Health | The Atlantic

RFK Jr.’s New Normal

2026-04-16T17:15:18-04:00

Updated at 6:58 p.m. ET on April 16, 2026

The White House has reportedly urged Health and Human Services Secretary Robert F. Kennedy Jr. to avoid talking about vaccines, but this morning he had no choice. When he appeared before the House Ways and Means Committee—the first of seven congressional testimonies that he’s scheduled to give in the coming days as part of the 2027-budgeting process—members pressed him on the issue, which he has written and spoken about nearly nonstop for two decades.

He mostly sidestepped those questions, declining to repeat claims he’s made before about the supposed links between vaccines and autism (no such links have been found), or about how contracting measles might boost a person’s immune system (the opposite is true). When asked whether an unvaccinated girl who died of measles in Texas last year might have been saved by the shot, the health secretary responded: “It’s possible, certainly.”

Kennedy recently seems to be steering clear of public statements about vaccines because the White House fears that his anti-vaccine agenda will tank Republicans in the midterms. Instead, he’s touted the government’s new inverted food pyramid and the return of whole milk to school cafeterias. The first episode of his new podcast, released this week, features the celebrity chef Robert Irvine—the man “making my dream come true,” Kennedy says, by revamping military meals—who sits with Kennedy in front of shelves displaying several of Kennedy’s conspiracy-theory-laden books and a picture of his father. (Irvine has a history of embellishing his résumé, which he’s called “errors in my judgment.” A Health and Human Services spokesperson did not respond to a request for comment on the department’s recent moves.)

This more restrained version of Kennedy is appearing as the Trump administration is making moves to tamp down turmoil at HHS. Two months ago, Chris Klomp, the head of Medicare, became the department’s chief counselor, reportedly to keep Kennedy in line. And today, after months of confusion and chaos, President Trump nominated a new director for the Centers for Disease Control and Prevention: Erica Schwartz, a former deputy U.S. surgeon general and a retired rear admiral in the Commissioned Corps of the U.S. Public Health Service.

If Schwartz’s nomination is confirmed by Congress, she would step in as head of an agency that, over the past year, has dealt with several high-profile resignations and flagging morale. The CDC has had a confirmed director for only 29 days since Kennedy took office. Right now—at least officially—it has no director at all. The Trump administration missed a deadline last month to nominate a new one, which means the previous acting director, Jay Bhattacharya, can no longer claim that title, even though he appears to remain in charge. Bhattacharya, whose other job is serving as director of the National Institutes of Health, has seemed intent on winning over employees at the beleaguered agency, telling them at an all-staff meeting last month that they needed to “focus on what we know how to do” rather than getting caught up in politics. This month, though, Bhattacharya, who is known for his contrarian views on the public-health response to the coronavirus pandemic, reportedly delayed the publication of a CDC study showing that the COVID vaccine reduced the likelihood of hospitalization. (An HHS spokesperson told The New York Times that Bhattacharya “wants to make sure that the paper uses the most appropriate methodology.”)

[Read: RFK Jr. is losing his grip on the CDC]

Schwartz’s selection could signal a move toward stability. She has a long public-health track record, including serving in the first Trump administration during the coronavirus pandemic. She holds a medical degree from Brown University and a law degree from the University of Maryland. (The acting director who preceded Bhattacharya, Jim O’Neill, has no medical background and was viewed internally as a Kennedy loyalist.) Several current and former CDC employees I contacted welcomed the news of her possible selection.

A number of other key CDC roles that have been vacant for months will also soon be filled with qualified officials. Jennifer Shuford, an infectious-disease specialist and Texas’s health commissioner, who emphasized the importance of measles vaccination during the state’s outbreak last year, will be the agency's deputy director and chief medical officer. Sara Brenner, a physician who is currently serving as the principal deputy commissioner of the Food and Drug Administration, will become a senior counselor to Kennedy.

Such selections by no means guarantee that the agency will return to normal. The CDC’s last permanent director, a longtime government scientist named Susan Monarez, has testified that she lost her job because she refused to rubber-stamp Kennedy’s agenda or to get rid of certain public-health experts. (Kennedy has said she was fired because she denied being a trustworthy person.) If Schwartz in fact becomes the next director, she, like Monarez, could find herself standing between agency staff and Kennedy, who has repeatedly called the CDC corrupt. Daniel Jernigan, the former director of the National Center for Emerging and Zoonotic Infectious Diseases who resigned in protest over Monarez’s firing last year, told me he believes that, for the next director—whoever that turns out to be—acquiescing to Kennedy’s anti-vaccine views is “likely a necessary job skill.”

[Read: A new level of vaccine purgatory]

If Kennedy was circumspect about his own views today, the actions he’s already taken on vaccines as HHS secretary are still bearing fruit. Last summer, he stacked the agency’s vaccine advisory board with allies; this spring, a judge temporarily blocked changes that the board made to the childhood-vaccine schedule and declared most of its members illegitimate. But last week, seemingly in response, Kennedy signed off on changes to the board’s charter, which now says that, among its duties, the board will work on identifying “gaps in vaccine safety research including adverse effects following vaccination.” It’s hard not to read that as code for continuing to cast doubt on vaccines.

When Trump made Kennedy health secretary, he famously promised to let him “go wild.” Lately, Kennedy seems to have been tamed. But that doesn’t mean he’s abandoned his anti-vaccine agenda, or that he won’t push it from behind the scenes.

This article has been updated to reflect Shuford’s and Brenner’s new roles

The DNA Fix for Aging

2026-04-16T13:11:00-04:00

On his son’s fourth birthday, Michael Prescott had his first heart attack. Prescott, who worked as a civil engineer designing bridges in Tennessee, was in his 30s, and until that day, he had appeared to be in excellent health. But within two years of that first heart attack, he had four more. His doctors, who were baffled by his repeated medical crises, decided that he needed a heart transplant. In 2001, he underwent the procedure in Nashville. But a few years later, he needed a kidney transplant too. No one could explain why his organs were failing him.

As time dragged on, Prescott’s symptoms became more outwardly visible. His skin began wrinkling like that of someone decades older than him, and he developed cataracts. By his early 40s, Prescott looked like he was in his 60s. When he attended baseball games with his son, Carter, people would mistake him for the boy’s grandfather.

Frustrated, Prescott decided to diagnose himself. He would sit for hours in the living room in his favorite chair, his slim form enveloped in a sweatshirt with the logo of his favorite football team, the Tennessee Volunteers, as he read one research article after another. “He had a hard time sleeping at night,” Carter told me, “and so he’d be in his recliner with his little lamp, on his laptop, just kind of scouring through stuff, taking notes and trying to figure it out.” Finally, Prescott struck upon a disease that seemed to explain everything. His doctors agreed to test him right away, and the results vindicated his hunch. Prescott had a real illness with a real name: Werner syndrome.

A person with Werner syndrome seems to age at fast‑forward speed. By their mid-20s, they experience hair loss, muscle atrophy, and loss of the fat under their skin. During their next decade of life, many patients develop other early hallmarks of aging, such as hardened blood vessels. Individuals with this condition live, on average, until their early 50s. They lack a functioning version of a DNA-stabilizing protein, and their cells rapidly accumulate sequence errors as they age.

A version of that same process occurs even in those of us without Werner syndrome. We all amass DNA damage and countless mutations in our tissues throughout our lives. We just do so a bit more gradually.

Scientists now recognize that spontaneous DNA errors, which we acquire in early development all the way until our last breath, can drive several ailments such as heart disease, autoimmunity, epilepsy, Alzheimer’s disease, and cancer. These errors could even be the missing piece in explaining the universal phenomenon of aging.

Scientists’ earliest understanding of genetic disease had to do with mutations in the genetic code people inherit at birth. (Think of hereditary disorders such as hemophilia, cystic fibrosis, and sickle cell disease.) Later, they came to understand that epigenetic marks—the chemical tags that sit on top of genes, helping switch them on and off—can play a role too. More recently, scientists have discovered the massive number of sequence mutations everyone experiences throughout life. Consider this stark possibility: Even as you read this sentence, the brain cells you are using to process it might be mutating.

Unlike inherited conditions, spontaneous genetic diseases can emerge at any point in a person’s life. Some non-inherited genetic diseases are rare, such as the bone condition melorheostosis, which was first described decades ago and causes a painful overgrowth of bone that on X-rays resembles dripping candle wax. But the list of diseases linked to spontaneous mutations expands with each passing year, thanks in part to advances that enable scientists to decipher the DNA of single cells rather than bulk-tissue samples alone. In 2020, doctors added a new one to the list. They discovered a sometimes-fatal inflammatory disorder resulting from spontaneous mutations in the UBA1 gene. Non-inherited genetic errors have also been implicated more and more in common conditions: Upwards of one-third of children with autism spectrum disorder possess spontaneous mutations that appear connected to their condition.

Scientists’ greater understanding of acquired mutations is already inspiring major updates to medical treatment. Take cancer: Decades ago, oncologists believed that tumors were driven by a couple of genetic errors. Now they know that cancers are rife with genetic change—by some estimates, thousands upon thousands of mutations per advanced tumor. By sequencing the genetic changes in a tumor, scientists can figure out which mutations fuel its growth, and design drugs to strike those targets. Meanwhile, in neurology, some epilepsy patients have received drugs for their seizures that target specific spontaneous mutations detected in their brains.

For decades, scientists have suspected that acquired mutations might also explain health problems adults experience as they age. Among the earliest researchers to make the connection were physicists who had worked on developing the first atomic bombs. The United States used these weapons to kill hundreds of thousands of people at the end of World War II, and they have since been linked to cancers in people exposed to the bombs’ mutation‑inducing radiation. Understanding the effects of such mutations remained an obsession for some Manhattan Project scientists, including Gioacchino Failla and Leo Szilard. In the 1950s, they theorized that “hits” to the genome could explain the universal process of aging.

By the next decade, British scientists observed that many men seem to be losing copies of their Y chromosome as they age. Scientists now know that almost half of men over the age of 70 have lost the Y chromosome in some of their blood cells—a phenomenon that has been linked to an increased risk of cancer. (Women also seem to lose copies of their X chromosome as they age, but the number of published studies related to this phenomenon is paltry.) In recent years, geneticists have found that people in their later decades of life are more likely to have blood cells with mutations in specific genes. These cells, present in about 10 to 20 percent of people ages 65 and older, double someone’s risk of coronary heart disease and stroke. Medical researchers have estimated that a single white blood cell from a 100‑year‑old can contain more than 3,000 acquired mutations.

Now that scientists have described just how much mutation happens in aging, they’re curious if DNA repair might offer a counteracting force. In other words, does fixing DNA improve longevity? Biologists are taking different tacks to find out. Some have turned to gene editing to try to create antiaging therapies: One company, Spellcheck Bio, has started designing a treatment that relies on the CRISPR-Cas9 genome‑editing system to look for—and correct—DNA mutations.

Vera Gorbunova, a biologist at the University of Rochester, traveled to the sea around Utqiagvik, Alaska, to study the genes of the mammal with the longest lifespan on Earth: the bowhead whale. “This is the only mammal proven to live longer than humans,” she told me. One bowhead whale was estimated to have lived to 211, and genetic clues suggest that members of the species could have a maximum lifespan of 268 years. Gorbunova and her colleagues worked with the local Inupiat community to collect small samples from whales hunted using traditional methods. In the lab, the scientists observed that the bowhead cells mended breaks and mismatches in their genetic sequence extremely well. The cells also contained astronomical levels of a molecule known as cold‑inducible RNA-binding protein, or CIRBP. Gorbunova imagines that proteins such as CIRBP—if they do indeed counteract DNA damage—could perhaps have a place in modern medicine.

Gorbunova is on the scientific advisory board of the start-up Genflow Biosciences, which leans into the belief that activating DNA repair might reduce damage to the genome, and therefore extend life. All of the drugs it has in development involve the SIRT6 gene, which makes a protein that helps guide DNA repair. Gorbunova previously helped lead a genetic-sequencing project that found that some centenarians possessed a rare variant of the SIRT6 gene that enhances genomic stability. The company aims to start clinical trials on a compound to reverse liver damage, and on another one it hopes will have antiaging effects in dogs. Genflow is also developing a drug to treat Werner syndrome, the inherited genetic condition of accelerated aging that affected Michael Prescott.

Prescott, for his part, forged ahead despite his worrisome prognosis. He continued cheering on the Tennessee Volunteers and guiding his son through life. Ultimately, though, Prescott developed cancer—another common complication of Werner syndrome. He died at age 52, weighing only 65 pounds.

The breakthroughs of recent years came too late for patients such as Prescott. But with the new understanding that DNA is dynamic and endlessly changing, modern medicine is now better equipped to adapt to—and perhaps even influence—the cacophony of mutations we all inevitably accumulate.

This article was adapted from Roxanne Khamsi’s new book, Beyond Inheritance: Our Ever-Mutating Cells and a New Understanding of Health.

America Has a New GLP-1 Playbook

2026-04-11T07:30:00-04:00

By most measures, the new GLP-1 pills are underwhelming. Earlier this month, the pharmaceutical giant Eli Lilly debuted a weight-loss tablet that is far less effective than its popular injectable counterpart, Zepbound. Oral Wegovy, which hit the market in December, can hold its own with the shot version—but it has to be taken on an empty stomach with fewer than four ounces of water. And both pills come with many of the same side effects as the shots, namely nausea and diarrhea.

As someone who’s currently on a GLP-1 injection, I still can’t wait to start taking the pills instead. No, I’m not afraid of needles. The injector pens that are used to administer GLP-1s are so quick and painless that sometimes I worry the needle didn’t actually go into my skin. But the shots are a nuisance nonetheless. They’re supposed to be taken on the same day every week, but I struggle to stick to the schedule. The injections also need to be refrigerated—which is especially a hassle whenever I travel. Last month, I visited relatives who don’t know that I’m on a weight-loss drug. I was too sheepish to have a conversation with them about it, so I left the pen in my toiletry bag and didn’t throw it in the trash until I got home.

This might all seem trivial, but a mere annoyance compounds when it must be repeated every week for the rest of your life. Even though many GLP-1 users hit a weight-loss plateau after several months, they have to continue injecting themselves to avoid gaining the weight back. “Over time—particularly as patients transition from the active-weight-loss phase to long-term maintenance—the psychological burden of ongoing injections can become more apparent,” Akshay Jain, a clinical instructor at the University of British Columbia, told me. (Jain has consulted for both Eli Lilly and Novo Nordisk.)

[Read: The Ozempic plateau]

This may be where the true value in weight-loss pills lies. Patients may be able to use the injections to actually lose weight, and then lean on the tablets to keep it off. The pills can be downed with a swig of water just like statins, SSRIs, and so many other pharmaceuticals that are already part of people’s daily routine. On that front, Eli Lilly’s pill, sold under the brand name Foundayo, is especially notable. For most people, the drug doesn’t come with fussy rules about when it should be taken. Doctors I spoke with were enthusiastic about the idea of switching some patients to pills because it allows them to feel as if they’ve made meaningful progress toward normalcy.

So far, doctors just haven’t had very good options for GLP-1 patients who are looking to maintain their weight loss. Some have attempted to switch patients to older weight-loss pills. Others have suggested that patients space out injections to every few weeks. But neither strategy is foolproof. The older drugs have been successfully tested as a way to maintain weight after bariatric surgery, but they haven’t been studied among people coming off of GLP-1s, David Cummings, a professor at the University of Washington, told me. Anecdotal evidence suggests that the method may not be all that effective. “I have a lot of patients that regain all of their weight,” Catherine Varney, the director of obesity medicine at UVA Health, told me. (Varney has done paid speaking gigs for Eli Lilly.) The tactic of taking a GLP-1 shot less frequently, meanwhile, hasn’t been tested in a large randomized clinical trial.

By contrast, a recent clinical trial by Eli Lilly tracked nearly 400 subjects who switched from shots to Foundayo, and found that on average, they maintained most of their weight loss after 52 weeks. (The study has not yet been published in a peer-reviewed journal.) A comparable study hasn’t been done with oral Wegovy, but Novo Nordisk, the company that manufactures the drug, believes that patients should be able to switch from the Wegovy shot without affecting their weight. Because the two drugs are made with the same molecule, “there’s no reason to think that there’d be any difference,” Andrea Traina, the senior medical director for obesity at Novo Nordisk, told me. Doctors told me that they have been encouraged by patients who have already switched from shots to oral Wegovy. “Initial anecdotal reports are promising, but we still need more long data to form conclusions,” Katie Robinson, an assistant professor at the University of Iowa, told me.

All of this comes with a significant caveat. These pills may not remedy the biggest reason people stop taking GLP-1s: price. The new tablets are cheaper than the shots, but they’re still not cheap. If you pay out of pocket, the lowest dose of Foundayo costs $149 a month, which is about half the price of the cheapest version of Zepbound. The Wegovy pill also starts at $149, compared with $199 for the injection. Again, this is $149 every month indefinitely—it quickly adds up. With insurance, the cost of these drugs can be much lower, but few people can count on that. A recent survey of employers found that only about one in five insurance plans at large companies covered GLP-1s for weight loss. The situation gets especially tricky for older Americans. Medicare is technically banned by law from covering weight-loss drugs, though the Trump administration is piloting a program to provide beneficiaries with access.

[Read: The obesity-drug revolution is stalling]

There is hope that the price of Foundayo, in particular, will drop over time because of the way it is manufactured. Unlike all of the other GLP-1s on the market, it is not a peptide—a class of drugs that mimics hormones in the body—which makes it much simpler to produce. But even if the price plummets, not everyone may be as eager to switch to a pill as I am. Everyone who takes a GLP-1 has their own issues that affect whether they stick with their regimen. For some, the once-weekly injection may be more convenient than daily pills; others may want drugs that come with fewer side effects; and still others may just decide to take whatever is cheapest and does the job.

So much of the attention surrounding GLP-1s has been on their remarkable efficacy at shedding weight—and the search for drugs that are even better. Retatrutide, a much-hyped injection that is in the works, can apparently lead to nearly 30 percent loss in body weight on average. But options that lessen the burden of taking a forever drug may matter even more.

A Cancer Treatment That Does More Than Scientists Thought

2026-04-09T11:00:00-04:00

By the time Fabian Müller met the patient at the center of his newest research paper, he was fairly certain that an experimental treatment was her last hope. The patient, a 47-year-old mother of two, had for years been battling three severe autoimmune diseases, all of which were triggering her body to attack components of her blood. Her doctors had made nine separate attempts to treat her conditions, but none of them had worked. By the start of 2025, she’d been confined to a hospital in Dresden, Germany, for more than two months, being dosed with multiple immunosuppressive drugs and receiving up to three daily transfusions of red blood cells, as her care team tried and failed to control a massive disease flare.

In desperation, the woman’s care team reached out to Müller, a hematologist-oncologist at the University Hospital of Erlangen, a roughly three-hour drive away by ambulance. In recent years, he and his colleagues have made a name for themselves pioneering experimental CAR-T cell treatments—a type of personalized immunotherapy originally developed for cancer—against a variety of autoimmune diseases, with promising early results. Small studies of CAR-T, as well as early results from several ongoing clinical trials, show that many people with autoimmune disease go into remission after treatment; some patients are now years out from CAR-T cell therapy and remain in good health without the help of any drugs. Müller hopes that this latest patient—the most complex autoimmune case to receive the treatment to date—will soon be able to say the same. She received CAR-T treatment early last year and has since returned to a mostly normal life. After years of being intermittently lashed to machines and tubes, she hasn’t needed a hospital stay in many months. (The patient has asked to remain anonymous to protect her privacy, Müller told me.)

Müller and other CAR-T researchers are cautious about forecasting the future of their technology. CAR-T is brand-new to autoimmune disease—it was first trialed in a patient in 2021—and scientists still aren’t certain how long remission might last or whether patients might experience long-term side effects. But for the first time, patients with some of the world’s most severe autoimmune conditions are entering prolonged remission after a one-and-done treatment. And many researchers are starting to think that CAR-T may offer people with autoimmune disease a new kind of hope: the possibility of permanent recovery.

Autoimmune diseases—a broad and complex category of ailments including rheumatoid arthritis and type 1 diabetes—have long puzzled researchers. For reasons that are still poorly understood, the body’s immune system, normally tuned exquisitely to root out and destroy invasive pathogens or sickly cells, begins to assault healthy cells instead. Although the conditions can be managed, usually with immunosuppressive drugs, scientists have never figured out a way to permanently jolt the immune system back on track.

CAR-T therapies could be exactly the kind of factory reset that the immune system needs. The treatment involves reengineering T cells—a type of immune defender—into chimeric antigen receptor T cells (hence, CAR-T) that can kill other cells of scientists’ choosing. In the case of many autoimmune diseases, that means targeting B cells, another variety of immune cell that is commonly responsible for the body mistakenly turning on itself. CAR-T treatments wipe out the misbehaving cells, allowing the body to, theoretically, restock its B cells with ones that leave healthy tissues alone.

So far, that theory has panned out. Early experiments—many of them headed by Müller’s team—suggest that CAR-T therapies can work against several different autoimmune diseases, including myositis, systemic sclerosis, ulcerative colitis, and myasthenia gravis, with few side effects. Across trials, including several recent studies from Müller and his colleagues, most of the dozens of lupus patients that researchers have infused with CAR-Ts have gone into remission, and stayed there for many months. Overall, CAR-T has been astoundingly successful against autoimmune disease, Marcela Maus, the director of the Cellular Immunotherapy Program at Massachusetts General Hospital, told me, especially considering CAR-T’s somewhat spotty track record against certain cancers. These experimental treatments also offer a major lifestyle improvement over traditional management of very severe and complex autoimmune disease, which can entail a lifetime of regularly dosing immunosuppressive drugs. And although CAR-T can trigger extreme inflammatory responses in some cancer patients, those risks don’t seem as common in people with autoimmune disease.

[Read: A ‘crazy’ idea for treating autoimmune diseases might actually work]

Müller’s recent patient still presented a new puzzle—not least because she suffered from three separate autoimmune diseases. In 2014, around the time she had her first son, she’d been diagnosed with autoimmune hemolytic anemia, in which the body rampantly annihilates its own red blood cells. Shortly after, she developed two other autoimmune conditions: one that caused her blood to clot excessively, and another that destroyed platelets, making her more prone to uncontrolled bleeding. Before falling ill, the patient had been active, energetic, “always doing a million things at once,” Müller told me. Within a few years of her diagnosis, though, she was struggling through daily tasks, unable to work, hospitalized for months every year. Her younger son, who’s about 8 years old, knew his mother “only as a sick person,” Müller said. In early 2025, the patient told Müller that she was willing to try whatever he and his colleagues had to offer. With each additional day of intensive, unsuccessful treatment, her risk of a serious complication was rising while her chances of survival were ticking steadily down.

Early last year, Müller and his colleagues extracted the patient’s T cells, programmed them to destroy most of her body’s B cells, and then infused the modified T cells back into her body. Her B cells quickly began to disappear, and within weeks, her bloodwork began to look roughly normal. A year out from treatment, she still has lingering fatigue, and has to undergo weekly bloodletting to purge the iron that built up in her body after receiving so much donated blood. But her outpatient doctor manages that care, and she no longer depends on drugs or blood transfusions. She’s spending time with her children in ways she never could before. As far as Müller’s team can tell, the treatment accomplished the immunological reboot they hoped for: Her body has since produced new B cells, and they so far seem unperturbed by any components of her blood, just as immune cells should be.

Not everyone will be so lucky. CAR-T therapy can cost hundreds of thousands of dollars or more. Germany allows people with serious autoimmune conditions to receive the treatment on the basis of compassionate use, and covers it through the country’s universal health-care system. But in the United States, the only reliable access to CAR-T for those patients comes through sparse clinical trials. Some researchers worry that certain patients won’t stay in remission, perhaps because they carry some sort of predisposition to generate rogue immune cells. And certain autoimmune diseases—especially those that might not hinge on misbehaving B cells—may be harder to treat with CAR-T. Wiping out a lot of T cells, for example, carries a high risk of pushing someone into an immunocompromised state, similar to AIDS, Avery Posey, a CAR-T expert at the University of Pennsylvania, told me. But new developments are in the works that could address some of those issues, Posey said. Scientists are tinkering with new ways to generate CAR-T cells more efficiently and cheaply, including via injections, somewhat similar to vaccines, that can coax patients’ bodies into reprogramming some of their T cells—that is, generating their own CAR-Ts in house. In some cases, the subsets of cells that CAR-Ts target can also be narrowed, so that only the body’s most problematic cells are taken out of commission, while healthy immune cells remain intact.

Müller remains encouraged by the fact that his first autoimmune patient, a young woman with lupus, is still doing well more than five years out from her CAR-T treatment. She’s since gotten her master’s degree and now works at his hospital, running clinical trials; they wave when they glimpse each other in the cafeteria. For now, her immune system seems to be behaving just as it should.

