Ever find yourself hunched over your laptop, eyes glazed, slack jawed, and stunned by the quantity of information modern life is throwing at you? You might take a break to stare at your phone. Or you could try switching from one browser tab to the next while checking your email and inching closer to the day’s deadline. 

Some people call this TikTok brain. Others call it brain rot. Either way, it feels like a distinctly 21st-century affliction, caused by scrolling through too many short-form videos and social media feeds that trains your brain to seek out little hits of dopamine and ruins your ability to focus on anything for more than a few seconds. People with the condition may not be able to read books or even watch feature-length films. They can’t do anything except watch little videos, leaving them prone, catatonic, faces blank and bright in the glow of their smartphone screens. 

I don’t even use TikTok, but I feel this way all the time. Give me one hour to complete a task that requires even a medium amount of mental fortitude, and I’ll find 55 minutes’ worth of other things to do. It’s not that I’m avoiding the task. But once I get started, my mind wanders relentlessly, no matter how hard I try to keep it on track.

You can blame technology for doing this to you — and I do — but the real issue is with how we treat our brains. Generally speaking, the human brain works like an analog computer, processing one thing at a time, and when you switch tasks (which is what we’re actually doing when we say we are multitasking), it comes at a cost: It drains your cognitive resources, which makes it even harder to pay attention in the future. The more you do this, the more ingrained the behavior becomes.

“It’s a myth to think that we should push ourselves to focus as long as possible and we’ll be more productive,” said Gloria Mark, the author of Attention Span: A Groundbreaking Way to Restore Balance, Happiness and Productivity and the Substack The Future of Attention. 

The human attention span is not one thing. There are different types of attention, including sustained attention (your ability to stay engaged with a task over a period of time) and selective attention (your capacity to take in certain information while tuning out irrelevant details). Alternating attention (the mental flexibility required to switch tasks rapidly) and dividing attention (process multiple things at once) are especially demanding on your cognitive resources. And all of this is managed by the brain’s command center, your prefrontal cortex, which handles executive function. When you’re experiencing cognitive fatigue, there’s a physical reason why: There’s actually less blood flowing to this portion of the brain.

“We need to stop trying to recover from cognitive fatigue and overload by consuming more information.”

Amisha Jha, University of Miami neuroscience professor

The good news is that the damage is not permanent. The human brain’s capacity to focus is just as intact as it was in the 19th century when everyone spent their evenings reading novels and knitting fisherman sweaters. Lots of things have changed since then, of course. As smartphones have driven us to consume endless amounts of information, psychologists have been working on strategies to put the pieces of our attention spans back together. I called a few of these attention experts hoping that they might tell me the secret to regaining my ability to focus. They all agreed that two things are necessary to solve the problem: Be intentional with your attention and let your brain rest.

“What we need most is the capacity to know where attention is, moment by moment, and greater agency over our attention so we can direct it intentionally,” Amishi Jha, a neuroscience professor at the University of Miami and author of Peak Mind, told me. “We need to stop trying to recover from cognitive fatigue and overload by consuming more information.” 

Put another way, in order to reclaim your attention span, you first need to be mindful. That means spending less brain power dissociating on social media feeds and more on whatever you’re actually interested in. You also need to give your brain a chance to rest and recover. Staring at your phone will not help you recharge and reclaim your attention span. Staring at a tree, however, will. 

Let your brain rest

One way to think about your own attention span is to consider what is voluntary and what is not. When something like a bright light or a loud noise grabs your attention, it engages your involuntary attention, which is effectively limitless. When you’re deciding to pay attention to something, however, you’re using your voluntary, or directed attention. This is a limited resource. As you’re making an effort to focus on something, like a book, your supply of directed attention runs down, but it can be replenished in specific ways.

This simpler way to understand how our attention works dates back to the 19th-century psychologists, like Williams James, but it’s making a comeback thanks to attention restoration theory (ART). This school of thought, first developed in the 1980s by University of Michigan psychology professors Stephen and Rachel Kaplan, suggests that spending time in nature restores your directed attention. The theory claims that the natural world does this by captivating our indirect, or involuntary, attention and allowing our cognitive resources to recover.

Imagine you’ve gone for a hike and happen upon a waterfall that’s so fascinating you can’t look away from it. Marc Berman, one of Stephen Kaplan’s former students and now a professor at the University of Chicago, refers to such a spectacle as a “soft fascination,” something that can grab your attention without consuming it, thus giving your mind space to wander. You might get the same effect from staring at a campfire or looking up at tree branches swaying in the breeze. Hard fascinations, by contrast, capture so much of your attention that you can’t look away and you can’t quickly recover. Times Square is a canonical example, but being on social media counts, too.

“Doomscrolling, streaming, surfing the internet — they’re activities that maybe seem restful, but we actually think that they’re fatiguing and depleting,” said Berman, who is also the author of the book Nature and the Mind: The Science of How Nature Improves Cognitive, Physical, and Social Well-Being. 

In one study Berman conducted, he and his team (which included Kaplan) gave research subjects difficult attention and memory tasks, sent them on a walk in nature or an urban environment, and then repeated the tests. The participants who went on nature walks improved their performance in these tests by about 20 percent, Berman said, and the improvements held regardless of whether participants said they liked the walk or not.

“One of the great misconceptions about attention is that it’s simply a matter of us paying attention.”

Nilli Lavie, University College London psychology professor

Berman said they aren’t entirely sure why nature seems to have this effect on us, but he theorizes that it relates to fractals, or repeating, self-similar patterns whose individual parts resemble their larger whole — tree branches or fern leaves, for instance. Fractals are common in nature, and Berman thinks their orderly arrangement helps our brains to process the information. “It’s easy to get the gist and you don’t need to encode all the details,” he said. “Whereas in the built environment, it’s not very fractal and you might have to encode everything, which might be more taxing.”

Of course, it’s not always possible to zip over a forest in the middle of the work day. If you can’t take a walk in the park, Berman said that even looking at a picture of nature scenes can help. (Try not to do that on Instagram, though, because you might end up just doomscrolling.) 

Be intentional with your attention

Reclaiming your attention is one thing, but holding onto it in the first place is its own distinct challenge. When you find yourself feeling distractable, it might be that you need a break. If that’s the case, you can’t will your way into concentrating.

“One of the great misconceptions about attention is that it’s simply a matter of us paying attention,” said Nilli Lavie, a professor of psychology and brain sciences at University College London. “It’s not enough to just want to pay attention.”

Instead, you have to put yourself in an environment that makes paying attention not only possible but achievable. That means making a concerted effort to avoid multitasking, which will drain your cognitive resources. Try the alternative: monotasking. 

Monotasking likely requires clearing away clutter, whether that’s literal clutter on your desk, or digital clutter on your screen in the form of extra apps or browser tabs. Turning off all notifications is essential. You should also hide your phone — put it in a drawer or in another room. (A widely cited study published in 2017 found that even having a phone in sight can reduce your cognitive capacity and affect your ability to concentrate.) When you need to take a break, don’t go find your phone: Take a walk outside, or stare at a tree, or look out the window and listen to a song you like.

Monotasking also means being intentional about how you do that one thing, avoiding distractions along the way. At work, this might mean carving up projects into digestible chunks. You might even try the Pomodoro technique: Set a timer for 25 minutes, focus hard on the task until it goes off, take a five-minute break, and repeat. At home, it could mean making to-do lists and prioritizing tasks so that the toughest ones get done first, while you still have some gas in the tank.

If you aren’t ready to turn off all notifications at this point, at the very least turn off all the ones that aren’t coming from humans. You do not need to be alerted of an Amazon flash sale while you’re trying to plan your family’s meals for the week.

Give yourself some constraints

There’s no such thing as being 100 percent locked in to any given task. When there are no external distractions, your brain actually turns inward and finds something else to pay attention to, which can lead to daydreaming and mind wandering. Daydreaming — creating a structured narrative of imaginary scenarios — is not necessarily a bad thing, by the way. It can be productive in helping you plan and think creatively. But if you’re just mentally wandering from random topic to topic, you’re getting into the danger zone. 

Some people find that adding constraints can improve their attention. One approach you’ll see in self-help books is the use of a so-called commitment device that restricts future behavior in service of a larger goal. If you’ve read (or seen) The Odyssey, you might remember the scene in which Odysseus orders his crew to tie him to the ship’s mast and ignore his orders so that he won’t steer the boat into the rocks when he hears the Sirens’ call. Odysseus was using a commitment device to avoid killing his whole crew. You might use a commitment device, like a dedicated writing space or the Pomodoro technique, to avoid distractions, both external and internal. 

So how do you focus just the right amount? Removing those external distractions is a great start. Much like paying attention, ignoring these distractions consumes your cognitive resources, impacting your performance, and causing you to make mistakes. It also takes more effort to stay on task as time goes on. From there, do your best to avoid overtaxing your brain to the point that the internal distractions take over and your mind is wandering. That’s how you know it’s time to take a break.

“For several minutes, give yourself no new input,” Jha said. “Do not reach for the phone while waiting in line. Take a short walk without listening to anything. Look out a window. Let the mind wander without trying to solve a problem.”

Take a walk in the park. Sit quietly and look at a bird. Paying attention has never sounded so relaxing.

Over the weekend, Rep. Alexandria Ocasio-Cortez (D-NY) announced on Instagram that she had joined the thousands of American women who freeze their eggs every year, a number that has been steadily growing for the past decade.

“This is a choice that I am making to feel more in control of my life,” Ocasio-Cortez said in her Instagram story sharing her decision. 

As politicians in the public eye often do, Ocasio-Cortez turned her personal choice into a statement:

Usually I keep my private life quite private, but I have made the decision to start freezing my eggs, and I want to share this because I was weighing it for a very long time. I was saving for it for a very long time, and there just isn’t a ton out there, I feel, and sometimes it can feel very daunting. As women in general, we are not taught about our own bodies. We are not prepared for our own lives. … We need to show more depictions of women having full lives.

At the same time, she acknowledged being “in a very privileged position” to be able to take advantage of egg freezing. The process still typically costs $10,000 or more — and most insurance still doesn’t cover it. Not even AOC’s federal health plan. Egg freezing is a luxury afforded only to the people who can pay for it and take on the significant burden of the treatment and all of the uncertainty that comes with it.

Ocasio-Cortez’s announcement underscores the awkward place that egg freezing still occupies in the landscape of fertility access — at a moment when Republicans in power are lamenting falling birth rates and searching for ways to encourage more people to start families. In theory, egg freezing gives women the flexibility to take more control of their decisions about having kids and preserve that possibility for themselves in the future. But in reality, the promises of this important procedure have often been unfulfilled. 

Beyond the intimidating price tag, as AOC alluded to, many young women don’t know some of the basics about age-related fertility decline and how to maximize their chances that egg freezing will lead to an actual pregnancy. There are some “significant gaps in fertility knowledge amongst Gen Z women in particular,” said Danielle Melfi, CEO of Resolve, a fertility treatment advocacy group. 

“That points to why someone like AOC who has such broad awareness and broad reach across her channels,” Melfi told me, “specifically younger people who aren’t tuned into any politician but would be tuned into her. Her sharing her story and journey matters.”

Egg freezing is not a panacea, and it never will be. But it can give individuals options and a sense of empowerment. And right now, as AOC acknowledged in her video, those are privileges reserved for the people who are in the know and have the means to take advantage of it. For everyone else, significant barriers still remain.

Freezing time doesn’t come cheap — or easily

On average, the cost of egg freezing averages between $10,000 and $20,000. And, for most people, including AOC, who makes $174,000 a year on her congressional salary alone, health insurance coverage is not an option. According to a 2024 KFF employer survey, just 12 percent of large employers who offer health insurance provide egg or sperm freezing.

That’s not for lack of trying.

As of now, 21 states have mandates requiring health insurers to provide some level of coverage for “fertility preservation” when it is deemed medically necessary — for a younger cancer patient who is about to undergo chemotherapy, for example, a more and more common scenario these days. But coverage for what is viewed as elective freezing, as AOC is doing, is still generally not included in those requirements.

But even the state-level mandates come with a huge carveout. Under America’s Frankenstein healthcare system, there is a very important type of health insurance plan that is exempt from such state laws: self-funded employer plans, meaning those that fully cover their workers’ medical expenses without relying on an outside insurance company. They are governed only by a federal law known as the Employee Retirement Income Security Act, and that law provides no guarantees for egg freezing or other reproductive care. 

About half of Americans get their insurance through their work, and of those employer plans, more than 60 percent are self-funded. That is a lot of people who have no guarantees for this kind of service, even when a serious medical reason is motivating them to freeze their eggs. The select few who can get egg freezing covered are typically higher-income, too, adding to the disparity between the US healthcare system’s haves and have-nots.

Support for IVF among the American public has been rising, with 70 percent saying in 2024 that access to IVF was a good thing. And fertility coverage is having a political moment, too: the HOPE With Fertility Services Act, which would require insurers to cover some basic fertility treatment when it is deemed medically necessary, was introduced this year with a bipartisan slate of more than 20 sponsors, though it remains stuck at the committee level for now. The Trump administration has fixated on dropping fertility rates, but, beyond a limited IVF executive order, they have not seriously pursued plans to expand access to egg freezing. A national mandate to cover egg freezing, even only when medically necessary, could end up being opposed by both health insurers (which have fought all kinds of benefit requirements in the past) and the religious right (which has specifically challenged mandates for reproductive healthcare, like the Affordable Care Act’s contraceptive mandate).

It will likely take a variety of policy changes to give people more financial support for this important but expensive service. So what now? Unfortunately, I think we are stuck with patchy coverage and can expect only incremental improvements for the foreseeable future. On the plus side, Melfi said, more employers may increasingly offer these benefits as a competitive advantage.

