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Tag: good reason

  • Florida’s Experiment With Measles

    Florida’s Experiment With Measles

    The state of Florida is trying out a new approach to measles control: No one will be forced to not get sick.

    Joseph Ladapo, the state’s top health official, announced this week that the six cases of the disease reported among students at an elementary school in Weston, near Fort Lauderdale, do not merit emergency action to prevent unvaccinated students from attending class. Temporary exclusions of that kind while an outbreak is ongoing are part of the normal public-health response to measles clusters, as a means of both protecting susceptible children and preventing further viral spread. But Ladapo is going his own way. “Due to the high immunity rate in the community, as well as the burden on families and educational cost of healthy children missing school,” he said in a letter released on Tuesday, the state’s health department “is deferring to parents or guardians to make decisions about school attendance.”

    That decision came off as brazen, even for an administration that has made systematic efforts to lower vaccination rates among its constituents over the past two years. Ladapo’s letter acknowledges the benefits of vaccination, as well as the fact that vulnerable children are “normally recommended” to stay home. Still, it doesn’t bother giving local parents the bare-minimum advice that all kids who are able should get their MMR (measles, mumps, and rubella) shots, Dorit Reiss, a professor and vaccine-policy expert at UC Law San Francisco, told me. “I wouldn’t have expected him, in the middle of a measles outbreak, to be willing to sacrifice children in this way.”

    The Florida Department of Health has not responded to a request for comment on Ladapo’s future plans, should this situation worsen. For the moment, though, he has chosen to lower the guardrails from their standard height. It’s an escalation of his, and Florida’s, broader push against established norms in public health, especially as they relate to vaccination. So what happens now?

    At least in any immediate sense, Ladapo’s decision may not do much harm. In fact, there’s good reason to believe that its effects will end up being minimal. Parents who have children at the school, Manatee Bay Elementary, have until today to decide whether to pull out those kids for the next three weeks. Many seem to have already done so: About 200 students, and six teachers, have been absent, according to local news reports. In the meantime, Broward County Public Schools’ superintendent said yesterday that just 33 students out of the school’s nearly 1,100 were still unvaccinated. Given those two facts—some degree of self-imposed isolation, and 97 percent of the community now having some level of immune protection—the virus will have a hard time spreading no matter what the rules for attendance might be.

    Disease modeling, too, suggests that the risk of a larger outbreak is low. For a study released in 2019, a team of researchers based at Newcastle University and the University of Pittsburgh simulated thousands of measles outbreaks at schools in Texas, the most populous state to allow nonmedical exemptions from routine vaccine requirements. The researchers looked at the extent to which a policy of sequestering unvaccinated kids would help to reduce the outbreaks’ size. In the median outcome, even without any school-wide interventions, they found that an initial case of measles spreads only to a small handful of people. Adding in the rule that unvaccinated kids must stay at home has no effect on transmission. When the school’s vaccination rates are assumed to be unusually low, the rule reduces the outbreak’s size by one case.

    Not all the modeling outcomes are so rosy. For the very worst-case scenarios, in which a case of measles emerges in a school where unvaccinated kids happen to be clustered, the study found that forced suspensions have dramatic benefits. A major outbreak in the Dallas–Fort Worth area, for example, might end up infecting 477 people in the absence of any interventions, according to the model. When unvaccinated kids are kept from going to school, that number drops by 95 percent.

    Hypothetical models can’t tell us what will happen in a real-life school with real-life kids, like the one in Weston, Florida. But given Manatee Bay Elementary’s reported vaccination rate, it’s fair to assume that Ladapo’s policy won’t be catastrophic. Indeed, it may well end up sparing a few dozen families from the fairly serious inconvenience of being out of school without having much effect at all on the outbreak’s final size.

    But is the sparing of that inconvenience worth the risks that still remain? (And how should one value the time of a parent who could have vaccinated their child but chose not to?) As Reiss points out, if this policy leads to even one more case in the current outbreak, it will have put one more kid at risk of hospitalization, long-term complications, or even death. Worst-case outbreak scenarios do occur from time to time, as we all know well by now; and the Weston outbreak getting much worse is certainly within the realm of possibility. Any public-health authority would have to weigh these odds in the face of a six-case cluster; and surely almost every statewide health authority would choose to err on the side of caution. In Florida, though, the scale appears to tip the other way. Ladapo has rolled the dice on doing less.

    That’s been his way since the very day he was appointed by Governor Ron DeSantis, in September 2021. Just hours after he was introduced, the state ended mandatory quarantines for low-risk students who had been exposed to COVID. The following March, just a few weeks after being confirmed into the job, Ladapo announced that Florida would be “the first state to officially recommend against the COVID-19 vaccines for healthy children.” He continued to scale up from there: That fall, he recommended against the use of mRNA vaccines by any men under the age of 40. A year later, in October 2023, his office warned everyone under the age of 65 about the risks of getting an mRNA-based COVID booster. And then, finally, just last month, Ladapo came out with a warning that mRNA-based COVID vaccines “are not appropriate for use in human beings.”

    Read: The curious case of Florida’s pandemic response

    The man’s commitment to undermining vaccination is truly unparalleled among leading public-health officials. “As a surgeon general he stands alone,” Reiss told me. Yet Ladapo’s policy activism, however grotesque it might seem, has been bizarrely ineffective in practice. Take his March 2022 move to lead the way on not vaccinating young people against COVID. Media coverage of that announcement dwelled on reasonable concerns that this policy would dampen immunization rates; vaccine experts said it was a dangerous and irresponsible move that would “cause more people to die.” In practice, though, it seems to have done almost nothing. At the time of Ladapo’s announcement, 24.2 percent of Florida’s kids and 66.3 percent of its teenagers had received at least one dose of a COVID vaccine. (The corresponding national numbers at the time were somewhat higher.) By the end of the year, and in spite of Ladapo’s contrarian guidance, Florida’s vaccination numbers for these age groups were up by about four and three points respectively—which is almost exactly the same amount, percentage-wise, as the increases in those numbers seen across the country.

    Or compare Florida’s experience to that of Nevada, a state which had very similar child and teen vaccination rates in March 2022: 23.1 percent and 64.0 percent. Through the end of 2022, while Ladapo was discouraging his constituents from getting shots, that state’s Democratic governor was engaged in a large-scale effort to do just the opposite. And yet the results were essentially the same: Nevada’s rates increased by pretty much the same amount as Florida’s.

    For all of Ladapo’s efforts to dampen his state’s enthusiasm for life-saving interventions, Florida’s age-adjusted rates of death from COVID do not appear to have increased relative to the rest of the country, at least according to reported numbers. In this way, one of the nation’s loudest and most powerful voices of vaccine skepticism seems to be shouting into the wind. His proclamations and decisions to this point have been exquisitely effective at producing outrage, but embarrassingly feeble when it comes to changing outcomes. Even taken on its own terms, as a means of changing public-health behavior, Ladapo’s anti-vaccine activism has been a demonstrable failure.

    Read: The good news about vaccine hesitancy

    Perhaps this week’s decision to relax the rules on fighting measles will mark just one more step along that path: Once again, Florida’s surgeon general will have taken an appalling stance that ends up having no effect. But then again, now could be different. By the time Ladapo got around to undermining COVID shots, more than two-thirds of the state’s population, and 91 percent of its seniors, were already fully vaccinated. The damage he could have done was limited, by definition. But the measles outbreak in Weston is unfolding in real time. More such outbreaks are nearly guaranteed to occur in the U.S. in the months ahead. Reiss worries that Ladapo’s new idea, of choosing not to separate out unvaccinated kids during a school outbreak, could end up spreading into other jurisdictions. “If this becomes a precedent, that becomes a bigger problem,” she told me.

    For the first time since taking office, Ladapo may finally have a real opportunity to make a difference through his vaccination policy. That’s a problem.

    Daniel Engber

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  • Amending the Constitution Is Impossible Until Suddenly It’s Not

    Amending the Constitution Is Impossible Until Suddenly It’s Not

    The American experiment with constitutional democracy is in grave peril. If Donald Trump becomes president again, fighting to preserve U.S. constitutional democracy through his second term will require the courage, commitment, and creativity of a broad prodemocracy coalition.

