Health | The Atlantic

Medicine Needs to Get Serious About AI

2026-09-08T12:54:01-04:00

For as long as ChatGPT has existed, Americans have been asking it, “Could that funny little spot on my toe be cancer?” And as AI has advanced over the past few years, doctors have begun to use specialized models to ask much the same questions in clinics. In the face of these developments, professional medical societies have presented a unified front: Doctors must always have the final say in clinical care.

We disagree. As the medical societies allow, physicians’ enhancing their work with AI tools may be a perfectly good way to deliver medicine. (One of us—Khosla—has in fact invested in a primary-care start-up, co-founded by his son, in which doctors supervise AI assistants.) But for Americans to get the best health care possible, we need to be willing to experiment with models that put AI in control.

This notion has caused a stir in the medical community. When we published a commentary in the Journal of the American Medical Association last month arguing that AI-only care could soon become superior to care provided by human physicians, the CEO of the American Medical Association denounced us as undermining the patient-doctor relationship. The organization’s position was unchanged: AI should be relegated to a supporting role in clinical care. It’s an argument that ignores the available evidence and could hold untold numbers of Americans back from better health.

Much of modern medicine—including managing hypertension, determining the right treatment for many cancers, and addressing chemotherapy side effects—is largely algorithmic. A physician needs to ask a patient targeted questions, determine possible diagnoses, order tests to identify the correct one, offer a treatment plan, and adjust it depending on how the patient responds. That series of actions is steered by detailed guidelines from professional societies.

Yet doctors—despite the best of intentions—make plenty of mistakes when following those steps. Studies indicate that up to 15 percent of American patients are misdiagnosed each year, leading to tens of thousands of preventable deaths. That’s why health-care providers have software that notifies them if they, say, prescribe a deadly dose of a drug. Any software that could practice medicine autonomously would be similarly specialized: not generic ChatGPT, but a model trained in medical knowledge with the appropriate guardrails to minimize risks and mistakes. Such a model could check for drug interactions more consistently and comprehensively than physicians. And it would be able to check in with patients much more frequently than human health-care providers do.

Some AI models have already proved adept at such tasks. In one study published last year, expert physicians judged Google’s Articulate Medical Intelligence Explorer—a highly trained AI model for medical diagnosis and reasoning—as significantly better than human doctors at getting actors playing patients to open up. The “patients” revealed more about their complaints, along with their medical, family, and medication history, all of which can be crucial for an accurate diagnosis. In a 2023 study, patients with type 2 diabetes were randomized to have their insulin dose adjusted by physicians or autonomous AI. The machines got patients to a stable dose faster than human physicians, and their patients took their insulin more reliably and had less distress related to their diabetes.

What about the physician-AI hybrids that medical associations are backing? Research on them is sparse, and more is needed. A 2025 review of 52 studies concluded that, on balance, such hybrids “neither outperformed medical AI alone nor surpassed the best of clinicians.” In at least a few of those studies, human-AI hybrids outperformed AI alone. But in those hybrid teams, the AI controlled the final clinical decision—the opposite of what the AMA and others have in mind.

Medical organizations are not entirely closed-minded to the possibility of change. For example, last week the American College of Physicians published a position paper that allowed that “fully autonomous AI is possible,” but cautioned that its use should be infrequent and “limited to low-risk, low-complexity decisions, and always allow for bringing a clinician into the loop.” John Whyte, the CEO of the AMA, told The Atlantic that he was “disappointed” in the quality of the analysis in our JAMA commentary last month. He questioned the design of the studies we reviewed, many of which involved simulated situations with actors or a retrospective review of existing cases rather than real clinical outcomes, and did not follow patients for years or decades. We agree that longer-term, real-world studies are necessary; hopefully, once advanced AI medical tools have existed for more than a handful of years, results will begin to arrive. Whyte was enthusiastic about further study of physicians controlling AI tools, but only cautiously open to further exploration of autonomous AI in medicine, arguing that the latter would need to be highly regulated.

Reasons exist, of course, to be skeptical of AI-driven medical care. In nine of the 51 studies we reviewed, human physicians outperformed the machines. But some of these tested older AI models or general-use AI models that weren’t trained on medical information and specific guardrails for patient care. Prominent physicians have also argued that real-life doctors are harried by 15-minute appointments and administrative burdens such as prior authorization. That is certainly true, but it is also irrelevant to many of the experiments we reviewed, which examined relatively hassle-free simulations of medical appointments.

One of the most common objections to an AI-doctor future is that robots lack the human connection that patients need to build trust. The American College of Physicians’ recent position paper, for example, cited AI’s inability to make eye contact. But consider that doctors, too, can be robotic. In a Gallup survey conducted late last year, 21 percent of respondents said they had turned to AI because they had previously felt dismissed by a health-care provider. In the 2025 study of Google’s AMIE, patient actors reported that the AI was more emotionally supportive than the physicians were. In a systematic review of 15 studies comparing AI chatbots with physicians, 13 found that AI had significantly higher perceived empathy.

Like human physicians, AI is not and never will be perfect. But isn’t the possibility of reducing fatalities caused by physician error—even by just a little—worth exploring? Instead of writing off a possible source of progress, the medical community should help answer the key questions raised by AI: How should researchers devise ethical, real-world situations to test autonomous AI models? How should governments and professional organizations regulate them? And how should medical education be reformed so that human doctors can continue to do what they uniquely can?

Hundreds of years ago, doctors believed that disease was caused by an imbalance of “humors” in the body. Even after Louis Pasteur proved that bacteria caused infection and Joseph Lister introduced sterile surgical techniques, physicians cut patients to have them bleed out what ailed them, not bothering to clean the knife or their hands. But medicine progresses. Humans have learned from our past mistakes and created new drugs, procedures, and treatments to massively lengthen lifespan and improve quality of life.

Today need not be any different. Doctors have been presented with a powerful tool that has the potential to improve care for millions of people. It’s their duty not to stand in the way.

Cereal Has Strayed Too Far

2026-09-08T12:44:15-04:00

Breakfast-cereal boxes are a window into both the politics of food and American culture. As a particularly timely example, since Robert F. Kennedy Jr. took office last year as secretary of health and human services, he has called for the removal of artificial dyes from breakfast cereals. On Fox News in 2024, he lamented that the bright colors in Froot Loops are “literally poisoning our kids.” (How exactly these dyes interact with human health is complicated.)

Cereal companies responded right away. General Mills announced last month that it had transitioned its entire U.S. portfolio of cereals—including Trix and Lucky Charms—to all-natural dyes made from fruits, veggies, and spices. Kellogg had previously announced plans to do the same by the end of 2027. Target stopped selling any cereals with artificial colors earlier this year.

For the Make America Healthy Again movement, the removal of artificial dyes is a big win. But cereal still comes with a major concern for many consumers. Nearly all ready-to-eat breakfast cereals sold in the United States—and especially those marketed to children—are presweetened.

The initial loading of breakfast cereals with sugar has been attributed to a single person: Jim Rex, a heating-equipment salesman who lived in Pennsylvania in the early 20th century. As the story goes, Rex was appalled by the spoonfuls of sugar his kids added to their breakfast cereals and set out to create a version that would not induce such behavior. His brilliant contribution: a glossy honey coating on puffed wheat, a cereal he named Ranger Joe Wheat Honnies in 1939.

It didn’t take long for Rex’s strategy to backfire. By 1949, Post had launched Sugar Crisp. Kellogg introduced Sugar Pops in 1951, Sugar Frosted Flakes in 1952, and Froot Loops in 1963, each among the company’s all-time best sellers. General Mills launched Sugar Smiles in 1953. The next year, the company added sugar and artificial colors to its Kix cereal, thus creating Trix.

In 1950, such presweetened cereals represented just 5 percent of all cereals sold, but by the mid-1970s, kids accounted for almost 40 percent of all cereal consumption. In 2014, the Environmental Working Group estimated that kids could ingest about nine pounds of sugar a year just by eating a serving of cereal every day.

Advocates for children’s health have long complained about the high sugar content of breakfast cereals. In the early 1970s, Congress held hearings to highlight cereal’s inadequate nutritional quality. Cereal companies objected, arguing, correctly, that grains are nutritious. But they also responded by trying to make their products appear less sugary.

They began by removing the S-word from cereal names, and some substituted honey for sugar on the theory that people perceive honey as more wholesome and nutritious. In the 1990s, companies hit on another clever strategy: If they used multiple sugar types, they could list grains first on a product’s ingredients but sprinkle sugars throughout the list. Cereals looked healthier, but when Consumer Reports compared the sugars in 27 breakfast cereals in 2008, it found that many were still 50 percent sugar by weight. Rumors circulated that federal agencies were working to set nutrition standards for foods advertised on television programs aimed at children younger than 12, which would likely spell trouble for sugary cereals.

In 2009, General Mills pledged to reduce sugar in its most popular kids’ cereals—most of which had at least 12 grams a serving—to single digits. Its pledge would apply to 10 cereals, including some of its most popular, such as Lucky Charms and Cocoa Puffs. The results were mixed. By 2012, General Mills had reached the single-digit goal for Cinnamon Toast Crunch, Cookie Crisp, and more. Some of this success was due to decreased serving size. And the best General Mills could do for Lucky Charms was 10 grams of sugar in a three-quarters-cup serving—which the company found to be the minimum sweet spot for kids’ acceptance. The project had encountered a harsh reality: Kids like sugar, and companies remove it at their peril.

Sugary cereal is not just a consumer concern; it is also a matter of government nutrition policy. Since 1980, the federal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has limited the sugars in cereals it will cover to six grams an ounce, about half of the amount in typical cereals aimed at kids. WIC can be a lucrative business for cereals that qualify, so the limit has induced companies to take two actions. The first is to formulate new cereals with less sugar specifically for the WIC market. In 2006, for example, General Mills introduced a new kid-targeted cereal, Dora the Explorer, “lightly sweetened cinnamon corn puffs,” with six grams of sugar in a 27-gram serving—an amount that meets the WIC standards.

The second is to petition to change how sugar in cereals is counted. When the six-gram rule went into effect, in the early 1980s, Kellogg immediately objected. Its Bran Flakes met the WIC standards, but Raisin Bran did not; it contained 12 grams of sugar an ounce, seven from the raisins. Kellogg argued that raisins are healthy and pointed out that WIC was encouraging women to add raisins to their diet to increase their iron intake. For decades, despite Kellogg’s persistent efforts, the U.S. Department of Agriculture did not budge. But times change. In 2024, USDA issued its third comprehensive update to the WIC food package since 1975. The agency retained the six-gram limit but specified that it applied only to added, not total, sugars. It said the policy change was justified to align with listing “added sugars” on food labels and with the government publication Dietary Guidelines for Americans, and to create a “more permissive standard for products containing naturally occurring sugars.”

The distinction between natural and added sugars has continued under Kennedy. The new dietary guidelines, released in January, declare that no amount of added sugar is recommended for healthy eating. At a press conference announcing the new guidelines, Kennedy told reporters, “Today, our government declares war on added sugar.”

Current breakfast cereals have less sugar than they did years ago, but it’s hard to remove completely. Some amount of sugar is still needed to mask the bitter taste of added vitamins. Sugar also helps cereal flakes, puffs, and Os hold their shape in milk. Less sugar is better for kids’ health, but more is better for structural integrity—and taste.

For a truly healthy cereal, look to a time before Jim Rex. The most nutritious option will have one ingredient: wheat or oats. Even if you add your own teaspoon of sugar, it will be only four grams.

This article has been adapted from Marion Nestle and Lisa Sutherland’s new book, Sugar Coated.

The Dark Side of Mindfulness

2026-09-04T09:00:00-04:00

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In 2004, Willoughby Britton, then a doctoral candidate in clinical psychology at the University of Arizona, began recruiting participants for a study that, she felt sure, would show meditation improves sleep.

Britton, a meditation teacher, was so devoted to the practice that she saw herself as a “double agent,” someone who uses science to promote meditation. Although she had grown up in a nonpracticing Episcopalian home, she’d become deeply invested in Buddhist teachings. She read meditation books in her spare time and at one point considered becoming a Buddhist nun. She was confident that meditation improved most things, including sleep; it had already improved much about her own life.

For her study, Britton split 26 participants into two groups: one that would go through an eight-week-long meditation class, and one that would serve as a control group. She brought them all into a lab to sleep overnight while sensors measured their brain waves, muscle activity, and eye movements.

But when she reviewed the results, she was dismayed to find they were the opposite of what she had predicted. The participants in the meditation group slept more fitfully, with more frequent awakenings, than those who didn’t meditate. They spent more time in “Stage 1,” the lightest sleep phase, from which people are easily roused. “Graph after graph after graph, no matter how you looked at it—number of awakenings, number of micro arousals, number of Stage 1 minutes,” Britton told me, the amount of meditation that the subjects practiced was directly correlated with worse sleep quality.

Britton wasn’t sure what had happened. Had she done something wrong? Designed the study poorly? Was the result a fluke, a random finding that didn’t mean much? Or perhaps meditators just need less sleep. At the time, promoting meditation was more important to her than scientific ethics, and she worried that publishing the results would mean “harming the dharma”—criticizing the teachings of the Buddha. So she didn’t.

On a meditation retreat not long after this, she was chatting about her study with a meditation teacher when the teacher said, “I don’t know why all you psychologists try to make meditation into a relaxation technique. Everyone knows if you meditate enough, you stop sleeping.”

On some level, Britton must have known this. At that point, she had spent years both meditating and studying the brain. Because most kinds of meditation aim to enhance concentration, the practice can act like a stimulant. And just as chemical stimulants such as caffeine and Adderall can interfere with sleep, so, too, can excessive meditation.

What else, she wondered, did meditation teachers know that they weren’t telling people? Gradually, starting with that sleep study, the tiers of thought propping up Britton’s worldview—that Buddhism is a cure-all, and that meditation was always beneficial, and could never cause harm—would collapse. Over time, she would find that meditation, a multibillion-dollar industry that is promoted as a treatment for anxiety, chronic pain, alcohol abuse, addiction, and many other ailments, can sometimes, for some people, cause severe and lasting side effects: depression, anxiety, even acute psychosis. Losing the belief system that had been foundational to her life would lead her to produce a trailblazing body of research about the adverse effects of meditation, and then to found a clinical practice geared toward helping the people—a lot of them, as it turns out—who believe that meditation has harmed them.

Britton has straight blond hair, blue eyes, and a muted affect. When you say something to her, she pauses, as if considering whether or not to smile. A colleague once suggested to her that she might be autistic. “And I’m like, ‘Okay,’” she told me one day recently.

She grew up on a farm in Massachusetts with parents who believed that a person should find a problem that isn’t being solved and embrace it as their niche. Her father’s niche was fermenting waste from local businesses and selling it as compost.

Britton was, by her own description, a weird kid who spent a lot of time by herself. She was always asking strange questions like “What is looking out of my eyes?”

One day during the summer break after her junior year at Colgate University, where she was majoring in neuroscience, Britton went over to the house of her best friend, Sarah, a champion athlete at Dartmouth, and discovered her lying lifeless on the bed, a hunting rifle on the floor and a splatter of blood on the wall. Overwhelmed by the pressure of competitive sports, Sarah had taken her own life.

After Sarah’s death, Britton developed symptoms of PTSD. She grew afraid of crossing the street and of driving. She didn’t like opening doors, because she feared she might find a dead body behind them. At one point, while killing rats at her bench in the National Institutes of Health lab where she worked between college and graduate school, she watched the blood drain from their eyes and wondered aloud to a colleague, “Where does it go?” “In the freezer,” the colleague responded. But Britton wasn’t asking about the rat’s body, but its life force. Where did that go?

She was reluctant to take medication, so her father sent her the book A Path With Heart, by the famous meditation teacher Jack Kornfield. She appreciated Kornfield’s explanation for why humans are so prone to rumination—“over and over we feel the familiar tug of thoughts and reactions that take us away from the present moment,” he writes—and that he offered a way out via meditation. She began meditating for half an hour to an hour each day.

In graduate school, Britton initially focused her research on the neuroscience of near-death experiences, but for her dissertation she pivoted to studying meditation, which had been so steadying for her personally.

Meditation was, even then, having a moment. In 2005, the filmmaker David Lynch established a foundation that aimed to promote Transcendental Meditation in colleges and schools. Soon, tech CEOs were flocking to mindfulness summits to learn about “wisdom in the workplace” or “conscious leadership,” and a mindfulness class for Google employees regularly had a long waiting list. High-powered celebs including Oprah and Arianna Huffington credited meditation for centering them amid their empire building. LeBron James partnered with Calm, a multibillion-dollar meditation-and-sleep app. Today, according to one study, about half of all Americans have tried meditation, and about a fifth meditate regularly.

Meditation’s popularity is well-founded. Although the practice has long been supported by the more woo-woo corners of the wellness industry, as well as by Eastern philosophy, an accumulating body of scientific research has suggested that it has all kinds of measurable benefits. Major studies show that meditation can alleviate anxiety and depression—at least about as well as the antidepressant Lexapro can, but without the cost and with fewer side effects. Even short periods of meditation have shown notable effects on the brain: Several studies have found that eight weeks of meditation training can reduce reactivity in the amygdala, the emotion center of the brain, and another showed that meditation could help activate brain regions involved in attention, memory, and perspective-taking in people with social-anxiety disorder. Other reputable studies have linked meditation to positive mood; improved immune function; reduced chronic inflammation; less back pain; lower blood pressure; enhanced self-awareness; better attention spans; greater compassion; and even reduced feelings of loneliness in older adults.

Beyond the scientific evidence, Britton believes that meditation became popular because it’s a health hack that people can do independently, without relying on expensive medical care. The practice suggests that “underneath all of your thinking is some beautiful, basic state” just waiting to be discovered, she said. It probably helps, she added, that meditation is “this ancient thing from Asia and therefore seems more legit or real or something.”

In graduate school, Britton became a serious meditator in the Western insight tradition, which includes sitting and focusing on an “anchor,” such as one’s breath, sometimes for hours at a time. Britton describes it as an austere practice intended to “train the mind.” She molded her life around ancient Buddhist principles. When colleagues remarked on her plain appearance, she said, “Why would I adorn myself?”

Soon, Britton immersed herself in Tibetan studies. Instead of reading novels at night, she’d read dharma books. Her belief at this time, she said, was that “getting enlightened is the most helpful thing you could do for the world.” She considered dropping out of academia to move to a monastery in Asia, which would have meant renouncing her former life, taking a vow of celibacy, and living under a new name.

But she stayed in the United States and continued her academic work, while also training to teach mindfulness-based stress reduction (MBSR), a secular meditation program developed in the ’70s by a molecular biologist named Jon Kabat-Zinn, and a related course called mindfulness-based cognitive therapy. These classes promise to help everyday people with their stress, low moods, and chronic pain; alongside daily meditation practice, they typically include some non-Buddhist teachings from psychology and literature.

Britton moved to Rhode Island to begin her clinical residency at Brown University’s Warren Alpert Medical School. She didn’t know anyone, and, working 12-hour days, she felt intimidated by the cutthroat Ivy League academic life. To fill the time she had to herself, she started meditating for three hours a day.

One night, after meditating on her balcony for an hour, she went back inside and noticed that her house felt like someone else’s home. A picture of her with two friends looked like a picture of three people she happened to know.

Britton decided to take a walk, and as she strolled the streets of Providence, she felt like a bird sitting on her own shoulder, watching herself. She walked into a creperie where she noticed two people arguing. When they both turned and glared at her, she thought, Oh my God, I forgot that I am a person.

What Britton was experiencing is called dissociation, a state that can occasionally be evolutionarily useful—it can help people push through a task when faced with overwhelming terrors. But according to Britton and other researchers, it can happen to extreme meditators too. Britton told me that extensive meditation can prompt the prefrontal cortex to essentially shut off the brain’s emotional centers, causing feelings to seem blunted. And without the typical emotions that we project onto objects, familiar things—our hands, our homes—can start to look foreign. Heleen Slagter, a cognitive neuroscientist at the Vrije Universiteit Amsterdam who studies meditation, says that part of the way the brain gives rise to our sense of self is by predicting how we will interact with the world in the future. If you spend enough time zeroing in on the present moment, as one aims to do during meditation, Slagter says, your sense of the future can start to recede—and with it your sense of self. This can produce dissociation.

Britton began dissociating a few times a week. She had trouble driving because she couldn’t sense where her body began and ended. She’d watch a sappy commercial and suddenly notice her face was wet, not realizing she had shed tears. She felt porous, like other people’s states of mind were her own, a fact that became especially disturbing when she was treating suicidal patients. The dissociation continued for six or seven years, sometimes happening during meditation, but other times at random.

When she told meditation teachers about the dissociation, she said they told her she had entered a new stage of enlightenment—that she was “riding the ox backward.” She had “seen the truth of no-self,” they said, and this was a good thing. They told her to keep meditating, which made the dissociation worse. Somehow, Britton got through her postdoc, but she wasn’t entirely functional. She didn’t date anyone for a decade.

Lauren Lancaster for The Atlantic

Willoughby Britton at home in Vermont. Now retired from Brown University, she runs an organization that counsels people who have had distressing experiences during or after meditation, such as insomnia, anxiety, depression—even psychosis.

Even before she started dissociating, another layer of Britton’s worldview began to crumble after she moved to Rhode Island and was working at an inpatient psychiatric hospital as part of her residency. One day, someone came in from a meditation-retreat center in a state of florid psychosis. Three months later, another psychotic meditator came in, from the same retreat center. That’s weird, Britton thought. Do they know each other? They did not.

It’s well known that psychedelics such as LSD can spark psychotic breaks, but meditation can produce altered states of consciousness almost as powerful as those induced by psychedelics. The brain likes and expects a certain amount of input; go long enough without doing anything and the neurons might start to fire spontaneously, producing, say, flashes of light or made-up memories. Inuit people in the Arctic Circle have been known to experience a type of hysteria known as piblokto, which might be brought on by the sensory deprivation of long winters. No one seems to know why, exactly, psychedelics and meditation can both occasionally prompt psychosis, but it might have to do with the fact that both can have the effect of “rewiring your brain,” which can be a positive thing but can also mean your brain just doesn’t work the way it used to. It might become more easily influenced, for example, or impart grave significance on unimportant events.

At this point in her research, Britton’s studies were still mostly focused on the benefits of meditation, such as on how it can be helpful for depressed people and substance-abusing teens. But now, when she spoke about her studies at conferences, she’d sometimes briefly mention some of the potential adverse effects of meditation. Afterward, people would corner her in the halls or in the bathroom and tell her they’d had negative experiences with meditation—everything from increased depression to psychotic breaks.

She started to wonder whether the unintended effects of meditation might extend beyond a few anecdotes and her own experience with dissociation. Centuries ago, meditation was practiced mostly by monks and other spiritual seekers in East Asia and India; it wasn’t something ordinary people did, Pierce Salguero, a historian of Buddhism and medicine at Penn State Abington and the editor of the book Meditation Sickness, told me. The point of meditation was never merely to relax or just “clear your mind” but to wholly rearrange one’s relationship to one’s thoughts. This might make sense for a Buddhist monk pursuing the great unbinding, but not for a random Brooklynite who just wants to be more productive at work. The “no-self” teachings of Buddhism can be at odds with the goals of Westerners, who are generally aiming to be their best selves, not to disconnect from themselves.

Britton began to perceive that the research on mindfulness contained a giant lacuna: its potential risks. Meditation researchers, she felt, tended not to find adverse effects among their study participants because they didn’t ask their participants about them. What’s more, many meditation studies are funded by pro-meditation organizations, and some study participants might feel pressured to say that their mental health improved after meditating. There’s no such thing as a placebo for meditation, which complicates studying its effects. When Britton looked for past studies on the risks of meditation, she found mostly isolated case reports and small studies—one of which found that two of 27 long-term meditators had had “profound adverse effects,” including confusion, depression, and severe shaking.

Britton still believed in many of the potential benefits of meditation, but she began to rethink her role as a booster for it. “It just seemed like the world does not need another meditation researcher who’s going to promote meditation,” Britton told me. “We’re like Starbucks—there’s one on every corner.” Assessing the extent and severity of possible negative effects of meditation, she decided, would be her version of a problem to solve—her niche. In 2007, she began interviewing meditators for what would become the first comprehensive study of meditation’s adverse effects.

In 2010, Britton met a religious-studies scholar named Jared Lindahl at a conference. At that point, Britton had been meditating so much that she saw stars even with her eyes open—usually either one blue star or one white star—a phenomenon that Buddhists call nimitta. Lindahl had written his dissertation on visual light experiences of this sort. Meeting him, Britton said, “was having somebody understand a part of my experience that no one else had understood.” They wrote a paper about meditation-induced light experiences together, began meditating together, and, eventually, fell in love. The year she met Lindahl, she also finally published the sleep study she’d conducted in Arizona—the one showing that too much meditation can keep people awake.

Lindahl joined her on the meditation-challenges project, for which they conducted interviews about various types of adverse effects experienced and witnessed by 60 meditators and 32 meditation teachers—a smallish sample that is nevertheless rather large for qualitative studies such as this one. They finally published their first study, called “The Varieties of Contemplative Experience,” in 2017, nearly 10 years after they started it.

The most common adverse effects, reported by 82 percent of the meditators (which, importantly, included only people who had experienced an adverse effect of any kind), were “fear, anxiety, panic, or paranoia.” Second-most common were “changes in motivation or goal,” experienced by 78 percent. (Britton later talked with one meditator who sat on her couch for two years, unable to do much of anything, though most of the motivational effects reported were less dramatic.) Smaller numbers reported experiencing delusions, hallucinations, physical pain, rage, and suicidality. The effects lasted for a median duration of one to three years, and the majority of the sample indicated “moderate to severe” impairment in at least one area.

Although the study suggests that what’s most likely to cause problems is intensive meditation—sitting in silence in a retreat hall for hours or days on end—28 percent of the meditators had issues arise from their everyday non-retreat practice, and 25 percent of those in the study were meditating less than an hour each day.

Being an experienced or even expert meditator didn’t necessarily protect people. “I was like, ‘You’ve written a bunch of dharma books. How come you never mentioned this?’” she told me she asked one of the teachers. “And he’s like, ‘Well, it’s not good advertising.’” Notably, much of Britton’s sample of people harmed by meditation had graduate degrees; Britton believes that this is because high achievers tend to try to “ace” meditation, by, say, ignoring any internal sense that something might be wrong. (This struck me as similar to the endurance it takes to earn a Ph.D.: Power through years of pain and tedium for the promise of a big payoff at the end.)

As a study, “The Varieties of Contemplative Experience” had some inherent limitations. Because it recruited people who had had negative experiences, the study could conclude nothing about their prevalence. The study also couldn’t definitively prove causality—for instance, it’s possible that the meditators’ symptoms happened after meditation, but for unrelated reasons. Some Buddhists would also say that experiencing negative emotions or other bad effects is supposed to be part of the practice. But by and large, the study was well received and widely cited in the field. It acknowledged its own limitations and, if anything, respect has grown for it over time.

In part that’s because subsequent studies, some of which Britton was involved with and some not—and some of which were conducted in part by the most well-known academic boosters of meditation—have provided sturdy evidence that some percentage of meditators do experience negative effects from it, ranging from mild to severe. The frequency of bad effects found varies, but most studies, and most experts I talked with, estimate that about 10 percent of all meditators experience them, with the prevalence being considerably higher in certain situations. Richard Sears, a clinical psychologist and Zen master who’s been practicing meditation for some 40 years, has said that he thinks Britton’s research is important. “Something is happening” to these meditators who have bad experiences, “and we should be aware of it. This is opening up a conversation.”

Britton and Lindahl went on to publish many other studies on meditation’s dark aspects, including delusion-like ideation and feeling bolts of electricity traveling through the body. One study subject grew paranoid at a meditation retreat, left, and on the way home believed that street signs were delivering secret messages just to her; another became convinced that she needed to save the world from a “black Tantric plot” contrived by retreat-center staffers, threw water in her meditation teacher’s face and slapped the center’s director; a third began experiencing “messianic visions” about the “need to sacrifice myself in some way for the benefit of saving mankind” and was convinced that meditation teachers were communicating with him in secret code; a fourth reported that meditation awakened an “energy” inside him with “a will of its own” that once almost compelled him to jump from a balcony because it “wanted to lift up and fly.” None of these people had previously experienced any psychosis or been treated for mental illness.

Different types of meditation seem to have different adverse effects on the people who experience them. In one of Britton’s studies, a “noting” practice—labeling thoughts or body sensations—was more likely to trigger anxiety, whereas focusing on an anchor such as one’s breath was more likely to prompt a depressive episode. Overall, Britton has found that about one in 10 people who have meditated, even once, had an adverse effect that lasted more than a month—a rate that, were meditation a drug, would qualify as “very common” under the standard classification used for adverse drug reactions. More frequent meditation tends to increase negative effects, Britton said.

The body of evidence that Britton and Lindahl have amassed showing that meditation can sometimes cause harm is now bolstered by others’ research. A Clemson University study found that mindfulness can paradoxically increase distress. (Cultivating a hopeful outlook was more effective than mindfulness at shoring up workers’ resilience and well-being.) A 2020 study found that 3 to 7 percent of schoolteachers and university students in the U.K. who took a mindfulness class reported “unpleasant experiences”—including anxiety, distressing memories, obsessive thoughts, and physical pain; another study found that a quarter of meditators experienced “unwanted effects” such as panic attacks, nausea, headaches, dizziness, insomnia, and dissociation, though most of these effects were transitory. A German research group studying more than 1,300 regular meditators around the world found that 13 percent experienced adverse effects, including a small number who experienced “very severe effects with lasting consequences” or “extremely severe effects” that were life-threatening or required hospitalization. Yet another large survey found that a quarter of meditators, and a higher percentage of nonreligious meditators, had a “particularly unpleasant meditation-related experience.”

