If you’re like me, and you grew up in a house where your mom refused to let you get a video game console, because she believed sitting and staring at a TV was bad for you, you might think of video games as antithetical to health. And there is plenty of research about the ways in which gaming too much can harm your physical and mental well-being. I don’t think anyone would argue that eight hours of Call of Duty every day is doing your body or your mind much good.

But the old caricature of video games as simple brain rot is increasingly out of date. Even some normal, non-educational games can help with brain function (as long as they are played in moderation — and some games are better than others). 

Beyond that, what if we could take something that is wildly popular (there are 3 billion gamers worldwide, 190 million in the United States) and reimagine it in a way that goes beyond just entertainment? Gaming tech has advanced to the point that we can put people into hyperrealistic virtual realities or use AI to create new personalized gaming apps with a brief voice prompt. These and other capabilities are unlocking new ideas from ambitious physicians and game developers that would have sounded like science fiction when I was a teen.

There’s increasing evidence that these platforms can be adapted to do genuinely incredible things to benefit our health. Here are just two ways in which video games are poised to change medicine — including one that allows any of us to game out in the name of advancing science. I can’t wait to tell my mom.

Video games could solve some big challenges in caring for kids

My perspective on video games in medicine started to change when I learned about one specific use: as an alternative to anesthesia for children and adolescents.

Here is a genuine clinical problem: For years, doctors have had few options beyond general anesthesia for kids who need to undergo imaging or minor surgeries. An MRI, for example, really only works when the patient is able to stay completely still and, as anyone who has spent a single minute around a child can attest, that’s hard for kids to do. So, children have been put under during routine MRIs or minor procedures that, when they’re performed on an adult, require only local anesthesia or no anesthesia at all.

But giving children general anesthesia comes with health risks. The FDA warns against repeated or lengthy use of general anesthesia for children 3 and younger because of the risks to their growing brains and future learning development. Other studies have suggested that general anesthesia also poses some risk to the development of older children, and its use should be minimized as much as realistically possible.

Enter virtual reality video games.

“Games and VR can be especially effective for reducing pain and anxiety during pediatric procedures, including burn care, needle procedures, and other medical treatments,” Dr. Kimberly Hieftje, co-director and co-founder of XR Pediatrics and the Yale Center for Immersive Technologies in Pediatrics, told me over email. “If we can help a child get through a procedure comfortably without sedation, that’s a significant benefit. Sedation and anesthesia carry risks, and minimizing unnecessary or repeated exposure is particularly important in children.”

Several small-scale studies have examined using virtual reality games as an alternative to general anesthesia for minor and routine surgeries and for MRI imaging — with promising results. In one 2024 experiment, more than 100 kids (average age of 11) wore a mobile VR headset during a minor procedure (most frequently a hormone implant) and played a relaxing game such as Pebbles the Penguin (in which players navigate a snowy world and collect pebbles) or Space Pups (in which they play as a canine soaring through outer space and eating treats) while doctors performed the operation.

The surgical team kept general anesthesia on hand in case it was needed, but none of the children involved in the experiment required it or any other kind of sedation. They were also able to follow simple directions from their physician during the procedure. Their post-surgery reports of pain were similar to patients who did receive anesthesia, and they had shorter recovery times.

Likewise, a study out of Canada published in December 2025 tested how younger patients responded to VR as an alternative to anesthesia when they needed an MRI. It was a small study of only 18 patients, but, once again, the results were encouraging. The kids (average age of 5) went into a VR game prior to the MRI scan, learning about the procedure while collecting magic fairy dust. Then, they went into the actual MRI. And all of the kids who had played the VR game prior to the procedure were able to complete the imaging scan without any additional sedation or anesthesia.

The foundational idea here is: Kids are not little adults. It’s harder for them to sit still. They get anxious about even imaging scans. “We create for adults and, then, put kids in it,” Hieftje said, “and we need to think backwards.”

Video games can help kids stay calm and stop moving — or, for kids with different medical needs, start moving. As any parent knows, children also aren’t very good at following directions or being self-motivated to exercise — even if it would be good for their health, like if they have Type 1 diabetes, for example. That’s why a group of researchers from Yale, as described in a study published earlier this year and which Hieftje co-authored, experimented with introducing kids with Type 1 diabetes to a virtual reality video game that coached them through exercises. 

It was a small group — 17 adolescents, an average age of 15 — but patients who participated were motivated to play the game, followed through with their routines, and even registered a small but detectable decrease in their blood sugar levels. The researchers are hoping that larger studies could demonstrate the program’s effectiveness and continue taking it mainstream.

The list goes on: Hieftje said their work uses games and immersive technologies to address everything from substance use and human trafficking prevention to mental health, child loss and grief, and infection prevention for infants in a natal intensive care unit.

But video games are doing more than changing clinical care for challenging patients. They are also unlocking the basic science that leads to new breakthroughs in treatment for everybody.

Video games could allow all of us to contribute to future scientific advances

When I think of massive multiplayer online games, I think of my friends and I camping out in somebody’s basement to play Halo against strangers for hours on end. But Attila Szantner, the co-founder and CEO of Massively Multiplayer Online Science, has found a more productive use for these remarkable platforms that can connect hundreds of people from all around the world.

What his company has done, in tandem with academic scientists, is integrate important but tedious basic research tasks into the gameplay of popular commercial multiplayer games like Borderlands 3. When I attended the Aspen Ideas: Health summit this summer, Szantner presented a demo of one of his company’s modules. What appeared to be players sorting colorful tiles in gameplay that would look familiar to anyone who’s played Tetris, he said, was actually players — normal people with no special training — helping to sequence DNA samples for people’s gut bacteria. Players in the game learn the task from a Borderlands character — including its ultimate scientific aim — and, then, complete the puzzles that the scientists have set up.

“Games are the absolute masters of engagement. They found the magic formula to make repetitive tasks feel fun,” he said. “In citizen science, people have intrinsic motivation to help, but standard tasks get monotonous and people drop off. Games solve that completely.”

They’ve turned the boring but vital work of number crunching and sequencing into gameplay — and convinced millions of their fellow citizens to help. In a paper published in October 2024 in Nature Biotechnology, Szantner and his co-authors described a project that involved more than 4 million individuals completing more than 135 million science puzzles in order to align a million human microbiome sequences. They found that the players’ collective contributions led to better sequencing than the current state-of-the-art computational methods. In another project, they turned some basic cellular analysis tasks into gameplay on the multiplayer game EVE Online that, once again, performed better than what is now the standard.

We have only scratched the surface of gaming’s awesome potential. Clinicians are also optimistic about gaming’s ability to preserve the cognitive health of aging adults and coach them through exercise routines (much like the kids in that Yale experiment), especially as the native gamer generations get older. Video games could revolutionize trauma care by placing burn victims inside of a cold VR environment — and what if you could reduce PTSD by playing Tetris? In 2020, the FDA approved the first video game for ADHD treatment: EndeavorRx. Experts confronting a male loneliness epidemic believe they can use video games to bring young men together. These programs could also transform medical training and allow surgeons to preplan and practice surgeries using their patient’s unique data to produce a bespoke virtual reality practice module.

The point is: The caricature of video games as a gateway to couch potato-itis is a relic of the past. Gaming could help all of us stay healthy — seriously.

Since January, many Cubans have lived a life of near-constant darkness. The Trump administration’s oil blockades have led the country into a worsening energy crisis, collapsing what was already an eroding national power grid. 

Daily blackouts have plunged the Cuban nationalized, universal health system, once the pride of the country, into a humanitarian crisis. For months, hospitals have been without necessary power and ambulances strapped for fuel. Piles of trash line the streets, increasing the risk of disease. Cold storage issues threaten lifesaving vaccines, and a combination of the frail economy and US sanctions has left pharmacy shelves almost empty. 

The public health crisis exposes an often overlooked aspect of the way we tend to think about the promise of universal healthcare. Having accessible and free medical services is only one part of the solution. While Cuba’s once-vaunted health system is bound up in its own history and national context, it still demonstrates that public health of all kinds can only be as resilient as the electricity, water, transportation, refrigeration, supply chains, and institutions that enable it. 

An old prototype for universal healthcare 

Not long ago, Cuba’s health system was seen as a promising model for successful free universal healthcare. In the years following Fidel Castro’s rise to power, health authorities focused on the integration of healthcare delivery models into a single public system. The Castro government aimed to expand services once concentrated in Havana into rural areas, such that the entire population would have access to basic care services. In 1974, the government launched community-based polyclinics that placed primary care specialists in almost every Cuban community. 

Over the decades that followed, that widened access to healthcare led to significant, measurable returns. Infant mortality in the country has dropped from 37 per 1,000 live births right after the revolution to seven per 1,000 live births in 2024. Infectious and parasitic disease mortality also improved, dropping from a rate of 45.4 per 100,000 inhabitants in 1970 to 9.8 per 100,000 inhabitants in 2019, according to data reported by the Cuban Public Health Ministry. 

It’s not entirely surprising that the successful Cuban national health model has been the site of curiosity and enthusiastic scrutiny in American health equity circles, despite vast differences in state ideologies. The US has never ensured that every citizen has affordable access to healthcare, and large disparities persist in low-income and rural populations. The chokehold of private insurance has ensured that, unlike nearly every other country in the world, the US has largely rejected the prospect of universal care. Even historic gains in insurance coverage have faced rollback threats under the One Big Beautiful Bill. 

On certain key metrics, the US also falls far behind Cuba, which boasted 9.5 physicians to 1,000 people in 2021. That same year, the US reported just 3.7 physicians to every 1,000 people. The 2019 measles epidemic demonstrated a gap in childhood vaccination rates as well: 92 percent of children ages 13 to 17 in the US received two doses or more of the measles, mumps, and rubella vaccine. In Cuba, the childhood completion rates were well over 99 percent, and the country has not seen a measles outbreak since 1993. 

