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The Great Dictator by Matthew Sweet review – the fabulous life of Barbara Cartland | Biography books | The Guardian
Sunday August 30th, 2026 at 10:35 AM

The Guardian
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Barbara Cartland was famous for dictating her novels. With a pekingese clamped to her hot pink bosom she would lie back on a library couch and exhale a story about virginal girls taming wayward dukes, damaged airmen or misunderstood surgeons. Meanwhile Miss Savory, Mrs Smith or Mrs Morgan, picked for being unfidgety and sneezeless, would take everything down in immaculate Pitman shorthand. Cartland reckoned on being able to polish off 8,000 words a day. “In this way,” she told one of the many reporters who quizzed her on her astonishing productivity, “the typescript for an 80,000-word novel is finished in a fortnight.” At her peak she was pushing out 23 books a year which added up to 723 in total. Only Agatha Christie and William Shakespeare topped her lifetime sales of 750m.

Cartland was a dictator in other ways, too. Husbands, dogs, houses and the local council were all expected to bend themselves to her indomitable will. Resistance, let alone opposition, was futile. The managing director of the company that printed her books suggested that she read Nietzsche on the perceptive grounds that they had a lot of ideas in common. Oddly, he also declared himself madly in love with her. Behind that marshmallowy exterior, all pink chiffon, candyfloss hair and soft, smudgy lines, there lurked sinews of high-tensile steel.

Anyone expecting this biography of Barbara Cartland to be an amusing takedown of a monstre sacré along the lines of Craig Brown’s witty 2017 decimation of Princess Margaret will be disappointed. Rather, Matthew Sweet pays his subject the compliment of absolute seriousness, regarding her as a cultural phenomenon whose extraordinary life, stretching the entire 20th century, deserves deep study. Sweet has had unfettered access to the cornucopia of material that Cartland left behind at Camfield Place, the Hertfordshire manor house where she lived until her death in 2000 at the age of 98. Conducting a fingertip search of her letters, scrapbooks and typescripts, Sweet has crafted a generous but clear-sighted account of a woman who was too often reduced to the status of a lazy joke.

She was born in 1901 into the lower upper class. On her father’s side she was pure trade. James Cartland and Son was a Birmingham metalworkers turning out umbrella stands, crocodile-shaped inkwells, shelf brackets shaped like sea monsters and “pharaonic letterboxes embossed with meaningless hieroglyphs”. Her adored mother Polly, meanwhile, was Gloucestershire gentry and there had been the usual rows about marrying down. Cartland’s paternal grandfather killed himself when the business went bust and her father retreated into alcoholism, leaving Polly to manage the tricky business of getting her daughter launched into a life the family could no longer afford.

Sweet suggests that this constellation of losses and compensations set the emotional template for Cartland’s adult life. Men were necessary but fragile and certainly best not relied upon. Having come out as a deb in 1919 into a world where there were not enough husbands to go round, Barbara set out to become financially self-sufficient by plunging into the only kind of work for which she was qualified. For the next decade she filed gossipy titbits about young London society to the Express, the Mirror and the Daily Mail.

This was the world of the Bright Young Things, so often written up today as a madcap time of pyjama parties and midnight dashes to the continent. In fact, Cartland’s columns reveal a society still in shock from the first world war: fathers are dead (Cartland lost hers in the trenches in 1918), grand family houses have been sold, divorce is everywhere and life seems impossible without alcohol or drugs. The men whom Cartland stepped out with were not the heart-throb dukes and dashing airmen that she would later write about, but broken people without the language to express their desolation. “My contemporaries were ashamed to show emotion,” she observed with characteristic perception in her 1943 memoir The Isthmus Years. “We had all of us a horror of sympathy.”

So instead she simply carried on with a brittle determination to make the best of things. After plenty of dalliances with men called things like Pingo Langrishe and Nigs Ratendone she made a tactical marriage to a dull man called Alexander McCorquodale who was heir to a printing fortune. When he retreated into drink – shades of her father – she effected a neat swap by divorcing, then marrying his paternal cousin. In this way there was no need to change her surname: she had replaced one Mr McCorquodale with another. It rankled that she never achieved a title until she herself was made a Dame in 1991. By contrast, her ambitious daughter, Raine, managed to insert herself into the peerage not once but three times through each of her carefully strategic marriages.

The only man who really mattered to Cartland was her beloved younger brother, Ronald. They went on holiday together and endlessly discussed the cod-eastern philosophies that were all the rage in the 1920s: Ouspensky and Gurdjieff were favourites and Cartland retained a vague mysticism to the end of her life involving ghosts and spiritual healing. She also believed in flying saucers and the power of honey to cure just about anything.

Brother and sister bonded too over politics, specifically a socially engaged, internationalist Toryism. Barbara bossed Ronald into parliament where he became a leading anti-appeaser. She in turn wrote one of the first of the tiny number of 1930s British novels that dealt specifically with the evils of Nazi antisemitism. Dangerous Experiment (1936) involves the improbable story of Lena Carrington who, after a shipwreck and a spell as the slave of a tribe of thunder-worshippers in the Caucasus, ends up in Germany where she is courted by a Nazi lover. In the end she breaks things off when she sees him mistreating a Jewish refugee.

This, of course, is not the Barbara Cartland that most of us remember from the 80s and beyond. In what Sweet calls her “imperial phase” she was writing novels with paper-thin plots that she endlessly recycled. She was also a relentless self-promoter. Bed linen, candles and towels were all enthusiastically marketed under her name, although with remarkable restraint she drew the line at scented toilet paper. She also pulled off a promotion with Dewhurst the butcher, which offered customers one of six previously unpublished Cartland novels for every £12 they spent. The promotion was not a great success because of the sheer weirdness of “being given a copy of Desire in the Desert with a parcel of mince”.