To some extent, this is to be expected. It would be odd if a single treatment, billed as the solution for dozens of mental and physical problems, alleviated all of these ailments without any side effects. In medicine, “if it’s not doing any harm, then it’s probably also not helping,” Nicholas Van Dam, a psychologist at the University of Melbourne who has co-authored papers with Britton, told me. Along with a team of researchers in Australia, Van Dam found that about 9 percent of meditators in their survey reported a functional impairment arising from a meditation-related problem, including sleep changes and a sense of disconnection from others. Van Dam’s team suggested that people should be warned that meditation is contraindicated for certain groups, just as certain medications should not be given to some people. Miguel Farias, an experimental psychologist at Coventry and Oxford Universities who specializes in the science of meditation, told me that the early literature on cognitive behavioral therapy, from the ’70s and ’80s, recommended against meditating during a depressive episode. “Physical activity is a wonderful antidote to depression,” Farias said. But “meditation makes you physically be more passive.” In a systematic review, Farias and his co-authors found that adverse events among all meditators were “not uncommon,” appearing in 65 percent of the studies reviewed; the most prevalent symptoms were anxiety and depression.

Some of the side effects these researchers are finding may be attributable to the fact that, in the years since Eastern traditions of meditation were introduced to the West in the 19th century, this once primarily religious ritual has expanded far beyond its original intent; its more sweeping remit may have consequences that the practice’s original Buddhist context might have prevented. But as Salguero and others pointed out, early Buddhist texts cautioned that “meditation sickness” plagued even the devout contemplatives of earlier eras: In one eighth-century Chinese writing, the Buddha warns of 50 “demonic states” in which meditators could become trapped, including hallucinations, sorrow, anxiety, suicidal thoughts, and possession by ghosts.

While working on my most recent book, about personality change, I wanted desperately to change one thing about myself in particular: to bring down my stratospheric level of neuroticism, the personality trait associated with anxiety and depression. When I Googled how to reduce depression and anxiety, the first drug-free thing that came up was meditation.

So I signed up for an online mindfulness-based-stress-reduction class—the kind of meditation that Britton also once taught, and which now has hundreds of classes and instructors to choose from around the country.

I found some of the class’s Buddhist teachings, though watered down for newbies, very helpful, and by the end of the eight-week class, a test revealed that my neuroticism score had, indeed, ticked down. This surprised me because I’m bad at meditating, so I would spend entire 45-minute sessions reviewing my to-do list, my worries, and other earthly matters.

What annoyed me the most, though, was the way the meditation teachers talked, which tended toward New Age–isms in passive voice. “There’s a subtle striving in what you shared,” one of the teachers responded when I asked a question about how to make “mindful walking” more restorative. “Maybe you want for it to be relaxing and not challenging. But that’s not the reason we practice. We practice for the sake of practicing and to meet with whatever is arising.”

This is what Britton calls a “thought-terminating cliché”: a profound-seeming phrase deployed by people in power to quash debate—or, as Britton put it, a way for teachers to politely convey “Shut the fuck up and do what I say.”

But many Buddhists and meditation teachers would agree with my instructor: Feeling, and observing, discomfort is part of the point. In keeping with this, a good number of the meditators whom Britton has interviewed told her that when they had brought up their symptoms with meditation teachers, the teachers dismissed them, saying things like “It gets worse before it gets better” and “What you resist persists.”Their teachers would suggest that all negative experiences are inherently growth opportunities, or that perhaps the person was meditating incorrectly. The mentality seemed to be “Try our product and if you don’t like it, then you did it wrong,” Britton said.

This attitude tracks with what I heard from a few experienced meditators who suffered acute distress while meditating. One man told me that after a long retreat, when he began experiencing spasms that would seize up half his face, his meditation teacher just told him to relax more. Two other experienced meditators I talked with, Terran Palmer-Angell and Carmen Maria Alvarez, also told me that some fellow meditators at a long retreat they attended, organized by the Center for Contemplative Research, had experienced psychotic breaks or developed tics, including one man who would rotate his head around compulsively. The teacher and one of the center’s co-founders, B. Alan Wallace, they said, told them that it was just “an involuntary movement” and nothing to be concerned about.

Palmer-Angell and Alvarez emphasized that their experiences reflected this specific retreat, and not meditation in general. Eva Natanya, the center’s other co-founder, told me that “no one has been diagnosed with a psychotic break by a psychiatrist” at the retreat since its founding, in 2020. However, she said that some “individuals develop physical tics” because of a “burst of energy” while meditating. She said these tics are sometimes referred to as “involuntary movements,” and that initially, meditators might be encouraged to “let it go and go back to meditating because that energy will work itself out by itself.” She added that she herself worked with the person with the compulsive head rotations by “asking questions and listening.” She said the center has multiple forms of support available, including meetings with herself and Wallace, psychological counseling, appointments with doctors, and physiotherapy.

Britton remembers peddling a version of this logic as an MBSR teacher herself. “I was trying to tell people ‘Nothing is good or bad, but thinking makes it so,’” channeling Hamlet and Stoic philosophy. For a while, this idea seemed radical, and constructively life-changing: The secret to a good life is to just be okay with whatever! But then her own meditation practice started to make her think “like, Okay, but wait; I don’t feel like I exist now.”That didn’t seem like a good thing, no matter how you thought about it.

Lauren Lancaster for The Atlantic

Having moved away from Buddhism, Britton now finds her own kind of tranquility in the natural world, taking care of her plants and chopping wood.

After Britton and Lindahl published the “Varieties” study, the phone in their lab started ringing. People experiencing psychosis, dissociation, tics, and other problems after meditating were asking for help. The meditators felt confused and ashamed, like they had damaged themselves. Traditional psychotherapists, they said, didn’t understand what they were going through—and neither did anyone else. How can you hurt yourself meditating?

The surge in outreach prompted Britton to open what she called Cheetah House—a play on citta, the Sanskrit word for “consciousness”—and develop it into a full-fledged nonprofit aimed at helping people who have had difficult meditation experiences. Based at first out of her house in Providence, it now serves 200 people a month, entirely over Zoom.

The Cheetah House program consists mostly of talks with experts, sessions with a “care team” member, and support groups with other meditators who have had distressing experiences. The program is priced on a sliding scale; most people pay $50 a session with a care-team member, and $100 or more for a session with Britton herself.

Many of Cheetah House’s clients have (relatively) manageable problems such as anxiety and insomnia, but Britton told me that, once or twice a month, she gets a call from someone whose family member has had a psychotic break triggered by meditation. Far more rarely, people have killed themselves after intensive meditation retreats. “When people say that I’m fearmongering,” Britton told me, “my response is, ‘We haven’t even gotten into the suicides yet.’” She recently decided to start a support group for the parents of meditators who experienced severe psychiatric symptoms after 13 families, four of whose children had already died, expressed interest.

Between half and three-quarters of Cheetah House’s clientele began having symptoms after a meditation retreat, Britton told me. People often go on retreats to try to deepen their practice or to “relax”—but these are generally not relaxing affairs. Many retreats involve waking up at dawn, eating very little, and sitting perfectly still while focusing on one’s breath for hours on end. Several days of this, Britton said, can cause neurons to become more sensitive, such that minor stimuli, like the ticking of a clock or the sound of another person’s breath, can start to feel overwhelming—as can emotions such as rage and grief. Kieran Fox, a psychiatrist at UC San Francisco and an experienced meditator, told me that retreats are “some of the hardest things I’ve ever done in my entire life. And that’s including med school.”

Among the Cheetah House clients I interviewed, retreats were a common trigger for adverse effects. One meditator, Dan Millstein, told me that after a 10-day retreat, he spent years feeling emotionally shut down and disconnected, like he was “living behind a glass wall or a veil.” Another man, Billy, who asked that I not use his last name, had been meditating regularly for a decade when a seven-day silent retreat ratcheted up his physical and mental anxiety: Shivering relentlessly, he started feeling better when he stopped meditating.

About 15 years ago, a woman who asked to remain anonymous was on her second 10-day silent retreat when she began feeling a twitch in her face that developed into an urge to roll her head around. She felt like electricity was shooting through her body. She would shake uncontrollably and at times writhe on the floor. Eventually, she was hospitalized for psychosis. She was later diagnosed with complex PTSD, and although she’s learned how to manage those symptoms, she told me that she still experiences involuntary muscle movements today. Another woman, Rebecca Fischer, told me that, more than 12 years after a retreat she attended, she still has chronic pain in her legs and back.

A good number of Cheetah House’s clients do suffer ill effects outside of retreats. In the days after meditating at home with an app, a client named Susan Small told me she was driving when “my whole sense of myself disappeared,” and she went on to experience “waves of terror” for months. A man named Eoin told me that after eight days of doing 30-minute audio meditations on his own every morning, he started feeling like a “nervous wreck,” on the edge of psychosis, and like he didn’t really know who he was, a phenomenon called depersonalization.

These people and other clients said they appreciated hearing from fellow meditators with similar experiences, and that Cheetah House helped them feel less like a “misfit toy,” as Millstein put it. They’d had a hard time finding support elsewhere, in part because one of the most common recommendations for emotional distress is to try meditating. Many of her clients, Britton said, seem relieved when she tells them it’s okay if they want to stop.

One recent New Year’s Eve, Britton hosted what she jokingly called a “parallel play” party—a kind of get-together for introverts where everyone works on a craft so they don’t have to talk much. She made margaritas, and friends and colleagues brought over magazines to cut up for collages. A few hours in, someone held up an article from the magazine Psychotherapy Networker and said, “Hey, is this about you?”

The story was, indeed, about Cheetah House, and Britton waited until everyone left to read it. One quote in particular stopped her cold:

“There should be a trigger warning for the Cheetah House website,” says renowned Buddhist teacher and clinical psychologist Jack Kornfield. “Too much of it is misleading information and over-the-top fearmongering.”

This was the Jack Kornfield, the mindfulness guru who wrote A Path With Heart, the book that had launched Britton’s journey into Buddhism. He was like a father figure and a mentor to her. Jack Kornfield thought she was fearmongering. Now all she could think was “Thanks, Dad.” She spent a week in bed after that. (Kornfield declined to comment.)

As she continued with her research, Britton gradually started to feel iced out of the Buddhist circles that had once comprised her entire personal and professional networks. She said a Buddhist organization sent her a threatening letter after she interviewed members of their community. One time, after she gave a talk about adverse effects at a conference, Britton said a prominent meditation researcher cornered her outside and yelled, “I don’t believe you!” (The researcher denies saying this.)

Invitations to conferences started to dry up—and when she did receive them, she said, it would turn out to be an invite to debate whether meditation-related challenges even existed—“just an insult to everyone that I’ve interviewed,” she said.

“If you want to build a bridge, you can’t just be like, A bridge is gonna be so cool. You have to think about where could it possibly fail,” Britton told me. “And it’s so unpopular to be that person.” Her former postdoc, Roman Palitsky, told me that Britton suffered for pointing out the problems with the bridge. “Nobody was doing meditation difficulties before her, not seriously anyway,” he said. “And I think large parts of the meditation world kind of turned on her.”

Some of this criticism can be chalked up to differing interpretations of the science, and of how best to treat stubborn afflictions such as anxiety and depression when all of the remedies have potential downsides. “Is it better for an anxious person to be meditating or on Lexapro?” is not an easily answerable question. Fox, the UCSF psychiatrist, told me that some of the neuroscientific effects that Britton attributes to meditation, such as increased activity in the insula, can also be interpreted as a sign of better “autonomic awareness”—basically, being more attuned to the inner workings of your body—rather than a sign of trauma or panic.

But some of the criticism seems to emanate from a reflexive defensiveness on the part of meditation’s promoters, who—perhaps understandably, given the abundant benefits that have shown to be associated with the practice—don’t want to tarnish the reputation of a good thing.

I’ve noticed that people are apt to defend meditation with a zeal I haven’t witnessed since evangelical youth group in my teens. You don’t enjoy meditation? Good, you’re not supposed to enjoy it. You say it doesn’t work for you? Well, you’re just not doing it right. The answer to every problem with meditation seems to be more meditation.

This touchiness can extend to meditation researchers, most of whom are meditators themselves; academic meetings Britton attended would sometimes kick off with a meditation. Nicholas Van Dam, the University of Melbourne psychologist, told me that meditation communities tend to carry a sense that “if you say anything bad, you’re negating the good.” Farias mentioned that after he included a chapter about meditation’s risks in his book The Buddha Pill, some of his friends “were very, very annoyed,” and a couple of them told him that “we could not be publicly seen as associates.”

Some pro-meditation researchers are more evenhanded—recognizing the value of Britton’s findings even if they quibble with aspects of them. Eric Loucks, the director of the Mindfulness Center at Brown, pointed out that a person can have a challenging experience during meditation and still find their overall meditation practice to be beneficial. He also noted that several studies have found mindfulness-based interventions to have fewer side effects than pharmacological treatments, including Lexapro. Still, he called Britton “innovative” and “courageous,” and said her work influenced not only his own views and scholarship—including updates to the standard MBSR curriculum, which the Mindfulness Center now maintains—but also mindfulness research as a whole. “Just looking for the good stuff,” he said, is not his goal. “We really want to know the truth.”

But several meditation teachers I interviewed did seem protective of the practice. Carol Greco, a psychologist at the University of Pittsburgh and an MBSR teacher, once co-authored a paper that aimed to “dispel the notion” that anxiety, pain, and psychosis “are adverse events due to mindfulness meditation.” She seemed chagrined that I was working on this story, writing in an email, “I would rather talk with you about how meditation can be helpful.” When Britton’s studies began coming out, she said, it “brought a heightened awareness of the potential of trauma in a person’s background and how we can create a safe environment.” But her “heart hurt” because “it felt like it was making mindfulness and meditation seem like it’s really dangerous and really bad.” She told me that in her two decades as a meditation teacher she’s never seen a serious adverse event like psychosis or dissociation.

A few of the scholars I interviewed who defended meditation acknowledged some of Britton’s findings, at least implicitly. Richard Davidson, a University of Wisconsin at Madison professor of psychiatry and psychology who is a well-known mindfulness researcher, told me that, as far as relaxation techniques go, meditation is fairly benign. He believes that for most people there’s a greater risk of harm from not meditating than there is from meditating, because the physical and emotional benefits of the practice are so robust, and he’s co-authored studies supporting that claim. But, he added, people with serious psychiatric disorders should meditate only under the guidance of a mental-health professional who also happens to be a meditator—advice that would probably come as news to the many thousands of people who meditate by using apps at home.

The Buddhist scholar and teacher Gil Fronsdal told me that although he doesn’t think meditation causes adverse effects, retreats may exacerbate preexisting psychological problems. (Britton said adverse effects can crop up even for people without prior mental-health conditions.) Fronsdal recalled one meditator who gradually lost touch with reality after a monthlong retreat: She stalked Fronsdal’s wife, became homeless, and spent hours in a medical-law library researching how it was that Fronsdal had managed to exchange his wife’s spine for hers. Having schizophrenic people on meditation retreats has been “one of my most challenging situations as a teacher,” he told me. He said that people with psychosis shouldn’t go on meditation retreats, and neither should people who are “hyper-anxious”—a quality that described me when I sat for a daylong MBSR retreat for my book.

The substantial and sometimes hostile pushback against her work has made Britton hypervigilant. Maybe excessively so: To my eye, she sometimes detects criticism where there isn’t any. When I asked her to describe what it was like working at Brown’s largely pro-meditation research group while publishing study after study finding that meditation can be risky, she wouldn’t say much more than that the situation could be “tense.” (Loucks, the Mindfulness Center’s director, denied that there was tension.) “When it comes to somebody choosing their religion or your friendship,” she told me at one point, “they will choose their religion every time.”

Starting in the early 2020s, Britton and Lindahl struggled to find funding to continue studying the downsides of meditation; they said an organization once rejected their proposal for a grant on “transformative experiences” for being too critical of religion. She says that when they submitted papers to academic journals, the peer-review comments for the papers focusing on the risks of meditation were “six times longer” than for those focusing on the benefits.

Equanimity is a cornerstone of Buddhist thought; Britton herself had repeated the words to rooms full of meditation students many times: “Nothing is good or bad, but thinking makes it so.” But she was starting to think that, actually, some things are good and other things are bad. Sure, you can just accept everything, but sometimes you shouldn’t. She had made a big contribution to the field; it seemed to me like she was feeling done with Brown, with academia, with living in Rhode Island, with all of it.

When Britton first met Lindahl, he persuaded her to start taking one day off a week, something she had not done in two decades. Then it was two days. Then she stopped teaching in the summers. Soon, they were scouting for a plot of land in Vermont they could move to. They now live in an off-the-grid cabin in the woods, where a botanical drawing greets visitors on a wall by the entryway. What is the human soul, the caption reads, but a claw pointing back to the forest?

Britton is consulting on a research project with her former postdoc, Palitsky, who is now at Emory University and running a much larger, longitudinal study of meditation-related challenges. This summer, both she and Lindahl officially left Brown. They’re enjoying exploring “other sections of the bookstore,” as she put it. Running Cheetah House takes up the bulk of her time now.

Britton stopped meditating in 2017, around the time she published the “Varieties” study, and she “began to have a less romantic and more nuanced view of Buddhism.” Now she finds her own kind of tranquility in the natural world, taking care of her plants and chopping wood.

It’s important to emphasize that neither Britton’s research nor her work with Cheetah House clients has turned her against meditation per se; it’s just attuned her to the importance of doing it safely. Meditating for longer than about 30 minutes a day tends to be associated with more negative side effects, she said, and certain types of meditation can be a poor fit for certain people. (For instance, some anxious people shouldn’t do a “body scan” type of meditation, because they are already too focused on their body.) People considering extended meditation retreats should try meditating for a few hours at home first, to be sure they can tolerate long stretches. And those who experience challenges with their meditation practice should consider changing the kind of meditation they’re doing, modifying their practice, or just not meditating. “Treat meditation like any other relationship,” she said. “If you feel like shit with that person, maybe it’s time to break up.”

Spending so much time with Britton made me want to revisit my own adventures in Buddhism and what I had found valuable about it. Mostly, I found old notes about how much I hated meditating: “This is the part of the book where I’m not having a lot of fun”; “I would literally rather give birth than do nothing for 45 minutes”; “I’m just an anxious immigrant who fears you can mindful yourself onto a park bench.”

But I also came across some teachings that I did appreciate, and which I’m going to oversimplify here because I’m not a Buddhist. Among them: The Buddha taught that people should pursue a “middle way” between decadent indulgence and rigid austerity—to not live mindlessly, but to not be so ascetic as to immiserate yourself. “Avoiding these two extremes,” one sutta reads, “the Realized One understood the middle way of practice.” Maybe he was onto something.

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How ‘Somatics’ Became the Solution to Modern Life

2026-09-03T07:00:00-04:00

When clients go to Sybil Ottenstein for therapy, they tend to arrive with answers. Many of them have seen shrinks before. They can tell her which events from their past were formative, and point to the ripple effects in their current life. They’re like detectives, she told me, with all the dots connected on their corkboard of evidence. Intellectually, they’ve cracked the case. The problem is that they don’t feel any better.

That’s why they’re seeking something different from Ottenstein: somatic psychotherapy. Traditional talk therapy could be seen as a top-down approach. You identify problems in your thinking, your habits, or your life, and hope that by working through them, you can resolve physical manifestations of emotional issues—the chest palpitations of anxiety, the stomachache of stress. Somatic therapy, by contrast, works from the bottom up. Ottenstein typically starts her sessions by asking clients to slow down and pay attention to corporeal sensations: “What does it feel like in your chest? In your throat?” As they talk, she encourages them to stay in their body, to let themselves feel whatever is coming up. People cry. They yawn. They scream. They stretch. They dance.

The word somatic, according to Merriam-Webster, merely means “of, relating to, or affecting the body.” But recently, it’s been popping up everywhere, appended to a variety of practices that involve tuning in to physical symptoms in order to ameliorate psychological ones. Somatic therapists like Ottenstein have noticed a significant bump in interest; one of the major somatic-therapy training programs reported that its applicants more than doubled from 2020 to 2023. Other practitioners offer somatic dance, somatic yoga, somatic workouts. (The terms seem a touch redundant.)

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

On Instagram, hundreds of thousands of posts appear with the hashtag #somatic. A “somatic exercise” trainer who goes by the “Workout Witch” (nearly 2 million followers) teaches small, repetitive movements meant to discharge negative feelings—curl your head down for “sorrow/despair,” pull your right ear for “overwhelm”—and promises that “trauma can be released from your hips.” All over my feed, fit young women are humming, hitting their sternum, pinching their nose bridge, and bouncing their knees all the way to inner peace.

[Read: These Millennials can’t get out of their head]

Much of the time, as with many other wellness ventures, someone stands to make money. At one somatic-workout class I attended, where a staffer told me that the goal was to “move stagnant energy out,” the lobby featured a gift-shop corner with jewelry, T-shirts, and $65 “body gloss” from a brand called Oui the People. But clearly, plenty of Americans are willing to pay for the promise of a psychic cleanse. Practitioners refer to “stuck energy,” to “trapped emotions,” to “resetting” a nervous system caught in fight-or-flight mode. “We have all these ways of just storing that gunk inside,” Ottenstein told me. I pictured, uncomfortably, a thick, black goo running through my veins.

Somatics—the whole roomy umbrella of practices—might seem like an odd fit for the information age, when people are more accustomed to finding answers on the internet than within themselves. But that could be precisely the draw for thinkers and analyzers who are tired of ruminating in anxious circles, who spend their days in front of a laptop and nights scrolling an iPhone. For millennia, people have yearned to break out of the confines of their bodies; they’ve searched—through religion, spirituality, drugs—for transcendence. Now, for some, the existential quest is inverted: Instead of seeking to escape their prison of flesh and bones, they want to reinhabit it.

The origin of somatics is difficult to pinpoint, though it’s certainly not recent. Some credit Wilhelm Reich, a student of Freud’s, who theorized in the early 1900s that patients held tension in their bodies—“muscular armor”—as a subconscious defense against trauma, leading to aches, pains, and inflammation. But it wasn’t until the 1970s that the field began to formalize, developed in part by the American philosophy professor Thomas Hanna, who defined somatics as the study of “the body as perceived from within.” That same decade, a UC Berkeley biophysics doctoral student, Peter Levine, developed “somatic experiencing”: a therapeutic method based on the idea that people, like other animals, react to trauma with a flight, fight, or freeze response, powered by a burst of adrenaline. After the source of danger is gone, Levine argued, they have pent-up “survival energy” to unleash: They need to physically shake it off. He pointed to videos of impalas, quaking and buckling after surviving a cheetah attack. When humans go through something upsetting, Ottenstein told me, “we go to work the next day.”

This idea—that trauma is held in the body, and thus must be physically remedied—was once fairly niche. In recent years, though, it has been jolted into prominence. The psychiatrist Bessel van der Kolk’s book The Body Keeps the Score, which argues for somatic treatments of PTSD, was first released in 2014 and was not an immediate hit. In 2021, it reached the No. 1 spot on the New York Times best-seller list for paperback nonfiction. And although it has been accused of resting on shaky science, it has continued to dominate the charts for years.

Van der Kolk wrote about violent assaults, wartime atrocities, severe childhood abuse—circumstances that many readers hadn’t directly experienced. Yet The Body Keeps the Score seemed to resonate anyway. When it gained momentum, lots of Americans had spent the previous year safe in their homes, baking bread and taking Zoom calls. (“When people say the pandemic has been a collective trauma,” van der Kolk told The Atlantic that year, “I say, absolutely not.”) Most had also, however, been detached from the rich sensory experience of interacting with the external world. Now here was a book about people who’d felt estranged from their own body—and then, through simple movement, play, and touch, found their way back to their surroundings, and to themselves.

[Read: The self-help that no one needs right now]

In the years since, most people have emerged from pandemic isolation. Yet the share of Americans who say they frequently experience stress, which has been rising for decades, has continued its upward trend. Talk therapy remains popular, but it’s not always affordable or accessible—and much of the time, it doesn’t take physical symptoms into account. Meanwhile, many medical doctors don’t consider psychological causes of physical ailments. Stress in particular is “like this mythical creature,” Aditi Nerurkar, a physician at Harvard Medical School, told me. “And we don’t have a lot of time. We have to focus on your hemoglobin. Did you get a mammogram? Did you get a pap smear? What is your cholesterol?”

No wonder, then, that somatics is a flourishing industry. Many Americans already distrust medical institutions; maybe they want to bypass the dismissive doctor, or the therapist who wants to rehash every daddy issue but can’t seem to fix anything. So they turn to this strange constellation of New Age–y courses, TikTok sages, and licensed counselors. Some offerings target people with capital-T Trauma; others claim to be for just about anyone. Many present themselves as alternatives to more traditional paths to mental well-being. The question is whether they can really help the frazzled masses.

Somatics does get a lot of things right. Plenty of bodily sensations are, at root, psychological. Some communication does need to happen between the brain and the rest of the body. That’s how you know to respond to danger: The amygdala triggers the nervous system to increase your heart rate, deliver more blood to muscles, and release a flood of adrenaline. When I spoke with Nerurkar, she rattled off an incomplete list of physical symptoms that might result from stress: headaches, dizziness, nausea, vision changes. When she was in residency training, she said, she experienced what felt like a “stampede of wild horses” across her chest and was convinced that she had a heart problem—until her doctors, having conducted a battery of tests, recommended that she seriously consider chilling out.

And many components of somatic practice have evidence to back them up. Interoception, or awareness of one’s own physical signals, really can be important for well-being—perhaps because it increases people’s sense of attunement with their body, connection with the present moment, or agency over otherwise vague and inscrutable sensations. Mindfulness meditation, which involves interoception, has been shown to decrease stress and anxiety and even reduce physical pain. Yoga and breathing exercises can decrease amygdala activation and lead to better concentration, memory, and executive function.

But the somatics packaging of these techniques is alluring partly because of the emotional liberation it promises. Somaticists tend to describe a clear path: identify a physical signal, connect it to its psychic cause, then let it go. If the nervous system overactivates, surely you can just reset it. If the body holds trauma, surely the body can relinquish it.

These were always just metaphors, though, and imperfect ones. The amygdala doesn’t have a reboot button. There is no viscous gunk of emotional pain to flush out. The Body Keeps the Score has been somewhat debunked; critics have argued that van der Kolk incorrectly described certain studies, and that he seems to have made up others entirely. (Responding to the writer Emi Nietfeld’s critique in Mother Jones, van der Kolk said that at times he drew on unpublished data.) Trauma experts have pushed back on his wholesale condemnation of talk therapy, which can be, according to a mountain of evidence, very helpful for treating PTSD. There’s also something ironic in how certain somaticists—ostensibly advocates for the mind-body connection—talk as if the two are separated by a nearly unbridgeable gap: the physical burden of trauma unreachable through thinking or conversation, and perhaps not even accessible to conscious awareness.

[Read: Why we’re still talking about the ‘trauma plot’]

So somatics isn’t a miracle cure. And it’s probably right to be skeptical of influencers who seek to collect on people’s need to feel at home in their body. But that doesn’t mean somatics can’t be helpful. Much of it, after all, turns out to be pretty straightforward. Movement is good, generally. Breathing is good. Stepping away from your screen—stretching your limbs, remembering you are real and tangible and mortal—is good.

When I signed up for that somatic-exercise class, I expected that I might leave rolling my eyes, but I secretly hoped I’d walk out lighter, more alive and connected to myself and the world. What I found was something in between. The actual workout couldn’t have been more basic: It consisted largely of squats, jumping jacks, crunches, some yoga—downward dog, child’s pose. Occasionally the instructor would remind us to check in with our bodies: “What are you being invited into? And I don’t mean the burpee.” Or: “Let the chin enter the conversation.” Otherwise it hardly seemed uniquely somatic, or uniquely anything.

Then again, I had the post-workout endorphin glow. I’d left my apartment and shut my phone in a locker. An hour later, I exited the studio somewhat baffled. But walking out onto a busy Manhattan street, I felt a little more conscious of the sun on my cheek, the solidness of the ground pushing against my feet. This was silly, I thought. And also: Maybe I’ll come back.

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The Truth About American Food Safety

2026-09-02T10:27:57-04:00

The phrase When it rains, it pours isn’t one you like to see applied to outbreaks of foodborne illness, yet here we are. The summer started with a diarrhea-causing parasite called Cyclospora cayetanensis, which infested iceberg lettuce. Then came news of Shiga toxin–producing bacteria in organic frozen berries, and a Salmonella outbreak linked to Whole Foods guacamole that eventually got traced to tainted jalapeños. (Pico de gallo, salsa fresca, and a variety of spicy dips have also been implicated.) Ricotta-style cheese was recalled for Listeria. Both Salmonella and E. coli were found in products from the aptly named Everything Sprouts. And 10,000 cases of lightly fried tofu were flagged for potential contamination with printing ink.

This flood of food-contamination events comes at just the time when our systems to prevent such outbreaks may be hobbled. Since last year, three cyclospora-research projects at the Department of Agriculture have lost either their funding or staffing, the CDC team that tracks the parasite’s genetics has nearly disappeared, and experienced government employees responsible for food safety have left their job or been fired.

