Summer is supposed to be the best time for fresh produce. Corn on the cob at the cookout. Berries plucked right from the vine. Salads on the cafe patio while you take an extra long lunch break because the weather and the food is that good. 

But this year, summer’s harvest brought something much different than the flavorful dishes we’ve come to expect. Since May, the United States has seen more than 17,000 lab-confirmed cyclosporiasis cases. Before this summer’s massive outbreak, the country had never recorded more than a few hundred infections in a single year from this parasite, which can cause watery and at times explosive diarrhea.

And that isn’t the only bug invading Americans’ digestive tracts.

One person died from a listeria infection traced to ricotta cheese. Close to 100 people came down with salmonella from recalled eggs, while more than 400 people have gotten sick in a separate salmonella outbreak involving jalapeños. Last week, the Food and Drug Administration issued its highest urgency warning for frozen blueberries believed to be contaminated with E coli. 

And now several dozen people across 15 states have become ill after eating alfalfa sprouts in a new outbreak that involves salmonella and E coli. Four of them have been hospitalized.

It’s gotten so bad that one Washington Post columnist argued we should stop eating lettuce altogether. Experts have told me they were worried people might actually completely stop consuming vegetables — vital to any healthy diet — for fear of contracting cyclosporiasis and enduring a month of watery diarrhea. I personally avoided the bagged salad kits that provided me with many easy lunches on a workday.

While this spate of foodborne illness is especially bad, the worst may be yet to come. 

It’s only natural to look for somebody to blame. Culpability has understandably fallen on the Trump administration and Robert F. Kennedy Jr., who helms the US Department of Health and Human Services — especially after his deep staffing cuts at the FDA and the Centers for Disease Control and Prevention, the two federal agencies most responsible for investigating and responding to disease outbreaks. Those cuts have slowed the response, and officials have struggled to communicate with the public clearly in a fast-moving crisis.

While our government officials are partly to blame, the problem is bigger than Trump and Kennedy, or even this one summer. While seasonal changes will always play a role — the warmer months, when people eat more fresh produce and consume more food that’s been sitting out at unsafe temperatures, typically have more foodborne illnesses — the underlying factors contributing to these outbreaks are becoming more potent. The food supply is more and more globalized. And the planet continues to warm, allowing these pathogens to spread to more and more farms all over the world, including in the US.

As the weather finally begins to cool down, I’ve been asking myself an uncomfortable question: What if diarrhea summer never really ends?

Climate change is spreading dangerous germs

Our globalized food supply chain has a lot to do with our food safety — and that isn’t going to change any time soon. Americans expect access to any produce they want year-round, even produce that isn’t in-season locally, or that may not grow anywhere in the US at all. We source food from all over the world: Most cyclospora outbreaks originated with foods grown in other countries. This year’s crisis was eventually linked to iceberg lettuce from Mexico.

And as the New York Times recently documented, the sometimes international trip from the farm to the store for a bagged salad kit offers multiple moments for potential contamination, including tainted irrigation water, local wildlife excrement, and poor storage practices, making it possible for dangerous pathogens to take hold before a person even buys their groceries.

Warming temperatures around the world are also helping those bugs spread. Humidity is essential for salmonella and warmer summers will mean more humid-favorable conditions for the bacteria to grow. E coli likewise will thrive as temperatures rise. Cyclospora has historically been found in subtropical climates, so for a long time, infections from food grown inside the United States were unheard of. Not anymore. 

“Climate change has allowed pathogens like cyclospora…to expand from the tropic, subtropic lines into areas more north and south of that tropic line,” said Joseph Eisenberg, a professor of epidemiology and global public health at the University of Michigan School of Public Health. 

“With respect to the US, we’re starting to see new infectious diseases in southern Louisiana, Texas; that also increases the presence of cyclospora in food systems in other countries,” he said. “It suggests that, through climate change, we might potentially start seeing it be endemic in the United States at some point.”

And indeed, cyclospora was found in farms in Florida in 2020. This is a problem that is going to become worse, not better, given the expected trends in global warming in the decades to come.

“It wasn’t until about within the last 10 years we started to see cases from domestic origin,” Francisco Diez-Gonzalez, director of the Center for Food Safety at the University of Georgia, told me. “Before, there were predominantly cases due to international travel or importation of products because it used to be endemic in some tropical or warmer climates.” 

“It’s clear that now,” he said, “it’s become established in the domestic environment.”

The US is less prepared than ever to stop food contamination

To make matters worse, at the same time conditions for foodborne illness are ripening, the US government has been sharply cutting its ability to monitor for and respond to these outbreaks.

At the beginning of the second Trump administration, as part of the widespread government staffing cuts, the FDA laid off 3,500 workers. Between the FDA and the US Department of Agriculture, which also oversees food safety, and several related agencies, more than 11,000 workers have been lost, a 22 percent cut, according to the Partnership for Public Service. And the CDC, which helps respond to outbreaks once they start, has lost about a quarter of its workforce from January 2025 to October 2025, according to Reuters; by this summer, CBS reported, the number of scientists tracking food parasites at the agency dropped from 11 to three. Meanwhile, the administration has been rushing to hire 2,200 people in the middle of the crisis.

“There have been a lot of federal cuts. There have been cuts around CDC surveillance, around state and local public health. You’ve lost people,” Dr. Anurag Malani, vice chief of staff at Trinity Health’s Ann Arbor, Michigan, campus, told me. “The ability to do what you need to do to keep citizens safe and to keep the public safe, we don’t have as many people doing that as we used to.

The federal government also shut down several national monitoring programs for foodborne illness in 2025 — including for the cyclospora parasite specifically. The state and local agencies that surveil for and respond to food outbreaks have also faced staff cuts because they depend on the federal government for their funding.

“It’s hard when there is one larger entity kind of controlling all of that,” Dr. Kathleen Linder, the hospital epidemiologist at the Veterans Affairs hospital in Ann Arbor, told me in July. “Local health departments are having to do more on their own than they would have had to do in the past just because of decentralization at that level. It has been very hard to get updated information. The information has been lagging a little bit behind.”

Food safety is hard enough to tackle on its own. Part of the reason we experience regular outbreaks of cyclospora is that it can successfully infect people even when only very little of it is present, and because we can’t grow it in a lab to study it.

But the US has made things harder by cutting these important programs. Rebuilding the staff and capacity to do this work is not likely to happen under the Trump administration, and former FDA officials have described a “brain drain” for the food safety programs that won’t be easy to reverse in the next administration. 

But something will have to be done if we’re ever to escape the food recall cycle. Despite the name, food has historically been neglected by the “Food and Drug” Administration, and better food safety could require serious restructuring and investment in these capabilities. And foodborne illnesses aren’t the only kind of infection that climate change will make more likely: The United States is also seeing the spread of mosquito-borne diseases like dengue. Responding to those new threats is going to require a rebuilt and potentially reimagined federal public health apparatus.

If there is any good news in the short term, it’s that there are a lot of great recipes for grilling your vegetables to eliminate any pathogens hiding in our side dishes at next summer’s cookouts. It sure seems like we’re going to need them.

Affordability is the top political problem of the moment, and lawmakers in both parties have increasingly blamed large investors for buying up housing, hospitals, and other staples families can’t do without, while jacking up prices and degrading quality. 

Earlier this year, Sen. Jeff Merkley (D-OR), who has backed bills on both fronts, turned his attention to childcare. The ranking member of the Senate Budget Committee sent sweeping document requests to KinderCare Learning Companies and Learning Care Group, the two largest private-equity-owned childcare companies in the country, seeking information like board minutes, subsidy totals, staffing ratios, dividend records, and the investment memos the firms wrote when they bought in. Private equity, Merkley said in announcing the requests, has increasingly prioritized “investor profits over the well-being of the families and communities that depend on these services.”

The federal inquiry follows several years of national childcare advocacy groups warning that private equity, an industry known for acquiring businesses for quick-turnaround sales, should be kept far away from kids.

In 2022, Elliot Haspel, a progressive childcare expert, wrote in the New Republic that private-equity owned childcare chains “ultimately answer to investors or shareholders first, parents second.” Citing their record in nursing homes, where acquisitions have been associated with declines in quality, Haspel wrote that there’s “little reason to think that early care and education would be magically exempt from these sideways influences.” In 2024 the Open Markets Institute, the National Women’s Law Center, and Community Change put out a report contending that private equity-owned centers would not only seek to soak up public funding, but stall reforms limiting their reach long enough to capture local market share, until they could argue they’d become too embedded to remove without harming families. 

Since then, lawmakers in at least five states — Colorado, Connecticut, Massachusetts, New York, and Pennsylvania — have introduced or passed bills that write ownership structure into childcare policy, cap what large for-profit chains can draw from state grants, or attach strings to public dollars that apply to those providers alone. The coalition of national groups published model state legislation of its own this past February, built partly on those state experiments. 

