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Commentary: AI isn’t ready to be your doctor yet — but will it ever be?

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Commentary: AI isn’t ready to be your doctor yet — but will it ever be?

As almost everybody knows, the AI gold rush is upon us. And in few fields is it happening as fast and furiously as in healthcare.

That points to an important corollary: Beware.

Artificial intelligence technology has helped radiologists identify anomalies in images that human users have missed. It has some evident benefits in relieving doctors of the back-office routines that consume hours better spent treating patients, such as filing insurance claims and scheduling appointments.

Eventually, a lot of this stuff is going to be great, but we’re not there yet.

— Eric Topol, Scripps Research

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But it has also been accused of providing erroneous information to surgeons during operations that placed their patients at grave risk of injury, and fomenting panic among users who take its offhand responses as serious diagnoses.

The commercial direct-to-consumer applications being promoted by AI firms, such as OpenAI’s ChatGPT Health and Anthropic’s Claude for Healthcare — both of which were introduced in January — raise special concerns among medical professionals. That’s because they’ve been pitched to users who may not appreciate their tendency to output erroneous information errors and offer inappropriate advice.

“Eventually, a lot of this stuff is going to be great, but we’re not there yet,” says Eric Topol, a cardiologist associated with Scripps Research Institute in La Jolla.

“The fact that they’re putting these out without enough anchoring in safety and quality and consistency concerns me,” Topol says. “They need much tighter testing. The problem I have is that these efforts are largely stemming from commercial interests — there’s furious competition to be the first to come out with an app for patients, even if it’s not quite ready yet.”

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That was the experience reported by Washington Post technology columnist Geoffrey A. Fowler, who provided ChatGPT with 10 years of health data compiled by his Apple Watch — and received a warning about his cardiac health so dire that it sent him to his cardiologist, who told him he was in the bloom of health.

Fowler also sought out Topol, who reviewed the data and found the Chatbot’s warning to be “baseless.” Anthropic’s chatbot also provided Fowler with a health grade that Topol deemed dubious.

“Claude is designed to help users understand and organize their health information, framing responses as general health information rather than medical advice,” an Anthropic spokesman told me by email. “It can provide clinical context—for example, explaining how a lab value compares to diagnostic thresholds—while clearly stating that formal diagnosis requires professional evaluation.”

OpenAI didn’t respond to my questions about the safety and reliability of its consumer app.

Topol, who has written extensively about advanced technology in medicine, is nothing like an AI skeptic. He calls himself an AI optimist, citing numerous studies showing that artificial intelligence can help doctors treat patients more effectively and even to improve their bedside manners.

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But he cautions that “healthcare can’t tolerate significant errors. We have to minimize the errors, the hallucinations, the confabulations, the BS and the sycophancy” that AI technology commonly displays.

In medicine, as in many other fields, AI looks to have been oversold as a labor-saving technology. According to a study of AI-equipped stethoscopes provided to about 100 British medical groups published earlier this month in the Lancet, the British medical journal, the high-tech stethoscopes effectively identified some (but not all) indications of heart failure better than conventional stethoscopes. But 40% of the groups abandoned the new devices during the 12-month period of the study.

The main complaint was the “additional workflow burden” experienced by the users — an indication that whatever the virtues of the new technology, they didn’t outweigh the time and effort needed to use them.

Other studies have found that AI can augment physicians’ skills — when the doctors have learned to trust their AI tools and when they’re used in relatively uncomplicated, even generic, conditions.

The most notable benefits have been found in radiology; according to a Dutch study published last year, radiologists using AI to help interpret breast X-rays did as well in finding cancers as two radiologists working together. That suggested that judicious use of AI could free up time for one of the two radiologists. But in this case as in others, the AI helper didn’t do consistently well.

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“AI misses some breast cancers that are recalled by human assessment,” a study author said, “but detects a similar number of breast cancers otherwise missed by the interpreting radiologists.”

AI’s incursion into healthcare even has become something of a cultural touchstone: In HBO’s up-to-the-minute emergency room series “The Pitt,” beleaguered ER doctors discover that an AI app pushed on them as a time-saving charting tool has “hallucinated” a history of appendicitis for a patient, endangering the patient’s treatment.

“Generative AI is not perfect,” the app’s sponsor responds. “We still need to proofread every chart it creates” — thus acknowledging, accurately, that AI can increase, not relieve, users’ workloads.

