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  • Why Attacks on Trump’s Mental Acuity Don’t Land

    Why Attacks on Trump’s Mental Acuity Don’t Land

    Ten years ago, I stood in the back of a large room at Saint Anselm College in New Hampshire, watching Donald Trump ramble. The celebrity billionaire had been loitering on the fringes of American politics for a few years, but this was my first time seeing him give a proper speech. At least, that’s what I thought he was supposed to be doing. Speaking at the Politics & Eggs forum is a rite of passage for presidential aspirants, and Trump at the time was going through his quadrennial ritual of noisily considering a bid for office. Typically, prospective candidates give variations on their stump speech in this setting. Trump was doing something else—he meandered and riffed and told disjointed stories with no evident connection to one another. The incoherence might have been startling if I had taken him seriously. But the year was 2014, and this was Donald Trump—the man who presided over a reality show in which Gary Busey competed in a pizza-selling contest with Meat Loaf. Nobody took Trump seriously. That was my first mistake.

    Over the past decade, I’ve told the story of what happened next so many times that I can recite each beat in my sleep. The ride to the tarmac in the back of Trump’s SUV. The phone call from his pilot with news that a blizzard had shut down LaGuardia Airport. The last-minute decision to reroute his plane to Palm Beach, and his fateful insistence that the 26-year-old BuzzFeed reporter in the car (me) tag along. What was supposed to be a short in-flight interview turned into two surreal, and oddly intimate, days at Mar-a-Lago, which I spent studying Trump in his natural habitat.

    The article I published a few weeks later—“36 Hours on the Fake Campaign Trail With Donald Trump”—cannot exactly be called prescient, in that I rather confidently predicted that my subject would never run for office. But my portrait of Trump—his depthless vanity, his brittle ego, his tragic craving for elite approval—has largely held up. I described him on his plane restlessly flipping through cable news channels in search of his own face, and quoted him casually blowing off his wedding anniversary to fly to Florida. (“There are a lot of good-looking women here,” he told me once we arrived, leaning in at a poolside buffet.)

    Trump, suffice it to say, did not like the article, and he responded in predictably wrathful fashion. He insulted me on Twitter (“slimebag reporter,” “true garbage with no credibility”), planted fabricated stories about me in Breitbart News (“TRUMP: ‘SCUMBAG’ BUZZFEED BLOGGER OGLED WOMEN WHILE HE ATE BISON AT MY RESORT”), and got me blacklisted from covering Republican events where he was speaking. It was a jarring experience, but enlightening in its way. I’ve returned to it repeatedly over the years, mining the episode for insight into the improbable president’s psyche and the era that he’s shaped.

    As the tenth anniversary of my Mar-a-Lago misadventure approached this week, much of the conversation about Trump was focused on his mental competency. There were political reasons for this. Democrats, hoping to deflect concerns about President Joe Biden’s age and memory, were circulating video clips in which Trump sounded confused and unhinged. Trump’s Republican primary opponents had suggested that he’d “lost the zip on his fastball” or was “becoming crazier.” Nikki Haley had called on Trump (and Biden) to take a mental-acuity test. On social media and in the press, countless detractors have speculated that Trump is losing touch with reality, or sliding into dementia, or growing intoxicated by his own conspiracy theories. The sense of progression is what unites all these claims—the idea that Trump is not just bad, but getting worse.

    Helen Lewis: Biden’s age is now unavoidable

    To test this theory, I went back and listened to the recording of my hour-long interview with Trump at Mar-a-Lago in 2014. Half-convinced by the narrative of the former president’s worsening mental health, I expected to find in that audio file a more lucid, cogent Trump—one who hadn’t yet been unraveled by the stresses and travails of power. What I found instead illustrates both the risks of returning him to the Oval Office and the futility of trying to prevent that outcome by focusing on his mental decline: He sounded almost exactly the same as he does now.

    This is not to say he sounded sharp. He struggled at times to form complete sentences, and repeatedly lost his train of thought. Throughout our conversation, he said so many obviously untrue things that I remember wondering whether he was a pathological liar or simply deluded.

    Take, for example, our exchange over Trump’s embrace of the “birther” conspiracy theory. Trump had notoriously accused President Barack Obama of forging his U.S. citizenship and, near the end of the 2012 election, had offered to donate $5 million to a charity of Obama’s choosing if he released his college transcripts.

    Here is what Trump said to me, verbatim, when I asked him about the stunt:

    Well, I thought it was good. I mean, I offered $5 million to his charity if he produced his records, so—to his favorite charity if he produced his records. Uh, and I didn’t want to see his marks; I wanted to see where it says “place of birth.” I wanted to see what he put on there. And to this day, nobody’s ever seen any of those records. Uh, they have seen a book that was written when he was a young man saying he was a man from Kenya, a young man from Kenya, ba ba ba ba ba. And the publisher of the book said, “No, that’s what he said,” and then a day later he said, “No, no, that was a typographical error.” Well, you know what a typographical error—that’s when you type the word, when you put an S at the end of a word because it was wrong. You understand that. The word Kenya versus the United States—okay. So he has a book where he said he was from Kenya. Uh, and then, uh, they said that was a typographical error. I mean, there’s a lot of things. Um, I mean I have a whole theory on it, and I’m pretty sure I’m right. Uh, but I have a whole theory as to where he was born, uh, and what he did. And if you noticed, he spent millions and millions of dollars on trying to protect that information. And to this day, I’m shocked that with the three colleges that we’re talking about—you know, Columbia, Harvard, and, and Occidental—that somebody in the office didn’t take that file and say, “Hey, here it is.” I just am shocked. But—and by the way, if it were a positive thing, I would say that it’s something he should’ve done. Because there were a lot of people that agree with me. You know, a lot of people say, “Oh, that was controversial.” A lot of those people in the room loved me because of it. You understand this. You know, there’s a group, a big group of people—I’m not saying it’s a majority, but I want to tell you, it’s a very strong silent minority at least that agrees with me. And I actually said that if he ever did it, I would hope that it showed that I was wrong. And that everything would be perfect. I would rather have that than be right.

    A couple of minutes later, I asked Trump about the charges of racism he’d faced as a result of the birther crusade. His response:

    Don’t forget, Obama called Bill Clinton a racist, and Clinton has never forgiven him for it. Um, uh, many, they called many—anytime anybody disagrees with Obama, they call him a racist. So there have been many people called racists. No, that didn’t, it never stuck in my case, uh, at all. It’s something I was never called before, and it never stuck. At all. But if you notice, whenever anyone got tough with Obama, including Bill Clinton, and including others, they would call him, they would call that person a racist. Uh, so, it’s, it was a charge that they tried, and it never stuck. And you know why it never stuck? ’Cause I am, I am, I am so not a racist, it’s incredible. So it just never stuck. As I think you would notice.

    George T. Conway III: Unfit for office

    What do you do with an answer like this if you’re a reporter? On a substantive level, it’s objectively detached from reality: Barack Obama was born in Hawaii, and there is no record of his having called Bill Clinton a racist. On a sentence level, the remarks are incoherent, confused, repetitive, and syntactically strange. Transcribing Trump is a nightmare. So is fact-checking him. In the end, I quoted eight words from this rant—“I am so not a racist, it’s incredible.”

    Maybe that was a failure on my part. For years, a contingent of Trump’s critics have argued that journalists fail to show this side of the former president—that we sanitize him by extracting only his most coherent quotes for our stories. And I’ll be the first to admit that it’s difficult to capture Trump’s rambling rhetorical style in print.

    But does anyone believe that publishing those comments in full would have meaningfully changed the public’s perception of Trump, then or now? There may have been a time—in the 1980s and ’90s, perhaps—when he sounded more articulate and grounded in reality. But that Trump was long gone by the time he announced his first campaign. It was not a secret. We all watched those rallies on TV; we all saw him in those debates. And he was elected president anyway.

    There’s a simple reason coverage of verbal flubs, memory lapses, and general octogenarian confusion is more damaging to Biden than it is to Trump. Biden ran for president on a platform of stability and competence, and that image is undermined by suggestions of mental decline. Accusing Trump of going crazy doesn’t work because, well, he has sounded crazy for a long time. The people who voted for him don’t seem to mind—in fact, it’s part of the appeal.

    After listening to the old recording of my Trump interview, I called Sam Nunberg for a gut check. A former political operative with a thick New York accent and a collection of shiny neckties, Nunberg was the prototypical Trump acolyte when I first met him. But his relationship with his former boss has been rocky since he arranged for my access to Trump in 2014 and accompanied me on that trip to Mar-a-Lago: Trump theatrically fired him after my story came out, hired him back, fired him again, then sued him for $10 million, before eventually agreeing to a settlement.

    Rich Jaroslovsky: The other time America panicked over a president’s age

    The two men haven’t spoken in years, according to Nunberg—but that hasn’t stopped reporters from calling him up for quotes about Trump’s mental state. “They’re wanting me to say he’s not the same,” Nunberg told me. “But I don’t see it, at least publicly. I think he’s the same guy.”

    And what kind of guy is that? “He’s reckless, and he’s a narcissist,” Nunberg said. But that’s not exactly news. He’s always been that way.

    McKay Coppins

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  • Ozempic Can Turn Into No-zempic

    Ozempic Can Turn Into No-zempic


    No medication in the history of modern weight loss has inspired as much awe as the latest class of obesity drugs. Wegovy and Zepbound are so effective that they are often likened to “magic” and “miracles.” Indeed, the weekly injections, which belong to a broader class known as GLP-1s, can lead to weight loss of 20 percent or more, fueling hype about a future in which many more millions of Americans take them. Major food companies including Nestlé and Conagra are considering tailoring their products to suit GLP-1 users. Underlying all this excitement is a huge assumption: They work for everyone.

    But for a lot of people, they just don’t. Anita, who lives in Arizona, told me she “took it for granted” that she would lose weight on a GLP-1 drug because “the people around me who were on it were just dropping weight like mad.” Instead, she didn’t shed any pounds. Likewise, Kathryn, from Florida, hasn’t lost any weight since starting the medication in October. “I was really hoping this was something that would be a game changer for me, but it feels like it was just a lot of wasted money,” she told me. (I’m identifying both Anita and Kathryn by their first name only to allow them to speak openly about their health issues.)

    Some people can’t tolerate the side effects of the drugs and have to stop taking them. Others simply don’t respond. For some, the strength of the dose, or length of the treatment, does not seem to make a difference. Appetites might remain robust; the “food chatter” in the brain may stay noisy. Together, both groups of less successful GLP-1 users account for a not-insignificant share of patients on these drugs—potentially up to a third. “We don’t really know why it happens, [but] we know it does happen,” Louis Aronne, an obesity-medicine specialist at Weill Cornell Medical College, told me. Despite the promise of a so-called Ozempic revolution, lots of “No-zempics” have been left behind.

    Of the two biggest reasons some people don’t lose weight on GLP-1 drugs—side effects and nonresponse—the former is much more straightforward. The GLP-1 drugs Wegovy and Zepbound (which contain the active ingredients semaglutide and tirzepatide, respectively), are known for causing potentially gnarly gastrointestinal symptoms, such as nausea and vomiting, although most people’s reactions are mild and temporary. Yet some have it far worse. Severe, albeit uncommon, side effects include pancreatitis, severe gastrointestinal distress, low blood sugar, and even hair loss, which “can push people off” the drugs, Steven Heymsfield, a professor who studies obesity at Louisiana State University, told me. In one of the biggest studies of semaglutide, encompassing more than 17,000 people over about five years, nearly 17 percent of patients discontinued the medication because of side effects.

    Far more mysterious are the people who tolerate the drugs but respond weakly to them—or sometimes not at all. Researchers have known this might happen since these drugs were in early clinical trials. About 14 percent of people who took semaglutide for obesity saw minimal impacts of less than 5 percent weight loss in one study, as did 9 to 15 percent of people who took tirzepatide in a similar one. In her own experience working with patients, “somewhere between a quarter and a third” are nonresponders, Fatima Cody Stanford, an obesity-medicine specialist at Harvard, told me, adding that it can take up to three months to determine whether the drug is working or not. That the same medication at the same dosage can lead to dramatic weight loss in one person and hardly any in another “remains confounding,” Aronne told me.

    The broad explanation is that it has something to do with genetics. The drugs work by masquerading as the appetite-suppressing hormone GLP-1 and binding to its receptor, like a key fitting into a lock. Although the lock’s overall shape is generally consistent from person to person, its nooks and crannies can vary because of genetic differences. “For some people, that key just won’t fit right,” Eduardo Grunvald, an obesity-medicine doctor at UC San Diego Health, told me. In other cases, genes may limit the effects of these drugs after they bind to GLP-1 receptors. One possibility is that people metabolize the drugs differently: Some patients may break them down too quickly for them to take effect; others may process them too slowly, potentially building up such high levels of the medications that they become toxic, Heymsfield said.

    For No-zempic patients, perhaps the most consequential impact of individual variation is on the propensity for obesity itself. “We are all very different from a genetic standpoint, in terms of our risk of weight gain,” Grunvald said. Numerous factors can drive obesity, including diet, environment, stress, and—most pertinent to GLP-1 drugs—altered brain function.

    GLP-1 drugs target a pathway that regulates appetite and insulin levels. Some cases of obesity can be caused by a disruption in that particular mechanism, in which case GLP-1s can indeed be wondrous. But “not everyone has dysfunction in this particular pathway,” Stanford said. When that is the case, the drugs won’t be very effective. A different pathway, for example, controls the absorption of fat from food; another increases energy expenditure. In these people, GLP-1s might tamp down appetite to a degree, maybe leading to some weight loss, but a different drug may be required to treat obesity at its root. “It is not all about food intake,” Stanford said.

