Protecting our coasts from sea level rise is increasingly urgent, especially for densely populated coastal communities such as Southern California’s. Coastal flooding and beach erosion from rising seas and storms are far more than a threat; they’re already happening in many places in California and beyond. But new research suggests one relatively simple means of shoring up our beaches: leaving them alone.
As I and my colleagues at UC Santa Barbara and our partner institutions showed in a recent paper, natural dune formation can help restore and adapt urban coasts to climate change. In fact, we found that natural processes can cause the sands to rise much faster than the seas.
Our research began in 2016 with a partnership among the Los Angeles-based nonprofit the Bay Foundation, the city of Santa Monica and scientists from UC Santa Barbara to test the capacity of dune restoration to reduce coastal flooding. We envisioned allowing an urban shoreline to return to a more natural state after decades of frequent beach grooming.
Beach grooming, which employs heavy equipment to rake sand, is a widespread practice used to collect trash, remove seaweed and flatten beaches to maintain views and accommodate recreation along urban shores. By altering natural processes such as plant growth and wind- and wave-driven accumulation of sand, grooming prevents dunes from forming on beaches with enough space to develop them.
Without dunes, beaches are less resistant to erosion and more vulnerable to flooding driven by more intense storms and higher seas. Grooming also reduces habitat for wildlife, including threatened species such as the western snowy plover.
After the crucial first step of extensive outreach for community input and securing approval for the demonstration project, we worked with the city, community groups, students and the public to fence off an approximately 3-acre section of Santa Monica Beach next to the Annenberg Community Beach House. The study site was protected from grooming and seeded with native dune plants.
The sand fencing was left open along the ocean side so that people and wildlife could interact with the site and sand could drift in and out with the tides and wind. Interpretive signs and a central public access path enhanced viewing and provided information about the experiment in urban beach restoration. And other than some occasional hand weeding in the initial years, the site progressed naturally on its own without irrigation or any use of heavy equipment.
The native coastal foredune plant species we seeded the site with, such as red sand verbena (Abronia maritima) and beach bur (Ambrosia chamissonis), are specialists at trapping and holding sand in place. As these plants grow, they act as living ecosystem engineers that trap small mounds of sand, grow on top of them, trap more sand and so forth. Over time, with sufficient sand and beach width, they promote the formation of dunes.
Once the demonstration project was in place, we studied its effects over six years. What we found exceeded our expectations.
Wind-driven sand began to accumulate naturally along the sand fences almost immediately. Native plants germinated quickly and spread gradually over time. And as the plants grew and spread, we saw additional sand accumulation and the formation of a small foredune ridge along the ocean edge of the project.
By the sixth year of the study, the new dunes had risen to a height of more than 3 feet in many places. Overall, the site had accumulated more than 2,200 cubic yards of sand — enough to fill more than 200 large dump trucks. The dunes grew at more than 10 times the rate of sea level rise during the years of our study.
Our project, the first of its kind in the region, highlights a nature-based adaptation that can enhance the resilience of beaches and coastal communities while conserving sandy ecosystems. Conducted without heavy machinery or other expensive equipment, it was also cost-effective compared with traditional methods of coastal defense, such as sea walls and coastal armoring. And it can be widely replicated by restricting grooming in areas with enough beach space and sand supply to promote dune formation.
Many more small dune restoration projects are already being implemented throughout California. It’s time to begin scaling up these efforts across our coastlines. We can achieve a healthy balance between continuing to enjoy our beaches for recreation and shifting practices to promote more coastal resilience with thoughtful planning and engagement with all the affected interests. People, plants, plovers and protection can coexist on our beautiful California beaches.
Karina Johnston is a doctoral student at UC Santa Barbara’s Bren School of Environmental Science and Management and the Marine Science Institute.
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. Multiplestudies 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.
A police spokesperson said staff received four reports in which people had been assaulted in the Auckland CBD on Saturday morning. Photo / Dean Purcell
Two people have been arrested following four aggravated robberies in Auckland this morning.
A police spokesperson said staff received four reports in which people had been assaulted in the Auckland CBD on Saturday morning. No one suffered serious injuries, the spokesperson said.
The incidents were between 1.30am and 1.50am in the Wellesley St and Federal St area.
“In the final incident, a vehicle was unlawfully taken. The vehicle was observed by police soon after on Mount Albert Rd and tracked by Police Eagle helicopter as it fled. Police deployed road spikes on Stoddart Rd, Mount Roskill, and the vehicle came to a stop. Two men ran but were quickly arrested”.
As the chair of the department of obstetrics and gynecology at UT Southwestern Medicine, Catherine Spong is used to seeing a lot of baby bumps. But through her decades of practice, she’s been fascinated by a different kind of bump: Year after year after year, she and her colleagues deliver a deluge of babies from June through September, as much as a 10 percent increase in monthly rates over what they see from February through April. “We call it the summer surge,” Spong told me.
Her hospital isn’t alone in this trend. For decades, demographers have documented a lift in American births in late summer, and a trough in the spring. I see it myself in my own corner of the world: In the past several weeks, the hospital across the street from me has become a revolving door of new parents and infants. When David Lam, an economist at the University of Michigan who helped pioneer several early U.S. studies on seasonal patterns of fertility, first analyzed his data decades ago, “we were kind of surprised how big it was,” he told me. Compare the peak of some years to their nadir, he said, and it was almost like looking at the Baby Boom squished down into 12 months.
Birth seasonality has been documented since the 1820s, if not earlier. But despite generations of study, we still don’t fully understand the reasons it exists, or why it differs so drastically among even neighboring countries. Teasing apart the contributions of biology and behavior to seasonality is messy because of the many factors involved, says Micaela Martinez, the director of environmental health at the nonprofit WE ACT for Environmental Justice, who has been studying seasonality for years. And even while researchers try to track it, the calendar of human fertility has been changing. As our species has grown more industrialized, claimed more agency over reproduction, and reshaped the climate we are living in, seasonality, in many places, is shifting or weakening.
There is no doubt that a big part of human birth seasonality is behavioral. People have more sex when they have more free time; they have less sex when they’re overworked or overheated or stressed. Certain holidays have long been known to carry this effect: In parts of the Western world with a heavy Christian presence, baby boomlets fall roughly nine months after Christmas; the same patterns have been spotted with Spring Festival and Lunar New Year in certain Chinesecommunities. (Why these holidays strike such a note, and not others, isn’t entirely clear, experts told me.)
In addition to free time, family-focused celebrations probably help set the mood, Luis Rocha, a systems scientist at Binghamton University, told me. Cold weather might help people get snuggly around Christmastime, too, but it’s not necessary; Rocha’s studies and others have shown the so-called Christmas effect in southern-hemisphere countries as well. No matter whether Christmas falls in the winter or summer, around the end of December, Google searches for sex skyrocket and people report more sexual activity on health-tracking apps. In a few countries, including the U.S., condom sales rise too.
But cultural norms have never been able to explain everything about the Homo sapiens birth calendar. “It’s pretty common for mammals to have a specific breeding season” dictated by all sorts of environmental cues, Martinez told me. Deer, for instance, mate in the fall, triggered by the shortening length of daylight, effectively scheduling their fawns to be born in the spring; horses, whose gestations are longer, breed as the days lengthen in the spring and into summer, so they can foal the following year.
Humans, of course, aren’t horses or deer. Our closest relatives among primates “are much more flexible” about when they mate, Élise Huchard, a behavioral ecologist at the University of Montpellier, in France, told me. But those apes are not immune to their surroundings, and neither are we. All sorts of hormones in the human body, including reproductive ones, wax and wane with the seasons. Researchers in the United States and Australia have found that couples hoping to conceive via in vitro fertilization have a higher chance of success if the eggs are retrieved during the summer. At the same time, summer conceptions appear to be less common, or less successfully carried to term, in somecountries, a trend that sharpens at lower latitudes and, Lam told me, during hotter years. The subsequent spring lulls may be explained in part by heat waves dissuading people from sex. But Alan Barreca, an economist at UCLA, suspects that ultrahigh temperatures may also physiologically compromisefertility, potentially by affecting factors such as sperm quantity and quality, ovulation success, or the likelihood of early fetal loss.
No matter its exact drivers, seasonality is clearly weakening in manycountries, Martinez told me; in some parts of the world, it may be entirely gone. The change isn’t uniform or entirely understood, but it’s probably to some extent a product of just how much human lifestyles have changed. In many communities that have historically planted and harvested their own food, people may have been more disinclined to, and less physically able to, conceive a child when labor demands were high or when crops were scarce—trends that are still prominent in certain countries today. People in industrial and high-income areas of the modern world, though, are more shielded from those stressors and others, in ways that may even out the annual birth schedule, Kathryn Grace, a geographer at the University of Minnesota, told me. The heat-driven dip in America’s spring births, for instance, has softened substantially in recent decades, likely due in part to increased access to air-conditioning, Lam said. And as certain populations get more relaxed about religion, the cultural drivers of birth times may be easing up, too, several experts told me. Sweden, for example, appears to have lost the “Christmas effect” of December sex boosting September births.
Advances in contraception and fertility treatments have also put much more of fertility under personal control. People in well-resourced parts of the world can now, to a decent degree, realize their preferences for when they want their babies to be born. In Sweden, parents seem to avoid November and December deliveries because that would make their child among the youngest in their grade (which carries a stereotype of potentially having major impacts on their behavioral health, social skills, academics, and athletic success). In the U.S., people have reported preferring to give birth in the spring; there’s also a tax incentive to deliver early-winter babies before January 1, says Neel Shah, the chief medical officer of Maven Clinic, a women’s health and fertility clinic in New York.
Humans aren’t yet, and never will be, completely divorced from the influences of our surroundings. We are also constantly altering the environment in which we reproduce—which could, in turn, change the implications of being born during a particular season. Births are not only more common at certain times of the year; they can also be riskier, because of the seasonal perils posed to fetuses and newborns, Mary-Alice Doyle, a social-policy researcher at the London School of Economics, told me. Babies born during summer may be at higher risk of asthma, for instance—a trend that’s likely to get only stronger as heat waves, wildfires, and air pollution become more routine during the year’s hottest months.
The way we manage infectious disease matters too. Being born shortly after the peak of flu season—typically winter, in temperate parts of the world—can also be dangerous: Infections during pregnancy have been linked to lower birth weight, preterm delivery, even an increased likelihood of the baby developing certain mental-health issues later on. Comparable concerns exist in the tropics, where mosquitoes, carrying birth-defect-causing viruses such as dengue or Zika, can wax and wane with the rainy season. The more humans allow pathogens to spill over from wildlife and spread, the bigger these effects are likely to be.
Children born in the spring—in many countries, a more sparsely populated group—tend to be healthier on several metrics, Barreca told me. It’s possible that they’re able to “thread the needle,” he said, between the perils of flu in winter and extreme heat in summer. But these infants might also thrive because they are born to families with more socioeconomic privilege, who could afford to beat the heat that might have compromised other conceptions. As heat waves become more intense and frequent, people without access to air-conditioning might have an even harder time getting pregnant in the summer.
The point of all this isn’t that there is a right or wrong time of year to be born, Grace told me. If seasonality will continue to have any sway over when we conceive and give birth, health-care systems and public-health experts might be able to use that knowledge to improve outcomes, shuttling resources to maternity wards and childhood-vaccination clinics, for instance, during the months they might be in highest demand.
Humans may never have had as strict a breeding season as horses and deer. But the fact that so many people can now deliver safely throughout the year is a testament to our ingenuity—and to our sometimes-inadvertent power to reshape the world we live in. We have, without always meaning to, altered a fundamental aspect of human reproduction. And we’re still not done changing it.
Ballet flats are back. Everyone’s saying it—Vogue, the TikTok girlies, The New York Times, Instagram’s foremost fashion narcs, the whole gang. Shoes from trendsetting brands such as Alaïa and Miu Miu line store shelves, and hundreds of cheap alternatives are available online at fast-fashion juggernauts such as Shein and Temu. You can run from the return of the ballet flat, but you can’t hide. And, depending on how much time your feet spent in the shoes the last time they were trendy, maybe you can’t run either.
The ballet flat—a slipperlike, largely unstructured shoe style meant to evoke a ballerina’s pointe shoes—never disappears from the fashion landscape entirely, but its previous period of decided coolness was during the mid-to-late 2000s. Back then, teens were swathing themselves in Juicy Couture and Abercrombie & Fitch, Lauren Conrad was ruining her life by turning down a trip to Paris on The Hills, and fashion magazines were full of Lanvin and Chloé and Tory Burch flats. The style was paired with every kind of outfit you could think of—the chunky white sneaker of its day, if you will.
How you feel about the shoes’ revival likely has a lot to do with your age. If you’re young enough to be witnessing ballet flats’ popularity for the first time, then maybe they seem like a pleasantly retro and feminine departure from lug soles and sneakers. If, like me, you’ve made it past 30(ish), the whole thing might make you feel a little old. Physically, ballet flats are a nightmare for your back, your knees, your arches; when it comes to support, most offer little more than you’d get from a pair of socks. Spiritually, the injury might be even worse. Twenty years is a normal amount of time to have passed for a trend to be revived as retro, but it’s also a rude interval at which to contemplate being punted out of the zeitgeist in favor of those who see your youth as something to be mined for inspiration—and therefore as something definitively in the past.
Trends are a funny thing. Especially in fashion, people see trends as the province of the very young, but tracing their paths is often less straightforward. Take normcore’s dad sneakers: In the mid-2010s, the shoes became popular among Millennials, who were then hitting their 30s, precisely because they were the sneakers of choice for retired Boomers. But in order for a trend to reach the rare heights of population-level relevance, very young people do eventually need to sign on. In the case of dad sneakers, it took years for Zoomers to come around en masse, but their seal of approval has helped keep bulky New Balances popular for nearly a decade—far past the point when most trends fizzle.
The return of ballet flats is a signal of this new cohort of fashion consumers asserting itself even more widely in the marketplace. The trends young people endorse tend to swing between extremes. The durable popularity of dad shoes all but guaranteed that some young people would eventually start to look for something sleeker and less substantial. The ballet flat fits perfectly within the turn-of-the-millennium fashion tropes—overplucked eyebrows, low-rise jeans, tiny sunglasses—that Zoomers have been tinkering with for several years.
Ballet flats are an all-the-more-appropriate sign of a generational shift, in fact, because they are the folly of youth made manifest. Wearing them is an act of violence against podiatry, yes, but their drawbacks go further. Many ballet flats are so flimsy that they look trashed after only a few wears. They’re difficult to pair with socks, so they stinklike feet almost as quickly. Ballet flats are impractical shoes that sneak into closets under the guise of practicality—hey, they’re not high heels!—and prey on people who do not yet know better.
What does that mean, then, for the people who do know better? For one, it means that the extended adolescence that some Millennials experienced following the Great Recession is finally, inarguably over. We’re old, at least relatively speaking. Every generation eventually ages out of the particular cultural power of youth and then watches as younger people make mistakes that seem obvious in hindsight, and the ballet flat is a reminder that people my age are no longer the default main characters in culture that we once were. When I was a middle schooler begging for a pair of wooden-soled Candie’s platform sandals in the mid-’90s, I remember my mother, in a fit of exasperation, telling me that I couldn’t have them because she saw too many people fall off their platforms in the ’70s. This is the first time I remember contemplating my mom as a human being who existed long before I was conscious of her: someone who bought cool but ill-advised clothes and uncomfortable shoes, who went to parties where people sometimes had a hard time remaining upright.
Even the cool girls with the coolest shoes at some point grow to regard parts of their past selves as a bit silly, and they become the people trying to save the kids from their own fashion hubris. This sensation is undoubtedly acute for Millennials, because this hubris is displayed most prominently in an arena they used to rule: the internet. On TikTok, the world’s hottest trend machine, the over-30 crowd is more onlooker than participant, and the youth are using the platform to encourage one another to dress like they’re going to a party at the Delt house in 2007. Someone has to warn them.
If you’re realizing that this someone is you, my advice would be to not let the generational responsibilities of aging weigh too heavily on you. The upside of losing your spot at culture’s center stage, after all, is freedom. You can look around at what’s fashionable, pick the things that work for you, and write off the rest as the folly of youth. (The Zoomers are right: The lug-soled combat boots that I wore in high school actually are very cool.) In place of chasing trends, you can cultivate taste. When you fail at taste, at least you can be aware of your own questionable decisions. In the process of writing this article, I realized that French Sole still makes the exact same prim little flats that I must have bought three or four times over during the course of my first post-college job, in the late 2000s. They’re as flimsy as ever, but whatever made me love them 15 years ago is still there, buried under all of my better judgment. I haven’t closed the tab quite yet.
Here is a straightforward, clinical description of a migraine: intense throbbing headache, nausea, vomiting, and sensitivity to light and noise, lasting for hours or days.
And here is a fuller, more honest picture: an intense, throbbing sense of annoyance as the pain around my eye blooms. Wondering what the trigger was this time. Popping my beloved Excedrin—a combination of acetaminophen, aspirin, and caffeine—and hoping it has a chance to percolate in my system before I start vomiting. There’s the drawing of the curtains, the curling up in bed, the dash to the toilet to puke my guts out. I am not a religious person, but during my worst migraines, I have whimpered at the universe, my hands jammed into the side of my skull, and begged it for relief.
That probably sounds melodramatic, but listen: Migraines are miserable. They’re miserable for about 40 million Americans, most of them women, though the precise symptoms and their severity vary across sufferers. For about a quarter, myself included, the onset is sometimes preceded by an aura, a short-lived phase that can include blind spots, tingling, numbness, and language problems. (These can resemble stroke symptoms, and you should seek immediate medical care if you experience them and don’t have a history of migraines.) Many experience a final phase known as the “migraine hangover,” which consists of fatigue, trouble concentrating, and dizziness after the worst pain has passed.
These days, migraine sufferers are caught in a bit of a paradox. In some ways, their situation looks bright (but, please, not too bright): More treatments are available now than ever before—though still no cure—and researchers are learning more about what triggers a migraine, with occasionally surprising results. “It’s a really exciting time in headache medicine,” Mia Minen, a neurologist and the chief of headache research at NYU Langone, told me.
And yet the enthusiasm within the medical community doesn’t seem to align with conditions on the ground (which, by the way, is a nice, cool place to press your cheek during an attack). Migraine sufferers cancel plans and feel guilty about it. They struggle to parent. They call in sick, and if they can’t, they move through the work day like zombies. In a 2019 survey, about 30 percent of participants with episodic migraines—attacks that occur on fewer than 15 days a month—said that the disorder had negatively affected their careers. About 58 percent with chronic migraines—attacks that occur more often than that—said the same.
Migraines are still misunderstood, including by the people who deal with them. “We still don’t have a full understanding of exactly what causes migraine, and why some people suffer more than others do,” Elizabeth Loder, a headache clinician at Brigham and Women’s Hospital in Boston and a neurology professor at Harvard Medical School, told me. Despite scientific progress, awareness campaigns, and frequent reminders that migraines are a neurological disorder and not “just headaches,” too often, they’re not treated with the medical care they require. Yes, it’s the best time in history to have migraines. It just doesn’t feel that way.
Humans have had migraines probably for as long as we’ve had brains. As the historian Katherine Foxhall argues in her 2019 book, Migraine: A History, “much evidence suggests migraine had been taken seriously in both medical and lay literature throughout the classical, medieval, and early modern periods as a serious disorder requiring prompt and sustained treatment.” It was only in the 18th century, when medical professionals lumped migraines in with other “nervous disorders” such as hysteria, that they “came to be seen as characteristic of sensitivity, femininity, overwork, and moral and personal failure.” The association persisted, Stephen Silberstein, the director of the headache center at Thomas Jefferson University, told me. When Silberstein began his training in the 1960s, “nobody talked about migraine in medical school,” he told me. Physicians still believed that migraines were “the disorder of neurotic women.”