From its early years, the Cuban health system has functioned against a background of economic decline particular to the country, one attributable to a complex combination of external pressures, among them US blockades, a complicated economic reliance on Venezuela, a struggling state-run economy, and a flailing industry heavily impacted by the Covid-19 pandemic. 

While other sectors faced attrition, Cuba’s health system, at least, appeared capable of weathering these crises. During the pandemic, the country proved to be a model in global health, having developed a homegrown Covid-19 vaccine rapidly and reaching a 95 percent vaccination rate. Its robust supply of trained health professionals made headlines when Cuban healthcare workers provided essential pandemic aid to a small town in Italy.

 So why has this system proved to be so fragile now? 

New blockades deal the final blow after Hurricane Melissa 

Torrents of rain and flooding from the Category 3 Hurricane Melissa hit Cuba in October of last year, affecting much of the island’s eastern provinces. More than 735,000 people were evacuated, and the environmental disaster has put the country’s basic health infrastructure in a precarious state. 

In the storm’s wake, a combination of flooding and damaged water systems increased the spread of viral infections of arboviral diseases such as dengue and oropouche. A report by the Pan American Health Organization published in March placed water, food, and vector-borne diseases in the “very high” health risk categories. Apart from damaged water and sanitation infrastructure, the report describes how disruptions to health service access, routine surveillance of disease vectors, and environmental conditions that breed mosquito-borne disease outbreaks have dramatically increased the risk of infectious disease spread. 

Hurricane Melissa arrived during a recovery period from earlier storms, such as Hurricane Rafael in late 2024, as well as sporadic earthquakes in recent years. These natural disasters also heavily damaged health facilities, leading to collapsed roofing, damaged roads and cables, and the loss of supplies and equipment. 

For years, Cuba’s economy was propped up in large part by its relationship with Venezuela. In exchange for support from Cuba’s highly trained professionals — especially healthcare workers — Venezuela long provided a critical supply of crude oil, which helped the country keep the lights on even in the face of US sanctions. 

That partnership ended in January after the nighttime capture of former Venezuelan President Nicolás Maduro, and the sweeping Trump oil blockade soon after has dealt a challenge too difficult for the energy infrastructure to withstand. 

Already struggling to recover from other disasters, Cuba plunged further into its present crisis. Mario Cruz Peñate, Pan American Health Organization representative for Cuba, said that while the public health situation has been evolving for a while, he has seen more acute upheavals as sanctions persist, causing mass blackouts that have made it impossible to sustain vital health services and emergency care.

Disease control continues to struggle post-Melissa, with aid organizations worrying about communicable food- and water-borne diseases, such as hepatitis A and diarrhea, that can be caused by unrefrigerated food. On the administrative level, limited transportation resources and electricity have led to a dearth of vaccine supplies, which typically require cold rooms for transfer and storage. 

Continuity of care, in particular, has been affected for the worse. More than 100,000 elective and reconstructive surgeries have been postponed, for example, because of a lack of supplies and a backlog of emergency surgeries. At a briefing in May, representatives of the UN Office for the Coordination of Humanitarian Affairs and the World Health Organization reported that over 32,000 pregnant women faced limited access to diagnostics and limited amounts of the stable electricity needed to sustain neonatal units. Prenatal care faces delays because of the lack of everything from testing supplies to available facilities. And now, even once successful improvements in health indicators have fallen: a report from the Center for Economic and Policy Research measured an increase in infant mortality rates from 4.0 to 9.9 per 1,000 births between 2018 and 2025. 

For humanitarian aid organizations, alleviating this health crisis also poses a stark challenge. Cruz Peñate ascribes this to availability, timing, and opportunity to distribute aid supplies, all of which have been made inconsistent by the ongoing blockade. 

“The response to the situation in Cuba has to increase; we have to scale up the response. All the support we can manage to receive will be important,” Cruz Peñate said. “Here in Cuba there is really a situation that needs attention.”

Is Cuba now an outdated prototype for universal healthcare? 

While Cuba’s healthcare system was never bound to map precisely onto the US, some of its most notable successes — the high physician-to-patient ratio, the almost entirely vaccinated population, the ample health screenings — still remain desirable. And yet those very accomplishments have crumbled under the threat of extreme weather events and the country’s inability to restore its broken power grid.  

Trump targeted even more petroleum suppliers in his latest round of sanctions on July 23, leaving Cuba scrambling still further to revitalize its energy sector. Those same sanctions also took aim at the Cuban healthcare export economy, alleging that it involves forced labor. 

Earlier this month, Cuba’s government loosened constraints on a handful of private operations, including pharmaceuticals and elder-care facilities, in response to the shortage of medicine in the country.  With state-stocked shelves running empty, the new decree allows private pharmacies with Cuban health registration to fill in the medicine gap. Similarly, privatized elder facilities are also allowed to operate at a capped rate of 60 people per home, with mandatory visits from state physicians. 

The government still prohibits private sector medical and dental care, and Cuban officials remain adamant that the “socialist state enterprise keeps its central role,” so it’s difficult to claim that the country’s medical model is being pressured towards privatization. But the erosion of some of its elements still speaks to a state-run health system under strain. 

We often think of healthcare itself as an equation of medical services along with healthcare personnel and the authorities — government, industry, or both — that control it. But the crisis facing Cuba gets at the dependence of all of these factors on the broader energy ecosystem. Even a once-promising healthcare model can quickly collapse when a crucial component is missing: fuel.

A version of this story originally appeared in the Future Perfect newsletter. Sign up here!

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!

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

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

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

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

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

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

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

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

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

Freezing time doesn’t come cheap — or easily

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

That’s not for lack of trying.

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

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

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

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

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

But access isn’t the only problem.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How does your book start?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Where have we seen biological weapons used?

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

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

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

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

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

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

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

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

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

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

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

How do you sleep through the night?

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

Do you have a biohazard suit?

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

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

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

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

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

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

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

The egg came first

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

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

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

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

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

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

Building off the platform

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

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

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

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

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

Of course, you need to actually get the vaccine

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

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

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

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

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

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

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

Or so the thinking went. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Will the GLP-1 stigma ever go away?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The doctor who decided crashes were not accidents

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

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

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

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

A safer system

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

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

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

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

The people we left outside the car

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

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

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

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

Driver Zero

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

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

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

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

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

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

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

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

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

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

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

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

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

How AI is currently being used in medicine

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

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

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

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

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

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

The questions you should ask your doctor about AI

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A lifesaving genetic mutation

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

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

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

Closing the loop

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

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

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

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

The war continues

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

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

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

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

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

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

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

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

Ticks are taking over the United States. Due to climate change, changing land use, and an explosion in the deer population, ticks have been expanding their territory and infecting more people than ever. They carry pathogens that cause everything from Lyme disease to the red meat allergy-inducing Alpha gal syndrome. In some cases, tick bites can be fatal.

Ticks usually lurk in the tall grass in wooded areas. That means going on a hike or even just hanging out in your backyard or a park can expose you to a tick bite. In many parts, of the country fear of ticks is changing how people live their lives, including the way they dress, how they enjoy their hobbies, or even whether they spend much outdoors at all. 

The tick surge is catching public health officials off guard. Emergency room visits due to tick bites are the highest they’ve been since 2017. In spite of the uptick, most public health departments still focus on lowering the population of mosquitos in their areas over ticks. 

Climate reporter Jonthan Mingle says we can fix this problem. As Mingle explained in a recent New York Times op-ed, encouraging the public to do tick checks and use bug spray is a part of the solution, but we’re leaving a bunch of larger interventions on the table. Mingle joined Today, Explained co-host Sean Rameswaram to explain why ticks are expanding their range and what we can do about it. 

Below is an excerpt of their conversation, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get your podcasts, including Apple Podcasts, Pandora, and Spotify.

We covered Lyme disease and tick bites on this show back in 2018 because the tick situation was getting out of hand. How much more out of hand has it become since then?

You know some experts I talked to used the word exponential. So what’s happening is that some of these tick species are spreading into areas where people aren’t familiar with them, doctors aren’t familiar with them. Thanks to warmer winters, ticks are expanding their hunting season. You may have a day that’s like 40 degrees in January, ticks are out looking for you, waiting for you to walk by and grab on and grab a meal. 

In 2024, a pilot named Brian Weitzel, father of three in northern New Jersey, had a hamburger, at a barbecue, went home to mow his lawn, and a few hours later was unresponsive on the floor and he died that night. His family was left in shock, of course, trying to figure out why he had died. And it turned out that he had likely been bitten by the lone star tick and had developed an allergy to red meat. This is referred to as Alpha-gal syndrome, which is just the latest entrant into the files of all the many ways in which tick bites can make us sick. The most familiar one, of course, is Lyme disease. Each year, about half a million people are treated for Lyme disease. It’s the fastest growing vector-borne disease in the US. Cases have more than doubled over the past decade, and those cases are mostly as a result of getting bitten by the black-legged tick or the deer tick. The thing is both of these ticks — and many other ticks that are also marching northward and westward and expanding their empires rapidly across North America — they can deliver all kinds of pathogens.

They’re claiming more and more of the map, and they’re claiming more and more of our psychic map right? I tell people I’m not a tick expert, although I’ve talked to a bunch of them, but I’ve become a tick expert in the sense that I am very familiar with tick paranoia and how it can keep you from venturing out into the places you love: hiking paths or picnic grounds or parks. And so that was part of the story I wanted to write about, too — Why are we letting the ticks keep us, if not out of these places that we need and love, why aren’t we fighting back?

And why is it? Are we not fighting back against the ticks?