    But the problem is not merely Trump. The U.S. Constitution itself contributes to the country’s crisis. As David Frum observed in a recent issue of The Atlantic, “If Trump is elected, it very likely won’t be with a majority of the popular vote” but rather because our system for selecting the president “has privileged a strategically located minority, led by a lawbreaking president, over the democratic majority.” America must fight the immediate threat, but it must also go beyond that and stop this problem at its core: addressing once and for all the aspects of the Constitution that enable an authoritarian leader to remain within striking distance of the presidency.

    The original Constitution was written when democracy meant something radically different than it does today. Over time, Americans have amended the Constitution to make it more democratic, but shortcomings remain. The most significant, in our view, are the hardwired constitutional structures that are inimical to any modern understanding of democracy: the Electoral College, which could put Trump in office without majority support for a second time, and the equal allocation of two seats in the Senate to each state (an arrangement that gives a Wyoming voter 70 times more senatorial clout than a Californian). Reforming those structures would get the country much closer to the one-person, one-vote democratic ideal.

    Adam Serwer: Who’s afraid of calling Donald Trump an insurrectionist?

    In 1787, few considered the one-person, one-vote principle to be foundational to democratic republican governance. Now it’s axiomatic. In American law, the principle traces its origins to a Supreme Court decision called Reynolds v. Sims, decided almost 60 years ago in an opinion by Chief Justice Earl Warren. “Legislators,” the Court noted, “represent people, not trees or acres. Legislators are elected by voters, not farms or cities or economic interests.” As Chief Justice Warren explained, once you see voters, not geographic units, as the source of democratic legitimacy, it quickly follows that “a majority of the people of a State could elect a majority of that State’s legislators.”

    One person, one vote is a standard principle structuring democratic republics around the world. Contemporary commentators on the left and right espouse it. And yet, none of the three branches of the federal government has its members chosen in a manner consistent with this principle. The president is elected through an Electoral College system that encourages campaigns to ignore most states and that sometimes grants the presidency to a candidate who loses the overall vote, the Senate is grossly malapportioned, and the members of the Supreme Court are determined by those two flawed institutions together.

    These antidemocratic structures have an odious historical pedigree. The Electoral College and the composition of the Senate resulted from compromises required to get slave states to agree to the Constitution by overweighting the influence of those states. And they continue to prevent the federal government from functioning effectively, particularly in areas where a coalition of senators representing a minority of the country can systematically block legislation. They also increase the risk of American democracy declining into authoritarianism. As the democracy scholars Daniel Ziblatt and Steven Levitsky have pointed out in this publication, “The U.S. Constitution, in its current form,”—meaning with the Senate and the Electoral College—“is enabling the radicalization of the Republican Party and exacerbating America’s democratic crisis.” They argue that these distorted institutions allow “the GOP to pursue extremist strategies that threaten our democracy without suffering devastating electoral consequences.”

    Although the Senate and the Electoral College are not all that ails American democracy, they should be the focus of efforts to amend the Constitution. Some important improvements to our democracy (such as court reform) may be accomplished by enacting statutes; other valuable amendment ideas (such as taking money out of politics or enshrining a stronger right to vote) are worth pursuing but could be vulnerable to death by interpretation at the Supreme Court. Reforming the Senate and the Electoral College would change the underlying structures of our democracy. At the same time, because such reforms seek to rewire the basic constitutional machinery, they could not be accomplished by passing ordinary laws or persuading the Supreme Court to adopt better judicial doctrines; the only way to truly fix these structures is to amend the document.

    Nancy Pelosi: What January 6 made clear to me

    This will not be easy. We are under no illusions about the difficulty of our country re-brokering key elements of the compromises that first created a union, however imperfect, more than 200 years ago. Indeed, one of us works for a democracy organization within which progressives, moderates, and conservatives all committed to fixing some of the core problems of American democracy have yet to reach consensus on these types of reforms.

    But debating them openly is what a healthy 21st-century democracy should do, and those who would preempt that debate on the theory that our Constitution is unamendable both do our future a deep disservice and misread our history. The history of constitutional amendment can offer some encouraging—and concretely useful—insights for considering the Constitution’s future. Those insights teach that amending the Constitution is always impossible, except for when it suddenly becomes inevitable.

    Why has the U.S. lived with this creaky constitutional architecture for so long? Part of the answer is that a quest to amend the Constitution is viewed as futile, and with good reason: The procedures for passing an amendment, as provided in Article V of the Constitution, set out a daunting path. First, a proposed amendment must win support from two-thirds of the members of both the House and Senate, and it must then be ratified by three-quarters of the states. (In theory, the proposed amendment can also come from a convention established by Congress, if two-thirds of the state legislatures petition for one, before being submitted to the states for ratification, but that process has never been used.) An effort to restructure the Senate faces an additional obstacle: The text of Article V blocks amendments that would deprive any state of its “equal Suffrage in the Senate” without its “consent” (although nothing in the text prohibits amending that provision).

    In a sense, amending the Constitution’s antidemocratic structures presents a sort of constitutional catch-22: Because a supermajority in Congress and a supermajority among state legislatures are required to amend the Constitution, a determined political minority can block constitutional change. The conventional wisdom is that Republican politicians have the most to lose from more democratic structures, so they have an incentive and the means to shut down any change. Amendments are thus treated as a nonstarter. One prominent constitutional scholar, in an influential 2006 book lamenting the Constitution’s democratic deficits, referred to the amendment process as an “iron cage” confining the country to a dangerously outdated national charter.

    These procedures are overwhelming, but are they truly insurmountable? We might find inspiration in the successful effort, just over 100 years ago, to make the Senate more democratic through Constitutional amendment.

    By the turn of the 20th century, the Senate was a mess—a millionaires’ club, filled with people who had no business being there. In the words of one influential journalist of the time, the Senate’s corruption was so profound as to render it a site of “treason.” This was no surprise given the way senators were selected. The Constitution gave state legislatures—not voters—the power to choose senators. But this was a disaster. For one thing, state legislators often couldn’t agree on whom to send to Washington, and many of the resulting deadlocks meant they sent no one. One study found that from 1891 to 1905, “eight state legislatures failed to elect senators and were without full representation from periods of ten months to four years.” The alternative to a deadlock was in many cases a “stampede election,” in which a legislature would vote several dozen times without converging on a winner. As the clock ran out, exhausted and acrimonious legislators would settle on characters with little to recommend them in terms of individual merit or popular standing within their state. The resulting scenes were sometimes reminiscent of a Coen-brothers script. Consider this description of the Missouri legislature’s efforts, in 1905, to appoint a member to the World’s Greatest Deliberative Body:

    Lest the hour of adjournment should come before an election was secured, an attempt was made to stop the clock upon the wall of the assembly chamber. Democrats tried to prevent its being tampered with; and when certain Republicans brought forward a ladder, it was seized and thrown out of the window. A fist-fight followed, in which many were involved. Desks were torn from the floor and a fusillade of books began. The glass of the clock-front was broken, but the pendulum still persisted in swinging until, in the midst of a yelling mob, one member began throwing ink bottles at the clock, and finally succeeded in breaking the pendulum. On a motion to adjourn, arose the wildest disorder. The presiding officers of both houses mounted the speaker’s desk, and, by shouting and waving their arms, tried to quiet the mob. Finally, they succeeded in securing some semblance of order.

    For years, people had proposed amending the U.S. Constitution to fix this mess. By the 1890s, the House of Representatives backed a constitutional amendment providing for the direct election of senators. But passing this amendment meant persuading two-thirds of the Senate to renounce the system that had made them senators in the first place, and then persuading three-quarters of the states’ legislatures to surrender an important power that gave them huge political influence in their home state and in Congress. And so, for almost two decades, the Senate itself was the graveyard for efforts to reform the Senate.

    George T. Conway III: The Colorado ruling changed my mind

    And yet, we all know how this story ends: The Constitution changed, and now voters choose their senators directly. The reason for that transformation is the Seventeenth Amendment, which became part of the Constitution in 1913. How did reformers a century ago pull this off?

    They started with hacks and work-arounds. In Oregon, where voters were especially fed up with the Senate’s dysfunction, they enacted a law in 1901 that set up an advisory “election” to choose senators. The election lacked direct legal force, but the idea was to influence the legislators by requiring that the results be read to state lawmakers before they selected a senator. This initial experiment failed miserably: After the first advisory election, the legislators still fought and deadlocked, eventually selecting someone who had received exactly zero votes in the popular “election.”

