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  • Death Sentences Are Doled Out Based on Looks

    Death Sentences Are Doled Out Based on Looks

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    Though there are guidelines for when a convicted criminal merits the death penalty (in states that still have capital punishment), ultimately, the jury makes the decision. A new study finds that the facts of the case are not the sole determinant of whether or not a jury will issue a death sentence—based on the research, certain “untrustworthy” facial features appear to play a significant role in capital-punishment sentencing. 

    According to the study, published Dec. 14 in the journal Psychology Science, people associate certain facial features such as down-turned lips and heavy brows with being untrustworthy. It’s one of the earliest forms of stereotype bias humans learn—even babies prefer those without these traits—and scientists have found it affects outcomes such as who we select as leaders, who gets paid more, and criminal-sentencing outcomes.

    “There’s longstanding knowledge among practicing attorneys that jurors form impressions of defendants, oftentimes based on arbitrary unreliable characteristics,” says Craig Haney, a professor of psychology at the University of California, Santa Cruz. For example, decades of evidence suggest that Black defendants generally and defendants of any skin color accused of killing white females are more likely to be sentenced to death. 

    “Researchers have for decades used what’s called counter-stereotype interventions to reduce things like racial bias, gender bias, etc.,” says Jon Freeman, an associate professor of psychology at Columbia University, and an author of the new study. “We’ve been wanting to apply those same kinds of principles and take a very different approach to understanding facial stereotype biases as learned and malleable.” In Freeman’s study, he shows for the first time that facial bias can be accounted for with a short training when the death penalty is at stake.

    To test this, Freeman conducted a series of four experiments using images of 400 inmates convicted of murder in Florida, all white males, some of whom received a death sentence and some of whom received life in prison. In the first experiment, more than 450 volunteers were shown the images and asked to score each on trustworthiness and attractiveness. Before the exercise, a portion of the participants were put through a short training module designed to break the association between facial features and trustworthiness, in which traditionally “untrustworthy” faces were shown with descriptions of positive behaviors, and vice versa. Across the board, men who were sentenced to death were more likely to be labeled as untrustworthy by participants in the control group, with attractiveness scores closely related as well. In the trained group, however, trustworthiness didn’t predict real-world sentencing outcomes. 

    The other three experiments included similar trainings with slightly different tests afterwards, including one where participants were asked to make sentencing recommendations assuming full guilt and another where they were asked to do the same after being given the full details of a case. In each experiment, participants who received the training were less likely to fall into the same associative patterns.

    Read More: What My Week of Jury Duty Taught Me About Race

    That facial bias can be corrected so easily in the short term is really telling of just how unprepared jurors in the real world are, says Haney, who was not involved with the study. Jury selection is “a fairly crude process,” he says. “We really put jurors in the position of making profoundly important decisions, including the decision between life or death. And it’s a role for which they receive no training whatsoever.”

    A fundamental philosophical shift happens when capital punishment enters a courtroom, says Haney. Rather than looking at evidence to determine how an event occurred, when a jury is considering the death penalty, their analysis becomes about a person. “At that stage, they’ve been convicted,” Haney says, “Now, the question is, do they deserve the ultimate penalty or the next worst penalty? And that is very much a decision based on who [a jury] thinks the defendant is.” Any biases that jurors feel are more likely to bubble to the surface when making this more subjective moral evaluation.

    Still, training jurors before they sit in on actual cases just isn’t realistic yet, say Freeman and Haney. First, experts need to know more about how these different types of biases interact—trustworthiness, race, gender, and more all tend to be associated with one another in different ways that Freeman hopes to uncover by replicating his study with other populations of inmates. 

    Even with all the information in the world, says Haney, it’s unlikely that widespread anti-bias training for juries would ever be supported across the political spectrum. “I can imagine differences of opinion about what the content [of such training] should be,” he says. Second, and perhaps the biggest non-political barrier than anyone attempting to design an anti-bias jury training would encounter, is that short-term trainings like Freeman’s don’t tend to correct biases for much longer than it takes to run an experiment. Trials for capital offenses are often weekslong, and in research settings, lasting changes in implicit bias require repeated, regular interventions. But learning that attitudes towards facial features can be changed at all is “quite striking,” says Freeman. 

    “I think the larger point is that there are these biases, and there are things that can be done about them. And this is just one more way in which we don’t really prepare jurors for the all important role that they’re going to be asked to play,” says Haney. 

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    Contact us at letters@time.com.

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    Haley Weiss

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  • What to Know About the JN.1 Variant

    What to Know About the JN.1 Variant

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    A new variant of the virus that causes COVID-19 is rising to prominence in the U.S. as winter illness season approaches its peak: JN.1, yet another descendent of Omicron.

