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

Every day it seems scientists are making breakthroughs in Alzheimer’s disease. 

New treatments that actually slow the disease’s progression — lecanemab and donanemab — have finally appeared on pharmacy shelves in the past few years, delivering real-world results for patients and their families. New blood tests promise to identify at-risk patients earlier in their lives, giving them the chance to make lifestyle changes and potentially start treatment to stave off symptoms. 

The media and wellness influencers are always reporting on new diets, workouts, or hobbies that can combat dementia. Just last month, there was even a report out of China about an experimental brain surgery that allegedly reverses the symptoms of Alzheimer’s disease — the Holy Grail that researchers have been pursuing for generations.

But hype has outpaced the science of treating Alzheimer’s disease before. Promising treatments have gotten a lot of attention before only to fizzle out a short time later. Less than a decade ago, many scientists were wondering whether we had the theory of Alzheimer’s disease completely wrong. 

For those of us who don’t work in the field, that confusing history can make it hard to make sense of these recent developments. It sounds like we are entering a new age for Alzheimer’s prevention and treatment — but are we actually? And, if we are, how can people benefit from it?

I called a couple of leading experts to find out.

Here’s the good news: They say scientists are genuinely shifting the paradigm for treating, detecting, and ultimately preventing Alzheimer’s disease. The two drugs on the market can actually slow down cognitive decline for many patients, something that had been out of reach for decades. And more treatments are coming.

“Diagnosis and treatment of Alzheimer’s has changed in a way that is revolutionary compared to, say, four or five years ago,” said Dr. Jason Karlawish, co-director of the Penn Memory Center.

At the clinic where he sees patients, “people are feeling a sense of hope and promise,” he said.

For a long time, the science on Alzheimer’s disease felt stuck. Now it’s moving. There’s only one thing that could stop it, according to experts: the Trump administration’s anti-science agenda.

Scientists are getting closer to game-changing Alzheimer’s treatments

In 2023, the approval of two drugs transformed the landscape of Alzheimer’s care: lecanemab (sold as Leqembi) and donanemab (sold as Kisunla), two IV treatments that target amyloid plaque in the brain of a person with Alzheimer’s. Before these two drugs — and the approval of aducanemab, a similar but less effective and riskier treatment — it had been decades since the last new Alzheimer’s treatment had come onto the market.

They are not perfect treatments. They are effective only for people with mild cognitive impairment, not more advanced stages of the disease. They can only slow the progression of Alzheimer’s for those people, not stop or reverse it. And they do come with the risk of serious side effects, particularly brain bleeds.

“The good news is, we have these two drugs that can help people,” said Tara Spires-Jones, professor of neurodegeneration at the University of Edinburgh and author of the forthcoming book, Fighting for our Minds: The Neuroscience of Defeating Dementia. “The bad news is, you don’t get any better. You’re still getting worse — you just get worse more slowly.”

These drugs are a start, not the endpoint. Researchers are already working on the next generation of treatments. The drug pipeline is becoming more robust because scientists are finally coalescing around a theory of the disease that’s more complex — and, crucially, opens more potential targets for new drugs. 

For a long time, Alzheimer’s research was dominated by the amyloid hypothesis. The theory posited that the buildup of plaque made from amyloid proteins was responsible for disrupting brain signals and creating the telltale loss of memory and identity associated with Alzheimer’s. Scientists are still confident that amyloid plays a role in Alzheimer’s — and the success of these amyloid-targeting drugs supports that interpretation. But there is also a stronger consensus that other mechanisms must be at work. Some people who have evidence of amyloid plaque building up in their brain nonetheless never develop Alzheimer’s disease. 

Another type of protein called tau seems to be associated with the disease. Scientists also increasingly believe that inflammation may play a role. Part of the breakthrough of the past few years is that scientists are no longer arguing about whether they even understand this disease at all. Instead, the mission is to pursue different drug targets and increase the chances of delivering new treatments.

“I don’t think people in the field are fighting over, ‘Your mechanism is wrong and mine is right,’” Karlawish said. “I think there’s a kind of general democratization. There are multiple promising mechanisms.”

New tau-targeting treatments are moving through clinical trials. Biogen has a drug called diranersen that aims to stop the production of the tau proteins moving through clinical trials. Preliminary results showed that the drug did appear to reduce tau and improve cognitive symptoms — although, curiously, the most effective response was at the lowest dose. Further research is needed before the drug could receive FDA approval. Another tau-targeting drug from Eisai has also entered clinical trials and is in the earlier safety-check phases. And new amyloid-targeting treatments aim to better penetrate the brain-blood barrier and deliver more effective relief for patients.

In the short term, scientists hope these drugs can slow or even stop cognitive decline better than the currently approved medications. In the longer term, these new approaches — and potentially a combination of different drugs with different targets — could eventually allow scientists to reverse Alzheimer’s. (As for that experimental surgery in China, as Nature reported, scientists say its results will need to be replicated in other clinical trials before we’re confident that it really works.)