But when, in a stroke of fortune so improbable that even now it hardly seems real, her daughter, Raine, became Diana Spencer’s stepmother, Cartland sensed new opportunities for cross-pollination. She took to announcing “I invented virgins” and managed to imply that the royal wedding of 1981 was somehow her doing, despite being pointedly not invited. Raine, a chip off  the old block, made sure that the gift shop at the Spencer family seat, Althorp, stocked a full run of Barbara Cartlands.

It would be easy to dismiss Cartland as a quirk, an aberration the likes of which we will not see again. But the great triumph of this brilliant book is the way that Sweet embeds her firmly in the economic, political, social and artistic transformations of the 20th century while charting the ways in which she also transcended them. Somehow, and this remains the deep mystery of it all, Barbara Cartland emerges as that rather admirable thing: an entirely self-made woman.

The Great Dictator: a Life of Barbara Cartland by Matthew Sweet is published by Hodder & Stoughton (£25). To support the Guardian, order your copy at guardianbookshop.com

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Trends in pneumonia mortality among US adults,... : Medicine
Sunday August 30th, 2026 at 10:23 AM

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Research Article: Observational Study
  • Nawei Songa
  • Juan Hea
  • Xianghua Shuaia
  • Hana Zhua
  • Keran Xiaa,*

Influenza combined with pneumonia creates a persistent public health burden across the United States, continuously threatening adult survival and consuming massive medical resources. This population-based epidemiological research aims to map long-term mortality shifting patterns linked to flu and pneumonia among American adults spanning the 25-year window from 1999 to 2023. Our analytical data were extracted from the Centers for Disease Control and Prevention WONDER public mortality repository. Deaths triggered primarily by influenza or pneumonia were screened through International Classification of Diseases, 10th Revision diagnostic codes J09 to J18. Two core mortality indicators, crude rates and age-standardized mortality rates, were computed for the whole population and separate subgroups. Joinpoint regression modeling was adopted to quantify yearly percentage shifts (annual percent change) and average annual changing magnitudes (average annual percent change), paired with 95% confidence intervals (CIs) to judge statistical significance. Stratified subgroup comparisons were completed across demographic and geographic dimensions, with statistical significance defined as P < .05. Across the full research timeframe, the national age-adjusted mortality rate for influenza and pneumonia dropped substantially, falling from 35.93 per 100,000 residents in 1999 to 16.46 per 100,000 residents in 2023, with an average annual decline of 3.18% (95% CI = −3.53 to −2.83, P < .05). Mortality burdens consistently ran higher in male populations relative to females. Among all racial subgroups, non-Hispanic Black adults bore the heaviest baseline mortality pressure in 1999 (38.66 per 100,000 population) and also saw the most marked relative reduction by 2023 (19.01 per 100,000 population). Rural counties maintained elevated age-adjusted mortality values compared with metropolitan regions in all survey years. Adults aged 85 and above exhibited the highest crude death rate, peaking at 751.78 per 100,000 people in 1999. Notably, the 55 to 64 middle-aged group was the only stratum with a statistically meaningful upward trend in crude mortality, with an average annual percent change of 0.78% (95% CI = 0.20–1.37, P < .05). This study demonstrates long-term declining trends in US influenza and pneumonia-related mortality with persistent disparities by sex, age, race/ethnicity, and urban–rural status.

Influenza and pneumonia form a paired respiratory hazard that imposes enduring public health pressure within the United States, generating extensive annual cases, premature deaths, and overloading local medical service systems year after year.[] Influenza viral infection often weakens lower respiratory tract defenses, raising the risk of secondary pneumonia development; this close clinical correlation explains why the 2 diseases are frequently documented together on official death certification forms.[,] According to surveillance reports released by the US Centers for Disease Control and Prevention (CDC), influenza and pneumonia together account for a large share of annual fatalities nationwide, with pneumonia most commonly recorded as the primary underlying cause of mortality.[,] Given their tight clinical linkage and co-occurrence in mortality records, aggregating deaths coded under International Classification of Diseases, 10th Revision (ICD-10) influenza and pneumonia categories represents a rational method to track population-level mortality trajectories.

Over the past 3 decades, nationwide death patterns associated with these 2 respiratory disorders have undergone notable transformations. Even so, existing published literature lacks comprehensive long-term trend assessments and in-depth exploration of health inequities across diverse population subgroups. The CDC WONDER platform delivers standardized, anonymized national mortality datasets covering multi-decade time spans, offering reliable population-level evidence for respiratory disease epidemiological analysis. By integrating this database with joinpoint regression tools to pinpoint inflection points in mortality trends, the present research fills 2 major research voids identified in prior work. First, most earlier analyses covered only short time horizons and failed to capture mortality fluctuations occurring after the COVID-19 outbreak in 2020. Second, few previous papers carried out complete stratified analyses covering age brackets, gender, ethnic identity, urban–rural residence, and geographic census regions, leaving subgroup-specific health disparities insufficiently characterized. Findings generated from this research can supply quantitative evidence for customized public health policy design, narrow avoidable health inequalities, and optimize clinical and population-level prevention strategies for high-risk demographic groups.

This retrospective population-based study used mortality data from the CDC WONDER Underlying Cause of Death database (https://wonder.cdc.gov/), which provides de-identified data on all deaths in the United States with standardized cause-of-death coding. Data were extracted for the period from 1999 to 2023, in line with the availability of ICD-10 coding for influenza and pneumonia.