    JN.1 was first detected in the U.S. in September but spread slowly at first. In recent weeks, however, it has accounted for a growing percentage of test samples sequenced by labs affiliated with the U.S. Centers for Disease Control and Prevention (CDC), surpassing 20% during the two-week period ending Dec. 9. By some projections, it will be responsible for at least half of new infections in the U.S. before December ends.

    Here’s what to know about JN.1.

    Is JN.1 more infectious or severe than other SARS-CoV-2 variants?

    JN.1 is closely related to BA.2.86, a fellow Omicron descendent that first popped up in the U.S. this past summer. The two variants are nearly identical, according to the CDC, except for a single difference in their spike proteins, the part of the virus that allows it to invade human cells.

    The fact that JN.1 is responsible for a growing portion of infections suggests it is either more contagious or better at getting past our bodies’ immune defenses than previous iterations of the virus, the CDC says. But there is no evidence that it causes more severe disease. The World Health Organization (WHO) has not labeled JN.1 a variant of concern—that is, a new strain of the SARS-CoV-2 virus with potential for increased severity; decreased vaccine effectiveness; or substantial impacts on health care delivery.

    Right now, there’s nothing that suggests JN.1 is any more dangerous than other viral strains, even though it may cause a bump in transmission, the CDC says. Primary symptoms are likely to be the same as those from previous variants: a sore or scratchy throat, fatigue, headache, congestion, coughing, and fever.

    Do vaccines, tests, and treatments work against JN.1?

    So far, the signs are positive. COVID-19 tests and treatments are expected to be effective against JN.1, the CDC says. And even though the latest COVID-19 booster shot was designed to target the XBB.1.5 variant, preliminary research suggests it also generates antibodies that work against JN.1, albeit fewer of them. (As ever, vaccines will not totally block JN.1 infections, but should reduce the likelihood of death and severe disease.)

    In a Dec. 13 statement, WHO’s expert COVID-19 vaccine advisory group recommended sticking with the current XBB.1.5 vaccines, since they seem to provide at least some cross protection.

    Will JN.1 cause a COVID-19 surge in the U.S.?

    The CDC no longer logs every single COVID-19 diagnosis in the U.S., but other indicators of disease are up. Wastewater surveillance data suggest there’s a lot of COVID-19 going around, particularly in the Northeast. Hospitalizations are also on the rise, although far fewer people are being admitted than at this time last year. Death rates are currently stable, though they tend to lag slightly behind hospitalizations.

    It’s too soon to say whether JN.1 will cause a significant spike in cases, although its ascendance during the busy holiday travel and gathering season could fuel increased transmission. “Right now, we do not know to what extent JN.1 may be contributing to these increases or possible increases through the rest of December like those seen in previous years,” the CDC wrote in a Dec. 8 update on the variant.

    The best defenses against JN.1—and other variants of SARS-CoV-2—remain getting vaccinated, masking in crowded indoor areas, and limiting exposure to people who may have been infected.

    More Must-Reads From TIME

    Write to Jamie Ducharme at jamie.ducharme@time.com.

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    Jamie Ducharme

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  • The Language of Hospice Can Help Us Get Better at Discussing Death

    The Language of Hospice Can Help Us Get Better at Discussing Death

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    Just because death is inevitable doesn’t make it easy or natural to talk about. In a new study, researchers wondered if hospice workers—experts in end-of-life care—had lessons to teach the rest of us when it came to speaking with patients and families about death.

    Daniel Menchik, an associate professor of sociology at the University of Arizona who studies the use of language in different fields of medicine, spent eight months sitting in on team meetings at a hospice care facility that were also open to patients’ families. His goal was to study how both groups talked to each other about the impending death of the patient. His findings, which will be published in the journal Social Science & Medicine, reinforce the importance of framing death as a process rather than an outcome when caring for frightened patients and loved ones. It’s a helpful strategy that he says everyone could use when facing loss.

    “People aren’t dead until they’re dead,” Menchik says. “And even then, they may not be experienced that way by the people that they are connected to, especially if they’ve had quality time with that person.” 

    In the study, Menchik noticed that hospice workers used three different types of verbs in meetings with family members: predictive, subjunctive, and imperative. Predictive verbs are used to assert things about the future and include words like “will” and “going to.” Imperative verbs carry a similar firmness, but include a call to action; the most common one Menchik encounters in medical settings is “should.” Subjunctive verbs convey some sort of personal stance when talking about the future. “Think,” “feel,” “want,” and many other expressive phrases fall in this category. 