A future in which robots perform surgical operations or make accurate diagnoses remains the stuff of science fiction. In medicine, as elsewhere, AI technology has been shown to be useful to take over automatable tasks from humans, but not in situations requiring human ingenuity or creativity — or precision. And attempts to use AI-related algorithms to make healthcare judgments have been challenged in court.

In a class-action lawsuit filed in Minnesota federal court in 2023, five Medicare patients and survivors of three others allege that UnitedHealth Group, the nation’s largest medical insurer, relied on an AI algorithm to deny coverage for their care, “overriding their treating physicians’ determinations as to medically necessary care based on an AI model” with a 90% error rate.

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The case is pending. In its defense, UnitedHealth has asserted that decisions on whether to approve or deny coverage remain entirely in the hands of physicians and other clinical professionals the company employs, and their decisions on coverage and care comply with Medicare standards.

The AI algorithm cited by the plaintiffs, UnitedHealth says, is not used “to deny care to members or to make adverse medical necessity coverage determinations,” but rather to help physicians and patients “anticipate and plan for future care needs.” The company didn’t address the plaintiffs’ assertion about the algorithm’s error rate.

“We shouldn’t be complacent about accepting errors” from AI tools, Topol told me. But it’s proper to wonder whether that message has been absorbed by promoters of AI health applications.

Disclaimers warning that AI responses “are not professionally vetted or a substitute for medical advice” have all but disappeared from AI platforms, according to a survey by researchers at Stanford and UC Berkeley.

The issue becomes more urgent as the language of chatbots becomes more sophisticated and fluent, inspiring unwarranted confidence in their conclusions, the researchers cautioned. “Users may misinterpret AI-generated content as expert guidance,” they wrote, “potentially resulting in delayed treatment, inappropriate self-care, or misplaced trust in non-validated information.”

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Typically, state laws require that medical diagnoses and clinical decisions proceed from physical examinations by licensed doctors and after a full workup of a patient’s medical and family history. They don’t necessarily rule out doctors’ use of AI to help them develop diagnoses or treatment plans, but the doctors must remain in control.

The Food and Drug Administration exempts medical devices from government licensing if they’re “intended generally for patient education, and … not intended for use in the diagnosis of disease or other conditions. That may cover AI bots if they’re not issuing diagnoses.

But that may not help users who have willingly uploaded their medical histories and test results to AI bots, unaware of concerns, including whether their information will be kept private or used against them in insurance decisions. Gaps in their uploaded data my affect the advice they receive from bots. And because the bots know nothing except the content they’ve been fed, their healthcare outputs may reflect cultural biases in the basic data, such as ethnic disparities in disease incidence and treatment.

“If there’s a mistake with all your data, you could get into a pretty severe anxiety attack,” Topol says. “Patients should verify, not just trust” what they’ve heard from a bot.

Topol warns that the negative effect of misleading AI information may not only fall on patients, but on the AI field itself. “The public doesn’t really differentiate between individual bots,” he told me. “All we need are some horror stories” about misdiagnoses or dangerous advice, “and that whole area is tarred.”

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In his view, that would limit the promise of technologies that could improve the effectiveness of medical practice in many ways. The remedy is for AI applications to be subjected to the same clinical standards applied to “a drug, a device, a diagnostic. We can’t lower the threshold because it’s something new, or different, with some broad appeal.”

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What SpaceX and its record IPO have riding on the new race to the moon

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What SpaceX and its record IPO have riding on the new race to the moon

A recent policy change by NASA has given Elon Musk’s SpaceX a greater role in the Artemis moon program just as the company contemplates a record initial public offering.

When the first American crew since 1972 orbits around the moon this month, SpaceX’s stylized logo will be nowhere to be found — but it might as well be plastered everywhere.

Elon Musk’s rocket company is preparing what is expected to be the largest initial public offering in history, and it has as much, if not more, riding on NASA’s Artemis program as Boeing and the other contractors that built the SLS rocket that will blast the astronauts into space and the Orion capsule carrying them on their mission — a fly-by of our closest celestial neighbor.

Radical changes announced in February by new NASA Administrator Jared Isaacman to speed up the country’s return to the moon could make the program more reliant on SpaceX on future launches.

