ReportWire

Tag: everyday life

  • It’s Not the Economy. It’s the Pandemic.

    It’s Not the Economy. It’s the Pandemic.

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    America is in a funk, and no one seems to know why. Unemployment rates are lower than they’ve been in half a century and the stock market is sky-high, but poll after poll shows that voters are disgruntled. President Joe Biden’s approval rating has been hovering in the high 30s. Americans’ satisfaction with their personal lives—a measure that usually dips in times of economic uncertainty—is at a near-record low, according to Gallup polling. And nearly half of Americans surveyed in January said they were worse off than three years prior.

    Experts have struggled to find a convincing explanation for this era of bad feelings. Maybe it’s the spate of inflation over the past couple of years, the immigration crisis at the border, or the brutal wars in Ukraine and Gaza. But even the people who claim to make sense of the political world acknowledge that these rational factors can’t fully account for America’s national malaise. We believe that’s because they’re overlooking a crucial factor.

    Four years ago, the country was brought to its knees by a world-historic disaster. COVID-19 hospitalized nearly 7 million Americans and killed more than a million; it’s still killing hundreds each week. It shut down schools and forced people into social isolation. Almost overnight, most of the country was thrown into a state of high anxiety—then, soon enough, grief and mourning. But the country has not come together to sufficiently acknowledge the tragedy it endured. As clinical psychiatrists, we see the effects of such emotional turmoil every day, and we know that when it’s not properly processed, it can result in a general sense of unhappiness and anger—exactly the negative emotional state that might lead a nation to misperceive its fortunes.

    The pressure to simply move on from the horrors of 2020 is strong. Who wouldn’t love to awaken from that nightmare and pretend it never happened? Besides, humans have a knack for sanitizing our most painful memories. In a 2009 study, participants did a remarkably poor job of remembering how they felt in the days after the 9/11 attacks, likely because those memories were filtered through their current emotional state. Likewise, a study published in Nature last year found that people’s recall of the severity of the 2020 COVID threat was biased by their attitudes toward vaccines months or years later.

    [From the May 2021 issue: You won’t remember the pandemic the way you think you will]

    When faced with an overwhelming and painful reality like COVID, forgetting can be useful—even, to a degree, healthy. It allows people to temporarily put aside their fear and distress, and focus on the pleasures and demands of everyday life, which restores a sense of control. That way, their losses do not define them, but instead become manageable.

    But consigning painful memories to the River Lethe also has clear drawbacks, especially as the months and years go by. Ignoring such experiences robs one of the opportunity to learn from them. In addition, negating painful memories and trying to proceed as if everything is normal contorts one’s emotional life and results in untoward effects. Researchers and clinicians working with combat veterans have shown how avoiding thinking or talking about an overwhelming and painful event can lead to free-floating sadness and anger, all of which can become attached to present circumstances. For example, if you met your old friend, a war veteran, at a café and accidentally knocked his coffee over, then he turned red and screamed at you, you’d understand that the mishap alone couldn’t be the reason for his outburst. No one could be that upset about spilled coffee—the real root of such rage must lie elsewhere. In this case, it might be untreated PTSD, which is characterized by a strong startle response and heightened emotional reactivity.

    We are not suggesting that the entire country has PTSD from COVID. In fact, the majority of people who are exposed to trauma do not go on to exhibit the symptoms of PTSD. But that doesn’t mean they aren’t deeply affected. In our lifetime, COVID posed an unprecedented threat in both its overwhelming scope and severity; it left most Americans unable to protect themselves and, at times, at a loss to comprehend what was happening. That meets the clinical definition of trauma: an overwhelming experience in which you are threatened with serious physical or psychological harm.

    [Read: Why are people nostalgic for early-pandemic life?]

    Traumatic memories are notable for how they alter the ways people recall the past and consider the future. A recent brain-imaging study showed that when people with a history of trauma were prompted to return to those horrific events, a part of the brain was activated that is normally employed when one thinks about oneself in the present. In other words, the study suggests that the traumatic memory, when retrieved, came forth as if it were being relived during the study. Traumatic memory doesn’t feel like a historical event, but returns in an eternal present, disconnected from its origin, leaving its bearer searching for an explanation. And right on cue, everyday life offers plenty of unpleasant things to blame for those feelings—errant friends, the price of groceries, or the leadership of the country.

    To come to terms with a traumatic experience, as clinicians know, you need to do more than ignore or simply recall it. Rather, you must rework the disconnected memory into a context, and thereby move it firmly into the past. It helps to have a narrative that makes sense of when, how, and why something transpired. For example, if you were mugged on a dark street and became fearful of the night, your therapist might suggest that you connect your general dread with the specifics of your assault. Then your terror would make sense and be restricted to that limited situation. Afterward, the more you ventured out in the dark, perhaps avoiding the dangerous block where you were jumped, the more you would form new, safe memories that would then serve to mitigate your anxiety.

    Many people don’t regularly recall the details of the early pandemic—how walking down a crowded street inspired terror, how sirens wailed like clockwork in cities, or how one had to worry about inadvertently killing grandparents when visiting them. But the feelings that that experience ignited are still very much alive. This can make it difficult to rationally assess the state of our lives and our country.