    Undeterred, the voters of Oregon tried again. In 1904, they passed another popular initiative with a more muscular policy to tame its legislature: This time, when state legislators ran for office, they would have to choose between two possible position statements accompanying their name on the ballots. They had to either pledge to vote for the candidate who received the most votes in the (formally nonbinding) election, or else stipulate that they would remain “at liberty to wholly disregard that vote.” This did the trick. From then on, Oregon legislators threw their support behind the popular-vote winner (even when it meant crossing party lines), and over the next several years, enough states adopted this policy that it came to be known as “the Oregon system.”

    Alongside those state-centered strategies, advocates looked for ways to increase pressure on the Senate by making inaction seem worse to senators than allowing an amendment to move forward. To do so, they focused on that unused alternative pathway to amending the Constitution that we mentioned earlier. Article V requires Congress to summon a “convention for proposing amendments” if asked to do so by two-thirds of the state legislatures. The prospect of opening the Constitution to potentially sweeping revision through a convention struck many onlookers at the time as a scary proposition. (It still does today.) Beginning in the 1890s, a group of state legislatures that favored direct elections began submitting petitions to Congress seeking an amendment convention. According to one early-20th-century scholar, “Some senators who were opposed to popular election saw in this proposal of a constitutional convention a portent so big that they preferred to submit the specific amendment that was desired rather than incur the risks that might be opened up if such a convention were called.” In other words, many senators concluded that the devil they knew (direct election of senators) was preferable to a potentially open-ended mandate to rethink the constitutional order.

    And then in 1912, after four decades of glacial and uncertain progress, the country sprinted toward amendment: Congress sent the proposed Seventeenth Amendment to the states, and a year later, the amendment was ratified. Voters would get to choose their senators.

    The Constitution’s process for amendment is intimidating. Devoting time and energy to that process can feel futile, even politically naive. Indeed, the editorial board of The Washington Post once declared that “we may properly regard the Constitution as practically unamendable.”

    It made that pronouncement in 1899. Americans would go on to amend the Constitution 12 times over the next several decades. That surge of activity would include—in addition to providing for the democratic election of senators—amendments granting women the right to vote, establishing (and then disestablishing) Prohibition, ending the poll tax, lowering the voting age, and clarifying the rules of presidential succession.

    The last time Congress proposed a constitutional amendment that was successfully ratified was in 1971, when Congress sent to the states the Twenty-Sixth Amendment, establishing a universal voting age of 18. More than half of the U.S. population today wasn’t even alive in 1971. What’s become clear in the intervening years is that the current document isn’t up to the job of protecting and promoting a vibrant 21st-century democracy.

    In the midst of an ongoing democratic crisis—where a leading presidential candidate speaks openly of acting as a “dictator” and exacting retribution against his political opponents—investing in long-term reform can seem like a fantasy. Failing to do so, however, carries its own risks. Without attending to the architecture of American democracy, the inherent weaknesses at its foundation may, in time, cause it to come tumbling down.

    Larry Schwartztol

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  • Pack Your Memories Into Your Disaster Bag

    Pack Your Memories Into Your Disaster Bag

    This April, when a 1,000-year storm drenched South Florida, my father and older sister were among the thousands of people abruptly hit with severe flash flooding. They made it out physically unscathed, but many of their possessions were reduced to waterlogged piles of debris. Among those ruined mementos were sets of baby clothes, which my sister had painstakingly preserved for the future but forgotten during the rush of the flood. More than half a year later, she’s still grieving them. “Stuff is stuff,” she told me. But those pieces of clothing had been in the family for decades; she had worn them, and so had her 2-year-old. She just wished, she told me, that she could have held on to those outfits, “and my daughter could have had them for her kids.”

    The “rain bomb” that displaced my family from their damaged rental homes was amplified by a warmer climate. Climate change is likely making storms wetter and more frequent, and in coastal hot spots across South Florida, where drastically rising sea levels are driving tidal flooding, a sudden storm can easily become a disaster. Extreme hazards such as these are a by-product of the planet’s unprecedented pace of warming, which could change where and when wildfires, floods, and other catastrophes strike and how they overlap. These events affect millions of Americans—roughly one in 70 adults has been displaced by a hurricane, flood, or other disaster event in the past year, per the latest U.S. Census Household Pulse Survey data.

    People living in hurricane or earthquake zones have long been taught to be ready for the worst, but these new threats make “all hazards” preparedness that much more important for everyone, no matter your location. Emergency-management guidelines in the United States already include recommendations for every household to keep a supply kit on standby, with a more compact version that can be mobilized in case of evacuation. Both should contain emergency medications, copies of identity documents, food, water, and other essentials. “What you put in those ‘go bags’ are the items that really are essential to you,” Sue Anne Bell, a researcher and nurse practitioner who specializes in disaster response at the University of Michigan, told me.

    But in talking with experts about disaster preparedness, I was surprised to find that recommendations on storing personal possessions in those bags are basically nonexistent. That necessities come first makes sense: These items can make a life-and-death difference in moments of crisis. But ever since members of my immediate family were displaced, I have started thinking about a third way to prepare for the uncertainty of extreme weather and the disasters that follow—what I like to call my “climate carry-on.”

    This bag can now be found, zipped up and resting on a shelf in my bedroom closet, ready to be wheeled out if the need arises. In it, I have stashed away some of my most prized personal objects: photos of loved ones swaddled in pieces of clothing inherited from relatives who have died; a tarnished ring, priceless to me alone; a stack of journals teeming with childhood ramblings. All are relatively small physical mementos that I consider my most indispensable belongings. All are things that I’d like to one day be able to share with a family of my own.

    Most of the advice about preparing for an extreme-weather-related calamity is extremely practical, for good reason. “First and foremost, we need to safeguard our lives,” Fernando Rivera, a professor at the University of Central Florida who studies the sociology of disasters, told me. Bracing for the realities of recovery—grabbing physical copies of identity, medical, employment, and financial documents to help with disaster assistance and insurance claims—comes second. But survivors of climate disasters can benefit from preserving other meaningful parts of their life too.

    Read: Tiny climate crises are adding up to one big disaster

    Bell told me that losing a home and certain possessions can affect a survivor’s well-being throughout the recovery process. In a small, qualitative study about supporting elderly patients through a disaster, the in-home caregivers she interviewed described the stress and personal devastation their patients experienced from those losses after Hurricanes Harvey and Irma. “There’s a kind of trauma that comes along with knowing everything you’ve worked for in your life is something that you no longer have,” she said. That can affect “their larger health trajectory, as they’re trying to recover from a disaster in advancing age and feeling like they’re starting over.”

    Although it varies person-by-person, life changes after disasters do cause grief that can manifest in health complications, Priscilla Dass-Brailsford, a psychologist and Georgetown University professor who studies the effects of trauma, told me. And if these hazards put someone in a state of chronic stress, they can lead to serious physical health problems, including cardiovascular dysfunctions and cancer. “Extreme trauma and loss from a disaster, that’s a given,” Dass-Brailsford said. In the immediate aftermath, a person’s focus is typically on physical safety and navigating any remaining threats; the interwoven mental- and physical-health effects usually come later. “Once that’s done, and you’re settled down a little bit, the enormity of what happens then strikes people,” she said—problems such as headaches and stomach issues can suddenly flare up terribly, as she’s seen in her own patients.

    Losing personal property and, for those permanently displaced by a disaster, the place they live, can mean that survivors fare worse psychologically, according to Dass-Brailsford. She was a Hurricane Katrina first responder: “I remember walking through the rubble, looking at things that were lost during the storm, and wanting to pick things up and save them,” she said. She remembered thinking that “this is someone’s treasured object, and it was just now going to be sent to the dump.”

    Some may balk at the suggestion of packing away belongings that they’d rather see every day. Precautions like this can seem unnecessary—and it’s easy to tell yourself you’d move quickly enough to save what matters in case of a crisis. But although we may feel we are ready for an unexpected disaster event, that perception can often be far from reality, Bell, the University of Michigan disaster-response researcher, told me. A 2021 study she led found that, even for the basic steps of all-hazards readiness—having a stocked emergency kit, having conversations with family or friends about evacuation plans—people believed they were more prepared than they actually were.

