing. And then it trained the audience to agree.

That is not democracy. That is manufactured consent.

Those are the direct responses. Now here’s the bigger picture.

This has nothing to do with talent. 🚫

I used to believe what Alexandra believes. I thought the problem was execution. I hired social media managers. I hired content strategists. I hired people with impressive portfolios and platform-specific expertise. None of it moved the needle.

What worked is when I stopped thinking like a content creator and started thinking like a scientist.

We run experiments. We export analytics. We compare controlled datasets. And what the data shows — consistently, across three years of active testing — is that the suppression is structural, not creative.

I run a parallel brand. Same team. Same infrastructure. Same content strategy. We can gain 2,000 followers in a weekend when the subject matter is benign — lifestyle, general wellness, nothing politically charged. Growth is immediate and predictable.

The moment the content touches maternal health policy, racial disparities in care, doula bans, ICE enforcement, Black maternal mortality — the graph changes. Not the slope. The origin.

One starts at the starting line. The other starts behind a wall.

The difference isn’t quality. It’s classification. The algorithm categorizes content before the audience ever sees it, and certain categories are born suppressed.

The verification experiment. 🧪

My pen name — a fictional alter ego — is verified by Meta. She is thriving. Growing. The algorithm serves her content to her audience reliably and predictably.

I — a practicing OB-GYN with an MD from Harvard, a PhD from MIT, and a healthcare infrastructure company — have been denied Meta verification repeatedly.

Same person. Same team. Same workflows. Same content calendar. Different subject matter, different algorithmic treatment.

We are not looking at two accounts with different growth rates. We are looking at two accounts with different starting positions. One was given access to the race. The other was not given a lane.

The platforms have a financial incentive for you to believe that if your content were just a little better, you’d be a little more visible. The research calls it “digital neurosis” — creators internalizing algorithmic suppression as personal failure. That confusion is the product.

The algorithm is not a bigot. It’s an actuary. 📊

I want to be precise about what I am claiming — and what I am not.

I am not suggesting a grand cabal. No one at LinkedIn or Meta sat down and decided to suppress Black creators. That’s not how structural discrimination works. Structural discrimination doesn’t require a villain. It requires a system that produces racial outcomes without racial intent — and it’s harder to fight than overt bigotry precisely because no one has to be the bad guy.

Here’s the mechanism.

The algorithm doesn’t ask whether you’re Black. It asks whether your content creates liability — moderation flags, advertiser discomfort, regulatory attention. And it has learned, through training data built on a society with deeply embedded racial hierarchies, that content about maternal mortality, racial health disparities, immigration enforcement, and medical racism triggers all three.

That content is disproportionately produced by Black women. Because it describes their lives.

You don’t teach a computer to be racist. You teach it to find the markers of risk through surrogate variables — topic, sentiment, lexical cues, audience demographics — and then let it decide which markers create liability versus incentive. The racial outcome is a byproduct. The algorithm doesn’t need the label. It learned the proxy.

The CEO can say “we don’t see race” and be telling the truth. The algorithm doesn’t see race either. It sees liability. It just so happens that in America, those two things cast the same shadow.

And if the algorithms were simply racist — if they just didn’t want Black people on the platform — they wouldn’t survive. Black creators generate an outsized share of the cultural content that keeps these platforms alive. TikTok’s most viral creators skew young and minority. The platforms don’t just tolerate that content. They depend on it.

They need Black creativity. They just don’t need Black pain. The music but not the funeral. The dance but not the data.

That is the oldest structural trap minorities face: your labor is commodified, but your suffering is inconvenient.

This is not only a race issue. And the women reading this already know that. 👁️

I have plenty of white women in this community. They’re here in solidarity — and they’re here because the algorithm has decided that women’s issues broadly are among the most inconvenient content categories of all.

Post about abortion. Doesn’t matter the color of your skin. They don’t want it.

Post about trans healthcare access. Same calculation — liability without profit.

Post about maternal mortality, postpartum depression, doula bans, reproductive rights. The platform runs the same math every time: does this content create more engagement value than moderation risk? And for women’s health content, the answer keeps coming back no.

The suppression is universal on gender. It compounds at the intersection of race. Both of those things are true simultaneously, and acknowledging one does not erase the other.

Diosa Ara doesn’t have a Facebook page anymore. Not because we violated community standards. Because we published images of pregnancy and breastfeeding and the platform flagged it until we were removed.

We are not a pornographic company. We are a women’s health organization. And we were banned from Facebook for showing what women’s bodies do.

A platform that hosts billions of pieces of content every day decided that a pregnant belly was too much. If you need one example that captures everything this series is about, that’s the one.

Same creator. Same account. Different content. Different outcome. ⚖️

I have boosted posts before. When it’s a photo of me with a benign caption — something personal, something light — the boost performs as expected. Reach expands. Audience matches targeting. The product works.

When I boost a post about doulas hiding from ICE, the product breaks.

Same creator. Same face. Same ad budget. Different content classification. Different algorithmic treatment.

Here’s what nobody tells you about deploying an ad budget on these platforms: when you are a user, you are the product. When you spend money, you become a customer. That changes the relationship — and the liability.

Once you pay, the platform has a contractual obligation to deliver. But it also has an incentive to monitor what it’s distributing under a paid arrangement. Spending money doesn’t just buy reach. It buys scrutiny. More visibility and more surveillance, simultaneously.

We deployed a budget and saw degradation — not improvement. Because spend changes the contract. You’re no longer a user generating free engagement. You’re a customer whose content the platform is now responsible for. And if that content touches maternal mortality or ICE enforcement, the safest move — for the platform — is to bury it quietly and keep the money.

“But don’t platforms have the right to manage liability?” 💰

Yes. And at the scale they operate, that liability management is economic policy — whether they recognize it or not.

These companies are not making decisions about individual posts at individual moments. They are making systemic classification decisions that affect entire demographics and entire categories of economic activity. When you suppress maternal health content at scale, you are not moderating one physician’s video. You are making a macroeconomic bet that the economic value of that content is less than the moderation cost.

The data says that bet is wrong.

The content they suppress has direct economic value — not just to creators, but to the platform’s own revenue model. Maternal health is not free. Poor outcomes are not economically neutral — not for families, not for insurers, and not at scale.

The women who consume this content on LinkedIn are professionals. Many have disposable income. And once basic needs are met, spending shifts to safety, dignity, experience, and respect — the products and services that serve those higher-order needs. That spending generates economic activity. That activity creates the consumer base advertisers pay the platform to reach. Suppress the content that serves those needs, and you interrupt the loop that feeds your own ad revenue.

On LinkedIn specifically, the argument is even more direct. People are here to work — to find talent, collaborators, products, networks, information. When an entire segment cannot reliably build professional ecosystems on this platform, you have excluded them from your marketplace. That exclusion costs the platform transaction volume, not just the creator visibility.

You think these platforms would survive if they couldn’t guarantee Amazon: pay X, get Y? They wouldn’t. Because Amazon doesn’t want to be popular. Amazon wants to be profitable. And when paid distribution produces negative returns — when investing in the product makes the product worse — the system is not broken by accident.

Apply economic logic, not entertainment logic. 🧠

This is the reframe that changes everything — and it’s what Part 3 of this series will break down in detail.

When you apply entertainment logic to your social media performance, every dip feels personal. Every suppressed post feels like failure. You start wondering if your hook was wrong, your video was too long, your thumbnail was off. You start listening to people who are incentivized to sell you content improvement services. And you lose months — sometimes years — chasing creative fixes to a structural problem.

When you apply economic logic, the data becomes interpretable. You can see that there are forces larger than you moving the market’s response to your content. You can contextualize a bad week without internalizing it. And you can make strategic decisions instead of emotional ones.

I am not an economist. I took intro to economics in my MPH program and I read widely. But this much is clear: the economics of platform distribution have very little relationship to your personal experience of money. It requires a different kind of thinking — and most people have never been asked to apply it to their social media presence. That’s by design. The platforms benefit when creators think in terms of content quality rather than market structure.

We want you focused on your mission — not on chasing advice from an industry that profits from your confusion.