    One remedy is for leaders to encourage remembrance while providing accurate and trustworthy information about both the past and the present. In the early days of the pandemic, President Donald Trump mishandled the crisis and peddled misinformation about COVID. But with 2020 a traumatic blur, Trump seems to have become the beneficiary of our collective amnesia, and Biden the repository for lingering emotional discontent. Some of that misattribution could be addressed by returning to the shattering events of the past four years and remembering what Americans went through. This process of recall is emotionally cathartic, and if it’s done right, it can even help to replace distorted memories with more accurate ones.

    President Biden invited the nation to grieve together in 2021, when American death counts reached 500,000, and again in 2022, when they surpassed 1 million. In his 2022 State of the Union address, he rightly acknowledged that “we meet tonight in an America that has lived through two of the hardest years this nation has ever faced,” before urging Americans to “move forward safely.” But in the past two years, he, like almost everyone else, has largely tried to proceed as if everyone is back to normal. Meanwhile, American minds and hearts simply aren’t ready—whether we realize it or not.

    [Read: The Biden administration killed America’s collective pandemic approach]

    Perhaps Biden and his advisers fear that reminding voters of such a dark time would create more trouble for his presidency. And yet, our work leads us to believe that the effect would be exactly the opposite. Rituals of mourning and remembrance help people come together and share in their grief so that they can return more clear-eyed to face daily life. By prompting Americans to remember what we endured together, paradoxically, Biden could help free all of us to more fully experience the present.

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    George Makari

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  • Ozempic Makes You Lose More Than Fat

    Ozempic Makes You Lose More Than Fat

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    The newest and much-hyped obesity drugs are, at their core, powerful appetite suppressants. When you eat fewer calories than you burn, the body starts scavenging itself, breaking down fat, of course, but also muscle. About a quarter to a third of the weight shed is lean body mass, and most of that is muscle.

    Muscle loss is not inherently bad. As people lose fat, they need less muscle to support the weight of their body. And the muscle that goes first tends to be low quality and streaked with fat. Doctors grow concerned when people start to feel weak in everyday life—while picking up the grandkids, for example, or shoveling the driveway. Taken further, the progressive loss of muscle can make patients, especially elderly ones who already have less muscle to spare, frail and vulnerable to falls. People trying to slim down from an already healthy weight, who have less fat to spare, may also be prone to losing muscle. “You have to pull calories from somewhere,” says Robert Kushner, an obesity-medicine doctor at Northwestern University, who was also an investigator in a key trial for one of these drugs.

    Kushner worries about patients who start with low muscle mass and go on to become super responders to the drugs, losing significantly more than the average 15 to 20 percent of their body weight. The more these patients lose, the more likely their body is breaking down muscle. “I watch them very carefully,” he told me. The impacts of losing muscle may go beyond losing just strength. Muscle cells are major consumers of energy; they influence insulin sensitivity and absorb some 80 percent of the glucose flooding into blood after a meal. Extreme loss might alter these metabolic functions of muscle too.

    Exactly how all of this will affect people on Wegovy and Zepbound, which are still relatively novel obesity drugs, is too early to say. (You may have heard these same two drugs referred to as Ozempic and Mounjaro, respectively, which are their names when sold for diabetes.) These drugs cause a proportion of muscle loss higher than diet and exercise alone, though roughly on par with bariatric surgery. Lifestyle changes can blunt the loss, but pharmaceutical companies are on the hunt for new drug combinations that could build muscle while burning fat.

    The arrival of powerful weight-loss drugs has moved the field beyond simple weight loss, Melanie Haines, an endocrinologist at Massachusetts General Hospital, told me. That challenge is largely solved. Instead of fixating on the number of pounds lost, researchers, doctors, and ultimately patients can focus on where those pounds are coming from.

    Doctors currently offer two pieces of standard and unsurprising advice to protect people taking obesity drugs against muscle loss: Eat a high-protein diet, and do resistance training. These recommendations are perfectly logical, but their effectiveness against these drugs specifically is unclear, John Jakicic, a professor of physical activity and weight management at the University of Kansas Medical Center, told me. He is now surveying patients to understand their real-world behavior on these drugs.

    Fatigue, for example, is a common side effect. “When you’re tired, and you’re fatigued, do you really feel like exercising?” he said. Haines wonders the same about eating enough protein. The drugs are so good at suppressing appetite, she said, that some people might not be able to stomach enough food to get adequate protein. (Food companies have started pitching high-protein snacks and shakes to people on obesity drugs.)

    Read: The Ozempic plateau

    If patients stop taking Wegovy and Zepbound—and about half of patients do stop within a year, at least in real-world studies of people taking this class of drugs for diabetes—the weight regained comes back as fat more than muscle, says Tom Yates, a physical-activity professor at the University of Leicester. Muscle mass tends not to entirely recover. It’s “almost as if you’re better off staying where you are than going through cycles of weight loss,” he told me.

    Yet, he pointed out, the U.K. recommends Wegovy for a maximum of two years. In the U.S., patients who can’t afford the steep out-of-pocket price have been forced to stop when insurance companies abruptly cut off coverage or a manufacturer’s discount coupon expires. These policies are likely to trigger cycles of weight loss and gain that lead, ultimately, to net muscle loss.

    Meanwhile, drug companies are already thinking about the next generation of weight-loss therapies. “Wouldn’t it be great to have another mechanism that’s moving away from just appetite regulation?” Haines said. Companies are testing ways to preserve—perhaps even enhance—muscle during weight loss by combining Wegovy or Zepbound with a second muscle-boosting drug. Such a combination could, in theory, allow patients to lose fat and gain muscle at the same time.