“The brain is amazing. You can make new synapses,” Spires-Jones said. “If we could stop the insult, it’s theoretically possible in the future that we could have treatments that not only slow the progression but actually let you get better. But I think we’re pretty far from those. What I think is much closer is really, really meaningful treatments that will slow or even stop disease progression. We’re probably going to see something coming out in the next couple of years.”

How patients can get the most out of these new treatments

But even a “cure” in the long term will be conditional. Because Alzheimer’s eventually causes the brain to die (thus its 100 percent fatality rate), there may still be a point of no return once the disease is too entrenched. “A cure for people in the late stages is practically impossible because too much of the brain has died,” Spires-Jones said.

And that reality makes early detection all the more important. That’s the way patients can get the most out of the current medications and their eventual successors.

It used to be that doctors couldn’t confirm whether somebody had Alzheimer’s disease until the person died and they could perform an autopsy. But the new treatments can give people more time with their loved ones before the disease’s worst symptoms kick in. 

That means waiting is not an option. Patients are demanding better methods of detection.

“Treatment attracts patients, for good reason, and treatment demands diagnosis,” Karlawish said. “Treatment really does drive the business model for a disease.”

So, scientists are designing new blood tests that can detect the presence of tau proteins and predict the later onset of Alzheimer’s disease with impressive accuracy. And they are learning more about pivotal periods in a person’s life where their risk of Alzheimer’s might start to grow — and when interventions might therefore be more effective. New research has suggested that menopause may be an accelerant for Alzheimer’s progression, and therefore may represent an important point in someone’s life. 

These developments are shaping what the near-term future of Alzheimer’s care will look like. As a person ages, they will be able to take one of these blood tests to see if there are signals they are at a higher risk of the disease. If they are, they will have a growing number of medications that they could take to delay or potentially prevent dementia from setting in. For a woman at risk, for example, hormone replacement therapy has been associated with a reduced risk of dementia. Clinical trials are also underway to test whether existing drugs like donanemab and lecanemab can delay the onset of symptoms for somebody who is at higher risk but has not yet started to experience cognitive decline.

“We couldn’t get the right people at the right time early on — and now we can,” Spires-Jones said. “That’s a problem that’s almost solved now.”

Prevention may also be where GLP-1 drugs ultimately prove most useful. As scientists come to better understand the intimate relationship between vascular health and brain health, there is growing reason to think these medicines could help reduce dementia risk decades before symptoms appear.

That would make GLP-1s a complement to drugs such as lecanemab and donanemab, rather than a competitor. Those treatments are designed for people who already have early-stage Alzheimer’s. GLP-1s, by contrast, have so far shown little ability to slow the disease once cognitive decline has begun. In a disappointing clinical trial involving people with mild cognitive impairment or early Alzheimer’s, researchers found that the drugs had a negligible effect on the progression of the disease.

But that result doesn’t mean there isn’t a role for Ozempic and the next generation of GLP-1 drugs in the fight against Alzheimer’s. 

Scientists increasingly believe that chronic inflammation, obesity, and poor vascular health can all accelerate cognitive aging. GLP-1 drugs reduce inflammation, while their effects on weight and metabolic health can substantially lower cardiovascular risk. If US obesity rates continue to fall as these medicines become more widely used, their most consequential effect on Alzheimer’s may therefore be indirect: improving the health of millions of people long before the disease takes hold.

“I think where we’re going in the future is those semaglutide-type drugs will probably be very good for prevention,” Spires-Jones said. “If we can keep people’s obesity in check, that will probably more likely be a preventative treatment. That trial pretty conclusively told us that once you have symptoms, at least, that drug is not going to help.”

This summer, the Alzheimer’s Association announced a $100 million research project to examine whether lifestyle changes plus a GLP-1 medication could reduce the risk of dementia in at-risk older adults.

If you’re worried about your own cognitive health or that of a loved one, you have options, and those options are only going to grow. Talk to your doctor. There are FDA-approved blood tests you can already take. Ask about lecanemab and donanemab. You may also be a good candidate to help scientists in the most active areas of development. Researchers need people to participate in their clinical trials. The Alzheimer’s Association and the federal government have online tools to help people find clinical trials that you or someone you love could be a candidate for. 

Science funding cuts could slow down this progress

All the optimism about the future of Alzheimer’s treatment is based on research and clinical trials. When I asked Karlawish and Spires-Jones about where the story goes from here, they shared one concern: that science becomes so politicized that it would be difficult to get grant funding for research projects that could lead to additional breakthroughs.

“In some sense, the biggest threat is outside the science,” Karlawish said. “There’s deep concern that this politicization of the grant process will essentially wreck American science. We can’t sustain that kind of environment and still demand the results that we’ve come to expect.”

