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Nvidia is, in crucial ways, nothing like Enron – the Houston energy giant that imploded through multibillion-dollar accounting fraud in 2001. Nor is it similar to companies such as Lucent or Worldcom that folded during the dotcom bubble.

But the fact that it needs to reiterate this to its investors is less than ideal.

Now worth more than $4tn (£3tn), Nvidia makes the specialised technology that powers the world’s AI surge: silicon chips and software packages that train and host systems such as ChatGPT. Its products fill datacentres from Norway to New Jersey.

This year has been an exceptional one for the company: it has struck at least $125bn in deals, ranging from a $5bn investment into Intel – to facilitate its access to the PC market – to $100bn invested in OpenAI, the startup behind ChatGPT.

But even as those deals have fuelled surging stock prices and paved the way for chief executive Jensen Huang’s energetic world tour, doubts have emerged about how Nvidia does business, especially as it has become increasingly central to the health of the global economy.

The start of these concerns has been the circular nature of many of its deals. These arrangements resemble vendor financing: Nvidia lending money to customers so they can buy its products.

The largest of these is its deal with OpenAI, which involves Nvidia investing $10bn into the company each year for the next 10 years – most of which will go to buying Nvidia’s chips. Another is its arrangement with CoreWeave, a company that provides on-demand computing capacity to big AI firms, essentially leasing out Nvidia’s chips.

The circularity of these deals has drawn comparisons with Lucent Technologies, a telecoms company that also aggressively lent money to its customers, only to overextend itself and unravel in the early 2000s. Nvidia has aggressively rebutted suggestions of any similarity, saying in a leaked recent memo that it “does not rely on vendor financing arrangements to grow revenue”.

James Anderson, a renowned tech investor, describes himself as a “huge admirer” of Nvidia, but said this year that the OpenAI deal presented “more reason to be concerned there than before”.

He added: “I have to say the words ‘vendor financing’ do not carry nice reflections to somebody of my age. It’s not quite like what many of the telecom suppliers were up to in 1999-2000, but it has certain rhymes to it. I don’t think it makes me feel entirely comfortable from that point of view.”

Other high-profile recent deals include the tech firm Oracle spending $300bn on datacentres for OpenAI in the US – with the ChatGPT developer then paying back roughly the same amount to use those datacentres. In October, OpenAI and the chipmaker AMD signed a multibillion-dollar chip deal that also gave OpenAI the option to buy a stake in the Nvidia rival.

There is also a deal with CoreWeave where, along with a commitment to buying $22bn of data centre capacity from the cloud provider, OpenAI is receiving $350m in CoreWeave stock. Asked this month about circularity in the AI industry, the chief executive of CoreWeave, Michael Intrator, said: “Companies are trying to address a violent change in supply and demand. You do that by working together.”

All these moves form part of OpenAI’s $1.4tn bet on computing capacity to build and operate models that, it argues, will transform economies – and make back that expenditure. OpenAI argues that, while the Nvidia and AMD deals have an investment component, it only kicks in once the chips have been bought and deployed, while the investments themselves create aligned incentives to build out AI infrastructure at huge scale.

Graphic showing the companies Nvidia has deals with and the types of deals they are

Nvidia has also used structures called special-purpose vehicles (SPVs) in financing deals. The best-known example is the SPV linked to Elon Musk’s xAI: an entity into which Nvidia invested $2bn, money that will be used to buy Nvidia’s chips.

This drew comparisons with Enron, which used SPVs to keep debts and toxic assets off its balance sheets, convincing investors and creditors that it was stable while concealing ballooning liabilities.

Nvidia has also strongly denied that it is like Enron: in the same leaked memo where it discussed Lucent, it said its reporting was “complete and transparent” and “unlike Enron” it “does not use special-purpose entities to hide debt and inflate revenue”.

The journalist Ed Zitron, a noted sceptic of the AI boom, agrees that Nvidia is not like either company. Unlike Lucent, it does not appear to be taking on a great deal of debt to finance its circular deals, he says, and most of the customers it is supporting are not as obviously risky as Lucent’s dotcom bubble partners. And it isn’t like Enron, Zitron argues, because it’s being fairly transparent about its own complex, off-balance sheet deals.

So what could warrant a comparison? Nvidia “is not hiding debt, but it is leaning heavily on vendor-financed demand, which creates exposure if AI growth slows,” says Charlie Dai, an analyst at the research firm Forrester. “The concern is about sustainability, not legality.”