    Years ago, scientists first became interested in potential muscle-enhancing drugs that mimic mutations found in certain breeds of almost comically ripped dogs and cattle. At the time, they hoped to treat muscle-wasting diseases. The drugs never quite worked for that purpose, but the trial for one such drug, an antibody called bimagrumab, found that patients also lost fat in addition to gaining lean mass. A start-up acquired the drug and began testing it for weight loss in combination with semaglutide, the active ingredient in Wegovy, or Ozempic. And last year, Eli Lilly, the maker of Zepbound, snapped up that company for up to $1.9 billion—in hopes of making its own combination therapy.

    Read: Are you sure you want an Ozempic pill?

    Pairing bimagrumab with an existing obesity drug could potentially maximize the weight loss from both. Losing weight tends to get harder over time; as you lose muscle, your body burns fewer calories. A drug that minimizes that muscle loss—or even flips it into muscle gain—could help patients boost the amount of energy their body expends, while Wegovy or Zepbound suppresses calories consumed. The mechanisms of how this might actually work in the body still need to be understood, though. Previous studies of bimagrumab found that patients grew more muscle, but they didn’t necessarily become faster or stronger. Haines, who is planning a small study of her own with bimagrumab, is most interested in how the combination affects not the structural but the metabolic functions of muscle.

    Bimagrumab is the furthest along of several drugs that tinker with the same pathway for muscle growth. The biotech company Regeneron recently published promising data on two of its muscle-enhancing antibodies paired with semaglutide in primates; a trial in humans is due to begin later this year. The start-up Scholar Rock is testing another antibody called apitegromab. Other companies are interested in combining the obesity drugs with different potential muscle boosters that work by mimicking certain hormones such as apelin or testosterone. If they succeed, the next generation of drugs could help sculpt a more muscular body, not just a smaller one. Eating less can only do so much to better your health.

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    Sarah Zhang

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  • Do Not Underestimate the To-Do List

    Do Not Underestimate the To-Do List

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    Productivity is a sore subject for a lot of people. Philosophically, the concept is a nightmare. Americans invest personal productivity with moral weight, as though human worth can be divined through careful examination of work product, both professional and personal. The more practical questions of productivity are no less freighted with anxiety. Are you doing enough to hold on to your job? To improve your marriage? To raise well-adjusted kids? To maintain your health? What can you change in order to do more?

    Anxiety breeds products, and the tech industry’s obsession with personal optimization in particular has yielded a bounty of them in the past decade or two: digital calendars that send you push notifications about your daily schedule. Platforms that reimagine your life as a series of project-management issues. Planners as thick as encyclopedias that encourage you to set daily intentions and monthly priorities. Self-help books that cobble together specious principles of behavioral psychology to teach you the secrets of actually using all of the stuff you’ve bought in order to optimize your waking hours (and maybe your sleeping ones too).

    Underneath all of the tiresome discourse about enhancing human productivity or rejecting it as a concept, there is a bedrock truth that tends to get lost. There probably is a bunch of stuff that you need or want to get done, for reasons that have no discernable moral or political valence—making a long-delayed dentist appointment, picking up groceries, returning a few nagging emails, hanging curtains in your new apartment. For that, I come bearing but one life hack: the humble to-do list, written out on actual paper, with actual pen.

    First, cards on the table: I’m not an organized person. Much of the advice on these topics is given by people with a natural capacity for organization and focus—the people who, as kids, kept meticulous records of assignments and impending tests in their school-issued planners. Now they send out calendar invites to their friends once next weekend’s dinner plans are settled and have never killed a plant by forgetting to water it. They were, in my opinion, largely born on third base and think they hit a triple. I, by contrast, have what a psychiatrist once called a “really classic case” of ADHD. My executive function is never coming back from war. I have tried the tips, the tricks, the hacks, the apps, and the methods. I have abandoned countless planners three weeks into January. Years ago, I bought a box with a timed lock so that I could put my phone in it and force myself to write emails. Perhaps counterintuitively, that makes me somewhat of an amateur expert in the tactics that are often recommended for getting your life (or at least your day) in order.

    It took me an embarrassingly long time to try putting pen to paper. By the time I was in the working world, smartphones were beginning to proliferate, and suddenly, there was an app for that. In the late 2000s, optimism abounded about the capacity for consumer technology to help people overcome personal foibles and make everyday life more efficient. Didn’t a calendar app seem much neater and tidier than a paper planner? Wouldn’t a list of tasks that need your attention be that much more effective if it could zap you with a little vibration to remind you it exists? If all of your schedules and documents and contacts and to-do lists could live in one place, wouldn’t that be better?

    Fifteen years later, the answer to those questions seems to be “not really.” People habituate to the constant beeps and buzzes of their phone, which makes rote push-notification task reminders less likely to break through the noise. If you make a to-do list in your notes app, it disappears into the ether when you finally lock your phone in an effort to get something—anything!—done. Shareable digital calendars do hold certain practical advantages over their paper predecessors, and services such as Slack and Google Docs, which let people work together at a distance, provide obvious efficiencies over mailing paperwork back and forth. But those services’ unexpected downsides have also become clear. Trivial meetings stack up. Work bleeds into your personal time, which isn’t actually efficient. Above all, these apps and tactics tend to be designed with a very specific kind of productivity in mind: that which is expected of the average office worker, whose days tend to involve a lot of computer tasks and be scheduleable and predictable. If your work is more siloed or scattered or unpredictable—like, say, a reporter’s—then bending those tools to your will is a task all its own. Which is to say nothing of the difficulty of bending those tools to the necessities of life outside of work.