But a forthcoming paper reviewed by Vox from two leading national researchers focused on the economics of childcare — Jessica Brown at the University of South Carolina and Chris Herbst of Arizona State University — complicates the case that has been building against the private-equity owned centers. In the country’s first systematic, descriptive look at how far private equity has actually spread through American childcare, the scholars found no smoking guns. 

If anything in the findings gives Herbst pause, it’s the geography.

Private equity is not sweeping the childcare sector, the researchers report. Its share of the childcare workforce stopped growing around 2010 and has hovered near 10 percent ever since. It isn’t everywhere, either — three-quarters of private-equity childcare centers sit in just 5 percent of US counties, clustered around Phoenix, Las Vegas, Denver, Atlanta, and northern Virginia. Nor do the centers look uniformly distressed. They have been operating for 18 years on average, longer than other chains — and between 2021 and 2024, while non-private-equity providers cut staff, these programs added workers. 

“Given what we see,” Brown told me, “private equity is not the reason that childcare is unaffordable.” 

Herbst agreed: “You know, we jokingly at one point said we’re gonna call our paper, ‘Much Ado About Nothing.’” 

This is not to say the researchers have no further questions. Their work explores the recent past, but their findings are not causal, so they couldn’t say specifically what happened when private equity took the centers over. And their data also couldn’t confirm what the chains pay their teachers, or what benefits they offer. Critics have guessed both ways — that they squeeze wages for profit, or that their size allows them to pay more than a small provider could offer and muscle out competitors. 

An important question is what actually separates private equity-owned chains from other large childcare companies. Herbst and Brown found that on price, private-equity chains operate not so differently from large competitors that aren’t investor-owned. They are less likely to take public subsidies (70 percent do) than other large chains (78 percent), but are more likely to hold their state’s top quality rating. Large chains, private-equity-owned or not, tend to locate in wealthier areas with more college-educated families. Private-equity providers, though, seem distinctly drawn to states with looser staffing rules and to counties with the tightest childcare markets in the country.

If anything in the findings gives Herbst pause, it’s the geography. “It may not be that they are rendering low-quality care,” he said. “They may be rendering very high-quality care, but inaccessible to a large number of families because of where they are doing business.”

How this study came to be

Despite the amount of national attention, very little research has existed on private equity and childcare up to this point. 

“People were sort of copying and pasting evidence from these other domains like nursing homes and hospitals, extrapolating results from these other sectors to childcare, and we were skeptical about this,” Herbst said.

While they were gathering information, new international evidence did come out — a working paper on Dutch childcare, which found that private-equity centers charged more and had fewer regulatory violations overall, but more staffing-related violations. The Netherlands sets its childcare rules nationally, though, which makes the findings harder to apply in the US, where staffing ratios and teacher qualifications are set state by state.

Nobody had done a deep US analysis before, largely because it’s expensive. With funding from the Alfred P. Sloan Foundation and the Washington Center for Equitable Growth, Brown and Herbst had to stitch together at least seven sources, including two proprietary databases costly enough to be out of reach for most researchers even with a grant — one tracking every business in the country year by year since 1997, the other tracking private equity deals. Then they merged all of it against state licensing records, accreditation files, and an original survey they fielded themselves in three states.

“It took an extraordinary amount of resources — both monetary and labor — to put our datasets together,” Herbst said. The lack of quality national data on childcare providers broadly has been a major barrier for researchers, and leaves the terms of the debate often set by interest groups. No federal survey tracks what providers charge, and most states don’t collect it either. Brown and Herbst could compare prices in only two states, the ones that require providers to report them as a condition of licensing. 

Why is private equity interested in childcare?

One of the main questions looming over the conversation is that, broadly speaking, childcare is a low-margin business — so why is private equity involved at all?

“My answer right now is they’re not interested in childcare writ large,” said Herbst. “They’re interested in childcare in very select communities.” 

The classic private-equity playbook is to buy a company, raise its value through expansion, consolidation, or cost-cutting, and sell within three to seven years. This is the model that ran through Toys ‘R’ Us, Payless, and a long line of local newspapers, and helped earn the industry a reputation for loading businesses with unmanageable debt they couldn’t carry. 

But not every private-equity strategy is a short-term flip. Over the past decade Blackstone, KKR, and Carlyle have all raised long-hold funds designed to keep companies for 15 years or more. It’s a small slice of the industry, but both childcare companies now under Senate scrutiny fit that longer pattern, with Partners Group having held KinderCare since 2015 and still controlling roughly 69 percent of it after an IPO, and American Securities having owned Learning Care Group since 2014.

A representative from KinderCare did not return a request for comment, but in an interview, Brian Gutman, the senior vice president of public policy at Learning Care Group, told me that yes, their investors want to see a profit and “be a sustainable company.” Something like childcare, he said, is “a long-term play, not a short-term play” because the costs that matter most can’t be recovered inside a short window. Refurnishing a single school might run $100,000 to $300,000, and a firm looking to exit in three years would have to push that into tuition, which wouldn’t be feasible. He put the company’s reinvestment at more than $1 billion dollars.

Merkley’s letter tells a different side of that story. In 2018 Learning Care Group borrowed to pay its owners at least $636 million, and now carries roughly $5.50 in debt for every dollar it earns. In other words, the money went out the door to the owners, but the loan stayed on the company’s books, and the interest is serviced out of the same tuition that pays teachers.

Asked how that squared with the long-term picture he described, Gutman did not address the 2018 payout or the debt load. He said that under American Securities’ ownership Learning Care has spent more than $1 billion on capital expenditures and maintenance — building upgrades, safety systems, classroom technology, not counting acquisitions — and that the company’s average wage growth has outpaced its own tuition increases, inflation, and national wage growth in each of the past three fiscal years.

What private capital buys, he says, is scale. The clearest example is cameras: Before the pandemic, Learning Care put livestreaming cameras in classrooms near military bases so deployed parents could watch their kids during the day. When Covid hit and parents couldn’t come inside, the company put one in every classroom across the chain, meaning tens of thousands of cameras. It’s the kind of investment he said families appreciate and an operator with two or three buildings can’t afford. Access to capital, he argued, is what made it possible.

The right target?

I reached out to Merkley’s office to learn more about their federal investigation and a staffer told me that it had been prompted by the number of concerning stories his team had been seeing in the media. KinderCare is also headquartered in Merkley’s home state of Oregon, though they said their inquiry wasn’t driven by complaints from his local constituents specifically.

The staffer said they hope to get their report out by the end of the year, but acknowledged that “a lot of the [companies]’ responses have been lackluster” so far. “Legislation is definitely something my boss is thinking about,” they added, but said they are waiting to hash out details until their probe is finalized. 

Gutman said Learning Care responded to Merkley’s request, but sees the focus on private equity as a bit of a scapegoat, or red herring. The company isn’t opposed to new regulation, he said, including more transparency about investors, decision-making, and wages. His objection is to rules that sort providers by who owns them. “Where there’s a need for enhanced regulation,” he said, “that’s a need for the sector, not a need for a couple of actors within the sector.”

He said that plenty of large childcare operators, like family-owned regional chains and big nonprofits, aren’t private-equity backed, and that ownership structure doesn’t reliably predict behavior. He cited a venture-capital-backed Montessori chain in Colorado that closed its five locations abruptly. Because the bills moving through statehouses key on private equity ownership specifically, a company like that one wouldn’t trigger regulation.

Haspel said he’s fine with legislation that targets large for-profit chains more broadly, but emphasized that the focus on institutional investors will only become more important as the conversation around universal childcare picks up momentum in the United States. “I don’t think the focus is a red herring…[private equity] presents some real threats potentially if you have bad actors that are attracted by the increased public funding,” he said. He pointed to England, where the competition regulator just launched an investigation last month to examine whether private-equity ownership is serving families or driving up childcare costs. Provisional findings are due early next year. 

Gutman said Learning Care Group will fight being cut out of public programs. Some of the state proposals would restrict which providers can access grants or participate in state pre-K, and Gutman argued that in much of the country there isn’t a backup. About 85 percent of the company’s families live within a 10-minute drive of their center, he said. “If we’re the only game in town, and we can’t access a grant program that helps us pay teachers better, I’m not sure who that serves,” Gutman said.

Brown and Herbst’s own immediate recommendation is more public information. More states could collect prices at licensing, they argue, and make wage and staff turnover data easier for researchers to find which in turn would help generate more targeted policy fixes. “I think in some ways people are trying to look for an easy solution,” Brown said, “but the thing is there is no easy solution in childcare.”