    Read: Hurricane Otis was too fast for forecasters

    When measuring well-being after disaster or success in recovering, the focus is on quantifiable indicators, Sara McTarnaghan, a senior research associate at the Urban Institute who studies resilience planning and disaster recovery, told me. Disasters can put people in debt, or land them in the hospital. But, she said, hazard preparation shouldn’t just consider those tangible aspects of recovery. “As people, we’re often boiled down to those financial resources,” McTarnaghan said. When I asked her how people could better prepare for other types of loss they might experience, she stressed the importance of mental health, which climate-hazard-recovery processes tend to put less emphasis on. Reminding people that sentimental belongings—whether a photograph, a figurine, or an item of clothing—matter too could be a small stride toward helping them recover emotionally after a disaster.

    Of course, the objects that would be most meaningful to save will differ from person to person. And that’s probably one reason it’s harder to find guidance about selecting and storing personal property ahead of a calamity, McTarnaghan said. Thinking about this question at all is a good first step. “I absolutely encourage the reflection of some of the more personal and sentimental pieces that also lead to loss for individuals,” she said.

    Because searching for those items really isn’t what anyone should be doing in the rushed moments before evacuating, or as they start to shelter in place. No one should prioritize personal memorabilia over their own physical safety. Think of a climate carry-on as an optional supplement to a disaster kit and go bag. The latter two reflect the things we can’t live without; the first, the things we’d rather not.

    Still, creating a climate carry-on isn’t a bad idea, Rivera, the UCF sociologist, said. He has thought, too, about the possibility of a communal repository, where things that matter to people could be stored and easily accessed year-round, further encouraging community-wide hazard resilience. “Individually, you never think that you’re going to be in that situation,” he said. But climate change is that much of a threat, becoming all the more real in our daily lives. Some of us will end up in that very position, forced to swiftly determine what we consider irreplaceable.

    My dad never fathomed he would be displaced by a flood until he was watching the waters rising around him. “As the water increases, you have to, right away, rationalize what is important and take it from there,” he told me. If he could go back in time and pack a bag full of memories, he would stuff it with objects that are now lost: a collection of books he’d kept with him for decades and photo albums of his parents, his brother, and his sister, all of whom he’s lost. But of course, not everything can fit. He was thinking, too, of a rug worn down by multiple countries and moves, and a box of schoolwork and memorabilia handcrafted by my siblings and me.

    “I saved a good amount,” he said. “But the rest of it? It’s gone. And you have no choice but to move on.”

    Ayurella Horn-Muller

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  • We Have a Mink Problem

    We Have a Mink Problem

    Bird flu, at this point, is somewhat of a misnomer. The virus, which primarily infects birds, is circulating uncontrolled around much of the world, devastating not just birds but wide swaths of the animal kingdom. Foxes, bobcats, and pigs have fallen ill. Grizzly bears have gone blind. Sea creatures, including seals and sea lions, have died in great numbers.

    But none of the sickened animals has raised as much concern as mink. In October, a bird-flu outbreak erupted at a Spanish mink farm, killing thousands of the animals before the rest were culled. It later became clear that the virus had spread between the animals, picking up a mutation that helped it thrive in mammals. It was likely the first time that mammal-to-mammal spread drove a huge outbreak of bird flu. Because mink are known to spread certain viruses to humans, the fear was that the disease could jump from mink to people. No humans got sick from the outbreak in Spain, but other infections have spread from mink to humans before: In 2020, COVID outbreaks on Danish mink farms led to new mink-related variants that spread to a small number of humans.

    As mammals ourselves, we have good reason to be concerned. Outbreaks on crowded mink farms are an ideal scenario for bird flu to mutate. If, in doing so, it picks up the ability to spread between humans, it could potentially start another global pandemic. “There are many reasons to be concerned about mink,” Tom Peacock, a flu researcher at Imperial College London, told me. Right now, mink are a problem we can’t afford to ignore.

    For two animals with very different body types, mink and humans have some unusual similarities. Research suggests that we share similar receptors for COVID, bird flu, and human flu, through which these viruses can gain entry into our bodies. The numerous COVID outbreaks on mink farms during the early pandemic, and the bird-flu outbreak in Spain, gravely illustrate this point. It’s “not surprising” that mink can get these respiratory diseases, James Lowe, a veterinary-medicine professor at the University of Illinois at Urbana-Champaign, told me. Mink are closely related to ferrets, which are so well known for their susceptibility to human flu that they’re the go-to model for flu research.

    Mink wouldn’t get sick as often, and wouldn’t be as big an issue for humans, if we didn’t keep farming them for fur in the perfect conditions for outbreaks. Many barns used to raise mink are partially open-air, making it easy for infected wild birds to come in contact with the animals, sharing not only air but potentially food. Mink farms are also notoriously cramped: The Spanish farm, for example, kept tens of thousands of mink in about 30 barns. Viral transmission would be all but guaranteed in those conditions, but the animals are especially vulnerable. Because mink are normally solitary creatures, they face significant stress in packed barns, which may further predispose them to disease, Angela Bosco-Lauth, a biomedical-sciences professor at Colorado State University, told me. And because they’re often inbred so their coats look alike, an entire population may share a similar genetic susceptibility to disease. The frequency of outbreaks among mink, Bosco-Lauth said, “may actually have less to do with the animals and more to do with the fact that we raise them in the same way … we would an intensive cattle farm or chickens.”

    So far, there’s no evidence that mink from the Spanish farm spread bird flu to humans: None of the workers tested positive for the virus, and since then, no other mink farms have reported outbreaks. “We’re just not very susceptible” to bird flu, Lowe said. Our bird-flu receptors are tucked deep in our lungs, but when we’re exposed, most of the virus gets caught in the nose, throat, and other parts of the upper respiratory tract. This is why bird-flu infection is less common in people but is often pneumonia-level severe when it does happen. Indeed, a few humans have gotten sick and died from bird flu in the 27 years that the current strain of bird flu, known as H5N1, has circulated. This month, a girl in Cambodia died from the virus after potentially encountering a sick bird. The more virus circulating in an environment, the higher the chances a person will get infected. “It’s a dose thing,” Lowe said.

    But our susceptibility to bird flu could change. Another mink outbreak would give the virus more opportunities to keep mutating. The worry is that this could create a new variant that’s better at binding to the human flu receptors in our upper respiratory tract, Stephanie Seifert, a professor at Washington State University who studies zoonotic pathogens, told me. If the virus gains the ability to infect the nose and throat, Peacock, at Imperial College London, said, it would be better at spreading. Those mutations “would worry us the most.” Fortunately, the mutations that arose on the Spanish mink farm “were not as bad as many of us worried about,” he added, “but that doesn’t mean that the next time this happens, this will also be the case.”

    Because mink carry the receptors for both bird flu and human flu, they could serve as “mixing vessels” for the viruses to combine, researchers wrote in 2021. (Ferrets, pigs, and humans share this quality too.) Through a process called reassortment, flu viruses can swap segments of their genome, resulting in a kind of Frankenstein pathogen. Although viruses remixed in this way aren’t necessarily more dangerous, they could be, and that’s not a risk worth taking. “The previous three influenza pandemics all arose due to mixing between avian and human influenza viruses,” Peacock said.

    While there are good reasons to be concerned about mink, it is hard to gauge just how concerned we should be—especially given what we still don’t know about this changing virus. After the death of the young girl in Cambodia, the World Health Organization called the global bird flu situation “worrying,” while the CDC maintains that the risk to the public is low. Lowe said “it’s certainly not very risky” that bird flu will spill over into humans, but is worth keeping an eye on. H5N1 bird flu is not new, he added, and it hasn’t affected people en masse yet. But the virus has already changed in ways that make it better at infecting wild birds, and as it spreads in the wild, it may continue to change to better infect mammals, including humans. “We don’t understand enough to make strong predictions of public-health risk,” Jonathan Runstadler, an infectious-diseases professor at Tufts University, told me.

    As bird flu continues to spread among birds and in domestic and wild animal populations, it will only become harder to control. The virus, formally seasonal, is already present year-round in parts of Europe and Asia, and it is poised to do the same in the Americas. Breaking the chain of transmission is vital to preventing another pandemic. An important step is to avoid situations where humans, mink, or any other animal could be infected with both human and bird flu at the same time.