Essentially, whether Nvidia is able to stick the landing depends on whether AI really takes off, generating billions for its corporate users and putting companies such as OpenAI, Anthropic and CoreWeave – Nvidia’s customers – firmly in the black, and able to keep buying its systems. That possibility alone is debatable. If this does not happen, says Dai, Nvidia “could face write-downs on equity stakes and unpaid receivables”: meaning, it could lose a lot of money and its stock price could then tank.

Approached for comment, an Nvidia spokesperson referred the Guardian to remarks its chief financial officer, Colette Kress, made to investors in early December. Kress said they were not seeing an AI bubble, instead gesturing at trillions of dollars of business that lie ahead for Nvidia in the next decade.

In particular, Kress argued that Nvidia’s recent – massive – deals are just the start for the company, and the real money will be made in the coming years, largely through replacing almost all the chips in existing datacentres with its products.

There is another complexity, which is that Nvidia’s health – and therefore the health of the entire global economy – also depends on whether AI takes off in time for Nvidia and its customers to service the debt from their huge datacentre buildouts and significant capital expenditures.

Add to this a final category of concern: recent, big-ticket deals with countries such as South Korea and Saudi Arabia, worth multiple billions of dollars, whose terms are opaque. In October, Nvidia said that it would supply 260,000 of its Blackwell chips to South Korea’s government and South Korean companies. The value of this deal was not disclosed, but is estimated to be in the billions.

Likewise with Saudi Arabia. Its government-owned AI startup, Humain, has committed to deploying up to 600,000 Nvidia chips: when that deployment will involve actual purchases, and at what price, is again undisclosed. Nvidia has a number of other strategic partnerships like this – with Italy, with the French AI champion Mistral and with Deutsche Telekom, for example – all involving thousands of chips and unknown sums.

Governments are likely to pay. There’s nothing circular about a sovereign partnership with Germany. But the deals mean more – quite large – uncertainties nested within a straining web of commitments that require massive capital outlay, and rely on ambitious assumptions about the economy undergoing a revolution in the next years.

“They concentrate risk in a few big customers,” says Dai. “If execution delays occur, Nvidia’s revenue recognition and cashflow could be affected.”

A systematic review of studies evaluating cannabis as a pain treatment concluded that some cannabis products do likely work to reduce chronic pain a little bit.

The overall reduction in pain was small — lowering pain by about 1 point on a scale from 1 to 10. Yet most conventional painkillers, including ibuprofen and opioids, perform similarly in randomized controlled trials.

But the review is likely to disappoint proponents of medical cannabis on one finding: It found that the pain reduction effect only occurred with products containing a significant amount of tetrahydrocannabinol, or THC.

THC, one of the two main compounds in cannabis, is responsible for the psychoactive effects of the plant. The other main component is cannabidiol, or CBD.

Oregon was the first state in the nation to decriminalize cannabis, and one of the first to legalize it for medical use and then for recreational use.

The review, which was led by OHSU researchers and published in the Annals of Internal Medicine, analyzed the results of 25 randomized controlled trials of cannabis as a pain treatment in Europe, the United States and Canada. It was funded by the U.S. Department of Health and Human Services, as a follow-up to an earlier synthesis of the evidence on cannabis and pain.

In recent years, pain patients and some researchers have pinned their hopes on CBD as a potential treatment that could reduce pain without inducing an unwanted “high” or other psychoactive effects. It’s also been appealing because there’s no concern that cannabidiol is addictive.

CBD products like gummies, tinctures and salves have proliferated, and some have been marketed for pain relief.

Roger Chou, a professor and pain management specialist at OHSU and the leading author of the review, said products containing CBD only had a trivial effect on pain in randomized controlled trials.

“The idea or hope has been that the CBD component might be the one that provides the therapeutic effects,” Chou said. “Unfortunately, what we found was that the CBD products essentially had no impact on pain.”

The review found that products with equal amounts of THC and CBD, or higher THC, while somewhat effective at reducing pain, were more likely to have side effects like nausea, sedation, and dizziness.

Chou said drugs for chronic pain have a history of falling short.

Controlled studies, he said, have found that most work about as well as non-pharmaceutical interventions like exercise, massage, and spinal manipulation.

“We keep kind of finding that these treatments don’t work as good as we thought they would. But that’s part of what’s driven this search for other things that may work better,” he said.

Chou said the review’s results shouldn’t necessarily dissuade anyone currently using CBD who is experiencing some benefit from it for their pain, noting that the studies measure an average response and individual experiences might be different.

“I don’t think our study says anything that would say you have to stop your CBD,” he said.