That includes using its massive Starship rocket to ferry crews and construction materials to the moon, where Isaacman said NASA now plans to build a research and exploration station as it faces competition from a joint China-Russian team.

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SpaceX, which maintains a large presence in Southern California’s burgeoning aerospace sector, is readying an initial public offering possibly for this summer that is expected to be the largest in history, perhaps raising as much as $75 billion. It follows Musk’s merging of his xAI artificial intelligence company into his rocket company in February.

The funds would help pay for Musk’s equally giant if quixotic plans: building his own Moonbase Alpha colony, manufacturing millions of driverless cars and robots, and putting artificial intelligence data centers into space, using satellites that use solar energy to do AI computations.

Here’s what to know about what this means for SpaceX, which has large operations in Hawthorne and launches its workhorse Falcon 9 rockets from Vandenberg Space Force Base in Santa Barbara County.

How important is it for SpaceX that NASA is returning American astronauts to the moon?

Wedbush analyst Dan Ives calls the Artemis launch a “watershed” event for the company, which he expects will be a leader in the new space economy where trillions will be spent on artificial intelligence, space infrastructure and related businesses.

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“The moon ultimately represents the golden goose for Musk and SpaceX,” he said. “It’s a fourth industrial revolution and we just happen to live in it.”

What plans does SpaceX have for the moon?

Musk has long said that his life’s ambition is to colonize Mars, but in February the world’s richest man posted on X that his company first planned to build “a self-growing city on the Moon, as we can potentially achieve that in less than 10 years.”

What would be the purpose of such a city?

A moon outpost would solve some of the same technological challenges a Mars colony would face without the same level of cost and risk, given how much faster and less expensive it is to reach the moon. Musk also has sketched out a futuristic vision of building AI data centers on the moon with the help of the company’s Optimus robots and catapulting them into space.

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Catapulting data centers into space from the moon sounds like science fiction. How is that even possible?

At a February presentation, Musk said that the lower gravity of the moon would allow the satellites to be shot into space using a magnetic accelerator — what he called a “mass driver” — radically reducing the cost compared with Earth launches, in which rockets expend tons of fuel to escape gravity. “I want to just live long enough to see the mass driver on the moon, because that’s going to be incredibly epic,” he said. That timeline doesn’t even consider that SpaceX has yet to launch a data center satellite from Earth.

How does this fit into NASA’s plans?

In March, Isaacman announced the government’s own highly ambitious plans to spend $20 billion to start building a sustained human presence on the moon within seven years. While the SLS rocket would still lift the Orion capsule into Earth’s orbit, Artemis could now rely on the Starship rocket, still in its testing and development phase, to dock with the capsule in Earth’s orbit and ferry astronauts to the moon, where it would land the crew and building materials. A spacecraft being developed by Jeff Bezos’ Blue Origin could serve as another moon lander given the vast payload needed for a moon colony. The first crewed mission to the moon’s surface is planned for 2028.

How does this tie in to SpaceX’s IPO?

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SpaceX has confidentiality filed for an IPO expected later this year sources told Bloomberg on Wednesday. It could value the company at $1.75 trillion, which would allow it to sell just a fraction of its shares yet still raise more than twice as much as the current largest IPO on record: Saudi Aramco’s $29.4-billion oil-and-gas offering in 2019. Given its massive size, SpaceX is in talks with at least 21 banks to sell the securities to investors, Reuters reported.

The company has a massive need for capital if it is going to pull off Musk’s dreams, which he said rely on vast numbers of AI chips. In February, he announced the construction of a giant chip fabrication plant in Austin, Texas, because of a lack of supply from existing chipmakers.

How are financial markets reacting to Musk’s plans?

The IPO has drawn huge attention given its size and SpaceX’s prospects for growth.

“As an investor, I’m excited. As a human being, I’m excited. It’s just opening a whole different world, a universe, essentially, that we were not exposed to before. We went to the moon over 50 years ago, and that was it. Nothing has happened really since then,” said Mike Alves, founder of Pasadena’s Vida Vision Fund, which has a stake in SpaceX and xAi that accounts for 45% of his AI and robotics fund.

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An analysis of the IPO by PitchBook assigns no revenue to Musk’s AI data centers or his Moonbase Alpha plan but estimates that the company earned $7.5 billion in profit last year on nearly $16 billion of revenue from its Starlink satellite network, commercial launch services for third parties and other businesses.