    Since the COVID outbreaks, mink farms have generally beefed up their biosecurity: Farm workers are often required to wear masks and protective gear, such as disposable overalls. To limit the risk to mink—and other susceptible hosts—farms need to reduce their size and density, reduce contact between mink and wild birds, and monitor the virus, Runstadler said. Some nations, including Mexico, Ecuador, have recently embraced bird-flu vaccines for poultry in light of the outbreaks. H5N1 vaccines are also available for humans, though they aren’t readily available.  Still, one of the most obvious options is to shut mink farms down. “We probably should have done that after SARS-CoV-2,” Bosco-Lauth, at Colorado State, said. Doing so is controversial, however, because the global mink industry is valuable, with a huge market in China. Denmark, which produces up to 40 percent of the world’s mink pelts, temporarily banned mink breeding in 2020 after a spate of COVID outbreaks, but the ban expired last month, and farms are returning, albeit in a limited capacity.

    But mink  are far from the only animal that poses a bird-flu risk to humans. “Frankly, with what we’re seeing with other wildlife species, there really aren’t any mammals that I would discount at this point in time,” Bosco-Lauth said. Any mammal species repeatedly infected by the virus is a potential risk, including marine mammals, such as seals. But we should be most concerned about the ones humans frequently come into close contact with, especially animals that are raised in high density, such as pigs, Runstadler said. This doesn’t pose just a human public-health concern, he said, but the potential for “ecological disruption.” Bird flu can be a devastating disease for wildlife, killing animals swiftly and without mercy.

    Whether bird flu makes the jump into humans, it isn’t the last virus that will threaten us—or mink. The era we live in has become known as the “Pandemicene,” as my colleague Ed Yong has called it, one defined by the regular spillover of viruses into humans, caused by our disruption of the normal trajectories of viral movement in nature. Mink may never pass bird flu to us. But that doesn’t mean they won’t be a risk the next time a novel influenza or coronavirus comes around. Doing nothing about mink essentially means choosing luck as a public-health strategy. Sooner or later, it will run out.

    Yasmin Tayag

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  • The Case for a Primary Challenge to Joe Biden

    The Case for a Primary Challenge to Joe Biden

    Joe Biden seems like he’s running again, God love him.

    He will most likely make this official in the next couple of months, and with the support of nearly every elected Democrat in range of a microphone. That is how things are typically done in Washington: The White House shall make you primary-proof. The gods of groupthink have decreed as much.

    Unless some freethinking Democrat comes along and chooses to ignore the groupthink.

    In private, of course, many elected Democrats say Biden is too old to run again and that they wish he’d step away—which aligns with what large majorities of Democrats and independents have been telling pollsters for months. The public silence around the president’s predicament has become tiresome and potentially catastrophic for the Democratic Party. Somebody should make a refreshing nuisance of themselves and involve the voters in this decision.

    Yes, this would be a radical move, and would anger a bunch of Democrats inside the various power terrariums of D.C., starting with the biggest one of all, at 1600 Pennsylvania Avenue. There would be immediate blowback from donors, the Democratic National Committee, and other party institutions. But do it anyway. Preferably before Biden makes his final decision, while there’s an opening. If approached deftly, the gambit could benefit the president, the party, and even the challenger’s own standing, win or lose.

    David A. Graham: The 2024 U.S. presidential race: A cheat sheet

    There has to  be one good Challenger X out there from the party’s supposed “deep bench,” right? Someone who is compelling, formidable, and younger than, say, 65. Someone who is not Marianne Williamson. Someone who would be unfailingly gracious to Biden and reverential of his career—even while trying to end it.

    Before we start tossing out names, let’s establish a big to be sure. To be sure, primaries can be very bad for presidents seeking reelection. There is good reason no incumbent has been subjected to a serious intraparty challenge in more than three decades—not since the Republican Pat Buchanan launched a populist incursion against President George H. W. Bush in 1992. A dozen years earlier, President Jimmy Carter had endured an acrid primary challenge from Senator Edward Kennedy. Both Carter and Bush managed to hold off their challengers, but they came away battered and wound up losing their general elections.

    Biden, however, is a special case, for two reasons. The first concerns the disconnect between how affectionately most Democrats view him versus their desire to move on from him. Recent surveys show that 60 percent of Democrats don’t want Biden to run again. These spigots of cold water in the polls have been accompanied by icy buckets of liberal commentary and chilly assessments from (mostly) anonymous elected Democrats in the press. By contrast, large majorities of Republicans wanted Donald Trump to seek reelection in 2020, and an overwhelming consensus of Democrats wanted Barack Obama to run again in 2012. Same with Republicans and George W. Bush in 2004, and Democrats and Bill Clinton in 1996.

    Why should Biden not enjoy the same coronation? He’s done a good job in the eyes of the people who voted for him in 2020. His party overperformed in the midterms. He seems to be humming along fine—feisty State of the Union here, muscular visit to Ukraine there, and endless jokers to the right. He has achieved important things, has clearly enjoyed the gig, and appears quite eager for more. The difference in Biden’s case, of course, goes directly to the second reason for his special predicament. It begins with an 8.

    Allow me to point out, as if you don’t already know this, that Biden is old. He is 80 now, will be 82 on Inauguration Day 2025, and will hit 86 if he makes it all the way through a second term. He was born during the Roosevelt administration (Franklin, not Teddy, but still).

    The Delaware Corvette has flipped through the odometer a time or two. I’ve pointed this out before, in this publication. The White House did not like that story. But it was true then, and it’s truer now—by eight months, and a lot more Democrats are getting a lot more anxious.

    “This is not a knock on Joe Biden, just a wish for competition,” says Representative Dean Phillips of Minnesota, one of a tiny number of elected Democrats who have expressed on-the-record trepidation about Biden’s plans. Phillips couches the absurdity of this in terms of free enterprise. “In the business world, if the dominant brand in a category had favorability ratings like the current president does, you would see a number of established brands jump into that category,” Phillips told me. “Believe me, there are literally hundreds in Congress who would say the same thing,” he said. “But they simply won’t fucking say a word.”

    Read: Why Biden shouldn’t run in 2024

    Here’s the deal, as Biden would say. No one wants to be accused of messing around with established practices when the alternative—very possibly Donald Trump—is so terrifying. But just as Trump has intimidated so many Republicans into submission, he also has paralyzed Democrats into extreme risk aversion. This has fostered an unhealthy capitulation to musty assumptions. And if you believe groupthink can’t be horribly wrong, I’ve got some weapons of mass destruction to show you in Iraq, not to mention a Black man who will never be elected president and, for that matter, a reality-TV star who won’t either.

    The big riddle is: Who? Let’s assess an (extremely) hypothetical primary field. First, eliminate Vice President Kamala Harris, Secretary of Transportation Pete Buttigieg, and any other member of Biden’s administration from consideration. Such an uprising against the boss would represent an irreparably disloyal and unseemly act and simply would not happen. Let’s also eliminate Senator Bernie Sanders from consideration, because been there, done that (twice), and he’s actually Biden’s senior by a year.

    Otherwise, indulge me in a bit of mentioning. Here is a hodgepodge of possible primary nuisances: Michigan Governor Gretchen Whitmer; Senator Cory Booker of New Jersey; Senator Chris Murphy of Connecticut; Senator Amy Klobuchar of Minnesota; former Representative Tim Ryan of Ohio; Representative Alexandria Ocasio-Cortez of New York; California Governor Gavin Newsom; Maryland Governor Wes Moore. This is a noncomprehensive list.

    Let’s take the first Challenger X on the list, the newly reelected Whitmer, who, for the record, says she will not be running in 2024, regardless of what Biden does. She declared as much after her double-digit crushing of Republican Tudor Dixon in November. “Gov. Gretchen Whitmer says she is committed to a full second term,” reads the report in Bridge Michigan, the local publication to which she revealed her plans. The article refers to the 46th president as “aging Democratic incumbent Joe Biden.”

    What might it look like if Whitmer did make a run at said “aging Democratic incumbent”? The how dare you types would be unpleasantly aroused. Words like ingrate, disloyal, and opportunist would be hurled in her face. She would be blamed for creating a turbulent situation for the self-styled “party of grown-ups,” and at a time when they can credibly portray Republicans as an irresponsible brigade of nutbags, cranks, and chaos agents. Whitmer would also, implicitly, be accused of not “waiting her turn.” Just as Obama was in 2008, when he opted to skip the line and sought the Democratic nomination, even though the groupthink memo at the time stipulated that it was Hillary Clinton’s turn.