The bureaucracy is crumbling, and the produce aisle is a mess. But let’s be fair: The status quo on foodborne illness was never very good. According to 2019 estimates from the CDC, Americans suffer (sometimes unaware) through at least 9.9 million bouts of foodborne illness each year; more than 50,000 people end up in the hospital, and about 1,000 die. Depending on how you measure outbreak numbers—whether by FDA investigations into foodborne illnesses, for instance, or by the number of food-product recalls—the 2026 statistics have been pretty much in line with recent history. How quickly we forget the Salmonella-dusted cucumbers of summer 2024 that sickened more than 500 souls. Or the cantaloupes that killed half a dozen people in 2023. Occasional salad-based catastrophes have been the norm for many years. Food-safety experts say that something on the order of 150 million meals of leafy greens are served in this country every day. Now as always, a very small proportion of them will make you ill.

But one of this summer’s outbreaks does suggest that our “very small proportion” might be growing into a slightly larger very small proportion. Although the jalapeño and berry outbreaks have had many doleful precedents of their size and scope, the cyclospora summer stands alone. Annual cases of its associated diarrheal disease, called cyclosporiasis, have been slowly increasing over time, from hundreds in the 2010s to a few thousand in the early 2020s. (This is, in part, due to faster diagnosis: One used to have to find the parasite’s oocysts under a microscope; now the fragments of its DNA can be identified in a rapid-PCR screening test.) This year, though, the CDC has confirmed 17,180 cases of the illness, and many thousands more suspected cases still need to be examined. State-level agencies have tallied more than 30,000 infections. “It’s just absolutely crazy,” Kalmia Kniel, an expert in microbial food safety at the University of Delaware and a former president of the International Association for Food Protection, told me. “It is completely overwhelming and insane that this happened.” I suppose it’s nice to know the sense of overwhelm afflicts experts too.

No one seems to know exactly how or why this year’s cyclosporiasis caseload got so big. The largest group of cases, which has been centered in the upper Midwest, has been linked to iceberg lettuce grown in Mexico. Kniel suspects that in Michigan, the parasite may have worked its way from the feces of the first infected people into the local water supply, spawning a secondary, local outbreak. Michael Osterholm, who runs the University of Minnesota’s Center for Infectious Disease Research and Policy and previously spent 15 years as the state’s head epidemiologist, told me that he’s seen no evidence to support the secondary-outbreak theory. Either way, some mystery remains as to how the parasite got into the food supply in Mexico. Taylor Farms, which recalled its iceberg lettuce in July, is “one of the leading produce companies in terms of food safety,” Kniel said. And yet here we are.

Perhaps the government could be doing more to resolve some of this uncertainty. On this point, though, expert opinions vary widely. Kniel said that, at least at first, the FDA and the CDC appeared to be posting information about the cyclospora situation more slowly than they had in past years. Steven Mandernach, the executive director of the Association of Food and Drug Officials and a former food-safety official in Iowa, told me that as far as he can tell, information has been coming out just as efficiently as ever. Osterholm believes that the sky is falling. “We have hit an all-time low, in my 50 years in public health, in our capacity to identify and respond to foodborne outbreaks,” he said, adding that the government’s slow response time on the cyclospora outbreak was nothing less than “public-health malpractice.” In an emailed statement, Grace Davis Jamison, a Department of Health and Human Services spokesperson, wrote, “Claims that HHS has lacked transparency overlook the extensive information FDA and CDC have shared as investigations progress including timely updates that help the public understand potential risks and make informed decisions.” She also said that no FDA investigators had been lost to staffing changes, and that the CDC laboratory that supports foodborne-outbreak investigations was likewise “unaffected.”

Perhaps this disagreement can be squared by acknowledging the failings of the past. The system has long been underfunded while needed changes were delayed, Barbara Kowalcyk, the director of George Washington University’s Institute for Food Safety and Nutrition Security, told me. The recent departures of experienced personnel, to retirements and layoffs, have made things only worse. “We had one hand tied behind our back before this administration happened, and now we have both hands tied,” she said. (How exactly this might translate into disease outbreaks in years ahead remains unclear.)

History suggests that few new investments in food safety come before a tragic outbreak of disease. “It was the 1993 Jack in the Box outbreak that really changed things at USDA,” Kowalcyk said, referring to the undercooked, contaminated hamburgers that killed four children who had eaten at the fast-food chain. A 2006 outbreak of E. coli in bagged spinach, which caused hundreds of illnesses and $200 million in lost spinach sales, helped inspire the passage of the Food Safety Modernization Act. Now we have the cyclospora summer. “I think that this is going to drive another paradigm shift,” Kowalcyk said.

Cyclosporiasis is, by the grace of God, a relatively gentle and self-limiting disease. Many people recover on their own within a few weeks. And for all of the tens of thousands of cases that have been registered in recent months (and the many more infections that were never diagnosed), just two deaths have been reported. Their loss is a tragedy; the economic devastation caused by falling lettuce prices, and the fact that many consumers have spent months in fear of eating leafy greens, is a shame. But given that this summer’s cyclospora plague stands among the largest foodborne-illness outbreaks in the nation’s history, these outcomes seem modest.

Consider this a solace and a warning: Our summer of contamination could have been much worse.

The Backlash Against Polyester Has Gone Too Far

2026-09-01T17:00:00-04:00

Lately, the men of the internet who are obsessed with self-optimization have found a new fixation: their underwear. Many standard pairs use polyester or spandex, or sometimes both. What are they doing to the environment and their bodies, wearing clothes that shed all of those microplastics and leach forever chemicals? They want the underwear of their ancestors—underwear made from natural fibers. On Reddit forums such as r/PlasticFreeLiving and r/SustainableFashion, people trade strategies for breaking up with polyester boxer briefs: “Any recs or leads to find linen cloth for making my own underwear?” one exasperated user wondered. Another wanted recommendations for all-natural underwear that would also be formfitting. He knew about organic cotton and hemp, he explained, but the problem was, they chafed.

Seemingly everyone is interested in natural fibers. Whitney Crutchfield, who teaches textile development at the Fashion Institute of Technology, told me that she first noticed natural-fiber mania brewing among her sustainability-minded students. Then, a year or two ago, she sensed the discourse shifting to regular consumers. Across the internet, people are purging their closets of synthetics, swearing allegiance to only natural fibers from now on. The enthusiasm seems to cut across gender, culture, and politics. “I need my workout clothes to show my nasty sweat!” the fashion journalist Liana Satenstein wrote last year, praising the emergence of a new generation of natural-fiber workout wear amid posts about French pedicures and vintage Prada thongs. “Make all clothes natural fibers again,” posted Carnivore Aurelius, an anonymous wellness influencer who sells “beef collagen peptides.”

Natural fibers are indeed pretty great. Silk, wool, hemp, linen, cotton, and the like—all of which come directly from either plants or animals—don’t carry the baggage of their artificial competitors. They don’t shed microplastics. They’re generally understood to be biodegradable. And although the research is far from settled, synthetics have been linked to adverse hormonal effects. When I visited the website for a natural-underwear brand, a pop-up asked me what I looked for in my underwear: “Fertility health” and “supporting low T” were among the options.

Natural fibers have also become an easy way to gauge the quality of a garment. Cotton, wool, and linen generally cost more than polyester and acrylic do, and they can look and feel luxurious in a way that many synthetics don’t. The reason finding a decent sweater these days is so hard is that so many of them are blended with synthetics, and one major reason for all of that blending is reduced production costs. Earlier this summer, when Gap released a reimagined version of a classic sweater from the early 2000s, fans revolted. What had originally been a chunky, cotton-blend knit turtleneck was now an entirely synthetic printed mesh. The anti-synthetic zeitgeist has transcended clothing; it is an attitude. Gen Z apparently now uses polyester as an insult meaning “cheap” and “inauthentic.”

But the frenzy has gone too far. Are you really sure it’s always better to buy cotton or wool over a nylon blend? The whole point of man-made fibers is that they can have properties that specifically don’t exist in nature. “There are reasons that these things were produced in the first place,” Crutchfield said. When DuPont unveiled nylon—the world’s first synthetic fiber—to the public at the 1939 World’s Fair, it was a revelation. In the dawning era of synthetics, people would no longer be beholden to the limits of nature; instead, we had chemistry, which was going to free women from the drudgery of endless laundering and usher in an age of universal luxury. This did not, perhaps, play out exactly as one might have hoped, but even today, synthetic fabrics have plenty of benefits.

Synthetics can enhance the performance of a garment, or the feel, or the durability, all of which contribute to a garment’s lifespan. The better it serves its intended purpose, the less likely you are to replace it with something new. A beautiful, all-natural raincoat isn’t an especially virtuous purchase if it doesn’t repel rain. On the whole, clothing with some percentage of man-made fiber requires less care than an item made with wool or silk or linen does—no hand-washing, no ironing, no reason to worry that moths might eat your favorite sweater.

Sometimes, they really are the best materials for the job. The designer Issey Miyake’s famous pleated pieces are polyester because, as one textile expert explained to NPR, their thermoplastic qualities are what helps them keep their shape. Polyester actively repels moisture and dries quickly, which is why it’s used in so much athletic gear. Wool is stronger and more durable when it’s blended with a bit of nylon—not important for sweaters, crucial for hiking socks. A little spandex can help a pair of cotton leggings keep their shape. If we want the forgiving comforts of stretch denim and athleisure, “we have to make peace with the fact that synthetic fibers are going to be incorporated into our clothes,” Nancy Deihl, a fashion historian at NYU, told me. Yes, synthetic clothing can release microplastics—bad—but it isn’t clear how much swapping out your stretch pants does to meaningfully reduce your exposure.

There is another problem with the natural-fiber obsession: Plenty of common fibers are neither synthetic nor natural. Semi-synthetics such as Tencel (the brand name for lyocell), modal, and rayon (otherwise known as bamboo) are made from natural plant material that’s been chemically dissolved and then reconstituted, a process that can be staggeringly toxic or ecologically responsible. Conventional cotton, for example, takes significantly more water to produce than lyocell and modal do.

Further complicating matters, although terms such as organic cotton, regenerative cotton, and recycled cotton tell you something about the production of fibers, they do not tell you something about the quality of a garment. Yarn spun from longer cotton fibers is stronger and wears better than yarn spun from shorter ones, but fiber length is a result of the type of cotton plant, or the growing conditions, or how the fibers have been processed. “You can compare the fiber quality of three different cotton fibers, all making the same exact T-shirt,”—same weight of yarn, same knitting machinery, same pattern, same sewing process—“and those three T-shirts can, depending on fiber quality, last wildly different amounts of time,” Crutchfield said. Fiber quality is one reason a 100 percent cashmere sweater can be $50 or upwards of $500. “You must investigate the context and the nuance,” she told me.

And fiber, natural or otherwise, is only one of a matrix of concerns that determine whether your clothing is ethical and well made. “Synthetics and natural fibers can both last a long time, but it depends on how they’re used, how they’re worn, and the quality of the garment they were made into,” Deihl said. The look and performance of any given garment are products of the fibers but also of the fabric weight, the weave, the cut, the construction, and the care instructions—all of which require at least some knowledge to assess, and none of which is easy to evaluate online.

In a dizzying consumer landscape of infinite options, it is understandable, even admirable, to want some kind of universal rubric to guide your purchasing. This can’t be cost, which may or may not correspond with quality, and there is no single label guaranteeing sustainability or ethics. You probably don’t know where a fiber was farmed and how it was harvested and processed—whether it’s been bleached and how it’s dyed, and the conditions under which a garment has been constructed—and the people selling it might not, either. Fiber content, though, is listed on the label: therefore, natural fibers! But natural isn’t a reliable shorthand for good—no matter how much you pay for your all-cashmere pants.

What Happened to Yoga?

2026-08-31T07:30:00-04:00

At a recent Pilates class, where I pumped and pulsed under infrared heat panels until my fingertips were sweating, I ran into a former yoga teacher of mine, our mats inches apart in the neon-lit room. Afterward, I said hi and told her that I hadn’t seen a yoga class that packed in a while. She shrugged. “Yoga,” she told me, “is dead.”

She was being hyperbolic, of course—yoga is still plenty popular. In some ways, it’s more mainstream than ever. People practice it in airports, offices, prisons, schools. But her words illuminated something I’ve noticed: Yoga, it seems, is no longer the defining symbol of holistic health in America that it used to be.

The decline has been building for a while. Yoga studios, which have long been plagued by razor-thin profit margins, took a hit during the pandemic. Independent studios closed; YogaWorks, a California-based chain, filed for bankruptcy. In September 2020, The New York Times asked, “Is This the End of the New York Yoga Studio?” Even after the fitness industry rebounded and people returned to in-person workouts, many yoga studios continued to struggle for all sorts of reasons—rising costs, increased competition from other workout styles, the decision by some students to stick with at-home practices established during the pandemic. On Reddit, teachers commiserated about low class attendance. In May, a beloved studio near my home in the Hudson Valley emailed a desperate plea for students to return, calling its current business “unsustainable.”

[Read: The enduring appeal of being hot]

Plenty of studios are doing just fine: Representatives from apps that track fitness attendance, such as ClassPass and Walla, told me that yoga remains one of the top choices at boutique fitness studios. But the data reveal something else, too. Many yoga studios are succeeding by offering less yoga. Walla’s “veteran” yoga studios, defined as those opened for more than three years, have cut yoga class supply by 25 percent this year. ClassPass said that in April, more than 40 percent of its yoga studios also had reservations for Pilates classes. Mindbody, another booking platform, said that the number of its yoga studios offering Pilates grew more than 20 percent from 2023 to 2025. On the yoga Subreddit, people frequently gripe about Pilates and sculpt classes bumping yoga from the schedule.

Fitness trends come and go. But the workouts people choose also reflect the contemporary understanding of what it means to be well. For years, that meant yoga and its promise of stress reduction and mindfulness. In today’s world of fitness-maxxing and social-media-driven obsession over image, though, the cultural ideal seems to have shifted from inner peace to outward perfection.

When yoga first came into vogue in the United States, physical fitness wasn’t the primary goal. During the countercultural movement of the late 1960s, many Americans were drawn to yoga because it was “exotic,” Andrea R. Jain, a religious-studies professor at Indiana University at Indianapolis and the author of Selling Yoga, told me. At the time, some people disillusioned with mainstream American religion and values were “looking for something radically ‘other’ than the traditions they had been brought up in,” Jain said. Yoga was a compelling answer: It originated in ancient India and is deeply intertwined with Buddhism, Hinduism, and Jainism. Practicing yoga was seen as a rebellious act, an alternative path to spirituality and enlightenment.

Over the next few decades, yoga transformed from a fringe activity into a lifestyle empire. During the gym boom of the ’80s and ’90s, people became much more enticed by the practice’s physical aspects; the Los Angeles Times reported in 1987 that yoga was appealing to people burned out from aerobics and craving a gentler workout. In the mid-’90s, “integrative medicine,” a whole-person approach to health, became more widely accepted, and likely gave some of yoga’s messaging more credence. Celebrities also started endorsing the practice’s benefits. Sting appeared shirtless on the cover of Yoga Journal in 1995, one lithe arm wrapped around a leg; three years later, Madonna taught an incredulous Rosie O’Donnell how to do sun salutations and ujjayi breathing on daytime television. They touted deeper connections among their mind, body, and soul, and flaunted the strong bodies yoga had helped them achieve. Madonna told O’Donnell: “I don’t work out anymore. I do yoga.”

[Read: Inside the surprisingly litigious world of luxury fitness]

In 2004, when I took my first class, the commercialization of yoga was well under way. The industry had spawned countless brands of yoga mats and athleisure, then franchised studios, and, eventually, Instagram influencers. (My mom, who practiced yoga in the ’70s and ’80s, recalls students using only towels or blankets, and wearing whatever comfortable clothes they already owned.) Soon, yoga became more than a workout—it was a lifestyle, at times even an identity. If someone said they were into yoga, the assumption was that they were healthy, spiritually minded, and self-aware. Many dedicated students (myself included) signed up for yoga teacher training, some without any intention of making a career of it but rather to further educate themselves in the practice. Etsy vendors sold hoodies that said namaste, a Sanskrit word commonly spoken at the end of a yoga class. And kitschy iterations such as goat yoga—in which playful farm animals tramp all over students’ backs—emerged, geared more toward entertainment than mindful practice.

Yoga’s ubiquity, however, may have triggered its cultural decline in America. The most devout practitioners started arguing that the expansion had trivialized yoga’s spiritual roots. (One former instructor told me he used to teach brewery yoga—which, yes, involved beer; years later, the memory makes him cringe.) The perceived novelty of the practice, Jain said, was less important to young consumers who grew up exposed to more spiritual and religious diversity. In other words, yoga lost its cool.

The practice has also developed a reputation for being a gentle workout that focuses on flexibility, characteristics that don’t align as well with recent fitness trends. In the past few years, more women have adopted strength training involving weights and resistance—especially those of a certain age who are bombarded with messaging about the bone and muscle loss that comes with getting older. Although anyone who’s taken a vinyasa class knows that chaturangas (sometimes called “yoga push-ups”) will fire up the triceps, yoga is not known for quickly building muscle mass. Suzanne Davis, a yoga-studio owner in Oregon, told me that adding lifting classes and wall-mounted resistance machines at her business was a “no-brainer.” Studios still need to pay rent, so they have to meet customers where they are, even if that place is no longer on a yoga mat.

[Read: The perilous spread of the wellness craze]

But wellness culture in general has changed too. Simply exercising and eating well is no longer enough—“biohacking” has become hot. Some of today’s wellness devotees wear continuous glucose monitors to clock blood-sugar spikes in real time as well as $400 titanium rings to track heart-rate variability and REM sleep. The goal: 24/7 self-improvement. Although people surely sign up for yoga to better themselves, the practice typically encourages them to do so slowly, with humility. Yoga tends to be about letting go of ego and striving, and about surrender—principles that don’t quite fit into a culture obsessed with optimization. This priority shift also mirrors what has happened with the body-positivity movement: A push to make peace with our bodies has been minimized amid the rise of GLP-1s, and many people have gone back to sculpting and shrinking. If skinny is unapologetically in again, fitness classes other than yoga might seem like a faster route to toned arms and a flat stomach.

Of course, what people consider a well life could change again. In fact, this year’s report from the Global Wellness Summit, an influential industry conference, suggests that the interest in maximizing every moment has already peaked: “Optimization itself has become a stressor.” Laura Munkholm, the president of the fitness app Walla, told me she knows many people who have given up on tracking entirely. “People are shifting into a conversation of I don’t care what the numbers are. I just want to live well.” Apparently, wellness seekers are craving something restorative. As it turns out, I may have just the activity for them.

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The Measles-Stricken Mother Who Lost Her Newborn Son

2026-08-30T19:20:31-04:00

When the Amish man emerged from his barn to greet me, he had no idea that his newborn son’s death had become national news. The man wore a straw hat, black trousers, and suspenders over a long-sleeved blue shirt; one of his similarly dressed sons was guiding a horse-drawn plow in a nearby field.

The man told me that, like most Amish people, he and his family don’t watch TV or use the internet. They don’t read the newspaper either. So they didn’t know until I told them that last Tuesday, Pennsylvania’s governor, Josh Shapiro, held a press conference to announce the first two “measles-associated” deaths in the state in 35 years. Both of the people who died were from Lancaster County, which is home to the largest Amish community in the country and has been hardest hit by the state’s months-long measles outbreak.

They also didn’t know that Shapiro’s political opponents are accusing him of using the deaths to score political points, or that the county’s coroner later told reporters that his office had performed an autopsy on an infant who tested positive for measles but that the cause of death had been a ruptured spleen. The confusion led Robert F. Kennedy Jr., the secretary of health and human services, to mock Shapiro on X, calling his press conference “unseemly” and an example of “the weaponization of infectious disease fears for political gain.” Without evidence, Kennedy wrote that “the deaths may even have been altogether fabricated by one of the Governor’s hopeful staffers.”

The Amish man asked me not to reveal his and his family’s names or exactly where they live, to protect the family’s privacy. His son has not been publicly identified as the newborn whose death has been the subject of so much controversy. But the circumstances of the death match, and when I told him about the case that had made the news, he said it sounded like his son. When I ran the family’s biographical details past the Lancaster County coroner, Stephen Diamantoni, he said that the office was not currently investigating any additional infant deaths in the area. When further pressed, Diamantoni said he could neither confirm nor deny the identity of the child whose death his office was investigating.

The story the baby’s father told me filled in many details missing from the accounts of both the coroner and the state. And it made clear that, amid the political squabble and competing theories, an actual family is grieving the death of their child.

I spent part of yesterday afternoon speaking with the newborn’s father and mother, whom I’ll call John and Anna. After John and I had been talking for a while, Anna came out of the house, and—although hesitant at first—agreed to join us. We sat at a table on their porch, which overlooks their postcard-beautiful farm, tucked away down a long gravel driveway. They mostly grow corn on their 45 acres, along with some hay and tobacco. They have a well-tended garden next to the house, and a small chicken coop. They’ve lived on the property for 20 years and have 13 children, some of whom stood nearby on the porch to listen or peered out through one of the screen-covered windows.

About a month ago, John and Anna became aware that measles was spreading in their community. At last count, Lancaster County has recorded 210 cases so far this year. Besides John, no one in the family had been vaccinated against the virus. John told me he’d heard from someone that this strain of measles wasn’t dangerous for pregnant women, but he wasn’t sure whether to believe it. (In fact, measles, regardless of the strain, can cause serious pregnancy complications.) Anna, who was pregnant, worried about the effect measles might have on her baby, but she didn’t think she could avoid being exposed. “I saw we can’t even get away from it because so many people have it,” she told me. Even if Anna had wanted to get vaccinated then, it would have been too late: The CDC recommends against giving the vaccine to pregnant women.

Sure enough, a few weeks ago, one of John and Anna’s older children got sick. The rest of them soon followed. Two of the children became dehydrated and required IVs. Anna became extremely ill, at one point spiking a fever of 102 degrees. She struggled to hold down food and fluids. For days, she could speak only in a whisper. On August 13, she was taken to a clinic to get an IV for dehydration.

The next day, she went into labor. Anna remembers being very weak. “I didn’t have a single piece of energy,” she told me. The baby was delivered at a birthing center by the same midwife who had attended the births of Anna’s other children and, remarkably, Anna’s own birth. The baby, who weighed seven pounds, was born a little after 5 p.m. on August 14. They knew right away that something was wrong: He had a pulse, but he wasn’t breathing. The midwife contacted paramedics, who arrived within minutes. John recalled them giving the newborn oxygen and gentle chest compressions with two thumbs, to no avail. It was all over in less than half an hour. The paramedics told them that the county coroner would need to be contacted to take the body.

As John and Anna spoke with me, one of their sons, who recently turned 1, played with a toy horse and buggy while one of their daughters bounced an orange ball against the table. Anna and John were somber but matter-of-fact about their son’s death. “There’s nothing we can do about it,” Anna told me. John said he viewed the tragedy as part of God’s plan, and pointed out that other parents lose children too. “I guess he chose us this time,” he told me.

Neither John nor Anna has strong feelings about vaccination. Anna told me she wasn’t sure why her parents didn’t get her any shots. Choosing not to immunize their children wasn’t a political statement, and they didn’t make the decision after extensive research. They just didn’t do it.

Pennsylvania allows children to attend school without being vaccinated if their parents object on religious or moral grounds. Though the Amish Church has no official doctrine against vaccines, the vaccination rate among the Amish tends to be low: Last year, the state’s health department estimated that only 25 percent of the Amish community in Lancaster County had received the measles, mumps, and rubella vaccine. In 2021, Kennedy declared that the United States needs to “think more like the Amish” at an Amish country fair just a short drive from where John and Anna live. Standing under a big white tent, Kennedy also joked about measles, saying that when he and his siblings caught the disease, they had to “stay at home and watch TV the whole week.” That got a big laugh. He also said the best treatment for measles is vitamin A and chicken soup—a statement that Shapiro has been using to attack Kennedy’s vaccine beliefs since he announced the two measles-associated deaths in his state.

Because they don’t follow the news, John and Anna weren’t aware of the controversy between Shapiro and Kennedy. In fact, they didn’t know who either man was. John said that he had recently received a voicemail from someone saying that a man named Kennedy wanted to speak with him, but he didn’t return the call. (An HHS spokesperson declined to answer questions about that call, instead criticizing Shapiro for prematurely speaking about the measles-associated deaths.) John’s father told them that the local newspaper had published a story about a baby who had died, and that it sounded as though the baby could be theirs, but they weren’t sure. They also didn’t think that their baby’s death was much of a mystery. They assumed that Anna’s severe case of measles contributed to their loss. That’s what the midwife told them as well.

Arguments over whether measles caused the infant’s death have largely centered around the lacerated spleen. It’s a confusing detail. When children acquire measles, the infection can lead to an enlarged spleen, which is more likely to burst. To some people, that might seem like clear evidence that the infant died because of measles. But Diamantoni, the coroner, has publicly maintained that his office believes that the spleen was not enlarged and therefore that the cause of death was not related to measles. (Prominent physicians have since pointed out that a ruptured spleen may not look enlarged even if it was affected by measles.) “I’ve had several discussions with our forensic pathologist, and he feels adamantly that this was not a measles death and that it was a traumatic rupture of his spleen,” Diamantoni told me. He also noted that the investigation was still ongoing and he wasn’t sure when it would be completed.

Diamantoni told me he is “very in favor of immunization,” but questioning whether measles really contributed to measles-associated deaths is becoming more typical among anti-vaccine activists. Last year, two young girls died in West Texas’s massive measles outbreak. Not long after their funerals, anti-vaccine activists reframed their deaths as caused by something other than the measles. Yes, they had the measles, the argument went, but really they died from another infection or hospital error. Children’s Health Defense, the anti-vaccine organization Kennedy founded before becoming HHS secretary, aggressively pushed that narrative.

What anti-vaccine activists usually neglect to mention is that measles, which can temporarily hamper the immune system’s memory, sets the stage for other infections. Most young children who die from measles are actually killed by pneumonia after their immune system has been overwhelmed. But they almost certainly wouldn’t have died if not for measles.

What exactly happened to John and Anna’s son remains unclear. A ruptured spleen is extremely rare in newborns in any circumstance, and so far the coroner hasn’t determined what could have caused it. John and Anna told me they had no idea either. In fact, they hadn’t heard anything about a ruptured spleen until I mentioned the coroner’s public comments to them; they simply knew that Anna had been sick, and then they had lost their child. John told me he had called the coroner’s office on Friday but was told that the investigation was still under way. They were surprised that details of their baby’s case were being discussed—if indeed the case that has captured national attention is their son’s—while they were still waiting to hear from the coroner and eager to read his report once the investigation had concluded. When I asked Diamantoni why he hadn’t been in touch with John and Anna, he said, speaking generally, that “there may be lots of factors that go into when a notification is made,” but didn’t elaborate further.

John and Anna’s son’s body was returned to them on August 17. He is buried in a cemetery a few miles away from their home. A small mound of fresh dirt sits in the cemetery’s center, marked on either end with flat wooden stakes. Scrawled on one of the stakes is the word sillborn—the t is missing—along with his father’s name. As in other Amish cemeteries in Lancaster County, a white fence surrounds the neatly kept graves, and the headstones are unadorned. It’s everything the public narrative over the boy’s death hasn’t been: simple, modest, and solemn.

The Golden Girls, but in a Camp Cabin

2026-08-30T07:00:00-04:00

At Camp Social, where grown women return to girlhood, friendship has no preamble. Within 15 minutes of meeting eight of the campers from Cabin 3, I learned this: In their 50s and 60s, they have no use for the menstrual discs in the camp swag bag; one of them found online dating so depressing after her divorce that she’s given up entirely; when they laugh, they pee a little; they feel like they’ve known one another for years, even though most of them met last night.

The campers signed up for this weekend-long adult summer camp for exactly this purpose—to make new friends. On August 21, more than 400 women, some as young as 21, some older than 80, arrived at what usually is a children’s sleepaway camp in the Poconos to spend the weekend bunking in twin beds in log cabins, climbing the ropes course, developing middle-school-level inside jokes, making friendship bracelets, and performing choreographed dances at the flagpole to Cher’s “Believe” and Shania Twain’s “Man! I Feel Like a Woman!” Everyone at Camp Social, regardless of age, is referred to as a “girl.” The camp promises to re-create a childhood experience so that grown-ups can bond with one another as easily as they might have as kids. I signed myself up because I wanted to know what kinds of adults would go back to summer camp and how seriously they would take it.

Nancy Walecki / The Atlantic

My new home for the weekend with more than 400 possible friends-to-be

The girls of Cabin 3 were all in. When they were younger, they told me, making friends did feel more straightforward. But then they got jobs that kept them late at the office, or their kids grew up, or they stopped drinking, and the friendships they’d made with other parents or neighbors faded. They began wondering: How do you meet new people? Where do you go? None of these women ever really thought they’d end up at an adult summer camp, but they saw ads for it and thought, Maybe I’ll give that a try.

Which is how they found themselves at breakfast in the mess hall, cross-talking at Gilmore Girls speed, comparing notes on their adult sons, laughing when one revealed her favorite prank—taking a picture of her cleavage on the disposable cameras passed out at weddings. Over the hollering, Jackie Prendergast, a retiree who smiles so wide she shows both rows of teeth, told me that Cabin 3 had decided that its mascot for the weekend would be the flamingo. When a flamingo loses essential nutrients, as it does when reproducing, the pigment begins to drain from its feathers. With time and nourishment, though, the pink returns. “We’ve lost our color, but we’re going to get it back,” Jackie said. Ten minutes later, we headed to archery.