This work was supported by a grant from the Bainum Family Foundation. Vox Media had full discretion over the content of this reporting.

Update, August 27, 11 am ET: This article was originally published on August 27 and has been updated to include more details about the study funders.

“If this is democratic socialism,” wrote one New Yorker under a mayoral Facebook post, “maybe it is the change we need.” She was referring neither to Mayor Zohran Mamdani’s heavily scrutinized plan for city-run grocery stores, nor to his pied-à-terre tax on the rich, nor even to his trademark — though thus far, unrealized — vision for fast, free buses and universal childcare. 

No, she was talking about candy-colored scaffolding. The mayor recently made good on his plan to give a facelift to the city’s ubiquitous scaffolding, that odiously ugly green eyesore that envelops hundreds of miles of New York City sidewalks. Another New Yorker posted on TikTok complaining about a smattering of potholes on his street. By the time he got home from work, they had all been filled, setting off a maelstrom of viral requests, including one from a dateless Brooklynite looking for love: “Zohran, what are you gonna do to fix this?” (The mayor cheekily obliged with a list of local meet-cute spots.) 

Symbolic urbanism is having a moment, especially this summer in New York City, where the air is far too humid, but the potholes increasingly get filled, sometimes personally by the internet’s favorite millennial mayor himself. 

Mamdani’s embrace of what he calls “pothole politics” — a shrewd modern-day twist on the “sewer socialism” that once propelled some 20th-century leftists into office — has delighted and exhilarated New Yorkers who’ve long yearned for a City Hall that heeded their most mundane municipal calls over a scorching-hot subway station or a sidewalk full of cracks. 

With a smile plastered on his face, Mamdani has, in fact, filled potholes at a faster rate than any New York City mayor in years. In cities where everything seems to take forever to build, literally covering over these sites of everyday urban friction has become a powerfully visible form of political currency. 

“There’s just this thirst for competence right now,” Don Moynihan, a professor of public policy at the University of Michigan, told me, and Mamdani in particular has “brought a sense of joy and fun to the nuts and bolts of public administration.” It may even be enough to help restore some of the public trust needed for the more arduous, less palatable work involved in making our cities more liveable in the long run.

Sixty-nine percent of New Yorkers currently have a favorable view of Mamdani, according to a Siena Research Institute poll conducted earlier this month, meaning that he has already won over at least some of the one-third of residents who told the New York Times last September that they would never vote for him. He has higher ratings at this point in office than any NYC mayor in decades.

He is even more popular now than he was a few months ago, when the Knicks clinched their first NBA championship in decades, the sort of sports victory that can quantifiably boost an incumbent’s electoral prospects. So, no, it’s not the Knicks that have made Mamdani even more popular than he was during his mayoral honeymoon.

It is, quite possibly, the potholes. 

“There are easy issues for voters to understand about their local government, and then there are much more difficult issues,” said Justin de Benedictis-Kessner, a public policy professor at Harvard and author of the forthcoming book The Fog of Accountability. “When you make campaign promises about more difficult issues, you might pair them with some clear issues like potholes,” which are decidedly easy for voters to understand. 

But the bigger question is whether Mamdani or others like him can borrow from the public trust they earn from filling them to help move the needle on the hard stuff, “especially when those next things aren’t going to be what your constituents like as much,” like large-scale zoning reforms or tax hikes, he said. “They might be tougher policies to swallow.” 

Pothole populism, explained

“If government can’t do the small things,” Mamdani declared at a rally to mark his first 100 days in office, “how could you ever trust it to do the big ones? How can we promise to transform our city if we can’t pave your street?”

There’s plenty of data to back him up on this, not just in New York City but across the nation. For every extra week it takes their city to fix a nearby pothole, Chicagoans report being measurably less satisfied with their lives, according to one study. A separate survey found that Bostonites became 14 percent more trusting of their government after they were able to see it respond to complaints like potholes or broken street lamps. Much as doing the dishes or taking out the trash can be more romantic than the occasional pricey date night, these everyday municipal acts of service resonate with beleaguered urbanites.

Mamdani is not the first politician to build political capital on the strength of small, some even symbolic or aesthetic, infrastructural upgrades. Milwaukee, for example, elected a slew of leftists roughly a century ago who earned the pejorative moniker “sewer socialists” for their focus on small-scale engineering projects. These mayors understood that “it was not manifestos or ideological pamphlets that would win hearts and minds. It was about proving to people that the government could do things that had a sort of broadly shared benefit,” said Philip Rocco, a professor of political science at Marquette University. “They were picking really low-hanging fruit as a way of building a coalition.”

“There are easy issues for voters to understand about their local government, and then there are much more difficult issues. When you make campaign promises about more difficult issues, you might pair them with some clear issues like potholes.”

Justin de Benedictis-Kessner, public policy professor at Harvard

Milwaukee’s 20th-century socialist mayors went on to double the city’s size through annexation and new housing, built a pioneering sewage treatment plant, and set up the nation’s first Bureau of Economy and Efficiency. Along the way, they installed new street lights, drinking fountains, park benches, and countless other low-cost urban fixes that made everyday life safer, healthier, and more joyful. By 1936, Time was running a cover story about how six-term Mayor Daniel Hoan, “one of the nation’s ablest public servants,” had transformed Milwaukee into “perhaps the best-governed city in the US.” Hoan won election after election not because of his party affiliation (to be clear, literally Socialist with a capital S), but in spite of it, wrote Time, his competence and charisma charming even most conservative Milwaukeeans. 

Mamdani, who often invokes Milwaukee’s sewer socialists, clearly craves a similar legacy. He is actively attempting to disprove the idea that progressives today “are disconnected from reality, and that they have a lot of pie-in-the-sky ideas,” Moynihan said, “but that they can’t actually govern” when it comes to the often unglamorous, nitty-gritty demands of public service.

According to Moynihan, Mamdani may also be inheriting elements of another lineage; “broken windows” theory, though he may be less apt to say so. While it’s best known now for justifying controversial policing policies like stop-and-frisk, he said the approach also took seriously the idea that your “quality of life depends upon fixing the small things in your neighborhood.”

Now what? 

If imitation is the greatest form of flattery, then take note of the other local electeds beginning to engage in botched attempts to recreate Mamdani’s pothole politik. Los Angeles Mayor Karen Bass earned scorn a few weeks ago for voluntarily posting a video in which she fails to fix a pothole because of a car parked atop it. The road ahead will not, in fact, be paved with good intentions alone. 

@malikizhere

MAYOR COME AND HELP YOUR PEOPLE!! #zohranmamdani #nyc #fixthis #lol

♬ original sound – Malikyyy

But while Mamdani has clearly earned the trust of much of his city, what he will do with it is just starting to take shape. As Mayor Hoan showed a century ago, it’s one thing to fill a pothole with a scoop of asphalt, but it’s another to make your city’s housing more affordable or make the buses run faster. 

And yet, it is possible that the political symbolism he is curating today might indeed make the path ahead easier. Just this week, Mamdani announced his biggest infrastructure project to date, a mammoth 10-year, $4 billion rebuild of a crumbling section of the Brooklyn-Queens Expressway, which two past mayoral administrations have tried and failed to fix. Whether or not he can be the one to pull it off will hinge on the public trust he cultivates today. 

“If Mamdani wants to get things done quickly, he’s going to have to implement a lot of policies that are a mix of really popular but perhaps minimally effective,” said de Benedictis-Kessner, “and ones that are much more effective but definitely not as popular.” 

Take rent control, which is very popular with voters, but, as my colleague Marina Bolotnikova has pointed out, does little to fix the roots of our dysfunctional housing market. By embracing it anyway, Mamdani is signaling that “he’s doing something that listens to his constituents,” said de Benedictis-Kessner, and the trust he earns from doing so could ultimately make “less popular policies that are actually much bigger in scale” more politically viable, like zoning reforms or density bonuses for developers. 

What I really want, my own personal North Star for good municipal governance in New York, is the Interborough Express, a long-awaited light rail line connecting Brooklyn and Queens that probably won’t be finished until at least 2031. Those are the kind of large-scale urban renovations that I’ll be writing about — and sometimes advocating for — in my new Vox newsletter, Nice Things. (Seriously, sign up!) But in the interim, I will settle for somewhere I can lock up my bike without lugging it up the stairs, or a subway station that isn’t quite so sweltering in the summertime. The little fixes that make our days just a little smoother, while also maybe laying the foundations for big changes.

No barrage of pothole-fixing blitzes will make the trains run on time or protect a city’s shore from flooding. But at a time when nobody thinks the government can do much of anything anymore, it’s a start. “To be able to argue, ‘Look, if you give me money, I will make things work,’” said Moynihan, “is a much more compelling argument if you can show that you are actually making things work.”