    But perhaps the pushback would not be as rough as Challenger X expected. In all likelihood, it would occur mostly in private or anonymously. Biden would be somewhat obliged to project calm and indifference in public. “The more the merrier,” the president and his surrogates would say through tight smiles. Nobody would benefit from any appearance of resentment.

    David A. Graham: The catch-24 of replacing Joe Biden

    Challenger X could earn goodwill by campaigning with class and expressing unrelenting gratitude to Biden. She could simply nod and shrug in response to the various admonitions. Emphasize her own credentials and the grave threat posed by Trump, Florida Governor Ron DeSantis, or any other Republican. Say repeatedly that she would do whatever was necessary to help and support the president if primary voters nominated him again.

    For any Challenger X, the main selling point would fall into the general classification of representing “new blood,” a “fresh start,” or some such. These terms would serve as polite stand-ins for the age issue rather than smears about Biden’s mental capacity. Another thematic argument would involve popular American ideals such as “choice” and “freedom.” As in: Democrats deserve a “choice” and should enjoy the “freedom” to vote for someone other than the oldest president in history—the guy well over half of you don’t want to run.

    Challenger X would almost certainly receive tons of press coverage—probably good coverage, too, given that the media are predisposed to favor maverick-y candidates who inject unforeseen conflict into the process. When the voting starts, maybe this upstart would overperform—grabbing 35 percent or so in the early states, say. Maybe they wouldn’t surpass Biden, but could still reap the good coverage, gracefully drop out, and gain an immediate advantage for 2028. Or maybe Biden would take the hint, step away on his own, and let Democrats get on with picking their next class of national leaders. To some degree, the party has been putting this off since Obama was elected.

    Quite obviously, Democrats today have a strong craving for someone other than the sitting president. (Also obvious: That someone is not the current vice president.) Many voters viewed Biden’s candidacy in 2020 as a one-term proposition. He suggested as much. “Look, I view myself as a bridge, not as anything else,” Biden said nearly three years ago at a campaign event in Michigan, where he appeared with Harris, Booker, and Whitmer. “There’s an entire generation of leaders you saw stand behind me. They are the future of this country.”

    Some mischief-maker should give Democrats a path to that future starting now. Voters bought the bridge in 2020. But when does it become a bridge too far?

    Mark Leibovich

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  • Psychedelics Open Your Brain. You Might Not Like What Falls In.

    Psychedelics Open Your Brain. You Might Not Like What Falls In.

    If you’ve ever been to London, you know that navigating its wobbly grid, riddled with curves and dead-end streets, requires impressive spatial memory. Driving around London is so demanding, in fact, that in 2006 researchers found that it was linked with changes in the brains of the city’s cab drivers: Compared with Londoners who drove fixed routes, cabbies had a larger volume of gray matter in the hippocampus, a brain region crucial to forming spatial memory. The longer the cab driver’s tenure, the greater the effect.

    The study is a particularly evocative demonstration of neuroplasticity: the human brain’s innate ability to change in response to environmental input (in this case, the spatially demanding task of driving a cab all over London). That hard-won neuroplasticity required years of mental and physical practice. Wouldn’t it be nice to get the same effects without so much work?

    To hear some people tell it, you can: Psychedelic drugs such as psilocybin, LSD, ayahuasca, and Ecstasy, along with anesthetics such as ketamine, can enhance a user’s neuroplasticity within hours of administration. In fact, some users take psychedelics for the express purpose of making their brain a little more malleable. Just drop some acid, the thinking goes, and your brain will rewire itself—you’ll be smarter, fitter, more creative, and self-aware. You might even get a transcendent experience. Popular media abound with anecdotes suggesting that microdosing LSD or psilocybin can expand divergent thinking, a more free and associative type of thinking that some psychologists link with creativity.

    Read: Here’s what happens when a few dozen people take small doses of psychedelics

    Research suggests that psychedelic-induced neuroplasticity can indeed enhance specific types of learning, particularly in terms of overcoming fear and anxiety associated with past trauma. But claims about the transformative, brain-enhancing effects of psychedelics are, for the most part, overstated. We don’t really know yet how much microdosing, or a full-blown trip, will change the average person’s mental circuitry. And there’s reason to suspect that, for some people, such changes may be actively harmful.

    There is nothing new about the notion that the human and animal brain are pliant in response to everyday experience and injury. The philosopher and psychologist William James is said to have first used the term plasticity back in 1890 to describe changes in neural pathways that are linked to the formation of habits. Now we understand that these changes take place not only between neurons but also within them: Individual cells are capable of sprouting new connections and reorganizing in response to all kinds of experiences. Essentially, this is a neural response to learning, which psychedelics can rev up.

    We also understand how potent psychedelic drugs can be in inducing changes to the brain. Injecting psilocybin into a mouse can stimulate neurons in the frontal cortex to grow by about 10 percent and sprout new spines, projections that foster connections to other neurons. It also alleviated their stress-related behaviors—effects that persisted for more than a month, indicating enduring structural change linked with learning. Presumably, a similar effect takes place in humans. (Comparable studies on humans would be impossible to conduct, because investigating changes in a single neuron would require, well, sacrificing the subject.)

    The thing is, all those changes aren’t necessarily all good. Neuroplasticity just means that your brain—and your mind—is put into a state where it is more easily influenced. The effect is a bit like putting a glass vase back into the kiln, which makes it pliable and easy to reshape. Of course you can make the vase more functional and beautiful, but you might also turn it into a mess. Above all else, psychedelics make us exquisitely impressionable, thanks to their speed of action and magnitude of effect, though their ultimate effect is still heavily dependent on context and influence.

    Read: A new chapter in the science of psychedelic microdosing

    We have all experienced heightened neuroplasticity during the so-called sensitive periods of brain development, which typically unfold between the ages of 1 and 4 when the brain is uniquely responsive to environmental input. This helps explain why kids effortlessly learn all kinds of things, like how to ski or speak a new language. But even in childhood, you don’t acquire your knowledge and skills by magic; you have to do something in a stimulating enough environment to leverage this neuroplastic state. If you have the misfortune of being neglected or abused during your brain’s sensitive periods, the effects are likely to be adverse and enduring—probably more so than if the same events happened later in life.

    Being in a neuroplastic state enhances our ability to learn, but it might also burn in negative or traumatic experiences—or memories—if you happen to have them while taking a psychedelic. Last year, a patient of mine, a woman in her early 50s, decided to try psilocybin with a friend. The experience was quite pleasurable until she started to recall memories of her emotionally abusive father, who had an alcohol addiction. In the weeks following her psilocybin exposure, she had vivid and painful recollections of her childhood, which precipitated an acute depression.

    Her experience might have been very different—perhaps even positive—if she’d had a guide or therapist with her while she was tripping to help her reappraise these memories and make them less toxic. But without a mediating positive influence, she was left to the mercy of her imagination. This must have been just the sort of situation legislators in Oregon had in mind last month when they legalized recreational psilocybin use, but only in conjunction with a licensed guide. It’s the right idea.

    Read: What it’s like to trip on the most potent magic mushroom

    In truth, researchers and clinicians haven’t a clue whether people who microdose frequently with psychedelics—and are thus walking around in a state of enhanced neuroplasticity—are more vulnerable to the encoding of traumatic events. In order to find out, you would have to compare a group of people who microdose against a group of people who don’t over a period of time and see, for example, if they differ in rates of PTSD. Crucially, you’d have to randomly assign people to either microdose or abstain—not simply let them pick whether they want to try tripping. In the absence of such a study, we are all currently involved in a large, uncontrolled social experiment. The results will inevitably be messy and inconclusive.

    Even if opening your brain to change were all to the good, the promise of neuroplasticity without limit—that you can rejuvenate and remodel the brain at any age—far exceeds scientific evidence. Despite claims to the contrary, each of us has an upper limit to how malleable we can make our brain. The sensitive periods, when we hit our maximum plasticity, is a finite window of opportunity that slams shut as the brain matures. We progressively lose neuroplasticity as we age. Of course we can continue to learn—it just takes more effort than when we were young. Part of this change is structural: At 75, your hippocampus contains neurons that are a lot less connected to one another than they were at 25. That’s one of the major reasons older people find that their memory is not as sharp as it used to be. You may enhance those connections slightly with a dose of psilocybin, but you simply can’t make your brain behave as if it’s five decades younger.

