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The Worst Part of the Cyclosporiasis Response

2026-07-22T16:10:11-04:00

If you’re confused about whether you can eat the shredded lettuce on your Doritos Locos tacos again, you’re not alone. I cover food safety for a living—and I love Taco Bell—and I’m not sure when I’ll be comfortable living más.

At the end of last week, the worst concerns about the ongoing cyclosporiasis outbreak seemed to be behind us. Parasite-laden lettuce should no longer be anywhere near a Taco Bell, because all of the iceberg that’s been linked to the outbreak has, according to the company that produced it, been recalled. And yet, somehow, the response has generated only more drama this week. Communication has been shaky from the start. As I’ve previously written, the CDC was slow to alert the public to the warning signs that a multistate outbreak was brewing, even as cases were rising dramatically in Michigan and other states. The messaging got only worse as the government began to figure out why people were getting sick.

Late Thursday, the CDC and the FDA announced that the Midwest cluster of cyclosporiasis cases stemmed from contaminated iceberg lettuce produced at a single farm in Mexico (later revealed to be a supplier for a large chain called Taylor Farms) and shipped to Taco Bells in five states. That should have been a breakthrough, giving consumers confidence that they could resume their normal eating habits (sans tacos). But almost immediately, the outbreak seemed to be bigger than the government was letting on. Taco Bell’s official statement encouraged “all relevant restaurants, retailers, and foodservice operators”—not just Taco Bells in the five states that the government had identified—to act responsibly, as Taco Bell did by pulling lettuce off their menu. And Taylor Farms’ initial recall included lettuce shipped not just to Taco Bell, but also to a number of major companies such as Sysco, which provides food for restaurants, hospitals, and schools. By Friday evening, Walmart had pulled certain Marketplace-branded bagged lettuce off of shelves in 15 states.

[Read: Cyclosporiasis is solved! Right?]

Then, on Saturday, the FDA posted a since-deleted announcement that it had found cyclospora (the parasite that causes the illness) on iceberg lettuce that was produced by Taylor Farms de Mexico but not part of the initial recall. The result promised to be the most definitive evidence to date that regulators had linked Taylor Farms to the problem. But the FDA reversed course the next day after agency staff reexamined the sample and deemed the earlier result a false positive. The embarrassing mistake was only compounded by Taylor Farms, which issued a statement that began with: “Today, FDA apologized to us.” But the FDA denied that it had issued a formal apology.

The FDA still seems confident that lettuce linked to Taco Bell and Taylor Farms is the culprit behind the spike in cyclosporiasis cases. More than 1,600 people who have tested positive for cyclospora across the five-state outbreak have reported eating Taco Bell, according to the FDA’s website. Seems straightforward! And yet, that website also prominently displays the warning “Don’t eat recalled lettuce at any Taco Bell location or other restaurants.” What other restaurants? The Department of Health and Human Services, Taylor Farms, and Taco Bell did not immediately respond to requests for comment.

Perhaps, as a Chicagoan, I’m particularly sensitive to the uncertainty; after all, the government has not explained how my local Taco Bell is safe when one 40 minutes to the south in Indiana is part of the outbreak. And as regulators continue to try to explain the Midwest’s cyclospora mess, the question remains of what is going on with elevated cyclosporiasis cases in the rest of the country, which the FDA has not publicly linked to iceberg lettuce, Taylor Farms, or Taco Bell. Cyclosporiasis has for decades flared in the United States during summer, which has made pinpointing where cases are truly elevated this year difficult business. The FDA told reporters on Monday that it has investigated five clusters of cyclosporiasis cases across the United States since May, three of which are over, but it has not publicly explained where these clusters have been, which ones are considered over, and what foods have caused the various outbreaks. North Carolina, for example, reported an 83 percent spike in cases over the past week, bringing its total cases to 561 since May. State officials have hinted that the outbreak could be caused by parsley, cilantro, or lettuce, but apparently not Taco Bell’s lettuce. In a press release Friday, the health department said, “At this time, the increase in cyclosporiasis cases in North Carolina does not appear to be associated with the outbreak in other states involving Taco Bell.”

[Read: America’s homegrown-parasite problem]

In the absence of clear information, Americans seem to be doing the only thing they can to protect themselves: opting out. Foot traffic to chain restaurants—not just Taco Bell—is down significantly over the past week, according to news reports. America is still likely in a much better situation than it was just a week ago, before the Taco Bell link was announced: Cyclosporiasis is notoriously hard to trace, and state and federal experts have managed to interview people who caught the bug about everything they ate prior to getting sick and identify a major commonality. It’s a shame that their work has been overshadowed by enough confusing communication that we all still have to look skeptically at a salad.

Just Ask the Dinosaurs How Bad Air Quality Can Get

2026-07-17T18:42:59-04:00

The air quality this week is bad. Smoke from Canadian wildfires has turned the sky orange in Philadelphia. It has veiled the Statue of Liberty in Manhattan. In Detroit, which has dealt with some of the worst conditions in the country, the smoke has almost entirely blurred the city’s skyline. The eastern United States isn’t exactly accustomed to smoke days, which can prompt someone like me, from the wildfire-prone West, to brag about how they’ve seen far worse. But those smoke days are nothing compared with the ones 66 million years ago. If you want to talk about bad air quality, ask the dinosaurs.

The asteroid that spelled the beginning of their end struck the Earth at about 40,000 miles an hour, blasting a 112-mile-wide crater into Mexico’s Yucatán Peninsula. The explosion was so big that it punched a hole into the atmosphere, bringing “outer space down to the surface of the Earth,” Kirk Johnson, the director of the Smithsonian National Museum of Natural History, told me. The impact flung trillions of tons of debris into the sky, and much of it headed right into that yawning atmosphere and into Earth’s orbit. As the planet continued to rotate, “you basically got a global cloud of dust and debris that blocked sunlight from hitting the ground,” Johnson said. And it blocked virtually all of the sunlight—plunging the world into solar-eclipse-level darkness. Some hot debris fell back down from the atmosphere, and within minutes, wildfires were spreading. Enormous conflagrations combusted “all the biomass on the planet, not just some forests in Canada,” Johnson said—and with debris blocking the sun, those wildfires were “burning in a dark world.”

Given the worldwide fires, dinosaurs would have been trapped in a level of smoke far more intense than the kind of downwind exposure that the U.S. experienced this week, Brian Toon, a senior research scientist at the Laboratory for Atmospheric and Space Physics at the University of Colorado Boulder, told me. Unfortunately—or maybe fortunately for them—many dinosaurs were not alive to experience this global-wildfire-pitch-black hellscape. The asteroid-impact event was a “massive, atomic-blast-scale thing, like 1 billion Hiroshimas of energy released,” Johnson said. The dinosaurs within about 1,000 miles of the impact site died “just by being exploded, basically,” he said—and given the magnitude of the blast, “if you were a human-sized animal standing anywhere on the planet at the surface, your survival of the first week is pretty unlikely.”

Other creatures perished during the ensuing climate mayhem. Within a week, maybe for months, the brightest day would have looked more like a moonlit night, Ken MacLeod, a geology professor at the University of Missouri, told me. The air wasn’t just smoky, he said; it was loaded with dust and gases. The gloom lasted for about two years, as particulates from the asteroid impact remained in the atmosphere and soot from wildfires added to them. The next couple of decades were “very low light, very difficult for photosynthesis to occur,” which led herbivores to starve, Brian Huber, a research geologist at the Smithsonian National Museum of Natural History, told me.

At what point would the atmosphere of this dark, foreign planet have settled into something like the haze hanging over Detroit today? No one was totally sure: “I would bet years, decades after,” Huber said. Johnson estimated that it would have been about a couple of years after impact; curators at New York City’s American Museum of Natural History found that 40 percent of sunlight was still blocked two years after the asteroid event, the museum told me. Although most soot and dust particles went away within a few years, sulfate aerosols continued to create “a global, orange-brown smog,” the dinosaur-extinction exhibit notes. According to the museum, it was only about four years after the asteroid arrived that full sunlight reappeared. The era in which the dinosaurs perished would be unrecognizable to a modern person. Compared with that, the air pollution Americans are facing right now, Huber said, “ain’t nothin’.”

Scientists know all of this in part because the sheer amount of charcoal and soot—millions and millions of tons of it—that fell to the ground left traces that are still detectable today. The asteroid itself also left a thin layer of debris made of meteorite and ancient parts of what we now call Mexico. You can touch it in Trinidad Lake State Park, in southern Colorado, Toon said—evidence from a time in this planet’s history when things looked pretty much as apocalyptic as one could imagine.

So, yes, the smoke this week is bad. The outdoor air quality is poor, and people should take precautions to limit the amount of it they’re breathing. And yet, there is something to be grateful for each day. And today, it is that we are not dinosaurs.

Cyclosporiasis Is Solved! Right?

2026-07-17T18:22:10-04:00

Produce lovers of the Midwest, rejoice! It seems that parents can stop fretting about serving their kids berries, Redditors can stop trying to do their own epidemiological investigations, and I can stop cooking my salads. The mystery of what food caused an outbreak of cyclosporiasis, the diarrhea-causing parasitic illness, across several midwestern states appears to be solved: It was shredded lettuce served at Taco Bell, federal health agencies announced yesterday.

As far as foodborne outbreaks go, this result is about as good as it gets. Yes, thousands of people got sick, but no one died. And the fact that regulators found not just the vegetable at issue, but also the source—a supplier in Mexico—means that they can now get to the bottom of what went wrong, and perhaps Americans can enjoy the spoils of summer produce with less fear. Even so, the nation’s collective freak-out should serve as a wake-up call to both the food industry and regulators. Behind jokes about “diarrhea lettuce” and bingeing on processed foods was a real fear that the system is failing to keep Americans safe.

The cyclosporiasis outbreak seemed to confirm Americans’ suspicions about our food-safety system and the people in charge of it. Trust in the safety of the U.S. food supply is at its lowest in at least 13 years, according to recent survey data from the International Food Information Council, an industry-funded group; many respondents said they believe that companies put profit over safety and that regulations aren’t strict enough. Surveys have found that confidence in the CDC and FDA is similarly in the dumps, reflecting both Americans’ long-standing issues of trust in the agencies, as well as a particular response among Democrats to the Trump administration’s changes to the agencies.

The current cyclosporiasis outbreak was handled poorly by the industry and regulators alike. Many Americans suspected that Taco Bell was the culprit after photos surfaced last week of signs posted outside Taco Bell branches announcing that they weren’t serving certain toppings. But the company’s PR team failed to provide a clear explanation of what was going on and how widespread the potential problem might have been. Yesterday, Taco Bell posted on its website that it was acting “out of an abundance of caution” by removing produce from some stores but still did not explain what had gone wrong. When I reached out today to ask whether Taco Bell is confident that the issue was isolated to midwestern states, the company directed me to a statement that did not address the question, but confirmed that it “has completed removal of affected Taylor Farms lettuce from our restaurants.”

Meanwhile, late last week, when Michigan had reported upwards of 1,500 positive tests for the bug, the CDC’s website still said that fewer than 200 cases had been identified nationwide. The delay may have stemmed from CDC officials scrutinizing preliminary data from states in an attempt to put together a true national count of confirmed cyclosporiasis cases, but from the outside, it looked as if the agency had no idea what was going on.

Federal officials didn’t call a press conference until earlier this week. By that point, Michigan had announced that 3,309 people had gotten sick and publicly identified lettuce as the likely cause of the outbreak, and the lettuce-less Taco Bells had already gone viral. When NBC News asked whether officials were looking at Taco Bell as a potential culprit, the acting head of the FDA’s food center, Donald Prater, demurred: “FDA certainly is continuing its traceback investigation on multiple produce items, also including locations that are reported by the case patients before they became sick.” The first confirmation that Taco Bell was actually being investigated came not from the company or the CDC, but from anonymous sources who spoke with The Washington Post.

The advice that Americans received about how to keep themselves safe has been confusing too. Prater said during the press conference that washing produce was “very helpful in lowering the risk of this parasite.” But food-safety experts told me that they don’t know how much washing actually helps. Yesterday’s CDC advisory offers more actionable advice: “Do not eat shredded iceberg lettuce served at Taco Bell locations in Indiana, Kentucky, Michigan, Ohio, and West Virginia.” But it makes no mention of what might be causing states such as New York and North Carolina to report spikes in cyclosporiasis cases as well, or what, if anything, residents should do to stay safe.

Plus, news outlets are reporting that the facility in Mexico is associated with Taylor Farms, an enormous operation that supplies lettuce to restaurants and grocery stores around the country. The CDC, which made no mention of Taylor Farms in its announcement, has not communicated why it believes that the only product affected is the shredded iceberg lettuce served at specific Taco Bell locations. The brief notice Taco Bell posted on its website makes the issue seem much bigger. The company wrote that it encourages “all relevant restaurants, retailers, and foodservice operators” to take similar precautionary action. The CDC’s website also says that the FDA “is working directly with the supplier to determine if contaminated shredded iceberg lettuce went to other places.”

In a statement, Taylor Farms’ parent company, Taylor Fresh Foods, told me that although the FDA’s investigation pinpointed one “independent farm,” the company has indefinitely removed all iceberg lettuce sourced from Central Mexico. The company also said that the affected farm “represents less than 1% of the U.S.’s iceberg lettuce supply,” and “no other Taylor Fresh Foods products across the country are impacted.” The company did not respond to my follow-up questions about whether the farm had supplied iceberg lettuce to any entity other than the Taco Bell locations identified in the investigation.

Perhaps the iceberg lettuce from the farm in Mexico really did go only to Taco Bells in the Midwest. It’s possible, too, that the apparent spikes outside of this epicenter are not a sign of a larger outbreak. After all, cyclosporiasis cases traditionally rise in the summer, and the frenzy of news around the parasite likely prompted people who typically would have weathered the illness at home to get tested. But Americans won’t know that unless the CDC says something. When I asked today what is causing cyclosporiasis cases outside the Midwest, and why the CDC was confident that other Taylor Farms products were not affected, an agency spokesperson ignored my questions and directed me to the government’s previous statements.

The Lessons About Ebola the U.S. Wants to Forget

2026-07-16T15:45:55-04:00

The Ebola outbreak in the Democratic Republic of the Congo is now the third-largest Ebola outbreak ever recorded. It will likely pass the second largest, an outbreak in the same region of Congo from 2018 to 2020. Already, the current outbreak has grown past 2,000 cases and to 754 deaths; according to the World Health Organization, it is likely to reach more than 8,000 cases and 1,400 deaths by mid-September. The CDC’s worst-case scenario projects more than 20,000 cases by mid-August.

I worked as a physician and epidemiologist in Guinea during the outbreak in West Africa that began in 2013. In 2014, I survived Ebola myself. I’ve followed every outbreak since, and this one worries me more than any other of the dozen that the world has undergone in the past decade.

Certainly, the world is better at containing and controlling Ebola than it was when I worked in Guinea. Much of that knowledge now lives in Kinshasa and Kampala and at the Africa CDC, in institutions that didn’t exist or weren’t ready a decade ago. When this outbreak is stopped, it will be stopped largely by people who learned what the previous outbreaks taught. Yet this outbreak is also revealing how much the United States, once the backbone of the response to crises like this one, seems willing to forget.

One of the earliest challenges in the 2013 West Africa epidemic was the monthslong delay in detecting initial cases in Guinea, where Ebola’s presentation was unfamiliar to health-care providers. In Congo, too, cases were likely occurring for months because testing was looking for the Zaire species of the virus, not the less common Bundibugyo species that was circulating.

Despite this delay, detection has improved in the past decade. The number of Ebola outbreaks is increasing: Climate change and more frequent contact between people and the animals that carry the virus mean more chances for it to spread. But most outbreaks are picked up far earlier than they once were. In 2017, for instance, an outbreak in DRC was detected at just eight cases.

And when an outbreak is declared, the ability to quickly start testing for Ebola has scaled up dramatically. In West Africa, testing often took days, during which infected people were exposing other patients in treatment centers to the virus. At the start of this outbreak, two months ago, Congo had essentially no ability to test for the Bundibugyo strain; today, capacity exists for thousands of tests a day.

Performing research and clinical trials during outbreaks is more possible than it was a decade ago, too. While treating Ebola patients in 2014, I had no vaccine or specific treatment to offer. Trials during that epidemic were slow to start, and poor methods meant that few produced conclusive results.

Since then, research has yielded a vaccine and antibody treatments for the Zaire strain. Now that a vaccine stockpile is in place, doses can be quickly deployed when an outbreak is declared. Trials are also moving faster. In a 2022 outbreak in Uganda, caused by the Sudan species of Ebola, an investigational vaccine was ready to test within three months. By then, cases were waning, but by preparing protocols and prepositioning vaccine candidates in the country, Uganda was able to launch a trial in four days when the next outbreak emerged, in 2025. Multiple organizations are now racing to manufacture vaccines for the Bundibugyo strain; one trial to evaluate potential treatments has already kicked off.

What ultimately determines the trajectory of outbreaks, however, is the speed and scale of the response. In 2014, the world did not take the outbreak seriously until Ebola threatened Western countries. An international emergency was declared within days of the first Americans getting sick, a coincidence that didn’t escape my colleagues in West Africa who had been watching the outbreak expand for months. The WHO declared the current outbreak an emergency within two days of Congo’s and Uganda’s own declarations. Community mistrust and widespread conflict still makes the work of finding the sick and persuading them to come in for treatment difficult. But the machinery is faster and is now being run together by the WHO, the Africa CDC—an organization started in the aftermath of West Africa’s Ebola outbreak—and the Congolese government.

If in 2014 the international community was slow to respond to Ebola’s threat, it did eventually respond at scale. The U.S. committed billions of dollars in funding and extensive logistical support to ending the outbreak; USAID helped with essential tasks, such as training burial teams and setting up airport screening.

Since then, much of the capacity to find outbreaks early—whether for Ebola or other pathogens—was built with international investment, especially from the United States. The U.S. helped construct the infrastructure that now catches the sparks of what would otherwise become larger outbreaks, bankrolled much of the research and development for Ebola vaccines and treatment, and has played a central role in responding to nearly every Ebola outbreak—until the one declared in Uganda in February 2025.

For that outbreak, the CDC didn’t send specialists, USAID wasn’t deployed, and Elon Musk’s DOGE canceled multiple contracts dedicated to responding to the outbreak. The response to the current outbreak is a partial correction. The Trump administration has committed more than $700 million and has requested another $1.4 billion from Congress. It deployed a group of highly trained specialists and has finally filled the long-vacant top role at the Office of Pandemic Preparedness and Response. The secretary of state is reportedly considering appointing an Ebola czar, as the Obama administration did in 2014.

But these actions reflect deep reflexes, triggered by a big outbreak. A strong, successful response to an outbreak relies on not just quick responses, but systems that require maintenance and constant training. And the U.S. appears to be forgetting the lessons about those systems.

This amnesia is reflected in where the U.S. has aimed its effort—on keeping disease “over there” at all costs. Americans infected with Ebola have been transferred to Germany, rather than specialized treatment centers built in the U.S. after 2014; soon, Americans exposed to the virus may quarantine at a quickly constructed center in Kenya. These actions are part of a broader bet that the virus can be kept out of the U.S. It can’t. Ebola has many ways to cross a border; as we learned a decade ago, the only reliable way to protect Americans is to end the outbreak.

That work has been made harder by the Trump administration’s deep cuts to global health funding and disinterest in international coordination. After 2014, the U.S.—along with the rest of the world—spent years building a more nimble, operational World Health Organization. Now the U.S. does not appear to be fully engaging with the WHO, despite the organization’s role in leading this response. The Trump administration has also been trading disease-specific programs for transactional deals struck country by country, and a proposed plan at the State Department would remake the CDC’s overseas work along the same lines. Countries would pay à la carte for the agency’s help and skip whatever they choose to forgo, including surveillance designed to catch an outbreak like this one. The plan could close roughly a third of the CDC’s 60 overseas offices within a few years. This country-by-country approach may be advantageous politically, but it will lower our defenses against pathogens.

The world’s capacity to control infectious disease has never been fully self-sustaining. It lives in lab technicians and community health workers detecting outbreaks, in stockpiles that expire and need replenishing, and in institutions whose budgets can go up or down each year. It was built over decades, with American support and expertise, and once that support is withdrawn, the gains of the past decade are not guaranteed to hold.

American leaders are betting that the rest of the world will keep doing the work we taught it to do, with less and less help from us. White House spokesperson Kush Desai said as much in response to a request for comment, arguing that bringing global health functions once housed at USAID to the State Department “has made our Ebola response efforts more effective” and that “nothing is stopping other wealthy nations from also stepping up and contributing more to these and other efforts.” (A spokesperson for the State Department emphasized the speed of the U.S.’s response to this outbreak and said that its current strategy is still focused “on building the capacity of national and regional actors.”)

For a while, that bet may pay off. But the weakness of the systems that do exist are already showing. The health workers on whom so much of this response depends recently went on strike: They report not being paid and working without the supplies needed to safely do their job—so far, 112 health-care workers have been infected, and 35 have died. Some version of this has occurred in nearly every outbreak over the past decade, and it erodes the trust needed for a response to function successfully. When communities hear that money is pouring in, and watch Western aid workers speed by in expensive Land Rovers while local workers go unpaid, they stop believing the help is for them. Treatment reaches them just as unevenly. Since the Zaire drugs were approved in 2020, only a third of Congolese Ebola patients have received them, even though one was developed from the blood of a Congolese survivor and both were approved after a trial in Congo. The doses exist, but their manufacturers control them and most sit in American stockpiles.

Rather than work to close those gaps, the United States is testing how much stress the system can take before breaking. The outcome of the next outbreak will rest not on what we know, but on what we’ve bothered to keep.

Pete Hegseth Wants YOU to Test Your Testosterone

2026-07-15T21:43:01-04:00

Updated at 1:38 p.m. ET on July 16, 2026

Pete Hegseth wants a manly military. And he really, really wants you to know how badly he wants a manly military. In his 2024 book, The War on Warriors, Hegseth worried that the military risked becoming “effeminate, and apologetic”; he insisted that what liberals really want is “soft men, and a weak military,” and he scolded “Pentagon pussies” who refuse to stand up for soldiers on the battlefield. As secretary of defense, Hegseth has blocked the promotion of female military officers, removed the first woman to lead the Navy, and ordered a review of women’s “effectiveness” in ground-combat roles. He has also used the Defense Department’s social-media channels to post a steady stream of tougher-than-thou videos.

The latest entry in this genre came earlier today, when Hegseth announced that he is requiring every service member over 30 to have their testosterone tested annually. He let this be known in a video posted on X captioned “The High-T Department of War.” In the video, he tells soldiers that if they’re found to have low testosterone, they might be recommended for testosterone-replacement therapy but that it won’t be mandatory. Then again, given what he then says about testosterone “restoring and optimizing your natural capabilities,” it sure seems like he believes that everyone should partake. How much this new initiative will cost taxpayers, and the question of whether the military health system’s labs even have the capacity for such testing, is unclear. But the bigger question is whether this is in any way a good idea.

The military’s interest in testosterone predates Hegseth’s tenure. For years, the idea that low testosterone might be a problem for Special Forces personnel in particular has been flagged by both researchers and members of Congress. Representative Jimmy Panetta of California has called for a study of the “link between the stress of military service and decreased testosterone levels.” A 2020 paper cited low testosterone as one possible contributor to so-called operator syndrome, a cluster of conditions including depression and cognitive impairment among Special Forces.

But when Army researchers have examined whether taking testosterone might help soldiers recover more quickly following the physical demands of combat, they’ve found mixed results. A 2019 paper, for example, found that civilian men who received testosterone injections during a 28-day period of intense exercise and restricted diet—meant to simulate the rigors of training and combat—held on to more muscle than those who received a placebo, but the extra testosterone didn’t improve their strength or endurance. A follow-up study three years later reached similar conclusions. Crucially, both of those studies focused on short-term use under specific circumstances, not on the broader screening and routine therapy that Hegseth is advocating.