    That’s not to say that No-zempics are out of options. They might have better success switching from one GLP-1 to the other, or even stacking them, Heymsfield said. Some patients who don’t respond to GLP-1s at all can get better results with older drugs that work on different obesity pathways, Aronne said. One, called Qysmia, a combination of the decades-old drugs phentermine and topiramate, can lead to an average weight loss of 14 percent body weight at its highest dose. If medications don’t work, bariatric surgery remains a powerful option, one that may even be growing in popularity. Last year, the number of bariatric surgeries performed in the U.S. grew despite the boom in GLP-1 usage, a trend that some expect to continue, because so many people don’t tolerate the drugs.

    The intense hype around the game-changing nature of GLP-1s makes it easy to forget that they are, in fact, just drugs. “Every drug that’s ever been made” works in some people and not in others, Heymsfield said; there’s no reason to think GLP-1s would be any different. Remembering that they are in an early stage of development has a sobering effect. Eventually, obesity drugs may leave fewer people behind. The category is expanding rapidly: By one count, more than 90 new drug candidates are in development.

    They are evolving to attack obesity from multiple fronts, which, at least in theory, widens their net of potential users. In an early study on an experimental candidate named retatrutide—called a triple agonist because it acts on GLP-1 as well as two other targets involved in obesity, GIP and glucagon receptors—100 percent of people on the highest dose lost 5 percent or more of their body weight. New candidates are also expected to have fewer side effects. They have to, Heymsfield said, because the competition is so steep that any new drug has to be “as good with less side effects, or better.”

    But no matter how good these drugs get, it’s unrealistic to think that they’ll become a one-size-fits-all treatment for everyone with obesity. The disease is simply too complex, with too many drivers, for a single type of medication to treat it. More than 200 different drugs exist for treating high blood pressure alone; in comparison, Aronne said, regulating weight is “far more complicated.” The future, rife with options, holds promise that No-zempics may find a way forward. Yet considering all the unknowns about obesity and what causes it, that may not be enough to guarantee that they will see the results they want.



    Yasmin Tayag

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  • Political Accountability Isn’t Dead Yet

    Political Accountability Isn’t Dead Yet

    On September 22, when federal prosecutors accused Senator Robert Menendez of taking hundreds of thousands of dollars in bribes, Representative Andy Kim, a fellow New Jersey Democrat, asked one of his neighbors what he thought of the charges. “That’s Jersey,” the man replied.

    The neighbor’s shrug spoke volumes about not only a state with a sordid history of political corruption but also a country that seemed to have grown inured to scandal. In nearby New York, George Santos had settled into his Republican House seat despite having been indicted on more than a dozen counts of fraud and having acknowledged that the story he’d used to woo voters was almost entirely fiction. Criminal indictments have done nothing to dent Republican support for Donald Trump, who is currently the front-runner for both the GOP nomination and the presidency next year.

    It turns out, however, that the supposedly cynical citizens of New Jersey did care that their senior senator was allegedly on the take. In the days after the indictment was unsealed, multiple polls found that Menendez’s approval rating had plummeted to just 8 percent. New Jersey’s Democratic governor, Phil Murphy, and its other Democratic senator, Cory Booker, both called on Menendez to quit. All but three of the nine Democrats in New Jersey’s House delegation have urged the senator to resign, and one of them is his own son.

    Menendez has pleaded not guilty to the charges and rejected calls to resign. A son of Cuban immigrants, he has denounced the case against him as a racially motivated persecution. But his days in the Senate are almost certainly numbered, whether he leaves of his own accord or voters usher him out. Kim has announced that he will challenge Menendez next year, and so has Tammy Murphy, New Jersey’s first lady. Menendez’s trial is scheduled for May, just one month before the primary. Early polls show Menendez barely registering support among Democrats.

    Casey Michel: We’ve never seen anything like the Menendez indictment

    “I hit a breaking point,” Kim told me, explaining his decision to run. “I think a lot of people hit a breaking point, where they’re just like, ‘We’re done with this now.’”

    Accountability has come more swiftly for Santos. National party leaders had largely protected him—Speaker Kevin McCarthy and his successor, Mike Johnson, both needed Santos’s vote in the GOP’s tight House majority. But a damning report from the bipartisan House Ethics Committee proved to be his undoing: Earlier this month, Santos became just the sixth lawmaker in American history to be expelled from the House.

    The government’s case against Menendez could still fall apart; he’s beaten charges of corruption before. But the public can hold its elected officials to a higher standard than a jury would. If the appearance (and, in this case, reappearance) of impropriety can cause voters to lose faith in the system, the events of the past few months might go some way toward restoring it. That both Menendez and Santos have suffered consequences for their alleged misdeeds offers some reassurance to ethics watchdogs who have seen Trump survive scandal after scandal, and indictment after indictment. “You can’t get away with anything. There are still some guardrails,” Noah Bookbinder, the president of Citizens for Responsibility and Ethics in Washington, told me.

    Yet Trump’s enduring impact on political accountability remains an open question. Has he lowered the standards for everyone, or do the laws of political gravity still apply to ethically compromised lawmakers not named Trump? “Donald Trump is a unique animal,” Lisa Gilbert, the executive vice president of the Washington-based nonprofit Public Citizen, told me. “He has built a cultlike following and surrounded himself with people who believe that no matter what he does, he is in the right.” Few politicians could ever hope to build such a buffer.

    Trump hasn’t evaded accountability entirely: The ethical norms he shattered while in office likely contributed to his defeat in 2020. And although he’s leading in the polls, one or more convictions next year could weaken his bid and demonstrate that the systems meant to hold American leaders in check function even against politicians who have used their popularity to insulate themselves from culpability. “He is being charged,” Gilbert said. “There are accountability mechanisms that are moving in spite of that apparatus. And to me, that’s a sign that eventually the rule of law will prevail.”

    At the same time, the Menendez and Santos examples provide only so much comfort for ethics watchdogs. The allegations against both politicians were particularly egregious. The phrase lining his pockets is usually metaphorical, but in addition to gold bars, the FBI found envelopes of cash in the pockets of suit jackets emblazoned with Menendez’s name in his closet.

    The earlier allegations Menendez faced were almost as lurid; prosecutors said he had accepted nearly $1 million in gifts from a Florida ophthalmologist, including private flights and lavish Caribbean vacations, in exchange for helping the doctor secure contracts and visas for his girlfriends. A 2018 trial ended in a hung jury, and the Department of Justice subsequently dropped the case.

    Santos was caught lying about virtually his entire life—his religion, where he had gone to school, where he worked—and then was accused of using his campaign coffers as a personal piggy bank, spending the money on Botox and the website OnlyFans.

    Read: George Santos was finally too much for Republicans

    Some of the charges against Trump, such as falsifying business records and mishandling classified documents, involve more complicated questions of law. “A lot of the Trump scandals that he’s been indicted for may sort of be beyond the grasp of the average voter,” says Tom Jensen, the director of the Democratic firm Public Policy Polling, which conducted one of the surveys finding that Menendez’s approval rating had sunk after the indictment. “Gold bars are not beyond the grasp of the average voter. Voters get gold bars, and when it’s something that’s so easy for voters to understand, you’re a lot more likely to see this sort of precipitous decline.”

    Jensen told me that in his 16 years as a pollster, he had seen only two other examples where public support dropped so dramatically after the eruption of scandal. One was Rod Blagojevich, the former Democratic governor of Illinois who was convicted of attempting to sell the Senate seat that Barack Obama vacated when he became president in 2009. The other was John Edwards, who, after running for president as a Democrat in 2008, admitted to having an affair while his wife, Elizabeth, was battling a recurrence of breast cancer. (He would later admit to fathering a child with his mistress, and face charges that he illegally used campaign funds to hide the affair; Edwards was found not guilty on the one count on which the jury reached a verdict.)

    The Trump era has revealed an asymmetry in how the parties respond to scandal. Republicans have overlooked or justified all sorts of behavior that would have doomed most other politicians, including multiple allegations of sexual assault (such as those that Trump essentially admitted to in the infamous Access Hollywood video made public in 2016). Although Santos was expelled by a Republican-controlled House, Democrats provided the bulk of the votes to oust him, while a majority of GOP lawmakers voted against expulsion. Democrats were quick to pressure Senator Al Franken to resign in 2018 after several women accused him of touching them inappropriately. (Some Democrats later regretted that they had pushed Franken out so fast.) The party also forced a defiant New York Governor Andrew Cuomo to step down in 2021 amid multiple allegations of misconduct and harassment.

    Trump’s gut-it-out strategy seems to have inspired politicians in both parties to resist demands to resign and to bet that the public’s short attention span will allow them to weather just about any controversy. Gone are the days when a scandalized politician would quit at the first sign of embarrassment, as New York Governor Eliot Spitzer did in 2008, less than 48 hours after the revelation that he had patronized high-end prostitutes. Virginia Governor Ralph Northam was able to serve out his full term despite losing the support of virtually the entire Democratic Party in 2019 after photos surfaced of him dressed in racist costumes in a medical-school yearbook. Cuomo defied calls to resign for months, and Santos forced the House to expel him rather than quit. Menendez has similarly rebuffed the many longtime colleagues who have urged him to leave.

    Shame may have left politics in the Trump era, but consequences haven’t—at least in the cases of Menendez and Santos. “Maybe these can be first steps,” Bookbinder told me, sounding a note of cautious optimism. “If you say nothing matters, then really nothing will matter. I hope we can go back to the place where people do feel like they owe it to their constituents to behave in an ethical and legal way.”

    Russell Berman

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  • Why So Many Accidental Pregnancies Happen in Your 40s

    Why So Many Accidental Pregnancies Happen in Your 40s

    After she turned 42, Teesha Karr thought she was done having kids. Six, in her mind, was perfect. And besides, she was pretty sure she had started menopause. For the past six months she’d had all the same signs as her friends: hot flashes, mood swings, tender breasts. She and her husband decided they could probably safely do away with contraception. But less than a month later, Karr felt a familiar twinge of pain in her ovary—the same twinge she’d felt every time she’d been pregnant before.

    Karr felt embarrassed. “Teenagers accidentally get pregnant. Forty-two-year-old women don’t usually accidentally get pregnant,” she told me. But, really, 42-year-old women accidentally getting pregnant is surprisingly common. Nearly 4 percent of all new babies are born to women 40 and older, according to the latest data from the National Center for Health Statistics. As many as 75 percent of pregnancies in this age range are unplanned. It’s a frequent enough occurrence that the plots of Downton Abbey, Sex Education, And Just Like That, Grey’s Anatomy, and Black-ish have depended on it.

    Many women still believe that by their 40s, unintended pregnancy just isn’t something they have to worry about. After all, many of us are told our whole lives that our biological clock is ticking, that our fertility plummets after 35, and that if we wait too long we’ll likely need some form of reproductive technology to get pregnant—if we can get pregnant at all. If conceiving at this age is so hard, surely you wouldn’t get pregnant by accident, right?

    To understand why pregnancy can, and does, happen at this age, it helps to consider the wacky in-between land that is perimenopause. This stage, which can last anywhere from a few months to about eight years, is typically assumed to be a smooth transition into menopause. In reality, it’s more like the hormonal chaos of puberty, when the ovaries first sputter to life, wreaking all sorts of bodily havoc as they try to figure out their new groove.

    In perimenopause, the ovaries are once again trying to adapt to a new normal. Only now they’re in overdrive, sending out scattered spurts of estrogen to recruit a much scarcer pool of eggs to release during ovulation. During this time, you might ovulate twice in one cycle, miss a cycle altogether, or experience unpredictable flash periods. “Those ovaries are kind of going nuts,” Robin Noble, a gynecologist and menopause specialist in Maine, told me. That can have all sorts of weird consequences. For one, extreme hormone spikes can stimulate the ovary to release extra eggs, which is one reason why fraternal twins are more common in older pregnancies.

    If your ovaries are still ovulating, however sporadically, then you can still get pregnant. The likelihood of getting pregnant does decline with age, particularly toward the tail end of your 30s. By 40, according to the American Society for Reproductive Medicine, the chance of getting pregnant during a single menstrual cycle is less than 5 percent. The problem starts when these low odds lead women to use less reliable contraception, such as the rhythm method or withdrawal. Thanks to hormone spikes and the menstrual cycle becoming less predictable, those methods become even riskier during perimenopause, and the odds can stack up.

    Read: The secret power of menopause

    “I hear it every day,” Rachel Pope, an OB/GYN and the head of female sexual health at University Hospitals, in Ohio, told me. “Many women really think that their reproductive potential doesn’t exist anymore, which is not true.” In reality, you can’t be sure you’re in menopause—and therefore really done worrying about pregnancy—until you haven’t had a period for at least a year. For this reason, the Menopause Society recommends keeping a hormonal IUD in or continuing hormonal birth-control pills for a year after your last period, just in case.

    To add to the confusion, some symptoms of perimenopause—missed periods, fatigue, mood shifts—resemble early signs of pregnancy. Lisa Perriera, an OB/GYN and the chief medical director of the Women’s Centers, a group of abortion clinics across several states, sees women almost every month who are shocked to find that their body is still capable of getting pregnant. “I’ve definitely cared for my share of 47-year-olds that are like, ‘I just thought it was menopause,’” she told me.

    Because women in their 40s may be expecting aging-related changes in their body but not looking out for signs of pregnancy, many don’t realize they’re pregnant until 16 or even 20 weeks along, Perriera said. That’s what happened to Anne Ruiz. In 2017, the 43-year-old mom wasn’t experiencing any signs of perimenopause but figured her window for pregnancy was closing fast. Her period had always been irregular, so she wasn’t overly concerned when it didn’t come for a month or two. By the time she started getting morning sickness and took a pregnancy test, she was almost four months pregnant.

    Read: Capitalism has plans for menopause

    Ruiz and her husband welcomed the news, but also felt overwhelmed. “It was probably maybe like 60 percent excited and 40 percent Oh my God, how are we going to start over?” she told me. She gave birth the next year and immediately got an IUD.