President Donald Trump and US Health Secretary Robert F. Kennedy Jr. like to present their crusade to reform American science as being targeted at frivolous DEI projects. But there are already examples of serious dementia studies being affected: Last month, the Trump administration canceled $15 million in grants for studies to evaluate how discrimination affects long-term brain health.

This is another place where we have more agency to impact what happens next: the ballot box. Use your individual political power to support lawmakers who defend the scientists and researchers doing critical work. 

“You can vote for people who will fund and support science as an endeavor,” Spires-Jones said. “Advances in science don’t happen on their own. We need all of society to get involved.”

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

PALAU, Micronesia — On a bright, sunny day last May, I stood on a boat surrounded by the turquoise waters of the island nation of Palau. I was there in the western Pacific watching scuba divers as they prepared to bring up evidence of a mysterious aquatic world. 

Palau is famous for its spectacular and rich coral reefs. But these divers were planning to descend past those sun-lit marine communities and down into a lesser-known twilight zone known as the “mesophotic coral ecosystems.” 

Mesophotic essentially means “middle” and “light,” which is where these ecosystems are — not quite in the bright daylight, not quite in the profound darkness, but somewhere in between. For simplicity’s sake, we’ll call these communities, which range from some 30 meters to 150 meters below the surface, the “deep reefs.” 

One of the divers on the boat with me was a zoologist and curator at the California Academy of Sciences named Luiz Rocha, who has spent decades studying these deep reefs and their secrets. 

“Anything between 30 meters and 150 meters is really, really unknown,” he told me.

Because these deep reefs are so unknown, researchers like Rocha are left with big questions. They want to get a baseline picture of what is going on in these ecosystems — even just who lives there! — so that they can better understand how they function.  They’ve also tried to work out whether (or not) these deep reefs might provide a refuge for species living in shallower coral reefs.

I was in Palau for Vox’s Unexplainable podcast because, in an effort to gather more information about these mysterious places, Rocha left some scientific structures down in these twilight depths back in 2016. Those structures then spent almost a decade becoming encrusted with all kinds of marine life. And now, Rocha was back to retrieve them, hoping that he — along with many other scientists — would be able to open them up, like a box of scientific puzzle pieces, full of clues about this under-understood marine world.

So what is a mesophotic “deep reef”? 

One thing that’s often acknowledged in papers about and descriptions of the “mesophotic coral ecosystems” is that scientists don’t know as much as they’d like to. A National Oceanic and Atmospheric Administration article about them from 2019 is full of “may’s” as in: they may “serve as essential fish habitat for economically and ecologically important species.”

Researchers do know some things, of course. They know that these deep reefs can be found in many of the same locations as shallower coral reefs — so mainly the tropical and subtropical parts of the world, like Micronesia, the Caribbean, and even the Gulf of Mexico. They’ve found that there are many species that seem to be unique to these places, and recent research points to their potential susceptibility to climate change.

Researchers have also gotten a sense of some of the key differences between these deep reefs and their shallower coral neighbors. In shallow reefs, hard corals team up with photosynthesizing algaes. The algaes provide the corals with nutrients, and the corals secrete a calcium-carbonate matrix that helps create the architecture of the reef. 

As you go deeper, though, the light begins to fade, and the opportunities for photosynthesis start to fade with it. The temperature also drops. So the animals living down in the deep reefs are the ones that can survive in a dimmer, cooler world.

Why are these places so mysterious? 

Scientists can dive into the deep reefs to try to learn more about these understudied places — as Rocha has — but exploring down at 100 meters requires more difficult, riskier technical diving than exploring at shallower depths. The deeper you dive, for example, the faster gasses get pushed into your tissues, which imposes limits on these really deep dives.

“We have a very, very short time,” Rocha says, “And by short time, I mean five minutes. Six, seven minutes.” 

Scientists might take some pictures in that time, or make some measurements, or collect a few samples, but then they have to move back upwards, a process which can take hours because they have to rise slowly to avoid decompression sickness.

It is, obviously, not particularly efficient to study an ecosystem in five- to seven-minute bursts. People have also used remote operated vehicles and submersibles to explore the deep reefs, but those have their own issues, and cameras can’t always capture all the detail you might want, or photograph more secretive, cryptic animals. So huge gaps remain in scientific knowledge about these ecosystems. 

“Whenever we go somewhere,” Rocha says, “the first thing we find is new species. … It’s the most basic thing in science you can do.” But this effort goes beyond just cataloguing new species of fish or sponges or sea slugs. 

Rocha wants to answer seemingly fundamental questions like: What is the main energy source for everything down here in the dimmer light? What does the food chain look like? How have things evolved to live down at these depths? How similar are they to the shallow ecosystems, and how different? How are they affected by climate change — and what’s the most efficient way to protect them? 

But, “in some ways we don’t even know what questions to ask,” Rocha says. “We really only know what questions to ask after we have a baseline understanding of what the ecosystem is. And for deep reefs, we don’t know that yet.” 