At least within the general population, universal testosterone screening for men is not considered standard practice. The Endocrine Society recommends against testing for hypogonadism—the medical term for when the body doesn’t produce enough testosterone or sperm—unless a man has symptoms such as erectile dysfunction. The American Urological Association’s guidelines say that a low-testosterone diagnosis shouldn’t be made based solely on a test. That’s because testosterone levels can vary widely, and a man with a lower-than-average number might still be perfectly healthy. The threshold for diagnosing low testosterone remains a matter of debate even among medical organizations. Many of those who favor testosterone “optimization” argue that the cutoff has been set too low and that even men with hormone levels in the normal range would benefit from replacement therapy. A Department of Defense official declined to say whether it had settled on an acceptable baseline.

In the video, Hegseth notes that testosterone levels go down with age. That’s true of everyone; in men, levels usually start to decline around age 40. But they don’t fall off a cliff: They tend to dip about 1 to 2 percent a year. Other factors, such as maintaining a healthy weight and getting enough sleep, can also play a significant role.

Testosterone therapy is the only treatment Hegseth cites in the announcement video. But even if a man’s testosterone level drops below what’s considered normal, doctors don’t automatically recommend testosterone-replacement therapy. For starters, non-pharmaceutical interventions might work. It’s not obvious that, say, a 33-year-old man with low testosterone levels needs to start getting shots. It might be that he needs to start taking the stairs and going to bed at a reasonable hour. Cutting back on drinking could help too: Excess alcohol consumption is known to lower testosterone.

Testosterone-replacement therapy also comes with real side effects. Hegseth and other proponents of testosterone therapy, including Health and Human Services Secretary Robert F. Kennedy Jr., sometimes talk about the drug like it’s just another supplement. (Kennedy has acknowledged using testosterone himself; the Defense Department official didn’t respond to a question about whether Hegseth, who is 46, takes the steroid.) But taking testosterone is not the same as popping a vitamin for a B12 deficiency. Testosterone therapy suppresses a man’s natural production of the hormone and decreases sperm count. That’s why experts caution against its use by men trying to conceive. In 2023, a large study published in The New England Journal of Medicine alleviated decades-old fears that middle-aged and older men who take testosterone might be at increased risk of having a heart attack. But last year, the Food and Drug Administration added a warning to testosterone’s label noting that it can increase blood pressure.

The new edict doesn’t apply just to men. In response to a question about whether women will have to have their testosterone tested, the DOD official wrote that “everyone over 30 years old will be tested annually.” Although women do produce the hormone, albeit usually in much lower amounts than men, replacement therapy is rarely recommended except in cases of low sexual desire after menopause. (In practice, middle-aged women have recently been flocking to testosterone to alleviate all sorts of symptoms of menopause and perimenopause.) What women are supposed to make of their test results, and what it has to do with turning them into more effective soldiers, is unclear. Hegseth has made a point of emphasizing the differences between the sexes and of questioning the ability of women to serve in combat. But in this instance, he has inexplicably opted for a gender-neutral policy.

Checking the testosterone levels of military members isn’t necessarily going to hurt anyone. But it also isn’t supported by current medical guidelines. Neither, for that matter, was Hegseth’s decision in April to make the annual influenza vaccine optional. (After a flu outbreak at a base in San Antonio, Texas, last month, the military reinstated the mandate for some new recruits.)

Although Hegseth insists in his video that the new order is about keeping soldiers on “the leading edge of lethality,” it’s hard to see how requiring a blood test they probably don’t need contributes to military readiness. Instead, like Hegseth’s chest-thumping workout videos, his fat-shaming of generals, and his denouncement of anything he deems weak or woke, it is an exercise in projecting a masculine image. His announcement comes at a moment when the Iran war is once again heating up, which is certain to put more strain on the military’s already depleted missile stockpiles. Maybe that’s the number Hegseth should be worried about.

All the Cool Kids Are Birding

2026-07-15T09:30:04-04:00

Not long before the sun rose on a Saturday in May, five men in their mid-20s were standing alongside an unassuming wetland in New Jersey, searching for birds. Ryan Zucker, a 23-year-old who could do an impressive impersonation of an eastern screech owl, had just taken a small branch to the eye, but still the group was exuberant.

Since midnight, they’d heard that owl, a common gallinule, and—after following some freight-rail tracks through the dark—the high-pitched, near-electronic trill of a sedge wren, the first recorded in Sussex County in 13 years. (A police officer had asked what exactly they thought they were doing on the tracks at 2 a.m., but took “We’re looking for birds” as answer enough.) In the previous 10 minutes, they had seen a sandhill crane raise its head above the reeds, watched a mallard chase an otter away from her ducklings, and heard a brown thrasher in the distance.

Each species put the five men one notch closer to being the repeat championship team in the World Series of Birding, a 24-hour contest to identify as many species as possible, by eye or ear, throughout New Jersey. The birds would start singing in earnest soon, and to cover the state before midnight came again, the guys needed to leave, now.

As one, the men—called ***mega (pronounced star-star-star-mega, or Team Mega if you can’t be bothered)—took off sprinting toward their van. William von Herff, a fast-talking 26-year-old originally from Canada, told me that he took up running ahead of his first World Series, in 2024. He needed to be sure he could race into a bog, then control his heart rate enough to sense the drumming of a ruffed grouse’s wings.

Birding has historically been the domain of the AARP crowd, but in the World Series, young people have an edge. And these days, birders in their 20s (and 30s and 40s) are showing up not just at birding competitions, but seemingly everywhere. Some of my friends who, like me, are in their early 30s now bring binoculars on vacation; so do a number of my sister’s friends, who are younger and cooler than mine. Young birding influencers are all over TikTok and Instagram. The National Audubon Society had 10 college chapters in 2019; today, it has 117. South by Southwest hosted its first bird lovers’ meetup last year and its first birding panel in March.

Andrew Marden, the 27-year-old who drove ***mega’s van, has been competing in the World Series since age 15, and he told me that only in the past few years have people his age started perking up when he mentions his hobby. Oh, that’s really cool, they might say. Some have even said they wanted to go birding too.

Virtually all of the 20 or so birders and bird-adjacent professionals I spoke with attributed the shift to two watershed events. The first is the coronavirus pandemic: At a moment when many Americans spent far too much time anxiously bouncing around their own home, birding represented a low-stress, low-screen, outdoor activity that could be done without travel.

The second is a revolution in birding tech. Birders have always used the newest tools available to them, whether vinyl records of bird calls, rare-bird hotlines, or push notifications. (***mega is lingo for an ultrarare species noted on eBird, a forum where birders report sightings.) But soon after the bird-identification app Merlin introduced Sound ID, a sort of Shazam for bird calls, in 2021, millions of people started using the app, including the 29-year-old Super Bowl champion Sam Darnold and the 33-year-old pop star Ariana Grande.

Merlin and similar tools have upended the culture of birding. Ten years ago, aspiring birders had little choice but to learn from the old-timers, who might be less than cool or less than welcoming. Jessica Wills, a 43-year-old birder who works in the restaurant industry in Tucson, Arizona, told me that older birders have sometimes walked up to her to explain things she already knows, or rudely corrected beginner birders when they make a mistaken ID. The apps have freed new birders to learn a good deal on their own. Instead of memorizing birds’ sounds and physical appearances, you can start a Merlin recording, see what songs it picks up, see what the birds singing them look like, and then try to locate them in your binoculars. And instead of staking out bird habitats for days on end in the hopes of seeing an elusive species, you can browse bird sightings on Discord or eBird. Several people I interviewed described birding as akin to Pokémon Go. (Really, Pokémon Go is a knockoff of birding.)

With or without an app, the basic activity is the same: You spend hours and hours standing around, straining your eyes and ears, and you get to know a lot about birds. If you’re really dedicated, you also get to know “habitats within the habitats, the very specific ways in which birds behave and when they’re active, and what sounds they might make, and what times of day are best, and what weather patterns are best for them,” Zucker told me in the van. Many of the birders I spoke with praised the benefits of such close attention to nature—María-Elena Montero, the president of the D.C. Bird Alliance, described birding as a practice, similar to yoga and meditation. Jax Quamme, a 33-year-old hearing-aid technician in Tucson who’d struggled with postpartum depression and then her brother’s unexpected death, told me that birding gave her the sense of purpose and “hits of dopamine” that she’d been lacking.

I also get a significant portion of my dopamine outdoors, but birding has always seemed to me like a mightily inefficient way to do so. Backpacking can get you sensational views along with the mental-health benefits of exercise. Skiing and cycling provide reliable thrills. Why would I spend countless hours studying a bird that may or may not choose to appear when I go looking for it? After ***mega heard the sedge wren at 2:30 a.m., we trudged back down the tracks and waited in the cold, rainy dark for marsh birds that mostly didn’t show. The only thrill was the latent possibility of an oncoming train. At one point, von Herff sat down and dozed off as we all stood by the tracks, and I began wondering what any of us were doing there.

But an hour and a canned espresso later, I understood. We’d arrived before dawn at the marsh under a light-polluted sky; I could just make out the hills behind it. And for the most part, we stood still, contemplating the faint landscape and the quiet around us, broken by the calls of frogs and, occasionally, a target bird. After a few minutes watching the hills’ dark reflections spread across the water, I noticed that a sense of calm and expansiveness—awe, even—had crept up on me.

In some ways, the young men of ***mega are like their peers who are more recent converts to birding. Older birders tend to have money and time to invest in regular bird-driven travel; these guys are more likely to be found at their local green spaces—Central Park for Zucker, D.C.’s Rock Creek Park for von Herff—amid work, school, and social commitments. They let tech into their sacred hobby: Marden has a life list of birds, 408 species so far, that his friends have shown him on FaceTime. (A previous generation might be scandalized by the list’s existence.) And whereas older birders have a reputation for being interested mostly in birds, the members of ***mega and others in their cohort tend to see the hobby as part of a broader commitment to conservation. Three of the five are studying or work full-time in green energy or environmental science; during the World Series, the team wasted precious seconds stopping the van so that Zucker could carry a wood turtle safely across an exurban road.

In other respects, the ***mega crew is a relic of an older model of birder. They’ve all been avid birders since childhood; most of them have a story about a relative who took them birding, or bought them binoculars, or left a field guide lying around to be devoured by a curious elementary schooler. Von Herff, Zucker, and Marden met as teenage birders, and Zucker and the two remaining team members—Benjamin Hack and David Benvent—knew one another at Cornell. (The school’s Lab of Ornithology is one of birding’s nerve centers and created both eBird and the Merlin app, and had factored heavily into Hack’s, Benvent’s, and Zucker’s decision to enroll.) Because they started birding so young, they all have longtime mentors several generations older than them.

Hack and von Herff had stayed with two of those mentors—Louise Zemaitis, 67, and Michael O’Brien, 61—at their home in Cape May the week before the World Series. Zemaitis and O’Brien are both bird guides and run birding summer camps for teenagers; O’Brien is also a co-author of an upcoming guide to North American birds, designed to be used alongside Merlin and eBird. Their yard is full of bird feeders and is apparently among the most reliable ruby-throated-hummingbird hangouts in New Jersey.

The first time ***mega’s route took the teammates past the house, they bickered over whether they had time to stop, and whether failing to do so would be too rude to bear. They pulled over, everyone yelled at one another while looking for hummingbirds out the window, and then Marden kept on driving to a nearby boardwalk, where they hoped to spot several crucial seabirds. But later, they stopped at Zemaitis and O’Brien’s house after all. (They still needed a hummingbird, Hack needed his overnight bag, and someone needed to pee.)

Zemaitis and O’Brien, who met at the 1994 World Series of Birding, are deeply invested in young birders. Many of their former campers, including most of ***mega, were competing in the World Series; they could recall who was friends with whom, and who grew up as part of the same birding clubs. They are enthusiastic about how birding has changed in their lifetime, and told me that the growing popularity of the hobby and the apps has meant that their campers arrive with more knowledge (and their own ideas about what birds they want to see). But Merlin alone can’t give you a fundamental understanding of ecology. Neither, I thought as I watched hummingbirds and a Baltimore oriole visit the feeders scattered through the yard, can it give you friends like Zemaitis and O’Brien.

Spending the day with ***mega, I was struck, too, by how its members cared for and respected one another even as they disagreed over their next move, or got frustrated when one of them couldn’t train their binoculars on a bird that everyone else had seen. Gen Z is notoriously lonely, and young men supposedly have it worst of all. But those narratives were difficult to reconcile with the guys’ mature, loving way of interacting. When I pressed the teammates on why they were birders and how that shared love had bonded them together, Hack, who had been stuck in the third row of the van with me for most of the day, told me the motivation was simple enough: “I think it’s just fun to do this with my friends.”

When I woke up in a Wildwood motel the morning after the World Series, ***mega was still waiting to find out if it had held on to its title. I decided to go for a walk, and before I left the room, I hesitated, as if on the precipice of a great personal choice. Then I grabbed my binoculars and my phone and set up a Merlin account before heading down to the beach. When I got the text from von Herff— “WE WON!!!”—I was standing in the surf, trying to figure out whether I was looking at a sanderling or a semipalmated sandpiper.

America’s Homegrown-Parasite Problem

2026-07-11T09:00:00-04:00

The other night, I found myself in the unenviable position of trying to cook a salad. And I mean cook a salad: I spread fresh, delicious-looking gem lettuce in a pan and watched it wilt away into a sad, heated blob.

America appears to be in the midst of an outbreak of—I’m sorry, but there’s no better way to say this—explosive diarrhea. More than 2,900 people nationwide have reportedly been sickened by the parasite Cyclospora cayetanensis, which has historically been spread through raw produce, including basil, cilantro, raspberries, and, yes, lettuce. The resulting illness, cyclosporiasis, causes bouts of diarrhea that, if left untreated, can wreak havoc on the digestive system for a month.

Cyclospora is most common in tropical climates and areas with substandard sanitation. It’s spread through contact with bits of human waste that have sat in a warm environment for a week or two, allowing the parasite to mature and become infectious. One of the first documented large-scale outbreaks of foodborne cyclosporiasis in the United States, for example, was caused by raspberries imported from Guatemala. In recent years, though, it’s started to seem that the U.S. has a homegrown-parasite problem on its hands. Americans were sickened in both 2018 and 2020 by outbreaks that were believed to be caused by domestic produce. The FDA set up a task force to deal with the issue in 2019. It apparently hasn’t stopped what is looking like a dramatic uptick in cases this summer. Michigan usually sees about 50 cyclosporiasis cases a year. During this current outbreak, it has recorded upwards of 1,500.

Officials and scientists are not yet sure just how dire the apparent rise in cyclosporiasis is and whether the cases around the country are actually connected. Although the CDC reports that 31 states are seeing cases, the majority are reporting fewer than 10, which is close to normal for the summer months.

They also don’t know what is behind this spate of illness. Don Schaffner, a food scientist at Rutgers University, told me his theory is that perhaps the largest cluster of cases came from people swimming in or otherwise consuming water from a common water source, such as Lake Erie, which borders the affected states of Michigan and Ohio. Michigan’s chief medical executive has said, however, that the state’s working theory is that the cases are tied to produce.

That lack of clarity has led public-health officials to offer somewhat unsatisfactory advice on how to keep yourself safe. My home state of Illinois suggests that people avoid food and water “that may have been contaminated with feces,” as if that were not always the goal. Other states recommend washing produce, but that won’t eliminate all of the risk, Schaffner said. Some experts believe that washing might help reduce the number of infectious particles that a person takes in, but they don’t know for sure how many a person needs to ingest to actually get sick, and some data suggest that the number may be very low. The only way to reliably kill the parasite is to cook your food thoroughly—hence my feast of wilted, warm greens.

Americans have little other recourse to protect themselves from cyclosporiasis and, thanks to ongoing uncertainty about the outbreak’s size, little way of knowing how likely they are to catch it. In healthy people, cyclosporiasis causes mostly mild (if uncomfortable) symptoms. But that lack of control still makes cyclosporiasis, like other foodborne illnesses, unsettling and frustrating. Right now, choosing to eat only cooked produce is one of the few decisions I can make to protect my fast-approaching wedding from being interrupted by frantic trips to the bathroom, so I’m going with it.

When a foodborne outbreak happens, public-health officials’ goal is to quickly identify its cause and warn people to stay away from the suspect food. Sometimes that happens quickly—in 2018, for example, investigators took just nine days to tie an E. coli outbreak to chopped romaine. The current investigation into cyclospora has already been happening for nearly a month. In the coming weeks, Americans might learn the cause, or causes, of the surge, which would make taking precautions much easier. And if the parasite has been in fact spread by raw produce, the contaminated products may already be off grocery-store shelves.

Cyclosporiasis, though, is particularly tough to track. Scientists can analyze the genetic sequence of most pathogens to identify clusters of related diseases, but that process doesn’t work as well for cyclospora, because the parasite is difficult to extract from stool and can’t be grown in a laboratory for testing the same way other pathogens can. And even if officials zero in on specific foods that they believe were contaminated, the public may never learn what specifically went wrong. The CDC’s website notes that “no one fully knows how Cyclospora gets into food and water.” Although past investigations of the parasite have turned up suspected sources, they have stopped short of concluding how those sources became contaminated. When bagged lettuce caused a cyclospora outbreak in 2020, for example, officials suspected that the parasite had been introduced to farms through a municipal water canal, but they were ultimately unable to definitively establish a causal link. The investigation may also be hindered by the Trump administration’s recent cuts to the CDC and the FDA. Until yesterday morning, the CDC was reporting that fewer than 200 people in the U.S. had contracted the parasite, despite ample evidence from states that the situation was much more severe. It has since updated that count to 843. (A CDC spokesperson declined to explain the earlier discrepancy between state reporting and its own case count, and did not respond to a follow-up request for comment after the new numbers were released.)

Cyclosporiasis, thankfully, is not the most serious foodborne illness that the world has to deal with. Although cyclosporiasis has landed nearly 100 Americans in the hospital so far this summer, no one has died. That’s much preferable to, say, the 2024 listeria outbreak tied to lunch meat that killed 10 people. In that case, a clear culprit was identified, and there were consequences for the company that produced the tainted meat, which has paid out millions in settlements. The United States may never get the same closure to its cyclospora problem.

The Newest Way to Go Analog

2026-07-09T12:33:21-04:00

When the iPod Nano was first released, in 2005, it cost $199 and was sold on the promise of limitlessness. This year, Celeste Stange bought her magenta 8-gigabyte model on eBay for $69 and the exact opposite reason. Every time she’d pick a song on Spotify to stream, she’d think about the millions of other songs she could listen to instead and get paralyzed by musical FOMO, she told me. “Now I only have what’s on here.”

Stange, who is 29, is part of a recent “analog” movement in which people—usually those in Gen Z—opt for less distracting alternatives to their “everything” device. Those alternatives are not always, in fact, analog, but are in many cases older digital devices: an iPod, a digital Canon PowerShot, a DVD player. Tiffany Ng, the 25-year-old author of the newsletter Cyber Celibate, now has a first-generation iPhone, an 11-year-old iPod, two CD players, a Walkman radio, and a 1986 Macintosh Plus that takes 45 seconds to load the “Welcome to Macintosh” screen.

Ng lives in Williamsburg, Brooklyn, where 20 years ago, the word analog would’ve conjured hipsters getting into vinyl. The argument then was that a record player produced real, textured music in a way an iPod’s digital files could not. But today, people are “going analog,” as they call it, to escape devices that offer endless options, in favor of those that offer a modicum of constraint.

The iPod’s original tagline—“1,000 songs in your pocket”—suggested that you could dance like the carefree silhouettes in the ads because you didn’t have to lug around CDs. This was the era when technology was “convenient, but not connected,” Tony Fadell, a former senior vice president at Apple who is known as the “father of the iPod,” told me; then the iPod became the iPhone, which soon had an app store, and convenience and connectivity became inextricably linked. People had their library of songs, but now they also had app notifications and Angry Birds and Instagram posts from that girl they went to middle school with. Eventually, streamable Apple Music replaced iTunes, and tens of thousands of songs became 100 million songs. “I can’t go through all of it,” Stange said.

Stange could still carve out her own corner of Spotify through playlists, but on her Nano, she truly has only music she chooses, with artist photos she uploads manually. For many people, that little bit of added friction is part of the appeal. Jess Fisher, a 29-year-old actor in Los Angeles, now buys new CDs each month, which she puts on her Innioasis Y1, an iPod-esque MP3 player that the company started making in 2023, after users complained that their touch-screen MP3 devices were too distracting. “I am more excited about music because I am restricting myself from it,” she told me. When we spoke, she’d just gotten a new CD. “I’m going to sit down and listen to it and relish it, because I’ve been waiting a week to get it.” She also looks forward to the five free weekly MP3 downloads she gets with her library card, through a music site called Freegal. She has an alert set to repeat every Monday: “It’s Freegal Time!”

I spoke with nearly a dozen people trying out similar technology. Isaac Mosna, who creates YouTube videos about tech under the handle Canoopsy, started taking photographs on a first-generation iPhone because he was nostalgic for a time when “everything was a little more physical and real.” (The older camera also makes the pictures look warmer, he said.) Others told me about their Nintendo DSes and emulators they’d filled with vintage games, so they could play without distractions. These choices have become popular enough that they’re juicing secondhand markets for older tech. On eBay, people searched iPod 1,300 times an hour on average last year, and prices of certain models are up by more than 50 percent, according to data provided by the site. Back Market, a refurbished-technology company, started carrying iPods, Game Boys, and other retro tech after a limited run of Nokia 3310 phones (which can basically be used only to call, text, and play Snake) sold out much faster than expected, Thibaud Hug de Larauze, the company’s CEO, told me.

For at least some people buying into this trend, the logic goes something like: I get a DVD player, therefore I learn how to exist comfortably in the present moment. Ng has been replacing a different modern piece of technology with its older counterpart every month, an experiment she began after her iPhone broke. For the five or so hours that the Genius Bar was repairing it, she “felt so, so stupid.” She didn’t have a way to tell time. She didn’t know how to get around Manhattan without Google Maps. She decided then that she wanted to know she could live without modern technology. When she posted a newsletter titled “I chained my phone to a wall for a week,” people DMed her to ask where she’d bought the chain. (It was an old belt.)

Going “analog” is also one of the few ways to own an actual copy of a song, a movie, or a game these days. And buying those products means a person has to commit to their own taste more than they would by just pressing “Play” on “Fun Upbeat Mix” curated by Spotify. It has given Stange the ability to say, “I’m not going to pretend that Geese is the second coming of God” just because everyone else is listening to them. She’d gotten so used to streaming, though, that she wasn’t sure what to put on her iPod at first. She looked up a Rolling Stone “Greatest Albums” list and downloaded some of the recommendations. Fisher did the same.

A CD or DVD is more work to buy and can physically break down in a way a Spotify playlist cannot, but the people I spoke with generally framed those inconveniences as part of the experience. “If I want to listen to an album that I really love, it involves me spending maybe $20 on a CD, it involves me putting that CD on, it involves me using the physical remote,” Mosna said—it’s “an experience.” (Cleaning and maintaining his CD player is a bit of a pain, though.) Dan Cohen, a 24-year-old fashion designer, told me his professors couldn’t imagine why anyone would want the cross-body CD holder he’d made for his undergraduate thesis: They’d lived through the annoyance of CDs getting scratched, iPods crashing and deleting music, and DVDs getting stuck on their menu pages for eternity. And some of these devices were outmoded for a reason. Ng, the newsletter writer, got the 1986 Macintosh in part to play around with PageMaker and its word processor, but she’s still trying to figure out exactly how to use the computer.