Not really. I mean, this is one of the surprising takeaways from my reporting is that we’re barely even trying. One way of understanding that is to think about two numbers. One number is 90 percent. 90 percent of vector-borne disease cases in the US are from ticks.

90 percent?

Yeah. And yet despite the fact that 90 percent of cases of vector-borne illness come from tick bites, if you look at what local city, county health agencies do in terms of vector control, 80 percent of what they do is mosquito control, and only about 10 or 11 percent of these local health agencies around the country do any kind of tick control. So why is that? It’s a familiar story in the public health world. It’s not enough funding or policy support for trying out, testing, deploying new approaches to controlling ticks.

Even though people are dying?

We’re just kind of taking for granted that, ‘Oh, well, what can you do? You just tuck your pants in and spray some insecticide on your boots and that’s all you can do.’ It’s like, well, actually we have a long history of going to war with mosquitoes. Before there was tick control, there was mosquito control. The CDC was founded with the sole mandate in 1946 of wiping out malaria and fighting mosquitoes. 

It feels like they lost that fight because in my neighborhood you can’t go out between the hours of seven and nine o’clock.

The mosquitoes haven’t gone away, but malaria did for the most part. You know, in talking to experts today, including folks at the CDC, they told me that there’s a suite of tools we could be using if we wanted to get serious about fighting ticks. As one veteran tick expert at the CDC told me, if you want to make a dent in this problem, you have to get to the deer. The deer are the engine driving a lot of these tick species spreading, and we just have way more deer than we did decades ago, especially in the eastern US and suburban parts of America. So how do you get to the deer? I had people in the comments section of my piece saying the clear answer is just we should all be hunting deer. But in talking to the experts, they’ll tell you it’s not really a feasible solution. You would have to knock deer populations way down to make a dent in the tick populations. 

What is more promising is a combined approach of stuff like vaccines. There are people developing vaccines that you could deliver to deer or to rodents, which are another important host for these ticks so that when the tick bites them, they’ll die. That, I learned from talking to folks who do this kind of research for a living, is a more promising avenue for controlling ticks than all of us picking up crossbows and becoming deer hunters.

So why is it that we’re not doing anything?

What I heard from experts is that we’re not even funding this research in a serious way. We do this stuff for mosquitoes. People don’t realize it, but your local county health agency, they go out and they find where the mosquito breeding grounds are and stagnant pools the water and they treat it. It takes this sustained quiet effort. 

We saw the consequences of not doing that recently. This is a bit tangential, but screwworm. Screwworm was this flesh eating larval pest that devastates cattle herds that it was eradicated in the US in 1966, and it was kept at bay by the vigilance of people at USDA and USAID who ran these programs to release millions of sterile screwworm males out of airplanes. It created this wall that kept the screwworm from coming into the southern US. And probably if we stopped doing the mosquito control at a local scale, we’d see more cases of dengue fever, West Nile virus, and all these other rare but serious illnesses that climate change is making more of a threat here in the US.

Could you just practically help people understand how they can protect themselves in the absence of, I don’t know, a functional government?

Doing tick checks. And we do it in my household pretty much daily when you come home, do a thorough tick check, throw your clothes in the dryer. Ticks hate heat. And some people like to use permethrin spray, which is this insecticide that’s designed to kill ticks on your boots or your pants when you go out for a hike. Researchers have known these things are really effective if you keep doing them, if you stay vigilant. And all it takes is that one time, that one time you go out for a hike and you come back and you forget to do the tick check. 

So we need those kinds of personal measures of vigilance and protection, but we still need to kind of push for a bigger public health response to this. The ticks are going to keep spreading into the calendar, too, in the sense that as winters get warmer, more and more days of the year when you’re outdoors, you’re going to encounter ticks who are hungry, and they’re looking for you. 

What caused the ongoing outbreak of cyclospora, the diarrhea-causing parasite currently spreading across the United States? Michigan officials have been saying for weeks that they believed the outbreak may be linked to bagged salad or salad kits. What we were waiting to learn was the specific brands and specific products in question. 

And late last week, it looked like we finally had the answer — but then things quickly got cloudy. 

On July 16, the Washington Post reported, citing anonymous sources, that the outbreak had been linked to shredded iceberg lettuce supplied to Taco Bell by Taylor Farms. A day later, Taylor Farms said it was withdrawing products from US stores and restaurants based on information from the FDA.

But then on July 19, per NBC News, the FDA said that there had been a false positive for cyclospora when testing a sample of Taylor Farms iceberg lettuce; Taylor Farms said in its own statement that the FDA had “apologized” for the mix-up. The next day, the company and the federal government were stuck in a semantic argument: Per NOTUS, the FDA insisted it did not “officially apologize” to Taylor Farms but “explain[ed] factually the issues” with the false positive. 

So where does that leave us right now? Officials still believe that Taylor Farms iceberg lettuce was the source of the Michigan outbreak. But whether those are the only products driving the outbreak remains unclear, with almost every state now reporting at least one cyclospora case in 2026. And on Thursday afternoon, the FDA announced that it was tracking a second outbreak linked to other unspecific products, though details were otherwise scarce.

Any outbreak of food-borne illness requires careful public communication. Officials need to tell people how to avoid contaminated food without scaring them away from eating fresh fruits and vegetables altogether.

But instead, many Americans have been left wondering what, exactly, they’re supposed to do. As one frustrated Reddit user put it: “So is the damn lettuce bad or not????” (If you need some advice on what foods are safe and what foods to be cautious about, we have a story for you.)

It may sound like a funny question, but it’s a profoundly serious one. The problem isn’t just that people are confused about their lettuce. The Trump administration’s handling of the cyclospora outbreak — from its conflicting public messages to accusations of political favoritism — has left many Americans even more confused about whether they can trust anything they’re hearing from the government. That’s a dangerous place to be during any public health emergency.

The cyclospora outbreak has become a communications nightmare

We are approaching 10,000 cyclosporiasis cases across the US this year: Michigan alone has recorded 7,664 as of this morning, Ohio has seen more than 1,200, and more than 40 states have now reported at least one case in 2026. The country usually sees a few hundred cases at most in a given year. Cyclosporiasis, the disease caused by the cyclospora parasite, leads to what public health experts describe as “watery” and “frequently explosive” diarrhea. While it isn’t typically life-threatening, it can cause serious complications: 160 people have been hospitalized in Michigan since the outbreak began.

And so for those of us who very much hope to eat fresh produce but do not want diarrhea, there’s a bit of urgency to figure out where the cyclospora is coming from. Food-borne illness investigations are already inherently difficult because of how globalized our food supply has become: Produce can travel all over the country and the world before it comes to your grocery shelf, and the process of government health workers interviewing the people who get sick and cross-checking to identify the shared foods that they might have in common is laborious.

Once investigators find a source, the information has to be shared clearly and responsibly. That is where the Trump administration has tripped up this week. 

Trump — and Health Secretary Robert F. Kennedy Jr. in particular — came into office criticizing the public health establishment. They accused officials of misleading the public about the novel coronavirus and the vaccines developed to fight it, while failing to convey the nuances of the pandemic. But now, as they grapple with the incomplete picture of the cyclospora emergency, they are making many of the same mistakes.

“They’re very similar problems, even if on the outside, they don’t look quite the same,” said Michael Mackert, director of the Center for Health Communication at the University of Texas at Austin. “The underlying commonality is very much that we are dealing with imperfect information all the time.”

In any outbreak, some uncertainty is to be expected. Investigators have struggled to identify the source of earlier cyclosporiasis outbreaks too. And the FDA maintains that the likely source of the outbreak is Taylor Farms iceberg lettuce, based on the information they have gathered from sick patients and other sources, no matter the false positive result that has sparked so much confusion.

“The epidemiological evidence is so strong that the lack of a positive test is almost meaningless,” said Francisco Diez-Gonzalez, director of the Center for Food Safety at the University of Georgia. 

But the mistake that the Trump administration made was in sharing preliminary results and then having to issue a seemingly contradictory statement shortly afterward.

“FDA should have waited for confirmation of the presumptive results before going public,” Diez-Gonzalez said.

The larger stakes of the Trump administration’s poor communication

Investigations like these are hard enough — but when you add in the public health funding cuts of the past 18 months and the casual and widespread corruption characteristic of the Trump administration, trust in the government’s public health apparatus has sunk even lower.

It’s created just the conditions for conspiracies to bloom. “Unfortunately our FDA is compromised,” wrote one top commenter on Reddit. “I would not trust what comes out of it during this administration.” 

Several news outlets and influential social media accounts noted that Taylor Farms had donated $1 million to Trump’s MAGA super PAC and, in the middle of the controversy, received a private White House meeting. According to the New York Times, Taylor Farm officials used that meeting to dispute the findings that their products were responsible for the outbreak — and shortly thereafter, the FDA made its “false positive” announcement.

The administration insists that their decision-making is being guided by science, but even the appearance of impropriety has become a common theme in the press coverage. The broader uncertainty and distrust may help to explain why it’s not only Taco Bell and Taylor Farms taking a hit right now: According to Market Watch, Chipotle and the fast-casual salad chain Chopt have also seen a decline in traffic in recent weeks.

Public health requires public confidence. Perceived influence from special interests is a problem, even if the interactions didn’t alter the FDA or CDC’s actions.

Kennedy, who helms our government’s health department, should understand this well: His Make America Healthy Again movement made restoring public trust a central part of its message while accusing the existing public health establishment as being in league with special interests. 

The cyclospora outbreak has revealed how difficult that is to do in practice. 

In trying to communicate nuanced information during an active outbreak — while consulting interested parties like Taylor Farms itself — the administration has instead fueled doubts about the credibility of its messaging

Even before cyclospora turned eating salad into a leap of faith, Trump had a poor track record: His administration has slashed CDC staff, brought on vaccine skeptics to set vaccine policy, and clashed with the scientific establishment on a number of high-profile issues, like the time Trump held a televised press conference to argue a disproven theory that Tylenol can cause autism.