Lawyers claim Eman el-Shazly, from Birmingham, was detained in effort to silence her sister, a critic of Sisi regime

The UK Foreign Office has been asked to intervene to secure the release of a British-Egyptian woman who it is claimed has been arrested in Cairo because of her sister’s political activism.

Eman el-Shazly, a 45-year-old based in Birmingham, was arrested on 16 August while visiting Egypt. Her lawyers say she has been detained in an attempt to silence her sister Mona, a relentless and harsh critic of the Egyptian government on her UK-based YouTube channel.

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© Composite: supplied

© Composite: supplied

© Composite: supplied

The historic settlement reignites ongoing concern around how age-verification technology puts privacy at risk.

Every once in a while, I feel the urge to shout “women are not small men!” at inanimate objects. Today, that object is the flat-chested plastic torso typically used for CPR training. 

Breasts, it turns out, are really the bane of every woman’s existence — the back pain, the boob jail, the running. But here’s a new one: In a public cardiac arrest, they may be the reason nobody helps you.

Two years ago, an analysis of over 300,000 cardiac arrests showed that women are 14 percent less likely than men to receive CPR from a stranger if they have a cardiac arrest in public. Bystanders tend to be more hesitant and feel less comfortable providing CPR or using external defibrillator paddles, called AEDs, on people with breasts. Experts have time and again pointed, in part, to the fact that nearly everyone learns to perform CPR using the traditional, flat-chested dummies called “manikins,” which overwhelmingly represent the male anatomy. If the first time a stranger has to perform CPR on someone with breasts is in the middle of a high-stakes emergency — what else would you expect? 

For the last 20 years, not only has the survival rate for out-of-hospital cardiac arrests been around 10 percent, but also the chances of the victim surviving decrease by 10 percent every minute that interventions like CPR are not performed. It makes it all the more harrowing that women are not receiving the care they need when they experience cardiac arrests — especially in places where they are surrounded by people. 

Whether it is manikins used for CPR training, crash tests or medical care in combat, the default stand-in for what is “human” has long been male. 

But recently, researchers, advocates and governing bodies like the American Heart Association and European Resuscitation Council are pushing for better representation in CPR training and education. Increases in simulation-based research on the use of representative manikins, like ones that accurately represent female anatomy, are changing how people train to respond to cardiac arrest — and simultaneously exposing bigger gender gaps in design that systematically exclude women from experiencing the same level of safety and care as men. 

One size doesn’t fit all

The first CPR manikin was developed in 1960 by the Norwegian toy manufacturer Laerdal. The manikin, called Resusci Anne, which had the anatomy of a prepubescent teen, was ironically modeled off an unnamed girl who was thought to have drowned in the river Seine in Paris. Laerdal famously wanted a female face on the manikin since he thought men might hesitate to practice mouth-to-mouth resuscitation on a male manikin. It’s not surprising that women trainees didn’t factor into the equation at all back in the 1960s — they weren’t even included in clinical trials yet — but the norm of designing with the comfort of men at the forefront continues to this day. 

Since then, Resusci Anne has been reengineered many times over, and today’s manikins are surprisingly high-tech and interactive. However, as of 2022, about 95 percent of manikins on the market from mainstream manufacturers were still flat-chested and androgynous. 

So why does this matter?

In the past, research has hinted at three main reasons why bystanders don’t immediately rush to the aid of a woman in cardiac arrest. One, they are hesitant to expose or touch her in any way that could be misconstrued as inappropriate and are worried about sexual assault allegations after the fact. Two, they don’t want to accidentally hurt them, perceiving them as generally more fragile than the average man. And three — perhaps saddest of all: bystanders often don’t recognize that a woman is in cardiac arrest if, say, she collapses in public, misattributing it as overreacting, simply fainting or faking it. 

CPR training with female manikins would go a long way in teaching people to be comfortable with the female form.  

In one study, people at MassCPR — the free CPR certification program offered by Massachusetts Institute of Technology for the MIT community — were trained using standard manikins,  as well as a few which were retrofitted with a mold resembling breasts. At the end of the certification, participants who practiced on the manikin with breasts reported greater comfort performing CPR on women. 

If there was widespread adoption of manikins that looked and felt different, this could ultimately become the norm. 

It’s really only in the past five years or so that research on this disparity has sped up, offering some evidence for the need for more representative manikins. Even then, widespread adoption of female manikins is hindered by commercial availability of anatomically correct models and the cost of switching existing CPR training programs over to using them.   

Closing the design (gender) gap

There are two main ways to go about increasing the availability of female manikins: Either you retrofit existing standard manikins with breasts or you design completely new ones. 

When Christoph Veigl and colleagues at the Medical University of Vienna surveyed 133 training organizations across 43 countries from six continents, they found that of more than 5,000 manikins in use, only a fifth of organizations owned a female one. While that number is still low, adoption is triple what it was four years ago. The researchers acknowledge that just the availability of female manikins is not necessarily an indication of how much they are used in training — about a quarter of the organizations were also employing makeshift adaptations, like placing a bra on standard manikins, to simulate training on women. 

Dr. Pooja Nawathe, a resuscitation science researcher and pediatric critical care clinician at Cedars-Sinai Hospital, chose to focus her research on gender disparity in resuscitation for a specific reason. 

“Skin color is about implicit biases, but female breast tissue, which is a normal physical characteristic, is about the actual science of this,” she said, speaking about variations in care during cardiac arrests. “Are we teaching how to place the pads on the breast tissue?”  

She also stresses the importance of gathering good, granular data on how CPR performance changes when people are exposed to diverse populations.     

CPR manikins are just one example of the gender gap in design: Across fields like crash testing, the “human” body has long been modeled on men.

CPR manikins are just one example of the gender gap in design: Across fields like crash testing, the “human” body has long been modeled on men. But that’s starting to change, too. Last year, the National Highway Traffic Safety Administration (NHTSA) released the design details for THOR-05F, the first detailed female crash-test dummy.

Before this, the standard female crash-test dummy was a model called the Hybrid III 5th percentile female dummy — literally just a scaled-down version of the Hybrid III 50th percentile male dummy that represents the average male body dimensions. But the THOR-05F — every woman’s dream name, I’m sure — is a much more anatomically accurate female dummy, and includes a female pelvis, breasts, and a flexible spine. 

THOR-05F has arrived just as new research by the NHTSA affirmed the need for better crash-testing on women. Although the gap in vehicular accident fatality rates between the sexes has narrowed significantly in newer car models, women continue to experience a higher injury rate compared to men in multiple different types of vehicular accidents. The hope is that testing with the THOR-05F will provide a better understanding of this trend and help engineer safer vehicles and regulations for women.

Women are not small men!

Women are often referred to as the “invisible sex,” and the lack of female manikins really brings that to the forefront. It’s not like the manufacturers or policymakers intentionally excluded women from this area — they simply ignored them, accepting an androgynous body as the standard with an unchallenged assumption that what applies to it will undoubtedly apply to women too. 

In 2019, Joan Creative, the New York-based ad agency, launched the Womanikin, a universal attachment for CPR manikins, in partnership with United State of Women, a now-shuttered organization focused on gender equity. Launched during National CPR Week, the Womanikin is a neoprene vest with silicone breasts that can be zipped onto any standard manikin. Built as an awareness campaign, they open-sourced the design for the breasted vest and helped spark a broader conversation about the CPR gender gap. But we don’t have any detailed information about its success or adoption. 

More recently, other manufacturers like Prestan have come out with newly designed female manikins that can be purchased as is. They also sell “replacement female skin” that retrofits any existing Prestan adult manikins. Notably, these are now available on the American Red Cross store, increasing visibility for female manikins.

The fact that women account for 50 percent of the world’s population and yet have to mold themselves to standards not designed for them in the first place is atrocious. Not only is it frustrating to live in a world not built for you, but in cases like CPR training, the gender gap can quite literally be fatal. This is true whether it is for motor vehicle crash-test dummies or those used to train battlefield medics — another field where women injured in battle have a higher fatality rate than their counterparts.

The basic idea is that repeated exposure to female bodily characteristics during training or testing can significantly alleviate discomfort that causes dangerous hesitation. If people had more practice administering CPR to models that looked more feminine, they wouldn’t be thrown off by breasts, would understand how to cut away clothing like bras if needed, and learn how to efficiently place the pads of the external defibrillator on a female body. 

CPR techniques remain largely the same irrespective of sex. Chest compressions are performed on the sternum, which is the flat bone running down the center of your chest. For women, it lies between the breasts, so there are some additional considerations. That is what representation in training manikins is meant to address — not new skills, but familiarity. 

Ultimately, it really comes down to not feeling awkward about putting your hand in between two breasts, if it means you save a life.