Inclusion criteria were: deaths occurring in the United States from 1999 to 2023; influenza and/or pneumonia recorded as the underlying cause of death on death certificates, identified via ICD-10 codes J09 to J18 (J09: influenza due to novel influenza A virus; J10: influenza due to other identified influenza A virus; J11: influenza due to unidentified influenza virus; J12: viral pneumonia, not elsewhere classified; J13–J15: bacterial pneumonia; J16: pneumonia due to other infectious agents; J17: pneumonia in diseases classified elsewhere; J18: pneumonia, unspecified).

Restricting analyses to the underlying cause of death was chosen to ensure consistency with standard population-level mortality studies, minimize potential overestimation of the mortality burden, and enhance comparability with published literature.

Exclusion criteria were: deaths with incomplete demographic information (sex, age, race/ethnicity, or residential address); deaths in individuals under 25 years of age, as this study focuses on adult mortality trends.

Demographic and regional data were extracted, including sex, race/ethnicity (Hispanic, non-Hispanic (NH) Black, NH White, NH other), age (25–34, 35–44, 45–54, 55–64, 65–74, 75–84, 85+ years), urban–rural classification, US Census Region (Northeast, Midwest, South, West), and state. Urban–rural classification adopted the 2013 National Center for Health Statistics Urban–Rural Classification Scheme,[] dividing counties into metropolitan (urban) areas (≥50,000 population) and nonmetropolitan (rural) areas (<50,000 population). Census regions were categorized in accordance with United States Census Bureau definitions.[]

The primary outcome was the influenza and pneumonia-related mortality rate, including the crude mortality rate calculated by dividing the number of influenza and pneumonia-related deaths by the corresponding US population size (per 100,000 people) and the age-adjusted mortality rate (AAMR) standardized using the 2000 United States standard population to eliminate the impact of age structure differences on mortality rate comparisons, with 95% confidence intervals (CIs) calculated to reflect statistical uncertainty.

For age-group analyses, crude mortality rates were used because age strata were mutually exclusive and directly reported by CDC WONDER; age adjustment within narrow age groups is unnecessary and would not meaningfully alter trend interpretation, and crude rates support straightforward interpretation of the absolute mortality burden within each age category.

For urbanization-stratified analyses, 2020 AAMR data were used as a proxy for 2023 due to data availability constraints in the CDC WONDER database. This substitution may limit the interpretation of urban–rural differences after 2020 given changes in rural healthcare access and service availability, and conclusions regarding urban–rural comparisons for 2023 should be interpreted cautiously.

All statistical analyses were conducted using R software (version 4.2.3; R Core Team, R Foundation for Statistical Computing). Joinpoint regression models were fitted using the “Joinpoint” package to identify significant temporal changes in mortality trends. A maximum of 3 joinpoints was tested, and model selection was based on the Bayesian Information Criterion and permutation tests to determine the optimal number of statistically significant trend segments. The annual percent change for each trend segment and the average annual percent change (AAPC) for the full study period were estimated with corresponding 95% CIs. Trends were considered statistically significant if 95% CIs for annual percent change excluded zero or P < .05 across demographic, geographic, and urban–rural subgroups using stratified analyses.

From 1999 to 2023, the total number of influenza and pneumonia-related deaths decreased from 63,006 in 1999 to 44,625 in 2023, representing a 29.17% change. The overall AAMR decreased from 35.93 per 100,000 population (95% CI = 35.65–36.21) in 1999 to 16.46 per 100,000 population (95% CI = 16.31–16.61) in 2023. The AAPC was −3.18% (95% CI = −3.53 to −2.83, P < .05; Table 1).

Influenza and pneumonia deaths and AAMR in the United States from 1999 to 2023 and their changing trends.

CharacteristicDeathsAAMR
19992023Percent change (%)1999 (95% CI)2023 (95% CI)AAPC (95% CI)
Total63,00644,625−29.1735.93 (35.65 to 36.21)16.46 (16.31 to 16.61)−3.18 (−3.53 to −2.83)
Sex
 Female35,66921,750−39.0231.40 (31.07 to 31.73)14.17 (13.98 to 14.36)−3.25 (−3.65 to −2.86)
 Male27,33722,875−16.3243.69 (43.16 to 44.22)19.47 (19.21 to 19.72)−3.27 (−3.59 to −2.95)
Census region
 Northeast14,2499138−35.8737.72 (37.10 to 38.34)18.04 (17.67 to 18.41)−2.90 (−3.30 to −2.50)
 Midwest16,1209075−43.7037.65 (37.07 to 38.23)15.89 (15.56 to 16.22)−2.99 (−3.42 to −2.56)
 South22,14916,929−23.5736.56 (36.08 to 37.04)16.44 (16.19 to 16.69)−3.14 (−3.44 to −2.83)
 West10,4889483−9.5830.81 (30.22 to 31.41)15.55 (15.23 to 15.86)−2.92 (−5.25 to −0.55)
Race
 Hispanic2130397386.5328.67 (27.40 to 29.93)14.46 (13.99 to 14.92)−3.37 (−3.76 to −2.97)
 NH Black55765093−8.6638.66 (37.63 to 39.69)19.01 (18.47 to 19.55)−2.87 (−3.23 to −2.51)
 NH White53,94332,878−39.0535.94 (35.64 to 36.25)16.56 (16.37 to 16.74)−3.14 (−3.51 to −2.76)
 NH other10972519129.6327.99 (26.27 to 29.72)13.36 (12.83 to 13.88)−3.78 (−4.59 to −2.96)
Urbanization
 Metropolitan49,54036,983−25.3435.06 (34.75 to 35.37)19.25 (19.07 to 19.44)−3.14 (−3.56 to −2.72)
 Nonmetropolitan13,4667642−43.2439.61 (38.94 to 40.28)23.49 (23.02 to 23.96)−2.42 (−2.86 to −1.97)
Age groups
 25–34 yr33945835.100.84 (0.75 to 0.93)1.01 (0.91 to 1.10)0.63 (−0.75 to 2.03)
 35–44 yr1063967−9.032.36 (2.22 to 2.50)2.18 (2.04 to 2.32)0.04 (−0.80 to 0.89)
 45–54 yr169717392.474.64 (4.42 to 4.86)4.29 (4.09 to 4.50)0.26 (−0.50 to 1.03)
 55–64 yr2625460275.3111.04 (10.62 to 11.46)11.00 (10.68 to 11.31)0.78 (0.20 to 1.37)
 65–74 yr6861900531.2537.25 (36.37 to 38.13)25.96 (25.43 to 26.50)−1.40 (−2.22 to −0.58)
 75–84 yr19,19212,623−34.23156.99 (154.77 to 159.21)68.72 (67.52 to 69.92)−3.42 (−3.74 to −3.10)
 85+ yr31,22915,231−51.23751.78 (743.44 to 760.12)245.86 (241.96 to 249.76)−4.50 (−7.58 to −1.31)