Nancy Walecki / The Atlantic

The vibes were, indeed, good.

The night before, Camp Social’s girls had gathered in the barn for a dance where a band (all male, all handsome) played Prince, Michael Jackson, and Bruno Mars covers. Liv Schreiber, the camp’s 29-year-old founder, took the stage in her Camp Social shirt. “Welcome to camp!” she shouted, then launched into an ecstatic speech about the weekend ahead.

If anyone’s job could be described as “friend maker,” it is Schreiber’s. She is the type of person who skips more than she walks, makes it a point to memorize campers’ names, and, as I witnessed when we met up in New York City before camp, can form a real connection with strangers in a coffee shop in 10 minutes flat. She was working in real estate when she launched a viral matchmaking Instagram account and a matchmaking-party business, which morphed into events for adults to meet new friends. She opened Camp Social in 2023 to relive her own sleepaway-camp experience and to give women a place to meet. The waitlist, she told me, now runs north of 60,000 people.

Adult summer camps have been cropping up over the past couple of decades—one even dates back to the 1970s—but many of them are co-ed and have the feel of either Club Med in the woods or an all-out bacchanalia. Schreiber’s is one of the only all-female options with an explicit friend-making focus. Bubble letters on the camp bulletin board read You Haven’t Met All The People Who Are Going to Love You; the camp’s tagline promises that “99% of campers arrive solo and 100% leave as friends.” To get the crowd riled up at that opening camp dance, Schreiber asked, with genuine enthusiasm, “Who wants to meet a new friend?” Hundreds of hands went up.

Nancy Walecki / The Atlantic

Mornings at the flagpole included choreographed dances to Cher’s “Believe” and Shania Twain’s “Man! I Feel Like a Woman!”

That “99% arrive solo” isn’t technically true. Mother-daughter duos and friends arrive together, and returning campers offer wisdom such as: Get to the Soffe-shorts distribution early to get your size, do not miss the Saturday pool party, and be sure to lean back right before the water slide spits you out into the lake.

Even so, Schreiber has designed the camp for people to make new connections. Before arrival, campers received a guide titled “How to Camp Social,” which encouraged them to reconnect with their childhood self—the person “who made a friend at the playground in four minutes flat, who didn’t ask if she was too much or not enough.” The camp’s “10-Foot Rule” says that if you’re within 10 feet of another camper, you should smile and say hi. Bunks are grouped by age, but other than that, women are encouraged to make friends outside their generation. The counselors (all female) are trained to be welcoming, Schreiber said. They dance with campers at mealtimes, cheer when someone reaches (or tries to reach) the top of the rock wall, and shout out “Camp Social?!”—a cue for campers to circle their hips and respond with a Kool-Aid-Man-style “Ohhhhh yeaaaahhhh.”

Nancy Walecki / The Atlantic

The girls of Cabin 3

Who needs this kind of help making friends as an adult? Before I arrived, I’d wondered how many socially anxious people I might meet. Maybe the shyer campers were making themselves scarce, like Cabin 3’s mysterious tenth bunkmate, who kept to herself, or the girl in my cabin who disappeared when we all got ready for Saturday night’s camp disco. But most of the women there seemed capable enough of making friends; they were just in a moment in their life when opportunities to find those relationships felt scarcer. Compared with men, whose friendship skills are more often lamented, women do typically have more friends and are less likely to be severely socially isolated. But having a lot of friends doesn’t necessarily mean that a person’s social needs are getting met, and overall, rates of loneliness between the genders are roughly the same. The women at Camp Social were new mothers, grandmothers, empty nesters, divorcées, widows, and retirees; pretty much everyone was going through some kind of potentially isolating life transition. The average camper that weekend was 39 years old, an age when many people are taking care of kids and aging parents, which doesn’t leave much time for friendship.

For some attendees, camp simply functioned as a three-day lake vacation they didn’t have to plan—where they could do yoga on a paddleboard, attend an outdoor screening of The Princess Diaries, and drink signature camp cocktails. Last year, Schreiber told me, one woman in her 80s did nothing but archery the entire weekend. But many of the women I met came in order to feel like girls again, maybe with the hope that that would make friendship feel as easy as it did when they were kids.

For Cabin 3, Camp Social seemed to work a spell of quick intimacy. Of the cabin’s 10 girls, eight of them moved as a pack. (The ninth had come with her daughters and was spending time with them; the tenth I could never track down.) On the way to archery—along the lake and past the cabins, the pickleball courts, the pool, and the ropes course—the girls speculated about how someone would even use those menstrual discs, and Sandi Sullivan, who works for a construction company in Chicago, considered transforming her camp-branded bandana into a halter top for the camp disco, like the one her mom made her in the ’70s. When the archery instructor approached the group, he asked Vicki Petroski, a recent retiree, if she’d be a five—as in the fifth person on the range. “No, I’m a 10,” she replied. The girls cackled. The instructor blushed, and they cackled even louder. (Unlike the counselors, the camp’s staff members—who run the archery range, lifeguard the pool, and referee the camp Olympics—all seemed to be handsome 20-something men with British, New Zealand, or Australian accents.)

Nancy Walecki / The Atlantic

Jackie Prendergast, a flamingo regaining her color

“In my 20s and 30s, I never would have talked so openly with other women I’d just met,” Jackie told me. It helped that Cabin 3 had all reached the age where, as Linda Gryn, a business owner from Pennsylvania, said, “We no longer give a shit.” Some of the girls rarely speak about sex with their friends back home, but here, thanks to Vicki, whose daughter is a sex therapist, somehow every conversation seemed to come back to it.

The group was too busy for awkward pauses, anyway. The girls danced: Linda, who had been a majorette in high school and dated a football player, watched the dance instructor like a hawk during morning flagpole routines. They painted (okay, while drinking mimosas) at the paint-and-sip. Vicki went tubing for the first time in about 30 years. “Everything I did was 30 or 40 years ago,” she said. “When I turned 60, I said, Fuck it, I’m having fun again.”

Nancy Walecki / The Atlantic

Vicki Petroski and I survived tubing.

But being 60 is not always as fun as being 10. At the afternoon pool party, as girls from Cabin 3 and I waved at Vicki, in line for the water slide, Christine—the most reserved in the group, a sensible lawyer with a sensible black bob—came over to me. (She is perhaps so sensible that she asked me not to use her last name.) Going to an adult summer camp at all, let alone by herself, was not usually her speed, she said, and she already has a close group of friends. But recently, the man she’d been with for 40 years “decided he didn’t want to be married to me anymore.” One night, he said “I love you” before bed as usual, and then the next day, he told her, “We’ve had a good run, but I’m ready for the next chapter of my life.” A good run? Christine remembered thinking. I thought that I was happily married. Her adult sons were trying to stay neutral; she was trying to be okay with that.

Just then, Vicki went down the slide. The red-and-yellow half tube shot her multiple feet in the air, and we cheered when she emerged from the lake, grinning. Her curls were matted; the purple face paint she put on for camp Olympics was running down her cheeks.

Nancy Walecki / The Atlantic

The water slide was a hit among campers.

Somehow, as the evening set in, everyone still had the energy for karaoke and the disco. The girls in my own cabin, all in their 20s, were getting along well, but if Cabin 3 had reached the peak of camp friendship, my cabin was still in the “friendly roommates who ask about one another’s day” stage. As we got ready to go back out, one bunkmate did my makeup; another, who had been to Camp Social three times, told me the “vibes were off” at the pool party this year because it was overcast. At karaoke, while other bunks performed as a group, we bobbed our heads and drank our alcoholic “Bug Juice,” garnished with gummy worms. Meanwhile, Cabin 3 was on fire. Sandi, whose camp-branded bandana she wore tied up as a headband after all, raged to Smash Mouth’s “All Star.” At the disco, they danced in sequins and jumpsuits to the songs that had been on the charts when Linda was in high school.

Then it was Sunday morning and time to go back to real life.

Nancy Walecki / The Atlantic

“Y.M.C.A.” at the disco

Before the last morning flagpole, campers swapped Instagram handles and phone numbers. People seemed to have made friends, although a couple of younger girls I spoke with told me they definitely had not. They were ashamed that, even in an environment set up for friendship, they hadn’t connected with anybody. Those who had made friends wondered whether they would see them again soon or if they’d be only “camp friends.” When I asked my bunkmates whether they thought they’d stay in touch with anyone, one of them said rather ominously, “Only time will tell.”

Nancy Walecki / The Atlantic

Goodbye, Camp Social!

But over breakfast, the girls of Cabin 3 helped one another download WhatsApp and started a group chat. Since then, they’ve been trading photos of the shirts they had tie-dyed and group pictures from the disco. One of the girls, Jacqui Moore, had painted a flamingo at the paint-and-sip, which has stuck as the group’s symbol. “Keep your pink coming!” Linda wrote in one message. Three girls who live close to one another in Pennsylvania are planning to get lunch. Others might join one bunkmate walking a marathon. (In accordance with their flamingo theme, they say their team name would be “The Flockstars.”)

They probably won’t come back to Camp Social, though: The camp served its purpose. Maybe these women will get together annually to share the secrets they can’t with the people they see everyday. Maybe they’ll have a ball at Jacqui’s 60th birthday party. Maybe, like their other friendships, these will fade too. For now, they’re planning a reunion for next year. Greece—or maybe Moab?—could be nice.

Pennsylvania’s Public-Health Officials May Be Wrong About a Measles Death

2026-08-27T19:47:44-04:00

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Measles outbreaks around the country are already a disaster, but more bad news arrived on Tuesday. Pennsylvania Governor Josh Shapiro announced that two measles-associated deaths had occurred in Lancaster County. “These mark the first deaths related to measles within the Commonwealth in 35 years,” an accompanying statement declared. Both individuals were said to have been unvaccinated, but the state Health Department declined to release any other information about the cases, citing privacy concerns.

By yesterday morning, though, this story was in doubt. Lancaster County Commissioner Josh Parsons posted on X that he had spoken with the county’s coroner, who said that he had not identified any deaths due to measles. One individual, Parsons wrote, “died WITH measles, but not from measles.” That evening, Health and Human Services Secretary Robert F. Kennedy Jr. offered a more conspiratorial angle: Perhaps the entire episode had been “fabricated by one of the Governor’s hopeful staffers.”

Pennsylvania’s Health Department quickly doubled down: “As a pediatrician with more than 30 years of caring for children,” the state’s health secretary wrote, “I have thoroughly reviewed the case investigation information and sadly can confirm that there were two recent measles-associated deaths in Lancaster County.” But the facts that have emerged over the past 48 hours suggest that health officials may indeed have committed a catastrophic communication blunder—by either overstating the evidence or politicizing the deaths of citizens without conveying complete information about what had happened.

Here’s what we know so far: In the one case for which additional information has been released, an infant whose lab tests showed evidence of a measles infection died shortly after birth because of a lacerated spleen. According to an interview with the county coroner conducted by The Philadelphia Inquirer, a forensic pathologist decided that this fatal injury was not related to the infection.

That pathologist’s judgment might be wrong. Viruses (including measles) can cause the spleen to grow abnormally large, making it prone to rupture. A 2024 Polish study, for instance, documented an enlarged spleen in four out of 26 infants who had been hospitalized for measles. But there are certainly other potential explanations. Only a doctor familiar with all of the details of this particular patient’s situation would be equipped to reach a reasonable conclusion. Yet when Shapiro announced the two fatalities, he implied that the link was unambiguous. “Death from measles is completely preventable,” he said.

The baby in Lancaster could not have been vaccinated; newborns are not typically given their first dose of the MMR vaccine until they are 1 year old. According to the coroner, the infected newborn acquired the disease in utero from their mother. (Her vaccination status has not been publicly confirmed.) If some genuine uncertainty remains as to whether a measles infection led directly to the baby’s death, state officials’ announcement was premature. Think of the consequences: A grieving parent would hear her governor announce that the tragedy was in some way her fault. And anti-vaccine activists would have the opportunity to pounce on the mistake to continue downplaying the lethality of infections.

As a pathologist, I am used to fielding questions about how and why people die. Such calls were particularly frequent during the early days of the coronavirus pandemic, when many people doubted COVID-19’s official death toll. Some alleged that anyone who merely happened to die while infected—in a car crash, let’s say, or from cancer—was being counted in official numbers. (In fact, government statistics were underestimating the number of Americans who were dying from COVID.) Admittedly, determining why someone died is in many cases difficult for experts such as myself. The body is a frustratingly complex machine. A mild illness can lead to a cascade of severe bodily dysfunction; disparate diseases may all crop up simultaneously. Seemingly ill people can live for years, while apparently healthy individuals rapidly deteriorate. And measles, in particular, may pose a special challenge for cause-of-death discernment, because the virus tends to interfere with the body’s normal immune responses, making death from any pathogen more likely.

[Read: Yes, some children may have died from COVID shots]

Doctors have developed a specialized language to convey these nuances. Many people end up having two listed causes of death: an immediate cause and an underlying cause. The immediate cause is the disease process that was most closely related to a fatal malfunction of a patient’s heart, lungs, or brain; the underlying cause is the event that initiated a patient’s decline. The Pennsylvania Health Department has said that it uses the term measles-associated death when measles infection is present but may not be the “immediate cause of death.” To see how this works, consider the deaths of two children from measles in Texas last year. Anti-vaccine activists seized on the fact that these kids had both died after contracting non-measles infections to cast doubt on the conclusion that measles was the cause. In fact, this is the typical way that measles kills: The virus weakens a patient’s body, allowing harmful bacteria or viruses to take hold more easily. Bacterial pneumonia or sepsis may have been the children’s immediate cause of death—but measles was the underlying cause.

The situation does not seem to be as clear-cut in Pennsylvania. A fatal splenic injury caused by a congenital measles infection may be plausible, but it would not be a typical cause of death from the disease. And regardless of whether measles unequivocally led to either of the two deaths in Pennsylvania, officials have already emboldened vaccine skeptics and lent credibility to their doubts. The state Health Department seems to have withheld relevant information from its constituents—that is, that local investigators were not themselves attributing the infant’s death to measles—and then it politicized its announcement of the deaths by having Shapiro, who is currently running for reelection, play a prominent role in the press conference. (In response to questions, Stephanie Nojiri, the deputy press secretary for the health department, directed me to the health secretary’s prior statement. She declined to provide any further details about the cases, again citing patient confidentiality.)

[Read: Do childhood vaccines cause tornadoes?]

Public-health experts should have known that the anti-vaccine movement would use any modicum of ambiguity in the evidence to press its case. Kennedy himself has been doing this for years. In 2021, he called the idea that “measles is a deadly disease” propaganda, and visited an Amish fair in Lancaster County to congratulate locals on their wariness toward vaccines (“The Amish are doing it right,” he said), make light of measles’ risks, and tout chicken soup and vitamin A as its cure.

Kennedy has repeatedly denied having any responsibility for measles outbreaks. Indeed, he is neither the underlying nor the immediate cause of the country’s current crisis. Vaccine doubts have been around as long as the shots themselves, and immunization rates had begun to decline, at least a bit, before Kennedy became HHS secretary. But another part of a death certificate is relevant here: a listing of any significant conditions that contributed to a patient’s death. There is no doubt that Kennedy’s years as a prominent anti-vaccine activist and his actions since taking office have misinformed the public about immunizations. Health leaders who reach premature conclusions and unjustly turn a family’s private tragedy into a public morality tale will only make this preexisting condition worse.

The Lights Are Back On in Gary, Indiana

2026-08-26T15:41:37-04:00

Last night, NIPSCO, an Indiana utility company that provides electricity to half a million people in the northern part of the state, finally made the deadline for restoring power to the city of Gary. On August 11, a derecho swept across northwest Indiana, and winds nearing 100 miles an hour knocked out power for more than 370,000 people, NIPSCO has said. In Gary, home to nearly 70,000 people, 75 percent of them Black, more than half of the utility’s customers lost power in the initial aftermath of the storm. For the next two weeks, NIPSCO kept pushing back its timeline for restoring power; even on Monday, thousands in Gary were still in the dark. As of yesterday evening, the utility said, it had restored power to 99 percent of its customers—which also meant that hundreds of people in Gary still didn’t have electricity this morning.

Blackouts follow plenty of storms, and at a press conference eight days after the storm hit, Gary Mayor Eddie Melton described the ongoing blackout as a situation for “not just Gary” but also all of northwest Indiana. However, as the days of darkness stretched on, and the power started going back in other parts of the region—first Dyer and East Chicago, then Hobart and Merrillville—the initial inconvenience of a Tuesday, a Wednesday, then a Thursday, then a Friday without power started to become a crisis in Gary. This past weekend, Melton was no longer talking about the blackout as a regional problem. Gary, he told me, had not initially been on NIPSCO’s schedule for restoring power and had seemingly been overlooked until the city pushed back.

NIPSCO declined to comment on the specifics of its restoration schedule, but a spokesperson wrote in a statement that it had hired extra contractors and drawn on support from neighboring utilities and that “no outage is being overlooked.”

The people I spoke with in Gary felt differently—that whatever efforts had been made to restore power had not been fast enough. They described throwing out maggot-filled food from their refrigerators, and temporarily moving in with friends and family members who had generators. They were charging their phones in their cars while running the air-conditioning just to stay cool in the summer heat. Gary’s median household income is about $40,000 a year; nearly 20 percent of its people are 65 or older, according to the latest U.S. census data—it’s a community with limited money to spare. People were spending their last dollars on gas to drive through the city on roads without functional streetlights—past uprooted trees, fallen street signs, and loose power lines—just to find supplies.

As the power outage dragged on, relief efforts started reaching the city, but some were first come, first served; others limited relief packages to one per household, which kept people from picking up extra care packages for neighbors stuck at home. “Our seniors are stuck in their apartments, completely dark,” Willett Wright, a 77-year-old resident who was still without power, told me. “There’s no generators in the world that can get up to their apartments. They’re stuck in their rooms with all this heat, and no food.”

Power slowly began to come back this weekend, but not across all of Gary’s neighborhoods. Some residents were still waiting in the dark. And even in the places where power had come back on, the lights were still flickering. If you ask Gary residents what time their power was turned back on, they can share it almost down to the minute: 11:32 p.m. on Saturday; just after midnight on Sunday; 2:45 p.m. on Monday.

Indiana is used to dealing with some types of severe storms, which were responsible for nearly 50 percent of the major disaster costs in the state over the past 44 years, a 2025 report from the National Oceanic and Atmospheric Administration found. But this derecho—a strong windstorm that moves in straight lines and can be as fast as a hurricane or a tornado—felt different, residents told me. Climate change is contributing to a steady increase in storm frequency and severity across the United States, which is in turn increasing damage to power grids across the country, Kyri Baker, a University of Colorado at Boulder associate professor who focuses on power systems and power-grid resilience, told me. “A lot of the extreme weather events are happening in areas that we didn’t initially expect,” she said. “Utilities need to change their game plans in preparing for those low-probability events.”

Gary’s problems with infrastructure were clear long before the storm rolled in. Over the past decades, as deindustrialization has shrunk the city’s population and tax base, its infrastructure has crumbled too. NIPSCO has a monopoly on Gary’s electricity, and a 2025 analysis by the Citizens Action Coalition, a consumer-advocacy organization, found that NIPSCO customers were already paying the highest bills of any of Indiana’s five investor-owned electric utilities; last year, NIPSCO was approved for another rate increase to upgrade power lines and technology updates. Even though low-income Black households tend to spend more of their incomes on utilities, they are disproportionately affected by electric-grid failures and face slower restoration times after extreme weather events. (NIPSCO did not respond to questions about its infrastructure investments or its rates.)

Each day that the lights stayed off added to the disruption in people’s lives. David Rucker and his wife, Tiffany, told me that they’d had to drive about an hour every day to Chicago to charge his BiPAP ventilator, which he needs to breathe when he sleeps. The device runs only four hours when it’s battery-powered. Although Gary is only about 30 minutes away from the South Side of Chicago, the journey takes twice as long, because their car’s transmission needs to be fixed. “The money we would’ve spent to fix it, we don’t have,” Tiffany said. “Now everything is depleted. The storm has taken a lot—mentally, physically, and monetarily.” Their power was restored on Monday night at 10 p.m.

As the power comes back on, people are ready to restock and return to a sense of normalcy. They are refilling insulin prescriptions that went bad in warm refrigerators, recharging glucometers, and getting wellness check-ups for high blood pressure and A1C levels, practitioners at Gary’s NorthShore Health Center said. Several people I spoke with said that they are cautiously refilling their refrigerators with groceries, and stocking up on batteries in case of another emergency. Earlier this week, Indiana Governor Mike Braun requested an investigation into NIPSCO’s tree maintenance, as well as a review of approved state funds for the city’s infrastructure. Yesterday, President Trump approved a major-disaster declaration for Indiana, allowing FEMA aid to help the state recover from the damage. The city is finally getting some of the attention and help it has long needed.

More American Families Are Refusing Vaccines

2026-08-25T12:59:39-04:00

As millions of children around the country start another school year, they’ll be confronting new classes, new teachers, and, inevitably, a new slate of germs. And this fall, they’ll be more vulnerable to infectious disease than children have been in decades.

Earlier this month, President Trump signed yet another executive order insisting that the United States shrink its schedule of recommended vaccines—federal guidance that currently guards Americans against 17 diseases with safe, effective shots. He also demanded that the U.S. split the MMR vaccine into three separate courses for measles, mumps, and rubella, without citing solid scientific evidence or acknowledging the infeasibility of such a system. (Scholars have already questioned whether the order has legal power.) Days later, the CDC released new data showing that, under Trump, the nationwide vaccine-exemption rate among kindergartners has reached a record high.

The new exemption rate of 4.2 percent is a relatively modest bump, up from the previous school year’s 3.6. The national numbers, though, paper over widening gaps among states. Roughly 98 to 99 percent of West Virginia kindergartners, for instance, are still getting routine shots. Meanwhile, in Idaho, the percentage of kindergartners who are up-to-date on vaccines that guard against diseases such as polio, chickenpox, and measles has tumbled to about 75 percent—well below the estimated thresholds for reliably staving off such outbreaks. These numbers reflect what Thomas Patterson, the president of the American Academy of Pediatrics’ Idaho chapter, has been seeing and hearing in the hospitals and clinics where he works: more families expressing skepticism, more families refusing or delaying shots, and more families opting out of his care after he reveals that he supports all of the vaccines that the AAP recommends. (The professional society has sued Trump’s Department of Health and Human Services over its attempts to pare down vaccine recommendations.) Idaho also bans employers, schools, and day cares from requiring medical interventions, including vaccines. Its vaccine-exemption rate is now 17.5 percent, the highest in the nation.

National polls show that the majority of Americans still think vaccines work well to prevent disease, and that at least two-thirds support requiring vaccines in schools. Those sentiments remain especially common in Democratic strongholds. Jennifer Shu, a pediatrician in Atlanta, told me that in the past year and a half, she and her colleagues have been flooded with calls from families who are worried that the vaccines they want for their children could soon be taken away. In response to a request for comment, Kush Desai, a White House spokesperson, told me in an email, “None of the Trump administration’s actions undermine access to or insurance coverage of any vaccine—they instead create an environment that fosters parents making informed decisions together with physicians and public health officials who are supposed to guide and support, not force, crucial vaccinations to ultimately ensure that American children do not suffer from serious vaccine preventable infections.” (HHS did not respond to a request for comment.)

At the same time, surveys show that national confidence in vaccine safety has eroded, especially among Republicans, who are also far less likely to support school requirements for shots. Since the start of the coronavirus pandemic, the partisan split around vaccine attitudes has been widening. The second Trump administration has exacerbated those tensions, pediatricians around the country told me—and top health officials’ inaccurate portrayals of vaccine side effects seem to have emboldened more people to push back against standard medical advice. Elizabeth Hawse, a pediatrician in Lexington, Kentucky, told me that many of her patients have begun asking whether she’s aware of any new research to indicate that vaccines need to be newly restricted. Those questions tend to follow federal vaccine news: administration officials’ suggestions that the U.S. should mirror Denmark’s trimmer vaccine schedule, or Health Secretary Robert F. Kennedy Jr.’s handpicked vaccine advisory committee’s elimination of the long-standing recommendation for universal hepatitis B vaccination at birth. Hawse’s answer is blunt: Nothing has changed.

Faced with doubts that tend to be informed more by politics than by scientific evidence, pediatricians have only so many tools. Sometimes, they can convince families with facts—reassuring them, for instance, that decades of studies have debunked the notion that vaccines cause autism, or correcting Trump’s recent statement that vaccines are the “size of a bottle of soda poured into a little child’s body” (most vaccines are about a tenth of a teaspoon). Other parents respond more to common emotional ground: Hawse tells them that she gave these vaccines to her own children, the oldest of whom is 26. Caitlyn Neltner, another doctor at the same practice as Hawse, told me that she shows patients her own vaccination record from the 1990s. Families seem comforted by the shared experience, Hawse said—and by the fact that the pediatrician-recommended vaccine schedule has remained mostly unchanged for decades.

Some doctors told me that they’ve started spending far longer discussing vaccines with families, and that some conversations stretch across hours or multiple visits—heavy workloads that can sap the time and resources that small practices could otherwise offer to other patients. Benjamin Dowse, a pediatrician in southern Utah, where vaccination rates remain low, told me that, in a few cases, turning a “no” on vaccines into a “yes” has been possible only over the course of several years. Sometimes, the work seems unlikely to ever pay off. Patterson, in Idaho, has learned to pick his battles: Families who buy heavily into conspiracy theories or are adamant that vaccines have harmed their loved ones aren’t likely to be easily persuadable.

Several of the pediatricians I spoke with, especially those in larger cities, told me that they insist their patients follow the AAP-recommended vaccine schedule. But in rural areas, telling families to seek care elsewhere is not really an option, Dowse said. If he pressures people too much about vaccines and they leave his care entirely, they may end up without any pediatrician, which would put their kids at risk of all sorts of preventable health problems.

In places where vaccination rates are not high enough to prevent outbreaks, disease itself can make a powerful argument. Lately, the U.S. has been battling its worst measles resurgence in the past 35 years; just this morning, Pennsylvania announced two measles-associated deaths in unvaccinated residents. A few pediatricians told me that the arrival of the virus in their community has spurred an interest in vaccines, even from previously skeptical families. Lisa Costello, a pediatrician in West Virginia, told me that the grandparents in her community are some of the biggest advocates for vaccines: Many of them can still remember a time before routine polio immunization, when the disabling disease ran rampant, and never want to return to it. Even so, fear of disease isn’t always enough. Vaccination rates have ticked up only slightly in South Carolina, the epicenter of the largest recent measles outbreak—and exemption rates have risen too.

As federal guidance on vaccines softens, states’ ability to require shots is one of the most effective strategies to keep protections against diseases in place. West Virginia—where some counties lack any pediatricians at all and many families must drive long distances to seek care, including vaccines—has maintained some of the highest childhood-vaccination rates in the country for many years because it does not allow nonmedical exemptions. States that have followed West Virginia’s lead, including California, have seen vaccination rates increase as well. Meanwhile, some of the most obvious drops in protection have played out in states where vaccination laws have slackened. Prior to 2023, Mississippi forbade nonmedical exemptions, too, and its kindergarten-vaccination rate was the nation’s highest; more than 99 percent of children met school requirements. But since a federal judge eliminated that restriction, eight counties in the state have dropped below 95 percent, potentially putting them at risk for measles outbreaks.

Last July, citing concerns about falling vaccination rates, the AAP recommended the elimination of all nonmedical exemptions to school-immunization requirements. But in the current political environment, vaccine policies seem more likely to further degrade. In his recent executive order, Trump explicitly embraced liberal exemption policies, citing a need for “maximizing parental choice over childhood vaccines.” Politicians—most of them Republican—and anti-vaccine activist groups have continued to push for the elimination of vaccine requirements in several states as well. In March, before South Carolina’s recent measles outbreak had officially been declared over, state lawmakers killed a Democrat-sponsored bill that would have eliminated religious exemptions for the MMR vaccine for kids in public schools.

Kennedy has told Americans to consult their doctors about vaccination; he’s also urged them to distrust experts and do their own research. Many Americans are, in effect, now being asked to choose between the advice of their preferred politicians and their longtime health-care providers. Anita Henderson, a pediatrician in southern Mississippi, told me that she recently encountered a family who had vaccinated all of their older children but, on the mother’s insistence, were declining shots for their new baby. As they were leaving the appointment, Henderson said, the mother turned back “and made the comment, I’m so glad President Trump made that law changing the vaccine schedule. I’m glad he is bringing to light all the problems that we’re seeing with vaccines.”

By the time that baby is old enough to attend public school, Henderson expects that many more schoolchildren in her state will lack the vaccine safeguards they need. In Mississippi, she said, health department officials have logged more than 7,000 religious exemptions among kids 4 or younger. The more young children who join that poorly protected cohort, the more vulnerable everyone in the community will be the next time a dangerous virus arrives.

It’s Low-Calorie and Packed With Protein. Is It Healthy?

2026-08-21T13:49:45-04:00

Ice cream is one of life’s simplest and most enduring culinary pleasures. The first published recipe, which dates back to the 17th century, combined milk, water, sugar, and candied citron or pumpkin. By the early 20th century, companies were regularly adding stabilizers to their ice creams to prevent them from getting freezer burn and artificial dyes to give them appealing hues. But the core essence of ice cream—sweetened, frozen dairy—remained largely unchanged into the 21st century. Even Halo Top, the diet ice cream that surpassed Ben & Jerry’s as the nation’s best-selling in 2017, simply subbed in skim milk and artificial sweeteners to keep the calories down.