Additionally, the review only considered pain reduction and didn’t evaluate the evidence behind some of CBD’s other uses, like for some types of epilepsy and anxiety.drugsChou, an internal medicine doctor, said pain specialists are eager to identify safer alternatives to opioids. Patients, too, are very interested in cannabis for medical and recreational use, and have legal access to it in many states, making it important for doctors to carefully evaluate the costs and benefits.

But, Chou said, it’s a challenging research question. Most of the products that have gone through randomized trials are medical-grade or lab-made, unlike most of the plant-based products for sale in states like Oregon that have legalized cannabis.

Earlier this month, President Donald Trump ordered cannabis be moved to a lower schedule of drugs, paving the way for easier access and research into the plant.

One product that the study concluded has some evidence of working, an oral spray combination THC-CBD product called nabiximols, is approved for medical use in the United Kingdom and Canada but not the United States.

And while the review focused on cannabis’s two main components, THC and CBD, the plant contains a number of other compounds, Chou said.

At present, the American College of Physicians recommends against cannabis as a chronic pain treatment for young adults and adolescents, patients with a history of substance use disorder, patients with serious mental illness, frail patients and those at risk of falling. Other adults should discuss the potential costs and benefits with their doctor.

In November during the 2025 American Association of Neuromuscular & Electrodiagnostic Medicine meeting, Jonathan Strober, MD, a pediatric neurologist from the University of California, San Francisco, and Benioff Children’s Hospital, presented new data from the ongoing phase 2/3 VIBRANCE-MG trial (NCT05265273). This trial is evaluating pediatric response to nipocalimab for generalized myasthenia gravis (MG) in patients 2 years to younger than 18 years (international arm) and in patients 8 years to younger than 18 years (US arm). At present, nipocalimab is approved for use in patients 12 years or older who are anti–acetylcholine receptor positive or anti–muscle-specific kinase antibody positive.

In this interview, Strober emphasizes the positive safety and efficacy results seen in pediatric patients that are comparable with those seen in adult patients. He also speaks of the difficulties in diagnosing MG in a pediatric population, as well as the need to improve testing, standardize care, and overcome regulatory and insurance barriers to grant necessary treatment access to younger patients.

This transcript was lightly edited for clarity and conciseness.

AJMC: How was the VIBRANCE-MG trial designed to evaluate nipocalimab?

Strober: The VIBRANCE-MG trial is the child and adolescent arm of the study that was done in the adult population on a drug called nipocalimab. Nipocalimab is an antibody that basically prevents the antibodies that you have, the immunoglobulins, from being able to be recycled. It basically drops the amount of immunoglobulins you have in your body. It doesn’t drop [the level] completely—so you still have the ability to fight infections, which is how we use the antibodies—but the antibodies are what cause a lot of the problems in myasthenia by attaching themselves to the receptors on the muscle, blocking them from being stimulated or causing them to be broken down. By dropping the antibodies you have in your blood, you can help prevent a lot of the problems that these antibodies cause and therefore improve the symptoms.

AJMC: According to the data you presented at AANEM, what is the overall message regarding nipocalimab’s safety and efficacy?

Strober: The trial that we presented data on looked at kids who were 12 years to just under 18 years. There is an ongoing trial for younger kids, 8 to 12 years in this country and 2 to 12 years internationally, so that we get a better sense of: does this work the same way as it does in adults and is it as beneficial as it was in adults? We’re happy to say that, yes, it kind of dropped the antibodies pretty much the same as it did for the adults, and the safety was actually really good. There was a very low risk of problems. Maybe a little bit of infection in the nose and pharynx being the most common, and COVID-19 was actually the other highest amount of adverse effects. But it’s hard. I don’t really consider that an adverse effect since people get COVID all the time. But we do know that because your antibodies are lower, you definitely are at higher risk of infection. Still, it doesn’t really seem to be that significant of a risk, which is great. Patients did really well with it.

Most of the patients continued on through 72 weeks of taking this medication, so past the initial phase of the safety study. A lot of them were able to move from an every-other-week treatment to a once-a-month treatment. Only 1 patient had the flu during it and stopped for a little bit but then was able to go back on. Another patient had some worsening of symptoms, kind of outside the window, which happens in myasthenia—it is an up-and-down type of thing—but the patient was able to get treated for that bit of worsening and stayed on medication. Only 1 person stopped because they felt it wasn’t doing anything for them.

AJMC: What are the next steps in your investigation of nipocalimab?

Strober: We still have the trial ongoing, so we’re still following patients out longer. Only 3 patients had made it to the 72 weeks at the time of the cutoff when we looked at the data, so it takes a little while to kind of process the data and then be able to present it, since it all has to be scrutinized and checked out to make sure it’s all good for us to present. It is ongoing in the world; it’s international, and like I said earlier, we’re trying to get younger and younger kids into the trial.