    Read: What it’s like to get worse at something

    This reality has never stopped a highly profitable industry from catering to people’s anxieties and hopes—especially seniors’. You don’t have to search long online before you find all kinds of supplements claiming to keep your brain young and sharp. Brain-training programs go even further, purporting to rewire your brain and boost your cognition (sound familiar?), when in reality the benefits are very modest, and limited to whatever cognitive task you’ve practiced. Memorizing a string of numbers will make you better at memorizing numbers; it won’t transfer to another skill and make you better at, say, chess.

    We lose neuroplasticity as we age for good reason. To retain our experience, we don’t want our brain to rewire itself too much. Yes, we lose cognitive fluidity along the way, but we gain knowledge too. That’s not a bad trade-off. After all, it’s probably more valuable to an adult to be able to use all of their accumulated knowledge than to be able to solve a novel mathematical problem or learn a new skill. More important, our very identity is encoded in our neural architecture—something we wouldn’t want to tinker with lightly.

    At their best, psychedelics and other neuroplasticity-enhancing drugs can do some wonderful things, such as speed up the treatment of depression, quell anxiety in terminally ill patients, and alleviate the worst symptoms of PTSD. That’s enough reason to research their uses and let patients know psychedelics are an option for psychiatric treatment when the evidence supports it. But limitless drug-induced self-enhancement is simply an illusion.

    Richard A. Friedman

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  • Why We Just Can’t Quit the Handshake

    Why We Just Can’t Quit the Handshake

    Mark Sklansky, a pediatric cardiologist at UCLA, has not shaken a hand in several years. The last time he did so, it was only “because I knew I was going to go to the bathroom right afterwards,” he told me. “I think it’s a really bad practice.” From where he’s standing, probably a safe distance away, our palms and fingers are just not sanitary. “They’re wet; they’re warm; they’re what we use to touch everything we touch,” he said. “It’s not rocket science: The hand is a very good medium to transmit disease.”

    It’s a message that Sklansky has been proselytizing for the better part of a decade—via word of mouth among his patients, impassioned calls to action in medical journals, even DIY music videos that warn against puttin’ ’er there. But for a long time, his calls to action were met with scoffs and skepticism.

    So when the coronavirus started its sweep across the United States three years ago, Sklansky couldn’t help but feel a smidgen of hope. He watched as corporate America pocketed its dealmaking palms, as sports teams traded end-of-game grasps for air-fives, and as The New Yorker eulogized the gesture’s untimely end. My colleague Megan Garber celebrated the handshake’s demise, as did Anthony Fauci. The coronavirus was a horror, but perhaps it could also be a wake-up call. Maybe, just maybe, the handshake was at last dead. “I was optimistic that it was going to be it,” Sklansky told me.

    Read: Good riddance to the handshake

    But the death knell rang too soon. “Handshakes are back,” says Diane Gottsman, an etiquette expert and the founder of the Protocol School of Texas. The gesture is too ingrained, too beloved, too irreplaceable for even a global crisis to send it to an early grave. “The handshake is the vampire that didn’t die,” says Ken Carter, a psychologist at Emory University. “I can tell you that it lives: I shook a stranger’s hand yesterday.”

    The base science of the matter hasn’t changed. Hands are humans’ primary tools of touch, and people (especially men) don’t devote much time to washing them. “If you actually sample hands, the grossness is something quite exceptional,” says Ella Al-Shamahi, an anthropologist and the author of the book The Handshake: A Gripping History. And shakes, with their characteristic palm-to-palm squeezes, are a whole lot more prone to spread microbes than alternatives such as fist bumps.

    Not all of that is necessarily bad: Many of the microscopic passengers on our skin are harmless, or even beneficial. “The vast majority of handshakes are completely safe,” says David Whitworth, a microbiologist at Aberystwyth University, in Wales, who’s studied the griminess of human hands. But not all manual microbes are benign. Norovirus, a nasty diarrheal disease infamous for sparking outbreaks on cruise ships, can spread easily via skin; so can certain respiratory viruses such as RSV.

    The irony of the recent handshake hiatus is that SARS-CoV-2, the microbe that inspired it, isn’t much of a touchable danger. “The risk is just not very high,” says Jessica Malaty Rivera, an infectious-disease epidemiologist at the Johns Hopkins Center for Health Security. Despite early pandemic worries, this particular coronavirus is more likely to use breath as a conduit than contaminated surfaces. That’s not to say that the virus couldn’t hop from hand to hand after, say, an ill-timed sneeze or cough right before a shake. But Emily Landon, an infectious-disease physician and hand-hygiene expert at the University of Chicago, thinks it would take a hefty dose of snot or phlegm, followed by some unwashed snacking or nose-picking by the recipient, to really pose a threat. So maybe it’s no shock that as 2020’s frantic sanitizing ebbed, handshakes started creeping back.

    Read: The great pandemic hand-washing blooper

    Frankly, that doesn’t have to be the end of the world. Even when considering more shake-spreadable pathogens, it’s a lot easier to break hand-based chains of transmission than airborne ones. “As long as you have good hygiene habits and you keep your hands away from your face,” Landon told me, “it doesn’t really matter if you shake other people’s hands.” (Similar rules apply to doorknobs, light switches, subway handrails, phones, and other germy perils.) Then again, that requires actually cleaning your hands, which, as Sklansky will glady point out, most people—even health-care workers—are still pretty terrible about.

    For now, shakes don’t seem to be back to 2019 levels—at least, not the last time researchers checked, in the summer of 2022. But Gottsman thinks their full resurgence may be only a matter of time. Among her clients in the corporate world, where grips and grasps are currency, handshakes once again abound. No other gesture, she told me, hits the same tactile sweet spot: just enough touch to feel personal connection, but sans the extra intimacy of a kiss or hug. Fist bumps, waves, and elbow touches just don’t measure up. At the pandemic’s worst, when no one was willing to go palm-to-palm, “it felt like something was missing,” Carter told me. The lack of handshakes wasn’t merely a reminder that COVID was here; it signaled that the comforts of routine interaction were not.

    If handshakes survive the COVID era—as they seem almost certain to do—this won’t be the only disease outbreak they outlive, Al-Shamahi told me. When yellow fever pummeled Philadelphia in the late 18th century, locals began to shrink “back with affright at even the offer of a hand,” as the economist Matthew Carey wrote at the time. Fears of cholera in the 1890s prompted a small cadre of Russians to establish an anti-handshake society, whose members were fined three rubles for every verboten grasp. During the flu pandemic that began in 1918, the town of Prescott, Arizona, went so far as to ban the practice. Each time, the handshake bounced back. Al-Shamahi remembers rolling her eyes a bit in 2020, when she saw outlets forecasting the handshake’s untimely end. “I was like, ‘I can’t believe you guys are writing the obituary,’” she told me. “That is clearly not what is happening here.”

    Handshakes do seem to have a knack for enduring through the ages. A commonly cited origin story for the handshake points to the ancient Greeks, who may have deployed the behavior as a way to prove that they weren’t concealing a weapon. But Al-Shamahi thinks the roots of handshaking go way further back. Chimpanzees—from whom humans split some 7 million years ago—appear to engage in a similar behavior in the aftermath of fights. Across species, handshakes probably exchange all sorts of sensory information, Al-Shamahi said. They may even leave chemical residues on our palm that we can later subconsciously smell.

    Read: What a handshake smells like

    Handshakes aren’t a matter of survival: Plenty of communities around the world get by just fine without them, opting instead for, say, the namaste or a hand over the heart. But palm pumping seems to have stuck around in several societies for good reason, outlasting other customs such as curtsies and bows. Handshakes are mutual, usually consensual; they’re imbued with an egalitarian feel. “I don’t think it’s a coincidence that you see the rise of the handshake amongst all the greetings at a time when democracy was on the rise,” Al-Shamahi told me. The handshake is even, to some extent, built into the foundation of the United States: Thomas Jefferson persuaded many of his contemporaries to adopt the practice, which he felt was more befitting of democracy than the snobbish flourishes of British court.

    American attitudes toward handshakes still might have undergone lasting, COVID-inspired change. Gottsman is optimistic that people will continue to be more considerate of those who are less eager to shake hands. There are plenty of good reasons for abstaining, she points out: having a vulnerable family member at home, or simply wanting to avoid any extra risk of getting sick. And these days, it doesn’t feel so strange to skip the shake. “I think it’s less a part of our cultural vernacular now,” Landon told me.