But access isn’t the only problem.

Egg freezing works best when people actually know how to take advantage of it

Even if a person is able to access egg freezing, it doesn’t always pay off. 

A study published in the American Journal of Obstetrics and Gynecology in February found that fewer than 6 percent of people who froze their eggs electively had come back to thaw them within five to seven years. Of those people, 79 percent had a usable embryo after warming and 29 percent had a pregnancy that resulted in a live birth.

Of course, just because some people haven’t warmed their eggs within seven years doesn’t mean they won’t come back in nine: The point of this service is you could freeze your eggs at 30 even if you’re not ready for kids until you are 40. Those numbers will likely grow with time. And some of those people might end up successfully getting pregnant on their own the old-fashioned way, which means they won’t need their frozen eggs at all. 

“Typically, people who are coming in to freeze their eggs haven’t actually tried to conceive yet. When they are ready to start conceiving, a lot of people may not have any issues conceiving,” said Dr. Mabel Lee, a reproductive endocrinologist and infertility specialist at HRC Fertility in Pasadena, California who led the published study. 

What is true is that getting pregnant is difficult no matter how you go about it — even conceiving through intercourse only results in a 20 to 25 percent success rate on a given try, Lee said — and success with frozen eggs depends on how young the person was when their eggs were preserved: The younger they are, the higher the chances of success. That makes it all the more important that people — particularly younger people — know about the realities of egg freezing and how to make the most of it, whether they are spending thousands of dollars of their own money or whether they are using insurance to pay for it. Awareness among young people of the basic relationship between age and fertility remains discouragingly low. Lee said she has patients come in all the time who say they wish they had known more about egg freezing sooner.

The likelihood of a live birth may go up if the eggs were younger, but is that enough to convince someone in their mid-20s to pay out of pocket to freeze their eggs? In the midst of an affordability crisis, is that even an option? It might not be; in the meantime, Lee said women could get a blood test to measure their ovarian reserves, which estimates a person’s egg count, and use that to make an informed decision about egg freezing in consultation with their doctor.

Once you have decided to freeze your eggs, using a high-quality clinic is a must: That’s the other major variable in success, Lee told me. The Society for Assisted Reproductive Technology maintains a national database covering clinics across the country and tracking birth success rates and other metrics. It’s like a report card of sorts, so you can hopefully choose the best provider for you.

There are still no guarantees. Fertility is too fickle. But by improving access and raising awareness, there are clear steps we can take to try to maximize egg freezing’s potential.

This story appeared in The Logoff, a daily newsletter that helps you stay informed about the Trump administration without letting political news take over your life. Subscribe here.

Welcome to The Logoff: President Donald Trump is trying to revise the childhood vaccine schedule. 

What’s happening? On Monday, Trump signed an executive order recommending fewer childhood vaccines, directing new vaccine research, and attempting to advance “parental choice” on vaccines. The new guidance substantially cuts the number of shots recommended for all children, from vaccines for 18 diseases to just 11. 

Vaccines for rotavirus, meningococcal disease, the flu, and Covid-19 are all among those the order no longer recommends for all children.

What does that mean for vaccine access in the US? For now, not too much. The order only issues recommendations, and as the Washington Post points out, many states have already elected to stop relying on federal vaccine recommendations. It’s certain to increase confusion over vaccine safety, though, and could throw up new administrative barriers for parents. 

Why does Trump care? Trump has long amplified baseless conspiracy theories linking childhood vaccines to autism; on Monday, he claimed that childhood vaccine doses are “the size of a bottle of soda poured into a little child’s body.” (They are not.) 

Parts of the order directly reflect Trump’s personal hobbyhorses around vaccines, such as a recommendation to break up the MMR (measles, mumps, and rubella) vaccine into three separate shots; as the Post points out, those kinds of individual shots aren’t even commercially available right now.

What’s the big picture? Monday’s EO doesn’t make any earthshattering changes, but it’s concerning to see vaccine policy — or at least policy recommendations — made from the Oval Office. And the order will have another impact: Trump’s attempts to dictate vaccine policy to states, combined with Health Secretary Robert F. Kennedy Jr.’s year and a half plus of meddling, will only serve to further demolish America’s splintered public health consensus.

And with that, it’s time to log off…

Have you heard about the fitness competition Hyrox, possibly against your will? Have you not heard about Hyrox? Are you perhaps thinking of the Oreo-adjacent cookie Hydrox instead? Whichever category you fall into, I recommend my colleague Alex Abad-Santos’s latest piece explaining what exactly is going on over there. You can read it with a gift link here.

Have a great evening, and we’ll see you back here tomorrow!

Exercise can be a humbling experience. 

A simple push-up can debase the most dignified humans, transforming them into helpless little halibuts, unable to unmoor their bellies from the floor. Squats and lunges can leave their victims crouching like tiny goblins or trembling against gravity’s will. Have you ever willingly watched yourself run at full speed? Only if you have self-esteem of steel.

But for certain people, the most physically demanding experience of their lives is not something they want to avoid, but an alluring temptation: a challenge too impossible to ignore, an irresistible dare that must be completed day after day. And they quench this desire — as well as the thirst for friendship and community; some vanity muscles; and mini vacations to the likes of Oslo, Brisbane, and Bangkok — in the sweaty, grunty, made-for-TikTok $200 million world known as Hyrox. 

What is Hyrox and why is everyone doing it without me?

HYROX is stylized in all caps. Capitalization makes it seem as if it’s a word that only exists to be yelled, an apt choice for an experience that seems to take inspiration from military training and/or the PE class you hated growing up.  

Since launching in Germany in 2017, Hyrox has become a worldwide phenomenon. As CNBC reported in June, it initially started with just 650 people and now is projected to capture roughly 1.5 million participants across 121 events in 34 countries around the world. Revenue, which comes from a combination of contest entry fees, sponsorships, merch, licensing for Hyrox-affiliated gyms, and other avenues, is expected to reach $270 million in 2026. This year, 42,000 tickets were sold to the New York City race in the event’s first 24 hours. In 2025, there were roughly 12,700 athletes registered for the event.     

Technically speaking, Hyrox is a timed competition that spans eight rounds; the person or team — athletes can compete as individuals, as doubles with a partner, or as part of a relay — with the fastest overall time wins.

Each round consists of a 1-kilometer run followed by a more “functional” strength-based move, often done using a machine. These exercises include: 1,000 meters on a SkiErg; a weighted 50-meter sled push; a weighted 50-meter sled pull; 80-meter burpee broad jumps; a 1,000-meter row; a 200-meter Farmers Carry (lugging around two heavy weights at your side while walking); 100 meters of lunges with a sandbag on your back; and 100 wall balls (squat thrusts that involve launching a medicine ball into the air as you stand). It’s run-exercise-run-exercise-run-exercise until all eight kilometers and all eight movements are completed.

But Hyrox is also, Hyroxers say, a lifestyle. Because the best way to succeed at Hyrox — and for many participants, winning or at least finishing with a decent time is the goal — is to train for it. That likely means going to Hyrox-affiliated gyms that prepare you for the different exercises, and training alongside other people who also plan to run the race. And that’s where it can get all-consuming.    

Abby Roskind, a 35-year-old project manager living in Washington, DC, who has finished two races, told me that Hyrox sort of subsumes your entire existence. Training for Hyrox, she said, involved 5:30 am workouts, an excruciating amount of time learning how to properly broad jump, daily soreness, and lots of complaining. 

“Because you are always with other people doing these things, it becomes a little bit of a hostile takeover of your life where you meet up with your ‘fitness’ friends, and then they become your actual friends, and all you end up doing when you’re not training for Hyrox is talking about Hyrox,” she said. 

Roskind and other Hyroxers told me that people who are very serious about wanting to do well in competition may go on a diet, cut alcohol before the race, or squeeze in extra workouts, which naturally leads to less dinners out, less meeting up for drinks, and, ultimately, less socializing. It makes sense that people going through this experience will want to talk about Hyrox since so much of their life centers on it, and that the best audience for a discussion on Hyrox strategy would be other people doing Hyrox. 

“It definitely didn’t come across as culty where it’s like, ‘Oh, welcome to my Scientology of Exercise and you’re going to do this,’” said LJ, a 34-year-old with one Hyrox under his belt. (LJ told me he was afraid of being “canceled” by fellow Hyroxers and maybe his friends for talking to Vox, so we agreed to let him use his first initials to maintain some anonymity.) LJ said that one of his friends had run races in Europe and talked him and a small group of others in their circle into competing this past year. They generally approach it as a fun, casual thing to do together.  

@sotrue.kristin

just a spectator, speculating😌 #hyrox #chicago #fyp #foryoupage #spectator

♬ WHERE IS MY HUSBAND! – RAYE

“But then when I got to the actual venue day of the race, I felt like Hillary Clinton walking through that apartment like, What the hell is going on here?” he said. “Because there are a lot of people where this is a big chunk of their life. I saw people walking around — I guess they [Hyrox] give out badges — showing all the badges that they had from all the different cities that they competed in.” 

The idea of someone, ostensibly with a day job, going from city to city to compete in Hyrox and then showing off commemorative brooches is what signaled to LJ that the workout he enjoyed could be experienced in a different, more serious way. In that moment, LJ saw Hyrox the way outsiders might. Still, for him, the positives of Hyrox — being in better shape; experiencing runner’s highs, friendships, and the rush of competition — outweighed the possible cult-by-association.

A lot of people want to feel like an elite athlete, and now we can pay for the experience

If you make a Hyroxer feel comfortable enough, you will find that they all love to talk about the parts of the race they hate the most. It’s the feeling of thick death rushing through their lungs as they stare down the number of meters left in the burpee broad jump section. It’s the judges who are there to make sure participants are getting low enough during the wall balls. It’s seemingly everything about the race. 

There’s a bottomless chasm between how much people love Hyrox and how much they love to talk about how much it actually sucks to do. The bridge that connects the two is getting to feel like an elite athlete.  

“Once you become an adult, how many times are you going to get a sticker?” James McMillian, a trainer and the president at Tone House, a strength and conditioning facility in New York City, asked me. “How many times are you going to get a reward? How many times are you going to get a medal? People just want to be part of something. They want to feel close to greatness.”

McMillian, who has completed six Hyrox races, said that the vast majority of us will never ever know what it’s like to be a GOAT like A’ja Wilson or Lionel Messi, but Hyrox lets racers microdose it: the discipline sticking to a training schedule (as opposed to just working out day after day), the adrenaline of competing on game day, and the high of thousands of people cheering for you. 

“They turned working out into an athletic sport,” McMillian said. “Making everyday people feel like an athlete and giving them that opportunity to compete like one — that’s a smart business.”

Because it turns out that people are more than willing to pay for that athlete feeling. 

While participants aren’t required to work out at Hyrox-affiliated gyms to run the race, Hyrox-specific classes can cost more than regular group fitness packages. One Hyroxer told me that their 10-class package was around $600. There’s also a microindustry developing around getting better times. You might, for example, purchase Hyrox-branded fitness trackers and training apps, Hyrox shoes, and Hyrox equipment for your home gym (like a Hyrox Official Competition Power Rope, $275; Official Competition Sandbag, $87; or HYROX Perform Turf, starting at $1,799).     

The actual competition varies in price depending on the race and location, but can cost upward of $200. Racers can also opt in for a $35 photo package, which means a professional will take shots of themselves looking muscular and sweaty during the race.

You don’t have to beat anyone else better or qualify to compete in Hyrox — you just have to buy a ticket in.

Then there’s Hyrox’s travel aspect. Hyrox is a benchmark and a goal, and race day is the culmination of all the training and sacrifice. It’s also where you get an official time. More competitive racers are training not just for their home city’s Hyrox, but to go to other races on the Hyrox calendar. 

The races are often in desirable destinations like Rome, Berlin, and Miami Beach, which can make Hyrox seem like vacation or, I guess, make a vacation seem more like Hyrox. If you’re traveling for Hyrox, that may mean paying for a plane or train ticket, or gasoline, and lodging. One Hyroxer I spoke to said that he spent roughly $1,500 on airfare and a hotel in addition to the official entry fees and photo options. Another said they spent roughly $500 in travel, saving money by splitting a hotel with a fellow racer. 

“Look, it’s the fitness space’s Eras Tour,” Bobby McMullen, a trainer and founder of the fitness app Adonis, told me. McMullen has completed four Hyrox races. “If you don’t get to do as well as you think, you’re like, ‘I’ve always wanted to go to Vegas, I’ll go to Vegas,’” McMullen said. “Or if maybe you do really well and you’re like, ‘Oh, I want to go do that again.’”

“If you travel for Hyrox, just like if you travel for Taylor or if you travel for Disney, that’s fine,” McMullen added. “But the thing I learned about Disney adults is they’re rich. It’s so expensive. Same with Hyrox.” 

Hyrox is easy, sort of 

Here is a secret to the success of Hyrox that you may not believe: Despite its HARDCORE exterior and all of its supposed brutality, Hyrox is fairly accessible for a certain type of person, particularly millennials who have made fitness a part of their life for a couple of decades now, and who’ve dabbled in intense workout trends that included Tae Bo, CrossFit, Orange Theory, and Peloton. Think about it: Hyrox couldn’t do $270 million in business if it was too difficult for people with injuries, or if participants couldn’t finish, let alone do it over and over again.

Adherents claim there’s less injury risk compared to CrossFit because Hyrox exercises are relatively lower impact and don’t involve lifting heavy weights in complicated ways. Hyrox requires less training than preparing for something like a marathon, coaches and trainers told me. Unlike a triathlon, you don’t need to find access to water or risk drowning. The same cannot be said of an IRONMAN (another race, stylized in capitalizations that just feel very aggressive).