It’s just really hard for us to get patients into trials like these because [we have less chance of finding the antibodies in] the kids that we want to have in order to enroll them in the study, and a lot of them are not as severe as the adults. They only get problems with the eyes, or they just have mild weakness, and then some of them are really severe and then we can’t have them in a clinical trial—so it’s kind of a middle ground that we’re looking for in patients who have positive antibodies. We are still trying to recruit patients into the study. The first cohort was the 12-to-18 years range, and now the second cohort is a 2-to-12-year-old range.

In the US, it’s only limited to 8 to 12 years, but internationally, it’s down to 2. That is the ongoing nipocalimab trial. It’s kind of an extension of this, it’s just the second cohort. We wanted to make sure it was safe in a slightly older population and ones that we have a better ability to test. Once you get down to the younger kids, it’s harder to do some of the functional testing that we do for these patients and really know if it’s helping, but we are enrolling patients in that cohort.

AJMC: With myasthenia gravis being so rare in pediatric patients, what factors are thought to trigger the disease in younger patients?

Strober: One is that a lot of kids, for some reason, don’t make the antibodies like we see in adults. It’s, again, something we know is working on the antibody level, so we want to make sure the patients who are in the trials have the antibodies that we can watch and make sure they’re dropping to make sure it’s effective for that. We do know that in some patients who have myasthenia, who we believe have myasthenia but are antibody negative, what we call seronegative, if we repeat their testing over time, eventually they do develop the antibodies. For whatever reason, the antibody levels get delayed in appearing in the blood.

We’re also developing better tests to be able to pick up small amounts of antibodies better. We’re using better state-of-the-art testing to be able to confirm. We have other ways of confirming myasthenia in patients who are seronegative by doing electrical testing and testing with different medications to see if it’s something that we believe they truly have, even if they don’t have the antibodies. But again, for these studies, we need to make sure we’re really doing this study in a patient population that’s as similar as possible, and so having those antibodies helps us make sure that we’re trying to treat the same condition.

AJMC: How do insurance and regulatory decisions influence whether patients can actually receive the most appropriate treatment?

Strober: I don’t know exactly what they go through in Europe vs what we go through in this country. I can tell you that if it’s not approved by the FDA, it’s really hard to get insurance companies to cover it. Often they say it’s experimental if it’s not approved by the FDA, but even once it’s approved by the FDA, because the newer drugs tend to be a little bit more expensive than older drugs, and the older drugs [are] more generic [and] cheaper, a lot of insurance companies try to push us to use the older stuff, even though those still haven’t been approved for this specific condition. It’s just that they’re older and we’ve been using them for longer. It’s really important for these regulatory agencies to approve them or provide positive feedback so that these drugs can be used and [we] know they’re being used safely, but also that they can get paid for our patients.

AJMC: What are some key unmet needs in the myasthenia gravis treatment landscape?

Strober: I think one is, in pediatrics, again, trying to come up with better tests would be really nice. I think what we’re trying to do in our pediatric myasthenia gravis consortium, which has 6 centers currently, is to develop better tools to follow these patients but also develop a standard of care. There really is no standard of care for these patients. We’re just so used to using drugs that have only been approved for adults that people just try the different ones on kids and hope that they’re safe and hope we have the right dosing, and so kind of getting a better sense of what are people doing out there and what do we actually see in real life, in real time, what is actually working for the patients, so we can put together and say, “Hey, you know what, this is what we recommend as people who take care of these patients and take care of a good number of these patients, this is really the treatment options that you should go [with] and what route you should go in, what’s the safest for the patients, what’s the most effective for the patients.” That’s really what I want to see; I really want us to get a better understanding of pediatric myasthenia gravis and how we can follow these patients and best take care of them safely.

I think also what I’ve learned is that the reason that there are so many studies is because now it’s become a requirement that in order to get approval for adult drugs, the companies have to have a pediatric arm. That’s been a wonderful thing.

Just to be given the opportunity to talk about pediatric myasthenia gravis, that people are actually caring about kids with this condition, has been a huge step forward for those of us in the community who take care of it. I’ve had so many patients who have been told by providers, “Oh, myasthenia doesn’t happen in kids. They can’t have myasthenia.” We’re kind of used to that in pediatrics for these rarer diseases, so the fact that word’s getting out that, yes, kids can get myasthenia gravis and that we can treat them and we can treat them effectively and safely, it’s just wonderful to have that opportunity, so I appreciate that, and thank you.