“Unfortunately, this is another example of a missed opportunity to establish credible and trusted communications to prepare the public to understand the real risks from the pathogen and confidence in the food safety and information from the FDA,” Scott Ratzan, editor-in-chief of the Journal of Health Communication: International Perspectives, told me. “Faith in our institutions continues to erode. We could do better.”

We are lucky cyclospora is not a deadly disease. Next time, the stakes for these miscues could be much higher.

In January 2025, Linda-Gail Bekker stood inside a vaccine manufacturing plant and allowed herself to believe that the first HIV vaccine candidate conceived through African science and led by Africans might finally become a reality.

The vaccine would be built on mRNA technology, the same platform that had helped tame the Covid-19 pandemic. Bekker hoped it might finally crack the puzzle that had frustrated HIV researchers for more than four decades.

No virus has proved more evasive. Hundreds of HIV vaccines have entered testing; none has succeeded at providing durable protection against infection. And the need remains vast: In 2025, roughly 1.2 million new HIV infections were reported; anti-retroviral treatments have turned it into more of a survivable disease, but more than half a million people died from AIDS-related causes the same year. There is still no known cure.

So researchers like Bekker, an infectious disease specialist at the University of Cape Town, have more hope now, in part because there is finally a clearer idea of what an effective vaccine needs to do. It must coax the immune system into producing a particular type of protective antibody, a rare class of defender, capable of recognizing and disabling HIV despite the virus’s extraordinary diversity and rapid ability to mutate.

No one yet knows how to reliably do that. But mRNA is uniquely suited to the task of finding out, vaccinologists say. Thanks to the platform’s speed and flexibility, researchers can iterate rapidly through the otherwise laborious process of designing, testing, and refining the series of vaccine components needed to guide the body toward making those essential antibodies.

At the start of last year, Bekker and her colleagues were ready to put that strategy to the test. The clinical trial for their new mRNA-based HIV vaccine was just on the verge of enrolling its first participants. But the project depended on the same backing that had sustained HIV vaccine research for decades: US government funding. Washington had long supplied roughly 90 percent of the world’s investment in the field. Then President Donald Trump returned to office.

Within hours of his inauguration, Trump signed an executive order freezing foreign aid. The $45 million contract from the US Agency for International Development (USAID) that was supposed to fund clinical trials like Bekker’s disappeared, as did a web of other funds, many routed through the National Institutes of Health (NIH), that had helped fuel the field’s progress for years.

The timing could hardly be more cruel. After 40-odd years of chasing a shape-shifting foe, scientists believe they now know what kind of immune response an HIV vaccine must generate — and have in mRNA a powerful new tool for pursuing it. But just as many researchers have finally glimpsed a path to victory, the United States and much of the funding has pulled away from the fight. 

Pushing the envelope

From the outset, the target for preventing HIV was clear. Within a year of identifying the virus as the cause of AIDS in 1983, researchers had zeroed in on its envelope protein as the most promising point of attack for a vaccine.

Protruding from the virus’s surface in knobby clusters, the envelope protein acts like a molecular grappling hook, latching onto immune cells before pulling the virus itself inside. Without this feature, HIV cannot infect a cell.

Much as the coronavirus spike protein would later become the basis for Covid vaccines, this protein on the surface of HIV seemed an obvious bullseye. But identifying the target didn’t mean researchers could hit it. Most of what the immune system sees of the envelope protein is actually just a decoy. The parts that stick out and draw the strongest immune response are also its most changeable, differing from one strain to the next and mutating freely whenever antibodies close in, leaving the body to waste its firepower on a target that keeps slipping away.

Candidate vaccines kept making the same mistake. They would elicit plenty of antibodies, but not the kind that could keep up with the virus. Time and again, promising candidate vaccines generated excitement in the laboratory, only to come up empty when it mattered most in large-scale clinical testing.

The field’s fortunes started to change in the late 2000s when researchers began studying the small fraction of people living with HIV who developed antibodies capable of recognizing the virus’s concealed, conserved features. Though these hard-won antibodies came too late to protect their makers, they gave scientists a molecular blueprint for the defenses a vaccine would need to build.

As the field came to learn, these “broadly neutralizing antibodies” do not appear overnight but rather after years of battle with the virus. 

The challenge, then, was to design a vaccine that would not just trigger an immune response but guide a person’s immune system through the same evolutionary journey. This would require a succession of vaccine components to prompt a carefully choreographed process within the body, rather than the single, fixed target that suffices for shots against measles or hepatitis B.

It was a strategy rooted in rational design but dependent on trial and error. Progress would come through a steady stream of small proof-of-concept studies, each informing the next generation of vaccine candidates. Ordinarily, it would take at least a year — often longer — to manufacture and prepare each vaccine iteration before it could be tested in people. 

But then the Covid pandemic rocketed mRNA into the spotlight.

The mRNA advantage

mRNA technology upends the old recipe of vaccine development. Conventional shots work by showing the immune system a mugshot of the enemy: a killed or weakened germ, or one of its proteins, grown batch by batch in vats of cells or eggs. An mRNA vaccine takes a different route. Rather than supplying the mugshot, it supplies the instructions to draw one: a short, lab-printed strip of messenger RNA, the molecule cells normally use to ferry genetic directions from DNA to their protein-making machinery.

Inject the right sequence, and it will program the body’s own cells to become tiny factories, producing the target protein and presenting it to the immune system as if it were the real intruder. Because it is all just code, refining a design means editing text, not rebuilding a factory — the work of days, not months.

“We’ve been able to design vaccines in real time,” said University of Pennsylvania Perelman School of Medicine assistant professor Ted Kreider, who is a specialist in infectious diseases.

To HIV researchers, the appeal was obvious. HIV’s greatest weapon was its ability to shift and adapt. Now, at last, a vaccine could, too. 

The timing was ideal. Just as researchers were beginning to map the path to an effective vaccine, mRNA offered a way to move down that path at speed. With vaccine designs no longer bottlenecked by design and manufacturing, what once might have taken decades of stepwise vaccine development could, thanks to mRNA, be compressed into years.

Across a growing number of clinical trials, researchers are now testing different vaccine components, different sequences, and different delivery platforms, searching for the combination that most effectively nudges the immune system toward a truly HIV-thwarting response.

A paper published last month in Nature offered one such path forward, showing in monkeys that a painstaking sequence of eight shots could coax the immune system into producing potent antibodies capable of neutralizing a broad range of HIV strains. But even the study’s authors see a catch. “It’s still too many [shots] to be practical in humans,” said Dennis Burton, a professor of immunology and microbiology at Scripps Research who worked on the project.

Whether mRNA ultimately becomes the vaccine itself — or simply the tool that helps researchers discover it — remains an open question.

The fundamental challenge for now, after all, is vaccine design, notes Mark Feinberg, president and CEO of IAVI, a nonprofit research organization focused on developing vaccines against HIV. And for that task, he says, “the most obvious advantage of mRNA is simply the speed of getting an idea from the laboratory to the clinic.”

But if the technology reaches the finish line, researchers say it could offer other advantages as well. Because the protein is made inside the body’s own cells rather than in a lab, it folds and displays itself much as it would on the real virus, giving the immune system a more faithful target to train against. That way, when the real virus arrives, the body already knows its true face.

It also gives vaccine designers an unusual number of knobs to turn, notes Kristie Bloom, an mRNA vaccine researcher and molecular biologist at the University of Witwatersrand in South Africa. By altering the vaccine’s formulation, dose, or genetic design, researchers can shape not just the magnitude of the immune response but also its balance: favoring antibody-producing B cells, virus-killing T cells, or some mix of the two.

With mRNA, “there’s quite a bit of flexibility,” she said.

Not so fast

For all the putative upsides, however, mRNA does carry some baggage. There are concerns about public acceptance given the intense backlash and misinformation campaigns that followed the rollout of Covid-19 vaccines. And though those shots ultimately proved remarkably safe, with very low rates of serious side effects, a peculiar skin problem has emerged in early-stage trials of mRNA vaccine candidates for HIV specifically. 

In two separate trials reported last year, around one in 12 participants who received mRNA-based HIV vaccines manufactured by Moderna developed chronic urticaria, a form of persistent hives that in some cases endured for years. The vaccines encoded different portions of HIV’s envelope protein, yet both produced the same unexpected side effect.

The fact that the reactions appeared across distinct vaccine designs — but never before in Moderna’s other mRNA vaccine programs — has fueled suspicion that something about HIV’s envelope protein itself may be involved. Even so, no clear explanation has emerged. 

“We’ve ruled a bunch of things out,” said William Schief, a professor at Scripps Research’s department of immunology and microbiology who doubles as vice president for protein design at Moderna, “but there’s no smoking gun.”

Schief is continuing to investigate the source of the immune reactions. But not wanting an unresolved safety signal to bring the program to a halt, he and his collaborators have pressed ahead with lower-dose versions of the vaccine, betting that the hives will fade while the desired immune response remains intact. 

That strategy is now being evaluated in an IAVI-backed trial led by Bekker in South Africa. Known as IAVI G004, it has yielded encouraging early results. (Unlike the African-developed vaccine whose launch was derailed by the USAID funding freeze, this study is testing a different mRNA vaccine candidate, manufactured by Moderna.)

At the lowest dose tested, just one-tenth of the amount used in the original studies, the hives that had troubled earlier trials never materialized, Bekker said. Her team has since moved on to a somewhat higher dose, seeking the sweet spot between safety and immune potency. 