After all, modern “analog” enthusiasts still have backups. Everyone I talked with had kept their smartphone. When Stange and I met, she took out her magenta Nano and her laptop, to show me how she downloaded her music onto the iPod. The Nano promptly died. She plugged it into the laptop to charge, but still, no dice. “I’m pretty sure it broke on the way here,” she said, and told me she’d need to figure out how to fix it. She sounded a little excited about the challenge. In the meantime, she still had her Spotify subscription.

*Illustration sources: Adam Rountree / Bloomberg / Getty; Jaap Arriens / NurPhoto / Getty; Jacobs Stock Photography / Getty; liangpv / Getty; Nick Dolding / Getty; trumzz / Getty; Yoshikazu Tsuno / AFP / Getty.

Lab-Leak Payback Has Begun

2026-07-07T13:09:31-04:00

Updated at 5:43 p.m. on July 10, 2026

The origins of the coronavirus pandemic remain contested; the evidence is incomplete. But pundits, activists, and members of the Trump administration have long insisted that the case is closed, and that the virus slipped out from a lab in China. They’ve maintained the view that U.S. scientists were involved and later tried to hide the facts. They’ve said that justice must be served.

Now the reckoning they want appears to have arrived. An expert on the flu got hauled off by the FBI. A coronavirus researcher was indicted in Detroit. Two prominent virologists stepped down or were removed from senior roles. And a fifth infectious-disease researcher—Anthony Fauci, the central figure in an alleged “lab-leak” cover-up—was recently subpoenaed to appear before the U.S. Senate.

The precise timing of these cases, which have all come to light since April, may be a coincidence. Yet all five are centered on a small community of scientists affiliated with the National Institute of Allergy and Infectious Diseases, which Fauci ran for nearly 40 years. “There has been a snowballing of developments recently,” Richard Ebright, a molecular biologist at Rutgers University who focuses on biosafety issues and has repeatedly denounced Fauci and his “criminal associates,” told me. “I can’t provide an explanation for why it’s taken so long for that process to begin.”

The first case was Ralph Baric, a 72-year-old virologist and bat-coronavirus expert at the University of North Carolina at Chapel Hill. Baric worked closely with researchers at the Wuhan Institute of Virology, which many adherents to the lab-leak theory posit as the source of the pandemic; one contingent thinks that Baric might have been the creator of the SARS-CoV-2 virus. On April 15, the NIH, which has in the past provided Baric’s lab with hundreds of millions of dollars in research funds, referred him for debarment from all federal contracts for at least three years. The claims against him focus on some inconsistencies in paperwork and a series of decade-old experiments that the agency says were carried out in violation of a pause of a “gain-of-fuction” research. Baric told Science magazine’s Jon Cohen that he’s fighting the debarment, and that he’d been targeted on account of the furor over COVID origins; he appears to have retired from UNC on June 1. (Neither Baric nor the Department of Health and Human Services, which oversees NIH, responded to requests for comment.)

The day after the government kicked off Baric’s debarment proceedings, David Morens, a 78-year-old influenza specialist and one of Fauci’s close advisers at NIAID, was indicted for conspiring to hide or falsify discussions of coronavirus research grants. “We have to keep all communications like this on private email so that it can’t be retrieved via a FOIA,” he wrote in one message from 2021. On April 27, per Cohen’s reporting, armed federal agents in bulletproof vests arrived at Morens’s home in Chester, Maryland, and handcuffed him in his underwear. Morens pleaded not guilty to the charges. (The FBI told Science that this description of the arrest was “inaccurate”; Morens’s attorney declined to comment for this story.)

Just a few weeks later, news came out that the acting head of NIAID—the virologist Jeffrey Taubenberger, a very close colleague of Morens’s—had either stepped down or been fired from his role. He and Morens had worked together on more than 60 academic papers, including 13 that also list Fauci as an author—and both had been on the radar of the lab-leak hard-liners. (Taubenberger did not respond to a request for comment.)

News also broke in May that the FBI was investigating another NIAID virologist, Vincent Munster, who had been called out for collaborating with Baric and the scientists in Wuhan. Since then, prosecutors have filed an indictment charging Munster and another researcher from his lab with a conspiracy to smuggle mpox into the U.S. and with making false statements to federal agents. The government claims that on January 25, Munster and that colleague arrived at an airport in Detroit from the Republic of the Congo with a black plastic case containing samples of the mpox virus, seemingly deactivated and noninfectious, and that they both lacked proper documentation for these materials and misled the customs agents who questioned them. The two virologists have pleaded not guilty. (Munster’s attorney did not respond to a request for comment.)

[Read: Trump thinks he knows what started the pandemic]

The strongest argument for connecting all of these cases is that lab-leak activists themselves have done the same. Anthony Bellotti, the founder and president of the White Coat Waste Project, an animal-activist group that has leveraged the lab-leak theory in pursuit of its goal of ending all taxpayer-funded animal testing, declared that “Morens’ indictment should be the beginning—not the end—of long-overdue lab leak accountability at NIH.” Just two weeks before Munster was indicted on charges that seem to have no connection with the pandemic, Bellotti’s group joined the right-wing activist Laura Loomer in hawking what they called a “whistleblower report” about the virologist’s alleged misdeeds. That document describes Munster as a “Fauci acolyte and all around egotistical, arrogant foreigner that joined his research project (to aerosolize covid virus) to Ralph Baric’s project (to weaponize it).” (I could find no evidence that Munster, who is a Dutch citizen, ever worked on a project to “aerosolize” SARS-CoV-2 in order to engineer a new virus, as the whistleblower document seems to suggest. He did work on several papers that tested its stability in aerosols.)

In the meantime, Senator Rand Paul has linked Munster’s name to an early draft of a Defense Advanced Research Projects Agency grant application, with Baric listed as a principal investigator, that proposed to gauge the spillover risk associated with bat coronaviruses. The project’s ultimate goal was to limit that threat but involved altering the viruses in ways that might have made them more infectious—and more like SARS-CoV-2. (The final version of that proposal does not mention Munster, and the extent to which he knew its details are unclear.)

If you believe, as Paul and others do, that this unfunded DARPA project may have been a blueprint for generating the pandemic virus—and that, one way or another, virologists’ disregard for biosafety helped cause the deaths of millions—then seeking justice would be natural. If you’re also sure that COVID got its start in studies funded by the U.S. government, and specifically through NIAID, then there is no greater villain in this story than Fauci. Just last week, Paul announced that he’d subpoenaed the lab-leak theory’s final boss to testify in Congress at the end of this month. “He has not really gotten his just deserts,” Paul said in a weekend interview on Fox. He later added: “There needs to be repercussions.” A hearing is one of the clearest avenues to pursue such measures: The blanket pardon that Fauci received from President Biden wouldn’t cover any charges of lying to Congress that arose from new sworn testimony. (Neither Fauci nor Paul responded to requests for comment.)

Those repercussions may yet extend to other scientists. Ebright, the Rutgers professor, gave me a long list of names of researchers who he says should be held accountable. Justin Goodman, the senior vice president for advocacy at White Coat Waste, told me that every holdover from the “Fauci era” at NIH ought to be fired for their involvement in gain-of-function research, which the group sees as responsible for creating COVID. “I would throw Morens, Munster, and Taubenberger all in the same box of reckless and arrogant animal experimenters who fucked around and are finding out,” he said.

Even if this thirst for COVID retribution could be satisfied, its supposed higher purpose—to help prevent the next pandemic, by promoting more responsible research—hasn’t yet been served. Despite the years of Sturm und Drang about pandemic origins, and the wholesale adoption of the lab-leak theory by the party that controls both Congress and the White House, a shaky status quo still persists in biosafety. The rules for how to work on dangerous pathogens and which sorts of experiments should be allowed aren’t clear; oversight is spotty.

A better, more comprehensive system remains a worthy goal. Shortly after President Trump took office, his administration took a few half steps in that direction. Last May, the president issued an executive order meant to limit and track all research that involves the potential enhancement of dangerous pathogens. “This is an historic day—the end of gain-of-function-research funding by the federal government,” HHS Secretary Robert F. Kennedy Jr. told reporters at the signing ceremony; NIH director Jay Bhattacharya said gain-of-function work would “go away forever.” Yet Ebright and others told me that this project has stalled out. The Office of Science and Technology Policy had been placed in charge of revising the rules on this research by the end of last summer and implementing a national strategy for tracking all gain-of-function research before the end of last year. Those deadlines came and went. No such policies were put in place. (In response to a request for comment on this delay, the White House said that the administration “continues to implement our updated framework to govern, limit, and track dangerous gain-of-function research across the United States.”)

[Read: The lab leak will haunt us forever]

In the absence of that administrative work and with little progress being made on the various biosafety laws that have been proposed in Congress, the nation has been left with just the vengeful spectacle of lab-leak prosecutions. In effect, research policy is being handled by the Department of Justice. America’s doctor may soon be dragged out to testify once more: The science that he championed appears to be unfettered; the scientists he funded are at risk of ending up in chains.

This piece was updated to clarify that Munster worked on several projects that involved the generation of SARS-CoV-2 aerosols.

The Genes That Could Cancel Out a Fatal Diagnosis

2026-07-07T09:38:28-04:00

When Ludivine Verboogen and Romain Alderweireldt’s third child was born in Belgium in late 2015, they marveled at his long fingers. Perhaps one day he will be a famous pianist, they thought. But soon Ludivine grew worried that her son was not developing as well as his two older sisters had. His muscles seemed weak, and the physiotherapy appointments she was taking him to three times a week didn’t seem to be helping. “A lot of doctors were telling us that he was fine, nothing was wrong with him,” Romain recalled to me.

Ludivine persisted, and shortly before their son was a year old, she and Romain found out that his long fingers and lack of muscle tone had a devastating explanation. He was diagnosed with a disease called Marfan syndrome, which generally involves mutations in a gene that helps build connective tissue in the body. Many people with Marfan are exceptionally tall—Abraham Lincoln, for one, may have had the syndrome—and are at very high risk of a kind of fatal rupture in the heart. Ludivine and Romain learned that their son had the neonatal form of the condition, and they were told that he probably would not live past 16 months.

When Romain got the news, he lay down on his office floor, overwhelmed with emotions. His boss found him there and encouraged him to get back up and start working on a solution. Before long, Romain and Ludivine came across a new paper describing how scientists had combed through genetic data from more than 500,000 people and identified 13 adults who defied their genetic destinies—who were alive and healthy despite having multiple or dominant genetic mutations that normally cause grave illness beginning in childhood. The hope of such studies, they learned, is to identify “modifier” genes within the human genome that can be manipulated to mitigate or cancel out genetic conditions.

“I had a look to see if something like that had been done in the field of Marfan, and it had not,” Romain said. Marfan syndrome is particularly mysterious because members of a family who carry the same exact mutation can have wildly different health trajectories, Catherine Boileau, a geneticist at the French health research institution INSERM, told me. Within a given family, she said, the disease can appear at very different ages and with starkly different severity. Some people might experience a fatal tear in their aorta early in life; their relatives might have only mild symptoms and not require surgery.

Romain began combing through databases of genetic information to see if he could find people with Marfan mutations who did not appear to have symptoms of the disease. He found 122 of them, including 24 who had errors in the gene thought to cause the neonatal version of Marfan. Perhaps one of these people, or someone like them, held in their genes the possibility of a different life for his son.

Boileau knows from experience that finding modifier genes can pave the way to lifesaving therapies. She was involved in early research into a gene called PCSK9: Mutations that lower the gene’s activity, it turns out, can avert sky-high cholesterol levels usually caused by inherited errors in another gene. That discovery helped create a class of drugs that mimic the effects of disabling PCSK9.

Modifier genes also have a role in sickle cell disease, one of the most common inherited disorders in the world. In the disease, the body produces an abnormal form of the oxygen-carrying molecule hemoglobin. Scientists identified genetic mutations causing sickle cell disease decades ago, but around the mid-2000s, they began discovering modifier genes, including one that could help jump-start hemoglobin production. Normally, this modifier gene suppresses the creation of a second kind of hemoglobin, typically made only during fetal development; repressing the gene prompts cells to start making the fetal form of hemoglobin again, which acts as a backup. One of the very first gene-editing therapies that the FDA approved for sickle cell disease works precisely by shutting down this modifier gene.

In recent years, more scientific groups have been identifying genetic outliers who might possess helpful variants of modifier genes. A study published in March from researchers in Singapore and Australia, for example, examined the genomes of almost 10,000 healthy people and looked for errors in more than 1,600 genes associated with severe pediatric disease. They found nine individuals ranging in age from 12 to 62 years old who showed no signs of illness despite having DNA profiles presumed to cause grave health issues in childhood. Last month, researchers presented new data at the European Human Genetics Conference in which they searched for 15 genetic conditions in about 900,000 individuals and found that, for some illnesses, the degree of severity is more variable than previously believed.

The research that first inspired Ludivine and Romain’s was part of an effort called the Resilience Project, which was led by scientists at the Icahn School of Medicine at Mount Sinai and has been paused for a number of years. Stephen Friend, a physician-scientist who helped spearhead the original project, told me that, a decade ago, confirming the beneficial effects of suspected modifier genes was difficult, but the advent of techniques such as CRISPR editing has made running such tests far easier. Now the scientists behind the project are looking to reboot it. In the new iteration, the project will apply AI tools to scan more than 2 million genomes for more than 500 rare and ultra-rare diseases, Eric Schadt, a computational biologist at the Icahn School of Medicine, told me. Schadt is working with Friend, and they have assembled a team that spans multiple institutions; their goal is to identify the modifying genes in outliers and develop drugs that replicate their beneficial effects. In a paper published last week, Friend and other scientists note that modifier genes that suppress symptoms have so far been found in around 100 different human diseases.

The mystery of why some people who carry a deadly gene variant might not have symptoms traces back a century, to when biologists were trying to understand how traits were passed from one generation to the next. In fruit flies, they noticed, the expected mutations sometimes caused only partial changes in the insects’ anatomy. Some other factor, or factors, helped determine the flies’ fate.

In the intervening years, scientists have identified modifier genes and other forces that can influence whether a particular trait manifests. Environmental factors can play a huge role. For example, people with phenylketonuria, an inherited metabolic disorder, usually develop severe cognitive impairment, but won’t if they follow a diet that omits foods with specific proteins. Scientists also now know that chemical tags on DNA known as epigenetic markers can switch genes on and off, affecting the degree to which genetic traits produce symptoms.

Identifying the factors that influence the intensity of symptoms caused by inherited mutations is getting easier—and really “has only recently become possible to study systematically,” according to Caroline Wright, a geneticist at the University of Exeter Medical School, in England. Wright, who was involved in the report on 900,000 people, told me that looking at large populations has made it more possible to identify people with other changes in their genomes that mitigate congenital diseases. These large studies have also shown that the symptoms caused by pathogenic mutations are commonly milder than doctors had believed. Focusing scrutiny on the DNA of people who were unwell—a reasonable choice when genetic analysis tools were neither cheap nor fast—might have introduced a bias toward believing that the mutations were always extremely harmful.

And better understanding the flip side—the ways in which worrisome gene mutations might not always cause severe illness—is the key to knowing “if and when to start treatment for those that carry the mutation but still don’t have the disease,” Dusan Bogunovic, the director of the Center for Genetic Errors of Immunity at Columbia University Irving Medical Center, told me.

Bogunovic published a paper in March that highlighted how much we don’t understand about these phenomena. Each of us inherits a set of genes from each of our parents, but recent studies have suggested that the copy from one parent is four times as active as the other version. So if a person’s healthy copy is more active than the mutated one, they might have far fewer symptoms than expected. This kind of skewing has become much easier for scientists to track with new sequencing technology. For as many as half of the genes we carry, one copy might be at least 50 percent more active than the other, Bogunovic estimated.

Gene skewing might even influence outcomes of Marfan syndrome: A small number of case reports have hinted that skewed gene activity might happen with the fibrillin-1 gene. One study, in which 80 people with Marfan were compared with 80 healthy volunteers, found a roughly fourfold difference in fibrillin-1 gene activity in both groups, suggesting that it might be prone to skewing. This skewing has been hypothesized as a contributor to the variability in symptoms of Marfan in families with the same mutation.

Romain and Ludivine’s son has not yet needed heart surgery, but they are still eager to identify outliers with Marfan and learn which factors are helping those people. They started the 101 Genomes Foundation in an attempt to create a database of complete, “whole genome” data from that many people with Marfan mutations. In the past decade, the effort has amassed more than 230 genomes, and it continues to add more each month. (Boileau, the geneticist in France, is an adviser to the project.) The puzzle of why some people with neonatal forms of Marfan’s succumb within months and others live with mild effects weighs on Ludivine and Romain: They have met countless patients and parents like themselves, and although their son is doing relatively well, they know children who have died from the condition in infancy.

They now have a glimmer of insight into genetic variation outside the fibrillin-1 gene that determines whether Marfan patients get sick early in life or remain relatively healthy. At the European Conference on Rare Diseases in June, the 101 Genomes team presented what their years of research had uncovered: five potential modifier genes that had a chance of explaining some of those wild variations. And in as-yet-unpublished data, they have identified a variant of an additional modifier gene that affects the heart’s ability to contract and has a strong protective effect against Marfan mutations, according to Bart Loeys, a clinical geneticist at the University of Antwerp who is helping to lead the research supported by the 101 Genomes Foundation. “If nature has the means of correcting or buffering the effects of a pathogenic variant in one gene, we can learn from that,” he told me. “Maybe we can try to mimic that in other patients.”

At Least You’re Not Playing in the World Cup Right Now

2026-07-02T10:48:38-04:00

Last June, England’s men’s national soccer team went to Spain for a training camp. Next to the pitch were tents artificially heated to a minimum of 95 degrees Fahrenheit, where players completed fitness tests on exercise bikes while staff measured their performance. Each player swallowed a biometric tablet, about the size of a large vitamin, so that scientists could see how well his body cooled itself. At the time, England’s head coach, Thomas Tuchel, told reporters, “I will be very surprised if we do not suffer” at the 2026 World Cup in North America, where his athletes would be tested not just against other teams but against the hot and humid summer.

The weather in the United States in the coming days will provide such a test—for World Cup athletes and for millions of Americans alike. The heat wave sweeping across the country will hit several World Cup locations, including New Jersey, Kansas City, and Philadelphia, where stadiums lack roofs and air-conditioning. The last time North America hosted the World Cup, in 1994, games were infamously hot, and this tournament could give it a run for its money. Tomorrow, temperatures in Kansas City, Missouri, are expected to reach into the 90s, and they’ll get close to 100 in Philadelphia when the city hosts a game on Saturday. Both cities have been placed under extreme-heat warnings by the National Weather Service. If we mere mortals are made miserable by the heat, these footballers will be miserable and vigorously exercising—they usually run about seven miles during a game, Orlando Laitano, a professor of applied physiology and kinesiology at the University of Florida who works with Brazil’s national team, told me.

For months, teams have strategized about how best to prepare their athletes for this kind of heat and humidity—with post-training saunas, hot-water immersion, sweaty outdoor workouts, and heat-training camps. In an ideal world, athletes would spend about 15 days working out in the heat to get used to a region’s climate in the lead-up to the tournament, Lee Taylor, an exercise and environmental physiologist at Loughborough University who consults with several soccer teams competing in the World Cup, told me. Many teams try to do exactly that. Norway’s squad—probably especially in need of some heat training—went to Greensboro, North Carolina, where, at one point, it got so hot that the coaches reportedly cut practice short. Brazil’s team, meanwhile, decamped to Orlando, Florida, where Laitano affixed players with sweat-collection patches and analyzed their fluid and electrolyte loss during workouts to concoct a hydration regimen for each person.

But many players get less than 15 days of acclimatization time. Although England’s team held a 10-day training camp in Miami ahead of the World Cup, some players arrived late because they were busy with the Champions League finals. Laitano still ruminates over Brazil’s loss in the 2014 World Cup, which the country hosted not long after he started working with the team. Brazil chose to train in the mountains of Rio de Janeiro, a region that, during the Southern Hemisphere’s winter, was colder than the other parts of the country where they’d be playing, he told me. Germany, which won the tournament, trained in Brazil’s sweltering state of Bahia. “I can’t say they won only because they stayed in the heat,” Laitano said, “but they did choose to have their base in a hot environment, because they knew it could be an edge for them.”

Acclimatized or not, players are still dragged down by the heat. Research has shown that athletes generally don’t play as intensely during hot matches—not sprinting as often, for instance—and just as a heat wave can zap a person’s energy over multiple days, the fatiguing effects of heat accumulate during the tournament. Still, trainers have a few tricks that can help athletes—or anyone, really—withstand the heat. To lower their core body temperature, athletes might don an ice-filled vest (admittedly, not a household item) or, before a match, dunk themselves in an ice bath (easier to try at home). FIFA has mandated periodic hydration breaks throughout this year’s games, too, during which players can drink ice slurries and wrap themselves in cold towels. (Again—not a bad idea when air-conditioning leaves something to be desired.)

For those of us who haven’t spent months preparing for heat under the care of dozens of experts, the options are somewhat limited. People take about eight to 10 days to get well acclimated to heat, Michael Sawka, an exercise physiologist and heat-adaptation expert at Georgia Tech, told me. When heat waves come on suddenly, people have little chance to acclimatize, and many of the areas affected this week, such as New York City, have had fairly reasonable temperatures recently, Carol Ewing Garber, an exercise physiologist at Columbia University’s Teachers College, told me. Most people will just have to get through it. Garber suggests that those of us not competing in the World Cup follow a few basics: In lieu of a mandated uniform, we should wear breathable clothing; entire nations are not fiercely anticipating our performance on a soccer pitch, so we can choose to spend time in the shade and to exercise in the cooler hours of the day. And on one count, the advice is the same for both normies and World Cup players: Take frequent water breaks.

The Beef Administration’s Blind Spot

2026-06-27T12:00:00-04:00

If there’s one message that Robert F. Kennedy Jr.’s campaign to redefine healthy eating has imparted, it’s that Americans need to eat their beef. In January, the health secretary rolled out the new food pyramid—with a marbled rib eye in the pole position. Weeks later, Kennedy modeled good beef-eating behavior, posing for a pic on his 72nd birthday while tucking in to a bone-in steak decked out with candles. In February, he dropped by the trade show CattleCon and begged the assembled ranchers to increase the size of their herds. “I eat beef every day, twice a day,” Kennedy boasted to the hooting crowd.

The secretary’s beef-intensive diet, which is shared by other members of the Cabinet, including Vice President Vance, is informed by the idea that people should be eating as our prehistoric ancestors did. When the Department of Health and Human Services put out its update to the food pyramid, it also published a 90-page document laying out the “scientific foundation” for the new advice. The report cited several papers on the benefits of the Paleo diet. One specifically endorses eating wild game, and argues that every person should strive to change their diet to “become a 21st-century hunter-gatherer.”

This mode of thinking can be traced back to at least the 19th century, but its current incarnation—the version that has wormed its way inside the U.S. government—dates to the 1970s, when the growing plague of heart disease and obesity was starting to receive sustained attention on Capitol Hill. That’s also when a Seattle gastroenterologist named Walter Voegtlin published a pale volume with a drawing of a loincloth-wearing hominid on the cover. His book was called The Stone Age Diet, and on the title page was a modest proclamation: “It’s Safe, It’s Sane, It’s Simple, and It Really Works!”