How the Whole-Grain Trend Went Wrong

2026-04-07T07:00:00-04:00

Refined grains can be a dangerous business. They are digested quickly, flooding the bloodstream with a wave of sugar and stressing the pancreas, the latter of which compensates by producing spikes of insulin. Eventually, those sugar bursts can result in obesity, diabetes, and heart disease. But starting in the 1990s, nutrition experts began offering Americans an enticing deal: You can still eat your bread and pasta, as long as you avoid those dangerous refined grains and accept the salvation of whole grains.

Dozens of studies showed that whole-grain consumption was linked with a lower risk of cancer, cardiovascular disease, and diabetes. By 2015, the Dietary Guidelines for Americans was recommending making whole grains at least half of one’s total grain consumption. Grocery stores were soon filled with delicious whole-grain snacks, cereals, and shelf-stable breads, each promising a shortcut to health. When Robert F. Kennedy Jr. unveiled his inverted food pyramid this past January—which demoted whole grains to the narrowest tip and elevated animal products—some nutrition experts cried foul, concerned that Americans would abandon a category with decades of science behind it.

Nutritionists broadly concur that unrefined foods of all sorts, including oats, vegetables, seeds, and nuts, are a healthier choice than foods that have been heavily processed. At the same time, many researchers suspect that the whole grains on grocery shelves are a fiction. No one can actually agree on what a whole-grain food is. And the whole-grain products Americans most commonly eat behave in the body much the same as the refined-grain foods they were meant to replace.

A whole grain, in principle, is a grain—wheat, rice, oats—that retains all three of its original components. Those components are layered a bit like an egg: The bran is the sturdy eggshell, dense in fiber. The starchy endosperm is the biggest part of the grain, akin to the egg white. Buried at the center is the yolk-like germ, rich in vitamins and phytonutrients. Refined grains, such as white flour, have been stripped of their fibrous, nutritious bran and germ, leaving primarily the starch and a bit of protein behind.

A whole-grain food—the pasta, bread, and breakfast cereals that you actually buy and eat—is a different matter entirely. The 2025–30 Dietary Guidelines for Americans describes a whole-grain food simply as one that contains bran, endosperm, and germ. The industry-sponsored Whole Grain Council grants its “basic stamp” to any product with at least eight grams of whole-grain ingredients in each serving, but it places no restrictions on what might fill the rest of the package. The FDA counts as a whole-grain product any food whose grain content is at least 51 percent whole grain. Walter Willett, a professor of epidemiology and nutrition at Harvard, told me that such definitions are “obviously misleading.” Several bills have been introduced to Congress that would require food companies to disclose a product’s actual whole-grain content as a percentage of total grain, but they have all died without a vote.

This inconsistency makes studying the health effects of whole grains challenging. A 2022 study applied five competing institutional definitions of whole-grain foods to dietary data from approximately 40,000 Americans. The authors found that the same person could be a consumer of a high amount of whole grains under one standard and of a low amount under another. They also found that the food category that most commonly qualified as “whole grain” was ready-to-eat breakfast cereals, which are among the most heavily processed foods in the grocery store; many of them are high in added sugar and lacking in fiber. Another analysis concluded that foods bearing the Whole Grain Council stamp contain more calories and added sugar on average than products without it.

It should be no surprise, then, that when scientists examine whole grains more closely, some claims about their health effects begin to crumble. For instance, a 2022 study Willett co-authored followed more than 200,000 Americans for 25-plus years. The team found that foods such as brown rice and oatmeal reduce the risk of coronary heart disease but that popcorn—technically a whole grain under any definition—does not. And in a small randomized trial from 2009, whole-wheat bread produced a higher blood-sugar spike than white pasta did, despite the fact that the bread contained five times as much fiber as the pasta. In other words, a refined-grain product clearly outperformed a whole-grain product on the very metric on which whole grains are supposed to win.

[Read: Coke, Twinkies, Skittles, and … whole-grain bread?]

It’s still not clear what is driving those inconsistencies. But some researchers have an idea: Perhaps, instead of the presence of bran and germ, what matters is the physical architecture of the grain itself, including how tightly its molecules are packed together. Most commercial whole-grain breads and cereals are “molecularly disassembled,” Dariush Mozaffarian, a cardiologist and a nutrition researcher at Tufts University, told me. Bran, endosperm, and germ may be sourced from different factories and then recombined into a new food product. Compared with intact grains such as brown rice and corn kernels from the cob, molecularly disassembled whole grains are digested more quickly and, just like refined grains, spike your blood sugar faster and leave you hungrier sooner, which may contribute to metabolic disease over time.

Even if the grain’s components aren’t sourced separately, structure seems to matter. In one small 2022 study, a team of researchers matched whole-grain and refined-wheat products for every possible physical property: They ground them to the same particle size, prepared them in the same food form (in this case, porridge), and sourced all samples from the same batch of wheat at the same mill. Participants ate the matched products, and researchers measured blood-sugar response. The whole-grain advantage vanished. An earlier study from the University of Otago, in New Zealand, had a small group of adults with type 2 diabetes eat a variety of 100 percent whole-grain foods that differed only in milling method. After two weeks, the participants who were eating less processed whole grains had lost about a pound of body weight while those eating finely milled equivalents gained about the same amount. And even for products that have been finely milled, the final structure of the product seems to matter, because denser foods resist rapid digestion. Bread and pasta, for example, are both made from flour, but only pasta is extruded under pressure, compacting the starch into a dense matrix that digestive enzymes access slowly.

Disrupting the structure of a whole grain may also change how it affects the microbiome. When a grain is highly processed, its starch gets rapidly broken down in the small intestine, spiking your blood sugar but never reaching the colon, where most gut bacteria live. In a less processed grain, some of that starch travels farther, arriving to the colon intact, Mozaffarian explained. In theory, the colon microbiome then feeds on that starch to produce hundreds of beneficial compounds that have positive effects on other organs. Plus, during processing, many commercial whole-grain breads have their natural insoluble fibers extracted and replaced with a soluble fiber such as inulin, Bruce Hamaker, a professor of food science at Purdue University, told me. Soluble fibers can improve the texture of the bread and help it retain moisture to keep it fresher longer. But that comes at a cost—those natural fibers selectively nourish a group of gut bacteria that help reduce inflammation and reinforce the intestinal barrier.

[From the May 2023 issue: Could ice cream possibly be good for you?]

Without a label to indicate whether a grain’s structure has been disrupted before it goes into your food, choosing the healthiest grains can be difficult. Mozaffarian recommends looking for products that contain no more than 10 times as many grams of carbohydrate as grams of fiber—a rough proxy for structural and fiber integrity. He also recommends a rubric that requires no math: “Imagine putting the product into a cup of water and coming back four hours later,” he said. “If it’s a mush, it tells you it’s going to be rapidly digested. If it looks mostly the same, it probably has some natural intact structure.”

None of this means that people should abandon whole grains in favor of meat and whole milk. What it suggests, rather, is that the benefits scientists have been measuring may be only a fraction of what minimally processed whole grains can actually do.

*Sources: Sepia Times / Getty; Bildagentur-online / Getty; J. Magee / The New York Historical / Getty.

The ChatGPT Symptom Spiral

2026-04-06T18:30:00-04:00

After George Mallon had his blood drawn at a routine physical, he learned that something may be gravely wrong. The preliminary results showed he might have blood cancer. Further tests would be needed. Left in suspense, he did what so many people do these days: He opened ChatGPT.

For nearly two weeks, Mallon, a 46-year-old in Liverpool, England, spent hours each day talking with the chatbot about the potential diagnosis. “It just sent me around on this crazy Ferris wheel of emotion and fear,” Mallon told me. His follow-up tests showed it wasn’t cancer after all, but he could not stop talking to ChatGPT about health concerns, querying the bot about every sensation he felt in his body for months. He became convinced that something must be wrong—that a different cancer, or maybe multiple sclerosis or ALS, was lurking in his body. Prompted by his conversations with ChatGPT, he saw various specialists and got MRIs on his head, neck, and spine.

Mallon told me he believes that the cancer scare and ChatGPT together caused him to develop this crippling health anxiety. But he blames the chatbot for keeping him spiraling even after the additional tests indicated that he wasn’t sick. “I couldn’t put it down,” he said. The chatbot kept the conversation going and surfaced articles for him to read. Its humanlike replies led Mallon to view it as a friend.

The first time we met over a video call, Mallon was still shaken by the experience even though the better part of a year had passed. He told me he was “seven months sober” from talking with the chatbot about health symptoms after seeking help from a mental-health coach and starting anxiety medication. But he also feared he could get sucked back in at any moment. When we spoke again a few months later, he shared that he had briefly fallen into the routine again.

Others seem to be struggling with this problem. Online communities focused on health anxiety—an umbrella term for excessive worrying about illness or bodily sensations—are filling up with conversations about ChatGPT and other AI tools. Some say it makes them spiral more than ever, while others who feel like it helps in the moment admit it’s morphed into a compulsion they struggle to resist. I spoke with four therapists who treat the condition (including my own); they all said that they’re seeing clients use chatbots in this way, and that they’re concerned about how AI can lead people to constantly seek reassurance, perpetuating the condition. “Because the answers are so immediate and so personalized, it’s even more reinforcing than Googling. This kind of takes it to the next level,” Lisa Levine, a psychologist specializing in anxiety and obsessive-compulsive disorder, and who treats patients with health anxiety specifically, told me.

Experts believe that health anxiety may affect upwards of 12 percent of the population. Many more people struggle with other forms of anxiety and OCD that could similarly be exacerbated by AI chatbots. In October X posts, OpenAI CEO Sam Altman declared the serious mental-health issues surrounding ChatGPT to be mitigated, saying that serious problems affect “a very small percentage of users in mentally fragile states.” But mental fragility is not a fixed state; a person can seem fine until they suddenly are not.

Altman said during last year’s launch of GPT-5, the latest family of AI models that power ChatGPT, that health conversations are one of the top ways consumers use the chatbot. According to data from OpenAI published by Axios, more than 40 million people turn to the chatbot for medical information every day. In January, the company leaned into this by introducing a feature called ChatGPT Health, encouraging users to upload their medical documents, test results, and data from wellness apps, and to talk with ChatGPT about their health.

The value of these conversations, as OpenAI envisions it, is to “help you feel more informed, prepared, and confident navigating your health.” Chatbots certainly might help some people in this regard; for instance, The New York Times recently reported on women turning to chatbots to pin down diagnoses for complex chronic illnesses. Yet OpenAI is also embroiled in controversy about the effects that an overreliance on ChatGPT may have. Putting aside the potential for such products to share inaccurate information, OpenAI has been accused of contributing to mental breakdowns, delusions, and suicides among ChatGPT users in a string of lawsuits against the company. Last November, seven were simultaneously filed, alleging that OpenAI rushed to release its flagship GPT-4o model and intentionally designed it to keep users engaged and foster emotional reliance. (The company has since retired the model.) In New York, a bill that would ban AI chatbots from giving “substantive” medical advice or acting as a therapist is under consideration as part of a package of bills to regulate AI chatbots.

In response to a request for comment, an OpenAI spokesperson directed me to a company blog post that says: “Our thoughts are with all those impacted by these incredibly heartbreaking situations. We continue to improve ChatGPT’s training to recognize and respond to signs of distress, de-escalate conversations in sensitive moments, and guide people toward real-world support, working closely with mental health clinicians and experts.” The spokesperson also told me that OpenAI continues to improve ChatGPT’s safeguards in long conversations related to suicide or self-harm. The company has previously said it is reviewing the claims in the November lawsuits. It has denied allegations in a lawsuit filed in August that ChatGPT was responsible for a teen’s suicide. (OpenAI has a corporate partnership with The Atlantic’s business team.)

Two years ago, I fell into a cycle of health anxiety myself, sparked by a close friend’s traumatic illness and my own escalating chronic pain and mysterious symptoms. At one point, after I was managing much better, I tried out a few conversations with ChatGPT for a gut-check about minor health issues. But the risk of spiraling was glaring; seeking reassurance like that went against everything I’d learned in therapy. I was thankful I hadn’t thought to turn to AI when I was in the throes of anxiety. I told myself, Never again.

Meanwhile, in the health-anxiety communities I’m part of, I saw people talk more and more about looking to chatbots for comfort. Many say it has made their health anxiety worse. Others say AI has been extraordinarily helpful, calming them down when they’re caught in a cycle of unrelenting worry. And it is that last category that is, in fact, most concerning to psychologists. Health anxiety often functions as a form of OCD with obsessive thoughts and “checking,” or reassurance-seeking compulsions. Therapeutic best practices for managing health anxiety hinge on building self-trust, tolerating uncertainty, and resisting the urge to seek reassurance, but ChatGPT eagerly provides personalized comfort and is available 24/7. That type of feedback only feeds the condition—“a perfect storm,” said Levine, who has seen talking with chatbots for reassurance become a new compulsion in and of itself for some of her clients.

Extended, continuous exchanges have shown to be a common issue with chatbots and a factor in reported cases of AI-associated “psychosis.” Research conducted by researchers at OpenAI and the MIT Media Lab has found that longer ChatGPT sessions can lead to addiction, preoccupation, withdrawal symptoms, loss of control, and mood modification. OpenAI has also acknowledged that its safety guardrails can “degrade” in lengthy conversations. Over a 10-day period of his cancer scare, Mallon told me, “I must have clocked over 100 hours minimum on ChatGPT, because I thought I was on the way out. There should have been something in there that stopped me.”

In an October blog post, OpenAI said it consulted more than 170 mental-health professionals to more reliably recognize signs of emotional distress in users. The company also said it updated ChatGPT to give users “gentle reminders” to take breaks⁠ during long sessions. OpenAI would not tell me specifically how long into an exchange ChatGPT nudges users to take a break or how often users actually take a break versus continue chatting after being served this reminder.

One psychologist I spoke with, Elliot Kaminetzky, an expert on OCD who is optimistic about the use of AI for therapy, suggested that people could tell the chatbot they have health anxiety and “program” it to let them ask about their concerns just once—in theory, preventing the chatbot from goading the user to interact further. Other therapists expressed concern that this is still reassurance-seeking and should be avoided.

When I tested the idea of instructing ChatGPT to restrict how much I could talk to it about health worries, it didn’t work. ChatGPT would acknowledge that I put this guardrail on our conversations, though it also prompted me to keep responding and allowed me to keep asking questions, which it readily answered. It also flattered me at every turn, earning its reputation for sycophancy. For example, in response to telling it about a fictional pain in my right side, it cited the guardrail and suggested relaxation techniques, but ultimately took me through a series of possible causes that escalated in severity. It went into detail on risk factors, survival rates, treatments, recovery, and even what to expect if I were to go to the ER. All of this took minimal prompting, and the chatbot continued the conversation whether I acted worried or assured; it also allowed me to ask about the same thing as soon as an hour later, as well as multiple days in a row. “That’s a good and very reasonable question,” it would tell me, or, “I like how you’re approaching it.”

“Perfect — that’s a really smart step.”

“Excellent thinking — that’s exactly the right approach.”

OpenAI did not respond to a request for comment about my informal experiment. But the experience left me wondering whether, as millions of people use chatbots daily—forming relationships and dependencies, becoming emotionally entangled with AI—it will ever be possible to isolate the benefits of a health consultant at your fingertips from the dangerous pull that some people are bound to feel. “I talked to it like it was a friend,” Mallon said. “I was saying stupid things like, ‘How are you today?’ And at night, I’d log off and go, ‘Thanks for today. You’ve really helped me.’”

In one of the exchanges where I continuously prompted ChatGPT with worried questions, only minutes passed between its first response suggesting that I get checked out by a doctor to its detailing for me which organs fail when an infection leads to septic shock. Every single reply from ChatGPT ended with its encouraging me to continue the conversation—either prompting me to provide more information about what I was feeling or asking me if I wanted it to create a cheat sheet of information, a checklist of what to monitor, or a plan to check back in with it every day.

The Man Holding MAHA Together

2026-04-05T09:00:00-04:00

Tony Lyons knows how Republicans can win the midterm elections later this year. All they need to do, as he explained in a memo to GOP leaders in February, is embrace the Make America Healthy Again movement, or at least the popular parts of it, like banning soda from SNAP benefits and ditching artificial food dyes. Divisive anti-vaccine issues, in contrast, must be “addressed carefully and with nuance.” Follow this plan, insists Lyons—who is president of MAHA Action, a nonprofit that promotes Health Secretary Robert F. Kennedy Jr.’s agenda—and the “MAHA Winnable Middle” will be yours.

Getting Republicans on board with MAHA is Lyons’s primary mission. Also important: making sure the movement doesn’t implode in the meantime.

In recent weeks, MAHA diehards have been fuming, particularly after Donald Trump signed an executive order shielding manufacturers of the widely used weed killer glyphosate from liability. Some studies suggest that glyphosate exposure leads to cancer, and MAHA activists want it banned. More recent setbacks for Kennedy—such as Casey Means’s stalled bid for surgeon general and a federal judge’s preliminary injunction against changes to the childhood vaccine schedule—haven’t exactly helped. Lyons has counseled frustrated supporters to “stay together and stay focused.” Several influential MAHA figures have told me, however, that if the Trump administration shrugs off their priorities, they see no reason to remain loyal.

With the exception of Kennedy himself, no one is more central to MAHA as a political project than Lyons. He is the movement’s chief strategist, primary spokesperson, and—as of late anyway—most ardent apologist. Along with heading MAHA Action, he is a co-president of MAHA PAC, the political arm of the movement, which aims to help elect GOP candidates who support MAHA causes to the Senate and House. Lyons told me he plans to back as many as 20 Republicans in the midterms; recently, MAHA PAC gave $1 million to Julia Letlow, the Louisiana congresswoman running in the Republican primary against Senator Bill Cassidy, a frequent Kennedy critic. Lyons is also the president of MAHA Center, the nonprofit responsible for the former boxer and current Trump supporter Mike Tyson’s apple-chomping Super Bowl commercial. Whereas MAHA PAC’s stated goal is to elect Republicans, MAHA Center is at least officially nonpartisan.

In contrast with the wellness influencers in the MAHA movement, Lyons is unlikely to be caught promoting a supplement stack or posting shirtless cold-plunge videos. Instead he’s the suit with the salt-and-pepper beard in charge of making it all sound reasonable. I met Lyons last fall in Austin at the annual conference for Children’s Health Defense, the anti-vaccine nonprofit Kennedy founded in 2018, where he told me that the movement had been unfairly maligned as unscientific and irresponsible. We’ve since exchanged texts and spoken on the phone a number of times—usually late in the evening. “I feel like I could work around the clock and that I get more and more energy because I believe that I’m doing something that’s important,” he told me during one such exchange. Lyons considers Kennedy both a folk hero and a friend.

[Read: The meme-washing of RFK Jr.]

Lyons’s day job—and the way he first got involved in Kennedy’s world—is running Skyhorse Publishing. Lyons founded the independent press in 2006 and carved out a lucrative niche with books about fishing and sports along with occasional forays into politics, including former Minnesota Governor Jesse Ventura’s best seller American Conspiracies, which asserts that officials in George W. Bush’s administration were complicit in the 9/11 attacks, among other wild and unsupported claims. Over time, Skyhorse became known for acquiring titles by scandal-tainted authors, including Woody Allen and the Philip Roth biographer Blake Bailey, after they’d been dumped by major publishing houses.

Lately Skyhorse has become the publisher of choice for MAHA-aligned writers—so much so that it now has a MAHA imprint. In 2014, Skyhorse published Thimerosal: Let The Science Speak. The book, edited by Kennedy, makes the case that the mercury-derived vaccine preservative is dangerous and could be to blame for the rise in autism rates since the 1990s. (Thimerosal was removed from routine childhood vaccines in the United States such as DTaP, which protects against diphtheria, tetanus, and whooping cough, in 2001; no credible evidence has linked the compound to autism.) The book was widely panned, including by the Union of Concerned Scientists, which cited its “misrepresentations of facts and slippery slope distortions of research.” But those reviewers, Lyons said, “were making the argument that Bobby Kennedy was dangerous” not because Kennedy’s views ran counter to experts in the field—though they certainly did—but because he was a threat to pharmaceutical companies’ profits. (The Union of Concerned Scientists doesn’t accept corporate or government funding.)

Skyhorse has since published a dozen or so books by Kennedy, including a memoir and several more anti-vaccine treatises. The most successful of those books, by far, is The Real Anthony Fauci, a nearly 500-page diatribe against the now-retired director of the National Institute of Allergy and Infectious Diseases that suggests that drugs such as hydroxychloroquine and ivermectin are effective treatments for COVID (they are not) and entertains doubts about whether HIV causes AIDS (it does). Since Kennedy took office, Skyhorse has also published books by his allies and family. Among them is a memoir by Kennedy’s wife, Cheryl Hines, and a satirical book about Fauci by Robert Kennedy III. According to Skyhorse’s website, a children’s book titled Making America Healthy Again, due in August and written by the author of another book titled I’m Unvaccinated and That’s OK!, touts the “exciting progress” being made by MAHA, which includes “updating the childhood vaccine schedule to prioritize safer, evidence-based options.” (Last month, a judge temporarily blocked changes made to the childhood vaccine schedule in response to a lawsuit filed by the American Academy of Pediatrics. When I asked Lyons whether the book would be updated, he demurred.)

[Read: A new level of vaccine purgatory]

Before Kennedy was confirmed last year, he disclosed that he will receive advances of $2 million to $4 million from Skyhorse for three upcoming books. According to Lyons, the health secretary has been working on a new book, though it’s not listed on Skyhorse’s website. Lyons wouldn’t reveal the title or when it would be available, though he did confirm that the book would include an account of a supposed CDC cover-up of vaccine harms. For years, Kennedy has accused the CDC of practicing politicized science, and during his confirmation hearing, he said it might be the most corrupt agency in the federal government. Hundreds of people will be involved in researching and fact-checking the book, Lyons told me. (The Department of Health and Human Services did not respond to a request for comment.)

Skyhorse authors are frequent guests on the MAHA Action Media Hub, a livestreamed show that Lyons hosts every Wednesday afternoon. When Senator Rand Paul of Kentucky appeared on the show in December to question the necessity of the hepatitis-B birth dose, a split screen showed the cover of his 2023 Skyhorse book, Deception: The Great COVID Cover-Up. Russell Brand, the British comedian who has become MAHA’s court jester—and who in his home country faces charges of rape, which he has denied—usually appears toward the end of the show to proclaim his unabashed admiration for Kennedy, sometimes while driving in his car and once while naked in the bathtub. (Brand’s book How to Become a Christian in Seven Days is forthcoming from Skyhorse in May.) Another regular is Robert Malone, who has written a couple of conspiracy-themed books for Skyhorse denouncing the news media and the government, which he accuses of wielding “reality-bending information-control capabilities.” Kennedy named Malone to the CDC’s vaccine-advisory panel last year, but he recently quit in a huff, complaining that the Trump administration now considers debate over vaccines a “losing issue” in the midterms. In fact, the fate of Kennedy’s entire handpicked panel is in legal limbo, and the health secretary has apparently stopped speaking publicly about vaccines altogether, reportedly at the White House’s insistence.

[Read: RFK Jr. is losing his grip on the CDC]

I asked Lyons what he thought of reports that Kennedy has been reined in, and that Trump advisers worry that MAHA, far from being the key to victory in the midterms, has become a distraction or even a liability. Lyons wasn’t having any of it. He denied that he’s personally been instructed by the White House, or Kennedy, to stop talking about vaccines: “Nobody’s telling me what to do.” The reason the movement seems to be in turmoil now, he said, is that corporate interests and “corrupt deep-state allies” are trying to convince the left that MAHA has gone too far, and the right that it hasn’t gone far enough. “Who has been looking at the hidden ingredients in our food that are making us sick?” he said. “MAHA comes along, starts telling you what these things are, and then we have every major newspaper in the country saying that we’re anti-science, and that everything’s settled, everything’s perfect the way it is.”

Everything’s not perfect the way it is. The majority of American adults have at least one chronic disease, such as hypertension or diabetes. Most of us consume too much sugar and don’t get enough exercise. Some of MAHA’s priorities—like encouraging Americans to eat less junk food and be more physically active—should be uncontroversial. At the same time, MAHA rhetoric has also undermined confidence in childhood vaccines as measles outbreaks in under-vaccinated communities threaten the country’s elimination status.

Lyons, like Kennedy and other anti-vaccine advocates, rejects the idea that MAHA is anti-vaccine, instead casting it as an effort to challenge taboos and champion medical freedom. “The success is that people are starting to see through the idea that somehow vaccines are magic,” he told me. The issue is personal for Lyons: His adult daughter, Lina, has severe autism, and he has described her as vaccine-injured. Lina communicates using a method in which a nonspeaking person spells out words with the assistance of a facilitator, often a family member. The American Speech-Language-Hearing Association, along with other medical organizations, considers the technique scientifically discredited. But at a MAHA event in January, Lyons told the audience that, thanks to facilitated communication, “what we’re seeing now is that these children’s brains are intact.” Lina is writing a book using the technique; Lyons told me it will likely be published this summer.