All of these discoveries and challenges along the way have helped map a path forward. “We know what we need to do,” said Barton Haynes, director of the Human Vaccine Institute at the Duke University School of Medicine. The task for them now is to move through the necessary iterations as quickly as the science — and the funding and political landscape — allow.

“A black hole”

When Bekker and her team learned about the sudden funding cut that would halt their African-designed, USAID-funded vaccine study in January 2025, they were already in Tanzania to prepare its launch. They immediately had to stop work on the project, which had been years in the making. “It was like falling into a black hole of depression,” she said. 

And the setbacks kept coming. With prominent vaccine critic Robert F. Kennedy Jr. overseeing US health policy, the federal government moved to undermine both vaccine science broadly and mRNA technology in particular.

The NIH, in addition to terminating dozens of smaller HIV-related grants, began winding down its flagship Consortia for HIV/AIDS Vaccine Development (CHAVD) program, which has long served as a cornerstone of global HIV vaccine research, while other federal agencies curtailed support for mRNA vaccine projects across multiple disease areas.

At the same time, South Africa, the continent’s leading center for biomedical research, found itself in the Trump administration’s crosshairs over allegations of anti-white discrimination. New federal research grants were no longer permitted to support collaborations with South African scientists, severing ties that had underpinned years of international HIV research.

“That’s a perfect storm to prevent us from building on the most exciting science HIV vaccines have had in 45 years,” said Mitchell Warren, executive director of AVAC, a nonprofit dedicated to HIV prevention access and policy. 

Yet for all the financial and political disruption, the scientific momentum hasn’t stopped. Philanthropic organizations and governments elsewhere have stepped up to help fill the funding gap, allowing key trials to move forward, although in scaled-down forms with more modest ambitions. 

The Africa-led effort that Bekker had dreamed of was salvaged, with emergency backing from the South African Medical Research Council, albeit in diminished form and built, in the end, on the same protein-based technology that mRNA was meant to leapfrog.

The only mRNA-based HIV vaccine study that is actually underway in Africa is IAVI G004: a program designed by US scientists, not by locals, and funded largely by the Gates Foundation.

A longtime backer of HIV research, that foundation is estimated to invest around $70 million annually — with $64 million being invested in 2022, and $70 million in 2026 — across a global portfolio of HIV vaccine programs. That’s a substantial sum, though only a fraction of the hundreds of millions of dollars once provided by the NIH, USAID, and other federal agencies. 

For now, some of that funding continues to flow. But even what remains is far from assured. The Trump administration’s proposed 2026 budget would slash the National Institute of Allergy and Infectious Diseases — the NIH institute that has long anchored HIV vaccine science — along with the Office of AIDS Research that coordinates HIV research across the entire NIH, leaving the field’s longer-term future in doubt.

“We’re not going to be able to fill the gap that’s been left by the US government,” said Nina Russell, director of TB & HIV research and development at the Gates Foundation. Still, she says, the foundation remains determined to keep the most promising vaccine programs moving forward: “We are super committed to it.”

All of these changes have left the research field daunted, but not hopeless. “It’s been a very disruptive time,” said Burton, who leads one of the CHAVD research hubs. But he remains convinced the field is on the right track. “The pieces of the puzzle are in place,” he said. “It’s obviously been a long, long journey, but you can begin to see the end.”

A higher bar

The funding crisis and political challenges are not the only forces reshaping HIV vaccine development.

For much of the HIV epidemic, which has killed over 40 million people worldwide, even a partially effective vaccine might have been enough to transform the course of HIV. Today, however, vaccine researchers are also competing against long-acting preventive drugs that can protect people for months at a time with just two injections. 

These drugs are an enormous step forward for HIV protection, but they also raise the standard the vaccine field must meet, Warren said. “The bar for a licensed vaccine that is going to have a public health impact has gotten much higher,” he said.

But these prophylactic drugs, which began as daily pills and have evolved into long-acting injectables, are only as good as the systems that deliver them. Cost, stigma, and the need for regular clinic visits have limited access in many countries with the highest HIV burdens. A vaccine, by contrast, that provided years of protection after a handful of doses could overcome many of those barriers.

That is precisely why many scientists view the current retreat of the US government with such alarm. After decades of disappointments and billions of dollars in investment, the field finally believes it has a coherent strategy for building an effective HIV vaccine. The fear is that momentum could stall just as researchers have begun to see a path across the finish line. As a result, what once seemed like a scientific problem increasingly looks like a political one.

For Bekker, the current moment feels all too familiar. In the early 2000s, South Africa’s government embraced AIDS denialism, delaying the rollout of lifesaving treatments and forcing researchers and clinicians to battle both the virus and the state. A quarter-century later, she says, the political opponent has merely changed address to Washington, DC, threatening once again to undermine the fight against HIV and cost countless lives.

“When politics interferes in science,” Bekker said, “that is the death of scientific progress.”

Bekker still does not know whether the vaccine she watched being manufactured last year will ever reach the people it was designed to protect. She and her colleagues still hope to carry out the made-in-Africa mRNA vaccine trial they spent years designing — if they can find a way to pay for it. But Bekker remains convinced that the scientific strategy behind it is the right one, and that mRNA may yet do for HIV what it did for Covid-19, rapidly transforming decades of scientific groundwork into an effective shot.

She only hopes politics does not succeed where HIV itself has failed in slowing the field’s progress. “We should only be fighting the virus,” Bekker said. “But we’re fighting the administration and its policies, and that is a waste of our energy.”

If the US wanted to be the world’s police officer, then why not try to be its doctor too? 

Just two months before the invasion of Iraq in 2003, George W. Bush announced an ambitious plan to pump $15 billion into the global fight against HIV, stunning his allies in Congress, health advocates, and heads of state of the program’s intended beneficiaries. 

The President’s Emergency Plan for AIDS Relief, or PEPFAR, was the largest commitment by any nation in history dedicated to addressing a single disease, a disease that killed about 3 million people in 2003, most of them living in sub-Saharan Africa, and infected 5 million more. “Ladies and gentlemen,” Bush proclaimed in his State of the Union address that year, “seldom has history offered a greater opportunity to do so much for so many.”

On that, he was right. In the two decades to follow, PEPFAR would save an astounding 25 million people’s lives through lifesaving HIV therapies, and prevent millions of babies from being born with HIV in the first place, all at a cost of about 0.08 percent of the federal budget. 

And yet, in the wake of the Trump administration’s foreign aid cuts, one of the greatest achievements in American history is now at risk. PEPFAR, mercifully, still exists, saved from the sledgehammer by an outpouring of bipartisan support last February. But experts say the program has been transformed beyond recognition by countless small cuts, and the abrupt gutting of global health architecture, reshaped not by decades of accumulated wisdom around HIV prevention, but by at times absurdly petty ideology.

Over the past year, more than 77 percent of PEPFAR grantees have lost funding or had their payments delayed, according to a survey released Tuesday by the HIV research group amfAR. 

Nearly two-thirds of grantees — especially those supporting vulnerable populations such as LGBTQ people, young women, and sex workers — said the cuts had disrupted their ability to offer HIV treatments and other services. The Trump administration released limited data showing a deep reduction in HIV prevention services, but a relative consistency in access to treatment earlier this year. However, this new survey paints one of the first pictures available of how PEPFAR cuts are actually being felt on the ground, and how the administration’s priorities are reshaping who and what gets funded.

According to the survey’s authors, at least 1,700 HIV-related sites or clinics have shut down as a result of cuts. Well over 16,000 health workers — including those going door to door to make sure pregnant parents get tested for HIV or children get on treatment — have lost their jobs. 

Many organizations surveyed reported receiving emails when their PEPFAR grants were terminated, noting that their work violated President Donald Trump’s executive order against “unlawful diversity, equity, and inclusion.” It appears, they say, that many of these groups were flagged not because they embraced the distinctly American concept of DEI in their work, but because their name or mission description included a phrase like “gender” or “LGBTQ.”  

A health clinic serving survivors of domestic violence in Mozambique, for example, might now be flagged just for using the phrase “gender-based violence” in their name. This may be part of the reason why even pregnant women — who even the Trump administration has emphasized as a critical demographic in its HIV goals — have lost access to services. 

Back in 2003, Bush defied conservative critics in his own party who attempted to redirect PEPFAR funding to abstinence-only programs. For decades, American presidents have been able to see past their ideology in service of saving lives. They largely understood that contraceptives like condoms and special interventions for those most at risk, including LGBTQ people, were necessary for stopping the spread of HIV. Under the Trump administration, this norm is unraveling. 

“This administration has zero interest in addressing clinical outcomes for vulnerable people with HIV,” said Asia Russell, executive director of the advocacy group Health GAP, who noted that “to be effective, HIV prevention and treatment services actually have to go where the disease is, and that risk is not evenly distributed,” surging in certain geographies like South Africa or within key populations like trans people or young women. Getting support to these groups is “morally right,” she said, but it is also “the only way to do effective HIV work, regardless of your stance on the morals or the merits.”

The fight against HIV is running on fumes

When HIV aid does get doled out these days, it is distributed with far less transparency than in the past, and in ways that often appear to be ideologically or politically driven, both in terms of the populations they serve and the countries they operate in, rather than guided by best practices. 

In theory, lifesaving HIV care was exempted from sweeping aid cuts last year. But in reality, access to even the most basic HIV services and treatments has also atrophied across the board, while falling disproportionately on at-risk populations. 

That’s come both in the form of direct cuts and as a byproduct of broader disruptions to the kind of outreach services, testing, and socioeconomic programs that get patients in the door to begin with. 

“You can’t cut pieces of the architecture of how PEPFAR functions and expect to maintain a really robust treatment program in the long term,” said Jennifer Sherwood, director of research and public policy at amfAR. “If you cut the testing program, the prevention programs, the kind of services that allow people to stay in care and return to care, you’re going to see that you can’t maintain a treatment program.”