Voegtlin’s approach to nutrition may not have been any of those things, but it set the model for the glut of Paleo-diet books that were to come. The book laid out its author’s odd ideas and strong opinions, such as his profound loathing of “baleful salads” and especially the garlicky Caesar, which he regarded as a “gastric atrocity.” Beef, on the other hand, is an excellent source of protein, Voegtlin said. He noted that the man who eats a roast-beef sandwich gets all the amino acids he needs while the peanut-butter-sandwich eater does not. But Voegtlin wasn’t wedded to any single flavor of carnivory. In fact, he had some beef misgivings. Eating cows might not be sustainable, he argued, in a world teeming with billions of slavering Homo sapiens.

Perhaps another beast could be used for making hamburgers instead. Voegtlin had a notion: Instead of land cows, we should eat sea cows, or manatees. And he was not the first American scientist—and far from the most famous one—to hit on this very notion. In fact, schemes to radically expand the nation’s deli counter have been a strange motif in U.S. history.

Voegtlin’s book laid out the premise for the modern Paleo diet. According to its basic theory, Homo sapiens as a species moved so rapidly from hunting and gathering to buying food at supermarkets that our genes never caught up. We’re Stone Agers on the inside, built to eat whatever could be plucked from the bushes or clubbed to death on the savanna, but now we’re marooned in a sickening landscape of nachos and pizza. The goal, for Voegtlin and the people he inspired, was to get back to eating whatever it was that our primitive ancestors ate. The challenge was to figure out what exactly appeared on the caveman food pyramid.

Given the patchy nature of Paleolithic evidence, this matter has provoked many disagreements, which began long before the publication of The Stone Age Diet. In his 1913 book, My Life With the Eskimo, Vilhjalmur Stefansson, an Arctic explorer and anthropologist, described how he believed an Inuit community he’d met in Canada’s far North provided a window into the lifestyles and dietary habits of our Stone Age ancestors. Stefansson’s polar adventures made him famous, especially for the all-meat diet he ate while camping in an igloo: seal flipper and whale tongue; raw and boiled caribou; grizzly-bear jerky and polar-bear steaks; blood soup and tallow-dipped ptarmigan feathers; and, on one desperate occasion, his own bootlaces.

[From the November 1945 issue: Vilhjalmur Stefansson reports on the dental benefits of an all-meat diet]

Tales of Stefansson’s gastronomical feats circulated at a moment when Americans were also exploring new kinds of food. The First World War brought meat shortages and a national austerity campaign, launched in 1917, that encouraged “Meatless Tuesdays” and “Porkless Thursdays.” For years, naturalists with the American Museum of Natural History, which funded some of Stefansson’s expeditions, had been arguing that Americans should really eat more whale. During the war, the U.S. government got on board, promoting the consumption of fresh and canned leviathan and explaining that because these sea monsters were mammals, their flesh tasted like beef or venison, not fish. The feds published a bulletin with 32 cetacean recipes, including “Stuffed Roast Whale,” “Whale Croquettes,” and “Corned Porpoise.” And the museum hosted a widely publicized “whale steak luncheon,” which more than one newspaperman described as sweet revenge for poor Jonah.

[Read: I ate whale meat]

Meanwhile, Alexander Graham Bell, the renowned inventor and a co-founder of the American Telephone and Telegraph Company, was out with a related plan for solving America’s meat crisis. In a statement published in the Journal of Heredity, Bell suggested that the government should look into the possibility of domesticating manatees. Although Florida lawmakers had recently criminalized the killing of these charismatic animals, which one 1891 children’s-book author had called “as amiable, mild, gentle, playful, kindly a creature as ever drew breath,” Bell noted that the sea cow offered “many points of superiority” over even such a promising candidate for husbandry as the pygmy hippopotamus, which the journal had previously considered. “Dr. Bell wants to see the south dotted with manatee ranches,” The Augusta Herald reported in an article about the idea that included recipes for broiled, stewed, and curried manatee, and explained that the sea cow’s tail was usually pickled and served cold.

This was not a bonkers notion. Manatees had been a coveted food source for the Seminole peoples and for southern Americans extending into even the 20th century. “The fattest, juiciest Tennessee beef is by no means equal to it and I doubt if there is anything in the animal kingdom that is so utterly delicious,” one manatee enthusiast wrote in 1885. Bell’s scheme, presented in a journal devoted to eugenics and geared toward optimizing dietary protein, would later resurface at another moment of food anxiety, when Walter Voegtlin was inventing the Paleo diet in the 1970s.

newspapers.com

The Knoxville Sentinel, November 27, 1917

University of Georgia / Georgia Historic Newspapers

The Augusta Herald, September 21, 1917

After training as a doctor and specializing in gastroenterology, Voegtlin had devoted most of his career to trying to find a cure for alcoholism. But on the side he was a nutritional contrarian, arguing in talks that human digestion is better suited to a diet rich in fat and protein than one based on carbohydrates. To prove this point, he cited Stefansson’s tales of Stone Age eating and his own early lab research on dogs.

Voegtlin’s anti-starch opinions spread, at first, on the basis of these lectures. By the 1950s, they were being touted in Prevention, a magazine known for its back-to-nature ethos and openness to vaccine-skeptical views. The Stone Age Diet, his first and only published work on caveman nutrition, did not come out until 1975, just months before his death. Voegtlin saw Mother Nature’s food chain in simple terms: Herbivores eat plants, and carnivores eat herbivores. Humans are in the latter group, with digestive tracts that are “practically identical” to those of dogs, he said. (Voegtlin conceded that omnivores exist, but he argued they are merely “transitional forms.”) But if man is a “pure carnivore,” as Voegtlin claimed, he is flexible as to what kinds of meat ought to go in the tank. Bugs, snails, worms, snakes, leeches, monkeys, lizards, the stomach contents of sharks: All are regarded as delicacies by some human societies, according to the book.

Indeed, for Voegtlin, the future of the species might depend on man’s willingness to broaden his horizons with respect to meat. Writing at a time when concerns about the impending human “population bomb” were widespread, Voegtlin thought the world was not harvesting enough protein to fend off malnutrition. He argued that people might need to start eating up the world’s predators, because they competed with humans for flesh. “There are four thousand tigers left in India and each tiger eats six thousand pounds of meat each year,” Voegtlin noted with alarm. Alligators, crocodiles, lions, tigers, and bears might have to become supper. Ocean predators such as the seal, whale, dolphin, and walrus would be hunted down and made into supermarket steaks. And in the brutal, man-eat-dog world of the book’s imagination, human populations, too, would need to be controlled: Voegtlin proposed that reproduction should be limited to “superior types of individuals” under the watch of an “omnipotent Bureau of World Census.”

As for nature’s mermaid—the gentle, seagrass-chewing sea cow—she might carry on her lineage in water farms, domesticated as a novel form of floating livestock. “This marine mammal, as does its dry land counterpart, eats only vegetation, totally unfit for human consumption,” Voegtlin noted. Sea cows are superior to land cows, Voegtlin suggested, because land cows eat grains, which humans could survive on in a pinch. Since manatees live on baleful sea-salads and don’t deplete the world’s meat supply, they could live alongside humans in peace—until such time as they were ground into meatballs.

Voegtlin’s book did not initially garner much attention. One of its few reviews, in the journal Medical History, described it as full of “opinions that oppose accepted belief and substantiated fact.” Academics who promoted Paleolithic nutrition in the 1980s called for plenty of plant foods in the diet and ignored Voegtlin, perhaps on account of his endorsement of eugenics. But by the time the Paleo world was coalescing online in the ’90s, Voegtlin’s book was cited as a pioneering work. Its message would be channeled through the 2010s as the Paleo lifestyle became associated with zealous meat-eating and an emerging band of popular “meatfluencers.”

But as it turned out, the archaeology would prove Voegtlin wrong: It wasn’t true that Stone Age humans never touched a processed grain. Starch residue found on 30,000-year-old grinding stones indicates that Paleolithic peoples may have eaten bread. Ancient bits of DNA suggest that genes for starch-digesting enzymes might have been proliferating as early as 800,000 years ago, when cave-chefs started roasting primordial potatoes. Marlene Zuk, an evolutionary biologist and the author of a 2013 book that debunked some of Voegtlin’s arguments, recalled how the Paleo community dealt with this evidence that challenged their largely carb-avoidant worldview. “They liked the word tuber,” Zuk told me. “The word tuber was very popular because it sounded more caveman-y.”

[Read: How close are manatees to extinction?]

Even for its time, The Stone Age Diet missed the mark with its sharp dichotomy between herbivores and carnivores (and its bizarre denial of omnivores). These distinctions can be fuzzy: Crocodilians, for example, may eat kumquats and pond apples in the wild, while cows and sheep will snack on baby birds. Even the kindly Florida manatee, connoisseur of bayou seagrass, sometimes flies into a carnivorous rage, snapping up fish and gnashing them in its terrible teeth.

Yet no branch of science has debunked the idea that humans are neglecting lots of opportunities for ingesting animals. Indeed, the notion that we should be eating strange meats has been backed by a range of influential authorities. Voegtlin got his vision of sea-cow cuisine not directly from Bell but from Scientific American, which had proposed that we domesticate not just the manatee but also the “palatable” capybara, and from The Journal of the American Medical Association, which lent its weight to the idea of building enormous blue-whale farms in the Pacific Ocean, fenced in by coral reefs. More recently, advocates of livestock alternatives have zeroed in on smaller animals: In 2013, the United Nations released a report on global food security that argued for the mass cultivation of edible insects. The report noted that various groups have made a habit of consuming beetles, caterpillars, wasps, mealworms, and dragonflies.

I’m not here to suggest that the logic of evidence-based nutrition demands that we consume more manatee meatloaf or chili con capybara or dragonfly dumplings. But there’s something ho-hum about the fact that a norm-breaking MAHA administration, led by a carnivorous health secretary who has boasted that he’s a “very adventurous eater” and will “eat virtually anything,” has stuck so monotonously to beef. It’s not as if beef has been shown to be healthier than any other meat. Examined through a political lens, though, Kennedy’s bovine-forward dietary approach makes perfect sense, Amy Bentley, a food historian, told me. The burger is the quintessential American meal, and beef-related imagery calls to mind the virile cowboys who drove cattle and made America great by filling its larders with sirloin. There’s a resonance between this sentimentality for the Old West and the Paleo-nostalgia that animates the carnivore community, she said, in that both are romantic fantasies about a time when men were unapologetic warriors. “When gender roles are being questioned, there’s often renewed interest in the vitality-giving properties of animal flesh,” Adrienne Bitar, a food scholar who has written about Voegtlin, told me.

Proposals to put manatees or mealworms on the food pyramid would face challenges. On the left, a plan to farm sea cows would enrage conservationists, even though Trichechus manatus has in recent years been downgraded from “endangered” to “threatened.” On the right, the UN’s edible-insect report sparked an “I will not eat the bugs” campaign from skeptics of climate-driven policies. Perhaps that’s why, for all of the MAHA bluster about remaking the American diet, the architects of our new dietary guidelines have turned out to be picky eaters when it comes to meat. We’re all a bit afraid to try new things. That tendency, which may have been with us since the Stone Age, today serves the interests of our cumbersome friends in the Florida Everglades. For now, at least, pickled manatee tail is off the table.

Europe’s Come-to-AC Moment

2026-06-26T14:10:37-04:00

In stifling apartments and sweaty row houses in England, Germany, and even Scandinavia, some Europeans are considering a very American idea: They really need an air conditioner.

One of their most accessible options, though, might feel unfamiliar to anyone accustomed to central air. Among Europe’s commonly used types of air-conditioning is a clunky, inefficient unit that stands a few feet high and has a wide exhaust tube meant to go out a window. Such units are typically “a panic-buy on a hot weekend,” Brian Motherway, the head of energy efficiency at the International Energy Agency, told me. People grab the first machine they see and end up living with it for a decade, he said. Many people leave the window gap around the exhaust tube uncovered, letting hot air right back in. Walking down a Paris street last week, I saw three different stores where such units stood beside a door propped open by the tube.

Sales of air conditioners of all sorts are climbing in Britain too. I’ve lived in London for 25 years, and I don’t recall ever hearing anyone talk about buying a home air conditioner—until three acquaintances mentioned, unprompted, on the same sweltering day, that they had purchased one, or were considering it.

Much of Europe wasn’t built for air-conditioning, or for coping with hot weather at all. In Britain, for instance, which has been long accustomed to cool summers and dark, rainy winters, older houses like mine are poorly insulated and often leave inhabitants baking when outside temperatures climb. But many newer buildings are designed to retain heat and maximize sunlight, making them also poorly suited for the new normal, Andy Love, a sustainability consultant who founded Shade the UK, an advocacy group that presses for smarter building regulations, told me. However sleek and modern the big glass apartment towers going up around London look, he said that many residents are “moving into those flats in the winter to then find out in the summer, it’s a furnace.” Britain’s Climate Change Committee, which advises the government, put the problem bluntly in a report in May: “The UK was built for a climate that no longer exists.”

All across the continent, Europeans enduring heat waves that are growing more frequent and intense are coming to similar realizations about their own buildings and cities. The zinc roofs that top nearly four-fifths of Parisian apartment buildings, for instance, create baking conditions for those beneath. Temperatures are brutal, too, in the concrete towers on the city’s poorer outskirts, where high electricity prices make some people wary even of running fans. France’s housing minister, Vincent Jeanbrun, said that one in three dwellings in the country was “like a thermal kettle.” Many European nations have worked hard to improve buildings’ energy efficiency, but although insulation can help modulate temperatures in summer as well as winter, many homes have also been made airtight to retain heat.

Now Europeans urgently need ways to cool down. Although climate change will cause the biggest absolute increases in heat in African nations, eight of the 10 countries likely to see the most “dramatic relative increases in the number of days that require cooling” are in northwestern Europe, a study by researchers from the University of Oxford and the University of Bristol found. That list includes Switzerland, Britain, and Norway, and all of those places, the study warns, are unprepared.

Already this summer, two major heat waves have broiled Europe. During the first, Ireland, France, and the United Kingdom sweated through their hottest-ever May temperatures. A month later, France notched its two hottest days and its hottest night since records began: Thermometers soared past 110 degrees Fahrenheit in the west and 104 degrees in Paris. Spain reported its two hottest June days since at least 1950, and Britain, where temperatures reached 99 degrees, recorded its three hottest June days. The temperature in Basel, Switzerland, hit 100 degrees. Germany and Austria are enduring heat in the 90s, and braced for worse as the weather moves east. Temperatures this high can be life-threatening: More than 200,000 people have died because of heat in Europe in just the past four years, the World Health Organization estimates.

The imperative of reducing that toll prompted Britain’s Climate Change Committee to warn that although installing shades, awnings, and shutters can and should help lower temperatures, air-conditioning and other cooling systems will be needed in many homes, hospitals, long-term-care facilities, and schools. That need couldn’t have been clearer this week, as patients sweltered and radiation and MRI machines broke down in hospitals just as emergency rooms were swamped with heat-stricken arrivals.

Making changes like those the committee recommends will take money—potentially $10 billion annually between now and 2050—and time. A 2021 report estimated that less than 5 percent of U.K. homes had air-conditioning, although one market survey reported more recently that the number with an AC had doubled in the past three years. Even so, air-conditioning the country will take decades. The climate panel recommended that temperatures be kept to safe levels in all hospitals by 2035, in long-term-care facilities by 2040, and in schools and prisons by 2050.

The shift to AC is happening across Europe, where only about 20 percent of homes currently have air-conditioning. (Compare that with about 90 percent in the United States.) Ownership is skewed toward the south of Europe—about half of homes in Italy and 40 percent in Spain use it, for example. But a survey in Germany found that AC ownership jumped by 6 percent between 2023 and 2024. Even residents of Scandinavia and the Baltic countries are buying air conditioners, Simon Pezzutto, who studies cooling demand at the Institute for Renewable Energy at Eurac Research, in Northern Italy, told me.

Those clunky portable units do ease discomfort, at least; another widely available air-conditioning option, known as a split unit, is typically more efficient, but also more expensive and harder to install. Reversible air-to-air heat pumps, which are gaining popularity, are an even more efficient option and can both heat homes in winter and cool them in summer.

In Europe, where electricity prices are significantly higher than in the United States and incomes are typically lower, the price of cooling can mean a painful surprise when the power bill comes. If air-conditioning use spikes rapidly, it could also burden a grid that is not yet ready for big new peaks. In a taste of that possible future, tens of thousands of French homes lost power during this week’s brutal heat. Electricity prices spiked as demand climbed, and some nuclear reactors had to curtail generation. Britain’s grid operator coughed up an estimated $13 million to get extra generation online.

Roxana Slavcheva, a buildings expert at the World Resources Institute, told me that the continent would benefit from making sure that the air conditioners it does use are as efficient as possible. But it also needs to prioritize less energy-hungry cooling measures, including better ventilation and more shade for both streets and buildings, she said. In southern Europe, Italy’s wooden shutters and the Greek islands’ thick white walls moderate temperatures, Anna Mavrogianni, a built-environment professor at University College London, told me. Street trees, pergolas, and parks can make being outside more enjoyable, and even help reduce the urban heat-island effect, which makes cities hotter than surrounding areas. Awnings stop heat before it gets inside, as does orienting new homes to minimize direct sunlight on big windows. Light-colored or reflective paint keeps temperatures down, and ceiling fans help too.

Such upgrades aren’t all easy—or quick. In Paris, for instance, officials sometimes decline permission to modify those hot zinc roofs because they’re part of the city’s distinctive look. Elsewhere, too, local planning rules aimed at preserving historic buildings’ aesthetics can mire exterior changes in red tape. In Britain, windows that typically open out instead of in mean that external shutters can’t be installed. Love, the sustainability consultant, knows that retrofitting millions of homes and thousands of neighborhoods is a daunting project that will take years, if it happens at all. Done right, the changes he envisions could make Britain “feel a little bit more Mediterranean than we’re currently used to,” he said. But with the heat here today, “people now just want solutions.”

A Fancy Name for Junk Food

2026-06-23T07:30:00-04:00

Once again, Americans are in a panic over what we eat. More than two-thirds of those surveyed now regard the industrially produced, ultra-processed foods, or UPFs, that dominate the U.S. food supply as addictive, according to a study published earlier this month in the American Journal of Public Health. That’s just the start of it. Most respondents said that UPFs are a major source of type 2 diabetes, cardiovascular disease, and obesity. At least one-third blame these foods for causing cancer, ADHD, depression, and anxiety. And nearly half—corresponding to some 130 million American adults, if the survey’s findings can be extrapolated—believe that UPFs are simply “not what God intended for people to eat.”

For the past couple of years, concerns about the potential health effects of UPFs have been highlighted in the media, and at nearly every level of the public-health establishment. New restrictions on the sale of UPFs have been introduced or passed in blue- and red-state legislatures alike. Health and Human Services Secretary Robert F. Kennedy Jr. has said repeatedly that UPFs are “poisoning” Americans. And the World Health Organization is planning to put out global guidance on the problem.

To some extent, this is nothing more than a rebranding of an old idea, that the foods being sold at convenience stores or fast-food restaurants are anything but good for us. These products, at least some of which are almost assuredly detrimental to our health, have gone by several different names. For those of us old enough to remember the 20th century, we didn’t use to call them “ultra-processed” foods, but simply “processed” foods or “junk” foods. Now an ultra- prefix has been added to the same fuzzy category. Ultra-processed in the world of nutrition circa 2026 is, first and foremost, just the latest synonym for unhealthy.

Any more specific meaning, though, has been elusive. The U.S. government, for all of its UPF-related rhetoric, hasn’t even resolved the most basic matter of semantics: “A definition for ultra-processed foods is really hard,” one FDA official said in April, to explain why the project of creating one had already taken many months and could still be far from done. So many of the foods we eat are processed in so many different ways. Where do we even begin?

To the staunchest anti-UPF crusaders, though, ultra-processing may also represent an outgrowth of a deeper problem. The nutritional epidemiologists and other scholars who have led this push in public health are out to challenge an entire system of beliefs, propagated by nutritionists for a century or more, about what makes a food unhealthy in the first place. When they swap in ultra-processed for junk, they are shifting the focus from the nutrient content of a processed food—whatever fats, salt, carbs, and sugary sweeteners it might contain—to how it’s made, where it’s made, and even why it’s made.

Going by this logic, even basic intuitions about what is good or bad to eat may be twisted into strange new shapes. Keebler’s Soft Batch cookies might be labeled harmful on account of their industrial ingredients—preservatives, emulsifiers, and hydrogenated oils—although your grandma’s home-baked snickerdoodles could be equally sugar-rich and considered benign. Store-bought whole-grain rye bread, with preservatives added to prolong its shelf life, could be viewed as toxic, but home-baked white bread is thought of as just a wholesome treat.

The war on UPFs, if its advocates are to be taken seriously, has many such confusing implications. At best, these complicate the conversation over how we should address the chronic-disease crisis on a national scale: What, exactly, should we eat and why? At worst, they suggest we’re stepping backwards and away from any hope of progress in the science of nutrition.

In the grand tradition of ideological revolutions, the turn against UPFs began with a manifesto—or rather two of them. The journalist Michael Pollan wrote the first. His 2008 best seller, In Defense of Food, blames the rise of margarine, low-fat cookies, and other healthy-seeming packaged foods on a scientific ideology called “nutritionism.” This refers dismissively to just about everything that nutrition researchers had been doing for the past century—that is, assuming that a food’s value is determined by the sum of its nutrients, and that eating healthy means optimizing for that value. Any truly healthy diet would reject this way of thinking, Pollan argues, and instead rely on how people have been eating for generations. Eat real food, the book implores, not “foodlike substances.”

That idea has now been taken up in earnest by the U.S. government as the touchstone of its dietary guidance. But Pollan’s argument would also feed into the second manifesto, which was the call for scientific revolution. Two years after In Defense of Food, the Brazilian epidemiologist Carlos Monteiro laid this out in an academic paper arguing that nutrition science on the whole, and its paradigm of healthy eating, had been a failure. (An editorial accompanying that paper notes Monteiro’s admiration for Pollan and references In Defense of Food.) People in Brazil had been getting fatter, in keeping with global trends, Monteiro observes, but they had not been purchasing more fats, oils, flour, or sugar, as might have been predicted by conventional theories of nutrition. Instead, he focuses on another dietary pattern: In Brazil, he writes, as elsewhere in the world, people tended to be heavier and more likely to have diabetes when their diets were less traditional and more reliant on packaged, frozen, and fast foods. He had already started using the term ultra-processed to describe the latter set of products; now he was declaring it the “big issue” in public health.

Here was the revolution in a single phrase. For half a century, at least, debates about our diet had focused on its nutrient content. That approach was inherently reductive, but it had the benefit of being scientific; it made testable claims about causes and effects. A Big Mac, for instance, contains more than a gram of sodium and almost 100 calories’ worth of saturated fat; nutrition science had hypotheses about the mechanisms by which those substances might lead, respectively, to hypertension and heart disease. A 12-ounce can of Coke delivers 39 grams of sucrose or high-fructose corn syrup—nearly 10 teaspoons—and nutrition researchers could study what those sugars do inside a human body, day in and day out, and speculate about the cumulative effects over a lifetime. That work had been going on for decades, and many of its central questions remain unresolved.

According to Monteiro’s theory, this nutrition research and the arguments that it has engendered are secondary concerns. The fight against ultra-processing does not fixate on the details of a food’s constituents, but on the means of its production. It’s not just what’s in the Big Mac or the Coke or the Cheez-It crackers that should concern us, but what the food industry has done to them: the sum total of unnatural ingredients and industrial processes that have been added to make these products cheap, convenient, and desirable.

[Read: The Big Tobacco playbook comes for your Oreos]

Monteiro and his colleagues can only guess at why a food becomes unhealthy when subjected to this transformation. Among their many hypotheses: Precisely engineered combinations of fat, sugar, salt, and refined carbohydrates might override our satiety signals; soft-textured food could lead to faster eating and more consumption overall; toxic chemicals may be leaching out from product packaging; and flavor enhancers, colorings, and other additives might disrupt the gut microbiome and reduce the body’s natural secretion of GLP-1.