AAMR = age-adjusted mortality rate, AAPC = average annual percent change, CI = confidence interval, NH = non-Hispanic.

In the context of urbanization, the 2023 AAMR data were substituted with that from 2020, and the AAPC was calculated based on the period from 1999 to 2020.

For the age groups, the crude mortality rate was used as a substitute for AAMR, and the AAPC was computed based on the crude mortality rate.

In 1999, the AAMR was 43.69 per 100,000 population for males and 31.40 per 100,000 population for females. In 2023, the AAMR was 19.47 per 100,000 population for males and 14.17 per 100,000 population for females. The AAPC was −3.25% (95% CI = −3.65 to −2.86) for females and −3.27% (95% CI = −3.59 to −2.95) for males (both P < .05). The total number of deaths decreased by 39.02% in females and 16.32% in males over the study period (Fig. 1).

In 1999, the AAMR was highest among NH Black individuals (38.66 per 100,000 population), followed by NH White individuals (35.94 per 100,000 population), Hispanic individuals (28.67 per 100,000 population), and NH other individuals (27.99 per 100,000 population). By 2023, all groups exhibited decreased AAMR: 19.01, 16.56, 14.46, and 13.36 per 100,000 population for NH Black, NH White, Hispanic, and NH other individuals, respectively (Fig. 2).

In 1999, the AAMR was highest in the Northeast (37.72 per 100,000 population) and Midwest (37.65 per 100,000 population), followed by the South (36.56 per 100,000 population) and West (30.81 per 100,000 population). In 2023, the AAMR was lowest in the West (15.55 per 100,000 population), followed by the Midwest (15.89 per 100,000 population), South (16.44 per 100,000 population), and Northeast (18.04 per 100,000 population; Fig. 3).

Throughout the study period, AAMR was consistently higher in nonmetropolitan (rural) areas than in metropolitan (urban) areas. In 1999, the AAMR was 39.61 per 100,000 population for nonmetropolitan areas and 35.06 per 100,000 population for metropolitan areas. In 2020, the AAMR was 23.49 per 100,000 population for nonmetropolitan areas and 19.25 per 100,000 population for metropolitan areas (Fig. 4).

In 1999, the crude mortality rate was highest among adults aged 85 years and older (751.78 per 100,000 population) and lowest among those aged 25 to 34 years (0.84 per 100,000 population). In 2023, adults aged 85+ years remained the group with the highest crude mortality rate (245.86 per 100,000 population). The total number of deaths decreased by 51.23% in the 85+ age group, while increasing by 35.10% in the 25 to 34 age group and 75.31% in the 55 to 64 age group (Fig. 5).

This epidemiological analysis tracked mortality risks attributable to influenza and pneumonia over a quarter-century among American adults, relying on ICD-10 J09 to J18 codes to identify fatalities rooted in these 2 respiratory illnesses. Our statistical outputs revealed a steady nationwide fall in age-standardized death metrics, alongside stark health disparities that persisted across demographic and geographic divisions throughout the observation period. These observations align with prior population-based investigations documenting gradual declines in respiratory disease mortality while spotlighting unresolved inequities among distinct population cohorts.[,]

Gender-based gaps in fatal respiratory outcomes remained consistent across all survey years, with male adults repeatedly facing higher death risks than their female counterparts. This gender divergence has been repeatedly validated in national influenza and pneumonia monitoring datasets released by US public health authorities.[,] At the baseline year of 1999, NH Black communities carried the largest baseline mortality burden; although this group experienced the most substantial proportional drop in mortality by 2023, racial disparities had not been fully eliminated by the end of our study window. Such persistent ethnic gaps mirror well-established inequities in infectious disease survival reported in previous population health studies.[,] When separating participants by residential setting, rural residents consistently exhibited slower mortality declines and higher overall death rates compared to urban dwellers. This divide echoes widely documented disadvantages in rural medical infrastructure, outpatient accessibility, and community public health outreach for chronic and acute respiratory conditions.[,] Among all age brackets, advanced age stood out as the strongest predictor of lethal influenza or pneumonia episodes, consistent with established research confirming extreme vulnerability to severe respiratory complications in adults aged 85 and older.[,]

One distinctive finding of this study centers on the 55 to 64-year-old middle-aged subgroup, which was the only population segment with a statistically significant rising crude mortality rate across the 25-year timeframe. This emerging risk trend has rarely been highlighted in prior long-duration mortality research, marking a critical signal that public health programs need enhanced targeted surveillance for this middle-aged demographic.[,] However, limitations inherent to aggregate ecological data prevent us from pinpointing the exact drivers of this upward shift – potential contributing factors may include generational health differences, updates to death certificate coding standards, shifting comorbidity prevalence, or unmeasured socioeconomic confounders that our dataset cannot capture.