Internal calls to end war get louder as Gulf neighbours plan alternative pipelines to cut reliance on waterway

Is the strait of Hormuz, recently cited by the office of the Iranian supreme leader as “the pillar of Iran’s new security order”, and as transformative as possessing a nuclear weapon, in reality becoming a fast-diminishing asset, leaving Iran increasingly vulnerable to the new planned US wave of economic sanctions?

It is the key debate that is raging inside Iran, with many different conclusions being drawn for Tehran’s negotiating strategy. Those who warn the strait’s value as a chokehold on the world economy will erode, leaving the country without foreign exchange reserves, argue that Iran’s negotiators should seek a deal soon.

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© Photograph: Majid Asgaripour/Reuters

© Photograph: Majid Asgaripour/Reuters

© Photograph: Majid Asgaripour/Reuters

Zillow and Redfin reached a settlement with the FTC, which requires Redfin to reenter the rental advertising business.

The Dutch Data Protection Authority is fining Uber €825 million in the second-largest penalty issued under Europe’s GDPR.

Flock Safety faces a growing public outcry over concerns that its surveillance technology could be misused.

On the latest episode of Equity, we wonder why the DOJ is investigating startup board seats.

OpenAI is calling for California to strengthen SB 53, an AI safety bill that the company previously opposed.

U.S. battery startups pulled in $500 million in grants from the Department of Energy, throwing a lifeline to an industry that was on the ropes after EV incentives were slashed.

A few things are certain in life: death, taxes, LeBron James playing professional basketball — and Americans’ belief that crime is getting worse. Since Gallup began asking about national crime in 1989, a majority of respondents said they thought crime in the US was higher than the year before in every survey year except 2000, 2001, and 2025. Even in that last year, 49 percent still said more crime was happening. It’s perhaps the archetypal example of negativity bias, the mental habit of giving more weight to bad news than good.

Last week, the FBI put some numbers on just how big that bias is. The American murder rate — which peaked in 1980 at 10.2 per 100,000 — fell to an estimated 4.1 per 100,000 people in 2025, matching the rates recorded in 1955 and 1956 for the lowest ever measured in the country. The violent crime rate (murder, rape, robbery and aggravated assault) fell 9.7 percent, the largest single drop since J. Edgar Hoover was running the bureau in 1936. 

That much is known. But what’s not known for sure about the crime drop is almost everything else. Adam Gelb, who runs the Council on Criminal Justice, says that there is no single or easy explanation for the historic lows, while Jeff Asher, the analyst who spotted this decline before nearly everyone else, agrees. For every leading candidate — federal pandemic spending, some normalization after the 2020 social collapse, better violence prevention, even the decline of drinking — there is a corresponding hole. 

But there is one American city where researchers can point to a specific program, measure what it did, and put real numbers on it. And it just happens to be the city that spent 50 years — and five award-winning seasons on HBO — as America’s shorthand for murder.   

What Baltimore did

Baltimore recorded more than 300 homicides a year for most of the last decade, and more than 200 for most of the past half-century. In one month, July 2015, 45 people were killed — an astounding figure for a city of just around 600,000 people at the time. 

But Baltimore finished 2025 with 133 homicides, the fewest since 1977 and about 60 percent fewer than in 2020. Through the first eight months of this year, the city has seen 60 murders, and the police commissioner’s target is to stay under 100. 

What caused this? Three things at once.

Baltimore Mayor Brandon Scott’s Group Violence Reduction Strategy identifies the few people most likely to shoot or be shot — two groups that heavily overlap — and sends people to their doors with two messages: you are on our radar, and here is housing and job training. Separately, the longer-running Safe Streets program puts outreach workers with real street credibility between disputes, aiming to interrupt them before they become shootings.

That’s the harm reduction element. There’s also a tough-on-crime component. The state’s attorney office says it has secured 2,129 convictions since 2023 across several gun-related violent-crime categories, with over 1,700 of those defendants incarcerated. 

Meanwhile, Baltimore’s homicide clearance rate reached 60 percent by mid-2026. Its nonfatal-shooting clearance rate was 54 percent, up more than 12 percentage points from a year earlier. Criminologists have long held that the certainty of being caught deters criminals more than the severity of the sentence, and more successful shooting investigations are a common thread where violence is falling around the country. 

How do you tell whether a program worked, or whether a city just got lucky? Drug trials get a control group; cities don’t. Baltimore got one almost by accident: the strategy launched in the city’s Western District in 2022 and nowhere else, which left the rest of the city as a comparison.

That’s what a team of economists and criminologists used. They measured the Western District against Baltimore neighborhoods that hadn’t started the program yet, and over 18 months the number of people shot there, fatally or not, ran about 30 percent below that stand-in. Killings alone fell by a similar share, but deaths are rare enough that chance couldn’t be ruled out. Police made no more arrests than before. Arrests for serious violent crime rose 81 percent.

A second, looser test set the whole city against a composite of other big American cities and put Baltimore’s murder rate about 25 percent below it. The authors are careful with that one: too much changed in Baltimore at once to say how much it the strategy was responsible for.

Murder is contagious

Baltimore’s success is built on two ideas, and they came from two very different places. 

The first came from a doctor named Gary Slutkin, who spent the 1980s and early 1990s fighting tuberculosis in San Francisco, cholera in Somali refugee camps, and AIDS across Africa. He came home to Chicago in 1995, a year the city recorded over 800 homicides. 

When Slutkin examined the city’s shooting maps, they looked familiar. Clustered in space, clustered in time, and spreading case to case — murder resembled the outbreaks he used to fight. Slutkin reasoned that the way to treat violence was to treat it like cholera: find the people most likely to transmit. Interrupt the transmission. Change the conditions that let it spread. Slutkin built the model into a program called CeaseFire, now Cure Violence Global, and its Baltimore descendant is Safe Streets.  

The second idea came from a criminologist. David Kennedy, working in Boston in the 1990s, found that 61 gangs with about 1,300 members — under 1 percent of the city’s young people — were tied to at least 60 percent of its youth homicides. Get those people in a room with police, prosecutors, and community elders, tell them plainly what comes next, and the shooting slows down.

That approach is called focused deterrence. Baltimore’s Group Violence Reduction Strategy is a version of it. To see how it works over a longer period of time, take a trip across the Atlantic to Glasgow in Scotland, which in the early 2000s was considered the murder capital of Europe.

In 2005, in the midst of that wave of violence, Glasgow’s Strathclyde Police established a Violence Reduction Unit that operated with a basic thesis: evidence shows that violence can be prevented. Among other interventions, the unit sent trauma surgeons into schools to describe what a blade does to a face and stationed outreach workers at hospital bedsides to reach victims in the vital hours after an attack, the moment when retaliation can still be stopped. 

In 2024-25, Scotland recorded 45 homicide victims, the fewest since comparable records began in 1976 and down from 96 two decades earlier. Every case was solved.

Pull the handle

So we have clues to why crime has dropped so much, but not clear conclusions. As successful as Baltimore’s group violence strategy has proved, a 2023 study of a similar street-outreach effort in Boston found no effect whatsoever. And the latest evaluation of Baltimore’s own Safe Streets — 11 sites, each measured against a stand-in version of the same neighborhood without the program — produced numbers that sound terrific but settle very little: youth homicides down 42 percent and youth shootings down 21 percent, but neither is strong enough to rule out chance. And while some sites saw youth homicide fall by as much as 100 percent, two sites saw it rise by 42 and 89 percent. 

Some experts, like the UC Irvine criminologist Emily Owens, argue the crime decline has been so widespread and similar — big cities and small, red and blue governments — that the true cause is some larger social change rather than what any one city is doing. Nor can we be sure the fall will continue. Billions in federal pandemic relief money has supported many of the programs that have worked well in places like Baltimore, and that money is already running out. But we can identify one reason why it happened, and learn from that success. 

As it happens, Gary Slutkin was not the first doctor to look at a map of the dead and see a pattern in it. In September 1854, a cholera outbreak was killing hundreds of people in London’s Soho district. A doctor named John Snow had mapped the outbreak and saw the dead were clustered disproportionately close to the district’s Broad Street water pump. Snow had a theory that water was connected to the disease and convinced a Soho parish board to remove the handle of the pump. 

Nobody in Soho at that moment could have told you what caused cholera. It would only be 29 years later that someone would definitely identify the responsible pathogen, and in doing so, explain why Snow’s intervention worked. But the explanation could wait. The dying stopped that month in Soho, just as it is stopping in Baltimore and around the US today. And that’s what counts.

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

Two years after the U.S. Department of Justice alleged that TikTok violated the Children’s Online Privacy Protection Act, it has reached a $400 million settlement.

The security review is being performed by the Idaho National Laboratory, and the research is being funded by a company -- or a group of companies -- in the electric and autonomous vehicle industries.