    Facing a pregnancy at a time when you think it is no longer a possibility can be profoundly distressing. “I do see a lot of people shaken by it,” Pope said. “Having a pregnancy that’s not planned can be just so life-altering,” especially at a time when abortions are difficult or impossible to access in many states. A common first reaction is denial. After Christina Ficicchia started experiencing irregular periods, at 42, her gynecologist told her she was in perimenopause. So when she missed a period entirely, she assumed her menstrual cycle was on its way out. Then she started “feeling” pregnant—“after you’ve been pregnant a few times, you kind of know,” she told me. Yet even after a positive pregnancy test, she asked her doctor to take an in-office test to confirm the results. After planning her first two children, Ficicchia struggled to wrap her mind around the choice that she now faced: “It was one that I realistically never thought that I had to make.”

    Many women face extra distress because they know that being pregnant over the age of 40 comes with greater risks. The chance of miscarriage above that age rises to one in three, if not much higher, according to the Mayo Clinic. Pregnant people over 40 are also at a greater risk for preeclampsia, gestational diabetes, placenta previa, preterm delivery, hypertension, pelvic-floor injuries—“basically everything that could go wrong,” Pope said. Risks for Down syndrome and other chromosomal abnormalities also rise.

    Read: Please don’t call my cervix incompetent

    After talking with her obstetrician, Ficicchia ultimately chose to continue her pregnancy. Despite her heightened anxiety, she delivered her fourth child, Emmerson, at age 43 with no complications. Karr wasn’t so lucky. After she and her husband adjusted to the news, Karr told her other children to expect a new sibling, and even told her colleagues. Then, at her eight-week ultrasound, the technician told her the fetus had no heartbeat.

    After finally having allowed herself to imagine another baby in her future, Karr was crushed. “I was pretty set with where I was in life and then this all happened and turned everything upside down,” she said. She is still trying to make sense of the loss, and dreads the weekly emails she still receives from pregnancy websites, telling her what to expect at each stage of pregnancy and advertising breastfeeding products. “If I’d known what was happening in my body, then this would have never happened,” she told me. “I was not informed.”

    Of course, bodies can be confusing even for the extremely well informed—for instance, doctors who spend their days explaining perimenopause to their patients. When Pope missed her period in July and started feeling tenderness in her breasts, she had a hunch that she knew what was going on: perimenopause. At 38, she was on the early side. Still, she thought, “this is probably it,” she said. A spontaneous pregnancy seemed unlikely, given that she and her husband had used IVF for their two children and were planning on using it again.

    “Then my husband, who’s a family doctor, was like, ‘Maybe you should check a pregnancy test,’” she said. In fact, Pope wasn’t perimenopausal. She was five weeks pregnant.

    Rachel E. Gross

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  • ‘Nothing Is Going to Stop Donald Trump’

    ‘Nothing Is Going to Stop Donald Trump’

    “Anybody ever hear of Hannibal Lecter?” former President Donald Trump asked last night. “He was a nice fellow. But that’s what’s coming into our country right now.”

    The leader of the Republican Party—and quite likely the 2024 GOP nominee—was on an extended rant about mental institutions, prisons, and, to use his phrase, “empty insane asylums.” Speaking to thousands of die-hard supporters at a rally in South Florida, Trump lamented that, under President Joe Biden, the United States has become “the dumping ground of the world.” That he had casually praised one of the most infamous psychopathic serial killers in cinema history was but an aside, brushed over and forgotten.

    This was a dystopian, at times gothic speech. It droned on for nearly 90 minutes. Trump attacked the “liars and leeches” who have been “sucking the life and blood” out of the country. Those unnamed people were similar to, yet different from, the “rotten, corrupt, and tyrannical establishment” of Washington, D.C.—a place Trump famously despises, and to which he nonetheless longs to return.

    His candidacy is rife with a foreboding sense of inevitability. Trump senses it; we all do. Those 91 charges across four separate indictments? Mere inconveniences. Palm trees swayed as the 45th president peered out at the masses from atop a giant stage erected near the end zone of Ted Hendricks Stadium in Hialeah. He ceremoniously accepted an endorsement from Arkansas Governor Sarah Huckabee Sanders, his former press secretary. He basked in stadium-size adulation and yet still seemed sort of pissed off. He wants the whole thing to be over already. Eleven miles away, in downtown Miami, Trump’s remaining rivals were fighting for relevance at the November GOP primary debate. “I was watching these guys, and they’re not watchable,” Trump said. His son Donald Jr. referred to the neighboring event as “the dog-catcher debate.”

    Read: Trump’s rivals pass up their chance

    Though not a single vote has been cast in this election, Trump’s 44-point lead and refusal to participate in debates has made a mockery of the primary. And though many try to be, no other Republican is quite like Trump. No other candidate has legions of fans who will bake in the Florida sun for hours before gates open. No one else can draw enough people to even hold a rally this size, let alone spawn a traveling rally-adjacent road show, with a pop-up midway of vendors hawking T-shirts and buttons and ball caps and doormats and Christmas ornaments. Voters don’t fan themselves with cardboard cutouts of Chris Christie’s head.

    Multiple merchandise vendors told me that the shirts featuring Trump’s mug shot have become their best sellers. Some other tees bore slogans: Ultra MAGA, Ultra MAGA and Proud, CANCEL ME, Trump Rallies Matter, 4 Time Indictment Champ, Super Duper Ultra MAGA, Fuck Biden. “Thank you and have a MAGA day!” one vendor called out with glee. As attendees poured into the stadium, some of the pre-rally songs were a little too on the nose: “The Devil Went Down to Georgia,” “Jailhouse Rock.” Kids darted up and down the aisles between the white folding chairs, popping out to the snack bar for ice cream and popcorn. The comedian Roseanne Barr, who a few years ago was forced out of her eponymous show’s reboot after posting a racist tweet, took the stage early and thanked the MAGA faithful for welcoming her in. “You saved my life,” she said. Feet rumbled on the metal bleachers. People danced and embraced. In the hours before the night’s headliner, this felt less like a political event and more like a revival.

    I saw the GOP operative Roger Stone and his small entourage saunter past the food trucks to modest applause. Onstage, Trump complimented Stone’s political acumen. (Stone, who is sort of the Forrest Gump of modern American politics, has played a role in seemingly every major scandal from Watergate to January 6, not to mention the Brooks Brothers riot that helped deliver Florida to George W. Bush in the 2000 election.)

    That afternoon, seeking air-conditioning at a nearby Wendy’s, I met Kurt Jantz, who told me he’s been to more than 100 Trump rallies. Jantz had driven down to Hialeah from his home in Tampa. His pickup truck is massive, raised, and wrapped in Trump iconography. (He has an image of Trump as Rambo with a bald eagle perched on one shoulder, surrounded by a tank, a helicopter, the Statue of Liberty, and the White House, plus a background of exploding fireworks. That’s only one side of the truck.) Jantz has found a niche as a pro-MAGA rapper—he performs under the name Forgiato Blow. Tattoos cover much of his body, including a 1776 on the left side of his face. He rolled up his basketball shorts to show me Trump’s face tattooed on his right thigh. “Trump’s a boss. Trump’s a businessman. Trump has the cars. Trump has the females. Trump’s getting the money. He’s a damn near walking rapper to the life of a rapper, right? I want a Mar-a-Lago.” Jantz said he’s met and spoken with Trump “numerous times,” as recently as a couple of months ago at a GOP fundraiser. Trump, he said, was aware of the work Jantz was doing to spread the president’s message, not only through his music. “I mean, that truck itself could change a lot of people’s ways,” he said.

    Though people travel great distances to experience Trump in the flesh—I spoke with one supporter who had come down from Michigan—many attendees at last night’s event were local. Dalia Julia Gomez, 61, has lived in Hialeah for decades. She told me she fled Cuba in 1993 and supports Trump because she believes he loves “the American tradition.” Hialeah is more than 90 percent Hispanic and overwhelmingly Republican. Onstage last night, Trump warned that “Democrats are turning the United States into Communist Cuba.” People booed. Some hooted. He quickly followed up, seemingly unsure of what to say next: “And you know, because we have a lot of great Cubans here!”

    Trump won Florida in 2016 and 2020. His closest rival, Florida Governor Ron DeSantis, has just been endorsed by Iowa Governor Kim Reynolds, but has otherwise been struggling to connect with voters for months. Trump has already secured many key Florida endorsements, including from Senator Rick Scott. (Senator Marco Rubio has yet to endorse.)

    Read: Inside Ivanka Trump’s dreamworld

    The night was heavy on psychological projection. “We are here tonight to declare that Crooked Joe Biden’s banana republic ends on November 5, 2024,” Trump said. Later, he vowed to “start by exposing every last crime committed by Crooked Joe Biden. Because now that he indicted me, we’re allowed to look at him. But he did real bad things,” Trump said. “We will restore law and order to our communities. And I will direct a completely overhauled DOJ to investigate every Marxist prosecutor in America for their illegal, racist, and reverse enforcement of the law on day one.”

    He seemed to tiptoe around the idea of January 6, though he did not mention the day, specifically. Instead, he said: “We inherit the legacy of generations of American patriots who gave their blood, sweat, and tears to defend our country and defend our freedom.” Earlier in the day, I spoke with Todd Gerhart, who was selling Trump-shaped bottles of honey, with a portion of the profits going to January 6 defendants (Give the “Donald” a Squeeze: $20). Gerhart lives in Charleston, South Carolina, and is among the vendors who follow the Trump show around the country. He told me that Mike Lindell, the MyPillow guy, is a fan of his product, as is General Michael Flynn. He introduced me to a woman from Tennessee named Sarah McAbee, whose husband, Ronald, was convicted on five felony charges related to January 6 and is currently awaiting sentencing. She told me she’s able to speak with him by phone once a day. Yesterday she informed him she was going to the Trump rally. “It’s a one-day-at-a-time sort of thing,” she said.

    About 100 yards away, people were lining up to meet Donald Trump Jr., who was scheduled to sign copies of his father’s photography book, Our Journey Together. Junior smiled and scribbled as his fiancée, Kimberly Guilfoyle, snapped selfies with fans. Walking around yesterday afternoon, I heard a rumor: Not only had Trump already picked his next vice president, but there was no one it could conceivably be besides his loyal namesake, Don Jr.

    A little while later, I saw Jason Miller, a senior adviser to the Trump campaign, milling about. I asked him about this rumor explicitly. He gave me an inquisitive look. “President Trump’s not ready to announce his VP pick yet,” he said. “Can you even have someone from the same family? I know you can’t have two people from the same state. So that rules it out right there.”

    Family remains a confounding part of the Trump story. His daughter Ivanka spent the day in Manhattan testifying in the case that could demolish what’s left of the family’s real-estate empire. Trump himself had taken the witness stand on Monday. The occasion seemed to still be weighing on him, and at the rally, yielded a microscopic moment of familial self-reflection. “Can you believe—my father and mother are looking down: ‘Son, how did that happen?’” (For this he did an impression of a parental voice.) He quickly pivoted. “‘We’re so proud of you, son,’” he said (in the voice again). It didn’t make much sense. He rambled his way to the end of the thought. “But every time I’m indicted, I consider it a great badge of honor, because I’m being indicted for you,” Trump told the crowd. “Thanks a lot, everybody.”

    During my conversation with Miller, I asked him if the campaign had discussed the logistics—or practicalities—of Trump getting convicted and having to theoretically run the country from prison. “There’s nothing that the deep state can throw at us that we’re not going to be ready for,” he said. “We have a plane, we have a social-media following of over 100 million people. We have the greatest candidate that’s ever lived. There’s nothing they can do. Nothing is going to stop Donald Trump.”

    What about something like a house arrest at Mar-a-Lago?

    “Nothing is going to stop Donald Trump.”

    John Hendrickson

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  • America’s Concussion Problem Is Way Bigger Than Sports

    America’s Concussion Problem Is Way Bigger Than Sports

    The months of haze began in an instant, when the horse I was riding stumbled at the exact moment I was shifting my seat. I don’t remember falling, though I do remember the feeling of the leather reins moving through my hand. I hit my thigh on the ground. Then the flat of my back hit the wall of the indoor arena so hard it felt like I’d popped every vertebrae in my spine. After a few minutes, I got back on the horse (everyone always asks if I got back on the horse), but I haven’t ridden since.

    Only on the way home did my thoughts begin to feel sluggish, like a fog was rolling across my brain. I heard ringing in my ears when I tried to think. Everything became too bright and too loud. I slept 17 to 20 hours each of the next three days. I woke up, ate, used the bathroom, and then wandered back to bed, exhausted.

    I suspected I had a concussion as soon as the brain fog began. Just the week before, I had heard on a podcast that people could get one without hitting their head. The day after the accident, my doctor confirmed my suspicion. The force of my back against the wall had given me whiplash, my neck jerking forward and back after the collision. My brain, jostling around in my skull, had been injured too.

    In my mind, the dangers of concussions were most acute for people who got too many of them—football players, boxers, military veterans, and others who underwent repeated trauma to the brain and had chronic traumatic encephalopathy. A single bump on the head? That was no big deal—except when it was.

    For months, a five-minute phone call made me exhausted, as though I’d been swimming laps for an hour. I couldn’t drive, and even as a passenger, looking out the window made me nauseous. Observing anything felt like work; my eyes skipped, as though the world was a slowed-down film reel. My real work—the writing I got paid to do—was impossible. Fun, too, was out of the question. Trying to retrieve thoughts felt like rummaging through one empty file cabinet after another. My self, that person who exists in the wiring in my brain, had gone missing. I worried that she might be gone for good.

    During that time, I started to rage against a system that leaves people suffering from concussions or “mild traumatic brain injuries” wading through bad or outdated advice. Studies keep showing that getting targeted rehabilitation for concussion symptoms can lead to a faster recovery, but that’s not what the average patient hears. Many people are still being told by doctors to simply wait a concussion out, when early treatment can make a big difference.