In November, The Lancet, a prestigious British medical journal, published a three-part, 60-page series of papers—co-authored by Monteiro—that explores the science and policy of UPFs. The “key driver” of the global epidemics of obesity and diabetes, it says, is the rise of UPFs, which is itself a product of “the growing economic and political power of the UPF industry, and its restructuring of food systems for profitability above all else.” According to Monteiro and his many co-authors, every aspect of that system is to blame: the food manufacturers, for starters, but also the ingredient suppliers, the plastic producers, the packagers, the grocery stores, the advertising firms, the lobbyists, the industry groups, and even the “research partners” of industry, a category that would seem to include a significant portion of all of the nutritionists and food chemists in academia.

The mere science of “nutrition”—as it has been understood by its practitioners for many years, and implemented by authorities in public health—provides at most a bit of context for this bigger story.

Ultimately, though, the claim that “ultra-processing” is the big issue here—the proximate cause of the obesity and diabetes epidemics—is full of holes. First there is the obvious: What, exactly, constitutes an ultra-processed food? But also: Which aspects of a UPF (however it’s defined) are harmful to our health, and how? And finally: Will demonizing ultra-processing really bring us any closer to addressing the country’s soaring rates of chronic disease?

These are the kinds of questions that public-health authorities should be asking, and whether they can be answered with the existing evidence is at the center of the controversy. In 2010, Monteiro and his colleagues came up with Nova, a food-classification scheme that identifies UPFs as those food products that are industrially formulated to be “ready to eat or ready to heat with little or no preparation.” This working definition was then applied to observational research; the series in The Lancet compiled data from 92 such studies that had been carried out through 2024, and says they show that individuals who eat the most UPF-rich diets are 33 percent more likely to have abdominal obesity, and 21 percent more likely to be overweight or obese, than those who eat the least.

That sounds bad, but how meaningful is this kind of evidence? Even the epidemiologists who do this sort of research are unable to reach agreement on whether associations of this magnitude are even likely to reflect a genuine causal relationship. For comparison, the purported risks of eating UPF-rich diets are roughly one-hundredth the size of the lung-cancer risk that can be attributed to heavy smoking. The Purdue University nutritionist Richard Mattes, writing with half a dozen colleagues, notes that UPF consumption correlates with obesity to just about the same degree as people’s educational attainment, sleep duration, frequency of TV viewing, and many other factors.

[Read: What happens when you’ve been on Ozempic for 20 years?]

Far better research is necessary to clarify the evidence, but the kind of clinical trials that might be definitive aren’t likely ever to be done. Thousands, if not tens of thousands, of individuals—ideally men, women, and children—would have to be randomized to eat diets that are either high or low in ultra-processed foods, they’d have to keep eating their assigned diet for many years, and they’d have to be monitored closely to establish which dietary pattern ended up producing better health. Even if such an expensive trial could be done (at a cost that might run well into nine figures), and even if it demonstrated that a low-UPF diet is superior, which would surprise no one, it wouldn’t tell us why: whether because of the industrial processing and food additives that went into the UPFs or because the UPFs were, like any of the foods we once described as “junk,” simply high in sugar, fat, processed starches, or salt.

So instead, the two sides of the UPF debate argue over a handful of published clinical trials, lasting from a day to a few months, that aim to demonstrate that the ultra-processing of food itself makes people eat too much. The most influential, by far, was a 2019 study led by Kevin Hall, then at the National Institutes of Health. Marion Nestle, a professor emerita of food studies at New York University and a co-author on two of the three recent Lancet articles on UPFs, called Hall’s research “the most important study ever done to explain weight gain.” But some researchers, such as the Harvard endocrinologist David Ludwig and nutritional epidemiologist Walter Willett, both of whom have co-authored papers with Nestle, have argued that the design of Hall’s research is fatally flawed, not least because the experimental diets were maintained for only two weeks each. Willett told me via email that the NIH study and other short-term studies of its kind are not just meaningless but “likely to give the wrong result (which is worse than no result at all).”

Hall, who is now a clinical scientist at AstraZeneca, noted in an email to The Atlantic that this type of research will be necessary if you want to measure energy intake with accuracy and precision. “With all of their limitations, our studies are among the longest and largest such studies that assess how changing aspects of participants’ food environments affects their energy intake,” he wrote.

Whether the results of such research will tell us anything about the cause of obesity remains to be seen. In the meantime, other nutritionists have tried to resolve the conflict between UPFs and traditional nutrition science by amending or rethinking Monteiro and his colleagues’ Nova scheme. In 2024, Susanne Bügel, a nutritionist at the the University of Copenhagen who has studied how plant-based dairy products might be better fortified with vitamins and minerals, proposed a research initiative that would develop a “next generation of the Nova classification” that might account better for each food’s nutrient content and quality. She organized a workshop to bring together critics and proponents of the system, food chemists and nutritionists and public-health researchers, in the hopes that a kind of multidisciplinary synergy would emerge—and with it, a means of establishing not only which foods are “ultra-processed” but also which UPFs might be harmful and which benign.

The project quickly exploded into controversy. Monteiro refused an invitation to participate in the workshop and demanded that it abandon any usage of the terms Nova and ultra-processed foods to avoid the implication that he or his group had actually endorsed the workshop or any new system that might emerge from it. He also took issue with the fact that funding for the project came from the Novo Nordisk Foundation, which is connected to the company that makes Ozempic and other obesity-related drugs. “Public health policy should be based on independent science, not shaped by entities with a financial stake in diet-related diseases,” he told the Financial Times. By that point, Monteiro’s allies had published an open letter calling for a boycott of the project and urging Bügel to “respect the scientific foundations upon which NOVA has been built.” (The Novo Nordisk Foundation has said that its grant decisions are made independently of the pharmaceutical company. Bügel told me that the project’s funders had not exerted any influence: “They don’t interfere; they don’t tell us what to do.”)

[Read: Avoiding ultra-processed foods is completely unrealistic]

In an academic article published in January, Monteiro and half a dozen co-authors make clear that any work dedicated to making food-industry products “healthy”—a category that would include Bügel’s research into plant-based milks—serves to legitimize “industry narratives,” and defeats the purpose of the UPF classification. Even the mere discussion of such products, they suggest, “risks normalizing ultraprocessing and delays effective interventions.” In short, traditional nutritionism is so fundamentally broken, and so compromised by its ties to industry, that it’s counterproductive to the public health on its own terms.

In spite of the rhetoric—and for all of the talk about a war on UPFs—nutritionism itself remains intact, which might not be a bad thing. The U.S. government’s website for this year’s update to the dietary guidelines, for instance, doesn’t actually use the word ultra-processed; it says instead that people should avoid “highly processed foods laden with refined carbohydrates, added sugars, excess sodium, unhealthy fats, and chemical additives.” Reductionist science, and the assessment of a food’s nutrient components in determining its value, still holds sway.

By the same token, Kennedy announced in February that HHS was backing a petition submitted by the former FDA chief David Kessler that would force the agency to reassess the safety of industrial ingredients in highly processed foods. Although that petition has been portrayed as an attack on UPFs, its scope is actually more narrow. The ingredients in question, which could in theory lose their FDA designation as “Generally Recognized as Safe,” are none other than sugar and other “refined carbohydrates.” Kessler told me in an email that he is not necessarily worried about the chemical additives in processed foods, so much as he is the carbs—“flour starches and sweeteners.” In Kessler’s world, the Keebler Soft Batch cookies may be just as harmful as Grandma’s snickerdoodles because both are sugar-rich, and both might be detrimental to those predisposed to obesity and diabetes. We have yet to do the research necessary to establish whether that is true.

Monteiro himself acknowledges the large overlap between UPFs and traditional concepts of sugar-rich junk food. The first article in his Lancet series notes that food products designated as ultra-processed by the Nova system are dominated by sweetened drinks, as well as “sweet snacks, desserts and confectionery.” The same paper notes that these beverages and foods constitute virtually all of the UPFs consumed in low-income countries and, with baked goods added, close to 75 percent of UPFs in high-income countries.

Given those numbers, couldn’t much of the global chronic-disease problem be resolved by communicating the message that, say, sugar and refined grains are harmful, rather than targeting an ill-defined new category that lumps in all of these treats with vitamin-fortified oat milk and whole-grain rye bread with preservatives?

I called Monteiro in Brazil to ask this basic question. He responded by turning the question around and pointing out that 90 percent of the added sugars in the American diet come from ultra-processed foods, along with a significant amount of our saturated fat and salt. “If you avoid ultra-processed foods,” he told me, “you improve your diet in terms of sugar, salt, and saturated fat.” The old advice to avoid specific nutrients could be dead-on, he said, and dietitians, nutritionists, and doctors should continue to dispense it. But that wasn’t enough: “It is not feasible for people to follow advice if you don’t change the food system, to liberate it from these corporations.”

To Monteiro, critics of his UPF hypothesis are conflating discussions about evidence with discussions about policy. “We cannot mix these two,” he said. “One is the evidence, the causality, the explanation for the pandemic of obesity. The other is what each country should do.” To worry about whether UPFs might be a useless or pseudoscientific category is to miss this point. Instead of trying to extrapolate the scientific evidence to policies in a “non-intelligent way” that only slows things down, he said, we should take some obvious steps to address the problem: Tax sugary beverages, subsidize farmers’ markets, and promote more fresh and minimally processed foods.

This all sounded very sensible. Maybe “ultra-processed foods” can be a way of focusing attention on the sorts of policies we need. But even then, wouldn’t the science of nutrition matter? The argument to tax sugary beverages, for instance, depends on evidence that these beverages are chronic toxins that cause obesity and diabetes, and are perhaps addictive as well, not just empty calories that we happen to consume to excess. And if we promote fresh, minimally processed foods, the question is, which ones? Red meat is a minimally processed food, and so are full-fat milk and cream. The current HHS secretary has insisted that red meat and animal fats are good for us, and he’s not alone in thinking so. Monteiro has more conventional views, and the evidence is ambiguous. So what exactly should we do?

The war on UPFs is based on the idea that traditional nutrition science will never land on useful answers to these questions. It sees the failures of the past—ill-fated admonitions from experts to cut back on fat, for example, and base our diets, as the FDA once recommended, on starches and grains—as signs of the inherent rot of nutrition science. But there’s another way to think about this history. Maybe the nutritionists had the right idea with their reductionist approach to the science, but they did a poor job with the research itself. Maybe a concerted effort to identify precisely what it is about the foods we eat that causes obesity and diabetes, done with far greater care and rigor, would at last produce the understanding that we’ve sought. If that’s the case, then an all-out fight to break the power of the multinational food companies, however righteous that may be, would entail enormous wasted effort—and it may not even work.

Are GLP-1s Performance-Enhancing Drugs?

2026-06-20T09:00:00-04:00

Before Serena Williams picked up her racket at London’s Andy Murray Arena last week, two questions hung over her return to tennis.

First: How would she do? She answered that, in her first competition in nearly four years, by winning. The 44-year-old and her doubles partner, the 19-year-old Victoria Mboko, ended up besting the third seed in their opening match of the Queen’s Club tournament. Their victory was sealed by a 116-mile-an-hour serve from Williams that her opponents couldn’t return.

The second will take longer to answer: Did a GLP-1 weight-loss drug enhance her performance?

Williams is a paid spokesperson for Ro, a telehealth company that specializes in such medications. In ads, she says that she lost 34 pounds with the help of GLP-1s. It’s unclear whether Williams is still on her drug of choice, tirzepatide (her publicist declined to comment), which has helped her lose stubborn baby weight and manage her cholesterol. Although there’s no indication that she took it to gain a competitive advantage, Williams has also said that the medication improved her training and her game. The drug “helped me enhance everything that I was already doing—eating healthy and working out, whether it was as a professional athlete at the top level of tennis or just going to the gym every day,” she told People magazine in August.

With her comeback, Williams is the first active elite athlete to publicize her use of GLP-1s. But the world of sports is full of whispers that she is not the only one. The more athletes who follow Williams’s lead, the more urgent the question of whether GLP-1s should be treated as performance-enhancing drugs will become.

The World Anti-Doping Agency, which sets rules adopted by most international sporting leagues, has said that it is keeping a close eye on whether GLP-1s are being abused; for now, athletes are free to take them. (A Ro spokesperson told me that “any patient who receives a GLP-1 prescription through Ro has been determined to be clinically eligible for that treatment by a licensed medical provider.”) But experts are divided over whether GLP-1s have the potential to improve athleticism. “I can’t see that there would be much of an advantage at all to using these substances in an athlete,” Thomas Hudzik, a pharmaceutical consultant who has served on the advisory group that recommends what drugs WADA should ban, told me. Meanwhile, Lars Engebretsen, the head of WADA’s health, medical, and research committee, told the Norwegian Broadcasting Corporation that he believes the drugs should be banned, but mostly because they could exacerbate eating disorders.

Opinions diverge because no studies have yet tested these drugs in elite athletes. Williams’s return to tennis—which will continue with a doubles appearance alongside her sister Venus at Wimbledon—is one of the first opportunities, as far as we know, to see how an elite athlete performs after taking a GLP-1. So far, the results have been uneven: She won with Mboko at the Queen’s Club, but lost her first doubles match at the Berlin Open this week. Doubles also demands less of athletes than a singles match does, so Williams’s full abilities have not yet been tested in competition. (Tennis fans are eager to know if Williams will get a wild-card singles spot at Wimbledon too.) “The jury is out in terms of endurance, stamina,” Rick Macci, who trained Williams during her childhood, told me.

[Read: America has a new GLP-1 playbook]

Being trim can be an advantage in some sports. A lighter frame can reduce the amount of effort needed for, say, climbing, running, or gymnastics. And weight is built into the structure of other sports. Wrestlers, for example, must weigh in to qualify for their matches. The popular strategy is to get just under the maximum weight for a given class—a process that GLP-1s might make easier. “It makes perfect sense in weight-category sports,” John Hawley, the director of Australian Catholic University’s Centre for Human Metabolism and Performance, told me via email.

But whether GLP-1s will deliver meaningful weight loss for athletes already in tip-top shape is an open question. No major trials have tested GLP-1s in healthy people with a normal or low BMI, so it’s unclear how much weight such people might lose on the drug. That could mean that among elite athletes, the drugs might have significant effects for only a small group, including Williams, who are seeking to get back into shape. Several clinical trials have also shown that GLP-1s can reduce an inflammation marker in the blood—but it’s still unclear how much of that improvement is the result of weight loss or an independent effect of the drugs.

Besides, being light isn’t necessarily an upside if it means a reduction in strength. Roughly 25 to 35 percent of the weight that GLP-1 patients lose is lean mass, according to a meta-analysis published in March. Athletes using GLP-1s will need to closely watch their diet and training to make sure they maintain muscle (perhaps while dealing with the vomiting, nausea, and diarrhea often associated with GLP-1s). Plus, GLP-1s are believed to dampen dopamine signaling, which “might actually put the lid on initiative and drive and competitiveness,” Ziyad Al-Aly, a researcher at Washington University in St. Louis who has studied GLP-1s, told me. Lack of research is a problem here too, Al-Aly emphasized: The best evidence of this hypothetical effect is a preprint study that found that mice sought out their exercise wheel less after being injected with semaglutide.

[Read: Ozempic is a brain drug]

Some studies on the effects of GLP-1s in certain sports are now under way. WADA, for example, is funding a trial to test how semaglutide changes runners’ body composition and performance. But pharmaceutical companies are actively testing new types of weight-loss medications that may have different effects on muscle, as well as combinations of GLP-1s with other drugs meant to preserve strength. Some of those drugs, such as a class that overrides the body’s natural limit on muscle growth, are already banned by WADA. Every new weight-loss medication will complicate any tenuous understanding of how these drugs affect athletic performance.

Determining whether a drug should be banned is not solely a scientific endeavor: WADA bases its decisions in part on whether the use of a drug violates “the spirit of sport,” which it defines as “the ethical pursuit of human excellence through the dedicated perfection of each Athlete’s natural talents.” Athletes earn our admiration because they work hard to perfect skills that most of us could never imagine having. We marvel at baseball sluggers because hitting a small ball traveling 90 miles an hour requires hard work; regularly hitting it 400 feet is that much harder. When a hitter takes an anabolic steroid, the wonder is largely lost.

Williams became a tennis icon in part because of her relentless desire to compete. Even as a child, “she would run so hard to try to get to the ball, she’d fall,” Macci said. When she competed in the Australian Open while pregnant in 2017, she defeated every opponent who faced her, without dropping a set. Being 44, having two kids, and struggling with extra weight didn’t stop her from returning to professional tennis. Yes, she was probably lighter and quicker because she took a GLP-1. But a good comeback embodies the spirit of sport, too.

AI Is Taking Over Hospitals

2026-06-17T07:00:00-04:00

Every knowledge-based profession may one day reach the point when AI outperforms the human experts. In medicine, that day appeared to come in April. A group of primarily Harvard and Stanford researchers announced the results of a study that pitted ChatGPT against hundreds of physicians in a diagnostic obstacle course involving written medical mysteries and information from real-world patients. The bot had won, and the humans weren’t entirely happy about it.

“I get a little bit queasy about how some of these results might be used,” Adam Rodman, a lead author on the study, said at a press conference just ahead of its publication in the journal Science. The work had amounted to an academic exercise, he told reporters; as thorough as it may have been, it did not prove that ChatGPT or any other AI tool was ready to become a standard part of medical practice. His caution was in line with that of other experts, yet as Rodman knew, most people will ignore the warning. AI has already wormed its way into the U.S. health-care system, evidence and safeguards be damned.

Even as I was watching Rodman’s press conference, I got a message on my phone from the administrators at the medical center where I work as a pathologist. They’d emailed me to say that an “AI-powered clinical reasoning tool” was now available for me to use. This wasn’t the first time I’d gotten this sort of email; it wasn’t the second or third time either. In fact, I’ve lost count of how many generative-AI products have been rolled out to us in recent years, none of which has been approved for medical use by the FDA.

This enthusiasm feels unprecedented. Health care is typically among the last fields to adopt a new technology; I still use a pager, and I send faxes on a regular basis. (Younger readers can ask Claude to explain what these things are.) A tendency toward simple tech is in part a product of doctors’ safety-focused culture: We know that any ill-timed glitch has the potential to turn deadly. But these days, clinicians are allowed—encouraged, even—to run wild with the latest software, guided by a generic warning that “AI can make mistakes.”

Those mistakes can be consequential. Although Rodman’s research shows that generative AI can help diagnose rare diseases or make sense of unusual symptoms, a randomized trial that was published in NEJM AI just the week before found that intentionally erroneous output from an AI model can easily lead doctors astray. Nonprofessionals could be similarly misled. A recent study by Oxford scientists found that using AI did not significantly improve patients’ ability to diagnose themselves or others. Another one, led by researchers at Mount Sinai, suggested that chatbots may fail to alert users to potential medical emergencies.

[Read: Drink whole milk, eat red meat, and use ChatGPT]

Misdiagnosis is not the only concern. As AI permeates the health-care system, errors are cropping up in unexpected places. When I spoke with Rodman by phone after his press conference, he told me that he’d been surprised one day to find that his hospital, Beth Israel Deaconess Medical Center, had enlisted AI to draft messages to patients on his behalf—sometimes producing output for his review that he described as “completely absurd.” (Sarah Finlaw, a spokesperson for Beth Israel Lahey Health, told me that use of AI tools is voluntary and subject to hospital training and support. She also said that any output from AI tools must be approved by a physician.)

Part of the problem is that health-related AI products can be deployed without any vetting by officials at the FDA. If a software package that is intended for physicians is classified as a “clinical decision support tool,” and not a medical device, it usually avoids the agency’s oversight. To be counted in this category, an AI-powered app generally must rely on the existing medical literature, avoid analyzing medical scans or images, explain its reasoning, and leave diagnosis and treatment up to a physician. Most of the generative-AI products that doctors use today seem to meet these criteria.

Consumer-wellness apps and devices may also bypass FDA review so long as they are intended for “maintaining or encouraging a healthy lifestyle” and not for diagnosing or treating specific conditions. With this in mind, Microsoft, OpenAI, Anthropic, and xAI all warn users that their health-related chatbots are not meant to provide medical care or issue diagnosis and treatment recommendations. In practice, though, the distinction isn’t always clear. Elon Musk encourages people to use his Grok chatbot to generate second medical opinions and interpretations of their X-ray and MRI images; a marketing video for ChatGPT Health shows the app reassuring people that their lab results are in a healthy range and encouraging them to continue taking cholesterol medication.

Most of these apps also invite users to connect their medical records and wearable health devices. AI companies wouldn’t need to gobble up all of these data just to offer generic health information. A new product from the medical start-up Hims & Hers, called Labs AI, goes so far as to help interpret the results from “up to 130 biomarker tests” for its users and then provide a “deep, personalized, and actionable analysis on whole body health, risks, and patterns.” I, too, analyze a patient’s lab results and then give personalized, actionable advice. What’s the difference?

When I reached out to the makers of these products, they reaffirmed that no actual medical advice is being given out to users. Dominic King, the vice president of health at Microsoft AI, told me in an emailed statement that its Copilot app provides “helpful information and support for conversations with clinicians” and not “a single, firm diagnosis.” Patrick Carroll, the chief medical officer of Hims & Hers, told me that Labs AI does not diagnose or recommend treatment: “That responsibility belongs to clinicians, and Labs is designed to reinforce that boundary.” Anthropic and xAI did not respond to my inquiries. OpenAI declined to comment for this article.

Perhaps that boundary—between doctor and algorithm—is somewhat artificial to begin with. One idea kicking around the medical literature is to stop treating AI products as if they were merely standard medical devices. Given their humanlike ability to learn new information and tailor answers to individual patients, medical AIs may function more like doctors than defibrillators—so perhaps they should be evaluated in the same way that physicians are. Instead of requiring FDA approval for each and every function it can perform, a chatbot might be asked to pass a medical-licensing exam and undergo a period of supervision akin to a medical residency.

[Read: The ChatGPT symptom spiral]

For the moment, though, that idea remains on the fringe. Haider Warraich, a cardiologist and program manager at the Advanced Research Projects Agency for Health, the U.S. government’s program for developing advanced health technology, is leading a major effort to get medical chatbots approved in the traditional way. His agency is providing funding for the development of an AI tool that is tailor-made for heart conditions, and then to send it through a full FDA-authorization process. Warraich’s hope is that by undergoing such a rigorous evaluation, the chatbot will be able to safely evaluate and treat patients without the involvement of a doctor. Rodman praised this approach but warned that the process is going to take years, during which time a plethora of new health AIs will have slipped into the market with little scrutiny.

In this way, the emergence of today’s AI health products remind me of the rise, in the 2010s, of ride-sharing services such as Uber and Lyft. The taxi industry is heavily regulated, making it difficult for new players to enter the market. Yet by skirting and at times ignoring those rules, ride-sharing companies were able to acquire a critical mass of users in a short period of time. Pretty soon, governments had little choice but to adjust their laws to match what had by then become the status quo. The same pattern could end up playing out in medicine. Will regulations meant to ensure that medical products are safe and effective remain in force? Or will they instead be weakened or removed to clear the path for tools that everyone is already using?

We’ll soon find out. The health-care system is not going to “slow down and wait for the evidence to accrue,” Rodman told me. Eighty percent of doctors are already using AI tools in their job, according to a 2026 survey by the American Medical Association. Patients aren’t far behind. The benefits of AI may remain uncertain, but they’re already too enticing to pass up.