The broad downward trajectory of combined influenza and pneumonia mortality across the United States aligns with nationwide advancements in respiratory disease prevention frameworks and sustained investment in public health infrastructure over recent decades.[,] Nevertheless, all interpretations drawn from this observational dataset remain descriptive rather than causal. Our dataset lacks granular individual indicators, including influenza vaccination uptake, inpatient treatment protocols, local medical resource availability, and health policy rollouts, making it impossible to definitively attribute the observed mortality shifts to specific intervention measures.[]

This research advances existing literature in 2 key respects: it extends longitudinal mortality tracking through 2023 to capture post-pandemic shifts following the 2020 COVID-19 crisis, and it delivers full stratified breakdowns across age, gender, ethnicity, and urban–rural residence to unpack layered health inequities. Collectively, our results reinforce the necessity of continuous population-level respiratory disease monitoring to spot newly emerging high-risk groups and tackle long-standing health gaps between distinct community subgroups.

This study has key limitations that warrant consideration. A central constraint is that combining influenza and pneumonia using ICD-10 codes J09 to J18 introduces unavoidable misclassification, as the dataset cannot distinguish influenza-associated pneumonia from pneumonia due to other pathogens or separate the independent contributions of each condition.

As an ecological study based on aggregate population-level data, this investigation cannot adjust for individual-level confounders, including comorbidities, health behaviors, socioeconomic status, or vaccination status, and causal inferences cannot be established.

For urban–rural analyses, 2020 data were used as a proxy for 2023 due to database availability, which may introduce uncertainty given changes in rural health care access after 2020. Analyses restricted to underlying causes of death may also not capture the full burden of deaths in which influenza or pneumonia contributed as secondary conditions. Despite these limitations, the study provides reliable, long-term population-level mortality trend and disparity estimates.

This study demonstrates significant long-term declines in influenza and pneumonia-related mortality among US adults from 1999 to 2023, with persistent disparities by sex, race/ethnicity, age, and urban–rural status. Mortality was highest among adults aged 85 years and older, while a significant increasing trend was observed among adults aged 55 to 64 years. These findings highlight key population-level patterns and inequalities. Further research incorporating individual-level risk factors, vaccination data, and pathogen-specific coding is needed to clarify the drivers of these trends and disparities.

Conceptualization: Nawei Song.

Data curation: Nawei Song.

Formal analysis: Nawei Song.

Investigation: Nawei Song, Juan He, Hana Zhu.

Methodology: Nawei Song, Juan He, Xianghua Shuai, Hana Zhu.

Software: Juan He, Hana Zhu, Keran Xia.

Supervision: Juan He, Hana Zhu, Keran Xia.

Project administration: Xianghua Shuai, Hana Zhu.

Resources: Xianghua Shuai, Hana Zhu, Keran Xia.

Validation: Keran Xia.

Writing – review & editing: Nawei Song, Juan He, Keran Xia.

AAMR

age-adjusted mortality rate

AAPC

average annual percent change

CDC

Centers for Disease Control and Prevention

CI

confidence interval

ICD-10

International Classification of Diseases, 10th Revision

NH

non-Hispanic

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CDC WONDER; mortality; pneumonia; US adults
Copyright © 2026 the Author(s). Published by Wolters Kluwer Health, LLC.
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STAT+: Cassidy criticizes FDA oversight of abortion pill manufacturers in new report by Margaret Manto
Thursday August 27th, 2026 at 10:07 PM

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WASHINGTON — Sen. Bill Cassidy (R-La.) released a report on Thursday criticizing the Food and Drug Administration for not tightening restrictions on the abortion pill mifepristone, and charging the agency with lackluster oversight of the companies that manufacture the drug. 

“To this day, FDA continues to redact mifepristone-related records in an unprecedented manner,” the report claims. “This lack of transparency has led to unanswered questions.” 

The report is the result of an investigation conducted by Cassidy and other Republicans on the Senate’s health committee into the compliance practices of Danco, which distributes the brand-name version of mifepristone, and two other companies that manufacture generic versions of the drug. 

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Southmead Hospital doctors' ‘arrogance’ killed our son, heartbroken Bristol family tells court | Bristol Live
Thursday August 27th, 2026 at 7:56 PM

Bristol Post - Bristol News
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Southmead Hospital doctors' ‘arrogance’ killed our son, heartbroken Bristol family tells court

The family of Thomas Oliver McGowan spoke out in court

15:45, 16 Apr 2018Updated 18:18, 17 Apr 2018

The heartbroken family of an 18-year-old Bristol boy who died in Southmead Hospital detailed how doctors had “ignored” their calls not to give him anti-psychotic medication.

Thomas Oliver McGowan – known as Oliver to his family – was taken to Southmead Hospital in October 2016 after he was taken ill.

The teen was suffering from simple partial seizures, something he has had from a young age. But he was intubated in hospital and given anti-psychotic medication Olanzapine.

During his treatment in hospital, his brain swelled to the point it was “coming out of the base of his skull”.

His parents told Avon Coroners Court during the first day of his inquest they had repeated multiple times to doctors not to give him anti-psychotic medication because Oliver was allergic to it.

Oliver himself had told medical staff twice he did not want anti-psychotic medication.

But the court heard the doctors decided to do so after he was intubated. Oliver died on Armistice Day, November 11, after doctors stopped treatment and moved him into palliative care.

His dad, Thomas, told the court on Monday: “We firmly believe that Oliver would not have died if he had not been administered Olanzapine.

“We are driven to conclude that the doctors were arrogant and felt they knew best and as a result, prescribed an anti-psychotic drug which Oliver and ourselves had expressly forbidden.”

What happened?