    When a family starts hospice care, “their capabilities to engage in intense conversations [about death] are usually pretty limited,” Menchik says. But he believes that hospice workers help bridge that gap by minimizing their use of imperative verbs. In meetings he observed, imperative verbs made up just 17% of the verb phrases used by hospice professionals. That’s fairly uncommon in medicine. Menchik has also researched how surgeons speak—a field where questions about courses of treatment and illness progression demand quick and conclusive answers—and found that they use imperative verbs much more often, likely as a way of projecting that they have control over outcomes.

    A higher priority in hospice is emotional management. “With the language that they’re using, they’re there as guides, not as the authorities,” says Dr. Maya Giaquinta, a pediatric resident at the Medical College of Wisconsin who worked with Menchik on the paper (and emphasized that she’s speaking in her own capacity, and not on behalf of the school). Using more predictive and subjunctive verbs allows hospice experts to orient care around current emotional needs, rather than future events.

    Read More: Losing a Loved One Can Be Life-Threatening

    While predictive verbs were used the most often in the meetings Menchik and Giaquinta observed, at least half of the verbs most frequently used were words that conveyed uncertainty, like “could,” “might,” and “may.” In declining to talk about future events as set in stone, the researchers found, professionals were better able to redirect conversations to the current moment and focus on anxieties and emotions. 

    Hospice professionals aren’t taught about care at a grammatical level in training, at least not explicitly, says Dr. Robert Gramling, a physician and the chair of palliative medicine at the University of Vermont, who was not involved with the study. Research that describes and identifies the skills experts pick up over time can be valuable for expanding the general public’s ability to think and talk about death, he says.

    Gramling has studied end-of-life conversations, which he says require “thinking granularly about the words we use and how they land with other people.” When speaking to a family or a patient facing death, ask yourself: “Am I referring to this person as dying? Or am I referring to this person as living?” Gramling suggests. Such reflection grounds the conversation firmly in the present. Another question to consider about your wording: “Is that framed in the language of the person who’s experiencing it, or is it really my perspective of things?” In hospice, where patients face only one outcome, speaking with empathy and compassion along the path to it is one thing within people’s control.

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    Contact us at letters@time.com.

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    Haley Weiss

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  • 6 Myths About IBD, Debunked

    6 Myths About IBD, Debunked

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    Michelle Pickens’ symptoms escalated in college. At the time, she was throwing up at least once a day, and experiencing frequent nausea, abdominal pain, diarrhea, and constipation. Juggling classes with work at a design studio became an extreme exercise in perseverance. She knew in her gut that something was wrong.

    Yet three different doctors “wrote it off as stress,” says Pickens, now 32, who lives in Annapolis, Md. Lab work and procedures to see inside her gastrointestinal tract showed nothing abnormal. “No one wanted to dig deeper,” she recalls. In a final act of desperation, Pickens saw yet another doctor, and this one gave her a different kind of test: a pill-sized camera to swallow. It revealed an angry area of inflammation deep within her bowel—a “blind spot” that the colonoscopy and endoscopy hadn’t reached. It was Crohn’s disease. 

    Crohn’s is one of two types of inflammatory bowel disease (IBD), a chronic condition that causes the intestinal tract to become swollen and sometimes painful. Crohn’s affects the entire digestive channel from mouth to anus, while ulcerative colitis (UC) impacts the colon, sometimes creating sores along the lining of the large intestine.

    “The underlying reasons for IBD are still under investigation,” says Dr. Florian Rieder, vice chair of the department of gastroenterology, hepatology, and nutrition, and co-director of the inflammatory bowel disease section at the Cleveland Clinic in Ohio. It’s clear that certain people are more vulnerable to IBD, due to some combination of genetic, environmental, and lifestyle factors. Whatever the catalyst, IBD arises when the immune system uses its trademark weapon—inflammation—to attack healthy gut tissue as if responding to infection or injury. 

    Approximately 1 in every 100 Americans is living with the disease, according to recent prevalence data published in the journal Gastroenterology. Diagnosing IBD and treating it promptly is critically important, as it can have serious, potentially life-threatening health complications, says Dr. Jordan Axelrad, director of research for the Inflammatory Bowel Disease Center at NYU Langone Health in New York City.

    But as Pickens knows all too well, IBD can fly under the radar. Clouding the picture are abundant myths and misconceptions, which at best create confusion—and at worst, cause harm. Here are six that doctors and patients would like everyone to digest.

    1. Myth: IBD and IBS are the same thing.

    Fact: While their acronyms are nearly identical and their symptoms can overlap, irritable bowel syndrome (IBS) and inflammatory bowel disease are hardly carbon-copy conditions. 