“For the New York marathon, I would have to start training right now,” McMillian, the coach and president at Tone House said. “I could start training a month and a half before and be able to finish.” 

To be clear, McMillian makes his living being fit. Though we did not put this to the test, I’m pretty sure he could squat two of me. McMillian competes in the pro division, the competition’s advanced tier. His definition of what’s physically doable is relative because McMillian looks like he could physically do anything. 

Still, he assured me that Hyrox’s barrier to entry is lower than it might seem. While prospective Hyrox racers also have the option of taking uniquely tailored classes at Hyrox-affiliated gyms (over 15,000 across the world) and group fitness studios, McMillian said you can do most of the race’s strength-based exercises or variations of them on your own, at any basic modern gym, making it somewhat more accessible. 

“What we noticed with our clients was that these are movements they’re already doing,” McMillian said. “All we have to do is make you better at those movements and teach you how to breathe during the movements, teach you the actual metrics on the rowers to be more efficient, teach you how to be a better runner instead of teaching you a whole new style of training. We’re already teaching you what you know how to do.”

Essentially, people already working out — and there are plenty of them — are well equipped to try Hyrox. Part of Hyrox’s appeal is that it’s a bigger, bolder version of the popular, grueling luxury fitness classes that already exist, or a more competitive version of what everyone’s already doing at Equinox. “It’s a little like, how good can you gym?” says Roskind, the DC-based project manager who’s competed in two Hyrox races. 

She wryly pointed out that being good at Hyrox is a little different than winning a tournament in a skill-based sport (e.g., tennis, soccer, basketball) or getting a qualifying time into a speed-based race like swimming or running. You don’t have to beat anyone else better or qualify to compete — you just have to buy a ticket in.

Being so good at the gym and spending money to compete against other people who are good at the gym is perhaps why some racers I spoke to seemed to temper their love of Hyrox with a scrim of self-deprecation. It’s as if they’re slightly embarrassed that this race may be a millennial-targeted fake Olympics, and it’s scored a direct hit with them. In mixed company, they might not want to say why they’re really going to Athens, Mexico City, or Dublin.

This may be the most relatable thing about Hyrox and the people who love it: Even when you’re really good at exercise, it can still find a way to be, at least, a little humbling.    

Of all the extinction-level threats vying for our attention, AI, climate change, and nuclear war tend to get most of the airplay. But Annie Jacobsen thinks biological war should be near the top of our mental list of doomsday scenarios, too.

She should know — Jacobsen has carved out a unique niche as America’s foremost reporter on the ways we could end the world. Her bestselling 2024 book Nuclear War: A Scenario terrified readers and experts alike, and has been optioned by Hollywood. 

It was while conducting dozens of interviews with high-level government sources for Nuclear War that Jacobsen was told repeatedly that biowarfare should be her next focus.

She took their advice. Her gripping new book Biological War: A Scenario follows a similar ticking-clock format that shows, step by step, just how a humanity-threatening man-made biological catastrophe could play out. (Spoiler alert: not great.)

The result feels like dystopian science fiction, albeit the kind that comes heavily footnoted with government studies that come to similarly grim conclusions. The fact that tech CEOs are also sounding the alarm that advanced AI could make creating killer germs even easier only adds to the growing sense of anxiety. And this book has also been optioned by Hollywood for a TV adaptation. 

Jacobsen sat down with Today, Explained host Noel King to talk through the plot of her nightmare scenario, why we’re still developing biological weapons despite the clear risks, and what needs to happen to avoid disaster. Below is an excerpt of their conversation, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify.

How does your book start?

The inciting incident in the book is an accident at a Biosafety Level 4 lab, shorthand BSL-4, in Siberia called Vector. And it’s an actual BSL-4 lab, the highest classification. … And there was an actual accident, an explosion there in 2019. 

In that real-life incident, a deadly pathogen was not released that we know of. But of course, in Biological War: A Scenario, a deadly pathogen is released. And it’s a form of pneumonic plague, which is a nightmare pathogen and sits at the top of the Tier 1 select agent list of the CDC. And so in the first act of the book, I show the scrambling of the intelligence community and the Defense Department, trying desperately to determine if something got out and what it is. … The release of the pathogen widens, and so once you have escape. You do not have mitigation, which has to happen in the first 24, 48 hours. Now you have a situation which is unstoppable.

You say this is now an unstoppable scenario. What is it?

A plague itself, of course, conjures up images and ideas of the bubonic plague of the 14th century, the Black Death. That killed between one half and one third of Europe. The bacteria is called Yersinia pestis. And pneumonic plague is the airborne version of plague. The problem with an airborne pathogen is that because the delivery system is the human lungs, it can move very quickly from a scientist in that lab who now has Yersinia pestis in his lungs out to the general public. And that is precisely what happens in the scenario.

How does it spread from there? The city where this BSL-4 lab sits isn’t Moscow. What happens once the pathogen is in the lungs of the people who work in that lab, or the janitor who was cleaning it that night?

That’s right. Well, suddenly it’s in everyone’s lungs, and those people go out into their community. And even though Koltsovo, the science town where Vector is located, is a small town, it is just 12 miles from Novosibirsk, which is the third-largest city in Russia. And, also, there happens to be in this scenario a group of international hunters on a hunting trip in that area who come across a dying scientist in the snow. One of them gives him CPR, being the Good Samaritan that he is. And lo and behold, those travelers suddenly are now getting on an airplane in Novosibirsk, flying home to where they reside in five or six of the continents.

What makes this form of plague so novel, so dangerous?

I pull this information from actual facts of the Soviet Cold War-era biological weapons program that we know about from Soviet defectors. And I want you to keep in mind: This is 40 years ago when gene editing was in its infancy. But there are two things specifically that the Soviet bioweapons engineers did to plague. 

Their idea was to create a super plague weapon. And one of them has never been revealed before. They were working to insert the gene for euphoria into the plague pathogen. … When you get a disease, a pneumonic-type disease, pneumonia, tubercular, you want to go home and get under the covers because you feel terrible. And when you do that, you’re infecting a lot less people than you would if a gene for euphoria had been inserted into the pathogen, which would make you feel terrific, which would make you want to go out and socialize with people, perhaps even go to a crowded disco. 

And the other thing that the Soviet scientists were working on was a way to defeat medical countermeasures, but with an added component of psychological distress. They inserted a gene into the pathogen that would be triggered by the taking of antibiotics. And that second pathogen would give you encephalitis, which is a swelling of the brain. The psychological part of it, according to the Soviet scientists, was that they wanted the last thought of the person dying of what they thought was pneumonic plague, but would in fact be encephalitist to be, “My government and Western medicine has failed me.”

Those of us who try to remain optimistic think there’s a way to stop it. In the movies, there’s an outbreak, then the government gets it under control, and okay, maybe a lot of people die, but we’re all right. That is not where your book is headed. How does your scenario end?

So in the book, I take readers from outbreak to anarchy in six days. Anarchy is what will happen according to Pentagon war gaming and pandemic planning. And this is because fear of infection becomes a secondary weapon, if you will. People begin to behave like they are about to die, which is most certainly underpinning everyone’s mind. And so after those first six days, the Principals Committee, the President’s Biodefense Committee, must make a decision. The president has to declare the Insurrection Act, which allows the military to step in as a law enforcement agency. 

“Imagine the president — with a few Secret Service outside the door, the military aide with the nuclear football — sitting alone in a room wearing a gas mask.”

What happens to the president really blew my mind as a reporter. He goes somewhere in the United States very far away from everyone. Because the idea, the goal, is to make sure that the president doesn’t get the airborne pathogen in his lungs. So maybe I’ll leave you with an image. Imagine the president — with a few Secret Service outside the door, the military aide with the nuclear football — sitting alone in a room wearing a gas mask.

In the book, the people who survive are the ones who have gas masks. Everyone else is gone.

And look, we hope we never get to that, by all means. But yes, the Pentagon has issued 1.7 million gas masks to its military personnel. And that is a spooky thought in and of itself, coupled with the idea that the military is predominantly male. There’s something like 17 percent women in the military. And so, unlike the Nuclear War scenario in which I had science-based nuclear winter theory to work from, in Biological War, nothing has been written on the science record about what it might be after. And so the one imaginative part of the book is the very end where I write about biological twilight. … And it is a very, very ugly world.

Let’s back up. We did outlaw biological weapons at some point, right?

That’s right. Very mysteriously in 1969, President Nixon just unilaterally declared that the arsenal was going to be destroyed. At the same time that all of the nations of the world were working to sign this treaty called the Biological Weapons Convention Treaty, which would outlaw bioweapons. Soviet Russia at the time signed it but immediately began work on an illegal biological weapons program that was colossal. And this went without notice, without any idea really by the CIA and the Pentagon all the way until 1989, when one of the Soviet scientists named Vladimir Pasechnik had a crisis of conscience and he defected and he told British intelligence all about the program.

Where have we seen biological weapons used?

Maybe the most important example of a biological attack in the past, certainly here in the United States, are the anthrax attacks, which occurred right after 9/11. Weaponized anthrax was sent through the mail to US senators and a number of media outlets. So five people ended up dying; 22 got sick in four states. But that really kicked off what can be considered the biological military-industrial complex, if you will, which led to this buildup in BSL-4 labs around the world today. There are 110 BSL-4 labs around the world. There are more than 3,500 BSL-3 labs.

Your book has a map of where those labs are, which I found weirdly comforting, mainly because I don’t live too near any of them. If one of these things is going to be released, either accidentally or deliberately, where is the threat coming from? A rogue nation? Terrorists?

Certainly, bad actors getting a hold of a biological weapon was the great concern of the post-anthrax situation. And that is why so much emphasis was put on bioterrorism. Now I avoided that specifically in the book. … And I didn’t even have an attack. Rather, I had an incident. I had a lab leak because I have learned in the decades since that really is the greatest concern. So many of these BSL-3 and 4 labs are in places without a lot of security, including in countries where there are wars going on.

Could somebody be making a biological weapon in a basement somewhere, off books?

Absolutely. And another disturbing document I came across, unclassified in the Pentagon, was a threat spectrum that showed weapons of mass destruction in terms of destructiveness. And of course, nuclear weapons sit at the far end of the spectrum. They are the most destructive. But very close behind were biological weapons. And even more startling was the notion that biological weapons present the greatest overall threat. 

Nuclear weapons have an extremely high barrier for entry. You have to have fissile material. … You have to have a weapons delivery system like an ICBM or a submarine. … That creates a situation where most nuclear weapons, all nuclear weapons, if you will, are in the hands of a command-and-control system within a nation. 

Biological weapons have no such barriers. In fact, the barriers for entry are getting lower literally by the day. You now can have a situation where someone with very limited knowledge of biology can create a biological weapon in their basement with the use of computational systems like an AI system, for example.

Your book reads like a thriller. How much have you exaggerated? How much have you novelized in order to hold our attention?

Everything in the book is based in science fact, meaning all of the facts, all of the figures. I write a hundred or so pages of notes in the back of the book for readers to be able to answer the question that you are asking me. … In the notes, you can find that answer.

Did any of those people give you good recommendations for how to avoid a disaster scenario, or at least how to avoid these things proliferating?

Well, you know, the ticking clock scenario that I write has an even more urgent ticking clock, which is the public’s pressure on lawmakers to absolutely do something about this nightmare scenario before it happens. Look, we have a world right now where you have the CEOs of the largest AI companies in the world admitting publicly that the lane of bio mixed with AI is of their top concern. You don’t hear that about nuclear. You hear that about bio.

How do you sleep through the night?

Anyone who knows me personally can vouch for the fact that I am an optimist at heart. I really believe that information is king. Once you know things, it gives you a lot of power. Perhaps that’s whistling by the graveyard, but that’s what works for me.

Do you have a biohazard suit?

I do not. I do not. But I do have a few gas masks. I must tell the truth.

Post-traumatic stress disorder in the general population has increased by 70 per cent following the October 7 attacks

On August 5, 2025, the US Department of Health and Human Services canceled 22 mRNA vaccine projects worth roughly $500 million and told the country it would stop investing in the technology that had brought us life-saving Covid vaccines. Health Secretary Robert F. Kennedy Jr., a longtime vaccine skeptic, claimed that the data showed these vaccines fail to protect against upper respiratory infections like Covid and flu. That his claims weren’t true — Moderna had already published Phase 3 trial results showing the opposite — didn’t seem to matter.

On August 5, 2026 — one year to the day later — the Food and Drug Administration (FDA) approved mFLUSIVA, the first mRNA influenza vaccine ever licensed in the United States.

That symmetry, while highly useful to writers like myself who are always looking to identify the rhymes of history, wasn’t planned. The approval landed on the one-year anniversary simply because of the deadline the agency had set for itself in February of this year, after it refused to review Moderna’s application and then, 15 days later, reversed itself. 

The decision didn’t earn a huge amount of press, in part because seasonal flu is a disease Americans have rarely taken seriously — fewer than 50 percent of US adults got their flu shot this past fall and winter. But flu is no joke: The 2024–’25 season produced 51 million illnesses, 710,000 hospitalizations, and 45,000 deaths. That’s more than the number of Americans who died in car crashes last year. And the damage from a flu virus doesn’t stop when the fever does. In the week after a confirmed infection, the risk of a heart attack runs roughly six times higher than normal. 

So a better flu vaccine matters. But the more interesting thing is what the approval says about the year that produced it. The nine experts who voted unanimously that this vaccine’s benefits outweigh its risks were appointed under the very same secretary who was against mRNA technology. Asked to look at the evidence, those experts couldn’t produce a single vote against it. 

That’s not quite a change of heart, but at a dark time for public health, it’s something to hang our hopes on — because flu could just be the start for this technology.

The egg came first

If you’ve ever taken a flu shot, thank a chicken.