The affordability and availability of healthcare is emerging as a top concern for Americans, with some recent surveys ranking it easily as the top concern. Voters are upset with rising costs, and federal cuts to Medicaid and Obamacare subsidies threaten to leave millions more uninsured. 

Progressive candidates, who have won major primaries this cycle, have been eager to offer Medicare-for-all as a solution. Polling suggests there is broad support for the idea, even if most American voters aren’t sure what the phrase means in practice.

But Democrats have also been fighting about Medicare-for-all for the last decade, with battles reaching a fever pitch in the 2020 presidential primary. The popular slogan has been most closely associated with Vermont Senator and two-time presidential candidate Bernie Sanders, whose federal Medicare for All Act would enroll virtually every American into one national plan and largely eliminate private health insurance. Six years later, plenty of Democrats still remember bitter arguments over whether to replace private insurance or build on it, dividing the party over an issue they otherwise agreed was a top priority.

Yet there are emerging signs that the party is not about to experience déjà vu when it comes to healthcare politics. In interviews over the last few weeks, activists, pollsters, and policy experts sound cautiously optimistic that the Democratic healthcare wars might finally be headed for a collaborative truce. And Abdul El-Sayed, the buzzy Michigan progressive who wrote a book on Medicare-for-all, is campaigning for US Senate on a version that would let people keep their private health insurance, a potentially major shift. In a recent interview, El-Sayed went as far as to say, “as long as it reduces the power of healthcare corporations, expands healthcare, and does so publicly, I’m for it.”

In the meantime, Democrats have been busy building a new stockpile of ideas. New and serious healthcare proposals are circulating among lawmakers and potential 2028 presidential contenders, ranging from breaking up healthcare monopolies and expanding public drug manufacturing, to regulating hospitals and establishing new public options, meaning government-run health insurance plans that people can choose to buy instead of private insurance.

Next year is shaping up to be particularly painful. Health insurers want to raise Obamacare premiums by a median of 15 percent, on top of a roughly 20 percent jump this year, and starting in January, millions on Medicaid will have to prove they’re working to keep their coverage. Higher premiums and new hurdles to staying on Medicaid will land right as the next presidential campaign gets going.

That’s part of why the drafting feels urgent. Major healthcare legislation is rare, and the groups crafting these proposals think the next window may be opening.

“People have moved on from messaging; people aren’t staking out extreme positions to move the Overton Window,” said Neale Mahoney, a Stanford healthcare economist who has been reviewing many of the new proposals and advises the Kitchen Table Project, one of the groups developing them. “I think people are very much in the ‘what is something that could actually work?’ phase.”

What Americans really think about Medicare-for-all

One reason healthcare experts are feeling hopeful that reform may play out more amicably this time is that the fight that consumed the last one — whether everyone would be forced off their private plans — may not happen. Medicare-for-all supporters themselves seem tentatively open to paths beyond the strict single-payer program outlined in Sanders’ bill.

This is also significant because to many Americans, “Medicare-for-all” means having the option to enroll in a public health insurance program, but to keep their employer health coverage if they want.

The ambiguity over private insurance became the single biggest source of confusion and infighting among Democrats the last time they debated Medicare-for-all. A 2019 Kaiser Family Foundation poll found over half of Americans thought Medicare-for-all meant you could keep your private insurance, a finding that led presidential primary candidates to finger-point and flip-flop on the question for months. Kamala Harris, for example, initially backed Sanders’ bill in her presidential run, but later renounced her support after facing questions about whether she’d back abolishing private plans. 

New polling suggests Americans’ ideas about Medicare-for-all remain largely the same today. A March 2026 survey led by the center-left Searchlight Institute and Impact Research, a progressive polling firm, found that while 60 percent of Americans agreed that Medicare-for-all would create a single-payer health system, 61 percent also said Medicare-for-all would allow people to keep their current private health insurance plan if they preferred to.

Another recent survey led by Searchlight, the Democratic polling firm Tavern Research, and the progressive media organization Zeteo found that support for government-run health insurance was least attractive to voters when it included mention of the elimination of private and employer-sponsored plans and that it would be funded through higher federal taxes. Asked directly, 70 percent said they’d rather keep their current coverage than enroll in a federal plan similar to Medicare.

Battleground state focus groups held this past spring by the Democratic research firm Navigator found that while nearly all wished the country’s healthcare system was “universal” and “affordable,” few could say what separates one healthcare reform label from the next.

Put differently, most voters, including most Medicare-for-all supporters, seem open to a range of approaches that improve access to affordable care. 

Mahoney, the Stanford health economist, thinks what’s new is that Democrats are realizing they don’t have to choose between improving the coverage people have now and building something better over time, like a strong public option. There’s a growing recognition among experts, he said, that people are being squeezed right now, while deeper structural problems keep mounting underneath, like an insurance system tied to employment that would only grow more precarious if AI drives waves of layoffs. 

Natasha Murphy, the director of health policy at the Center for American Progress,  a liberal think tank, said voter research has led them to recommend new “short-term solutions” that can bring healthcare costs down now. “Candidates and elected officials would serve themselves and their constituents by focusing on the more immediate benefits,” she told me, “while continuing to talk about universal coverage and broader-scale change” that could take a decade or more.

Adam Gaffney, a prominent single-payer advocate who previously served as president of Physicians for a National Health Program, believes Americans indicating support for “Medicare-for-all” in polls broadly support a national insurance health system, but it doesn’t mean that everyone therefore knows “everything in Bernie’s bill, or Jayapal’s bill, or [Physicians for a National Health Program] proposal” since “very few people do.” 

Gaffney says he’s not opposed to incremental reforms on the path to single-payer, though he does believe voters interpret “Medicare-for-all” as one insurance program that covers everyone, just as they generally know that Medicare covers all people above age 65.

The 2028 test

Whether Democrats can actually sustain a tentative peace on healthcare will likely depend on how the next presidential primary season shakes out.

Alexandra Ocasio-Cortez, who is considering a run, is a vocal Medicare-for-all supporter closely aligned with Sanders — yet both have enthusiastically endorsed El-Sayed and continue to stump for him. Would Ocasio-Cortez campaign on Sanders’s bill specifically, or on something like El-Sayed’s broader healthcare vision? How would she handle disagreements with rival plans, which at times became heated in 2020? And where will groups like the Democratic Socialists of America draw their lines for endorsements?

Weighing in on the topic recently on his political newsletter, journalist and Vox co-founder Matt Yglesias noted that El-Sayed’s recent remarks characterizing Medicare-for-all as more aspirational than any specific piece of legislation may help build a “permission structure” for all kinds of center-left Democrats to run on worthy healthcare reform ideas. 

“The single most important thing that El-Sayed can do to win moderate support is to leverage his credibility with the left into ending the destructive Medicare for All wars that have paralyzed the Democratic Party for the past 15 years,” Yglesias argued. 

The reverse might help too. Single-payer supporters have long suspected a public option is meant to defuse pressure for bigger change, and moderates could answer that by stating plainly they want a plan that grows to cover nearly everyone — not a patch for people falling through the cracks.

In Jacobin earlier this month, the socialist writer who publishes under the pseudonym Carl Beijer urged leftists to hold the line on single-payer healthcare. He noted that El-Sayed’s position is almost identical to the stance that Democrats like Pete Buttigieg and Elizabeth Warren got slammed for by the left for proposing back in 2020. The Sanders wing of the party, Beijer stressed, held back then that any plan that allows for private insurance has no right to associate itself with Medicare-for-all. The risk now, he argued, is that rather than serve as a stepping stone to single-payer, a private option would let the rich opt out, and voters who’ve opted out don’t tend to fight to fund what they’ve left behind. He mused that socialists may be more willing to let El-Sayed off the healthcare hook because of the uncompromising stance he’s taken on Israel, but that the underlying issues had not changed. 

Beijer’s warning is that agreement this easy is agreement about nothing. The next presidential primary is where we’ll find out where the real differences remain.

The safeguard was designed to prevent users from being overwhelmed by harmful content, but TikTok wanted to determine whether it made the app less engaging.

Rebecca Feinglos never expected to get divorced. She’d been with her partner for nine years, and married for six, but finally she had to admit to herself that her relationship had taken an abusive turn.

It was 2021 when she decided to end it. But Feinglos was surprised to discover then that the state she was living in, North Carolina, requires couples to reside in separate homes continuously for a full year before they can even file. 

“In amicable divorces you could lie, but I did not have an amicable divorce,” she told me. “It took 18 months for my divorce to be signed by a judge, and we did not have children.”