Economies are interdependent. Your success is our success. 🤝

Here’s the thing about niche markets that most people get wrong: the presence of competition doesn’t reduce your market. It generates it.

You can go to any store and buy six or seven different types of the same soda. Those companies aren’t destroying each other’s demand. They’re collectively creating the demand for that product category. The same principle applies to women’s health content. Every creator, every organization, every physician who builds an audience in this space is expanding the ecosystem that all of us need to survive.

If someone in this community has a breakthrough — if a maternal health organization or a women’s health creator exits the normal distribution patterns and enters a genuinely different growth trajectory — that elevates everyone in the ecosystem. That’s how algorithms actually work. Engagement in a content category raises the visibility of that entire category. One account’s virality creates spillover reach for accounts in the same space.

We have every incentive to help each other. And so do you.

Fifty percent of the population are women. And yet women’s health is treated as niche. If you were an AI company building another PowerPoint generator, you’d have a completely different algorithmic trajectory. Different category. Different calculus. Different starting position.

We don’t get that starting position. So we build together. Because in a suppressed category, collective growth is the only reliable path to individual visibility.

The proof is in what happened this week. 📈

This newsletter — The Non-Compliant Physician — gained 358 subscribers in seven days. That is a 35,800% increase. Impressions are up 3,336%. Members reached are up 4,046%.

This is the first edition.

This content is no more important than dozens of other things I’ve published. The writing is no sharper. I am the same person I was last month. The difference is that the distribution infrastructure existed before the content dropped. That’s strategy — not talent, not luck, not a better hook.

We have an entire library of work that would never perform like this on its own. Not because it’s less valuable. Because it touches subjects the algorithm has classified as inconvenient. The quality didn’t change. The conditions did.

Why it took three years to say this publicly. ⏳

I want to be honest about something that I think will resonate with anyone who isn’t a natural content creator.

I had to make this analytical because the frustration was making it impossible to function inside the process.

I am not a content creator. I am a scientist. I look at data for a living — that’s the whole job, regardless of the domain. When I export my LinkedIn analytics and compare two controlled datasets, I’m not guessing. I’m reading. And if you aren’t trained to live inside data, you might miss the structural patterns. That’s not an insult. That’s the entire point of this series — to make the patterns visible to everyone.

I don’t produce content because I think it will entertain. I produce content because it’s true and it’s important. For three years, that calculus didn’t translate into reach. I hired experts. I tested formats. I spent money. Nothing produced consistent, predictable results.

What changed is that we stopped chasing creative fixes and started studying the system. We are a group of engineers, scientists, and physicians trying to maintain a professional presence that doesn’t undermine the business we’re building. We don’t have a VC-funded marketing department with a $40,000 quarterly line item for paid social. And that’s what people don’t see when they wonder why the same mediocre posts keep appearing in their feed — it’s not because audiences chose them. It’s because someone paid for those placements. That’s not organic visibility. That’s a budget.

We don’t have that budget. So we learned the mechanics instead. Three years of constant evolution and trial and error. And we didn’t publish until we were confident the patterns were consistent — not a one-time occurrence, not bad luck, not an emotional reaction. A documented, reproducible trend.

Why we’re publishing this now. 📢

Because what turns something from anecdotal to structural is other people’s data. That’s what changes the calculus. One account’s analytics is a case study. A hundred is evidence. A thousand is a policy argument.

We are presenting our perspective not as universal truth but as a guidepost — so that other creators and organizations can analyze their own performance and see if these patterns hold. If they don’t, push back against us. We welcome it.

But what we suspect is that many more people will recognize what they’re seeing once they know what to look for. Especially in women’s health — a space so anodyne, so clinically straightforward, that the suppression can’t be explained by controversy. We publish on maternal health. We’re not provocateurs. And we were still banned from Facebook for images of pregnant women.

Part 2 drops next week with the full data — reach collapse tables, CAC benchmarks, the influencer pay gap coded to skin tone and hair texture, healthcare AI bias studies, and the $1.7 trillion economic case. I’m giving people time to digest this before publishing the receipts. Timing and release matter. You don’t cannibalize your own momentum.

Part 3 will be what we’ve learned — not theory, but practice. How to think about platform strategy like a scientist. How to protect your mental health when your numbers fluctuate for reasons you can’t see. How to stop wasting time on advice from people whose business model depends on you believing the problem is your content. We haven’t figured it all out. But there are patterns, and accounts doing similar work may benefit from what we’ve found.

We’re publishing this because we want you focused on your mission. There are moral reasons to care about algorithmic equity — and they matter to us. But people hear moral arguments and shut down. So we’re making the economic case. Because your success is our success — quite literally, through the mechanics of how these algorithms distribute content within a category.

The bottom line. 🔩

An algorithm is a statistical machine with human bias layered on top. It is predictable. It is documentable. And these platforms know that. They built trillion-dollar companies on open distribution. Facebook’s valuation was built on the premise that anyone could reach anyone. LinkedIn’s value proposition is professional connectivity. They proved that democracy scales. They proved that democracy makes money.

And now they are dismantling the mechanism that made them valuable — gambling that they can keep extracting without reinvesting, suppressing content while maintaining the ecosystem advertisers pay to reach.

If you look at what happened to every platform that made that bet — MySpace, Tumblr, Twitter under its current management — the answer is already written. Greed has never outrun the math. It never will.

If you are a Black woman founder, a minority-led health organization, a physician posting about things that matter and watching your numbers flatline — it is not you. It is not your content. It is not your hook.

It is the system. And the system is documented.

Add your data. Export your analytics. Share what you’re seeing. We are building the public record — and the more of us who contribute, the harder it becomes for anyone to call this anecdotal.

Dr. Yamicia Connor, MD, PhD, MPH OB-GYN | CEO, Diosa Ara | Founder, The Labora Collective

The Algorithmic Tax Series: Part 1

The Argument Part 1B — This Has Nothing to Do With Talent (you are here)

Part 2 — The Evidence (next week)

Part 3 — What We’ve Learned (coming soon)

Dr. Yamicia Connor, MD, PhD, MPH

Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective

The Labora Collective publishes at the intersection of clinical care, policy, and innovation — because only 10% of your health outcomes come from the exam room. The other 90% is what we cover.

Explore the Labora Collective → Member Home: Start Here

Become a Member → Subscribe to The Labora Collective by Diosa Ara: Member Edition

Message from our founder → Read Viva Voce: Come Inside the Build

Let me be clear about something before people decide what kind of doctor I am. I have stepped out of patient rooms. I have called security. I have told a nurse: when she is ready to have a conversation, I will be in my call room — right down the hall, not going anywhere, but I am not standing here to be cursed at.

That is not abandonment. That is a boundary.

Those are two different things, and I think it matters that we say so.

I am not out here telling you that patients are never wrong or that physicians should absorb abuse as part of the job. I am not some idealist who has never had a difficult patient, a combative family member, a situation that required security or risk management or a very uncomfortable conversation with hospital administration.

What I am telling you is that there is a framework for those situations — and calling a federal judge is not in it.

🚔 The Police Officer Analogy

Here is the analogy that keeps coming back to me: being a police officer means working in real danger—and yet there are lines that cannot be crossed. The job carries real risk, there are people who are genuinely dangerous, and there are situations that are genuinely threatening. That is true. And none of that — none of it — gives you the right to shoot an unarmed person.

The risk is real and the line still holds. Obstetrics is the same. The liability exposure is real. The fear is legitimate. I have been post-call, running on nothing, covering for a colleague who didn’t show up, standing in a room knowing I was not at my sharpest and that I could not leave. I have been in situations where I knew, clinically, that the outcome was not going to be good no matter what I did. The risk is real. And the line still holds.

🎯 Where Your Focus Is

Here is what I want to say about that fear — because I think this is the part nobody talks about honestly: I rarely worry about getting sued. What I worry about, constantly, is neurological compromise in a baby. I worry about the woman I haven’t checked on. I worry about the EKG nobody looked at. I worry about the patient who is writhing in a way that doesn’t look like fibroid pain — because I have seen that before, and I have seen what happens when nobody goes back in the room. That is a completely different orientation than worrying about liability. And I think that difference — in where your focus is, in what you are afraid of — is actually the thing that determines what kind of physician you become.