    My doctor told me to rest—that most concussion symptoms resolve within a few days. Three days later, the doctor said not to worry until it had been seven to 10 days. Later she updated that range to a month.

    When I was awake, I ate and used the little mental energy I had to search for information about concussions online and send emails to specialists. I wanted to know what was actually happening in my brain and if I could do anything to speed the recovery process along. I learned that a helmet can’t completely protect against a concussion because simply accelerating and decelerating quickly can exert enough force on the brain to injure it.

    Then I took a nap.

    I learned that researchers were working on blood tests that could detect a concussion by measuring protein fragments from damaged nerve fibers. (The first commercial product got FDA approval in March.) Douglas Smith, the director of the Center for Brain Injury and Repair at the University of Pennsylvania, describes these nerve fibers as the electrical grid for the city that is the brain. “Having a concussion is like having a brownout,” he told me. The brain’s connections aren’t gone, “but the signals aren’t going through.” And long-term symptoms after a single concussion aren’t uncommon. They happen to roughly 20 percent of concussion patients, Smith said.

    I rested again.

    I read books about concussions, a few chapters at a time. Most described people being told that, because their CT scan showed nothing, nothing could be done for them. (Concussions rarely show up on imaging.) Or they described people being discharged from hospitals while their brains felt so broken, they could hardly speak. Conor Gormally, the executive director of  Concussion Alliance, told me that he believes concussions are treatable injuries that just aren’t being treated by the average medical professional. “The biggest problem people face are barriers to the care that they need, which is out there,” he said.

    I closed my eyes in the dark room.

    Every time I would spend a little while awake and active, a sensation of pressure would build up behind my ears, in a way that made me feel like my brain was swelling. I’d always been able to push through feeling tired and keep working. Now I couldn’t. When I reached my limit, I’d hear buzzing, as though a bug was stuck inside my eardrums.

    I rested again.

    This went on for weeks. I started looking up treatments for concussions in my area and found page after page of listings for chiropractors or special centers that didn’t always take insurance but promised that they’d be able to fix my brain. I joined support groups on Facebook where patients shared what had and hadn’t worked for them. Sometimes the posts were hopeful—people got better—but many of the people who remained in the groups did so because years had gone by and they still had problems. What if I never recovered?

    After five weeks with no answers, I started sobbing in the middle of the day. I’m a journalist who believes in evidence-based medicine, yet I found so few resources that I started looking into alternative therapy. At a particularly low point, I went to see a doctor whose website looked like it hadn’t been updated since the early 2000s. Over the phone, he’d made multiple mentions of “clean eating” and similar things that gave me pause. I ignored my misgivings because he’d also all but promised he could make me better. I wanted so badly to be myself again. He sold tablets that promised to fight 5G radiation at the front desk. I considered walking away then but didn’t. His alternative treatments, which included wearing tinted glasses and a blanket that blocked electric radiation, didn’t help. They did cost $500.

    I went back to bed.

    No one really knows how many people get mild traumatic brain injuries every year. Emergency- room data don’t capture everybody, Elizabeth Sandel, a brain-injury-medicine specialist and the author of Shaken Brain, told me, because “a lot of people just go to their primary-care doctor.” The statistic of 3.8 million Americans a year gets bandied about, sometimes linked to mild head injuries from sports and other times to brain injuries of all kinds. Falls, recreational activities, car crashes, and domestic violence all can cause head trauma.

    One of the reasons a concussion is so hard to treat is that every brain injury is a little bit different. There are more than 30 concussion symptoms, Smith told me: Some people get severe headaches; others have troubles with cognition, balance, vision, and so on. The treatment might be different for each of these symptoms.

    Until recently, Sandel said, doctors often recommended that people with a brain injury spend the first days “cocooning,” or resting in a dark room. Now experts better understand that, for some patients, resting may be beneficial, but for others activities that don’t overly exacerbate symptoms might speed healing. The latest guidelines for concussion recovery, which came out in October 2022, continue to shift toward suggesting better rehab, sooner. If dizziness, neck pain, or headaches persist after 10 days, the guidelines now recommend “cervicovestibular rehabilitation”—exactly the kind of therapy that ultimately helped me recover. It’s a combination of manual therapy on key muscles and rehab for the vestibular, or balance, system. Multiple studies have shown the benefits of this type of rehab, including a 2014 study that found that 73 percent of treated patients recovered after eight weeks, compared with 7 percent in the control group.

    By the time I got an appointment at a multidisciplinary brain-injury-rehab center near where I lived, more than two months had passed. After a lot of phone calls with my eyes closed—I could focus longer if I limited external stimulation—I found a vestibular therapist. This kind of therapy focuses on restoring the balance system through a combination of physical and eye exercises. My eyes not working in tandem was a classic sign that this area needed rehab.

    The therapist gave me exercises where I tracked my finger with my eyes to help them get back in sync. At my first appointment with him, I could hardly stand on one leg with my eyes open without falling over. After practicing the balance exercises he gave me for a few weeks, I could once again stand on one leg with my eyes closed.

    Manual physiotherapy, especially for the back and neck, can help restabilize and strengthen muscles after an accident. For me, this meant targeted physical therapy, strengthening exercises, and visits to a specialized chiropractor who used X-rays and gentle adjustments to put my neck back where it belonged.

    Some of the things I’d found through trial and error, like using a stationary bike for an hour each day, the brain-rehab center would have been recommended for me anyway. But long waitlists to get into places like that aren’t uncommon—and having the right doctors made a significant difference.

    Soon I noticed my stamina increasing every day. The neighbor’s dog didn’t seem so loud anymore. I could drive for 20 minutes, and then a full hour. I could even talk on the phone with friends and family whom I hadn’t been able to connect with for months. I read or went outside and did not need to nap. I wasn’t recovered but, finally, I was recovering.

    After three months, I began taking some writing assignments again. I’d been struggling to hold more than one thought in my head at a time, but now it was like my brain had rebooted. I was again the person I remembered.

    Six months after falling off the horse, my final, lingering symptom—the feeling of pressure in my head when I’d been working for too long—went away. I recovered but was left wondering why it had taken so much time for me to be routed to the care that I needed. I’ll never know if I would have gotten better without it, but I suspect recovery would have, at the very least, taken much longer. Why had I—a patient with a brain injury—been the one sifting through scientific papers and online support groups rather than getting these referrals from my doctor? In our American health-care system, many patients are expected to be their own advocates, but in this case, when a better, clearer path to recovery is so well established, it seems like that should have been unnecessary.

    I often think wistfully about returning to riding, but then think again of that one moment when I slipped from the saddle and the months it took to recover. We brush off the dangers of a single concussion, but sometimes one fall or bad knock to the head is all it takes to turn your life upside down.

    Tove Danovich

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  • Do Not Underestimate the To-Do List

    Do Not Underestimate the To-Do List

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

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

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

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

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

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

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

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

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

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

    Amanda Mull

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  • How Bad Could BA.2.86 Get?

    How Bad Could BA.2.86 Get?

    Since Omicron swept across the globe in 2021, the evolution of SARS-CoV-2 has moved at a slower and more predictable pace. New variants of interest have come and gone, but none have matched Omicron’s 30-odd mutations or its ferocious growth. Then, about two weeks ago, a variant descended from BA.2 popped up with 34 mutations in its spike protein—a leap in viral evolution that sure looked a lot like Omicron. The question became: Could it also spread as quickly and as widely as Omicron?

    This new variant, dubbed BA.2.86, has now been detected in at least 15 cases across six countries, including Israel, Denmark, South Africa, and the United States. This is a trickle of new cases, not a flood, which is somewhat reassuring. But with COVID surveillance no longer a priority, the world’s labs are also sequencing about 1 percent of what they were two years ago, says Thomas Peacock, a virologist at the Pirbright Institute. The less surveillance scientists are doing, the more places a variant could spread out of sight, and the longer it will take to understand BA.2.86’s potential.

    Peacock told me that he will be closely tracking the data from Denmark in the next week or two. The country still has relatively robust SARS-CoV-2 sequencing, and because it has already detected BA.2.86, we can now watch the numbers rise—or not—in real time. Until the future of BA.2.86 becomes clear, three scenarios are still possible.

    The worst but also least likely scenario is another Omicron-like surge around the world. BA.2.86 just doesn’t seem to be growing as explosively. “If it had been very fast, we probably would have known by now,” Peacock said, noting that, in contrast, Omicron’s rapid growth took just three or four days to become obvious.

    Scientists aren’t totally willing to go on record ruling out Omicron redux yet, if only because patchy viral surveillance means no one has a complete global picture. Back in 2021, South Africa noticed that Omicron was driving a big COVID wave, which allowed its scientists to warn the rest of the world. But if BA.2.86 is now causing a wave in a region that isn’t sequencing viruses or even testing very much, no one would know.

    Even in this scenario, though, our collective immunity will be a buffer against the virus. BA.2.86 looks on paper to have Omicron-like abilities to cause reinfection, according to a preliminary analysis of its mutations by Jesse Bloom, a virologist at the Fred Hutchinson Cancer Center, in Washington, but he adds that there’s a big difference between 2021 and now. “At the time of the Omicron wave, there were still a lot of people out there that had never been either vaccinated or infected with SARS-CoV-2, and those people were sort of especially easy targets,” he told me. “Now the vast, vast majority of people in the world have either been infected or vaccinated with SARS-CoV-2—or are often both infected and vaccinated multiple times. So that means I think any variant is going to have a very hard time spreading as well as Omicron.”

    A second and more likely possibility is that BA.2.86 ends up like the other post-Omicron variants: transmissible enough to edge out a previous variant, but not transmissible enough to cause a big new surge. Since the original Omicron variant, or BA.1, took over, the U.S. has successively cycled through BA.2, BA.2.12.1, BA.5, BQ.1, XBB.1.5—and if these jumbles of numbers and letters seem only faintly familiar, it’s because they never reached the same levels of notoriety as the original. Vaccine makers track them to keep COVID shots up to date, but the World Health Organization hasn’t deemed any worthy of a new Greek letter.

    If BA.2.86 continues to circulate, though, it could pick up mutations that give it new advantages. In fact, XBB.1.5, which rose to dominance earlier this year, leveled up this way. When XBB.1.5’s predecessor was first identified in Singapore, Peacock said, it wasn’t a very successful variant: Its spike protein bound weakly to receptors in human cells. Then it acquired an additional mutation in its spike protein that compensated for the loss of binding, and it turned into the later-dominant XBB.1.5. Descendents of BA.2.86 could eventually become more transmissible than the variant looks right now.

    A third scenario is that BA.2.86 just fizzles out and goes away. Scientists now believe that highly mutated variants such as BA.2.86 are probably products of chronic infections in immunocompromised patients. In these infections, the virus remains in the body for a long time, trying out new ways to evade the immune system. It might end up with mutations that make its spike protein less recognizable to antibodies, but those same mutations could also render the spike protein less functional and therefore the virus less good at transmitting from person to person.

    “Variants like that have been identified over the last few years,” Bloom said. “Often there’s one sample found, and that’s it. Or multiple samples all found in the same place.” BA.2.86 is transmissible enough to be found multiple times in multiple places, but whether it can overtake existing variants is unclear. To do so, BA.2.86 needs to escape antibodies while also preserving its inherent transmissibility. Otherwise, Bloom said, cases might crop up here and there, but the variant never really takes off. In other words, the BA.2.86 situation basically stays where it is right now.

    The next few weeks will reveal which of these futures we’re living in. If the number of BA.2.86 cases starts to go up, in a way that requires more attention, we’ll know soon. But each week that the variant’s spread does not jump dramatically, the less likely BA.2.86 is to end up a variant of actual concern.

    Sarah Zhang

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  • The Missing Piece of the Foraging Renaissance

    The Missing Piece of the Foraging Renaissance

    Harvesting wild local produce in Brooklyn’s Prospect Park may not seem like the best idea. And yet, on a foraging tour of the lively public park last month, a straw-hatted forager named “Wildman” Steve Brill and his teenage daughter, Violet, led roughly 40 of us amateurs into the grassy areas beyond the park’s paved footpaths for a four-hour tromp. Among plastic wrappers and bottle caps we found edible roots, fragrant herbs, and sturdy greens, all ripe for experimentation in the adventurous cook’s kitchen.

    At least in theory. There was food here, for sure, but hardly of the practical variety. We recovered fallen pods from the Kentucky coffeetree, whose seeds can be used to brew a caffeine-free alternative to a morning cup. That is, if one is willing to harvest enough of them, wash them of green toxic goo, and roast them for hours—though even then, it won’t really be coffee. I stuffed a few pods in a canvas bag alongside sassafras root, once used to make root beer the old-fashioned way, and a handful of lettuce-flavored violet leaves that could, in the right quantities, constitute a small salad. Two weeks later, I’m still wondering what, if anything, I’ll actually make with these odd new ingredients.

    What I didn’t anticipate were all the medicinal plants. Just a few minutes into the tour, we came across enough wild analgesics and anti-inflammatories to insure a casual hike. Here among the cigarette butts was broadleaf plantain, an easy-to-miss herb (unrelated to the bananalike fruit) known for calming mosquito bites. Over near the urinating puppy was jewelweed, which soothes poison-ivy and stinging-nettle rashes. Twigs snapped from a black birch tree exuded wintergreen oil, also known as methyl salicylate, a relative of aspirin that powers pain-killing ointments such as Bengay and Icy Hot.

    Interest in foraging for food has taken off in recent years, owing in part to the gourmet-ification of eating locally and in part to its popularity on social media, where influencers make chips out of stinging nettles and add fir needles to granitas. Foraged ramps and morel mushrooms have become so well known that they now appear on restaurant menus and in high-end grocery stores. But the foraging boom has largely left behind what has historically been a big draw of scrounging for plants—finding treatments for minor ailments. To be clear, medicinal plants aren’t likely to save the casual forager’s life, and they lack the robust clinical data that back up pharmaceuticals. But even some scientists believe they can be handy in a pinch. In a way, being able to find a jewelweed stem is more useful than identifying a handful of leaves that can substitute for lettuce.