The first drug treatments for migraines appeared in the 1920s, and they were discovered somewhat by accident: Doctors found that ergotamine, a drug used to stimulate contractions in childbirth and control postpartum bleeding, also sometimes relieved migraines. (It could also cause pain, muscle weakness, and, in high enough doses, gangrene; some later studies have found that it’s little better than placebo.) The drug constricted blood vessels in the brain, so doctors assumed that migraine was a vascular disorder, the symptoms brought on by changes in blood flow and inflamed vessels. In the 1960s, a physician studying the effectiveness of a heart medication noticed that one of his participants experienced migraine attacks less frequently than he used to; a decade later, the FDA approved that class of drug, called beta-blockers, as a preventative treatment. (In the decades since their approval, studies have found that beta-blockers helped about a quarter of participants reduce their monthly migraine days by half, compared with 4 percent of people taking a placebo.)
Things changed in the 1990s, when triptans, a new class of drugs made specifically for migraines, became available. Triptans were often more effective and faster at easing migraine pain than earlier drugs, though the effects didn’t last as long. Around the same time, genetic studies revealed that migraines are often hereditary. Meanwhile, new brain-imaging technology allowed researchers to observe migraines in real time. It showed that, although blood vessels could become inflamed during an attack and contribute to pain, migraine isn’t strictly a vascular disorder. The chaos comes from within the nervous system: Scientists’ best understanding is that the trigeminal nerve, which provides sensation in the face, becomes stimulated, which triggers cells in the brain to release neurotransmitters that produce headache pain. How exactly the nerve gets perturbed remains unclear.
The past few years of migraine medicine have felt like the ’90s all over again. In 2018, the FDA approved a monthly injection that prevents migraines by regulating CGRP, a neurotransmitter that’s known to spike during attacks. For 40 percent of people with chronic migraines participating in one clinical trial, the treatment cut their monthly migraine days in half. Similar remedies followed; Lady Gaga, a longtime migraine sufferer, appeared in a commercial this summer to endorse Pfizer’s CGRP-blocking pill, and the company’s CEO launched a migraine-awareness campaign earlier this month. Solid evidence has emerged that cognitive behavioral therapy and relaxation techniques tailored to migraine can be helpful as part of a larger treatment plan. The FDA has cleared several wearable devices designed to curb migraines by delivering mild electric stimulation. Last year, the agency decided to speed up the development of a device that deploys gentle puffs of air into a user’s ears.
Researchers are still, to this day, making progress on identifying migraine triggers. Experts agree on many common triggers, such as skipping meals, getting too little sleep, getting too much sleep, stress, the comedown from stress, and hormone changes linked to menstruation or menopause. They’re also realizing that some long-held beliefs about triggers might be entirely wrong. MSG, for example, probably doesn’t induce migraines; changes in air pressure don’t do so as often as many people who have migraines seem to think.
Some supposed triggers might actually be signs of an oncoming migraine. The majority of migraine sufferers experience something called the premonitory phase, which can last for several hours or days before headache pain sets in and has its own set of symptoms, including food cravings. We migraine sufferers are frequently advised to steer clear of chocolate, but if you’re craving a Snickers bar, the migraine may already be coming whether or not you eat it. “When you get a headache, you blame it on the chocolate—even though the migraine made you eat the chocolate,” Silberstein said. “I always tell people, if they think they’re getting a migraine, eat a bar of chocolate … It’s more likely to do good than harm.”
Silberstein’s advice sounded like absolute blasphemy to me. Virtually every migraine FAQ page in existence had led me to believe that chocolate is a ruthless trigger. Maybe I shouldn’t have been relying on general guidelines on the internet, even though they came from reputable medical institutions. But I had turned to the internet because I didn’t think my migraines necessitated a visit to a specialist. According to the American Migraine Foundation, the majority of people who have migraines never consult a doctor to receive proper diagnosis and treatment.
Recent surveys have shown that people are reluctant to see a professional for a variety of reasons: They think their migraine isn’t bad enough, they worry that their symptoms won’t be taken seriously, or they can’t afford the care. The hot new preventative medications in particular “are extremely expensive, putting them out of reach of some of the people who might benefit the most,” Loder said. In 2018, when the much-heralded CGRP blocker hit the market, the journalist Libby Watson, a longtime migraine patient herself, interviewed migraine sufferers who described themselves as low-income, and found that most of them hadn’t heard of the new drug at all.
Even if you can get them, the treatments don’t guarantee relief. One recent study showed that triptans might not relieve pain—or might not be tolerable—for up to 40 percent of migraine patients. Experts are still trying to figure out why the same treatment might work wonderfully for one person, and not at all for another, Minen said. Some patients find that drugs eventually stop working for them, or that they come with side effects bad enough to discourage continued use, such as dizziness and still more nausea.
These problems remain unsolved in part because of a dearth of research. Like other conditions that mostly afflict women, migraines receive “much less funding in proportion to the burden they exert on the U.S. population,” Nature’s Kerri Smith reported in May. And many doctors are unaware of the research that exists: A 2021 study of non-migraine physicians found that 43 percent had “poor knowledge” of the condition’s symptoms and management, and just 21 percent were aware of targeted treatments. Specialists tend to have a much better knowledge base, but good luck seeing one: America has too few headache doctors, and there are significantly fewer of them in rural areas.
Many migraine sufferers rely on over-the-counter pain relievers, myself included. Years ago, my primary-care physician prescribed me a triptan nasal spray. It produced a terrible aftertaste and worsened the throbbing in my head, and I gave up on it after only a couple of uses. Back to Excedrin I went, not realizing—until reporting this story—that nonprescription medications can cause even more attacks if you overuse them. Some people get by on home remedies that the journalist Katy Schneider, who battles migraines herself, has described as a “medicine cabinet of curiosities”; one person she interviewed shotguns an ice-cold Coke when she feels the symptoms coming on.
When triptans and tricks fail, some people try to prevent migraines by avoiding triggers. Don’t stay up too late or sleep in. Don’t drink red wine. Put down that Snickers. This strategy of avoidance “interferes with the quality of their life in many cases,” Loder said, and probably doesn’t stop the attacks. And drawing associations is a futile exercise because most migraines are brought on by more than one trigger, Minen said. People can end up internalizing the 18th-century idea that migraines are a personal failure rather than a disease—and migraine FAQs perpetuate that myth by advising patients to live an ascetic life.
The misconceptions surrounding migraine, combined with its invisibility, make the disorder easy to stigmatize. The authors of a 2021 review found that, compared with epilepsy, a neurological disorder with a physical manifestation, “people with chronic migraine are viewed as less trustworthy, less likely to try their hardest, and more likely to malinger.” Perhaps as a result, many feel pressure to grind through it. Migraines are estimated to account for 16 percent of presenteeism—being on the job but not operating at full capacity—in the American workforce.
Before reporting this story, I had never thought to call my migraines a neurological disorder, let alone a “debilitating” one, as Minen and other experts do. Migraines were just this thing that I’ve lived with for more than a decade, and had accepted as an unfortunate part of my existence. Just my Excedrin and me, together forever, barreling through the wasted days. The attacks began in my late teens, around the same time that my childhood epilepsy mysteriously vanished. I never got an explanation for my seizures, despite years of daily medication and countless EEGs. A neurologist once told me that the two might be related, but he couldn’t say for sure; research has shown that people who have epilepsy are more likely to experience migraines. And so I assumed that I just had a slightly broken brain, prone to electrochemical misfiring.
All of the experts I spoke with were politely horrified when I told them about my migraines and how I manage them. I promised them that I’d make an appointment with a specialist. Before we got off the phone, Silberstein gave me a tip. “Put a cold pack on your neck and then a heating pad, 15 minutes alternating,” he said. “It’ll take the migraine away.” He told me that researchers are developing a device that does this, but the old-fashioned way can be effective too. At this point, my cabinet of curiosities is falling apart, its hinges squeaking from overuse. I’m already rethinking my entire migraine life, so I may as well try this too.
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.
For most of his life, Mitt Romney has nursed a morbid fascination with his own death, suspecting that it might assert itself one day suddenly and violently.
He controls what he can, of course. He wears his seat belt, and diligently applies sunscreen, and stays away from secondhand smoke. For decades, he’s followed his doctor’s recipe for longevity with monastic dedication—the lean meats, the low-dose aspirin, the daily 30-minute sessions on the stationary bike, heartbeat at 140 or higher or it doesn’t count.
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He would live to 120 if he could. “So much is going to happen!” he says when asked about this particular desire. “I want to be around to see it.” But some part of him has always doubted that he’ll get anywhere close.
He has never really interrogated the cause of this preoccupation, but premonitions of death seem to follow him. Once, years ago, he boarded an airplane for a business trip to London and a flight attendant whom he’d never met saw him, gasped, and rushed from the cabin in horror. When she was asked what had so upset her, she confessed that she’d dreamt the night before about a man who looked like him—exactly like him—getting shot and killed at a rally in Hyde Park. He didn’t know how to respond, other than to laugh and put it out of his mind. But when, a few days later, he happened to find himself on the park’s edge and saw a crowd forming, he made a point not to linger.
All of which is to say there is something familiar about the unnerving sensation that Romney is feeling late on the afternoon of January 2, 2021.
It begins with a text message from Angus King, the junior senator from Maine: “Could you give me a call when you get a chance? Important.”
Romney calls, and King informs him of a conversation he’s just had with a high-ranking Pentagon official. Law enforcement has been tracking online chatter among right-wing extremists who appear to be planning something bad on the day of Donald Trump’s upcoming rally in Washington, D.C. The president has been telling them the election was stolen; now they’re coming to steal it back. There’s talk of gun smuggling, of bombs and arson, of targeting the traitors in Congress who are responsible for this travesty. Romney’s name has been popping up in some frightening corners of the internet, which is why King needed to talk to him. He isn’t sure Romney will be safe.
Romney hangs up and immediately begins typing a text to Mitch McConnell, the Senate majority leader. McConnell has been indulgent of Trump’s deranged behavior over the past four years, but he’s not crazy. He knows that the election wasn’t stolen, that his guy lost fair and square. He sees the posturing by Republican politicians for what it is. He’ll want to know about this, Romney thinks. He’ll want to protect his colleagues, and himself.
Romney sends his text: “In case you have not heard this, I just got a call from Angus King, who said that he had spoken with a senior official at the Pentagon who reports that they are seeing very disturbing social media traffic regarding the protests planned on the 6th. There are calls to burn down your home, Mitch; to smuggle guns into DC, and to storm the Capitol. I hope that sufficient security plans are in place, but I am concerned that the instigator—the President—is the one who commands the reinforcements the DC and Capitol police might require.”
McConnell never responds.
I began meeting with Romney in the spring of 2021. The senator hadn’t told anyone he was talking to a biographer, and we kept our interviews discreet. Sometimes we talked in his Senate office, after most of his staff had gone home; sometimes we went to his little windowless “hideaway” near the Senate chamber. But most weeks, I drove to a stately brick townhouse with perpetually drawn blinds on a quiet street a mile from the Capitol.
The place had not been Romney’s first choice for a Washington residence. When he was elected, in 2018, he’d had his eye on a newly remodeled condo at the Watergate with glittering views of the Potomac. His wife, Ann, fell in love with the place, but his soon-to-be staffers and colleagues warned him about the commute. So he grudgingly chose practicality over luxury and settled for the $2.4 million townhouse instead.
He tried to make it nice, so that Ann would be comfortable when she visited. A decorator filled the rooms with tasteful furniture and calming abstract art. He planted a garden on the small backyard patio. But his wife rarely came to Washington, and his sons didn’t come either, and gradually the house took on an unkempt bachelor-pad quality. Crumbs littered the kitchen counter; soda and seltzer occupied the otherwise-empty fridge. Old campaign paraphernalia appeared on the mantel, clashing with the decorator’s mid-tone color scheme, and a bar of “Trump’s Small Hand Soap” (a gag gift from one of his sons) was placed in the powder room alongside the monogrammed towels.
Top left: Mitt and Ann Romney at a dinner in Washington for Richard Nixon’s inauguration, January 1973. Top right: Romney speaking to a Mormon congregation in the Boston area, 1980s. Bottom: Romney and several of his sons. (Courtesy of Mitt Romney)
In the “dining room,” a 98-inch TV went up on the wall and a leather recliner landed in front of it. Romney, who didn’t have many real friends in Washington, ate dinner alone there most nights, watching Ted Lasso or Better Call Saul as he leafed through briefing materials. On the day of my first visit, he showed me his freezer, which was full of salmon fillets that had been given to him by Lisa Murkowski, the senator from Alaska. He didn’t especially like salmon but found that if he put it on a hamburger bun and smothered it in ketchup, it made for a serviceable meal.
Sitting across from Romney at 76, one can’t help but become a little suspicious of his handsomeness. The jowl-free jawline. The all-seasons tan. The just-so gray at the temples of that thick black coif, which his barber once insisted he doesn’t dye. It all seems a little uncanny. Only after studying him closely do you notice the signs of age. He shuffles a little when he walks now, hunches a little when he sits. At various points in recent years, he’s gotten so thin that his staff has worried about him. Mostly, he looks tired.
Romney’s isolation in Washington didn’t surprise me. In less than a decade, he’d gone from Republican standard-bearer and presidential nominee to party pariah thanks to a series of public clashes with Trump. What I didn’t quite expect was how candid he was ready to be. He instructed his scheduler to block off evenings for weekly interviews, and told me that no subject would be off-limits. He handed over hundreds of pages of his private journals and years’ worth of personal correspondence, including sensitive emails with some of the most powerful Republicans in the country. When he couldn’t find the key to an old filing cabinet that contained some of his personal papers, he took a crowbar to it and deposited stacks of campaign documents and legal pads in my lap. He’d kept all of this stuff, he explained, because he thought he might write a memoir one day, but he’d decided against it. “I can’t be objective about my own life,” he said.
Some nights he vented; other nights he dished. He’s more puckish than his public persona suggests, attuned to the absurdist humor of political life and quick to share stories that others might consider indiscreet. I got the feeling he liked the company—our conversations sometimes stretched for hours.
“A very large portion of my party,” he told me one day, “really doesn’t believe in the Constitution.” He’d realized this only recently, he said. We were a few months removed from an attempted coup instigated by Republican leaders, and he was wrestling with some difficult questions. Was the authoritarian element of the GOP a product of President Trump, or had it always been there, just waiting to be activated by a sufficiently shameless demagogue? And what role had the members of the mainstream establishment—people like him, the reasonable Republicans—played in allowing the rot on the right to fester?
I had never encountered a politician so openly reckoning with what his pursuit of power had cost, much less one doing so while still in office. Candid introspection and crises of conscience are much less expensive in retirement. But Romney was thinking beyond his own political future.
Earlier this year, he confided to me that he would not seek reelection to the Senate in 2024. He planned to make this announcement in the fall. The decision was part political, part actuarial. The men in his family had a history of sudden heart failure, and none had lived longer than his father, who died at 88. “Do I want to spend eight of the 12 years I have left sitting here and not getting anything done?” he mused. But there was something else. His time in the Senate had left Romney worried—not just about the decomposition of his own political party, but about the fate of the American project itself.
Shortly after moving into his Senate office, Romney had hung a large rectangular map on the wall. First printed in 1931 by Rand McNally, the “histomap” attempted to chart the rise and fall of the world’s most powerful civilizations through 4,000 years of human history. When Romney first acquired the map, he saw it as a curiosity. After January 6, he became obsessed with it. He showed the map to visitors, brought it up in conversations and speeches. More than once, he found himself staring at it alone in his office at night. The Egyptian empire had reigned for some 900 years before it was overtaken by the Assyrians. Then the Persians, the Romans, the Mongolians, the Turks—each civilization had its turn, and eventually collapsed in on itself. Maybe the falls were inevitable. But what struck Romney most about the map was how thoroughly it was dominated by tyrants of some kind—pharaohs, emperors, kaisers, kings. “A man gets some people around him and begins to oppress and dominate others,” he said the first time he showed me the map. “It’s a testosterone-related phenomenon, perhaps. I don’t know. But in the history of the world, that’s what happens.” America’s experiment in self-rule “is fighting against human nature.”
“This is a very fragile thing,” he told me. “Authoritarianism is like a gargoyle lurking over the cathedral, ready to pounce.”
For the first time in his life, he wasn’t sure if the cathedral would hold.
Optimism—quaint in retrospect, though perhaps delusional—is what first propelled Romney to the Senate. It was 2017. Trump was president, and the early months of his tenure had been a predictable disaster; the Republican Party was in trouble. Romney’s friends were encouraging him to get back in the game, and he was tempted by the open Senate seat in Utah, a state where Trump was uniquely unpopular among conservative voters. On his iPad, he typed out the pros and cons of running—high-minded sentiments about public service in one column, lifestyle considerations in the other. Then, at the top of the list, he wrote a line from Yeats that he couldn’t get out of his mind: “The best lack all conviction, while the worst / Are full of passionate intensity.”
To Romney, this was the problem with the Trump-era GOP. He believed there were still decent, well-intentioned leaders in his party—they were just nervous. They needed a nudge. A role model, perhaps. As the former nominee, he told me, he felt that he “had the potential to be an alternative voice for Republicans.”
Romney leaves the Trump National Golf Club after meeting with the president-elect, November 19, 2016. (Drew Angerer / Getty)
Five years earlier, while running for president, Romney had accepted Trump’s endorsement. At the time, he’d rationalized the decision—yes, Trump was a buffoon and a conspiracy theorist, but he was just a guy on reality TV, not a serious political figure. Romney now realized that he’d badly underestimated the potency of Trumpism. But in the summer of 2017, it still seemed possible that the president would be remembered as an outlier.
Two days before he was sworn in as a senator, Romney published an op-ed in The Washington Post designed to signal his independence from Trump. “On balance,” Romney wrote, the president “has not risen to the mantle of the office.” He pledged to work with him when they agreed on an issue, to oppose him when they didn’t, and to speak out when necessary. He thought of this as a new way to be a Republican senator in Trump’s Washington.
His colleagues were not impressed. A few days after Romney was sworn in, Politico ran a story about the “chilly reception” he was receiving from his fellow Republican senators. The story quoted several of them, on the record or anonymously, griping about his unwillingness to get along with the leader of their party. Romney emailed the story to his advisers, describing himself as “the turd in the punch bowl.” “These guys have got to justify their silence, at least to themselves.”
Romney had spent the weeks since his election typing out a list of all the things he wanted to accomplish in the Senate. By the time he took office, it contained 42 items and was still growing. The legislative to-do list ranged from complex systemic reforms—overhauling immigration, reducing the national deficit, addressing climate change—to narrower issues such as compensating college athletes and regulating the vaping industry. His staff was bemused when he showed it to them; even in less polarized, less chaotic times, the kind of ambitious agenda he had in mind would be unrealistic. But Romney was not deterred. He told his aides he wanted to set up meetings with all 99 of his colleagues in his first six months, and began studying a flip-book of senators’ pictures so that he could recognize his potential legislative partners.
In one early meeting, a colleague who’d been elected a few years earlier leveled with him: “There are about 20 senators here who do all the work, and there are about 80 who go along for the ride.” Romney saw himself as a workhorse, and was eager for others to see him that way too. “I wanted to make it clear: I want to do things,” he told me.
He quickly became frustrated, though, by how much of the Senate was built around posturing and theatrics. Legislators gave speeches to empty chambers and spent hours debating bills they all knew would never pass. They summoned experts to appear at committee hearings only to make them sit in silence while they blathered some more.
As the weeks passed, Romney became fascinated by the strange social ecosystem that governed the Senate. He spent his mornings in the Senate gym studying his colleagues like he was an anthropologist, jotting down his observations in his journal. Richard Burr walked on the treadmill in his suit pants and loafers; Sherrod Brown and Dick Durbin pedaled so slowly on their exercise bikes that Romney couldn’t help but peek at their resistance settings: “Durbin was set to 1 and Brown to 8. 🙂 :). My setting is 15—not that I’m bragging,” he recorded.