👩🏾⚕️ Two Completely Different Doctors

The doctor who is afraid of getting sued practices defensively. The court order is a defensive move. The Pepcid for chest pain nobody investigated is a defensive move. Covering yourself is a defensive move.

The doctor who is afraid of missing something practices differently. She goes back in the room. She looks at the EKG. She comes back for conversation six and seven. She stays post-call when the other physician doesn’t show, not because she is heroic but because she cannot imagine the alternative.

I am not claiming to be the best doctor in the world. I am saying there are principles and standards — and if you practice by them, you are probably going to be okay. Not because the legal system is fair. It isn’t always. But because the physicians I have seen get into serious trouble were not, in my experience, physicians who showed up. They were the ones who didn’t.

And I think we owe it to each other — and to our patients — to say that out loud instead of letting fear drive us toward mechanisms that should never be part of medicine at all.

📍 Series Navigation The Physician Conscience Trilogy

Part 1: The Court Order Was Not Medicine

Part 2: I Would Refuse

Part 3: Where Your Focus Is ← You are here

Dr. Yamicia Connor, MD, PhD, MPH

Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective

The Labora Collective publishes at the intersection of clinical care, policy, and innovation — because only 10% of your health outcomes come from the exam room. The other 90% is what we cover.

Explore the Labora Collective → Member Home: Start Here

Become a Member → Subscribe to The Labora Collective by Diosa Ara: Member Edition

Message from our founder → Read Viva Voce: Come Inside the Build

I need to say something that might cost me professionally but I will say it anyway.

There are things I would not do. Not because I can’t, but because they are wrong.

If a hospital I worked at called a federal judge to compel a laboring woman to have surgery against her will — I would refuse to participate. I could not stop the institution from doing it, but I would not cooperate. I would not be in that room under those circumstances, and I would present my own version of the clinical data to that judge, even if the institution was furious with me for doing it. Because a judge making a decision about a woman’s body while she is in labor deserves to have the full picture — not just the picture the hospital’s lawyers assembled.

That is not a popular position. It is the correct one.

🏛️ On Hospital Ethics Committees

I’ve called hospital ethics committees. I’ll be honest: I’ve largely found them to be worthless. Not because the people on them are bad. It’s because they exist, in many cases, to manage institutional risk — not to protect patients. There is a difference. And physicians need to start saying that out loud.

⚖️ The Calculated Risk We Accepted

Here is what I actually believe about liability in obstetrics: it is a calculated risk. Every time you walk into a delivery room, you are accepting that risk. That is the job. And there are going to be cases where you do everything right and something still goes wrong. There are going to be cases where a patient is angry, or frightened, or has psychiatric instability, or is simply making a decision you disagree with. In those circumstances, you call your risk management team. You document. You have the conversation again. And again. You bring in colleagues. You exhaust every relational tool available to you.

What you do not do is call a federal judge.

🔎 Why This Is So Clear to Me

I want to be honest about something, because I think it matters to this conversation: maybe part of why this is so clear to me is because I am Black. Maybe it’s because I have personally experienced what it feels like to have the weight of a large institution brought to bear on your body and your choices. That is not a bias that clouds my judgment. That is knowledge. There is a difference between the two — and the people who invoke “bias” to dismiss this perspective are often the ones who have never had to feel that weight.

💔 I Know Exactly How It Happens Now

Here is what I know from training in a well-resourced academic center and then practicing in very different environments: I used to genuinely not understand how women died in childbirth in this country. In residency, if a patient had a bad fetal heart rate tracing, there were two attendings in the room. A shoulder dystocia brought five OBs to the floor. I thought maternal mortality was a mystery.

It is not a mystery. I know exactly how it happens now.

It happens when nobody shows up. It happens when a post-call physician doesn’t come in and nobody covers. It happens when a Haitian Creole-speaking woman at 20 weeks is given Dilaudid overnight for what everyone assumes is degenerating fibroid pain — and nobody checks her, and she is actually in preterm labor, and by morning she is far enough along that everything we could have offered that baby we no longer can. It happens when a Black woman has chest pain and three providers round on her and order Pepcid and nobody actually looks at the EKG — and she is quietly dissecting a coronary artery, and the only reason she survives is because one person, finally, looks at the strip and says: this doesn’t look right.

I have been that person. More than once.

🚨 The Cases That Shocked Me Were Never the Hard Ones

The cases I have seen that shocked me were never the edge-of-viability deliveries or the rare catastrophic ruptures. They were the cases of plain, pure neglect. Someone not showing up. Someone not looking. Someone not coming back to check.

That is what kills women. Not the difficult clinical decisions. The absence.

And so when I hear colleagues frame the Florida case as a liability calculation — as a rational institutional risk management decision — I want to ask them: what is the liability calculation for not showing up? For not checking? For the EKG nobody read?

Because in my experience, the physicians most consumed by liability fear are not the ones at greatest risk. The ones at greatest risk are the ones who aren’t there. The ones who aren’t present. The ones whose nurses are not documenting “provider at bedside” because the provider is not at the bedside.

Calling a federal judge on a laboring woman is not medicine. It is not risk management. It is an institution using the machinery of the state to override a patient’s body — and asking physicians to participate in that override.

I won’t. And I think more of us need to say that clearly.

📍 Series Navigation The Physician Conscience Trilogy

Part 1: The Court Order Was Not Medicine

Part 2: I Would Refuse ← You are here

Part 3: Where Your Focus Is - Coming soon

Dr. Yamicia Connor, MD, PhD, MPH

Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective

The Labora Collective publishes at the intersection of clinical care, policy, and innovation — because only 10% of your health outcomes come from the exam room. The other 90% is what we cover.

Explore the Labora Collective → Member Home: Start Here

Become a Member → Subscribe to The Labora Collective by Diosa Ara: Member Edition

Message from Myself → Read Viva Voce: Come Inside the Build

I was supposed to be on call today. The schedule got messed up. And I find myself with no kids, no patients, and a dangerous amount of space to think.

So I’m doing a thing.

Maybe brilliant. Maybe catastrophic. Only time will tell. But I am tired of living as a fractured mind — something women are asked to do every single day without ever being given the language for it.

I am integrating.

If you know me as a physician — a maternal health researcher, a clinical intelligence builder, someone who thinks in systems about how to keep women alive — that’s real.

That’s one room in my mind.

If you don’t know about the other room, that’s by design. I have a pen name. I write fiction. Erotic romance. Stories about power and desire and what happens when women stop performing safety for everyone around them. A million words. Eighteen storylines.

Characters I’ve lived with for years.

Two identities. Two brands. Two audiences. One mind running both.

Today I’m opening a door between those rooms.

This is where I talk about the architecture of my mind — how the clinical and the creative run on the same operating system, why the pen name exists, what it means to build two companies from the same set of obsessions, and what I’m learning about integration in real time.

This will be raw. This will be unscripted. This is not a strategy — it’s a reckoning.

The first session is a live. Today. Because when the universe clears your schedule, you listen.

If you’re interested in how a physician builds worlds — both the clinical kind and the fictional kind — this is where that conversation happens.

Subscribe to join. More soon.

— YC

Dr. Yamicia Connor, MD, PhD, MPH

Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective

I need to say something as both a physician and a patient.

I’ve had two C-sections. I’m pretty sure I had a bladder injury with my second one. My bladder was never the same after that. I’m not saying anyone did anything wrong — it’s surgery. Surgery is hard, and bodies are complicated. I know that better than most.

I also know what a uterine rupture looks like. I’ve been in that room. And I will tell you — those babies did not come out well. That experience stays with you. It shapes how you counsel. It impacts how many times you go back to have that conversation with a patient who isn’t ready to hear it yet.

So when colleagues push back on my piece about the Florida case — I hear you. I understand the liability fear. Practicing OB/GYN is not for the faint of heart. You are one bad outcome away from losing everything you built. That is real and I am not dismissing it.