Then came David. The protein-bar company has turned its attention to “frozen dessert,” which is, of course, more commonly known as ice cream, though the company can’t legally call their product that. Instead of being made with cream and milk, it comprises a “protein system,” a “structure system,” a “fat system,” and a “flavor system,” each of which is composed of ultra-processed ingredients such as whey protein isolate and “modified plant fat.” The only whole natural ingredients on the vanilla flavor’s label are water, salt, and vanilla bean. And yet, the treat’s basic nutritional stats are impressive: A pint has just 210 calories, less than 1 gram of sugar, and 30 grams of protein. Unlike diet ice creams of the past, it is rich and creamy. When the product launched on David’s website in June, it sold out in 28 minutes. (The company declined to tell me how many units it sold.)

David’s ice cream is perhaps the most outwardly refined of a whole category of frozen desserts that are being deliberately packed with protein. These protein-ice-cream companies and others processing their way to a palatable nutrition label are making a bet on what Americans truly want from food. We (and our government) might have grown more skeptical than ever of industrially produced foods, but we also expect quite a lot from every morsel we consume. When I recently spoke with Brendan Niemira, the chief science and technology officer of the Institute of Food Technologists, he spent nearly two minutes listing qualities that Americans now desire: that food be tasty and safe, sure, but also low-calorie, high-protein, probiotic, full of omega-3 fatty acids, and so on.

Last month, PepsiCo launched a powdered oatmeal drink, with 15 grams of protein, that dissolves in cold milk or water. It also makes a prebiotic version of Pepsi that contains 3 grams of fiber and does not taste like Metamucil. Kraft Heinz recently introduced a mac and cheese with 17 grams of protein and 6 grams of fiber, thanks largely to a “proprietary protein-and fiber-enriched pasta.” Nestlé offers a 45-calorie “pre-meal hunger support nutritional drink” that is composed almost entirely of industrially processed ingredients and that the company says helps people feel full sooner. At the Institute of Food Technologists’ annual conference earlier this summer, I feasted on “better-for-you BBQ pizza,” the crust of which was fortified with wheat-protein isolate, and watermelon-lime “satiety soda” that was spiked with corn fiber. I even ate frozen yogurt that starred a “network of cell-signaling peptides from the fava bean” and was supposed to help me recover from workouts.

On paper, Americans are generally wary of such products: In a June 2025 survey, more than 60 percent of respondents said they believe that ultra-processed foods are addictive. And some experts worry that the ingredients such products depend on—emulsifiers, preservatives, and sugar substitutes—are somehow messing with our metabolism, such that the impressive macros of these products don’t provide the full picture of their healthfulness. (The FDA approves the safety of such additives, but that review process historically has focused on toxicity and, say, cancer risk, not metabolic effects.) Many believe that the manipulation of ingredients causes our bodies to react in unforeseen ways to the food we eat—that a manufactured “protein system” might not be beneficial in the way that, say, lentils’ protein system is. Or they note the simple fact that many UPFs—even those that may be high-protein, probiotic, or high-omega-3—still contain a lot of fat, sugar, and salt, which are clearly bad for us.

Take PepsiCo’s SunChips Fiber, which launched in March. A 7-ounce bag of the chips—seven servings, according to the company, but honestly not that enormous of a snack—has 21 grams of fiber, most of what the FDA recommends an adult eat in a day. But it also has 910 calories. Even if these fiber-filled SunChips had fewer calories, UPF critics would point to the way they’re made—using an industrial process called extrusion, which essentially pulverizes grains into easily digestible morsels—as a potential danger. (Some researchers suspect that extruded grains spike insulin more than their unprocessed counterparts.)

The problem is that the science around which processing steps and industrial ingredients might actually be harmful is still in its infancy. And it will struggle to catch up with the food industry’s innovation. Major food companies are regularly creating new processes for spiking foods with nutrients without making them taste like health foods. Nestlé’s “hunger support” drink, for example, uses something the company calls “whey protein microgels,” which help prevent the drink from getting too thick in the manufacturing process. David’s frozen dessert is so low-calorie and yet so indulgent because of that “modified plant fat,” a chemical called esterified propoxylated glycerol that is not absorbed by the digestive tract and was cleared for use in food by the FDA in 2015. (An earlier nondigestible fat, olestra, infamously flopped after people began reporting that it was causing them “anal leakage” in the ’90s; safety studies of EPG indicate that such leakage could occur with very high doses.) Scientists might be convinced that extrusion can make an otherwise healthy product like whole grains metabolically harmful. But what about “supercritical fluid extrusion” that—according to Frito-Lay, which patented the technology—uses less heat and thus can “deliver high levels of fruits or vegetables” in a still-crispy snack?

Until experts can articulate precisely why ultra-processed health foods are a problem, we’ll all be stuck in limbo. Companies will continue offering ever more processed and refined health foods, made with shiny new ingredients and methods; meanwhile, some experts will continue warning Americans that we should not eat them, without being able to back those warnings up with data on the latest foods. Every time a new processed health food hits the shelves, anyone who visits a grocery store will have to guess whether this one will be truly healthy. In the face of some uncertainty, at least some Americans are, so far, turning to products such as David’s: The company sold $131 million worth of its protein bars in their first year on the market.

Most Americans don’t actually need more protein in their diet, and certainly they could get it without spending about $9 on a pint of David. “This so-called ice cream looks to me a boondoggle for all concerned, save those selling it at, no doubt, extremely high profit margins,” David Katz, the founding director of the Yale-Griffin Prevention Research Center, told me via email. But David’s CEO, Peter Rahal, told me his detractors are Luddites. He argued that people need more protein than the daily recommended amount to “thrive,” and that having the option of a new diet ice cream on the shelf shouldn’t be controversial. “You want the full-fat, full-cream, full-sugar thing that has this amazing heritage, go for it. But if you want something that’s really close to taste and texture, that’s more advanced and more sophisticated, it should be there for you,” he said. (David’s product is so expensive, Rahal said, because of the cost of whey protein.)

Clearly, some Americans see the world like Rahal does. When the craving for ice cream hits, a pint under 300 calories has its own appeal—even if it’s not ice cream at all.

America’s Gerontocracy Needs a Public Physician

2026-08-21T13:04:58-04:00

Aside from some brief written statements, the public has not heard directly from 84-year-old Senator Mitch McConnell since he fell at his home in Washington, D.C., and was taken away by an ambulance two months ago. Why he fell, what has happened since, and how he’s doing now remain unclear. His absence has inspired conspiracy theories, memes, and morbid speculation that a couple of awkwardly staged proof-of-life photos have done little to assuage.

If Americans are doubtful that McConnell will ever return to the Senate floor, it’s understandable: This is not the country’s first encounter with a frail or ailing representative. Six elderly members of Congress have died just this term, and others have demonstrated mental decline. Younger members have also had episodes of incapacity, as when Representative Tom Kean of New Jersey missed months of work this past spring while hospitalized for depression. Our previous president suffered obvious but under-disclosed deterioration while in office; our current leader, who will leave office the oldest president we’ve ever had, is under constant scrutiny for signs of impairment.

Historically, our elected leaders have argued, for plenty of good reasons, that they are entitled to privacy regarding their health and discretion about when they leave. Congressional norms tie power to seniority, which discourages early retirement; airing the health status of our leaders risks creating national-security concerns. But letting politicians judge their own capacity to serve has simply not worked in the public’s interest. I’m a physician—a geriatrician, in fact—and I know from countless encounters with frail, aging patients that many have difficulty admitting when their capacity has started to slip. Many people struggle to recognize, too, when a new impairment means a permanent change in conditions, not just a temporary setback.

The United States needs a system to oversee its leaders’ fitness to serve. Currently, no independent entity assesses and publicly reports on the health of the president or members of Congress. Congress should make one. Let’s call it the Office of the Medical Adviser: an office of medical personnel designated to routinely evaluate whether our highest-ranking public servants can reliably fulfill their duties.

The OMA would serve a distinct function from the Office of the Attending Physician, which responds to emergencies at the Capitol, handles occupational-health concerns for Congress and the Supreme Court, and provides many members with primary care. Brian Monahan has held the role of attending physician of the U.S. Congress since 2009. On occasion, Dr. Monahan has provided information to the public about a representative’s health; in McConnell’s case, for instance, he has twice recently provided letters that offered few details about the senator’s condition, other than to imply that McConnell’s health was not as bad as the speculation surrounding it would indicate. (The OAP did not respond to a request for comment.)

This is the dilemma of both the OAP and the president’s physician: Their charge is to provide clinical services, not to represent the interests of the public. Their loyalty, correctly, is primarily to their patients. I would never lie if one of my patients asked me to offer documentation of their health, but I might agree to downplay areas of uncertainty or to keep some things private. My obligation to disclose would be secondary to my patient’s wishes and privacy.

The OMA, crucially, would not provide elected officials with care or medical advice. Rather, the office would periodically—say, once every two years—evaluate officials’ health and cognitive well-being. Congressionally appointed physicians would be empowered to request medical records, refer officials to specialists for additional input, and arrange additional testing. Their charge would be to determine whether an individual is cognitively and physically capable of carrying out the responsibilities of their office until their next evaluation, two years down the line.

The OMA would then publicly release brief, structured documentation attesting to a congressional member’s functional capacity. These letters would provide insight into a member’s health status without revealing details immaterial to their ability to meet the demands of their position. The public doesn’t need to know about every blood-pressure medicine someone is prescribed or every mole they have removed. Many members can and do ably perform their role while living with a disability, a chronic disease, or a treated mental illness; the OMA would enumerate only issues relevant to someone’s ability to meet the terms of their job, and would summarize all else as “additional health issues reviewed.”

But were a member to show signs of decline, whether from age or illness progression, the OMA would assess whether that person’s ability to fulfill their responsibilities was in jeopardy. And if an official suffered an acute event that might change their circumstances, as McConnell may have this summer, the office would automatically conduct additional evaluations of their health after a two-week absence.

Other high-stakes professions require their practitioners to submit to this kind of evaluation. Hospitals, the military, and the Federal Aviation Administration all conduct periodic, proactive health assessments to determine fitness for duty. Pilots get evaluated for risk of sudden incapacitation during flight; soldiers get evaluated for “force readiness.” I am tested each year for various communicable diseases and have agreed to random drug testing in order to be staffed at the clinic where I work. If a pilot is found to have a health condition that might put them at risk midair, or a soldier is found to have developed a new impairment, or I am found to have tuberculosis, our employer can compel us to resolve those conditions before returning to duty, or put limitations on what work we can do.

In a situation in which an OMA physician had concerns about a member’s capacity, those concerns would be evaluated by a second physician. If both doctors agreed, they would then communicate their findings to the patient, to allow the person time to consider and adjust their plans—they might take a medical leave, or decide not to run for office again, or, in extreme cases, resign. Within a month, the OMA would provide the documentation to the relevant bipartisan ethics committee for review. In cases of member misconduct, the House and Senate ethics committees can recommend censure, expulsion, or, in the case of the president, impeachment; their mandate should be expanded to consider cases of medical incapacity, with the same recourses to action. Whatever decisions the committees or the officials themselves come to, the OMA would release its findings into the public record after an additional period, barring significant security concerns.

The OMA, in other words, would not have the authority to remove anyone from office; it would be empowered only to provide expert input to the committees already charged with maintaining the integrity of our government and to inform the public of its findings.

The U.S. would not require such an office if elected officials were willing to step aside when their health demanded it or if the people closest to them—their doctors, staff, and family—were willing to confront them in cases of decline. But recent years have provided too many examples of this kind of self-policing failing. In her memoir, Jill Biden confessed that she’d become concerned after President Biden’s disastrous 2024 debate performance that he’d had a stroke; Hunter Biden, on a recent podcast, suggested that perhaps the president’s undiagnosed-at-the-time prostate cancer was already causing impairment. These reports only affirm suspicions that people around the former president knew that he wasn’t well, even as he insisted on another presidential run.

Most Americans resent such lack of transparency. More than 60 percent believe that Biden was not forthcoming regarding his health, and approximately the same percentage agree that presidents ought to be required to release all medical information to the public. In another national survey, a proposal to remove officials when they show signs of mental decline achieved 87 percent approval. Age limits for office, which I support wholeheartedly, are also extremely popular.

Some younger elected officials recognize this. This year, Democratic representatives have put forward three separate proposals that would increase transparency about the health of public officials, whether by empowering a newly created commission to remove a president, creating a standard for “significant irreversible cognitive impairment,” or requiring members to file a public disclosure regarding any absence longer than 21 days. But none of these proposals can account for the uncertainty inherent in so many clinical scenarios, and they rely too much on civilians to make sense of complex medical situations. The proposals also become relevant only once an official shows signs that they are unable to do the job. Creation of an OMA would proactively offer assurance that they could.

Aging representatives may balk at increased medical scrutiny, but an OMA would also protect them. Structured disclosures should help prevent prying and skepticism. The public would be provided with enough information that leaders could then demand their privacy in good faith. An official process for determining whether and for how long someone needs to be out of work when ill would also mean that sick officials can take time and space to convalesce without feeling furtive.

The mere existence of medical oversight would also help nudge American elected leaders to confront their own frailties before they were faced with real censure. The body is a rate-limiting factor that many of us choose to ignore until we can’t; the requirement to disclose some health information might serve as a deterrent to older members considering running again, or to younger ones struggling to balance health issues with the job. Our leaders, after all, are only human, and most people don’t readily give up the keys when it’s time to stop driving. Sometimes, the right decision is to take the keys away.

Anthony Fauci’s Group Chat Is Making People Lose Their Minds

2026-08-15T08:00:00-04:00

Did Anthony Fauci really get a text from Joan Baez, as his private diary suggests, wishing him a “happy fucking birthday” in the midst of the pandemic? Until now, the answer to that question has remained blessedly unclear. But soon we may have access to the former National Institutes of Health official’s phone. Senator Ron Johnson announced this week that he’d retrieved tens of thousands of messages and hundreds of voicemails from Fauci’s government-issued device and made them fully searchable. In the meantime, though, Johnson has shared just a single set of texts: a Fauci group chat that he considered so explosive in its implications that it had to be released forthwith. “This is a blockbuster revelation,” the senator said on Tuesday. The public had to know.

The texts in question were from a short exchange that Fauci had with two other public-health officials—former U.S. Surgeon General Vivek Murthy and former CDC Director Rochelle Walensky—in January 2021. Murthy had asked whether either of them knew of “any data or theoretical reason” why an expectant mother might choose to vaccinate early versus late in pregnancy. Walensky answered no, that this was all “data free.”

Fauci agreed, but a couple of hours later, he followed up. After asking around, he’d heard about a theoretical concern: A second dose of the vaccine could lead to fever and cytokine storm—an overactivation of the immune system, also linked to COVID itself—which in turn might lead to early-term miscarriage. In an interview that Fauci gave just one week later, he alluded to the need for balanced thinking on vaccination during pregnancy, given the lack of clinical-trial data. But he noted that thousands of expectant mothers had already gotten shots by then, and no issues had arisen. “We’ve got to be careful,” he said, but “I would rather take my chances with a vaccine than getting infected while I’m pregnant.”

Fauci’s critics now assert that this was tantamount to murder. Fauci knew that COVID shots were killing babies, they argue—he said so in a private text—and then he went out and pretended that the shots were safe. Representative Anna Paulina Luna called this “a crime against humanity and the most evil thing that could’ve ever been done.” Meghan McCain demanded that the 85-year-old be handcuffed, perp-walked, and put in a jail cell for the rest of his life. (“This is not hyperbole,” she noted, rather unconvincingly.) Senator Roger Marshall called for the appointment of a special counsel to investigate the matter—either that, he said, or “a full 9/11-style commission.”

Even a cursory reading of the context at the time suggests that Fauci’s group chat doesn’t quite reach the level of a “crime against humanity.” In fact, the new material is unremarkable, unrevealing, and—worst of all—maddeningly irrelevant to the many, far more interesting questions that still surround one of our most important public-health leader’s behavior and decision making during the pandemic.

Despite this week’s operatic calls for justice, there wasn’t really any gap between what Fauci typed into his phone and what he said in public at the time. Indeed, according to the messages released this week, Fauci sent another text to the same two colleagues just one day after he’d voiced his “theoretical” concern about the risks of vaccination. In that message, he gave essentially the same assessment that he’d offer to the public shortly after. He even used similar language: “No red flags” had yet emerged from real-world use, but even so, in the absence of clinical-trial data, “one must weigh the potential risks against the benefits.” (Senator Johnson’s office told me that the records show that “Dr. Fauci withheld information from pregnant women that they had the right to know,” and in doing so he robbed them of informed consent. Fauci, Murthy, and Walensky did not respond to requests for comment.)

That logic still applies. The safety and efficacy of the COVID shot during pregnancy were never tested in a full-scale, randomized clinical trial. But observational data—of which we now possess a very large quantity, after many millions of vaccinations—have not identified any reason to believe that any risk of miscarriage, if present, is significant. If the mRNA shots really were abortions in a needle, as some of Fauci’s critics have alleged—if they really caused a loss of pregnancy in 82 percent of cases, as Senator Ted Cruz and many others claim—then this catastrophic harm would surely have caused at least a blip in U.S. birthrates in 2021, when more than 200 million Americans were fully vaccinated. (As it happens, the number of Americans born that year went up.)

More tempered critics acknowledge that the COVID shots never did turn out to be dramatically unsafe for pregnant women—but then, no one could be confident about the risk at the start of 2021. The text message shows that Fauci clearly was aware of the uncertainty, they argue, yet he buried it in public statements; his crime, in other words, was one of clinical duplicity in the first degree. “He essentially told the public that it was safe for pregnant women to take it when he didn’t know that,” NIH Director Jay Bhattacharya said this week.

But Fauci and the public-health establishment did signal their uncertainty. If anything, they were unusually direct about the known unknowns around this topic—at least compared with their messaging on COVID origins, the value of masking, and the importance of school closures, among other squirrelly, scientific questions. When it came to vaccination during pregnancy, no one hid the fact that the most conclusive safety data were lacking. Fauci made this point both in public and in private; he also said repeatedly, both in public and in private, that the systems used to track vaccines’ adverse events had not yet picked up on any reasons for concern—an assessment that more formal analyses would later confirm. In the meantime, the CDC had already found that getting COVID was itself a major threat to pregnant women’s health, associated with a tripled likelihood of going to the ICU and a 70 percent higher risk of death.

What was this, if not transparency? Vaccines had been made available; the CDC’s official advice was that expectant mothers should discuss the matter with their doctors and reach their own conclusions. In the face of all this cautious, careful guidance, many women did decide to skip the shots: By the end of July 2021, fewer than one-quarter of all the pregnant women in the country had been vaccinated, according to CDC data from the time. That lack of uptake may well have had a grave human cost all its own, given that maternal mortality rates doubled in that year.

In other words, this week’s attacks on Fauci haven’t just inflated the importance of his text message; they’ve reversed its meaning altogether, transfiguring a moment of humility into one of arrogance and self-contradiction. The resulting tangle of misinformation has done little more than bring disgrace to the actual work of determining whether, and how, Fauci and other public-health officials might really have misused their power.

The case against Fauci has always been diverse; its most aggressive prosecutors are a big-tent assemblage of anti-vaxxers, libertarians, and lab-leak truthers. Some believe that he lied about the safety of the COVID shots; others say that he was the capo of immoral lockdown measures, or that he played a role in paying for (and then concealing) the research that started the pandemic. So far, the entire spectacle of this investigation—the email dumps, the diary, and now the texts, as well as the Senate hearing where Fauci refused to answer any questions—has only cast a scattered, insufficient light across a range of matters large and small. To choose just one: Do Fauci’s emails really show, as Senator Josh Hawley and others have asserted, that Fauci cajoled his institute’s grantees for help in winning large cash prizes for himself? The documentary evidence doesn’t indicate that he violated any ethics laws, but it is at least suggestive of self-dealing—and it does at least invite further questions about his use of public office. (When pressed on this during his Senate testimony, Fauci responded as he did to every question, by pleading the Fifth.)

And what about the mystery of COVID’s origins? Released emails and private chats do seem to show that virologists in Fauci’s circle took seriously, over many months, the possibility of a lab’s involvement—yet this idea was rarely given credence in the public sphere. Did Fauci help coordinate some sort of message discipline? How much did he really know about the coronavirus work in China that his institute had funded, and what does he think about that sort of research now? The information we have is inconclusive on these points and many others too.

Fauci remains, in the eyes of many experts, a public-health hero whose work on treating and preventing AIDS and other infectious diseases has saved millions of lives. But there are real uncertainties in his pandemic record and questions as to how he and others led the government’s response to COVID—and these points are only getting lost amid the rampant lust for retribution and the wild overreading of his private records. Fauci’s critics say he papered over gaps in knowledge and in doing so misled the public. Now they’re doing just the same.

Our Last Wi-Fi-Less Refuge Is Gone

2026-08-13T12:07:58-04:00

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Until very recently, airplanes were one of the last places where you couldn’t count on having good Wi-Fi. Even the Amazon’s most remote villages have high-speed internet, but for years, the typical in-flight connectivity experience could have been best summed up by the aviation Reddit thread titled “WiFi horrible?”

Now major airlines have started rolling out Wi-Fi that is both free and usable. In June, United announced that by the end of this year, nearly 1,000 of its planes would be getting high-speed Wi-Fi via Starlink, the network of low-Earth-orbit satellites owned by SpaceX. Other major airlines, including Delta, JetBlue, and Alaska, are partnering with either Starlink or its closest competitor, Amazon Leo, to offer better Wi-Fi in the next year or two. This new technology provides almost the same internet experience you’d get on the ground, Seth Miller, an airline-industry analyst, told me. This is not Wi-Fi that’s “good for an airplane.” It’s just … good.

As technology conquers this final Wi-Fi frontier, air travel will never be the same. The fickleness that made in-flight Wi-Fi infuriating was also its own kind of luxury: Planes were a bastion of unreachability. And once that luxury is gone, we may miss it.

Delivering the internet to a metal tube traveling at 500 miles per hour, 30,000 feet above the Earth, is so difficult because the tube is both far from internet sources and constantly moving. In the early days of plane Wi-Fi, aircraft had what were essentially giant mobile hot spots attached to their bellies, which would connect to cell towers on the ground. (This was Gogo’s in-flight Wi-Fi which, let’s be honest, never really Gogo’d.) For the past decade or so, major airlines have connected instead to satellites about 22,000 miles above the Earth, which provided Wi-Fi good enough to send an email (sometimes) but too slow for Instagram. The satellites that Starlink and Amazon Leo use travel much closer to the Earth and the plane, so they’re about 10 times less laggy, Miller said. With these connections, people can use social media, play online poker, and—in theory—Zoom, though many airlines still forbid or discourage video calls.

This level of connectivity might sound like a win: Airplane travel is a cramped, chaotic experience; the least you might ask is for the ability to scroll through TikTok when the limited catalog of in-flight movies gets stale. The pitch, as Grant Milstead, the vice president of digital technology at United Airlines, told me, is that with faster, free Wi-Fi, the plane can become a “living room in the sky”—where, just like in a living room on the ground, people can have the TV on for entertainment, their laptop out for productivity, and their phones nearby for messages and social media. Some people are clearly embracing that reality: On a recent 10-hour flight, the guy next to me prepped a slide deck, listened to Spotify, and flirted over DM with someone I sincerely hoped was his girlfriend.

But this level of connectivity also means that, on a plane, you can no longer be blissfully unaware of what’s happening back on the ground. Before Starlink, someone on a business trip might still decide to expense suboptimal Wi-Fi to keep up the pretense of working. But for the rest of us, “Sorry, I was on a plane” was one of the last socially acceptable reasons a person could be unreachable while doing nothing except eating Biscoff cookies. A plane ride meant hours set aside to watch movies, read, or doodle, free of guilt and earthbound demands. Instead of responding to a message from your mother-in-law, you could look out the window and see rivers transformed into green ribbons. While my seatmate worked on his slide deck, all I did was watch Top Gun and Top Gun: Maverick and slam Bloody Mary mix. It was glorious.

The level of disconnection on a plane might have once been an inconvenience, but now people pay good money for enforced breaks from their phone. Sixteen years ago, when Starbucks started offering free Wi-Fi, this magazine declared, “It’s about time!” These days, many cafés withhold Wi-Fi and ban laptops as a selling point. At least 10 million people use the Opal app, whose premium tier costs $100 annually, to lock themselves out of distracting apps, while others pay $59 for the Brick to do the same. Subpar airplane Wi-Fi included this kind of detox with the price of your ticket.

No one will argue that breathing stale air in a seat that offers 30 inches of leg room counts as a wellness retreat, and the research on how much dedicated tech detoxes actually improve well-being is mixed. Still, a disconnected plane ride “might create an opportunity to temporarily remove some of the demands that normally compete for our attention—email, work messages, social media, news, and notifications,” Lisa Walsh, a psychology professor who researches happiness at Nanyang Technological University in Singapore, told me. Flying was a rare, bounded period of time untethered from the world below. Whether or not someone might benefit from that time depends on how they spend it, Kostadin Kushlev, a psychology professor at Georgetown who studies technology and well-being, told me. A nice use of a plane ride might include actually talking to the strangers next to you (an act tied to well-being, he said), letting your mind wander (also linked to well-being), or even just really focusing on Top Gun (research has yet to link Tom Cruise to well-being, but you never know). Kushlev told me about how, during grad school, he once set aside a flight to journal about what he wanted from his life and future. “It really kind of changed my trajectory,” he said. Now, with enough to keep him busy on the plane, he said, “I don’t bother.”

Of course, passengers don’t have to log into the Wi-Fi. But as fast connections become ubiquitous on planes, expectations may begin to shift. We already spend just about every moment of our life near our phones—at work, at the grocery store, at parties, at concerts, in bed, and, for the 75 percent of Americans who’ve copped to this, in the bathroom—where anyone can message us. Now people could easily expect a response while we’re hurtling through the lower stratosphere, too. (And if you don’t reply, people will know it’s because you wanted to eat Biscoff cookies and ignore them.) Connectivity also means the plane becomes just another place to be productive. Milstead, the United executive, told me that one of the company’s customers vibe-coded a website for his new business from the air. Meanwhile, people have already started complaining online about fellow passengers taking Zoom calls and Microsoft Teams meetings onboard. When your seatmate is leading a Q1 strategy session, staring out the window and daydreaming—one of the most distinct opportunities of flying—may seem like time wasted.

If 30,000 feet is yet another place where Zoom meetings are unavoidable, it’s hard not to see a future in which we are nostalgic for the recent past when the Wi-Fi was bad. The early aviator Anne Morrow Lindbergh once wrote that flying is “a miracle that has nothing to do with any of its practical purposes—purposes of speed, accessibility, and convenience.” Instead, a plane ride was an opportunity to watch the familiar world grow strange. Most people who fly no longer treat the experience like a miracle, but now we barely need to notice we are up in the air. It’s just another place to check Instagram.

Nobody Knows What Ultra-Processed Food Is

2026-08-12T13:27:27-04:00

You might know a tomato when you see one, but for the federal government, identifying one is harder. Is a tomato a fruit or a vegetable? In 1893, this question went all the way to the Supreme Court, which decided that, for tax purposes, at least, a tomato was a vegetable. What about milk? For a bureaucrat setting standards, a straightforward explanation such as “liquid from a cow’s udders” won’t quite cut it; according to the FDA, milk is “the lacteal secretion, practically free from colostrum, obtained by the complete milking of one or more healthy cows.”

Even for the government, however, tomatoes and milk are relatively simple to define compared with ultra-processed foods. Although many researchers agree that these creations are negatively affecting people’s health, they cannot agree on what foods do and don’t belong in that category. That’s not keeping Robert F. Kennedy Jr. from trying: After months of promising the federal government’s first formal definition of ultra-processed foods, the secretary of Health and Human Services announced on Monday that the department is finalizing one.

He stopped short, though, of sharing the exact text in either the public announcement or at a “food policy celebration” held Monday at HHS’s Washington headquarters; the definition is still being reviewed by the White House. This effort may have real upsides. Having a regulatory definition of ultra-processed foods (or UPF, as they’re often referred to) could at the very least advance inquiries into the harms of these products. But the effort also raises the question: Can the government adequately define a problem before researchers know its true cause?

So far, scientific efforts to define UPF have revealed only how fuzzy the category is. The most commonly used definition, which was developed by Brazilian researchers, takes the most expansive approach: It lumps all foods with industrial ingredients, such as sweeteners and emulsifiers, into the ultra-processed category. A classification system created by academics at the University of North Carolina at Chapel Hill, meanwhile, defines “highly processed foods” as products “processed to the extent that they are no longer recognizable as their original plant/animal source.” Yet another well-respected system, this one designed by a French analytics company, attempts to incorporate additional factors, such as a food’s salt, sugar, and fat content, as well as the “function, number, and potential health risk of additives.”

These rubrics are distinct enough from one another that flavored yogurt is an ultra-processed food under the Brazilian system and a moderately processed food under the UNC system. Under the French system, the classification depends entirely on the yogurt itself (even though a paper from the group found that 95 percent of flavored yogurts in French grocery stores were indeed ultra-processed).

Researchers disagree on how to define these foods, because the science around how and why they may be harmful is ambiguous. Epidemiological studies have found that UPF-heavy diets have consistently been associated with a range of maladies including cardiovascular disease and type 2 diabetes. But although researchers suspect that certain additives are causing dietary issues, the number of industrial ingredients or additives in Americans’ food is so large that many more may also be causing trouble. Nor do researchers know what processing steps cause everyday food ingredients to go from healthful to harmful. That means Kennedy and his department are essentially trying to define a food group that no one really understands.