It’s easy to imagine how the media and political infrastructure Lyons has helped create could serve as a springboard for a presidential campaign. In February, MAHA Action hosted Kennedy at an “Eat Real Food” event in Austin featuring Steak ’n Shake burgers and fries (cooked, naturally, in beef tallow) along with complimentary copies of The MAHA Cookbook (published, naturally, by Skyhorse). I was there, and it felt, at times, like a campaign rally, albeit one with posters of whole milk and ribeyes. Nevertheless, Lyons insists that the odds of Kennedy running for president are one in a million. “He is not really trying to get more power,” Lyons told me.

[Read: MAHA has been given an impossible task]

Whether Kennedy can hold on to the power he already has may depend on whether Lyons can somehow appease Kennedy’s restless supporters—all while convincing Republicans that, when it comes to their chances next November, MAHA actually matters.

HHS Officials’ Year in Purgatory Is Ending

2026-03-31T18:17:58-04:00

Last week, the Department of Health and Human Services finally followed through on a plan it first outlined for several of its top officials nearly a year ago: It reassigned them to positions in the Indian Health Service.

Many of the officials who were sent the reassignments—a group that includes at least half a dozen top-ranking employees at the National Institutes of Health, the CDC, and other agencies—have been on administrative leave since last spring, when they were abruptly ousted from their roles without explanation, or any indication of how long their hiatus might last. So they were shocked last week when, with no preamble, they received phone calls, then a letter, informing them of their new role, and an April 8 deadline to decline or accept.

In most or all cases, accepting these new roles would represent a major career shake-up and force a move across the country: Many senior HHS officials are based in Maryland—where the FDA and the NIH are located—or near Atlanta, where the CDC is headquartered; the recent letters lay out reassignments to places such as Arizona, New Mexico, Oklahoma, North Dakota, and South Dakota. If the officials accept the reassignments, they’ll be expected to report for their new jobs no later than May 26. If they decline, the officials expect to be removed from federal service entirely.

I spoke with two of the letter recipients, along with several former HHS officials who were also placed on leave by the administration last spring; all of them requested anonymity to avoid professional repercussions. For several of the reassigned officials, April 1 will mark the one-year anniversary of when they were put on administrative leave, shortly after HHS initially proposed via email to reassign them to IHS. The two officials who recently received reassignments also told me that last week is the first time they’ve heard from HHS since May or June 2025, when they were asked to provide their CVs. After being left for so long in limbo, then given so little time to make this choice, some officials feel like HHS is pretending it didn’t ghost some of its highest-ranking, highest-paid employees for the better part of 12 months. “Honestly, it’s hilarious,” one official told me: HHS did do what it said it would. It just took a year to do it.

When reached for comment, Emily G. Hilliard, HHS’s press secretary, emphasized in an email that HHS was dedicated to improving the IHS and that “each executive who joins IHS will strengthen leadership capacity and support mission delivery.”

IHS is, unquestionably, in need of more staff, especially in its more rural and remote locations. For years, the agency’s vacancy rate has hovered around 30 percent (and, for certain roles, has climbed higher in some regions). Last spring, when dozens of HHS officials were initially put on administrative leave, Thomas J. Nagy Jr., HHS’s deputy assistant secretary for human resources, wrote to them in an email that American Indian and Alaskan Native communities deserve “the highest quality of service, and HHS needs individuals like you to deliver that service.” In January, the IHS also announced what it described as the “largest hiring initiative” in its history to address staffing shortfalls, noting that the effort had the full support of HHS Secretary Robert F. Kennedy Jr., who has described tribal health as a priority.

But the reassigned officials and the tribal-health experts I spoke with both questioned how well the new reassignments fit current IHS needs. The primary feature of the re-assignees, as a group, is that they were high-ranking officials with extensive experience in administrative leadership; many were running departments of hundreds of employees or more. Among those who received the proposed reassignment last spring were the directors of several NIH institutes, leaders of several CDC centers, a top-ranking official from the FDA tobacco-products center, a bioethicist, a human-resources manager, a communications director, and a technology-information officer. Meanwhile, IHS’s greatest need is for “hands-on clinical people,” such as physicians and nurses, David Simmons, the director of government affairs and advocacy at the National Indian Child Welfare Association, told me. “People in communications, HR, researchers? Those are not going to be the people who are going to be helpful on a daily basis,” Simmons said. “On some level, I have to ask the question: Why are they sending these kinds of people?”

Last week’s letters, also signed by Nagy, described new IHS positions, multiple of them located at small hospitals in some of the country’s most rural and remote regions, several officials told me. The roles come with titles such as “Chief of Staff” and “Senior Advisor,” but the letters don’t describe the specific responsibilities attached to those positions. I asked one official whether their credentials lined up in any way with their reassigned role. “Zero,” they told me. If senior-executive officials accept the reassignment, the letters say, they will keep their current salaries—a minimum of about $150,000, though many high-level reassigned officials make far more, two officials told me. The IHS will likely be responsible for the salaries of reassigned officials, one NIH official told me, even though its budget is a small fraction of the NIH’s; the official told me that, as far as they could tell, they would be making about as much as their new supervisors.

To build trust and effectively deliver care, health officials need to be deeply familiar with tribal communities’ needs and should have an understanding of the local culture, Simmons told me. In 2023, American Indians and Alaskan Natives had lower life expectancy at birth than any other racial and ethnic group in the United States; Native people are especially vulnerable to conditions such as asthma, diabetes, and substance-use disorder. Tribes also have a long history of being severely mistreated by the federal government. But the officials I spoke with told me that they were not aware of any reassigned individuals who identified as Native or had extensive background in working with such communities. Last year, Deb Haaland, a member of the Pueblo of Laguna and a Democratic candidate for governor of New Mexico, criticized the reassignment proposals as “shameful” and “disrespectful.” The experts I spoke with also weren’t aware of any attempts HHS had made since to thoroughly consult tribal leaders about these reassignments; in at least one case, when a reassigned official tried making contact with their new hospital, with their new hospital, their new supervisor expressed confusion about who the official was or why they were reaching out at all, three current and former HHS officials told me. (Hilliard did not address my questions about whether the IHS or tribal leaders had been consulted about the reassignments, how qualified the reassigned officials were to meet the agency’s needs, or why HHS made the reassignments now.)

Meanwhile, health experts across the country have felt the loss of these officials from top tiers of HHS, especially agencies that focus on public health. “At the local health department level, we depend on their expertise,” Philip Huang, the director of Dallas’s health department, told me.

What prompted HHS to finally end these officials’ administrative leave is unclear; many officials had wondered if their hiatus might stretch on indefinitely, until they themselves chose to resign, as many of their colleagues have. The action may have been triggered by guidance from the Office of Personnel Management, released after the officials were first put on leave and newly effective in 2026, that limits administrative leave connected to workforce reassignment to 12 weeks. The end of March coincides with that limit.

No matter the trigger, the officials I spoke with told me they feel roughly the same as they did a year ago: “They obviously don’t want us to take these jobs, and want us to leave on our own,” one official said. Firing federal officials is difficult, especially without clear cause, and none of the officials I spoke with could identify a valid reason that they or their colleagues had been in federal limbo since last spring. The officials I spoke with uniformly emphasized that filling IHS with qualified people is essential, but added that they didn’t fit the bill. And several officials told me they worry that, should many of the reassigned officials reject the government’s offer, IHS will have a harder time attracting the personnel it needs. HHS’s “goal is to get people out, and I think that has been the goal from the beginning,” another official told me. “It’s cruel and unkind and unprofessional.”

Some of the letter recipients still feel extreme pressure to accept their reassignment. One told me that they’re just weeks away from full retirement eligibility but can’t run out the clock before the acceptance deadline passes. “I might have to move,” the official said. And, as federal policy states, if HHS pays for any part of their relocation, they’ll have to remain in a federal job for at least a year. (Early-retirement options do exist, with fewer benefits; another official told me they’re taking this option, and accepting another job elsewhere.) Still, even as officials weigh their decision, they feel a new sense of finality: Their administrative leave is ending, and whatever hope they might have had of returning to the agencies they once worked at has been extinguished.

The Family That Decided to Have Their Stomachs Removed

2026-03-31T11:45:03-04:00

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“What do you mean, you just take the stomach out?” Karyn Paringatai wondered, when doctors first said her stomach had to be surgically removed. Could she still eat? Yes, but differently. What would replace it? Nothing. She would have to live the rest of her life missing a major organ.

Paringatai was not actually sick, not yet. Her stomach was fine. But her cousin, just a few years older, had recently died of an aggressive stomach cancer at age 33, leaving behind three children. In a video recorded after her diagnosis turned terminal, the cousin told her little kids to be good for their father. “Please don’t be too mean to the lady that he meets,” she added, anticipating how the void left by her death might be filled. But she must have known that this void could not be filled, not ever. The cousin’s own mother had died young of stomach cancer. So had her grandmother. So had her sister.

To the doctors who saw Paringatai’s cousin in Tauranga, New Zealand, this pattern was hauntingly familiar. Her cancer was an unusual and distinct kind called diffuse gastric cancer, in which cancerous cells percolate undetected through the stomach, forming obvious masses only in advanced stages—usually too late to treat. The doctors had witnessed the same rare cancer run through a large Māori family near Tauranga. In that family, one woman lost six of her siblings to stomach cancer; a boy had died at 14. The family now reached out to Paringatai’s. It’s genetic, they said. You have to get tested.

Paringatai, whose father was also Māori, got tested. And indeed, she carried a mutation in the same gene, known as CDH1, as the other family. This gave her a 70 percent lifetime risk of developing advanced diffuse gastric cancer. Because this form of cancer can metastasize so quickly and unpredictably, the only surefire method of prevention is a complete removal of the stomach, or total gastrectomy. It’s analogous to a preventive mastectomy for breast cancer—but far more physically taxing. A number of women with a CDH1 mutation have actually had both their stomach and breasts removed because this mutation can also confer a 40 percent risk of breast cancer. One of them told me, about her gastrectomy, “If you can do that, you can do anything.”

Paringatai’s surgeon could not answer all of her questions about living without a stomach—her total gastrectomy was the first he would ever perform in a healthy person. But she went through with the procedure in 2010, and she credits it with saving her life. In the operating room, her surgeon made a long incision down her abdomen, cut out the fist-size pouch of her stomach, and stitched her esophagus to her small intestine. She was the first in her family to have her stomach removed prophylactically. Others followed. On a recent trip to visit her father’s family, Paringatai found herself sitting on a porch with her aunties and cousins. Of the eight people there, she realized, only one still had a stomach: her partner. “You’re the odd one out,” she teased.

Mutations in CDH1 seem to be unusually prevalent in Māori families, where they arose multiple times, possibly because they once conferred some evolutionary advantage. But mutated versions of CDH1 have been found around the world too, and thousands of patients have likely now had gastrectomies to head off cancer.

In New Zealand, “we’re coming up to nearly 30 years of people living with no stomachs,” says Paringatai, who is now a Māori-studies professor at the University of Otago. For the past several years, she has been documenting the experiences of Māori with CDH1. That people can live this long without a stomach is a testament to the adaptability and resilience of the human body. That doctors resort to such radical measures exposes the limits of what modern medicine can offer.

The first Māori to undergo prophylactic gastrectomies were the family that warned Paringatai’s about the cancer gene. They knew all about the gene because they had helped find it. Back in 1994, Maybelle McLeod contacted a genetics lab at the University of Otago about the premature cancer deaths stalking her relatives. Among themselves, she told me, “nobody even talked about it.” The family believed they lived under a curse for letting their land be sold for a quarry. McLeod grew up listening to the quarry’s warning sirens, learning to take cover indoors before the blasting began. She watched as the hill near her home was stripped bare.

McLeod eventually moved away, became a nurse, and learned of the then-nascent field of cancer genetics. This, she thought, explained the so-called curse. The geneticist she contacted, Parry Guilford, agreed to take the case. But her family still had to be persuaded to trust this pakeha, this white man, with their DNA. Over a series of meetings—attended by as many as 100 members—Guilford explained that his motive was the same as McLeod’s: to find the cause of so much death. They ultimately agreed to a contract where only the family, not Guilford, could directly approach members and gather their DNA samples. From there, the gene mapping went quickly, and scientists homed in on CDH1. The gene encodes a protein that normally orients and aligns cells in the stomach; without it, the cells become lopsided, rogue, and possibly cancerous. Any parent with a mutation in the gene has a 50 percent chance of passing it on to their children.

This breakthrough meant that a genetic test could now reveal who was at risk of diffuse gastric cancer; the family would no longer have to live in fear of where cancer would strike next. McLeod herself tested negative for the mutation. She was in the clear.

But those who tested positive for the mutation now faced an agonizing new dilemma. Doctors could not guarantee that endoscopies, even annual ones, would reliably catch such an aggressive cancer in time. Total gastrectomies had been performed before, in patients whose stomachs were already ridden with tumors—but never routinely in healthy people who did not have cancer and may ultimately never have cancer at all. So now they had to choose: 70 percent chance of deadly cancer or surgery with a 100 percent chance of significant side effects?

Rangi McLeod, who worked alongside Maybelle in urging relatives to join the study, was the first of the family to test positive for the CDH1 mutation. Not long after, doctors found a tumor in his stomach. It’s not all bad news, Guilford recalls Rangi saying. “I can lead my family to the next stage.” His gastrectomy would no longer be strictly prophylactic, but he’d have his stomach out, he’d recover, and he’d show anyone who still feared the surgery that it was safe. Rangi did not recover, though. He fell into a coma after the new connection between his esophagus and intestine grew weak. He died a few weeks later. “The whole project almost fell apart immediately on the spot,” Guilford told me.

In time, the family decided that Rangi would not want them to stop—he would not want for their children and grandchildren to continue to succumb to cancer. The family found a more experienced surgeon in a bigger hospital in Auckland; the next 10 gastrectomies were a success. Since then, stomach cancers in the family have plummeted. And the hill where the quarry once operated is green again. The land, it turned out, had not been sold but taken by the government, and was returned to the family. In any case, the curse, some in the family said, had finally lifted.

A successful gastrectomy looks like this: For at least the first six months, your life revolves completely around food, and not in a fun way. You eat tiny portions 10 times a day. You have to chew, chew, chew food like gum to make up for the lack of a stomach. Your digestive system spews from both ends. Your blood sugar rises and crashes unpredictably; you faint at the worst times. You are tired all the time. You lose a lot of weight, which might feel welcome at first but then feels scary. You are unable to work for a couple of months—longer if your job is physical or your recovery is difficult. About one in 10 patients has complications serious enough to warrant hospitalization, according to studies done in U.S. hospitals.

Gradually, the upper part of the intestine adapts into a sort of stomach. You start eating larger portions, less often. You gain weight. You still need regular shots of B12, which you cannot absorb without a stomach. But several people more than 10 years out from surgery told me they eat almost normally—with only small, lingering quirks. Plain water, for example, can be strangely hard to drink, possibly because of its surface tension, while flavored water goes down fine. Young women who have had their stomach out routinely go on to get pregnant and have healthy children.

Still, those who ultimately recovered well knew of family members who continue to struggle years later with nausea or reflux or fatigue. One of Paringatai’s cousins left her teaching position because she could no longer physically keep up in the classroom. Another cousin, Isaia Piho, was a firefighter. He, too, switched to a less demanding job afterward. Isaia and his younger brother, James, told me they had watched their mother die of stomach cancer. They are fathers themselves now, and they did not want their children to experience the same.

But not everyone who weighs the odds decides on surgery. Guilford knows another guy, also a firefighter, who decided to keep his stomach. “I run into burning buildings every second day,” he told Guilford. “I’m good with risk.” He’s chosen to have regular endoscopies instead. Still others might prefer not to know that they carry a CDH1 mutation. In the McLeod family, a young man in his 30s who went untested recently died of cancer, Guilford said. Diffuse gastric cancer has remained stubbornly difficult to treat over the three decades he’s been studying it. At the stage when it can be easily detected, the survival rate is just 20 percent.

Doctors are still trying to fully grasp the long-term consequences of losing a stomach, which makes it more difficult for the body to take up nutrients. “We’re learning that gastrectomy severely impacts bone health in the long run,” Daniel Coit, a surgical oncologist who recently retired from Memorial Sloan Kettering Cancer Center, told me. The loss of stomach acid may make calcium harder to absorb. As these patients age and continue to lose bone density, they will be particularly vulnerable to fractures.

Coit, who performed numerous prophylactic gastrectomies in his career, thinks the social and psychological consequences of losing a stomach deserve more attention too. He had one family in which multiple people died prematurely of suicide or alcohol use after their surgeries. Did the procedure lead directly to their struggles, or unmask a previous predisposition? His example is only anecdotal, he said, but the issue should be studied.

This is anecdotal as well, but alcohol also came up repeatedly in conversations I had with people who have been through gastrectomies—without me asking. Either they themselves started drinking too much, or they had family members who started drinking too much.

James Piho told me he drank to numb his fear of cancer and then he drank to numb his depression after his surgery, when he was unable to provide for his daughter. James actually works in a drug-and-alcohol rehab center, and his experience had him wondering about a link between total gastrectomy and alcohol. Could it be psychological or biological, or both? For people who find drinking plain water uncomfortable, alcohol seems to literally go down easier. And bariatric surgery, in which the stomach is shrunk but not entirely removed, is correlated with a well-documented increase in alcohol-use disorder. Losing even part of a stomach may make patients’ bodies more sensitive to alcohol—two drinks, according to one study, might feel like four. Haupiua Steventon, a member of McLeod’s family who had her stomach removed at 18, got a job at a bar after the long recovery derailed her university studies. “I fell into alcoholism very easily,” she told me. She eventually found her footing and has two kids now, but looking back, she wishes she had been warned about alcohol post-surgery. She wouldn’t have chosen to work in a bar.

In interviews that Paringatai conducted with different generations of McLeod’s family, she observed that some of the younger members struggled more, mentally, post-surgery. The older generation, she told me, had witnessed the deaths of so many “mothers, sisters, fathers, first cousins, children, grandchildren.” Today, young people in the family have not experienced those tragedies firsthand—a sign of progress that nevertheless made the sacrifice of a stomach harder to bear.

“I think we’ll look back one day and we’ll go, ‘Man, I can’t believe that we did such draconian surgery on those people,’” Guilford said. His lab continues to investigate diffuse gastric cancer, with the hope of developing a treatment or drug that makes a total gastrectomy obsolete. In recent years, doctors have become more open to patients choosing surveillance over surgery, especially as it’s become clear that CDH1 carriers with no family history are at lower risk for diffuse gastric cancer—perhaps a lifetime risk of about 10 to 40 percent rather than 70 percent. But even Coit, who is among the more skeptical of surgery, recommends prophylactic gastrectomies for people with a strong family history. Their risk is high. Surgery is the best solution we’ve got. But of course, Guilford said, “people would love to keep their stomachs.”

Paringatai found that some of the Māori took their stomachs home, rather than allow the hospital to discard the organ as medical waste. In Māori culture, she explained, the body is sacrosanct. They wanted to honor the stomach, thanking it for its service. Several buried theirs on their family land. In a way, this is how they can, for now, keep their stomachs.

The Making of a Diagnostic Mind

2026-03-31T07:29:38-04:00

Gurpreet Dhaliwal sat onstage in a hotel ballroom in Minneapolis. The gray curtains behind him were illuminated by bright blue lights, giving the slightest hint of performance at an otherwise typical medical conference. The presentation was among the most anticipated at the Society to Improve Diagnosis in Medicine’s 2022 meeting. The attendees were there to watch a kind of showcase: a complex diagnosis in action.

Dhaliwal, a professor of medicine at UC San Francisco, was given the details of a patient he had never seen before. As another physician slowly revealed pieces of the case, Dhaliwal narrated his thinking out loud: why he was considering one possibility and rejecting another, and what each new clue revealed for him. Eventually, he decided that the patient was likely suffering from a dangerous buildup of pressure in her abdomen. Left untreated, she could experience organ failure. It was the correct diagnosis, and the audience responded with applause.

Dhaliwal is regarded as one of the country’s most gifted diagnosticians. Colleagues have praised not only his command of physiology but also his ability to make his reasoning legible—to turn clinical uncertainty into something teachable. “To observe him at work is like watching Steven Spielberg tackle a script or Rory McIlroy a golf course,” a New York Times reporter wrote in 2012.

“I appreciate the designation but sort of reject it, only because of my own philosophical stance, which is that it’s very hard to master the diagnostic process,” Dhaliwal told me when I talked with him for my book about diagnosis. He considers himself a student of diagnosis, committed to getting better. “To me, the concept of the master diagnostician is that you’re never good enough.”

That belief puts Dhaliwal on one side of a core question of medicine: Are some doctors inherently better diagnosticians than others, or is diagnostic excellence a skill that any clinician can achieve? Doctors usually get it right—some estimates suggest about 90 percent of the time. But with roughly 1 billion physician-office visits each year in America, even a low error rate can still affect a large number of people. A 2023 study estimated that 371,000 people die a year and 424,000 are disabled following a misdiagnosis.

In 2015, the National Academies of Sciences, Engineering, and Medicine published a seminal report on diagnostic error with a startling finding: Most people will experience at least one (such as a delayed, wrong, or missed diagnosis) in their lifetime, “sometimes with devastating consequences.” That report prompted a small but vocal group of physicians and other health providers to look inward. They argue that the number of diagnostic errors is unacceptable and must be improved. Dhaliwal has been part of the movement to figure out how.

Some research suggests that many, if not most, diagnostic errors arise from failures in thinking—cognitive bias, premature closure, insufficient reflection. Accordingly, some researchers frame diagnostic error as largely a problem in clinical judgment: the ability to reason through uncertainty and weigh competing explanations in order to reach the right diagnosis and make decisions about care. “Regrettably, how to think in medicine has been a much‑neglected area for medical educators, who stalled somewhere in the Middle Ages, or a century or two earlier,” Pat Croskerry, a retired professor in emergency medicine at Dalhousie University in Canada who’s known for his work on cognitive errors in the diagnosis, told me.

Dhaliwal credits his own abilities to paying close attention to his own thinking. “I do think you can train yourself to be a better diagnostician,” he said. Early in his training, he closely observed the physicians he most admired. Some of them had a knack for identifying rare diseases that evaded their peers. Others mastered the diagnosis of common conditions so thoroughly that they could recognize every permutation of pneumonia. Dhaliwal wanted to excel at both.

But when he asked physicians how to become that kind of doctor, their advice was usually the same: See a lot. Read a lot. It felt unsatisfying. Every physician sees patients. Every physician reads. What, he wondered, truly separates an exceptional diagnostician from a competent one?

He hung on to this question, and about two years after finishing residency in 2003, during a yearlong faculty-development course for medical educators, he encountered a session on clinical reasoning—an emerging field at the time. The physician and medical historian Adam Rodman has described clinical reasoning as “the study of the ability for expert physicians to see what others don’t.” Researchers were beginning to investigate what actually happens in doctors’ minds when they make diagnoses: how they organize their knowledge and put it into practice. Dhaliwal quickly recognized this as the quality he had seen in his role models, even though “they didn’t have a term for it, and neither did I.” The idea of clinical reasoning helped clarify the process; the next question was how to get better at it.

Dhaliwal laid out the key steps of a doctor’s reasoning process: collecting data from a patient; synthesizing that information; accessing “files” in the mind, including the details about diseases and how they present; listing possible diagnoses; and choosing one over others. He also began studying the science of expertise and how people—whether Nobel laureates, Olympic swimmers, or mechanics—become exceptional in their field. “They seek out challenges, whereas most of us instinctively try to minimize challenges after we’re competent,” he said.

They also learn from their mistakes. In a 2017 paper, Dhaliwal wrote that ordinary people develop “extraordinary judgment by extracting as much wisdom as possible from their inevitable errors,” a lesson he drew from Philip Tetlock and Dan Gardner’s book, Superforecasting: The Art and Science of Prediction. But medicine doesn’t make that easy for doctors, who may treat a patient once and never see them again. If the patient’s condition worsens, or they receive a different diagnosis later on from someone else, that information may never make its way back to the first doctor. With these ideas in mind, Dhaliwal set out to sharpen his skills. Today, he works in the San Francisco VA Medical Center’s emergency room, where he sees a variety of illnesses and necessarily follows that early advice to see a lot of patients. But, crucially, he also started keeping track of his own cases so that he could follow up on what happened. When he discovers he was wrong, he tries to figure out why. Did he miss something important? Was he exhausted at the end of a long shift? Did he anchor himself to a particular conclusion too quickly?

