Jake Collective and the American Foundation for Suicide Prevention are launching a $5 million, five-year initiative
Editor’s note, July 26, 8 am ET: We’re bringing you some of our best-loved Your Mileage May Vary columns while Sigal Samuel is on parental leave. The one below was originally published in December 2025.
This unconventional advice column offers you a unique framework for thinking through moral dilemmas. It’s based on value pluralism: the idea that each of us has multiple values that are equally valid but that often conflict with each other. Submit your own question here.
I’ve worked in communications for the past decade helping get important ideas out to the public. I’m good at what I do, and I think it’s useful, but I don’t really feel like I’m having a grand impact on the world.
Meanwhile, some of my friends have built their entire careers around the goal of having the biggest positive impact possible. They’re busy pulling big levers — doing global health work that saves lives, shaping federal policy that protects the environment, etc. I feel like my contribution is tiny in comparison.
I know life’s not a competition, but I grew up being told I was smart and had so much potential to change the world, and I worry I’m not living up to that. On the other hand, I also value work-life balance and relationships and experiences outside of work. Should I consider switching careers to something more impactful? Do I need to have an extraordinary career, or is it okay to just do an average amount of good and live a small(ish) life?
Dear Impact-Minded,
How do you feel about the fact that you’re going to die one day?
That might sound like a weird place to start, but I ask because I think fear of our mortality is what drives a lot of our modern quest for extraordinary careers.
In fact, the American anthropologist Ernest Becker argued in his 1974 Pulitzer Prize-winning book, The Denial of Death, that one of the main functions of culture is to offer effective ways to manage the terror of knowing that we’re going to die and eventually be forgotten.
The prospect of absolute annihilation is so terror-inducing, Becker argues, that we come up with all sorts of ways to convince ourselves we can achieve immortality. In the pre-modern era, most people looked to religion for this. It promised us literal immortality, in the form of an eternal soul that could enjoy a happy afterlife in heaven or maybe a nice reincarnation here on Earth.
In the modern era, as religion’s dominance waned, we’ve had to come up with new types of “symbolic immortality.” That can come in the form of publishing an autobiography, being part of a great nation, or — especially popular starting in the 18th century — achieving social progress “at scale.” As the Industrial Revolution propelled globalization, and it became possible to think about affecting people halfway around the world, utilitarian philosophers argued that our actions are good to the extent that they create “the greatest happiness for the greatest number.”
The idea that we could use our working lives to maximize the good gave people a new way to be extraordinary and thus achieve a lasting legacy — that is, a sense of immortality. By belonging to the grand project of social progress, we could live on well past our physical death.
On the one hand, the tacit promise is comforting. If we all chase these superlative lives, we can participate in the great forever! But on the other hand, it creates a crushing amount of pressure. There’s a sense that you need to be engaged in a maximally heroic quest; otherwise, your life is basically meaningless.
Not everyone, however, sees things this way.
For an alternative, consider Saint Thérèse of Lisieux. Born in France in 1873, she only lived to the age of 24, and the last nine years of her life were spent cloistered in a convent. She was an extremely pious young woman who prioritized kindness. But she was acutely aware of her own imperfections and limitations. She didn’t believe she was a great soul capable of great, heroic deeds. She definitely didn’t think her vocation was to have a positive impact “at scale.”
Instead, she developed a very different approach to goodness, which she called her “Little Way.” It wasn’t about trying to reach a wide swath of people. It was about trying to go deep on little, daily actions, infusing every glance and word with the purest love.
When the other nuns in the convent annoyingly interrupted her with chit-chat while she was trying to write, she made sure “to appear happy and especially to be so.” When one made exasperating clicking noises during prayers, she worked so hard to conquer her irritability that she broke into a sweat. She made lots of sacrifices lovingly, and trusted that through that, she could achieve holiness — and, yes, eternal life.
Saint Thérèse compared people to flowers. Although most people want to be a big, showy flower like a rose or lily, she wrote, she was content to be a little flower at the feet of Jesus:
If all the lowly flowers wished to be roses, nature would lose its springtide beauty, and the fields would no longer be enamelled with lovely hues. And so it is in the world of souls, Our Lord’s living garden. He has been pleased to create great Saints who may be compared to the lily and the rose, but He has also created lesser ones, who must be content to be daisies or simple violets flowering at His Feet.
Saint Thérèse became known as the Little Flower. After she died of tuberculosis, her spiritual memoir grew famous. People fell in love with her theology of the Little Way, and she ended up being one of the most popular saints in Catholic history.
I suspect she struck a chord with people because she offered them a strong counterpoint to the idea, which was gaining traction at the time, that it’s not enough to do good — we have to do the most good possible.
But, personally, I’m satisfied neither by the utilitarian perspective nor by Saint Thérèse’s perspective. Both are extremes: one says “you absolutely must do the most good,” and the other says “don’t even bother trying to help more people — just give the few people in your cloister the deepest love possible.”
Yet, it’s a feature of our modern life that the fortunate among us have the capacity to go both wide and deep — to consider both scale and other dimensions of value. People who go all-in on just one of these tend to feel regret, whether it’s the effective altruist who’s so focused on helping at scale that he ignores everything else or the monk who spends decades in deep contemplation but doesn’t do a thing to help others.
So, when you consider your own potential, I’d encourage you to consider the full picture. I don’t think you should obsess over finding a career that’ll allow you to do “the most good.” But doing “more good”? Sure! If you can find a job like that, why not?
But, as you look around to see whether there’s a job where you could have a bigger positive impact, you have to be mindful of a few things. For one, there are many different kinds of “good,” and you can’t always run an apples-to-apples comparison between them. (Is your current job doing more or less good than, say, being a journalist or an educator? Hard to say.) Also, there’s more to life than just “doing good” — a life well lived includes reveling in other precious things, like art or relationships, so you don’t want a job that’ll bar you from that. Plus, you don’t want a job that’ll be unsustainable for your physical or mental wellbeing or that’ll wreck your integrity by contravening other values you believe in.
Ultimately, what’ll probably work best is settling on a career that lets you achieve a decent balance among multiple criteria: doing substantial good, allowing for a pluralistic enjoyment of all life’s riches, feeling sustainable, and fitting with your values. (And after scanning the landscape, you just might find that the best career for you overall is the one you’ve already got!)
You’ll notice that this doesn’t sound as “grand” as either the utilitarian recommendation or the Saint Thérèse recommendation. But that’s the point: Those are extreme visions of life, and if you ask me, they’re not even really about life at all. They’re about death and achieving a legacy that you think will earn you a kind of eternal life after death. The assumption is that you need to do something “grand” in order to make your time on Earth not worthless.
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There’s a radically different starting assumption available to you: What if life is just a gift, and the time you have on this mysterious, weird, wondrous Earth is inherently precious, even if it’s temporary? When you get a gift — like, say, a box of candy — the point is not to try to make it last forever. The point is to appreciate the candy! To savor it yourself, and also savor the pleasure of sharing it with others.
If we embrace this view, then we don’t feel like we need to do something grand or extraordinary. Life is extraordinary, and living it well means relishing all the goods it offers us — and extending those goods to other beings so they can relish them too. Not out of fear that we’ll be worthless and forgettable otherwise, but simply because we realize we’ve been given talents and resources and, feeling grateful for them, we naturally want to share those gifts with others.
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.
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