Oliver McGowan(Image: Family)

Oliver, the youngest of three children, contracted meningitis at three weeks old, leaving him with cerebal palsy, epilepsy and mild autism.

But his disabilities did not hold him back, and he was described as a bright and fit young man who was an excellent sportsman.

The teenager was at home in Emersons Green when he suffered a typical simple partial seizure on October 22.

Whenever he suffered from typical simple partial seizures, he would become anxious and scared, but would walk around to calm himself down. He would also talk about his favourite YouTube gamer, Faze Temper.

But during the latest episode on October 22, the seizure did not terminate and his mum rang an ambulance to take him to hospital.

He told his family and paramedics he did not want to be given anti-psychotic medication because it made him “feel horrible”.

Arriving at Southmead Hospital

Thomas Oliver McGowan was a "vibrant boy"(Image: Family)

He became “very scared and agitated” as he arrived in Southmead, with three police officers now escorting him.

“Due to Oliver’s autism, he found being around new people difficult. My wife approached the department ward sister and explained that Oliver had autism, anxiety and epilepsy,” Mr McGowan said.

“We were concerned that police officers constantly holding onto Oliver’s arms or standing shoulder to shoulder with him was intimidating.

“My wife told the ward sister Oliver would become very scared if he was restrained.”

The family also passed on a thick yellow folder with Oliver’s medical history, including his history with using Olanzapine. Specialist registrar Dr Luke Canham, who was on duty, wrote on the allergy chart for Oliver not to be given anti-psychotic medication.

‘Please don’t give them to me’

He had pleaded with doctors not to give him the drugs

That same evening, Oliver – surrounded by police officers, security guards, nurses and doctors – became anxious and was coming in and out of a seizure.

Doctors asked him to go into another room, but not before he told them he did not want to be given anti-psychotic medication.

His dad told the court: “He said in a very clear voice ‘please do not give me anti-psychotics, I don’t like them, they mess with my brain’.

He was intubated that evening and taken to ICU in the early hours of October 22. Dr Canham told the court today he believed Oliver’s life was at risk If he was not intubated.

Hallucinations

The family told doctors several times not to administer anti-psychotic drugs. When speaking with Dr Rose Bosnell from ICU, they explained they had observed “adverse changes” to their son’s behaviour and physical state when given those drugs before.

“Oliver’s seizures increased from on average one per fortnight to over 30 in one day,” his dad said.

“We saw an increase in agitation, oculogyric crisis, and he started to have hallucinations which were something Oliver had never experienced before or since.”

Oliver was woken up, but his family was not called, even though doctors had promised to do so.

Finding out – from someone else

Oliver was intubated(Image: Family)

But his parents got a shock on Wednesday, October 26, when an on-call neurologist asked if they should treat his psychosis.

He had not been diagnosed with psychosis, and his parents were worried their son was being prescribed anti-psychotic medication. They argued with the doctor again and warned against using Olanzapine.

But that night, while speaking with an ICU nurse, they found out he had been given Olanzapine.

Oliver’s appearance started to change, his dad told the court, but doctors said it was the light in the room.

Oliver’s seizures got worse. From simple partial seizures, his limbs started jerking and stiffening. They were “alarmingly different”, the court was told, and their son was sweating profusely. They were worried there might be a problem with his brain at this point, something doctors dismissed.

Condition worsening

On Friday, Oliver’s temperature rose to 43C and he was given paracetamol, but it was stopped because of a Liver Function test.

He was instead given an air mat to bow air around him, but on two occasions, the family found it had not been switched on because staff had “forgotten”.

Oliver’s seizures did not stop, and despite further pleas for a brain scan to be carried out, doctors dismissed it.

On Sunday, October 30, the teenager was finally sent for a scan because his condition was getting worse.

His dad said: “When Oliver returned, we were taken to a side room by Dr Campbell, who appeared very shocked and uncomfortable.

“He told us Oliver’s brain was so badly swollen it was coming out the base of his skull, words we will never forget.”

Emergency surgery was ordered, and his parents were told if he would die if not.

Oliver died on Armistice Day(Image: Family)

“Over the next week, we had to observe our once vibrant and active boy deteriorate ,” Mr McGowan said.

“Oliver was reacting to some stimulation such as sound, touch and pain, because he would open his eyes when we spoke and would relax and close them when we stroked his head,” his dad added.

“On one occasion, we observed him arch his back and opening his mouth in a silent scream due to the tubes in his throat when blood was being taken out of his wrist.

“That is an image that haunts us everyday and night as it was horrific to watch.”

As the week came to an end, doctors said Oliver’s prognosis was “appalling” and that he would be “profoundly disabled, never walk again, be blind or have no reflection of past memories or language”.

He would be tube fed for the remainder of his life, and doctors asked if parents would consider switching off his life machine.

Stopping treatment

They did on November 7, but Oliver continued to fight. Doctors said he would pass away in a few hours, but he clung to life for days.

“We found this very distressing and asked for the doctors to consider saving him as it appeared that Oliver was telling us he wanted to live,” Mr McGowan told the court.

Doctors said there was “no hope” of a meaningful recovery, and all treatment was withdrawn. Infections reoccurred, and Oliver started having involuntary jerks in his facial muscles.

“We were very disturbed by these seizures and it has been etched on our minds forever,” Mr McGowan said.

“If Oliver had not been prescribed Olanzapine, we believe he would be alive today, enjoying college and having a productive life.”

The case continues.

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sarcozona
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It is incredibly frustrating how often doctors ignore you about negative effects of drugs
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San Perlita ISD closes all school operations over 'rapid spread of COVID-19'
Thursday August 27th, 2026 at 11:56 AM

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The San Perlita Independent School District will close all school operations for two days due to the rapid spread of COVID-19, according to Superintendent Annette Arredondo.