“I started to get kind of addicted to it,” he said. He explained that the mind wants closure; without knowing the outcome, people tend to assume that things turned out well. His habit of tracking down a patient’s outcome echoes advice delivered more than a century ago by William Osler, one of modern medicine’s founding figures: “Learn to play the game fair, no self-deception, no shrinking from the truth; mercy and consideration for the other man, but none for yourself, upon whom you have to keep an incessant watch.” Diagnostic mastery, Dhaliwal illustrates, is not a mysterious gift bestowed on a talented few. It is the result of examining one’s own thinking and practice without mercy.

But the reasoning that goes into diagnosis may start to look very different. Since his third year of medical school, Dhaliwal has read The New England Journal of Medicine’s Clinicopathological Conference, or CPC. The CPC is a teaching exercise in which doctors are presented with a real patient’s case and asked to reason aloud toward a diagnosis, similar to Dhaliwal’s Minneapolis presentation. Last fall, Dhaliwal participated in a CPC that put him in competition with an AI agent called Dr. CaBot, a medical-education tool developed by researchers at Harvard Medical School.

Both Dhaliwal and Dr. CaBot reached the correct diagnosis and explained their reasoning step by step. They correctly concluded that the patient had a problem in the upper part of his digestive system, which caused a bacterial infection to trigger sepsis, among other complications. Dr. CaBot didn’t identify the cause of the problem, whereas Dhaliwal deduced, correctly, that the man had swallowed a toothpick, which poked through his gut and caused the infection. He had seen that kind of case before.

That Dr. CaBot’s problem-solving came as close as it did to Dhaliwal’s is both promising and disconcerting: It suggests that machines may be able to match the performance of elite diagnosticians. More formal evidence also indicates that large language models may be able to approximate the kind of clinical reasoning expected of physicians. One study published in July 2024 found that when OpenAI’s GPT‑4 examined the medical information of 100 patients in an emergency room, the AI was able to diagnose them with 97 percent accuracy, outperforming resident physicians. (OpenAI’s models have advanced since then.) Another study found that ChatGPT scored higher on a clinical-reasoning measure than internal-medicine residents and attending physicians at two academic medical centers. Other studies have been more mixed.

Serious concerns about reliability, sycophancy, and hallucinations remain. But in some ways, what a diagnostician does is not so different from what AI claims to do. Both use enormous amounts of information to recognize patterns in symptoms and diagnoses that tend to appear together. A doctor does this through medical education and personal experience; AI does it by predicting plausible explanations based on statistical patterns it has learned from its training materials.

“This is an electric moment in medicine,” Mark Graber, a physician and co-founder of the nonprofit Community Improving Diagnosis in Medicine, told me. “If you can come up with an AI agent that’s as good as Gurpreet Dhaliwal, that is an amazing accomplishment that will surpass the abilities of 99.9 percent of doctors.”

How medicine embraces any of this is an open question. Perhaps AI will strengthen clinicians’ reasoning and close the gap between the Dhaliwals and everyone else. Or it could become a crutch for clinicians, and lead them to lose skills. A 2025 study found that after just three months of using an AI tool to find precancerous growths during colonoscopies, doctors were less likely to identify the growths on their own.

For his part, Dhaliwal is equanimous. “I think AI is going to transform health care radically. I don’t think it’s going to change doctoring radically,” he said. He believes that AI is likely to perform best at the extremes of diagnosis: the very simple cases (such as a poison-ivy rash) and the very complex ones (rare or novel diseases). In the not-so-distant future, people may be able to get answers to routine medical questions at home—What’s this spot? Is my cough concerning? How’s my blood pressure?—without ever needing to see a physician. That may be entirely appropriate, because attending to these everyday concerns usually does not require sophisticated clinical judgment or nuanced decision making.

AI could also prove valuable in identifying conditions that a physician may never encounter in their career, or in helping diagnose patients that have stumped multiple clinicians. These cases tend to hinge on how encyclopedic a doctor’s knowledge of the medical literature is; AI can recognize obscure patterns across millions of cases and publications, and surface possibilities that may lie outside any single physician’s experience.

“What I think is less likely to change is sort of the muddy middle, which is what I think the vast majority of medical practice is,” Dhaliwal said. Much of medicine involves choosing between possibilities: Does a person have an infection, an allergic reaction, or an autoimmune disease? Is it a psychiatric or medical issue? AI could certainly help parse through the options. But medical judgment goes beyond identifying what’s most likely; it involves deciding what the diagnosis means for a particular patient. Two people diagnosed with the same cancer may desire different futures. One may want the most aggressive treatment available, whereas the other may decline interventions that would trade quality of life for longevity. These are value-laden decisions that, at least for now, still require something irreducibly human to navigate. An LLM can recite treatment options and survival rates, but it cannot share responsibility for the choices that follow.

Relying on AI for certain aspects of diagnosis could help free doctors to focus on those more human parts of the job. In the United States, more than 100 million people don’t have a primary-care provider, and the profession itself is dwindling. “If in some form AI is able to beat us, or help us improve our ability to do clinical reasoning, you don’t have to be the smartest person in the room to be a physician, which I think is better for the community,” Jeffrey Goddard, a medical student at the University of Iowa who uses chatbots in his training, told me. A diagnosis, most simply, is an answer to the question What is making me ill? But it can offer much more than that—reassurance, coherence, and, ultimately, relief. Not all of that can be outsourced.

This essay was adapted from Alexandra Sifferlin’s book, The Elusive Body: Patients, Doctors, and the Diagnosis Crisis, published today.

MAHA Has Been Given an Impossible Task

2026-03-30T20:58:31-04:00

When he was interviewed onstage at the Conservative Political Action Conference on Saturday, Health and Human Services Secretary Robert F. Kennedy Jr. was asked a question unlikely to be on anyone’s mind in the midst of upheaval in the department he oversees and a conflict in the Middle East: “Who’s stronger—you or Secretary of War Pete Hegseth?”

The exchange was emblematic of the role that Kennedy and other HHS officials played during the four-day conference. As some MAGA attendees grumbled over the war in Iran, they were met with a whole lot of MAHA. Kennedy went after Froot Loops and bemoaned how Americans don’t know how to cook anymore. Mehmet Oz, the Centers for Medicare & Medicaid Services chief, warned about hospice fraud in California. And Jay Bhattacharya, the director of the National Institutes of Health and the acting director (of a sort) of the CDC, explained the value of repurposing already-approved drugs for new diseases. “This sounds geeky,” he told the crowd, “but it is really, really important.”

Perhaps the administration thought that leaning into health would distract from what’s going on in Iran—a sore subject for Republicans who want President Trump to focus on domestic issues. Kennedy did say, unprompted, that he believed that his war-averse uncle and his father would have approved of the military action. But he also was the most prominent member of the Trump administration to take the stage at CPAC. Notably absent was anyone named Trump or any official involved in the decision to bomb Iran.

If that was indeed the administration’s strategy, it didn’t seem to work among MAGA world’s staunchest opponents to Trump’s recent military action. Although a poll of this year’s CPAC attendees found that 89 percent approve of the administration’s actions in Iran, others I spoke with worried about the specter of another “forever war” in the Middle East. As Madeline Elizabeth, a Republican strategist who attended CPAC, told me, “I think that the MAHA movement is almost the only thing that’s ‘America First’ about this administration.”

As he has in his other recent public appearances, Kennedy mostly stuck to his talking points. He touted what he considers to be his wins at HHS—notably, the flipping of the food pyramid to emphasize protein consumption—and insisted that the president was “on my side on virtually every issue” when Kennedy decided to endorse Trump in 2024. But Kennedy didn’t mention his remaking of the CDC’s vaccine-advisory committee or the changes to the recommended childhood-immunization schedule, which are easily among the most consequential policies of his first year in office. Perhaps he avoided doing so because, as The Washington Post has reported, the White House has instructed him to stop taking action on vaccines for fear of Republicans losing the midterms. (The HHS spokesperson Andrew Nixon told me, “We remain focused on the priorities Americans consistently say matter most to them, including tackling chronic disease, improving nutrition and food quality, and lowering the cost of care and prescription drugs.” The White House did not respond to a request for comment.)

The closest Kennedy came to any talk of immunization was when he mentioned that, growing up, he didn’t know any kids who had autism—a seemingly veiled reference to his long-standing belief that vaccines have contributed to the rise in autism since the 1990s. That rise, according to experts, is largely due to better surveillance and broader diagnostic criteria. When Bhattacharya did talk about vaccines—to praise the shingles shot and to tease research on whether it might reduce the risk of Alzheimer’s—the crowd was unmoved. Bhattacharya’s only real applause line came when he said, “It’s no longer Tony Fauci’s NIH.”

[Read: RFK Jr. is losing his grip on the CDC]

Most of the CPAC-goers I spoke with told me they loved Kennedy. Usually in those words: I love him. They weren’t always sure about the specifics of his agenda, but they liked that he was in favor of being healthy. A CPAC attendee named Michael Smith, who was promoting the posting of the Ten Commandments in public schools and dressed as Moses—complete with a staff and a stick-on beard—told me that Kennedy was “getting us back to the Garden of Eden diet.” Several people, including a woman who says she lost 50 pounds just eating meat, told me their personal health stories. (Kennedy recently acknowledged that he’s on the carnivore diet.) Everyone, it seemed, had read Kennedy’s best seller, The Real Anthony Fauci, and many volunteered to me that they had not gotten the COVID vaccine.

The Kennedy adoration created an odd sense of tension at the meeting. It’s true that some GOP strategists have argued that the MAHA coalition is the key to Republicans winning the midterms later this year. For the most part, they’re talking about health-conscious voters who might be persuaded to back Republican candidates. Perhaps it should be no surprise that, at CPAC, the fans are MAGA first and MAHA as a kind of bonus.

But at the same time, the MAGA loyalties clearly supersede the MAHA hype. It was striking how no one seemed to be there solely, or even primarily, to support MAHA. At one point during Kennedy’s fireside chat, the interviewer, Mercedes Schlapp, asked attendees whether they were “MAHA moms.” In a crowd of several hundred, maybe a dozen hands shot up. Scanning the crowd, I saw no shortage of Trump-themed apparel, but no one wearing MAHA T-shirts or hats. Talking about MAHA priorities “doesn’t electrify anybody, and quite honestly, it’s not the conversation, like, broadly, that’s being had,” Vish Burra, a Republican strategist and MAGA provocateur, told me. (Last fall, Burra was fired from his job as a producer for One America News Network after he posted an anti-Semitic AI-generated video on his personal X account. He later deleted the post.)

[Read: The meme-washing of RFK Jr.]

Kennedy, who recently underwent surgery for a rotator-cuff injury, ended up telling Schlapp that Hegseth might have the edge in a test of strength: “He’s got a couple of pounds on me.” But even if Hegseth can bench more than the HHS secretary, at the country’s best-known conservative gathering, Kennedy was the one the Trump administration seems to have tasked with lifting up its disappointed fans.

Don’t Get Sucked Into the War on Lice

2026-03-29T10:53:35-04:00

The human-head louse has a ghostly quality. It tends to glimmer in and out of view, leaving only subtle signs and omens of its presence. Is that oblong speck an egg sac or a flake of dandruff? Was that a prickle on your scalp? Is it normal that your son is scratching just behind his ear? Maybe you have lice and he has lice, and you’ve all had lice for weeks. The possibility is frightening. The uncertainty leads to madness.

The louse evolved to be intrepid and sneaky. Its behavioral imperative is simple and relentless: “They are naturally negatively geotropic,” Ian Burgess, a medical entomologist who runs a company that tests insect-control products, told me. “They will always climb upwards towards the head.” He recalled a day when one must have fallen on his shoe during a comb-out in his lab. He was driving home that afternoon and noticed that the bug was sitting on his knee, apparently confused. “It had climbed to the highest point it could get, and it didn’t know where to go from there.”

Once the bugs ascend, they suck your blood and attach their eggs to the roots of your hair. Within a month or two, your skin might start reacting to the parasites’ saliva, and some degree of itching will ensue. But otherwise, a case of head lice has no ill effects. “To say the truth, head lice are not a real medical problem,” Kosta Mumcuoglu, a lice entomologist at the Hebrew University of Jerusalem, told me. Still, their presence is unwelcome, to say the very least. Emergency scalp checks, precautionary treatments, instant-onset symptoms of delusional parasitosis: “It is definitely a psychological, emotional problem,” Mumcuoglu said.

Mumcuoglu is an expert, but this was not a useful insight. I have two kids in elementary school. I am quite familiar with the psychological, emotional problem that is lice.

For decades now, experts have been trying to convince Americans that the plague of Pediculus humanus capitis is very mild, and that it doesn’t really merit drastic measures; for decades, too, parents have heard the opposite from schools, in the form of urgent letters saying lice have been detected and countermeasures are essential. Along the way, we’ve heard claims and rumors that the head-lice situation is deteriorating—that outbreaks are increasing, that drug-resistant superbugs are taking over. Yet the basic facts of lice remain the same. The parasites are programmed to get up to our heads. We are programmed to let them get inside our minds.

The modern lice wars got their start in Newton, Massachusetts. Deborah Altschuler’s son had lice, and his school implied that this was her fault—that a family like hers would not be welcome anymore. It seemed to her just then, in the early 1980s, that the school itself should have taken more responsibility, that its policies on lice should have been clearer. For that matter, shouldn’t everyone, from parents up to politicians, have been more informed about the problem?

The group she formed out of her home, first called Parents Against Lice and later the National Pediculosis Association, would advocate for aggressive lice-check protocols and more systematic rules for expelling kids from class. If this was not a movement to abolish lice, then it was at least an all-out bid for taking head lice seriously as a public-health concern. With the help of several entomologists at Harvard and the University of Massachusetts, Altschuler pressed the case. At one point, she proposed that head lice were a vector for the virus causing AIDS, spreading it from scalp to scalp. “I felt that AIDS was a wake-up call,” she told me. “We got lucky that it wasn’t insect borne, but it could’ve been.”

[From the September 1987 issue: AIDS and insects ]

Altschuler also worried that the common treatments of the time—various insecticide shampoos either used alone or, more distressingly, in combination—were causing harm to kids. In this and other ways, she was an early incarnation of the MAHA mom: incensed about the failings of the public-health establishment, inclined to do her own research, worried about toxic products and the companies that manufacture them. And in the ’90s, her approach to lice caught on. A new industry of lice consultants and lice-removal salons began to form. Altschuler herself became a known expert in the field. (Her proudest moment, she said, was speaking to the Armed Forces Epidemiological Board in 1992, not long after Operation Desert Storm.) Eventually she’d have a dozen people working for her association, taking about 100 calls a day and selling T-shirts with messages such as Keep your wits, not your nits and Don’t let your child become an egghead.

But even as this wave was gaining strength, a sort of countercurrent formed beneath it. One of Altschuler’s Harvard contacts, a public-health entomologist named Richard Pollack, had begun to worry that the newly fostered panic was unfounded. He knew that the bugs were harmless in themselves; more than that, he believed that they might be far less prevalent than many people suspected, especially the ones who had been reaching out to him with horror stories: “They were telling me that lice had become so common, so abundant, that I could go into any elementary school and collect thousands of them in a morning.” But when he followed up on this idea, and started doing field research on grade-schoolers’ heads, the results weren’t really that alarming. Misdiagnosis was indeed a rampant problem, and the people who were the most upset—the ones who’d put their families through repeated treatments—were the least likely, as he saw it, to actually have lice. “They were stuck in this vicious cycle,” he told me.

A folk entomology of head lice had taken hold, and it entailed a range of false beliefs. Pollack sometimes heard it said that lice could jump from one child’s head to another, and that they were infesting kids from classroom desks and rugs. None of this was true, he said; in general, contagion happens with only direct head-to-head contact—and a louse that falls off a kid at school will soon dry out, infesting no one else. (Mumcuoglu told me that parents needn’t worry about lice-infested furniture or bedding either.)

Even worse, for many schools and lots of parents, the mere presence of a nit, or even a nitlike object in a child’s hair, was prima facie evidence of a dangerous contagion. But a louse’s empty egg sac can remain adhered to growing hair for months, like a shell casing on a dormant battlefield. This is one reason why studies find little benefit from screening kids in class: False positives abound. In 2006, Mumcuoglu estimated that two-thirds of all lice treatments in the U.S. are given to children who don’t have an active infestation. And because many schools send kids home if they’re suspected of having lice, those false positives may add up to as many as 24 million lost days of school. (No one has tallied the time and tears wasted on unnecessary pillow quarantines and the bagging of stuffed animals.)

If Altschuler and her group hoped to raise awareness and concern, then Pollack sought, in part, to tone things down. The two of them had worked together in the ’90s, but inevitably they had a falling out. “Early on, I saw him as a wonderful ally and a helpful person to the cause,” Altschuler told me, “but then he started trying to become us, in his own way, with information that was inconsistent with ours.”

In particular, Pollack and the other head-lice moderates took aim at the unforgiving “no nit” policies in schools, which might exclude a child from the classroom on the basis of a single empty egg sac, and they were winning some important hearts and minds. In 2002, when the American Academy of Pediatrics put out its first clinical report on treating head lice, its authors called no-nit policies “detrimental” and “a response to infestations that is out of proportion to their medical significance.” Two years later, the nation’s school nurses—who have been focused on the scourge of head lice since their profession’s founding in 1902—followed suit. Eventually, some school systems would ease up too. In New York City, where I live, the public schools that service a million students had done away with no-nit policies by 2008.

These were salutary changes, to be sure. Fewer kids would be ejected from the classroom, and presumably some degree of lice-related learning loss was curbed. But the new guidelines did not eliminate the broader set of problems that the parasites create for children and their families. Even though some schools now tolerate nits on children’s heads during the school day, they still communicate aggressively with parents on lice-related matters, encouraging frequent checks at home and better-safe-than-sorry interventions.

No one ever articulates the rationale for treating the mere possibility of lice with more concern than a cold or even COVID. (No one ever gets a letter home from school saying A case of rhinovirus has been detected in your classroom.) But the thinking surely boils down to this: It’s icky to imagine that your child’s hair—and yours!—might at this very moment be aswarm with bloodsucking bugs. Once the lice have gotten to your head, and in your head, no amount of “Just calm down” can make them go away.

If the fear of lice can be recalcitrant, the lice themselves are even more defiant. “It’s an insect that is abnormally subjected to stresses on its survival,” Burgess, the entomologist who tests insect-control products, told me. A louse’s clawlike feet hold fast in both a shower and a swimming pool. Its physiology weathers perfumes and soaps and the bristles on our hairbrushes. And given time enough, its genome may adapt to shrug off almost any poison we apply.

You don’t need to hire experts to dislodge an infestation—humans have managed to delouse themselves since deep antiquity—but the process takes some work, along with proper information. I’m sorry to say that the latter isn’t always near at hand. The New York City schools, for instance, suggest that parents give their kids chemical treatments, naming two kinds in particular—permethrins and pyrethrins—that were obsolesced long ago by insect evolution. America’s head-lice problem will never improve, Mumcuoglu told me with some annoyance in his voice, so long as our institutions insist on making this mistake, particularly about permethrin. (In an emailed statement, the New York City Department of Health said that over-the-counter, permethrin-based products are “an accessible starting point for many families,” but other products may be necessary if “there is treatment failure or suspected resistance.”)

In fact, we do have many other ways of getting rid of lice, even so-called drug-resistant superlice. Ivermectin may not be an anti-cancer, anti-COVID wonder drug, but it’s miraculous at treating parasites: A topical ivermectin cream can likely cure your child of an infestation, and may be purchased over the counter. Ivermectin pills—which could be even more effective—can be prescribed off-label. (Dawn Nolt, the lead author of the American Academy of Pediatrics’ head-lice report, told me that ivermectin may be upgraded to a first-line treatment in the next update to the guidelines.) I happen to be partial to dimethicone, a lubricant that will coat a louse’s body and seal up the holes it uses to get rid of excess water. Since dimethicone’s effect on lice is physical instead of chemical, it may be less likely to provoke resistance over the long term. But Burgess, who first identified dimethicone as a lice-killer, warned me that he’s seeing signs of its waning potency. (Perhaps the louse’s body has been changing shape, he said, and their excretion holes are now harder to plug up.)

[Read: How ivermectin became right-wing aspirin]

And then, of course, there is the fine-toothed comb—a medical device that seems to have been in use by human populations for at least 5,000 years. (Archaeologists have found lice on human mummies, and lice combs in mummies’ tombs.) Combing, when performed with diligence, can sometimes be effective on its own accord, even if it’s also highly, highly inconvenient. Proper combing technique involves sectioning out and clipping up the hair in strips, then combing out each section repeatedly while inspecting for lice and nits that may be the size of sesame seeds. After that, one might need to repeat the entire procedure as soon as two or three days later. Strangely, the AAP guidelines say this process might be beneficial, head lice notwithstanding, in the sense that it allows “a caregiver and child or adolescent to have some close, extended time together.” Extended? Yes. Close? Please be serious. I asked Nolt why the AAP was spreading this absurd misinformation. “We were trying to have a silver lining,” she said.

But there is no silver lining, I’m afraid. In the end, the lice wars have only brought us back to where we started, and also where we’ve always been: worried, inconvenienced, and confused. Pollack says he’s proud of what his 40 years of advocacy accomplished—“an awful lot of kids stayed in school, rather than being sent home,” he said. But he also knows that certain head-lice myths have never gone away, and maybe never will.

When I spoke with Altschuler, she lamented the idea, sometimes floated by today’s head-lice experts, that head lice aren’t so important. “They are important for the people who have them,” she said. This, at least, is a scientific fact.

America’s Raw-Cheddar Chaos

2026-03-28T07:00:00-04:00

Raw Farm does not sell your typical cheddar. A one-pound block of the aged, GMO-free cheese retails for $16. (Naturally, it’s for sale at Erewhon, the high-end grocery chain.) Some people are willing to pay that kind of premium because the cheese is made exclusively from unpasteurized milk. So is almost everything else that’s sold by Raw Farm, a 400-acre dairy farm in Fresno, California, that is commonly cited as the country’s biggest purveyor of raw milk and cheese. When Robert F. Kennedy Jr. ran for president in 2024, his running mate, Nicole Shanahan, visited Raw Farm and filmed herself on a tour of the milking operations. Raw Farm has carved a very successful niche out of the unfounded belief that raw milk and cheese are more nutritious than the regular stuff.

Pasteurization exists for a reason: It is a time-tested way to make sure that dairy products don’t contain bacteria that can make you sick. And now Raw Farm has found itself in the middle of an E. coli outbreak. The FDA is pointing to Raw Farm’s cheddar cheese as the reason nine people—including multiple children under the age of 5—have fallen ill. Three of the individuals have been hospitalized, and one has developed a serious kidney condition. Regulators have asked Raw Farm to recall the product. Yet the company has refused to do so. Grocery stores are still carrying the cheddar.

A maxim of food safety is that when the government says your product is making people sick, you stop selling it. Sometimes companies are in a “state of shock and disbelief,” Frank Yiannas, a former deputy FDA commissioner who was previously the vice president of food safety at Walmart, told me. “They can’t imagine that it’s truly their product.” In the history of the modern FDA, essentially every company implicated in a foodborne outbreak has agreed to a recall—until now. Democrats in Congress have even tried to place pressure on Raw Farm to pull the product off shelves, but the company is not backing down.

[Read: The real appeal of raw milk]

In this cheddar chaos, Raw Farm has painted itself as the victim. When I spoke with Aaron McAfee, the company’s president, he was quick to note that he takes safety very seriously. Raw Farm has voluntarily recalled its products at the FDA’s urging more than a dozen times. In 2024, Raw Farm immediately pulled its cheddar cheese after it was linked to E. coli. (The company subsequently wrote on its website that the recall was “UNFOUNDED.”) This time, however, the request “just felt wrong,” McAfee told me. He insists that the government’s case is based on “circumstantial evidence” and that his company isn’t at fault. None of Raw Farm’s cheddar has actually tested positive for E. coli.

Food-safety investigations are messy. Regulators need to move quickly to prevent more people from getting sick. Companies are often asked to voluntarily initiate a recall before the government can actually prove that a product is unsafe. At times, the FDA does shift its focus to other foods: In 2008, the agency warned consumers not to eat tomatoes suspected to be contaminated with Salmonella, but it later identified serrano peppers as the likely cause of the illnesses.

Still, food-safety experts I spoke with were emphatic that the FDA is probably correct about Raw Farm’s cheddar. Despite the lack of a positive test that the cheese is contaminated, the agency has two facts to rely on: The E. coli strains from all of the patients are closely related, suggesting that they came from the same product. Second, of the eight people who investigators have been able to interview, seven confirmed that they consumed Raw Farm’s dairy products. “The statistical likelihood of that just being pure chance is almost zero,” Yiannas said.