    My personal collision with the shortcomings of digital productivity hacks came during the first year of the pandemic, when many people were feeling particularly isolated and feral. Without the benefit of the routines that I’d constructed for myself in day-to-day life in the outside world, time passed without notice, and I had trouble remembering what I was supposed to be doing at any given time. I set reminders for myself, opened accounts on task-management platforms, tried different kinds of note-taking software. It was all a wash. At the end of my rope, I pulled out a notebook and pen, and flipped to a clean page. I made a list of all the things I could remember that I’d left hanging, broken down into their simplest component parts—not clean the apartment, but vacuum, take out the trash, and change your sheets.

    It worked. When I made a list, all of the clutter from my mind was transferred to the page, and things started getting done. It has kept working, years later, any time I get a little overwhelmed. A few months after my list-making breakthrough, I tried to translate this tactic to regular use of a planner, but that tanked the whole thing. I just need a regular notebook and a pen. There’s no use in getting cute with it. Don’t make your to-do list a task of its own.

    All of this might sound preposterously simple and obvious. If you were born with this knowledge or learned it long ago, then I’m happy for you. But for people like me for whom this behavior doesn’t come naturally, that obvious simplicity is exactly the genius of cultivating it. Your list lives with you on the physical plane, a tactile representation of tasks that might otherwise be out of sight and out of mind (or, worse, buried in the depths of your laptop). It contains only things that you can actually accomplish in a day or two, and then you turn the page forever and start again. If you think of more things that need to be on the list after you think you’re done making it, just add them. If you get to the last few things on the list and realize they’re not that important, don’t do them. This type of to-do list doesn’t take any work to assemble. It isn’t aesthetically pleasing. It doesn’t need to be organized in any particular way, or at all. It’s not a plan. It’s just a list.

    If you’d feel more convinced by some psychological evidence instead of the personal recommendation of a stranger with an aversion to calendars, a modest amount of research has amassed over the years to suggest that I’m on the right track. List-making seems to be a boon to working memory, and writing longhand instead of typing on a keyboard seems to aid in certain types of cognition, including learning and memory. My own experience is in line with the basic findings of that research: Writing down a list forces me to recall all of the things that are swimming around in my head and occasionally breaking through to steal my attention, and then it moves the tasks from my head onto the paper. My head is then free to do other things. Like, you know, the stuff on the list. There are no branded tools you have to buy, and no subscriptions. It cannot be monetized. Write on the back of your water bill, for all I care. Just remember to pay your water bill.

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    Amanda Mull

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  • From Feminist to Right-Wing Conspiracist

    From Feminist to Right-Wing Conspiracist

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    In 2019, a mnemonic began to circulate on the internet: “If the Naomi be Klein / you’re doing just fine / If the Naomi be Wolf / Oh, buddy. Ooooof.” The rhyme recognized one of the most puzzling intellectual journeys of recent times—Naomi Wolf’s descent into conspiracism—and the collateral damage it was inflicting on the Canadian climate activist and anti-capitalist Naomi Klein.

    Explore the October 2023 Issue

    Check out more from this issue and find your next story to read.

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    Until recently, Naomi Wolf was best known for her 1990s feminist blockbuster The Beauty Myth: How Images of Beauty Are Used Against Women, which argued that the tyranny of grooming standards—all that plucking and waxing—was a form of backlash against women’s rights. But she is now one of America’s most prolific conspiracy theorists, boasting on her Twitter profile of being “deplatformed 7 times and still right.” She has claimed that vaccines are a “software platform” that can “receive ‘uploads’ ” and is mildly obsessed with the idea that many clouds aren’t real, but are instead evidence of “geoengineered skies.” Although Wolf has largely disappeared from the mainstream media, she is now a favored guest on Steve Bannon’s podcast, War Room.

    All of this is particularly bad news for Klein, for the simple reason that people keep mistaking the two women for each other. Back in 2011, when she first noticed the confusion—from inside a bathroom stall, she heard two women complain that “Naomi Klein” didn’t understand the demands of the Occupy movement—this was merely embarrassing. The movement sprang from Klein’s part of the left, and in October of that year she was invited to speak to Occupy New York. Was it their shared first name, their Jewishness, or their brown hair with blond highlights? Even their partners’ names were similar: Avram Lewis and Avram Ludwig. Klein was struck that both had experienced rejection from their peer groups (in her case, by fellow students when she first criticized Israel in the college newspaper).

    Klein had once admired The Beauty Myth, but she realized to her horror that Wolf had drifted from feminist criticism to broader social polemics. When she picked up Wolf’s 2007 book, The End of America: Letter of Warning to a Young Patriot, her own book, out the same year, came to mind. “I felt like I was reading a parody of The Shock Doctrine, one with all the facts and evidence carefully removed.” To Klein, the situation began to seem sinister, even threatening. She was being eaten alive. “Other Naomi—that is how I refer to her now,” Klein writes at the beginning of her new book, Doppelganger: A Trip Into the Mirror World. “A person whom so many others appear to find indistinguishable from me. A person who does many extreme things that cause strangers to chastise me or thank me or express their pity for me.”