Every flu vaccine Americans have received since the 1940s has been grown inside fertilized chicken eggs. It’s a laborious process, closer to agriculture than it is high technology. Each batch incubates for nine to 12 days; the World Health Organization then spends months making the reagents manufacturers need to calibrate doses. The whole sequence runs about six months.

That means that the flu strains in your vaccine in November were selected back in February. Which is a problem, because flu viruses don’t like to stand still. Between February and November, the virus drifts, and the current dominant H3N2 flu drifts especially fast. 

The eggs are a problem, too. Growing flu virus in a chicken egg forces it to adapt to egg cells, and those adaptations alter the very surface protein the vaccine is meant to teach your immune system to recognize. Between the 2011 and 2020 flu seasons, egg-adaptive mutations caused more mismatches than the virus’s own drift did. And more mismatches mean a less effective vaccine — while the flu shot prevented an estimated 12,000 deaths in the 2024–’25 flu season, it is the weakest vaccine in routine American use, landing anywhere between 20 and 60 percent effective depending on how well February’s guess matched November’s virus.

mRNA skips the egg. The shot carries instructions, a strip of genetic code that tells your own cells to build the flu’s surface protein, which your immune system then learns to attack. And swapping in a new strain means retyping that code, not growing a new virus.

As a result, Moderna told the FDA’s advisory panel it can go from strain selection to finished vaccine in two to three months instead of six. That means strain picks could move later, closer to the season they cover, and a novel flu virus surfacing in September could still be blocked by a reformulated vaccine in the same season. Eggs are great, but they can’t do that.

Building off the platform

Back in January I wrote here about the universal flu vaccine — one shot covering every strain for years. It’s a public health dream. mFLUSIVA isn’t that, but some of the best hopes for a universal flu vaccine run through the mRNA platform, and platforms only improve when somebody uses them.

That word — platform — is where last August’s decision went wrong. Kennedy made a claim about one application, mRNA respiratory vaccines, and cut funding for the technology underneath all of them. But over the 12 months that followed, the science on mRNA kept flowing.

In June, five-year melanoma results showed an individualized mRNA therapy given after surgery alongside pembrolizumab cut the risk of recurrence or death by 49 percent. In April, a Memorial Sloan Kettering team reported that among pancreatic cancer patients whose immune systems responded to a personalized mRNA vaccine, nearly 90 percent were alive six years later; the five-year survival rate in that disease sits near 13 percent. And KJ Muldoon, the first person treated with a gene-editing therapy built for his mutation alone, is walking and talking, though half the infants born with his disorder never see a first birthday. The editor that rewrote his DNA was delivered to his liver as messenger RNA — mRNA as the delivery truck rather than the vaccine.

None of those is a flu shot. All of them are the same chemistry — a strip of genetic code wrapped in a lipid nanoparticle — and none of them were what Kennedy was talking about when he defunded it.

Partially as a result, Americans are falling behind. Moderna’s combined Covid-and-flu shot is already licensed in Europe while patients here wait for a resubmission. The Phase 3 trial of its H5 bird flu vaccine — the one meant to be ready if bird flu ever learns to spread between people — runs on money from the Coalition for Epidemic Preparedness Innovations, and the British government, after the administration killed a $760 million BARDA contract. “The United States invented this platform,” Johns Hopkins RNA biologist Jeff Coller wrote on Thursday, “and is the only country walking away from it.”

Of course, you need to actually get the vaccine

mFLUSIVA beat a standard-dose flu shot by 26.6 percent in a 40,700-person trial. (Against flu bad enough to send someone to a doctor, the figure was 33.7 percent — an exploratory finding the trial wasn’t built to prove, but that points in the same direction.) This is a better flu shot, but it hasn’t solved flu.

There are issues with side effects: Two-thirds of recipients reported injection-site pain, against 30 percent for the comparison. Most cleared in a day or two, but in a country where a quarter of the people who skip the flu shot cite side effects, that’s not a minor problem.

And approval, unfortunately, isn’t access. The CDC’s vaccine advisory committee has been frozen by a federal court since March, so there is no clinical recommendation, which means insurers aren’t required to cover mFLUSIVA at no cost. The $500 million in canceled contracts hasn’t been restored. As Michael Osterholm, who runs the University of Minnesota’s infectious disease center, put it after the government reversed its mRNA decision in February: “We don’t have any idea why they reversed course. That’s part of the problem.”

The most optimistic reading is that nine independent experts appointed by this government looked at the evidence on mRNA and could not produce a single vote against it. The more pessimistic one is that it took a refusal-to-file letter, a public outcry and two senior departures to get there.

But here’s what we do know: Some morning this fall a 58-year-old will roll up a sleeve at a CVS for a vaccine designed off a sequence rather than grown in an egg, and will think about none of this. That’s more progress than I would have expected a year ago.

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The Food and Drug Administration approved Moderna’s mRNA flu vaccine this week — a major public health breakthrough for an administration that’s been troublingly down on vaccines. 

The flu is a gigantic and costly illness, causing 1 billion infections and 300,000 deaths each year. But this new shot, built on advances from the Covid-19 pandemic, is expected to outperform the standard flu vaccine that we’ve used, largely unchanged, for the past 80 years.

The new shot fixes a problem that has long bedeviled the traditional vaccine: the gap between how quickly the flu virus mutates and how slowly vaccines are produced. The flu is changing constantly. But under current methods, manufacturing a flu vaccine — which, to my enormous fascination, most commonly involves secret chicken farms — takes six to eight months. 

That long lag often means the virus circulating during flu season isn’t the one the vaccine was designed to target. But the new mRNA vaccine works differently: Instead of using a weakened or dead virus to trigger an immune response, mRNA vaccines contain genetic instructions that train the immune system to fight influenza. 

mRNA vaccines also take less time to manufacture, so they can be produced closer to flu season. In a clinical trial, older adults who received Moderna’s mRNA vaccine were 27 percent less likely to get the flu than those who received the standard vaccine.

Heads up: Vox’s offices are closed tomorrow, so Today, Explained is taking a day off. We’ll be back in your inbox on Monday.

A world without flu?

Public health experts are justifiably hyped about mRNA technology. In addition to this new flu shot, researchers are developing mRNA vaccines against diseases including malaria, tuberculosis, and HIV.

But when it comes to influenza, mRNA isn’t the endgame. The real white whale is a “universal flu vaccine” — a shot that’s at least 75 percent effective against influenza A, the most dangerous type of flu virus, and lasts at least a year.

The challenge, again, is that the virus keeps mutating. Flu vaccines, whether mRNA or conventional, teach the immune system to recognize a viral protein called hemagglutinin and then fight off the virus. 

But hemagglutinin is a part of the flu virus that mutates often. To make a more durable vaccine, researchers are trying to either target parts of the virus that rarely change or teach the immune system to simultaneously recognize many different strains.

Several vaccines that use these approaches are already in clinical trials. And if they succeed, the flu shot could hypothetically become more like the measles vaccine — providing years of protection in one go, instead of requiring annual updates.

In other words, we’re used to thinking of the flu as a routine winter hazard, but that might not always be the case. If you can persuade people to get their shots, at least.

One link for later

➨ Go ahead, take your time. Three etiquette experts tell Vox that, in most casual situations, you can run 10 to 15 minutes late without appearing inconsiderate. But that guideline is very culturally and contextually dependent, which is bad news for chronically late people like myself. I prefer to think it’s a result not of rudeness, but of polychronicism.

Before you go…

• Did you know…that the Fast & Furious franchise, now on its 10th movie, is (loosely) based on a 1998 magazine article? The author of that piece is still a working journalist, so it would not appear he got his money’s worth from Hollywood. 
• Today’s trivia: What’s the fourth largest Great Lake? (You can find this and other brain puzzles in Vox’s daily crossword. Look for the answer in Monday’s edition.)
• Yesterday’s trivia: Yesterday we asked you for the name of the Nickelodeon game show hosted by Marc Summers. That would be Double Dare, which just celebrated the 40th anniversary of its first episode. The show is credited with influencing a generation of children’s media. 

GLP-1 drugs promised to usher in a new era of treating obesity as a disease. We could leave behind the anti-fat biases of the past, which blamed obesity on moral failing or personal weakness. Instead, these drugs would allow us to approach it as a medical condition, a complex matrix of genetics and other forces which could be changed with the right dose of these powerful new medicines. 

Or so the thinking went. 

While the clinical potential of these drugs remains immense, they have yet to change how the broader US culture perceives and engages with weight and weight loss. Even as millions of Americans shed pounds in bulk for the first time, they are also contending with fierce stigma and shaming from others — instead of being criticized for being fat, they are being criticized for using GLP-1s. 

The social media communities that have blossomed around GLP-1s are filled with tales of awkward conversations and much worse. Partners who berate a significant other who wants to go on Wegovy or Zepbound. Coworkers who blame the drugs for their rising insurance costs. Even dismissive and unsympathetic doctors and nurses. 

Some people who take GLP-1s must contend with an uneasy sense of living behind enemy lines: Many people describe being at work or out in public and overhearing people talking about GLP-1s and passing judgment on people who they think are taking a “shortcut” to lose weight.

“It’s like you’re being stigmatized without the person who’s [saying] it even realizing it, necessarily,” said Adriana, a 33-year-old GLP-1 user who lives in the Chicago area. (Vox agreed to identify the people we spoke to by their first name, to protect their privacy when discussing stigma.)

“There’s a lot of internalized stigma and judgment we have from the culture about our bodies and ourselves.”

Erin Standen, psychology professor who studies health and behavior change at Rice University

This is not just evident from anecdotes. Researchers have put the question to the test. And they have found that Americans not only feel more negative stigma toward somebody who lost weight with a GLP-1 than somebody who lost weight through diet and exercise — they also feel more negatively about the GLP-1 user than somebody who never lost weight at all.

“It seems like people are really reacting negatively to the idea that somebody who has lost weight with a GLP-1 might be, quote-unquote, ‘taking the easy way out’ or cheating the system,” said Erin Standen, a psychology professor who studies health and behavior change at Rice University and led one such study. “There’s a lot of internalized stigma and judgment we have from the culture about our bodies and ourselves.”

Americans have internalized the message that being overweight is a personal failure so thoroughly that, now that the kind of extraordinarily powerful weight-loss shots and pills long hoped for are here, many people struggle to see it as good news. They see it as cheating.

GLP-users feel damned if they do, damned if they don’t 

GLP-1 users have found themselves in a trap. They’ve felt judged for years for their bodies: Studies have found that up to 42 percent of adults with obesity have experienced some kind of weight discrimination; and between 40 and 50 percent have internalized weight bias. One survey from this year found that 81 percent of people taking GLP-1s said that they had felt social pressure to be thin, and more than half said that those attitudes influenced their decision to take one of the new weight-loss drugs.

And yet, now that they’re cutting weight, they’re being judged for how they lose it. In the same survey, 69 percent of GLP-1 users said other people saw the drugs as a cheat code, 23 percent said that it was hard to handle other people’s feelings about the meds, and 43 percent said that they didn’t like talking about their GLP-1 use for fear of judgment.

“Culturally we have a widespread belief that weight isn’t complex — it’s simply energy in versus energy out,” Susan Persky, a behavioral scientist at the National Institutes of Health who has studied GLP-1 stigma, told me in an email. “If everyone ‘should’ be able to manage their weight through diet and exercise, engaging willpower and hard work, using GLP-1s is seen as a cheat or a hack. So someone with higher weight who uses a GLP-1 is not only seen as lazy or weak, they’re also seen as cheating to achieve weight loss that other people have ‘earned’.”

Perhaps the most extensive study on GLP-1 stigma so far is from scholars at Rice University, UCLA, and the Mayo Clinic, published in the International Journal of Obesity in April. It followed an earlier paper, published in April 2024 in the same journal, that suggested people had more negative views of a woman who lost weight with a GLP-1 versus somebody who lost weight with diet and exercise.

The new experiment sought to replicate those findings and extend them. How did people feel about somebody who took a GLP-1 versus somebody who never lost weight at all? How would people feel about somebody who regained weight? They gave more than 600 participants short profiles of hypothetical patients who were all alike except for one thing: One had lost weight with diet and exercise, one had lost weight using a GLP-1, one didn’t lose weight. They were asked to rate the person on various positive and negative metrics, to measure how they perceived the person and whether they’d want to associate with them socially.

What they found revealed how deep the bias against GLP-1 users seems to run.

When comparing the two hypothetical people who lost weight, study participants offered far more negative traits and far fewer positive ones to the people who had used a GLP-1, Standen told me. “That really stuck out,” she said. They also ranked the GLP-1 user as more unhealthy. 

But even beyond that, people actually rated the person who didn’t lose weight at all more positively than the GLP-1 user. “People were more likely to say they were willing to connect socially with the person who hadn’t lost weight as compared to the person who was a GLP-1 user,” Standen said.

The study didn’t ask the participants to explain in detail why they felt the way they did about GLP-1 users. But Standen and other experts attributed the attitude to those cultural norms around body weight that have turned obesity in the minds of many into a matter of personal morality rather than the medical and socioeconomic issue that most clinicians view it as.

“Stigma toward GLP-1 use reflects deeply rooted cultural beliefs about effort, discipline, and personal responsibility for weight and health,” Stacy Post, a postdoctoral scholar at Georgetown University who authored the 2024 study on GLP-1 stigma with Persky, told me over email. “In this context, it is not surprising that GLP-1s are often viewed as a ‘quick fix’ for a problem that many believe should be solved through willpower and lifestyle changes alone.” 

And the consequences of stigma go beyond straining someone’s personal relationships. People can feel shame and stress when they think they’re being judged, and that in turn can have direct physical effects that are bad for their health. 