The agency does have the legal power to force Raw Farm’s cheese off the market through a legal maneuver known as a mandatory recall. Such a move has little precedent. In 2018, the FDA forced a mandatory recall of a brand’s kratom supplement, which had been contaminated with Salmonella. But the FDA would likely be in a tougher situation this time around. The kratom seller didn’t fight the mandatory recall, but Raw Farm would. McAfee told me that he had asked the FDA to pursue a mandatory recall because it would give him the opportunity to appeal. “I was not granted due process,” he said. (Companies can request an “informal hearing” to discuss the order.)

Exactly why the FDA hasn’t moved forward with a mandatory recall is unclear. (I asked a spokesperson at the Department of Health and Human Services, which oversees the FDA. The spokesperson referred me to only what the FDA has already said publicly about the case.) The agency could still be gathering the necessary evidence to justify such a step. Or perhaps Kennedy doesn’t want to declare a mandatory recall: He said shortly before his nomination as HHS secretary that the FDA’s alleged “war” on raw milk must end. McAfee claimed that Kennedy is a Raw Farm customer but that he has “not heard anything from D.C.”

[Read: America’s real ‘secretary of war’]

Even if the FDA eventually pushes Raw Farm to pull its products off the shelves—whether voluntarily or through force—that may not be the end of this saga. The reality is that we might never know with 100 percent certainty what caused those nine people to get sick. And doubt about the dangers of unpasteurized products is a reason they are so popular in the first place. The business of raw milk is based on convincing people that the milk is worth consuming despite objections from the FDA that it has no proven benefits over conventional pasteurized products and that it comes with an outsize risk of making you sick. If people found the FDA credible, a company like Raw Farm wouldn’t exist.

During my conversation with McAfee, it was easy to see why people might believe him more than they would a nameless bureaucrat. He talked about trusting his cheese so much that he feeds it to his daughter, and he cited FDA regulations like a trained lawyer. When we spoke, he was quick to emphasize all of the tests his company had done to ensure that the cheese was safe, and he referenced the company’s food-safety plan, which spans five binders.

People experiment with all kinds of products because they trust unproven anecdotes over government warnings. But the fact that a company is willing to risk more people falling sick from E. coli because of a belief that the FDA can’t be trusted should be a much bigger wake-up call for the agency. By McAfee’s telling, Raw Farm is the subject of a “witch hunt.” The FDA has the power to regulate the food supply with an iron fist, but its job has historically been much easier because companies have faith that the agency is doing what it can to stop an outbreak. That is no longer a guarantee.

RFK Jr. Is Losing His Grip on the CDC

2026-03-25T18:47:18-04:00

Updated at 7:40 p.m. ET on March 25, 2026

Today, Acting CDC Director Jay Bhattacharya said something that no other prominent health leader in the Trump administration has. “I think it is vital that every kid in this country get the measles vaccine. Absolutely vital,” he told CDC staff at a meeting this morning.

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That declaration went further than Health and Human Services Secretary Robert F. Kennedy Jr.’s previous tepid endorsement of the vaccine did—and is in line with what past CDC directors have said about immunization. In fact, the whole point of the meeting seemed to be to signal a turn toward normalcy, away from the more extreme elements of Kennedy’s agenda. Bhattacharya told the CDC’s beleaguered employees that the agency needed to “move on” from the chaos of the past year. He encouraged employees to “remove politics” from their work and “focus on what we know how to do.” He echoed Kennedy’s slogan while acknowledging the limits of his position, but also seemed to contradict it, saying, “You can’t just snap your fingers and make people healthy again.”

By tomorrow, Bhattacharya’s position may be even more limited. Thanks to some complicated laws about federal governance, if President Trump does not nominate anyone for the role of CDC director by the end of the day today, no one can serve in that role in an acting capacity. Right now, all signs point to the administration missing the deadline. Andrew Nixon, a spokesperson for the Department of Health and Human Services, told me that Bhattacharya “will continue to oversee the CDC by performing the delegable duties of the CDC director” until a nominee is found. He also said that Bhattacharya and Kennedy are “aligned to refocus the CDC on its original mission of infectious diseases,” and pointed me to a post in which Bhattacharya said he learns much from “respectful conversations” about his disagreements with Kennedy.

The nomination delay comes at a moment when the Make America Healthy Again movement and, by extension, Kennedy appear to be on the ropes. MAHA supporters are angry that Trump recently signed an executive order shielding the makers of the weed killer glyphosate from legal liability. The confirmation of Casey Means, the wellness influencer whom Trump nominated to become surgeon general, appears to be stalled in the Senate. The FDA’s vaccine chief, Vinay Prasad, will leave his position for the second time at the end of April, following a tumultuous tenure. Last week, a federal judge ruled that the CDC’s January shrinking of the childhood-vaccine schedule was probably illegal, and that Kennedy likely broke the law, too, when he remade the CDC’s vaccine advisory panel in his own image. All of the decisions made by that panel, the judge ordered, should be put on hold. The committee’s vice chair, Robert Malone, a Kennedy ally and a popular figure in the MAHA movement, resigned yesterday.

[Read: A new level of vaccine purgatory]

Each of these events individually is bad news for Kennedy’s agenda; together, they suggest that his grip on power is waning. Kennedy has a history of advocating against glyphosate, and has indicated that he’s disappointed with that decision. The White House no doubt knew that the executive order would cause problems for Kennedy among the MAHA base—and the president signed it anyway. Means is a like-minded Kennedy ally, and her rejection would be a defeat for the movement. After Kennedy, Prasad is the senior official most antagonistic toward pharmaceutical companies. (An HHS official told me that Prasad had planned to return to his academic job after a year at the FDA.) And as my colleague Katherine J. Wu has written, Kennedy may struggle to find new vaccine advisers who support his agenda and can get through the traditional vetting process.

Meanwhile, a December poll seems to have scared the White House off Kennedy’s vaccine agenda. The survey, conducted by the longtime Republican strategists Tony Fabrizio and Bob Ward, forecasted “electoral downsides” for candidates who supported doing away with vaccine recommendations. The Washington Post has reported that the White House subsequently pressured HHS to avoid any more vaccine-policy changes and installed a new chief counselor, Chris Klomp, to rein in the department. All of this likely explains why Kennedy has retreated from commenting on vaccine issues in public; instead, he has spent this year celebrating his inverted food pyramid and making vague threats to companies that sell highly processed snacks. At an “Eat Real Food” rally in Austin this month, Kennedy said that his department would ask Dunkin’ and Starbucks to prove that their high-sugar drinks are safe. A week later, HHS posted an AI-generated video of a shirtless Kennedy body-slamming a man in a Twinkie costume.

[Read: The meme-washing of RFK Jr.]

Before and after taking charge of HHS, Kennedy called the CDC corrupt and maligned its officials as beholden to pharmaceutical companies. This may be one reason that he and the White House have had trouble finding a permanent leader for the agency. The first nominee was Dave Weldon, a doctor and a former representative from Florida who shares some of Kennedy’s anti-vaccine views. But Weldon’s nomination was pulled by the White House before his Senate confirmation hearing because he clearly didn’t have the votes.

The second nominee, the microbiologist and immunologist Susan Monarez, got the Senate’s approval; less than a month later, Kennedy pushed her out. Monarez testified in front of a Senate committee that she was removed because she refused to go along with Kennedy’s request that she dismiss certain public-health experts and approve the recommendations of the agency’s remade vaccine advisory board. Kennedy said she was fired because Monarez had told him that she wasn’t trustworthy. In the aftermath of Monarez’s ouster, several top CDC officials resigned, including Debra Houry, the agency’s chief medical officer, who told me at the time that she and her colleagues couldn’t stay “if there was not a scientific leader at CDC.”

[Read: ‘It feels like the CDC is over’]

Since then, the CDC has been led by acting directors. The first, Jim O’Neill, is a biotech entrepreneur who lacks a degree in medicine or public health and was widely seen as a yes-man for Kennedy. He was removed from the position last month with little explanation and was instead nominated to be director of the National Science Foundation. (He doesn’t have a degree in science either.) O’Neill was replaced with Bhattacharya, who is also the director of the National Institutes of Health, which means that he oversees roughly 30,000 people at agencies that are approximately 650 miles apart.

Bhattacharya’s brief tenure has felt, to some CDC researchers I’ve spoken with, like the beginning of a return to reason. Bhattacharya is contentious in his own right: He does not practice medicine, has no formal training in infectious disease, and has been criticized by health experts within and outside the government for his contrarian pandemic convictions. Daniel Jernigan, the former director of the National Center for Emerging and Zoonotic Infectious Diseases who resigned after Monarez’s firing, texted me that since Bhattacharya was put in charge, he’d heard a “general sigh of relief from staff” after a strange and dispiriting year. During a measles outbreak last spring in West Texas that claimed the lives of two girls, Kennedy offered mixed messages, eventually endorsing the measles vaccine—to the chagrin of his fellow anti-vaccine activists—while privately telling the father of one of the girls that “you don’t know what’s in the vaccine anymore.” (Nixon would not confirm Kennedy’s statement.) In August, a 30-year-old man who was upset about COVID vaccines fired close to 200 shots at the agency’s Atlanta headquarters, killing a police officer. Kennedy visited the campus in the aftermath and expressed his condolences, but a letter signed by hundreds of CDC officials accused him of “endangering the nation’s health by repeatedly spreading inaccurate health information.” (In 2021, Kennedy falsely called COVID shots “the deadliest vaccine ever made.”)

Nixon said that Klomp and Kennedy are working together to find the next CDC director. According to reporting by Bloomberg and The Washington Post, a few candidates are on the shortlist. At least one of them, Joseph Marine, has defended Kennedy and expressed support for the MAHA movement. Another, Daniel Edney, Mississippi’s state health officer, has been an advocate for childhood vaccination and would be a more conventional choice.

[Read: A new level of vaccine purgatory]

The nomination of a director with public-health bona fides and mainstream views on vaccines could mean a return to normalcy at the CDC. But whoever is confirmed as director will take over an agency in need of a reset. At today’s meeting, one employee told Bhattacharya that “we’re missing a lot of trust in our leadership” and asked how he planned to rebuild that trust. The question prompted nearly 30 seconds of applause. In response, Bhattacharya said the agency should “deescalate scientific disagreement.”

The new director, if confirmed, will also face pressure to continue pushing forward the MAHA agenda. At least, as long as Kennedy sticks around.

The Meme-Washing of RFK Jr.

2026-03-24T07:30:00-04:00

Millions of people have watched Robert F. Kennedy Jr. body-slam a man dressed up as a Twinkie. In an AI-generated video that Kennedy posted to X last week, he walks into a wrestling ring—shirtless, shredded, wearing his signature blue jeans. His opponent is smiling and holding a sign that reads I ♥️ Junk Food before Kennedy plants his foot into the Twinkie’s chest and suplexes the oversize treat into the mat. After a barrage of punches, kicks, and throws—all set to a Limp Bizkit song—the 72-year-old flexes his muscles while flames shoot out around him.

America’s health secretary has been on a meme blitz. Last month, the real-life Kennedy stripped down to his jeans to pump iron, cold plunge, and drink whole milk with Kid Rock. Thanks to AI, Kennedy has also been depicted as a character in the Nintendo game Super Smash Bros. who launches a frosted donut into oblivion, and as an action figure complete with “waterproof jeans” who protects kids from artificial food dyes. On Christmas Eve, Kennedy posted an AI-generated clip in which he calls Santa Claus to persuade him to put down the cookies, jump on the treadmill, and start chugging whole milk.

The memes are PSAs made for the TikTok age. Many of them explicitly mention Kennedy’s new slogan: “Eat real food.” They are absurd, juvenile, and, one has to acknowledge, pretty funny in their commitment to the bit. Many politicians have turned to memes to spread their message in ways that come off as embarrassing or out of touch (Hillary Clinton once urged her fans to “Pokémon Go to the polls”). But Kennedy—or his team, at least—seems to recognize the advantages of being in on the joke. A crusading 72-year-old with a six-pack, let alone one who works out in jeans, makes for prime internet silliness.

The recent memes are reportedly conceived of and made by a group of young staffers. Liam Nahill, Kennedy’s 26-year-old digital director, had a donut slapped out of his hand by Mike Tyson for one video. The approach is especially notable in the context of the Trump administration’s broader hunt for virality. The White House and other agencies have leaned into using social media to double down on the president’s antagonistic messaging—attacking opponents and making cruel jokes about volatile political issues such as war and mass deportations. The White House’s official X account has recently tried to promote the war in Iran by splicing footage of missile strikes with clips from Call of Duty and Wii Sports. Last year, the White House shared the image of a sobbing immigrant in handcuffs and turned it into an AI cartoon; Border Patrol posted a video of immigrants in shackles set to the song “Closing Time.”

[Read: The gleeful cruelty of the White House X account]

Kennedy’s memes, while over-the-top, offer a much more sanitized message: Be healthy. (At least, as far as Kennedy would define healthiness.) “The tonality of it doesn’t have quite the same emphasis on dominance, control, and fear,” Donald Moynihan, a professor at the University of Michigan who has written about the Trump administration’s approach to social media, told me. The memes are clearly invested in portraying Kennedy as an avuncular, larger-than-life cartoon hero. The health secretary moonlights as a falconer and follows a “carnivore diet.” In January, the HHS X account wished Kennedy a happy birthday by posting a photo of him cutting into a steak adorned with birthday candles. In the meme of Kennedy as an action figure, he changes from a suit into jeans to go rescue a peregrine falcon.

What Kennedy’s memes are not addressing is telling. Since taking office, Kennedy has attempted to dramatically rejigger America’s vaccine system. Though those efforts have recently been met with legal resistance, the result has been a kind of vaccine purgatory, in which it’s unclear who exactly is setting the country’s immunization policy. Kennedy’s meme campaign is happening at the same time that the Trump administration is reportedly trying to rein in the secretary’s anti-vaccine advocacy ahead of the midterm elections. Late last year, a prominent Republican pollster published a memo stating that “vaccine skepticism is bad politics.” It’s likely not a coincidence that there are no HHS memes about measles or autism.

Emily Hilliard, an HHS spokesperson, did not answer questions about strategies to divert attention away from Kennedy’s anti-vaccine efforts. “Secretary Kennedy is the most-followed Cabinet Secretary in the Administration across all platforms,” Hilliard told me in an email. “Our content is designed to reach broader audiences, meet people where they are, and reinforce practical, everyday steps.”

While Kennedy’s anti-vaccine views remain unpopular, his critiques of the food supply have broad bipartisan support. A February poll found that nearly 70 percent of Americans think the government should do more to discourage unhealthy eating. On that front, however, Kennedy and his team haven’t actually accomplished much. The health secretary came into office pledging to “end the chronic-disease epidemic,” but several of the policies he promised—such as removing ultra-processed foods from school lunch—are not even within his purview as health secretary. In a YouTube video posted shortly before he was picked to lead HHS, Kennedy decried the fact that America hadn’t yet banned certain artificial food dyes, promising that “President Trump and I are going to stop the mass poisoning of American children.” Instead of eradicating synthetic food dyes, which is within his purview as health secretary, Kennedy has focused on using his bully pulpit to pressure food companies to voluntarily remove them.

[Read: America’s convenience-store conundrum]

Amid prodding from the secretary, some food companies have said they will do so, but many of those pledges do not go into effect until next year or later. Doritos is one the few brands that has already introduced dye-free versions of its chips, and yet the company also still sells the bright-orange version. Although the administration has also released new dietary guidelines, telling people to “eat real food” and getting them to actually do so are separate challenges entirely.

This middling progress—the actual work of government, of public service—is obscured by Kennedy’s online persona. Twinkies might still be on supermarket shelves, but the health secretary will meme his way to the notion that he is laying the smackdown on the junk-food industry nonetheless.

There’s Only One Reason to Cold Plunge

2026-03-19T16:10:00-04:00

Cold-water bathing has a long history as a health hack. The ancient Greeks and Romans partook to treat fevers. Eighteenth-century mental institutions employed a tactic called the bain de surprise, suddenly dunking their patients in cold water to jolt them out of their depression or psychosis. (Some doctors aimed to wet only the head to cure “hot brain.”) Last year, Mehmet Oz, the celebrity doctor who is now the head of Medicaid and Medicare, posted an Instagram video of himself in a one-man ice bath, promoting it as a possible boon for immunity and longevity. “Maybe you affect how the mitochondria work,” he says, before dunking his head into the bath and then flipping his hair as “Careless Whisper” plays in the background.

Maybe. Certainly the plunge has a bit of logic behind it. Cold exposure dampens inflammation, which can contribute to a person’s risk of heart disease and cancer. In nature, some very long-lived animals, such as the bowhead whale (lifespan: about 200 years) and the Greenland shark (500 years) basically cold plunge for their entire life. In fact, cold water does seem to provide some benefits for humans as well—just not the ones that Oz and other wellness enthusiasts most loudly promote.

Cold-plunge partisans claim, for instance, that cold exposure activates “brown fat,” a special type of fat tissue that burns energy to generate heat. Activating this fat is said to convey almost-magical health benefits, reducing the risk of diabetes and other chronic diseases. Casey Means, President Trump’s pick to be surgeon general, pointed to brown fat when explaining to her followers why she’s come to “LOVE cold plunges” in a 2024 Instagram post. Unfortunately, most adults typically have only a few grams of brown fat, so any beneficial effect from activating it is likely quite small. Even a study of Wim Hof, the Dutch health guru nicknamed “The Iceman” who helped popularize ice bathing, proved disappointing: Using fMRI and other imaging techniques, researchers found that his brown-fat activation after a session of his Wim Hof Method (breathing exercises plus extended cold plunging) was “unremarkable.” (In an email to The Atlantic, Hof acknowledged that brown fat is not primarily responsible for warming the body in cold environments, but said that his breathing techniques support muscular activity that functions as a “physiological radiator.” He did not elaborate on the health effects of said muscular activity or cold plunging more generally.)

[Read: How cold can a living body get?]

Cold plunging has also been touted as a workout-recovery tactic. It took off after Paula Radcliffe, once the fastest women’s marathoner of all time, told BBC Sport in 2002 that post-race ice baths were her secret weapon. Michael Phelps and LeBron James have carried the torch, and photos of pained athletes sitting in icy tubs have become a social-media staple, spreading the practice to the common gym goer. Last month, Health and Human Services Secretary Robert F. Kennedy Jr. posted a workout video (co-starring Kid Rock) in which he does push-ups and rides an exercise bike in a sauna, then does a cold plunge in his jeans. (HHS did not return a request for comment.) Although a handful of studies suggest that cold-water immersion may help reduce feelings of muscle soreness after exercise, it also seems capable of limiting your gains. Some studies have shown that cold-water immersion immediately after resistance exercise reduces gains in muscle size and strength. One 2015 study found that cold plunging after resistance training reduced muscle growth by 20 percent.

Cold plunging has grown so popular that it seems to be almost mandatory at many North American sauna establishments. In some, guides wield timers and even whistles to ensure that patrons realize the full health benefits of “contrast therapy,” moving from a hot sauna to an icy-cold plunge and back again. But research suggests that the hot part of contrast therapy may be more helpful for muscle health and exercise gains, and that intermittent cold plunging may even neuter those benefits. For example, the cardiovascular and cellular benefits of heat adaptation typically take place when the core body temperature reaches about 101.3 degrees Fahrenheit. But many contrast-therapy regimens march their adherents into a cold plunge immediately after the hot sauna, which pulls their core temperature down before it can rise to the sweet spot. The current trend in the NBA, for instance, is to toggle between 15-minute infrared-sauna sessions and three frigid minutes of plunge.

In fact, recent research suggests that heat alone is a better exercise-recovery tool than ice or cold water. A 2017 clinical trial had volunteers perform an hour of “exhaustive” arm-cycling intervals (think stationary bikes but with handheld cranks instead of pedals). They recovered far better from this ordeal when their arms were warmed rather than cooled. In yet another study, researchers found that cold-water immersion did nothing for subjects with laboratory-induced muscle damage, whereas warm water speeded healing and reduced soreness. Perhaps that’s because warm water (or a warm sauna) opens blood vessels, increasing blood flow to the tired or injured muscles. It also activates heat-shock proteins, which repair damaged cells. Cold water, however, does the opposite—constricting blood flow, blunting repair mechanisms, and making muscles and connective tissue less elastic.

[Read: How did healing ourselves get so exhausting?]

Even the doctor who popularized the RICE injury-recovery protocol in the 1970s—rest, ice, compression, and elevation—has recanted the “ice” part, after it became clear that inhibiting inflammation can also inhibit healing. In the 2010s, researchers found that transient inflammation created by exercise (and other short-term stressors) acts as a signaling mechanism that helps marshal the body’s own healing response, while also spurring the strength and endurance improvements brought on by exercise.

Still, many if not most of the published studies on cold plunging, including those that undermine its hype, are quite small, with 20 subjects or fewer, the large majority of whom were healthy, fit young men likely volunteering for studies at universities they attended. Relatively few subjects were female, or old enough to be president. These studies also tended to be short-term, sometimes involving only a single ice bath or hot-water-immersion session. And for obvious reasons, carrying out a truly blind study of cold (or heat) exposure is impossible.

The popularity of cold plunging may come down to the simple truth that it makes some adherents feel good. In the only truly large-scale cold-water study, done in the Netherlands, researchers told more than 3,000 people to take cold showers. They ranged in age from 18 to 65, and they were randomized to end their usual daily shower with 30, 60, or 90 seconds of cold water for a month. The study wasn’t designed to measure brown-fat activation or muscle recovery, but it did reveal that the cold showerers missed about 30 percent fewer workdays than a control group who took only hot showers every day. Both groups reported the same number of total illness days—but for whatever reason, the cold showerers seemed more motivated to go into work.

The amazing thing about this study, however, was that many of the subjects voluntarily continued with the cold showers after the initial 30-day study period expired—although they, presumably, were no longer being compensated for participating in the study. This may speak to why some people swear by cold plunges and showers with an almost-religious fervor. They get hooked.

“That sudden fall in skin temperature releases quite a lot of stress hormones, and ends up releasing serotonin. So you get a feel-good factor,” Mike Tipton, a professor of extreme physiology at the University of Portsmouth who has studied cold-water immersion for decades, told me. “It’s the thing that makes you feel alive.” Perhaps the most consistent reported benefit of cold-water exposure is its effect on mood and mental health. People do it because, for some reason, it makes them feel better.

I struggle with cold plunging, mostly because I dislike cold water and pain, and being hounded into doing things. To me, a plunge usually feels best when it is over. I began to see the appeal only after a 2024 experience at Sauna Days, an eclectic gathering that’s like a music festival, but with wood-burning saunas instead of bands, held near the shores of Lake Superior, the deepest, rockiest, and coldest of the Great Lakes. I was initially happy to sleep through the early-morning swims that most other attendees were partaking in—I was there for the saunas—but eventually, the combination of a sunny day, the coaching of a friend, and latent FOMO led me to the water. At the rocky shore, I gingerly waded in and squatted, keeping my hands and, crucially, my nipples out of the 43-degree water. To my surprise, I felt relief rather than pain, as I unloaded all of that pent-up sauna heat into the chilly lake water. I dunked myself neck-deep and let out a deep, satisfying sigh.

Submerged in Lake Superior, I realized that viewing cold plunging as so many of its champions suggested—through the lens of health optimization, as a purely physical practice wrapped in bro science—had been a mistake. That wasn’t it at all. It was really more about changing your mental state, knocking you out of whatever spiral you happen to be stuck in—rather like a bain de surprise. (To be fair to Oz, he mentions this upside too: Plunging is a reminder, he says, that “your mind is strong and your body can keep up.”)

My second mistake had been to think of plunging as a purely solo activity. My Instagram Reels are replete with longevity bros (and babes) dunking themselves in one-person cold plunges that resemble high-design coffins. But I found that the cold was much easier to take with company, which turned it into a bonding experience, as opposed to ritual self-punishment. I had to admit, splashing around in water cold enough to induce hypothermia had a certain thrill. I felt a little naughty. And I felt even better when I got out.

This article has been adapted from Bill Gifford’s forthcoming book, Hotwired: How The Hidden Power of Heat Makes Us Stronger.

A New Level of Vaccine Purgatory

2026-03-18T11:50:22-04:00

On Monday, a federal judge issued a preliminary ruling with a harsh reprimand for the Trump administration: You’ve done this vaccine stuff all wrong.

The Trump administration likely broke the law, the judge’s 45-page decision argued, when it dismissed and abruptly reconstituted the CDC’s expert vaccine-advisory panel last June, stacking the committee with members who have aggressively questioned the safety of vaccines. Top health officials also probably acted illegally, the ruling said, when they made sweeping alterations to the nation’s childhood-immunization schedule in January, without the input of their own, remade panel.