🩺 But here is what I know from being in those rooms:

The way you mitigate liability is not through a court order. It’s through presence. It’s through sitting down — not standing in the doorway. It’s through honest, direct, non-paternalistic conversation. Not, “do what I say.” But, “I have watched this go wrong, and I need you to understand what I’m worried about, and why.”

I have never — not once — met a patient who, after that kind of sustained, genuine, empathetic counseling, still refused when I was truly worried. It might not happen on conversation one. It might be conversation six or seven. But it happens. It happens because patients know the difference between a doctor who is covering themselves and a doctor who actually gives a damn about their baby.

🔦 What Stopped Me Cold

And here’s something I need to say that has been sitting with me:

I have been thanked — genuinely thanked — by nurses for showing up to a call. For coming to the bedside. Multiple times. They were relieved. Like they hadn’t been sure I was coming. And I remember standing there thinking: I didn’t know that was considered extraordinary. I didn’t know that not coming was an option anyone was taking.

That stopped me cold.

Because some of the best documentation of my clinical presence and decision-making was never written by me. It was written by nurses. In real time. Every conversation I had at that bedside, every recommendation I made, every time I came back — documented. Provider at bedside. Provider counseling patient. Provider stating this concern. While I was focused on the patient, they were building the record.

That is what protection looks like. Not a court order. A relationship. A team. A documented pattern of showing up.

⚖️ The Physicians Most Consumed by Liability Fear

There is enormous heterogeneity in this specialty. The physicians most consumed by liability fear are often — not always, but often — the ones with the least reason to be worried about it. Because the ones who are present, who counsel thoroughly, who have nurses writing 25 notes to their one — those are not the ones getting sued. Plaintiffs’ attorneys are not filing weak cases. They are looking for absence. For dismissiveness. For a patient who felt like no one came.

There is a difference between counseling and coercion. And when we blur that line — when we reach for legal mechanisms instead of relational ones — we don’t just fail the patient. We fail ourselves. We fail the profession. And we create the exact liability exposure we were trying to avoid.

I can only do so much. I cannot predict the future. But I can be present, be honest, and trust that the relationship I build with my patient is the strongest legal protection I have.

The court order was not medicine. It was fear dressed up as clinical necessity. And we deserve to be honest about that.

📍 Series Navigation The Physician Conscience Trilogy

Part 1: The Court Order Was Not Medicine ← You are here

Part 2: I Would Refuse - Coming soon

Part 3: Where Your Focus Is - Coming soon

Dr. Yamicia Connor, MD, PhD, MPH

Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective

The Labora Collective publishes at the intersection of clinical care, policy, and innovation — because only 10% of your health outcomes come from the exam room. The other 90% is what we cover.

Explore the Labora Collective → Member Home: Start Here

Become a Member → Subscribe to The Labora Collective by Diosa Ara: Member Edition

Message from our founder → Read Viva Voce: Come Inside the Build

Let’s talk about the recent ProPublica article highlighting a case where a Florida hospital brought a federal judge into a pregnant woman’s room to force her to have a fourth C-Section against her will.

For context: I’m an OB/GYN, a physician-scientist, and I run an obstetrical emergency infrastructure company. I look at maternal and fetal data for a living.

When a story like this breaks, the public assumes the medical risk must have been astronomical to justify a judge intervening. But this case perfectly illustrates a massive, systemic misunderstanding of medicine and a misunderstanding of risk. And it should terrify every woman who plans to give birth.

Here is why this was literally nonsensical, and why we don’t call federal judges to terrorize women for “bad“ medical decisions.

⚖️ 1. We Tolerate a 1.5% Fetal Risk Every Single Day

The hospital wanted to force a C-section because the patient had three prior C-sections and wanted to labor (a 3-peat Trial of Labor After Cesarean, or TOLAC). The fear is uterine rupture. The clinical data shows the risk of rupture after three prior C-sections is roughly 1.2% to 2.5% [1].

Here is the open secret in Obstetrics: A 1.5% risk of fetal morbidity is completely routine. If we didn’t clinically tolerate a 1.5% fetal risk, literally no one would ever have a vaginal delivery.

Patients make decisions that carry significantly higher statistical risks than this constantly. They decline inductions after their water has been broken for 24 hours. They decline gestational diabetes screening. The risks of fetal sepsis or hypoxic injury in those scenarios are often objectively higher. When patients make those choices, we counsel them, document it with AMA (Against Medical Advice) forms, and monitor them. We do not call judges.

🔬 2. The “Delta of Danger” is a Fraction of a Percent

The American College of Obstetricians and Gynecologists (ACOG)—our national governing body—states that allowing a woman to labor after two prior C-sections is a safe, reasonable option for appropriate candidates [2].

The risk of uterine rupture for a 2-peat TOLAC is roughly 0.9% to 1.8% [3].

So, we are talking about a fractional, roughly ~0.5% increase in absolute risk between a delivery where we confidently say, “Go ahead, it’s safe to labor!” and a delivery where a hospital says, “This is so uniquely dangerous we are getting a court order to cut your abdomen open.”

That isn’t biology; that is a hospital panicking because their standard-of-care liability shield ran out after the second C-section.

🏥 3. The Hospital Ignored the Maternal Risk Entirely

The hospital’s legal team treated a fourth C-section like it was a benign, zero-risk procedure that magically fixed the 1.5% fetal risk.

It is not. Based on the reporting, this patient had heavy comorbidities, including severe obesity. A fourth C-section on an obese patient carries staggering maternal risks: massive hemorrhage from dense scar tissue, bowel or bladder injury, devastating post-op infections, and blood clots (DVT/PE).

The hospital used the threat of the court system to compel a woman to accept very high, very real maternal morbidities to mitigate a 1.5% fetal risk that she had already consented to take on.

🚨 4. The Slippery Slope Should Terrify You

And THIS is the real problem. Once you establish the legal precedent that a state can force a major abdominal surgery to mitigate a fractional fetal risk, where does it end?

This is what happens when women lose reproductive autonomy. My fear is that they aren’t going to let women labor at all. If you have a Category II fetal heart rate tracing—which happens constantly in normal, healthy labor—is an administrator going to walk in with a court order and force you to have a C-section because they don’t want to accept the risk of waiting for a Category III?

We do not call federal judges to terrorize women in the middle of labor. This is the weaponization of fetal personhood to offload institutional liability onto a woman’s body, and it just made all of obstetrics infinitely more dangerous.

References

1. Risk of uterine rupture with TOLAC after multiple prior C-Sections: Limited data places the risk generally under 2%. Cahill AG, Tuuli M, Odibo AO, Stamilio DM, Macones GA. Vaginal birth after cesarean for women with three or more prior cesareans: assessing safety and success. (While older, this foundational perspective remains in clinical modeling.)

2. ACOG Guidelines on VBA2C: American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery. (Reaffirmed consistently, validating TOLAC for women with two previous low transverse cesarean deliveries).

3. Risk of uterine rupture with VBA2C: Tahseen S, Griffiths M. Vaginal birth after two caesarean sections (VBAC-2)—a systematic review with meta-analysis of success rate and adverse outcomes of TOLAC-2 versus LSCS-3. BJOG (Meta-analysis showing rupture rates near 1.4% for VBA2C).

Yamicia D. Connor, MD, PhD, MPH

Physician Scientist | Writer

Explore The Labora Collective → Member Home: Start Here

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Subscribe to Dr. Connor’s Substack → Join the Community

© 2026 Diosa Ara, PLLC. All rights reserved.

I want to be clear about what this is and what it isn’t.

This is not a complaint. The amount Black women absorb daily without complaint would fill ten Truth Social accounts. That silence is strategic triage, not contentment. We are quiet because we are working. We are working because we don’t have the luxury of being loud about every indignity and still getting things done.

This is documentation.

I am a physician-scientist. I know what data looks like. And what I’m going to show you is not anecdotal, not conspiratorial, and not a feelings-based argument about fairness. It is an economic analysis of how the platforms that promised to democratize access instead built a toll road with racial pricing.

And I have the receipts.