    The confusion was particularly galling because No Logo (1999), Klein’s breakout work, was a manifesto against branding. And yet here she was, feeling an urgent need to protect her own personal brand from this interloper. Klein asserts that she didn’t want to write Doppelganger—“not with the literal and metaphorical fires roiling our planet,” she confesses with a hint of pomposity—but found herself ever more obsessed by Wolf’s conspiracist turn. How do you go from liberal darling to War Room regular within a decade?

    Like Klein, I loved The Beauty Myth as a young woman, and then largely forgot about Wolf until 2010, when Julian Assange was arrested for alleged sex offenses (the charges were later dropped), and she claimed that Interpol was acting as “the world’s dating police.” Two years later, she published Vagina: A New Biography, which mixed sober accounts of rape as a weapon of war with a quest to cure her midlife sexual dysfunction through “yoni massages” and activating “the Goddess array.” In one truly deranged scene, a friend hosts a party at his loft and serves pasta shaped like vulvae, alongside salmon and sausages. The violent intermingling of genital-coded food overwhelms Wolf, who experiences it as an insult to womanhood in general and her own vagina in particular, and suffers writer’s block for the next six months. (I suspect that the friend was just trying to get into the spirit of Wolf’s writing project.) I remember beginning to wonder around this time whether Wolf might be a natural conspiracy theorist who had merely lucked into writing about one conspiracy—the patriarchy—that happened to be true.

    Her final exile from the mainstream can probably be dated to 2019, when she was humiliated in a live radio interview during the rollout of her book Outrages: Sex, Censorship, and the Criminalization of Love. She had claimed that gay men in Victorian England were regularly executed for sodomy, but the BBC host Matthew Sweet noted that the phrase death recorded in the archives meant that the sentence had been commuted, rather than carried out. It was a grade A howler, and it marked open season on her for all previous offenses against evidence and logical consistency. The New York Times review of Outrages referred to “Naomi Wolf’s long, ludicrous career.” In the U.K., the publisher promised changes to future editions, and the release of the U.S. edition was canceled outright.

    Klein dwells on this incident in Doppelganger, and rightly so: “If you want an origin story, an event when Wolf’s future flip to the pseudo-populist right was locked in, it was probably that moment, live on the BBC, getting caught—and then getting shamed, getting mocked, and getting pulped.” If the intelligentsia wouldn’t lionize Wolf, then the Bannonite right would: She could enter a world where mistakes don’t matter, no one feels shame, and fact-checkers are derided as finger-wagging elitists.

    “These people don’t disappear just because we can no longer see them,” Klein reminds any fellow leftists who might be enthusiastic about public humiliation as a weapon against the right. Denied access to the mainstream media, the ostracized will be welcomed on One America News Network and Newsmax, or social-media sites such as Rumble, Gettr, Gab, Truth Social, and Elon Musk’s new all-crazy-all-the-time reincarnation of Twitter as X. On podcasts, the entire heterodox space revels in “just asking questions”—and then not caring about the peer-reviewed answers. By escaping to what Klein calls the “Mirror World,” Wolf might have lost cultural capital, but she has not lost an audience.

    Helen Lewis: Why so many conservatives feel like losers

    Klein notes that this world is particularly hospitable to those who can blend personal and social grievances into an appealing populist message—I am despised by the pointy-heads, just as you are. She ventures “a kind of equation for leftists and liberals crossing over to the authoritarian right that goes something like this: Narcissism (Grandiosity) + Social media addiction + Midlife crisis ÷ Public shaming = Right wing meltdown.” She is inclined to downplay “that bit of math,” though, and feels uncomfortable putting Wolf on the couch. Nonetheless, I’m struck by how narcissism (in the ubiquitous lay sense of the term) is key to understanding conspiracy-theorist influencers and their followers. If you feel disrespected and overlooked in everyday life, then being flattered with the idea that you’re a special person with secret knowledge must be appealing.

    Klein’s real interest, as you might expect from her previous work, tends more toward sociology than psychology. Her doppelgänger isn’t an opportunist or a con artist, Klein decides, but a genuine believer—even if those beliefs have the happy side effect of garnering her attention and praise. But what about the culture that has enabled her to thrive?

    At first, I thought what I was seeing in my doppelganger’s world was mostly grifting unbound. Over time, though, I started to get the distinct impression that I was also witnessing a new and dangerous political formation find itself in real time: its alliances, worldview, slogans, enemies, code words, and no-go zones—and, most of all, its ground game for taking power.

    To explore this ambitious agenda, the book ranges widely and sometimes tangentially. At one point, Klein finds herself listening to hours of War Room, hosted by a man who has built a dark empire of profitable half-truths. Why does Klein find Bannon so compelling? Here Doppelganger takes a startling turn. The answer is that, quite simply, game recognizes game. Klein’s cohort on the left attacks Big Pharma profits, worries about “surveillance capitalism,” and sees Davos and the G7 as a cozy cabal exploiting the poor. Understandably, she hears Other Naomi talk with Bannon about vaccine manufacturers’ profits, rail against Big Tech’s power to control us, and make the case that Klaus Schwab of the World Economic Forum has untold secret power, and she can’t help noting some underlying similarities. When Bannon criticizes MSNBC and CNN for running shows sponsored by Pfizer, telling his audience that this is evidence of rule “by the wealthy, for the wealthy, against you,” Klein writes, “it strikes me that he sounds like Noam Chomsky. Or Chris Smalls, the Amazon Labor Union leader known for his EAT THE RICH jacket. Or, for that matter, me.”