    That has definitely been the case for Marla Emery, a scientific adviser to the Norwegian Institute for Natural Research and a former research geographer for the U.S. Forest Service who studies community foraging. Several years ago, when huge, oozing blisters formed on her legs after a run-in with poison ivy on a hunting trip, Emery visited an herbalist in Scotland who applied lobelia, an herb with pale-violet flowers, and slippery elm, a tree with mucilaginous properties, to her calf. Soon, she felt a tingling sensation—“as if someone had poured seltzer over the area”—and within an hour the blisters had healed, Emery told me.

    Both plants, traditionally used to treat skin conditions, “are supportive of health and have medicinal value,” she said, and they’re especially useful because “you’re highly unlikely to poison yourself” with them. Such anecdotes illustrating the profound utility of medicinal plants are common among botanist types. “If you get a cut and put [broadleaf] plantain on it, you can see it close up,” Alex McAlvay, an ethnobotanist at the New York Botanical Garden, told me. At least for some species, he said, “the proof is in the pudding.”

    Though foraging has long been a medicinal practice, and so many modern drugs are derived from plants, in the West, medicinal flora has largely been relegated to “traditional” or “folk remedy” status. Still, their use lives on in many communities, including immigrant groups that “come with medicinal-plant uses from their homelands and seek to continue them,” Emery said. People in Chinese, Russian, and certain Latin communities in the U.S. commonly forage dandelion, a weed with diuretic properties, to support kidney and urinary-tract health, she added.

    Along the concrete footpaths of Prospect Park, the Brills pointed out stands of burdock; its roots, in addition to being a tasty potato dupe, are used in some cultures to detoxify the body. Pineapple weed, found in baseball diamonds and sidewalk cracks, can calm an upset stomach, Steve told me later. Scientific data for such claims are scant, much like they are for other foraged plants, and using the plants for health inevitably raises questions about scientific credibility. Many medicinal plants that a casual forager will encounter in the wild will not have been studied through rigorous clinical trials in the same way that any prescription drug has been. Whether people ultimately embrace foraging for medicinal plants depends on how they believe “we make evidence and truth,” McAlvay said. “A lot of people are like, ‘If there’s no clinical research, it’s not legit.’ Other people are like, ‘My grandma did it; it’s legit.’” Nothing beats clinical research, though clearly some plants share valuable properties with certain drugs. Lamb’s quarters, a dupe for spinach, is so packed with vitamin C that it was traditionally used to prevent scurvy; stinging nettle, traditionally used for urination issues, may have similar effects as finasteride, a prostate medication.

    Naturally, the experts I spoke with unanimously recommended using foraged medicinal plants only for minor ailments. Just as foraging for food comes with some risks—what looks like a delicious mushroom can make you sick—the same is true of medicinal foraging. Take established, reputable classes and use books and apps to correctly identify plants, many of which have dangerous look-alikes; the edible angelica plant, for example, is easily confused with poisonous water hemlock, of Socrates-killing notoriety. Learning about dosage is important too. A benign plant can become poisonous if too large a dose is used, warned Emery. When working with medicinal plants, she said, “you’ve got to know what you’re doing, and that doesn’t lend itself to the casual TikTok post.” Beginner foragers should stick to “gentle but definitely powerful, easy-to-identify herbs,” such as dandelion and violet, said McAlvay.

    As the Brills instructed, when I got home I submerged a foraged jewelweed stem in witch hazel to make a soothing skin tincture. Days later, when I dabbed some onto a patch of sunburn on my arm, I felt, or maybe imagined, a wave of relief. Whatever the case, my delight was real. When I had asked both tour-goers and experts why foraged medical plants mattered in a world where drugs that accomplish the same things could be easily bought at a pharmacy, some said it was “empowering” or “satisfying,” but the description that resonated with me most came from McAlvay, who called it “magic”: the power to wield nature, in nature, in order to heal.

    When I got home from the tour and opened my bag of foraged goods, I found a black birch twig, still redolent of wintergreen. Coincidentally, that is the one smell I have craved throughout 38 weeks (and counting) of pregnancy, but moms-to-be are advised to avoid the medicinal ointments containing the oil. I sniffed the twig deeply, again and again, recalling that it might become useful in the months to come. When teething infants are given black birch twigs to chew, the gently analgesic qualities of the low-dose wintergreen oil helps soothe their pain, Brill had said. All of a sudden, their crying stops. What’s more magical than that?

    Yasmin Tayag

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  • The New Pro-life Movement Has a Plan to End Abortion

    The New Pro-life Movement Has a Plan to End Abortion

    The unpleasant reality facing the anti-abortion movement is that most Americans don’t actually want to ban abortion.

    This explains why the pro-life summer of triumph, after the U.S. Supreme Court overturned Roe v. Wade, led to a season of such demoralizing political outcomes. Voters in Montana, Kansas, and Kentucky in November rejected ballot measures to make abortion illegal; just last month, in Wisconsin, voters elected an abortion-rights supporter to the state supreme court.

    Yet the movement’s activists don’t seem to care. Thirteen states automatically banned most abortions with trigger laws designed to go into effect when Roe fell; a Texas judge this month stayed the FDA approval of the abortion pill mifepristone, setting in motion what is sure to be a drawn-out legal battle; and some lawmakers are pursuing restrictions on traveling out of state for the procedure—what they call “abortion trafficking.”

    Even as the anti-abortion movement lacks a Next Big Objective, a new generation of anti-abortion leaders is ascendant—one that is arguably bolder and more uncompromising than its predecessors. This cohort, still high on the fumes of last summer’s victory, is determined to construct its ideal post-Roe America. And it’s forging ahead—come hell, high water, or public disgust.

    The groups this new generation leads “are not afraid to lose short term if they think the long-term gain will be eliminating abortion from the country,” Rachel Rebouché, a family-law professor at Temple University, told me.

    One such leader is Kristan Hawkins, the president of the anti-abortion group Students for Life. After Dobbs v. Jackson Women’s Health Organization, “some organizations had to go through this period where they had to reflect and figure out what they were going to do,” she told me. “But nothing changed in our organization—we’d already had that conversation years ago.” Students for Life participants have been calling themselves “the post-Roe generation” since 2019; that’s the year they launched a political-action committee to beef up their state-level presence and begin drafting legislation for a post-Roe society. In 2021, the organization started the Campaign for Abortion-Free Cities to promote what they call “alternatives to abortion” and neighborhood resources for pregnant women.

    Read: What winning did to the anti-abortion movement

    “What the anti-abortion movement is, who’s leading it, and what it stands for are still being contested,” Mary Ziegler, a UC Davis law professor who has written about abortion for The Atlantic, told me. But organizations such as Students for Life will, in all likelihood, “be the ones running the movement going forward.” To understand the goals of people like Hawkins is, in other words, to peer into the future of America’s anti-abortion project.

    The thing about Hawkins is that she’s an optimist—and not a cautious one. So when the draft opinion suggesting that the Supreme Court was about to overrule Roe v. Wade leaked last May, she wasn’t particularly surprised, she told me—she felt vindicated. Other pro-lifers had refused “to let themselves even dare think that a post-Roe America was coming,” Hawkins said. “Of course it was.” She’d always assumed it would happen in her lifetime.

    As soon as the draft opinion came out, anti-abortion leaders began to consider their response. Some were worried that taking any kind of victory lap would be inappropriate—that it might scare the justices into moderating or reversing their ultimate decision. Hawkins didn’t care about any of that. “Why would we be guarded? It was important, good news!” she told me. “Folks across the country needed to see this generation celebrating.” Students for Life was one of the first anti-abortion organizations to release a statement praising the draft opinion—while being careful to condemn the leak itself.

    Hawkins, who is 37, styles herself as a straight shooter. She doesn’t dress up arguments with religious rhetoric—despite being Catholic herself—and she can be an effective, if sometimes abrasive, debater. Which makes sense, because she came to the pro-life movement through electoral politics. Hawkins knocked on doors for local and state Republican candidates; in college, she worked for the Republican National Committee to reelect President George W. Bush—and, for a year, she worked in his administration. Then, when Students for Life came looking for a new president in 2006, she eagerly accepted.

    Hawkins “saw the politics in this in ways a lot of people don’t,” Ziegler told me—and she brought that acumen to the movement. She knew how to lead a grassroots campaign, and how a state legislature functions. Then just 20, she was younger than other pro-life leaders, so she had a better idea of how to engage young people. Hawkins is trying, Ziegler said, “to grow the movement in a way that no one else really ever did.”

    The organization’s 14,000 participants campaign for state-level anti-abortion candidates and legislation in their local legislatures. Hawkins, who oversees a staff of 100 paid employees, spends her days traveling to meet with chapter leaders, organizing demonstrations, delivering speeches, and generally doing her best, as she put it to me, “to stir up discussion.” In March, during a visit to Virginia Commonwealth University, protesters shouted over Hawkins when she tried to speak. Demonstrators called her a Nazi and a fascist. Eventually, campus security shut down the event, and police arrested two protesters (who weren’t actually VCU students). Hawkins, who livestreamed the drama, later went on Fox News to offer a full account.

    The Students for Life YouTube channel has a 22-minute highlight reel called “Greatest Pro-Choice Takedowns,” in which Hawkins responds to questions from young, often-emotional abortion-rights advocates. As you might expect, the videos feel mean. In each clip showing Hawkins facing off against a different student with a shaky voice, she makes them look silly and ill-informed, a relatively easy thing to do when your opponent is not being paid to perfect her talking points. But these exchanges don’t seem intended to change minds; they’re meant instead to humiliate—and thereby reveal the purported weaknesses in abortion-rights arguments.

    Doggedness and moral conviction have always characterized the anti-abortion movement. Activists have sustained their energy for 50 years “by believing that success was possible, even in the absence of clear victories,” Daniel K. Williams, a history professor at the University of West Georgia, told me. Dobbs gave this new generation a taste of victory. Activists like Hawkins are bolder now. Without Roe, they reason, anything is possible.

    Daniel K. Williams: This really is a different pro-life movement

    Students for Life, in particular, is “more abolitionist than prior generations of similar groups,” Rebouché told me. In contrast to other organizations that have pursued incremental progress, the group adopts strategies that are “totalizing and absolute.” Throwing out the rule book, they operate as though they’ve got nothing to lose.

    “I admire their persistence; I admire their sacrifices,” Lila Rose, the president of the anti-abortion nonprofit Live Action, says of previous generations of anti-abortion activists. “But we’re playing to win. This isn’t just some nonprofit job.” Rose, who is 34, achieved early prominence in the movement back in 2006 for partnering with the conservative activist James O’Keefe to film undercover exposés at abortion clinics. Live Action doesn’t have the kind of nationwide membership that Students for Life has, but its email list contains more than 1 million contacts, Rose told me, and its social-media following runs into the millions.

    Students for Life and Live Action frame their anti-abortion efforts as not just saving babies but empowering women—enabling them to avoid the depression and regret the organizations say can be caused by having an abortion. These aren’t new ideas in themselves, but they’ve been repackaged in a way that mimics the language of a modern social-justice movement appealing to young people. “They’re using phrases like born privilege,” Jennifer Holland, a gender-and-sexuality professor at the University of Oklahoma, told me. “Language that’s hip—in the culture—but that still leads back to this one point of view that maybe you thought was old or conservative.”

    Historically, there’s been “a lack of vision” in the movement, Rose said. It was great, she allowed, that the National Right to Life Committee fought so hard in the 2000s to ban what they called “partial-birth abortion” (using a pro-life term not recognized by medical professionals). But, to Rose, pill-induced abortion is just as “anti-human and anti-woman”; a 15-week abortion limit is nothing to celebrate. “I don’t think that we do ourselves any favors as a movement by, like, walking over to the opponent’s side of the field and saying that that’s a victory.”

    Hawkins’s master plan to completely eradicate abortion in America begins with passing as many state controls as possible. She calculates that 26 state legislatures contain enough anti-abortion Republicans to be amenable to a strict ban of some sort, and her organization is pushing an “early abortion” model, which means that it drafts and supports legislation restricting abortion either entirely or after six weeks. Hawkins claims credit for pressuring reluctant Republican state leaders in Florida to take up the six-week abortion ban that Governor Ron DeSantis signed late Friday night. Gone are the days of small-ball second-trimester limits, Hawkins says, because most abortions happen before then. “We’re not going to spend a significant amount of resources to pass legislation that’s going to save only 6 percent of children.”

    Right now the centerpiece of Students for Life’s campaigning is the effort to ban medication abortion—what Hawkins and her allies call “chemical abortion.” For two years, the group lobbied Republicans in Wyoming to prohibit mifepristone from being sold in pharmacies; the governor signed that measure into law last month. Now it’s setting its sights on the pharmacy chains Walgreens, Rite Aid, and CVS—which Hawkins singles out as “the nation’s largest abortion vendor.”

    Mary Ziegler: The Texas abortion-pill ruling signals pro-lifers’ next push

    On campuses, Students for Life leaders are trying to mobilize young people who might otherwise be ambivalent about the abortion pill; Hawkins says they’ve had luck with the message that mifepristone, when flushed, enters the water system and threatens the health of humans and wildlife. “Young people are aghast to find out that something they care deeply about—the environment—is now conflicting with their views on abortion,” Hawkins told me. Never mind that there is no evidence for these claims. According to Tracey Woodruff, the director of the Program on Reproductive Health and the Environment at UC San Francisco, the amount of mifepristone found in drinking water is so small that it might not even be measurable.

    “Of all the things we have to worry about with our drinking water,” she told me, “this is not one of them.” Students for Life’s messaging on this, she added, is “a perverse use of science.” The organization is nonetheless backing new laws in several states that would require women prescribed abortion pills to use medical-waste “catch kits” and return them to a health-care provider.