💬 What the Platforms Promised

Social media was supposed to level the playing field. That was the pitch. For the first time in history, a small business — a woman running a practice out of a rented office, a doula building a client base from her kitchen table, a health educator who couldn’t afford a PR firm — could reach her audience directly. No gatekeepers. No agency retainers. No million-dollar ad budgets.

That was real, for a while. And then it wasn’t.

Facebook’s organic reach — the percentage of your followers who actually see what you post — dropped from 16% in 2012 to 2.6% by 2024. That’s an 84% decline. Not because your content got worse. Not because your audience lost interest. Because the platform realized it could charge you for access to people who already chose to follow you.

Seventy-seven percent of U.S. small businesses use social media for marketing. Forty-one percent depend on it directly for revenue. These are not Fortune 500 companies with diversified marketing budgets. These are the businesses that employ your neighbors. And the platforms pulled the rug.

The alternative? A PR agency retainer starts at $18,000 to $30,000 for six months. That is not a real option for most of the people reading this.

So you pay the platform. You boost. You target. You play the game.

And then you find out the game is rigged.

📊 What the Data Shows

In 2019, peer-reviewed research from Northeastern University proved that Facebook’s ad delivery system skews by race and gender even when the advertiser sets fully inclusive targeting. You can target everyone. The algorithm decides who actually sees it. And the algorithm has preferences.

In 2022, the Department of Justice settled with Meta over discriminatory delivery of housing advertisements. The platform was showing housing ads to different racial groups at different rates — not because advertisers requested it, but because the algorithm learned to do it on its own.

Facebook’s own internal researchers found that Black Instagram users were 50% more likely to have their accounts disabled than other users. When the researchers flagged this, management suppressed the findings. They knew. They chose not to fix it.

Meanwhile, the content moderation systems that are supposed to protect users from harmful content have been shown to misclassify racial discrimination discourse as “toxic.” You can talk about racism on these platforms — as long as you’re abstract enough that the algorithm doesn’t notice. The moment you get specific, the moment you name what’s happening, you get flagged.

And the money? The money is a separate scandal.

$12.4–19.5B

Ad fraud costs U.S. social media advertisers annually. LinkedIn carries a 25% invalid traffic rate — the highest of any major platform. A quarter of what you’re paying for doesn’t even reach a real person.

Facebook settled for $40 million after admitting it inflated video metrics by 150 to 900 percent — meaning advertisers were making budget decisions based on fabricated data.

You are paying for access you’re not getting, to audiences that are being filtered by race, on platforms that are lying about performance, while the content you create gets suppressed if it says anything the algorithm finds inconvenient.

That is not a marketplace. That is an extraction system.

💰 The Influencer Economy and Who Gets Paid

It’s not just advertising. The entire creator economy is structured around the same asymmetry.

Black creators earn 34% less than white creators for equivalent work. Southeast Asian creators earn 57% less. This is not because the content is different in quality. It’s because brand partnership rates, algorithmic amplification, and sponsorship pipelines all flow through the same biased infrastructure.

The platforms built their empires on Black culture. Black language, Black humor, Black trends, Black creativity — these are the raw materials of social media. TikTok without Black creators is a different platform. Instagram without Black aesthetics is a different product. And yet the people who generate the cultural value that makes these platforms relevant are systematically paid less and shown to fewer people.

That is not an accident. That is a business model.

⚡ Three Levels of Harm

The damage isn’t just personal. It operates at three levels, and each one compounds the others.

The first is business. A great product no one can find is not a business. It’s a group project. When the algorithm decides that your content doesn’t get distributed — not because it isn’t good but because of who you are — your business doesn’t fail on its merits. It fails because the infrastructure was designed to make it fail. I run a medical practice. I run a health media company. I produce clinical content that people seek out, share, and fight to distribute even when the platform buries it. And the platform buries it.

The second is economic. Black women own 3.5 million businesses in this country, generating over $60 billion in annual revenue. We disproportionately employ and invest in other marginalized communities. When our businesses fail, it doesn’t just affect us. It cascades. The employees lose jobs. The communities lose services. The local economies lose circulation. If Black women achieved revenue parity with men, it would add $1.7 trillion to the U.S. economy. That is not a diversity statistic. That is a GDP number.

The third is community. Black women provide social infrastructure that the United States traded away for free-market capitalism. We run the nonprofits. We staff the clinics. We organize the mutual aid. We hold the communities together. And we don’t even get the benefits of the free-market capitalism that was supposed to be the trade-off. Black founders received 0.4% of all U.S. venture capital in 2024. The racial wealth gap grew by $49,950 per household between 2019 and 2022. McKinsey estimates this gap costs the U.S. economy $1 to $1.5 trillion per year.

This is not capitalism. It is exploitation dressed as capitalism. A handful of trillionaires extracting value from communities absorbing all the risk and none of the reward.

🧾 My Receipt

I’ll make this specific, because I don’t ask anyone to trust data they can’t see.

I posted a video on LinkedIn — myself, on camera, which I rarely do — about doulas in Minneapolis who have formed a quiet coalition to attend home births for women too afraid of ICE raids to go to the hospital. These are women whose babies will be born American citizens. Babies who may never get birth certificates. A population that will grow up in this country with no paper trail, no vaccination records, no way for the public health system to even know they exist.

That video got 100 views in 24 hours. I have over 6,000 followers. That is 1.6% reach.

The benchmark for personal accounts on LinkedIn is 20 to 30 percent reach. I got 1.6%. For a physician. On camera. Discussing a public health emergency involving American-born children.

Meanwhile, my cumulative profile impressions hit 17,000. People are still commenting, still sharing, still going out of their way to manually distribute content that the platform is actively burying. The content resonates so much that my audience is fighting the algorithm to get it seen.

That is the tell. When your users have to work against your product to share healthcare information, your product is broken.

And then there’s the boost experiment. I spent $80 to boost a post on LinkedIn. I targeted executives, C-suite, healthcare leaders. Here’s what I got:

💸 Boosted post ($80 spent)
Reached research assistants and software engineers at Amazon, Google, and Meta.
Entry-level: 34% · Healthcare: 9.2% · Impressions/hr: 73

📢 Organic post (free)
Reached founders, co-founders, and CEOs at healthcare organizations.
Senior-level: 35% · Healthcare: 13.1% · Impressions/hr: 100

I paid $80 for audience degradation. The free post found my actual audience. The paid post buried me in people who would never become patients, subscribers, or partners.

I am a physician-scientist. I have an MD from Harvard. A PhD from MIT. I run a medical practice and a healthcare infrastructure company. And a platform is charging me money to show my clinical content to interns at tech companies instead of the healthcare leaders who are already looking for it.

I can do bad all by myself. I don’t need to pay for it.

🧠 The Competence Argument

I am not making a moral argument. I’ve learned that moral arguments don’t move people who don’t make decisions based on morality. So let me make an economic one.

The people running these platforms are bad at their jobs.

Every major social media company became what it is because of a very specific set of conditions: concentrated human stability, widespread economic participation, relative absence of large-scale conflict, and a population with enough leisure, safety, and disposable attention to scroll, click, and buy.

That is the product. Not the technology. Not the algorithm. The product is a calm, connected, consuming population. That is what advertisers pay for.

And the leadership of these companies is systematically dismantling every condition that makes their own product possible.

When you suppress the voices of the people who stabilize communities — healthcare providers, educators, small business owners, the people who employ their neighbors and invest in their own zip codes — you are not saving money on moderation. You are destroying your customer base.

When you allow misinformation to outperform clinical guidance because high-arousal content drives engagement metrics, you are not optimizing revenue. You are eroding public health infrastructure that keeps your users alive and online.

When you build advertising systems that provably deliver worse results to Black business owners, you are not running a neutral marketplace. You are leaving $1.7 trillion in economic activity on the table — activity that would generate the spending, the employment, and the tax base that sustains the consumer economy your shareholders depend on.

This is not ideology. This is arithmetic.

The platforms got rich selling access to a stable, prosperous society. They are now — through algorithmic bias, moderation failures, and strategic cowardice — actively destabilizing that society. When the internal conflict scales enough, when the external wars multiply enough, when people stop feeling safe enough to shop and scroll and share — no one will be on LinkedIn looking at advertisements.