He joked to friends that the Senate was best understood as a “club for old men.” There were free meals, on-site barbers, and doctors within a hundred feet at all times. But there was an edge to the observation: The average age in the Senate was 63 years old. Several members, Romney included, were in their 70s or even 80s. And he sensed that many of his colleagues attached an enormous psychic currency to their position—that they would do almost anything to keep it. “Most of us have gone out and tried playing golf for a week, and it was like, ‘Okay, I’m gonna kill myself,’ ” he told me. Job preservation, in this context, became almost existential. Retirement was death. The men and women of the Senate might not need their government salary to survive, but they needed the stimulation, the sense of relevance, the power. One of his new colleagues told him that the first consideration when voting on any bill should be “Will this help me win reelection?” (The second and third considerations, the colleague continued, should be what effect it would have on his constituents and on his state.)
Perhaps Romney’s most surprising discovery upon entering the Senate was that his disgust with Trump was not unique among his Republican colleagues. “Almost without exception,” he told me, “they shared my view of the president.” In public, of course, they played their parts as Trump loyalists, often contorting themselves rhetorically to defend the president’s most indefensible behavior. But in private, they ridiculed his ignorance, rolled their eyes at his antics, and made incisive observations about his warped, toddlerlike psyche. Romney recalled one senior Republican senator frankly admitting, “He has none of the qualities you would want in a president, and all of the qualities you wouldn’t.”
This dissonance soon wore on Romney’s patience. Every time he publicly criticized Trump, it seemed, some Republican senator would smarmily sidle up to him in private and express solidarity. “I sure wish I could do what you do,” they’d say, or “Gosh, I wish I had the constituency you have,” and then they’d look at him expectantly, as if waiting for Romney to convey profound gratitude. This happened so often that he started keeping a tally; at one point, he told his staff that he’d had more than a dozen similar exchanges. He developed a go-to response for such occasions: “There are worse things than losing an election. Take it from somebody who knows.”
One afternoon in March 2019, Trump paid a visit to the Senate Republicans’ weekly caucus lunch. He was in a buoyant mood—two days earlier, the Justice Department had announced that the much-anticipated report from Special Counsel Robert Mueller failed to establish collusion between the Trump campaign and Russia during the 2016 election. As Romney later wrote in his journal, the president was met with a standing ovation fit for a conquering hero, and then launched into some rambling remarks. He talked about the so-called Russia hoax and relitigated the recent midterm elections and swung wildly from one tangent to another. He declared, somewhat implausibly, that the GOP would soon become “the party of health care.” The senators were respectful and attentive.
As soon as Trump left, Romney recalled, the Republican caucus burst into laughter.
Few of his colleagues surprised him more than Mitch McConnell. Before arriving in Washington, Romney had known the Senate majority leader mainly by reputation. With his low, cold mumble and inscrutable perma-frown, McConnell was viewed as a win-at-all-costs tactician who ruled his caucus with an iron fist. Observing him in action, though, Romney realized that McConnell rarely resorted to threats or coercion—he was primarily a deft manager of egos who excelled at telling each of his colleagues what they wanted to hear. This often left Romney guessing as to which version of McConnell was authentic—the one who did Trump’s bidding in public, or the one who excoriated him in their private conversations.
In the fall of 2019, Trump’s efforts to pressure Ukrainian President Volodymyr Zelensky into investigating the Biden family’s business dealings were revealed in the press. Romney called the scheme “wrong and appalling,” and Trump responded with a wrathful series of tweets that culminated with a call to #IMPEACHMITTROMNEY. A few weeks later, Romney read in the press that McConnell had privately urged Trump to stop attacking members of the Senate. Romney thanked McConnell for sticking up for him against Trump.
Romney’s Senate office (Yael Malka for The Atlantic)
“It wasn’t for you so much as for him,” McConnell replied. “He’s an idiot. He doesn’t think when he says things. How stupid do you have to be to not realize that you shouldn’t attack your jurors?
“You’re lucky,” McConnell continued. “You can say the things that we all think. You’re in a position to say things about him that we all agree with but can’t say.” (A spokesperson said that McConnell does not recall this conversation and that he was “fully aligned” with Trump during the impeachment trial.)
As House Democrats pursued their impeachment case against the president, Romney carefully studied his constitutional role in the imminent Senate trial. He read and reread Alexander Hamilton’s treatise on impeachment, “Federalist No. 65.” He pored over the work of constitutional scholars and reviewed historical definitions of “high crimes and misdemeanors.” His understanding was that once the House impeached a president, senators were called on to set aside their partisan passions and act as impartial jurors.
Meanwhile, among Romney’s Republican colleagues, rank cynicism reigned. They didn’t want to hear from witnesses; they didn’t want to learn new facts; they didn’t want to hold a trial at all. During an interview with CNN, Lindsey Graham frankly admitted that he was “not trying to pretend to be a fair juror here,” and predicted that the impeachment process would “die quickly” once it reached the Senate.
On December 11, 2019, McConnell summoned Romney to his office and pitched him on joining forces. He explained that several vulnerable members of their caucus were up for reelection, and that a prolonged, polarizing Senate trial would force them to take tough votes that risked alienating their constituents. McConnell wanted Romney to vote to end the trial as soon as the opening arguments were completed. McConnell didn’t bother defending Trump’s actions. Instead, he argued that protecting the GOP’s Senate majority was a matter of vital national importance. He predicted that Trump would lose reelection, and painted an apocalyptic picture of what would happen if Democrats took control of Congress: They’d turn Puerto Rico and D.C. into states, engineering a permanent Senate majority; they’d ram through left-wing legislation such as Medicare for All and the Green New Deal. Romney said he couldn’t make any promises about his vote. (McConnell declined to comment on this conversation.)
A week later, Republican senators met for their regular caucus lunch. Romney had come to dread these meetings. They had a certain high-school-cafeteria quality that made him feel ill at ease. “I mean, it’s a funny thing,” he told me. “You don’t want to be the only one sitting at the table and no one wants to sit with you.” He had always had plenty of friends growing up, but his religion often made him feel like he didn’t quite fit in. At Cranbrook prep school, in Michigan, he was the only Mormon on campus; at Stanford, he would go to bars with his friends and drink soda. Walking into those caucus lunches each week—deciding whom to sit with, and whether to speak up—Romney felt his differentness just as acutely as he had in his teens.
The meeting was being held shortly before Christmas break, and Romney hoped the caucus would get some guidance on what to expect from the trial. Instead, he was dismayed to learn that the featured guest was Vice President Mike Pence, who was there to talk through the White House’s defense strategy. “Stunning to me that he would be there,” Romney grumbled in his journal. “There is not even an attempt to show impartiality.” (Romney had long been put off by Pence’s pious brand of Trump sycophancy. No one, he told me, has been “more loyal, more willing to smile when he saw absurdities, more willing to ascribe God’s will to things that were ungodly than Mike Pence.”)
At the next meeting, McConnell told his colleagues they should understand that the upcoming trial was not really a trial at all. “This is a political process,” he said—and it was thus appropriate for them to behave like politicians. “If impeachment is a partisan political process, then it might as well be removed from the Constitution,” Romney recalled muttering to Ted Cruz and Mike Lee, who were seated near him. The senators politely ignored him.
Two articles of impeachment arrived at the Senate on January 15, 2020, and the trial began. Romney did his best to be a model juror—he took notes, parsed the arguments, and agonized each night in his journal over how he should vote. “Interestingly, sometimes I think I will be voting to convict, and sometimes I think I will vote to exonerate,” he wrote on January 23. “I jot down my reasons for each, but when I finish, I begin to consider the other side of the argument … I do the same thing—with less analysis of course—in bed. That’s probably why I’m not sleeping more than 4 or 5 hours.”
The other members of his caucus didn’t seem quite so burdened. They mumbled dismissive comments while the impeachment managers presented their case. He heard some of them literally cheer for Trump’s defense team. Maybe Romney was naive, but he couldn’t get over how irresponsible it all seemed. “How unlike a real jury is our caucus!” he wrote in his journal.
And yet, to at least some of his fellow Republicans, the case against Trump was compelling—even if they’d never say so in public. During a break in the proceedings, after the impeachment managers finished their presentation, Romney walked by McConnell. “They nailed him,” the Senate majority leader said.
Romney, taken aback by McConnell’s candor, responded carefully: “Well, the defense will say that Trump was just investigating corruption by the Bidens.”
“If you believe that,” McConnell replied, “I’ve got a bridge I can sell you.” (McConnell said he does not recall this conversation and it does not match his thinking at the time.)
By the time the defense wrapped up its arguments, on January 28, Romney was privately leaning toward acquittal. In his journal, he rationalized the vote—Trump hadn’t explicitly told Zelensky he would withhold military aid until an investigation was open—but he also admitted a self-interested motive. “I do not at all want to vote to convict,” he wrote. “The consequences of doing so are too painful to contemplate.”
When he informed his senior staff of his thinking the next morning, he detected a palpable sense of relief. Maybe their boss still had a future in Republican politics after all. Romney’s wife, though, seemed less elated by the news. Ann didn’t argue with him. She didn’t render any judgment at all. She just said she was “surprised.” Romney, who’d organized much of his life around winning and keeping Ann’s respect, couldn’t help but wonder if she meant something more.
On January 30, the senators were allowed to question lawyers on both sides of the impeachment case. Late in the day, a question submitted by Graham caught Romney’s attention: Even if Trump really had done exactly what the House accused him of, he asked, “isn’t it true that the allegations still would not rise to the level of an impeachable offense?” Trump’s lawyers concurred.
The answer stunned Romney. Until then, Trump’s defense had been that he wasn’t really trying to shake down a world leader for political favors by threatening to withhold military aid. Now, it seemed to Romney, Trump’s lawyers were effectively arguing that such a shakedown would have been fine. Allowing that argument to go unchallenged would set a dangerous precedent. When the Senate recessed, Romney returned to his office to go over the facts of the case again. The gravity of the moment was catching up to him. Finally, Romney knelt on the floor and prayed.
A few days earlier, Romney had paid a visit to Senator Joe Manchin’s houseboat, Almost Heaven—the West Virginian’s home in Washington. The impeachment trial had presented a serious political quandary for Manchin, a moderate Democrat whose state Trump had carried with 68 percent of the vote in 2016. While the voters there liked Manchin’s independence, they wouldn’t be happy if he voted to convict. After listening to Manchin describe his predicament, Romney offered his take: “We’re both 72. We should probably be thinking about oaths and legacy, not just reelection.”
Now it was time for Romney to follow his own advice. Writing in his journal, he once again laid out the facts of the case as he understood them. Hundreds of words, page after page, he wrote and wrote and wrote, until finally the truth was clear to him: Trump was guilty.
Romney slept fitfully that night, rising at 4 a.m. to review the case one more time. Still convinced of the president’s guilt, he opened up a laptop at his kitchen table and wrote the first draft of the speech he’d eventually give on the Senate floor.
After that, he made his way to the Russell Building, where he broke the news to his senior staff. Some were surprised but approving; others were distressed. One staffer simply put her head in her hands. She didn’t speak or look up again for the rest of the meeting.
Shortly before 2 p.m. on the day of the vote, Romney left his office and walked to the Capitol, where he waited in his hideaway for his turn to speak. Minutes before going on the floor, he received an unexpected call on his cellphone. It was Paul Ryan. Romney and his team had kept a tight lid on how he planned to vote, but somehow his former running mate had gotten word that he was about to detonate his political career. Romney had been less judgmental of Ryan’s acquiescence to Trump than he’d been of most other Republicans’. He believed Ryan was a sincere guy who’d simply misjudged Trump.
Yael Malka for The Atlantic
And yet, here was Ryan on the phone, making the same arguments Romney had heard from some of his more calculating colleagues. Ryan told him that voting to convict Trump would make Romney an outcast in the party, that many of the people who’d tried to get him elected president would never speak to him again, and that he’d struggle to pass any meaningful legislation. Ryan said that he respected Romney, and wanted to make absolutely sure he’d thought through the repercussions of his vote. Romney assured him that he had, and said goodbye.
He walked onto the Senate floor and read the remarks he’d written at his kitchen table. “As a Senator-juror,” Romney began, “I swore an oath before God to exercise impartial justice. I am profoundly religious. My faith is at the heart of who I am—” His voice broke, and he had to pause as emotion overwhelmed him. “I take an oath before God as enormously consequential.”
Romney acknowledged that his vote wouldn’t change the outcome of the trial—the Republican-led Senate would fall far short of the 67 votes needed to remove the president from office, and he would be the lone Republican to find Trump guilty. Even so, he said, “with my vote, I will tell my children and their children that I did my duty to the best of my ability, believing that my country expected it of me.”
He would never feel comfortable at a Republican caucus lunch again.
Early on the morning of January 6, 2021, Romney slid into the back of an SUV and began the short ride to his Senate office, with a Capitol Police car in tow. Ann had begged him not to return to Washington that day. She had a bad feeling about all of this. In the year since his impeachment vote, her husband had become a regular target of heckling and harassment from Trump supporters. They shouted “traitor” from car windows and confronted him in restaurants. Romney had tried to make light of her concern: “If I get shot, you can move on to a younger, more athletic husband.” A special police escort had been arranged for him that morning. But now, as he looked out the window at the streets of D.C., he found himself wondering about its utility. If somebody wants to shoot me, he thought, what good is it to have these guys in a car behind me?
He tried to go about his morning as usual, but he struggled to concentrate. Two miles away, at the White House Ellipse, thousands of angry people were gathering for a “Save America” rally.
The Senate chamber is a cloistered place, with no television monitors or electronic devices, and strict rules that keep outsiders off the floor. So when the Senate convened that afternoon to debate his colleagues’ objection to certifying the 2020 electoral votes, Romney didn’t know exactly what was happening outside. He didn’t know that the president had just directed his supporters to march down Pennsylvania Avenue—“We’re going to the Capitol!” He didn’t know that pipe bombs had been discovered outside both parties’ nearby headquarters. He didn’t know that Capitol Police were scrambling to evacuate the Library of Congress, or that rioters were crashing into police barricades outside the building, or that officers were beginning to realize they were outnumbered and wouldn’t be able to hold the line much longer.
At 2:08 p.m., Romney’s phone buzzed with a text message from his aide Chris Marroletti, who had been communicating with Capitol Police: “Protestors getting closer. High intensity out there.” He suggested that Romney might want to move to his hideaway.
Romney looked around the chamber. The hideaway was a few hundred yards and two flights of stairs away. He didn’t want to leave if he didn’t have to. He’d stay put, he decided, unless the protesters got inside the building.
A minute later, Romney’s phone buzzed again.
“They’re on the west front, overcame barriers.”
Adrenaline surging, Romney stood and made his way to the back of the chamber, where he pushed open the heavy bronze doors. He was expecting the usual crowd of reporters and staff aides, but nobody was there. A strange, unsettling quiet had engulfed the deserted corridor. He turned left and started down the hall toward his hideaway, when suddenly he saw a Capitol Police officer sprinting toward him at full speed.
“Go back in!” the officer boomed without breaking stride. “You’re safer inside the chamber.”
Romney turned around and started to run.
He got back in time to hear the gavel drop and see several men—Secret Service agents, presumably—rush into the chamber without explanation and pull the vice president out. Then, all at once, the room turned over to chaos: A man in a neon sash was bellowing from the middle of the Senate floor about a security breach. Officials were scampering around the room in a panic, slamming doors shut and barking at senators to move farther inside until they could be evacuated.
Something about the volatility of the moment caused Romney— a walking amalgam of prep-school manners and Mormon niceness and the practiced cool of the private-equity set—to lose his grip, and he finally vented the raw anger he had been trying to contain. He turned to Josh Hawley, who was huddled with some of his right-wing colleagues, and started to yell. Later, Romney would struggle to recall the exact wording of his rebuke. Sometimes he’d remember shouting “You’re the reason this is happening!” Other times, it would be something more terse: “You did this.” At least one reporter in the chamber would recount seeing the senator throw up his hands in a fit of fury as he roared, “This is what you’ve gotten, guys!” Whatever the words, the sentiment was clear: This violence, this crisis, this assault on democracy—this is your fault.
Soon, Romney was being rushed down a hallway with several of his colleagues. The mob was only one level below, so they couldn’t take the stairs; instead, the senators piled into elevators, 10 at a time, while the rest loitered anxiously in the hallway.
When they reached the basement, Romney asked a pair of police officers, “Where are we supposed to go?”
“The senators know,” one of the officers replied.
Marroletti, Romney’s aide, spoke up: “These are the senators. They don’t know. Where are we supposed to go?”
Romney was mystified by the ineptitude, but he knew the situation wasn’t the police’s fault. He thought about the text message he’d sent to McConnell a few days earlier explicitly warning of this scenario. How were they not ready for this? It was, in some ways, a perfect metaphor for his party’s timorous, shortsighted approach to the Trump era. As a boy, he’d read Idylls of the King with his mother; now he could understand the famous quote from Tennyson’s Guinevere as she witnesses the consequences of corruption in Arthur’s court: “This madness has come on us for our sins.”
Eventually the senators made it to a safe room. There were no chairs at first, so the shell-shocked legislators simply wandered around, murmuring variations of “I can’t believe this is happening.” When someone wheeled in a TV and turned on CNN, the senators got their first live look at the sacking of the Capitol. A sickened silence fell over the room as anger and outrage were replaced by dread. To Romney, the Senate chamber was a sacred place. Watching it transform into a playground for violent, costumed insurrectionists was almost too much to bear.
The National Guard finally dispersed the crowd and secured the Capitol. As the Senate prepared to reconvene late that night, Romney took solace in assuming that his most extreme colleagues now realized what their ruse had wrought, and would abandon their plan to object to the electors. Romney had written a speech a few days earlier condemning their procedural farce, but now he was thinking of tossing it. Surely the point was moot.
But to Romney’s astonishment, the architects of the plan still intended to move forward. When Hawley stood to deliver his speech, Romney was positioned just behind the Missourian’s right shoulder, allowing a C‑SPAN camera to capture his withering glare.
Romney glares at Missouri’s Josh Hawley as he addresses the Senate on January 6, 2021. (Senate Television / AP)
What bothered Romney most about Hawley and his cohort was the oily disingenuousness. “They know better!” he told me. “Josh Hawley is one of the smartest people in the Senate, if not the smartest, and Ted Cruz could give him a run for his money.” They were too smart, Romney believed, to actually think that Trump had won the 2020 election. Hawley and Cruz “were making a calculation,” Romney told me, “that put politics above the interests of liberal democracy and the Constitution.”
When it was Romney’s turn to speak, he wasted little time before laying into his colleagues. “What happened here today was an insurrection, incited by the president of the United States,” Romney said. “Those who choose to continue to support his dangerous gambit by objecting to the results of a legitimate, democratic election will forever be seen as being complicit in an unprecedented attack against our democracy.” His voice sharpened when he addressed the patronizing claim that objecting to the certification was a matter of showing respect for voters who believed the election had been stolen. It struck Romney that, for all their alleged populism, Hawley and his allies seemed to take a very dim view of their Republican constituents.
“The best way we can show respect for the voters who are upset is by telling them the truth!” Romney said, his voice rising to a shout.
Before sitting down, he posed a question to his fellow senators—a question that, whether he realized it or not, he’d been wrestling with himself for nearly his entire political career. “Do we weigh our own political fortunes more heavily than we weigh the strength of our republic, the strength of our democracy, and the cause of freedom? What is the weight of personal acclaim compared to the weight of conscience?”
For a blessed moment after January 6, it looked to Romney as if the fever in his party might finally be breaking. GOP leaders condemned the president and denounced the rioters. Trump, who was booted from Twitter and Facebook for fear that he might use the platforms to incite more violence, saw his approval rating plummet. New articles of impeachment were introduced, and McConnell’s office leaked to the press that he was considering a vote to convict. Federal law enforcement began sifting through hundreds of hours of amateur footage from January 6 to identify and arrest the people who had stormed the Capitol. Joe Biden was sworn in as the 46th president of the United States, and Trump—who skipped the inauguration—flew off to Florida, where he seemed destined for a descent into political irrelevance and legal trouble.
But the Republicans’ flirtation with repentance was short-lived. Within months, Fox News was offering a revisionist history of January 6 and recasting the rioters as martyrs and victims of a vengeful, overreaching Justice Department. The House Republican leader, Kevin McCarthy, who’d initially blamed Trump for the riot, paid a visit to Mar-a-Lago to mend his relationship with the ex-president.