A new way to understand the deep reefs using “prefab housing”

Rocha is not deterred by the enormous number of question marks that surround these deep reefs. For years now, he has been gathering bits of basic information about them, often via those very short dives. 

About a decade ago, though, Rocha got interested in another method for sampling the biodiversity of this sort of marine ecosystem — a technique involving “autonomous reef monitoring structures” (ARMS).

Basically, each ARMS is a stack of several PVC plates, separated at uniform intervals and attached to a base plate. They look like little grey, featureless hotels. You take them to a place that you want to study, bring them down, secure them, and then leave them alone for a while to let them collect…life.

“As soon as you drop any kind of clean structure on a reef,” Rocha says, “it starts getting colonized by larvae of everything around it — of sponges, gorgonians, corals. And then, because there’s all a lot of hiding spots between the plates — so between the floors of the hotel — they start getting colonized by shrimp, by mollusks, by ascidians, by anything you can imagine in the ocean. … And it becomes this stable, diverse mini reef, if you will, packed with a lot of biodiversity that would be very hard to collect all at once in any given reef.”

A few years after that initial drop, you come back, collect the ARMS, and then study the mini reef that has grown on them. You can sample and touch and analyze things to your heart’s content. 

It’s not only a very effective way to collect lots of creatures, all at once, but also a great way to do so in a standardized way. If you went down — or sent a robot down — to collect an encrusted rock from a reef, you could learn a lot about the life on it, but it would be hard to compare the life on that rock to life on other rocks from other reefs, or even the same reef, because each rock would have its own unique characteristics. Not so for ARMS.

“ Every one’s the same,” Chris Meyer, director of the Smithsonian Global ARMS program, told me, “It’s prefab housing, and then you just look to see who moves in.” 

To Rocha, this seemed like a great way to get a really good, long look at the deep reefs instead of the brief glimpses he was getting from diving. It was also, he told me, fairly cheap to deploy them. So from 2016 to 2018, with some private funding, he and his colleagues left ARMS in some of the deep reefs around Palau — as well as in Guam, the Marshall Islands, and French Polynesia. They installed some around 50 meters, and some around 100, and then some around 10 meters, so he could compare the deep reefs to their shallower neighbors. 

After that, he waited. 

In fact, he waited a little longer than he would have liked, because the retrieval of ARMS is more expensive than deploying them, so he had to work out more funding. 

Eventually, private funders agreed to underwrite the retrieval of the ARMS that Rocha had left. Which is how he and his fellow divers finally found themselves on a boat in Palau again, ready to pull up these structures for the deep.

Opening the scientific puzzle box

Over the course of a few days, I watched a whole team of people pull several ARMS out of the deep reefs of Palau. Some of the ARMS were relatively sparse, but others were almost fuzzy with organisms — vibrant with red and orange and green and pink and white. One had a massive sponge attached to it, another had several delicate fronds dangling from it like coralline ferns. The ARMS collected each day traveled to the Palau International Coral Reef Center in bins full of seawater, where the scientists quickly got to work — seeing and touching (and smelling) this mysterious ecosystem right up close.

The process was, as it turned out, equal parts magical excitement and well-oiled, Cheez-It fueled disassembly line. After the plates were taken apart, Meyer took photographs of the plates — what he called a “time capsule of the place.” Others in the lab picked carefully through trays of debris, hunting for tiny crabs and worms and mollusks, or scraped samples off the plates and deposited them in tubes.

They collected sea squirts, said to be our closest invertebrate relatives. They collected sponges — flat ones that felt dry underwater, thick ones with bristles like tiny, unmoving caterpillars, one as thin as a flake of skin and shot through with silver filaments. They collected strange, soft corals known as “octocorals,” and they collected colonies of animals called bryozoans, which created what looked like swirling, two-dimensional honeycombs.

“We’re looking for every unique thing, which we call a morphospecies,” a Smithsonian research biologist named Sarah Tweedt explained. “And we’re trying to get some representative tissue samples from all of these things so that we can sequence the DNA — and match the DNA to the organism.”

That is, of course, assuming there is already a known genetic match in our existing DNA libraries. 

On the first day that I spent with the team, a Cal Academy curator named Terry Goslinger identified several potential new species. He is an expert on colorful, delightful sea slugs known as nudibranchs, and so, because of his deep knowledge (and because nudibranchs’ bright hues and patterns make them somewhat easier to tell apart than some other underwater creatures), he was able to make some on-the-spot calls about whether or not certain species were likely to be new to science, pending genetic testing to confirm.

Many of the animals were trickier to pin down, though. The researchers did their best to identify the creatures they were finding, but even now, several months out, there’s still a lot of work to be done. Of the close to 3,000 specimens, only a small fraction were identified at a species level. The numbers are a little bit inexact because researchers are still processing the data, but when I checked in with a Cal Academy postdoc working on the project, Susanne Bähr, in July, she told me that only 3 percent of samples had been ID’d by species, and a little less than 20 had a genus designation. Many, many more were only identified at higher, broader taxonomic levels. Genetic testing of the samples, paired with photographs and descriptions of the samples, will help people work out more specific species, and also help them identify whether certain species are new to science.