The New Science of Psychedelic Drugs

2026-06-12T08:00:00-04:00

Nature is always performing chemistry experiments, and in the dark and sticky corners of its forests and jungles, it creates compounds that have hyper-specific effects on the human mind. In China’s Yunnan province, a yellow mushroom with a droopy cap sprouts up in the mountains, usually in the shade of long-needled pines. Many people of different ages and cultural backgrounds have eaten this mushroom and experienced the same hallucination. They report seeing elf-like figures that parkour around on clothes, on furniture, and on walls. These little people seem to like dancing and performing acrobatics. Large groups of them will march in formation. This “lilliputian hallucination” can last for a day, and closing your eyes is no escape. The tiny humans sometimes linger in the blank space of your mind, staring back at you in a teasing way.

For thousands of years, humans have searched nature for mind-altering substances through a process of trial and (sometimes fatal) error. People have choked down foul roots, boiled woody vines, and scraped bitter bark off of tree trunks. They’ve milked toad glands and chugged the urine of reindeer that were themselves tripping on fungi. These experiments have revealed hundreds of plants and fungi that contain psychedelic compounds.

Now that psychedelic research has been legitimized, scientists at university labs and biotech start-ups are wondering whether they can create a better one. It’s a seductive idea, that some new and perfect drug might be hiding in the near-limitless parameter space of synthetic chemistry. Who wouldn’t want to take a little pill that could help you slough off your old self and see the world anew, a half-day therapy that would leave you with a feeling of enlightenment, if not in the exalted state itself?

“Nature’s compounds aren’t always optimal,” Manoj Doss, a professor of psychiatry at the University of Texas at Austin, told me. Take ibogaine, a naturally occurring psychedelic derived from an African shrub. A single dose of it seems to help people liberate themselves from opioids, quelling their cravings and mellowing their withdrawal symptoms. But ibogaine is a dirty drug, a blunt biochemical instrument that travels all across the body and puts particular stress on the heart. “If we could remove ibogaine’s cardio risks and preserve its therapeutic benefit, that’s something we should do,” Doss said. And indeed, a gentler analogue has already been developed in the lab, although it hasn’t yet reached clinical trials.

Doss has noticed a proliferation of lab-modified psychedelics. He recently heard that researchers had synthesized a promising new compound in the same class that includes MDMA. This one is supposed to be “the best ever,” he said. “It’s said to be less intense than MDMA, and socially lubricating, but not the full out ‘I love you!’—and it’s followed by way less of a crash. It just kind of cruises to the end.”

Psilocybin, the “magic mushroom” compound, could also be improved. It’s hardly toxic—no one dies from overdosing on psilocybin—but its effects are at times unpleasant or even tragic. People who use psilocybin recreationally may become confused and jump off a building, David Yaden, a researcher at the Center for Psychedelic and Consciousness Research at Johns Hopkins University, told me. Even in the lab at Hopkins, where the drug is carefully tested as a treatment for a number of mental-health disorders, patients can have adverse reactions. In that setting, every user will be screened for cardiac issues and a family history of psychosis, and guided through their trip by two professional facilitators who have a doctor on call—and even then, some users experience a psychotic break or profound dissociative episodes. It’s an intense experience, Yaden said, “like running a marathon or climbing a mental mountain. Some people don’t do well with it.”

[Read: The meditation start-up that’s selling bliss on demand]

One way to make psilocybin trips less intense is to shorten them. A standard trip on the drug tends to last six to eight hours, and like other powerful psychedelics, it can leave a residue on the windowpanes of your consciousness that may not rinse clean until you’ve slept. Several companies are now working on milder versions of psilocybin that can be delivered via nasal sprays, injectables, and Listerine-style strips. They activate similar receptors across the nervous system but metabolize more rapidly, shortening the trip. A psilocybin analogue developed by Reunion Neuroscience appears to produce a high that lasts just three or four hours, according to findings from a Phase 2 trial of 84 women with postpartum depression. The drug showed signs of being clinically effective too, though Yaden is not yet fully sold on the idea that shorter-acting psychedelics can have the same therapeutic pop as a daylong trip on psilocybin. He’d like to see more evidence.

In San Francisco, a start-up called Mindstate Design Labs is trying to extend this work on engineering psychedelics beyond the modest goal of inducing shorter and more easygoing trips. “We don’t want to just develop a more convenient psilocybin,” its CEO, Dillan DiNardo, told me on a recent call. “We want to provide mental states that aren’t yet reliably accessible.” The company is starting with a compound that aims to enhance aesthetic perception, for example. “It makes the world around them into a sort of sensory feast,” DiNardo said. In theory, it could be used to treat a person suffering from anhedonia, and it would have obvious recreational appeal.

Mindstate started by compiling a large database of more than 70,000 trip reports. Some of the reports were pulled from Erowid, an online library of information about psychoactive substances. Others are from books that contain first-person psychedelic accounts, which DiNardo said the company transcribed. And still more were taken from clinical materials. The reports contain descriptions of the subjective effects of hundreds of psychoactive drugs, including many that were first synthesized by Alexander “Sasha” Shulgin, the underground researcher who almost single-handedly drove the field of psychedelic chemistry forward from the 1960s to the 1990s. (Ann Shulgin, his widow, was a co-owner of Mindstate until her death, in 2022.) Then the company used an AI model to turn that database into a drug-discovery engine. By linking the subjective reports from each psychoactive compound to its receptor-binding profiles, it tries to predict the underlying neurobiology of specific emotional states.

[Read: The weak science behind psychedelics]

DiNardo claimed that Mindstate’s AI works like AlphaFold, the model from Google DeepMind that has wowed structural biologists—and the Nobel Committee for Chemistry—by predicting the three-dimensional structures of proteins. We won’t know whether this is true for a long while. Only one of the company’s compounds has reached the testing phase in humans, and it wasn’t discovered by the model; Shulgin synthesized a version of it in the 1980s. Human trials for the other drugs that Mindstate has in development could be years away. Doss, the UT Austin psychiatrist, told me that he is skeptical of Mindstate’s approach to automated drug discovery. The trip reports may constitute the richest database of recreational pharmacology that we have, but they’re still “crap,” he said. They’re colored by all kinds of biases and limited by people’s inability to cram psychedelic states into words.

Boris Heifets, an anesthesiologist and a neuroscientist at Stanford University, also has doubts about Mindstate. “I am cheering them on and I would love to be wrong, but my deep suspicion is that they’re barking up the wrong tree,” he told me. He thinks that simply adjusting the intensity of a trip will have the most important effects on the psychedelic experience. He also said that in his lab, he’s seen evidence that altering a person’s pre- and post-trip experiences can have more transformative clinical effects than tweaks to the drugs. “That context of care is an enormous determinant of a patient’s outcome,” he said. If this context didn’t matter, he continued, then anyone who took these drugs on their own might end up cured of mental illness or otherwise enlightened. The average rave attendee would be a guru.

Recreational users of psychedelics do tinker with the experience on their own terms, by choosing to trip with different kinds of people or in different kinds of places—in cities, or on mountaintops, or while camping at the beach. On the one hand, “you could imagine that being in the natural world and feeling awe would be beneficial,” Yaden said. “On the other hand, if people are more engaged with their perceptual environment and the novelty that’s around them, they might lose the benefit of being left with the workings of their own mind, which might be part of what produces insight during these experiences.” Testing this in any formal way would be dangerous, however. A clinical trial of psilocybin in the wilderness could easily result in a participant running away, or worse.

[Read: The man behind the Trump administration’s favorite psychedelic]

But even indoors, in labs, scientists could try to engineer a particular psychedelic high just by varying the conditions. They might provide patients with preparatory materials that go beyond the typical one-page handout. They could encourage patients to engage in certain kinds of introspection, invite them to bring in a photo to focus on during their session, or ask them to look into a mirror for a sustained period while they’re tripping. They could pipe in a greater variety of music. (Doss said that he hates “the Hopkins playlist,” which consists primarily of Western classical music.) Yaden said that not nearly enough of this kind of work has been done.

But even if researchers did perform all of these experiments, and many more, there’s no guarantee that they’d be able to observe and analyze any shifts in experience that were triggered. The “perfect trip” may always be beyond the reach of engineering, biochemical or otherwise. Psychedelic journeys might be too ineffable and too particular to a person’s individual consciousness for the methods of science. We may instead be stuck with storytelling, folk knowledge, and the nuggets of wisdom that have come down to us in ancient texts. For 17 centuries, Chinese Taoists have been preserving one such text called Baopuzi. It was written by the scholar Ge Hong, and it tells of a “flesh spirit mushroom” that could, when eaten raw, allow one to “see a little person” and experience transcendence.

Flu Vaccines Should Not Be This Hard

2026-06-07T08:00:00-04:00

In a typical year, the process of bringing a new seasonal flu shot to market is one of the United States’ most predictable vaccine routines. This, however, is not a typical year.

Vaccine manufacturers have prepared updated versions of the annual flu shot, as they normally do. The FDA has green-lighted those recipes, as it normally does. And normally, the next step would fall to the CDC’s expert vaccine advisory panel, known as ACIP, which guides the agency’s recommendations for which Americans should take those shots. The CDC almost always accepts ACIP’s advice verbatim—and those recommendations inform health-care providers’ advice to their patients and coverage from private insurance and government programs.

But in March, a ruling from a federal judge effectively suspended ACIP, on the grounds that Health Secretary Robert F. Kennedy Jr. had violated the lawful procedure for selecting new members when he hastily remade the panel’s roster last June. Currently, no functional ACIP exists to guide this autumn’s immunization campaigns. (The Trump administration has appealed the judge’s order.)

Although ACIP itself doesn’t make policy, the CDC has depended on its guidance on vaccination for more than 60 years—and has almost never strayed from its advice. Without the committee, the federal government is missing a crucial check on how vaccines might best protect Americans. The experts I spoke with—nearly a dozen former ACIP members, former HHS officials, pediatricians, and vaccine lawyers—told me that they have never encountered such a profound level of ambiguity and uncertainty about this basic government pursuit. “Even those of us who follow this 24/7 don’t completely understand where anything stands right now,” Michelle Fiscus, a pediatrician and the chief medical officer of the Association of Immunization Managers, told me.

In the past two months, Kennedy has made multiple attempts to issue a new ACIP charter—a key step toward reconstituting the panel. At the end of last month, President Trump also signed an executive order that called on the CDC and ACIP to review and reaffirm the pared-down vaccination schedule—including more limited recommendations for flu and COVID vaccines—that the administration has previously put together (and that the judge’s order has voided for now). Both actions suggest that the administration might attempt to cobble together a new vaccine advisory committee in the coming weeks or months, which could address the new flu and COVID vaccines, Dorit Reiss, a vaccine-law expert at UC Law San Francisco, told me. Alternatively, Reiss said, Jay Bhattacharya, the acting CDC director, could issue a set of recommendations, leapfrogging the ACIP step. Depending on how the administration approaches these options, though, it could open itself up to further legal challenge.

The experts I spoke with for this piece were all tentatively optimistic that—even if ACIP remains in disarray—Americans will still be able to get their flu vaccines this fall. They were less certain about COVID vaccines, which since 2023 have been annually updated through a similar, if less well-established, process and are now similarly jammed up. New formulations for both vaccines now have the FDA’s nod, clearing the path for manufacturers to crank out doses and sell them, and for health-care providers to receive and deliver them. ACIP was suspended in March, but generally, by that point in the year, states and health-care providers have put in most of their preorders for fall flu shots, experts told me. A spokesperson for Sanofi, which is one of the main manufacturers of U.S. flu vaccines and also handles sales of the Novavax COVID vaccine, confirmed in an email that preorders for both of those shots have already been placed. Strain selection—part of FDA approval—“is the critical step to ensure timely manufacturing, not ACIP,” the spokesperson wrote.

Many experts also suspect that private insurance will cover this autumn’s slate of shots, pointing to a recent statement from AHIP, a trade association representing health-insurance companies, that reaffirmed its commitment to an “evidence-based approach to coverage of immunizations”; in an email, a spokesperson wrote that those sources of evidence may go beyond ACIP recommendations. (Insurers could, for instance, follow the recommendations from professional societies, such as the American Academy of Pediatrics—a plaintiff in the lawsuit that nullified recent ACIP decisions—which have published vaccine schedules that mostly mirror earlier CDC guidance.) Separately, multiple states have pledged to maintain broad insurance coverage for vaccines.

Whether the federal Vaccines for Children Program, or VFC, can offer the shots, though, is a gray area. ACIP is the sole arbiter of which vaccines are included in the program, which provides vaccines to children whose families might not otherwise be able to afford them—a group that includes more than half of American kids. Usually, the committee convenes a new VFC vote each time it recommends a new flu vaccine, Grace Lee, a former ACIP chair, told me. But the experts I asked were divided on how necessary such a vote would be to ensure access to new COVID and flu shots (and few of them felt certain in their assessment). The CDC did find a way, for instance, to fold one recently recommended immunization into existing VFC coverage even after the judge’s order nullified ACIP’s endorsement.

These sorts of confusion and delays can cause real issues for vaccine providers and patients. Last year, Kennedy’s ACIP didn’t issue a guidance on COVID vaccines until September, then softened the recommendations for their use, sowing confusion as pharmacies, doctors’ offices, and patients tried to figure out who was eligible for the shots and whether insurers would pay. Some pediatricians’ offices delayed placing orders for the shots by months, and multiple states encountered issues when trying to order them through the VFC program. Several of the experts I spoke with anticipated that the COVID vaccine could face similar issues this autumn if ACIP delays or skips its recommendations.

In this moment, at least, the administration does seem motivated to make sure flu shots are available. Kennedy has pledged that he won’t “take away anybody’s vaccines”; in the lead-up to the midterms, the White House has also reportedly muffled Kennedy’s unpopular anti-vaccine agenda. In this political environment, “I think they’ll find some way to make sure there’s coverage,” Angela Shen, a vaccine-policy expert at the University of Pennsylvania, told me. When asked how HHS would navigate the ACIP pause, Andrew Nixon, HHS’s deputy assistant secretary for media relations, wrote that the legal ruling “has impeded ACIP’s ability to carry out its established review process for influenza and COVID-19 vaccines” but that “HHS is considering all available options to ensure access to these vaccines.”

Whatever option the department lands on could cause more drama. The Trump administration has repeatedly questioned whether annual flu shots should be universally recommended for Americans six months and older, and stripped away decades-old military mandates for the immunization. COVID vaccines have been a primary target of this administration, too—and are especially disfavored by Bhattacharya, one of the few individuals who could override or bypass ACIP decisions. Yet the softened recommendations for both shots that the administration and Kennedy’s ACIP pushed through since last spring are among the decisions that prompted the recent lawsuit. “If they come out and basically repeat prior recommendations that we’ve challenged, then I’m going to certainly take issue with that,” Richard Hughes IV, a lawyer for the plaintiffs in the lawsuit that resulted in ACIP’s suspension, told me.

The administration could also do nothing, with the expectation that the rest of the vaccine-delivery pipeline will operate as usual even in ACIP’s absence—a tactic of “rock the boat as little as possible, to reduce embarrassment,” Reiss said. If the process goes forward without ACIP, though, that could further undermine ACIP’s role as a key scientific check on government policy. In our conversations, experts repeatedly emphasized that it was essential for ACIP to someday return—to help recommend brand-new vaccines against brand-new diseases and to align the entire nation onto one simple, collective immunization schedule. But they also admitted that they could now better imagine how U.S. vaccination could survive without the committee. After all, for right now, it has to. If the administration’s goal was to shrink the government’s involvement in infectious disease, in this way, it’s succeeding.

*Illustration sources: Heather Diehl / Getty; Heritage Art / Heritage Images / Getty; Photo12 / Universal Images Group / Getty; Megan Varner / Bloomberg / Getty.

Canned Cocktails Will Smash You to the Ground

2026-06-03T13:19:24-04:00

Until recently, cocktails were a rarity at baseball stadiums. Beer was far easier to grab on the go, and getting rowdy fans liquored up was in no one’s best interest. Liquor was limited, sometimes exclusively to air-conditioned suites where cosmopolitans could be sipped far from the masses. And yet, on Memorial Day weekend, I found myself squeezed into the stands at Wrigley Field drinking a mai tai, next to a stranger drinking a margarita.

My seatmate and I were having Cutwaters, a line of canned cocktails from Anheuser-Busch. The stadium’s beer stand offered canned Long Island iced teas, canned palomas, even canned espresso martinis. Alcohol companies have been trying to make the idea of portable cocktails stick for more than a century, and they have finally succeeded. In 2025, Americans consumed nearly 11 billion servings of ready-to-drink cocktails, according to IWSR, a data firm that tracks trends in the alcohol industry. Depending on your state, you can now buy Cutwaters at CVS, Walmart, and Trader Joe’s. A four-pack, which contains about six to eight shots’ worth of liquor, will run you $12 or so.

The road to canned-cocktail ubiquity was paved by so-called malternatives: bubbly, fruity, portable drinks that are technically made from a component of beer but taste like nothing of the sort. Whereas early beer alternatives such as Coors Zima never really took off, products such as White Claw found mass appeal in the late 2010s and early 2020s, thanks in part to their low alcohol content; at 5 percent, they seemed like the perfect drink for an American populace that was facing down the reality that drinking is not good for your health. But the new breed of prepackaged cocktails represents a strange inversion. Cutwater, BuzzBallz, and BeatBox—three of the most popular brands—sell sweet, fruity flavors that clock in at 7 to 15 percent alcohol. (Cutwater also sells standard cocktail flavors, including Bloody Mary and “gin Collins.”) Even White Claw is getting in on the high-proof canned-drink market: In 2021, the brand launched Surge, an 8 percent version of its signature seltzer.

[Read: Why Millennials love canned cocktails]

U.S. beer sales still dwarf those of canned cocktails, as evidenced by the plastic pint glasses that littered the stands of Wrigley. But ready-to-drink cocktails have emerged as a rare bright spot for the alcohol industry, which has seen business slump in recent years. Year-over-year sales of premixed cocktails jumped by 40 percent in 2025, according to data from the market-research firm Circana, whereas beer sales were slightly down.

Since the repeal of Prohibition, states have taken care to make sure that liquor is harder to access than other libations because of its high alcohol content. Many states allow hard drinks—including mixed ones—to be sold only at designated liquor stores. States have also historically taxed liquor at a higher rate than beer and wine to discourage consumption.

But the spirits industry has been pushing for change so that it can sell more cans. First, malternatives got around liquor laws because they contained similar ingredients to beer’s. Now the Distilled Spirits Council of the United States, which lobbies for liquor companies, is arguing that canned cocktails should be sold anywhere beer is because they can have approximately the same alcohol content as beer (in some cases, a very, very strong beer). In a statement, the council told me that more than half of the ready-to-drink cocktails sold are less than 5 percent alcohol. But the higher-proof options are still selling remarkably well. Anheuser-Busch recently announced that Cutwater, which doesn’t make a single drink below 7 percent, is by far the most popular spirit-based canned-cocktail brand.

[From the July/August 2021 issue: America has a drinking problem]

In the past five years, four states have changed their laws to allow the sale of canned cocktails anywhere beer or wine is sold. (Although states set a cap for how much alcohol can be in a grocery-store canned cocktail, that limit typically allows many high-ABV products to be sold.) Taxes on canned cocktails have also been slashed in multiple states. Meanwhile, BuzzBallz makes both liquor and wine versions of its neon-colored, orb-shaped drinks so that they can be sold in the most settings possible. Jess Scheerhorn, the president of BuzzBallz, told me in an email that this is a “widely adopted practice” across the alcohol industry. She also emphasized that the company supports moderation for drinkers.

The United States’ newfound thirst for higher-alcohol drinks is somewhat perplexing: After all, the percentage of Americans who say they do not drink is at an all-time high. Still, most Americans do drink, and as the cost of all sorts of consumer goods goes up, many people are reaching for cheaper versions of their favorite beverages. Canned cocktails fit that bill. Plus, a bright-blue, berry-cherry-limeade-flavored BuzzBall adds a layer of goofiness to heavy drinking that, say, a handle of Fireball lacks. It also looks cuter on Instagram.

Some drinkers might not realize how much booze they’re really consuming. People regularly post online about how they threw back two or three Cutwaters and were surprised to find themselves hammered, as if they’d been wholly unaware that they had, in fact, been binge drinking. (Under the official definition, two Piña Colada Cutwaters in two hours lands squarely in binge-drinking territory.) Some videos are recorded from hospital beds. In one TikTok with nearly 400,000 likes, a woman suggests that Cutwater gets its customers so destroyed because its products are secretly cut with fentanyl. (They are not.) A spokesperson for Anheuser-Busch told me in an email that the company “has a longstanding commitment to responsible drinking, and we market our products responsibly.” (White Claw’s parent company did not respond to a request for comment.)

[Read: Not just sober-curious, but neo-temperate]

To be fair, the amount of liquor in these drinks is not a secret. Most alcoholic beverages list their strength on the package, and Cutwater cans additionally advertise the number of shots of liquor in each can. But Cutwaters have become so notorious for causing accidental blackouts that drinking an entire four-pack has become its own social-media challenge. The White Claw generation, used to pounding cans of seltzers at backyard barbecues and feeling nothing more than a light buzz, doesn’t yet seem to understand how to responsibly partake in these new products. People may see having one can of cocktail versus multiple boozy seltzers as moderating their drinking, Marten Lodewijks, the president of IWSR, told me. (They may also think they’re making a healthier choice by taking in fewer calories.) “Consumers often use packaging as a shortcut for what counts as a single serving or socially acceptable amount,” Logan Pant, a marketing professor who has studied consumers’ perception of alcohol, told me in an email.

The problem, in short, might be the can. I knew how much liquor was in my mai tai, but as the Cubs game slowed down around the fifth inning, I decided to have another. Even though I knew that this wasn’t the best choice for a Saturday afternoon, I took some solace in the fact that I had only two empties at my feet.

The U.S. Is Winging This Ebola Outbreak

2026-05-28T15:04:46-04:00

By the time African health officials confirmed the world’s latest Ebola outbreak, the epidemic had already spilled from the Democratic Republic of the Congo into neighboring Uganda. Within two days, the World Health Organization declared the outbreak a public-health emergency of international concern. Less than two weeks later, the potential case count has risen past 1,000, including more than 230 deaths, and 10 other African countries have been designated at risk of being swept into the crisis.

Countries and health coalitions from around the globe have quickly mobilized funds, medical resources, and personnel to the region. But one nation has been conspicuously absent from the core of the international response. Prior to January, when the United States officially withdrew from the World Health Organization, it was one of the coalition’s largest, richest, and most prominent partners, and its biggest funder. Now it has sidelined itself—limiting the potential effect any of its actions will have.

Were the U.S. still a member of the WHO, its federal health officials likely would have been able to start responding to the crisis sooner and better positioned to direct resources where they were most needed; were USAID still intact, its officials would have been in Congo, managing the outbreak before it ballooned. As things stand, American health officials did not learn of the epidemic until nine days after the WHO did. (When reached for comment, a State Department spokesperson wrote over email that the U.S. began its response within 24 hours of hearing about the outbreak and argued that “the WHO’s delay in informing the world of concerns until May 15 had a grave impact.”) Even as the U.S. has leaped into action, it has remained on the outskirts of the primary effort to control this outbreak.

American leaders “are not doing nothing,” Lawrence Gostin, a global-health-law expert at Georgetown University, told me. The U.S. government has announced that it is dispatching more than $160 million in emergency and humanitarian funds to contend with Ebola on the ground, deploying CDC personnel and a disaster-assistance-response team to the region, and bankrolling “up to 50” Ebola-treatment units in affected areas. Yet to public-health experts around the world, the U.S. response looks siloed, uncoordinated, and ultimately less effective than it would otherwise be. When one country holds itself at arm’s length from other global-health actors during an international crisis, “at best it wastes resources,” Jennifer Nuzzo, the director of the Pandemic Center at Brown University School of Public Health, told me. “At worst it winds up conflicting with or impeding the work of others.”