Some of the reluctance to hold Trump accountable was a function of the same old perverse political incentives—elected Republicans feared a political backlash from their base. But after January 6, a new, more existential brand of cowardice had emerged. One Republican congressman confided to Romney that he wanted to vote for Trump’s second impeachment, but chose not to out of fear for his family’s safety. The congressman reasoned that Trump would be impeached by House Democrats with or without him—why put his wife and children at risk if it wouldn’t change the outcome? Later, during the Senate trial, Romney heard the same calculation while talking with a small group of Republican colleagues. When one senator, a member of leadership, said he was leaning toward voting to convict, the others urged him to reconsider. You can’t do that, Romney recalled someone saying. Think of your personal safety, said another. Think of your children. The senator eventually decided they were right.
As dismayed as Romney was by this line of thinking, he understood it. Most members of Congress don’t have security details. Their addresses are publicly available online. Romney himself had been shelling out $5,000 a day since the riot to cover private security for his family—an expense he knew most of his colleagues couldn’t afford.
By the time Democrats proposed a bipartisan commission to investigate the events of January 6, the GOP’s 180 was complete. Virtually every Republican in Congress came out in full-throated opposition to the idea. Romney, who’d been consulting with historians about how best to preserve the memory of the insurrection—he’d proposed leaving some of the damage to the Capitol unrepaired—was disappointed by his party’s posture, but he was no longer surprised. He had taken to quoting a favorite scene from Butch Cassidy and the Sundance Kid when he talked about his party’s whitewashing of the insurrection—twisting his face into an exaggerated expression before declaring, “Morons. I’ve got morons on my team!” To Romney, the revisionism of January 6 was almost worse than the attack itself.
In spring 2021, Romney was invited to speak at the Utah Republican Party convention, in West Valley City. Suspecting that some in the crowd might boo him, he came up with a little joke to defuse the tension. As soon as he went onstage, he’d ask the crowd of partisans, “What do you think of President Biden’s first 100 days?” When they booed in response, he’d say, “I hope you got that out of your system!”
But when Romney took the stage, he quickly realized that he’d underestimated the level of vitriol awaiting him. The heckling and booing were so loud and sustained that he could barely get a word out. As he labored to push through his prepared remarks, he became fixated on a red-faced woman in the front row who was furiously screaming at him while her child stood by her side. He paused his speech.
“Aren’t you embarrassed?” he couldn’t help but ask her from the stage.
Afterward, Romney tried to reframe it as a character-building experience—a moment in which he got to live up to his father’s example. When he was young, Mitt had watched an audience stacked with auto-union members vociferously boo his dad during a governor’s debate. George had been undeterred. “He was proud to stand for what he believed,” Romney told me. “If people aren’t angry at you, you really haven’t done anything in public life.”
But there was also something unsettling about the episode. As a former presidential candidate, he was well acquainted with heckling. Scruffy Occupy Wall Streeters had shouted down his stump speeches; gay-rights activists had “glitter bombed” him at rallies. But these were Utah Republicans—they were supposed to be his people. Model citizens, well-behaved Mormons, respectable patriots and pillars of the community, with kids and church callings and responsibilities at work. Many of them had probably been among his most enthusiastic supporters in 2012. Now they were acting like wild children. And if he was being honest with himself, there were moments up on that stage when he was afraid of them.
“There are deranged people among us,” he told me. And in Utah, “people carry guns.”
“It only takes one really disturbed person.”
He let the words hang in the air for a moment, declining to answer the question his confession begged: How long can a democracy last when its elected leaders live in fear of physical violence from their constituents?
In some ways, Romney settled most fully into his role as a senator once Trump was gone. He joined a bipartisan “gang” of lawmakers who actually seemed to enjoy legislating, and helped pass a few bills he was proud of.
He even tried to work productively within his caucus. Romney drew a distinction between the Republican colleagues he viewed as sincerely crazy and those who were faking it for votes. He was open, for instance, to partnering with Senator Ron Johnson of Wisconsin, the conspiracy-spouting, climate-change-denying, anti-vax Trump disciple, because while he could be exasperating—once, Romney told me, after listening to an extended lecture on Hunter Biden’s Ukrainian business dealings, he blurted, “Ron, is there any conspiracy you don’t believe?”—you could at least count on his good faith. What Romney couldn’t stomach any longer was associating himself with people who cynically stoked distrust in democracy for selfish political reasons. “I doubt I will work with Josh Hawley on anything,” he told me.
But as Romney surveyed the crop of Republicans running for Senate in 2022, it was clear that more Hawleys were on their way. Perhaps most disconcerting was J. D. Vance, the Republican candidate in Ohio. “I don’t know that I can disrespect someone more than J. D. Vance,” Romney told me. They’d first met years earlier, after he read Vance’s best-selling memoir, Hillbilly Elegy. Romney was so impressed with the book that he hosted the author at his annual Park City summit in 2018. Vance, who grew up in a poor, dysfunctional family in Appalachia and went on to graduate from Yale Law School, had seemed bright and thoughtful, with interesting ideas about how Republicans could court the white working class without indulging in toxic Trumpism. Then, in 2021, Vance decided he wanted to run for Senate, and reinvented his entire persona overnight. Suddenly, he was railing against the “childless left” and denouncing Indigenous Peoples’ Day as a “fake holiday” and accusing Joe Biden of manufacturing the opioid crisis “to punish people who didn’t vote for him.” The speed of the MAGA makeover was jarring.
“I do wonder, how do you make that decision?” Romney mused to me as Vance was degrading himself on the campaign trail that summer. “How can you go over a line so stark as that—and for what?” Romney wished he could grab Vance by the shoulders and scream: This is not worth it! “It’s not like you’re going to be famous and powerful because you became a United States senator. It’s like, really? You sell yourself so cheap?” The prospect of having Vance in the caucus made Romney uncomfortable. “How do you sit next to him at lunch?”
By the spring of 2023, Romney had made it known to his inner circle that he very likely wouldn’t run again. He’d been leaning this way for at least a year but had kept it to himself. There were practical reasons for the coyness: He didn’t want to start hemorrhaging staffers or descend into lame-duck irrelevance. But some close to Romney wondered if he was simply being stubborn. Several Utah Republicans were already lining up to run for his seat, and the talk in political circles was that he’d struggle to win another primary. Romney, who couldn’t stand the idea of being put out to pasture, insisted that stepping down was his call. “I’ve invested a lot of money already in my political fortunes,” he told me, “and if I needed to do so again to win the primary, I would.”
But he was now at an age when he had to ruthlessly guard his time. He still had books he wanted to write, still dreamed of teaching. He wanted to spend time with Ann while they were both healthy.
Yet even as he made up his mind to leave the Senate, he struggled to walk away from politics entirely. Trump was running again, after all. The crisis wasn’t over. For months, people in his orbit—most vocally, his son Josh—had been urging him to embark on one last run for president, this time as an independent. The goal wouldn’t be to win—Romney knew that was impossible—but to mount a kind of protest against the terrible options offered by the two-party system. He also wanted to ensure that someone onstage was effectively holding Trump to account. “I was afraid that Biden, in his advanced years, would be incapable of making the argument,” he told me.
Romney relished the idea of running a presidential campaign in which he simply said whatever he thought, without regard for the political consequences. “I must admit, I’d love being on the stage with Donald Trump … and just saying, ‘That’s stupid. Why are you saying that?’ ” He nursed a fantasy in which he devoted an entire debate to asking Trump to explain why, in the early weeks of the pandemic, he’d suggested that Americans inject bleach as a treatment for COVID-19. To Romney, this comment represented the apotheosis of the former president’s idiocy, and it still bothered him that the country had simply laughed at it and moved on. “Every time Donald Trump makes a strong argument, I’d say, ‘Remind me again about the Clorox,’ ” Romney told me. “Every now and then, I would cough and go, ‘Clorox.’ ”
Romney leaves the Senate chamber after a vote, May 4, 2023. (Kent Nishimura / Los Angeles Times / Getty)
Romney almost went through with it, this maximally disruptive, personally cathartic primal scream of a presidential campaign. But he abandoned it once he realized that he’d most likely end up siphoning off votes from the Democratic nominee and ensuring a Trump victory. So, in April, Romney pivoted to a new idea: He privately approached Joe Manchin about building a new political party. They’d talked about the prospect before, but it was always hypothetical. Now Romney wanted to make it real. His goal for the yet-unnamed party (working slogan: “Stop the stupid”) would be to promote the kind of centrist policies he’d worked on with Manchin in the Senate. Manchin was himself thinking of running for president as an independent, and Romney tried to convince him this was the better play. Instead of putting forward its own doomed candidate in 2024, Romney argued, their party should gather a contingent of like-minded donors and pledge support to the candidate who came closest to aligning with its agenda. “We’d say, ‘This party’s going to endorse whichever party’s nominee isn’t stupid,’ ” Romney told me.
He acknowledged that this plan wasn’t foolproof, that maybe he’d be talked out of it. The last time we spoke about it, he was still in the brainstorming stage. What he seemed to know for sure was that he no longer fit in his current party. Throughout our two years of interviews, I heard Romney muse repeatedly about leaving the GOP. He’d stayed long after he stopped feeling at home there—long after his five sons had left—because he felt a quixotic duty to save it. This meld of moral responsibility and personal hubris is, in some ways, Romney’s defining trait. When he’s feeling sentimental, he attributes the impulse to the “Romney obligation,” and talks about the deep commitment to public service he inherited from his father. When he’s in a more introspective mood, he talks about the surge of adrenaline he feels when he’s rushing toward a crisis.
But it was hard to dispute that the battle for the GOP’s soul had been lost. And Romney had his own soul to think about. He was all too familiar with the incentive structure in which the party’s leaders were operating. He knew what it would take to keep winning, the things he would have to rationalize.
“You say, ‘Okay, I better get closer to this line, or maybe step a little bit over it. If I don’t, it’s going to be much worse,’ ” he told me. You can always convince yourself that the other party, or the other candidate, is bad enough to justify your own decision to cross that line. “And the problem is that line just keeps on getting moved, and moved, and moved.”
This article was adapted from McKay Coppins’s book Romney: A Reckoning. It appears in the November 2023 print edition with the headline “What Mitt Romney Saw in the Senate.”
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Paul Offit is not an anti-vaxxer. His résumé alone would tell you that: A pediatrician at Children’s Hospital of Philadelphia, he is the co-inventor of a rotavirus vaccine for infants that has been credited with saving “hundreds of lives every day”; he is the author of roughly a dozen books on immunization that repeatedly debunk anti-vaccine claims. And from the earliest days of COVID-19 vaccines, he’s stressed the importance of getting the shots. At least, up to a certain point.
Like most of his public-health colleagues, Offit strongly advocates annual COVID shots for those at highest risk. But regularly reimmunizing young and healthy Americans is a waste of resources, he told me, and invites unnecessary exposure to the shots’ rare but nontrivial side effects. If they’ve already received two or three doses of a COVID vaccine, as is the case for most, they can stop—and should be told as much.
His view cuts directly against the CDC’s new COVID-vaccine guidelines, announced Tuesday following an advisory committee’s 13–1 vote: Every American six months or older should get at least one dose of this autumn’s updated shot. For his less-than-full-throated support for annual vaccination, Offit has become a lightning rod. Peers in medicine and public health have called his opinions “preposterous.” He’s also been made into an unlikely star in anti-vaccine circles. Public figures with prominently shot-skeptical stances have approvinglyparroted his quotes. Right-leaning news outlets that have featured vaccine misinformation have called him up for quotes and sound bites—a sign, he told me, that as a public-health expert “you screwed up somehow.”
Offit stands by his opinion, the core of which is certainly scientifically sound: Some sectors of the population are at much higher risk for COVID than the rest of us. But the crux of the controversy around his view is not about facts alone. At this point in the pandemic, in a country where seasonal vaccine uptake is worryingly low and direly inequitable, where health care is privatized and piecemeal, where anti-vaccine activists will pull at any single loose thread, many experts now argue that policies riddled with ifs, ands, or buts—factually sound though they may be—are not the path toward maximizing uptake. “The nuanced, totally correct way can also be the garbled-message way,” Anthony Fauci, the former director of the National Institute of Allergy and Infectious Diseases, told me.
For the past two years, the United States’ biggest COVID-vaccine problem hasn’t been that too many young and healthy people are clamoring for shots and crowding out more vulnerable groups. It’s been that no one, really—including those who most need additional doses—is opting for additional injections at all. America’s vaccination pipeline is already so riddled with obstacles that plenty of public-health experts have become deeply hesitant to add more. They’re opting instead for a simple, proactive message—one that is broadly inclusive—in the hope that a concerted push for all will nudge at least some fraction of the public to actually get a shot this year.
On several key vaccination points, experts do largely agree. The people who bear a disproportionate share of COVID’s risk should receive a disproportionate share of immunization outreach, says Saad Omer, the dean of UT Southwestern’s O’Donnell School of Public Health.
Choosing which groups to prioritize, however, is tricky. Offit told me he sees four groups as being at highest risk: people who are pregnant, immunocompromised, over the age of 70, or dealing with multiple chronic health conditions. Céline Gounder, an infectious-disease specialist and epidemiologist at NYC Health + Hospitals/Bellevue, who mostly aligns with Offit’s stance, would add other groups based on exposure risk: people living in shelters, jails, or other group settings, for instance, and potentially people who work in health care. (Both Gounder and Offit also emphasize that unvaccinated people, especially infants, should get their shots this year, period.) But there are other vulnerable groups to consider. Risk of severe COVID still stratifies by factors such as socioeconomic status and race, concentrating among groups who are already disproportionately disconnected from health care.
That’s a potentially lengthy list—and messy messaging has hampered pandemic responses before. As Gretchen Chapman, a vaccine-behavior expert at Carnegie Mellon University, told me last month, a key part of improving uptake is “making it easy, making it convenient, making it the automatic thing.” Fauci agrees. Offit, had he been at the CDC’s helm, would have strongly recommended the vaccine for only his four high-risk groups, and merely allowed everyone else to get it if they wanted to—drawing a stark line between those who should and those who may. Fauci, meanwhile, approves of the CDC’s decision. If it were entirely up to him, “I would recommend it for everyone” for the sheer sake of clarity, he told me.
The benefit-risk ratio for the young and healthy, Fauci told me, is lower than it is for older or sicker people, but “it’s not zero.” Anyone can end up developing a severe case of COVID. That means that shoring up immunity, especially with a shot that targets a recent coronavirus variant, will still bolster protection against the worst outcomes. Secondarily, the doses will lower the likelihood of infection and transmission for at least several weeks. Amid the current rise in cases, that protection could soften short-term symptoms and reduce people’s chances of developing long COVID; it could minimize absences from workplaces and classrooms; it could curb spread within highly immunized communities. For Fauci, those perks are all enough to tip the scales.
Offit did tell me that he’s frustrated at the way his views have frequently been framed. Some people, for instance, are inaccurately portraying him as actively dissuading people from signing up for shots. “I’m not opposed to offering the vaccine for anyone who wants it,” he told me. In the case of the young and healthy, “I just don’t think they need another dose.” He often uses himself as an example: At 72 years old, Offit didn’t get the bivalent shot last fall, because he says he’s in good health; he also won’t be getting this year’s XBB.1-targeting brew. Three original-recipe shots, plus a bout of COVID, are protection enough for him. He gave similar advice to his two adult children, he told me, and he’d say the same to a healthy thrice-dosed teen: More vaccine is “low risk, low reward.”
The vax-for-all guideline isn’t incompatible, exactly, with a more targeted approach. Even with a universal recommendation in place, government resources could be funneled toward promoting higher uptake among essential-to-protect groups. But in a country where people, especially adults, are already disinclined to vaccinate, other experts argue that the slight difference between these two tactics could compound into a chasm between public-health outcomes. A strong recommendation for all, followed by targeted implementation, they argue, is more likely to result in higher vaccination rates all around, including in more vulnerable populations. Narrow recommendations, meanwhile, could inadvertently exclude people who really need the shot, while inviting scrutiny over a vaccine’s downsides—cratering uptake in high- and low-risk groups alike. Among Americans, avoiding a strong recommendation for certain populations could be functionally synonymous with explicitly discouraging those people from getting a shot at all.
Offit pointed out to me that several other countries, including the United Kingdom, have issued recommendations that target COVID vaccines to high-risk groups, as he’d hoped the U.S. would. “What I’ve said is really nothing that other countries haven’t said,” Offit told me. But the situation in the U.S. is arguably different. Our health care is privatized and far more difficult to access and navigate. People who are unable to, or decide not to, access a shot have a weaker, more porous safety net—especially if they lack insurance. (Plus, in the U.K., cost was reportedly a major policy impetus.) A broad recommendation cuts against these forces, especially because it makes it harder for insurance companies to deny coverage.
A weaker call for COVID shots would also make that recommendation incongruous with the CDC’s message on flu shots—another universal call for all Americans six months and older to dose up each year. Offit actually does endorse annual shots for the flu: Immunity to flu viruses erodes faster, he argues, and flu vaccines are “safer” than COVID ones.
It’s true that COVID and the flu aren’t identical—not least because SARS-CoV-2 continues to kill and chronically sicken more people each year. But other experts noted that the cadence of vaccination isn’t just about immunity. Recent studies suggest that, at least for now, the coronavirus is shape-shifting farfaster than seasonal flu viruses are—a point in favor of immunizing more regularly, says Vijay Dhanasekaran, a viral-evolution researcher at the University of Hong Kong. The coronavirus is also, for now, simply around for more of the year, which makes infections more likely and frequent—and regular vaccination perhaps more prudent. Besides, scientifically and logistically, “flu is the closest template we have,” Ali Ellebedy, an immunologist at Washington University in St. Louis, told me. Syncing the two shots’ schedules could have its own rewards: The regularity and predictability of flu vaccination, which is typically higher among the elderly, could buoy uptake of COVID shots—especially if manufacturers are able to bundle the immunizations into the same syringe.
Flu’s touchstone may be especially important this fall. With the newly updated shots arriving late in the season, and COVID deaths still at a relative low, experts are predicting that uptake may be worse than it was last year, when less than 20 percent of people opted in to the bivalent dose. A recommendation from the CDC “is just the beginning” of reversing that trend, Omer, of UT Southwestern, told me. Getting the shots also needs to be straightforward and routine. That could mean actively promoting them in health-care settings, making it easier for providers to check if their patients are up to date, guaranteeing availability for the uninsured, and conducting outreach to the broader community—especially to vulnerable groups.
Offit hasn’t changed his mind on who most needs these new COVID vaccines. But he is rethinking how he talks about it: “I will stop putting myself in a position where I’m going to be misinterpreted,” he told me. After the past week, he more clearly sees the merits of focusing on who should be signing up rather than who doesn’t need another dose. Better to emphasize the importance of the shot for the people he worries most about and recommend it to them, without reservation, to whatever extent we can.
In the 1970s, they tried lithium. Then it was zinc and THC. Anti-anxiety drugs had their turn. So did Prozac and SSRIs and atypical antidepressants. Nothing worked. Patients with anorexia were still unable to bring themselves to eat, still stuck in rigid thought patterns, still chillingly underweight.
A few years ago, a group led by Evelyn Attia, the director of the Center for Eating Disorders at New York Presbyterian Hospital and the New York State Psychiatric Institute, tried giving patients an antipsychotic drug called olanzapine, normally used to treat schizophrenia and bipolar disorder, and known to cause weight gain as a side effect. Those patients in her study who were on olanzapine increased their BMI a bit more than others who were taking a placebo, but the two groups showed no difference in their cognitive and psychological symptoms. This was the only medication trial for treating anorexia that has shown any positive effect at all, Attia told me, and even then, the effects were “very modest.”