    Understanding which one is at play is essential. That’s true not just for peace of mind, but because the treatments—and potential health consequences—are different. 

    Over time, IBD’s hallmark trait of inflammation can damage the body, even setting the stage for certain cancers, particularly of the colon, experts say. 

    IBS, meanwhile, doesn’t cause inflammation or raise the risk of cancer. Unlike IBD, it is not a disease but a constellation of symptoms that can absolutely be debilitating but without causing bodily harm.

    In short: “IBD causes tissue damage. IBS does not,” Rieder says. 

    And how’s this for a gut punch? People can have both conditions at the same time—some 30% to 50% of IBD patients may also develop IBS, according to the Cleveland Clinic. 

    2. Myth: IBD only affects the gut.

    Fact: It can impact the joints, bones, kidneys, liver, eyes, and skin (picture: ulcers or red nodules), for example. These beyond-the-gut issues happen in about one-third to half of patients with IBD, Rieder says. 

    Sometimes, they’re “the first clue” of an impending IBD diagnosis, according to a Harvard Medical School publication. In existing patients, they may signal “the need for treatment review and adjustment” to better control the disease and its health complications. 

    “When I first tell people I have Crohn’s, they say, ‘Oh, it’s the poop disease,’” Pickens says. “Yeah, it involves the digestive system, but it’s so much more than that.”

    Read More: IBD Patients on the Most Effective Ways Doctors Can Treat Their Condition

    3. Myth: Diet is a permanent fix for IBD.

    Fact: “This is a huge misconception,” Axelrad says. “I hear this very often—if not from patients, then from their family members.” 

    The internet is full of claims that special diets are the antidote to IBD, he says. “This has been studied and unfortunately, no specific diet has been shown to cure IBD, and very few dietary interventions have been shown to reduce inflammation in IBD.” Similarly, there is no definitive proof that specific foods cause IBD and its inflammatory response, adds Axelrad, who is also a spokesperson for the American Gastroenterological Association.

    Of course, everyone knows that eating certain foods can trigger GI symptoms. “If we eat a giant kale salad, we might feel bloated after,” he points out. “But it’s not because we’ve made our gut more inflamed.”

    For people with IBD, reaching for those foods may worsen symptoms. That’s why Axelrad often recommends trying IBS-friendly eating patterns designed to ease gas, bloating, abdominal pain, and other GI issues. “That can just make patients feel a lot better, even if it’s doing nothing to reduce their underlying inflammation.”

    4. Myth: Only adults get IBD.

    Fact: People are most often diagnosed between ages 15 to 40, but the disease can affect anyone, Rieder explains. “There are thousands of children around the world with inflammatory bowel disease.”

    Take it from Sneha Dave. The 25-year-old from Indianapolis was 6 when she developed ulcerative colitis. “I’ve lived with it my whole life,” says Dave, founder of Generation Patient, an advocacy organization for young adults living with chronic conditions. As part of this work, she runs a fellowship for young people with IBD in the U.S. and all over the globe, including in countries like India and Ethiopia.

    “I had very early onset IBD, which tends to be a lot more aggressive and severe,” she says. Extremely ill for much of her childhood, she was in and out of the hospital. By high school, she weighed just 60 pounds, prompting surgery to remove her diseased colon and rectum.

    She now lives with a J-pouch—essentially a makeshift bowel surgeons created using her small intestine, restoring continence and bowel function. She still requires medication to manage her underlying disease and flare-ups, which is an excellent segue to the next point of confusion.

    5. Myth: Surgery is a cure.

    Fact: For certain patients with IBD, surgery is an essential and sometimes lifesaving treatment. It may curb debilitating symptoms when medications don’t work or lose their edge. Make living manageable. Prevent death. (Over time, IBD-related inflammation can create medical emergencies—a swollen-shut intestine, say, or hole in the colon wall.)

    But the story doesn’t end when damaged organs are removed. “Some patients may feel that cutting it out cures you,” Rieder says. “That’s certainly not the case.”

    After surgery, Crohn’s “invariably comes back,” and more than half of people with ulcerative colitis will see their inflammation return, at least temporarily, despite having a new bowel fashioned from healthy tissue, Rieder explains. 

    Because of this, Crohn’s patients who undergo surgery are typically put on preventive medications to keep IBD at bay, while people with ulcerative colitis generally start medication when their symptoms return post-operatively.

    To learn that drug therapy may be a lifelong reality after surgery? “It’s disappointing,” Dave says, especially because many of these medications are no cakewalk. “Surgery is an amazing option for many patients, but it’s important to know the full story early on.”