Kennedy is under no illusions about how little we know about the American food supply. He has frequently criticized a decades-old loophole that allows food companies to put new additives in their food without even telling the FDA. On Monday, he announced a new proposal to fix this issue; if finalized, the rule would require companies to let the FDA know when they’re introducing a new additive. But even that won’t fully solve America’s additive problem.

Researchers at the Pew Health Group estimated in 2011 that America’s food supply already features more than 10,000 additives. The new rule would require manufacturers that quietly introduced such compounds to tell the FDA what those additives are but not to submit any scientific proof of the additives’ safety. And although the FDA can do its own review of such ingredients, that process is often glacially slow. (The agency still hasn’t completed its rereview of several chemicals nearly a year after announcing that it was taking a second look at their safety.) Plus, certain additives may be safe when consumed on their own but harmful when consumed alongside other additives. A study published last year found, for example, that consuming a cocktail of emulsifiers, a preservative, and a dye was associated with higher rates of type 2 diabetes but that several other industrial concoctions were not.

If anything, researchers know less about how processing changes the ways humans digest certain foods. As the term ultra-processed implies, researchers believe that the ways food companies process individual ingredients has had a profound impact on our health. But because that concept is so new, very little research has been done on it. The Brazilian researchers, for example, have cited pre-frying as a mark of ultra-processing, even though it’s hard to imagine that precooking chicken nuggets could meaningfully affect how they’re digested. And although research does suggest that extrusion, which is used to make products such as cereal by pushing ingredients through a heated tube with rotating screws, makes it easier for the body to break down starches, the evidence of any ill effect on humans is limited.

All of this makes Kennedy’s push to define UPF difficult. Any earnest effort to “Make America Healthy Again” cannot ignore the fact that a majority of the calories Americans consume come from ultra-processed foods, and that something in those foods seems to be making people ill. Creating a definition is an obvious first step toward addressing the issue, and the previous definitions for ultra-processed foods have undoubtedly advanced researchers’ understanding of those foods’ impact on our health. A 2019 study using the Brazilian definition found, for example, that people ate faster and gained more weight when fed an ultra-processed diet compared with an unprocessed one.

But for researchers, the definition of UPF serves more as a hypothesis—an idea that they can test and adjust about how to think about this category of food. A government definition of UPF has a different purpose—it can prompt research, but it can also be used to make rules about how foods are tested, advertised, and sold. An overbroad definition could cost food companies millions in unnecessary costs and stoke unsubstantiated fear in consumers; a narrower definition, based on a hunch, could cause the same problems.

Government definitions are not written in stone: In 2024, the FDA overhauled an outdated definition of healthy foods, which was issued amid the low-fat craze of the 1990s and excluded foods such as nuts and fatty fish. But the process of revising the definition took eight years. As Kennedy said Monday, “If you can’t define a problem, you can’t solve it.” But if you define a problem in the wrong way, you probably can’t solve it either.

The 108-Degree Eviction

2026-08-10T07:00:00-04:00

Photographs by Mikayla Whitmore

On any other day when the high was forecast to be 108 degrees, Susie Tyson would not have left her Las Vegas apartment. The stroke she’d had at 30 made her sensitive to the heat, she found; at 67, going out during Nevada’s hottest months would make her dizzy, nauseous, and, in her words, “hurting everywhere.” But on June 17, she had no choice. That morning, a Clark County constable came to evict her and her daughter Shelby from the apartment they’d lived in for nearly 20 years.

The three-bedroom unit was in a stuccoed two-story building, the generic type found in suburban Vegas’s gated complexes, with a spindly olive tree out front. In the summer, they cloistered the place, hanging blankets over their blinds to make the apartment darker and save on the energy bill. Sometimes, they skimped on air-conditioning. Susie and Shelby had wanted to stay in their apartment, and had cleared their clutter enough to pass a housing-authority inspection in June. But that month, their landlord had terminated their lease, saying they’d violated it by leaving the apartment in disrepair and letting their personal property become a fire hazard.

During the weeks that followed the eviction, Susie and Shelby scrambled to find housing, trying not to think about their worst-case scenario—that they could be forced to live outside during a heat wave.

In Las Vegas, heat is the backstory to every summer. It kills car batteries, skyrockets energy bills, makes steering wheels hot to the touch. Heat can make a good day bad, and a bad day worse, for anyone, but some people bear more of its burden than others. For people who are old or work outside or don’t have a stable place to live, the heat is particularly dangerous. When a person’s core temperature gets too hot, their organs can fail, and they can go into cardiac arrest. In recent summers in Vegas, hundreds of deaths have been attributed to heat; one study found that in recent years half of all deaths of homeless people in this county were heat-related.

Mikayla Whitmore for The Atlantic

Susie Tyson moves her belongings from the apartment where she and her daughter lived for 20 years.

Mikayla Whitmore for The Atlantic

Shelby and Susie Tyson’s home on July 15, 2026

Mikayla Whitmore for The Atlantic

The two women were given 30 days to move out and packed what they could.

People have lived in the area that’s now Las Vegas for thousands of years, but only in the past century have they lived like this—tethered to air-conditioning, reliant on year-round shelter. The increasing temperatures threaten to render the city inhospitable. The summer of 2024, which featured one record-breaking 120-degree day, was the city’s hottest ever, and about 400 people in Clark County died of heat-related illness.

In mid-July, when Susie and Shelby had run out of money to pay for the weekly rental where they’d moored themselves for the time being, the temperatures were ticking up to 114 degrees. They could handle the heat or the housing uncertainty, but facing both stresses at once felt impossible. An urgent question loomed: In the middle of a Las Vegas summer, where would they go?

This city was not Susie’s first choice of hometown. Originally from Buffalo, New York, she had lived in California and Oregon before she landed in Las Vegas. Her brother was here, her parents were coming, and she could use child-care help after leaving her husband. The stroke had made her right side weak and, in combination with back issues and a degenerative disc disease, made it necessary to use a cane. She couldn’t work much, and her health issues made driving difficult, in a place where a single errand might send a person a dozen or more miles from home.

Immediately after the eviction, Susie had Ubered to a hospital; the heat and stress had made her sick. Then, she Ubered to Arizona Charlie’s, a casino hotel 10 miles from the apartment, where she and Shelby stayed six nights and paid about $50 for each one. After bouncing for four more nights between two other casinos, they ended up at Siegel Suites, a weekly rental studio, the cheapest option they could find. Even that cost them $1,000 a month more than the rent they’d been paying.

Mikayla Whitmore for The Atlantic

Shelby and Susie, on the last day they had access to their home

The studio was also more than an hour’s journey via rideshares and buses to the Macy’s and Target where Shelby, who’s 32, worked part-time, and more than 20 miles from their old apartment. According to Nevada law, they had 30 days to collect any belongings remaining there. On an oppressive July morning, Susie and Shelby took an $8 Lyft to a U-Haul facility near the weekly rental, where they met up with Mia Kells, a woman from a local mutual-aid Facebook group. Susie’s parents and brother had died years earlier, and without family to help, she and Shelby had enlisted Kells as a driver.

Susie was talkative and apologetic, and quick to smile; Shelby was quiet and firm. During the school year, Shelby taught as a substitute teacher in the Clark County School District and had recently started a bachelor’s degree in early-childhood education, on a scholarship. The two were close—so close, Susie said, that the radio psychic Gary Spivey once told them they were bound together in a past life, but in that reality Shelby was the mother and Susie was the daughter. In this life, Shelby was Susie’s primary caregiver, helping her walk and sometimes dressing her. They were rarely apart.

Mikayla Whitmore for The Atlantic

The two women took a paratransit bus to the apartment for the last time on July 15, 2026.

Even with air-conditioning, their apartment was stuffy inside. As they sorted through cups, coats, Christmas ornaments, dresses, dolls, DVDs, makeup, and old schoolwork, they moved with a detached sense of purpose, their apartment of two decades no longer feeling like home. In anticipation of the eviction, they’d found a new apartment close to Shelby’s retail jobs. But now they’d lost their housing voucher—public-housing programs can revoke assistance after lease violations—and couldn’t afford the rent.

Susie collapsed into the couch to sip water. She was winded, and the small fans she’d plugged into the wall were still.

“The air doesn’t even seem to be working,” Shelby said. She, too, suffered in the heat, especially when her legs swelled and she couldn’t wear the knee braces that helped her manage the pain of her scoliosis.

“I’m melting, literally. I’m sweating,” Susie said.

By 1 p.m., it was 107 outside. It felt, said Kells, like 107 inside. Their faces were shimmering and flushed, and the mood was grim.

This was just the beginning of a week of accounting and logistics, during which they would attempt to reinstate the housing voucher and request a social-services payment to cover housing in the next weeks. Their costs were mounting, and the 10 nights in casino hotels, along with the weekly rental—paid only through July 18—had used up Susie’s monthly disability and Social Security checks. At one point, after they’d trekked to the regional housing authority, then been sent to a legal-aid office, an aid worker from another group called to say that they’d been approved for temporary housing—if they could be ready within two hours. But getting back to the rental they’d just paid for and packing up everything they’d be able to bring seemed too tall an order.

Mikayla Whitmore for The Atlantic

A visit to the Division of Social Services in Henderson, Nevada

Mikayla Whitmore for The Atlantic

The weekly rental at Siegel Suites was the cheapest option they could find.

Mikayla Whitmore for The Atlantic

Susie and Shelby Tyson at Siegel Suites

A few days later, their best chance of staying even in temporary housing was a friend from social media who had offered to pay for an extra week in the Siegel Suites, Susie said. But the friend’s payment wasn’t going through.

Susie and Shelby took a paratransit bus one last time to the old apartment, to gather jewelry, clothing, and a few pieces of family memorabilia. They couldn’t take anything else.

“Doesn’t it feel strange to even be here now?” Susie asked Shelby.

A little after 1 p.m., a staffer for the complex locked the apartment. It was 106 degrees out.

Two days later, the heat had broken; the temperature was in the 90s. Shelby took a $9 Uber to a bus stop, so that she was 40 minutes early; sometimes the buses came early, too. In the sky, dark clouds were billowing: The summer monsoon season promised some measure of relief. When the bus arrived, Shelby took a seat near the front. The bus passed her middle school, then the Strip, and then, more than an hour into the trip, climbed to the wealthier area of town, Summerlin, where she worked.

After the exertion of the week, her mother was unable to stand for more than five minutes before her back started hurting, a stabbing pain. Still, Shelby was feeling hopeful, at least about the next couple of weeks. The online friend’s payment had gone through, so they could stay at Siegel Suites through July 25. Using a payment plan—$40 a month for 12 months—Shelby reserved the studio until August 1. When Susie received her monthly disability payment, they could use that check to pay for a few more weeks and hope to sort out the housing voucher before running out of money again.

Mikayla Whitmore for The Atlantic

Shelby takes a public bus to work.

Mikayla Whitmore for The Atlantic

Shelby Tyson waits before her shift at a retail store in downtown Summerlin.

Shelby arrived at the mall before her shift started and looked for a place to do her homework; school took her mind off things. She chose a seat in the outdoor plaza. The more forgiving temperatures didn’t change the fact that she and her mother were still unhoused. Nor did it change the long-term outlook for Las Vegas. The city was in drought, and Lake Mead, the reservoir that fed the city—along with millions of other people in Arizona, California, and Mexico—was projected to hit a record low within a month. Most people in Las Vegas could avoid the heat by hunkering down in air-conditioned cars and air-conditioned buildings. But low lake levels could threaten the power supply of much of the Southwest—and the region’s water supply, too. Drought is hard to escape.

The next day, July 18, Shelby and her mother would celebrate Shelby’s recent birthday by seeing Ed Sheeran at Allegiant Stadium. They’d bought the tickets back in October, on payments, before they were worried about eviction. When she was younger, her mother had made a habit of calling into radio programs in order to win concert tickets, restaurant gift cards, even a cruise to Ensenada. This would be their first concert in ages. It was difficult to think much further ahead than that.

The Most Basic Step of the Ebola Response Is Falling Short

2026-08-07T09:13:54-04:00

The fight against Ebola is not going well. Last week, the head of Africa CDC, Jean Kaseya, announced that the ongoing outbreak of the virus in the Democratic Republic of the Congo had ballooned into the second worst of all time, a milestone he had thought was possible to avoid only weeks before. Rather than the spread of the virus slowing, cases are doubling about every 10 days; more than 1,800 people have died, though the actual toll is likely at least twice as high. His organization is now fighting to keep this Ebola outbreak from becoming the worst on record, Kaseya said at a press conference.

This outbreak is spreading more quickly than any other in history partly because one of the basic tools needed to control infectious disease—testing for the pathogen—is not working. So the Congolese government, along with scientists, aid groups, the World Health Organization, and the world’s biotech companies, is racing to fix it.

In its early stages, Ebola can resemble several more common viruses, including malaria, so health-care workers rely on tests, rather than symptoms, to diagnose the disease. After the 2014 West African Ebola outbreak, which killed more than 11,000 people, Congo began stockpiling machines that could detect the Zaire species of Ebola virus, which causes most outbreaks. Hundreds of these GeneXpert devices are now in hospitals all over Congo, along with cartridges that can test a patient’s sample for the virus within an hour, Christian Happi, a molecular biologist who leads a team in Congo working on surveilling this outbreak, told me.

Health officials in Congo began using those stockpiles to test patients for Ebola on April 30, after a smattering of health-care-worker deaths, a calling card of the virus. The results came back negative. So did more samples a couple of weeks later. Ebola, we now know, was circulating. But the species turned out to be Bundibugyo, which is far rarer than Zaire, and which cannot be detected by the existing supply of GeneXpert cartridges. That didn’t become clear until officials had sent samples more than 1,000 miles away, to Kinshasa, for more robust PCR testing, creating a disastrous four-week gap between when the first known patient developed symptoms and when officials received laboratory confirmation of a new Ebola outbreak.

PCR testing is still the only reliable way to detect the Bundibugyo strain in Congo. Under the current system, a car drives to Ebola-treatment centers in affected regions, picks up tests, then drives back to labs that can run the tests, Trish Newport, a lead on Doctors Without Borders’ Ebola programs, explained to me. Some routes take longer than they otherwise would because the samples have to be driven over uneven roads that are frequently blocked by fighting between the Congolese military and the armed group known as M23. After the PCR is run, the car returns handwritten results to the centers.

Nineteen laboratories in Congo can now run PCR tests to detect Bundibugyo, which is a major improvement since the beginning of the outbreak, when only two labs had that capacity in a country of more than 116 million people. But according to figures released by Africa CDC in July, one in eight Ebola tests still took more than 72 hours to return a result. Despite the increase in Ebola testing, the proportion of tests that come back positive has stayed constant, about 45 percent. That probably means the country is still dramatically undertesting, Abraar Karan, an epidemiologist at Stanford, told me.

Meanwhile, Ebola is expanding into new parts of the country. Bringing the outbreak to heel will almost certainly require upping testing to catch more cases, trace chains of transmission, and isolate people who are contagious before they spread the disease further. Modeling done after the 2014 Ebola outbreak suggested that diagnosing 60 percent of patients within one day rather than within five days could have drastically reduced the infection rate.

The fastest solution to Congo’s testing crisis would be to distribute GeneXpert cartridges that can detect Bundibugyo. After all, hundreds of hospitals already have the machines, and each can run 80 or so patient samples at once, which would allow many patients to get same-day results, Happi said. A GeneXpert cartridge that tests for every human strain of Ebola does exist: The U.S. Department of Defense funded its development as part of a biothreat-preparedness program in 2020. The FDA approved the panel earlier this year—but only for use by labs at DOD, which intended to continue conducting research on them. (The Department of Defense did not respond to repeated requests for comment.)

In June, with DOD’s permission, Cepheid, the company that makes GeneXpert machines, donated at least some of the tests meant for U.S. government research to Congo’s national health system, Larry Kelmar, the vice president of government relations for Cepheid, told me. (Kelmar did not say how many.) But before they can be used, their accuracy will still need to be compared with PCR tests. Shanelle Hall, a principal adviser at Africa CDC, told me that the GeneXpert cartridges have been tested and that data from those tests are currently being analyzed. A decision on approval is expected in a matter of “weeks, maybe days.”

Other companies and institutions are scrambling to speed up testing, too. Last month, the Gates Foundation issued a Global Grand Challenge to fund teams that will work urgently to develop “field-ready” diagnostics. The WHO has selected eight Ebola diagnostics capable of detecting Bundibugyo—including the GeneXpert cartridges—for fast-track testing, and has already approved two. A test made by a South Korean company, the RADIONE, was approved for use in patients earlier this summer and has become the cornerstone of the WHO’s plan to decentralize and speed up Ebola testing. A senior official at Africa CDC told reporters in early June that 50 RADIONE machines would be in Congo by the end of that month. As of this week, 37 have been delivered. But the machines can test only 24 or so patient blood samples at once, too few to make the dent in diagnosis times needed, Happi said. In a statement, a spokesperson from the WHO said the organization has “established a joint validation platform to rapidly evaluate the performance of a selection of diagnostic products” and that the introduction of new PCR machines has increased testing capacity from 200 tests a day to more than 2,000. KH Medical, the small manufacturer that makes the RADIONE tests, did not respond to a request for comment.

Meanwhile, Happi told me, some Ebola-treatment centers without enough isolation wards are sending suspected Ebola patients home to wait for test results and, potentially, expose other people during that wait. Africa CDC also plans to intensify its contract-tracing efforts by sending thousands of health workers door-to-door, which would require still more testing capacity to support.

The wait for results can discourage the feverish from presenting themselves for testing, Newport, who has been in Congo most of this summer, said. In part because of the delays—and in part because many people in Congo are skeptical of international responders, or believe that treatment centers are places people go to die—those who show up to the hospital typically do so late in disease progression. That’s a real problem, not just because they stay in the community infectious for longer, but also because Ebola cases are far more survivable when they’re caught early, Newport said. Currently, most Ebola deaths are happening at home, rather than in a treatment center or hospital, meaning that many of these infections are never recorded and that teams meant to disinfect homes and sanitarily bury the dead to prevent further spread of the disease never intervene.

The shortage of tests throughout this outbreak has resulted in a shortage of answers to fundamental questions about how the disease has been spreading. Experts still disagree on whether the outbreak began in January or in April. Patient zero remains a mystery. Currently, 80 percent of people who test positive for Ebola haven’t had contact with any other confirmed patients. If that number doesn’t go down, Kaseya told reporters last week, “we will not stop this outbreak.”

Running From a Fire Should Not Be This Routine

2026-08-06T10:40:41-04:00

In the western United States, particularly in fire-prone areas, people have become well versed at preparing to flee. They’re experts at using the tools and technology for monitoring a wildfire’s advance; they consult the Watch Duty app as often as checking the time. They know the three levels of evacuation—Ready, Set, Go—and many perform a running calculation of how much time they might need to get to safety.

On Saturday afternoon, Rita Gregovich was following that script. She wasn’t much concerned about the small wildfire burning across a river from her home in Spokane, Washington, although she’d noticed neighbors running sprinklers on their roofs to make them less immediately flammable and was tracking the fire’s progress on her phone. She was not too worried, either, when she lowered her American flag so that it wouldn’t get too smoky, she told me. Then she stepped around her garage and saw a wall of smoke. “And it was right on top of us,” she said. She and her husband, Dan, would learn, in a moment of rising distress, how much heavier their automatic garage door becomes when the power is out. She would discover what a burning ember feels like when it falls into your shoe.

Nearly 100 large wildfires are burning across the country at the moment, more than half of them in Oregon and Washington, and many of those have prompted evacuations. The three fires converging on Spokane, Washington’s second-largest city, have destroyed 800 to 1,100 homes and other buildings, fire authorities have said, and displaced more than 65,000 people. As more people have moved into forested exurbs and wildfires’ footprints have grown, such evacuations have become a distressingly familiar summer ordeal: a dayslong limbo in relatives’ spare rooms or emergency shelters, pets in hotel lobbies, possessions lugged around in plastic bags. In France and Spain this summer, record-breaking wildfires forced more than 300,000 people from their homes, an exodus that one French minister described as the largest peacetime evacuation in the country’s modern history.

An evacuee, for however long, steps into a kind of parallel existence, in which locations remain familiar but the rhythms of navigating them have changed. The route home is the same, but now a National Guard checkpoint stands in the way. Your boss is still eager to see you at work, but suddenly you’re living in a van at the fairgrounds. Almost as soon as the calculation to flee is complete, you must begin the harder, more uncertain calculation about how to hold together your life until you can return, if you choose to do so. At the Spokane County Fairgrounds, an evacuation site for animals, Jennifer Hynek was trying to ease her anxious horses, which were kicking and pacing, unaccustomed to city water and the confines of a stable after living on an 18-acre ranch, a nonprofit horse-boarding facility. (She also brought five goats, two pigs, two dogs, and four cats, but she “left the chickens all at home,” she told me. “Fend for themselves.”) In one evacuation zone in Spokane that was at the highest level of alert—leaving was mandatory—a sign on the door of the closed Little Garden Cafe read Still level 3, hoping for Weds.

But swaths of devastated land are still smoldering, and more heat and wind are in the forecast. Authorities have not yet been able to say when most evacuees can return home. “I know people want to have certainty about ‘When can I get back to my property? When can I get back to my homes?’ We don’t have it,” Spokane Mayor Lisa Brown told reporters on Monday. “It could be a week. It could be weeks.”

Randall Barkley, a 65-year-old retired Green Beret, spent his first night after leaving home in his Lotus Evora. He loves the two-seat sports car, but he never expected to sleep in it at a park, let alone with another person. He fled on Saturday when he saw flames near a dumpster outside his townhouse and heard the pop of exploding transformers. “The two booms was my cue,” he told me. As he drove away, he watched firefighters hoist patients into vehicles at the Alzheimer’s and dementia-care facility across the street, leaving dozens of tipped-over wheelchairs splayed outside. He and his brother Brian followed the night in the Lotus with one at a “price gouging” motel, as he put it, then a night at Brian’s boss’s house. They never know quite where each day of evacuation will end. “We might sleep in the car downtown,” Barkley told me on Tuesday. “We’re running out of resources.”

The lucky evacuees whose houses still stand may wonder, as they return home to retrieve birth certificates, heart medication, or a pair of pants, whether the gas leak audibly hissing in the wreckage next door will blow them up while they are on their errand. They must consider the inexorably melting side of beef in the now lifeless freezer. The unlucky ones must start thinking about what to buy a teenage daughter who has just lost all of her belongings.

Donna Light learned that her apartment, in a 12-unit building, was gone before she could get there. A friend sent her a photo the day after the fire. She discovered on Facebook that her parents’ home, not far away, had also burned down. On Tuesday afternoon, Light, a 48-year-old who works in hospital administration, poked through the ruins of her apartment, looking for her jewelry and her collection of Polish pottery. Her Honda CR-V was still in its parking spot, charred down to its metal frame. Light had recently given up her rental insurance on her apartment because “nothing ever happens here,” she told me. Her 14-year-old daughter, who kept belongings at both houses, lost everything except for her electronics and a spare pair of pajamas. “We just start from scratch,” Light said.

This is what a successful evacuation looks like, by the most basic measure, at least: So far, in the face of multiple fast-moving wildfires, nobody has been found dead, and first responders have reported no major injuries. The familiarity of evacuation math—when to go, how long to stay away—can be its own kind of protection. Disasters tend to be less disastrous, in certain ways, when the people who face them know what to expect and what’s expected of them.

Police and National Guard soldiers have tended to let people walk or take bikes and scooters back to their properties, but not drive to them. For some people, the walk home covers multiple miles, in the heat of summer, through a bitter pall of smoke. On her way into the disaster zone, Nikki Martin, a 33-year-old caregiver whose home survived, has felt the pang of passing others who had little to retrieve. “One guy held up a brick and a metal Welcome door sign,” she told me. “He said, ‘This is my house, right here.’”

Kill the Ticks

2026-08-03T13:17:33-04:00

In parks, in backyards, in woods that are lovely, dark, and deep, a many-legged menace now stalks the land. I speak of ticks, and I come bearing absolutely no good news. In recent decades, ticks have made the leap from nuisance to genuine public-health threat: Their numbers are rising. Their ranges are expanding. And the diseases they carry are multiplying. Lyme cases have more than doubled since 2000, in which time scientists have also discovered eight new tick-borne diseases—plus an unusual and potentially dangerous tick-induced meat allergy called alpha-gal syndrome.

“The ticks are winning,” a CDC scientist wrote in a recent paper. To put it even more bluntly, humans are losing and are on the retreat. Ilia Rochlin, a tick researcher at Stony Brook University, told me he stopped hiking in the Pine Barrens of New Jersey after he and his wife came across hundreds and hundreds of newly hatched lone star ticks on a trail several summers ago. And on Long Island, where he lives, “it is impossible to go hiking in most areas,” Rochlin said. “Just because of ticks.”

Tick prevention today is a matter of individual responsibility. If you can’t avoid ’em, you’re supposed to pretreat clothes with the pesticide permethrin, tuck your pants into your socks, and check your entire body for ticks—a real pain, honestly, just to hang out in your backyard. Maria Diuk-Wasser, a tick researcher at Columbia, told me her own family doesn’t always listen to this advice. “I’m like, oh my God, if we don’t even do it here …” The tick problem has reached an inflection point: It is too big to address with personal protective measures alone.

What we need, tick experts now argue, is widespread tick control, akin to mosquito control that has been carried out by state and local agencies for more than a century. Rochlin, who used to work in mosquito control, pointed out that his predecessors in New York were chiefly concerned with malaria. Yes, malaria—now known as a tropical disease—once killed hundreds of New Yorkers every year. In the early 20th century, a massive national mosquito-eradication effort, which led to the CDC’s creation, ultimately expunged the disease from the country. “Compare this huge success story of malaria control in the United States,” Rochlin said, with “this humongous failure to control tick-borne disease.” Today, the number of Americans who contract diseases from tick bites dwarfs the number falling ill from mosquito bites.

To beat the ticks, we need new tools, such as pesticides and vaccines. We need the political will to actually use existing ones, namely, killing deer. We need to make the United States into an environment hostile to ticks—something Americans have accomplished once before, just not on purpose.

When the colonists arrived in what would become the United States, they began turning forests into farmland and hunting white-tailed deer, which neared extinction by 1900. This turned out to be an excellent, if unintended, tick-control strategy. It deprived the parasites of habitat and, more crucial, their key host animal. In low numbers, infected ticks crossed over only occasionally to bite humans.

But as farming declined in the 20th century, forests regenerated. Deer populations rebounded, this time without natural predators such as wolves to keep them in check. Ticks flourished too. In recent decades, two formerly obscure tick species have enormously expanded their reach: the black-legged or deer tick, which is best known for spreading Lyme, and the lone star tick, best known for causing alpha-gal syndrome. (The lone star tick, at least, seems to be reclaiming its former range; it was likely in modern-day New York in the 1700s, before disappearing to the south and not reappearing this far north again until the 1990s.) The two species collectively carry a number of other, lesser-known pathogens, too, including anaplasmosis, babesiosis, Powassan virus, Ehrlichia, and Bourbon virus. These diseases likely once circulated primarily among animals, but they are now spilling over into humans because of the sheer number of ticks that are out and looking for blood.

No one thinks we should solve our modern tick problem by chopping down all of the trees. But everyone I spoke with agreed: We have to do something about the deer. “Deer are the key.” The “common denominator.” The “crux of the issue.” The “main driver of all that is evil today in the northeastern United States.”

That last quote is from Sam Telford III, an epidemiologist studying tick-borne diseases at Tufts University, who calls himself “the nation’s biggest advocate for killing deer.” Ticks rely on the blood of deer to reproduce, his argument goes. A single deer, Telford told me, can feed 1,500 female deer ticks, each of which can lay 2,000 eggs. That’s 3 million deer ticks per deer, over one breeding season—even higher for the more fecund lone star tick. Killing deer is therefore “the biggest bang for your buck,” he said. This strategy was most convincingly implemented in 1997 on Monhegan Island, off the coast of Maine, where residents fed up with Lyme disease hired a sharpshooter to cull all of the deer. After that, Lyme virtually disappeared from the island.

We know very well how to kill deer (“Rifle,” Rochlin deadpanned), but doing so is unpopular. It makes animal-rights activists livid, the general population squeamish, and even hunters unhappy about competing for fewer deer. Lately, though, Telford said, people have become desperate enough about ticks to reconsider. On Martha’s Vineyard, which has come under recent siege by lone star ticks, hunting is having a resurgence. The island extended its hunting season and plans to build a new deer-processing facility.

Hunting can accomplish only so much, though. It can reduce the density of deer from 70 to 40 per square mile, but breaking the disease-transmission cycle requires going below 10, according to Kirby Stafford III, an emeritus chief scientist at the Connecticut Agricultural Experiment Station, where his department studied this exact issue. Moreover, hunting in many of the suburbs home to tick-infested deer is impossible because of all the people who live there, too. On New York City’s Staten Island, where hunting is illegal, the city has been giving vasectomies to male deer for the past 10 years. The deer population has fallen by nearly half, but the tick story is more complicated; while tick numbers have gone down, the proportion carrying Lyme has gone up.