When she was finally out of her marriage she felt angry. She knew that many people could not afford to live in separate places, let alone pay for the attorneys needed to navigate all the fraught legal proceedings. Feinglos, a former state government employee with a master’s degree in public policy, started researching divorce laws nationwide. “It was so confusing even for me,” she said. “This was before ChatGPT, and all the Google search results were from family attorneys saying, ‘Oh this is really complicated, you definitely need to hire us to help you.’” She has spent the years since pushing to change those laws.

North Carolina is one of a handful of states, including South Carolina and Arkansas, that require couples to live separately for a set period before they can file for no-fault divorce. Most states make couples wait after they file, a “cooling-off” period meant to give spouses a chance to change their minds. In Wyoming, it’s 20 days. In Missouri, 30. In California, couples need to wait six months, and having children can stretch the timelines further. In some states the clock only starts when one’s spouse is formally served, which means a husband or wife who’s hard to track down can add weeks to the wait before it even begins.

“The system sets people up for conflict, sets people up for war,” said Erin Levine, a former divorce lawyer who founded a company that helps people navigate divorce outside the traditional law firm model. “In some states it’s called a ‘petition,’ in some states it’s called a ‘complaint,’ the forms say ‘spouse v. spouse’ — you are being sued.”

This issue runs, inevitably, into the culture wars. Today some conservatives are trying to make it even harder to get divorced, part of a broader push to strengthen the traditional nuclear family, built on the argument that children fare better when parents stay together. Over the last few years Republican lawmakers in states like Missouri, Tennessee, and Texas have considered new restrictions on no-fault divorce, which lets a person end a marriage without proving their spouse did something wrong. Others have proposed expanding so-called covenant marriages, which require counseling before the wedding and allow divorce only for specific reasons like adultery or abuse. House Speaker Mike Johnson has long endorsed making divorce harder, and Vice President JD Vance has complained that no-fault divorce allows people to “shift spouses like they change their underwear.” (Faced with criticism, a spokesperson later said that Vance does not support changes to divorce law.) 

But as more people come forward with stories of the financial cost, family stress, and even physical danger of extended divorce proceedings, there’s a growing push to address their complaints by making it easier to separate and divorce rather than harder. In 2023, Maryland lawmakers eliminated fault-based divorce entirely, cut Maryland’s separation mandate from a year to six months, and let couples count as separated even while living under the same roof. Washington, DC, has gone further. The same year, the DC Council unanimously scrapped its requirement that couples separate before divorce, and in Virginia, a law that took effect just last month lets people get in front of a judge on the first day they separate, instead of waiting six months or a year to sort out custody, support, and who stays in the house.

The issue has gotten more attention on social media over the last few weeks, as Jen Hamilton and Hadley (Vlahos) Fairley, two bestselling authors with more than 7 million followers across Instagram and TikTok, have started speaking out about how divorce laws in their respective states affect women like them. Hamilton, who is based in North Carolina and separated from her husband in June, has blasted the “asinine, outdated, and paternalistic laws” that keep people trapped in marriages, and has been fundraising on her platforms to help women afford to escape their unsafe relationships. 

Fairley, based in Mississippi, has been recounting the many court filings, legal fees, and emotional pain she endured for nearly three years trying to end her marriage. A no-fault divorce in Mississippi requires both spouses to agree to it, and when they don’t, the only way out is to prove in court that your spouse did something wrong, like adultery or desertion. In May, after eleven days in court, a judge finally granted Fairley a divorce, determining that her ex-husband’s conduct met the state’s legal standard for “habitual cruel and inhuman treatment,” citing a DUI he lied about under oath, more than $200,000 in secret trading losses that were mostly her earnings, a cancer diagnosis he faked to get her sympathy, and months of messages the judge called harassing and manipulative. Custody and the division of their assets are still unresolved, and more trial days are set for September.

“I understand burden of proof for a murder trial, but when it’s your personal life it’s very different,” Fairley told me. “I mean, you’re having our friends and our family go on the stand and testify to what they witnessed and it’s incredibly intrusive…even my therapy notes were subpoenaed.” 

Feinglos has been watching this all, and feeling cautiously hopeful that a reform bill pending in her state’s legislature might finally gain traction. “I do believe we’re at an inflection point,” she said.

The wait itself is the danger

Until the late 1960s, ending a marriage meant proving in court that your spouse had done something the state recognized as wrong, like cheating or abandonment. The burden fell on whoever wanted out, and meeting it often meant airing intimate details that judges weighed differently depending on whether a husband or a wife was asking. Starting in 1969, when California enacted the first no-fault law, states began letting couples divorce without assigning blame. Most followed within a decade, though holdouts like New York lingered. Divorce rates, already rising, peaked around 1980.

The laws mandating divorce waiting periods carry the logic of that earlier system. States tend to justify them by saying couples might reconcile if they’re given time. States also argue that decisions about custody and property shouldn’t be made quickly in the heat of the moment. Underneath both rationales is a theory that married households are valuable to the public, especially where children are involved, and so the state has a responsibility to slow couples down rather than treating marriages like contracts either side can simply cancel. 

Critics have long argued that the first rationale doesn’t hold up, since couples rarely reconcile during the waiting period and few people end a marriage on a whim. The second, they say, ignores what the wait actually does to someone leaving an unhappy or unsafe marriage, which is put them in danger. Separation is one of the most dangerous periods in an abusive relationship, and researchers have found that homicide risk climbs when an abuser senses they are losing control. Some research suggests a court’s intervention can make things worse rather than better if it provokes retaliation without actually getting the victim away from the abuser.

This danger has become a major issue in Virginia, where the push for divorce reform has been closely tied to a horrific murder-suicide by a prominent Democratic politician that made national headlines. 

Cerina Fairfax spent nearly two years in the same house as the husband she was trying to divorce, former Lt. Gov. Justin Fairfax. Up until last month, Virginia required couples with children to be separated a year before they could file, though permitted them to spend that year under one roof, so long as they could show a judge the marriage was genuinely over. When she finally filed for divorce in July 2025, her husband — a lawyer, representing himself — argued she hadn’t specified that she intended their separation to be permanent and in January a judge agreed with the technicality. Cerina Fairfax was told she could amend her complaint and try again. At some point during the proceedings she installed cameras throughout their house.

On March 30 a judge granted her sole physical custody and ordered Justin Fairfax to move out within a month. He was still there when he shot her in the house in the middle of April and then killed himself. Their two teenagers were home, and the cameras were recording.

Virginia’s new divorce law had just been signed days earlier. Tucked into it was an order for a work group to study whether the state should scrap fault-based divorce altogether. Activists pushing officials to take that next step point to the Fairfax episode, arguing it shows the dangers of prolonged divorce proceedings with a spouse who could become unstable or threatening. The report is due to the legislature in December.

Courtenay Schwartz, the legal and policy director for the Virginia Sexual and Domestic Violence Action Alliance, told me that while the change that just took effect in Virginia is a big one, her state’s laws still make it “very onerous” to get divorced, noting that the requirement to be separated still stands. 

“If you have someone interested in dragging out the process which Justin Fairfax was, it can really get drawn out and run in the hundreds of thousands of dollars,” she said. “It’s just prohibitively expensive, especially if you are experiencing domestic violence.” 

Schwartz says Virginia Democrats, who control both chambers of the legislature and the governor’s office, have grown increasingly interested in “access to justice” issues, meaning reforms that make the legal system navigable for people who can’t afford a lawyer. This has been driven partly by a 2022 Legal Services Corporation study that found 92 percent of the civil legal problems experienced by low-income Americans received inadequate or no legal help. 

North Carolina’s governor tells Vox he backs reform

Woodson Bradley, a Democratic state senator in North Carolina, won her first race in 2024 by just 209 votes, in a district the Republican-controlled legislature had redrawn the year before. She holds one of the most competitive seats in the state.

Now Bradley is the lead sponsor of SB 626, which would cut North Carolina’s separation requirement from a year to six months and let survivors of domestic violence file for divorce immediately, with no separation at all. It’s been stalled in committee for nearly a year and a half.

The issue is personal to Bradley, who experienced domestic violence in her 20s while living in another state. “When I left I was tracked down and beaten, and there were no real stalking laws back then in the 1990s,” she told me. She later moved to North Carolina, remarried someone “who I thought was wonderful, had two kids, and then things weren’t wonderful anymore.”

Bradley soon found herself in yet another abusive, coercive relationship, fleeing with her children, an experience she describes as “the most brutal thing I’ve ever been through.” It took her years to finally get a divorce, because her ex-husband continued to contest and extend the proceedings. 

Jen Hamilton, the famous labor and delivery nurse and author of the New York Times bestselling book Birth Vibes, has been raising the issue on her platforms and talking with Bradley about changing North Carolina’s laws.