“These small little moments where people feel discriminated against do accumulate in the body,” Standen said. “Experiencing stigma or feeling judged for having used or not used a GLP-1 is directly harmful to your overall physical and mental health.”

Feeling judgment “also might lead you to either avoid health care or be less open when seeking healthcare in ways that could long-term harm your health as well,” Standen said. We know how much GLP-1s can improve the health prospects of somebody who is obese, so if somebody decides not to take a weight-loss med for fear of being judged, that is a net loss to their health. 

What it’s like to be a GLP-1 user when society shames GLP-1 users

The Rice study affirms something GLP-1 users have been saying in online communities since these drugs hit the market a few years ago. I have spent the past few months reading these stories on the various Reddit communities dedicated to GLP-1 drugs and weight loss, and the frustration that users experience in being judged for medications they feel are approaching a miracle drug is palpable.

One poster described her boyfriend becoming “extremely upset” when she said she was considering going on a weight-loss medication; another person also detailed their fight with an unsupportive partner. Others have contended with rude comments from coworkers. People have faced judgmental questions when they were visiting a hospital’s emergency room for something unrelated. One person even encountered the stigma at their cross-stitch club.

I spoke with two people, Adriana and Mike, who had shared their experiences of GLP-1 stigma on Reddit.

Mike, 50, and living near Boston, says he had been big his entire life, but after seeing an unflattering vacation photo a couple years ago, he decided he wanted to get serious about losing weight and thought a GLP-1 could help him. After losing some weight through Weight Watchers, he went on Zepbound; all told, he’s shed about 170 pounds.

He and others have encountered judgment for his weight loss in surprising places. Mike told me the story of going to visit an old friend from college, after he had started taking Zepbound. 

His friend’s mother was there and she inquired about his evident weight loss. He told her he was taking a GLP-1 medication. And for the rest of the weekend, she badgered him about whether whatever he was eating fit with his “diet.”

“It was eye-opening because when I first went on it, I’m like, ‘I don’t understand why people don’t want to tell anybody. This is a good thing. The world should know,’” he told me. “And then you realize, ‘Oh, God, this is affecting my ability to enjoy myself this weekend because I have to answer for it every two seconds.’ That’s when you’re like, ‘Okay, I understand why people don’t want to tell.’” (He added that the incident has, fortunately, become a running joke between him and his friend.)

Adriana from Chicago had been naturally thin for most of her life, never developing particularly good diet or exercise habits. But a couple of years ago, she had a bad mental health episode and started to cope by overeating, she says; she gained 50 pounds in a year. She had a family history of diabetes, and her doctor told her she was prediabetic. She felt an urgency to do something, she told me: “I just need to go on this medication before I do irreversible damage to my health.”

The medicine has revitalized her she said. She hasn’t experienced serious side effects and the food temptations that led her to binge-eat have been quieted. She says she’s seeing a therapist and a dietitian and feels as good as she has in years.

But she’s experienced stigma at every stage of her journey too. Adriana said that growing up, she was often praised by her family for being thin. Then when she gained weight, her family nagged her about it and friends started cutting her out of more physical activities.

Since she started taking Zepbound, she hasn’t told a lot of people — but she has still felt the prejudice toward GLP-1 users in unexpected ways. Many people in her life just assume that she is reverting back to her previous body type and compliment her for looking slim, then turn around and judge somebody else who’s on a weight-loss drug.

“My coworkers will say, ‘Oh, you look so good,’ and then they’ll mention some other person who was maybe always bigger, and they’ll say, ‘But she’s on the shot,’” Adriana said.

And online spaces, where so many of our health and wellness conversations take place these days, are filled with people expressing hurtful opinions about GLP-1 users, often fixating on reports — both credible and not so credible — of dangerous side effects. That was what prompted Adriana to post her frustrations on Reddit.

“What really bothers me is the fake concern for our health, which is the thing that always comes along when people are policing other people’s bodies,” she said. “When people are overweight, people say, ‘Well, I’m just concerned for their health.’” she said. But “now that there is this medication that’s helping, the stigma is: ‘Well, what about the side effects?’”

Will the GLP-1 stigma ever go away?

As GLP-1 use continues to rapidly expand across the country, there are signs that this stigma could eventually be broken down.

It starts with sheer numbers: The more people who take a GLP-1 or know somebody who has, the more likely they might have a more charitable view of GLP-1 users. About 12 percent of Americans said in an August 2025 survey that they had taken a GLP-1 drug. As of May 2026, one in five US households had at least one GLP-1 user, according to data from PricewaterhouseCoopers. This growth may be the best hope for breaking the stigma that is a nasty asterisk on what is otherwise a remarkable moment in medicine. 

“As these medications become more prevalent and more people have either used them themselves or have a close loved one who has used them, it is possible that that will help to reduce the stigma and increase acceptance,” Standen said. “We know that in general, one of the more robust findings in social psychology is that as people have more contact with folks who have identities or situations that might be unfamiliar to them, bias tends to go down over time.”

It is expected to be one of the largest prescription drug rollouts ever.

Mike said he has confronted acquaintances who spoke badly of GLP-1s, explaining how they have worked for him and the hard work he has put into the process. “Your perspective always changes when you suddenly know someone,” he said. 

The number of GLP-1 users is probably as low as it will ever be. Medicare launched its $50 GLP-1 prescription program in July, and millions of Americans will be eligible to receive these medications cheaper. It is expected to be one of the largest prescription drug rollouts ever.

And access should continue to expand. Pharmaceutical executives say they are making inroads with the private employer-based insurance plans that cover about half of the US population; at a health conference — Aspen Ideas: Health — in late June, Laura Steele, group vice president of US cardiometabolic health at Eli Lilly, said the company has seen large employer coverage increase significantly, from about 20 percent covering the medications in 2025 to 67 percent. 

In a decade, 50 percent or more adults in the US may be taking one of these drugs, Alison Furman, partner and US consumer markets industry leader at PwC, said at the Aspen panel. 

As bad as things might still feel to people taking GLP-1s right now, social attitudes do seem to be evolving. According to PricewaterhouseCoopers data shared with Vox, 23 percent of current GLP-1 users openly share that they are on the drugs, compared to the 2 percent who say they haven’t told anyone. People who are considering going on a GLP-1 are even more open-minded. More than half of those considering the drugs (53 percent) say they would share their use with their immediate family members, versus 42 percent of current users.

“The stigma is subsiding,” Furman said. “You see an increase in just openness around this drug. All those signs we believe point to increased adoption over time.”

Adriana has even seen hints of it herself. She has opened up to a few friends who had asked about her weight loss. “Once you start that conversation,” she said, “it’s kind of shocking how many people are like, ‘You know what? I’ve been thinking about going on.’”

Let me start with the most local of local stories: the intersection down the street from my apartment in Brooklyn, New York, where Columbia Street meets Summit Street.

Since my family moved into the neighborhood in 2023, I’ve hated this intersection. It has no stop signs, no crosswalks, no signal. Crossing on foot with my son has meant grabbing his hand and hoping any oncoming cars would slow down, which, given that this is New York City, is maybe a 50/50 proposition at best. Everyone knew a stop sign or signal was needed, but the city did nothing.

That finally began to change late last year, after a 10-year-old girl was struck and injured by a car just two blocks north of the intersection. The neighborhood organized, packed a public meeting, and eventually walked a city official down the block so he could stand in the intersection and see what they saw every day. Which is how I woke up on July 17 to see four stop signs and freshly painted crosswalks at the intersection I hated so much.

My very local story is part of a much bigger one. Cars kill about 1.16 million people a year worldwide — more than the population of San Jose, California erased every year. Road injuries remain the leading cause of death for everyone between the ages of 5 and 29 — ahead of malaria, ahead of war and homicide, ahead of every disease we spend more time worrying about.

For most of the 20th century, that was simply the price of moving around faster. Being in a car was the most dangerous thing most of us did on any given day, and we seemed to have no choice but to accept the consequences.

But, it turns out, we don’t. According to new data released last month, between 2011 and 2025, the rate at which the world’s roads killed people, measured against population, fell 21 percent, even as more than a billion motor vehicles were added to the world’s roads. It’s still far too high, and the death rate actually increased in Africa, as more vehicles are added to often substandard roads. But in epidemiological terms: Globally, exposure went up while deaths went down. What ultimately changed was an argument about whose fault it really is when a car crashes.

The doctor who decided crashes were not accidents

It’s not too much of an exaggeration to say that American cars were once all but literal death traps. In 1966, they killed 50,894 Americans and injured 1.9 million more, in vehicles with rigid steering columns aimed at the driver’s chest and metal dashboards studded with knobs that lacerated and impaled human bodies. The toll was horrific; as President Lyndon B. Johnson put it in 1966, the million and a half Americans who had died on the roads so far that century were “nearly three times as many Americans as we have lost in all our wars.”

Detroit’s answer to all this was that Americans were bad drivers. A doctor named William Haddon Jr. thought the industry was looking at the wrong thing. Haddon trained as a physician and came to car crashes as an epidemiologist. He saw them as systems failures and understood that cars had to be designed to protect drivers against themselves.

Haddon wasn’t working alone. In April 1959, a Labor Department official named Daniel Patrick Moynihan published “Epidemic on the Highways,” making a version of the same argument: The problem was how cars were built, not who was driving them. In 1965, the consumer advocate Ralph Nader — whom Moynihan had hired the year before to help write the government’s highway safety report — published Unsafe at Any Speed, a catalog of everything automakers already knew they should fix and had decided not to.

Nader’s book became a national bestseller, and, in September 1966, Johnson signed the National Traffic and Motor Vehicle Safety Act, which finally gave the federal government power to mandate how cars could be built. Johnson appointed Haddon to lead the new federal traffic- and highway-safety agencies that later became National Highway Traffic Safety Administration (NHTSA).

A safer system

NHTSA estimated that federal vehicle-safety standards prevented more than 860,000 deaths and 49 million nonfatal injuries from 1968 through 2019. Preliminary data released this week showed that the US motor vehicle death rate for the first quarter of 2026 was 0.99 per 100 million vehicle miles traveled: the second lowest first quarter figure on record and down 82 percent from the 1966 death rate, when Congress passed the vehicle safety act.

But while America has largely aimed to make crashes survivable, other countries decided that wasn’t ambitious enough. In October 1997, the Swedish parliament adopted a national policy called Vision Zero, built on the premise that nobody should be killed or seriously injured on the roads — and that, when someone is, ultimate responsibility belongs to the people who designed the system, rather than solely to the person who made the mistake. Sweden began adding median barriers to rural highways in 1998, and a national revision of speed limits rolled out in 2008-’09. Since Vision Zero’s adoption, Swedish road deaths have fallen about 61 percent, from 541 in 1997 to 213 in 2024 — about two deaths per 100,000 people, the lowest rate in the EU.

New York adopted the same framework in February 2014, explicitly modeled on the Swedish work, and cut its default speed limit from 30 to 25 miles per hour that November. By the end of 2025, the city’s traffic deaths were down 31 percent from 2014. The year closed with 205 road deaths, the fewest since New York began keeping records in 1910. In the first half of 2026, pedestrian deaths were more than 42 percent below the comparable period in 2014.

Four stop signs on a Brooklyn corner are what that idea looks like at its smallest possible scale.

The people we left outside the car

But, in our effort to make our cars safer, we neglected to do the same for everyone else on the street. Between 2009 and 2023, US pedestrian deaths rose 80 percent, even as other categories of traffic deaths increased just 13 percent. By 2022, pedestrian deaths had climbed to a 40-year high — back to 1981 levels.

One major contributor is as simple as geometry. The Insurance Institute for Highway Safety (IIHS) found that vehicles with hoods above 40 inches are about 45 percent more likely to kill the pedestrian they hit than vehicles with hoods of 30 inches or less and a sloped profile. A low, sloped hood catches an adult at the legs and rolls the body up onto it. A tall flat one catches the torso and drives the body down and under. Light trucks — which have gone from under a fifth of new vehicle sales in 1975 to more than four-fifths today — accounted for 54 percent of US pedestrian deaths with a known vehicle type in 2023.

It’s only recently that this second curve has begun to bend. Preliminary state data indicated that US pedestrian deaths fell about 7 percent in 2025 to an estimated 6,732, a third consecutive annual decline. Part of it is that a pandemic-era spike in reckless driving is receding. Part is states spending on infrastructure and enforcement. And part is that cars now come with automatic emergency braking with pedestrian detection spreading, which IIHS found cuts pedestrian crash risk by about a quarter.

Pedestrian-detecting automatic emergency braking is spreading, as well. IIHS found that it was associated with a 27 percent reduction in pedestrian crashes, though detection spreading, which IIHS found cuts pedestrian crash risk by about a quarter. (But there is work to do, as those systems don’t reduce risk on unlit roads at night, and more than three-quarters of pedestrian deaths happen after dark.)

Driver Zero

I’m glad there are stop signs at Summit and Columbia now, but it was a good outcome produced by a bad process — one that required a child being hit by a car to get started. There are more dangerous intersections in this country than there are communities with the voice and the stamina to demand fixes. A real Vision Zero wouldn’t wait for the crash; it would identify which intersections could kill someone and fix those first.

For now, though, I’m simply happy that, in my local corner of the world, the streets got just a little bit safer.

New York is also an outlier. As my colleague Marina Bolotnikova wrote earlier this year, Vision Zero hasn’t worked nearly as well elsewhere in the country, largely because the American public is less accepting of road designs that inconvenience drivers.

That’s why the US, for all its long-term improvement, lags behind its peers. Over the decade to 2021, road deaths fell 36 percent in WHO’s European region and did not move at all in the Americas. The US sees about 12 road deaths per 100,000 people, more than twice the rate in Australia, Israel, or South Korea — a gap so large that the International Transport Forum publishes OECD road safety averages both with the US included and without it, presumably to keep us from skewing the results.