It estimates that growth from the company’s Starlink internet, launch and nascent satellite phone service could boost profit to $60 billion and revenue to $150 billion by 2040 — making an IPO that values the company at $1.5 trillion “expensive but not irrational.”

Are there skeptical voices about SpaceX and its IPO?

Yes, plenty. There are technological hurdles for SpaceX to carry out its plans. Most immediately, the Starship rocket that NASA is relying on — even bigger than Apollo’s Saturn V — has suffered some bad test flights. SpaceX also must master a key technological hurdle: refueling the rocket while it’s in Earth’s orbit so it has enough fuel to carry out its flight to the moon, land there and return to Earth. Beyond that, Musk’s plans to manufacture millions of chips and robots aren’t close to becoming a reality.

“There is an AI-hungry market at the moment and there’s a lot of investors waiting for those opportunities to happen,” said Igor Pejic, author of “Tech Money.” “But you face the likelihood that it might never happen, or it might happen in three years, five years, 10 years from now.”

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Commentary: Why isn’t the stock market freaking out more over the Iran war? Here’s why

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Commentary: Why isn’t the stock market freaking out more over the Iran war? Here’s why

Since the end of February, the three major stock market indices — the Standard & Poor’s 500, the Dow Jones industrials and the Nasdaq composite — have fallen by a few percentage points.

One might ask: That’s all? Doesn’t the market know there’s a war on?

Yes, the stock market knows. It just doesn’t care as much as you might think it should.

It feels like this drawdown should be worse than this given everything going on in the world.

— Ben Carlson

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History tells us that we shouldn’t be all that surprised. Although geopolitical events like the launch of military actions tend to rattle the securities markets in the short term, investors eventually shift to the long view, assuming that these conflicts will eventually be resolved and the door reopened to bullish sentiment.

The major downturns of the past, such as the crashes of 1929, 2000 and 2008, have been caused less by external events than by business and investment internals, such as threats to economic structure — over-leveraging in the first, the dot-com crash in the second and the housing crash in the third. Those were genuine crashes, not short-term downturns.

The Iran war hasn’t yet taken on the coloration of an economic threat, although that bulks large on the horizon if the disruption of oil supplies created by the closing of the Strait of Hormuz continues or tightens or the Middle East energy infrastructure sustains more damage.

Indeed, two of the most severe downturns of recent times are associated with oil — the Arab oil embargo of 1973, following the Yom Kippur War, which brought the S&P 500 down by more than 16% over a period of about six weeks, and Iraq’s seizure of Kuwaiti oilfields in 1990, which caused a 16% drop in the S&P over about two months.

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Let’s take a look at the condition of the stock market since the U.S. attacks on Iran began on Feb. 28, and then place it in the context of market behavior after other major events, dating back to the start of World War II.

From Feb. 28 through Thursday’s trading close, the S&P lost 4.31%, the Dow, 5.05% and the Nasdaq, 3.57%. Those declines feel ugly, in part because they’ve occurred over a short time frame of about five weeks. But in the grand scheme of things, they’re modest.

“It feels like this drawdown should be worse than this given everything going on in the world,” Ben Carlson of Ritholtz Wealth Management posted last week. But Carlson observed that 5% pullbacks are common, in good times and bad — only three years since 1990 have gone without one.

There were two each in 2023, 2024 and 2025, which all ultimately delivered double-digit S&P returns. None, obviously, came close to the 10% pullback known as a correction, which by Carlson’s reckoning occurs on average every 1.8 years.

The latest pullbacks have come with the stock market percolating along at historically generous valuations. This year, the S&P’s price-earnings multiple has hovered around 30x, well above its historical average of less than 20x. That alone should have had investors bracing for a reversal or even a correction.

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When similar events occur during bull markets, external events are often a trigger rather than a cause. Investors look for reasons to take profits, even though the rationales may have nothing to do with the market action.

To place things in a longer perspective, let’s review how the stock market has reacted to great global events of the past. (Thanks to Ryan Detrick of the financial advisory firm Carson Group for compiling these statistics.)