Beyond discovering new species…and toward solving the big puzzle

The most important parts of this work will involve more than just identifying species. In fact, the more time I spent with these researchers in the lab, (including one evening spent with them as they worked past midnight), the more I got the sense that, while they seemed excited about seeing new species, they seemed equally excited to witness relationships between animals.

When I walked into the lab one day, for example, several people urged me to go over and look through a microscope at a creature known as a pompom crab — a tiny yellow crustacean holding purple anemones in its modified front claws. Tweedt was extremely jazzed when she found something referred to as a “skeleton shrimp,” which looked to me like the marine equivalent of a stick insect, blending in on something called a hydroid. She pulled me aside another time, around one in the morning, to show me “the frosting on the cake” of the day, which turned out to be some bright red sea snails and the bright red octocorals they seemed to live on

As she put it in a later conversation, these relationships are, in many ways, the key takeaway from this ARMS project, and what distinguishes it from efforts to bring up a few individual samples at a time. Studying them, or even just looking at the fuller picture ARMS provide, is what will let researchers tackle some of the outstanding questions about these ecosystems. Bähr, for example, is already working with the data from ARMS retrieved in Guam, trying to analyze how much overlap (or lack thereof) there is between species at different depths in the deep reefs.

Really, though, this is all just the beginning. In one of our conversations, Rocha compared the work they are doing now to ecology work done in the mid-20th century to understand how species’ vertical distribution changes as you go up a mountain. This drove home for me how far behind researchers working on the mesophotic deep reefs are compared to their colleagues working on, say, shallower coral reefs. I asked him what kept him working on such a difficult puzzle.

“It’s the reward at the end of it,” he said, “If it’s a hard puzzle, at the end of it, the reward is always bigger.” 

“But…in our lifetimes, will we assemble the deep reef puzzle?” I asked.

“No, we will not assemble the puzzle, no,” Rocha said, “but we’ll generate some good pieces for the next generation to assemble.”

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.

My wife says I’m a people pleaser. I want to turn over a new leaf (maybe to please her?!) so I’m making a resolution to be less of a weathervane and stand up for myself more. But it’s hard — I love to fit in. I’m a joiner and a collaborator. It’s not that I’m passive, it’s more that I find other people’s “ways of being” contagious. Sometimes I catch myself slipping into imitation of the friends or colleagues I’m talking to.

What’s a chameleon to do? Or, more scarily, who am I when I’m alone? How do I find out who I really am?

Dear Identity Crisis,

At first glance, it’s a bit funny to be accused of being a people pleaser as if it’s entirely a bad thing. It sounds like you have others’ interests genuinely in mind, and that seems like a nice way to build connection.

But I find the term people pleaser to also be a sneaky euphemism. Do you want to know how this sort of behavior is often discussed in the psychological literature? In studies, it’s not always called people pleasing; it’s called lying. 

In fact, wanting to please other people is an incredibly prevalent motivation for lying; it’s more common than lying for personal gain or pleasure. When psychologists evaluated the top reasons that people lied in their everyday life, many wanted to seem more agreeable. Their lies support seemingly magnanimous goals, like complimenting a friend or making sure a social interaction went well. But they were lies all the same, defined by the researchers as a “message that one gives to another in which they are deliberately deceiving them.” 

I find this shift in perspective helpful, if a little harsh, if you’re looking to break a people-pleasing habit. It’s one thing to think about yourself as dedicated to keeping other people pleased. But when you consider that actually, all of your interactions are suffused with lies, the approach becomes a bit more unsavory. 

Imagine the situation in reverse: What if you found out that all the time you had spent with a close friend, they were keeping their real thoughts and feelings from you? You might feel differently about the time you’d spent together. I can bet it certainly wouldn’t feel as authentic. 

I used to be a bartender, and I would be nice and mildly obsequious to frequent customers. Several of them I genuinely liked. But I’ll never forget the uncomfortable moments of running into a regular elsewhere — and their figuring out that we weren’t actually friends. There’s a distance between two people when one’s main role is to please the other. You are creating that distance, even if you may not realize it, and not even getting tipped for it. 

So for starters, try trusting that the people around you are able to handle your real thoughts and feelings. But what are your real thoughts or feelings? This points to the bigger conundrum you face: Who is your true self? 

You’re in good company worrying about this. Religious figures, philosophers, and scientists alike have been trying to figure out if there even is a continuous self, and if there is, what is it made up of? 

Scientifically speaking, there’s not a part of your brain that’s “truer” than others, or where the true self resides. But your ideas about your true self matter, according to research by Rebecca Schlegel, a social scientist at Texas A&M University. She has found that people have greater well-being and find their lives to be more meaningful if they think that they’ve made choices that align with who they “really” are. 