If the decision becomes final, it stands to all but wipe away a year’s worth of vaccine-policy change at the CDC. The judge’s ruling calls for staying “all votes taken” by the panel since Health and Human Services Secretary Robert F. Kennedy Jr. remade it—essentially resetting the United States’ vaccine-policy clock to early 2025. But the ruling remains preliminary, and the Trump administration has already hinted at its intent to appeal. Andrew Nixon, the deputy assistant secretary for media relations at HHS, did not respond to a request for comment, but he told reporters this week that “HHS looks forward to this judge’s decision being overturned just like his other attempts to keep the Trump administration from governing.”

Since the Trump administration took office, states and professional medical societies have broken with the CDC, vaccine recommendations have splintered, and trust in federal health agencies, especially in their vaccine advice, has plunged. This latest ruling shifts the nature of the United States’ vaccine chaos, but the turmoil is far from done: Lawyers and judges could be arguing for months over who has the authority to set U.S. vaccine policy.

As things stand, the CDC’s national immunization schedule—and the primary committee that shapes it—is in a kind of purgatory. The current roster of the panel, the Advisory Committee on Immunization Practices (ACIP), should never have come to exist at all, the judge wrote, because it violated the Administrative Procedure Act: When Kennedy fired all 17 of the panel’s former members last spring and replaced them with a more vaccine-skeptical group, he eschewed the “rigorous screening that had been the hallmark of ACIP member selection for decades.” Kennedy’s ACIP, the ruling says, may also fail to fulfill a requirement of the Federal Advisory Committee Act, which calls for the membership of such panels to have “balanced” points of view. The ruling temporarily suspended the appointment of 13 of the 15 current ACIP members, most of whom lack “meaningful experience in vaccines,” the judge wrote. (The other two members were appointed in late February, after the plaintiffs filed their motion, and so were excluded from the decision.) As a result, the panel has been forced to postpone a meeting originally scheduled for this week.

All of that effectively leaves the U.S. without the advisory group that has most influentially shaped American vaccine policy for the past 60 years. “There is no functioning ACIP as of now,” Richard Hughes IV, a lawyer for the plaintiffs, told me. The nation has never been so suddenly stripped of its vaccine advisers, with no backup plan. Experts told me they’re unsure who, if anyone, will advise the CDC on its recommendations for vaccines in the coming months, when the agency might need to weigh in on brand-new immunizations against diseases that have so far lacked them, as well as as this fall’s slate of vaccines against COVID and flu, which are typically reformulated annually to keep up with viral evolution.

In theory, Kennedy or the CDC director—a position temporarily held by Jay Bhattacharya, who also leads the National Institutes of Health—could simply make a unilateral decision about future vaccine recommendations. But the judge also faulted Jim O’Neill, the CDC’s previous acting director, for doing exactly that in January, when O’Neill signed a memo announcing major changes to the agency’s immunization schedule that downgraded recommendations for several vaccines at once, without seeking ACIP’s advice. “The CDC cannot simply bypass ACIP in altering the immunization schedules,” the judge wrote. And because part of the judge’s ruling criticized the hurried way in which the current ACIP was assembled, Kennedy might have a difficult time summoning a fresh panel to replace most of his picks on short notice.

In the lawsuit that led to this week’s ruling, the plaintiffs—which include major medical groups, such as the American Academy of Pediatrics and the Infectious Diseases Society of America—challenged three of ACIP’s votes over the past year in particular. Last summer, on the advice of an anti-vaccine activist, the panel voted to stop recommending the use of flu vaccines containing thimerosal, a preservative with a proven safety record. In September, it opted to downgrade what was once a universal recommendation for COVID vaccines to guidance that Americans first consult a health-care provider. Then, in December, it voted to rescind a long-standing recommendation that all newborns receive a hepatitis-B vaccine, a change that health experts fear could cause cases of severe liver complications to skyrocket.

But if the ruling actually stays “all votes” taken by Kennedy’s ACIP, it could also undo moves the panel has made that are very much in line with what other versions of ACIP have or would have done, Dorit Reiss, a vaccine-law expert at UC Law San Francisco, told me. For example, the committee recommended the 2025–26 flu vaccines for all Americans six months and older, as it has done in years prior. It also recommended a new monoclonal antibody that can protect babies against RSV, the leading cause of infant hospitalization in the U.S., and qualified the shot for the Vaccines for Children program, which helps immunizations reach underinsured families. If those decisions are canceled, coverage for families that have relied on those shots could be compromised.

For now, the decision may accomplish more symbolically than it does practically. It holds that evidence and proper procedure are key to formulating vaccine policy in the United States. But the actions of both the Trump administration and the judge suggest that the government is still conflicted over just how crucial ACIP is. Kennedy and his allies have taken great care to fill the panel with people whose views align with theirs, a tacit endorsement of ACIP’s importance; at the same time, they have made some of their largest modifications to the national immunization schedule without the committee’s input. The judge’s ruling, too, emphasized the influence of ACIP, noting that the committee is the only body that can determine which immunizations qualify under Vaccines for Children—even as it has frozen ACIP’s ability to act for the foreseeable future.

The ruling does not erase, or even much lessen, the deep sense of unease over vaccine decision making in this country that has resulted from the past year of haphazard changes; if anything, a prolonged legal battle could further diminish public trust, Grace Lee, a former chair of the advisory committee and a pediatrician at Stanford, told me. Kennedy, O’Neill, and other administration officials have repeatedly cited a goal of restoring public trust when modifying the nation’s vaccine recommendations. But one recent poll found that trust in the CDC had dropped since the start of the second Trump administration, and that fewer than half of respondents now trust the agency at least “a fair amount” to provide reliable information on vaccines. Several professional medical societies, including the American Academy of Pediatrics, have broken away from CDC vaccine advice; “no serious health-care provider looks to ACIP anymore for advice,” Noel Brewer, a vaccine-behavior expert at the University of North Carolina’s Gillings School of Global Public Health whom Kennedy dismissed from ACIP last year, told me. Dozens of states have declared that they’re no longer following the CDC on vaccines, either. Americans, in effect, have been left with all too many options for whom to listen to about vaccines.

Even if court proceedings eventually revert the country’s immunization schedule to a version of what it was about a year ago—and even if the administration reverts ACIP to its typical process of rigorously vetting members—the U.S. will still be far from its previous vaccine status quo. Vaccination depends not just on the governing bodies that issue recommendations about shots, but also on Americans’ willingness to heed that advice—a far harder shift to reset.

Girls’ Sports Are Getting More Physical

2026-03-17T10:23:16-04:00

At the turn of the 20th century, a sporty American woman would have had relatively few arenas to test her skill: croquet, maybe, or archery, or basketball played gently in an ankle-length skirt. Public displays of aggression were almost universally condemned, and colliding was especially unsavory. To avoid it, women’s-basketball competitions prohibited “snatching” the ball until the 1960s.

Although men’s and women’s sports generally follow the same fundamental objectives today—stealing the basketball is a smart tactic in anyone’s game—physical contact in women’s sports remains controversial. When Caitlin Clark and Angel Reese exchange elbows in the WNBA, outrage and concern inevitably follow. Meanwhile, NBA players sparring over the ball, or NHL players outright brawling, is typically treated as business as usual.

And yet, girls seem to be more interested than ever in contact. Ice hockey, rugby, and football (of the tackle, seven-on-seven, and flag varieties) are all among the fastest-growing sports for teenage girls. And at American high schools last academic year, more girls played on teams for wrestling than field hockey, gymnastics, or dance.

A high schooler today can join any number of sports teams, including, in some districts, rodeo or bass fishing. Basketball and soccer remain among the most-played girls’ team sports, and typically the first ones that girls play at a young age, Karissa Niehoff, the CEO of the National Federation of State High School Associations, told me. But by high school, not everyone can make the basketball or soccer team, and private leagues can be both competitive and expensive. That leaves a deep bench of untapped players for newer and less conventional sports—bass fishing, yes, but also roller hockey, flag football, and, for girls, sports that traditionally haven’t allowed them to play.

[Read: What’s lost when only rich kids play sports]

Girls’ participation in such sports is growing so quickly in part because it’s starting from a small denominator. But they also seem to offer girls something that traditional options don’t. Some are particularly welcoming to beginners: They take all comers, are relatively affordable, and consume less time than other popular sports. Flag-football games last about 40 minutes—half the time of a typical soccer game—and practice usually precedes the game, making scheduling relatively easy.

Many high-growth sports appeal to a rising cultural sense that women and girls can—and should—bulk up. Girls drop sports at twice the rate of boys, and nearly half cite body-image concerns for doing so. “Thin to win” narratives are still deeply embedded in certain sports, such as long-distance running and Nordic skiing, Nicole LaVoi, the director of the University of Minnesota’s Tucker Center for Research on Girls and Women in Sport, told me. In wrestling, too, competitors sometimes resort to unhealthy strategies to stay in a given weight class. But in flag football and rugby, this preoccupation is largely irrelevant. Flag is about agility; several players I spoke with lift weights to help them achieve faster, more explosive movement. A girl interested in playing football 10 years ago may have been teased for being too masculine, LaVoi said. But the popularity of girls’-football programs today suggests that Americans are more likely to accept that a middle-school girl can be a linebacker.

Flag football, which has seen particularly steep growth over the past five years among teen girls, is technically a noncontact sport, which is part of what makes it appeal to safety-conscious parents of both boys and girls; the NFL started promoting it heavily in the past decade, when youth participation in tackle football was declining amid concerns about concussions. But it is viscerally physical: Players dive for catches and tumble into one another as they pull flags. It’s notable that girls are seeking out this sort of play at a time when so much of adolescent socialization happens over screens. Research from the Women’s Sports Foundation shows that social connection and friendship are the main reasons girls play sports.

[Read: You’ll become a fan of these strange, fierce girls]

Evelyn, a 13-year-old linebacker on a flag-football team in Washington, D.C., told me that flag football’s culture is “nicer” than the culture of the softball, lacrosse, baseball, and swimming teams she’d previously joined and then left. When she joined the flag team, she had an easier time bonding with her teammates, she said. “When I make a good flag pull, my team immediately surrounds me—like I did something good. I did it for my team.” Other sports that put kids in close physical proximity are associated with their own social benefits. For example, a recent study of Turkish adolescent boys found that wrestling may improve psychological resilience, not just because athletes become more physically dominant, but also because the close physical encounters require sustained attention and emotional control, which may promote self-regulation.

Contact sports may lead more girls to play team sports of any kind—something they could benefit from for the rest of their lives. Girls who play sports throughout childhood tend to have better physical health in adulthood compared with those who never played or dropped out. Kids who play sports are likely to experience better mental health, stronger friendships, higher confidence, more positive body image, and superior academic achievement, according to research from the Tucker Center. In a 2014 survey of 400 female corporate executives, 94 percent had played a sport. Sally Roberts, the CEO of the nonprofit Wrestle Like a Girl, credits her high-school wrestling career with setting her up for success elsewhere in life: She was the first in her family to graduate high school and college, and became a three-time national wrestling champion. The growth of more gladiatorial girls’ sports has been successful enough that professional leagues are starting to make long-term investments in them. Several NHL teams sponsor girls’ ice-hockey clinics and camps. In December, the NFL announced it was developing a professional flag-football league for women.

[From the April 2025 issue: Why aren’t women allowed to play baseball?]

Evelyn’s team lost its fall championship in double overtime. But in December, the players were back on the field at a Washington, D.C., middle school. When the game began, Emi, a 13-year-old wide receiver, tumbled toward my feet at the sideline after having her flag pulled. She bounced up and returned to the huddle. Her father explained to me that Emi is naturally very shy, but since starting flag, she’s become more self-assured and comfortable meeting new people.

Later, Emi ran a route, broke free from the defensive back, and caught the ball for a touchdown. Her teammates swarmed her so thoroughly that I couldn’t see her buried under the heap in the end zone.

The Peptide Boom Is Getting Out of Hand

2026-03-16T07:30:00-04:00

There’s no ambiguity about who Vyleesi is for. The prescription drug, commonly referred to as female Viagra, boosts the libido of women experiencing hypoactive-sexual-desire disorder, a condition in which lack of interest in sex causes distress. When Vyleesi was approved in 2019, an FDA official announced that it was evidence of the agency’s “commitment to protect and advance the health of women.”

But since then, female Viagra seems to have found an unexpected market: men. On the Reddit forum SexOnDrugs—which chronicles, you guessed it, people’s sexual escapades while on various prescription and illicit drugs—guys talk about taking the drug even if they have no apparent issues with sexual drive or performance. “Everything feels richer,” noted one man, who compared taking the drug to adding butter to food. Another claimed that he’d had sex with his wife “about 30 times over 20 hours.” (The drug, however, does frequently make people queasy: “The nausea hit me so hard that sex wasn’t even a thought,” another man reported.)

Vyleesi has never been approved for men. Some clinics advertise that they’ll prescribe the drug to men off-label, but even that is often not necessary for men to get ahold of it. Vyleesi is now readily available without a prescription. Many online retailers sell vials of the drug under the guise that they are for “research use only” and not for human consumption—a disclaimer that technically makes the drugs legal.

Americans are relying on this technicality to get hold of all kinds of drugs—some that, like Vyleesi, are supposed to require a prescription and others that aren’t even approved in the United States at all. Athletes are taking a banned horse-racing drug to speed up their recovery. Beauty influencers are shooting something known as the “Barbie drug” up their nose to get a better tan. My colleague Sarah Zhang recently described the process of buying retatrutide, an unapproved obesity drug, as “just like ordering socks.”

[Read: I bought ‘GLP-3’]

Not all experimentation requires scouring the gray market. Online pharmacies staffed by licensed doctors now regularly prescribe “personalized” medications that include an FDA-approved medication paired with additional experimental additives. One company, BlueChew, sells an erectile-dysfunction pill that contains the active ingredients in Viagra and Cialis, in addition to other chemicals that the company claims improve sex. These products are made by compounding pharmacies, which are not regulated by the FDA for safety, quality, or efficacy.

Taking experimental drugs is nothing new. Sigmund Freud frequently used cocaine to treat his depression; athletes have doped for decades; biohackers have long taken pills in hopes of becoming more efficient at work. What is new, however, is the scale, accessibility, and uptake of faddish pharmaceuticals. Now everyone is a biohacker—or at least anyone can be.

Few experimental drugs have become as popular as peptides—a class of compounds that mimic existing hormones in the body. Peptides have developed a cult following among fitness enthusiasts, looks-maxxers, and Silicon Valley types, who believe that the drugs can boost muscle gain, increase focus, and lead to better skin. On a recent episode of his podcast, Joe Rogan urged Ben Affleck and Matt Damon to use the peptides BPC-157 and TB-500—commonly known as the “Wolverine stack”—to speed up recovery should they ever get injured.

The P in GLP-1 stands for peptide. The success of Ozempic and other FDA-approved drugs for weight loss and diabetes “opened a lot of eyes,” Dave Asprey, a longevity influencer who credits himself with starting the biohacking movement, told me. “People started asking what else is out there.” And there is, it turns out, a ton out there. One online vendor of unapproved peptides that are not intended for human consumption carries dozens of drugs on its website.

GLP-1s are also a big part of the reason Americans are now experimenting with unregulated drugs made by compounding pharmacies. Legally, these businesses are supposed to make custom versions of drugs for people who can’t take an FDA-approved drug, or when an FDA-approved drug is unavailable because of a shortage. Roughly a decade ago, entrepreneurs realized that they could use compounding pharmacies to make nominally customized versions of FDA-approved medicines and sell them to the masses via the internet. Hims pioneered the strategy, selling hair spray loaded with finasteride, an FDA-approved hair-loss drug previously available only in pill form. Now telehealth companies offer compounded drugs for sexual health, hair growth, skin care, and especially weight loss. Sales of these obesity-drug dupes have become an enormous business; both Hims and Ro ran Super Bowl ads touting their offerings.

[Read: GLP-1 envy was just the beginning]

Some of this might seem like a positive development for American medicine. In the cases of weight loss and erectile dysfunction, more patients are getting the care they want or need. I personally experimented with compounded GLP-1s because of the high cost of the real thing. But again, these drugs are not made with any government oversight. Consider Musely, a company that sells skin cream for dark spots. The cream contains three times the amount of the active ingredient hydroquinone, which is FDA-approved, that you’d get in the traditional version of the drug—despite the fact that regulators have warned that hydroquinone may cause skin discoloration. (Musely did not respond to a request for comment.)

Experimental drugs that lack any FDA-approved ingredients can be even more questionable. Although anecdotal evidence abounds about the benefits of the “Wolverine stack” and certain other peptides, most haven’t been researched enough to prove they actually work. “We don’t even know what’s in these bottles,” Christopher Robertson, a Boston University law professor who studies the FDA, told me.

The modern FDA exists to ensure that pharmaceuticals are safe. But the agency has failed to stop the boom of unregulated, potentially dangerous drugs. It has gone after some companies for selling research chemicals after determining that the drugs were, in fact, being sold for human consumption, but the agency is playing a game of whack-a-mole. Dozens of websites selling BPC-157 can be found via a quick Google search. Shutting down compounding pharmacies operating on the gray market would likely be even more difficult, and prompt protracted court battles.

It’s easy to take the FDA for granted. In the 1960s, thalidomide, a drug marketed for morning sickness, left children around the world with irreversible birth defects; the United States avoided such a fate thanks to the FDA’s oversight. Due to the thalidomide scare, America began to require drugs to be proved not only safe but also effective.

Robert F. Kennedy Jr., who oversees the FDA and other major health agencies as the secretary of Health and Human Services, knows this history. During his confirmation hearing, Kennedy name-checked Frances Oldham Kelsey, the FDA official who refused to approve thalidomide in the U.S., as an example of how scientists must follow the data and question science. Yet Kennedy seems poised to make it even easier for Americans to get certain unregulated drugs. On Rogan’s podcast late last month, Kennedy teased that he will soon act to make roughly a dozen peptides “more accessible,” in line with his penchant for medical freedom. He also revealed that he is a “big fan” of certain peptides and has used them himself to help with injuries. (An HHS spokesperson did not respond to a request for comment.)

Just as Americans’ appetite for experimental drugs reaches new heights, the FDA’s capacities to ensure the safety of America’s medicines seem to be diminishing.

What 100 Million Volts Do to the Body and Mind

2026-03-16T07:00:00-04:00

Photographs by Stacy Kranitz

Updated at 11:04 p.m. ET on March 23, 2026

What does it feel like to be struck by lightning?

There is no easy analogue. A defibrillator delivers up to 1,000 volts to a patient’s heart; inmates executed by electric chair typically receive about 2,000. A typical lightning strike, by contrast, transmits 100 million volts or more. But lightning races through the body in milliseconds, and therefore often spares it. Some people black out instantly upon being struck. Others recall the moment vividly, as if in slow motion: the flash of light whiting out all vision; the sound, which many survivors say is the loudest they’ve ever heard. The pain, for some, is excruciating, yet others feel no pain at all. “It felt like adrenaline, but stronger,” one survivor reported. “I felt an incredible pulsing,” another said, “a burning sensation from head to toe.”

The severity of the resulting injury depends on, among countless other variables, how the electricity enters the body, and where, and the path the current takes through it. Direct strikes are the deadliest, but most strikes are indirect—a side flash coming off a tree, a current running through the ground, a streamer rising up from below—and most people survive these.

In some cases, the damage is immediately apparent. Lightning, in addition to being very bright and very loud, is very hot—the air around it can hit temperatures about five times hotter than the surface of the sun—and so it can singe or burn people. The shock wave from the strike can fling victims a great distance, breaking bones or causing concussions as they land. The current inscribes some victims’ skin with mysterious scarlike patterns called Lichtenberg figures, which resemble the limbs of a barren tree—or the branching structure of lightning itself.

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Just as often, though, survivors manifest no burns, bruises, or scars. Even Lichtenberg figures generally vanish within a few days; no one knows exactly why. On the outside, survivors look normal. Which doesn’t mean they feel that way.

Many of the body’s essential systems—the heart, the brain, the nervous system—depend on electrical signals, and lightning can throw these thoroughly out of whack. Forgetfulness, sleep problems, sexual dysfunction, and headaches that manifest as intense pressure—like “my eyeballs are just popping out,” one person told me—are common. Some people become hypersensitive to noise; others lose their hearing entirely. A few, almost miraculously, are freed of a prior ailment: a bad leg healed; vision, once impaired, restored. Pretty much all of them feel permanently off balance. Some have to relearn simple things, things they’ve done their whole life—how to read, how to sing, how to ride a bike.

Phantom sensations are prevalent. One woman told me she often feels as though water is running down her limbs. Another, in a Facebook group for survivors, said she feels “an indescribable itching” coming from inside the back of her head. Inexplicable odors can emerge; food can taste like cardboard or glue. The symptoms can last for decades. Yet standard neurological imaging, such as MRI scans, almost never detects abnormalities, and most physicians, who understand the symptoms’ basis in only the most rudimentary sense, can offer little useful counsel. Faith in survivors’ stories—among friends, colleagues, even loved ones—can waver.

The most fundamental consequences of being struck by lightning are often metaphysical, and not easily communicable. How does falling victim to one of the most notoriously unlikely of all misfortunes reorient your sense of chance, of fate? How does it feel, when you’re trying to describe the most transformative experience of your life, to be met, routinely, with disbelief?

Last May, I attended a conference of Lightning Strike and Electrical Shock Survivors International. It was held, as it often is, in Pigeon Forge, Tennessee, a smallish town on the edge of the Great Smoky Mountains best known as the home of Dollywood, Dolly Parton’s Appalachia-themed amusement park. The town’s main drag resembles a sort of family-friendly version of the Las Vegas strip. Instead of casinos, there are dinner-show theaters, go-kart tracks, and a sprawling Margaritaville megacomplex, its central fountain inhabited by giant animatronic Brachiosaurus that roar from time to time.

The conference was staged at a Staybridge Suites just off the strip. About 30 people were there, mostly men who looked to be over the age of 60, many of them conference regulars who’d been struck long ago, though there were some women and younger attendees too. Most had brought their spouse and were making a weekend of it. They were there primarily to connect with other people who understood what they had been through.

Like senior prom, the conference always has a theme, and this year’s was Hawaii. Survivors wore leis, and pineapples adorned with sunglasses sat on every table in the Staybridge’s modest meeting room. A folding table converted into a makeshift tiki bar dispensed virgin piña coladas and hurricanes. Against this backdrop, specialists gave presentations on trauma therapies. Attendees compared notes on which treatments have worked for them and which haven’t.

Stacy Kranitz for The Atlantic

Steve Marshburn Sr., the founder of the group, seated at a conference luncheon. The conference always has a theme, and that year’s was Hawaii.

In one session, a man I’ll call Matt, a young, redheaded survivor who for a year and a half after his strike could hardly feel pain, temperature, or most other sensations on much of his skin, said laser therapy had eventually restored his nerves. Having a massage therapist work on his vagus nerve had helped too. For a while, he’d slept inside a Faraday cage, to protect him from static electricity during storms. Today, to cope with intrusive thoughts about lightning, he dumps a packet of salt in his mouth because when you do that, he said, “that’s all you can think about.”

A woman I’ll call Caroline, who’d been struck on the job two years earlier, used that same strategy, she said, only with Warheads candies instead of salt. One problem she had not solved was that no matter how hot she gets, no matter how hard she exerts herself, she can’t sweat anymore. Matt said he’d had the same problem for a while. What fixed it for him was spending significant time in a sauna—up to 90 minutes three times a day.

If the discussion had a certain DIY quality to it, that reflects the paucity of medical literature on what lightning does to the body. Few systematic studies have been conducted, and most physicians have never treated a strike victim. Many survivors’ experiences defy medical explanation, so doctors have little to say.

Given the limited counsel that the medical establishment can offer them, survivors tend to be open to alternative therapies, but they’re also wary of being taken advantage of. At the conference, several attendees reminisced about the year when two “hippies” had shown up and started hawking New Age–type products. “They said they were linked in voodoo,” one survivor recalled.

Much of the group conversation focused on Caroline, whose injury was the freshest. She used to cook her family elaborate meals, but “after the accident,” she said, “I left the oven on so many times that I even ended up burning the element out.” For a while she refused to get a new one, because she worried she’d burn the house down. She leaves sticky notes everywhere to remind her of what she needs to do, but even so, she rarely has the energy to do all of it. She has to ask for help, which makes her feel bossy. She worries that others think she’s lazy.

Gary Reynolds’s experiences after he was struck in the summer of 2007 were similar. He was grabbing sodas from his family’s extra fridge, he’d told me earlier, when lightning hit him through the open garage door. For months, he could barely get out of bed. His whole body hurt constantly. He had trouble concentrating, and simple tasks that had once been second nature now seemed complex. On warm afternoons, he watched the sky warily. A therapist diagnosed him with PTSD, which by some estimates afflicts more than 25 percent of lightning-strike survivors. In 2009, just a few months shy of their 20th anniversary, Reynolds and his wife divorced. Initially she’d been sympathetic, he said, but over time she lost patience. “You’re not over this yet?” Reynolds recalled her saying. “It can’t be that bad.”