The Pearl Harbor attack of Dec. 7, 1941, brought the S&P down by 11% over the following three months — but one year later the market was up by 4.3%. One month after Richard Nixon’s resignation on Aug. 9, 1974, the market was down by 14.4%; one year later it was up by 6.4%. The market entirely shrugged off the Cuban missile crisis, the Kennedy assassination, the Hamas attack on Israel on Oct. 7, 2023, and Russia’s 2014 annexation of Crimea and its 2022 invasion of Ukraine; none was associated with a market decline over the following month.

Even when events did precede a market decline, stocks often recovered within weeks or months. North Korea’s invasion of the South in 1950, launching the Korean War, took the market down 12.9% over the next two weeks, but as Kelly Bogdanova of RBC Wealth Management documents, it made up the loss over the next 56 trading days. Similarly, the Russian invasion of Ukraine in February 2022 is blamed for a 7.4% decline over the following two weeks, but the market broke even 27 trading days later.

Bogdanova notes that after the 1990 Kuwait invasion, which knocked the market down by 16% over seven weeks, the market didn’t break even for an additional four months. But that was oil talking.

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The current market environment may be unique, because it’s entirely in the hands of one reckless individual. As the late Michael Metz of Oppenheimer & Co. taught me, the stock market typically rises in times of economic growth and economic downturns, as long as investors know where things stand on the turn of the wheel.

What they hate is uncertainty, and no one revels in squeezing uncertainty until it screams for mercy like Trump. Consider how the market got whipsawed by his announcement of “Liberation Day” tariffs, a faux-protectionist stunt that took place on April 2, 2025, and therefore marked its one-year anniversary Thursday.

The draconian tariffs were announced, amended, partially withdrawn, reimposed, etc., etc., until investors got queasy on the merry-go-round. The Supreme Court finally put a stop to the shenanigans on Feb. 20.

One month after the initial announcement, investors still didn’t know what to make of it. The S&P was virtually flat, the Dow had lost 2.15% and the Nasdaq was up 2.1%. Since then, investors have learned enough about Trump’s decision-making to disregard the chatter. (This is the TACO trade, for “Trump Always Chickens Out,” in action.) As of Thursday, the S&P had gained 13.7% since Liberation Day, the Dow was up 9.1% and the Nasdaq was up 19.3%.

The Iran war is driving a whipsaw all its own. The market has been rising and falling in accordance with whether investors buy into Trump’s optimism or grow downcast at the absence of any endgame, a judgment that can change minute by minute. But it has remained in a tight range of 3 to 5 percentage points.

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The latest week provides a good illustration: Tuesday saw shares turn in their best day in months, with the Dow gaining 1,125 points, or 2.49%, and the other indices roughly matching its performance.

But on Thursday, the stock index futures markets plummeted after Trump’s vacuous address to the nation, ostensibly due to disappointment that he didn’t provide an ending date or show that he knows what he’s doing. Yet investors didn’t show the same anxiety once trading started, sending the indices into a sort of fugue state. The S&P gained a meager 7.37 points, or 0.11%, the Dow lost 61.07 (0.13%) and the Nasdaq gained 38.23 points (0.18%), all on volume a fraction of what it has been in recent weeks. The trading range held.

It’s possible, of course, that the market will be stirred out of its slumber by a major development. A ceasefire, say, or something bad. Or that the Iran war will transition to a new phase that makes it resemble the oil embargos of the past rather than a transitory disruption of the status quo. We won’t know until it happens.

Until then, the average investor’s choice is between moving everything into cash, or strapping in for the ride.

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Consumers aren’t clicking the PayPal button. It’s a big problem for California’s fintech pioneer

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Consumers aren’t clicking the PayPal button. It’s a big problem for California’s fintech pioneer

PayPal, once the cutting-edge trailblazer of digital payments, is struggling to cash in on consumer clicks like it used to.

The San José fintech giant is losing market share to competitors and had to swap out its leadership recently as its shares plunged, and it scrambled for a faster fix.

When online shoppers reach the checkout screen, they’re not clicking on the PayPal button to buy items as much as they did in the past. People have payment options from Apple, Google and others, some of which are easier to use on their smartphones.

A slowdown in PayPal’s branded checkout is at the core of the company’s biggest challenges, analysts and company executives said.

In February, PayPal let go of its chief executive, who had been working to fix the problem, but the company said his “pace of change and execution” over two years didn’t meet the board’s expectations.

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In the fourth quarter, PayPal’s online branded checkout growth slowed to 1%. The company reported an adjusted profit of $1.23 per share on revenue of $8.68 billion, missing Wall Street’s expectations.