When people make a decision that they think aligns with their own true self, it regularly leads to feeling more satisfaction with that decision — more so than choices steered by considering what other people want, by religious belief, or by advice from others. 

Doing this yourself can be remarkably simple. In one experiment, Schlegel asked participants to make an arbitrary decision and told some to “use your true self” to make up their minds, and others to “use rational thinking.” Those who framed their choices as being guided by their true self were much happier with their selection. For you, it could be that just introducing the question — what would my true self do? — can start making your life feel more like it belongs to you. 

If it feels odd to ask your true self what to do, defining your truest self as what’s moral about you isn’t a bad place to start. Researchers have found again and again that when they ask people which of their traits feel the “truest,” it’s usually the parts that are morally good. When I call my mother on her birthday, that’s my true self. When I say something hurtful to my friend, that’s a deviation from my true self, who knows better. I wasn’t myself this morning, I might say as an apology. So you could make a list of your best qualities, like your generosity or your creativity. Then, when you ask what your core self would do, you’ll have even more specific guideposts to follow. 

Of course, if having a true self still doesn’t feel relatable, you can turn to an approach I’ve found helpful in my own life from Eastern traditions, like Buddhism and Taoism. They endorse the idea that there is no rigid self at all. In Buddhism, this is called anatman, which translates roughly to “no self.” This teaching emerged in response to an earlier Hindu belief: a concept called “atman,” which asserted that all people had an eternal and unchanging core, similar to a soul. Anatman was a rebuttal to that idea.

I’ve found that anatman relieves some of the pressure around all of this. We feel as if there should be an essence to us, some permanent quality that persists over time that you can point to. But anatman reminds us that there’s no aspect of the self that doesn’t change.  

Life is long, and we transform throughout it. As we grow, we learn new physical skills like playing soccer and the piano, and eventually acquire back problems and wrinkles. Our minds evolve too. We read novels, maybe we can do calculus, and we develop political convictions. Hopefully, we gain the skills of being kind and patient. In all of these developments, change is the only constant. This is why the Buddha thought that you couldn’t find the singular, stable self in any of these places — not the mind, the physical form, our habits, or our perceptions. “What is impermanent, subject to change…cannot be taken to be ‘me,’ ‘mine,’ or a ‘self,’” the Buddha taught. 

You asked what you, as a chameleon, should do? You could frame everything you do as being in service to your deeper self. Or you could try halting the search for a strictly defined, enduring version of you, and start making decisions based on who you want that person to become.   

Bonus: What I’m reading

• My book club just read Love, Always, a novel by Ann Beattie, about a group of people who start a magazine in rural Vermont. It’s a summery tale, though somewhat frustrating, about what happens when people don’t change themselves, and only follow their worst instincts. 
• This is a fascinating story of multiple selves in Popular Mechanics by Michael Natale. It documented what happened when seven men confessed to being the culprit of a plane hijacking in 1973 in the Pacific Northwest.
• Over the course of several nights recently, I watched the 1926 silent movie, Faust, directed by F.W. Murnau. It’s a haunting tragedy about the consequences of wanting to hold onto a quality of yourself indefinitely — in this case, staying young forever. I was amazed by the special effects they pulled off for that era! An evergreen reminder that if someone promises you something that’s too good to be true (especially if he looks like the devil), it probably is. 

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

Over the years, Julianne Holt-Lunstad has fielded many requests from startups looking for her help. These entrepreneurs came to the Brigham Young University professor with the well-meaning goal of “solving” loneliness; they believed their app or company could help consumers build genuine connections, and wanted Holt-Lunstad’s opinion on this feature or that business tactic. 

Across the pond, University College London professor Noreena Hertz was getting the same calls. They wanted her to join their boards, to advise them, to give their proof of concept a stamp of approval. 

“Of the many startups who’ve approached me, and it’s probably about 50 or 60 in the space,” Hertz told Vox, “there hasn’t been one where I felt convinced by their business model.”

That CEOs and founders were clamoring to pick the brains of these two women is entirely predictable — their work may have been the basis on which these startups were founded. Holt-Lunstad is among the most cited academics who study loneliness and social connection. The commonly repeated stat that loneliness is equivalent to smoking 15 cigarettes a day? That came from her research. She was the lead science editor on the Surgeon General’s 2023 advisory on loneliness and isolation. As for Hertz, in her 2020 book The Lonely Century: How to Restore Human Connection in a World That’s Pulling Apart, she coined the phrase “loneliness economy,” at the time, a fledgling market of niche services, like friends for rent and professional cuddling.