The number of people getting on treatment for the first time has sharply declined over the past year, even according to the administration’s own limited data drop, while access to testing, contraceptives, and other preventative services — all critical to keeping infections down in the long run — face cuts that threaten their ability to function at all. 

To make matters worse, amfAR’s survey shows that services designed for the populations most at risk of HIV — such as sex workers, LGBTQ people, young women, and teenage girls — have been disproportionately affected by PEPFAR cuts. Among those who lost funding, a staggering 90 percent of organizations that serve gay and bisexual men were forced to slash access to PrEP — which strongly protects against HIV infection — and many stopped offering it entirely. The same was true for over half of organizations serving pregnant women, whose children now face a higher risk of contracting HIV in the womb.  

The majority of new HIV infections are concentrated in these “key populations,” as they’re known in public health parlance, many of whom face stigma or other obstacles to obtaining care. “One really powerful aspect” of how PEPFAR used to work, said Thomas McHale, public health director at Physicians for Human Rights, was that it consistently “followed the science and followed the epidemiology” to serve “groups that are at the margins of society.” That approach appears to have been thrown out under the new administration, and in at least some cases, actively discouraged.

McHale has been documenting the impact of PEPFAR cuts in South Africa in recent months, and “what we saw was a system under severe stress and strain,” he said. It is one in which a bisexual man stopped taking his HIV medications for weeks because the LGBTQ clinic he used to go to closed. “He just couldn’t bear the stigma of accessing services in a place that’s not meant for him,” according to McHale. Similarly, a young woman was forced to wait in line for 10 hours just to refill her PrEP prescription. 

“If we’re not focusing on preventing disease,” McHale said, “it’s just a more expensive and more devastating challenge to address in the future.”

Some countries may soon stop receiving PEPFAR funding altogether

As I’ve written previously, the Trump administration has attempted to remake foreign aid into a dealmaking enterprise, one in which money flows directly through national governments rather than through large, western-led non-governmental organizations or NGOs. 

In theory, there are benefits to this approach, because it prioritizes the expertise of local health groups and policymakers who are often best equipped to evaluate and address the needs of those in their care. In practice, however, amfAR’s survey shows that so far, under the Trump administration, local organizations have actually lost more funding and been forced to close more sites than international groups have. “These cuts fell heavily on locally-based organizations” while NGOs have fared somewhat better, said Sherwood, “and that really runs counter to all of our global health goals.”  

“I’m concerned because public health is no longer how we’re measuring success” when it comes to reaching PEPFAR’s goals, said Jirair Ratevosian, a senior fellow at the Duke Global Health Institute who served as chief of staff of PEPFAR under the Biden administration. He is especially alarmed by the decision last month to end PEPFAR support for South Africa, which has the largest HIV epidemic in the world. The administration appears to have done so in part because of Trump’s insistence that the nation is waging a nonexistent “genocide” against white Afrikaners. 

“If we’re not focused on preventing disease, it’s just a more expensive and more devastating challenge to address in the future.”

Thomas McHale, Physicians for Human Rights

“HIV control is not their chief concern,” said Ratevosian, who recently ran the numbers on a separate fissure with Zimbabwe, finding that cutting PEPFAR would lead to 75,000 new HIV infections in just one year. In South Africa, similar cuts could lead to over 2 million more infections over the next two decades, a toll that would invariably cross borders, and could threaten the world’s immense, hard-won progress against HIV. “You can’t have a global HIV strategy,” said Ratevosian, “if you’re not engaging these countries.”

Priorities shift under any new administration, and it’s not abnormal for an organization to tweak its language or services to adapt. But PEPFAR, the bipartisan program which began under Republican leadership, and thrived and expanded under three successive presidencies, including during Trump’s first term, has never faced such turmoil. 

“Even among organizations who didn’t lose US funding, we’re still picking up changes to the way they work, the populations they serve, the words they use,” said Sherwood of amfAR. Her group’s survey showed that nearly 80 percent of organizations that did not lose funding still altered the way their organization worked to comply with new policies. “This network of changes from the US,” she said, “are prompting a lot of changes on the ground.”

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

Defense Secretary Pete Hegseth announced this week that the Pentagon would begin testing the testosterone levels of all military members over the age of 30 as part of their regular, annual physical exams. And — if their levels are low — service members could choose to receive testosterone replacement therapy.

“It’s not about artificial enhancement,” Hegseth said. “It’s about restoring and optimizing your natural capabilities, protecting your longevity, and ensuring you have the biological foundation required to sustain the fight.”

The High-T Department of War. pic.twitter.com/hlAUq3j2cD

— Secretary of War Pete Hegseth (@SecWar) July 15, 2026

It’s another example of the performative masculinity that has defined Hegseth’s time atop the US military. He has sought to rebrand the Department of Defense as the Department of “War,” preached a “warrior” ethos, rolled back DEI initiatives while blocking promotions for women, and taken an unusual interest in the beard-grooming standards of service members.

The testosterone obsession is just one of several ways that the military is having a Make America Healthy Again movement. Hegseth announced over the spring that service members would no longer be required to get an annual flu vaccine. (The military later reinstated the mandate for new recruits, after a major flu outbreak at a boot camp.) And also this week, he launched a new investigation into the Defense Department’s decision in 2021 to mandate the Covid-19 vaccine — shades of the efforts being made by Robert F. Kennedy Jr. at the US Department of Health and Human Services.

Go a little deeper

The “T” trend is not just a fixation of Kennedy’s, who has said that he takes testosterone supplements, and Hegseth. More Americans of every age group are taking testosterone. By one count, prescriptions grew from 7.3 million in 2019 to more than 11 million in 2024.

So, is getting more people to take supplemental testosterone actually a good idea? Should everybody be screened, as Hegseth is suggesting for service members over 30?

The Endocrine Society said in a statement after Hegseth’s announcement that there was “insufficient evidence” to support testosterone-level screening for asymptomatic Americans. Previous research suggests that, if anything, testosterone is already overprescribed in the US; only 12 percent of men receiving a prescription had received appropriate diagnostic testing.

Testosterone levels indeed fall as men age, and there has been a general decline in testosterone among men today compared to men of the past. But what’s not clear is whether widespread testosterone testing and supplementation is the solution. 

For one, distinguishing between a natural decline in testosterone and a decline that warrants clinical intervention is the subject of ongoing debate among doctors. Low T can also be a sign of other chronic health conditions that it would be better to treat. If your T is dropping because of obesity, for example, it would be better to lose weight (or take a GLP-1 drug instead of a testosterone supplement). The evidence is mixed on how much taking T actually improves things like mood, energy, sexual performance — or military effectiveness — and taking too much testosterone could come with its own health risks.

The dialogue around T supplements is still evolving. Doctors used to worry that extra testosterone could cause cardiovascular problems, but more recent research has allayed those fears, leading  proponents in the Trump administration to call for more prescribing. But the evidence right now does not appear to support the widespread T testing and supplementation that the military’s new program would suggest.

One link for later

How to keep your cool on a bad day: As a parent of three children, I’m always on the lookout for better ways to manage my stress — and took heart in the four strategies suggested by Vox’s Allie Volpe in her piece this week. If we can take the time to acknowledge how we’re feeling and really reflect on what has led us to feel that way, we might be able to avoid a full-blown meltdown. That’s news you can really use.

Before you go…

• Did you know: Prediction markets correctly guess the winner of reality TV shows upward of 90 percent of the time? It’s a trend that raises questions about insiders using insider knowledge to make a buck — and risks ruining the fun of following these shows.
• Today’s trivia: What is a Russian name meaning “holy”? (You can find this and other brain puzzles in Vox’s daily crossword. Look for the answer in Monday’s edition.)
• Yesterday’s trivia: Yesterday, we asked you what animal can be as narrow as a few millimeters or as wide as 13 feet. That would be crabs, the various species of which can range from tiny and adorable to monstrously terrifying.

Update, July 20, 2026, 2 pm ET: This story, first published July 17, has been updated with the current case numbers and developments in the search for the source of the outbreak.

Have you been looking at the lettuce aisle at your grocery store with a wary eye since the diarrhea outbreak began? You’re not alone. This is the summer, which should be high time for fresh produce. But the ongoing emergency has even doctors asking themselves unthinkable questions: Should I stop eating salad? Are any fruits and vegetables safe?

The disease in question, cyclosporiasis, is caused by the parasite cyclospora, which can infect people when it is attached to fresh produce and then consumed. Watery diarrhea — described by public health authorities as “frequent” and “sometimes explosive” — is the most common symptom.

Michigan health officials said last week that they suspect lettuce or bagged salad to be the culprit for the parasite-driven outbreak in the state that has sickened more than 6,100 people. But identifying the specific products to blame has been a challenge. On Thursday, the Washington Post, citing anonymous federal officials, reported the outbreak may trace back to Taylor Farms products that were used by Taco Bell. But then, on Sunday, the FDA said that the tests showing the Taylor Farms product contained cyclospora had been false positives. As of Monday afternoon, the source of the outbreak is still unclear, although Taylor Farms has continued a voluntary recall of its iceberg lettuce products.

I live in Ohio, where there have been nearly 1,200 cases, and I love salad kits. The current outbreak is a major cramp on my lunch plans — and I know I’m not alone. 

So, what do we do? I’ve consulted with a food safety expert and a dietitian to get the answers. The topline message is: Don’t stop eating your fruits and vegetables. They’re good for you. But be smart with your food hygiene.

“I don’t think we’re at that point of shying away from eating your green vegetables,” Francisco Diez-Gonzalez, director of the Center for Food Safety at the University of Georgia, told me. “The benefits overall still outweigh the risks.”

How can we still enjoy our summer produce in this time of cyclospora? Here’s a guide.