For this particular Ebola outbreak, the margin for error is even slimmer than usual. The viral strain causing the epidemic, Bundibugyo, is frequently missed by standard field tests and lacks both treatments and licensed vaccines. Local and international health officials were weeks late responding to it, which allowed the virus to spread more widely. Many regions of Congo, including ones at the center of the outbreak, have been fragmented by intensifying armed conflict, which has weakened health infrastructure. And the Trump administration’s gutting of domestic and international public-health infrastructure increased the region’s fragility, cut down on available health personnel, and likely delayed the initial detection of Bundibugyo, researchers told me.

Situations this dire, Nuzzo said, call for an incident-command system, in which roles are carefully delegated “so we aren’t showing up and stepping on the toes of others who are already in the area.” American leaders are still communicating with relevant countries to some degree—setting up bilateral financial agreements, for instance, with Congo and Uganda. The government also has contributed to an emergency-response fund through the United Nations Office for the Coordination of Humanitarian Affairs and is working with “implementing partners, Africa CDC, and technical channels on the ground,” according to the State Department spokesperson; Andrew G. Nixon, the deputy assistant secretary for media relations at the Department of Health and Human Services, wrote in an email that the U.S. has “activated an aggressive, coordinated response.”

Meanwhile, the WHO, a UN agency that marshals responses across its nearly 200 member nations, is spearheading collaborative efforts on a much larger scale and leveraging its own technical expertise—capabilities that the U.S. does not have on its own. The Trump administration has also reportedly placed restrictions on the number of federal health officials who can attend virtual WHO meetings.

As a result, the U.S. is now a side channel to the main event, risking redundancies through its bespoke response. “You’re going to get massive confusion and duplication,” Salim Abdool Karim, who chairs Africa CDC’s Emergency Consultative Group, told me. (The WHO did not respond to requests for comment.)

The WHO has never been the sole or perfect arbiter of public-health response. In recent years, experts have criticized aspects of the WHO’s delayed responses both to the Ebola outbreak that began in 2014 and to COVID-19. (When justifying the U.S.’s withdrawal from the WHO, the White House specifically cited the organization’s “mishandling of the COVID-19 pandemic.” President Trump has also said that the WHO asked the U.S. to contribute too much money, insisting that “World Health ripped us off.”) But few agree with U.S. leaders that improving global health involves withdrawing from the organization. As Ebola rips through Congo and threatens to overflow into neighboring regions, coordination is the only viable path—and the WHO is the main channel through which coordination occurs. “Trying to imagine how you would do this response without WHO? It boggles my mind,” Abdool Karim said. Yet that’s exactly what the U.S. is now attempting to do.

As things stand, Gostin, who has been in constant contact with colleagues in Congo and at the WHO, said that he and many of his fellow public-health experts have little knowledge of what actions that U.S. officials have actually taken. Some of the government’s choices so far also seem incongruous with the region’s needs. For instance, funneling so many early-response resources into Ebola-treatment units—which are extremely expensive—makes “absolutely no sense,” Courtney Blake, who helped lead the USAID response to the Ebola outbreak that began in 2014, told me. Treatment units, although important, represent a late line of defense, Blake said, because they do little to halt the virus’s spread. Top officials in Uganda’s Ministry of Health have also expressed confusion about the American contribution to the outbreak response, at one point last week saying that the ministry hadn’t communicated with the U.S. about treatment centers at all.

Those resources, Blake and others told me, could be better focused on efforts that would directly slow viral transmission—including PPE dispersal, testing, quarantining, and community engagement. And this morning, the State Department did announce that some of its allocated funds would help its “implementing partners” with “PPE procurement and delivery, border screening and surveillance, contact tracing, and diagnostics supplies.” Several experts also emphasized the importance of local communication: In the past week, two Ebola-treatment centers have been set on fire by protesters, in at least one case because family members of a man suspected to have died from the virus had been prohibited from retrieving his body. (The Ugandan Ministry of Health and Congo Ministry of Public Health did not respond to requests for comment.)

But what the U.S. actions add up to hasn’t been apparent to the experts I spoke with. “Is there a big-picture strategy?” Mohammad Karamouzian, an infectious-disease epidemiologist at the University of Toronto’s Dalla Lana School of Public Health, told me. “Or are they just trying to show they are doing something?” Any attempt to limit the virus’s spread is now more difficult, too, because “arguably the biggest implementation force on the ground in the region is gone,” Karamouzian said—namely, USAID.

The State Department has started to reconstitute some of the humanitarian resources that the Trump administration previously rendered defunct, Paul Spiegel, the director of the Johns Hopkins Center for Humanitarian Health, told me, by setting up a Bureau of Disaster and Humanitarian Response in the State Department and reassembling disaster-assistance-response teams. The department’s spokesperson argued that USAID reform has not undermined the country’s Ebola response and said that the U.S. responded faster to this outbreak than USAID did to similar outbreaks in 2014 and 2018. (Blake pointed out that although international emergencies were declared later for those epidemics—which grew more slowly than this one—USAID officials were already in the region, available to mount a local response, when those outbreaks began.)

Ultimately, though, the U.S. has been very clear about where its priorities lie—with its own interests. At a recent press conference, Secretary of State Marco Rubio said, “We don’t want anyone dying or being affected by Ebola, but our No. 1 priority will always be making sure it doesn’t come to the United States.” The Trump administration has put in place multiple travel restrictions aimed at keeping Ebola out of the U.S. And although in the past, Americans caught up in dangerous outbreaks have been flown home to be monitored and treated, during this Ebola epidemic, the U.S. has instead evacuated ill and exposed Americans to Germany and the Czech Republic and is standing up a makeshift quarantine center—for Americans specifically—in Kenya.

This “America First” stance has stoked anger among some communities in Congo, Leslie Roberts, an epidemiologist at Columbia University, told me, and where Americans were once welcomed as public-health allies, they are now seen as enemies. If a main part of the U.S. strategy is to coordinate directly with national health ministries, this depends on those ministries wanting to coordinate—which is not always possible in countries that have poor diplomatic relations with the U.S.

In the past, such as during a 2023 outbreak of Marburg virus in Equatorial Guinea, the U.S. depended on WHO relationships with other countries’ ministry of health, Beth Cameron, a former global-health-security adviser for USAID, told me. Coordinating through the WHO means that individual nations don’t need to scramble to remake such connections, or forge them anew, to confront each challenge. Inevitably, in some future outbreak, the U.S. will find that its isolation has left it unprepared to protect even itself.

The Largest Undocumented Disparity in Maternal Health

2026-05-27T08:00:00-04:00

For the past few years, George King, the director of research at Boston’s Joslin Diabetes Center, has been following a medical mystery that has flown under the public-health radar—even, he told me, among most other diabetes experts. He and his colleagues have been alarmed by the skyrocketing rates of gestational diabetes they’ve seen among Chinese American populations, which mirror a similar phenomenon in mainland China and Taiwan.

For years, gestational diabetes has been ticking upward in people of Asian descent—both in countries in Asia and in highly multicultural nations such as the United States. In general, those rises have tracked with increases in type 2 diabetes, a condition with similar risk factors. But “one group is an outlier,” King said. In recent years, gestational diabetes has climbed among people of Chinese descent at a rate that appears to outpace the rise in diabetes in that population, and “no one seems to know why,” he said.

The data supporting this discrepancy are still just emerging, King and his colleagues told me, and they hope to collect more of the evidence themselves. By this fall, they plan to apply for federal funding to study an intervention they’d like to test in the greater Boston area to reduce rates of gestational diabetes among Asian Americans more broadly. If, along the way, they collect evidence that helps crack the mystery of whether Chinese Americans are at particularly high risk, that information could help clarify risk factors about gestational diabetes in general or sharpen their intervention further—perhaps allowing them to tailor it even better to some of the communities that need the most help.

Gestational diabetes is most simply understood as a form of type 2 diabetes that first crops up during pregnancy. “Pregnancy is a pressure test for your body,” Tam Nguyen, a chronic-disease researcher at Boston College, told me—and it can catalyze health issues that might not have plagued people otherwise. Roughly half of people with gestational diabetes will go on to develop type 2 diabetes; the child, too, ends up at higher risk of metabolic issues.

Asian Americans develop gestational diabetes at notably high rates, but even among communities of Asian descent, that risk is little known, experts told me. “I think it’s totally invisible,” perhaps in part because people in those communities tend to develop diabetes at lower BMIs than white populations do, Nguyen said. Compared with other racial and ethnic populations, many people of Asian heritage tend to have less lean-muscle mass and carry more fat centrally, around their vital organs—a type of fat linked to many metabolic issues. That tricky combination leaves many cases undiagnosed early on and many individuals unaware of their own elevated risk.

That can be especially dangerous during pregnancy: Left unmanaged, gestational diabetes ups the chances of preeclampsia, premature birth, high birth weight, and stillbirth. At a meeting at Joslin earlier this month that I attended, Atif Adam, a research fellow at the center, described gestational diabetes among Asian American populations as “the largest undocumented disparity in maternal health.”

Experts on this population have also long recognized that the umbrella of “Asian” encompasses many different groups with different genetics, physiologies, lifestyles, and cultural preferences—and, as a result, different vulnerabilities to disease, including gestational diabetes. South and Southeast Asians, for instance, tend to develop the condition at particularly high rates. The data on where people of Chinese descent may fall on this broad spectrum are a bit mixed, but King and Adam told me that at least a handful of recent reports—especially out of China and nearby Taiwan—suggest that rates of gestational diabetes in this population have risen markedly over time. And the pattern of growth, Adam said, “seems to be different from other ethnicities.”

The exact reason for the rise has eluded researchers, though they’ve raised plenty of possibilities. In China, for instance, some experts think that at least part of the explanation is the implementation of the two-child policy, which bumped up the average maternal age at birth—a key risk factor for gestational diabetes. But that can’t account for comparable rises in nations that haven’t adopted such policies; average maternal age has also risen in countries around the world without tugging up gestational diabetes in the same way. King, for one, suspects that nutrition may be playing a particularly big role in Chinese communities, where Westernized menu items have made up a big part of the diet in recent years, including in China. Nguyen, though, said she thinks that researchers studying any emerging trends in gestational diabetes among Asian populations have to consider several variables at once. Subtle factors such as toxin exposure and the composition of the gut microbiome could contribute; so, too, could social stressors such as racism. (One recent study suggested, for instance, that the intense anti-Asian sentiment connected to COVID-19, which President Trump described as being caused by the “China virus,” could help explain recent rises in gestational diabetes among Asian groups, including people of Chinese descent.)

Nailing down this trend and any reasons for it won’t be easy. Researchers don’t consistently disaggregate “Asian” populations into the many possible subgroups, and even when they do, different researchers have different approaches to categorizing people. That makes it challenging to tease apart problems that might be plaguing specific communities. And although several of the Boston-based researchers I spoke with are collecting some of their own population-specific evidence from local health centers, they aren’t sure when data collection might improve more generally. A few years ago, the state of Massachusetts announced that it would begin collecting more detailed demographic data on racial and ethnic groups, including within the Asian community. But the implementation of that plan has been slow, and some locals have expressed discomfort with the idea of submitting more identifying information, Nguyen said. On the national scale, the U.S.’s National Health and Nutrition Examination Survey, a vital source of data on diabetes, has been purposefully oversampling Asian Americans since 2011, which has allowed researchers to dig deeper into trends in specific subpopulations. But last fall, the Trump administration fired core staff from the CDC division that runs the survey, leaving its future uncertain.

Even without more definitive data, Adam said, he and his colleagues are eager to design an intervention that could help any Asian group lower its gestational-diabetes risk, or better manage the condition once it arises. In broad strokes, the advice would mirror what the general population is told in the U.S. about avoiding and dealing with the condition: Eat well, exercise, avoid excessive weight gain. But it would be delivered more consistently, across health-care settings, and would be better tailored to certain groups’ cultural preferences. For many families deeply embedded in Asian food culture, “it’s difficult to be told to reduce white-rice intake,” Nguyen pointed out; some people might also benefit from a discussion about incorporating familiar types of physical activity, such as walking and tai chi, into their routine, rather than vaguer cautions to work out more.

In the meantime, the researchers will keep observing what trends they can, to see whether certain Asian subgroups might warrant special attention. They feel confident that they know enough about what works and how to deliver it to make some impact. But any specific vulnerabilities are still worth narrowing in on, so that no vulnerable community risks being lost to an aggregated trend.

Americans Have Entered the Age of the Needle

2026-05-26T08:43:55-04:00

My generation—which is to say, the pillbox generation—came of age during the 1990s. The number of adults who were taking five or more prescription drugs doubled in that decade; the use of medications for depression and cholesterol more than tripled. If pills had once been used from time to time to curb a headache or stifle an infection, now they were a daily ritual for tens of millions of Americans. Popping meds, whether by catapult or tweezers, became the norm.

In the 2020s, we’re living through a second such transition: the dawning of the needle age.

For the past five years, the nation’s shots have multiplied to levels never seen before. Injected medications were once unusual, and mostly limited to diabetics who needed insulin. Now millions of diabetics use syringes of Ozempic, and millions of other people are on Mounjaro for weight loss. In 2025, some 12 percent of all U.S. adults partook of these injections or others in their class. GLP-1 shots were so commonplace last year that they accounted for about 7 percent of all prescriptions in America.

Even this is just the tip of the needle. Americans’ use of IVF has doubled in a decade, and now requires something on the order of 10 million to 20 million self-administered hormone shots a year. By 2024, 10 million rounds of Botox (or other wrinkle relaxants) were given out, along with 8 million filler treatments. Although some cosmetic shots are administered in doctors’ offices, many of the rest are received at the 10,000 “medical spas” that have lately come to dot the country. These are puncture parlors, more or less, and they offer a growing list of services: not just treatments for the skin but also vitamin injections, IV-dripped electrolytes, and minerals delivered through a tube. One needle-forward wellness chain, called JECT, has locations in Miami Beach, West Hollywood, the Hamptons, and, as it happens, right around the corner from my house in Brooklyn. If I were ever in the mood, I could head over for a “24K gold micro-dosing” process that will supposedly inject my face 2,400 times a minute.

[Read: No one in movies knows how to swallow a pill]

These needle trend lines have been building for a while. Botox was approved for cosmetic use in 2002, and the first GLP-1-based drug for diabetes reached the market three years after that. But today’s rampant culture of injection did not have its breakthrough moment until early summer 2021, when the FDA signed off on semaglutide, the ingredient in Ozempic, as a treatment for obesity. That kicked off the weight-loss-medication craze. A month later, Joe Rogan told his millions of podcast listeners that injecting peptides—not insulin or Ozempic, but other, less established ones—can have miraculous results. Rogan said he’d tried one in particular called BPC-157, which cured his elbow tendinitis in two weeks. Peptide fever built from there, on glowing testimonials from tech bros, celebrities, and eventually officials at the highest levels of the U.S. government. “I’m a big fan of peptides; I’ve used them myself,” Health and Human Services Secretary Robert F. Kennedy Jr. told Rogan earlier this year. (RFK Jr. has also promised that regulators will soon be easing restrictions on the sale of peptides.)

The funny thing about our growing love for getting shots is how utterly at odds it is with human nature. Who, exactly, has any sort of love for getting shots? Needlephobia is natural and indeed appears to be widespread, even among grown-ups. Although formal research on the topic has been somewhat limited, a 2018 review of several dozen studies found that for adults under 40, the rate of needle fear may be as high as 30 percent. According to the same analysis, 16 percent may skip their flu shots simply to avoid the stress of an injection.

[Read: Should your flu and COVID shots go in different arms?]

This last point in particular was worried over in summer 2021, just as our needle age was starting. New vaccines had been developed to reduce the risk of death from COVID-19, and experts worried that anxiety over needle sticks would hamper uptake. One paper out that June concluded that one-tenth of all COVID-vaccine hesitancy could be explained in just this way. Some people even called for a needle-fear exemption to be added to the mandates for vaccines.

And yet none of this posed a challenge to the rollout that ensued, which became without a doubt the largest mass injection effort in the nation’s history. By the end of 2021, more than half a billion doses of the COVID shots had been plunged into our deltoids. Let’s put that in “24K gold micro-dosing” terms: Americans received an average of 1,000 COVID shots a minute, every single minute of that year.

[Read: The good news about vaccine hesitancy]

Yet a wariness about vaccines persists; perhaps it’s even grown, in certain quarters, since we started getting immunized against COVID. Jennifer Reich, a medical sociologist at the University of Colorado at Denver, has found that some people who refuse vaccines may indeed be hung up on the thought of a needle entering their body. But they aren’t simply squeamish; they’re worried by the fact that injections are unnatural, that a shot administers medicine in a way that isn’t right. “I would love it if they would put more research into edible vaccinations,” one mother told her, “so that it goes through the digestive system rather than directly—bang!—into the bloodstream.”

This framing of injection as a shortcut into people’s bodies conveys another meaning, too: It suggests that shots have greater potency and purity than other forms of medication. As a medical technology, the needle “plays in these contradictory ways,” Reich told me; what makes it scary also makes it strong. If you really want a given treatment, then you might prefer the needle version to a pill, so that it is delivered—bang!—into your bloodstream, where presumably it acts with greatest force. Inject that Botox straight into my wrinkles, please. Let me shoot this muscle-building peptide right into my butt.

In this way, America’s needlephilia and needlephobia are tightly coupled, both across the culture and among individuals. “There’s a huge overlap between people who sell the promise of wellness through alternative means and people who oppose vaccines,” Reich said. Indeed, this overlap has been a hallmark of the age of injections: The same person who might “stack” half a dozen experimental peptide injections into his weekly regimen may also end up saying no to a COVID booster; the same person who will pay $900 for microneedling with salmon sperm may refuse a hepatitis B shot for her newborn baby.

This isn’t quite a contradiction, though. People seem to draw a line between injections for the greater good and injections for their own well-being. When you’re given a vaccine, you’re participating in the work of public health, and hoping to stave off an illness that you may have never experienced and that may never pose a risk to you directly. When you take a dose of semaglutide, you’re engaged in private care, and expecting to optimize your own health, visibly and quickly. That difference is reflected in the hand that holds the needle: A vaccine gets put into your arm by someone else; most GLP-1 drugs are self-injected. (Oral formulations of GLP-1s for weight loss have become available in recent months.) “I think that sense of control over the mode of administration might be really important,” Reich said. The line between public health and private wellness also changes how the drugs are regulated: In the past two years the government has taken steps to raise the bar for demonstrating the safety of vaccines, while lowering it for peptides.

Reich told me that she thinks the needle is an emblem of a broader shift toward asking individuals to solve their own health problems. For some parents, even vaccines have been “recast as kind of an optimization technology,” she said; they tell her how they pick and choose among the recommended shots, asking whether and how each one might personally benefit their children. In this worldview, the vaccine schedule may not look that different from the menu of services at JECT.

Maybe this is where we’re headed next: injections as a vector for autonomy in medicine, vaccinations à la carte, home recipes for peptide shots, glucose sensors poking through your skin. This is health care in 2026. Welcome to the needle age.

The Man Behind the Trump Administration’s Favorite Psychedelic

2026-05-24T08:00:00-04:00

W. Bryan Hubbard speaks a lot about divinity. He thinks that psychedelic drugs have divine origin and can put you in touch with a higher power. He also believes that his role in catalyzing the most prominent political action supporting psychedelics to date was divinely orchestrated.

And so meeting him at Trinity United Methodist Church in downtown Denver felt natural. The late-April light streamed through stained-glass windows while Hubbard, a broad-shouldered man with straight posture, settled into a pew. His brown hair was pulled back into a low bun, and he wore a plaid shirt and blue jeans. In a southern lilt, he described how he’s been generating previously unheard-of Republican enthusiasm for psychedelics, in particular for a drug called ibogaine. Though robust data from U.S.-based clinical trials about this drug are lacking, some researchers—along with a number of enthusiasts—believe that ibogaine may help people with opioid addiction and withdrawal, and perhaps PTSD and traumatic brain injuries too.

On a Saturday morning a couple of weeks before Hubbard and I met, Donald Trump signed an executive order that directed several federal agencies to accelerate research on psychedelics—including ibogaine—as treatments for mental-health conditions. Rumors about such an order had circulated among psychedelics insiders since the beginning of April, when Joe Rogan had hosted Hubbard and former Texas Governor Rick Perry on his podcast. When the headphones came off, Hubbard told me, he decided to ask Rogan for a favor: Would he contact the president about ibogaine? As Rogan recounted at the Oval Office, “Trump’s reply was, ‘Sounds great. Do you want FDA approval?’” (At the signing, Trump didn’t know at first how to pronounce the word ibogaine, though he did jokingly ask if he could have some.)

From the beginning of Trump’s second presidency, many psychedelics enthusiasts hoped that his administration would be favorable to the medical use of psychedelic drugs. MDMA for PTSD and psilocybin for treatment-resistant depression seemed to be the likeliest candidates, given that both regimens are in the late phases of clinical trials. But the final push for Trump’s most consequential psychedelics policy was linked to a drug whose benefits are supported by only a handful of preclinical studies and a single Phase 1 trial.

That strange turn speaks to Hubbard’s advocacy over the past few years. His success can be partly attributed to the fact that a meat-eating southerner and lifelong Republican is not the typical psychedelics spokesperson. But it also reflects a bigger shift in the political culture of psychedelics since the days of LSD-taking environmentalists and anti–Vietnam War protesters. Perry, a conservative as well, has been a prominent ibogaine supporter since he tried the drug in a Mexican medical clinic in 2023. Many high-profile combat veterans want medical access to ibogaine. Hubbard, who had posters of Ronald Reagan in his childhood bedroom, said that these days, he has more success proselytizing for ibogaine on the right than on the left. “I have been able to talk to the most religiously fundamentalist, white, Republican conservatives that you would imagine,” he told me. And many of them are on board.

In the dimly lit sanctuary of the church, Hubbard explained how he used to have the “typical conservative” view of psychedelics: “that these were a bunch of subversive, hippie drugs that made people roll around in the mud naked, and they had no beneficial or helpful purpose.” Then, in 2018, he read a Scientific American article that mentioned research on psilocybin for the treatment of alcohol-use disorder that piqued his curiosity. He estimated he had about a dozen psilocybin trips over the next four years.

In 2022, Hubbard, a lawyer, was offered a position as chair of the Kentucky Opioid Abatement Advisory Commission, in charge of distributing nearly $1 billion in settlement money from opioid companies to programs for addiction prevention, treatment, and recovery. Hubbard hosted town halls, where, he told me, “the sum-total message from the people who came to attend, was, We don’t think that you have either the competence or the honesty to do anything that’s going to help us.” Hubbard, eager for a new solution, turned to a psychedelics Substack writer he admired to ask if she knew of any compound that might help with opioid addiction. As he tells it, she responded, “Have you ever heard of ibogaine?”

Ibogaine is derived from a shrub called Tabernanthe iboga, which grows in Central and West Africa. In Gabon, iboga root is used in ritualistic ceremonies in the Bwiti tradition. Those ceremonies mark the transition to adulthood and can be grueling. “The experience was intended as a kind of temporary death,” the French anthropologist Julien Bonhomme wrote in a chapter of the book Expanding Mindscapes: A Global History of Psychedelics.

After the compound was isolated in Europe at the turn of the 20th century, an ibogaine-based drug was sold in France as a mild stimulant (low doses can increase energy), but it stopped being manufactured after athletes took it to enhance their performance. In 1962, an American with a heroin addiction, Howard Lotsof, received a gift of ibogaine from a chemist friend and noticed that his cravings disappeared after he took the drug. He shared it with other people who had heroin addictions and found that some of them also reduced their use and sidestepped major withdrawal symptoms. Some quit using entirely. Thanks to stories like Lotsof’s, even today, “ibogaine comes with this tremendous amount of mythology around its benefits for opioid disorder,” Joji Suzuki, an addiction psychiatrist at Brigham and Women’s Hospital, told me.