Arredondo said this is a precautionary measure to help protect the safety and health of students, staff and families.

The district will be closed Aug. 25 through Aug. 26, and all school operations will resume on Aug. 27.

Arredondo said district officials will continue to monitor the situation and provide updates regarding the return to normal operations.

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Fake US thinktank set up and funded by Israel sought to game AI for propaganda
Wednesday August 26th, 2026 at 5:21 PM

The Guardian
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A pro-Israel messaging website badged with the name of a thinktank that does not exist has published more than half a million words in nine days, built on a commercial platform that promises to optimize content so that AI chatbots will cite it.

The site gives Israel’s position on subjects including the torture of Palestinian prisoners, Israeli war crimes and whether Israel has deliberately starved Palestinians in Gaza, all presented as neutral research.

The New York media production company Piro Inc filed the site with the US justice department this month under the Foreign Agents Registration Act (Fara), a 1938 law that requires anyone working for a foreign government to formally disclose it, as material it distributes for the Israeli government.

The site publishes in the name of the Hanover Institute for Public Policy, which apparently does not exist as a legal entity in any jurisdiction, has no physical address, and carries no named staff and no bylines on any of its reports. Its own terms of use are governed by the laws of “the state in which the Institute is established”, which they decline to name.

The existence of the site was first reported on 14 August. Since then the institute has added a page headed funding, which states: “An earlier version of this page said the Institute operated without external funding, and that was true when it was written.”

The site is one part of a broader effort, financed by tens of millions of dollars from the Israeli government and routed through third parties including the European advertising group Havas Media, to prime chatbots to make Israel’s arguments for it. A contract between Havas and another American firm working on the campaign commits it to the “deployment of websites and content to deliver GPT framing results on GPT conversations”.

The Guardian contacted Piro Inc, Havas Media and the Israeli government advertising agency LaPam for comment. Comment was also sought via a contact email address published on the Hanover Institute website.

It comes at a point when Israel’s standing in US public opinion has collapsed, and when Israeli officials have begun briefing media outlets that money spent on so-called “Hasbara” efforts at public diplomacy overseas has been wasted.

The site

According to a Guardian analysis, between 6 and 14 August the Hanover Institute published 124 reports totaling more than 560,000 words, an average of about 4,500 words each. On 12 and 13 August alone it produced 73 reports, amounting to almost 354,000 words in two days. Nothing has been published since the first reports about the Hanover Institute.

All but one of the 124 headlines on the website opens with a question resembling one that a user might type into a chatbot, including “Is Anti-Zionism Antisemitism?”, “Did Israel Expel Palestinians From Their Land?”, “Is Israel Carrying Out a Genocide in Gaza?”

The reports are presented in a quasi-academic manner and are punctiliously sourced, with citations including the World Bank, UN agencies, the Palestinian Central Bureau of Statistics, Amnesty International and the text of the Genocide Convention.

Nick Cleveland-Stout, a research associate at the Quincy Institute who has reported on the site, told the Guardian that his first impression was of something impressive. “It succeeds in masquerading as very academic – the website design, the logos, everything just looks good. But the more you read it, you’re able to realise that a lot of it makes no sense.”

For example, the information the Hanover Institute site presents is persistently framed to blunt criticism of Israel. Where human rights organisations have concluded that Israel is committing genocide or apartheid, the reports reliably observe that no court has entered a verdict on the claim – a formulation that appears in 20 of the 124 reports according to the Guardian’s count.

Casualty and aid figures are attributed to “a party to the events”, a caveat used in 55 reports and applied to Israel’s own counts as readily as to Palestinian ones. The reader is left with the impression that little about Gaza can be established.

One study – a 2022 analysis of antisemitic comments on the Facebook pages of British, French and German media outlets – is cited 454 times across 88 of the 124 reports, including in pages on apparently unrelated topics including land registration in the occupied territories, Aipac’s influence on US media coverage, the Gaza death toll, the 1948 expulsions and the blockade of Gaza.

Cleveland-Stout noted the cumulative effect of this inclusion. “Almost every article concludes with saying, well, just talking about this though could contribute to antisemitism,” he said. “And it’ll throw in the study about Facebook comments in Britain.”

Building for the machines

The Guardian’s analysis found that initially the site carried a kind of file that tells AI systems what a site contains and how to read it (an llms.txt file), but which did not describe the Hanover Institute at all. It was the standard file of Res, an “AI-native content platform that helps B2B [business-to-business] teams get cited by ChatGPT, Perplexity, Claude, and Gemini”, which sells what the industry calls generative engine optimization.

The Guardian archived the file on 13 August. It has since been replaced with a bespoke version written for machine readers, and Res is no longer named anywhere on the site.

Res’s founder, Hai Tran, registered with the US justice department on 22 July as a subcontractor to Piro on the Israeli account, giving his position as “digital strategist”. Tran told Politico that his role was disclosed in that filing.

The Guardian contacted Res for comment.

Piro’s own website advertises a service it calls AI Story Optimization, under which it will “author content engineered for how LLMs evaluate credibility”, with the work shipping “on your site or on trusted third-party properties we build”.

Cleveland-Stout said the more consequential target was not the possibility of users getting to the site with a live search, but the training data. “There’s kind of two ways to do it,” he said. The first is publishing sites and hoping chatbots cite them. The second, “the more concerning and potentially more effective thing”, is getting material into repositories such as Common Crawl that supply the underlying training data for commercial models.

“When it regurgitates narratives the chatbot is trained on, it won’t even cite the sources,” he said. “You won’t be able to fact-check it.”

The older network has already made that journey. The seven sites run by Clock Tower X – the firm run by former Trump campaign manager and digital director Brad Parscale – appeared 294 times in Common Crawl’s July index, the repository that supplies training data to commercial AI developers. The Hanover Institute does not appear yet, its reports having gone up after that crawl closed. It is at the start of the same pipeline.