Here are the “red light” foods linked to prior outbreaks

While we don’t know for certain the cause of the current outbreak, cyclosporiasis has been linked with specific foods in the past. Let’s start with that list:

• Basil
• Bagged salads and salad mixes
• Cilantro
• Mesclun lettuce
• Parsley
• Raspberries
• Snow peas
• Sweet peas

These foods — either because of where they’re grown or their texture or both — have historically had a higher risk of carrying cyclospora. It might be wise to steer clear entirely for the time being — especially the prepackaged salad products.

The Michigan health department, for example, is urging people to avoid bagged lettuce and salad kits and to purchase whole heads of lettuce instead. And since the outbreak is impacting most states now, it’s advice we’d all be wise to heed.

Then there are “yellow light” foods that need careful cleaning

But for a lot of fruits and vegetables, including whole lettuce, you should still wash them thoroughly — because that’s always a good idea. If you need tips for washing your produce, we’ve got them. For heads of lettuce, for example, cut away the outer layers and wash in between each leaf as best you can. 

“Fresh produce is still generally safe, delicious and nutrient-dense,” Rosemary Trout, a food scientist at Drexel University, told me over email. 

But she gave a yellow light for any leafy greens or fruits and veggies that have textured edible skins. The more texture there is, the more of a risk there is because the parasite can stay attached more easily — even if it’s been diligently washed. Raspberries carry a higher risk than blueberries, for example, and those have been associated with earlier cyclosporiasis outbreaks.

Another point of emphasis: Several doctors have told me that, even if an item says it is prewashed, you should wash it again. And again.

But there are lots of “green light” foods you probably don’t need to worry about

Trout gave a green light to any canned fruits and vegetables, any produce that you cook — importantly, at high heat — at home, and any frozen fruits and veggies.

In general, these are Trout’s safety tips for prepping fruits and vegetables at this uncertain time:

• Be consistent and thorough — at least 20 seconds — when washing your hands and always use hot, soapy water. 
• Peel or remove the outside layer of the fruit or veggies — the rind of a watermelon or cantaloupe, for example, or the outer layer of a head of lettuce.  
• Don’t consume damaged, bruised produce. 
• Keep produce cold in storage, ideally for a relatively short amount of time. 

Get creative with your recipes

If you want to steer clear of any questionable produce or take the safest preparation route that you can, you might want to get a little creative with your recipes. With your lunch salad, for instance, “peeled, shredded carrots, thinly sliced radish, or thinly sliced cooked beets might be a nice substitute for leafy greens,” Trout said.

Heat remains the most surefire way to eliminate any cyclospora parasite that might be lingering on your produce. So look through your cookbooks for any dishes that feature grilled vegetables. Vox Even Better editor Rachel Miller (a more accomplished cook than I) suggested a few recent New York Times Cooking recipes, which you can check out via these gift links:

• Grilled halloumi and vegetables
• One-pan orzo with spinach and feta
• Orzo salad with peppers and feta

Peppers, eggplant, squash, and zucchini are your friends. They respond well to heat, and they are easy to clean. And even some leafy greens — like spinach — hold up nicely to sautéing. 

Support your local farmer’s market

Right now is also a great time to check out your local farmer’s market for produce. 

Dr. Kathleen Linder, who is the hospital epidemiologist at the Veterans Affairs hospital in Ann Arbor, Michigan, told me that she has been buying locally since the outbreak began. Prior outbreaks have been linked to produce that was grown elsewhere — whether in the US or internationally — and shipped long distances before it arrived on our grocery shelves. Summer is a crucial season for small farms and farmers’ markets; they shouldn’t be penalized for a health emergency that they had nothing to do with.

Buying locally could reduce the risk that your produce has been exposed to the parasite. Trout said you can ask your local growers about their water supply to make sure that what you are buying is safe.

“Single-source produce from a local farm with good manufacturing/farming practices in place, with a safe water supply, are good,” Trout told me. “Commercially processed, pre-packaged foods are likely combining produce from various farms, which may increase risk, despite good manufacturing practices in place.”

So while cyclosporiasis is an unwelcome concern as we plan our summer cookouts, it doesn’t need to stop you from enjoying fresh fruits and vegetables. Be a little more diligent about your food hygiene, get a little creative with what you’re preparing, maybe stop by a farmer’s market — and you’ll be fine.

As if we needed one more thing to worry about so soon after the hantavirus scare, there is a new public health threat for Americans to contend with: a rapidly escalating outbreak of, of all things, diarrhea.

It’s a parasite-borne illness called cyclosporiasis. It can cause explosive and watery bowel movements — and it is wreaking havoc across the United States this summer.

How bad exactly? As of July 15, Michigan’s health department is reporting 3,762 cyclosporiasis cases, up from 1,500 late last week. Forty-four people have been hospitalized as of July 9. To put that number in context, the state normally sees about 50 cases in a year. To the south, at least 364 people have been infected in Ohio. According to a USA Today compilation of state health department data, almost every state has reported at least one cyclosporiasis case this year. 

This is not our first bout with a cyclosporiasis outbreak. In 2013, the US saw more than 600 cases, and more than 500 people were sickened across the country by contaminated McDonald’s salad meals in 2018. Cyclosporiasis is caused by the parasite cyclospora, which can infect people when it is attached to fresh produce and then consumed. It does not, fortunately, spread from person to person. We do know some likely culprits: Bagged salads, basil, cilantro, peas, and berries have been linked to prior outbreaks. 

Watery diarrhea — described by public health authorities as “frequent” and “sometimes explosive” — is the most common symptom. People can also experience cramping, bloating, nausea, and vomiting. Symptoms can start anywhere between two days and two weeks after a person eats tainted food. No one has died, and thankfully, cyclosporiasis is rarely fatal. But it is an extremely unpleasant experience that could last for up to a month without treatment, and certain people, such as folks who are immunocompromised, are at higher risk of more serious complications.

There are steps that everyone can take to protect themselves from cyclosporiasis (more on that in a moment). But the current situation is challenging, because, right now, officials don’t actually know which products are causing the outbreak. “At this time, no specific produce grower, supplier, or type of produce has been identified as the source,” Laina Stebbins, a spokesperson for the Michigan Department of Health and Human Services, said in a statement to Vox on Friday. On Monday, Michigan officials said they believed lettuce or bagged salad products were to blame, but still had not identified specific brands or items that could be linked to the growing outbreak.

It’s a public health mystery, one that results from both the sneaky nature of the parasite itself and our increasingly globalized food supply. It could be a while before we learn the answer. But, in the meantime, if you’ve found yourself spooked by some of the recent headlines, here’s what you actually need to know.

Why cyclosporiasis outbreaks are so hard to trace

Cyclosporiasis makes itself hard to find. Scientists don’t know exactly how much of the parasite a person needs to be exposed to to become infected — one of many unknowns about the basic features of the bug. The foods carrying this pathogen may not be contaminated with much of it at all, which makes any preemptive testing a challenge.

And, on top of that, there can be a long gap between the parasite being introduced to the food supply and when a person actually gets sick, which further complicates any efforts to trace the outbreak’s origins. A fruit or vegetable could be contaminated in one of the various tropical or subtropical regions of the world where cyclosporiasis is more common, well before it lands in your grocery store in the United States. 

“Oftentimes when we see these outbreaks, what happens is that somewhere in the world, a contamination event occurs, and then that produce is then shipped throughout the area and it could go anywhere in the world,” Dr. Kathleen Linder, the hospital epidemiologist at the Veterans Affairs hospital in Ann Arbor, Michigan, told Vox. 

Sometimes, the source can be closer to home: A 2020 outbreak appeared to be linked to produce grown in Florida and shipped to a plant in Illinois that produced bagged salad kits. But, as if to demonstrate the difficulty of doing this work, the FDA said it could not conclusively prove those farms were the source of the outbreak.

The point is: We have a food production supply chain that sources produce and combines ingredients from all over the country and the globe — providing more opportunities for a parasite like this to find its way in.

“We’re relying more and more on produce coming from other countries so that we can have raspberries all year round,” Joseph Eisenberg, a professor of epidemiology and global public health at the University of Michigan, told Vox. “That kind of luxury only happens when we centralize our food distribution system.”

Even once an outbreak is underway, it can be hard to pinpoint the source. Symptoms may not occur for up to two weeks after a person eats contaminated food. 

“I can barely remember what I had for dinner a couple nights ago; there’s no way I’m going to be able to remember a week ago,” Linder told me. “It takes a lot of time and a lot of manpower to get all that information collected.”

As with any outbreak under the Trump administration, the Centers for Disease Control and Prevention is responding with significantly fewer workers and resources than it used to have. To be clear: This cyclosporiasis outbreak could have happened either way. This parasite has sparked widespread infections before. But Linder said that because the CDC has rolled back some of its national reporting programs, it’s been left to the states to take the lead — and that has made it harder to pull together a complete picture of the outbreak.

“It has been very hard to get updated information,” Linder said. “The information is lagging a little bit behind because it’s being done at the state level.”

What you can do to reduce your risk of cyclosporiasis

For scientists, the work ahead involves better understanding the properties of the pathogen itself and developing surveillance tools and techniques that allow us to catch contaminated food before it reaches people. But what can the rest of us do right now, during an active outbreak?

According to various public health authorities, the short version is to cook the produce that you can — heat is the absolute best option for eliminating cyclosporiasis — and to clean your raw fruits, vegetables and herbs as thoroughly as possible. 

Wash everything with running water before eating or preparing it. Scrub the firmer fruits, like melons and cucumbers, with a produce brush if you have one. If you see damaged or bruised areas on your fruit or lettuce, cut them away. Even if a food’s package says it’s prewashed, Linder said she advises people to rewash it just to be sure.