The question is not whether this is unjust. The question is whether it is sustainable. And the answer — by their own metrics, by their own revenue models, by their own shareholder logic — is no.

🪞 The Diversity Argument They Don’t Want to Hear

I keep hearing “diversity” framed as a values proposition. A nice thing to do. An aspiration.

It’s not. It’s a risk management strategy. And the fact that this has to be explained to people who claim to be good at business tells you everything about the quality of decision-making at the top of these organizations.

Homogeneous leadership makes homogeneous mistakes. When everyone in the room has the same risk tolerance, the same blind spots, the same instinct to protect their position over protecting the platform, you get exactly what we have: the most prosperous companies in human history giving away their competitive advantage because no one in the room had the courage or the perspective to say “this is going to break.”

The most minuscule pressure — a regulatory threat, a political shift, a loud voice on social media — and these leaders fold. They abandon principles they publicly claimed. They restructure moderation to appease whoever is loudest. They sacrifice long-term platform health for short-term political safety.

That is not leadership. That is fragility. And fragility at scale, with this much power, is the most expensive liability in the global economy.

If there were more Black women in leadership at these companies, this would not be happening. Not because we are morally superior — though you can draw your own conclusions — but because we don’t buckle. We have been trained by history, by medicine, by motherhood, by the daily practice of operating inside institutions that were not built for us, to make decisions under pressure that the current leadership class simply cannot make.

🛠️ What We Do Instead

I’m not waiting for the platforms to fix themselves. I don’t believe they will, because the incentive structure doesn’t require it. They will continue to extract wealth from communities that have no other viable distribution infrastructure until either regulation forces change or the communities build alternatives.

So we build alternatives.

The $80 I could spend pushing a post into LinkedIn’s suppression machine could instead pay a content creator with an aligned audience to put it in front of real people. The creator gets paid. The content gets distributed. The money stays in the community. And I don’t subsidize the system that’s burying me.

That is the future. Not because it’s fairer — though it is. Because it works better. And eventually, the platforms will have to answer for the fact that paying each other works better than paying them.

We are not complaining. We are not asking for special treatment. We are not asking for anyone to feel sorry for us.

We are asking for our work to stand on its own merit. And when the infrastructure won’t allow that, we are building new infrastructure.

Social media promised democratization of access. What it built was a toll road with racial pricing. We’ve paid the toll long enough. Now we’re building our own road.

Dr. Yamicia Connor is the founder of Diosa Ara, a women’s health infrastructure company, and the creator of The Labora Collective. She is a practicing OB-GYN with an MD from Harvard Medical School and a PhD from MIT.

Yamicia D. Connor, MD, PhD, MPH

Physician Scientist | Writer

I write at the intersection of medicine, power, policy, and lived experience—where data meets narrative and clinical truth meets political reality.

Explore The Labora Collective → Member Home: Start Here

Become a Member → Subscribe to The Labora Collective

© 2026 Diosa Ara, PLLC. All rights reserved.

Citations and Sources

1. Facebook organic reach decline: Hootsuite/We Are Social Digital Reports, 2012–2024

2. Small business social media dependency: U.S. Chamber of Commerce, 2024

3. PR agency retainer costs: Holmes Report / PRovoke Media industry surveys

4. Facebook ad delivery racial skew: Ali et al., “Discrimination through Optimization,” Northeastern University, 2019 (peer-reviewed)

5. DOJ/Meta housing discrimination settlement: U.S. Department of Justice, June 2022

6. Black Instagram users 50% higher account disabling rate: Meta internal research, reported by The Washington Post, 2021

7. Content moderation misclassification of racial discourse: Sap et al., “The Risk of Racial Bias in Hate Speech Detection,” ACL 2019

8. Ad fraud costs: Association of National Advertisers / Juniper Research, 2024

9. LinkedIn 25% invalid traffic rate: Pixalate Ad Fraud Reports

10. Facebook video metric inflation: Facebook Inc., class action settlement, 2019 ($40M)

11. Black creator pay gap (34% less): MSL Group / The Influencer League, 2023

12. Southeast Asian creator pay gap (57% less): MSL Group, 2023

13. Black women-owned businesses (3.5M, $60B): American Express State of Women-Owned Businesses Report

14. Revenue parity / $1.7 trillion GDP impact: McKinsey Global Institute

15. Black founders VC funding (0.4%): Crunchbase Annual Diversity Report, 2024

16. Racial wealth gap ($49,950 growth): Federal Reserve Survey of Consumer Finances, 2019–2022

17. GDP cost of racial wealth gap ($1–1.5T): McKinsey Global Institute, “The Economic Impact of Closing the Racial Wealth Gap,” 2019

18. Optum/UnitedHealth AI bias (Black patients received 50% less care): Obermeyer et al., Science, 2019

19. LinkedIn analytics (boost experiment): Author’s own data export, February 2023–2026

20. Minneapolis doula coalition / ICE impact: Author’s direct clinical knowledge and on-camera reporting

The Obvious Answer We Keep Refusing

There’s this endless, performative debate about what to do with the internet, what to do with big tech, what to do about billionaires, what to do about the “state of society.” Panels. Podcasts. White papers. A thousand think pieces that all sound like someone trying to solve a fire by rearranging the furniture.

Entire industries now exist to “reform” social media without ever touching ownership, incentives, or concentration of power–ethics boards, content moderation frameworks, trust-and-safety theater–everything downstream of the same profit model.

And what makes me feel like I’m losing my mind is that the answer isn’t even subtle.

Power is concentrated because we keep concentrating it.

We keep building a world where the same narrow set of traits gets rewarded, over and over, and then we act shocked when the people who win under those rules behave exactly like the rules incentivized them to behave.

We need to give more people opportunities–real opportunities–so that power isn’t continuously recycled through the hands of a few people who are unusually comfortable stepping on others.

Not “opportunities” as a slogan. Not “diversity” as corporate wallpaper. Actual access. Actual resources. Actual shots at the steering wheel. Who gets early funding. Who gets forgiven for failure. Who gets second chances. Who gets backed when the idea isn’t already de-risked.

Because here’s the part nobody wants to admit: the output is not a mystery. The output is the design.

Meritocracy Is a Story We Tell After the Fact

People love meritocracy the way people love fairy tales: because it’s comforting, because it flatters the winners, because it turns chaos into a clean narrative. It tells you the world is basically fair–and if it isn’t fair, it’s because someone cheated.

But meritocracy always comes down to the same quiet question: who decides what counts as merit?

Is it an SAT score? Is it a résumé line? Is it a particular accent, a particular posture, a particular kind of confidence? Is it a polished performance of “potential”? Is it knowing how to behave in rooms that were never built for you?

People swear they want objective measures and then argue over the measures for the next hundred years.

And even when you pick one–like standardized tests–you’re pretending it’s objective in a way that conveniently ignores everything that shaped who had time, safety, tutoring, calm, nutrition, stability, and expectation. We know SAT scores track closely with household income and parental education. We know test prep is a multi-billion-dollar industry. We know which students schools quietly invest in and which ones they don’t.

Here’s what I can tell you from my own life: I do well on standardized tests. I always have. It is not a moral achievement. It is not proof of deservingness. It is a brain quirk plus training plus environment plus endurance. It is a particular kind of performance–one that our society has decided to reward.

And what kills me is that people treat that performance like it’s the same thing as character.

It isn’t.

It has zero implications for what I did this morning at a patient’s bedside. Zero. It has almost nothing to do with what makes someone a good physician, a good parent, a good leader, a good neighbor, a good human. It doesn’t measure patience, ethical restraint, emotional attunement, or the willingness to choose care over efficiency.

But we’ve agreed–collectively–to pretend it does. Because that agreement protects a system.

The Traits We Reward Are Not the Traits We Need

If you want to understand why society looks like it does, stop asking what people say they value and look at what we pay for. Look at what we elevate. Look at what we excuse.

We treat “winning” as evidence of virtue. We treat wealth like it’s a credential. We treat proximity to power like it’s proof of worth.