In the years since Hertz gave it a name, the loneliness economy has only ballooned. As public attention to loneliness has mounted — despite the fact that research doesn’t consistently show whether a loneliness epidemic exists in the first place — the market stepped in to offer solutions. No longer are the lonely limited to joining a running club, they can now rent friends and cuddlers. They can hire a coach to help vanquish loneliness and build a community. (One charges $3,000 for a three-month program.) They can attend a $1,000 weekend-long summer camp to make friends (with the option to pay in installments via Klarna). They can buy a $250 pendant that listens to their every word and can communicate back via voice or text. They can join a coworking space meant to quell loneliness with a nearly $300 a month price tag. They can enroll in a bootcamp for how to be less shy, hop in a group travel excursion with other solo venturers, download an app where AI pairs you with other strangers for activities. Loneliness is no longer a societal issue with mental and physical costs and structural solutions but one businesses hope consumers can buy their way out of.

But is it possible to disrupt the slow burn that is making a friend? To outsource the intimacies of friendship to AI? To put a price tag on human connection? 

“I would caution developers to really critically evaluate their business model and the barriers to who they’re actually reaching,” Holt-Lunstad told Vox. “Think about ways that [connection] can occur organically without monetizing it.”

The cottage industry of loneliness services is just another example of capitalism wrapping its tentacles around human desire. But in most cases, the cost of the app, or product, or experience is going to be much higher than the possibility of eliminating loneliness.

One person’s loneliness is another’s business opportunity

Since the early 2000s when Harvard political scientist Robert Putnam warned of the decline of civic and social spaces in his seminal work Bowling Alone, we have witnessed the “privatization of community,” according to Sam Pressler, a fellow at the Harvard Human Flourishing Program who studies community, connection, and class. Gathering spaces shifted away from places of worship and union halls to boutique fitness centers and private, members-only clubs. “There was already this dynamic in place where you could, at a premium level, sell people on community,” Pressler said.

The pandemic pushed the loneliness economy into overdrive. Widespread social isolation enabled researchers to study perceived levels of loneliness during lockdowns. Media coverage of loneliness outlined its harms. Although Vivek Murthy, the US surgeon general during the Obama and Biden administrations, first referred to loneliness as a “health epidemic” in 2017, his 2023 report opened the door for other iterations: the male loneliness epidemic, the Gen Z well-being slump, a worsening midlife crisis. Over the past five years, search interest in the loneliness epidemic grew over 600 percent.

Naturally, the startup world began to see a business opportunity, Pressler said. WeWork founder Adam Neumann launched a new residential real estate company with a goal of “solving loneliness” and $350 million in funding from Andreessen Horowitz. The app 222, which uses AI to pair strangers for group activities based on personality-based questions, raised $10 million in funding. “You then get this anchor within startup land that really has an approach of solve customers’ problems and pain points, in that loneliness is a customer problem or pain point to be solved, through productized market solutions,” Pressler said.

Brian Choi had heard of the male loneliness epidemic, but luckily didn’t feel like he fell into that category. He grew up in the Los Angeles area, where he still lives, and has plenty of friends, but he signed up for 222 several years ago as a way to supplement his social life and meet people who might be interested in activities his existing friends aren’t.

“Dance, for me, means a lot,” the 34-year-old video game character artist, told Vox. “For my best friends, hard to sell them on that. So 222 is a good angle on sharing that experience with other people who are presumably also open to dance.”

But most of the platform’s events, Choi found, were centered around dinner and drinks, which didn’t appeal to him. If there was a meetup with an interactive element, like brunch and a pottery class, he was more likely to engage. But despite attending about a dozen 222 events over the years, Choi hasn’t fostered any serious friendships. “It’s dependent on individuals to be proactive about inviting folks into their lives after the 222 event,” Choi said. “And that can be scary for a lot of people.” 

Once a market emerged for loneliness-adjacent services and products, influencers started promoting them. Over the last few years, the content creator Zaid Khan observed his peers hosting “community” events that seemed well-meaning enough until a few common themes emerged: The events seemed to be furthering the creators’ brands, they often came with a ticket price, and they were attended mostly by young, white people. This widespread commodification of community is what Hertz refers to as “WeWashing” — like greenwashing — because an occasional knitting club with a $50 fee does not a community make. 

Charging any sort of premium for a social event or service runs the risk of exacerbating inequities. According to Holt-Lunstad’s research, people with only a high school education or less or those who made less than $75,000 a year were less socially connected than those with higher education and incomes. People who stand to benefit the most from interventions to build relationships often can’t afford a $200 a month gym, or lack the time to swipe for friends. These spaces can then become, like Khan observed, homogenized by race, class, and ability. “I’m sorry, but young, attractive, white, straight, 20-somethings living in New York will have no issue. … You can walk into any West Village bar and meet those people,” Khan said. “It’s excluding the people who, I think, genuinely could need it.”

“Masking” a symptom

There is a contradiction at the heart of the loneliness economy: the need for human connection in the modern world is difficult to solve, let alone value and commodify. In order to make money, companies either have to charge top dollar for their social club or camp, or, they need their product to be used by as many people as possible, as often as possible, which inherently flies in the face of how relationships are fostered. 

“The ethical problem begins when a company intentionally exploits a consumer’s loneliness, insecure attachment, or fear of missing out to pressure that person into purchasing.”