Since the US probably won’t adopt Sweden’s approach, a more realistic hope might be autonomous vehicles. This month, the Insurance Institute compared about 50 million driverless Waymo miles across four cities with human driving in the same places and found that, per mile, the robotaxis were involved in 68 percent fewer crashes of the kind a human driver would typically report to police. Waymo’s own tally across more than 220 million driverless miles claimed 93 percent fewer injury-causing crashes involving pedestrians — which is to say the technology is best at precisely the thing American road design has been worst at.

If Haddon fundamental insight was that systems have to be built to counter the inevitable errors when a human drives a two-ton hunk of metal and glass at 60 mph, then maybe it makes sense that the ultimate system response is to remove the human altogether. For now, though, I’m simply happy that, in my local corner of the world, the streets got just a little bit safer.

A version of this story originally appeared in the Good News newsletter. Sign up here!

Hi readers! Shayla Love here, science journalist and longtime fan of Your Mileage May Vary. I’m honored to be subbing for Sigal Samuel while she’s out on parental leave. I’m diving into your questions as a way to help understand human nature and our choices through multiple lenses: philosophical, psychological, and beyond. Please send in any emotional, body/brain, sociological, perceptual, or other kind of life quandaries you might have.

I’m swimming in information. I have tracking apps to keep tally of my daily steps, minutes online, my calories, my sleep. Throughout the day, I am awash with data — some “actionable” and some useless. I find it a struggle to prioritize. I find myself looking up the latest betting odds for a Senate race in a state where I don’t live. (I didn’t bet on the race.) What I want to know is: What should I know less about? I’ve heard that ignorance is bliss, though I don’t often find that to be the case. But maybe I know too much, or…too little about how much to know?

Dear Un-blissfully Aware,

As a fellow know-it-all, I relate to your impulse to gather as much information as possible. I used to obstinately reject the idea that ignorance was bliss. Even if I learned something that was unpleasant, wouldn’t it be much worse not to know it? 

But, as you may suspect from sharing my temperament in this arena, this approach to life can lead to hoarding knowledge like a frantic animal preparing for winter. You’re acquiring information as if it’s a scarce resource (which it’s not) and as if choosing to know something is neutral (it isn’t). What helped me understand the implications of this sort of approach was learning about the cases when people decided not to know, or the study of “deliberate ignorance.” 

Several years ago, a psychologist, Ralph Hertwig, and lawyer, Christoph Engel, who both work at the Max Planck Institute in Berlin, examined what happened in the early 1990s, when the archives of East Germany’s secret police, the Stasi, opened to the public. Any person who had been living in the German Democratic Republic could check if they had been spied on. There was a pretty substantial catch, though: The spies were often “unofficial collaborators” — friends, family, teachers, or lovers who had been tasked with covertly collecting information. When the files were opened, many elected not to look. Hertwig and Engel estimated that potentially more people chose not to know what their files contained than those who did. 

This goes against what we think we know about humans and how you have described yourself. Even Aristotle seemed quite certain that “all men naturally desire knowledge.” In the 1980s, the psychologist George Miller followed along in this line of thinking. He described humans as informavores: creatures with minds that constantly seek out and consume information. So, it can feel surprising to hear about occasions when people didn’t start grabbing for every available datapoint like squirrels dashing for acorns as the first winds of fall arrive. 

But, as Hertwig and Engel — who collaborated on an entire book called Deliberate Ignorance: Choosing Not to Know — point out, we’re surrounded by people choosing ignorance all the time. They avoid looking at their bank statements, they skip doctor’s appointments, and they cover their ears and say “no spoilers” if someone is talking about a movie they haven’t yet seen. 

Even Nobel Laureates do this. When James Watson, one of the co-discoverers of DNA’s double helix, had his own genome sequenced, he requested that a specific gene be left out: ApoE4, which can reveal an increased Alzheimer’s risk. Watson’s grandmother had Alzheimer’s, and her experience clearly made an impression on him. (Then, many in the scientific world tried to remain ignorant to Watson’s increasingly misogynistic and racist comments, until it was unignorable.) 

Why do people choose not to know? The most common reason: Ignorance can be an extremely effective way to regulate any emotions that might crop up in response to knowledge. You can minimize negative feelings by, for example, not knowing that your otherwise friendly neighbor had been reporting on your comings and goings. 

In a study about romantic relationships, a majority of people said they didn’t want to know if their partner had ever thought about cheating on them (but never acted on it). Other research showed that most people wouldn’t want to know the exact time of their death. Alternatively, someone could cultivate the feelings of joy and surprise by waiting to find out the sex of a baby until it’s born.

Deliberate ignorance can also be used to protect us from our biases. Scientists do blinded studies, because the knowledge of what drugs are being used can unwittingly change the outcomes or research. When orchestras implemented blind auditions, more women musicians were accepted. 

Of course, deliberate ignorance can be problematic when it causes harm to yourself or others, like failing to gather basic information about your financial or physical health. In some cases, for instance, about 10 percent of people who got tested for HIV didn’t come back for their results — which could lead to further spread of the disease. 

But when skipping out on knowledge doesn’t endanger you or those around you, it’s worth asking: How would this information make me feel? 

This sounds like a question that’s missing from your information-ingestion habits. You don’t have to — and shouldn’t — ignore everything that comes across your desk. But your deliberate ignorance filter is turned entirely off; seemingly anything passes through it. To take just one of your examples, you mentioned fitness wearables. It can be useful to be aware of your general activity levels and your sleep, but honestly, don’t you already know enough from your memories of a workout class and how rested you feel in the morning? A quest for more detailed knowledge like this can backfire, making people more anxious, and disconnected from their actual physical experience. 

It’s not just about how much knowledge to take in, it’s also about what kind. The breadth of information that you’re seeking out makes me wonder if you’re not already using knowledge to regulate your emotions by favoring superficial knowledge over the meaningful. When we face difficult tasks (even if they’re important, and we want to get them done), that’s usually when, suddenly, a Senate race in a far-off state starts to become interesting, or you find yourself scrolling a high school acquaintance’s wife’s Instagram. 

In the 1990s, two technology researchers proposed the concept of “information foraging,” which was inspired by early user behavior on the web. A few years later, Webster’s dictionary announced that their word of the year was “infosnacking,” or mindless grazing for useless knowledge online in order to pass the time. 

Snacking sometimes is fine, but you’ll start to suffer if you only eat chips for every meal rather than something more nutritious. I suspect you might be avoiding the slightly more challenging task of taking in other, more nutrient-dense knowledge. If you cut out the step tallies, screen minute totals, and news headlines scrolling, what could you choose to know instead? 

What I’ve learned about myself is that I will always lean towards being an informavore. I can’t help it. I am hungry to know, and there is no need to totally overhaul this valuable part of who you are (as I also tell myself!). This means you don’t need to replace your infosnacking with zenfully staring at the ceiling or emptying your mind through meditation. You can still put new things into it! But you could worry less about your daily information calorie intake and spend more time thinking about the nutrition content of your knowledge diet. 

Take a lesson from our many deliberately ignorant friends, and try disregarding some of the little stuff — the body tracking, the random factoids — for a period of time. But, at the same time, increase your knowledge about other subjects: a neglected hobby or a nonfiction book collecting dust on your shelf. Have a long conversation with your best friend and ask each other questions you’ve never asked before or interview an older relative about their childhood. 

And remember that all of this knowledge relates back to your emotional life. Rather than asking yourself what you should or shouldn’t know, examine how you might be using knowledge to alter how you feel. Knowledge changes us. It can make us happy, anxious, excited, or sad; it impacts our decisions and how we see ourselves and other people. 

In some of your newfound spaces of intentional ignorance, you may find just some surprising moments of bliss.

Bonus: What I’m reading

• The ostrich may be famous for its head-burying ignorance, but that’s actually a myth dating back to the ancient Romans. Ostriches don’t hide their heads, but, rather, bury their eggs underground. I highly suggest flipping through the book Ostrich by Edgar Williams, professor of cardiopulmonary science at the University of South Wales, for a natural and cultural history of our largest living bird that is way more interesting than it needs to be. 
  
• In a moving essay in the China Books Review, poet and writer Zhang Er remembers growing up during the Cultural Revolution and receiving “torn books,” or sections of forbidden books, to read from a family member. Even with incomplete knowledge, “my world expanded with each torn book,” she writes. 
  
• Not a book, but a powerful story on the ripple effects of being exposed to new information in East Germany: the 2006 movie The Lives of Others, from director Florian Henckel von Donnersmarck, which I recently saw for the first time. A Stasi officer listens into the life of a playwright, whose own fragile ignorance about his situation in the GDR is becoming challenged.

Once reserved for professional athletes, these gadgets are now more mainstream. We weigh up the facts to see what could work for you

AI is the hottest thing in medical care right now — but many of us feel trepidation about it. Just one illustrative public survey sample: An October 2025 KFF poll found just 8 percent of Americans reported feeling a “great deal” of trust in AI managing their appointments or analyzing their health records, and only 32 percent said they would trust an online health tool that uses AI to access their medical records to provide personalized health information.

But many clinicians and healthcare administrators see AI as a powerful new tool that offers myriad opportunities to streamline and improve treatment. A 2026 survey found that more than 80 percent of US doctors use AI professionally — doubling the share from 2023. Physicians are excited by AI’s potential to keep more accurate notes of interactions with patients, to act as a second pair of eyes for human doctors, and to monitor people at risk of deteriorating and ending up in a dangerous situation.

The disconnect between what people and their providers want from AI could create more distrust, at a time when faith in the healthcare system and the medical profession have slid. Patients today want to feel empowered and in control. How can that be possible when these seemingly godlike machines are becoming more and more entrenched in our hospitals and doctors offices?

The answer comes in four words: “human in the loop.” It’s the principle upon which the ethical integration of AI depends and it could help to bridge the gap between lay people and the professionals on AI in medicine. In surveys, people are much more comfortable with the idea of their doctor using AI as an assistant than with AI acting on its own. And most clinicians want to use AI in that way, as a second opinion or passive monitor, not as a replacement for their judgment. There are real fears among the healthcare workforce about that possibility: A group of NYC nurses who were recently laid off claim it’s because their labor was going to be replaced by AI. “Human in the loop” appears to be a point of agreement between doctors and patients at this pivotal moment.

“Doctors…and nurses and staff always have been interested in primarily making the best decision for the people under their care — and these tools can help with that,” Alison Callahan, a research scientist at Stanford University who works on AI programs used in the university’s health system, told me. “The interest in making sure those tools are accurate is high.”

But what does “human in the loop” really mean in practice? How can you know when and how your doctor is using AI? And what is the best way to talk to your provider about the sudden influx of artificial intelligence in healthcare before a robot starts taking appointment notes or analyzing your MRI? I called some leading experts to find out. 

How AI is currently being used in medicine

Patients and providers alike are incorporating AI into healthcare. Individuals are using commercial AI chatbots to ask about their symptoms or the health metrics tracked by their Apple Watch, while large academic medical centers are developing sophisticated programs and protocols to try to improve medical care at the population level.

It starts with ChatGPT, Claude, etc. — the large language models that are available to the public. People are increasingly turning to them to try to understand what’s going on with their own bodies. Individual physicians are also consulting with large language models to answer questions or get up-to-date on the latest research as they figure out how to best care for their patients. 

Then there are ways in which hospitals and doctors offices are adopting AI at the institutional level. Many facilities are using AI as a way to take, collate, and summarize notes on a patient; in theory, it’s a more organized way to keep track of the informal interactions and observations that doctors have when checking on their own patients. Hospitals are also using AI to handle some administrative tasks, like scheduling follow-up appointments; some health systems have even started to use AI to help patients get ready for appointments — to send reminders about colonoscopy prep, for example.

And finally, you have maybe the most ambitious use of AI by health systems right now: as a diagnostic and risk prediction tool. In these cases, AI might offer a second opinion when, for example, a doctor is triaging a patient in the emergency room. It might help the ER staff figure out how to prioritize patients. Or these programs could monitor people either during a hospital stay or out in the real world (by drawing data from the person’s wearable) and make predictions about who may be at higher risk of complications and require further care. AI could recommend that somebody would benefit from seeing certain specialists or receiving a specific medicine or lab test, and generally offer proactive advice about the patient’s medical care.

But at this point, AI adoption is still “highly localized,” said Jennifer Goldsack, CEO of the Digital Medicine Society, a nonprofit that works with healthcare providers, drug makers, and government agencies on how to incorporate new tech (including AI) into clinical care. It depends on the individual doctor or health system. A lot of them are setting up their own programs and their own protocols for how to use these tools.

That is a big reason why it is so important for patients to be proactive about understanding how AI is being used for their health care. You can’t make assumptions; the only way you’re going to know for sure is to ask.

The questions you should ask your doctor about AI

By and large, experts say, patients should feel confident: Doctors and nurses want to keep a human in the loop, even as they integrate AI into their workflows.

“It will be a doctor who is going to be reading that summary or a nurse who is going to be reading that summary and then taking an action to order a lab or put a recommendation in for a follow-up appointment,” Callahan said. “There is high interest in making sure that that is the right decision for that person. That hasn’t changed.” 

Still, many patients say they’d be more comfortable with AI use if their doctor fully explained it in advance. And health systems may have their own priorities that push their facilities toward more rapid AI adoption and delegating more tasks to these AI tools, as seen in the recent NYC nurse layoffs.

So if you want to be informed on exactly where this technology is present and have the ability to consent to its use, you have every right to ask your doctor, experts say. 

“AI is new, but the trust that serves as the foundation of the physician-patient relationship is not,” Timothy Keyes, a machine learning scientist at Stanford Health Care, told me over email. “To that end, I think that conversations about medical AI use should be open, honest, and transparent — just like any other conversations about shared decision-making in the clinical environment should be.”