    Sklansky, once again in the minority, is disappointed by the recent turn of events. “I used to say, ‘Wow, it took a pandemic to end the handshake,’” he told me. “Now I realize, even a pandemic has failed to rid us of the handshake.” But he’s not ready to give up. In 2015, he and a team of his colleagues cordoned off part of his hospital as a “handshake-free zone”—an initiative that, he told me, was largely a success among health-care workers and patients alike. The designation faded after a year or two, but Sklansky hopes that something similar could soon return. In the meantime, he’ll settle for declining every proffered palm that comes his way—although, if you go for something else, he’d rather you not choose the fist bump: “Sometimes,” he told me, “they just go too hard.”

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    Katherine J. Wu

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  • Should Your Flu and COVID Shots Go in Different Arms?

    Should Your Flu and COVID Shots Go in Different Arms?

    At a press briefing earlier this month, Ashish Jha, the White House’s COVID czar, laid out some pretty lofty expectations for America’s immunity this fall. “Millions” of Americans, he said, would be flocking to pharmacies for the newest version of the COVID vaccine in September and October, at the same appointment where they’d get their yearly flu shot. “It’s actually a good idea,” he told the press. “I really believe this is why God gave us two arms.”

    That’s how I got immunized last week at my local CVS: COVID shot on the left, flu shot on the right. I spent the next day or so nursing not one but two achy upper arms. Reaching high shelves was hard; putting on deodorant was worse. And it did make me wonder what would have happened if I’d ignored Jha’s teleological advice and gotten both jabs in the same arm. Maybe my annoyance would have been lessened. Or perhaps the same-side shots would have made the soreness in my left arm way worse. When I posed this puzzle to immunologists, vaccinologists, and pharmacists, I got back a lot of hems and haws. For the millions of Americans who will be getting two-shot appointments by fall’s end, they told me, the choice really does come down to personal preference in the absence of clear data: You’ve just gotta pick a side. Or, you know, two.

    On the one hand (sorry), there are the vaccine double-downers. Sallie Permar, a pediatrician at Weill Cornell Medicine, and Stephanie Langel, an immunologist at Duke University, both said they’d probably get both shots in the same shoulder; so would Rishi Goel, an immunologist at the University of Pennsylvania. “Personally, I’d rather have one arm that’s slightly uncomfortable than both,” Goel told me.

    On the other hand, we’ve got Team Divide-and-Conquer. Several experts said they’d follow the White House protocol of splitting shots left and right. Ali Ellebedy, an immunologist at Washington University in St. Louis, told me he’d prefer to have two slightly sore arms to one totally dead one. Jacinda Abdul-Mutakabbir, a pharmacist at Loma Linda University, says she generally recommends that her patients get the vaccines on separate sides “for comfort.” Last year, she opted to get the flu shot and a COVID booster within a few inches of each other, and “I wanted to chop my arm off,” she told me. “Never again.”

    Read: America’s fall booster plan has a fatal paradox

    The deciding logic here should be pretty intuitive, Permar told me. Two shots on one side might be expected to double how sore that arm will get, though the experience of each vaccine recipient will depend on a bevy of factors, including the ingredients in the shots and that person’s infection and vaccination history, as well as their immune-system health. Also, for people like my husband—who’s prone to very heavy vaccine side effects—the choice may not matter at all. He was so knocked out by the fever and chills that came with his COVID-flu-shot combo, he couldn’t have cared less which arms got the shots.

    I dug around for studies examining the consequences of the one-versus-two-arm choice and found only one: a Canadian trial from 2003, which vaccinated a few hundred sixth-graders at two dozen middle schools against group C meningitis and hepatitis B at the same time. Roughly half the kids got both shots in the same arm; the others received one on each side. (Some kids in the latter group requested that their shots be administered by a pair of nurses who could plunge both syringes at the same time.) Among students in the same-arm group, 18 percent ended up with tenderness at the injection site that they rated “moderate or severe.” But those kids fared better than the ones in the two-arm group, 28 percent of whom experienced moderate or severe tenderness in at least one arm, and 8 percent of whom had it in both arms at the same time.

    But those results apply only to that group of kids in that setting, with those two specific vaccines; there’s no telling whether the same trends would be seen with flu shots and COVID shots when given to children or adults. Michela Locci, an immunologist at the University of Pennsylvania, told me she suspects that combining flu and COVID inoculations in the same arm could actually drive extra side effects: “The overall inflammation might be higher,” she said.

    Many pediatricians, who often have to administer four or five shots to a baby at once, are habitual splitters. “If there’s more than one vaccine syringe to give to a baby, generally, two legs are used,” Permar told me. (Kids usually upgrade to arm shots sometime in toddlerhood—it’s all about finding a muscle that’s big enough for the needle to hit its mark.) Doctors also have a nerdy reason to split shots between arms or legs. “If there’s a local reaction to the vaccine,” Permar said, “you can identify which vaccine it was if you separate them by space.” (For the record, I had a more painful reaction in my left arm, where I got the COVID shot. Others I’ve spoken with have reported the same disparity.)

    Read: Families are going rogue with rapid tests

    The CDC advocates for separating vaccination shots by at least one inch of space. Per the agency, if a COVID shot is being given at the same time as a vaccine “that might be more likely to cause a local injection site reaction,” the shots should be dosed into “different limbs, if possible.” Two types of flu shots cleared for use in people 65 years and older—the high-dose vaccine and the adjuvanted one—fall into that category. But the different-limb advice doesn’t seem to apply to other flu shots, including those cleared for use in younger adults and kids.

    However someone ends up taking simultaneous flu and COVID shots, the placement is unlikely to affect how much protection the vaccines provide. There could be an argument for letting “each side focus on its own thing,” says Gabriel Victora, an immunologist at Rockefeller University. “But it probably doesn’t make a whole lot of difference.” Children routinely get combo vaccines, such as DTaP and MMR, each of which combines multiple disease-fighting ingredients in a single syringe. The triple-threat formulas work just as well as injecting their individual parts. The immune system is used to multitasking: It spends all day being bombarded by microbes, so there’s good reason to believe that with vaccines, too, our body will see simultaneous shots “as independent events,” Goel told me.

    Which arm gets picked for which shot, though, will affect where the jab’s contents end up. After a vaccine is injected, its immunity-inducing ingredients meander to the nearest lymph node, such as the ones in the armpits. There, hordes of immune cells fight over the vaccine’s bits, and the fittest and fiercest among them are selected to leave the lymph node and fight. Here, again, doubling up on one arm shouldn’t be an issue, Goel said: The immune-cell boot camps in these lymph nodes have “a good amount of real estate.”

    It might even be a good idea to stick the same limb—and thereby, the same lymph node—every time you get another dose of a particular vaccine. After immune cells in a lymph node spot a particular bit of pathogen, some of them march off into battle, but others may hang around like reserve troops, mulling over what they’ve learned. A couple of recent studies, one of them in mice, hint that repeated delivery of the same ingredients to those veteran learners could give the body a slight edge—though the extent of that advantage “might be marginal,” Victora told me. Still, Langel, of Duke, told me jokingly that because she usually gets all of her vaccines in her “non-writing” arm, the lymph node beneath it could now be especially superpowered—a “nice bonus” for her defenses on the whole.

    That said, no one should stress too much about getting a shot in the “wrong” arm. “It’s not like you’re immune on the left side and not on the right side,” Goel told me. Immune cells travel throughout the body; there is no midline DMZ. Permar even points out that getting the newly formulated COVID vaccine, which includes new ingredients tailored to fight Omicron subvariants, on the opposite side from the previous rounds could help its ingredients reach a fresher slate of cells. “I think you could convince yourself either way,” she told me. Which, honestly, leaves me totally at peace with my choice. Apart from arm achiness, I had no other side effects—and in a way, I preferred the symmetry of the one-on-each-side injections.

    With all that said, it’s worth briefly acknowledging a third option: Splitting the flu and COVID vaccines into separate visits. I was, before my most recent COVID shot, some 10 months out from my previous dose. But it felt awfully early for my flu shot, which might be better timed for peak protection if taken later in the season. Still, the allure of getting it all over with was too tantalizing, especially because I happen to have a lot of travel up ahead. In the grand scheme of things, the bigger, more important choice was opting into the shots at all.

    Katherine J. Wu

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