Venture capital explicitly prioritizes speed, dominance, and scale. “Winner-take-all” isn’t a metaphor; it’s a funding thesis.

And that’s how you end up with the richest man in the world being someone you would not invite into your home. Someone you wouldn’t want in your life. Someone you wouldn’t want your daughter marrying–except for the fact that he’s a billionaire.

I’m saying that plainly on purpose, because people are trained to talk around it. To soften it. To intellectualize it. To be polite about something that is not polite.

This isn’t normal. It isn’t healthy. It isn’t a sign of human flourishing. It’s a sign that we have built a system where a certain mix of traits gets disproportionately rewarded: enough intelligence to exploit a structure, and enough sociopathy to not care what it costs everyone else.

Yes, there are a lot of smart people in the world. Most of them do not become that. Most of them don’t want to become that. Most of them are not willing to burn down the social fabric, crush everyone around them, and call it “innovation.” Many talented people self-select out of hyper-extractive environments because the cost–to their ethics, their families, their health–is too high.

So when we act like billionaire outcomes are just the natural result of “talent,” we are lying to ourselves. It’s not just talent. It’s also the willingness to make a thousand small decisions that treat other people as obstacles.

And the system we’ve built treats that willingness like a feature, not a bug.

Capitalism Has a Definition of “Waste,” and It’s Brutal

This morning I spent 45 minutes–maybe an hour–with a patient who wasn’t medically complicated, but was emotionally struggling. If you’re a human being, you understand immediately why that mattered. You understand the dignity of sitting with someone when they’re unraveling.

But in the language of the system we live under, that was “waste.”

Not billable enough. Not efficient. Not scalable. Not optimized.

Medicine measures productivity in RVUs. Time spent listening often counts for nothing, or is actively penalized.

If the hospital were watching the clock the way capitalism watches the clock, there’s a version of this where someone is irritated that I didn’t spend that hour doing something that converts more neatly into reimbursement. More discharge summaries. More throughput. More boxes checked.

That’s what we’ve chosen.

We’ve chosen a society where care is treated like a luxury, where attention is treated like a liability, where the highest good is whatever can be turned into a line item.

And then we act surprised that the people who thrive in that environment are not caregivers.

Why People Hate Affirmative Action: It Threatens the Lie

Let’s talk about the thing people get so emotional about: affirmative action.

The loud argument is “fairness.” The quieter, truer argument is fear.

Because affirmative action isn’t just about letting someone in. It’s about admitting that the gate was never neutral in the first place.

It forces a question the system can’t survive if too many people ask it: what if the people at the top aren’t actually the most deserving?

What if we’ve been selecting for a narrow kind of performance and calling it excellence?

What if we’ve been confusing polish with competence, entitlement with leadership, pedigree with value?

What if we’ve been confusing access with merit?

Legacy admissions, donor influence, unpaid internships, and “culture fit” are rarely framed as affirmative action–even though that’s exactly what they are.

The deeper fear is this: what if, with real opportunity, a lot of people would meet their potential–and the entire supremacy narrative would collapse because it’s held up by nothing?

If you were truly confident in your superiority, you would want a functional society. You would want widespread education. You would want healthcare. You would want people safe and stable.

But if your status is propped up by advantage and exclusion, you can’t allow that. So the system stays tight. The gates stay guarded. The measures stay “objective” in ways that keep reproducing the same winners.

And then everyone pretends the results are just natural law.

The MAGA Aesthetic: Antisocial Isn’t a Political Philosophy

Here’s another thing we refuse to say out loud: much of what we’re dealing with right now isn’t “difference of opinion.” It’s antisocial behavior dressed up as ideology.

There are people in public life–elevated, platformed, treated as legitimate–whose emotional baseline is rage, grievance, humiliation, domination. They cannot be satisfied because satisfaction isn’t the point. Power is.

Outrage-driven media ecosystems reward the loudest, cruelest voices with attention, money, and influence.

You recognize these people in real life. You don’t put them on pedestals. You don’t trust them with leadership. You don’t invite them into your home.

But our systems reward them anyway, and then we act surprised when the culture feels sick.

Black History Month and the Emotional Arc of Becoming Aware

It’s Black History Month, and as a Black parent, there’s a particular ache in watching your kids slowly understand what it means to be Black.

At first, difference is just a descriptor. Brown skin. White skin. Hair texture. No moral weight.

Then society arrives. History arrives.

Difference becomes shame. Embarrassment. Being “other.” Curriculum omissions and sanitized narratives quietly communicate whose lives are central and whose are peripheral.

If you’re lucky, you eventually gain access to the rooms you were told mattered–the elite schools, the prestigious institutions.

And then you look around and realize: this is it?

These are the supreme people?

This is the best we could do?

That’s where shame turns into anger–not childish anger, but clarifying anger. The kind that comes from realizing you were trained to doubt yourself so you wouldn’t notice that the pedestal is made of papier-mâché.

The system isn’t held up by excellence. It’s held up by repetition. By inheritance. By whiteness. By maleness. By networks.

If it were truly about merit, it would look different.

The Refusal

So here’s my frustration, stripped down:

We keep asking what to do about the internet.

What to do about billionaires.

What to do about our broken society.

And then we refuse the obvious thing.

We refuse to expand access in ways that redistribute power.

We refuse to challenge the measures that define worth.

We refuse to reward care as much as extraction.

We refuse to stop treating wealth as evidence of goodness.

We refuse to admit that meritocracy is a curated story that protects the people already holding the microphone.

And then we act shocked when the output is ugly.

I’m not surprised by the output.

I’m exhausted by the pretending.

Because if you keep supporting the same people, doing the same things, with the same incentives, you will keep getting the same society.

And at some point the question stops being why does society look like this?

The question becomes: how much longer are we going to keep choosing it?

What Does It Mean to Deliver Exceptional Care?

There are ethical principles that sound beautiful when spoken aloud. Compassion. Respect. Nonmaleficence. Justice.

Most people agree with them in the abstract. Most people, given infinite resources and no tradeoffs, would choose kindness over harm and dignity over neglect. But character—individual or institutional—is not revealed in the abstract. It is revealed under constraint.

Exceptional care is not defined by what you claim to value when nothing is at stake.

It is defined by what you do when the costs are real, when the choices are hard, and when someone else’s life depends on whether you are willing to absorb inconvenience, sacrifice, or loss.

This matters profoundly in healthcare, and nowhere more clearly than in high-stakes fields like obstetrics.

We need to be honest about something that makes people uncomfortable: delivering truly excellent care is incompatible with the popular, colloquial understanding of “work-life balance.” Full stop.

If you were sitting across from the person who might one day be responsible for your life or your baby’s life, and they told you that their primary professional priority was work-life balance, you would pause. You might nod politely, but something inside you would hesitate. Because when it is your body, your pregnancy, your child, you want the person on the other end to behave as if you are family. And that expectation carries weight.

That does not mean clinicians should never rest, never take time off, never preserve their mental or physical health. In fact, the opposite is true. Sustainable excellence requires rest, recovery, and relationships that allow clinicians to keep going without breaking.

But that is not “work-life balance” as it is commonly used to mean personal convenience, protected leisure, or an insistence that work must never intrude.

What healthcare requires is something different entirely: disciplined preservation of capacity in service of others.

Rest not as entitlement, but as responsibility. Balance not for self-optimization, but for safety, judgment, and endurance. That distinction matters.

I do not have “me time” in the way people often mean it. I am not saying that for sympathy, and I am certainly not apologizing for it. I chose this profession with open eyes. Physicians are well compensated, not just financially but socially and morally. The authority we carry, the trust we are given, and the freedom we have to speak with clarity and force all rest on the seriousness of what we are asked to do and what we are willing to deliver in return.

That seriousness does not end with individual clinicians. It extends to entire organizations.

The quality of care a patient receives is not determined solely by whether their doctor is skilled or compassionate. It is determined by the system surrounding that doctor. Is there coverage when something goes wrong? Are there protocols when the unexpected happens? Has the organization planned for failure modes, absences, emergencies, and surges? When the moment comes—and it always does—will someone fill the gap?