    A major goal of IBD treatment is to achieve remission. That means “healing up the gut”—i.e., getting the affected areas to look as normal and uninflamed as possible on tests—and helping patients feel better, Axelrad says. 

    Treatments for IBD typically range from medication to surgery, often in combination. Both paths are used to help quell symptoms and curb internal damage.

    One big medication category includes biologics, usually in the form of monoclonal antibodies, which are lab-made immune system proteins designed to target and tamp down that erroneous attack on healthy tissue. These are usually given via in-the-vein infusions or injections, Rieder says.

    The other large category includes small molecules, “chemical structures” taken in pill form to control the immune system, Rieder says. There are other drug options, too, from antibiotics to steroids, depending on a patient’s disease type, risk factors, and needs.

    As with any medication, these drugs aren’t without side effects. Some may create an opening for infections by dampening immunity. Some may raise cancer risk. Some come with nausea or skin rashes, for example. 

    This helps explain why many patients who need IBD surgery aren’t pleased to learn that IV infusions every few weeks or daily pills may remain fixtures in their lives, Rieder says: “It’s a fact that’s not easy to take.” 

    “Overall, the medications that we use are safe,” he adds. “They have been extensively tested, and the effect of the drugs outweighs the risk for side effects.” 

    As Axelrad puts it, “These medications are there to give patients back their lives.”

    Read More: How to Maintain Your Social Life When You Have IBD

    6. Myth: Very little can be done.

    Fact: The notion that IBD is a one-way ticket to lifelong suffering from which there is no relief comes up a lot, Axelrad says. His response is simple: “There are really a lot of options from a therapeutic standpoint to improve patients’ quality of life, reduce inflammation, and reduce complications,” he says. And he should know, not only as a physician in the field but as someone who also lives with Crohn’s.

    Today, Dave describes living a very normal life. “I’ve gotten to climb mountains,” she says. She frequently travels around the country and world as part of her Generation Patient advocacy work. 

    Pickens, who now has two young kids, is also content with her journey. So far, she hasn’t needed surgery. Trial and error with several medications finally led her to a biologic that she says is working. Although she isn’t symptom-free and needs IV infusions every six to eight weeks—a two-and-a-half-hour process each time—she says it’s worth it. “I finally got a clear colonoscopy, which is really exciting.”

    Pickens is “sharing the realness” of her IBD journey on social media and other platforms under the moniker Crohnically Blonde. A patient influencer with the American Gastroenterological Association, she says being someone others can “vent back and forth with” and making people feel less alone gives her purpose. 

    She isn’t shy about describing the time she barfed in secret on a first date with her now-husband, a nurse who didn’t make her feel judged or “like it was gross or embarrassing” when she was in the hospital “going through all these bowel movement things,” early in their relationship. Therapy helps her cope with the emotional toll of the disease. “There are a lot of negative ways that IBD has impacted my life,” Pickens says. “But it has impacted me positively, too.”

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    Contact us at letters@time.com.

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    Lindsay Lyon

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  • Teens Are Taking More Reliable Birth Control

    Teens Are Taking More Reliable Birth Control

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    The teen birth rate in the U.S. has been declining consistently for more than 30 years, despite the fact that the number of teenage girls having sex has not changed since at least 2002. A new report from the U.S. Centers for Disease Control and Prevention (CDC) suggests a key driver of this trend: a dramatic increase in teenage girls using long-lasting and reliable forms of contraception.

    The percentage of girls ages 15 to 19 using long-acting reversible contraception, which includes intrauterine devices (IUDs) and contraceptive implants, reached a reported high of 19% from 2015-2019. That’s more than three times the rate at which they were used from 2011-2015. 

    Long-lasting birth control can be up to 20 times as effective as birth control pills and other hormonal contraceptive options like the NuvaRing over time, and they can offer years of protection. “Public health focuses on these because they’re easy to use,” says Joyce Amba, a social scientist at the CDC’s National Center for Health Statistics and co-author of the report. “They don’t require a daily regimen like a pill and they’re very effective.” But for many teens, and even women, they can be the most difficult methods of birth control to access. Insurance coverage for teens looking to have an IUD or implant placed can be spotty, and the placement procedures mean that physician visits are more intensive than the consultations other methods require and more difficult to afford for teens without parental consent.