Despite nearly half a century of attempts, no pill or shot has been identified to effectively treat anorexia nervosa. Anorexia is well known to be the deadliest eating disorder; the only psychiatric diagnosis with a higher death rate is opioid-use disorder. A 2020 review found people who have been hospitalized for the disease are more than five times likelier to die than their peers without it. The National Institutes of Health has devoted more than $100 million over the past decade to studying anorexia, yet researchers have not found a single compound that reliably helps people with the disorder.
Other eating disorders aren’t nearly so resistant to treatment. The FDA has approved fluoxetine (a.k.a. Prozac) to treat bulimia nervosa and binge-eating disorder (BED); doctors prescribe additional SSRIs off-label to treat both conditions, with a fair rate of success. An ADHD drug, Vyvanse, was approved for BED within two years of the disorder’s official recognition. But when it comes to anorexia, “we’ve tried, I don’t know, eight or 10 fundamentally different kinds of approaches without much in the way of success,” says Scott Crow, an adjunct psychology professor at the University of Minnesota and the vice president of psychiatry for Accanto Health.
The discrepancy is puzzling to anorexia specialists and researchers. “We don’t fully understand why medications work so differently in this group, and boy, do they ever work differently,” Attia told me. Still, experts have some ideas. Over the past few decades, they have been learning about the changes in brain activity that accompany anorexia. For example, Walter Kaye, the founder and executive director of the Eating Disorders Program at UC San Diego, told me that the neurotransmitters serotonin and dopamine, both of which are involved in the brain’s reward system, seem to act differently in anorexia patients.
Perhaps some underlying differences in brain chemistry and function play a role in anorexia patients’ extreme aversion to eating. Or perhaps, the experts I spoke with suggested, these brain changes are at least in part a result of patients’ malnourishment. People with anorexia suffer from many effects of malnutrition: Their bones are more brittle; their brain is smaller; their heart beats slower; their breath comes shorter; their wounds fail to heal. Maybe their neurons respond differently to psychoactive drugs too.
Psychiatrists have found that many patients with anorexia don’t improve with treatment even when medicines are prescribed for conditions other than their eating disorder. If an anorexia patient also has anxiety, for example, taking an anti-anxiety drug would likely fail to relieve either set of symptoms, Attia told me. “Time and again, investigators have found very little or no difference between active medication and placebo in randomized controlled trials,” she said. The fact that fluoxetine seems to help anorexia patients avoid relapse—but only when it’s given after they’ve regained a healthy weight—also supports the notion that malnourished brains don’t respond so well to psychoactive medication. (In that case, the effect might be especially acute for people with anorexia nervosa, because they tend to have lower BMIs than people with other eating disorders.)
Why exactly this would be true remains a mystery. Attia noted that proteins and certain fats have been shown to be crucial for brain function; get too little of either, and the brain might not metabolize drugs in expected ways. Both she and Kaye suggested a possible role for tryptophan, an amino acid that humans get only from food. Tryptophan is converted into serotonin (among other things) when we release insulin after a meal, Kaye said, but in anorexia patients, whose insulin levels tend to be low, that process could end up off-kilter. “We suspect that that might be the reason why [SSRIs] don’t work very well,” he said, though he emphasized that the theory is very speculative.
In the absence of meaningful pharmacologic intervention, doctors who treat anorexia rely on methods such as nutrition counseling and psychotherapy. But even non-pharmaceutical interventions, such as cognitive behavioral therapy, are more effective at treating bulimia and binge-eating disorder than anorexia. Studies from around the world have shown that as many as half of people with anorexia relapse.
Colleen Clarkin Schreyer, a clinical psychologist at Johns Hopkins University, sees both patients with anorexia nervosa and those with bulimia nervosa, and told me that the former can be more difficult to treat—“but not just because of the fact that we don’t have any medication to help us along. I often find that patients with anorexia nervosa are more ambivalent about making behavior change.” Bulimia patients, she said, tend to feel shame about their condition, because binge eating is stigmatized and, well, no one likes vomit. But anorexia patients might be praised for skipping meals or rapidly losing weight, despite the fact that their behaviors can be just as dangerous over the long term as binging and vomiting.
Researchers are still trying to find substances that can help anorexia patients. Crow told me that case studies testing a synthetic version of leptin, a naturally occurring human hormone, have produced interesting data. Meanwhile, some early research into using psychedelics, including ketamine, psilocybin, and ayahuasca, suggests that they may relieve some symptoms in some cases. But until randomized, controlled trials are conducted, we won’t know whether or how well any psychedelic really works. Kaye is currently recruiting participants for such a study of psilocybin, which is planned to have multiple sites in the U.S. and Europe.
Pharmaceutical companies just don’t seem that enthusiastic about testing treatments for anorexia, Crow said. “I think that drug makers have taken to heart the message that the mortality is high” among anorexia patients, he told me, and thus avoid the risk of having deaths occur during their clinical trials. And drug development isn’t the only area where the study of anorexia has fallen short. Research on eating disorders tends to be underfunded on the whole, Crow said. That stems, in part, from “a widely prevailing belief that this is something that people could or should just stop … I wish that were how it works, frankly. But it’s not.”
For one week of every month, I have a very bad time. My back aches so badly I struggle to stand up straight. My mood swings from frantic to bleak. My concentration flags; it’s difficult to send an email. Then, my period starts, and the curse is lifted. I feel okay again.
Like some 1 to 7 percent of menstruating women, I meet the criteria for premenstrual dysphoric disorder, or PMDD. According to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), a person with PMDD experiences marked emotional changes—such as sadness, anger, or anxiety—and physical or behavioral changes—such as difficulty concentrating, fatigue, or joint pain—in the week before their period. PMDD can also affect trans men and nonbinary people who menstruate.
When I first heard of PMDD, it was a revelation. Here was a concrete explanation for the pain and stress I was feeling every month. Better yet, there was a simple, effective treatment: common antidepressant drugs called selective serotonin reuptake inhibitors, or SSRIs, which can be prescribed for people to take only in the two weeks before their period. Birth-control pills, cognitive behavioral therapy, and calcium supplements may also help.
Then I heard about the controversy surrounding the diagnosis. When the American Psychiatric Association added a form of PMDD as a proposed disorder to the diagnostic manual in the 1980s—DSM-III-R—some scholars pushedback. They saw the diagnosis as part of the historical oppression of women, done in the name of mental health. The controversy reared up again as PMDD remained in the 1994 DSM-IV, where it was also listed under “Depressive Disorder Not Otherwise Specified.” Many people who menstruate experience emotional changes during their cycles, so defining it as a mental illness could have serious personal and societal consequences, critics argued. A 2002 Monitor on Psychology article, “Is PMDD real?,” quoted the late psychologist and author Paula Caplan: “Women are supposed to be cheerleaders,” she said. “When a woman is anything but that, she and her family are quick to think something is wrong.”
In the end, the APA weighed these concerns and pushed ahead, adding PMDD to the DSM-5 as an official diagnosis in 2013. But I found the criticism disquieting. Had I embraced a modern hysteria diagnosis? Were the symptoms I experienced even real?
Researchers have looked for hormonal differences between people who experience severe premenstrual distress and people who don’t. In some cases, they’ve found them: A 2021 meta-analysis found that people with PMDD tend to have lower levels of estradiol, a form of estrogen, between ovulation and menstruation. But other studies have shown little to no difference in hormone levels. “There are no biomarkers. There’s no test that can be done which helps identify someone with PMDD,” says Lynsay Matthews, who researches PMDD at University of the West of Scotland.
Instead, to receive treatment, people experiencing premenstrual distress have to monitor their own mind and body. PMDD diagnosis is based on a symptom diary kept over the course of multiple menstrual cycles.
The symptoms recorded in those diaries can be severe. In a 2022 survey, 34 percent of people with PMDD reported a past suicide attempt. More than half reported self-harm. “If someone has suicidal ideation or self-harm, or suicide attempts every month for 30 years, that wouldn’t be described as a normal female response to the menstrual cycle,” Matthews says.
There is evidence that SSRIs work for people with PMDD, in ways researchers don’t fully understand. “In some cases, hours after taking an effective SSRI, people can feel a lot better,” Matthews says, referring to PMDD patients. In contrast, people with depression usually need to take SSRIs for weeks before feeling the effects. Researchers know the drugs’ mechanism of action is different for PMDD—they just don’t know why. “When people find that out, they find it quite validating that it is a medical condition,” Matthews says.
Tamara Kayali Browne, a bioethicist at Deakin University, in Australia, agrees that some people experience serious distress in the week before their period—but disagrees with calling it a mental illness.
“The crux of the problem seems to be that we are in a patriarchal society that treats women very differently and puts a lot of women under a lot of significant, disproportionate stress,” Browne says. That disproportionate stress begins early. Eighty-three percent of a sample of Australian PMDD patients reported trauma in early life. It continues in adulthood. A Swedish survey of 1,239 people with PMDD found that raising children was associated with higher rates of premenstrual distress.
Between ovulation and menstruation, many people experience higher physical and emotional sensitivity. They may feel unwilling or unable to deal with the stressors they tolerate the rest of the month: the screaming baby, the messy partner. “Is it the time of the month where the truth comes out?” Browne suggests. Seen in this light, irritability, anxiety, and low mood are understandable reactions to life stressors, not symptoms of mental illness.
There is a long history of doctors labeling women crazy. There is also a long history of doctors dismissing women’s pain. Debates about premenstrual distress are caught in the middle.
When critics question PMDD and the less severe premenstrual syndrome, it can feel invalidating. “It’s time to stop questioning whether women’s experiences are real and instead start making them real priorities,” the journalists Emily Crockett and Julia Belluz wrote in response to an article that suggested PMS is culturally constructed.
At the same time, when left unchecked, casual sexism can seep into the medical discourse around PMDD. Early pharmaceutical advertisements marketing SSRIs for PMDD show how this works in practice. In 2000, Eli Lilly packaged fluoxetine hydrochloride in a pink-and-purple capsule and branded it Sarafem. Advertisements for the drug featured incapable, unreasonable women; one fights a shopping cart, another bickers with her (male) partner. “Think it’s PMS? Think again. It could be PMDD.” (The Sarafem brand has since been discontinued.)
What if we can question the structural factors that make life harder for women while providing medical support for people who are suffering? Could the critiques lead us to more, not fewer, options for people with PMDD?
Medical interventions can be lifesaving for people with PMDD. But they don’t address a society that places a heavy burden on the shoulders of people assigned female at birth.
Browne compares severe premenstrual distress to a broken leg. “If you have a broken leg, you really do need painkillers, because you’re experiencing pain,” she says. “But it’s not going to be helpful in the long term if you don’t deal with whatever the underlying cause is.” In the week before menstruation, the life stressors a person with PMDD deals with the rest of the month can feel unbearable. Those life stressors can and should be addressed alongside conventional medical treatment.
One common stressor is the caregiving load. “Parenting is not only a massive trigger, but it’s also the biggest burden or the biggest guilt that comes with having PMDD,” Matthews says. “Not only are you struggling yourself every month, but you also feel as though you’re failing your children every month.” The co-parent can help alleviate this burden. When fathers spend more time with their kids—and doing child-related chores—mothers tend to be less stressed about parenting.
Another stressor is relationship difficulties. The emotional changes that come with the premenstrual phase can make conflict with a partner more likely. They can also prompt the PMDD sufferer’s partner to dismiss those feelings. “Nowadays, a partner might still be inclined to say, ‘Wait a minute, I know it’s that time of your month again. You’re just being oversensitive,’” Browne points out. Women in relationships with women, who tend to be more understanding of premenstrual change than men, report a more positive experience of the week before their period.
Researchers have done great, necessary work to understand PMDD, work that should continue. How are people who experience premenstrual distress biologically different from people who don’t? Can we find new, more effective drugs to treat that distress?
In the meantime, we need to build a better world for people who experience premenstrual distress. Doctors can prescribe medicine, but managers can make accommodations in the workplace. Co-parents can take on more caregiving responsibility. And partners can provide love and support.
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Ayude a las mascotas del condado de Hays: breve encuesta
¡Su participación es importante para nosotros! Complete esta breve encuesta para informar mejor cómo servimos a las personas y las mascotas en Hays County.
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Learn more about the partnership:
Hays County has partnered with non-profit organization Austin Pets Alive! to lead the development of a new animal shelter that will provide programs focused on public safety, animal safety and lifesaving, increased public access to important resources for pet owners, and community education to provide safe and humane care for pets.
We are conducting a community survey to help guide the Hays County Pet Resource Center program development, and we need your help! Your participation will help guide the future of people and pets in the area.
You can read more about the project and stay up to date by signing up for our newsletter by visiting https://linktr.ee/hayspetresource
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¡Hays County está trabajando con Austin Pets Alive! para desarrollar un nuevo modelo de bienestar animal propuesto que proporcionará programas centrados en la seguridad pública, la seguridad animal y el salvamento de vidas, un mayor acceso público a recursos importantes para los dueños de mascotas y educación comunitaria para proporcionar un cuidado seguro y humano a las mascotas. Para ayudar a guiar el desarrollo de Hays County Pet Resource Center, estamos realizando una evaluación de las necesidades de la comunidad.
Estamos realizando una encuesta comunitaria para ayudar a guiar el desarrollo del programa del Hays County Pet Resource Center, ¡y necesitamos su ayuda! Su participación ayudará a guiar el futuro de las personas y las mascotas en el área.
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Read our Press Release from August 30, 2023 Below:
Help the People and Pets of Hays County by Sharing Your Feedback
Hays County Pet Resource Center and Austin Pets Alive! Launch Community Survey
HAYS COUNTY – Calling all Hays County community members and animal lovers to participate in an important survey! Your participation will help guide the future of animal welfare in the area.
Hays County has partnered with non-profit organization Austin Pets Alive! to lead the development of a new animal shelter that will provide programs focused on public safety, animal safety and lifesaving, increased public access to important resources for pet owners, and community education to provide safe and humane care for pets. The survey launches September 1, and community participation will help determine programs for the Hays County Pet Resource Center.
“We want to know what the community’s needs are for people and pets,” said Lee Ann Shenefiel, Austin Pets Alive! Executive Advisor and Project Coordinator. “All survey responses will be looked at and considered, so this is an important opportunity for the community to share their input with us and drive the conversation from the beginning on what people and pets need in Hays County. ”
The project aims to implement recommendations from a 2022 feasibility study that proposed an animal welfare model for Hays County. This includes the construction of a new shelter designed to support 2000 dogs and cats annually, investment in robust community programs designed to reduce the number of animals coming into the shelter and help keep people and pets together, and a high-volume public veterinary clinic. Initial construction estimates are around $24 million.
The survey is open to participants through September 30 and is available in online and print formats in English and Spanish. Austin Pets Alive! is also looking for volunteers to attend local events promoting the Pet Resource Center. Volunteers will visit with local community partners to share information about the project, gather survey input, and input survey results. Training and community service hours are provided, and application fees are waived for Hays County volunteers. For more information or to sign up to volunteer, visit austinpetsalive.org/volunteer or email [email protected].
Please contact us at [email protected] to schedule any interviews or for more information.
In an ideal version of this coming winter, the United States would fully revamp its approach to respiratory disease. Pre-pandemic, fall was just a time for flu shots, if that. Now, hundreds of millions of Americans have at their fingertips vaccines that can combat three cold-weather threats at once: flu, COVID, and, for a subset of us, respiratory syncytial virus. If everyone signed up to get the shots they qualified for, “it would be huge,” says Ofer Levy, the director of the Precision Vaccines Program at Boston Children’s Hospital. Hospital emergency rooms and intensive-care units wouldn’t fill; most cases of airway illness would truly, actually feel like “just” a common cold. “We would save tens of thousands of lives in the United States alone,” Levy told me.
The logic of the plan is simple: Few public-health priorities are more pressing than getting three lifesaving vaccines to those who need them most, ahead of winter’s viral spikes. The logistics, however, are not as clear-cut. The best way to get vaccines into as many people as possible is to make getting shots “very, very easy,” says Chelsea Shover, an epidemiologist at UCLA. But that’s just not what we’ve set up this fall lineup of shots to do.
Convenience isn’t the only issue keeping shots out of arms. But move past fear, distrust, or misinformation, solve for barriers such as insurance coverage, and getting a vaccine in the United States still means figuring out when shots are available and which you qualify for, finding and booking appointments, carving out the time to go. For adults, especially, who don’t routinely visit their doctor for wellness checkups, and whose workplaces don’t require vaccines to the extent that schools do, vaccination has become an onerous exercise in opt-ins.
Bundling this year’s flu, COVID, and RSV vaccines into a single visit could, in theory, help ease the way to becoming a double or triple shotter. “Any time we can cut down on the number of visits for a patient to take care of them, we know that’s a big boost,” says Tochi Iroku-Malize, the president of the American Academy of Family Physicians. But the easiest iteration of that strategy, a three-in-one shot, similar to the MMR and DTaP vaccines of childhood, doesn’t yet exist (though some are in trials). Even the shorter-term solution—giving up to three injections at once—is hitting stumbling blocks. Pharmacies started receiving flu vaccines earlier this summer and are already giving them out to anyone over the age of six months. RSV vaccines, too, have hit shelves, and have been approved for people over the age of 60 and those 32 to 36 weeks pregnant; so far, however, they are being offered only to the first group. And although nearly all Americans are expected to be eligible for autumn’s updated COVID vaccines, those shots aren’t slated to make an appearance until mid-September or so, according to Kevin Griffis, a CDC spokesperson.
Timing two or three shots together isn’t a perfect plan. Get them all too early, and some people’s protections against infection might fade before the season gets into full swing; get all of them too late, and a virus might beat the vaccine to the punch. Respiratory viruses don’t coordinate their seasons: Right now, for instance, COVID cases are on a sharp rise, but flu and RSV ones are not. Some data on the new RSV vaccines also suggests that co-administering them with other shots might trigger slightly worse side effects, or mildly curb the number of antibodies that the injections raise. Still, Levy argues that those theoretical downsides are outweighed by known benefits. “If someone is at clinic in the fall, they should get all the vaccines they’re eligible for,” he told me. Getting a slightly less effective, slightly more ornery shot a few months early is better than never getting a shot at all.
All of that supposes that people understand that they are eligible for these shots. But already, family-medicine physicians such as Iroku-Malize, who practices in Long Island, have been fielding queries about the RSV vaccines from confused patients. Some new parents, for instance, have gotten the impression that the RSV vaccines are designed to be administered to infants, which isn’t quite right: Babies are the target of protection for the shots for pregnant people, but only because they temporarily inherit antibodies—not because they can get the injections themselves. Regulators also haven’t yet nailed down how often older adults might need the shot, though the current thinking is that the vaccine’s protection will last at least a couple of years. “It’s very hard to tell people, ‘I don’t know,’” says Jacinda Abdul-Mutakabbir, an infectious-disease pharmacist at UC San Diego.
Other parts of the RSV-shot messaging are peppered with even more unknowns. The CDC has yet to release its final recommendation for pregnant people; for people over 60, the agency’s language has been “noncommittal,” says Rupali Limaye, a behavioral scientist at Johns Hopkins University. Unlike past guidelines that have straightforwardly recommended flu shots or most doses of the COVID-19 vaccine, RSV guidance says that eligible people may protect themselves against the virus—and are urged to first consult a health-care provider, which not all people have. The wishy-washiness is partly about safety: A few rare but serious medical events cropped up during the RSV vaccines’ clinical trials, including abnormal heartbeats and neurological complications. None of the experts I spoke with had qualms about recommending the shots anyway. Even so, some private health-insurance companies have seized on the CDC’s watered-down recommendation—and the fact that the agency hasn’t yet included RSV in its annual vaccine schedule for adults—as an excuse to not cover the shot, leaving some patients paying $300-plus out of pocket.
For any of these shots, viral reputation matters too. Despite hospitalizing tens of thousands of Americans each year, especially at age extremes—numbers that, in some years, nearly rival those linked to flu—RSV is a lesser-known winter disease. People tend to take it less seriously, if it’s on their radar at all, Abdul-Mutakabbir told me. Which bodes poorly for future RSV-shot uptake. Annual flu shots have been recommended for 13 years for every American over the age of six months for 13 years. And still, just half the eligible population gets them in any given year. People tend to dismiss shots as subpar interventions against a disease that they don’t much fear, Limaye told me. With COVID, too, “people think it’s gotten mild,” she said. Only 28 percent of American adults are currently up to date on their COVID vaccine. And although older people have historically been more vigilant about nabbing shots, even vaccines against shingles—a notoriously painful disease—have reached just over a third of people who are 60-plus.