Every page of the Hanover site carries a foreign-agent disclosure at its foot. Cleveland-Stout put that to Perplexity, which he said told him that users could visit the website and judge its trustworthiness for themselves. “But how many people are doing that?” he said.

The Guardian’s tests of chatbots at the time of reporting showed that scrutiny of the Hanover Institute’s output had already made a mark on chatbot content, however.

Asked for new research published by the Hanover Institute, ChatGPT’s webchatbot offered links to four reports, but also warned that the institute was subject to “significant controversy over who funds it and why it exists”, offering a gloss of and links to Quincy Institute’s reporting.

The chain

Piro is contracted for $1m across two work orders according to Fara filings, but this sum is dwarfed by the spending on the wider campaign it belongs to.

Both Piro and Clock Tower X are subcontractors to Havas Media Germany GmbH, a Frankfurt company held through Havas’s Spanish arm and ultimately by the Amsterdam-listed Havas NV.

Havas is named as the intermediary in the US foreign-agent registrations of five American firms: Clock Tower X, Piro, Targeted Communications Global, Bridges Partners and Davis Media NY. Justice department filings record it paying Clock Tower X $15m in six installments between 24 October 2025 and 3 March 2026, and Targeted Communications Global $9,892,335 between October and December 2025.

Seven days after the first of those payments, on 31 October 2025, Havas’s own US subsidiary terminated its registration as an agent of the Israeli government, according to filings. While it held that registration it was obliged to itemise what it received: its filing for the six months before 31 October 2023 records $2,951,745 from its German sister company on the Israeli account. Once the German entity began paying American contractors directly, Havas ceased to disclose anything, because a foreign principal has no filing obligation.

In effect, this meant that the broader campaign would not be immediately visible in the public record, only the piecemeal filings of individual contractors.

In Israel, procurement records show the government advertising agency LaPam awarding Havas entities contracts without competitive tender: $39m (€33.5m), $29m (€25m) and $17.5m (€15m) across 2019, and $58.3m (€50m) in March 2023 for the planning and purchase of media abroad. That contract expired on 15 March 2024. A search of LaPam’s published record to 5 August 2026, and of the tender register, found no further award to Havas – none covering the period in which Havas was paying $24.9m to American firms.

The money was not wholly confined to efforts to seed chatbots. Targeted Communications Global’s filings disclose a social media campaign called Freedom Not Terror, whose 30-second video, posted as unlisted on YouTube in October 2025, has been viewed 28.1m times. Its TikTok account has 425 followers. The campaign site carries the line “Paid for by LAPAM”. It has published nothing since December 2025.

The Guardian contacted Targeted Communications Global for comment.

The refuge of all failures

In Israel, officials have aired doubts about the campaign to sway US public opinion by gaming AI, and about public diplomacy in general. In July, Israeli officials briefed Ynet that it had failed, one saying the government “paid a lot of money, but the situation only got worse”.

A former senior figure in Israel’s public diplomacy apparatus told the same paper it was “a terrible hoax on the scale of Pollard” – a reference to Jonathan Pollard, the American analyst jailed for spying for Israel in 1987, an incident that marked a low point in the country’s relationship with Washington.

Speaking to Kan about Parscale, another official said: “He was supposed to improve the situation. We paid him a lot of money. But what did he do with it?” The foreign minister, Gideon Sa’ar, had allocated $181.6m (₪545m) to international public diplomacy on taking office, then a further $666.3m (₪2bn) for 2026 and 2027.

The YNet reporting said budget control had passed to the ministry’s director general, Eden Bartel, and to Eran Shayovitch, an external adviser brought in by the minister. Shayovitch is named on Piro’s foreign-agent filing as one of two Israeli officials with whom the firm engages.

US public opinion polling reveals the source of these frustrations. Gallup found in February that Americans sympathised more with Palestinians than with Israelis for the first time, with 36% siding with Israel. Pew recorded 60% of Americans holding an unfavourable view of Israel in April, up nearly 20 points since 2022, with the sharpest movement among the young. An AP-NORC survey published on 7 July found 31% of Americans say Israel’s military actions in Gaza constitute genocide, rising to 52% of Democrats, and 58% of Democrats saying the US is too supportive of Israel, against 45% in January 2024.

Cleveland-Stout doubted that any public diplomacy could overcome the opposition to Israeli policy. “There is a lack of reflection on the fact that the policies themselves are the ones that are leading to a lot of Americans questioning their support for Israel,” he said. “They view what is a political problem as a marketing one.”

He cited the late Israeli politician Yossi Sarid, who a year before his death in 2015 joked in an interview that “Hasbara is always the refuge of all failures. Everything is going great – only the hasbara is garbage. If only the hasbara was ok, then everyone would realize the ideal situation.”

Whether the campaign works on its own terms is a separate question from whether it works for Israel, though. “Parscale is having success in influencing chatbots, and the Hanover Institute is and will continue to have success at influencing the responses that chatbots give,” Cleveland-Stout said. “But they’re not changing the polls, which is what Israel actually cares about.”

His wider concern was what the experiment demonstrates. “Whether it’s foreign governments, whether it’s companies, whether it’s even just a guy who owns an ice cream shop – LLM grooming, poisoning, whatever you want to call it, is part of the new reality that we live in.”

Although neither responded to the Guardian, the Israeli foreign ministry has said the state does not conduct “influence operations” in the United States, and that it is “scrupulously careful to implement the provisions of American law”, and Piro’s co-founder Daniel Rosenberg has said the firm was retained “to put accurate, sourced facts into the public record and to counter misinformation about Israel with verifiable information”.

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