Excellence is rarely about heroics. It is about whether, when it matters, there is someone willing to step in when it would be easier not to.

Practically, that willingness has a cost.

It means missed dinners and interrupted holidays. It means sleep deprivation and time away from children. It means, for those of us building healthcare organizations, real financial sacrifice and delayed personal reward. It means choosing rigor over ease, again and again.

I wish I could deliver the level of care we insist on and make it easy for everyone involved. That would simplify my life.

I do not enjoy asking people to work weekends or cover late hours. I do not want to pull anyone away from their families.

But wanting does not change reality. We have made promises—to patients who are trusting us with their lives—and those promises carry obligations.

As a physician, this is not “just a job.” It is a legal, moral, and financial commitment with real consequences. When I walk into a hospital, I am putting my livelihood and my family’s future on the line. Leadership in healthcare means ensuring that everyone in the organization understands and operates under that same gravity, especially when we are small and margins are thin. Administrators. Contractors. Executives. Everyone.

This level of commitment is not for everyone, and that is okay. I believe deeply in second chances. I do not hold grudges. I have worked with people for years, parted ways, and worked together again. Mistakes happen. People grow. What I do not compromise on is moral clarity.

The patient on the other end of the system does not care about our internal justifications. They care that when it is inconvenient, when it is hard, when it costs something, we still show up. They expect commitment. And commitment means availability—on holidays, at night, when your child is crying and wants you to stay home, when every part of you would rather not go in.

That is the promise we have made. Personally, and organizationally.

I speak openly about this because honesty is part of ethical leadership.

Anyone who wants to work with us, build with us, or align themselves with what we are creating deserves to understand what is being asked. We want to invest in people. We want to support them. But we will not pretend that this work can be done without sacrifice.

Not every company should be a healthcare company. Not every organization should ask people to hold human lives in their hands.

But if you choose to do so—if you invite that level of trust—then you must be willing to meet the standard that trust requires.

Exceptional care is not a slogan. It is a series of decisions made under constraint. And it is always paid for by someone. The only ethical question is whether the cost is borne by the people we serve—or by those who have chosen to serve them.

Authoritarianism doesn’t spread on vibes. It spreads on logistics.

It needs the paperwork, the uniforms, the fear—and the part that people forget: it needs control of communication. Not as a philosophical preference, but as an operational requirement. The faster a regime wants compliance, the more aggressively it has to collapse the public’s ability to coordinate, verify reality, and tell one another the truth in real time.

Historically, that meant controlling printing presses, radio, and television. In the modern era, it means something simpler and more brutal: turn the internet off, or warp it into a mirror.

That’s why what we’re watching in places like Iran has such a specific shape: you don’t just beat people in the streets—you silence the nervous system that lets the streets talk back. You sever the pathways people use to document harm, organize care, move money, warn neighbors, and keep each other alive. When the network goes dark, violence becomes cleaner. Not less violent—just less witnessed.

So the obvious question is: What’s the U.S. equivalent?

And the honest answer is that the U.S. has structural resistance that a lot of authoritarian projects underestimate—not because Americans are uniquely enlightened, but because our system has been built (for better and worse) around diffuse power, chaotic incentives, and an addicted communications economy.

Start with the simplest problem: you can’t “just” cut American internet.

Not in a country where people have panic attacks after thirty minutes of no signal, and not in an economy where a huge portion of commerce—banking, shipping, retail, hospitals, scheduling, payroll, emergency dispatch, air travel—assumes continuous connectivity as baseline reality. A nationwide shutdown would not feel like “a policy.” It would feel like a disaster.

And disasters don’t stay politely political. They become physical.

You would see immediate cascading failures: confusion, financial disruption, blocked access to medical systems, lost wages, supply chain rupture. And once you do that, the regime doesn’t inherit quiet. It inherits riots—fast, decentralized, and furious.

Then there’s the second obstacle, which is even more cynical and therefore more reliable: money.

The U.S. is not just connected—it is monetized through connection. If you think the people who profit from attention, data, and digital infrastructure are going to watch their revenue evaporate because the government wants a quieter public, you’re giving them too much moral credit and not enough capitalist realism.

Greed is not virtue, but it is a stabilizing force in one narrow sense: when power threatens profit at scale, profit fights back. Sometimes with lawyers. Sometimes with lobbyists. Sometimes with silence. Sometimes with teeth.

So could an authoritarian project do it through suppression alone—without a full shutdown?

Not effectively. Because in a population that can communicate, censorship becomes a game, not a wall. Humans are not merely resilient; they are relentlessly inventive when survival is on the line. When you block one channel, people build another. When you ban a phrase, people invent a metaphor. When you flag an image, people turn it into a joke. And when you try to crush organizing, people learn the oldest skill on earth: passing messages through culture.

Yes—TikTok dances can become a language. Memes can become signal. Humor can become coordination. Even the act of “going viral” becomes a kind of protective force: when witnesses are everywhere, violence gets riskier for the people committing it.

That doesn’t mean there won’t be harm. There will be.

Some people will be destroyed by what happens in the gap between reality and response time. Some people will be targeted before the network can defend them. Some will die. Some will be permanently injured. Some will lose years of their lives to fear, displacement, retaliation, or bureaucratic cruelty. Connectivity is not a magic shield; it’s a contested space.

But what it does do—what it might be uniquely capable of in the American context—is prevent the kind of clean, total consolidation of control that authoritarian projects rely on to become permanent.

The reason isn’t romance. It’s structure.

First: diversity.

Authoritarian systems become efficient when a large majority is either aligned or easily coerced into alignment. When a regime can convince most people that the target is “someone else,” it can scale cruelty without triggering universal resistance. But the U.S. is too plural for that to remain stable forever. We are racially diverse, linguistically diverse, culturally diverse, regionally fractured, and ideologically messy. That means there is no single, simple “national consensus” to capture and hold.

It also means there is a hard floor of refusal.

There is a portion of this country that will not be convinced. Not bribed. Not shamed. Not threatened into genuine agreement. People may retreat. They may go quiet strategically. They may choose their moments. But they will not convert. That matters because authoritarianism isn’t just about controlling institutions—it’s about controlling mass psychology. And mass psychology is harder to dominate when the “mass” is not one coherent body.

Second: size.

A very large country is not just hard to govern—it is hard to occupy. Control requires presence: surveillance, enforcement, physical reach. The larger the terrain, the more the regime has to spend—on personnel, on compliance systems, on punishment capacity. And every dollar spent on holding the country down is a dollar not spent on making the country work.

At a certain point, the math turns on the regime. It becomes exhausted by its own need to dominate.

Third: networked wealth.

This is the part we’re living inside and rarely name clearly: the U.S. economy is not merely “online.” It is structurally dependent on continuous digital function. And because that dependency concentrates immense wealth into communications infrastructure, it creates a powerful class of actors who will defend that infrastructure—not out of democratic virtue, but out of self-interest.

That matters, because authoritarian systems need chokepoints. They need switches they can flip. They need simple methods to cut oxygen to resistance. But when the “switch” is tied to billions in daily commerce, and when the corporate incentives do not reliably align with political incentives, flipping the switch becomes politically expensive.

Which returns us to the real thesis: the internet has harmed us in a hundred obvious ways, but it has also created one quiet advantage that we haven’t fully respected.

It makes power harder to concentrate.

It doesn’t eliminate authoritarianism. It doesn’t prevent violence. It doesn’t stop the cruelty that can happen locally, quietly, bureaucratically. But it changes the regime’s problem from “capture the capital” to “hold the entire network.”

And holding the entire network is harder than people think.

So no—this isn’t cheerful Sunday morning news. It’s not optimism. It’s not a motivational poster about democracy.

It’s a recognition of structural reality: if people can still communicate, the project of total control becomes unstable.

The administration may do evil things. They may succeed in harming real human beings. They may carve out zones of lawlessness where some lives are treated as disposable. But if the country remains connected—if truth can still travel—then the system cannot fully seal itself.

Because the oldest enemy of tyranny is not heroism.

It’s coordination.

And for all its damage, social media has taught millions of people how to coordinate—fast, sideways, and under pressure.

That skill may end up saving us.