For some things, your doctor should be asking you proactively if you consent to AI use — note-taking, for example. At my most recent primary care appointment, my doctor asked me if it’d be okay for him to use AI to take and summarize notes from our conversation; Goldstack told me she’d experienced the same at recent physician visits. (This is probably the most common AI use that you will encounter, and Keyes said it’s worth considering giving your consent: “There is growing evidence that they reduce physician burnout and save them at least a bit of time each day writing notes.”)

There are also a number of direct questions that you can ask:

• Will AI be used in my care and how?
• How is my data being protected?
• Can I opt out of any AI services that I do not feel comfortable with? (Keyes noted that patients should be allowed to opt out of any care, AI-related or not; if opting out is not an option, ask how a human provider will be involved.)
• How is the health system or clinic making sure that any AI system they use is working as intended?

And the transparency goes both ways. If you’re asking a question because you consulted ChatGPT before your appointment, tell your doctor. If you’ve talked with a chatbot because of mental health struggles, tell your doctor. And at the same time, feel free to ask your physician how you yourself could actually use AI in a responsible and productive way to improve your health.

“This opens up the opportunity for both the physician and the patient to be humans-in-the-loop,” Keyes said, “in different parts of the loop, with different perspectives, using an AI system to better understand the bigger picture.”

In a way, the novelty of AI and its rapid adoption is an opportunity for all of us to be nosier and more inquisitive patients. What all of these questions really come down to, Callahan said, is how your doctor is making decisions about your health care. That is relevant to all of us, no matter how AI is involved or even if there is no AI being used at all. 

Callahan said she always has a list of questions for her doctor when they recommend a course of treatment: “What are the factors in my health that are informing this recommendation that you have? Would you be making this recommendation for other patients who are similar to me? What can you tell me about the outcomes that I might expect to experience if I say yes to this?”

“I actually think if they can point to the part of your health that is connected to the decision, whether or not an AI tool helped to make that connection is secondary to their ability to communicate effectively to me about it, and help me to feel engaged in making a decision about my own care,” she said.

AI is changing medicine quickly, for both patients and their doctors. The best way to stay ahead is to talk about it.

This story appeared in Today, Explained, a daily newsletter that helps you understand the most compelling news and stories of the day. Subscribe here.

Surely Anthony Fauci has earned the right to party with Robert De Niro in peace. But instead, America’s embattled former Covid-19 czar was hauled before the Senate today to defend five-year-old diary entries. 

Senate Republicans subpoenaed Fauci, the former director of the National Institute of Allergy and Infectious Diseases, as part of a broader effort to dispute the origins of the Covid-19 pandemic.

Fauci is the longtime face of American infectious disease research and has appeared in front of Congress more than 250 times. But this morning — in a tense, highly partisan spectacle — he invoked the Fifth Amendment and refused to testify. 

Fauci accused Kentucky Sen. Rand Paul, who’s leading this circus, of nursing an “unhinged” and “obvious obsession” with him. Paul recently released Fauci’s unredacted diary, which includes lots of deeply cringe tidbits about the immunologist’s celebrity hobnobbing…but nothing that materially alters our understanding of the pandemic or Fauci’s handling of it. 

“The only conclusion I can reach is that the sole reason he is calling me before this committee is to get me to say something, anything, that could vindicate his repeated public pledges that I end up, in his words, ‘behind bars,’” Fauci said. “Any reasonable person who has followed his unhinged obsession with me would readily come to the same conclusion.”

Why we’re still arguing about Covid-19

Fauci occupies an uneasy spot in American politics. To some people, he’s a hero who helped steer the country through a terrifying pandemic. To others, he’s a villain who imposed damaging policies, concealed inconvenient facts, and never answered for his various missteps.

The evidence doesn’t back that darker story. But Fauci’s vilification points to one possibility that is worth taking seriously: As a country, we never adequately reckoned with the mistakes and uncertainties of Covid-19.

Consider the narrative trajectory of the lab-leak theory, which is central to Paul’s vendetta against Fauci. Early in the pandemic, Paul and other proponents argued that the novel coronavirus might have escaped from a Chinese laboratory. Some people went even further, claiming that Fauci had funded the lab’s research and then covered it up. Both theories were treated as ridiculous.

To be clear, the second theory is ridiculous. (There’s absolutely no evidence that Fauci was somehow, improbably involved in the making of Covid-19.) But the consensus around the lab-leak theory has changed. While most researchers still believe the virus spread naturally from animals to humans, a laboratory accident has never been definitively ruled out — and many now allow for the possibility in a way that they didn’t four or five years ago. 

The same is true of other pandemic controversies, too. Reasonable people can now debate whether lengthy school closures did more harm than good. Guidance on masks and other measures changed repeatedly, sometimes without a ton of explanation. 

None of that means officials acted in bad faith. But we’ve arguably never had the kind of serious, bipartisan examination of the pandemic’s missteps that a once-in-a-century public health crisis deserved. And in the absence of that (naive? impossible?) shared reckoning…we’re getting Fauci’s leaked journals. 

One link for later

➨ Check for ticks. Ticks are responsible for a whopping 90 percent of vector-borne disease in the US, but local and county health departments do very little to stop them. To protect yourself, use permethrin spray when you go outside and examine your body for the little buggers when you get home. Throw your clothes in the dryer after a hike, too — ticks hate heat! Who knew. 

Before you go…

• Did you know…that in Wisconsin, placing certain bets on the prediction market Kalshi can cost you your right to vote? The law dates back to 1849, and it’s one of several state laws that bar voters from gambling on elections. 
• Today’s trivia: In Greek mythology, who is Hercules’s stepmother? (You can find this and other brain puzzles in Vox’s daily crossword. Look for the answer in tomorrow’s edition.)
• Yesterday’s trivia: Yesterday we asked you the name of the Dutch cheese typically coated in red wax. That would be the Edam. In the 15th century, Edam reportedly helped make its namesake city one of Europe’s most important cheese markets. 

The 2026 Commonwealth Games medallist hopes more women, of any age, can feel inspired to take up space in the gym

This story appeared in Today, Explained, a daily newsletter that helps you understand the most compelling news and stories of the day. Subscribe here.

America formally eradicated measles in the year 2000. But like many other remnants of the 1990s — flip phones, CDs, baggy pants — measles is now regrettably and undeniably back. 

More than 2,300 Americans have come down with measles so far this year — the highest number since 1992. New data from the Centers for Disease Control and Prevention shows that there’ve been more cases in the country in the last two years than in the 24 years prior. 

Many of the cases trace back to large outbreaks in South Carolina, Utah, Virginia, and Pennsylvania, some of which have ended. But the underlying problem is both much broader and much trickier to address: As more parents pass on routine childhood vaccinations for their kids, these once-eradicated viruses have more chances to spread.

For measles, which is incredibly — almost frightfully — contagious, 95 percent of people in any given community must be immune to stop its transmission. But today, only 28 percent of US counties vaccinate enough of their kindergarteners to meet that threshold. 

Another record-setting year for measles

Lower vaccination rates are, in large part, a result of political polarization, misinformation, and declining trust in health authorities and institutions. But there’s another, more ironic reason for measles’ resurgence: We did such a good job getting rid of it.

As late as the 1950s, virtually every American child contracted measles before age 16. Roughly 48,000 patients were hospitalized each year with measles, which is among the most contagious infections known to humanity. 

But the development of a highly effective vaccine in the 1960s, and a series of aggressive public immunization campaigns in the decades after that, all but eradicated a once-common childhood illness. The federal government poured millions of dollars into vaccination programs, especially for low-income kids. Everyone from Michael Jackson to the Teenage Mutant Ninja Turtles championed measles immunization. 

All that campaigning worked. By the end of the 1990s, more than 90 percent of Americans had received the measles vaccine, and a similar percentage agreed that it was important to vaccinate children. As a result, most people born in the last 40 years have no firsthand experience of how dangerous measles is.

“We’ve done too good of a job,” one doctor joked to Vox last December. In other words, ironically, America’s success at vaccinating against measles … has made Americans complacent about measles vaccination. 

One link for later

➨ Go with your gut. The hashtag #GutTok has over 6 billion views on TikTok, and viral trends that promise to “hack your gut” through miracle products and cleanses are all the rage. But you don’t need an influencer-endorsed supplement for digestive wellness. Instead, actual experts recommend basic lifestyle steps like eating a high-fiber diet and reducing stress. 

Before you go…

• Did you know…that there are more endangered species in California than in any other US state? But more surprising is the runner-up: After California, Alabama has the most endangered species. 
• Today’s trivia: Which Irish musician sings the song “Orinoco Flow”? (You can find this and other brain puzzles in Vox’s daily crossword. Look for the answer in tomorrow’s edition.)
• Yesterday’s trivia: On Friday we asked you for the four-letter university located in Athens. That would be Ohio. But there are more than two dozen Athenses in the US, and a rival Athens is also home to the University of Georgia. 

This story was originally published on June 29 in The Highlight. To get access to member-exclusive stories like this every month, become a Vox Member today.

America in the summer of 1976 was not in a good place. 

The president who presided over the country’s bicentennial, President Gerald Ford, only had the job because the previous president and vice president had resigned in disgrace, making him the sole US president who was never actually elected. The Vietnam War had ended in defeat and disgrace when Saigon fell the year before, after the deaths of nearly 60,000 American servicemembers. Inflation hit double digits in 1974 and stayed ugly, unemployment sat near 8 percent, and economists had to invent a word — stagflation — for an economy that seemed to encompass the worst of both worlds.

Given all that, you might assume the national mood leading up to the 200th anniversary was grim. And, yet, on July 4, 1976, something strange happened: Americans threw themselves a hell of a party. 

In New York Harbor, more than 200 tall ships sailed up the Hudson for Operation Sail, drawing an estimated six million spectators — the largest crowd in the city’s history. Ford reviewed the fleet from the deck of the aircraft carrier USS Forrestal. It was the same scene up and down the country that day: parades in small towns, fireworks over the National Mall, church bells ringing in unison at 2 o’clock. It was one cathartic day of celebration after a decade that had offered little reason for it.

And when pollsters asked people how they felt about the country’s future that year, the mood was, improbably, sunny. A Roper survey found more Americans were optimistic than pessimistic about the future by a nearly three to one ratio. More than three-quarters told Gallup the nation had already achieved at least a fair amount of its founding ideals. Somehow, a nation that was in the middle of a genuinely miserable decade looked in the mirror and liked what it saw.

Jump forward 50 years, to this year’s 250th anniversary, and you’ll find the vibes flipped. Roughly 60 percent of Americans tell pollsters the nation is on the wrong track. A majority say its best years are behind it. About three-quarters think today’s children will end up worse off than their parents. Asked a version of that same founding-ideals question from 1976, 77 percent now say the founders would be disappointed in what we’ve become.

But just as they were in 1976, the vibes don’t match reality. Set the mood aside and look only at the numbers, and the country that felt so good in 1976 was, by the most important measures, a worse place to be alive than the country that now feels so terrible on its 250th birthday.

Start with whether you’re alive

Let’s start with the most basic test of how a society is doing: how long its people live.

Life expectancy at birth in the US was 72.6 years in 1976. In 2024, it reached a record high of 79 years — an extra six and a half years of life. At the start of life, a baby born now is far more likely to survive its first year than one born during the Bicentennial, while cancer, once nearly a synonym for a death sentence, now kills a much smaller share of the people it strikes. 

The US made those gains by stopping some of its worst habits, things that were commonplace in 1976 . You might have seen the Bicentennial celebrations through a cloud of smoke, as cigarettes were woven into ordinary life — on airplanes, in offices, in hospital wards — and roughly 37 percent of adults smoked. Today, it is closer to one in 10, and it keeps falling. 

The heart disease and lung cancer that were connected to all that tobacco have receded with it. Add seatbelts and airbags, better trauma care, and cheap drugs that lower cholesterol and blood pressure, and the result is a country where the things that were most likely to kill an American in 1976 are less deadly now.

The America of 1976 sat at the leading edge of a brutal crime wave; the murder rate would peak in 1980 and stay high for more than a decade. By the early 2020s, however, violent crime had fallen back to roughly a 50-year low, and homicide rates this year may end up at a record low. And the single most dangerous thing most Americans do — get behind the wheel of a car — is far less likely to kill them, with the death rate per mile driven now a fraction of what it was at the Bicentennial.

The country got cleaner, and richer, and fairer

In 1976, the air in American cities carried lead, an honest-to-God neurotoxin that was pumped out of every tailpipe of the more than 90 percent of American vehicles that used leaded gasoline. 

Rivers literally caught fire: The Cuyahoga in Cleveland had burned so many times it became a national joke, and Lake Erie was widely written off as dead. And things were bad outside Ohio, too. In Los Angeles, the smog got thick enough to keep kids inside at recess and erase the nearby mountains from view.

Since 1970, however, the combined emissions of the six main air pollutants the EPA tracks have fallen 78 percent — even as the economy nearly quadrupled in real terms, the population grew by tens of millions, and Americans drove far more miles. That split, with growth going one way and pollution the other, is one of the least celebrated but most consequential triumphs of the past half-century, the product of legislative efforts and technological response. And lead? It’s essentially disappeared from the air. 

And it’s not just economic or environmental statistics that have improved; society advanced, as well. Women now earn the majority of college degrees. The Black poverty rate sits near a record low. Support for same-sex marriage is now the norm — maybe the single biggest social change from 1976, when homosexuality was criminalized in most states. Pick a metric more or less at random, and the line usually runs the right way.

This is not a matter of cherry-picking a few flattering numbers. It is the overwhelming direction of the evidence, across health, wealth, safety, rights, even the basic cleanliness of the physical world an American walks through every day. Measured against its own recent past, the US is in some of the best shape it has ever been.