Cindy Rippé, Terry College of Business at the University of Georgia

Relationships are projects of patience. They unfold after repeated interactions in a physical space, after slow revelations and disclosures and laughs. The loneliness economy isn’t built on unhurried bonding. Instead of consistently showing up to a community event and slowly building connections, some apps are effective at connecting users with strangers for one-time events, but are less focused on encouraging users to exchange numbers and hang out again. “We know from the research that relationships take time to develop, and that there needs to be consistency also over time. When you get to know someone, it takes time,” Holt-Lunstad said. “If you’re only doing it sporadically or once, that’s going to be less likely. If it’s all virtual, that’s going to be less likely.”

Just like hunger and thirst cue you to eat and drink, loneliness is a sign to interact. Swiping for friends may feel productive and occupy time, but without actually hanging out, it may just be a distraction, Holt-Lunstad said. “What I worry is that [apps] may be effective in masking that symptom without actually fulfilling any social needs,” she said. “It would be like no longer feeling thirsty, but we’re not actually drinking any water.”

The loneliness economy also fails to take into account the barriers preventing people from making friends in the first place. In recent surveys, the results of which have not been published, Holt-Lunstad has found both internal and external obstacles to connection, including anxiety, a fear of rejection, physical and mental health limitations, the economic cost of participation, and the time investment required with joining a club. “It might be, that’s a great program, but it’s too far away, or that’s a great program, but it costs too much,” Holt-Lunstad said. “And then, of course, there’s the internal barriers where there’s so much shame and stigma associated with this that many people don’t want to feel like I have to have an app or a program to make friends.”

These potentially lonely consumers may be more vulnerable to companies’ marketing efforts, even though the products are unlikely to solve the underlying issue. According to research, when people feel like they are lacking close, intimate relationships, they are more likely to buy themselves things. “One of the things, for instance, could be spending money to go on group activities rather than individual activities,” Aulona Ulqinaku, an associate professor of marketing at Università Carlo Cattaneo LIUC in Italy, told Vox. People could spend money to join a club you aren’t particularly interested in just to feel a part of something. 

Shopping can also serve as a social experience in itself, Cindy Rippé, a senior lecturer in the Department of Marketing at the Terry College of Business at the University of Georgia, told Vox in an email. Employees and other patrons can become familiar and friendly faces, effectively turning a retail space into a third place. A paid social experience, such as a club, could theoretically achieve the same fulfilling effects as shopping, Rippé said. But spending money isn’t what makes people feel better; it’s repeated social interaction, familiarity, belonging.

Because companies can track your activity online, users who search for local clubs or interact with these groups on social media may be repeatedly served ads for other community-centric businesses and thus spend more money on services that may not be effective.

“I hope that we are looking at a world where marketing can be looked at as an instrument for helping people rather than exploiting people,” Ulqinaku said. “The aim should not be, ‘I make money [off] of you.’ The aim should be, ‘I want to make you feel better. I don’t want to exploit you.’”

Putting a price tag on relationships

The pairing of lonely consumers who might be willing to spend money and businesses that definitely want to make it may be good for the bottom line in the short-term, but perhaps not for social health or for revenue in the long-term. (After all, if these products don’t work, people will stop paying for them, and if they do work as promised, people will also stop paying for them.) Friendship isn’t a product you can advertise or put a dollar amount to, Pressler said, and we shouldn’t apply market solutions to non-market goods.

“You can approach it with a consumptive mindset where it’s like, ‘Well, I just need to consume more relationships, and if I consume more relationships, ergo, I will not be lonely or disconnected,’” he said — but that’s not how real-world interactions work. The power imbalance between the companies earning money and the consumer spending it to fulfill a core human need may veer on exploitative, too, Rippé said: “The ethical problem begins when a company intentionally exploits a consumer’s loneliness, insecure attachment, or fear of missing out to pressure that person into purchasing.”

Which isn’t to say communal gatherings with a price tag are inherently exploitative. Live music and events, like concerts, successfully bring people together for shared experiences, according to Hertz, the professor and author. (Of course, tickets have become so expensive that seeing your favorite act perform is becoming a luxury.) Groups centered around an activity have the potential to connect people, too. But buying your own yarn and needles to bring to a weekly craft night at your local knitting shop is different from paying $50 to join a one-off “knitting club” organized by a VC-backed friendship app.

Because social health touches so many aspects of life — the physical spaces we inhabit, the technology that both facilitates and inhibits socialization, the costs of interacting — the path toward connection is more complex than marketable products or individual purchases. It involves government investment in public spaces and low- or no-cost community events; policies that allow everyone to lead a dignified life, which includes the space for leisure activities; and a societal shift that prioritizes slow, intentional relationship building instead of instant connection. 

“The need is real,” Hertz said. “The purported solutions are many. Some of them I think can be part of the solution. Some of them may well end up making us lonelier as a society.”

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