    From the July/August 2022 issue: Steve Bannon, American Rasputin

    This is Doppelganger at its best, acknowledging the traits that make us all susceptible to manipulation. In a 2008 New Yorker profile of Klein, her husband described her as a “pattern recognizer,” adding: “Some people feel that she’s bent examples to fit the thesis. But her great strength is helping people recognize patterns in the world, because that’s the fundamental first step toward changing things.” Of course, overactive pattern recognition is also the essence of conspiracism, and a decade and a half later, Klein expresses more caution about her superpower. When 9/11 truthers turn up at her events—drawn perhaps by her criticism in The Shock Doctrine of George W. Bush’s response to the tragedy—their presence leads her to conclude “that the line between unsupported conspiracy claims and reliable investigative research is neither as firm nor as stable as many of us would like to believe.”

    We live in a world where the U.S. government has done outlandish stuff: The Tuskegee experiment, MK-Ultra, Iran-Contra, and Watergate are all conspiracies that diligent journalism proved to be true. QAnon’s visions of Hollywood child-sex rings might be a mirage, but the Catholic Church’s abuse of children in Boston was all too real—and uncovering it won The Boston Globe a Pulitzer Prize. Klein worries about whether a political movement can generate mass appeal without resorting to populism, and about how to stop her criticisms of elite power from being co-opted by her opponents and distorted into attacks on the marginalized.

    Read: A 2014 interview with Naomi Klein about climate politics

    However, Klein’s (correct) diagnosis of American conspiracism as a primarily right-wing pathology prevents her from fully acknowledging the degree to which it has sometimes infected her own allies and idols. In Doppelganger, Klein notes that anti-Semitism has served as “the socialism of fools”—stirred up to deflect popular anger away from the elite—but she does not discuss the anti-Jewish bigotry in the British Labour Party under its former leader Jeremy Corbyn, whom she endorsed in the 2019 election. (Corbyn once praised a mural of hook-nosed bankers counting money on a table held up by Black people, and his supporters suggested that his critics were Israeli stooges.) The party has since apologized for not taking anti-Semitism seriously enough.

    At times, this can be a frustrating book. Near the end, Klein says she requested an interview with Wolf, promising that it would be “a respectful debate” about their political disagreements. She also hoped to remind Wolf of their original meeting, more than three decades earlier—when Wolf, then 28, captivated the 20-year-old Klein, showing her the possibilities of what a female author could be. But Wolf never responded to the request, and the doppelgängers have not met face-to-face since then.

    Still, Klein emerges with a sense of resolution. She writes that the confusion between the two of them has lately died down, now that Other Naomi has become an “unmistakable phenomenon unto herself.” Even better, the situation has introduced “a hefty dose of ridiculousness into the seriousness with which I once took my public persona.” Not that the zealous Klein has disappeared: The next few pages are a paean to collective organizing, worker solidarity, and “cities in the grips of revolutionary fervor.”

    Doppelganger is least interesting when Klein returns to her comfort zone, but her brutally honest forays into self-examination are fascinating. The book is also a welcome antidote to the canceling reflex of our moment and a bracing venture across ideological lines. Klein successfully makes the case that the American left is more tethered to reality than the right—not because it is composed of smarter or better people, but because it has not lost touch with the mechanisms, such as scientific peer review and media pluralism, that act as a check on our worst instincts. Exposed to many of the same forces as her conspiracist doppelgänger—fame, cancellation, trauma, COVID isolation—this Naomi stayed fine. That has to offer us some hope.

    This article appears in the October 2023 print edition with the headline “The Other Naomi.”

    Doppelganger: A Trip Into the Mirror World

    By Naomi Klein

    ​When you buy a book using a link on this page, we receive a commission. Thank you for supporting The Atlantic.

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    Helen Lewis

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  • Doctors Suddenly Got Way Better at Treating Eczema

    Doctors Suddenly Got Way Better at Treating Eczema

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    Up until a few years ago, Heather Sullivan’s 14-year-old son, Sawyer, had struggled with eczema his entire life. When he was just a baby, most of his body would be covered in intensely itchy rashes that bled and oozed when he couldn’t help but scratch. His family tried steroid creams, wet wraps, bleach baths, and all of the lotions. They tore up their carpet and replaced their sheetrock in hopes of eliminating triggers. At 15 months, he went on cyclosporine, a powerful immunosuppressant usually given to organ-transplant patients. It cleared him up, but the drug comes with potentially dangerous side effects over time. Doctors, Sullivan recalls, were “just appalled that my child would be on this amount of medicine at this age”—but his eczema came roaring back as soon as he went off it.

    When a new eczema drug called Dupixent finally became available to Sawyer a few years ago, his turnaround was fast and dramatic. Within a week, his itchiness and redness started calming down. He felt and looked better. The condition that had dominated their lives began to fade into the background.