So what’s with the bad vibes?

A more perfect union doesn’t mean perfect

Well, some things genuinely got worse, and they are not insignificant. 

Americans’ faith in their government has collapsed; fewer than one in five now trust Washington to do the right thing, down from solid majorities in the 1960s — and the country is more polarized than it was in 1976. Democratic decline and even collapse is a live threat. Those economic gains I highlighted above have flowed disproportionately upward. The top 1 percent’s share of income, near a historic low in 1976, has since roughly doubled.

Climate change barely registered in 1976. The carbon dioxide in the atmosphere has since climbed from around 330 parts per million to about 427, and warming will only get worse in the future. And buying a home increasingly feels out of reach for many. By 2024, a record share of households spent more than a third of their income on housing. (Notably, though, the percentage of Americans who own a home is slightly higher than it was in 1976, and those homes are much larger on average.) 

These are real problems, but they remain exceptions to a broader half-century trend of improvement. And a country that scrubbed the lead from its air and put out smoking can overcome new challenges, as well. 

Which brings us back to a tale of two birthdays. In 1976, Americans had less of nearly everything you can count, and, yet, they reported feeling good about the future anyway. In 2026, we have more, and we don’t. 

Just as it can be for a person, a country’s mood is a poor instrument; it measures the story we are telling ourselves more than the lives we are actually living. For all our pessimism about the state of the nation, more than three-quarters of Americans say they are satisfied with their own lives.

The Americans crowding New York Harbor in 1976 were cheering a country that was sicker, dirtier, more dangerous, and less free than the one we live in now. But they were right to cheer; the line was already bending the right way, and it kept bending. It turns out a nation can travel a long way, even while it is convinced it is going nowhere.

A version of this story originally appeared in the Good News newsletter. Sign up here!

Medicine has come a long way. We are living longer than ever, we have eradicated diseases that once seemed like a certain death sentence, and new improvements  are constantly being made to our quality of life. But despite all the advances, there’s a huge gap in women’s health. “I think there’s such an interconnectedness between society, culture, medicine, and science,” Dr. Elizabeth Comen told Vox. She’s a medical oncologist who specializes in breast cancer and an associate professor at NYU Langone. She says medicine often mirrors what’s happening in society at large. “For many societies across the globe, women did not have equal agency or power over their bodies, and that’s really reflected in the history of medicine.”

It’s reflected in medicine’s present, too. The share of women with heart disease in the United States is rising, there’s a cultural backlash and skepticism surrounding birth control, and almost half Americans are turning to social media influencers (many of whom aren’t credentialed) for medical information. 

Why is there such a disconnect when it comes to health care for women? And what will it take for it to end? We find out on this week’s episode of Vox’s weekly call-in podcast, Explain It to Me.

Below is an excerpt of my conversation with Evans, edited for length and clarity. You can listen to the full episode on Apple Podcasts, Spotify, or wherever you get your podcasts. If you’d like to submit a question, send an email to askvox@vox.com or call 1-800-618-8545.

We are at this point where we know more about our bodies than we ever have before. Sometimes you go to the doctor, and it feels like they’re still catching up on some pretty basic aspects of women’s health. Why does it feel that way?

Because it’s true. It takes a long time for medical science to catch up with the glaring gaps in our healthcare system. The gaps are not just about the obvious women’s health issues. We focus a lot on breast cancer. We focus a lot on reproductive function or our gynecological needs. But the gaps exist head to toe from our neurologic care, our gastroenterology care, how our hearts function, how our immune system functions, how our joints function. The gaps are real, and the experiences are real.

Can you walk me through some of the history? What did it look like to study women’s health before the 20th century? What were we dealing with?

When we think about modern medicine today and these specialties of urology, gastroenterology, they really didn’t exist before the 1900s at all; those are relatively new concepts. For much of the history of medicine, at least in the Western world, the idea was that, at best, we were small men and, at worst, there were many ridiculous diagnoses like hysteria and a long legacy of dismissing women’s medical needs because we were largely not taken care of by women. Those women that were caregivers in the history of medicine, whether it was the midwives or other types of healers, were largely pushed out of medicine as it became codified, and the idea of medical science really came to rise in the late 19th century.

So, I’m guessing that they weren’t really talking about menopause at the time, let alone perimenopause.

Perimenopause wasn’t even discussed. That’s a relatively new term and new part of our lexicon when it comes to lay discussion and the public at large. With respect to menopause, one of the famous physicians, Roger Wilson, wrote a book [called] Feminine Forever and referred to women going through menopause as vapid cows. He was the one that advocated in the 1960s and 1970s for women to be on hormone replacement therapy. But understand that, in the 1850s, it’s not like people really were wildly aware of what estrogen, and testosterone, and progesterone did. These are all relatively new ideas — the concept of hormones and how they can travel in our body. And again, we have a long way to go.

I read that women were rarely included in clinical trials until the National Institutes of Health mandated it in 1993. I find that so surprising. Why were women missing there? 

Well, these studies were not designed with women in mind. Some of the massive cardiology studies for drugs that we use day in and day out were done on thousands of men and not women. There is so much to that history, including the animal models on which many of these drugs were developed. In order to develop a drug, often, they are developed on mouse models first. It wasn’t until 2016 that you were even required to state the sex of the mice that you were studying. In many of these instances, female mice were not even included in drug development.

Oh my gosh — even the mice? How were these hormones marketed to people when hormone replacement therapy first became a thing?

It depends on which advertisements that you look at. If you look at advertisements of women in the 1950s, ’60s and ’70s, a lot of women were being prescribed anti-anxiety medicine. “Can’t manage your household at home? Don’t want to take care of your kids? Here’s what will sedate you and at least make you able to prepare breakfast for your husband.” It’s really shocking, and yet, not that surprising. If you look at Instagram today, are we really that far off from what gets marketed to women? Women sink billions of dollars probably into sham supplements and sham treatments, because they don’t feel cared for when they go to the doctor. And what fills that space? A lot of people trying to market things that have no proven evidence.

I think it’s really interesting that, at one point, hormone replacement therapy was this big thing, because I feel like growing up in the ’90s and 2000s, hearing women who are older than me speak, they were kind of anti-hormones. How did the pendulum swing that way?

Well, the pendulum has swung in wildly different directions. At first, it was: Every woman needs to be on it. And there were wildly successful sales. Then, there was the women’s health study that exaggerated the risk of breast cancer. Understandably, women were terrified. They were told by the media and by reputable scientists that these risks were significantly high and that they could not be on it, and we didn’t leave them with any alternatives. Now, we’ve become much more granular about what we know and what we don’t know, but I still think we’re far behind on the science. There’s still a lot that we need to learn, but, fortunately, an understanding of the prior studies and what their limitations are has come to light.

There are all these gaps in trust and treatment. There’s going to be a fair amount of snake oil out there, but are there ways that this moment is actually driving better treatment for women?

I’m so grateful that we’re talking about it, but I am terrified of what I see from influencers on Instagram. People can fake their knowledge. There’s so much fake imagery and information that is out there. I wish that we could invest this in quality science, which is long and laborious and painful at times but gives us the quality answers that we need. Every day, I see the consequences of fake information online, whether it’s an incredible loss of financial resources or just wasting money so that you could buy a nice pair of shoes. That would make you feel better than the ridiculous thing online that’s over promising and under delivering. The fear mongering is out of control.

What do you think it will take to trust their doctors again, rather than turning to the treatments they’re being sold online that might be dangerous? What will it take for them to feel good about the interactions they’re having at the doctor’s office? 

I think it’s going to be really challenging. We can’t blame patients, because we’ve done them a disservice. Medicine has fragmented the care of many patients — not just women, but men as well. We have to build a health care system that allows for time to be with patients and really hold space for them. I think that’s where the trust is really going to be built, because, at the end of the day, despite all the technology that’s available, medicine is about human to human care. That is what everybody wants to be treated as: a human to be seen and heard in the ways that you can’t just reduce a body to biology.

Last week, the Food and Drug Administration (FDA) approved a small pill called enlicitide. It is a tablet you swallow once a day on an empty stomach with a sip of black coffee, water, or tea. But it does something that until now took a needle and a specialist’s prescription: It lowers the most dangerous kind of cholesterol by nearly 60 percent, about as much as the strongest injectable drugs on the market.

If that sounds less innovative than some of the medical advances I sometimes cover here — there’s no AI or gene editing involved — you’re missing the story. Enlicitide is just the latest example of how medicine has been quietly making progress against the deadliest thing in the modern world.

That thing is heart disease. It has been the leading cause of death in the United States for essentially a century, and in 2025 it killed 694,708 Americans — about one in five deaths — more than every form of cancer combined. Around the world, cardiovascular disease kills roughly 20 million people a year, the biggest cause of death on the planet.

But today, our enemy is on the retreat. In the US, the age-adjusted death rate from cardiovascular disease has fallen about three-quarters since 1950. In plain terms: A 60-year-old today is roughly four times less likely to die of heart disease this year than a 60-year-old was when Harry Truman was president. As I wrote last year, deaths specifically from heart attacks are down 89 percent since 1970.

That progress comes down to a single number. Low-density lipoprotein, or LDL, aka the “bad” cholesterol your doctor always wants you to lower. Until recently, a high LDL score was all but inescapable, something you could nudge lower with a better diet and willpower but struggle to really fix. What has changed is that we can now lower LDL for nearly anyone who needs it — further, more easily, and earlier in life than before.

A lifesaving genetic mutation

It’s a story that goes back 20 years. In the early 2000s, two geneticists at University of Texas Southwestern, Helen Hobbs and Jonathan Cohen, wanted to solve a medical mystery: Why did some individuals have striking low cholesterol levels? They combed the Dallas Heart Study for an answer. They found a handful — many of them Black Americans — carrying a broken copy of a gene called PCSK9. Their bodies cleared LDL from the blood with unusual efficiency, and the payoff was staggering: carriers of the strongest variant had about 28 percent lower LDL and roughly 88 percent lower risk of heart disease than people who did not carry the mutation.

That finding proved lowering LDL prevents heart attacks, and it handed drugmakers a target: copy that gene. Every PCSK9 drug since — including the new enlicitide — imitates a mutation a few people in Dallas were simply born with.

Millions of Americans still take the old cholesterol-lowering workhorses, statins, and they’ve proven highly effective at reducing heart disease for most people. But not everyone: Some people can’t tolerate the muscle aches; others take them faithfully and still don’t get their LDL low enough. Enlicitide is built for exactly those people: a pill as cholesterol-lowering as an injection but without the needle, and a drug that spares them the statin muscle aches.

Closing the loop

If the pill is today, gene editing is tomorrow — and it may be the answer to a problem no pill can reliably solve: getting people to keep taking their medicine.

About half of patients on statins quit them within a year, and a daily pill, however potent, only helps the people who actually take it. So that demands a fix you can’t forget. A company called Verve Therapeutics, now owned by Eli Lilly, has been testing a treatment that makes a single-letter edit to the PCSK9 gene in the liver — one infusion, in theory for life. In its first human trial, published over the spring in the New England Journal of Medicine, a single dose cut LDL by as much as 62 percent, and held it there for more than a year. Instead of a pill mimicking the effects of the genetic mutation that protected those people in Dallas, gene editing just switches off the gene.

As important as it is, cholesterol isn’t the whole story when it comes to heart disease. There’s smoking, which declined from about 40 percent of US adults in the 1960s to under 15 percent today, sparing countless arteries. High blood pressure — the silent condition that killed President Franklin D. Roosevelt at 63 in 1945, when doctors had few effective ways to treat it — can now be caught early and treated with cheap generic pills.

And then there are the GLP-1s. More than one in 10 US adults say they are currently on an anti-obesity drug, and whatever else you may think of them, they’ll make a significant dent in heart disease. In one major trial semaglutide cut cardiovascular events by 20 percent.

The war continues

Still, the war on heart disease won’t be easy to win.

Just because a pill like enlicitide has been proven to lower a lab value does not mean it’s yet proven to lower deaths. They should — the injectable versions of these drugs cut heart attacks and strokes by about 20 percent in long trials. But enlicitide’s own outcomes study won’t conclude for years.

Precisely because the condition itself so widespread, treatments for heart disease will only be effective if they are equally widespread.

Heart disease is shifting, too. The same research showing heart-attack deaths down 89 percent found deaths from other heart conditions — heart failure, arrhythmias, hypertensive disease — up 81 percent since 1970, though because heart attacks were killing several times as many people, overall heart-disease deaths have still dropped by about two-thirds since 1970.  Some of that shift is perversely the result of success: people who might have died of an initial heart attack now live long enough for the heart to wear out in other ways. And some of this is the reverse of progress: As smoking and cholesterol fell, obesity climbed to about 40 percent of US adults, pulling diabetes and high blood pressure with it.

And then there’s perhaps the biggest problem in medicine: access. A 60 percent drop in cholesterol helps only the people who can actually get the drug. Half of patients abandon cheap statins within a year. Enlicitide arrives at about $300 a month with uncertain insurance coverage. The gene edit, whenever it becomes available, will certainly cost far more, and at first will reach only the sickest.

More than 60 percent of US adults are projected to have some form of heart disease over the course of their life. Precisely because the condition itself so widespread, treatments for heart disease will only be effective if they are equally widespread.

Which brings us back to that unassuming little pill. It’s just a tablet, doing what a generation of scientists spent their careers trying to do: turning one of the deadliest numbers in medicine into one you can change. It’s the kind of progress that’s too easy to miss — until it saves your life.

A version of this story originally appeared in the Good News newsletter. Sign up here!

Ensuring the right fit matters. Inadequate support could contribute to breast pain, impact movement and cause stretching of breast tissue