An alternative idea: Make the deer themselves tick resistant. A device called the “4-poster” station lures deer with corn as bait, before rubbing permethrin—the same pesticide we humans use—onto the animals as they snack. But that approach has not proved terribly successful. (Too expensive; limited range.) “Not practical,” concludes Stephen Rich, a microbiologist at the University of Massachusetts at Amherst, who has tested these bait stations on Cape Cod and nearby Chappaquiddick Island. Lately, he’s homed in on a different idea: Turn the blood of deer into tick poison, as we already do to dogs. Rich is exploring the use of fluralaner, sold for dogs as Bravecto: He hopes to apply it to captive deer this fall, before expanding to Chappaquiddick next year, where his team will be pouring the fluralaner onto deer that have been tranquilized.

Or perhaps a vaccine could make ticks simply fall off their host. Animals such as rabbits and cattle naturally become resistant to ticks after repeated bites, likely by mounting an immune response to tick saliva; this is the biological basis for anti-tick vaccines that scientists are trying to develop in humans. Durland Fish, a tick researcher at Yale, argues a deer version could be simpler to develop for biological and regulatory reasons. The challenge then becomes how to vaccinate deer. The USDA currently air-drops fish-meal-flavored oral rabies vaccines to raccoons, and researchers are now studying how to similarly entice deer. “I’m like, what kind of deer crack can we put in there?” says Jean Tsao, a tick researcher at Michigan State University who has tested baits locally. Currently, it’s alfalfa, which has not quite hit the “deer crack” threshold.

In speaking with tick researchers, I sometimes got a sense of mosquito envy. “I’m still amazed,” Tsao told me, when she goes to mosquito-control meetings. “They know what size droplet to spray that will be effective as the plane is flying over to kill mosquitoes down below.” They know what time of day to spray and where. And those same conferences discuss all kinds of ideas for new mosquito pesticides, Diuk-Wasser, the researcher at Columbia, said. “But there’s funding to do that,” which is not the case for ticks.

Existing chemicals are very effective at killing ticks, but they are very effective at killing friendlier bugs, including pollinators, too. Scientists are studying how to target their application—to certain habitats or certain times of the year—to minimize harm to other bugs. (Tick researchers I spoke with were largely skeptical of popular natural yard sprays that are derived from essential oils.) And they are searching for more specific alternatives, such as fungi that kill only ticks.

Ultimately, tick control will likely require a combination of strategies, rather than any one magical solution. Hunting, vaccines, and pesticides applied both to deer and in the larger environment could all play some role. When Lyme first appeared in isolation in the U.S., we conceived of it as a medical problem, Fish told me, putting the bulk of public research dollars into medical treatments. But the subsequent appearance of so many novel tick-borne conditions points to a larger ecology problem. Better than finding stand-alone treatments for each of these conditions is preventing Americans from getting sick in the first place—by making ticks less abundant across the land.

The Real Antidepressant Crisis

2026-07-30T15:49:34-04:00

Robert F. Kennedy Jr. is vocal about his view that Americans overuse psychiatric medications, particularly antidepressants. As a general rule, the health and human services secretary is skeptical of pharmaceuticals, but he’s gone further in his critiques of SSRIs, suggesting without credible evidence that their use might be linked to violent behavior, including school shootings. This past spring, he announced plans to discourage doctors from prescribing antidepressants and encourage them to de-prescribe the drugs—that is, to help patients who have previously been prescribed SSRIs stop taking them.

According to a recent survey, about 17 percent of American adults take an antidepressant. Some of them are my patients, many of whom were upset or infuriated by Kennedy’s move to rein in the prescribing of drugs whose benefits they have experienced firsthand. One of my patients, who has tried to stop taking Zoloft several times only for his depression to recur, told me that he couldn’t understand why the nation’s health secretary might want to discourage people from taking the SSRIs they’ve been prescribed.

Kennedy’s claim that antidepressants are overprescribed contains a grain of truth. Some patients receive antidepressants without really needing them or stay on them for longer than necessary. Earlier this year, an independent task force of psychiatrists suggested that more attention be paid to how and when patients and their doctors test whether tapering off these medications would be reasonable. In fact, inappropriate prescribing creates the impression among both patients and doctors that antidepressants are less effective than they are.

When Kennedy talks about de-prescribing antidepressants, exactly what he’s proposing remains unclear. He doesn’t specify which groups of depressed patients he believes can stop their medication. In fact, contrary to his often-heated rhetoric about SSRIs, he said in May when announcing the de-prescription measures that “if you are taking psychiatric medication, we are not telling you to stop”—and then encouraged such patients to “make the right decision” in consultation with their doctor. The benefits of antidepressants vary greatly. There is abundant evidence that antidepressants are effective for people who have moderate or more severe forms of depression. If you feel persistently sad, believe that life isn’t worth living, and lose your energy, appetite, concentration, or ability to experience pleasure, you likely have clinical depression, and your symptoms would be good targets for antidepressant treatment. But the same is not true of people experiencing what psychiatrists call everyday distress. Feeling, say, unhappy in a soul-sucking job or grief-stricken over the loss of a loved one are painful but entirely appropriate emotional responses. They call for changing your situation or contacting a friend for support, not for an antidepressant.

[Read: Talk to your doctor about your distrust of public health]

Taking an SSRI in such a scenario would be like prescribing an antibiotic for a common cold: a waste of resources that’s likely to only give the patient side effects and leave them questioning the efficacy of the drug. Some providers nevertheless prescribe antidepressants for everyday distress. I’ve seen patients going through grief or job loss who were prescribed SSRIs by my colleagues, perhaps because they thought the patients were right on the edge of depression. And in the clinic where I teach and supervise residents, I’ve met many people who were unnecessarily prescribed a cocktail of antidepressants by other clinicians in the community. Many of my colleagues have come across such patients too.

Even people who have chronic mild depression can respond well to antidepressants, some studies have found. But a 2010 meta-analysis showed that people with the most severe depression experienced the greatest improvement from antidepressant treatment, whereas the benefit for those with milder depression was smaller, in some cases near zero. One possible explanation for this finding is that placebo responses tend to be higher in patients with milder depression (perhaps because they start to feel better when researchers ask how they’re doing throughout the study), so drug-placebo differences in that group are slight. Another explanation is that people with more severe depression likely have more biological abnormalities in the brain, such as elevated levels of the stress hormone cortisol and exaggerated responses in the fear circuit, which can be good targets for antidepressants.

No national data prove that antidepressant overuse is rampant, though. The closest approximation we have is a landmark 2014 study that examined the health records of more than 1 million patients during one year of treatment and found that about 40 percent of antidepressant prescriptions were written without a documented psychiatric diagnosis. This, however, doesn’t prove that the prescriptions were medically unnecessary: Antidepressants are legitimately prescribed for other reasons, including pain, quitting smoking, and insomnia. And the fact that nearly a fifth of Americans are taking an antidepressant is in line with the actual burden of psychiatric illness in the general population: In the most recent national data available, which were published in 2005, 7 percent of survey respondents reported having major depressive disorder, 4 percent reported PTSD, and others reported additional diagnoses for which SSRIs can be appropriate.

[Read: 20-somethings are in trouble]

Of course, some patients don’t like being on antidepressants, even if they experience an improvement in their mood. A small proportion of SSRI users experience side effects such as decreased libido, weight gain, and tiredness. Although these effects can understandably be distressing, they are also commonly transient and manageable. If Kennedy’s efforts lead to widespread de-prescribing of antidepressants, it would be a potentially harmful overreaction to a limited problem.

Meanwhile, Kennedy’s focus on antidepressant overprescribing ignores—and may even deepen—a more urgent crisis in psychiatry. The 2023 National Survey on Drug Use and Health found that roughly one in three adults who experienced a major depressive episode received no treatment for their illness that year. Evidence suggests that several common barriers drive this undertreatment of depression: People don’t know where to go for help, think they can manage without help, or cannot afford help. In my experience, some depressed patients avoid treatment because they feel that a depression diagnosis is stigmatizing and connotes that they are weak rather than medically ill. The more doubts Kennedy and other officials instill about antidepressants, the more likely some people who really need them may be to turn them down. “The United States is facing a growing challenge of overmedicalization in behavioral health care,” Emily Hilliard, an HHS spokesperson, told The Atlantic in an email. “Under Secretary Kennedy’s leadership, HHS is committed to ensuring that patients and clinicians have transparent information about the benefits, risks, side effects, and potential withdrawal effects of psychiatric medications so they can make informed, evidence-based treatment decisions.”

Depression is a serious illness, and discouraging people who need antidepressants from seeking them—or enacting policies that impede access to them—would only spur on its greatest harms. Roughly half of people who experience an episode of major depression will go on to have a chronic course of the illness. That means many patients cannot stop taking antidepressants without a significant risk of relapse or worse: Depression carries a lifetime suicide risk of about 2 to 9 percent, with more severe forms of the disease corresponding to higher risk. In this sense, depressed patients are dependent on their SSRIs in the same way that people with high blood pressure are dependent on their antihypertensive drugs. To mitigate the risk of fatal complications of the illness, you might have to stay on the treatment for life. That kind of dependency is something that competent clinicians and health-policy experts should encourage.

[Jeffrey Ruoff: Between not wanting to live and not wanting to die]

Kennedy, by contrast, has likened antidepressant dependence to heroin addiction. “Listen, I know people, including members of my family, who’ve had a much worse time getting off of SSRIs than people have getting off heroin,” he told a Senate committee at his confirmation hearing last year. But the fact is that, unlike an opiate such as heroin, antidepressants do not make people high and do not result in habituation, which requires users to take ever-larger doses to maintain their clinical effect. And although research on tapering is somewhat limited, one of the largest available studies shows that any withdrawal symptoms tend to be mild and dissipate within weeks.

Kennedy’s desire to reduce Americans’ reliance on antidepressants fits in with his larger antipathy toward pharmaceuticals, especially vaccines. He generally seems to believe that eating and exercising well is all that is necessary for health. In the case of depression, he favors non-drug alternatives, such as psychotherapy, exercise, and “real food.” But I’ve seen many patients in exemplary physical health—for example, triathletes and serious swimmers who adhere to strict diets—become suicidally depressed. Taking an antidepressant after you have tried exercise, a healthy diet, and psychotherapy isn’t a sign of weakness or a character flaw. It’s a recognition that disease has an underlying biological basis—and that sometimes, you need medication to get better.

The Cities That Said Yes to Drugs

2026-07-30T07:00:00-04:00

Photographs by Dana Golan

Late last year, I walked roughly a mile from downtown Seattle to the working-class neighborhood of Little Saigon and came upon a montage of human despair. An open-air drug market stretched along the intersection of 12th and Jackson: about 250 people, many smoking fentanyl or bent over in the thrall of the drug, tilting as if mid-fall. Three women lay passed out on the sidewalk, their chests slowly rising and falling, while fellow addicts stepped over them and dealers made sales. Young boys, schoolbags on their backs, stood on a far corner and watched.

I walked around the block to the Hoa Mai playground, named for a Vietnamese flower that signifies rebirth. City workers had installed gates to keep drug users away, but at 4 p.m. on a Wednesday, I counted 27 people smoking drugs and nodding off. No children were in sight.

Half a mile to the south, in the Beacon Hill neighborhood, I visited a 10-acre park named after the Filipino nationalist Jose Rizal. It has a playground and the remnants of an apple orchard, and at night you can peer downtown and see the city lights. As I arrived, a drug user squatted next to a child’s slide and relieved himself. Others had set up tents and colonized the park pavilion, where they heated fentanyl on tinfoil and inhaled the fumes with glass pipes. A few went old-school and injected it.

Across the street, I spoke with Angelina Monsegur as she waited at a bus stop. When she was a kid, she told me, she and her father ate candied apples in the park and watched Fourth of July fireworks. A few weeks earlier, she and her 6-year-old daughter had gotten on the bus and seen a man smoking fentanyl on board. “Are you serious?” she’d shouted at him. “My daughter has asthma.” I asked if she had called the police, and she smiled at my naivete. “All the city does is send out teams who hand out aluminum foil and fentanyl pipes.”

Seattle is one of the wealthiest and best-educated cities in the world. It can afford to try various strategies to address its drug epidemic and high rate of fatal overdoses. Yet many of the city’s leaders, apparently supported by voters, view enforcing bans on the open sale and use of narcotics, and forcing addicts off the streets and into treatment, as akin to an act of state repression.

Seattle, like a striking number of other liberal American cities, has embraced a radical form of “harm reduction,” which is more a philosophy about treating addiction than a scientific approach to it. Harm reduction’s adherents hold that police and outreach workers should “meet the addicted where they are,” which is to say without judgment. The New York State Department of Health, a bastion of harm reduction, describes it as a “social movement” committed to “building leadership” among drug users. In these places, de facto and sometimes legal restrictions on narcotics use have been greatly loosened; cities fund teams of workers to hand out drug paraphernalia, and in some rare cases they’ve created dedicated spaces for addicts to shoot up. Meanwhile, police departments struggling with staffing shortages and budget cuts have stopped devoting resources to sweeping users and dealers off the streets or out of parks and playgrounds.

Harm reduction was born 50 years ago of an admirable humanitarian impulse. Its most basic ideas, such as providing clean needles to users, deservedly draw broad support. There’s a debate to be had, though, about whether this approach has saved lives or added to the carnage of America’s terrible drug epidemic. From 2014 to 2024, roughly 862,000 Americans died of drug overdoses, more than twice the toll of the previous decade. Several studies have shown that addicts who shoot up at official injection sites are far less likely to die of overdoses than those who use drugs in, say, alleyways and parks. Over the past decade, however, overdose-death rates climbed sharply in nearly every city where the strongest harm-reduction policies were in place, and even with declines in the past two years, the rates remain well above those of previous decades. From 2016 to 2025, 7,089 people died of overdoses in King County, which includes Seattle—seven times the number of homicides in that period.

Harm reduction isn’t just a problem for addicts. In many cities, the autonomy of drug users has taken precedence over nearly everything and everyone else, not least working-class families like Monsegur’s who must live alongside addicts and accept dystopian decay. Keith Humphreys, a Stanford psychiatry and behavioral-sciences professor and a former adviser to President Obama, supports needle exchanges and opposes the widespread jailing of users. But when he argues that drug policy must take into account the impact on communities, he told me, some critics dismiss him as a reactionary. Their arguments, he said, “sound a lot more like gun rights and vaccine refusal. It’s no longer about the whole population; it’s about the subset who use drugs.”

In recent years, officials in cities such as San Francisco and Philadelphia have moved to rein in the excesses of harm-reduction policies. Nevertheless, these policies retain a powerful hold on public-health and political leaders in blue parts of the country. I witnessed this in visits to Seattle and Burlington, Vermont—two of America’s more progressive cities. Both are afflicted by high overdose rates, overwhelmed police forces, parks and public squares often captive to drug use, and the theft and disorder that accompany all of that. Yet many of their elected officials continue to insist, despite everything, that harm reduction is the most effective and moral solution to addiction.

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Dana Golan for The Atlantic

In Seattle’s working-class Little Saigon neighborhood, where hundreds of people gather in open-air drug markets, businesses and playgrounds have installed gates to keep addicts away.

Harm reduction took root in the 1970s in the Netherlands, where addicts formed unions—the Junkiebond in Rotterdam, for instance—that distributed needles and pushed back against official insistence on abstinence from hard drugs. Not long afterward, this philosophy gained support in some American and Canadian cities. I first encountered it when I reported on a heroin-shooting gallery in Bushwick, Brooklyn, in 1991. The work of harm-reduction advocates at the time undoubtedly saved lives. HIV-infection rates for drug users in Bushwick had reached 50 percent or higher, at a time when that diagnosis was close to a death sentence. Activists risked arrest to distribute clean needles and bleach to disinfect used ones. But some began to argue for a more radical step: There would be less death, they said, if addicts could inject drugs without fear of arrest.

That momentous step came about not in New York but in Vancouver, a city whose political culture was left-wing and libertarian, celebrating the rights of the individual. In 2003, as overdose deaths surged, the Liberal Party of Canada carved out an exemption to federal drug laws and established North America’s first sanctioned injection site, in Vancouver’s Downtown Eastside, a troubled dockside neighborhood. Addicts could bring their heroin and cocaine to a 13-seat center where staff dispensed needles, swabs, and sterile water to cook the drugs and offered advice on vein maintenance. Clinic staff were trained to reverse overdoses, and if that failed, to call a hospital for help.

Initial opinion surveys found broad public support for the center, and it shone like a beacon for some activists, academics, and journalists in the United States and other parts of Canada. A stream of studies and articles celebrated Vancouver’s legal shooting gallery, which resulted in fewer cases of AIDS and other infections, and fewer deaths. Public-health officials coined a nonjudgmental nomenclature that persists to this day. The word addict was stigmatizing; better to refer to people who use drugs. People used rather than abused narcotics. They did not fail a drug test ; they tested positive.

Vancouver’s model spawned dozens of injection sites across Canada. Health officials in British Columbia went still further, championing a program known as “safer supply”: Former government officials started companies that provided addicts with free opioid alternatives such as pharmaceutical-grade hydromorphone pills—considerably more powerful than heroin. Drug users obtained these pills from pharmacies and specially designed vending machines.

By 2020, the rights of addicts in the province had edged toward the fantastical. In 2023, the province decriminalized small amounts of certain hard drugs. One hospital instructed nurses not to confiscate fentanyl or meth from patients and not to restrict suspected dealers from visiting patients. When British Columbia banned illicit-drug use within 50 feet of a public park, playground, or swimming pool, the provincial supreme court blocked the law, ruling that it could cause “irreparable harm” to drug users. “Harm reductionists had the force of a bulldozer,” Julian Somers, who studies addiction at Simon Fraser University, told me.

Some addicts learned to game the system by obtaining daily allotments of hydromorphone pills—15 or more a day was typical—and then selling them to dealers in exchange for stronger fentanyl concoctions. Dealers could then sell the original pills on the street. An investigation by the National Post reported a price drop of 70 percent or more for black-market pills in cities that had instituted safer supply. This, in turn, expanded the circle of the addicted and led to more overdoses.

Gary Coronado / Los Angeles Times / Getty

Medics attend to a man who overdosed on drugs in Vancouver’s Downtown Eastside neighborhood. Thousands of addicts have poured into the city since it opened North America’s first sanctioned injection site, inspiring similar programs across the U.S. and Canada.

The consequences were predictable. Over the course of two decades, many thousands of drug users poured into the Downtown Eastside and other Canadian neighborhoods in search of narcotics and places to shoot up. Overdoses spiked. In 2014, British Columbia recorded 369 overdose deaths; in 2023, the figure peaked at more than 2,500. Fatal overdoses last year decreased to 1,826, as Canada moved to reverse decriminalization and tighten regulation of narcotics, but that still represents a nearly ninefold increase over 15 years. Advocates of harm reduction have long held that more addicts would die if officials closed injection centers. But a recent study found that after an injection site in Alberta closed, there was no increase in the number of overdose deaths, and more addicts sought treatment. Advocates have also insisted that crime does not spike near injection centers, but the data are more mixed than they admit.

Not long ago, I walked through a park in Toronto to a fence with hundreds of purple ribbons tied to it. Each represented a resident who had died of an overdose, and I was unavoidably moved. Then, as I read a leaflet, I realized that the memorial was the work of the Harm Reduction Advocacy Collective, “a liberation movement of people who use drugs,” along with public-health professionals and academics who “stand up for the rights of drug users.” It’s one of a number of similar groups in Canada, such as the Substance Use Health Network, which condemns “anti-euphoria prohibitionist principles” such as “the idea that illicit drugs are inherently bad.”

British Columbia is starting to rethink its runaway experiment. In 2025, the province began requiring addicts using the safer-supply program to consume their prescribed narcotics in front of pharmacists, and earlier this year, the drug-decriminalization program expired. Provincial health authorities are now making attempts to encourage addicts to get treatment. The sense is of a political culture reluctantly shaking off a decades-long stupor. In 2024, the premier of British Columbia appointed Daniel Vigo, a psychiatrist and public-health researcher, as the province’s chief scientific adviser on toxic drugs. Vigo has spoken of the terrible toll that repeat overdoses take on addicts’ brains, and has advocated for a new policy of mandating treatment for some addicts. Progressive activists and journalists tend to talk about forced treatment as a conservative-driven return to a carceral state, but considerable data show that addicts who enter mandated treatment are as likely to avoid drug use and rearrest as the relatively small number who seek treatment voluntarily.

Vigo’s words today would have amounted to heresy a few years ago. “It’s as if we forgot that the goal was to try and stop people from getting addicted,” he told me, adding later: “Harm reduction gets people in trouble when it stops being one part of a holistic strategy and it becomes an ideological movement.”

But even as Vancouver has begun the painful process of revising its harm-reduction policies, the city still exerts a powerful hold on the imagination of liberal leaders in the United States. In New York City, which established two injection sites in 2021, health officials and academics point to the perceived success of Vancouver as inspiration. Rhode Island, where an injection center opened in Providence in 2024, also holds up Vancouver as a model. The Washington State legislature appointed a working group that in 2025 recommended establishing a safe supply of narcotics for addicts, and officials repeatedly cited the Vancouver program.

The shadow cast by Vancouver extends to Burlington. Last year, the city council approved the establishment of an injection center. The group that the city chose to run it noted that Vancouver “remains the source of much of the evidence” showing the benefits of such spaces for drug users and the community.

Burlington sits on Lake Champlain, the Adirondack Mountains rising on the far shore. It’s a beautiful city, but its drug scene is not covert, spreading over downtown and several other neighborhoods. Users pitch tents in churchyards and parks and along the waterfront. When I sat in City Hall Park last September, I counted at least 70 users and dealers, many looking hyperkinetic in the way of the strung out. I walked through an alley next to city hall where, a few weeks earlier, a group of young people had allegedly beaten a man to death in an argument over drugs.

Vermont has strict laws against possession of heroin and cocaine, but users in Burlington are rarely arrested or prosecuted for possessing small amounts. Although it’s hard to isolate the effects of these policies, in 2024, the city of almost 45,000 recorded 585 drug overdoses, 28 of which were fatal. That is more than twice the rate of fatal overdoses per capita in New York City the same year.

Beth Sightler walked me around her working-class neighborhood in the Old North End. Burlington’s progressive political culture and tradition of caring for the poor are well established; Bernie Sanders served four terms as mayor in the 1980s. Sightler, a liberal who runs a mental-health center, said she has fished needles out of her flower boxes and seen people overdosing in cars and cemeteries. She carries naloxone, a medication that can reverse an opioid overdose, when she walks her dog. One morning she saw a young woman on the grass near her porch wearing underwear, a bra, and sandals. “There was this beautiful woman, absolutely beautiful, sitting there trying to find a vein and inject,” Sightler recalled. “I told her, ‘Sweetie, you gotta move along.’”

Many people in Burlington offer similar stories. A block from City Hall Park, the King Street Center provides tutoring and recreation programs for families living in poverty. Staff members arrive early to sweep up needles outside the building. When drug dealers began playing dice out front last summer, Shabnam Nolan, the executive director, called the police, who eventually chased the dealers away. “We’ve tried to sound the alarm, and yet people are not taking us seriously enough about what’s happening,” Nolan told me. Why does a drug user’s “right to ‘dignity’ violate children’s right to come to our center without seeing blood and needles?”

“It’s as if,” she said of Burlington and its culture, “we are frozen with fear that someone might see us as uncompassionate.”

The city’s political class has compounded these problems. In 2020, activists launched a campaign to defund the police department, although it was regarded as relatively progressive and community-oriented. The city council cut almost $1 million from the police budget. Six years ago, Burlington had about 100 officers; now it has fewer than 70. The current city-council president, Ben Traverse, a liberal Democrat who has grown uncomfortable with Burlington’s direction, told me that sometimes as few as five officers are on duty citywide after midnight on the weekends. It used to be that if you wanted to deal drugs, “you did not come to Burlington,” Traverse said. But that’s changed: “Open-air drug sales are a common occurrence here.”

State’s Attorney Sarah George, the prosecutor for the county that includes Burlington, is a progressive Democrat who once wrote that the American legal system “was built on the oppression and caging of black, brown, and poor people.” She told me that the combination of COVID, ever less affordable housing, and a cascade of evictions fed a drug crisis that has devastated Vermont. But she doesn’t blame addicts, who she said are “rarely dangerous” and are suffering. “I’m very frustrated with this narrative that City Hall Park is the end of the world,” George added. “That park is still a very safe place to be.”

I asked her how Burlington might balance drug users’ sometimes dominant presence in the city’s parks and streets with the desire of residents to use and enjoy those same places. The city, she replied, should start by opening its planned injection center so that addicts can use drugs in private. The state legislature has allocated about $2 million that it obtained from a national opioid settlement to help fund the center, though potential neighbors have pushed back against the sites that have been floated so far. More broadly, George opposes pushing addicts to the margins. “They cannot be disappeared,” she said. “They are part of our community.”

In 2022, George announced a new policy: If police officers stopped cars with broken taillights, tinted windows, or expired licenses and found a cache of narcotics, her office would most likely decline to prosecute the cases, on the grounds that racial discrimination could have motivated the traffic stops. She emphasized to me that police officers could in any case confiscate and destroy the drugs. But she questioned the need to go beyond that. “Is prosecution needed?” she said. “Or have we done enough already?” George has been reelected twice and is running for a third term.

In April, I spoke with Burlington’s mayor, Emma Mulvaney-Stanak, of the Vermont Progressive Party, which has governed the city for much of the past four decades. She has seen firsthand the effects of the drug epidemic. When she lived in the Old North End and her child was a toddler, they awoke to drug dealers beating on their door. She told me that she supports police and Drug Enforcement Administration investigations that target dealers, although she noted the “whack-a-mole” nature of that work, as new dealers replace those who are arrested. She said that without more help from the county and state, the city lacks the funds to build larger shelters that could help keep addicts off the streets. She is aware that Burlingtonians have grown impatient living with a drug-abuse epidemic. “We are fatigued with our compassion,” she told me. “All of the attention on harm reduction and public health—I get that.”

But, like George, Mulvaney-Stanak has not backed away from harm-reduction policies that she sees as humane and essential. Last summer, she opposed a city-council resolution calling for police officers to be stationed in City Hall Park to clear out users and dealers, arguing that the drug traffic would only go elsewhere and that there were not enough officers to enforce the policy. She signed off on the resolution, but she shares George’s philosophical objections: “Displacement and removal of people is not the solution,” the mayor said.

Wouldn’t an injection center, I asked her, draw more addicts and dealers to Burlington? She acknowledged the possibility, but framed it as a necessary risk. She repeated the harm-reduction maxim: “It helps people where they are at.” The city’s problems, Mulvaney-Stanak insisted, were more image than reality: “People need to ignore the clickbaity articles that distort the nature of Burlington.”

Recently, Traverse and other Democrats on the city council have begun to challenge the mayor on harm reduction. Jennifer Morrison, the state’s public-safety commissioner, has also spoken up. She served as Burlington’s interim police chief for six months in 2020 before quitting, in part because of what she described as the city’s “mismanagement” and “social activism.” She and Governor Phil Scott, a moderate Republican, have clashed with Mulvaney-Stanak. They have periodically, at the city’s request, sent state troopers to Burlington to help local police with drug enforcement and patrolling the central business district. “I lived through the decisions that got us to the place that we are now,” Morrison told me. “We are exposing our youth to terrible consequences by normalizing drug use and addiction.”

The business community in Burlington has also pushed back. In more than a dozen interviews, local merchants spoke of feeling abandoned. In testimony before the state legislature, the owner of Outdoor Gear Exchange reported that in 2024, the business lost an estimated $400,000 to shoplifting, as addicts stole to support their habit. At Homeport, a 40-year-old home-furnishings store downtown, a co-owner, Mark Bouchett, told me that he lost $95,000 to shoplifting in 2024 and was forced to hire a security guard. Drug users defecate in the doorways of businesses.

Bouchett joined 170 other business owners and restaurateurs who last year wrote an open letter to the mayor warning that the city was in crisis. Their tone was reasonable; they sought treatment for addicts, not incarceration. But a broad coalition of the political left in Burlington—unions, harm-reduction groups, pro-Palestine and trans-rights activist groups, and the local chapter of the Democratic Socialists of America—countered with their own letter, in which they denounced the business owners and demanded that they open bathrooms and sheltered doorways to addicts. To call for more police to help address the city’s drug problem, this group wrote, would “further harm our most vulnerable community members.” One of the signatories, Food Not Cops Burlington, posted and then deleted a boycott map targeting the business owners.

Overdose deaths in Vermont dropped last year to 170, a 37 percent decrease from the peak in 2022, but still far above the 78 deaths recorded in 2010. At the Ben & Jerry’s on Church Street, I saw staff hand out cards to customers who asked to use the bathroom: “Vermont is experiencing a tragic increase in overdose fatalities. Our bathroom has also become a destination for folks seeking to inject drugs.” The bathroom was permanently locked.

Families and children speak of being left on their own to navigate these harsh realities. Through the King Street Center, I met a young woman who was earning top grades at the University of Vermont. When she walks her younger sisters home from school, they pass drug dealers on the way. A Burlington High School student told me that her teachers have instructed students to avoid eye contact with dealers and users. A week earlier, she said, an addict had trailed her home after volleyball practice. She broke into a run, yelling for help, and the person eventually turned away.

Then there was Britany, a mother of three young children, who moved two years ago from a homeless shelter to an apartment on King Street. (She asked me not to use her last name, fearing for her family’s safety.) She said that she often found drug paraphernalia in the apartment building and, on some nights, encountered an addict sleeping in the hallway; her next-door neighbor was a fentanyl dealer. She had constructed a safe room for her children to flee to in case of gunfire. “Everyone talks about needle exchange and harm reduction,” she said. “I mean, okay. But it’s like my children and I are living in the zombie apocalypse.”