    Doctors who treat severe eczema now speak of pre- and post-Dupixent eras: “It changed the landscape of having eczema forever,” says Brett King, a dermatologist at Yale. Today, a half dozen novel treatments are available for the skin condition, all of which work by quieting the same biological pathway in eczema; dozens more are in clinical trials. Unlike older drugs, these new ones are precisely targeted and in many cases startlingly effective.

    Eczema, also known as atopic dermatitis, is characterized by red, itchy, and inflamed skin. It’s a very common condition, estimated to affect 10 percent of Americans. Of those, a large minority suffer from moderate to severe eczema that seeps into everyday life. “Just imagine scratching endlessly,” King says. “You wake up from sleep scratching. Your sheets are bloody in the morning.” The most basic eczema advice is to moisturize, and moisturize often, to protect the barrier of the skin. But scientists now know that eczema’s cause is not in the skin alone. Many patients also have “an over-reactive or overzealous immune system,” says Dawn Davis, a dermatologist at the Mayo Clinic. Their immune cells release chemicals that irritate nerves, causing itch, and even degrade the skin itself.

    Topical steroids, such as over-the-counter hydrocortisone cream, can tamp down the immune reaction that flares in eczema. If these fail, doctors have resorted to more powerful oral steroids, such as prednisone, or other oral immunosuppressants, such as the aforementioned cyclosporine. The drugs can calm eczema, but because they suppress the overall immune system, they also do much more. Prednisone, for example, makes you more prone to infections as well as bone fractures, high blood pressure, and glaucoma when taken in the long term. Of course, for many people, eczema is a chronic condition that requires long-term treatment. “Prednisone is kind of like carpet bombing,” says Peter Lio, a dermatologist at Northwestern University. It blasts eczema away, but at a cost.

    In contrast, the newer drugs, Lio says, are more like shotguns that target specific parts of the immune system—with less collateral damage. They fall into two broad classes. Monoclonal antibodies, such as Dupixent, intercept the immune-signaling molecules that trigger itch and skin inflammation. And then JAK inhibitors, which include pills such as Rinvoq and the topical cream Opzelura, scramble the signal after cells have received it. The development of these drugs came after years of research zeroed in on some of the key immune molecules dysregulated in eczema. But serendipity played a role too: The first such drugs were originally developed for other conditions, such as rheumatoid arthritis—only to be repurposed when researchers realized that they targeted the very pathways involved in eczema. The breakthroughs in eczema treatment, in fact, are part of a broader revolution in treating inflammatory disorders; both classes of new drugs are now used to tune the immune system in a whole host of different conditions.

    The monoclonal antibodies and oral JAK inhibitors may have their own serious side effects, such as blood clots, which, Lio says, give some doctors unfamiliar with the new drugs—especially the latter type—pause. But the traditional drugs are not great either. “I’m frustrated that a lot of clinicians are very cavalier about prednisone and cyclosporine … They’re like, ‘Oh, they’re our old friends,’” he told me. “Then they get nervous about JAK inhibitors.” In his mind, the new drugs are simply the better option in terms of safety and efficacy.

    Jonathan Silverberg, a dermatologist at George Washington University who specializes in eczema, says he now rarely uses the old oral steroids and immunosuppressants. When he does revert to them, it’s not for medical reasons: He ends up prescribing older (that is, generic and therefore cheaper) drugs for uninsured patients who can’t afford the new ones, or for patients who have insurance but are nevertheless denied coverage. “Insurance says, ‘Can it be fixed with a $10 medicine? Or does it really need the $1,000 tube?’” King told me. Getting patients these newer drugs can mean a lot of time fighting with insurance.

    For now, these drugs have most dramatically improved the lives of patients with moderate to severe eczema—at least those patients who can access them. But doctors told me that topical JAK inhibitors, which are safer than the oral version, could one day be first-line treatments for mild eczema as well. “In a perfect world, I would love it if I never had to prescribe a topical steroid again,” Silverberg said, citing the side effects that come with long-term use. Topical steroids can thin the skin, causing stretch marks, fragility, and poor healing. But at the moment, steroids are also cheap and easily available. They’re not going anywhere as long as the new treatments still come with hefty price tags.

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    Sarah Zhang

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  • The ‘End’ of COVID Is Still Far Worse Than We Imagined

    The ‘End’ of COVID Is Still Far Worse Than We Imagined

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    When is the pandemic “over”? In the early days of 2020, we envisioned it ending with the novel coronavirus going away entirely. When this became impossible, we hoped instead for elimination: If enough people got vaccinated, herd immunity might largely stop the virus from spreading. When this too became impossible, we accepted that the virus would still circulate but imagined that it could become, optimistically, like one of the four coronaviruses that cause common colds or, pessimistically, like something more severe, akin to the flu.

    Instead, COVID has settled into something far worse than the flu. When President Joe Biden declared this week, “The pandemic is over. If you notice, no one’s wearing masks,” the country was still recording more than 400 COVID deaths a day—more than triple the average number from flu.