    Read More: Why Everyone Is Having Bad Sex (Especially Young People)

    Despite the barriers, the increasing popularity of these methods suggests that access to and knowledge about them are improving. One likely reason why is the growing public support for comprehensive sex education over time, which—despite being in danger in 2023—grew more common in schools throughout the 2010s. Overall, teens use more varied methods of contraception than they did when the CDC established its current survey methods in 2002, including emergency contraception, which went from being used by 8% of girls ages 15 to 19 in 2011-2015 to 22% of girls in 2015-2019. A similar increase occurred in the share of teens who reported using more than one contraceptive method, which reflects that teens may be more aware of their choices than they used to be.

    The data in the new report only go up to 2019, and Amba says that it’s still too early to know how trends may have continued or changed beyond that year—including how they may have been affected by the political battles over contraceptive access that have begun since the Supreme Court overturned the federal right to abortion in 2022. According to separate smaller surveys and information shared by clinics including Planned Parenthood, the Supreme Court’s decision led to a significant increase in teens and women of all ages seeking long-lasting contraceptive methods. “The data in the future will be very interesting,” Amba says. 

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    Contact us at letters@time.com.

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    Haley Weiss

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  • WeightWatchers Is Now Prescribing Weight Loss Drugs

    WeightWatchers Is Now Prescribing Weight Loss Drugs

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    WeightWatchers has been through a lot of changes recently. In 2018 the popular weight loss program changed its name to WW with an updated mission: “Wellness That Works.” For the first time, that mission includes medications.

    Last spring, the company acquired Sequence, a digital health company, which allowed members to get prescriptions for weight loss drugs. Now the 60-year old company is launching WeightWatchers Clinic, which will give them access to telehealth weight loss management and doctors who can prescribe weight loss medications like semaglutide (Wegovy) and tirzepatide (Zepbound).

    It’s a significant shift for a company that has long focused on behavior-based strategies: making changes in diet and exercise, utilizing a “points” system for tallying the caloric and nutritional value of different foods, and relying on a community of support through coaches and other members that meet regularly to keep dieters motivated.

    “We are no longer a consumer retail brand; we are a digital health company,” says WeightWatchers CEO Sima Sistani. “We are trying to lead the conversation around obesity and get people thinking about not just lifestyle interventions, but also clinical solutions like medications.”

    “If we get it right, it could be the end of diet culture,” Sistani says, “and diet can go back to literally meaning habitual nourishment.”

    WeightWatchers won’t be generating revenue from prescribing weight loss medications, but it will charge members an additional $99 a month on top of the monthly fee to access the clinic that givens them access to the drugs. The company is also beefing up the programs it offers on its app and is launching a program specifically for people taking these medications.

    More From TIME

    “Some people see it as a left turn,” says Gary Foster, chief scientific officer at WeightWatchers. “But we’re evolving as the science evolves.”

    Foster says the program is needed since the medications introduce a completely different set of challenges for people taking them. Most people trying to lose weight focus on managing the constant food cues that surround them, as well as learning about portion control and how to quell emotional triggers for eating. But because the new drugs drastically reduce appetite, people taking them have the opposite problem: remembering to eat, and specifically making sure they consume enough protein to maintain muscle mass.

    WeightWatchers’ evolving stance on weight loss drugs

    Jean Nidtech founded WeightWatchers in 1963 when she realized that having a group of friends who were trying to lose weight together would provide critical psychological support and motivation. The support-group-style meetings, in which members shared their challenges and successes and received encouragement throughout their journey, remain a mainstay of the program.

    Even when various weight loss drugs became available over the years, WeightWatchers has never included them in its program. “There wasn’t much consumer interest in those medications, since they were associated with 7%, 8%, and 9% weight loss,” says Foster.

    The program focused instead on more scientifically supported strategies, such as addressing sleep and stress and teaching cognitive behavioral skills such as recognizing eating triggers and findings ways to manage cravings.

    But then a new generation of drugs called GLP-1 agonists came along, achieving mainstream popularity over the past few years. What makes these drugs different is how effectively they suppress hunger signals and control the activity of the stomach and digestive system. Semaglutide (sold under the brand names Ozempic and Wegovy) is part of this group, while tirzepatide (brand names: Mounjaro and Zepbound) targets both GLP-1 and another hormone, GIP. Both are more effective than any previous weight loss drugs. Studies show that people taking semaglutide can lose around 15% of their body weight, and people taking tirzepatide can lose more than 20%.

    With strong scientific studies supporting how well they worked, Foster says adding them to WeightWatcher’s options just made sense. “We are combining the best of biology with the best of behavior change,” he says. “It’s a false dichotomy to say it’s either behavior or medications. Medications will drive weight loss, but behavior change has never been more important because no medication will teach you how to eat healthier, make sure you’re getting enough protein, and ensure you have enough muscle mass through strength training.”