“Jen speaking out is very much changing things,” Bradley told me, adding that although the issue is very partisan in North Carolina, five Republican lawmakers have reached out to her recently about her bill. Past efforts at reform in North Carolina have failed, including in 2015, 2019, and 2021.

North Carolina’s lame-duck Senate leader Phil Berger, who lost his Republican primary in March, did not return requests for comment but a spokesperson for North Carolina’s Democratic Gov. Josh Stein told me he supports reform. 

“North Carolinians don’t need government making their life harder, especially during some of their darkest times,” they said. “The Governor is willing to work with anyone to ensure our laws are more appropriate for the world we live in today.” Last year Stein signed a bill that made habitual domestic violence a felony.

For Rebecca Feinglos, the proposals moving through Raleigh are still catching up to what she already lived through.

“I remember the line in my divorce decree allowing me to change my last name back to my maiden name, my now late father’s last name,” she said. “Every moment I had to use my married name throughout the proceedings felt like a reminder that I was still stuck in a life I didn’t want.”

Just last month, I marked my 25th year as a professional journalist, which I guess means my journalistic career is old enough to rent a car, no questions asked. Work in the news for that long, and you’ll occasionally find yourself surprised by things you published in the past. Like, I had all but forgotten that I had written this Time magazine cover story in 2008:

A couple things here. One, as the cover demonstrates, journalistic sensitivity was…less than ideal then, to say the least. And two, over a quarter-century occasionally covering obesity (both childhood and adult), that story only seemed to go in one direction: worse.

It wasn’t for lack of trying. We put calorie counts on menus, taxed soda (well, in some places), built workplace wellness programs, and funded a small library of diet research. We deplored food deserts and promoted farmers’ markets. We told people — again and again — to eat less and move more. But the lines just kept going up.

By the CDC’s measured survey, the share of US adults with obesity did not change meaningfully between 2013 and 2023. The age-adjusted obesity rate sat at 40.3 percent, while the age-adjusted severe obesity climbed from 7.7 percent to 9.7 percent over the same stretch.

While the question of weight in America is inextricably tied to body image and moralizing, those numbers had a deadly effect. One demographic model estimated that obesity was associated with roughly 18 percent of deaths among Black and white Americans ages 40 to 85 between 1986 and 2006. From diabetes to kidney failure, heart disease to sleep apnea, obesity is the delivery system for other diseases.

Which is what makes a Gallup report published in July so surprising. In Gallup’s self-reported height-and-weight series, the US adult obesity rate fell to 36.4 percent, down from a peak of 39.9 percent in 2022. Over roughly the same period, the share of adults who said they were currently taking a GLP-1 drug for weight loss rose from 3 percent in 2024 to 11 percent in 2026 — approximately 29 million people. While this only shows correlation, not causation, and Gallup’s self-reported measure should not be compared directly with the CDC’s measured rate, the timing is suggestive to say the least. 

And the weight might be the least interesting thing about these drugs. 

Semaglutide — the molecule sold as Ozempic and Wegovy — was first developed and approved as a treatment for type 2 diabetes, not obesity. It was only after earlier GLP-1 drugs and diabetes trials showed substantial effects on appetite and weight that researchers deliberately tested a higher dose for obesity, resulting in Wegovy in 2021. 

But as it turns out, the list of things that have been noticed happening on the side with GLP-1s has gotten so long it’s begun to eclipse the main event. The coverage of GLP-1s has barely kept up with this news, because weight loss is what made these drugs famous and what we continually obsess over. But it turns out, weight loss may not be what they’re best at.

Side effects may include…

Let’s start with sleep apnea, which, untreated, drives up blood pressure, strains the heart, and raises the risk of stroke. These are people whose breathing stops dozens of times an hour, all night, every night. Two year-long trials put 469 of them on tirzepatide — the drug sold as Mounjaro and Zepbound — and cut those interruptions by more than half. Roughly half the group finished the year with no apnea at all, or with so little left that they stopped being tired all day.

Then there are the kidneys. A major trial followed 3,533 people with type 2 diabetes and chronic kidney disease for a median of 3.4 years. Semaglutide reduced the relative risk of a composite of kidney failure, a sustained loss of at least half of kidney function, or death from kidney-related or cardiovascular causes by 24 percent; all-cause mortality was 20 percent lower.

And the liver: A trial, still underway, biopsied the livers of 800 people whose organs had grown fatty, inflamed and scarred and randomly assigned them to semaglutide or a placebo. After 72 weeks the inflammation had cleared in nearly 63 percent of those on the drug, with no worsening of the scarring, against 34 percent on placebo. 

And the knees: In 407 adults with obesity and moderate knee osteoarthritis, pain scores on the 0-100 WOMAC metric fell 41.7 points against 27.5 on placebo. 

And to top it off, a 17,604-person trial of participants who were overweight or obese but did not have diabetes found a 20 percent drop in major cardiovascular events.

These results may not be as grabby as cultural debates over “Ozempic face,” but they deserve far more attention.

Medicine’s happy accidents  

As GLP-1s — which in part came out of a hormone in Gila monster venom — demonstrate, medicine has long found some of its biggest wins in the margins of drugs ostensibly built to do something else entirely. 

Sildenafil, better known as Viagra, began life at Pfizer as a candidate treatment for the heart disease angina. It failed at that, and its now-famous use turned up in data as a side effect in what must have been a very interesting trial for its subjects. Minoxidil (Rogaine) was a blood pressure pill that turned out to help patients grow hair. Finasteride (Propecia) was approved for enlarged prostates before anyone thought to sell it for baldness — and then a trial of more than 18,000 men found it cut prostate cancer diagnoses by about 25 percent, a benefit that took 20 years of follow-up to fully vindicate. 

Perhaps the most famous example is aspirin, which spent most of a century as a painkiller before a doctor in California named Lawrence Craven noticed that the patients he’d given aspirin gum to after tonsillectomies bled more than they should. He guessed the aspirin thinned the blood, and started handing it out to middle-aged men, who were at higher risk of heart attacks. Craven died in 1957; the trial that ultimately proved that he was onto something — showing that aspirin in heart attack victims cut vascular deaths by a fifth — didn’t run until 1988. 

The strange morality of Ozempic

Viewed this way, GLP-1s can seem like miracle drugs — but even miracle drugs can’t cure everything.

There had been great hope that GLP-1 might reduce dementia rates, but when Ozempic maker Novo Nordisk ran a proper trial, it didn’t show evidence of slowing clinical progression of Alzheimer’s. Much the same happened with cancer. Observational data had hinted that GLP-1 users developed tumors less often, but when a Harvard team pooled 48 placebo-controlled trials covering 94,245 people, they found the drugs have little to no effect on the risk of thyroid, breast or kidney cancer, though evidence for other cancers was less certain, leading to FDA boxed warnings. One plus: In some early animal studies, high doses of GLP-1 drugs caused thyroid tumors in rodents, but further research largely hasn’t validated the fears that it could be more widespread, though uncertainty about some rare thyroid cancers remains.  

For many people, weight loss isn’t the end of what these drugs seem able to do. It’s where the benefits begin.

The bigger concerns largely remain the known ones, starting with muscle loss. Across 22 randomized trials, about 25 percent of the weight lost on these drugs turns out to be lean muscle mass. Some of that is simply unavoidable in any weight loss, but too much can mean a great deal, especially if you’re 75. 

And cost remains a barrier: In a 2025 KFF poll, 56 percent of adults who had ever used a GLP-1 said the drugs were difficult to afford; 27 percent said they had insurance but paid the full cost themselves. In a separate Cleveland Clinic chart review of 288 adults without diabetes who stopped injectable semaglutide or tirzepatide within a year, 47.6 percent stopped because of cost or insurance problems, compared with 14.6 percent because of side effects. (The money, at least, is improving. An oral GLP-1 drug was approved in April, and it starts at $149 a month for people paying cash, while Medicare trial pricing of $50 a month for some GLP-1s went live in July.)

A stickier obstacle is the one that can’t seem to be divorced from questions about weight: judgment. As my colleague Dylan Scott wrote recently, researchers at Rice University found that people rate a GLP-1 user more harshly than someone who never lost weight at all. That makes perfect sense when you consider how contentious weight is in America — and none at all when you think about just how many people have benefited from these drugs in so many different ways.

I sometimes wonder how we would view GLP-1s if they could do everything they’ve been shown to do, but somehow not change a person’s appearance. 

So much of the discourse around these drugs has been shaped by the fact that many of the earliest and most public and apparent users were already thin people, often celebrities, using them to get even thinner. But that framing has become increasingly difficult to square with reality. 

Two things can be true at once: American culture has a toxic relationship to weight, and millions of Americans can and are benefiting from these drugs. For many people, weight loss isn’t the end of what these drugs seem able to do. It’s where the benefits begin.

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