Previous outbreaks have specifically been linked to bagged lettuce and salads, so you might consider buying whole heads of lettuce instead. If you do that, cut away the outer layers and then separate the inner leaves to wash them. For green onions, you should cut away the bulby root and the outer layer and then wash them thoroughly. Raspberries were associated with one of the first US outbreaks in the 1990s, and they are particularly tricky to clean given their bumpy surfaces; you may want to consider eating them only after cooking (to prepare a jam or compote, for example) or opt for frozen raspberries for the time being. (Freezing is believed to reduce, if not completely eliminate, the parasite.) And be careful with leftovers: You should refrigerate any unused foods that you plan to eat later within two hours. 

You could also consider buying locally sourced foods, Linder said, because cyclosporiasis is more common in food sourced from other parts of the world.

If you do start to experience extreme diarrhea, make sure to hydrate very well to avoid dehydration. Linder told me that if somebody experiences dizziness, they can’t keep fluids down, or they have very dark urine, then they should seek immediate medical attention. And anybody experiencing those symptoms should get in touch with their health care providers and their local health department. 

Sooner or later, experts will probably figure out what caused the current outbreak, whether it’s one source or several. But cyclosporiasis will still be a concern in the future; it’s a byproduct of the food system we have built. It serves as a potent reminder about the importance of good food hygiene. A little extra effort to wash your food before you eat it could save you a lot of pain later.

Update, July 15, 2026, 11:45 am ET: This story, first published July 10, has been updated with current case numbers and products linked to the outbreak.

As I am typing this, a device rests on my wrist that purports to unlock a trove of real-time information about my body’s performance. I can click a button and check my heart rate and review how much it’s varied over the course of the day. It can tell me how many steps I’ve taken, how many minutes I’ve been “active” throughout the day, and — if I wore it while I slept — just how well I rested, according to the data its sensors can pick up from my arm.

The Apple Watch is a remarkable piece of technology, when you stop and really think about what it does. It’s no surprise, perhaps, then, that we have collectively become obsessed with these things. One 2023 government survey found that one in three Americans wear a smartwatch or wristband to track their health and fitness. More recent industry surveys put that figure even higher: More than half of the US population owns a wearable or connected device and tracks at least one health metric with it.

That’s a lot of people who are swimming in the ocean of information that our Apple Watches, and FitBits, and Oura Rings, and Whoops report back to us. Dr. Michael Joyner, who studies the physiology of exercise at the Mayo Clinic, said he has a three-pronged criteria for thinking about the usefulness of these metrics: Is it measurable? Is what you’re measuring actually meaningful? And is the information that you’re receiving actually actionable? 

“If one or two are missing, the thing may be the most interesting thing in the world. It may be cool,” he said. “But it’s not going to make a difference in long-term outcomes.”

Across medicine, we are developing remarkable tools for detecting things in the human body, outpacing our ability to interpret what we are finding. We are getting closer to a future where these devices could offer invaluable insights into how our body is performing outside of the doctor’s office or hospital, but here in the present, we should keep our expectations in check.

Here’s what you should know about some of the most common metrics that wearables track.

Do we really understand what our wearables are telling us?

These devices claim to track both old-fashioned and new-fangled measures of your body’s performance. You’ve got your heart rate — something humans have been able to pick up from the wrist before anybody had dreamed of smart devices — and your step count. My Apple Watch estimates how many calories I have burned throughout the day. The Oura Ring takes your temperature, which can help predict ovulation or offer an early sign that you’re coming down with something.

But as the technology has gotten better, new measures for things many of us have never heard of have emerged. Heart rate variability, or HRV, has gained a lot of recent interest. It assesses the tiny variations, measured in milliseconds, in the rhythm of your heartbeat; the Economist dubbed it “the most useful indicator” of your overall health. Some devices then use HRV to deliver “recovery” scores that judge how well your body bounces back from your workout or “stress” scores that attempt to quantify how much strain you are under.

HRV demonstrates the conundrum that wearables can present to us, Joyner said. The metric itself has a scientific basis: Researchers have, in fact, found that the amount your heart rate varies over time is associated with your overall health. In general, a higher HRV is better than low, because it suggests your body is more adaptable and better regulated.

But that doesn’t necessarily mean that tracking your HRV from minute to minute with a smartwatch will translate to better health. For starters, we don’t have specific interventions for improving HRV, Joyner said. We don’t even have universally accepted definitions of what high or low HRV is.

In any case, the best strategies are the same heart health guidelines we’ve known about for decades: don’t smoke, don’t drink to excess, eat a healthy diet, exercise. You didn’t need a smartwatch to tell you that’s the best way to take care of your heart, Joyner pointed out. So what good was really derived from closely monitoring your HRV?

“As an individual metric that you can track and do something about, it’s interesting, but there’s no definitive data that you’re going to get better,” Joyner, who was speaking for himself and not the Mayo Clinic, said. “Follow the guidelines. People who follow the guidelines are going to do better on these metrics. But whether you can intervene specifically to make the metrics better or should pay much attention to them, who knows?”

Dr. Ami Bhatt, chief innovation officer at the American College of Cardiology, told me that the bedrocks of evaluating your heart health are still the old mainstays like your blood pressure and your cholesterol, along with newer metrics checked via blood test such as ApoB and lipoprotein. Are you a smoker? What’s your family history?

The value from wearables is less about the specific numbers they are reporting — especially with something like HRV, for which there are not universal guidelines — and more about the long-term trends they can track. By collecting your personal data over time, they can help you figure out what’s normal for you and help you notice if something changes. So don’t freak out if your HRV is different from somebody else’s, or you see one abhorrent reading in your daily report. But if you notice a change in your resting heart rate or HRV that persists over time, then it might be worth going to see a doctor about it.

“We don’t want to overreact to just one abnormal reading,” Bhatt said. “If you just know your baseline when you’re relatively healthy, you can catch the trends.”

It’s all about having realistic expectations about what your wearable can deliver — and recognizing that, for some things, the old ways are still better. When it comes to those metrics that incorporate HRV to determine your stress and “recovery,” Joyner said that self-reported data (literally, how do you feel?) remains the more accurate way to evaluate a person. 

And at a certain point, your wearable can straight-up make your health worse. Fixating too much on your sleep problems, for example, can paradoxically cause more sleep problem. An American Society of Sleep Medicine survey this year found that 76 percent of US reported losing sleep because they were worrying about their sleep. It’s a problem — dubbed “orthosominia” — that scientists have been warning about for nearly a decade: the possibility that our obsession with better sleep, and doing things like wearing a device to track our sleep, could actually give us insomnia.

Bhatt said she’d like to see these devices develop the capability to detect when a user may be checking their data a little too compulsively. Joyner, for his part, said he worried that the culture around health and wellness could, ironically, create a lot of stress for the people who get deeply invested in tracking their activity. 

“I actually worry we’re entering a too-much-information world,” he said. “It’s going to be anxiety-provoking.”

How to have a healthier relationship with your wearables

Even as we recognize the limitations of wearables, that doesn’t mean they can’t be useful — and they’re going to keep getting better.

Right now, there are obvious situations where a wearable can be helpful. As Bhatt suggested, they can help you understand your personal baseline and notice any changes. Certain patients, such as those with congenital heart failure, can clearly benefit from ongoing monitoring of their heart’s performance, per the American Heart Association. Anybody can use a wearable to make sure their heart rate doesn’t reach dangerous levels during a workout. And these devices could ultimately prove effective in catching underlying heart problems — but there is still work to do. A 2019 study on wearables and atrial fibrillation is telling: At the time, only a tiny percentage of wearers received a notification of an irregular heartbeat, suggesting that there were others that the devices were missing. But, for those who did get an alert, the majority of them did in fact have A-fib. (The FDA has since said that several smartwatches are capable of A-fib detection.) Some patients who have had a serious cardiac event are being asked to put on a wearable, so their doctors can remotely monitor their heart, utilizing an AI assistant that checks the incoming data for any signs of a pending emergency.

And these are the worst wearables we’ll ever have. The future iterations of these devices are going to become more precise and more integrated with AI, which could allow them to ultimately provide more value to the people wearing them. The hypothetical potential for integrating wearables with health care delivery more broadly is immense. 

“None of these things will exist in a silo,” Bhatt said. “Your health records, how you’re doing, your wearables, your lab data, people are going to be pulling those together…and trying to give you insights.”

But for now, for the average person, it’s more of a personal choice. Joyner, whose work is all about maximizing human performance, does not wear a smartwatch. Bhatt likes to experiment with different devices with a certain goal in mind, like trying to improve her sleep over the course of a few months.

As Bhatt put it to me, if a wearable motivates you to take your health more seriously, then it’s already doing your body some good. “The best health metric is the one that changes what you do in a way that improves your health,” she said. “For you and I, that may be different things. For your grandmother, it’s something else. For the woman down the road, it’s something else.”

At the most fundamental level, people who use wearables tend to move more when they do — up to 40 more minutes of walking per day, according to a 2022 Lancet study. That is a gain for their health; recent research has shown that even a little bit of movement can have life-saving benefits. The more wearables encourage people to move, the more they can deliver real health benefits. 

So if you like wearing one, that’s fine. I’m not dropping my Apple Watch’s step tracker any time soon, because it pushes me to get moving. But be mindful of how your use affects you and how preoccupied you are with certain metrics. Stress is one of the worst things for your health. So is a lack of sleep. If you find your sleep metrics are keeping you up at night, or that your sleep seems to have gotten worse since you started using it, it’s okay to take it off.

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

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

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

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

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

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

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

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

Start with whether you’re alive

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

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

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

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

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

The country got cleaner, and richer, and fairer

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

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

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

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

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

So what’s with the bad vibes?

A more perfect union doesn’t mean perfect

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

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

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

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

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

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

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

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