Since January, PayPal’s stock price has fallen by more than 20%.

“The problem is that transition and push for branded checkout really has not paid off,” said Grace Broadbent, a senior analyst of payments for eMarketer.

PayPal attributed the slowdown partly to the “K-shaped economy,” in which wealthier Americans see their incomes rise while lower-income Americans struggle financially. PayPal has many middle-income customers and some lower-income customers, so a pullback in spending affects use of its payments platform.

Other factors that have hurt it recently include product execution and a hit in high-growth areas such as crypto, gaming and ticketing.

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The slowdown raised questions about whether PayPal’s turnaround efforts were working. The company makes most of its money by charging fees for payment services.

“The vast majority of PayPal’s profits come from the branded checkout button,” said Mizuho analyst Dan Dolev. “The yield they get when you click on the branded checkout button is multiples of any other product that they have.”

Now the pressure is on Enrique Lores, who became PayPal’s president and chief executive in March, to get the company back on track. Lores was on PayPal’s board for nearly five years and came from computer and printer maker HP, where he served as chief executive. PayPal is investing $400 million to improve and grow branded checkout this year.

“The payments industry is changing faster than ever, driven by new technologies, evolving regulations, an increasingly competitive landscape, and the rapid acceleration of AI that is reshaping commerce daily,” Lores said in a February statement. “PayPal sits at the center of this change, and I look forward to leading the team to accelerate the delivery of new innovations.”

PayPal has seen growth in its subsidiary Venmo, a social mobile payment app, and its buy-now-pay-later services. The company is scheduled to report its first-quarter earnings in May.

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“They’re going through some hard times, but I still think there’s a lot of value in PayPal,” Dolev said. “Not that many companies out there that have this kind of moat, which is a global wallet that everyone recognizes.”

Before PayPal transformed into a multibillion-dollar company with 23,800 employees and 439 million active consumer and merchant accounts across roughly 200 markets, the startup weathered a lot of change.

Founded in 1998 under a different company name by Max Levchin, Peter Thiel and Luke Nosek, the startup initially focused on security software for handheld devices before shifting to digital payments.

After merging with Elon Musk’s online bank X.com, the company was renamed PayPal. The platform made it possible for people to securely send money digitally using their email address, which was easier than writing up a check or filling out a money order.

PayPal went public in 2002 and shortly after EBay acquired the startup for $1.5 billion. In 2013, PayPal acquired the fintech company Braintree, which owned the social payment service Venmo, giving PayPal an edge in mobile commerce.

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Two years later, it became an independent company when it split from EBay.

PayPal’s founders and early employees, dubbed the “PayPal Mafia” by Fortune magazine in a 2007 story, would go on to invest or build successful Silicon Valley companies.

During the COVID-19 pandemic in 2020, PayPal was flying high. People spent a lot of time stuck at home and online shopping skyrocketed. PayPal’s stock price peaked in July 2021, but has plummeted since then.

Over the last five years, its share price has dropped more than 80%.

“Now the industry is maturing, so there’s less growth to go around,” Broadbent said.

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The competition is heating up, especially in the United States.

PayPal’s core users in the United States are projected to grow by fewer than 1% year-over-year to 92.1 million in 2026, eMarketer forecasts. Nationwide, Apple and Google are expected to see their digital wallet users grow more, reaching 90.5 million and 55 million U.S. users, respectively.

Apple Pay is popular among Gen Z and makes it easy to pay by double-clicking the side of their phone.

“They do so much more shopping on their phone than ever before, so Apple Pay is ingrained in their iPhone,” Broadbent said.

Google has also integrated its payment service into products such as its browser, Google Chrome. Then there are more buy-now-pay-later services that people are taking advantage of as they spread out their spending on expensive items.

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Other challenges are on the horizon for payment services.

Tech companies are contending with the rise of artificial intelligence, which could disrupt the way people shop. Tech executives have talked about a future in which AI agents will shop and buy items on behalf of consumers, with their approval.

Last year, PayPal teamed up with AI company Perplexity so people could use its service to purchase products from retailers such as Abercrombie & Fitch and Ashley Furniture within Perplexity’s chat interface.

“That’s a future challenge for PayPal that opens up a lot of different dynamics of who’s gonna win,” Broadbent said.

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