To establish fall as an immunity-seeking season, shots would need to become an annual habit, ideally one easy to form. Mandates and financial incentives do prod people toward vaccines, but smaller nudges can persuade people to take initiative on their own. Some strategies may be as simple as semantic tweaks. Studies on HPV and flu vaccines suggest that telling patients they are “due” for a shot is better than offering it as an optional choice, says Gretchen Chapman, a behavioral scientist at Carnegie Mellon University. Otherresearchsuggests that carefully worded text-message reminders can evoke ownership—noting that a shot is “waiting for you,” or that the time has come to “claim your dose.” Noel Brewer, a behavioral scientist at the University of North Carolina at Chapel Hill, also thinks that vaccine deliverers could take inspiration from dentists who gently dog their patients with phone calls and postcards.
Other interventions could be aimed at streamlining delivery. Government funding could make shots more available in rural regions, ensure access for those who lack insurance, and help local health departments offer shots in churches and hair salons, or even bring them door to door. More schools and workplaces, too, might try boosting uptake among students and employees. And although most shots are already given within the health-care system, there’s sludge to clear from that pipeline too. Better universal recordkeeping could help track people’s vaccination status through their lifetime. Kimberly Martin, a behavioral scientist at Yale, is researching ways to revamp medical training to help health-care providers earn their patients’ trust—especially among populations that remain marginalized by systemic racism. “The single biggest impact on vaccine uptake,” Brewer told me, “is a health-care provider recommendation.”
An ideal vision of a fall in the future, then, would be turning vaccines into a default form of prevention—a more typical part of this country’s wellness workflow, says Saad Omer, the dean of the Peter O’Donnell Jr. School of Public Health, at UT Southwestern. After getting their vital signs checked, patients could have their vaccination status reviewed. “And then, if they’re eligible, you vaccinate them,” Omer told me. It’s a routine that pediatricians already have down pat. If adult health care follows suit, regular immunization is a habit we may never have to outgrow.
For years, the American approach to protein has been a never-ending quest for more. On average, each person in the United States puts away roughly 300 pounds of meat a year; we are responsible for more than a third of the multibillion-dollar protein-supplement market. Our recommended dietary allowance, or RDA, for protein is 0.8 grams per kilogram of body weight per day—a quota that a 160-pound person could meet with a couple of eggs in the morning and an eight-ounce steak at night. American adults consistently eat well above that amount, with men close to doubling it—and recentpollsshow that millions of us want to increase our intake.
The American appetite for protein is, simply put, huge. And still, Jose Antonio thinks we’re getting nowhere near enough.
The RDA of 0.8 grams per kilogram is “nothing, literally nothing,” Antonio, a health-and-human-performance researcher at Nova Southeastern University, in Florida, told me. “Most of my friends get that at breakfast.” In an ideal world, Antonio said, totally sedentary adults should consume at least twice that; people who seriously exercise should start with a minimum of 2.2 grams per kilogram, and ramp their levels up from there. (Antonio is also a co-founder of the International Society of Sports Nutrition, which has received sponsorships from companies that sell protein supplements.)
In Antonio’s pro-protein world, people would be fitter, more energetic, and suffer less chronic disease; they’d build muscle more efficiently, and recover faster from workouts. There is no definitive cap, in his view, on how much protein people should strive for. The limit, he said, is “How much can a human consume in a single day?”
Among nutritionists, Antonio’s viewpoint is pretty fringe. There is, other experts told me, such a thing as too much protein—or at least a point of rapidly diminishing returns. But researchers don’t agree on how much protein is necessary, or how much is excessive; they’ve reached no consensus on the extent of its benefits, or whether eating extra servings can send our health into decline. Which leaves Americans with no protein ceiling—and plenty of room for our protein hunger to grow, and grow, and grow.
Not having enough protein is clearly very bad. Protein is essential to the architecture of our cells; we rely on it for immunity and hormone synthesis, and cobble it together to build muscles, skin, and bone. Among the three macronutrients—the other two being carbohydrates and fat—protein is the only one that “we need to get every day,” Joanne Slavin, a nutrition researcher at the University of Minnesota, told me. Nearly half of the 20 amino-acid building blocks that make up protein can’t be produced in-house. Go without them for too long, and the body will start to break its own tissues down to scavenge the molecules it needs.
That state of deficiency is exactly what the protein RDA was designed to avoid. Researchers decided the thresholddecades ago, based on their best estimations of the amount of protein people needed to balance out their loss of nitrogen—a substance that’s in amino acids but that the body can’t itself make. The average person in the study, they found, needed 0.66 grams of protein per kilogram of body weight to avoid going into the red. So they set the guidelines at 0.8, a level that would keep the overwhelming majority of the population out of the deficiency zone. That number has stuck in the many years since, and Slavin, who has sat on the Dietary Guidelines Advisory Committee, sees no reason for it to change. People who are expending extra energy on growth, or whose muscles are taxed by exercise or aging, might need more. But for the typical American adult, Slavin said, “I think 0.8 is the right number.”
Others vehemently disagree. The current standard is “not enough to support everyday living,” Abbie Smith-Ryan, a sports-nutrition expert at the University of North Carolina at Chapel Hill, told me. Adults, she and others told me, should be getting more like 1.2 or 1.6 grams per kilogram at baseline. Their beef with the RDA is twofold. For one, the original nitrogen analysesoversimplified how the body metabolizes and retains protein, Stuart Phillips, a protein researcher at McMaster University, in Canada, told me. And second, even if the 0.8 number does meet our barest needs, “there’s a much more optimal amount we should be consuming” that would further improve our health, Katie Hirsch, an exercise physiologist at the University of South Carolina, told me. (I reached out to the USDA, which helps develop the U.S.’s official Dietary Guidelines, about whether the RDA needed to change; a spokesperson referred me to the National Academy of Sciences, which said that the RDA was last reviewed in 2002, and was expected to be reviewed again soon.)
If Hirsch and others are right, even people who are slightly exceeding the government guideline might not be maximizing their resilience against infections, cardiovascular disease, metabolic issues, muscle loss, and more. People who are working out and still eating the measly 0.8 grams per kilogram per day, Antonio told me, are also starving themselves of the chance to build lean muscle—and of performance gains.
But the “more” mentality has a limit. Experts just can’t agree on what it is. It does depend on who’s asking, and their goals. For most people, the benefits “diminish greatly” past 1.6 grams per kilogram, Phillips told me. Smith-Ryan said that levels around 2.2 were valid for athletes trying to lose weight. Antonio is more liberal still. Intakes of 3.3 or so are fair game for body builders or elite cyclists, he told me. In one of his studies, he had athletes pack in 4.4 grams of protein per kilogram of body weight for weeks—a daily diet that, for a 160-pound person, would require three-plus pounds of steak, 16 cups of tofu, or 89 egg whites.
That is … a lot of protein. And most of the other experts I spoke with said that they didn’t see the point, especially for Americans, who already eat more protein than people in most other countries. “There’s very little evidence that more is better,” Marion Nestle, a nutrition researcher at New York University, told me.
The worry isn’t necessarily that tons of protein would cause acute bodily harm, at least not to people who are otherwise in good health. Over the years, researchers have raised concerns that too much protein could damage the kidneys or liver, leach calcium from the bones, or even trigger cancer or early death—but the evidence on all fronts is, at best, mixed. In Antonio’s high-protein studies with athletes, he told me, their organs have remained in tip-top shape. The known drawbacks are more annoying than dangerous: High-protein diets can raise the risk of bloating, gas, and dehydration; burning through tons of protein can also make people feel very, very hot. Roughly a quarter of the participants in Antonio’s ultra-high-protein study dropped out: Many of them felt too full, he told me, and no longer enjoyed food. One volunteer was so plagued by night sweats by the close of the trial, he said, that she could no longer fall asleep.
Whether many years of an ultrahigh-protein lifestyle could be harmful is less clear. Native communities in the Arctic have healthfully subsisted on such diets for generations, but they’ve had a long time to adapt; those in Western society might not fare the same.
Over the years, it’s gotten easy to interpret protein’s apparent lack of immediate downsides as permission to reach for more. But for now, many experts would rather err on the side of moderation. “Would I feed that much to one of my relatives? I would not,” Susan Roberts, a nutrition researcher at Tufts University, told me. Even if protein itself turns out not to be hard on the body, the foods it comes in still might be, including processed meats or sugary “high-protein” powders, shakes, cookies, chips, and bars. People pounding protein also risk squeezing other nutrients out of their diet, Roberts told me—whole grains, nuts, fruits, and vegetables, all of them packed with fiber, a vital ingredient that nutritionists actually do agree we lack.
Plus, Slavin argued, there’s a point at which excess protein becomes a straight-up waste. When people eat more than about 20 to 40 grams of protein in a single sitting, their protein-processing machinery can get overwhelmed; the body eliminates the nitrogen as waste, then treats the rest as it would a carbohydrate or fat. “You can get fat on proteins just like you can get fat on carbohydrates,” Slavin told me. Which makes overdoing protein, in her eyes, “expensive and stupid.”
The excess can have consequences beyond what our own bodies endure. Meat production drives greenhouse-gas emissions and uses up massive tracts of land. And Maya Almaraz, a food-systems researcher at Princeton, has found that the majority of the nitrogen pollution in wastewater is a by-product of our diets. The more protein we eat, the more we might be feeding toxic algal blooms.
There’s no denying that protein deficiency is a problem in many parts of the world, even within the United States. Protein sources are expensive, putting them out of reach of poor communities. Meanwhile, many of the people who worry most about getting enough of it—the wealthy, the ultra-athletic, the educated—are among those who need to supplement the least. Experts, for now, may not agree on how much protein is too much for individuals. But if appetite is all we have to curb our intake, going all in on protein might create problems bigger than anything we’ve had to stomach so far.
Check out BT in his tiny aviator costume! That’s what this sweet guy wore to celebrate sitting shotgun next to the pilot, on his rescue flight from Texas to Massachusetts.
BT could easily have not made this journey. He is diabetic, and has a disease called feline leukemia (FeLV)—a virus that affects a cat’s immune system.,. In many shelters, cats with FeLV are euthanized as a matter of course. This is largely based on the unfounded belief that people won’t want to adopt cats with the illness because it affects the animal’s life span.
But APA! has proven this is not the case. wWe’ve shown that not only can cats with FeLV live long, healthy lives, but many adopters even seek these cats out. them out, but because so many FeLV cats are euthanized in shelters, it can be hard to find one who is available.
That’s what happened with BT, whose adopters were in Massachusetts. sThey loved him from the moment they saw his photo, and so we caught him a transport flight to his new home, on a plane that was otherwise full of dogs.
APA!’s Transport Program means thousands of adoptable pets facing euthanasia in crowded Texas shelters are able to reach in communities where they are welcomed into new homes. Transport can also mean aviator suits on kitties who don’t normally get to live, in the current sheltering system. But when they do, when they do, they are so special, so wanted, and so loved, that people will move mountains—and airplanes—to get them to home.
The City of Laredo and Laredo Animal Care Services (LACS) partnered with Austin Pets Alive! (APA!) in February 2023 as a result of the city’s desire to meet the Laredo community’s need for shelter improvement. Due to limited resources, LACS has historically faced challenges in implementing veterinary best practices, struggling to save half of the 8,000 pets that come into its shelter. Recognizing that a change was needed, LACS contracted with APA! to provide veterinary care services and updated shelter operations. Because LACS has unnecessarily delayed implementing animal welfare industry standards at its shelter, APA! is calling on the citizens of Laredo to join our efforts in advocating for the thousands of pets who are at risk of being euthanized.
APA! has been helping LACS with rescue transport since 2020 and partnered with LACS during Winter Storm Uri, which led to this bigger partnership. In May 2023, after working with LACS over many months, APA! built a set of customized recommendations and an implementation plan to establish Laredo as a leader in animal sheltering throughout South Texas. LACS has been presented with its first opportunity to accept resources, in the form of time and money, from a transformational organization to help save more animal lives. APA!’s objective is to help fill the gap in necessary training and support, at the request and with the cooperation of LACS, to help people and their pets in Laredo.
APA!’s implementation plan includes shelter best practices such as support at intake,Trap, Neuter, Release (TNR) program, lost pet reunification, and placement programs. A people focused intake model, which includes an appointment-based intake of animals in non-emergency situations into the animal services facility, is a modern practice that prioritizes sick or injured pets, animals in immediate danger, or dogs that pose a threat to public safety. Organized intake frees up shelter resources to ensure emergencies and critical situations are handled promptly and effectively.
PROGRESS IN SAVING LIVES
APA!’s vet and national shelter support teams have made significant progress at LACS:
Since March, APA! doubled spay and neuters with over 1,000 animals, and in 2023 since the start of the contract, we have brought the feline live outcome rate to over 65%. APA! is responsible for over 1,100 live outcomes in 2023 through rescue transport.
Implemented treatment protocols to ensure every sick, treatable animal receives medication and vaccines, health certificates, and more to increase the number of pets saved.
Performed an elevated level of medical attention for shelter animals, including leg amputations, mass removals, surgeries, and more to save the pet’s life. Previously animals requiring this care would have been automatically euthanized.
Furthermore, APA! designed free custom staff training, over 30 standard operating procedures, and an implementation plan for LACS based on best practices that include:
Intake Counseling and Triage – To help provide treatment and care to the animals in need, providing consent-based resources for pets that may not need to come to the shelter, and reducing euthanasia rates.
Trap, Neuter, Release (TNR) program – To ensure stray cats aren’t euthanized upon intake at alarming rates.
Lost Pet Reunification – To ensure that at least the national standard number of lost pets make it back to their families.
Placement Programs- Rescue/Transport, Adoption, Case Management, Foster, Volunteer – To help reduce the number of pets at the shelter by promoting adoptions, fostering, and working with rescue partners.
The implementation of these programs and procedures is fundamental to the success of the contract between Austin Pets Alive! and Laredo Animal Care Services to increase adoptions and provide community guidance to better support the people and pets of Laredo. APA! is also providing additional resources such as:
5 Full-time employees (4 directly operations focused and local to Laredo and 1 focused on marketing and communication)
National Field Services in-person training
Online course module with in-person guidance and assessment for free
Weekly transport van and driver dedicated to picking up Laredo animals and taking in-state partners.
Once a month, state transport van and driver assistance are dedicated to Laredo animals.
$90K pet food donation for the community via HSUS/Chewy secured by APA!.
Adoption incentive grant of $3,000 for gift bags for adopters.
Handouts, flyers, resources, and posters – printed for the front lobby, and for staff to hand out to the community to help people with their pets.
CHALLENGES BEING FACED:
While APA! has addressed the many issues with LACS’s current practices by providing recommendations, staff training, and standard operating procedures, LACS has unnecessarily delayed implementing animal welfare industry standards at its shelter.
APA!’s implementation plan, introduced in May 2023, includes shelter best practices such as support at intake, Trap, Neuter, Release (TNR) program, lost pet reunification, and placement programs.
To be successful, Laredo Animal Care Services needs to implement these changes immediately and take the community’s and animals’ needs into consideration. Many of the recommendations made by APA! in May have yet to be implemented, leading to the continued killing and warehousing of shelter pets.
HISTORY
When APA!’s team first arrived at LACS, they encountered dire conditions, including an extremely high rate of disease in pets–predominately parvovirus; overcrowding, unsanitary kennels; inadequate water and food supplies; and unattended injured animals in urgent need of medical care.
Upon arrival, APA! quickly identified and implemented immediate solutions to solve these harsh conditions and continued to work with the LACS team to implement additional medical and treatment protocols. These actions have already contributed to saving the lives of several hundred pets that most certainly would have died without intervention due to lack of medical care and euthanasia. The year-end goal is to increase live outcomes to 90%, almost double what they were when APA! first arrived.
This summer, I set out to write about Vivek Ramaswamy because I thought that his public-speaking skills set him apart from his GOP presidential rivals. Whereas most candidates were struggling to find their lane, Ramaswamy knew exactly what he was offering: a message that seemed to be libertarian at its core, paired with views that were consistent with more extreme corners of the right. Ramaswamy’s team agreed to participate in the profile.
Ramaswamy let me shadow him over the course of three days at the end of July. I visited his Ohio campaign headquarters and got a behind-the-scenes view of several of his media appearances. He brought me to his home and introduced me to his family. I flew aboard a private jet with him and rode on his campaign bus in Iowa.
Over the three days, Ramaswamy and I had regular conversations—sometimes in short bursts, other times in longer sit-down sessions. Last night, in an interview with CNN’s Kaitlan Collins, he used the phrase free-flowing to describe our interactions. Our discussions were often challenging, but they were always respectful. With Ramaswamy’s permission, and in keeping with standard journalistic practice, I recorded all of our interviews.
During our final interview aboard his campaign bus, I brought up one of his more explosive claims—a suggestion that we don’t know “the truth” about January 6. I asked him: What is the truth about January 6 that you’re referring to? His answer went down a curious path, invoking the investigation into the 9/11 terrorist attacks, among other topics. At one point, he said this to me: “I think it is legitimate to say, How many police, how many federal agents were on the planes that hit the Twin Towers? Like, I think we want—maybe the answer is zero, probably is zero for all I know, right?”
Yesterday, after The Atlantic published my story and his comments about 9/11 and January 6 drew attention, Ramaswamy told Semafor that the quote we published wasn’t “exactly what I said.” Last night, asked by CNN’s Collins about the same quote, Ramaswamy said, “I’m telling you the quote is wrong, actually.”
The quote is correct.
Here is the unedited audio and a transcript of our exchange about 9/11 and January 6.
John Hendrickson: When you talk about all the things, We can handle the truth about X, you know, and you list off a bunch of stuff—one of them that you said last night is: We can handle the truth about January 6. What is the truth about January 6 that you’re referring to?
Vivek Ramaswamy: I don’t know, but we can handle it. Whatever it is, we can handle it. Government agents. How many government agents were in the field? Right?
Hendrickson: You mean like entrapment?
Ramaswamy: Yeah. Absolutely. Why can the government not be transparent about something that we’re using? Terrorists, or the kind of tactics used to fight terrorists. If we find that there are hundreds of our own in the ranks on the day that they were, that they were—I mean, look …
Hendrickson: Well, there’s a difference between entrapment and a difference between a law-enforcement agent identifying—
Ramaswamy: I think it is legitimate to say, How many police, how many federal agents were on the planes that hit the Twin Towers? Like, I think we want—maybe the answer is zero, probably is zero for all I know, right? I have no reason to think it was anything other than zero. But if we’re doing a comprehensive assessment of what happened on 9/11, we have a 9/11 commission, absolutely that should be an answer the public knows the answer to.
Well, if we’re doing a January 6 commission, absolutely, those should be questions that we should get to the bottom of. And there can’t be hush-hush, separate, it shouldn’t be outside the commission, leaked to some media personality the hours of footage. No, this is transparent. These are the doors that were open. Here are the people that opened the doors, to whom? Here are the people who were armed. Here are the people who were unarmed. What percentage of the people who were armed were federal law-enforcement officers? I think it was probably high, actually. Right? There’s very little evidence of people being arrested for being armed that day. Most of the people who were armed, I assume the federal officers who were out there were armed. And so, I don’t know the answers. We deserve to know the answers, right?
We did a Jan. 6 commission. There are certain questions you can ask. We did a 9/11 commission, and if there are federal agents on the plane we deserve to know. And if we’re doing a Jan. 6 commission and there are federal officers in the field, we deserve to know. Just tell us the truth. Tell us what happened.