    This shifting of goal posts is, in part, a reckoning with the biological reality of COVID. The virus that came out of Wuhan, China, in 2019 was already so good at spreading—including from people without symptoms—that eradication probably never stood a chance once COVID took off internationally. “I don’t think that was ever really practically possible,” says Stephen Morse, an epidemiologist at Columbia. In time, it also became clear that immunity to COVID is simply not durable enough for elimination through herd immunity. The virus evolves too rapidly, and our own immunity to COVID infection fades too quickly—as it does with other respiratory viruses—even as immunity against severe disease tends to persist. (The elderly who mount weaker immune responses remain the most vulnerable: 88 percent of COVID deaths so far in September have been in people over 65.) With a public weary of pandemic measures and a government reluctant to push them, the situation seems unlikely to improve anytime soon. Trevor Bedford, a virologist at the Fred Hutchinson Cancer Center, estimates that COVID will continue to exact a death toll of 100,000 Americans a year in the near future. This too is approximately three times that of a typical flu year.

    I keep returning to the flu because, back in early 2021, with vaccine excitement still fresh in the air, several experts told my colleague Alexis Madrigal that a reasonable threshold for lifting COVID restrictions was 100 deaths a day, roughly on par with flu. We largely tolerate, the thinking went, the risk of flu without major disruptions to our lives. Since then, widespread immunity, better treatments, and the less virulent Omicron variant have together pushed the risk of COVID to individuals down to a flu-like level. But across the whole population, COVID is still killing many times more people than influenza is, because it is still sickening so many more people.

    Bedford told me he estimates that Omicron has infected 80 percent of Americans. Going forward, COVID might continue to infect 50 percent of the population every year, even without another Omicron-like leap in evolution. In contrast, flu sickens an estimated 10 to 20 percent of Americans a year. These are estimates, because lack of testing hampers accurate case counts for both diseases, but COVID’s higher death toll is a function of higher transmission. The tens of thousands of recorded cases—likely hundreds of thousands of actual cases every day—also add to the burden of long COVID.

    The challenge of driving down COVID transmission has also become clearer with time. In early 2021, the initially spectacular vaccine-efficacy data bolstered optimism that vaccination could significantly dampen transmission. Breakthrough cases were downplayed as very rare. And they were—at first. But immunity to infection is not durable against common respiratory viruses. Flu, the four common-cold coronaviruses, respiratory syncytial virus (RSV), and others all reinfect us over and over again. The same proved true with COVID. “Right at the beginning, we should have made that very clear. When you saw 95 percent against mild disease, with the trials done in December 2020, we should have said right then this is not going to last,” says Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia. Even vaccinating the whole world would not eliminate COVID transmission.

    This coronavirus has also proved a wilier opponent than expected. Despite a relatively slow rate of mutation at the beginning of the pandemic, it soon evolved into variants that are more inherently contagious and better at evading immunity. With each major wave, “the virus has only gotten more transmissible,” says Ruth Karron, a vaccine researcher at Johns Hopkins. The coronavirus cannot keep becoming more transmissible forever, but it can keep changing to evade our immunity essentially forever. Its rate of evolution is much higher than that of other common-cold coronaviruses. It’s higher than that of even H3N2 flu—the most troublesome and fastest-evolving of the influenza viruses. Omicron, according to Bedford, is the equivalent of five years of H3N2 evolution, and its subvariants are still outpacing H3N2’s usual rate. We don’t know how often Omicron-like events will happen. COVID’s rate of change may eventually slow down when the virus is no longer novel in humans, or it may surprise us again.

    In the past, flu pandemics “ended” after the virus swept through so much of the population that it could no longer cause huge waves. But the pandemic virus did not disappear; it became the new seasonal-flu virus. The 1968 H3N2 pandemic, for example, seeded the H3N2 flu that still sickens people today. “I suspect it’s probably caused even more morbidity and mortality in all those years since 1968,” Morse says. The pandemic ended, but the virus continued killing people.

    Ironically, H3N2 did go away during the coronavirus pandemic. Measures such as social distancing and masking managed to almost entirely eliminate the flu. (It has not disappeared entirely, though, and may be back in full force this winter.) Cases of other respiratory viruses, such as RSV, also plummeted. Experts hoped that this would show Americans a new normal, where we don’t simply tolerate the flu and other respiratory illnesses every winter. Instead, the country is moving toward a new normal where COVID is also something we tolerate every year.

    In the same breath that President Biden said, “The pandemic is over,” he went on to say, “We still have a problem with COVID. We’re still doing a lot of work on it.” You might see this as a contradiction, or you might see it as how we deal with every other disease—an attempt at normalizing COVID, if you will. The government doesn’t treat flu, cancer, heart disease, tuberculosis, hepatitis C, etc., as national emergencies that disrupt everyday life, even as the work continues on preventing and treating them. The U.S.’s COVID strategy certainly seems to be going in that direction. Broad restrictions such as mask mandates are out of the question. Interventions targeted at those most vulnerable to severe disease exist, but they aren’t getting much fanfare. This fall’s COVID-booster campaign has been muted. Treatments such as bebtelovimab and Evusheld remain on shelves, underpublicized and underused.

    At the same time, hundreds of Americans are still dying of COVID every day and will likely continue to die of COVID every day. A cumulative annual toll of 100,000 deaths a year would still make COVID a top-10 cause of death, ahead of any other infectious disease. When the first 100,000 Americans died of COVID, in spring 2020, newspapers memorialized the grim milestone. The New York Times devoted its entire front page to chronicling the lives lost to COVID. It might have been hard to imagine, back in 2020, that the U.S. would come to accept 100,000 people dying of COVID every year. Whether or not that means the pandemic is over, the second part of the president’s statement is harder to argue with: COVID is and will remain a problem.

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    Sarah Zhang

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