    Hawkins is realistic about the fact that her movement’s progress has a ceiling. Some states, especially the liberal strongholds of Illinois and New York, are never going to go for the kinds of laws that she’s pushing for. This is when, she says, her organization will shift its emphasis to the federal government—pushing for a constitutional amendment that would recognize fetal personhood, or for a ruling from the Supreme Court to affirm that the Fourteenth Amendment already does.

    Abortion should become “both illegal and unthinkable” in America, Hawkins said. But even when the anti-abortion movement can no longer change hearts and minds, it plans to find a way to change the law anyway. She favors using the law as a tool because, in her view, people tend to derive morality from legality: “Nothing’s going to change their minds until the law changes their minds.” Hawkins envisions a future, 20 years from now, in which university students will discover with abject horror that other states allow the murder of babies in the womb—culturally, she believes, “that’s gonna be massive.” The idea that young people in college would be shocked to learn that different states have different laws on abortion may seem implausible now, but Hawkins is articulating her larger goal—of making abortion unconscionable.

    Yet American culture seems to be moving in the opposite direction. The Dobbs ruling, though exciting for anti-abortion activists, was so enraging for abortion-rights supporters that, in some places, they responded by enshrining the right to abortion into state law. These and other political losses suggest that the pro-life movement is already overreaching—and generating a backlash. “It’s breathtaking to see people so motivated and so well funded to push an agenda that is so incredibly unpopular,” Jamie Manson, the president of the abortion-rights organization Catholics for Choice, told me. The months since Dobbs have exposed a fundamental tension between the outcome that abortion-rights opponents want and the one democracy supports.

    As it becomes clear that abortion is not always an election winner—that, on occasion, it is even a predictable loser—some Republican legislators have broken from the movement in order to support rape and incest exceptions; others have simply avoided the issue. “Most of the members of my conference prefer that this be dealt with at the state level,” Senate Minority Leader Mitch McConnell told reporters last fall. Hawkins and Rose are happy to criticize those Republicans they see as wishy-washy on abortion. When former President Donald Trump blamed Republicans’ 2022 midterm losses on the extremism of the anti-abortion movement, Rose called it “sniveling cowardice.” But Hawkins and Rose may be underestimating how much more challenging and complex the post-Roe environment is.

    “This is much more expensive politics around abortion,” Holland said. “It used to be cheap: You could promise all sorts of things” without penalty, because with Roe intact, such radical measures would never pass.

    Does this give Hawkins any pause—the idea that her movement’s aims are so antithetical to what most Americans want? Hawkins said that public opinion doesn’t concern her. The fact that most Americans support abortion access doesn’t make them morally correct, she argued, and neither does it make her own efforts undemocratic. “Do I look upon abolitionists in pre–Civil War America as undemocratic for trying to change people’s minds and prevent the proliferation of owning another human being for your own financial gain? No,” she said.

    Hawkins has spent a lot of time thinking about this question. Consider the civil-rights era, she went on. “We had states that stubbornly refused to integrate.” In the end, federal legislation forced them to comply. The implication is that the same sort of national ban should eventually happen for abortion.

    Given this goal, we can expect that abortion will be an issue in almost every single election, in almost every single state, for the next many cycles. In some parts of the country, the anti-abortion-rights movement will fail. In others, it will skate along with utter success. Lawmakers will tighten laws, ban pills, and restrict travel. They may even feel audacious enough to venture into the broader realm of reproductive tools—outlawing or restricting IUDs, the morning-after pill, and even in vitro fertilization.

    Post-Roe, we can expect these hungry, mobilized activists to seek new conquests. But even as they do, pro-life leaders will have to wonder whether they are guiding their movement toward righteous victory—or humiliating defeat.

    Elaine Godfrey

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  • Republicans’ 2024 Magical Thinking

    Republicans’ 2024 Magical Thinking

    Press them hard enough, and most Republican officials—even the ones with MAGA hats in their closets and Mar-a-Lago selfies in their Twitter avatar—will privately admit that Donald Trump has become a problem. He’s presided over three abysmal election cycles since he took office, he is more unstable than ever, and yet he returned to the campaign trail this past weekend, declaring that he is “angry” and determined to win the  GOP presidential nomination again in 2024. Aside from his most blinkered loyalists, virtually everyone in the party agrees: It’s time to move on from Trump.

    But ask them how they plan to do that, and the discussion quickly veers into the realm of hopeful hypotheticals. Maybe he’ll get indicted and his legal problems will overwhelm him. Maybe he’ll flame out early in the primaries, or just get bored with politics and wander away. Maybe the situation will resolve itself naturally: He’s old, after all—how many years can he have left?

    This magical thinking pervaded my recent conversations with more than a dozen current and former elected GOP officials and party strategists. Faced with the prospect of another election cycle dominated by Trump and uncertain that he can actually be beaten in the primaries, many Republicans are quietly rooting for something to happen that will make him go away. And they would strongly prefer not to make it happen themselves.

    “There is a desire for deus ex machina,” said one GOP consultant, who, like others I interviewed, requested anonymity to characterize private conversations taking place inside the party. “It’s like 2016 all over again, only more fatalistic.”

    The scenarios Republicans find themselves fantasizing about range from the far-fetched to the morbid. In his recent book Thank You for Your Servitude, my colleague Mark Leibovich quoted a former Republican representative who bluntly summarized his party’s plan for dealing with Trump: “We’re just waiting for him to die.” As it turns out, this is not an uncommon sentiment. In my conversations with Republicans, I heard repeatedly that the least disruptive path to getting rid of Trump, grim as it sounds, might be to wait for his expiration.

    Mark Leibovich: The most pathetic men in America

    Their rationale was straightforward: The former president is 76 years old, overweight, appears to maintain the diet of a college freshman, and believes, contrary to all known science, that exercise is bad for you. Why risk alienating his supporters when nature will take its course sooner or later? Peter Meijer, a former Republican representative who left office this month, termed this strategy actuarial arbitrage.

    “You have a lot of folks who are just wishing for [Trump’s] mortal demise,” Meijer told me. “I want to be clear: I’m not in that camp. But I’ve heard from a lot of people who will go onstage and put on the red hat, and then give me a call the next day and say, ‘I can’t wait until this guy dies.’ And it’s like, Good Lord.” (Trump’s mother died at 88 and his father at 93, so this strategy isn’t exactly foolproof.)

    Some Republicans are clinging to the hope that Trump might finally be undone by his legal troubles. He is currently the subject of multiple criminal investigations, and his detractors dream of an indictment that would derail his campaign. But most of the people I talked with seemed resigned to the likelihood that an indictment would only boost him with the party’s base. Michael Cohen, who served for years as Trump’s personal attorney and now hosts a podcast atoning for that sin titled Mea Culpa, grudgingly told me that his former boss would easily weaponize any criminal charges brought against him. The deep-state Democrats are at it again—the campaign emails write themselves. “Donald will use the indictment to continue his fundraising grift,” Cohen told me.

    David A. Graham: A guide to the possible forthcoming indictments of Donald Trump

    Others imagine a coordinated donor revolt that sidelines Trump for good. The GOP consultant told me about a private dinner in New York City that he attended in the fall of 2021, when he saw a Republican billionaire give an impassioned speech about the need to keep Trump from returning to the Oval Office. The man said he would devote large sums of money to defeating the former president and urged his peers to join the cause. The others in the room—including several prominent donors and a handful of Republican senators—reacted enthusiastically that night. But when the consultant saw some of the same people a year later, their commitment had waned. The indignant donors, he said, had retreated to a cautious “wait and see” stance.

    This plague of self-deception among party elites contains obvious echoes of Trump’s early rise to power. In the run-up to the 2016 Republican presidential primaries, a fractured field of feckless candidates spent time and money attacking one another, convinced that the front-runner would eventually collapse. It was widely believed within the political class that such a ridiculous figure could simply never win a major party nomination, much less the presidency. Of course, by the time Trump’s many doubters realized they were wrong, it was too late.

    Terry Sullivan, who ran Marco Rubio’s 2016 presidential campaign, told me that Trump’s rivals failed to beat him that year in large part because they were “always convinced that his self-inflicted demise was imminent.”

    “There is an old quote that has been attributed to Lee Atwater: ‘When your enemy is in the process of drowning, throw him a brick,’” Sullivan told me. “None of Donald Trump’s opponents ever have the balls to throw him the damn brick. They just hope someone else will. Hope isn’t a winning strategy.”

    For conservatives who want to prevent a similar fiasco in 2024, the emerging field of GOP presidential prospects might seem like cause to celebrate. After all, the healthiest way to rid their party of Trump would be to simply beat him. But a sprawling cast of challengers could just as easily end up splitting the anti-Trump electorate, as it did in 2016, and allow Trump to win primaries with a plurality of voters. It would also make coalescing around an alternative harder for party leaders.

    One current Republican representative told me that although most of his colleagues might quietly hope for a new nominee, few would be willing to endorse a non-Trump candidate early enough in the primary calendar to make a difference. They would instead “keep their powder dry” and “see what those first states do.” For all of Trump’s supposedly diminished political clout, he remains a strong favorite in primary polls, where he leads his nearest rival by about 15 points. And few of the other top figures in the party—Ron DeSantis, Mike Pompeo, Nikki Haley—have demonstrated an ability to take on Trump directly and look stronger for it.

    Meijer, who voted to impeach Trump after January 6 and went on to lose his 2022 primary to a far-right Trump loyalist, attributes Republican leaders’ current skittishness about confronting Trump to the party’s “ideological rootlessness.” The GOP’s defenestration of long-held conservative ideals in favor of an ad hoc personality cult left Republicans without a clear post-Trump identity. Combine that with what Meijer calls “the generalized cowardice of political figures writ large,” and you have a party in paralysis: “There’s no capacity [to say], ‘All right, let’s clean the slate and figure out what we stand for and build from there.’”

    Read: What the GOP does to its own dissenters

    Even if another Republican manages to capture the nomination, there’s no guarantee that Trump—who is not known for his grace in defeat—will go away. Last month, Trump caused a minor panic in GOP circles when he shared an article on Truth Social suggesting that he might run an independent spoiler campaign if his party refuses to back him in 2024. The Republicans I talked with said such a schism would be politically catastrophic for their party. No one had any ideas about how to prevent it.

    Meanwhile, the most enduring of GOP delusions—that Trump will transform into an entirely different person—somehow persists.

    When I asked Rob Portman about his party’s Trump problem, the recently retired Ohio senator confidently predicted that it would all sort itself out soon. The former president, he believed, would study the polling data, realize that other Republicans had a better shot at winning, and graciously bow out of 2024 contention.

    “I think at the end of the day,” Portman told me, “he’s unlikely to want to put himself in that position when he could be more of a Republican senior statesman who talks about the policies that were enacted in his administration.”

    I let out an involuntary laugh.

    “Maybe that’s wishful thinking on my part,” Portman conceded.

    McKay Coppins

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  • Annual COVID Shots Mean We Can Stop Counting

    Annual COVID Shots Mean We Can Stop Counting

    A couple of weeks ago, a friend asked me how many COVID shots I’d gotten so far. And for a brief, wonderful moment, I forgot.

    “Three,” I told them, before shaking my head. “No, actually, four.” I had no trouble recalling when I’d received my most recent shot (September). But it took me a moment to tabulate all the doses that had preceded it.

    By this point in the pandemic, a lot of people must be losing track. “I actually think this is a good thing,” says Grace Lee, a pediatrician at Stanford, and the chair of the CDC’s Advisory Committee on Immunization Practices. Now that so many Americans have racked up several shots or infections, she told me, the question is no longer “‘How many doses have you gotten cumulatively?’ It’s ‘Are you up to date for the season?’”

    The flip is subtle, but it marks a rethink of the COVID-vaccination paradigm. We’re at a define-the-relationship moment with these shots, when people are trying to commit—to normalize them as a routine part of our lives. At a September ACIP meeting, CDC officials noted that “we are changing the way we are thinking about these vaccines,” and trying to “get on a more regular schedule.” If COVID shots are here for good, then at least we can be rid of the bother of counting them.

    Read: It’s a bad time to be a booster slacker

    Counting doses was more apt early in the vaccine rollout, when it seemed that two jabs (or even one) would be enough to get Americans “fully vaccinated” and out of the danger zone. When more shots followed, they were often advertised with confusing finality: What some initially described as the booster was later retconned as the first booster after a second one was recommended for certain groups. But with immunity against infection more fragile than some hoped, and a virus that quickly shapeshifts out of antibodies’ grasp, those ordinal adjectives have stopped making sense. Until our vaccine tech becomes much more durable or variant-proof, repeat doses will be, for most of us, a fixture of the future—and it won’t do anyone much good to say, “‘I’m on shot 15’ or ‘I’m on shot 16,’” Angela Shen, a vaccine expert at Children’s Hospital of Philadelphia, told me.

    The numbers certainly matter when they’re small: It will continue to be important for people to count off their first few shots, for instance, especially those without a history of infections. But after that initial set of viral-spike-protein exposures, the total count is moot. In most cases, about three vaccinations or infections—preferably vaccinations, which are both safer and easier to accurately track—should be “enough to fully charge up the immune system’s battery” for the first time, says Rishi Goel, an immunologist at the University of Pennsylvania. Further COVID shots will help only insofar as they can recharge the battery toward max capacity when it starts to lose its juice. Scheduling a vaccine, then, becomes a matter of “how long it’s been since your last immunity-conferring event,” regardless of how many exposures a body has racked up, says Avnika Amin, a vaccine epidemiologist at Emory University.

    People who are immunocompromised may need four or more shots to establish that initial immunity charge, and their own (maybe smaller) peak capacity. But ultimately, the threshold effect they experience—a point of “diminishing returns”—is similar, says Marion Pepper, an immunologist at the University of Washington. Given how many vaccinations and infections the U.S. has now logged, the majority of Americans “can be done with counting,” she told me.