And it’s not just that, right? I think it’s also the reflective, the reflection on the truth about the underlying motivations of people. What were the sources of the frustration? Right? Is it really just, Donald Trump riled them up in an eight-week period? Or are these people who have been lied to and suppressed for a longer period of time? I think it’s clearly the latter, right? And I think that the failure to recognize the whole truth—we want the truth, the whole truth, and nothing but the truth. That’s, that’s really, when I say we deserve—and I don’t think we’ve gotten it on any of those questions. On the Jeffrey Epstein client list, on unidentified flying objects, on January 6, on vaccine—on COVID-19 vaccine—on the origin of the pandemic, which we now know, by the way, systematic efforts by people who had no idea what the origin was to shoot down the origin. And I remember this at the time there were people in sort of the, uh, like, in the sort of the greater Harvard/MIT space, the Broad Institute and otherwise, who were sort of talking about, Well, there’s a decent chance it could have, but we should be careful about talking about this or It could undermine, erosion of trust in science. There’s no such thing as a noble lie. That’s my view. The noble lie is nonexistent. No lie is noble.
Hendrickson: I think it’s interesting to compare and contrast 9/11 and January 6.
Ramaswamy: Oh, yeah. I don’t think they belong in the same conversation. I’m only bringing it up because it was … I am not making the comparison. I think it’s a ridiculous comparison—
Hendrickson: I’m not comparing—
Ramaswamy: But I’m saying that I brought it up only because it was invoked as a basis for the Jan. 6 commission.
Hendrickson: Of course. What I’m saying, though, is that I think Democrats and Republicans would agree that 9/11 is a day that’s like Pearl Harbor day, where there are good guys and bad guys and America was attacked. I mean, I think that’s very clear—
Ramaswamy: I mean, I would take the truth about 9/11. I mean, I am not questioning what we—this is not something I’m staking anything out on. But I want the truth about 9/11.
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Vivek Ramaswamy leaned forward in his leather seat aboard the Cessna 750. He was fiddling with his pen, talking about Donald Trump. It was the final Friday in July. In several hours he’d join his fellow Republican presidential contenders at the Iowa GOP Lincoln Dinner. Ramaswamy—not even 40, zero political experience—was the second-to-last speaker on the bill. Trump, of course, was the headliner.
Ramaswamy is the author of Woke, Inc., a book-length takedown of corporations that champion moral causes along with profits. The treatise was a New York Times best-seller and is now part of the American culture-war canon. His first company, Roivant Sciences, netted him hundreds of millions of dollars by bringing a Wall Street ethos to biotech: Drug patents were prospective assets. Another Ramaswamy venture, Strive Asset Management, markets itself as a place where return-on-investment outweighs all else, including concerns about social issues or the environment.
That afternoon’s flight was a short hop, Columbus to Des Moines. As the private jet barreled west, Ramaswamy sipped a Perrier and scribbled his thoughts in a large notebook. It was on a flight like this, he told me, where he sketched out his 10 “truths”:
God is real. There are two genders. Human flourishing requires fossil fuels. Reverse racism is racism. An open border is no border. Parents determine the education of their children. The nuclear family is the greatest form of governance known to mankind. Capitalism lifts people up from poverty. There are three branches of the U.S. government, not four. The U.S. Constitution is the strongest guarantor of freedoms in history.
“I just wrote down things that are true,” he said flatly. “It took me about 15 minutes.”
Ramaswamy doesn’t consider himself a culture warrior; he insists that he is merely speaking the truth. He presents his ideas as self-evident, eternal truths. I asked him if he believes that truths can change over time. For instance, what did he make of the fact that most white Americans used to view it as a “truth” that Black people were genetically inferior—that they weren’t fully human?
“I don’t think that’s true,” he said.
“It is true,” I said. “That’s partly what justified slavery.”
“But it was a justification; it wasn’t a belief,” he said. “Look at emperors—Septimius Severus in Rome. He was Black. He had dark skin. They viewed dark skin as the way we view dark eyes.”
This is how a debate with Ramaswamy unfolds. He’ll engage with your question, but, when needed, he’ll expand its parameters. If that fails, he’ll pivot to thoughts on the existence of a higher power. “I don’t think that human beings ever accepted that Black people were not created equal in the eyes of God,” he said. (His favorite president, Thomas Jefferson, believed exactly that.)
Here’s where else he’s gone in his quest for the truth. He has tantalized audiences with the idea that Americans don’t know “the truth about January 6” and has argued that those who stormed the Capitol have been lied to and “suppressed.” He argues that people who identify as transgender suffer from a mental-health disorder: “I think there is something else going wrong in that person’’s life, badly wrong,” he has said. He calls race-based affirmative action “a cancer” and vows to end it “in every sphere of American life.” He endorses using the military to secure America’s borders, brokering a deal that would cede a huge chunk of Ukraine to Russia, and defending Taiwan from Chinese aggression “only as far as 2028.” His grandest vision might best be described as the inverse of Franklin D. Roosevelt’s New Deal: a demolition of the federal government—FBI, CDC, DOE, ATF, IRS—gone.
Ramaswamy radiates confidence: steady eye contact, knowing nod, satisfied smile. He campaigns for up to 18 hours a day. He mostly keeps to a uniform of black pants, black T-shirt, and a black blazer. He operates in a world of declarative statements and punctuates his sentences with “right?” and “actually,” like a tech bro. He’s currently in third place in most national polls. At last month’s Turning Point USA conference, in Florida, Ramaswamy had a breakout moment when 51 percent of straw-poll respondents said he was their second choice for president. “Pretty remarkable how far he’s come in a very short amount of time,” Charlie Kirk, the organization’s founder, tweeted.
Last week, leaked documents designed to inform Ron DeSantis’s strategy at Wednesday’s first presidential debate portrayed Ramaswamy as the candidate to beat. The Florida governor’s super PAC advised him to “take a sledgehammer” to the 38-year-old outsider. Many potential voters will likely be intrigued when they hear Ramaswamy speak his truths onstage this Wednesday. He is living a life they can only dream about: Start a company or two, make half a billion dollars, say whatever you want. And then, naturally, run for president.
The Republican presidential hopeful Vivek Ramaswamy on his phone after a taping of the PBS political talk show Firing Line With Margaret Hoover.
A colossal American flag hangs on the outside of Ramaswamy’s spare-no-expense campaign headquarters in Columbus. The property is a former barn; the word TRUTH is plastered everywhere. One communal work area, for phone banking, is roughly the size of a basketball court. He has his choice of two production studios from which to record his never-ending stream of cable-news hits, podcast appearances, and social-media videos.
During my visit, John Schnatter—a.k.a. Papa John—flew in from Kentucky via private helicopter to speak his truth on Ramaswamy’s own nascent podcast, The Vivek Show.
Papa John told the candidate how he became very rich—how his single pizza shop grew into a chain of over 5,000 stores—then turned to a long, complicated story about his downfall. He claims that he was set up by a PR firm that goaded him into saying a racial slur during a private coaching session and that this firm is connected to Hillary Clinton and Jeffrey Epstein. (Reached for comment, a spokesperson for the PR firm referred me to a recent partial summary judgment against Schnatter in the firm’s favor.) He used the words “demonic” and “satanic” to describe the American left. At one point, the conversation veered toward Russia and Hunter Biden’s laptop. “I don’t know why the Creator put me through this,” Papa John said.
All the while, Ramaswamy nodded, smiled, or, when applicable, shook his head in disbelief. This was his media-forward candidacy, distilled: a morning behind the mic inside a posh podcast setup chatting with a fellow entrepreneur about the perils of woke capitalism. When the episode aired, he’d have a cautionary tale for listeners, a potentially viral clip that would get him in front of new voters.
The night before, I watched Ramaswamy speak to a couple hundred young conservatives at the Forge Leadership Summit. He looked around the room and preached that “hardship is not a choice, but victimhood is a choice.” It’s one of his favorite lines, and a nod to his second book, Nation of Victims. The crowd that night was almost exclusively white, and Ramaswamy’s inflection was temporarily suffused with twang.
“We’re starved for purpose and meaning and identity at a time in our national history when the things that used to fill our void—faith, patriotism, hard work, family—these things have disappeared,” he said. He rattled off a list of “poisons” that have filled the void, pausing for dramatic beats between each one: “Wokeism. Transgenderism. Climatism. COVIDism. Globalism. Depression. Anxiety. Fentanyl. Suicide.” The crowd murmured.
He kept rolling. He said that Russia’s war against Ukraine is “really just a battle between two thugs on the other side of Eastern Europe.” He warned that incremental change within American institutions is impossible.
Right now, he said, we have reached a “1776 moment” in this country.
“Do we stand on the side of reform?” he asked. “Or do we stand on the side of revolution?”
When he finished, half the people in the room jumped to their feet.
Vivek Ramaswamy with his son, Karthik, before speaking at a house party and fundraiser in Hubbard, Iowa.
Ramaswamy hurried out and ducked into an SUV: He feared he’d be late for his prime-time interview on Chris Cuomo’s NewsNation show. During the ride, he revisited one of the more challenging audience questions. A woman had asked if, as president, he would commit to making abortion illegal at the federal level. He told her that he is “unapologetically pro-life,” but a strict constitutionalist—an originalist. He said he viewed recent state-level abortion restrictions as victories for federalism. The woman seemed unsatisfied.
Ramaswamy knew that abortion questions would keep coming up. “I do feel like I’m being bullied a little bit on this issue,” he told his aides. They ran through his options. A video? A public address? Suddenly the subject seemed fraught. “Eh, probably an abortion speech isn’t a good idea, to be honest with you,” he said.
After the Cuomo interview, we drove to Ramaswamy’s house. It’s bright and white with giant ceilings—suburban palatial. One of the family’s two nannies appeared and started putting together a spread: chili, kale, watermelon salad, tofu tacos.
Throughout his professional life, Ramaswamy has aimed to be perceived as an American traditionalist who is simultaneously ahead of the curve. He is the son of Indian immigrants and a practicing Hindu. As a high-school student at St. Xavier, a Jesuit prep school in Cincinnati, he quickly got up to speed on all things Bible. On the campaign trail, he frequently invokes spirituality, and his message has the feel of old-school Christianity.
Growing up, he loved hip-hop, especially Eminem, and his own performances under his alter-ego “Da Vek” as a Harvard student landed him in The Crimson. He still occasionally leans into it. The day we met, he had just freestyled on Fox News. Earlier this month, he grabbed the mic and did an Eminem impression at the Iowa State Fair.
Though now running as a Republican, he long identified as a libertarian. He cast his first vote, when he was a 19-year-old, in the 2004 election, supporting the Libertarian candidate Michael Badnarik. (He sat out every subsequent presidential election until 2020, when he voted for Trump.)
Ramaswamy told me a story about how in eighth grade, he was pushed down a flight of stairs at his public school. Though he underwent hip surgery afterward, he was careful not to portray himself as a victim. Instead, he described the event as the catalyst for his arrival at St. Xavier.
I asked him about coming of age in the post-9/11 world, when many ignorant Americans assumed that anyone with brown skin might be a terrorist. He told me about the experience of being singled out and questioned while flying to Israel—that unique sensation of being the last passenger permitted to board. “I didn’t chafe at that, though, because, honestly, in some ways it was data-driven,” he said. I asked if he considered the action itself to be racist. “No, I think racism has to involve some level of animus, actually,” he said. “I have experienced racism, to be clear. But that’s not—I don’t think that entails animus. So it doesn’t qualify as racism to me.”
He told me he doesn’t believe his race will negatively affect his electability in 2024. He said that among most GOP voters, the No. 1 political problem is “not, like, Arabs right now.” He spoke of what he saw as other underlying American anxieties, such as “the feeling of being victimized right here at home,” he said. “Forces that are different than Mohamed Atta,” he added, alluding to one of the 9/11 hijackers.
The entrepreneur and political newcomer Vivek Ramaswamy speaks at the Republican Party of Iowa’s 2023 Lincoln Dinner fundraiser, which featured 13 Republican presidential hopefuls including former President Donald Trump.
Ramaswamy’s wife, Apoorva, was leaning on the kitchen island, listening to our conversation. After her husband slipped away to hop on a Zoom call with “a bunch of people from Silicon Valley,” she joined me at the table. She was fighting a cold but nonetheless happy to make time for a stranger in her home at nearly 10 p.m. on a weeknight. Besides, she said, she wanted to wait up for Vivek when he was done for the day.
The couple met at a house party in 2011, when they were both graduate students at Yale. They struck up conversation, realizing they were neighbors. Apoorva was following in her father’s footsteps, studying medicine, while Vivek was pursuing a law degree after a few years working in finance in New York. “He just seemed awesome, like someone who was interesting and someone who was full of life,” she said. “I was pretty sure pretty early on that I was going to probably end up marrying him.”
Apoorva, like her future husband, grew up a practicing Hindu. The couple is now raising their two toddlers, Karthik and Arjun, in the faith. Apoorva’s parents also came to the United States from India. “I think, as a child of immigrants, we defaulted toward being Democrats insofar as we thought about it at all, which was honestly not very much,” she said. In recent years, she told me, her mom and dad had become Trump supporters. “They chose this country—they love this country more than any country in the world, and they believe in it,” she said. “And it was cool” for them “to see someone who was unapologetic about it.”
I asked Apoorva if she could recall the first time Vivek told her he wanted to become president.
“I think that, like, on a serious level, it was …” she paused for a long moment. “This December.” Vivek, she said, saw the presidency as one of “the different options open to him.” Other young, rich men unsure of what to do next with their life have bought a yacht or a big-city newspaper, or run for governor of Texas. Ramaswamy chose the presidency.
Apoorva is a head-and-neck-cancer surgeon at the Ohio State University. I asked her if, as a physician, she supported vaccines. She told me that she and her entire family had received COVID shots, but like her husband, she endorses the idea of personal choice over government mandates. This libertarian approach permeates many aspects of their life. Instead of sending their kids to public school, they have “some educators who come to the house.” (She pointed to the special relationship between Alexander the Great and his private tutor, Aristotle, as a model.) Like Vivek, she’s ambitious and career-driven. She told me she doesn’t necessarily plan to give up her job at OSU even if her family moves into the White House. “I think Jill Biden did show that it is possible to be a spouse who is working,” she said.
“This is a totally new world for me, and the concept of being a political spouse is not, like, the fifth thing I would call myself,” she said. “It’s, you know, this is the thing we’re doing, for sure. And I’m proud to support my husband in it. But I think this is about him and his vision. This is not about me.”
The next day, in Des Moines, Ramaswamy periodically stepped away from our interview aboard his campaign bus to play with his older son, Karthik, who had come along for the trip. I asked Ramaswamy if his friends and family were surprised when he told them he was running for president.
“Not shocked, but a combination of excited and personally concerned for me, actually—just knowing how dirty this is,” he said. “I’m pretty uncompromising. And I think most people have an impression that politics is a dirty sport where you have to, you know, be compromised.”
I brought up something Papa John had told him: This wasn’t a knife fight, but a gunfight.
“I mean, I would phrase it differently, but I would say you need a spine of steel to play this sport, for sure,” Ramaswamy said. “Some people who have been coddled in their siloed kingdoms, mini kingdoms they’ve created for themselves, have not been ready for when they’ve shown up for the real thing. I think it was an advantage not to be surrounded by people who heaped false praise on me in one of the 50 states of the union—I think that’s a trap that certain governors almost every cycle have fallen into.”
He smiled, making it clear that he was going out of his way not to invoke his closest rival, Ron DeSantis, by name.
While DeSantis spent the first stretch of his campaign blackballing the mainstream media, Ramaswamy has taken a different approach. His presidential candidacy was preceded by a profile in The New Yorker, and though he himself is perpetually on cable news, he said he hardly ever tunes in. With one exception: “I think Tucker Carlson was great, actually. I really enjoyed watching him.”
“I think Tucker had something to say,” he said. “We’re not slaves to a partisan orthodoxy. I don’t have a particular affinity for the Republican Party apparatus, and I think neither does Tucker.”
He told me he admired how Carlson wasn’t a “delivery mechanism” for something that showed up on the teleprompter. I asked if he had read any of the evidence that came out in the discovery process of the Dominion Voting Systems lawsuit against Fox News, the case that ultimately led to Carlson leaving the network. “I really didn’t,” Ramaswamy said. “It didn’t strike me as super interesting because it seemed like a lot of inside baseball.” I told him that Carlson had been saying certain things on air and, in some cases, texting the direct opposite to his producer. For instance: He said he hates Trump. “Did he say that?” Ramaswamy asked.
For a moment, he seemed genuinely surprised.
The Republican presidential candidate Vivek Ramaswamy speaks during a live event with Elon Musk and David Sacks on X Spaces (formerly known as Twitter).
“Most people have barely heard of me,” Ramaswamy admitted to Elon Musk. He was pacing barefoot around his 30th-floor downtown–Des Moines hotel room, doing a live Twitter (X) Spaces broadcast. It was late Friday afternoon, just a few hours before the Lincoln Dinner. Half-eaten takeout was idling in clamshell containers. Ramaswamy had been going nonstop but didn’t seem remotely tired.
Musk and his Silicon Valley friend David Sacks had been trying to make the social network’s shaky audio platform a virtual destination on the 2024 campaign trail, with intermittent success. I could hear Musk’s voice through Ramaswamy’s earbuds. Over and over again, he’d interrupt the candidate. If Ramaswamy was frustrated, he didn’t let it show. After having watched several of his media hits in a row, I noticed how Ramaswamy had developed an array of tricks to wrangle attention, such as when he brought up “our mutual friend Peter,” as in Thiel. He told Musk how much he “loved” the Twitter Files. By the end of the broadcast, he seemed to have made a new fan. Last week, Musk called him “a very promising candidate.”
He continues to find support among a group of very online iconoclasts. “That Vivek guy is very interesting,” Joe Rogan said recently. “He’s very rational and very smart.” Jordan Peterson has praised him as “hard to corner in the best way.” Andrew Yang, who ran as a freethinking businessman in the 2020 Democratic primary, told me he believes that people are just waiting for others to rally behind Ramaswamy. “Vivek’s going to have his moment. There’s going to be a wind at his back. And then when that wind hits, I think people will be stunned at how quickly his support grows.”
At the Iowa Events Center, more than 1,000 people listened politely as 13 Republican candidates (pretty much the entire field except Chris Christie) each made a 10-minute case for themselves. DeSantis announced that “The time for excuses is over!” before clomping away in his heeled boots. Senator Tim Scott of South Carolina preached the value of hard work, telling the room that President Joe Biden and the left were selling “a narcotic of despair.” Former Vice President Mike Pence trudged through his speech and received hardly any applause when endorsing the idea of a federal abortion ban after 15 weeks of pregnancy.
Just after 8 p.m., Ramaswamy was waiting offstage, looking over his notes. He bounded up the steps to the sounds of Brooks & Dunn’s “Only in America.”
“It’s good to be here, back in Iowa. I feel like I live here now!” Ramaswamy told the crowd.
He was speaking slower than usual, and he had ditched the twang from the previous night. He seemed utterly at ease. He talked about securing our southern border “and our northern border too.” He received lively applause after saying he would shut down scores of three-letter government agencies. He cycled through his list of poisons and his 10 truths. The clapping waxed and waned. His line about “two genders” was a hit, as was his finale about the Constitution. All in all, he received one of the strongest responses of the night: When the speech concluded, he was treated to a partial standing ovation. He paused for a few extra moments to take it all in, waving at the crowd with both hands.
Downstairs, Ramaswamy glowed in his after-party suite. “Eye of the Tiger” and “Born in the U.S.A.,” and a series of country songs blared from speakers. He told the few dozen people before him that he was prepared not only to win the nomination but to deliver a Ronald Reagan–style landslide victory. Some seemed convinced.
The Republican presidential hopeful Vivek Ramaswamy leaves American Dream Machines after he and his son, Karthik, visited the vintage-car shop between campaign events. Ramaswamy’s son joined the candidate on the two-day campaign trip to Iowa.
The next morning, as his campaign bus lumbered to rural Hubbard, I asked Ramaswamy if he had heard what his fellow Republican Will Hurd had said at the event. Hurd, a former Texas congressman, was booed off the stage after telling the Lincoln Dinner crowd “the truth”: that Trump was running only to stay out of prison. “I know the truth,” Hurd said. (Loud boos.) “The truth is hard.” (Louder boos.)