    Inside WeightWatchers’ new GLP-1 program

    The new GLP-1 support program, which will be included in the company’s $23 monthly membership, is for people who want to address the physical and psychological changes that come with taking these drugs.

    Donna Deutsch, a longtime WeightWatchers member, decided she wanted to try one of the newly approved drugs for weight loss earlier this year. Most were approved for treating diabetes at the time, but could be prescribed off label to help with weight loss. She didn’t feel comfortable asking her primary care physician about them—thinking “I would be automatically denied if I asked her about these drugs,” she says—so she turned to the telehealth company, Sequence, after seeing a commercial about its services. After a virtual consultation in which the doctor discussed her weight and medical history, the physician prescribed tirzepatide (Mounjaro).

    Deutsch understood that the prescription was off label, and because she does not have diabetes, she had to pay for the injections out of pocket.

    Still, she says it was worth it. She quickly started losing weight because she no longer felt hungry. “The food noise disappeared: the noise coming from my kitchen, telling me to come back and eat chocolate or ice cream,” she says. She’s been taking Mounjaro for nearly a year and no longer snacks throughout the day. Within a few months, she had lost 30 to 35 pounds.

    Around that time, Deutsch was invited to participate in a pilot program WeightWatchers was launching for members who were taking one of the newer weight loss medications—what is now the GLP-1 program. Deutsch joined, eager to better understand how her body was responding to the medication, and wanting to sustain the early success she was having. The supportive community she had previously found in WeightWatchers, along with resources like recipes and access to a dietitian, were a huge help. “It became a lot easier,” she says, to grocery shop and know what to cook to meet the specific nutritional needs she has while taking the medication, such as getting enough protein and drinking plenty of water.

    Her current diet is much different from the one she used to adhere to when doing WeightWatchers before Mounjaro. That’s because her dietary needs are, too. “I’m learning about different sources of protein and combinations of foods I can incorporate into my daily diet,” she says. “I was not a big egg-eater, but now I do a lot of egg salads and deviled eggs, and I always have hard boiled eggs in the refrigerator. And my big craving now is for blueberries.”

    WeightWatchers’ new clinic

    Members can now get the drugs directly from the WeightWatchers telehealth clinic: a reworked version of Sequence’s telehealth services. Those who are interested in prescriptions for Wegovy, Zepbound, or other weight loss medications can take an intake survey and then discuss with a health care provider whether they qualify for one of the new drugs according to criteria set by the U.S. Food and Drug Administration: namely, that they have a BMI over 30 or a BMI of 27 or above plus at least one obesity-related condition, such as high blood pressure or elevated cholesterol. Members can upload parts of their electronic health records to help providers determine if they could benefit from taking a weight loss drug, and if so, which one. Members also must upload pictures of themselves, with identification, to validate their weight and identity to ensure that they are getting the appropriate drug.

    Clinic users will also benefit from another perk: WeightWatchers will help them obtain any pre-authorization clearance required by their insurers if the drug is covered by their plan or by their employer. Playing an active role in advocating for reimbursement is important, says WeightWatchers CEO Sistani. “If employers and insurers start covering these drugs, that will be an opportunity to really shift global health outcomes,” she says.

    Because Wegovy and Zepbound can cause thyroid issues and digestion problems, members receiving these drugs through the clinic will also get monthly check ins with their clinic health care provider to monitor their weight loss and any side effects. Dr. Spencer Nadolsky, medical director at WeightWatchers, says half of the doctors staffing the clinic are board certified in obesity medicine, and all of them need to complete a training program to ensure they are up to date on using the newer weight loss medications.

    Not everyone who wants the new drugs will necessarily be right for them, or, even if they qualify, be able to get access to them. That’s especially true of Wegovy, which is in short supply after its manufacturer, Novo Nordisk, decided to limit starter doses to ensure that anyone who starts taking the drug can continue to get it. That’s why some members using the clinic can also get older weight loss drugs at no cost if their clinic doctors believes these medications can help until supply increases.

    Deutsch is currently taking the highest dose of Mounjaro and hopes to eventually move to maintenance treatment, which could mean tapering down the dose or even stopping the injections. “I’m hoping I will continue to be successful in keeping weight off once I’m off Mounjaro,” she says. “But if not, I know I still have WeightWatchers, and I can still go back to following the system that made WeightWatchers so successful. I know I won’t be alone.”

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    Alice Park

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  • After Recalls and Infections, Experts Say Safer Eyedrops Will Require New FDA Powers

    After Recalls and Infections, Experts Say Safer Eyedrops Will Require New FDA Powers

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    WASHINGTON — When you buy eyedrops at a U.S. store, you might assume you’re getting a product made in a clean, well-maintained factory that’s passed muster with health regulators.