    If we’re going to shift our focus to timing shots, instead of counting them, we’ll have to schedule our shots smartly. Several prominent figures have already come out and said that yearly doses are a top choice. Albert Bourla, Pfizer’s CEO, has been pushing that idea since early 2021; Peter Marks, who heads the FDA’s Center for Biologics Evaluation and Research, has been delivering a similar line for several months. Even President Joe Biden has endorsed the annual approach, noting in a September statement that the debut of the bivalent shot heralded a new phase in COVID vaccination, in which Americans would receive a dose “once a year, each fall.”

    That plan is not unreasonable. Shots will have to come with at least some regularity, as variants keep rolling in and immunity against infection ebbs. But re-dose prematurely with a shot with similar ingredients, and the body—still hopped up from the previous dose—may destroy the vaccine before it has much effect, making it about as useful as charging a battery that’s already at 95 percent. SARS-CoV-2 antibody levels drop off steeply in the first six months following a vaccine dose, and then, the rate of drain slows down. It’s as if the immune system goes into “power-saver mode,” Goel told me, which means there might not be a huge difference between revaccinating twice a year or only once. Plus, living out much of the year with lower antibody levels is not as worrisome as it might sound. Although antibodies can be a rather useful proxy for our level of protection, especially against infection, they don’t paint the whole defensive picture: T cells and other fighters tend to stick around for far longer, maintaining safeguards against severe disease. (The immunocompromised and older people may still need more frequent COVID-immunity top-offs.)

    Read: Are we really getting COVID boosters every year forever?

    The optimal pace for COVID vaccination will also depend on the speed at which the virus spews out variants. A yearly schedule works for influenza, Shen told me, but “we know flu’s cadence.” SARS-CoV-2 hasn’t yet settled down into a predictable, seasonal pattern; its waves aren’t relegated to the chilliest months. The degree to which we, as the coronavirus’s hosts, tamp down transmission also matters quite a bit. Having more virus around puts more pressure on vaccines to perform, especially when there aren’t many other mitigation measures in place. If all this talk of “once a year, each fall” turns out to be another red-herring recommendation, Amin told me, it could undermine any messaging that follows.

    All of that said, the autumn regimen may yet stick around because it’s the easiest approach. Flu-shot uptake is far from perfect, but the messaging around it is “simple and clean,” says Rupali Limaye, a behavioral scientist and vaccine-attitudes researcher at Johns Hopkins. After dosing up twice in four weeks as infants, people are asked to get a yearly shot, and that’s it. Compare that with the most convoluted days of COVID vaccination, when people couldn’t dose up without accounting for their age, health status, number of previous doses, vaccine brand, time since last dose, and more. “That’s absolute overload,” Limaye told me. Complicated schedules burn people out—or dissuade them from showing up at all. This fall, when the bivalent shot debuted, a troubling proportion of Americans didn’t even know they were eligible.

    Encouraging COVID vaccines at the same, straightforward pace as flu shots would make it easy for people to sign up for both at once, and maybe, eventually, to get them in the same syringe. Vaccines tend to ride one another’s coattails, Shen told me. “In the fall, there’s a bump in other routine vaccines,” she said, because people “are already there for their flu shot.” It would also make a big difference if the COVID-vaccine recipes changed for everyone at the same time, as they do for flu.

    Read: When’s the perfect time to get a flu shot?

    If we’re going to pivot from numbering doses to timing them, we might as well take the opportunity to discard the term booster as well. Some people don’t understand what it means, Limaye told me, or they default to a logical question—How many more boosters will I need? Plus, booster may no longer fit the science. “When we start updating formulas, it’s not really a booster anymore,” Amin told me. That’s not how we generally talk about flu shots: I certainly couldn’t tell you how many “boosters” of that vaccine I’ve had. (I don’t know, maybe 14? 15?) Pivoting to a terminology of “seasonal shots” could make COVID vaccination that much more routine.

    So, fine, if anyone should ask: I’ve had (count ’em: one, two, three) four doses of the vaccine so far. But more important, I’ve gotten the shot most recently available to me.

    Katherine J. Wu

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  • America’s COVID Booster Rates Are a Bad Sign for Winter

    America’s COVID Booster Rates Are a Bad Sign for Winter

    And just like that, with the passing of Labor Day, fall was upon us. Seemingly overnight, six-packs of pumpkin beer materialized on grocery shelves, hordes of city dwellers descended upon apple orchards—and America rolled out new COVID boosters. The timing wasn’t a coincidence. Since the beginning of the pandemic, cases in North America and Europe have risen during the fall and winter, and there was no reason to expect anything different this year. Spreading during colder weather is simply what respiratory diseases like COVID do. The hope for the fall booster rollout was that Americans would take it as an opportunity to supercharge their immunological defenses against the coronavirus in advance of a winter wave that we know is going to come.

    So far, reality isn’t living up to that hope. Since the new booster became available in early September, fewer than 20 million Americans have gotten the shot, according to the CDC—just 8.5 percent of those who are eligible. The White House COVID-19 response coordinator, Ashish Jha, said at a press conference earlier this month that he expects booster uptake to increase in October as the temperatures drop and people start taking winter diseases more seriously. That doesn’t seem to be happening yet. America’s booster campaign is going so badly that by late September, only half of Americans had heard even “some” information about the bivalent boosters, according to a recent survey. The low numbers are especially unfortunate because the remaining 91.5 percent of booster-eligible people have already shown that they’re open to vaccines by getting at least their first two shots—if not already at least one booster.

    Now the bungled booster rollout could soon run headfirst into the winter wave. The virus is not yet surging in the United States—at least as far as we can tell—but as the weather cools down, cases have been on the rise in Western Europe, which has previously foreshadowed what happens in the U.S. At the same time, new Omicron offshoots such as BQ.1 and BQ.1.1 are gaining traction in the U.S., and others, including XBB, are creating problems in Singapore. Boosters are our best chance at protecting ourselves from getting swept up in whatever this virus throws at us next, but too few of us are getting them. What will happen if that doesn’t change?

    The whole reason for new shots is that though the protection conferred by the original vaccines is tremendous, it has waned over time and with new variants. The latest booster, which is called “bivalent” because it targets both the original SARS-CoV-2 virus and BA.5, is meant to kick-start the production of more neutralizing antibodies, which in turn should prevent new infection in the short term, Katelyn Jetelina, a public-health expert who writes the newsletter Your Local Epidemiologist, told me. The other two goals for the vaccine are still being studied: The hope is that it will also broaden protection by teaching the immune system to recognize other aspects of the virus, and that it will make protection longer-lasting.

    In theory, this souped-up booster would make a big difference heading into another wave. In September, a forecast presented by the Advisory Committee on Immunization Practices (ACIP), which advises the CDC, showed that if people get the bivalent booster at the same rate as they do the flu vaccine—optimistic, given that about 50 percent of people have gotten the flu vaccine in recent years—roughly 25 million infections, 1 million hospitalizations, and 100,000 deaths could be averted by the end of March 2023.

    But these numbers shouldn’t be taken as gospel, because protection across the population varies widely and modeling can’t account for all of the nuance that happens in real life. Gaming out exactly what our dreadful booster rates mean going forward is not a simple endeavor “given that the immune landscape is becoming more and more complex,” Jetelina told me. People received their first shots and boosters at different times, if they got them at all. And the same is true of infections over the past year, with the added wrinkle that those who fell sick all didn’t get the same type of Omicron. All of these factors play a role in how much America’s immunological guardrails will hold up in the coming months. “But it’s very clear that a high booster rate would certainly help this winter,” Jetelina said.

    At this point in the pandemic, getting COVID is far less daunting for healthy people than it was a year or two ago (although the prospect of developing long COVID still looms). The biggest concerns are hospitalizations and deaths, which make low booster uptake among vulnerable groups such as the elderly and immunocompromised especially worrying. That said, everyone aged 5 and up who has received their primary vaccine is encouraged to get the new boosters. It bears repeating that vaccination not only protects against severe illness and death but has the secondary effect of preventing transmission, thereby reducing the chances of infecting the vulnerable.

    What will happen next is hard to predict, Michael Osterholm, an epidemiologist at the University of Minnesota, told me, but now is a bad time for booster rates to be this low. Conditions are ripe for COVID’s spread. Protection is waning among the unboosted, immunity-dodging variants are emerging, and Americans just don’t seem to care about COVID anymore, Osterholm explained. The combination of these factors, he said, is “not a pretty picture.” By skipping boosters, people are missing out on the chance to offset these risks, though non-vaccine interventions such as masking and ventilation improvements can help, too.

    That’s not to say that the immunity conferred by the vaccination and the initial boosters is moot. Earlier doses still offer “pretty substantial protection,” Saad Omer, a Yale epidemiologist, told me. Not only are eligible Americans slacking on booster uptake, but lately vaccine uptake among the unvaccinated hasn’t risen much either. Before the new bivalent shots came around, less than half of eligible Americans had gotten a booster. “That means we are, as a population, much more vulnerable going into this fall,” James Lawler, an infectious-diseases expert at the University of Nebraska Medical Center, told me.

    If booster uptake—and vaccine uptake overall—remains low, expecting more illness, particularly among the vulnerable, would be reasonable, William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center, told me. Hospitalizations will rise more than they would otherwise, and with them the stress on the health-care system, which will also be grappling with the hundreds of thousands of people likely to be hospitalized for flu. While Omicron causes relatively minor symptoms, “it’s quite capable of producing severe disease,” Schaffner said. Since August, it has killed an average of 300 to 400 people each day.

    All of this assumes that we won’t get a completely new variant, of course. So far, the BA.5 subvariant targeted by the bivalent booster is still dominating cases around the world. Newer ones, such as XBB, BQ.1.1, and BQ.1, are steadily gaining traction, but they’re still offshoots of Omicron. “We’re still very hopeful that the booster will be effective,” Jetelina said. But the odds of what she called an “Omicron-like event,” in which a completely new SARS-CoV-2 lineage—one that warrants a new Greek letter—emerges out of left field, are about 20 to 30 percent, she estimated. Even in this case, the bivalent nature of the booster would come in handy, helping protect against a wider crop of potential variants. The effectiveness of our shots against a brand-new variant depends on its mutations, and how much they overlap with those we’ve already seen, so “we’ll see,” Omer said.

    Just as it isn’t too late to get boosted, there’s still time to improve uptake in advance of a wave. If you’re three to six months out from an infection or your last shot, the best thing you can do for your immune system right now is to get another dose, and do it soon. Though there’s no perfect and easy solution that can overcome widespread vaccine fatigue, that doesn’t mean trying isn’t worthwhile. “Right now, we don’t have a lot of people that feel the pandemic is that big of a problem,” and people are more likely to get vaccinated if they feel their health is challenged, Osterholm said.

    There’s also plenty of room to crank the volume on the messaging in general: Not long ago, the initial vaccine campaign involved blasting social media with celebrity endorsers such as Dolly Parton and Olivia Rodrigo. Where is that now? Lots of pharmacies are swimming in vaccines, but making getting boosted even easier and more convenient can go a long way too. “We need to catch them where they come,” said Omer, who thinks boosters should be offered at workplaces, in churches and community centers, and at specialty clinics such as dialysis centers where patients are vulnerable by default.

    After more than two years of covering and living through the pandemic, believe me: I get that people are over it. It’s easy not to care when the risks of COVID seem to be negligible. But while shedding masks is one thing, taking a blasé attitude toward boosters is another. Shots alone can’t solve all of our pandemic problems, but their unrivaled protective effects are fading. Without a re-up, when the winter wave reaches U.S. shores and more people start getting sick, the risks may no longer be so easy to ignore.

    Yasmin Tayag

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  • Will the Bivalent Booster Cause Worse Side Effects?

    Will the Bivalent Booster Cause Worse Side Effects?

    For as long as my marriage lasts, my household will be divided by reactions to vaccines.

    I am, fortunately, speaking of physical reactions rather than ideological ones; my partner and I are both shot enthusiasts, a fact we verified on our first date. But if my immune system is a bashful wallflower, rarely triggering more than a sore arm in the hours after I get a vaccine, then my spouse’s is a party animal. Every immunization I’ve watched him receive—among them, four doses of Moderna’s COVID-19 vaccine—has absolutely clobbered him with fevers, chills, fatigue, and headaches for about a full day. When he got the flu shot and the bivalent COVID jab together a few weeks ago, he ended up taking his first day off work in more than a decade. As usual, the same injections caused me so few symptoms that I wondered if I was truly dead inside.

    “Why don’t you feel anything?” my spouse howled at me from the bedroom, where his sweat was soaking through the sheets. “Sorry,” I yelled back from the kitchen, where I was prepping four days’ worth of meals between work calls after returning from an eight-mile run.

    If this is how every autumn will go from now on, so be it: A few hours of discomfort is still worth the rev-up in defenses that vaccines offer against serious disease and death. But it’s not hard to see that gnarly side effects will only add to the many other factors that work against COVID-vaccine uptake, including lack of awareness, sloppy messaging, dwindling access, and spotty community outreach. Back in the spring, when I spoke with several people who hadn’t gotten boosters despite being eligible for many, many months, several of them cited the post-shot discomfort as a reason. Now I’m getting texts and calls from family members and friends—all up to date on their previous COVID vaccines—admitting they’ve been dillydallying on the bivalent to avoid those symptoms too. “I don’t know if we’re going to continue to get strong buy-in from the public if they have this sort of reaction every year,” says Cindy Leifer, an immunologist at Cornell University.