Ramaswamy waved away Hurd’s assertion. He told me that if Trump weren’t running, “they” wouldn’t be prosecuting him. With each passing month, with each new indictment, Ramaswamy has doubled down on his public promise to pardon Trump if elected. He told me that he believes doing so would be “the right thing for the country.” He said the indictments, so far, were “obviously politically motivated.”
During one of his “truth” monologues at the Lincoln Dinner, Ramaswamy told the crowd, “We can handle the truth about what really happened on January 6.” As the bus rolled north, I asked him: What is the truth about January 6?
“I don’t know, but we can handle it,” he said. “Whatever it is, we can handle it. Government agents. How many government agents were in the field? Right?”
Then, suddenly, he was talking about 9/11.
“I think it is legitimate to say how many police, how many federal agents, were on the planes that hit the Twin Towers. Maybe the answer is zero. It probably is zero for all I know, right? I have no reason to think it was anything other than zero. But if we’re doing a comprehensive assessment of what happened on 9/11, we have a 9/11 commission, absolutely that should be an answer the public knows the answer to. Well, if we’re doing a January 6 commission, absolutely, those should be questions that we should get to the bottom of,” he said. “‘Here are the people who were armed. Here are the people who are unarmed.’ What percentage of the people who were armed were federal law-enforcement officers? I think it was probably high, actually. Right?”
I pressed him on the comparison, and suddenly, the bold teller of truths was just asking questions. “Oh yeah, I don’t think they belong in the same conversation,” he said. “I think it’s a ridiculous comparison. But I brought it up only because it was invoked as a basis for the January 6 commission.”
But is he actually confused about who was behind the 9/11 attacks? It was hard to get a straight answer from him. “I mean, I would take the truth about 9/11,” he said. “I am not questioning what we—this is not something I’m staking anything out on. But I want the truth about 9/11.” Some truths, it seems, can be proudly affirmed; others are more elusive. (Asked to clarify Ramaswamy’s views on 9/11, his spokesperson pointed me to a 1,042-word tweet from the candidate, in which he suggested that the U.S. government covered up involvement by Saudi intelligence officials in planning the attacks.)
Ramaswamy told me he’s not interested in being Trump’s vice president, or serving in Trump’s Cabinet. “Reporting in to somebody is not something I’m wired to do well,” he said. “I’m not in this to be a politician. I think there’s a chance to lead a national revival, cultural revival, that touches the next generation of Americans. I don’t think I’m going to be in a position to do that if I’m in an administrative role.”
Unlike Trump, Ramaswamy has signed the “loyalty pledge” to support the eventual GOP nominee—a prerequisite for participation in the debate. He also told me that he would commit to accepting the results of the election. So far, the closest he’s come to ever actually criticizing Trump is saying that 30 percent of the country became “psychiatrically ill” when he was in office. Throughout our discussions, it was clear that Ramaswamy seemed to view Trumpism as something he could tap into. He told me that his path to winning involved recognizing and celebrating Trump’s accomplishments, and promising to build on them.
“I believe with a high degree of conviction that I will win this election,” he said.
If, for whatever reason, that didn’t come to pass, he told me he would “probably just go back to what I was doing”—business, writing books, hanging out with his family. “And I might take a look at the future.”
During our final conversation, I asked Ramaswamy if he felt understood or misunderstood as a candidate. He didn’t hesitate to answer.
“Mostly misunderstood.”
What do you think people misunderstand about you?
“My motivations,” he said.
“I’m not aggrieved by that. I’m patient. But I hope that by the end of this, actually—it’s a deep question—but I think I would rather be properly understood and lose because people decided that the real me is not who they want, than to lose because people never got to know who I really am. That would bother me. And it would be hard to reconcile myself with that. But if people across this country really know just who I am and what I stand for, and then that’s not what they want in a leader, I am 100 percent at peace with that. I have no problem. So that’s kind of my goal in this process.”
The bus pulled onto a sprawling private property in the middle of nowhere. Ramaswamy and his aides hopped off. The millionaire outsider candidate, beholden to no one, was preparing to speak his truth before a wealthy Iowa donor and his friends.
People near me at the Iowa State Fair were frantic. “Do you see him yet?” they panted. “Do you think he’ll come out into the crowd to talk?” When the presence of Secret Service officers made it clear that former President Donald Trump would appear at the Steer ’N Stein restaurant on the Grand Concourse, fairgoers formed a line whose end was out of sight.
Not all of them could squeeze into the restaurant, so they filled the street outside, one giant blob of eager, sweating Iowans. When the former president finally appeared, the scrum was so dense that they could barely make out his silhouette through the restaurant’s open side. “You know, the other candidates came here, and they had like six people,” Trump’s giddy voice said through the speakers above us. The audience responded with hoots and cheers.
One of the few rules of American politics to have withstood the weirdness of these past tumultuous years is that anyone who wants to be president of the United States must endure both the many splendors and the equally many ritual humiliations of the Iowa State Fair. It is an essential audition, at least for the GOP. (The Democratic Party has recently shuffled the order of its primary season, demoting the Iowa caucus from its first-in-the-nation status.)
If a Republican candidate, drenched in sweat and stuffed with fried butter, can pique the interest of Iowa’s choosy voters, then that candidate has a real shot in the caucuses and, perhaps, the White House. Sometimes, a long-shot outsider can work the crowds and gain an unexpected edge, as Rick Santorum did in 2012, and Ted Cruz did in 2016.
So the fair is a place to charm and be charmed. Early on in the weekend, it seemed to be working its magic.
“He’s really very engaging,” Shirley Burgess, from Des Moines, said of Mike Pence. “I thought he delivers a much clearer message in person than what I’m getting from him on TV.” The former vice president had just wrapped one of several “Fair-Side Chats” hosted by Republican Governor Kim Reynolds. This was a new feature at the fair, at which the governor asks the candidates such hard-hitting questions as “What’s your favorite walkout song?”
The night before, Pence had been heckled by a man who asked how he was doing “after Tucker Carlson ruined your career.” Another said, “I’m glad they didn’t hang you!”
But on Friday morning, Pence drew a respectful crowd for his conversation with Reynolds at J.R.’s Southpork Ranch. Attendees asked him polite questions, and half a dozen people personally thanked him for his “integrity” when Trump was trying to overturn the results of the 2020 election.
Pence had company, however. Florida Governor Ron DeSantis, former UN Ambassador Nikki Haley, and the entrepreneur Vivek Ramaswamy also attracted crowds at the Pork Ranch and at the Des Moines Register’s Soapbox venue. Most of the undecided Iowans who attended told me that they’d supported Trump in 2016 and in 2020. These voters appreciated his service, they said, but after eight years of idiotic rants on social media, baseless but relentless assertions of election fraud, and a string of criminal indictments, they were hankering for some new energy. You know, a leader without so much baggage, they told me; someone more … classy.
“Everything out of his mouth is like, ‘Shut up, Donald,’” Charles Dunlap, a two-time Trump voter from Johnston, Iowa, told me. He was eager to hear from Ramaswamy and Haley, people he believed would “institute similar policies” to Trump’s—just without the drama.
But the intimate enchantment of the fair—the promise of thoughtful, measured consideration—dissipated around 1 p.m. Saturday, when the former president arrived. What very quickly became clear was that the Trump-exhausted, change-minded Iowans I’d met that morning were in the minority. Most folks? They still love Trump.
The former president skipped possible speaking slots at the Soapbox and with Reynolds (because of his strange beef with the governor), but showed up to mingle with his people. They packed into every fair establishment where the president might conceivably speak. Because his event wasn’t on any official schedule, everyone was kept guessing. Parts of the fairground came to a standstill. People who just wanted to slurp lemonade and admire the prize-winning steers were annoyed. “Why did we have to come on the day that all the politicians are here?” a man pushing a stroller through the throng asked his wife. (Almost every Iowan, for the record, has at one point uttered the phrase.)
Given his commanding lead in the GOP primary polling, it’s not so shocking that Trump’s presence would create such fervor. But seeing it, feeling it, was different. By contrast, the crowds that had gathered for the other Republican candidates didn’t seem impressive at all. Suddenly, the entire GOP primary contest felt painfully futile, pathetic even. Why are they even doing this? For the also-rans—basically, the rest of the field already—was suffering the abuses of the campaign trail worth even the best-case scenario of being anointed Trump’s running mate?
On Saturday, while Pence stood in the sun flipping pork burgers, people in the crowd whispered about him. “Look at him sweat,” someone behind me said. “He’s a dweeb, and so is DeSantis,” a young man from Cedar Rapids named Jacob, who declined to give his last name, told me. “You just want to take their lunch money. It’s instinct.” Ramaswamy, whose big personality has charmed many Republicans, apparently felt the need to put on a non-dweeb showing after his interview with the governor, and rapped confidently to the Eminem song “Lose Yourself.” A sea of silver-haired onlookers, who found themselves trapped near the front of the stage, were obliged to awkwardly bob along.
DeSantis, more than anyone else, suffered at the fair. While he spoke with Reynolds, a plane flew in circles overhead, carrying a long sign that read Be likable, Ron! DeSantis pretended not to notice it. When the Florida governor took his turn in the Pork Tent, Trump supporters gathered behind his photo op, wearing green-and-yellow trucker hats handed out by the Trump campaign. They chanted and yelled insults as DeSantis and his wife flipped burgers.
And when Trump finally arrived on Saturday afternoon, he brought with him a posse of Florida lawmakers who had endorsed him over DeSantis. (Representative Matt Gaetz warmed up the crowd by saying that he’d grilled burgers well done at the Pork Tent, but “the most done you can be is Ron DeSantis.”) Will the humiliation pay off in the end? DeSantis’s campaign has to hope so. At least in Iowa, the Florida governor is running somewhat closer to Trump than he is nationally.
Earlier in the day, I’d interviewed Matt Wells, a DeSantis supporter and a county chair from Washington, Iowa, who had been following the candidate around the fair all morning. Trump’s people “don’t really know what they’re doing; it’s all an emotional thing,” he told me. Wells worked for Ted Cruz’s campaign in 2016. They’d had a strong ground game then, as DeSantis does now, he said. “Trump,” Wells added, “doesn’t have any ground game here.”
Cruz may have won Iowa, but he quite memorably did not go on to win the 2016 election. I was about to bring up this fact when someone near us gasped. A dozen fingers pointed toward the sky, and people began to scream with excitement. There, in the bright-blue ocean above us, was a plane with TRUMP emblazoned on its side heading for the nearby airport. Someone whispered, “Did I tell you that I shook his hand twice?” The clamor grew louder.
Trump would be here soon. The man, the myth, had landed.
Over the past few decades, what Americans want out of their beverages has swung wildly between two extremes. In the 1990s, sweet drinks were all the rage. Soda sales were on what seemed like a limitless upward trajectory. Quaker bought the then-ascendant Snapple brand for $1.7 billion in cash, a sum that made me actually snort when I read it in the harsh light of 2023. Gimmicky drinks such as Surge, Orbitz, and SoBe “elixirs” crowded grocery-store shelves. As a middle schooler in the late ’90s, my consumption patterns were practically a case study in the era’s marketing magic. I’m not sure a single drop of plain water ever touched my lips outside of soccer practice.
Toward the end of that decade, the first evidence of the coming reversal was already visible. Skepticism (most of it warranted, though some of it not) toward sugar and artificial sweeteners steadily grew. The soda giants, reading the room, began marketing their own bottled-water brands to compete with the more fashionable likes of Evian and Perrier. Dasani and Aquafina came right on time: As soda sales faltered, bottled-water sales took off. In 2016, the Beverage Marketing Corporation estimated that, for the first time, Americans consumed more bottled water—almost 40 gallons per capita on average—than carbonated beverages. Tap water, too, has found a new home in an ever-increasing number of reusable water bottles. New Stanley cup, anyone?
Americans, in short, got sold on hydration. As my colleague Katherine J. Wu recently wrote, how much water any particular person needs to drink to maintain a healthy baseline is still the subject of significant disagreement among experts. But in the absence of clear guidance—and with plenty of encouragement from the health-and-wellness industry—many people seem to have simply decided that more is more, and they shoot for as much as a gallon a day.
That isn’t to say that everyone likes drinking all this water. As the nation has disciplined itself to refill its glasses, Americans have been forced to confront the inconvenient reality that drinking plain water day in and day out can be kind of a chore. To choke it all down, they’ve returned to powders and concentrated syrups designed to make water more palatable, more healthful, or both. Sweet drinks are back again, albeit in a different form. Enter the water enhancer.
Today, products meant to gussy up your water are everywhere at grocery and convenience stores. They come in little brightly colored squeeze bottles or single-serving packets. The sales pitch is pretty simple: Throw one in your purse or laptop bag, and instead of buying a packaged beverage, you squirt a couple of drops of syrup or mix a tablespoon or two of powder into regular water. Voilà. Now water is better. This is not exactly a new type of product: Powdered mixes from Crystal Light and Gatorade were around in the 1980s. But unlike the water enhancers of yore, today’s mixes are mostly portioned for single servings instead of big batches.
According to Phil Lempert, a grocery-industry expert and the founder of the website Supermarket Guru, water enhancers split into roughly two categories: low-calorie flavorings, such as Kraft Heinz’s highly concentrated MiO drops, and hydrating sports (or hangover) drinks, such as powdered electrolyte packets from Liquid I.V. Both MiO and Liquid I.V. debuted in the early 2010s. Within a few years, competitors including LMNT, Cure, and Buoy entered the market, along with the new entrants from old brands, Crystal Light and Gatorade among them. Most of these brands boast about their products’ low sugar content; even some of the enhancers flavored to taste like Skittles, Starburst, or other candy rely on artificial or alternative sweeteners and have few calories. Other ingredients have been incorporated into new products: Companies such as Cure now make caffeinated concentrates. Liquid I.V. has a powder that includes melatonin for sleep. Lots of other products now contain additional vitamins, minerals, or electrolytes. Many water enhancers have become, in essence, drinkable supplements.
Water enhancers’ rise can easily be charted in sales numbers. Darren Seifer, the food-and-beverage-industry analyst at the consumer-data firm Circana, told me that although the products are still a small part of the overall beverage market, they’ve seen consistent growth. In 2022, sales volume of sports-drinks mixes—the category in which the firm places most water enhancers—was up 15 percent over the previous year. According to Seifer, the growth has been much larger for some brands. A spokesperson for Liquid I.V., which was bought by Unilever in 2020, told me that the brand’s sales have nearly doubled in each of the past four years.
Like so many cultural phenomena, water enhancers also have become the subject of a viral trend. WaterTok, a subset of TikTok where users mix and match different powders and syrups into recipes inside giant insulated water bottles, flooded the internet earlier this year with tips on how to make tap water taste like, among other things, birthday cake. (Like most TikTok trends, it’s a little extreme, and it doesn’t seem to be especially indicative of how regular people end up using the products. TikTok Franken-water sounds sort of terrifying, and some health experts have expressed concern over its potential misuse as a weight-loss aid.)
The whole concept of water enhancement can be pretty easy to mock: Why, exactly, can some people not find it within themselves to drink regular water? Why do they need it to taste like Skittles? Why do some people think a random wellness company might actually be able to improve on water, of all things? Once you’ve got the water in your glass, just stop there! Drink that! And yes, drinking Jolly Rancher aspartame water does strike me as more ludicrous than just having a Diet Coke. But if you let go of your immediate revulsion at the occasional licensed candy branding and consider water enhancers as a concept on its merits, you’ll find that even the worst of the bunch isn’t functionally much different than a sugar-free sports drink or low-calorie lemonade. In most cases, they’re arguably better if your goal is to stay hydrated, have a little treat, and have some say in how much sugar or sweetener you consume in the process.
There’s little reason to believe that the people who use water enhancers are doing so at the expense of the plain water that they’d be drinking otherwise. Americans’ consumption of plain water remains, by all indications, robust. It’s mostly sales of soda and juice that are generally sluggish, which at least hints that, for a lot of the people who like those types of drinks, the trade-off that’s actually being made is between water enhancers and some kind of heavily sweetened beverage. In a lot of cases, that trade-off seems positive, on balance, especially because the enhancers allow people to control how much sweetness actually goes into a drink. This does not guarantee that people consume lower concentrations of flavorings, but it at least allows them to do so if they want.
To fully understand why people are suddenly so enthusiastic about water enhancers, you also have to look outside of the beverage market and to the kinds of vessels that are so often used to consume them: reusable water bottles and high-capacity insulated cups. According to Circana’s data, the Hydro Flasks and Yetis and Stanleys of the world are still selling like hotcakes, and they present a significant shift in the physical reality of how a lot of Americans get their daily fluids—and, potentially, how much of those fluids they intend to be drinking. If you’ve already got 30 or 40 ounces of water on your desk at work, buying a Gatorade or coconut water or other premixed beverage to lug around with it makes less sense than it otherwise would, and having a couple of packets of sweetened electrolyte powder in your laptop bag is comparatively easy.
At the core of all of this is a fundamental anxiety. Americans want to do what they can for their health, but for so many people, the most meaningful changes—easier, more affordable access to nutritious foods; taking time for exercise; less stress—are difficult to achieve or outside of their control. Swapping out sugary drinks for plausibly healthier options might not be life-altering, but at least it feels like something. “It’s a low-hanging fruit, in terms of healthy behaviors,” Caleb Bryant, a food-and-beverage analyst at the consumer-data firm Mintel, told me. The same anxiety exists for people who buy bottled water regularly, which Circana’s Seifer points out is still a huge group whose numbers have not yet shown any decline. If you’re selling water enhancers, you don’t need to convert bottled-water drinkers away from a product they already like, as you would with a bottled drink—you just have to convince them that they might occasionally like adding something to it.
The enhancers have their limits. The freedom they confer can easily mislead consumers about how much better self-mixed drinks actually are: The experts I spoke with all agreed that at least some people seem to assume that no matter how much or what kind of water enhancer they use, their beverage will end up inherently healthier than something prepackaged, just because they get to see the water first before they add anything to it. In that way, the brands behind water enhancers are still very much profiting off of the confusing hydration hype that’s been separating people from their money in dubiously healthful ways for years.
On balance, though, water enhancers do seem to offer something desirable to people who want their water to be a little bit more palatable and the companies who want to sell to them. They are, on some level, a rare win-win: Water enhancers’ smaller, lighter proportions have significant upsides for the companies marketing them, according to Supermarket Guru’s Lempert. The beverage business as a whole is already a more profitable, less cost-intensive category in which to operate than many other sectors of the grocery industry, he told me, which likely helps account for all the upstarts flocking to the water-enhancer category—they’re inexpensive to produce and don’t spoil quickly. When you take away the necessity of buying plastic bottles and packing, shipping, and stocking heavy liquids, the beverage math gets even better. Consumers find some advantages in those differences too: They create less plastic waste (as long as you’re not always buying bottled water to use with them), take up less room in the pantry, and are sometimes less expensive per serving than a bottled alternative.
Ultimately, the biggest driver behind water enhancers’ popularity is probably just the nature of water itself. It’s great, but drinking a ton of it every day can become drudgery. These additive products play to a tendency to tinker with water in pursuit of health, stimulation, or pleasure that humans have had for thousands of years. Teas, coffee, beer, wine, and sweetened, fruity drinks such as aguas frescas were all developed because, on some level, water—humble and utilitarian as it is—just wasn’t satisfying all of the needs and desires that our forebears had. Now that lots of people believe they need to be downing liters of water every day for their health, they’ve rediscovered an age-old problem. Yes, water is great. But maybe it could be better, or at least more fun?
You do need to drink water; any downsides of erring on the side of overhydration don’t really kick in until the volume gets extreme. But forgoing a little fun or flavor in pursuit of perfect physical health is something that humans have never been particularly good at doing. One medieval religious text even cited drinking nothing but plain water as a just punishment for swearing against God. With that in mind, it might have been foolish to expect that in the 21st century, with so many alternatives available, copious amounts of plain water would be the widespread drink of choice for long.