Stacy Kranitz for The Atlantic

Gary Reynolds, who was first struck in 2007

“I just keep thinking, I want to wake up the next day and it’s going to be normal,” Caroline said at one point during the session. But she wasn’t even two years out from her strike. She had not yet come to the conclusion that the veteran survivors at the conference had reached long ago: that no matter what you do, no matter how many therapies you try, you still have to accept that you’ll never be the person you were before. “You still look the same and everything else, but it’s like a different person inside,” Reynolds said. “It’s a different soul.”

The odds of being struck by lightning in the United States in a given year are roughly one in 1.2 million, according to a 2019 analysis by the National Weather Service—about the same as flipping a coin and landing on heads 20 times in a row. But this is only a generic estimate. The likelihood of being struck in San Francisco is not the same as the likelihood of being struck in Orlando, last year’s urban lightning capital of America, according to Vaisala Xweather, a provider of local weather data. The likelihood of being struck for lawyers is not the same as the likelihood of being struck for roofers.

The majority of people killed by lightning—about 20 each year in the U.S.—are struck while engaging in some sort of outdoor leisure or labor. But in truth, almost anyone can be struck almost anytime. People have been struck while talking on landlines, while using computers, even while sitting on the toilet, according to the National Weather Service, because current can travel through telephone wires, electrical connections, and metal pipes. When lightning survivors insist, as many do, on unplugging their appliances in preparation for a storm, this is not tinfoil-hat mania. And the old advice about not showering during a thunderstorm? Sensible.

[Read: Almost no Americans die from lightning strikes anymore—why?]

Steve Marshburn Sr., who founded Lightning Strike and Electrical Shock Survivors International in 1989, told me that he was struck at age 25 on a seemingly clear November morning in 1969. He was working as a teller at First Citizens Bank in Swansboro, North Carolina, sitting at the drive-through window, and he thinks the bolt must have passed through an ungrounded speaker. For years, he struggled not only with debilitating headaches and back problems, but also with the sheer improbability of the event that had produced them. Many of the doctors he visited didn’t believe his story. For a long time, even his parents wondered whether he was making the whole thing up.

And to some extent, Marshburn understands why. “It’s so unbelievable that it’s hard to talk about,” he said. Eventually, a doctor introduced him to another patient who had survived an electrical injury, and that experience led Marshburn to start his survivors’ group. Membership now numbers about 2,000, and in September the organization hosted its first-ever West Coast conference, in Scottsdale, Arizona. For years, most people found their way to the group via their local weather station, or after seeing it featured in news outlets or on TV. Now more find it through Facebook.

That’s how Gary Reynolds did. His second wife, Lisa, discovered the group while searching online for other people who’d been struck, people who could understand him. Doctors never had. When he first went to the emergency room, they ran a battery of tests, but the results all came back normal. After he’d been at the hospital for about nine hours, a doctor said, “I’m not really sure what to tell you,” and sent him home. Roughly the same thing happened when he visited his primary-care physician. Other doctors told him to his face that he was making the whole thing up.

Not until his first conference did he meet people who could truly empathize with him. He’d never spoken with a fellow lightning-strike survivor in person before, and he was nervous on the drive up, but when he arrived he felt almost like he was at a reunion. “You walk into that room and it’s like we’re family,” he said. After he joined the group, he felt normal for the first time in years. “It was validating,” he said. “Like, Okay, I’m not crazy.”

Stacy Kranitz for The Atlantic

A walking stick used by one attendee

A poem describing the feeling of being struck, and then the aftermath, by Lisa Devine, who attended the conference with her husband, Danny, a strike survivor

In June 2008, Reynolds told me, he was struck by lightning a second time. It was 11 months after his first strike, and he’d woken up at 2 a.m. with an awful headache. Ever since the initial incident, his head had throbbed in exactly the same spot when he sensed a storm coming. As he lay beside his open bedroom window, he felt a shock go through his hand. “Not again,” he thought. Half of his hand turned bright red, he said, but he hadn’t yet paid off the previous year’s hospital bills, and this strike seemed less serious than the last, so he decided not to seek care. In the following months, though, his lingering symptoms from the first strike all worsened. He was often dizzy, and he couldn’t grip well. Reynolds ran a tree service at the time, one he’d started a few years after high school, and these were serious problems for someone whose vocation involved wielding a chainsaw. The divorce came about six months later.

In the years that followed, Reynolds pieced his life back together: He remarried, moved his family to western North Carolina, began working at a lumberyard, started attending survivors’ conferences. Then, while standing in the kitchen of his mountainside home on a June afternoon in 2016, he was struck a third time. And six years after that, a fourth, he said, this time while sitting in a leather recliner watching TV with his grandchildren. Must’ve been a streamer, he told me. Came up through the floor and hit him square in the back.

If the likelihood of getting struck once in your lifetime is one in 15,300, as the National Weather Service estimated in 2019, then statistically, the number of people in the United States today whom you’d expect to have been struck multiple times is … one. One single person. And yet the National Weather Service’s collection of about 50 lightning-survivor stories on its website includes two from people who say they’ve been struck twice and another from someone who says she’s been struck three times. Andy Upshaw, a North Carolina landscaper, says that he, too, has been hit three times. Charles Winlake, struck four times before the age of 30, added rubber soles to all of his shoes and began to wear only plastic-rimmed glasses. Linda Cooper, a former South Carolina schoolteacher, says she’s been struck six times, and so does Carl Mize, a former Oklahoma rodeo rider. One member of the Lightning Strike and Electric Shock Survivors Support Facebook group says she’s been struck nine times, and another says she stopped counting after 13. Media reports document more multistrike cases. In all, my far-from-exhaustive search turned up more than two dozen.

Stacy Kranitz for The Atlantic

Clockwise from top left: Electrical-shock survivor Rodney Burkholder and lightning-strike survivors Danny Devine, Danny “Joe” Jude, and Betsy Silby, in Pigeon Forge with their partners and caregivers

All of this, to state the obvious, is incredibly improbable. Extrapolating from the National Weather Service estimates, the likelihood of being struck six times is roughly one in 13 septillion—that’s a 13 followed by 24 zeros. If you multiplied the number of people who have ever existed on Earth by about 100 trillion, you’d expect one person among them to have been struck six times.

It can seem cruel to suggest that some lightning-strike survivors may be lying, especially when disbelief causes so much hardship for those who are not. But because relatively few lightning strikes are documented, the question often lingers. People lie for all kinds of reasons, and there can be financial incentives to claiming you’ve been struck: workers’ compensation, disability benefits. Mary Ann Cooper was an emergency-medicine faculty member at the University of Louisville when she published the first systematic study of lightning injury in 1980—instantly becoming the leading authority on the subject in doing so. Cooper served for years as an expert witness in workers’-comp cases, brought in to assess whether the claimant really had been struck. She told me that she’s encountered some frauds, identifiable because they reported inconsistent or physiologically impossible symptoms.

But the people trying to cheat their way into benefits, Cooper said, are largely not the ones attending survivors’ conferences. She believes that the overwhelming majority of the people she has met at those conferences are telling the truth about being struck, and about all the calamities that followed, at least as they understand them. Which is not to say that every statement should be taken at face value.

Like several doctors and scientists I spoke with, Cooper thinks that most people who say they’ve been struck multiple times genuinely believe that, even if they haven’t. Many survivors have flashbacks as a result of PTSD, just as combat veterans and wildfire survivors do. But when a combat veteran or a wildfire survivor resurfaces from a flashback, their surroundings verify to them that they are not, in fact, caught in the middle of a war zone or a fire. A lightning-strike flashback prompted by a storm involves no such assurance. A lightning bolt is there and gone in an instant.

What’s more, because lightning leaves the nervous system damaged, it can make people feel bursts of pain—real, excruciating, and unconnected to any physical stimulus. Together, PTSD and nervous-system damage may explain many reports of second or third or fourth strikes.

Stacy Kranitz for The Atlantic

Charles O’Connor Jr., a lightning-strike survivor, attending the conference for the first time with his wife, Chrissy

Not so long ago, that explanation might have sounded far-fetched, just as some of the chronic symptoms of a lightning strike still do, to some. But the idea that trauma can alter the way people perceive the world and interpret their experience is ubiquitous now. And the emergence of long COVID, along with increased awareness of other difficult-to-diagnose chronic conditions, has created a greater respect for individual testimony, and a greater appreciation for how much the medical profession does not know. In this sense, society is finally catching up to what lightning survivors and the people who study them have long understood.

The most grinding suspicions encountered by many survivors—about whether they were ever really struck at all—may in any case be mooted in the coming years. On a recent trip to France, Cooper met with a physician who told her he’d identified a biological marker for lightning injury, which may enable doctors to determine, with a simple urine test, whether someone really has been struck. Nothing has been published on it yet, Cooper said, and no such test seems imminent, so for the moment she isn’t getting too excited. But she has an open mind to the possibility.

All of this, of course, is mostly to the good. Yet the lightning-survivor community has always defined itself by a sort of oppositional faith: There, you are doubted; here, you are believed. There, you are strange; here, you are normal. When I asked Reynolds what he made of the trauma-plus-nervous-system-damage theory of why there are so many multistrike survivors, I felt as though I was doing something almost sacrilegious, as though I was violating that ethos of mutual faith. I worried that he’d react with indignation. The notion that he might hang up on me and refuse to speak with me again did not seem unlikely. Instead, he said he thought the theory made a lot of sense.

Might then it explain his multiple strikes? I asked.

Well, he answered, not his.

What does one make of a life so fundamentally altered by an event as unlikely as a lightning strike? In Pigeon Forge, when I asked survivors whether on balance they felt lucky (for having survived a lightning strike) or unlucky (for having been struck in the first place), the question didn’t register. “I don’t think luck has anything to do with it,” Susan Deatrick told me. She doesn’t like the word providential either, she said, “but at the same time, God is in control over everything down to the minutest detail.”

This response, and others like it, initially surprised me. If lightning is a manifestation of the divine, I thought, how do people explain why it struck them? How do you make sense of a miracle that comes at your expense?

[From the July 1875 issue: Lightning and lightning-rods]

Jim Segneri, who moderated the conference’s final and most intense group discussion, has a succinct answer, one more focused on his having been spared than his having been struck. “I firmly believe that whether you worship Allah or Buddha or God or Jesus or whoever put us here, the reason we’re still here is so that we can help other people”—those who are doubted, those who are struggling.

Large numbers of survivors hold some version of this belief. Marshburn, the group’s founder, often speaks of the number of survivors—more than 20—whom he has talked out of suicide, reciting in vivid detail the conversations he’s had with people on the brink. Over her many years speaking with lightning-strike victims, Mary Ann Cooper said, “I can’t tell you how many people have said to me, ‘I should have been dead. God must have kept me alive for a reason.’”

And yet for those survivors who hold it, the belief in destiny can cut both ways. Reynolds says that after his third strike, he felt doomed. He’d left his career, gotten divorced, gotten remarried, started a new job, moved more than 600 miles away—and still the lightning had found him. “It’s like it’s looking for me,” he told his therapist. “It’s like it’s a living, breathing creature.”

She assured him that it wasn’t, and part of him knew she was right, but he couldn’t stop thinking that he was fated to be struck again. She told him that she doesn’t believe in destiny. That there is no providence, only circumstance. That sometimes you’re just in the wrong place at the wrong time. He’d believed that once. But now he can’t shake the feeling that she’s wrong.

This article appears in the April 2026 print edition with the headline “Struck.” It has been updated to clarify the source of the data used to determine the urban lightning capital of the U.S. last year. The data was provided by Vaisala Xweather.

The Dieting Myth That Just Won’t Die

2026-03-13T10:30:00-04:00

Back in the early 1970s, psychologists at Northwestern University performed an experiment that, on the surface, looked like a child’s fantasy. The researchers gathered 45 college women and asked some of them to drink a milkshake—or two. Then they placed three pints of ice cream in front of each woman and asked her to taste each one. Afterward, they told each participant to “help herself to any of the remaining ice cream, as she wished,” the researchers wrote in the Journal of Personality. Finally—and this was key—each woman completed a survey meant to measure how much she dieted or “restrained” her eating, outside of the treats she had just consumed.

The findings were dramatic. On average, the women who said they didn’t diet or have weight concerns ate less ice cream if they drank at least one milkshake. The first sweet treat satiated their hunger. But for the women who dieted and felt worried about their weight, the milkshake appeared to unleash a hidden hunger. On average, they ate 66 percent more ice cream after the milkshake than they did without it.

From these data, the researchers devised a bold new theory: Dieting and weight concerns make people overeat and gain weight. Dieting remains pervasive in American culture, but the milkshake study, and similar ones that followed, nonetheless reshaped many Americans’ views of dieting and obesity. Experts concluded that all types of eating disorders—including anorexia, binge eating, and bulimia—can be brought on by intentionally trying to reduce the number of calories that you eat. Some scientists believe that dietary restraint causes obesity too.

This line of research inspired treatments for eating disorders, helped launch an anti-diet movement, fueled the trend of so-called intuitive eating, and shifted how many parents raised their kids to think about food. But more recent evidence suggests that attempting to restrict one’s food intake typically doesn’t have such dire consequences after all.

The notion that trying to diet causes eating disorders and obesity makes some sense. “There’s the idea that if you’re finding yourself thinking about food, trying to restrict what you eat or trying not to overeat, then you’re developing an eating-disorder mentality,” Michael Lowe, a psychologist at Drexel University, told me. The theory is also inherently appealing, in that most people don’t like avoiding tasty food; they can easily believe that doing so would be harmful. No wonder, then, that the idea spread far among clinicians and everyday Americans. Social media supercharged the theory, enough that many people now believe that placing any limits on your diet could be dangerous or harmful, Ashley Gearhardt, a psychologist at the University of Michigan, told me. Many parents share the belief that letting kids follow their own appetites will create healthy attitudes toward food; taken to its logical extreme, that way of thinking means that “in a lot of circles now, if you don’t let your kids have unlimited access to ultra-processed foods, it’s a bad thing,” Katherine Balantekin, a registered dietitian at the University at Buffalo, told me.

Such ideas spread even as researchers were uncovering major flaws in early studies on the link between dietary restrictions and eating disorders. Those experiments didn’t use a consistent definition of dietary restraint, and never tested whether it actually caused eating disorders or overeating; they could say only that those behaviors occurred together. Plus, many studies lumped together several types of eating disorders, or didn’t separate participants with obesity from those with low body weights.

[From the May 2023 issue: Nutrition science’s most preposterous result]

Scientists, including the ones who ran the 1975 milkshake study, also relied on self-reports or surveys to quantify how much a participant dieted, assuming that people who said that they greatly restricted their consumption really did take in fewer calories. But decades later, when scientists gave the same surveys to new participants and measured their calorie intake, they found that the surveys simply didn’t correlate with calorie restriction, Eric Stice, a psychologist at Stanford who led some of these measurement studies, told me. People whom such surveys would label “high dieters” may not have been dieting at all, Stice found. In one of his studies, a so-called high dieter ate, on average, 23 calories fewer a day than a low dieter. “That’s like not eating four peanuts each day and saying you’re on a diet,” he said.

By the 2000s, scientists began to run randomized, controlled trials that could accurately test the model proposed back in the ’70s. In one series of studies, people were prescribed personalized diets aimed at reducing calorie consumption, and taught effective ways to adhere to their eating plans. After six months, those volunteers lost about 10 percent of their body weight, on average, compared with the 1 percent that the control group lost. And the increased dieting didn’t exacerbate participants’ eating-disorder symptoms. In fact, it decreased their binge eating, and they felt less concerned about their body size (perhaps, in part, because their body size decreased). In the past decade, psychologists at Yale School of Medicine have run similar randomized, controlled studies on people who had already been diagnosed with binge-eating disorder and obesity. And again, on average, calorie restriction reduced binge eating; participants’ eating-disorder symptoms worsened only occasionally, and no more so than in the control group. In at least one paper, eating-disorder symptoms improved far more among people in the restricted group than in the control group. In another, weight loss led to remission of binge-eating in nearly three-quarters of the participants.

The scientific consensus that has emerged after these and similar studies is much more nuanced than the one proffered 50 years ago—even though that one still has significant traction in American culture today. “Dietary restriction is not necessarily all good or all bad. But different degrees may be helpful or harming to different people,” Sydney Yurkow, a psychologist at Yale School of Medicine who contributed to the recent trials there, told me in an email. For example, she said, cutting back on food would never be recommended for people diagnosed with anorexia nervosa. And even for people without an eating disorder, “extreme restriction that often coincides with self-directed dieting is largely unhealthy and unhelpful,” Yurkow wrote.

[Read: We have no drugs to treat the deadliest eating disorder]

The new generation of experiments has also uncovered a surprising way to prevent future eating disorders in high-risk adolescents and young women: a small amount of effective dietary restraint. One 2021 meta-analysis found that teaching people about healthy eating habits—including how to curb a tendency to overeat—prevents the future development of eating disorders. Altogether, Stice said, the modern experiments suggest two likely pathways for developing eating disorders. The first involves a person who’s dissatisfied with their body and engages in extreme weight-loss behaviors to change it. “But there’s a whole other pathway that many people have been ignoring,” he said—one in which a person overeats or binges, gains weight, and then becomes dissatisfied with their body as a result.

From this perspective, the milkshake study looks quite different. Fifty years ago, psychologists concluded that dietary restraint caused the women to overeat the pints of ice cream. But the modern interpretation suggests that the reverse was likely true for many of the participants: An underlying tendency to overeat drove the women to try to diet.

In hindsight, the timing of the milkshake study is almost prophetic. Around the late 1970s, the food environment in America began to change rapidly, Lowe, the Drexel psychologist, told me. “The availability of fast food, restaurants and high-sugar, high-fat foods began to explode,” he said. Food became much more difficult to resist, even when Americans weren’t hungry. “People suddenly had to restrain their eating much more in order to maintain their weight.” More people began to gain weight, and by the early ’80s, the country had entered the first stage of the current obesity epidemic. Today, the average American consumes about half their calories from ultra-processed foods. The precise bounds of the category generate debate among some scientists, but they generally agree that such foods are highly refined, manufactured in industrial factories, and calorically dense. Studies have found that diets high in these foods can coax people to consume hundreds of extra calories each day, and when people binge eat, they tend to do so with only ultra-processed foods.

[Read: Coke, Twinkies, Skittles, and … whole-grain bread?]

Recently, scientists and government leaders have begun warning Americans about the potential harms of eating too much ultra-processed food, including an elevated risk of diabetes, certain cancers, and depression. Health Secretary Robert F. Kennedy Jr. has declared war on added sugars, and as of this year, the national dietary guidelines advise against eating highly processed foods. In reality, the study of this kind of food is just getting started. But if Americans are ever to really understand just how such foods affect us, now is the time to abandon the misguided lessons of the milkshake study. Maybe then we can explore how we might develop a truly healthy relationship with the tantalizing food around us.

Florida Is Trying to Ignore Measles Until It Can’t

2026-03-13T07:00:00-04:00

Out of the 30 states where measles has been detected in 2026, Florida currently ranks third in case counts. Since the start of the year, at least 132 confirmed or probable cases of measles have been reported across the state, where vaccination rates have consistently fallen below the threshold required to prevent outbreaks. The measles situation in Florida is, in other words, an urgent problem for the state that the state should be urgently addressing.

But on all things measles, the state’s health department has been mostly silent. The department’s measles landing page has no map of the state’s cases and no list of vaccination sites; its “Data and Statistics” section points to measles numbers that were last updated in 2024. In the months that measles has been spreading in the state, health officials have not issued press releases about the virus or launched information campaigns to caution residents about the risks. They have not publicly advertised the benefits of vaccines. Many of Florida’s health experts remain in the dark about their own state: “There has been no—capital N, capital O—communication to physicians, in particular pediatricians, about the outbreak,” Jeffrey Goldhagen, a pediatrician at the University of Florida at Jacksonville and the former head of the Duval County health department, told me.

Officials in other states are not being so coy. In South Carolina, where nearly 1,000 measles cases have been documented in recent months, the state health department holds weekly press briefings and has plastered an orange MEASLES OUTBREAK banner at the top of its website; in Utah, which has had more than 200 cases in 2026, the health department shares granular details about where the virus has been found. Even South Dakota, which has reported just 23 cases in the past year, provides a list of vaccination clinics at the top of its health department’s measles page.

Florida is the stark outlier—and has been headed in this direction for some time. Under the leadership of Governor Ron DeSantis and Surgeon General Joseph Ladapo, the state has spent the past few years bucking public-health wisdom. A year ago, when measles spread through a Florida elementary school, Ladapo allowed unvaccinated children to return to class instead of staying home to limit the size of the outbreak; in September, he and DeSantis announced that they intend to do away with all vaccine mandates. Now, by all appearances, Florida is testing out a head-in-the-sand approach to measles.

During an outbreak, health departments are usually the first line of defense. Few other entities can serve as a hub for public communication and a trove of data while coordinating across health-care systems and emergency services. In the dozens of states that have reported measles cases since the start of 2025, most health departments have offered a consistent and very public response: issuing press releases, mapping infections, sending health-care bulletins, hosting vaccination clinics. Last year, for instance, after measles started to spread in Texas, New Mexico health officials began pushing out information before the virus had been detected there; by the time New Mexico’s own 2025 outbreak ended, the state had logged 56,000 new immunizations, Andrea Romero, the state’s immunization-program manager, told me. Several of the state health officials I spoke with emphasized transparency as one of their core philosophies: “People have a right to know,” Natasha Bagdasarian, Michigan’s chief medical executive, told me.

In Florida, though, several of the doctors I spoke with weren’t even certain how many cases had been detected in their own county. “We cannot get any information on what is happening in various parts of the state,” Mobeen Rathore, a pediatric-infectious-disease specialist at the University of Florida at Jacksonville, told me. Researchers have been able to tap into Florida’s measles-case counts only via a poorly publicized database that is not linked on the health department’s measles page. Lauren Gardner, an infectious-disease modeler at Johns Hopkins University, where she and her colleagues run a national measles tracker, told me that Florida’s data stand out as unusually difficult to find, and of the 11 Florida physicians and epidemiologists I spoke with for this story, most were unaware that recent measles cases could be found on the state database. Even when cases hit Jacksonville, Rathore said, he heard about them only because some of his colleagues had seen them; pediatricians in the broader community, meanwhile, weren’t told at all.

In response to a request for comment, the Florida Department of Health’s communications director, Brian Wright, told me in an email that The Atlantic was “leaning on unverified third- and fourth-hand claims and calling it reporting.” The department did not respond to questions about why it has not readily publicized measles cases.

Florida’s health department used to be as reliable as other states’: As recently as 2019, its website clearly documented recent measles cases and described the measles-mumps-rubella vaccine as “the best way to prevent measles.” That information is now gone—and the experts I spoke with consistently described the measles content left on the health department’s website as superficial, biased, and even misleading. Although the website does warn about “suspected measles cases” in Collier County—which accounts for about three-quarters of the cases in the state—it then links to Collier’s health-department website, which links back to the state health department’s website. The state’s site also fails to mention that unvaccinated people are at high risk of severe illness; meanwhile, it promotes vitamin-A supplements as a possible treatment (as Health and Human Services Secretary Robert F. Kennedy Jr. has), even though supplementation is generally considered essential only for those with a deficiency, which is very rare in the United States.

Rana Chakraborty, a pediatric-infectious-disease specialist at the University of Miami’s Miller School of Medicine, told me that he has stopped relying on the health department for measles information and has instead been following the advice of the American Academy of Pediatrics and the Infectious Diseases Society of America. Health-care establishments across the state are now charting their own course as they prepare for future outbreaks. “We’re all scrambling a little bit to know what the right or best thing to do is,” Chakraborty said.

Even in Collier County, where dozens of cases have been detected at Ave Maria University since late January, information is spotty. Shannon Fox-Levine, who represents that region in the Florida chapter of the AAP, told me that she consistently hears from her colleagues in Collier that “there has been very little transparency from the school and the health department” about local measles cases—including whether officials have continued to detect spread. A page on Collier’s health-department website lists two clinics where vaccine appointments can be scheduled, but not much else; Ave Maria University has said that it has coordinated with the health department to perform contact tracing and testing, but it stopped releasing data about the outbreak in mid-February. (Neither Ave Maria University nor the Collier County health department returned a request for comment.)