Lotsof tried to get scientists around the world to set up a proper clinical trial. But by the 1990s, such attempts had mostly stalled. Instead, advocacy groups raised money to send people desperate for addiction treatment, and later veterans, to ibogaine clinics outside the U.S., including in Saint Kitts, Mexico, and the Netherlands. In those settings, ibogaine leads to a trip that lasts anywhere from 12 to 36 hours. At first, a person has vivid, dreamlike hallucinations, often scenes from their own life. That’s followed by periods of contemplation, energized wakefulness, and, purportedly, a vanishing of withdrawal symptoms. The drug can also induce nausea and vomiting and has serious cardiac risks. Using it safely requires continuous heart monitoring, and some clinics now offer intravenous magnesium to reduce the chances of heart complications.

Few studies have examined ibogaine’s effects on opioid-use disorder and other conditions, and they tend to be on very small groups of people, many of whom sought out ibogaine on their own. In one observational study, 88 people who had gone to a clinic in Mexico between 2012 and 2015 filled out a survey. A majority said that ibogaine reduced their opioid-withdrawal symptoms, and at the time of the survey, 41 percent were abstinent. In a more recent, often-cited paper from Stanford, researchers scanned the brains of veterans with traumatic brain injuries before and after they went to a clinic in Mexico. Most of the veterans’ symptoms significantly improved. But the study had no control group, and the participants were atypical: male former Special Operations Forces veterans who were motivated enough to pay to travel for the treatment. Without further study, it’s hard to say how the effects they experienced might generalize to other populations.

[Read: Tripping on nothing]

Despite the scant hard evidence, Hubbard saw ibogaine as the solution his state needed. Within a year of learning about the drug, he drafted a proposal to dedicate 5 percent of the state’s opioid-settlement funds to researching ibogaine for opioid-use disorder. In addition to its potential to treat addiction, Hubbard believed ibogaine to be the ideal political candidate for state-funded psychedelics research in general. LSD and mushrooms came with baggage—notably the belief that they would make you go crazy or start wearing tie-dye—but no one had heard of ibogaine. It wasn’t a recreational drug, and had little potential to become one thanks to its often-punishing physical side effects. “I thought there was an opportunity to introduce ibogaine as a blank slate,” Hubbard said. In November of 2023, Hubbard and his wife even traveled to a clinic in Mexico to try ibogaine for themselves.

But then, political turnover killed the project. In late 2023, Hubbard alleges, a new state attorney general, Russell Coleman, pushed him out. “He expressed great displeasure with my public advocacy for ibogaine in Kentucky,” Hubbard wrote in his resignation letter. (Coleman did not respond to requests for comment.)

Hubbard, though, remained convinced that the need for new opioid-addiction treatments, as well as the potential benefits for veterans, made ibogaine the ultimate bipartisan psychedelic. In 2025, he and Perry founded their nonprofit, Americans for Ibogaine, and successfully lobbied for Texas to pass a $50 million fund-matching bill for ibogaine research. AFI has also been lobbying for a multistate partnership that would create a nationwide ibogaine trial. Lawmakers in red states—including Tennessee, Missouri, Oklahoma, Mississippi, and West Virginia—have led the charge on introducing, and in some cases passing, laws that support research on ibogaine. Even Kentucky recently passed a framework to study the use of ibogaine to treat substance-use disorders. Hubbard called it “full-circle justice.”

Psychedelics come with no inherent ideologies, of course. “Psychedelics seem to appear throughout history at moments when people are deeply questioning something,” Erika Dyck, a historian of medicine and psychedelics at the University of Saskatchewan, in Canada, told me.

This is how Hubbard understands any Republican acceptance of psychedelics. The new support coming from the right, he believes, mirrors the left’s mindset in the 1960s: a response to the widespread distrust of powerful people and federal institutions, and the resulting sense of disillusionment. “The right’s embrace of psychedelics is its own countercultural response,” he said. (The fact psychedelics may help American service members is certainly a helpful selling point too.)

Hubbard told me that his own politics are informed by his ancestors, who were coal miners from the mountains of Virginia, western North Carolina, and East Kentucky. One of his greatest influences, he said, is the United Mine Workers of America, a union that organized around improving working conditions and increasing wages. He said his great-great-grandfather, along with four of his brothers, crossed the Ohio River to fight against the South during the Civil War. Psychedelics, by his reckoning, are crucial for “everybody who wants to have a shot at living with any measure of freedom or dignity.”

Listening to Hubbard muse about universal human rights and freedom, it’s easy to understand why he’s frequently compared to a preacher. His remarks about the medical benefits of ibogaine quickly morph into pronouncements of the sacredness of humankind. “I see the science as a gateway to the spirituality,” he said. The 4,202-pipe organ gleamed over us.

Psychedelics and religion are no strangers. These compounds are used as religious sacraments in both Indigenous traditions and contemporary psychedelic churches. The author Aldous Huxley, who wrote about his own mescaline experience in The Doors of Perception, went on to argue that psychedelics would lead to mass spiritual evolution. (More recently, psychedelics researchers and advocates have said the same.) One of the most infamous studies of the 1960s involved a Harvard Ph.D. student giving mushrooms to divinity students because of the drugs’ ability to reliably induce mystical experiences. Lucas Richert, a historian of medicine and pharmacy at the University of Wisconsin at Madison, told me Hubbard is so effective because he taps into that legacy. Hubbard’s advocacy becomes “as much a moral argument or a nationalistic argument, as a biomedical or regulatory argument,” Richert said. Hubbard is also not the only 21st-century conservative making the connection: Perry recently wrote the foreword for a book called The Christian’s Guide to Psychedelics.

For all his success with the right, Hubbard worries he’s not reaching, and is maybe even alienating, essential groups, including public-health experts and medical professionals. The American Psychiatric Association, for example, released a response to Trump’s executive order welcoming federal investment in research, but cautioning that there was “currently inadequate scientific evidence for endorsing the use of psychedelics to treat any psychiatric disorder except within the context of approved investigational studies.” Other psychedelics researchers have expressed wariness at how simplistically advocates like Hubbard sometimes present the drugs: as quick, miraculous cures, rather than difficult psychological and physical experiences that don’t work for everyone and can come with challenging side effects.

Opinions may be shifting even among the public-health establishment. Nora Volkow, the longtime director of the National Institute on Drug Abuse, said in 2024 that ibogaine was unlikely to ever receive approval as a treatment for opioid addiction. But at the American Psychiatric Association conference earlier this month, her presentation included positive remarks on ibogaine and other psychedelics, the industry news site Psychedelic Alpha reported. Still, Hubbard remains concerned about his audience. The week after we met, he testified at the Ohio capitol in support of legislation to establish ibogaine research in the state. When I asked him how it went, he said, “I wish that some of the audiences that I had the opportunity to speak to had a lot more Democrats and were a lot less white. That’s probably my biggest preoccupation right now.”

[Read: The horseshoe theory of psychedelics]

Suzuki, too, told me he worries about the politicization of psychedelics. If Republican enthusiasm can remove bureaucratic barriers to research on ibogaine and other drugs, he said, “I’m fully in support of it.” But too much partisan support could risk undermining the credibility of his and other researchers’ work. “The impression that I would want to avoid is that this particular project or that particular drug is being approved only because of their alignment with the current administration.”

In an ideal world, politics wouldn’t be able to soil good research. But partisan strife has a long reach. In Denver, I had originally arranged to meet Hubbard at a different church nearby. But the day before the scheduled appointment, I got a rush of emails and calls from a woman who worked there. She told me that after searching Hubbard’s name online, she would not be willing to host us. The church is progressive, and Hubbard, thanks to his association with Trump and Rogan, could alienate the congregation.

When I relayed this story to Hubbard, he momentarily appeared taken aback, then recovered. The woman’s reluctance, he said, was a sign of how divided the country is—exactly why psychedelics were needed to “restore the nation’s soul.” Before we left the church, I looked back at stained-glass windows depicting Jesus rising from the dead, winged and crowned, representing a link between the divine and humankind. Psychedelics, I thought, are undergoing a resurrection of their own. But it’s unclear if their worshippers will be willing to gather under the same roof.

The U.S.’s Most Concerning Anti-Vaccine Policy

2026-05-21T11:13:51-04:00

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Midway into 2026, the most overt attacks on vaccines in the United States have stopped. With the midterm elections looming, the White House reportedly asked Health Secretary Robert F. Kennedy Jr. to quiet his anti-vaccine rhetoric—publicly, at least. But protections against infectious disease are continuing to falter, both domestically and abroad, through sheer neglect. Although the full impact of the U.S.’s disinterest has only started to play out, one effect is already clear: When vaccines’ reach is eroded, the poorest, least well-served people feel the brunt of that loss first.

Paring back the CDC’s national childhood immunization schedule, for instance, has limited more Americans’ access to shots; Kennedy’s haphazard reconstitution of the nation’s top vaccine advisory panel led to that expert group being put on hiatus, imperiling immunizations for children from underinsured families. When the White House dismantled the U.S. Agency for International Development, accusing the organization of waste and abuse, it compromised efforts to deliver vaccines around the world; when it stopped funding the World Health Organization, citing the group’s mishandling of the coronavirus pandemic, it put global immunization campaigns at risk. But among the more than half a dozen experts I spoke with for this story, the chief concern was for Gavi, the Vaccine Alliance, the world’s largest initiative supporting immunization access in lower-income countries.

Since last year, the U.S. has been withholding hundreds of millions in funds from the organization. The U.S. played a vital role in Gavi’s founding and has historically been one of its heaviest funders: In 2024, under President Biden, the country pledged nearly $1.6 billion to Gavi, to be meted out over five years. That contribution should have covered roughly 13 percent of the organization’s funding through 2030. But the U.S. State Department hasn’t sent the $600 million that Congress budgeted for Gavi in fiscal years 2025 and 2026. (If left unused, the funds will expire on September 30; earlier this month, senators from both parties called on the State Department to relinquish the appropriated money to Gavi.)

Kennedy himself is not in charge of the State Department’s funds, but a spokesperson for the State Department wrote in an email that “President Trump entrusted Secretary Robert F. Kennedy Jr. to manage the U.S. government’s relationship with Gavi.” And Kennedy has repeatedly accused Gavi, without evidence, of having “ignored the science” on immunizing children, of being lax on vaccine safety issues, and for relying on a combination diphtheria-tetanus-pertussis vaccine (known as DTwP) that he has accused of causing brain damage in kids, despite data to the contrary. The Trump administration’s policies toward Gavi have also, at times, mirrored Kennedy’s agenda at the Department of Health and Human Services: Several months ago, officials asked Gavi to halt its use of vaccines that contain the preservative thimerosal, a compound that Kennedy helped push to phase out of U.S. flu shots last year and that he and many of his anti-vaccine allies argue can cause autism, despite a lack of data showing any such connection; at the time, an HHS official told Reuters that future funding for Gavi would be withheld until “a plan for removal of thimerosal-containing vaccines is developed and the plan initiated.”

In an email, Andrew Nixon, HHS’s Deputy Assistant Secretary for Media Relations, wrote that HHS and State are still “cautiously optimistic” that ongoing discussions with Gavi could yield “a constructive path forward,” but that “Gavi has not provided the United States with the specific data, studies, or detailed accounting needed to fully evaluate how U.S. taxpayer funds are being used.”

The U.S. itself has largely or entirely replaced DTwP and thimerosal with newer, more expensive alternatives that, in some cases, have fewer short-term side effects. But in lower-income, lower-resource places, where medical facilities are short on money, refrigeration, and space, some of these older vaccines are the best options, simply because the alternative is no vaccination at all. So whereas Kennedy’s attacks on these particular tools of vaccination have had a relatively marginal effect on immunization in the U.S., they have the potential to significantly curtail vaccination in other countries, and potentially lead to countless unnecessary deaths.

To vaccinate widely in low-resource settings, “you need inexpensive products, and you also need products that don’t require a lot of boosters,” Seth Berkley, an infectious-disease expert who previously led Gavi, told me. Using the cheaper vaccines can have trade-offs; all vaccines do. The DTwP shot, for instance, is more likely to cause short-lived fevers and pain than other formulations of the vaccine. But it protects people for far longer than those other immunizations and requires fewer total shots—which is to say, fewer follow-up visits. The World Health Organization has continued to recommend the vaccine, citing its popularity, price point, and excellent efficacy—and noted that it works well even in situations where vaccination is interrupted or pared back, as it often is in countries with reduced health-care access; in the past 50 years, DTwP is estimated to have saved some 40 million lives. The case for using thimerosal also rests on practicality: It allows clinicians to safely immunize more people without wasting freezer space, because it stamps out contamination in vials that contain multiple doses of the vaccine.

The U.S. is now effectively holding funds hostage until Gavi changes up its vaccination strategy—a change that Gavi can’t make overnight. And abruptly halting the distribution of vaccines with thimerosal now would mean depriving people of protection against a whole host of dangerous illnesses. “That condition is going to cause kids in the developing world to die,” Bruce Gellin, the former president of Global Immunization at the Sabin Vaccine Institute, told me. Gavi has already begun the process of transitioning to some newer, thimerosal-free alternative immunizations, Berkley said. But such switches would come with costs—and the holdup in payment from the U.S. “has hampered and slowed down these efforts,” a Gavi spokesperson wrote over email.

Gavi’s funding shortfalls will hold back immunization in other ways, too. In recent years, the organization has helped several nations roll out vaccines against HPV and malaria, with more introductions planned by 2030. But those plans are fracturing. Kate O’Brien, the director of the WHO’s Department of Immunization, Vaccines and Biologicals, told me she worries especially about the malaria program, which is now confronting a nearly 30 percent budget deficit. Essentially, that means that Gavi can support the number of doses that will cover only about 70 percent of its targeted moderate- and high-transmission malaria regions, O’Brien said—calling for “some really tough decisions.” She added: “Who are the 30 percent of communities that are actually not going to get this vaccine?” (The Gavi spokesperson said the funding cuts would limit the potential of malaria vaccination efforts and that, more generally, reductions in funding risk depleting vaccine stockpiles for a number of deadly infectious diseases and diminished the organization’s capacity for preventing outbreaks.)

Global vaccination was already on shaky ground. Emergency conditions at the height of the coronavirus pandemic disrupted supply chains and health-care delivery, which impeded access to routine vaccinations and set the conditions for major outbreaks of diseases such as diphtheria. In many parts of the world, countries still have not returned to their pre-COVID immunization baseline, Anita Shet, a pediatrician and an infectious-diseases researcher at Johns Hopkins’ Bloomberg School of Public Health, told me. As funding shrinks, communities in hard-to-reach regions, where immunizing children is more expensive to begin with, may inadvertently lose out, exacerbating existing health disparities. Within the U.S., where health care is privatized, vaccine access for low-income and rural families is already wobbling: The paring-back of the national immunization schedule has prompted insurers and states to reconsider which vaccines to cover, and the Vaccines for Children Program, which covers underinsured kids, depends on an expert vaccine panel that the Trump administration’s decisions have rendered nonfunctional.

Many lower-income countries, particularly on the African continent, have been working to independently finance vaccination, so that they are “no longer reliant on donations from high-income countries,” Abdu Adamu, a vaccine-implementation researcher based in Nigeria, told me. And in some ways, the abruptness with which American leaders have rescinded their support serves to only further motivate those efforts. But countries cannot instantaneously achieve immune sovereignty—and part of the tragedy here is how quickly the U.S. is undoing years of work. “We’ve made so much progress in the past 20 years, to bring low- and middle-income countries closer to where high-income countries are in terms of access to vaccines,” Chizoba Wonodi, a global vaccination expert at the Bloomberg School of Public Health, told me. A regression could happen much more rapidly, and then take far longer to recover from.

In the meantime, the U.S.’s retreat from global vaccination could set this country back, too. Whatever infectious diseases spread more widely abroad could cross borders to threaten Americans, especially as vaccination rates here continue to waver and dip. Vaccine manufacturers facing resistance here could take their business elsewhere, putting other wealthy nations first in line to receive novel vaccines, Gellin said. Global well-being depends intimately on cooperation and trust. And when infectious threats inevitably crop up in the future, other countries won’t soon forget how quickly U.S. leaders broke their commitment to public health.

It’s Maddeningly Difficult to Ban Smoking

2026-05-19T15:10:05-04:00

Since tobacco first arrived on the shores of England in the late 16th century, some Brits have wanted to eradicate it. Back in 1604, King James I was so alarmed about his country’s new smoking habit that he imposed a 4,000 percent tariff on the crop. That year, he wrote one of the world’s first anti-tobacco essays, declaring smoking “lothsome to the eye, hatefull to the Nose, harmefull to the braine, dangerous to the Lungs.”

Despite the best efforts of the king and the generations of anti-tobacco activists who followed him, people in the United Kingdom still smoke. Now advocates are hoping a new law that prohibits anyone born on or after January 1, 2009, from ever buying cigarettes will finally end the habit for good. But the tobacco-free generation, at least in the short term, is unlikely to truly be tobacco free.

Generational tobacco bans were first proposed in 2010 by a group of researchers in Singapore. Around that time, less extreme anti-tobacco measures—such as media campaigns, clean-air laws, and taxes—had reduced smoking in many countries to such a point that public-health advocates started to seriously consider policies that could shrink rates to effectively zero. A tobacco “endgame,” as it has become known, was in sight. “I want to stamp out smoking for good,” Rishi Sunak, the former U.K. prime minister, said in a statement when he first proposed the plan in 2023.

Currently, U.K. residents need to be 18 or older to purchase cigarettes. The new generational ban will introduce a more unusual paradigm: Beginning on January 1, 2027, an 18-year-old born on New Year’s Day 2009 will not be able to buy products such as cigarettes and chewing tobacco for the rest of their life. But a friend born one day earlier would face no such barrier. That means, as some critics of the ban have pointed out, that 18-year-olds will almost certainly bum cigarettes from older friends—the same way younger teens have acquired them since time immemorial. Data suggest that most adolescent British smokers get cigarettes for free from older people they know. In one study, in which researchers interviewed British smokers as young as 12 about how they obtained cigarettes, kids who waited outside of tobacco shops in the hopes that an older customer would buy for them reported mostly targeting people under 25.

[Charles Fain Lehman: The end of cigarettes is coming]

Lawmakers included language in the bill designed to dissuade older people from buying cigarettes for their underage acquaintances. But, more important, that issue will likely work itself out over time. By 2034, no one under 25 will be able to purchase cigarettes. And with each passing year, kids’ sources of illegal cigarettes should progressively dwindle. Because having peers who smoke increases young people’s chances of starting themselves, fewer kids being able to get their hands on cigarettes should have a ripple effect, dissuading more and more of their peers from experimenting. By 2079, no one under 70 will be legally able to smoke. It will become the habit not of teenage rebellion but of retirement homes.

This all depends, of course, on retailers actually following the law—a big if, according to some tobacco-control experts I spoke with. In a 2023 NHS survey, one-third of youth smokers reported regularly (and illegally) buying cigarettes from shops. “I don’t think we should play down the need for enforcement,” Nathan Davies, a doctoral fellow at the University of Nottingham who studies tobacco control, told me. And even if shopkeepers play by the rules, other people might not. Consider the small Himalayan nation of Bhutan, where all tobacco sales were banned in 2004 but cigarettes remained easy to access because a black market quickly cropped up. Those dealers didn’t serve just existing smokers but also young children. In 2019, nearly a quarter of 13-to-15-year-olds in the country used tobacco.

Nigel Farage, the leader of the right-wing Reform U.K. Party, has repeatedly insisted that such a black market could appear in the U.K. too. But the country’s experiment was not technically a generational tobacco ban, unlike the policy in the U.K., which was crafted to ensure that most current smokers can continue to buy their products legally, thus shrinking the profitability of any black market. The Bhutan and U.K. policies are “structurally so different in scope, sequencing, enforcement infrastructure, and market context that the comparison generates more confusion than insight,” Kashish Aneja, who leads initiatives in Asia at Georgetown University’s O’Neill Institute for National and Global Health Law, told me via email.

[Read: What’s so bad about nicotine?]

No actual generational tobacco ban has existed for enough years to reveal its long-term effects. The Maldives, a small island nation south of India, implemented such a policy in November. Several Massachusetts towns have also passed similar bans. Brookline, a wealthy suburb of Boston, was the first, enacting its own version in 2021. Available data suggest the ban has had little effect on cigarette smoking thus far, but according to advocates, real change will take much more time. “It is a slow and gentle policy change which will result in changes over the mid and long-term,” Mark Gottlieb, the executive director of the Public Health Advocacy Institute at the Northeastern University School of Law, told me in an email.

New Zealand’s left-wing Labour Party passed a tobacco-free-generation policy in 2022. But the country’s new center-right coalition government, on taking power in 2024, repealed the law before it went into effect. The government’s stated reasons for the repeal were so that cigarette-tax revenue could pay for a slew of new tax cuts, and because, it was argued, the policy would have fueled illegal smuggling. Something similar might happen in the U.K. Farage, himself a smoker, has called the ban “puritanical” and vowed to repeal it if his party takes power.

He’s probably not the only one who’d like to see that happen. Tobacco companies urged Parliament not to pass the law, arguing that it was discriminatory and would not prevent youth smoking—and would increase crime, to boot. “Every year from 2027 onwards a generational ban will hand more of the UK tobacco market to the serious organised criminal groups who will use the proceeds of illegal tobacco to fund activities including terrorism, weapons trading, the distribution of narcotics and people smuggling,” Japan Tobacco International, which owns a number of the most popular cigarette brands in the U.K., wrote. (In a statement, a JTI spokesperson added to that list, writing, “Illegal tobacco in the UK has been linked to organized crime, including activities such as money laundering, human trafficking, and violence.”) The tobacco industry, along with smokers’-rights groups, also aggressively courted certain U.K. conservatives as the new ban was being debated, hosting them for lunches and at least one party.

[Read: The allure of smoking rises again]

I asked several major British tobacco companies whether they would like to see the ban repealed, but they declined to answer, instead emphasizing that they will work with the U.K. government to determine how the law is implemented. If the industry wants to continue fighting the ban, they’ll be aided by the fact that the policy will take so long to have real effects. A recent modeling study led by Davies found that the ban should result in smoking rates among people under 30 dropping below 5 percent—a commonly accepted goal of so-called endgame strategies—by 2049. That would give cigarette makers decades to publicize middling results, along with any instances of smuggling they can uncover.

Some proponents of tobacco-endgame policies have their own doubts about the feasibility of generational tobacco bans. Ruth Malone, a UC San Francisco professor who wrote one of the first articles articulating the idea of a tobacco endgame, has suggested that governments could instead pursue a “rapid ban” on cigarettes for people of all ages, additional restrictions on where tobacco can be sold, and prohibitions on all flavored tobacco products. Whereas generational bans give cigarette companies time to influence policy, Malone says, immediate policies would more quickly diminish the industry’s profits, and thereby its power.

[Read: America just kinda, sorta banned cigarettes]

Despite the debate, generational smoking bans are broadly popular. A poll commissioned by the anti-smoking group Action on Smoking and Health found that 68 percent of English people support the new ban. In New Zealand, about 60 percent of voters opposed the country’s about-face. Perhaps that’s because smoking remains one of the world’s leading causes of preventable death, or because the overwhelming majority of smokers regret ever starting. The new policy might not make much difference for today’s teens, but decades from now, a new generation really might avoid that lifelong error—as long as the ban actually sticks around.