    But repeated recalls involving over-the-counter drops are drawing new attention to just how little U.S. officials know about the conditions at some manufacturing plants on the other side of the world—and the limited tools they have to intervene when there’s a problem.

    The Food and Drug Administration is asking Congress for new powers, including the ability to mandate drug recalls and require eyedrop makers to undergo inspections before shipping products to the U.S. But experts say those capabilities will do little without more staff and resources for foreign inspections, which were a challenge even before the COVID-19 pandemic forced regulators to skip thousands of visits.

    “The FDA is not getting its job done in terms of drug quality assurance inspections abroad,” said David Ridley of Duke University and co-author of a recent paper tracking the downturn in inspections. “Very few foreign drugmakers have been inspected in the past four years.”

    In 2022, FDA foreign inspections were down 79% from 2019, according to agency records collected by Ridley’s group. Inspections increased this year but are still far below pre-pandemic levels.

    FDA spokesman Jeremy Kahn said: “The FDA works to inspect as many facilities possible, but ultimately industry is responsible for the quality of their products.”

    An October recall of two dozen eyedrop brands came after FDA staff found cracked floors, barefoot workers and other unsanitary conditions at a Mumbai plant that supplied products to CVS, Walmart and other major retailers. It was the first time FDA staff had visited the site.

    That inspection was prompted by an earlier recall of tainted eyedrops from a different Indian plant that’s been linked to four deaths and more than a dozen cases of vision loss. That plant had also never been previously inspected.

    “These are very rare instances, but what we’ve seen is that these products can cause real harm,” said Dr. Timothy Janetos, an ophthalmologist at Northwestern University. “Something needs to change.”

    Experts point to three possible changes:

    Earlier inspections

    Prescription medicines are highly regulated. Before a drugmaker can sell one in the U.S., it must undergo FDA review to establish its safety and effectiveness. As part of the process, the FDA typically inspects the factory where the drug will be made.

    But eyedrops and other over-the-counter products don’t undergo preliminary review or inspections. Instead, they are governed by a different system called a monograph, essentially a generic recipe for all medicines in a particular class. So long as drugmakers attest that they are using the standard recipe, they can launch a product within days of filing with the FDA.

    “It’s nothing more than electronic paperwork,” said Dr. Sandra Brown of the Dry Eye Foundation, a nonprofit advocating for increased regulation. “There’s no requirement for the facility to be inspected prior to shipping for sale.”

    The FDA says it has flexibility to adjust its review process “to ensure safety.”

    But the agency is asking Congress for the power to require manufacturers of eyedrops and other sterile products to give at least six months notice before shipping products from a new factory. That would give inspectors time to visit facilities that aren’t on their radar.

    The proposal could face pushback from some over-the-counter drugmakers, who aren’t accustomed to preapproval inspections.

    But Brown says the unique risks of tainted eyedrops require a different approach from pills and tablets.

    “Anything you swallow is going to meet up with your stomach acid, which is going to kill most bacteria,” Brown said. “It’s much more dangerous to put a product in your eye.”

    Requiring recalls

    The FDA warned consumers in late October not to use the eyedrops sold at CVS, Rite-Aid and other stores. But the products weren’t officially recalled until Nov. 15, almost three weeks later.

    That’s because Indian manufacturer, Kilitch Healthcare, initially declined to cooperate. The FDA can force recalls of food, medical devices and many other products, but it lacks the same authority for drugs and instead must ask companies to voluntarily take action.

    The FDA recently asked Congress for mandatory recall authority over drugs.

    Funding foreign inspectors

    Since the 1990s, drug manufacturing has increasingly moved to India, China and other lower-cost countries.

    The Government Accountability Office has raised concerns for years about the FDA’s oversight of the global supply chain, flagging it as a “high-risk” issue for more than a decade.

    The FDA said in a statement it uses “all available tools” to ensure Americans get “high quality, safe and effective” medications.

    The agency generally prioritizes factories that have never been inspected or haven’t been inspected in the last five years. It halted most routine, in-person foreign inspections in March 2020 and did not resume them until 2022. The agency didn’t conduct any inspections in India during the first year of COVID-19.

    FDA leaders have long said it’s challenging to recruit and keep overseas inspectors.

    Experts say Congress can and should address that.

    “Federal hiring is inherently slow and pay is often not competitive,” said Ridley, the Duke researcher. ”Congress needs to try and help FDA solve that problem and then hold them responsible for staffing inspections.”

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    Matthew Perrone/AP

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