Just a few years ago, voters in Seattle seemed primed for a change. In 2021, they elected Ann Davison, a moderate and independent-minded Republican, as city attorney. Sara Nelson, a Democrat who had advertised her willingness to challenge the harm-reduction consensus, won a seat on the city council the same year and became its president two years later. With support from Davison, she passed laws cracking down on open drug use, prostitution, and dealing downtown, and substantially increasing the number of surveillance cameras in high-crime neighborhoods. Nelson persuaded the city council to redirect money to on-demand addiction treatment. “You can’t meet people where they’re at, because where they’re at is on death’s door,” she told me, adding that she believes many addicts can be saved only by a firm push toward treatment.

Dana Golan for The Atlantic

An encampment in South Queen Anne, Seattle. Since taking office in January, Mayor Katie Wilson has authorized sweeps of encampments and signaled an openness to pulling back on harm-reduction policies.

Nelson also asked pointed questions about what had become the received wisdom in Seattle, such as why the county government paid millions of dollars to supply kits to addicts with tinfoil, pipes, and instructions on how to smoke fentanyl. (Incongruously, these kits came emblazoned with an image of Martin Luther King Jr., the namesake of King County.) What harm was reduced, Nelson asked at a 2023 council hearing, by helping addicts get high? Amber Tejada, an employee of a health nonprofit that had partnered with the city, raised her hand to answer. “I know it can be a little controversial,” she told the councilwoman, “but one of the key tenets of harm reduction that I see is that we want to be able to facilitate and champion autonomy of people who use drugs.” Tejada added, “There are folks for whom abstinence is not something by which they measure their success in life.”

Nelson was no hard-line conservative. She pushed to expand the number of treatment beds for addicts and talked openly of her own past struggles with alcohol. But in elections last November, voters turned out both her and Davison. Their replacements had concerns over the use of surveillance cameras and opposed laws that barred repeat public drug users from certain areas in the city. I spoke with Davison in her office shortly before her term was up. She wrestled with her sense of a job not completed. “It’s really sad to watch the slow death of so many people,” she said, adding later, “You cannot act like this is a victimless crime.”

[Read: Crime in Chicago is a choice]

I asked Sandeep Kaushik, a Democratic political consultant who has lived in Seattle for decades, if he could explain the persistent attraction of radical harm-reduction policies in his city. Kaushik described himself as an “unreconstructed Obama Democrat,” which he noted “codes me as a conservative in some circles here.” He told me that local leaders “really believe the city should be on the leading edge of translating progressive ideas into policy.” There is also a curious disconnect between the policies that political leaders put in place and the desires of voters. In many polls, Seattle residents list crime and illegal drug use as among their greatest concerns, and a Seattle Times survey three years ago found that 60 percent of respondents wanted police to arrest those who used drugs in public places.

Last year, the city elected a new mayor, Katie Wilson, a self-described democratic socialist with no experience in elected office. Wilson has signaled an openness to pulling back some harm-reduction policies. Before she officially entered the race, she wrote an essay for Seattle’s alt-weekly, The Stranger, in which she cautioned fellow leftists against smugness. “The central weakness of the left narrative,” she wrote, “is a habit of deflection that makes it sound, at best, as though we are in denial about the grim reality on the streets.” The left, she continued, should not trivialize “what anyone who spends some time walking around Seattle’s streets can plainly observe: People with acute mental illness whose behavior is disturbed and occasionally aggressive. People using drugs, often incapacitated or passed out on the ground.”

Since she took office, Wilson has backed up her words by signing off on sweeps of large encampments in parks. Police and city workers have dismantled tents and carted away garbage. In late June, the mayor emerged from what she described in a statement as a period of “deep listening” and promised to “disrupt the drug dealing” and “public disorder” that plague the city’s Little Saigon and Beacon Hill neighborhoods. The police, she said, would commit more officers to those areas, and arrest users and dealers or press them to accept treatment. For a Seattle politician to argue that tolerating drug crime and disorder amounts to harm enhancement registered as something close to startling news.

Yet Wilson runs a political risk. By pledging to crack down, she has broken with many of her allies and supporters. Now she will be judged by her ability to clear the city’s streets. Andrea Suarez leads a group, We Heart Seattle, that combines care for the homeless with a hardheaded insistence on legal consequences and addiction treatment for drug users. She was in Jose Rizal Park when police swept it one day in April, and watched users and dealers amble off into the woods or walk over to Little Saigon. They returned a few hours later, she told me. A day or two after that, the tents reappeared. “Everyone who lives in this park knows there is no consequence for being swept multiple times or doing drugs or vandalizing a park,” Suarez said.

Dana Golan for The Atlantic

People who live in Jose Rizal Park know “there is no consequence for being swept multiple times or doing drugs or vandalizing a park,” one community activist says.

What’s baffling is that none of this lies beyond the ability of city officials to address. San Francisco Mayor Daniel Lurie has instructed police to crack down on dealers and dismantle tent cities. Philadelphia Mayor Cherelle Parker has sent officers into drug-scarred neighborhoods and established a treatment court, which offers first-time felony drug offenders a chance to avoid jail if they enter a treatment program. San Jose, California, has put more police officers in targeted neighborhoods, built emergency housing as police dismantle homeless encampments, and increased fines for landlords whose abandoned buildings are used by dealers to sell drugs and guns. In Boston, Mayor Michelle Wu was once enamored of harm reduction and injection centers. But she has ordered police to clear street encampments, and her administration now puts more emphasis on pushing addicts into treatment, by detaining them if necessary. Wu has also dropped all mention of injection centers from her plans.

In Seattle, by contrast, efforts to reduce public drug use force afflicted neighborhoods to pay a high price. For years, when playgrounds and parks became drug hot spots, the city reacted by fencing them off, depriving families of access. In May, police and city workers returned to Jose Rizal Park and again booted out dealers and addicts, preparing the park for a renovation. As a first step, city workers dismantled the picnic pavilion where addicts smoked and shot up, its condition having deteriorated from all the misuse. Park officials do not plan on replacing it, acknowledging the obvious in bureaucratese: The park “has been impacted by activities not aligned with intended use.” The bus shelter around the corner, where drug users gathered day and night, was also ripped out “because of an increase in loitering, littering and vandalism,” a King County Metro representative told me by email. All of this felt like another admission of defeat—officials destroying Seattle in the name of saving it.

This article appears in the September 2026 print edition with the headline “The Cities That Said Yes to Drugs.”

What Anthony Fauci Didn’t Say

2026-07-29T17:01:34-04:00

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Sitting in front of the Senate Committee on Homeland Security and Governmental Affairs today, Anthony Fauci twirled his pen. He huffed and straightened his shoulders. He glanced down at a set of papers. He muted and unmuted his microphone.

But other than a brief initial statement, in which he referred to Chairman Rand Paul’s “unhinged obsession” with slandering his reputation and putting him in prison, the only words the former director of the National Institute of Allergy and Infectious Diseases spoke into the public record—as senators interrogated him about his institute’s funding choices, maligned him as an egomaniacal money-grabber, and accused him of shattering American trust in public health—were these: “On the advice of counsel, I respectfully decline to answer based upon my rights under the Fifth Amendment to the Constitution.”

“Nothing says honesty like taking the Fifth, huh, Doc?” Senator Josh Hawley, a Republican from Missouri, asked him at one point. “Let’s try something. What day of the week is it today?”

Fauci consulted the paper in front of him: “On the advice of counsel, I respectfully decline to answer based upon my rights under the Fifth Amendment to the Constitution.”

“What color tie are you wearing?”

Fauci consulted the paper in front of him: “On the advice of counsel, I respectfully decline to answer based upon my rights under the Fifth Amendment to the Constitution.”

Senator Paul had said he called the hearing—billed simply as “Testimony of Anthony Fauci”— because “the American people deserve answers” about Fauci’s role in the origins of the coronavirus pandemic. Instead, the American people got something absurd: a three-hour spectacle of unchallenged allegations and distorted facts.

That Fauci would stonewall the committee was entirely predictable. Paul has led a yearslong effort to punish him for allowing NIAID to fund research that allegedly enhanced the coronavirus’s ability to harm people, and for allegedly lying to Congress and the American people about that fact. (Some federal intelligence agencies favor the theory that the pandemic started with a virus that leaked from a lab in Wuhan, China; Fauci, in keeping with the consensus among virologists and other infectious-disease experts, has said that the preponderance of biological evidence points instead to the virus having a natural origin, likely spilling over from a wild animal into humans.) In January 2025, during the final hours of Joe Biden’s term, Fauci received a sweeping, preemptive presidential pardon for “any offenses against the United States which he may have committed or taken part in” over the previous 11 years.

That pardon doesn’t cover Fauci’s actions past the end of Biden’s presidency, or protect him from prosecution over any statements he might have made today. “He could perjure himself now,” Health Secretary Robert F. Kennedy Jr. said this week on Fox News. “If he lies again, then he could be subject to perjury prosecution.”

But the most obvious distortions at the hearing came from the Senate panel. Senator Ron Johnson, a Republican from Wisconsin, proposed that the pulmonary infarction Fauci experienced in 2021—the details of which were revealed in the pages from Fauci’s private diary that Paul released last weekend—may have resulted from COVID vaccination and booster shots. More than 39,000 deaths had resulted from COVID-19 vaccination, he said, and although Facebook had censored his supporters when they tried to share that fact, “this wasn’t disinformation, this was the truth.”

Fauci only sat there with his fingers clasped. He did not point out that this was not the truth at all, and that Johnson’s data—derived from unvetted, user-submitted information in the Vaccine Adverse Events Reporting System—are likely to overestimate the real total by about 1,000 times. When Johnson finally ended his remarks with a question—he asked whether Fauci knew about the “dozens of safety signals associated with the COVID injection”—Fauci gave only his standard 21-word response: “On the advice of counsel, I respectfully decline to answer based upon my rights under the Fifth Amendment to the Constitution.”

Paul claimed on multiple occasions that Fauci had been so dogmatic in his support for dangerous and irresponsible gain-of-function research that he’d written a 2011 op-ed for The Washington Post in support of an experiment that made avian influenza more transmissible in ferrets. According to Paul, Fauci wrote in that op-ed that “even if a scientist is bitten, even if a pandemic should occur, the knowledge is worth the risks.” Fauci did write in the Post that he thought that the benefits of that experiment likely outweighed the risk. But he did not make the preposterous argument that such research would have been worth doing even if it had kicked off a pandemic.

In the past, Fauci could easily have corrected the record and provided a nuanced description of this work. Over decades, he had built a reputation as the nation’s “nonpolitical” spokesperson for public health—the role he stepped into most publicly in early 2020, when the coronavirus was first burning across the U.S. When President Trump touted ineffective drugs as cures and insisted the coronavirus would vanish “like a miracle,” Fauci refuted those claims.

Now Fauci wasn’t talking, and no one else could speak on his behalf. Early on in the hearing, one of his lawyers, David Schertler, spoke up to defend his client against Paul, but was escorted out of the chamber by security at Paul’s request, after the senator repeatedly told him, “You are not recognized!”

Democrats, meanwhile, shied away from asking Fauci questions at all—if they had, he almost certainly would have deferred every question from them, too. Instead, they spent their time scolding Paul for convening the panel at all, thanking Fauci for his service, and criticizing the Trump administration for its attacks on science and public health. The Republicans’ most aggressive allegations went unchallenged in the room.

Fauci seemed to want to say more. At least once, he leaned behind him to consult his panel of lawyers before, once again, invoking his Fifth Amendment rights; at other times, he tensed his shoulders or sighed heavily. In a 2021 Senate hearing, Paul accused him of being responsible, by funding gain-of-function research, for the deaths of millions of people. At the time, Fauci briefly broke his composure. “You are implying that what we did resulted in the deaths of individuals,” Fauci said, pointing his finger at Paul. “I totally resent that, and if anyone is lying here, Senator, it is you.”

Faced with personal attacks this morning, he offered no response. “You became a narcissist and a megalomaniac and a liar,” Hawley said. “You’ve done more to harm science than anybody in my lifetime.” Paul called the hearing the “capstone” to Fauci’s career and said he’d displayed “hubris the likes of which the world has rarely seen.” Rick Scott, a Republican from Florida, told Fauci he was a “villain” who had “destroyed the federal government’s credibility when it comes to public health” because he wanted to fuel his own ego. “What would you do differently, knowing what you know today, Dr. Fauci?” Scott asked him.

Fauci consulted the paper in front of him. “On the advice of counsel, I respectfully decline to answer based upon my rights under the Fifth Amendment to the Constitution.”

The Unmaking of Anthony Fauci

2026-07-28T08:00:00-04:00

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When Anthony Fauci arrives on Capitol Hill tomorrow to testify before Congress, he will be trailed by a security detail he’s paying for himself. Fauci has been testifying before the nation’s elected officials for roughly four decades now, since his days at the forefront of early AIDS research. In years past, he would have prepped by consulting colleagues and poring over data—he would have been there, as he might say, to speak for science. Now he’s under a subpoena from the Senate Homeland Security and Governmental Affairs Committee, and has been conferring with his lawyers on how best to navigate a grilling about his own actions—and what seems to be an effort to catch him in a lie, one that isn’t covered by the blanket presidential pardon he received from Joe Biden. Once famed for being America’s consummate nonpartisan scientist, Fauci is now a far more polarizing kind of public figure: beloved and reviled for what he’s said to represent; targeted by threats to end his life. The more he talks, the more he stands to lose.

This is not the professional coda that Fauci’s half century in government once seemed to be heading toward. For decades, he has been one of the nation’s best-known and most-respected scientists. In the late 1960s, Fauci helped lead a team at the National Institutes of Health that repurposed cancer therapies as cures for several once-fatal rheumatological conditions. His later partnerships with AIDS activists and his push to accelerate experimental-drug trials for HIV helped transform the infection into a survivable condition. He went on to serve as a chief architect of PEPFAR, a global HIV-prevention-and-care program that has prevented an estimated 25 million deaths since 2003. And over the course of his nearly 40 years as the head of the National Institute of Allergy and Infectious Diseases, he turned one of the NIH’s quietest branches into a $6 billion research juggernaut. Fauci has “saved more lives, created more amazing infrastructures for developing research opportunities, cured more people, provided health care to more people both in the United States and abroad, probably, than any single scientist in his lifetime,” Larry Corey, an infectious-disease expert at the Fred Hutchinson Cancer Center, told me.

His achievements speak to his scientific credentials, but also to his ambition and savvy. Fauci was a master of the system: He knew how to acquire and maintain scientific power; he had the ear of both academics and politicians. He eagerly courted attention, while maintaining that he was “completely nonpolitical,” to the point that even his close colleagues at NIAID had no idea how he voted in elections. “Congress really saw him as a straight shooter,” Judith Feinberg, an infectious-disease researcher who worked at NIAID early in her career, told me, without “a particular political axe to grind.” Fauci was that rare bureaucrat who could be given a Presidential Medal of Freedom by George W. Bush and then be praised as a “once-in-a-century public health leader” by Barack Obama.

But ever since President Trump retook office in 2025, his administration has engaged in a systematic effort to obliterate Fauci’s legacy. One of Trump’s first actions in office—just days after Biden issued his pardon—was to strip away Fauci’s government-funded security detail. Fauci’s image was cut out from a mural on the NIH campus around the same time. By the end of spring, the administration had rerouted government webpages once dedicated to information on COVID resources to a new site, alleging that Fauci had tried to hide the “true origins” of COVID. Trump officials went on to largely dismantle PEPFAR, imperiling many of the 20 million people the program has supplied with lifesaving therapies. They ousted most of NIAID’s long-standing leadership, including several officials who served under Fauci for years, as well as Jeanne Marrazzo, the director who succeeded him; they forced out Fauci’s wife, Christine Grady, once a bioethicist at the NIH, and arrested David Morens, one of Fauci’s longtime advisers. (Morens has pleaded not guilty to charges of conspiring to hide and destroy government records.) “Anything that he had his name on, or that was under his accomplishments, is being destroyed,” Judith Currier, an infectious-disease expert at UCLA, told me. (The White House and the Department of Health and Human Services did not respond to requests for comment.)

The attacks haven’t let up. In recent days, Rand Paul, now the chair of the Senate Homeland Security and Governmental Affairs Committee, has released troves of documents related to Fauci; among them are more than 1,500 pages from Fauci’s private diary. In one set of entries, which runs from the end of 2019 through his retirement from government at the end of 2022, Fauci meticulously chronicled his growing fame. “Truly unbelievable,” he wrote in May of 2020. “People naming their dogs after me. Sally Quinn saying that I was the erotic lead male in a book she wrote in 1994.”

Fauci has observed this campaign of vengeance and humiliation mostly without public comment—marking one of the quietest stretches of his career to date. (He declined to be interviewed for this article.) Tomorrow, though, Paul is forcing him to talk. At the age of 85, Fauci will be dragged onto the Senate floor to defend his reputation, but something bigger will be contested too: not what Fauci did during his years in government but how he did it—the way he wielded his nonpartisanship to gain resources for his institute and stay in the good graces of powerful people. That approach was once routine, and Fauci perhaps its most skilled practitioner. Now its future is in doubt.

For all of Fauci’s fame and clout, he was not necessarily the most obvious choice, in early 2020, to be the public face of the United States’ response to COVID. In title alone, the CDC director, then Robert Redfield, would have been a far more obvious choice, Georges Benjamin, the executive director of the American Public Health Association, told me. But the Trump administration instead put Fauci onstage.

Through the early months of the pandemic, as people scrubbed down their groceries and watched news clips of bodies being piled into refrigerated trucks, Fauci’s calm, science-focused statements were a stabilizing force. Eventually some came to regard him with a singular reverence—as if public health were a new religion, and Fauci its living idol. His likeness appeared on T-shirts, socks, and buttercream-frosted donuts; there were Fauci bobbleheads and face-masked Fauci action figures; people put up yard signs declaring In Fauci we trust. On votive candles dedicated to “Saint Fauci,” artists ringed his gray hair with a golden halo. At times, Fauci appeared to embrace his status as expertise personified. “A lot of what you’re seeing as attacks on me, quite frankly, are attacks on science,” he told MSNBC in 2021.

[Anthony Fauci: What I saw inside the government’s response to COVID]

But his fame quickly began to cut both ways. If some Americans (especially establishment-minded Democrats) designated him the heroic embodiment of public health, others (including the MAGA and proto-MAHA crowds) quickly cast him as its lead villain: a power-drunk official who overhyped the benefits of masking, tanked the economy, annihilated small businesses, and pointlessly disrupted learning for millions of children. For the first time, Fauci was openly and repeatedly clashing with a president, too. He masked in public when Trump would not, and he contradicted Trump’s wild claims about injecting bleach and taking hydroxychloroquine. His strategy of aligning himself with the public-health consensus, which had once endeared him to politicians, now made him appear to be a partisan opponent. In the early months of COVID, Fauci’s staff at NIAID began to flag the most violent emails in his inbox for a security team. One man said that Fauci and his family would be “dragged into the street, beaten to death, and set on fire.” (That man was convicted of threatening a federal official and sentenced to more than three years in federal prison.) By the end of 2020, he was traveling with bodyguards.

Certainly, Fauci made mistakes. Early on, for instance, he advised against the widespread use of masks amid a shortage of them and then reversed that position. “I don’t think the communication around that was particularly good,” Emily Erbelding, a former director of NIAID’s Division of Microbiology and Infectious Diseases who was ousted from her role last year, told me. “It was just No masks, and then all of a sudden Everybody’s wearing masks, and you must wear a mask.” But Fauci was also asked to weigh in on seemingly every pandemic policy, including many far outside his purview, and he was doing so as everyone’s understanding of the virus was evolving rapidly and in real time. When Fauci said that sending kids back to school without a vaccine could be risky, and that opening schools in areas experiencing intense viral transmission would not be prudent, many people took that to mean Fauci said to keep all kids home, indefinitely. (School closures were ultimately up to individual states and districts, and decisions about them were complicated by demands from teachers’ unions.)

If Fauci was the patron saint of all that was good about public health, he was also demonized for all of its failings. By the fall of 2020, the apolitical persona that Fauci had cultivated over nearly half a century had started to come apart.

Anthony Fauci in his office in Bethesda, Maryland, 2003 (Michael Geissinger / LOC / Getty)

Fauci has described the principles that drive him—public service, integrity, clarity of thought and speech—as the yield of his Jesuit schooling. He came to understand that, as a doctor working at the NIH, he could aid not just individual patients or a single hospital, but potentially entire nations that stood to benefit from cutting-edge research. And despite repeated offers to be nominated for NIH director, he chose to remain at NIAID—in part to remain in proximity to the HIV/AIDS research that he felt closest to, his colleagues told me, but also because he didn’t want the baggage that came with being a political appointee. He preferred to maintain unchallenged influence, they said, over almost his entire field.

That penchant for control was coupled with a sizable ego. I spoke with 15 of Fauci’s friends and former colleagues, and they described him as someone who adored the attention that came with being a go-to health expert for journalists and presidents alike. “He certainly embraced that role—sometimes, I thought, a little too much,” Hugh Auchincloss, Fauci’s former deputy director at NIAID who retired in 2024, told me. The pandemic diary entries fit that assessment: The phrase prolonged standing ovation appears seven times throughout; his admirers are repeatedly described as being brought to tears by his presence. “As soon as people recognized me there was a wave of applause and squealing and screaming and clapping and thanking me with multiple people coming and asking for selfies,” he wrote in May of 2021. “It was a little bit embarrassing, but it was just a manifestation of how people need a symbol of integrity and truth.”

[Read: America is thirsty for Anthony Fauci]

Many people told me that Fauci could be a challenging supervisor. He was a chronic workaholic who expected the same of his top officials. In his institute, everyone knew that if you were early to a meeting with Fauci, you were on time; if you were on time, you were late; if you were late, you were in serious trouble. “He has a very Italian temper, and he’s famous for losing it,” especially at people who pretended to understand what they did not, Judith Feinberg told me. To get on Fauci’s good side was to earn his confidence, his respect, and the benefits of his network of resources; to land on his bad side was to be carved into shreds inside his office, the worst of his rampages audible through the closed door.

Fauci could inspire others’ fury, too, even well before the pandemic. During the early days of the HIV/AIDS epidemic, activists from the gay community lambasted him and his institute for the plodding pace of research on the virus. In 1988, the playwright and activist Larry Kramer wrote an open letter describing Fauci as a murderer and a “fucking son of a bitch of a dumb idiot”; two years later, the group ACT UP surged onto the NIH campus to burn Fauci in effigy, carrying a casket that read Fuck you, Fauci. (He later invited those same activists to weigh in on the state of AIDS research, eventually converting them into allies.)

His biggest adversaries now, though, are not representatives of a marginalized group that many Americans once condemned, but some of the country’s most influential figures in media and politics. Joe Rogan has described him as a “monster”; Elon Musk has said he was a “freaking demon.” Health Secretary Robert F. Kennedy Jr. published a 500-page book called The Real Anthony Fauci, which accuses him of having organized a “historic coup d’état against Western democracy” and seized a “power enjoyed by few rulers and no doctor in history.” (Meanwhile, the book lionizes people who promote AIDS denialism and anti-vaccine views.) Trump has referred to Fauci as a “disaster” and an idiot “who got it wrong.”

Fauci’s most extreme critics don’t just contend that he endorsed wrongheaded pandemic-era mitigations; they allege that he played a role in starting the pandemic—that under his direction, NIAID knowingly funded dangerous research that boosted coronaviruses’ ability to infect and kill humans. Fauci “knows a lot more than he’s told so far,” Jeffrey Sachs, a Columbia University economist who chaired The Lancet’s COVID commission and has been publicly critical of Fauci, told me. (Sachs has argued that the coronavirus may have originated from U.S.-funded research, and that Fauci knew this very early on and tried to hide that fact.)

The consensus view among virologists is that the virus that causes COVID likely spilled into humans from a wild animal—a known and common cause of new epidemics. Several agencies within the U.S intelligence community agree, but a few others have come to the opposite conclusion. In any case, some senior leaders in the Trump administration, as well as members of the GOP majorities in Congress, feel certain that the pathogen first emerged from a Chinese laboratory. To them, Fauci is a prime culprit in this story: As they see it, he concealed evidence linking NIAID to the Chinese facility where that research occurred. Rand Paul, in particular, seems bent on getting Fauci prosecuted for allegedly bribing and coercing intelligence officials to aid in his cover-up. “He has not really gotten his just deserts,” Paul recently told Fox News. “There needs to be repercussions.” (Paul’s office did not respond to repeated requests for comment.)

[Read: Lab-leak payback has begun]

Fauci, for his part, has vehemently denied that NIAID bankrolled irresponsible research, and maintains that his former institute is not to blame for COVID; he has called the notion of a cover-up “preposterous” and pointed to an email from February 2020—in which he said that if legitimate evidence of a lab leak emerged, it should be reported to intelligence officials—as confirmation of his transparency. Fauci has also openly favored the natural-origin hypothesis, as have most others in his field. All along the way, he has continued to present himself as someone whose primary allegiance is to the facts—a “nonpolitical” person to the end. Yet much of the public has long since stopped perceiving him as such. By the 2020 election, Fauci had become a campaign talking point; Trump mocked Biden for trusting Fauci, and accused Fauci of being a Democrat. (Fauci has long been registered as an independent.)

In December 2020, Fauci accepted Biden’s offer to become the president’s chief medical adviser, a position he’d never previously held. And in early 2025, hours before Biden left office, the president issued Fauci a full and unconditional pardon for “any offenses against the United States which he may have committed or taken part in” over the previous 11 years. Many on the right took that as an admission of Fauci’s guilt for COVID-related crimes. At the very least, it was an indication that Fauci’s strategy of scientific separatism had come up short. Now he needed politics to protect him.

For many Americans, Fauci remains a public-health icon. A recent poll shows that, nearly four years after he left government, more than half of Americans still have confidence in what he said about public health. In that regard, he polls far better than health officials who are currently in office, including Kennedy and Mehmet Oz.

But polling also suggests that trust in Fauci has ticked down over time. Several of his former colleagues told me they worry that Americans will continue to sour on him as the political fight over his legacy drags out. For the moment, Fauci is constrained in his ability to defend himself. Paul has argued that Fauci’s sweeping pardon precludes him from invoking his Fifth Amendment right. But whether he could plead the Fifth throughout the hearing comes down to whether there is “a realistic threat of prosecution,” which still seems highly plausible, Richard Hughes IV, a legal expert at George Washington University, told me. But that defensive strategy, even if effective, could also leave a lasting mark on Fauci’s legacy: For the scientist who never shied away from attention, and who came with all the answers, the repetitive demurral would surely be excruciating.

Even if Fauci emerges unscathed, several of his friends told me they despair at the disruption this saga is causing to his life. (Although the death threats against his three daughters have mostly subsided, he and his wife have continued to receive them.) Fauci still holds a teaching position at Georgetown University and regularly travels to give talks—accompanied by security guards. But at 85, he is weary; some of his closest friends told me they want nothing more for him than peace. Barney Graham, a former deputy director of the NIH’s Vaccine Research Center, told me that he and some of his colleagues feel some survivor’s guilt as they watch Fauci endure attack after attack: “He kind of martyred himself for the sake of all the other scientists.” Several were reluctant to criticize Fauci in any way, on the theory that doing so would only give more fodder to his right-wing critics. (A few of his close friends and colleagues declined to speak with me at all, citing fears that their words would not help Fauci.)

If Fauci’s legacy now seems fragile, that may be partly due to how he built it, Jeanne Marrazzo, the most recent NIAID director, told me. Many of the researchers in top leadership positions at NIAID were Fauci’s longtime colleagues; the institute’s priorities were heavily shaped by his personal research goals. Fauci “owned an empire,” she said, and when you own an empire, “it lives and dies with you.” The first time she walked into the director’s office after Fauci had retired, it still resembled a self-curated shrine, its walls covered with awards and celebrity-studded photographs that hadn’t yet been cleared. Fauci obviously wanted his own presence at the NIH to last, she told me. In the days after Trump’s second inauguration, Fauci emailed her to ask what would happen to an expensive portrait of him, completed in 2023, that had never been hung.

Marrazzo inherited Fauci’s throne in the fall of 2023; the Trump administration forced her into administrative leave less than two years later. (Kennedy personally fired her at the end of 2025, after she filed a whistleblower complaint criticizing recent shake-ups at the NIH; Marrazzo has since sued the Trump administration for wrongful termination.) Unlike many other members of NIAID’s leadership, she had never been personally close to Fauci, and she took over NIAID eager to nudge the institute in new directions. But as far as she could tell, succeeding him seemed enough to make her a target.

Several of Fauci’s friends and former colleagues told me that they were hopeful that, with the passage of time, the vitriol would fade, administrations would change over, and the history books would ultimately memorialize Fauci for the scientific advances he spearheaded and the lives he saved. At the same time, several of the people I talked with admitted that Fauci’s recent experiences had forced them to reflect on what it meant to be a scientist in the modern era, when the practice of research and public health is under political attack.

They may understand that the approach to scientific leadership at which Fauci most excelled—moving through the nation’s politics, instead of being caught up in them—no longer works the way it did before. Americans have been advised by top health officials to second-guess traditional scientific expertise; some of those same officials now profess neutrality as they make “gold-standard science” their euphemism for political control. For decades, Fauci stood before the nation to offer steady and nonpartisan advice. In tomorrow’s hearing, that voice of science may not be heard at all.