The relative silence in and around Collier has made communicating with patients challenging, Fox-Levine told me. “We are the trusted source for our families,” she said. “When we don’t have answers, it can be hard to reassure them.” Many physicians also worry that the lack of public information has lulled the rest of the state into complacency: Surely, if Florida officials aren’t sounding the alarm, there’s little to worry about. “For the rest of Florida, it’s like, Measles? What measles?” one physician in southern Florida told me. (Several of the health experts I spoke with for this article requested anonymity to avoid professional repercussions for speaking about measles and vaccination without the permission of the health department or their university.)

Many of the Florida experts I spoke with said they didn’t blame health officials specifically for Florida’s minimalist response to measles. Across the health department, officials desperately want to do more to address measles cases, Goldhagen, who remains connected with many former health-department colleagues, told me. But “their hands are tied by the state.”

Several of the experts I spoke with—including one health-department employee—cited an environment of fear and restriction within Florida’s health department. The message from state leaders, they told me, has been that health officials are not to publicize outbreaks, or encourage quarantines, isolation, or vaccines. The state has embraced such hands-off policies since the coronavirus pandemic: In 2020, DeSantis strongly encouraged COVID vaccines for the elderly, but as political sentiment toward COVID vaccines and policy shifted, Florida began taking a more relaxed approach to infectious disease. In 2021, the state passed a law that restricted officials’ ability to quarantine students exposed to COVID; measles cases are not subject to such restrictions, but attitudes about the viruses appear to be similar, several researchers told me.

Unlike many other states, Florida runs a fairly centralized health department: The local health departments are staffed with state employees. “All the directors are scared enough that nobody talks,” one physician in northern Florida told me. The department has suffered serious budget cuts too in the past few years, and many health-department employees worry that doing the job they were hired for could now mean losing it altogether. (Neither the health department nor DeSantis’s office responded to my questions about how politics has shaped Florida’s measles response, or about the limits put on health-department employees.)

Still, where they can, many health officials are “working quietly to implement standard public-health practices,” the northern-Florida physician said. After two cases were detected at the University of Florida at Gainesville, for instance, health-department officials performed contact tracing, ultimately reaching some 1,000 people, Fred Southwick, an infectious-disease specialist at the university, told me. Health officials also recommended quarantines and isolation as appropriate—and people were able to seek vaccines through the health department as well as through the university or their own health-care providers, two physicians in Gainesville said. (Southwick spoke to me in a personal capacity, not on behalf of the University of Florida. In response to a request for comment, the university referred me to communications it had sent to its students, faculty, and staff about measles and then directed me to the health department; it did not answer my questions about the department’s degree of involvement or transparency in managing the cases.)

But these covert operations won’t cut it for much longer, experts told me. A key part of public health, Goldhagen said, is to be public about health, so that everyone has the opportunity to protect themselves and their community. Matt Hitchings, an infectious-disease researcher at the University of Florida at Gainesville, told me that “there are lots of places in Florida that appear to be right on the knife’s edge between sufficient vaccine coverage and not enough,” and although active messaging from the health department wouldn’t change every mind, Hitchings suspects that it could bump vaccination rates enough to prevent outbreaks in some of those regions. As things stand, two physicians told me that they’ve begun to imagine a future in which measles could soon be detected in nearly every single one of the state’s 67 counties.

DeSantis and Ladapo’s approach to infectious disease has been polarizing: Recent polls show that roughly 80 percent of Florida parents support maintaining current laws that require vaccines for schoolchildren—approximately in line with national attitudes. But Florida has become a firmly red state, and across the country, Republicans express doubts more frequently than Democrats do that immunizations are safe and beneficial. In Florida, the number of families seeking exemptions from vaccine requirements has been increasing steadily, and is now about 5 percent.

At some point, the health department may be forced to change tactics—if other states begin warning against travel to Florida, hospitals are overrun, or people begin to die. The “look away” strategy, after all, works only as long as a disease’s impact is small enough to ignore without political consequence. But Hitchings and others told me that they can’t yet picture what that shift might look like. “What is the endgame? I really don’t know,” Hitchings said. DeSantis has pitched Florida as a haven from liberal policies: In 2024, the state posted on its borders signs reading Welcome to the free state of Florida, advertising its commitment to personal choice. It may yet have to reckon with how the decisions of a relatively small number of individuals will affect the health of entire populations—who may soon have less of a choice about whether they get sick.

One Food All Americans Can Agree On

2026-03-12T11:51:04-04:00

If nutrition is a sport, it has no casual fans. Supporters of Team Protein, the 2025 champions, are numerous and passionate, backed up by a sprawling industry of protein-supplemented products such as popcorn, soda, and cereal. Also popular is Team MAHA, captained by Health Secretary Robert F. Kennedy Jr., which endorses “real foods,” especially red meat and dairy. The Dietitians are veteran players with an old-school strategy: going heavy on plants and light on saturated fats. Alongside underdogs like Team Keto and the Vegans, there are the Fiber-Maxxers, upstarts whose popularity has soared alongside sales of fiber-filled cookies, powders, and drinks.

As in any fandom, choosing one team can mean demonizing the others’ stars: MAHA partisans despise the Dietitians’ low-fat milk, and the Fiber-Maxxers sneer at Team Protein’s constipating supplements. Yet there is one player that any team would gladly welcome. It’s packed with fiber and protein. Kennedy would call it a “real food.” It’s plant-based, widely available, and incredibly affordable. It is the homeliest and humblest of foods: the bean.

Beans have a lot going for them. (The term beans is often deployed as a catchall term for the larger family of legumes, which includes beans as well as a subset called pulses; here, I’m talking about all of them.) These tiny packages pack a nutritional punch—so much so that the advisory committee for the 2025 U.S. Dietary Guidelines recommended upping the daily serving size of legumes and promoting them as a protein source over meat and seafood. (The meat-happy published guidelines did not incorporate this suggestion.) Navy beans, for example, are especially fiber-dense, and lentils are protein powerhouses. To the farmer, beans are a boon: The plants store nitrogen in their roots, so they require less fertilizer and leave soil healthy once they’re harvested. They are significantly gentler on the climate than meat. Cooked well, they are creamy, tender, and excellent vehicles for flavor.

[Read: If everyone ate beans instead of beef]

Even the most skilled player can’t excel at everything. Dried beans take time and effort to cook. Expert technique can make them delicious, but they’ll never be as succulent as steaks. And yes, they can cause horrible gas, especially among bean novitiates—that is, most Americans. Unlike, say, Mexican or South Asian cuisines, American food is not particularly bean-heavy. Americans consume roughly 60 pounds of beef annually, but only about nine pounds of beans.

The discrepancy is partly because of beans’ lackluster image. Bean companies “might need a little bit of extra oomph in the marketing department,” Jonna Parker, a produce analyst at the industry-research firm Circana, told me. Zach Conrad, a nutritional epidemiologist at William and Mary, recently co-authored a study showing that most Americans don’t eat enough beans to meet the recommendations of the Dietary Guidelines advisory committee. The paper also noted that beans, owing to their relative cheapness, have a stigmatizing association with poverty. “At a nice restaurant, on a date, most people are not going to get a bean salad,” Conrad told me.

But a confluence of changes in American life are making beans a more attractive choice. Other humble foods, such as tinned fish and cottage cheese, have lately experienced a bump in their status, thanks in part to the nation’s ongoing protein obsession. The protein in beans isn’t as easy for the body to absorb as that in animal products, so you have to eat more to get the same amount, Conrad said, but the conversion is hardly unreasonable. Opting for beans also helps square some of the conflicting nutritional advice in the 2025 Dietary Guidelines. The latest version newly emphasizes protein consumption, but also maintains firm limits on saturated fat, which is plentiful in red meat and associated with a higher risk of heart disease and stroke. As my colleague Nicholas Florko has noted, meeting those standards with animal products would be a challenge. But with beans, it’s almost trivial.

Lately, food costs have become eye-wateringly high, particularly for protein. Beef prices were nearly 15 percent higher in September 2025 than they were a year earlier; this year, chicken will likely become less affordable too. Kennedy recently encouraged people to embrace offal as a more affordable source of protein. Even canned foods have become more expensive. Yet beans, canned or otherwise, are still one of the cheapest protein sources around. A can of navy beans costs about a dollar and contains nearly the same amount of protein as a McDonald’s Quarter Pounder.

[Read: America’s grocery lifeline is fraying]

If the nutritional, environmental, and financial benefits aren’t sufficient reasons to root for beans, take note of their recent makeover. Beans are no longer “what Grandma used to make,” Parker said. American culinary enthusiasts have been experimenting with them since at least the early 2000s, but bean innovation really took off in the early days of the coronavirus pandemic, when people adopted pantry cooking as a matter of staying safe, budgeting, and passing the time, says Bettina Makalintal, a senior reporter at Eater whose popular Instagram account is filled with alluring photos of stewed legumes. Well-known recipe developers including Alison Roman—who in 2021 helped propel the “brothy bean” into culinary-world ubiquity—elevated beans further. The food influencer and model Pierce Abernathy gives beans the gourmet treatment with ingredients such as salsa verde and bottarga. Abernathy, whose bean recipes include lesser-known varieties such as Anasazi and gigante beans, is among a growing number of heirloom-bean enthusiasts; Rancho Gordo, an heirloom-bean company, runs a subscription club that reportedly has 29,000 people on its waitlist.

Food companies are riding this leguminous wave, introducing bean-based products with unexpected flavors and convenient formats. The vibrantly branded canned-bean stews from Heyday Canning, launched in 2020, include products such as kimchi-sesame navy beans, harissa-lemon chickpeas, and vodka-sauced cannellini beans. A brand called Lentiful sells individually packaged, microwavable lentil stews in flavors such as Thai Coconut Curry and Lemon Mediterranean, marketing them as grab-and-go lunches. Lentil Telepathy, which launched in 2023, specializes in air-toasted crunchy lentils that can be eaten as snacks or salad toppers, as in the case of the peri-peri and salt-and-vinegar varieties, or as breakfast cereal, if toasted-marshmallow or chocolate lentils hold more appeal. Bean dips can be scooped up with bean chips. Should you prefer a lighter bite, a line of jarred fermented-bean salads is due to launch next month.

“Americans are finally catching up to what much of the world has known for centuries,” Ben Bacon, a co-founder of Lentiful, told me: Beans are a main course, not just a side. Steve Sando, the founder of Rancho Gordo, told me that he hopes the beanthusiasm is here to stay. “Being the flavor of the week is kind of fun, but I really want people just to incorporate beans into the American diet,” he said. Team fandoms, of course, run deep. But no matter where allegiances lie, everyone should be able to agree that beans are the MVP.

The Fight Over Tylenol and Autism Just Got Messier

2026-03-09T11:00:05-04:00

Last September, during a memorably bizarre press conference, President Trump told pregnant women—repeatedly and emphatically—not to take Tylenol. His health secretary, Robert F. Kennedy Jr., pointed to studies that “suggest a potential association” between acetaminophen use during pregnancy and neurodevelopmental disorders. Kennedy was more adamant on The Joe Rogan Experience recently, insisting that he had read 76 studies on the subject over one weekend and concluded that the “science is really clear” in showing a link between the drug and the conditions.

The science, in fact, is not at all clear. Although some studies have indeed found an association between prenatal acetaminophen use and autism or ADHD, others have not, including a recent systematic review of 43 studies. But a new study, carried out in Taiwan and published today in JAMA Pediatrics, seems poised to inflame the controversy anew.

Kennedy’s confident assertions aside, the FDA has offered a more evenhanded assessment of prior evidence. On the day of the September press conference, the agency issued a notice to doctors acknowledging that “a causal relationship has not been established” between prenatal acetaminophen use and neurological conditions. That’s exactly right. The studies that have found an association tend to be small and unable to determine causality or rule out other potential causes. Two recent large studies—one conducted in Japan, the other in Sweden—examined siblings and found no association between acetaminophen and autism. Such studies, common in epidemiology, compare siblings in the same family, making use of the similarities in their genetics and environment to help rule those out as culprits. The Swedish researchers, for example, found a weak association between acetaminophen and neurological disorders among all 2.4 million children in the study. But when the study was narrowed just to siblings, comparing, for instance, one who was exposed prenatally and one who was not, the association vanished, suggesting that a factor other than acetaminophen use was at play. The Japanese results followed a similar pattern.

At first glance, the new Taiwanese study appears to mirror the conclusions of the Swedish and Japanese studies. The researchers analyzed the health records of more than 2 million children born from 2004 to 2015, along with their mothers. Across the entire study, mothers who were prescribed acetaminophen during pregnancy were more likely to give birth to a child who would later be diagnosed with autism or ADHD. (In Taiwan, most acetaminophen is taken by prescription, the study’s authors suggest.) And, as in the Swedish and Japanese studies, the apparent association between acetaminophen and the neurological disorders disappeared when the analysis was narrowed to look only at siblings.

But the researchers conducting the Taiwan study also found something weird. When only an older sibling was exposed to acetaminophen during pregnancy, that child was more likely than the younger, unexposed sibling to have ADHD or autism. When only a younger sibling was exposed, the risk for that child decreased. In other words, the siblings didn’t appear to be acting as reliable controls for each other in the experiment, as would be expected.

It’s a head-scratching result, and even the authors don’t seem to have an explanation for it. (Zeyan Liew and Pei-Chen Lee, who are listed as the study’s corresponding authors, did not respond to my requests for comment.) In the paper, they argue that their findings cast doubt on the validity of sibling studies more generally, including their own, arguing that the study design might accidentally introduce unexplained biases and that the families included might not be a representative sample of the general population. Their skepticism of sibling studies runs counter to the long-established notion that the more narrow approach is more rigorous, but it does seem to support Kennedy’s dismissal of the many studies that indicate acetaminophen’s safety. Late last month, Kennedy told Rogan that such studies “have huge holes in them.” (He did not specify what those holes might be; Andrew Nixon, a spokesperson for the Department of Health and Human Services, did not clarify when I asked him.)

[Read: The Trump administration’s unintended autism experiment]

To try to make sense of the findings, I spoke with Viktor Ahlqvist, an author of the Swedish sibling study. Ahlqvist thought the new study’s results were broadly consistent with his own and was perplexed by the researchers’ emphasis on what seemed to him like a “local quirk,” perhaps related to some unknown variable that’s specific to Taiwan. (For instance, a mother in Taiwan who’s more likely to use acetaminophen in a first pregnancy might be different from other mothers in other ways as well.) Besides, Ahlqvist said, the oddity in the Taiwanese data doesn’t invalidate the overall results of the Swedish or the Japanese studies—or of the Taiwanese study itself, for that matter. Yusuke Okubo, a co-author of the Japanese sibling study, was more cautious. He told me that although the new study mostly confirmed his research, the discrepancy between the outcomes for older and younger siblings “suggests that unaddressed biases may also remain.” Ruling out any potential harm based solely on siblings studies like his own is therefore premature, he said.

And so the science remains just as inconclusive as it was back in September. Since then, several of the administration’s acetaminophen-related promises seem to have fallen by the wayside. Kennedy said at the time that the FDA would start the process of updating acetaminophen’s label to indicate the possible risks during pregnancy; in an email, a spokesperson for Kenvue, which makes Tylenol, said the FDA has yet to contact the company about that proposed change. (“We believe that there is no credible data that shows a proven link between taking acetaminophen and autism,” the spokesperson wrote.) The secretary also teased “a nationwide public-service campaign to inform families” about the alleged dangers of prenatal acetaminophen use; if such a campaign has begun, it has gone under the radar.

Back in the fall, the FDA did advise doctors to consider minimizing the use of acetaminophen for low-grade fevers in pregnancy, though the notice also correctly stated that the drug is safer for pregnant women than aspirin or ibuprofen. A recent analysis in The Lancet found that, in the weeks following the White House press conference, prescriptions for acetaminophen given to pregnant women who visited emergency rooms dropped as much as 20 percent below what would otherwise have been expected; after 11 weeks, prescription rates were approaching typical levels again. (Nixon didn’t respond to questions about the label change or the nationwide campaign, but did point me to an X post about the Lancet data, in which he wrote, “Delivering a message about a specific neurological risk for babies is another example of our commitment to telling the truth about public health.”)

[Read: Trump tells pregnant women to ‘fight like hell’ not to take Tylenol]

Last spring, Kennedy promised that the health department would figure out, in just a few months, not only what has caused autism rates to rise in the United States, but also how to prevent kids from being exposed to whatever it is. This proposal was unlikely, if not absurd. Autism researchers have been trying for decades to understand the complex disorder, and the consensus among them is that the increase can largely be attributed to broader diagnostic criteria and better surveillance. But pinning the blame on acetaminophen, even if the case has always been weak, allowed the Trump administration to appear to meet its self-imposed deadline. That association, at least, is clear.

Jay Bhattacharya Might Get His COVID Capstone

2026-03-05T16:39:57-05:00

This time last year, Jay Bhattacharya’s main claim to fame was, in essence, a hot take on COVID. In 2020, Bhattacharya, then a health economist at Stanford University without specialized training in infectious disease, co-authored the Great Barrington Declaration, an open letter that downplayed the risk of COVID and called for most of society to reopen before the arrival of vaccines. Back then, health experts widely excoriated this laissez-faire approach as dangerous and ill-conceived; now Bhattacharya wields more power over the direction of U.S. health policy than most Americans ever have. When Donald Trump returned to office, he tapped Bhattacharya to lead the National Institutes of Health. And last month, Bhattacharya became the only person who has ever been tasked with directing the NIH and the Centers for Disease Control and Prevention at the same time.

As the acting director of the CDC, Bhattacharya’s tenure will likely be brief; Trump reportedly plans to name a new permanent director soon. But Bhattacharya clearly wants something from the agency. In his first email to CDC staff, he wrote that the federal government’s “decisions, communications, and processes” broke the public’s trust during the pandemic, and that “acknowledging this reality is a necessary step toward renewal.”

In practice, the CDC has been undergoing a kind of forced renewal for months. Since Robert F. Kennedy Jr. took over as the secretary of the Department of Health and Human Services, thousands of people have been pushed out of the CDC, and several prominent agency leaders have resigned their post. Last year, Kennedy also dismissed the entirety of the agency’s independent vaccine-advisory group, the Advisory Committee on Immunization Practices (ACIP), and replaced it with a more anti-vaccine cohort. Several of the CDC’s vaccine recommendations have been stripped down too—in many cases, “as far as they can go without affecting coverage guarantees” from insurers, Jason Schwartz, a vaccine-policy expert at Yale, told me. And the CDC has lacked a permanent leader since Susan Monarez, the most recent director, was abruptly ousted from her role last August. (Monarez asserts that she was forced out after she refused to rubber-stamp Kennedy’s restrictive and scientifically unfounded vaccine policies; Kennedy has contradicted this account, accused Monarez of lying, and said that she resigned after he pressed her on whether she was trustworthy.)

Bhattacharya himself remains steadfast in his pandemic-era views. More than five years after he first became a vocal opponent of COVID lockdowns, he continues to relitigate that position on podcasts, in interviews, and on social media. Lockdowns themselves might now be a moot policy point, but another of Bhattacharya’s pandemic sore spots, COVID vaccines, are still under active discussion at HHS.

For years, Bhattacharya has insisted that policies that pushed for widespread COVID vaccination violated “informed consent rights” and were “dangerous for public health.” He has disputed the abundant evidence that COVID vaccines are effective and safe. He has also argued that the continued investment in COVID shots has been a waste and that improving Americans’ baseline health is a better way to guard against future pandemics than stockpiling vaccines is.

In the lead-up to the midterms, Kennedy is reportedly nudging HHS away from attacking infectious-disease policy. But COVID vaccines, which are particularly unpopular among Trump’s Republican base, might still represent a politically palatable target, Dorit Reiss, a vaccine-law expert at UC Law San Francisco, told me. Several new members of Kennedy’s remade ACIP have repeatedly cast doubt on COVID vaccines’ safety; following that group’s advice, the CDC recently stopped recommending the shot to all Americans and now says that people should consult with their physicians before receiving one. Bhattacharya may oversee further downgrades to the CDC’s recommendations: At its next meeting, later this month, ACIP is scheduled to discuss COVID vaccines again—this time, weighing in on “injuries” that the shots might cause to the people who choose to receive them.

What exactly that discussion might touch on, or what the committee might vote on, isn’t yet clear. Although COVID vaccines do come with side effects, serious and lasting consequences are very rare; the shots are still a powerful protective measure against severe disease, especially for populations at the highest risk. Separately, some of the Trump administration’s FDA officials have faulted COVID shots for deaths in children, without publicly revealing evidence. But typically, the National Vaccine Injury Compensation Program, which is operated by a different agency at HHS, handles reports of adverse effects from shots. ACIP, meanwhile, is supposed to advise the CDC on which Americans should get which vaccines.

Any exaggeration of the harms of COVID vaccines by ACIP’s members could give the committee, and ultimately Bhattacharya’s CDC, justification to advise certain populations to stop taking the shots altogether. The net effect of such a change could be small; uptake for COVID shots, after all, is already low. But if the CDC or its advisers cast further doubt on the vaccines’ effectiveness and safety, that shift might seem to vindicate Bhattacharya’s long-standing views—that the immunity left behind from bouts of COVID “is stronger and longer lasting than vaccine-induced immunity,” and that unchecked infection among the young and healthy is an acceptable, and even desirable, pandemic strategy. For the CDC, an agency whose explicit goal is to protect public health by controlling and preventing disease, injury, and disability, the change would reinforce the idea that politics has come to supersede evidence under this administration.

When reached for comment, Andrew Nixon, the deputy assistant secretary for media relations at the Department of Health and Human Services, wrote that Bhattacharya “is focused on restoring CDC as the world’s most trusted guardian of public health through sustained reform and by ending the culture of insularity that eroded public confidence during the pandemic.” (Bhattacharya did not respond to a direct request for comment.)

Gigi Gronvall, an immunologist and a health-security expert at Johns Hopkins University, worries that Bhattacharya’s approach to previous outbreaks could also color the CDC’s response to current threats. Among the largest concerns is measles, which has sparked thousands of cases in the United States since the start of 2025 and may soon be declared endemic in the country again. HHS’s response to the virus’s resurgence has been unorthodox: Kennedy has acknowledged that vaccines are the most effective way to prevent the spread of measles and yet has also derided measles vaccines’ effectiveness and exaggerated their harms, and declined to directly urge families to immunize their children. (He has also inappropriately propped up nutritional supplements as a first-line defense against the virus.)

Bhattacharya has departed from Kennedy on measles vaccination in key ways. During his confirmation hearing last year, Bhattacharya said he was convinced by the data showing no connection between the measles, mumps, and rubella (MMR) vaccine and autism—a sentiment that Kennedy refused to convey during his own hearing. In January, on a New York Times podcast, Bhattacharya also described his distress that uptake of the MMR vaccine was “too low.” And in meetings at the CDC last week, Bhattacharya reportedly offered to publicly encourage parents to vaccinate their children against measles.

Some within the agency greeted this announcement with gratitude and enthusiasm. But Reiss and several other outside experts told me that such reactions only reinforce how low the agency’s standards have been set. In theory, Bhattacharya’s internal comments could presage a friendlier approach to vaccination from the federal government, but that has yet to materialize: In a video posted to social media this week, Bhattacharya, like Kennedy has done, lauded the protective powers of measles vaccination but stopped short of directly encouraging families to vaccinate. (Nixon disputed the notion that any of Bhattacharya’s comments on the MMR vaccine represented a departure from other HHS leaders. “Vaccination remains the most effective way to prevent measles, and Secretary Kennedy and other HHS principals have been very clear and consistent on this point,” he wrote.)

The measles vaccine, Bhattacharya has correctly noted, is more powerful than the COVID one, especially when it comes to reducing transmission. But containing measles outbreaks also requires substantial investment in contact tracing, quarantines, and public-health messaging that might restrict people’s movements and behaviors—all of which could run up against Bhattacharya’s sensibilities. The Great Barrington Declaration suggested that maintaining a relatively open society, largely free of mitigation measures, could keep deaths low while limiting other harms to the public. But it also implicitly accepted a level of suffering and death that most people in public health found untenable—a framework that could easily translate to today’s epidemic responses. Bhattacharya’s COVID rhetoric has at times mirrored Kennedy’s framing of measles: minimizing the severity of disease, dismissing infection as inconsequential for the young and healthy. I asked HHS whether, in Bhattacharya’s view, the country’s current measles outbreaks might warrant prolonged quarantines, strengthened vaccine mandates, or strict school policies—such as excluding unvaccinated children from classrooms after potential exposures—but Nixon did not answer that question.

Bhattacharya seems bent on “rewriting all of history retroactively to prove he was right all along,” Santiago Enrique Sanchez, a Stanford M.D.-Ph.D. student who has closely followed and written about Bhattacharya’s career, told me. Even if Bhattacharya’s time at the CDC will be brief, he seems eager to force the agency to acknowledge his version of reality while he’s in charge. As much as he may claim to be working to restore trust in the agency, his actions seem far more likely to achieve the opposite.