    Read: America created its own booster problems

    The good news, at least, is that experts told me they don’t expect this bivalent recipe—or future autumn COVID shots, for that matter—to be worse, side-effect-wise, than the ones we’ve received before. It’ll take a while for data to confirm that, especially considering that more than a month into this fall’s rollout, fewer than 15 million Americans have received the updated shot. But Kathleen Neuzil, a vaccinologist at the University of Maryland School of Medicine who has studied the performance of COVID vaccines in clinical trials, pointed out to me that the mRNA shots’ ingredients have been swapped out before without altering the rate of side effects. As the alphabet soup of variants began to sweep the world in early 2021, she told me, vaccine makers started to tinker with alternate formulations, sometimes combining multiple versions of the spike protein into a single shot—“and they’re all comparable.” (If anything, early data suggest that bivalent shots containing an Omicron variant spike may be easier to take.) The same goes for flu vaccines, which are also retooled each year: When measured across the population, the frequency and intensity of side effects remain more or less the same.

    On average, then, mRNA-vaxxed people can probably expect to have an annual experience that’s pretty similar to the one they had with their first COVID booster. As studies have shown, that one was actually better for most people than dose No. 2, the most unpleasant of the injections so far. (The math, of course, becomes tougher for people getting another vaccine, such as the flu shot, at the same time.) There are probably two main reasons why side effects have lessened overall, experts told me. First, the spacing: Most people received the second dose in their Pfizer or Moderna primary series just three or four weeks after the first. That’s an efficient way to get a lot of people “fully vaccinated” in a short period of time, but it means that many of the immune system’s defensive cells and molecules will still be on high alert. The second shot could end up fanning a blaze of inflammation that was never quite put out. In line with that, researchers have found that spacing out the primary-series doses to eight weeks, 12 weeks, or even longer can prune some side effects.

    Dose matters a lot too: Vaccines are, in a way, stimulants meant to goad the immune system into reacting; bigger servings should induce bigger jolts. When vaccine makers were tinkering with their recipes in early trials, higher doses—including ones that were deemed too large for further testing—produced more side effects. Each injection in Moderna’s primary series contains more than three times the mRNA packaged into Pfizer’s, and Moderna has, on average, caused more intense side effects. But Moderna’s booster and bivalent doses contain a smaller scoop of the stimulating material: People 12 and older, for instance, get 50 micrograms instead of the 100 micrograms in each primary dose; kids 6 to 11 years old get 25 micrograms instead of 50. (All of Pfizer’s doses stay the same size across primaries and boosters, as long as people stay in the same age group.) People who switch between brands, then, may also notice a difference in symptoms.

    It’s a tricky balance, though. Sometimes, the immune system adjusts the magnitude of its protection to match the danger posed by a pathogen (or shot), a bit like titrating a crisis response to the severity of a threat—so it’s important that vaccine makers don’t undershoot. For better or worse, the mRNA-based COVID vaccines do seem to cause a rougher response than most other vaccines, including annual flu shots. One of the offending ingredients might be the mRNA itself, which codes for SARS-CoV-2’s spike protein. But Michela Locci, an immunologist at the University of Pennsylvania, told me that the mRNA’s packaging—a greasy fat bubble called a lipid nanoparticle—may be the more likely culprit. For some people, in any case, the side effects of COVID shots might be on par with those of the two-dose Shingrix vaccine, one of the most infamously reactogenic immunizations in our roster. Leifer, who has received both, told me the second dose of each “floored” her to about the same extent.

    The fact that I get fewer side effects than my spouse does not imply that I’m any less protected. A ton of factors—genetics, hormone levels, age, diet, sleep, stress, pain tolerance, and more—could potentially influence how someone experiences a shot. Women tend to have more reactive bodies, as do younger people. But there are exceptions to those trends: I’m one of them. The whole topic is understudied, Locci told me. Her own recent experience with the bivalent threw her for a loop. After her first, second, and third dose of Moderna each ratcheted up in side-effect severity, she cleared her calendar for the couple of days following her bivalent, “afraid I was going to be in bed with a fever again,” she said: “But it was a light headache for a morning, and then it was over.” She has no idea what next year will bring.

    Either way, side effects such as fevers and chills tend to be short-lived. “Very few side effects are severe,” Neuzil told me, “and COVID continues to be a severe disease.” Still, Grace Lee, a pediatrician at Stanford and the chair of the CDC’s Advisory Committee on Immunization Practices, hopes that scientists will keep developing new COVID vaccines that might come with fewer post-shot issues—including the very rare ones, such as myocarditis—without sacrificing immune protection. Lee doesn’t tend to react much to vaccines, but her daughter “always misses school the next day,” she told me. “I plan her shots for a Friday afternoon so she can lay out all Saturday.” Early on, when hardly anyone had immunity to the virus, signing everyone up for somewhat reactogenic shots was a no-brainer—especially given the hope that two doses would yield many, many years of protection. Now that we know it’s a repeated need, Neuzil said, “the equation changes a bit.”

    People aren’t totally helpless against side effects. Deepta Bhattacharya, an immunologist at the University of Arizona, had an “awful, terrible” experience with his second and third doses, which slammed him with 102- and 103-degree fevers, respectively. He weathered the side effects without intervention, worried that a painkiller would curb not just the agony, but also his protective immune response. This time, though, armed with new knowledge from his own lab that anti-inflammatory and pain-relieving drugs don’t blunt antibody levels, “the first sign I feel even the slightest bit shitty,” he told me, “I’m dosing up.”

    I’ll probably do the same for my spouse the next time he’s due for a vaccine of any kind … likely while I chill on the sidelines. Bhattacharya’s spouse, too, is kind of an immune introvert, a fact that he bemoans. “Her only side effect was she felt thirsty,” he said. “It’s just not fair.”

    Katherine J. Wu

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  • ‘Stop the Steal’ Is a Metaphor

    ‘Stop the Steal’ Is a Metaphor

    Starting in 2008, a widely circulated conspiracy theory was that Barack Obama was not actually born in America. Strivers on the political right scrounged around to try to produce a Kenyan birth certificate for him; they filed state and federal legal complaints alleging that Obama was not eligible to be president. But proof of this theory was never a requirement for subscribing to it; you could simply choose to believe that a Black liberal with a Muslim-sounding middle name was not one of us. And at several points during Obama’s presidency, almost a quarter of Americans did.

    The country has not changed much. Theda Skocpol, a Harvard sociologist and political scientist who has studied the Tea Party movement and right-wing grievances of the Obama years, draws a straight line from that era to today’s “Stop the Steal” efforts. I talked with Skocpol on Wednesday morning about that connection, and the roots of resentment in America.

    Now, as then, you can take the right’s scramble for evidence of fraud with a grain of salt, she told me. The election deniers who say they are perturbed by late-night ballot dumps or dead people voting are actually concerned with something else.

    “‘Stop the Steal’ is a metaphor,” Skocpol said, “for the country being taken away from the people who think they should rightfully be setting the tone.” More than a decade later, evidence remains secondary when what you’re really doing is questioning whose vote counts—and who counts as an American.

    This interview has been edited and condensed for clarity.

    Elaine Godfrey: Tell me what connection you see between the Tea Party movement that you studied and the Trump-inspired Stop the Steal effort.

    Theda Skocpol: There’s a definite line. Opinion polls tell us that people who participated in or sympathized with the Tea Party—some groups are still meeting—were disproportionately angry about immigration and the loss of America as they know it. They became core supporters of Trump. I’m quite certain that some organizations that were Tea Party–labeled helped organize Stop the Steal stuff.

    Trump has expanded the appeal of an angry, resentful ethno-nationalist politics to younger whites. But it’s the same outlook.

    Read: Why the Tea Party isn’t going anywhere

    Godfrey: So how do you interpret the broader Stop the Steal movement?

    Skocpol: I don’t think Stop the Steal is about ballots at all. I don’t believe a lot of people really think that the votes weren’t counted correctly in 2020. They believe that urban people, metropolitan people—disproportionately young and minorities, to be sure, but frankly liberal whites—are an illegitimate brew that’s changing America in unrecognizable ways and taking it away from them. Stop the Steal is a way of saying that. Stop the Steal is a metaphor. And remember, they declared voting fraud before the election.

    Godfrey: A metaphor?

    Skocpol: It’s a metaphor for the country being taken away from the people who think they should rightfully be setting the tone. Doug Mastriano said it in so many words: It’s a Christian country. That doesn’t mean we’ll throw out everybody else, but they’ve got to accept that we’re the ones setting the tone. That’s what Hungary has in mind. Viktor Orbán has been going a little further. They’re a more muscular and violence-prone version of the same thing.

    People in 2016 who were otherwise quite normal would say, There’s something wrong with those votes from Milwaukee and Madison. I’d push back ever so gently and say, Those are big places; it takes a while to count the votes. I’d get a glassy-eyed stare at that point: No, something fishy is going on.

    They feel disconnected from and dominated by people who have done something horrible to the country. And Trump gave voice to that. He’s a perfect resonant instrument for that—because he’s a bundle of narcissistic resentments. But he’s no longer necessary.

    Read: The Bannon strategy

    Godfrey: Elaborate on that for me.

    Skocpol: He’s not necessary for an authoritarian movement to use the GOP to lock in minority rule. The movement to manipulate election access and counting is so far along. I think it’s too late, and we’re vulnerable to it because of how we administer local elections.

    What’s happened involves an interlocking set of things. It depends not just on candidates like Trump running for president and nationalizing popular fears and resentments, but also on state legislatures, which have been captured, and the Supreme Court. The Court is a keystone in all of this because it’s going to validate perfectly legal manipulations that really are about locking in minority rule. In that sense, the turning point in American history may have happened in November 2016.

    Godfrey: The turning point toward what?

    Skocpol: Toward a locking-in of minority rule along ethno-nationalist lines. The objective is to disenfranchise metro people, period. I see a real chance of a long-term federal takeover by forces that are determined to maintain a fiction of a white, Christian, Trumpist version of America.

    That can’t work over the long run, because the fastest-growing parts of the country are demonized in that scheme of things. But a lot of things liberals do play into it: Democrats are the party of strong government, and they’re almost as fixated on the presidency as Trumpists are. People on the left started bashing Joe Biden less than a year into his presidency. Why won’t the president just exert his will? Well, that doesn’t work.

    The hour is late. This election this fall is critical.

    Godfrey: Why so?

    Skocpol: We’ve got about five pivotal states where election deniers—the culmination of the Tea Party–Trumpist strand of the GOP—are close to gaining control of the levers of voting access and counting the results. If that happens, in even two of those places, it could well be enough. The way courts are operating now, they will not place limits on much of anything that happens in the states.

    Read: The radical fringe that just went mainstream in Arizona

    Godfrey: So what would you say is on the ballot in 2022?

    Skocpol: The locking-in of minority authoritarian rule.

    People talk about it in racial terms, and of course the racial side is very powerful. We had racial change from the 1960s on, and conservative people are angry about Black political power. But I wouldn’t underestimate the gender anger that’s channeled here: Relations between men and women have changed in ways that are very unsettling to them. And conservatives are angry about family change.

    This is directed at liberal whites, too. Tea Partiers talked about white people in college towns who voted Democratic the way the rulers of Iran would speak of Muslims that are liberal—as the near-devil.

    Godfrey: What are the roots of that resentment?

    Skocpol: The suspicion of cities and metro areas is a deep strand in America. In this period, it’s been deliberately stoked and exploited by people trying to limit the power of the federal government. They can build on the fears that conservatives have—about how their children leave for college and come back thinking differently. As soon as you get away from the places where upper-middle-class professionals are concentrated, what you see is decay. People see that. They’re resentful of it.

    Anti-immigrant politics is very much at the core of this. Every time in the history of the U.S., when you reach the end of a period of immigration, you get a nativist reaction. When the newcomers come, they’re going to destroy the country. That’s an old theme in this country.

    Godfrey: The 2016 election was surrounded by a lot of discussion about whether Trump’s supporters were motivated by racism or economic anxiety. What’s your view on that?

    Skocpol: That whole debate tends to be conducted with opinion polls. I’m in a minority, but I don’t find them very helpful for understanding American politics. Even when well conducted, polls treat the American political system as a bunch of potatoes in a sack—so you can pull out What women think, for instance, but not which women and where. And in American politics, everything is about the where.

    If you drive into a place in Iowa or Nebraska where immigration is happening, it’s changed the shops downtown, it’s changed the language, it’s changed the churches, it’s changed the schools. And people’s jobs have changed—so it’s also about economics. In our 2011 interviews, Tea Party members were angry about immigrants. I’m not saying everybody in those communities is angry at newcomers, but it creates tensions that rabble-rousing politicians can take advantage of.

    We know that Trump supporters, Stop the Steal supporters, are much more likely than other Republicans and conservatives to resent immigrants and fear them. In my 2017–2019 period of research, I visited eight pro-Trump counties. Tea Party types were just furious about immigrants. Trump’s emphasis on immigration interjected the idea that the debate is about what the nature of America is.

    Trumpism is nativism. It’s also profoundly resentful of independent women, and it’s resentful of Black people whom it considers out of place politically. Trump channeled that and fused it into one big, angry brew.

    Read: The deep story of Trumpism

    Godfrey: How organic have these movements been? At a certain point, we heard a lot about how the Tea Party movement became a Koch-funded operation, not a true grassroots movement.

    Skocpol: The Tea Party was not created by the Koch brothers; it was taken advantage of by the Kochs. But the Kochs were not anti-immigrant. The Tea Partiers really were. The Kochs didn’t control the results. The Kochs didn’t select Donald Trump. They didn’t even like him. Marco Rubio was their guy. The Chamber of Commerce crowd wanted a Bush. Both were easily dispatched by Trump.

    Republican leaders could have done something—and they still could. The real story is about Republican Party elites and their willingness to go along with what they’ve always known was over the top. That’s a mystery that’s a little hard to completely solve. A lot of the opportunists think they can ride that tiger without it devouring them, even though sometimes it does. But nobody seems to learn.

    At this point, what does resistance in the party consist of? Mitch McConnell taking a day to start denouncing the FBI. That’s it. Just discernibly different from Kevin McCarthy.

    Elaine Godfrey

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